General public awareness of heart failure: results of questionnaire survey during Heart Failure Awareness Day 2011.

INTRODUCTION: General public views about heart failure (HF) alone and in comparison with other chronic conditions are largely unknown; thus we conducted this survey to evaluate general public awareness about HF and HF disease burden relative to common chronic disease. MATERIAL AND METHODS: This was a cross-sectional survey during European Heart Failure Awareness Day 2011. People visiting the stands and other activities in 12 Slovenian cities were invited to complete a 14-item questionnaire. RESULTS: The analysis included 850 subjects (age 56 ±15 years, 44% men, 55% completed secondary education or higher). Overall, 83% reported to have heard about HF, 58% knew someone with HF, and 35% believed that HF is a normal consequence of ageing. When compared to other chronic diseases, HF was perceived as less important than cancer, myocardial infarction, stroke and diabetes with only 6%, 12%, 7%, and 5% of subjects ranking HF as number 1 in terms of prevalence, cost, quality of life, and survival. A typical patient with HF symptoms was recognized by 30%, which was comparable to the description of myocardial ischemia (33%) and stroke (39%). Primary care physicians (53%) or specialists (52%) would be primary sources of information about HF. If experiencing HF, 83% would prefer their care to be focused on quality of life rather than on survival (14%). CONCLUSIONS: Many participants reported to have heard about heart failure but the knowledge was poor and with several misbeliefs. Heart failure was perceived as less important than several other chronic diseases, where cancer appears as a main concern among the general public.

Is diabetic cardiomyopathy a specific entity?

Diabetes mellitus (DM) is characterised by hyperglycemia, insulin resistance and metabolic dysregulation leading to diastolic and systolic dysfunction in diabetes. In this review, the pathogenetic and pathomorphological changes leading to diastolic and systolic dysfunction in diabetes are discussed. Changes in metabolic signalling pathways, mediators and effectors contribute to the pathogenesis of cardiac dysfunction in DM called diabetic cardiomyopathy (DC). Echocardiographic studies report on the association between DM and the presence of cardiac hypertrophy and myocardial stiffness that lead to diastolic dysfunction. More recently reported echocardiographic studies with more sensitive techniques, such as strain analysis, also observed systolic dysfunction as an early marker of DC. Depression of systolic and diastolic function is continuum and the line of separation is artificial. To conclude, according to current knowledge, DC is expected to be a common single phenotype that is caused by different pathogenetic and pathomorphological changes leading to diastolic and systolic dysfunction in diabetes.

With computed tomography confirmed anterolateral left ventricular pseudoaneurysm in patient with dilatative alcoholic cardiomyopathy.

BACKGROUND: Pseudoaneurysms are rare complications of myocardial infarction with propensity for rupture. There is still a challenge with which diagnostic imaging we performed a final diagnosis of pseudoaneurysm and differentiate it from true aneurysm what is clinically important due to the different treatment. CASE REPORT: We presented the unusual case of a 56-year-old man with signs of decompensated heart failure which had worsened a few months before hospitalization. We believed that during worsening of symptoms the patient suffered a silent myocardial infarction complicated by subacute free wall rupture which resulted into left ventricular pseudoaneurysm formation without tamponade. Echocardiography showed dilatative cardiomyopathy which was already present years before and a very rare location of the left ventricular pseudoaneurysm on the anterolateral part of the left ventricle. Pseudoaneurysm was confirmed with CT scan. Due to the severity of contractile dysfunction and no response in treatment for congestive heart failure the directive for the resection was tempered and the patient died due to the progressive heart failure and embolic phenomena. CONCLUSIONS: This report shows the importance of non-invasive imaging diagnostic evaluation of acute decompensated heart failure where echocardiography and chest X-ray are the first diagnostic steps. Based on those findings further imaging diagnostic steps must be performed such as CT scan in our case which finally confirms left ventricular pseudoaneurysm with dilatative cardiomyopathy.

Oestrogen receptor dinucleotide (TA) polymorphism affects total and LDL cholesterol but does not predict premature myocardial infarction in Caucasian men.

OBJECTIVE: The aim of this association study was to test the hypothesis whether the oestrogen receptor gene dinucleotide (TA) polymorphism is a risk factor for premature myocardial infarction in Caucasian men. Moreover, we investigated an association between oestrogen receptor gene dinucleotide (TA) polymorphism and serum lipid levels. METHODS AND RESULTS: One hundred and thirty men with premature myocardial infarction were compared with healthy men. Cases and controls did not demonstrate a statistically significant difference in distribution of the oestrogen receptor dinucleotide (TA) gene polymorphism alleles. Neither did we demonstrate the length of the dinucleotide (TA) repeats of the oestrogen gene to be associated with premature myocardial infarction in Caucasian men. Subjects with larger alleles (both alleles of > or =19 repeats) differed from subjects with other genotypes in serum total and LDL cholesterol, but not in HDL cholesterol and triglycerides. CONCLUSIONS: Despite an association between the oestrogen receptor gene dinucleotide (TA) polymorphism in the regulatory region of the alpha oestrogen receptor gene and serum total and LDL cholesterol, our study suggests that the oestrogen polymorphism is not associated with premature myocardial infarction in Caucasian men.

Apolipoprotein E gene polymorphism effects triglycerides but not CAD risk in Caucasian women younger than 65 years.

The pathogenesis of CAD is similar in man and woman, yet some risk factors have a greater impact on the CAD risk in woman than in man. In this study we assessed the effect of the apoE gene polymorphism on lipid metabolism and risk for CAD in women younger than 65 years (premature CAD). In a cross-sectional case-control study, 147 female Caucasian patients with premature CAD (confirmed by coronarography) were compared with a control group of 114 healthy Caucasian women. The apoE allele frequencies of patients vs. controls were 5.1% vs. 5.7% for 2, 85.4% vs. 83.3% for 3, and 9.5% vs. 11% for epsilon4. The subjects with epsilon2/3 genotype had statistically significantly higher triglycerides levels than the subjects with epsilon3/3 genotype (2.23 +/- 2.13 mmol.L(-1) vs. 1.73 +/- 0.84 mmol.L(-1); p<0.05). Logistic regression analysis revealed no association between risk genotypes (3/4 and 4/4) of the apoE gene polymorphism and CAD risk (OR 0.9; 95% CI 0. 5-1.7, P=0.7). We observed metabolic clustering of diabetes mellitus, arterial hypertension, higher BMI and triglycerides, and lower HDL cholesterol in the CAD group compared to the control group. Arterial hypertension, diabetes, HDL cholesterol level, and BMI were independent risk factors for premature CAD in female population, whereas, the risk genotype of the apoE gene polymorphism was not. In conclusion, in Slovene women risk genotypes of the apoE gene polymorphism are not associated with premature CAD; a metabolic clustering of diabetes, HDL, triglycerides and arterial hypertension is frequently present in Caucasian women with premature CAD.

Sex difference in the effect of ACE-DD genotype on the risk of premature myocardial infarction.

In this association study the authors compared the insertion/deletion (I/D) angiotensin-I converting enzyme (ACE) gene polymorphism in females and males with premature myocardial infarction (MI). I/D ACE gene polymorphism was tested in 738 subjects: 302 patients with MI (151 men and 151 women) and 436 healthy subjects (207 men and 229 women). In women the ACE-DD genotype was not associated with MI (OR 1.1, 95% CI 0.6-2.1, p=0.6), whereas the ACE-DD genotype conferred a 2-fold independent risk for MI in men (95% CI=1.2-3.4; p=0.013) after adjustment for cardiovascular risk factors. The authors found evidence for the sex difference in the effect of the ACE-DD genotype on MI risk. The ACE-DD genotype conferred a 2-fold independent risk for premature MI in males.

The eNOS gene polymorphism does not have a major impact on lipid parameters and premature coronary artery disease in Caucasian women.

Endothelial nitric oxide synthase (eNOS) catalyzes the formation of nitric oxide (NO) which has vasodilatory, antithrombotic, antiinflammatory and antiproliferative actions through which NO regulates blood pressure and modulates the process of atherosclerosis. Genetic polymorphism of the eNOS gene has been identified in several studies as a risk factor for cardiovascular diseases. In this case-control study we examined a possible association of the polymorphism in intron 4 (4a/b) of the eNOS gene (eNOS 4a/b) on coronary artery disease (CAD) risk in 151 Slovenian women with premature CAD (younger than 65 years) and in 109 women without CAD. The eNOS 4a/b polymorphism was analysed by PCR reaction. CAD in women was confirmed by coronary angiography. An aged-matched control group was without a history of symptomatic CAD. The frequency of 4a/b genotypes did not differ between patients and controls: in CAD patients the frequencies of the 4aa, 4ab, or 4bb genotype were 4.0%, 27.2%, or 68.8%, respectively, and in controls the genotype frequencies were 6.4%, 26.6%, or 67.0%, respectively. In our study there were no differences in lipid parameters (total cholesterol, low-density lipoprotein (LDL) cholesterol, high-density lipoprotein (HDL) cholesterol and triglycerides) between the subjects with the aa genotype and the subjects with the ab or bb genotype. Also, there was no association between the rare genotype aa and an increased risk of CAD in current and ex-smokers, and in hypertensive individuals. In this study we found that the eNOS 4a/b polymorphism was not associated with premature CAD (OR 0.7; 95% CI 0.2-3.7; p = 0.7), but the clustering of classical risk factors has a major impact on premature CAD in Caucasian women.

Complete atrioventricular block induced by alcohol abuse.

A patient with a history of chronic alcoholism and a reversible complete AV block due to excessive alcohol abuse is reported. The conduction disorder gradually improved after the complete cessation of alcohol consumption as the only means of therapy. During 6 month follow-up he continued to abstain from alcohol and had intact AV conduction.

Insertion/deletion polymorphism of angiotensin-converting enzyme gene--risk factor for coronary artery disease in the Tuzla region population (Bosnia and Herzegovina).

Angiotensin II is the major effector molecule of renin-angiotensin system; its production can be conveniently interrupted by angiotensin-converting enzyme (ACE). Typical plasma levels of ACE accompany the I/D polymorphism; however, a controversy exists as to whether the DD genotype of the ACE polymorphism affects the risk for the development of coronary artery disease (CAD) and to what extent the ACE polymorphism is associated with CAD in different populations. We compared the I/D polymorphism in 212 CAD patients younger than 50 years with 165 healthy control individuals. They were all from the Tuzla region in Bosnia and Herzegovina. Patients with CAD had a higher prevalence of the DD genotype (36.3%) than controls (25.6%). The odds ratio for the ACE DD genotype in CAD patients was 1.7 (95% confidence interval 1.0-2.7; p < 0.05). We may conclude that the D/D genotype of the ACE gene polymorphism is associated with an increased risk for CAD in the Bosnian population.