Long-term serial functional evaluation after implantation of the Fantom sirolimus-eluting bioresorbable coronary scaffold.

BACKGROUND: Quantitative flow ratio (QFR) has been validated as an accurate surrogate of standard wire-based fractional flow reserve. The clinical and angiographic outcomes of the Fantom sirolimus-eluting bioresorbable coronary scaffold (BRS) have been previously studied and reported. We investigate the functional performance of the Fantom BRS. METHODS: The FANTOM II trial prospectively enrolled 240 patients with stable coronary artery disease or unstable angina, of which 235 patients received the Fantom BRS and were included in the present analysis. We performed an independent serial QFR analysis of the target vessel at baseline, post-percutaneous coronary intervention (PCI), and at 6- or 9-month and 24-month follow-up, using a QFR threshold ≤0.80 to define functional ischemia. RESULTS: QFR was analyzable in 178 patients at baseline, 185 post-PCI, 178 at 6- or 9-month follow-up, and 30 at 24-month follow-up. At baseline, 119 patients (66.9%) had a QFR ≤0.80, whereas 12 (6.5%) post-PCI, 13 (7.3%) at 6- or 9-month follow-up, and 3 (10.0%) at 24-month follow-up had a QFR ≤0.80. QFR improved from baseline to post-PCI, and decreased from post-PCI up to 24-month follow-up. During follow-up period, 28 patients (11.9%) had target vessel revascularization, of which 21 had analyzable QFR and 16 patients (76.1%) had QFR ≤0.80 at the time of revascularization. CONCLUSIONS: Off-line serial QFR assessment demonstrated that around 30% patients did not have functionally significant lesions at baseline and the time with target vessel revascularization. PCI with the Fantom BRS improved functional ischemia with a slight decrease in QFR values over 24 months.

Clinical outcomes after PCI treatment of very long lesions with the XIENCE V everolimus eluting stent; Pooled analysis from the SPIRIT and XIENCE V USA prospective multicenter trials.

BACKGROUND: Lesion length has been an important factor in predicting a worse outcome after percutaneous coronary interventions (PCI); however, the safety and efficacy of second-generation drug eluting stents in very long coronary lesions has not been validated in large scale randomized controlled trials. METHODS: We performed a patient level pooled analysis of 13,266 patients undergoing planned overlapping stent treatment of very long coronary lesions with the XIENCE V everolimus eluting coronary stent system from 6 trials evaluating the XIENCE V stent (Spirit II, III, IV, V, Spirit Small Vessel and XIENCE V USA). Patients were divided into two cohorts, a very long lesion (VLL) group (lesions ≥35 mm) and a control group (lesions >24 to <35 mm). The primary outcome measures were Target Lesion Failure (TLF), Major Adverse Cardiac Events (MACE), and Academic Research Consortium (ARC) defined definite and probable stent thrombosis at 1 year. RESULTS: A total of 13,266 patients were included in the pooled analysis of which 2.4% (323 patients with 328 total lesions) had a mean lesion length of 47.1 ± 13.7 mm in the VLL group which were compared to controls comprised of 3.6% of the cohort (482 patients with 500 total lesions) with mean lesion length of 28.1 ± 2.4 mm.There was no significant difference in the rates of TLF between the VVL and control groups (8.9 vs. 10%, P = 0.63), MACE (9.2 vs. 10%, P = 0.74) or stent thrombosis (1.6 vs. 1.5%, P = 0.92) at 1 year. CONCLUSIONS: In the treatment of very long coronary lesions, the XIENCE V stent appears as safe and effective as percutaneous coronary interventions for long lesions. © 2016 Wiley Periodicals, Inc.

A case-control study of hopelessness and suicidal behavior in the city of Athens, Greece. The role of the financial crisis.

This study aimed to examine the psychometric properties of Beck Hopelessness Scale (BHS) in Greek patients with a recent suicide attempt, the predictive ability of BHS especially in terms of age and the possible effect of the financial crisis on hopelessness as it has been identified as a significant suicide risk factor. The study included a total of 510 individuals, citizens of Athens, Greece. Three hundred and forty individuals (170 attempted suicide patients, and 170 -age and gender- matched healthy individuals used as controls) completed BHS before the financial crisis onset (from 2009 to 2010). A sample of 170 healthy individuals also completed the BHS after the financial crisis onset (from 2013 to 2014), when the impact of the austerity measures was being felt by the Greek society. The Greek BHS version demonstrated good psychometric properties and a sufficient degree of internal consistency. Attempted suicide patients (M = 9) presented higher hopelessness than the controls (M = 3). The patients' age positively correlated with hopelessness (rs = .35, p < .001), and the ROC curve revealed that the BHS ability to discriminate the individuals with pathological rates of hopelessness from those without, strengthened as age increased. No significant differences were found between the individuals evaluated before (M = 3) and after (M = 3, p > .05) the crisis onset. Nevertheless, regarding the latter group, the women, the younger individuals, the less educated, the unemployed and the participants with low or mediocre self-reported financial status presented increased hopelessness. Our findings suggest that BHS could be a useful instrument especially when screening for suicide risk in people of older age, and that the financial crisis in Greece had a greater impact on subgroups of the population regarding hopelessness.

Association of quality of life, anxiety, and depression with left atrial ablation outcomes.

BACKGROUND: Atrial fibrillation (AF) is associated with significant impairment of quality of life (QoL). Anxiety and depression are common in AF patients and might predispose to AF. We sought to investigate associations of preablative QoL and stress parameters with AF ablation outcomes, as well as possible changes in QoL, anxiety, and depression parameters after ablation. METHODS: A total of 57 consecutive patients with paroxysmal AF underwent pulmonary vein (PV) antral isolation. The Short-Form Life Survey-36 items (SF-36), the State-Trait Anxiety Inventory (STAI), and the Beck Depression Inventory (BDI) were assessed before and at 6 months after ablation. RESULTS: After a mean follow-up of 8.0 ± 2.5 months, 41 patients (71.9%) remained free from arrhythmia. Baseline mental health summary QoL SF-36 score was significantly lower in patients with AF recurrence (53.2 ± 10.3 vs 69.7 ± 17.9; P = 0.001), while the physical health summary score did not differ significantly between patients with and without recurrence. Patients with recurrence had higher baseline STAI-trait (41.9 ± 1.5 vs 34.7 ± 4.9) and BDI (17.3 ± 9.7 vs 5.4 ± 3.0) scores (P < 0.001 for both). In multivariable analysis, SF-36 mental health summary, STAI-trait, and BDI scores remained significant predictors of recurrence after adjustment for age, gender, body mass index, diabetes, and hypertension. Mental and physical domain SF-36 summary scores were significantly improved 6 months after ablation (P = 0.001) and a significant reduction in symptoms of depression (P = 0.001) and anxiety (P = 0.001) was observed. CONCLUSIONS: Baseline QoL, anxiety, and depression metrics were associated with AF recurrence following PV antral isolation. Furthermore, there was a significant improvement in QoL, anxiety, and depression after left atrial ablation.

Differences between elderly voluntary and involuntary admitted psychiatric patients in Greece.

BACKGROUND: Involuntary psychiatric admission is a controversial issue with legislation varying from country to country. Research on elderly individuals being involuntary admitted has been limited. This study aims first at assessing whether elderly involuntary admitted patients (IAPs) differ with regard to demographic, psychopathological, and behavioral characteristics from voluntary admitted psychiatric patients (VAPs) and second to assess whether the former group should be treated in a different (special) way. METHODS: Forty IAPs were compared to 39 VAPs with regard to sociodemographic data, DSM-IV diagnosis, as well as behavioral issues recorded by the Patient-Staff Conflict Checklist - Shift Report (PSCC-SR). All patients were aged 60 years and over and were admitted in the psychiatric departments of four general hospitals in Athens. The study period lasted 12 months. RESULTS: VAPs were more likely to be suffering from mood disorders, while IAPs presented higher rates of delirium. From the 20 items of the PSCC-SR, differences were found only in two: IAPs presented more aggressive behavior during the first few days of admission whereas VAPs had committed recent suicide attempt just before admission. CONCLUSION: From the clinical point of view, IAPs presented with delirium and more aggressive behavior, whereas, the VAPs presented with higher rates of mood disorder and suicidality. However, from the medicolegal point of view, our findings lend support to the argument of either setting a limited time frame for involuntary admission in elderly patients, and/or allowing for elderly individuals with acute organic conditions to be treated against their will.

A case-control validation of Type D personality in Greek patients with stable coronary heart disease.

BACKGROUND: Type D personality has been associated with a variety of emotional and social difficulties as well as with poor prognosis in patients with established coronary heart disease (CHD). We examined the psychometric properties and validity of the Type D Scale-14 (DS14) and the prevalence of Type D personality among Greek patients with CHD while taking into account demographic; clinical, such as diabetes mellitus, hypertension, and hypercholesterolemia; as well as psychological variables such as depression, anxiety, and psychological stress. METHODS: Ninety-six patients with stable coronary heart disease and 80 healthy participants from the general population completed the Greek version of the DS14 and the Hospital Anxiety and Depression Scale (HADS). RESULTS: Cronbach's α coefficient for the negative affectivity (NA) and social inhibition (SI) subscales was 0.83 and 0.72 for the CHD and 0.88 and 0.76 for the control group, respectively. Internal-structural validity was assessed by a factor analysis (two-factor solution), and the factor structure of the original DS14 was replicated. Using the standardized cutoff point of NA ≥10 and SI ≥10, instead of the median scores, in order to have compatible results with the majority of studies, the prevalence of Type D personality was 51% for the CHD patients and 13% for the control group. Higher NA and SI were connected with higher anxiety, depression, and total psychological stress. Finally, more patients with CHD and Type D personality than those without were diagnosed with type 2 diabetes; however, no differences were observed in hypertension or hypercholesterolemia. CONCLUSIONS: These results indicate that the Type D construct is reliable and valid in a Greek population. The prevalence of Type D personality was higher in patients with stable coronary heart disease than in people from the general population. The DS14 subscales were positively correlated with higher anxiety, depression, and total psychological stress. Regarding other CHD risk factors, only diabetes mellitus was found more frequently in CHD patients with Type D personality.

1H, 13C, 15N backbone resonance assignment of apo and ADP-ribose bound forms of the macro domain of Hepatitis E virus through solution NMR spectroscopy.

The genome of Hepatitis E virus (HEV) is 7.2 kilobases long and has three open reading frames. The largest one is ORF1, encoding a non-structural protein involved in the replication process, and whose processing is ill-defined. The ORF1 protein is a multi-modular protein which includes a macro domain (MD). MDs are evolutionarily conserved structures throughout all kingdoms of life. MDs participate in the recognition and removal of ADP-ribosylation, and specifically viral MDs have been identified as erasers of ADP-ribose moieties interpreting them as important players at escaping the early stages of host-immune response. A detailed structural analysis of the apo and bound to ADP-ribose state of the native HEV MD would provide the structural information to understand how HEV MD is implicated in virus-host interplay and how it interacts with its intracellular partner during viral replication. In the present study we present the high yield expression of the native macro domain of HEV and its analysis by solution NMR spectroscopy. The HEV MD is folded in solution and we present a nearly complete backbone and sidechains assignment for apo and bound states. In addition, a secondary structure prediction by TALOS + analysis was performed. The results indicated that HEV MD has a α/ß/α topology very similar to that of most viral macro domains.

Depression and Perceived Stress After Spontaneous Coronary Artery Dissection and Comparison With Other Acute Myocardial Infarction (the VIRGO Experience).

Data on depression and stress among patients with spontaneous coronary artery dissection (SCAD) are limited. Using data from the VIRGO (Variation in Recovery: Role of Gender on Outcomes of Young AMI Patients) study, which prospectively enrolled 3,572 acute myocardial infarction (AMI) patients between 18 and 55 years of age, we identified 67 SCAD cases. We compared Patient Health Questionnaire-9 (PHQ-9) and 14-item Perceived Stress Scale (PSS-14) scores obtained at baseline, 1 month, and 12 months between SCAD and AMI of all other causes. Using longitudinal linear mixed-effects analysis, we compared depression and stress scores between SCAD and other AMI, adjusting for time and selected covariates. Patients with SCAD had lower baseline PHQ-9 scores (6.1 ± 6.0 vs 7.7 ± 6.4 for other patients with AMI, p = 0.03), similar 1-month scores, and lower 12-month scores (3.2 ± 4.3 vs 4.9 ± 5.5, p = 0.004). At baseline and 1 month, patients with SCAD had similar PSS-14 scores to those of other patients with AMI. At 12 months, patients with SCAD had lower scores (18.4 ± 8.8 vs 21.5 ± 9.3 for other patients with AMI, p = 0.009). After adjustment for cardiovascular risk factors, co-morbidities, and clinical acuity, no differences in PHQ-9 or PSS-14 scores remained between SCAD and other AMI. Similar results were obtained in a subgroup analysis of only women with SCAD and other AMI. In conclusion, patients with SCAD had a relatively lower burden of depression and perceived stress than other patients with AMI, potentially because of fewer co-morbidities and favorable socioeconomic factors. However, given high depression and stress burden in both SCAD and other patients with AMI, routine screening can help identify and treat these patients.

Health status outcomes after spontaneous coronary artery dissection and comparison with other acute myocardial infarction: The VIRGO experience.

BACKGROUND: Data on health status outcomes after spontaneous coronary artery dissection (SCAD) are limited. METHODS AND FINDINGS: Using the Variation in Recovery: Role of Gender on Outcomes of Young AMI Patients (VIRGO) study we compared patients with SCAD and other acute myocardial infarction (AMI) at presentation (baseline), 1-month, and-12 months using standardized health status instruments. Among 3572 AMI patients ≤ 55 years, 67 had SCAD. SCAD patients were younger (median age (IQR) 45 (40.5-51) years vs. 48 (44-52) in other AMI, p = 0.003), more often female (92.5% vs. 66.6%), have college education (73.1% vs. 51.7%) and household income >$100,000 (43.3% vs. 17.7% (All p<0.001). SCAD patients at baseline had higher mean ± SD Short Form-12 [SF-12] physical component scores [PCS] (48.7±10.2 vs. 43.8±12.1, p<0.001) and mental component scores [MCS] (49.6±12.4 vs. 45.4±12.5, p = 0.008), and at 12-months [PCS (50.1±9.0 vs. 44.3±12.3, p<0.001) and MCS (53±10.1 vs 50.2±11.0, p = 0.045)]. The Euro-Quality of Life Scale [EQ-5D] VAS and EQ-5D index scores were similar at baseline, but higher at 12-months for SCAD (EQ-5D VAS: 82.2±10.2 vs. 72.3±21.0, p<0.001; EQ-5D index scores; 90.2±15.3 vs. 83.7±19.8, p = 0.012). SCAD patients had better baseline Seattle Angina Questionnaire [SAQ] physical limitation (88.8±20.1 vs. 81.2±25.4, p = 0.017). At 12-months SCAD patients had better physical limitation (98.0±8.5 vs. 91.4±18.8, p = 0.007), angina frequency (96.4±8.8 vs. 91.3±16.8, p = 0.018) and quality of life scores (80.7±14.7 vs 72.2±23.2, p = 0.005). Magnitude of change in health status from baseline to 12-months was not statistically different between the groups. After adjustment for time and comorbidities there remained no difference in most health status outcomes. CONCLUSIONS: SCAD patients fare marginally better than other AMI patients on most health status instruments and have similar 12-month health status recovery. Better pre-event health status suggests a need to modify exercise prescriptions and cardiac rehabilitation protocols to better assist this physically active population to recover.

Left Ventricle Architecture and Valvular Integrity Following Microaxial Mechanical Support: A Two-Year Follow-Up Study.

Although the use of microaxilar mechanical circulatory support systems may improve the outcome of patients with cardiogenic shock (CS), little is known about its effect on the long-term structural integrity of left ventricular (LV) valves as well as on the development of LV-architecture. Therefore, we aimed to study the integrity of the LV valves and architecture and function after Impella support. Thus, 84 consecutive patients were monitored over two years having received ImpellaTM CP (n = 24) or 2.5 (n = 60) for refractory CS (n = 62) or for high-risk percutaneous coronary interventions (n = 22) followed by optimal medical treatment. Beside a significant increase in LV ejection fraction after two years (p ≤ 0.03 vs. pre-implantation), we observed a statistically significant decrease in LV dilation (p < 0.001) and severity of mitral valve regurgitation (p = 0.007) in the two-year follow-up period, suggesting an improved LV architecture. Neither the duration of support, nor the size of the Impella device or the indication for its use revealed any devastating impact on aortic or mitral valve integrity. These findings indicate that Impella device is a safe means of support of LV-function without detrimental long-term effects on the structural integrity of LV valves regardless of the size of the device or the indication of support.

Functional and Structural Aspects of La Protein Overexpression in Lung Cancer.

La is an abundant phosphoprotein that protects polymerase III transcripts from 3'-5' exonucleolytic degradation and facilitates their folding. Consisting of the evolutionary conserved La motif (LAM) and two consecutive RNA Recognition Motifs (RRMs), La was also found to bind additional RNA transcripts or RNA domains like internal ribosome entry site (IRES), through sequence-independent binding modes which are poorly understood. Although it has been reported overexpressed in certain cancer types and depletion of its expression sensitizes cancer cells to certain chemotherapeutic agents, its role in cancer remains essentially uncharacterized. Herein, we study the effects of La overexpression in A549 lung adenocarcinoma cells, which leads to increased cell proliferation and motility. Expression profiling of several transcription and translation factors indicated that La overexpression leads to downregulation of global translation through hypophosphorylation of 4E-BPs and upregulation of IRES-mediated translation. Moreover, analysis of La localization after nutrition deprivation of the transfected cells showed a normal distribution in the nucleus and nucleoli. Although the RNA binding capacity of La has been primarily linked to the synergy between the conserved LAM and RRM1 domains which act as a module, we show that recombinant stand-alone LAM can specifically bind a pre-tRNA ligand, based on binding experiments combined with NMR analysis. We propose that LAM RNA binding properties could support the expanding and diverse RNA ligand repertoire of La, thus promoting its modulatory role, both under normal and pathogenic conditions like cancer.

Acute and one-year clinical outcomes following implantation of bioresorbable vascular scaffolds: the ABSORB UK Registry.

AIMS: The aim of this registry was to monitor practice patterns and outcomes in patients treated with Absorb bioresorbable vascular scaffolds (BVS) during the early phase of usage in the UK. METHODS AND RESULTS: A total of 1,005 patients with de novo coronary lesions were treated using careful implantation techniques at 24 centres. Follow-up at one year was obtained in 99%. An independent clinical events committee and angiographic core lab adjudicated all events. Patient age was 52 years and 46% presented with acute coronary syndromes. Lesion complexity was B2/C in 47.4%, with an average of 1.4±0.6 BVS implanted and a BVS length of 28±14.3 mm. A single BVS was implanted in 71.3%. High pressure post-dilatation was performed in 94.9%, with 50% using intravascular imaging. Device success was achieved in 98.7% and procedure success in 97.3% of patients. At one year, the device-oriented endpoint target lesion failure was 3.2%, and the patient-oriented endpoint major adverse cardiac events was 3.4%. Definite ST occurred in 1.4%. By multivariable analysis, scaffold size of 2.5 mm predicted ST at one year (OR 3.27, 95% CI: 1.28-8.37; p=0.014). CONCLUSIONS: With careful patient selection and technique, TLF rates following BVS implantation in real-world practice are comparable with contemporary drug-eluting stents. ST rates remain high, with small vessel size identified as a contributory factor.

Comparison of Physician Visual Assessment With Quantitative Coronary Angiography in Assessment of Stenosis Severity in China.

Importance: Although physician visual assessment (PVA) of stenosis severity is a standard clinical practice to support decisions for coronary revascularization, there are concerns about its accuracy. Objective: To compare PVA with quantitative coronary angiography (QCA) as a means of assessing stenosis severity among patients undergoing percutaneous coronary intervention (PCI) in China. Design, Setting, and Participants: A cross-sectional study (2012-2013) of a random subset of 1295 patients from the China Patient-centered Evaluative Assessment of Cardiac Events (PEACE) Prospective PCI Study was carried out. The PEACE Prospective PCI study recruited a consecutive sample of patients undergoing PCI at 35 hospitals in 18 provinces of China. The coronary angiograms of this subset of participants were reviewed using QCA by 2 independent core laboratories blinded to PVA readings. Main Outcomes and Measures: Differences between PVA and QCA assessments of stenosis severity for lesions for which PCI was performed and variation of these differences among hospitals and physicians, stratified by the diagnosis of acute myocardial infarction (AMI). Results: In patients without AMI, the mean (SD) age was 62 (10) years, and 217 (31.5%) were women; in patients with AMI, the mean (SD) age was 60 (11) years, and 153 (25.2%) were women. The mean (SD) percent diameter stenosis by PVA was 16.0% (11.5%) greater than that by QCA in patients without AMI and 10.2% (12.3%) in those with AMI (P < .001 for both comparisons). In patients without AMI, of 837 lesions with 70% or more stenosis by PVA, 427 (50.6%) were less than 70% by QCA; in patients with AMI, similar patterns were observed to a lesser extent. Among patients without AMI, only 4 (0.47%) lesions were additionally assessed with fractional flow reserve. Among 30 hospitals, the difference between PVA and QCA readings of stenosis severity varied from 7.6% (95% CI, 0.4%-14.7%) to 21.3% (95% CI, 17.1%-24.9%) among non-AMI patients. Across 57 physicians, this difference varied from 6.9% (95% CI, -1.4%-15.3%) to 26.4% (95% CI, 21.5%-31.4%). Conclusions and Relevance: For coronary lesions treated with PCI in China, PVA reported substantially higher readings of stenosis severity than QCA, with large variation across hospitals and physicians. These findings highlight the need to improve the accuracy of information used to guide treatment decisions in catheterization laboratories.

Conversion disorder in a preschool age girl.

This article reports a case of a 5-year-old girl with clinical manifestations of a conversion disorder. Children presenting with a conversion disorder very often have multiple investigations and more than two-thirds of them are admitted to the hospital. This case illustrates the necessity of adapting, from the outset, a multidisciplinary approach to diagnosis and management, which helps in providing an explanatory model that takes into account stressors, factors within the child and the family, and aids in planning an appropriate psychotherapeutic intervention based on the child's and family's needs.

Calcium Ions in Inherited Cardiomyopathies.

Inherited cardiomyopathies are a known cause of heart failure, although the pathways and mechanisms leading from mutation to the heart failure phenotype have not been elucidated. There is strong evidence that this transition is mediated, at least in part, by abnormal intracellular Ca(2+) handling, a key ion in ventricular excitation, contraction and relaxation. Studies in human myocytes, animal models and in vitro reconstituted contractile protein complexes have shown consistent correlations between Ca(2+) sensitivity and cardiomyopathy phenotype, irrespective of the causal mutation. In this review we present the available data about the connection between mutations linked to familial hypertrophic (HCM), dilated (DCM) and restrictive (RCM) cardiomyopathy, right ventricular arrhythmogenic cardiomyopathy/dysplasia (ARVC/D) as well as left ventricular non-compaction and the increase or decrease in Ca(2+) sensitivity, together with the results of attempts to reverse the manifestation of heart failure by manipulating Ca(2+) homeostasis.

Preterm birth and maternal psychological health.

Studies have shown that preterm birth significantly influences mothers' psychological health. This study aimed to identify factors associated with preterm birth and assess postnatal depression and anxiety symptoms in mothers of preterm infants (n = 75) compared to mothers who delivered at term (n = 125) in a Greek sample. Multiple pregnancies, assisted reproduction technology, caesarean section, non-Greek ethnicity and smoking during pregnancy were associated with preterm delivery. Moreover, preterm infants' mothers had higher depression, state anxiety and trait anxiety scores. These findings suggest that addressing preventable causes of preterm delivery is crucial, while mothers of preterm infants should receive postnatal support.

Amino-terminal B-natriuretic peptide levels and postablation recurrence in hypertensive patients with paroxysmal atrial fibrillation.

BACKGROUND: Amino-terminal B-type natriuretic peptide (NT-proBNP) has been shown to predict postablation recurrences of atrial fibrillation (AF); however, given the associations of natriuretic peptides with various cardiovascular parameters potentially related to AF, whether the observed association with recurrence is truly an independent one is not clear. OBJECTIVE: The purpose of this analysis was to assess the association of NT-proBNP levels with AF recurrence after radiofrequency ablation. METHODS: This was a post hoc analysis of a prospective study of 296 hypertensive patients with symptomatic paroxysmal AF and no history of heart failure who were scheduled to undergo pulmonary vein isolation. NT-proBNP was measured at baseline, and patients were followed for a median of 13.7 months. RESULTS: NT-proBNP levels at baseline were higher in patients with recurrence (269 pg/mL [199-361 pg/mL]) vs those who remained arrhythmia-free (188 pg/mL [146-320 pg/mL], P<.001). In a univariate Cox regression model, each higher quartile of NT-proBNP corresponded to a 47% (95% confidence interval 21.5%-77.9%) increase in the risk of recurrence. However, when baseline clinical AF burden, in terms of the number of clinical AF episodes in the previous year, was added to the model, the association of NT-proBNP lost its significance (adjusted hazard ratio 1.22, 95% confidence interval 0.94-1.57). CONCLUSION: This is the largest series to date showing that NT-proBNP is a univariate predictor of postablation AF recurrence. However, it seems that adjustment for other covariates, including the number of AF episodes within the previous year, renders this association nonsignificant.

Inflammation and chronic heart failure: from biomarkers to novel anti-inflammatory therapeutic strategies.

Heart failure (HF) is a complex heterogeneous syndrome with immune, metabolic and neurohumoral mechanisms interacting and leading to gradual heart contractility impairment. From the first study-to correlate inflammation with HF, inflammation biomarkers have been the subject of intense inquiry in patients with various forms of HF. Chronic HF (CHF) is strongly associated with inflammation in terms of pathogenesis, progression, severity and prognosis. Inflammatory mediators participate in CHF pathophysiology in various ways like exerting direct impact on cardiac myocytes, fibroblasts and ß-adrenergic receptors leading to hypertrophy, fibrosis and impaired cardiac contractility, respectively, or inducing apoptosis by stimulation of the proper genes. The anti-inflammatory effects of classical heart failure therapeutic strategies such as ACEI and b-blockers are rather conflicting. Whether novel immunomodulating and anti-inflammatory therapeutic approaches should be added to existing therapies in order to ensure additional benefit to HF patients is under investigation. In this review, we summarize the pathophysiological link between inflammatory processes and CHF, focusing on the role of novel and traditional inflammatory biomarkers and highlighting novel anti-inflammatory therapeutic strategies.

Inflammation markers in essential hypertension.

Essential hypertension is a common health disorder with uncertain etiology and unclear pathophysiology. There is evidence that various systems interact in uncertain ways and mechanisms to cause hypertension. It is also well known that inflammation is a key feature in the initiation, progression and clinical implication of several cardiovascular diseases. Recently, it has become evident that the immune system and inflammatory response are also essential in the pathogenesis of hypertension. Many inflammation markers such as CRP, cytokines, and adhesion molecules have been found elevated in hypertensive patients supporting the role of inflammation in the pathogenesis of hypertension. Also, in normotensive individuals, these markers have been associated with the risk of developing hypertension, whereas in hypertensive patients they have been associated with target organ damage as well as with the risk for future cardiovascular events. Thus, understanding the role of inflammation in hypertension provides new insights for novel therapeutic approaches, targeting inflammation for the treatment of hypertension and its complications.

Innate immune inflammatory response in the acutely ischemic myocardium.

The "holy grail" of modern interventional cardiology is the salvage of viable myocardial tissue in the distribution of an acutely occluded coronary artery. Thrombolysis and percutaneous coronary interventions, provided they can be delivered on time, can interrupt the occlusion and save tissue. At the same time restoring the patency of the coronary vessels and providing the ischemic myocardium with blood can cause additional tissue damage. A key element of ischemic and reperfusion injury and major determinant of the evolution of damage in the injured myocardium is the inflammatory response. The innate immune system initiates and directs this response which is a prerequisite for subsequent healing. The complement cascade is set in motion following the release of subcellular membrane constituents. Endogenous 'danger' signals known as danger-associated molecular patterns (DAMPs) released from ischemic and dying cells alert the innate immune system and activate several signal transduction pathways through interactions with the highly conserved Toll like receptors (TLRs). Reactive oxygen species (ROS) generation directly induces pro-inflammatory cascades and triggers formation of the inflammasome. The challenge lies into designing strategies that specifically block the inflammatory cascades responsible for tissue damage without affecting those concerned with tissue healing.