Comparison of Hemodynamic Response between Patients with Systolic Heart Failure Differing in Serum Aldosterone Concentrations during and after a 6-Minute Walk Test.

Aldosterone regulates hemodynamics, including blood pressure (BP), and is involved in the development and progression of cardiovascular diseases, including systolic heart failure (HF). While exercise intolerance is typical for HF, neither BP nor heart rate (HR) have specific characteristics in HF patients. This study compares BP and HR profiles during and after standardized exercise between patients with systolic HF with either lower or higher aldosterone concentrations. We measured BP and HR in 306 ambulatory adults with systolic HF (left ventricular ejection fraction (LVEF) <50%) during and after a 6 min walk test (6MWT). All patients underwent a resting transthoracic echocardiography, and venous blood samples were collected for biochemical analyses. The patients were also divided into tertiles of serum aldosterone concentration: T1 (<106 pg/mL), T2 (106 and 263 pg/mL) and T3 (>263 pg/mL), respectively. Individuals from T1 and T2 were combined into T1-T2 as the reference group for comparisons with patients from T3. The individuals from T3 had significantly lower systolic, mean and diastolic BPs at rest, at the end and at 1 and 3 min post-6MWT recovery, as well as a more dilated left atrium and right ventricle alongside a higher concentration of N-terminal pro-B-type natriuretic peptide (NT-proBNP). Higher serum aldosterone concentration in HF patients with an LVEF < 50% is associated with a lower 6MWT BP but not an HR profile.

The serum concentration of brain­derived neurotrophic factor is lower in ambulatory and clinically stable patients with more advanced systolic heart failure.

INTRODUCTION: Brain­derived neurotrophic factor (BDNF) is decreased in heart failure (HF), but whether serum BDNF concentration is related to the severity of HF with reduced left ventricular (LV) ejection fraction (LVEF) below 50% is uncertain. OBJECTIVES: We aimed to compare cardiac structure and function in ambulatory and clinically stable patients with HF and LVEF below 50% for lower and higher BDNF serum concentrations. PATIENTS AND METHODS: A total of 361 ambulatory patients with a compensated HF and LVEF below 50% underwent cardiac evaluation and measurement of serum BDNF and N­terminal pro-B­type natriuretic peptide (NT­proBNP). Patients from the lower (below median) and higher (equal to or above median) BDNF serum concentration groups were compared by analysis of covariance (ANCOVA) adjusted for age, sex, body mass index, resting heart rate, and systolic blood pressure. RESULTS: The patients were at a median age of 63.8 (interquartile range [IQR], 57.7-71.5) years and had a median LVEF of 31.0% (IQR, 23.0-37.4). Individuals with lower BDNF (<23.5 ng/ml) had significantly (P ≤0.05) more dilated right and left atria both before and after emptying, larger right ventricular end-diastolic diameter, LV end-systolic diameter, lower tricuspid annulus plane systolic excursion, shorter pulmonary acceleration time, higher mitral E to A waves ratio and mitral E wave to tissue Doppler e' wave ratio, and higher concentration of NT­proBNP. CONCLUSIONS: HF patients with LVEF below 50% and lower serum BDNF concentration present more advanced cardiac remodeling and dysfunction than individuals with higher BDNF. Potential mechanisms and clinical consequences of these findings require further investigation.

Preclinical atherosclerosis in cystic fibrosis: Two distinct presentations are related to pancreatic status.

BACKGROUND: Patients with cystic fibrosis (CF) are exposed to overlapping cardiovascular risk factors. We hypothesized that CF is characterized by increased arterial stiffness and greater intima-media thickness (IMT). METHODS: This cross-sectional study assessed the digital volume pulse arterial stiffness index (SIDVP) using photopletysmography, measured intima-media complex thickness (IMT) at the common carotid artery, and obtained an extended set of clinical and atherosclerosis-related laboratory parameters. RESULTS: Fifty-five patients with moderate-to-severe CF (mean age 26.3±8.6 years, BMI 20.3±3.1 kg/m2, FEV1 62±26%) and 51 healthy controls (25.1±4.4 years, BMI 21.7±3.0 kg/m2) entered the study. SIDVP was greater in pancreatic insufficient (PI), but not pancreatic sufficient (PS) CF patients compared with control (7.3±1.8 m/s vs 6.0±1.2 m/s; p=7.1 × 10-5). IMT was increased in PS (but not PI) participants relative to control (552±69 µm vs 456±95 µm, p=0.0011). SIDVP was also greater in PI than in PS patients (7.3±1.8 m/s vs 6.3±1.7 m/s, p=0.0232) and IMT was higher in PS compared with PI (552±69 µm vs 453±82 µm, p=0.0002). SIDVP independently associated with age, PI, the lack of liver cirrhosis, and with Pseudomonas aeruginosa colonization. PS was the only independent correlate of IMT in CF. CONCLUSIONS: PI patients are at risk of developing general arterial stiffness. PS may relate to carotid IMT thickening, which underscores the need for further study that could lead to reconsideration of dietary guidance in PS CF.

The Effect of Sports Rules Amendments on Exercise Intensity during Taekwondo-Specific Workouts.

We aimed to compare the change in exercise response to taekwondo-specific circuit workouts before and after competition rule amendments. A total of 240 workouts in 15 elite athletes were analyzed over two years. Physiological and kinematic data were gathered with the wireless Bioharness system along with capillary blood samples for lactate concentration. Progressive exercise tests until exhaustion were periodically performed to obtain reference data. The rule changes resulted in significant increases (mainly medium or large effects) in the physiological (2.9-14.4%) and kinematic (4.8-10.1%) response to taekwondo-specific workouts. The largest increases were for peak breathing rate (12.0%), energy expenditure (6.6%), blood lactate immediately after exercise (10.2%) and at the 30th min of recovery (14.4%), and peak kinematic activity (10.1%). Significant differences between taekwondo-specific workouts and tournament combats persisted after the shift from old to new rules, ranging from 2.4 to 38.5% for physiological and from 2.9 to 15.5% for kinematic variables. The largest workout-combat differences were revealed for post-exercise (15.9%) and recovery (38.5%) blood lactate, peak (-15.8%) and relative (-15.0%) breathing rate, and mechanical (13.5%) and physiological (14.2%) intensity. Our study suggests that the rule amendments significantly modify the exercise response to discipline-specific workouts and that taekwondo-specific training sessions do not fully recreate the tournament demands in terms of physiological and kinematic load.

Association of muscular strength with pulsatile and steady hemodynamics in patients with acute myocardial infarction.

INTRODUCTION: Grip strength and blood pressure are strongly interrelated. Blood pressure is an essential component of arterial load, which modulates cardiac output. OBJECTIVES: We aimed to asses the correlation between grip strength and both steady and pulsatile components of arterial load in patients with acute myocardial infarction. PATIENTS AND METHODS: We included 295 participants (mean age, 63 years) with acute myocardial infarction. The following data were assessed: grip strength, echocardiography, local arterial stiffness, arterial tonometry, continuous arterial pulse, and beat­to­beat wave. RESULTS: In univariable analyses, grip strength correlated with arterial stiffness (pulse wave velocity), ventricular-arterial coupling, and measures of pulsatile arterial load: aortic characteristic impedance (Zao), total arterial compliance (TAC), and central fractional arterial pulse pressure (cFPP). In a multivariable model including age, grip strength, body mass index, systolic blood pressure, sex, and descriptors of pulsatile load, the following remained associated with grip strength: Zao (R2 for the model = 0.58; P <0.001), TAC (R2 = 0.23 for the model; P <0.001), and cFPP (R2 for the model = 0.2; P <0.001). In the second model that included sex, only Zao remained associated with grip strength (R2 for the model = 0.67). Comparisons between men and women of the adjusted mean value demonstrated that Zao and cFPP were considerably higher (P <0.001 and P = 0.02, respectively) and TAC was lower in women (P <0.001). CONCLUSIONS: In a cohort of patients with acute myocardial infarction, grip strength correlated independently and significantly with descriptors of the pulsatile arterial load. The role of sex in these interrelations needs further study.

Pulse wave velocity to the global longitudinal strain ratio in survivors of myocardial infarction.

BACKGROUND: New index of pulse wave velocity to global longitudinal peak systolic strain (PWV/GLPSS) was reported to be associated with cardiovascular damage. We evaluated the prognostic role of this metric in survivors of acute myocardial infarction (AMI). MATERIAL AND METHODS: We investigated in 569 patients with AMI, whether PWV/GLPSS was associated with a composite endpoint of death, stroke or new myocardial infarction, in long-term follow-up. Left ventricular longitudinal strain was evaluated by speckle tracking, and carotid arterial stiffness (local PWV) was determined using radiofrequency data technology. RESULTS: During follow-up (median 1316 days), 114 subjects reached composite endpoint. These subjects were significantly older (P < 0.0001) and were characterized by lower ejection fraction (P < 0.0001), lower GLPSS (P < 0.0001), higher PWV (P = 0.007) and lower PWV/GLPSS index (P < 0.0001). Patients with PWV/GLPSS <-0.74 were at a significantly higher risk for the composite endpoint during the follow-up (hazard rate: 1.7; 95% confidence interval: 1.2-2.6; P < 0.001). The PWV/GLPSS was additive to the predictive value of EF < 35%-patients with PWV/GLPSS <-0.74 and EF < 35% had the highest risk for the endpoint events. CONCLUSIONS: The current study shows that PWV/GLPSS index has significant, independent and additive value in predicting CV complications, in subjects with myocardial infarction.

Sex differences in excess and reservoir arterial blood pressures as markers of phenotype.

OBJECTIVES: Excess pressure and reservoir pressure are related to various clinical outcomes in cardiovascular diseases, but whether there are sex differences in healthy individuals remains uncertain. We compared phenotypes of excess pressure and reservoir pressure between healthy men and women. METHODS: Different features of noninvasively recorded radial and reconstructed aortic pressure waveforms were measured in 435 healthy adults (257 women, 59%). In addition to SBP and DBP, we compared values of maximal excess pressure and reservoir pressure (RPMAX), excess pressure and reservoir pressure time integrals, respectively, as well as relative contributions of excess pressure (EPREL) and reservoir pressure to total blood pressure time integral, respectively, between men and women divided in two age categories, below 51 (82 women and 66 men) and greater than or equal to 51 years old (175 women and 112 men), corresponding to average age of menopause for women and acceleration of vascular ageing for all. RESULTS: In both age categories, compared with men, women had significantly lower peripheral and aortic SBP and DBP. Analysis of covariance adjusted for BMI revealed that women who were greater than or equal to 51 years old had significantly higher excess pressure time integral, RPMAX, reservoir pressure time integral, EPREL, and relative contributions of reservoir pressure than men in the same age category. In the younger age category below 51 years old, EPREL and RPMAX were also significantly higher in women than men. CONCLUSION: Our study shows that healthy women have lower peripheral and aortic SBP and DBP compared with healthy men; however, their excess and reservoir pressures are higher, particularly after 51 years of age.

Arterial excess­reservoir pressure integral as a predictor of cardiovascular complications in patients with acute coronary syndrome.

INTRODUCTION    The excess pressure-time integral (excess PTI) and reservoir pressure-time integral(reservoir PTI) are new measures derived from blood pressure (BP) waveform decomposition. Thesemarkers predict cardiovascular (CV) complications and are associated with target organ  damage inpa tients on antihypertensive treatment or those with chronic and acute heart failure. OBJECTIVES    We investigated whether reservoir PTI or excess PTI predict future CV events (death, stroke, myocardial infarction [MI]) in patients with acute coronary syndrome (ACS) and reduced ejection fraction (EF). PATIENTS AND METHODS    BP waveforms were obtained by radial tonometry in 251 patients with ACS (median age, 64 years) and reduced EF (median, 40%). Left ventricular EF was assessed by transthoracic echocardiography. Reservoir PTI and excess PTI were derived by decomposition of the BP waveform RESULTS    A total of 78 CV events occurred during the follow­up (median, 1245 days). A Kaplan-Meier analysis showed that the highest tertile of excess PTI was a significant predictor of adverse outcome. A multivariate Cox regression analysis demonstrated that excess PTI was a predictor of CV events after adjustment for EF, age, history of stroke, MI, and coronary artery bypass grafting (hazard ratio, 1.9; 95% confidence interval, 1.1-3.3; P = 0.02). CONCLUSIONS    In conclusion, excess PTI, a new measure derived from reservoir-pressure analysis, predicts outcome in survivors of ACS with reduced EF.

Arterial structure and function in patients with acute coronary syndrome after 1­year treatment.

INTRODUCTION    The modification of arterial stiffness and intima-media thickness (IMT) is controversial in patients with clinically significant atherosclerosis. OBJECTIVES    We evaluated the effects of 1­year pharmacological therapy on arterial stiffness and IMT in survivors of non­ST­segment elevation myocardial infarction (NSTEMI) who were treated according to current clinical guidelines. PATIENTS AND METHODS    A total of 298 patients with NSTEMI (median age, 64 years; 85 women) were enrolled to this study. Local (carotid) arterial stiffness and IMT were measured noninvasively before discharge and after 12 months of contemporary pharmacological treatment according to current clinical guidelines. The study group was divided into patients with normal systolic blood pressure (BP) (<140 mm Hg) and those with increased systolic BP (≥140 mm Hg) at 12 months. The results were presented as median (25th-75th percentile). RESULTS    There were no significant changes in local arterial stiffness between patients with normal and those with increased systolic BP (8.9 m/s [7.9-10.9 m/s] vs 8.7 m/s [7.8-10.1 m/s] at baseline and 9.6 m/s [8.3-11.0 m/s] vs 10.4 m/s [9.1-12.4 m/s] at 12 months, P = 0.67 and P = 0.05, respectively); however, a significant reduction in IMT was found in both groups (777 µm [664-896 µm] vs 715 µm [619-841 µm] at baseline and 818 µm [720-962 µm] vs 760 µm [674-897 µm] at 12 months, P = 0.0003 and P = 0.001, respectively). Arterial stiffness and IMT were affected by age and mean BP; however, adjustment for these variables did not affect the obtained results in multivariate models. CONCLUSIONS    The 1­year pharmacological treatment of patients after NSTEMI was associated with a significant reduction in IMT but had no effect on the properties of the arterial structure.