Isoprenaline induced Takotsubo syndrome: Histopathological analyses of female rat hearts.

BACKGROUND: Takotsubo syndrome (TTS) is a stress-induced disorder affecting mostly postmenopausal women. The aim of the study was to evaluate isoprenaline (ISO) dependent female rat model and histopathological characteristics in TTS. METHODS: Forty-nine Sprague Dawley female rats, 12 weeks old, were injected intraperitoneally with a single dose of ISO at doses 50 (n = 8), 75 (n = 6), 100 (n = 3), 150 (n = 27) and 200 (n = 5) mg/kg body weight (bw). The control group (n = 6) was injected with physiological saline. The echocardiographic examination to assess wall motion abnormalities took place 24, 48, 72 h, and 7 days post-ISO. Histopathological analysis was performed on the basis of hematoxylin-eosin staining. RESULTS: The total mortality rate was 3/49 (6.12%). The optimum dose of ISO to induce TTS was 150 mg/kg bw and 21/27 (77.77%) rats showed apical ballooning. Histopathological analysis revealed focal necrosis/apoptosis of cardiomyocytes with inflammatory and fibroblast-like cell infiltration. Foci were the most numerous in the central muscle layer with apical-basal gradient 24, 48, 72 h post-ISO (p < 0.05). Significant differences were noted 48 h post-ISO in the central layer in apical vs basal segments (p = 0.0032), in the endocardial layer in apical vs basal segments (0.00024) and in mid-cavital vs. basal segments (p = 0.0483). The number of foci in endocardium of apical region differ 48 h post-ISO in rats with a dose of 150 vs. 200 mg/kg bw (p = 0.0084). CONCLUSIONS: The ISO female rat model of TTS is associated with higher optimum dose and lower mortality in comparison with the male TTS model. TTS presents as a singles cardiomyocyte disorder, foci concerned mainly central muscle layer with apical-basal gradient.

In-hospital heart rate reduction and its relation to outcomes of heart failure patients with sinus rhythm: Results from the Polish part of the European Society of Cardiology Heart Failure Pilot and Long-Term Registries.

BACKGROUND: Currently, there is no information on whether in-hospital heart rate (HR) reduction has an influence on risk of death or rehospitalization. The study evaluates the relation between inhospital HR reduction in heart failure (HF) patients on mortality and rehospitalization within 1-year observation. METHODS: The analysis included patients hospitalized in Poland with sinus rhythm from the European Society of Cardiology Heart Failure Pilot (ESC-HF-Pilot) and ESC Heart Failure Long-Term Registries (ESC-HF-LT), who were divided into two groups: reduced HR and not-reduced HR. HR reduction was defined as a reduced value of HR at discharge compared to admission HR. The primary endpoint was 1-year all-cause death, the secondary endpoint was 1-year all-cause death or rehospitalization for worsening HF. RESULTS: The final analysis included 747 patients; 491 reduced HR (65.7%) and 256 not-reduced HR (34.3%). The primary endpoint occurred in 58/476 (12.2%) from reduced HR group and in 26/246 (10.5%) from not-reduced HR group (p = 0.54). In the reduced HR group, independent predictors of primary endpoint were age, New York Heart Association class at admission, serum sodium level at admission and systolic blood pressure at discharge. In the not-reduced HR group the independent predictor of primary endpoint was diastolic blood pressure at discharge. The secondary endpoint was observed in 180 patients, 124/398 (31.2%) from reduced HR and 56/207 (27.1%) from the not-reduced HR group (p = 0.30). In the not-reduced HR group only angiotensin converting-enzyme inhibitor usage at discharge was independently associated with lower risk of the secondary endpoint. CONCLUSIONS: In-hospital HR reduction did not influence on the outcomes of HF patients in sinus rhythm.

Differences in clinical characteristics and 1-year outcomes of hospitalized patients with heart failure in ESC-HF Pilot and ESC-HF-LT registries.

INTRODUCTION The management of heart failure (HF) has changed significantly in recent decades. OBJECTIVES We analyzed the clinical profile, 1­year outcomes, predictors of mortality, and hospital readmissions in hospitalized patients enrolled in the European Society of Cardiology Heart Failure Pilot Survey (ESC­HF Pilot) and Heart Failure Long­Term Registry (ESC­HF­LT). PATIENTS AND METHODS The analysis included hospitalized Polish patients from both registries. The primary endpoint was all­cause death at 1 year, while the secondary endpoint was all­cause death or hospitalization for worsening HF at 1 year. RESULTS The study included a total of 1415 hospitalized patients (650 from ESC­HF Pilot; 765 from ESC­HF­LT). The primary endpoint occurred in 89 of the 650 patients (13.7%) and in 120 of the 711 patients (16.9%) from ESC­HF Pilot and ESC­HF­LT, respectively (P = 0.11). The secondary endpoint was more frequent in ESC­HF Pilot than in ESC­HF­LT (201 of 509 [39.5%] vs 222 of 663 [33.5%]; P = 0.04). Compared with ESC­HF Pilot, patients from the ESC­HF­LT registry were older and more often had hypertension, atrial fibrillation, peripheral artery disease, and chronic kidney disease, while the incidence of chronic obstructive pulmonary disease was lower. The percentage of patients receiving drugs for HF (diuretics, angiotensin­converting enzyme inhibitors, angiotensin receptor blockers, ß­blockers, mineralocorticoid receptor antagonists), anticoagulants, cardiac resynchronization therapy, and implantable cardioverter­defibrillator were higher in the ESC­HF­LT group in comparison with the ESC­HF Pilot group. CONCLUSIONS Patients from the ESC­HF­LT registry had a lower risk of death or hospitalization for worsening HF despite the fact that they were older and had more comorbidities. The results might suggest an improvement in physicians' adherence to the guidelines on the management of HF in the ESC­HF­LT registry.

OCULUS study: Virtual reality-based education in daily clinical practice.

BACKGROUND: Atrial fibrillation (AF) is associated with high risk of stroke and other thromboembolic complications. The OCULUS study aimed to evaluate the effectiveness of the three-dimensional (3D) movie in teaching patients about the consequences of AF and pharmacological stroke prevention. METHODS: The study was based on a questionnaire and included 100 consecutive patients (38% women, 62% with AF history). Using the oculus glasses and a smartphone, a 3D movie describing the risk of stroke in AF was shown. Similar questions were asked immediately after, 1 week and 1 year after the projection. RESULTS: Before the projection 22/100 (22.0%) declared stroke a consequence of AF, while immediately after 83/100 (83.0%) (p < 0.0001) patients declared this consequence. Seven days after, stroke as AF consequence was chosen by 74/94 (78.7%) vs. 22/94 (23.4%) when compared to the baseline knowledge; p < 0.0001, a similar trend was also observed in 1-year follow-up (64/90 [71.1%] vs. 21/90 [23.3%]; p < 0.0001). Before the projection 88.3% (83/94) patients responded, that drugs may reduce the risk of stroke, and after 1 week the number of patients increased to (94/94 [100%]; p = 0.001). After 1 year 87/90 (96.7%) answered that drugs may diminish the risk of stroke (p = 0.02 in comparison to the baseline survey 78/90 [86.7%]). Use of oral anticoagulation to reduce the risk of stroke was initially chosen by 66/94 (70.2%), by 90/94 (95.7%; p < 0.0001) 7 days after and by 83/90 (92.2%; p < 0.0001) 1 year after. CONCLUSIONS: 3D movie is an effective tool in transferring knowledge about the consequences of AF and the pivotal role of oral anticoagulation in stroke prevention. TRIAL REGISTRATION: ClinicalTrials.gov, NCT03104231. Registered on 28 March 2017.

Autonomic nervous system in Takotsubo syndrome.

Takotsubo syndrome (TTS) is an acute and usually reversible heart failure syndrome with symptoms resembling acute myocardial infarction, however, without obstruction of coronary arteries. In the majority of cases, TTS is preceded by emotional or physical stress and the disease concerns mainly postmenopausal women. Although several hypotheses have been introduced, the pathogenesis of TTS is controversial and still remains to be determined. As reported in recent studies, the role of the autonomic nervous system (ANS) seems to be pivotal in the pathogenesis of TTS. Therefore, the aim of this article is to summarize and discuss the current knowledge of the pathogenesis of TTS with a special focus on the ANS.

Study design and rationale for biomedical shirt-based electrocardiography monitoring in relevant clinical situations: ECG-shirt study.

BACKGROUND: Today, the main challenge for researchers is to develop new technologies which may help to improve the diagnoses of cardiovascular disease (CVD), thereby reducing healthcare costs and improving the quality of life for patients. This study aims to show the utility of biomedical shirt-based electrocardiography (ECG) monitoring of patients with CVD in different clinical situations using the Nuubo® ECG (nECG) system. METHODS: An investigator-initiated, multicenter, prospective observational study was carried out in a cardiology (adult and pediatric) and cardiac rehabilitation wards. ECG monitoring was used with the biomedical shirt in the following four independent groups of patients: 1) 30 patients after pulmonary vein isolation (PVI), 2) 30 cardiac resynchronization therapy (CRT) recipients, 3) 120 patients during cardiac rehabilitation after myocardial infarction, and 4) 40 pediatric patients with supraventricular tachycardia (SVT) before electrophysiology study. Approval for all study groups was obtained from the institutional review board. The biomedical shirt captures the electrocardiographic signal via textile electrodes integrated into a garment. The software allows the visualization and analysis of data such as ECG, heart rate, arrhythmia detecting algorithm and relative position of the body is captured by an electronic device. DISCUSSION: The major advantages of the nECG system are continuous ECG monitoring during daily activities, high quality of ECG recordings, as well as assurance of a proper adherence due to adequate comfort while wearing the shirt. There are only a few studies that have examined wearable systems, especially in pediatric populations. TRIAL REGISTRATION: This study is registered in ClinicalTrials.gov: Identifier NCT03068169. (Cardiol J 2018; 25, 1: 52-59).

The role of epidermal sphingolipids in dermatologic diseases.

Sphingolipids, a group of lipids containing the sphingoid base, have both structural and biological functions in human epidermis. Ceramides, as a part of extracellular lipids in the stratum corneum, are important elements of the skin barrier and are involved in the prevention of transepidermal water loss. In addition, ceramides regulate such processes as proliferation, differentiation and apoptosis of keratinocytes. Another important sphingolipid, sphingosine-1-phosphate (S1P), inhibits proliferation and induces differentiation of keratinocytes. A recent clinical study of the efficacy and safety of ponesimod (a selective modulator of the S1P receptor 1) suggested that sphingolipid metabolism may become a new target for the pharmacological treatment of psoriasis. The role of sphingolipids in some dermatologic diseases, including psoriasis, atopic dermatitis and ichthyoses was summarized in this article.

Sphingolipids in cardiovascular diseases and metabolic disorders.

Many investigations suggest the pivotal role of sphingolipids in the pathogenesis of lifestyle diseases such as myocardial infarction, hypertension, stroke, diabetes mellitus type 2 and obesity. Some studies suggest that sphingolipids are important factors in cellular signal transduction. They serve as biologically active components of cell membrane and are involved in many processes such as proliferation, maturation and apoptosis. Recently, ceramide and sphingosine-1-phosphate have become the target of many investigations. Ceramide is generated in three metabolic pathways and many factors induce its production as a cellular stress response. Ceramide has proapoptotic properties and acts as a precursor for many other sphingolipids. Sphingosine-1-phosphate is a ceramide derivative, acting antiapoptotically and mitogenically and it is importantly involved in cardioprotection. Further research on the involvement of sphingolipids in cellular pathophysiology may improve the prevention and therapy of lifestyle diseases.