Myeloperoxidase and protein carbonyl levels are elevated in plasma after acute MI, apparently via independent mechanisms. High MPO is a risk factor for long-term mortality and adds prognostic value to LVEF and plasma NT-proBNP measurements.

Intensive management of chronic heart failure improves 1-year mortality compared with UC. Compared with clinically guided treatment and UC, hormone-guided treatment selectively improves longer-term mortality in patients

After myocardial infarction (MI), the heart may undergo progressive ventricular remodeling, resulting in a deterioration of cardiac function. TGF-beta is a key cytokine that both initiates and terminates tissue repair, and its sustained production underlies the development of tissue fibrosis, particularly after MI. We investigated the effects of a novel orally active specific inhibitor of the TGF-beta receptor 1 (SD-208) in an experimental model of MI. Mice underwent ligation of the left coronary artery to induce MI and were subsequently treated for 30 d after infarction with either SD-208 or a vehicle control. Blockade of TGF-beta signaling reduced mean arterial pressure in all groups. SD-208 treatment after MI resulted in a trend for reduced ventricular and renal gene expression of TGF-beta-activated kinase-1 (a downstream modulator of TGF-beta signaling) and a significant decrease in collagen 1, in association with a marked decrease in cardiac mass. Post-MI SD-208 treatment significantly reduced circulating levels of plasma renin activity as well as down-regulating the components of the cardiac and renal renin-angiotensin system (angiotensinogen, angiotensin converting enzyme, and angiotensin II type I receptor). Our findings indicate that blockade of the TGF-beta signaling pathway results in significant amelioration of deleterious cardiac remodeling after infarction.

Angiotensin-converting enzyme genotyping may provide additional prognostic information in patients after MI in combination with the proven utility of LVEF, plasma BNP, and N-BNP measurements.

Abstract-Angiotensinogen M235T and T174M polymorphisms have individually been associated with elevated levels of plasma angiotensinogen, hypertension, and left ventricular hypertrophy. In this study, heart failure patients (nϭ451) were genotyped for the angiotensinogen M235T and T174M polymorphisms to investigate association with survival (recorded over 4 years of follow-up) and prognostic hormone markers. Patients carrying the 235TT genotype (nϭ86) were 3 years younger at admission (Pϭ0.011), and, in those with hypertension, diagnosis was made Ϸ10 years earlier than other patients. Patients carrying Ն1 174M allele (nϭ94) were more likely to have a previous history of heart failure (Pϭ0.044) and increased mortality during follow-up (risk ratio: Key Words: angiotensinogen Ⅲ polymorphism Ⅲ single nucleotide Ⅲ mortality Ⅲ heart failure Ⅲ congestive Ⅲ association T he renin-angiotensin system (RAS) is a key element in pressure/volume homeostasis and exerts a wide range of systemic and local effects through endocrine, paracrine, and autocrine signaling. 1 In patients with cardiovascular disease, activity of the RAS is often increased and contributes to a poor prognosis. 2 Detrimental effects include promotion of inappropriate sodium and water retention, increased peripheral vascular resistance, and promotion of adverse vascular and cardiac remodeling in response to cardiac injury. 3 Gene polymorphisms that increase baseline RAS activity are, therefore, candidates for increasing risk of, and adverse outcomes in, heart disease.The gene encoding angiotensinogen (AGT) has been implicated in hypertension both through genetic linkage studies 4,5 and by allelic association. A missense mutation in exon 2 of the gene (AGT M235T) has been associated with elevated levels of AGT, with 235TT homozygotes having between 10% and 20% more plasma AGT than 235MM individuals. 4,6,7 These individuals also have increased blood pressure, 4,8 -11 although a large-scale study of 9100 men and women from the Danish general population found that this was only true in women. 7 The frequency of the 235T allele has been shown to be significantly greater in hypertensive patients than in normotensive control subjects 4,12-14 and has also been linked with pre-eclampsia, 15 left ventricular hypertrophy, 16 increased risk of coronary heart disease, 17,18 and atrial fibrillation. 19 A second variant within the AGT gene, T174M, has also been associated with hypertension, with the M allele associated with an increased risk. 4,14 The M235T and T174M variants are in linkage disequilibrium. 4,14 However, a large-scale meta-analysis found no consistent association between either AGT polymorphism and increased risk for ischemic heart disease, myocardial infarction, or ischemic cerebrovascular disease in the Danish population. 20 To date, no studies have examined the combined influence of AGT M235T and T174M variants in heart failure (HF). Neither has the influence of these variants on long-term patients survival been explored. We hypothesized that these gene ...