Heart Systolic Dysfunction Research Articles

Clinical, laboratory changes and fibroblast growth factor in patients with myocarditis

Annotation. The relevance of the problem of diagnosis and treatment of myocarditis in the world and in Ukraine is growing. The prevalence of myocarditis is up to 20% of all non-coronary heart lesions. According to the results of the study of the sudden death causes in young people, the detection of inflammatory lesions of the myocardium varies in the range of 2-42%. The article analyzes the course of acute myocarditis of unknown etiology in 48 adult patients (31 patients with a moderate-severe course and 17 patients with a severe course), establishes clinical features of the course of the disease and laboratory markers associated with the severity of the course of the disease and myocardial fibrosis. The severity of the course of the disease was determined based on the volume of myocardial damage, the stage and functional class (FC) of heart failure, the presence of systolic heart dysfunction and life-threatening rhythm and conduction disorders. Statistical processing of the research results was carried out using the created database of examined patients in the StatSoft Statistica v 10.0 program, with a known number of observations (n). The Mann-Whitney test was used to determine differences between quantitative traits. Spearman's rank correlation coefficient was calculated to determine the degree of statistical dependence between indicators. It was established that myocarditis mostly had a course of moderate severity (64,6 %) with the presence of heart failure of II A stage in 54,8 % of inspected patients, and was accompanied by combined complex rhythm and conduction disorders in 38,7 % of patients. A reliable correlation was established between the increase in markers of inflammation (CRP, fibrinogen), cardiomyocyte lysis (CFC-MV) and fibroblast growth factor 23 (FGF-23), which indicates an increase in profibrotic processes as a result of myocardium inflammatory damage. It is important to carry out a detailed study of the clinical features of myocarditis with the further perspective of developing diagnostic methods for timely etiopathogenetic treatment and forecasting the adverse course of the disease.

Концентрація розчинного ST2 у плазмі крові та дисфункція серця в пацієнтів з есенціальною гіпертензією

Мета роботи – оцінити роль розчинного ST2 (sST2) як можливого біомаркера ремоделювання та дисфункції серця у хворих з есенціальною гіпертензією (ЕГ) різної тяжкості.Матеріали і методи. Обстежено 150 чоловіків з підтвердженою ЕГ різної тяжкості та 70 чоловіків без серцево-судинних захворювань, репрезентативних за віком, які становили контрольну групу. Критерії залучення в дослідження: вік 40–60 років, чоловіча стать, верифікований діагноз ЕГ. Рівень sST2 у плазмі крові визначали методом імуноферментного аналізу. Результати та обговорення. Встановлено, що концентрація пептиду в плазмі крові в чоловіків без серцево-судинних захворювань статистично значуще не корелює з віком та особливостями конституції, функцією нирок, станом системної та внутрішньосерцевої гемодинаміки, морфометричними показниками серця. У пацієнтів з ЕГ середній рівень sST2 у плазмі крові статистично значуще вищий, ніж у осіб контрольної групи. Виявлено, що до статистично значущого зростання концентрації пептиду в плазмі крові у хворих з ЕГ призводить формування гіпертрофії лівого шлуночка (ЛШ), незалежно від її типу, та діастолічної дисфункції серця. Також у пацієнтів з ЕГ і фракцією викиду (ФВ) ЛШ менше 40 % концентрація пептиду статистично значуще більша, ніж у хворих зі збереженою ФВ ЛШ.Висновки. Таким чином, у чоловіків з ЕГ різної тяжкості рівень sST2 у плазмі крові статистично значуще вищий, ніж у осіб без серцево-судинних захворювань. В обох випадках концентрація пептиду в плазмі крові не пов’язана з віком та особливостями конституції. У пацієнтів з неускладненою ЕГ статистично значуще вищі рівні sST2 асоціюються з розвитком гіпертрофії ЛШ, незалежно від її типу, та з порушенням діастолічної функції серця. У разі розвитку серцевої недостатності на тлі ЕГ рівень sST2 у плазмі крові також статистично значуще вищий, особливо при формуванні систолічної дисфункції серця з ФВ ЛШ < 40 %.

SHEWANELLA ALGAE: A RARE CAUSE OF SEPTICEMIA

SESSION TITLE: Medical Student/Resident Critical Care Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: October 18-21, 2020 INTRODUCTION: Shewanella algae, a motile gram-negative bacillus, is one of the four species of Shewanella genus known to cause human infections (1). Shewanella, with its broad spectrum of clinical presentations, is becoming an emerging cause of opportunistic infections. We present a first case of death in an immunocompromised patient with Shewanella algae septicemia in the United States (US) with no known exposure to marine environments or recent seafood consumption. CASE PRESENTATION: This is a 65-year-old male with past medical history of AIDS with CD4 count of 30 cells/mm3, multiple serositis-ascites, chronic bilateral pleural effusion and recurrent pericardial effusion, liver cirrhosis, penile intraepithelial neoplasia, and chronic hepatitis C infection who presented with a three-day history of generalized malaise, fever, and productive cough with yellow sputum. He was afebrile, hypotensive and dyspneic, with decreased bilateral breath sounds which quickly decompensated into acute hypoxic respiratory failure, needing intubation. Labs notable for elevated lactate, white count and creatinine. He was admitted to the critical care unit for management of septic shock, started on vasopressors and vancomycin, piperacillin-tazobactam, and trimethoprim-sulfamethoxazole. Chest x-ray was suspicious for heart failure, with later echocardiogram confirming left ventricular systolic heart dysfunction with markedly decreased ejection fraction 10-15% and diffuse hypokinetic wall motion. Patient developed hyponatremia, worsening lactic acidosis, generalized anasarca, and oliguria, prompting start of Continuous Veno-Venous Hemofiltration. Blood cultures grew Shewanella Algae and piperacillin-tazobactam was switched to meropenem. Repeat blood cultures 10 days later turned negative. Unfortunately, patient's condition worsened, with bradycardia and hypotension despite multiple vasopressors progressed into pulseless electrical activity and death. DISCUSSION: Shewanella algae primarily causes opportunistic infection in people with exposed skin ulcers who have been exposed to marine environment and patients with hepatobiliary disorders who ingest raw seafood. Literature review shows that this virulent pathogen has also been implicated in invasive infections like bacteremia, infective arthritis and osteomyelitis especially in the elderly and immunocompromised patients (2). Most cases of invasive infections have been reported outside the US, with only about a total of less than 10 cases reported in mainland US. CONCLUSIONS: Given the possible grave consequence of Shewanella infections, it is important to include it in the differential diagnosis of invasive infections with or without skin ulceration, not only following reported exposure to marine environments, but also in all immunocompromised patients. Reference #1: 1.Holt HM, Gahrn-Hansen B, Bruun B. Shewanella algae and Shewanella putrefaciens: clinical and microbiological characteristics. Clinical Microbiology and Infection. 2005;11(5):347–52. Reference #2: 2.Torri A, Bertini S, Schiavone P, et al. Shewanella algae infection in Italy: report of 3 years' evaluation along the coast of the northern Adriatic Sea. New Microbes New Infect. 2018;23:39–43. DISCLOSURES: No relevant relationships by Giovanna Bettoli, source=Web Response No relevant relationships by Abidemi Idowu, source=Web Response No relevant relationships by MARIA MARITATO, source=Web Response No relevant relationships by Alice Yau, source=Web Response

Orthophosphate increases the efficiency of slow muscle-myosin isoform in the presence of omecamtiv mecarbil

Omecamtiv mecarbil (OM) is a putative positive inotropic tool for treatment of systolic heart dysfunction, based on the finding that in vivo it increases the ejection fraction and in vitro it prolongs the actin-bond life time of the cardiac and slow-skeletal muscle isoforms of myosin. OM action in situ, however, is still poorly understood as the enhanced Ca2+-sensitivity of the myofilaments is at odds with the reduction of force and rate of force development observed at saturating Ca2+. Here we show, by combining fast sarcomere-level mechanics and ATPase measurements in single slow demembranated fibres from rabbit soleus, that the depressant effect of OM on the force per attached motor is reversed, without effect on the ATPase rate, by physiological concentrations of inorganic phosphate (Pi) (1-10 mM). This mechanism could underpin an energetically efficient reduction of systolic tension cost in OM-treated patients, whenever [Pi] increases with heart-beat frequency.

Investigation of Association Between Cardiac Dose Distribution and Strain/Tissue Doppler Echocardiographic Indices During 1-Year Post-Mastectomy Radiation Therapy Follow-Up in Breast Cancer Patients

This study aimed to determine the association between cardiac dose distribution and strain and Tissue Imaging Doppler (TDI) echocardiographic indices during 1-year follow-up after Post-Mastectomy Radiotherapy (PMRT) in breast cancer patients. In this prospective cohort study, patients with left breast cancer candidate for PMRT were included. The patients treated radiation dose of 50 Gy in 25 fractions over 5 weeks. Before the radiotherapy, and 6 and 12 months after it, the patients underwent echocardiography using strain and TDI methods. The changes in echocardiographic indices and their association with cardiac radiation dose were evaluated. In this study, 31 patients with mean age of 36.6 ± 4.6 years old and the cumulative doses of doxorubicin to 237 ± 5 mg/m2 were participated. Correlation between cardiac dose during radiotherapy and changes in strain and TDI echocardiographic indices showed a significant inverse relation between minimum cardiac dose and 6-month TAPSE changes (p = 0.04, r = − 0.3), maximum cardiac dose and 6-month RV strain changes (p = 0.04, r = − 0.3) and 6 and 12-month S′ changes (p = 0.02, r = − 0.4 and p = 0.05, r = − 0.3), Cardiac V30 with 6 and 12-month E velocity changes (p = 0.05, r = − 0.3 and p = 0.02, r = − 0.4, respectively) and Heart V20 with 12-month E velocity changes (p = 0.04, r = − 0.3). Normal RV strain observed before starting the study in 12 patients (38.7%) was found to be abnormal after 6-month follow-up (p = 0.004). Results of this study showed that, PMRT was associated with left heart diastolic dysfunction and right heart systolic dysfunction especially in the first 6 months after radiotherapy.

Left Ventricle Can't Stay Alone – A Review of Right Ventricular Failure Post-Left Ventricular Assist Device Implantation

Background: Increasing incidence of heart failure with end-stage heart disease and limited availability of donor heart for transplantation made mechanical assist devices a lucrative option. Left ventricular assist device (LVAD) is used increasingly in recent years as a bridge to transplant and also as destination therapy with significantly improved outcomes. Implantation of LVAD improves the left heart systolic dysfunction, but its reliance on adequate right ventricular (RV) function with proposed risk of aggravating RV dysfunction may result in dismal outcomes if not intervened timely. Methodology: MeSH database was searched for LVAD, RV failure (RVF), RV anatomy and physiology, assessment for RV functions from 1990 till current year and was included in the narrative review. Results: The above searched English Medical Literature revealed that RVF contributed to dismal outcomes post-LVAD implantation. The absence of consistent defining criteria makes it hard to determine RVF. RVF leads to impaired LVAD flows, difficulty in weaning from cardio-pulmonary bypass, decreased tissue perfusion, and multi-organ failure, increasing the morbidity and mortality. Ideal durable mechanical assist devices to support the RV are still not available. Conclusion: This review highlights the details about perioperative assessment for RV dysfunction, criteria for RVF, investigational modalities to assess RV function, and management of RVF following LVAD implantation. Early identification, treatment, and prevention of RVF are of paramount importance and understanding this is a pivotal first step in successfully managing RVF post-LVAD implantation. The development of durable right-sided mechanical support would improve the scope of care of LVAD patients developing persistent RVF.

Tissue Doppler Imaging versus Conventional Echocardiography in Evaluation of Cardiac Functions in Diabetes Mellitus

Background: Conventional echocardiography and tissue Doppler imaging have been highlighted to diagnose diastolic and systolic heart dysfunction. We aimed to compare tissue Doppler imaging with conventional echocardiography to diagnose heart dysfunctions in diabetes mellitus type 1 (DMT1) patients. Materials and Methods: This case-control study was conducted in the Ali Asghar Clinic, Zahedan, Iran. The study lasted from 2017 to 2018 on 140 participants aged from 4-18 years, and consisted of 70 patients with DMT1, and 70 children who referred to hospital for checkup as control group. The participants went under tissue Doppler imaging andconventional echocardiography (M mode and 2D) by an invariable cardiologist. The 5 ml blood samples were taken to test blood leptin and ferritin. The data were analyzed using SPSS software (version 18.0). Results: Conventional findings such as left and right deceleration time, left, and right peak E velocity, left ejection time, left Myocardial performance index and TDI findings such as left, and right ET’, right S’, right E’, left MPI’, right MPI’, and left E/E’ were different in patients and the control group (p<0.05). Left and right deceleration time, and LV Mass index in conventional and left ET’, right ET’ in TDI were different in age groups of patients (p<0.05). In sex groups, left deceleration time, left peak A velocity, right acceleration time, right deceleration time and right E/A in conventional and left ET’, left ICT’, left IRT’, right ICT’, right IRT’, right S’ and right MPI’ in TDI were different (p<0.05). Conclusion: This study concluded that both conventional and TDI were different between DMT1 patients and the control group, but TDI was stronger in discrimination.

Hysterotomy Under Epidural Anesthesia In Patient With Peripartum Cardiomyopathy, Pregnancy Induced Hypertension and Acute Renal Failure

Peripartum cardiomyopathy is a type of left ventricular systolic heart dysfunction with an unknown cause. We report a case of a 32-year-old female patient of 50 kg, known case of hypertension since 1.5 year. An epidural, catheter was inserted at the level of L3 and L4 intervertebral spaces. After confirmation 7 ml of 0.5% bupivacaine was injected into epidural space with two top-up doses of 2 ml of 0.125% bupivacaine. Echocardiography demonstrated findings suggested of peripartum cardiomyopathy with mild tricuspid regurgitation and mild mitral regurgitation. Key words Hysterotomy, Epidural anesthesia, Cardiomyopathy.

The Effect of Exercise Training Intensity on Quality of Life in Heart Failure Patients: A Systematic Review and Meta-Analysis

Objectives: To establish if exercise training intensity produces different effect sizes for quality of life in heart failure. Background: Exercise intensity is the primary stimulus for physical and mental adaptation. Methods: We conducted a MEDLINE search (1985 to February 2016) for exercise-based rehabilitation trials in heart failure using the search terms ‘exercise training', ‘left ventricular dysfunction', ‘peak V<smlcap>O</smlcap>₂', ‘cardiomyopathy', and ‘systolic heart dysfunction'. Results: Twenty-five studies were included; 4 (16%) comprised high-, 10 (40%) vigorous-, 9 (36%) moderate- and 0 (0%) low-intensity groups; two studies were unclassified. The 25 studies provided a total of 2,385 participants, 1,223 exercising and 1,162 controls (36,056 patient-hours of training). Analyses reported significant improvement in total Minnesota living with heart failure (MLWHF) total score [mean difference (MD) -8.24, 95% CI -11.55 to -4.92, p < 0.00001]. Physical MLWHF scorewas significantly improved in all studies (MD -2.89, 95% CI -4.27 to -1.50, p < 0.00001). MLWHF total score was significantly reduced after high- (MD -13.74, 95% CI -21.34 to -6.14, p = 0.0004) and vigorous-intensity training (MD -8.56, 95% CI -12.77 to -4.35, p < 0.0001) but not moderate-intensity training. A significant improvement in the total MLWHF score was seen after aerobic training (MD -3.87, 95% CI -6.97 to -0.78, p = 0.01), and combined aerobic and resistance training (MD -9.82, 95% CI -15.71 to -3.92, p = 0.001), but not resistance training. Conclusions: As exercise training intensity rises, so may the magnitude of improvement in quality of life in exercising patients. Aerobic-only or combined aerobic and resistance training may offer the greatest improvements in quality of life.

The effect of resistance training on clinical outcomes in heart failure: A systematic review and meta-analysis

To quantify the change in effect sizes, for selected clinical outcome measures, in people with heart failure, from resistance exercise, either in isolation, or in combination with aerobic training. Most exercise training data in heart failure, relates to aerobic exercise, we sought to provide current evidence for the benefits of resistance training in this population. We conducted a MEDLINE search (1985 to May 1, 2016), for exercise based rehabilitation trials in heart failure, using search terms 'resistance training, combined training, left ventricular dysfunction, peak VO2, cardio-myopathy and systolic heart dysfunction'. The 27 included studies provided a total of 2321 participants, 1172 in an intervention and 1149 in either sedentary controls or aerobic exercise only groups, producing over 31,263 patient-hours of training. Mortality, hospitalization, resting blood pressure and Left ventricular fraction were all unchanged with resistance or combined aerobic and resistance training. Peak VO2 was improved in combined exercise vs. control MD of 1.43ml·kg(-1)·min(-1) (95% CI 0.63, 2.23, p=0.0004; and in resistance vs. control MD 3.99ml·kg(-1)·min(-1) (95% CI 1.47, 6.51, p=0.002). Quality of Life (MLwHFQ) was improved in combined vs. control MD -8.31 (95% CI -14.3, -2.33, p=0.006). Six-minute walk distance was improved combined exercise vs. control, MD 13.49m (95% CI 1.13, 25.84, p=0.03); and resistance vs. control MD 41.77m (95% CI 21.90, 61.64, p<0.0001): SMD 1.25 (95%CI 0.53, 1.98, p=0.0007). Resistance only or combined training improves peak VO2, quality of life and walking performance in heart failure patients.

Atrial fibrilation in patients with systolic heart dysfunction and central vs. obstructive sleep apnea

Atrial fibrilation in patients with systolic heart dysfunction and central vs. obstructive sleep apnea

Exercise training program characteristics and magnitude of change in functional capacity of heart failure patients

Intuitively higher exercise program volume may be the primary stimulus for physical adaptation. We sought to establish if aerobic exercise training program characteristics produced different effect sizes for change in cardiorespiratory fitness in heart failure patients. We conducted a MEDLINE search (1966 to 2012), for exercise based rehabilitation trials in heart failure, using the search terms 'exercise training, left ventricular dysfunction, peak VO2, cardio-myopathy and systolic heart dysfunction'. Forty seven studies were included, producing 54 intervention groups; 3 (6%) were high-, 29 (54%) vigorous-, 20 (37%) moderate- and 2 (3%) low- intensity groups, providing a total of 2285 exercising subjects and 2098 control subjects, totaling 4383 participants. Peak VO2 increased by a mean difference of 3.3 ml kg(-1)min(-1) [95% CI 0.53 to 6.13, p=0.02] with high intensity training in exercise groups versus control, equating to a 23% improvement from baseline. The corresponding data for vigorous, moderate and low intensity were 8%, 13%; and 7% respectively. Weekly exercise energy expenditure >460 kcal was associated with a mean difference in peak VO2 of 2.6 ml kg(-1)min(-1) [95% CI 1.88 to 3.28, p<0.00001]. Our data suggest that high-intensity exercise, achieving at least 460 kcal weekly energy expenditure may elicit the greatest changes in cardiorespiratory fitness.

Clinical Outcomes and Cardiovascular Responses to Different Exercise Training Intensities in Patients With Heart Failure: A Systematic Review and Meta-Analysis

The aim of this study was to establish whether aerobic exercise training intensity produces different effect sizes for fitness, adherence, event rates, mortality rates, and hospitalization rates in patients with heart failure. Intuitively, greater exercise intensity is considered to result in higher risk for serious events, but intensity may be the primary stimulus for physical adaptation. A MEDLINE search (1985 to 2012) was conducted for exercise-based rehabilitation trials in heart failure, using the search terms "exercise training," "left ventricular dysfunction," "peak Vo2," "cardio-myopathy," and "systolic heart dysfunction." Seventy-four studies were included, producing 76 intervention groups; 9 (11.8%) were high-intensity, 38 (50%) vigorous-intensity, 24 (31.6%) moderate-intensity, and 5 (6.6%) low-intensity groups, providing a total of 3,265 exercising subjects and 2,612 control subjects. Peak oxygen consumption increased by a mean difference of 3.33 ml·kg(-1)·min(-1) (95% confidence interval [CI]: 0.53to 6.13 ml·kg(-1)·min(-1); p= 0.02) with high-intensity training in exercise groups compared with control groups, equating to a 23% improvement from baseline. For vigorous intensity, the mean difference was 2.27 ml·kg(-1)·min(-1) (95% CI: 1.70 to 2.84 ml·kg(-1)·min(-1); p< 0.00001), with an 8% weighted mean; for moderate intensity, the mean difference was 2.17 ml·kg(-1)·min(-1) (95% CI: 1.34 to 2.99 ml·kg(-1)·min(-1); p< 0.00001), with a weightedmean of 13%; and for low intensity, the mean difference was 1.04 ml·kg(-1)·min(-1) (95% CI:-2.50 to 4.57 ml·kg(-1)·min(-1); p=0.57), with a weighted mean of 7%. In 123,479 patient-hours of training, not a single death was directly attributable to exercise. As exercise training intensity rises, so may the magnitude of improvement in cardiorespiratory fitness, accompanied by lower study withdrawal in exercising patients. Total exercise time may be a confounder.

Physiological homology betweenDrosophila melanogasterand vertebrate cardiovascular systems

SUMMARYThe physiology of the Drosophila melanogaster cardiovascular system remains poorly characterized compared with its vertebrate counterparts. Basic measures of physiological performance remain unknown. It also is unclear whether subtle physiological defects observed in the human cardiovascular system can be reproduced in D. melanogaster. Here we characterize the cardiovascular physiology of D. melanogaster in its pre-pupal stage by using high-speed dye angiography and optical coherence tomography. The heart has vigorous pulsatile contractions that drive intracardiac, aortic and extracellular-extravascular hemolymph flow. Several physiological measures, including weight-adjusted cardiac output, body-length-adjusted aortic velocities and intracardiac shear forces, are similar to those in the closed vertebrate cardiovascular systems, including that of humans. Extracellular-extravascular flow in the pre-pupal D. melanogaster circulation drives convection-limited fluid transport. To demonstrate homology in heart dysfunction, we showed that, at the pre-pupal stage, a troponin I mutant, held-up2 (hdp2), has impaired systolic and diastolic heart wall velocities. Impaired heart wall velocities occur in the context of a non-dilated phenotype with a mildly depressed fractional shortening. We additionally derive receiver operating characteristic curves showing that heart wall velocity is a potentially powerful discriminator of systolic heart dysfunction. Our results demonstrate physiological homology and support the use of D. melanogaster as an animal model of complex cardiovascular disease.

The effects of continuous positive airway pressure on plasma brain natriuretic peptide concentrations in patients presenting with acute cardiogenic pulmonary edema with preserved left ventricular systolic function

It has been established that plasma brain natriuretic peptide (BNP) concentrations in patients with acute cardiogenic pulmonary edema (ACPE) increase in proportion to heart failure. The aim of this study is to assess the effects of continuous positive airway pressure (CPAP) treatment on plasma BNP concentrations in patients presenting with ACPE with preserved left ventricular (LV) systolic function. This was a prospective, observational single-center study in the emergency unit of Valduce Hospital. Twelve patients (group A) presenting with ACPE and preserved LV ejection fraction and 14 patients (group B) with systolic heart dysfunction (LV ejection fraction <45%) underwent CPAP (10 cm H(2)O) through a face mask and standard medical therapy. Plasma BNP concentrations were collected immediately before CPAP and 3, 6, and 24 hours after treatment. All patients underwent a morphological echocardiographic investigation shortly before CPAP. Three hours after admission, BNP significantly decreased in patients with ACPE and preserved LVEF (from 998 + or - 467 pg/mL to 858 + or - 420 pg/mL; P < .05), whereas in those with systolic dysfunction, BNP was higher than during baseline (from 1352 + or - 473 pg/mL to 1570 + or - 595 pg/mL; P < .05). The preliminary results of the present study show that CPAP, after 3 hours, lowers BNP levels in patients with ACPE and preserved LV systolic function compared with patients affected by systolic ACPE dysfunction where BNP levels do not change significantly.

The role of continuous positive airway pressure in acute cardiogenic edema with preserved left ventricular systolic function

The objective of the study was to compare the effect of continuous positive airway pressure (CPAP) in patients with acute cardiogenic pulmonary edema (ACPE) with preserved or impaired left ventricular systolic function with regard to resolution time. In a prospective, preliminary observational cohort study, 18 patients with preserved left ventricular systolic function (group A) and 18 patients with systolic heart dysfunction (group B) with ACPE underwent CPAP (10 cmH(2)0) through a face mask with standard medical therapy after a morphologic echocardiographic investigation shortly before CPAP. Resolution time did not differ significantly between the 2 groups of patients (64 +/- 25 minutes in diastolic group vs 80 +/- 33 minutes in systolic group). One patient in preserved left ventricular systolic function group required endotracheal intubation (not statistically significant). No patient died during hospital stay. Arterial blood gases improved after a trial of CPAP in both groups of patients. The results of this preliminary study show that resolution time is not significantly different in patients with ACPE with preserved or impaired systolic function submitted to CPAP.

Acute myocardial infarction induced increases in plasma tumor necrosis factor-α and interleukin-10 are associated with the activation of poly(ADP-ribose) polymerase of circulating mononuclear cell

Systemic inflammatory response to acute myocardial infarction (AMI) is detrimental to heart function. In this study, we proved that poly(ADP-ribose) polymerase (PARP) activity of circulating mononuclear cell (MNC) increased significantly in post-AMI patients. MNC PARP activity was correlated positively with plasma tumor necrosis factor-alpha (TNF-alpha) level, interleukin-10 (IL-10) level and the ratio of plasma TNF-alpha/IL-10 respectively. On the contrary, MNC PARP activity was correlated negatively with left ventricular ejection fraction and left ventricular fractional shortening which were measured with echocardiography in the same day when blood sample was collected. These results implicated that activation of PARP in MNC contributes to the increases in plasma TNF-alpha and IL-10 and is associated with systolic dysfunction of heart after AMI.

Apoptosis in heart failure represents programmed cell survival, not death, of cardiomyocytes and likelihood of reverse remodeling

Apoptosis is a highly orchestrated form of programmed cell death, and this is believed to contribute to continuous decline of ventricular function in heart failure. However, the apoptotic cascade is not completed in failing myocardium and DNA damage is prevented due to abolition of DNA fragmentation factors. The extranuclear apoptotic program is interrupted secondary to inhibition of activated caspase-3 by upregulated inhibitors of apoptotic process. During the apoptotic process, upstream step comprising extensive mitochondrial loss of cytochrome c may contribute to systolic dysfunction of heart. Intactness of nuclear blueprint underscores the likelihood of reverse remodeling that has been demonstrated in the post-LVAD myocardial specimens.