Existentially Oriented Group Intervention for Patients With Heart Failure: Intervention Development and Preliminary Assessment.

BACKGROUND: Patients with heart failure (HF) cope with a chronic, life-threatening, particularly disabling medical condition. Their well-being is considered to be at a greater risk than that of patients with any other cardiovascular disease, and their psychological distress is associated with a worse prognosis. These patients are often preoccupied with existential concerns such as fear of death, loneliness, and a loss of sense of meaning. However, there is a dearth of literature regarding psychological interventions that address these issues among this population. AIMS: We, the authors of the current pilot study, present the development and initial implementation of a novel protocol: "existentially oriented group intervention for patients with heart failure." Our aims were to test the intervention's feasibility, as well as to explore patients' subjective experience of it. METHODS: The intervention (consisting of seven 1-hour weekly sessions) was applied to 2 consecutive groups. Twelve patients coping with HF levels III and IV-according to the New York Heart Association classification-from a hospital-based HF clinic participated. The Narrative Evaluation of Intervention Interview was applied. RESULTS: Although high dropout levels were detected, the patients who fully participated in the program reported on satisfaction and progress in the following 4 domains: personal growth, social support, self-worth, and mastery. CONCLUSIONS: On the basis of our preliminary findings, the "existentially oriented group intervention for patients with heart failure" is recommended to be further tested among patients coping with HF.

Incidence and Expression of Circulating Cell Free p53-Related Genes in Acute Myocardial Infarction Patients.

AIM: The circulating RNA levels are predictive markers in several diseases. We determined the levels of circulating p53-related genes in patients with acute ST-segment elevation myocardial infarction (STEMI), indicating major heart muscle damage. METHODS: Plasma RNA was extracted from the patients (n=45) upon their arrival to the hospital (STEMI 0h) and at four hours post-catheterization (STEMI 4h) as well as from controls (n=34). RESULTS: Of 18 circulating p53-related genes, nine genes were detectable. A significantly lower incidence of circulating p21 (p ＜ 0.0001), Notch1 (p=0.042) and BTG2 (p ＜ 0.0001) was observed in the STEMI 0h samples in comparison to the STEMI 4h and control samples. Lower expression levels (2.1-fold) of circulating BNIP3L (p=0.011), p21 (3.4-fold, p=0.005) and BTG2 (6.3-fold, p=0.0001) were observed in the STEMI 0h samples in comparison to the STEMI 4h samples, with a 7.4-fold lower BTG2 expression (p ＜ 0.001) and 2.6-fold lower p21 expression (p=0.034) compared to the control samples. Moreover, the BNIP3L expression (borderline significance, p=0.0655) predicted the level of peak troponin, a marker of myocardial infarction. In addition, the BNIP3L levels on admission (p=0.0025), at post-catheterization (p=0.020) and the change between the groups (p=0.0079) were inversely associated with troponin. The BNIP3L (p=0.0139) and p21 levels (p=0.0447) were also associated with a longer time to catheterization. CONCLUSIONS: Our results suggest that circulating downstream targets of p53 are inhibited during severe AMI and subsequently re-expressed after catheterization, uncovering possible novel death-or-survival decisions regarding the fate of p53 in the heart and the potential use of its target genes as prognostic biomarkers for oxygenation normalization.

Cortisol and testosterone in hair as biological markers of systolic heart failure.

BACKGROUND: Congestive heart failure (CHF) is associated with increased stress and alterations in metabolism, favoring catabolism over anabolism. Hormonal profiles of patients with heart failure have been assessed using serum and saliva as matrices, which are only point measurements and do not provide long-term information. Scalp hair is a novel matrix that allows for measurement of hormones over a period of several months. PATIENTS AND METHODS: We aimed to evaluate whether levels of cortisol and testosterone and their ratio (C/T) in hair correlate with severity of heart failure. We conducted a prospective study in ambulatory male patients with a left ventricular ejection fraction (LVEF)≤40%. Hormone levels were measured using immunoassays in the proximal 2 cm of hair (representing approximately two months of systemic hormone exposure). Primary endpoints included the correlation of hair cortisol, testosterone, and C/T levels with the New York Heart Association (NYHA) class, LVEF, exercise capacity and NT-proBNP. RESULTS: The 44 CHF patients had a median hair level (range) of cortisol of 207 (117.7-1277.3)ng/g. Hair cortisol levels correlated positively with NYHA class (r=0.48, p=0.001) and negatively with treadmill stress test performance, (r=-0.37, p<0.05). The hair testosterone was 5.17 (2.39-24.64)ng/g and the C/T ratio was 39.89 (12.98-173.73). No associations were found between hair testosterone and C/T ratio and heart failure severity; however, the C/T ratio was higher in patients who required a CHF-related hospitalization than in patients who did not require this in the year following the inclusion in the study. CONCLUSIONS: Hair cortisol levels correlate with heart failure severity as assessed by the NYHA class and exercise capacity, while hair testosterone and C/T levels do not correlate with heart failure severity.

Soluble transferrin receptor as a diagnostic laboratory test for detection of iron deficiency anemia in acute illness of hospitalized patients.

BACKGROUND: Many patients in the internal medicine ward have anemia. The etiology for the anemia may be multifactorial and, in the setting of inflammatory process when the ferritin is increased, it is difficult to diagnose iron deficiency anemia. Soluble transferrin receptor (sTfR) had been suggested as an indicator for iron deficiency. No study has investigated the meaning of high sTfR as the only positive marker of iron deficiency anemia (IDA) caused by gastrointestinal tract (GIT) bleeding in hospitalized patients. OBJECTIVES: To demonstrate the importance of high levels of sTfR as a marker for further GIT investigation in cases of anemia where the level of ferritin was normal or increased. METHODS: We retrospectively assessed all patients in an internal medicine ward in our facility who had anemia, high sTfR levels (> 5.0 mg/L) and normal or high ferritin levels and who underwent esophagogastroduodenoscopy and colonoscopy. RESULTS: Of 32 patients with anemia and normal or high ferritin levels and high sTfR, 22 patients (68%) had findings that explained IDA (in some patients more than one finding). Those findings were colonic polyps (n=9), carcinoma of colon (n=4), duodenal ulcer (n=4), carcinoma of stomach (n=3), colitis (n=3), atrophic gastritis (n=1), erosive gastritis (n=1) and angiodysplasia (n=1). CONCLUSIONS: High sTfR may be a good indicator of IDA caused by GIT bleeding when the ferritin level is normal or high. GIT investigation is warranted in such cases.

Six- and twelve-month clinical outcomes after implantation of prokinetic BMS in patients with acute coronary syndrome.

AIMS: To evaluate the Prokinetic bare metal stent implanted in patients presenting with acute coronary syndrome (ACS). METHODS: We retrospectively studied ACS patients who underwent percutaneous coronary intervention (PCI) with a Prokinetic stent implantation. Excluded were patients presenting with cardiogenic shock, undergoing PCI to left main coronary artery (LM), or having implantation of additional stents other than Prokinetic. Six and 12 months clinical follow-up was obtained by phone. RESULTS: A total of 140 Prokinetic stents were implanted in 117 patients (age 64+/-13.0 years, 78% men). Thirty two percent of the patients had unstable angina, 36% had non ST-elevation myocardial infarction (NSTEMI) and 33% had ST-elevation myocardial infarction (STEMI). Forty two percent of lesions were categorized as B2 and 21% as C type. Procedural success was achieved in 99.1% of lesions. Clinical success was achieved in 97.4% of patients. Major adverse cardiac events (MACE) rate was 8.5% and 11.1% at 6 and 12 months follow-up, respectively. The incidence of cardiac death, MI and TLR was 2.6%, 3.4% and 2.6%, respectively at 6 months, and 4.3%, 4.3%, 2.6% respectively at 12 months. CONCLUSIONS: Clinical outcomes at 6 and 12 months after Prokinetic stent implantation are excellent and may be attributable to its unique combination of composition, design and coating.

Mean platelet volume on admission correlates with impaired response to thrombolysis in patients with ST-elevation myocardial infarction.

Mean platelets volume (MPV) has been shown to correlate with impaired reperfusion and increased mortality in patients with ST-elevation myocardial infarction (STEMI) treated with primary precutaneous coronary intervention (PCI). We aimed to study whether the same association exists in STEMI patients treated with thrombolysis. Included in the study were STEMI patients receiving thrombolysis. Thrombolysis failure was defined as a need for rescue precutaneous coronary intervention (PCI), in-hospital mortality, unplanned PCI during hospitalization or complete occlusion of the culprit coronary artery in a follow-up angiography. MPV levels were compared between patients with failed or successful thrombolysis. Of the 122 patients, 30 had failed thrombolysis while the other 92 fulfilled the criteria for successful treatment. There were no significant differences in demographic or clinical baseline characteristics of the two groups. Mean MPV was significantly higher in patients with failed thrombolysis compared to patients with successful treatment (9.2 +/- 1.1fl and 8.7 +/- 1.0fl respectively, p = 0.019 in multivariate analysis). The prevalence of thrombolysis failure was significantly higher in patients with MPV > 8.6 fl compared to those with MPV

Insertion of inferior vena cava filters in patients with the antiphospholipid syndrome.

BACKGROUND: The antiphospholipid syndrome (APS) is a disease with a high prevalence of thromboembolic events, especially pulmonary emboli (PE). These events may recur despite anticoagulation therapy. In such cases, placement of an inferior vena cava (IVC) filter may be considered to prevent propagation of a distal thrombus toward the pulmonary vessels. It is unclear whether the placement of such a filter is beneficial in patients with APS. OBJECTIVE: Retrospective evaluation of the value of IVC filter placement as prophylaxis against recurrent pulmonary emboli in patients with medically treated APS. METHODS: We identified 10 patients suffering from APS who, despite anticoagulation treatment, had recurrent thromboembolic events. All of them underwent placement of an IVC filter. We examined their medical files for further recurrences. RESULTS: Of the 10 patients in our study, only 1 had a documented PE following the intervention. The remaining patients had no evidence of PE after the filter insertion. Five of the 10 patients died, 2 of them suddenly. In those 2 patients, the cause of death is unknown, but PE cannot be excluded. CONCLUSION: IVC filters seem to be protective against recurrent PE in APS patients but the true extent of their efficacy requires further study.

Autoantibodies in nonautoimmune individuals during infections.

Infections can act as environmental triggers inducing or promoting autoimmune disease in genetically predisposed individuals. Identification of microbial peptides similar to self-tissues may by molecular mimicry, provide the inducing mechanism for an immune response. The aim of this study was to identify autoantibodies (autoAbs) in nonautoimmune individuals during acute bacterial, viral, or parasitic infections. Specific Abs or specific infections with an increased autoAb load may shed insight into the mechanisms of autoimmune disease. Sera from 88 patients with acute infections (41 bacterial, 23 viral, 17 parasitic, and 7 rickettsial) were tested by the ELISA method for antinuclear antibodies (ANA) 8 Pro, and Abs to thyroid peroxidase (TPO), thyroglobulin, phospholipids, annexin-V, laminin, anti-Saccharomyces cervisiae (ASCA), and prothrombin, along with 80 normal controls. Elevated titers of Abs to annexin-V and prothrombin were the most prevalent in viral, parasitic, and rickettsial infections and to laminin in viral and parasitic infections. Elevated titers of ASCA and ANA were found in viral and bacterial infections. Antiphospholipid Abs were found in parasitic and Q-fever infections. Thirty-four individuals harbored elevated titers of at least two Abs. An autoAb burden was detected in individuals with hepatitis A, hepatitis B, toxoplasma or Q-fever infections. In nonautoimmune individuals with various (bacterial, viral, parasitic, and rickettsial) infections, elevated titers of Abs to annexin-V, prothrombin, laminin, ASCA, ANA, and phospholipids were most frequently detected.