Chronic Ischemic Heart Disease Patients Research Articles

Two-Year Follow-Up of Chronic Ischemic Heart Disease Patients in a Specialized Center in Brazil.

The incidence of cardiovascular events in patients with chronic ischemic heart disease (CIHD) may vary significantly among countries. Although populous, Brazil is often underrepresented in international records. This study aimed to describe the quality of care and the two-year incidence of cardiovascular events and associated prognostic factors in CIHD patients in a tertiary public health care center in Brazil. Patients with CIHD who reported for clinical evaluation at Instituto do Coração (São Paulo, Brazil) were registered and followed for two years. The primary endpoint was a composite of myocardial infarction (MI), stroke, or death. A significance level of 0.05 was adopted. From January 2016 to December 2018, 625 participants were included in the study. Baseline characteristics show that 33.1% were women, median age 66.1 [59.6 - 71.9], 48.6% had diabetes, 83.1% had hypertension, 62.6% had previous MI, and 70.4% went through some revascularization procedure. At a median follow-up (FU) of 881 days, we noted 37 (7.05%) primary endpoints. After adjustments, age, previous stroke, and LDL-cholesterol were independently associated with the primary endpoint. Comparing baseline versus FU, participants experienced relief of angina based on the Canadian Cardiovascular Society (CCS) scale according to the following percentages: 65.7% vs. 81.7% were asymptomatic and 4.2% vs. 2.9% CCS 3 or 4 (p < 0.001). They also experienced better quality of medication prescription: 65.8% vs. 73.6% (p < 0.001). However, there was no improvement in LDL-cholesterol or blood pressure control. This study shows that CIHD patients had a two-year incidence of the primary composite endpoint of 7.05%, and the reduction of LDL-cholesterol was the only modifiable risk factor associated with prognosis.

Particulate matter and ozone might trigger deaths from chronic ischemic heart disease

AimsTo study the association between short-term exposure to air pollutants and mortality of Chronic Ischemic Heart Disease (CIHD). MethodsUsing a case-crossover design, we investigated 148,443 CIHD deaths from 2015 to 2020 in Jiangsu Province, China. Exposure to six ambient pollutants, including PM10, PM2.5, NO2, CO, SO2, and O3, was assessed by extracting daily concentrations from validated 10 km × 10 km pollutant grids at each subject’s residential address. A conditional logistic regression approach was used to explore the exposure-response relationship with adjustment for temperature and relative humidity. We calculated the Population Attributable Fractions (PAFs) and the attributable deaths number of CIHD. ResultsAn increase of 10 μg/m3 in PM10 and PM2.5 exposure was associated with a 1.16% (95% CI: 0.85–1.48%) and 1.80% (1.36–2.24%) increase in CIHD mortality, respectively. A threshold value of 123 µg/m3 was identified for the association between O3 exposure and CIHD mortality. Controlling for PM2.5, each increase of 10 µg/m3 in O3 (>threshold) was statistically significantly associated with a 0.94% (0.19–1.71%) increase in CIHD mortality, however there was no association between NO2, SO2, CO exposure and CIHD mortality. Reducing PM2.5, PM10 and O3 to the WHO air quality guidelines would prevent 6.16% (95% CI: 4.70–7.58%), 4.30% (3.18–5.43%) and 1.29% (0.48–4.20%) of CIHD deaths, respectively. During the warm season, mortality and PAFs of CIHD associated with PM2.5, PM10, and O3 were significantly higher. ConclusionsShort-term exposure to ambient PM2.5, PM10, and O3 might trigger deaths from CIHD. These findings indicate that the premature deaths of CIHD patients can be alleviated by reducing exposure to polluted air.

Physical Vascular Therapy (BEMER) Affects Heart Rate Asymmetry in Patients With Coronary Heart Disease.

The aim of this study was to assess the acute effects of physical vascular therapy (PVT) on the autonomous nervous system by heart rate variability (HRV) and heart rate asymmetry (HRA) analysis. The low-frequency, pulsed electromagnetic field (<35 μTesla) with a patented BEMER pattern can improve vasomotion and microcirculation. A non-invasive confirmation of the instant effects of PVT may provide an opportunity to give an immediate feedback to the patient and therapist. Altogether 48 patients on inward rehabilitation with coronary heart disease (CHD) were involved, their treatment included PVT with B.Box Professional and B.Body Pro applicator (BEMER International AG, Triesen, Lichtenstein). After 15 min of postural adaptation, 6-min electrocardiograms (ECG) were taken immediately before, in the first and in the last 6 min of the 20-min PVT, and one hour after the treatment. Of the 48 patients, the last twenty patients received sham PVT with the same protocol. Off-line analysis was blinded. We used linear mixed statistical model to compare HRV and HRA parameters. The time domain parameters did not show any statistically significant differences between the changes in the real PVT and sham groups but, in the first stage of the treatment, Porta and Guzik indices significantly rose everywhere except in the sham group. PVT significantly increases the Guzik and Porta indices in chronic ischemic heart disease patients reflecting a delicate autonomic response. HRA as a measure of autonomic regulation seems to be more sensitive than time domain parameters.

Abstract 10839: Two-year Follow-up Of Patients With Chronic Ischemic Heart Disease In A Specialized Center In Brazil

Introduction: Incidence of cardiovascular events in patients with chronic ischemic heart disease (CIHD) may vary significantly between regions. Although populous, Brazil is often underrepresented in international registries. Objective: This study aimed to describe the quality of care and 2-year incidence of cardiovascular events and prognostic factors in CIHD patients in a tertiary public health care center in Brazil. Methods: Patients with CIHD, denoted as previous revascularization, myocardial infarction (MI) or stenosis &gt; 50% in at least one epicardial coronary artery, were enrolled and followed for at least 2 years. Main endpoint was the composite of MI, stroke or death. We also evaluated prescription, symptoms and laboratory records. Results: 625 patients with mean age 65 (±9.6) years, 33.3% women, were included. Previous MI was present in 59.8%, CABG in 26.8%, and percutaneous coronary intervention in 40.6%. Diabetes was prevalent in 48.6%, high blood pressure in 83.1%, and chronic kidney disease (creatinine clearance &lt; 60 mL/min) in 34.7%. Residual coronary anatomy was known in 266 patients, of whom 29.3% had multivessel disease, and 11.7% had lesion in the left main artery. At a median follow-up (FU) of 881 days, we recorded 37 events of primary composite endpoint, with 2-year estimate event incidence of 7.05%. Age (HR per 10 years 1.61, 95%CI 1.32-1.97), stroke (3.65, 1.48-9.00) and LDL-cholesterol (1.23, 1.14-1.33) were the main prognostic factors in multivariate analysis. The participants experienced relief of angina symptoms based on Canadian Cardiovascular Society (CCS) scale (baseline vs. FU respectively): 65.7% vs. 81.7% were asymptomatic, 13 vs. 7.2% CCS1, 17.1 vs. 8.3% CCS2, 4.2 vs. 2.9% CCS3 or 4 (p &lt; 0.001). Analysis of therapeutic goals identified better quality of medication prescription, defined as the use of angiotensin-converting enzyme inhibitor or angiotensin receptor blocker plus statin and any antithrombotic agent: 65.8% vs. 73.6% (p&lt;0.001) comparing baseline with FU. On the other hand, there was no improvement in LDL or blood pressure control. Conclusion: This study shows that CIHD patients had a 2-year incidence of the primary composite endpoint of 7.05%, LDL was the main modifiable risk factor of worse prognosis.

Abstract 13663: Safety and Possible Effectiveness of Paclitaxel Associated to LDL-Like Nanoparticles (LDE) in the Treatment of Patients With Chronic Ischemic Heart Disease

Introduction: Experimental studies have shown that anti-proliferative chemotherapeutic agents such as paclitaxel (PTX), associated to solid lipid nanoparticles (LDE), have marked anti-atherosclerotic effects. The combination with LDE nearly abolishes PTX toxicity. Hypothesis: Treatment with LDE-PTX in patients with chronic ischemic heart disease (CIHD) is tolerable and safe, and favorably changes plaque characteristics, as denoted by coronary computerized tomography angiography (CCTA). Methods: In this prospective, randomized, double-blind, placebo-controlled study, patients with multivessel CIHD received IV infusions of either LDE-PTX (n=20; PTX dose: 175 mg/m2 body surface) or LDE alone (n=20; placebo group). Infusions were administered every 3 weeks for 6 times. Analysis of cardiovascular risk and inflammatory biomarkers and CCTA data was performed at baseline and at the end of the study. Clinical and laboratorial safety evaluations were made before each infusion. Results: Overall, patients aged 65.6 ±8 yrs, 58% had diabetes, 50% had history of myocardial infarction and 91% were under statin and aspirin therapy. Baseline demographics, risk factors and laboratory data were similar between infusion groups. There was no statistical difference regarding the levels of hsCRP, IL-1β, IL-6, IL-8 and TNF-α from baseline to follow-up between groups, but there was a trend for decrease in IL-6 levels in the LDE-PTX group (-16%), not observed in the placebo group. Regarding the CCTA high-risk plaques, a tendency for reduction of the napking-ring signal after infusion was observed in the LDE-PTX group (figure 1) compared to placebo (p=0.098). No clinical or laboratorial toxicities were observed. Conclusions: This study shows that LDE-PTX was safe in CIHD patients and showed signs of benefits in reducing inflammatory biomarkers and modification of high-risk plaque characteristics.

Study on Heart Failure Patients Admitted in National Institute of Cardiovascular Diseases

Background: Heart failure is a complex clinical syndrome that arises secondary to abnormalities of cardiac structure and/or function (inherited or acquired) that impair the ability of the left ventricle to fill or eject blood. There is a paucity of data on characteristics of the patients of heart failure admitted in hospitals in terms of demographic and etiological information. So, this study aimed to see the disease burden of heart failure patients and the age and sex specific prevalence of heart failure among patients admitted into NICVD and to identify the etiological pattern of diseases leading to heart failure with associated comorbid factors.&#x0D; Methods: It was a cross sectional study carried out at National Institute of Cardiovascular Diseases (NICVD) Dhaka Bangladesh and was conducted from January 2015 to December 2015. Total 400 heart failure patients were taken.&#x0D; Results: The mean age of the patients were 54 ± 14 years ranging from 16 to 95 years with a high preponderance of male. Most the patient population was in the age group of 51- 60 years (29.5%). 79% of the cases were male &amp; 21% female by gender specification. Ischaemic cardiomyopathy (ICM) was found to be the common cause of heart failure (n=153, 40.75%) followed by Acute coronary syndrome (32.5%) and Valvular heart disease (18.25%). The patients with heart failure having acute coronary syndrome (n=107) had hypertension (46.8%) as the most prevalent major risk factor. In the present study only 11% patient had heart failure with preserved ejection fraction. Mortality rate of the study population were 6.3%.&#x0D; Conclusion: In this study, the most common cause of heart failure is ischaemic heart disease. So, patients of acute and chronic ischemic heart disease patients should be treated and follow up with care. Clinical and epidemiological studies are needed to explore further.&#x0D; Cardiovasc. j. 2021; 13(2): 172-176

Abstract 14451: Bone Marrow Cell Therapy Improves Cardiac Function, Survival, and Clinical Outcomes in Patients With Chronic Ischemic Heart Disease

Introduction: The effects of bone marrow cell (BMC) therapy in patients with chronic ischemic heart disease (CIHD) remain controversial. Hypothesis: We hypothesized that injection of BMCs in patients with CIHD would improve left ventricular (LV) structure and function. We also hypothesized that BMC therapy would improve clinical outcomes in CIHD patients. Methods: We performed a systemic review and meta-analysis of pooled data from published randomized controlled trials (RCTs) that evaluated the efficacy of BMC administration in patients with CIHD. The effects of BMC injection on LV ejection fraction (LVEF), LV end-systolic volume (LVESV), LV end-diastolic volume (LVEDV), infarct size, and patient outcomes were analyzed using random-effects meta-analysis. Results: The literature search yielded 30 RCTs enrolling 1,548 patients. Transplantation of BMCs resulted in an improvement in LVEF in cell-treated patients compared with controls (2.89%; 95% confidence interval (CI): 1.80 to 3.97; P &lt;0.001). There was a trend toward reduced LVESV (-4.96 ml; 95% CI: -11.64 to 1.71 ml; P = 0.14) and LVEDV (-5.95 ml; 95% CI: -12.09 to 0.18 ml; P =0.06). The improvement in LVEDV was more pronounced (-7.42 ml; 95% CI: -13.68 to -1.17ml; P =0.02) in patients with baseline LVEF &lt;40%, indicating improved LV remodeling. BMC injection was also associated with marked reduction in the risk of all-cause mortality, rehospitalization due to heart failure, and ventricular arrhythmias in CIHD patients. Conclusions: BMC injection improves cardiac function and remodeling in patients with CIHD. These benefits are more pronounced in patients with LVEF &lt;40% at baseline. Perhaps more importantly, BMC therapy also improves clinical outcomes that are critically important for this patient population with LV dysfunction, including survival, rehospitalization due to heart failure, and ventricular arrhythmias.

Associations between acute exposure to ambient air pollution and length of stay for inpatients with ischemic heart disease: a multi-city analysis in central China.

Ambient air pollution (AAP) has been widely associated with increased morbidity of ischemic heart disease (IHD). However, no prior studies have investigated the effects of AAP exposure on the length of stay (LOS) due to IHD. Hospital data during 2015-2017 were obtained from hospital information system in five cities of Hubei province, China. We collected daily mean concentrations of air pollutants, including PM2.5, PM10, SO2, NO2, O3, and CO, and meteorological data during the same time period. Poisson regression was applied to estimate the acute impacts of AAP on the LOS of IHD inpatients. A total of 42,114 inpatients with primary diagnosis of IHD were included, 50.63% of which were chronic IHD inpatients. Annual average concentrations of PM2.5, PM10, SO2, NO2, O3, and CO were 61.93μg/m3, 95.47μg/m3, 18.59μg/m3, 35.87μg/m3, 100.30μg/m3, and 1.117mg/m3, respectively. After adjusting for temperature, relative humidity, gender, age group, payment method, number of hospital beds, location of hospital, and surgery or not, exposures to PM2.5, PM10, SO2, O3, and CO were associated with increased LOS for all IHD patients in both single- and multi-pollutant models, and stronger associations were observed among chronic IHD patients. In addition, subgroup analyses demonstrated that males and the group aged 65+ years were more vulnerable to air pollution, and the adverse effects were also promoted by low temperature in cold season. This study provides the first investigation of the adverse effects of AAP on the LOS for IHD patients. In order to shorten the LOS of IHD, measures should be taken to strengthen the AAP management and protect the high-risk population.

Erythropoietin and Mesenchymal Stem Cells Properties

The present work reports the effect of the long-term exposure bone marrow mesenchymal stem cells from chronic ischemic heart disease patients with erythropoietin on morpho-functional properties. The mesenchymal stem cells were grown under 3rd passage in medium supplemented with 33.4 IU/mL of recormon to study expression of adhesion molecules, erythropoietin receptor, cytokine receptor to common β-chain on surface, and proliferative potential (MTT test, CFU, cell cycle), migratory ability, nitric oxide production under growth factor deprivation, oxidative stress and hyperglycemia conditions, and autophagy activity, and ultrastructure changes in cells. The results showed that the long-term exposure mesenchymal stem cells with erythropoietin significantly increased proliferation, nitric oxide production and some adhesion molecules and receptors expression on surface of those cells. In addition, the erythropoietin long-term exposure with mesenchymal stem cells increases autophagy activity. The finding of this work indicates that erythropoietin could be used to augment cell resistance to adverse microenvironment condition.

Living with stable angina: patients' pathway and needs in angina.

There is evidence that stable angina patients may suffer from emotional disorders that further impair their quality of life. However, the emotional experience of living with stable angina from the patient's perspective still has to be explored. Thus, the main aim of this study was to explore patients' emotional experience of having stable angina and their reported needs during the pathway from the first symptoms, through the process of diagnosis, to management and related lifestyle changes. A survey was conducted in 75 chronic ischemic heart disease patients with angina (Brazil, China, Romania, Russia, and Turkey) using a 75-min, face-to-face in-depth interview. Patients' responses highlighted the need to increase individuals' awareness on the first signs and symptoms of the disease. The survey also showed that chronic stable angina patients need constant emotional support to overcome stress, anxiety, and depression. Finally, this study suggests the need to offer greater space for dialogue with healthcare professionals to get more comprehensive and 'patient-friendly' information.

Modelling of the ICF core sets for chronic ischemic heart disease using the LASSO model in Chinese patients

BackgroundThis study aimed to examine the associations among the International Classification of Functioning, Disability, and Health (ICF) core sets relevant to chronic ischemic heart disease (CIHD) using the least absolute shrinkage and selection operator (LASSO) model based on the ICF core sets scale in Chinese patients.MethodsThis was a prospective study of 120 patients with CIHD selected from January 2013 to June 2014 at the Fada Institute of Forensic Medicine & Science (Beijing, China). Functioning was qualified using the ICF core sets checklist for CIHD (Chinese version). The variables of core set categories of the ICF assessment scale for CIHD were entered into the LASSO model for mining dependencies among those variables. Graphical modeling was applied using LASSO generalized linear models.Results“Muscle endurance functions”, “sensations associated with cardiovascular and respiratory functions”, “blood vessel functions”, and “heart functions” were the most injured in CIHD status. “Recreation and leisure” and “intimate relationships” were the most affected in CIHD status. “General social support services, systems, and policies” and “acquaintances, peers, colleagues, neighbors, and community members” were important for the outcome of functional status of the CIHD patient. “Economic self-sufficiency” and “family relationships” of the CIHD patient were not undermined in most cases.ConclusionsGraphical modeling can be used to describe associations between different areas of functioning in CIHD patients. The results suggest that these associations could be used as basis to improve rehabilitation and provide a deeper understanding of functioning in Chinese CIHD patients.

Role of Tissue Doppler Tei Index in Evaluating Myocardial Performance after Coronary Revascularization

Background: Tei index expresses the overall systolic and diastolic myocardial function in a single number. The use of tissue Doppler instead of conventional pulsed wave Doppler enables us to measure Tei index in a single scan. It also has many advantages for the assessment of myocardial function with coronary revascularization in IHD patients. Methods: We included 47 chronic ischemic heart disease patients with LV dysfunction (EF<50%) who were subjected to coronary revascularization with either CABG or PCI. They were divided into 2 groups according to the improvement of EF after revascularization. Group I: Included 35 patients who had an increase ≥ 5% in LV EF at follow up. Group II: Included 12 patients who had an increase <5% increase in LV EF at follow up. Echocardiography including tissue Doppler Tei index (tdTei) was done twice; just before and at least 4 months after coronary revascularization. Results: Following revascularization; improvement of ejection fraction correlated well with tdTei improvement (r=0.67, p<0.001) and was associated with improvement of wall motion score index (p<0.001) and diastolic function parameters including E`/A` (p<0.05) and E/E` (p<0.001). Using ROC curve, we found that the tdTei index at cut-off point 72.9; can predict patients who are expected to have ejection fraction improvement from coronary revascularization with high sensitivity (83.3%) and specifity (80%). It also correlated well to TIMI score (p<0.05). Conclusion: Tissue Doppler Tei index is a promising technique allowing accurate quantitative description of the effect of ischemia on myocardium including both diastolic and systolic dysfunction in a single number. Baseline tdTei index can predict patients who are expected to have improvement of myocardial function (both diastolic and systolic) after coronary revascularization.

Effect of Coronary Artery Bypass Grafting on the Plasma Levels of VEGF, bFGF, Copper and NO as Angiogenic Biomarkers in Chronic Ischemic Heart Disease Patients

Objectives: Myocardial ischemia offers paradoxical protection from ischemic necrosis by the development of coronary collateral circulation through the process of angiogenesis. The current study aimed to assess the plasma levels of vascular endothelial growth factor basic fibroblast growth factor nitric oxide and copper as angiogenic biomarkers to evaluate their role in the development of coronary collateral circulation in patients with chronic ischemic heart disease. Also, to evaluate the angiogenic modulator effects of coronary artery bypass grafting (CABG) via repeated measurements of such biomarkers 3 months postoperative. Methods: This case control and observational study involved 25 ischemic heart disease male patients candidate for elective coronary artery bypass grafting who admitted at the department of cardiothoracic surgery, faculty of medicine, Assiut University and 25 healthy age matched males as control group. Spectrophotometric assay of NO and copper and ELISA assay of VEGF and bFGF plasma levels were done. Results: Significant higher plasma VEGF, bFGF, copper and NO levels preoperatively when compared with the control group (p<0.01 for all) with significant lowering of their plasma levels when repeatedly measured three months following the CABG (p<0.01 for all). Conclusions: Our findings revealed that plasma levels of VEGF, bFGF, copper and NO have been significantly decreased in patients with chronic myocardial ischemia following CABG, thus, proving the proper coronary reperfusion effect of CABG with decrease the demand for the angiogenesis in the ischemic myocardium. There was a positive correlation between the plasma levels of VEGF and NO.

PILOT RESULTS OF THE CHRONIC ISCHEMIC HEART DISEASE REGISTRY IMPLEMENTATION IN ALTAISKY KRAI

Aim. Implement the chronic ischemic heart disease (CHD) registry in Altaisky Krai as a system for CHD patients monitoring, and the first results of its work. Material and methods. As a basement for the registry development we used actual Federal and regional registries. In the Altaisky Krai the Registry was started in 16 piloting healthcare institutions, and the center of data processing was KSBHI Altaisky Krai cardiological dispensary and KSBHI Krai Clinical Hospital. Into the Registry we included all patients with CHD who received a specialized cardiological care in these institutions, not related to the type of a care. We used research methods as following: empirical, theoretical, statistical. Results. The system let us to evaluate and influence the qualitative and quantitative parameters of cardiological care system in Altaisky Krai. The availability of cardiological care became better for rural regions, and the volumes of specialized care, including higher technologies as Cardiovascular Surgery line, were increased; it became possible to screen cardiovascular diseases at their earlier stages and hence to decrease mortality. The CHD registry provides opportunity to assess the epidemiological issues by CHD in Altaisky Krai and to reveal the defects of cardiovascular care at its stages. Conclusion. The necessity to the monitoring system implementation to all healthcare institutions of the Altaisky Krai for more effective and on- time work with the patients demanding specialized medical care, including high technologies.

Abstract 16619: Bone Marrow Cell Therapy Improves Left Ventricular Function And Survival in Patients With Chronic Ischemic Heart Disease and Cardiomyopathy

Introduction: Results from randomized controlled trials (RCTs) of bone marrow cell (BMC) therapy for cardiac repair have been discordant. The true impact of BMC therapy in patients with chronic ischemic heart disease (CIHD) and ischemic heart failure remain unclear. Hypothesis: We hypothesized that BMC injection would improve clinical outcomes and left ventricular (LV) parameters in patients with CIHD. Methods: We performed a systematic review and meta-analysis of data from RCTs of BMC therapy on LV ejection fraction (LVEF), LV end-systolic volume (LVESV), LV end-diastolic volume (LVEDV), infarct scar size, and clinical outcomes in patients with CIHD. Database searches based on specified criteria identified 15 eligible RCTs (enrolling 648 CIHD patients). Changes in predefined parameters were analyzed with random-effects meta-analysis. Peto odds ratio (OR) was calculated for clinical outcomes. Results: Compared with standard therapy, BMC transplantation improved LVEF (3.84%; 95% confidence interval [CI], 2.30 to 5.38; P&lt;0.00001), reduced scar size (-5.90%; 95% CI, -8.03 to -3.78; P&lt;0.00001) and LVESV (-10.37 ml; 95% CI, (-18.56 to -2.18; P=0.01). Reduction in LVEDV (-1.84 ml; 95% CI, -9.13 to 5.46; P=0.62) was not significant. The improvement in LVEF in BMC-treated patients was also significant (1.78%; 95% CI: 0.63 to 2.93; P=0.002) in a separate analysis of RCTs that used MRI. Importantly, BMC therapy reduced all-cause mortality (OR: 0.35; 95% CI 0.16 to 0.73; P=0.005) and incidence of cerebrovascular accident (CVA) (OR: 0.07; 95% CI, 0.01 to 0.55; P=0.01) and tended to reduce the incidence of heart failure (OR: 0.36; 95% CI 0.11 to 1.14; P=0.08) in patients with CIHD (Table). Conclusions: BMC therapy improves LVEF, LVESV, and infarct scar size in patients with CIHD. The improvement in LVEF was also confirmed in meta-analysis of RCTs using MRI. Importantly, these numerically small benefits translated into improved clinical outcomes in BMC-treated CIHD patients.

Fibrillazione Atriale e Malattia Renale Cronica

Atrial fibrillation represent the most common type of arrhythmia encountered in clinical practice, especially in chronic ischemic heart disease patients and in chronic kidney disease (CKD) patients, and is often correlated to increased age and related comorbidities. CKD patients often present several comorbidities, such as hypertension, diabetes, and vascular disease, and they often present arrhythmias that are usually linked to their related cardiomyopathy. During the last 2 decades, an increase in the prevalence of atrial fibrillation among CKD patients, especially those on hemodialysis treatment, was reported.&nbsp;(Cardionephrology)

Effectiveness of a new health care organization model in primary care for chronic cardiovascular disease patients based on a multifactorial intervention: the PROPRESE randomized controlled trial.

BackgroundTo evaluate the effectiveness of a new multifactorial intervention to improve health care for chronic ischemic heart disease patients in primary care. The strategy has two components: a) organizational for the patient/professional relationship and b) training for professionals.Methods/designExperimental study. Randomized clinical trial. Follow-up period: one year. Study setting: primary care, multicenter (15 health centers). For the intervention group 15 health centers are selected from those participating in ESCARVAL study. Once the center agreed to participate patients are randomly selected from the total amount of patients with ischemic heart disease registered in the electronic health records. For the control group a random sample of patients with ischemic heart disease is selected from all 72 health centers electronic records.Intervention components: a) Organizational intervention on the patient/professional relationship. Centered on the Chronic Care Model, the Stanford Expert Patient Program and the Kaiser Permanente model: Teamwork, informed and active patient, decision making shared with the patient, recommendations based on clinical guidelines, single electronic medical history per patient that allows the use of indicators for risk monitoring and stratification. b) Formative strategy for professionals: 4 face-to-face training workshops (one every 3 months), monthly update clinical sessions, online tutorial by a cardiologist, availability through the intranet of the action protocol and related documents.Measurements: Blood pressure, blood glucose, HbA1c, lipid profile and smoking. Frequent health care visits. Number of hospitalizations related to vascular disease. Therapeutic compliance. Drug use.DiscussionThis study aims to evaluate the efficacy of a multifactorial intervention strategy involving patients with ischemic heart disease for the improvement of the degree of control of the cardiovascular risk factors and of the quality of life, number of visits, and number of hospitalizations.Trial registrationNCT01826929

Comparison of Serum Magnesium and Potassium in Acute Myocardial Infarction and Chronic Ischemic Heart Disease

The comparative study has been designed to estimate serum magnesium (Mg) and potassium (K) in patients with acute myocardial infarction (AMI) and chronic ischemic heart disease (CIHD). A total 61 subjects were selected and were divided as group-I (30 subjects of AMI) and group-II (31 subjects of CIHD). Laboratory investigations were done for estimation of serum glucose and serum creatinine to exclude the diabetes mellitus and renal disease. Serum Mg was estimated by atomic absorption spectrophotometer and serum K by ion selective electrode. This study showed that Mg and K level in serum is significantly lower in patients with AMI than that of CIHD subjects. Findings of the study suggested that significantly reduced serum level of Mg and K persists in AMI than those of CIHD, which may be the cause of further cardiac complications. So it may be recommended for estimation and supplementation of Mg and K in both the cases of AMI and CIHD patients for better management. DOI: http://dx.doi.org/10.3329/jdnmch.v17i1.12190 J. Dhaka National Med. Coll. Hos. 2011; 17 (01): 33-36

DETERMINANTS OF PREVENTIVE BEHAVIOR REGARDING CARDIOVASCULAR DISEASES AND RISK FACTORS IN PATIENTS WITH ESSENTIAL HYPERTENSION AND CHRONIC ISCHEMIC HEART DISEASE

Aim. To analyze potential determinants of preventive behavior (PB) in patients with essential hypertension (HT) and chronic ischemic heart disease (CIHD), and to establish their significance and hierarchy. Material and methods. Patients with HT (n=285) and CIHD (n=223) were studied. Questioning of all patients was performed to assess the characteristics of their PB. Differentiated multivariate analysis of activity and efficacy of PB determinants was performed in HT and CIHD patients by the method of step-by-step backward logistic regression. Results. Awareness of the cardiovascular diseases (CVD) and its prevention (odds ratio [OR] 6.08) as well as high level of general education (OR=2.29) were the most significant determinants of active PB in HT patients. Sufficient social support (OR=3.77), awareness of CVD and its prevention (OR=3.16) were the most significant determinants of active PB in patients with CIHD. Efficacy of PB in patients with HT and CIHD mostly depends on satisfaction of medical service (OR=10.2 and 6.63, respectively), social support (OR=6.25 and 10.5, respectively), adequate awareness of CVD and its prevention (OR, 6.92 and 6.64, respectively). Conclusion. PB activity and efficacy in patients with HT and CIHD depends on many contributing and impeding factors. Disregarding these factors can result in failure in preventive efforts at both individual and population levels.

Chirurgische intramyokardiale Stammzelltherapie bei chronischer Myokardischämie

Chronic ischemic heart disease patients are already being treated worldwide with bone marrow stem cells both in the context of clinical studies and in therapy trials. By combining this therapy with established revascularization procedures such as bypass surgery, a high level of patient safety can be achieved. To date, no stem cell-related cardiac complications following intramyocardial injection of bone marrow-derived stem cells during CABG (coronary artery bypass graft) surgery have been reported. The functional advantage conferred by surgical bone marrow stem cell therapy is a 7.2% increase in LVEF (left ventricular ejection fraction) compared to controls. Randomized placebo-controlled trials, like the German trial PERFECT, are needed to obtain a more evidence-based assessment of this therapy.