Małgorzata Kobusiak-Prokopowicz

Expression of Proinflammatory Factors, Proangiogenic Factors and Endostatin in Patients with Heart Failure and Different Grades of Collateral Circulation Development*

BACKGROUND The process of collateral vessel maturation is stimulated by numerous factors affecting the endothelium and smooth muscle cells building the vessel wall. Looking for arteriogenesis stimulating factors means looking for a potential innovative heart failure treatment method in the patients unresponsive to traditional therapies. OBJECTIVES The purpose of this study was to assess the changes in serum concentrations of pro-inflammatory factor IL-6, growth factors FGF (FGFa, FGFb, FGFbH), HGF, VEGF and endostatin in heart failure patients in relation to the coronary collaterals development stage. MATERIAL AND METHODS This study included 22 patients with chronic heart failure NYHA II or III (mean age 62.5 ± 11.6 years) and 8 control patients (mean age 58.4 ± 10.7 years). Coronary angiography was performed and the presence and grade of collateral circulation was assessed by a four-level scale proposed by Rentrop and Cohen. The level of the studied factors was determined in the blood samples collected during the angiographic procedure. RESULTS The concentration of IL-6 was significantly higher in the heart failure patients than in the control group (p < 0.001) and in NYHA III vs. NYHA II patients (p < 0.02). Patients with heart failure and collaterals grade 1 or 2 exhibited higher serum concentrations of FGFbH (from p < 0.03 to p < 0.01). The serum VEGF level in NYHA III patients was significantly higher than in NYHA II individuals (from p < 0.03 to p < 0.01). CONCLUSIONS Higher levels of IL-6 and FGFbH were observed in patients with heart failure. Collaterals formation seems to be associated with the activation of pro-inflammatory factors, growth factors and endostatin.

MMP-2 and TIMP-2 in patients with heart failure and chronic kidney disease

Abstract The aim of the study was to assess MMP-2 (matrix metalloproteinase-2) and TIMP-2 (tissue inhibitor of metalloproteinase-2) serum levels in patients with diverse types of heart failure (HF) and chronic kidney disease (CKD). 101 patients with chronic HF were enrolled. Each patient has assessed the serum levels of MMP-2, TIMP-2, and NT-proBNP. Patients were initially classified into 2 groups based on their LVEF. 43 patients were classified into the HFREF group (HF with Reduced Ejection Fraction) and 58 characterized as HFPEF (HF with Preserved Ejection Fraction). Next, all patients were subdivided into 4 groups according to the degree of diastolic dysfunction. 38 patients with CKD were classified into HF/CKD(+) group. The HF/CKD(-) (HF without CKD) group comprised 61 patients. This study provides original data on positive correlation between ejection fraction and MMP-2 levels in all patients with heart failure. Elevated levels of MMP-2 and TIMP-2 were found in serum from patients with chronic kidney disease; in addition, serum levels of MMP-2 were correlated with the degree of kidney failure. In all groups of patients there was positive correlation between MMP-2 and TIMP-2. Among patients with heart failure etiology was not related to MMP-2 and TIMP-2 serum levels.

Characteristics of chaotic processes in electrocardiographically identified ventricular arrhythmia.

BACKGROUND The theory of chaos proves a deterministic mechanism of induction of multiple complex processes previously thought to be random in nature. This research explains how these complex processes develop. The aim of the study was to test the hypothesis of the chaotic nature of myocardial electrical events during ventricular tachycardia (VT) and ventricular fibrillation (VF). METHODS Original hardware and software was developed for digitalization of on-line electrocardiography (ECG) data, with the functions of automatic and manual identification as well as categoriza-tion of specific ventricular arrhythmias. Patient ECGs were recorded by specially developed measuring equipment (M2TT). Available ECG sampling frequency was 20,000 Hz, and it was possible to analyze the signal retrospectively. Digital ECG of the sinus rhythm (SR) was analyzed with non-sustained VT, VT and VF. The signals were then subjected to mathematical analysis. Using wavelet analysis, signals carrying frequencies from various ranges were isolated from baseline and each of these isolated signals was subjected to Fourier transformation to check on differences in the Fourier power spectra of the analyzed VT and VF signals. RESULTS Ventricular tachycardia identified based on ECG fulfills the criteria of a chaotic process, while no such properties were found for SR and VF. Information obtained by the ECG is used to record myo-cardial electrical signals, but they are not sufficient to differentiate between an advanced chaotic state and the process of linear expansion of electrical activation within the myocardium. CONCLUSIONS Electrophysiological study requires advanced methods to record the signal of myocardial electrical activity, as ECG is not sufficiently sensitive to identify the features of a chaotic process during VF. (Cardiol J 2017; 24, 2: 151-158).