| 1. |
- Aburawi, Elhadi, et al.
(author)
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A transthoracic Doppler echocardiography study of C-reactive protein and coronary microcirculation in children after open heart surgery.
- 2007
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In: Cardiology in the Young. - 1467-1107. ; 17:5, s. 472-477
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Journal article (peer-reviewed)abstract
- Background Systemic inflammation has been suggested to underlie in part the elevated risk of arrhythmias and myocardial dysfunction during the first weeks after cardiac surgery. Recent transthoracic Doppler studies from our centre indicated increased basal coronary arterial flow in children 5 days after cardiopulmonary bypass surgery. In these children, we investigated whether the inflammatory mediator, C-reactive protein, could influence this association. Methods The peak flow velocity, velocity time-integral in diastole and systole, and basal blood flow in the proximal part of the left anterior descending artery, were assessed by transthoracic Doppler echocardiography 1 day before, and 5 days after, cardiac surgery in 17 children with ventricular and atrioventricular septal defects whose mean age at surgery was 6 months. Levels of C-reactive protein in the plasma were measured at both time-points. Results Prior to surgery, all children had levels of C-reactive protein under the limit for detection, that is less than 0.8 milligrams per litre. The levels of the protein had increased significantly by the second day, when the median value was 25, and the range from 20 to 142 milligrams per litre. They remained elevated on the fifth day after surgery, when the median was 11, and the range from 3 to 20 milligrams per litre. On the fifth day, the percentage increase in velocity time integral corrected for left ventricular mass was significantly lower in those patients with C-reactive protein greater than or equal to 10 milligrams per litre than in the remaining patients. Also, both the velocity time integral and the velocity of diastolic peak flow correlated inversely with log C-reactive protein, r being equal to −0.54 and p less than 0.02 and r equal to −0.74 and p less than 0.01, respectively, particularly among those patients in whom clamping of the aorta lasted for more than 1 hour, r for this statistic being equal to −0.8. Conclusion The postsurgical increase in the velocity of coronary arterial flow in children is inversely associated with rising levels of C-reactive protein. The duration of the aortic cross-clamping during surgery strengthens the association between levels of C-reactive protein and the microcirculatory changes.
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| 2. |
- Aburawi, Elhadi, et al.
(author)
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Coronary Blood Flow by Transthoracic Echocardiography in Children with Endomyocardial Fibrosis.
- 2009
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In: Pediatric Cardiology. - : Springer Science and Business Media LLC. - 0172-0643 .- 1432-1971. ; 30, s. 371-373
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Journal article (peer-reviewed)abstract
- We report herein the coronary flow (CF) pattern determined by transthoracic Doppler echocardiography (TTDE) in two children with biventricular endomyocardial fibrosis (EMF). Endomyocardial biopsy showed various degrees of cardiac fibrosis in both patients as well as signs of chronic inflammation in one of the patients. TTDE showed a significant increase in CF in both the left anterior descending coronary artery and the posterior descending coronary artery compared with age-matched healthy controls. The diastolic flow in patients with EMF appeared to terminate earlier than in controls. The mechanisms and the potential significance of these novel findings are discussed.
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| 3. |
- Aburawi, Elhadi, et al.
(author)
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Coronary flow before and after surgical versus device closure of atrial septal defect.
- 2009
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In: International Journal of Cardiology. - : Elsevier BV. - 0167-5273. ; 135, s. 14-20
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Journal article (peer-reviewed)abstract
- BACKGROUND: Cardiopulmonary bypass (CPB) affects coronary flow after the operation. Surgical as compared to device closure of atrial septal defect (ASD) serves as a good model to clarify the effects of surgery with CPB on coronary flow. METHODS: Coronary flow parameters were determined by transthoracic Doppler echocardiography before and after ASD closure. Thirteen children underwent surgery on CPB and fourteen children had device closure of their ASD under interventional cardiac catheterisation. Fourteen age-matched healthy controls were studied. RESULTS: Left ventricular fractional shortening increased and cardiac output increased after the device closure but there were no significant changes after the surgery. After the surgery the mean diameter of left anterior descending coronary artery increased from 1.7+/-0.6 to 2.1 +/-0.4 mm (p=0.03), the peak flow velocity in diastole (PFVd) from 48+/-10 to 70+/-12 cm/s (p=0.0001) and basal blood flow (BF) from 62+/-18 to 105+/-35 ml/min (p=0.0001). Flow parameters in the right coronary artery increased similarly. In contrast, all coronary flow parameters decreased substantially after catheter interventions, but still remained significantly elevated as compared with controls. CONCLUSIONS: Surgery with cardiopulmonary bypass but not the device closure affects coronary flow beyond the pure effects of anatomical correction. Cardiac output increases after the device closure. The reported decrease of coronary flow reserve is obviously due to increased basal coronary flow.
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| 4. |
- Aburawi, Elhadi, et al.
(author)
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Effects of Balloon Valvuloplasty on Coronary Blood Flow in Neonates With Critical Pulmonary Valve Stenosis Assessed With Transthoracic Doppler Echocardiography.
- 2009
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In: Journal of the American Society of Echocardiography. - : Elsevier BV. - 1097-6795 .- 0894-7317. ; 22, s. 165-169
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Journal article (peer-reviewed)abstract
- BACKGROUND: Treating pulmonary valve stenosis with balloon valvuloplasty (BV) is a good model to study the effect of right ventricular (RV) pressures on coronary flow. METHODS: Transthoracic Doppler echocardiography was used to register coronary flow in 10 age-matched healthy controls and 7 neonates before and 1 day after BV. RESULTS: Left ventricular fractional shortening and cardiac output increased significantly after BV. Right coronary artery diameter decreased from 1.2 +/- 0.2 to 1.1 +/- 0.1 mm (P < .02). Posterior descending coronary artery flow parameters decreased significantly, with blood flow decreasing from 8.4 to 5.7 +/- 1.9 mL/s (P < .003). RV end-diastolic pressure and RV systolic pressure explained almost totally the variation in coronary flow (r(2) = 0.87). CONCLUSIONS: RV end-diastolic pressure and RV systolic pressure determined coronary flow in neonates with critical pulmonary valve stenosis. Cardiac output and left ventricular fractional shortening increased after pulmonary valve BV.
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| 5. |
- Aburawi, Elhadi, et al.
(author)
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Effects of cardio-pulmonary bypass surgery on coronary flow in children assessed with transthoracic Doppler echocardiography.
- 2007
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In: American Journal of Physiology: Heart and Circulatory Physiology. - : American Physiological Society. - 1522-1539 .- 0363-6135. ; 293:2, s. 1138-1143
-
Journal article (peer-reviewed)abstract
- Perturbation of coronary blood flow (CF) is an important contributor to myocardium-related complications. The study was primarily designed to assess the impact of cardiopulmonary bypass (CPB) surgery on CF by aid of transthoracic Doppler echocardiography. Changes in CF after off-pump coarctation surgery were also studied. All ultrasounds were performed before and 5 ± 1 days after surgery. Eighteen children underwent CPB surgery of ventricular left-to-right shunts at the mean age of 6 mo, while off-pump surgery (aortic coarctectomy) was undertaken at the mean age of 10 days in 12 children. After CPB surgery, both left anterior descending coronary artery mean diameter and basal CF increased from 1.7 ± 0.3 to 2.1 ± 0.4 mm (P = 0.001) and 27 ± 10 to 47 ± 15 ml/min (P = 0.0001), respectively. These two coronary variables decreased after off-pump coarctectomy: left anterior descending coronary artery mean diameter from 1.8 ± 0.1 to 1.7 ± 0.1 mm (P = 0.06), and CF from 44 ± 12 to 25 ± 8 ml/min (P = 0.001). The findings are in keeping with the hypothesis that the previously reported impairment of coronary flow reserve after CPB surgery could be due to increase in basal coronary flow after CPB. Off-pump coarctectomy seems to have little impact on CF, as the postsurgical decline in flow in these patients seems to relate to the reduction in cardiac pressure afterload.
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| 6. |
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| 7. |
- Andersson, Sven Ingmar, et al.
(author)
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Perspectives that lay persons with and without health problems show toward coronary heart disease: An integrated biopsychosocial approach.
- 2007
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In: Heart & Lung. - : Elsevier BV. - 1527-3288 .- 0147-9563. ; 36:5, s. 330-338
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Journal article (peer-reviewed)abstract
- Objective: We studied what patients with acute coronary heart disease (CHD) considered the three most stressful factors experienced during the month before testing and what they attributed their heart disease to. Methods: We studied the occurrence and severity of physiologic, psychologic, and psychosocial stressors in 117 patients with acute CHD and 117 referents, not diagnosed with CHD, matched by age,, sex, and municipality. The subjects were first to select the factors they considered stressful from a list of potentially stressful factors. They were then to select the three they regarded as most stressful and to provide situational accounts of these. Results: The patients with CHD were found to less frequently live with a partner, to more frequently have a body mass index higher than 30.0, and to report a greater number of stressors. The stressors best differentiating them from the referents were fatigue, shortness of breath, pain, and high blood pressure. The causal factors they most frequently named were heart problems, smoking, heredity, high workload, and poor eating habits. Conclusions: The situational accounts the patients provided illustrate the biopsychosocial complexities involved in the various categories of stressful factors.
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| 8. |
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| 9. |
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| 10. |
- El-Segaier, Milad, et al.
(author)
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Atrial septal defect: a diagnostic approach
- 2006
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In: Medical & Biological Engineering & Computing. - : Springer Science and Business Media LLC. - 0140-0118 .- 1741-0444. ; 44:9, s. 739-745
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Journal article (peer-reviewed)
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| 11. |
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| 12. |
- El-Segaier, Milad, et al.
(author)
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Detection of cardiac pathology: time intervals and spectral analysis.
- 2007
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In: Acta Pædiatrica. - : Wiley. - 1651-2227 .- 0803-5253. ; 96:7, s. 1036-1042
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Journal article (peer-reviewed)abstract
- AIM: To develop an objective diagnostic method that facilitates detection of noncyanotic congenital heart diseases. METHODS: Heart sounds and murmurs were recorded from 60 healthy children and 173 children with noncyanotic congenital heart disease. Time intervals were measured and spectrum of the systolic murmurs analyzed. Stepwise logistic regression analysis was used to distinguish physiological from pathological signals. The receiver operating characteristic (ROC) curve was plotted to show the classification performance of the model and the area under the curve (AUC) was calculated. The probability cut-off points for calculation of sensitivities and specificities were estimated. RESULTS: The distinguishing variables were the interval from the end of the first heart sound (S(1)) and the beginning of the systolic murmur, respiratory variation of the splitting of the second heart sound, intensity of the systolic murmur, and standard deviation of the interval from the end of the S(1) to the maximum intensity of the murmur. The AUC was 0.95, indicating an excellent classification performance of the model. The sensitivity of 95% and specificity of 72% was achieved at a probability cut-off point of 0.45. Significant cardiac defects were correctly classified. CONCLUSION: Interval measurements and spectral analysis can be used to confirm significant noncyanotic congenital heart diseases. Further development of the method is necessary to detect also insignificant heart defects.
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| 13. |
- Harling, Solweig, et al.
(author)
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Acute decrease of coronary flow after indomethacin delivery in newborn lambs.
- 2007
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In: Acta Pædiatrica. - : Wiley. - 1651-2227 .- 0803-5253. ; 96:10, s. 1460-1463
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Journal article (peer-reviewed)abstract
- Aim: To document the effects of indomethacin (IND) on coronary flow. Methods: We studied nine premature lambs during the first day of life. The gestational age varied between 132 and 134 days (term 145 days) and weight 3.1-4.7 kg. Coronary flow velocities were recorded with an intracoronary Doppler guide wire in the proximal left anterior descending coronary artery (LAD). Average peak flow velocity was measured before, during and after an intravenous IND injection of 0.2 mg per kilogram of body weight. Results: IND increased systemic blood pressure (p < 0.05) and rate pressure product (RPP; p < 0.05) indicating that IND increased cardiac workload. IND decreased coronary average peak flow velocity in all lambs (p < 0.05). The maximal fall in coronary velocity appeared after 3 min (range 1-7 min) and was regained 10 min (range 4-53 min) after the drug delivery. The maximal reduction of coronary average peak flow velocity was 52% (median 26). The recovery time was directly related to the maximal reduction of the coronary average peak flow velocity (R = 0.91, R-2 0.84, p < 0.002). Conclusion: Coronary flow velocity decreased markedly in premature born lambs given a bolus dose of IND.
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| 14. |
- Harling, Solweig, et al.
(author)
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Quantification of left to right shunt in patent ductus arteriosus by color doppler
- 2009
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In: Ultrasound in Medicine and Biology. - : Elsevier BV. - 0301-5629. ; 35, s. 403-408
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Journal article (peer-reviewed)abstract
- Ultrasound is a reliable tool to diagnose patent ductus arteriosus in premature infants but no reliable noninvasive method exists to quantify ductal flow. The aim of this study was to quantify the size of the shunt via persistent ductus arteriosus from pixel counts in color Doppler flow images. A cotton band was placed around the ductus arteriosus of newborn lambs to adjust the magnitude of flow. For flow measurements, ultrasonic transit time flow probes were applied around the ascending aorta and ductus arteriosus. Twenty-four different flow states were attained in four newborn lambs. An Acuson Sequoia scanner equipped with a 7 MHz transducer was used to register Doppler data and images with maximal color distribution during diastole in the pulmonary artery longitudinal sections (PALS). Each image-pixel was matched with the color velocity bar and the pixels were assigned to the corresponding flow velocity. The total area showing color relative to the area of the PALS correlated well with the amount of ductal flow (r = 0.87, r(2) = 0.75, p < 0.001). When Qp/Qs was >1.4:1, more than 40% of the area in PALS in diastole exhibited color information. Similarly, the color pixel velocities squared correlated with the size of the shunt. Quantification of the percentage of pixels in a color Doppler registration via a computer-based analysis shows a high correlation with the size of ductal shunting. (E-mail: solweig.harling@med.lu.se).
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| 15. |
- Juonala, Markus, et al.
(author)
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Geographic Origin as a Determinant of Carotid Artery Intima-Media Thickness and Brachial Artery Flow-Mediated Dilation. The Cardiovascular Risk in Young Finns Study.
- 2005
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In: Arteriosclerosis, Thrombosis and Vascular Biology. - 1524-4636. ; 25:2, s. 392-398
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Journal article (peer-reviewed)abstract
- Objective - People living in eastern Finland have approximate to 40% higher coronary heart disease mortality rates than western Finns. Whether this is because of genetic or environmental factors is unknown. We examined the effect of geographic family origin on subclinical atherosclerosis among young Finns. Methods and Results - As part of a longitudinal follow-up study, we measured carotid intima-media thickness (IMT) in 2264 and brachial flow-mediated dilation (FMD) in 2109 white adults, aged 24 to 39 years. Subjects from eastern Finland had greater IMT and lower FMD compared with western subjects. These differences accentuated when the subjects' family origin ( grandparents' birthplace) was taken into account and remained significant after adjusting for several environmental factors. Among subjects with all grandparents born in eastern or western Finland, IMTs were ( mean +/- SEM) 0.592 +/- 0.003 versus 0.565 +/- 0.005 mm ( P < 0.0001), respectively. The corresponding FMD values were 7.61 +/- 0.15% versus 8.75 +/- 0.26%; P < 0.01. The number of grandparents born in eastern Finland was directly related to IMT ( P < 0.0001) and inversely to FMD ( P < 0.05). Conclusions - Young adults originating from eastern Finland have greater carotid IMT and lower brachial FMD than western Finns. Consistent with a hereditable component predisposing to or protecting from atherosclerosis, these differences accentuated when subjects' family origin was taken into account.
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| 16. |
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| 17. |
- Liuba, Petru, et al.
(author)
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Effects of Bradykinin on Aortic Endothelial Function in ApoE-Knockout Mice With Chronic Chlamydia Pneumoniae Infection.
- 2007
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In: Circulation Journal. - : Japanese Circulation Society. - 1346-9843 .- 1347-4820. ; 71:9, s. 1480-1484
-
Journal article (peer-reviewed)abstract
- Background Impaired muscarinic receptor-mediated vasodilation is an important feature of early atherosclerosis. Earlier studies on apolipoprotein E-knockout mice (apoE-KO) mice suggested adverse effects of Chlamydia pneumoniae infection on the endothelial vasomotor responses of aortas to the muscarinic agonist methacholine. Using additional aorta samples the present study investigated the responses to bradykinin. Methods and Results ApoE-KO mice were repeatedly inoculated with either Chlamydia pneumoniae (C. pneumoniae) or saline. At 2, 6, and 10 weeks after the first inoculation, precontracted aorta rings from both groups were exposed to bradykinin in the absence and presence of L-NAME and diclofenac. In noninfected animals, the vasomotor responses to bradykinin were similar at all timepoints (p > 0.5). Compared with noninfected animals, the responses in infected animals tended to increase through the study period (p < 0.05 at 10 weeks). Although diclofenac and L-NAME had no effect in noninfected mice, they inhibited the responses to bradykinin in infected mice at 6 and, more markedly, 10 weeks (p < 0.05 for both). Conclusion Bradykinin stimulation of aorta endothelium from C. pneumoniae-infected apoE-KO animals appears to activate compensatory kinin receptor-related mechanisms that could involve nitric oxide and vasorelaxing prostanoids. Although the precise molecular mechanisms require further investigation, one could speculate that strategies increasing bradykinin availability might reverse the arterial dysfunction during chronic infectious disease.
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| 18. |
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| 19. |
- Liuba, Petru, et al.
(author)
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Protective effects of simvastatin on coronary artery function in swine with acute infection.
- 2006
-
In: Atherosclerosis. - : Elsevier BV. - 1879-1484 .- 0021-9150. ; 186:2, s. 331-336
-
Journal article (peer-reviewed)abstract
- Background: The risk for coronary events may rise during acute infection. Perturbation in coronary endothelial function emerges as one important link. We investigated whether simvastatin could protect the coronary arterial function from the adverse effects of acute infection in swine. Methods: Coronary endothelium-dependent and -independent vasomotor responses were assessed by Doppler velocimetry in 12 Chlamydia pneunioniae-infected and 6 sham-infected swine 2 weeks after intratracheal inoculation. Half of animals from the infection group were pretreated with simvastatin (80 mg daily), while the remaining animals received placebo. The treatment was started 2 weeks prior to inoculation and Continued until the end of the Study. ANOVA was used for statistical calculations. Data are mean +/- S.D. Results: All animals inoculated with C. pneumoniae developed IgM antibodies against this organism. As compared to noninfected animals, peak-to-baseline coronary flow velocity (CFV) ratio after bradykinin was significantly decreased in infected animals regardless of statin treatment (1,p=0.01). Intracoronary 10(-6) M acetylcholine caused slight dilatory responses in both noninfected and infected-treated animals (CFV ratio: 1.6 +/- 0.2and 1.4 +/- 0.2, respectively: p > 0.1),while a velocity drop (CFV ratio: 0.7 +/- 0.1; p < 0.01 versus noninfected-infected and treated). indicating constriction, was observed in in fected-non treated animals; 10(-5) M acetylcholine caused vasoconstriction in all animals, with a significantly more prolonged response in the infected-non treated group (p < 0.01). Intracoronary adenosine and SNP induced similar dilatory responses in all groups (p > 0.5). There were no differences in markers of systemic inflammation (fibrinogen, amyloid, and CRP) and lipid profile (HDL, LDL and total cholesterol) between the groups (p > 0.2). Conclusion: Acute infection is associated with impairment of the muscarinic and kinin-related reactivity of coronary circulation. These functional abnormalities are in part prevented by simvastatin through mechanisms unrelated to lipid lowering. (c) 2005 Elsevier Ireland Ltd. All rights reserved.
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| 20. |
- Liuba, Petru, et al.
(author)
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Residual adverse changes in arterial endothelial function and LDL oxidation after a mild systemic inflammation induced by influenza vaccination
- 2007
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In: Annals of Medicine. - : Informa UK Limited. - 1365-2060 .- 0785-3890. ; 39:5, s. 392-399
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Journal article (peer-reviewed)abstract
- Background. Several clinical studies have suggested possible increase in cardiovascular risk during and in the first weeks after an acute inflammatory disease. Using influenza vaccine as inflammatory stimulus, we investigated whether arterial endothelial dysfunction could persist beyond the inflammatory state, and whether amplified oxidative modification of low-density lipoprotein (LDL) accompanies this vascular disturbance. Methods and subjects. The brachial artery responses to hyperemia (flow-mediated dilatation (FMD), and to sublingual glyceryl trinitrate (GTN), and the carotid intima-media thickness were assessed by external ultrasound in eight healthy male volunteers (age 17-30 y) before, and 2 and 14 days after intramuscular administration of influenza vaccine. Plasma levels of high-sensitivity C-reactive protein (CRP), fibrinogen, cyclic guanosine monophosphate (cGMP), and antibodies against oxidized LDL (oxLDL) were measured at each time point. Data are means +/- standard errors of the mean (SEM). Results. Influenza vaccination caused a slight elevation in CRP (from 0.5 +/- 0.1 at baseline, to 2 +/- 0.6 mg/L, P=0.01) and fibrinogen (from 2.3 +/- 0.1 to 2.7 +/- 0.1 g/L, P=0.01) at 2 days, which completely resolved at 14 days (CRP: 0.6 +/- 0.2 mg/L, P=0.9, and fibrinogen: 2.3 +/- 0.1 g/L, P=0.8 versus baseline). OxLDL antibody levels rose significantly at 2 days (from 1 +/- 0.1 at baseline to 2 +/- 0.4, P=0.04), and remained elevated at 14 days (1.7 +/- 0.3, P=0.1 versus baseline). FMD of the brachial artery decreased at 2 days (from 8.3 +/- 1.2% at baseline, to 5.4 +/- 1%, P=0.05) with a further decrease at 14 days (4.9 +/- 0.8%, P=0.03 versus baseline). The dilatory responses to GTN and the carotid IMT remained unchanged throughout the study period (P>0.5). Conclusion. Abnormalities in arterial function and LDL oxidation may persist for at least 2 weeks after a slight inflammatory reaction induced by influenza vaccination. These could explain in part the earlier reported increase in cardiovascular risk during the first weeks after an acute inflammatory disorder.
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| 21. |
- Noponen, Tommi, et al.
(author)
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Circulatory Effects of Inhaled Iloprost in the Newborn Preterm Lamb.
- 2009
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In: Pediatric Research. - 1530-0447. ; 66, s. 416-422
-
Journal article (peer-reviewed)abstract
- Inhaled nitric oxide (iNO) has an established role in the treatment of pulmonary hypertension in the newborn. However, costs and potential toxicity associated with iNO have generated interest in alternative inhaled selective pulmonary vasodilators such as iloprost. In a preterm lamb model of respiratory distress syndrome, we studied effects of increasing doses of iloprost followed by iNO on right ventricular pressure (RVP) and circulation including cerebral oxygenation. Fetal sheep were randomized to three doses (0.2 - 4 mg/kg) of iloprost (n=9) or saline (n=10), administered as 15 min inhalations with 15 min intervals after a 60-min postnatal stabilisation. No differences were found in RVP, arterial pO2, or cardiac index according to treatment. The cerebral oxygenation, measured with near-infrared spectroscopy, deteriorated in control lambs, but not in iloprost lambs. Iloprost treatment followed by iNO resulted in a larger decrease (p=0.007) in RVP than saline treatment followed by iNO. In conclusion, iloprost stabilised cerebral oxygenation and when followed by iNO had a larger effect on RVP than iNO alone. Although species differences may be relevant, these results suggest that iloprost should be studied in newborn infants for the treatment of pulmonary hypertension.
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| 22. |
- Pesonen, Erkki, et al.
(author)
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Dual role of infections as risk factors for coronary heart disease.
- 2007
-
In: Atherosclerosis. - : Elsevier BV. - 1879-1484 .- 0021-9150. ; 192:2, s. 370-375
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Journal article (peer-reviewed)abstract
- Aims: The aim of the study was to explore whether exposure to microbial agents determines the prevalence of acute coronary events. Methods and results: Patients with unstable angina pectoris and myocardial infarction (N = 335) and their paired controls were investigated. The subjects answered a questionnaire about their childhood contagious diseases: varicella, scarlet fever, measles, rubella, mononucleosis and mumps. Blood samples were taken for bacterial and viral serology. The odds ratio for CHD was highest in the upper quartile of the enterovirus (EV), herpes simplex virus (HSV) and Chlamydia pneumoniae HSP60 IgG antibody titers (1.86, p = 0.001, 1.57, p < 0.048 and 1.70, p = 0.016, respectively). The antibody titers increased cumulatively the risk for CHD (odds ratios 1.89, 2.24, 3.92 and p-values < 0.001, 0.001 and 0.047). Childhood contagious diseases (n = 6) had a protecting effect against CHD (odds ratio 0.86, p = 0.013). The risk for acute coronary events decreased significantly with increasing number of childhood contagious diseases (p = 0.007). Conclusions: Infections have a dual role in the genesis of CHD. EV, HSV and C. pneumoniae heat shock protein 60 IgG antibodies are associated with increased risk for CHID. Protection from infections usually suffered during the childhood before the era of MMR vaccination may predispose the individual to CHD.
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| 23. |
- Pesonen, Erkki, et al.
(author)
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Elevated infection parameters and infection symptoms predict an acute coronary event.
- 2008
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In: Therapeutic Advances in Cardiovascular Disease. - : SAGE Publications. - 1753-9447 .- 1753-9455. ; 2:6, s. 419-424
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Journal article (peer-reviewed)abstract
- BACKGROUND: The etiology and significance of flu-like symptoms often appearing before myocardial infarction should be clarified. METHODS: In a case-control study of 323 matched controls and a random sample of 110 out of 351 cases the presence of infection symptoms during the preceding four weeks before admission were asked and blood samples taken. RESULTS: Enterovirus (EV), herpes simplex virus (HSV), and Chlamydia pneumoniae IgA titers were significantly higher in cases than in controls (p<0.001, 0.008 and 0.046, respectively). Flu-like symptoms appeared significantly more often in patients than in controls the most common one being fatigue (p<0.001). In controls with fatigue, EV and HSV titers showed a trend to be higher (1.50 vs 1.45 and 4.29 vs 3.73) than in controls without fatigue but only HSV titers were statistically significantly higher (3.47 vs 3.96, p = 0.02). Even CRP and amyloid A concentrations (3.49 vs 2.08, p<0.0001 and 5.70 vs 3.77 mg/l, p = 0.003, respectively) as well as C4 (0.40 vs 0.44, p = 0.02) were higher in controls with fatigue. CONCLUSIONS: Odds ratios for a coronary event in a logistic regression model were 4.79 for fatigue and 2.72 for EV antibody levels in their fourth quartile. A linear-by-linear association test showed increasing number of single symptoms with higher EV titer quartiles (p = 0.004).
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| 24. |
- Pesonen, Erkki, et al.
(author)
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Hjärtsjukdomar
- 2006
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In: Barnmedicin. - 9789144044699 ; , s. 321-342
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Book chapter (other academic/artistic)
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| 25. |
- Pesonen, Erkki, et al.
(author)
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Infections as a stimulus for coronary occlusion, obstruction, or acute coronary syndromes.
- 2009
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In: Therapeutic Advances in Cardiovascular Disease. - : SAGE Publications. - 1753-9447 .- 1753-9455.
-
Journal article (peer-reviewed)abstract
- BACKGROUND: : Atherosclerosis is considered to be an inflammatory disease. Infections are a significant cause of inflammation. Acute infections might precipitate acute coronary syndromes (ACS) whereas chronic infections might be stimuli for the development of atherosclerosis. METHODS: : Coronary angiograms were done on 211 of 335 patients with ACS and the percentage of coronary obstruction was determined. Serum antibody levels to Chlamydia pneumoniae, C. pneumoniae heat shock protein 60 (CpnHSP60), human heat shock protein 60 (hHSP60), enterovirus (EV), herpes simplex virus (HSV), cytomegalovirus (CMV), and two major periodontal pathogens, Aggregatibacter actinomycetemcomitans and Porphyromonas gingivalis, were measured in healthy controls (n = 355) and all patients. RESULTS: : Serum antibody levels to periodontal pathogens did not correlate with ACS. However, IgA-class antibody levels to Aggregatibacter actinomycetemcomitans (p = 0.021), CpnHSP60 (p = 0.048) an hHSP60 (p = 0.038) were higher in patients with coronary occlusion or obstruction compared to those without any obstruction. Odds ratios for coronary changes in the highest quartile as compared to the lower quartiles were for A. actinomycetemcomitans IgA 7.84 (95% CI 1.02-60.39, p = 0.048), for CpnHSP60 IgA 8.61 (1.12-65.89, p = 0.038), and for human HSP60 IgA 3.51 (0.79-15.69, p = 0.100). CONCLUSIONS: : We have previously reported that EV and HSV titres correlated significantly to acute coronary events. They do not correlate to the degree of coronary obstruction as shown here. However, infection by A. actinomycetemcomitans or C. pneumoniae or host response against them associated with coronary obstruction. Clinical coronary events may arise by the effect of acute infections and obstructing lesions by a chronic inflammatory stimulus.
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