Aleksandra Arandjelovic

Prognostic significance of new atrial fibrillation and its relation to heart failure following acute myocardial infarction

New‐onset atrial fibrillation (AF) after acute myocardial infarction (AMI) frequently occurs in association with postinfarction complications, particularly with heart failure (HF).

Association of adiponectin with peripheral muscle status in elderly patients with heart failure

BACKGROUND Reduced peripheral muscle mass was demonstrated in patients with chronic heart failure (HF). Adipokines may have potent metabolic effects on skeletal muscle. The associations between adipokines, peripheral muscle mass, and muscle function have been poorly investigated in patients with HF. METHODS We measured markers of fat and bone metabolism (adiponectin, leptin, 25-hydroxy vitamin D, parathyroid hormone, osteoprotegerin, RANKL), N-terminal pro B-type natriuretic peptide (NT-pro-BNP) in 73 non-cachectic, non-diabetic, male patients with chronic HF (age: 68 ± 7 years, New York Heart Association class II/III: 76/26%, left ventricular ejection fraction 29 ± 8%) and 20 healthy controls of similar age. Lean mass as a measure of skeletal muscle mass was measured by dual energy X-ray absorptiometry (DEXA), while muscle strength was assessed by hand grip strength measured by Jamar dynamometer. RESULTS Serum levels of adiponectin, parathyroid hormone, osteoprotegerin, RANKL, and NT-pro-BNP were elevated in patients with chronic HF compared to healthy controls (all p<0.0001), while no difference in serum levels of leptin, testosterone or SHBG was noted. Levels of 25-hydroxy vitamin D were reduced (p=0.002) in HF group. Peripheral lean mass and hand grip strength were reduced in patients with HF compared to healthy subjects (p=0.006 and p<0.0001, respectively). Using backward selection multivariable regression, serum levels of increased adiponectin remained significantly associated with reduced arm lean mass and muscle strength. CONCLUSIONS Our findings may indicate a cross-sectional metabolic association of increased serum adiponectin with reduced peripheral muscle mass and muscle strength in non-cachectic, non-diabetic, elderly HF patients.

Emerging Biomarkers in Heart Failure and Cardiac Cachexia

Biomarkers are objective tools with an important role for diagnosis, prognosis and therapy optimization in patients with heart failure (HF). To date, natriuretic peptides are closest to optimal biomarker standards for clinical implications in HF. Therefore, the efforts to identify and test new biomarkers in HF are reasonable and justified. Along the natural history of HF, cardiac cachexia may develop, and once at this stage, patient performance and prognosis is particularly poor. For these reasons, numerous biomarkers reflecting hormonal, inflammatory and oxidative stress pathways have been investigated, but only a few convey relevant information. The complex pathophysiology of HF appears far too complex to be embraced by a single biomarker; thus, a combined approach appears reasonable. With these considerations, we have reviewed the recent developments in the field to highlight key candidates with diagnostic, prognostic and therapy optimization properties, either alone or in combination.

Outcome of Patients in Relation to Duration of New-Onset Atrial Fibrillation following Acute Myocardial Infarction

Aim: The duration of new-onset atrial fibrillation (AF) following the acute myocardial infarction (AMI) was evaluated as well as its relation to in-hospital and 7-year mortality. Methods and Results: A total of 320 consecutive patients with AF following AMI were examined and patients with AF <7 h (n = 141) were compared to those with AF ≧7 h in duration (n = 179). Receiver Operating Characteristic analysis was performed to identify the most useful AF duration cut-off level for the prediction of poor outcome. Patients with longer AF duration were older and had more advanced heart failure than patients with short arrhythmia duration. Patients with longer AF duration had worse outcome, including higher in-hospital (22.3 vs. 12.8%) and 7-year (67.4 vs. 34.4%) mortality. After multivariate adjustment, longer AF duration remained an independent predictor of long-term mortality (relative risk = 2.04, 95% confidence interval = 1.39–2.99, p = 0.0002). Conclusion: New-onset AF ≧7 h in duration following the AMI independently predicts long-term mortality.

Systemic rapamycin without loading dose for restenosis prevention after coronary bare metal stent implantation

Objectives: The aim of this study was to assess the role of short oral administration of rapamycin, without loading dose, in the reduction of restenosis rate after bare metal stent implantation. Background: Previous studies suggest that the administration of oral rapamycin reduces angiographic restenosis after bare metal stent implantation. Methods: This was prospective, open‐label study of 80 patients randomized to either oral rapamycin (2 mg/day for 30 days, starting within 24 hr of stent implantation) or no therapy after implantation of a coronary bare metal stent. The primary study end point was incidence of angiographic binary restenosis and late loss at six months. The secondary end points were target lesion revascularization (TLR), target vessel revascularization (TVR), and incidence of major adverse cardiovascular events (MACE) at 6 months. Results: Angiographic follow up was completed in 72/80 (90%) of patients. In the rapamycin group, the drug was well tolerated (22.5% minor side effects) and was maintained in 100% of patients. At six months, the in‐segment binary restenosis was 10.5% in rapamycin group vs. 51.4% in no‐therapy group, P < 0.001) and the in‐stent binary restenosis was 7.9% in rapamycin group vs. 48.7% in no‐therapy group, P < 0.001. The in‐segment late loss was also significantly reduced with oral therapy (0.29 ± 0.39 vs. 0.86 ± 0.64 mm, respectively, P < 0.001). Similarly, after six months, patients in the oral rapamycin group also showed a significantly lower incidence of TLR and TVR (7% vs. 22.7%, respectively, P = 0.039) and MACE (7% vs. 22.7%, respectively, P = 0.039). Conclusions: This study showed that the administration of oral rapamycin (2 mg/day, without loading dose) during 30 days after stent implantation significantly reduces angiographic and clinical parameters of restenosis.

Should procalcitonin be measured routinely in acute decompensated heart failure

AIM To elucidate the prognostic role of procalcitonin (PCT) in patients with acute decompensated heart failure (ADHF) without clinical signs of infection at admission. MATERIALS & METHODS Serial measurements of PCT and NT-proBNP were performed in 168 patients, aged 68 ± 10 years with ADHF followed by 3-month outcome evaluation. RESULTS Cox regression analysis demonstrated significant predictive value of baseline PCT for all-cause death/hospitalization (area under the curve: 0.67; p = 0.013) at 90th day. The patients with persistently elevated PCT or with an increase during the first 72 h of hospitalization had the worst prognosis (p = 0.0002). CONCLUSION Baseline and serial in-hospital measurements of PCT have significant prognostic properties for 3-month all-cause mortality/hospitalization in patients with ADHF without clinical signs of infection at admission.

Beneficial and harmful effects of exercise in hypertensive patients: the role of oxidative stress

Oxidative stress has been implicated in the development and progression of hypertension. This review presents a comprehensive summary of original investigations focused on exercise-induced oxidative stress in hypertensive individuals. Single bouts of exercise can induce an acute state of oxidative stress. Chronic low-to-moderate exercise training improves the antioxidative defense and reduces the disease severity. However, the data that are currently available on the chronic intensive interval training-induced modification of the redox state in hypertensive patients are insufficient to draw adequate conclusions.

Assessment of the left ventricular chamber stiffness in athletes.

Since diastolic dysfunction is an early sign of the heart disease, detecting diastolic disturbances is predicted to be the way for early recognizing underlying heart disease in athletes. So‐called chamber stiffness index (E/e′)/LVDd was predicted to be useful in distinguishing physiological from pathological left ventricular hypertrophy, because it was shown to be reduced in athletes. It remains unknown whether it is reduced in all athletic population. Standard and tissue Doppler were used to assess cardiac parameters at rest in 16 elite male wrestlers, 21 water polo player, and 20 sedentary subjects of similar age. In addition to (E/e′)/LVDd index, a novel (E/e′)/LVV, (E/e′)/RVe′lat indices were determined. Progressive continuous maximal test on treadmill was used to assess the functional capacity. VO2 max was the highest in water polo players, and higher in wrestlers than in controls. LVDd, LVV, LVM/BH2.7 were higher in athletes. Left ventricular early diastolic filling velocity, deceleration and isovolumetric relaxation time did not differ. End‐systolic wall stress was significantly higher in water polo players. RV e′ was lower in water polo athletes. Right atrial pressure (RVE/e′) was the highest in water polo athletes. (E/e′lat)/LVDd was not reduced in athletes comparing to controls (water polo players 0.83 ± 0.39, wrestlers 0.73 ± 0.29, controls 0.70 ± 0.28; P = 0.52), but (E/e′s)/RVe′lat better distinguished examined groups (water polo players 0.48 ± 0.37, wrestlers 0.28 ± 0.15, controls 0.25 ± 0.16, P = 0.015) and it was the only index which predicted VO2 max. In conclusion, intensive training does not necessarily reduce (E/e′lat)/LVDd index. A novel index (E/e′s)/RVe′lat should be investigated furthermore in detecting diastolic adaptive changes. (Echocardiography 2011;28:276‐287)

Ergonovine-induced changes of coronary artery diameter in patients with nonsignificant coronary artery stenosis : relation with lipid profile.

Background and Purpose:Serum cholesterol is positively associated with the risk of developing coronary heart disease. The aim of this study was to determine the relation between response of coronary arteries to ergonovine provocation and lipid profile in patients with nonsignificant coronary artery disease.Patients and Methods:105 patients (46 male, 59 female, mean age 52 ± 8 years) with chest pain syndrome and nonsignificant coronary artery stenosis (< 50% diameter stenosis) were analyzed. Ergonovine test was performed at the end of diagnostic catheterization. Coronary spasm was defined as total or near total obstruction of the coronary artery. By quantitative coronary arteriography, changes of minimal luminal diameter (MLD) during ergonovine provocation were evaluated. Total cholesterol, LDL and HDL cholesterol, and triglycerides were measured.Results:There was a significant negative correlation between resting MLD and LDL cholesterol (r = –0.215; p = 0.034), and a significant positive correlation between MLD decrease provoked by ergonovine and total cholesterol (r = 0.275; p = 0.006), as well as LDL cholesterol (r = 0.284; p = 0.004), but not for HDL cholesterol and triglycerides (p = NS [not significant]).Conclusion:In patients with nonsignificant coronary artery stenosis evaluated by ergonovine provocation, there was not only a significant negative correlation between MLD and LDL cholesterol, but also a positive correlation between coronary vasoconstriction induced by ergonovine provocation and both total and LDL cholesterol.ZusammenfassungHintergrund und Ziel:Serumcholesterin ist bekanntlich ein wichtiger Risikofaktor für ischämische Herz-Kreislauf-Erkrankungen. Bei Verdacht auf vasospastische Angina pectoris wird mittels intrakoronarer Gabe von Ergonovin in die linke und rechte Herzkranzarterie der Grad der Vasokonstriktion objektiviert. Das Ziel dieser Studie war es, die Korrelation zwischen dem Ergonovineffekt auf Koronararterien und dem Lipidprofil bei Patienten mit einer nichtsignifikanten Koronarkrankheit zu bestimmen.Patienten and Methodik:105 Patienten (46 männlich, 59 weiblich, Alter 52 ± 8 Jahre) mit Herzschmerzen und nichtsignifikanten Koronarstenosen (< 50%ige Verengung des Koronardurchmessers) wurden analysiert. Ein Ergonovintest wurde am Ende der diagnostischen Herzkatheteruntersuchung durchgeführt. Dabei wurde ein Koronarspasmus als total oder subtotal krampfartige Gefäßverengung definiert. Durch die quantitative Auswertung der Koronarangiogramme wurden Änderungen des minimalen Lumendurchmessers (MLD) während der Ergonovinprovokation bewertet. Bei allen Patienten wurden Gesamtcholesterin, LDL- und HDL-Cholesterin sowie Triglyzeride gemessen.Ergebnisse:Es gab eine signifikante negative Korrelation zwischen dem MLD in Ruhe und dem LDL-Cholesterin (r = –0,215; p = 0,034) Eine signifikante positive Korrelation bestand zwischen der MLD-Abnahme – provoziert durch Ergonovin – und dem Gesamtcholesterin (r = 0,275; p = 0,006) sowie dem LDL-Cholesterin (r = 0,284; p = 0.004), aber nicht zum HDL-Cholesterin und zu den Triglyzeriden (p = NS [nicht signifikant]).Schlussfolgerung:Bei Patienten mit einer nichtsignifikanten Koronarstenose fand sich eine signifikante negative Korrelation zwischen dem MLD in Ruhe und dem LDL-Cholesterin. Nach Provokation mit Ergonovin zeigte der Grad des erzeugten Koronarspasmus eine positive Korrelation zum Gesamt- und zum LDL-Cholesterin.

Ergonovine-Induced Changes of Coronary Artery Diameter in Patients with Nonsignificant Coronary Artery Stenosis

Background and Purpose:Serum cholesterol is positively associated with the risk of developing coronary heart disease. The aim of this study was to determine the relation between response of coronary arteries to ergonovine provocation and lipid profile in patients with nonsignificant coronary artery disease.Patients and Methods:105 patients (46 male, 59 female, mean age 52 ± 8 years) with chest pain syndrome and nonsignificant coronary artery stenosis (< 50% diameter stenosis) were analyzed. Ergonovine test was performed at the end of diagnostic catheterization. Coronary spasm was defined as total or near total obstruction of the coronary artery. By quantitative coronary arteriography, changes of minimal luminal diameter (MLD) during ergonovine provocation were evaluated. Total cholesterol, LDL and HDL cholesterol, and triglycerides were measured.Results:There was a significant negative correlation between resting MLD and LDL cholesterol (r = –0.215; p = 0.034), and a significant positive correlation between MLD decrease provoked by ergonovine and total cholesterol (r = 0.275; p = 0.006), as well as LDL cholesterol (r = 0.284; p = 0.004), but not for HDL cholesterol and triglycerides (p = NS [not significant]).Conclusion:In patients with nonsignificant coronary artery stenosis evaluated by ergonovine provocation, there was not only a significant negative correlation between MLD and LDL cholesterol, but also a positive correlation between coronary vasoconstriction induced by ergonovine provocation and both total and LDL cholesterol.ZusammenfassungHintergrund und Ziel:Serumcholesterin ist bekanntlich ein wichtiger Risikofaktor für ischämische Herz-Kreislauf-Erkrankungen. Bei Verdacht auf vasospastische Angina pectoris wird mittels intrakoronarer Gabe von Ergonovin in die linke und rechte Herzkranzarterie der Grad der Vasokonstriktion objektiviert. Das Ziel dieser Studie war es, die Korrelation zwischen dem Ergonovineffekt auf Koronararterien und dem Lipidprofil bei Patienten mit einer nichtsignifikanten Koronarkrankheit zu bestimmen.Patienten and Methodik:105 Patienten (46 männlich, 59 weiblich, Alter 52 ± 8 Jahre) mit Herzschmerzen und nichtsignifikanten Koronarstenosen (< 50%ige Verengung des Koronardurchmessers) wurden analysiert. Ein Ergonovintest wurde am Ende der diagnostischen Herzkatheteruntersuchung durchgeführt. Dabei wurde ein Koronarspasmus als total oder subtotal krampfartige Gefäßverengung definiert. Durch die quantitative Auswertung der Koronarangiogramme wurden Änderungen des minimalen Lumendurchmessers (MLD) während der Ergonovinprovokation bewertet. Bei allen Patienten wurden Gesamtcholesterin, LDL- und HDL-Cholesterin sowie Triglyzeride gemessen.Ergebnisse:Es gab eine signifikante negative Korrelation zwischen dem MLD in Ruhe und dem LDL-Cholesterin (r = –0,215; p = 0,034) Eine signifikante positive Korrelation bestand zwischen der MLD-Abnahme – provoziert durch Ergonovin – und dem Gesamtcholesterin (r = 0,275; p = 0,006) sowie dem LDL-Cholesterin (r = 0,284; p = 0.004), aber nicht zum HDL-Cholesterin und zu den Triglyzeriden (p = NS [nicht signifikant]).Schlussfolgerung:Bei Patienten mit einer nichtsignifikanten Koronarstenose fand sich eine signifikante negative Korrelation zwischen dem MLD in Ruhe und dem LDL-Cholesterin. Nach Provokation mit Ergonovin zeigte der Grad des erzeugten Koronarspasmus eine positive Korrelation zum Gesamt- und zum LDL-Cholesterin.