AimsVarious beta-blockers with distinct pharmacological profiles are approved in heart failure, yet they remain underused and underdosed. Although potentially of major public health importance, whether one agent is superior in terms of tolerability and optimal dosing has not been investigated. The aim of this study was therefore to compare the tolerability and clinical effects of two proven beta-blockers in elderly patients with heart failure.Methods and resultsWe performed a double-blind superiority trial of bisoprolol vs. carvedilol in 883 elderly heart failure patients with reduced or preserved left ventricular ejection fraction in 41 European centres. The primary endpoint was tolerability, defined as reaching and maintaining guideline-recommended target doses after 12 weeks treatment. Adverse events and clinical parameters of patient status were secondary endpoints. None of the beta-blockers was superior with regards to tolerability: 24% [95% confidence interval (CI) 20–28] of patients in the bisoprolol arm and 25% (95% CI 21–29) of patients in the carvedilol arm achieved the primary endpoint (P= 0.64). The use of bisoprolol resulted in greater reduction of heart rate (adjusted mean difference 2.1 b.p.m., 95% CI 0.5–3.6, P= 0.008) and more, dose-limiting, bradycardic adverse events (16 vs. 11%; P= 0.02). The use of carvedilol led to a reduction of forced expiratory volume (adjusted mean difference 50 mL, 95% CI 4–95, P= 0.03) and more, non-dose-limiting, pulmonary adverse events (10 vs. 4%; P < 0.001).ConclusionOverall tolerability to target doses was comparable. The pattern of intolerance, however, was different: bradycardia occurred more often in the bisoprolol group, whereas pulmonary adverse events occurred more often in the carvedilol group.This study is registered with controlled-trials.com, number ISRCTN34827306.

An efficient ECG modeling algorithm is presented in this paper. The model is based on fitting polynomial functions to real ECG. This algorithm describes a segmentation of a heartbeat and fitting an appropriate polynomial function to the segments. The model performances are evaluated in terms of PRD, preserve of ST-T segment clinical information and the execution time. When comparing this model with the existing one, the PRD improvements can be seen, especially in those signals with high morphological diversity heartbeats. Moreover, the computing time is significantly reduced. Using appropriate model features, ST-T analysis achieves an average accuracy of more than 94%. The obtained data shows that this model is applicable to other ECG processing like: heartbeat analysis, compression and filtering. Ill. 2, bibl. 9, tabl. 3 (in English; abstracts in English and Lithuanian).http://dx.doi.org/10.5755/j01.eee.110.4.304

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Metabolic syndrome (MetS), which is a cluster of medical disorders, is common and it is associated with increased cardiovascular morbidity and mortality. The aim of this study was to evaluate the relationship between characteristics of metabolic syndrome and the grade of diastolic dysfunction. The study included 72 patients (29 male and 43 female), who had central obesity and at least two of the other four characteristics of metabolic syndrome according to IDF (International Diabetes Federation) criteria. The exclusion criteria were age above 65, impaired systolic function (left ventricular ejection fraction < 55%) atrial fibrillation, valvular and pericardial heart disease. Diastolic function was determined according to the criteria of the American Society of Echocardiography. There was a positive correlation between the number of characteristics of metabolic syndrome and the diastolic dysfunction grade (p < 0.0001). The positive correlation was found between the grade of diastolic dysfunction and the waist circumference (p < 0.0001), arterial hypertension (p < 0.001). pared glucose tolerance/diabetes (P = 0.0063), and hypertriglyceridemia (p = 0.0262). A low level of high-density lipoprotein did not show a statistically significant correlation. The presence of metabolic syndrome is associated with the presence of diastolic dysfunction. The grade of diastolic dysfunction is dependent on the number of coexisting characteristics of metabolic syndrome. Arterial hypertension, central obesity, hyperglycemia and hypertriglyceridemia showed a significant correlation with the degree of diastolic dysfunction.

Apolipoprotein E displays polymorphism with three common alleles, e2, e3, and e4. The aim of this research was to determine apoE gene polymorphism in a group of healthy patients and a group of patients with CHD, and to reveal the relation between anthropometric and biochemical parameters and the apoE genotype. In CHD group significantly higher values of blood pressure, waist circumference, BMI and fat %, triglycerides, insulin (HOMA IR) and CRP were found. A statistically significant higher presence of the e3e4 genotype and e4 allele was detected in the CHD group. Statistically significant differences between waist circumference, BMI, insulin and HOMA IR were found between subjects with e3e3 and e3e4 genotypes