Aspirin and clopidogrel are important components of medical therapy for patients with acute coronary syndromes, for those who received coronary artery stents and in the secondary prevention of ischaemic stroke. Despit...Aspirin and clopidogrel are important components of medical therapy for patients with acute coronary syndromes, for those who received coronary artery stents and in the secondary prevention of ischaemic stroke. Despite their use, a significant number of patients experience recurrent adverse ischaemic events. Interindividual variability of platelet aggregation in response to these antiplatelet agents may be an explanation for some of these recurrent events, and small trials have linked "aspirin and/or clopidogrel resistance", as measured by platelet function tests, to adverse events. We systematically reviewed all available evidence on the prevalence of aspirin/clopidogrel resistance, their possible risk factors and their association with clinical outcomes. We also identified articles showing possible treatments. After analyzing the data on different laboratory methods, we found that aspirin/clopidogrel resistance seems to be associated with poor clinical outcomes and there is currently no standardized or widely accepted definition of clopidogrel resistance. Therefore, we conclude that specific treatment recommendations are not established for patients who exhibit high platelet reactivity during aspirin/clopidogrel therapy or who have poor platelet inhibition by clopidogrel.展开更多
Intracardiac manifestation of hepatocellular carcinoma (HCC) is a rare condition and an uncommon finding even at autopsy. Pulmonary tumor embolism as a presenting feature of HCC has been published only twice previousl...Intracardiac manifestation of hepatocellular carcinoma (HCC) is a rare condition and an uncommon finding even at autopsy. Pulmonary tumor embolism as a presenting feature of HCC has been published only twice previously. In our case report, a 63-year-old man presented with high fever and six episodes of recurrent pneumonias during the last half year. Echocardiography was performed, a solid mass was found in the right atrium. Transesophageal echocardiography proved a tumor mass in the inferior vena cava (IVC) extending into the right atrium, abdominal ultrasound revealed tumor mass in the IVC and a solid tumor in the liver. Combined liver and heart surgery was attempted in order to remove the tumor mass from both the liver and the right atrium. Acute cor pulmonale occurred during tumor removal from the right atrium and the patient expired. In addition to local factors the possibility of embolization should arise in the background of recurrent pneumonia. Occult carcinoma must be included in possible causes of recurrent pulmonary embolism. Searching for primary malignancy should include HCC as frequent cause of hypercoagulability. In case of HCC, echocardiography is suggested because of the possibility of expansion in IVC or right atrium and tumor-embolization.展开更多
Hypertension is an increasing health problem worldwide especially among the elderly.Its therapeutical importance is indicated by the caused organ damages like hypertensive heart disease(HHD) and heart failure with the...Hypertension is an increasing health problem worldwide especially among the elderly.Its therapeutical importance is indicated by the caused organ damages like hypertensive heart disease(HHD) and heart failure with the subsequent higher morbidity and mortality in the population.In HHD ventricular hypertrophy develops as a compensatory mechanism for pressure overload but as the left ventricular compliance decreases,the process can transform into heart failure with firstly preserved and then into reduced ejection fraction(HFp EF,HFr EF).The main characteristics of underlying mechanisms involve cardiomyocyte growth,vessel changes,increased collagen production in all of which several mechanical stress induced neurohumoral agents,signal transduction pathways are involved.According to the new ESC and AHA guidelines five main groups of antihypertensive agents can be applied for decreasing blood pressure and for the prevention of organ damages.Occasionally,patients are not able to tolerate antihypertensive medication because of side effects,drug intolerance or interactions thus it is more difficult to reach the target blood pressure values.Therefore there are several efforts to complete the existing therapeutical possibilities against the development of organ damages like inhibition of Rho/ROCK pathway(e.g.,statins),regulation of ROS formation,influence on mitochondrial biogenesis and enhancing recombinant adenovirus hepatocyte growth factor gene.Hypertension induced oxidative stress causes DNA breaks producing the activation of nuclear poly(ADP-ribose) polymerase-1(PARP) enzyme that leads to energy depletion and unfavorable modulation of different kinase cascades.PARP activation promotes the development of HHD,and its transition to heart failure.Therefore inhibition of PARP-enzyme offers another new therapeutical approach among hypertensive patients.The purpose of this review is to give a comprehensive summary about the most significant mechanisms in HHD and an insight into new potential therapies.展开更多
基金Supported by The University of Pecs (PTE AOK KA-34039-16/2009)
文摘Aspirin and clopidogrel are important components of medical therapy for patients with acute coronary syndromes, for those who received coronary artery stents and in the secondary prevention of ischaemic stroke. Despite their use, a significant number of patients experience recurrent adverse ischaemic events. Interindividual variability of platelet aggregation in response to these antiplatelet agents may be an explanation for some of these recurrent events, and small trials have linked "aspirin and/or clopidogrel resistance", as measured by platelet function tests, to adverse events. We systematically reviewed all available evidence on the prevalence of aspirin/clopidogrel resistance, their possible risk factors and their association with clinical outcomes. We also identified articles showing possible treatments. After analyzing the data on different laboratory methods, we found that aspirin/clopidogrel resistance seems to be associated with poor clinical outcomes and there is currently no standardized or widely accepted definition of clopidogrel resistance. Therefore, we conclude that specific treatment recommendations are not established for patients who exhibit high platelet reactivity during aspirin/clopidogrel therapy or who have poor platelet inhibition by clopidogrel.
文摘Intracardiac manifestation of hepatocellular carcinoma (HCC) is a rare condition and an uncommon finding even at autopsy. Pulmonary tumor embolism as a presenting feature of HCC has been published only twice previously. In our case report, a 63-year-old man presented with high fever and six episodes of recurrent pneumonias during the last half year. Echocardiography was performed, a solid mass was found in the right atrium. Transesophageal echocardiography proved a tumor mass in the inferior vena cava (IVC) extending into the right atrium, abdominal ultrasound revealed tumor mass in the IVC and a solid tumor in the liver. Combined liver and heart surgery was attempted in order to remove the tumor mass from both the liver and the right atrium. Acute cor pulmonale occurred during tumor removal from the right atrium and the patient expired. In addition to local factors the possibility of embolization should arise in the background of recurrent pneumonia. Occult carcinoma must be included in possible causes of recurrent pulmonary embolism. Searching for primary malignancy should include HCC as frequent cause of hypercoagulability. In case of HCC, echocardiography is suggested because of the possibility of expansion in IVC or right atrium and tumor-embolization.
文摘Hypertension is an increasing health problem worldwide especially among the elderly.Its therapeutical importance is indicated by the caused organ damages like hypertensive heart disease(HHD) and heart failure with the subsequent higher morbidity and mortality in the population.In HHD ventricular hypertrophy develops as a compensatory mechanism for pressure overload but as the left ventricular compliance decreases,the process can transform into heart failure with firstly preserved and then into reduced ejection fraction(HFp EF,HFr EF).The main characteristics of underlying mechanisms involve cardiomyocyte growth,vessel changes,increased collagen production in all of which several mechanical stress induced neurohumoral agents,signal transduction pathways are involved.According to the new ESC and AHA guidelines five main groups of antihypertensive agents can be applied for decreasing blood pressure and for the prevention of organ damages.Occasionally,patients are not able to tolerate antihypertensive medication because of side effects,drug intolerance or interactions thus it is more difficult to reach the target blood pressure values.Therefore there are several efforts to complete the existing therapeutical possibilities against the development of organ damages like inhibition of Rho/ROCK pathway(e.g.,statins),regulation of ROS formation,influence on mitochondrial biogenesis and enhancing recombinant adenovirus hepatocyte growth factor gene.Hypertension induced oxidative stress causes DNA breaks producing the activation of nuclear poly(ADP-ribose) polymerase-1(PARP) enzyme that leads to energy depletion and unfavorable modulation of different kinase cascades.PARP activation promotes the development of HHD,and its transition to heart failure.Therefore inhibition of PARP-enzyme offers another new therapeutical approach among hypertensive patients.The purpose of this review is to give a comprehensive summary about the most significant mechanisms in HHD and an insight into new potential therapies.
