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Background: Previous studies have demonstrated therapeutic benefits of slow breathing (SLOWB) in chronic heart failure (HF) but its impact on cardiovascular reactivity in response to laboratory stressors remains unknown., Methods: Using device-guided breathing this study explored the acute and long-term effects of SLOWB on hemodynamic responses to handgrip, mental and cold pressor tests, and health-related quality of life (QoL) in stable HF patients with reduced ejection fraction (HFrEF) who had received all available optimal drug and device therapies. Blood pressure (BP) and heart rate (HR) were measured in 21 patients with HFrEF (23.9 ± 5.9%) at rest, during laboratory stressors, before and after acute SLOWB, and 12 weeks after SLOWB home training (30 min daily). Health-related QoL (MacNew questionaries) was assessed before and 12 weeks after SLOWB home training., Results: Resting BP significantly increased in response to three laboratory stressors. Pressor and cardiac changes during mental stress were greater than responses to the handgrip test (p < 0.05). Mental stress also produced a greater HR change than cold pressor test (p < 0.05). Both acute and long-term SLOWB significantly reduced BP and HR responses to mental stress (p < 0.05), but not to isometric and cold pressor tests. SLOWB improved scores of all domains of QoL (p < 0.05) at 12 weeks follow-up., Conclusions: These findings demonstrate that SLOWB reduces acute and chronic effects of cardiovascular reactivity to mental stress and improves various aspects of health-related QoL in patients with severe HFrEF. Whether stress reduction and psychological changes achieved with SLOWB may translate to improved outcomes in HFrEF warrants further exploration.

Background: Slow breathing (SLOWB) alleviates symptoms of chronic heart failure (HF) but its long-term effects are unknown. We examined the acute and long-term impact of device-guided breathing on hemodynamics and prognostic parameters in HF patients with reduced ejection fraction (HFrEF)., Methods and Results: Twenty-one patients with HFrEF (23.9 ± 5.8%, SD ± mean) on optimal medical therapy underwent blood pressure (BP), heart rate (HR), HR variability, 6-min walk test (6MWT), cardiopulmonary exercise testing (CPET), and echocardiography measurements before and 3 months after SLOWB home training (30 min daily). After 3 months, all patients were assigned to continue SLOWB (Group 1) or no-SLOWB (Group 2). All tests were repeated after 6 months. Acute SLOWB (18 ± 5 vs 8 ± 2 breaths/min, P < 0.001) had no influence on BP and HR but improved saturation (97 ± 2 vs 98 ± 2%, P = 0.01). Long-term SLOWB reduced office systolic BP (P < 0.001) but not central or ambulatory systolic BP. SLOWB reduced SDNN/RMSSD ratio (P < 0.05) after 3 months. One-way repeated measures of ANOVA revealed a significant increase in 6MWT and peak RER (respiratory exchange ratio) from baseline to 6-month follow-up in group 1 (P < 0.05) but not group 2 (P = 0.85 for 6MWT, P = 0.69 for RER). No significant changes in echocardiography were noted at follow-up. No HF worsening, rehospitalisation or death occurred in group 1 out to 6-month follow-up. Two hospitalizations for HF decompensation and two deaths ensued in group 2 between 3- and 6-month follow-up., Conclusions: SLOWB training improves cardiorespiratory capacity and appears to slow the progression of HFrEF. Further long-term outcome studies are required to confirm the benefits of paced breathing in HFrEF.

Background: Heart failure (HF) is a growing cause of hospitalisation worldwide, and despite significant progress in its treat-ment it is still associated with high mortality., Aim: The aim of this study was to find factors predicting in-hospital death in acute decompensated HF by analysis of basic laboratory data and echocardiography, routinely collected on admission to the hospital., Methods: To this single-centre retrospective study we involved 638 consecutive patients hospitalised in the years 2007-2008 due to acute decompensated HF. To the initial univariate analysis we included the results of echocardiography and 36 basic laboratory tests performed at hospital admission. Parameters significantly associated with in-hospital death in univariate analysis were taken to multivariate regression analysis., Results: In-hospital death occurred in 119 cases (median age 75 years; 40.3% females). The multivariate analysis revealed sig-nificant association between in-hospital death and: higher leukocyte count (death [D]: 13.5 vs. survival [S]: 8.8 G/L, p < 0.01), higher neutrophil count (D: 10.5 vs. S: 5.9 G/L, p < 0.01), lower lymphocyte count (D: 1.3 vs. S: 1.7 G/L, p < 0.05), higher C-reactive protein concentration (D: 20.8 vs. S: 6.7 mg/dL, p < 0.01), higher serum glucose concentration (D: 167.0 vs. S: 116.0 mg/dL, p < 0.00001), higher serum creatinine concentration (D: 1.5 vs. S: 1.2 mg/dL, p < 0.0001), higher blood urea nitrogen concentration (D: 29.0 vs. S: 22.0 mg/dL, p < 0.00001), and higher aspartate aminotransferase (D: 72.0 vs. S: 27.0 U/L, p < 0.0001). Surprisingly, there was no significant association with echocardiographic parameters., Conclusions: Analysis of basic laboratory data collected on admission to the hospital may help to identify patients with acute decompensated HF, who are at high risk of in-hospital death.

Background/Objective: Diseases of the cardiovascular system and depression are common, and they often coexist, significantly deteriorating the quality of life. Another factor influencing vital functions is impairment of cognitive functions occurring in patients with heart failure (HF). Deficits of different degrees of severity have been observed within a variety of cognitive domains. Cognitive deficits, which may impair daily functioning, hinder adaptation to the disease and worsen prognosis, are also observed in depression. The aim of this study was to assess the relationship between the quality of life, the severity of depressive disorders and disorders of certain executive functions, and memory in patients with severe, stable heart failure. Method : The study group consisted of 50 patients with stable, severe heart failure and 50 appropriately selected patients with coronary heart disease, without heart failure. Results: The results of cognitive tests are significantly lower in the HF group than in the control group. In the HF group, a significantly lower quality of life, as well as a higher result in the BDI-II test, was observed. No influence of cognitive disorders on the reduction in the quality of life was demonstrated. The factor that significantly affects the quality of life is the intensification of depression symptoms. Conclusions: The factor that significantly affects the quality of life is the intensification of depression symptoms.

Introduction: Quality of life measures are useful when interventions or treatments are indicated for several reasons such as improvement of physical functioning, pain relief, to estimate the effectiveness of therapies or to predict mortality. The aim of the current study was to describe quality of life in patients with stable coronary artery disease, myocardial infarction and heart failure and to evaluate the relationship between depression and health-related quality of life., Material and Methods: Patients after STEMI, with stable coronary artery disease, and heart failure (n = 332) completed the MacNew Heart Disease Health-related Quality of Life Questionnaire and the Hospital Anxiety and Depression Scale., Results: Patients with myocardial infarction had significantly higher scores than patients with stable coronary artery disease or heart failure on the MacNew global scale (p < 0.001) and the physical (p < 0.001), emotional (p < 0.001) and social (p < 0.001) subscales. The anxiety scores were significantly higher in the group of patients with stable coronary artery disease than in patients with myocardial infarction (p < 0.05). The depression scores were significantly higher in patients with heart failure (p < 0.01)., Conclusions: In patients with stable CAD, anxiety correlated mainly with symptoms, i.e. angina, than with the history of MI. Patients with symptoms of angina react to the illness with anxiety more than depression, whereas patients with heart failure with dyspnea react to the illness with depressive symptoms more than anxiety. In patients after MI and with stable CAD, cognitive-behavioral techniques could be useful to quickly reduce the level of anxiety, while patients with heart failure require long-term support therapy to reduce the risk of depressive symptoms.

Background: The presence of depression symptomatology significantly deteriorates the prognosis for the patient. There are many instruments developed to measure depression and anxiety in clinical trials; however, the suitability of the specific scale for screening these disorders in cardiovascular patients is debatable. The aim of current study is to verify which of the major assessment instruments is the most relevant for the screening evaluation of depression and anxiety in patients with cardiovascular system diseases., Aim: The sample studied consisted of 120 patients with stable coronary artery disease (CAD). They did not display serious psychiatric or somatic disorders., Methods: To assess depressive and anxiety symptoms we used self-reporting measures (BDI-II, HADS, SSAI/STAI, and PHQ), the results of which were compared to results obtained on the basis of a clinician-rating instrument (HRSD)., Results: We found that depressive symptoms assessed on the basis of HRSD, BDI-II, and PHQ-9 were equivalent in results, while the results obtained in HADS-D were significantly lower. Anxiety symptoms were found at approximate levels in HADS, SSAI, and GAD-7. The assessment of somatic symptoms in patients with CAD indicates that 87.5% of the subjects reported somatic symptoms of various intensity., Conclusions: Screening assessment of depression in patients with CAD gives different results depending on the tool used. We found that HADS significantly underestimates the percentage of patients with symptoms of depression in patients with CAD. Assessing anxiety symptoms with the aid of HADS gave outcomes close to the results gained by use of other tools.

Background: The relationship between depression and heart disease is very complex. In the group of patients with depression the coronary artery disease risk factors related to lifestyle (lack of physical activity, smoking, hypertension, and diabetes) are frequently observed. For many years, researchers have been interested in the relationship between personality and the tendency to collapse on somatic disorders. The result of this research was to create the concept of type D personality, which is formed by two dimensions: negative emotionality and social inhibition. These features have their reflection in many aspects of life, including in stressful situations., Aim: The prime goal of the study was to evaluate the prevalence of type D personality and dominant styles of coping with stress for patients with coronary artery disease. The study also tried to determine the correlation between the presence of type D personality and style of coping with stress in the examined group., Methods: The studied group consistent of 100 patients (70 men and 30 women) with coronary heart disease. Patients were examined with the Type D Scale (DS14) and the Coping Inventory for Stressful Situations Questionnaire (CISS)., Results: Type D personality was found in 54% of cases for men and 47% for women. Distribution of type D personality did not differ for women and men. Analysis of the correlation between coping style in difficult situations and type D personality did not show that people with type D personality significantly more often chose a specific style of coping., Conclusions: Type D personality was found in 52% patients with stable coronary artery disease. Similar scores were observed for men and women. There was no evidence that patients with type D personality prefer a specific style of coping with stress.

Background. The prognostic value of cardiopulmonary exercise testing (CPET) is known, but the predictive value of 6MWT in patients with heart failure (HF) and patients undergoing coronary artery bypass grafting (CABG) is not established yet. Objective. We conducted a systematic review exploring the prognostic value of 6MWT in HF patients undergoing cardiac surgery. The aim was to find out whether the change in the distance walked during follow-up visits was associated with prognosis. Data Source. We searched "PubMed" from January 1990 to December 2012 for any review articles or experimental studies investigating the prognostic value of 6MWT in HF patients and patients undergoing cardiac surgery. Results. 53 studies were included in the review, and they explored the role of 6MWT in cardiology, cardiac surgery, and rehabilitation. The results did not show the relation between the six-minute walk distance and adverse events after CABG. The predictive power of the distance walked for death in HF patients undergoing cardiac surgery was not found. It is not yet proved if the change in the six-minute walk distance is associated with prognosis. The predictive power of the six-minute walk distance for death in HF patients undergoing cardiac surgery remains unclear.

Background: Uridine (Ur) and hypoxanthine (Hx) are the major end products of ischemic nucleotide breakdown in the human heart. Hypoxanthine is further metabolized to uric acid (UA). The aim of the study was the evaluation of whether changes in nucleotide concentrations during exercise correlate with electrocardiography (ECG) changes, and the severity of coronary artery disease (CAD)., Methods: Twenty-nine males with CAD and 11 controls without CAD (mean age 56.1 vs. 51.45) were subjected to treadmill exercise. The test was considered positive if ECG showed more then 1 mm ST segment depression. Venous blood samples taken before and 10 minut after the exercise were analysed by high performance liquid chromatography., Results: Twenty-two out of 29 patients with CAD and 6 of 11 in the control group had abnormal exercise stress tests according to ECG criteria only. Mean Ur was positive in the CAD group and negative in the control group (0.45 SEM +/- 0.09 microM/L vs. -0.43 SEM +/- 0.21 microM/L, p < 0.0001). UA was positive in the CAD group (15.31 SEM +/- 5.52 microM/L) and negative in the control group (15.31 SEM +/- 5.52 microM/L vs. -48.18 SEM +/- 13,8 microM/L, p < 0.00001); Hx increased in both groups, and the change was not significantly different. Correlations of CAD-index with ST depression, Ur and UA, were: r = 0.43 (p < 0.005), r = 0.62 (p < 0.001), and r = 0.39 (p < 0.01), respectively. Sensitivity of any increase of uridine was superior to 1.5 mm ST depression during exercise., Conclusions: Blood Ur and UA concentration changes during exercise correlate with severity of CAD. We observed slightly greater accuracy of uridine change in comparison to ST changes, thus being a possible new tool in diagnosis of CAD. (Cardiol J 2007; 14: 573-579).

The effectiveness of hypertension treatment remains low in many developed countries. The aim of our study was to evaluate the treatment effectiveness in hypertensives treated by general practitioners (GPs) in Poland. Twenty thousand three hundred and five hypertensive patients (mean age 60.1 +/- 12.0 years, 9918 women, 10 387 men), pharmacologically treated by 677 GPs in Poland, were investigated. Blood pressure (BP) in every patient was measured twice, within approximately a 5-min interval, in a seated position, using a mercury sphygmomanometer, after a rest of at least 10 min. Mean blood pressure from both measurements was used for further analysis. Measurements were carried out by a GP in the office. Every physician investigated 30 consecutive hypertensive patients. Of the investigated hypertensive patients treated, 8.3% had systolic blood pressure (SBP) < 140 mmHg and diastolic blood pressure (DBP) < 90 mmHg (7.8% in women, 8.8% in men respectively; p > 0.05). Mean SBP in the investigated group was 161.9 +/- 20.4 mmHg, 162.7 +/- 20.8 mmHg in women and 161.1 +/- 20.1 mmHg in men, respectively; p < 0.05. Mean DBP was 95.4 +/- 11.0 mmHg. The difference between mean DBP in women (95.3 +/- 11.0 mmHg) and men (95.5 +/- 11.1 mmHg) was not significant, p > 0.05. Mean pulse pressure (PP) for the whole group was 66.5 +/- 16.3 mmHg. In this cohort, 26.7% of patients were treated with one, 37.6% with two, 26.7% with three, 8.2% with four and 0.8% with five antihypertensive drugs. Mean number of antihypertensive drugs prescribed for one hypertensive patient was 2.2 +/- 1.0. Effectiveness of hypertension treatment by GPs in Poland remained unsatisfactory despite frequent implementation of combined antihypertensive drug therapy.

Background: It is well established that a depressed baroreflex sensitivity may adversely influence the prognosis in patients with chronic heart failure (CHF) and in those with previous myocardial infarction., Methods and Results: We tested whether a slow breathing rate (6 breaths/min) could modify the baroreflex sensitivity in 81 patients with stable (2 weeks) CHF (age, 58+/-1 years; NYHA classes I [6 patients], II [33], III [27], and IV [15]) and in 21 controls. Slow breathing induced highly significant increases in baroreflex sensitivity, both in controls (from 9.4+/-0.7 to 13.8+/-1.0 ms/mm Hg, P<0.0025) and in CHF patients (from 5.0+/-0.3 to 6.1+/-0.5 ms/mm Hg, P<0.0025), which correlated with the value obtained during spontaneous breathing (r=+0.202, P=0.047). In addition, systolic and diastolic blood pressure decreased in CHF patients (systolic, from 117+/-3 to 110+/-4 mm Hg, P=0.009; diastolic, from 62+/-1 to 59+/-1 mm Hg, P=0.02)., Conclusions: These data suggest that in patients with CHF, slow breathing, in addition to improving oxygen saturation and exercise tolerance as has been previously shown, may be beneficial by increasing baroreflex sensitivity.

Background: In chronic heart failure (CHF), impaired pulmonary function can independently contribute to oxygen desaturation and reduced physical activity. We investigated the effect of breathing rate on oxygen saturation and other respiratory indices., Methods: Arterial oxygen saturation (SaO2) and respiratory indices were recorded during spontaneous breathing (baseline) and during controlled breathing at 15, six, and three breaths per min in 50 patients with CHF and in 11 healthy volunteers (controls). 15 patients with CHF were randomly allocated 1 month of respiratory training to decrease their respiratory rate to six breaths per min. Respiratory indices were recorded before training, at the end of training, and 1 month after training., Findings: During spontaneous breathing, mean SaO2 was lower in CHF patients than in controls (91-4% [SD 0.4] vs 95.4% [0.2], p<0.001). Controlled breathing increased SaO2 at all breathing rates in patients with CHF. Compared with baseline, minute ventilation increased at 15 breaths per min (+45.9% [9.8], p<0.01), did not change at six breaths per min, and decreased at three breaths per min (-40.3% [4.8], p<0.001). In the nine CHF patients who had 1 month of respiratory training, resting SaO2 increased from 92.5% (0.3) at baseline to 93.2% (0.4) (p<0.05), their breathing rate per min decreased from 13.4 (1.5) to 7.6 (1.9) (p<0.001), peak oxygen consumption increased from 1157 (83) to 1368 (110) L/min (p<0.05), exercise time increased from 583 (29) to 615 (23) min/s (p<0.05), and perception of dyspnoea reduced from a score of 19.0 (0.4) to 17.3 (0.9) on the Borg scale (p<0.05). There were no changes in the respiratory indices in the patients who did not have respiratory training., Interpretation: Slowing respiratory rate reduces dyspnoea and improves both resting pulmonary gas exchange and exercise performance in patients with CHF.

Decreased cardiac vagal activity is a known risk factor in coronary artery disease. The aim of our study was to determine the effect of coronary artery bypass grafting (CABG) on heart rate variability (HRV) before and 6 weeks after CABG. The study group consisted of 34 patients (4 women, 30 men, mean age 56 +/- 9 years). ECGs were recorded in 10 minutes periods in both supine and standing position with controlled breathing rate (0.25Hz). The analysis of HRV power spectrum was done by means of fast Fourier transformation. The total spectral power (TPS), power in very low frequency band (VLF: < 0.05 Hz), low frequency band (LF:0.05-0.15Hz), high frequency band (HF:0.15-0.5Hz), LF/HF ratio and percentage fraction of total power in these frequency bands (%VLF, %LF, %HF) were analysed. Significant attenuation of all spectral components of HRV were found during orthostatic load before CABG (p < 0.05). TPS, VLF, LF, %HF decreased in standing position to about half of their level in supine position, HF decreased to as little as one fourth, while LF/HF ratio and %LF increased significantly (p < 0.05). After the CABG these changes were not significant. We have found significant increase of HF (p < 0.05) and %HF (p < 0.01) in standing position after the CABG. The results suggest that CABG causes an improvement in cardiac vagal activity especially in standing position.