The Impact of Intravenous Ferric Carboxymaltose on Reverse Electrical Remodeling Following Cardiac Resynchronization Therapy.

Background: The influence of intravenous ferric carboxymaltose (FCM) on reverse electrical remodeling (RER) in patients with heart failure with reduced ejection fraction (HFrEF) post-cardiac resynchronization therapy (CRT) is unknown. This study examines the effect of iron replacement using intravenous FCM on RER in CRT-implanted HFrEF patients with iron deficiency anemia. Methods: We retrospectively analyzed 65 patients with successful CRT-defibrillator between March 2017 and January 2020, all with iron deficiency anemia at implantation. The cohort comprised 35 patients in the FCM group and 30 in the non-FCM group. Follow-up data were obtained from visits 6 months post-CRT implantation including baseline characteristics, echocardiographic left ventricular measurements, and electrocardiograms. Changes in intrinsic QRS duration (iQRS) and left ventricular ejection fraction (LVEF) from baseline to 6 months were assessed. Results: The FCM group showed a greater reduction in iQRS duration compared to the non-FCM group (-10.4 ± 2.2 ms vs. -3 ± 2.9 ms, p < 0.0001). Additionally, at the 6-month follow-up, the increase in LVEF was higher in the FCM group than in the non-FCM group (+3.6 ± 1.6% vs. -0.1 ± 1.7%, p < 0.0001). Correlations were found between changes in ferritin levels and iQRS duration (r = -0.725, p < 0.0001) and LVEF (r = 0.712, p < 0.0001). Multivariate regression analysis revealed that elevated ferritin independently influenced the increase in LVEF (p = 0.006, ß = 0.554) and the decrease in iQRS (p < 0.001, ß = -0.685). Conclusions: Intravenous iron treatment with FCM may reduce iQRS duration and improve LVEF and functional status in HFrEF patients with iron deficiency anemia following CRT.

Relação entre os Sinais de Strain do Ventrículo Direito no Eletrocardiograma e Níveis de Biomarcadores Associados à Gravidade da Pneumonia por COVID-19 / Relationship between Right Ventricular Strain Signs in Electrocardiography and Levels of Biomarkers Associated with COVID-19 Pneumonia Severity

Resumo Fundamento A nova doença por coronavírus (COVID-19) pode levar a uma enfermidade grave e causar a morte. Sabe-se que a COVID-19 afeta o sistema cardiovascular. A detecção precoce da progressão para um estágio grave da doença que afeta o sistema cardiovascular pode desempenhar um papel crítico no tratamento da COVID-19. Objetivos Explorar a possível relação entre a pneumonia por COVID-19 e os achados de strain do ventrículo direito no eletrocardiograma (ECG). Métodos Foi realizado um estudo retrospectivo de 141 pacientes hospitalizados com COVID-19. A correlação de Spearman e as análises de regressão logística foram aplicadas para avaliar as relações entre as manifestações de strain ventricular direito na ECG e os níveis de biomarcadores e outros achados laboratoriais e de imagem do tórax. O nível de significância foi considerado estabelecido como p < 0,05. Resultados Os sinais de ECG de estresse ventricular direito foram significativamente mais frequentes e os níveis de fibrinogênio, PCR e ferritina foram significativamente mais elevados em pacientes com COVID-19 com níveis elevados de hs-cTnI, procalcitonina e dímero-D. A análise univariada mostrou que existem relações significativas entre a presença de pneumonia bilateral, a maioria dos sinais eletrocardiográficos de strain ventricular direito e lesão cardíaca e biomarcadores inflamatórios e trombóticos. A análise multivariada revelou que o supradesnivelamento do segmento ST em V1 e padrão S1Q3T3 são preditores independentes de lesão cardíaca ( odds ratio =0,23; IC95%, 0,06 a 0,90; p=0,035) e níveis elevados de procalcitonina ( odds ratio =0,19; IC 95%, 0,06 a 0,62; p=0,006), respectivamente. Conclusão Os achados do presente estudo sugerem que a dano cardíaco direito é prevalente na COVID-19. Além disso, nosso estudo demonstra o valor clínico do ECG na avaliação e monitoramento de pacientes com pneumonia por COVID-19.

Abstract Background The novel coronavirus disease (COVID-19) may lead to severe disease that can cause death. COVID-19 is known to affect the cardiovascular system. Early detection of the progression to the severe disease stage that affects the cardiovascular system may play a critical role in the treatment of COVID-19. Objectives To explore the possible relationship between the COVID-19 pneumonia and right ventricular strain findings on electrocardiography (ECG). Methods We conducted a retrospective study of 141 hospitalized patients with COVID-19. Spearman's correlation and logistic regression analyses were applied to assess relationships between ECG manifestations of right ventricular strain and levels of biomarkers and other laboratory and chest imaging findings. The significance level was considered as < 0.05. Results The ECG signs of right ventricular stress were significantly more frequent and the levels of fibrinogen, CRP, and ferritin were significantly higher in COVID-19 patients with elevated levels of hs-cTnI, procalcitonin and D-dimer. The univariate analysis showed there are significant relations between the presence of bilateral pneumonia, most of the ECG signs of right ventricular strain and cardiac injury and inflammatory and thrombotic biomarkers. The multivariate analysis revealed that ST-segment elevation in V1and the S1Q3T3pattern are independent predictors of cardiac damage (odds ratio=0.23; 95% CI, 0.06 to 0.90; p=0.035) and elevated procalcitonin levels (odds ratio=0.19; 95% CI, 0.06 to 0.62; p=0.006), respectively. Conclusion The findings of the present study suggest that right heart damage is prevalent in COVID-19. In addition, our study shows the clinical value of ECG in evaluating and monitoring the patients with COVID-19 pneumonia.

Relationship between Right Ventricular Strain Signs in Electrocardiography and Levels of Biomarkers Associated with COVID-19 Pneumonia Severity. / Relação entre os Sinais de Strain do Ventrículo Direito no Eletrocardiograma e Níveis de Biomarcadores Associados à Gravidade da Pneumonia por COVID-19.

BACKGROUND: The novel coronavirus disease (COVID-19) may lead to severe disease that can cause death. COVID-19 is known to affect the cardiovascular system. Early detection of the progression to the severe disease stage that affects the cardiovascular system may play a critical role in the treatment of COVID-19. OBJECTIVES: To explore the possible relationship between the COVID-19 pneumonia and right ventricular strain findings on electrocardiography (ECG). METHODS: We conducted a retrospective study of 141 hospitalized patients with COVID-19. Spearman's correlation and logistic regression analyses were applied to assess relationships between ECG manifestations of right ventricular strain and levels of biomarkers and other laboratory and chest imaging findings. The significance level was considered as < 0.05. RESULTS: The ECG signs of right ventricular stress were significantly more frequent and the levels of fibrinogen, CRP, and ferritin were significantly higher in COVID-19 patients with elevated levels of hs-cTnI, procalcitonin and D-dimer. The univariate analysis showed there are significant relations between the presence of bilateral pneumonia, most of the ECG signs of right ventricular strain and cardiac injury and inflammatory and thrombotic biomarkers. The multivariate analysis revealed that ST-segment elevation in V1and the S1Q3T3pattern are independent predictors of cardiac damage (odds ratio=0.23; 95% CI, 0.06 to 0.90; p=0.035) and elevated procalcitonin levels (odds ratio=0.19; 95% CI, 0.06 to 0.62; p=0.006), respectively. CONCLUSION: The findings of the present study suggest that right heart damage is prevalent in COVID-19. In addition, our study shows the clinical value of ECG in evaluating and monitoring the patients with COVID-19 pneumonia.

FUNDAMENTO: A nova doença por coronavírus (COVID-19) pode levar a uma enfermidade grave e causar a morte. Sabe-se que a COVID-19 afeta o sistema cardiovascular. A detecção precoce da progressão para um estágio grave da doença que afeta o sistema cardiovascular pode desempenhar um papel crítico no tratamento da COVID-19. OBJETIVOS: Explorar a possível relação entre a pneumonia por COVID-19 e os achados de strain do ventrículo direito no eletrocardiograma (ECG). MÉTODOS: Foi realizado um estudo retrospectivo de 141 pacientes hospitalizados com COVID-19. A correlação de Spearman e as análises de regressão logística foram aplicadas para avaliar as relações entre as manifestações de strain ventricular direito na ECG e os níveis de biomarcadores e outros achados laboratoriais e de imagem do tórax. O nível de significância foi considerado estabelecido como p < 0,05. RESULTADOS: Os sinais de ECG de estresse ventricular direito foram significativamente mais frequentes e os níveis de fibrinogênio, PCR e ferritina foram significativamente mais elevados em pacientes com COVID-19 com níveis elevados de hs-cTnI, procalcitonina e dímero-D. A análise univariada mostrou que existem relações significativas entre a presença de pneumonia bilateral, a maioria dos sinais eletrocardiográficos de strain ventricular direito e lesão cardíaca e biomarcadores inflamatórios e trombóticos. A análise multivariada revelou que o supradesnivelamento do segmento ST em V1 e padrão S1Q3T3 são preditores independentes de lesão cardíaca ( odds ratio =0,23; IC95%, 0,06 a 0,90; p=0,035) e níveis elevados de procalcitonina ( odds ratio =0,19; IC 95%, 0,06 a 0,62; p=0,006), respectivamente. CONCLUSÃO: Os achados do presente estudo sugerem que a dano cardíaco direito é prevalente na COVID-19. Além disso, nosso estudo demonstra o valor clínico do ECG na avaliação e monitoramento de pacientes com pneumonia por COVID-19.

Usefulness of Pre-Procedural Imaging of the Coronary Venous System With Coronary Angiography Before Cardiac Resynchronization Therapy.

Cardiac resynchronization therapy (CRT) is a treatment modality for selected patients with refractory heart failure. We intended to examine the usefulness of coronary venous system imagining with conventional coronary angiogram before the CRT implantation procedure. A total of 180 patients were scheduled for CRT and were prospectively randomized 1:2 into 2 groups. Group 1 (n = 60) received standard CRT procedure without the guidance of selective left coronary angiography. In group 2 (n = 120), CRT implantation was accomplished with the guidance of the preprocedural coronary angiography. We compared the 2 groups in terms of the total implantation time, total fluoroscopy time, the amount of contrast medium used, and cumulative radiation exposure. The total implantation and fluoroscopy times, the amount of contrast medium used, and cumulative radiation exposure were significantly less in group 2 compared with group 1 (53 ± 7 vs 66 ± 9 minutes, 11 ± 3 vs 20 ± 5 minutes, 24 ± 8 vs 42 ± 14 mL, 26 192 ± 6658 vs 37 388± 9064 mGy cm2, and 253 ± 49 vs 392 ± 79 mGy, P < .0001, respectively). We concluded that coronary angiography prior to CRT implantation is useful in simplifying the procedure, saving time, reducing radiation exposure, and reducing contrast use.

Evaluation of serum platelet-derived growth factor receptor-ß and brain-derived neurotrophic factor levels in microvascular angina.

OBJECTIVE: Microvascular angina (MVA) is a coronary microcirculation disease. Research on microcirculatory dysfunction has revealed several biomarkers involved in the etiopathogenesis of MVA. Platelet-derived growth factor receptor ß (PDGFR-ß) and brain-derived neurotrophic factor (BDNF) are 2 biomarkers associated with microcirculation, particularly pericytes function. The aim of this study was to investigate the role of PDGFR-ß and BDNF in MVA. METHODS: Ninety-one patients (median age, 56 y; age range, 40-79 y; 36 men) with MVA and 61 control group subjects (median age, 52 y; age range, 38-76 y; 29 men) were included in the study. Serum concentrations of PDGFR-ß and BDNF were measured with commercially available enzyme-linked immunosorbent assay kits. RESULTS: PDGFR-ß [2.82 ng/ml; interquartile range (IQR), 0.57-7.79 ng/ml vs. 2.27 ng/ml; IQR, 0.41-7.16 ng/ml; p<0.0005] and BDNF (2.41 ng/ml; IQR, 0.97-7.97 ng/ml vs. 1.92 ng/ml; IQR, 1.07-6.67 ng/ml; p=0.023) concentrations were significantly higher in patients with MVA compared with the controls. PDGFR-ß correlated positively with age (r=0.26, p=0.001), low-density lipoprotein (r=0.18; p=0.02), and BDNF (r=0.47; p<0.001), and BDNF showed a significant positive correlation with age (r=0.20; p=0.01). In binary logistic regression analysis, high-sensitivity C-reactive protein, uric acid, and PDGFR-ß values were found to be independent predictors of MVA. CONCLUSION: MVA is associated with higher PDGFR-ß and BDNF levels. This association may indicate an abnormality in microvascular function. Future studies are required to determine the role of these biomarkers in the pathogenesis of MVA.

Evaluation of serum sST2 and sCD40L values in patients with microvascular angina.

OBJECTIVES: Coronary microvascular dysfunction plays a major role in the pathogenesis of microvascular angina (MVA). Along with endothelial dysfunction, microvascular atherosclerosis and inflammation seem to contribute to the development of coronary microvascular dysfunction. Serum soluble ST2 (sST2) and serum soluble CD40 ligand (sCD40L) are two biomarkers associated with inflammation and atherosclerosis. The aim of this study was to investigate the role of these biomarkers in the pathogenesis of MVA and determine their possible association with coronary microvascular dysfunction. METHODS: A total of 152 patients were included in the study. Ninety-one patients with MVA {median age 56 years (40-79), of which 55 are women} and sixty-one controls {median age 52 (38-76), of which 29 are women} were included in the study. Serum concentration of sST2 and sCD40L were measured with a commercially available ELISA kit. RESULTS: Serum sST2 (median 13.6 ng/ml; interquartile range (IQR), 3.5-63.8 ng/ml vs median 10.6 ng/ml; IQR, 2.9-34.2 ng/ml, p < 0.0005) and sCD40L (median 5.3 ng/ml; IQR, 0.5-20.6 ng/ml vs median 2.2 ng/ml; IQR, 0.7-10.8 ng/ml, p < 0.0005) were significantly higher in patients with MVA compared to controls. Analysis of the associations between these biomarkers and potential contributors of MVA revealed that serum sST2 showed a positive correlation with LDL-cholesterol (r = 0.19, p = 0.016) and serum sCD40L concentrations correlated positively with hs-CRP (r = 0.22, p = 0.005). In logistic regression analysis, sCD40L and hs-CRP but not sST2 were found to be significantly associated with MVA. CONCLUSION: Higher serum concentrations of sST2 and sCD40L in MVA patients may be associated with inflammatory activation and coronary microvascular dysfunction. Larger studies are required for understanding their role in the pathogenesis of inflammatory and possibly fibrotic process in MVA patients.

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.

[Relationship between serum level of CD40 ligand and persistent lone atrial fibrillation]. / Serum CD40 ligand düzeyi ile tek basina israrci atriyum fibrilasyonu iliskisi.

OBJECTIVE: Inflammation is thought to play a role in the pathogenesis of atrial fibrillation. The relationship between CD40 ligand (CD40L), a prothrombotic and proinflammatory molecule, and lone atrial fibrillation was presently investigated for the first time. Levels of serum CD40L were also tested, regarding potential to distinguish patients with lone atrial fibrillation from healthy individuals. METHODS: Presently included were 35 patients with lone persistent atrial fibrillation and a control group of 30 healthy individuals. Serum levels of CD40L and high-sensitive C-reactive protein (hs-CRP) were measured, and transthoracic echocardiography was performed. RESULTS: Mean serum CD40L, hs-CRP, left ventricular end-diastolic diameter, and left atrial diameter values were significantly higher in the group with lone persistent atrial fibrillation than in the control group (7.4±3.5 ng/mL vs 4.3±1.2 ng/mL, p<0.0001; 3.7±1.6 mg/L vs 1.7±0.8 mg/L, p<0.0001; 53.0±4.2 mm vs 46.0±3.8, p<0.0001; 43.5±3.5 mm vs 33.7±3.5, p<0.0001, respectively). Serum CD40L levels were positively correlated with left atrial diameter (r=0.81, p<0.0001) and hs-CRP (r=0.72, p<0.0001). Receiver operating characteristic curve analysis revealed that serum CD40L at the optimal cut-off level of >4.5 ng/mL successfully discriminated patients with lone atrial fibrillation from controls (area under the curve: 0.847; 95% confidence interval: 0.759-0.934; p<0.0001). CONCLUSION: The present findings suggest that CD40L levels play a crucial role in the development of lone atrial fibrillation. In addition, results support that regular clinical follow-up of these patients is necessary, due to increased cardiovascular disease risk, determined by elevated CD40L levels.

A Retrospective Study of Congenital Cardiac Abnormality Associated with Scoliosis.

STUDY DESIGN: Retrospective study. PURPOSE: To identify the incidence of congenital cardiac abnormalities in patients who had scoliosis and underwent surgical treatment for scoliosis. OVERVIEW OF LITERATURE: Congenital and idiopathic scoliosis (IS) are associated with cardiac abnormalities. We sought to establish and compare the incidence of congenital cardiac abnormalities in patients with idiopathic and congenital scoliosis (CS) who underwent surgical treatment for scoliosis. METHODS: Ninety consecutive scoliosis patients, who underwent surgical correction of scoliosis, were classified as CS (55 patients, 28 female [51%]) and IS (35 patients, 21 female [60%]). The complete data of the patients, including medical records, plain radiograph and transthoracic echocardiography were retrospectively assessed. RESULTS: We found that mitral valve prolapse was the most common cardiac abnormality in both patients with IS (nine patients, 26%) and CS (13 patients, 24%). Other congenital cardiac abnormalities were atrial septal aneurysm (23% of IS patients, 18% of CS patients), pulmonary insufficiency (20% of IS patients, 4% of CS patients), aortic insufficiency (17% of IS patients), atrial septal defect (11% of IS patients, 13% of CS patients), patent foramen ovale (15% of CS patients), dextrocardia (4% of CS patients), bicuspid aortic valve (3% of IS patients), aortic stenosis (2% of CS patients), ventricular septal defect (2% of CS patients), and cardiomyopathy (2% of CS patients). CONCLUSIONS: We determined the increased incidence of congenital cardiac abnormalities among patients with congenital and IS. Mitral valve prolapse appeared to be the most prevalent congenital cardiac abnormality in both groups.

Diagnostic significance of serum galectin-3 levels in heart failure with preserved ejection fraction.

OBJECTIVE: Galectin-3, reflecting cardiac fibrosis, is a promising biomarker in early detection of heart failure with preserved ejection fraction (HFpEF). We aimed to clarify the clinical utility of galectin-3 levels in the diagnosis of HFpEF and to compare galectin-3 with N-terminal pro-brain-type natriuretic peptide (NT-proBNP) levels. METHODS AND RESULTS: The study included 44 HFpEF patients (mean age 60 ± 6.78 years, 24 men) and 38 control subjects (mean age 57 ± 8.98 years, 20 men). Galectin-3 and NT-proBNP levels were assessed by the ELISA kits. The receiver operating characteristics (ROC) curve was used to examine the diagnostic performance of galectin-3 and NT-proBNP in HFpEF. Galectin-3 and NT-proBNP levels were significantly increased in patients with HFpEF compared to controls [5.35 ng/ml (0.86 ­ 14.90) vs 0.51 ng/ml (0.15 ­ 1.71) P < 0.0001, 617.75 ± 271.30 pg/ml vs 66.35 ± 54.01 pg/ml P < 0.0001, respectively]. Galectin-3 correlated with NT-proBNP, left atrial volume index, left ventricular mass index, and E/E' (r = 0.90, P < 0.0001; r = 0.75, P = 0.0001; r = 0.86, P = 0.0001; r = 0.80, P = 0.0001; respectively). The area under the ROC curve was 0.98 for galectin-3 and 1.0 for NT-proBNP. CONCLUSIONS: Our results support that, in addition to NT-proBNP, galectin-3 is also a valuable biomarker for the diagnosis of patients with HFpEF.

Low vitamin D status associated with dilated cardiomyopathy.

In recent years, a growing body of evidence supports that vitamin D plays a crucial role in various cardiovascular diseases. Cardiac muscle cells have vitamin D receptors as well as calcitriol-dependent Ca(2+) binding protein. Therefore, the vitamin D may have an effect on cardiac function. In this research, we investigated the association between vitamin D status and dilated cardiomyopathy (DCMP). We compared serum 25-hydroxy-vitamin D3 (25OHD3) concentrations in 39 patients (mean age 50.4 ± 11.7 years, 15 women) with DCMP and in 35 healthy controls (mean age 54.6 ± 13.2 years, 17 women). Parathyroid hormone (PTH), calcium (Ca++), phosphorus, lipid profile, albumin and echocardiographic parameters (left-ventricular (LV) ejection fraction, LV fractional shortening, LV-end-diastolic and end-systolic dimensions) were measured in all study participants. The mean serum 25OHD3 concentrations in patients with the DCMP were significantly lower in compared to healthy controls (24.1 ± 10.4 ng/mL versus 41.4 ± 20.9 ng/mL, P < 0.0001). PTH concentrations were significantly higher in patients with DCMP in comparison with healthy controls (90.6 ± 29.8 pg/mL versus 49.1 ± 18 pg/mL, P < 0.0001). Additionally, we observed a significant negative correlation between 25OHD3 concentrations and PTH concentrations, LV end-diastolic dimensions, LV end-systolic dimensions (r = -0.66; P < 0.0001, r = -0.49; P < 0.0001, r = -0.50; P < 0.0001, respectively). Moreover, 25OHD3 was positively correlated with LV ejection fraction, LV fractional shortening, stroke volume, cardiac output, cardiac index (r = 0.46; P < 0.001, r = 0.44; P < 0.001, r = 0.25; P = 0.03, r = 0.37; P < 0.001, r = 0.25; P = 0.03; respectively). Our findings support that vitamin D has a potential role both in the development of DCMP and LV remodeling.

Serum concentrations of galectin-3 in patients with cardiac syndrome X.

OBJECTIVE: Microvascular dysfunction has been reported in cardiac syndrome X (CSX), even though the underlying mechanisms still remain uncertain. Galectin-3 has been recently recognized as a biomarker of cardiovascular fibrosis and inflammation. We sought to investigate the role of galectin-3 in the CSX. METHODS: We studied 115 consecutive CSX patients (mean age 55.43 ± 8.71 years, 36 men) and 74 healthy controls (mean age 54.53 ± 10.07 years, 31 men). Serum concentrations of galectin-3 and high-sensitive C-reactive protein (hs-CRP) were measured on the blood samples. RESULTS: Galectin-3 concentrations were significantly higher in patients with CSX compared to controls (0.90 ng/ml; IQR, 0.40-1.70 ng/ml vs 0.40 ng/ml; IQR, 0.36-0.44 ng/ml, p < 0.0001). Although, the prevalence of diabetes mellitus, hypertension and family history of coronary artery disease (CAD) were significantly higher among patients with CSX, following adjustment for diabetes mellitus, hypertension, and family history of CAD, serum galectin-3 concentrations were still found significantly increased in patients with CSX. Galectin-3 concentrations correlated positively with hs-CRP (r = 0.16, p = 0.03). In addition, concentrations of galectin-3, hs-CRP, fasting glucose, uric acid and family history of CAD were determined as independent predictors of the CSX. CONCLUSION: It was found that galectin-3 serum concentrations are higher in patients with CSX compared to healthy controls. Further studies on larger population are needed to confirm the relation between the fibrosis and the CSX, as well as to explore the potential role of galectin-3 in the CSX.

Serum adiponectin, anemia and left ventricular dimensions in patients with cardiac cachexia.

OBJECTIVES: Our study aims to determine the role of serum adiponectin in chronic heart failure (CHF) and cardiac cachexia (CC). METHODS: Ninety consecutive patients were included in the study. Patients were divided into three groups: 30 CHF patients with CC, 30 CHF patients without CC, and 30 healthy individuals. Adiponectin levels were measured through human ELISA kits. RESULTS: Levels of serum adiponectin were significantly higher in the CHF patients with cachexia in comparison with the other groups (CHF with CC: 58.4 ± 15.5 ng/ml vs. CHF without CC: 24 ± 6.7 ng/ml and controls: 7.7 ± 3.4 ng/ml; p = 0.001). Serum adiponectin was negatively correlated with BMI, high-sensitivity C-reactive protein, and hemoglobin (r = -0.37, p = 0.02; r = -0.29, p = 0.02; r = -0.18, p = 0.03, respectively) in the CHF patients with cachexia. Additionally, serum adiponectin levels were positively correlated with B-type natriuretic protein levels, left ventricle end-diastolic and end-systolic diameters (r = 0.36, p = 0.02; r = 0.46, p = 0.01; r = 0.49, p = 0.006, respectively) in the CHF patients with cachexia. CONCLUSION: Our findings suggest that adiponectin may play a critical role in the pathogenesis of cardiac remodeling and anemia in CC.

ω-3 fatty acid treatment in cardiac syndrome X: a double-blind, randomized, placebo-controlled clinical study.

OBJECTIVE: We conducted a clinical trial to examine the effect of ω-3 fatty acids in patients with cardiac syndrome X (CSX). We aimed to evaluate the potential impact of ω-3 fatty acids on endothelial function, oxidative stress, and symptom relief in the CSX. METHODS AND RESULTS: Eighteen patients with CSX were enrolled according to a double-blind, randomized, placebo-controlled design. Patients were randomized to ω-3 fatty acids (1440 mg/day, n=8) or placebo (n=10) for 4 months. We assessed plasma levels of malondialdehyde (MDA), endothelium-dependent vasodilatation [flow-mediated dilatation (FMD)], endothelium-independent vasodilatation [nitroglycerin-mediated dilatation (NMD)], and status of symptom [score with Seattle Angina Questionnaire (SAQ)] before and after the treatment. After 4 months, patients who were treated with ω-3 fatty acids showed significant increases in the FMD (from 47±48 to 104±23%, P<0.05) and NMD (from 51±53 to 93±35%, P<0.05) values, and significant decreases in the plasma MDA levels (4.4±0.86 to 3.35±0.33 µmol/l, P=0.012). SAQ scores were increased significantly in both groups (from 60±14 to 73±15%, P<0.05 placebo, from 67±10 to 81±9%, P<0.05 treatment group). NMD was correlated negatively with the plasma MDA levels. CONCLUSION: Four months of therapy with a moderate dose of ω-3 fatty acids improved the endothelial function and reduced oxidative stress in patients with CSX.

Cardioprotective effects of zofenopril, enalapril and valsartan against ischaemia/reperfusion injury as well as doxorubicin cardiotoxicity.

OBJECTIVE: The aim of this study is to compare possible protective effects of zofenopril, enalapril and valsartan against both ischaemia/reperfusion injury as well as acute doxorubicin cardiotoxicity. All three agents have never been compared in this setting before. METHODS AND RESULTS: Sixty-four male rats were divided into eight groups by computer-generated random numbers and each group included 8 rats. Groups 1, 2, 3 and 4, respectively, received 0.5 ml distilled water, 15 mg/kg/day zofenopril, 2 mg/kg/day enalapril, and 30 mg/kg/day valsartan intragastrically for 7 days. Groups 5, 6, 7, and 8 underwent the same procedures as groups 1, 2, 3 and 4. On the 7th day, groups 1-4 and groups 5-8, respectively, were injected with serum saline or 20 mg/kg doxorubicin intraperitoneally. On the 9th day, isolated rat hearts were perfused in the Langendorff perfusion system. At the end of each Langendorff experiment, the rat hearts were kept for histological analysis. Left ventricular systolic pressures were negatively affected by doxorubicin with ischaemia (group 5 initially: 61.4 +/- 13.6 mmHg--post-ischaemic (PI): 20.7 +/- 17.5 mmHg (P = 0.0002), group 6 initially: 63 +/- 18.2 mmHg--PI: 24.2 +/- 24.3 mmHg (P = 0.0135), group 7:82 +/- 26 mmHg--PI: 14.3 +/- 12.1 mmHg (P < 0.0001), group 8:73.1 +/- 27.8 mmHg--PI: 20.4 +/- 27.3 mmHg (P < 0.0001). The lowest troponin I levels (group 2: 0.3 +/- 0.2 ng/ml, group 6:0.2 +/- 0.1 ng/ml (P = 0.003) versus the groups' baseline value) were recorded in the groups of zofenopril in the coronary perfusate during post-ischaemic period. Light microscopic evaluation revealed marked cardiac damage with doxorubicin, since zofenopril treatment prevented a doxorubicin induced increase in the histopathological scores. CONCLUSIONS: In respect of our results zofenopril could be considered more effective than enalapril and valsartan in protecting against both ischaemia/reperfusion injury as well as doxorubicin induced-cardiotoxicity.

Circulating p53 and cytochrome c levels in acute myocardial infarction patients.

BACKGROUND: Apoptosis causes myocardiocyte loss during and after myocardial infarction. Therapeutic approaches designed to arrest apoptosis would be a significant new development in the recovery of acute myocardial infarction (AMI). In order to examine apoptotic markers in the circulation, serum levels of p53 and cytochrome c were assessed in patients with AMI. METHODS: Blood samples were taken on admission (before initiation of therapy) and on the 3rd and 7th days of hospitalization. Serum levels of p53 and cytochrome c were measured by enzyme-linked immunassay. RESULTS: The serum level of p53 was higher in AMI patients on admission compared to the control group. A time-dependent decrease was observed in the serum level of p53, but there was no significant change in the serum level of cytochrome c during therapy. CONCLUSIONS: p53, but not cytochrome c, appears to have potential as a biomarker for reporting on apoptosis following myocardial infarction.

Oxidative DNA damage and antioxidant defense after reperfusion in acute myocardial infarction.

PURPOSE: Myocardial damage mediated by oxidative stress during acute myocardial infarction (MI) has been suggested as an obstructive factor on recovery after an MI. 8-Hydroxydeoxyguanosine (8-OHdG) is a marker for oxidative DNA damage; superoxide dismutase (SOD) and glutathione peroxidase (G-Px) are major antioxidant enzymes. We determined changes in the plasma level of 8-OHdG and activities of SOD and G-Px in patients with MI and examined the relations between those changes and other cardiac markers. METHODS: Blood samples were taken at the beginning of the therapy, on the third day of hospitalization, and on the day patients were discharged home. Plasma level of 8-OHdG and SOD and G-Px activities were measured by enzyme-linked immunosorbent assay and spectrophotometric kits, respectively. RESULTS: 8-Hydroxydeoxyguanosine level at the beginning of the therapy was found to be decreased on the third day of therapy and on the day patients were discharged home. With respect to the treatment way, 8-OHdG level was found to be slightly decreased on the third day of therapy and then remained stable in the group treated with thrombolytic agents. However, 8-OHdG level was found to be sharply decreased on the third day of therapy in the group that underwent primary percutaneous transluminal coronary angioplasty. No significant relations were determined between those measured parameters and serum levels of cardiac markers. CONCLUSION: Although not correlated with other cardiac markers, plasma level of 8-OHdG shows a decrease after reperfusion therapy in patients with MI, and primary percutaneous transluminal coronary angioplasty seems much more effective than thrombolytic therapy for providing a low level of 8-OHdG.

Effects of erucic acid supplemented feeding on chronic doxorubucin toxicity in rats.

One of the undesired complications of the chemotherapy with doxorubicin is cardiotoxicity. Cardiac effect of erucic acid, which is a member of omega-9 fatty acid, is investigated on doxorubicin treatment in this study. Forty-eight rats were divided into eight groups and each group contained six rats. First group rats were fed with milk. In the third and fifth groups we fed rats with milk supplemented 0.5% and 5% erucic acid respectively. The groups 2, 4, 6 were fed as the groups 1, 3, 5 respectively; we injected 2 mg/kg twice weekly intraperitoneal doxorubicin to these groups whereas we injected isovolumous normal saline to the groups 1, 3, 5. Two other groups (groups 7 and 8) were fed with standard pellet. Group 8 received 2 mg/kg doxorubicin twice weekly; group 7 received normal saline. After 4 weeks hearts were isolated and mounted on a Langendorff apparatus perfused by modified Tyrode solution. Surviving rats were significantly less in erucic acid + doxorubicin groups at the end of the treatment period (p<0.05). No significant difference was found between groups for malondialdehyde, catalase, cytochrome c oxidase and isolated heart measurements. Concomitant application of erucic acid and doxorubicin showed profound toxicity.

Unusual case of aortic valve involvement in patient with Löffler's endomyocarditis: management, follow-up and short review of the literature.

Idiopathic hypereosinophilic syndrome (IHES) is an uncommon systemic disease which is characterised by blood eosinophilia and multiple clinical presentations. Cardiac involvement is the major cause of mortality and morbidity. Here we describe a 59-year-old man with symptoms of progressive dyspnea on exertion, and productive cough as an unusual case of Löffler endomyocarditis with a mass on the aortic valve which showed regression with treatment.