Impact of levosimendan on right ventricular functions by using novel tissue Doppler derived indices in patients with ischaemic left ventricular failure.

BACKGROUND: Right ventricular (RV) dysfunction complicates advanced left ventricular (LV) heart failure (HF) and contributes to a poor prognosis. Levosimendan is a positive inotropic agent improving cardiac contractility without increasing myocardial oxygen consumption in HF. AIM: To evaluate the effect of levosimendan therapy on RV systolic function, by using derived tissue Doppler imaging (TDI) in patients with ischaemic HF. METHODS: The study consisted of 30 patients with HF who were admitted to our hospital due to new onset of decompensated HF, having LV ejection fraction < 40%, with functional status class III-IV, according to the New York Heart Association (NYHA). TDI-derived systolic velocities of tricuspid annulus (isovolumic myocardial acceleration [IVA], peak myocardial velocity during isovolumic contraction [IVV], peak systolic velocity during ejection period [Sa]) and diastolic indices (early [Ea] and late diastolic [Aa] velocities, Ea/Aa, E/Ea ratios and myocardial performance index [Tei index]) were measured. 72 hours after treatment, all measurements were re-evaluated. RESULTS: Considering TDI-derived systolic indices of the RV, IVA and IVV increased significantly, whereas Tei index decreased, after the therapy. Also, there was a significant decrease in serum levels of B-type natriuretic peptide. No significant change was observed in TDI derived diastolic indices of the RV. CONCLUSIONS: Levosimendan improves RV systolic function as expressed by TDI-derived parameters in patients with acutedecompensated HF.

Association of serum fetuin-A levels with heart valve calcification and other biomarkers of inflammation among persons with acute coronary syndrome.

PURPOSE: Fetuin-A is a multifunctional hepatic secretory protein that inhibits dystrophic vascular and valvular calcification. Our aim was to evaluate the relationship among fetuin-A levels, heart valve calcification and other biomarkers of inflammation in patients with acute coronary syndrome (ACS). METHODS: The associations among serum fetuin-A concentrations, mitral annular (MAC) and aortic valve calcification and other biomarkers of inflammation (hs-CRP, ferritin, fibrinogen, white blood cell count (WBC), erythrocyte sedimentation rate (ESR), albumin levels) were evaluated in ACS patients and healthy controls. The study included 95 patients (mean age 61.8 ± 12.10 years) and 81 healthy controls (mean age 48.33 ± 9.19 years). RESULTS: Fetuin-A levels were significantly lower in patients with ACS than in healthy controls (0.76 ± 0.23 and 1.10 ± 0.45 g/L, respectively; p < 0.001). Fetuin-A was lower in patients with mitral annular calcification (p = 0.007) and aortic (p = 0.001) valve calcification. In patients with ACS, there was a negative correlation among serum urea (r = -0.377; p < 0.001) and creatinine (r = -0.232; p = 0.024) levels and fetuin-A, and a negative correlation among WBC (r = -0.156; p = 0,132), ESR (r = -0.214; p = 0.037), hs-CRP (r = -0.220; p = 0.032) levels and fetuin-A. A positive correlation was seen between albumin and fetuin-A (r = 0.362; p < 0.001). Multivariate logistic regression analysis revealed that fetuin-A was the variable that had a significant effect on ACS (p = 0.020 OR = .015; (95% CI)(0.000-0.520). CONCLUSION: Fetuin-A levels decrease in patients with acute coronary syndromes, independent of heart valve calcification. Fetuin-A may therefore act as a negative acute phase protein after myocardial infarction.

Evaluation of oxidative stress, the activities of paraoxonase and arylesterase in patients with subclinical hypothyroidism.

INTRODUCTION: In subclinical hypothyroidism (SH), serum lipid and lipoprotein concentrations are frequently changed. Compared with the healthy population, the levels of oxidized low-density lipoprotein cholesterol are higher, and the levels of high-density lipoprotein cholesterol are lower. In patients with SH, the mechanism of atherosclerosis may be attributed to the lipid abnormalities. There is evidence showing that oxidation plays an important role during the process of atherosclerosis. In this study, we evaluated the activity of paraoxonase (PON) and arylesterase (ARE) in patients with SH and investigated their relation with oxidative stress. METHODS: The study enrolled 25 patients with SH and 20 sex- and age-matched healthy controls. The patient group and the control group were compared in terms of the activity of PON and ARE and the oxidative stress index. RESULTS: Between 2 groups, no significant difference was found in terms of age, sex, serum levels of total cholesterol, low-density lipoprotein, and high-density lipoprotein. In the SH group, the activity of PON was significantly lower than that observed in the control group (P < 0.05). Arylesterase activity also was significantly lower in the group with SH, compared with the control group (P < 0.05). Oxidative stress index was found to be significantly higher in the patient group, compared with the healthy subjects (P < 0.01). Oxidative stress index showed a strong positive correlation with the levels of thyroid stimulating hormone in all cases (r = 0.60, P < 0.01). CONCLUSIONS: The activity of PON and ARE were significantly decreased, and oxidative stress was increased in patients with SH. Lower activities of these 2 biomarkers indicate increased oxidative damage in SH. Atherosclerosis in SH can be attributed to increased oxidative stress.

Evaluation of the effect of L-thyroxin therapy on endothelial functions in patients with subclinical hypothyroidism.

Subclinical hypothyroidism (SH) is characterized by normal serum free T4 (FT4), free T3 (FT3) levels and increased serum thyroid-stimulating hormone (TSH) levels. Endothelial dysfunction, which is an early step of atherosclerosis, has been reported in patients with subclinical hypothyroidism. The aim of this study is to evaluate endothelial functions and the effect of L-thyroxin (L-T4) therapy on endothelial functions in SH. Twenty-seven patients with SH and 22 healthy controls were evaluated in terms of endothelial functions, using brachial artery Doppler ultrasonography. After restorating euthyroidism, measurements were repeated. Baseline and nitroglycerin induced diameter (NID) of brachial artery were similar in patients with SH and the control group. Compared to the control group, the patients with SH showed significantly reduced flow-mediated diameter (FMD). Baseline and NID values were significantly higher after LT4 therapy in SH group. FMD also significantly increased after LT4 therapy. Hypothyroidism accelerates atherogenesis through modification of atherosclerotic risk factors and direct effects on the blood vessels. In this study, we observed marked improvement in endothelial functions after L-T4 therapy in SH patients. We suggest that thyroid hormone replacement therapy may help to prevent atherosclerosis in this group of patients.

Evaluation of ventricular functions using tissue Doppler echocardiography in patients with subclinical hypothyroidism.

OBJECTIVES: We evaluated right (RV) and left (LV) ventricle functions by tissue Doppler imaging (TDI) in patients with subclinical hypothyroidism (SH). STUDY DESIGN: Twenty-seven patients (24 women, 3 men; mean age 35.4±11.4 years) with newly diagnosed SH and 22 age- and sex-matched healthy subjects (20 women, 2 men; mean age 34.8±8.6 years) were evaluated by standard echocardiography and TDI. The diagnosis of SH was based on increased serum thyrotropin (TSH) level in the presence of normal free T3 and free T4 levels. The following TDI-derived parameters were measured: isovolumic myocardial acceleration (IVA), peak myocardial velocity during isovolumic contraction (IVV), peak systolic velocity during ejection period (S), and diastolic indices including peak early (E') and late (A') diastolic velocities, E'/A' and E/E' ratios, and myocardial performance index. RESULTS: Compared to healthy controls, patients with SH had higher LV mitral A velocity (p=0.022), lower E/A ratio (p=0.021), lower E' velocity (p=0.019), and higher E/E' ratio (p=0.017), suggesting significant LV diastolic dysfunction. The patient group also had lower IVV (p=0.004) and IVA (p<0.001), and higher isovolumic contraction time (p=0.012), suggesting LV subclinical systolic dysfunction. For RV parameters, decreased E/A ratio (p=0.014) and E' velocity (p=0.028) and increased isovolumic relaxation time (p=0.003) in SH patients were consistent with RV diastolic dysfunction, whereas parameters of RV systolic function were similar in the two groups. Myocardial performance indices of both ventricles were also significantly higher in the patient group (p<0.05). CONCLUSION: Our data suggest that SH is associated with biventricular systolic and diastolic dysfunction.

Evaluation of the effect of L-thyroxin therapy on cardiac functions by using novel tissue Doppler-derived indices in patients with subclinical hypothyroidism.

OBJECTIVES: Subclinical hypothyroidism (SH) is characterized by normal serum free T4 (fT4), free T3 (fT3) levels and increased serum thyroid stimulating hormone (TSH) levels.The aim of this study was to assess the validity of tissue Doppler imaging (TDI) in evaluating cardiac effects of SH and to demonstrate the improving effects of L-thyroxin(L-T4) on TDI parameters. METHODS: Twenty-seven patients with SH and 22 healthy controls were evaluated by standard echocardiography and TDI. TDI-derived systolic velocities [isovolumic myocardial acceleration (IVA), peak myocardial velocity during isovolumic contraction (IW), peak systolic velocity during ejection period (Sa)] and diastolic indices (peak early (Ea) and late diastolic (Aa) velocities, Ea/Aa, E/Ea ratios and Tei index) were measured. After restoring euthyroidism, all measurements were repeated. RESULTS: At baseline, left ventricular (LV) systolic velocities (IW and IVA) and diastolic indices were significantly impaired in the SH group. After L-T4 therapy, left ventricular systolic and diastolic functions were improved. Right ventricular (RV) systolic velocities were similar between the study group and the healthy controls but diastolic functions were impaired in the SH group, at baseline. Tei index of the RV was improved after L-T4 therapy. RV IVA remained unchanged after hormone replacement therapy. CONCLUSIONS: SH is associated with biventricular systolic and diastolic dysfunction. IVA which is an accurate estimate of subclinical systolic dysfunction, was significantly impaired in the left ventricle and had improved after L-T4 therapy. We found that IVA is able to detect early effects of subclinical hypothyroidism on LV systolic functions and L-T4 therapy can improve ventricular functions.

Evaluation of oxidative stress, the activities of paraoxonase and arylesterase in patients with subclinic hypothyroidism.

INTRODUCTION: In subclinical hypothyroidism (SH), serum lipid and lipoprotein concentrations are frequently changed. Compared to the normal population, the levels of oxidized low-density lipoprotein (LDL) cholesterol are higher and the levels of high density lipoprotein (HDL) cholesterol are lower. In SH patients, the mechanism of atherosclerosis may be attributed to the lipid abnormalities. There is evidence showing that, oxidation plays an important role during the process of atherosclerosis, preventing the lipid peroxidation of paraoxonase 1 and thereby, acting against the atherosclerosis. In this study, we evaluated the activity of paraoxonase and arylesterase in subclinical hypothyroidism and investigated its relation with oxidative stress. METHOD: The study enrolled 25 cases with SH and 20 healthy controls. The patient group and the control group were compared in terms of the activity of paraoxonase and arylesterase and the oxidative stress index. RESULTS: Between two groups, no significant difference was found in terms of age, gender, total cholesterol, low-molecular weighted lipoprotein, high-molecular weighted lipoprotein. In SH group, the activity ofparaoxonase was significantly lower than that observed in the control group (p=0.01). Also, the activity of arylesterase was significantly lower in the group with subclinical hypothyroidism (p=0.03). Oxidative stress index was found to be significantly higher in the group with subclinical hypothyroidism compared to the healthy controls (p<0.01). Oxidative stress index showed a strong positive correlation with the levels of TSH in all cases (r=0.60, p<0.01. CONCLUSION: Consequently, in SH, the activity of paraoxonase and arylesterase were significantly low and oxidative stress was significantly high. Lower activities ofparaoxonase and arylesterase indicated increased oxidative damage in SH. This may be useful to elucidate the mechanism of atherosclerosis in SH. In addition, these findings suggested that the activities of paraoxonase and arylesterase may be used for the determination of therapeutical response and during the follow-up. (www.actabiomedica.it).