Erectile dysfunction as a predictor of two-year prognosis in acute myocardial infarction

  Background: Erectile dysfunction (ED) is a predictor or marker of coronary artery disease in patients at high risk of cardiovascular diseases. The aim of this study was to investigate the prevalence of ED in patients with acute myocardial infarction (AMI) and after 2 years of follow-up, and to determine the association between ED and the concentrations of the markers of inflammation, endothelial dysfunction and oxidative stress which were measured on the third day after hospital admission. Methods: The study included 80 patients aged 62.25 ± 10.47 years. The primary endpoints of interest were re-hospitalization due to cardiovascular causes and death during the 2 year period after hospital­ization. The Sexual Health Inventory for Men (SHIM) was assessed at the point of hospital discharge and 24 months thereafter. Results: 40.1% of patients had some degree of ED. The percentage of patients without ED increased (13.2%), while the percentage of patients with severe ED significantly decreased (14.7%) after 2 years. Patients with ED had significantly higher B-type natriuretic peptide (BNP) levels and decreased levels of nitric-oxide. During the 2 years of follow-up, 9 patients died (6.5% without ED, 68.6% with ED) (c2 = 7.19, p = 0.015). During the same time period, 22 (27.5%) patients were re-hospitalized due to cardiovascular causes, of whom 59.1% had ED at hospital admission (p < 0.05). Conclusions: Low levels of nitric-oxide were the best predictors of ED during AMI and after 2 years. ED predicted the worst outcomes of AMI: death and re-hospitalization. Lifestyle changes and nitric- -oxide donors could assist in the treatment of ED and in the improvement of long-term prognosis for AMI. (Cardiol J 2017; 24, 4: 393–402

Regional differences among female patients with heart failure from the Cardiac Insufficiency BIsoprolol Study in ELDerly (CIBIS-ELD)

Background: The aim of our study was to examine regional differences in the demographics, etiology, risk factors, comorbidities and treatment of female patients with heart failure (HF) in the Cardiac Insufficiency BI soprolol Study in ELDerly (CIBIS-ELD) clinical trial.Methods and results: One hundred and fifty-nine female patients from Germany and 169 from Southeastern (SE) Europe (Serbia, Slovenia and Montenegro) were included in this subanalysis of the CIBIS-ELD trial. Women comprised 54% of the study population in Germany and 29% in SE Europe. German patients were significantly older. The leading cause of HF was arterial hypertension in German patients, 71.7% of whom had a preserved ejection fraction. The leading etiology in SE Europe was the coronary artery disease; 67.6% of these patients had a reduced left ventricular ejection fraction (34.64 ± 7.75%). No significant differences were found in the prevalence of traditional cardiovascular risk factors between the two regions (hypertension, diabetes, hypercholesterolemia, smoking and family history of myocardial infarction). Depression, chronic obstructive pulmonary disease and malignancies were the comorbidities that were noted more frequently in the German patients, while the patients from SE Europe had a lower glomerular filtration rate. Compared with the German HF patients, the females in SE Europe received significantly more angiotensin converting enzyme inhibitors, loop diuretics and less frequently angiotensin receptor blockers and mineralocorticoid receptor antagonists.Conclusions: Significant regional differences were noted in the etiology, comorbidities and treatment of female patients with HF despite similar risk factors. Such differences should be considered in the design and implementation of future clinical trials, especially as women remain underrepresented in large trial populations.

Protein Carbonyl Content Is a Predictive Biomarker of Eccentric Left Ventricular Hypertrophy in Hemodialysis Patients

High prevalence of left ventricular hypertrophy (LVH) and elevated oxidative stress are associated with poor outcomes in chronic hemodialysis patients. Abnormal left ventriculаr geomеtry and different geometric patterns play an important role as well. Our study analyzed the role of oxidative stress on myocardial remodeling in these patients. Plasma malondialdehyde (MDA), protein carbonyl (PC) content, and total antioxidative capacity (TAC) were investigated in 104 hemodialysis patients together with transthoracic echocardiography. Compared to patients with normal ventricular geometry, patients with LVH had increased MDA and PC plasma concentration. Multivariate analysis demonstrated that protein carbonyls, as biomarkers of oxidative protein modification, were an independent predictor of eccentric hypertrophy (eLVH), including higher LV end-diastolic diameter and LV end-diastolic volume, (β = 0.32 and β = 0.28, p < 0.001 for both). The incidence of eLVH increased progressively from the lowest to the highest baseline PC tertile (p < 0.001 for the trend) and the subjects in the former group showed a 76% greater risk of developing eLVH compared to their counterparts. After further adjustment for the potential mediators, PCs carried eLVH odds (95% confidence interval (CI)) of 1.256 (0.998–1.514), per standard deviation increase. High plasma protein carbonyls levels are a significant independent predictor of eccentric LVH in chronic hemodialysis patients

IMPACT OF ECHOCARDIOGRAPHIC OPTIMIZATION OF RESYNCHRONIZATION PACE-MAKER USING DIFFERENT PACING MODALITIES AND ATRIOVENTRICULAR DELAYS ON ACUTE HEMODYNAMIC RESPONSE AND LONG TERM PROGNOSIS

Cardiac resynchronization therapy (CRT) improves ventricular dyssynchrony and is associated with an improvement in life quality and prognosis.Aim. The aim of study was to examine acute hemodynamic changes with different of CRT device modalities throughout optimization procedure and its impact on one year prognosis.Material and methods. The study comprised 62 patients with severe left ventricular systolic dysfunction (LVEF 24,6±4,4%, QRS duration 154,71±14,92 ms, NYHA class III/IV 47/15) with implanted CRT device. After implantation and before discharge all the patients underwent optimization procedure guided by Doppler echocardiography. Left (LVPEI) and right (RVPEI) ventricular pre-ejection intervals, interventricular mechanical delay (IVD) and the maximal rate of ventricular pressure rise during early systole (max dP/dt) were measured during left and biventricular pacing with three different atrioventricular (AV) delays. Stroke volume derived from the left ventricular outflow tract velocity–time integral (VTI) of left ventricular outflow tract (LVOT VTI) was measured as well. After one year patients underwent clinical, echocardiographical examination and 6 minute walking test.Results. After CRT device optimization, optimal AV delay and CRT mode were defined. Left ventricular pre-ejection intervals changed from 175,4±21,5 to 142,6±16,7 (p < 0,01), RVPEI from 108,6±18,9 to 127,3±18,3 (p < 0,001), IVD from 71,3±14,8 to 24,7±7,6 (p < 0,001) and dP/dt from 532,2±74 to 675,2±111 (p < 0,001). Left ventricular outflow tract VTI increased after optimization procedure from 18±3,4 to 21±1,5 cm (p<0,05).Conclusions. Echocardiographic optimization procedure emphasizes the individualized approach in CRT optimization procedure in order to derive the best short and long term results

CARDIAC RESYNCHRONIZATION THERAPY WITH OR WITHOUT AN IMPLANTABLE CARDIOVERTER DEFIBRILLATOR IN DIFFERENT GROUPS OF HEART FAILURE PATIENTS

Aim. Patients with heart failure have poor prognosis and mortality rate is between 15–60% per year. Implantable cardioverter-defibrillators and cardiac resynchronization therapy have been shown to improve survival, decrease hospital readmissions and mortality, and improve functional status and quality of life in patients with heart failure and left ventricular systolic dysfunction. Aim of the study was to examine the effects of different CRT devices in carefully selected heart failure patients during 1 year.Material and methods. We included 98 heart failure patients. First group (n=60) received CRT-P, while in second group (n=38) were patients with CRT-D pacemaker (with an additional cardioverter-defibrillator option).Results. Data gathered in our the study showed that both CRT-P and CRT-D in adequately selected heart failure patients improve different clinical parameters: symptoms, echocardiographic parameters, decrease QRS duration, increase 6 min walk test distance, decrease mortality rate.Conclusion. Patients with both CRT-P and CRT-D showed improvement in heart failure symptoms and CRT had significant influence on disease prognosis during 1 year of follow up. Nevertheless we do not have the perfect criteria for selection of patients and their follow up after the device implantation. In patients with the rhythm disturbances CRT-D option is the right choice only if the patient has the indications for resynchronization therapy as well. This choice however depends on clinical judgment of the operator more than on strict protocols and guidelines which are necessary but we need more clinical trials to support current hypothesis

FREQUENCY OF MAJOR UNWANTEDFREQUENCY OF MAJOR UNWANTED CORANARY EVENTS IN PATIENTS WITH AORTOCORONAROGRAPHY BYPASS AND PTCA DURING THE THREE YEAR FOLLOW UP

The paper compares the major unwanted coronary events in patients with surgical revascularization of myocardium and with percutaneous transluminal coronary angioplasty during the period of 36 months. The frequency of major unwanted coronary events, above all mortality, was higher in group of patients with surgical revascularization of myocardium, but the difference was not statistically significant

Health-status outcomes with invasive or conservative care in coronary disease

BACKGROUND In the ISCHEMIA trial, an invasive strategy with angiographic assessment and revascularization did not reduce clinical events among patients with stable ischemic heart disease and moderate or severe ischemia. A secondary objective of the trial was to assess angina-related health status among these patients. METHODS We assessed angina-related symptoms, function, and quality of life with the Seattle Angina Questionnaire (SAQ) at randomization, at months 1.5, 3, and 6, and every 6 months thereafter in participants who had been randomly assigned to an invasive treatment strategy (2295 participants) or a conservative strategy (2322). Mixed-effects cumulative probability models within a Bayesian framework were used to estimate differences between the treatment groups. The primary outcome of this health-status analysis was the SAQ summary score (scores range from 0 to 100, with higher scores indicating better health status). All analyses were performed in the overall population and according to baseline angina frequency. RESULTS At baseline, 35% of patients reported having no angina in the previous month. SAQ summary scores increased in both treatment groups, with increases at 3, 12, and 36 months that were 4.1 points (95% credible interval, 3.2 to 5.0), 4.2 points (95% credible interval, 3.3 to 5.1), and 2.9 points (95% credible interval, 2.2 to 3.7) higher with the invasive strategy than with the conservative strategy. Differences were larger among participants who had more frequent angina at baseline (8.5 vs. 0.1 points at 3 months and 5.3 vs. 1.2 points at 36 months among participants with daily or weekly angina as compared with no angina). CONCLUSIONS In the overall trial population with moderate or severe ischemia, which included 35% of participants without angina at baseline, patients randomly assigned to the invasive strategy had greater improvement in angina-related health status than those assigned to the conservative strategy. The modest mean differences favoring the invasive strategy in the overall group reflected minimal differences among asymptomatic patients and larger differences among patients who had had angina at baseline