Plasma leptin and insulin-like growth factor I levels during acute exacerbations of chronic obstructive pulmonary disease

<p>Abstract</p> <p>Background</p> <p>Recent studies have provided evidence for a link between leptin and tumor necrosis factor-alpha (TNF-α). Insulin-like growth factor I (IGF-I) mediates the metabolic effects of growth hormone (GH). The GH axis is believed to be suppressed in chronic obstructive pulmonary disease (COPD). The aim of this study is to find out whether acute exacerbations of COPD are followed by changes in plasma leptin and insulin-like growth factor I (IGF-I) levels and furthermore, whether these changes are related to systemic inflammation.</p> <p>Methods</p> <p>We measured serum leptin, IGF-I, TNF-α, interleukin 1β (IL-1β), interleukin 6 (IL-6) and interleukin 8 (IL-8) levels in 52 COPD patients with acute exacerbation on admission to hospital (Day 1) and two weeks later (Day 15). 25 healthy age-matched subjects served as controls. COPD patients were also divided into two subgroups (29 with chronic bronchitis and 23 with emphysema). Serum leptin and IGF-I were measured by radioimmunoassay and TNF-α, IL-1β, IL-6 and IL-8 were measured by ELISA.</p> <p>Results</p> <p>Serum leptin levels were significantly higher and serum IGF-I levels significantly lower in COPD patients on Day 1 than in healthy controls (p < 0.001). A positive correlation was observed between leptin and TNF-α on Day 1 (r = 0.620, p < 0.001). Emphysematous patients had significantly lower IGF-I levels compared to those with chronic bronchitis both on Day 1 and Day 15 (p = 0.003 and p < 0.001 respectively).</p> <p>Conclusion</p> <p>Inappropriately increased circulating leptin levels along with decreased IGF-I levels occured during acute exacerbations of COPD. Compared to chronic bronchitis, patients with emphysema had lower circulating IGF-I levels both at the onset of the exacerbation and two weeks later.</p

Middle Aortic Syndrome: A Case Report and Review of the Literature

Coarctation of the aorta is a relatively common defect that accounts for 5-8% of all congenital heart defects and is characterized by discrete medial thickening with superimposed neointimal tissue, leading to aortic lumen narrowing of different degrees.&nbsp;Today’s knowledge is that the majority of lesions are juxtaductal, with the classic coarctation located in the thoracic aorta distal to the origin of the left subclavian artery at about the level of the ductal structure [1]. However, a coarcted segment may be present in the distal descending thoracic or abdominal aorta and is referred as Middle Aortic Syndrome (MAS). This entity is extremely rare, representing only 0.5-2% of all aortic coarctation cases [2], with total number of published patients not exceeding three hundred. Congenital, acquired, inflammatory, and infectious etiologies have been proposed.</p

The Ca2+-sensitizer levosimendan improves oxidative damage, BNP and pro-inflammatory cytokine levels in patients with advanced decompensated heart failure in comparison to dobutamine

Aim: To investigate the effect of a new inotropic drug, levosimendan compared with dobutamine on levels of brain natriuretic peptide (BNP), interleukin-6 (IL-6), tumor necrosis factor alpha (TNF-alpha), and malondialdehyde (MDA) in patients with severe decompensated heart failure. Methods and results: Twenty-nine consecutive patients (22 males and 7 females), mean age 70.5 +/- 9.9 years, with decompensated heart failure on standard medical therapy, were randomised to receive either a 24 h infusion of levosimendan (n = 15) or dobutamine (n = 14). Blood samples were drawn at baseline, 48 h and 5 days post infusion. Levosimendan produced a significant reduction in BNP compared to baseline, at both 48 h (744.1 +/- 100 vs 1136.3 +/- 93.7 pg/ml, p =0.04) and 5 days (446 +/- 119.3 vs 1136.3 +/- 93.7 pg/ml, p =0.03), while IL-6 values decreased after 5 days (4.8 +/- 1.3 vs 8.6 +/- 1.5 pg/ml, p = 0.01). MDA levels were significantly lower 5 days after levosimendan compared to baseline (2.3 +/- 0.2 vs 3 +/- 0.3 mu M, p = 0.01). TNF-alpha levels did not differ between the groups. The comparison of percentage alteration compared to baseline showed that BNP (-44.5 +/- 7.6% vs 4.8 +/- 18.7%, p = 0.025), MDA (-21.8 +/- 5.1% vs 14.9 +/- 8.5%, p = 0.001) and IL-6 (-38.8 +/- 12.5% vs 70.2 +/- 24%, p = 0.001) levels were significantly lower in the levosimendan group 5 days after treatment compared to the dobutamine group. Conclusions: Treatment with levosimendan in advanced decompensated heart failure exerts a beneficial hemodynamic, anti-inflammatory and antioxidant effect. These findings may give an insight into the favourable impact on mortality that levosimendan appears to have in published multicenter trials. (c) 2005 European Society of Cardiology. Published by Elsevier B.V. All rights reserved

Bifocal right ventricular pacing: An alternative way to achieve resynchronization when left ventricular lead insertion is unsuccessful

Purpose: Bifocal pacing in the right ventricle is an option for patients with end-stage heart failure in whom biventricular pacing is not possible, due to failure in left ventricular (LV) lead insertion. The purpose of this prospective study was to document the clinical response of these patients, after bifocal pacing. Methods: From the patients referred for cardiac resynchronization therapy (CRT), from 2009 to 2010, 13 cardiac CRT candidates who underwent unsuccessful LV lead implantation were included. The bifocal system&apos;s leads were implanted in the right atrium, the right ventricular (RV) apex, and the RV outflow tract. Initial patient assessment and follow-up evaluation after 6 months included clinical criteria, echocardiographic indices, and biochemical parameters. Results: From 13 patients (age 68±9 years, nine male), 10 improved clinically. New York Heart Association classification was reduced by one grade (from 3.6±0.5 to 2.8±0.8, p&lt;0.005 and respectively), while hospitalizations in 6-month time were reduced from three to one (p&lt;0.001). Six-minute walk test (in meters) increased from 176±86 to 297±91 (p&lt;0.001) and quality of life improved (EQ-VAS scale changed from 42±12.5 % to 70.8±20.3 %, p&lt;0.001). Mean shortening in QRS duration was 31.3 ms (from 165.1±16.3 to 133.8±12.7, p&lt;0.001) and B-type natriuretic peptide (in picograms per milliliter) dropped from 834±350 to 621±283 (p&lt;0.001). Ejection fraction (in percent) increased from 27.5±4.6 to 33.3±4.4 (p&lt;0.001), and mitral regurgitation severity decreased by one grade (from 2.7±0.9 to 1.8±0.7, p&lt;0.05). Conclusion: RV bifocal pacing seems to offer a substantial clinical benefit to heart failure patients with traditional CRT indications and could be an alternative option when LV access is unsuccessful. © 2012 Springer Science+Business Media, LLC

Efficacy and safety of the pulsed infusions of levosimendan in outpatients with advanced heart failure (LevoRep) study: A multicentre randomized trial

Aims The aim of this study was to determine whether intermittent ambulatory treatment with levosimendan would improve functional capacity, quality of life, and event-free survival in patients with advanced heart failure. Methods and results This was a prospective, randomized, double-blind, placebo-controlled, multicentre, parallel-group trial of pulsed infusions of levosimendan in 120 outpatients with advanced heart failure (EF ≤35%, NYHA class III or IV). The study was conducted at 11 centres in Austria, Greece, and Germany. Levosimendan (0.2 μg/kg/min) or placebo was administered for 6 h at 2-week intervals over 6 weeks, in addition to standard care therapy. The primary outcome was the proportion of patients with a ≥20% improvement in the 6 min walk test and a ≥15% score increase on the Kansas City Cardiomyopathy Questionnaire at the end of the 24-week study period. Secondary outcomes included event-free survival after 24 weeks. Analyses were performed on an intention-to-treat basis. The primary endpoint was reached in 19% of patients receiving levosimendan and 15.8% of patients receiving placebo (odds ratio 1.25; 95% confidence interval 0.44-3.59; P = 0.810). Cardiac death (four vs. one), heart transplants (two vs. one), and acute heart failure (14 vs. nine) were more frequent with placebo as compared with levosimendan. The incidence of side effects was comparable between groups. Conclusion Intermittent ambulatory treatment with levosimendan in patients with advanced heart failure did not improve significantly functional capacity or quality of life as compared with placebo. An adequately powered, event-driven trial is warranted to enlarge on our findings. Trial registration: NCT01065194. © 2014 The Authors. European Journal of Heart Failure © 2014 European Society of Cardiology

Epidemiology and initial management of pulmonary arterial hypertension: real-world data from the Hellenic pulmOnary hyPertension rEgistry (HOPE)

Pulmonary arterial hypertension (PAH) is a heterogenous clinical entity with poor prognosis, despite recent major pharmacological advances. To increase awareness about the pathophysiology, epidemiology, and management of the disease, large national registries are required. The Hellenic pulmOnary hyPertension rEgistry (HOPE) was launched in early 2015 and enrolls patients from all pulmonary hypertension subgroups in Greece. Baseline epidemiologic, diagnostic, and initial treatment data of consecutive patients with PAH are presented in this article. In total, 231 patients with PAH were enrolled from January 2015 until April 2018. At baseline, about half of patients with PAH were in World Health Organization functional class II. The majority of patients with PAH (56.7%) were at intermediate 1-year mortality risk, while more than one-third were low-risk patients, according to an abbreviated risk stratification score. Half of patients with PAH were on monotherapy, 38.9% received combination therapy, while prostanoids were used only in 12.1% of patients. In conclusion, baseline data of the Greek PAH population share common characteristics, but also have some differences with other registries, the most prominent being a better functional capacity. This may reflect earlier diagnosis of PAH that in conjunction with the increased proportion of patients with atypical PAH could partially explain the preference for monotherapy and the limited use of prostanoids in Greece. Nevertheless, early, advanced specific therapy is strongly recommended. © The Author(s) 2019