Dumitru Tudor Zdrenghea, Maria Ilea, Mihnea D.T. Zdrenghea, Adela Viviana Sitar-Tǎut and Dana Pop
Background: The submaximal exercise testing, four hundred meters walking test (400mWT), respectively six minutes walking test (6MWT) were proposed as an alternative to classical exercise stress testing on cycloergometer in heart failure patients. Purpose: to compare 400mWT and 6 MWT between them, but also with classical exercise stress testing on cycloergometer, by using amino-terminal pro-B-type natriuretic peptide values (NT-proBNP) before and after exercise. Method: 20 patients were studied with systolic heart failure (LVEF<40%), 16 males and 4 females aged 37-70 years. After the relief of congestive syndrome, each patient was submitted, on three consecutive days, to a classical cycloergometer exercise stress testing, 6 MWT and 400mWT. Plasma NT- proBNP levels were measured at rest and also immediately after exercise by using ELISA method. Results: NT-proBNP values on three consecutive days were already increased at rest. During exercise, NT-proBNP increased for cycloergometer from 688±72 fmol/ml to 1868±91 fmol/ml (p<0.05), for 6MWT from 843±90 fmol/ml to 977±93 fmol/ml (15%, p<0.05) and for 400mWT from 676±63 fmol/ml to 927±95 fmol/ml (37%, p<0.05). The correlation of the peak values of NT-proBNP on cycloergometer /6 MWT and for cycloergometer/ 400mWT was r=0.71; for 400mWT/6MWT r=0.81, p<0.01 . Conclusion: NT-proBNP concentrations increase significantly and similarly in patients with chronic heart failure, both during maximal and submaximal exercise. The two submaximal tests from the current study have a sufficient intensity in order to stimulate the release of the natriuretic cardiac peptides and may be used as alternative approaches to maximal exercise testing.
Ischemic heart disease is underdiagnosed in women due to atypical symptomatology as well as to the lower specificity of several paraclinical tests, such as exercise stress testing. The aim of the study was to ascertain whether the Duke treadmill score (DTS) could be an efficient parameter in the diagnosis of ischemic heart disease in women.
Material and method. 105 patients were enrolled in the study, 45.71% women with average age ranged between 20 and 70 years, investigated in the Rehabilitation Hospital, Cardiology-Departament, Cluj-Napoca, Romania. All the patients were clinically assessed as concerns the presence of cardiovascular risk factors, and they underwent electrocardiographic, echocardiographic and treadmill stress tests. DST was calculated according to the formula: exercise time – 5 x (ST deviation expressed in mm–4 x Angina Index).
Results. DTS was lower in women as compared to men: 2.54±5.36 vs. 6±4.69, p=0.0006. 54.28% of the patients were ranged with a low DTS risk category, whereas 45.71% belonged to a moderate and high risk category. DTS was significantly lower in women than in men with high blood pressure (2.03±4.8 vs. 5.8±4.28), hypercholesterolemia (1.14±4.51 vs. 6.24±4.13), diabetes mellitus (1.83 ± 3.73 vs. 6.13±4.8), and obesity (2.42±5.35 vs. 5.81±4.64). By analyzing the presence of cardiovascular risk factors only in women, we noticed that only those with high blood pressure (2.03±4.89 vs. 8.13 ±7.85) and hypercholesterolemia (2.31±4.76 vs. 3.89±5.95) had a statistically significant low DTS (p<0.05). In conclusion, our research, which showed differences in DTS between women and men, raises concerns about the early diagnosis of ischemic heart disease in women.
Dana Pop, Adela-Viviana Sitar-Tăut, Lucia Procopciuc, Mirela Cebanu, M. Zdrenghea and D. Zdrenghea
Background. Genetic polymorphism of renin-angiotensin-aldosterone system affects the pathogenesis of hypertension (HTN), ischemic heart disease (IHD) and heart failure (HF). The purpose of our study is to analyze A/G renin genetic polymorphism in heart failure patients.
Methods. We investigated renin polymorphism in 83 subjects hospitalized in the Cardiology Department of the Rehabilitation Hospital Cluj-Napoca, using the PCR amplification method. 43 patients were diagnosed with heart failure [NYHA III-IV class], and 40 subjects without cardiovascular disease (control group). The NT-proBNP and the presence of cardiovascular risk factors were assessed.
Results. Heart failure etiology was IHD in 60.46 % of patients. The average value of NT-pro BNP was 2991.24 ± 2034.6 pg/ml. As it was expected, HF patients presented low lipid levels: total cholesterol = 162.36 ± 38.28mg/dl, LDL-Cholesterol = 104.88 ± 27.60mg/dl, triglycerides= 109.12 ± 55.84mg/dl, HDL-Co= 35.68 ± 9.55mg/dl. A/G renin genetic polymorphism [with pathogenic potential] in heart failure patients was of 60.46% (homozygote 4.65% and heterozygote 55.81%). Conversely, pathogenic mutations were found only in 38.46% of hypertensive patients, but also in 55.88% and 22.22% patients with obesity/overweight and diabetes. The heterozygote form was found in only 37.5% of control subjects.
Conclusion. This study showed no involvement of A/G renin polymorphisms in the pathogenesis of HF.
Dana Pop, P. Peter, Alexandra Dădârlat, Adela Sitar-Tăut and D. Zdrenghea
Ghrelin, a newly discovered bioactive peptide, was originally reported to induce growth hormone release. Recent studies have shown beneficial hemodynamic effects of ghrelin in the cardiovascular system to support the wide distribution of its receptors in cardiovascular tissues. The aim of the study was to determine whether cardiovascular risk factors influence plasma ghrelin levels.
Methods. We evaluated in the Rehabilitation Hospital Cluj-Napoca, Cardiology - Department 88 consecutive subjects, 65 (73.86%) being women, with mean age 61.7±10.33 years. We assessed the presence of cardiovascular risk factors (obesity, arterial hypertension, diabetes mellitus, metabolic syndrome, smoking and lipid fractions). Plasma ghrelin levels were determined with a commercial ELISA kit (pg/ml).
Results. After the evaluation of cardiovascular risk factors, we found no statistically significant difference between ghrelin levels in the patients with vs those without cardiovascular risk factors (p>0.05). A negative correlation was found between ghrelin levels and age, r = −0.32 (p <0.05). Using the HeartScore Internet tool we calculated the cardiovascular risk for each patient according to the risk score system (SCORE) for high cardiovascular risk countries. Statistically, the risk of fatal cardiovascular events in the next 10 years was indirectly correlated with the ghrelin levels in each patient - correlation between ghrelin levels and SCORE system r=−0.25, p=0.015. In conclusion, low serum ghrelin concentrations are associated with an increased global cardiovascular risk, calculated based on the European SCORE scale. However, we could not demonstrate a direct relationship between any of the major risk factors and ghrelin.