Efficacy of once daily penbutolol in chronic stable angina. An objective comparison with long-acting propranolol

The effects of penbutolol (40 mg daily) and long-acting propranolol (160 mg daily) were assessed in 26 patients with chronic stable angina in a placebo-controlled randomised double-blind crossover study with 2-weekly treatment periods. In addition to conventional subjective assessment, serial multistage treadmill exercise was used to obtain objective data on drug efficacy and 24-hr ambulatory electrocardiography performed for diurnal heart rate analysis. The mean exercise time of 6.3 ± 0.5 (SEM) min on placebo increased to 7.3 ± 0.6 min on penbutolol (P < 0.01) and to 7.9 ± 0.5 min on propranolol (P < 0.001). The pre-exercise resting heart rate was 73 ± 2 beats/min on placebo and decreased to 63 ± 2 beats/min on penbutolol (P < 0.001) and 58 ± 2 beats/min on propranolol (P < 0.001). The maximum exercise heart rate was similarly reduced by both drugs and there was a corresponding reduction in peak exercise double product. The time-corrected maximum ST segment depression was reduced by both drugs and neither produced a delay in ST segment recovery. Both drugs effected significant reductions in ambulatory maximum hourly heart rates throughout 24 hr. The lowest observed heart rate on penbutolol was 40 beats/min and 34 beats/min on propranolol. Penbutolol is an effective antianginal agent with a profile of action similar to that of propranolol.     

Serum uric acid is an independent predictor of metabolic syndrome in a Japanese health screening population

Serum levels of uric acid (UA) are associated with metabolic syndrome (MetS). However, no study has been aimed to investigate whether baseline UA is a predictor of MetS in a Japanese population. The multivariable adjusted hazard ratios (HRs) of MetS through 3 years were calculated for each 1 SD increase in baseline UA, for the higher quartiles of baseline UA compared with the lowest quartile, and for baseline hyperuricemia defined as ≥7.0 mg/dl for men and ≥6.0 mg/dl for women in apparently healthy 1,606 men aged 51.7 ± 9.4 years and 953 women aged 51.6 ± 9.4 years who visited a medical check-up center in Japan. The HRs (95 % confidence interval; p value) were 1.282 (1.097–1.499; 0.002) in men and 1.354 (1.041–1.762; 0.024) in women for 1 SD increase in baseline UA, 2.206 (1.344–3.620; 0.002) in men and 3.110 (1.121–8.627; 0.029) in women for the highest quartile of baseline UA compared with the lowest quartile, and 1.900 (1.376–2.622; <0.001) in men and 2.088 (1.040–4.190; 0.038) in women for baseline hyperuricemia adjusting for the pre-existing components of MetS, age, smoking, drinking, physical activity, use of antihypertensive, antihyperlipidemic, and antidiabetic medications and histories of coronary heart disease and stroke. However, no significant association was found between longitudinal changes in UA and incident MetS. Baseline UA is an independent predictor of MetS in a Japanese health screening population.     

Hemodynamic effects of oral ephedrine given alone or combined with nitroprusside infusion in patients with severe left ventricular failure

Potent vasodilator or inotropic agents alone may be of limited value in some patients with severe congestive heart failure because of their exaggerated peripheral vascular effects. Nitroprusside and potent inotropic agents in combination are hemodynamically more effective than either alone. Although oral vasodilators can mimic nitroprusside, there is a need for potent oral inotropic agents. Ephedrine is an oral sympathomimetic inotropic drug. The hemodynamic effects of ephedrine alone (50 mg orally), nitroprusside alone and the two agents combined were studied in 11 patients with severe congestive heart failure. Heart rate increased from 89.9 ± 5.2 (standard error of the mean) to 98.2 ± 5.0 beats/min after ephedrine (P < 0.001) and to 96.4 ± 4.7 beats/min with ephedrine plus nitroprusside (P < 0.02); it was unchanged with nitroprusside alone. Mean systemic arterial pressure increased from 83.7 ± 2.1 to 89.2 ± 2.7 mm Hg after ephedrine (P < 0.02) and decreased to 73.4 ± 2.4 mm Hg with nitroprusside added (P < 0.01). Left ventricular filling pressure was unchanged after ephedrine but decreased from 30.9 ± 2.3 to 20.6 ± 2.1 mm Hg during nitroprusside infusion (P < 0.01). Control cardiac output averaged 3.94 ± 0.30 liters/min and increased by 1.25 ± 0.31 liters/min with nitroprusside, by 1.09 ± 0.30 liters/min after ephedrine and by 2.20 ± 0.34 liters/min with the two combined. Although the increases in cardiac output with each agent alone were significant and similar, the increase with the two combined was significantly greater than with either alone. The data suggest that ephedrine is an orally effective inotropic agent especially when combined with a vasodilator. Further evaluation of ephedrine in congestive heart failure is warranted.     

The learning curve associated with the implantation of the Nanostim leadless pacemaker

Purpose

Use of novel medical technologies, such as leadless pacemaker (LP) therapy, may be subjected to a learning curve effect. The objective of the current study was to assess the impact of operators’ experience on the occurrence of serious adverse device effects (SADE) and procedural efficiency.

Methods

Patients implanted with a Nanostim LP (Abbott, USA) within two prospective studies (i.e., LEADLESS ll IDE and Leadless Observational Study) were assessed. Patients were categorized into quartiles based on operator experience. Learning curve analysis included the comparison of SADE rates at 30 days post-implant per quartile and between patients in quartile 4 (>?10 implants) and patients in quartiles 1 through 3 (1–10 implants). Procedural efficiency was assessed based on procedure duration and repositioning attempts.

Results

Nanostim LP implant was performed in 1439 patients by 171 implanters at 60 centers in 10 countries. A total of 91 (6.4%) patients experienced a SADE in the first 30 days. SADE rates dropped from 7.4 to 4.5% (p =?0.038) after more than 10 implants per operator. Total procedure duration decreased from 30.9?± 19.1 min in quartile 1 to 21.6?± 13.2 min (p <?0.001) in quartile 4. The need for multiple repositionings during the LP procedure reduced in quartile 4 (14.8%), compared to quartiles 1 (26.8%; p <?0.001), 2 (26.6%; p <?0.001), and 3 (20.4%; p =?0.03).

Conclusions

Learning curves exist for Nanostim LP implantation. Procedure efficiency improved with increased operator experience, according to a decrease in the incidence of SADE, procedure duration, and repositioning attempts.

     

Resting heart rate predicts metabolic syndrome in apparently healthy non-obese Japanese men

Autonomic nervous dysfunction is considered to be one of the mechanisms of metabolic syndrome (MetS). The aim of this study is to investigate whether resting heart rate, a marker of autonomic nervous dysfunction, is a predictor of MetS in apparently healthy non-obese [body mass index (BMI) <25 kg/m²] Japanese men. This is an observational study through 3 years in apparently healthy Japanese 1,265 men and 793 women without MetS and with no history of cardiovascular disease and no use of antihypertensive, antidiabetic, or antihyperlipidemic medication at baseline. Hazard ratios (HRs) of incident MetS were calculated for each 1 SD increase in heart rate stratified by gender and obesity. Incidence of MetS for each tertile of heart rate and HRs of MetS for the highest tertile (T3) compared with the lowest tertile (T1) were calculated stratified by gender and obesity. The HRs [95 % confidence intervals (CIs)] of MetS for each 1 SD increase in heart rate were 1.319 (1.035–1.681) (p = 0.025) in non-obese men, 1.172 (0.825–1.665) (p = 0.377) in obese men, 1.115 (0.773–1.608) (p = 0.560) in non-obese women, and 1.401 (0.944–2.078) (p = 0.094) in obese women adjusted for BMI, age, smoking, alcohol drinking, and physical activity. The HRs (95 % CIs) of MetS for T3 were 2.138 (1.071–4.269) (p = 0.031) in non-obese men and 1.341 (0.565–3.180) (p = 0.506) in obese men adjusted for pre-existing five components of MetS, age, smoking, alcohol drinking, and physical activity. In conclusion, an increase in resting heart rate was a significant predictor of MetS in non-obese Japanese men.     

Inflammation and ventricular-vascular coupling in hypertensive patients with metabolic syndrome

Background and aims

Metabolic syndrome (MetS) is currently considered to raise the risk for type 2 diabetes and cardiovascular events. It has been suggested that part of this risk excess may be due to a cluster of additional factors associated with MetS. We aimed to investigate the role of inflammation on the ventricular-vascular coupling in patients with MetS.

Total bilirubin is inversely associated with metabolic syndrome but not a risk factor for metabolic syndrome in Japanese men and women

Serum total bilirubin (TB) is a potent antioxidant and inversely associated with metabolic syndrome (MetS) in Asian populations. However, there has been no study which is aimed to investigate whether TB is a risk factor for MetS or not. We investigated cross-sectional and longitudinal associations between TB and MetS in 2,435 Japanese men and 1,436 Japanese women. The odds ratios [95 % confidence interval (CI)] of coexisting MetS for each 1 SD increase in log TB were 0.850 (0.754–0.958) (p = 0.008) in men and 0.809 (0.656–0.998) (p = 0.047) in women adjusted for sex, age, smoking, and other confounding covariates. Those for the third and fourth quartiles of TB compared with the lowest quartile were 0.720 (0.537–0.965) (p = 0.028) and 0.737 (0.530–1.052) (p = 0.095), respectively, in men and 0.822 (0.473–1.427) (p = 0.486) and 0.704 (0.362–1.369) (p = 0.301), respectively, in women. There was a tendency that TB and MetS changed inversely to each other. The similarly adjusted hazard ratios of developing MetS for each 1 SD increase in log TB and for the higher quartiles of TB compared with the lowest quartile were not significant either in men or in women. TB is inversely associated with MetS but not a risk factor for MetS in Japanese men and women.     

Reproducibility of multistage graded exercise testing in patients with chronic stable angina

Exercise testing is widely used for the diagnosis of ischaemic heart disease and for the evaluation of antiaginal drugs. To assess reproducibility, analysis was carried out on 128 paired graded exercise tests from 103 patients performed at the same time of day and under identical conditions. Six different parameters were evaluated and compared between the basal test (no treatment) and the placebo test. During the basal period the mean (±SEM) exercise time to the development of angina was 6.0 (±0.2) min and the 1 mm ST depression time was 4.1 (±0.2) min. After 2 weeks of placebo the exercise time was 6.1 (±0.2) min (P = NS) and the 1 mm ST depression time was 4.2 (±0.2) min (P = NS). There was no significant difference between the resting or maximum heart rate on either test and the maximum ST segment depression (leads CM5 and CC5) was unaltered. In a second group of 17 patients where the basal tests were performed in the afternoon and the placebo tests in the morning, heart rate and ST segment were found to be reproducible but there was a significant difference in exercise time: 5.7 (±0.7) min for the basal test and 8.3 (±0.5) min for the placebo test (P < 0.001); and of the 1 mm ST depression time: 2.7 (±0.4) min for the basal test, and 5.4 (±0.5) min for the placebo test (P < 0.001).We conclude that exercise tests done under standardised conditions in the morning are highly reproducible in patients with chronic stable angina and therefore provide a valuable test for the evaluation of antianginal drugs.     

Weight loss but not gains in cardiorespiratory fitness after exercise-training predicts improved health risk factors in metabolic syndrome

Background and aims

To examine the relationship between changes in cardiorespiratory fitness (CRF; estimated by VO₂max) and metabolic syndrome (MetS) after an exercise training intervention to confirm/contradict the high association found in cross-sectional observational studies.

Epidural anesthesia with the trendelenburg position for cesarean section with or without a cardiac surgical procedure in patients with severe mitral stenosis: A hemodynamic study

The hemodynamic effects of epidural anesthesia (EA) with the Trendelenburg position were studied in seven patients with severe mitral stenosis undergoing emergency cesarean section (CS) because of hemodynamic deterioration. In six patients, the CS was immediately followed by an open mitral commissurotomy under general anesthesia, whereas in one patient, the CS was performed alone. A significant reduction in heart rate (120 ± 5 to 83 ± 7 beats/min; P < 0.001) was observed after induction of EA. Mean arterial pressure (MAP) decreased (78 ± 9 to 55 ± 5 mm Hg; P < 0.01) simultaneously with reduction of the pulmonary capillary wedge pressure (PCWP) (37 ± 4 to 15 ± 4 mm Hg, P < 0.001) and cardiac index (CI) (2.4 ± 0.3 to 1.8 ± 0.32 L/min/m²; P < 0.001). However, PCWP could be adjusted by selecting the appropriate angle of the Trendelenburg position. When the PCWP was approximately 25 mm Hg, MAP and CI increased to 72 ± 7 mm Hg and 3.1 ± 0.4L/min/m², respectively, and a satisfactory hemodynamic state was achieved. Systemic vascular resistance decreased after induction of EA (2,250 ± 250 to 1,750 ± 450 dyne · s · cm⁻⁵; P < 0.001), and remained unchanged during the perioperative period. It is concluded that the combination of epidural anesthesia with tilting of the table is a safe method for urgent CS in pregnant women with critical mitral stenosis in whom termination of pregnancy is indicated because of hemodynamic deterioration.     

Inotropic effect of post-stimulation potentiation in man: an echocardiographic study.

To determine the magnitude of enhancement of the inotropic state in the intact human left ventricle, echocardiographic studies were performed in 11 subjects during pacing-induced changes in heart rate. Incremental atrial or ventricular pacing (80 to 160 beats/min) was performed for 1 minute at each rate, and echocardiographic variables of left ventricular function and indexes of left ventricular thickening were assessed for the post-stimulation beats and compared with the values obtained during sinus rhythm before pacing. For the first post-stimulation beat at maximal paced rates (146 ± 3 beats/min, mean ± standard error of mean), the ejection fraction (+23 percent P < 0.001), percent fractional shortening (+45 percent, P < 0.001) and mean velocity of circumferential fiber shortening (+45 percent, P < 0.001) increased significantly, whereas the end-systolic dimension (?22.4 percent, P < 0.001) and volume (? 52 percent, P < 0.001) decreased significantly. The end-diastolic dimension (+1.42 percent) and volume (+4.8 percent) did not change significantly. Similarly, septal thickening (+21.89 percent, P < 0.005), posterior wall thickening (+23.4 percent, P < 0.001), left ventricular thickening (+21.91 percent, P < 0.001) and the mean rate of left ventricular thickening (+33 percent, P < 0.001) increased significantly. Similar significant changes, although of a lesser magnitude, occurred at lower paced rates; the magnitude of these changes was proportional to the pacing rate. Decay in potentiation occurred within four to five beats after pacing was stopped at any given rate.Thus, in the intact human heart (1) the positive inotropic effects of stimulation on the left ventricle are reflected as post-stimulation potentiation, (2) potentiation is related to the pacing rate, and (3) decay in potentiation occurs rapidly when pacing is stopped.     

Differences in cardiovascular manifestations between ankylosing spondylitis patients with and without kyphosis

The objective of this study is to evaluate the differences in cardiovascular manifestations between ankylosing spondylitis (AS) patients with and without kyphosis. A retrospective review of consecutive AS patients treated at our hospital between June 2013 and June 2015 was performed. There were 122 patients who met all of the inclusion and exclusion criteria. Among these patients, there were 57 (ASK group) patients with global kyphosis (GK)?>?40° and 65 (AS group) patients with GK?<?40°. General information, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), electrocardiography, and echocardiography were record. ESR and CRP levels in the ASK group were significantly higher than the AS group (P?<?0.05). Fifteen patients in ASK group but 3 patients in AS group suffered from a left ventricular high voltage (P?<?0.05). Heart rate in ASK group was 83.91?±?13.68 beats/min, and it was 73.88?±?13.04 beats/min in AS group (P?<?0.05). The E/A ratio was 1.13?±?0.38 in ASK group and 1.32?±?0.49 in AS group (P?<?0.05). The mitral E-wave deceleration time and isovolumetric relaxation time were, respectively, 236.25?±?34.26 ms and 101.86?±?17.57 ms in ASK group, which were shorter in AS group (P?<?0.05). This study showed that AS patients with kyphosis had a statistically increased incidence of cardiovascular complications including a more rapid heart rate, left ventricular high voltage, and left ventricular diastolic dysfunction.     

Preferred QT Correction Formula for the Assessment of Drug‐Induced QT Interval Prolongation

Drug‐Induced QTc Interval Assessment. Introduction: There is debate on the optimal QT correction method to determine the degree of the drug‐induced QT interval prolongation in relation to heart rate (ΔQTc). Methods: Forty‐one patients (71 ± 10 years) without significant heart disease who had baseline normal QT interval with narrow QRS complexes and had been implanted with dual‐chamber pacemakers were subsequently started on antiarrhythmic drug therapy. The QTc formulas of Bazett, Fridericia, Framingham, Hodges, and Nomogram were applied to assess the effect of heart rate (baseline, atrial pacing at 60 beats/min, 80 beats/min, and 100 beats/min) on the derived ΔQTc (QTc before and during antiarrhythmic therapy). Results: Drug treatment reduced the heart rate (P < 0.001) and increased the QT interval (P < 0.001). The heart rate increase shortened the QT interval (P < 0.001) and prolonged the QTc interval (P < 0.001) by the use of all correction formulas before and during antiarrhythmic therapy. All formulas gave at 60 beats/min similar ΔQTc of 43 ± 28 ms. At heart rates slower than 60 beats/min, the Bazett and Framingham methods provided the most underestimated ΔQTc values (14 ± 32 ms and 18 ± 34 ms, respectively). At heart rates faster than 60 beats/min, the Bazett and Fridericia methods yielded the most overestimated ΔQTc values, whereas the other 3 formulas gave similar ΔQTc increases of 32 ± 28 ms. Conclusions: Bazett's formula should be avoided to assess ΔQTc at heart rates distant from 60 beats/min. The Hodges formula followed by the Nomogram method seem most appropriate in assessing ΔQTc. (J Cardiovasc Electrophysiol, Vol. 21, pp. 905‐913, August 2010)     

Dynamic QT Interval Changes from Supine to Standing in Healthy Children

Background

QT-interval variations in response to exercise-induced increases in heart rate have been reported in children and adults in the diagnosis of long QT syndrome (LQTS). A quick standing challenge has been proposed as an alternative provocative test in adults, with no pediatric data yet available.

Hematological parameters and metabolic syndrome: Findings from an occupational cohort in Ethiopia

AimsTo examine associations between hematological parameters (i.e., hemoglobin, hematocrit, platelet counts, red blood cell (RBC), and white blood cell (WBC) counts) and components of metabolic syndrome (MetS) among working adults in Addis Ababa, Ethiopia.Materials and MethodsParticipants were 1868 (1131 men and 737 women) working Ethiopian adults. MetS was classified according to the International Diabetes Federation criterion. Odds ratios (ORs) and 95% confidence intervals (95% CIs) of MetS were calculated using logistic regression procedures.ResultsHematologic parameters (hemoglobin, hematocrit, and RBC) were positively associated with MetS components (P_trend < 0.05). In both men and women, white blood cell (WBC) counts were positively associated with BMI and waist circumference (P < 0.05). RBC counts were associated with diastolic blood pressure in men (P < 0.05) and women (P < 0.001). Men in the third quartile of hemoglobin concentrations had 2-fold increased odds (OR = 1.99; 95% CI) of MetS compared with the lowest reference quartile (P_trend = 0.031) while women in the fourth hemoglobin quartile had 2.37-fold increased odds of having MetS compared with the reference group (P_trend = 0.003). Both men and women in the fourth quartiles of RBC counts had 2.26-fold and 3.44-fold increased odds of MetS (P = 0.002 in men, P < 0.001 in women). Among women, those in the fourth quartiles of hematocrit and platelet counts had 2.53-fold and 2.01-fold increased odds of MetS as compared with those in the reference group (P_trend = 0.004 and 0.065 respectively).ConclusionOur study findings provide evidence in support of using hematological markers for early detection of individuals at risk for cardiovascular disease.     

Prevalence and risk factors of metabolic syndrome among an endangered tribal population in Malaysia using harmonized IDF criteria

The prevalence and risk factors associated with metabolic syndrome (MetS) of endangered subtribes are scantly reported. The purpose of this study was to assess the risk factors associated with MetS among the endangered Orang Asli (OA) populations using the latest harmonized International Diabetes Federation (IDF) definition. This cross-sectional study was conducted in geographical locations of the endangered subtribes namely Che Wong, Kensiu, Lanoh, and Orang Kanaq by random selection, and Semai was selected as a subtribe with a larger population as a comparison area in Peninsular Malaysia. A total of 160 respondents aged between 18 and 72 years were recruited. The respondents were measured for their weight, height, waist circumference, and blood pressure. Overnight fasting venous blood samples were analyzed for lipid profile and plasma glucose. The overall prevalence of MetS was 17.0 % (27/159). MetS rate among the endangered population only was 20.5 % (24/117). MetS prevalence was higher among the suburban Orang Kanaq (63.6 %), Che Wong (18.5 %), and Kensiu (16.4 %) subtribes and lower among the rural Lenoh (12.5 %) and Semai (7.1 %) subtribes (P = 0.003). MetS was significantly higher in females (23.8 %) compared to male (5.2 %) respondents. The risk factors identified for higher prevalence of MetS in females included overweight and obesity (P < 0.001), increased waist circumference (P < 0.001), and reduced high-density lipoprotein cholesterol (HDL-C) (P < 0.001). The prevalence of MetS among the endangered OA females is alarmingly high, especially among Orang Kanaq subtribe, which needs immediate attention.     

Cholinergic Stimulation Improves Autonomic and Hemodynamic Profile During Dynamic Exercise in Patients With Heart Failure

BackgroundParasympathetic dysfunction is an independent risk factor for mortality in heart failure for which there is no specific pharmacologic treatment. This article aims to determine the effect of pyridostigmine, an anticholinesterase agent, on the integrated physiologic responses to dynamic exercise in heart failure.Methods and ResultsPatients with chronic heart failure (n = 23; 9 female; age = 48 ± 12 years) were submitted to 3 maximal cardiopulmonary exercise tests on treadmill in different days. The first test was used for adaptation and to determine exercise tolerance. The other tests were performed after oral administration of pyridostigmine (45 mg, 3 times/day, for 24 hours) or placebo, in random order. All patients were taking their usual medication. Pyridostigmine reduced cholinesterase activity by 30%, inhibited the chronotropic response throughout exercise, up to 60% of maximal effort (pyridostigmine = 108 ± 3 beats/min vs. placebo = 113 ± 3 beats/min; P = .040), and improved heart rate reserve (pyridostigmine = 73 ± 5 beats/min vs. placebo = 69 ± 5 beats/min; P = 0.035) and heart rate recovery in the first minute after exercise (pyridostigmine = 25 ± 2 beats/min vs. placebo = 22 ± 2 beats/min; P = .005), whereas peak heart rate was similar to placebo. Oxygen pulse, an indirect indicator of stroke volume, was higher under pyridostigmine during submaximal exercise.ConclusionsPyridostigmine was well tolerated by heart failure patients, leading to improved hemodynamic profile during dynamic exercise.     

Different distribution of phenotypes and glucose tolerance categories associated with two alternative proposed cutoffs of insulin resistance

We investigated whether two alternative HOMA-IR thresholds recently proposed identify similar phenotype and have the same impact on gluco-metabolic risk. The two IR cutoffs, IR1 and IR2 (IR1: HOMA-IR >5.9 and IR2: HOMA-IR between 2.8 and 5.9 with HDL-C <51 mg/dl), were applied to a database of 2,360 outpatients, and their association with phenotypes, glucose tolerance, lipids and metabolic syndrome (MetS) was examined. IR1 group showed 5.5 % of overweight versus 27.8 % of IR2 subjects, and obesity was present in 92.3 versus 68.4 %, respectively. We observed the major prevalence of pathological waist in IR1 compared to IR2 subjects: 96.0 versus 80.5 % (p < 0.001). After OGTT, IR1 patients presented higher prevalence of impaired glucose tolerance (IGT: 25.8 vs. 20.2 %, p < 0.001) and DM2 was diagnosed in 39.7 % of IR1 versus 11.3 % of IR2 patients (p < 0.001) with odds ratio (OR) 8.3 (95 % CI 6.1–11.6) versus 0.8 (0.6–1.2), respectively. IR1 versus IR2 cutpoint showed higher significant (mean ± SEM) total cholesterol (224.8 ± 2.6 vs. 213.1 ± 1.7 mg/dl, p < 0.001) and triglyceride (208.1 ± 12.3 vs. 177.4 ± 4.8 mg/dl, p < 0.001) levels. MetS prevalence was significantly higher in IR1 than IR2 (89.0 vs. 78.3 %, p < 0.001). The IR1 cutpoint was associated with a higher OR of MetS 7.3 (5.3–10.2) versus 5.2 (2.8–9.5) of IR2. In summary, the two alternative HOMA-IR cutoffs identify subjects with different distribution of phenotypes and gluco-metabolic risk. The IR1 patients are characterized by higher prevalence of obesity, pathological waist, MetS, dyslipidemia and IGT/DM2.     

Heart rate predicts mortality in patients with heart failure and preserved systolic function

BackgroundElevated resting heart rates have been associated with increased mortality and morbidity in patients with heart failure and decreased left ventricular ejection fraction (EF). It is unclear, though, if this association applies to those with heart failure and preserved EF.Methods and ResultsWe determined outcome for 685 consecutive patients with a prior diagnosis of heart failure and a preserved EF (>50%) documented on echocardiography at 1 of 3 laboratories. Patients with non-sinus rhythm were excluded from the analysis. We determined adjusted mortality rates at 1 year after the echocardiogram. The mean age of the cohort was 70 ± 11 years. Of the 685 included patients, 87% had a history of hypertension, 50% had diabetes, and the mean EF was 60% ± 6%. All-cause mortality at 1 year was significantly lower in the group with heart rate below 60 beats/min (10%) when compared with the group with heart rates between 60 and 70 beats/min (18%), 71–90 beats/min (20%), and >90 beats/min (35%) (P < .0001). After adjustment for patient history, demographics, laboratory values, and echocardiographic findings, the hazard ratios for total mortality (relative to a heart rate of <60) were 1.26 (95% CI, 0.88–1.80) for HR 60–69, 1.47 (95% CI, 1.02–2.07) for HR 70–90, and 2.00 (95% CI, 1.31–3.04) for HR>90 (P = .01 across all groups).ConclusionsThese data suggest that an elevated resting heart rate is a marker for increased mortality in patients with heart failure and preserved systolic function. Heart rate may be useful in these patients for improved cardiovascular risk assessment.     

Clinical significance of heart rate during acute decompensated heart failure to predict left ventricular reverse remodeling and prognosis in response to therapies in nonischemic dilated cardiomyopathy

Although an increased heart rate (HR) is a strong predictor of poor prognosis in cases of chronic heart failure (HF), the clinical value of HR as a predictor in acute decompensated HF (ADHF) is unclear. Seventy-eight patients with nonischemic dilated cardiomyopathy (NIDCM) with sinus rhythm who were first hospitalized for ADHF from 2002 to 2010 were retrospectively investigated after exclusion of patients with tachycardia-induced cardiomyopathy. The patients were divided into two groups stratified by HR on admission with a median value of 113 beats/min (Group H with HR ≥ 113 beats/min; Group L with HR < 113 beats/min). Despite similar backgrounds, including pharmacotherapy for HF, HR changes responding to titration of β-blocker (BB) therapy and myocardial interstitial fibrosis, left ventricular (LV) ejection fractions improved more significantly 1 year later in Group H than in Group L (57 % ± 11 % vs. 46 % ± 12 %, P < 0.001). Cardiac event-free survival rates were also significantly improved in Group H (P = 0.038). Multiple regression analysis revealed that only the peak HR on admission was an independent predictor of LV reverse remodeling (LVRR) 1 year later (β = 0.396, P = 0.005). High HR on first admission for ADHF is a strong predictor of LVRR, with a better prognosis in the event of NIDCM in response to optimal pharmacotherapy, independent of pre-existing myocardial damage and subsequent HR reduction by BB therapy.