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Introduction: Hyperuricemia is a cardiovascular risk factor associated with oxidative stress and inflammation, conditions that are involved in the genesis of atherosclerotic disease and in the progression of ischemic heart disease to heart failure. The aim of our retrospective study is to evaluate the variations of serum uric acid level in patients with ventricular dysfunction, in order to highlight any correlations. Methods: We enrolled 118 patients. In our population we identified three groups: patients with systolic and diastolic dysfunction (ejection fraction A wave, n = 54). All patients underwent echocardiography and laboratory test (VES, PCR and serum uric acid). Results: Patients with diastolic dysfunction with or without systolic dysfunction showed higher values of serum uric acid than patients with normal ventricular function (6.54 ± 0.72 vs. 5.42 ± 0.78, p = 0.016). The linear regression in the group of patients with systolic dysfunction, showed a inverse relationship between the two variables analyzed, so with increasing serum uric acid there is a proportional reduction of the ejection fraction. Conclusions: Patients with isolated left ventricular diastolic dysfunction and patients with systolic and diastolic dysfunction had higher uric acid levels than patients with normal ventricular function and the progressive deterioration of systolic function correlates with a gradual increase in the values of serum uric acid.

Background High values of cardiac troponin in acute decompensated congestive heart failure (ADHF) identify patients at higher risk and worsened prognosis. A cardiac troponin increase during therapy indicates the need for more appropriate intervention, aimed at compensating cardiac disease and effectively minimizing myocardial wall stress and subsequent cytolysis. This study evaluated the effects of an intravenous high dose of furosemide with (group A) or without small volume hypertonic saline solution (HSS) (group B) on myocardial cytolysis in patients with ADHF. Methods A total of 248 consecutive patients with ADHF (148 men, mean age 74.9 ± 10.9 years) were randomly assigned to group A or B. Plasma levels of cardiac troponin-I, brain natriuretic peptide, glomerular filtration rate by Modification of Diet in Renal Disease formula, bioelectrical impedance analysis measurements, and delta pressure/delta time (dP/dt) rate were observed on admission and discharge for all patients. Results We observed a significant reduction of cardiac troponin in both groups and a significant improvement in renal function, hydration state, pulmonary capillary wedge pressure (P b .0001), end diastolic volume (P b .01), ejection fraction (P b .01), and dP/dt (P b .004) in group A. We also observed a significant reduction in body weight (64.4 vs 75.8 kg) (P b .001), cardiac troponin I (0.02 vs 0.31 ng/mL) (P b .0001) and brain natriuretic peptide (542 vs 1,284 pg/mL) (P b .0001), and hospitalization time (6.25 vs 10.2 days) (P b .0001) in the HSS group. Conclusions These data demonstrate that intravenous high doses of furosemide do not increase myocardial injury and, in addition, when associated to HSS, significantly reduce cardiac troponin I release. This behavior is mirrored by the achievement of improved hemodynamic compensation at echocardiography and body hydration normalization

This study aimed to assess if proton pump inhibitors (PPIs) may reduce the effectiveness of clopidogrel, than H2 antagonist (anti-H2) in order to determine rehospitalization for acute coronary syndrome (re-ACS), target vessel revascularization (TVR) and cardiac death. This case-control study included 176 patients with ACS undergoing angioplasty (PCI) with drug-eluting stent implantation. The population was divided into two groups: PPI group (n=121) consisting of patients receiving at discharge dual antiplatelet therapy (DAT) plus PPI and anti-H2 group (n=55), consisting of patients receiving at discharge DAT + H2 receptor antagonist (H2RA). In a followup of 36 months the prevalence of ACS event (P=0.014), TVR (P=0.031) was higher in the PPI group than in the anti-H2 group; instead there was no statistically significant difference between groups for death. The variables independently associated with ACS were the diabetes, omeprazole, and esomeprazole; instead the variables independently associated with TVR were only omeprazole. Our data shows that the use of omeprazole and esomeprazole, with clopidogrel, is associated with increased risk of adverse outcomes after PCI with drug-eluting stent implantation.