Effect of Combined Endurance/Strength Training on Heart Rate Variability of Men with Chronic Coronary Artery Disease

31 mužů s chronickou ischemickou chorobou srdeční (průměrný věk 64 ± 11 let, průměrná váha 83 ± 10 kg, průměrná výška 177 ± 6 cm, průměrná ejekční frakce levé komory srdeční 47 ± 11 %), bylo vyšetřeno před a po tři měsíce trvajícím aerobním tréninku kombinovaném (od třetího týdne) se silovým cvičením. Symptomy limitovaná spiroergometrie byla provedena před a po tréninkové periodě. Trénink (tréninková jednotka) byla prováděna třikrát týdně. Před zátěžovým testem byla provedena krátkodobá analýza variability srdeční frekvence. Ukazatelé HRV ve frekvenční doméně byly získány ráno v klidu při metronomem kontrolovaném dýchání. Celkový spektrální výkon (TP), spektrální výkon v nízkofrekvenčním (LF, 0,05–0,15 Hz) a spektrální výkon ve vysokofrekvenčním (HF, 0,15–0,5 Hz) pásmu spektra a jejich vzájemný poměr (LF/HF) byly měřeny v průběhu 5minutového monitorování. Dvanáct týdnů trvající kombinovaný vytrvalostní/silový trénink zvýšil HRV (HF, LF a TP) u mužů se stabilní chronickou ischemickou chorobou srdeční.31 men with chronic coronary artery disease (mean age 64 ± 11 years, mean body weight 83 ± 10 kg, mean height 177 ± 6 cm, mean ejection fraction of left heart ventricle 47 ± 11%), were examined before and after three months of combined aerobic and strength training (from 3rd week). Before exercise testing, short-term heart rate variability (HRV) analyses of all subjects were obtained. Symptom-limited spiroergometry was provided before and after the training period. The training (exercise unit) was performed three times a week. Frequency domain HRV indexes were determined in the morning and during quiet periods under metronome-controlled breathing. Total power (TP), low-frequency spectral component HRV (LF, 0,05–0,15 Hz), high-frequency spectral component HRV (HF, 0,15–0,5 Hz) and low frequency-to-high frequency (LF/HF) ratio were measured and monitored for 5 minutes. The primary outcome was that after twelve weeks of combined endurance/strength training, the findings showed an increase in HRV (HF, LF and TP) in men with stable chronic coronary disease

Quality Of Life In Patients With Chronic Coronary Artery Disease: Effect Of Three Months Lasting Combined Endurance/Resistance Training

83 pacientů (mužů) se stabilní chronickou ischemickou chorobou srdeční (průměrný věk 62 ± 9 let, výška 177 ±6 cm, hmotnost 86 ±11 kg, průměrná ejekční frakce levé komory 47 ± 8 %) bylo vyšetřeno před a po dvanáctitýdenním aerobním tréninku kombinovaném se silovými prvky. Před tréninkovou periodou bylo provedeno spiroergometrické vyšetření se stanovením anaerobního prahu k určení limitu intenzity aerobní zátěže. Intenzita zátěže při silovém tréninku byla určena metodou 1-RM (30-60%). Trénink (tréninková jednotka) byla prováděna třikrát týdně. Vliv na kvalitu života byl hodnocen pomocí SAQ (The Seattle Angina Questionnaire). Ve všech pěti SAQ hodnocených oblastech došlo po tréninku k signifikantnímu zlepšení. Limitace fyzické aktivity (79,7 ± 19,0 vs. 84,9 ± 16,4*), stabilita symptomů (78,2 ± 19,1 vs. 85,6±16,1*), frekvence symptomů (83,5 ± 15,6 vs. 88,2 ± 4,5**), spokojenost s léčbou (87,8 ± 14,6 vs. 92,9 ± 11,5*), vnímání onemocnění (67,2 ± 19,7 vs. 73,8 ± 19,5**). Vrcholový příjem kyslíku (VO2peak ) se zvýšil z 18,6 ± 3,1 to 19,8 ± 4,0** ml.kg-1.min-1 (*P < 0.05, ** P < 0.01, Wilcoxon).83 patients (men) with stable chronic coronary disease (mean age 62 ± 9 years, mean body weight 86± 11 kg, mean height 177 ± 6 cm, mean ejection fraction of left ventricle 47± 8%) were examined before and after three months lasting aerobic training combined with strength components. Before the training period symptom-limited spiroergometry was provided. Spiroergometry was applied for the evaluation of anaerobic threshold to decide on the aerobic training intensity. Load intensity for the strength training phase was determined by the method of 1-RM (30-60%). The training (exercise unit) was performed three times a week. The impact on quality of life was measured using SAQ (The Seattle Angina Questionnaire). The all five SAQ dimensions were significantly better after the training. Physical limitations (79,7 ± 19,0 vs. 84,9 ± 16,4*) stability of symptoms (78,2 ± 19,1 vs. 85,6 ± 16,1*) frequency of symptoms (83,5 ± 15,6 vs. 88,2 ± 14,5**), treatment satisfaction (87,8 ± 14,6 vs. 92,9 ± 11,5*), and disease perception (67,2 ± 19,7 vs. 73,8 ± 19,5**). Peak exercise oxygen uptake (VO2 peak) increased from 18,6 ± 3,1 to 19,8 ± 4,0** ml. kg-1.min-1 (*P < 0.05, ** P < 0.01, Wilcoxon)

The role of quantitative Tc-99m-MIBI gated SPECT/F-18-FDG PET imaging in the monitoring of intracoronary bone marrow cell transplantation

BACKGROUND: A lot of unresolved questions still exist concerning the exact mechanism of the beneficial effects of bone marrow cell (BMC) transplantation for myocardial regeneration. The aim of this communication is to report the cases of patients with and without post-transplantation left ventricular function improvement. MATERIAL AND METHODS: To this study we included consecutive patients with irreversible damage after a first acute ST-elevation myocardial infarction treated by coronary angioplasty with stent implantation. The irreversible damage was identified by dobutamine echocardiography and confirmed by rest gated Tc-99m-MIBI gated SPECT and in the majority of patients by F-18-FDG PET imaging as well. Using 4D-MSPECT software, we quantified MIBI/FDG uptake and gated SPECT left ventricular ejection fraction, end-diastolic/end-systolic volumes (LVEF, EDV/ESV) before BMC therapy and 3 months later. RESULTS: The results obtained in the initial group of patients in this study (27 patients in the BMC treated group, 16 patients in the control group) have been published previously [Eur J Nucl Med 2005; 32 (Suppl 1 ): S46]. Among the BMC group, we identified 13 responders to therapy with average LVEF improvement from 43.3% &plusmn; 11% to 51.4% &plusmn; 10.4% and EDV/ESV improvement from 145 ml/84 ml to 133 ml/67 ml. The remaining 14 patients were non-responders to therapy with no significant change in LVEF (39.1% &plusmn; 8.1% versus 39.8% &plusmn; 7.4%), the EDV/ESV increased from 166 ml/105 ml to 188 ml/116 ml. Responders to the cell therapy had prevailing MIBI uptake in the range of 31-50% of maximum in the infarction territory. On the other hand, non-responders to BMC therapy had prevailing MIBI uptake in the range of 0-30% of maximum. Two cases are presented in this report. CONCLUSIONS: Further studies with a larger cohort of patients would be helpful to evaluate our findings. We observed strong interindividual differences in the effectiveness of the cell therapy. Prevailing residual MIBI uptake in the range of 31-50% of maximum was in the subgroup of responders to the cell therapy

Hepcidin and ferritin levels as markers of immune cell activation during septic shock, severe COVID-19 and sterile inflammation

IntroductionMajor clinically relevant inflammatory events such as septic shock and severe COVID-19 trigger dynamic changes in the host immune system, presenting promising candidates for new biomarkers to improve precision diagnostics and patient stratification. Hepcidin, a master regulator of iron metabolism, has been intensively studied in many pathologies associated with immune system activation, however these data have never been compared to other clinical settings. Thus, we aimed to reveal the dynamics of iron regulation in various clinical settings and to determine the suitability of hepcidin and/or ferritin levels as biomarkers of inflammatory disease severity.CohortsTo investigate the overall predictive ability of hepcidin and ferritin, we enrolled the patients suffering with three different diagnoses – in detail 40 patients with COVID-19, 29 patients in septic shock and eight orthopedic patients who were compared to nine healthy donors and all cohorts to each other.ResultsWe showed that increased hepcidin levels reflect overall immune cell activation driven by intrinsic stimuli, without requiring direct involvement of infection vectors. Contrary to hepcidin, ferritin levels were more strongly boosted by pathogen-induced inflammation – in septic shock more than four-fold and in COVID-19 six-fold in comparison to sterile inflammation. We also defined the predictive capacity of hepcidin-to-ferritin ratio with AUC=0.79 and P = 0.03.DiscussionOur findings confirm that hepcidin is a potent marker of septic shock and other acute inflammation-associated pathologies and demonstrate the utility of the hepcidin-to-ferritin ratio as a predictor of mortality in septic shock, but not in COVID-19

The Relation between eNOS −786 C/T, 4 a/b, MMP-13 rs640198 G/T, Eotaxin 426 C/T, −384 A/G, and 67 G/A Polymorphisms and Long-Term Outcome in Patients with Coronary Artery Disease

Aim. The purpose of this study is to determine the association between eotaxin 426 C/T, −384 A/G, 67 G/A, eNOS −786 T/C, 4 a/b, and MMP-13 rs640198 G/T and prognosis of patients with known CAD. Methods. From total of 1161 patients referred to coronary angiography, 532 patients with angiographically confirmed CAD were selected. Their long-term outcome was followed up using hospital database. Subsequent events were assessed in this study: death or combined endpoint-myocardial infarction, unstable angina pectoris, revascularization, heart failure hospitalization, and cardioverter-defibrillator implantation. Results. The multivariate Cox regression model identified age, smoking, and 3-vessel disease as significant predictors of all-cause death. Further analysis showed that eotaxin 67 G/A (GA + AA versus GG) and eotaxin −384 A/G (GG versus GA + AA) were significant independent prognostic factors when added into the model: HR (95% CI) 2.81 (1.35–5.85), p=0.006; HR (95% CI) 2.63 (1.19–5.83), p=0.017; eotaxin −384 A/G was significantly associated with the event-free survival, but it did not provide the prognostic information above the effect of two- or three-vessel disease. Conclusion. The A allele in eotaxin 67 G/A polymorphism is associated with worse survival in CAD patients

Cadmium–zinc–telluride SPECT scanners – New perspectives in nuclear cardiology

AbstractNuclear cardiology is one of the most important non-invasive imaging methods in cardiac imaging. It makes possible primarily functional assessment of the heart with quantification of perfusion and systolic function. Development of new types of scanners for nuclear cardiology brings more possibilities in research and clinical practice. This paper describes a brief review of some applications of cadmium–zinc–telluride (CZT) scanners in comparison with conventional cameras

Cardiac profile of the Czech population of Duchenne muscular dystrophy patients: a cardiovascular magnetic resonance study with T1 mapping

Abstract Background The progressive cardiomyopathy that develops in boys with Duchenne and Becker muscular dystrophy (DMD/BMD) is presumed to be a secondary consequence of the fibrosis within the myocardium. There are only limited data on using parametric imaging in these patients. The purpose of this study was to assess native T1 and extracellular volume (ECV) values in DMD patients. Methods The Czech population of males with DMD/BMD was screened. All eligible patients fulfilling the inclusion criteria were included. Forty nine males underwent cardiac magnetic resonance (MR) examination including T1 native and post-contrast mapping measurements. One DMD patient and all BMD patients were excluded from statistical analysis. Three groups were compared – Group D1 - DMD patients without late gadolinium enhancement (LGE) (n = 23), Group D2 - DMD patients with LGE (n = 20), and Group C – gender matched controls (n = 13). Results Compared to controls, both DMD groups had prolonged T1 native relaxation time. These results are concordant in all 6 segments as well as in global values (1041 ± 31 ms and 1043 ± 37 ms vs. 983 ± 15 ms, both p < 0.05). Group D2 had significantly increased global ECV (0.28 ± 0.044 vs. 0.243 ± 0.013, p < 0.05) and segmental ECV in inferolateral and anterolateral segments in comparison with controls. The results were also significant after adjustment for subjects’ age. Conclusion DMD males had increased native T1 relaxation time independent of the presence or absence of myocardial fibrosis. Cardiac MR may provide clinically useful information even without contrast media administration

Myocardial native T1 mapping and extracellular volume quantification in asymptomatic female carriers of Duchenne muscular dystrophy gene mutations

Abstract Background Female carriers of dystrophin gene mutations (DMD-FC) were previously considered non-manifesting, but in recent decades, cardiomyopathy associated with muscular dystrophy and myocardial fibrosis has been described. Our study aimed to assess prospectively myocardial fibrosis in asymptomatic DMD-FC compared to a sex-matched control group (CG) with similar age distribution using native T1 mapping and extracellular volume (ECV) quantification by cardiovascular magnetic resonance (CMR) imaging. Materials and methods 38 DMD-FC with verified genetic mutation and 22 healthy volunteers were included. Using CMR, native T1 relaxation time and ECV quantification were determined in each group. Late gadolinium enhancement (LGE) was assessed in all cases. Results There were 38 DMD-FC (mean age 39.1 ± 8.8 years) and 22 healthy volunteers (mean age 39.9 ± 12.6 years) imagined by CMR. The mean global native T1 relaxation time was similar for DMD-FC and CG (1005.1 ± 26.3 ms vs. 1003.5 ± 25.0 ms; p-value = 0.81). Likewise, the mean global ECV value was also similar between the groups (27.92 ± 2.02% vs. 27.10 ± 2.89%; p-value = 0.20). The segmental analysis of mean ECV values according to the American Heart Association classification did not show any differences between DMD-FC and CG. There was a non-significant trend towards higher mean ECV values of DMD-FC in the inferior and inferolateral segments of the myocardium (p-value = 0.075 and 0.070 respectively). Conclusion There were no statistically significant differences in the mean global and segmental native T1 relaxation times and the mean global or segmental ECV values. There was a trend towards higher segmental mean ECV values of DMD-FC in the inferior and inferolateral walls of the myocardium

Persisting IL-18 levels after COVID-19 correlate with markers of cardiovascular inflammation reflecting potential risk of CVDs development

COVID-19 manifestation is associated with a strong immune system activation leading to inflammation and subsequently affecting the cardiovascular system. The objective of the study was to reveal possible interconnection between prolongated inflammation and the development or exacerbation of long-term cardiovascular complications after COVID-19. We investigated correlations between humoral and cellular immune system markers together with markers of cardiovascular inflammation/dysfunction during COVID-19 onset and subsequent recovery. We analyzed 22 hospitalized patients with severe COVID-19 within three timepoints (acute, 1 and 6 months after COVID-19) in order to track the impact of COVID-19 on the long-term decline of the cardiovascular system fitness and eventual development of CVDs. Among the cytokines dysregulated during COVID-19 changes, we showed significant correlations of IL-18 as a key driver of several pathophysiological changes with markers of cardiovascular inflammation/dysfunction. Our findings established novel immune-related markers, which can be used for the stratification of patients at high risk of CVDs for further therapy