| 1. |
- Barani, Jamal, et al.
(författare)
-
Cardiac function, inflammatory mediators and mortality in critical limb ischemia.
- 2006
-
Ingår i: Angiology. - : SAGE Publications. - 0003-3197 .- 1940-1574. ; 57:4, s. 437-444
-
Tidskriftsartikel (refereegranskat)abstract
- Patients with critical limb ischemia (CLI) have a high frequency of concomitant coronary heart disease and congestive heart failure. The aim of the study was to evaluate cardiac function in relation to inflammatory markers and 1-year mortality rate among patients with CLI. The authors investigated 232 consecutive patients with CLI by means of electrocardiogram (ECG), and measurements of endothelin (ET)-1, tumor necrosis factor alpha (TNF)a, interleukin (IL)-6, neopterin, CD40 ligand, and 8-epi-prostaglandin (PG)F2a in plasma. Echocardiography (echo) was performed in 88 (38%) patients. One-year mortality rate was assessed after prospective follow-up. One hundred and eighty-six (80%) patients had sinus rhythm (SR), 36 (16%) had atrial fibrillation or flutter (AF), and 10 (4%) pacemaker rhythm. Ischemic ECG changes occurred in 143 (62%) patients. Patients with AF showed higher IL-6 (p=0.0296) and neopterin (p=0.0494) concentrations. Patients with ischemic ECG changes showed higher ET-1 (p=0.0303), 8-epi-PGF2a (p=0.0027), neopterin (p=0.0004) concentrations and 1-year mortality rate (p=0.0105). The difference in ET-1 remained in logistic regression (p=0.0152). Internal diameter of the left ventricle on echo correlated with IL-6 (r =0.345, p=0.0017), TNFa (r =0.240, p=0.0273), and neopterin (r =0.327, p=0.0028). Internal diameter of the left atrium correlated with TNFa (r =0.384, p=0.0092) and neopterin (r =0.526, p=0.0004), and ejection fraction (EF) correlated inversely with IL-6 (r =-0.380, p=0.0015) and neopterin (r =-0.346, p=0.0038). Patients with EF <40% showed higher (p=0.0462) 1-year mortality rate than patients with EF >40%. In conclusion, in critical limb ischemia, cardiac rhythm disturbances and ischemic ECG changes were related to inflammatory mediators and predicted 1-year mortality rate. The inflammatory mediators correlated with echocardiographic signs of congestive heart failure.
|
|
| 2. |
- Barani, Jamal
(författare)
-
CRITICAL LIMB ISCHAEMIA WITH SPECIAL EMPHASIS ON EPIDEMIOLOGY, INFLAMMATORY MARKERS AND CARDIAC FUNCTION
- 2006
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- In Conclusion Paper I. In patients undergoing aorto-iliac angiography, no effects of the procedure were seen upon inflammatory mediators. On the other hand, angiography influenced markers of platelet activation in these patients. Paper II. The incidence of CLI in southern Sweden is 38/100 000 subjects/year. Both medical risk factors for atherosclerosis and concomitant cardiovascular disease are common among patients with CLI. Furthermore, medical risk-factor treatment in these high-risk patients is suboptimal in relation to current recommendations. Patients with CLI need to be evaluated and treated by physicians with knowledge of and interest for treatment of risk factors for atherosclerosis. Papers III-IV. Of Swedish CLI patients, 24 % die during the first year after hospitalisation. Inflammatory markers, especially neopterin and TNF-?, independently predict 1-year mortality in CLI, and are related to indices of cardiac dysfunction. Paper V. Diabetes in CLI is often combined with renal impairment and more often with infra-inguinal atherosclerosis. The inflammatory markers TNF-? and neopterin are increased in diabetic patients with CLI as compared to non-diabetic patients with CLI.
|
|
| 3. |
|
|
| 4. |
- Barani, Jamal, et al.
(författare)
-
Platelet and leukocyte activation during aortoiliac angiography and angioplasty.
- 2002
-
Ingår i: European Journal of Vascular and Endovascular Surgery. - : Elsevier BV. - 1532-2165 .- 1078-5884. ; 23:3, s. 220-225
-
Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: to evaluate platelet and leukocyte activation during aortoiliac angiography and percutaneous transluminal angioplasty (PTA). METHODS: an observational study of 14 patients with aortoiliac atherosclerotic disease, nine of whom underwent PTA. The proportion of fibrinogen-, and P-selectin positive platelets, P-selectin expression on platelets, intraplatelet cGMP and cAMP, CD18 positive granulocytes, CD18 expression on granulocytes, plasma (p)-neopterin, p-TNF alpha and p- interleukin-6 were repeatedly measured in arterial blood during angiography and in venous blood before and after. RESULTS: compared to a previous venous sample, arterial intraplatelet cAMP was increased proximal to the atherosclerotic lesion before contrast infusion and PTA (median 18 [range: 14-22] vs 16 [15-21] pmol/10(9) platelets p<0.05), and intraplatelet cGMP was increased proximal to the lesion after contrast infusion and PTA (1.2 [0.8-3.9] vs 0.9 [0.6-2.5] pmol/10(9) platelets p<0.05). Four hours after angiography, both the proportion of P-selectin positive platelets (28[11-55]%) and platelet P-selectin expression (9[6-40]) had decreased (p<0.05), from arterial values distal to the lesion before contrast infusion and PTA (57 [24-78]% and 26 [10-83]). Granulocyte CD18 expression was lower during angiography than in a previous venous sample. CONCLUSIONS: the results are compatible with platelet but not leukocyte activation during peripheral angiography.
|
|
| 5. |
- Barani, Jamal, et al.
(författare)
-
Suboptimal treatment of risk factors for atherosclerosis in critical limb ischemia
- 2005
-
Ingår i: International Angiology. - 0392-9590 .- 1827-1839. ; 24:1, s. 59-63
-
Tidskriftsartikel (refereegranskat)abstract
- Aim. The epidemiology of critical limb ischemia (CLI) is insufficiently studied, and treatment of risk factors for atherosclerosis has received less attention in CLI patients than in patients with coronary or precerebral atherosclerosis. The aim of this study was to establish the incidence of CLI and the quality of risk factor treatment in Swedish CLI patients. Methods. During 14 months, 316 consecutive CLI patients were referred to the Malmö Department of Vascular Diseases. Two hundred and fifty-nine (82%) consented to evaluation of intercurrent disease, medication, ankle and arm blood pressures (BP), plasma glucose and lipid levels, phomocysteine, cardiolipin antibodies and activated protein C (APC)-resistance. Results. The incidence of CLI was 38/100 000 inhabitants/year. Patient age was 75±10 years, and BP 147±26/75±14 mmHg. Systolic or diastolic BP above recommended levels (140/90 mmHg) occurred in 137 (53%) patients. P-cholesterol was 4.8±1.2 mMol/L, but cholesterol above recommended level (5 mMol/L) or LDL above recommended level (3 mMol/L) occurred in 125 (48%) patients. Only 24% of patients met national recommendations for both BP and lipid levels. Diabetes mellitus was previously known in 123 (47%) patients, and another 12 (5%) patients showed diabetic fasting glucose levels during the hospital stay. Eightyfour (32%) patients were active, and 72 (28%) were former smokers. Myocardial infarction or angina pectoris had previously been diagnosed in 123 (47%) patients. P-homocysteine was 17±7 μol/l, cardiolipin antibodies occurred in 71 (27%) and APC-resistance in 34 (13%) patients. Conclusion. Patients with CLI show high comorbidity in vascular diseases and high prevalence of modifiable risk factors for atherosclerotic vascular disease. The use of evidence-based medical therapy is suboptimal in this high-risk group.
|
|
| 6. |
- Bertz, L, et al.
(författare)
-
Are there differences of inflammatory bio-markers between diabetic and non-diabetic patients with critical limb ischemia?
- 2006
-
Ingår i: International Angiology. - 1827-1839. ; 25:4, s. 370-377
-
Tidskriftsartikel (refereegranskat)abstract
- Aim. This observational study was undertaken in order to analyse whether any differences could be detected between diabetic and non-diabetic patients with critical limb ischemia (CLI) concerning the inflammatory response. Methods. A total number of 259 consecutive patients with CLI were treated between October 2001 and January 2003. Results. Among the 259 patients, 135 (52%) had diabetes, previously known in 123, and detected during hospitalization in 12. The diabetic patients more often showed gangrene (P < 0.05) and infra-inguinal atherosclerosis (84% vs 67%, P=0.001). The patients with diabetes showed a better lipid profile (total cholesterol 4.6 vs 5 mmol/L, P=0.006 and lower LDL-cholesterol (2.7 vs 3.1 mmol/L, P=0.010) despite the same frequency of statin treatment. They showed a higher creatinine (149 vs 117 pmol/L, P=0.0003) than the nondiabetic patients. Of the inflammatory markers, C-reactive protein (CRP) was equally elevated in both groups. Tumor necrosis factor-a (TNF-a) was increased among the diabetic patients (2.6 vs 1.8 pg/mL, P < 0.05), and this difference was most evident in those with gangrene. Neopterin was also higher among the diabetic patients (31 vs 21 mmol/L, P < 0.01), but CD40L was not different between groups. Conclusions. Diabetes mellitus was very common in CLI patients, and more often combined with renal impairment and infra-inguinal atherosclerosis. The inflammatory markers TNF-alpha and neopterin were elevated in patients with diabetes as compared to non-diabetic patients, but this difference cannot explain why CLI is 10 times more frequent in diabetic patients.
|
|
| 7. |
- Isma, Nazim, et al.
(författare)
-
Lipid-Lowering Therapy is Related to Inflammatory Markers and 3-Year Mortality in Patients With Critical Limb Ischemia.
- 2008
-
Ingår i: Angiology. - : SAGE Publications. - 0003-3197 .- 1940-1574. ; 59, s. 542-548
-
Tidskriftsartikel (refereegranskat)abstract
- To evaluate relationships between lipid-lowering therapy, inflammation, and 3-year mortality in critical limb ischemia (CLI), 259 consecutive CLI patients underwent evaluation of medication, tumor necrosis factor-alpha, interleukin-6 (IL6), neopterin, high-sensitivity C-reactive protein (hs-CRP), 8-epi-PGF2alpha, and endothelin-1. Mortality was assessed after 3 years. Sixty-one patients (24%) were on lipid-lowering therapy and 59 patients (97%) on statins. Patients on lipid-lowering therapy were younger and showed lower low-density lipoprotein cholesterol, hs-CRP, and IL-6 levels than patients without therapy. Three-year survival was higher among patients on lipid-lowering therapy. In logistic regression, the effect of lipid-lowering therapy on 3year survival was significant with inflammatory markers entered into the model one by one but disappeared when all inflammatory markers were entered into the model together. In conclusion, hs-CRP and IL-6 levels were lower and 3-year survival was higher in CLI patients on lipid-lowering therapy.
|
|
