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MS318 INFLUENCE OF ENHANCED EXTERNAL COUNTERPULSATION ON ANGIOGENESIS INDUCED FACTORS
78th EAS Congress
Atherosclerosis Supplements 11, no. 2 (2010) 109–222
MS315 EFFECT OF ATORVASTATIN IN PATIENTS WITH SYSTOLIC HEART FAILURE DUE TO ISCHEMIC CARDIOMYOPATHY AFTER MYOCARDIAL INFARCT T. Vakhtangadze, F. Todua, M. Razmadze, M. Akhvlediani. Clinical Medicine, Tbilisi, Georgia Purpose: To identify the effect of Atorvastatin + conventional therapy of heart failure on ejection fraction in patients with ischemic dilated cardiomyopathy developed after myocardial infarct. Methods: 42 consecutive patients with ischemic systolic left ventricle dysfunction (LVEF 18 − 30%, mean 23%) were enrolled in the study. All of them had previous history of myocardial infarct. Inclusion criteria: History of MI, fixed perfusion defect in Gated SPECT, low EF detected by Gated SPECT/echocardiography. Lipids and echocardiography was performed at the beginning of the study, after 6 months of conventional therapy and by the end of the study. All patients received conventional heart failure treatment for 6 months before initiation of Atorvastatin treatment. Mean time of follow-up was 27 months (12−36 months). Atorvastatin was given to all of them after 6 months of enrolment in the study. Results: Patients developed improvement of symptoms of HF after 6 months of conventional heart failure treatment − mean EF has risen from 23 to 27%. Atorvastatin addition to conventional treatment led to additional improvement of EF in 72% of patients, which was more clear after 1 year of treatment − mean EF has risen from 23% to 36% by the end of the study. Patient who did not respond to Atorvastatin treatment had larger perfusion defects and more severe coronary arteries disease than patients who respond to Atorvastatin treatment. Conclusion: Atorvastatin addition to conventional heart failure treatment leads to improvement of EF in patients with heart failure due to ischemic cardiomyopathy. MS316 ADVENTITIAL CALCIFICATIONS: SURPRISE LOCATION. ATHEROSCLEROTIC AND CALCIFIED PLAQUES BEGIN AND GROW UP NOT ONLY BENEATH THE ENDOTHELIUM, BUT ALSO ON THE ADVENTITIA F. Erzengin. Cardiology, University of Istanbul, Istanbul Medical Faculty, Istanbul, Turkey Multislice computed tomography (MSCT) is an important tool for the noninvasive evaluation. We have recently shown that by MSCT the formation of ateromatous component, atherosclerotic or calcified plaques start and grow up not only under the endothelium, but also just beneath the Adventitia. Most patients (55.1%), the calcified plaques begin just beneath of the epithelium on the Adventitia and grow up to ward of the lumen. MSCT is useful for the characterization of human coronary plaque morphology by determining tissue density within the lesion non-invasively. Also MSCT is a unique method for the diagnosis of dangerous silent myocardial ischemia by lumen narrowing calcified plaques. Interestingly, the formation of calcified plaque much frequently begins beneath the sub epithelium of the adventitia and quickly grows up towards to the lumen and keeping classical atherosclerotic cascade on the coronary arteries. The cholesterol (oxLDL) and macrophage easily arrive to the Adventitia by vase vasorums. Molecular imaging most probably will be sort it out this morphology in the near feature. In this study, randomised 98 cases (38 F, 60 M) were investigated making a comparison between MSCT (using with computerised magnifying glass) and conventional coronary angiography. Stents implantations were performed 66 of cases, 22 of patients underwent CABS and 10 patients were treated medically. In this study we have described that Adventitial location of atherosclerotic, fibrotic or calcified plaques’ formation begin not only from endothelium but also mostly (55.1%) from the Adventitia. This finding is firstly described in the Literature. MS317 CORONARY ARTERY CALCIUM IS AN IMPORTANT RISK INDEX FOR ARTERIAL HYPERTENSION PATIENTS T. Kuznetsova1 , D. Gavrilov2 , S. Madany3 , I. Dudanov4 . 1 Faculty Therapy, Petrozavodsk State University, Petrozavodsk, 2 Cardiology, 3 Therapy, Medical Center, Kondopoga, 4 Surgery, Petrozavodsk State University, Petrozavodsk, Russia 273 arterial hypertension patients (AH) have been examined (average age of 53.3±6.9, 29% − women). Standard examination was conducted. Additional risk factors (RF) were evaluated: smoking s- 136 patients, AH family history − 194, obesity − 111, dislypidaemia − 142, diabetes mellitus − 23 patients, combination of more than 3 RF − 164. Left ventricular hypertrophy was found in 37%, microalbuminuria − 2.3%, ultrasound signs of carotid artery involvement − 79% (plaques in 49%). 51 patients had history of ischemic heart disease (IHD), 17 − stroke, 7 − peripheral atherosclerosis. Coronary artery calcium (CAC) was calculated by 64-row multidetector computer tomography. CAC was found in 54%, calcium index was higher than the age norm in 38%. CAC was associated with sex (OR 2.8, p = 0.0001 in men), age after 50 (OR 2.1, p = 0.003). CAC wasn’t connected with smoking (OR 1.5, p = 0.08), family history (OR 1.2, p = 0.4), obesity (OR 1.5, p = 0.1), dislipidaemia (OR 0.8,
173
p = 0.3), diabetes (OR 1.1, p = 0.8). CAC was associated with the combination of more than 2 RF (OR 2.6, p = 0.01). CAC correlated with ultrasound signs of atherosclerosis (OR 2.3, p = 0.006), IHD (OR 2.6, p = 0.0036). Risk assessment by CAC correlated with the SCORE scale (OR 2.5, p = 0.0002). CAC in AH patients is a reliable method of risk assessment, comparable with SCORE, mostly after 50 years old, in men, with the combination of 2 and more RF. Ultrasound signs of carotid lesion are the marker of coronary calcium. MS318 INFLUENCE OF ENHANCED EXTERNAL COUNTERPULSATION ON ANGIOGENESIS INDUCED FACTORS I. Sergienko1 , S. Gabrusenko2 , V. Malakhov2 , V. Masenko3 , V. Kukharchuk2 . 1 Atherosclerosis, Russian Cardiology Research and Production Center Cardiology Research Complex, 2 Atherosclerosis, 3 Immunology, Russian Cardiology Research and Production Center, Moscow, Russia Aim: At present Enhanced external counterpulsation (EECP) is used in clinical practice for treatment patients with refractory angina pectoris, but the mechanism remains unclear. The aim of our investigation was to assess the dynamic of vascular endothelial growth factor (VEGF), transforming growth factor b (TGF b), brain and atrium natriuretic peptide (BNP and ANP) after EECP treatment. Material and Methods: 42 patients (38 mail, 4 female, mean age − 62.9±8.1) with ischemic heart disease − stable angina pectoris − were treated by EECP on. The treatment duration was 35 h for each patient. Before and after treatment we measured the serum level of VEGF, TGF b, BNP and ANP. The myocardial perfusion was assisted by single photon emission computer tomography (SPECT). Results: There was significant increase of exercise test duration till stressinduced myocardial ischemia onset, reduce of chest pain episodes and decreasing of nitrates consumption. SPECT demonstrated decreasing of perfusion defects severity from 64.86±14.01 std till 58.5±19.9 std, p < 0.01. The VEGF level significantly increased after EECP treatment − 287.30 (219.70– 417.25) pg/ml before and 353.50 (281.90–512.10) pg/ml after, p < 0.05. But TGF b level didn’t change − 4.51 (3.34–5.48) and 4.20 (3.02–6.18) ng/ml accordingly. Initial level of ANP was 570.33 (412.39–650.45) pg/ml, after treatment it decreased − 354.12 (177.37–615.88) pg/ml, p < 0.05. BNP b level didn’t change − 526.84 (255.58–657.20) and 471.12 (253.88–579.16) ng/ml, p > 0.05. Conclusion: This study shows that EECP treatment influences on exercise duration and myocardial perfusion. These improvements can be determined by coronary angiogenesis mechanisms stimulation. MS319 IDENTIFICATION OF NOVEL PROTEIN BIOMARKERS FOR ATHEROSCLEROTIC CARDIOVASCULAR DISEASE S. Decasper1 , D. Hof1 , B. Biedermann2 , A. von Eckardstein1 . 1 Institute of Clinical Chemistry, University Hospital Zurich, Zurich, 2 Molecular Nephrology, Department of Research, University Hospital Basel, Basel, Switzerland The early diagnosis of acute coronary events suffers from low diagnostic sensitivity of myocardial necrosis markers and the identification of patients at high cardiovascular risk is limited by the low predictive positive value of risk factors. At least in theory both the diagnostic and prognostic efficacy may be improved by biomarkers that are released from the atherosclerotic lesion into the blood for example by plaque ruptures or erosions. Subtractive antibody phage display was used to identify proteins that are specifically present in advanced atherosclerotic lesions. As we want to find a biomarker present in blood we are working with so-called secretomes, i.e. the array of proteins secreted from arterial tissues which are classified according to the severity of the lesion and incubated in protein-free medium for 24 hours. During this time, proteins were secreted or diffused out into the medium, which was used as an antigen mixture for antibody phage display screening. In our selections we found several phages that specifically recognize proteins in the secretome from atherosclerotic plaque tissues in ELISA and western blot analysis. We have now recloned the antibodies to express them as soluble recombinant antibodies. Now we will use the antibodies for characterizing and identifying their antigens by immunohistochemistry on tissue slides, western blotting of secretomes and plasma as well as mass-spectrometry. MS320 DETERMINANTS OF CORONARY PLAQUE COMPOSITION BY COMPUTERIZED CORONARY TOMOGRAPHY ANGIOGRAPHY IN HETEROZYGOUS FAMILIAL HYPERCHOLESTEROLEMIA ´ M.H. Miname, M.S. Ribeiro, F. Avila, J. Parga, C.E. Rochitte, R.D. Santos. ˜ Paulo, Sao ˜ Paulo, Brazil Heart Institute (InCor) − University of Sao Introduction: Previous studies showed a high prevalence of subclinical atherosclerosis in heterozygous familial hypercholesterolemia (FH). Objective and Methods: Our objective was to evaluate the association of coronary plaque composition with clinical and laboratorial parameters, arterial stiffness (pulse wave velocity-PWV and carotid distensibility-CD), and with
Atherosclerosis Supplements 11, no. 2 (2010) 109–222
MS315 EFFECT OF ATORVASTATIN IN PATIENTS WITH SYSTOLIC HEART FAILURE DUE TO ISCHEMIC CARDIOMYOPATHY AFTER MYOCARDIAL INFARCT T. Vakhtangadze, F. Todua, M. Razmadze, M. Akhvlediani. Clinical Medicine, Tbilisi, Georgia Purpose: To identify the effect of Atorvastatin + conventional therapy of heart failure on ejection fraction in patients with ischemic dilated cardiomyopathy developed after myocardial infarct. Methods: 42 consecutive patients with ischemic systolic left ventricle dysfunction (LVEF 18 − 30%, mean 23%) were enrolled in the study. All of them had previous history of myocardial infarct. Inclusion criteria: History of MI, fixed perfusion defect in Gated SPECT, low EF detected by Gated SPECT/echocardiography. Lipids and echocardiography was performed at the beginning of the study, after 6 months of conventional therapy and by the end of the study. All patients received conventional heart failure treatment for 6 months before initiation of Atorvastatin treatment. Mean time of follow-up was 27 months (12−36 months). Atorvastatin was given to all of them after 6 months of enrolment in the study. Results: Patients developed improvement of symptoms of HF after 6 months of conventional heart failure treatment − mean EF has risen from 23 to 27%. Atorvastatin addition to conventional treatment led to additional improvement of EF in 72% of patients, which was more clear after 1 year of treatment − mean EF has risen from 23% to 36% by the end of the study. Patient who did not respond to Atorvastatin treatment had larger perfusion defects and more severe coronary arteries disease than patients who respond to Atorvastatin treatment. Conclusion: Atorvastatin addition to conventional heart failure treatment leads to improvement of EF in patients with heart failure due to ischemic cardiomyopathy. MS316 ADVENTITIAL CALCIFICATIONS: SURPRISE LOCATION. ATHEROSCLEROTIC AND CALCIFIED PLAQUES BEGIN AND GROW UP NOT ONLY BENEATH THE ENDOTHELIUM, BUT ALSO ON THE ADVENTITIA F. Erzengin. Cardiology, University of Istanbul, Istanbul Medical Faculty, Istanbul, Turkey Multislice computed tomography (MSCT) is an important tool for the noninvasive evaluation. We have recently shown that by MSCT the formation of ateromatous component, atherosclerotic or calcified plaques start and grow up not only under the endothelium, but also just beneath the Adventitia. Most patients (55.1%), the calcified plaques begin just beneath of the epithelium on the Adventitia and grow up to ward of the lumen. MSCT is useful for the characterization of human coronary plaque morphology by determining tissue density within the lesion non-invasively. Also MSCT is a unique method for the diagnosis of dangerous silent myocardial ischemia by lumen narrowing calcified plaques. Interestingly, the formation of calcified plaque much frequently begins beneath the sub epithelium of the adventitia and quickly grows up towards to the lumen and keeping classical atherosclerotic cascade on the coronary arteries. The cholesterol (oxLDL) and macrophage easily arrive to the Adventitia by vase vasorums. Molecular imaging most probably will be sort it out this morphology in the near feature. In this study, randomised 98 cases (38 F, 60 M) were investigated making a comparison between MSCT (using with computerised magnifying glass) and conventional coronary angiography. Stents implantations were performed 66 of cases, 22 of patients underwent CABS and 10 patients were treated medically. In this study we have described that Adventitial location of atherosclerotic, fibrotic or calcified plaques’ formation begin not only from endothelium but also mostly (55.1%) from the Adventitia. This finding is firstly described in the Literature. MS317 CORONARY ARTERY CALCIUM IS AN IMPORTANT RISK INDEX FOR ARTERIAL HYPERTENSION PATIENTS T. Kuznetsova1 , D. Gavrilov2 , S. Madany3 , I. Dudanov4 . 1 Faculty Therapy, Petrozavodsk State University, Petrozavodsk, 2 Cardiology, 3 Therapy, Medical Center, Kondopoga, 4 Surgery, Petrozavodsk State University, Petrozavodsk, Russia 273 arterial hypertension patients (AH) have been examined (average age of 53.3±6.9, 29% − women). Standard examination was conducted. Additional risk factors (RF) were evaluated: smoking s- 136 patients, AH family history − 194, obesity − 111, dislypidaemia − 142, diabetes mellitus − 23 patients, combination of more than 3 RF − 164. Left ventricular hypertrophy was found in 37%, microalbuminuria − 2.3%, ultrasound signs of carotid artery involvement − 79% (plaques in 49%). 51 patients had history of ischemic heart disease (IHD), 17 − stroke, 7 − peripheral atherosclerosis. Coronary artery calcium (CAC) was calculated by 64-row multidetector computer tomography. CAC was found in 54%, calcium index was higher than the age norm in 38%. CAC was associated with sex (OR 2.8, p = 0.0001 in men), age after 50 (OR 2.1, p = 0.003). CAC wasn’t connected with smoking (OR 1.5, p = 0.08), family history (OR 1.2, p = 0.4), obesity (OR 1.5, p = 0.1), dislipidaemia (OR 0.8,
173
p = 0.3), diabetes (OR 1.1, p = 0.8). CAC was associated with the combination of more than 2 RF (OR 2.6, p = 0.01). CAC correlated with ultrasound signs of atherosclerosis (OR 2.3, p = 0.006), IHD (OR 2.6, p = 0.0036). Risk assessment by CAC correlated with the SCORE scale (OR 2.5, p = 0.0002). CAC in AH patients is a reliable method of risk assessment, comparable with SCORE, mostly after 50 years old, in men, with the combination of 2 and more RF. Ultrasound signs of carotid lesion are the marker of coronary calcium. MS318 INFLUENCE OF ENHANCED EXTERNAL COUNTERPULSATION ON ANGIOGENESIS INDUCED FACTORS I. Sergienko1 , S. Gabrusenko2 , V. Malakhov2 , V. Masenko3 , V. Kukharchuk2 . 1 Atherosclerosis, Russian Cardiology Research and Production Center Cardiology Research Complex, 2 Atherosclerosis, 3 Immunology, Russian Cardiology Research and Production Center, Moscow, Russia Aim: At present Enhanced external counterpulsation (EECP) is used in clinical practice for treatment patients with refractory angina pectoris, but the mechanism remains unclear. The aim of our investigation was to assess the dynamic of vascular endothelial growth factor (VEGF), transforming growth factor b (TGF b), brain and atrium natriuretic peptide (BNP and ANP) after EECP treatment. Material and Methods: 42 patients (38 mail, 4 female, mean age − 62.9±8.1) with ischemic heart disease − stable angina pectoris − were treated by EECP on. The treatment duration was 35 h for each patient. Before and after treatment we measured the serum level of VEGF, TGF b, BNP and ANP. The myocardial perfusion was assisted by single photon emission computer tomography (SPECT). Results: There was significant increase of exercise test duration till stressinduced myocardial ischemia onset, reduce of chest pain episodes and decreasing of nitrates consumption. SPECT demonstrated decreasing of perfusion defects severity from 64.86±14.01 std till 58.5±19.9 std, p < 0.01. The VEGF level significantly increased after EECP treatment − 287.30 (219.70– 417.25) pg/ml before and 353.50 (281.90–512.10) pg/ml after, p < 0.05. But TGF b level didn’t change − 4.51 (3.34–5.48) and 4.20 (3.02–6.18) ng/ml accordingly. Initial level of ANP was 570.33 (412.39–650.45) pg/ml, after treatment it decreased − 354.12 (177.37–615.88) pg/ml, p < 0.05. BNP b level didn’t change − 526.84 (255.58–657.20) and 471.12 (253.88–579.16) ng/ml, p > 0.05. Conclusion: This study shows that EECP treatment influences on exercise duration and myocardial perfusion. These improvements can be determined by coronary angiogenesis mechanisms stimulation. MS319 IDENTIFICATION OF NOVEL PROTEIN BIOMARKERS FOR ATHEROSCLEROTIC CARDIOVASCULAR DISEASE S. Decasper1 , D. Hof1 , B. Biedermann2 , A. von Eckardstein1 . 1 Institute of Clinical Chemistry, University Hospital Zurich, Zurich, 2 Molecular Nephrology, Department of Research, University Hospital Basel, Basel, Switzerland The early diagnosis of acute coronary events suffers from low diagnostic sensitivity of myocardial necrosis markers and the identification of patients at high cardiovascular risk is limited by the low predictive positive value of risk factors. At least in theory both the diagnostic and prognostic efficacy may be improved by biomarkers that are released from the atherosclerotic lesion into the blood for example by plaque ruptures or erosions. Subtractive antibody phage display was used to identify proteins that are specifically present in advanced atherosclerotic lesions. As we want to find a biomarker present in blood we are working with so-called secretomes, i.e. the array of proteins secreted from arterial tissues which are classified according to the severity of the lesion and incubated in protein-free medium for 24 hours. During this time, proteins were secreted or diffused out into the medium, which was used as an antigen mixture for antibody phage display screening. In our selections we found several phages that specifically recognize proteins in the secretome from atherosclerotic plaque tissues in ELISA and western blot analysis. We have now recloned the antibodies to express them as soluble recombinant antibodies. Now we will use the antibodies for characterizing and identifying their antigens by immunohistochemistry on tissue slides, western blotting of secretomes and plasma as well as mass-spectrometry. MS320 DETERMINANTS OF CORONARY PLAQUE COMPOSITION BY COMPUTERIZED CORONARY TOMOGRAPHY ANGIOGRAPHY IN HETEROZYGOUS FAMILIAL HYPERCHOLESTEROLEMIA ´ M.H. Miname, M.S. Ribeiro, F. Avila, J. Parga, C.E. Rochitte, R.D. Santos. ˜ Paulo, Sao ˜ Paulo, Brazil Heart Institute (InCor) − University of Sao Introduction: Previous studies showed a high prevalence of subclinical atherosclerosis in heterozygous familial hypercholesterolemia (FH). Objective and Methods: Our objective was to evaluate the association of coronary plaque composition with clinical and laboratorial parameters, arterial stiffness (pulse wave velocity-PWV and carotid distensibility-CD), and with