Walentyna Mazurek

Plasma levels of Tnf-α, Il-6, and Il-10 and their relationship with left ventricular diastolic function in patients with stable angina pectoris and preserved left ventricular systolic performance

AimsThe role of inflammation – a key factor underlying coronary artery disease (CAD) and systolic heart failure – in promotion of left ventricular (LV) diastolic dysfunction has not been investigated extensively so far. The aim of this study was: (i) to evaluate plasma levels of TNF-&agr;, IL-6, and IL-10 in patients with stable CAD and preserved LV systolic function and (ii) to assess their relationships with LV diastolic function. MethodsThe study population consisted of 126 patients with single vessel and 58 patients with multivessel stable CAD and LV ejection fraction >50%, and 39 healthy controls. Each participant underwent echocardiographic study including estimation of LV diastolic function indices: peak velocities of early (E) and late (A) transmitral flows, deceleration time of E wave, isovolumic relaxation time, E wave (ETT) and A wave (ATT) transit time to the LV outflow tract, and flow propagation velocity of E wave (Ep). Plasma TNF-&agr;, IL-6, and IL-10 levels were evaluated by radioimmunometric method. ResultsPatients with CAD presented higher TNF-&agr; and IL-6 levels and higher values of IL-6/IL-10 and TNF-&agr;/IL-10 ratio than the controls. IL-6 levels were higher in patients with multivessel disease than in those with single vessel disease. Significant correlations (all P<0.001) were found for TNF-&agr; and Ep (r=−0.41), E/Ep (r=0.45), and ETT (r=0.38). IL-6 correlated with Ep (r=−0.39) and E/A (r=−0.33), whereas IL-10 with ETT (r=0.37), Ep (r=−0.44), and E/Ep (r=0.46). ConclusionIn patients with stable CAD and preserved LV systolic performance, plasma levels of TNF-&agr; and IL-6 are elevated and there is association between immunoinflammatory activation reflected by plasma levels of cytokines and LV diastolic dysfunction.

Electrocardiographic characteristics of atrioventricular block induced by tilt testing

AIMS The electrocardiographic (ECG) characteristics of atrioventricular (AV) block during reflex syncope may be unique due to the presence of hypervagotonia. The aim of the present study was to define the ECG characteristics of the AV block induced by neurocardiogenic reflex provoked by tilt testing (TT). METHODS AND RESULTS A series of 31 patients with presumed vasovagal syncope and AV block provoked by TT was studied. The duration of PP and PR interval, AV block grade and type, concomitant arrhythmias, and timing of the AV block occurrence were assessed. The AV block occurred at TT termination in 26 patients, in the recovery in 4 patients, and in both periods in 1 patient. Atrioventricular block was preceded by sinus slowing, and sinus rhythm during AV block was slow and instable. Mobitz I, 2:1 second-degree AV block, and advanced second-degree AV block were recognized in 35.5, 48.4, and 67.8% of patients, respectively. Third-degree AV block was diagnosed in 41.9% of patients. Twenty-one patients had at least two AV block forms. The most prevalent concomitant arrhythmia was junctional escape rhythm (61.3%). CONCLUSION (i) The occurrence of the AV block during neurocardiogenic reaction induced by TT is always preceded by sinus rhythm slowing and usually by PR interval prolongation. (ii) The AV block provoked by TT usually occurs at TT termination, but may occur even in the recovery period in a supine position. Sometimes the AV block may be present both at TT termination and during the recovery period.

The influence of a tilt training programme on the renin-angiotensin-aldosterone system activity in patients with vasovagal syncope.

Objective — We assessed the influence of short-term and long-term tilt training on the activity of the renin-angiotensin-aldosterone system (RAAS) in vasovagal patients. Methods and results — Thirty-nine patients (28 F, 11 M) aged 39.7 ± 11.2 years with a history of vasovagal syncope and a positive head-up tilt test (HUT) were studied. Blood samples for plasma renin activity (PRA) and aldosterone (ALDO) concentration were drawn at the baseline, immediately after HUT and 10 min after HUT, during the diagnostic, the negative short-term (2-5 days) follow-up HUT and long-term (1-3 months) follow-up HUT.Tilt training was started after diagnostic HUT. In diagnostic HUT, PRA increased significantly immediately after HUT comparing to the baseline, during recovery the values did not change.ALDO concentration increased after HUT comparing to baseline and further increased during recovery. After short-term tilt training, PRA and ALDO concentrations did not significantly change compared to their corresponding values in diagnostic HUT.After long-term tilt training, PRA did not significantly change compared to the values in the diagnostic and short-term follow-up HUT.ALDO concentration also did not change significantly at the baseline and immediately after HUT, and 10 min after HUT ALDO concentration was significantly lower than after diagnostic HUT. Conclusions — Tilt training changes the response of RAAS to the prolonged orthostasis in vasovagal patients. The coupling between PRA and ALDO after diagnostic HUT has been found to be altered and the physiological relationship was restored after long-term tilt training.The beneficial effect of tilt training depends partially on changed RAAS activation.

Influence of tilt training on activation of the autonomic nervous system in patients with vasovagal syncope.

Objective — Tilt training is a new treatment for vasovagal syncope. Its therapeutic efficacy is thought to be the result of the desensitization of cardiopulmonary receptors, but it could be the influence of the tilt training on the activation of the autonomic nervous system as well. Methods and results — The study group consisted of 24 vasovagal patients (17 women and 7 men) aged 32.5 ± 11.8 years.The diagnostic head-up tilt test was performed according to the Italian protocol with nitroglycerin if necessary. The monitoring head-up tilt test was performed according to the Westminster protocol without provocation, after 1 to 3 months of tilt training. Holter ECG recordings for HRV parameters (time and frequency domain) were obtained from selected 2-min intervals before, during and after the diagnostic and monitoring tilt test. The diagnostic test was positive in the passive phase in 6 and after provocation in 18 patients. During the training period no syncope occurred.Analysing the HRV parameters we demonstrated the following findings: 1. mRR decreases immediately after assumption of a vertical position in both tests (diagnostic and monitoring) but in the diagnostic test its further decrease occurs earlier than in the monitoring test; 2. the absolute power of the HF component is greater in the early phase of tilt after tilt training than in the corresponding period in the diagnostic test. Conclusions — After a longer period of tilt training the activation of the sympathetic nervous system in response to the erect position is diminished.