Heart Rate Variability-Guided Training for Improving Mortality Predictors in Patients with Coronary Artery Disease.

The objective of this research was to investigate whether heart rate variability (HRV)-guided training improves mortality predictors to a greater extent than predefined training in coronary artery disease patients. Twenty-one patients were randomly allocated to the HRV-guided training group (HRV-G) or the predefined training group (PRED-G). They measured their HRV at home daily and trained three times a week for six weeks. Resting heart rate, isolated vagal-related HRV indices (i.e., RMSSD, HF, and SD1), weekly averaged RMSSD, heart rate recovery, and maximum oxygen uptake were assessed before and after the training period. There was a statistically significant difference (p = 0.034) in the change in weekly averaged RMSSD in favor of the HRV-G, while no differences were found in the remaining analyzed variables (p > 0.050). Regardless of the training prescription method, exercise training decreased resting heart rate (p = 0.001; -4.10 [95% CI = -6.37--1.82] beats per minute (bpm)), and increased heart rate recovery at 2 min (p = 0.010; 4.33 [95% CI = 1.15-7.52] bpm) and maximum oxygen uptake (p < 0.001; 3.04 [95% CI = 1.70-4.37] mL·kg-1·min-1). HRV-guided training is superior to predefined training in improving vagal-related HRV when methodological factors are accounted for.

Cierre percutáneo de fugas paravalvulares residuales después del cierre percutáneo de la orejuela izquierda con dispositivo WATCHMAN: serie de dos casos / Catheter-based closure of residual leaks after percutaneous occlusion of the left atrial appendage with WATCHMAN device: two cases

No disponible

Interleucina 6 y proteína C reactiva ultrasensible para la predicción de la evolución clínica en síndromes coronarios agudos sin elevación del segmento ST / Interleukin-6 and high-sensitivity C-reactive protein for the Prediction of outcomes in non-ST-segment elevation acute coronary syndromes

Introducción y objetivos. Las concentraciones basales de interleucina 6 y proteína C reactiva elevadas comportan un aumento del riesgo de muerte en el síndrome coronario agudo sin elevación del segmento ST. El objetivo del estudio es delucidar si las determinaciones seriadas de interleucina 6 y proteína C reactiva ultrasensible aportan información pronóstica adicional a las determinaciones basales para la estratificación del riesgo a largo plazo de los pacientes con síndrome coronario agudo sin elevación del segmento ST. Métodos. Se incluyó prospectivamente en el estudio a 216 pacientes consecutivos con síndrome coronario agudo sin elevación del segmento ST. Se obtuvieron muestras de sangre en un plazo de 24 h tras el ingreso en el hospital y a los 30 días de seguimiento. La variable de valoración principal fue la combinación de muerte por todas las causas, infarto de miocardio no mortal e insuficiencia cardiaca aguda descompensada. Resultados. Las concentraciones tanto de interleucina 6 como de proteína C reactiva ultrasensible se redujeron del día 1 al día 30, con independencia de los eventos adversos aparecidos (p < 0,001 en ambos casos). Los valores de interleucina 6 en los dos momentos de valoración (día 1, por pg/ml; hazard ratio = 1,006; intervalo de confianza del 95%, 1,002-1,010; p = 0,002; día 30, por pg/ml; hazard ratio = 1,047; intervalo de confianza del 95%, 1,021-1,075; p < 0,001) fueron predictores independientes de eventos adversos, pero no los de proteína C reactiva ultrasensible del día 1 y el día 30. Los pacientes con interleucina 6 el día 1 <= 8,24 pg/ml y el día 30 <= 4,45 pg/ml fueron los que presentaron la tasa de eventos adversos más baja (4,7%), mientras que los pacientes con valores superiores a la mediana de ambos parámetros fueron los que tuvieron la tasa de eventos adversos más alta (35%). Después de la adición de la interleucina 6 del día 30 al modelo multivariable, el índice C aumentó de 0,71 (intervalo de confianza del 95%, 0,63-0,78) a 0,80 (intervalo de confianza del 95%, 0,72-0,86, p = 0,042) y la mejora neta de la reclasificación fue de 0,39 (intervalo de confianza del 95%, 0,14-0,64; p = 0,002). Conclusiones. En esta población, tanto la concentración de interleucina 6 como la de proteína C reactiva ultrasensible se reducen tras la fase aguda. La determinación de las concentraciones de interleucina 6 en muestras seriadas mejora la estratificación pronóstica del riesgo en estos pacientes (AU)

Introduction and objectives. High baseline levels of interleukin-6 and C-reactive protein confer an increased risk of mortality in non-ST-segment elevation acute coronary syndrome. The aim of the study was to determine whether serial measurements of interleukin-6 and high-sensitivity C-reactive protein provide additional information to baseline measurements for risk stratification of non-ST-segment elevation acute coronary syndrome. Methods. Two hundred and sixteen consecutive patients with non-ST-segment elevation acute coronary syndrome were prospectively included. Blood samples were obtained within 24h of hospital admission and at 30 days of follow-up. The endpoint was a composite of all-cause death, nonfatal myocardial infarction, or acute decompensated heart failure. Results. Both interleukin-6 and high-sensitivity C-reactive protein levels decreased from day 1 to day 30, regardless of adverse events (both P<.001). Interleukin-6 levels at 2 time points (interleukin-6 day 1, per pg/mL; hazard ratio=1.006, 95% confidence interval, 1.002-1.010; P=.002 and interleukin-6 day 30, per pg/mL, hazard ratio=1.047, 95% confidence interval, 1.021-1.075, P<.001) were independent predictors of adverse events, whereas high-sensitivity C-reactive protein day 1 and high-sensitivity C-reactive protein day 30 levels were not. Patients with interleukin-6 day 1<=8.24 pg/mL and interleukin-6 day 30<=4.45 pg/mL had the lowest event rates (4.7%), whereas those with both above the median values had the highest event rates (35%). After addition of interleukin-6 day 30 to the multivariate model, C-index increased from 0.71 (95% confidence interval, 0.63-0.78) to 0.80 (95% confidence interval, 0.72-0.86), P=.042, and net reclassification improvement was 0.39 (95% confidence interval, 0.14-0.64; P=.002). Conclusions. In this population, both interleukin-6 and high-sensitivity C-reactive protein concentrations decreased after the acute phase. Serial samples of interleukin-6 concentrations improved the prognostic risk stratification of these patients (AU)

Interleukin-6 and high-sensitivity C-reactive protein for the prediction of outcomes in non-ST-segment elevation acute coronary syndromes.

INTRODUCTION AND OBJECTIVES: High baseline levels of interleukin-6 and C-reactive protein confer an increased risk of mortality in non-ST-segment elevation acute coronary syndrome. The aim of the study was to determine whether serial measurements of interleukin-6 and high-sensitivity C-reactive protein provide additional information to baseline measurements for risk stratification of non-ST-segment elevation acute coronary syndrome. METHODS: Two hundred and sixteen consecutive patients with non-ST-segment elevation acute coronary syndrome were prospectively included. Blood samples were obtained within 24 h of hospital admission and at 30 days of follow-up. The endpoint was a composite of all-cause death, nonfatal myocardial infarction, or acute decompensated heart failure. RESULTS: Both interleukin-6 and high-sensitivity C-reactive protein levels decreased from day 1 to day 30, regardless of adverse events (both P<.001). Interleukin-6 levels at 2 time points (interleukin-6 day 1, per pg/mL; hazard ratio=1.006, 95% confidence interval, 1.002-1.010; P=.002 and interleukin-6 day 30, per pg/mL, hazard ratio=1.047, 95% confidence interval, 1.021-1.075, P<.001) were independent predictors of adverse events, whereas high-sensitivity C-reactive protein day 1 and high-sensitivity C-reactive protein day 30 levels were not. Patients with interleukin-6 day 1≤8.24 pg/mL and interleukin-6 day 30≤4.45 pg/mL had the lowest event rates (4.7%), whereas those with both above the median values had the highest event rates (35%). After addition of interleukin-6 day 30 to the multivariate model, C-index increased from 0.71 (95% confidence interval, 0.63-0.78) to 0.80 (95% confidence interval, 0.72-0.86), P=.042, and net reclassification improvement was 0.39 (95% confidence interval, 0.14-0.64; P=.002). CONCLUSIONS: In this population, both interleukin-6 and high-sensitivity C-reactive protein concentrations decreased after the acute phase. Serial samples of interleukin-6 concentrations improved the prognostic risk stratification of these patients.

Usefulness of ß-trace protein and cystatin C for the prediction of mortality in non ST segment elevation acute coronary syndromes.

Beta-trace protein (BTP) is a low-molecular mass protein belonging to the lipocalin protein family, which is more sensitive than serum creatinine for detecting impaired renal function. The aims of the present study were to evaluate whether plasma BTP improves the risk stratification of patients with non-ST-segment elevation acute coronary syndromes and to compare it to cystatin C (CysC), serum creatinine, and estimated glomerular filtration rate. Two hundred twenty-six consecutive patients with non-ST-segment elevation acute coronary syndromes were prospectively included. Blood samples were obtained within 24 hours of hospital admission to measure BTP, CysC, and creatinine. The study end point was all-cause death. Over a median follow-up period of 859 days (interquartile range [IQR] 524 to 1,164), 24 patients (10.6%) died. Decedents had higher concentrations of BTP (1.03 mg/L [IQR 0.89 to 1.43] vs 0.74 mg/L [IQR 0.61 to 0.92], p <0.001), CysC (1.16 mg/L [IQR 0.91 to 1.59] vs 0.90 mg/L [IQR 0.76 to 1.08], p = 0.001), and serum creatinine (1.10 mg/L [IQR 0.87 to 1.46] vs 0.94 mg/L [IQR 0.80 to 1.10], p = 0.004) and a lower mean estimated glomerular filtration rate (60 ± 20 vs 80 ± 24 ml/min/1.73 m(2), p <0.001). After multivariate adjustment, BTP and CysC were predictors of all-cause death, while estimated glomerular filtration rate and serum creatinine concentrations did not achieve statistical significance. In stratified analyses according to kidney function, elevated BTP and CysC were associated with a higher risk for all-cause death. Reclassification analyses showed that BTP and CysC added complementary information to Global Registry for Acute Coronary Events (GRACE) risk score. In conclusion, BTP and CysC levels were associated with all-cause death risk and modestly improved prognostic discrimination beyond the GRACE risk score in patients with non-ST segment elevation acute coronary syndromes.

High-sensitivity troponin T and copeptin in non-ST acute coronary syndromes: implications for prognosis and role of hsTnT and copeptin in non-STEACS.

UNLABELLED: High-sensitivity TnT (hsTnT) has been proposed to improve the diagnosis and stratification in acute coronary syndromes. Copeptin has been proposed for a rapid and accurate rule out of acute myocardial infarction, but some doubts exist about its use out of the first hours from admission. Abnormalities of serum hsTnT and copeptin levels in non-STEACS and negative TnT, could have prognostic implications. METHODS: We included 122 non-STEACS patients without raised TnT, 33 disease controls and 43 healthy controls. We measured hsTnT and copeptin levels. Clinical follow-up at 12 months was performed for adverse endpoints. RESULTS: Non-STEACS patients had raised hsTnT compared with both control groups (P = 0.036 and P < 0.001). Copeptin levels were higher in non-STEACS patients than healthy controls (P = 0.021), without differences with disease controls. Raised levels of hs-TnT presented prognostic implications [HR 3.29 (95%CI: 1.33-7.49), P = 0.010]. hs-TnT could be used for invasive approach decision, as it shows prognostic relevance in conservative approach-patients whereas remains unrelevant for catheterized-patients. Copeptin levels were not associated with adverse events. CONCLUSION: hsTnT levels increased in non-STEACS, were predictive of adverse events and could be important for recommending an invasive management. We cannot confirm a predictive role of copeptin out of the first hours from admission.

Prognostic value of mean platelet volume in patients with non-ST-elevation acute coronary syndrome.

The aim of this study is to determine mean platelet volume (MPV) in a population with non-ST-elevation acute coronary syndrome (nSTEACS) and explore its relation with prognosis. Patients (n = 329) with a diagnosis of nSTEACS at admission were recruited, with a determination of MPV in the first 12 hours at admission. We also collected blood from 87 healthy controls. A composite end point of cardiovascular death and new ACS was assessed at 6-month follow-up. Patients with nSTEACS showed larger platelets (MPV: 11.0 [10.3-11.8] vs 9.2 [8.6-10.0] fL; P < .001.). In Cox regression analysis, MPV at admission was a significant predictor of cardiovascular adverse events in univariate analysis, hazard ratio (HR) 1.4 95% confidence interval (CI) 1.1-1.8; P = .018; but after adjustment with clinical variables, MPV lost its statistical significance. In conclusion, patients with nSTEACS present with larger platelets than healthy controls, however this parameter did not show an independent prognostic significance at 6-month follow-up.

Rescue angioplasty: characteristics and results in a single-center experience.

PURPOSE AND METHODS: Rescue angioplasty (RA) has demonstrated its efficacy for the treatment of failed thrombolysis after acute myocardial infarction (AMI). We analyzed clinical, angiographic, and procedural characteristics, and prognosis at 30 days of prospective cohort of unselected patients admitted for RA. RESULTS: From August 2004 to August 2009, 361 patients were included in a single center. The median time pain to the thrombolysis was 140 minutes (interquartile range [IQR] 90-210), delay transfer 100 minutes (IQR 65-120); pain to PCI was 330 minutes (IQR 270-400). Initial flow TIMI 3 (Thrombolysis in Myocardial Infarction) was presented in 102 (28.3%) of cases and blush grade 3 in 88 (24.4%). After the procedure, TIMI 3 flow was achieved in 286 (79.2%) and blush grade 3 in 256 (71%) (P < 0.001 and P < 0,001, respectively). A glycoprotein IIb/IIIa receptor inhibitor (Abciximab) was used in 115 patients (32%). Stents were implanted in 339 (94%) of patients, 137 (38%) of which were drug-eluting stent. Complete ST segment resolution was observed in 202 (64.5%) patients in 12-lead electrocardiogram (ECG) and procedural success was 77.6%. Adverse cardiac events and death after 30 days follow-up were 13.6% and 10.7%, respectively. Target vessel revascularization at 30 days was 1.9%. CONCLUSIONS: Routine application of RA in patients with persistent ST elevation 90 minutes after thrombolysis is a useful technique for achieving revascularization of the affected artery. In-hospital mortality remains high especially in patients with cardiac shock, despite new interventional techniques available, and adjunctive antithrombotic therapy.

Short- and long-term effects of growth hormone on the heart.

OBJECTIVE: To make a critical analysis of using growth hormone (GH) in patients with chronic heart failure and to asses its effects on the heart in long-term replacement. METHODS: We have studied 27 GHD patients (20 men; mean age: 36+/-15 years; 11 with childhood onset GHD) in a longitudinal, prospective study to assess the effect of GH therapy on the cardiovascular system with a long-term follow-up. RESULTS: After a mean period of 45.3+/-29.6 months, there were no significant differences in echocardiographic parameters of cardiac structure or function. By contrast, the duration of exercise test improved after treatment (8:19+/-3:27 versus 10:23+/-3:25 min; p=0.01) especially in the subgroup of patients with childhood onset of GH deficiency (7:02+/-4:23 versus 11:33+/-3:07 min; p=0.004) but not in the adult onset GHD subgroup. Systolic blood pressure was significantly higher after treatment in the global group (118+/-18.2 mmHg versus 128+/-17.9 mmHg; p=0.004) and in both subgroups. CONCLUSIONS: The beneficial effects of GH replacement on the cardiovascular system is suggested but not fully proved and long-term GH substitution in GHD syndrome is not associated with significant changes in cardiac structure or function although these patients exhibit improved exercise capacity.