Kallirrhoe Kourea

Effects of darbepoetin-alpha on quality of life and emotional stress in anemic patients with chronic heart failure.

Objective Anemia is a frequent comorbidity in chronic heart failure (CHF) adversely affecting patients’ prognosis. Erythropoietin seems to improve exercise capacity in CHF patients. This study investigates the effects of recombinant human erythropoietin analog darbepoetin-α on quality of life and emotional stress, evaluated by relevant questionnaires in patients with CHF and anemia. Methods Forty-one CHF patients [New York Heart Association class: II-III; left ventricular (LV) ejection fraction (EF) ≤40%; hemoglobin < 12.5 g/dl; serum creatinine < 2.5 mg/dl] were randomized (1:1) to receive either 3-month darbepoietin-α at 1.5 μg/Kg every 20 days plus iron orally (n = 21) or placebo plus iron orally (n = 20). Echocardiographic LVEF, questionnaires addressing quality of life (Kansas City Cardiomyopathy Questionnaire, functional and overall, Dukes Activity Status Index) and emotional stress [Zung self-rating depression scale (SDS), Beck Depression Inventory], as well as plasma b-type natriuretic peptide and 6-min walking distance (6MWT as a marker of exercise capacity) were assessed at baseline and posttreatment. Results A significant improvement in LVEF (32 ± 6 from 26 ± 6%, P < 0.001), 6MWT (274 ± 97 from 201 ± 113m, P < 0.01), hemoglobin (12.8 ± 1.4 from 10.9 ± 1.0 g/dl, P < 0.001) and plasma b-type natriuretic peptide (517 ± 579 from 829 ± 858 pg/ml, P = 0.002) was observed posttreatment only in darbepoetin-treated group. Kansas City Cardiomyopathy Questionnaire functional (78 ± 14 from 57 ± 24%, P < 0.01) and overall (68 ± 20 from 47 ± 22, P < 0.001), Dukes Activity Status Index (19 ± 11 from 14 ± 9, P < 0.05), Zung SDS (38 ± 10 from 47 ± 11, P < 0.05) and Beck Depression Inventory (11 ± 9 from 16 ± 10, P < 0.05) scores also improved in darbepoetin-treated patients, whereas they remain unchanged in the placebo group except for the Zung SDS which worsened (P≤0.05). A significant correlation between drug-induced percent changes in 6MWT and Zung SDS (r = –0.627, P < 0.05) was also observed. Conclusions Darbepoetin-α improves quality of life and emotional stress in CHF patients with anemia, with a parallel increase in exercise capacity.

Effects of levosimendan on coronary artery flow and cardiac performance in patients with advanced heart failure

Levosimendan has inotropic and vasodilatory effects. We investigated the effects of levosimendan on coronary flow and associated changes in neurohormonal activation and cardiac performance in patients with advanced heart failure.

Effects of Darbepoetin Alfa on Plasma Mediators of Oxidative and Nitrosative Stress in Anemic Patients With Chronic Heart Failure Secondary to Ischemic or Idiopathic Dilated Cardiomyopathy

Increased oxidative and nitrosative stress are important mediators of left ventricular (LV) and vascular dysfunction in patients with chronic heart failure (CHF). This study investigated the effects of darbepoetin alfa on plasma markers of oxidative and nitrosative stress in patients with CHF with anemia. Thirty patients with CHF (LV ejection fraction [LVEF] <40%, hemoglobin <12.5 g/dl, and serum creatinine <2.5 mg/dl) were randomly assigned (1:1) to receive either a 3-month darbepoetin alfa regimen at 1.5 microg/kg every 20 days plus oral iron or placebo plus oral iron. Plasma B-type natriuretic peptide (BNP), markers of oxidative (oxidative, malondialdehyde, carbonyl proteins; antioxidative, glutathione) and nitrosative (nitrotyrosine) stress, LVEF, and 6-minute walked distance were assessed at baseline and after treatment. A significant improvement in LVEF and 6-minute walked distance was observed in only darbepoetin-treated patients. Plasma BNP (F = 14.8, p = 001), malondialdehyde (F = 9.4, p = 0.006), protein carbonyl (F = 9.2, p = 0.006), and nitrotyrosine (F = 4.4, p = 0.045) were significantly decreased, along with an increase in antioxidative glutathione (F = 4.2, p = 0.049) after darbepoetin alfa treatment. These factors were unaffected in placebo-treated patients. Darbepoetin-induced percentages of change in carbonyl protein significantly correlated with respective changes in plasma BNP (r = 0.55, p <0.05) and LVEF (r = -0.46, p <0.05). Finally, a drug-induced percentage of decrease in nitrotyrosine significantly correlated with the respective improvement in 6-minute walked distance (r = -0.63, p <0.05). In conclusion, darbepoetin alfa attenuated deleterious effects of oxidative and nitrosative stress into the cardiovascular system of anemic patients with CHF, improving also cardiac function and exercise capacity.

Electronic Cigarette Smoking Increases Arterial Stiffness and Oxidative Stress to a Lesser Extent Than a Single Conventional Cigarette: An Acute and Chronic Study

The electronic cigarette (e-cig) has been proposed as a safer alternative than tobacco cigarettes (con-cigs)1,2 and as a bridge to smoking cessation. We aimed to examine its effects (1) on aortic stiffness as assessed by pulse wave velocity (PWV) and augmentation index (AIX75), (2) exhaled CO concentration, and (3) oxidative stress as assessed by malondialdehyde (MDA) plasma concentrations, both acutely and after 1 month of use. We studied 70 current smokers (age: 48±5 years, 56% female, 24±8 cigarettes/d, 30±7 pack-years, no other atherosclerotic risk factors or any medication) attending the hospital’s smoking cessation unit. Of those, 35 were assigned to use nicotine-free e-cig fluid (NOBACCO eGo Epsilon BDC 1100, eGo battery, 1100 mAh, operating at 3.9 V) during the acute-phase protocol, whereas the remaining 35 were assigned to an e-cig fluid with nicotine concentration of 12 mg/mL (propylene glycol 74.3%, glycerin 20%, flavoring 4.5%, nicotine 1.2%). All subjects underwent a baseline sham smoking for 7 minutes (inhaling on a nonlighted cigarette) and then were randomly assigned to smoke a single con-cig or vape an e-cig for 7 minutes (simulating the duration of a normal cigarette smoking). …