Detrimental effects of intense vasodilation in women with acute heart failure: novel insights from a prospective randomized controlled trial

Background

Guidelines recommend evaluating the risk/benefit ratio of novel therapies individually in women and men, as the pathophysiology and the response to treatment may differ according to sex. Among patients with acute heart failure (AHF), a strategy of intensive vasodilation, compared with usual care, overall did provide comparable outcomes. However, sex-specific differences in heart failure pathophysiology and the effect of the strategy in women with AHF remained unclear.

Purpose

To characterize sex-specific differences in heart failure pathophysiology and to evaluate the effect of a strategy that emphasized early intensive and sustained vasodilation in women with AHF.

Methods

In a randomized, open-label blinded-end-point trial patients hospitalized for AHF were enrolled in 10 hospitals in Switzerland, Bulgaria, Germany, Brazil, and Spain. Inclusion criteria were AHF expressed by acute dyspnea and increased plasma concentrations of natriuretic peptides, systolic blood pressure ≥100 mmHg, and a plan for treatment in a general ward. Patients were randomized 1:1 to a strategy of early intensive and sustained vasodilation throughout the hospitalization or usual care. The primary end point was a composite of all-cause mortality or rehospitalization for AHF at 180 days. The subgroup analysis according to sex was predefined.

Results

Among 781 patients who completed the trial, 288 (36.9%) were women. Women were significantly older, had a higher systolic blood pressure at presentation and a more common history of diastolic dysfunction (all ps<0.05), whereas men had a significantly higher body surface area, a more common history of ischemic heart disease and a significant lower left ventricular ejection fraction (all ps<0.05). The primary end point, a composite of all-cause mortality or rehospitalization for AHF at 180 days, occurred in 53 female patients (37.9%) in the intervention group (including 28 deaths [20.0%]) and in 35 female patients (23.6%) in the usual care group (including 22 deaths [14.9%]) (absolute difference for the primary end point, 14.3%; adjusted hazard ratio, 1.62 [95% CI, 1.05–2.50]; P=0.03).

Conclusion

Among women with AHF, a strategy of early intensive and sustained vasodilation, compared with usual care, had a detrimental effect on a composite outcome of all-cause mortality and AHF rehospitalization at 180 days.

Funding Acknowledgement

Type of funding sources: Public hospital(s). Main funding source(s): University Hospital Basel

Prognostic value of a disease-specific health-related quality score in acute heart failure

Background

Despite the striking therapeutic progress made in the treatment of heart failure (HF), rehospitalization rate and mortality remain a major and often unpredictable problem. Previous studies have shown the prognostic value of Kansas City Cardiomyopathy Questionnaire (KCCQ), a score assessing disease-specific health-related quality of life in stable chronic HF patients. Recently, a large study including 4898 patients with acute HF (AHF) enrolled in China reported the incremental predictive ability of KCCQ for a composite outcome of death and rehospitalization. However, these findings were not yet confirmed. In order to address this unmet need, the aim of this study was to examine the prognostic value of KCCQ in another AHF cohort.

Purpose

To validate the prognostic value of the KCCQ in AHF.

Methods

Goal-directed AfterLoad Reduction in Acute Congestive Cardiac Decompensation Study (GALACTIC) was a prospective, multicenter (n=10), randomized, interventional controlled trial enrolling adult patients presenting with AHF. KCCQ was assessed shortly after admission. We focused on the prognostic value of the short version KCCQ-12, explored the association with the composite of all-cause mortality and AHF rehospitalization within 30- and 180-day follow-up and compared it to the original score. Patients were grouped into quartiles according their KCCQ: high-risk (0–<25), moderate- to high-risk (25–<50), low- to moderate-risk (50–<75) and low-risk group (75–100). Cumulative incidence of assessed endpoints was displayed in Kaplan-Meier curves. Covariate adjustments were made using Cox regression. Prognostic accuracy over N-terminal pro-B-type natriuretic peptide (NT-proBNP) was evaluated by time-dependent area under the curve.

Results

Among 781 patients, 419 (median age 78, 35% female, 32% new onset of HF) had a complete set of variables to calculate KCCQ. Follow-up was available in all patients up to 180 days. 29 (7%) and 122 (29%) patients died or were rehospitalized for AHF within 30- and 180-days, respectively. Median KCCQ-12 was 37.5 with 25% of patients attaining the high- and 8% the low-risk group. After adjustment, each 10-point decrease in the KCCQ was associated with a 10% increase in 180-day risk regardless of new onset or acute decompensated chronic HF, age, sex, comorbidities, systolic blood pressure, creatinine, NT-proBNP and sodium levels. The prognostic ability for a 30-day risk was not significant. Using the same adjustments, a 10-point decrease in the original KCCQ was significant for a 20% and a 11% increase in risk for the short- and long-term composite outcome. The prognostic accuracy of KCCQ was comparable to NT-proBNP.

Conclusions

Health status, measured by the KCCQ-12 among patients with AHF, is significantly associated with a long-term composite outcome of all-cause mortality and AHF rehospitalization. The original KCCQ overall score is an independent predictor for both, the 30- and 180-day composite outcome.

Funding Acknowledgement

Type of funding sources: Public grant(s) – EU funding. Main funding source(s): European Union, the Swiss National Science Foundation

Association of 24-hour ambulatory central aortic pressure and left atrium-ventriculo-arterial interactions

Funding Acknowledgements

Type of funding sources: None.

INTRODUCTION

Arterial stiffness is an independent risk factor in arterial hypertension, but little is known about the association between  left –heart side remodeling and arterial stiffness in middle – aged hypertensive patients.

AIM

The aim of our study was to assess the independence between the parameters of arterial stiffness and their relation with left atrium – ventriculo – arterial coupling in hypertensive patients, without any target-organ damage (TOD).

METHODS

A total 110 patients (56 ± 14 years) with hypertension, were separated in two groups: 32 patients with normal EA/Ees ratio (Arterial elastance (AE) and ventricular elastance (Ees)) and 78 hypertensive patients with decrease EA/Ees ratio, marker for ventriculo – arterial coupling. All patients underwent standard two - dimentional echocardiography with Speckle tracking analysis for LA – reservoir (LARs), conduit (LAScd) and contractile (LASct) and LV global longitudinal strain ( LV - GLS). End – systolic pressure was determined from the brachial pulse wave. Arterial elastance (AE) and ventricular elastance (Ees) were calculated as and – systolic pressure/stroke volume and end – systolic pressure/end – systolic volume. Parameters for arterial stiffness – 24 - hour central systolic pressure (cSys24h), central pulse pressure (cPP24h) and 24 - hour pulse wave velocity (PWV24h) were measured non – invasively with oscillometric method by Mobil-O-graph PWA.

RESULTS

Statistically significant differences in parameters of vascular stiffness were found in patients with normal ventriculo – arterial coupling in comparison with disturbed EA/Ees: cSys24h (106.78 ± 9.33 vs. 114.59 ± 16.1 mm Hg, p = 0.02), cPP24h (39.89 ± 11.78 vs. 48.56 ± 10.21 mm Hg, p= 0.04). There were statistically significant differences in echocardiography parameters between patients with disturbed VAC in comparison to other group: LAScd (16.66 ± 1.67 vs. 19.57 ± 1.34 %, p< 0.001), LASr (31.76 ± 5.14 vs. 30.56 ± 3.28 %, p= 0.007) and LAVI (30.15 ± 9.20 vs. 36.78 ± 8.80 ml/m², p= 0.007). There was positive correlation between LAScd with EA/Ees (r = -0.285, p< 0.008) and negative E/Em (r = -0.278, p< 0.01). LAVI correlated moderate positively with E/Em ratio (r = 0.416, p< 0.0001) and negatively with LAScd (r = - 0.418, p < 0.0001). cSys24h correlated negatively with LV – GLS (r = - 0.218, p < 0.03) and with EA/Ees (r = - 0.253, p = 0.013).

CONCLUSION

In well-controlled hypertension, 24 - hour ambulatory central aortic pressure played a part in LV remodeling. High LV filling pressures determined LA remodeling and dysfunction in middle–aged patients. These results could be used for a new direction of central aortic pressure-guided therapy.

Discordance in prognostic ability between physician assessed NYHA classification and self-reported health status in patients with acute heart failure

Background

Especially in patients with acute heart failure (AHF) the NYHA classification remains of uncertain representation of patients' actual health state. Alternatively, patient's subjective well-being, in terms of health-related quality of life (HRQL), showed to have an excellent prognostic ability in out clinic patients with chronic heart failure.

Objectives

It is unknown whether HRQL instruments can assess a more reliable prognostication in patients hospitalized due to AHF than the NYHA classification.

Methods

Goal Directed Afterload Reduction in Acute Congestive Cardiac Decompensation Study (GALACTIC) was a multicenter, randomized, open-label blinded-end-point trial that emphasized early intensive and sustained vasodilation in adult patients hospitalized due to AHF with NYHA functional class III/IV, however provided neutral findings. HRQL was assessed by the generic EQ-5D-3L which is a 3-leveled 5-item instrument and the disease-specific Kansas City Cardiomyopathy Questionnaire (KCCQ). Unadjusted and adjusted Cox regression models were performed after patients were grouped into low (EQ-5D −0.074<0.25; KCCQ 0<25), moderately low (0.25<0.5; 25<50), moderately high (0.5<0.75; 50<75) and high HRQL (0.75–1.0; 75–100).

Results

781 patients were enrolled in 10 centres in 5 countries over 2 continents among which 536 (69%) patientshad completed theEQ-5D and 419 (54%) the KCCQ shortly after admission. Within 180 days of follow-up69 (13%) and 54 (13%) patients died and 151 (28%) and 122 (29%) died or were rehospitalized due to AHF, respectively. Cumulative incidence as well as HRs in patients grouped according to NYHA (n=536) indicated a comparable or significantly lower risk in patients with NYHA IV: e.g. for the combined outcome HR 1.07 (95% CI 0.777–1.473) and aHR 0.463 (95% CI 0.245–0.875). Whereas HRs in patients grouped according to both, EQ-5D (n=536) and KCCQ (n=419), increased from the group with highest to the group with the lowest HRQL: e.g. aHR for moderately high 1.11 (95% CI 0.718–1.715), for moderately low 1.721 (95% CI 1.102–2.688) and for low EQ-5D index 1.891 (95% CI 1.136–3.149) referenced to high HRQL (EQ-5D index 0.75–1.0).

Conclusions

These findings corroborate and extend previous work suggesting that NYHA classification poorly discriminates AHF patients' prognosis and challenge its' extensive application. HRQL might be a possible alternative to easily assess these patients' heath state.

Funding Acknowledgement

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Swiss National Science Foundation, the Swiss Heart Foundation A. 180-day mortality; B. composite outcome

Sleep disorders in patients with overweight and acute and exacerbated chronic heart failure

Funding Acknowledgements

Type of funding sources: Public Institution(s). Main funding source(s): Medical University - Sofia University Hospital "Tsaritsa Yoanna – ISUL”

Background

 Often accompanying comorbidity in patients with heart failure and overweight is sleep disorders. Detection and treatment of sleep apnea will be helpful in these patients. 

Purpose

 To determine the phenotypic characteristics of sleep apnea in these patients. To determine whether there is a link between forms of sleep apnea and type of heart failure. 

Methods

Hospitalized 46 patients with acute and exacerbate heart failure. Measuring of NT proBNP. Sleep apnea screening with ApneaLink™. Echocardiographic assessment of left ventricular ejection fraction (LVEF) and the E/e‘ ratio. Statistical methods to compare independent samples and correlation analysis for linear dependence. 

Results

Of the 46 overweight patients with acute and exacerbated chronic heart failure, sleep apnea was diagnosed in 36 patients (78.2%). Of these, 83.3% (n = 30) have оbstructive sleep apnea (OSA) and 16.7% (n = 6) have central sleep apnea (CSA). There was a statistically significant difference in LVEF for the group with CSA (n = 6) vs group with OSA (n = 30) (41.67 ± 13.88 vs. 50.57 ± 8.16, p = 0.038). For diastolic function didn"t reach statistical significance for E/e" ratio (20,33 ± 5,00 vs. 17,06 ± 4,02, p = 0,089). Regarding NTproBNP, there is no significant difference between the groups with OSA and those with CSA (2978.5 ± 2664.1 vs. 2063.36 ± 1877.27 pg/ml, p = 0.316). There is a moderate negative correlation with LVEF and number of central sleep apnea events (r=-0,334, p = 0,047).

Conclusions

With greater frequency occurs obstructive sleep apnea. Left ventricular systolic function is lower in patients with central sleep apnea. There is a reverse correlation between ejection fraction and number of central apnea.

The predictive value of left atrial expansion index and left atrial contractile strain in younger hypertensive patients with atrial fibrillation

Funding Acknowledgements

Type of funding sources: None.

BACKGROUND

  Arterial hypertension (HTN) is the most prevalent risk factor for Atrial fibrillation (AF) through structural and functional changes of the left atrium. Paroxysmal AF is mainly asymptomatic and silent forms in patients with HTN are associated with thromboembolic complications. However, prompt identification of HTN patients at risk for AF may be strategic for preventing purposes. 

PURPOSE

To assess sensitive and  predictive parameters for AF onset in HTN patients using two-dimensional (2D) conventional and speckle tracking echocardiography of the left atrium (LA) and left ventricle (LV). 

METHODS

A total of 165 consecutive patients were screened for participation in the study.  Only 80 patients met the inclusion criteria ( age below 60 years; with well controlled HTN or HTN with AF; without concomitant disease or other risk factors for AF).They were separated in two groups: 43 with HTN and 37 patients with AF and HTN. All patients underwent standard 2D echocardiography with volumetric and Speckle tracking analysis for assessment of: LV global longitudinal strain; LA total ( LATEF), passive ( LAPEF), active (LAAEF) emptying fractions; LA stiffness and expansion index; LA - reservoir (LASr), conduit (LAScd) and contractile (LASct) strain. 

RESULTS

There were statistically significant differences between patents with HTN and  HTN with AF group in: LASr (30.88 ± 3.99% vs. 27.89 ± 8.21 %, p= 0.049), LASct (-17.64 ± 2.04% vs. -14.4 ± 6.74 %, p= 0.007) and LA expansion index (122 ± 42% vs. 174 ± 115%; p = 0.014). There were no significant differences in other LV and LA structural and functional indices. Multiple regression analysis demonstrated that  LASct ( B= - 0.043’ p= 0.001; 95%CI -0.063- -0.023) and expansion index (B= 0.023; p= 0.001, 95%CI 0.117- 0.349)  are independent predictors of AF in hypertensive patients. 

Conclusion

Preserved LA compliance and contractile function are essential for maintenance of sinus rhythm in younger HTN patients. These findings could be used for  prediction of cardiovascular events and preventing AF onset in younger hypertensive population with a huge social impact.

Echocardiographic predictors of atrial fibrillation in middle-aged patients without overt heart disease

Background

Left atrial volume index (LAVi) has been established as a surrogate marker for chronically elevated left ventricular (LV) filling pressure. Moreover it is a powerful predictor of atrial fibrillation (AF) in different pathologies. However, there is limited data for additional and sensitive echocardiographic predictors of AF in patients without over heart disease.

Purpose

To investigate middle- aged AF patients without overt heart disease and to identify additional echocardiographic predictors of AF.

Methods

A total of 936 consecutive patients with AF, who had been admitted for sinus rhythm restoriation in our hospital for the period January 2016- December 2018, were screened for participation in the study. Only 70 patients met the inclusion criteria- stable sinus rhythm, age between 40–60 years, without over heart disease. They were separated in 2 groups: with new onset AF (n=33) and recurrent AF (n=37); 30 healthy subjects were enrolled in the control group. All patients underwent two dimensional echocardiographic assessment with volumetric and speckle tracking analyses.

Results

There were significant differences between all groups in: LAVi; LA total (LATEF), passive (LAPEF) and active (LAAEF) emptying fractions; LA reservoir (LASr), conduit (LAScd) and contractile (LASct) strain; LV global longitudinal strain (GLS), but not in other LV indices – table. Multiple regression analysis demonstrated that LAVi (B=0.012, p=0.05, 95% CI: 0.000–0.023), LASr (B=−0.055, p=0.0001, 95% CI: −0.071 to −0.039), LASct (B=0.041, p=0.001, 95% CI: 0.016–0.066) are independent predictors of AF.

Conclusion

In middle- aged patients without overt heart disease LASr and LASct have additive value beyond LAVi in prediction of AF.

Funding Acknowledgement

Type of funding source: None

Is 24 hour central aortic pressure superior to single measurement of central aortic pressure in well controlled hypertensive patients

Background

Non-invasive measurements of 24 h ambulatory central aortic systolic pressure (24hCASP) is now feasible method than single measurement of CASP. There is growing interest in CASP as cardiovascular risk marker beyond conventional brachial blood pressure (BP). Pulse wave velocity estimates arterial stiffness, whereas CASP is representative of the BP in major organs.

Purpose

To evaluate non- invasive parameters for arterial stiffness using oscillometric method and to compare 24hCASP with single measurement of CASP in well-controlled hypertensive patients to detect target organ damage (TOD).

Methods

A total 95 patients (57±14 years) with hypertension, were separated in two groups: 22 patients with normal EA/Ees ratio (Arterial elastance (EA) and ventricular elastance (Ees)) and 73 hypertensive patients with decrease EA/Ees ratio, marker for ventriculo-arterial coupling. EA and Ees were calculated as and – systolic pressure/stroke volume and end-systolic pressure/end-systolic volume. Parameters for arterial stiffness – 24hCASP, ambulatory central systolic pressure (CASP), 24-hour pulse wave velocity (PWV24h) and ambulatory PWV were measured non-invasively with oscillometric method by Mobil-O-graph PWA.

Results

Statistically significant differences in parameters of vascular stiffness were found in patients with normal ventriculo-arterial coupling in comparison with disturbed EA/Ees: 24hCASP (107.64±9.19 vs. 116.64±16.7 mm Hg, p=0.02), CAP (117.45±9.26 vs. 128.42±16.15 mm Hg, p<0.0001). There were no statistically significant differences in PWV and PWV24h. Multiple regression analysis demonstrated that CAP (B=−0.264 p=0.003; 95% CI: −0.003–0.014) is independent predictor of TOD in hypertensive patients, than 24 hour central aortic pressure.

Conclusion

There is no superiority of 24hCASP than single measurment of CASP. CASP could predict preclinical damage and cardiovascular outcome.

Funding Acknowledgement

Type of funding source: None

Effect of comprehensive vasodilation vs usual care on mortality and heart failure rehospitalization in women with acute heart failure

Background

Guidelines recommend evaluating the risk/benefit ratio of novel therapies individually in women and men, as the pathophysiology and the response to treatment may differ between women and men. Among patients with acute heart failure (AHF), a strategy of intensive vasodilation, compared with usual care, overall did provide comparable outcomes.

Purpose

To evaluate the effect of a strategy that emphasized early intensive and sustained vasodilation in women with AHF.

Methods

In a randomized, open-label blinded-end-point trial patients hospitalized for AHF were enrolled in 10 hospitals in Switzerland, Bulgaria, Germany, Brazil, and Spain. Inclusion criteria were AHF expressed by acute dyspnea and increased plasma concentrations of natriuretic peptides, systolic blood pressure ≥100mmHg, and a plan for treatment in a general ward. Patients were randomized 1:1 to a strategy of early intensive and sustained vasodilation throughout the hospitalization or usual care. The primary end point was a composite of all-cause mortality or rehospitalization for AHF at 180 days.

Results

Among 788 patients randomized, 781 completed the trial and were eligible for the primary end point analysis. Of these 288 (36.9%) were women. The primary end point, a composite of all-cause mortality or rehospitalization for AHF at 180 days, occurred in 53 female patients (37.9%) in the intervention group (including 28 deaths [20.0%]) and in 34 female patients (23.0%) in the usual care group (including 22 deaths [14.9%]) (absolute difference for the primary end point, 14.9%; adjusted hazard ratio, 1.67 [95% CI: 1.08–2.59]; P=0.02). Clinically significant adverse events with early intensive and sustained vasodilation vs usual care included hypotension (8% vs 2%).

Conclusion

Among women with AHF, a strategy of early intensive and sustained vasodilation, compared with usual care, had a detrimental effect on a composite outcome of all-cause mortality and AHF rehospitalization at 180 days.

Cox Proportional Hazard Curve

Funding Acknowledgement

Type of funding source: None

P1567 Left atrial function - association with left ventriculoarterial function in hypertensive patients

BACKGROUND

Vascular stiffness and left atrial volume index (LAVI) are predictors of cardiovascular complications in hypertensive patients. The correlation of left atrium (LA) with left ventricle (LV) – arterial functional changes has not been well established.

PURPOSE

To investigate the relationship between LA remodeling and ventriculoarterial function.

METHODS

We studied 70 consecutive middle-aged patients (54 ± 13 years), separated in two groups: 55 with mild to moderate hypertension and duration up to 5 years and 15 healthy controls. All parameters for arterial stiffness – 24-hour central systolic pressure (cSys24h), central pulse pressure (cPP24h), augmentation index 24h (Aix24h) and 24-hour pulse wave velocity (PWV24h) were measured non–invasively with oscillometric method by Mobil-O-graph PWA. All patients underwent standard two-dimentional echocardiography with Spackle tracking analysis for LA and LV global longitudinal strain (GLS).

RESULTS

Statistically significant differences in parameters of vascular stiffness were found in patients with hypertension in comparison with healthy controls: cSys24h (116.64 ± 10.52 vs. 108.4 ± 6.19 mm Hg, p < 0.001), cPP24h (47.64 ± 9.43 vs. 40.4 ± 4.98 mmHg, p < 0.001), PWV24h (8.59 ± 1.49 vs. 6.29 ± 0.91 m/s, p < 0.0001). Patients with hypertension have higher LV filling pressures: E/e ratio (9.62 ± 3.13 vs. 7.62 ± 1.58, p < 0.006), higher velocities of A–wave transmitral blood flow (85.15 ± 16.88 vs. 64.57 ± 13.76 cm/s, p < 0.0001), dilated LA (LAVI: 33.78 ± 10.68 vs. 24.96 ± 4.89 ml/m², p < 0.001) and reduced LA GLS (29.34 ± 3.45 vs. 41.33 ± 4.37%, p < 0.0001) in comparison to control group. There were no statistically significant differences in Aix24h and cardiac output between the two groups. There is moderate positive correlation between LAVI with cPP24h (r = 0.491, p < 0.0001) and cSys24h (r = 0.366, p < 0.004). We found moderate positive correlation between LAVI and LV mass index (r = 0.386, p < 0.002). PWV24h correlated moderately and positively with LAVI (r = 0.404, p< 0.0001), and negatively with LA GLS (r = -0.471, p < 0.0001). CONCLUSION: LA remodeling is determined by the high 24-hour values of non-invasively measured central systolic pressure and pulse wave velocity. The parameters of arterial stiffness - cSys24h, cPP24h correlate positively with LA. PWV24h correlates negatively with reservoir strain of the left atrium. Using the method in clinical practice can improve risk stratification and therapeutic management. Further investigations are needed for prognostic and therapeutic value of LA remodeling.

P1353 Left ventricular performance patterns in patients with dilated cardiomyopathy and advanced heart failure

Background

Left ventricular (LV) global longitudinal strain (GLS) is a more sensitive parameter than ejection fraction in the assessment of LV function. It has been established as a predictor of cardiac death and adverse events. In patients with dilated cardiomyopathy (DCM) LV deformation and twist mechanics are reduced in varying degrees.

Purpose

The aim of the study was to determine different LV performance patterns in patients with DCM and advanced heart failure (HF).

Methods

In 52 patients with DCM with HF NYHA class III-IV (62 ± 13 years, 36 males) LV function had been assessed by conventional, Tissue Doppler and 2D-speckle tracking echocardiography (2D-STE) with measurement of GLS, circumferential strain (CS) and twist mechanics. Patients were divided into two groups: with GLS≥-7 %, and GLS<-7 %.

Results

In a group with more reduced GLS≥-7% systolic parameters were worse, Table. Systolic velocities of medial and lateral mitral annulus (S’lat), and CS at the LV basal and mid levels (CSmid) were significantly more altered. Rotational parameters did not differ between the groups. In a multivariate regression model CSmid (p < 0.0001; B = 0.66, 95%CI [0.37 ÷ 0.95]), S’lat (p = 0.001; B=-0.34, 95%CI [-1.5÷-0.46]) and VCW (p = 0.002; B = 0.31, 95%CI [0.15 ÷ 0.66]) were independent predictors of GLS. ROC curves identified CSmid (AUC 0.91, p < 0.0001) and VCW (AUC 0.69, p = 0.02) as the best discriminators of patients with severely reduced GLS≥-7%.

Conclusions

Patients with DCM and HF with severely depressed LV function assessed by GLS were characterized with more altered CS and more pronounced MR. Rotational parameters failed to be significant determinants of LV performance.

Echocardiographic parameters GLS≥-7% N = 24 GLS<-7% N = 28 p End diastolic volume index(ml/m²) 113.55 ± 41.64 87.98 ± 26.98 0.01 End systolic volume index(ml/m²) 84.50 ± 39.05 55.51 ± 21.93 0.001 Ejection fraction (%) 28 ± 8 35 ± 7 0.001 Systolic velocity of medial mitral annulus (cm/sec) 3.57 ± 0.81 4.88 ± 1.52 0.001 Systolic velocity of lateral mitral annulus (cm/sec) 4.38 ± 1.09 5.38 ± 1.42 0.014 Circumferential strain at basal level (%) -5.92 ± 3.15 55.52 ± 21.93 0.014 Circumferential strain at mid-level (%) -5.11 ± 1.77 -8.71 ± 2.34 <0.0001 Epicardial Torsion (°/cm) 0.31 ± 0.18 0.47 ± 0.35 0.05 Vena contracta width of mitral regurgitation (mm) 7.34 ± 2.23 5.58 ± 2.82 0.017 GLS - global longitudinal strain.

Reduced concentrations of soluble adhesion molecules after antioxidant supplementation in postmenopausal women with high cardiovascular risk profiles--a randomized double-blind study

BACKGROUND

One of the suggested mechanisms of increased cardiovascular risk in postmenopause is a loss of the antioxidant effects of estrogens. It has been shown that classical cardiovascular risk factors increase oxidative stress on the arterial wall, and that endothelial cells react to this insult by increased expression of cellular adhesion molecules (CAM), which in turn are markers of arterial wall inflammation.

METHODS

A randomized, placebo-controlled, double-blind study was performed in 60 postmenopausal women with high cardiovascular risk profiles, but free from clinical atherosclerotic disease. Patients were randomized to either antioxidant supplementation (using a combination of natural antioxidants; n = 30) or placebo (n = 30), and followed for 12 weeks. The concentrations of the adhesion molecules sVCAM-1 and sICAM-1 were measured by ELISA at baseline and at the end of the study, as well as total cholesterol, LDL, HDL, triglycerides and blood pressure.

RESULTS

27 women in the antioxidant supplementation group and 29 on placebo completed the study. At baseline, there were no significant differences in measured parameters between the groups: sICAM-1 concentrations were 341.8 +/- 116.9 vs. 349.9 +/- 104.6 ng/ml (active treatment vs. placebo; p = n.s.) and sVCAM-1 concentrations were 780.5 +/- 325.8 vs. 761.0 +/- 333.7 ng/ml (p = n.s.). In contrast, at the end of the study, sICAM-1 concentrations were 301.6 +/- 56.0 vs. 356.0 +/- 134.8 ng/ml (active treatment vs. placebo; p = 0.053) and sVCAM-1 concentrations were 656.0 +/- 326.5 vs. 818.5 +/- 381.0 ng/ml (p = 0.04). There were no significant differences between or changes within the groups in measured cholesterol and blood pressure.

CONCLUSION

Antioxidant supplementation reduces serum concentrations of endothelium-derived adhesion molecules sICAM-1 and sVCAM-1 in postmenopausal women with high cardiovascular risk profiles.

Effects of the combined hormonal replacement drug estradiol valerate/levonorgestrel on climacteric complaints, endometrium and lipid profile of peri- and postmenopausal women

The effects of the combined hormone replacement (HRT) drug estradiol valerate/levonorgestrel (Klimonorm) on climacteric complaints, endometrial status and lipid profile was studied in 100 peri- and postmenopausal women aged between 41 and 57 years. The duration of therapy was 6 months. The following parameters were investigated: Kuppermann index, endometrial thickness, duration of bleeding, arterial blood pressure, body weight and serum lipids and lipoproteins (total cholesterol TC, LDL cholesterol, HDL cholesterol, and triglycerides [TG]). A separate analysis was made for 27 patients who had abnormal lipid status before treatment. Total cholesterol above 6.0 mmol/l and/or LDL of more than 3.5 mmol/l was considered abnormal and those patients were labeled as "high risk". The results showed a statistically significant reduction in the severity of climacteric symptoms (Kupperman index). A large decrease in the score was observed during the first 3 months of treatment (from 27.9 at the start to mean values of 9.3, p < 0.001). A further slight decrease of the score to 4.0 (p < 0.001) was seen after 6 months of treatment. Endometrial thickness did not change. At the start of the treatment the mean duration of bleeding was 5.1 +/- 0.3 days and at the end of the 6th month it was 3.8 +/- 0.2 days (p < 0.001) Klimonorm favorably affected the lipid profile. TC decreased significantly during the therapy: by 5.2% (p < 0.05) in all women and 7.1% (p < 0.05) in the high risk group. LDL cholesterol decreased slightly: by 4.3% (p < 0.05) in all women and was more pronounced in the high risk group (7.0%, p < 0.01). HDL cholesterol increased by 12.1% (p < 0.01) in all women and by 14.7% (p < 0.001) in the high risk group. TG were elevated slightly by 9.5% (p < 0.05) in all women and 3.9% (p > 0.05) in the high risk group. LDL/HDL ratio decreased from 2.7 to 2.3 in all women and from 3.0 to 2.4 (p < 0.05) in the high risk group. No significant changes in systolic and diastolic blood pressure were recorded. Body weight did not change significantly during the treatment period.

Serum level of IgG autoantibodies against oxidized low density lipoproteins and lag-phase of serum oxidation in coronary heart disease--inverse correlation

High affinity IgG autoantibodies (ABs) against oxLDLs and lag-phase of serum oxidation were tested in patients with coronary heart disease (CHD). Fifty one (37 M/14 F) patients with CHD defined as Q-wave myocardial infarction and/or stenosis of more than 50% and 51 (34 M/17 F) healthy blood donors as controls participated in this study. LDLs were isolated by gradient ultracentrifugation and oxidized with CuSO4. The modified LDLs (oxLDLs) or native LDLs (nLDLs) were used as antigens in an enzyme immunoassay (ELISA) to detect IgG ABs in both groups. The serum was oxidized by CuSO4 and the oxidation was monitored spectrophotometrically at lambda = 234 nm to follow the formation of conjugated diens. The lag-phase (in minutes) is the interval between the addition of CuSO4 to the serum and the beginning of extensive oxidation (increasing absorbance at 234 nm). The concentrations of total cholesterol, triglycerides, HDL-cholesterol, apo-A and apo-B were measured as well. The mean level of ABs against oxLDLs (expressed as optical density units) was 0.590 +/- 0.330 in CHD-patients vs 0.244 +/- 0.200 in controls (p < 0.001). The lag-phase in minutes was 47.00 +/- 27.19 in CHD-patients and 80.23 +/- 26.30 in controls (p < 0.001). A negative correlation between ABs levels and lag-phase was established in CHD-patients (r = -0.69, p < 0.001) and controls (r = -0.62, p < 0.001). A poor correlation was established between ABs levels or lag-phase, on one hand, and other measured parameters. In conclusion, the lag-phase of serum oxidation by Cu2+ could be informative for LDL susceptibility to modification and the extent of consequent humoral immune response.