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Patients with familial hypercholesterolemia (FH) are at increased risk of premature cardiovascular disease. We compared factors associated with the presence of carotid plaques and carotid intima–media thickness (cIMT), markers of subclinical atherosclerosis, in 241 patients with FH (98, 40.7% men; mean age 41 ± 18.4 years). Patients with FH having carotid plaques (36.5%) had mean age, apolipoprotein (apo) B, glucose, apoA1, systolic blood pressure (SBP) and diastolic BP, waist/hip ratio (WHR), and body mass index higher than patients without plaques. Logistic regression revealed that apoB (odds ratio [OR] per 1 unit change 1.03, P = .005), high-density lipoprotein cholesterol (HDL-C; OR per 1 standard deviation [SD] change 0.59, P = .015), and non-HDL-C (OR per 1SD change 1.53, P = .04) were significantly associated with the presence of plaques. The cIMT correlated with obesity parameters, BP, apoB, glucose, high-sensitivity C-reactive protein, creatinine, γ-glutamyl transpeptidase, and alanine transaminase (P < .001). Regression analysis revealed that cIMT was significantly associated with apoB, SBP, and WHR. These results confirm the role of apoB-containing lipoproteins and low HDL-C with the presence of carotid plaques and apoB, BP, and WHR with cIMT. [ABSTRACT FROM AUTHOR]

Abstract Background Different diagnostic criteria limit comparisons between populations in the prevalence of diastolic left ventricular (LV) dysfunction. We aimed to compare across populations age-specific echocardiographic criteria for diastolic LV dysfunction as well as their correlates and prevalence. Methods We measured the E and A peaks of transmitral blood flow by pulsed wave Doppler and the e' and a' peaks of mitral annular velocities by tissue Doppler imaging (TDI) in 2 cohorts randomly recruited in Belgium (n = 782; 51.4% women; mean age, 51.1 years) and in Italy, Poland and Russia (n = 476; 55.7%; 44.5 years). Results In stepwise regression, the multivariable-adjusted correlates of the transmitral and TDI diastolic indexes were similar in the 2 cohorts and included sex, age, body mass index, blood pressure and heart rate. Similarly, cut-off limits for the E/A ratio (2.5th percentile) and E/e' ratio (97.5th percentile) in 338 and 185 reference subjects free from cardiovascular risk factors respectively selected from both cohorts were consistent within 0.02 and 0.26 units (median across 5 age groups). The rounded 2.5th percentile of the E/A ratio decreased by ~0.10 per age decade in these apparently healthy subjects. The reference subsample provided age-specific cut-off limits for normal E/A and E/e' ratios. In the 2 cohorts combined, diastolic dysfunction groups 1 (impaired relaxation), 2 (possible elevated LV filling pressure) and 3 (elevated E/e' and abnormally low E/A) encompassed 114 (9.1%), 135 (10.7%), and 40 (3.2%) subjects, respectively. Conclusions The age-specific criteria for diastolic LV dysfunction were highly consistent across the study populations with an age-standardized prevalence of 22.4% vs. 25.1%.

Background and Aims: High low-density lipoprotein (LDL)-cholesterol levels are a major cause of premature coronary heart disease (CHD) and death in patients with familial hypercholesterolemia (FH). It is uncertain whether these risk factors affect men and women equally. We aimed to compare the risk factors of carotid plaques, which are reliable surrogates of coronary atherosclerosis, in men and women with FH., Methods: 154 patients with FH (40.9% men) were included, diagnosed according to Simon Broome criteria. Carotid plaques were assessed by ultrasound., Results: In women multiple logistic regression analysis revealed that systolic blood pressure, high-density lipoprotein-cholesterol (HDL-C), apolipoprotein (apo) A1, and alanine aminotransferase (ALT) were associated with the presence of carotid plaques. In this female cohort, the age adjusted odds ratio for the increase of HDL-C by 1 standard deviation was related to a 55% decrease in the odds of having carotid plaques (p=0.01) and the age adjusted odds ratio for the increase of ALT by 1U/L was related to a 7% in the increase odds of having carotid plaques (p=0.02). In men, in multiple logistic regression analysis only apo B concentration was significantly related to carotid plaque presence. The odds ratio for the increase of apo B by 1mg/dl corresponded to a 4% increase in the odds of having carotid plaques (p=0.01) and, interestingly, in men not treated with statin, this ratio reached 8% (p=0.04)., Conclusions: In summary, our study suggests a difference in risk factors of carotid artery plaques between men and women with FH., (Copyright © 2017 Elsevier Ireland Ltd. All rights reserved.)

Introduction: The aim of this study was to determine whether baseline right ventricular (RV) function assessed by standard echocardiography may indicate patients who will respond to cardiac resynchronization therapy (CRT)., Material and Methods: The data of 57 patients (54 men, 95%), aged 66.4 ±8.7 years with heart failure (HF) having a CRT device implanted were collected. All patients had left ventricular ejection fraction (LVEF) ≤ 35% and QRS complex duration ≥ 120 ms. Echocardiographic examination with tissue Doppler imaging techniques and complex RV evaluation were performed at baseline and three months after CRT onset., Results: Three months after CRT implantation, patients responding to CRT, defined as a reduction of left ventricle end-systolic volume (LVESV) of at least 10% (n = 34), compared to patients with a reduction of LVESV of less than 10% (n = 23), had at baseline a smaller right atrium diameter (47.85 ±11.33 mm vs. 52.65 ±8.69 mm; p = 0.028), higher TAPSE (14.56 ±2.57 mm vs. 13.04 ±2.93 mm; p = 0.030) and lower grade of tricuspid valve regurgitation (1.82 ±0.97 vs. 2.3 ±0.88; p = 0.033)., Conclusions: This study showed that there are differences in baseline right ventricular function between responders and non-responders to CRT. Yet in our study, none of the baseline RV parameters provided any value in identifying patients who would respond to CRT.

Background: Familial hypercholesterolaemia (FH) is a monogenic lipid metabolism disorder characterised by markedly elevated serum low-density lipoprotein (LDL) cholesterol level due to a mutation in the LDL receptor gene. Clinical features of FH include premature atherosclerosis and coronary artery disease., Aim: To explore associations between noninvasive markers of atherosclerosis including intima-media thickness (IMT) and pulse wave velocity (PWV) and blood lipids, blood pressure (BP) and obesity in a group of young patients with FH., Methods: Study population included 36 patients aged < 35 years with the diagnosis of FH based on the Simon Broome Register criteria, and their 49 relatives who comprised the control group free of FH., Results: Mean IMT values were higher in FH patients than controls (0.60 ± 0.19 vs. 0.53 ± 0.07 mm, respectively, p < 0.05).Mean body mass index (BMI) and waist circumference were similar in patients and controls. The prevalence of carotid atherosclerotic plaques was significantly higher among FH patients (n = 6) than in controls (n = 1) (21.4% vs. 2.6%, p = 0.012). Arterial hypertension was present in 27.8% of patients with FH and 16.3% of subjects in the control group. Systolic blood pressure (SBP) in FH patients correlated significantly with age (r = 0.35), BMI (r = 0.48) and waist circumference (r = 0.47), and diastolic blood pressure (DBP) correlated with BMI (r = 0.42) and waist circumference (r = 0.41). PWV correlated significantly with age (r = 0.44), SBP (r = 0.63) and DBP (r = 0.52). We did not find any correlations between IMT and serum lipids, BP or obesity indices in FH patients., Conclusions: Our findings show a higher rate of arterial hypertension in young FH patients compared to their relatives free of FH, with significant associations between BP and indices of obesity and arterial stiffness. Intensive lipid lowering and antihypertensive therapy along with a reduction in central fat may be considered a mandatory treatment strategy in young FH patients to prevent atherosclerosis and increased arterial stiffness.

Background: Chronic heart failure (CHF) is a serious public health problem associated with high rates of morbidity and mortality. Cardiac resynchronisation therapy (CRT) is a well established treatment for selected patients who do not respond to optimal drug treatment of CHF., Aim: To assess the impact of CRT on the physical ability and quality of life (QoL) of patients with CHF., Methods: The study group consisted of 60 patients (mean age: 66.3 ± 8.7 years, 57 males and three females) with CHF classified as NYHA class III or IV (despite optimal pharmacotherapy for more than three months), a left ventricular end-diastolic diameter ≥ 55 mm, ejection fraction (LVEF) ≤ 35%, and a QRS duration ≥ 130 ms. Just before CRT, and three months after the procedure, patients were assessed using echocardiography and the 6-minute walk test (6-MWT), while their QoL was assessed by the Psychological General Well-Being index (PGWB). Three months after CRT, a 10% increase in baseline values of the 6-MWT constituted a positive response - patients who improved in this manner were classified as responders. Changes of at least ± 10% from baseline values of the PGWB total index were considered as improvement or worsening in QoL., Results: During the follow-up, three men died, and so 57 patients were included in the final analysis. At the end of the study, an increase in the walking distance during the 6-MWT (298.0 ± 107.4 m vs 373.1 ± 127.2 m; p 〈 0.001) was observed. After three months, 38 (66.7%) patients were classified as responders while 19 (33.3%) subjects were classified as non-responders to CRT. Concurrently, after CRT we observed an improvement in QoL in 34 (59.6%) patients, while 23 (41.4%) patients showed no such effect. Patients who demonstrated an increased QoL at three months after CRT were characterised by lower baseline values of the total PGWB index as well as its dimensions (with the exception of the general health dimension). Improvement in QoL after CRT was observed only in the responders group (p 〈 0.01)., Conclusions: The implementation of CRT leads to a reduction of heart failure related symptoms and an increase in physical ability in roughly two thirds of patients. Improvement in QoL after CRT pertains only to patients who demonstrate simultaneously an improvement in their 6-MWT. None of the other baseline clinical and echocardiographic parameters were useful in predicting better QoL and exercise capacity after CRT implementation.

Background and Aim: The aim of this study was to evaluate the short term effect of cardiac resynchronisation therapy (CRT) on right ventricular (RV) function assessed by standard echocardiography., Methods: Data from 57 patients (54 men, 95%; three women, 5%), aged 66.4 ± 8.7 years with heart failure (HF) was analysed. All patients were in NYHA III-IV functional classes, despite optimal pharmacological treatment according to the current guidelines, had left ventricular ejection fraction ≤ 35% and QRS complex ≥ 120 ms in a standard electrocardiogram. At baseline and three months after CRT implantation the patients' histories were taken, an anthropometrical examination was made, laboratory tests including the level of NT-proBNP and electrocardiogram were performed, and echocardiographic examination was extended by tissue Doppler imaging techniques and complex RV evaluation., Results: Three months after CRT implantation in the whole study group, the average NYHA functional class had decreased from 3.11 ± 0.28 to 2.25 ± 0.68 (p < 0.001), and the six-minute walk test distance had increased from 298.04 ± 107.42 m to 373.12 ± 127.15 m (p < 0.001). CRT improved RV systolic function in the whole study group. Tricuspid annular plane systolic excursion had increased from 13.95 ± 2.80 to 15.79 ± 2.33 mm (p < 0.001), and so likewise had systolic excursion velocity (S'), which rose from 8.84 ± 3.45 to 11.00 ± 3.43 cm/s (p < 0.001). Tricuspid regurgitation grade decreased from 2.02 ± 0.95 to 1.86 ± 0.91 (p = 0.013). RV systolic pressure decreased from 31.07 ± 20.43 to 27.75 ± 17.35 mm Hg (p < 0.001). RV fractional area change rose from 31.35 ± 10.30% to 35.40 ± 10.51% (p < 0.001)., Conclusions: This study showed that CRT improved RV systolic function evaluated with parameters assessed in standard echocardiographic examination three months after therapy initiation. The observed improvement was consistent among all applied echocardiographic parameters reflecting RV systolic function.

Introduction: The aim of the study was to assess the relation of baseline mechanical dyssynchrony with the left ventricular end-systolic volume (LVESV) decrease following cardiac resynchronization (CRT) therapy introduction., Material and Methods: Sixty consecutive patients (aged 66.3 ± 8.7 years; 57 men) with chronic heart failure (71.7% of ischaemic and 28.3% of non-ischaemic origin) and current indications for CRT were assessed before and 3 months after biventricular heart stimulator implantation. Longitudinal movements of twelve segments of the left ventricle (LV) (6 basal and 6 midlevel) and two segments of the right ventricle (RV) were analysed using tissue Doppler imaging (TDI) techniques with time from onset of Q wave in ECG to peak systolic velocity in colour-coded TDI (T(TDI)), time to peak strain (T(strain)) and time to peak strain rate (T(strain) (rate)). Minimal and maximal time differences within LV and between LV and RV walls were calculated., Results: In the study group LVEF and 6-min walk test distance increased, while NYHA class, NT-proBNP level, left ventricular end-diastolic volume and LVESV decreased. Significant correlations between the magnitude of LVESV reduction with maximal time differences between T(strain) of 12 LV segments (r=0.34, p = 0.017) and time differences between T(TDI) basal LV-RV segments (r = -0.29, p=0.041) were found., Conclusions: Only a few TDI-derived parameters such as maximal time differences between T(strain) of 12 LV segments and T(TDI) difference of LV-RV basal segments can be useful to predict the magnitude of left ventricle reverse remodelling after CRT introduction.

The role of hypercholesterolemia as a risk factor for cardiovascular disease has been well-documented. Hypercholesterolemia is the most prevalent modifiable risk factor in Poland. Despite the fact that the benefits of cholesterol lowering have been known for a long time, the therapeutic goals recommended by guidelines are still often not attained in clinical practice. Only 3% of Poles with hypercholesterolemia achieve recommended cholesterol levels, and the rate of reaching recommended goals among patients receiving lipid-lowering drugs is low, approximately 30%. Control of hypercholesterolemia is not satisfactory also in patients with ischemic heart disease. The introduction of new statins, use of higher statin doses, and the evidence pointing to the effectiveness of combination therapy have provided us with effective tools whose broad application in everyday practice may lead to a significant improvement in the control of hypercholesterolemia in Poland.

Background: The aim of the study was to assess clinical and classic echocardiographic data in patients with different cardiac resynchronization therapy (CRT) outcomes., Methods: Sixty consecutive patients (aged 66.3 ± 8.7 years, 57 men) with chronic heart failure (CHF) in New York Heart Association (NYHA) classes III-IV despite optimized pharmacotherapy, with left ventricular end-diastolic diameter (LVEDD) > 55 mm, left ventricular ejection fraction £ 35% and wide QRS complex (≥ 120 ms), including individuals with permanent atrial fibrillation (AF) and single- and dual-chamber pacing, were assessed firstly before, and secondly three months after, biventricular heart stimulator implantation (excluding three patients who died during the follow-up). Patients developing ≥ 10% reduction of left ventricular end-systolic volume (LVESV) were classified as responders to CRT., Results: The group of responders (n = 34, 59.7%) and the group of non-responders (n = 23, 40.3%) did not differ regarding baseline echocardiographic parameters or in terms of clinical data of age, gender, concomitant diseases, smoking or pharmacological treatment. The differences involved higher rates of ischemic CHF background, prevalence of hypertension and permanent AF, and a higher concentration of N-terminal pro-B-type natriuretic peptide (NT-proBNP) among the non-responders. In the multivariate logistic regression analysis, NT-proBNP, body mass index (BMI) and the presence of permanent AF correlated negatively with the magnitude of LVESV reduction following CRT introduction., Conclusions: Classic echocardiographic data did not predict left ventricle reverse remodeling. Higher rates of ischemic CHF aetiology, hypertension, permanent AF and higher NT-proBNP concentration were found in the group without at least 10% LVESV reduction at the three month follow-up. NT-proBNP, BMI and the presence of permanent AF had negative effects on the magnitude of LVESV.

Background: Sleep-related breathing disorders are common in patients with chronic heart failure (CHF) and contribute to exacerbation of CHF. The effects of biventricular stimulation (CRT) seem to exceed the improvement of mechanical heart performance and are likely to affect other aspects of CHF pathophysiology. The aim of the study was to assess the influence of CRT on subjective and objective sleep features., Material and Methods: Twenty seven consecutive patients (aged 67.7 +/- 8.7 years, 23 men - 85%) with chronic heart failure (62.9% with ischaemic background and 37.1% of non-ischaemic etiology) in stable for at least 3 months NYHA class III - IV despite optimized pharmacotherapy, with left ventricular end-diastolic diameter (LVEDd) > 55 mm, left ventricular ejection fraction (LVEF) < or = 35% and wide QRS complex (> or = 120 ms) were appraised before and 12-16 weeks after CRT introduction clinically (including 6-minute walk test--6-MWT), echocardiographically and in polisomnography. The apnea-hypopnea index (AHI) and apnea indexes (AI) of central, obstructive and mixed types were calculated. The sleep quality was assessed with the Pittsburgh Sleep Quality Index (PSQI), daytime sleepiness with the Epworth Sleepiness Scale (ESS)., Results: LVEF increased, 6-MWT distance rose. Left ventricular diameters and left ventricular end-systolic volume decreased. PQSI and ESS fell (9.3 +/- 4.2 vs 6.2 +/- 3.2, p < 0.001 and 8.4 +/- 4.1 vs 7.0 +/- 3.4, p < 0.001, respectively). AHI, obstructive AL and mixed AL did not alter but significant reduction of central AL was noted (9.6 +/- 13.0 vs 3.7 +/- 6.2, p = 0.023)., Conclusions: CRT decreases central sleep apnea and improves quality of sleep and daytime sleepiness in patients with CHF.

Background: Solid evidence shows that cardiac resynchronization therapy (CRT) improves prognosis, physical capacity and quality of life in selected groups of patients with chronic heart failure (CHF). Nonetheless, marked percentage of patients seem not to benefit from CRT., Material and Methods: Sixty consecutive patients (aged 66.3 +/- 8.7 years, 57 men - 95%, 3 women - 5%) with CHF (71.7% with ischaemic and 28,3% with non-ischaemic origin) of stable for > or = 3 months NYHA III or IV class despite optimized pharmacotherapy, with left ventricle end-diastolic diameter (LVEDd) > or = 55 mm, left ventricular ejection fraction (EF) < or = 35% and QRS > 130 ms were evaluated before and 3 months after CRT implementation (biventricular stimulation BiV) echocardiographically and clinically., Results: EF increased (21.7% vs 26,6%, p<0,0001), 6-minute walk distance (6-MWT) rose (298.0 m vs 373.1 m, p<0,0001), left ventricular end-diastolic volume (LVEDV) and left ventricular end-systolic volume (LVESV) decreased (244.3 ml vs 226,4 ml, p=0.0002; 192.8 ml vs 168,7 ml, p<0,0001 respectively). Mean NYHA class dropped from 3.1 to 2.2 (p<0.0001). Absolute increase in EF of > or = 4%, > or = 5%, > or = 6% was observed in 63.2%, 52.6%, and 35.7% respectively; relative increase of > or = 25% presented 21.1%, > or = 10% reduction of LVESV--59.7%, > or = 15% reduction of LVESV--43.8%, decrease in NYHA class--78.3%, > or = 10% reduction of 6-MWT--66.7%, no death and no hospitalization due to heart failure--78.3%., Conclusions: Response to CRT rate differs markedly according to the applied definition.

Although the differences between central and peripheral blood pressure (BP) values have been known for decades, the consequences of decision making based on peripheral rather than central BP have only recently been recognized. There are only a few studies assessing the relationship between intraaortic BP and cardiovascular risk. In addition, the relationship between central BP and the risk of cardiovascular events in a large group of coronary patients has not yet been evaluated. Therefore, the aim of the study was to determine the prognostic significance of central BP-derived indices in patients undergoing coronary angiography. Invasive central BPs were taken at baseline, and study end points were ascertained during over a 4.5-year follow-up in 1109 consecutive patients. The primary end point (cardiovascular death or myocardial infarction or stroke or cardiac arrest or heart transplantation or myocardial revascularization) occurred in 246 (22.2%) patients. Central pulsatility was the most powerful predictor of the primary end point (hazard ratio [HR] 1.30, 95% confidence interval [CI] 1.14 to 1.48). Central pulse pressure was also independently related to the primary end point (HR 1.25, 95% CI 1.09 to 1.43). Central mean BP as well as peripheral BP parameters were not independently related to the primary end point risk. Central pulsatility was also related to risk of cardiovascular death or myocardial infarction or stroke. The pulsatile component of BP is the most important factor related to the cardiovascular risk in coronary patients. It is more closely associated with cardiovascular risk than steady component of BP.