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Background: The coexistence of hyponatremia and atrial fibrillation (AF) increases morbidity and mortality in patients with heart failure (HF). However, it is not established whether hyponatremia is related to AF or not., Objective: Our study aims to seek a potential association of hyponatremia with AF in patients with reduced ejection fraction heart failure (HFrEF)., Methods: This observational cross-sectional single-center study included 280 consecutive outpatients diagnosed with HFrEF with 40% or less. Based on sodium concentrations ≤135 mEq/L or higher, the patients were classified into hyponatremia (n=66) and normonatremia (n=214). A p-value <0.05 was considered significant., Results: Mean age was 67.6±10.5 years, 202 of them (72.2%) were male, mean blood sodium level was 138±3.6 mEq/L, and mean ejection fraction was 30±4%. Of those, 195 (69.6%) patients were diagnosed with coronary artery disease. AF was detected in 124 (44.3%) patients. AF rate was higher in patients with hyponatremia compared to those with normonatremia (n=39 [59.1%] vs. n=85 [39.7%), p= 0.020). In the logistic regression analysis, hyponatremia was not related to AF (OR=1.022, 95% CI=0.785-1.330, p=0.871). Advanced age (OR=1.046, 95% CI=1.016-1.177, p=0.003), presence of CAD (OR=2.058, 95% CI=1.122-3.777, p=0.020), resting heart rate (OR=1.041, 95% CI=1.023-1.060, p<0.001), and left atrium diameter (OR=1.049, 95% CI=1.011-1.616, p=0.002) were found to be predictors of AF., Conclusion: AF was higher in outpatients with HFrEF and hyponatremia. However, there is no association between sodium levels and AF in patients with HFrEF.

Objective: Galanin, a cotransmitter similar to neuropeptide Y (NPY), aggravates autonomic imbalance in systolic heart failure (HF) by attenuating vagal tonus after burst sympathetic activity. In animal HF models, galanin antagonists have improved cardiac function. To determine whether galanin is a promising therapeutic target in HF, we studied its concentrations in HF patients and evaluated its correlation with NPY, markers of humoral activity such as pro-BNP and copeptin, and echocardiographic parameters of HF severity., Methods: After recording demographic and echocardiographic characteristics of 87 individuals (57 HF patients and 30 control subjects), fasting serum concentrations of galanin, NPY, copeptin, and pro-BNP were determined., Results: Unlike pro-BNP, copeptin, and NPY, which were significantly elevated in HF patients (p<0.001, p<0.001, and p=0.001, respectively), galanin was similar in HF patients and control subjects (p=0.9). NPY correlated with the echocardiographic parameters of HF severity (r=-0.22, p=0.03 for EF; r=0.3, p=0.005 for Tei index of RV; r=-0.23, p=0.03 for TAPSE; and r=0.24, p=0.024 for E/e') and pro-BNP (r=0.22, p=0.046). NPY levels were also associated with beta blocker (BB) use, wherein BB significantly decreased NPY in both HF patients and control subjects. Galanin correlated with humoral biomarkers, pro-BNP and copeptin (r=0.39, p<0.001 and r=0.41, p<0.001, respectively). Although current smoking, BB therapy, pro-BNP, copeptin, and body mass index were associated with galanin in univariate analyses, the multiple linear regression model revealed that pro-BNP was the only significant determinant of galanin levels in HF patients., Conclusion: Our findings confirmed the role of NPY in autonomic balance and suggest that galanin is associated with the proadrenergic state, but its role in HF in humans remains unclear.

Objective: In order to evaluate the utility of the heart rate performance index (HRPI), which is obtained by dividing HR mean by the difference of HR max and HR min in the context of Holter monitoring, we sought to determine whether there was any correlation or relationship between the HRPI and LVEF values as determined by echocardiography and to compare the HRPI between the study and control groups., Methods: This study is a cross-sectional, controlled observational study. Thirty-two patients with symptomatic or asymptomatic left ventricular systolic dysfunction (LVEF <45%) were included as study group and 32 subjects without chronic heart failure (CHF) were included as a control group. In the study group, 10 patients were in NYHA class I (31.2%), 12 - were in NYHA class II (37.6%) and 10 - were in NYHA class III (31.2%). Heart rate analysis was measured using 24-hour Holter ambulatory electrocardiography. To determine the HRPI, the difference between maximum (HR max) and minimum heart rate (HR min) was divided by mean heart rate (HR mean) (beats/minute): HRPI=(HR max-HR min) / HR mean. Statistical analysis was performed using t-test for independent samples, Mann-Whitney U test, Chi-square test, Kruskal-Wallis test, Pearson's correlation and linear regression analyses., Results: The HRPI index value was markedly decreased [0.83 (0.58-1.1) and 1.10 (0.74-1.3), p<0.001] in the study group as compared to the control group. The data collected for the study group and the control group (n=64) demonstrated a positive correlation between the HRPI and LVEF (r=0.62, p<0.001) as well as a negative correlation between the HR mean and LVEF (r=-0.39, p<0.003). The HR mean was higher (80.2±11.3 and 75.2±6.7, p<0.007) and HR max-HR min (67.9±11.6 and 83.3±14.3, p<0.001) were lower in the study group as compared to the control group. Linear regression analysis demonstrated no significant relationship between LVEF and HRPI and other heart rate derivatives (unstandardized β=42.43 95% CI: 21.98-50.51, p=0.231)., Conclusion: According to our findings, patients with CHF exhibited higher HR mean values, reduced HR max-min values and significantly decreased HRPI values. There is a positive correlation between HRPI and LVEF, a decreased HRPI is associated with a decreased LVEF, but there is no relationship between these two variables. Therefore, HRPI values may represent a viable option for assessing daily exercise activity and potentially sympathetic activation in patients with CHF. The assessment of HRPI may be helpful the evaluation of CHF patients, as well as resting HR.

Objectives: Fortilin is a multifunctional protein that protects cells against apoptosis. We aimed to investigate the levels of fortilin in patients with heart failure. Methods: Patients with ejection fraction (EF) below 40% were divided into two groups according to coronary angiography results: those with ischemic heart failure (Group 1) and those with non-ischemic heart failure (Group 2). Patients with normal anatomy and EF over 50% were included in the control group (Group 3). Results: A total of 119 patients were prospectively included in the study. A total of 81 patients (41 patients with ischemic heart failure and 40 patients with non-ischemic heart failure) were included in the heart failure group. 38 patients with EF >50 and normal coronary anatomy were included in the control group. There was no significant difference in serum fortilin levels between the study groups (Group 1: 5.5 ± 2.6 ng/mL, Group 2: 6.1 ± 3.8 ng/mL, and Group 3: 5.6 ± 3.6 ng/mL; P=0.693). Fortilin did not show a correlation with any other variables. Conclusion: In our study, there was no significant difference in fortilin levels between the groups, and no relationship was found between coronary ischemia and fortilin levels in heart failure. [ABSTRACT FROM AUTHOR]

Objective: Galanin, a cotransmitter similar to neuropeptide Y (NPY), aggravates autonomic imbalance in systolic heart failure (HF) by attenuating vagal tonus after burst sympathetic activity. In animal HF models, galanin antagonists have improved cardiac function. To determine whether galanin is a promising therapeutic target in HF, we studied its concentrations in HF patients and evaluated its correlation with NPY, markers of humoral activity such as pro-BNP and copeptin, and echocardiographic parameters of HF severity. Methods: After recording demographic and echocardiographic characteristics of 87 individuals (57 HF patients and 30 control subjects), fasting serum concentrations of galanin, NPY, copeptin, and pro-BNP were determined. Results: Unlike pro-BNP, copeptin, and NPY, which were significantly elevated in HF patients (p<0.001, p<0.001, and p=0.001, respectively), galanin was similar in HF patients and control subjects (p=0.9). NPY correlated with the echocardiographic parameters of HF severity (r=-0.22, p=0.03 for EF; r=0.3, p=0.005 for Tei index of RV; r=-0.23, p=0.03 for TAPSE; and r=0.24, p=0.024 for E/e') and pro-BNP (r=0.22, p=0.046). NPY levels were also associated with beta blocker (BB) use, wherein BB significantly decreased NPY in both HF patients and control subjects. Galanin correlated with humoral biomarkers, pro-BNP and copeptin (r=0.39, p<0.001 and r=0.41, p<0.001, respectively). Although current smoking, BB therapy, pro-BNP, copeptin, and body mass index were associated with galanin in univariate analyses, the multiple linear regression model revealed that pro-BNP was the only significant determinant of galanin levels in HF patients. Conclusion: Our findings confirmed the role of NPY in autonomic balance and suggest that galanin is associated with the proadrenergic state, but its role in HF in humans remains unclear. [ABSTRACT FROM AUTHOR]

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Objectives: Levosimendan is a with positive inotropic and hemodynamic effects and is widely used for decompensated heart failure. Purpose of this study is to compare the red cell distribution width (RDW) in advanced heart failure patients who were treated with levosimendan before and after the treatment. Material and methods: One hundred and eight advanced heart failure patients who had levosimendan treatment during hospitalization were screened retrospectively. Echocardiographic and hemogram data before and one month after the treatment were obtained from retrospective records. Values before and after the treatment were compared. Results: Mean RDW was 15.4% before the treatment and mean RDW was 15.2% after the treatment. Mean change was 0.70 and this decrease was found to be statistically significant (p=0.019). Mean left ventricular end diastolic diameter and mean left ventricular end systolic diameter were decreased significantly and mean left ventricular ejection fraction (before 29,3%, after 30.3%, mean change 1,61%, p<0.001) increased significantly after the treatment. There was no change with regard to hemogram, RBC, MCV, MCHC, WBC, NE, LY, PLT, MPV values before and after the treatment. Conclusion: RDW which was shown to have prognostic value in cardiovascular disease was demonstrated to be decreased significantly in patients with advanced heart failure after the levosimendan treatment. [ABSTRACT FROM AUTHOR]