Left atrioventricular remodeling in the assessment of the left ventricle diastolic function in patients with heart failure: a review of the currently studied echocardiographic variables

Multiparametric echocardiographic imaging of the failing heart is now increasingly used and useful in decision making in heart failure. The reasons for this, relies on the need of different strategies of handling these patients, as differentiation of systolic or diastolic dysfunction, as well as on the gamma of approaches available, such as percutaneous and surgical revascularization, devices implantations, and valvular regurgitations and stenosis corrections. Congestive heart failure in patients with normal left ventricular diameters or preserved left ventricular ejection fraction had been pointed out recently as present in a proportion so high as 40 to 50 percent of cases of heart failure, mainly due to the epidemics in well developed countries, as is the problem of not well controlled metabolic states (such as obesity and diabetes), but also due to the real word in developing countries, as is the case of hypertension epidemics and its lack of adequate control. As a matter of public utility, the guidelines in the diagnosis and treatment of such patients will have to be cheap, available, easily reproducible, and ideally will furnish answers for the clinician questions not in a binary "black or white" manner, but with graduations, so if possible it has to be quantitative. The present paper aim to focus on the current clinical applications of tissue Doppler and of left atrial function and remodeling, and its pathophysiologic relationship with the left ventricle, as will be cleared in the documented review of echocardiography that follows, considering that the need of universal data on the syndrome of the failing heart does not mean, unfortunately, that all patients and clinicians in developing countries have at their own health facilities the same imaging tools, since they are, as a general rule, expensive

Effect of aliskiren on post-discharge outcomes among diabetic and non-diabetic patients hospitalized for heart failure: insights from the ASTRONAUT trial

Aims The objective of the Aliskiren Trial on Acute Heart Failure Outcomes (ASTRONAUT) was to determine whether aliskiren, a direct renin inhibitor, would improve post-discharge outcomes in patients with hospitalization for heart failure (HHF) with reduced ejection fraction. Pre-specified subgroup analyses suggested potential heterogeneity in post-discharge outcomes with aliskiren in patients with and without baseline diabetes mellitus (DM). Methods and results ASTRONAUT included 953 patients without DM (aliskiren 489; placebo 464) and 662 patients with DM (aliskiren 319; placebo 343) (as reported by study investigators). Study endpoints included the first occurrence of cardiovascular death or HHF within 6 and 12 months, all-cause death within 6 and 12 months, and change from baseline in N-terminal pro-B-type natriuretic peptide (NT-proBNP) at 1, 6, and 12 months. Data regarding risk of hyperkalaemia, renal impairment, and hypotension, and changes in additional serum biomarkers were collected. The effect of aliskiren on cardiovascular death or HHF within 6 months (primary endpoint) did not significantly differ by baseline DM status (P = 0.08 for interaction), but reached statistical significance at 12 months (non-DM: HR: 0.80, 95% CI: 0.64-0.99; DM: HR: 1.16, 95% CI: 0.91-1.47; P = 0.03 for interaction). Risk of 12-month all-cause death with aliskiren significantly differed by the presence of baseline DM (non-DM: HR: 0.69, 95% CI: 0.50-0.94; DM: HR: 1.64, 95% CI: 1.15-2.33; P < 0.01 for interaction). Among non-diabetics, aliskiren significantly reduced NT-proBNP through 6 months and plasma troponin I and aldosterone through 12 months, as compared to placebo. Among diabetic patients, aliskiren reduced plasma troponin I and aldosterone relative to placebo through 1 month only. There was a trend towards differing risk of post-baseline potassium ≥6 mmol/L with aliskiren by underlying DM status (non-DM: HR: 1.17, 95% CI: 0.71-1.93; DM: HR: 2.39, 95% CI: 1.30-4.42; P = 0.07 for interaction). Conclusion This pre-specified subgroup analysis from the ASTRONAUT trial generates the hypothesis that the addition of aliskiren to standard HHF therapy in non-diabetic patients is generally well-tolerated and improves post-discharge outcomes and biomarker profiles. In contrast, diabetic patients receiving aliskiren appear to have worse post-discharge outcomes. Future prospective investigations are needed to confirm potential benefits of renin inhibition in a large cohort of HHF patients without D

Antibodies Against Oxldl and Acute Coronary Syndrome

Abstract Background: The oxidation of low-density lipoprotein (oxLDL) induces the formation of immunogenic epitopes in molecules. The presence of autoantibodies against oxLDL has been demonstrated in the serum of patients with coronary artery disease (CAD). However, the role of these autoantibodies in the pathophysiology of acute coronary syndromes (ACS) and their clinical significance remain undefined

Anticuerpos contra LDL-ox y síndrome coronario agudo

FUNDAMENTO: A oxidação da lipoproteína de baixa densidade (LDL-ox) induz à formação de epítopos imunogênicos na molécula. A presença de autoanticorpos contra a LDL-ox tem sido demonstrada no soro de pacientes com doença arterial coronariana (DAC). Contudo, o papel desses autoanticorpos na fisiopatologia das síndromes coronarianas agudas (SCA) e o seu significado clínico permanecem indefinidos. OBJETIVO: Avaliar a associação entre autoanticorpos contra a LDL-ox e SCA. MÉTODOS: Os títulos de imunoglobulina G autoanticorpos contra a LDL-ox por cobre (antiLDL-ox) e contra o peptídeo sintético D derivado da apolipoproteína B (antipeptD) foram determinados por ensaio imunoenzimático (ELISA) em 90 pacientes, nas primeiras 12h de SCA (casos) e em 90 pacientes com DAC crônica (controles). RESULTADOS: Os resultados mostraram que os títulos de antiLDL-ox foram significativamente mais elevados (p = 0,017) nos casos (0,40 ± 0,22), do que nos controles (0,33 ± 0,23). Por outro lado, os títulos de antipeptD foram significativamente menores (p < 0,01) nos casos (0,28 ± 0,23) do que nos controles (0,45 ± 0,30). A diferença dos títulos de ambos anticorpos entre os dois grupos estudados foi independente de idade, sexo, hipertensão arterial, diabete melito, dislipidemia, índice de massa corporal, tabagismo, perfil lipídico, uso de estatinas e história familiar de DAC. CONCLUSÃO: Os resultados mostraram que os títulos de antiLDL-ox foram significativamente mais elevados nos pacientes com síndrome coronariana aguda quando comparados aos pacientes com doença arterial coronariana e podem estar associados à instabilidade da placa aterosclerótica.BACKGROUND: The oxidation of low-density lipoprotein (oxLDL) induces the formation of immunogenic epitopes in molecules. The presence of autoantibodies against oxLDL has been demonstrated in the serum of patients with coronary artery disease (CAD). However, the role of these autoantibodies in the pathophysiology of acute coronary syndromes (ACS) and their clinical significance remain undefined. OBJECTIVE: To evaluate the association between antibodies against oxLDL and ACS. METHODS: Titers of IgG autoantibodies against oxLDL by copper (anti-oxLDL) and anti-D synthetic peptide derived from apolipoprotein B (antipeptD) were determined by Enzyme-linked immunosorbent assay (ELISA) in 90 patients, in the first 12 hours of ACS (cases) and in 90 patients with chronic CAD (controls). RESULTS: The results showed that the titers of anti-oxLDL were significantly higher (p = 0.017) in cases (0.40 ± 0.22) than in controls (0.33 ± 0.23). On the other hand, the titers of antipeptD were significantly lower (p < 0.01) in cases (0.28 ± 0.23) than in controls (0.45 ± 0.30). The difference in the titers of both antibodies between the two groups was independent of age, sex, hypertension, diabetes mellitus, dyslipidemia, body mass index, smoking, lipid profile, statin use and family history of CAD. CONCLUSION: The results showed that the titers of anti-oxLDL were significantly higher in patients with acute coronary syndrome as compared to patients with coronary artery disease and may be associated with atherosclerotic plaque instability.FUNDAMENTO: La oxidación de la lipoproteína de baja densidad (LDL-ox) induce a la formación de epítopos inmunogénicos en la molécula. La presencia de autoanticuerpos contra la LDL-ox ha sido demostrada en el suero de pacientes con enfermedad arterial coronaria (EAC). No obstante eso, el papel de esos autoanticuerpos en la fisiopatología de los síndromes coronarios agudos (SCA) y su significado clínico permanecen indefinidos. OBJETIVO: Evaluar la asociación entre autoanticuerpos contra la LDL-ox y SCA. MÉTODOS: Los títulos de inmunoglobulina G autoanticuerpos contra la LDL-ox por cobre (antiLDL-ox) y contra el péptido sintético D derivado de la apolipoproteína B (antipeptD) fueron determinados por ensayo inmunoenzimático (ELISA) en 90 pacientes, en las primeras 12h de SCA (casos) y en 90 pacientes con EAC crónica (controles). RESULTADOS: Los resultados mostraron que los títulos de antiLDL-ox fueron significativamente más elevados (p =0,017) en los casos (0,40 ± 0,22), que en los controles (0,33 ± 0,23). Por otro lado, los títulos de antipeptD fueron significativamente menores (p < 0,01) en los casos (0,28 ± 0,23) que en los controles (0,45 ± 0,30). La diferencia de los títulos de ambos anticuerpos entre los dos grupos estudiados fue independiente de edad, sexo, hipertensión arterial, diabetes mellitus, dislipidemia, índice de masa corporal, tabaquismo, perfil lipídico, uso de estatinas e historia familiar de EAC. CONCLUSIÓN: Los resultados mostraron que los títulos de antiLDL-ox fueron significativamente más elevados en los pacientes con síndrome coronario agudo cuando fueron comparados a los pacientes con enfermedad arterial coronaria y pueden estar asociados a inestabilidad de la placa aterosclerótica

Anticorpos contra LDL-ox e síndrome coronariana aguda Anticuerpos contra LDL-ox y síndrome coronario agudo Antibodies against OxLDL and acute coronary syndrome

FUNDAMENTO: A oxidação da lipoproteína de baixa densidade (LDL-ox) induz à formação de epítopos imunogênicos na molécula. A presença de autoanticorpos contra a LDL-ox tem sido demonstrada no soro de pacientes com doença arterial coronariana (DAC). Contudo, o papel desses autoanticorpos na fisiopatologia das síndromes coronarianas agudas (SCA) e o seu significado clínico permanecem indefinidos. OBJETIVO: Avaliar a associação entre autoanticorpos contra a LDL-ox e SCA. MÉTODOS: Os títulos de imunoglobulina G autoanticorpos contra a LDL-ox por cobre (antiLDL-ox) e contra o peptídeo sintético D derivado da apolipoproteína B (antipeptD) foram determinados por ensaio imunoenzimático (ELISA) em 90 pacientes, nas primeiras 12h de SCA (casos) e em 90 pacientes com DAC crônica (controles). RESULTADOS: Os resultados mostraram que os títulos de antiLDL-ox foram significativamente mais elevados (p = 0,017) nos casos (0,40 ± 0,22), do que nos controles (0,33 ± 0,23). Por outro lado, os títulos de antipeptD foram significativamente menores (p FUNDAMENTO: La oxidación de la lipoproteína de baja densidad (LDL-ox) induce a la formación de epítopos inmunogénicos en la molécula. La presencia de autoanticuerpos contra la LDL-ox ha sido demostrada en el suero de pacientes con enfermedad arterial coronaria (EAC). No obstante eso, el papel de esos autoanticuerpos en la fisiopatología de los síndromes coronarios agudos (SCA) y su significado clínico permanecen indefinidos. OBJETIVO: Evaluar la asociación entre autoanticuerpos contra la LDL-ox y SCA. MÉTODOS: Los títulos de inmunoglobulina G autoanticuerpos contra la LDL-ox por cobre (antiLDL-ox) y contra el péptido sintético D derivado de la apolipoproteína B (antipeptD) fueron determinados por ensayo inmunoenzimático (ELISA) en 90 pacientes, en las primeras 12h de SCA (casos) y en 90 pacientes con EAC crónica (controles). RESULTADOS: Los resultados mostraron que los títulos de antiLDL-ox fueron significativamente más elevados (p =0,017) en los casos (0,40 ± 0,22), que en los controles (0,33 ± 0,23). Por otro lado, los títulos de antipeptD fueron significativamente menores (p BACKGROUND: The oxidation of low-density lipoprotein (oxLDL) induces the formation of immunogenic epitopes in molecules. The presence of autoantibodies against oxLDL has been demonstrated in the serum of patients with coronary artery disease (CAD). However, the role of these autoantibodies in the pathophysiology of acute coronary syndromes (ACS) and their clinical significance remain undefined. OBJECTIVE: To evaluate the association between antibodies against oxLDL and ACS. METHODS: Titers of IgG autoantibodies against oxLDL by copper (anti-oxLDL) and anti-D synthetic peptide derived from apolipoprotein B (antipeptD) were determined by Enzyme-linked immunosorbent assay (ELISA) in 90 patients, in the first 12 hours of ACS (cases) and in 90 patients with chronic CAD (controls). RESULTS: The results showed that the titers of anti-oxLDL were significantly higher (p = 0.017) in cases (0.40 ± 0.22) than in controls (0.33 ± 0.23). On the other hand, the titers of antipeptD were significantly lower (p < 0.01) in cases (0.28 ± 0.23) than in controls (0.45 ± 0.30). The difference in the titers of both antibodies between the two groups was independent of age, sex, hypertension, diabetes mellitus, dyslipidemia, body mass index, smoking, lipid profile, statin use and family history of CAD. CONCLUSION: The results showed that the titers of anti-oxLDL were significantly higher in patients with acute coronary syndrome as compared to patients with coronary artery disease and may be associated with atherosclerotic plaque instability

Naproxen as Prophylaxis against Atrial Fibrillation after Cardiac Surgery: the NAFARM Randomized Trial

PURPOSE: We sought to assess the effect of naproxen versus placebo on prevention of atrial fibrillation after coronary artery bypass graft (CABG) surgery.METHODS: in this randomized, double-blind, placebo-controlled, single-center trial of 161 consecutive patients undergoing CABG surgery, patients received naproxen 275 mg every 12 hours or placebo at the same dosage and interval over 120 hours immediately after CABG surgery. the primary outcome was the occurrence of atrial fibrillation in the first 5 postoperative days.RESULTS: the incidence of postoperative atrial fibrillation was 15.2% (12/79) in the placebo versus 7.3% (6/82) in the naproxen group (P = .11). the duration of atrial fibrillation episodes was significantly lower in the naproxen (0.35 hours) versus placebo group (3.74 hours; P = .04). There was no difference in the overall days of hospitalization between placebo (17.23 +/- 7.39) and naproxen (18.33 +/- 9.59) groups (P = .44). Intensive care unit length of stay was 4.0 +/- 4.57 days in the placebo and 3.23 +/- 1.25 days in the naproxen group (P = .16). the trial was stopped by the data monitoring committee before reaching the initial target number of 200 patients because of an increase in renal failure in the naproxen group (7.3% vs 1.3%; P = .06).CONCLUSIONS: Postoperative use of naproxen did not reduce the incidence of atrial fibrillation but decreased its duration, in a limited sample of patients after CABG surgery. There was a significant increase in acute renal failure in patients receiving naproxen 275 mg twice daily. Our study does not support the routine use of naproxen after CABG surgery for the prevention of atrial fibrillation. (C) 2011 Elsevier Inc. All rights reserved. . the American Journal of Medicine (2011) 124, 1036-1042Duke Univ, Duke Clin Res Inst, Med Ctr, Durham, NC 27705 USAUniversidade Federal de São Paulo, Div Invas Clin Electrophysiol, Dept Cardiol, São Paulo, BrazilPontificia Univ Catolica Rio Grande do Sul, Div Cardiol, Porto Alegre, RS, BrazilBrazilian Clin Res Inst, São Paulo, BrazilUniversidade Federal de São Paulo, Div Invas Clin Electrophysiol, Dept Cardiol, São Paulo, BrazilWeb of Scienc