We have speculated previously that the abrupt conversion from chronic stable to unstable angina and the continuum to acute myocardial infarction may result from myocardial ischemia caused by progressive platelet aggregation and dynamic vasoconstriction themselves caused by local increases in thromboxane and serotonin at sites of coronary artery stenosis and endothelial injury. Platelet aggregation and dynamic coronary artery vasoconstriction probably result from the local accumulation of thromboxane and serotonin and also relative decreases in the local concentrations of endothelially derived vasodilators and inhibitors of platelet aggregation, such as endothelium-derived relaxing factor (EDRF) and prostacyclin. With severe reductions in coronary blood flow caused by these mechanisms, platelet aggregates may increase, and an occlusive thrombus composed of platelets and white and red blood cells in a fibrin mesh may develop. When coronary arteries are occluded or narrowed for a sufficient period of time by these mechanisms, myocardial necrosis, electrical instability, or sudden death may occur. We believe that unstable angina and acute myocardial infarction are a continuum in relation to the process of coronary artery thrombosis and vasoconstriction. When the period of platelet aggregation or dynamic vasoconstriction at sites of endothelial injury and coronary artery stenosis is brief, unstable angina or non-Q wave infarction may occur. However, when the coronary artery obstruction by these mechanisms is prolonged for several hours, Q wave myocardial infarction results. Chronic endothelial injury and coronary artery stenosis are probably associated with the accumulation of platelets, white and red blood cells, and a fibrin mesh at the site of stenosis and endothelial injury.

After cardiac ischemia, long-chain fatty acids, such as palmitate, increase in plasma and heart. Palmitate has previously been shown to cause apoptosis in cardiac myocytes. Cultured neonatal rat cardiac myocytes were studied to assess mitochondrial alterations during apoptosis. Phosphatidylserine translocation and caspase 3-like activity confirmed the apoptotic action of palmitate. Cytosolic cytochrome cwas detected at 8 h and plateaued at 12 h. The mitochondrial membrane potential (ΔΨ) in tetramethylrhodamine ethyl ester-loaded cardiac myocytes decreased significantly in individual mitochondria by 8 h. This loss was heterogeneous, with a few energized mitochondria per myocyte remaining at 24 h. Total ATP levels remained high at 16 h. The ΔΨ loss was delayed by cyclosporin A, a mitochondrial permeability transition inhibitor. Mitochondrial swelling accompanied changes in ΔΨ. Carnitine palmitoyltransferase I activity fell at 16 h; this decline was accompanied by ceramide increases that paralleled decreased complex III activity. We conclude that carnitine palmitoyltransferase I inhibition, ceramide accumulation, and complex III inhibition are downstream events in cardiac apoptosis mediated by palmitate and occur independent of events leading to caspase 3-like activation.

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The accuracy and reproducibility of magnetic resonance (MR) imaging in the determination of left ventricular mass in humans was investigated. Left ventricular wall volume was measured from ten short-axis, end-diastolic MR images that spanned the left ventricle. Mass was estimated on the basis of average left ventricular wall volume and an assumed myocardial density. To establish the accuracy of the technique, the authors imaged ten cadaver hearts and compared true left ventricular weight with the mass estimate based on MR imaging findings. In vivo determination of left ventricular mass was evaluated in 40 subjects, with resultant calculated masses of 156.4-319.3 g. Intra- and interobserver variabilities of the technique were analyzed in ten subjects. Both the intra- (r = .96, standard error of estimate [SEE] = 11.1 g) and interobserver variabilities (r = .91, SEE = 17.8 g) were excellent. Eight subjects were imaged on two separate occasions to evaluate reproducibility of the technique and confidence limits for a given measurement. For these eight, there was good correlation between the two estimates (r = .93, SEE = 21 g). The authors conclude that MR imaging yields highly accurate and reproducible estimates of left ventricular mass in humans in vivo.

Adenovirus-mediated transfer of COX-1 to angioplasty-injured carotid arteries was efficacious in augmenting PGI2 synthesis and was associated with an inhibition of thrombosis when a relatively high titer of adenovirus was instilled.