Serum autoantibodies against human oxidized low-density lipoproteins are inversely associated with severity of coronary stenotic lesions calculated by Gensini score

Background: The relationship between autoantibodies against human oxidized low-density lipoprotein (anti-oxLDL) and the progression of atherosclerotic diseases is unclear. This study aimed to investigate the association between serum anti-oxLDL titers and the severity and extent of coronary stenotic lesions. Methods: We measured the titers of IgG anti-oxLDL by enzyme-linked immunosorbent assay (ELISA) in 154 consecutive patients undergoing coronary angiography for suspected coronary heart disease (CHD). The severity and extent of coronary stenotic lesions were evaluated on coronary angiography findings by Gensini score. Results: The anti-oxLDL titers were significantly lower in 117 patients with CHD than those in 37 controls (p < 0.01). The serum anti-oxLDL titers were significantly correlated to serum levels of globulin (r = 0.405), conjugated bilirubin (r = 0.280), high-density lipoprotein (HDL) cholesterol (r = 0.238), homeostatic model assessment for insulin resistance (HOMA-IR) (r = &#8211;0.267), high sensitivity C-reactive protein (hs-CRP) (r = &#8211;0.230), triglyceride (r = &#8211;0.207), advanced glycation end products (AGEs) (r = &#8211;0.200), and malondialdehyde (r = &#8211;0.165). However, only HDL cholesterol and AGEs remained independent predictors of the anti-oxLDL titers after adjusting for confounders. Multivariate regression analysis showed that the anti-oxLDL titers, as well as serum levels of hs-CRP, fasting glucose, and albumin, were significantly associated with Gensini scores. Conclusions: Titers of anti-oxLDL are inversely associated with complicated proatherogenic metabolic risk factors, and the severity of coronary stenotic lesions calculated by Gensini scores, supporting a protective role for anti-oxLDL against the progression of atherosclerosis. (Cardiol J 2011; 18, 4: 364&#8211;370

A novel three-dimensional and tissue Doppler echocardiographic index for diagnosing and prognosticating heart failure with preserved ejection fraction

Introduction: The diagnosis of heart failure with preserved ejection fraction (HFpEF) remains challenging. In this study, a novel echocardiography index based on three-dimensional and tissue Doppler echocardiography for diagnosing and estimating prognosis in HFpEF. Materials and Methods: Patients with symptoms and/or signs of heart failure and normal left ventricular ejection fraction (LVEF ≥50%) who underwent right heart catheterization were screened. Patients were divided based on pulmonary capillary wedge pressure (PCWP) of ≥15 mmHg and PCWP <15 mmHg. A diagnosis of HFpEF was confirmed by PCWP of ≥15 mmHg according to ESC guidelines. A novel index was calculated by the ratio between stroke volume standardized to body surface area (SVI) and tissue Doppler mitral annulus systolic peak velocity S' (SVI/S'). Its diagnostic and prognostic values were determined. Results: A total of 104 patients (mean age 64 ± 12 years) were included. Of these, 63 had PCWP ≥15 mmHg and 41 patients had PCWP <15 mmHg. Compared to the PCWP <15 mmHg group, the ≥15 mmHg group had a significantly lower SVI/S' (P < 0.001). Logistic regression showed that SVI/S' was associated with high PCWP measured invasively. The SVI/S' had an area under the curve of 0.761 for diagnosing classifying between PCWP ≥15 mmHg and <15 mmHg. Kaplan–Meier analysis showed that the lower SVI/S' group showed a poorer prognosis. Conclusions: SVI/S' is a non-invasive index calculated by three-dimensional and tissue Doppler echocardiography. It is a surrogate measure of PCWP and can be used to diagnose and determine prognosis in HFpEF

A Novel Three-Dimensional and Tissue Doppler Echocardiographic Index for Diagnosing and Prognosticating Heart Failure With Preserved Ejection Fraction

INTRODUCTION: The diagnosis of heart failure with preserved ejection fraction (HFpEF) remains challenging. In this study, a novel echocardiography index based on three-dimensional and tissue Doppler echocardiography for diagnosing and estimating prognosis in HFpEF. MATERIALS AND METHODS: Patients with symptoms and/or signs of heart failure and normal left ventricular ejection fraction (LVEF ≥50%) who underwent right heart catheterization were screened. Patients were divided based on pulmonary capillary wedge pressure (PCWP) of ≥15 mmHg and PCWP <15 mmHg. A diagnosis of HFpEF was confirmed by PCWP of ≥15 mmHg according to ESC guidelines. A novel index was calculated by the ratio between stroke volume standardized to body surface area (SVI) and tissue Doppler mitral annulus systolic peak velocity S' (SVI/S'). Its diagnostic and prognostic values were determined. RESULTS: A total of 104 patients (mean age 64 ± 12 years) were included. Of these, 63 had PCWP ≥15 mmHg and 41 patients had PCWP <15 mmHg. Compared to the PCWP <15 mmHg group, the ≥15 mmHg group had a significantly lower SVI/S' (P < 0.001). Logistic regression showed that SVI/S' was associated with high PCWP measured invasively. The SVI/S' had an area under the curve of 0.761 for diagnosing classifying between PCWP ≥15 mmHg and <15 mmHg. Kaplan–Meier analysis showed that the lower SVI/S' group showed a poorer prognosis. CONCLUSIONS: SVI/S' is a non-invasive index calculated by three-dimensional and tissue Doppler echocardiography. It is a surrogate measure of PCWP and can be used to diagnose and determine prognosis in HFpEF

Biomarkers for Predicting Left Atrial or Left Atrial Appendage Thrombus in Anticoagulated Patients with Nonvalvular Atrial Fibrillation

Purpose. Although atrial fibrillation (AF) is often associated with thromboembolic complications, there is no definite biomarker for detecting the presence of thrombi in the left atrial (LA) or left atrial appendage (LAA) in patients with nonvalvular atrial fibrillation (NVAF). Methods. NVAF patients who underwent transesophageal echocardiography (TEE) to evaluate LA/LAA thrombus and spontaneous echo contrast (SEC) before AF ablation were included. Multivariate logistic regression and receiver operating characteristic curve (ROC) analyses were performed to explore the independent risk factors of LA/LAA thrombus and indicate the best cutoff point. Results. Of the 260 consecutive subjects (mean age: 63.67 ± 9.39 years; 42% women), 45 (17.3%) patients were with LA/LAA thrombus, 131 (50.4%) were with SEC, and 84 (32.3%) were with neither thrombus nor SEC. The results of multivariate logistic regression analysis showed that N-terminal pro-B-type natriuretic peptide (NT-proBNP) (OR, 2.179; 95% CI: 1.191–3.987; p=0.012) and red cell distribution width (RDW) (OR, 2.398; 95% CI: 1.075–5.349; p=0.033) were independently correlated with the presence of LA/LAA thrombus but not D-dimer (OR, 0.999; 95% CI: 0.998–1.000; p=0.210). When all patients were divided into four groups based on the combination between RDW (cutoff value: 12.95%) and NT-proBNP levels (cutoff value: 368.9 ng/L), the rate of LA/LAA thrombus was the highest in the high RDW and NT-proBNP group. Conclusion. In anticoagulation patients with NVAF, elevated NT-proBNP and RDW are related to LA/LAA thrombus. Therefore, these might be considered as useful prognostic markers in the management and treatment of NVAF patients

Combination of SVI/S′ and diagnostic scores for heart failure with preserved ejection fraction

The diagnosis of heart failure with preserved ejection fraction (HFpEF) remains a challenge. There are three methods proposed as diagnostic tools. H2FPEF score was determined by six weighted clinical characteristics and echocardiographic variables. Heart Failure Association (HFA)-PEFF algorithm consists of various functional and morphological variables as well as natriuretic peptides. SVI/S′ is a novel echocardiographic parameter calculated by stroke volume index and mitral annulus systolic peak velocity. This study aimed to compare the three approaches in patients with suspected HFpEF. Patients referred to right heart catheterization for suspected HFpEF were classified into low-, intermediate- and high-likelihood groups according to H2FPEF or HFA-PEFF scores. A diagnosis of HFpEF was confirmed by pulmonary capillary wedge pressure (PCWP) of ≥15 mm Hg according to the guidelines. In result, a total of 128 patients were included. Of these, 71 patients with PCWP ≥15 mm Hg and 57 patients with PCWP <15 mm Hg. Moderate correlations were observed between H2FPEF score, HFA-PEFF score, SVI/S′ and PCWP. The area under curve of SVI/S′ was 0.82 for diagnosis of HFpEF, compared with 0.67 for H2FPEF score and 0.75 for HFA-PEFF score by receiver-operating characteristics analysis. Combining SVI/S′ with diagnostic scores showed higher Youden index and accuracy than each score alone. Kaplan–Meier analysis reported that the high-likelihood group showed poorer outcomes regardless the method used for diagnosis. Among the contemporary tools for identifying HFpEF in this study, the combination of SVI/S′ with risk scores showed best diagnostic ability. Each of the strategies can determine rehospitalisation because of heart failure

Combination of SVI/S′ and diagnostic scores for heart failure with preserved ejection fraction

The diagnosis of heart failure with preserved ejection fraction (HFpEF) remains a challenge. There are three methods proposed as diagnostic tools. H2FPEF score was determined by six weighted clinical characteristics and echocardiographic variables. Heart Failure Association (HFA)-PEFF algorithm consists of various functional and morphological variables as well as natriuretic peptides. SVI/S′ is a novel echocardiographic parameter calculated by stroke volume index and mitral annulus systolic peak velocity. This study aimed to compare the three approaches in patients with suspected HFpEF. Patients referred to right heart catheterization for suspected HFpEF were classified into low-, intermediate- and high-likelihood groups according to H2FPEF or HFA-PEFF scores. A diagnosis of HFpEF was confirmed by pulmonary capillary wedge pressure (PCWP) of ≥15 mm Hg according to the guidelines. In result, a total of 128 patients were included. Of these, 71 patients with PCWP ≥15 mm Hg and 57 patients with PCWP <15 mm Hg. Moderate correlations were observed between H2FPEF score, HFA-PEFF score, SVI/S′ and PCWP. The area under curve of SVI/S′ was 0.82 for diagnosis of HFpEF, compared with 0.67 for H2FPEF score and 0.75 for HFA-PEFF score by receiver-operating characteristics analysis. Combining SVI/S′ with diagnostic scores showed higher Youden index and accuracy than each score alone. Kaplan–Meier analysis reported that the high-likelihood group showed poorer outcomes regardless the method used for diagnosis. Among the contemporary tools for identifying HFpEF in this study, the combination of SVI/S′ with risk scores showed best diagnostic ability. Each of the strategies can determine rehospitalisation because of heart failure