Tag Archives: heart failure

MicroRNAs as Biomarkers and Therapeutic Targets in Heart Failure

DOI: 10.2478/amma-2019-0016

Heart failure still represents a real challenge both in everyday practice and research, due to the complex issues related to its pathogenesis and management. Humoral biomarkers have emerged in the last decades as useful tools in the diagnosis, risk stratification and guiding the treatment of heart failure. These molecules are related to different pathological and adaptive processes, like myocardial injury, neurohormonal activation and cardiac remodeling, their most widespread representatives being the natriuretic peptides (e.g. NT-proBNP). The role of altered gene expression and transcription as the basis of myocardial structural and functional changes in heart failure is largely recognized. MicroRNAs (miRNAs) are non-coding RNAs which have a major role in post-transcriptional gene expression by interfering with messenger RNA molecules. Our short review summarizes the molecular biology of miRNAs and their possible role as biomarkers in the diagnosis and prognosis of heart failure. Furthermore, the therapeutical perspectives conferred by these molecules are also presented.
Keywords: miRNA, biomarkers, heart failure

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COPD – Risk Factor for Complex Chronic Comorbidities, a Retrospective Case-Control Study

Background: Increasing evidence indicates that chronic obstructive pulmonary disease (COPD) is a complex disease involving more than airflow obstruction. Systemic inflammation can initiate or worsen comorbid diseases, such as ischemic heart disease, heart failure, arrhythmia, diabetes, osteoporosis, lung cancer and depression.
Material and method: We explored the Medprax database, from an ambulatory care in order to obtain rates of comorbidities in COPD patients. Medprax electronic database is a locally developed system designed to fulfil the requirements of an integrated healthcare system. We identified a population of 9,659 patients (4472 men and 5187 women) aged ≥ 30 years registered between 01.01.2000 and 01.02.2010.
Results: The overall prevalence of COPD was 5.17% (384 men and 116 women). Compared to the non-COPD patients, COPD was found to be a significant risk factor in both sexes for cardiovascular events: ischemic heart disease (OR = 3.06, 95%CI 2.54–3.68), atrial fibrillation (OR = 2.70, 95%CI 2.12–3.43) and heart failure (OR = 4.49, 95%CI 3.74–5.40) regardless of age. Association with diabetes mellitus type 2 was extremely significant in COPD men (OR = 1.69, 95%CI 1.26–2.27), but not in COPD women. Significant correlation with osteoporosis (OR = 3.26, 95%CI 1.94–5.48) was found only in women over 60 years and men under 60. Pulmonary malignancy was found only in male COPD patient compared to non-COPD patients (OR = 5.04, 95%CI 2.02–12.44). The impact on
depressive disorders was noted only in younger COPD men (OR = 5.71, 95%CI 1.94–16.82).
Conclusions: Our results indicate that COPD is a risk factor for all these comorbid conditions and that in the management of COPD all these conditions need to be carefully evaluated.

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Mechanical Versus Electrical Dissynchronism in Patients with Heart Failure

Background: Despite the existence of significant correlation between the mechanical and electric dissynchronism, it is widely known that these two types of dissynchronisms are quite different and there are a number of reasons why mechanical dyssynchronism might be an important variable to measure in addition to electrical dyssynchronism.
Objective: The objective of study was to highlight a group of patients with impaired systolic function who suffer from mechanical dissynchronismin in absence of evident electric dissynchronism (narrow QRS) and who might represent a target group for cardiac resynchronization therapy (CRT).
Materials and methods: We enrolled in study patients with heart failure, NYHA class II-IV and ejection fraction (EF) under 35%, admitted to the Cardiology Department of Internal Medicine Clinic IV. Patients were divided in two groups, according to the duration of QRS complex – one group with wide (≥120 ms) and another one with narrow QRS complex (<120 ms).
Results: Overall, 73.7% of patients had positive criterias for intraventricular dissynchronism – appreciated with ultrasound measurment of septal-to-posterior wall motion delay (SPWMD >130 ms). 10 patients had narrow QRS and 28 had wide QRS. In the wide QRS complex group we found intraventricular dissynchronism at 85.7% of patients, while 14.28% had normal SPWMD. 40% of patients with EF < 35% and narrow QRS had intraventricular dissynchronism.
Conclusions: The duration of QRS complex seems to be an insensitive indicator of ventricular dissynchronism, hence the ultrasound evaluation is recommended for better selection of candidates for CRT.

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