Inflammatory markers and left ventricular diastolic dysfunction in a family-based population study.

BACKGROUND: Heart failure affects patients with normal left ventricular systolic function (heart failure with preserved ejection fraction [HFPEF]) and those with reduced ejection fraction (HFREF). The treatment of HFPEF remains an unresolved issue. AIM: We sought to determinate the relationship between inflammatory markers and left ventricular diastolic dysfunction (LVDD) in a family-based population study. METHODS: A total of 303 participants from the general population (55% women, median age 49 years and 45% men, median age 40 years) underwent echocardiography and measurement of serum inflammatory markers: C-reactive protein (CRP), myeloperoxidase (MPO), and interleukin 6 (IL-6). RESULTS: Serum IL-6 concentration correlated with peak transmitral late diastolic velocity (A) and pulmonary vein systolic-to-di-astolic velocity (S/D) ratio (p < 0.01). Moreover, a significant correlation between IL-6 concentration and E/A ratio and early diastolic peak velocities of the mitral annulus displacement (E') was observed. The association of IL-6 concentration and peak transmitral early diastolic velocities (E) and the E/E' ratio (p < 0.05) was noted in men. In addition, the CRP concentration was shown to have an effect on E/A ratio in women (p < 0.05). A significant correlation between the CRP concentration and S/D ratio was observed both in women (p < 0.01) and men (p < 0.05). No significant correlation was found between the level of MPO and LVDD parameters. Additionally, only one predictive model was identified; E' was found to be dependent on IL-6, age, and heart rate in men (p < 0.001, R2 = 0.611). CONCLUSIONS: The above results suggest that inflammation may lead to the onset of LVDD, probably via vascular endothelial dysfunction.

Gastric myoelectric and autonomic activities and dyspeptic symptoms in cardiological syndrome X patients.

Syndrome X is defined as anginal chest pain accompanied by objective signs of ischemia on exercise testing but with angiographically normal coronary arteries. The aetiology of this syndrome is still not known. The AIM of this study was to evaluate changes in circadian rhythm of gastric myoelectric activity (MA) and autonomic system (AS) and their correlation with dyspeptic symptoms in SX patients. We studied forty consecutive patients, mean age 46+/-8 yrs with syndrome X and 40 sex-, age- and gender-matched healthy volunteers (47+/-5 yrs). The population of syndrome X patients is heterogeneous combining subgroups with normal and low AS activity with high tonic sympathetic drive. Patients with autonomic dysfunction had a high percent of gastric dysrrhythmia with disturbed sympatho-vagal balance particularly at night. We conclude that dyspeptic symptoms in SX patients with autonomic dysfunction are caused mostly by high adrenergic drive affecting stomach myoelectric activity and inducing gastric dysrrhythmias.

Gene polymorphisms predisposing to cardiac hypertrophy in patients with cardiac syndrome X.

Polymorphisms of the angiotensin-converting enzyme gene and endothelial nitric oxide synthase gene have been suggested to be associated with left ventricular hypertrophy. The aim of our study was to asses the association between above polymorphisms and left ventricular hypertrophy in patients with cardiac syndrome X. The presence of allele 4 of eNOS VNTR polymorphism could predispose to cardiac hypertrophy. The pathological course of postprandial lipemia in patients with CSX may add to the understanding of the CSX pathology.

[Socioeconomical status of life and regularity of intake of medicines among hypertensive patients]. / Status socjalno-ekonomiczny a regularnosc zazywania leków u chorych z nadcisnieniem tetniczym.

UNLABELLED: As hypertension occurs very commonly in contemporary population, its complications and costs of treatment are one of the most important health and social issues. Non-compliance of the patients with respect to the intake of medicines and not-obeying medical instructions on healthy life style are said to be an important cause of hypertension treatment failures. Socioeconomic status of life has also a strong impact on the regularity of medicine intake. The goal of this article was to analyze the influence of social and economical factors on the regularity of medicine intake in hypertensive patients. The test group consisted of 222 patients (20-80 years old (x = 56.85 +/- 8.59); 123 women and 99 men, all of whom were treated in the out-patient department in the First Department of Cardiology of the Jagiellonian University Medical College in Cracow. The impact of place of living, education, professional activity, income, knowledge about the illness and the goal of hypertension treatment on the regularity of medicine intake was assessed using a specially elaborated assessment questionnaire. The patients were divided into two categories depending on their compliance and extend to which they followed doctor's recommendation concerning the need of regular medicine intake (129 persons with regular intake and 93 persons with irregular medicine intake). Within the study groups, statistically significant differences concerning analyzed parameters were observed. Regular medicine intake was more common among city citizens (64.91%), persons with secondary education (69.69%), with higher education (71.69%), with employment status (67.44%), with higher average income and regularly checking their blood pressure at home at least once per week (66.85%). CONCLUSIONS: Socioeconomic factors have a decisive influence on following the instructions on hypertension by the patients. Special care is needed in the treatment of hypertensive patients with low socioeconomic status.

[The current opinion on inflammatory, biochemistry and hemostatic markers and factors in atherosclerosis. Part I]. / Aktualne spojrzenie na zapalne, biochemiczne i hemostatyczne markery oraz czynniki ryzyka choroby niedokrwiennej serca. Czesc I.

Atherosclerosis remains the leading cause of morbidity and mortality in many countries. Recent studies have established an immuno-inflammatory theory of atherosclerosis where the process of atherosclerosis has a chronic, fibroproliferative character as an immuno-inflammatory response to factors that damage vessel endothelium. The development of coronary artery disease in subjects without traditional risk factors has prompted a search for new markers of the disease, which may improve primary prevention strategies. The relationship between markers of chronic inflammation and infection and development and progression of atherosclerotic may provide a basis for establishing new methods for causative treatment of cardiovascular diseases. The markers of endothelial damage and activation of inflammatory response have a prognostic value independent of traditional risk factors.

[The current opinion on inflammatory, biochemistry and hemostatic markers and factors in atherosclerosis. Part II]. / Aktualne spojrzenie na zapalne, biochemiczne i hemostatyczne markery oraz czynniki ryzyka choroby niedokrwiennej serca. Czesc II.

Atherosclerosis remains the leading cause of morbidity and mortality in many countries. Recent studies have established an immuno-inflammatory theory of atherosclerosis where the process of atherosclerosis has a chronic, fibroproliferative character as an immuno-inflammatory response to factors that damage vessel endothelium. The development of coronary artery disease in subjects without traditional risk factors has prompted a search for new markers of the disease, which may improve primary prevention strategies. The relationship between markers of chronic inflammation and infection and development and progression of atherosclerotic may provide a basis for establishing new methods for causative treatment of cardiovascular diseases. The markers of endothelial damage and activation of inflammatory response have a prognostic value independent of traditional risk factors.

[Fibrinogen--acute phase protein as a marker of immunological process as atherosclerosis]. / Fibrynogen--bialko ostrej fazy jako marker procesu zapalnego miazdzycy.

The most important CAD risk factors are: smoking, high level of LDL-cholesterol and low level of HDL-cholesterol, hypertriglyceridemia, diabetes, obesity, hypertension, men sex, age over 45 in men and over 55 in women. Carl von Rokitanski was the first who suggested the role of thrombosis and fibrynolisis in the development of atherosclerosis and was the author of thrombolic theory. The recently studies show that atherosclerosis is an immuno-inflamatory process. Fibrinogen as an acute phase protein is a new marker of ischemic heart disease and its role in atherosclerosis needs further investigations.

[Role of human and bacterial heat shock proteins in inflammatory and immunological mechanisms of atherosclerosis]. / Rola ludzkich i bakteryjnych bialek szoku ciepinego w zapalno-immunologicznych mechanizmach rozwoju miazdzycy.

Atherosclerosis remains the leading cause of morbidity and mortality in many countries. Recent studies have demonstrated that the pathogenesis of atherosclerosis involves not only lipid deposition, but also the inflammatory process. The heat shock proteins (HSPS) are expressed in normal cells but their expression is enhanced by a number of different stress factors including heat and ischaemia. They play important roles in chaperoning the "folding" of other proteins and in protein degradation.

[Chlamydia pneumoniae and cardiovascular diseases]. / Chlamydia pneumoniae i jej zwiazek z chorobami ukladu krazenia.

The theories formulated to explain atherogenesis evolved from vessel wall lipid to endothelial dysfunction with vascular wall remodelling. Chlamydia pneumoniae has been demonstrated to play an important role in the development of inflammatory and immunological process and can initiate atherogenesis. This pathogen is found in atherosclerotic plaques, which can induce complex activation of local inflammatory and immunological events and lead to the development of unstable plaque, vascular remodelling and vessel lumen constriction.

Cardiac syndrome X--autonomic system disorders.

BACKGROUND: The abnormal neural regulation of the heart is one of the most important pathogenesis of cardiac syndrome X (CSX). The aim the study was to evaluate changes in autonomic nervous system activity (ANS) in CSX patients. METHODS: Forty-two patients (age 46 +/- 9 years) with CSX and forty-two healthy volunteers (age 47 +/- 9 years) as a control group were included in the study. Function of ANS was estimated with non-invasive tests based on simple cardiovascular reflexes. RESULTS: In 50% of CSX patients was diminished response to parasympathetic stimulation in deep breathing test. In response to sympathetic stimulation (the changes in body position, hand grip test) was observed decreased 30/15 ratios. The cardiac autonomic activities were altered with parasympathetic withdrawal and/or sympathetic abnormality in patients with CSX. CONCLUSIONS: The population of CSX patients is heterogeneous with normal autonomic system (about 23% of population) and abnormal ANS activity (about 77% patients). In cardiac syndrome X patients selected tests of ANS indicated presence of disturbances in sympathetic-parasympathetic balance.

Exercise tolerance and hyperinsulinemia in cardiac syndrome X.

The aim of the study was to evaluate the relationship between exercise tolerance, glucose and insulin levels and biochemical parameters related to endothelial function [endothelin-1 (ET-1), nitrite/nitrate (NOx)] in patients with cardiological syndrome X in comparison with healthy volunteers. The decrease of NOx level and NOx / ET-1 ratio suggests that endothelial dysfunction is present in cardiological syndrome X. Exercise tolerance correlated positively with NOx and negatively with insulin concentrations.

[C-reactive protein in patients with coronary heart disease]. / Rola bialka C-reaktywnego u chorych z choroba niedokrwienna serca.

High-sensitive C reactive protein (hs-CRP) is a circulating acute-phase reactant that shows the systemic inflammation. Some prospective trials have shown that hs-CRP is a strong predictor of future cardiovascular events. The relative risk associated with hs-CRP is independent of other cardiovascular risk factor.

[Activity of the autonomic nervous system in cardiological syndrome X]. / Aktywnosc ukladu autonomicznego w kardiologicznym zespole X.

BACKGROUND: The etiology of cardiological syndrome X (CSX) is unknown, however the dysfunction of cardiac autonomic nerves has been reported. AIM: The aim of the study was to evaluate changes in autonomic nervous system (ANS) activity in CSX patients. METHODS: Forty-three patients (age 48 +/- 9 yrs) with CSX and forty-three healthy volunteers (age 47 +/- 9 yrs) as a control group were included in the study. The function of ANS was assessed using non-invasive methods: heart rate variability (HRV) and tests based on cardiovascular reflexes. RESULTS: According to HRV analysis the patients were divided into two groups: A--22 pts with decreased HRV parameters and B--18 pts without significant differences as compared with the controls. At rest there was a difference in the HRV parameters between CSX patients and the controls. The CSX patients had the advantage of sympathetic component (the higher ratio LF/HF and LF value). Additionally an increase in heart rate and rate-pressure product was observed in 58% of CSX patients. In CSX patients the 30/15 ratio was decreased in response to changes in the body position in about 45% of CSX patients. A deep breathing test revealed a drop in the Expiration to Inspiration ratio. CONCLUSIONS: In patients with cardiological syndrome X selected tests of ANS indicated the presence of disturbances in the sympathetic-parasympathetic balance. In 40% of CSX patients the response to all autonomic tests was diminished. This indicates that the population of CSX patients is heterogeneous with normal and low abnormal ANS activity.

[Relations between endothelial nitric oxide synthase and angiotensin-converting gene polymorphisms and certain biochemical parameters in patients with cardiac syndrome X]. / Zwiazek miedzy polimorfizmem genu dla sródblonkowej syntazy tlenku azotu oraz dla konwertazy angiotensyny a wybranymi parametrami biochemicznymi u pacjentów z kardiologicznym zespolem X.

Cardiological syndrome X (CSX) is defined as effort anginal pain, positive exercise tolerance test and absence of angiographically documented stenosis in coronary arteries. Some genetic predispositions and metabolic disturbances can participate in development of this syndrome. The aim of our study was to investigate the associations between some biochemical parameters and polymorphism of ACE and eNOS (VNTR and Glu298Asp) genes in patients with CSX. 36 patients with CSX and a control group of 30 healthy volunteers were included in the study. The genotypes were determined by the polymerase chain reaction. Our study revealed that patients with CSX exerted lower fasting NOx levels, tended to have higher insulin values measured at 1 h of oral glucose tolerance test and higher levels of triglycerides and free fatty acids during oral lipid tolerance test. Patients with genotype T/T Glu298Asp of eNOS and 4/4 VNTR of eNOS revealed lower levels of NOx compared to patients with genotypes G/G and 5/5, respectively (30.5 +/- 7.2 vs 13.2 +/- 4.5; 28.6 +/- 8.4 vs 14.2 +/- 7.4; p<0.05). Thus, we conclude that disturbances in free fatty acid utilization, estimated by postprandial lipaemic test play important roles in the development of endothelial injury in CSX.

[Factors affecting the cooperation of hypertensive patients in the process of treatment]. / Ocena czynników wplywajacych na wspólprace pacjentów z nadcisnieniem tetniczym w procesie leczenia.

INTRODUCTION: Arterial hypertension is one of the leading causes of cardiovascular morbidity and mortality. Despite rigorous knowledge of pathophysiology of this entity and wide accessibility to highly effective drugs the rate of hypertension control is still low. Currently the lack of appropriate patient cooperation including irregular drug taking and unhealthy lifestyle are regarded to contribute most to the low efficacy of hypertension treatment. Many studies demonstrated the role of educational programmes in better hypertension control. It is now necessary to indicate those groups that need such efforts particularly. AIM: The aim of this study was to assess the factors affecting regular drug taking among hypertensive patients. METHODS: 222 ambulatory patients (x=56 years, 123 males and 99 females) of the I Department of Cardiology of the Jagiellonian University Medical College in Krakow were analyzed in this study. We used a detailed, uniform own questionnaire to get the following information from the patients: regularity of drug taking, age, level of education, place of living, occupational category, incomes, coexisting diseases, costs of drugs and self-control of blood pressure. Afterwards we compared two groups: patients that use drugs systematically and those who do not. A computer software Statistica PI was used for statistical analyses. RESULTS: Most of patients (129; 58%) declared regular drug taking. We observed statistically significant differences between two analyzed groups for the following parameters: level of education, place of living, occupational category, incomes, knowledge of the definition of hypertension and regularity of blood pressure self-control. Patients living in cities, currently working, with higher level of education, higher incomes, well defining hypertension and measuring blood pressure regularly were more systematic in drug taking. The logistic regression analysis showed that only low incomes were independently associated with irregular drug using.

[Autonomic nervous system function in cardiologic syndrome X]. / Funkcja ukladu autonomicznego w kardiologicznym zespole X.

Syndrome X is defined as typical angina pectoris, positive treadmill exercise test, negative intravenous ergonovine test and angiographically normal coronary arteries. The pathogenesis of his syndrome is still not known. Alteration of autonomic nervous control of cardiac function have been described in syndrome X. The population of SX patients is heterogeneous having subgroup with normal and low abnormal autonomic system activity which in 40% of patients had normal heart regulation of autonomic system and in 60% we can observed abnormal regulation. It may be a result of high tonic sympathetic driver or low parasympathetic activity.