Clinical profile and management of outpatients with non-ischemic and non-hypertensive systolic heart failure: Analysis of the Polish DATA-HELP registry

Background: Although coronary artery disease and arterial hypertension are the most common etiologies underlying heart failure (HF), there are still many patients present with non-ischemic and non-hypertensive HF whose management remains very challenging. In this research study the clinical profile and applied treatment of patients with HF without coronary artery disease or hypertension versus patients with known etiology of HF (ischemic/hypertensive) were compared. Methods: Clinical data about 5563 patients with stable systolic HF were obtained from prospective multicenter DATA-HELP registry performed between October and December 2009 in ambulatory clinics in Poland, in which 500 cardiologists and 290 general practitioners participated. Results: Heart failure of non-ischemic and non-hypertensive etiology which affected 10% of all patients and was particularly frequent in younger patients, both in women: < 50 years old 42%; 50–65 years old 12%; > 65 years old 7%; and men: < 50 years old 47%; 50–65 years old 10%; > 65 years old 5%; p < 0.0001. Patients with non-ischemic and non-hypertensive HF were characterized by younger age, fewer co-morbidities, shorter duration of HF and, surprisingly, more advanced HF. Patients in this group were less likely to have received life-prolonging treatment in HF recommended by European Society of Cardiology (ESC) and more often required symptomatic management. Similarly, they were more likely to have implanted CRT-D and ICD. Conclusions: Heart failure of non-ischemic and non-hypertensive origin affects particularly young patients. These patients, despite suffering from more advanced HF are not optimally managed according to ESC guidelines

Clinical and CMR characteristics associated with cardiac events in patients with Fabry disease

BACKGROUND The assessment of late gadolinium enhancement (LGE) and left ventricular hypertrophy (LVH) by cardiac magnetic resonance (CMR) as diagnostic and prognostic maker in Fabry disease is advancing. We aimed to investigate the impact of clinical characteristics and CMR findings on cardiac outcome in patients with FD. METHODS In this study 55 patients with genetically confirmed FD and available CMR imaging were included. The primary endpoint was defined as a composite of cardiac events including cardiac death, new occurrence of atrial fibrillation, heart failure, ventricular tachycardia and bradycardia requiring device insertion. RESULTS During a median follow-up of 4.9 years (IQR 3.7-5.9), 9 patients (16.3%) reached the primary cardiac end point. The global amount of LGE was associated with an increased risk for primary endpoint in the univariate analysis (HR 1.4 per 10% increase in LGE, p = 0.002). However maximal wall thickness (MWT) was the sole independent predictor of the primary endpoint in a stepwise logistic regression model (HR 9.8 per mm increase in MWT, p < 0.0001). Kaplan-Meier analysis revealed significant difference in event free survival rate between patients with and without LVH (Long-rank p = 0.006) and in patients with and without LGE (Long-rank p < 0.001). Patients without LVH and LGE were free of adverse cardiac events. CONCLUSION LVH and LGE detected by CMR were associated with adverse cardiac events in FD. In particular maximal wall thickness can be useful in cardiac risk stratification of FD patients

Guzy przysadki - trzy warianty kliniczne; różne konsekwencje terapeutyczne

Autorzy omówili 3 przypadki guzów przysadki. Przedstawiono chorych z guzem hormonalnie czynnym, hormonalnie nieczynnym oraz guzem bezobjawowym, określanym jako incydentaloma. W każdym z tych przypadków kliniczne objawy guza oraz schemat postępowania leczniczego były różne. Podkreślono znaczenie badań obrazowych przysadki (rezonans magnetyczny) oraz badań hormonalnych - zarówno w postępowaniu diagnostycznym, jak i w ustalaniu indywidualnych algorytmów leczenia. Zwrócono również uwagę na brak typowego obrazu klinicznego większości guzów przysadki

clinical profile and management of outpatients with non ischemic and non hypertensive systolic heart failure analysis of the polish data help registry

Background: Although coronary artery disease and arterial hypertension are the most common etiologies underlying heart failure (HF), there are still many patients present with non-ischemic and non-hypertensive HF whose management remains very challenging. In this research study the clinical profile and applied treatment of patients with HF without coronary artery disease or hypertension versus patients with known etiology of HF (ischemic/hypertensive) were compared. Methods: Clinical data about 5563 patients with stable systolic HF were obtained from prospective multicenter DATA-HELP registry performed between October and December 2009 in ambulatory clinics in Poland, in which 500 cardiologists and 290 general practitioners participated. Results: Heart failure of non-ischemic and non-hypertensive etiology which affected 10% of all patients and was particularly frequent in younger patients, both in women: 65 years old 7%; and men: 65 years old 5%; p < 0.0001. Patients with non-ischemic and non-hypertensive HF were characterized by younger age, fewer co-morbidities, shorter duration of HF and, surprisingly, more advanced HF. Patients in this group were less likely to have received life-prolonging treatment in HF recommended by European Society of Cardiology (ESC) and more often required symptomatic management. Similarly, they were more likely to have implanted CRT-D and ICD. Conclusions: Heart failure of non-ischemic and non-hypertensive origin affects particularly young patients. These patients, despite suffering from more advanced HF are not optimally managed according to ESC guidelines

Przypadek rozrodczaka podwzgórza i szyszynki

A case of 19-year-old male with idiopathic diabetes insipidus diagnosed 9 years ago. 1.5 years from the onset of the disease vision disturbances, neurologic deficiencies and symptoms of hypopituitarism showed up. MRI examination revealed an advanced hypophyseal and pineal gland tumor - germinoma. Total regression was achieved with radio- and chemotherapy. For 7 years from the end of treatment patient has not declared any complains except for vision disturbances and hypopituitarism has been substituted succesfully. The case puts on the necessity of a strict endocrinologic and radiologic follow-up in patients with idiopathic diabetes insipidus due to the possibility of existing potencially curable disease ie. intracranial tumor. (Pol J Endocrinol 2007; 58 (5): 448-452)W pracy przedstawiono 19-letniego chorego, u którego przed 9 laty rozpoznano idiopatyczną moczówkę prostą. Po półtora roku wystąpiły zaburzenia widzenia, neurologiczne i objawy niewydolności przedniego płata przysadki, a w badaniu rezonansem magnetycznym (MRI, magnetic resonance imaging) ujawniono zaawansowanego guza okolicy podwzgórza i szyszynki o typie germinoma. Po radio- i chemioterapii stwierdzono całkowitą regresję zmian. Po 7 latach od zakończenia leczenia, poza znacznym ograniczeniem pola widzenia, chory nie zgłasza dolegliwości, a niewydolność przysadki jest wyrównana substytucyjnie. Przedstawiony przypadek i dane z piśmiennictwa wskazują na konieczność częstej kontroli endokrynologicznej i obrazowej w przypadkach samoistnej moczówki prostej, gdyż po miesiącach lub latach może ujawnić się guz, w tym także o typie rozrodczaka, a podjęcie odpowiedniego postępowania lekarskiego rokuje nawet wyleczenie. (Endokrynol Pol 2007; 58 (5): 448-452

Myocardial Fibrosis Quantification Methods by Cardiovascular Magnetic Resonance Imaging in Patients with Fabry Disease

Background/Objectives: The presence of late gadolinium enhancement (LGE) on cardiac magnetic resonance (CMR) in patients with Fabry disease (FD) is a predictor of adverse cardiac events. The aim of this study was to establish the most reliable and reproducible technique for quantifying LGE in patients with FD. Methods: Twenty FD patients with LGE who underwent CMR on the same scanner and LGE sequence were included. LGE quantifications were done using gray-scale thresholds of 2, 3, 4, 5 and 6 standard deviations (SD) above the mean signal intensity of the remote myocardium, the full width at half maximum method (FWHM), visual assessment with threshold (VAT) and the fully manual method (MM). Results: The mean amount of fibrosis varied between quantification techniques from 36 ± 19 at 2SD to 2 ± 2 g using the FWHM (p < 0.0001). Intraobserver reliability was excellent for most methods, except for the FWHM which was good (ICC 0.84; all p < 0.05). Interobserver reliability was excellent for VAT (ICC 0.94) and good for other techniques (all p < 0.05). Intraobserver reproducibility showed the lowest coefficient of variation (CV, 6%) at 5SD and at 2SD and VAT (35% and 38%) for interobserver reproducibility. The FWHM revealed the highest CV (63% and 94%) for both intra- and interobserver reproducibility. Conclusions: The available methods for LGE quantification demonstrate good to excellent intra- and interobserver reproducibility in patients with FD. The most reliable and reproducible techniques were VAT and 5SD, whereas the FWHM was the least reliable in the setting of our study. The total amount of LGE varies strongly with the quantification technique used

Persistent hyperlactataemia is related to high rates of in-hospital adverse events and poor outcome in acute heart failure

Background: Although lactate is a well-established marker in intensive care, our understanding of its utility in acute heart  failure (AHF) is modest and based on studies with a single measurement of this marker.  Aims: We aimed to investigate whether persistent elevation of lactate during hospitalisation is related to a higher risk of ad- verse events.  Methods: We conducted a prospective study to assess AHF patients hospitalised in one cardiac centre. The diagnosis of persistent hyperlactataemia was based on two measurements of the marker (on admission and at 24 h of hospitalisation) and it was defined as lactate elevation (≥ 2 mmol/L) at both time points.  Results: The population consisted of 222 patients at a mean age of 70 ± 13 years. Mean ejection fraction and creatinine level on admission were 37% ± 16% and 1.36 ± 0.51 mg/dL, respectively. The percentage of patients with elevated lactates on admission, at 24 h of hospitalisation, and persistent hyperlactataemia were 47%, 35%, and 24%, respectively. The group with persistent hyperlactataemia did not differ in most clinical and laboratory variables from the rest of the population. Patients with persistent hyperlactataemia had higher rate of adverse events during hospitalisation: worsening of heart failure (22.6% vs. 6.5%, p &lt; 0.05), inotrope use (22.6% vs. 5.3%, p &lt; 0.05), and increase of N-terminal pro–B-type natriuretic peptide at 48 h of hospitalisation (30% vs. 18%, p &lt; 0.05). Persistent hyperlactataemia was an independent predictor of one-year mortality (hazard ratio 2.5, 95% confidence interval 1.5–4.3, p &lt; 0.001).  Conclusions: Persistent hyperlactataemia within the first 24 h of hospitalisation is a predictor of a worse outcome in AHF and is related to higher rates of in-hospital adverse events and one-year mortality.

Iron status and myocardial injury while recovering from acute myocarditis

Introduction. The pathophysiology of acute myocarditis (MCD) and subsequent recovery involves complex interplay between the virulence of pathogen, host immunity with possible genetic-based immune dysregulation, comorbidities and environmental factors. Precise identification of patients with increased risk of subsequent post-inflammatory cardiomyopathy is challenging. Abnormal iron status not only is a hallmark of immune activation but also plays a role in the development of cardiomyopathy, hence we investigated whether iron indices relate to myocardial injury in patients with acute MCD. Material and methods. Consecutive patients hospitalized for acute MCD in two cardiology centers were prospectively enrolled. We analyzed clinical characteristics, cardiac magnetic resonance (CMR) findings and biomarkers of myocardial necrosis, neurohormonal activation, inflammation, and comprehensive systemic iron status from index hospitalization and an ambulatory control visit after 6 months. Healthy volunteers were control group. Results. We enrolled 40 patients hospitalized for acute myocarditis (age: 32 ± 9 years, male gender: 98%). In-hospital serum ferritin correlated with CMR late gadolinium enhancement (LGE) mass (r = 0.537, p &lt; 0.001) and global T2 ratio (r = 0.360, p = 0.03). LGE, regional abnormalities in myocardial T1 relaxation time and elevated extracellular volume persisted after 6 months of recovery in comparison to healthy controls. Persistent LGE mass correlated with lower transferrin saturation and serum iron at the ambulatory visit (r = –0.520, p = 0.03; and r = –0.465, p = 0.04; respectively). Conclusions. Acute-phase reactant ferritin relates to myocardial injury in the acute phase of MCD, whereas in the recovery phase residual fibrosis is greater in subjects with more profound functional iron deficiency, the latter reflecting, to some extent, systemic low-grade inflammation.Introduction. The pathophysiology of acute myocarditis (MCD) and subsequent recovery involves complex interplay between the virulence of pathogen, host immunity with possible genetic-based immune dysregulation, comorbidities and environmental factors. Precise identification of patients with increased risk of subsequent post-inflammatory cardiomyopathy is challenging. Abnormal iron status not only is a hallmark of immune activation but also plays a role in the development of cardiomyopathy, hence we investigated whether iron indices relate to myocardial injury in patients with acute MCD. Material and methods. Consecutive patients hospitalized for acute MCD in two cardiology centers were prospectively enrolled. We analyzed clinical characteristics, cardiac magnetic resonance (CMR) findings and biomarkers of myocardial necrosis, neurohormonal activation, inflammation, and comprehensive systemic iron status from index hospitalization and an ambulatory control visit after 6 months. Healthy volunteers were control group. Results. We enrolled 40 patients hospitalized for acute myocarditis (age: 32 ± 9 years, male gender: 98%). In-hospital serum ferritin correlated with CMR late gadolinium enhancement (LGE) mass (r = 0.537, p < 0.001) and global T2 ratio (r = 0.360, p = 0.03). LGE, regional abnormalities in myocardial T1 relaxation time and elevated extracellular volume persisted after 6 months of recovery in comparison to healthy controls. Persistent LGE mass correlated with lower transferrin saturation and serum iron at the ambulatory visit (r = –0.520, p = 0.03; and r = –0.465, p = 0.04; respectively). Conclusions. Acute-phase reactant ferritin relates to myocardial injury in the acute phase of MCD, whereas in the recovery phase residual fibrosis is greater in subjects with more profound functional iron deficiency, the latter reflecting, to some extent, systemic low-grade inflammation

Out-of-hospital cardiac arrest: Do we have to perform coronary angiography?

Out-of-hospital cardiac arrest (OHCA) remains a leading cause of global mortality, while survivors are burdened with long-term neurological and cardiovascular complications. OHCA management at the hospital level remains challenging, due to heterogeneity of OHCA presentation, the critical status of OHCA patients reaching the return of spontaneous circulation (ROSC), and the demands of post ROSC treatment. The validity and optimal timing for coronary angiography is one important, yet not fully defined, component of OHCA management. Guidelines state clear recommendations for coronary angiography in OHCA patients with shockable rhythms, cardiogenic shock, or in patients with ST-segment elevation observed in electrocardiography after ROSC. However, there is no established consensus on the angiographic management in other clinical settings. While coronary angiography may accelerate the diagnostic and therapeutic process (provided OHCA was a consequence of coronary artery disease), it might come at the cost of impaired post-resuscitation care quality due to postponing of intensive care management. The aim of the current statement paper is to discuss clinical strategies for the management of OHCA including the stratification to invasive procedures and the rationale behind the risk-benefit ratio of coronary angiography, especially with patients in critical condition

Wpływ nacisku i prędkości ślizgania na współczynnik tarcia elastomerów poliuretanowych (EPUR) o różnej twardości podczas ich tarcia po stali przy smarowaniu smarem plastycznym

Polyurethanes (PUR) are widely used for some elements of machinery and equipment, including in motorized shock-absorbing nodes and technical seals that can work in various operating conditions. The article presents the results of tribological investigations of polyurethane elastomers (EPUR) with different hardness (75, 83, and 93 °Sh A), which cooperated with steel in assembly lubrication conditions (mixed friction) with two types of grease (showing low and high adhesion to steel), with variable values of unit pressure p and sliding speed v. For the research, a rotary plan for two variables (p and v) was applied at five levels of their value. Based on the results of the tests of particular associations, the regression functions of the form of the second degree polynomial were determined, enabling the development of results in the form of spatial and contour diagrams. Based on the results of tribological tests, recommendations for designers dealing with the design and construction of friction junctions and seals in which polyurethane elastomers cooperating with steel elements can be used.Poliuretany (PUR) znajdują szerokie zastosowanie na niektóre elementy maszyn i urządzeń, między innymi w ruchowych węzłach amortyzujących i uszczelnieniach technicznych, które mogą pracować w różnych warunkach eksploatacyjnych. W artykule przedstawiono wyniki badań tribologicznych elastomerów poliuretanowych (EPUR) o różnej twardości (75, 83 i 93 °Sh A), które współpracowały ze stalą w warunkach smarowania montażowego (tarcie mieszane) dwoma rodzajami smaru plastycznego (wykazujących małą i dużą adhezję do stali), przy zmiennych wartościach nacisku jednostkowego p i prędkości ślizgania v. Do realizacji badań zastosowano plan rotalny dla dwóch zmiennych (p i v) na pięciu poziomach ich wartości. Na podstawie wyników badań poszczególnych skojarzeń wyznaczono funkcje regresji o postaci wielomianu drugiego stopnia, umożliwiające opracowanie wyników w postaci wykresów przestrzennych i poziomicowych. Na podstawie wyników badań tribologicznych opracowano zalecenia dla konstruktorów zajmujących się projektowaniem i konstruowaniem ślizgowych węzłów i uszczelnień, w których mogą być zastosowane elastomery poliuretanowe współpracujące z elementami stalowymi