Background: Contemporary antiplatelet treatment in acute myocardial infarction (AMI) is based on one of two P2Y12 receptor inhibitors, prasugrel or ticagrelor. The aim of this study was to compare diurnal variability of platelet reactivity between patients receiving prasugrel and ticagrelor during the initial phase of maintenance treatment after AMI. Methods: It was a prospective, two-center, pharmacodynamic, observational study. Blood for platelet testing was sampled at four time points on day four after AMI (8:00, 12:00, 16:00, 20:00). Diurnal variability of platelet reactivity was expressed as a coefficient of variation (CV) of the above-mentioned measurements. Results: 73 invasively-treated patients were enrolled (ticagrelor: n = 47, prasugrel: n = 26). CV was greater in patients treated with ticagrelor compared with prasugrel according to a VASP assay (47.8 [31.6–64.6]% vs. 21.3 [12.9–25.5]%, p < 0.001), while no statistical differences were detected when the CVs of platelet aggregation according to Multiplate were compared between ticagrelor- and prasugrel-treated patients. Ticagrelor-treated patients showed more pronounced platelet inhibition than prasugrel at 16:00 and 20:00 (VASP16:00: 20.6 ± 15.0 vs. 24.9 ± 12.8 PRI, p = 0.049; VASP20:00: 18.6 ± 17.7 vs. 26.0 ± 11.7 PRI, p = 0.002). Conclusions: Ticagrelor shows greater diurnal variability in platelet aggregation than prasugrel during the initial maintenance phase of AMI treatment, and this is due to the continuous increase of platelet inhibition after the morning maintenance dose. Both drugs provide an adequate antiplatelet effect early after AMI. Evaluation of the clinical significance of these findings warrants further investigation.

Background: Under physiological conditions, the myocardial extracellular matrix (ECM) is maintained by matrix metalloproteinases (MMPs) and tissue inhibitors of metalloproteinases (TIMPs). However, certain stimuli cause the upregulation of MMPs, which can lead to pathological remodeling of the ECM. We assessed serum levels of MMPs and TIMP-2 in patients with myocarditis and their relationship(s) to myocardial damage.Methods: In total, 45 patients with myocarditis who underwent cardiac magnetic resonance imaging were included, comprising 11 with concurrent chronic kidney disease (CKD). Blood samples were obtained to assess serum levels of MMP-2, MMP-3, MMP-9, and TIMP-2. Results: Serum MMP-2, MMP-3, and TIMP-2 levels negatively correlated with ejection fraction values in patients with myocarditis, while MMP-3 levels correlated with longitudinal deformation (p<0.05). Serum MMP-2, MMP-3, and TIMP-2 levels also negatively correlated with renal function, as assessed by the estimated glomerular filtration rate (p<0.05). Patients with myocarditis and concurrent CKD had higher levels of MMP-2 and TIMP-2 than those without kidney damage.Conclusions:1. We demonstrated serum MMP-2, MMP-3, and TIMP-2 concentrations were related to left ventricular ejection fraction, and MMP-3 levels correlated with longitudinal deformation, indicating MMPs play an important role in the post-inflammatory remodeling of the myocardium.2. The occurrence of other heart diseases was an important element in modifying the relationship between MMPs and the degree of myocardial damage.3. Chronic kidney damage in patients with myocarditis results in increased MMP activity. A negative correlation between eGFR and MMP-2, MMP-3 and TIMP-2, and a positive correlation between creatinine and MMP-3 levels, underlines the role of fibrosis in myocarditis with concomitant chronic kidney disease.

82D 1 and D 5 ), dopamine activates subunit Gs of protein G and indirectly stimulates adenylate cyclase. 1 On the other hand, activation of receptors belonging to the D 2 -like family (D 2 , D 3 , and D 4 ) leads to the inhibition of protein G and adenylate cyclase and triggers sodium channels. 1,2 Due to the large numbers of dopamine receptors distributed throughout the CNS, endogenous dopamine has the ability to regulate a broad range of physio logical functions such as locomotion and cognition. Dopamine also plays an important role in neurohormonal regulation, modulates renal function, and the function of gastrointestinal and cardiovascular systems. 3 Generally, dopamine does not cross the blood-brain barrier; AbstrAct IntroductIon Catecholamines, including dopamine, are used in cardiac intensive care. objectIves The aim of the study was to assess the effect of intravenous dopamine infusion on the function of pituitary gland in patients with acute cardiac failure. We analyzed changes in the serum levels of thyroid-stimulating hormone (TSH) and adrenocorticotropic hormone (ACTH), as well as potential nephroprotection. PAtIents And methodsThe study involved 29 patients with chronic decompensated heart failure (New York Heart Association class III/IV; mean age 77.4 ±13.3 years). Dopamine was administered intravenously in doses varying from 1 to 5 μg/kg/min. Measurements of TSH, free triiodothyronine (FT 3 ), free thyroxine (FT 4 ), and ACTH were taken directly before dopamine infusion, after 12 hours of continuous infusion, and 12 hours after the 72-hour infusion was completed.results Serum FT 3 levels were significantly higher before dopamine infusion than at 12 hours post infusion (5.12 ±1.16 vs. 4.27 ±0.89 pmol/l, P <0.005). Serum FT 4 levels before the infusion were significantly higher than after 12 hours of continuous infusion as well as after 12 hours post infusion (18.79 ±5.33 vs. 17.06 ±4.61 pmol/l, P <0.05; 18.79 ±5.33 vs. 16.26 ±4.53 pmol/l, P <0.05, respectively). There were no statistically significant differences between serum TSH and ACTH levels or in creatinine clearance before, during, and 12 hours post infusion.conclusIons Intravenous infusion of dopamine may downregulate endocrine thyroid function; however, it has no significant effect on the pituitary gland-derived TSH and ACTH. There was no significant nephroprotective effect of low-dose dopamine infusion in patients with chronic decompensated chronic heart failure.IntroductIon Catecholamines are commonly used in intensive care. They help maintain vital body functions by increasing peripheral blood flow. Synthetic epinephrine, norepinephrine, dopamine, and dobutamine are the most common catecholamines in the clinical setting. The population of patients diagnosed with advanced heart failure and episodes of decompensation is on the rise, as is the use of catecholamines in cardiology practice.Dopaminergic neurons located in the central nervous system (CNS) are the main source of dopamine. Depending on the type of receptors, dopamine can exert ei...

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