Subtotal nephrectomy plus coronary ligation leads to more pronounced damage in both organs than either nephrectomy or coronary ligation
Am J Physiol Heart Circ Physiol. 2012 Feb;302(3):H845-54.
Bongartz LG, Joles JA, Verhaar MC, Cramer MJ, Goldschmeding R, Tilburgs C, Gaillard CA, Doevendans PA, Braam B.
Coexistence of chronic kidney disease (CKD) and heart failure (HF) in humans is associated with poor outcome. We... more Coexistence of chronic kidney disease (CKD) and heart failure (HF) in humans is associated with poor outcome. We hypothesized that preexistent CKD worsens cardiac outcome after myocardial infarction, and conversely that ensuing HF worsens progression of CKD. Subtotally nephrectomized (SNX) or sham-operated (CON) rats were subjected to coronary ligation (CL) or sham surgery in week 9 to realize four groups: CON, SNX, CON + CL, and SNX + CL. Blood pressure and renal function were measured in weeks 8, 11, 13, and 15. In week 16, cardiac hemodynamics and end-organ damage were assessed. Blood pressure was significantly lower in SNX + CL vs. SNX. Despite this, glomerulosclerosis was more severe in SNX + CL vs. SNX. Two weeks after CL, SNX + CL had more cardiac dilatation compared with CON + CL (end-diastolic volume index: 0.28 ± 0.04 vs. 0.19 ± 0.03 ml/100 g body wt; mean ± SD, P < 0.001), although infarct size was similar. During follow-up in SNX + CL, ejection fraction declined. Mortality was only observed in SNX + CL (2 out of 9). In SNX + CL, end-diastolic pressure (18 ± 4 mmHg) and tau (29 ± 9 ms), the time constant of active relaxation, were significantly higher compared with SNX (13 ± 3 mmHg, 20 ± 4 ms; P < 0.01) and CON + CL (11 ± 5 mmHg, 17 ± 2 ms; P < 0.01). The diameter of small arterioles in the myocardium was significantly decreased in SNX + CL vs. CON + CL (P < 0.01). Urinary excretion of NO metabolites was significantly lower in SNX + CL compared with both CL and SNX. This study demonstrates the existence of more heart and more kidney damage in a new model of combined CKD and HF than in the individual models. Such enhanced damage appears to be separate from systemic hemodynamic changes. Reduced nitric oxide availability may have played a role in both worsened glomerulosclerosis and cardiac diastolic function and appears to be a connector in the cardiorenal syndrome.
Purpose in Life and Reduced Risk of Myocardial Infarction Among Older U.S. Adults with Coronary Heart Disease: A Two-Year Follow-Up
by Eric S. Kim
Published in: Journal of Behavioral Medicine
This study examined whether purpose in life was associated with myocardial infarction among a sample of older adults... more This study examined whether purpose in life was associated with myocardial infarction among a sample of older adults with coronary heart disease after adjusting for relevant sociodemographic, behavioral, biological, and psychological factors. Prospective data from the Health and Retirement Study – a nationally representative panel study of American adults over the age of 50 – were used. Analyses were conducted on the subset of 1,546 individuals who had coronary heart disease at baseline. Greater baseline purpose in life was associated with lower odds of having a myocardial infarction during the two-year follow-up period. On a six-point purpose in life measure, each unit increase was associated with a multivariate-adjusted odds ratio of 0.73 for myocardial infarction (95% CI, 0.57-0.93, p =.01). The association remained significant after controlling for coronary heart disease severity, self-rated health, and a comprehensive set of possible confounds. Higher purpose in life may play an important role in protecting against myocardial infarction among older American adults with coronary heart disease.
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Download (.pdf) Factors associated with posttraumatic growth among the spouses of myocardial infarction patients
by Mithat Durak
Key Words: cognitive processing, environmental factors, individual factors, myocardial infarction patients, posttraumatic growth, spouses of myocardial infarction patients
To clarify the rationale behind Posttraumatic Growth (PTG), a model by Schaefer and Moos describes the relative... more To clarify the rationale behind Posttraumatic Growth (PTG), a model by Schaefer and Moos describes the relative contribution of environmental resources, individual resources, event related factors, cognitive processing and coping (CPC) on PTG. In the present study, this model was tested with the spouses of myocardial infarction patients with data from various hospitals in Turkey. A structural equation model revealed that neither individual nor environmental resources had indirect effects on PTG through the effect of event-related factors and CPC, while they showed direct effects on PTG. The findings were discussed in the context of the theoretical model.
Factors Associated with Posttraumatic Growth Among Myocardial Infarction Patients: Perceived Social Support, Perception of the Event and Coping
by Mithat Durak
Key Words: Posttraumatic growth, Perceived social support, Perception of the event, Coping, Myocardial infarction patients
Posttraumatic Growth (PTG) is accepted as positive transformations that are a product of struggling with significant... more Posttraumatic Growth (PTG) is accepted as positive transformations that are a product of struggling with significant stressors such as chronic illness. A model, conceptualized by Schaefer and Moos (Posttraumatic growth: Positive changes in the aftermath of crisis, pp 99–126, 1998), suggests a relative contribution of environmental and individual resources, perception of the event (PE) and coping in the development of PTG. The aim of the present study was to examine the effect of perceived social support (PSS), PE and coping on PTG. This model was tested in a sample of patients with myocardial infarction (MIP, N = 148) from various hospitals in Turkey. The structural equation analysis of the model revealed that PSS was significantly related to PTG through the effect of coping. While coping was significantly and directly related to PTG, PE was not. The findings are discussed in the context of the theoretical model with suggestions for future research.
Cardiac rehabilitation effects on quality of life in patients after acute myocardial infarction.
Aim of this study was to investigate the significance of cardiac rehabilitation (CR) on Health Related Quality of Life... more
Aim of this study was to investigate the significance of cardiac rehabilitation (CR) on Health Related Quality of Life ( HRQoL) in post acute myocardial infarction (AMI) patients.
Methods. A total number of 110 individuals divided in 3 groups was included in the study. Group A consisted of 60 post-AMI patients participating in a CR program. It was a multidisciplinary rehabilitative approach including supervised bike exercise, with parallel education, counselling, psychological and social support, performed 3 times per week for 2 months after AMI. Group B consisted of 40 post-AMI patients not participating in any CR program while the control group C consisted of 10 apparently healthy people. HRQoL was evaluated by the Velasco-Del Barrio questionnaire. Questions on this questionnaire are refered to 9 categories (health, sleep and rest, emotional behavior, concerns for the future, mobility, social interaction, alertness behavior, communication, work and leisure time). A 5-point scale (1=all of the time, 5=none of the time) and a special (1 to 8 coefficient for each parameter were used for the evaluation of each parameter. The highest score of 220 indicates the poorest QL.Results. Group A patients had better score of HRQoL as compared to Group B (94?±3 vs 114?±3, p < 0.001) and slightly worse than Group C patients (94?±4 vs 69?±3, p < 0.01). Significant difference was found among Group A and B patients regarding the most important evaluated parameters such as symptoms (17 ?±6.8 vs 22?±6.5, p < 0.001) and social behavior (21?±4.2 vs 23?±5.5, p < 0.0001). Conclusion. It is concluded that participation in a multidisciplinary CR program significantly improves HRQoL in post AMI patients. All these patients must urged to take part in such programs. Hippokratia 2006; 10 (4): 176-181
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Seen by: Effect of electronic health record subsystems on hospital-wide risk-adjusted mortality rates of Medicare patients with acute myocardial infarction and congestive heart failure
by Peiyin Hung
Background: The final rule from CMS for the meaningful use of electronic health records (EHR) leaves unanswered basic... more Background: The final rule from CMS for the meaningful use of electronic health records (EHR) leaves unanswered basic questions about how the implementation of different EHR subsystems and the sequence of the implementation influences various treatment outcomes. Objectives: To examine the impact of five EHR subsystems on risk-adjusted mortality rates (RSMRs) in patients with AMI or CHF. Methods: 969 non-federal, acute care hospitals in 12 states were extracted from the linked 2008 American Hospital Association EHR Survey and CMS Hospital Compare Database. Adjusting for major hospital characteristics using least squares regression and propensity scores, we analyzed the impact of both EHR adoption and number of adopted EHR subsystems (clinical documentation, test results viewing system, physician order entry, decision support, bar-code system) on the outcomes of AMI and CHF inpatients. Results: Significant variation exists in the implementation of EHR subsystems across U.S. hospitals. The presence of an EHR in a hospital resulted in significant reductions in RSMRs for both AMI and CHF by as much as 0.59%. Adopting an additional subsystem resulted in a reduction in AMI and CHF RSMRs by 0.24% and 0.13%, respectively. However, optimal results were achieved in AMI when hospitals fully adopted at least 3 subsystems; for CHF, results were optimal when a hospital had adopted all 5 subsystems. Conclusions: Adoption of EHR reduces AMI and CHF mortality rates, but their effectiveness is dependent on how many subsystems are adopted. National implementation efforts may benefit from taking into account the sequence of EHR subsystem adoption in hospitals.
Cardiomyocyte VEGFR-1 activation by VEGF-B induces compensatory hypertrophy and preserves cardiac function after myocardial infarction
Co-authored paper with Lorena Zentilin et al from the Molecular Medicine Lab at ICGEB, Trieste.
I worked on this project in 2006 while I was a master student in Medical Biotechnology and doing an internship in the Molecular Medicine Lab at ICGEB, Trieste.
Mounting evidence indicates that the function of members of the vascular endothelial growth factor (VEGF) family... more Mounting evidence indicates that the function of members of the vascular endothelial growth factor (VEGF) family extends beyond blood vessel formation. Here, we show that the prolonged intramyocardial expression of VEGF-A165 and VEGF-B167 on adeno-associated virus-mediated gene delivery determined a marked improvement in cardiac function after myocardial infarction in rats, by promoting cardiac contractility, preserving viable cardiac tissue, and preventing remodeling of the left ventricle (LV) over time. Consistent with this functional outcome, animals treated with both factors showed diminished fibrosis and increased contractile myocardium, which were more pronounced after expression of the selective VEGF receptor-1 (VEGFR-1) ligand VEGF-B, in the absence of significant induction of angiogenesis. We found that cardiomyocytes expressed VEGFR-1, VEGFR-2, and neuropilin-1 and that, in particular, VEGFR-1 was specifically up-regulated in hypoxia and on exposure to oxidative stress. VEGF-B exerted powerful antiapoptotic effect in both cultured cardiomyocytes and after myocardial infarction in vivo. Finally, VEGFR-1 activation by VEGF-B was found to elicit a peculiar gene expression profile proper of the compensatory, hypertrophic response, consisting in activation of αMHC and repression of βMHC and skeletal α-actin, and an increase in SERCA2a, RYR, PGC1α, and cardiac natriuretic peptide transcripts, both in cultured cardiomyocytes and in infarcted hearts. The finding that VEGFR-1 activation by VEGF-B prevents loss of cardiac mass and promotes maintenance of cardiac contractility over time has obvious therapeutic implications.—Zentilin, L., Puligadda, U., Lionetti, V., Zacchigna, S., Collesi, C., Pattarini, L., Ruozi, G., Camporesi, S., Sinagra, G., Pepe, M., Recchia, F. A., Giacca, M. Cardiomyocyte VEGFR-1 activation by VEGF-B induces compensatory hypertrophy and preserves cardiac function after myocardial infarction.
Evaluating the quality of care provided by graduates of international medical schools
by Amy Opalek
Norcini JJ, Boulet JR, Dauphinee WD, Opalek A, Krantz ID, Anderson ST. Evaluating the quality of care provided by graduates of international medical schools. Health Affairs. 2010;29(8):1461-1468.
One-quarter of practicing physicians in the United States are graduates of international medical schools. The quality... more One-quarter of practicing physicians in the United States are graduates of international medical schools. The quality of care provided by doctors educated abroad has been the subject of ongoing concern. Our analysis of 244,153 hospitalizations in Pennsylvania found that patients of doctors who graduated from international medical schools and were not U.S. citizens at the time they entered medical school had significantly lower mortality rates than patients cared for by doctors who graduated from U.S. medical schools or who were U.S. citizens and received their degrees abroad. The patient population consisted of those with congestive heart failure or acute myocardial infarction. We found no significant mortality difference when comparing all international medical graduates with all U.S. medical school graduates.