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Paditsaeree K, Mitranun W. Acute Effects of Combining Weight and Elastic Resistance Exercise on Vascular Function in Older Adults. Geriatrics (Basel) 2024; 9:56. [PMID: 38804313 PMCID: PMC11130816 DOI: 10.3390/geriatrics9030056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 04/23/2024] [Accepted: 04/25/2024] [Indexed: 05/29/2024] Open
Abstract
Prior research has suggested that resistance exercise may result in a temporary decrease in vascular function, as measured by flow-mediated dilation (FMD), among untrained young individuals. However, the immediate impact of combined elastic and weight resistance training on older adults remains insufficiently explored. We assessed vascular function before, after, and 30 min after acute exercise under three resistance conditions to evaluate whether a combination of weight and elastic resistance exercises has an acute effect on vascular function in older adults. Fourteen older adults (65.6 ± 2.9 years) executed three sets of 12 repetitions at 65% of one repetition maximum (1 RM) of the bench press (BP) exercise. Testing was performed on three separate days as follows: (1) barbell alone (BA); (2) barbell plus elastic bands (10% of 65% 1 RM) (BE10); and (3) barbell plus elastic bands (20% of 65% 1 RM) (BE20). A two-way (time × condition) repeated measures analysis of variance was employed to assess the time and condition effects on flow-mediated dilation (FMD) and pulse wave velocity (PWV). At 0 min post-exercise, FMD was significantly higher during BE10 than during BA (p < 0.05); however, at 30 min post-exercise, no significant difference (p ≥ 0.05) was observed between the three conditions. In each condition, FMD results did not differ significantly at different times (p ≥ 0.05). For FMD, the main effect of the condition (F[2,26] = 3.86, p = 0.034) and that of the time and condition (F[4,52] = 3.66, p = 0.011) were significant. For PWV, only the difference between the BA and BE10 conditions was significant at 0 min (p < 0.05). PWV increased from baseline in the BA condition (p < 0.05) but not significantly in the BE10 and BE20 conditions (p ≥ 0.05). Therefore, BA, BE10, and BE20 demonstrated various changes in vascular function. Long-term training intervention studies are needed to validate these findings.
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Affiliation(s)
- Kampanart Paditsaeree
- Department of Physical Education, Faculty of Education, Phuket Rajabhat University, Phuket 83000, Thailand;
| | - Witid Mitranun
- Department of Sports Science, Faculty of Physical Education, Sports, and Health, Srinakharinwirot University, Nakhon Nayok 26120, Thailand
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Caraba A, Iurciuc S, Nicolin M, Iurciuc M. Endothelial Dysfunction in Primary Sjögren's Syndrome: Correlation with Serum Biomarkers of Disease Activity. Int J Mol Sci 2023; 24:13918. [PMID: 37762225 PMCID: PMC10531316 DOI: 10.3390/ijms241813918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 08/31/2023] [Accepted: 09/07/2023] [Indexed: 09/29/2023] Open
Abstract
To assess the relationship between endothelial dysfunction and serum cytokines, anti-SSA and anti-SSB antibodies, beta-2 microglobulin levels, focus score and EULAR Sjögren's Syndrome Disease Activity Index (ESSDAI) in primary Sjögren's syndrome (pSS) patients. The study included 90 patients with pSS and 45 healthy subjects, matched for age and gender, as controls. Serum beta-2 microglobulin, total cholesterol, HDL-cholesterol, triglycerides, TNF-α, and IL-6 were analyzed in both the groups. Patients with pSS were also tested for antinuclear antibodies, anti-SAA (anti-Sjögren's syndrome-related antigen A) antibodies, anti-SSB (anti-Sjögren syndrome related antigen B) antibodies, and focus score (the histopathologic one, based on minor salivary gland biopsy). Endothelial dysfunction was assessed by means of flow-mediated dilation (FMD) in the brachial artery. Data are presented as mean ± standard deviation. Statistical analysis was performed using the t-test and the Pearson's correlation. Differences were considered to be statistically significant if the value of p < 0.05. Endothelial dysfunction was identified in pSS patients (p < 0.00001). The serum levels of cytokines (TNF-α, respective IL-6) and beta-2 microglobulin were increased in pSS patients compared with controls (p < 0.00001). Endothelial dysfunction (expressed as FMD%) was correlated with focus score, ESSDAI, levels of anti-SSA and anti-SSB antibodies, beta-2 microglobulin, IL-6, and TNF-α, with statistical significance. Endothelial dysfunction is present in pSS patients and is associated with a high focus score and activity as well as increased concentrations of antibodies, pro-inflammatory cytokines, and beta 2-microglobulin.
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Affiliation(s)
- Alexandru Caraba
- 3rd Internal Medicine, Diabetes and Rheumatology Department, University of Medicine and Pharmacy “Victor Babeș”, 300041 Timișoara, Romania;
| | - Stela Iurciuc
- Cardiology Department, University of Medicine and Pharmacy “Victor Babeș”, 300041 Timișoara, Romania;
| | - Mihaela Nicolin
- Cardiology Department, “Victor Popescu” Military Hospital, 300080 Timișoara, Romania;
| | - Mircea Iurciuc
- Cardiology Department, University of Medicine and Pharmacy “Victor Babeș”, 300041 Timișoara, Romania;
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Khandouzi N, Zahedmehr A, Asadian S, Nasrollahzadeh J. Effects of olive oil and flaxseed consumption in a healthy diet on endothelial function, plasma lipids and inflammatory factors of patients with coronary heart disease: a randomized clinical trial. Coron Artery Dis 2023; 34:332-340. [PMID: 37335239 DOI: 10.1097/mca.0000000000001259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/21/2023]
Abstract
OBJECTIVES A healthy lifestyle, including a healthy diet has been associated with an improvement in cardiovascular risk factors. The aim of the present study was to assess the effect of olive oil and flaxseed consumption as part of a healthy diet on endothelial function, plasma inflammatory factors, and lipid profile in patients with coronary heart disease (CHD). METHOD This randomized nonblinded trial was performed on CHD patients. In the control group, participants received general heart-healthy dietary recommendations while in the intervention group, in addition to these recommendations, the participants consumed 25 ml of olive oil and 30 g of flaxseeds daily for 3 months. At baseline and after 3 months, changes in brachial flow-mediated dilation (FMD), plasma asymmetric dimethyl arginine, interleukin-6 (IL-6), IL-10, high-sensitivity C-reactive protein (hs-CRP), tumor necrosis factor-α (TNF-α), monocyte chemoattractant protein-1 (MCP-1), and lipids and lipoproteins were measured. RESULTS A total of 50 patients finished the trial ( n = 24 in the intervention and n = 26 in the control groups). Compared to the control group, consumption of flaxseed and olive oil significantly improved brachial artery FMD%, and reduced plasma IL-6, TNF-α, MCP-1, total cholesterol, and tended to reduce hs-CRP, and non-HDL-cholesterol but the concentration of other study indices were not different between the two groups. CONCLUSION Inclusion of olive oil and flaxseed in the diet of CHD patients may contribute to secondary prevention by improving endothelial function and plasma inflammatory factors.
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Affiliation(s)
- Nafiseh Khandouzi
- Department of Clinical Nutrition and Dietetics, Faculty of Nutrition Sciences and Food Technology, Shahid Beheshti University of Medical Sciences
| | | | - Sanaz Asadian
- Department of Radiology, Rajaie Cardiovascular, Medical & Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Javad Nasrollahzadeh
- Department of Clinical Nutrition and Dietetics, Faculty of Nutrition Sciences and Food Technology, Shahid Beheshti University of Medical Sciences
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Paolucci L, Mangiacapra F, Viscusi MM, Guarino L, Bressi E, Creta A, Di Gioia G, Capuano M, Colaiori I, Di Sciascio G, Ussia GP, Grigioni F. Impact of Endothelial Dysfunction on Long-Term Clinical Outcomes in Patients With Chronic Coronary Syndromes Treated With Second Generation Drug-Eluting Stent Implantation. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2023; 51:18-22. [PMID: 36804305 DOI: 10.1016/j.carrev.2023.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 01/06/2023] [Accepted: 02/02/2023] [Indexed: 02/10/2023]
Abstract
BACKGROUND Studies investigating clinical outcomes of patients with or without endothelial disfunction (ED) treated with percutaneous coronary intervention (PCI) for stable coronary artery disease (CAD) using second generation drug eluting stents (DES) are lacking. METHODS We prospectively collected data from 109 patients undergoing PCI with second generation DES due to stable CAD between December 2014 and September 2016. ED was evaluated evaluating the flow mediated dilation (FMD) at the brachial artery level and defined by an FMD < 7 %. Primary outcome were major adverse cardiovascular events (MACE), secondary outcomes were target vessel failure (TVR), myocardial infarction (MI) and all-cause death. RESULTS Five-year follow-up was available in all patients. Median FMD didn't significantly differ between patients who experienced the outcome and those who didn't [no TVR vs. TVR: p = 0.358; no MI vs. MI: p = 0.157; no death vs. death: p = 0.355; no MACE vs. MACE: p = 0.805]. No association between ED and an increased risk for the primary outcome as well as for the secondary ones was evident [MACE: 17.0 % vs. 14.3 %, HR 0.87 (0.33-2.26), log rank p = 0.780; TVR: 9.4 % vs. 5.4 %, HR 0.53 (0.12-2.24), log rank p = 0.384; MI: 3.7 % vs. 8.9 %, HR 2.46 (0.47-12.76), log rank p = 0.265; death: 7.5 % vs. 3.6 %, HR 0.53 (0.09-2.90), log rank p = 0.458]. These findings were confirmed using a lower threshold of FMD to define ED and at one-year landmark analysis. CONCLUSIONS ED is not associated with an increased risk of adverse events at long-term follow-up in a contemporary cohort of patients undergoing PCI with second generation DES.
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Affiliation(s)
- Luca Paolucci
- Unit of Cardiovascular Science, Department of Medicine, Campus Bio-Medico University, Rome, Italy.
| | - Fabio Mangiacapra
- Unit of Cardiovascular Science, Department of Medicine, Campus Bio-Medico University, Rome, Italy
| | - Michele Mattia Viscusi
- Unit of Cardiovascular Science, Department of Medicine, Campus Bio-Medico University, Rome, Italy
| | - Lorenzo Guarino
- Unit of Cardiovascular Science, Department of Medicine, Campus Bio-Medico University, Rome, Italy
| | - Edoardo Bressi
- Unit of Cardiovascular Science, Department of Medicine, Campus Bio-Medico University, Rome, Italy
| | - Antonio Creta
- Unit of Cardiovascular Science, Department of Medicine, Campus Bio-Medico University, Rome, Italy
| | - Giuseppe Di Gioia
- Unit of Cardiovascular Science, Department of Medicine, Campus Bio-Medico University, Rome, Italy; Institute of Sport Medicine and Science, National Italian Olympic Committee CONI, Rome, Italy; Department of Movement, Human and Health Sciences, University of Rome "Foro Italico", Rome, Italy
| | - Marialessia Capuano
- Unit of Cardiovascular Science, Department of Medicine, Campus Bio-Medico University, Rome, Italy
| | - Iginio Colaiori
- Unit of Cardiovascular Science, Department of Medicine, Campus Bio-Medico University, Rome, Italy
| | - Germano Di Sciascio
- Unit of Cardiovascular Science, Department of Medicine, Campus Bio-Medico University, Rome, Italy
| | - Gian Paolo Ussia
- Unit of Cardiovascular Science, Department of Medicine, Campus Bio-Medico University, Rome, Italy
| | - Francesco Grigioni
- Unit of Cardiovascular Science, Department of Medicine, Campus Bio-Medico University, Rome, Italy
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Hao Y, Zhang L, Zhang Z, Chen L, He N, Zhu S. Tai Chi exercise and functional electrical stimulation of lower limb muscles for rehabilitation in older adults with chronic systolic heart failure: a non-randomized clinical trial. Braz J Med Biol Res 2019; 52:e8786. [PMID: 31778439 PMCID: PMC6886363 DOI: 10.1590/1414-431x20198786] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 09/12/2019] [Indexed: 12/28/2022] Open
Abstract
Exercise-based training decreases hospitalizations in heart failure patients but such patients have exercise intolerance. The objectives of the study were to evaluate the effect of 12 weeks of Tai Chi exercise and lower limb muscles' functional electrical stimulation in older chronic heart failure adults. A total of 1,084 older adults with chronic systolic heart failure were included in a non-randomized clinical trial (n=271 per group). The control group did not receive any kind of intervention, one group received functional electrical stimulation of lower limb muscles (FES group), another group practiced Tai Chi exercise (TCE group), and another received functional electrical stimulation of lower limb muscles and practiced Tai Chi exercise (FES & TCE group). Quality of life and cardiorespiratory functions of all patients were evaluated. Compared to the control group, only FES group had increased Kansas City Cardiomyopathy Questionnaire (KCCQ) score (P<0.0001, q=9.06), only the TCE group had decreased heart rate (P<0.0001, q=5.72), and decreased peak oxygen consumption was reported in the TCE group (P<0.0001, q=9.15) and FES & TCE group (P<0.0001, q=10.69). FES of lower limb muscles and Tai Chi exercise can recover the quality of life and cardiorespiratory functions of older chronic heart failure adults (trial registration: Research Registry 4474, January 1, 2015).
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Affiliation(s)
- Yi Hao
- Department of Cardiac Surgery, Beijing Luhe Hospital, Capital Medical University, Beijing, China
| | - Long Zhang
- Department of Cardiology, Beijing Luhe Hospital, Capital Medical University, Beijing, China
| | - Zhenhua Zhang
- Department of Cardiac Surgery, Beijing Luhe Hospital, Capital Medical University, Beijing, China
| | - Lin Chen
- Department of Cardiac Surgery, Beijing Luhe Hospital, Capital Medical University, Beijing, China
| | - Ning He
- Department of Cardiac Surgery, Beijing Luhe Hospital, Capital Medical University, Beijing, China
| | - Shuai Zhu
- Department of Cardiac Surgery, Beijing Luhe Hospital, Capital Medical University, Beijing, China
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Long M, Huang Z, Zhuang X, Huang Z, Guo Y, Liao X, Luo C. Association of Inflammation and Endothelial Dysfunction with Coronary Microvascular Resistance in Patients with Cardiac Syndrome X. Arq Bras Cardiol 2017; 109:397-403. [PMID: 29069202 PMCID: PMC5729774 DOI: 10.5935/abc.20170149] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Accepted: 07/05/2017] [Indexed: 11/20/2022] Open
Abstract
Background Although a proportion of CSX patients have impaired brachial artery
flow-mediated dilatation (FMD) in response to hyperemia, suggesting that
endothelial dysfunction in these patients may be systemic and not just
confined to the coronary circulation; the underlying mechanisms triggering
endothelial dysfunction in these patients are still incompletely
understood. Objectives To assess the association of the index of Microcirculatory Resistance (IMR)
with endothelial dysfunction and inflammation in patients with CSX. Methods We studied 20 CSX patients and 20 age and gender-matched control subjects.
Thermodilution-derived coronary flow reserve (CFR) and IMR were measured
using a pressure-temperature sensor-tipped guidewire. Brachial artery FMD
was measured using high-resolution, two-dimensional ultrasound images
obtained with a Doppler ultrasound device (HDI-ATL 5000, USA) with a 5 MHz
to 12 MHz linear-array transducer. Results Compared with in control subjects, CFR was significantly lower (2.42 ±
0.78 vs. 3.59 ± 0.79, p < 0.001); IMR was higher (32.2 ±
8.0 vs. 19.5 ± 5.5, p < 0.001); the concentration of hs-CRP and
FMD was higher (4.75 ± 1.62 vs. 2.75 ± 1.50; 5.24 ±
2.41 vs. 8.57 ± 2.46, p < 0.001) in CSX patients. The Duke
treadmill score (DTS) was correlated positively to CFR and FMD (0.489 and
0.661, p < 0.001), it was negative to IMR and hsCRP (-0.761 and -0.087, p
< 0.001) in CSX patients. Conclusions The main finding in this study is that the DTS measured in patients with CSX
was associated to hsCRP and FMD. Moreover, the independent effects of
exercise tolerance can significantly impair FMD and hsCRP in CSX patients;
especially it is particularly important to whom where FMD was associated
negatively with IMR.
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Affiliation(s)
- Ming Long
- First Affiliated Hospital, Sun Yat-sen University, Guangzhou - China
| | - Zhibin Huang
- First Affiliated Hospital, Sun Yat-sen University, Guangzhou - China
| | - Xiaodong Zhuang
- First Affiliated Hospital, Sun Yat-sen University, Guangzhou - China
| | - Zena Huang
- First Affiliated Hospital, Sun Yat-sen University, Guangzhou - China
| | - Yue Guo
- First Affiliated Hospital, Sun Yat-sen University, Guangzhou - China
| | - Xinxue Liao
- First Affiliated Hospital, Sun Yat-sen University, Guangzhou - China
| | - Chufan Luo
- First Affiliated Hospital, Sun Yat-sen University, Guangzhou - China
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Flintholm Raft K, Frestad D, Michelsen MM, Suhrs HE, Rask AB, Nilsson M, Hermann TS, Prescott E. Peripheral Endothelial Function and Coronary Flow Velocity Reserve Are Not Associated in Women with Angina and No Obstructive Coronary Artery Disease: The iPOWER Study. J Vasc Res 2017; 54:309-319. [DOI: 10.1159/000479374] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Accepted: 07/05/2017] [Indexed: 01/22/2023] Open
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The Relative Efficacy of Land-Based and Water-Based Exercise Training on Macro- and Microvascular Functions in Older Patients With Type 2 Diabetes. J Aging Phys Act 2017; 25:446-452. [DOI: 10.1123/japa.2016-0193] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Microvascular and macrovascular dysfunction plays an important role in the pathogenesis of diabetic vascular disease. Twenty-nine older patients with type 2 diabetes were randomly assigned into the land-based (LB; n = 14) or water-based (WB; n = 15) groups. Both groups completed supervised aerobic cycling exercises three times per week for 12 weeks. The WB group performed cycling exercise training in warm water (36 °C) immersed to the hip level. After 12 weeks, blood glucose concentration and insulin resistance did not change but hemoglobin A1c levels decreased (P < .05) in both groups. Plasma nitric oxide concentrations increased (P < .05) in both groups. Flow-mediated dilation in the popliteal artery increased and arterial stiffness decreased (P < .05) in both exercise groups. Indices of microvascular reactivity improved (P < .05) only in the WB group. The benefits of warm water-based training were similar in general, and superior in some measures, to the more established land-based cycling exercise.
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Nabaei G, Oveisgharan S, Ghorbani A, Fatehi F. Impaired arterial smooth muscle cell vasodilatory function in methamphetamine users. J Neurol Sci 2016; 370:107-111. [DOI: 10.1016/j.jns.2016.09.027] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2016] [Revised: 09/15/2016] [Accepted: 09/16/2016] [Indexed: 11/16/2022]
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Gupta N, Giri S, Rathi V, Ranga GS. Flow Mediated Dilatation, Carotid Intima Media Thickness, Ankle Brachial Pressure Index and Pulse Pressure in Young Male Post Myocardial Infarction Patients in India. J Clin Diagn Res 2016; 10:OC35-OC39. [PMID: 27891375 DOI: 10.7860/jcdr/2016/20872.8751] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Accepted: 07/12/2016] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Due to increase in Coronary Artery Disease (CAD) at a younger age, we should try to diagnose atherosclerotic process and population at risk, at the earliest. Flow Mediated Dilatation (FMD), Carotid Intima-Media Thickness (CIMT) and Ankle-Brachial Pressure Index (ABI) are probable markers for early atherosclerosis and may be useful in coronary risk stratification. AIM To compare and correlate the FMD, CIMT, ABI and Pulse Pressure (PP) in young male patients of Myocardial Infarction (MI) with age and sex matched healthy controls. MATERIALS AND METHODS Eighty male patients of MI aged ≤45 years, who presented to the Cardiac Care Unit and Department of Medicine of Guru Teg Bahadur Hospital, Delhi, India, from November 2010 to April 2012 were recruited consecutively for this case control study and same number of age and sex matched healthy controls were also analyzed. Six weeks after MI, FMD of the brachial artery, intima media thickness of carotid artery, ABPI and PP were measured in the cases and compared with healthy controls. RESULTS The FMD was lower among young patients of MI than controls (p<0.001). CIMT was higher among cases than controls (p=0.001). ABI was lower among cases than controls (p<0.001). Compared to controls, PP was higher among cases (p=0.001). In all subjects, a negative correlation between FMD and CIMT (r=-0.220, p=0.005) and a positive correlation between FMD and ABPI (r=0.304, p<0.001) was found. A statistically significant negative correlation was found between endothelial dependent FMD and PP among cases and control groups (r=-0.209, p=0.007). CONCLUSION Biophysical parameters were deranged in young post MI patients. Majority of our young male patients fell in low risk Framingham risk score but still they manifested with CAD. Despite six weeks of treatment among young male patients of MI, various biophysical parameters were still deranged.
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Affiliation(s)
- Nikhil Gupta
- Senior Resident, Department of Rheumatology, CMC , Vellore, Tamilnadu, India
| | - Subhash Giri
- Professor, Department of Medicine, University College of Medical Sciences , Dilshad Garden, Delhi, India
| | - Vinita Rathi
- Professor, Department of Radio-Diagnosis, University College of Medical Sciences , Dilshad Garden, Delhi, India
| | - Gajender Singh Ranga
- Professor, Department of Medicine, University College of Medical Sciences , Dilshad Garden, Delhi, India
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“State-of-Art” paper of the Italian Working Group on Atherosclerosis: Preclinical assessment of early coronary atherosclerosis. Int J Cardiol 2016; 214:442-7. [DOI: 10.1016/j.ijcard.2016.03.205] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Accepted: 03/26/2016] [Indexed: 11/19/2022]
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The Effect of Low-dose Combined Oral Contraceptive Pills on Brachial Artery Endothelial Function and Common Carotid Artery Intima–Media Thickness. J Stroke Cerebrovasc Dis 2014; 23:675-80. [DOI: 10.1016/j.jstrokecerebrovasdis.2013.06.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2013] [Revised: 06/05/2013] [Accepted: 06/07/2013] [Indexed: 11/22/2022] Open
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Di Fiore DP, Beltrame JF. Chest pain in patients with 'normal angiography': could it be cardiac? INT J EVID-BASED HEA 2013; 11:56-68. [PMID: 23448331 DOI: 10.1111/1744-1609.12002] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Approximately 20% of patients undergoing diagnostic angiography for the evaluation of chest pain are found to have a normal coronary angiogram. Although this finding is generally associated with a low risk of cardiac events, approximately half will continue to experience chest pain over the next 12 months. Therefore, the finding of normal angiography warrants further evaluation of the potential causes for the presenting chest pain if we are to improve the disability suffered by these patients. In this review, the potential non-cardiac and cardiac causes for the chest pain in patients with normal angiography are briefly discussed with an in-depth focus on coronary vasomotor disorders including coronary artery spasm (variant angina) and microvascular disorders such as syndrome X, microvascular angina, the coronary slow flow phenomenon and microvascular spasm.
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Affiliation(s)
- David P Di Fiore
- The Queen Elizabeth Hospital, Discipline of Medicine, The University of Adelaide, Woodville South, South Australia, Australia
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Arienti V, Aluigi L, Pretolani S, Accogli E, Polimeni L, Domanico A, Violi F. Ultrasonography (US) and non-invasive diagnostic methods for non-alcoholic fatty liver disease (NAFLD) and early vascular damage. Possible application in a population study on the metabolic syndrome (MS). Intern Emerg Med 2012; 7 Suppl 3:S283-90. [PMID: 23073869 DOI: 10.1007/s11739-012-0824-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Abdominal ultrasonography (US) represents the first-line imaging examination in chronic liver diseases; in most cases, US, laboratory findings and the clinical context are generally sufficient to guide the diagnosis. Thanks to the considerable diffusion of US, we have seen an increased diagnosis of NAFLD in recent years, although this condition is generally silent from a clinical point of view. We have to identify the metabolic syndrome in the general population and to promptly recognize NAFLD to prevent its development into non-alcoholic steatohepatitis, cirrhosis and hepatocellular carcinoma. Among the non-invasive diagnostic techniques for NAFLD and for early vascular damage, ultrasonography represents the method of choice. In fact, besides the traditional semiotics of fundamental US of the liver, new US techniques have recently been proposed (contrast enhancement US, acoustic structure characterization), with respect to serum biomarkers and Fibroscan, for the study of liver fibrosis. Similarly, also as concerns the US measurement of carotid intima-media thickness, new automated methods with sophisticated software and radio-frequency signal have recently been introduced. Finally, we report the preliminary results of a personal experience on liver and carotid US in the epidemiology of the metabolic syndrome.
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Affiliation(s)
- Vincenzo Arienti
- Ultrasound Center, Internal Medicine A, Maggiore Hospital, Bologna, Italy.
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