Low triiodothyronine syndrome and selenium deficiency - undervalued players in advanced heart failure? A single center pilot study.

BACKGROUND: The function of deiodinases - selenoproteins converting thyroid hormones may be disturbed by oxidative stress accompanying heart failure. Selenium (Se) may be used by glutathione peroxidase, leading to a lack of deiodinase and triiodothyronine (T3). The aim of the study was the evaluation of the prevalence and clinical significance of low T3 syndrome in heart failure and the assessment of the association of low fT3 and Se deficiency. METHODS: The study group consisted of 59 consecutive patients hospitalized due to decompensated HFrEF NYHA III or IV. Exclusion criteria were: thyroid dysfunction, severe systemic disease, treatment with amiodarone, steroids or propranolol. Group A included 9 patients with low free T3 (fT3) concentration below 3.1 pmol/L. Group B consisted of the remaining 50 patients with normal fT3 levels. RESULTS: The prevalence of low T3 syndrome was 15.3%. The prevalence of Se deficiency was 74.6%. We demonstrated correlations between fT3 and main clinical variables (i.e. NT-proBNP, LVEF, hsCRP), but we did not find correlation between fT3 and the Se level. Kaplan-Meier survival analysis showed lower survival probability in patients with low fT3 (p < 0.001). CONCLUSIONS: Low T3 syndrome is frequently found in patients with HFrEF and is associated with a poor outcome. We did not identify any significant correlation between Se and fT3 level.

Correction to: Low triiodothyronine syndrome and selenium deficiency - undervalued players in advanced heart failure? A single center pilot study.

After publication of the original article [1], the authors have notified us of a typing error in spelling Dr. Kabat's name. The original publication has been corrected.

Relationship between abdominal obesity, platelet blood count and mean platelet volume in patients with metabolic syndrome.

AIM: There is evidence that patients with the metabolic syndrome have altered platelet indices including higher mean platelet volume. According to the 2009 International Diabetes Federation criteria of metabolic syndrome diagnosis, elevated waist circumference (≥94 cm in M, ≥80 cm in F), as a determinant of abdominal obesity, is not an obligatory component. The aim of this study was to evaluate the relationship between platelet indices, including mean platelet volume, and abdominal obesity in patients with metabolic syndrome. METHODS: 382 consecutive patients were enrolled in the study and divided into three groups: group A, 218 patients with metabolic syndrome and abdominal obesity (132 M, mean age 65.3 ± 10.9 yrs); group B, 35 patients with metabolic syndrome without abdominal obesity (28 M, mean age 63.3 ± 11.2 yrs); and, group C, 129 patients without metabolic syndrome and without abdominal obesity (99 M, mean age 62.2 ± 13.8 yrs). RESULTS: In group A, mean platelet volume was significantly higher than in group C (10.70 ± 1.01 vs. 10.35 ± 0.94 fL, p = 0.007). However, there was no difference in mean platelet volume between group A and B (10.70 ± 1,01vs. 10.63 ± 1.03 fL, p >0.05). Furthermore, in group A, mean platelet volume was correlated with waist circumference (r = 0.14, p = 0.041) and body mass index (r = 0.14, p = 0.045). In all study groups, a significant association between mean platelet volume and platelet count (r = -0.33, p <0.001) was found. CONCLUSION: In individuals with metabolic syndrome and abdominal obesity mean platelet volume is positively correlated with waist circumference and significantly higher than in patients without these abnormalities.

Thin-cap fibroatheroma and increased coronary intima-media thickness are associated with an altered balance of arginine metabolites.

INTRODUCTION: Arginase inhibition increases plasma citrulline and citrulline / ornithine (C/O) ratio, and reduces plasma ornithine and ornithine / arginine (O/A) ratio in an animal model of myocardial infarction (MI). OBJECTIVES: We hypothesized that the presence of thin­cap fibroatheroma (TCFA) in the culprit lesion and increased non­culprit intima­media thickness of an infarct­related artery (IRA) are associated with an altered balance of arginine metabolites. PATIENTS AND METHODS: Arginine and its metabolites were measured using liquid chromatography and tandem mass spectrometry in 100 consecutive MI patients upon admission and at 6­month follow­up. TCFA and adjacent to culprit lesion proximal and distal 10­mm segments were assessed with optical coherence tomography in the acute phase. Twenty five patients without coronary lesions on angiography served as controls. RESULTS: The C/O ratio increased 5.33 times (P <0.001), while the O/A ratio decreased 2.53 times (P <0.001) at the 6­month follow­up, as compared with the acute phase of MI. The patients with (n = 75) vs without (n = 25) TCFA had lower C/O ratio by 29% (P = 0.003), while the mean intima­media diameter of adjacent non­culprit region correlated with the follow­up O/A ratio (R = 0.337; P = 0.003). In a multivariable analysis, a higher acute phase C/O ratio was associated with a lower risk of TCFA presence (odds ratio, 0.978; 95% CI, 0.962-0.994; P = 0.006), whereas a higher follow­up O/A ratio correlated with larger intima­media diameter of the adjacent segments (ß coefficient, 0.227; 95% CI for ß coefficient, 0.045-0.409; P = 0.018). CONCLUSIONS: Enhanced arginase activity over nitric oxide synthase following ischemia was associated with the presence of TCFA in the culprit lesion, while a similar metabolic shift in the chronic phase correlated with a greater thickness of the intima­media in the adjacent non­culprit IRA segments.

Unsaturated fatty acid composition in serum phospholipids in patients in the acute phase of myocardial infarction.

BACKGROUND: Recent improvements in optimal cardiovascular therapy have questioned the beneficial effects of polyunsaturated fatty acids (PUFAs) observed in previous studies. AIMS: We investigated the fatty acid (FA) composition in serum phospholipids in patients with an established acute phase of myocardial infarction (MI) and in high­risk patients with stable atherosclerotic cardiovascular disease (CVD). METHODS: We studied 83 patients hospitalized within 12 hours from the onset of the first clinical symptoms of MI. As a control group, we assessed 74 patients at high cardiovascular risk with an established stable atherosclerotic CVD treated at an outpatient cardiology clinic. Gas chromatography was used to evaluate the FA composition in serum phospholipids in both groups. RESULTS: The final analysis included 52 patients with acute MI and 74 controls. In both groups, saturated FAs constituted the largest fraction of serum phospholipid FAs (median, 1574.67 µmol/l), followed by n­6 PUFAs (median, 1106.99 µmol/l). The levels of total saturated FAs, monounsaturated FAs, n­6 PUFAs, as well as the ratio of n­6 to n­3 PUFAs significantly differed between groups. Palmitic acid constituted the largest fraction of serum phospholipids both in patients and controls (31.9% and 31.16%, respectively). In a multivariate logistic regression analysis, body mass index, low­density lipoprotein cholesterol, aspartate aminotransferase, high­sensitivity C­reactive protein, and palmitoleic and eicosadienoic acids were independently associated with MI. CONCLUSIONS: We showed major differences in the FA composition of serum phospholipids between patients with acute MI and high­risk individuals with stable atherosclerotic CVD. Eicosadienoic and palmitoleic acids, apart from typical cardiovascular risk factors, were independently associated with MI.