Aberrant right coronary artery occlusion during the percutaneous pulmonary trunk stenting in a patient with tetralogy of Fallot.

Aberrant coronary arteries are frequently observed in patients presenting with Fallot\’s tetralogy (TOF). Before the complete surgical repair of the TOF, the percutaneously performed pulmonary trunk (PT) angioplasty is often performed in order to temporarily increase the pulmonary circulation, thus increasing the pulmonary vessel size, finally improving surgical outcome. This case reports a 12-year-old boy with a TOF insufficiently improved by surgical correction, in whom a PT angioplasty with stent implantation was complicated by an extrinsic compression of an aberrant right coronary artery (RCA) causing a myocardial ischemia with severe hypotension. The RCA, originating from the left anterior descending coronary artery, passed through the aortic root and the PT and was thus compressed by the PT-stent. Finally the RCA was successfully treated with standard coronary balloon angioplasty and stenting, improving myocardial perfusion and the hemodynamics of the patient, who finally died several days thereafter due to septic shock and massive pulmonary embolism.

Perret X, Bonvini RF, Aggoun Y, Verin V.

Cardiology Center, University Hospital of Geneva, Rue Micheli du Crest 24, 1211, Geneva 14, Switzerland.

Electron paramagnetic resonance investigation on modulatory effect of benidipine on membrane fluidity of erythrocytes in essential hypertension.

It has been shown that benidipine, a long-lasting calcium (Ca) channel blocker, may exert its protective effect against vascular disorders by increasing nitric oxide (NO) production. The purpose of the present study was to investigate whether orally administered benidipine might influence the membrane function in patients with essential hypertension. We measured the membrane fluidity of erythrocytes by using an electron paramagnetic resonance (EPR) and spin-labeling method. In the preliminary study using erythrocytes obtained from healthy volunteers, benidipine decreased the order parameter (S) for 5-nitroxide stearate (5-NS) and the peak height ratio (ho/h-1) for 16-NS in the EPR spectra in vitro. The finding indicated that benidipine increased the membrane fluidity and improved the microviscosity of erythrocytes. In addition, it was demonstrated that the effect of benidipine on membrane fluidity of erythrocytes was significantly potentiated by the NO-substrate, L-arginine. In the separate series of the study, we observed that orally administered benidipine for 4 weeks significantly increased the membrane fluidity of erythrocytes with a concomitant increase in plasma NO metabolite levels in hypertensive subjects. The results of the present study demonstrated that benidipine might increase the membrane fluidity and improve the microviscosity of erythrocytes both in vitro and in vivo, to some extent, by the NO-dependent mechanism. Furthermore, it is strongly suggested that orally administered benidipine might have a beneficial effect on the rheologic behavior of erythrocytes and the improvement of the microcirculation in hypertensive subjects.

Tsuda K.

Division of Cardiology, Department of Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8509, Japan, tsudak@mail.wakayama-med.ac.jp.

Beneficial effects of low doses of red wine consumption on perturbed shear stress-induced atherogenesis.

Moderate wine intake is associated with a reduced risk of morbidity and mortality from cardiovascular disease. Atherosclerosis is enhanced in arterial segments exposed to disturbed flow. Perturbed shear stress increases also the endothelial expression of oxidation-sensitive responsive genes (such as ELK-1 and p-JUN). This study evaluates the effects of chronic consumption of red wine on perturbed shear stress-induced atherogenesis. Results indicated that chronic treatment with red wine significantly attenuated the activation of redox-sensitive genes (ELK-1 and p-JUN) and increased endothelial nitric oxide synthase (eNOS) expression (which was decreased by perturbed shear stress) in cultured human coronary endothelial cells (EC) and in atherosclerosis-prone areas of hypercholesterolemic mice. Oral administration of red wine to hypercholesterolemic mice reduced significantly the progression of atherosclerosis. Moreover, short-term supplementation with red wine to C57BL/6J mice significantly increased upregulation of aortic eNOS and SIRT1 expression induced by physical training. These findings establish that administration of low doses of red wine can attenuate the proatherogenic effects induced by perturbed shear stress in vitro and in vivo. This evidence may have implications for the prevention of atherosclerotic lesion progression and its clinical manifestations.

Napoli C, Balestrieri ML, Sica V, Lerman LO, Crimi E, De Rosa G, Schiano C, Servillo L, D\’Armiento FP.

Department of General Pathology, Division of Clinical Pathology, 1st School of Medicine, II University of Naples, Complesso S. Andrea delle Dame, Via L. de Crecchio 7, Naples, 80138, Italy, claudio.napoli@unina2.it.

Visualization of the azygos arch valves on multidetector-row computed tomography.

To evaluate the frequency and appearance of the azygos arch valves on chest examinations using multidetector-row computed tomography (MDCT), we retrospectively reviewed findings from 194 contrast-enhanced MDCT examinations of the chest. Rate of injection of 300 mgI/ml contrast materials was low (2.0 ml/s) and high (3.0 ml/s). Scanning delay was 80 s on examination on low-rate injection of contrast material and 20 s on high-rate injection of contrast material. The presence of residual contrast material in the azygos arch valves and reflux of contrast material into the azygos arch were recorded. The Cochran-Armitage trend test was used to compare the frequency of residual contrast material in the azygos arch valves and reflux of contrast material into the azygos arch in both groups. Of 92 examinations of high-rate injection of contrast material, 63 (68.5%) demonstrated residual contrast material in the azygos arch valves and 71 (77.2%) demonstrated reflux of contrast material into the azygos arch. A significantly higher frequency of reflux of contrast material into the azygos arch and residual contrast material in the azygos arch valves was seen in the high-rate injection group than in the low-rate injection group (P < 0.05). Residual contrast material in the azygos arch valves was demonstrated more frequently when contrast material was administered in the right side of the arm than in the left side of the arm (P < 0.05). Reflux of contrast material into the azygos arch was common in the high-injection-rate group and residual contrast material in the azygos arch valves was far more frequently seen in the high-injection-rate group than in the low-injection-rate group on MDCT.

Ichikawa T, Endo J, Koizumi J, Ro A, Kobayashi M, Saito M, Kawada S, Hashimoto T, Imai Y.

Department of Radiology, Tokai University School of Medicine, Boseidai, Isehara, 259-1193, Japan, tamaki-i@mars.sannet.ne.jp.

Functional implications of the right ventricular myocardial performance index in patients after surgical repair of tetralogy of Fallot.

The myocardial performance index (MPI) has been proposed to be a simple echocardiographic index of right ventricular (RV) function in patients after surgical repair of tetralogy of Fallot (TOF). However, its functional status remains to be clarified. The functional implications of RV MPI were determined by exploring its relationships with parameters of RV function as derived from cardiovascular magnetic resonance (CMR), and exercise capacity of postoperative TOF patients Thirty patients (11 males), aged 15.6 +/- 3.1 years, who have undergone surgical repair of TOF at 4.0 +/- 1.8 years, were studied. The RV and left ventricular (LV) MPIs determined using pulsed-wave Doppler echocardiography were related to CMR-derived RV and LV ejection fractions, and pulmonary regurgitant fraction and treadmill exercise testing parameters. Log RV MPI correlated positively with log LV MPI (r = 0.38, P = 0.037) and negatively with CMR-derived RV ejection fraction (r = -0.4, P = 0.028) and pulmonary regurgitant fraction (r = -0.4, P = 0.031). No significant correlations were found between LV MPI and any of the CMR parameters. Using receiver operated characteristics analysis, a cutoff value of 0.30 for RV MPI was found to have a sensitivity of 100% and specificity of 74% in predicting a RV ejection fraction <35%. Right ventricular, but not LV, MPI correlated inversely with exercise duration (r = -0.45, P = 0.013) and peak oxygen consumption (VO(2) max) (r = -0.56, P = 0.001). Multivariate analysis identified RV MPI (beta = -0.6, P < 0.001), male sex (beta = 0.44, P = 0.01), and duration from surgery (beta = -0.30, P = 0.019) as significant determinants of VO(2) max. Increased MPI is a reflection of reduced RV ejection fraction and exercise capacity in patients after TOF repair.

Cheung EW, Lam WW, Cheung SC, Cheung YF.

Division of Paediatric Cardiology, Department of Paediatrics and Adolescent Medicine, Grantham Hospital, The University of Hong Kong, 125 Wong Chuk Hang Road, Hong Kong, China.

The mild form of mucopolysaccharidosis type I (Scheie syndrome) is associated with increased ascending aortic stiffness.

Mucopolysaccharidosis type I (MPS IS) is a rare autosomal recessive disease caused by a deficiency of the lysosomal enzyme alpha-L: -iduronidase, which is involved in the degradation of sulfated glycosaminoglycans (GAGs). The deficiency results in the intra-and pericellular accumulation of the GAGs heparan sulfate and dermatan sulfate. Eight adult patients with typical features of MPS IS aged 31.5 +/- 6.8 years (five men) were included and compared to age-and gender-matched controls. With transthoracic echocardiography, cyclic ascending aortic diameter changes were measured and ascending aortic elastic properties were calculated to characterize aortic elasticity. In MPS IS patients, aortic stiffness index was significantly increased (23.1 +/- 10.4 vs 3.9 +/- 1.5, P < 0.001), while aortic distensibility was significantly decreased (1.6 +/- 0.8 vs 1.6 +/- 1.9 Ca(2)/dynes 10(-6), P < 0.001) compared to age-and sex-matched controls. The results of the present study demonstrate that in addition to the known cardiac complications, MPS IS patients have an impairment of ascending aortic elasticity. Further follow-up studies are needed to examine arterial elasticity using other methods in this patient population, and to detect possible effects of enzyme replacement therapy.

Nemes A, Timmermans RG, Wilson JH, Soliman OI, Krenning BJ, Ten Cate FJ, Geleijnse ML.

Department of Cardiology, Thoraxcenter, Erasmus Medical Center Rotterdam, Dr Molewaterplein 40 Room Ba304, 3015 GD, Rotterdam, The Netherlands.

The K121Q polymorphism of ENPP1 and peripheral arterial disease.

The K121Q variant of the ectonucleotide pyrophosphatase/ phosphodiesterase 1 (ENPP1) gene is associated with obesity, insulin resistance, and early myocardial infarction. Therefore, we hypothesized that the K121Q polymorphism might also be associated with an increased risk for peripheral arterial disease. Four hundred patients with peripheral arterial disease and 400 controls matched for sex and age (+/- 2 years) were genotyped cross-sectionally for the K121Q single nucleotide polymorphism of the ENPP1 gene. The frequency for the 121Q allele was 0.25 both in patients with peripheral arterial disease and in controls (P = 0.75). Subgroup analysis revealed association of the ENPP1 121QQ genotype with higher glycohemoglobin A1C levels (P = 0.001) and earlier onset of peripheral arterial disease (P = 0.003) in the cohort of nonsmokers. Whereas the K121Q genotype of the ENPP1 gene is not associated with presence of peripheral arterial disease in the whole Linz Peripheral Arterial Disease population, it is associated with type 2 diabetes mellitus and earlier onset of peripheral arterial disease in the subgroup of nonsmoking patients.

Eller P, Schgoer W, Mueller T, Tancevski I, Demetz E, Duwensee K, Ritsch A, Haltmayer M, Patsch JR.

Department of Internal Medicine, Medical University Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria, philipp.eller@i-med.ac.at.

Abdominal obesity and inflammation predicts hypertension among prehypertensive men and women: the ATTICA Study.

The aim of this work was to assess the 5-year incidence of hypertension and its predictors among prehypertensive adults. Under the context of the ATTICA Study, data from 1188 individuals, free of cardiovascular disease, but with defined high blood pressure levels (prehypertension) at baseline examination (during 2001-2002) were retrieved. In 2006, the 5-year follow-up of the study was performed, and 798 of the prehypertensive participants were allocated. In this work, incidence and determinants of developing hypertension were evaluated. The 5-year ageadjusted incidence of hypertension was 18.7% in men and 24.6% in women (P = 0.05); while almost one half of prehypertensive individuals at the age of 55-65 years developed hypertension, and approximately 6 out of 10 people over 65 years of age developed the disease. Multiple logistic regression analysis revealed that increased age (odds ratio [OR] per 1 year = 1.09, 95% confidence interval [CI] 1.07-1.12), male sex (OR = 0.40, 95% CI 0.21-0.68), high education status (OR per 1 year of school = 0.94, 95% CI 0.88-0.98), waist circumference (OR per 1 cm = 1.04, 95% CI 1.02-1.06) and C-reactive protein (OR per 1 mg/l = 1.12, 95% CI 1.05-1.20), were positively associated with the development of hypertension. Moreover, greater adherence to Mediterranean diet seems to protect only prehypertensive, with abdominal obesity patients prone to develop hypertension (OR = 0.94, 95% CI 0.90-0.98). Annual incidence of hypertension was roughly 4% in men and women. Older people, with low education, abdominal obesity, lower adherence to the Mediterranean diet, and increased inflammation, constitute a model of prehypertensive individuals that are prone to develop hypertension.

Pitsavos C, Chrysohoou C, Panagiotakos DB, Lentzas Y, Stefanadis C.

First Cardiology Clinic, School of Medicine, University of Athens, Athens, Greece.

Synergistic effect of amlodipine and atorvastatin on blood pressure, left ventricular remodeling, and C-reactive protein in hypertensive patients with primary hypercholesterolemia.

Our aim in this study was to investigate the changes of serum high-sensitive C-reactive protein (hs-CRP) and uric acid (UA), and evaluate the synergistic effect of amlodipine and atorvastatin on blood pressure and left ventricular remodeling in hypertensive patients with primary hypercholesterolemia. One hundred and twenty-six hypertensive patients with hypercholesterolemia were randomized into amlodipine group (10 mg/day, group A, n = 65) and amlodipine (10 mg/day) plus atorvastatin group (20 mg/day, group B, n = 61), treated for 4 months continuously. Serum concentrations of total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, triglycerides, hs-CRP, and UA were determined, and blood pressure of both groups was examined before and after treatment. Left ventricular posterior wall thickness and interventricular spectum thickness were measured by echocardiography, and left ventricular mass index (LVMI) was calculated. After 4-months of treatment with atorvastatin, serum concentrations of total cholesterol, low-density lipoprotein cholesterol, triglycerides, hs-CRP, and UA were significantly decreased in group B (P < 0.05, P < 0.01), while serum concentrations of high-density lipoprotein cholesterol was elevated (P < 0.05). Meanwhile, systolic blood pressure and diastolic blood pressure were reduced in both groups (P < 0.05), and blood pressure in group B was markedly lower than that in group A after treatment (P < 0.05). Compared with that before treatment, LVMI in both groups decreased (P < 0.05), to a significantly lower degree in group B than in group A (P < 0.05). Atorvastatin can decrease serum concentrations of hs-CRP and UA. The amlodipine-atorvastatin combination markedly reduces blood pressure and reverses left ventricular hypertrophy more than amlodipine monotherapy. The positive effect suggests that in hypertensive and hypercholesterolemic patients, the combination of amlodipine and atorvastatin could be the treatment of choice.

Ge CJ, Lu SZ, Chen YD, Wu XF, Hu SJ, Ji Y.

Department of Cardiology, Beijing Anzhen Hospital, Capital University of Medical Science, Beijing, 100029, P.R. China, cjge1116@163.com.

Comparison of effect between nitrates and calcium channel antagonist on vascular function in patients with normal or mildly diseased coronary arteries.

The comparative long-term antianginal efficacy of long-acting nitrates versus calcium channel antagonists remains unclear. The goal of the present study was to compare the coronary endothelial cell function and coronary artery vasoconstriction between patients with normal or mildly diseased coronary arteries treated with long-acting nitrates or calcium channel antagonists. Forty-two patients suspected to have angina pectoris and with normal or mildly diseased coronary arteries underwent Doppler flow study of the left anterior descending coronary artery. All patients were suspected to have angina pectoris and were receiving either long-acting nitrates (n = 18; Nitrates group) or calcium channel antagonists (n = 24; Ca-antagonists group) for at least 1 year. Vascular reactivity was assessed by intracoronary administration of papaverine, acetylcholine (Ach), and nitroglycerin using a Doppler guidewire. Segments that showed the greatest constrictive response to Ach were used for assessment of vasoconstriction. The percent increase in coronary blood flow (CBF) and coronary artery diameter (CAD) induced by Ach was significantly smaller in the Nitrates group than in the Ca-antagonists group (33% +/- 74% vs 83% +/- 77%, P < 0.05; -3% +/- 16% vs 11% +/- 12%, P < 0.01, respectively). The percent diameter reduction in the region of greatest constrictive response to Ach was significantly greater in the Nitrates group than in the Caantagonists group (44% +/- 39% vs 15% +/- 32%, P < 0.02). Long-term treatment with long-acting nitrates may produce less favorable effects on coronary endothelial function and the constrictive response to Ach when compared with long-acting calcium channel antagonists in patients with normal or mildly diseased coronary arteries.

Ninomiya Y, Hamasaki S, Saihara K, Ishida S, Kataoka T, Ogawa M, Orihara K, Oketani N, Fukudome T, Okui H, Ichiki T, Shinsato T, Kubozono T, Mizoguchi E, Ichiki H, Tei C.

Department of Cardiovascular, Respiratory and Metabolic Medicine, Graduate School of Medicine, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima, 890-8520, Japan.