The Influence of Cardiac Pacemaker Programming Modes on Exercise Capacity.

BACKGROUND/AIM: The cardiac pacing mode influences the atrioventricular synchronicity and the response of the heart rate to physical exercise. The aim of this study was to compare the influence of the most common pacemaker programming modes on exercise capacity. PATIENTS AND METHODS: Fifty-two pacemaker-wearing patients were clinically evaluated and submitted to an exercise stress test. RESULTS: Symptoms of heart failure were more frequently met in the single-chamber pacemaker group compared to the dual-chamber group. The parameters recorded during the exercise stress test were significantly better with the rate responsive function (RRF) activated. The effort time was higher by an average of 2.1 minutes and the exercise capacity was higher by 0.92 metabolic equivalents. CONCLUSION: Dual-chamber pacing is superior to single-chamber (ventricular) pacing and the activation of the RRF in single-chamber pacemakers has similar impact on exercise capacity as the preservation of atrioventricular synchronicity by dual-chamber pacemakers.

NT-proBNP values in elderly heart failure patients with atrial fibrillation and diabetes.

AIM: To evaluate N-terminal pro-BNP-type natriuretic peptide (NT-proBNP) plasmatic levels in heart failure patients with/without atrial fibrillation (AFib) and with/without diabetes (DM). METHODS: The study enrolled 120 patients with heart failure, age 71.26±9.14, 48.3% AFib and 30.8% with DM. The patients were divided into 4 groups according to the presence or absence of AFib and DM: group 1, 46 patients in sinus rhythm (SR) without DM; group 2, 16 patients in SR with DM; group 3, 37 patients with AFib and without DM; group 4, 21 patients with both AFib and DM. RESULTS: The patients in SR with DM displayed lower NT-proBNP levels than those with AFib without DM (1196.75±1183.11 vs 1940.59±963.665, p=0.02). We recorded no significant difference in comparison with the patients who had both AFib and DM (1196.75±1183.11 vs 1452.67±1257.94, p=NS). There was no significant difference between groups 3 and 4. Statistically significant correlations between ejection fraction, namely NYHA class and NT-proBNP levels were recorded only in the patients in SR-group 1 (r=-0.42, p<0.01) and group 2 (r=-0.66, p<0.01). CONCLUSIONS: Correlations between plasma NT-proBNP levels and ejection fraction, namely NYHA class, were evinced only in patients in SR.

NT-pro-BNP during isotonic and isometric exercise in heart failure patients with preserved LV ejection fraction.

BACKGROUND: NT-pro-BNP level is increased in both systolic and diastolic heart failure (HF) and furthermore increases more during exercise. In diastolic HF, NT-pro-BNP might increase more during isometric exercise than during isotonic exercises because of increased afterload. We studied NT-pro-BNP values during isometric (hand-grip) and isotonic (cycloergometer) exercise in HF patients with preserved left ventricular ejection fraction and different degrees of diastolic dysfunction. METHODS: We studied 87 patients, aged 58 ± 7.9 years, 42.6% females, with heart failure with LVEF > 40% and diastolic dysfunction. The patients were randomly distributed in two groups: 43 patients (Group I) and 44 patients (Group II). Group I underwent ramp exercise testing on a cycloergometer. Group II performed an isometric handgrip test. Plasma NT-pro-BNP levels were measured at rest and immediately after exercise. RESULTS: An abnormal relaxation (AR) pattern was recorded in 30 patients of Group I and 31 patients of Group II. Pseudonormalisation (PSN) and restrictive (R) pattern were noted in 13 patients of each group. As concerns Group I, NT-pro-BNP levels were increased in all patients, particularly in those with PSN or R pattern (p < 0.05). During exercise NT-pro-BNP decreases significantly in AR (1033 ± 516.63 to 800.51 ± 675.89 pg/mL) but not in PSN or R patients (1656.75 ± 977.48 to 1486.38 ± 1182.51 pg/mL). For Group II, NT-pro-BNP registered a similar increase as in Group I, with maximal values in PSN or R subgroup as compared to abnormal relaxation (p < 0.05). At peak exercise, NT-pro-BNP was practically unchanged as compared to the rest values for the whole group (-6%) and for the two subgroups (AR -6.7% and PSN or R -5.21%). We compared rest and exercise NT-pro-BNP with E/E' ratio > 12 in order to identify increased diastolic filling pressure in the LV; AUC was 0.70 and 0.66 for rest and exercise NT-pro-BNP in case of isotonic testing and 0.74 and 0.72 in case of isometric exercise. CONCLUSIONS: Our data suggest that in HF patients with preserved left ventricular ejection fraction, moderate isotonic and isometric exercises do not determine a significant increase (isometric exercise) or even decrease (isotonic exercise) in the value of NT-pro-BNP.

Evolution of cardiovascular risk factors and ischemic heart disease in an elderly urban Romanian population over the course of 1 year.

BACKGROUND: Romania has some of the highest mortality figures in the world attributable to ischemic heart disease and stroke among both men and women. OBJECTIVES: To assess the changes in cardiovascular risk factors and ischemic heart disease in a group of subjects over 65 years of age during 1 year in an urban community of Romania. MATERIALS AND METHODS: We studied 515 subjects (264 women and 251 men) with a mean age of 73.41±6.44 years, followed up over the course of 1 year in order to determine the changes that occurred in cardiovascular risk factors and in the evolution of ischemic heart disease. At the beginning and after 1 year, we determined the following parameters: anthropometric measurements, blood pressure, smoking status, lipid profile (total cholesterol, triglycerides, high-density lipid cholesterol, low-density lipid cholesterol), fasting plasma glucose, and the presence of ischemic heart disease. RESULTS: There were no differences between the first and second assessments concerning the incidence of smoking (12.3% versus (vs) 12.5%), obesity (25% vs 26%), diabetes mellitus (19% vs 22.9%), or hypertension (88.2% vs 92.2%). Statistically significant differences were recorded regarding dyslipidemia (40.6% vs 30.3%, P<0.001). Cholesterol median values decreased (204 mg/dL vs 194 mg/dL, P=0.003), while median concentrations of plasma glucose increased (101 mg/dL vs 105 mg/dL, P<0.05). At the same time, we noted a higher incidence of ischemic heart disease (51.65% vs 63%). CONCLUSION: Our data show that in subjects over 65 years of age, cardiovascular disease occurs more often in women, but with certain features that should be taken into account. In addition, we point out the importance of reducing cardiovascular risk factors. However, we should not expect a major decrease or improvement in cardiovascular risk factors with such a short follow-up. Such results will be achieved only through long-term interventions.

Comparative heart failure profile over a 3-year period in a Romanian general hospital.

BACKGROUND: Heart failure (HF) has become an increasingly significant public health problem, associated with repeated hospitalizations, high costs, low quality of life, and decreased survival rate. The progress of the disease may be slowed if treatment is administered in accordance with current guidelines. OBJECTIVES: To compare the clinical profile of HF patients in a Romanian general hospital over a 3-year period. METHODS AND RESULTS: We studied two cohorts of patients admitted in the cardiology department of a rehabilitation hospital with a diagnosis of chronic HF New York Heart Association class II-IV The first, in 2006, included 415 patients, 67.08 ± 10.59 years; the second, in 2009, included 500 patients, 67.31 ± 11.27 years. Considering all patients, the left ventricle ejection fraction (LVEF) was not statistically different in the two cohorts. Compared to the 2006 cohort, the 2009 female cohort had higher LVEF (60.49% ± 13.41% vs 64.42% ± 13.79%, P < 0.05), while males over 65 years of age had lower LVEF (52.75% ± 15.02% vs 54.37% ± 15.23%, P = NS). For females, the probability of having LVEF <45% was higher in 2006 (odds ratio = 1.573). HF with preserved LVEF was more common in females, both in 2006 (78.2% vs 54.2%) and 2009 (87.2% vs 57.3%). In the 2009 cohort, LVEF was higher both in young patients (59.08% ± 14.22% vs 55.35% ± 14.92%) and patients ≥ than 75 years of age (62.28% ± 13.81% vs 56.79% ± 14.81%) compared to the 2006 cohort. Ischemic heart disease was the main underlying cause for HF in both cohorts. CONCLUSION: HF appeared to have the same clinical profile over a 3-year period. Females diagnosed with HF showed higher rates of preserved LVEF.