ABSTRACT
BACKGROUND & AIMS: Polyunsaturated fatty acids (PUFAs) may affect the cardiovascular system with a multiplicity of mechanisms. We assessed the effects of omega-3 PUFAs supplements on inflammation, fibrosis, left ventricle performance and endothelial function of ischemic heart failure (HF) patients. METHODS: In this double-blind, placebo controlled, cross-over trial we enrolled 31 patients with ischemic HF, followed by a 6-week wash-out period. Omega-3 PUFAs (2 g daily, 8 weeks) were administered PO in the intervention arm. Left ventricle ejection fraction (EF), global longitudinal strain and the ratio E/e' (early ventricular filling to early mitral annulus velocities)were measured. Endothelial function was evaluated by flow mediated dilation and myocardial fibrosis by soluble ST2. High sensitive C Reactive protein (hsCRP) levels were measured as an inflammatory marker. RESULTS: Treatment with omega-3 PUFA, compared to placebo, improved: left ventricle EF (percent increased by 4.7% vs 1.7%); global longitudinal strain (decreased by -10.6% vs -2.3%); the E/e' ratio (decreased by -9.47% vs -2.1%); ST2 levels (decreased by -4.53% vs -2.37%); flow mediated dilation (percent increased by 44% vs. 11% and hsCRP levels (decreased by -6.13% vs 4.35%) (p < 0.05 for all). CONCLUSION: Short term treatment with omega-3 PUFAs in subjects with stable ischemic HF improved inflammatory and fibrotic status as well as endothelial function in parallel with systolic and diastolic performance of left ventricle. These findings provide further insights regarding the impact of omega-3 PUFAs administration on left ventricle performance indices, systemic inflammation and fibrosis biomarkers in patients with ischemic HF.
Subject(s)
Endothelium, Vascular/drug effects , Fatty Acids, Omega-3/pharmacology , Heart Failure/metabolism , Ventricular Function, Left/drug effects , Aged , Cross-Over Studies , Double-Blind Method , Fatty Acids, Omega-3/administration & dosage , Female , Fibrosis/metabolism , Humans , Inflammation/metabolism , Male , Middle AgedABSTRACT
OBJECTIVE: The aim of the present study was to assess the level of access site pain in patients undergoing transradial coronary catheterization by using topical application of an anesthetic ointment (lidocaine/prilocaine-AO) compared to standard local anesthesia (LA) by means of injectable lidocaine. METHODS: We prospectively studied 444 patients undergoing elective trans-radial coronary angiography. The quality of analgesia was assessed using a visual analogue scale (VAS) immediately after the puncture and 30 min after the removal of the sheath. The number and duration of attempts before successful sheath insertion, as well as artery spasm, were compared between the two groups. RESULTS: Pain levels measured by VAS were found to be similar between the two groups during sheath insertion (VAS: AO: 4.84 ± 1.0 vs 4.82 ± 1.2, P = NS), as well as 30 min after sheath removal (VAS: AO: 0.07 ± 0.5 vs LA: 0.15 ± 0.6, P = NS). The time to obtain radial access was also not affected by the use of anesthetic ointment (AO: 62.24 ± 25.7 s vs LA: 64.04 ± 18.78 sec, P = NS). The rate of clinical or angiographic radial artery spasm was similar (8-10%) between the groups (P = NS) CONCLUSION: Use of a local anesthetic ointment, versus injectable lidocaine, in trans-radial cardiac catheterization as means of local anesthesia, was found to be equally effective in terms of pain, artery spasm, or artery cannulation speed.
Subject(s)
Anesthesia, Local/methods , Anesthetics, Local/administration & dosage , Cardiac Catheterization/adverse effects , Lidocaine/administration & dosage , Pain, Procedural/prevention & control , Prilocaine/administration & dosage , Radial Artery , Administration, Cutaneous , Aged , Coronary Angiography , Drug Combinations , Female , Humans , Injections, Subcutaneous , Lidocaine, Prilocaine Drug Combination , Male , Middle Aged , Ointments , Pain Measurement , Pain, Procedural/diagnosis , Pain, Procedural/etiologyABSTRACT
BACKGROUND: The failing heart is characterized by a depleted metabolic energy reserve and the upregulation of several molecular mechanisms leading to cardiac hypertrophy, inflammation, fibrosis, angiogenesis, and apoptosis. Dietary or non-dietary supplementation of vitamins could potentially benefit energy balance. OBJECTIVE: The objective of the present study was to evaluate all available information on vitamins supplementation in patients with chronic HF for possible beneficial effect on metabolic, inotropic, chronotropic and hemodynamic indices. METHOD: We searched MEDLINE via Pubmed by using the following terms: "chronic heart failure" OR "cardiomyopathy" AND "vitamins", "vitamin A", "B complex vitamins", "vitamin C", "ascorbic acid", "vitamin D", "retinol", "vitamin E", "thiamine", "riboflavin", "niacin", "pyridoxine", "cobalamin", "folate", "pantothenic acid", "biotin", "tocopherol" and combinations of them. RESULTS: Data regarding supplementation of micronutrients in HF for most vitamins were sparse, and the inference about cardiovascular outcomes was obscured by the heterogeneity of studies, high inherent morbidity, and mortality of this group of high-risk patients, limited sample sizes in certain studies, unclear design and lack of head to head comparisons. Most vitamins in human trials failed to offer survival, or robust beneficial effect. Mostly indirect favorable evidence is derived from patients with deficiencies of certain micronutrients rather than their ad hoc supplementation. CONCLUSION: While vitamins and micronutrients are promising compounds for optimizing myocardial metabolism and homeostasis in HF, additional randomized clinical trials of larger scale are warranted to demonstrate the benefits of their supplementation in this high risk group of patients.