Prognostic value of echocardiography and ECG in heart failure with preserved ejection fraction.

OBJECTIVE: The aim of this study was to evaluate characteristics of patients with heart failure (HF) with preserved ejection fraction (HFPEF) and to assess prognostic predictors in 2-year follow-up. METHODS: We included prospectively 109 patients admitted to the internal department for HF, grouped into HFPEF (EF>40 %, n = 63) and HF with reduced EF (HFREF) (EF≤40 %, n=46). Preserved right ventricular systolic function (PRV) was defined as the peak systolic tricuspid annular velocity (S') >10.8 cm/s. RESULTS: HFPEF and HFREF patients had non-significantly different 2-year all-cause and CV mortality (28.6 % vs 37.0 %, 17.5 % vs 21.7 %). Patients with HFPEF and PRV vs dysfunctional RV had a better survival (76.6  % vs 56.3 %, p=0.045). In HFPEF, the patients who survived had a trend to better S' (13.6±3.1 cm/s vs 11.9±3.4 cm/s, p=0.055), shorter QTc (427±42ms vs 454±42ms, p=0.058), and all-cause mortality was lowered only by anticoagulants (12.0 % vs 39.5 %, p=0.02). QTc interval and PRV emerged as predictors of all-cause mortality (HR 1.7 per 40 ms change, 95  % CI 1.1-2.6, p = 0.02, HR 0.38, 95 % CI 0.15-0.93, p=0.03). CONCLUSIONS: In HFPEF, we observed a trend to lower all-cause and CV mortality compared to HFREF and anticoagulants were the only therapy that significantly lowered mortality. PRV and QTc interval emerged as independent predictors of survival (Tab. 6, Fig. 2, Ref. 26).

[Changes in NT-proBNP levels in patients with atrial fibrillation related to heart failure]. / Zmeny hladín NT-proBNP u pacientov s fibriláciou predsiení v iávislosti od srdcového zlyhávania.

INTRODUCTION: NT-proBNP, a well-established diagnostic and prognostic marker in clinical practice, is significantly elevated in individuals with atrial fibrillation (AF), even in absence of heart failure or major structural heart disease. OBJECTIVES: The aim of this study was to determine the cut-off value of NT-proBNP for diagnosis of heart failure in individuals with atrial fibrillation. METHODS: We compared 44 patients (25 male/19 female) with AF and concomitant overt heart failure [age 76 (62-82) years; median (interquartile range - IQR)] versus 29 patients (16 male/13 female) with AF with no signs of heart failure [age 59 (50-67) years; median (IQR)]. We considered the underlying causes of heart failure and its severity, comorbidities, echocardiographic and selected laboratory parameters, the body mass index as well as the treatment at discharge. We determined the cut-off value for heart failure and major structural heart disease using ROC curve analysis. RESULTS: Median NT-proBNP in the group of patients with AF and concomitant heart failure was 3 218 ng/l (IQR 1 758-7 480 ng/l) vs 981 ng/l (IQR 431-1 685 ng/l) in the group of patients with AF with no signs of heart failure; this difference was statistically significant (p < 0.001). The level of NT-proBNP higher than 1 524 ng/l in patients with AF was diagnostic of major structural heart disease and pointed towards a possible heart failure (sensitivity 80%, specificity of 76%, accuracy 78%, positive predictive value 83%, negative predictive value 71%). The NT-proBNP levels significantly correlated with age (p < 0.001), left atrial diameter (p < 0.01) and furosemide dose at discharge (p < 0.05). The NT-proBNP levels significantly negatively correlated with left ventricular ejection fraction (p < 0.001) and body mass index (p < 0.05). CONCLUSION: We found out that NT-proBNP is significantly elevated in patients with AF with preserved left ventricular function and in absence of heart failure and significantly correlates with age, left ventricular ejection fraction, left atrial diameter, body mass index and the furosemide dose necessary to achieve cardiac compensation. Furthermore, we determined the NT-proBNP cut-offvalue predictive of a possible heart failure in patients with AF.

Chronic toxic neuropathy after organophosphorus poisoning in quails (Coturnix coturnix japponica).

Peripheral neuropathy was induced by the long-term administration of organo-phosphorus compounds (phtalimid/phosmet) in quails (Coturnix coturnix japponica). After 4 weeks, the first symptoms of organophosphorus (OPC) poisoning (apathy, diarrhea) were present. During the second month of a daily administration of the toxic substance using the probe, an apparent clinical autonomic and peripheral neuropathy with ataxia had developed. Toxic disturbance of the nervous system was confirmed by the examination of spinal and cortical somatosensory evoked potentials (SEP) after tibial nerve stimulation. The prolongation of the peripheral conduction time (wave P6 and N9 represent the response from the ischiadic nerve and the entry of the stimulus to spinal cord, respectively) confirmed a peripheral nerve lesion. We suggest that these clinical and electrophysiological changes, displayed by the disturbed nervous system, are caused by either slowing or stoppage of the axonal flow, transport of proteins and other substances, as well as by axon demyelination (Tab. 1, Fig. 1, Ref. 22).

[Effect of ACE-inhibitors on changes in creatinine in the blood-- introduction]. / Vliv ACE-inhibitoru na zmeny koncentrace kreatininu v krvi--úvod do studie.

In a retrospective study a total of 44 ambulatory examinations were made before enalapril was administered to 13 patients with essential hypertension and 52 ambulatory examinations during enalapril treatment of these patients. All patients were followed up on a long-term basis: 1. without enalapril treatment (2-24 months), 2. during enalapril treatment (4-24 months). For both investigation periods arithmetic means of plasma creatinine were calculated. The length of the investigation period was intentionally used as the sole criterium for inclusion in the group of patients. In nine patients during treatment the serum creatinine levels rose. The authors found a close positive correlation between the rise of plasma creatinine levels and the patients' age (correlation coefficient r = 0.59, n = 13, p < or = 0.02). Between the rise of creatinine (dependent variable) and independent variables (daily enalapril dose, initial creatinine blood level, the drop of the median arterial pressure during enalapril treatment) no close relationships were found. The rise of creatinine during enalapril treatment can be explained by a drop of the filtration pressure in the glomeruli during dilatation of the vas efferens. This drop of the filtration pressure was manifested by a slight increase of plasma creatinine only in patients with a drop of the renal perfusion (haemodynamic) reserve, i.e. in more advanced age groups.

Intermolecular Foerster's energy transfer in labeled poly[N-(2-hydroxypropyl)methacrylamide].

By copolymerization of monomers containing donor (carbazole) and acceptor (dansyl) fluorophores withN-(2-hydroxypropyl)methacrylamide (HPMA), statistical copolymers with "low" and "high" contents of the fluorophores were prepared. The increase in nonradiative energy transfer between copolymers with a low content of fluorophores was probably due to intermolecular penetration of the polymer coils in concentrated solutions.

Yersinia enterocolitica in water and foods.

Yersinia enterocolitica (Ye) isolates from water (367 strains) and different foods (114 strains) were typed serologically and biochemically. In some samples, especially of water, several Ye serotypes were found simultaneously. A noteworthy finding was Ye 03, biotype 4 in tinned meat paste that had already been on sale without, however, any case of diarrhoeal disease being reported in the particular district. The food and water strains included all Ye O-serotypes except 09. Numerous strains were untypable, probably possessing unknown O-antigens. Water isolates were less active biochemically than strains of identical serotypes from food sources.