Myocardial Angiotensin-Converting Enzyme 2 Protein Expression in Ischemic Heart Failure.

The angiotensin-converting enzyme 2 (ACE2)-angiotensin-(1-7)-Mas receptor axis plays a significant role in regulating myocardial remodeling and the development of heart failure (HF), with ACE2 being the primary focus. However, contemporary understanding of the membrane-bound form of the human ACE2 protein remains insufficient. The purpose of this study was to determine the expression of ACE2 protein in different cells of the left ventricular myocardium in non-diseased hearts and at various stages of ischemic HF. A total of 103 myocardial tissue samples from the left ventricle underwent quantitative and semi-quantitative immunohistochemical analysis. Upon assessing ACE2 immunostaining in all myocardial cells through unselective digital image analysis, there was no change in the stage A HF group. Nevertheless, the expression of ACE2 membrane protein in cardiomyocytes showed a tendency to increase, while non-cardiomyocyte ACE2 expression decreased significantly (p < 0.001). In the stage B HF group, the intensity of ACE2 immunostaining continued to increase with rising cardiomyocyte ACE2 expression (p < 0.001). Non-cardiomyocyte expression, in contrast, remained similar to that observed in the stage A HF group. In the stages C/D HF group, ACE2 expression reached its highest level in cardiomyocytes (p < 0.001), while ACE2 expression in non-cardiomyocytes was the lowest (p < 0.001). These changes in ACE2 protein levels are associated with left ventricular remodeling in ischemic HF.

Strongmen sport is associated with larger absolute heart size and impaired cardiac relaxation.

This study was carried out to compare cardiac structure and function and blood lipids among Strongmen, sedentary controls, and marathoners. Echocardiography was performed, and endothelial function, blood lipids and maximal oxygen uptake were measured in 27 Caucasian adult men (8 Strongmen, 10 marathoners, 9 controls). Absolute cardiac size parameters such as left ventricular (LV) diameter and wall thickness of Strongmen were higher (p < 0.05), but relative (body surface area indexed) parameters were not different between controls and Strongmen. In Strongmen, the relative LV diameter (p < 0.05), wall thickness (p < 0.001), and LV mass index (p < 0.01) were lower than in marathoners. The absolute but not relative right ventricular diameter was larger in Strongmen as compared with controls, whereas all of the measured relative cardiac size parameters were higher in marathoners as opposed to in controls. The endothelial function and the ratio of wall thickness to chamber diameter were similar among the groups (p > 0.05). Maximal oxygen uptake of Strongmen was lower than in controls (p < 0.05) and marathoners (p < 0.001). Global diastolic LV function of Strongmen was impaired in comparison to controls (p < 0.05) and marathoners (p < 0.05). Plasma lipids were not different between Strongmen and sedentary controls, but in comparison to runners, Strongmen had higher low-density lipoprotein-cholesterol (p < 0.05) and lower high-density lipoprotein cholesterol (p < 0.01). Participation in Strongmen sport is associated with higher absolute but not relative cardiac size parameters, impaired myocardial relaxation, and low cardiorespiratory fitness. Therefore, Strongmen may demand greater attention as an extreme group of athletes with regard to cardiovascular risk.

[Return to work after coronary artery bypass surgery]. / Ligoniu grizimas i darba po vainikiniu jungciu suformavimo operacijos.

The aim of this study was to assess the possible reasons for not returning to work after coronary artery bypass surgery. A total of 134 patients (aged 65 years and younger) who underwent coronary bypass surgery in 2003 were examined. The analysis was performed in three groups of the patients: Group I, patients who were employed before surgery and returned to work after it (n=51); Group II, patients who were employed before surgery but did not return to work after surgery (n=55); and Group III, patients who were unemployed before and remained unemployed after surgery due to health problems (n=28). Number of injured coronary arteries, the extent of operation, postoperative complications, risk factors for ischemic heart disease, clinical status of patients (angina pain and heart failure), physical tolerance, and return to work within one year after coronary bypass surgery were analyzed. It was found that 48.1% of patients who were employed before surgery returned to work after myocardial revascularization. About 30% of patients experienced recurrent symptoms of angina after 12 months. Logistic regression analysis revealed that return to work was significantly influenced by female gender, physical pattern of work, age, and severity of heart failure.

[Evaluation of a chronic fatigue in patients with moderate-to-severe chronic heart failure]. / Serganciuju vidutinio sunkumo ir sunkiu letiniu sirdies nepakankamumu letinio nuovargio tyrimas.

THE AIM OF THE STUDY: To evaluate the chronic fatigue and its relation to the function of hypothalamus-pituitary-adrenal axis in patients with New York Heart Association (NYHA) functional class III-IV chronic heart failure. MATERIAL AND METHODS: A total of 170 patients with NYHA functional class III-IV chronic heart failure completed MFI-20L, DUFS, and DEFS questionnaires assessing chronic fatigue and underwent echocardiography. Blood cortisol concentration was assessed at 8:00 am and 3:00 pm, and plasma N-terminal brain natriuretic pro-peptide (NT-proBNP) concentration was measured at 8:00 am. Neurohumoral investigations were repeated before cardiopulmonary exercise test and after it. RESULTS: The results of all questionnaires showed that 100% of patients with NYHA functional class III-IV heart failure complained of chronic fatigue. The level of overall fatigue was 54.5+/-31.5 points; physical fatigue - 56.8+/-24.6 points. Blood cortisol concentration at 8:00 am was normal (410.1+/-175.1 mmol/L) in majority of patients. Decreased concentration was only in four patients (122.4+/-15.5 mmol/L); one of these patients underwent heart transplantation. In the afternoon, blood cortisol concentration was insufficiently decreased (355.6+/-160.3 mmol/L); reaction to a physical stress was attenuated (Delta 92.9 mmol/L). Plasma NT-proBNP concentration was 2188.9+/-1852.2 pg/L; reaction to a physical stress was diminished (Delta 490.3 pg/L). CONCLUSION: All patients with NYHA class III-IV heart failure complained of daily chronic fatigue. Insufficiently decreased blood cortisol concentration in the afternoon showed that in the presence of chronic fatigue in long-term cardiovascular organic disease, disorder of a hypothalamus-pituitary-adrenal axis is involved.

Echocardiographic parameters in athletes of different sports.

Competitive athletics is often associated with moderate left ventricular (LV) hypertrophy, and it has been hypothesized that training mode and type of exercise modulates long-term cardiac adaptation. The purpose of the study was to compare cardiac structure and function among athletes of various sports and sedentary controls. Standard transthoracic two-dimensional M-mode and Doppler echocardiography was performed at rest in Caucasian male canoe/kayak paddlers (n = 9), long distance runners (LDR, n = 18), middle distance runners (MDR, n = 17), basketball players (BP, n = 31), road cyclists (n = 8), swimmers (n = 10), strength/power athletes (n = 9) of similar age (range, 15 to 31 yrs), training experience (4 to 9 years), and age-matched healthy male sedentary controls (n = 15). Absolute interventricular septum (IVS) thickness and LV wall thickness, but not LV diameter, were greater in athletes than sedentary controls. Left ventricular mass of all athletes but relative wall thickness of only BP, swimmers, cyclists, and strength/power athletes were higher as compared with controls (p < 0.05). Among athletes, smaller IVS thickness was observed in MDR than BP, cyclists, swimmers or strength/power athletes, while LDR had higher body size-adjusted LV diameter as compared to BP, cyclists and strength/power athletes. In conclusion, relative LV diameter was increased in long distance runners as compared with basketball players, cyclists, and strength/power athletes. Basketball, road cycling, strength/power, and swimming training were associated with increased LV concentricity as compared with paddling or distance running. Key pointsThe type of cardiac hypertrophy seems to be only moderately exercise-specific.Long-distance runners develop larger left ventricular dilation as compared with basketball players, cyclists, and strength/power athletes.Myocardial wall thickening is triggered by different sporting activities that involve large muscle groups.

[Left ventricular remodeling in ischemic heart disease patients with signs and symptoms of chronic heart failure: an impact of the long-term exercise training]. / Ilgalaikio fizinio treniravimo poveikis sirdies kairiojo skilvelio remodeliacijai sergant isemine sirdies liga ir sirdies nepakankamumu.

Our study aimed at determining the effects of long-term exercise training on cardiorespiratory function and left ventricular remodeling in ischemic heart disease patients with the evidence of chronic heart failure, who had undergone a successful coronary angioplasty. One hundred thirty-five patients were entered into one-year study: 70 patients were assigned to the long-term exercise training group, and the remaining 65 persons--to the control group. All the patients were subjected to ergospirometry and echocardiography at study entry and at 6 and 12 months. At the outset, both groups showed no significant difference (P>0.05) in terms of ergospirometry findings. However, after 6 months, the rehabilitation group demonstrated significant changes (P<0.05) in exercise time, double product, RQ, AT VO2, VE/VO2, while the control group displayed no significant changes. After 12 months, the patients of rehabilitation group showed further increase in exercise time (from 5.6+/-1.9 min to 6.5+/-2.1 min) and AT VO2 (from 17.3+/-7.2 ml/kg/min to 20.8+/-5.4 ml/kg/min) indices (P<0.05). Those of double product and VE/VO2 decreased slightly when compared with findings at 6 months. RQ remained virtually at the same level, but significantly differed from the corresponding indices at the outset. Echocardiography performed at the entry and at 6 and 12 months revealed significant changes in systolic left ventricular function among the patients of rehabilitation group: wall movement index, ejection fraction as well as the left atrial long axis and left ventricular wall thickness. Echocardiographic changes indicate a positive impact of complex rehabilitative measures on systolic left ventricular function as evidenced by the ejection fraction and wall movement index values, as well as by regression of left ventricular wall thickness and left atrial long axis. Ergospirometry findings allow us to propose that the adequate choice of rehabilitative tools favorably affects the cardiovascular system, and this is reflected in exercise time and AT VO2 indices.

[Relationship between the metabolic syndrome, endothelial function and intima-media thickness in asymptomatic middle-aged individuals]. / Rysys tarp metabolinio sindromo, endotelio funkcijos, intimos ir medijos storio bei paciento amziaus.

OBJECTIVE: To evaluate the relation between cardiovascular risk factors, metabolic syndrome, endothelial function and carotid intima-media thickness in asymptomatic middle-aged individuals. MATERIALS AND METHODS: A total of 180 subjects (86 men and 94 women, mean age 38.8+/-0.3 years) have been investigated. Anthropometric, blood pressure measurements have been performed and lipid as well as high sensitivity C-reactive protein blood levels have been tested. The endothelial function was assessed by measuring the vasodilatation of the brachial artery. The carotid intima-media thickness was measured with high resolution B-mode ultrasound imaging. Metabolic syndrome was diagnosed using International Diabetes Federation definition criteria (2005). RESULTS: The metabolic syndrome has been diagnosed in 48 (26.7%) individuals: 28 (32.6%) males and 20 (21.3%) females. Significantly reduced endothelial function has been established in asymptomatic men when compared to women. However, statistically significant decrease (4.84%) in endothelial function in metabolic individuals was detected only among males. In the metabolic patients intima-media of common carotid artery, carotid bulb and internal carotid artery was thicker than in those without metabolic syndrome (0.006, 0.007 and 0.007 cm, respectively) (alpha=0.000, beta=0.01). Endothelial dysfunction and intima-media thickening correlated with increased blood pressure, abdominal circumference and body mass index as well as with elevated blood triglyceride and glucose levels. Intima-media thickness was greater in individuals with impaired endothelial function in all carotid segments tested. No relationship has been observed between total or low-density lipoprotein cholesterol concentrations and endothelial function, intima-media thickening or high sensitivity C-reactive protein levels. CONCLUSIONS: These observations suggest that the metabolic syndrome and/or its components may influence the different initial mechanisms of atherosclerosis--disorder of endothelial function and intima-media thickening. It is presumable that the lipid disorders as well as inflammation may play more significant role in the presence of impaired endothelial function.

Exercise training after coronary angioplasty improves cardiorespiratory function.

AIM: The aim of this prospective randomized study was to evaluate the impact of long-term aerobic exercise training on respiratory function, left ventricular systolic function and remodeling in patients with coronary heart disease and ischemic heart failure after successful angioplasty. DESIGN: Patients (n=185) have undergone Doppler echocardiography and ergospirometry. Ninety-five patients practiced 6 month-term aerobic exercise training, less by 10% to their anaerobic threshold. Ninety patients were studied as controls. They were given only drug treatment without training. Measurements were repeated after 6 and 12 months. RESULTS: Training group patients after 6 months showed significant (p<0.05) improvement in exercise capacity, oxygen consumption and ventilating equivalents. The Doppler echocardiographic findings revealed significant (p<0.05) improvement in ejection fraction, left ventricular and atria morphometric data. Improved ergospirometric and echocardiographic data were established after 12 months, too. CONCLUSIONS: Long-term aerobic exercise training is an effective and workable measure improving respiratory efficiency, left ventricular systolic function, attenuating negative remodeling and stopping further progression in patients with coronary heart disease and chronic heart failure after successful angioplasty.

Development of structural cardiac adaptation in basketball players.

BACKGROUND: As specific features of the basketball player's myocardial structure and function are still rather poorly investigated, we aimed at comparing left ventricular (LV) echocardiographic indices in players of different age groups. METHODS: Male basketball players aged 8-13 years (n=31), 14-17 years (n=31) and 18-28 years (n=31) were examined using standard echocardiography. End-diastolic LV posterior wall thickness and internal diameter, as well as interventricular septum thickness, were measured by M-mode. Relative wall thickness was calculated by dividing the sum of the thicknesses of the interventricular septum and LV posterior wall by LV internal diameter. LV mass and ejection fraction were also calculated. The morphological LV parameters were corrected for body surface area. The peak early (E) and peak late (A) transmitral flow velocities were measured using pulsed Doppler, and the ratio (E/A) was calculated. RESULTS: Significant differences in the absolute internal LV diameter among the age groups disappeared after allometric scaling. However, relative wall thickness as well as body size indexed LV posterior wall thickness and LV mass were significantly greater in the adolescents and adults than in the children. Players of different age groups did not differ in the E/A ratio, while ejection fraction was elevated in adolescents. CONCLUSIONS: Regular basketball training results in moderate cardiac hypertrophy in adolescents and adult athletes due to thickening of myocardial walls.