Troponin as ischemic biomarker is related with all three echocardiographic risk factors for sudden death in hypertrophic cardiomyopathy (ESC Guidelines 2014)

Abstract Background Sudden cardiac death (SCD) risk stratification is the most important preventive action in patients with hypertrophic cardiomyopathy (HCM). The identification of the ischemia biomarker high sensitive troponin I (hs-TnI) role for this arrhythmic disease may provide additional information for SCD risk stratification. The aim of the study was to compare echocardiographic parameters (prognostic for risk stratification of SCD in HCM) among two subgroups of HCM patients: with elevated hs-TnI versus non-elevated hs-TnI level. Methods In 51 HCM patients (mean age 39 ± 8 years, 31 males and 20 females) an echocardiographic examination, including the stimulating maneuvers to provoke maximized LVOT gradient, was performed. The hs-TnI was measured 24 h later. Results By comparing two subgroups of patients, 26 members with hs-TnI positive versus 25 with hs-TnI negative, the study showed that the values of all three parameters were greater: provocable left ventricular outflow tract gradient (LVOTG) – 49.1 ± 45.9 vs 25.5 ± 24.8 mmHg, p = 0.019; left atrial diameter – 50.1 ± 9.6 vs 43.9 ± 9.8 mmHg, p = 0.041; maximal LV thickness – 22.1 ± 5.3 vs 19.9 ± 34 mm, p = 0.029. Conclusion The increased value of all three echocardiographic parameters used as risk factors for SCD (ESC Guidelines) is related to the elevated level of hs-TnI in HCM. Due to the high LVOTG – great hs-TnI relationship, exercise stress, both diagnostic and even rehabilitation/training, should be monitored by biomarker control

Elevated level of troponin but not N-Terminal probrain natriuretic peptide is associated with increased risk of sudden cardiac death in hypertrophic cardiomyopathy calculated according to the ESC guidelines 2014

The aim of this study was to assess the relationship between biomarkers (high-sensitive troponin I [hs-TnI], N-Terminal probrain natriuretic peptide [NT-proBNP]) and calculated 5-year percentage risk score of sudden cardiac death (SCD) in hypertrophic cardiomyopathy (HCM). Methods. In 46 HCM patients (mean age 39 ± 7 years, 24 males and 22 females), echocardiographic examination, including the stimulating maneuvers to provoke maximized LVOT gradient, had been performed and next ECG Holter was immediately started. After 24 hours, the ECG Holter was finished and the hs-TnI and NT-proBNP have been measured. Patients were divided according to 1/value of both biomarkers (hs-TnI-positive and hs-TnI-negative subgroups) and 2/(NT-proBNP lower and higher subgroup divided by median). Results. In comparison between 19 patients (hs-TnI positive) versus 27 patients (hs-TnI negative), the calculated 5-year percentage risk of SCD in HCM was significantly greater (6.38 ± 4.17% versus 3.81 ± 3.23%, P < 0 05). In comparison between higher NT-proBNP versus lower NT-proBNP subgroups, the calculated 5-year percentage risk of SCD in HCM was not significantly greater (5.18 ± 3.63% versus 4.14 ± 4.18%, P > 0 05). Conclusions. Patients with HCM and positive hs-TnI test have a higher risk of SCD estimated according to SCD calculator recommended by the ESC Guidelines 2014 than patients with negative hs-TnI test

Reversed septal curvature is associated with elevated troponin level in hypertrophic cardiomyopathy

The aim of study was to compare patients with hypertrophic cardiomyopathy divided according to septal configuration assessed in a 4-chamber apical window. The study group consisted of 56 consecutive patients. Reversed septal curvature (RSC) and non-RSC were diagnosed in 17 (30.4%) and 39 (69.6%) patients, respectively. Both RSC and non-RSC groups were compared in terms of the level of high-sensitivity troponin I (hs-TnI), NT-proBNP (absolute value), NT-proBNP/ULN (value normalized for sex and age), and echocardiographic parameters, including left ventricular outflow tract gradient (LVOTG). A higher level of hs-TnI was observed in RSC patients as compared to the non-RSC group (102 (29.2-214.7) vs. 8.7 (5.3-18) (ng/l), p=0.001). A trend toward increased NT-proBNP value was reported in RSC patients (1279 (367.3-1186) vs. 551.7 (273-969) (pg/ml), p=0.056). However, no difference in the NT-proBNP/ULN level between both groups was observed. Provocable LVOTG was higher in RSC as compared to non-RSC patients (51 (9.5-105) vs. 13.6 (7.5-31) (mmHg), p=0.04). Furthermore, more patients with RSC had prognostically unfavourable increased septal thickness to left LV diameter at the end diastole ratio. Patients with RSC were associated with an increased level of hs-TnI, and the only trend observed in this group was for the higher NT-proBNP levels. RSC seems to be an alerting factor for the risk of ischemic events. Not resting but only provocable LVOTG was higher in RSC as compared to non-RSC patients

Jaki chory z nadciśnieniem tętniczym odnosi największe korzyści z zastosowania skojarzenia losartanu z amlodipiną?

Combination of antihypertensive agents can better control blood pressure and reduce the number and severity of drugs side effects than a monotherapy. Calcium channel blockers and angiotensin II receptor type-1 blockers are effective antihypertensive drugs. Losartan and amlodipine are frequently used as first-line therapy in hypertensive patients, and combining these two drug has also been shown to be effective and safe in lowering blood pressure. Early initiation of amlodipine/losartan combination followed by subsequent dose escalation in patients who have not achieved recommended blood pressure levels may be particularly beneficial for patients with hypertension and metabolic syndrome, diabetes, pulmonary diseases and hyperuricaemia.Terapia skojarzona jest skuteczniejsza od monoterapii w obniżaniu ciśnienia tętniczego, a — stosując ją — można uzyskać zmniejszenie działań niepożądanych leków hipotensyjnych. Antagoniści wapnia oraz inhibitory receptora AT1 dla angiotensyny II to szeroko stosowane i skuteczne klasy leków hipotensyjnych. Losartan i amlodipinę często stosuje się jako leki pierwszego wyboru w terapii przeciwnadciśnieniowej, zaś ich skojarzenie okazało się bezpiecznym i skutecznym połączeniem w terapii hipotensyjnej. Wczesne zastosowanie leku złożonego z amlodipiny i losartanu w odpowiednio dobranej dawce może być szczególnie korzystne w terapii nadciśnienia tętniczego u pacjentów z zespołem metabolicznym, cukrzycą, schorzeniami pulmonologicznymi i hiperurykemią

Monakolina — pomost między prozdrowotną modyfikacją diety a farmakoterapią hipercholesterolemii

Choroby układu sercowo-naczyniowego (CVD) są główną przyczyną przedwczesnych zgonów na świecie. Z kolei dyslipidemia to najczęściej występujący, modyfikowalny czynnik ryzyka CVD. Podstawę interwencji służącej normalizacji stężenia cholesterolu stanowi postępowanie niefarmakologiczne obejmujące modyfikację stylu życia, w tym przede wszystkim aktywność fizyczną i odpowiednią dietę. Grupą leków najczęściej stosowaną w leczeniu zaburzeń gospodarki lipidowej są statyny. Pośrednim etapem między postępowaniem niefarmakologicznym a leczeniem statynami może być zastosowanie żywności funkcjonalnej oraz suplementów diety, takich jak monakolina K. Skuteczność monakoliny K zawartej w czerwonym ryżu drożdżowym w obniżaniu stężenia cholesterolu potwierdzono w wielu randomizowanych badaniach klinicznych. Zastosowanie suplementów diety oraz żywności funkcjonalnej jako alternatywy dla leczenia statyną jest uprawnione tylko u pacjentów z niskim bądź umiarkowanym ryzykiem sercowo-naczyniowym, ewentualnie w tej grupie chorych obciążonych wysokim ryzyka sercowo-naczyniowym, u których wyjściowo stężenie cholesterolu frakcji LDL nie przekracza 100 mg/dl