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Background: The interpretation and clinical usefulness of elevated levels of cardiac troponins in acute heart failure (AHF) remain controversial. We aimed to characterize the relationship between changes in cardiac troponin I (measured using a new high-sensitive immunoassay by single-molecule counting technology, Singulex, Alameda, USA; hs-TnI) during first 48h of hospital stay and patients' characteristics and the outcomes., Methods and Results: We measured hs-TnI at baseline, after 24 and 48h in 130 AHF patients (mean age: 65±13years, 77% men). The percentage of patients with elevated hs-TnI (i.e., above the upper reference limit [URL]>10.19pg/mL) were: on admission - 59%, after 24h - 61%, and after 48h - 58%. Elevated baseline level of hs-TnI was associated with more severe dyspnoea on admission but neither peak level nor changes in hs-TnI during first 48h were related to the dyspnoea severity or magnitude of dyspnoea relief. During 1-year follow-up there were 32 (25%) cardiovascular deaths. Neither absolute baseline nor peak values of hs-TnI predicted cardiovascular mortality. Only changes in hs-TnI were independently associated with cardiovascular mortality with the strongest relationship seen in peak change in hs-TnI: patients with an increase vs. remaining patients - hazard ratio (95% confidence interval): 3.22 (1.52-6.82)p=0.002., Conclusions: Using the new assay (proved to be more sensitive that the other available troponin assays) we observed that approximately 60% of patients with AHF presented elevated hs-TnI above URL during first 48h of hospital stay. Only significant increase in hs-TnI predicted cardiovascular mortality., (Copyright © 2017 Elsevier B.V. All rights reserved.)

Late onset cardiac tamponade is a rare and particularly challenging (both from diagnostic and management perspectives) complication of intracardiac lead implantation. We present a case of a late tamponade leading to cardiogenic shock, which occurred 1,164 days after implantable cardioverter-defibrillator (ICD) implantation. Open repair revealed unusual and, to our knowledge, not yet reported mechanism of the disease. A pressure sore caused by an ICD lead was found in the parietal layer of pericardium with no visible damage to the visceral layer. Conservative management in the described clinical scenario could be fatal, thus awareness of this pathomechanism of tamponade is critical., (Copyright © 2015 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)

Background/objectives: Iron deficiency (ID) may be an important, treatable co-morbidity complicating cardiovascular diseases, but considerable uncertainty exists about the diagnostic accuracy of blood tests. Accordingly, we investigated the relationship between blood tests for ID and iron stores in bone marrow aspirates, the diagnostic gold-standard for ID, in patients with stable coronary artery disease (CAD)., Methods: Bone marrow aspirates were obtained from 65 patients with stable CAD undergoing cardiac surgery and 10 healthy controls. ID was defined as depleted extracellular iron stores (0-1 grade according to Gale scale) accompanied by ≤10% of erythroblasts containing iron., Results: Bone marrow ID was found in 31 (48%) patients with CAD but in none of the controls (p<0.01). Amongst patients with CAD, ID was present in 10 of 16 (63%) with and 21 of 49 (43%) without anaemia (p=0.17). The clinical profiles of patients with and without ID were similar. Of circulating biomarkers of ID, serum soluble transferrin receptor had the strongest association with bone marrow ID (area under curve: 0.876±0.048, 95% confidence interval: 0.762-0.948, for cut-off of ≥1.32mg/L-sensitivity: 67%, specificity: 97%)., Conclusions: Almost half of patients with stable CAD have profound bone marrow iron depletion that can be accurately assessed non-invasively using serum soluble transferrin receptor., (Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.)

Objective: We sought to determine and compare clinical profile and management of outpatients with heart failure with reduced ejection fraction (HFREF) treated by cardiologists and general practitioners (GPs) in Poland., Methods: All the 790 randomly selected cardiologists and GPs in the DATA-HELP registry, which included 5563 patients, filled out questionnaires about 10 consecutive outpatients with HFREF., Results: Outpatients managed by GPs were older (69±10 vs 66±12 years), and the prevalence of men was less marked (58% vs 67%). They also had higher left ventricular ejection fraction (38±6% vs 35±8%) and had more pulmonary congestion (63% vs 49%) and peripheral oedema (66% vs 51%), compared with those treated by cardiologists (all p<0.001). Hypertension (74% vs 66%), previous stroke and/or transient ischaemic attack (21% vs 16%), diabetes (40% vs 30%), and chronic obstructive pulmonary disease (14% vs 11%) were more common in outpatients of GPs (all p<0.001). GPs were less likely to prescribe β-blocker (95% vs 97%, p<0.01), mineralocorticoid receptor antagonist (MRA) (56% vs 64%, p<0.001), and loop diuretic (61% vs 64%, p<0.05) or use PCI (33% vs 44%, p<0.001), CABG (11% vs 16%, p<0.001), ICD (4% vs 10%, p<0.001), or CRT (1% vs 5%, p<0.001). Prescription of renin-angiotensin system inhibitors (94% vs 94%, p>0.2) and digoxin (20% vs 21%, p>0.2) by GPs and cardiologists was similar., Conclusion: In contemporary Poland, most outpatients with HFREF receive drugs that improve survival and undergo revascularisation procedures, although devices are rare, but the clinical profiles and management of those treated by GPs and cardiologists differ. Outpatients treated by GPs are older and have more co-morbidities. Outpatients treated by cardiologists more commonly receive β-blocker, MRA, ICD, and CRT, and undergo coronary revascularisations., (Copyright © 2014. Published by Elsevier Ireland Ltd.)

Patients affected by chronic heart failure (CHF) present significant impairment of health-related quality of life (HRQoL). Iron deficiency (ID) is a common comorbidity in CHF with negative impact in prognosis and functional capacity. The role of iron in energy metabolism could be the link between ID and HRQoL. There is little information about the role of ID on HRQoL in patients with CHF. We evaluate the impact of ID on HRQoL and the interaction with the anaemia status, iron status, clinical baseline information and HRQoL, measured with the Minnesota Living with Heart Failure questionnaire (MLHFQ) was obtained at baseline in an international cohort of 1278 patients with CHF. Baseline characteristics were median age 68 ± 12, 882 (69%) were males, ejection fraction was 38% ± 15 and NYHA class was I/II/III/IV (156/247/487/66). ID (defined as ferritin level< 100 µg/L or serum ferritin 100-299 µg/L in combination with a TSAT<20%) was present in 741 patients (58%). 449 (35%) patients were anaemic. Unadjusted global scores of MLHFQ (where higher scores reflect worse HRQoL) were worse in ID and anaemic patients (ID+: 42 ± 25 vs. ID-: 37 ± 25; p-value=0.001 and A+: 46 ± 25 vs. A-: 37 ± 25; p-value<0.001). The combined influence of ID and anaemia was explored with different multivariable regression models, showing that ID but not anaemia was associated with impaired HRQoL. ID has a negative impact on HRQoL in CHF patients, and this is independent of the presence of anaemia., (Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.)

Background: Percutaneous coronary intervention (PCI) of a persistently totally occluded infarct-related artery (IRA) in stable high-risk patients >24h after myocardial infarction (MI) does not reduce the occurrence of death, re-infarction, or heart failure. Diabetic patients are at higher risk for cardiovascular events; we examined their outcomes overall with PCI and optimal medical therapy alone (MED)., Methods: The long-term (7-year) outcomes of 454 diabetic patients (20.6%) randomized to PCI or MED in the Occluded Artery Trial (OAT) were assessed for the composite primary endpoint of death, re-MI, or New York Heart Association class IV heart failure. Diabetics and non-diabetics were compared and outcomes assessed by treatment strategy., Results: The 7-year cumulative primary event rate for diabetic patients was 35.0% vs. 19.4% in the non-diabetic cohort (p<0.001). Multivariable analyses revealed diabetes to be an independent predictor (p<0.01) for the primary outcome, fatal or nonfatal recurrent MI, Class IV Heart Failure (HF), and death. The 7-year cumulative primary event rates were 35.3% in the PCI group vs. 34.5% in the medical therapy group in diabetic patients (p=0.19) and 19.3% in the PCI group vs. 19.5% in the medical therapy group in patients without diabetes (p=0.60)., Conclusions: Despite the higher overall risk conferred by the presence of diabetes, PCI did not improve clinical outcomes in this subpopulation, and is not indicated in otherwise stable patients with a totally occluded infarct-related artery in the sub-acute phase after MI., (Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.)

Background: Augmented reflex response from peripheral chemoreceptors characterises chronic heart failure (CHF), contributes to autonomic imbalance and exercise intolerance and predicts poor outcome., Methods and Results: We present a case of a 56-year-old male patient with ischaemic CHF, who underwent surgical, unilateral carotid body resection to reduce peripheral chemosensitivity. At 2-month and 6-month follow-ups, we document a persistent decrease in peripheral chemosensitivity accompanied by an improvement in exercise capacity, sleep disordered breathing and quality of life. Autonomic balance was favourably affected as evidenced by improved heart rate variability and augmented cardiac baroreflex sensitivity. There were no procedure-related adverse events., Conclusions: Denervation of a carotid body may offer a clinical strategy to restore autonomic balance and improve morbidity in heart failure (NCT01653821)., (Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.)

Question: Does the distance covered during a 6-minute walk test predict risk of death or hospitalisation for cardiovascular reasons in men with stable heart failure over three years of follow-up?, Design: Prospective observational study., Participants: 243 men with stable systolic heart failure, with a mean age of 60 yr (SD 11) and left ventricular ejection fraction of 29% (SD 8). According to the New York Heart Association (NYHA) classification, 15% of the participants were in Class I, 44% in Class II, 37% in Class III, and 4% in class IV., Outcome Measures: The exercise capacity of participants was measured using the 6-minute walk test. The participants were followed up for at least three years in the case of survivors. The primary end-points of the survival analyses included cardiovascular death or urgent cardiovascular hospitalisation., Results: During the 3-year follow-up, 44% of the participants died, and 69% died or required hospitalisation for cardiovascular reasons. A multivariate analysis showed that the shorter the distance covered in the 6-minute walk test, the greater the 1-year and 3-year mortality risk. Participants with a 6-minute walk test ≤ 468 m had a mortality hazard ratio of 3.22 (95% CI 1.17 to 8.86) at one year and 2.18 (95% CI 1.18 to 4.03) at three years. Multivariate analysis also showed that higher risk mortality or hospitalisation for cardiovascular reasons was predicted by a 6-minute walk distance ≤ 468m, with a hazard ratio of 2.77 (95% CI 1.30 to 5.88) at one year and 1.71 (95% CI 1.08 to 2.72) at three years., Conclusion: The 6-minute walk test distance constitutes an independent predictor of mortality and mortality or hospitalisation for cardiovascular reasons in men with stable systolic heart failure., (Copyright © 2013 Australian Physiotherapy Association. Published by .. All rights reserved.)

Background: There are few experimental models of heart failure (HF) in large animals, despite structural and functional similarities to human myocardium. We have developed a porcine model of chronic tachycardia-induced cardiomyopathy., Methods: Homogenous siblings of White Large breed swine (n=6) underwent continuous right ventricular (RV) pacing at 170 bpm; 2 subjects served as controls. In the course of RV pacing, animals developed a clinical picture of HF and were presented for euthanasia at subsequent stages: mild, moderate and end-stage HF. Left ventricle (LV) sections were analyzed histologically and relative ANP, BNP, phospholamban and sarcoplasmic reticulum calcium ATPase 2a transcript levels in LV were quantified by real time RT-PCR., Results: In the course of RV pacing, animals demonstrated reduced exercise capacity (time of running until being dyspnoeic: 6.6 ± 0.5 vs. 2.4 ± 1.4 min), LV dilatation (LVEDD: 4.9 ± 0.4 vs. 6.7 ± 0.4 cm), impaired LV systolic function (LVEF: 69 ± 8 vs. 32 ± 7 %), (all baseline vs. before euthanasia, all p<0.001). LV tissues from animals with moderate and end-stage HF demonstrated local foci of interstitial fibrosis, congestion, cardiomyocyte hypertrophy and atrophy, which was not detected in controls and mild HF animals. The up-regulation of ANP and BNP and a reduction in a ratio of sarcoplasmic reticulum calcium ATPase 2a and phospholamban in failing myocardium were observed as compared to controls., Conclusions: In pigs, chronic RV pacing at relatively low rate can be used as an experimental model of HF, as it results in a gradual deterioration of exercise tolerance accompanied by myocardial remodeling confirmed at subcellular level., (Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.)

Background: Age-related decline in circulating androgens in men is associated with poor cardiovascular (CV) outcome. Men with type II diabetes mellitus (DM) are prone to develop androgen deficiency., Objectives: We studied the prevalence and prognostic consequences of deficiencies in circulating total and free testosterone (TT, FT) and dehydroepiandrosterone sulphate (DHEAS) in type II DM men with coronary artery disease (CAD)., Methods: We examined 153 diabetic men with stable CAD (age: 65±9 years). Serum levels of FT were estimated (eFT) from TT and sex hormone binding globulin levels., Results: TT, eFT and DHEAS deficiencies (serum levels≤the 10th percentile of healthy peers) were found in 22%, 33% and 77% of DM men with CAD, being more frequent than in healthy peers (all p<0.001). During follow-up (median: 19 months), there were 43 (28%) CV deaths. We identified 4 independent predictors of CV mortality: testosterone (TT, eFT) and DHEAS deficiencies, high plasma N-terminal pro-B-type natriuretic peptide (≥2661 pg/mL, upper quartile), high serum high sensitivity C-reactive protein (≥6.58 mg/L, upper quartile) (all p<0.01). There was a graded relation between the number of risk factors and increased CV mortality: hazard risk (95% confidence interval) for 1, 2, 3-4 vs. no risk factors, respectively: 5.9 (0.8-45.6), p=0.09, 9.2 (1.2-69.2), 63.0 (8.0-498.7), p<0.0001 (χ(2)=42.23, p<0.0001)., Conclusions: In diabetic men with stable CAD, testosterone and DHEAS deficiencies are common and related to high CV mortality. Whether an androgen substitution would improve prognosis in androgen deficient men with type II diabetes and stable CAD, requires further studies., (Copyright © 2009 Elsevier Ireland Ltd. All rights reserved.)

Background: Abnormalities in the skeletal musculature underlie exercise intolerance in chronic heart failure (CHF). We investigated, whether in CHF selective resistance training without accompanying aerobic regime favourably affects muscle strength, muscle mass and improves exercise capacity., Methods: Ten patients with stable ischaemic CHF in NYHA class III (9 men, age: 70+/-6 years [mean+/-SD], left ventricular ejection fraction: 30+/-5%, peak oxygen consumption [peak VO(2)]: 12.4+/-3.0 mL/min/kg) underwent the rehabilitation programme which consisted of a 12-week training phase (progressive resistance exercises restricted to the quadriceps muscles) followed by a 12-week detraining phase., Results: All subjects completed a training phase of the programme with no adverse events. Resistance training markedly increased quadriceps strength (right leg: 260+/-34 vs. 352+/-28 N, left leg: 264+/-38 vs. 342+/-30 N, both p<0.01 - all comparisons: baseline vs. after training), but did not affect lean tissue mass of lower extremities (both p>0.2). It was accompanied by an improvement in clinical status (all NYHA III vs. all NYHA II, p<0.01), quality of life (Minnesota questionnaire: 44+/-15 vs. 33+/-18 points, p<0.05), exercise capacity assessed using a distance during 6-minute walk test (6MWT: 362+/-83 vs. 455+/-71 m, p<0.01), but not peak VO(2) (p>0.2). Plasma NT-proBNP remained unchanged during the training. At the end of detraining phase, only a partial improvement in quadriceps strength (p<0.05), a 6MWT distance (p<0.05) and NYHA class (p=0.07 vs. baseline) persisted., Conclusions: Applied resistance quadriceps training is safe in patients with CHF. It increases muscle strength, improves clinical status, exercise capacity, and quality of life.

Background: Optimal risk stratification in heart failure patients surviving an episode of acute decompensation has not yet been established. We investigated whether a lack of significant decrease in plasma levels of N-terminal pro-brain natriuretic peptide (NT-proBNP) during hospital stay can identify patients at high risk of poor outcome., Methods: We studied 103 consecutive patients with acute heart failure (86 men, age: 64 + or - 13 years, LVEF: 28 + or - 8%). The primary end-point was all-cause mortality at 1-year follow-up., Results: Median plasma NT-proBNP on admission was 6116 pg/mL (upper/lower quartiles: 3575, 10,958) vs. 2930 pg/mL (1674, 5794) after clinical stabilization (7 + or - 3 days after admission). During the 1-year follow-up 29 (28%) patients died. A decrease in plasma NT-proBNP during clinical recovery (expressed as percentage of NT-proBNP on admission) predicted favorable outcome in the single predictor analysis (p<0.001) and multivariable analyses (p<0.001). Receiver operating characteristic curve analysis revealed that 65% was the cut-off value for NT-proBNP decrease having best prognostic accuracy for predicting death (sensitivity 90%, specificity 37%, AUC=0.65, 95% CI: 0.54-0.74). Kaplan-Meier analysis showed that 12-month survival was 92% (95% CI: 81-100%) for patients with > pr = 65% NT-proBNP decrease vs 66% (95% CI: 56-76%) in those with <65% NT-proBNP decrease (p=0.02)., Conclusions: The magnitude of plasma NT-proBNP decrease in patients with acute heart failure is helpful in discrimination of patients at high risk of death. Plasma NT-proBNP level monitoring is important for risk stratification in this group of patients.

Background: Inflammatory immune mechanisms are involved in the pathogenesis and progression of chronic heart failure (CHF), and also promote the development of generalised body wasting seen in this syndrome. We examined the activity of nuclear factor kappa-B (NF-kappaB), the major mediator of immune response, in peripheral blood mononuclear cells (PBMC) isolated from cachectic and non-cachectic patients with CHF., Methods: Using electromobility shift assay, NF-kappaB activity was assessed in nuclear fractions of PBMC isolated from 43 patients with systolic CHF (88% men, age: 64 years [median], left ventricular ejection fraction [LVEF]: 30%, ischaemic CHF aetiology: 79%, NYHA class [I/II/III/IV]: 2/21/19/1, 10 patients with cardiac cachexia) and 12 healthy adult subjects., Results: As compared to healthy controls, NF-kappaB activity in PBMC was increased in patients with CHF (P<0.05), in particular in those with severe CHF (NYHA class III-IV) (P<0.05). NF-kappaB activity in PBMC in CHF patients was not related either to age, sex, CHF aetiology, LVEF, or any clinical parameters reflecting disease severity (haemoglobin, LDL cholesterol, sodium and creatinine levels) (all P>0.1). Regardless of the severity of CHF expressed as NYHA class, patients with cardiac cachexia demonstrated significantly reduced NF-kappaB activity in PBMC as compared to both non-cachectic CHF patients (P<0.001) and healthy controls (P<0.05)., Conclusion: The activity of NF-kappaB system in peripheral immune cells is augmented in patients with advanced CHF, whereas it is diminished in those with cardiac cachexia. The significance of derangements within NF-kappaB system in PBMC for immune phenomena seen in cachectic and non-cachectic CHF patients remains further studies.

Background: Patients with chronic heart failure (CHF) may be particularly susceptible to unfavorable effects of hyperhomocysteinemia (HHcy). The aim of this study was to assess the prevalence of HHcy (plasma homocysteine [Hcy]>or=14 micromol/L) in an unselected cohort of CHF patients, its clinical determinants, and prognostic implications., Methods and Results: In 108 consecutive CHF patients (81 men, age: 66+/-11 years) with mean plasma Hcy level 12.5+/-5.5 micromol/L (range 2.3-28.3 micromol/L), 38 (35%) patients demonstrated HHcy. Among clinical and metabolic parameters, in multivariable regression models, advanced NYHA class (P<0.0001), plasma NT-proBNP (P<0.001), peak oxygen consumption (P<0.05), reduced glomerular filtration rate (P<0.0001) and elevated serum uric acid (P<0.05) predicted high plasma Hcy level. HHcy was related to increased mortality (HR=3.26, 95% CI: 1.78-5.98, P=0.0001), also when adjusted for conventional prognosticators in multivariable models (all P<0.01). In patients with HHcy, a 3-year survival was 37% (95% CI: 22-52%) as compared to 73% (95% CI: 63-83%) in those with normal Hcy levels (P<0.0001)., Conclusions: HHcy is common in CHF, is related to the disease severity, depicts generalized metabolic imbalance (evidenced by hyperuricaemia), and independently predicts poor long-term prognosis.

Background: In severe chronic heart failure (CHF) elevated serum levels of uric acid (UA) predict poor survival. This study investigates whether hyperuricaemia (defined as serum UA level > or = 6.5 mg/dL) extends its prognostic value on population with less advanced CHF., Methods: We studied 119 consecutive patients with stable, mild-moderate CHF (88 men, age: 64+/-11 years, NYHA class I/II/III: 9/65/45, LVEF: 32+/-8%)., Results: Serum UA level (mean: 6.2+/-2.0 mg/dL, range: 2.0-16.2 mg/dL) increased in parallel to CHF severity expressed as NYHA class (4.9+/-1.1 vs. 5.7+/-1.5 vs. 7.2+/-2.4 mg/dL, NYHA I vs. II vs. III; NYHA I, II vs. III, p<0.01), inversely correlated with peak oxygen consumption (r=-0.39, p<0.01) and LVEF (r=-0.31, p<0.01), but not with renal function (expressed as creatinine clearance calculated from Cockcroft-Gault formula; r=-0.14, p>0.1), and predicted inflammatory status as evidenced by the correlation with C-reactive protein (r=0.31, p=0.003). Hyperuricaemia was detected in 48 (40%) patients. During follow-up (mean: 580+/-209 days, > 18 months in all survivors), 27 (23%) patients died. Hyperuricaemia was related to impaired survival in univariate (HR 2.8, 95%CI: 1.3-6.1, p=0.01) and multivariate analyses (adjusted for NYHA class and impaired renal function--the only mortality predictors in this population; p<0.05). The 18-month survival for CHF patients with hyperuricaemia was 71% (95% CI: 58-84%) vs. 89% (95% CI: 81-96%) in those with normal UA level (p=0.01)., Conclusion: In patients with mild-moderate CHF, hyperuricaemia predicts exercise intolerance and inflammatory activation and is strongly and independently related to poor prognosis. Whether elevated serum UA level may become a novel therapeutic target in CHF, deserves further studies.

Background: There is minimal evidence that HMG-CoA reductase inhibitors (statins) are beneficial in patients with chronic heart failure (CHF). Treatment with statins may lead to a lower mortality in CHF, independent of cholesterol levels, CHF etiology and clinical status., Methods: In a first study, we included 3132 patients with CHF from the ELITE 2 study in whom information on body mass index (BMI) and statin use at baseline were available. In a second study, we pooled the databases of 5 tertiary referral centers with 2068 CHF patients. In this cohort 705 patients were on a statin (34%), 585 of 1202 (49%) patients with ischemic etiology, and 120 of 866 (14%) patients with non-ischemic etiology (established by coronary angiography)., Findings: Patients in ELITE 2 who received statin therapy at baseline (n=397, 13%) had lower mortality (hazard ratio [HR] 0.61, 95% CI 0.45-0.83; p=0.0007). In univariate analysis, increasing age, NYHA class, creatinine, and decreasing BMI, LVEF, and cholesterol, as well as lack of beta-blocker treatment and ischemic etiology (all p<0.002) related to higher mortality. In multivariable analysis, statin therapy related to lower mortality independently of all these variables (adjusted HR 0.66, 95% CI 0.47-0.93; p=0.017). In the second study CHF patients on statins had lower mortality (adjusted HR 0.58, 95% CI 0.44-0.77; p=0.0001). Both in patients with ischemic (p<0.0001) and non-ischemic etiology (p=0.028) statin treatment related to better survival., Interpretation: In chronic heart failure, treatment with statins is related to lower mortality, independent of cholesterol levels, disease etiology and clinical status.

Background: Mild anaemia frequently occurs in patients with chronic heart failure (CHF), particularly in the advanced stages of the disease. The correction of anaemia with erythropoietin is a therapeutic possibility. The aim of this study was to assess prospectively the relationship between the prevalence of anaemia (haemoglobin level18 months in all survivors), and the end-point of the study was all-cause mortality., Results: A total of 176 patients were enrolled (mean age: 63 years, New York Heart Association (NYHA) classification I/II/III/IV: 15/81/51/29; left ventricular ejection fraction (LVEF): 42%, ischaemic aetiology in 62%). In the whole population the mean haemoglobin level was 140+/-15 g/l. Anaemia was found in 18 (10%) patients, and was significantly more common in women than in men (18 vs. 7%, respectively, P=0.02) and in those with most severe CHF symptoms (frequency in NYHA I/II/III/IV: 0/9/10/21%, respectively; NYHA IV vs. I-III, P=0.03), but not related to the other clinical indices. Univariate analysis revealed NYHA class III-IV (hazard ratio 3.8, 95% CI: 1.6-8.9, P=0.003), low LVEF <35% (hazard ratio 2.3, 95% CI: 1.0-4.9, P=0.04) and anaemia (hazard ratio 2.9, 95% CI: 1.2-7.2, P=0.02) as predictors of 18-month mortality. In multivariate analysis, anaemia remained an independent predictor of death when adjusted for NYHA class and LVEF (hazard ratio: 2.6, 95% CI: 1.0-6.5, P=0.04). In anaemic patients, 18-month survival was 67% (95% CI: 45-89%) compared to 87% (81-92%) in patients with a normal haemoglobin level (P=0.016)., Conclusions: Mild anaemia is a significant and independent predictor of poor outcome in unselected patients with CHF. Correction of low haemoglobin level may become an interesting therapeutic option for CHF patients.

Objective: Testosterone (T) is assumed to be a risk factor for coronary artery disease (CAD). However, recent studies have demonstrated a beneficial effect of T on myocardial ischaemia in men with CAD. To assess the potential role of T in CAD in postmenopausal women we investigated the association between T level and CAD and relationship between T and other CAD metabolic risk factors., Results: Within the 12-month study period, 108 consecutive, postmenopausal women (age 62+/-7 years) referred for diagnostic coronary angiography were prospectively included in the study. In all patients serum level of T, sex hormone-binding globulin (SHBG), total cholesterol (T-chol), LDL-chol, HDL-chol, triglycerides (TG), apolipoproteins A(1) and B (apo A(1), apo B), lipoprotein a [Lp(a)], and C reactive protein were measured. Testosterone free index (TFI) was calculated as Tx100/SHBG. CAD was documented in 51 (47%) patients (CAD+). Women with CAD had decreased T level and lower TFI (T: 0.99+/-0.4 vs. 1.41+/-0.7 nmol/l, P=0.005; TFI: 3.2+/-1.4 vs. 4.2+/-2.2, P=0.04, CAD+ vs. CAD-, respectively). No difference in SHBG was found between the two groups. In 16 women (six CAD+, 10 CAD-) who were on hormonal replacement therapy (HRT+) we observed significantly elevated T level and TFI (T: 1.62+/-0.5 vs. 1.15+/-0.7 nmol/l; TFI: 5.0+/-2.2 vs. 3.5+/-1.8, HRT+ vs. HRT-, respectively, P<0.05). When these women were excluded from the analysis, T level remained decreased in CAD+ group (0.96+/-0.4 vs. 1.22+/-0.5 nmol/l, CAD+ vs. CAD- respectively, P<0.02). CAD+ group had an unfavourable profile of metabolic CAD risk factors as evidenced by elevated T-chol, LDL-chol, Lp(a), apoB, and decreased apoA(1) (P<0.05 vs. CAD- in all comparisons). Neither T nor TFI correlated with CAD metabolic risk factors (r<0.2, P>0.1 for all correlations), apart from an inverse correlation between T and Lp(a) (r=-0.24, P=0.04)., Conclusion: In postmenopausal women decreased T level is associated with CAD independently of the other CAD metabolic risk factors. Hormonal replacement therapy tends to increase T level which may further support the beneficial role of HRT in postmenopausal women.

The aim of the study was to assess whether the P-wave triggered signal-averaged ECG (SAECG) used in patients with idiopathic mitral valve prolapse syndrome could predict the risk of the development of supraventricular arrhythmias. Fifty patients with idiopathic mitral valve prolapse syndrome (15 men, 35 women, mean age: 37 +/- 9 years) were prospectively studied. P-wave triggered SAECG was recorded with a commercially available system (HIPEC-200HA Aerotel). The following parameters were calculated: the root-mean-square voltage for the terminal 10, 20, 30 ms of filtered P-wave (RMS10,20,30) and time duration of filtered P-wave (PWD). Nine patients with mitral valve prolapse syndrome (18%) revealed the occurrence of supraventricular arrhythmias on Holter monitoring whereas of the remaining 41 (82%), no clinically relevant supraventricular arrhythmias were detected. We found PWD values to be significantly longer in patients with supraventricular arrhythmias when compared with those without arrhythmias: 119.8 +/- 6.9 ms vs. 111.7 +/- 12.1 ms, respectively, P < 0.02. We conclude that P-wave triggered SAECG could be a useful technique for detecting patients with idiopathic mitral valve prolapse syndrome at risk of paroxysmal supraventricular arrhythmias.