Influence of co-existing atrial fibrillation on the efficacy of atorvastatin treatment in patients with dilated cardiomyopathy: a pilot study.

INTRODUCTION: The aim of the study was to assess the influence of co-existing atrial fibrillation (AF) on inflammatory condition factors, left ventricular function, clinical course and the efficacy of statin treatment of congestive heart failure in the course of dilated cardiomyopathy (DCM). MATERIAL AND METHODS: In a prospective, randomized, open-label study, 69 patients with DCM and left ventricular ejection fraction (LVEF) < or =40% were divided into two groups, with and without AF, who were treated according to the recommended standards. 68% of patients from the group with AF and 59% of patients from the group without AF were administered atorvastatin 40 mg daily for 8 weeks and 10 mg for next 4 months. Clinical examination with the assessment of body mass index (BMI) and waist size were followed by routine laboratory tests, measurement of concentration of tumor necrosis factor (TNF-alpha), interleukin-6 (IL-6), and IL-10 in blood plasma, N-terminal pro-brain natriuretic peptide (NT-proBNP) concentration in blood serum, echocardiographic examination, and the assessment of exercise capacity in 6-minute walk test (6-MWT). After six months, morbidity rate and the number of heart failure hospitalizations were also observed. RESULTS: In the whole population of patients, a significantly higher concentration of NT-proBNP was observed in the AF group (2669 +/- 2192 vs 1540 +/- 1067, p = 0.02). After statin treatment, in patients with DCM and co-existing AF, higher values of NT-proBNP and IL-6 were observed compared to non-AF patients (1530 +/- 1054 vs 1006 +/- 1195, p = 0.04 and (14.16 +/- 13.40 vs 6.74 +/- 5.45, p = 0.02, respectively). CONCLUSION: In patients with DCM and co-existing AF, a weaker effect of atorvastatin concerning the reduction of IL-6 and NT-proBNP concentration was observed than in patients without atrial fibrillation.

The influence of atorvastatin on parameters of inflammation and function of the left ventricle in patients with dilated cardiomyopathy.

BACKGROUND: We assessed the influence of atorvastatin on selected indicators of an inflammation, function of the left ventricle and factors affecting the occurrence of rehospitalisation and mortality in patients with dilated cardiomyopathy (DCM). MATERIAL/METHODS: In a prospective, randomized study, 68 patients with DCM with LVEF

Genetic insight into syncopal tilted population with severe clinical presentation.

UNLABELLED: An impairment of cardiovascular reflexes may be the result of functional alterations in the G proteins intracellular signaling produced by functional genes' polymorphisms. The aim was to evaluate the relationships between single nucleotide polymorphisms in genes encoding G-proteins signaling pathways and syncopal patients with severe clinical manifestation. METHODS AND RESULTS: From 307 syncopal patients free from any other diseases 83 (27%) had at least one malignant episode of syncope with a significant injury as fractures. There was 1.9 malignant spells per patient. All patients were tilted and genotyped by polymerase chain reaction followed by restriction fragment length polymorphism method. 74 healthy volunteers with negative history of syncope constituted the control group were also genotyped. Following polymorphisms were detected: C393T in gene encoding the alfa-subunit of Gs-protein (GNAS1), C825T of gene for G-protein beta 3 subunit (GNB3) and C1114G for the gene of cardiac regulator of G-protein signaling (RGS2). We found an association with lower risk of malignant syncope in positive tilting patients during passive phase of the test compared to NTG-enhanced (OR 0.38; 95% CI 0.15-0.95; P=0.04). No difference between healthy controls and patients in the alleles frequency was found (P>0.05). Neither the 393T allele of GNAS1 and 825T allele of GNB3 nor 1114G allele of RGS2 was associated with enhanced risk of severe clinical manifestation (P>0.05). CONCLUSIONS: The studied single nucleotide polymorphisms of genes encoding G-proteins signaling pathways seem to be not connected with the severe clinical manifestation of syncope.

Factors associated with C-reactive protein at the early stage of acute myocardial infarction in men.

BACKGROUND: Elevation of C-reactive protein (CRP) is associated with acute coronary events. CRP is related to cardiovascular risk factors and adipokines. The aim of the study was to reveal the factors associated with elevated CRP levels in patients with ST-segment elevation acute myocardial infarction (STEMI). As there are sex-related differences in plasma levels of CRP and adipokines, our study was designed for males. METHODS: Seventy men admitted within the initial 6 hours of STEMI were categorized into 4 groups according to the quartile of CRP. Clinical data and laboratory measurements were analyzed. RESULTS: Anthropometric measurements, glucose at admission, resistin, and leptin were significantly higher, and adiponectin lower with the increase of CRP quartile. A significant positive correlation between CRP and body mass index, waist circumference, glucose at admission, resistin, and leptin and a negative relation of CRP to HDL-cholesterol and adiponectin were observed. In univariate logistic regression analysis, variables associated with a level of CRP above the fourth quartile were history of angina, obesity, diabetes, glucose at admission, resistin, leptin, and adiponectin, and independent predictors were glucose at admission and resistin. To predict the elevated CRP level the optimal cut-off for glucose at admission was 144 mg/dL (sensitivity 84%, specificity 86%) and for resistin was 21.5 ng/mL (sensitivity 79%, specificity 71%). CONCLUSIONS: Glucose at admission and resistin are independently associated with elevated levels of CRP in men during the early stage of STEMI.

Value of blood adipose tissue hormones concentration--adiponectin, resistin and leptin in the prediction of major adverse cardiac events (MACE) in 1-year follow-up after primary percutaneous coronary intervention in ST-segment elevation acute myocardial infarction.

OBJECTIVES: The objective of the study was to assess the impact of adipokines on the future major adverse cardiac events (MACE) in patients with acute myocardial infarction. METHODS: Subjects were 77 men with first, ST-segment elevation acute myocardial infarction undergoing primary percutaneous coronary intervention in whom data were available after one year follow-up. Baseline clinical and angiographic data were collected, blood level of C-reactive protein, uric acid, fasting glucose, lipid profile, adiponectin, resistin and leptin and left ventricular ejection fraction on echocardiography were assessed. MACE was defined as cardiac death, nonfatal myocardial infarction, hospitalization for angina or heart failure. RESULTS: 12% of patients experienced MACE. As revealed by univariate logistic regression analysis predictors of MACE were diabetes, multivessel disease, ejection fraction, blood C-reactive protein and adiponectin level. In multivariable analysis diabetes (OR=22.19, 95%CI 1.22-402.19; p=0.0360), lower left ventricular ejection fraction (OR=0.78, 95%CI 0.63-0.98; p=0.0298) and lower adiponectin level (OR=0.19, 95%CI 0.04-0.90; p=0.0362) were independent negative predictors of MACE. The optimal value of adiponectin for predicting MACE was 4.23 microg/ml. CONCLUSION. In male patients with myocardial infarction undergoing primary percutaneous coronary intervention, a baseline blood adiponectin but not resistin or leptin is independently predictive of MACE. The other prognostic factors are diabetes mellitus and left ventricular ejection fraction.

Atrial fibrillation as a nonpsychiatric predictor of delirium after cardiac surgery: a pilot study.

BACKGROUND: Preoperative atrial fibrillation (AF) increases the risk of cardiac surgery and the occurrence of postoperative complications, including arrhythmias, low-output syndrome, delirium, and death. The aim was to evaluate its direct influence on prognosis of patients subjected to cardiac surgery. MATERIAL/METHODS: This is a pilot study of the CODACS trial (COnsciousness Disorders After Cardiac Surgery). Two hundred sixty patients admitted for open-heart surgery were prospectively included in the study. Preoperative AF was diagnosed on the basis of multiple electrocardiographic examinations and confirmed by 24-h Holter monitoring. Diagnosis of delirium following surgical intervention was based on DSM-IV criteria. RESULTS: Preoperative AF was diagnosed in 23 patients (8.8%): in 15 patients in the nondelirious group (7%) and 8 (27.0%) in the delirious group. Preoperative AF was an independent predictor of postoperative delirium (p<0.001), increasing its risk of occurrence over sevenfold (OR=7.2). AF also increased the risk of such postoperative complications as supraventricular arrhythmia (AF: 78.3% vs. non-AF: 22.8%, p<0.001), stroke (8.7% vs. 1.3%, p<0.001), and low-output syndrome (21.7% vs. 17.3%, p=0.033) and worsened prognosis, significantly increasing the risk of death (8.7% vs. 0.8%, p<0.001). CONCLUSIONS: Preoperative AF was an independent risk factor of postoperative delirium (OR=7.2). It was also associated with significantly worse postoperative outcome (supraventricular arrhythmia, stroke, low-output syndrome, and risk of death). These results and data from available studies suggest that preoperative AF should be considered as an important predictor of postoperative outcome. This problem should be the subject of future research to establish beneficial treatment options.

Mutation T/C,Ile 131 of the gene encoding the alfa subunit of the human Gs protein and predisposition to vasovagal syncope.

BACKGROUND: Mutation T/C inside codon 131 of the gene encoding the alpha subunit of Gs protein (GNAS1) causes the increased activation of adenyl cyclase, which plays an important role in cardiovascular regulation. The aim of the present study was to evaluate GNAS1 T/C,Ile 131 mutation's manifestation in syncopal patients regarding head-up tilt test (HUTT) results. METHODS AND RESULTS: In 137 syncopal patients (without any other diseases) the silent T/C,Ile 131 mutation within the GNAS1 codon on chromosome 20 q was identified. This mutation consists of the presence (+) or absence (-) of a target site for endonuclease FokI (Promega). Ninety-six patients (70%) with positive HUTT had a higher FokI+ allele frequency compared with those with negative tilting results (49% vs 27%, X(2)=12.05; p<0.001). In positive tilted patients, the studied mutation had significant influence on blood pressure (p<0.05). When comparing positive HUTT with vasodepressore component, cardioinhibition results and negative HUTT, the frequencies of the FokI+ allele were decreased among these groups: 53%, 36% and 27%, respectively. CONCLUSIONS: An association between positive tilting and mutation C/T,Ile 131 within the GNAS1 codon was found. The predisposition to vasovagal syncope seems to be associated with the GNAS1 FokI+ allele.

Resistin increases with obesity and atherosclerotic risk factors in patients with myocardial infarction.

The objective of the study was to assess the relation of resistin to the anthropometric parameters, metabolic risk factors, and C-reactive protein (CRP) in men with myocardial infarction. Subjects were 40 obese (age, 53.6 +/- 7.39 years; body mass index, > or =30 kg/m2) and 40 lean (age, 54.4 +/- 6.62 years; body mass index, <25 kg/m2) men with first acute myocardial infarction. Waist and hip circumferences, CRP, uric acid, fasting glucose, lipid profile, and blood resistin concentration were measured. In obese patients, triglycerides, fasting glucose, and CRP were significantly higher whereas high-density lipoprotein cholesterol was lower than in lean patients. The range of blood resistin concentration was 6.0 to 70.5 ng/mL: 27.84 +/- 12.15 ng/mL in obese subjects and 17.35 +/- 11.08 ng/mL in lean subjects (P < .0001). Significant positive correlation was revealed between blood resistin concentration and each of the analyzed anthropometric parameter and with fasting glucose, low-density lipoprotein cholesterol, and CRP, whereas negative relation was observed between resistin and high-density lipoprotein cholesterol. As revealed by univariate logistic regression analysis, risk of blood resistin concentration being greater than the median value (19.75 ng/mL) was increased by obesity, high-density lipoprotein cholesterol <40 mg/dL, hypertension, and CRP. In multivariate model, independent variables associated with higher median of resistin were obesity and CRP. Obesity increased 5.5-fold the probability of blood resistin concentration being greater than 19.75 ng/mL, whereas each 1-mg/dL increase in CRP increased this probability by 13%. In patients with acute myocardial infarction, obesity is positively related to blood resistin concentration. Resistin is likely to play a major role in the atherogenesis and its complications, and this action seems to be mostly related to the inflammatory reaction.

Predictors of paroxysmal atrial fibrillation in patients undergoing aortic valve replacement.

OBJECTIVE: Atrial fibrillation is one of the most common complications after cardiac surgery. This study evaluates the risk factors of paroxysmal atrial fibrillation in patients who underwent aortic valve replacement. METHODS: The study comprised 300 patients with aortic valve defects of either aortic stenosis (n = 150) or regurgitation (n = 150) who underwent aortic valve replacement. For each patient, 2-mode and Doppler echocardiographic examinations were performed in the preoperative period, early postoperative period, and long-term observation, and selected hemodynamic parameters were analyzed. RESULTS: Factors significantly associated with atrial fibrillation in patients with aortic stenosis were heart failure (odds ratio = 5.5), age 70 years or more (4.5), low (3.9) and high body mass index (1.7), maximal transvalvular gradient (3.7), low left ventricular ejection fraction (5.1), end-systolic (2.9) and end-diastolic intraventricular septum thickness (1.5), and insignificant mitral regurgitation (1.9) in the preoperative period; and left ventricular ejection fraction (4.4) and end-systolic intraventricular septum thickness (1.8) in the early postoperative period. In the aortic regurgitation group, factors significantly associated with atrial fibrillation were age (1.8), left ventricular ejection fraction (3.7), left ventricular end-systolic diameter (1.7), end-diastolic intraventricular septum thickness (1.7), left atrium dimension (4.1) and insignificant mitral regurgitation (2.5) in the postoperative period; essential arterial hypertension (3.3), diabetes mellitus (2.6), and heart failure in the history (4.5) in the preoperative period; and left ventricular ejection fraction (1.9) and left atrium dimension (2.9) in the early postoperative period. CONCLUSION: On the basis of the separated risk factors, all patients should be preoperatively classified to applicable groups of risk of postoperative atrial fibrillation appearance, and the prophylactic treatment should be administered in the group of patients with the highest risk. It may essentially decrease the rate of complications and deaths, and, consequently, the costs of postoperative medical care.

Vasovagal syncope patients and the C825T GNB3 polymorphism.

OBJECTIVE: The G protein is responsible for signal intracellular transduction and participates in cardiovascular reflexes. C825T polymorphism of the gene encodes the B3 subunit of G protein (GNB3) and causes the increased intracellular signal transduction. The aim was the evaluation GNB3 C825T polymorphism manifestation in vasovagal patients with no other diseases. METHODS: In 68 positive tilted patients genomic DNA was extracted from blood using an extraction kit. The GNB3 C825T polymorphism was diagnosed by restriction of the PCR amplicon with BseDI (MBI Fermentas). All patients were genotyped and next analyzed in regard to typical vasovagal history. RESULTS: The prevalence of genotype CC was 38%. Genotypes CT and TT were found equally in 31% of cases. The C allele in comparison to the T allele appeared in 54% vs 46% (p>0.05). Typical vasovagal history was present in 83% of patients. The frequency of GNB3 825T allele was significantly higher in patients with non-typical vasovagal history than in group with typical history (p<0.001). CONCLUSIONS: Genotype CC GNB3 is the most popular in vasovagal patients. The predisposition to vasovagal syncope seems to be not associated with the GNB3 825T allele. Further studies are planned to clarify the genotype/phenotype relationship in vasovagal patients.