Elevated levels of vitamin B12 in chronic stable heart failure: a marker for subclinical liver damage and impaired prognosis.

BACKGROUND: Elevated vitamin B12 is a sign for liver damage, but its significance in chronic stable heart failure (HF) is less known. The present study investigated the clinical correlates and prognostic significance of vitamin B12 levels in stable systolic HF. METHODS: A total of 129 consecutive patients with HF and 50 control subjects were enrolled. Data regarding demographics, clinical signs, therapeutic and conventional echocardiographic measurements were recorded for all patients. Right-sided HF was defined as the presence of at least one of the typical symptoms (ankle swelling) or specific signs (jugular venous distention or abdominojugular reflux) of right HF. Cox proportional hazards regression analyses were performed to determine the independent prognostic determinants of mortality. RESULTS: Baseline B12 levels in HF patients (n=129) with and without right sided HF were significantly higher compared to healthy controls (n=50): Median 311 pg/mL and 235 pg/mL vs 198 pg/mL, respectively (P=0.005). Folic acid levels were similar between the study groups. Age, ejection fraction, left atrial size, estimated glomerular filtration rate, and direct and indirect bilirubin levels were significantly correlated to serum B12 level in univariate analysis. In multivariate analysis, independent correlates of B12 were direct bilirubin (R=0.51, P<0.001) and age (R=0.19, P=0.028). Patients with HF were followed-up for a median period of 32 months. Median B12 levels were significantly higher in patients who subsequently died (n=35) compared to survivors, but folic acid was not different between the two groups. ROC analysis showed that B12 values ≥270 pg/mL had 80% sensitivity and 58% specificity for predicting all-cause mortality (area under the curve=0.672, 95% CI=0.562-0.781; P=0.003). However, in Cox regression analysis, only left atrial diameter, level of direct bilirubin, and the presence of abdominojugular reflux were independent predictors of death. CONCLUSION: Increased B12 in stable HF patients is associated with increased direct bilirubin due to right HF, indicating a cardiohepatic syndrome, but neither B12 nor folic acid are independently associated with mortality.

A simple discharge risk model for predicting 1-year mortality in hospitalised acute decompansated heart failure patients with reduced ejection fraction.

OBJECTIVE: The risk stratification for prognosis in heart failure is very important for optimal disease management and decision making. The aim of this study was to establish a simple discharge 1-year mortality prediction model by integrating data obtained from demographic characteristics, clinical evaluation, laboratory biomarkers and echocardiographic evaluation of hospitalised heart failure with reduced ejection fraction (HFrEF) patients with acute decompensation. METHODS AND RESULTS: A risk score model was developed based on ß-coefficient number of variables in a multivariable logistic regression model which was created with the use of data on clinical, laboratory, imaging and therapeutic findings of 670 patients (65.4% males, 65 ± 11 years) who was hospitalised with acute decompensated HFrEF. The mean left ventricular ejection fraction (LVEF) was 26 ± 9%. Independent predictors of mortality were: age ≥75 years, sodium <130 mEq/L, hepatomegaly at admission, unable to use beta-blocker at discharge and LVEF ≤20%. The 1-year mortality rate was 7.8% in the study population. The existence of each predictor was scored as 1 point and the discharge risk score identified patients into low (0-1 points), intermediate (2-3 points) and high (4-5 points) risk individuals with 3, 15.6 and 44.4% 1-year mortality rates, respectively. The model performance evaluated by concordance index was 0.74. CONCLUSIONS: This simple discharge risk score model for hospitalised acute decompensated HFrEF patients using easily determined demographic characteristics, clinical signs, echocardiographic and laboratory data is a valuable and an easy risk assessment tool to use at point-of-care.

Predictors of Long-Term Mortality and Frequent Re-Hospitalization in Patients with Acute Decompensated Heart Failure and Kidney Dysfunction Treated with Renin-Angiotensin System Blockers.

BACKGROUND Assessment of risk for all-cause mortality and re-hospitalization is an important task during discharge of acute heart failure (AHF) patients, as they warrant different management strategies. Treatment with optimal medical therapy may change predictors for these 2 end-points in AHF patients with renal dysfunction. The aim of this study was to evaluate the predictors for long-term outcome in AHF patients with kidney dysfunction who were discharged on optimal medical therapy. MATERIAL AND METHODS The study was conducted retrospectively. The study group consisted of 225 AHF patients with moderate-to-severe kidney dysfunction, who were hospitalized at Kocaeli University Hospital Cardiology Clinic and who were prescribed beta-blockers and ACE-inhibitors or angiotensin II receptor blockers at discharge. Clinical, echocardiographic, and biochemical predictors of the composite of total mortality and frequent re-hospitalization (≥3 hospitalizations during the follow-up) were assessed using Cox regression and the predictors for each end-point were assessed by competing risk regression analysis. RESULTS Incidence of all-cause mortality was 45.3% and frequent readmissions were 49.8% in a median follow-up of 54 months. The associates of the composite end-point were age, NYHA class, respiration rate on admission, eGFR, hypoalbuminemia, mitral valve E/E' ratio, and ejection fraction. In competing risk regression analysis, right-sided HF, hypoalbuminemia, age, and uric acid appeared as independent associates of all-cause mortality, whereas NYHA class, NT-proBNP, mitral valve E/E' ratio, and uric acid were predictors for re-hospitalization. CONCLUSIONS Predictors for all-cause mortality in AHF with kidney dysfunction treated with optimal therapy are mainly related to advanced HF with right-sided dysfunction, whereas frequent re-hospitalization is associated with volume overload manifested by increased mitral E/E' ratio and NT-proBNP levels.

Effect of Oral Nitrates on All-Cause Mortality and Hospitalization in Heart Failure Patients with Reduced Ejection Fraction: A Propensity-Matched Analysis.

BACKGROUND: Hydralazine-nitrate combination is recommended for patients with heart failure with reduced ejection fraction (HFrEF)/systolic heart failure who are symptomatic despite guideline-directed medical therapy (GDMT). Use of nitrates alone for this indication is not well-established. This study aims to evaluate the effect of oral nitrates on all-cause mortality and hospitalization in HFrEF patients using GDMT. METHODS AND RESULTS: Nitrate prescription at discharge and its association with all-cause mortality and heart failure hospitalization were examined in a propensity-matched analysis of 648 HFrEF patients followed for a median of 56 months. A total of 269 (42%) patients died during that period. In Cox regression analysis, nitrate usage was associated with a slightly increased mortality risk compared with not using nitrates (hazard ratio 1.29; 95% confidence interval 1.01-1.65; P = .040), which continued modestly after the propensity-matched analysis (hazard ratio 1.26; 95% confidence interval 0.95-1.68; P = .102). In both prematch and propensity-matched analyses, nitrate use was not associated with risk of rehospitalization. No significant effect was detected on subgroups stratified by coronary artery disease, age, gender, and background medical therapy. CONCLUSIONS: In this study, oral nitrate use alone in addition to GDMT did not affect all-cause mortality and hospitalization risk in HFrEF patients during a long-term follow-up. There was even a modest tendency for increased risk of mortality.

Post-discharge heart failure monitoring program in Turkey: Hit-PoinT.

OBJECTIVE: The aim of this study was to assess the efficacy and feasibility of an enhanced heart failure (HF) education with a 6-month telephone follow- up program in post-discharge ambulatory HF patients. METHODS: The Hit-Point trial was a multicenter, randomized, controlled trial of enhanced HF education with a 6-month telephone follow-up program (EHFP) vs routine care (RC) in patients with HF and reduced ejection fraction. A total of 248 patients from 10 centers in various geographical areas were randomized: 125 to EHFP and 123 to RC. Education included information on adherence to treatment, symptom recognition, diet and fluid intake, weight monitoring, activity and exercise training. Patients were contacted by telephone after 1, 3, and 6 months. The primary study endpoint was cardiovascular death. RESULTS: Although all-cause mortality didn't differ between the EHFP and RC groups (p=NS), the percentage of cardiovascular deaths in the EHFP group was significantly lower than in the RC group at the 6-month follow up (5.6% vs. 8.9%, p=0.04). The median number of emergency room visits was one and the median number of all cause hospitalizations and heart failure hospitalizations were zero. Twenty-tree percent of the EHFP group and 35% of the RC group had more than a median number of emergency room visits (p=0.05). There was no significant difference regarding the median number of all-cause or heart failure hospitalizations. At baseline, 60% of patients in EHFP and 61% in RC were in NYHA Class III or IV, while at the 6-month follow up only 12% in EHFP and 32% in RC were in NYHA Class III or IV (p=0.001). CONCLUSION: These results demonstrate the potential clinical benefits of an enhanced HF education and follow up program led by a cardiologist in reducing cardiovascular deaths and number of emergency room visits with an improvement in functional capacity at 6 months in post-discharge ambulatory HF patients.

Associations Between Neutrophil Gelatinase Associated Lipocalin, Neutrophil-to-Lymphocyte Ratio, Atrial Fibrillation and Renal Dysfunction in Chronic Heart Failure.

BACKGROUND Atrial fibrillation (AF) and renal dysfunction are two common comorbidities in patients with chronic heart failure with reduced ejection fraction (HFrEF). This study evaluated the effect of permanent AF on renal function in HFrEF and investigated the associations of atrial fibrillation, neutrophil gelatinase-associated lipocalin (NGAL), and neutrophil-to-lymphocyte ratio (NLR) with adverse clinical outcome. MATERIAL AND METHODS Serum NGAL levels measured by ELISA and NLR were compared between patients with sinus rhythm (HFrEF-SR, n=68), with permanent AF (HFrEF-AF, n=62), and a healthy control group (n=50). RESULTS Mean eGFR levels were significantly lower, and NLR and NGAL levels were significantly higher in the HFrEF patients than in the control patients but the difference between HFrEF-SR and HFrEF-AF was not statistically significant (NGAL: 95 ng/mL in HFrEF-SR, 113 ng/mL in HFrEF-AF and 84 ng/mL in the control group; p<0.001). Independent associates of baseline eGFR were age, hemoglobin, NLR, triiodothyronine, and pulmonary artery systolic pressure. In a mean 16 months follow-up, adverse clinical outcome defined as progression of kidney dysfunction and composite of all-cause mortality and re-hospitalization were not different between HFrEF-SR and HFrEF-AF patients. Although NGAL was associated with clinical endpoints in the univariate analysis, Cox regression analysis showed that independent predictors of increased events were the presence of signs right heart failure, C-reactive protein, NLR, triiodothyronine, and hemoglobin. In ROC analysis, a NLR >3 had a 68% sensitivity and 75% specificity to predict progression of kidney disease (AUC=0.72, 95% CI 0.58-0.85, p=0.001). CONCLUSIONS Presence of AF in patients with HFrEF was not an independent contributor of adverse clinical outcome (i.e., all-cause death, re-hospitalization) or progression of renal dysfunction. Renal dysfunction in HFrEF was associated with both NLR and NGAL levels, but systemic inflammation reflected by NLR seemed to be a more important determinant of progression of kidney dysfunction.

Discharge risk scoring method for predicting mortality in hospitalized chronic heart failure patients with severe systolic dysfunction.

OBJECTIVE: Prognostic risk stratification in heart failure is crucial to guide clinical decision-making.The aim of our study was to develop a prognostic discharge risk score model to predict all-cause mortality for chronic heart failure patients with multiple co-morbidities and severe systolic dysfunction. METHODS AND RESULTS: A multivariable logistic regression model was developed with the use of data on clinical, laboratory, imaging and therapeutic findings of 630 patients with advanced systolic heart failure. A risk score model was developed based on multiplying the beta-coefficient number of each variable in the multivariable model. The model performance was evaluated by concordance index and internally validated by the bootstrapping method. 313 patients (49.7%) of the cohort died during a median follow-up duration of 54 months. Median age was 66 years, 37% were female, 26% had atrial fibrillation and 40% had diabetes mellitus. The mean left ventricular ejection fraction (EF) was 25 +/- 10% and 264 patients (42%) had left ventricular EF < or = 20%. Independent predictors of mortality were older than 70 years, orthopnoea, previous hospitalisations, lack of renin-angiotensin system inhibitor therapy at discharge, hyperuricaemia (>7 mg/dl) and haemoglobin level (<10 g/dL). Discharge risk score identified low-, intermediate- and high-risk individuals with 18%, 40% and 52% mortality rates, respectively. The risk score had a discrimination ability with a concordance index of 0.70. CONCLUSIONS: In a large heart failure cohort, including patients with severe systolic dysfunction and having multiple comorbidities, a simple discharge risk score with non-invasive and easy-to-obtain variables during hospital admission represents a valuable tool for risk assessment.

Major depressive disorder in chronic heart failure patients: Does silent cerebral infarction cause major depressive disorder in this patient population?

OBJECTIVE: Depression frequently occurs in patients with heart failure as similar pathophysiological mechanisms present in both these diseases. Patients with dilated cardiomyopathy (DCM) have a high incidence of clinically asymptomatic silent cerebral infarction (SCI). This study aimed to evaluate the relation between SCI and major depressive disorder (MDD), and between MDD and clinical and biochemical parameters in DCM patients. METHODS: Patients with ischemic and non-ischemic DCM who had chronic heart failure (CHF) (39 male, 10 female, age 60±10 years) were included in the study. Mean patient ejection fraction (EF) was 34±10%. Patients had no localized neurological symptoms or stroke history. The etiology of DCM was ischemic in 40 and non-ischemic in 9 patients. Twenty-five age-matched healthy volunteers served as a control group for comparison of SCI and MDD prevalence. RESULTS: Patients had mild to severe CHF symptoms. Prevalence of SCI and MDD was significantly higher in patients with DCM than in the control group; 63% vs 8%; p<0.001, and 52% vs 20%; p<0.001 respectively. Patients with SCI had a higher prevalence of MDD than patients without SCI in DCM (61% vs 27%, p=0.02). CONCLUSION: CHF patients have an increased prevalence of SCI and MDD. Patients with SCI have a higher prevalence of MDD compared to patients without SCI in CHF.

Could decreased vitamin D levels be related with impaired cardiac autonomic functions in patients with chronic heart failure: an observational study.

OBJECTIVE: Vitamin D status has been implicated in the pathophysiology of heart failure (HF). The aim of this study was to investigate the association between vitamin D levels with heart rate variability and heart rate turbulence in patients with heart failure whom had ischemic and non-ischemic dilated cardiomyopathy. METHODS: Study designed as an observational cross-sectional study. Seventy-one patients [36 non-ischemic dilated cardiomyopathy (NIDCM), 35 ischemic dilated cardiomyopathy (IDCM)] with chronic heart failure and 25 control subject were included. It was evaluated the association between 25 hydroxyvitamin D [25(OH)D] and calcitriol levels with heart rate variability time domain (SDNN, SDANN, RMSSD) and heart rate turbulence [turbulence onset (TO), turbulence slope (TS)] parameters. Statistical analysis was performed using Kruskal-Wallis test and ANOVA. RESULTS: Calcitriol levels in NIDCM patients with abnormal TO and TS were significantly lower than NIDCM patients with normal TO (17.1 ± 11.3 vs. 27.6 ± 15.5 pg/mL, p=0.05) and TS (16.6 ± 9.1 vs. 29.4 ± 16.9 pg/mL, p=.018). There was a positive correlation between 25 (OH) D with heart rate variability parameters SDNN (r=0.368, p=0.027) and SDANN (r=0.360, p=0.031). It was not found any association between vitamin D and parameters of heart rate variability and heart rate turbulence in IDCM patients. CONCLUSION: Insufficiency of vitamin D may have deleterious effects on cardiac autonomic functions which were showed with heart rate turbulence and heart rate variability in patients with NIDCM. Vitamin D levels might be a predictor to determine the sudden cardiac death in patients with non-ischemic etiology.

Low radioiodine uptake in congestive heart failure.

OBJECTIVES: Our aim was to compare the radioiodine uptake (RAIU) of congestive heart failure (CHF) patients with that of a control group and investigate the prognostic value. We also assessed correlations of RAIU with other clinical parameters. METHODS: A total of 32 CHF patients and 14 controls were included in this study. RAIU was measured at the fourth and 24th hour using an uptake probe. The patients were followed up for a mean period of 32.09±8 months. RESULTS: The mean fourth-hour RAIU was 6.28±5.51 and the mean 24th-hour RAIU was 14.43±9.49 in the patient group. The mean fourth and 24th hour RAIUs of the control group were 9.93±1.92 and 22.90±5.89, respectively, which were statistically higher than that of the patient group (P=0.0001 and 0.001, respectively).Cardiac death occurred in nine patients during follow-up. The fourth and 24th hour uptake ratios were statistically significantly lower in the cardiac death group compared with the no-death group (3±2.01 vs. 7.57±5.93 and 7.39±7.34 vs. 17.18±8.9, respectively; P=0.003 and 0.007). On stepwise multivariate Cox regression analyses, only urea proved to be a significant independent predictor of cardiac death (hazard ratio 1.021; 95% confidence interval 1.005-1.037; P<0.008). Significant negative correlations were found between the fourth and 24th hour RAIUs and high-sensitivity C-reactive protein, urea, and creatinine levels, but no correlation was found between RAIUs and estimated glomerular filtration rate. CONCLUSION: CHF patients have lower RAIU values probably because of an expanded iodine pool and prolonged Wolff-Chaikoff effect. Also, patients who died during follow-up had lower RAIU values, but RAIU did not emerge as an independent predictor of death. However, studies with larger patient groups are definitely needed.

Treatment with enhanced external counterpulsation improves cognitive functions in chronic heart failure patients.

OBJECTIVES: Chronic heart failure (CHF) has been associated with an increased risk of poorer cognitive performance in older adults. Reversibility of cognitive impairment after medical treatment has been reported, although the restorative effects of enhanced external counterpulsation (EECP) on cognitive performance have not been studied. We investigated the effect of EECP on cognitive functions in CHF patients. STUDY DESIGN: Thirty-six individuals (mean age: 66±8 years) who were diagnosed with CHF and were New York Heart Association (NYHA) Class II-III and Canadian Cardiovascular Society (CCS) Class II-III participated in this study. Neuropsychological assessment was performed in these patients. RESULTS: Patients in the EECP treatment group showed a statistically significant improvement in spontaneous naming (p=0.011) and forward row score of the attention subset among domains of cognition (p=0.020) and interference time of executive function (p=0.012). CONCLUSION: Enhanced external counter pulsation resulted in improvement in all domains of cognitive functions except verbal and visual memory tests.

A Turkish perspective on coronary artery bypass surgery and percutaneous coronary artery intervention in chronic heart failure patients.

The impact of coronary revascularization methods (coronary artery bypass graft [CABG] surgery and stent implantation) on clinical outcome has not been determined yet in patients with systolic heart failure (SHF). We examined outcomes in patients discharged from our hospital after hospitalization for decompensated SHF. Of 637 patients with SHF (mean age, 64 ± 13 years; mean ejection fraction, 26.5% ± 9%), 402 patients (63%) had coronary artery disease (CAD) and 235 patients (37%) had no CAD; 223 patients (35%) died because of cardiovascular reasons during follow-up. Patients who had stenting alone and patients who had CABG surgery and stenting had better prognosis than patients with CAD but no revascularization procedure (P < .001 and P = .013, respectively). In the patients with SHF having CAD who had stenting and CABG surgery + stenting may have better prognosis compared with patients with CAD who had no revascularization procedure in their past.

Number of leads with fragmented QRS predicts response to cardiac resynchronization therapy.

BACKGROUND: Cardiac resynchronization therapy (CRT) is an effective option in the treatment of patients with heart failure (HF) and wide QRS. Fragmented QRS (fQRS) on 12-lead electrocardiography has been shown to predict cardiac events in several patient populations. However, the relationship between the number of leads with fQRS and response to CRT has not been investigated. HYPOTHESIS: The number of leads with fQRS may predict response to CRT. METHODS: One hundred five patients with HF undergoing CRT were prospectively studied. The presence of fQRS was assessed using standardized criteria. Echocardiographic response to CRT was defined by a ≥15% reduction in left ventricular end-systolic volume at 6 months follow-up. RESULTS: Seventy-four patients (71%) had CRT response after 6 months of follow-up. In multivariate analysis, significant associates of response to CRT were evaluated adjusting for gender, etiology of cardiomyopathy, QRS width, baseline left ventricular ejection fraction, and the number of leads with fQRS. The number of leads with fQRS was the only predictor of response to CRT (odds ratio: 0.61, 95% confidence interval: 0.48-0.77, P < 0.001). CONCLUSIONS: The more leads with fQRS predicts nonresponse to CRT and may help in the selection of CRT candidates.

Low serum triglyceride levels as predictors of cardiac death in heart failure patients.

Understanding the influence of sex differences on predictors of cardiac mortality rates in chronic heart failure might enable us to lengthen lifetimes and to improve lives. This study describes the influence of sex on cardiovascular mortality rates among chronic heart failure patients. From January 2003 through December 2009, we evaluated 637 consecutive patients (409 men and 228 women) with chronic heart failure, who ranged in age from 18 through 94 years (mean age, 64 ± 13 yr) and ranged in New York Heart Association (NYHA) functional class from II through IV. The mean follow-up period was 38 ± 15 months, the mean age was 64 ± 13 years, and the mean left ventricular ejection fraction was 0.27 ±0.11. By the end of the study, both sexes had similar cardiovascular mortality rates (36% men vs 37% women, P=0.559). In Cox regression analysis, NYHA functional class, triglyceride level, and history of coronary artery disease were independent predictors of cardiovascular death for women with chronic heart failure. For men with chronic heart failure, the patient's age, ejection fraction, and sodium level were independent predictors of cardiovascular death. In a modern tertiary referral heart failure clinic, decreased triglyceride levels were, upon univariate analysis, predictors of poor outcomes for both men and women. However, upon Cox regression analysis, reduced triglyceride levels were independent predictors of cardiac death only in women.

Respiratory changes in the E/A wave pattern can be an early sign of diastolic dysfunction: an echocardiographic long-term follow-up study.

BACKGROUND: The left ventricular filling pattern may show changes during respiration, which are generally used in the diagnosis of diastolic dysfunction. The clinical importance of the respiratory E/A wave pattern change has been investigated in a limited number of studies. The aim of the present study was to assess the diastolic function of hypertensive patients with respiratory changes in mitral flow over a long-term follow-up period. MATERIAL/METHODS: Our study included 107 newly diagnosed and untreated hypertensive patients (49 males; mean age, 46±10 years) with respiratory changes during transthoracic echocardiography (TTE). In addition, the patient group was classified into 2 groups according to the change in E/A pattern by the Valsalva maneuver. After a mean follow-up period of 44±7 month, 90% of the hypertensive patients and the entire control group were re-examined. RESULTS: Relaxation abnormalities developed in 84% of the patients (58/80) in the Valsalva-positive group after the follow-up period. The frequency of relaxation abnormalities was 60% in the Valsalva-negative group and 3.1% in the control group (p<0.001). Based on multivariate regression analysis, the echocardiographic predictors of the development of relaxation impairment were mitral E velocity, A velocity, deceleration time, isovolumetric contraction time, E/E' ratio, and the presence of respiratory change. The most important parameter for the development of an abnormal relaxation pattern was the presence of respiratory change after adjustment according to the changes with the Valsalva maneuver. CONCLUSIONS: Respiratory change in mitral flow can be evaluated as an early sign of diastolic dysfunction in patients with hypertension.

Relationship between endothelial functions and acetylsalicylic acid resistance in newly diagnosed hypertensive patients.

BACKGROUND: We aimed to investigate the effects and dose dependency of aspirin on endothelial functions and prevalence of aspirin resistance in newly diagnosed hypertensive patients without previous drug therapy and development of cardiac complications. HYPOTHESIS: Acetylsalicyclic acid improves endothelial function. METHODS: Fifty-eight hypertensive patients and 61 healthy subjects in the control group were included in the study. Endothelial functions of the patient and control groups were evaluated with brachial artery examination. Patient and control groups were divided into 2 groups. A total of 100 mg and 300 mg of aspirin were given to the separate groups for 1 week. After 1 week, endothelial functions were reevaluated and aspirin resistance examined with a platelet function analyzer (PFA-100; Dade Behring, Marbourg, Germany). RESULTS: Baseline flow-mediated dilatation (FMD) change percent in hypertensive patients was 9.8%, and it was significantly lower than in the control group (12%) (P < 0.001). Frequency of acetylsalicylic acid (ASA) resistance was 20% and 26% in control and hypertensive patient groups, respectively (P = not significant). ASA resistance was 28% and 24% in 100 mg and 300 mg in hypertensive patients, respectively (P = not significant). FMD change percent increased both in the control and hypertensive groups after ASA treatment from 12.4% to 13.3% and 9.8 % to 11.9 %, respectively. FMD percentage change was significantly increased in hypertensive patients irrespective of ASA resistance (P = 0.02, for ASA resistance [+]; P < 0.012, for ASA resistance [-]). CONCLUSIONS: Endothelial functions were impaired more in hypertensive patients compared to the control group. Endothelial functions were improved with all ASA doses in hypertensive patients irrespective of ASA resistance.

Renal function has an effect on cardiovascular mortality in patients with dilated cardiomyopathy.

BACKGROUND: Chronic heart failure (CHF) is a major and growing public health problem resulting from the cardiac damage caused by a variety of disease processes. CHF has many comorbid conditions such as hypertension, coronary artery disease, peripheral artery disease and chronic kidney disease (CKD). Some of the chronic conditions may have an effect on cardiac mortality in CHF patients. We have investigated the effect of renal dysfunction on cardiovascular mortality in patients with ischemic dilated cardiomyopathy (DCM) and nonischemic DCM. METHODS: Six hundred and thirty-seven patients with DCM were evaluated between January 2003 and January 2011. All individuals in the study population were admitted to the cardiology clinic because of decompensated heart failure. In this prospective observational study, a total of 637 patients [409 men, 228 women, 18-94 years old, mean age 63 ±â€Š13 years; New York Heart Association (NYHA) functional class II-IV] with diagnoses of ischemic (402) and nonischemic (235) DCM were enrolled in the study. Baseline glomerular filtration rate was calculated using the Cockcroft-Gault equation. RESULTS: By the end of the study, 228 patients had died due to cardiovascular reasons. Both DCM types had similar cardiovascular mortality [151 patients with ischemic DCM (37%) vs. 77 patients with nonischemic DCM (32%); P = NS]. Renal dysfunction had an effect on cardiovascular mortality in patients with ischemic and nonischemic DCM (respectively, glomerular filtration rate 54 ±â€Š24, 56 ±â€Š24; P < 0.001). CONCLUSION: We have demonstrated that renal function is a prognostic risk marker in patients with ischemic and nonischemic DCM.

Association between red blood cell distribution width and response to cardiac resynchronization therapy.

PURPOSE: Red blood cell distribution width (RDW) predicts adverse outcomes in patients with heart failure. We aimed to investigate the prognostic value of RDW on response to cardiac resynchronization therapy (CRT). METHODS: Sixty-six consecutive patients (mean age, 57 ± 13 years; 42 men) undergoing CRT were included in the study. Hematological parameters and echocardiographic parameters were measured before and 6 months after CRT. An echocardiographic response to CRT was defined as a ≥15 % relative increase in left ventricular ejection fraction after 6 months. RESULTS: After 6 months of CRT, 47 (71 %) patients were responders. High baseline RDW levels were found in 11 (23 %) and 10 (52 %) patients in responders and non-responders, respectively (p < 0.05). In non-responders, RDW at 6 months was significantly high compared to baseline RDW (17.1 ± 2 vs. 19 ± 2.9) (p < 0.001). There was not any significant change in RDW after CRT in responders (16 ± 1.6 vs. 15.5 ± 1.4) (p > 0.05). In multivariate analysis, significant associates of response to CRT were evaluated adjusting for QRS width, QRS morphology, age, New York Heart Association functional class, hemoglobulin, and RDW level. Baseline RDW level was the only predictor of response to CRT (odds ratio, 1.435; 95 % confidence interval, 1.059-1.945, p = 0.020). CONCLUSIONS: Our data suggest that patients with elevated RDW at baseline are associated with poor response to CRT. Therefore, RDW at baseline could help to identify patients with response to CRT.

Reduced heart rate response to dipyridamole in patients undergoing myocardial perfusion SPECT.

OBJECTIVE: A mild decrease in blood pressure and increase in heart rate (HR) are considered normal hemodynamic responses to dipyridamole. In this study, we tried to investigate HR response to dipyridamole and its predictors in patients undergoing gated myocardial perfusion single photon emission computed tomography (SPECT). METHODS: 201 consecutive patients undergoing dipyridamole stress Tc99m-MIBI or Tl-201 gated myocardial perfusion SPECT were prospectively enrolled. Dipyridamole was infused over 4 min and radiopharmaceutical was injected 3 min after the end of infusion. A reduced heart rate response to dipyridamole considered if the HR ratio (peak HR/rest HR) was 1.20 or less. Stress (sLVEF), rest (rLVEF) left ventricular ejection fractions, stress and rest motion (SMS, RMS) and thickening scores (STS, RTS) were derived automatically by QGS. Summed stress score (SSS), summed rest score (SRS), and summed difference score (SDS) for myocardial perfusion were calculated. Patients were grouped according to HR response and groups were compared. A logistic regression analysis was used to determine independent predictors of reduced HR response. RESULTS: Reduced HR response was found in 78 % of patients. Patients with abnormal HR response were more frequently had a history of diabetes mellitus, chronic renal failure, and had lower high-density lipoprotein (HDL) levels. Peak HR, SSS, SRS, sLVEF and rLVEF were lower; rest HR, RTS, and the number of patients with ≤ 45 % sLVEF and rLVEF were higher in reduced HR response group (all p < 0.05). There was no difference between groups by means of gender, rest and peak systolic or diastolic tension, SDS, SMS, STS, RMS, history of hypertension, peripheral arterial disease, metabolic syndrome, coronary interventions, digoxin, calcium channel blocker or beta blocker usage. Multivariable logistic regression analysis demonstrated that the independent predictors of reduced HR response were HDL, rest HR and SSS. When HDL was removed from the model, chronic renal failure also emerged as an independent predictor. CONCLUSION: Reduced HR response to dipyridamole is associated with ventricular dysfunction, cardiac autonomic neuropathy. Low HDL levels also seem to be related with reduced HR response.

Comparative analysis of apoptotic resistance of mesenchymal stem cells isolated from human bone marrow and adipose tissue.

AIM: Mesenchymal stem cells (MSCs) isolated from human bone marrow (hBM) and adipose tissue (hAT) are perceived as attractive sources of stem cells for cell therapy. The aim of this study was to compare MSCs from hBM and hAT for their immunocytochemistry staining and resistance to in vitro apoptosis. METHODS: In our study, we investigated the antiapoptotic ability of these MSCs toward oxidative stress induced by hydrogen peroxide (H(2)O(2)) and serum deprivation. Results were assessed by MTT and flow cytometry. All experiments were repeated a minimum of three times. RESULTS: Flow cytometry and MTT analysis revealed that hAT-MSCs exhibited a higher resistance toward H(2)O(2)-induced apoptosis (n = 3, hBM-hAT viability H(2)O(2) 58.43 ± 1.24-73.02 ± 1.44, P < 0.02) and to serum-deprivation-induced apoptosis at days 1 and 4 than the hBM-MSCs (n = 3, hAT-hBM absorbance, resp., day 1: 0.305 ± 0.027-0.234 ± 0.015, P = 0.029, day 4: 0.355 ± 0.003-0.318 ± 0.007, P = 0.001, and day 7: 0.400 ± 0.017-0.356 ± 0.008, P = 0.672). hAT-MSCs showed superior tolerance to oxidative stress triggered by 2 mmol/L H(2)O(2) and also have superior antiapoptosis capacity toward serum-free culture. CONCLUSION: In this study we found that hAT-MSCs are more resistant to in vitro apoptosis.