The advent of new laboratory methods and noninvasive imaging modalities has extended the diagnostic possibilities in normal individuals. This article elaborates the new options for the assessment of stroke risk offered by these techniques. In this context we present the Austrian Stroke Prevention Study, which is the first prospective long-term investigation of normals that includes Doppler sonography, magnetic resonance imaging and single photon emission computed tomography. The design, utility and limitations of this study are discussed.
Published data on the association between paraoxonase1 (PON1) polymorphisms and coronary heart disease (CHD) have yielded controversial results. The objective of this study was to determine the possible relationship between the two human PON1 amino acid variants, the Leu55Met and the Gln192Arg polymorphism, and the risk of CHD in a community-dwelling cohort of European ancestry. PON1 genotypes of 152 women and 151 men out of 1,998 randomly selected individuals aged 44–75 years were determined by polymerase chain reaction-based restriction enzyme digestion. Study participants underwent cardiological examination including a structured clinical interview, resting ECG, exercise testing and echocardiography. The diagnosis of CHD was based on history and/or appropriate findings during cardiac examination. Evidence for CHD was found in 43 (14.2%) study participants. The Leu/Leu (LL), Leu/Met (LM) and Met/Met (MM) genotypes at position 55 were noted in 131 (43.2%), 128 (42.2%) and 44 (14.5%) subjects; the Gln/Gln (QQ), Gln/Arg (QR) and Arg/Arg (RR) genotypes at codon 192 occurred in 167 (55.1%), 118 (38.9%) and 18 (5.9%) individuals, respectively. Homozygosity for the 55L-allele was significantly associated with CHD (p = 0.02), while the Gln192Arg polymorphism had no effect (p = 0.16). Logistic regression analysis demonstrated age (odds ratio 1.06/year), smoking (odds ratio 2.86), HDL cholesterol (odds ratio 0.94/mg/dl) and the paraoxonase LL genotype (odds ratio 2.25) to be significant predictors of CHD. These data suggest that the paraoxonase LL genotype at position 55 may present a risk factor for CHD.
The efficacy of benazepril, metoprolol OROS and their combination was evaluated in 29 patients (42 to 74 years of age) with chronic stable angina and documented coronary artery disease in a placebo-controlled, double-blind, crossover trial using serial quantitated exercise testing and ambulatory electrocardiographic (ECG) monitoring. The mean (+/- SEM) exercise time was 8.5 +/- 0.7 min with placebo, 8.3 +/- 0.6 min (95% confidence interval [CI]-1.06 to 0.54) with benazepril, 9.4 +/- 0.5 min (95% CI -0.32 to 2.14) with metoprolol OROS and 9.6 +/- 0.5 min (95% CI -0.25 to 2.47) with the combination of benazepril and metoprolol OROS. The mean exercise time to the development of 1 mm ST segment depression was prolonged from 6.0 +/- 0.6 min with placebo to 6.3 +/- 0.6 min (95% CI -0.93 to 1.45) with benazepril, 7.9 +/- 0.5 min (95% CI 0.83 to 3.0) with metoprolol OROS and 8.1 +/- 0.6 min (95% CI 0.88 to 3.29) with the combination of benazepril and metoprolol OROS. Benazepril did not alter the rest or maximal heart rate, whereas metoprolol OROS alone and in combination significantly lowered the heart rate at rest and during maximal exercise. Systolic blood pressure at rest was nonsignificantly reduced, whereas diastolic blood pressure was lowered significantly by all treatments in comparison with placebo. At maximal exercise, only metoprolol OROS, whether given alone or in combination with benazepril, was able to blunt significantly systolic blood pressure and rate-pressure product.(ABSTRACT TRUNCATED AT 250 WORDS)
The most common cause of obstructive renal artery disease is atherosclerosis, accounting for 90 % of cases of renal artery stenosis. Atherosclerotic renal artery stenosis can be associated with renovascular hypertension, ischemic nephropathy, or both or it may occur alone. The prevalence of atherosclerotic renal artery stenosis among hypertensive patients is estimated between 1 and 5 %, but the frequency rises among patients with refractory hypertension (20 %) coronary heart disease (15 to 20 %) or peripheral arterial disease (30 to 40 %). The gold standard for diagnosing renal artery disease is contrast renal arteriography. MR angiography, CT angiography and color duplex ultrasonography have the highest sensitivity and specifity among the non invasive screening methods. Therapy is based on consequent medical treatment of hypertension, antiplatelet therapy and modification of risk factors for atherosclerosis. Revascularisation is advised in patients with severe hypertension, in patients with pulmonary edema and cases of acute worsening of renal function. Percutaneous angioplasty with stent implantation is the method of choice for revascularisation. The prognosis of patients with atherosclerotic renal artery stenosis is determined by cardiovascular and renal complications.
Long-term ambulatory electrocardiographic monitoring [AEM] of the ST segment is clinically the most practical test for the documentation and quantification of myocardial ischaemia. However, there is still some controversy about the validity of ST measurements in Holter monitoring. Therefore, in the present study, in a series of 26 patients with angiographically proven (greater than 70%) coronary heart disease and a positive exercise electrocardiogram, the number, duration and the severity of symptomatic and asymptomatic ischaemic episodes were measured by (1) the ST change at the J point, (2) the ST change 0.07-0.10 s after the J point (immediately before the T wave), (3) the change of the slope of the ST segment, and (4) the area under the ST segment, with a Reynolds Pathfinder III and compared with visual analysis. At the J point (1) there were a total of 264 episodes with a duration of 3947 min and a maximum of 0.35 mV, before the T wave (2) 276 episodes with a duration of 3440 min and a maximal change of 0.40 mV; looking at the slope of the ST segment (3) the figures were 118, 1041 min and regarding the area under the ST segment they were 198, 2385 min. In conclusion, ST deviations are safely detected by automated analysis of the ST segment. Compared with visual analysis (220 episodes), deviation of the ST1 (J point) and ST2 point (80 ms thereafter) overestimate the incidence of true ischaemic ST depression by about 20%.(ABSTRACT TRUNCATED AT 250 WORDS)
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