Cardiology Research Center Research Articles

Chronic inflammation is associated with impaired cardiac structure and function in patients with inflammatory arthritis: the ARTCADIA Study

Abstract Background Inflammation as an underlying cause of cardiac dysfunction has been underscored in recent years. Patients with inflammatory arthritis (IA) are at risk of being exposed to a high degree of chronic and systemic inflammation. It is therefore important to investigate whether high inflammatory burden impacts cardiac structure and function in patients with IA. Purpose To examine the impact of long-term inflammation on measures of cardiac structure and function in individuals with rheumatoid arthritis (RA) and axial Spondyloarthritis (axSpA), collectively referred to as IA, in a large cohort. Methods In a prospective cohort study, outpatients with a diagnosis of IA were included over two years during their biannual rheumatological routine appointment. In total, 1,285 participants were included. Participants were evaluated at a cardiology research center where echocardiography was performed following a pre-defined protocol. To evaluate chronic inflammation, C-reactive protein (CRP) was averaged from clinical outpatient visits registered in a rheumatological database. Uni- and multivariable linear regressions were used to examine the relationship between echocardiographic measures and log-transformed CRP. Results Among the 1,285 participants, 903 (70%) were diagnosed with RA, 358 (28%) with axSpA, and 24 (2%) with other forms of IA. Mean age was 60 ± 13 years, 64% were female. The median number of outpatient visits was 30 (Interquartile range (IQR): 18 - 48), median disease duration was 12 (IQR: 6 - 20) years, and the median outpatient CRP was 5.7 (IQR: 3.7 – 9.8) mg/L. 519 (40%) patients had hypertension (HT), 113 (9%) diabetes mellitus (DM), 76 (5.9%) ischemic heart disease (IHD) and 35 (2.5%) heart failure (HF). Mean left ventricular (LV) ejection fraction was 54.6 ± 5.7%, mean numerical global longitudinal strain (GLS) was 17.8 ± 2.4%, mean LV mass index (LVMi) was 73 ± 18 g/m2 and mean tricuspid annular plane systolic excursion (TAPSE) was 2.5 ± 0.4 cm. In univariable analyses, higher levels of CRP were significantly associated with lower GLS, p < 0.001; higher E/e’, p = 0.001; higher LVMi, p < 0.001 and lower TAPSE, p = 0.005 (Figure). The associations remained significant after adjusting for clinical characteristics including disease duration, age, sex, blood pressure, body mass index, physical activity, pack-years of smoking, cholesterol, HT, DM, heart rate, atrial fibrillation, IHD and HF (p < 0.05 for all associations). We observed no significant interactions between the IA diagnosis and inflammation across the significant echocardiographic measures. Conclusion In a large cohort of patients with IA, increasing levels of chronic inflammation determined by outpatient CRP was associated with impaired measures of cardiac structure and function and remained significant after adjusting for clinical characteristics. The prognostic and clinical implication of these findings needs to be explored in future studies.Linear regression splines

Features of Coronary Atherosclerosis in Patients with Coronary Artery Disease Residing in the Far North

Aim: To evaluate the features of coronary artery disease (CAD) in patients in the Far North and determination of the potential impact of extreme climatic factors on the development of coronary atherosclerosis. Material and Methods. Using the “Register of performed coronary angiography operations”, 5,679 patients with coronary artery disease were selected, who underwent coronary angiography at the Tyumen Cardiology Research Center. The main study group consisted of 2,590 patients permanently residing in the YamaloNenets Autonomous Okrug and 3,089 patients residing in the South of the Tyumen Region. Results. Patients with permanent residence in the Yamalo-Nenets Autonomous Okrug were on average younger (53.20 ± 7.49 versus 56.79 ± 8.34 years, p < 0.001), men were more common among them. In the extreme North there were more smokers (40.7 vs. 32.0%, p < 0.001) and alcohol users (19.7 vs.15.0%, p < 0.001), and more frequent myocardial infarction in anamnesis (57.1 vs. 48.2%, p < 0.001). At the same time, in patients permanently residing in the South of the Tyumen Region, a burdened hereditary history of CAD was more often determined, and the frequency of arterial hypertension and dyslipidemia was higher. In groups balanced by baseline clinical and demographic characteristics, including CAD risk factors, patients from the Yamal-Nenets Autonomous Okrug had more frequent lesions of the three main coronary arteries: anterior descending artery (42 vs. 35%, p < 0.001), circumflex artery (25 vs. 23%, p = 0.038) and right coronary artery (42 vs. 38%, p = 0.007). It should be noted that in balanced groups in patients permanently residing in the Far North, occlusive lesions of the coronary arteries were statistically significantly more likely to be determined (54 vs. 47%, p < 0.001). Also, between the compared groups, statistically significant differences were found in the type of left ventricle (LV) myocardial remodeling, but these differences were not determined in the balanced groups. Also, in the group of patients permanently residing in the Far North, there was a trend towards a decrease in the LV ejection fraction (53.6 ± 8.6% vs. 54.2 ± 8.7, p = 0.074).Conclusion. In patients with verified coronary artery disease living in the Far North, a more frequent and pronounced atherosclerotic lesion of the coronary bed is determined. These pathological changes are probably due to the complex impact of unfavorable natural and climatic environmental factors.

Artificial intelligence-based model for automatic real-time and noninvasive estimation of blood potassium levels in pediatric patients.

An abnormal variation in blood electrolytes, such as potassium, contributes to mortality in children admitted to intensive care units. Continuous and real-time monitoring of potassium serum levels can prevent fatal arrhythmias, but this is not currently practical. The study aims to use machine learning to estimate blood potassium levels with accuracy in real time noninvasively. Hospitalized patients in the Pediatric Department of the Rajaie Cardiology and Medical Research Center and Tehran Heart Center were recruited from December 2021 to June 2022. The electrocardiographic (ECG) features of patients were evaluated. We defined 16 features for each signal and extracted them automatically. The dimension reduction operation was performed with the assistance of the correlation matrix. Linear regression, polynomials, decision trees, random forests, and support vector machine algorithms have been used to find the relationship between characteristics and serum potassium levels. Finally, we used a scatter plot and mean square error (MSE) to display the results. Of 463 patients (mean age: 8 ± 1 year; 56% boys) hospitalized, 428 patients met the inclusion criteria, with 35 patients having a high noise of ECG were excluded. After the dimension reduction step, 11 features were selected from each cardiac signal. The random forest regression algorithm showed the best performance with an MSE of 0.3. The accurate estimation of serum potassium levels based on ECG signals is possible using machine learning algorithms. This can be potentially useful in predicting serum potassium levels in specific clinical scenarios.

Factors Associated With Hospital Mortality in Acute Myocardial Infarction

Aim To determine clinical and laboratory parameters associated with in-hospital mortality in patients with acute myocardial infarction and to develop a multifactorial prognostic model of in-hospital mortality.Material and methods This was a study based on the 2019-2020 Registry of acute coronary syndrome of the Tyumen Cardiology Research Center, a branch of the Tomsk National Research Medical Center. The study included 477 patients with ST-segment elevation acute myocardial infarction (AMI), 617 patients with non-ST segment elevation AMI, and 26 patients with unspecified AMI. In-hospital mortality was 6.0 % (n=67). Clinical and laboratory parameters were assessed on the day of admission. The separation power of indicators associated with in-hospital mortality was determined using a ROC analysis. The data array of each quantitative parameter was converted into a binary variable according to the obtained cut-off thresholds, followed by creation of a multifactorial model for predicting in-hospital mortality using a stepwise analysis with backward inclusion (Wald). The null hypothesis was rejected at p<0.05.Results The multivariate model for prediction of in-hospital mortality included age (cut-off, 72 years), OR 3.0 (95 % CI: 1.5-5.6); modified shock index (cut-off threshold, 0.87), OR 1.5 (95 % CI: 1.1-2.0); creatine phosphokinase-MB (cut-off threshold, 32.8 U / L), OR 4.1 (95 % CI: 2.2-7.7); hemoglobin (121.5 g / l), OR 1.7 (95 % CI: 1.2-2.3); leukocytes (11.5×109 / l), OR 1.9 (95 % CI: 1.3-2.6); glomerular filtration rate (60.9 ml / min), OR 1.7 (95 % CI: 1.2-2.2); left ventricular ejection fraction (42.5 %), OR 4.1 (95 % CI: 2.0-8.3); and size of myocardial asynergy (32.5 %), OR 2.6 (95 % CI: 1.4-5.0).Conclusions Independent predictors of in-hospital mortality in AMI are age, modified shock index, creatine phosphokinase-MB, peripheral blood leukocyte count, hemoglobin concentration, left ventricular ejection fraction, size of myocardial asynergy, and glomerular filtration rate. The in-hospital mortality model had a high predictive potential: AUC 0.930 (95 % CI: 0.905-0.954; p <0.001) with a cutoff threshold of 0.15; sensitivity 0.851, and specificity 0.850.

Validation of a predictive model of the left atrium appendage thrombosis in patients with nonvalvular atrial fibrillation

Aim: To test the previously developed predictive model on a test set, including patients with non-valvular atrial fibrillation (AF).Material and Methods. A predictive model was previously developed on a training set of 638 patients with non-valvular AF. The test set included 175 randomly selected patients with non-valvular AF hospitalized at the Tyumen Cardiology Research Center for radiofrequency ablation (RFA) or electrical cardioversion in 2018-2021. The quality of the predictive model was assessed using ROC analysis.Results. Arterial hypertension, coronary heart disease, congestive chronic heart failure, and persistent AF were more common in patients of both sets with left atrial appendage (LAA) thrombosis. Patients of the training and test sets with LAA thrombus had more pronounced structural changes in the heart cavities and similar changes in the geometry of the heart: normal left ventricle (LV) geometry was less common and eccentric LV hypertrophy was more common. According to the results of a previous retrospective analysis of the data, independent predictors of LAA thrombosis were persistent type of AF, left atrium size, and eccentric LV hypertrophy. Based on the data gathered, a predictive model LAA thrombosis was developed as an equation that includes 3 variables. The cut-off point for calculating the probability of LAA thrombosis is 0.07. Applying this model on a test set showed the good quality of the model: the area under the curve obtained using ROC analysis was 0.750 (p < 0.001). At the same time, the sensitivity and specificity of this model for the detection of LAA thrombosis were 72.3% and 71%, respectively.Conclusion. The evaluation of the quality of the LAA thrombosis predictive model developed on the training set confirmed its good quality on a similar test set of patients with non-valvular AF hospitalized for RFA or electrical cardioversion.

Factors Associated with Family Consent to Organ Donation in Qatar: Results from a Household Survey

Background: Family consent and organ donors rates are colinear to each other. The low consent rate can be influenced by socioeconomic and behavioral factors in the population. This study aimed to assess the influence of sociodemographic and behavioral factors on family consent for organ donation in the household population.Subjects dan Method: This is a secondary data analysis of the cross-sectional research design of 1044 household participants conducted in Qatar on organ donation between October and November 2016. A two-stage systematic random sampling was applied to collect data. The dependent variable was family consent. The independent variables were demographic and behavioral factors such as knowledge, attitude, intention, and beliefs about organ donation. Data were collected using household survey Questionnaire and analyzed using Student t-tests (unpaired), chi-square tests, and multivariate logistic regression analysis. C-statistics were applied to see discriminate accuracy of the developed regression model for family consent.Results: Knowledge (aOR= 1.63; 95%CI= 0.55 to 4.80; p= 0.380), behavioral belief (aOR= 1.11; 95%CI= 0.77 to 1.61; p= 0.580), heard organ donation (aOR= 1.12; 95%CI= 0.71 to 1.76; p= 0.630), registered for organ donation (aOR= 1.11; 95%CI= 0.50 to 2.46; p= 0.800), donated any organ/ blood/tissue (aOR= 1.63; 95%CI= 0.55 to 4.80; p= 0.380) can increased with family consent for organ donation registration. But, it’s not significantly statistic. Attitude (aOR= 1.73; 95%CI= 1.28 to 2.34; p= 0.001), control belief (aOR= 0.74; 95%CI= 0.55 to 0.99; p= 0.050), and Intention (aOR= 7.50; 95%CI= 4.04 to 13.92; p= 0.001) can increased with family consent for organ donation registration and the results were statistically significant.Conclusion: Attitude, control belief, and intention can increase family consent for organ donation registration. Keywords: Family consent, intention, attitude, knowledge, organ donation. Correspondence:Rajvir Singh. Cardiology Research Center, Heart Hospital, Hamad Medical Corporation (HMC), Doha, Qatar, Post Box: 3050; email: rajvir.aiims@gmail.com. Mobile: 97455897044.

Factors Associated with Family Consent to Organ Donation in Qatar: Results from a Household Survey

Background: Family consent and organ donors rates are co-linear to each other. The low consent rate can be influenced by socioeconomic and behavioral factors in the population. This study aimed to assess the influence of sociodemographic and behavioral factors on family consent for organ donation in the household population. Subjects dan Method: This is a secondary data analysis of the cross-sectional research design of 1044 household participants conducted in Qatar on organ donation between October and November 2016. A two-stage systematic random sampling was applied to collect data. The dependent variable was family consent. The independent variables were demographic and behavioral factors such as knowledge, attitude, intention, and beliefs about organ donation. Data were collected using household survey Questionnaire and analysed using Student t-tests (unpaired), chi-square tests, and multivariate logistic regression analysis. C-statistics was applied to see discriminate accury of the developed regression model for family consent. Results: Attitude (aOR= 1.73; 95%CI= 1.28 to 2.34; p= 0.001) and Intention (aOR= 7.50; 95%CI= 4.04 to 13.92; p= 0.001) factors were significantly associated to family consent to increase organ donation registration whereas; control belief (aOR= 0.74; 95%CI= 0.55 to 0.99; p= 0.050) was negatively associated to family consent. Knowledge (aOR= 1.63; 95%CI= 0.55 to 4.80; p= 0.380), behavioral belief (aOR= 1.11; 95%CI= 0.77 to 1.61; p= 0.580), heard organ donation (aOR= 1.12; 95%CI= 0.71 to 1.76; p= 0.630), registered for organ donation (aOR= 1.11; 95%CI= 0.50 to 2.46; p= 0.800), and donated any organ/blood/tissue (aOR= 1.63; 95%CI= 0.55 to 4.80; p= 0.380) factors were not statistically significant to family consent to increase organ donation registration. Conclusion: Attitude and intention can increase family consent to organ donation registration. Keywords: Family consent, intention, attitude, knowledge, organ donation. Correspondence: Rajvir Singh, Cardiology Research Center, Heart Hospital, Hamad Medical Corporation (HMC), Doha, Qatar, Post Box: 3050; email: rajvir.aiims@gmail.com. Mobile: 97455897044. Journal of Epidemiology and Public Health (2022), 07(04): 520-534 https://doi.org/10.26911/jepublichealth.2022.07.04.09

Factors of atherosclerosis progression in rheumatoid arthritis, prospective study data

Abstract Aim of the study Determine in prospective observation study the factors of progression of atherosclerosis in pts with rheumatoid arthritis (RA) during 3 yrs. Matherial and methods This prospective study included 124 patients with RA and suspected ischemic heart disease (IHD), the average age was 58 [52; 63] years. Follow-up period was 3 years (37.5 moths). All RA pts were examined and had treatment, according to European and National guidelines for the diagnosis and treatment of stable CAD (2013) and EULAR for RA (2016). Carotid ultrasound and coronary angiography were also completed. In course of all RA pts the following risk factors were assessed: arterial hypertension (AH), smoking, overweightbody (BMI), heredity for cardiovascular diseases (CVD), diabetes mellitus (DM), dyslipidemia (DLP). The laboratory studies were: CBC and total cholesterol (TC), HDL-C, LDL-C, TG, highly sensitive C-reactive protein (hs-CRP), RA detected activity markers: rheumatoid factor (RF), antibodies to cyclic citrullinated peptide (ACCP), index DAS28. Pro-inflammatory cytokines -interleukin (IL) -1-beta, IL-6, tumor necrosis factor alpha (TNF alpha) were assessed in single RA pts once after 3 years of observation. Results The median duration of RA in inclusion in the study was 11 years, the DAS28 index was 3.8 points (middle degree of activity). DLP was detected in 41% RA pts. DM was in 13% pts. In RA pts, initially atherosclerotic plaques with stenosis of the carotid arteries (CA) 20% or more in 94 pts (77%) were revealed, in 3 of them CA stenosis exceeded 50%. 90 RA pts (72%) were examined again. 21 pts had signs of progressing atherosclerosis marked in CA and/or coronary arteries: 12 (13%) RA patients had only progression of atherosclerosis of CA, 7 (8%) - only progression of atherosclerosis of coronary arteries, 2 (2%) had both progression CA and coronary arteries. There are 2 formed subgroups of RA pts: Gr1 with the progression of atherosclerosis (n=21) and Gr 2 without progression of atherosclerosis (n=69). There are no differences between groups of risk factors of atherosclerosis development age, AH, BMI, lipids,TG, hs CRP, index DAS28. Following rick factors: smoking (n=12 (57%) vs n=21 (30%)), heredity for CVD (n=11 (52%) vs n=17 (25%)), RA duration (13 yrs [10; 18] vs 12 years [6; 18]) were often revealed among pts of Gr 1. All differences p>0.05 Immunological data TNF alfa level, (8,08 [2,3; 8,44] pg/ml vs 1,22 [0,13; 8,00] pg/ml), IL-1β level, 3,97 [3,56; 4,10] pg/ml vs 3,52 [0,30; 4,53] pg/ml, and IL-6 level 3,50 [2,92; 5,76] pg/ml vs 2,52 [0,92; 4,36] pg/ml were significant higher in Gr1 than in Gr2. All differences was p>0.05. Conclusion The progression of atherosclerosis in RA with a low and moderate degree of activity of the disease occurs despite antirheumatic and lipid-lowering therapy. The development of atherosclerosis in this disease is defined by lipid, inflammatory and immunological disorders. Funding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Russion National Cardiology Research Center Ministry of Health of Russion Federation

The level of growth differentiation factor 15 as a predictor of left atrial thrombosis in patients with nonvalvular atrial fibrillation.

Aim To study the role of blood concentration of growth differentiation factor 15 (GDF-15) as a predictor of left atrial/left atrial appendage (LA/LAA) thrombosis in patients with nonvalvular atrial fibrillation (AF).Material and methods 538 patients with nonvalvular AF were admitted to the Tyumen Cardiology Research Center in 2019-2020 for radiofrequency ablation and elective cardioversion. According to findings of transesophageal echocardiography (EcoCG), 42 (7.8%) of these patients had LA/LAA thrombosis and 79 (14.7%) of them had the effect of spontaneous echo contrast (SEC). This comparative, cross-sectional, cohort study included at the initial stage 158 successively hospitalized patients with nonvalvular AF: group 1 (with LA/LAA thrombosis, n=42) and group 2 (without LA/LAA thrombosis and without SEC, n=116). To eliminate significant differences in age between the groups, an additional inclusion criterium was introduced, age from 45 to 75 years. Finally, 144 patients were included into the study: group 1 (with LA/LAA thrombosis, n=42, mean age 60.9±7.2 years) and group 2 (without LA/LAA thrombosis and without SEC, n=116, mean age 59.5±6.0 years). 93 (91%) patients in group 1 and 40 (95%) patients in group 2 had arterial hypertension (p=0.4168); 53 (52%) and 29 (^(%), respectively, had ischemic heart disease (p=0.0611). The groups did not differ in sex, profile of major cardiovascular diseases, or frequency and range of oral anticoagulant treatment. General clinical evaluation, EchoCG, and laboratory tests, including measurements of blood concentrations of GDF-15 and NT-proBNP, were performed.Results In the group with LA/LAA thrombosis, 1) persistent AF prevailed whereas paroxysmal AF was more frequently observed in patients without thrombosis; 2) a tendency toward more pronounced chronic heart failure was observed; 3) tendencies toward a high median CHA2DS2‑VASc score and toward a greater proportion of patients with scores ≥3 were observed. According to EchoCG findings, group 1 had higher values of sizes and volumes of both atria and the right ventricle, left ventricular (LV) end-systolic volume and size, pulmonary artery systolic blood pressure, and LV myocardial mass index. LV ejection fraction (EF) was in the normal range in both groups but it was significantly lower for patients with LA/LAA thrombosis, 59.1±5.1 and 64.0±7.3, respectively (p=0.00006). Concentrations of GDF-15 (p=0.00025) and NT-proBNP were significantly higher in group 1 than in group 2 (p=0.000001). After determining the threshold values for both biomarkers using the ROC analysis, two independent predictors of LA/LAA thrombosis were obtained by the stepwise multiple regression analysis: GDF-15 >935.0 pg/ml (OR=4.132, 95 % CI 1.305-13.084) and LV EF (OR=0.859, 95 % CI 0.776-0.951). The ROC analysis assessed the model quality as good: AUC=0.776 (p<0.001), sensitivity 78.3 %, specificity 78.3 %.Conclusion For patients with nonvalvular AF, both increased GDF-15 (>935.0 pg/ml) and LV EF are independent predictors for LA/LAA thrombosis.

Association between human immunodeficiency virus serostatus and the prevalence of atrial fibrillation.

Atrial fibrillation (AF) leads to increased risk for stroke. Human immunodeficiency virus (HIV) is associated with cardiovascular disease (CVD), although it is unclear if HIV is associated with AF. The purpose of this study was to evaluate the association between HIV serostatus and the prevalence of AF in the Multicenter AIDS Cohort Study.A cross sectional study was conducted among 1674 HIV-infected (HIV+) and uninfected (HIV–) men who completed resting 12-lead electrocardiograms, and/or ambulatory electrocardiogram monitoring. Multivariable logistic regression was used to evaluate the association between AF, defined as the presence of either AF or atrial flutter, and HIV+ serostatus. Associations were adjusted for demographic variables, and then also for CVD risk factors.HIV+ men were younger than HIV– men (median 55.5 vs 61.7 years, P < .001) and were more frequently African-American (30.5% vs 17.8%, P < .001). Most HIV+ men (81%) had undetectable viral load. The age and race adjusted prevalence of AF was 3.0% in HIV+ and 3.3% in HIV– men. There was only 1 case of AF among African-American men. There were no associations between AF and HIV serostatus after adjusting for demographic factors (odds ratio 0.76; 95% CI 0.37 to –1.58; P = .47) or after further adjustment for CVD risk factors (odds ratio 0.84; 95% CI 0.39 to –1.81; P = .66).We found no association between HIV and AF in this cohort in which viral replication among the HIV+ men is generally suppressed. The overall prevalence of AF was low and was rare in African-American men.

Influence of long-term controlled therapeutic exercises on blood pressure profile parameters, elastic properties of arterial wall, metabolic and mineral indices in females with arterial hypertension

Abstract Funding Acknowledgements Type of funding sources: Public Institution(s). Main funding source(s): Tyumen Cardiology Research Center, Tomsk National Research Medical Center, Russian Academy of Sciences, Tomsk, Russia Objective To study the role of therapeutic exercises (TE) in the correction of blood pressure, stiffness of the vascular wall, metabolic indices of body structure (volume, mass, area of visceral fat) and bone mineral metabolism in postmenopausal hypertensive patients. Methods. The study included 138 patients (mean age was 58.32 ± 7.61 years). All patients are divided into 3 groups. The first control group is 20 women without arterial hypertension and menopausе. The second group consisted of 58 patients with arterial hypertension (AH) and postmenopause who was not undergone complex of TE and the 3rd group - 60 women with AH and postmenopause who was undergone TE complex. Patients of all groups were examined in dynamics: at the starting point of the study and in 12 months after, ambulatory monitoring of blood pressure; sphygmography; densitometry and test for serum biochemistry parameters of blood samples, including sex hormones, vitamin D. Results. In the course of the study, blood pressure, vascular wall stiffness parameters, metabolic indices of body structure and disorder parameters of bone mineral metabolism were comparable in group 2 and 3 against the background of significantly reduced levels of sex hormones. Multidirectional correlation relationships between the studied parameters are revealed. The basic therapy in combination with therapeutic exercises led to a significant decrease in blood pressure and metabolic indices of body structure (p&amp;lt;.001) and to a persistent tendency of decrease the pulse wave velocity and increase of bone mineral metabolism in gr.3. Conclusion. The result of the study indicates that the exercise therapy complex used in the form of regular classes can be recommended for implementation in clinical practice with the aim of comprehensively affecting the patient’s body and developing personalized treatment tactics for postmenopausal women with hypertension.

Retinal changes in patients with angina pectoris and anginal equivalents: a study of patients with normal coronary angiography

Abstract Background and aims. Approximately 10–30% of the patients with typical symptoms of angina pectoris have normal angiography showing normal macrovasculature. In these patients, however, the microvascular problems should be monitored. Hence, the main aim of this study is to evaluate retinal changes in normal angiographic patients. Methods. In this descriptive cross-sectional study, 60 normal angiographic patients with typical chest pain or anginal equivalents visiting Modarres Hospital Cardiology Research Center between 2018 and 2019 were enrolled and retinal changes were determined in Labbafinejad Hospital by Optical Coherence Tomography Angiography using Foveal Avascular Zone (FAZ), Superficial Vascular Density (SVD), and Deep Vascular Density (DVD). Results. The results of this study demonstrated that FAZ was normal in all subjects, but SVD and DVD were abnormal in 45% and 8.3%, respectively. Totally, 18.5% and 66.7% showed abnormal SVD among stable angina (SA) and unstable angina (UA) cases, respectively (P &lt; 0.001). There was no statistically significant difference between abnormal DVD in SA and UA cases (P = 0.058). Abnormal SVD was significantly more common among diabetic patients (P &lt; 0.001), while DVD was not related to diabetes presence in the study population (P &gt; 0.05). Moreover, abnormal SVD was more common among patients with chest pain (P = 0.036), while there was no significant difference for DVD (P = 0.371). Interestingly, abnormal ECG was associated with both abnormal DVD and SVD. Conclusions. The results of this study showed that nearly half of the patients with angina pectoris or anginal equivalents who revealed normal angiographic findings may suffer from retinal changes. Thus, retinal assessment is needed in these patients to evaluate microvascular changes.

Factors influencing the survival rate of patients after acute coronary syndrome and percutaneous coronary intervention, 5-year follow-up

Abstract Funding Acknowledgements Type of funding sources: Public hospital(s). Main funding source(s): Tyumen Cardiology Research Center, Tomsk National Research Medical Center, Russian Academy of Science Introduction Reduction in mortality from acute coronary syndrome (ACS) is an important medical and social problem. Determination of survival predictors can improve the effectiveness of secondary prevention and medical care provision in patients with ACS. Aim To determine the factors influencing 5-year survival in patients after ACS and percutaneous coronary intervention (PCI). Methods The study presents data obtained as a result of a registry study The analysis included 135 with ACS and PCI. Patients were contacted and examined in a year, and then 5 years after. The laboratory parameters (lipids, markers of inflammation and endothelial dysfunction) were determined upon admission to the hospital and after 60 months. The probability of 5-year survival for patients undergoing ACS and PCI was assessed by Kaplan-Mayer method. Log-rank test was used to compare the survival rate for the entire follow-up period in two groups. The Cox regression model was used to assess the impact of independent factors on survival and to predict risk of event. Results During the follow-up period, 18 people died (the average age of the deceased was 60.9 ± 13.5 years; of the living, 60.0 ± 8.9 years). Survival after 1 year was 97.1%, after 5 years-86.7%. According to the results of the Cox regression analysis, the risk of death increased in the presence of chronic kidney disease (CKD) (HR 15.1; 95 % CI 4.30-52.93; p = 0.001); diabetes mellitus (DM) (HR 3.67; 95% CI 1.18-11.43; p = 0.025) and a history of stroke (HR 9.07; 95% CI 1.85-44.60; p = 0.007). The prognosis was negatively affected by high pulse blood pressure (PBP) ≥ 60 mm Hg (HR 4.68; 95% CI 1.60-13.72; p = 0.005), heart rate &amp;gt;80 beats per minute (OR 4.34; 95% CI 1.51-12.26; p = 0.006). Significant risk factors for death from all causes were the number of platelets (OR 1.011 95% CI 1.003-1.019; p = 0.010), the level of homocysteine (OR 1.172 95% CI 1.008 - 1.364; p = 0.040), and an increase in matrix metalloproteinase-9 (MMP-9) &amp;gt;249 ng/ml (OR 7.052; 95% CI 1.346 - 36.950; p = 0.021). Conclusions According to a register study, the survival rate of patients after ACS and PCI after 5 years depended on the presence of comorbid pathology (CKD, DM, and a history of stroke). Factors that had a negative impact on the prognosis were high indicators of PBP and heart rate, as well as laboratory markers of cellular (platelets) and vascular inflammation (homocysteine, MMP9).

Association of P-Wave Abnormalities With Sudden Cardiac and Cardiovascular Death: The ARIC Study.

Association of P-Wave Abnormalities With Sudden Cardiac and Cardiovascular Death: The ARIC Study.

Mathematical models in cardiology: From formulas to real clinical practice

Aim. To develop and implement into clinical practice six calculators of risk for various cardiovascular diseases in the form of mobile application for iOS/Android and module for the 1C: Medicine software.Material and Methods. At the premises of Tyumen Cardiology Research Center (TCRC) of Tomsk NRMC, we developed the mobile application for iOS/Android and module for the 1C: Medicine software based on six mathematical models that were invented and patented in our center earlier.Results and Discussion. The use of mobile application improved the convenience of working with the mathematical formulas and reduces the time for obtaining results of calculations. Implementation of 1C as a programming environment allowed to perform automatic filling out the calculator fields with medical data from individual patients, which significantly simplified and accelerated the rate of work with mathematical models.Conclusion. The developed mobile application and external processing for 1C allowed to implement research products of TCRC in the form of mathematical formulas into real-life clinical practice. These developments contributed to speeding up the process for acquisition of results and partial automatization of filling out the form fields.

Medical information system for the rapid screening of cardiovascular risk in patients after coronary stenting

Aim. To develop and implement a decision support system for a software product – medical information system “1C: Medicine” in the form of calculator for assessment of the absolute risk of death from cardiovascular diseases (CVD) and to show the prospects of using this system for patients with coronary artery disease (CAD) after coronary stenting.Material and Methods. The medical information system “1C: Medicine” software interface was developed in Tyumen Cardiology Research Center. It was designed to assess 10-year absolute total mortality risk from CVD in males of working age (Tyumen Risk Scale (TRS)) to provide medical decision support. The program was tested in 764 male patients from the Prospective Registry of Percutaneous Coronary Interventions (PCI). The mean age of patients was 56.9 ± 8.8 years. All death cases, recorded within a year after PCI (n = 23), were used as the status check variable. The following algorithms were chosen to compare the predictive accuracy of the integrated model: PROCAM and FRAMINGHAM. The Schwarz information test and ROC analysis data were used to assess the predictive accuracy of the models.Results. The values of Schwarz’s criterion in males were 283 for TRS, 235 for PROCAM, and 490 for FRAMINGHAM model. AUC indicator for TRS was 0.655 (95% CI 0.510–0.800), suggesting the satisfactory quality of resulting model. AUC indicators for FRAMINGHAM and PROCAM algorithms were 0.599 (95% CI 0.442–0.757) and 0.653 (95% CI 0.509–0.796), respectively.Conclusion. The created TRS, integrated into the medical information system with psychosocial factors, may be quickly and successfully implemented to determine mortality risk in CAD patients within one year after coronary stenting. The TRS has an advantage over the traditional FRAMINGHAM risk scale and non-inferior to the PROCAM scale. Therefore, TRS may be used as a medical decision support program.

The prognostic value of socioeconomic status in the open male population and in patients with coronary artery disease

Abstract Background It has been established that low socioeconomic status associated with a poor prognosis in coronary artery disease (CAD). However the data about psychosocial risk factors in patients with CAD after percutaneous coronary intervention (PCI) are insufficient. Also socioeconomic factors and marital status of individuals are associated with risk of cardiovascular mortality in developed societies but in our country this association has not been studied sufficiently. Purpose To assess the relationship between socioeconomic factors, marital status and risk of cardiovascular mortality in working-age male population of Western Siberia and in patients with CAD after PCI. Methods A representative sample of 795 men aged 25–64 years living in our city in Russia, was examined with standard epidemiological methods in 1996. Cardiovascular death rate was studied during 12-year prospective follow-up (from 1996 till 2008). The clinical study included 977 consecutive patients with CAD (741 men and 236 women, mean age 58.6±9.4 years) who underwent PCI for the period 2012–2013 in our cardiology research center. Mean duration of follow-up was 12.0±1.8 months. The relationship between cardiovascular mortality and education, occupation, total income and marital status was evaluated using Cox proportional hazards model. Hazard ratio (HR) was calculated after adjustment for the following confounders: age, systolic and diastolic blood pressure, body mass index, smoking status, total cholesterol, triglycerides, high-density-lipoprotein cholesterol, history of coronary artery disease, and social risk factors. Results Over 12 years of prospective cohort study in the male cohort 85 deaths (10.69%) from cardiovascular disease were recorded. After adjusting for all mortality risk factors HR was significantly higher in manual workers – 2.72 (95% CI 1.42–5.23) compared to professionals. Compared to men with higher education, HR was higher for men with low education level – 1.92 (95% confidence interval (CI) 1.14–3.22). Compared to married men, HR was higher in single – 4.08 (95% CI 2.12–7.83), widowed – 3.19 (95% CI 1.22–8.34) and divorced men – 3.18 (95% CI 1.90–5.34). During the prospective clinical study 21 (2.1%) patients with CAD died from cardiovascular disease. After adjustment for the following confounders risk of cardiovascular mortality was significantly higher only in patients with low total income – HR: 5.14, 95% CI 1.73–15.29). Conclusions Our results showed that socioeconomic position (low education level and manual occupation) and marital status (widowed, divorced or single) were significant predictors of cardiovascular mortality in open male population. However, low income was significant and independent predictor of cardiovascular mortality in CAD patients after PCI. Funding Acknowledgement Type of funding source: None

Приверженность медикаментозной терапии пациентов с хронической ишемической болезнью сердца после чрескожных коронарных вмешательств

Background. Poor patient adherence to drug therapy (DT) for stable coronary heart disease (CHD) is an equally important component that affects treatment outcomes. Aim. To assess adherence to DT in patients with stable coronary heart disease in patients after percutaneous coronary interventions (PCI), compare with patients who received only DT. Materials and methods. The study included 150 patients with CHD (group 1) who underwent PCI surgery at the Tyumen cardiology research center. The com-parison group (group 2) consisted of 150 patients with stable CHD, receiving only DT. All patients were diagnosed with CHD and underwent coronary angiography in the anamnesis. The follow-up period was 30.8 months in both groups (8 months to 69 months). The groups of patients were comparable in the main indicators: sex, age, total cholesterol level, presence of concomitant arterial hypertension and diabetes mellitus, functional class (FC) of angina pectoris and heart failure, hemodynamically significant lesion of the main coronary arteries and arteries of the second order, the type of blood circulation and the number of affected vessels at the time of inclusion in the study. Patients of both groups were comparable in conservative therapy. Statistical analysis of the results was carried out using the statistical software package SPSS. Results. In the PCI group, FC of angina pectoris was higher, while in the MT group, III FC was more often registered. This reflects the positive effect of PCI on exercise tolerance. When analyzing regularly taken medications, it was determined that patients who underwent PCI were more likely to use all groups of drugs. On a face-to-face visit, biochemical blood tests for cholesterol spectrum were carried out. Attention is drawn to the low turnout of patients in the DT group compared to the PCI group. The target level of low-density lipoprotein (LDL) was not achieved in both groups, but due to greater adherence to statins in the PCI group, LDL was 0.7 mmol lower than in the DT group. Conclusion. PCI surgery in patients with CHD can not only improve the quality of stress angina pectoris, but also significantly increase adherence to the treatment of the main groups of drugs (statins and antiplatelets) that affect the prognosis.

Experience with Prasugrel in the Treatment of Patients with Acute Coronary Syndrome

Dual antiplatelet therapy (DAPT) with aspirin and one of inhibitors of P2Y12receptors (clopidogrel, ticagrelor, prasugrel) is an international standard of receptors (clopidogrel, ticagrelor, prasugrel) is an international standard of is an international standard of treatment strategy in patients with acute coronary syndrome (ACS). to analyze experience of prasugrel use in the National Medical Cardiology Research Center in comparison to similar groups of patients treated with other P2Y12inhibitors for determination of optimal place of DAPT with prasugrel in ACS patients.Materials and methods.We included in this retrospective study 40 patients who received therapy with prasugrel, ticagrelor, or clopidogrel in connection with urgent percutaneous coronary intervention (PCI) performed in the Department of Urgent Cardiology from May to December 2018. We analyzed specific characteristics of prasugrel treated patients including disease history, features of clinical presentation and coronary anatomy, use of strategies of escalation and de-escalation, as well as inhospital mortality, development of complications and side effects.Results.New P2Y12inhibitors were more effective in patients with higher risk of atherothrombosis compared with risk of bleeding. Median of implanted stents in ticagrelor and clopidogrel groups was equal to 1, in the prasugrel group - 2 stents per PCI. When multivascular stenting was performed the choice usually was made in favor of prasugrel or ticagrelor, excluding cases with presence of limiting factors - use of oral anticoagulants (OAC) (n=4) and prehospital thrombolytic therapy (n=5). Of note was close to statistical significance high number of side effects related to ticagrelor use (n=3, 23.08%, p=0.057). There were no significant differences between groups in rates of unfavorable outcomes and complications.Conclusion.Administration of prasugrel can be considered in patients with high risk of atherothrombosis: with diabetes, with large number of implantable stents. The choice between ticagrelor and prasugrel can be made with consideration of the potential for side effects that significantly impair the quality of life of patients. Main limitations for application of both prasugrel and ticagrelor are the need to permanent use of OAC, prehospital thrombolytic therapy, and higher cost compared to clopidogrel.

Abstract P371: Short-term Repeatability of the Peguero Electrocardiographic Index of Left Ventricular Hypertrophy

Background: Electrocardiographic left ventricular hypertrophy (ECG-LVH) represents preclinical cardiovascular disease and predicts cardiovascular disease and mortality. Current criteria include the Cornell voltage, Sokolow-Lyon, and the newly developed Peguero index (S D + SV 4 ). While the Peguero index has been shown to have better prognostic prediction compared with current criteria, its short term repeatability remains uncertain. Objectives: Characterize the repeatability and minimal detectable change of the Peguero ECG-LVH index. Methods: Participants (n=63; mean age 50 years; 31 females) underwent two standardized visits one week apart. At each visit, trained and certified technicians obtained two ECGs following a standardized protocol. The Epidemiological Cardiology Research Center automatically processed the ECGs using GE Marquette GE 12-SL software (GE, Milwaukee, WI) to obtain the Peguero (S D + SV 4 ) LHV index, defined as the deepest S wave in any single lead S D + SV 4 . We created a dichotomous using the following cut points: &gt;2.3 mV for women and &gt;2.8 mV for men. Random effects, mixed models were used to parse the variance of the index into the between-participant, between-visit, and within-visit components. We then calculated the intra-class correlation coefficient (ICC), Kappa coefficients, and minimal detectable change (95% confidence) between repeat measures. Results: Between-participant variation accounted for 93.58% (262,958 out of 280,985 SD points) of the total variation of the Peguero LVH index, while between-visit variation and within-visit variation were 5.51% (15,480 out of 280,985 SD points) and 0.91% (2,547 out of 280,985 SD points), respectively. The index had an ICC (95% confidence interval) of 0.94 (0.91-0.97) and a minimum detectable change value of 372.16 mV. Within visit Kappas were 0.79 (0.40-1.00) for the first visit and 1.00 (1.00-1.00) for the second visit. Between visit Kappas were 0.77 (0.70-0.84) for the first measurements of each visit and 0.79 (0.72-0.86) for the second measurements of each visit. Conclusion: The Peguero LVH index shows excellent repeatability for both within and between visits. The ICC and resulting confidence interval of the continuous index suggests near perfect agreement between groups. The Kappa values also suggest concurrence between groups of the dichotomous index, although the measures are not as precise as the ICC measure. The repeatability of this measure can be used to inform clinical and epidemiological studies and expand research of this novel index of ECG-LVH.