In an unselected cohort of patients admitted with AMI, the mortality was considerably higher than expected from voluntary-based registries and large-scale clinical trials. The most favourable outcome is observed in patients with STEMI.

The incretin hormone glucagon-like peptide-1 (GLP-1) and its analogs are currently emerging as antidiabetic medications. GLP-1 improves left ventricular ejection fraction (LVEF) in dogs with heart failure (HF) and in patients with acute myocardial infarction. We studied metabolic and cardiovascular effects of 48-h GLP-1 infusions in patients with congestive HF. In a randomized, double-blind crossover design, 20 patients without diabetes and with HF with ischemic heart disease, EF of 30 +/- 2%, New York Heart Association II and III (n = 14 and 6) received 48-h GLP-1 (0.7 pmol.kg(-1).min(-1)) and placebo infusion. At 0 and 48 h, LVEF, diastolic function, tissue Doppler regional myocardial function, exercise testing, noninvasive cardiac output, and brain natriuretic peptide (BNP) were measured. Blood pressure, heart rate, and metabolic parameters were recorded. Fifteen patients completed the protocol. GLP-1 increased insulin (90 +/- 17 pmol/l vs. 69 +/- 12 pmol/l; P = 0.025) and lowered glucose levels (5.2 +/- 0.1 mmol/l vs. 5.6 +/- 0.1 mmol/l; P < 0.01). Heart rate (67 +/- 2 beats/min vs. 65 +/- 2 beats/min; P = 0.016) and diastolic blood pressure (71 +/- 2 mmHg vs. 68 +/- 2 mmHg; P = 0.008) increased during GLP-1 treatment. Cardiac index (1.5 +/- 0.1 l.min(-1).m(-2) vs. 1.7 +/- 0.2 l.min(-1).m(-2); P = 0.54) and LVEF (30 +/- 2% vs. 30 +/- 2%; P = 0.93), tissue Doppler indexes, body weight, and BNP remained unchanged. Hypoglycemic events related to GLP-1 treatment were observed in eight patients. GLP-1 infusion increased circulating insulin levels and reduced plasma glucose concentration but had no major cardiovascular effects in patients without diabetes but with compensated HF. The impact of minor increases in heart rate and diastolic blood pressure during GLP-1 infusion requires further studies. Hypoglycemia was frequent and calls for caution in patients without diabetes but with HF.

In a cohort of patients scheduled for admission to a local hospital and subsequent transferral to an interventional centre for primary PCI, those diagnosed pre-hospitally had shorter treatment delay compared with those diagnosed in hospital, both in the setting of initial admission to a local hospital, and to an even larger extent in the setting of referral directly to the interventional centre.

In patients with SSS, chronic DDD pacing reduced inferior, septal and global mean MBF as well as LVEF, as compared with temporary AAI pacing. The LVEF reversed to baseline level during temporary AAI pacing despite 22 months of permanent ventricular pacing preceding it. Augmenting pace rate to 90 beats per min increased MBF equally in the two treatment groups.

In the intact human organism, the cardiac lumped constant varies with the metabolic condition, as predicted from studies of the brain and animal heart under experimental conditions.

Impaired systolic and diastolic left ventricular function, irrespective of afterload, were decisive independent pre-operative risk factors for early as well as late mortality after aortic valve replacement for aortic stenosis. The adverse influence of concentric hypertrophy was the main underlying mechanism. Operative intervention, before impairment of diastolic and systolic function, should be advocated.

Local and remote ischemic preconditioning (IPC) reduce ischemia-reperfusion (I/R) injury and preserve cardiac function. In this study, we tested the hypothesis that remote preconditioning is memorized by the explanted heart and yields protection from subsequent I/R injury and that the underlying mechanism involves sarcolemmal and mitochondrial ATP-sensitive K ϩ (KATP) channels. Male Wistar rats (300 -350 g) were randomized to a control (n ϭ 10), a remote IPC (n ϭ 10), and a local IPC group (n ϭ 10). Remote IPC was induced by four cycles of 5 min of limb ischemia, followed by 5 min of reperfusion. Local IPC was induced by four cycles of 2 min of regional myocardial ischemia, followed by 3 min of reperfusion. The heart was excised within 5 min after the final cycle of preconditioning, mounted in a perfused Langendorff preparation for 40 min of stabilization, and subjected to 45 min of sustained ischemia by occluding the left coronary artery and 120 min of reperfusion. I/R injury was assessed as infarct size by triphenyltetrazolium staining. The influence of sarcolemmal and mitochondrial K ATP channels on remote preconditioning was assessed by the addition of glibenclamide (10 M, a nonselective KATP blocker), 5-hydroxydecanoic acid (5-HD; 100 M, a mitochondrial KATP blocker), and HMR-1098 (30 M, a sarcolemmal KATP blocker) to the Langendorff preparation before I/R. The role of mitochondrial KATP channels as an effector mechanism for memorizing remote preconditioning was further studied by the effect of the specific mitochondrial K ATP activator diaxozide (10 mg/kg) on myocardial infarct size. Remote preconditioning reduced I/R injury in the explanted heart (0.17 Ϯ 0.03 vs. 0.39 Ϯ 0.05, P Ͻ 0.05) and improved left ventricular function during reperfusion compared with control (P Ͻ 0.05). Similar effects were obtained with diazoxide. Remote preconditioning was abolished by the addition of 5-HD and glibenclamide but not by HMR-1098. In conclusion, the protective effect of remote preconditioning is memorized in the explanted heart by a mechanism that involves mitochondrial K ATP channels.

Experiments were conducted to determine the effect of the physiological condition of swine on standardized ileal digestibility coefficients (SID). The apparent ileal digestibility coefficients were determined for crude protein and amino acids in six feed ingredients (corn, barley, wheat, soybean meal, canola meal, and meat and bone meal) in growing pigs and in gestating and lactating sows. Growing pigs and lactating sows were given free access to their diets, whereas gestating sows were allowed to consume only 2 kg of feed daily. The nonspecific (basal) endogenous losses of protein and amino acids were determined under similar feeding regimens after feeding a protein-free diet. The SID for crude protein and amino acids were calculated by correcting the apparent ileal digestibility coefficients for the nonspecific endogenous losses of protein and amino acids. With a few exceptions, there were no differences (P > 0.05) in the SID for crude protein and amino acids between growing pigs and lactating sows. Overall, gestating sows had higher (P < 0.05) SID for crude protein and all amino acids, except for tryptophan and aspartate, compared with growing pigs. Likewise, the SID of most amino acids obtained by gestating sows were higher (P < 0.05) than those obtained by lactating sows. Interactions (P < 0.05) between animals and diets were observed for gestating sows compared with growing pigs as well as gestating sows compared with lactating sows. As a consequence, it is not possible to extrapolate data from one feed ingredient to another. On most occasions, the lowest SID among the indispensable amino acids was calculated for threonine, valine, and lysine. It is concluded that gestating sows fed 2 kg of feed per day have higher standardized digestibility coefficients than do growing pigs and lactating sows given free access to their diets. This difference may be due to differences in daily feed intake rather than to the physiological status of the animals.