bluuebunny/crossref_metadata_2025 huggingface dataset:
Whether inflammatory disorders matter for long-term prognosis after myocardial infarction?
Authors: Leonova I , Boldueva S , Bykova E , Ivanova M
Published: May 2021

Funding Acknowledgements

Type of funding sources: None.

Introduction

In the acute period of myocardial infarction (MI) inflammatory disorders of blood are registered, but data of prognostic significance of these disorders is multiple-valued.

Purpose

Research of manifestation of the inflammatory response in patients who suffered MI, and estimation of its prognostic significance.

Materials and methods

772 patients with myocardial infarction were examined. Prospective follow-up from 1 to 7 years was performed.

Results

The death rate during all years of follow-up was 14,2 % of all included in the study. 61% of patients died suddenly, but 26% of them died as a consequence of the progression of chronic cardiac insufficiency. In patients died suddenly lower level of lymphocytes in the first 24 hours: 1,30 ± 0,47 * 109/l vs 1,80 ± 0,73*109/l, (p = 0,03) was registered. In patients who died due to heart failure progression, authentically registered higher leukocytosis in the first 24 hours, in comparison to survived ones, reached 13,83 ± 6,00*109/l (vs 11,9 ± 3,12*109/l; p = 0,005), but to 5th day in the compared groups leukocytes levels had practically the same values (7,36 ± 1,89*109/l vs 7,47 ± 1,99*109/l; accordingly p = 0,8). In the compared groups the number of lymphocytes, expressing CD 95 did not differ authentically, but in died abruptly patients this index was rather lower.

 There were not authentic differences detected among groups of dead and survived patients, in terms of interleukins 1β,2, and 6, whereas TNF-α was almost twice as high in patients who died due to CHF progression. Studying inflammatory markers were not included in the number of independent indexes, connected with the risk of death when conducting multivariate regressive Cox-analysis.

Conclusion

In our opinion, inflammatory factors were displaced from the prognostic model for assessing the risk of death, both sudden and due to heart progression, by more powerful structural-functional predictors.
Does climate change affect the chronobiological trends in occurrence of acute coronary syndromes?
Authors: Kuzma L , Kurasz A , Niwinska M , Dabrowski EJ , Swieczkowski M , Bachorzewska-Gajewska H , Dobrzycki S
Published: May 2021

Funding Acknowledgements

Type of funding sources: None.

Background

Acute coronary syndromes (ACS) are the leading cause of death all over the world, in the last years chronobiology of their occurrence has been changing.

Purpose

The aim of this study was to assess the influence of climate change on hospital admissions due to ACS.

Methods

Medical records of 10,529 patients hospitalized for ACS in 2008–2017 were examined. Weather conditions data were obtained from the Institute of Meteorology.

Results

Among the patients, 3537 (33.6%) were hospitalized for STEMI, 3947 (37.5%) for NSTEMI, and 3045 (28.9%) for UA. The highest seasonal mean for ACS was recorded in spring (N = 2782, mean = 2.52, SD = 1.7; OR 1.07; 95% CI 1.0-1.2; P = 0.049) and it was a season with the highest temperature changes day to day (Δ temp.=11.7). On the other hand, every 10ºC change in temperature was associated with an increased admission due to ACS by 13% (RR 1.13; 95% CI 1.04-1.3; P = 0.008). Analysis of weekly changes showed that the highest frequency of ACS occurred on Thursday (N = 1703, mean = 2.7, SD = 1.9; OR 1.16; 95% CI 1.0-1.23; P = 0.004), in STEMI subgroup it was Monday (N = 592, mean = 0.9, SD = 1.6, OR 1.2; 95% CI 1.1-1.4; P = 0.002). Sunday was associated with decreased admissions due to all types of ACS (N = 1098, mean = 1.7, SD = 1.4; OR 0.69; 95% CI 0.6-0.8, P < 0.001). In the second half of the study period (2013-2018) the relative risks of hospital admissions due to ACS were 1.043 (95%CI: 1.009-1.079, P = 0.014, lag 0) and 0.957 (95%CI: 0.925-0.990, P = 0.010, lag 1) for each 10ºC decrease in temperature; 1.049 (95% CI: 1.015-1.084, P = 0.004, lag 0) and 1.045 (95%CI: 1.011-1.080, P = 0.008, lag 1) for each 10 hPa decrease in atmospheric pressure and 1.180 (95% CI: 1.078-1.324, P = 0.007, lag 0) for every 10ºC change in temperature. For the first half of the study the risk was significantly lower.

Conclusion

We observed a shift in the seasonal peak of ACS occurrence from winter to spring which may be related to temperature fluctuation associated with climate change in this season. The lowest frequency of ACS took place on weekends. Atmospheric changes had a much more pronounced effect on admissions due to ACS in the second half of the analyzed period, which is in line with the dynamics of global climate change.
Syndrome of senile asthenia and anxiety-depressive disorders in elderly patients with acute coronary syndrome
Authors: Petrova VB , Shumkov VA , Boldueva SA , Petrova AI
Published: May 2021

Funding Acknowledgements

Type of funding sources: Public Institution(s). Main funding source(s): Northwestern State Medical University named after I.I. Mechnikov

Introduction. The syndrome of senile asthenia (ASA) ("fragility") in combination with anxiety-depressive symptoms in patients contributes to an increase in the frequency of hospitalizations, reduces the effectiveness of treatment and the quality of life. To study the relationship of SSA with anxiety-depressive disorders in elderly patients after acute coronary syndrome (ACS).

Materials and methods. The study included patients with acute coronary syndrome. The inclusion criterion was also a signed voluntary informed consent to participate in the study. A total of 76 patients, 44 men and 32 women hospitalized for ACS were included in this prospective observational study. The average age of the patients is 73.2 years. A questionnaire was conducted with a validated questionnaire "Age is not a hindrance", and the hospital anxiety and depression scale (HADS) was also used.

Results. SSA was found in 32% (p = 0.01) of hospitalized elderly patients, in the majority of women (71%) than men (29%). The average overall score according to the questionnaire "Age is not a hindrance" in elderly patients with ACS was 4.58. The results of the HADS survey showed that anxiety and depressive symptoms in fragile elderly patients occurred in 53.7% and 46.8%, respectively. There was a pronounced relationship between the occurrence of SSA and the symptoms of anxiety according to HADS (p <0.001), however, the more severe depressive symptoms were, the less frequent was SSA (p = 0.007).

Conclusions. "Fragility" in elderly hospitalized patients with ACS is associated with increased anxiety and depressive symptoms. In addition, a significant relationship was demonstrated between high scores on «the age is not a hindrance» questionnaire and the presence of anxiety, but not depression.
Incidence, characteristics and outcomes of Infective Endocarditis with low inflammatory markers
Authors: Maaroufi A , Zahidi H , Abdulhakeem M , Habbal R
Published: May 2021

Funding Acknowledgements

Type of funding sources: None.

Background

Bacterial infective endocarditis (IE) is rarely suspected in patients with a low C-reactive protein (CRP) concentration.

Aims

To address the incidence, characteristics and outcome of left-sided valvular IE with low CRP concentration.

Methods

This was a retrospective analysis of cases of IE discharged from a tertiary hospital between December 2013 and september 2019. 

The 10% lowest CRP concentration (<25mg/L) was used to define low CRP concentration. Right-sided cardiac device-related IE, non-bacterial IE, sequelar IE and IE previously treated by antibiotics were excluded.

Results

Of the 105 patients, 16 (16%; median age 41 [15–76] years) had definite (n = 12) or possible (n = 4) left-sided valvular IE with CRP < 25mg/L (median 14.25 [1.5–24.8] mg/L). The median white blood cell count was 7.7 (4.2–12.5) G/L. 

The main presentations were heart failure (n = 10; 62%) and stroke (n = 1; 6%). Transthoracic echocardiography (TTE) showed vegetations (n = 12) or isolated valvular regurgitation (n = 4). 

Overall, nine patients (56%) had severe valvular regurgitation on transoesophageal echocardiography (TOE), and seven patients (43%) underwent cardiac surgery. 

68% of patients survived at 1-year follow-up. Bacterial pathogens were documented  only in four patients (streptococci, coagulase-negative Staphylococcus, gamella morbillorum) using blood cultures solely ,  due to lack of disponibility of specific serology / valve culture and/or polymerase chain reaction analysis 

Conclusions

Left-sided valvular IE with limited or no biological syndrome is rare, but is often associated with severe valvular and paravalvular lesions. TOE should be performed in presence of unexplained heart failure, new valvular regurgitation or cardioembolic stroke when TTE is insufficient to rule out endocarditis, even in patients with a low CRP concentration.
Physical activity and its clinical correlates in chronic thromboembolic pulmonary hypertension
Authors: Schmidt C , Monteiro M , Reis A , Santos M
Published: May 2021

Funding Acknowledgements

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Fundação para a Ciência (FCT) Coordenação de Aperfeiçoamento de Pessoal de Nível (CAPES)

Background

 Limited data is available on physical activity (PA) levels in chronic thromboembolic pulmonary hypertension (CTEPH) patients, as well as on the impact of using different tools to assess PA such as questionnaires and accelerometers. 

Purpose

 We aimed to quantify PA levels of CTEPH patients and study its clinical correlates, as well as to compare PA levels measured by the International Physical Activity Questionnaire (IPAQ) with measures from accelerometers.

Methods

 This is a cross-sectional study (n = 50). Physical activity levels were measured using accelerometers and questionnaire (IPAQ). Clinical parameters evaluated were walked distance on the 6-minute-walking test (6MWT), pulmonary vascular resistance, N-terminal brain natriuretic peptide and quality of life (HRQoL) using the Cambridge Pulmonary Hypertension Outcome Review questionnaire.

Results

 Accelerometer-derived data showed that CTEPH patients spent 60% of the recorded time in sedentary behaviours and only 2% in moderate-to-vigorous PA (MVPA). MVPA was mildly correlated with 6MWT (r = 0.359; p= 0.023) and symptom domain of HRQoL (r=-0.371; p = 0.044) but not with NT-proBNP, pulmonary vascular resistance or functional domain of HRQoL. Time spent in sedentary behaviour was lower in self-reported measurement (279 ± 165min/day) compared to accelerometry (446 ± 117min/day, p < 0.001). Self-reported MVPA was significantly higher than the one registered by the accelerometer (411 ± 569 vs. 131 ± 108 min/week, p = 0.027). Bland-Altman analysis indicated poor agreement between the two methods. 

Conclusions

 Our results showed that CTEPH patients spend most of their days in sedentary behaviors and only a small amount of time in MVPA. MVPA was associated with symptoms domain of HRQoL and submaximal functional capacity. In addition, we showed a poor agreement between self-reported and accelerometer-derived PA in CTEPH patients, with the former overestimating the overall PA activity.
Impact of compliance with lifestyle recommendations and medication adherence on 1-year prevention of major cardiovascular events in diabetic patients undergoing partial foot amputation
Authors: Shalaeva E , Janabaev B , Shalaeva A , Dadabaeva N , Bano A , Saner H
Published: May 2021

Funding Acknowledgements

Type of funding sources: None.

Background

Partial foot amputation (PFA) is generally not considered a high-risk surgery. However, 3 years survival rate is less than 50-60%. The purpose of the study was to evaluate the impact of compliance with lifestyle recommendations and medication adherence on 1-year prevention of major cardiovascular events (MACE) in patients with type 2 diabetes mellitus (T2DM) after PFA.

Methods

In this prospective single-center interventional cohort study, 785 consecutive T2DM patients after PFA were included in the 1-year follow-up. Physical examination and laboratory tests were performed at baseline and every month after PFA for 1 year. Patients were considered as compliant with lifestyle recommendations if they followed a healthy diet, smoking cessation, and at least ≥30 min/day physical exercise. Patients were defined as adherent to medication if they followed ≥80% prescribed medication intake. MACE was defined as a composite endpoint including cardiovascular death, myocardial infarction (MI), stent thrombosis, acute stroke, or unstable arrhythmia.

Results

During 1-year follow-up MACE occurred in 63/535 patients who were medication adherent compared to 137/249 non-adherent patients (Chi square = 167,2, p < 0,001). Among lifestyle compliant patients, 55/498 had MACE compare with 145/286 non-compliant patients (Chi square = 150.3, p < 0,001). The COX regression analysis was conducted to present the adjusted effect of compliance and adherence to the incidence of MACE (B = 0.989, p < 0.001, and B= 1.096, p < 0.001, respectively) (Table). The potential confounders such as age and previous MI were statistically significant (Table). Gender, smoking, diabetes severity, HbA1c, hypertension, symptomatic coronary artery disease, history of ischemic events, heart revascularization were not statistically significant.

Conclusion. Failure to follow lifestyle recommendations in T2DM patients after PFA increases the OR of the incidence of MACE 2.7 fold, non-adherence to medication 3 fold. Our results indicate that optimizing preventive interventions is of outmost importance for patients with diabetes undergoing PFA

Cox Regression Results for predictors of Indicator Odds ratio B Standard error P-value Age 1.031 0.031 0.009 0.007 History of myocardial infarction 4.017 1.391 0.184 <0.001 Non-compliance to lifestyle changes 2.688 0.989 0.198 <0.001 Medication non-adherence 2.992 1.096 0.186 <0.001
Factors affecting night sleep in rotational shift workers in the Arctic
Authors: Shurkevich N , Vetoshkin AS , Simonyan AA , Gapon LI
Published: May 2021

Funding Acknowledgements

Type of funding sources: None.

Background

Our previous studies revealed that half of arterial hypertension (AH) patients had a flat type of non-dipper curve of blood pressure daily profile (BPDP).

Purpose

To study and differentiate the leading component of sleep disturbance in conditions of the Arctic rotational shift work and evaluate its relationship with the data of ambulatory blood pressure monitoring (ABPM).

Methods

In September 2019, 180 patients  with AH, including 79 males (M), (gr. 1) aged 48.7 ± 8.3 years and 68 females (F), (gr. 2) aged 50.0 ± 6.7 years (p = 0.06) were simultaneously examined in Yamburg (68 N) settlement in the Arctic Watch. Groups did not differ in rotational shift work duration (16.9 ± 8.7 and 16.2 ± 8.3 years, p = 0.72). Analysis of sleep quality (Pittsburg Sleep Quality Index - PSQI) with daytime sleepiness analysis (Epworth Sleepiness Scale) was carried out. Six components were investigated: 1 - subjective sleep (S) quality component; 2 - assessment of S latency; 3 - assessment of S duration; 4 – habitual S efficiency ; 5 – step disturbances of S; 6 - use of S medication; 7 - daytime S dysfunction with differentiation of global index (Global PSQI score). All individuals underwent ABPM with analysis of daily index of systolic blood pressure and diastolic blood pressure and BPDP.

Results

According to the survey, 22%  had S disorders in M gr., 30% (24/81) in F gr., p = 0.23. Global assessment of S quality was also not dependent on gender: mode of assessment was 4 points (P), (24 individuals) in M, 5 P (17) in F (p = 0.91).  Leading components of  S quality disorder were the subjective S quality with 2 P, (16); the S latently had  2 P (11); the step disturbances of S had the 2 P (11) and the daytime S dysfunction had the  2 P (14) in M. In F, the 1st component (C)C (2 P – 13); the 2nd C - 2 P (16) prevailed and the 5th and the 7th C were less manifested. Moreover, F had S latency complaints oftener than M (p = 0.031). Analysis of interconnections with ABPM revealed "over dipper" BPDP in the 12.5%, "dipper" BPDP in 42.5% (51); "non dipper" BPDP in 41.7% (50); "night peaker" BPDP in 3.3%. In individuals with normal S quality, "dipper" BPDP prevailed (54%). At the same time, leading components did not have significant correlations with abnormal BPDP.

Conclusion

In conditions of rotational shift work in the Arctic, regardless of gender, sleep disturbances are more associated with poor habitual sleep efficiency and less associated with disturbances of BPDP. This is obviously explained by increased exhaustion due to the intense nature of rotational shift work in the Arctic region.
Is sedentary lifestyle a critical driver for hypertension burden in Sub-Saharan Africa?: evidence from a community-based population in Ghana and Nigeria
Authors: Okekunle A , Akpa O , Akinyemi R , Sarfo F , Ogbole G , Akpalu A , Wahab K , Obiako R , Komolafe M , Fawale B , Owolabi L , Ovbiagele B , Owolabi M
Published: May 2021

Funding Acknowledgements

Type of funding sources: Public Institution(s). Main funding source(s): National Institute of Health (NIH)

OnBehalf

SIREN as part of the H3 Africa Consortium

Background

Hypertension is the principal risk factor for stroke events in Sub-Saharan Africa (SSA). However, international evidence on the significance of physical inactivity as a critical driver of hypertension risk in SSA is sparse.

Purpose

This study assessed determinants of hypertension risk among a stroke-free population in Ghana and Nigeria.

Methods

Participants were 4,267 stroke-free individuals recruited in the Stroke Investigative Research and Education Network study from Nigeria and Ghana. Data on sociodemographic, lifestyle, cardiovascular risk and blood pressure were collected using standard protocols. Hypertension was defined as systolic blood pressure (SBP) ≥ 140mmHg or diastolic blood pressure (DBP) ≥ 90mmHg or a previous diagnosis or current use of antihypertensive medications. Odds ratio (OR) and 95% confidence interval (CI) for hypertension risk was estimated using logistic regression at P < 0.05.

Results

Mean age was 55.9 ± 14.7 and 1.8% were physically inactive. Mean SBP and DBP were 135.8 ± 24.2mmHg and 82.7 ± 14.3mmHg respectively, and 56.7% had hypertension. Factors associated with hypertension were physical inactivity (OR: 9.09; 95%CI: 4.03, 20.53), being diabetic (OR: 2.70; 95%CI: 1.91, 3.82), being older than 60years (OR: 2.22; 95%CI: 1.78, 2.77) and family history of cardiovascular diseases (OR: 2.02; 95%CI: 1.59, 2.56) and elevated waist circumference (OR: 1.01; 95%CI: 1.00, 1.02).

Conclusion(s): Physical inactivity was the leading risk factor for hypertension in this population. Community-oriented interventions promoting physical activity should help in the control of hypertension among sub-Saharan African population.
Blood pressure level and laboratory indicators of disease severity in patients with arterial hypertension and COVID-19
Authors: Popov K , Novitskiy A , Shvarts Y
Published: May 2021

Funding Acknowledgements

Type of funding sources: None.

Background. Many patients with COVID-19 suffer from arterial hypertension and have marked variations in blood pressure (BP) during the acute period of infection. The reasons for such changes are poorly understood.

Purpose. To assess the relationship between the level of BP and the severity of changes in the main clinical and laboratory parameters in patients with arterial hypertension and with a moderate course of COVID-19 at the stage of the height of the disease.

Materials and methods. The study included 86 hospitalized patients with verified coronavirus disease of moderate severity: 46 of them were male, the median age was 65 years. Patients received adequate hypertension therapy for a long time. After hospitalization, treatment was adjusted if necessary. The level of laboratory parameters in the acute period of the disease was determined, including the electrolytes, C-reactive protein (CRP), albumin, ferritin, general blood test, etc. BP measured daily. The relationship between laboratory parameters and BP level was evaluated by nonparametric correlation using the Spearman coefficient and multivariate analysis based on the "generalized nonlinear model".

Results. In 67.44% of patients with hypertension, an elevated BP level (>140/90) was observed against the background of moderate COVID-19. There was a significant negative correlation between the levels of CRP and BP throughout the stay in the hospital, the most significant is the 5th day of hospitalization. At the same time, a slightly stronger relationship is observed with diastolic BP (r = -0.4425) than with systolic BP (r = -0.3525). A similar trend is observed in all BP measurements. Besides, a negative correlation was found between potassium levels and BP values. The strongest association of potassium levels is with systolic BP on the day of hospitalization (r = -0.4850) and diastolic pressure on the 1st day of hospitalization (r = -0.3561). Multivariate analysis confirmed independent and reliable "influence" of CRP (p = 0.00018) and potassium (p = 0.03921) as independent predictors of diastolic pressure.

Conclusions. Most patients with hypertension and moderate COVID-19 have elevated BP levels. There is a statistically significant negative relationship between the values of BP and levels of CRP and potassium. The obtained data may correspond to the existing hypothesis about the significant role of the kinin–kallikrein system in the pathogenesis of COVID-19.
Pulmonary embolism during the COVID-19 pandemic
Authors: Silva BV , Rodrigues T , Cunha N , Brito J , Alves Da Silva P , Silverio Antonio P , Couto Pereira S , Aguiar Ricardo I , Rigueira J , Mendonca C , Abreu A
Published: May 2021

Funding Acknowledgements

Type of funding sources: None.

Background

During the COVID-19 pandemic many countries have imposed lockdown restrictions to movement. Since the 18th of March in Portugal, thousands of people have been confined to their homes. While hospital admissions for COVID-19 patients increased exponentially, admissions for non-COVID-19 patients decreased dramatically. However, it remains unclear whether lockdown-related immobility can contribute to the increased incidence of pulmonary embolism.

Purpose

To compare the incidence of pulmonary embolism (PE) during the lockdown period (Abril 1 to May 31, 2020) compared to the reference period in 2019.

Methods

Retrospective study of consecutive outpatients who presented to the emergency department and underwent computed tomography pulmonary angiography (CTPA) due to suspicion of PE.

Results

Compared to the same period of 2019, the lockdown period was associated with a significant increase in PE diagnosis (29 versus 18 patients). PE patients during lockdown were older (median age 71 years; interquartile range [IQR][60-85] versus 59 years [44-76]; p = 0.046) and have lower prevalence of active cancer (14% versus 33% in the reference period). Women represent 55% (n = 16) of patients in lockdown group (versus 50% in 2019 group). Clinical probability (GENEVA score) was similar in both groups (median score 2.72 in lockdown group and 2.50 in reference group, p = 0.452). None of the patients with PE was diagnosed with COVID-19.

Conclusion

We have observed a marked increase (62%) in PE diagnosis during lockdown period compared to the reference period, which can be explained by the reduction in physical activity due to teleworking and closure of gyms and sports activities.

These data reinforce the importance of promoting physical activity programs at home. The role of pharmacological or mechanical thromboprophylaxis in this scenario remains unclear.
Association of nonalcoholic fatty liver disease with coronary artery calcification progression: a systematic review
Authors: Koulaouzidis G , Charisopoulou D
Published: May 2021

Funding Acknowledgements

Type of funding sources: None.

Background

Several studies have demonstrated the association of coronary artery calcification (CAC)  with non alcoholic fatty liver disease(NAFLD). The aim of this systematic review is to assess the association of NAFLD with the progression of subclinical atherosclerosis, reflected as the dynamic changes in CAC score(CACs) over time.

Methods

Electronic and manual searches retrieved 578 potentially relevant publications. The initial screening resulted in removing 486 papers according to title and abstract.  By reviewing the full articles, 53 papers were further excluded and eventually, 5 studies were included in this review.

Results

Four studies were from South Korea, while one study was from USA. 

VanWagner et al(1) showed that NAFLD participants had increased prevalence of CAC progression compared to those without NAFLD, 37.9% vs. 26.0% respectively, p < 0.001.

Sung et al(2) showed that in 592 (27.2%) participants, CACs increased from baseline; while in the rest 1583 subjects, CACs did not change or improved during follow-up, p < 0.001.

Park et al(3) noticed that more subjects with NAFLD than without showed CAC progression(48.8% vs. 38.4% respectively;p < 0.001. But in subjects without calcification at baseline, NAFLD significantly affected the development of calcification after adjusting for traditional metabolic risk factors. However, in subjects with baseline CAC, NAFLD did not affect progression.

Sinn et al(4) found that the annual rate of CAC progression in subjects with and without NAFLD were 22% and 17% respectively, p < 0.001. The association between NAFLD and CAC progression was observed both in subjects with CACs = 0 and in those with CACs > 0 at baseline.

In the study by Cho et al(5) CAC progression was seen in 28.3% of subjects with NALFD, and in 18.6% of subjects in the control group.

Conclusion

 In our review, we found that NAFLD is associated with the progression of subclinical atherosclerosis as it was expressed by the CAC.
Development of AI-based method to detect the subtle ECG deviations from the population ECG norm
Authors: Chaikovsky I , Popov A , Fogel D , Kazmirchyk A
Published: May 2021

Funding Acknowledgements

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): National Academy of Science of Ukraine

Background

Electrocardiogram (ECG) is still the primary source for the diagnostic and prognostic information about cardiovascular diseases. The concept of "normal ECG" parameters is crucial for the reliable diagnosis, since it provides reference for the ECG under examination. With the development of new methods and tools for ECG feature extraction and classification based on artificial intelligence (AI), it becomes possible to identify subtle changes in the heart activity to detect  possible abnormalities at the early stage.

 The challenge of this work is to identify the deviations in  ECG of clinically healthy persons  from the conditional "population" norm .

Methods

The normal ECG is described as a feature vector composed of the time-magnitude parameters of signal-averaged ECG (SAECG). To define the subjects that possibly have variations from the "population" norm, the outlier detection approach is proposed: first the cloud of the vectors , constructed from the set of normal ECG"s , obtained from  young, clinically similar healthy persons  was created in feature space. Then, a particular ECG is considered deviant and requires the attention of the clinician when it is considered an outlier of the cloud of normal ECGs.

In the experiment, SAECGs from the group of 139 young subjects (male, age 18-28  years) with no reported cardiovascular problems are used to extract 34 features from SAECG leads (magnitudes and durations of ECG waves, duration of ECG segments, etc.). ECGs were routinely previewed by qualified physicians, and no obvious anomalies were noticed. The Isolation Forest anomaly detection method is used with variable numbers of trees and different contamination parameters. 

Results

The ratio of outliers were changed from 5 to 10% (7-12 subjects) with various numbers of estimator trees. Seven outlier SAECGs were repeatedly appearing for various settings. Out of these, 4 subjects were the oldest persons in group examined , and 3 others had a rare ventricular premature beats during routine ECG examination.

Conclusion

The proposed method is promising for application in routine and express ECG tests since it is able to quantify the subtle deviations from the normal ECG group.
Prediction of subclinical coronary atherosclerosis in patients with high and very high cardiovascular risk
Authors: Pogosova N , Kachanova NP , Yufereva YM , Sokolova OY , Koltunov IE , Vygodin VA , Arutyunov AA
Published: May 2021

Funding Acknowledgements

Type of funding sources: None.

Background

Coronary atherosclerosis has a long subclinical period. It’s early detection may offer a possibility of timely initiation of preventive interventions

Purpose

To develop a diagnostic rule for detection of patients (pts) with high probability of subclinical atherosclerosis among those with high or very high cardiovascular (CV) risk.

Methods

This cross-sectional study enrolled 52 pts (32 men [62%]), aged 40 to 65 years [mean age 54.6 ± 8.0]) with high or very high CV risk (5-9 and ≥10% by The Systematic Coronary Risk Estimation Scale [SCORE], respectively). All participants underwent cardiac computed tomography (CT) angiography and calcium scoring. Traditional risk factors (RFs) (family history of premature CVD, smoking, overweight/obesity and abdominal obesity, hypertension, type 2 diabetes mellitus, lipids parameters (total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, triglycerides) and lipids-related markers (apolipoprotein A1, apolipoprotein B, ApoB/ApoA1 ratio), biomarkers of inflammation (high-sensitivity C-reactive protein [hs CRP], fibrinogen), indicator carbohydrate metabolism (glucose),  ankle-brachial index,  stress-test, carotid plaques according to ultrasound were evaluated in all pts. Psychological RFs were evaluated using Hospital Anxiety and Depression Scale and DS-14 for type D personality.

Results

All pts were divided into 2 groups according to the CT angiography results: pts in the main group (n = 21) had any non-obstructive lesions or calcium score >0, pts in the control group (n = 31) had intact coronary arteries. The groups did not differ in age or gender. 26 multiple linear logistic models for any subclinical atherosclerosis were developed based on obtained diagnostic features. Taking into account R-square = 0.344 (p = 0.0008), the best fitting model was follows: 

subclinical coronary atherosclerosis= -1.576 + 0.234 x SCORE ≥5%  + 0.541 x hs CRP >2 g/l + 0.015 x heart rate  (bpm) + 0.311 family history of premature CVD. 

The developed algorithm had sensitivity of 63% and  specificity of 80%.

Conclusions

The created diagnostic model diagnostic model suggests the presence of subclinical coronary atherosclerosis in patients with high / very high CV risk with a high degree of probability. This easy-to-use method can be used in routine clinical practice to improve risk stratification and management choices in high-risk pts.
Family history of premature coronary artery disease is not associated with coronary artery calcification
Authors: Koulaouzidis G , Charisopoulou D
Published: May 2021

Funding Acknowledgements

Type of funding sources: None.

Background

Controversy exists regarding the association of family history(FH) of premature coronary artery disease (CAD) with coronary artery calcification (CAC). The purpose of this study was to assess the potential association between family history of premature CAD (<55 years in first-degree male relatives and <65 years in first-degree female relatives) and CAC.

Methods

A retrospective study of 3613 asymptomatic individuals who underwent assessment of CAC score (CACs) according with the Agatston method. Individuals were selected based on the presence or absence of FH of premature CAD. Individuals with history of hypercholesterolaemia, hypertension, diabetes mellitus or obesity (BMI> 30), smokers (current or previous) were excluded. Furthermore, we excluded subjects with late-onset family history of CAD (>55 years in first-degree male relatives and >65 years in first-degree female relatives).

Results

Mean age of the cohort was 50.4 ± 9.5 year (74.6% males) and 15.6% reported FH in a parent, sibling or both (prevalence was 12.8% in parents only, 1.9% in siblings only and 0.9% in both parents and siblings). The prevalence of CAC was similar in individuals with FH (35%) and those without (36%), p = 0.2; with no difference in the mean CACs between the two groups, p = 0.4 (Table 1). Individuals with FH in parents only or siblings only had a similar incidence of CAC compared to those without FH (p = 0.9 and 0.7, respectively), with no difference in the mean CACs, p= 0.9 in both. Additionally, the incidence of CAC was not different in individuals with FH in both parents and siblings compared to those without FH (p= 0.1) and again there was no difference in the mean CACs (p = 0.6).

Conclusion

In asymptomatic individuals with none of the conventional risk factors for atherosclerosis, there was no relationship between the incidence and extent of CAC and the presence of FH of premature CAD.

CAC distribution based on FH of CAD No FH Yes FH FH in parents only FH in siblings FH in both Number 3047 566 464 68 34 Males 74.8% 73.3% 74.3% 69.1% 67.7% Age (mean ± SD) 52 ± 9.6 46.9 ± 8.2 46.6 ± 8.1 49.5 ± 8.4 47.3 ± 8.2 Prevalence of CAC 35% 36% 35.2% 36.7% 41% Log-transformed CACs (± SD) 0.5 ± 0.8 0.5 ± 0.8 0.5 ± 0.8 0.5 ± 0.8 0.7 ± 0.9
Cardio-ankle vascular index in persons with prediabetes and diabetes mellitus in a population sample of Western Siberia of the Russian Federation
Authors: Sumin AN , Bezdenezhnykh N , Bezdenezhnykh AV , Artamonova GV
Published: May 2021

Funding Acknowledgements

Type of funding sources: Public Institution(s). Main funding source(s): Federal State Budgetary Scientific Institution “Research Institute for Complex Issues of Cardiovascular Diseases”

The aim of this study was to evaluate the level of cardio-ankle vascular index (CAVI) in the presence of pre-diabetes and diabetes mellitus in the population sample of the Russian Federation, as well as to investigate the factors associated with pathological CAVI in these subjects.

Methods

1628 (age 25-64 years) were recruited in a observational cross-sectional study ESSE-RF in the period from 2012 to 2013. The standard protocol of the ESSE-RF has been extended with additional study of CAVI. The final sample included 1617 people, they are divided into 3 groups: group 1 - patients with type 2 diabetes mellitus (n = 272), group 2 - patients with prediabetes - IFG, IGT or their combination (n = 44), and group 3 - persons without CMD (n = 1301).

Results

The median CAVI was higher in diabetes and pre-diabetes groups (p = 0.009 and p <0.001, respectively, compared with group without CMD). Pathological CAVI (≥9.0) was detected in 16.8% of diabetes patients, in 15.9% of those with prediabetes, and in 9.0% of those without CMD (p <0.001 when comparing diabetes group and group without CMD). The groups with diabetes and prediabetes also did not differ in factors affecting the level of arterial wall stiffness (gender, blood pressure, age, dyslipidemia, uric acid level). According to the result of the correlation analysis in the general sample, CAVI positively correlated with age (p <0.001), male sex (p <0.001), type 2 diabetes (p <0.001), prediabetes (p = 0.002), waist circumference (p <0.001), visceral obesity (p <0.001), total cholesterol (p <0.001), triglycerides (p <0.001), LDL cholesterol (p <0.001), and with the inverse correlation - with glomerular filtration rate (GFR, p <0.001). In multivariate analysis, age and the presence of arterial hypertension were independently associated with pathological CAVI in the groups of patients with CMD, and in the group without CMD, in addition to these factors - a decrease in GFR.

Conclusions

In the population sample of the Russian Federation, the CAVI index values in the prediabetes and diabetes patients were higher than in the normoglycemia persons. The groups with diabetes and prediabetes also did not differ in factors affecting the level of arterial wall stiffness. Since the identified disorders of arterial stiffness in prediabetes are similar to those in diabetes, their identification is important to prevent further cardiovascular complications.
The feasibility of a newly developed local network system for cardiac rehabilitation (the CR-GNet) in disease management and physical fitness after acute coronary syndrome
Authors: Ando T , Watanabe T , Matsuo S , Samejima T , Yamagishi J , Bito T , Naruse G , Yoshida A , Minatoguchi S , Akiyama H , Nishigaki K , Minatoguchi S , Okura H
Published: May 2021

Funding Acknowledgements

Type of funding sources: Foundation. Main funding source(s): Grant-in-aid from.jpgu Prefecture

Background

The newly developed Cardiac Rehabilitation.jpgu Network (CR-GNet) has been implemented to create a regional alliance network and to provide periodic follow-up examinations to enhance the disease management in patients with cardiovascular disease. The effectiveness of a network like this support system has not yet been evaluated in Japan.

Purpose

We aimed to examine the feasibility of the CR-GNet in disease management, assisting patients in attaining physical fitness and its impact on long-term outcomes after acute coronary syndrome (ACS).

Methods

We enrolled 47 patients with ACS in the CR-GNet between February 2016 and September 2019; of these, 37, 29, and 21 patients underwent follow-up assessments for exercise capacity (peak oxygen uptake) at 3 months, 6 months, and 1 year after discharge, respectively. Major adverse cardiac events (MACE) were defined as the composite of death from cardiac causes, cardiac arrest, myocardial infarction, and rehospitalization due to unstable or progressive angina. MACE were compared with controls who were not registered in the CR-GNet.

Results

The coronary risk factors, except blood pressure, improved at 3 and 6 months, and 1 year after discharge. These risk factors in each patient significantly reduced from 2.9 at admission to 1.6, 1.4, and 1.9 at 3 months, 6 months, and 1 year after discharge (p < 0.05), respectively. Peak oxygen uptake was significantly higher at 3 months, 6 months, and 1 year after discharge to 17.5 ± 4.9 ml/kg/min, 17.9 ± 5.1 ml/kg/min, and 17.5 ± 5.5 ml/kg/min, respectively, than that at discharge (14.7 ± 3.6 ml/kg/min) (p < 0.05). During follow-up, there was no significant difference; MACE did not occur in any patients in the CR-GNet but occurred in controls.

Conclusions

The CR-GNet is a feasible option for long-term management of ACS patients. The prognostic impact of the CR-GNet needs further investigation with a larger sample size and longer follow-up.

Table1 At admission 3 months 6 months 1 year Average number 2.9 1.6* 1.4** 1.9*** † Average number of coronary risk factors for all patients (n = 21) p = 0.004, vs. at admission; **p = 0.001, vs. at admission; ***p = 0.011, vs. at admission; †p = 0.035, vs. at 6 months
Impact of Chronic kidney disease on the outcomes of hospitalizations for implantable cardioverter defibrillator or cardiac resynchronization defibrillator placement: An analysis of Inpatient Sample
Authors: Usman M , Almani M , Fatima N , Yousuf M , Qudrat Ullah M , Edigin E
Published: May 2021

Funding Acknowledgements

Type of funding sources: None.

1. Background

Implantable cardioverter defibrillator (ICD) and cardiac resynchronization therapy defibrillator (CRT-D) are indicated in primary and secondary prevention of dysrhythmias among other indications. We sought to determine the impact of chronic kidney disease (CKD) on hospitalizations for ICD or CRT-D placement.

2. Purpose

Determine how CKD impacts in-patient mortality and cardiovascular outcomes in patients undergoing ICD or CRT-D placement while hospitalized.

3. Methods

Data were extracted from the National Inpatient Sample (NIS) 2016 - 2018 Database. The NIS was searched for patients who underwent ICD or CRT-D placement. The patients were divided into two groups based on presence or absence of CKD as secondary diagnosis using ICD-10 codes. The primary outcome was inpatient mortality. Multivariate logistic and linear regression analysis was used accordingly to adjust for confounders (A univariate screen was done to confirm the confounders affected outcomes with variables having a p less than 0.2 were included in the multivariate regression analysis). STATA software was used to for analysis.

4. Results

Of 145,550 patients admitted for ICD or CRT-D placement, 47740 (32.8%) had CKD. The adjusted odds ratio (aOR) for inpatient mortality for patients undergoing ICD or CRT-D placement with co-morbid CKD compared to those without CKD was 1.66 (95% CI 1.194 – 2.329, p = 0.003). Patients with comorbid CKD had lower odds of developing cardiogenic shock (aOR: 0.83, 95% CI 0.718 – 0.948, p = 0.007) and cardiac arrest (aOR: 0.88, 95% CI 0.766 – 0.999, p = 0.048) compared to patients without CKD. Detailed outcomes are listed in table 1.

5. Conclusion

Chronic kidney disease is a risk factor associated with increased in-patient mortality in patients admitted for ICD or CRT-D placement.

Outcome Without CKD, % With CKD, % aOR (95% CI) p-value* Primary outcome In hospital mortality 0.6 1.9 1.66 (1.194 - 2.329) 0.003* Secondary outcomes Length of stay (days), mean 7.0 9.2 -0.01 (-0.345 - 0.322) # 0.945 Total hospital charges (US$), mean 218,962 241,679 -13047 (-20924 - -5171) # 0.001* Cardiogenic shock 6.8 8.0 0.83 (0.718 - 0.948) 0.007* IABP placement 1.7 1.7 0.52 (0.399 - 0.671) <0.001* Cardiac arrest 12..1 8.5 0.88 (0.766 - 0.999) 0.048* Acute renal failure 17.9 48.1 2.89 (2.648 - 3.163) <0.001* Abbreviations: *; statistically significant, #; adjusted mean difference, aOR: adjusted odds ratio, CI: confidence interval, IABP: Intra-aortic balloon placement.Adjusting factors: Age, Charlson comorbidity index, patient’s insurance, location and teaching status of the admitting hospital, dyslipidemia, old myocardial infarction, cerebral infarction, hypertension, diabetes mellitus, liver disease, smoking status and obesity.
Alirocumab effectiveness and rapidity in achieving and maintaining target LDL, HDL cholesterol and triglyceride values in patients at very high cardiovascular risk
Authors: Cavarra M , Salerno E , Chiaranda" G
Published: May 2021

Funding Acknowledgements

Type of funding sources: None.

Introduction

Still too few patients after an acute cardiocerebrovascular event reach C-LDL values recommended by guidelines even in therapy with statins and ezetimibe, thus maintaining a high risk of new cardiovascular episodes.

Purpose

To evaluate, in a long follow-up, the effectiveness and the rapidity of alirocumab in the attainment and maintenance of LDL-cholesterol target values in patients at very high risk and intolerant to statins.

Methods

Our case studies consist of 72 patients, 80% males (58) and 20% females (14), with an average age of 61.9. 90.2% of patients were hypertensive. 5.5% had chronic kidney disease (CKD stage III). 65.2% had an ACS and the 34.7% had CeVD. 84.7% of the patients were in therapy only with ezetimibe while 15.3% in association with PUFA N-3. The average value of C-LDL was 169.2 mg/dl. The follow up was 24 months with clinical checks and C-LDL at 3,6,12 and 24 months. The dosage of alirocumab was both 75 and 150 mg

Results

At 3 months the reduction of C-LDL was 52.24%; at 6 months of 51.18%; at 12 months of 51.36% and at 24 months of 52.47%. The 37 patients who had started with 150 mg, had a very high average C-LDL base, 183.0 mg/dl, and showed a reduction of C-LDL to 3 months of 59.04%, to 6 months of 58.45%, to 12 months of 65.05%, to 24 months of 55.76%. The target value of C-LDL recommended by the ESC guidelines was reached for 42.10% at 3 months; for 52.63% at 6 months; for 63.15% at 12 months and for 73.68% at 24 months. 5.5% of patients with a CKD showed a 73.68% reduction in C-LDL values to 3 months, 65.22% to 6 months, 57.49% to 12 months and 53.95% to 24 months. The follow-up to the Tg study showed a reduction of 3.55% to 3 months, an increase of 8.75% to 6 months, a reduction of 1.65% to 12 months and 7.95% to 24 months. C-HDL values showed an increase of 4.55% at 3 months, 3.69% at 6 months, 10.97% at 12 months and 7.82% at 24 months. 

Conclusions

Our case studies have confirmed the effectiveness of alirocumab in reducing C-LDL values in patients at very high cardiovascular risk and the rapidity in reaching the target value set by guidelines for the management of cardiovascular risk. Our study also confirmed the its effectiveness in increasing the values of C-HDL while it was not possible to confirm the reduction of Tg values.

% Alirocumab Efficacy C-LDL TGs C-HDL 3 MONTHS -52,24% -3,55% +4,55% 6 MONTHS -51,18% +8,75% +3,69% 12 MONTHS -51,36% -1,65% +10,97% 24 MONTHS -52,47% -7,95% +7,82% C-LDL: LDL-CHOLESTEROL TGs TRIGLYCERIDES C-HDL: HDL-CHOLESTEROL

Abstract Figure. % Alirocumab Efficacy
the impact of overweight and obesity on the development of systolic and diastolic myocardial dysfunction in patients with type 2 diabetes mellitus
Authors: Vanina D , Pokrovskaya A , Podzolkov V
Published: May 2021

Funding Acknowledgements

Type of funding sources: None.

OnBehalf

I.M. Sechenov First Moscow State Medical University

Background

Obesity and type 2 diabetes mellitus (DM) promote the development of systolic and diastolic myocardial dysfunction. The method of equilibrium radionuclide ventriculography (ERVG) can be used to estimate these dysfunctions.

Purpose

We conducted a comparative ERVG evidence-based analysis in patients with type 2 diabetes mellitus and varying degree of overweight. We analyzed the correlation between body mass index (BMI) and ERVG data.

Methods

The study included 42 patients (8 male and 34 female): group 1 – 12 patients with BMI 25.0-29.9 kg / m2, group 2 – 16 patients with BMI 30.0-34.9 kg / m2, group 3 – 14 patients with BMI 35.0-39.9 kg / m2. The average duration of type 2 diabetes mellitus was 11 ± 3.8 years. The average age of patients in each group was 65.8 ± 5 y.o., 57.7 ± 6 y.o., 64.6 ± 8 y.o. respectively. The groups were comparable in duration of type 2 diabetes mellitus, level of glycated hemoglobin, presence and severity of combined pathology. The patients with postinfarction cardiosclerosis and decompensated heart failure were excluded. The following ERVG indices of left ventricle (LV) and right ventricle (RV) were examined: systolic function – ejection fraction (EF), peak (PER) and average (AER) ejection rates, ejection within 1/3 of systole (ejec.1/3 s.), end-systolic volume (ESV), stroke volume (SV), diastolic function – peak filling rate (PFR), filling within 1/3 diastole (fil. 1/3 d.), end-diastolic volume (EDV).

Results

the EF of the LV in all examined patients was more than 40%. In group 2 we discovered an increase in the EDV and ESV indices of the LV, ESV of the RV compared to group 1 (123.8 ± 23.6 ml, 52.4 ± 14.5 ml, 66.3 ± 21.6 ml - in group 2 and 96.5 ± 22.7 ml, 37.9 ± 10.7 ml, 50.2 ± 16.7 ml - in group 1, respectively, p <0.05). SV of the LV in group 3 was considerably larger compared to group 1 (76.4 ± 17.8 ml vs 59.1 ± 15.6 ml, p <0.05). In all groups fil. 1/3 d. for LV and RV was below normal equal to 50% of EF. The correlation analysis revealed a negative association between fil. 1/3 d. of the RV and BMI (r = -0.46, p <0.05) in group 1.

Conclusions

As long as BMI increases in patients with type 2 diabetes mellitus, there is a significant increase in the ESV of both ventricles and EDV of the LV. The most sensitive ERVG indices during the obesity progression are ESV, EDV, and filling within 1/3 diastole. The revealed diastolic dysfunctions in absence of a significant decrease in EF are a manifestation of a myocardial stiffness. Early diagnosis of these disorders and correction of treatment can improve the prognosis of patients with type 2 diabetes mellitus and varying degree of overweight.