Low catestatin as a risk factor for cardiovascular disease - assessment in patients with adrenal incidentalomas.

Background: Catestatin (Cts) is a peptide derived from proteolytic cleavage of chromogranin A, which exhibits cardioprotective and anti-inflammatory properties. Cts has been proposed as a potential biomarker for cardiovascular (CV) disease. Objectives: examining Cts in patients with incidentally discovered adrenocortical adenomas (AI), and its associations with CV risk factors and blood pressure (BP). Materials and methods: In this cross-sectional study, 64 AI patients without overt CV disease other than primary hypertension were recruited along with 24 age-, sex-, and body-mass-index (BMI)-matched controls with normal adrenal morphology. Laboratory, 24-h ambulatory BP monitoring, echocardiography, and common carotid artery sonography examinations were performed. Results: Unadjusted Cts was higher in AI patients (median 6.5, interquartile range: 4.9-37 ng/ml) versus controls (4.5 (3.5 - 28)), p=0.048, however, the difference was insignificant after adjusting for confounding variables. Cts was lower in subjects with metabolic syndrome than in those without it (5.2 (3.9- 6.9) vs. 25.7 (5.8-115) ng/ml, p<0.01), and in men compared to women (4.9 (4-7.4) ng/ml vs. 7 (4.8-100), p=0.015). AI patients in the lower half of Cts levels compared to those in the upper had a higher prevalence of hypertension (OR 0.15, 95% CI: 0.041-0.5, p<0.001) and metabolic syndrome (OR 0.15, 95% CI 0.041-0.5, p<0.001). In AI patients Cts correlated positively with high-density lipoprotein cholesterol (Spearman's r=0.31), negatively with BMI (r=-0.31), and 10-year atherosclerotic CV disease risk (r=-0.42). Conclusions: Our data indicate associations between CV risk factors and Cts. More clinical research is needed to apply serum Cts as a biomarker.

Tunnelled haemodialysis catheter insertion into the persistent left superior vena cava.

Persistent left superior vena cava is an uncommon abnormality of the venous system. Most commonly, it is diagnosed incidentally during central vein catheterisation on the left side or pacemaker implantation. We present the case of a patient with persistent left superior vena cava, which was diagnosed after the attempted insertion of tunnelled haemodialysis catheter through the left internal jugular vein. The presence of the persistent left superior vena cava was confirmed by cardiac echography and angio-computed tomography scan. The 19-cm long tunnelled haemodialysis catheter was inserted into persistent left superior vena cava through the left internal jugular vein with good long-term function.

First uses of HAART 300 rings for aortic valve repair in Poland - 4 case studies.

INTRODUCTION: Aortic valve reconstructions using geometric annuloplasty rings HAART 300/200 open new era in aortic valve surgery. The HAART technology resizes, reshapes, stabilizes and simplifies aortic valve repair. The HAART aortic repair rings are designed to be implanted directly into aortic annulus (under aortic valve leaflets). AIM: We present first in Poland 4 cases of aortic valve reconstructions using geometric annuloplasty rings HAART 300. MATERIAL AND METHODS: Two patients had type IA aortic insufficiency (due to El-Khoury classification) - they were treated by HAART 300 ring insertion and ascending aorta prosthesis implantation. Third patient, Marfan with type IB aortic insufficiency was repaired by HAART 300 ring implantation followed by remodeling (Yacoub) procedure. Fourth patient with type II aortic insufficiency (due to RCC prolapse) was repaired by HAART 300 implantation and cusp plication. RESULTS: All patients shows good results on 6 months postoperative 3D TTE examinations. CONCLUSIONS: Presented technique is reproducible and simplify aortic valve reconstructions.

Heart rate and double product in relation to insulin resistance in patients with hypertension and coronary artery disease.

BACKGROUND: Elevated values of heart rate (HR) and insulin resistance (IR) reflect enhanced sympathetic nervous system activity and may be connected to the development of coronary artery disease (CAD) and diabetes. AIM: To evaluate the relationship between HR, blood pressure (BP), double product and IR in nondiabetic hypertensive patients with stable CAD. METHODS: There were 73 patients included in the study. Ambulatory BP monitoring was recorded in all patients by a Spacelabs 90207 device. Homeostasis model assessment (HOMA-IR) was used to estimate IR. Double product was calculated by multiplying systolic BP and HR. RESULTS: In the study population (mean age 67.1 ± 8.4 years, 52% males) there was a positive correlation between HOMAIR and 24-h double product (r = 0.35, p < 0.01) and body mass index (BMI) (r = 0.45, p < 0.001). The receiver operating characteristic analysis of 24-h double product and BMI as predictive markers of IR did not reveal statistical differences between AUC (0.72 ± 0.09 vs. 0.72 ± 0.08, 24-h double product and BMI, respectively, p = NS). The best cut-off points in predicting IR were 8,978 mm Hg/min for 24-h double product and 33.02 kg/m2 for BMI. There were differences between the non obese (n = 44, mean age 67.9 ± 9.2 years) and obese (n = 29, mean age 65.8 ± 6.9 years) groups in: serum insulin level (7.3 ± 2.3 µU/mL vs. 12.0 ± 7.3 µU/mL, p < 0.01), HOMA-IR (1.8 ± 0.7 µU/mL × mmol/L vs. 3.0 ± 2.0 µU/mL × mmol/L, p < 0.01), and day systolic BP (128.0 ± 10.8 mm Hg vs. 134.1 ± 10.1 mm Hg, p < 0.02). CONCLUSIONS: 24-h double product and BMI may be complementary parameters in the prediction of IR in hypertensive nondiabetics with CAD confirmed by percutaneous coronary interventions in history and/or at least one coronary artery stenosis ? 70% in elective coronary angiography.

Recanalization of isolated chronic total occlusions in patients with stable angina.

BACKGROUND: Despite procedural advances, recanalization of chronic total occlusions (CTOs) with percutaneous coronary intervention (PCI) remains controversial, particularly given that its long-term benefits are unclear. We assessed the association between successful PCI and symptom improvement as well as outcomes in patients with CTO and stable angina. METHODS: We performed a retrospective study of 386 consecutive patients undergoing attempted PCI of an isolated CTO (i.e., no other angiographically-significant disease was present). We analyzed prospectively the change in Canadian Cardiovascular Society (CCS) classification system and occurrence of major adverse cardiovascular events (death, myocardial infarction or target vessel revascularization), after stratifying patients by procedural success. To understand which patients might benefit most from attempted PCI, multivariable models were constructed to predict: likelihood of successful PCI and symptom improvement, defined as resolution of angina or improvement of ≥ 2 CCS classes. RESULTS: A total of 247 (64%) patients had successful PCI. Greater symptom improvement was noted after successful PCI at both 6 months (79.8% versus 34.5% with resolution of angina or improvement of ≥ 2 CCS classes, p<0.01) and 24 months (71.7% and 20.9%, respectively, p<0.01). No differences were noted in MACE (11.3% vs. 10.0% at 6 months, p=0.70; and 18.6% vs. 19.4% at 24 months, p=0.84). Multivariable analysis identified several factors associated with successful PCI, but not predictive of symptom improvement. In conclusion, successful PCI of an isolated CTO improves symptom burden, but is not associated with MACE at 6 or 24 months. CONCLUSIONS: Several factors are associated with successful PCI, but identifying those most likely to have symptom improvement remains challenging.

Improvement of ultrasonic myocardial properties after aortic valve replacement for pure severe aortic stenosis: the predictive value of ultrasonic tissue characterization for left ventricle reverse remodeling.

BACKGROUND: Aortic stenosis leads to left ventricular hypertrophy and accumulation of fibrillar collagens. The analysis of integrated backscatter (IBS) parameters provides information on ultrasonic myocardial properties. METHODS: The study population consisted of 58 patients with aortic stenosis. They were followed up for an average 18 ± 5 months after aortic valve replacement (AVR). Traditional transthoracic echocardiography and analysis of IBS reflectivity were performed before AVR and during the control visit after AVR. RESULTS: A significant reduction in left ventricular mass index, a significant increase in the mean cyclic variation of IBS, and a decrease in absolute end-diastolic IBS intensity were observed after AVR. CONCLUSIONS: These data suggest improvements in ultrasonic myocardial properties after AVR. Preoperative analysis of IBS parameters might provide additional information for predicting left ventricular reverse remodeling in patients a mean of 1.5 years after AVR for aortic stenosis.

Management of left ventricular diastolic heart failure: is it only blood pressure control?

PURPOSE OF REVIEW: Diastolic heart failure (DHF) is the most common form of heart failure (HF) seen by clinicians today in practice. With the increasing prevalence of DHF, the need for greater spectrum of proven therapies in this condition is clear. RECENT FINDINGS: There are few data available to guide the therapy of these patients, and no treatment has been shown to improve survival in DHF. The results of the Hong Kong DHF trial, the first comparative study between an angiotensin converting enzyme inhibitor (ACEI) and an angiotensin receptor blocker (ARB), again did not provide evidence for a superior effect of ACE inhibitors or ARBs in patients with diastolic heart failure. SUMMARY: Traditionally, treatments for congestive HF with decreased ejection fraction have been used to treat DHS, without much proof of benefit. The high mortality and morbidity of these patients underscore the urgent need to find ways to improve outcomes for these patients. Consequently, the care of these patients should be redirected toward screening and treatment of crucial comorbidities such as hypertension, coronary artery disease, atrial fibrillation, obesity, diabetes, and chronic kidney disease.

Comparison of wavelet transform modulus maxima and multifractal detrended fluctuation analysis of heart rate in patients with systolic dysfunction of left ventricle.

BACKGROUND: In recent years the WTMM (wavelet transform modulus maxima) and MDFA (multifractal detrended fluctuation analysis) methods have become widely used techniques for the determination of nonlinear, multifractal heart rate (HR) dynamics. The purpose of our study was to compare multifractal parameters of heart rate calculated using both methods in a group of 90 patients with reduced left ventricular systolic function (rlvs group) and in a group of 39 healthy persons (nsr group). METHODS: For each subject from the rlvs group (LVEF < or =40%) and the nsr group, a 24-hour ECG Holter monitoring was performed. The width of the multifractal spectrum and global Hurst exponent were calculated by means of WTMM and MDFA methods for 5-hour daytime and nighttime subsets. RESULTS: The width of the multifractal spectrum was significantly lower and the Hurst exponent was significantly higher in rlvs group in comparison to nsr group both during diurnal activity and nocturnal rest according to MDFA and only during diurnal activity according to WTMM method. In both groups we observed significant differences of the multifractal spectrum width and the global Hurst exponent between the nighttime and daytime recordings. CONCLUSIONS: MDFA seems to be more sensitive as compared with WTMM method in differentiation between multifractal properties of the heart rate in healthy subjects and patients with left ventricular systolic dysfunction.

Effect of preload reduction by hemodialysis on myocardial ultrasonic characterization, left atrial volume, and Doppler tissue imaging in patients with end-stage renal disease.

The purpose of this study was to investigate the effect of hemodialysis (HD) on myocardial cyclic variation of integrated backscatter (CVIBS), left atrium (LA) volume and tissue Doppler imaging (TDI) in end-stage renal disease (ESRD) patients. We examined 25 patients with ESRD undergoing routine HD and 19 age-matched healthy volunteers. CVIBS, LA volume and left ventricular echocardiographic parameters were measured before and after HD in ESRD patients. CVIBS of both the intervetricular septum and posterior wall were significantly diminished after HD (8.2 +/- 2.5 dB vs. 6.5 +/- 1.8 dB, P < 0.001; 9.2 +/- 2.6 dB vs. 7.6 +/- 2.2dB, p < 0.05 respectively). LA volume decreased significantly after HD (P < 0.05). There was no change in the mitral annulus early diastolic velocity (Em) estimated by TDI. The results of our study demonstrate that HD leads to decrease of CVIBS in ESRD patients and that early mitral annulus velocity (Em) could be preload independent marker of left ventricular diastolic function in ESRD patients.

[Ventricular septal rupture complicating surgically treated left ventricular free wall rupture in a patient with acute myocardial infarction. A case report]. / Ubytek miedzykomorowy u chorego operowanego z powodu pekniecia wolnej sciany lewej komory w ostrym zawale serca sciany przedniej. Opis przypadku.

There is a group of rare but serious complications of acute myocardial infarction (AMI), including free wall rupture (FWR) and, less frequent, ventricular septal rupture (VSR). Urgent surgery combined with simultaneous CABG is usually a treatment of choice. We present a case of a 65-year-old male with AMI, who developed cardiogenic shock due to cardiac tamponade as a result of FWR. The patient was successfully resuscitated and operated. During postoperative treatment parasternal systolic murmur was audible and VSR diagnosis was confirmed. Three months after AMI the AMPLAZER Muscular VSD Occluder was successfully implanted. The follow-up period was uneventful.

Left ventricular size, mass and function in relation to angiotensin-converting enzyme gene and angiotensin-II type 1 receptor gene polymorphisms in patients with coronary artery disease.

The objective of the present study was to analyse the potential synergistic influence of the insertion/deletion polymorphism of the angiotensin-converting enzyme gene (I/D ACE) and the A1166C polymorphism of the angiotensin-II type 1 receptor gene polymorphisms (A1166C AT1R) on the left ventricular size and performance. Three hundred sixty and one consecutive, Caucasian patients with angiographically confirmed coronary artery disease (CAD) were enrolled into the study. Left ventricular diameter, mass and function were evaluated by echocardiography. Screening for the I/D ACE and A1166C AT1R genotypes was performed by polymerase chain reaction of genomic DNA, followed by restriction enzyme digestion and agarose gel electrophoresis. The I/D ACE and A1166C AT1R genotypes separately were not significantly associated with the left ventricular size and function parameters in CAD patients. However, trends towards decreased left ventricular ejection fraction (LVEF) as well as increased left ventricular end-diastolic diameter (LVEDD) and left ventricular mass index (LVMI) were observed when patients with genotype DD+CC/AC and DD+CC were compared to patients homozygous only in one locus (DD or CC). Significant increase in LVEDD and LVMI was observed only in patients with a history of anterior myocardial infarction with combined genotype DD+CC/AC or DD+CC. This study does not support the role of the ACE I/D and AT1R A1166C polymorphisms in the determination of the left ventricular size and performance in patients with significant coronary atherosclerosis. However, it indicates that the influence of polymorphisms may be present in specific patient populations.