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Background: Impairment of renal function (IRF) is an independent risk factor of myocardial infarction (MI)., Aim: The aim of study was to determine if the presence of IRF affects the choice of treatment strategy in patients with MI, and if long-term mortality rates are influenced by the use of an invasive strategy in patients with MI according to the grade of IRF., Methods: Data from the PL-ACS Registry of 22,431 patients hospitalised for MI during 2007-2008 with an available estimated glomerular filtration rate (eGFR) with 2009 Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) formula were included. Patients were stratified based on eGFR: ≥ 90 (normal); 60-89 (mild IRF); 30-59 (moderate IRF); 15-29 (severe IRF); and < 15 mL/min/1.73 m² (end-stage IRF)., Results: After adjustment, each increase in IRF grade reduced the likelihood of percutaneous coronary intervention by 19% (odds ratio [OR] 0.81; 95% confidence interval [CI] 0.78-0.85; p < 0.001). A higher IRF grade was independently associated with mortality (OR 2.01; 95% CI 1.86-2.18; p < 0.001) and major bleeding (OR 1.42; 95% CI 1.22-1.66; p < 0.001) during hospitalisation, and mortality at 12 (hazard ratio [HR] 1.55; 95% CI 1.49-1.62; p < 0.001) and 36 months (HR 1.50; 95% CI 1.45-1.55; p < 0.001). Invasive treatment was independently associated with improved 12-month prognosis in non-ST-segment elevation MI (NSTEMI) patients with mild-to-severe IRF and in ST-elevation MI (STEMI) patients at all IRF grades., Conclusions: Invasive procedures were less frequent with worsening renal dysfunction. Invasive treatment was associ-ated with improved 12-month prognosis in STEMI patients regardless of renal function and in NSTEMI patients with eGFR ≥ 15 mL/min/1.73 m².

Background: Natriuretic peptides play an important role in the diagnosis and risk stratification of patients with acute and chronic heart failure. Multiple studies have shown that these peptides are liable to the influence of individual factors. For N-terminal-pro-B-type natriuretic peptide (NT-proBNP) some of these confounding factors have been evaluated over the years such as age, gender, New York Heart Association (NYHA) class and body mass index (BMI). The aim of this study was to establish confounding factors of mid-regional pro-atrial natriuretic peptide (MR-proANP) assessment., Methods and Results: We studied 684 patients (94% male, age 61.2±11.2, left ventricular ejection fraction [LVEF]<35%-45%, NYHA class (I/II/III/IV: 8.4/45.8/39.5/6.3%), ischaemic aetiology 71%, body mass index [BMI] 26.5±4.3kg/m(2), mean MR-proANP 296.0±281.0pmol/L, mean NT-proBNP 2792.0±5328.6pg/mL, mean creatinine level 110.2±38.0μmol/L and mean haemoglobin 13.9±1.5g/dL) with clinically stable chronic heart failure. MR-proANP levels increased with increasing NYHA class (p<0.0001) and an increasing BMI category was associated with decreasing values of MR-proANP (p<0.0001). We found MR-proANP to be independently associated with BMI, creatinine, ischaemic aetiology, LVEF and NYHA class. Meanwhile, NT-proBNP was independently associated with BMI, creatinine, haemoglobin, LVEF and NYHA class., Conclusion: MR-proANP is subject to the almost identical influencing factors like NT-proBNP. The effects of anaemia warrant further study., (Copyright © 2016. Published by Elsevier Ireland Ltd.)

Background and Aim: Heart failure (HF) has become a global health problem and is a significant burden for health-care systems worldwide. It is reported as the reason for 1-4% of all hospital admissions in developed countries. The prognosis in HF remains unfavourable. Having at our disposal a large group of patients with systolic HF at a high-volume reference cardiovascular centre with the possibility to implement complete diagnostics and therapy we decided to analyse the clinical data, administered therapies, and prognosis in HF patients., Methods: The COMMIT-HF is a single-centre observational study that is underway in the Third Chair and Department of Cardiology of the Silesian Centre for Heart Diseases in Zabrze. The study population is a cohort of adult HF patients with left ventricular ejection fraction (LVEF) ≤ 35%. Patients with acute coronary syndromes are excluded from the analysis. Complete patient demographics: medical history, hospitalisation data (diagnostic and therapeutic), and in-hospital results are collected. Twelve-month follow-up is based on the information acquired from the national health-care provider., Results: As of 31 December 2013 a group of 1798 patients have been enrolled (mean age 60.9 ± 12.8 years, 20.3% of subjects female, mean LVEF 26.06 ± 6.09, ischaemic aetiology 64.5%, atrial fibrillation 33.2%, diabetes mellitus 41.2%, chronic kidney disease stage ≥ III 29%). A significant proportion of patients underwent invasive procedures (ICD/CRT-D implantation 61.1%, coronary angiography 56.2%, PCI 19.6%, CABG 5.1%, heart transplantation qualification 5.5%, IABP 2.5%). All-cause 12-month morality was 12.5%. HF-related rehospitalisation rate was 28.9%., Conclusions: The COMMIT-HF study will provide valuable information on the HF patient population. Initial analyses show that in this difficult patient population satisfactory long-term results can be achieved.

Background: A higher serum phosphate level is associated with worse outcome. Energy-demanding intracellular transport of phosphate is needed to secure anion bioavailability. In heart failure (HF), energy starvation may modify intracellular and serum levels of phosphate. We analysed determinants of serum phosphates in HF and assessed if catabolic/anabolic balance (CAB) was associated with elevation of serum phosphate., Methods: We retrospectively reviewed data from 1029 stable patients with HF and have calculated negative (loss) and positive (gain) components of weight change from the onset of HF till index date. The algebraic sum of these components was taken as CAB. The univariate and multivariable predictors of serum phosphorus were calculated. In quintiles of CAB, we have estimated odds ratios for serum phosphorus above levels previously identified to increase risk of mortality. As a reference, we have selected a CAB quintile with similar loss and gain., Results: Apart from sex, age, and kidney function, we identified serum sodium, N-terminal fragment of pro-brain-type natriuretic peptide, and CAB as independent predictors of serum phosphorus. The odds for serum phosphorus above thresholds found in literature to increase risk were highest in more catabolic patients. In most catabolic quintile relative to neutral balance, the odds across selected phosphorus thresholds rose, gradually peaking at 1.30 mmol/L with a value of 3.29 (95% confidence interval: 2.00-5.40, P < 0.0001) in an unadjusted analysis and 2.55 (95% confidence interval: 1.38-2.72, P = 0.002) in a fully adjusted model., Conclusions: Metabolic status is an independent determinant of serum phosphorus in HF. Higher catabolism is associated with serum phosphorus above mortality risk-increasing thresholds.

Introduction: The activation of the renin-angiotensin-aldosterone (RAA) system is a main element of the pathophysiology of chronic heart failure (CHF), determining its symptoms and prognosis. Vitamin D is an RAA inhibitor, and its deficiency frequently accompanies CHF. The factors determining the concentration of 25-hydroxyvitamin D [25(OH)D] in CHF are not well understood, although an association has been suggested between the deficiency and the advancement of CHF. Also unknown is the influence of therapeutic escalation using recommended agents on the serum level of 25(OH)D. The aim of this study was to examine the incidence of abnormal 25(OH)D concentrations in CHF patients and to establish the clinical and laboratory determinants of low activity of this metabolite., Material and Methods: The retrospective analysis included the data of 412 CHF patients not receiving optimal pharmacological treatment who were initially in NYHA (New York Heart Association) class III or IV. Over the period of 3 months the therapy was escalated until reaching maximum tolerated doses or those recommended by the current guidelines. After optimizing the therapy, the incidence of 25(OH)D deficiency (< 30 ng/ml) and insufficiency (< 20 ng/ml) was established, and clinical and laboratory determinants for these abnormal concentrations were analyzed., Results: Normal serum level, insufficiency, and deficiency of 25(OH)D were observed in, respectively, 41.5%, 26.0% and 32.5% of patients. The NYHA class improved by at least 1 class in 63.6% of patients, remained unchanged in 32.8% of patients, and deteriorated in 3.6% of patients. In multivariables analysis, low availability of natural ultraviolet B (UVB) radiation, loss of body mass during the CHF, higher concentrations of phosphates and albumins, and the presence of diabetes increased the risk of 25(OH)D deficiency, while higher concentrations of uric acid reduced this risk. In patients with a positive response to therapy, the concentration of 25(OH)D was borderline significantly higher (p = 0.055), while insufficiency and deficiency were less frequent (p = 0.02) than in patients without a treatment response, but this pertained only to patients with higher exposure to UVB. These differences were not observed in patients with low UVB exposure., Conclusions: The concentration of 25(OH)D in CHF patients is not associated with the advancement of the disease, but is strongly determined by the potential availability of UVB radiation. A positive response to therapy increases the concentration of 25(OH)D only in the case of high UVB exposure; other determinants of 25(OH)D level include the patient's metabolic profile and the presence of diabetes.

Fetuina-A, protein discovered in the fifties of the twentieth century, is intensively investigated recently as a participant in many intracellular process. The aim of this article is to summarize, comment and order previous knowledge on it, in anticipation of the publication the result of further research, which could be very important in diagnostic and treatment many illness.

Introduction: Abnormal serum calcium levels are associated with adverse cardiovascular effects. Therapy of heart failure (HF) may result in urinary calcium excretion and calcium apposition to bones, and consequently, in calcemia., Objectives: The aim of the study was to assess the prevalence of abnormal calcium levels in the blood of patients receiving maximized HF therapy, to explore clinical and laboratory determinants of abnormal serum calcium levels, and to analyze the relation of abnormal calcium levels to prognosis., Patients and Methods: The study included 722 patients with HF classified as New York Heart Association (NYHA) classes III-IV at baseline (age 53 ±10 years, 13% of women), who underwent HF therapy optimization to maximum tolerated doses., Results: After therapy maximization, the NYHA class improved in 66.7% of the patients, while it did not change in 31.0% and worsened in 2.4%. Hypocalcemia occurred in 166 patients (22.9%) and was more prevalent in patients in whom the NYHA class improved. Hypercalcemia was diagnosed in 63 patients (8.7%) and was more common in patients with no functional improvement or worsening of the NYHA class. This effect was independent of age, sex, etiology of HF, body mass index, kidney function, or the use of thiazides. Hypercalcemia was associated with increased catabolism, hemodynamic compromise, more intensive inflammation, and lower bone mineral density. Lower albumin and higher phosphorus levels, were significant predictors of hypercalcemia, independently of kidney function. Hypocalcemia was associated with reduced catabolism, higher albumin and lower phosphorus levels, use of thiazides, and smoking history. Neither hypocalcemia nor hypercalcemia was associated with poor prognosis., Conclusions: Our study shows that abnormal serum calcium levels are associated with a clinical response to treatment maximization in patients with HF. Mild hypocalcemia after maximization of therapy is not associated with poorer prognosis. Hypercalcemia is associated with lack of response to treatment, and its prognostic value remains unclear.

Introduction: The assessment of prognosis is crucial for the clinical management of patients with heart failure (HF)., Objectives: The aim of the study was to evaluate the usefulness of novel biomarkers for the assessment of prognosis in patients with HF, compared with a detailed assessment based on routine laboratory tests., Patients and Methods: The study included 179 patients with HF. In all patients, routine laboratory tests were performed and selected biomarkers were measured (N-terminal pro-B-type natriuretic peptide, high-sensitivity C-reactive protein, growth hormone, myeloperoxidase, metaloproteinase 9, procollagen type III, soluble toll like receptor 2, insulin growth factor, and neutrophil gelatinase-associated lipocain). The primary endpoint was death or urgent heart transplantation, while the secondary endpoints encompassed primary endpoints plus cardioverter intervention or hospitalization for HF., Results: The mean age of the study group was 52.5 years (91% were men). Most patients had advanced HF. During a 6-month follow-up, 21 primary endpoints and 63 secondary endpoints were recorded. A multiple regression analysis showed that of all laboratory variables and biomarkers, only uric acid and sodium were independent predictors of primary endpoints, and only estimated glomerular filtration rate had a predictive value for secondary endpoints. None of the biomarkers were a significant prognostic factor in the study population., Conclusions: Biomarkers do not outweigh the value of standard laboratory tests. Routine laboratory workup allows to assess multiorgan damage and provides the most significant prognostic data. Biochemical tests should remain the gold standard for the assessment of prognosis in patients with HF.

Serum phosphorus abnormalities may pose a risk on the cardiovascular system. In heart failure (HF) phosphorus homeostatic mechanisms are altered and may be modified by modern HF therapy. The impact of therapy optimization on phosphorus abnormalities and related outcome remains unknown. In 722 patients with HF subjected to treatment up-titration we analyzed the prevalence of serum phosphorus abnormalities and their relation to HF severity on top of optimal treatment, and we assessed adjusted risk of phosphorus abnormalities at different stages of HF. We analyzed predictors of hypo- and hyperphosphatemia and relation to prognosis. Hypophosphatemia was associated with better response to therapy, was more prevalent in milder HF, and the association was independent of age, sex, BMI, etiology of HF, kidney function and the use of diuretics. Hypophosphatemic patients lost more phosphorus into urine. They had also less catabolic profile. Patients with hyperphosphatemia on top of optimal therapy responded worse to treatment. Hyperphosphatemia was more prevalent in advanced HF, but the effect was attenuated after adjustment for potential confounders. Clinical and biochemical profiles of hyperphosphatemics suggested domination of catabolism. Neither hypophosphatemia nor hyperphosphatemia modifies the outcome Serum phosphorus abnormalities are related to HF severity on top of optimal therapy. Hypophosphatemia occurring on HF up-titration therapy likely has a multifactorial pathophysiology comprising of urinary phosphorus wasting and refeeding effects. Hyperphosphatemia is linked to the catabolic profile but the effect of renal impairment can't be ruled out. The prognostic impact of serum phosphorus abnormalities remain to be established., (Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.)

Aims: Iron deficiency (ID), anaemia, and chronic kidney disease (CKD) are common co-morbidities in chronic heart failure (CHF) and all independent predictors of unfavourable outcome. The combination of anaemia and CKD in CHF has been described as the cardiorenal-anaemia syndrome. However, the role of ID within this complex interplay of co-existing pathologies is unclear., Methods and Results: We studied the clinical correlates of ID (defined as ferritin <100 µg/L or 100-299 µg/L in combination with a transferrin saturation <20%, anaemia) and renal dysfunction (defined as estimated glomerular filtration rate <60 mL/min/1.73 m(2) ) and their prognostic implications in an international pooled cohort, comprising 1506 patients with CHF. Mean age was 64 ± 13 years, 74.2% were male, and 47.3% were in NYHA functional class III. The presence of ID, anaemia, CKD, or a combination of these co-morbidities was observed in 69.3% of the patients. During a median (Q1-Q3) follow-up of 1.92 years (1.18-3.26 years), 440 patients (29.2%) died. Eight-year survival rates decreased significantly from 58.0% for no co-morbidities to 44.6, 33.0, and 18.4%, for one, two, or three co-morbidities, respectively (P < 0.001). Multivariate hazard models revealed ID to be the key determinant of prognosis, either individually (P = 0.04) or in combination with either anaemia (P = 0.006), CKD (P = 0.03), or both (P = 0.02)., Conclusions: Iron deficiency frequently overlaps with anaemia and/or CKD in CHF. The presence of ID amplifies mortality risk, either alone or in combination with anaemia, CKD, or both, making it a potential viable therapeutic target., (© 2014 The Authors. European Journal of Heart Failure © 2014 European Society of Cardiology.)

Introduction: Despite advances in pharmacotherapy, electrotherapy and interventional treatment, chronic heart failure (HF) is still associated with poor long-term outcome., Aim of the Study: To determine the death rate and risk factors in patients with HF of ischemic and non-ischemic etiology in five-year follow-up., Material and Methods: Consecutive patients with chronic systolic HF hospitalized in the period 2006-2008 were analyzed retrospectively. Study exclusion criteria were: infections (< 3 months before hospitalization), hemodynamically significant valve disease, advanced chronic kidney disease, liver cirrhosis and neoplastic diseases (< 5 years before hospitalization)., Results: The analysis encompassed 266 patients divided into two groups: Group A, with HF of ischemic etiology (n = 157), and Group B, with HF of non-ischemic etiology (n = 109). Mortality was significantly higher in Group A than in Group B (49% vs. 28.4%, p = 0.001). The independent risk factors for death in Group A were: New York Heart Association (NYHA) class (HR = 1.81; p < 0.001); concentrations of high-sensitivity C-reactive protein (hs-CRP) (HR = 1.01; p < 0.05), fibrinogen (HR = 1.04; p < 0.001) and N-terminal prohormone brain natriuretic peptide (NT-proBNP) (HR = 1.02; p < 0.001); and right ventricular end-diastolic diameter (RVEDd) (HR = 1.07; p < 0.01). In Group B they were age (HR = 1.07; p < 0.05) and NT-proBNP concentration (HR = 1.03; p < 0.001)., Conclusions: Mortality was significantly lower in Group B than in Group A. The independent risk factors for death in Group B were age and NT-proBNP serum concentration, whilst in Group A they were NYHA class, serum concentrations of hs-CRP, NT-proBNP and fibrinogen, and RVEDd.

Introduction:  Data regarding standardized trends in mortality from heart failure (HF) in the general population are limited., Objectives:  The aim of the study was to evaluate trends in HF mortality in Poland in the years 1980-2010., Patients and Methods:  An analysis of a database of mortality records from 1980-2010 based on National Statistics was performed. Mortality trends for HF by age and sex were analyzed by polynomial or linear regression., Results:  Total crude numbers of HF deaths in 1980 were 21,519 and 23,008 for women and men, respectively, whereas, in 2010, there were 23,304 and 19,558. There was a significant change in mortality trends for HF, from a decline during the first phase of the study to an increase during the most recent years, 2005-2010 (P <0.005 for changes of trends for both sexes). The lowest value reached in 2005 constituted 47% and 41% of the baseline for women and men, respectively. These ratios increased to 59% and 52% in 2010. Stratification by age and sex brought similar results, with the exception of the youngest groups, which showed initial increases in the rates for the years 1980-1985., Conclusions:  There was a significant decline in the rates of HF mortality in the Polish population for both men and women, showing a maximal reduction of about 50% around 2005. However, between 2005 and 2010, a significant increase in the rates of HF mortality was observed (crude difference equaled 12% for women and 11% for men). It is unknown whether this is a temporary or permanent trend, and the issue requires further investigation.

Objectives: We hypothesised that assessment of plasma C-terminal pro-endothelin-1 (CT-proET-1), a stable endothelin-1 precursor fragment, is of prognostic value in patients with chronic heart failure (CHF), beyond other prognosticators, including N-terminal pro-B-type natriuretic peptide (NT-proBNP)., Methods: We examined 491 patients with systolic CHF (age: 63±11 years, 91% men, New York Heart Association [NYHA] class [I/II/III/IV]: 9%/45%/38%/8%, 69% ischemic etiology). Plasma CT-proET-1 was detected using a chemiluminescence immunoassay., Results: Increasing CT-proET-1 was a predictor of increased cardiovascular mortality at 12-months of follow-up (standardized hazard ratio 1.42, 95% confidence interval [CI] 1.04-1.95, p = 0.03) after adjusting for NT-proBNP, left ventricular ejection fraction (LVEF), age, creatinine, NYHA class. In receiver operating characteristic curve analysis, areas under curve for 12-month follow-up were similar for CT-proET-1 and NT-proBNP (p = 0.40). Both NT-proBNP and CT-proET-1 added prognostic value to a base model that included LVEF, age, creatinine, and NYHA class. Adding CT-proET-1 to the base model had stronger prognostic power (p<0.01) than adding NT-proBNP (p<0.01). Adding CT-proET-1 to NT-proBNP in this model yielded further prognostic information (p = 0.02)., Conclusions: Plasma CT-proET-1 constitutes a novel predictor of increased 12-month cardiovascular mortality in patients with CHF. High CT-proET-1 together with high NT-proBNP enable to identify patients with CHF and particularly unfavourable outcomes.

Aims: Adrenomedullin (ADM) is a vasodilatory peptide. Its plasma levels or its precursors have not been evaluated in large populations of patients with chronic heart failure (CHF). We sought to explore mid-regional proADM (MR-proADM)., Methods and Results: We assessed MR-proADM in 501 CHF patients [age 63 +/- 11 years, New York Heart Association (NYHA) class I/II/III/IV 9/44/39/8%, median N-terminal pro-B-type natriuretic peptide (NT-proBNP) 878 pg/mL (interquartile range-IQR 348-2480 pg/mL), median left ventricular ejection fraction (LVEF) 31% (IQR 25-37%)]. Mid-regional pro-adrenomedullin levels (median 0.64 nmol/L, IQR 0.49-0.87 nmol/L) increased with NYHA class (P < 0.0001). During 1-year follow-up, 70 patients (14%) died. Increasing MR-proADM was a predictor of poor survival at 12 months (hazard ratio 1.82, 95% confidence interval 1.24-2.66, P = 0.002) after multivariable adjustment. In receiver-operating characteristic curve analysis of 12-month survival, the area under the curve for MR-proADM and NT-proBNP was similar (P = 0.3). Comparison of Cox proportional hazard models using the likelihood ratio chi(2) statistic showed that both NT-proBNP and MR-proADM added prognostic value to a base model of LVEF, age, creatinine, and NYHA class. Adding MR-proADM to the base model had stronger prognostic power than adding NT-proBNP (both P < 0.01)., Conclusion: Mid-regional pro-adrenomedullin is an independent predictor of mortality in CHF patients, which adds prognostic information to NT-proBNP.

Context: Androgen deficiency is common in men with chronic heart failure (HF) and is associated with increased morbidity and mortality. Estrogens are formed by the aromatization of androgens; therefore, abnormal estrogen metabolism would be anticipated in HF., Objective: To examine the relationship between serum concentration of estradiol and mortality in men with chronic HF and reduced left ventricular ejection fraction (LVEF)., Design, Setting, and Participants: A prospective observational study at 2 tertiary cardiology centers (Wroclaw and Zabrze, Poland) of 501 men (mean [SD] age, 58 [12] years) with chronic HF, LVEF of 28% (SD, 8%), and New York Heart Association [NYHA] classes 1, 2, 3, and 4 of 52, 231, 181, and 37, respectively, who were recruited between January 1, 2002, and May 31, 2006. Cohort was divided into quintiles of serum estradiol (quintile 1, < 12.90 pg/mL; quintile 2, 12.90-21.79 pg/mL; quintile 3, 21.80-30.11 pg/mL; quintile 4, 30.12-37.39 pg/mL; and quintile 5, > or = 37.40 pg/mL). Quintile 3 was considered prospectively as the reference group., Main Outcome Measures: Serum concentrations of estradiol and androgens (total testosterone and dehydroepiandrosterone sulfate [DHEA-S]) were measured using immunoassays., Results: Among 501 men with chronic HF, 171 deaths (34%) occurred during the 3-year follow-up. Compared with quintile 3, men in the lowest and highest estradiol quintiles had increased mortality (adjusted hazard ratio [HR], 4.17; 95% confidence interval [CI], 2.33-7.45 and HR, 2.33; 95% CI, 1.30-4.18; respectively; P < .001). These 2 quintiles had different clinical characteristics (quintile 1: increased serum total testosterone, decreased serum DHEA-S, advanced NYHA class, impaired renal function, and decreased total fat tissue mass; and quintile 5: increased serum bilirubin and liver enzymes, and decreased serum sodium; all P < .05 vs quintile 3). For increasing estradiol quintiles, 3-year survival rates adjusted for clinical variables and androgens were 44.6% (95% CI, 24.4%-63.0%), 65.8% (95% CI, 47.3%-79.2%), 82.4% (95% CI, 69.4%-90.2%), 79.0% (95% CI, 65.5%-87.6%), and 63.6% (95% CI, 46.6%-76.5%); respectively (P < .001)., Conclusion: Among men with chronic HF and reduced LVEF, high and low concentrations of estradiol compared with the middle quintile of estradiol are related to an increased mortality.

Tissue Doppler imaging (TDI) can be useful in the evaluation of right ventricular (RV) regional dysfunction due to pulmonary diseases. The aim of the study was to assess RV dysfunction in patients with severe interstitial lung diseases (ILD), using both TDI and conventional transthoracic echocardiography (TTE). The study group consisted of 40 consecutive patients with end-stage ILD referred for lung transplantation (LT). Eighteen of them, mean age 47 +/-12 yr, who fulfilled the ATS/ERS criteria for LT (mean forced vital capacity (FVC) 1.4 +/-0.8 l, mean diffusing capacity for carbon dioxide (DLCO) <50% of predicted) constituted the active group, and 22 age-matched patients (mean age 49 +/-12 yr), who did not fulfill these criteria, were placed in the waiting group for LT. We found that among the TDI parameters, the longitudinal peak systolic strain rate (SR) measured at the RV outflow tract, was significantly more negative (-1.1 +/-0.3 vs. -3.2 +/-1.2 s(-1), P=0.03) and the time to peak velocity (TpVEL) in the medial and apical septal segments were shorter (129.9 +/-47.9 vs. 159.2 +/-38.1 ms, P=0.018 and 126.8 +/-44.3 vs. 154.6 +/-40.9 ms, P=0.019) in the patients from the active than those from the waiting group. TTE showed that patients from the active group had significantly lower values of tricuspid annulus plane systolic excursion (TAPSE) (14.3 +/-3.3 vs. 20.6 +/-6.2 mm, P=0.0003) and pulmonary artery acceleration time (PVAT) (70.3 +/-23.3 vs. 96.9 +/-12.4 ms, P=0.0001)compared with those from the waiting group. No other differences were found for other parameters of RV function between the examined groups. In conclusion, severity of lung disease in patients with ILD influences RV systolic dysfunction, which is reflected in both TDI and conventional echocardiographic parameters.

Objectives: Our aim was assess the prognostic value of midregional pro-atrial natriuretic peptide (MR-proANP) using a new immunoassay in patients with chronic heart failure (HF)., Background: Assessment of natriuretic peptides represents a useful addition in establishing the diagnosis of chronic HF. Their plasma values are powerful predictors of survival in chronic HF., Methods: We assessed MR-proANP in 525 chronic HF patients (derivation study: age 61 +/- 12 years, New York Heart Association (NYHA) functional class I/II/III/IV 6%/44%/41%/9%, N-terminal pro-B-type natriuretic peptide (NT-proBNP) 3,637 +/- 6,362 pg/ml) and validated our findings in 249 additional chronic HF patients (age 63 +/- 9 years, NYHA functional class I/II/III/IV 14%/50%/33%/3%, NT-proBNP 1,116 +/- 1,991 pg/ml)., Results: The MR-proANP levels (mean 339 +/- 306 pmol/l, range 24.5 to 2,280 pmol/l) increased with NYHA functional class (p < 0.0001). During follow-up (>6 months in survivors), 171 patients (33%) died. Increasing MR-proANP was a predictor of poor survival (risk ratio 1.35 per increase in standard deviation, 95% confidence interval 1.17 to 1.57; p = 0.0061), adjusted for NT-proBNP, age, left ventricular ejection fraction, NYHA functional class, creatinine, and body mass index (BMI). In receiver operating characteristic curve analysis of 12-month survival, the area under the curve for MR-proANP was 0.74 and that of NT-proBNP was 0.75 (p = 0.7). In a validation study, MR-proANP levels above the optimal prognostic cutoff value from the validation cohort remained a significant independent predictor of death. In chronic HF patients in NYHA functional class II to III and all subgroups of BMI and kidney function, MR-proANP added prognostic value to NT-proBNP. In patients with BMI > or =30 kg/m2, MR-proANP had higher prognostic power than NT-proBNP., Conclusions: Midregional proANP is an independent predictor of mortality in patients with chronic HF. Midregional proANP adds prognostic information to NT-proBNP.

Objectives: We explored the prognostic utility of growth differentiation factor (GDF)-15 in patients with chronic heart failure (CHF)., Background: Growth differentiation factor-15 is a stress-responsive member of the transforming growth factor-beta cytokine superfamily. It has recently been observed that patients with CHF have increased circulating levels of GDF-15. The relations of GDF-15 to other biomarkers and to mortality in CHF have never been studied., Methods: Circulating levels of GDF-15 were determined by immunoradiometric assay in 455 patients with CHF with a median left ventricular ejection fraction (LVEF) of 32% (interquartile range 25% to 39%)., Results: The median GDF-15 level was 1,949 ng/l (interquartile range 1,194 to 3,577); 74.9% of the patients presented with GDF-15 levels >1,200 ng/l, the upper limit of normal in healthy elderly individuals. The GDF-15 levels were closely related to New York Heart Association (NYHA) functional class and to amino-terminal pro-B-type natriuretic peptide (NT-proBNP). The risk of death during follow-up increased with increasing quartiles of GDF-15. Mortality rates at 48 months were 10.0%, 9.4%, 33.4%, and 56.2% in the respective quartiles (p < 0.001). After adjustment for clinical variables and established biomarkers of adverse prognosis, including NT-proBNP, renal dysfunction, anemia, and hyperuricemia, GDF-15 remained an independent predictor of mortality (adjusted hazard ratio for 1 U in the Ln scale 2.26; 95% confidence interval 1.52 to 3.37; p < 0.001). Growth differentiation factor 15 provided prognostic information in clinically relevant patient subgroups (defined according to age, body mass index, heart failure etiology, concomitant medical therapy, renal function, and the levels of hemoglobin and uric acid) and added prognostic information to NYHA functional class, LVEF, and NT-proBNP., Conclusions: Growth differentiation factor 15 is a new biomarker of the risk of death in patients with CHF that provides prognostic information beyond established clinical and biochemical markers.

Nitric oxide is present in the exhaled air. Factors affecting the level of exhaled nitric oxide (exNO), except for smoking, are not well defined. In this study we seek to determine whether age, gender, body mass index (BMI), part of the day, or time after a meal could modulate exNO levels. exNO was examined by the use of a chemiluminescence method in 100 subjects - 31 women (19 nonsmokers and 12 smokers) and 69 males (55 nonsmokers and 14 smokers). Forty four subjects took medications due to stable coronary disease, 22 were after heart transplantation, and 34 did not take any drugs. We found that exNO levels did not differ either between the whole groups of women and men or between smokers and nonsmokers of either respective group (4.91 +/-2.38 vs. 6.27 +/-4.23 ppb; 3.21 +/-1.16 vs. 3.71 +/-1.55 ppb; 5.98 +/-2.35 vs. 6.92 +/-4.45 ppb). The correlation of exNO with age in the whole population was weak (r=0.23; P=0.02) and insignificant in the smoking and nonsmoking subgroups. Likewise, correlations of exNO with BMI, part of the day, or time after a meal were insignificant in whole population as well as the subgroups. We conclude that the aforementioned factors are not able to confound the measurement of exNO in the population studied.

Weight loss is a characteristic feature of chronic obstructive pulmonary disease (COPD) and a negative, independent predictor of outcome. It is a consequence of a misbalance between protein synthesis and breakdown resulting from increased energy requirement unbalanced by dietary intake. A depletion of fat-free mass is seen, especially in muscles (up to 60% of their mass) and leads to the loss of their power and endurance. The impairment of quality of life is very distinct. So far, there is no systemic treatment in cachectic patients with COPD, anti-catabolic treatment by polyunsaturated fatty acid may be of significance but needs further investigation.

Weight loss is a characteristic for advanced chronic obstructive pulmonary disease (COPD), but its mechanism remains unexplained. The decrease of lean body mass is due to a negative energy balance with a noncatabolic hypermetabolic state. Pulmonary inflammation or tissue hypoxia might contribute to it, the decrease in protein content is accompanied by an increase in reactive oxygen forms. Tumor necrosis factor (TNF) has been implicated, other candidates are cytokines IL-1B and IL-6. Activation of apoptosis may be noticed. Pulmonary inflammation and changes in serum leptin may be interrelated. Other hormonal disturbances involve serum IGF-1 level decrease, increase of insulin resistance, raised catecholamine and cortisol levels and other mechanisms which need further investigations. Up to now the attempts undertaken to counteract the observed hormonal changes failed to success.

Unlabelled: The inflammatory process in chronic heart failure (CHF) is the result of dysbalance between the function of inflammatory and natural antiinflammatory mediators. Tumor necrosis factor alpha (TNF-alpha) is increased in patients with severe CHF. Two soluble proteins, the extracellular domains of the TNF receptors (sTNF-RI and sTNF-RII) inhibit the TNF-alpha biological effect. The aim of the study was to examine the plasma levels of sTNF-RI and sTNF-RII in patients with CHF and its relation to clinical, biochemical parameters of CHF severity. 41 patients with CHF (NYHA III and NYHA IV) and 18 control subjects were enrolled in this study. Plasma levels of sTNF-RI and sTNF-RII were analyzed by immunosorbent assay (ELISA) kits R&D (Research and Diagnostics Systems) (pg/ml)., Results: CHF patients had significantly increased receptor plasma levels compared to controls (p < 0.001). Soluble sTNF-RI and sTNF-RII receptors levels were similar in class NYHA III and NYHA IV. Receptor sTNF-RII correlated negatively with sodium plasma levels (p < 0.001), and sTNF-RI positively correlated with urice acid plasma level (p < 0.05). No statistically significant correlations were found between those receptors and age and gender etiology and severity of CHF, body weight (BMI) or other examined parameters (clinical, hemodynamic, echocardiographic, holter)., Conclusions: Plasma level of sTNF-RI and sTNF-RII are increased in patients with CHF.

Exhaled nitric oxide (eNO) concentration measurement may allow for noninvasive estimation of severity of airways inflammation in asthma and other airways diseases. The purpose of this study was to evaluate usefulness of eNO concentration measurements in patients with pulmonary sarcoidosis. Study group consisted of 22 patients with sarcoidosis (8 women, 14 men aged 26-46). They included 11 patients with radiographically stage I and II and 11 patients with stage III of disease. Sixteen patients had active pulmonary sarcoidosis and 6 had nonactive disease. Ten patients had indications for treatment, 12 patients had not any. Exhaled NO was measured by means of SIEVERS 280 Nitric Oxide Analyser (USA). There was no significant difference in mean eNO concentration in study group (6.91 +/- 0.60 ppb) and in normal control (5.2 +/- 0.73 ppb, p = 0.10). Exhaled NO concentration was similar in patients with sarcoidosis stage I and II (7.5 +/- 1.08 ppb) and in patients with stage III disease (6.2 +/- 0.51 ppb, p = 0.27). We failed to found significant difference in eNO concentration between patients with active (6.7 +/- 0.71 ppb) and nonactive sarcoidosis (7.5 +/- 1.1 ppb; p = 0.57). Neither did eNO concentration differ between patients with and without indications for therapy (5.77 +/- 0.50 ppb vs. 7.8 +/- 0.95 ppb; p = 0.08). In conclusion our pilot study results indicate that measurement of eNO concentrations may be of little value in patients with sarcoidosis.

Bioprosthetic heart valve, derived from human or animal tissues is a commercial, implantable valve characterised by good haemodynamic parameters, low haemolysis ratio and satisfactory durability. Until now, its wide-spread therapeutic use has been limited by the progressing leaflet calcification. The aim of the paper is to present the benefits, adverse reactions as well as problems associated with the improvement of this bioprosthesis.

The circadian heart rate course was assessed in 3 groups of patients with left ventricular ejection fraction (LVEF) 10-15%, 20-25% and 30-35%. The study comprised 36 persons. In 9 patients heart failure was due to MI and in 17--to dilated cardiomyopathy. Those with atrial fibrillation, ventricular tachycardia, supraventricular tachycardia, diabetes, valvular heart diseases and with central system disorders were excluded from the study. Left ventricular ejection fraction was evaluated by echocardiography. Heart rate, calculated as a mean value every 5 minutes, was taken in patients during 24 hour recordings. For each patient separately, mean value of all measurement was calculated. Then a ratio of each actual value to the mean value was calculated. This ratio was defined as relative heart rate; [formula: see text] Circadian heart rate courses were approximated by Fourier row: [formula: see text]. The 24 harmonics were analyzed. Statistically significant differences in circadian courses were closed to amplitudes of 1st, 12th, 13th, 14th, 16th, 18th harmonics. Using test of variance homogeneity it has been demonstrated that variability of amplitudes of 12th and 17th harmonics as well as phase of 5th harmonic depend on left ventricular ejection fraction.

Investigations were carried out in 74 persons (32 female and 42 male, mean age: 39.7 +/- 10.0 years, range: 16 to 68 years) free of diseases known to affect autonomic function. After a quarter of rest in quite, air conditioned room, while on voluntary breathing in supine, and later on in vertical position, time-series of a few minutes of successive R-R intervals were collected in each person and than stored for further off line analysis. Multivariate autoregressive modeling approach with parametric decomposition of peaks has given a basis for computation of spectral power of heart rate variability. In each body position 150 seconds long, stationary epoch of R-R intervals free of ectopy and artifacts were selected, and spectral power were calculated in three frequency bands: very low frequency (VLF): below 0.03 Hz (rejected from further analysis), low frequency (LF): from 0.03 to 0.15 Hz, and high frequency (HF): 0.15 to 0.35 Hz. Than, computed powers were expressed in either absolute units, or as normalized values, that is as percentages of total power less VLF. Breathing was also monitored in each case and spectral characteristics of its frequency also given in ranges defined for heart rate variability. In vertical, as compared to supine position, mean R-R interval decreased: 856 +/- 119 ms vs. 695 +/- 111 ms (p < 0.0005). The power of LF increased: 8.1 +/- 7.3 BPM2 vs. 19.2 +/- 14.6 BPM2, (p < 0,005), and simultaneously the power of HF dropped: 4.7 +/- 3.6 BPM2 vs. 2.7 +/- 2.5 BPM2, (p < 0.0005). In normalized units LF power enhanced: 63 +/- 385 vs. 87 +/- 42%, (p < 0.0005), and HF dropped: 36.7 +/- 32% vs. 12.3 +/- 12%, (p < 0.0005). Autonomic balance expressed as LF/HF ratio was higher in vertical position: 2.0 +/- 1.6 vs. 11.0 +/- 8.7, (p < 0.0005). In 73 out of 74 subjects (98.6%) the power of LF increased, and in 71 (95.9%)-decreased. In one person who had lower power of LF in vertical than supine position, the increase of HF power was noticed. Mean percentage increase of LF in the whole group was 209.4 +/- 243%, but after rejection of the result mention above the mean value increased to 218 +/- 22.1%. Mean percentage decrease of HF power in the whole group was 34.7 +/- 37.7%, and increased to 39.5 +/- 26.9% after rejection of three results with changes in opposite direction. Mean values of respiratory power did not change with switching of posture neither in LF:14.4 +/- 6.6% vs. 17.8 +/- 7.1%, (NS), nor in HF: 77.7 +/- 9.2% vs. 73.6 +/- 12.1%, (NS).

The clinical symptoms of migraine point to autonomic disturbances, especially to disrupted regulation of the circulatory system and autonomic balance. Searching for more accurate autonomic system studies we turned to the spectral analysis of cardiac rhythm changes, that allows to estimate the autonomic balance in sinus node. 44 patients with migraine were studied and the results were compared with those obtained in 74 healthy subjects. The reduced influence of both sympathetic and parasympathetic part of autonomic system on the sinus rhythm in migraine patients was found. The autonomic balance is shifted to the parasympathetic innervation side in patients with migraine.

The autonomic impairment, which is the frequent complication of end-stage renal failure, may eventually trigger numerous crippling consequences. It is doubtful if standard dialysis techniques may effectively treat once developed autonomic lesions. Renal transplantation seems to be much more efficient. The article points out the discrepancies in symptoms attributable to autonomic impairment and results of autonomic testing, discusses also differences between somatic and autonomic nervous system involvement in uremic patients. The one of the most important part of the article describes the practical approach to the patient with severely symptomatic uremic autonomic neuropathy. Finally the authors articulate their proposals for further research on uremic autonomic neuropathy.

Autonomic impairment is associated with poor prognosis in many diseases. The pathogenesis of the uremic autonomic neuropathy has not been convincingly established, so the article reviews available information on factors involved in its development, furthermore the authors put forward their own hypothetical scheme of the pathogenesis. The last section outlines the methods most commonly used for its diagnosis and finally the authors discuss symptoms suggestive of this neuropathy in clinical setting.

Autonomic impairement is associated with poor prognosis in many diseases. The article (first of three parts) critically reviews arguments found in the literature showing autonomic dysfunction in chronic renal failure patients. The autonomic nervous system problems will become of great clinical relevance considering increasing number and age of uremic patients being dialysed worldwide.

Spectral analysis of hart rhythm variability makes possible assessment of the state (power) of autonomic innervation of the heart. The reported study was carried out in 40 patients (22 women) with migraine. The studies were done in times between migraine attacks. The control group comprised 62 clinically healthy subjects. In most patients (over 61%) the sympathetic and parasympathetic innervation of the heart was weaker than in healthy subjects and the index of automatic equilibrium in the sinus node was lower than in controls.