Inflammation and fibrosis in patients with atrial fibrillation and heart failure: is there a need for rehabilitation?

Background: Atrial fibrillation (AF) is increasingly prevalent among the general population as well as in those exhibiting heart failure (HF), and the symptomatology progressively worsens when both conditions are met. The aim of this study was to analyse the role of inflammation and fibrosis biomarkers in patients with AF and HF. Methods: 108 subjects with heart failure were enrolled in the study. All patients were evaluated clinically, biologically and echocardiographically. Plasma values of NT-proBNP, Gal-3 and sST2 were determined. Results: Out of all patients, 64.8% experienced at least one AF event. There were no differences in the mean left ventricular ejection fraction between the groups, which was 39.4 ± 11.2%. In terms of left atrium dimensions, the values in the AF group were significantly higher ( 51.19 ± 7.3 vs. 44.68 ± 7.16 mm, p<0.001). AF history was associated with a trend of decreased eGFR - 59,22±24,1 ml/min/1.73m3 vs 75,95±29,1 ml/min/1.73m3 (p=0.006). There was no statistically significant difference in the level of HF biomarkers (sST2, Galectin-3 and NT-pro BNP) between individuals with or without AF. Conclusion: Patients with HF are at greater risk to develop AF. HF biomarkers (sST2, Galectin-3 and NT-pro BNP) are not influenced by the presence of AF

Cardiac Amyloidosis

Amyloidosis represents a heterogeneous group of disorders caused by amyloid fibril deposition in the extracellular space in different organs. Among the many types of amyloidosis cardiac involvement occurs almost exclusively with immunoglobulin light chain amyloidosis (AL amyloidosis) or transthyretin amyloidosis (ATTR amyloidosis). When present cardiac amyloidosis (CA) has a significant impact on disease prognosis. The typical clinical presentation in CA is that of a restrictive cardiomyopathy. Clinical suspicion of CA is based on clinical, laboratory and electrocardiographic findings. The diagnosis is confirmed using echocardiography, cardiac magnetic resonance imaging, biopsy, and/or bone scintigraphy. A precise definition of amyloidosis type is essential for choosing the specific treatment for this condition. Treatment of CA has two components: general treatment of congestive HF, and specific treatment of the underlying protein misfolding disorder

Cardiac rehabilitation after catheter ablation of atrial fibrilation

Atrial fibrillation is the most common arrhythmia worldwide. Besides antiarrhythmic drugs and electrical cardioversion, atrial fibrillation can be treated with a newer technique called catheter ablation. Patients suffering a catheter ablation can benefit from an integrated rehabilitation programme like all other patients suffering a cardiac surgery. Physical training and psycho-educative consultations are specific after catheter ablation and integrated rehabilitation can improve mental health, physical capacity and permits return to sports activities

The Role of IL-6 and ET-1 in the Diagnosis of Coronary MicroVascular Disease in Women

Background: Microvascular angina is a common clinical entity, with about a three-fold higher frequency in women. The pathogenesis of microvascular angina has not been much studied, but inflammation and endothelial dysfunction have been incriminated as the main mechanisms of this disease. Methoss: Our purpose was to analyze whether certain inflammatory markers, i.e., interleukin 6 (IL-6) and endothelin 1 (ET-1), can play a role in the diagnosis of microvascular angina in women. Results: Ninety women with ischemic heart disease were divided into two groups, based on their affliction with either microvascular or macrovascular disease. In general, the levels of IL6 and ET1 were similar between the two groups. Analyzing these marker levels according to the number of coronary lesions, we obtained an increased IL6 value that was similar for patients with microvascular angina, one-vessel, and two-vessel coronary disease, but significantly lower than in women with three-vessel coronary lesions. Also, in microvascular angina, IL6 level was correlated with the NYHA IV functional class. Unexpectedly, the level of ET1 was correlated with left ventricular systolic dysfunction. Conclusions: In women with an increased suspicion of microvascular angina, in whom microvascular dysfunction cannot be tested invasively, IL-6 level, unlike the ET-1 level, might be considered a diagnostic marker of this disease

Particularities of Catheter Ablation in Women with Atrial Fibrillation and Associated Ischemic Heart Disease

Background: Atrial fibrillation is more common in men, but in the presence of ischemic heart disease, this arrhythmia is more frequent in women. However, like in coronary heart disease, women with atrial fibrillation are suboptimally treated. Methods: To identify particularities of ablation, in women with atrial fibrillation and ischemic heart disease. Results: 29 women and 26 men, with documented ischemic heart disease and atrial fibrillation, who underwent catheter ablation, were admitted in the study. No significant differences were registered regarding the heart rate control treatment. Electrical cardioversion was significantly higher in men, while pharmacological cardioversion was predominantly recommended in women. The ablation was performed later in women, after 2.55 &plusmn; 1.84 years versus 1.80 &plusmn; 1.05 in men (p = 0.05). The time elapsed until the ablation was performed was statistically correlated with atypical symptomatology and with the number of antiarrhythmics used prior to the ablation. There were no significant differences for the relapse of atrial fibrillation at 3 months. Quality of life at 3 months after ablation was increased in both groups. Conclusion: Catheter ablation is performed much later in women, and the causes responsible for this delay would be more atypical symptoms and a greater number of antiarrhythmics tried before the ablation