Serum phosphorus level is related to degree of clinical response to up-titration of heart failure pharmacotherapy.

Serum phosphorus abnormalities may pose a risk on the cardiovascular system. In heart failure (HF) phosphorus homeostatic mechanisms are altered and may be modified by modern HF therapy. The impact of therapy optimization on phosphorus abnormalities and related outcome remains unknown. In 722 patients with HF subjected to treatment up-titration we analyzed the prevalence of serum phosphorus abnormalities and their relation to HF severity on top of optimal treatment, and we assessed adjusted risk of phosphorus abnormalities at different stages of HF. We analyzed predictors of hypo- and hyperphosphatemia and relation to prognosis. Hypophosphatemia was associated with better response to therapy, was more prevalent in milder HF, and the association was independent of age, sex, BMI, etiology of HF, kidney function and the use of diuretics. Hypophosphatemic patients lost more phosphorus into urine. They had also less catabolic profile. Patients with hyperphosphatemia on top of optimal therapy responded worse to treatment. Hyperphosphatemia was more prevalent in advanced HF, but the effect was attenuated after adjustment for potential confounders. Clinical and biochemical profiles of hyperphosphatemics suggested domination of catabolism. Neither hypophosphatemia nor hyperphosphatemia modifies the outcome Serum phosphorus abnormalities are related to HF severity on top of optimal therapy. Hypophosphatemia occurring on HF up-titration therapy likely has a multifactorial pathophysiology comprising of urinary phosphorus wasting and refeeding effects. Hyperphosphatemia is linked to the catabolic profile but the effect of renal impairment can't be ruled out. The prognostic impact of serum phosphorus abnormalities remain to be established.

[Cardiogenic shock in the course of myocardial infarction--the results of treatment during hospitalization and in long-term follow-up]. / Wstrzas kardiogenny w przebiegu zawalu serca--wyniki leczenia w obserwacji wewnatrzszpitalnej i odleglej.

UNLABELLED: Cardiogenic shock develops in 5-15% of patients hospitalised with acute myocardial infarction. It is responsible for more than a half of all hospital deaths with survival rate of about 20%. Conventional medical therapy with use of adrenergic, vasoactive, inotropic and thrombolytic agents has failed to improve survival. Treatment strategy combine hemodynamic stabilisation with restoration of coronary blood flow. The aim of the study was evaluation of mechanical restoration of coronary blood flow in infarction related artery and to assess its influence on mortality in patients with myocardial infarction complicated by cardiogenic shock. We retrospectively analysed 58 subjects: 26 patients treated by primary angioplasty, 25 patients with PTCA angioplasty after streptokinase treatment and 7 ones treated conservatively. TIMI 3 flow in angioplasty treated patients was achieved in 70.6% with in hospital mortality rate 14%, however, when reperfusion was unsuccessful the mortality was high (80%). 12 months follow-up mortality rate was 41.8%. CONCLUSION: Successful reperfusion with coronary angioplasty of the infarct-related artery can significantly reduce mortality rate in patients with cardiogenic shock. Patients who survived in-hospital period have favourable one-year prognosis.

[Effect of Rilmenidine(Tenaxum) on the activity of the autonomic nervous system in patients with hypertension and asthma]. / Wplyw rilmenidyny (Tenaxum) na aktywnosc autonomicznego ukladu nerwowego u chorych na nadcisnienie tetnicze i astme.

Application of beta-adrenoreceptor blockers in asthmatic patients increases broncho-constriction, and angiotensin converting enzyme inhibitors may induce cough. In either case life quality of asthmatics may deteriorate. Increased sympathetic activity plays a significant role in the development and maintenance of arterial hypertension. Recently imidazoline receptor agonists have been used in the treatment of hypertension. The action of these drugs results in modification of the vegetative nervous system due to a decreased activity of the adrenergic system. Such modification could be disadvantageous in asthmatic patients in whom an increased parasympathetic tonus is an important mechanism of bronchoconstriction. The aim of the paper was to assess the autonomic nervous system during spontaneous overnight sleep in 10 mild or moderate asthmatic women in a stable stage of the disease; they were all treated for mild or moderate arterial hypertension with Tenaxum 1 mg daily. The examination consisted in spectral analysis of the heart rate variability of 10 min. periods repeated every five minutes. The following parameters of the spectral power were studied: high frequency components (HF) reflecting parasympathetic activity, low frequency components (LF) representing sympathetic activity, as well as the LF/HF ratio. The investigations, including spirometry, were performed before and on the 3rd and 21st day of treatment. Arterial tension was brought to normal in 7 out of 10 patients. Spirometric parameters (VC, FEV1, MEF50%FVC, MEF25%FVC) did not undergo any significant changes, however a significantly increased parasympathetic activity (HF) in the studied patients was found on day 21. The results of our investigations indicate that Tenaxum can be a safe therapeutic agent in the treatment of mild or moderate arterial hypertension in asthmatics.

[Tumor necrosis factor receptors sTNF-RI and sTNF-RII in advanced chronic heart failure]. / Receptory sTNF-RI i sTNF-RII w zaawansowanej przewleklej niewydolnosci serca. Doniesienie wstepne.

UNLABELLED: The inflammatory process in chronic heart failure (CHF) is the result of dysbalance between the function of inflammatory and natural antiinflammatory mediators. Tumor necrosis factor alpha (TNF-alpha) is increased in patients with severe CHF. Two soluble proteins, the extracellular domains of the TNF receptors (sTNF-RI and sTNF-RII) inhibit the TNF-alpha biological effect. The aim of the study was to examine the plasma levels of sTNF-RI and sTNF-RII in patients with CHF and its relation to clinical, biochemical parameters of CHF severity. 41 patients with CHF (NYHA III and NYHA IV) and 18 control subjects were enrolled in this study. Plasma levels of sTNF-RI and sTNF-RII were analyzed by immunosorbent assay (ELISA) kits R&D (Research and Diagnostics Systems) (pg/ml). RESULTS: CHF patients had significantly increased receptor plasma levels compared to controls (p < 0.001). Soluble sTNF-RI and sTNF-RII receptors levels were similar in class NYHA III and NYHA IV. Receptor sTNF-RII correlated negatively with sodium plasma levels (p < 0.001), and sTNF-RI positively correlated with urice acid plasma level (p < 0.05). No statistically significant correlations were found between those receptors and age and gender etiology and severity of CHF, body weight (BMI) or other examined parameters (clinical, hemodynamic, echocardiographic, holter). CONCLUSIONS: Plasma level of sTNF-RI and sTNF-RII are increased in patients with CHF.