Acute Cardiac Pathology Research Articles

Echocardiographic parameters of cardiac structure and function in the diagnosis of acute myocarditis in adult patients: A systematic review and meta-analysis.

Transthoracic echocardiography (TTE) plays a key role in the initial work-up of myocarditis where the identification of pathologic structural and functional changes may assist in its diagnosis and management. The aim of this systematic review was to appraise the evidence for the utility of echocardiographic parameters of cardiac structure and function in the diagnosis of myocarditis in adult populations. A systematic literature search of medical databases was performed using PRISMA principles to identify all relevant studies assessing TTE parameters in adult patients with myocarditis (1995-2020; English only; PROSPERO registration CRD42021243598). Data for a range of structural and functional TTE parameters were individually extracted and those with low heterogeneity were then meta-analyzed using a random-effects model for effect size, and assessed through standardized mean difference (SMD). Available data from six studies (with a pooled total of 269 myocarditis patients and 240 controls) revealed that myocarditis can be reliably differentiated from healthy controls using echocardiographic measures of left ventricular (LV) size and systolic function, in particular LV end-diastolic diameter, LV ejection fraction (LVEF) and LV global longitudinal strain (LV-GLS) (p ≤ .01 for all). LV-GLS demonstrated the highest overall effect size, followed by LVEF and LVEDD (SMD: |0.46-1.98|). Two studies also demonstrated that impairment in LV-GLS was associated with adverse cardiovascular outcomes in this population, irrespective of LVEF. LV-GLS demonstrated the greatest overall effect size and therefore ability to differentiate myocarditis populations from healthy controls. GLS was also shown to be a predictor of adverse cardiovascular outcomes, in this population. What is already known on this subject? Myocarditis is a disease process that is often a diagnosis of exclusion, as it frequently mimics other acute cardiac pathologies. Transthoracic echocardiography is traditionally the initial imaging modality used for noninvasive structural assessment in populations with myocarditis. What might this study add? This study demonstrates that left ventricular (LV) global longitudinal strain, LV ejection fraction and LV end-diastolic diameter can differentiate between myocarditis patients and healthy controls. LV-GLS demonstrated the greatest overall effect size when comparing these two populations, in comparison to the other measures. How might this impact on clinical practice? This study demonstrates that assessment of myocardial deformation indices allows for sensitive discrimination between myocarditis patients from healthy controls. Routine assessment of LV-GLS may serve as an important diagnostic tool in the acute care setting.

Transformation of Cardiac Intensive Care Wards Into Cardiac Resuscitation Department. The Five-year Evolution

The article highlights the key elements and results of the restructuring of emergency care for patients with acute myocardial infarction, the core of which is the teamwork of surgeons, anesthesiologist-intensivists and cardiologists of the department. The restructuring included a change in ideology, personnel changes, updating and expanding the range of equipment, development of inner protocols and their implementation. It took two years to transform the intensive care unit for patients with acute myocardial infarction into the cardiac intensive care unit, where patients with acute cardiac pathologies of various etiologies are treated and preoperative preparation and postoperative nursing are carried out.

Prevalence of Heart Failure in a Megalopolis

Aim To assess the prevalence of heart failure (HF) in St. Petersburg from 2019 through 2021 based on medical reports.Material and methods Medical records of 146 912 patients with HF who were managed in St. Petersburg from 2019 through 2021 were analyzed. Prevalence of HF was assessed using a standard ICD-10 I 50.x code for this disease. Also, expanded HF coding was used with ICD-10 codes I09.9, I11.0, I13.0, I13.2, I25.5, I42.0, I42.9, I43.0, I43.1, I43.8, I42.5, I42.7, and I42.8. An additional analysis was performed for mortality from cardiovascular diseases (CVD) as a whole and from HF in particular (n=192 133).Results From 2019 through 2021, the number of both male and female patients with HF increased by 18.14 %. The greatest number of HF patients was in the age group of 75-89 years in 2019-2020 and 60-74 years in 2021, with females prevailing. The HF incidence increased in the age group of 45-59 years with a peak morbidity at age of 60-74 for men and 75-89 for women, which was consistent with the life expectancy of each gender. The expanded coding allowed a more complete presentation of HF prevalence and also to take into account patients with HF caused not only by myocardial infarction or acute cardiac pathology but also by rheumatic heart disease, arterial hypertension, myocarditis, and cardiomyopathies. Cardiovascular mortality significantly increased by 20.1% during the period from 2019 through 2021. The HF prevalence for deceased patients also was steadily increasing during 3 years. Analysis of associated pathology in HF patients revealed, in most cases, hypertension, ischemic heart disease, cerebrovascular diseases, diabetes mellitus, and obesity.Conclusion The increase in HF prevalence and mortality draws attention and calls for managing measures to change the current situation in health care. A registry is required to characterize a typical patient with HF and to present an unbiased picture of HF prevalence. It is also necessary to develop programs for outpatient follow-up of patients in this category and for providing current, highly effective medicines. Education of patients and improving the knowledge of therapists in diagnosis and treatment of HF are most relevant for enhancing the quality and duration of patients' life and for reducing the number of hospitalizations and the HF mortality.

Iron chelation effects on lipid peroxidation, inflammation and ventricular performance in a rat model of isoproterenol induced acute myocardial stress.

Acute cardiac pathologies represent one of the leading causes of death, while iron metabolism is recognized to be implicated in reactive oxygen species production, lipid peroxidation, and inflammation. The aim of the present study was to assess iron chelation effects in isoproterenol (ISO) induced acute cardiac stress. We divided male Wistar rats into preventive and secondary treatment groups, with the active arm consisting in deferiprone (DFP), a lipid permeable chelator. Mortality of ISO was 10-18.18% in both preventive and secondary groups. We analyzed serum and myocardial tissue parameters of inflammation, iron dynamics, and lipid peroxidation, accompanied by ultramicroscopy, histological, and ultrasound-derived parameters of left ventricular function. Results reveal that ISO-mediated lipid peroxidation and inflammation are alleviated by administration of DFP, with negligible effect on systemic ferroregulation dynamics and global ventricular function (as assessed by ultrasound). DFP administration after cardiovascular stress is associated with a decrease in lipid peroxidation and inflammation, without an improvement in gross left ventricular parameters.

P337 SPORTS CARDIOLOGY NURSE IMPORTANCE IN YOUNG SPORTSMEN SUFFERING FROM ACUTE HEART DISEASE PREVENTION AND REHABILITATION. PILOT EXPERIENCE: REMOTE MONITORING DURING THE SARSCOV–2 PANDEMIC

This is because it is difficult to understand that a “well trained” heart is not necessarily a “healthy” heart, and many malignant arrhythmias are triggered by physical activity. A project on diagnosis and prevention aimed at recognizing acute cardiac pathologies in young sportsmen has been launched using professional nursing figures, who in addition to having acquired relevant skills in the critical, interventional and clinical cardiology area, have also acquired additional skills in the field of the Biomedical and Neuromotor Sciences. The “sport cardiology nurse” can represent a relevant support for athletes’ acute cardiac pathologies prevention and rehabilitation. It takes the young patient throughout the process together with the Doctor: – Outpatient activity (recognition of ECG alterations, preparation of the patient for drug tests, Tilt test, management of complications) – Interventional cardiology activities: implantation of loop recorders and implantable defibrillators. – Rehabilitation and physical, nutritional and psychological education. With the SARS–CoV–2 pandemic, our work has undergone a drastic change. We have worked with telemedicine and activated remote monitoring for implanted cardiac devices. Our experience from January 2020 to today counts the enrolment of 80 patients undergoing ICD implantation, of which 8 subcutaneous, in young athletes. With the video visiting service it was possible to follow young patients who had been diagnosed with acute heart disease, to monitor and identify the onset of symptoms and / or arrhythmias. Remote monitoring is managed by the Sports Cardiology Nurse and the Doctor in charge. Given the results obtained, the project also aims to expand its skills in the environments most attended by young people, such as schools and sports centres in association with local companies in a not too far future. This “Sport Cardiology” aims to train more nursing professionals, to plan interventions aimed at reducing mortality and to spread the basic concepts of health education in the field of prevention.

Outcomes of patients coming to the emergency department after kidney transplantation

Introduction: In kidney transplantation (KT) practice, improvements in patient care led to increased graft and patient survival. This study aimed to determine the symptomatology of KT patients presenting to emergency department (ED), their final diagnoses, and outcomes.
 Material and Method: Data including demographic data (age and gender), chief complaints (CCs), number of ED presentations, ED presentation date, KT date, donor type (live/deceased), patient disposition (discharge/admission), final diagnosis, and outcomes (acute renal graft dysfunction/graft loss/death) were retrieved and analyzed. 
 Results: Twenty-five KT patients presented to ED during the study period. These patients presented to ED for 46 times with 50 CCs. Fever was the most frequent CC (20%). The ED presentation led to a final diagnosis of infection in 32 presentations (69.4%). The most frequent infection was urinary tract infection (UTI) (26.1%) followed, by acute gastroenteritis (17.4%) and upper respiratory tract infection (17.4%). Acute graft dysfunction was the most common “non-infectious diagnosis” (17.4%) followed by cardiovascular disease (8.5%). The ED presentation led to admission in 32.6% (15/46) of the cases. Among 15 admissions, 7 (46.7%) were due to UTI. No rejections, graft loss, or mortality occurred following any ED presentations.
 Conclusion: When evaluating KT patients in the ED, physcians should bear in mind that they could have an infectious pathology that is often associated by fever, also they should check for acute graft dysfunction and cardiac pathologies.

Six Months After the Patients Stayed Home: A Nationwide Study of Cardiac Mortality and Readmissions Following the First Wave of the COVID-19 Pandemic in Malta.

BackgroundThe first COVID-19 wave resulted in a significant decline in acute cardiac admissions (ACAs) and delays to hospital presentation in Malta, as well as an excess of out-of-hospital cardiac arrests. The aim was to investigate the impact of the observed delays in presentation in 2020 on mortality and cardiac readmissions at six months.MethodsAll ACAs between 28th February and 30th April 2020 (first wave of COVID-19 in Malta) were included, and the corresponding 2019 period was used as a control. ACA was defined as an unplanned admission of an adult (aged ≥16 years) under the care of a cardiologist. Outcomes over the six months following the index ACA included death, cardiac readmission, and planned cardiac intervention at discharge. The term ‘death’ referred to all-cause mortality. Cardiac readmissions referred to unplanned admissions for acute cardiac pathology following the index ACA. During sub-analyses, ACAs were divided into acute coronary syndrome (ACS) and non-ACS. A first analysis compared the frequency of deaths, cardiac readmissions, and planned interventions between the 2019 and 2020 cohorts. A second analysis investigated differences in six-month survival and freedom from readmission between the two cohorts. Both analyses were followed by a sub-analysis.ResultsThere were 330 ACAs among the 2019 cohort and 220 in 2020. There were no significant differences between the 2019 and 2020 cohorts in all-cause mortality (2019, 8.8% vs 2020, 8.2%, p=0.466) and Kaplan-Meier survival estimates at a six-month follow-up (2019, 169.06 days (95% CI 164.95-173.17) vs 2020, 168.27 days (95% CI 162.82-173.72), p=0.836), including subgroup analysis for non-ACS (2019, 168.52 days (95% CI 163.08-173.96) vs 168.11 days (95% CI 160.93-175.30), p=0.952) and ACS patients (169.81 days (95% CI 163.54-176.09) in 2019 vs 168.45 days (95% CI 160.17-176.73) in 2020, p=0.739).A significantly higher number of patients from the 2019 cohort (75/319, 23.5%) required readmission compared to 2020 (32/212; 15.1%) (p=0.02). Similarly, there was shorter freedom from cardiac readmission among 2019 patients (mean 150.98 days (95% CI 144.63-157.33)) compared to 2020 patients (mean 158.66 days (95% CI 151.58-165.74, p=0.024). During sub-analysis, the difference in freedom from readmission was significant only for non-ACS patients (mean of 145.45 days (95% CI 136.58-154.32) in 2019 vs 158.92 days (95% CI 149.19-168.64) in 2020, p=0.018).Analysis of cardiac interventions during the six months post-index ACA discharge showed significantly more planned cardiac interventions in 2019 (52/319; 16.3%) compared to 2020 (20/212; 9.4%) (p=0.027).ConclusionsA delay in presentation of ACAs during COVID-19 in Malta resulted in lower readmission rates and increased freedom from readmissions, with no excess in all-cause mortality at a six-month follow-up. The reasons for the optimistic outcomes of patients admitted during the first wave of COVID-19 may be multifactorial. Reasons may include ongoing fear of hospital presentation, a more holistic approach to patients’ in-hospital care during 2020 aimed at reducing further hospital contact post-discharge, and a selection bias secondary to an excess of out-of-hospital cardiac arrests during the initial wave of COVID-19. Further studies will be required to truly assess the collateral impact of non-COVID-19-related illness. Public education on cardiovascular health is vital and must be emphasized during the pandemic.

Analysis of Significant Electrocardiogram (ECG/EKG) Variations in Psychological Stress

Purpose: Mental stress and other psychosomatic disorders have been linked to an increased risk of sudden cardiac death in population studies. There hasn't been a thorough examination as to whether emotional or physical stresses might cause sporadic ventricular arrhythmias in vulnerable patients. An outsized and mounting body of discovery shed light on the fact that internal health is interrelated to risk factors for heart complaint before an opinion of an internal health complaint and through treatment. These things can arise both directly, through natural pathways, and laterally, through parlous health actions. People who are passing through clinical depression, anxiety disorders, common and general stress syndromes, and indeed post-traumatic stress disorder commonly known as PTSD over an absolute period of your occasion may observe definite physiological alterations in the body, similarly, as a highly enlarged cardiac reactivity such as augmented vital signs and elevated blood pressure, deducted or condensed blood inflow directly to the center, and heightened or highly raised amount of an organic chemical compound called cortisol. Over time, these physiologic processes may generate calcium particle depositions or buildup within the normal organic pathways. It may also manifest events of body metabolic dysfunction as well as cardiac conduction problems. Substantiation shows that many physiological and psychiatric/psychological diseases -similar to chronic clinical depression, psychological stress, and PTSD can appear after any cardiac event regardless of its severity. Objective: The focal objective of this article is to identify psychological stress, its influence on cardiac problems such as cardiac arrhythmia, and its symptomatic manifestations on an electrocardiogram. Apart from that, this paper also focuses on the area of how ECG changes due to psychological distress. Another objective of this paper is to provide vivid information about psychological stress and its link with acute and chronic cardiac pathologies. Laymen should know the fact that the mind and the body are linked with each other and if the mind is distressed for a long time will affect the health condition of the physical body also. Design/Methodology/Approach: To build the paper, mostly secondary information has been used from various sources such as clinical literature, journals, websites, etc. Primary information has also been used to increase the accuracy and reliability of the paper. Primary data have been taken from neuropsychologists, cardiologists, clinical psychopathologists, and behavioral medicine specialists. Based on all these databases, systematic and scientific clinical analysis of information has been done to avoid any mistakes and errors. Findings/Result: In people with ICDs, stress and physical exercise might cause ventricular rhythm abnormalities. Future studies into medicines that prevent these stimuli' responses might reduce ventricular arrhythmias and upsets in some of these patients. People with type A personalities should try to control or adjust their innate personality and character to reduce the vulnerability to develop any kind of cardiac arrhythmia or any other cardiac pathologies. All ECG variations and arrhythmias are not related to psychological stress rather it needs differential diagnosis to rule out any other underlying problems. A thorough differential investigation is suggested to rule out whether the cardiac problem is due to psychological stress or not. Originality and value: A comprehensive analysis and interpretation have been made to cover the concerned topic of study and make information more reliable and valid. A new initiative is taken to provide information about the mind and heart link. Paper Type: Secondary clinical report analysis/interpretive paper

Kidney-Related Outcome in Cardiorenal Syndrome Type 3.

Methods A single-center, retrospective and observational trial. All subjects with positive AKI alert, treated at the University Hospital Brandenburg between January and December 2019, were evaluated. Definition of CRS type 3 was according to predefined criteria. The three endpoint categories were in-hospital death, dialysis, and recovery of kidney function. Results . A total number of 1,334 AKI alerts were screened. Finally, 95 subjects received the diagnosis CRS type 3. The survival rates were 47.1% (females) and 43.6% (males). 46.8% of affected females and 33.3% of the males required dialysis therapy. Complete recovery at the time of discharge occurred in 35.8%, and no recovery at all was found in 54.7%. Conclusions . All three predefined study endpoints, the mortality, the prevalence of dialysis, and the percentage of subjects without recovery of kidney function, were notably high. Therefore, AKI patients with imminent or established cardiac complications require the highest attention of nephrologists in charge.

Cardiovascular and Heart Failure Management of COVID-19: The New York Experience

The COVID-19 pandemic in New York started in March 2022 and rapidly escalated in a devastating way. There were almost 3,000 deaths per million population in United States as of May 5, 2022. In addition to pulmonary manifestations, COVID-19 is associated with deleterious effects on the cardiovascular system by increasing the risks of myocardial infarction, arrhythmias, and heart failure (HF). Apart from the common pathology including direct vascular or myocardial infection, systemic proinflammatory response, sympathetic stimulation, myocarditis, myocyte necrosis, hypercoagulability, and acute respiratory distress syndrome, a recent study had identified microthrombi as the predominant acute cardiac pathology. Cardiac involvement is associated with poorer clinical outcomes. The mortality is particularly high among HF patient and heart transplant recipients. Immunosuppression for most heart transplant recipients during COVID-19 infection was reduced. Extracorporeal membrane oxygenation (ECMO) can be used in patients with HF with predominance of refractory hypoxemia; veno-arterial-venous ECMO strategy has been developed in the setting of mixed severe acute respiratory distress syndrome and circulatory failure. In response to the pandemic crisis and restrictions, the patient care delivery model has been converted to telehealth. NewYork-Presbyterian Hospital in New York transitioned its management of HF program, initiated a shared clinic model, and introduced a comprehensive remote monitoring program to manage patients with HF and heart transplant, and left ventricular assist device.

Cardiometabolism as an Interlocking Puzzle between the Healthy and Diseased Heart: New Frontiers in Therapeutic Applications.

Cardiac metabolism represents a crucial and essential connecting bridge between the healthy and diseased heart. The cardiac muscle, which may be considered an omnivore organ with regard to the energy substrate utilization, under physiological conditions mainly draws energy by fatty acids oxidation. Within cardiomyocytes and their mitochondria, through well-concerted enzymatic reactions, substrates converge on the production of ATP, the basic chemical energy that cardiac muscle converts into mechanical energy, i.e., contraction. When a perturbation of homeostasis occurs, such as an ischemic event, the heart is forced to switch its fatty acid-based metabolism to the carbohydrate utilization as a protective mechanism that allows the maintenance of its key role within the whole organism. Consequently, the flexibility of the cardiac metabolic networks deeply influences the ability of the heart to respond, by adapting to pathophysiological changes. The aim of the present review is to summarize the main metabolic changes detectable in the heart under acute and chronic cardiac pathologies, analyzing possible therapeutic targets to be used. On this basis, cardiometabolism can be described as a crucial mechanism in keeping the physiological structure and function of the heart; furthermore, it can be considered a promising goal for future pharmacological agents able to appropriately modulate the rate-limiting steps of heart metabolic pathways.

Optimization Of Medical and Environmental Services Using TES Therapy

Experimental studies have shown the presence of antihypoxic, decongestant and immunomodulatory effects of endogenous opioid peptides (OP), as well as their effect on the synthesis of pituitary hormones, these effects are largely due to an increase in the blood content of opioid peptides ((3-endorphin and met-enkephalin), which are released when the structures of the antinociceptive system are activated. Studying the effect of TES therapy on reparative processes in patients with myocardial infarction and establishing that this accelerates the formation of postinfarction scar and the development of compensatory hypertrophy of extrainfarction parts of the myocardium, increases the number of cases of heart failure and the number of relapses of anginal pain, improves the general state of hemodynamics. However, until now, the question of the possibility of using TES therapy to correct the imbalance of cytokines in the acute period of myocardial infarction, which is an important pathophysiological factor in the development and course of acute cardiac pathology, remains open.

Critical Care Echocardiography as a Routine Procedure for the Detection and Early Treatment of Cardiac Pathologies.

Transthoracic and transesophageal echocardiography are important investigations in the intensive care unit (ICU) to diagnose acute cardiac pathologies and assess the haemodynamic status. Recommendations for critical care echocardiography (CCE) have been published recently, but these still lack an evidence-based foundation. It is not known if performing transthoracic echocardiography (TTE) on a routine basis instead of only when required in acute cases is feasible or clinically useful. In this single-centre prospective observational study, we routinely performed TTE on 111 consecutive non-cardiological, non-cardiothoracic surgical ICU patients in two surgical ICUs in a tertiary care facility. Significant cardiac pathologies were detected in 82 (76.6%) and critical cardiac pathologies in 33 (30.8%) of the 107 patients. The most common critical cardiac pathologies were sPAP > 50 mmHg (19.63%), tricuspid annular plane systolic excursion ≤ 13 mm (9.4%), grade III diastolic dysfunction (8.4%), severe tricuspid valve insufficiency (5.6%) and left ventricular ejection fraction (LV-EF) ˂ 30% (4.7%). Some of the most commonly found cardiac pathologies are not well emphasised in current recommendations and training programs. We observed a progression of the cardiac pathologies previously described in 41 of the patients (91.1%). Patients with echocardiographic abnormalities had a significant survival disadvantage in the ICU. By performing CCE routinely, we observed the range and prevalence of cardiac pathologies that can be detected by echocardiography in critically ill patients. We recommend routine transthoracic CCE in ICU patients for early detection of cardiac pathologies and to help inform early intervention regimens, since cardiac conditions carry a significant survival disadvantage for the ICU patient.

Consensus document ANMCO/FADOI/SIAARTI/SIC/SIMG/SIMI/SIMEU: The clinical-diagnostic and therapeutic pathway of patients with acute heart failure in the Emergency Department

Acute heart failure (HF) involves hospitals throughout the world and, as well as other acute cardiac pathologies such as coronary syndromes, has markedly unfavorable outcomes: the mortality or rehospitalization rate after 3 months is 33%, mortality 1 year after admission varies between 25% and 50%.
 A critical factor in managing acute HF is the multiplicity of health professionals involved in the diagnostic-therapeutic pathway of this syndrome - general practitioners, emergency doctors, cardiologists, internists, anesthesiologists/resuscitators - and therefore also the need to integrate different knowledge and skills and converge on care goals that can improve clinical outcomes.
 This consensus document originates from the joint work of the Scientific Societies, representing various professional figures involved in assisting patients with acute HF, and has shared strategies and pathways aimed at guaranteeing both quality care levels and better outcomes. The document details the entire journey of the patient with acute HF from the onset of symptoms at home, diagnosis, home management or sending to the Accident and Emergency/Emergency Admissions Department (AandE/EAD), mode of transport, early therapy, through the instrumental clinical pathways for diagnosis in AandE/EAD and the treatment, risk stratification and discharge of the patient in ordinary hospitalization or at home. It also analyses the possible role of cardiological "fast-track", Short Intensive Observation and regional welfare taking charge through general medicine and specialist clinics for the care of HF.
 The growing care burden and the complex problems generated by acute HF cannot find an adequate solution without an integrated multidisciplinary approach that effectively places emergency facilities in the network along with intensive and ordinary hospitalization units and within the context of regional care. Thanks to contributions from the most qualified Scientific Societies, this document pursues this objective by proposing a structured, shared and applicable pathway which can contribute to manage a widespread problem in the country.

Prognostic value of acute cardiorenal syndrome in patients with acute cardiac pathology

To assess the prevalence and prognostic value of AKI in patients with acute decompensation of chronic heart failure (ADCHF) with a reduced ejection fraction (HFrEF) and with preserved ejection fraction (HFpEF) or acute coronary syndrome (ACS), to identify predictors of AKI. In a prospective study included 863 patients, of which 141 with ADCHF, 446 - non-ST-elevation acute coronary syndromes (NSTE-ACS) and 276 - ST-segment elevation myocardial infarction (STEMI). AKI was diagnosed according to KDIGO recommendations. The end point was defined as death from cardiovascular causes. During the follow-up from 1 to 37 months (median follow-up was 18 months) for patients with ADCHF in 24,8 % an endpoint was reported. For patients with ACS, the observation time ranged from 1 day to 14 months (median follow-up was 12 months), in 4,3 % - NSTE-ACS, 10,9 % - STEMI the end point was recorded. AKI developed in 14,8 % of patients with ADCHF HFpEF and 11,2 % ADCHF HFrEF, in 23,1 % - STEMI and 21,4 % - NSTE-ACS. AKI increases the risk of death from cardiovascular causes in patients with ADCHF HFrEF (OR 95 % 98,750 (11,158-873,976), р<0,001) and STEMI (OR 95 % 5,395 (2,451-11,878), p<0,001), but did not increase the risk of an endpoint occurrence in patients with ADCHF HFpEF (OR 95 % 1,875 (0,221-15,930), р=0,565) and NSTE-ACS (OR 95 % 1,199 (0,421-3,412), р=0,734). The multivariate analysis revealed risk factors for the development of AKI in patients with ADCHF HFrEF: high albuminuria (AU) from 30 mg / l (OR 95 % 5,763 (1,338-24,819), р=0,019), GFR<45 ml / min initially at admission to hospital (OR 95 % 76,593 (1,193-36,446), p=0,031), age>75 years (OR 15,933 (1,020-248,856), р=0,048). In patients with STEMI: age>75 years (OR 95 % 3,248 (1,476-7,146), p=0,003), female gender (OR 95 % 2,321 (1,190-4,526), p=0,013), acute heart failure (AHF) Killip IV (OR 95 % 10,334 (1,777-60,110), p=0,009). Risk factors for the development of AKI in patients with NSTE-ACS: age>75 years (OR 95 % 1,761 (1,051-2,949), р=0,032), PCI on RCA (OR 95 % 2,565 (1,193-5,517), р=0,016). In patients with ADCHF HFrEF and STEMI development AKI is associated with a poor prognosis, but does not affect the prognosis of patients with ADCHF HFpEF and NSTE-ACS. AKI in patients with ADCHF HFrEF can be predicted using predictors: GFR<45 ml / min, AU more than 30 mg / l and age>75 years. In patients with STEMI, the predictors of AKI were age>75 years, female gender, AHF Killip IV, and in patients with NSTE-ACS age>75 years, PCI on RCA.

Abstract P2007: Muscadine Grape Extract Prevents Cardiac Cell Cytotoxicity Due to Oxidative Stress by Enhancing Mitochondrial Function

Mitochondrial health is critical for the physiological function of tissues and responses to stress. During oxidative stress, failure to maintain mitochondrial respiration can ultimately lead to cell death and thus cardiac dysfunction. Agents that preserve mitochondrial integrity and maintain or increase mitochondrial respiratory capacity may prevent cardiac tissue damage due to oxidative stress. Muscadine grapes are rich in polyphenols, which are natural antioxidants, and are known to reduce cardiac damage. We treated cardiac cells with a proprietary muscadine grape extract (MGE), to prevent cardiac myoblast death due to reactive oxygen species (ROS) in the presence of the redox cycling agent 2,3 dimethoxynaphthoquinone (DMNQ), which generates both superoxide and hydrogen peroxide intracellularly, thus mimicking pathologies of elevated ROS. DMNQ increased cardiac cell cytotoxicity, as measured by LDH release, which was prevented by doses of MGE equivalent to 60 μg/mL of total phenolics (1.3 ± 0.023 DMNQ vs. 0.90 ± 0.030, n=3, *p<0.01). Moreover, cell respirometry measurements indicated that, while DMNQ reduced the oxygen consumption rate (OCR) by 50% (*p<0.05, n=3), treatment with MGE prevented this reduction, suggesting that the protective effect may be mediated by preservation of mitochondrial function. Furthermore, MGE treatment prevented the decrease in ATP-linked respiration (18.8 ±. 2.6 DMNQ vs. 34.0±.4.7 DMNQ + MGE, n=3, *p<0.01) and maximal respiratory capacity (31.6 ± 8.2 DMNQ vs. 48.91 ± 6.54 DMNQ + MGE, n=3, *p<0.01) observed with DMNQ treatment. Furthermore, the basal extracellular acidification rate (ECAR) was increased 2-fold with MGE pretreatment when compared to DMNQ alone (13.6 ± 2.3 DMNQ + MGE vs. 6.8 ±.0.88 DMNQ, n=3, *p<0.01), suggesting that MGE treatment may also increase glycolysis as a response to stress. These data suggest that MGE enhances mitochondrial function and cellular bioenergetics in cardiomyoblast cells during stress and thus may be used as a strategy to prevent tissue damage from oxidative stress observed in acute and chronic cardiac pathologies.

MyD88 activation in cardiomyocytes contributes to the heart immune response to acute Trypanosoma cruzi infection with no effect on local parasite control.

Cardiomyopathy is the most serious consequence of Chagas disease, a neglected human disorder caused by Trypanosoma cruzi infection. Because T. cruzi parasites invade cardiomyocytes, we sought to investigate whether these cells recognize the parasite in vivo by receptors signaling through the MyD88 adaptor, which mediates the activation pathway of most Toll-like receptors (TLRs) and IL-1/IL-18 receptors, and influence the development of acute cardiac pathology. First, we showed that HL-1 cardiac muscle cell line expresses MyD88 gene and protein at resting state and after T. cruzi infection. To evaluate the role in vivo of MyD88 expression in cardiomyocytes, we generated Mer+MyD88flox+/+ mice in which tamoxifen treatment is expected to eliminate the MyD88 gene exclusively in cardiomyocytes. This Cre-loxP model was validated by both PCR and western blot analysis; tamoxifen treatment of Mer+MyD88flox+/+ mice resulted in decreased MyD88 gene and protein expression in the heart, but not in the spleen, while had no effect on littermates. The elimination of MyD88 in cardiomyocytes determined a lower increase in CCL5, IFNγ and TNFα gene transcription during acute infection by T. cruzi parasites of the Y strain, but it did not significantly modify heart leukocyte infiltration and parasitism. Together, our results show that cardiomyocytes can sense T. cruzi infection through MyD88-mediated molecular pathways and contribute to the local immune response to the parasite. The strong pro-inflammatory response of heart-recruited leukocytes may overshadow the effects of MyD88 deficiency in cardiomyocytes on the local leukocyte recruitment and T. cruzi control during acute infection.

COMPARISON OF GENERAL CLINICAL DATA FROM TWO INDEPENDENT REGISTERS AMONG MALE SUBJECTS IN ONE AREA TASHKENT CITY

The register is an organized system for collecting information about patients with specific diseases. Functions of registers on acute coronary diseases allow using them to characterize therapeutic approaches and assess their quality. It is with the help of registers that help to identify the status and deficiencies in the management of patients at individual stages of specialized care, you can see the most optimal ways to improve the quality of treatment. Carrying out registers and estimation of their dynamics for today are poorly covered in the literature, and in this connection we conducted a comparative analysis of the database of two independent registers (in 2009 and 2015) in one of the districts of Tashkent (a total of 894 patients with acute coronary syndrome and acute myocardial infarction). The analysis revealed that the incidence of ACSAMI in the 2nd register among men younger than 40 years decreased, but the number of obese individuals increased. In the 2nd register, the number of men with HR> 90 beats/min decreased, but the mean values of blood pressure increased. Among men with ACS/ АMI, an increase in the level of triglycerides of blood was registered in the 2nd register, but the percentage of men with hypertriglyceridemia was less. In the 2nd register, the number of troponin determinations has increased, which indicates an increase in the coverage of laboratory studies. The results of the 2nd register on ACS/ АMI among males revealed a significant increase in the groups of drugs used in the treatment, not only those included in the basic therapy of IHD, but also the main ones in the treatment of ACS/ АMI, which indicates positive qualitative shifts in treatment acute cardiac pathology. Thus, the use of the population methodologies of the Registers allows the creation of a program for predicting the outcome of the disease, and also to improve the volume and quality of medical care, taking into account individual risk factors and the potential of their interrelationships

Letter Re: Practice guideline summary: Reducing brain injury following cardiopulmonary resuscitation: Report of the Guideline Development, Dissemination, and Implementation Subcommittee of the American Academy of Neurology.

We read with interest the article by Geocadin et al.1 and found the conclusion of importance. Over the last 2 years, we observed a group of 32 patients treated with mild therapeutic hypothermia after an out-of-hospital nontraumatic cardiac arrest. When considering the effect of the cardiac arrest on the patients' subsequent outcomes in the short and middle term, a sharp difference between 2 conditions was observed. A cardiac arrest complicated by a not-shockable rhythm and a circulatory instability is usually accompanied by a worsening cerebral edema. These 2 signs, clearly connected to each other, are strong predictors of short survival and of poor neurologic outcome, independent from any treatment. On the contrary, in the case of cardiac arrest followed by a shockable rhythm, mild therapeutic hypothermia is directly indicated for the greater possibility of a good outcome.2–4 In these patients, any early invasive treatment of the acute cardiac pathology, or of any other intervening complication, is not contraindicated.

From Coronary Care Units to Cardiac Intensive Care Units: Recommendations for Organizational, Staffing, and Educational Transformation

Medical care in Canadian cardiac units has changed considerably over the past 3 decades in response to an increasingly complex and diverse patient population admitted with acute cardiac pathology. To maintain the highest level of care for these patients, there is a pressing need to evolve traditional coronary care units into contemporary cardiac intensive care units. In this article we aim to highlight the current variations in Canadian units, develop approaches to overcome logistical and infrastructural obstacles, and propose staffing and training recommendations that would allow for the establishment of contemporary cardiac intensive care units.