Soluble TNFα receptor type I and hepcidin as determinants of development of anemia in the long-term follow-up of heart failure patients.

BACKGROUND: Anemia is common in patients with chronic heart failure (CHF) and is associated with a worse prognosis. This study aims to identify the biological mechanisms which reflect evolutionary changes in the hemoglobin concentrations in heart failure patients who are still not anaemic. METHODS: Fifty-nine patients (54 ± 14 years, 83% males) with CHF (LVEF 28 ± 10%), who did not have anemia, and had not received any previous transfusions, were included. The parameters studied were: iron metabolism (ferritin, iron, transferrin, soluble transferrin receptor (sTfR), hepcidin); inflammation (C-reactive protein, soluble TNFα receptor I (sTNFRI), interleukin 6); and myocardial stress (NT-proBNP, high sensitivity TnT, growth differentiation factor 15). All parameters were measured on inclusion and 1 year after inclusion. RESULTS: Baseline hemoglobin (g/dL) was 14.7 ± 1.5 and at 1 year of follow-up it showed a significant decrease of -0.4 (RIC: -0.7 to -0.06) (p=0.02). At baseline, only the sTNFRI was a predictor of a decrease in hemoglobin 1 year later (p=0.007). During follow-up, the increase in sTNFRI (p=0.002, r=-0.39) and hepcidin (p=0.006, r=-0.35) were both associated with a decrease in hemoglobin. Similarly, the patients who became anemic (13%) had higher levels of hepcidin (p=0.001) and sTNFRI (p=0.008). The remaining parameters did not show any relationship with the evolution in the hemoglobin. CONCLUSIONS: In CHF patients without anemia, the increase in the inflammatory state (sTNFRI) and the following deterioration in the iron metabolism (hepcidin) were the main determinants of a decrease in hemoglobin and the appearance of anemia in the long term follow-up period.

[Influence of estrogen replacement therapy on atherogenic profile in postmenopausal women]. / Influencia del tratamiento hormonal sustitutivo en el perfil aterogénico de la mujer postmenopáusica.

OBJECTIVE: Postmenopausal women have higher risk of cardiovascular events compared with premenopausal. The aim of this clinical study was to evaluate the effect of hormone replacement therapy (HRT) on the atherogenic profile in apparently healthy postmenopausal women. METHOD: The subjects were 76 healthy postmenopausal women, aged 45 to 59 years, and 15 premenopausal women with regular cycles, aged 40 to 45 years. 63 postmenopausal women completed the study. None of the participating women had a history of hypertension, diabetes mellitus or medications known to affect the cardiovascular system. Twenty seven postmenopausal women received daily 50 micrograms of transdermal estradiol and 100 milligrams of oral progesterone. Thirty six dit not receive HRT. Checkups were preformed at baseline and after six months of treatment, except the group of premenopausal women (only at baseline). Examinations consisted in measurement of body weight, length, waist/hip ratio and plasma levels of biochemical parameters. RESULTS: Estradiol levels were higher among premenopausal women than among treated and non-treated postmenopausal women (83 +/- 78.47 versus 10 +/- 3.99; 12 +/- 4.56 mg/l, p < 0.0001). Levels of serum cholesterol (198 +/- 30.2 versus 236 +/- 33.7; 228 +/- 32.8 mg/dl; p < 0.002), LDL-cholesterol (120 +/- 25 versus 151 +/- 34.2; 144 +/- 31.5 mg/dl, p < 0.02), uric acid (3.98 +/- 0.5 versus 4.6 +/- 1; 4.8 +/- 1 mg/dl, p < 0.004) and homocysteine (9.8 +/- 3.3 versus 13 +/- 3.1; 11 +/- 1.7 mmol/l, p < 0.02) were higher among postmenopausal women than among premenopausal women. The treated women showed higher levels of serum estradiol (49 +/- 34.43 versus 10 +/- 3.99, p < 0.0001) and CRP (0.11 +/- 0.06 vs. 0.24 +/- 0.12 mg/l, p < 0.05), lower waist/hip ratio (0.82 +/- 0.06 versus 0.83 +/- 0.05, p < 0.03), glucose (78 +/- 15.4 versus 85 +/- 14.3 mg/dl, p < 0.03), cholesterol (215 +/- 33.2 versus 236 +/- 33.7 mg/dl, p < 0.03), triglycerides (90 +/- 30.1 versus 106 +/- 47 mg/dl, p < 0.003) and calcium (9.4 +/- 0.4 versus 9.5 +/- 0.4 mg/dl, p < 0.0005) than postmenopausal women without hormone replacement. CONCLUSION: That HRT may have a favourable effect on atherogenic profile in apparently healthy postmenopausal women.

La proteína C reactiva como marcador del riesgo cardiovascular / C-reactive protein as an indicator of cardiovascular risk

Se han publicado un gran número de estudios epidemiológicos que asocian distintos factores de inflamación, como la proteína C reactiva (PCR), y la enfermedad cardiovascular. Con la disponibilidad de sistemas de ensayo altamente sensibles, la medida de la concentración plasmática de la PCR puede proporcionar un método para la detección de individuos con alto riesgo de ruptura de placa y de eventos cardiovasculares. El límite superior del rango bajo-normal de la PCR podría ser un predictor independiente del riesgo de futuro infarto e ictus en individuos sin historia de enfermedad cardiovascular. La incorporación de la PCR al perfil del estudio lipídico puede mejorar la predicción del riesgo global tanto en individuos normolipidémicos como en hiperlipidémicos. La PCR también puede ser de utilidad en la monitorización de la respuesta antiinflamatoria de fármacos como el ácido acetilsalicílico y las estatinas, sobre todo en la prevención primaria de eventos vasculares. Por tanto, la PCR puede desempeñar un papel importante en la valoración del riesgo global en la prevención primaria de la enfermedad vascular (AU)

Automated detection of EEG artifacts during sleep: preprocessing for all-night spectral analysis.

This paper describes a simple artifact detection algorithm which can be used when large amounts of EEG data are to be automatically processed via spectral analysis techniques in a general purpose digital computer, and visual inspection of each EEG epoch becomes an impossible task. The technique is based on a chi-square (chi(2)) goodness-of-fit test to a Gaussian distribution (CSQ), and it was applied to EEG epochs each 30 sec long. This test proved to be very sensitive to non-stationarities in the EEG amplitude distribution for a particular epoch, and it produced a large value for the chi(2) coefficient when an artifact was present. EEG epochs that gave rise to chi(2) coefficients of value larger than a heuristically determined minimum were discarded from further analysis. The above technique enabled efficient data reduction and reliable automatic off-line processing of 50 nights of sleep EEG via spectral techniques.