Objective-To evaluate as predictors of reinfarction and mortality tissue plasminogen activator antigen and activity before and after venous occlusion, plasminogen activator inhibitor, von Willebrand factor, and established risk factors.Design-Prospective study with a mean observation time of 4 9 years.Setting-Secondary referral centre, the Department of Internal Medicine, University Hospital of Umea.Patients-123 consecutive survivors of myocardial infarction under the age of 70 years.Main outcome measures-Reinfarction and deaths from all causes.Results-23 patients died and 36 patients had at least one reinfarction. High concentrations of von Willebrand factor were independently associated with both reinfarction and mortality. A history of angina at entry into the study was also independently associated with reinfarction and mortality. Hypertension was independently associated with mortality but not with reinfarction. None of the fibrinolytic or lipid variables was associated with reinfarction or death.

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Ahlgren ÅR, Cinthio M, Steen S, Nilsson T, Sjöberg T, Persson HW, Lindström K. Longitudinal displacement and intramural shear strain of the porcine carotid artery undergo profound changes in response to catecholamines. Am J Physiol Heart Circ Physiol 302: H1102-H1115, 2012. First published December 23, 2011 doi:10.1152/ajpheart.00470.2011The effects of catecholamines on longitudinal displacements and intramural shear strain of the arterial wall are unexplored. Therefore, the common carotid artery of five anaesthetized pigs was investigated using an in-house developed noninvasive ultrasonic technique. The study protocol included intravenous infusion of low-dose epinephrine (␤-adrenoceptor activation), as well as intravenous boluses of norepinephrine (␣-adrenoceptor activation). Further, the effects of ␤-blockade (metoprolol) were studied. There were significant positive correlations between pulse pressure and longitudinal displacement of the intima-media complex (r ϭ 0.72; P Ͻ 0.001), as well as between pulse pressure and intramural shear strain (r ϭ 0.48; P Ͻ 0.001). Following administration of norepinephrine, the longitudinal displacement of the intimamedia complex and intramural shear strain profoundly increased (median 190%, range 102-296%, and median 141%, range 101-182%, respectively, compared with baseline), also when given during ␤-blockade (median 228%, range 133-266%, and median 158%, range 152-235%, respectively). During infusion of low-dose epinephrine, the longitudinal displacement of the intima-media complex and intramural shear strain decreased (median 88%, range 69 -122%, and median 69%, range 47-117%, respectively, compared with baseline). In conclusion, the present study shows, for the first time, that the longitudinal displacement and intramural shear strain of the porcine carotid artery undergo profound changes in response to catecholamines. Increase in longitudinal displacements seems to be strongly related to ␣-adrenoceptor activation. Thus metoprolol is insufficient to counteract a profound increase in longitudinal displacement and intramural shear strain following a surge of norepinephrine. longitudinal movements; epinephrine; norepinephrine; metoprolol; vascular mechanics; ultrasound CARDIOVASCULAR DISEASE IS a leading cause of morbidity and mortality in the industrialized countries. Mental stress is considered a risk factor for cardiovascular disease both acutely, following strong emotional stress, and chronically. The mechanisms behind this association still remain unclear.In cardiovascular research, the radial movement of the arterial wall, the diameter change, has been the subject of extensive research; measurement of the diameter change of arteries is now an established tool in cardiovascular research (2,21,26), forming the basis for estimation of arterial wall stiffness. Increased stiffness of large central arteries has been shown to be an independent risk factor for cardiovascular mortality (5, 19). In contrast, there are few studies on the longitudinal movement of the arterial wa...

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