Speckle tracking can detect subclinical myocardial dysfunction in rheumatoid arthritis patients.

INTRODUCTION: Patients with rheumatoid arthritis (RA) have shorter life expectancy and their risk of cardiovascular death is more than 50 % higher than the rest of the population. Early myocardial dysfunction in RA patients may be detectable sooner using speckle­tracking echocardiography. METHOD: Cross-sectional study enrolled 55 patients with RA (mean age 44.1 years) without known cardiovascular disease and 31 healthy controls. All subjects underwent a standard echocardiographic examination: indexed left ventricular mass, left ventricle ejection fraction, isovolumic contraction and relaxation times (IVCT and IVRT), mitral valve inflow curve (E/A), septal mitral annular motion (e'), and E/e' ratio as well as the speckle tracking assessment of left ventricle longitudinal, radial and circular strain and strain rate. RESULTS: In standard echocardiographic examination RA patients exhibited higher indexed left ventricle mass (96.36±20.90 g/m2 vs 95.84±21.86 %, p=0.013), lower ejection fraction (64.84±3.87 % vs 67.10±3.87 %, p=0.011) and prolonged IVCT (61.51±9.30 ms vs 53.71±8.95 ms, p=0.001). Diastolic dysfunction was demonstrated by prolonged IVRT (81.62±9.56 ms vs 74.58±12.02 ms, p=0.007) as well as by higher E/e' ratio (8.21±1.76 vs 7.21±1.52, p=0.009). Speckle­tracking method detected lower global longitudinal epicardial strain (-19.51 % vs -21.46 %, p=0.049). Radial, circular, and transversal strains and strain rates were same in both groups. Global longitudinal epicardial strain correlated with IVCT and IVRT, disease duration, and markers of myocardial damage NTproBNP. CONCLUSIONS: Standard echocardiographic assessment of myocardial function is examiner- and angle-dependent method with considerable limitations for evaluation of minimal subclinical changes. Speckle-tracking echocardiography significantly revealed incipient myocardial dysfunction in RA patients without overt cardiovascular diseases. This correlates with clinical RA characteristics and markers of cardiac damage (Tab. 4, Ref. 48).

Homocysteine Slovakia study: study design and occurrence of hyperhomocysteinaemia and other risk factors.

BACKGROUND: Slovakia belong to the European Union countries with the high incidence and prevalence of cardiovascular diseases in general and IHD in particular. METHOD: Homocystein-Slovakia is crossectional population study realised in subjects in high risk age 35-75 years in two groups. The first consists of patients with verified stable ischemic heart disease (IHD) (M= 152; F = 167) aged 60.8±9.37 yrs (males) res. 63.1±7.56 years (females) (NS) who were randomly selected from two cardiological registrars. Second population was formed by general population who were dichotomised according their medical records into IHD patients (M= 31, F= 53) and apparently healthy controls (M= 47; F = 55), the later in significantly younger age as patients, but in same age for intergender comparison 49.6±10.3 vs 46.6±9.2 yrs (NS). RESULTS: We found very high prevalence of classic as well as newer risk factors and risk markers both in IHD patients and in controls. Increased homocysteinen (Hcy >15 µmo/l for males and Hcy >13 µmo/l for females) was found even in 32.9 % of patients and 13.6 % of controls (p<0.001). Comparison of regulating vitamins levels between IHD patients and controls demonstrated similar prevalence. CONCLUSION: Homocystein Slovakia study found very high prevalence of hyperhomocysteinemia in patients with stable ischemic heart disease. Even the prevalence in healthy controls correspond to data reported for MI patients in Western countries. Vitamins regulating metabolism of homocysteine also shown high prevalence, however, without differences between IHD patients and controls (Tab. 5, Fig. 1, Ref. 27).

HSP60, oxidative stress parameters and cardiometabolic risk markers in hypertensive and normotensive Slovak females.

BACKGROUND: The aim of our study was to analyse the relationships between hypertension, HSP60, oxidative stress, lipid profile and cardiometabolic risk in 126 females with arterial hypertension (AHW) and 39 normotensive females (AH-). RESULTS: Females with AH+ were significantly older and more frequently suffered from ischemic heart disease, angina pectoris, prior MI, abdominal obesity, obesity, metabolic syndrome and diabetes mellitus. On the other hand, normotensive females smoked significantly more often. Plasma levels of HSP60 were similar in both AH+ and AH- groups. However, hypertensive females exhibited almost two times lower values of oxidative glutation and lower levels of carbonyl protein, but significantly higher levels of homocysteine. In normotensive females, the total glutathione was the only parameter predicting females with the plasma level of HSP60 = 60 ng/ml. The independent predictors in hypertensive females were angina pectoris, triglycerides and the mean arterial pressure (MAP). MAP had also a borderline significance in normotensive females suggesting an association between HSP60 and blood pressure. MAP formed a J shaped curve with HSP60. CONCLUSION: Results suggest the association of blood pressure and heart shock protein 60 Kda in form of the J curve (Tab. 11, Fig. 3, Ref. 29).

Costs related to medical treatment for common cardiovascular risk factors.

AIM: The aim of this study was to evaluate the direct and indirect costs of selected cardiovascular diseases, namely hypertension (HT), metabolic syndrome (MS) and diabetes mellitus (DM) in the Slovak Republic. METHODS AND RESULTS: This study analyzes the data of 1,000 patients, randomly selected from NEMESYS database (10,300 patients). Average direct pharmacotherapeutic costs of hypertension per year were 257 Euros in men and 264 Euros in women. Costs of metabolic syndrome were 334 Euros in men and 321 Euros in women. Finally, the costs of diabetes mellitus were 392 Euros in men and 384 Euros in women. The most expensive pharmacotherapy was used in patients with a combination of all three diagnoses (HT+MS+DM), namely 452 Euros in men and 455 Euros in women. Indirect costs represent an even more serious financial burden. The highest indirect costs were in patients with diabetes mellitus, namely 5,227 Euros in men and 5,365 Euros in women. CONCLUSIONS: The study proved the assumption of increasing the direct pharmacotherapeutic costs in correlation with the increased severity of disease. The gender differences on the other hand, were smaller in patients with more serious conditions. The indirect costs represented the greatest financial burden, and were 13 to 17 times higher than the direct pharmacotherapeutic costs (Tab. 4, Ref. 17).

MCP-1 -2518 A/G gene polymorphism is associated with blood pressure in ischemic heart disease asymptomatic subjects.

Monocyte chemoattractant protein-1 (MCP-1), one of the key inflammatory chemokines, plays an important role in the initiation of atherosclerosis, and represents a risk for coronary artery disease and myocardial infarction. A recent animal study showed that MCP-1 gene might be a candidate gene for salt-sensitive hypertension in Dahl salt sensitive rats. This effect has not been yet studied in asymptomatic humans. We tested the MCP-1 -2518 A/G single nucleotide polymorphism (SNP) in 66 hypertensive ischemic heart disease asymptomatic subjects. Inflammatory markers, classic risk factors and absolute cardiovascular risk (SCORE system) were also investigated in these subjects. Our results showed that both, systolic and diastolic values of blood pressure were associated with MCP-1 -2518 A/G SNP at the level of both, genotype and allele frequencies. Subjects with mutant G allele had higher levels of both values of blood pressure, systolic (p = 0.035) and diastolic (p = 0.040) than subjects with allele A. Statistically significantly higher levels of both values of blood pressure, systolic (p = 0.037) and diastolic (p = 0.021) were found also in IHD asymptomatic subjects with AG and GG genotypes. Subjects with AG and GG genotypes had also an increased absolute cardiovascular risk (1.62% vs 3.17%; p = 0.004) and an increasing trend for elevated plasma level of high-sensitive CRP (2.858 vs 2.062 mg/l; p = 0.076). We did not find any significant correlation between the serum level of MCP-1 and blood pressure. To our best knowledge, this is the first study concerning the association between MCP-1 polymorphism and arterial blood pressure in IHD asymptomatic subjects. These results indicate that the expression of MCP-1 may be increased before the onset of hypertension but further observations from larger cohorts are needed to confirm this finding (Tab. 6, Ref. 41).

The MCP-1 -2518 (A/G) single nucleotide polymorphism is associated with ischemic heart disease and myocardial infarction in men in the Slovak population.

We investigated the MCP-1 -2518 (A/G) single nucleotide polymorphism (SNP) in Slovak cohort of patients with ischemic heart disease (IHD). Our study comprised 270 patients with IHD, out of them 92 with myocardial infarction (MI). We found that the frequencies of the mutant GG genotype in Slovak patients with IHD (10.7%; p=0.019) and MI (12.0%; p=0.046) were significantly higher than those in the control subjects (5.8%). After subdividing the groups according to the sex, statistically significant difference was found only in men (IHD: p=0.013, MI: p=0.009). We also found a higher rate of GG homozygous genotype in patients with early (< or =50 years of age) MI (18.4%; p=0.004)--statistically significant again only in men (23.1%; p=0.002). The frequencies of G alleles in IHD male patients (30.3%, p=0.046) and in early MI male patients (38.5%, p=0.019) were also statistically significantly higher than in control group. Our results confirm that IHD and MI are linked to MCP-1 -2518 (A/G) single nucleotide polymorphism (Tab. 4, Ref. 34). Full Text (Free, PDF) www.bmj.sk.

Evaluation of alternative calculation methods for determining LDL cholesterol.

BACKGROUND: Due to limitations of the Friedewald formula, alternative methods for calculating low-density lipoprotein cholesterol (LDL-C) were suggested. We evaluated utility of these methods. METHODS: Ninety three subjects free of coronary heart disease were considered. LDL-C was measured by the homogeneous method, and calculated by the Friedewald formula LDL-C = TC-HDL-(TG/2.2) (LDL1) and alternative formulas LDL-C = 0.41 TC - 0.32 TG + 1.70 apoB - 0.27 (LDL2) and LDL-C = 0.94 TC - 0.94 HDL - 0.435 TG (LDL3). RESULTS: All three formulas underestimated the measured LDL-C, both in the whole group and in subgroups according to TG levels (TG < 1.7 and in a range of 1.7-4.5 mmol/l, p < 0.001 for all). We found significantly higher bias for all three formulas in subjects with 1.7 < or = TG < 4.5 mmol/l levels. The Friedewald formula showed the lowest assay bias in all the groups investigated. The mean absolute bias for LDL1 was 7.6%, 18.3% for LDL2 and 13.6% for LDL3, respectively. Linear regression analysis showed correlation of calculated LDL-C values with the direct method in the range of r = 0.82 - 0.90 (p < 0.0001 for all, except of LDL2 in 1.7 < or = TG < 4.5 mmol/l group where p = 0.0011). CONCLUSIONS: The Friedewald formula seems to be a better estimator of LDL-C in our study than the other two alternative formulas; however, it underestimated the LDL-C levels.

[The prevalence of abdominal obesity in Slovakia. The IDEA Slovakia study]. / Prevalencia abdominálnei obezity na Slovensku. Stúdia IDEA Slovakia.

Abdominal obesity represents an independent risk factor for subsequent severe cardiovascular events. It is one of the important diagnostic criteria for Metabolic Syndrome whose predictive value for severe cardiovascular events is similar to that of elevated LDL-cholesterol levels. The prevalence of abdominal obesity in the context of Metabolic Syndrome still has not been systematically monitored in Slovakia. The IDEA program evaluated a sample of 4183 patients in 103 centres in Slovakia. It has shown that only one in three adult inhabitants of Slovakia has a normal body weight. Almost every second inhabitant of Slovakia has intraabdominal obesity (by ATP III criteria). Obesity was recorded in every third woman (34.7 %) and in every fourth man (27.0 %). The prevalence of the principal risk factors (hypertension, hyperlipoproteinemia and diabetes mellitus) grew in proportion to the increase in waist circumference.

Chlamydia pneumoniae antibodies and markers of inflammation in patients with cardiovascular diseases.

BACKGROUND: Chlamydia pneumoniae is suggested to be associated with cardiovascular diseases. OBJECTIVES: To study the presence of IgG, IgA anti-C. pneumoniae antibodies, interleukin-6 (IL-6), and C-reactive protein (CRP) as markers of previous C. pneumoniae infection and inflammation, in sera of patients with acute myocardial infarction (AIM), hypertension (HT), and coronary heart disease (CHD). METHODS: Determination of these markers by ELISA method. RESULTS: Proportion of samples containing both IgG and IgA antibodies as well as IL-6 was significantly higher in all groups of patients than in a control group. The CRP was significantly higher in patients with AIM and HT, however, in other patients, the proportion of positive samples depended on the chosen cut-off value. CONCLUSIONS: The results obtained indicate the feasibility of following chlamydial antibodies on higher number of serum samples extended to direct detection of C. pneumoniae in blood and vascular tissue (Tab. 2, Ref. 24).

Effect of C677T methylenetetrahydrofolate reductase gene polymorphism on plasma homocysteine levels in ethnic groups.

The objective of this study was to examine plasma homocysteine levels and C677T methylenetetrahydrofolate reductase (MTHFR) gene polymorphism in two ethnic groups from Slovakia. The samples consisted of general Slovak-Romany population (68 men and 81 women) from Southwestern Slovakia and the Slovak-Caucasians (174 men and 177 women) who participated in the CINDI project. The homocysteine levels were examined by HPLC, the analysis of MTHFR genotypes was done by PCR. The Slovak-Romany men (12.0+/-5.6 (S.D.) micromol/l) and women (9.2+/-2.6 microol/l) have significantly lower plasma homocysteine levels (p<0.024 and p<0.00001) when compared to Caucasians (13.3+/-5.1 micromol/l in men and 11.3+/-4.3 micromol/l in women). The genetic equilibrium is assumed for the gene frequencies of the MTHFR polymorphism in both samples. The distribution of MTHFR genotypes did not differ between the two populations (TT 13 vs. 10.6 %; CT 46.6 vs. 41.7 %; CC 40.4 vs. 47.7 %, chí(2)2 = 2.315, df=2, ns). The effect of MTHFR genotypes on homocysteine levels was not confirmed in the Slovak-Romanies and TT homozygosity significantly increased plasma homocysteine levels only in Slovak-Caucasians (11.5+/-4.4 micromol/l, ns; vs. 14.8+/-4.8 micromol/l, p 0.002, respectively). To our knowledge, this is the first epidemiological study in the Romany population examining distribution of the MTHFR genotypes and their effect on homocysteine levels. Further studies are needed to establish the variety of cardiovascular risk factors among Romanies in order to evaluate the significance of particular factors.

Work-site hypertension prevalence and control in three Central European Countries.

Compared to Austria, cerebrovascular stroke (CVS) mortality is three times higher in Hungary, and twice as high in Slovakia. We hypothesized that this is due to better treatment and control of hypertension in Austria. To test this hypothesis, we carried out a cross-sectional survey of 'blue collar' employees on work sites in each of these countries. Blood pressure screening was carried out at three work sites in Austria, one in Hungary and one in Slovakia. A standardized protocol was followed in each of these countries. The Bp-TRU(TM) measuring instrument was used to provide accurate reproducible readings and eliminate interobserver error. After the exclusion of missing data and women, the study population included 323 males screened in Austria, 600 in Hungary, and 751 in Slovakia. The mean ages of the respondents ranged from 35 to 42 years. The prevalence of hypertension was 29% in Austria, 28% in Hungary and 40% in Slovakia. Of those identified as hypertensive, 73% in Austria, 45% in Hungary and 67% in Slovakia were newly diagnosed as a result of this screening. Of those treated for hypertension, 10% in Austria, 15% in Hungary and 5% in Slovakia were controlled. The differences in CVS mortality cannot be explained by better control of hypertension in Austria but indicate the involvement of other determinants.

[Clinical importance of the Gavornik classification of mushroom poisoning]. / Klinický význam Gavorníkovej klasifikácie otráv hubami.

The lack of experience and fundamental knowledge about mycology by some mushroomers is one of the leading causes of increasing occurrence of fatal mushroom poisonings. Mushroom intoxications are caused not only by poisonous mushrooms (true primary intoxications), but under certain conditions also by edible mushrooms (secondary intoxications, false intoxications, pseudo-intoxications). Apart from fresh mushrooms intoxications may result also from preserved mushrooms (sterilized in pickles, soured, dried, used for preparation of mushroom extracts, powders, etc.), which are used as garnish. (Tab. 1, Ref. 44.)

[Sudden cardiac death in patients with arterial hypertension and left ventricular hypertrophy on antihypertensive therapy]. / Náhla srdcová smrt u chorých s artériovou hypertenziou, hypertrofiou l'avej komory a pri liecbe antihypertenzívami.

The hypertrophy of the left ventricle in patients with arterial hypertension is an independent risk factor which increases c 9 times the probability of sudden cardiac death. Despite the fact that the incidence of sudden cardiac death in patients with arterial hypertension is low, regarding the high occurrence of hypertension it represents a significant medical problem. The therapy of arterial hypertension is able to decrease the general and cardiovascular mortalities with significant interspecies characteristics of individual antihypertensive drugs, as well as to promote the regression of hypertrophy of the left ventricle. The therapy per se can however increase the risk of cardiovascular complications: until now the complication of the therapy by diuretics rich in potassium and beta-blockers are best distinguished. Calcium antagonists are effective antihypertensive drugs but they do not decrease the total mortality. ACE inhibitors have a marked antihypertensive effect and few adverse effects, but until now there is not a sufficient number of large prospective studies which would definitely confirm the preliminary promising findings. Despite the presented problems the cured patients with arterial hypertension have a substantially better prognosis than patients that are not being cured.

Univalent cation fluxes in human erythrocytes from individuals with low or normal sodium intake.

BACKGROUND: High salt intake is a risk factor for essential hypertension in man. There is evidence that, in hypertension, intracellular sodium content and univalent cation transport across erythrocyte membranes are changed. It has been proposed that a low-sodium diet has an antihypertensive effect; this may be related to changes in cation fluxes across plasma membranes. METHODS: Sodium and potassium fluxes and the composition of fatty acids were studied in the erythrocytes of people who had eaten a low-sodium vegan diet for many years (n = 9) and in those of controls who had consumed a mixed diet (n = 11) to investigate the dependence of these variables on dietary factors. Both systolic and diastolic blood pressures were lower in vegans than in controls. RESULTS: The passive permeability to sodium (P < 0.05) ,Na+,K+ cotransport (P < .001) and the intracellular content of exchangeable sodium (P = 0.076) were decreased in the erythrocytes of those who had consumed the low-sodium diet compared with the controls. The activity of the Na+-K+ pump, Na+-H+ exchange and the passive permeability to potassium were unaltered. Swelling-induced K+,C1- cotransport was increased in the erythrocytes of those who had eaten the low-sodium vegan diet compared with controls (P < 0.01). The proportion of linoleic acid was increased (P < 0.01) at the expense of eicosapentaenoic and docosahexaenoic acids (P < 0.001) in the erythrocyte membranes of the vegans. CONCLUSION: Our results show that levels of intracellular sodium and Na+,K+ cotransport activity, which increase in patients with hypertension, decreased in those consuming a low-sodium vegan diet. This suggests that the risk of essential hypertension was diminished in the vegan participants, confirming our observation that systolic and diastolic blood pressures were lower in the strict vegans than in the controls.

Medicinal plants in a Middle Paleolithic grave Shanidar IV?

This paper deals with phytopharmacological evaluation of the therapeutic potential of the plants found in the Neanderthal grave of a Shanidar IV individual (Iraq), where the palynological analysis of some other authors discovered the following flowers: Achillea-type, Centaurea solstitialis, Senecio-type, Muscari-type, Ephedra altissima, Althea-type. The purpose of our theoretical analysis was to evaluate the objective healing activity of the flowers. The result of the research revealed that Shanidar IV flowers possess considerable therapeutic effects with marked medical activity, which could be an intentional reason for the selection of the flowers in Middle Paleolithic Shanidar Neanderthals.

Follow-up of outpatients with essential hypertension. A comparison of three methods of blood pressure measurement.

Compared with conventional, routine blood pressure measurement in the outpatient department of a hospital, 24-hour blood pressure monitoring provides more comprehensive information about blood pressure values in day-to-day life of the hypertensive patient. The hospital setting with all its stimuli affects the hypertensive patients so that their values will be statistically significantly higher compared with normal ones. Recent years have seen the introduction into clinical practice of self-monitoring by the patients themselves. Comparison of these three methods for blood pressure measurements revealed that self-monitoring may provide fairly accurate values comparable with those obtained by the "standard method", i.e., 24-hour monitoring. In view of the low variability of the mean value of blood pressure over a period of several days, self-monitoring can be employed in groups of selected outpatients on long-term follow-up.

ECG changes and exercise tolerance in patients after myocardial infarction.

The aim of the study was to analyse the type of ECG changes in patients after acute myocardial infarction and to compare them with changes in their physical performance. The authors examined 218 patients with acute myocardial infarction after discharge from hospital. Resting ECG and step-wise graded exercise ECG test on a bicycle ergometer was carried out. The technique of examination was in accordance with WHO recommendations. Statistical evaluation was performed by the Wilcoxon-Mann-Whitney's U-test. The workload in patients showing ECG changes of "transmural" myocardial infarction was not different compared with that of persons with "non-ransmural" lesion (70.00 W versus 71.7 W). When evaluating the relation between the site of ECG changes and the workload, the authors found that the lowest tolerated workload was in cases where ECG changes suggested an extensive damage to the myocardium (53.5 W, p less than 0.05). The authors conclude that the extent of ECG changes after myocardial infarction is a better marker of the level of impairment of physical performance than patient classification to Q or non-Q types.