Cardiovascular risk assessment by electrocardiographic Holter monitoring in patients with chronic hepatitis C.

INTRODUCTION: Cardiovascular diseases are ranked as the third cause of mortality among people infected with hepatitis C virus (HCV), but the relationship of infection with cardiovascular risk remains disputable. We have focused on the comprehensive use of parameters obtainable during long-term electrocardiographic (ECG) Holter monitoring. MATERIAL AND METHODS: Heart rate variability and turbulence (HRV and HRT), deceleration/acceleration capacity (DC/AC), corrected QT interval (QTc) and late potential (LP) were used. 36 persons were included, and 30 healthy subjects formed a control group. All were submitted to 24-hour Holter ECG-monitoring. RESULTS: The studied groups were not statistically significantly different with regards to basic anthropometric parameters. Statistically significantly higher medium and maximum heart rhythm and aminotransferase activities were recorded in patients with hepatitis C. The HRV parameters r-MSSD, p50NN, HF, and absolute DC/AC values were significantly lower in the subjects with hepatitis C than those in the control group. The QTc interval, measured for nocturnal hours, was also significantly longer in that group. There were no differences in the albumin level or basic echocardiographic parameters, including left ventricle ejection fraction. Nor was there any difference in the HRT parameters, or LP. The most interesting observation was the positive correlation among the number of viral RNA copies and DC, and LF. CONCLUSIONS: We confirmed the presence of autonomic disorders with prevalence of sympathetic system activity and prolonged QTc interval in patients with chronic hepatitis C. Those parameters significantly correlated with infection intensity. Our results suggest that HCV infection could be an independent cardiovascular risk factor, not associated with the lipid profile. Further prospective studies are needed.

[Evaluation of effects of cardiac rehabilitation in patients after coronary artery bypass grafting by six minute walk test]. / Ocena efektów rehabilitacji kardiologicznej u chory4 po zabiegach pomostowania aortalno-wiencowego przy uzyciu testu 6-minutowego marszu.

UNLABELLED: Exercise capacity testing is a procedure that enables enrollment into cardiac rehabilitation (CR) and CR effects evaluation. Six minute walk test (6MWT) is an easy and measurable method of exercise capacity assessment in patients after acute coronary syndrome (ACS). The aim of study was to evaluate effects of CR in patients after cardiac surgery for ACS using 6MWT MATERIAL AND METHODS: 50 patients (aged 41-65 years; mean age 56.7 +/- 9.1; 43 male and 7 female) after cardiac surgery for ACS NSTEMI were enrolled into the study. 6MWT was performed on admission and after the second stage of CR. RESULTS: The mean 6MWD (expressed in meters +/- SD) was 522.14 +/- 69.5 before CR and 584 +/- 70.8 after 4-week-long CR period (p < 0.05). The mean distance walked in patients before CR was 138,16% of recommended minimal value; in patients after CR was 154.37% of recommended minimal value, respectively, (p < 0.05). The mean distance walked by patients before CR was 98.26% of the recommended mean value; in patients after CR it was 109.83% of the recommended mean value, respectively (p < 0.05). None of the performed tests required interruption and none of the individuals required assistance during 6MWT. CONCLUSIONS. In patients after cardiac surgery 6MWT is a useful method of CR effects evaluation. Test is a well-tolerated and safe procedure for assessment of functional capacity in patients after cardiac surgery with an increased risk of ACS and reduced exercise capacity.

[Oxidative-reductive balance in patients after acute coronary syndrome that undergo cardiac rehabilitation]. / Ocena równowagi oksydacyjno-redukcyjnej krwi u chorych po ostrych zespolach wiencowych poddanych rehabilitacji kardiologicznej.

UNLABELLED: Cardiac rehabilitation is essential part of acute coronary syndrome (ACS) treatment. Controlled physical activity (both aerobic exercise and muscle-strengthening activities) is the most important part of cardiac rehabilitation (CR). There is a close relationship between regular physical exercise and secondary prevention in patients after ACS. However, influence of physical activity on antioxidative protection mechanisms and free radical reactions is not yet fully known. The aim of study was to evaluate CR effects (the second phase) on oxidative-reductive balance in patients after ACS hospitalised for CR. MATERIAL AND METHODS: Our study comprised 50 patients (32 male, 18 female), aged 42-75 years (56.42 +/- 8.34) after ACS treated by percutaneous transluminal coronary angioplasty (PTCA), that subsequently underwent the second phase of CR. Interval cycloergometer training was performed five times a week (in total 15 training sessions). In addition to interval training, patients underwent individual breathing exercises, relaxation exercises, isometric exercises of particular muscle groups and general rehabilitation twice a day. Thiobarbituric acid reactive substances (TBARS) level in erythrocytes, total antioxidant status (TAS) of plasma, superoxide dysmutase-1 (SOD-1), catalase (CAT) and glutathione peroxidase (GSH-Px) activity in erythrocytes were determined before and after CR programme. Statistical analysis of physical activity influence on oxidative-reductive balance was performed by Wilcoxon matched pairs test. P < 0.05 was acknowledged as statistically significant. RESULTS: After rehabilitation programme in patients after ACS following significant results were found: increase in SOD-1 activity compared to baseline values (3624.22 +/- 1003.38 U/gHb vs 3086.71 +/- 683.14 U/gHb; p = 0.007), increase in GSH-Px activity compared to baseline values (41.27+/- 13.87 U/gHb vs. 38.02 +/- 13.98 U/gHb; p = 0.006), decrease in CAT activity compared to baseline values (17.30 +/- 4.87 U/gHb vs. 19.64 +/- 4.36 U/gHb; p = 0.001), increase in TAS level compared to baseline values (2.00 +/- 0.75 mM/L vs. 1.66 +/- 0.71 mM/L; p = 0.003), increase in TBARS level compared to baseline values (0.21 +/- 0.05 microM/gHb vs. 0.19 +/- 0.03 microM/gHb; p = 0.0006). CONCLUSIONS: Improvement of antioxidative protection in patients after ACS was observed after cardiac rehabilitatiom programme. Increase in SOD-1 and GSH-Px activity in erythrocytes and TAS plasma level was found. Increase of TBARS level in erythrocytes in patients after ACS and subsequent cardiac rehabilitation is associated with intensification of free-radical chain reaction related to physical activity.

[Heart rate recovery after exercise in subjects undergoing cardiologic rehabilitation]. / Szybkosc normalizacji czestosci rytmu serca po wysilku u osób poddanych rehabilitacjti kardiologicznej.

UNLABELLED: Research indicates that slow heart rate recovery 1-2 minutes after exercise is a predictor of cardiovascular mortality, sudden mortality as well. It is hardly related to myocardial ischemia; most of all, it is related to impaired activities of the parasympathetic system. The purpose of this study was to assess HRR in subjects after a surgical treatment (percutaneous coronary intervention - PCI) of acute coronary syndromes (ACS), undergoing cardiologic rehabilitation. MATERIALS AND METHODS: The study comprised 58 subjects, 42 men and 16 women aged 49-68 (56.8 +/- 7.6) after ACS treated with PCI undergoing cardiologic rehabilitation (stage 2)--group I. The comparative group comprised 34 subjects, 25 men and 9 women aged 46-61 (55.5 +/- 8.9 lat) who were clinically healthy and who underwent a single sub-maximal exercise test--group II. In subjects undergoing rehabilitation, an exercise test was performed twice --before and after stage 2 of rehabilitation. HRR was defined as a difference between the peak heart rate and those after the 1st (HRR1) and 2nd (HRR) minute of recovery. RESULTS: After stationary rehabilitation as a part of stage 2 of cardiologic rehabilitation, HRR2 was 26.3 +/- 10.6/min and was 40.8/min +/- 13.8/min; both these values were not significantly different from values observed in healthy subjects (p > 0.05). Significant increase in HRR1 and HRR2 was observed after the completion of stage 2 of cardiologic rehabilitation in ill subjects (p < 0.05) as compared to initial values. CONCLUSIONS: In subjects after ACS treated with PCI, it is observed that HRR changes back to normal values observed in healthy subjects as a result of underwent cardiologic rehabilitation. HRR should become an important factor in assessing effectiveness of conducted cardiologic rehabilitation.

Heart rhythm turbulence and NT-proBNP in decompensated liver cirrhosis--a pilot study.

BACKGROUND: Heart rhythm turbulence (HRT) is a novel tool for evaluation of cardiovascular mortality. Liver cirrhosis is associated with hemodynamic and myocardial disturbances termed cirrhotic cardiomyopathy. In the stable stage of liver cirrhosis, systolic and myocardial dysfunction is correlated with brain natriuretic peptide (BNP). The aim was to evaluate HRT and its correlation with NT-proBNP, echocardiographic and biochemical parameters in patients with decompensation of liver cirrhosis. MATERIAL/METHODS: The study included 18 patients with decompensated liver cirrhosis and 18 healthy volunteers. Participants underwent echocardiography and 24-hour ECG monitoring. Serum NT-proBNP and other biochemical parameters were measured. Turbulence onset (TO) and turbulence slope (TS) were used to indicate HRT. RESULTS: Mean HR (87/min vs. 75/min), TO (-0.385% vs. -0.92%), NT-proBNP (304.85 pg/ml vs. 83.2 pg/ml), LAd (42.5 mm vs. 34.5 mm), RVdd (29.5 mm vs. 25 mm), SPAP (36.5 mmHg vs. 22.5 mmHg) were significantly (p<0.05) higher in patients with liver cirrhosis. Patients with normal TO and TS had better stage in Child-Pugh classification (P=0.04) than patients with abnormal values. Significant negative correlation was found between creatinine and TO, and between mean HR and TS, and significant positive correlation was found between LAd and TS. LV diastolic dysfunction was noted in a majority of cirrhotic patients (n=16). CONCLUSIONS: Patients with decompensated cirrhosis had elevated levels of NT-proBNP and LV diastolic dysfunction. TO values in cirrhotic patients differed significantly from the control group. These findings can indicate risk of symptomatic heart failure development and may be a marker of cirrhotic cardiomyopathy. HRT parameters seem not to be appropriate death predicators.

Melatonin treatment improves blood pressure, lipid profile, and parameters of oxidative stress in patients with metabolic syndrome.

Experimental studies have proven that melatonin has many beneficial pleiotropic actions. The aim of this study was to assess melatonin efficacy in patients with metabolic syndrome (MS). The study included 33 healthy volunteers (who were not treated with melatonin) and 30 patients with MS, who did not respond to 3-month lifestyle modification. Patients with MS were treated with melatonin (5 mg/day, 2 hr before bedtime) for 2 months. The following parameters were studied: systolic and diastolic blood pressure (SBP, DBP), levels of glucose, serum lipids, C-reactive protein, fibrinogen, activities of antioxidative enzymes: catalase (CAT), glutathione peroxidase (GSH-Px), superoxide dismutase (SOD), thiobarbituric acid reactive substrates (TBARS). After 2-month therapy in comparison with baseline, the following significant changes were measured: systolic blood pressure (132.8±9.8 versus 120.5±11.0 mmHg, P<0.001), DBP (81.7±8.8 versus 75±7.4 mmHg, P<0.01), low-density lipoprotein cholesterol (LDL-C) (149.7±26.4 versus 139.9±30.2 mg/dL, P<0.05), TBARS (0.5±0.2 versus 0.4±0.1 µm/gHb, P<0.01), and CAT (245.9±46.9 versus 276.8±39.4 U/gHb). Melatonin administered for 2 months significantly improved antioxidative defense (increase in CAT activity, decrease in TBARS level) and lipid profile (decrease in LDL-C), and lowered blood pressure. We conclude that melatonin therapy may be of benefit for patients with MS, particularly with arterial hypertension. Further studies with higher doses of melatonin or prolonged supplementation are awaited.

Persistent ductus arteriosus in a 72-year-old woman with paroxysmal atrial fibrillation and depression syndrome: a therapeutic and diagnostic problem.

Treating the elderly is often problematic, especially when congenital heart disease is diagnosed. The aim of this study is to present the case of a 72-year old woman with depression syndrome, paroxysmal atrial fibrillation and past cerebral stroke, in whom persistent ductus arteriosus Botalli was diagnosed. Due to exacerbation of the depressive syndrome, she did not give her consent to further diagnostics, possible interventional procedures and treatment with oral anticoagulants. After intermission of the therapy she was treated with dabigatran. The patient is still undergoing outpatient treatment and so far, no cerebrovascular episodes have been recorded.

Recurrent syncope and hypocalcaemic cardiomyopathy as manifestations of Fahr's syndrome.

In our report we would like to present a case of a 60-year-old patient with epileptic seizures, affective disturbances, only mild neurocognitive disorders and cardiomyopathy. A female patient was taken to the internal ward with a tentative diagnosis of recurrent syncope. Laboratory results disclosed severe hypocalcaemia, hypoparathyroidism, and hypothyroidism. An echocardiogram revealed left ventricle systolic dysfunction. Computed tomography revealed massive intracranial calcifications typical for Fahr's syndrome. Our patient demonstrated only mild neurological and psychiatric symptoms, but developed hypocalcaemic heart failure. It is possible that some cases of Fahr's syndrome remain undiscovered, particularly patients taken to internal wards with mild neurological or psychiatric signs.

Aronia melanocarpa extract reduces blood pressure, serum endothelin, lipid, and oxidative stress marker levels in patients with metabolic syndrome.

BACKGROUND: Experimental studies have shown that anthocyanins may exert pleiotropic effects. The aim of the study was to determine the influence of Aronia melanocarpa extract on blood pressure and serum concentration of endothelin-1 (ET-1), lipids, glucose, uric acid, C-reactive protein (CRP), fibrinogen, the antioxidant enzymes catalase (CAT), superoxide dysmutase (SOD), and glutathione peroxidase (GSH-Px), and lipid peroxidation (thiobarbituric acid-reacting substrates, TBARS) in erythrocytes of patients with metabolic syndrome (MS). MATERIAL/METHODS: The study comprised 22 healthy volunteers and 25 patients with MS. Patients with MS were treated with aronia extract (3 x 100 mg/day) for two months. The above parameters were measured. RESULTS: After two months of therapy, statistically significant decreases were observed in SBP (143.40+/-7.87 vs. 131.83+/-12.24 mmHg, p<0.001), DBP (87.20+/-9.9 vs. 82.13+/-10.33 mmHg, p<0.05), ET-1 (2.44+/-0.51 vs. 1.74+/-0.42 pg/ml, p<0.001), TC (242.80+/-34.48 vs. 227.96+/-33.07 mg/dl, p<0.001), LDL-C (158.71+/-35.78 vs. 146.21+/-34.63 mg/dl, p<0.01), TG (215.92+/-63.61 vs. 187.58+/-90 mg/dl, p<0.05), TBARS (0.0712+/-0.0191 vs. 0.0362+/-0.0135 micromol/g-Hb, p<0.001), and CAT (261.30+/-59.78 vs. 213.34+/-47.36 U/mg-Hb) and significant increases in SOD (2380.63+/-419.91 vs. 3066.53+/-542.24 U/g-Hb, p<0.001), GSH-Px (12.60+/-5.97 vs. 19.18+/-9.09 U/g-Hb, p<0.01), and fibrinogen levels (249.20+/-27.17 vs. 276.67+/-57.41 mg/dl, p<0.05) compared with the baseline values. CONCLUSIONS: Aronia extract may be of benefit to patients with MS. This seems to result from the influence of anthocyanins and possibly other flavonoids on blood pressure, serum level of ET-1, lipids, and oxidative status (GSH-Px, SOD, TBARS).

[Statins in chronic heart failure--new indication?]. / Statyny w przewleklej niewydolnosci serca --nowe wskazanie?

Chronic heart failure (CHF) is connected with very high risk of death. Discovery of neurohormonal mechanisms which contribute to pathogenesis of CHF changed therapeutic management of CHF. It was indicated that statins may exert beneficial effects in patients with CHF through preventing acute coronary syndromes, reducing myocardial hypertrophy, decreasing activation of renin-angiotensin-aldosterone system and sympathetic system, inhibitory effects on inflammatory cytokines and metalloproteinases, improving endothelial function. Usefulness of statins in CHF is however controversial. There is some evidence that lower serum cholesterol concentrations relate to impaired survival in patients with CHF. Before data from large scale trials (CORONA, GISSI-HF, UNIVERSE) will be published, statin therapy in CHF must be recommended carefully.