CARDIOLOGY 2001; October CARDIOLOGY 2001; October 18-20, 2001; 18-20, 2001; , Hofburg, Vienna, ; Jointly organized Austria by: Division of Cardiovascular Diseases, Mayo Clinic; Division of Cardiology, Journal für Kardiologie - Austrian Journal of Cardiology 2001; 8 (Supplementum E)

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non, possibly by inducing spasm in the ENDOTHELIN-1 IS INVOLVED IN CORONARY depending coronary microvasculature. CAN TRANSOESOPHAGEAL ECHOCARDIO- NO-REFLOW GRAPHY ACCURATELY PREDICT THE IMPLANT SIZE FOR TRANSCATHETER ATRIAL SEPTAL Ch. Adlbrecht, D. Bonderman, DEFECT CLOSURE? J. Jakowitsch, M. Gyöngyösi, W. Sperker, SYMPTOMATIC IMPROVEMENT AFTER P. Probst, G. Maurer, H. D. Glogar, TRANSCATHETER ATRIAL SEPTAL DEFECT I. M. Lang CLOSURE IN ADULTS H. Baumgartner, R. Rosenhek, H. Gabriel, Department of Cardiology, University of T. Binder, G. Maurer, P. Probst Vienna, Austria Department of Cardiology, University of H. Baumgartner, H. Gabriel, R. Rosenhek, Vienna, Austria Background: No-reflow (NR) is a multi- T. Binder, G. Maurer, P. Probst factorial condition comprising an acute Department of Cardiology, University of Background: Successful transcatheter reduction in coronary flow (TIMI grade Vienna, Austria atrial septal defect (ASD) closure requires 0–1) in the absence of epicardial vessel careful selection of the appropriate obstruction. Previous data have demon- Background: Transcatheter atrial septal device size. Undersizing may result in a strated that tissue factor that is shed from defect (ASD) closure has been shown to residual shunt and even device emboli- the atherosclerotic plaque, causes NR by be feasible and safe. However, little is zation. Balloon sizing is used to deter- inducing immediate and widespread known about the clinical outcome of mine the “stretched” defect diameter but coronary microvascular fibrin deposition. adult pts, particularly those of advanced it is time consuming. The purpose of this However, current concepts invoke vaso- age. study was to evaluate whether trans- constriction as an additional factor in oesophageal echo (TEE) can predict the NR. Therefore, we investigated the role Methods: We performed transcatheter stretched defect diameter and, therefore, of endothelin (ET-1), a potent vasocon- ASD closure with the Amplatzer Septal the required device size. strictor peptide that is present in athero- Occluder in 55 adults (mean age 47 ± sclerotic lesions. 17 years, 35 female) of whom 35 were Methods: Transcatheter ASD closure with older than 40 years (up to 82 yrs). the Amplatzer ASD Occluder was per- Methods and Results: Initial experiments Patients were followed for up to 2 years. formed in 55 adults (mean age 47 ± 17 utilized homogenates from atherosclero- years, 35 female). The size of the device tic arteries and confirmed the presence Results: ASD was successfully closed in was determined by balloon sizing. The of ET-1 antigen at levels tenfold above all pts (device size 23 ± 6 mm, range stretched defect diameter was compared normal plasma concentrations (0.4 ± 10–34 mm). No major complications with the native diameter measured by 0.07 fmol/ml). In the next step, right coro- occurred. Minor complications were TEE considering morphologic character- nary arteries (RCAs) from 6 domestic pigs atrial fibrillation (2), transient AV-block istics of the interatrial septum. were selectively injected with 2 ml each (1) and transient ST-elevation (1). At of homogenized atherosclerotic human follow-up, a mild residual left-to-right Results: The native defect diameter (TEE) plaque material containing 6.9 ± 4 fmol/ml shunt was found in 2 pts. was 15 ± 4 mm (6–22 mm). The ET-1 per g of tissue. In subsequent angio- stretched diameter (balloon sizing) was grams, flow was compromised in 5 of 6 Prior to intervention, 24 pts were symp- 23 ± 6 mm (10–34 mm). Thus, the size animals. Fractional flow reserve dropped tomatic of whom 19 were older than 40 of the device exceeded the native defect from 2.0 ± 1 to 0.8 ± 0.2 with a marked years. Most frequent symptoms were diameter by 65 ± 47 % (9 ± 5 mm) with decrease of baseline flow immediately limited exercise capacity and shortness a wide variation ranging from 6 to 200 % after the injection. To examine the role of of breath (NYHA class 2–3 or 3 in 13 pts). (1 to 16 mm). The relation between mor- ET-1 in human acute coronary NR, coro- At follow-up, all but one pt improved. phologic characteristics of the interatrial nary blood was drawn from patients un- This patient remained in NYHA class 3 septum (thickness, aneurysm, mobility, dergoing percutaneous interventions using but had marked pulmonary hyperten- rim to the aorta) and the distensibility of the distal protection devices PercuSurge sion. All other patients were asymptoma- the defect was studied. Although differen- GuardWire (n = 10), the Exciser Catheter tic or had only mild shortness of breath. ces between stretched and native diame- System Thrombus Removal Device (n = 9) All of the 10 pts who were 65 yrs or older ters tended to be greater in pts with a thin and Angioguard (n = 2). Fine particulate and who were treated because of signifi- and/or aneurysmatic interatrial septum, material that was recovered from each of cant symptoms markedly improved. prediction of defect distensibility in indi- those devices contained 0.13 ± 0.18 fmol vidual pts was impossible. Even for those ET-1 antigen/40ml whole blood (Percu Conclusion: Transcatheter atrial septal pts in whom a high defect distensibility Surge), 0.11 ± 0.12 fmol ET-1 antigen/80ml defect closure can safely and success- was expected from the morphologic ap- whole blood (Exciser), and 0.005 ± 0.02 fully be performed in adults. Sympto- pearance of the interatrial septum, differen- fmol ET-1 antigen/40000 ml (Angioguard). matic improvement can generally be ex- ces between native and stretched diame- pected even in patients of advanced age. ters varied from 2 to 16 mm (10 to 200 %). Conclusions: The data suggest that ET-1 is released into the coronary circulation Conclusion: TEE is crucial for selection from ruptured atherosclerotic plaque and of patients eligible for transcatheter ASD contributes to the no-reflow phenome- closure and for the monitoring of the

J KARDIOL SUPPL E/2001 3 CARDIOLOGY 2001 ABSTRACTS procedure. However, the stretched defect device related complications occurred. (LVEF 15 ± 5 %, RR mean 77 ± 14 mmHg, diameter and thus the size of the device MACE after 30 days was observed in one cardiac index 1.9 + 0.5 L/min/m2, plasma cannot be reliably predicted from the pt in the X-Sizer and in two pts in the big endothelin [ET] 7.4 ± 3.5 fmol/ml) TEE determined native defect diameter control group. Acute lumen gain, cor- were pretreated with 36 ± 30 % of the even if the morphology of the residual rected TIMI Frame Count (cTFC), CK maximum b-blocker dose for 4 ± 3 months interatrial septum is considered. peak and Coronary Flow Reserve (CFR) (group A), 32 pts (LVEF 16 ± 5 %, RR mean were not significantly different between 78 ± 14 mmHg, cardiac index 1.8 ± the two groups. However, ST-segment 0.5 L/min/m2, plasma big ET 7.1 ± scores immediately after, and 6 h post 4.0 fmol/ml) were not (group B). After INTRACORONARY THROMBECTOMY IN ACUTE procedure were significantly lower in the 4.5 + 7.2 months b-blocker dose was CORONARY SYNDROME WITH A NEW X-Sizer group (Table 1). increased to 80 ± 40 % of the maximum PERCUTANEOUS DEVICE: in group A (p = 0.0001), after 4.3 + 5.6 THE VIENNA X-SIZER STUDY Conclusion: The initial results of this months group B received 64 ± 39 % of ongoing first randomised trial demon- the maximum b-blocker dose. During strate safety and efficacy of the X-Sizer this treatment period plasma big ET de- G. Beran1, I. M. Lang1, B. Syeda1, catheter for thrombus-removal in ACS. A creased significantly compared to baseline T. Stefenelli1, S. Denk1, A. Laggner2, significantly faster normalization of ST- (5.9 ± 4.2 fmol/ml in group A, p = 0.01 H. D. Glogar1, P. Siostrzonek1 segment elevation was observed in pts vs baseline; 3.2 ± 2.1 fmol/ml in group 1Department of Cardiology, 2Department treated with X-Sizer. This possibly B, p = 0.0001 vs baseline; p = 0.003 of Emergency Medicine, University of indicates improved myocardial salvage between groups), plasma big ET did not Vienna, Austria by additional use of the X-Sizer system. decrease in group A, but decreased in group B below 4.3 fmol/ml (a cutpoint Background: Thrombus formation follow- repeatedly shown to indicate very poor ing plaque rupture is responsible for acute prognosis). In group A 7 pts (21 %) could vessel occlusion in acute myocardial in- EXPERIENCE WITH PROSTAGLANDIN E1 be weaned from PGE1, 6 pts (18 %) received farction (AMI) and contributes to compro- BRIDGING TO HIGH DOSE BETA-BLOCKER a left ventricular assist device, 16 pts (47 %) mised flow in unstable angina (UA). The THERAPY IN ADVANCED HEART FAILURE were transplanted and 5 pts (15 %) died. X-Sizer catheter is a new device for percu- PATIENTS – DIFFERENT OUTCOME IN In group B 19 pts (59 %) could be weaned taneous coronary thrombectomy. This pro- from PGE1 (p = 0.001 vs group A), 1 pt spective single-center controlled rando- PATIENTS WITH AND WITHOUT CHRONIC (3 %) received a left ventricular assist mised study investigated the effects of LOW DOSE BETA-BLOCKER PRETREATMENT device, 12 pts (38 %) were transplanted the X-Sizer system with regard to epicar- and no pt died (p = 0.02 vs group A). dial flow and microcirculatory function in pts with acute coronary syndrome (ACS). R. Berger, M. Hülsmann, A. Bojic, Conclusion: Despite similar baseline B. Stanek, R. Pacher characteristics pts with chronic low dose Methods: So far 44 patients (34 male; Department of Cardiology, University b-blocker pretreatment before HF worsen- 55.3 ± 9.6 yrs) with ACS (31 AMI, 13 UA) of Vienna, Austria ing have a worse outcome compared to pts in native vessels were randomised to without b-blocker pretreatment before HF treatment with the X-Sizer followed by Background: PGE1 improves clinical worsening when they are treated with PGE1 PTCA and/or stenting (n = 22) or to PTCA symptoms, neurohumoral status and as bridging to high dose b-blocker therapy. and/or stenting alone. Quantitative coro- haemodynamics and reduces the risk of nary angiographic (QCA) and Doppler heart failure (HF) worsening. Thus it is flow measurements, TIMI Frame Count, used to initiate or increase b-blocker ST-segment score (= sum of ST-elevation therapy in patients (pts) with HF worsen- PROGNOSTIC POWER OF NEUROHUMORAL in all 12 standard leads) and CK values ing. We compared the outcome of pts with PARAMETERS IN CHRONIC HEART FAILURE were obtained. Major Adverse Cardiac and without chronic low dose b-blocker DEPENDS ON THE CLINICAL STAGE AND ON Events (MACE) were determined after 30 pretreatment before HF worsening. THE OBSERVATION PERIOD days. Methods and Results: 66 HF pts in NYHA Results: In all pts treated with X-Sizer the class IV refractory to oral medical treat- R. Berger, K. Strecker, M. Hülsmann, B. Frey, lesion could be successfully crossed. No ment received continuous iv PGE1. 34 pts A. Bojic, P. Moser, B. Stanek, R. Pacher Department of Cardiology, University of Table 1: G. Beran et al. Vienna, Ludwig Boltzmann Institute of Experimental Endocrinology and Ludwig Acute cTFC cTFC CFR ST-score ST-score ST-score Boltzmann Institute of Cardiovascular lumen gain pre post post pre (mm)* post 6 h post (mm) Research, Vienna, Austria X-Sizer 2.03 ± 0.9 77 ± 30 19 ± 11 1.54 ± 0.6 10.8 ± 15.6 2.5 ± 3.5** 1.6 ± 2.2** Background: Endothelin (ET) and natri- Control 1.94 ± 0.6 73 ± 37 24 ± 14 11.55 ± 0.7 11.7 ± 7.1 5.5 ± 4.8** 4.0 ± 3.5* uretic peptides have prognostic signifi- cance in chronic heart failure (CHF). As Data are given as mean values ± SD, * in pts with AMI, ** p < 0. 05 (t-test) the stimuli for formation of these neuro-

J KARDIOL SUPPL E/2001 5 CARDIOLOGY 2001 ABSTRACTS hormones are different, we investigated gated the relationship between big ET paired FMD. Big ET is a strong indepen- whether their prognostic power depends plasma levels (by radioimmunoassay) dent predictor of endothelial dysfunction. on the clinical stage and on the length of and FMD (of the brachial artery by high the observation period. resolution ultrasound).

Methods and Results: Plasma levels of Methods: 44 CHF patients (NYHA class I/ INCREASED PREVALENCE OF ELEVATED big ET, BNP, N-terminal BNP (N-BNP) II/III/IV–10/7/22/5 patients; LVEF < 30 %) PLASMA FACTOR VIII IN CHRONIC THROMBO- and N-terminal ANP (N-ANP) in addition and 13 age, sex and risk factor-matched EMBOLIC PULMONARY HYPERTENSION to 11 clinical and haemodynamic varia- controls have been studied. Patients were bles were obtained from 453 patients stratified into group A, big ET below the with LVEF £ 35 %. According to their upper normal range of 1.8 fmol/ml, group B, D. Bonderman, J. Jakowitsch, W. Klepetko, NYHA class and LVEF, patients were strati- big ET between 1.8 and 4.3 fmol/ml (the M. B. Lang, A. Weltermann, P. A. Kyrle, fied into group A – mild CHF (n = 114), latter value being a cutpoint repeatedly I. M. Lang group B – moderate CHF (n = 210) and shown to indicate very poor prognosis) Department of Cardiology, University of group C – severe CHF (n = 128). For pre- and group C, big ET above 4.3 fmol/ml. Vienna, Austria diction of the combined endpoint death or urgent HTX a multivariate analysis was Results: Big ET plasma levels were 3.5 ± Background: Chronic thromboembolic performed after an observation period up 2.2 fmol/ml in CHF patients and 2.1 ± pulmonary hypertension (CTEPH) is the to 1, 2 and 3 years in all patients and in 0.6 fmol/ml in controls (p < 0.05). FMD result of non-resolving pulmonary throm- each subgroup. Best independent predic- was 6.8 ± 5.2 % in CHF patients and boembolism, eventually leading to right tors were as follows: 10.6 ± 5.1 % in controls (p < 0.05). heart failure and death. In accordance All patients: Up to 1 year – big ET (p = Comparing the control group and the CHF with the absence of deep vein thrombosis 0.0001, x2 = 59), 2 and 3 years – N-ANP subgroups (group A – n = 14, LVEF 19 ± (DVT) in over 60 % of CTEPH patients, (p = 0.0001, x2 = 68; p = 0.0001, x2 = 89). 4 %, group B – n = 16, LVEF 20 ± 5 % and a lack of risk factor sharing with DVT, Group A: Up to 2 and 3 years – N-ANP and group C – n = 14, LVEF 19 ± 6 %) there are no known abnormalities of (p < 0.001, x2 = 12; p = 0.0001, x2 = 25). with each other, FMD was similar between coagulation and fibrinolysis that could Group B: Up to 1 and 3 years – N-ANP controls and group A (10.5 ± 3.7 %), but explain the clinically progressive throm- (p = 0.0001, x2 = 16; p = 0.0001, x2 = 22), differed significantly between controls bosis in the pulmonary vasculature of 2 years – N-BNP (p = 0.0001, x2 = 19). and group B (5.8 ± 6.1 %, p < 0.05), bet- these patients. Group C: Up to 1, 2 and 3 years – big ET ween controls and group C (4.2 ± 2.8 %, (p = 0.0001, x2 = 23; p = 0.0001, x2 = 22; p < 0.01), between group A and group B Methods and Results: Because plasma p = 0.0001, x2 = 20). p < 0.05), and between group A and group factor VIII above 150 IU/dl has been C (p < 0.01). The difference between shown to confer a 5-fold increased risk Conclusion: Big ET was the best indepen- groups B and C was not statistically signifi- for DVT, we measured plasma factor VIII dent marker for short-term prognosis and cant. In a multivariate analysis including and levels in CTEPH patients (n = 87) in severe CHF, natriuretic peptides (espe- age, gender, underlying heart disease, and compared them with age and sex cially N-ANP) were better markers for smoking, diabetes, hypercholesterolaemia, matched healthy controls (n = 82). To rule long-term prognosis and in mild and mo- hypertension and big ET, big ET was the out dysfunctional endothelium of pulmo- derate CHF. strongest independent predictor of endo- nary hypertension as a source for elevated thelial dysfunction (R = –0.53, p = 0.0002) plasma factor VIII, the data were also com- with only diabetes mellitus providing ad- pared with matched samples from patients ditional information (R = 0.33, p = 0.002). with non-thromboembolic pulmonary ELEVATION OF SERUM BIG ENDOTHELIN IS arterial hypertension (PAH, n = 68). In ASSOCIATED WITH IMPAIRMENT OF Conclusion: Patients with normal big ET CTEPH patients factor VIII above 150 IU/dl ENDOTHELIUM MEDIATED VASODILATATION plasma levels have a similar FMD com- was more prevalent than in controls IN PATIENTS WITH CHRONIC HEART FAILURE pared to controls, whereas patients with (85.7 % versus 18.2 %, p < 0.0001) and elevated big ET plasma levels have an im- PAH patients (55.5 %, p = 0.002). More-

R. Berger, K. Strecker, B. Stanek, M. Hülsmann, R. Pacher, Th. Neunteufl Table 2: D. Bonderman et al. Haemodynamic parameters and plasma factor Department of Cardiology, University of VIII in 18 CTEPH patients before and after successful PTE Vienna, Ludwig Boltzmann Institute of Parameter Baseline Postoperative P-value Experimental Endocrinology and Ludwig Boltzmann Institute of Cardiovascular mPAP (mmHg) 54 ± 14 32 ± 12 < 0.05 Research, Vienna, Austria CO (L/min) 4.4 ± 1.1 5.5 ± 1.1 < 0.05 PVR (dynes x s x cm–5) 943 ± 435 317 ± 213 < 0.05 Background: We have previously repor- MVS (%) 59 ± 11 67 ± 7 < 0.05 ted that ETA receptor blockade improves Factor VIII (IU/dl) 224.4 ± 97.3 211.1 ± 97.2 0.71 impaired endothelium-dependent flow- mPAP = mean pulmonary arterial pressure, CO = cardiac output, mediated vasodilatation (FMD) in CHF PVR = pulmonary vascular resistance, MVS = mixed venous saturation patients. In the present study we investi-

J KARDIOL SUPPL E/2001 7 CARDIOLOGY 2001 ABSTRACTS over, CTEPH patients had higher levels Conclusions: Subacute stent thrombosis tirofiban showed no significant influence. of factor VIII than controls (232.9 ± is associated with GI conditions where a This effect was paralleled by a decrease 103.2 IU/dl versus 93.0 ± 23.3 IU/dl, reduced surface area for drug absorption in cell counts (30´ conc.: 43 % reduction, p < 0.001) and PAH patients (168.2 ± may lead to decreased plasma levels of p = 0.005), reflecting an inhibition of 81.2 IU/dl, p = 0.009). In addition, plasma ADP inhibitors. Pharmacokinetic studies cell proliferation. von Willebrand factor (vWF), a factor and, subsequently, different dosing regimes VIII-dependent risk factor for DVT, was are required for patients with the short Conclusions: Among the currently significantly increased in CTEPH (267.9 bowel syndrome/erosive gastritis to pre- available GP IIb-IIIa antagonists, only ± 137.5 %) versus PAH (208.1 ± 112.7 %, vent the occurrence of subacute stent eptifibatide showed a dose-dependent p = 0.043). Haemodynamic improvement thrombosis. inhibition of SMC proliferation in our after pulmonary thromboendarterectomy in-vitro assay system. Abciximab and (PTE) did not normalize plasma factor tirofiban exerted no significant effects. As VIII levels (224.4 ± 97.3 IU/dl versus these findings might be due to eptifibati- 211.1 ± 97.2 IU/dl, p = 0.71, n = 18) in INHIBITION OF SMOOTH MUSCLE PRO- de’s broader range of integrin specificity CTEPH patients (Table 2). LIFERATION BY GPIIB-IIIA ANTAGONISTS (a b and various an subunits of integrin), IIb 3 a b a b IN-VITRO: EPTIFIBATIDE MORE EFFECTIVE compared to abciximab ( IIb 3 and n 3) Conclusions: The data support the con- or tirofiban (only a b ), we hypothesize THAN ABCIXIMAB OR TIROFIBAN IIb 3 cept of a thromboembolic origin of CTEPH. that inhibition of SMC proliferation re- quires simultaneous blockade of several J. Fröhlich, J. Wojta, C. Kaun, K. Huber, integrin receptors. The clinical relevance G. Christ of this phenomenon, with reduction of late SUBACUTE STENT THROMBOSIS AND Department of Cardiology, University of restenosis after percutaneous coronary SEVERE GASTROINTESTINAL DISORDERS Vienna, Austria interventions needs to be proven.

D. Bonderman, P. Wexberg, P. Probst, Background: Recent data suggest that H. D. Glogar, I. M. Lang among the platelet glycoprotein (GP) IIb- a b LONG-TERM OUTCOME OF PATIENTS WITH Department of Cardiology, University of IIIa ( IIb 3) integrin antagonists not only Vienna, Austria abciximab (ReoPro®, a chimeric mono- VENTRICULAR SEPTAL DEFECT CONSIDERED clonal antibody), but also eptifibatide NOT TO REQUIRE SURGICAL CLOSURE ® Background: Subacute thrombosis is a (Integrilin , a cyclic heptapeptide) is able DURING CHILDHOOD potentially lethal complication after co- to bind to integrin-receptors of the an ronary stent implantation. Initial attempts subunit family, whereas the affinity of to reduce its occurrence with heparin tirofiban (Aggrastat®, a peptidomimetic) H. M. Gabriel1, M. Heger1, P. Innerhofer1, a b 1 1 and/or warfarin were not satisfactory. To is restricted to IIb 3. We were interested M. Zehetgruber , G. Mundigler , date, a combination antiplatelet therapy whether these differences in integrin M. Wimmer2, G. Maurer1, H. Baumgartner1 with aspirin plus ADP inhibitors (ticlopi- specificity might influence the effect on 1Department of Cardiology and dine, clopidogrel) has emerged as the human smooth muscle cell (SMC) migra- 2Department of Pediatric Cardiology, standard treatment for prevention of sub- tion and/or proliferation in-vitro. University of Vienna, Austria acute stent thrombosis with a remaining incidence between 0.5 % and 0.8 %. Methods: A two-dimensional assay Aim of the Study: The purpose of the system for determination of SMC migra- study was to assess the long-term out- Methods: To examine whether incom- tion/proliferation was used. Sterilized come of patients with small ventricular plete drug absorption due to severe steel supports were inserted into gelatine septal defects (VSD) considered not to gastrointestinal (GI) disorders might ac- coated six well plates. Human umbilical require surgical closure during childhood. count for subacute stent thrombosis we artery SMC were seeded into the middle Although patients with small VSD have retrospectively analysed the medical hole of each support. At confluency, generally been considered not to require histories of all patients with angiographi- inserts were removed and after 24 hours surgery, more recent data suggest that a cally documented subacute stent throm- of serum deprivation, GP IIb-IIIa antago- significant percentage of these patients bosis (> 72 hours after stent implantation) nists were added in culture media with develop serious problems during adult life. at our centre between November 1995 10 % calf serum. After 20 days cell-layers and July 2001. Patients receiving warfarin were stained, digitally quantified (Scion Methods: 229 consecutive pts (115 fe- were excluded from the analysis. Image) and in parallel cells counted. males) with a VSD considered too small to require surgery during childhood as Results: Fourteen patients (0.5 %) had Results: No GP IIb-IIIa antagonist influ- defined by normal pulmonary artery pres- experienced subacute stent thrombosis. enced SMC area significantly at therapeu- sure (PAP), < 50 % shunt, pulmonary vas- Of these patients 3 (21.4 %) had a short tic plasma concentrations (abciximab: cular resistance £ 200 dynes ´ sec ´ cm–5, bowel syndrome after gastrojejunostomy 200 ng/ml; eptifibatide: 2 µg/ml, tirofiban: no VSD related aortic regurgitation, and due to gastric ulcer, and one (7.1 %) 40 ng/ml). At 10´ conc. eptifibatide re- no symptoms who had no additional suffered from diffuse erosive gastritis. duced SMC area significantly by 30 % haemodynamically relevant heart defect Another 4 (28.6 %) patients had discon- (p = 0.01) and at 30´ conc. by 41 % were followed: Physical examination, tinued antiplatelet drug therapy. (p = 0.001), whereas abciximab and ECG, and echocardiography were per-

J KARDIOL SUPPL E/2001 9 CARDIOLOGY 2001 ABSTRACTS

formed in all pts in 1 to 3 year intervals; Material and Methods: We wrote down Case Presentation: A 54 y.o. man was exercise test and Holter monitoring 268 cases of out-of- sudden admitted to the hospital with fever, could be performed in 140 and 127 pts, cardiac deaths, which occurred in the malaise, dyspnoea and non-productive respectively. adult population in the last 11 years. cough. Three months before admission Necrotomy took place in the General the patient underwent a coronary-artery Results: Follow-up could be completed in Hospital of Trikala. Age and place of bypass grafting because of three-vessels 222 pts (97 %). Mean age at last visit was living were unknown in 12 and 14 cases, disease. Postoperatively, an episode of 30 ± 10 years. Spontaneous VSD closure respectively. (Population of the county of symptomatic atrial fibrillation was dia- was observed in 14 pts (6 %). No pt died, Trikala: 139,500, population of the city gnosed and amiodarone was added at a 4 pts (1.8 %) had an episode of endocar- of Trikala: 51,670). The sudden cardiac dose of 200 mg/d (without loading dose) ditis of whom 2 required aortic valve re- death is defined, in accordance to the in- to his basic medication. Four days before placement, one additional pt (0.4 %) had ternational standards, as the natural, admission a fever up to 39.2 °C and surgical closure for haemodynamic rea- unexpected, cardiac death occurring dyspnoea developed. sons. For 118 pts who entered the study within one hour of the onset of acute between 1993–1996 and were prospec- symptoms. Chi2 and t-test were per- He appeared tachypnoeic the breath tively followed for 7.4 ± 1.2 years, event formed for statistical analysis. sounds were accentuated, but no crack- free survival was 99.1 ± 0.8 % at 3 years, les were heard. The heart rate was 100, 96.5 ± 1.7 % at 6 years, 95.5 ± 1.9 % at Results: Sudden cardiac deaths: A: By rhythmic. His blood gases revealed a 8 years. At last visit, 94.6 % of all pts year: 1990: 24, 1991: 31, 1992: 36, 1993: hyperventilation with moderate hypo- studied were free of symptoms. LV size 11, 1994: 26, 1995: 25, 1996: 21, 1997: xaemia. In chest x-ray bilateral inter- by echocardiography was normal in 198 16, 1998: 26, 1999: 26, 2000: 26. B: By stitial infiltration was seen, a high reso- (89 %) patients, borderline in 23 patients gender: 214 male (m) (80 %), mean age lution CT showed ground-glass opacities and definitely enlarged in only one 60.5 years old and 54 female (f) (20 %), in both lungs with reticular abnormali- patient. None had systolic LV dysfunction mean age 67 years old. C: By age: 15– ties, septal thickening. Laboratory studies and PAP was normal in all except one. 24: 1 (1 m, 0 f), 25–34: 9 (8 m, 1 f), 35–44: disclosed a mild leucocytosis, elevated Mean exercise capacity was 92 ± 21 % 18 (17 m, 1 f), 45–54: 47 (43 m, 4 f), 55– sedimentation rate and acute phase reac- of expected and 87 % of pts had no ar- 64: 58 (46 m, 12 f), > 64: 123 (92 m, 31 tion. The thyroid hormones were within rhythmias on Holter monitoring with the f). D: By place of living: city of Trikala: normal range. Pulmonary function tests rest showing benign rhythm disorders. 73, rest county: 157, other places: 24. were abnormal with severe decrease in E: By cause: acute myocardial infarction: total lung capacity and carbon diffusing Conclusions: Outcome in well-selected 242 (90.2 %), acute cardiac failure: 19 capacity. In bronchoalveolar lavage there pts with a small VSD is good. Surgical (7 %), heart failure: 3 (1.2 %), acute car- was an increased number of neutrophils, closure does not appear to be required diogenic pulmonary oedema: 1 (0.4 %), lymphocytes and eosinophils, CD8+ during childhood as long as left-to-right unexplained: 3 (1.2 %). cells were also increased with a low shunt is less than 50 % and signs of left CD4/CD8 ratio. Foamy macrophages ventricular volume overload are absent, Conclusions: 1. The incidence of sudden were shown and the histology revealed when PAP is not elevated, and no VSD cardiac death has a significant prepon- widened septa and mixed infiltrates. The related aortic regurgitation or symptoms derance in males compared with females diagnosis of hypersensitivity pneumonitis are present. and increases according to age. 2. Sud- due to amiodarone was made and the den cardiac deaths occur more often out patient was started on corticosteroids of the city of Trikala. 3. The major cause and oxygen. Amiodarone has been dis- of sudden cardiac deaths is acute myo- continued. His condition stabilized ANALYSIS AND STUDY OF SUDDEN cardial infarction. within 10 days and he was discharged. CARDIAC DEATHS IN CENTRAL GREECE (RETROSPECTIVE STUDY) Discussion: Pulmonary toxicity is the feared side effect of amiodarone. In 20 % PULMONARY TOXICITY OF AMIODARONE – of the patients the pneumonitis developes Th. Galeas, V. Galea, St. Mylonas, CASE REPORT acute, mimicking pneumonia. Differential Ad. Bourdakis, K. Ranellou diagnosis includes any type of interstitial B’Internal Medicine Clinic, General S. Z. Geschev1, E. Wagner2, M. Mandl1, pneumonia. Hospital of Trikala, Greece B. Grasl2, H. A. E. Schinko1 1Department of Pulmonology and Conclusion: The diagnosis of amiodarone Purpose of study: The distribution of 2Department of Radiology, General pneumonitis is one of exclusion. There is sudden cardiac deaths by cause, gender, Hospital, Linz, Austria no threshold dose for developing pulmo- age, year and place of living has been nary complications. In case of our patient studied all over the world. There are only Introduction: Amiodarone is an anti- it was a maintenance dose of 200 mg for a few data analysis studies in Greece, so arrhythmic agent with significant benefit 2 months. far. The purpose of this study is to analyze for ventricular dysrhythmias in patients and study sudden cardiac deaths, which who do not respond to most other anti- occurred in the county of Trikala during arrhythmic drugs. One of its side effects the period from 1990–2000. is pulmonary toxicity.

10 J KARDIOL SUPPL E/2001 CARDIOLOGY 2001 ABSTRACTS

Conclusion: Our results show that ag- wall. The patient is doing well one year ATORVASTATIN OR SIMVASTATIN CONCO- gressive LDL-C reduction by atorvastatin postoperatively. MITANT TO LDL-APHERESIS TREATMENT IN combined with LDL-apheresis is a save PATIENTS WITH HOMOZYGOUS AND HETERO- and efficient choice in lipoprotein Conclusions: The diagnostic procedures ZYGOUS FAMILIAL HYPERCHOLESTEROLAEMIA: therapy in patients with heterozygous for detecting the tumours should be non- and even homozygous FH. invasive (ultrasound, CT, MRI) since in A PROSPECTIVE CROSSOVER STUDY our opinion invasive methods, such as ventriculography, do not give a better A. Goldammer1, G. Heinz2, M. Jansen1, insight into the lesion, but may endanger W. H. Hörl1, K. Derfler1 RIGHT VENTRICULAR METASTATIC the patient with the risk of distal emboli- 1Department of Nephrology and Dialysis, CHORIOCARCINOMA OBSTRUCTING zation of the tumour. Immediate operation 2Department of Cardiology, University of IN- AND OUTFLOW TRACT should be practised for accurate treat- Vienna, Austria ment of these patients.

Background: To enable further reduction V. Gorjup1, B. Gersak1, T. Gulic2, in LDL-cholesterol (LDL-C) in patients N. Suligoj Cernic3 with homozygous (n = 4) and severe 1Medical Center Ljubljana, 2General INTRAAORTIC BALLOON PUMP USE IN MEDICAL heterozygous (n = 10) familial hyper- Hospital Maribor, 3General Hospital INTENSIVE CARE UNIT IN MEDICAL CENTER cholesterolaemia (FH) undergoing LDL- Izola, Slovenia LJUBLJANA. RESULTS OF 10 YEARS OF USE immunoapheresis we altered the con- comitant drug treatment from simvastatin Objective: We wanted to demonstrate to atorvastatin following a prospective that fast diagnosis and immediate treat- V. Gorjup, A. Jazbec, M. Horvat designed crossover study protocol. ment of intracavitary myocardial neo- Medical Intensive Care Unit, Medical plasms as soon as they present them- Center Ljubljana, Slovenia Methods: While LDL-apheresis was selves with symptoms, is essential for performed at weekly intervals, lipoprotein accurate treatment of these patients. Aim of the study: Aim of our study was values were compared under 40 mg of to examine the use of an intraaortic simvastatin followed by a wash-out Methods: Surgical procedure was per- balloon pump (IABP) in our ICU. We period of 4 weeks and when patients formed on a 34 year old man in whom were interested in indications, com- received atorvastatin therapy, starting ECHO heart examination was revealing plications and patients outcome. with a 10 mg dose and escalating every a metastatic tumour in the enlarged right 4 weeks up to 80 mg. ventricle (RV) obstructing the RV in- Patients: From January 1, 1990 through and outflow tract and extending from December 31, 2000 we inserted IABP to Results: Comparable levels of LDL-C the tricuspid valve to the pulmonary 187 of our patients. We managed to re- were obtained when 10 mg of atorva- valve, filling the entire ventricle and trieve 164 of their medical records. The statin (206 ± 63 mg/dl) were adminis- outflow tract. The tumour was removed average age of our patients was 64.1 tered as during treatment with 40 mg on arrested heart, the method enabling years (21–83 years), 106 were males. of simvastatin (212 ± 38 mg/dl). When preservation of the tricuspid valve and 4 weeks on 80 mg of atorvastatin a fur- it’s supporting structures. The mass could Results: From 1990 through 1996 there ther 26 % reduction in LDL-C values not be removed from the RV free wall, were 10 patients with IABP support per (157 ± 34 mg/dl) was obtained, and ki- since the tumour invaded it completely year on average. With the introduction of netic analysis demonstrated that LDL-C and an attempt at removal would result percutaneous coronary interventions in levels increased from a post-treatment in complete absence of contractile force acute coronary syndromes in 1997 the value of 28.8 ± 14.2 mg/dl in a first or- of the RV. An additional chemotherapy number of patients with IABP support der kinetic to 156.6 ± 25.5 mg/dl at day was carried out with four cycles gradually rose up to 55 in 2000. Most of 7. When these kinetic results were com- according to the BEPO scheme. the patients required IABP support due to pared to those without concomitant cardiogenic shock in the setting of acute lipid lowering drug treatment patients Results: The results of histologic investi- myocardial infarction (AMI). Other indi- presented LDL-C values below the rec- gation of removed tissue revealed a meta- cations were: unstable angina pectoris, ommended target range for an extended stasis of choriocarcinoma with compo- mechanical complications and rhythm duration of almost 48 hours (until 72 nents of immature teratoma, originating disturbances during AMI, PTCA compli- hours after LDL-apheresis). The levels of from right testis. cations and myocarditis. The average time HDL-cholesterol and plasma fibrinogen of IABP support was 4.1 days (few hours remained comparable during the entire Control CT of the thorax was performed to 15 days). Complications were rare (total study period. The change in lipid lower- after six months, detecting no metastases 8 %; 7 % vascular, 1 % infectious). Out- ing drugs resulted in a 40 % reduction in the lung parenchyma. MRI of the heart, come was as follows: successful weaning in LDL-apheresis treatments despite im- however, still showed a thickened RV free and discharge from ICU – 45 patients, sur- proved LDL-C levels prior to and follow- wall and apex, mass vascularity equalled gery – 66 patients, death – 58 patients. ing LDL-apheresis treatment. that of the myocardium – compared to postoperative heart US recordings, there Conclusions: Use of IABP in our unit is was no regression of the mass in the RV increasing especially since introducing

J KARDIOL SUPPL E/2001 11 CARDIOLOGY 2001 ABSTRACTS

percutaneous intervention techniques in (p = 0.009) in the Eprosartan-group and acute coronary syndromes. The increase is from 2.24 ± 0.48 to 2.80 ± 0.75 l/min CHANGES IN MYOCARDIAL ELECTRICAL AND also related to widening of indications for (p = 0.0013) in the Telmisartan-group MECHANICAL FUNCTION ASSESSED BY IABP support (bridging to surgery). Compli- while there was no increase of cardiac ENDOCARDIAL MAPPING AFTER PER- cations and outcome are comparable with output in the control group. CUTANEOUS TRANSLUMINAL CORONARY results achieved in other centers. Conclusions: The additional treatment of ANGIOPLASTY severe heart failure patients who received digitalis, diuretics, and ACE-inhibitors M. Gyöngyösi, A. Khorsand, S. Graf, IMPROVEMENT OF CARDIAC OUTPUT IN with the AT 1-receptor antagonist Eprosar- H. Sochor, W. Sperker, H. D. Glogar SEVERE CHRONIC HEART FAILURE BY tan or Telmisartan shows a beneficial Division of Cardiology, University of COMBINING ACE-INHIBITORS AND EITHER effect by increasing cardiac output. This Vienna, Austria EPROSARTAN OR TELMISARTAN effect may be due to the sartans additio- nal property of blocking the autocrine Background: Nonfluoroscopic electroana- interaction of locally and not ACE-gene- tomical mapping displays simultaneously B. Gremmler, M. Kunert, H. Schleiting, rated angiotensin II with their respective the myocardial viability and the regional L. J. Ulbricht vascular and myocardial AT 1-receptors mechanical function of the heart, which Department of Cardiology, as well as the influence on prejunctional might be improved after angioplasty of Marienhospital Bottrop, University of AT 1-receptors located on sympathetic the narrowed coronary artery. Witten/Herdecke, Germany nerve terminals. Purpose: We compared the pre-percuta- Background: The importance of ACE- neous transluminal coronary angioplasty inhibitors in the therapy of chronic heart (PTCA) and follow-up (FUP) endocardial failure is established. Angiotensin II DIFFERENT ORIGIN OF ELEVATED HEPATO- voltage and local linear shortening (LLS) receptor type 1 antagonists act according CYTE- AND VASCULAR ENDOTHELIAL values in order to investigate the ability to a different pharmacological mecha- GROWTH FACTOR SERUM LEVELS IN of NOGA endocardial mapping for nism by additionally blocking the locally PATIENTS AFTER MYOCARDIAL INFARCTION. detection of hibernating myocardium. and not ACE-generated angiotensin II in the vessel wall and the myocardium. ROLE OF LEUKOCYTE ACTIVATION Methods: The left ventricular unipolar Furthermore, the AT-1-receptor antago- voltage and LLS values were analysed in nists block the prejunctional AT-1-recep- A. Gutersohn1, A. H. Elmaagacli2, the first 10 patients (8 male, 61 ± 12 yrs, tors and reduce the sympathetic outflow. J. Buchholz3, O. Oldenburg1, J. Schaar1, all with stable angina pectoris, three-vessel We examined the hypothesis that an ad- D. Baumgart1, Th. Budde3, U. W. Schäfer2, disease and previous myocardial infarction) ditional effect on cardioprotection can be R. Erbel1 before and 6 months after PTCA. The achieved by the combination of common 1Department of Cardiology, 2Department NOGA segmental quantitative analysis ACE- and bradykininase-inhibitor action of Bone Marrow Transplantation, was performed after transformation of the and the specific effects of sartans. University of Essen, 3Department of 3-dimensional endocardial map into po- Cardiology, Alfried Krupp Hospital, lar map, containing 12 segments (anterior, Methods: 51 patients (mean age 68.8 ± Essen, Germany lateral, posterior and septum, each of them 7.8 years) with severe chronic heart with apical, mid and basal subsegments). failure receiving long-term medication Abstract withdrawn. 201-Thallium rest and late-rest images were with digitalis, diuretics, and ACE-inhibi- performed in all patients, and the quanti- tors were randomised after clinical recom- tative 201-Thallium uptake data were pensation in a blind fashion to either analysed by polar map analysis by division Eprosartan (n = 17; 508.8 ± 118.0 mg/d) ASSOCIATION OF CORONARY CALCIUM into 12 comparable myocardial segments. or placebo (n = 17). Additionally a WITH THE GNB3 POLYMORPHISM IN prospective study by using Telmisartan EARLY CORONARY ARTERY DISEASE Results: On the basis of the PTCA (n = 17; 66.1 ± 15.4 mg) was performed. localization, the myocardium was Haemodynamic measurements were divided into “treated” and “untreated” made by impedance-cardiography at A. Gutersohn1, A. Schmermund1, W. Siffert2 regions. In the treated myocardial areas, baseline and after 9.9 ± 2.3 days. 1Department of Cardiology, 2Department the unipolar voltage values (from 7.71 ± of Pharmacology University of Essen, 3.37 to 9.74 ± 4.50 mV, p < 0.05; nor- Results: Additional treatment with sartans Germany mal value > 15 mV) and the LLS values resulted in an improvement of cardiac out- (from 6.81 ± 5.70 % to 9.24 ± 6.12 %, put. There was an increase in cardiac out- Abstract withdrawn. p < 0.05, normal value > 11 %) increased put from 2.38 ± 0.58 to 3.19 ± 1.0 l/min significantly. In contrast, in the untreated

12 J KARDIOL SUPPL E/2001 Figure 1: I. Hausleitner et al.

CARDIOLOGY 2001 ABSTRACTS region, neither the unipolar voltage nor episodes of persi- the LLS values changed. A trend to stent AF. Response increase in 201-Thallium resting uptake to electrical therapy (64.2 ± 14.8 % vs 69.3 ± 15.6 %, n.s.) was assessed. and a significant improvement in 201- Thallium late resting uptake (index of Results: SR was myocardial viability) (55.4 ± 17.3 % vs restored by DCCV 68.3 ± 16.9 %, p < 0.05) could be in 185 episodes of detected in the treated myocardial Results: Five of 6 pigs receiving RG- persistent AF (92 %). In 34 out of the segments. The 201-Thallium uptake did 13577-coated Genius stents died within 202 episodes preceding pharmacologic not change in the non-treated areas. 1 hour after stent implantation due to therapy had failed. Non-responders to ventricular fibrillation. In 2 pigs, acute electrical therapy had more often en- Conclusion: Myocardial regions with par- stent occlusion was documented angio- larged left atria. Choice of the initial allel decreased endocardial voltage and graphically in-vivo, while post mortem energy level was free. 200 Joule were LLS values of NOGA endocardial mapping angiography proved acute stent thrombo- applied for first shock in 165 cases and might present hibernating myocardium, as sis in the hearts of 2 other pigs. In one succeeded in 75 % (124 episodes). a significant improvement of both the pig, no visual documentation of stent Overall for successful termination a voltage and LLS values have been detected occlusion was done. Coronary angiogra- median of 1.4 shocks was necessary. No after restoration of myocardial blood flow. phy revealed also acute stent thrombosis serious adverse events occurred during in the 6th (survived) pig with RG-13577- observation period prior to hospital coated Genius stent, which experienced discharge (Figure 1). a small myocardial infarction. In the ACUTE STENT THROMBOSIS AFTER INTRA- other group (bare stent group), no acute Conclusion: External electrical cardio- CORONARY IMPLANTATION OF RG-13577 or subacute complication occurred and version is safe and effective for termi- COATED STENTS IN PIGS all pigs survived the 4-week follow-up. nation of persistent AF. As initial shock Volume measurements by 3D-recon- energy we recommend 200 J. struction of IVUS (EchoPlaque, Indec M. Gyöngyösi1, W. Sperker1, Systems, CA) revealed an intimal volume U. Windberger2, H. D. Glogar1 of 20.31 ± 5.76 mm3 within the stents. 1Department of Cardiology, 2Center for IVUS showed a minimum lumen area PREDICTION OF OUTCOME BY NEURO- Biomedical Research, University of of 3.48 ± 0.68 mm2, a maximum vessel HUMORAL ACTIVATION, SIX MINUTE WALK Vienna, Austria area of 8.50 ± 0.79 mm2 and a maximal TEST AND THE MINNESOTA LIVING WITH 2 intimal area of 1.91 ± 0.53 mm . HEART FAILURE QUESTIONNAIRE IN AN Background: RG-13577 is a non-toxic synthetic heparin-mimicking polyanionic Conclusion: Even though RG-13577 has OUTPATIENT COHORT WITH CONGESTIVE compound (polymer of 4-hydroxyphonoxy heparin-like capabilities, intracoronary HEART FAILURE acetic acid) which has been shown to implantation of RG-13577 coated stents inhibit in-vitro vascular smooth muscle leads to acute in-stent thromboses in cell proliferation induced by basic pigs. Bare Genius stent implantation M. Hülsmann1, R. Berger1, B. Sturm1, fibroblast growth factor and to block cell shows favourable results. A. Bojic2, B. Frey1, J. Bergler-Klein1, division in the G1/S-phase transition. The W. Woloszczuk3, R. Pacher1 aim of the present study was to reduce 1Department of Cardiology, 2Ludwig neointimal hyperplasia using RG-13577- Boltzmann Institute of Cardiovascular coated stents after intracoronary stent EXTERNAL ELECTRICAL CARDIOVERSION OF Research, and 3Ludwig Boltzmann implantation in pigs. PERSISTENT ATRIAL FIBRILLATION (AF) Institute of Experimental Endocrinology, University of Vienna, Austria Methods: In general anaesthesia, the left I. Hausleithner, H. Domanovits, coronary artery was cannulated in 14 do- M. Schillinger, F. Schadauer, G. Gamper, Introduction: Neurohumoral activation is mestic pigs. After administration of 200 M. Röggla, A. N. Laggner a well-known phenomenon in congestive IU/kg heparin, 8 pigs received bare (non- Department of Emergency Medicine, heart failure. Due to the central mecha- coated native) Genius stents (EuroCor Vienna General Hospital, Austria nism it is a value tool as a prognostic GmbH, Bonn, Germany) either in the marker. Nevertheless no data exist left anterior or left circumflex coronary Background: Restoration of sinus comparing the most powerful markers as arteries. After 4 weeks follow-up (250 mg rhythm (SR) is the primary goal in N-ANP, BNP, N-BNP and big-endothelin 1 acetylic salicylic acid administered daily patients with persistent AF. Direct- in one model in a widespread popula- per os to prevent stent thrombosis), repeat current electrical cardioversion (DCCV) tion of heart failure patients. The six- angiography and intravascular ultrasound can be performed primary or after minute walk test is very controversial (IVUS) using automatic pullback were pharmacological failure. discussed in respect to its predictive power performed. Six RG-13577-coated Genius and the Minnesota living with heart failure stents were implanted in 6 more pigs in Methods: Within 6 years DCCV was questionnaire has never been evaluated, one left coronary artery branch. applied to 162 patients with 202 whether it is related to outcome.

J KARDIOL SUPPL E/2001 13 CARDIOLOGY 2001 ABSTRACTS

Aim of the study: To compare these para- well as vasodilatatory effects and antago- meters in respect to short-term outcome nize the renin-angiotensin-aldosterone PLASMA LEVELS OF CARDIAC TROPONIN T, in an ambulatory heart failure population. system. The N-terminal brain natriuretic TROPONIN I, CREATINKINASE MB FRACTION, peptide (Nt-proBNP) shares the same car- C-REACTIVE PROTEIN AND FIBRINOGEN Patients and methods: Ninety-six patients dioprotective properties. ProANP(1–98) CORRELATE WITH TIMI RISK SCORE AND (57 ± 8 years, 82 % male, left ventricular and Nt-proBNP were found to be elevated ejection fraction of 26 ± 10 %) who after acute myocardial infarction. It is also LONG-TERM FOLLOW-UP IN PATIENTS WITH were treated as out-patients in the heart known that ischaemia and hypoxia may ANGINA PECTORIS failure unit were included. Within one enhance the secretion of the proANP (1– day blood samples of N-ANP, N-BNP, 98) hormone by atrial cells. Up to date BNP and big-endothelin 1 were obtained no data are available about the plasma N. Jordanova, M. Gyöngyösi, M. Ploner, as well as six-minute walk test and Min- levels of the different N-terminal ANPs in A. Anvari, Ch. Falkensamer, G. Zorn, nesota living with heart failure question- patients with stable and unstable angina. K. Huber naire were measured. The predictive Department of Cardiology, University power of these variables in respect to Methods: Plasma levels of proANP (1–30), of Vienna, Austria one-year event free survival was calcula- proANP (31–67), proANP (1–98) and ted by a Cox regression analysis. Nt-proBNP hormones were determined Background: The aim of the present in 115 patients with different clinical prospective study on 155 consecutive Results: All variables investigated had the stages of coronary artery disease, ac- patients (110 male, 63 ± 11 y) with typical power to predict outcome in an univariate cording to the Canadian Cardiac Society chest pain was to measure fibrinogen, analysis. Multivariate analysis revealed classification (I–IV). C-reactive protein (CRP) and cardiac tro- that only N-ANP (x2 = 66, p < 0.0001) ponin T (cTnT) at basal conditions, as well beside Minnesota living with heart failure Results: ProANP (1–30) and proANP as troponin I (cTnI), myoglobin, and questionnaire (x2 = 11, p < 0.001) and (31–67) levels were found to be higher in creatine phosphokinase myocardial BNP (x2 = 7, p < 0.01) are independent patients with stable angina (CCS I, II) and fraction (CKMB) at baseline and after 6 predictors. Kaplan-Meier analysis revealed effort angina (CCS III) compared to patients hours in order to prove the accuracy of a significant difference in outcome after with angina at rest (CCS IV, p = 0.014, these parameters as markers of different three months and one year at a cutpoint p = 0.02 and p = 0.003, respectively). risk in accordance with the TIMI risk of 5000 fmol/ml (p < 0.0001). The levels of proANP (1–98) hormone score for subsequent major adverse were higher in the CCS III and IV groups cardiac events (MACE). Conclusions: We conclude that in an compared to chronic stable patients open clinical cohort of patients with big (CCS I–II, p = 0.006). In contrast, Nt- Methods: The TIMI risk score was calcu- differences in the progression of the proBNP levels were significantly lower in lated and the patients were classified into disease. N-ANP is the most reliable pre- CCS III–IV than in CCS I–II (p = 0.003). high (score 6–7, n = 27 patients, 17.4 %), dictor of worsening heart failure in short- Patients, with “b” and “c” angiographic medium (score 4–5, n = 64 patients, term. Beside BNP, especially LHFQ is an lesion type in the culprit lesion have 41.3 %) and low (score 0–3, 64 patients, excellent substitute in case of lacking of significantly higher levels of both 41.3 %) risk groups. specialized laboratories. proANP(1–98) and Nt-proBNP. This ten- dency was also found with mid-proBNP, Results: High risk patients experienced but it did not reach statistical significance. significantly more frequently acute myo- cardial infarction (22.2 vs 6.3 and 3.1 %, CIRCULATING LEVELS OF N-TERMINAL ATRIAL Conclusions: Acute ischaemia seems to p < 0.05), revascularization (37 vs 10.9 NATRIURETIC PEPTIDES AND N-TERMINAL have inhibiting effects on the cleavage of and 10.9 %, p < 0.005), death (29.6 vs BRAIN NATRIURETIC PEPTIDE IN ACUTE AND the proANP (1–98) hormone leading to 10.9 and 1.6 %, p < 0.05) and composite CHRONIC CORONARY HEART DISEASE decreased levels of the potentially cardio- MACE (63 vs 20.3 and 14.1 %, p < 0.001) protective proANP (1–30) and (31–67). than medium and low risk patients. In contrast to other studies, our results Significantly elevated plasma levels were Rudolf Jarai1, M. Gyöngyösi1, suggest, that in patients with effort angina found for TnI, CRP, CKMB, cTnT and N. Jordanova1, Robert Jarai1, and angina at rest, the Nt-proBNP and fibrinogen in patients of the high risk group M. Gottsauner-Wolf1, J. Wojta1, mid-proBNP levels are lower than in as compared to patients with medium or W. Woloszczuk2, G. Geyer2, K. Huber1 chronic stable patients. low risk (Table 3). Plasma levels of myo- 1Department of Cardiology, 2Ludwig- globin did not identify the patients with Boltzmann Institute of Experimental The quality of the lesion type in the medium or high risk. Endocrinology, University of Vienna, coronary vessel seems to affect the Austria plasma levels of proANP (1–98) and Nt- Receiver operator characteristic (ROC) proBNP hormones. analyses revealed the following cut-off Objectives: The peptides derived from points for high risk groups: for cTnI at base- the atrial natriuretic peptide (ANP) line 0.3 U/l (predictive accuracy [p.a.] = prohormone, proANP (1–30), proANP 0.837), for cTnI after 6 h 0.64 U/l (p.a. = (31–67) and the N-terminal proANP (1–98) 0.908); for CRP at baseline 0.34 mg/dl hormone have natriuretic, diuretic as (p.a. = 0.734), for CRP after 6 h 0.732 mg/dl

14 J KARDIOL SUPPL E/2001 Table 3: N. Jordanova et al. High risk Medium risk Low risk p-value n = 27 n = 64 n = 64 CARDIOLOGY 2001 cTnI baseline [U/l] 5.57 ± 8.27 0.32 ± 0.61 0.16 ± 0.31 < 0.001 ABSTRACTS cTnI 6 h [U/l] 8.34 ± 9.32 0.78 ± 1.72 0.29 ± 0.63 < 0.001 CRP baseline [mg/dl] 1.45 ± 1.91 0.49 ± 1.00 0.81 ± 1.59 0.019 platelet load (CD42+) and adherent platelet activation were determined by CRP 6 h [mg/dl] 1.95 ± 2.09 0.83 ± 1.34 0.62 ± 0.94 < 0.001 flow cytometry and chromogenic assay Myoglobin baseline [U/l] 46.7 ± 46.9 28.9 ± 26.2 34.6 ± 33.6 0.055 from 57 coronary artery disease patients Myoglobin 6 h [U/l] 50.1 ± 42.5 40 ± 55.2 32.5 ± 27 0.127 with stable (SA, n = 42) and unstable CKMB baseline [U/l] 14.9 ± 20.7 2.9 ± 4.9 2.6 ± 2.6 < 0.001 angina (UA, n = 15). Monocyte TF levels and PCA were significantly higher in UA CKMB 6 h [U/l] 9.8 ± 11.5 3.7 ± 5.4 4.5 ± 8.5 0.004 (16.4 ± 3.3 MFI, 68.5 ± 38.2 units) com- CTnT baseline [U/l] 0.57 ± 1.1 0.03 ± 0.16 0.02 ± 0.09 < 0.001 pared with SA (14.1 ± 3.1 MFI, p = 0.03; Fibrinogen [mg/ml] 385 ± 84 324 ± 63 322 ± 67 < 0.001 47.9 ± 18.1 units; p = 0.04). Both platelet load (r = 0.69, p < 0.0001) and platelet activation (r = 0.47; p = 0.002) as deter- (p.a. = 0.784), for CKMB at baseline the leaflets could just poorly be seen. In mined by CD42 and CD62P expression 2.25 U/l (p.a. = 0.761), for CKMB after contrast to all other prostheses only a on CD14+ monocytes positively correlated 6 h 2.9 (p.a. = 0.742) and for fibrinogen very minimal closing volume was found. with monocyte-TF expression. TF messen- at baseline 367 mg/ml (p.a. = 0.737). Closing volumes were more often detec- ger RNA was expressed in 26 % of SA ted in aortic positioned valves as in and in 37.5 % of UA. Conclusion: In our patients with typical mitral positioned valves. The size of this chest pain, the cut-off levels for determi- closing volume did not correlate with Conclusions: We show elevated monocyte- nation of a high-risk group according to valve size (Table 4). TF expression and TF-dependent PCA in the TIMI risk score differ from those used UA compared with SA patients. Monocyte- in general and are either lower (CRP and Conclusion: This new valve has superior TF activity correlating with platelet load CKMB at baseline and CKMB after 6 h) or haemodynamics and demonstrates and platelet activation may be triggered higher (cTnI at baseline and after 6 h and significant improvement in regard to by platelet leucocyte cross-talk in-vivo. CRP after 6 h) for the respective para- closing volumes. Due to design features meters. the leaflets can be seen poorly on echo. RELATIONSHIP BETWEEN BLOOD PRESSURE, LIPIDS AND THERAPY IN PATIENTS IN THE ON-X® HEART VALVE: PLATELET-MONOCYTE CROSS-TALK AND SECONDARY PREVENTION OF IHD ECHOCARDIOGRAPHIC CHARACTERISTICS TISSUE FACTOR EXPRESSION IN STABLE AND UNSTABLE ANGINA M. T. Kasimir, J. Bialy, G. Seebacher, J. Lietava1, V. Kosmálová1, R. Šidlo2 N. Simon-Kupilik, R. Moidl, P. Simon 12nd Department of Internal Medicine, Department of Cardiothoracic Surgery, C. W. Kopp, S. Steiner, D. Seidinger, Comenius University and 2Department of University of Vienna, Austria N. Jordanova, M. Koreny, E. Minar, K. Huber Statistics, Economic University1, 2nd Department of Medicine, University Bratislava, Slovakia Background: The On-X® is a new mecha- of Vienna, Austria nical heart valve with a special valve de- Background: Hypertension is often sign. An On-X® has a flared orifice inlet, Background: Tissue factor (TF) is the associated with hyperlipidaemia an elongated orifice and thin leaflets that major procoagulant in-vivo and usually increasing the global atherosclerotic risk in are positioned parallel when the valve is absent from blood cells. However, a multiplicative way. The effect of the open. The position of the valve is supra- monocyte tissue factor (TF) expression therapy in secondary prevention has not annulary. and platelet activation are both features been studied at Slovakia. This study of unstable angina. evaluates occurrence of hypertension Patients and Methods: 154 On-X® prothe- and effect of the hypotensive therapy in ses were implanted, 73 aortic and 81 mitral Methods and Results: Monocyte-TF and relationship to lipid profile in high risk valves. Mean age was 61.3 ± 10.3 a procoagulant activity (PCA), monocyte patients with symptomatic IHD. (range 30–79) for implantation in mitral and 59.2 ± 10.1 a (range 25–79) for aortic position. Echocardiograms were Table 4: M. T. Kasimir et al. Data of last timepoint of examination performed including complete Doppler examination at discharge, 3 to 6 months On-X® aortic valve On-X® mitral valve after implantation and after one year. Diameter n Mean gradient Velocity Diameter n MVA Appearance of the valve in echo- cardiography was observed. 19 mm 5 19.85 mmHg 2.4 m/s 23 mm 1 21 mm 22 11.5 mmHg 2.1 m/s 25 mm 24 2.9 cm² Results: The On-X® showed a better 23 mm 22 11.1 mmHg 2.08 m/s 27 mm 41 2.6 cm² haemodynamic as compared to Carbo- 25 mm 17 9.8 mmHg 1.95 m/s 29 mm 2 medics® and Carbomedics SAV® heart valves. In both positions movements of 27 mm 7 9.8 mmHg 2.0 m/s 31 mm 17 2.8 cm²

J KARDIOL SUPPL E/2001 15 CARDIOLOGY 2001 ABSTRACTS

Table 5: J. Lietava et al. POLYMORPHIC MEMBRANE PROTEINS Mono Two Three ³ Four Together (PMPS) OF CHLAMYDIA PNEUMONIAE drugs drugs drugs INDUCE THE CHEMOKINES INTERLEUKIN-8 [%] [%] [%] [%] [%] (IL-8) AND MACROPHAGE CHEMOTACTIC SBP > 139 mmHg 66.5 73.2 79.4 90.9 64.2 PROTEIN-1 (MCP-1) AND THE PRO- DBP > 89 mmHg 44.9 53.4 54.4 63.6 35.8 INFLAMMATORY CYTOKINE INTERLEUKIN-6 SBP + DBP normal 29.5 23.8 15.7 9.1 26.6 (IL-6) IN HUMAN UMBILICAL VEIN 1556 895 159 12 2622 ENDOTHELIAL CELLS (HUVECS) IN-VITRO

Patients and method: In a cross-sectional heart valves. They are caused by localized A. Niessner1, C. Kaun1, G. Zorn1, multicentre trial 5062 patients with sympto- gradients and pressure recovery. The oc- G. Christiansen2, A. S. Pedersen2, matic IHD were examined and hyper- currence of this phenomenon appears to S. Simon3, A. Georgopoulos3, lipidaemia (total cholesterol > 5.2 mmol/l) be independent of the particular design W. Graninger3, G. Maurer1, K. Huber1, screened for statin therapy (2237 M/2825 F). of bileaflet valves. Tilting disc valves have J. Wojta1 Both sexes were in middle age (56.6 ± been insufficiently studied so far. While 1Department of Internal Medicine II, 10.37 vs 60.1 ± 9.51 yrs; p < 0.001), good agreement between Doppler and University of Vienna, Austria, 2Depart- mildly obese (BMI 28.3 ± 3.96 vs 28.3 ± catheter gradients was found for Medtronic ment of Medical Microbiology, 4.30 kg/m2; NS) with mild hypertension Hall valves, discrepancies have been re- University Aarhus, Denmark, 3Depart- (SBP 139.7 ± 18.28 vs 144.6 ± 18.47 mmHg; ported for Björk-Shiley valves. ment of Internal Medicine I, University p < 0.001) (DBP 85.5 ± 9.30 vs 86.1 ± of Vienna, Austria 9.36 mmHg; p < 0.001). Males suffered Methods: In a well-controlled pulsatile more MIs (36.0 % vs 10.5 %; p < 0.001) flow model we studied various sizes of Background: IL-6, IL-8 and MCP-1 are and were more often smokers (16.4 % vs Sorin tilting disc prostheses (19 to 25 mm) present in atherosclerotic lesions of the 4.9 %; 0.001). Diabetes mellitus was using continuous-wave and pulsed-wave vessel wall. Based on clinical studies a similarly distributed in both sexes (26.7 % Doppler as well as direct measurements role for C. pneumoniae in the develop- vs 26.9 %; NS). of pressure and flow rate. At each of 8 ment of atherosclerosis is currently dis- different flow rates (cardiac output 2.0 to cussed. Recent in-vitro studies have Results: Out of 5062 patients with 8.0 l/min) peak and mean Doppler and shown that C. pneumoniae can activate symptomatic IHD 2622 (51.8 %) were catheter gradients were simultaneously cultured endothelial cells thereby inducing treated hypertensives. Table 5 compiles measured. Valve areas were calculated among other effects also IL-6, IL-8 and percentages of hypertensives with using the continuity equation and the MCP-1 expression in these cells. controlled blood pressure during mono- Gorlin formula. and combined therapy. Aim: It was the aim of the present study Results: Excellent correlation and agree- to investigate whether purified isolated Conclusion: Patients with symptomatic ment between Doppler and catheter gra- components of C. pneumoniae, namely IHD and hyperlipidaemia exhibit 51.8 % dients were found (r = .95–.99 for peak polymorphic membrane proteins (PMPs) occurrence of treated hypertension, gradients and r = .98–.99 for mean gradi- could affect production of IL-6, IL-8 and which is controlled in 26.6 % of them. ents). For small valve sizes (19 and 21 mm) MCP-1 in human endothelial cells in-vitro. Paradoxically, with increasing complexity the mean difference between Doppler and of the therapy decreases its effectiveness, catheter gradients was 4.2 ± 3.3 mmHg Methods: HUVECs were incubated with probably conditioned by increased for peak and 0.5 ± 1.25 mmHg for mean purified PMPs. In order to exclude pos- severity of hypertension. gradients, respectively. Orifice areas as sible LPS-mediated effects aliquots of the calculated by the Doppler continuity respective PMPs were boiled for 5 equation did not show flow dependent minutes prior to addition to HUVECs. changes. In contrast, orifice areas calcu- Plasminogen activator inhibitor-1 (PAI-1), DOPPLER GRADIENTS ACROSS SORIN lated by the Gorlin formula increased IL-6, IL-8 and MCP-1 were quantified by TILTING DISC VALVES ACCURATELY REFLECT slightly by 10 to 15 % in small valves. specific ELISAs. CATHETER GRADIENTS IN-VITRO Conclusion: Peak and mean Doppler Results: gradients across Sorin tilting disc valves 1. Out of 15 PMPs tested PMP 20 and J. Mascherbauer, H. Schima, G. Maurer, accurately reflect the pressure drop as PMP 21 were the strongest inducers of H. Baumgartner. determined by catheter measurements. IL-6, IL-8 and MCP-1 production in Department of Cardiology, University of Prosthetic valve areas calculated with HUVECs. The effects were dose and time Vienna, Austria the Gorlin formula increase with increas- dependent. ing flow in small valve sizes whereas no Background: Significant discrepancies flow dependent changes were observed 2. The effect of PMP 20 and PMP 21 on between Doppler and catheter gradients in continuity equation valve areas. IL-6, IL-8 and MCP-1 was abolished by have been reported for bileaflet prosthetic heat-treatment.

16 J KARDIOL SUPPL E/2001 CARDIOLOGY 2001 ABSTRACTS

3. None of the PMPs tested had an effect heart murmur. The characterization was Conclusions: In patients with structural on PAI-1 production in HUVECs. made by auscultation, but localization heart disease, unexplained syncope and and proof was made by echocardio- no documented sustained ventricular ar- Conclusions: We conclude from our data graphy of existing intraaortic structures. rhythmias PVS reliably identifies patients that specific PMPs of C. pneumoniae in- at high risk for life-threatening tachyar- duce the expression of pro-inflammatory Conclusions: We suggest that if intra- rhythmias. Patients with severely de- cytokines in HUVECs in-vitro. If such a ventricular echo is normal, and the pressed left ventricular function and bad mechanism is also operative in-vivo, C. murmur is not consistent with a Still’s clinical condition appear to benefit most. pneumoniae could by specific interactions murmur or aortic/pulmonic ejection In this patient population primary ICD im- of its PMPs with the endothelium con- murmur, that echo exam should include plantation appears the treatment of choice. tribute to the process of vascular injury a thorough evaluation for seldom ten- during the development of an athero- dinous structures in the aortic arch. More sclerotic lesion. invasive diagnostic testing does not appear to be indicated, if the diagnosis is MILD AND MODERATE AORTIC STENOSIS: made by an experienced cardiologist. A SERIOUS DISEASE?

SELDOM FIBROTIC BAND IN THE AORTIC R. Rosenhek, T. Binder, M. Heger, ARCH AS A CAUSE OF AN INNOCENT C. Scholten, M. Zehetgruber, G. Maurer, ELECTROPHYSIOLOGICALLY GUIDED RISK MURMUR H. Baumgartner STRATIFICATION AND ICD THERAPY IN Department of Cardiology, University PATIENTS WITH UNEXPLAINED SYNCOPE, of Vienna 1 2 2 J. Nothroff , G. S. Suemenicht , A. Wessel NO DOCUMENTED VENTRICULAR ARRHYTH- 1Department of Thoracic and Background: Rapid progression from Cardiovascular Surgery, 2Department of MIAS AND STRUCTURAL HEART DISEASE mild and moderate aortic stenosis to Paediatric Cardiology, University severe disease has been observed. How- Children’s Hospital Goettingen, T. Pezawas, G. Stix, M. Wolzt, J. Kastner, ever, the natural history of this disease Georg-August-University, Goettingen, C. Mayer, D. Moertl, H. Schmidinger remains insufficiently determined. Germany Department of Cardiology, University of Vienna, Austria Methods: Therefore, we prospectively Background: Children with innocent followed 176 consecutive patients (73 murmurs are often referred to a Aims: To evaluate electrophysiologically female, age 58 ± 19 yrs) with mild to paediatric cardiologist for diagnosis. The guided implantable cardioverter defibril- moderate aortic stenosis (jet velocity most common murmurs of early child- lator (ICD) therapy in patients with syn- 2.5–4.0 m/s) from 1994 to 1999. The hood are the so called Still’s murmurs cope, no documented ventricular tachy- rate of progression of the peak aortic jet followed by pulmonary or aortic ejection cardia (VT) and structural heart disease. velocity was calculated, and a survival murmur and venous hum. There also analysis was performed. exists a high coincidence with false Methods and Results: Programmed ven- tendinous structures within the left tricular stimulation (PVS) was performed Results: Mean follow-up was 3.9 ± 1.6 yrs. ventricle. We found another seldom in 52 patients for risk stratification. The Kaplan-Meier event-free survival for the reason for an innocent murmur. mean age was 62 ± 10 years; 40 patients entire patient group, with endpoints had ischaemic and 12 patients had defined as death (n = 34) or aortic valve Methods: We report 6 patients (age 5 idiopathic cardiomyopathy. On PVS surgery (n = 33), was 95 ± 2 % at 1 yr, to 22 years) presented to our outpatient sustained VTs and ventricular fibrillation 75 ± 3 % at 3 yrs, and 60 ± 4 % at 5 yrs. pediatric cardiology clinic for workup were induced in 7 and 4 patients, Among 18 cardiac deaths, 6 were sudden, of heart murmur. None of them had respectively. Two non-inducible patients 1 patient had endocarditis and 11 con- abnormalities on clinical exam, ECG spontaneously experienced symptomatic gestive heart failure. Mean rate of pro- or echocardiography. They presented ventricular tachyarrhythmias shortly after gression of peak aortic jet velocity for the a similar murmur that in contrast to PVS in hospital. These patients received entire population was 0.24 ± 0.3 m/s/yr, innocent murmurs was also audible over an ICD (ICD group, n = 13). The but varied widely (–0.2 to 1.3 m/s/yr). It the back. The echocardiography was remaining non-inducible patients were was significantly faster for patients with done on two different echo-machines left on best conventional therapy (non an endpoint (0.43 ± 0.04 m/s/yr), than for with cross-sectional and colour-Doppler ICD group, n = 39). During a follow-up those without event (0.14 ± 0.02 m/s/yr; and the string was reproducible from period of 4.6 ± 2.7 years, 5 ICD patients p < 0.0001). Patients younger than 50 every examiner. received appropriate therapies. One and years had a significantly better outcome 6 patients died in the ICD and non-ICD with event-free survival rates of 100 % at Results: With closer examination of group, respectively, and all deaths were 1 yr, 95 ± 3 % at 3 yrs, and 89 ± 5 % at the aorta with cross-sectional echo non-sudden. Overall survival analysis 5 yrs compared with 93 ± 2 %, 68 ± 4 %, we revealed an echogenic, tendinous revealed no significant difference. The and 49 ± 5 % for patients older than 50 structure in all 6 patients crossing either positive and negative predictive values years (p < 0.0001). Peak aortic jet velocity the lumen of the descending aorta or of PVS for tachyarrhythmias or sudden at entry was also a significant predictor aortic arch as another cause for innocent death were 36 % and 95 %, respectively. of outcome.

18 J KARDIOL SUPPL E/2001 CARDIOLOGY 2001 ABSTRACTS

Of 129 patients with a follow-up echo- samplings were obtained after 10 days, (dissolved in 1 ml dimethylsulfoxid cardiographic exam, 59 (46 %) reached 6 weeks and 6 months of treatment. [DMSO] and 59 ml phosphate buffer a peak aortic jet velocity of 4 m/s or [PBS], infusion rate 6 ml/min) into the greater during follow-up. Results: At 6 weeks, CRP-levels decreased left coronary artery (group 1, n =10),

in both groups (lisinopril: p < 0.001, AT1- while 8 animals served as untreated Conclusion: Rapid progression from mild antagonists: p < 0.05). A further decrease controls (group 2) and 6 further pigs as or moderate to haemodynamically up to 6 months was only observed in the vehicle controls (DMSO + PBS) (group 3). severe aortic stenosis is common. In lisinopril group (p < 0.05) while no One coronary stent was then implanted

particular, patients older than 50 years change was seen in the AT1-antagonist in the left anterior descending or circum- and patients in whom echocardiographic group. After six months, median CRP- flex coronary artery. After 4 weeks, follow-up reveals a rapid increase of plasma levels in patients receiving lisino- control angiography and intravascular peak aortic jet velocity have a poor out- pril were 67.6 % lower than in patients ultrasound (IVUS) were performed. IVUS

come. Thus, moderate and even mild receiving AT1-antagonists (0.12 mg/dl vs parameters were measured using a aortic stenosis cannot be considered a 0.37 mg/dl, p < 0.05). computer-assisted 3D analysis system. benign disease and rapid progression is frequent. Conclusion: The ACEI lisinopril lowered Results: Ac-YVAD-cmk reduced in-stent plasma levels of C-reactive protein more neointimal volume (29.1 ± 12.5 vs 80.5 3 efficiently than the AT1-antagonists ± 24.9 and 67.4 ± 22.3 mm , p < 0.005) losartan and valsartan. ACE inhibition and maximal area stenosis (38.6 ± 8.0 vs THE ANGIOTENSIN-CONVERTING ENZYME and the stabilization of bradykinin and 71.0 ± 6.4 and 67.0 ± 9.9 %, p < 0.001) INHIBITOR LISINOPRIL LOWERS PLASMA subsequent increase in the production of assessed by IVUS in group 1 vs groups 2 LEVELS OF C-REACTIVE PROTEIN AFTER the antioxidant nitric oxide (NO) may be and 3, but did not influence vessel re- MYOCARDIAL INFARCTION MORE EFFICIENTLY responsible for the stronger antiinflamma- modeling (maximal vessel area 12.4 ± 3.3 tory effect of high dose lisinopril. Whether vs 13.5 ± 2.1 and 12.3 ± 2.7 mm3, non- THAN ANGIOTENSIN II TYPE 1 RECEPTOR an increase of dosage of AT1-antagonists significant). Smaller maximal neointimal ANTAGONISTS might have similar antiinflammatory thickness (0.38 ± 0.19 vs 0.94 ± 0.37 effects via other mechanisms, eg increased and 0.97 ± 0.44 mm, p < 0.01) and NO production due to stronger stimulation decreased maximal neointimal area

W. S. Speidl, M. Nikfardjam, of AT2 receptors remains to be proven. (1.73 ± 1.53 vs 3.66 ± 1.54 and 4.03 ± N. Jordanova, J. Wojta, K. Huber 0.86 mm2, p < 0.01) assessed by histology Department of Cardiology, University of (computerized planimetry) were found in Vienna, Austria pigs in group 1 vs groups 2 and 3. IVUS INTRACORONARY ADMINISTRATION OF A results (maximal neointimal area and Background: Recent studies have shown CASPASE-1-INHIBITOR (AC-YVAD-CMK) neointimal thickness) correlated signifi- that atherosclerosis is prevented in REDUCES NEOINTIMAL HYPERPLASIA AFTER cantly with histological data (r = 0.774, animal models and humans by blockage STENTING OF PORCINE CORONARY ARTERIES p < 0.001 and r = 0.699, p < 0.001, of the renin-angiotensin system via angio- respectively). Injury score did not differ tensin converting enzyme inhibitors (ACEI) significantly between the groups. or antagonists of the angiotensin II type 1 W. Sperker1, M. Gyöngyösi1, 2 1 receptor (AT1-antagonists), possibly by an U. Windberger , M. Gottsauner-Wolf , Conclusion: Our data indicate that the antiinflammatory mechanism. We P. Wexberg1, D. Bonderman1, I. M. Lang1, caspase-1 inhibitor Ac-YVAD-cmk compared the antiinflammatory effects of St. Marlovits3, H. D. Glogar1 reduces in-stent neointimal proliferation. 1 2 ACEI and AT1-antagonists after acute Department of Cardiology, Center for IVUS allows a quantitative 3D analysis myocardial infarction (AMI) by measure- Biomedical Research, 3Department of of experimental neointimal proliferation ment of high sensitivity C-reactive protein Trauma-Surgery, University of Vienna, and vessel remodeling and is able to (CRP), a sensitive marker for ongoing Austria guide targeted histological analysis. inflammation and strong predictor of cardiovascular risk. Background: The irreversible caspase-1 inhibitor Ac-YVAD-cmk inhibits apopto- Methods: 63 patients with their first AMI sis and proinflammatory cytokine release. ARTERIAL COMPLIANCE: A PREDICTOR OF and after fibrinolytic therapy were includ- In contrast to apoptosis inhibition, the CARDIOVASCULAR DISEASES? ed in our study and randomized in a 2:1 chloromethylketone chain of Ac-YVAD- ratio to receive either lisinopril 5 mg/d cmk increases smooth muscle cell apo- B. Syeda, M. Gottsauner-Wolf, S. Denk,

(n = 42) or an AT1-antagonist (losartan ptosis through elastase inhibition. The P. Pichler, A. Khorsand, T. Schoenau, 50 mg/d, n = 11; valsartan 80 mg/d, aim of the present study was to reduce H. D. Glogar n = 10) starting 24 hours after the acute neointimal proliferation after coronary Department of Cardiology, University of event. After 6 weeks of treatment the stent implantation using Ac-YVAD-cmk. Vienna, Austria initial dose of lisinopril was increased during two weeks in steps of 5 mg to Methods: After general anaesthesia, Background: Measures of the arterial 40 mg/d whereas the initial dose of the domestic pigs received intracoronary compliance can be derived non-invasively

AT 1-antagonists was not changed. Blood infusion of 50 mg Ac-YVAD-cmk from pressure pulse contour analysis of

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