Eplerenone Modulates Interleukin-33/sST2 Signaling and IL-1ß in Left Ventricular Systolic Dysfunction After Acute Myocardial Infarction.

This study aimed to evaluate the role of eplerenone on the modulation of interleukin (IL)-1ß and IL-33/sST2 signaling pathway in an experimental model of left ventricular (LV) systolic dysfunction after acute myocardial infarction (MI). MI rats were randomly assigned to no treatment (MI group, n = 10), to receive eplerenone (Epl group, n = 10), or anakinra (Ana group, n = 10). LV function was assessed by echocardiography. IL-1ß, IL-33/sST2, and cardiac fibrosis biomarkers were analyzed by quantitative real-time reverse transcription polymerase chain reaction (PCR). Rats with MI showed significant reduction of LV systolic function, but treatment with eplerenone or anakinra improved left ventricular end-diastolic volume (LVEDV) and LVEDV/mass values. In the infarcted myocardium, compared with sham animals, the MI group had higher level of IL-33, sST2, and IL-1ß, as well as higher concentrations of markers of fibrosis and inflammation. Treatment with anakinra downregulated sST2 but with no effects on IL-33. Eplerenone reduced levels of sST2 and IL-1ß significantly. Both anakinra and eplerenone treatments were associated with lower levels of fibrosis and inflammatory markers. IL-1ß could induce expression of sST2, accelerating the progression of heart failure after acute MI. Eplerenone could improve LV function by reducing expression of IL-1ß and sST2.

A meta-analysis of the effects of ß-adrenergic blockers in chronic heart failure.

Adrenergic ß-blockers are drugs that bind to, but do not activate ß-adrenergic receptors. Instead they block the actions of ß-adrenergic agonists and are used for the treatment of various diseases such as cardiac arrhythmias, angina pectoris, myocardial infarction, hypertension, headache, migraines, stress, anxiety, prostate cancer, and heart failure. Several meta-analysis studies have shown that ß-blockers improve the heart function and reduce the risks of cardiovascular events, rate of mortality, and sudden death through chronic heart failure (CHF) of patients. The present study identified results from recent meta-analyses of ß-adrenergic blockers and their usefulness in CHF. Databases including Medline/Embase/Cochrane Central Register of Controlled Trials (CENTRAL), and PubMed were searched for the periods May, 1985 to March, 2011 and June, 2013 to August, 2015, and a number of studies identified. Results of those studies showed that use of ß-blockers was associated with decreased sudden cardiac death in patients with heart failure. However, contradictory results have also been reported. The present meta-analysis aimed to determine the efficacy of ß-blockers on mortality and morbidity in patients with heart failure. The results showed that mortality was significantly reduced by ß-blocker treatment prior to the surgery of heart failure patients. The results from the meta-analysis studies showed that ß-blocker treatment in heart failure patients correlated with a significant decrease in long-term mortality, even in patients that meet one or more exclusion criteria of the MERIT-HF study. In summary, the findings of the current meta-analysis revealed beneficial effects different ß-blockers have on patients with heart failure or related heart disease.

Coronary Revascularization Improves QT Dispersion in Patients with Chronic Coronary Artery Total Occlusion.

As an important parameter of cardiac functions, QT interval is usually irregular in patients with chronic coronary artery total occlusion (CTO). We sought to determine the effect of coronary revascularization (CRV) on QT interval dispersion in patients with CTO. To this end, we used electrocardiogram of 12 leads to record changes in the QT interval dispersion in 22 patients with CTO treated with percutaneous coronary intervention (PCI) and 24 patients treated with coronary artery bypass grafting (CABG). Our data showed that QTd and QTcd diminished markedly (P < 0.01) after PCI or CABG. No significant difference was observed between the postoperative groups (P > 0.05) or between PCI and CABG groups. We concluded that CRV could diminish QTd and QTcd in patients with CTO with no distinguishable differences with PCI and CABG procedures. Therefore, CRV can revitalize the existing functional myocardium and resume the myocardial electrophysiological functions in patients with CTO.

Analysis of heart rate variability in masked hypertension.

To investigate heart rate variability (HRV) in patients with masked hypertension (MH), participants were classified based on clinic and 24-h ambulatory blood-pressure monitoring: essential hypertension (EH, n = 40; MH, n = 36) and normotension (NT, n = 48). The HRV parameters were observed using a 24-h Holter monitor. Compared with NT controls, the parameters of HRV (SDNN, SDANN, SDNN Index, RMSSD, HF) and parameters in EH and MH patients had significantly decreased. No statistically significant difference in the HRV parameters was found between the EH and MH groups. The changes in HRV parameters show cardiac autonomic nerve dysfunction in patients with MH.

Assessment of recanalization of chronic total occlusions on left ventricular function in patients with or without previous myocardial infarction by real-time three-dimensional echocardiography.

The changes of left ventricular ejection fraction (LVEF) were assessed after successful recanalization of chronic total occlusions (CTO) with or without previous myocardial infarction (MI) by real-time three-dimensional echocardiography (RT3DE). 32 patients with a successfully recanalyzed CTO were included in the present prospective study. The patients were divided into group 1 without previous MI and group 2 with previous MI in the territories of total occlusion vessel that was recanalized. In addition, there was a subgroup composed of 14 patients with collateral flow or retrograde flow in group 2. In all patients, LVEF was determined by RT3DE at baseline and after 6 weeks. In group 1, the evolution of LVEF increased significantly from 59.9 ± 7.2-67.5 ± 8.7% (P < 0.05). In group 2, the evolution of LVEF increased from 48.6 ± 6.1-50.1 ± 6.4%, however, it was without statistic significance (P > 0.05). The evolution of LVEF increased from 46.8 ± 7.1-53.0 ± 7.2% (P < 0.05) in the subgroup of group 2. Left ventricular function in patients with CTO can be feasibility and actually evaluated by RT3DE. The influence of recanalization of CTO on the improvement of left ventricular function was different between MI and non-MI patients. The left ventricular function did not improve in MI patients, but improved significantly in the patients having rich collateral circulation.