Łukasz Wołowiec

Melanoma cell adhesion molecule as an emerging biomarker with prognostic significance in systolic heart failure

BACKGROUND Melanoma cell adhesion molecule (MCAM) is a marker of endothelial damage. MCAM diagnostic and prognostic value was assessed in chronic heart failure (CHF). MATERIALS & METHODS 130 CHF patients and 32 controls were included in the study. Telephone follow-up lasted one year. End points were: death from all causes, and hospitalization with CHF exacerbation. RESULTS MCAM was higher in patients than in controls (p = 0.01). Receiver operator curve analysis revealed that MCAM may serve as a predictor of death (area under the curve: 0.8404; p < 0.002). Patients with MCAM above 500 ng/ml had worse prognosis (p = 0.03). NT-proBNP and age were independent predictors of death in multivariate analysis. CONCLUSION The increased MCAM indicates endothelial damage in CHF and may serve as a marker of worse prognosis in these patients.

Procalcitonin (PCT) Predicts Worse Outcome in Patients with Chronic Heart Failure with Reduced Ejection Fraction (HFrEF)

Introduction Procalcitonin (PCT) is an excellent marker of sepsis but was not extensively studied in cardiology. The present study investigated PCT plasma concentration in patients with chronic heart failure with reduced ejection fraction (HFrEF) and its prognostic value during 24-month follow-up. Material and Methods Study group consisted of 130 patients with HFrEF (LVEF ≤ 45%) and 32 controls. PCT level was assessed on admission in all patients. Telephone follow-up was performed every three months over a period of 2 years. Endpoints were death of all causes and readmission for HFrEF exacerbation. Results HFrEF patients had significantly higher PCT concentration than controls (166.95 versus 22.15 pg/ml; p < 0.001). Individuals with peripheral oedema had increased PCT comparing to those without oedema (217.07 versus 152.12 pg/ml; p < 0.02). In ROC analysis, PCT turned out to be a valuable diagnostic marker of HFrEF (AUC 0.91; p < 0.001). Kaplan-Meier survival curves revealed that patients with PCT in the 4th quartile had significantly lower probability of survival than those with PCT in the 1st and 2nd quartiles. In univariate, but not multivariate, analysis, procalcitonin turned out to be a significant predictor of death during 24-month follow-up. (HR 1.002; 95% CI 1.000–1.003; p < 0.03). Conclusions Elevated PCT concentration may serve as another predictor of worse outcome in patients with HFrEF.

Hypoglycaemia as a new cardiovascular risk factor

The journal has had 7 points in Ministry of Science and Higher Education parametric evaluation. Part B item 1223 (26.01.2017). 1223 Journal of Education, Health and Sport eISSN 2391-8306 7

Wartość oznaczania stężeń antygenu nowotworowego Ca 125 i kopeptyny w monitorowaniu terapii chorych z zaawansowaną niewydolnością serca

Introduction. A search continues for new markers and new monitoring methods that would be useful in the management of patients with advanced heart failure (HF). Recent studies have shown increased levels of cancer antigen 125 (Ca 125) and copeptin in patients with HF which implies that they may be used as markers of HF. Material and methods. The aim of the study was to evaluate levels of potential HF markers in relation to established biochemical markers. The study included 60 patients who were admitted due to exacerbation of chronic New York Heart Association class III or IV systolic HF. Before administration of initial intravenous diuretic dose, blood samples were collected to determine levels of conventional prognostic factors (uric acid, B-type natriuretic peptide [BNP]) and novel HF biomarkers (Ca 125, copeptin). Results. On admission, BNP level (median 1166.50 pg/mL [636.00–2068.50]) and uric acid level (9.497 ± 2.426 mg/ dL) in patients with HF was significantly higher compared to respective normal values. Ca 125 level (median 88.71 U/mL [29.28–169.00]) was also significantly increased, and copeptin level was significantly higher compared to the control group (median 96.55 vs 7.05 pg/mL, p < 0.0001). In additional, a statistically significant correlation between baseline BNP and Ca 125 levels (r = 0.48, p < 0.001) was observed. No correlations were found between baseline levels of copeptin and BNP or uric acid. Conclusion. In patients with chronic HF, several pathomechanisms are operating, which may be indicated by increased levels of several markers, including both conventional and new ones. Higher levels of Ca 125 were observed in patients with acute decompensated HF, even though these patients did not have a malignancy. However, Ca 125 did not exceed the prognostic value of BNP due to its low specificity. Despite different pathomechanisms of BNP and Ca 125 level elevations, a correlation was found between these markers, which might indicate a complex pathophysiology of HF in the studied group.

Prognostic significance of red cell distribution width and other red cell parameters in patients with chronic heart failure during two years of follow-up.

BACKGROUND Studies published during the last decade seem to indicate red blood cell parameters as inexpensive, rapidly available, and simple tools for the assessment of prognosis in patients with chronic heart failure (CHF). AIM To evaluate the prognostic value of red cell parameters determined in a routine blood count in patients with CHF. METHODS The study group included 165 patients with the New York Heart Association (NYHA) class II-IV CHF hospitalised in the 2nd Department of Cardiology in Bydgoszcz. On the first day of hospitalisation, all patients in the study group underwent a complete blood count with an assessment of haemoglobin (Hb) level, mean corpuscular volume (MCV), mean corpuscular haemoglobin (MCH), mean corpuscular haemoglobin concentration (MCHC) and red blood cell distribution width (RDW). Follow-up was carried over 24 months by phone calls every 3 months. RESULTS MCV, MCH and MCHC were not shown to be significant predictors of mortality in CHF patients at 1 and 2 years of follow-up. In univariate analysis at 1-year follow-up, the following variables were significantly associated with the occurrence of the study endpoint: Hb level (p = 0.022; HR = 0.80), RDW (p = 0.004; HR = 1.257), and N-terminal pro-B-type na-triuretic peptide (NT-proBNP) level (p = 0.0001; HR = 1). At 2 years of follow-up, the following variables were significantly associated with the occurrence of the study endpoint: left ventricular ejection fraction (p = 0.018; HR = 0.956), NYHA class (p = 0.007; HR = 0.378), RDW (p = 0.044; HR = 1.175), and NT-proBNP level (p < 0.001; HR = 1). Multivariate analysis for 1-year follow-up showed that RDW and NT-proBNP level were independent significant predictors of mortality, while NT-proBNP level (p = 0.006; HR = 1) and NYHA class (p = 0.024; HR = 0.439) were significant predictors of mortality at 2 years of follow-up. Based on receiver operating characteristic curve analysis, the cut-off RDW was 15.00% (AUC = 0.63; 0.523-0.737), at 12 months of follow-up and 14.00% (AUC = 0.6; 0.504-0.697), at 24 months of follow-up. The cut-off for Hb level was 13.9 g/dL (AUC = 0.662; 0.553-0.77), at 12 months of follow-up and 12.2 g/dL (AUC = 0.581; 0.482-0.681), at 24 months of follow-up. CONCLUSIONS Baseline RDW and Hb level in patients hospitalised with the diagnosis of NYHA class II-IV CHF seem to be important predictors of mortality in this population. Among the red blood cell parameters, only RDW was shown to be an independent prognostic factor at 1 year of follow-up but it appeared to lose its significance during longer-term follow-up.

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.