Diagnostic utility of a single-epitope sandwich B-type natriuretic peptide assay in stable coronary artery disease: Data from the Akershus Cardiac Examination (ACE) 1 Study

ObjectivesTo assess the merit of a novel single-epitope sandwich (SES) assay specific to the stable part of BNP in patients with reversible myocardial ischemia as post-translational modifications of BNP may influence assay performance.Design and methodsWe measured BNP concentration by a conventional assay and the SES-BNP assay in 198 patients referred for myocardial perfusion imaging (MPI). BNP concentration was determined before and immediately after exercise stress testing, and 1.5 and 4.5 h later. Patients were categorized according to MPI results.ResultsBNP concentration was higher with both assays at all time points in patients with reversible myocardial ischemia (n = 19) compared to the other patients (n = 179). Measuring BNP after stress testing or calculating the changes in BNP concentration did not improve diagnostic accuracy compared to baseline measurements: SES-BNP: AUC 0.71 (95% CI 0.58–0.84) vs. conventional BNP: 0.71 (0.59–0.83), p = 0.96. By linear regression analysis, reversible myocardial ischemia was significantly associated with baseline SES-BNP concentration (p = 0.043), but not with measurements by the conventional assay (p = 0.089). In multivariate logistic regression models, only baseline measurement with the SES-BNP assay was significantly associated with reversible myocardial ischemia: odds ratio [logarithmical transformed BNP] 2.00 (95% CI 1.16–3.47), p = 0.013. The SES-BNP assay, but not the conventional BNP assay, reclassified a significant proportion of the patients towards their correct category on top of the best clinical model of our data set: NRI = 0.47, p = 0.04.ConclusionsThe SES-BNP assay was significantly associated with reversible myocardial ischemia as assessed by several statistical indices, while a conventional BNP assay was not.     

Diagnostic performance of four point of care cardiac troponin I assays to rule in and rule out acute myocardial infarction

ObjectiveThis study evaluated the diagnostic performance of four point-of-care (POC) cardiac troponin I (cTnI) assays compared to a central laboratory cTnI assay for detecting myocardial injury and diagnosing acute myocardial infarction (AMI).Design and methodsPlasma obtained at admission, 3 h, and 6 h post-admission in 169 patients presenting with symptoms suggestive of acute coronary syndrome (ACS) was studied. cTnI concentrations were measured on the Instrumentation Laboratory prototype GEM Immuno, Radiometer AQT90, Mitsubishi PATHFAST, Abbott i-STAT and the Ortho-Clinical Diagnostic Vitros assays. MI was determined based on 99th percentiles according to Universal MI guidelines.ResultsFor ruling in MI at presentation (0 h), the GEM Immuno (sensitivity 63%, specificity 85%) and PATHFAST (sensitivity 53%, specificity 86%) were comparable to the OCD (sensitivity 68%, specificity 81%), and significantly better (p < 0.05) than the AQT90 (sensitivity 26%, specificity 93%) and i-STAT (sensitivity 32%, specificity 92%). cTnI concentrations and serial rising patterns after MI differed by each assay. Negative predictive values were > 90% and ROC AUCs were > 0.90 after 6 h for all assays. Detection of myocardial injury in non-ischemic pathologies accounted for lower than 100% specificity for MI.ConclusioncTnI is a sensitive biomarker for detection of myocardial injury. The analytical variability that exists between POC cTnI assays demonstrates substantial diagnostic differences for ruling in and ruling out MI in patients presenting with symptoms suggestive of ACS.     

Effect of low-impact aerobic exercise combined with music therapy on patients with fibromyalgia. A pilot study

ObjectiveFibromyalgia is a pathological entity characterized by chronic widespread musculoskeletal pain and the presence of “tender points”. It constitutes a significant health problem because of its prevalence and economic impact. The aim of the present study was to determine the therapeutic benefits of low impact aerobic exercise alone or in combination with music therapy in patients with fibromyalgia.MethodsA single-blind randomized controlled pilot trial was performed. Thirty-five individuals with fibromyalgia were divided into three groups: (G1) therapeutic aerobic exercise with music therapy (n = 13); (G2) therapeutic aerobic exercise at any rhythm (n = 13) and (CG) control (n = 9). The intervention period lasted eight weeks. Depression, quality of life, general discomfort and balance were assessed before and after intervention.ResultsAt post-intervention, group G1 improved in all variables (depression (p = 0.002), quality of life (p = 0.017), general discomfort (p = 0.001), and balance (p = 0.000)), while group G2 improved in general discomfort (p = 0.002). The change observed in balance was statistically different between groups (p = 0.01).ConclusionTherapeutic aerobic exercise is effective in improving depression and general discomfort in individuals with fibromyalgia. However, effectiveness is higher when combined with music therapy, which brings about further improvements in quality of life and balance.     

The paraoxonase L55M and Q192R gene polymorphisms and myocardial infarction in a Tunisian population

ObjectivesIn the present study, we examined a possible association between the PON1 Q192R and L55M polymorphisms and myocardial infarction (MI) in a sample of the Tunisian population.Design and methodsThree hundred and ten patients with MI and 375 controls were recruited. Paraoxonase gene polymorphisms at codon 192 and 55 were analyzed by PCR-RFLP.ResultsGenotype distributions and allele frequencies of L55M were similar among the control and MI groups. For the Q192R polymorphism patients with MI had significantly higher frequency of the RR genotype compared to controls [17.1% vs. 10.9%; OR (95% CI), 1.93 (1.24–3.02); p = 0.004]. The MI patient group showed a significantly higher frequency of the R allele compared to the controls [38% vs. 30%; χ² = 10.74, p = 0.001]. The association between the PON1 Q192R polymorphism and MI remained significant after adjustment for other well-established cardiovascular risk factors.ConclusionsThe present study showed a significant and independent association between the PON1 Q192R polymorphism (presence of R allele) and MI in the Tunisian population.     

Effectiveness of aerobic gymnastic exercise on stress,fatigue, and sleep quality during postpartum: A pilot randomized controlled trial

BackgroundGymnastics is a preferable safe exercise for postnatal women performing regularly.ObjectiveThe aim of this pilot randomized controlled trial was to determine whether the aerobic gymnastic exercise improves stress, fatigue, sleep quality and depression in postpartum women.DesignSingle-blinded, randomized controlled trial held from December 2014 until September 2015. Setting: Postnatal clinic of a medical center in southern Taiwan.Participants140 eligible postnatal women were systematically assigned, with a random start to experimental (n = 70) or a control (n = 70) group.InterventionsEngage in aerobic gymnastic exercise at least three times (15 min per section) a week for three months using compact disc in the home.Outcome measuresPerceived Stress Scale, Postpartum Fatigue Scale, Postpartum Sleep Quality Scale, and Edinburgh Postnatal Depression Scale.ResultsIn a two-way ANOVA with repeated measures, the aerobic gymnastic exercise group showed significant decrease in fatigue after practicing exercise 4 weeks and the positive effects extended to the 12-week posttests. Paired t-tests revealed that aerobic gymnastic exercise participants had improved significantly in perceived stress and fatigue after 4 weeks gymnastic exercise; these positive effects extended to the 12-week posttests. In addition, the changes in physical symptoms-related sleep inefficiency after 12 weeks gymnastic exercise were significantly decreased in the experimental group compared with the control group.Relevance to clinical practiceThe findings can be used to encourage postnatal women to perform moderate-intensity gymnastic exercise in their daily life to reduce their stress, fatigue and improve sleep quality.     

Characteristics of ventricular fibrillation in relation to cardiac aetiology and shock success: A waveform analysis study in ICD-patients

BackgroundVentricular fibrillation (VF) waveform characteristics are associated with cardiac arrest duration and defibrillation success. Recent animal studies found that VF characteristics and shock success also depend on the presence of myocardial infarction (MI). In patients, VF induction after implantable cardioverter defibrillator (ICD) implantation offers a unique setting to study early VF characteristics: we studied the relation with cardiac disease – either presence or absence of a previous MI – and with shock success.MethodsRetrospective cohort study of ICD-patients who underwent defibrillation testing, 117 (63%) with and 69 (37%) without a previous MI. Intracardiac recordings of induced VF were analysed using Fourier analysis.ResultsIn previous MI-patients, the fundamental frequency and organisation index of the VF signal were significantly lower as compared with patients without a previous MI: 4.9 Hz ± 0.6 vs. 5.2 Hz ± 0.6 (p = 0.005) and 56% ± 10 vs. 60% ± 9 (p = 0.001), respectively. The median frequency was not different (p = 0.25). We found no association between VF characteristics and ICD shock success.ConclusionsIn analogy with observations in animals, we found that a history of a previous MI was associated with slower and less organised VF. In our cohort of ICD-patients, early VF waveform characteristics were not associated with shock outcomes. Further study is warranted to determine to what extent VF characteristics are influenced by the underlying aetiology on the one hand, and time delay on the other. These findings could improve insight into the potential value of VF analysis to guide shock delivery.     

Combining high-sensitivity cardiac troponin and B-type natriuretic peptide in the detection of inducible myocardial ischemia

BackgroundSingle biomarker approaches provide only moderate accuracy in the non-invasive detection of exercise-induced myocardial ischemia. We therefore assessed the combination of the two most promising single biomarkers: high-sensitivity cardiac troponin I (hs-cTnI) and B-type natriuretic peptide (BNP).MethodsConsecutive patients with suspected myocardial ischemia referred to stress myocardial perfusion single-photon emission tomography imaging (MPI) were enrolled. Clinical judgment (CJ) of the treating cardiologist regarding myocardial ischemia, quantified using a visual analogue scale, and blood concentrations of hs-cTnI and BNP were determined before and after stress. The presence of myocardial ischemia was adjudicated by independent cardiologists using MPI, blinded to biomarker measurements. Death and acute myocardial infarction (AMI) during follow-up were the prognostic endpoints.ResultsAmong 1142 consecutive patients inducible myocardial ischemia was found in 456 (40%) of all patients. For the detection of inducible myocardial ischemia, CJ before exercise stress testing (CJb) showed an area under the receiver-operating-characteristics curve (AUC) of 0.66 (95%CI 0.63–0.69), hs-cTnI 0.70 (95%CI 0.67–0.73, p = 0.07 vs CJb), and BNP 0.66 (95%CI 0.62–0.69, p = 0.98). The use of a dual-biomarker strategy combining hs-cTnI and BNP with CJb did not provide a significant advantage over the combination of hs-cTnI alone and CJb (AUC 0.74, 95%CI 0.72–0.77 vs AUC 0.74, 95%CI 0.71–0.77, p = 0.16). Hs-cTnI showed good prognostic value for AMI (HR 1.6, 95%CI 1.3–1.9), and BNP for death (HR 1.6, 95%CI 1.3–2.1).ConclusionA dual-biomarker strategy combing BNP and hs-cTnI does not further increase diagnostic accuracy on top of clinical judgment and hs-cTnI alone.Summary and highlightsWe included 1142 consecutive patients with suspected inducible ischemia, and evaluated the added value of the biomarkers high-sensitivity cardiac troponin (hs-cTn) and B-type natriuretic peptide (BNP), alone and in combination, on top of clinical judgment.Clinical trial registrationBiochemical and Electrocardiographic Signatures in the Detection of Exercise-induced Myocardial Ischemia (BASEL VIII), NCT01838148, https://clinicaltrials.gov/ct2/show/NCT01838148     

Minor association of kinase insert domain-containing receptor gene polymorphism (rs2071559) with myocardial infarction in Caucasians with type 2 diabetes mellitus: Case–control cross-sectional study

ObjectiveVascular endothelial growth factor A (VEGF) and its receptor KDR play central roles in angiogenesis and vascular repair, which occur in diabetic vascular complications, such as MI. The aim of our study was to investigate if polymorphisms rs2071559 and rs2305948 in the kinase insert domain-containing receptor (KDR) gene are associated with myocardial infarction (MI) in Caucasians with type 2 diabetes (T2DM).Design and methodsThe association of KDR − 604T>C (rs2071559) and 1192G>A (rs2305948) polymorphisms was tested in a case–control cross-sectional study including 171 subjects with T2DM and MI compared to 855 subjects with T2DM without coronary artery disease (CAD). In addition, VEGF serum levels were analyzed in 98 subjects with type 2 diabetes without CAD.ResultsA significantly higher frequency of the CC genotype of the KDR − 604T>C (rs2071559) polymorphism was found in diabetic patients with MI compared to diabetic patients without CAD (27.5% vs. 21.1%, p = 0.04). On the other hand, the 1192G>A (rs2305948) polymorphism was not associated with MI in subjects with type 2 diabetes. Significantly higher VEGF serum levels were found in subjects with the − 604CC genotype compared to those with other (CT + TT) genotypes (73.8 ± 22.1 ng/l vs. 58.1 ± 18.5 ng/l; p < 0.01). Multiple logistic regression analysis adjusted for age, arterial hypertension, LDL cholesterol, HDL cholesterol and hsCRP revealed that carriers of the − 604CC genotype (rs2071559) had a 1.6-fold higher risk for MI (OR = 1.6; 95% CI = 1.1–2.1; p = 0.022).ConclusionThe present study demonstrates that the CC genotype of the KDR − 604T>C polymorphism (rs2071559) is a possible risk factor for MI in Caucasians with T2DM.     

Predicting myocardial infarction and other serious cardiac outcomes using high-sensitivity cardiac troponin T in a high-risk stable population

ObjectivesPrevious work on high-sensitivity troponin I (hs-cTnI) has demonstrated that it may identify patients with stable cardiovascular disease (CVD) at risk for future myocardial infarction (MI). In this study, we assessed if hs-cTnT concentrations could also identify those stable CVD patients at high risk for future MI and other ischemic cardiac outcomes.Methodshs-cTnT (lot:153-401) was measured in specimens obtained at randomisation in the Heart Outcomes Prevention Evaluation (HOPE) study (n = 2941 stable CVD patients, 4.5 years follow-up). The primary outcome for the HOPE study (MI, stroke, or cardiovascular death) was used to identify cutoffs by receiver operating characteristic (ROC) curve analysis and was used in conjunction with the 95th and 99th percentile upper limits to construct different concentration ranges, which were assessed using log-rank tests and multivariable Cox proportional hazard models. These different concentration ranges were then assessed for the components of the primary outcome and for heart failure (HF).ResultsThe ROC derived hs-cTnT cutoff was 8 ng/L for the primary outcome. Subjects with hs-cTnT either below (8 to < 14 ng/L) or slightly above the published 99th from a healthy population (14 to 21 ng/L) had similar probability for the primary outcome. Those with hs-cTnT concentrations > 31 ng/L had the highest probability and greatest risk for future MI, HF, and cardiovascular death as compared to those with hs-cTnT concentrations < 8 ng/L.ConclusionIn patients with stable CVD disease hs-cTnT measurement identifies those at risk for MI as well as HF and cardiovascular death.     

The −351A/G polymorphism of ESR1 is associated with risk of myocardial infarction but not with extreme longevity

BackgroundWomen live longer than men. Some possible reasons for this advantage are the protection provided by high concentrations of 17β-estradiol (E2) during the premenopausal period and polymorphic variants of the estrogen receptors (ERs), which mediate various cardiovascular functions of E2.MethodsWe tested whether the ?351A/G and ?397T/C polymorphisms of the ERα-encoding ESR1 were associated with extreme longevity. The genomic DNA of 148 centenarians (C), 414 young controls (Y), and 208 myocardial infarction patients (MI) was analyzed by RFLP-PCR.ResultsBoth polymorphisms were equally distributed in the Y, C, and in centenarians never diagnosed with MI (HC). In centenarians, none of these polymorphisms was associated with a particular lipid profile. The AA genotype of the ?351A/G polymorphism was less frequent in the C, HC and Y groups than in MI patients (p = 0.058, p = 0.021, and p = 0.004, respectively). In MI patients, the GG genotype of the ?351A/G polymorphism was associated with significantly lower mean total cholesterol, LDL, and HDL levels compared to the AG (p = 0.0194, p = 0.0213, and p = 0.0367, respectively) and AA genotypes (p = 0.0014, p = 0.0078, and p = 0.0448, respectively).ConclusionsThe ?351A/G ESR1 polymorphism might be associated with MI, but not with extreme longevity.     

Prognostic implication of out-of-hospital cardiac arrest in patients with cardiogenic shock and acute myocardial infarction

ObjectivesTo compare outcome in patients with acute myocardial infarction (MI) and cardiogenic shock (CS) presenting with and without out-of-hospital cardiac arrest (OHCA).BackgroundDespite general improvement in outcome after acute MI, CS remains a leading cause of death in acute MI patients with a high 30-day mortality rate. OHCA on top of cardiogenic shock may further increase mortality in these patients resulting in premature withdrawal of supportive therapy, but this is not known.Methods and resultsIn a retrospective study from 2008 to 2013, 248 consecutive patients admitted alive to a tertiary centre with the diagnosis of CS and acute MI were enrolled, 118 (48%) presented with OHCA and 130 (52%) without (non-OHCA patients). Mean lactate level at admission was significantly higher in OHCA patients compared with non-OCHA patients (9 mmol/l (SD 6) vs. 6 mmol/l (SD 4) p < 0.0001). Co-morbidities were more prevalent in the non-OHCA group. By univariate analysis age (Hazard ratio (HR) = 1.02 [CI 1.00–1.03], p = 0.01) and lactate at admission (HR = 1.06 [CI 1.03–1.09], p < 0.001), but not OHCA (HR = 1.1 [CI 0.8–1.4], p = NS) was associated with mortality. In multivariate analysis, only age (HR = 1.02 [CI 1.01–1.04], p = 0.003) and lactate level at admission (HR = 1.06 [1.03–1.09], p < 0.001) were independent predictors of mortality. One-week mortality was 63% in the OHCA group and 56% in the non-OHCA group, p = NS.ConclusionOHCA is not an independent predictor of mortality in patients with acute MI complicated by cardiogenic shock. This should encourage active intensive treatment of CS patients regardless of OHCA.     

The effect of aloe vera on ischemia—Reperfusion injury of sciatic nerve in rats

PurposeAloe vera is compound which has strong antioxidant and anti-inflammatory effects. We investigated the neuroprotective role of aloe vera treatment in rats with experimental sciatic nerve ischemia/reperfusion injury.MethodsTwenty-eight male Wistar Albino rats were divided equally into 4 groups. Groups; Control group (no surgical procedure or medication), sciatic nerve ischemia/reperfusion group, sciatic nerve ischemia/reperfusion + aloe vera group and sciatic nerve ischemia/reperfusion + methylprednisolone group. Ischemia was performed by clamping the infrarenal abdominal aorta. 24 hours after ischemia, all animals were sacrificed. Sciatic nerve tissues were also examined histopathologically and biochemically.ResultsIschemic fiber degeneration significantly decreased in the pre-treated with aloe vera and treated with methylprednisolone groups, especially in the pre-treated with aloe vera group, compared to the sciatic nerve ischemia/reperfusion group (p < 0.05). A significant decrease in MDA, an increase in NRF1 level and SOD activity were observed in the groups which obtained from the AV and MP groups when compared to the sciatic nerve ischemia/reperfusion group. When all results were analysed it was seen that the aloe vera group was not statistically different compared to the MP group (p > 0.05).ConclusionsAloe vera is effective neuroprotective against sciatic nerve ischemia/reperfusion injury via antioxidant and anti-inflammatory properties. Also aloe vera was found to be as effective as MP.     

Ventricular fibrillation waveform characteristics differ according to the presence of a previous myocardial infarction: A surface ECG study in ICD-patients

BackgroundCharacteristics of the ventricular fibrillation (VF) waveform reflect arrest duration and have been incorporated in studies on algorithms to guide resuscitative interventions. Findings in animals indicate that VF characteristics are also affected by the presence of a previous myocardial infarction (MI). As studies in humans are scarce, we assessed the impact of a previous MI on VF characteristics in ICD-patients.MethodsProspective cohort of ICD-patients (n = 190) with defibrillation testing at the Radboudumc (2010–2013). VF characteristics of the 12-lead surface ECG were compared between three groups: patients without a history of MI (n = 88), with a previous anterior (n = 47) and a previous inferior MI (n = 55).ResultsAs compared to each of the other groups, the mean amplitude and amplitude spectrum area were lower, for an anterior MI in lead V3 and for an inferior MI in leads II and aVF. Across the three groups, the bandwidth was broader in the leads corresponding with the infarct localisation. In contrast, the dominant and median frequencies only differed between previous anterior MI and no history of MI, being lower in the former.ConclusionsThe VF waveform is affected by the presence of a previous MI. Amplitude-related measures were lower and VF was less organised in the ECG-lead(s) adjacent to the area of infarction. Although VF characteristics of the surface ECG have so far primarily been considered a proxy for arrest duration and metabolic state, our findings question this paradigm and may provide additional insights into the future potential of VF-guided resuscitative interventions.     

Exercises improve body composition,cardiovascular risk factors and bone mineral density for menopausal women: A systematic review and meta-analysis of randomized controlled trials

BackgroundMenopause has been considered as an aggravating factor for developing cardiovascular diseases and the metabolic syndromes for women. Exercise might be an effective intervention for reducing such threats.ObjectiveThe purpose of this study was to evaluate the exercise effects on body composition, cardiovascular risk factors, and bone mineral density of menopausal women.MethodsTwo reviewers did a complete search of five electronic database (Medline, PubMed, Cochrane Central Register of Controlled Trials, CINAHL, and the Chinese Electronic Periodical Service) records up to January 31, 2014. Randomized controlled trials (RCTs) that compared female menopausal participants with exercises, and those without exercise or with placebo were included. Risk of bias was classified based on the Cochrane Collaboration tool, the meta-analysis was conducted using Comprehensive Meta-Analysis Version 2.2. The study selection, data extraction, and validation were performed independently by the 2 reviewers.ResultsA total of 17 RCTs with 792 participants were included for meta-analysis. Among the eight RCTs (247 participants), a moderate effect size of exercise on body fat was found (SMD = − 0.34, 95% CI: − 0.60 to − 0.08). In five RCTs (195 participants), a moderate effect size of exercise on waist circumference (SMD = − 0.39, 95% CI: − 0.68 to − 0.09), in seven RCTs (162 participants), a moderate effect size on triglyceride level (SMD = − 0.37, 95% CI: − 0.62 to − 0.11), and in five RCTs (311 participants), a moderate effect size on bone mineral density (SMD = 0.38, 95% CI: 0.08–0.68). Subgroup analysis revealed a significant effect of aerobic exercise on body fat (SMD = − 0.29, 95% CI: − 0.53 to − 0.06), and a short-term exercise on body fat (SMD = − 0.50, 95% CI: − 0.89 to − 0.11) and on triglycerides (SMD = − 0.42, 95% CI: − 0.79 to − 0.04). The trials included in this meta-analysis were small and some had methodologic limitations.ConclusionsThis study provides evidences to clinical practice for menopause women that exercise, compared with nonexercise or placebo exerted significant benefits on body fat, waist circumference, triglyceride level, and lumbar spine bone mineral density. Particularly, aerobic exercise did help menopausal women improve their body fat. A short-term exercise intervention had a benefit on not only body fat but also triglyceride level. However, well-designed, well-executed RCTs, and a detailed long-term clinical research should be needed in the future.     

The effect of a multidisciplinary intervention program on hepatic adiposity in overweight-obese children: protocol of the EFIGRO study

BackgroundNon-alcoholic fatty liver disease is the most frequent liver abnormality observed in overweight or obese children and is strongly associated with metabolic syndrome and insulin resistance.Objectives(i) To evaluate the effect of a 22-week multidisciplinary intervention program on hepatic fat fraction in overweight or obese children and (ii) to examine the effect of the intervention on cardiometabolic risk factors, self-esteem and well-being.MethodsA total of 160 children, 9–11 years, will be recruited by pediatricians and randomly assigned to control (N = 80) or intervention (N = 80) groups. The control group will receive a family-based lifestyle and psycho-educational program (2 days/month), while the intervention group will attend the same lifestyle education and psycho-educational program plus the exercise program (3 days/week). The duration of training sessions will be 90 min of exercise, including warm-up, moderate to vigorous aerobic activities, and strength exercises. The primary outcome is the change in hepatic fat fraction (magnetic resonance imaging, MRI). Secondary outcomes include cardiometabolic risk factors such as total adiposity (dual X-ray absorptiometry), visceral adiposity (MRI), functional peak aerobic capacity (cardiopulmonary exercise testing), blood pressure, muscular fitness, speed–agility, and fasting blood insulin, glucose, C-reactive protein, alanine aminotransferase, aspartate aminotransferase, gamma glutamyltransferase, lipid profile and psychological measurements (questionnaires). All the measurements will be evaluated at baseline prior to randomization and after the intervention.DiscussionThis study will provide insight in the efficacy of a multidisciplinary intervention program including healthy lifestyle education, psycho-education and supervised exercise to reduce hepatic fat and cardiometabolic risk in overweight children.     

Association of rs2781666 G/T polymorphism of arginase I gene with myocardial infarction in Tunisian male population

ObjectivesThe aim of this study was to investigate the association between rs2781666 G/T polymorphism of arginase I (ARG I) gene and myocardial infarction (MI) in the Tunisian male population.Design and methodsThree hundred eighteen patients with MI and 282 controls were recruited. The rs2781666 G/T polymorphism of ARG I was determined by PCR-RFLP analysis.ResultsPatients had significantly higher frequency of TT genotype compared to controls (10.4% vs. 6.7%; p < 0.001). The MI patients showed higher frequency of T allele compared to the controls [0.33 vs. 0.22; OR (95% CI), 1.79 (1.37–2.34), p < 0.001]. The association between rs2781666 G/T polymorphism of ARG I gene and MI remained significant after adjustment for other well-established risk factors.ConclusionA significant association between rs2781666 G/T polymorphism of ARG I gene and MI was found in the Tunisian male population.     

Tanshinone IIA protects against myocardial ischemia reperfusion injury by activating the PI3K/Akt/mTOR signaling pathway

ObjectiveTo determine the mechanism by which Tanshinone IIA (Tan IIA) relieves myocardial ischemia reperfusion injury (MIRI) in rats via the PI3K/Akt/mTOR signaling pathway.MethodsSprague-Dawley (SD) rats received an intravenous injection of Tan IIA and LY294002 and were divided into the sham, control (myocardial ischemia reperfusion), Tan-L (low-dose Tan IIA), Tan-H (high-dose Tan IIA), Tan-L + LY (low-dose Tan IIA + LY294002), Tan-H + LY (high-dose Tan IIA + LY294002) and LY (LY294002) groups. Cardiomyocytes obtained from neonatal rats were treated with hypoxia reoxygenatin, Tan IIA and LY294002 and divided into the blank, control, Tan-L, Tan-H, Tan-L + LY, Tan-H + LY and LY groups. Creatine kinase MB isoenzyme (CK-MB) and lactic dehydrogenase (LDH) levels in serum and cardiomyocytes were measured. Area of necrosis/area at risk (AN/AAR) was determined with double staining of TTC and Evan’s blue; viability and apoptosis of cardiomyocytes with MTT and TUNEL assays; SOD, MDA, H₂O₂, SDH and COX levels in heart mitochondria together with PI3K/Akt/mTOR and eNOS expressions and phosphorylation with Western blotting.ResultsThe Tan-L and Tan-H groups showed a remarkable decrease in AN/AAR, serum CK-MB and LDH, mitochondrial MDA and H₂O₂ levels but an increase in SOD activity, SDH and COX levels compared with the control group. However, compared with the Tan-L and Tan-H groups, the Tan-L + LY, Tan-H + LY and LY groups indicated an inverse tendency of those indicators. As shown by MTT and TUNEL, the control group had more severe cell damage than the blank group. Furthermore, cell damage and apoptosis were less severe in the Tan-L and Tan-H groups than in the control group, while the Tan-L + LY, Tan-H + LY and LY groups showed an opposite tendency when compared with the Tan-L and Tan-H groups. Meanwhile, the Tan-L and Tan-H groups showed significantly higher expression levels of PI3K, p-Akt/Akt, mTOR and p-eNOS/eNOS than the control group, whereas the Tan-L + LY, Tan-H + LY and LY groups had lower expression levels than the Tan-L and Tan-H groups.ConclusionOur study provided evidence that Tan IIA could activate the PI3K/Akt/mTOR signaling pathway to relieve MIRI in rats.     

Tai Chi with mental imagery theory improves soleus H-reflex and nerve conduction velocity in patients with type 2 diabetes

ObjectivesDiabetes is a disease that leads to damage to the peripheral nerves which may eventually cause balance instability. The purpose of this study was to determine the effect of 8 weeks of Tai Chi (TC) training combined with mental imagery (MI) on soleus H-reflex and nerve conduction velocity (NCV) of the sural and superficial peroneal nerves in people with diabetes.DesignsQuasi-experimental, one group pretest-posttest design.SettingHuman Research Laboratory.InterventionsA series of Yang style of Tai Chi classes with mental imagery, one hour, two sessions per week for 8 weeks was done.Main outcome measuresThe Activities-specific Balance Confidence (ABC) Scale, Functional Reach Test (FRT), and One Leg Standing Test (OLS) were measured as functional data. Hoffman reflex (H-reflex), and sural and superficial peroneal NCV were measured as main outcomes.ResultsAll functional outcomes measures were significantly improved after the intervention (p < 0.01). In the H-reflex, there was a significant increase in amplitude (μV) after completing 8 weeks of TC exercise (p = 0.02). In the sural nerve, the velocity (p = 0.01), amplitude (p = 0.01), and latency (p = 0.01) were significantly improved between pre and post-test. In the superficial peroneal nerve, significant improvements were observed in (p = 0.02) and latency (p = 0.01), but not in amplitude (μV) (p > 0.05).ConclusionsCombining TC intervention with MI theory showed an improvement in the H-reflex and NCV tests, which suggests improved balance and walking stability.     

Long-term high-intensity interval training associated with lifestyle modifications improves QT dispersion parameters in metabolic syndrome patients

BackgroundQT dispersion (QTd) is a marker of myocardial electrical instability, and is increased in metabolic syndrome (MetS). Moderate intensity continuous exercise (MICE) training was shown to improve QTd in MetS patients.ObjectivesTo describe long-term effects of MICE and high-intensity interval exercise training (HIIT) on QTd parameters in MetS.MethodsSixty-five MetS patients (53 ± 9 years) were assigned to either a MICE (60% of peak power output [PPO]), or a HIIT program (alternating phases of 15–30 s at 80% of PPO interspersed by passive recovery phases of equal duration), twice weekly during 9 months. Ventricular repolarization indices (QT dispersion = QTd, standard deviation of QT = sdQT, relative dispersion of QT = rdQT, QT corrected dispersion = QTcd), metabolic, anthropometric and exercise parameters were measured before and after the intervention.ResultsNo adverse events were noted during exercise. QTd decreased significantly in both groups (51 vs 56 ms in MICE, P < 0.05; 34 vs 38 ms in HIIT, P < 0.05). Changes in QTd were correlated with changes in maximal heart rate (r = ?0.69, P < 0.0001) and in heart rate recovery (r = ?0.49, P < 0.01) in the HIIT group only. When compared to MICE, HIIT training induced a greater decrease in weight, BMI and waist circumference. Exercise capacity significantly improved by 0.82 and 1.25 METs in MICE and HIIT groups respectively (P < 0.0001). Lipid parameters also improved to the same degree in both groups.ConclusionIn MetS, long-term HIIT and MICE training led to comparable effects on ventricular repolarization indices, and HIIT might be associated with greater improvements in certain cardiometabolic risk factors.     

Acute and chronic effects of high-intensity interval and moderate-intensity continuous exercise on heart rate and its variability after recent myocardial infarction: A randomized controlled trial

BackgroundResting heart rate (HR) and HR variability (HRV) are known to predict mortality in patients after myocardial infarction (MI).ObjectiveWe assessed acute and chronic effects of high-intensity interval training (HIIT) versus moderate-intensity continuous exercise (MICE) on HR and HRV in individuals after acute ST-segment elevation MI (STEMI).MethodsParticipants within 7 weeks after MI were randomly assigned to HIIT or MICE groups for a 9-week intervention. HR and the power spectrum of HRV were measured pre- and post-intervention by using orthostatic challenge and during sleep to assess chronic effects. Sleep measurements were performed at night after HIIT, MICE or no training to assess acute effects. Mixed models assessed time*group interaction for differences in chronic and acute effects, adjusted for beta-blocker dose and number of training sessions.ResultsOverall, 34 of 37 and 35 of 36 participants in the HIIT and MICE groups completed the study. We found a trend for an acute increase in HR of 2.5 bpm (4%, P = 0.023) during sleep after HIIT. We found a trend for a chronic decrease in HR during supine and standing position as well as during sleep in the MICE group but a trend for an increase in HR during supine and standing position in the HIIT group. Low- and high-frequency power (LF, HF) of the standing segment increased from pre- to post-intervention in the MICE group but decreased in the HIIT group (group*time interaction P = 0.005 and P = 0.026, respectively).ConclusionHR during sleep tended to be increased acutely during the night after HIIT but not after MICE as compared with controls. Chronic effects on resting HR, HF and LF tended to be more beneficial after MICE than HIIT in individuals with recent STEMI.