he vascular endothelium plays an integral role not only in regulation of vascular tonus, but also in prevention and formation of thrombus and inflammation. 1 It is known that endothelial dysfunction is associated with coronary risk factors and atherosclerosis, and has a close pathophysiological relation with acute coronary syndromes. [2][3][4] Endothelial dysfunction has been shown in patients with documented atherosclerosis, but it is also an early step in the pathogenesis of the atherosclerotic cascade. [5][6][7] Among various methods to assess endothelial function, endothelium-dependent vasodilatation (EDV) is a noninvasive, highly reproducible, simple method based on high-sensitivity ultrasound waves. 7,8 In this study we assessed the relationship between EDV in systemic arteries and coronary risk factors in patients with documented coronary artery disease (CAD). Methods Patient PopulationOne hundred and fifty patients with angiographically proven CAD (103 males, 47 females), age ranging between 29 and 78 years (mean: 58±10), were recruited. CAD was defined as the presence of angiographically demonstrated ≥70% stenosis in at least 1 major epicardial coronary artery. Hypertension (HT) was defined as blood pressure ≥140/ 90 mmHg or use of antihypertensive drugs and diabetes mellitus (DM) as fasting blood glucose level ≥126 mg/dl or use of antidiabetic agents. All study subjects underwent a complete physical examination, and biochemical, electrocardiographic and body mass index (BMI) measurements. Vascular endothelial function in the brachial artery was measured by the flow-mediated dilatation (FMD) technique. Patients with acute coronary syndromes, severe left ventricular dysfunction (ejection fraction <35%) or old myocardial infarction were excluded from the study. Vascular StudyEach subject was studied in the morning, after abstaining from alcohol, caffeine and tobacco, as well as food, within 8 h before the study. High-resolution echocardiography Doppler ultrasound (Technos MPX ultrasound ESOTA Inc) with an 8.0 MHz transducer was used to measure the Circ J 2007; 71: 698 -702 (Received August 1, 2006; revised manuscript received January 22, 2007; accepted February 9, 2007 Background Results of experimental and clinical studies suggest that both coronary artery disease (CAD) itself and its traditional risk factors lead to endothelial dysfunction. The aim of the present study was to determine which CAD risk factors sustain their contribution to endothelial dysfunction despite the presence of established CAD. Methods and ResultsThe study group comprised 150 patients with CAD. Using a high-resolution ultrasound, the diameter of the brachial artery at rest and during reactive hyperemia (flow-mediated dilatation, FMD%: endothelial-dependent stimulus to vasodilatation), as well as after sublingual administration of nitroglycerin (NTG%: endothelium-independent vasodilatation), was measured.

It has been suggested that successful percutaneous balloon mitral valvuloplasty (PMV) decreases the intensity of spontaneous left atrial contrast, reduces the size of the left atrium, and improves left atrial function in patient with mitral stenosis. However, left atrial mechanical functions immediately after PMV have not been extensively evaluated yet. The aim of this study was to evaluate the effects of PMV on left atrial mechanical functions. Twenty patients with critical mitral stenosis who have normal sinus rhythm (male/female: 4 to 16; mean age: 33 ± 8 years) were included in the study. Left atrial mechanical functions were evaluated before and after PMV, including left atrial passive emptying volume, LA passive emptying fraction, conduit volume, left ventricular stroke volume, LA active emptying volume, LA active emptying fraction, LA total emptying volume and LA total emptying fraction. PMV resulted in a significant increase in the mitral valve area ( p < 0.001) and a substantial reduction in the mean transmitral pressure gradient ( p < 0.001) as well as LA diameter ( p < 0.002). LA maximal volume, minimal volume and atrial presystolic volumes were significantly decreased after PMV ( p: 0.001; p: 0.002; p: 0.001, respectively). The conduit volume was increased and LA total emptying volume was decreased after PMV ( p: 0.014; p: 0.035). The other left atrial volumes were not altered after PMV. The early increase in conduit volume and the decrease in left atrial presystolic volume indicate that PMV has favorable effects on atrial reservoir and conduit functions. PMV therefore improves atrial mechanic functions. left atrial mechanical functions; percutaneous mitral valvuloplasty; mitral stenosis

The general recommended strategy after arterial invasive procedures is a 4- to 6-hour bed rest that is associated with patient discomfort and increased medical costs. We hypothesized that mobilization of selected patients at the second hour would not increase vascular complications. Coronary angiography was performed through the femoral route via 6-Fr catheters. Homeostasis was achieved by manual compression and maintained with a compressive bandage. A total of 1,446 patients were ambulated at the second hour and 1,226 of them were discharged without complication. A total of 220 patients required further follow-up due to blood oozing; 154 patients were conventionally ambulated due to difficult arterial access, longer (>15 minutes) compression time, hematoma formation within 2 hours, or hypertensive state (blood pressure >180/100 mm Hg). Twenty-five (16%) of those patients developed minor bleeding after ambulation. No major bleeding or large hematoma was observed during in-hospital observation. Ecchymosis (10% [2-hour group] vs 21% [4-5 hour group]) and small hematomas (22% vs 9%) were the most frequent complications after discharge. Early mobilization of selected patients undergoing diagnostic heart catheterization through the femoral artery via 6-Fr catheters is safe and associated with acceptable bleeding complication rates.

No abstract

No abstract