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Background: The endoplasmic reticulum (ER) fulfills multiple cellular functions. Various stimuli can potentially cause ER stress (ERS). ERS is one of the intrinsic apoptosis pathways and apoptosis plays a critical role in hypertension. Glucose regulated protein 78 (GRP78) has been widely used as a marker for ERS and caspase-12 mediated apoptosis was a specific apoptotic pathway of ER. The expression of GRP78 and caspase-12 remains poorly understood in the diastolic heart failure resulting from hypertension. Methods: We used spontaneously hypertensive rats (SHRs) to establish a model of diastolic heart failure, and performed immunohistochemistry, Western blot, and real-time PCR to analyze GRP78 and caspase-12. Results: We found that GRP78 and caspase-12 had enhanced expression at protein and mRNA levels. Conclusions: These results suggest that GRP78 and caspase-12 were upregulated in cardiomyocytes and ERS can contribute to cardiac myocyte apoptosis in the diastolic heart failure resulting from hypertension.
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Sleep disordered breathing in the elderly: a three year longitudinal cohort study

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The objective of this investigation was to assess the association between the presence of sleep disordered breathing (SDB) and daytime sleepiness, body mass index, hospitalisation, and survival. To this end, a prospective longitudinal study was conducted in the elderly population consisting of 80 patients of either sex over the age of 65 years admitted to a city hospital in Germany without any history of SDB. All patients met the following exclusion criteria: age <65 yr, heart failure, and chronic obstructive lung disease. Baseline anthropometric and cardiorespiratory (one-night portable polygraphic recording) data, and a standardized sleep and sleepiness-questionnaires (Epworth Sleepiness Scale, ESS) were obtained in 1999. A second screening was conducted in 2003. Thirty one women and 34 men completed the follow-up after 3 years. These patients were divided into two subgroups: (i) no clinically relevant SDB and (ii) SDB (apnea-hypopnea index, AHI, 5 plus excessive day time sleepiness, ESS, >9). Six men and 3 women fulfilled the criteria of SDB. Thirty three percent of patients with SDB and 20% of patients without SDB died during the follow-up period. Duration of hospital stay was 35 days for the SDB patients and 20 days for patients without it. Body weight and sleepiness did not change significant over the 3-year period between the two cohorts. We conclude that the presence of SDB was associated with a 1.5-fold higher mortality and longer hospital stay in elderly patients over a period of 3 years even in persons without previous history of SDB. Daytime sleepiness was a better predictor than AHI or BMI for death.
Background. Following pharmacological recommendations and leading a healthy lifestyle are imperative to improve the health and quality of life of patients with heart failure (HF). Material and methods. This cross-sectional, observational study examined 100 patients with HF who were treated in the cardiology department. The average age of the respondents was 70±14 years (mean±SD), and the majority were men (65%). The Health Behavior Inventory Questionnaire and the authors’ questionnaire were used. Results. The respondents collectively reported an average level of health behaviors. There was a negative correlation between age and proper eating habits (rho=-0.248; p=0.013) and a positive mental attitude (rho=-0.270; p=0.007). Higher or secondary education was associated with increased levels of health behaviors in all categories. Patients with a shorter duration of disease (<15 years) were more likely to take pro-health measures in the categories of proper eating habits (p=0.001) and positive mental attitude (p=0.004). Patients with a higher level of knowledge about the disease demonstrated higher levels of health behaviors. Subjects who had a pacemaker/cardioverter implanted had lower positive mental attitudes (p=0.048). Conclusions. It is important to encourage health behaviors in patients with HF. These actions should be aimed primarily at elderly people, with primary and vocational education, longer disease duration (>15 years), lower knowledge of the disease, and/or an implanted cardioverter/pacemaker.
Functional analysis of up- and down-regulated genes might reveal whether peripheral blood cells may be considered as a material of diagnostic or prognostic value in patients with end-stage heart failure (HF). The aim of the present study was to compare the transcriptomic profile of peripheral blood nuclear cells from 6 male patients with ischaemic end-stage HF with those of 6 male patients with asymptomatic cardiac dysfunction. The expression of genes in peripheral blood nuclear cells in both groups of patients was measured using whole-genome oligonucleotide microarrays utilizing 35 035 oligonucleotide probes. Microarray analyses revealed 130 down-regulated genes and 15 up-regulated genes in the patients with end-stage HF. Some of the down-regulated genes belonged to the pathways that other studies have shown to be down-regulated in cardiomyopathy. We also identified up-regulated genes that have been correlated with HF severity (CXCL16) and genes involved in the regulation of expression of platelet activation factor receptor (PTAFR, RBPSUH, MCC, and PSMA7). In conclusion, the identification of genes that are differentially expressed in peripheral blood nuclear cells of patients with HF supports the suggestion that this diagnostic approach may be useful in searching for the molecular predisposition for development of severe refractory HF in patients with post-infarction asymptomatic abnormalities and remodelling of the left ventricle. These results need further investigation and validation.
Thyroid hormone (TH) is critical in cardiac cell differentiation (regulating contractile proteins and cell geometry) and this effect could be potentially exploited therapeutically in reversing the process of de-differentiation which underlies postischemic cardiac remodeling. Acute myocardial infarction was induced in male Wistar rats by ligating left coronary artery (AMI, n=8), while sham operated animals served as control (SHAM, n=8). 13 weeks after AMI, TH was administered in a group of animals for 4 weeks (AMI-THYR, n=9). TH significantly increased ß-MHC and decreased -MHC expression in the myocardium. This response was accompanied by changes in cardiac geometry: sphericity index, (SI, long to short axis ratio) was found to be 1.95 (SEM, 0.02) in SHAM, 1.51(0.03) in AMI and 1.64(0.03) in AMI-THYR, p<0.05. As a consequence, cardiac function was significantly improved: left ventricular ejection fraction (EF%) was 74.5% (SEM, 2.8) in SHAM vs 29.5% (2.1) in AMI, and 40.0% in AMI-THYR, p<0.05. Furthermore, +dp/dt and -dp/dt were 4250 (127) and 2278 (55) in SHAM vs 2737(233) and 1508 (95) in AMI vs 3866 (310) and 2137(111) in AMI -THYR, respectively, p<0.05. TH treatment partially reverses cardiac dysfunction in rats with old myocardial infarction by favorably changing cardiac chamber geometry and expression of myosin isoforms. Thyroid hormone, unlike current treatments, appears to be a paradigm of therapeutic intervention which aims at restoring cardiac geometry and may prove new effective treatment for heart failure.
 Background. There is an increasing interest in the role of adipocytokines in cardiovascular pathophysiology. Aim. The aim of the study was to compare visfatin levels, a novel adipokine, in patients with heart failure (HF) due to the left ventricular systolic dysfunction with those in age- and body mass index (BMI) - matched healthy controls in relation to the parameters of glucose metabolism and high sensitivity C-reactive protein (hsCRP) levels. Material/Subjects and Methods. The study population consisted of 28 males with systolic HF referred for cardiopulmonary exercise testing, divided into two subgroups based on their NYHA class (HF patients NYHAI+II, n=17, and HF patients NYHAIII+IV, n=11), and 23 controls. The following indices were measured in a serum samples: visfatin, hsCRP, glucose and lipid metabolism parameters, and the insulin resistance index HOMAIR (homeostasis model assessment insulin resistance) was calculated. Results. Concentrations of visfatin and high-density lipoprotein cholesterol (HDL-cholesterol) in the HF subjects were significantly lower (p ≤ 0.01) than in controls. The Kruskal-Wallis test showed significant differences between three groups (controls and both subgroups of heart failure patients) in mean levels of visfatin, hsCRP, glucose, HOMAIR and HDL-cholesterol. Conclusion. Serum visfatin concentrations in patients with systolic HF, particularly with more advanced NYHA classes, are significantly lower in comparison to healthy controls and are independent of age or anthropometric and metabolic parameters.
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