Savvas Mazaris

Novel Biomarkers Assessing Renal Function in Heart Failure: Relation to Inflammatory Status and Cardiac Remodelling

BACKGROUND Patients with heart failure (HF) have a significant decline of renal function. We investigate the association between novel biomarkers of renal dysfunction and indices of inflammatory status and cardiac remodeling in patients with HF. METHODS We enrolled 79 consecutive patients with HF and 79 healthy subjects, adjusted for age and sex. Serum levels of neutrophil gelatinase-associated lipocalin (NGAL), cystatin-C, b-type natriuretic peptide (BNP), tumor necrosis factor alpha (TNFα) and matrix metalloproteinase-9 (MMP-9) were measured by ELISA. Creatinine clearance was estimated using Cockcroft-Gault formula (eCcl). Left ventricular ejection fraction was determined by echocardiography. RESULTS Patients with HF, compared to healthy subjects, had significantly higher NGAL (p=0.007) and cystatin-C levels (p=0.005). In HF patients, NGAL levels were positively correlated with Creatinine levels (r=0.40, p<0.001), TNFa levels (r=0.43, p<0.001), BNP levels (r=0.36, p=0.003), MMP-9 levels (r=0.37, p=0.02) and inversely correlated with left ventricle ejection fraction (r=-0.23, p=0.045). Interestingly, the association between NGAL and MMP-9 levels was independent from confounders such as age, gender, left ventricle ejection fraction, body mass index, TNFα levels, and BNP levels. Moreover, in HF patients, cystatin-C levels were inversely correlated with eCcl (r=-0.21, p=0.04). Cystatin-C levels were not correlated with TNFa, BNP, MMP-9 levels and with left ventricle ejection fraction (p=NS for all). CONCLUSIONS NGAL is associated with left ventricle ejection fraction, and biomarkers of inflammation and cardiac remodeling in patients with HF. These findings highlight a possible common pathogenetic mechanism of renal dysfunction, inflammatory process and cardiac dysfunction in HF.

Novel biomarkers in heart failure: usefulness in clinical practice

Biomarkers have become an increasingly important tool in clinical practice, helping to improve patient care. In heart failure (HF), brain natriuretic peptide and N-terminal prohormone of the brain natriuretic peptide have been widely applied in prognosis, clinical diagnosis and treatment. Recently, several novel biomarkers have been examined on their efficacy to improve diagnosis, determine the pathophysiologic state of HF, improve clinical decision making, clinical outcome, guide treatment and assess prognosis of HF patients. In this special report, the authors summarize the usefulness and significance of the most promising novel biomarkers in patients with HF.

The Natural History of Multifocal Atrial Rhythms in Elderly Outpatients: Insights from the “Ikaria Study”

Multifocal atrial tachycardias confer an adverse prognosis in hospitalized patients. We assessed the prognostic impact of multifocal atrial rhythms (MARs—either chaotic atrial rhythm or multifocal atrial tachycardia/bradycardia) in very elderly outpatients.

EFFECTS OF ATORVASTATIN TREATMENT ON ENDOTHELIAL FUNCTION AND INFLAMMATORY STATUS IN ISCHEMIC HEART FAILURE PATIENTS: THE IMPACT OF RENAL FUNCTION

Endothelial function has an independent predictive value in patients with cardiovascular disease. Impaired renal function is a major determinant of adverse prognosis in heart failure (HF). We examined the impact of atorvastatin treatment and renal function on endothelial function and biomarkers of

THE IMPACT OF ENDOTHELIAL DYSFUNCTION IN THE DEVELOPMENT OF DIABETIC RETINOPATHY: ROLE OF INFLAMMATION

Diabetic Retinopathy (DR) is a leading cause of blindness. Measurement of endothelial function and arterial stiffness are associated with adverse cardiovascular outcomes. We investigated the possible association of DR with endothelial function, arterial stiffness and inflammation. We enrolled 100

THE IMPACT OF ATRIAL FIBRILLATION ON ENDOTHELIAL DYSFUNCTION

Atrial fibrillation (AF) progress from paroxysmal to chronic (long standing persistent or permanent) over time. Endothelial dysfunction may be developed as a result of atrial fibrillation but may also contribute to the progression in the chronic form of the disease. In this cohort study we enrolled

THE ROLE OF SYSTEMIC INFLAMMATION IN PAROXYSMAL AND CHRONIC ATRIAL FIBRILLATION

Atrial fibrillation (AF) is a common encountered disorder associated with various cardiovascular diseases. Although, AF is well associated with left ventricle dysfunction and adverse cardiac remodeling there are limited data concerning the role of systemic inflammatory status in the progression from