094 Relationships between changes in time of quality of life and changes in time of the results of cardiopulmonary exercise test and echocardiography at a follow-up of patients with heart failure

PurposeCardiopulmonary exercise testing, echocardiography and plasma NT-proBNP levels assess patients (pts) with heart failure (HF). Quality of life (QoL) in HF is measured by Minnesota Living with Heart Failure Questionnaire (MLHF) and Specific Activity Questionnaire (SAQ). It is not known whether changes in QoL questionnaire scores correlate to changes in the results of the aforementioned laboratory tests during the follow-up of pts with HF.MethodsWe performed repeat measurements after a median of 26 (21 - 34) months in 30 pts with HF.They underwent a cardiopulmonary exercise test, an echocardiography test (LVEF) and a measurement of plasma NT-proBNP. Pts completed MLHF and SAQ. Changes were calculated in all measures between the first and the second measurement (Δ). All the patients were taking b-blockers, 83% ACE/ARBs and 83% diuretics.ResultsNonsignificant increases were found in peak VO2 (21.47±9.3 to 21.9±4.9 ml/kgr/min; ΔpeakVO2= 1.14±3.5; NS), VE/VCO2 slope (34.47±7 to 35.13±5.1; ΔVE/VCO2= 0.66±5.8; NS), LVEF (32.17±6.27 to 32.48±7.6%; ΔLVEF= 0.16±2.7; NS). NT-proBNP levels decreased nonsignificantly from a median value of 375.5 pg/ml to 235 pg/ml; median ΔNT-proBNP=-21 pg/ml; NS. SAQ scores improved significantly (6.86±1 to 7.48±1.15; ΔSAQ= 0.625±1.43; p=0.029) and MLHF scores decreased significantly from 21.5±9.3 to 16.6±13 (ΔMLHF= -4.13±9.5; p=0.033). ΔSAQ correlated with ΔMLHF (r=-0.417, p=0.03) and ΔpeakVO2 (r=0.448, p=0.017). ΔMLHF correlated with ΔLVEF (r=-0.557, p=0.007). ΔVE/VCO2 correlated with ΔpeakVO2 (r=-0.417, p=0.025). ΔNT-proBNP only correlated with ΔpeakVO2 (r=-0.518, p=0.004) and ΔVE/VCO2 (r=0.538, p=0.003), but with neither questionnaire.ConclusionsSignificant changes in quality of life expressed by MLHF scores relate to nonsignificant changes in left ventricular ejection fraction, while significant changes in activity capacity as measured by SAQ relate to nonsignificant changes in peak oxygen consumption

Low fasting low high-density lipoprotein and postprandial lipemia

BACKGROUND: Low levels of high density lipoprotein (HDL) cholesterol and disturbed postprandial lipemia are associated with coronary heart disease. In the present study, we evaluated the variation of triglyceride (TG) postprandially in respect to serum HDL cholesterol levels. RESULTS: Fifty two Greek men were divided into 2 main groups: a) the low HDL group (HDL < 40 mg/dl), and b) the control group. Both groups were further matched according to fasting TG (matched-low HDL, and matched-control groups). The fasting TG concentrations were higher in the low HDL group compared to controls (p = 0.002). The low HDL group had significantly higher TG at 4, 6 and 8 h postprandially compared to the controls (p = 0.006, p = 0.002, and p < 0.001, respectively). The matched-low HDL group revealed higher TG only at 8 h postprandially (p = 0.017) compared to the matched-control group. ROC analysis showed that fasting TG ≥ 121 mg/dl have 100% sensitivity and 81% specificity for an abnormal TG response (auc = 0.962, p < 0.001). CONCLUSIONS: The delayed TG clearance postprandially seems to result in low HDL cholesterol even in subjects with low fasting TG. The fasting TG > 121 mg/dl are predictable for abnormal response to fatty meal

Prevalence and predictors of liver steatosis and fibrosis in unselected patients with HIV mono-infection

OBJECTIVES: Significant liver disease may develop in HIV mono-infected patients, usually associated with fatty liver and/or cART exposure. We estimated the prevalence and predictors of hepatic steatosis and fibrosis as assessed by ultrasound and transient elastography (TE). METHODS: We enrolled 125 consecutive HIV mono-infected patients who underwent ultrasound and TE. Clinical, biochemical, immunological, virological features and medication history were analysed. RESULTS: Mean age was 39.5 ± 10.3 years and 91% were male. Metabolic syndrome (MS) was present in 9.8%, diabetes in 5.6%, hypertension in 9.7%, dyslipidemia in 32.8%. Increased AST and ALT were found in 5.6% and 16.8% respectively. Eighty-five (68%) patients were on cART (median length of treatment of 3 years, IQR 0–17). Hepatic steatosis was detected in 61 (55%) patients and was independently associated with male sex (OR 14.6, 95% CI 1.44–148.17), age (OR 1.082, 95% CI 1.01–1.16), HOMA (OR 2.56, 95% CI 1.101–5.96) and GGT (OR 1.037, 95% CI 1.007–1.075). Significant fibrosis (stiffness > 7.4 kPa) was present in 22 patients (17.6%) and was significantly associated with MS (OR 3.99, 95% CI 1.001–16.09). CONCLUSIONS: Liver fibrosis can develop in asymptomatic HIV mono-infected patients. This is likely associated with NAFLD and usually manifests with normal transaminases. Non-invasive screening for the presence of NAFLD and fibrosis should be considered in the routine care of such patients

Rate pressure product

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/73724/1/j.1365-2044.1980.tb05005.x.pd

Restitution of the Infarcted Myocardium- the Role of Stem Cells

Even after optimal reperfusion strategies implementing percutaneous coronary intervention (PCI) with stent implantation and modern medical regimen for patients with acute myocardial infarction, myocardial salvage is often incomplete and adverse ventricular remodeling with subsequent heart failure develops. The transplantation of autologous bone marrow stem cells (BM-SCs) via the intracoronary delivery route after PCI of the infarct related artery (IRA) has been investigated in several observational studies which proved the safety and feasibility of the method. The results of the randomized studies were rather controversial. The BOOST study (Bone Marrow transfer to enhance ST-elevation infarction regeneration) was the first randomized study with patients receiving either bone-marrow derived mononuclear cells or placebo 5 days after primary PCI. The improvement of the ejection fraction reported in the cell infusion group at 6 months was attenuated during a follow-up study of 18 months. Of note, a similar restenosis rate (13%) was reported between the 2 groups

Stem Cells and Cardiac Repair

Contrary to the initial belief that the heart is a terminally differentiated organ that cannot replace its own cell damage, there is now proof that the circulating blood provides the injured tissue with adult stem and progenitor cells, which have the potential to differentiate into cardiomyocytes and ultimately improve cardiac function. Thus, transplantation of stem cells into the myocardium in patients with severe myocardial dysfunction post-myocardial infarction is being currently investigated for experimental as well as for clinical purposes. Many issues regarding the mode of action remain to be elucidated. The BOOST trial was the first completed, randomized study that showed safety, feasibility and efficacy of the method. However, a more recent doubleblind, placebo-controlled study failed to reveal an increase in global left ventricular nejection fraction and cast doubt on the efficacy of the method. Thus, further randomized studies are needed to evaluate this novel approach in the treatment of ischemic heart failure and determine its role, safety and efficacy

Contrast-enhanced ultrasound performed under urgent conditions. Indications, review of the technique, clinical examples and limitations

Contrast-enhanced ultrasound (CEUS) is an imaging technique with various indications, most of which refer to scheduled examinations. However, CEUS can also be performed under urgent conditions for the investigation of many different clinical questions. This article reviews basic physics of ultrasound contrast agents and examines the commonest urgent clinical applications of CEUS. These include, among others, abdominal solid organ trauma and infarcts, scrotal and penile pathology and blood vessel imaging. Patients can be examined with a very short time delay at their bedside, without exposure to ionising radiation or risk of anaphylactic reaction and renal failure, while contraindications are minimal. CEUS technique is described for various urgent indications and imaging examples from our department’s experience are presented. Safety matters and limitations of CEUS are also mentioned. Teaching Points Contrast-enhanced ultrasound (CEUS) can be performed urgently for various clinical applications. Abdominal indications include solid organ trauma and infarcts. CEUS in abdominal organ trauma correlates well with CT and can replace it for patient follow-up. CEUS images testicular torsion, infection and infarction, as well as testicular and penile trauma. Blood vessels can be assessed with CEUS for obstruction, aneurysm, thrombosis and dissection