Adiponectin correlates with body mass index and to a lesser extent with left ventricular mass in dialysis patients

Background: Adiponectin is a serum protein produced by adipose tissue which exerts anti-inflammatory, anti-diabetic and anti-atherosclerotic properties, hence is considered a cardio-protective marker. With the current uncertain role of adiponectin in dialysis patients to the aim of this study was to investigate its relationship with left ventricular (LV) structure and function in these patients.Methods: This study included 89 (age 56 ± 13 years, 43% male) patients treated with regular dialysis for > 6 months, and 55 control subjects with normal renal function. A complete two-dimensional, M-mode and tissue-Doppler echocardiographic study, and biochemical blood analyses, adiponectin and anthropometric parameters were obtainedon the same day.Results: Dialysis patients had lower body mass index (BMI) and lower body surface area (BSA) (p < 0.001 for both), lower waist/hips ratio (p = 0.005), higher LV mass index (LVMI, p < 0.001), higher adiponectin level (p < 0.001) and LV end-systolic volume (p = 0.003), lower LV ejection fraction (p = 0.006), longer isovolumic relaxation time (p < 0.001), lower mean LV strain (p = 0.002), larger left atrium volume (p = 0.022) and lower left atrium emptying fraction (p = 0.026), compared to controls. In dialysis patients, adiponectin correlated with waist circumference (r = –0.427, p < 0.001), BMI (r = –0.403, p < 0.001) and BSA (r = –0.480, p < 0.001), and to a lesser extent with LVMI (r = 0.296, p = 0.005), waist/hips ratio (r = –0.222, p = 0.037) and total cholesterol (r = –0.292, p = 0.013). But in controls, it correlated only modestly with age (r = 0.304, p = 0.024), hemoglobin (r = 0.371, p = 0.005), high density lipoprotein cholesterol (r = 0.315, p = 0.019) and LVMI (r = 0.277, p = 0.043).Conclusions: It seems that in dialysis patients, adiponectin modest correlation with anthropometric measurements suggests an ongoing catabolic process rather than a change in ventricular function

Vessel Size and Outcome After Coronary Drug-Eluting Stent Placement Results From a Large Cohort of Patients Treated With Sirolimus- or Paclitaxel-Eluting Stents

ObjectivesThis study sought to investigate the influence of vessel size on the outcomes of patients after drug-eluting stent (DES) implantation.BackgroundThere are no dedicated studies on the influence of vessel size on the outcomes of patients treated with different DES.MethodsThe study population was composed of 2,058 consecutive patients who received sirolimus-eluting stents (SES) or paclitaxel-eluting stents (PES). Patients were grouped into tertiles according to vessel size (<2.41 mm in the lower tertile, 2.41 to 2.84 mm in the middle tertile, and >2.84 mm in the upper tertile). The primary end point was target lesion revascularization (TLR). Secondary end points were binary angiographic restenosis and the composite of death or myocardial infarction.ResultsVessel size did not influence the composite end point of death and myocardial infarction. The TLR rates were higher among patients in the lower tertile (12.1%) as compared with the middle (8.4%) and upper (8.0%) tertiles (p = 0.02). In a multivariate analysis, vessel size emerged an independent predictor of TLR (p = 0.009). The model showed also a significant interaction between DES type and vessel size regarding TLR (p = 0.008). There was a significant difference in TLR rates among patients treated with SESs (8.6%) and PESs (16.4%) in the lower tertile (p = 0.002), but not in the middle and upper tertiles.ConclusionsThe influence of vessel size on restenosis is related to the specific DES used, with SESs providing better outcomes than PESs in small but not in large coronary vessels

Association between Newly Diagnosed Type 2 Diabetes Mellitus and Left Ventricular Global Longitudinal Strain: A Single Center, Cross-Sectional Study

Objective: Diabetes mellitus is a major cardiovascular risk factor. Diabetic complications in the cardiovascular system randomly appear following long standing diabetes. However, newly diagnosed diabetes can also be associated with cardiac problems. The aim of this study was to compare patients with newly diagnosed type 2 diabetes mellitus (T2DM) to healthy controls in regard to echocardiography features, specifically left ventricular global longitudinal strain (LV GLS). Materials and methods: This was a prospective crosssectional study conducted on 94 patients, 52 patients with newly diagnosed T2DM that formed the first group and 42 healthy subjects, without history of diabetes mellitus and/or cardiovascular disease, which formed the second group. Results: Patients with newly diagnosed T2DM had mean glucose level of 16.37 ± 7.43 mmol/L and HbA1c of 8.57 ± 2.31 %. The groups did not differ in regard to age, gender, smoking, arterial hypertension or heart rate at the time of examination. The ratio between early mitral inflow velocity and mitral annular early diastolic velocity (E/e’) of the septal wall was significantly lower in patients with newly diagnosed T2DM (6.21 ± 3.14 vs. 7.8 ± 2.45, p = 0.009). The LV GLS resulted lower in patients with newly diagnosed T2DM compared to the healthy subjects (|–19.36|% ± 2.98 vs. |–20.43|% ± 1.99. p = 0.049). Of note, the LV GLS values are expressed as absolute numbers. The ratio of patients with LV GLS strain &lt; |–18.8|% was significantly higher in patients with newly diagnosed T2DM (42.31% vs. 21.43%, p = 0.03). Conclusions: LV GLS may serve as an important echocardiographic parameter to detect early myocardial changes in asymptomatic patients with newly diagnosed T2DM

Ecocardiografia e teste de caminhada de 6 minutos na disfunção sistólica do ventrículo esquerdo

FUNDAMENTO: Insuficiência cardíaca crônica é um grave distúrbio cardiovascular. OBJETIVO: O objetivo deste estudo foi avaliar prospectivamente se o resultado do teste de caminhada de 6 minutos (TC-6M) se correlaciona com as variáveis ecocardiográficas em pacientes portadores de disfunção sistólica do ventrículo esquerdo e insuficiência cardíaca crônica estável. MÉTODOS: Foram estudados prospectivamente 52 pacientes (65% homens; média de idade de 60±11 anos) portadores de insuficiência cardíaca crônica secundária à cardiopatia isquêmica ou miocardiopatia idiopática. Todos os pacientes apresentavam disfunção sistólica do ventrículo esquerdo (fração de ejeção <0.45) e encontravam-se em insuficiência cardíaca classe funcional II ou III da NYHA. Foram realizados um estudo de eco-Doppler e um TC-6M no mesmo dia. RESULTADOS: O TC-6M apresentou correlação moderada, mas estatisticamente significante, com o diâmetro sistólico final - DSF (r=-0,46; p=0,0006), com a fração de encurtamento - FEn (r=0,52; p=0,0001) e com a fração de ejeção (FE) (r=0,5; p=0,0001), e apresentou correlação fraca, mas estatisticamente significante, com o índice de desempenho miocárdico - IDM (r=-0,39; p=0,0046), a relação E/A (tricúspide) (r=-0,333; p=0,016), o tempo de aceleração do fluxo pulmonar (r=0,328; p=0,018), e com a amplitude do eixo longo lateral (r=0,283; p=0,04). O modelo de regressão linear demonstrou que a idade (&#967;2=-0,59, p=<0,001), o padrão de enchimento restritivo transmitral (&#967;2=-0,44, p=0,004) e a dimensão sistólica final do ventrículo esquerdo (&#967;2=-0,34, p=0,012) foram fatores independentes que influenciam o TC-6M. CONCLUSÃO: Em pacientes portadores de insuficiência cardíaca decorrente de disfunção sistólica do ventrículo esquerdo, o TC-6M como ferramenta de avaliação clínica da capacidade funcional apresenta uma correlação significante com os principais parâmetros da função sistólica global do VE e com o IDM do VE. Em pacientes com disfunção sistólica do VE, a idade, o padrão de enchimento restritivo transmitral e a dimensão sistólica do ventrículo esquerdo mostraram-se independentemente associados ao TC-6M

Treatment Benefits on Metabolic Syndrome with Diet and Physical Activity

The research has included 422 patients aged between 25 to 60, of whom 341 were men and 81 women. The purpose of research was to determine impact of diet and physical activity in the treatment of metabolic syndrome during the six month period. Processing of results through descriptive and discriminative analysis have indicated that 6 month treatment with diet and physical activity have had an impact in the: waistline decrease by 6,05 cm or 5,50% among males, and 4,92 cm or 5,10% among females; body mass index (BMI) decrease by 1.78 or 6.20% among males, and 2,3 or 8,16% among females; decrease of blood triglycerides levels by 0,35 mmol/L or 16,28% among males, and 0,27 mmol/L or 13,30% among females; increase of blood cholesterol HDL-C by 0,48 mmol/L or 34,78% among males, and 0,06 mmol/L or 4,28% among females; systolic arterial pressure decreased by 15 mmHg or 10,18%, and diastolic blood pressure by 8,74 mmHg or 9,47% among males, and systolic arterial pressure decreased by 7,39 mmHg or 5,17%, and diastolic blood pressure decreased by 5,18 mmHg or 5,75% among females; the level of blood glucose decreased by 0,45 mmol/L or 7,04% among males, and by 0,64 mmol/L or 9,92% decreased among females. The results show that physical exercise and diet are important factors in reducing the values symptoms of metabolic syndrome. In order to improve symptoms of metabolic syndrome, it is necessary to keep on with healthy diet and physical exercise that means the change of lifestyle

Use of the “Minnesota Living with Heart Failure Questionnaire” Quality of Life Questionnaire in Kosovo’s Heart Failure Patients

Background: Quality of life (QoL) is one of the most important end-points in heart failure (HF) patients. The Minnesota Living with Heart Failure Questionnaire (MLHFQ) is the most widely used measurement for assessing the QoL in HF patients. This questionnaire had been translated and validated into the Albanian language. We used this questionnaire to evaluate the QoL in HF patients in Kosovo. Methods The study subjects were 103 consecutive HF patients (63±10 years, 56 female, 48% hypertensive and 26% ischaemic etiology, classified as NYHA I-III) admitted in outpatient or in-patient clinics at University Clinical Centre of Kosovo. At the moment of evaluation the patients were clinically stable and on optimized drug therapy. Relationships were tested between questionnaire score and different clinical and demographic factors. Results There was no difficulty in the administration of the Albanian version of MLHFQ or in the patient’s understanding of the questions. The overall median score of MLHFQ was 51 (mean 50±18). Female patients had higher total (p=0.015), emotional (p=0.022) and physical (p=0.019) MLWH compared to male patients. Te total MQLQ score had good correlation with 6MWT distance (p<0.001), but not with the level of NTproBNP level (p=0.364).Significant relationship was found also between MLWH and NYHA functional class in HF patients (p=0.002 for total, p=0.026 for emotional, and p<0.001 for physical MLHF score). NYHA functional class also significantly correlated with 6MWT distance (p<0.001 for both). Conclusions The Albanian version of the MLHFQ proposed in this study proved to be valid for HF patients and served as a new and important instrument for assessing QoL in Kosovo’s patients. The MLHFQ was mildly higher in our patients compared with previous studies and was higher in female patients. The questionnaire score correlates with functional NYHA class, reflecting the severity of the disease, and with 6 minute walk test, reflecting exercise capacity

Impaired left atrial reservoir function in metabolic syndrome predicts symptoms in HFpEF patients

Background and Aim: The hospital readmission rate has been thought to reflect the quality of patient care. Understanding the risk factors for these can guide strategies to reduce them. Methods This study included 194 consecutive patients (age 62 ± 9 years) with stable HFpEF. LV dimensions, ejection fraction (EF), mitral annulus peak systolic excursion (MAPSE), myocardial velocities (s’, e’ and a’), LA dimensions and volumes were measured. Total LA emptying fraction (LA EF) was measured by Simpson rule volumes. Based on the NCEP-ATP III criteria, patients were divided into two groups; MetS (n=89) and non-MetS (n=105) and were compared with 34 age and gender matched controls. Results Age and gender were not different between patients and control neither between MetS and non-Met. LV dimensions, EF and longitudinal function indices were also not different. The MetS patients had higher LV mass index (p=0.038), lower septal and lateral e’ (p=0.003 and p=0.001, respectively) velocities, larger LA minimal volume (p=0.007) and lower LA EF (p<0.001) compared with the non-MetS patients. Age, LA EF and MetS independently predicted the NYHA class. Conclusions Despite no difference in LV systolic function, patients with HFpEF and MetS have worse LA emptying fraction, compared with HFpEF and non-MetS patients. In addition, LA reservoir function impairment and MetS independently predict patients limiting symptoms, thus add to a better understanding of HFpE

Different determinants of exercise capacity in HFpEF compared to HFrEF

BACKGROUND: Quality of life is as important as survival in heart failure (HF) patients. Controversies exist with regards to echocardiographic determinants of exercise capacity in HF, particularly in patients with preserved ejection fraction (HFpEF). The aim of this study was to prospectively examine echocardiographic parameters that correlate and predict functional exercise capacity assessed by 6 min walk test (6-MWT) in patients with HFpEF. METHODS: In 111 HF patients (mean age 63 ± 10 years, 47% female), an echo-Doppler study and a 6-MWT were performed in the same day. Patients were divided into two groups based on the 6-MWT distance (Group I: ≤ 300 m and Group II: &gt;300 m). RESULTS: Group I were older (p = 0.008), had higher prevalence of diabetes (p = 0.027), higher baseline heart rate (p = 0.004), larger left atrium - LA (p = 0.001), longer LV filling time - FT (p = 0.019), shorter isovolumic relaxation time (p = 0.037), shorter pulmonary artery acceleration time - PA acceleration time (p = 0.006), lower left atrial lateral wall myocardial velocity (a') (p = 0.018) and lower septal systolic myocardial velocity (s') (p = 0.023), compared with Group II. Patients with HF and reduced EF (HFrEF) had lower hemoglobin (p = 0.007), higher baseline heart rate (p = 0.005), higher NT-ProBNP (p = 0.001), larger LA (p = 0.004), lower septal s', e', a' waves, and septal mitral annular plane systolic excursion (MAPSE), shorter PA acceleration time (p &lt; 0.001 for all), lower lateral MAPSE, higher E/A &amp; E/e', and shorter LVFT (p = 0.001 for all), lower lateral e' (p = 0.009), s' (p = 0.006), right ventricular e' and LA emptying fraction (p = 0.012 for both), compared with HFpEF patients. In multivariate analysis, only LA diameter [2.676 (1.242-5.766), p = 0.012], and diabetes [0.274 (0.084-0.898), p = 0.033] independently predicted poor 6-MWT performance in the group as a whole. In HFrEF, age [1.073 (1.012-1.137), p = 0.018] and LA diameter [3.685 (1.348-10.071), p = 0.011], but in HFpEF, lateral s' [0.295 (0.099-0.882), p = 0.029], and hemoglobin level [0.497 (0.248-0.998), p = 0.049] independently predicted poor 6-MWT performance. CONCLUSIONS: In HF patients determinants of exercise capacity differ according to severity of overall LV systolic function, with left atrial enlargement in HFrEF and longitudinal systolic shortening in HFpEF as the the main determinants

Global dyssynchrony correlates with compromised left ventricular filling and stroke volume but not with ejection fraction or QRS duration in HFpEF

Background and Aim: Mechanical global left ventricular (LV) dyssynchrony reflected as prolonged total isovolumic time(t-IVT) has been introduced as a potential mechanism behind compromised stroke volume in heart failure (HF). It has alsobeen shown to be superior to other markers of dyssynchrony in predicting response to cardiac resynchronization therapy(CRT), but its application in HF with preserved ejection fraction (HFpEF) remains unknown. The aim of this study was toassess the role of t-IVT in explaining symptoms in HFpEF.Methods: In 55 symptomatic HFpEF patients (age 60±9 years, NYHA class II-IV; LV EF ≥45%) and 24 age and gendermatched controls, a complete Doppler echocardiographic study was performed including mitral annulus peak systolicexcursion (MAPSE) and myocardial velocities as well as LV filling, outflow tract velocity time integral (VTI) and stroke volumemeasurements. Global LV dyssynchrony was assessed by t-IVT [in s/min; calculated as: 60 - (total ejection time + total fillingtime)], Tei index (t-IVT/ejection time) and pre-ejection time difference between LV and RV.Results: Patients had reduced lateral and septal MAPSE (p=0.009 and p=0.01, respectively) lower lateral and septal s’(p=0.002 and p=0.04, respectively) and e’ (p&lt;0.001, for both) velocities and higher E/e’ ratio (p=0.01) compared to controls.They also had longer t-IVT (p&lt;0.001), higher Tei index (p=0.04), but similar pre-ejection time difference and LVEF to controls.T-IVT correlated with LV filling time (r=0.44, p&lt;0.001), stroke volume (r=-0.41; p=0.002), MAPSE (lateral: r=-0.36, p=0.007 andseptal: r=-0.31; p=0.02), but not with LV mass index, LVEF, E/e’ ratio or QRS duration.Conclusion: Patients with HFpEF have exaggerated global mechanical dyssynchrony shown by prolonged t-IVT, comparedwith healthy age and gender matched controls. The relationship between t-IVT, LV filling and stroke volume suggests anassociation, more important than with ejection fraction or electrical dyssynchrony. These results support the importance ofthe individualistic approach for optimum HFpEF patient management