Danuta Karasek

Relationship between B-type natriuretic peptide serum level, echocardiographic TEI index and the degree of diastolic dysfunction in patients with heart failure with preserved systolic function

Introduction The growing number of heart failure (HF) patients is becoming an important issue in cardiology. B-type natriuretic peptide (BNP) is a recognized marker of HF, including in patients with preserved systolic function. The TEI index is an indicator of left ventricular function. The aim of the study was to evaluate the relationship between BNP serum level, TEI index and the degree of diastolic dysfunction in patients with HF symptoms and preserved systolic function. Material and methods Hundred patients with arterial hypertension and preserved systolic function were enrolled in the study. The study group consisted of 51 individuals with impaired diastolic function and HF symptoms. Fourty-nine hypertensive individuals without HF symptoms were assigned to the control group. B-type natriuretic peptide and echocardiographic examination were performed. Patients were divided into 4 subgroups – with normal diastolic function, impaired relaxation, pseudonormalization and restriction. Results Median value of BNP in patients with normal diastolic function was 28.36 pg/ml, 87.10 pg/ml in patients with impaired relaxation, 212.75 pg/ml and 461.56 pg/ml in the pseudonormalization and restriction group respectively (p < 0.0001). The median value of the TEI index was: 0.386 in patients with normal diastolic function, 0.507 in individuals with impaired relaxation, 0.639 and 0.725 in the pseudonormalization and restriction group respectively. All the differences were statistically significant (p < 0.0001). A significant positive correlation (r = 0.80, p < 0.001) between BNP and the TEI index was found. Conclusions In hypertensive patients with HF symptoms and preserved left ventricular systolic function a highly significant increase in BNP serum level and in the TEI index values related to the deterioration of diastolic dysfunction was found.

Short-term alcohol consumption may have detrimental effect on fibrinolysis and endothelial function: preliminary report of prospective randomised study

BACKGROUND AND AIM This study was designed to clarify the impact of the short-term consumption of different types of alcoholic beverages on haemostatic factors, C-reactive protein (hsCRP) and endothelin-1 (E-1) plasma levels. METHODS The study group consisted of 57 healthy male volunteers, aged 20-29 years. Subjects were randomised to consume 300 mL of red wine, white wine, 12% ethanol, black currant juice or water for five days. Blood samples were collected for CRP, tissue type plasminogen activator antigen (t-PA:Ag), plasminogen activator inhibitor antigen (PAI-1:Ag) and E-1 at baseline, on day 2, and on day 6. RESULTS A significant increase in PAI-1:Ag concentration was observed in the red wine drinking group (day 1: 44.98; day 2:56.86; day 6: 47.44 ng/mL; p = 0.05). A similar increase of E-1 level was found in the 12% ethanol group (day 1: 0.53; day 2:1.65; day 6: 1.11 fmol/mL; p = 0.01). Dividing the whole study group according to ethanol content of consumed beverages revealed significant changes in tPA:Ag, PAI-1:Ag and E-1 levels. In the alcohol drinking group, significant increases of PAI-1:Ag (day 1: 44.75; day 2: 54.07; day 6: 44.80 ng/mL; p < 0.05); tPA:Ag level (day 1: 3.65; day 2: 4.17; day 6: 5.03 ng/mL;p < 0.02) and E-1 (day 1: 0.42; day 2: 1.01; day 6: 0.97 fmol/mL; p < 0.002) were observed. CONCLUSIONS Short-term alcohol consumption increases tPA:Ag, PAI:Ag and E-1 plasma levels. This effect may have an unfavourable impact on the fibrinolytic system and endothelial function.

Bone morphogenetic protein 6—a possible new player in pathophysiology of heart failure

Derangement of bone morphogenetic protein (BMP) signalling was observed in cardiovascular disorders. The present study assesses the diagnostic and prognostic value of BMP6 plasma concentration in chronic heart failure (CHF). 130 CHF patients and 32 controls participated in the study. BMP6 plasma level was measured at baseline. During 12‐month follow‐up death and hospitalisation with CHF exacerbation were recorded. BMP6 was significantly increased in CHF patients with highest concentration in most advanced disease. Individuals with pulmonary congestion or peripheral oedema had higher levels of BMP6 than isovolemic patients. BMP6 was not a predictor of all‐cause mortality or CHF hospitalisation. BMP6 may be involved in pathophysiology of systolic CHF. BMP6 plasma level is related to the disease severity and signs of exacerbation.

Use of transthoracic impedance cardiography and tissue Doppler echocardiography in the cardiovascular assessment of atrial fibrillation patients subjected to electroversion.

BACKGROUND Atrial fibrillation (AF) is the commonest complex cardiac arrhythmia, affecting approximately 2% of the general population. AIM To describe cardiovascular changes in tissue Doppler echocardiography (TDE) and impedance cardiography (ICG) in AF patients subjected to cardioversion. METHODS Forty-one patients (22 males and 19 females) with acute or persistent AF were examined by means of TDE and transthoracic ICG before electroversion, and then one week following the restoration of sinus rhythm. Additionally, the preand post-cardioversion serum levels of B-type natriuretic peptide (BNP) were determined. RESULTS The restoration of sinus rhythm was reflected by a significant increase in the following ICG parameters (average changes are presented): stroke volume (+25 mL), stroke volume index (+11.8 m/m²), contractility index (+12.6/s), end-diastolic index (+12.3 mL/m²), acceleration index (+6/s²), and left ventricular ejection time (+56 ms). These changes were accompanied by a significant increase in the TDE parameters of tricuspid annular systolic velocity and mitral annular systolic velocities. Moreover, a significant decrease in early diastolic velocities was also observed following the restoration of sinus rhythm, along with significantly lower levels of BNP. CONCLUSIONS Both TDE and ICG are modern, valuable diagnostic methods that complementarily explain changes occurring in the cardiovascular system of AF patients subjected to electroversion.

Ocena wartości rokowniczej wybranych parametrów ergospirometrycznych u chorych z przewlekłą skurczową niewydolnością serca kwalifikowanych wstępnie do transplantacji serca, w obserwacji 12-miesięcznej

Introduction. Despite recent advances in diagnosis and pharmacological treatment of cardiovascular diseases, chronic heart failure (HF) carries a poor prognosis. The identification of patients at highest risk for early death from HF is of special importance. Ergospirometric test is known to be useful in predicting survival and oxygen consumption (maximal/peak VO2) and minute ventilation-carbon dioxide production relationship (VE/VCO2slope) are the most frequently analyzed cardiopulmonary exercise test parameters. The aim of this study was to assess the ability of peak VO2 and VE/VCO2slope to predict cardiac-related mortality and cardiac-related hospitalization (MACE, major adverse cardiac event) in patients with chronic systolic HF, pre-qualified for heart transplantation. Material and methods. Forty-five patients (38 men; age 50 ± 8 years) with stable chronic HF (21 coronary artery disease, 24 dilated cardiomyopathy), in New York Heart Association functional class II (n. 16)–III (n. 29), with left ventricular ejection fraction (LVEF) below 35% (mean LVEF = 22.7 ± 5.1%), underwent cardiopulmonary exercise testing between 2006 and 2012 year. Results. At the end of follow-up, 5 (11%) patients had died and 17 (38%) had a hospitalization due to CHF exacerbation. Peak VO2 was 14.5 ± 5.7 mL/kg/min, VE/VCO2 slope was 35.1 ± 6.1. MACE(+) group had a lower peak VO2 (13.9 ± 6.9 mL/kg/min vs 15.1 ± 4.3, p = NS) and higher VE/VCO2slope (37.2 + 6.0 vs. 33.1 ± 5.6, p = 0.021) than MACE(–) group. MACE(+) death group had a lower peak VO2 than MACE(–) group (10.9 ± 1.3 vs. 15.1 ± 4.3, p = 0.045). The areas under the receiver operating characteristic curves for predicting MACE at 1 year were 0.68 for peak VO2 and 0.70 for VE/VCO2slope. The results of Kaplan-Meier analysis revealed a 1-year MACE free survival of 33% in patients with VE/VCO2slope > 34.9 and 67% in those with VE/VCO2slope 11.9 mL/kg/min (p = 0.0085). Conclusions. Both VO2 and VE/VCO2slope, are good prognostic parameters for serious cardiovascular events and improve the risk stratification of chronic HF patients.

Churg-Strauss syndrome with endocardial injury, clot formation in heart’s chambers, and neurological complications

Address for correspondence: Robert Bujak, MD, PhD, 2nd Chair and Clinic of Cardiology, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, ul. Ujejskiego 75, 85–168 Bydgoszcz, Poland, e-mail: robertbujak@wp.pl Conflict of interest: none declared Kardiologia Polska Copyright

Czy zmiany częstości rytmu serca obserwowane podczas próby obciążeniowej z wykorzystaniem dobutaminy korelują z odpowiedzią na terapię resynchronizującą serce u pacjentów z ciężką skurczową niewydolnością serca? Wyniki badania wieloośrodkowego ViaCRT

BACKGROUND According to current European Society of Cardiology guidelines for the diagnosis and treatment of heart failure (HF), cardiac resynchronisation therapy (CRT) is indicated in patients suffering from HF with reduced ejection fraction (EF) with significantly widened QRS complexes. The presence of vital myocardium proven by dobutamine stress echocardiography (DSE) is considered as a good prognostic factor for responsiveness to this treatment. Chronotropic incompetence is, on the other hand, a known factor of unfavourable outcome in HF. AIM The aim of this study was to analyse the relationship between heart rate (HR) response during DSE and resultant changes in echocardiographic parameters determined prior to CRT and six weeks post-implantation of the CRT system. METHODS The study included 72 men and 25 women with chronic HF and markedly deteriorated left ventricular (LV) sys-tolic function (EF < 35%). Low-dose DSE was performed prior to the CRT system implantation. Baseline echocardiographic parameters determined before CRT were compared to those measured six weeks after implantation. RESULTS Implantation of the CRT system resulted in an improvement of LV systolic function. DSE showed a significant in-crease in HR, by 16.3 bpm on average. Patients with the least prominent increase in HR during DSE (< 7 bpm) presented with significantly greater end-diastolic LV dimension and volume, as well as with significantly lower EF than the subjects with the most evident increase in HR (> 24 bpm). Improvement in EF at six weeks was associated with lower baseline HR and its greater absolute and relative increase during DSE. Greater absolute increase in HR during DSE was also associated with more prominent decrease in systolic/diastolic LV volumes. CONCLUSIONS Patients with better chronotropic response during DSE show significant improvement in LV parameters determined by echocardiography within six weeks of CRT. Chronotropic response to pharmacologic stress test may serve as a predictive factor in patients qualified for CRT.