Prognostic value of selected echocardiographic, impedance cardiographic, and hemodynamic parameters determined during right heart catheterization in patients qualified for heart transplantation.

The aim of the study was to verify prognostic value of selected echocardiographic (UKG), impedance cardiography (ICG), and right heart catheterization (RHC) parameters in systolic heart failure (HF). UKG, ICG, and RHC were performed in 46 patients with chronic HF with ejection fraction <35%. During a 1-year follow-up, composite endpoint (death or hospitalization due to HF exacerbation) was achieved by 23 (50.0%) patients. Analysis of receiver operating characteristic (ROC) curves identified UKG parameters: inferior vena cava diameter on inspiration (IVCinsp) >13 mm [area under curve (AUC), 0.791], right atrial (RA) >5.2 cm (AUC 0.710) and ventricular dimension (RVD) >3.5 cm (AUC 0.717), tricuspid annular plane systolic excursion (TAPSE) <17 mm (AUC 0.682), and its velocity (S'RV) <6.07 cm/s (AUC 0.716) as unfavorable prognostic factors. RHC parameters: low values of cardiac index (CI < 2.1 L/min; AUC 0.846) and high pulmonary capillary wedge pressure (PCWP > 24 mmHg; AUC 0.773) turned out to be the most accurate single predictors of worse outcome. Prognostic value of non-invasive parameters was improved due to the use of their composite measures: IVC% × TAPSE (<430%/mm; AUC 0.826), RVSP/TAPSE (>2.4 mmHg/mm; AUC 0.800), IVC% × SBP (>2097% mmHg; AUC 0.826), and RA × IVCinsp/S'RV (>11.8 cm s; AUC 0.839). In conclusion, composite measures based on non-invasive parameters, such as IVC%/TAPSE, RVSP/TAPSE and RA × IVCinsp/S'RV, may provide equally accurate prognosis as the invasive examination. PCWP and CI determined during RHC were the best individual predictors of the composite endpoint. In addition, echocardiographic parameters: RVD, RA, IVC, TAPSE, and S'RV are accurate predictors of the unfavorable outcome.

Aging Athlete's Heart: An Echocardiographic Evaluation of Competitive Sprint- versus Endurance-Trained Master Athletes.

BACKGROUND: Sports training triggers exercise-induced cardiac remodeling (EICR). Sprint- and endurance-trained master athletes are exposed to different hemodynamic stimuli accompanied by aging. The aim of this study was to compare EICR types in light of the Morganroth hypothesis, frequency of abnormalities, and relationships between cardiac traits and age. METHODS: In this observational cross-sectional study, echocardiographic examinations were conducted in 143 sprint-trained (age range, 36-83 years) and 114 endurance-trained (age range, 38-85 years) competitive master athletes. Structural and functional characteristics were compared with population reference values, and EICR types were identified. Athletic groups were compared using t tests and χ2 tests. Relationships with age were assessed using linear regression. RESULTS: In the sprint group, 51.0% of athletes had normal cardiac geometry (nonhypertrophic heart), 4.2% had eccentric hypertrophy, 36.4% had concentric remodeling, and 8.4% had concentric hypertrophy. In their endurance-trained peers, these proportions were 22.8%, 16.7%, 36.8%, and 23.7%, respectively. Many athletes in both groups had structural abnormalities, as assessed using population norms (up to ~81% for septal thickness) but their resting cardiac function was normal. The relationships of structural and functional cardiac characteristics with age were mostly weak to moderate and did not differ between training modalities. CONCLUSIONS: Even though many endurance- and sprint-oriented master athletes exceed population norms for cardiac structure, they do not go beyond the "gray zone" and preserve normal cardiac function. Therefore, physiologic adaptations, rather than pathologic abnormalities, are expected in aging but still active athletes. Inconsistent with the Morganroth hypothesis, EICR is shifted toward normal geometry in sprinters and toward concentric remodeling and hypertrophy in endurance runners. A better understanding of the mechanisms behind cardiac remodeling during aging is needed to adequately predict EICR types in master athletes.

Resveratrol and cardiovascular system-the unfulfilled hopes.

INTRODUCTION: Resveratrol is a natural polyphenolic compound with a stilbene structure endowed with multiple health-promoting effects. Among phenolic compounds, resveratrol is assigned a leading role in the health-promoting effects of red wine. METHODS: The aim of the study was to assess the effect of resveratrol on the cardiovascular system in the experimental and clinical studies conducted so far. Moreover, the paper discusses the results of the most recent meta-analyses assessing resveratrol's therapeutic effect on the cardiovascular system in humans. RESULTS: In animal and preclinical studies, resveratrol has demonstrated a wide physiological and biochemical spectrum of activity, including antioxidant, anti-inflammatory, antiplatelet, and anticoagulant activities, which translated into its health-promoting effects on the cardiovascular system. The performed meta-analyses allow to confirm such an impact, however, after the assessment with the use of the SYRCLE's tool, these studies are burdened with a high risk of bias, and the results are not clearly presented. CONCLUSION: Despite numerous articles and clinical studies, the convincing beneficial mechanisms of resveratrol as well as its health-promoting effects in cardiovascular diseases have not been clearly confirmed in humans. Therefore, there is a need for further clinical studies, especially randomized, double-blind, placebo-controlled trials to objectively confirm the possible health-promoting effects of this substance and to determine both the efficacy and safety, and possible therapeutic potential.

[The case of surgically treated severe thromboemboic pulmonary hypertension developing in the course of recurrent pulmonary embolism]. / Ciezkie zakrzepowo-zatorowe nadcisnienie plucne w przebiegu nawracajacej zatorowosci plucnej leczone operacyjnie.

A case of a patient with surgically treated progressive thromboembolic pulmonary hypertension in the course of recurrent pulmonary embolism resulting from deep vein thrombosis is presented. Acute embolic episode seems to have crucial role as an initiating factor triggering the cascade of unfavorable changes in pulmonary vasculature. The paper stresses the role of systematic clinical and echocardiographic control of patients after pulmonary embolism in order to diagnose developing complications as soon as possible. It would allow to introduce efficient treatment and improve prognosis.

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.

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.

Autonomic nervous function in Helicobacter pylori-infected patients with atypical chest pain studied by analysis of heart rate variability.

OBJECTIVES: Cardiovascular autonomic nervous system (ANS) activity estimated by analysis of heart rate variability (HRV) was compared in Helicobacter pylori-positive and H. pylori-negative male patients suffering from atypical chest pain to verify the hypothesis that autonomic neural system might be the way linking chronic H. pylori infection with gastrointestinal tract disorders. METHODS: We have analysed data obtained from 101 male patients examined in our clinic due to atypical chest pain, without evidence of serious cardiovascular, respiratory and digestive tract or metabolic diseases. In each patient, besides interview and physical examination, were performed: gastroscopy with mucosa biopsy (for urease test and histology), oesophageal pH-metry and manometry, ultrasound abdomen examination, chest X-ray, exercise test on running track, 24-h ECG Holter monitoring with time-domain and frequency-domain HRV analysis, and echocardiography. RESULTS: In comparison with H. pylori-negative, in all H. pylori-infected patients (n = 63) a significantly greater low frequency power, an index of sympathetic activity, and higher values of vagal tone parameters [pNN50, percentage of differences between RR intervals that are greater than 50 ms; high-frequency power in HRV analysis (HF)] were observed. The relationship between H. pylori infection and the HF value was confirmed in multi-factorial analysis. The aforementioned ANS activity differences were accompanied by: significantly fewer gastro-oesophageal acid reflux episodes, lower gastric acidity and more effective and complete oesophageal peristalsis in H. pylori-positive patients. CONCLUSIONS: H. pylori infection may affect ANS activity and via this way also contribute to gastro-oesophageal and cardiovascular pathology.

Increased risk of osteoarthritis after anterior cruciate ligament reconstruction: a 14-year follow-up study of a randomized controlled trial.

BACKGROUND: The reported prevalence of radiological osteoarthritis (OA) after anterior cruciate ligament (ACL) reconstruction varies from 10% to 90%. Purpose/ HYPOTHESIS: To report the prevalence of OA after ACL reconstruction and to compare the OA prevalence between quadrupled semitendinosus tendon (ST) and bone-patellar tendon-bone (BPTB) grafts. The hypothesis was that there would be no difference in OA prevalence between the graft types. The secondary aim was to study whether patient characteristics and additional injuries were associated with long-term outcomes. STUDY DESIGN: Randomized controlled trial; Level of evidence, 1. METHODS: Radiological examination results, Tegner activity levels, and Knee injury and Osteoarthritis Outcome Score (KOOS) values were determined in 135 (82%) of 164 patients at a mean of 14 years after ACL reconstruction randomized to an ST or a BPTB graft. Osteoarthritis was defined according to a consensus by at least 2 of 3 radiologists of Kellgren-Lawrence grade ≥2. Using regression analysis, graft type, sex, age, overweight, time between injury and reconstruction, additional meniscus injury, and a number of other variables were assessed as risk factors for OA 14 years after ACL reconstruction. RESULTS: Osteoarthritis of the medial compartment was most frequent, with 57% of OA cases in the ACL-reconstructed knee and 18% of OA cases in the contralateral knee (P < .001). There was no difference between the graft types: 49% of OA of the medial compartment for BPTB grafts and 65% for ST grafts (P = .073). The KOOS results were lower for patients with OA in all subscales, indicating that OA was symptomatic. No difference in the KOOS between the graft types was found. Meniscus resection was a strong risk factor for OA of the medial compartment (odds ratio, 3.6; 95% CI, 1.4-9.3) in the multivariable logistic regression analysis. CONCLUSION: A 3-fold increased prevalence of OA was found after an ACL injury treated with reconstruction compared with the contralateral healthy knee. No differences in the prevalence of OA between the BPTB and quadrupled ST reconstructions were found. An initial meniscus resection was a strong risk factor for OA; the time between injury and reconstruction was not.

Short-term alcohol consumption may have detrimental effect on fibrinolysis and endothelial function: preliminary report of prospective randomised study.

BACKGROUND AND AIM: This study was designed to clarify the impact of the short-term consumption of different types of alcoholic beverages on haemostatic factors, C-reactive protein (hsCRP) and endothelin-1 (E-1) plasma levels. METHODS: The study group consisted of 57 healthy male volunteers, aged 20-29 years. Subjects were randomised to consume 300 mL of red wine, white wine, 12% ethanol, black currant juice or water for five days. Blood samples were collected for CRP, tissue type plasminogen activator antigen (t-PA:Ag), plasminogen activator inhibitor antigen (PAI-1:Ag) and E-1 at baseline, on day 2, and on day 6. RESULTS: A significant increase in PAI-1:Ag concentration was observed in the red wine drinking group (day 1: 44.98; day 2:56.86; day 6: 47.44 ng/mL; p = 0.05). A similar increase of E-1 level was found in the 12% ethanol group (day 1: 0.53; day 2:1.65; day 6: 1.11 fmol/mL; p = 0.01). Dividing the whole study group according to ethanol content of consumed beverages revealed significant changes in tPA:Ag, PAI-1:Ag and E-1 levels. In the alcohol drinking group, significant increases of PAI-1:Ag (day 1: 44.75; day 2: 54.07; day 6: 44.80 ng/mL; p < 0.05); tPA:Ag level (day 1: 3.65; day 2: 4.17; day 6: 5.03 ng/mL;p < 0.02) and E-1 (day 1: 0.42; day 2: 1.01; day 6: 0.97 fmol/mL; p < 0.002) were observed. CONCLUSIONS: Short-term alcohol consumption increases tPA:Ag, PAI:Ag and E-1 plasma levels. This effect may have an unfavourable impact on the fibrinolytic system and endothelial function.

Giant post-infarction pseudoaneurysm of the left ventricle manifesting as severe heart failure.

A 57 year-old female was admitted for chronic heart failure (HF) with NYHA class IV symptoms. Transthoracic echocardiography revealed ruptured left ventricular (LV) lateral and posterior wall between their basal and middle segments resulting in giant, round pseudoaneurysm formation with a diameter of 12 cm. Bidirectional flow through a 2.9 cm orifice between the LV and the pseudoaneurysm cavity was shown. A 12-cm diameter pseudoaneurysm was resected and the orifice was closed with a Dacron patch. Twelve months after the diagnosis, the patient is in a stable condition with NYHA class II HF symptoms.

[Severe, thromboembolic pulmonary hypertension with recurrent pulmonary embolism and right heart thrombi in a patient with past myocardial infarction, cerebral ischaemic stroke and small intestine necrosis]. / Ciezkie, zakrzepowo−zatorowe nadcisnienie plucne z nawracajaca zatorowoscia plucna i skrzeplinami w prawych jamach serca u pacjenta z przebytymi zawalami serca, udarem pnia mózgu oraz martwica jelita cienkiego.

Chronic thromboembolic pulmonary hypertension (CTEPH) is a chronic progressive disease of pulmonary circulation characterised by indistinct ethiopathogenesis. We present a case of a 50 year-old male with thrombophilia of unknown origin leading to the formation of multiple thrombi within venous circulation followed by episodes of acute pulmonary embolism resulting ultimately in acute heart failure in the course of developing CTEPH. Unfortunately, despite the wide range of haemostasis laboratory tests we were not able to define the type of coagulation abnormality. Owing to the efficient cooperation between cardiologists and cardiosurgeons it was possible to save patient's life.

[Recurrent cardiac tamponade and sepsis in a patient with rheumatoid arthritis]. / Nawracajaca tamponada serca i posocznica u pacjenta z reumatoidalnym zapaleniem stawów.

Exudative pericarditis is found in 30-50% of the patients with rheumatoid arthritis (RA), particularly in later stages of the disease. Most cases present with no or few symptoms. We report a case of a 68 year-old male with a history of mild RA who developed exudative pericarditis leading to recurrent cardiac tamponade requiring repeated pericardiocenteses. Treatment with glucocorticosteroids, methotrexate and colchicine proved ineffective in preventing the recurrences. Immunosuppression contributed to the development of sepsis caused by Enterobacter cloacae and resulting in the patient's death.

[Severe tachycardiomyopathy and thrombus in the left atrial appendage--a case report]. / Zaawansowana kardiomiopatia tachyarytmiczna i przewlekla, oporna na leczenie skrzeplina w uszku lewego przedsionka.

We describe a case of severe left ventricular (LV) heart failure caused by tachycardiomyopathy with concomitant presence of unsolved thrombus in left atrial appendage despite effective oral anticoagulant treatment. Successful ablation of atrial flutter and atrioventricular nodal reentry tachycardia entailed resolution of heart failure symptoms and normalisation of LV function.

[Successful therapy and rehabilitation following stroke in a pregnant woman with prosthetic aortic valve]. / Pomyslna terapia i rehabilitacja udaru u ciezarnej ze wszczepiona sztuczna zastawka aortalna.

This report describes a case of a 40 year-old woman with implanted aortic prosthetic valve, who experienced thrombo-embolic complication in a form of ischaemic stroke in 15 week of pregnancy. At the beginning of the event, the patient suffered from mixed aphasia, right-side paresis and depressive syndrome. Thanks to cooperation of many specialists, especially rehabilitation team, she restored overall physical efficiency, speaking ability, delivered a healthy child, and returned to normal family and social activity. Problems of anti-thrombotic therapy during pregnancy in patients with prosthetic valves are discussed.

The reliability of noninvasive cardiac output measurement using the inert gas rebreathing method in patients with advanced heart failure.

BACKGROUND: Impaired cardiac output (CO) is a key element of heart failure (HF). So far, there has been no simple, reliable, inexpensive and non-invasive CO measurement method feasible for clinical practice. Not a single diagnostic test has been elaborated to diagnose and monitor HF. The aim of the study was the evaluation of the reliability of a new, non-invasive CO measurement device utilizing an inert gas rebreathing technique and an infrared photoacoustic gas analyzer, in comparison with standard invasive methods. METHODS: In 21 patients with advanced HF (NYHA classes III and IV) undergoing cardiac catheterization as a routine hemodynamic evaluation before heart transplantation, CO measurements with the tested non-invasive method were carried out during invasive examination. RESULTS: CO measured by the inert gas rebreathing technique (CO(RB)), according to the statistical Bland-Altman method, was, on average, 0.1 L/min higher than that determined by thermodilution (CO(TD)) and 0.006 L/min higher than the CO determined by the Fick formula (CO(Fick)). This magnitude of difference equals 2.8% of CO(TD) and 0.15% of CO(Fick) values. The limits of agreement between CO(RB) and CO(TD) were +/- 1.4 L/min, and between CO(RB) and CO(Fick) +/- 1.3 L/min. In the subgroup with atrial fibrillation, the mean difference between tested and reference methods (0.3 +/- 1.0 L/min for both CO(TD) and CO(Fick)) was higher than in the sinus rhythm subgroup (0.06 +/- 1.5 L/min for CO(TD) and 0.08 +/- 1.5 for CO(Fick)). CONCLUSIONS: CO measurement with the inert gas rebreathing method utilizing an infrared photoacoustic gas analyzer seems reliable enough to be employed in clinical practice. Being non-invasive, it may well be used for repeated determinations in patients with HF.

Immunoglobulin E in patients with ischemic heart disease.

BACKGROUND: In recent years, increased serum immunoglobulin E (IgE) concentration in patients with cardiovascular diseases has been generating more and more interest. It is as yet unknown, however, if the increased IgE level is a marker of future coronary incidents and whether it may be regarded as an ischemic heart disease risk factor, or if it is indicative of the participation of antibodies in an inflammatory reaction to tissue damage. The aim of the study was to evaluate what significant changes in the total IgE concentration occur in patients with different forms of ischemic heart disease (IHD) and whether the concentration differs in comparison to healthy people. Additionally, we evaluated the dynamics of serum IgE concentration in patients with acute myocardial infarction. METHODS: The study included 195 patients: 80 acute myocardial infarction (AMI) patients, 58 patients with troponin-negative acute coronary syndrome (ACS) and 57 patients with stable angina pectoris, with negative personal and family history of allergy. The control group consisted of 39 healthy, age-matched individuals. Serum IgE concentration measurements were carried out with an Uni-cap Total IgE kit, using the FEIA technique. RESULTS: In patients suffering from any form of ischemic heart disease, significantly increased concentrations of serum immunoglobulin E were found, as compared to the control group of healthy individuals. Changes of IgE serum concentration on the 1(st) day, 7(th) day, 14(th) day and 40(th) day after AMI did not reveal any significant differences. Males with AMI turned out to have significantly higher immunoglobulin concentrations than females. CONCLUSION: The observed higher serum IgE concentration in patients with IHD may serve as evidence contribution to atherogenesis and myocardial ischemia.

Immunoglobulin E as a marker of the atherothrombotic process in patients with acute myocardial infarction.

BACKGROUND: Clot formation is a crucial moment in the patophysiology of acute coronary syndromes. The aim of this research was to assess the relationship between immunoglobulin E (IgE), lipid parameters and chosen hemostatic markers. The role of IgE as a possible participant in the atherothrombotic process was also investigated. METHODS: A total of 80 patients with acute myocardial infarction (MI) was enrolled in the study. Concentrations of IgE, plasma lipid parameters, lipoprotein(a), markers of thrombin generation (TAT, AT III), markers of fibrinolysis (tPA:Ag, PAI-1:Ag, PAP, D-dimers) and markers of endothelial damage (von Willebrand factor) were measured in blood samples collected immediately after admission, before any treatment administration. RESULTS: In patients with acute MI and with IgE concentration above 100 kU/l, IgE values were strongly, positively correlated with LDL concentration (p < 0.05), lipoprotein(a) concentration (p < 0.02) and negatively correlated with HDL plasma levels (p < 0.02). Exclusion of patients with IgE concentration lower than 150 kU/l strengthened the correlation between IgE concentration and LDL (p < 0.002) and lipoprotein(a) (p < 0.01) levels. It also revealed a significant correlation between IgE and TAT (p < 0.001), IgE and AT III (p < 0.002), and IgE and D-dimers (p < 0.05). IgE and TAT values measured 7, 14 and 40 days after infarction also showed significant positive correlation between increments of these parameters. CONCLUSIONS: In patients with acute MI, a significant increase of thrombinogenesis and fibrinolysis markers is observed. Positive correlation between IgE concentration above 100 kU/l and markers of thrombinogenesis activation, lipid parameters and lipoprotein(a) levels, with significance increasing with IgE concentration and constant positive correlation between increments of IgE and TAT, can serve as evidence of IgE participation in the atherothrombotic process. (Cardiol J 2007; 14: 266-273).

Parameters of the functional and morphological status of the upper digestive tract in alcohol-dependent male patients with depression and alexithymia in the context of autonomic nervous system activity and nitric oxide plasma level.

BACKGROUND: Psychosomatic factors play an important role in the pathogenesis of many diseases. The aim of this study was to compare the results of upper digestive tract examinations in alcoholics with depression and/or alexithymia diagnosed with atypical chest pain. MATERIAL/METHODS: In 52 alcohol dependent male patients with atypical chest pain we performed gastroduodenoscopy, esophageal and gastric pH-metry, 24-h esophageal manometry, treadmill stress test, Holter monitoring, and blood sampling. Depression was diagnosed using the Beck Depression Inventory (BDI), and alexithymia according to the Toronto Alexithymia Scale (TAS). RESULTS: Depression and/or alexithymia were diagnosed in 37 patients (71%). Depressive and alexithymic patients, in comparison to subjects with lower BDI and TAS scores, had less intensive Helicobacter pylori antral colonization, higher values of gastro-esophageal acid reflux parameters in 24h pH-metry, higher mean amplitude of contraction, longer mean contraction duration, higher percentage of hypertensive contractions, and a greater percentage of effective peristalsis, in spite of a similar percentage of peristaltic and simultaneous contractions. The patient groups did not differ in relation to gastric pH-metry parameters or factors potentially connecting mental status and esophageal function regulation, such as plasma nitric oxide metabolite concentration and heart rate variability (HRV), which correlate with autonomic nervous system activity. CONCLUSIONS: In alcoholic patients with depression and alexithymia there is a tendency to greater functional disturbances in the upper digestive tract. The observed differences between groups were not related to changes in ANS activity and nitric oxide metabolism.