Despite increased cytokine levels, pharmacologic EPO blood levels were associated with increased reticulocyte counts in patients with multiple organ dysfunction syndrome.

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Abstract. Gabriel AS, Ahnve S, Wretlind B, Martinsson A (Karolinska Institute and Huddinge University Hospital, Stockholm, Sweden). J Intern Med 2000; 248: 61±66.Objectives. To determine if increased inflammatory activity, as reflected by interleukin-6 (IL-6) and interleukin-1 receptor antagonist (IL-1ra) levels, is present in patients with stable angina pectoris and if IL-6 levels on admission to the coronary care unit in patients with acute myocardial infarction (AMI) are related to heart failure and fever response. Subjects and methods. We studied 28 patients with stable angina pectoris enrolled for coronary angiography, and compared them with sex-and agematched controls. Thirty-four patients with AMI were studied and samples for determination of IL-6 levels were taken on admission within 36 h of onset of symptoms. IL-6 and IL-1ra were determined in serum by enzyme immunoassay. Results. Levels of IL-6 and IL-1ra were higher in patients with stable angina pectoris than in controls (mean 4.6 6 3.6 vs. 3.0 6 2.9 ng L 21 , P , 0.03, and 774 6 509 vs. 490 6 511 ng L 21 , P , 0.01, respectively). IL-6 and IL-1ra levels were not related to angiographic findings. IL-6 levels were high in patients with AMI (38.9 6 75.6 ng L 21 ). Patients with prolonged fever (duration . 4 days) had higher IL-6 levels (94.7 6 138.2 vs. 21.7 6 29.7 ng L 21 , P , 0.05). IL-6 levels were not related to heart failure. Conclusions. Our results indicate that increased inflammatory activity is present not only in acute coronary syndromes, but also in a chronic form of ischaemic heart disease, giving further evidence for a central role of inflammatory processes in coronary artery disease. With regard to AMI, we found increased inflammatory activity in patients with prolonged fever.

The high prevalence and persistence of positive pharyngeal C. pneumoniae polymerase chain reaction and elevated antibody titres in patients with ischaemic heart disease indicate a chronic infection. The pharyngeal presence of C. pneumoniae might contribute to a low grade inflammatory activation or be a source for further spread of the bacteria to atherosclerotic vessels.

The present study focuses on the accuracy in tracing fast beat-to-beat changes in blood pressure using a non-invasive technique. The measurements using a commercially available apparatus (Finapres, Ohmeda, USA) were compared to ipsilateral intra-arterial radial pressure. Eight patients were studied at rest, during deep breathing with a fixed rate of 6 breaths min-1, and during an exercise test on an ergometer cycle. A total of 900 systolic pressure values were included for statistical evaluation, covering a pressure range of 86-266 mmHg. On average the systolic correlation coefficient for the whole material was 0.97, with a range of 0.94-0.996. For mean pressure the correlation coefficient was on average 0.97, and for diastolic pressure 0.93. No systematic difference between the non-invasive and the invasive method was found, although for each individual patient a difference between direct and indirect measured blood pressure existed that could be relatively large (systolic pressure: average difference = 0.8 mmHg, SD = 16 mmHg). We found the method easy to handle and consider it excellently suited to track relative changes in blood pressure.

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