Disturbances of circadian profile and blood pressure control in patients with systemic lupus erythematosus without overt heart disease.

Introduction: Lupus erythematosus (SLE) is an autoimmune disease that causes a significantly increased risk of cardiovascular diseases. This process is underlain by the early and accelerated atherosclerosis. Aim: To assess the diurnal blood pressure profile disturbances in normotensive patients without overt cardiovascular disease and to correlate with early atherosclerotic markers. Material and methods: The study included 32 baseline normotensive women with SLE and 30 healthy control women. Each participant underwent a 24-hour automatic blood pressure measurement and an ultrasound assessment of intima media thickness (IMT) and the presence of carotid atherosclerotic plaques. Results: Atherosclerotic plaques were present in 46.9% of SLE women. They had a significantly higher IMT compared to those without atherosclerotic plaques and control group (0.833 ±0.216 vs. 0.606 ±0.121 vs. 0.66 ±0.16 mm). A significant positive correlation was found between IMT and age of patients, nocturnal systolic blood pressure (SBP), nocturnal systolic pressure (SP) load, nocturnal SBP decline and presence of atherosclerotic plaques. The plaques positively correlated with age and with ambulatory blood pressure monitoring (ABPM) parameters. Fifty percent of SLE women had an abnormal 24-hour BP profile, of which 4 had non-dipper, 8 invers, and 4 hyper-dipper profile. Based on ABPM, hypertension can be diagnosed in 14 (43.75%) initially normotensive women. Women with SLE and arterial hypertension (HA) had atherosclerotic plaques significantly more often, especially in nocturnal hypertension. Conclusions: The authors confirm the underestimation of hypertension in SLE. Most women diagnosed with hypertension by ABPM had nocturnal hypertension. We showed a more frequent disturbed BP and a significant relationship between the abnormal BP profile, especially nocturnal hypertension, and accelerated development of atherosclerosis.

[Increased level of lipid peroxidation products and disturbances in oxidation-reduction balance in erythrocytes from patients suffering from systemic sclerosis, who are chronically treated with vitamin E]. / Zwiekszone stezenie produktów peroksydacji lipidów oraz zaburzenia aktywnosci enzymów antyoksydacyjnych w erytrocytach u chorych na twardzine ukladowa, przewlekle leczonych witamina E.

UNLABELLED: Systemic sclerosis is a chronic connective tissue disease of unknown pathogenesis. In view of the reports of essential role of oxidative stress in development of disease, trials with supportive care with vitamin E are undertaken. The aim of the study was to estimate parameters of oxidation-reduction balance in erythrocytes from scleroderma patients, who were chronically treated with vitamin E compared with healthy controls. MATERIAL AND METHODS: In the study there were included 14 women with systemic sclerosis (limited form - ISSc - n = 10, diffuse form - dSsc - n = 4, age 53.8 lat +/- 11.5), who were treated with vitamin E in dose 400 mg/day not shorter than in 6 months period and 23 healthy women (age 52.7 +/- 11.2) as a control group. The following measurements were done: hs CRP (immunoturbidimetic method), glutathione peroxidase activity (Gpx--method of Rice-Evans, 1991), superoxide dismutase activity (SOD--method of Misra, 1972), catalase activity (CAT--method of Aebi H, 1984), free thiol group concentration (SH--method of ElIman, 1959), level of lipid peroxidation products (TBARs--method of Stocks and Dormandy, 1971), total antioxidant capacity (TAC) depended of slow (TAC "slow") and fast (TAC "fast") antioxidants. RESULTS: . In both forms of systemic sclerosis significantly higher TBARs in comparison of healthy controls (5.81 +/- 1.57 vs 4.28 +/- 0.89 nM TBARS/gHb; p < 0.01) was observed. Patients with limited systemic sclerosis have significantly higher activity of Gpx (59.9 +/- 26.11 vs 32.19 +/- 11.67 U/mg Hb; p < 0.01), and no differences in activity of CAT and SOD. In patients with diffuse systemic sclerosis significantly lower activity of CAT (173.06 +/- 60.3 vs 284.47 +/- 43.33 U/mg Hb; p < 0.01) and SOD (2334.95 +/- 193.97 vs 3231.47 +/- 840.21 U/mg Hb; p < 0.05) was observed. There are no differences in TAC and SH between investigated groups. CONCLUSIONS: In scleroderma patients despite chronical treatment with vitamin E, oxidation-reduction balance disturbances are observed in the form of increased level of lipid peroxidation products. Besides, a lower activity of catalase and superoxide dysmutase in patients who suffer from diffuse form of systemic sclerosis is noted. Patients with limited systemic sclerosis have higher glutathione peroxidase activity.

Heart rhythm turbulence and NT-proBNP in decompensated liver cirrhosis--a pilot study.

BACKGROUND: Heart rhythm turbulence (HRT) is a novel tool for evaluation of cardiovascular mortality. Liver cirrhosis is associated with hemodynamic and myocardial disturbances termed cirrhotic cardiomyopathy. In the stable stage of liver cirrhosis, systolic and myocardial dysfunction is correlated with brain natriuretic peptide (BNP). The aim was to evaluate HRT and its correlation with NT-proBNP, echocardiographic and biochemical parameters in patients with decompensation of liver cirrhosis. MATERIAL/METHODS: The study included 18 patients with decompensated liver cirrhosis and 18 healthy volunteers. Participants underwent echocardiography and 24-hour ECG monitoring. Serum NT-proBNP and other biochemical parameters were measured. Turbulence onset (TO) and turbulence slope (TS) were used to indicate HRT. RESULTS: Mean HR (87/min vs. 75/min), TO (-0.385% vs. -0.92%), NT-proBNP (304.85 pg/ml vs. 83.2 pg/ml), LAd (42.5 mm vs. 34.5 mm), RVdd (29.5 mm vs. 25 mm), SPAP (36.5 mmHg vs. 22.5 mmHg) were significantly (p<0.05) higher in patients with liver cirrhosis. Patients with normal TO and TS had better stage in Child-Pugh classification (P=0.04) than patients with abnormal values. Significant negative correlation was found between creatinine and TO, and between mean HR and TS, and significant positive correlation was found between LAd and TS. LV diastolic dysfunction was noted in a majority of cirrhotic patients (n=16). CONCLUSIONS: Patients with decompensated cirrhosis had elevated levels of NT-proBNP and LV diastolic dysfunction. TO values in cirrhotic patients differed significantly from the control group. These findings can indicate risk of symptomatic heart failure development and may be a marker of cirrhotic cardiomyopathy. HRT parameters seem not to be appropriate death predicators.