Daniela Tomčíková

ACE gene insertion/deletion polymorphism has a mild influence on the acute development of left ventricular dysfunction in patients with ST elevation myocardial infarction treated with primary PCI.

BackgroundWe evaluated the associations among angiotensin-converting enzyme (ACE) gene insertion/deletion (I/D) polymorphism, ACE activity and post-myocardial infarction (MI) left ventricular dysfunction and acute heart failure (AHF) early after presentation with MI with ST-segment elevation (STEMI).MethodsA total of 556 patients with STEMI treated by primary PCI (421 patients without AHF and 135 patients with AHF) were the study population. The activity of BNP, NT-ProBNP and ACE were measured at hospital admission and 24 h after MI onset. Left ventricular angiography was done before PCI; echocardiography was undertaken between the third and fifth day after MI.ResultsIn comparison with the II genotypes group, the DD/ID group had a higher level of ACE activity upon hospital admission (p < 0.001). We found a significantly higher level of ACE activity in patients with moderate LV dysfunction (EF 40-54%) in comparison both with patients with preserved LV function (EF ≥55%) and with patients with severe LV dysfunction (p = 0.028). A non-significant trend towards a higher incidence of mild AHF (22.1% vs. 16.02%, p = 0,093), a significantly higher value of end-systolic volume (ESV/BSA) (30.0 ± 12.3 vs. 28.5 ± 13.0; p < 0.05) and lower EF (50.2 ± 11.1 vs. 52.7 ± 11.7; p < 0.05) in the DD/ID genotypes group was noted. Even after multiple adjustments according to multivariate models, the EF for the DD/ID group remained significantly lower (p = 0,033). The DD/ID genotypes were associated with a significantly higher risk of EF <45% (OR 2.04 [95% CI 1.28; 3.25]).ConclusionsThese results suggest that the I/D polymorphism of ACE is associated with the development of LV dysfunction in the acute phase after STEMI. We demonstrated for the first time an association of the low ACE activity with the severe LV dysfunction, although patients with moderate LV dysfunction had higher level ACE activity than patients with preserved LV function.

Risk of in-hospital mortality identified according to the typology of patients with acute heart failure: Classification tree analysis on data from the Acute Heart Failure Database-Main registry ☆,☆☆

PURPOSE The purposes of this study are to identify the strongest clinical parameters in relation to in-hospital mortality, which are available in the earliest phase of the hospitalization of patients, and to create an easy tool for the early identification of patients at risk. MATERIALS AND METHODS The classification and regression tree analysis was applied to data from the Acute Heart Failure Database-Main registry comprising patients admitted to specialized cardiology centers with all syndromes of acute heart failure. The classification model was built on derivation cohort (n = 2543) and evaluated on validation cohort (n = 1387). RESULTS The classification tree stratifies patients according to the presence of cardiogenic shock (CS), the level of creatinine, and the systolic blood pressure (SBP) at admission into the 5 risk groups with in-hospital mortality ranging from 2.8% to 66.2%. Patients without CS and creatinine level of 155 μmol/L or less were classified into very-low-risk group; patients without CS, creatinine level greater than 155 μmol/L, and SBP greater than 103 mm Hg, into low-risk group, whereas patients without CS, creatinine level greater than 155 μmol/L, and SBP of 103 mm Hg or lower, into intermediate-risk group. The high-risk group patients had CS and creatinine of 140 μmol/L or less; patients with CS and creatinine level greater than 140 μmol/L belong to very-high-risk group. The area under receiver operating characteristic curve was 0.823 and 0.832, and the value of Briers score was estimated on level 0.091 and 0.084, for the derivation and the validation cohort, respectively. CONCLUSIONS The presented classification model effectively stratified patients with all syndromes of acute heart failure into in-hospital mortality risk groups and might be of advantage for clinical practice.

One year outcome of acute heart failure patients withhypertension as underlying disease

Purpose: Hypertension (HT) and diabetes mellitus are the most common underlying diseases of acute heart failure (AHF). Our aim was to analyse patients with anamnesis of HT hospitalised for AHF and to determine their one year mortality (1YM). Methods: During the years 2005–2007 we hospitalised 1253 patients with AHF. We selected 843 (70,3%) patients with anamnesis of HT (treated, not treated, diagnosed during hospital stay) and analysed their basic epidemiologic data, presentation during hospital stay in relation to one year mortality (1YM). Results: Mean age of HT patients was 72,3 years (patients deceased before 1 year follow up 76,0 years, p < 0,001), 54,1% of patients were male, 52,2% presented as new onset AHF. Main clinical manifestation was AHF with peripheral oedema/congestion (48,6%) with 1YM rate 22,2%, 12,8% of patients presented with cardiogenic shock with very poor one year outcome (89,8% shock patients died). The most common aetiology of AHF were acute coronary syndromes (41,3%) and chronic coronary heart disease (21,5%). Median length of hospital stay was 7 days, overall 1YM was 32,2%. Patients deceased before 1 year follow up presented with lower LV EF (mean value 30,6%, survived 38,8%, p < 0,001), lower entry haemoglobin level (126,9 g/l against 133,8 g/l of survived, p < 0,001), higher creatinine (124,9 ¦Ìmol/l deceased, 99,0 ¦Ìmol/l survived, p < 0,001) and CRP level (died 62,1 mg/l, 26,1 mg/l survived, p < 0,001). The use of ACE inhibitors (76,4%) and ¦Â-blockers (84,4%) after discharge was much higher by survived patients (55,5% and 65,2% respectively by deceased, p < 0,001). 65,8% of survived patients presented with admission systolic BP ≥ 140 mmHg, majority of deceased patients (60,3%) had entry SBP < 140. Conclusions: Hypertension as underlying disease of AHF patients affects their outcome. Especially cardiogenic shock of these patients is associated with very poor prognosis. One third of HT patients die before one year after the hospitalisation for AHF.