Omecamtiv mecarbil in chronic heart failure with reduced ejection fraction, GALACTIC‐HF: baseline characteristics and comparison with contemporary clinical trials

Aims: The safety and efficacy of the novel selective cardiac myosin activator, omecamtiv mecarbil, in patients with heart failure with reduced ejection fraction (HFrEF) is tested in the Global Approach to Lowering Adverse Cardiac outcomes Through Improving Contractility in Heart Failure (GALACTIC‐HF) trial. Here we describe the baseline characteristics of participants in GALACTIC‐HF and how these compare with other contemporary trials. Methods and Results: Adults with established HFrEF, New York Heart Association functional class (NYHA) ≥ II, EF ≤35%, elevated natriuretic peptides and either current hospitalization for HF or history of hospitalization/ emergency department visit for HF within a year were randomized to either placebo or omecamtiv mecarbil (pharmacokinetic‐guided dosing: 25, 37.5 or 50 mg bid). 8256 patients [male (79%), non‐white (22%), mean age 65 years] were enrolled with a mean EF 27%, ischemic etiology in 54%, NYHA II 53% and III/IV 47%, and median NT‐proBNP 1971 pg/mL. HF therapies at baseline were among the most effectively employed in contemporary HF trials. GALACTIC‐HF randomized patients representative of recent HF registries and trials with substantial numbers of patients also having characteristics understudied in previous trials including more from North America (n = 1386), enrolled as inpatients (n = 2084), systolic blood pressure < 100 mmHg (n = 1127), estimated glomerular filtration rate < 30 mL/min/1.73 m2 (n = 528), and treated with sacubitril‐valsartan at baseline (n = 1594). Conclusions: GALACTIC‐HF enrolled a well‐treated, high‐risk population from both inpatient and outpatient settings, which will provide a definitive evaluation of the efficacy and safety of this novel therapy, as well as informing its potential future implementation

Vaccination in the elderly population

It is known that the immune systems tend to weaken over time, putting elderly patients at higher risk for chronic diseases such as cardiovascular (CV) diseases, diabetes, chronic renal disorders and their complication as well as infectious disease leading to an increased mortality and morbidity rates in patients over 65 years old. Vaccination, a prophylactic treatment strategy, means that immunogenic materials from pathogens (or tumours) are administered to generate an adequate immune response specifically to these antigens. Vaccine-preventable diseases which can affect the elderly population are influenza, pneumococcal disease, tetanus, hepatitis B and zona zoster. It is recommended that all adults over 65 years old, and for adults younger than 65 years who have certain chronic health conditions receive seasonal influenza vaccination annually, pneumococcal vaccines and zoster vaccine. Also tetanus vaccine administration is recommended every 10 years in adults

Assessment of valvulopathy in Parkinson's disease patients on pergolide and/or cabergoline

Objective: To assess the effect of ergot derivatives on cardiac valves in patients with Parkinson's disease (PD). Materials and methods: Echocardiography was performed on 46 PD patients who used either pergolide or cabergoline (MonoPD) or both (MixPD) for a minimum of 1 year and 49 age-matched healthy controls. Valvular regurgitation was graded as mild, moderate and severe. MonoPD and MixPD groups were compared with regard to demographic features, drug profile and valvulopathy. Results: The PD group had a mean age of 63 years, agonist duration of 3.8 years and agonist equivalent dose of 3.5 mg/day. Moderate regurgitation in all three valves was significantly more common in the PD group than the controls. Severe valvular regurgitation was not observed in either group, with the exception of one PD patient. The frequency of valvulopathy and doses of agonists did not differ between MixPD and MonoPD groups. Conclusion: PD patients on dopamine ergot agonists are prone to moderate valvular regurgitation more than age-matched controls. However, the frequency of valvulopathy was similar in patients who used either one or more agonists. © 2007 Elsevier B.V. All rights reserved

Apelin in ST segment elevation and non-ST segment elevation acute coronary syndromes: a novel finding

Background: Apelin is a novel endogenous peptide with inotropic and vasodilatory properties. Aim: To investigate the role of apelin in the prognosis of acute coronary syndromes (ACS) and to assess the relationship between apelin and other diagnostic and prognostic markers. Methods: Seventy-six patients with ACS (mean age 62.1 ± 10 years) were evaluated in terms of their plasma apelin-36 concentrations, ejection fraction (EF), high sensitivity C-reactive protein (hsCRP), creatine kinase (CK), CK-MB and troponin I levels. The study group consisted of 35 ST elevation myocardial infarction (STEMI) and 41 non-ST elevation (NSTE) ACS patients. Patients were followed up for one year for cardiovascular outcomes. Results: There was no significant relationship between apelin and TIMI, GRACE, GENSINI scores, hsCRP and EF in STEMI and NSTE-ACS groups (p > 0.05). Apelin showed positive correlations with CK, CK-MB and troponin I in patients with NSTE-ACS, but a negative correlation in patients with STEMI (p < 0.05). There were no statistically significant differences between patients reaching the composite end point at one year with regard to apelin levels. Conclusions: Apelin was positively correlated with cardiac biomarkers in patients with NSTE-ACS but negatively correlated in patients with STEMI. In STEMI, generally larger amounts of myocardial cells are subjected to infarction compared to NSTE-ACS, which may explain why apelin levels decrease with increasing CK, CK-MB and troponin levels in STEMI patients. Copyright © Polskie Towarzystwo Kardiologiczne

Stężenie apeliny u chorych z ostrymi zespołami wieńcowymi z uniesieniem odcinka ST i bez uniesienia odcinka ST: nowe dane

Background: Apelin is a novel endogenous peptide with inotropic and vasodilatory properties.Aim: To investigate the role of apelin in the prognosis of acute coronary syndromes (ACS) and to assess the relationship between apelin and other diagnostic and prognostic markers.Methods: Seventy-six patients with ACS (mean age 62.1 ± 10 years) were evaluated in terms of their plasma apelin-36 concentrations, ejection fraction (EF), high sensitivity C-reactive protein (hsCRP), creatine kinase (CK), CK-MB and troponinI levels. The study group consisted of 35 ST elevation myocardial infarction (STEMI) and 41 non-ST elevation (NSTE) ACSpatients. Patients were followed up for one year for cardiovascular outcomes.Results: There was no significant relationship between apelin and TIMI, GRACE, GENSINI scores, hsCRP and EF in STEMI andNSTE-ACS groups (p &gt; 0.05). Apelin showed positive correlations with CK, CK-MB and troponin I in patients with NSTE-ACS, but a negative correlation in patients with STEMI (p &lt; 0.05). There were no statistically significant differences between patients reaching the composite end point at one year with regard to apelin levels.Conclusions: Apelin was positively correlated with cardiac biomarkers in patients with NSTE-ACS but negatively correlated in patients with STEMI. In STEMI, generally larger amounts of myocardial cells are subjected to infarction compared to NSTE-ACS, which may explain why apelin levels decrease with increasing CK, CK-MB and troponin levels in STEMI patients.Wstęp: Apelina jest nowym endogennym peptydem o działaniu inotropowym dodatnim i wazodylatacyjnym.Cel: Celem badania były ocena rokowniczego znaczenia apeliny u pacjentów z ostrym zespołem wieńcowym (ACS) i określenie zależności między stężeniem apeliny oraz innymi wskaźnikami diagnostycznymi i prognostycznymi.Metody: U 76 chorych z ACS (średnia wieku 62,1 ± 10 lat) wykonano badania w celu oceny stężenia apeliny-36 w osoczu, frakcji wyrzutowej (EF) oraz stężeń białka C-reaktywnego mierzonego metodą wysokoczułą (hsCRP), kinazy kreatynowej (CK), CK-MB i troponiny I. Badana grupa składała się z 35 chorych z zawałem serca z uniesieniem odcinka ST (STEMI) i 41 chorychz ACS bez uniesienia odcinka ST (NSTE-ACS). Chorych obserwowano przez rok pod kątem zdarzeń sercowo-naczyniowych.Wyniki: Ani w grupie STEMI, ani w grupie NSTE-ACS nie stwierdzono istotnych zależności między stężeniem apeliny a punktacją w skalach TIMI, GRACE i GENSINI, stężeniem hsCRP oraz EF (p &gt; 0,05). U pacjentów z NSTE-ACS wykazano dodatnią korelację między stężeniem apeliny a stężeniami CK, CK-MB i troponiny I, natomiast u pacjentów ze STEMI korelacja ta była ujemna (p &lt; 0,05). Po roku nie stwierdzono istotnych statystycznie różnic pod względem stężenia apeliny między pacjentami, u których wystąpił złożony punkt końcowy.Wnioski: Apelina korelowała dodatnio z biomarkerami sercowymi u osób z NSTE-ACS, jednak u pacjentów ze STEMI korelacja ta była ujemna. U chorych ze STEMI martwicy ulega na ogół większa liczba komórek miokardium niż w przypadku NSTE-ACS, co może tłumaczyć redukcję stężenia apeliny przy zwiększonych stężeniach CK, CK-MB i troponin u pacjentów ze STEMI

Apelin in ST segment elevation and non-ST segment elevation acute coronary syndromes: A novel finding

Background: Apelin is a novel endogenous peptide with inotropic and vasodilatory properties. Aim: To investigate the role of apelin in the prognosis of acute coronary syndromes (ACS) and to assess the relationship between apelin and other diagnostic and prognostic markers. Methods: Seventy-six patients with ACS (mean age 62.1 ± 10 years) were evaluated in terms of their plasma apelin-36 concentrations, ejection fraction (EF), high sensitivity C-reactive protein (hsCRP), creatine kinase (CK), CK-MB and troponin I levels. The study group consisted of 35 ST elevation myocardial infarction (STEMI) and 41 non-ST elevation (NSTE) ACS patients. Patients were followed up for one year for cardiovascular outcomes. Results: There was no significant relationship between apelin and TIMI, GRACE, GENSINI scores, hsCRP and EF in STEMI and NSTE-ACS groups (p > 0.05). Apelin showed positive correlations with CK, CK-MB and troponin I in patients with NSTE-ACS, but a negative correlation in patients with STEMI (p < 0.05). There were no statistically significant differences between patients reaching the composite end point at one year with regard to apelin levels. Conclusions: Apelin was positively correlated with cardiac biomarkers in patients with NSTE-ACS but negatively correlated in patients with STEMI. In STEMI, generally larger amounts of myocardial cells are subjected to infarction compared to NSTE-ACS, which may explain why apelin levels decrease with increasing CK, CK-MB and troponin levels in STEMI patients. Copyright © Polskie Towarzystwo Kardiologiczne