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Background Cardiac resynchronization therapy (CRT) is an effective treatment for left ventricular reverse remodeling (LVRR) in patients with congestive heart failure (HF) and ventricular dyssynchrony. Melatonin is a secretory product of the pineal gland with highly beneficial effects from any tissues including the heart. Herein, we investigated whether the response to CRT is associated with levels of melatonin before CRT implantation in patients with HF and ventricular dyssynchrony. Methods Diurnal melatonin levels were performed in serum from 93 patients with HF and ventricular dyssynchrony before CRT implantation. Moreover, we calculated the MADIT-CRT score. Evaluation of patients at 1-year follow-up included an echocardiographic study since the patients were categorized as responders if they presented both a reduction in left ventricular end-systolic volume index > 10% and an increase in left ventricular ejection fraction > 10%. Results At 1-year, 34 patients (36.5%) were considered responders to CRT according to the predefined criteria. The diurnal melatonin levels were significantly lower in the non-responder group (9.9 ± 2.84 vs 14.7 ± 2.32 pg/mL). After adjustment by multivariate analysis, diurnal serum melatonin levels ( P < 0.001) and diabetes mellitus ( P = 0.03) were predictors of LVRR. On Cox regression analysis, diurnal serum melatonin levels ( P < 0.001) and left atrial volume < 40 mL/m 2 ( P = 0.04) remained independent predictors of the adverse clinical events. The area under of curve for the prediction LVRR of melatonin (0.91, 95%CI 0.85–0.97; P < 0.001) was significantly higher compared to MADIT-CRT score (0.69, 95%CI 0.58–0.80; P = 0.002). Conclusion Diurnal levels of melatonin before CRT implantation are associated with LVRR at 12 month follow-up. [ABSTRACT FROM AUTHOR]

Abstract: Background: Levosimendan is a new calcium sensitizer with positive inotropic properties. In previous studies, it has recently been shown that levosimendan improves the Doppler echocardiographic parameters of the left ventricular (LV) diastolic function in patients with anterior acute myocardial infarction. We sought to evaluate the effects of levosimendan compared to dobutamine on LV diastolic function, using conventional transmitral Doppler, in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI) who subsequently developed cardiogenic shock. Methods: We randomized 22 consecutive STEMI patients with cardiogenic shock after primary PCI to levosimendan or dobutamine infusion and we also analyzed the diastolic function using conventional transmitral Doppler flow. Results: Twenty-four hours after the initiation of the drug infusion, patients treated with levosimendan (n =11) showed a significant reduction of the isovolumetric relaxation time (116±15.2–70.4±10.8 ms; P <.001), and a significant increase of the E/A ratio (0.6±0.3–1.4±0.5; P <.001). In the dobutamine group (n =11), no statistically significant differences were noted in the echocardiographic Doppler indexes. Conclusion: Levosimendan seems to be effective in improving the Doppler echocardiographic parameters of LV diastolic function in patients with STEMI revascularised by primary PCI who developed cardiogenic shock. [Copyright &y& Elsevier]

Background: Currently available evidence suggests a potentially protective role for interleukin (IL)-10 in atherosclerosis. Reactive oxygen species, such as superoxide anion, hydrogen peroxide, peroxynitrite, and hydroxyl radical, seem to play a pivotal role in the pathogenesis of ischemia-reperfusion injury. The aim of this study was to assess whether a rise in lipid peroxidation (LPx), as malondialdehyde (MDA) and 4 hydroxyalkenal (4-HNE), during acute myocardial infarction (AMI) is associated with serum concentrations of IL-10. Methods: A total of 50 patients diagnosed with AMI and 50 control subjects were studied. Primary angioplasty was performed in the 50 patients with an indication for reperfusion. Serum IL-10 and LPx (MDA+4-HNE) concentrations were measured using commercially available enzyme-immunoassays. The venous blood samples were taken 90±35 min after having obtained a TIMI III flow in patients with AMI. In control subjects, blood samples were taken at the time of admission to hospital. Results: IL-10 concentrations were higher in patients with AMI compared with control subjects (32.45±2.17 vs. 22.10±2.40 pg/ml; P=0.03). Serum LPx concentrations were higher in the AMI group (22.20±3.63 vs. 11.90±1.26 μM; P=0.01). IL-10 levels in patients with AMI were significantly correlated with the concentrations of LPx (Pearson''s r=0.49, P=0.02). Conclusions: Our results provide evidence that (1) IL-10 is increased in a human model of myocardial ischemia-reperfusion and (2) reperfusion injury and elevated IL-10 levels are related in patients with AMI treated with primary percutaneous transluminal coronary angioplasty. [Copyright &y& Elsevier]

Abstract: Myeloperoxidase (MPO) is a marker of inflammation that has been suggested to have prognostic role in patients with acute coronary syndrome. We sought to investigate whether day–night variations occur in the concentration of circulating MPO in patients with ST-segment elevation myocardial infarction (STEMI), as this may have practical implications. We assessed 70 consecutive STEMI patients admitted to the Coronary Care Unit and 50 age- and gender-matched apparently healthy control subjects. Blood samples were drawn at 09:00 a.m. (light phase) and 02:00 a.m. (dark phase). MPO was measured using a commercially available ELISA. MPO levels showed no diurnal variations in control subjects. In STEMI group, however, MPO concentration (ng/mL) in the dark phase was significantly higher than that in the light phase (83.30±33.08 vs. 64.10±31.30, p <0.001). The study shows for the first time the existence of diurnal variations in MPO levels in STEMI patients, which indicates the need for standardizing the time of blood sampling for the assessment of this molecule. [ABSTRACT FROM AUTHOR]

Abstract: Background: A circadian variation in the time of onset of ST-segment elevation myocardial infarction (STEMI) with peak in the morning hours has been described. We sought to investigate the impact of circadian patterns on the practice of primary angioplasty in individuals residing in Tenerife Island (Spain). Methods: 90 consecutive patients with STEMI were treated in our hospital. All patients were admitted within 6 h from symptom onset. Patients were divided into 2 groups according to the time of treatment: routine duty hours (0800–1800) and off-hours (1800–0800). Results: There were no differences in baseline clinical characteristics or treatment delays between routine duty hours and off-hours patients. There is a significant higher rate of angioplasty failure and in-hospital mortality from 1800 to 0800 h compared to the time range from 0800 to 1800 h. Conclusions: Circadian variations have a profound effect on the practice of primary angioplasty. [Copyright &y& Elsevier]

Abstract: Background: Patients with baseline renal dysfunction (BRD) have an increased cardiovascular risk and a worse prognosis after an acute myocardial infarction (AMI). Besides, the appearance of worsening renal failure (WRF) after an AMI is an independent predictor of worse prognosis too. The aim of the present study was to determine the in-hospital prognostic significance of BRD and WRF in patients with ST-segment elevation myocardial infarction (STEMI) who underwent successful primary angioplasty (PA). Methods: Seventy-six consecutive patients with STEMI diagnosis were admitted to our department and treated with PA successfully. Two groups were established in relation to the presence of BRD on admission (defined by a ClCr<60 ml/min/1.73 m2, estimated by the modification of diet in renal disease equation). We compared their baseline characteristics and their in-hospital mortality and developing of WRF. Results: BRD was associated to a greater in-hospital mortality (11.5% vs. 2.7%, p =0.009) and a higher incidence of WRF (12.2% vs. 2.5%, p <0.001). After adjusting by confounding factors, the multiple logistic regression analysis demonstrated that BRD was an independent predictor of in-hospital mortality (OR 2.5, CI 95% 1.5–3.8, p <0.001). Besides, WRF was associated to a greater in-hospital mortality too, independent of the presence of BRD (OR 1.9, CI 95% 1.3–2.4, p <0.001). Conclusions: BRD was an independent predictor of in-hospital mortality in patients with STEMI who underwent successful PA. Likewise, WRF occurring in these patients was an independent predictor of in-hospital mortality too. [Copyright &y& Elsevier]

Abstract: Background: Results of previous studies have shown that serum neopterin levels are higher in patients with acute myocardial infarction (AMI). However, little is known regarding the prognostic value of neopterin in survivors of AMI. The present study analyzes the prognostic value of neopterin serum concentration and left ventricular ejection fraction in survivors of AMI. Methods: The additional prognostic information provided by neopterin to parameters of left ventricular function in survivors of AMI was investigated through 82 patients with ST-segment elevation. Results: Binary logistic regression analysis identified the following predictors of 6-month cardiac death: Killip class >I at presentation (OR=2.4, 95% CI: 1.2 to 3.8, p =0.001), a reduced ejection fraction (OR=1.9, 95% CI: 1.3 to 2.2, p =0.001), and greater neopterin (OR=1.4, 95% CI: 1.1 to 1.6, p =0.01). Conclusions: Neopterin is associated with mortality, in addition to parameters of ventricular function (Killip class and ejection fraction) in survivors of AMI. [Copyright &y& Elsevier]

Abstract: Background: Recent studies have shown that pro-inflammatory cytokines play a significant contributory role in the pathogenesis of the acute heart failure. The purpose of this study was to determine whether the serum IL-8 concentration in patients with acute myocardial infarction (AMI), who were undergoing percutaneous coronary intervention (PCI) was related to the subsequent presence or absence of heart failure. Methods: The study included 50 patients who underwent successful PCI. During their subsequent stay in the coronary care unit, their maximum degree of heart failure was recorded. Patients were then divided into two groups: group A (Killip I) and group B (Killip class >I). The serum IL-8 concentration was measured during the 24 h following admission to the coronary care unit. Results: Serum levels of IL-8 in the group B were significantly higher than those of group A (P <0.001). By multivariante analysis a higher level of IL-8 was a significant predictor of heart failure after PCI. Conclusions: Serum levels of IL-8 after PCI appear to be a predictor for the development of heart failure in patients with AMI. [Copyright &y& Elsevier]