Could an analysis of mean corpuscular volume help to improve risk stratification in non-anemic patients with acute myocardial infarction?

Background: Nowadays, when the majority of patients with acute myocardial infarction (AMI) are treated with primary percutaneous coronary intervention and modern pharmacotherapy, risk stratification becomes a challenge. Simple and easily accessible parameters that would help in a better determination of prognosis are needed. The aim of the study was to estimate the prevalence of high mean corpuscular volume (MCV, defined as MCV > 92 fL) and to establish its prognostic value in non-anemic patients with AMI. Methods: We retrospectively analyzed the data of 248 consecutive non-anemic patients hospitalized due to AMI (median age: 65 [59–76] years, men: 63%, ST segment elevation myocardial infarction: 31%, and median left ventricular ejection fraction [LVEF]: 50%). Results: The prevalence of high MCV was 39 ± 6% (± 95% confidence interval) in the entire AMI population. High MCV was more prevalent in males, patients with low body mass index, non-diabetics and cigarette smokers (all p < 0.05). During the 180-day follow-up, there were 38 (15%) events, defined as another AMI or death. In a multivariable Cox proportional hazard model, female gender (p < 0.01), low LVEF (p < 0.001), previous AMI (p < 0.05), arterial hypertension (p < 0.05), and high MCV (p < 0.001) were prognosticators of pre-defined events. Conclusions: In non-anemic patients with AMI, high MCV is an independent prognostic factor of poor outcome defined as another AMI or death.

Iron status, catabolic/anabolic balance, and skeletal muscle performance in men with heart failure with reduced ejection fraction

Background: Metabolic derangements related to tissue energetics constitute an important pathophysiological feature of heart failure. We investigated whether iron deficiency and catabolic/anabolic imbalance contribute to decreased skeletal muscle performance in men with heart failure with reduced ejection fraction (HFrEF), and whether these pathologies are related to each other. Methods: We comprehensively examined 23 men with stable HFrEF (median age [interquartile range]: 63 [59–66] years; left ventricular ejection fraction: 28 [25–35]%; New York Heart Association class I/II/III: 17/43/39%). We analyzed clinical characteristics, iron status, hormones, strength and fatigability of forearm flexors and quadriceps (surface electromyography), and exercise capacity (6-minute walking test). Results: None of the patients had anemia whereas 8 were iron-deficient. Flexor carpi radialis fatigability correlated with lower reticulocyte hemoglobin content (CHR, p < 0.05), and there was a trend towards greater fatigability in patients with higher body mass index and lower serum ferritin (both p < 0.1). Flexor carpi ulnaris fatigability correlated with lower serum iron and CHR (both p < 0.05). Vastus medialis fatigability was related to lower free and bioavailable testosterone (FT and BT, respectively, both p < 0.05), and 6-minute walking test distance was shorter in patients with higher cortisol/FT and cortisol/BT ratio (both p < 0.05). Lower ferritin and transferrin saturation correlated with lower percentage of FT and BT. Men with HFrEF and iron deficiency had higher total testosterone, but lower percentage of FT and BT. Conclusions: Iron deficiency correlates with lower bioactive testosterone in men with HFrEF. These two pathologies can both contribute to decreased skeletal muscle performance in such patients

Correction to: Passive blood anaphylaxis: subcutaneous immunoglobulins are a cause of ongoing passive anaphylactic reaction

Upon publication of the original article [1], the authors reported the following funding information was omitted: Publication supported by Wroclaw Centre of Biotechnology, programme The Leading National Research Centre (KNOW) for years 2014–2018

ORGINAL ARTICLEUtrzymujące się wysokie stężenie NT-proBNP jest czynnikiem złego rokowania u chorych ze zdekompensowaną niewydolnoœcią serca

Introduction: Monitoring of natriuretic peptide concentration may be useful for the identification of high-risk patients presenting with decompensated chronic heart failure (CHF). Aim: Assessment of the predicting value of a significant decrease (by ≥20% vs. baseline) of N-terminal proBNP (NTpro-BNP, ROCHE) concentration during hospitalisation in patients with decompensated CHF. Methods: This study involved 54 patients admitted to our centre because of CHF decompensation. Concentration of NTpro-BNP was measured on admission and at discharge from hospital. Primary end-points of this study were overall mortality and mortality with a number of cardiovascular-related readmissions. Results: Mean NTpro-BNP concentration on admission was 7435±10040 pg/ml and at the time of discharge from hospital – 4816±7822 pg/ml. In 31 (57%) patients a significant decrease (≥20% vs baseline value) in NTpro-BNP level (mean: –58%±21%) was noted, while in the remainder (23 patients; 43%) neither an increase nor a decrease in NTpro-BNP levels was observed (mean: +72%±132%) despite optimal treatment and stabilisation of the clinical status. The mean follow-up duration was 358±240 days. Cox analysis showed that the absence of significant NTpro-BNP level decrease was associated with an increased risk of death – RR: 3.69 (95% CI: 1.10–12.37; p=0.035) and was the single independent risk factor for readmission due to cardiovascular-related reasons and/or death – RR: 2.29 (95% CI: 1.20–4.35; p=0.01). In the group of 23 patients with an increase or decrease in NTpro-BNP concentration of more than or equal to 20%, the survival rate was 65% vs. 87% in the remainder (p=0.02). Conclusions: The lack of a significant (≥20%) decrease of NTpro-BNP level during hospitalisation correlates with a higher mortality and rate of readmissions. NTpro-BNP level monitoring may be of clinical importance for risk stratification in patients hospitalised for decompensated CHF.Wstęp: Wśród chorych ze zdekompensowaną niewydolnością serca (NS) monitorowanie stężenia peptydów natriuretycznych może okazać się przydatne w selekcji grupy wysokiego ryzyka. Cel pracy: Ocena wartości prognostycznej istotnego spadku (≥20% wartości wyjściowej) stężenia N-końcowego fragmentu proBNP (Nt-proBNP, ROCHE) w trakcie hospitalizacji w grupie chorych ze zdekompensowaną NS. Metodyka: Do badania włączono 54 pacjentów, hospitalizowanych w naszym ośrodku z powodu dekompensacji NS. Stężenie Nt-proBNP oznaczano przy przyjęciu oraz przy wypisie chorego ze szpitala. Pierwotnymi punktami końcowymi była śmiertelność całkowita oraz śmiertelność wraz z liczbą hospitalizacji z przyczyn sercowo-naczyniowych. Wyniki: Stężenie Nt-proBNP przy przyjęciu wynosiło średnio 7435±10040 pg/ml, przy wypisie 4816±7822. U 31 chorych (57%) obserwowano istotny spadek (o ≥20% wartości wyjściowej) wartości Nt-proBNP (średnio: -58%±21%), natomiast u pozostałych 23 chorych (43%) brak istotnego spadku lub wzrost wartości Nt-proBNP (średnio: +72%±132%) pomimo leczenia i stabilizacji klinicznej. Analiza Coxa wykazała, że brak istotnego spadku Nt-proBNP wiązał się z podwyższonym ryzykiem zgonu – RR: 3,69 (95%CI: 1,10–12,37; p=0,035) oraz był jedynym czynnikiem wskazującym na zwiększone ryzyko hospitalizacji z przyczyn sercowo-naczyniowych i zgonu (łącznie) – RR: 2,29 (95%CI: 1,20–4,35; p=0.01). W grupie 23 chorych, u których wystąpił wzrost lub spadek stężenia Nt-proBNP o ł20% przeżycie wyniosło 65% vs 87% u pozostałych chorych (p=0,02). Wnioski: Brak istotnego (≥20%) spadku stężenia Nt-proBNP podczas hospitalizacji wiąże się z częstszym występowaniem zgonów i ponownych hospitalizacji. Monitorowanie stężenia Nt-proBNP może mieć praktyczne zastosowanie w stratyfikacji ryzyka u chorych ze zdekompensowaną NS