bluuebunny/crossref_metadata_2025 huggingface dataset:
BLOOD PRESSURE AND OTHER CLINICAL CHARACTERISTICS OF PATIENTS WITH MYOCARDIAL INFARCTION UNDER 50 YEARS OF AGE
Authors: Kamasova Monika , Kocianova Eva , Obrova Jana , Gizelova Nikola , Kvapil Tomas , Jelinek Libor , Taborsky Milos
Published: June 2022

Objective:

Arterial hypertension is the main risk factor for the development of cardiovascular diseases throughout the world. The prevalence of acute myocardial infarction (AMI) is increasing in young adults, especially men. Previous studies have identified that risk factors for AMI included tobacco use, obesity, arterial hypertension, and diabetes may be crucial to young individuals. Compared to the elderly, the risk factors are not well studied among the young patients with AMI.

Design and method:

We enrolled to our study 41 patients younger than 50 years (thirty-six men) admitted to the Department of Internal I - Cardiology, University Hospital Olomouc, with first episode AMI. We collected detailed information regarding family history of premature CVD (MI/ischaemic stroke in men aged < 55 and in women aged < 65 years, body mass index (BMI), smoking, hypertension, dyslipidemia, diabetes mellitus (DM). Hypertension was defined, according to ESH/ESC (European Society of Hypertension, European Society of Cardiology) guidelines, based on repeated blood pressure measurements, medical history and ongoing blood-pressure-lowering treatment.

Results:

Among 41 young patients with AMI (average 46 ± 3,4 years old), 15 patients (36,6%) had a known diagnosis of arterial hypertension prior to admisison. Mean level of systolic blood at admission were 128,6 ± 18,22 mmHg, diastolic blood pressure 81,35 ± 12,49 mmHg, mean heart rate was 76,32 ± 13,11 bpm. Uncontrolled arterial hypertension was diagnosed at admision in 6 patients, newly diagnosed hypertension in 4 patients. In our group, we diagnosed ST-elevation MI (STEMI) in 54 % of patients, NSTEMI in 46%. Mean level of TRPI was 24051,43 ± 32860,98 ng/l, NTproBNP was 731,1 ± 1019,92 pg/ml. Mean LDL-cholesterol was 3,26 ± 0,83 mmol/l. We newly diagnosed diabetes mellitus in 2 patients, mean HbA1c was 38,42 ± 9,43 (mmol/mol).

Conclusions:

In our group of young patients with myocardial infarction was prevalence of uncontrolled hypertension 17%. Compared to a group of healthy patients (data from literature), we found out a higher prevalence of arterial hypertension in our group.
FEATURES AND IN-HOSPITAL PROGNOSIS OF REDUCED OR PRESERVED EJECTION FRACTION IN ST-SEGMENT ELEVATION MYOCARDIAL INFRACTION MANAGED BY PRIMARY PERCUTANEOUS CORONARY INTERVENTION
Authors: Chamtouri Ikram , Amdouni Nesrine , Abdallah Wajih , Jomaa Walid , Ben Hamda Khaldoun , Maatouk Faouzi
Published: June 2022

Objective:

to assess features and in-hospital prognosis in STEMI patients treated by PPCI and presenting reduced or preserved LVEF.In-hospital mortality and complications were compared between patients with preserved or reduced LVEF

Design and method:

All patients admitted for STEMI between 2000 and 2019 and treated by PPCI were enrolled. On-admission echocardiography was performed in all patients after PPCI to determine LVEF.In-hospital mortality and complications were compared between patients with preserved or reduced LVEF

Results:

A total of 725 was studied. Mean age was 59.1 ± 12.2 years old and 148 (20.4%) were female. Diabetes, hypertension, obesity and tobacco consumption represented 36%, 26.9%, 41.1% and 67.7% respectively. Reduced LVEF< 50% was diagnosed in 324 patients (44.7%). In-hospital mortality was significantly higher in patients with reduced LVEF compared to patients with preserved LVEF on-admission. In-hospital outcomes including atrial fibrillation, ventricle tachycardia and fibrillation, atrioventricular block and pericardial effusion were significantly higher in reduced LVEF. 

Conclusions:

Patients presented STEMI managed by PCI and presenting reduced LVEF on admission are more exposed to in-hospital mortality and complications.
GENDER-RELATED DIFFERENCES IN CORONARY ARTERY DISEASE IN PATIENTS WITH RESISTANT HYPERTENSION
Authors: Solimene Maria Cecilia , Drager Luciano , Bortolotto Luiz
Published: June 2022

Objective:

Hypertension (HTN) is a major risk factor for cardiovascular disease (CVD). Gender differences in clinical aspects of CVD do exist and women seem to have poorer outcomes as compared to men. However the evidence regarding gender-related prognosis in the HTN scenario is controversial. Resistant HTN (RH) in women has been associated to a high increased risk of long-term CV events including death.

We aim to evaluate gender differences in the occurrence of obstructive coronary artery disease (CAD) in patients (pts) with RH and suspected symptoms/signs of CAD referred to cath lab.

Design and method:

Patients were retrospectively included based on admission at Hypertension Department of a tertiary Academic Hospital from May/2010 through May/2014. RH was defined as blood pressure (BP) > = 140/90 mmHg on > 3 anti-HTN drugs or BP< 140/90 mmHg using > = 4 drugs.

Results:

From a total of 1519 pts (883 pts excluded due incomplete data), a final cohort of 634 was established, 357(56,3%) women, mean age 52.5 ± 11 years, body mass index 30.4 ± 6 kg/m2, BP at admission 171 ± 29 / 101 ± 17 mmHg, on use of 3.5 ± 1 anti-HTN drugs. From these, 186 (30%) pts were submitted to coronary angiography. Diagnosis of CAD (coronary stenosis > 50% in at least one major vessel) was made in 113(60%) pts, 45% women. The only risk factor associated to CAD in men was diabetes (38%-CAD vs. 17% non-CAD), while in women the presence of CAD was significantly (p< 0.05) related to the presence of dyslipidemia (72%-CAD vs 46%-non CAD), family of history of CAD (56%-CAD vs 27%-non CAD), age (57yrs-CAD vs. 50 yrs-non CAD), hypertriglyceridemia (176 mg/dl -CAD vs. 114 mg/dl-non CAD), blood glucose (142 mg/dl -CAD vs. 109 mg/dl-non CAD) and lower glomerular filtration rate (58 ml.min.1.73 m2- CAD vs 73 ml.min.1.73 m2-no CAD).

Conclusions:

In pts with RH, the prevalence of CAD is higher in women than expected. There are gender differences regarding risk factors related to CAD in RH, where diabetes was the only CAD risk factor in men, while dyslipidemia and chronic kidney disease are significant risk factors for women, challenging current knowledge
ACUTE ST-ELEVATION MYOCARDIAL INFARCTION: ARE MEN AND WOMEN PARTICULAR CASES OF STEMI?
Authors: Duarte Fabiana , Santos Inês , Barradas Maria Inês , Oliveira Luís , Fontes António , Monteiro André , Machado Carina , Dourado Raquel , Santos Emília , Pelicano Nuno , Pacheco Miguel , Tavares Anabela , Martins Dinis
Published: June 2022

Objective:

To access the difference in clinical characteristics and prognostic outcomes between men and women who were admitted in our Cardiac Intensive Care Unit with STEMI diagnosis.

Design and method:

We retrospectively analyzed 121 patients with STEMI, during a mean follow-up period 135 ± 31 weeks.

We accessed baseline characteristics and time course of events.

Primary endpoint (PE) was a composite of in-hospital cardiovascular death, arrhythmic events or STEMI evolution in Killip-Kimbal III or IV.

Secondary endpoint (SE) was in-hospital major bleeding events and tertiary endpoint (TE) included admissions to the emergency department or hospitalization by heart failure decompensation, acute or chronic coronary syndromes and all-cause mortality.

Results:

Of the 121 patients, 102 were male (84.3%). The mean age was 58.3 ± 12.7 years and women had a superior mean age (69.8 ± 12.2 years).

Hypertension was more prevalent in women (84.2% vs. 47.1%, respectively; p 0.003) and also diabetes – 36.8% of women had type 2 diabetes and 5.3% of these female patients requires insulin therapy (vs 2% of men; p 0.021).

According to Charlson Comorbidity Index (CCI), women had a higher disease burden with 73.7% of them included into the moderate or severe group of mortality risk, compared to 42.2% of men (p 0.014).

Conversely, less women smoke (31.6% vs. 82.2%; p < 0.001) and less frequently chest pain was the onset symptom (78.9% vs. 95.1%; p 0.04).

Time since symptom onset to door admission was estimated on 510 ± 1149 minutes and the mean women delay was superior (557 ± 858 minutes).

Regarding to in-hospital hemorrhagic events, female patients had a statistically significant higher risk (22.2% vs. 7.1%, p 0.045), independently of hypertension, diabetes or anticoagulant therapy (r = 0.249; ANOVA p-value < 0.005), but it was associated with higher CCI (p 0.033). No other gender differences in outcomes were observed.

Conclusions:

Our study demonstrates gender-related differences among patients with STEMI. Indeed, women were older, had more clinical cardiovascular risk factors and tend to delay hospital admission after symptoms onset. Secondary endpoint was statistically more frequent in women, but no other differences in outcomes were observed.
ANGIOTENSIN-CONVERTING ENZYME INHIBITORS AND ANGIOTENSIN II RECEPTOR BLOCKERS AS A RISK FACTOR FOR PATIENTS HOSPITALIZED WITH COVID-19. IS THAT TRUE?
Authors: Luque Paula , Castilla-Guerra Luis , Ferrary Maria , Sanchez Nieves , Alegre Maria , Carmona Eduardo , Rico Miguel Angel
Published: June 2022

Objective:

The link with angiotensin-converting-enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) is because of the known association between angiotensin-converting enzyme 2 (ACE) and SARS-COV 2. ACE 2 has been shown to be a co-receptor for viral entry for SARS-COV-2 in the respiratory epithelium. It has been a global concern that the use of this drugs may be a risk for patients with COVID-19 infection. It has been published many studies about this subject. Even today there are still controversies regarding to the impact of these drugs.

The aim of this study was to determine the association between the previous use of ACEI/ARB and the prognosis of patients with COVID-19 infection

Design and method:

Single-center, restrospective, cohort study included 608 patients with hypertension diagnosed with COVID-19, who where hospitalized in Macarena`s hospital from Mars to December 2020. Analyses of main outcomes (mortality, need of intensive cares (ICU), and days of mean study) were adjusted by multivariate logistic regression.

Results:

Of a total population of 500,000, 608 patients (0.12%) required admission for COVID-19. A total of 83.7% were hypertensive, specifically 75.9% were under antihypertensive treatment (35.7% with only 1 drug, 29.9% were taking two drugs, 9% with three drugs, and 1.3% with 4 drugs). 26.2% were treated with an ACEI and 24.8% with ARBs. Treatment with ACEI / ARB-II (combined or individually) had no impact on mortality (OR = 1.29; 95% CI, 0.829–2.014; p = 0.257), nor ICU admission (OR = 1, 7; 95% CI, 0.68 - 4.95; p = 0.232), nor on the days of mean stay (OR = 0.98; 95% CI, 0.95–1.04; p = 0.325).

Conclusions:

It is unlikely that previous treatment with ACEI/ARB was associated with an increased mortality risk, neither ICU admission or an increase in days of mean stay. This study supports current guidelines that discourage discontinuation of ACEIS or ARBs in COVID-19 patients.
ARTERIAL HYPERTENSION AND COVID19 IN HOSPITAL MORTALITY
Authors: Vintila Ana Maria , Horumba Mihaela , Miron Paul , Balan Razvan , Catrangiu Maria Beatrice , Negoescu Iris Andreea , Trifan Iuliana , Vintila Vlad Damian , Gurghean Adriana , Ianula Raluca Ciomag , Savulescu-Fiedler Ilinca
Published: June 2022

Objective:

Our aim was to explore COVID19-related mortality in hypertensive patients as compared to other associated conditions as well as antihypertensive treatment effect.

Design and method:

We performed a retrospective, unicentric study on COVID19 patients admitted to our department between 1st of September and 1st of December 2021. Collected data included medical history, treatment, echocardiographic data and lab test results. SPSS version 23 was used for descriptive and inferential statistics.

Results:

The lot consisted of 139 consecutively enrolled patients. The median age was 68 years (range: 18–91) and 48.9% females. Only 14.9% of patients were fully vaccinated (3.9% partially vaccinated, 81.3% unvaccinated). Associated conditions were: arterial hypertension (64.7%), heart failure (41.7%), T2DM (29.5%), stroke (13.7%) and coronary artery disease (12.2%).

The inhospital mortality rate was 24.5% without differences between hypertensive and non-hypertensive patients (RR: 1.31 | 0.68 - 2.50). However, T2DM, coronary artery disease and stroke had higher relative risk than hypertension, AF and HF for COVID19 death (T2DM: 2.13 | 1.21 - 3.74; CAD: 2.21 |1.20 - 4.06; stroke: 7.11 |4.45 - 11.35).

Hypertensive patients underwent treatment with ACEi/ARB (37.8%), diuretics (32.2%), calcium channel blockers (13.3%) and betablockers (40%) prior to admission. There was a statistical trend showing that fewer hypertensive patients receiving ACEi/ARB prior to admission required ICU management (20.6% vs 39.3%, p = 0.052) with no difference of inhospital mortality (23.5% vs 28.6%, p = 0.394). Hypertensive patients undergoing BB treatment had lower ICU admission rates (16.7% vs 42.6%, p = 0.008).

Conclusions:

Most hospitalised COVID19 patients were not fully vaccinated. Inhospital mortality was higher among patients withT2DM, CAD and history of stroke, but not HTN. Home treatment with ACEi/ARB or BB treatment was associated with lower ICU admission rates.
ELEVATED RESTING HEART RATE AS INDEPENDENT IN-HOSPITAL PROGNOSTIC MARKER IN COVID-19
Authors: Serravalle Gino , Vanoli Jennifer , Dell’Oro Raffaella , Marro Giacomo , Facchetti Rita , Quarti-Trevano Fosca , Spanziani Domenico , Grassi Guido
Published: June 2022

Objective:

SARS-CoV-2 infection could be complicated by serious autonomic imbalance caused directly by the virus or through secondary release of inflammatory cytokines. Some studies suggested that elevated resting heart rate (HR) and resting tachycardia, being markers of an increased adrenergic cardiac drive, are associated with poor prognosis in COVID-19 syndrome.

Design and method:

We performed a retrospective analysis in an inpatient cohort of 389 subjects diagnosed with SARS-CoV-2 infection to investigate the prognostic relevance of HR in predicting the maximum care intensity needed during hospitalization according to the following four severity outcome classes: I) no need for oxygen support/need for low flow oxygen therapy; II) need for high flow oxygen therapy/continuous positive airway pressure; III) transfer to the Intensive Care Unit; IV) death. HR assessments were recorded on admission and during the first 3 and 7 days of hospitalization.

Results:

For each class increase in maximum care intensity we observed a corresponding significant increase in HR, considering both data collected on admission (average HR value: 90.1 ± 17 beats/minute, p-value trend = 0.0397), and during the first 3 days (p-value trend < 0.0006) or 7 days (p-value trend < 0.0001) of hospitalization. The significant trend was maintained after adjustment for age, sex, comorbidities and fever and in the subpopulation of patients (n = 118) not receiving drugs potentially active on HR both before and during hospitalization. Kaplan-Meier curves for survival based on HR displayed a significant decreased survival in patients with higher HR.

Conclusions:

The assessment of HR during hospitalization provides information on the clinical outcome of patients affected by SARS-CoV-2 infection independently of other confounders. HR as an in-hospital prognostic marker can be obtained both through a first assessment at the admission or mean values over the course of hospitalization with an increase of its accuracy by a 7-days longitudinal evaluation. Further studies might elucidate the association between SARS-CoV-2 infection with multiple autonomic abnormalities.
STAY ALERT ABOUT COAGULATION PARAMETERS - IMPLICATIONS OF THROMBOSIS TREATMENT IN COVID-19
Authors: Sielatycki Piotr , Zbroch Edyta , Markowska Martyna , Zalewska Aleksandra , Bowtruczuk Aleksandra , Warpecowski Jedrzej , Gryciuk Malgorzata
Published: June 2022

Objective:

The case report presents two patients with COVID-19 history. The first patient, treated with enoxaparin, was diagnosed with pulmonary embolism, and later developed heparin-induced thrombocytopenia. The second patient with history of chronic pulmonary thromboembolism and multiple comorbidities, treated with rivaroxaban and acetylsalicylic acid, reported haemorrhagic events. The objective of this case report is to highlight possible complications of anticoagulant treatment and the role of accurate and rapid response of clinicians in COVID-19 patients.

Design and method:

Case report of two patients with COVID-19 - related thrombotic complications treated respectively with low molecular weight heparin and rivaroxaban. Observation of the treatment process revealed complications in both cases, demanding change of medications within the same group of drugs.

Results:

Development of thrombotic episodes was noticed and treated in time. Both patients developed complications of treatment. Modifications of anticoagulation drugs (low molecular weight heparin replaced with fondaparinux and rivaroxaban with apixaban respectively) were provided with positive outcomes.

Conclusions:

SARS-CoV-2 infection is associated with a high risk of thrombotic events whereas anticoagulant treatment can also lead to various complications. The necessity of watchful observation of coagulation parameters in patients with COVID-19, but also potential complications of any anticoagulant treatment is crucial for the positive long-term outcomes.
COVID-19 IS ASSOCIATED WITH ENDOTHELIAL DYSFUNCTION: A META-ANALYSIS OF OBSERVATIONAL STUDIES
Authors: Patoulias Dimitrios , Katsimardou Alexandra , Stavropoulos Konstantinos , Imprialos Konstantinos , Aidinis Asterios , Sviggou Asimina , Kordalis Vasilios , Pyrpasopoulou Athina , Papadopoulos Christodoulos , Doumas Michael
Published: June 2022

Objective:

A number of studies have indicated a deleterious effect of severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) infection on endothelial function of enrolled subjects, further impairing during post-infectious stage. Endothelial function might indeed have a prognostic role in coronavirus disease-19 (COVID-19). Herein we sought to determine the effect of SARS-CoV-2 on endothelial function as quantified by flow-mediated dilation (FMD).

Design and method:

We searched the PubMed database from inception till 21st December, 2021, for observational studies assessing the impact of SARS-CoV-2 on endothelial function either in the in-hospital or the outpatient setting. We set as primary efficacy outcome the mean difference in FMD between infected patients and healthy controls.

Results:

We pooled data from 5 observational studies in a total of 541 enrolled subjects. One study enrolled children, while the rest 4 enrolled adults. Overall, COVID-19 induced a significant decrease in FMD by 3.29% (95% CI; -4.57 to -2.01, I2 = 81%) compared to healthy controls.

Conclusions:

Despite being preliminary, these results suggest a significant effect of SARS-CoV-2 on endothelial system, leading to significant endothelial dysfunction. Prognostic implications of that effect have to be determined in prospective studies.
COVID19 INFECTION IN CORONARY ARTERY DISEASE WITH DIABETES AND HYPERTENSION IN VALVULAR SURGERY PATIENTS IN TERTIARY HEART CENTRE
Authors: Jain Rajesh , Hosseini Js , Shoghli Reza
Published: June 2022

Objective:

The patient was a 59-year-old man who was referred to the hospital due to shortness of breath due to increased activity, accompanied by cough, weakness, and lethargy. The patient also had a history of diabetes, hypertension, hyperlipidemia, and asthma. The patient also underwent cardiac stenting last year. LCX and LAD stenting

Design and method:

He had a continuous pan-systolic murmur on cardiac examination diagnosed with valvular dysfunction.

Severe aortic regurgitation was reported on echo. The patient underwent a CT scan of the lungs and a

PCR test to rule out Covid-19, which was negative. Finally, the patient was diagnosed with severe aortic regurgitation and underwent aortic valve replacement surgery. Echocardiography was performed before the operation, and the diagnosis was confirmed.

Results:

Echocardiography was performed postoperatively, which showed good valve function and no valve leakage. From the 5th day after the operation, the patient developed fever and increased leukocytosis. Suspected of having Covid19 and accordingly underwent PCR test, the test result was positive; the patient underwent a CT scan of the lungs. After that, he was transferred to the corona ICU.

The patient was treated with Remdesivir, and after two weeks, his PCR was negative, and he was almost ready to be discharged.

The patient had completed the entire course of treatment and developed pulmonary fibrosis due to

Covid disease, but suddenly, after two weeks from the onset of the illness, she developed severe shortness of breath, which led to intubation.

We find severe pulmonary fibrosis in the re-CT scan, especially in the left lung, where the entire left lung had fibrosis.

Prednisolone was started at a dose of 50 mg three times a day. The patient was intubated for ten days, then gradually removed from the device. Now the patient is extubated and ready for discharge.

Conclusions:

Risk factors such as Past cardiac surgery and present cardiac intervention with diabetes mellitus increase the risk of developing lung failure in these Covid19 patients.

Elective intubation is better than emergency intubation in patients with comorbidities.

Corticosteroids can be effective in treating pulmonary insufficiency
COVID19 INFECTION AND LIBMAN –SACKS ENDOCARDITIS IN PAST VALVE REPAIRED PATIENT
Authors: Jain Rajesh , Hosseini Sj , Shoghli Reza
Published: June 2022

Objective:

The patient was a 61-year-old woman who typically underwent mitral valve replacement and tricuspid valve repair in 2011. During these years, she underwent an annual checkup and experienced no particular problems. The potential patient contracted Covid 19 a month ago and underwent conservative treatment.

The patient displayed no specific symptoms, no fever, and her Covid 19 disease was mild. In the accompanying echocardiography, we notice a lump on the atrial surface of the Tricuspid valve that we instantly suspect of local vegetation or heart mass. As a result, we admitted the patient to resume the examination.

Design and method:

Multi-slice (16) spiral thoracic CT scan:

Sternotomy and MVR are seen. Cardiomegaly is evident. Patchy peripheral ground-glass opacities are seen bilaterally, suggesting covid-19 pneumonia; correlation with clinical and paraclinical data is recommended. Degenerative changes are perceived in the thoracic spine. There is no pleural effusion.

Blood cultures and urinary trachea were requested to diagnose endocarditis, and she was also asked to have an esophageal echocardiogram.

The antibiotic Meropenem 500 was started three times a day with vancomycin 1 gram twice a day for prophylaxis.

After these examinations, the mass diagnosis was rejected as the image of vegetation on echocardiography did not found echogenicity similar to cardiac tissue and was denser. Consequently, we diagnosed vegetation. According to the negative culture results, and the patient had no symptoms (chills, heart pain), this patient’s diagnosis of an immunological reaction caused by Covid disease was made.

Libman –sacks endocarditis is a type of sterile nonbacterial thrombotic endocarditis (NBTE) secondary to inflammation.

Results:

In this rare case, the vital point is that immunological reaction after covid can give rise to vegetation on the heart artificial valve and can be typically established with endocarditis.

Covid can cause libman sac endocarditis, then we consider patients with heart disease maybe get limban sac or other forms of immunological reaction after covid virus.

Conclusions:

Concerning the explicit rejection of all the causes, the patient was diagnosed correctly with limb sac endocarditis. She underwent anticoagulant therapy and corticosteroid therapy accordingly and was recovered fully.
SELF-REPORTED CHANGE IN (UN)HEALTHY BEHAVIOURS OF PATIENTS WITH CARDIOVASCULAR DISEASES DURING THE SECOND COVID-19 LOCKDOWN IN NORTHERN GREECE: FOCUS ON DIABETES
Authors: Ioannidis Antonios , Pechlevanis Apostolos , Fragkiskou Afroditi , Asmani Filio
Published: June 2022

Objective:

The aim of the study was to compare the (un)healthy behaviours of diabetic (DM) and non-diabetic (non-DM) CVDs patients during the second COVID-19 lockdown in Northern Greece.

Design and method:

This is a cross-sectional short questionnaire telephone-based survey conducted in February 2021. Responders with known CVDs were primarily questioned about smoking, diet and physical activity, along essential medical history.

Results:

The response rate was high (62.6%) with the majority of the participants willing to speak for longer time than initially estimated. In total, answers by 374 patients (118 DM and 256 non-DM) were analyzed. There was no difference in term of gender but the DM group was older (mean age 59.3 ± 6.9 old vs 54.8 ± 6.1 years). There were 184 active smokers questioned (DM: 36, 30.5% and non-DM: 148, 57.8%). More non-DM patients increased smoking DM ones. Of note, the majority of the DM patients reported smoking similarly than before the lockdown. Unfortunately, none of the questioned participants attempted to quit smoking. The mean BMI of the non-DM patients was 27.1 ± 4.2 kg/m2(vs. 26.7 ± 3.8 kg/m2before lockdown) corresponding to a mean weight gain of about 1.5 kg. The rise in mean BMI could be explained, partly, by the increased eating as reported by almost half of the non-DM participants (124, 48.4%). There was a smaller increase in mean BMI of the DM sample (from 26.6 ± 3.9 kg/m2to 26.9 ± 4.1 kg/m2) corresponding to a mean weight gain of less than 0.5 kg. The limited weight gain is represented by the majority of the DM patients reported that they didn’t change their eating habits. About 1/5 of the participants answered that they increased exercising in comparison to their pre-lockdown habits (56, 21.9% vs 24, 20.3%, p> 0.05), Contrary to that, more than half of the DM patients had maintained similar levels of physical activity (68, 57.6%).

Conclusions:

The hard lockdown in Greece during the second wave was accompanied with an aggravation of unhealthy choices by patients with CVDs. This observation was less apparent in the patient with diabetes. Further research is warrant to assess the clinical impact of these behaviours.
HOW COVID -19 AFFECTED CARDIOLOGICAL OUTPATIENT CARE IN BULGARIA?
Authors: Gruev Ivan , Tsanova Veska
Published: June 2022

Objective:

During the last two years Covid 19 has turned into a deadly pandemia, but it also has a devastating effect on noninfectious chronic diseases, particularly on cardiovascular diseases. This situations was described by Prof. Hector Bueno as “sindemia”. SARS Covid-2 - related respiratory syndrome has a direct and strong biological, patophysiological and social interactions with cardiovascular system. Another serious problem is the admission to hospital because, many of cardiologial units and ICU s were transformed into Covid 19 wards. That is why the outpatient treatment of cardiovascular diseases and risk factors became even more important.

Design and method:

According to the regulations of the National Healthcare Fund in Bulgaria, all patients with cardiovascular diseases must have an annual examination by cardiologist. We studied the real –life data from one outpatient cardiological practice in Sofia, Bulgaria. 634 patients had to be checked in 2021. 15 of these patients had died with Covid 19 infection, one with myocardial infarction and one with stroke.

Results:

Only 243 patients attended the annual cardiological examination.172 of them were with worsened control of blood pressure, 48 with new symptoms of heart failure, 16 with newly found atrial fibrillation and 13 with newly diagnosed diabetes mellitus. In just one day the cardiologist met a patient with new decompensated diabetes, patient with new ECG data for myocardial cicatrix, patient with atrial fibrillation and patient with several collapses and ventricular tachycardia on ECG Holter! Many patients had antiaplatelet and anticoagulant treatment prescribed after Covid 19 infection, but also had uncontrolled hypertension and that increases the risk of hemorrhagic stroke

Conclusions:

Covid 19 infection, as an endothelial disease, has a devastating impact on patients with cardiovascular, cerebrovascular, pulmonary and metabolic disorders. The absence of team approach to the therapy leads to very high rate of mortality and long term consequences. The outpatient care of cardiovascular diseases is strongly damaged in Bulgaria. That results in bad control of arterial hypertension, delayed hospitalizations for acute coronary syndromes and heart failure, uncertain control of anticoagulation. It is time to recover healthcare system!
DETERMINANTS OF OUTCOME OF MODERATE TO SEVERE COVID-19 IN A HOSPITAL SETTING: A COMPARISON BETWEEN FIRST AND SECOND/THIRD WAVE IN LOMBARDY
Authors: Boari Gianluca , Leidi Francesca , Accordini Beatrice , Napoli Federico , Ghidelli Chiara , Archenti Giulia , Chiarini Giulia , Malerba Paolo , Scarano Ottavio , Mangili Benedetta , Gorla Giulia , Corbani Andrea , Bonetti Silvia , Braglia-Orlandini Federico , Bianco Gianluca , Faustini Cristina , Ferrari-Toninelli Giulia , Turini Daniele , Guarinoni Vittoria , Saottini Michele , Manzoni Franscesca , Rosei Claudia Agabiti , De Ciuceis Carolina , Rizzoni Damiano
Published: June 2022

Objective:

Coronavirus disease 2019 (COVID-19) represents a major clinical problem in terms of death and long-term sequelae. We conducted a retrospective cohort study at Montichiari Hospital (Brescia, Italy) to better understand different determinants of outcome in different COVID-19 outbreaks.

Design and method:

A total of 635 patients admitted from local emergency room with a confirmed diagnosis of SARS-CoV-2 infection and a moderate to severe COVID-19 were included in the present study. A group of 260 consecutive patients during SARS-CoV-2 first wave (from February to May 2020) and 375 consecutive patients during SARS-CoV-2 second/third wave (from October 2020 to May 2021) were considered. Demographic data, comorbidities, ongoing treatment and bio-humoral, respiratory and haemodynamic data were recorded and compared.

Results:

Main demographic data (Table 1) were not significantly different in the two considered time-lapses, except a lower prevalence of female sex during first wave. Mortality rate was significantly lower during the latter period (25% vs 11%; p < 0.001). Time from symptoms onset to hospital admission was longer during first wave (7.8 ± 5.6 vs 5.6 ± 4.3 days; p < 0.001) while hospital staying was significantly shorter (11 ± 10 vs 15 ± 12 days; p < 0.001).

Other significant differences were a wider use of corticosteroids and low-molecular weight heparin (LMWH) as well less antibiotic prescription during the second wave (Table 2). Respiratory, bio-humoral and x-Ray score were significantly poorer at the time of admission in first-wave patients (Table 3).

After a multivariate regression analysis, C-reactive protein and procalcitonin values, % fraction of inspired oxygen at admission, days after symptoms onset and duration of hospital staying were the strongest predictors of outcome in both periods.

Concomitant anti-hypertensive treatment (including ACE-inhibitors and ARBs) did not affect outcome.

Conclusions:

Our preliminary data suggest that an earlier diagnosis, a timely hospital admission and a rational use of the therapeutic options allowed to reduce the rate of systemic inflammation response (of which CRP is a hallmark) and granted a better outcome during the second of the two time-lapses considered.
PREVENTIVE EFFECT OF STATINS AGAINST RESPIRATORY TRACT INFECTION: A SYSTEMATIC REVIEW AND META-ANALYSIS
Authors: Alsanosi Safaa , Mccallum Linsay , Carberry Jaclyn , Alshanberi Asim , Berry Colin , Padmanabhan Sandosh
Published: June 2022

Objective:

Statins result in lower H5N1 (influenza A) titers on viral exposure and inhibit Ebola virus production and glycoprotein processing. So a similar pattern might be a target for SARS-CoV-2. However, there are data that indicate statins upregulate ACE2 which may have an opposite effect on SARS-CoV-2 infection. To address this question we conducted a systematic review on the efficacy of statins on the risk of respiratory tract infections (RTIs).

Design and method:

Publications of head-to-head randomized controlled trials (RCTs) of statins were retrieved from MEDLINE, EMBASE, Web of Science, and Cochrane (from 2000–July 2021). We included RCTs with at least 100 participants and with a minimum follow-up of one year. Two authors independently selected the included trials, evaluated the risk of bias, and retrieved the data on RTIs. Meta-analyses were performed to summarise the pooled risk ratios (RRs) of RTIs between treatment arms.

Results:

The initial literature search identified 568 records. After duplicates were excluded, there were 318 records. Twenty-five RCTs were excluded after a full-text review of the 29 eligible studies. In the end, four RCTs with a total of 7,912 participants were included in our meta-analysis. As to the effect of statins on RTIs, the point estimate for statins was less than 1, but it did not reach statistical significance in the overall analysis (the pooled RR in the fixed effect model was 0.99 [95% CI: 0.94, 1.04; I2 = 59%; x2 p = 0.66]).

Conclusions:

The findings of our systematic review and meta-analysis do not support the hypothesis that statins reduce the risk of including RTIs.
IMPACT OF ARTERIAL HYPERTENSION AND ANTIHYPERTENSIVE PHARMACOTHERAPY ON IN-HOSPITAL MORTALITY IN COVID-19 PATIENTS: THE CRACOV-HHS STUDY
Authors: Wojciechowska Wiktoria , Terlecki Michal , Klocek Marek , Januszewicz Andrzej , Grodzicki Tomasz , Kreutz Reinhold , Rajzer Marek
Published: June 2022

Objective:

Cardiovascular diseases including hypertension are common comorbidities in patients hospitalized due to COVID-19. We assessed the impact of hypertension on in-hospital mortality in patients hospitalized due to COVID-19.

Design and method:

We retrospectively analyzed the medical records of all consecutive patients who were admitted to the University Hospital in Krakow, Poland, due to confirmed SARS-CoV2 infection from March 2020 to May 2021.

Results:

Overall, data of 5191 patients (mean age 61.9 ± 16.7 years) were available for analysis. Patients with preexisting hypertension (58.3% of the study population) were older and had more comorbidities than patients without hypertension (p < 0.05). In-hospital mortality was significantly higher in patients with hypertension compared to those without hypertension also after adjustment for age (22.2% vs 12.9%; P = 0.02). Age above median (64 years, odds ratio [OR] 3.93; 95% confidence interval [CI] 3.23–4.83), male gender (OR 1.19; CI 1.01–1.40), a history of heart failure (OR 2.01; CI 1.58–2.56) or chronic kidney disease (OR 2.35; CI 1.86–2.96) and increased C-reactive protein levels (OR 1.09; CI 1.08–1.10), but not preexisting hypertension (OR 0.90; CI 0.74–1.09) were significantly associated with a higher risk of in-hospital death after multivariate logistic regression analysis. However, hypertension (OR 1.45; CI 1.06–1.97) was an independent predictor of in-hospital death in patients without established cardiovascular disease and antihypertensive treatment. Treatment with any first-line antihypertensive drug class in patients with hypertension at the time of hospitalization was associated with a lower risk of in-hospital death (beta-blockers OR 0.52; CI 0.41–0.65; angiotensin converting enzyme inhibitors OR 0.52; CI 0.38–0.68; angiotensin receptor blockers OR 0.24; CI 0.12–0.41; calcium channel blockers OR 0.61; CI 0.44–0.84; thiazide diuretics OR 0.40; CI 0.24–0.64).

Conclusions:

Besides the high prevalence, hypertension was not an independent risk factor of in-hospital death in the overall group of hospitalized COVID-19 patients. Treatment with all first-line antihypertensive medications was associated with significant reduction of in-hospital death in patients with hypertension.
IMPACT OF THE COVID-19 PANDEMIC ON THE INITIATION OF ANTIHYPERTENSIVE DRUG THERAPY IN FRANCE
Authors: Olié Valérie , Grave Clemence , Tuppin Philippe , Lesuffleur Thomas , Guenancia Charles , Blacher Jacques , Gabet Amélie
Published: June 2022

Objective:

The objective was to analyze time-trends in the rates of patients who had at least one reimbursement of an antihypertensive drug without reimbursement in the past 12 month for each year from 2017 to 2021, and to study changes according to sex, age, history of cardiovascular diseases, group of antihypertensive drugs and lockdown/curefew periods.

Design and method:

We used data from the French national healthcare database (“Systéme National des données de Santé”-SNDS) covering 99% of the French population. For each year and weeks from 1st January 2017 to 23 of May 2021, patients who initiated an antihypertensive drug treatment in France were selected. Crude and age-standardized rates of patients initiating an antihypertensive drug in overall population living in France were calculated and compared with the 2017–2019 incidence with incidence rate ratio (IRR) adjusted for age and time-trends. Consultations (with general practitioner (GP) or cardiologist) were also recorded over the study period

Results:

In 2020, 1,518,686 persons initiated an antihypertensive therapy in France which was less than the mean number 2017–2019 (n = 1,549,215). The age-standardized incidence in the French population were 2.2% for 2017, 2.3% for 2018, 2.4% for 2019 and 2.2% for 2020. The initiation of an antihypertensive treatment declined by 11% in 2020 as compared to 2017–2019 (reaching -30% during the first national lockdown), with a major differences between men (-5%) and women (-16%), and age groups (-2% in people aged < 45 years old, and -17% in more than 85 years). A similar decline was found between people with a personal history of cardiovascular disease and those without. Among antihypertensive treatments, the greater decrease in the initiation was observed for diuretics (-20%) and ARBs (-19%). In 2021, initiation of antihypertensive drugs were still diminished compared to 2017–2019 but in a lower extent (-4%). An increase was even observed in the youngest age group (+6%) and in men (+4%).

Conclusions:

The pandemic had a major impact on the initiation of antihypertensive drugs and therefore the incidence and/or screening of hypertension with an important age and sex effect and no catch-up effect was observed in 2021.
CLINICAL AND MORPHOLOGICAL FEATURES OF KIDNEY DAMAGE IN PATIENTS WITH ARTERIAL HYPERTENSION DIED OF SARS-COV-2 INFECTION
Authors: Makeeva Tatiana , Zbyshevskaya Elizaveta , Bitakova Fatima , Erinchek Vadim , Saiganov Sergey , Zaytseva Oksana , Nechaev Vladislav , Sivtsova Elena , Mayer Mark , Talibov Faiz
Published: June 2022

Objective:

To assess clinical and pathomorphological features of kidney damage in patients with arterial hypertension (AH) who died of the new coronavirus infection COVID-19.

Design and method:

A complex analysis of 268 kidney autopsies was carried out, including the study of macro- and microscopic changes reflected in the protocols of pathological and anatomical autopsies and identified during the histological examination. In 224 patients (83.6%) with AH, the diagnosis was confirmed by isolating the SARS-CoV-2 RNA using the polymerase chain reaction; in 44 (16.4%) – through computed tomography of the lungs. The causes of deaths were the following: in 31 patients (11.6%) acute myocardial infarction; in 40 (14.9%) cerebrovascular accident; in 11 (4.1%) pulmonary embolism; 222 patients (83%) had acute respiratory distress syndrome. The analysis included 130 men aged 36 to 92 (72.6 years old on average) and 138 women aged 40 to 106 (77.1 years old on average).

Results:

In the kidneys we detected ischemic changes caused by disturbances in the microvasculature. These are stases, sludges, erythrocyte and fibrin thrombi predominantly in the medulla. In the glomeruli diapedesis hemorrhages, mesangial cells proliferation, basement membrane thickening and fibrinoid necrosis of the capillary wall were observed. In the epithelium of the convoluted tubules, a granular, hyaline-drop dystrophy and a necrosis as the extreme degree of the damage were noted. In the kidneys, a pronounced lymphoid and leukocyte infiltration was detected. These changes were accompanied by inflammation and renal failure symptoms. In particular, the level of C-reactive protein was 140.6 ± 7.42 mg/l; blood ferritin 1258.0 ± 110.1 mcg/l; blood leukocytes 15.0 ± 0.67 10^9/l; blood lymphocytes 1.54 ± 0.29 10^9/l; procalcitonin 1.350 ± 0.51 ng/ml. The development of hemorrhagic syndrome was observed in 93 (35%) cases. The level of D-dimer was 4326.4 ± 696.1 ng/ml; fibrinogen 18.2 ± 13.04 g/l; platelets 179.0 ± 8.7 10^9/l. Blood creatinine in patients aged 36 to 59 (27 people) was 120.6 ± 12.2 mmol/l; aged 60 to 80 (136 people) 136.6 ± 10.12 mmol/l; aged over 80 (105 people) 139.0 ± 11.7 mmol/l.

Conclusions:

The study of the kidneys in patients who died from the new coronavirus infection revealed microvasculature vessels damage and development of coagulation disorders amid the renal failure.
COVID-19 INFECTION AND ARTERIAL HYPERTENSION – A RECIPROCAL INTERACTION?
Authors: Rodrigues Filipa Ferreira , Sá Juliana
Published: June 2022

Objective:

High prevalence rates of hypertension were identified among severely ill patients with the infection. The interaction between the virus and the angiotensin - converting enzyme 2 (ACE2) explains its pathogenesis, in particular in the lung and vascular tissues. Nevertheless, the impact of hypertension in the outcome and severity of this infection is still unclear.

Design and method:

This retrospective work aimed to understand the relation between arterial hypertension and COVID-19. We analyzed a pool of 500 admissions in a medical ward specially dedicated to coronavirus infection between 24th October 2020 and 05th March 2021.

Results:

Our representative patient was an elderly male patient with arterial hypertension that had suffer from severe infection, with bilateral pneumonia and acute respiratory insufficiency. In almost a third of patients, there was a reduction or suspension of the anti-hypertensive medication at the time of discharge.

Conclusions:

In line with literature, arterial hypertension was highly prevalent in our COVID-19 patients. However, the infection could also have a role in this cardiovascular disease, lowering the arterial pressure even after the acute phase.
COVID-19 RELATED CHANGE IN DAILY LIFE OF HYPERTENSIVE PATIENTS MAY AFFECT HYPERTENSION MANAGEMENT
Authors: Tsoutsouli Vasiliki , Sachla Zacharo , Efstathiou Kyprianos , Foutsitsakis Dimos , Damianos Alexander James , Gkogkos Konstantinos
Published: June 2022

Objective:

Since 2019, the rapid spread of the SARS-CoV-2 virus and the resulting pandemic, has influenced daily life significantly. Hypertensive patients were amongst the affected group due to psychological reasons and the sudden change in daily routine. In this study we present a group of patients from our hypertension outpatient clinic and we showcase the effect of the current pandemic to their daily life aspects.

Design and method:

We contacted 647 patients from our hypertension management outpatient clinic and through a questionnaire we assessed changes in body activity and body weight in the past six months. The patients were then divided in four groups according to their answers:

No change in body weight, but exercised daily (NC/E)

No change in body weight, but did not follow a routine exercise schedule (NC/NE)

Increase in body weight, but exercised daily (I/E)

Increase in body weight, but did not follow a routine exercise schedule (I/NE)

Results:

The results of our study are presented in the graphs bellow:

It is worth noting that all groups but the first one (NC/E) reported an average increase in systolic blood pressure (SBP) of at least 15 mmHg. This increase was most apparent in the fourth group (I/NE), which also reflected most of the patients, where the average increase of SBP was greater than 25 mmHg.

Conclusions:

The aim of this study is to shed a light in the possible effects of the SARS-CoV-2 pandemic in the life of the patients and more importantly how that affects the management of conditions such as hypertension. The resulting difference in body weight and SBP regulation between the groups can be attributed to an inconsistent exercise schedule, a known factor of SBP management and also a possible by-product of the current pandemic.
EFFECT OF CORONAVIRUS INFECTION ON PATIENTS WITH CONTROLLED AND UNCONTROLLED ARTERIAL HYPERTENSION
Authors: Denisova Anastasiya , Sivakova Olga , Solntseva Tatyana , Chazova Irina
Published: June 2022

Objective:

To assess the severity of coronavirus infection in patients with hypertension, including resistantand refractory hypertension, and to assess the effect of taking ACE inhibitors and ARBs on the course of COVID-19.

Design and method:

We called 252 people with an established diagnosis of hypertension, included in the database from November 2018 to July 2021, in order to identify patients who have recently undergone COVID-19. Initially, the patients were divided into groups depending on the number of drugs taken and the achievement of target blood pressure levels.

Results:

21 (8.3%) of 252 people had a coronavirus infection. 10 out of 21 patients (48%) noted blood pressure destabilization. 6 (60%) of these 10 initially belonged to the group of uncontrolled hypertension (4 of 6 had refractory hypertension, 2 of 6 had uncontrolled resistant hypertension), however, all of them noted worsening blood pressure control and increased frequency of hypertensive crises compared with the period before COVID-19. In 4 out of 9 patients with initially controlled hypertension, BP was destabilized with subsequent normalization of BP during the recovery period.

COVID-19 lasted no more than 14 days in all patients and hypertensive crises was treated by taking short-acting drugs, including an ACE inhibitor (Captopril) and an imidazoline receptor agonist (Moxonidine). 7 (33.3%) and 12 (57.1%) of 21 patients continued to take ACE inhibitors and ARBs, respectively, during coronavirus infection. In 2 (9.6%) of 21 patients, the target BP values were achieved during monotherapy with calcium channel antagonists. All patients with Covid-19 had mild or moderate disease; hospitalization was not required in any of the cases.

Conclusions:

COVID-19 can destabilize blood pressure in patients with hypertension. Taking an ACE inhibitor / ARB does not worsen the course of coronavirus infection in patients with both controlled and uncontrolled hypertension.