QUALITY OF LIFE IN PATIENTS WITH HEART FAILURE

Srčana insuficijencija zahtijeva od oboljelih svakodnevnu odgovornost i brigu za svoje zdravlje pridržavanjem raznih uputa u okviru svakodnevnog života. Poboljšanje kvalitete života je značajno s obzirom na činjenicu da je prognoza srčane insuficijencije lošija nego kod karcinoma dojke ili prostate. Cilj istraživanja bio je ocijeniti kvalitetu života oboljelih od srčane insuficijencije primjenom SF-36 i Minessota upitnika te utvrditi značenje primjene Framinghamskih kriterija kao prediktora vrijednosti SF-36 i Minnesota upitnika. Presječnom studijom analizirana je kvaliteta života 120 ispitanika oboljelih od srčane insuficijencije, podijeljenih u 4 skupine prema klasifikaciji NYHA. Kontrolnu skupinu činilo je 30 ispitanika koji ne boluju od srčane insuficijencije. Za potvrdu već postavljene dijagnoze srčane insuficijencije korišteni su Framinghamski kriteriji. Procjena kvalitete života učinjena je pomoću SF-36 i Minnesota upitnika. Utjecaj srčane insuficijencije na kvalitetu života bio je u uskoj vezi s težinom kliničke slike. Utvrđena je negativna i statistički značajna korelacija između klase NYHA i parametara SF-36 skora, a pozitivna i statistički značajna korelacija s vrijednosti Minnesota skora. Broj velikih i malih Framinghamskih kriterija značajno je pozitivno korelirao s vrijednostima Minnesota skora, dok je sa SF-36 skorom postojala negativna korelacija. Autori zaključuju da srčana insuficijencija utječe na kvalitetu života pacijenata s tom dijagnozom i u vezi je s težinom kliničke slike. Framinghamski kriteriji mogu poslužiti kao prediktori kvalitete života takvih pacijenata.Objective: The objective of this work was to determine the quality of life in patients with heart failure using the SF-36 and Minnesota questionnaire and to determine the importance of applying Framingham criteria as predictors of the value of these questionnaires. Patients and Methods: This cross-sectional study analyzed the quality of life in 120 subjects of both sexes and all age groups suffering from heart failure, according to the severity of clinical presentation. Subjects were divided into 4 equal groups according to NYHA classification of heart failure. Selection of subjects was made using the Framingham criteria for confirming already diagnosed heart failure. Control group included 30 patients not suffering from heart failure. Quality of life was assessed by use of the SF-36 and Minnesota questionnaire. Results: In the study population of 150 subjects, there were 76 (51%) male and 74 (49%) female subjects divided into 4 NYHA groups of 30 subjects (20.0%) and control group of 30 subjects (20.0%). The analysis of within-group sex representation yielded no statistically significant difference (χ2=1.70, df=4; p=0.79). There was no statistically significant between-group age difference either (ANOVA, F=0.74; p=0.57). The values of SF-36 and Minnesota score expressed as median in the control and 4 NYHA groups were 98.6, 90.76, 70.14, 36.45 and 25.41 (Ht=116.84; p<0.0001) and 0.0, 0.47, 1.64, 2.99 and 3.42 (Ht=113.42; p<0.0001), respectively. The correlation coefficient r between heart failure NYHA classes expressed in the values of SF-36 and Minnesota score was r=-0950; p<0.0001 and r=0.931; p<0.0001, respectively. The correlation coefficient r between the number of major and minor Framingham criteria and the values of SF-36 and Minnesota score was r=-0.790, -0.660; p<0.0001 and r=0.774, 0.671; p<0.0001, respectively. Conclusion: The findings suggested that the quality of life in patients with heart failure was impaired and associated with the severity of clinical presentation, and that Framingham criteria could serve as significant predictors of the value of SF-36 and Minnesota scores and quality of life in patients with heart failure

Utječu li hormon rasta i inzulinu sličan čimbenik rasta 1 na prognozu u bolesnika s akutnim infarktom miokarda klase killip I-II?

We investigated concentrations and roles of insulin-like growth factor 1 (IGF-1) and its binding protein (IGF1BP-3), growth hormone (GH), insulin, and markers of insulin resistance and inflammation in acute myocardial infarction (AMI). We aimed to assess any possible association between serum GH/IGF-1 axis following AMI and short-term survival rates. A follow up study was performed in 2010. Study group consisted of 75 patients with Killip I and II class AMI. There were 30 control subjects. Blood samples were obtained within 24 hours of admission and analyzed for the aforementioned hormones. Patients were followed-up during 6 months for new cardiac events. Median GH was higher in AMI (0.96; range 0.6-2.4) than in controls (0.26; p<0.001). IGF-1 was significantly lower in AMI (123 vs. 132; p<0.05), and so was the IGF-1/GH ratio (p<0.001) and IGF1BP-3. Insulin was higher in study group, but without statistical significance. However, we found significant between-group differences in other markers of insulin resistance (HbA1c, glycemia, HOMA-IR) and inflammation. Simple linear correlation showed positive correlation between GH and C-reactive protein. All patients with new cardiac events had IGF-1 below median and lower left ventricular ejection fraction. In conclusion, IGF-1 may affect outcome of AMI. GH resistance might be a result of inflammatory/immune response and therefore it could be a useful prognostic marker.Istraživali smo uloge inzulinu sličnog čimbenika rasta (IGF-1), njegovog vezujućeg proteina (IGF1BP-3), hormona rasta (growth hormone, GH), inzulina, biljega inzulinske rezistencije i upale u akutnom infarktu miokarda (AIM). Cilj je bio utvrditi utjecaj osovine IGF-1/GH na kratkoročnu prognozu AIM. U istraživanje provedeno tijekom 2010. godine bilo je uključeno 75 bolesnika s dijagnozom AIM (ispitna skupina) i 30 ispitanika kao kontrolna skupina. Uzorci krvi su uzimani unutar 24 h od prijma i potom analizirani na navedene hormone. Tijekom šestomjesečnog razdoblja pratili smo hoće li doći do pojave novih srčanih događaja; ultrazvučno se određivala ejekcijska frakcija (EF). Medijan GH bio je veći u skupini s AIM nego u kontrolnoj skupini (0,96 prema 0,26; p<0,001); medijan IGF-1 bio je znatno manji u ispitnoj skupini (123 prema 132; p<0,05), baš kao i omjer IGF-1/GH (p<0,001) i IGF-1BP-3. Inzulin je bio viši u ispitnoj skupini, ali razlika nije bila statistički značajna. Utvrđena je statistički značajna razlika u drugim glikemijskim parametrima (glukoza, HbA1c, HOMA IR) i nespecifičnim biljezima upale. Utvrdili smo pozitivnu linearnu korelaciju između GH i C-reaktivnog proteina. Svi bolesnici s novim koronarnim događajima imali su IGF-1 ispod medijana, te nižu EF. U zaključku, IGF-1 bi mogao utjecati na prognozu bolesnika s AIM. Rezistencija na GH je rezultat upalnog/imunog odgovora i mogla bi biti koristan prognostički biljeg

Aterosklerotske promjene krvnih sudova glave i vrata u bolesnika sa sistemskim eritemskim lupusom

The aim of this study was to evaluate the presence of atherosclerotic plaque of head and neck blood vessels and to determine the dynamics of circulation through the brain blood vessels in patients with systemic lupus erythematosus (SLE). In 35 patients with SLE aged 37.67±9.96 and whose disease lasted 3.8±4.51 years, Doppler carotid ultrasonography was used to identify the presence of intima-media thickness or atherosclerotic plaque. Brain perfusion scintigraphy was done in 15 out of 35 patients in order to evaluate the dynamics in circulation through carotid and cerebral media arteries. Measured by Doppler ultrasound, 2/35 of examined lupus patients had a plaque and the 2/35 had an intimal-medial thickness. The results of perfusion scintigraphy in 15 examined patients out 35 with SLE showed that 5/15 had mild circulatory changes in carotidogram. 4/15 patients had mild changes in cerebra media arteries circulation, 1/15 had severe changes in carotid circulation and 5/15 patients had normal brain scintigraphy finding. Some of the patients with SLE have atherosclerotic changes and only the early detection of atherosclerosis may provide an opportunity for therapeutic intervention.Cilj rada je evaluirati prisustvo aterosklerotskog plaka na krvnim sudovima glave i vrata te procjeniti promjene u cirkulaciji kroz krvne sudove mozga u bolesnika sa sistemskim eritemskim lupusom (SLE). U 35 pacijenata sa SLE prosječne životne dobi 37,67±9,96 godina i dužine trajanja bolesti od 3,8±4,51godina uradila se Doppler ultrasonografija karotidnih arterija da bi se ustanovilo eventualno prisustvo zadebljanja intima-media zida krvnog suda ili prisustvo aterosklerotskog plaka. Perfuziona scintigrafija mozga uradi se u 15 od 35 pacijenata sa ciljem procjene promjena u cirkulaciji kroz krvne sudove mozga. Mjereno ultrazvučno 2/35 pacijenata sa lupusom su imali aterosklerotski plak, a 2/35 zadebljanje zida krvnog suda. Rezultati scintigrafije mozga su pokazali blage cirkulatorne promjene na karotidogramu u 5/15 pacijenata, 4/15 pacijenata su imali blage promjene u cirkulaciji kroz aa. cerebri mediae. 1/15 je imao teške promjene u karotidnoj cirkulaciji, dok je u 5/15 pacijenata nalaz bio uredan. U pacijenata sa SLE postoji određen stepen aterosklerotskih promjena te samo rana dijegnoza može doprinjeti pravodobnoj terapijskoj intervenciji

Do growth hormone and insulin-like growth factor 1 affect prognosis in patients with killip I and II class acute myocardial infarction?

We investigated concentrations and roles of insulin-like growth factor 1 (IGF-1) and its binding protein (IGF1BP-3), growth hormone (GH), insulin, and markers of insulin resistance and inflammation in acute myocardial infarction (AMI). We aimed to assess any possible association between serum GH/IGF-1 axis following AMI and short-term survival rates. A follow up study was performed in 2010. Study group consisted of 75 patients with Killip I and II class AMI. There were 30 control subjects. Blood samples were obtained within 24 hours of admission and analyzed for the aforementioned hormones. Patients were followed-up during 6 months for new cardiac events. Median GH was higher in AMI (0.96; range 0.6-2.4) than in controls (0.26; p<0.001). IGF-1 was significantly lower in AMI (123 vs. 132; p<0.05), and so was the IGF-1/GH ratio (p<0.001) and IGF1BP-3. Insulin was higher in study group, but without statistical significance. However, we found significant between-group differences in other markers of insulin resistance (HbA1c, glycemia, HOMA-IR) and inflammation. Simple linear correlation showed positive correlation between GH and C-reactive protein. All patients with new cardiac events had IGF-1 below median and lower left ventricular ejection fraction. In conclusion, IGF-1 may affect outcome of AMI. GH resistance might be a result of inflammatory/immune response and therefore it could be a useful prognostic marker

Left ventricular diastolic function in acute myocardial infarction

Poremećaj dijastoličke funkcije lijeve klijetke (LK) je jedan od prvih poremećaja funkcije LK, koji se registriraju prije poremećaja regionalnog kontraktiliteta, EKG promjena i bola u prsnom košu, što bitno mijenja prognozu pacijenata sa akutnim koronarnim sindromom. Poremećaj relaksacije LK često se registrira u pacijenata s akutnim infarktom miokarda (AIM), a poremećaj krutosti LK u pacijenata s AIM prednje stijenke. Najizraženija dijastolička abnormalnost uzrokovana ishemijom miokarda je produžena i usporena relaksacija miokarda. Ehokardiografske tehnike omogućavaju evaluaciju dijastoličkog punjenja obje pretklijetke i klijetke. Cilj ovog rada je bio utvrditi dijastoličku funkciju LK u bolesnika s AIM i usporediti varijable dijastoličke funkcije u skupinama bolesnika s AIM anteroseptalne i inferiorne stijenke. U prospektivno istraživanje uključeno je 60 bolesnika (37 muškaraca, prosječne životne dobi 59±10 godina) s prvim AIM koji su podijeljeni u dvije skupine prema lokalizaciji EKG promjena (anteroseptalna naspram inferiorne stijenke). Praćene su varijable dijastoličke funkcije LK koje su analizirane kontinuiranom (mitralni protok) i pulsnom kolor Doppler ehokardiografskom tehnikom (protok u plućnim venama i pokreti mitralnog prstena). Vrijednosti brzina ranog dijastoličkog punjenja nije se statistički značajno razlikovala u obje skupine, ali je bila niža u odnosu na prosječnu vrijednost brzine ranog dijastoličkog punjenja LK kod zdravih osoba. U maksimalnoj brzini sistoličkog protoka plućnih vena registrirana je statistički značajna razlika (p<0,05) između ispitivanih skupina. U prvoj skupini iznosila je 0,48±0,10, a u drugoj skupini iznosila je 0,57±0,14. Maksimalna brzina dijastoličkog protoka plućnih vena u prvoj skupini iznosila je 0,37±0,09, a u drugoj skupini iznosila je 0,43±0,16. Odnos maksimalne brzine sistoličkog i dijastoličkog protoka plućnih vena je nešto veći nego kod zdravih osoba. U bolesnika s AIM dominira (70%) dijastolička disfunkcija tipa poremećaja relaksacije LK. U ispitivanoj skupini bolesnika s anteroseptalnim AIM dijastolička disfunkcija tipa poremećaja relaksacije je dominantna, odnosno registrirana je statistički značajna razlika u odnosu na očuvanu dijastoličku funkciju i na dijastoličku disfunkciju tipa poremećaja restrikcije LK (p<0,05). Zaključno, kod AIM, kako anteroseptalne tako i inferiorne stijenke, promijenjeni su parametri dijastoličke funkcije, odnosno prisutna su sva tri stupnja dijastoličke disfunkcije LK. Dominira dijastolička disfunkcija tipa poremećaja relaksacije miokarda. U AIM anteroseptalne stijenke najviše je prisutna dijastolička disfunkcija tipa poremećaja relaksacije, odnosno postoji dobra korelacija s infarciranom zonom u odnosu na inferiornu stijenku.Left ventricular (LV) diastolic function disorder is one of the first LV function disorders, which is detected before the regional disorder of contractility, ECG changes and chest pains, which significantly changes the prognosis of patients with acute coronary syndrome. The disorder of LV relaxation is often detected in patients with acute myocardial infarction (AMI), a disorder of LV stiffness in patients with anterior wall AMI. The most pronounced diastolic abnormality caused by myocardial ischemia is prolonged and delayed myocardial relaxation. Echocardiographic techniques allow the evaluation of diastolic filling of the both atria and ventricles. The aim of this study was to determine the LV diastolic function in patients with AMI and compare the diastolic function variables in the groups of patients with anteroseptal and inferior wall AMI. The prospective trial included 60 patients (37 men; mean age 59 ± 10) with first AMI who were divided into two groups according to the localization of ECG changes (anteroseptal vs. inferior wall). LV diastolic function variables were monitored that were analyzed by continuous (mitral flow) and pulsed color Doppler echocardiography technique (flow in the pulmonary veins and mitral ring motions). The value ​​of velocity of early diastolic filling was not statistically significantly different in the both groups, but it was lower compared to the average value of the velocity of the early diastolic filling of LV in healthy persons. In the maximum velocity of systolic pulmonary venous flow, a statistically significant difference was recorded (p <0.05) among the groups of patiets. In the first group it was 0.48±0.10, while in the second group it was 0.57 ± 0.14. Maximum velocity of diastolic pulmonary venous flow in the first group was 0.37±0.09, while in the second group it was 0.43±0.16. The ratio of maximum velocity of systolic and diastolic pulmonary venous flow was slightly higher than in healthy individuals. In patients with AMI, diastolic dysfunction of the LV relaxation disorder type prevails (70%). In the examined group of patients with anteroseptal AMI, diastolic dysfunction of the relaxation disorder type prevails, that is, a statistically significant difference compared to the preserved diastolic function and diastolic dysfunction of the LV restriction disorder type (p <0.05) is recorded. Finally, in case of anteroseptal and inferior wall AMI, the parameters of diastolic function are changed, that is, all three degrees of LV diastolic dysfunction are present. Diastolic dysfunction of myocardial relaxation disorder type prevails. In anteroseptal wall AMI, diastolic dysfunction of relaxation disorder type is present, that is, there is a good correlation with infarcated zone in relation to the inferior wall