ACTA ENDOCRINOLOGICA (BUC)

Metabolic syndrome may have direct myocardial effects in addition to their atherogenic effects, and this has been related to left ventricular systolic and diastolic dysfunction, as well as left ventricular remodelling. The aim of the study was to analyze the correlation between the metabolic syndrome clustering components (individual and additive) and heart failure severity in patients with prior myocardial infarction. We performed a cross-sectional study including 65 patients with heart failure post-myocardial infarction (31 men and 34 women) with a mean age at 64.1 (9.1). We evaluated the metabolic syndrome parameters (individual and additive) and analyzed their impact on heart failure severity by comparing NYHA I+II and NYHA III+IV groups. The elements of metabolic syndrome independently correlated with heart failure severity were identified by means of logistic regression method. The frequency of metabolic syndrome in our study group was high (49.23%). High blood pressure, fasting glucose, central obesity and low HDL-Cholesterol levels were significantly associated with severe heart failure (NYHA III and IV classification) in univariate logistic regression analyses. The only two independent variables: hyperglycaemia and reduced HDL-Cholesterol returned high enough levels of OR and 95%CI (1.79; 1.45-2.89 and 0.83; 0.67-0.91 respectively) to reach statistical significance beyond adjustment risk factors. In our study it was identified a significant correlation between presence of complete metabolic syndrome criteria and heart failure severity, measured in either NYHA IV categories (p=0.002), or by means of echocardiographical parameters such as: left ventricular ejection fraction (p=0.026), left ventricular masse index (p=0.006), peak E velocity (p=0.011), peak A velocity (p=0.037), Mitral E/A ratio (p=0.001) and E-deceleration time (0.021). Conclusions: Among the criteria for metabolic syndrome, hyperglycaemia and reduced HDLCholesterol levels had a strong association with heart failure severity. Our findings are relevant for\r\nclinical practice and intervention, and the aggressive treatment for conventional risk factors has also been effective in the prevention of heart failure.

Detecting the primary tumours in carcinoid malignancies is a critical challenge. We report the case of a 25 year old male patient with a typical clinical carcinoid syndrome. Metastatic carcinoid malignancy was easily diagnosed by very high plasma chromogranin, plasma serotonin and urinary 5-Hydroxy-Indol Acetic Acid levels, and the detection of multiple liver metastases by ultrasound. Somatostatin receptor scintigraphy (SRS) failed to detect the primary lesion, as did upper and lower gastrointestinal (GI) tract endoscopy, bronchoscopy, total body CT, MRI, and GI video tract endoscopy; only F-DOPA PET-scan ascertained and accurately localized the primary ileal tumor. Surgery confirmed the localisation, and pathology revealed a 3 cm highly differentiated carcinoid tumor with low proliferation grade (Ki67<2). The therapy with short and long acting somatostatin analogues was started before surgery and continued after surgical intervention. There was a regression of the clinical carcinoid syndrome and a numerical involution of liver metastases, but the levels of chromogranin A and serotonin remained elevated. Other therapeutical option should be discussed.