bluuebunny/crossref_metadata_2025 huggingface dataset:
Prevention of stroke and dementia in elderly patients with atrial fibrillation
Authors: Chung I
Published: May 2021

Funding Acknowledgements

Type of funding sources: None.

Background

Atrial fibrillation has been shown to associate with greater cognitive decline and increased dementia risk independent of ischaemic stroke. Anti-coagulation was associated with a lower risk of ischemic stroke and positive net clinical benefit in elderly patients.  We hypothesise that elderly patients (>75 years old) with atrial fibrillation on oral anti-coagulants have lower incidence of dementia compared with patients on anti-platelet agents or no anti-thrombotic treatment.

Method

A retrospective study of 747 patients, male 37%, mean age 84.29 ± 5.99 years old with mean follow up of  13.54  ± 3.38  years. 94 % hypertension, 40% diabetes mellitus, 38% ischaemic heart disease, 33% heart failure, 39% previous stroke, mean CHA2DS2-VASc score of 5.23 ± 1.59. 27% patients on oral anti-coagulants, 64% anti-platelet agent and 9% not on any anti-thrombotic medication.

Results

265 patients were diagnosed with dementia, 17 patients were on oral anti-coagulants, 222 patients were on anti-platelet agent. Oral anti-coagulants were associated with lower incidence of dementia compared with anti-platelet agents (p < 0.0001). 26 patients developed dementia were not on any anti-thrombotic agent. 261 patients were readmitted with stroke (2.58%/100 patient year) 182 patients were on anti-platelet agent while 12 were on anti-coagulant (P < 0.0001).

Conclusions

Oral anti-coagulants were associated with lower incidence of dementia and stroke compared with anti-platelet agents in elderly patients with atrial fibrillation.
The effect of omega-3 polyunsaturated fatty acids in prevention of postoperative atrial fibrillation development in patients undergoing coronary artery bypass graft surgery
Authors: Rubanenko O , Rubanenko A
Published: May 2021

Funding Acknowledgements

Type of funding sources: None.

Purpose. To estimate the effect of omega-3 polyunsaturated fatty acids (PUFAs) in prevention of postoperative atrial fibrillation (POAF) in patients with coronary artery disease undergoing coronary artery bypass graft (CABG) surgery.

Methods. Studied were 306 patients who underwent CABG. All the patients were divided into two groups depending on the prescription of omega-3 PUFAs in the pre- and postoperative period by randomization method: 1 group comprised 158 patients without PUFAs (82.7% men, median age 63.0 (57.0;67.0) years, 2 group - 148 patients with PUFAs (89.3% men, median age 60.0 (57.0;64.0) years). PUFAs were prescribed 2000 mg daily starting with 5 days before CABG and 1000 mg daily after CABG for 21 days. In all the patients, we studied interleukin (IL)-6, IL-8, IL-10, NT-proBNP, troponin, superoxide dismutase (SOD), malondialdehyde (MDA), glutathione and omega-3 index.

Results. During the observation period POAF occurred in 29.7% patients of group 1, and in 16.9% patients of group 2 (p = 0.009). In postoperative period patients of group 1 had median IL-6 level 39.3% higher (p = 0.001) and median IL-10 level - 20.2% higher (p = 0.01) comparing with group 2. In patients of group 2 we found SOD median level 78.9% lower (р<0.0001) and MDA median level 33.8% lower compared to the patients of group 1 (р=0.03). In postoperative period in group 2 the median level of docosahexaenoic acid was 55% higher (p = 0.03), and omega-3 index - 43.4% higher (h = 0.04) compared with group 1.

Conclusion. We found that patients with PUFAs had less activation of inflammation and oxidative stress after CABG than patients without PUFAs. The patients with PUFAs also had increased levels of docosahexaenoic acids and omega-3 index compared to the patients without PUFAs. We also found a significant decrease of the prevalence of POAF after CABG in patients with PUFAs.
Do not underestimate the blood urea nitrogen-to-creatinine ratio in heart failure
Authors: Borges-Rosa J , Campos GM , Martinho S , Almeida JL , Goncalves V , Ferreira C , Freitas AA , Milner J , Ferreira JA , Marinho V , Alves PM , Oliveira-Santos M , Goncalves L
Published: May 2021

Funding Acknowledgements

Type of funding sources: None.

Introduction

The blood urea nitrogen-to-creatinine ratio (BUN/SCr) has been proposed as a prognostic marker in heart failure (HF). We aimed to evaluate whether BUN/SCr predicts mortality outcomes in a real-world Southern European population with decompensated chronic HF.

Methods

We retrospectively studied 1057 patients with chronic HF admitted to our emergency department between November 2016 and December 2017 with acute decompensation. We excluded patients with a GFR <15mL/min/m2 or on dialysis. The incidence of cardiovascular (CV) and all-cause death was evaluated through multivariable logistic regression models and by Kaplan-Meyer survival curves.

Results

1025 patients were included, median age 80 years (IQR 73-85), 52.4% male, mean LVEF 42.8 ± 12.7%, and mean GFR 57.2 ± 23.9 mL/min/m2. Mean BUN/SCr was 24.9 ± 8.2 and mean SBP was 139 ± 29mmHg (r=-0.17, p < 0.001). After a median follow-up of 5 months (IQR 3-11 months), CV and all-cause death occurred in 8.0% and 21.6%, respectively. Mean BUN/SCr was higher in patients with fatal outcomes both for CV (31.3 vs. 24.3, p < 0.001) and all-cause death (28.6 vs. 23.8, p < 0.001). BUN/Scr was grouped by terciles: T1 (<20.78), T2 (20.78-27.15), T3 (>27.15). In the T3 group, the multivariable-adjusted  OR for CV and all-cause death was 5.43 (95% CI 2.20-13.37) and 2.72 (95% CI 1.66-4.46), respectively, compared to the T1 group. No significant differences between T1 and T2 groups.

Conclusions

BUN/SCr at admission predicts CV and all-cause death in patients with chronic HF after an episode of decompensation. BUN/SCr, as an easy-to-use tool, helps to identify those patients who benefit from tight monitoring both during hospitalization and after discharge.

Abstract Figure_1
Acute heart failure: is ACTION-ICU useful?
Authors: Santos M , Paula S , Santos H , Almeida I , Miranda H , Sa C , Chin J , Almeida S , Sousa C , Tavares J , Santos L , Almeida ML
Published: May 2021

Funding Acknowledgements

Type of funding sources: None.

Introduction

Patients (pts) with acute heart failure (AHF) are a heterogeneous population. Risk stratification at admission may help predict in-hospital complications and needs. ACTION ICU score is validated to estimate the risk of complications requiring ICU care in non-ST elevation acute coronary syndromes.

Objective

To validate ACTION-ICU score in AHF as predictor of in-hospital M (IHM), post discharge early M [1-month mortality (1mM)] and 1-month readmission (1mRA), in our center population, using real-life data.

Methods

Based on a single-center retrospective study, data collected from pts admitted in the Cardiology department with AHF between 2010 and 2017. Pts without data on previous cardiovascular history or uncompleted clinical data were excluded. Statistical analysis used non-parametric tests, logistic regression analysis and ROC curve analysis.

Results

We included 300 pts admitted with AHF. Mean age was 67.4 ± 12.6 years old and 72.7% were male. 37.7% had previous history of revascularization procedures, 66.9% had hypertension, 41% were diabetic and 38% had dyslipidaemia. Mean heart rate was 95.5 ± 27.5bpm, mean systolic blood pressure (SBP) was 131.2 ± 37.0mmHg, mean urea level at admission was 68.8 ± 40.7mg/dL, mean sodium was 137.6 ± 4.7mmol/L, mean glomerular filtration rate (GFR) was 57.1 ± 23.5ml/min. 35.3% were admitted in Killip-Kimball class (KKC) 4. Mean ACTION-ICU score was 10.4 ± 2.3. Inotropes’ usage was necessary in 32.7% of the pts, 11.3% of the pts needed non-invasive ventilation (NIV), 8% needed invasive ventilation (IV). IHM rate was 5% and 1mM was 8%. 6.3% of the pts were readmitted 1 month after discharge.

Older age (p < 0.001), lower SBP (p = 0,035), presenting in KKC 4 (p < 0.001, OR 8.13) and need of inotropes (p < 0.001) were predictors of IHM in our population. Older age (OR 1.06, p = 0.002, CI 1.02-1.10), lower SBP (OR 1.01, p = 0.05, CI 1.00-1.02) and lower left ventricle ejection fraction (LVEF) (OR 1.06, p < 0.001, CI 1.03-1.09) were predictors of need of NIV. None of the studied variables were predictive of need of IV. LVEF (OR 0.924, p < 0.001, CI 0.899-0.949), lower SBP (OR 0.80, p < 0.001, CI 0.971-0.988), higher urea (OR 1.01, p < 0.001, CI 1.005-1.018) and lower sodium (OR 0.92, p = 0.002, CI 0.873-0.971) were predictors inotropes’ usage.

ACTION-ICU was able to predict IHM (OR 1.51, p = 0.02, CI 1.158-1.977), 1mM (OR 1.45, p = 0.002, CI 1.15-1.81) and inotropes’ usage (OR 1.22, p = 0.002, CI 1.08-1.39), but not 1mRA, the need of IV or NIV.

ROC curve analysis revealed ACTION-ICU performs well when predicting IHM (Area under curve (AUC) 0.729, confidence interval (CI) 0.59-0.87), inotropes’ usage (AUC 0.619, CI 0.54-0.70) and 1mM (AUC 0.705, CI 0.58-0.84).

Conclusion

In our population, ACTION-ICU score was able to predict IHM, 1mM and inotropes’s usage.
Diastolic dysfunction of left ventricle as a consequence of lipotoxic myocardial damage in epicardial obesity
Authors: Gritsenko O , Chumakova GA
Published: May 2021

Funding Acknowledgements

Type of funding sources: None.

Visceral obesity results in lipotoxic myocardial damage and myocardial fibrosis with impaired diastolic function (DD) of left ventricle (LV), followed by progression to heart failure. However, there are no markers for early diagnosis DD of LV.

Objective

to study the relationship between levels of serum markers of lipotoxic myocardial damage and echocardiographic (ECG) parameters DD of LV in patients with epicardial obesity (EO).

Materials and methods

The study included 110 men with general obesity. According to the results of ECG, patients were divided into 2 groups: EO (+) with epicardial fat thickness (tEAT) ≥7 mm (n = 70); EO (-) with tEAT <7 mm (n = 40) without DD according to the results of ECG. All patients were assessed for the level of free fatty acids (FFA), as early markers of lipotoxic myocardial damage, markers of myocardial fibrosis in the blood serum (MMP-3, collagen I, collagen III, TGF – β, VEGFA, PICP) using enzyme immunoassay. ECG was used to determine such parameters DD of LV as the velocity of the lateral part of the mitral valve fibrous ring (e"); the ratio of the velocity E of the transmitral diastolic flow to the average velocity of the mitral ring E/e"; the left atrial volume index; the maximum speed of tricuspid regurgitation. Using speckle-tracking ECG, the mechanics of LV were studied (twist LV, peak twist ratio LV, time to peak twist of LV, peak untwist ratio LV, time to peak untwist of LV).

Results

The level of serum markers of myocardial fibrosis a statistically significant increase  all studied markers was revealed in the EO (+) group compared to the EO (-) group, and a statistically significant increase in the level of FFA in the EO (+) group compared to the EO (-) group (0.82 ± 0.02 mmol/l and 0.35 ± 0.01 mmol/l, respectively). According to the results of speckle-tracking ECG in the EO (+) group, an increase peak untwist ratio LV to -128.31 (-142.0; -118.0) deg/s-1 (p = 0.002) and an increase time to peak untwist of LV of 476.44 (510.0; 411.0) msec was determined (p = 0.03). There were no statistically significant differences in the study DD of LV parameters in the study groups. Weak statistically significant relationship between the level of FFA and peak untwist ratio LV was revealed (r = 0.26; p = 0.04) in the EO (+) group. Relationships between the level of FFA and the parameters of ECG (e"; E/e"; left atrial volume index; maximum tricuspid regurgitation rate) was not found in both groups.

Conclusion

In EO, as a result of neurohumoral disorders, lipotoxic myocardial damage develops and progresses, leading DD to LV, the detection of which is probably possible with the help of the rate of LV untwist.
Associations of severity of liver damages with physical function and prognosis in patients with heart failure
Authors: Noda T , Kamiya K , Hamazaki N , Nozaki K , Ichikawa T , Yamashita M , Uchida S , Maekawa E , Yamaoka-Tojo M , Matsunaga A , Ako J
Published: May 2021

Funding Acknowledgements

Type of funding sources: None.

Introduction

Heart failure (HF) and liver dysfunction often coexist because of complex cardiohepatic interactions, which adversely affects prognosis. However, the association between liver dysfunction and physical dysfunction, and between coexistence of both and prognosis in HF patients remains unclear.

Purpose

We evaluated the associations of severity of liver damage and physical function and prognosis in patients with HF.

Methods

The study population consisted of 895 patients with HF (mean age, 69.4 ± 14.2 years) who underwent liver function test using model for end-stage liver disease excluding international normalized ratio (MELD-XI) score and physical function test (grip strength, leg strength, gait speed, and 6-minute walking distance [6MWD]). The associations between MELD-XI score and physical function were assessed by multivariate linear regression model analysis. Moreover, we investigated the prognostic value of coexistence of liver dysfunction and physical dysfunction. The endpoint was all-cause mortality.

Results

After adjusting for covariates, MELD-XI score was independently associated with lower grip strength, leg strength, gait speed, and 6MWD (P < 0.001). In addition, hierarchical multivariate linear regression analysis revealed that adding MELD-XI scores or BNP explained additional variance in the physical function measures. The MELD-XI score added to the clinical model was significantly more predictive of physical function (grip strength, change in F: 27.105, P < 0.001; leg strength, change in F: 33.980, P < 0.001; gait speed, change in F: 22.826, P < 0.001; 6MWD, change in F: 59.193, P < 0.001) than BNP added to the clinical model. Eighty-six deaths occurred over a median follow-up period of 1.67 years (interquartile range: 0.62 – 3.04). Patients with high MELD-XI score and reduced physical function were found to have significantly higher mortality risk even after adjusting for several covariates (grip strength, hazard ratio [HR] = 3.80 [95% confidence interval (CI) = 2.04 – 7.08], P < 0.001; leg strength, HR = 4.65 [95% CI = 2.47 - 8.75], P < 0.001 and gait speed, HR = 2.49 [95% CI = 1.43 - 4.33], P = 0.001; 6MWD, HR = 5.48 [95% CI = 2.88 - 10.41], P < 0.001).

Conclusions

Liver dysfunction was correlated with reduced physical function. Moreover, the coexistence of lower physical function and liver dysfunction considerably affected prognosis in patients with HF.

Abstract Figure. Kaplan–Meier survival curves
Heart failure patients with implantable cardioverter-defibrillator: molecular predictors for risk assessment of adverse events
Authors: Grakova E , Kopeva K , Teplyakov AT , Isakov LK
Published: May 2021

Funding Acknowledgements

Type of funding sources: None.

Objective. The objectives of the study were to evaluate a multimarker strategy including galectin-3, soluble ST2 (sST2) and NT-proBNP for risk stratification of adverse cardiovascular events (ACE) and death in heart failure (HF) patients with implantable cardioverter-defibrillator (ICD) during the 12-month follow-up period. Methods. A total of 57 patients (41 men, median age of 65 [59; 68] years) of New York Heart Association (NYHA) class II-IV and baseline LVEF of 34% [26; 44]% were enrolled in the study. 71% of patients had prior myocardial infarction and 86% received prior myocardial revascularization (coronary artery bypass graft/stent). Serum levels of sST2, NT-proBNP and galectin-3 were measured using an enzyme immunoassay at baseline. All patients received implantation of cardioverter-defibrillator. Results. After the 12-month follow-up period, all patients were divided into 2 groups: group A (n = 17) comprised patients with ASE, group B (n = 40) comprised those without it. During 12-month follow-up period 15.8% of patients (n = 9) died. The median values of sST2 in group A were higher (p = 0.001) by 51% than in group B (24.42 [22.46; 31.4] and 49.94 [37.4; 58.54] ng/mL, respectively). The median values of galectin-3 in group A (p = 0.002) were 14.7 [9.95; 24.3] ng/L and 9.2 [7.2; 14.7] ng/L in group B. The median values of NT-proBNP were also higher (p = 0.021) by 22% in patients with ASE. Odds ratio for hyperexpression of sST2 was 3.06 (95% CI 2.89-3.17; p <0.0001), 3.79 for galectin-3 (95% CI 2.67-4.11; p < 0.001), and 1.27 for NT-proBNP (95% CI 0.89-2.21; p = 0.036). Reclassification did not significantly benefit after NT-proBNP addition into the full model; some indices even worsened with all 3 biomarkers. Based on ROC-analysis, baseline sST2 concentration of 34.43 ng/mL (sensitivity of 86.7%, specificity of 71.9%, and AUC of 0.78; p < 0.0001) and baseline galectin-3 concentration of 11.6 ng/L (sensitivity of 67.5%, specificity of 70.6%, and AUC of 0.72; p = 0.0014) were identified as a cut-off values predicting adverse cardiac events. The combined evaluation of both biomarkers increased the predictive value of the analysis (sensitivity of 90.1%, specificity of 79.1%, and AUС of 0.84; p < 0.0001). Conclusion. Our data suggest that ST2 and galectin-3 may be used as diagnostic biomarkers in HF patients with ICD. The combined use of sST2 and galectin-3 demonstrated higher diagnostic sensitivity and specificity for prediction of adverse outcomes. However, NT-proBNP in addition to ST2 and galectin-3 biomarkers had a limited effect on risk stratification.
Characteristics and management of heart failure: a retrospective single center study in Cambodia
Authors: Lim YOUHOK
Published: May 2021

Funding Acknowledgements

Type of funding sources: None.

Background

The most common etiologies of cardiovascular disease (CVD) in Cambodia included heart failure (HF) (52.9%), angina pectoris (11.6%), and acute myocardial infarction (4.11%).

Purpose

The goal of this study is to describe characteristics, clinical features, evaluation and treatment of patients with HF admitted to one public hospital in Cambodia.

Methods

This retrospective study included all patients age ≥18 years who were admitted with the diagnosis of HF to the Intensive Care Unit of one public hospital from 1st January 2017 to 31st December 2018. Out of 140 cases, 20 were excluded because they did not meet the inclusion criteria. Characteristics, evaluation, and treatment of the 120 remaining patients were analyzed.

Results

HF with reduced Ejection Fraction (HFrEF) was present in 15%, with mid-range EF (HFmrEF) in 13.3%, and preserved EF (HFpEF) in 71.7% of patients. Hypertension was more prevalent in HFpEF (89.5%, P <0.001) (table 1). Diabetes was more common in HFpEF and HFmrEF (52.3% and 43.7%, P = 0.316) (table 1). Coronary artery disease was more prevalent in HFrEF (72.2%, P = 0.015) (table 1). Global wall hypokinesia was more common in HFrEF group (72.2%, P <0.001) (figure 1). Patients with HFrEF who were given ACEi/ARB (44.4%, P = 0.324) was lower than those with HFpEF (55.8%, P = 0.324). Oral beta-blockers were commonly used in HFrEF (44.4%, P <0.175). Spironolactone was prescribed more in HFmrEF (56.2%, P <0.001) patients than in those with HFrEF (44.4%, P <0.001).

Conclusions

HFpEF was the most common types of HF in this population, and was associated with hypertension and diabetes. HFrEF was least common and was associated with CAD. Prevention and treatment of hypertension and diabetes is essential to reduce the incidence of HFpEF while greater use of guideline recommended drugs is needed in HFrEF.

TABLE 1: Characteristics of HF Patients Clinical characteristics Total (n = 120) HFrEF (n = 18) HFmrEF (n = 16) HFpEF (n = 86) p value Age (years) 58.8 ± 15.2 57.2 ± 16.3 57.3 ± 16.3 61.8 ± 12.9 0.274 Women, n (%) 57 (47.5) 10 (55.5) 4 (25.0) 43 (50.0) 0.14 Men, n (%) 63 (52.5) 8 (44.4) 12 (75.0) 43 (50.0) 0.14 Hypertension, n (%) 95 (79.2) 7 (38.9) 11 (68.7) 77 (89.5) <0.001 Diabetes, n (%) 58 (48.3) 6 (33.3) 7 (43.7) 45 (52.3) 0.316 CAD, n (%) 55 (45.8) 13 (72.2) 9 (56.2) 32 (37.2) 0.015 Values are shown as n (%) or mean ± SD. HFrEF, heart failure with reduced ejection fraction; HFmrEF, heart failure with mid-range ejection fraction; HFpEF, heart failure with preserved ejection fraction; CAD, coronary artery disease.

Abstract FIGURE 1: Proportion of HF and LVWM
Obesity paradox in HFrEF hospitalizations: analysis of national inpatient sample 2016-2018
Authors: Thyagaturu H , Shah K , Li S , Thangjui S , Shrestha B , Bondi G , Naik R
Published: May 2021

Funding Acknowledgements

Type of funding sources: None.

Introduction

Obesity is a common and known risk factor for many cardiovascular diseases. Prior studies on chronic systolic heart failure have demonstrated that obesity is inversely associated with mortality, the so-called obesity paradox.

Purpose

 To study the phenomenon of obesity paradox in HFrEF hospitalizations

Methods

We queried January 2016 to December 2018 National Inpatient Sample (NIS) to identify adult (≥18 yrs) hospitalizations with a primary diagnosis of HFrEF. Patients with an associated diagnosis of obesity and higher BMI were also identified based on appropriate ICD-10 CM codes. We used the Chi-square test to evaluate the differences between binary or categorical variables, and Student’s t-test for continuous variables. Multivariate logistic regression was used in outcomes analysis to adjust for potential hospital and patient-level confounders.

Results

 We identified 639,944 weighted HFrEF hospitalizations across three years. Of which, 130,949 (20.4%) of them were associated with obesity. HFrEF with obesity hospitalizations were associated with younger age (mean age 62.0 vs 70.7 yrs; P < 0.01), lesser CAD (55% vs 61%; P < 0.01), higher rate of comorbidity (% of >3 Elixhauser comorbidity score 99.2% vs 94.1%; P < 0.01) and higher Medicaid primary payer (18.2% vs 12.7%, P < 0.01). After adjusting for patient and hospital-level characteristics, we observe statistically significant difference in odds of in-hospital mortality when HFrEF with obesity hospitalizations was compared to HFrEF without obesity [Odds Ratio (OR): 1.1 (0.8 – 1.5); P = 0.52]. We observed statistically significant association with increased LOS [6.0 vs 5.3 days; P < 0.01], increased total hospitalization charges [US$ 61524 vs 55677; P < 0.01] and decreased coronary catheterizations [OR: 0.7 (0.5 – 0.9); P = 0.01] in HFrEF with obesity group compared to HFrEF without obesity.

Conclusion

In this retrospective cohort of hospitalized patients with HFrEF, higher BMI and obesity was not associated with in-hospital mortality. However, it was associated with longer LOS and higher total hospitalization charges. HFrEF with obesity hospitalizations are associated with lesser left coronary catheterizations. This may be explained by lesser burden of CAD in this patient population.
Optical coherent tomography for the diagnostic of non-obstructive coronary artery myocardial infarction
Authors: Leonova I , Boldueva S , Feoktistova V , Evdokimov D
Published: May 2021

Funding Acknowledgements

Type of funding sources: None.

The widespread use of coronary angiography (CAG) in patients with acute coronary syndrome led to the understanding that in some patients myocardial infarction (MI) occurs against angiographically unchanged or slightly modified coronary arteries (CA). In such cases, the so-called "type 2 IM" is diagnosed in some patients, however, to determine the true cause of MI, a modern method of investigation such as optical coherence tomography (OCT) is needed to visualize the intima of the CA and detect a minimal atherosclerotic process.

 The purpose of the study was to establish the etiology of MI without obstructive coronary artery disease (MINOCA) using OCT.

Materials and methods

160 conclusions of the OCT were analyzed. In 9 (6%) cases, the study was conducted in patients who underwent proven MI (mean age 43,1 ± 13,2, 8 males, 1 female) who had no hemodynamically significant CA stenosis according to CAG data.

Results

in 2 cases (22%) patients had ST-elevation MI, thrombotic occlusion of the CA (in one case, thrombaspiration was performed). In both patients, spontaneous dissection of the intima of the unmodified CA was detected in the OCT. The remaining 7 patients had non-ST-elevation MI, and in 2 cases, a diagnosis of type 2 MI was established: in both patients, the atherosclerotic plaque was visualized, narrowing the lumen of the CA less than 50%, in one case MI developed against a background of the hypertensive crisis, in another - against a background of spasm of CA. In the remaining 5 patients, OCT revealed subintimal atheromatous, with elements of local dissection of the intima. Thus, in 78% of patients atherosclerosis of CA of different severity (from the subintimal deposition of lipids to the development of atherosclerotic plaque, narrowing the clearance of the SC by less than 50%) was diagnosed. In the analysis of risk factors for coronary heart disease (CHD), 57% of patients with atheromatous CA had more than 2 risk factors for CHD: 3 (42%) smoked, 5 (71%) - obesity, 4 (57% ) - had arterial hypertension, 3 (42%) had dyslipidemia, 1 (14%) had type 2 diabetes. In the group of patients with spontaneous intima dissection of the CA, 1 patient (woman) did not have CHD risk factors, the 2-nd suffered from obesity and hypertension. For all patients a lifestyle correction was recommended; statins, antiplatelets were prescribed, patients with spontaneous dissection of CA had the recommendation of examination in the medical-genetic center.

Conclusion

Based on the results of the study, in most cases, the cause of IMBOC development was an atherosclerotic lesion of the coronary arteries, which is not always visualized with standard coronary angiography. Basically, the patients were young and middle-aged. Most patients had different risk factors for coronary heart disease.
Association of blood pressure classification using the 2017 ACC/AHA guidelines with the progression of coronary artery calcification
Authors: Won KB , Park EJ , Chun EJ , Sung J , Jung HO , Chang HJ
Published: May 2021

Funding Acknowledgements

Type of funding sources: None.

Aims

The recent American College of Cardiology/American Heart Association guidelines reinforced the criteria for diagnosis of hypertension. We assessed the association of this reinforced criteria with coronary artery calcification (CAC) progression in asymptomatic adults according to different age groups.

Methods and results

We included 10,839 asymptomatic Korean adults (23.4% aged ≤45 years) who underwent at least two coronary artery calcium score (CACS) evaluations between 2012 and 2016. All participants were categorised into normal blood pressure (BP) (untreated systolic/diastolic <120/<80 mmHg), elevated BP (untreated systolic/diastolic 120–129/<80 mmHg), stage 1 hypertension (untreated systolic/diastolic BP 130–139/80–89 mmHg), or stage 2 hypertension (systolic/diastolic BP ≥140/≥90 mmHg or taking anti-hypertensive medication) groups. CAC progression was defined as a difference ≥2.5 between the square roots (√) of the baseline and follow-up CACSs (Δ√transformed CACS). During a mean 3.3-year follow-up, the incidence of CAC progression was 13.5% and 36.3% in groups with ≤45 and >45 years, respectively. After multivariable adjustment for sex, diabetes, dyslipidaemia, obesity, current smoking, and baseline CACS, hazard ratios (95% confidence interval) for CAC progression versus normal BP in elevated BP, stage 1 hypertension, and stage 2 hypertension were 1.39 (0.93–2.07)(P = 0.107), 1.59 (1.17–2.17)(P = 0.003), and 2.38 (1.82–3.12)(P <0.001) in the ≤45 years group and 1.13 (0.97–1.32)(P = 0.111), 1.20 (1.06–1.34)(P = 0.003), and 1.72 (1.57–1.87)(P <0.001) in the >45 years group.

Conclusion

Newly defined stage 1 hypertension is independently associated with CAC progression in asymptomatic Korean adults irrespective of different age groups.
Does multivessel revascularization fit all patients with STEMI and multivessel coronary artery disease? a systematic review and meta-analysis
Authors: Mengjin H , Yang YJ
Published: May 2021

Funding Acknowledgements

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): CAMS Innovation Fund for Medical Sciences

Objective We sought to assess the relative merits of different revascularization strategies in patients with ST-segment elevation myocardial infarction (STEMI) and multivessel coronary artery disease complicated by cardiogenic shock or chronic total occlusion (CTO). Background Recent randomized trials and meta-analysis have suggested that multivessel percutaneous coronary intervention (PCI) is associated with better outcomes in patients with STEMI and multivessel coronary artery disease, however, patients complicated by cardiogenic shock or CTO were excluded. Methods Studies that compared multivessel PCI (immediate or staged) with culprit-only PCI in patients with STEMI and multivessel coronary artery disease complicated by cardiogenic shock or CTO were included. Random odd ratio (OR) and 95% confidence interval (CI) were conducted. Results Sixteen studies with 8695 patients complicated by cardiogenic shock and eight studies with 2259 patients complicated by CTO were included. In patients complicated by cardiogenic shock, a strategy of CO-PCI was associated with lower risk for short-term renal failure (OR: 0.75; 95% CI: 0.61 to 0.93; I2 = 0.0%), with no significant difference in MACE, all-cause mortality, re-infarction, revascularization, cardiac death, heart failure, major bleeding, or stroke compared with an immediate MV-PCI strategy. In patients complicated by CTO, a strategy of CO-PCI was associated with higher risk for long-term MACE (OR: 2.06; 95% CI: 1.39 to 3.06; I2 = 54.0%), all-cause mortality (OR: 2.89; 95% CI: 2.09 to 4.00; I2 = 0.0%), cardiac death (OR: 3.12; 95% CI: 2.05 to 4.75; I2 = 16.8%), heart failure (OR: 1.99; 95% CI: 1.22 to 3.24; I2 = 0.0%), and stroke (OR: 2.80; 95% CI: 1.04 to 7.53; I2 = 0.0%) compared with a staged MV-PCI strategy, without any difference in re-infarction, revascularization, or major bleeding. Conclusions For patients with STEMI and multivessel coronary artery disease complicated by cardiogenic shock, an immediate multivessel PCI was not advocated due to higher risk for short-term renal failure, whereas for patients complicated by CTO, a staged multivessel PCI was advocated due to reduced risks for MACE, all-cause mortality, cardiac death, heart failure, and stroke.
The evaluation of central pain mechanisms in patients with microvascular angina
Authors: Leonova I , Burova N , Boldueva S , Demidova M , Khomulo A , Korotkov A , Homsky A , Zakharova O
Published: May 2021

Funding Acknowledgements

Type of funding sources: None.

In patients with microvascular angina (MVA) besides of chest pain, a high neuronal activity of certain parts of the head (right anterior insula cortex) was revealed, which is not observed in the control in patients with coronary heart disease with coronary atherosclerosis. There is an opinion that the abnormal sensation of pain is caused not by myocardial ischemia, but by a violation of neuronal regulation. Functional MRI (fMRI) is currently a widely used method of functional mapping of the brain. The principle of the method is to register a BOLD signal (blood oxygen level-depended) from voxels (volumetric points) when examining the brain in response to the fulfillment of a task (paradigm).

In response to the activation of a particular region of the brain, hemodynamic parameters change in it, which leads to a decrease in the level of deoxyhemoglobin and an increase in the level of oxyhemoglobin. With neuroimaging, this phenomenon is characterized by an increase in signal intensity in a series of T2 * images, the quantitative assessment of which allows indirectly determining the degree of neuronal activation.

The study included 11 patients with MVA (3 men, 8 women). The average age of the patients was 61.45 ± 7.80 years. MVA was proved classic criteria and microvascular disorders (perfusion abnormalities) by cardiac PET. Neuroimaging examination included positron emission tomography scanning using 18-fluoro deoxyglucose (18F-FDG PET) and functional magnetic resonance imaging (fMRI) scanning using the GO / NOGO two-stimulus experimental paradigm. Throughout the study, fMRI and PET data were obtained for 11 patients with MVA and 20 healthy volunteers (control group).

Results

In patients with MVA, a decrease in neuronal activity was detected during the execution of actions ("GO" tests) compared with the norm in some brain structures: bilateral anterior and middle cingulate gyrus, additional motor region, postcentral gyrus, left in the islet cortex, on the right in the supramarginal gyrus. When ignoring the second stimulus ("P-P ignore."). A decrease compared with the norm was found bilaterally in the anterior and posterior cingulate cortex, the wedge, on the right in the cortex of the rolandic operculum and supramarginal gyrus. The detected clusters of decreased neuronal activity when performing actions and ignoring the second stimulus intersect bilaterally in the middle and anterior cingulate cortex, in the left paracentral lobe, and the right supramarginal gyrus. When suppressing actions ("NOGO samples"), no significant differences were found. According to PET, no significant changes in the level of glucose metabolism in patients with MVA compared with the control group were found.

Conclusion

In patients with MVA, a decrease in neuronal activity was found when performing actions compared to the norm in some brain structures.
Myocardial infarction in young adults: are the risk profile and mortality outcomes different from older patients?
Authors: Borges-Rosa J , Campos GM , Martinho S , Almeida JL , Goncalves V , Ferreira C , Freitas AA , Milner J , Ferreira JA , Monteiro S , Goncalves F , Monteiro P , Baptista R , Oliveira-Santos M , Goncalves L
Published: May 2021

Funding Acknowledgements

Type of funding sources: None.

Introduction

The incidence of acute myocardial infarction (AMI) among young patients is increasing. The YOUNG-MI Registry reported that those under 40 years had similar risk profiles and outcomes compared to those aged 41 to 50. We aimed to evaluate cardiovascular risk factors and mortality outcomes in two age cohorts from southern European.

Methods

We retrospectively evaluated 4758 patients admitted to our coronary intensive care unit between 2004 and 2017 with AMI. We only included patients <60 years in two subgroups: cohort A < 50 years and cohort B 50-60 years. 

Results

From the 1233 patients included (mean age 50.5 ± 6.5 years, 82.2% male), 53% had STEMI. Cohort B had higher rates of hypertension (59.8 vs. 42.9%, p < 0.001), diabetes (41.8 vs. 28.9%, p < 0.001), and dyslipidemia (59.4 vs. 46.4%, p < 0.001), while cohort A had higher rates of familial premature coronary artery disease (20.9 vs. 13.2%, p < 0.001) and smoking habits (54.4 vs. 40.0%, p < 0.001). Regarding coronary angiography, cohort B had higher rates of obstructive disease in each epicardial artery, except for left main involvement and non-obstructive disease (Fig. 1). Cohort A had lower all-cause mortality rates at the index hospitalization (1.3 vs. 3.2%, p = 0.045), 6-months (2.9 vs.5.4, p = 0.038), 1-year (3.1 vs. 6.3%, p = 0.014), and 3-years (3.6 vs 8.4, p = 0.001). After multivariable adjustment, we found no relationship between age cohorts and all-cause mortality for any follow-up timing: HR 1.57 (95% CI 0.56-4.37), 1.37 (95% CI 0.50-3.74), and 0.92 (95% CI 0.35-2.39) at 6-months, 1-year, and 3-years, respectively.

Conclusion

Among patients who suffer AMI, those under 50 years old have a different risk profile, compared to the 50-60 years cohort. However, there is no significant difference in all-cause mortality.

Abstract Figure.
Mitral valve dysfunction among sudden death victims
Authors: Gupta S , Keen S , Thota S , Jiang H , Jones H , Laible S , Sauter C , Lin FC , Simpson Jr RJ
Published: May 2021

Funding Acknowledgements

Type of funding sources: None.

Introduction

Mitral dysfunction is a commonly found valvular abnormality in the US. The association between mitral dysfunction with sudden death is both complex and controversial.

Purpose

To assess mitral dysfunction as a potential risk factor for sudden death using medical and autopsy records in a population-based registry of sudden deaths.

Methods

From 2013-2015, out-of-hospital deaths aged 18-64 reported by Emergency Medical Services in Wake County, North Carolina were screened to adjudicate 399 sudden death victims. Medical records were available in 270 victims, echocardiograms in 53, and autopsies in 64. Echocardiogram reports of none/trace/trivial mitral insufficiency were compared to patients with mild, moderate, or severe insufficiency. Autopsy reports for thickened mitral leaflets, calcification, and redundancy were reviewed. Additionally, available echocardiograms from a control group of 1101 patients were reviewed for mitral insufficiency. Demographics and clinical comorbidities were assessed from medical and death records. Mean, t-tests, and a bivariate logistic regression were estimated, as appropriate.

Results

Of the 53 victims with echocardiograms, mean age was 53 years, 36 (65.5%) were male, and 21 (39.6%) were African-American. Victims with available echocardiograms were more likely to have congestive heart failure (41.8%), coronary artery disease (50.9%), and diabetes (47.3%) compared to victims without echocardiograms. None/trivial/trace insufficiency was present in 27 victims (50.9%), mild insufficiency in 18 (34.0%), and moderate-severe insufficiency in 8 (15.1%). There was no association between severity of mitral insufficiency with demographic covariates or comorbid conditions. The presence of structural mitral valve abnormalities, including thickened leaflets, calcification, and redundancy of the mitral valve, were present in only 8 (12.5%) of 64 victims with autopsies. In a control group of 1101 date-matched patients from the same county, 57 (4.8%) patients had an echocardiogram available. 14 (24.6%) of these patients had mild-moderate mitral insufficiency.

Conclusion

Mitral insufficiency and structural abnormalities of the mitral valve are often identified in echocardiograms or autopsies of sudden death victims. Living controls had approximately half the prevalence of mitral insufficiency, suggesting that mitral dysfunction and its associated comorbidities are associated with sudden death.
Assessment of left ventricular myocardial deformation according to Speckle-tracking echocardiography in the long-term period in patients with takotsubo syndrome
Authors: Evdokimov D , Boldueva SA
Published: May 2021

Funding Acknowledgements

Type of funding sources: Public hospital(s). Main funding source(s): North-Western State Medical University named after I.I. Mechnikov

Complete improvement of left ventricle systolic function is an essential feature of takotsubo syndrome (TTS). Speckle -tracking echocardiography (STE) provides quantitative information about myocardial deformation, more accurately than conventional echocardiography.

Objective

to assess the global longitudinal strain (GLS) and global circumferential strain (GCS) by speckle-tracking echocardiography in patients with TTS in the long-term period.

Materials and methods

14 female with TTS were monitored, average age 57.5 ± 28.5. The diagnosis was verified by ventriculography and echocardiography. 1 year after the attack, complaints of the patients, cardiovascular events (CE) and signs of heart failure were evaluated. All patients underwent echocardiography using a Vivid-4 (General Electric) with a Speckle-tracking function. The ejection fraction (EF) of the left ventricle (LV), the zone of disorders  of local contractility, the level of GLS and GCS were evaluated.

Results

after an 1 year of observation, all patients had a good clinical condition, there were no CE, and heart failure was absent. The EF level was 56.3 ± 3.45%; no zones of disorders of local contractility were found in any patient. A GLS level below normal was observed in 7 patients (-12.05% ± 5.15%), and was normal in 7 patients (less than -18%), GCS level was reduced in 3 (21.4%) patients (- 9.7 ± 3.4%) at a normal level of -18 and below.

Conclusions

despite the absence of global and local contractility disorders in echocardiography, GLS was revealed in 50% of patients, GCS in 20% of patients. Thus, speckle-tracking shows that in some patients changes in LV contractility persist in the long term. It can be explained by a change in the orientation of the myocardial fibers due to remodeling, but this requires further evaluation.
Expanding the potential benefits of colchicine for preventing postpericardiotomy syndrome and atrial fibrillation complications after cardiac surgery: meta-analysis of randomized controlled trials
Authors: Putra BP , Putra FN
Published: May 2021

Funding Acknowledgements

Type of funding sources: None.

Introduction

Postpericardiotomy syndrome (PPS) and atrial fibrillation (AF) are complications occurred in one-third of cardiac surgery patients that increase morbidity and mortality. Colchicine is an anti-inflammatory drug for treating acute pericarditis and pericardial effusion. Previous studies suggested that colchicine also may prevent PPS and AF after cardiac surgery although the results were still inconsistent.

Purpose

This study intends to determine the efficacy of colchicine for preventing PPS and AF in post-cardiac surgery patients.

Methods

We conducted comprehensive literature searching in online databases of Pubmed, EMBASE, ScienceDirect, and The Cochrane Library, to include all relevant studies until November 2020. We included all randomized controlled trials (RCTs) that access the incidence of PPS and AF after cardiac surgery in patients who received colchicine before cardiac surgery compared with placebo. We use revised Cochrane risk-of-bias tool (RoB 2) for accessing the bias risk of included studies. We performed analysis to provide pooled risk ratio (RR) with 95% confidence interval (CI) using fixed-effect heterogeneity test.

Results

We included 9 RCTs with total of 2,372 participants met our inclusion criteria. The administration of colchicine before cardiac surgery decreases the incidence of PPS significantly (pooled RR = 0.55, 95% CI 0.43 – 0.71, p < 0.00001. I² = 0%). Besides, colchicine also significantly lowers the incidence of postoperative AF compared with placebo (pooled RR = 0.79, 95% CI 0.65 – 0.96, p = 0.02. I² = 20%).

Conclusions

Colchicine showed potential benefits for preventing PPS and AF after cardiac surgery. However, further trials are needed to establish the efficacies.
Risk of cerebrovascular accidents according to weather and pollution features
Authors: Biondi-Zoccai G , Anticoli S , Pezzella F , Di Giosa A , Marchegiani G , Calcagno S , Di Pietro R , Versaci F
Published: May 2021

Funding Acknowledgements

Type of funding sources: None.

BACKGROUND

Despite mounting evidence, there is uncertainty on the impact of the interplay between weather and pollution features on the risk of acute cerebrovascular events (CVE).

PURPOSE

We aimed at appraising role of weather and pollution on the daily risk of CVE.

METHODS

Anonymized data from a hub CVE center in a metropolitan area were collected analyzed according to weather and pollution on the same and the preceding days. Generalized additive models were used to explore the impact of individual and combined factors on the risk of daily CVE.

RESULTS

We collected data from 2012 to 2017, including a total of 2534 CVE, with a 1.56 daily rate (bootstrapped 95% confidence interval 1.48-1.64). In particular, CVE were distinguished as follows: ischemic stroke, hemorrhagic stroke, arterial dissection, ruptured aneurysm, and transient ischemic attacks, with daily rates ranging from 1.422 for stroke to 0.005 for ruptured aneurysm. Unadjusted analysis showed that daily temperature, atmospheric pressure, and humidity, among weather features, were all significantly associated with CVE (all P < 0.05). Similarly, concentrations of carbon monoxide, nitrogen dioxide, nitrogen oxides, ozone, and particulate matter <10 µm (PM10), among pollution features, were all significantly associated with CVE (all P < 0.05). Multivariable analysis, also adjusted for season, showed that CVE were significantly and inversely associated with same-day minimum temperature (P < 0.001), atmospheric pressure (P = 0.007), and humidity (P < 0.001), as well as significantly and positively associated with nitrogen dioxide (P = 0.005) and PM10 (P < 0.001).

CONCLUSION

Cerebrovascular events, and stroke in particular, are more common in days with lower temperature, pressure and humidity, and higher concentrations of NO2 and PM10.

Abstract Figure. Association between PM10 and CVE
Assessment of the effectiveness of antihypertensive therapy in the early post-stroke period of ischemic stroke based on indicators of arterial stiffness
Authors: Mayorova S , Lipatova T
Published: May 2021

Funding Acknowledgements

Type of funding sources: None.

Introduction

Globally, stroke is the second leading cause of death, leading to a reduction in life expectancy and disability of patients. It seems important to study and introduce into practical health care both new approaches to stroke prevention and measures aimed at full recovery in the post-stroke period.

Purpose

To assess the antihypertensive therapy (AHT) in patients with arterial hypertension (AH) in the early post-stroke period of ischemic stroke (IS), based on indicators of arterial stiffness.

Methods

The study included 180 patients with hypertension (mean age 64 years) in the acute period of ischemic stroke (IS). Inclusion criteria in this trial: AH, age over 40 years, time from the onset of stroke no more than 48 hours. Arterial stiffness was assessed by an oscillometric method with an assessment of the 24-hour reflected wave transit time (RWTT), aortic augmentation index (AIxao)), arterial stiffness index (ASI), and pulse wave velocity (PWV). The indicators were assessed at the time of admission, at the time of discharge from the hospital (14-21 days) and 2 months after discharge. We determined endothelin-1 (ET-1) levels by ELISA at admission and 2 months after discharge. Retrospectively, patients were divided into 5 groups depending on the prescribed AHT: group 1 (48 patients) - ACEIs/ARBs, thiazide-like diuretics (TLDs), group 2 (46 people) - ACEIs/ARBs, nondihydropyridine calcium antagonists (ACs) and beta-blockers (BBs), group 3 (39 people) - ACEIs/ARBs and ACs, group 4 (26 patients) - ACEIs/ARBs and BBs, group 5 (21 people) - ACEIs/ARBs, TLDs and BBs.

Results

AHT showed a positive trend in terms of arterial stiffness in all 5 groups. Compared with the baseline values, the significant decrease in PWV (12.4 ± 1.7m/s vs 10.9 ± 1.8m/s, p < 0.01), AIxao (39.8 ± 6.3% vs 36.8 ± 5,2%, p < 0.001), ASI (167.9(127.0;174.5) vs 158.8(115.0;168.7)), p < 0.05), increased RWTT (98.0 ± 9.8ms vs 105.3 ± 7.5ms) in group 2 of patients were found. After 2 months, when comparing indicators between groups the significant decrease in PWV to 9.1(8.7; 11.6)m/s, p < 0.01), AIxao to 31.7(29.8;41.9)%, p < 0.01, an increase in RWTT to 107.7(102.4; 110.2)ms, p < 0.01 in the group of patients taking ACEIs/ARBs, ACs and BBs were detected. After 2 months after discharge, a significant decrease of ET-1 was also observed in group 2 (5.8 ± 2.2ng/ml vs 4.2 ± 1.8ng/ml). The combination of ACEs/ARBs and BBs showed the least effectiveness in reducing arterial stiffness.

Conclusions

The combination of ACEIs/ARBs, ACs and BBs showed the greatest efficiency in reducing the stiffness in patients with hypertension in the early post-stroke period of IS. It seems important for the functional recovery of patients in the post-stroke period to use the drug therapy aimed not only at lowering blood pressure, but also favorably affecting the arterial stiffness.