Hypertension Predisposition and Thermoregulation Delays in Adolescents with Polycystic Ovary Syndrome: A Pilot Study.

BACKGROUND: Polycystic ovary syndrome (PCOS) is a heterogeneous disorder in which clinical, sonographic, and endophenotypic features have been underinvestigated or inconclusive, especially in the early stages of the disease (adolescence/young adulthood). OBJECTIVE: This prospective pilot study focused on the differences of multiple physiological functions between Greek adolescent/young adult females suffering from PCOS and age- and body mass index (BMI)- matched healthy controls. STUDY DESIGN: Nineteen PCOS patients and eighteen healthy controls (aged 13 to 23 years) were studied for: (i) biochemical and hormonal dysfunction by measuring circulating glucose, insulin, and androgen levels; (ii) arterial stiffness with pulse wave analysis (PWA) by Sphygmocord; (iii) intima-media thickness (IMT) by ultrasound; (iv) heart rate variability (HRV) by Task Force Monitor; and (v) QT, QRS, QT, P, QRSD by electrocardiogram (ECG). Statistical analysis included Hedge's g correction for small samples bias, and the results are shown using the Hedge's g effect size and 95% CI, in line with precision medicine prerequisites. RESULTS: Significant differences in pulse wave velocity (PWV) (g = 0.964 [0.296, 1.632]), subendocardial viability ratio (SEVR) carotid (g = -0.679 [-1.329, -0.030]), pulse pressure (PP) carotid (g = 0.942 [0.275, 1.608]), systolic pressure (SP) carotid (g = 0.785 [0.129, 1.440]), free-testosterone (g = 0.677 [0.042, 0.312]), and Delta4-androstenedione (g = 0.735 [0.097, 0.373]) were observed between PCOS patients and controls. No differences were detected in the remaining endocrine and PWA or ECG biomarkers. CONCLUSIONS: Our multidisciplinary approach showed early onset of vascular dysfunction, predisposition to hypertension, thermoregulation delays, and metabolic syndrome changes in adolescent/young adult PCOS.

Entropy in Cardiac Autonomic Nervous System of Adolescents with General Learning Disabilities or Dyslexia.

Heart rate variability (HRV) represents one of the two key markers of the autonomic nervous system. It is measured by the time variation in the beat-to-beat interval, while the period between successive beats is defined as the RR interval (RRI). Its components are classified as linear and non-linear. In the field of psychophysiology, HRV is investigated as a key player of possible predictive or diagnostic value. Female adolescents with general learning disabilities or dyslexia were recruited at the Center for Adolescent Medicine and UNESCO Chair on Adolescent Health Care of the National and Kapodistrian University of Athens. Adolescents were further assessed for HRV. Data were collected with the Task Force® Monitor at the Cardiovascular Laboratory of the Biomedical Research Foundation of the Academy of Athens. The RRI time-series were estimated for approximate entropy (AE), conditional entropy (CE), corrected conditional entropy (CCE), fuzzy entropy (FE), permutation entropy (PE), sample entropy (SE), and Shannon's entropy (ShE). RRI manifested complex dynamics, indicating a complex pattern of progression. This finding suggests that RRI conceals non-linear dynamics, which if investigated in depth could provide more knowledge on the relation between RRI and learning disorders.

Left atrial volume index in patients with heart failure and severely impaired left ventricular systolic function: the role of established echocardiographic parameters, circulating cystatin C and galectin-3.

Backround: Left atrial (LA) enlargement plays an important role in the development of heart failure (HF) and is a robust prognostic factor. Fibrotic processes have also been advocated to evoke HF through finite signalling proteins. METHODS: We examined the association of two such proteins, cystatin C (CysC) and galectin-3 (Gal-3), and other clinical, echocardiographic and biochemical parameters with LA volume index (LAVi) in patients with HF with severely impaired left ventricular ejection fraction (LVEF). Severe renal, liver, autoimmune disease and cancer were exclusion criteria. RESULTS: A total of 40 patients with HF (31 men, age 66.6 ± 1.7) with LVEF = 25.4 ± 0.9% were divided into two groups according to the mean LAVi (51.03 ± 2.9 ml/m2) calculated by two-dimensional transthoracic echocardiography. Greater LAVi was positively associated with LV end-diastolic volume ( p = 0.017), LV end-systolic volume ( p = 0.025), mitral regurgitant volume (MRV) ( p = 0.001), right ventricular systolic pressure (RVSP) ( p < 0.001), restrictive diastolic filling pattern ( p = 0.003) and atrial fibrillation ( p = 0.005). Plasma CysC was positively correlated with LAVi ( R2 = 0.135, p = 0.019) and log-transformed plasma Gal-3 ( R2 = 0.109, p = 0.042) by simple linear regression analysis. Stepwise multiple linear regression analysis showed that only MRV ( t = 2.236, p = 0.032), CysC ( t = 2.467, p = 0.019) and RVSP ( t = 2.155, p = 0.038) were significant predictors of LAVi. CONCLUSIONS: Apart from known determinants of LAVi, circulating CysC and Gal-3 were associated with greater LA dilatation in patients with HF with reduced LVEF. Interestingly, the correlation between these two fibrotic proteins was positive.

Thyroid hormones and cardiac remodeling.

Thyroid hormones have many cardioprotective actions expressed mainly through the action of T3 on thyroid receptors α1 and ß1. They are procontractile anti-apoptotic, anti-inflammatory, and anti-fibrotic, promote angiogenesis and regeneration, and have beneficial effects on microRNA profiles. They have proven to be anti-remodeling in numerous animal studies, mostly in rodents; a specific action on the border zone has been described. Studies in humans with DIPTA have been in conclusion. Remodeling can be defined as an increase of ≥20 % of the end-diastolic or end-systolic volume, together with a return to the fetal phenotype. An overview of animal and clinical studies is given.

Neurohormonal activity and vascular properties late after aortic coarctation repair.

BACKGROUND: Coarctation of aorta (CoA) patients present cardiovascular complications late after repair the causes of which are not fully understood. Our study investigates the neurohormonal and immune activation and the elastic properties of the aorta and peripheral vessels in adult patients with coarctation of aorta (CoA), late after repair. METHODS: Nineteen adult patients with repaired CoA and 29 matched healthy controls underwent aortic distensibility, stiffness index, a study of the elastic properties of peripheral vessels proximal to the coarctation site and measurement of plasma cytokine and neurohormone levels. RESULTS: Distensibility index was reduced (p=0.02) and stiffness index was increased (p=0.005) in CoA patients compared to control. Augmentation index (p=0.0007) and augmented pressure (p=0.001) were higher in CoA patients and Forearm Blood Flow (FBF) index was reduced (p=0.009). Plasma levels of sICAM-1 (p=0.01), sVCAM-1 (p=0.05), E-selectin (p=0.01), sFas-ligand (p=0.02) and IL-10 (p=0.01) were also elevated in CoA patients vs control. TNF-a, IL-6, Endothelin-1 and NT-pro-BNP levels were not. CONCLUSIONS: Adults with repaired CoA seem to develop a late inflammatory reaction, which reflects a functional problem in all vessels, regardless of the initial lesion. This may explain the late complications of the disease despite early repair and improved surgical procedures.

Neurohormonal and cytokine fluctuations following transcatheter closure for an atrial septal defect.

INTRODUCTION: Inflammation and neurohormonal activation are considered to be involved in the development of earlier and/or later complications in congenital heart disease patients, even after a successful repair of the lesion. It is not yet clarified what is the role of the therapeutic interventions in the occurrence of such a response and how it could be associated with possible postoperative complications. AIM: We sought to assess the inflammatory and neurohormonal response to transcatheter closure of secundum type atrial septal defects (ASD) over a six-month follow-up period. We also evaluated the association between the respective markers and catheterization data as well as echocardiographic measurements. METHODS: Plasma concentrations of interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-α), interleukin-10 (IL-10), N-terminal-proatrial natriuretic peptide (NT-proANP) and N-terminal-probrain natriuretic peptide (NT-proBNP) were assessed and echocardiographic measurements were performed in twenty-eight patients with atrial septal defect prior to, and at the first, second and sixth months post transcatheter closure. Thirty-three age-matched healthy volunteers were also enrolled. RESULTS: IL-6 plasma levels, although higher preoperatively, [physical logarithm (ln) IL-6: 3.37±0.66 vs 2.92±0.44 pg/ml, p=0.015], reached control levels postoperatively, at the end of the third month, whereas TNF-α and IL-10 were not influenced by the procedure. NT-proANP levels were elevated preoperatively compared to the control group (ln NT-proANP 3.78±0.572 vs 3.48±0.30, p=0.031), with a further significant increase during the 1st month (ln NT-proANP 3.78±0.572 vs 4.2±0.42, p=0.006), following the pattern of the left atrial volume enlargement, and remained high even 6 months after the procedure .On the other hand, the initially normal concentrations of NT-proBNP, after a transient significant increase during the first month postoperatively (ln NT-proBNP 3.56±0.94 vs 4.58±0.91, p<0.0001) returned to the controls' levels at the end of the third month. Preoperative concentrations of NT-proANP positively correlated with NT-proBNP concentrations and pulmonary to systemic flow ratio (Qp/Qs). CONCLUSIONS: Transcatheter closure could improve, on a mid- term basis, the inflammatory process but natriuretic peptides' secretion continues in parallel with left atrial volume increase. Further follow up is required to determine the long-term progress of the inflammatory and neurohormonal response to the procedure.

Activity questionnaires; a useful tool in accessing heart failure patients.

AIM: The aim of the study was to correlate the score derived from Specific Activity Questionnaire (SAQ), Left Ventricular Dysfunction 36 (LVD 36) and the Minnesota Living with Heart Failure Questionnaire (LIhFE) with peak oxygen consumption measured during maximal treadmill exercise spirometry in patients with heart failure. METHODS: We prospectively studied 106 patients, average age 47+/-15.5 (mean+/-SD), with symptomatic heart failure. All were asked to answer the questions of the above mentioned questionnaires. Subsequently patients underwent treadmill exercise spirometry to measure peak oxygen consumption (VO2 peak ml/kg/min) using the Dargie protocol and to derive functional class according to the Weber classification system. RESULTS: SAQ had a very high performance in classifying patients with a VO2 peak <20 ml/kg/min and those with a VO2 peak <14 ml/kg/min. The correlation between VO2 peak achieved and the METs corresponding to the score derived from SAQ according to the given answers was r=0.77 (p<0.01). The correlation between VO2 peak achieved and the score from LVD 36 was r=-0.74 (p<0.01). The correlation between VO2 peak achieved and the score from LIhFE was r=-0.71 (p<0.01). CONCLUSION: The Specific Activity Questionnaire, the Left Ventricular Dysfunction and the Minnesota Living with Heart Failure Questionnaire were used to predict aerobic capacity and all correlated significantly with peak VO2 achieved from exercise spirometry. The above questionnaires represent a useful method to access heart failure patients and are valuable for those unable to undergo a treadmill test.