Developing thyroid disorders is associated with poor prognosis factors in patient with stable chronic heart failure.

We sought to assess the developing of thyroid disorders in forty eight patients with chronic stable heart failure and without thyroid abnormalities during six months follow-up. Thyroid function disorders were observed in 27.1% of the subjects: sick euthyroid syndrome (12.5%), subclinical hypothyroidism (10.4%) and overt hypothyroidism (6.2%). Subjects with higher thyroid stimulating hormone (TSH) levels at the end of the study had more hospitalizations. The developing of altered thyroid profile was related to lower hemoglobin levels, smaller phase angle with bioelectrical impedance method and more fatigue perception by the patients. This abnormal thyroid function behavior on stable chronic heart failure and was observed as part of the disease progress and was associated to worse prognosis factors as lower phase angle and anemia.

Effect of L-arginine or L-citrulline oral supplementation on blood pressure and right ventricular function in heart failure patients with preserved ejection fraction.

BACKGROUND: The effect of L-arginine and L-citrulline on blood pressure and right ventricular function in heart failure patients with preserved ejection fraction (HFpEF) is unknown. We have therefore evaluated, in a randomized clinical trial, the effect of these aminoacids in chronic outstanding and stable patients with HFpEF. METHODS AND RESULTS: All patients underwent an echocardiogram and radioisotopic ventriculography rest/exercise, and were randomized in a consecutive manner to the L-arginine group (n = 15; 8 g/day); and the citrulline malate group (n = 15; 3 g/day). The duration of follow-up was two months. The principal echocardiographic finding was a statistically significant decrease in pulmonary artery pressure in the L-arginine (56.3 ± 10 vs 44 ± 16.5 mm Hg, p < 0.05) and the citrulline (56.67 ± 7.96 vs 47.67 ± 8.59 mm Hg, p < 0.05) groups. Duration on treadmill and right ventricular ejection fraction post exercise increased, while diastolic and systolic artery pressure decreased significantly in both groups. There were no other statistically significant differences between the groups. CONCLUSIONS: Administration of L-arginine and citrulline to patients with HFpEF improved right ventricular function by increasing right ventricular ejection fraction, and probably decreasing systolic pulmonary artery pressure.

The effect of L-arginine and citrulline on endothelial function in patients in heart failure with preserved ejection fraction.

BACKGROUND: To evaluate the effect of the amino acids L-arginine and citrulline on endothelial function in patients in stable diastolic and right heart failure using photoplethysmography. METHODS: Thirty patients from the Heart Failure Clinic of the Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán" underwent photoplethysmography using the hyperemia technique. Index finger flow was assessed at baseline and after ischemia every 30 s by maximum amplitude time (MAT), total time of the curve (TT) and the index of the two (MAT/TT < 30 = normal) before and after the administration of L-arginine (8 g/day in two doses, n = 15) or citrulline (3 g/day in one dose, n = 15) for 60 days in addition to optimal pharmacological treatment. RESULTS: There were no statistically significant differences between the two groups at baseline. After the intervention, the MAT/TT index of all patients normalized in each evaluation period with statistically significant differences. Basal L-arginine group = 38.75 ± 11.52, final 23.32 ± 6.08, p = 0.007 and basal citrulline group = 41.4 ± 13.47, final 23.65 ± 6.74, p = 0.007 at 60-90 s. Post-ischemia: basal L-arginine 36.60 ± 11.51, final 18.81 ± 15.13, p = 0.004 and basal citrulline = 49.51 ± 15.17, final 27.13 ± 7.87, p = 0.003. CONCLUSIONS: The administration of L-arginine and citrulline has a beneficial effect on endothelial function as shown by the normalized MAT/TT index. It probably improves systemic and pulmonary hemodynamics, which could help in the treatment of diastolic heart failure.

Reversible changes of electrocardiographic abnormalities after parathyroidectomy in patients with primary hyperparathyroidism.

BACKGROUND: Several studies have reported that primary hyperparathyroidism is a risk factor of higher cardiovascular mortality, mainly because hyperparathyroidism is related to arterial hypertension, arrhythmias, structural heart abnormalities and activation of the renin-angiotensin- aldosterone system. However, very few studies have shown the electrocardiographic changes that occur after parathyroidectomy. That was the aim of this study. METHODS: We studied 57 consecutive patients with primary hyperparathyroidism surgically treated. Electrocardiogram, serum electrolytes, parathyroid hormone, creatinine and albumin measures were obtained before and after surgery and were compared. RESULTS: The most common basal electrocardiographic abnormalities were left ventricular hypertrophy (LVH, 24.6%), conduction disturbances (16.3%), and short QT and QTc intervals. After surgery, a QTc interval lengthening and a tendency of T wave shortening were observed, as well as an inverse association between QTc interval and serum levels of magnesium and corrected calcium. There were no differences in LVH and conduction disturbances after surgery. CONCLUSIONS: Primary hyperparathyroidism is an important factor in the development of electrocardiographic abnormalities in this population, some of which are not corrected after parathyroidectomy. Further studies are required to demonstrate what factors are associated with persistence of electrocardiographic disturbances after surgery.

The effect of left ventricular dysfunction on right ventricle ejection fraction during exercise in heart failure patients: Implications in functional capacity and blood pressure response.

BACKGROUND: The aim of this study was to assess the effect of left ventricular dysfunction on right ventricular ejection fraction during exercise in heart failure patients and its implications in functional capacity and blood pressure response. METHODS: In a cross-sectional study 65 patients with heart failure were included. Left and right ventricular ejection fractions were evaluated by radio-isotopic ventriculography. All subjects underwent an exercise treadmill test (Bruce modified protocol). Systolic and diastolic blood pressures were also recorded. RESULTS: From the total population, 38 (58.46%) showed a significant increase (> or = 5%) in left ventricular ejection fraction (LVEF) and 27 (41.5%) showed a significant decrease in LVEF (> or = 5%) after the stress test. Patients with a significant reduction in LVEF during stress had lower exercise tolerance (4.1 +/- 2.5 vs. 6.1 +/- 2.5 METs, p = 0.009) compared to those who showed an increase in LVEF. Diastolic blood pressure was higher at rest among those who had a reduced LVEF during stress (83 +/- 12.2 vs. 72.6 +/- 12.2 mm Hg, p = 0.035) and during exercise (95 +/- 31.3 vs. 76.9 +/- 31.3 mm Hg, p = 0.057), as well as mean arterial pressure in the same group (97.1 +/- 11.6 mm Hg, p = 0.05). In addition, this group decrease of -8.8 +/- 51.6% in the right ventricular ejection fraction after exercise compared to an increase of 27.3 +/- +/- 49.1% (p = 0.007) among the patients with an increase in LVEF. CONCLUSIONS: Biventricular systolic dysfunction during exercise is associated with higher rest and stress blood pressure and worse functional capacity.