European Journal of Cardiovascular Medicine

This randomized clinical study conducted at MKCG Medical College & Hospital aimed to assess and compare the effectiveness of prophylactic infusion of ephedrine and phenylephrine in maintaining arterial pressure during lower segment caesarean section (LSCS) under sub-arachnoid block. The study included 80 full-term pregnant patients undergoing elective LSCS, with 40 patients in each group. The primary outcomes evaluated were changes in arterial pressure, heart rate, and fetal outcomes.

The results indicated that both ephedrine and phenylephrine were effective in maintaining arterial pressure within 20% of the baseline, with phenylephrine demonstrating a better blood pressure maintenance profile. Additional bolus dose requirements were significantly higher in the ephedrine group. Phenylephrine caused a reduction in heart rate, while ephedrine resulted in a significant rise. Neonatal outcomes, as measured by Apgar scores, were comparable between the two groups, but phenylephrine was associated with less fetal acidosis than ephedrine.

In conclusion, prophylactic infusion of phenylephrine at 15 micrograms/min proved more efficacious in maintaining arterial pressure during LSCS compared to ephedrine at 1.5 mg/min. The study suggests that phenylephrine may offer advantages in terms of maternal and fetal outcomes in the context of spinal anesthesia for caesarean section.

Statins exert beneficial effects on the endothelium, inflammation and the coagulation cascade that are independent of cholesterol lowering. The main mechanism underlying these effects is inhibi- tion of isoprenoid synthesis, modulating the inflammatory cascade and the endothelial activation reliable of atherosclerosis. Different studies demonstrated that statins improve endothelial function in patients with stable atherosclerotic plaque and that this effect is dose-dependent. Statins may modulate endothelial expression of adhesion molecules, as demonstrated in the ARMYDA-CAMS, and may enhance mobilisation of endothelial progenitor cells. Elevated C-reactive protein levels, an inflammatory marker that also plays a direct pathogenetic role in the atherosclerotic process, have been correlated with worse outcome in patients with cardio- vascular disease. Multiple studies demonstrated that statin attenuates the rise of inflammatory markers and improves clinical outcome in patients with stable angina, unstable angina and non-Q wave acute myocardial infarction. During percutaneous coronary intervention randomised trials showed a benefical effect of statin pre-treatment in reducing peri-procedural myocardial damage probably by plaque stabilisation and inhibition of microembolisation phenomena during stent implantation. The ARMYDA study and the NAPLES II trial demonstrated this beneficial effect in patients undergoing coronary revascularisation for stable angina. Also in patients with ACS, receiving invasive strategy, the role of statins in preventing peri-procedural damage was demonstrated in the ARMYDA-ACS study by the administration of an acute high loading-dose with atorvastatin. In patients already on chronic statin therapy at the time of the procedure, an acute drug reload before stenting would have cardio- protective effects, like demonstrated in the ARMYDA RECAPTURE study.

Ischemia is a common underdiagnosed vascular emergency, which is associated with an adverse prognosis1. It is initiated whenever the arterial flow cannot supply sufficient oxygen resulting to ir- reversible damage and cell death1,2. The clinical assessment is essential for the timely diagnosis and intervention of this disorder2. Yet, no laboratory test for ischemia is available for the diagnosis of this clinically challenging situation2. Ischemia-modified albumin (IMA) is regarded as a new sensitive marker of myocardial ischemia, in contrast to cardiac enzymes which are released when cardiac necrosis occurs3. During an acute isch- emic event, structural changes occur in the amino terminus of albumin, rapidly reducing its capacity to bind transition metal ions and generate a metabolic variant of the albumin referred as IMA4.

gery and interventional cardiology for almost one decade. With preclinical studies showing prom- today in the setting of ischemic heart disease has been rather modest. However, clinical studies per- completion of ongoing phase III trials is mandatory. The following article repeats preclinical and clinical prerequisites for cardiac stem cell application and introduces the German Phase III PERindo- pril Function of the Endothelium in Coronary artery disease Trial (PERFECT) for intramyocardial stem cell injection in combination with CABG surgery.

Coronary artery disease (CAD) is a multifactorial disease with the environment and multiple genes implicated in its pathogenesis. Thus, during the last decade several genes involved in the athero- sclerotic process and their polymorphisms have been suspected to increase the thrombotic predisposition and to influence the risk for acute coronary syndromes (ACS). It is well-known that platelets play a significant role in the pathogenesis and development of CAD and its clinical manifestations. Therefore, platelet polymorphisms have been extensively studied in order to clarify their contribution to atherothrombotic process and their role in CAD.

Diagnosing and managing heart failure according to the left ventricle’s ejection fraction (LVEF) has become part of evidence-based medicine. Not surprisingly, LVEF - a powerful prognostic factor in heart failure - has caused a marked heterogeneity in the clinical benefit of various therapeutic interventions. From a pathophysiological point of view, however, many disease characteristics are shared among the entire heart failure spectrum (from low to high LVEF). The many functional and anatomical differences within the spectrum are merely quantitative, with an extensive overlap between the extremes of the spectrum and belonging to the same linear relation when plotted against LVEF. Therefore, although counter-intuitive from a clinical point of view, from a patho- physiological point of view heart failure seems to progress along a common disease trajectory independently of LVEF. In this review, we will scrutinize this apparent paradox, estimate how it relates to the recent biomarker-oriented (as opposed to a classic LVEF-oriented) approach to heart failure and discuss to what extent it may affect conceptual progress in chronic heart failure.