The significant positive association of adrenaline concentration with pregnancy and with depression suggested that this adrenal hormone could be one of the links in the complex relationship between psychosocial stress and outcome after IVF/ICSI.

AimsAdvanced glycation endproducts (AGEs) have been associated with the development and progression of chronic heart failure (CHF). Advanced glycation endproducts-crosslink breakers might be of benefit in HF, but only smallscale and uncontrolled data are available. Our aim was to conduct a prospective, randomized, double-blind, placebo-controlled study to examine the effects of the AGE-breaker alagebrium on exercise capacity and cardiac function in patients with HF. Methods and resultsOne hundred and two patients with HF (78% male, aged 62 + 11 years), and a left ventricular ejection fraction (LVEF) ≤0.45, were randomized to either 200 mg alagebrium twice daily or placebo. After 36 weeks, the primary efficacy end-point peak VO 2 had changed by (mean + SEM) 22.1 + 0.5 mL/min/kg in alagebrium vs. 20.5 + 0.7 mL/min/kg in placebo-treated patients (P ¼ 0.06). No significant changes were observed in a number of secondary end-points, including diastolic function (mean E ′ : P ¼ 0.32; E/E ′ : P ¼ 0.81), systolic function (LVEF: P ¼ 0.43), AGE accumulation (skin-autofluorescence: P ¼ 0.42), N-terminal pro brain natriuretic peptide, P ¼ 0.20); New York Heart Association functional class (P ¼ 0.73), patient global assessment (P ¼ 0.32), physicians global assessment (P ¼ 0.76), and the Minnesota Living with Heart Failure Questionnaire score (P ¼ 0.38). Overall alagebrium was reasonably well tolerated. ConclusionIn the present proof-of-concept study, the AGE-breaker alagebrium did not improve exercise tolerance in patients with HF and systolic dysfunction, and no changes were observed in a number of secondary endpoints. The present data therefore do not support earlier data which suggested a beneficial effect of alagebrium in systolic HF. Clinical Trial Registration Information: NCT00516646

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AimsAdvanced glycation end products (AGEs) are increased in patients with diabetes and are associated with diastolic dysfunction through the formation of collagen crosslinks in the heart. The association among AGEs, diastolic function, and aerobic capacity in heart failure (HF) patients with and without diabetes is, however, unknown. We therefore studied the association among tissue AGEs, diastolic function, and aerobic capacity in patients with HF with or without diabetes. Methods and resultsIn chronic HF patients (with and without left ventricular systolic dysfunction), tissue AGEs [skin autofluorescence (AF)], diastolic function (echocardiographic mean E ′ and E/E ′ ), and aerobic capacity [peak oxygen uptake (VO 2 ) on cardiopulmonary exercise testing] were obtained. A total of 49 diabetics and 156 non-diabetics were included. Diabetics were older and had more cardiovascular risk factors, but left ventricular ejection fractions (LVEF) were similar. Tissue AGEs were higher in diabetics compared with non-diabetics (2.8 + 0.8 vs. 2.3 + 0.7 a.u.; P , 0.001). Furthermore, there was a correlation between tissue AGEs and mean E ′ (r ¼ 20.30; P , 0.001, after adjustment for age, r ¼ 20.21; P ¼ 0.004). Aerobic capacity was significantly lower in diabetic patients with HF (peak VO 2 : 17.4 + 5.1 vs. 21.7 + 6.1 mL/min/kg; P ¼ 0.001), even after adjustment for age and LVEF. Peak VO 2 was related to skin AF (P ¼ 0.03), independent of age, diabetes, LVEF, and New York Heart Association functional class. ConclusionPatients with diabetes and HF have similar LVEF but poorer exercise capacity compared with non-diabetic HF patients. Our data suggest that these findings might be explained by the observed association among tissue AGE levels, diastolic function, and exercise capacity.--