Oxidative Stress Markers in Hypertrophic Cardiomyopathy.

Background and Objectives: Hypertrophic cardiomyopathy (HCM) depends on the primary impairment of sarcomeres, but it can also be associated with secondary alterations in the heart related to oxidative stress. The present study aimed to examine oxidative-antioxidant disturbances in patients with HCM compared with control individuals. Materials and Methods: We enrolled 52 consecutive HCM patients and 97 controls without HCM. The groups were matched for age, body mass index, and sex. Peripheral blood was collected from all patients to determine the total antioxidant capacity (TAC), total oxidant status (TOS), lipid hydroperoxide (LPH), and malondialdehyde (MDA). The oxidative stress index (OSI) was defined as the ratio of the TOS level to the TAC level. Results: The median age was 52 years, and 58.4% were female. The area under the curve (AUC) indicated good predictive power for the TAC and TOS [AUC 0.77 (0.69-0.84) and 0.83 (0.76-0.90), respectively], as well as excellent predictive power for the OSI [AUC 0.87 (0.81-0.93)] for HCM detection. Lipid peroxidation markers also demonstrated good predictive power to detect HCM patients [AUCLPH = 0.73, AUCMDA = 0.79]. Conclusions: The TOS, the TAC, LPH levels, and MDA levels have good predictive power for HCM detection. The holistic assessment of oxidative stress by the OSI had excellent power and could identify patients with HCM.

Visfatin serum concentration is associated with cardiac allograft vasculopathy in heart transplant recipients.

Cardiac allograft vasculopathy (CAV) still is one of the most important limiting factors of long-term survival following heart transplant (HT). This study aimed to investigate the association between proinflammatory adipokine-visfatin and the incidence of CAV in HT recipients. After HT, 182 patients who had a follow-up visit at the Transplantation Clinic between 2016 and 2017 were analyzed. The median age was 60.5 years, and 76.4% were men. The incidence of CAV was 54.9%. According to the multivariable proportional hazard regression analysis, visfatin level (1.795 [1.539-2.094]; P < .001) was significantly associated with CAV, and statin use was protective against CAV (0.504 [0.32-0.793]; P = .003). The area under the receiver operating characteristic curve indicated an excellent discriminatory power of visfatin (0.9548 [0.9281-0.9816]) for CAV detection. The cutoff value of 5.42 ng/mL for visfatin yielded a sensitivity of 89% and specificity of 91%. This is the first study to demonstrate that visfatin serum concentrations are independently associated with the incidence of CAV in HT recipients. Visfatin allows for simple and cheap detection of CAV given its excellent discriminatory ability and high sensitivity and specificity. In addition, we have found an independent association between the statin use and a lower risk of CAV.

The association of functional polymorphisms in genes encoding growth factors for endothelial cells and smooth muscle cells with the severity of coronary artery disease.

BACKGROUND: Despite the important roles of vascular smooth muscle cells and endothelial cells in atherosclerotic lesion formation, data regarding the associations of functional polymorphisms in the genes encoding growth factors with the severity of coronary artery disease (CAD) are lacking. The aim of the present study is to analyze the relationships between functional polymorphisms in genes encoding basic fibroblast growth factor (bFGF, FGF2), epidermal growth factor (EGF), insulin-like growth factor-1 (IGF-1), platelet derived growth factor-B (PDGFB), transforming growth factor-ß1 (TGF-ß1) and vascular endothelial growth factor A (VEGF-A) and the severity of coronary atherosclerosis in patients with stable CAD undergoing their first coronary angiography. METHODS: In total, 319 patients with stable CAD who underwent their first coronary angiography at the Silesian Centre for Heart Diseases in Zabrze, Poland were included in the analysis. CAD burden was assessed using the Gensini score. The TaqMan method was used for genotyping of selected functional polymorphisms in the FGF2, PDGFB, TGFB1, IGF1 and VEGFA genes, while rs4444903 in the EGF gene was genotyped using the polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method. The associations between the selected polymorphisms and the Gensini were calculated both for the whole cohort and for a subgroup of patients without previous myocardial infarction (MI). RESULTS: There were no differences in the distribution of the Gensini score between the genotypes of the analyzed polymorphisms in FGF2, EGF, IGF1, PDFGB, and TGFB1 in the whole cohort and in the subgroup of patients without previous MI. The Gensini score for VEGFA rs699947 single-nucleotide polymorphism (SNP) in patients without previous myocardial infarction, after correction for multiple testing, was highest in patients with the A/A genotype, lower in heterozygotes and lowest in patients with the C/C genotype, (p value for trend = 0.013, false discovery rate (FDR) = 0.02). After adjustment for clinical variables, and correction for multiple comparisons the association between the VEGFA genotype and Gensini score remained only nominally significant (p = 0.04, FDR = 0.19) under the dominant genetic model in patients without previous MI. CONCLUSIONS: We were unable to find strong association between analyzed polymorphisms in growth factors and the severity of coronary artery disease, although there was a trend toward association between rs699947 and the severity of CAD in patients without previous MI.

Pulmonary embolism in cancer patients. Effectiveness of vitamin K antagonists and direct oral anticoagulants in long-term therapy.

Patients with cancer are prone to develop pulmonary embolism (PE) in the course of cancer-associated thrombosis. These patients have increased risk of both recurrent venous thromboembolism and major bleeding. Pulmonary embolism treatment in the cancer patient group is challenging. Selection of anticoagulants, duration of anticoagulation, decision of adjuvant therapy, and adjustment of the regimen in special situations are the major problems that need to be considered in the treatment of cancer-associated PE. Current first line treatment in long-term therapy following an episode of PE is low molecular weight heparin (LMWH), with direct oral anticoagulants (DOACs) and vitamin K antagonists (VKAs) listed as viable alternatives. This study aims to explore long-term oral anticoagulation therapy for cancer patients. Both VKAs and DOACs are compared to LMWH, which serves as a gold standard in anticoagulation therapy for cancer patients and has proven to be effective.

Characteristics and outcomes for patients with heart failure diagnosed according to the universal definition and classification of heart failure. Data from a single-center registry.

BACKGROUND: There are no data on the characteristics and outcomes for patients with heart failure (HF) with reduced (HFrEF), mildly reduced (HFmrEF), and preserved (HFpEF) ejection fraction diagnosed according to the universal definition and classification of HF. AIMS: We used the universal HF definition to compare baseline characteristics, hospital readmission and mortality rates in individuals with HFrEF, HFmrEF, and HFpEF diagnosed retrospectively. RESULTS: The study was designed as a single-center retrospective analysis of all consecutive 40732 hospital admissions between 2013 and 2021 in a tertiary department of cardiology. All patients with HF, defined according to the universal definition and classification of HF, were identified. The study included 8471 patients with a mean age of 65.1 (12.8) years, of whom 2823 (33.3%) were females. Most individuals had a prior diagnosis of HF (76.3%) and elevated N-terminal pro-B-type natriuretic peptide levels (99.0%) with a median of 1548 (629-3786) pg/ml. Mean ejection fraction (EF) was 36.2 (14.9)%. The median follow-up was 39.1 (18.1-70.5) months. The most frequent type of HF was HFrEF (n = 4947; 58.4%), followed by HFpEF (n = 1138; 28.2%) and HFmrEF (n = 2386; 13.4%). Urgent HF readmissions and all-cause deaths were highest in HFrEF (40.8% and 42.7%), followed by HFmrEF (25.4% and 31.5%) and HFpEF (15.2% and 23.8%, respectively). CONCLUSIONS: The highest rates of urgent HF readmissions and all-cause mortality were observed in patients with HFrEF, followed by HFmrEF and HFpEF. In all HF groups, the all-cause mortality rate was higher than the rates of urgent HF readmission.

The Barcelona Bio-Heart Failure risk calculator may predict 1-year mortality in patients with advanced heart failure.

INTRODUCTION: Accurate risk assessment in patients with heart failure (HF) is crucial. Developing new models that combine biochemical and clinical variables with novel biomarkers is the best approach to improving the management and prognostic evaluation in this population. OBJECTIVES: We aimed to assess and compare the predictive utility of a new prognostic scale, the Barcelona Bio­Heart Failure (BCN Bio­HF) risk calculator, as well as traditional risk scores, the Heart Failure Survival Score (HFSS) and the Seattle Heart Failure Model (SHFM), in patients with end­stage HF. We also searched for other risk factors associated with worse prognosis in the analyzed population. PATIENTS AND METHODS: This was a prospective analysis of 279 patients with end­stage HF listed for heart transplant between 2018 and 2021. The BCN Bio­HF, HFSS, and SHFM scores were calculated in all patients, and the accuracy of these 3 models for predicting 1­year mortality was assessed using receiver operating characteristic (ROC) analysis. RESULTS: Median (interquartile range) age of the patients was 56 (50-60) years, and 87.1% of the study population were men. During 1­year follow­up, a total of 95 patients (34.1%) died. The areas under the ROC curves for predicting 1­year mortality were 0.95 (95% CI, 0.92-0.97) for BCN Bio­HF, 0.81 (95% CI, 0.76-0.86) for HFSS, and 0.7 (95% CI, 0.63-0.76) for SHFM. We found that the BCN Bio­HF (hazard ratio [HR], 1.015; 95% CI, 1.012-1.019; P <0.001) and HFSS scores (HR, 2.801; 95% CI, 1.848-4.237; P <0.001), along with the circulating bilirubin concentration (HR, 1.015; 95% CI, 1.002-1.028; P = 0.02), were associated with 1­year mortality in the analyzed population. CONCLUSIONS: The BCN Bio­HF risk score had significantly better prognostic performance than HFSS or SHFM. Lower BCN and HFSS scores and a higher bilirubin concentration were independently associated with a higher risk of 1­year death in patients with end­stage HF.

Ceruloplasmin, Catalase and Creatinine Concentrations Are Independently Associated with All-Cause Mortality in Patients with Advanced Heart Failure.

The role of oxidative/antioxidative system imbalances in advanced heart failure (HF) has not been fully investigated. The aim of this study was to identify factors associated with one-year mortality in patients with advanced HF, with particular emphasis on oxidative/antioxidative balance parameters. We analyzed 85 heart transplant candidates who were hospitalized at our institution for right heart catheterization. Ten milliliters of coronary sinus blood was collected to measure oxidative/antioxidative markers. The median age was 58 (50-62) years, and 90.6% of them were male. The one-year mortality rate was 40%. Multivariable logistic regression analysis revealed that ceruloplasmin (OR = 1.342 [1.019-1.770], p = 0.0363; per unit decrease), catalase (OR = 1.053 [1.014-1.093], p = 0.0076; per unit decrease), and creatinine (OR = 1.071 [1.002-1.144], p = 0.0422; per unit increase) were independently associated with one-year mortality. Ceruloplasmin, catalase, and creatinine had areas under the curve of 0.9296 [0.8738-0.9855], 0.9666 [0.9360-0.9971], and 0.7682 [0.6607-0.8756], respectively. Lower ceruloplasmin and catalase in the coronary sinus, as well as higher creatinine in peripheral blood, are independently associated with one-year mortality in patients with advanced HF. Catalase and ceruloplasmin have excellent prognostic power, and creatinine has acceptable prognostic power, allowing the distinction of one-year survivors from nonsurvivors.

Growth differentiation factor-15 and routine laboratory parameters are associated with one-year mortality in patients with end-stage heart failure undergoing heart transplantation evaluation.

BACKGROUND: Growth differentiation factor-15 (GDF-15) is a hormone that regulates inflammatory responses, tissue repair, and cardiac remodeling, the three key processes underlying the development and progression of heart failure (HF). Furthermore, GDF-15 integrates information from cardiac and extracardiac disease pathways that are linked to multiorgan dysfunction in advanced stages of HF. AIM: This study aimed to determine which factors are associated with one-year mortality in patients with end-stage HF, with particular emphasis on GDF-15. METHODS: We prospectively analyzed 315 consecutive hospitalized patients with end-stage HF who underwent heart transplantation evaluation between 2018 and 2022. The endpoint was all-cause mortality during one-year follow-up. We measured routine laboratory parameters and the serum GDF-15 concentration using a sandwich enzyme-linked immunosorbent assay (ELISA) (SunRedBio Technology Co, Ltd, Shanghai, China). RESULTS: The median age of the patients was 57 (50-62) years. During follow-up, 97 patients died. Higher serum concentrations of GDF-15 (hazard ratio [HR], 1.119; 95% CI, 1.095-1.144; P <0.001), high-sensitivity C-reactive protein (HR, 1.140; 95% CI, 1.037-1.253; P = 0.006), fibrinogen (HR, 1.003; 95% CI, 1.001-1.005; P = 0.003), bilirubin (HR, 1.055; 95% CI, 1.027-1.084; P <0.001), N-terminal pro-B-type natriuretic peptide (HR, 1.342; 95% CI, 1.206-1.493; P <0.001), and gamma-glutamyl transpeptidase (HR, 1.007; 95% CI, 1.002-1.012; P = 0.003) were independently associated with one-year mortality. CONCLUSIONS: Higher GDF-15, high-sensitivity C-reactive protein, fibrinogen, bilirubin, gamma-glutamyl transpeptidase, and N-terminal pro-B-type natriuretic peptide concentrations were independently associated with worse survival in patients with end-stage HF.

Ceruloplasmin and Lipofuscin Serum Concentrations Are Associated with Presence of Hypertrophic Cardiomyopathy.

Oxidative stress reflects an imbalance between the systemic manifestation of reactive oxygen species and cells' ability to neutralize them by antioxidant systems. The role of oxidative stress in hypertrophic cardiomyopathy (HCM) is not fully understood. The aim of the study was to examine selected parameters of oxidative stress in patients with HCM compared to the control group. We enrolled 85 consecutive HCM patients and 97 controls without HCM. The groups were matched for sex, the body mass index, and age. Oxidative stress markers included superoxide dismutase (SOD), ceruloplasmin (CER), and lipofuscin (LPS). The median age of the HCM patients was 53 (40-63) years, and 41.2% of them were male. HCM patients, compared to the control ones, had significantly increased levels of CER and LPS. The areas under the receiver operating characteristics curves (AUC) indicated a good discriminatory power of CER (AUC 0.924, sensitivity 84%, and specificity 88%), an acceptable discriminatory power of LPS (AUC 0.740, sensitivity 66%, and specificity 72%), and poor discriminatory power of SOD (AUC 0.556, sensitivity 34%, and specificity 94%) for HCM detection. CER with good predictive strength, as well as LPS with acceptable predictive power, allows for HCM detection. The utility of SOD for HCM detection is limited.

Markers of malnutrition, inflammation, and tissue remodeling are associated with 1-year outcomes in patients with advanced heart failure.

INTRODUCTION: A number of predictive models and biomarkers are used to assess outcomes in patients with advanced heart failure (HF). OBJECTIVES: We sought to evaluate whether markers of malnutrition, inflammation, and tissue remodeling are associated with 1­year mortality in patients with advanced HF. PATIENTS AND METHODS: We analyzed 200 consecutive patients with advanced HF. We assessed markers of inflammation and malnutrition, such as the neutrophil percentage­to-albumin ratio (NPAR), the advanced lung cancer inflammation index (ALI), and the level of high­sensitivity C-reactive protein (hsCRP). We also evaluated the level of tenascin­C (TNC), as well as known markers of HF, such as N­terminal pro-B-type natriuretic peptide (NT-proBNP), creatinine, and bilirubin. Receiver operating characteristic (ROC) and Kaplan-Meier survival analyses were performed to evaluate the association of each parameter with 1­year mortality. RESULTS: The median (interquartile range) age of the patients was 58 (51-64) years. The independent predictors of death were ALI (odds ratio [OR], 0.966; 95% CI, 0.941-0.992; P = 0.01) and NPAR (OR, 1.373; 95% CI, 1.126-1.674; P = 0.002), as well as serum levels of TNC (OR, 1.04; 95% CI, 1.020-1.050; P <0.001), hsCRP (OR, 1.187; 95% CI, 1.037-1.360; P = 0.01), NT­ proBNP (OR, 1.110; 95% CI, 1.100-1.200; P = 0.02), creatinine (OR, 1.034; 95% CI, 1.013-1.055; P = 0.001), and bilirubin (OR, 1.079; 95% CI, 1.014-1.149; P = 0.02). The ROC analysis indicated a good discriminatory power of TNC (area under the curve [AUC] = 0.807), NT­ proBNP (AUC = 0.760), hsCRP (AUC = 0.706), ALI (AUC = 0.749), and NPAR (AUC = 0.785) in predicting mortality during the 1­year follow up. CONCLUSIONS: Our study demonstrated that a decreased ALI value, increased NPAR value, as well as elevated serum concentrations of TNC, NT­proBNP, hsCRP, creatinine, and bilirubin are associated with 1­year mortality in patients with advanced HF.

The Utility of Pentraxin and Modified Prognostic Scales in Predicting Outcomes of Patients with End-Stage Heart Failure.

Risk stratification is an important element of management in patients with heart failure (HF). We aimed to determine factors associated with predicting outcomes in end-stage HF patients listed for heart transplantation (HT), with particular emphasis placed on pentraxin-3 (PXT-3). In addition, we investigated whether the combination of PTX-3 with the Heart Failure Survival Score (HFSS), the Seattle Heart Failure Model (SHFM), or the Meta-Analysis Global Group in Chronic Heart Failure (MAGGIC) improved the prognostic strength of these scales in the study population. We conducted a prospective analysis of 343 outpatients with end-stage HF who accepted the HT waiting list between 2015 and 2018. HFSS, SHFM, and MAGGIC scores were calculated for all patients. PTX3 was measured by sandwich enzyme-linked immunosorbent assay with a commercially available kit. The endpoints were death, left ventricular assist device implantation, and HT during the one-year follow-up. The median age was 56 (50−60) years, and 86.6% were male. During the follow-up period, 173 patients reached the endpoint. Independent risk factors associated with outcomes were ischemic etiology of HF [HR 1.731 (1.227−2.441), p = 0.0018], mean arterial pressure (MAP) [1.026 (1.010−1.042), p = 0.0011], body mass index (BMI) [1.055 (1.014−1.098), p = 0.0083], sodium [1.056 [(1.007−1.109), p = 0.0244] PTX-3 [1.187 (1.126−1.251, p < 0.0001) and N-terminal pro-brain natriuretic peptide (NT-proBNP) [HR 1.004 (1.000−1.008), p = 0.0259]. The HFSS-PTX-3, SHFM-PTX-3 and MAGGIC-PTX-3 scores had significantly higher predictive power [AUC = 0.951, AUC = 0.973; AUC = 0.956, respectively] than original scores [AUC for HFSS = 0.8481, AUC for SHFM = 0.7976, AUC for MAGGIC = 0.7491]. Higher PTX-3 and NT-proBNP concentrations, lower sodium concentrations, lower MAP and BMI levels, and ischemic etiology of HF are associated with worse outcomes in patients with end-stage HF. The modified SHFM-PTX-3, HFSS-PTX-3, and MAGGIC-PTX-3 scores provide effective methods of assessing the outcomes in the analyzed group.

Factors associated with cardiac allograft vasculopathy after heart transplantation.

Introduction: Cardiac allograft vasculopathy (CAV) is a major threat to long-term survival after heart transplantation (HT). Aim: To determine factors associated with CAV detection in patients after HT. Material and methods: We analyzed 299 consecutive patients after HT who underwent routine visits at our institution between 2016 and 2018. Human interleukin 33 (IL-33) and suppression of tumorigenicity 2 (ST2) were measured by sandwich enzyme-linked immunosorbent assay with a commercially available kit (Human ST-2 and IL-33 ELISA, SunRedBio Technology Co, Ltd, Shanghai, China). Results: The patients' median age was 59.00 years, and 74.2% were men. The frequency of CAV was 47.5%. Multivariable logistic regression analysis showed that IL-33 (odds ratio (OR) = 1.044 (1.029-1.059), p < 0.001) and ST2 (OR = 1.061 (1.040-1.083), p < 0.001) serum concentrations, donor age (OR = 1.046 (1.009-1.085), p = 0.015), left ventricular diastolic dimension (LVDD) (OR = 1.081 (1.016-1.149), p = 0.013), and time from HT to blood collection (OR = 1.256 (1.151-1.371), p < 0.001) were independent risk factors for CAV. The area under the receiver operating characteristics curve (AUC) indicated good prognostic power of IL-33 and ST2 concentrations (AUC = 0.779 and AUC = 0.784, respectively) and excellent prognostic power of the IL-33/ST2 score (AUC = 0.863). Conclusions: Lower IL-33 and higher ST2 serum concentrations, as well as older donor age, larger LVDD and longer time from HT to blood collection, are independently associated with CAV. IL-33 and ST2 have good discriminatory power and the IL-33/ST2 score has excellent strength for detecting CAV.

Predictors of 1­year mortality in ambulatory patients with advanced heart failure awaiting heart transplant.

INTRODUCTION: Heart failure (HF) is a complex syndrome involving diverse pathways and pathological processes that can manifest themselves in circulation as abnormal levels of various biomarkers. OBJECTIVE: The aim of the study was to assess the factors associated with a worse prognosis in patients with advanced HF awaiting heart transplant during a 1­year follow­up. PATIENTS AND METHODS: We prospectively assessed the data of 203 adult patients with advanced HF, who were hospitalized at our institution between 2016 and 2018. The study end point was all­cause death during a 1­year follow­up. RESULTS: The median age of patients was 57 years (range, 52-60); 87.7% of patients were male. During follow­up, 62 patients (30.5%) died. Serum levels of procalcitonin (hazard ratio [HR], 1.027; 95% CI, 1.020-1.034; P <0.001; per 10­unit increase), high­sensitivity C­reactive protein (hs­CRP; HR, 1.099; 95% CI, 1.016-1.883; P = 0.02; per 1­unit increase), sodium (HR, 1.171; 95% CI, 1.076-1.272; P <0.001; per 1 ­unit increase), and N ­terminal pro-B ­type natriuretic peptide (NT ­proBNP; HR, 1.068; 95% CI, 1.033-1.105; P <0.001; per 1000­unit increase) were independent risk factors for mortality. Procalcitonin generated the largest area under the curve (0.780; 95% CI, 0.712-0.848). CONCLUSIONS: Our study showed that higher serum hs ­CRP, NT­proBNP, and procalcitonin levels and lower serum sodium levels were independent risk factors for death during a 1­year follow­up in patients with advanced HF. Procalcitonin showed the strongest predictive power, sensitivity, and specificity, allowing for an effective identification of 1­year survivors and nonsurvivors awaiting heart transplant.

The Impact of Short-Term Outdoor Air Pollution on Clinical Status and Prognosis of Hospitalized Patients with Coronary Artery Disease Treated with Percutaneous Coronary Intervention.

BACKGROUND: The aim of this study was to determine the influence of acute exposure to air pollutants on patients' profile, short- and mid-term outcomes of hospitalized patients with coronary artery disease (CAD) treated with coronary angioplasty. METHODS: Out of 19,582 patients of the TERCET Registry, 7521 patients living in the Upper Silesia and Zaglebie Metropolis were included. The study population was divided into two groups according to the diagnosis of chronic (CCS) or acute coronary syndromes (ACS). Data on 24-h average concentrations of particulate matter with aerodynamic diameter <10 µm (PM10), sulfur dioxide (SO2), nitrogen monoxide (NO), nitrogen dioxide (NO2), and ozone (O3) were obtained from eight environmental monitoring stations. RESULTS: No significant association between pollutants' concentration with baseline characteristic and in-hospital outcomes was observed. In the ACS group at 30 days, exceeding the 3rd quartile of PM10 was associated with almost 2-fold increased risk of adverse events and more than 3-fold increased risk of death. Exceeding the 3rd quartile of SO2 was connected with more than 8-fold increased risk of death at 30 days. In the CCS group, exceeding the 3rd quartile of SO2 was linked to almost 2,5-fold increased risk of 12-month death. CONCLUSIONS: The acute increase in air pollutants' concentrations affect short- and mid-term prognosis in patients with CAD.

Serum concentrations of interleukin-4 and interferon-gamma in relation to severe left ventricular dysfunction in patients with acute myocardial infarction undergoing percutaneous coronary intervention.

Many studies have suggested an imbalance between proinflammatory and anti-inflammatory markers in acute myocardial infarction (AMI). Interleukin 4 (IL-4) shows mainly anti-inflammatory activities. Interferon-gamma (IFN-γ) is a proinflammatory cytokine secreted by Th1 lymphocytes. Severe systolic left ventricular (LV) dysfunction following AMI is one of the major risk factors for poor prognosis. The aim of this study was to evaluate whether IL-4 and IFN-γ concentrations can serve as the correlates of impaired left ventricular function. Fifty-three patients with AMI were enrolled and divided into two groups depending on their ejection fraction (EF): group 1 with EF ≤ 30% (N = 10) and group 2 with EF >30% (N = 43). All patients underwent coronary angiography followed by percutaneous coronary intervention (PCI). Blood samples were taken (1) before, (2) immediately after, (3) 2 h after, and (4) 72 h after PCI. A receiver-operating characteristic (ROC) analysis was planned to identify possible cutoff values to predict LV dysfunction. There was no sex difference between the two groups. The rate of hypertension and diabetes mellitus was also similar. Median concentrations for IL-4 (pg/ml) were: (1) 13.4 versus 17.2 (p = 0.0001), (2) 16.8 versus 18.6 (p = 0.01), (3) 17.2 versus 17.6 (p = NS), and (4) 17.6 versus 17.2 (p = NS). Median concentrations for IFNγ (pg/ml) were: (1) 0.3 versus 1.9 (p = 0.00001), (2) 2.1 versus 1.6 (p = NS), (3) 0.4 versus 0.9 (p = NS), and (4) 0.9 versus 1.1 (p = NS). The area under the ROC curve (AUC) analysis is presented in the table below. Reported results suggest the high diagnostic value of IL-4 measurements before and immediately after PCI as the correlates of impaired LV dysfunction, whereas only IFN-γ measurement before PCI had a high diagnostic value. Measurements performed later on have no predictive value. Cutoff value AUC Sensitivity (%) Specificity (%) PPV (%) NPV (%) p IL-4 (a) ≤ 15.0 0.89 100 79 52 100 0.0001, IL-4 (b) ≤ 17.2 0.75 100 67 42 100 0.0007, IFNγ (a) ≤ 0.3 0.94 100 91 71 100 0.0001.

Adiponectin in heart failure.

The adipose tissue, apart from storing energy, plays a role of an endocrine organ. One of the most important adipokines secreted by adipose tissue is adiponectin, which is also produced by cardiomyocytes and connective tissue cells within the heart. Adiponectin is known for its beneficial effect on the metabolism and cardiovascular system and its low level is a factor of development of many cardiovascular diseases. Paradoxically, in the course of heart failure, adiponectin level gradually increases with the severity of the disease and higher adiponectin level is a factor of poor prognosis. As a result, there is a growing interest in adiponectin as a marker of heart failure progression and a predictor of prognosis in the course of this disease.

Fetuin-A and sodium concentrations are independently associated with all-cause mortality in patients awaiting heart transplantation.

INTRODUCTION: End­stage heart failure (HF) is a clinical condition with complex pathophysiology and poor prognosis. OBJECTIVES: This study aimed to identify factors associated with mortality during a 1.5­year follow­up in patients with end­stage HF. PATIENTS AND METHODS: We prospectively analyzed 72 patients hospitalized with end­stage HF. During right heart catheterization, 10 ml of coronary sinus (CS) blood was collected. The endpoint was all­cause mortality during a 1.5­yearfollow­up. We used a multivariable logistic regression model to find  factors associated with all­cause mortality. We created 2 separate models for CS fetuin and peripheral blood (PB) fetuin. RESULTS: The median (interquartile range) age of the patients was 58 (50-61.50) years. During the follow­up, 43.1% of the patients died. Lower levels of fetuin­A in the CS (OR, 1.103; 95% CI, 1.045-1.164; P <0.001, per 10-unit decrease in fetuin concentration) and PB samples (OR, 1.098; 95% CI, 1.046-1.153; P <0.001, per 10-unit decrease in fetuin concentration), along with lower plasma sodium levels (OR, 1.563; 95% CI, 1.134-2.156; P = 0.006 in the first model and OR, 1.639; 95% CI, 1.209-2.227; P = 0.002 in the second model; per 1-unit decrease in sodium concentration) were independently associated with death during the follow­up period. The area under the receiver operating characteristics curve (AUC) indicated a good prognostic power of CS and PB fetuin­A levels (AUC, 0.917 and AUC, 0.850, respectively) and an acceptable prognostic power of sodium concentration (AUC, 0.788). CONCLUSIONS: Lower levels of CS and PB fetuin­A, as well as lower sodium levels, are associated with an increased risk of death in patients with end­stage HF.

Everolimus-eluting stents versus sirolimus-eluting stents in patients with cardiac allograft vasculopathy.

INTRODUCTION: Cardiac allograft vasculopathy remains one of the most important factors leading to chronic cardiac allograft rejection. When revascularization is needed percutaneous coronary interventions are the method of choice. AIM: To compare the short- and long-term outcomes of cardiac allograft vasculopathy patients treated with everolimus- (EES) or sirolimus-eluting stents (SES). MATERIAL AND METHODS: Between December 2012 and December 2020, 319 patients after heart transplantation undergoing coronary angiography at our institution were analysed. Subsequently 39 patients underwent de novo angioplasty with second-generation EES. The primary study endpoint was angiographic restenosis as evaluated by quantitative coronary angiography. Secondary outcomes included binary restenosis, target lesion revascularization and cardiac death during the follow-up period (6 months). RESULTS: Twenty-four patients were treated with EES and 15 treated with SES. No significant differences were observed regarding the rate of risk factors of cardiovascular diseases and comorbidities. The patients treated with EES were younger (55.8 ±11.8 vs. 60.1 ±12.2) and less frequently male (79% vs. 93%). The majority of patients were diagnosed with single vessel disease with LAD involvement (62% and 86% in the EES group, and 47% and 56% in the SES group). In 6 months follow-up, late lumen loss was comparable in both groups, 0.19 ±0.15 vs. 0.14 ±0.15, and binary restenosis was 4% and 0% for EES and SES groups, respectively. CONCLUSIONS: Second generation drug-eluting stents eluting rapamycin analogues are associated with high direct efficacy of procedures and low incidence of restenosis in a 6-month follow-up.

Oxidative Stress Markers and Modified Model for End-Stage Liver Disease Are Associated with Outcomes in Patients with Advanced Heart Failure Receiving Bridged Therapy with Continuous-Flow Left Ventricular Assist Devices.

Left ventricular assist device (LVAD) is well established as an alternative treatment for end-stage heart failure (HF) patients. The aim of the study was to determine the prognostic value of oxidative stress markers and the modified Model for End-Stage Liver Disease (modMELD) in patients receiving bridged therapy with continuous-flow LVAD. We prospectively analyzed 36 end-stage HF patients who received LVAD therapy between 2015 and 2018. The total antioxidant capacity (TAC) and total oxidant status (TOS) were measured by the methods described by Erel. The oxidative stress index (OSI) was defined as the ratio of the TOS to TAC levels. The modMELD scores were calculated based on the serum bilirubin, creatinine, and albumin levels. The patients' median age was 58 (50-63.0) years. During the 1.5-years follow-up, a major adverse cardiac event-MACE (death, stroke, or pump thrombosis) was observed in 17 patients (47.2%). The area under the receiver operating characteristics curves (AUCs) indicated a good prognostic power of TAC (AUC 0.7183 (0.5417-0.8948)), TOS (AUC 0.9149 (0.8205-0.9298)), OSI (AUC 0.9628 (0.9030-0.9821)), and modMELD (AUC 0.87 (0.7494-0.9905)) to predict a MACE. Oxidative stress markers serum concentrations, as well as the modMELD score, allow the identification of patients with a risk of MACE.

Therapeutic window for calcium-channel blockers in the management of dilated cardiomyopathy: a prospective, two-centre study on non-advanced disease.

OBJECTIVE: This study aimed to investigate the usefulness of the calcium-channel blocker verapamil in non-advanced dilated cardiomyopathy (DCM). METHODS: This was a randomised trial of 70 DCM patients treated with carvedilol (36 patients) and verapamil (instead of ß-blocker; 34 patients) for 12 months. The remaining heart failure (HF) therapy was constant in both groups. The primary outcomes were to determine selected echocardiography parameters and functional status of patients. The secondary outcome included death, heart transplantation and re-hospitalisation due to HF progression. RESULTS: Of the primary outcomes, only the mean ratio of early to late transmitral flow velocities increased significantly in the verapamil-treated patients as compared with the carvedilol-based therapy (1.1 ± 0.3 vs. 0.7 ± 0.2; 95% CI -0.6 to -0.1; p = 0.015). Simultaneously, the Minnesota Quality of Life improved significantly in the verapamil group (95% CI 5.2-19.9; p = 0.002). It was accompanied by the favourable effect of verapamil therapy on exercise capacity in the 6-min walk test (95% CI 21.3-110.7; p = 0.005). CONCLUSION: The addition of verapamil to angiotensin-converting enzyme and aldosterone inhibitors in non-advanced DCM patients has been shown to have a neutral or even positive effect in a few patients.