Differences in Clinical Presentation and Findings between Idiopathic Dilated and Ischaemic Cardiomyopathy in an Unselected Population of Heart Failure Patients.

We explored the differences in epidemiologic, clinical, laboratory and echocardiographic characteristics between idiopathic dilated (IDCM) and ischaemic cardiomyopathy (ICM).Consecutive patients with stable chronic heart failure evaluated at a tertiary cardiac centre were enrolled. Clinical examination, blood tests and echocardiographic study were performed. A total of 76 patients (43 IDCM, 33 ICM) were studied. IDCM patients were younger (p<0.001) and female gender was more prevalent (p=0.022). NYHA class and left ventricular ejection fraction were similar. IDCM patients had lower rates of dyslipidaemia (p<0.001) but smoked more than ICM patients (p=0.023) and had higher rates of family history of sudden cardiac death (p=0.048). Blood pressure was similar but resting heart rate was higher in IDCM patients (p=0.022). IDCM patients presented less frequently with peripheral oedema or ascites (p=0.046 and 0.020, respectively) and showed better right ventricular function on echocardiogram. QRS duration was similar between groups but only in IDCM patients there was a positive correlation between QRS duration and age (r=0.619, p<0.001). Cardiac output was similar but functional capacity assessed by the Duke Activity Status Index was better in IDCM (p=0.036). Despite these differences, IDCM and ICM patients received similar treatments. Patients with IDCM were younger, presented lower rates of right ventricular dysfunction and clinical right ventricular failure and had better functional capacity. Additional differences in clinical and laboratory findings exist pointing to a different patient population with diverse prognosis and potential need for individualized management.

Serial measurements of acute phase proteins in patients with acute coronary syndrome.

INTRODUCTION: Levels of inflammatory markers increase in patients with acute coronary syndromes (ACS) and the magnitude of the inflammatory response has been related to clinical outcomes. The release patterns and, thereby, the time point of maximal increase for multiple inflammatory markers following an ACS are not fully defined. Our purpose was to serially measure three acute phase proteins (APPs) in patients with ACS. METHODS: We prospectively enrolled 74 consecutive patients (54 men, age 62.2 ± 9.8 years) with ACS: 38 with ST-elevation acute myocardial infarction (STEMI), and 36 with non-ST-elevation acute myocardial infarction (NSTEMI) or unstable angina (UA). Peripheral levels of alpha-1 antitrypsin (A1AT), alpha-1 acid glycoprotein (A1GP) and haptoglobin (HPT) were measured on admission, and 6, 12, 24, 48, 72 hours, 7 days and 6 months after the initial evaluation. RESULTS: Baseline levels of the APPs did not differ between the two groups. A1AT, A1GP and HPT all exhibited a similar time course among NSTEMI/UA patients, all reaching maximal values at 7 days. The markers showed an earlier increase and A1AT showed earlier peaking (at 72 hours) in STEMI patients. Peak levels were higher in patients with STEMI vs. NSTEMI/UA for all three APPs (p<0.01 for A1AT and HPT, p<0.05 for A1GP). CONCLUSIONS: A1AT, A1GP and HPT levels increase significantly in patients with ACS and display different release curves in those with STEMI versus NSTEMI or UA. Knowledge of the release patterns of APPs may determine the optimal time point of measurement and thereby enhance their potential prognostic value in the setting of ACS.

Digit ratios and relation to myocardial infarction in Greek men and women.

BACKGROUND: Digit ratios, such as the second to fourth digit ratio (2D:4D), are biometric markers that are influenced by estrogen and testosterone concentrations in utero and are determined genetically by HOX genes (homeodomain-containing homeotic genes). Sex steroids also play a crucial role in the occurrence of myocardial infarction (MI), which is considered to be gender dependent and related to testosterone. Additionally, first-trimester exposure to excess levels of estrogens and progesterone has been linked to cardiovascular anomalies. OBJECTIVE: The aim of this work was to study digit ratios in a Greek population and assess their clinical importance as markers of predisposition to MI. METHODS: Two samples were used: a group of Greek men and women hospitalized with MI, and a control group of healthy Greek men and women of the same age. Finger lengths were measured twice for both hands using electronic calipers. In the results, digits were designated as 2D (second digit), 3D (third digit), 4D (fourth digit), and 5D (fifth digit). RESULTS: A total of 50 Greek men and 50 Greek women with MI were recruited (mean [SD] age, 69.3 [11.2] years for men; 69.7 [11.0] years for women). The control group consisted of 40 healthy Greek men and 40 healthy Greek women (mean age, 68.0 [11.8] years for men; 66.8 [10.7] years for women). In the control group, 2D:4D, 2D:3D, and 2D:5D ratios were significantly higher in women than in men (2D:4D: right hand, P < 0.001; left hand, P = 0.002; 2D:3D: right hand, P < 0.001; left hand, P = 0.003; 2D:5D: right hand, P < 0.001; left hand, P < 0.05). The mean values of 2D:4D ratios appeared to increase in the following order: healthy men < men with MI < healthy women < women with MI, although this difference was not statistically significant. In men with MI, 2D:4D and 3D:4D ratios were significantly higher than the respective ratios in healthy men (2D:4D: right hand, P = 0.001; left hand, P < 0.05; 3D:4D: right hand, P < 0.05; left hand, P = 0.001), but no significant differences were observed in the ratios between women with MI and healthy women. CONCLUSIONS: Digit ratios that include ring-finger length (ie, 4D) may be useful biomarkers for predisposition to MI in Greek men, but not in Greek women. Sexual dimorphism of digit ratios was present in both groups and was independent of the individuals' health status.

Kinetics and prognostic value of inflammatory-sensitive protein, IL-6, and white blood cell levels in patients undergoing coronary stent implantation.

BACKGROUND: The levels of interleukin-6 (IL-6), white blood cells (WBCs), and some inflammatory-sensitive proteins (ISPs), such as fibrinogen (FIB) and C-reactive protein (CRP), have been related to coronary stent restenosis. The aim was to investigate the time course of the levels of IL-6, WBC, and several ISPs, i.e. FIB, CRP, cerruloplasmin (CER), haptoglobin (HPT), alpha-1 antitrypsin (A1AT), and alpha-1 acid glycoprotein (A1GP), after successful coronary stenting in patients with stable angina and to relate them to prognosis. MATERIAL/METHODS: FIB, CRP, IL-6, CER, HPT, A1AT, A1GP, and WBC levels were measured in 40 patients with stable angina before, and 6, 12, 24, 48, and 72 hours and 6 months after successful coronary stenting. The patients were followed up for 12 months. RESULTS: FIB levels increased significantly (p<0.05) 48 hours, CRP and WBC count 24 hours, CER, HPT, A1AT, and A1GP 72 hours, and IL-6 6 hours after stenting. All the levels remained unchanged in 20 control patients undergoing coronary angiography. During follow-up, stent restenosis occurred in 7 patients. Time-course and mean values of all the studied substances did not significantly differ in patients with or without restenosis (p>0.05). CONCLUSIONS: FIB, CRP, IL-6, CER, HPT, A1AT, A1GP, and WBC levels increase significantly after stenting, but they are not related to prognosis.

Prevalence of systolic impairment in an unselected regional population with hypertrophic cardiomyopathy.

Hypertrophic cardiomyopathy (HC) may transition to a phase characterized by systolic impairment resembling dilated cardiomyopathy. This study retrospectively assessed the incidence of left ventricular (LV) systolic impairment at initial clinical evaluation in 248 consecutive patients with HC (mean age 53 +/- 16 years). HC with systolic impairment was diagnosed if the LV ejection fraction was <50%, calculated by echocardiography. Twenty patients (8%) had HC with LV systolic impairment at initial evaluation. Patients with systolic impairment had a greater incidence of family histories of sudden cardiac death (SCD) than patients with preserved systolic function (25% vs 5.3%, p = 0.006) and more severe functional limitations (New York Heart Association class >or=III, p <0.001). All-cause mortality and cardiovascular mortality did not differ between the 2 groups. The incidence of SCD was 1.7% in patients with normal LV ejection fractions, and no SCD was observed in patients with systolic impairment. The latter group had more frequent major cardiac events (SCD, ventricular fibrillation, aborted cardiac arrest, and first implantable cardioverter-defibrillator discharge; p = 0.03). During follow-up, 2 patients progressed to HC with systolic impairment (annual incidence 0.85%). In conclusion, systolic impairment is not exceptional in patients with HC at initial evaluation and is associated with functional deterioration and major cardiac events.

Left ventricular Doppler characteristics in first-degree relatives of patients with hypertrophic cardiomyopathy.

Left ventricular (LV) diastolic function may be affected early in patients with hypertrophic cardiomyopathy (HCM), regardless of the phenotypic expression of the disease. The aim of the present study was to detect whether LV diastolic performance, evaluated by conventional Doppler echocardiography, is impaired in first-degree relatives of patients with phenotypically expressed HCM, who had no clinical, electrocardiographic, or echocardiographic signs of the disease. Twenty-two young adults having the previously described characteristics comprised the study population and 22 sex- and age-matched healthy individuals served as controls. The 2 groups were compared according to several echocardiographic parameters and the following diastolic function indices: peak velocity of E wave, representing early filling; peak velocity of A wave, representing late filling; ratio of peak early to peak late velocity (E/A); deceleration time of E wave; and LV isovolumic relaxation time. Slower deceleration time of transmitral early filling in first-degree relatives of patients with HCM (192 +/- 31 vs 149 +/- 31 msec, p < 0.001) was the only variable that significantly differentiated the 2 groups. This study shows that in healthy persons with a family history of HCM, Doppler-derived mitral filling pattern shifted toward that observed in HCM and the slower deceleration time may serve as an early sign of disease development.

Evidence of left ventricular dysfunction in asymptomatic elderly patients with non-insulin-dependent diabetes mellitus.

Diabetic cardiomyopathy is a distinct entity in diabetic patients with congestive heart failure, who have no angiographic evidence of significant coronary artery stenosis. The aim of this study was to evaluate left ventricular (LV) function in 24 elderly patients (mean age 67 +/- 2 years) with type 2 diabetes, who were asymptomatic and had no history of hypertension, or coronary or valvular heart disease. LV systolic indices (ejection fraction [EF] and fractional shortening [FS]), diastolic indices (E wave, A wave, E/A ratio, isovolumic relaxation time [IVRT] and deceleration time [DT]) and the myocardial performance index (MPI) were evaluated with echocardiography. Compared to controls (24 age- and gender-matched normal subjects), the E wave was reduced (0.60 +/- 0.10 m/sec vs 0.72 +/- 0.08 m/sec, p < 0.05), the A wave was increased (0.77 +/- 0.07 m/sec vs 0.68 +/- 0.06 m/sec, p < 0.05), the E/A ratio was decreased (0.78 +/- 0.20 vs 1.06 +/- 0.18, p < 0.001) and both IVRT and DT were prolonged (0.115 +/- 0.01 sec vs 0.09 +/- 0.01 sec, p < 0.001 and 0.240 +/- 0.04 sec vs 0.180 +/- 0.03 sec, p < 0.001, respectively). The MPI was significantly increased (0.640 +/- 0.170 vs 0.368 +/- 0.098, p < 0.001). LV diastolic function and the MPI are markedly impaired in asymptomatic elderly patients with type 2 diabetes.

Doppler echocardiographic evaluation of right ventricular diastolic function in patients with mitral regurgitation.

BACKGROUND AND AIM OF THE STUDY: The effect of left ventricular (LV) pressure overload on right ventricular (RV) diastolic function has been extensively studied. In contrast, no data are available concerning the influence of LV volume overload on RV diastolic function. Accordingly, RV diastolic function was studied in patients with mitral regurgitation (MR) using Doppler echocardiography. METHODS: RV diastolic indices were calculated, using pulsed Doppler echocardiography, in 30 patients (mean age 56.87 +/- 8.58 years) with severe MR, and in 30 healthy control subjects (mean age 56.67 +/- 8.52 years). RESULTS: Compared with controls, MR patients had a significantly lower RV E/A ratio (0.85 +/- 0.12 versus 1.21 +/- 0.16, p <0.001), a significantly prolonged RV isovolumic relaxation time (70 +/- 20 versus 30 +/- 10 ms, p <0.001), a significantly prolonged deceleration time of the transtricuspid E wave (210 +/- 20 versus 140 +/- 10 ms, p <0.001), and a significantly greater right atrial filling fraction (38.58 +/- 4.59 versus 32.58 +/- 3.14%, p <0.001). There was no statistically significant correlation between RV diastolic indices and LV mass index and interventricular septum thickness. CONCLUSION: RV diastolic function in patients with MR is impaired, reflecting prolonged relaxation and redistribution of RV filling into late diastole. Ventricular interdependence constitutes the most likely mechanism of this action.

Right ventricular diastolic function in patients with chronic aortic regurgitation.

Right ventricular diastolic function was evaluated using Doppler echocardiography in 40 patients with aortic regurgitation. Abnormal right ventricular relaxation and filling were the main findings of our study.