Decreasing myocardial deformation from endocardial to epicardial layers can be demonstrated with the use of an advanced analysis system allowing definition of deformation parameters for three myocardial layers. Myocardial deformation is reduced in all layers of segments with impaired wall motion.

Background: Traditional cardiovascular risk factors have been associated with aortic stenosis and coronary artery disease. As these two conditions often co-exist, the association of cardiovascular risk factors with aortic stenosis may reflect confounding. Objective: To compare the cardiovascular risk profile in patients with severe aortic stenosis undergoing elective coronary angiography with that of patients without aortic stenosis or calcification undergoing coronary angiography for suspected coronary artery disease. Methods: 523 patients referred for elective diagnostic left heart catheterisation because of severe aortic stenosis formed the case population; 3925 patients without valve disease referred for elective diagnostic left heart catheterisation formed the base control population. Of the latter, 523 were pair matched to the case population for sex, age, and prevalence of relevant coronary artery disease, forming a pair matched control population. Cardiovascular risk factors (male sex, hypertension, hypercholesterolaemia, smoking, diabetes mellitus, family history of coronary artery disease) were assessed in all the patients. Results: None of the cardiovascular risk factors was more prevalent in patients with aortic stenosis than in the base control population or in the pair matched control population. However, male sex, hypercholesterolaemia, smoking, diabetes mellitus, and a family history of coronary artery disease were significantly associated with the presence of additional coronary artery disease in patients with aortic stenosis. Conclusions: Cardiovascular risk factors are commonly present in patients with aortic stenosis. However, when compared with controls matched for age, sex, and angiographically defined coronary artery disease, no risk factor was significantly associated with the prevalence of aortic stenosis. Thus other factors are likely to be more important in the pathogenesis of aortic stenosis.

Inflammation is associated with atherosclerosis of coronary arteries. Chemokines have an important role in inflammation. The CCR2 chemokine receptor mediates leukocyte chemoattraction, which is involved in the pathogenesis of coronary heart disease. We prospectively studied 1960 consecutive patients aged under 65 years and referred for a first-time left ventricular catheter. Left heart catheters were analyzed by two independent cardiologists for the presence of myocardial infarction (regional wall motion abnormality) and moderate or severely reduced left ventricular function on cineventriculography and presence of coronary atherosclerosis on angiography. Genotyping for CCR2 V64I polymorphism was performed. The presence of the rare allele of the CCR2 gene was significantly associated with a higher prevalence of myocardial infarction on cinventriculography (32.0% vs. 24.2%, moderately or severely reduced left ventricular function (14.0% vs. 9.5%) and NYHA class III or IV (16.7% vs. 12.2%). The association of the CCR2 genotype with heart failure was not independent of the presence of myocardial infarction in multivariate analysis. There was no association of the CCR2 genotype with coronary atherosclerosis. The CCR2 genotype seems to predispose patients for myocardial infarction before the age of 65 years. The higher prevalence of heart failure in gene carriers with the rare alle might be a consequence of myocardial infarction. If the CCR2 genotype is associated with higher mortality in the general population must be investigated in further studies.

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The effect of Etomoxir as a carnitine palmitoyl transferase I-inhibitor was investigated in normal and chronic diabetic rats. Etomoxir (18 mg/kg) was given daily for 8 days by intraperitoneal injection in order to inhibit the oxidation of fatty acids and to increase the metabolism of glucose. This carnitine palmitoyl transferase I-inhibitor significantly improved and almost normalized the decreased heart function in chronic diabetic rats. Additionally to the improvement of ventricular heart function, alterations in the conducting system of the diabetic heart were significantly ameliorated. The serum concentrations of glucose, glycerol, cholesterol, tricylglycerol, phospholipids, and beta-hydroxybutyrate were significantly lower in comparison to untreated diabetic animals, while the serum concentration of free fatty acids markedly increased. In addition to the improvement of ventricular heart function, the carnitine content of heart and liver increased in the Etomoxir-treated rats. On the other hand, the lipid content of heart and liver increased in the Etomoxir-treated rats. On the other hand, the lipid content of heart and liver increased significantly. Thus, Etomoxir may be valuable not only as a potential anti-diabetic drug but also as a lipid-lowering agent for the treatment of diabetic related dyslipoproteinaemias and, in addition, as an agent in the treatment of diabetic cardiomyopathy. However, a long-term evaluation of the metabolic consequences of the blocked carnitine palmitoyltransferase I is necessary.