Coexistent Cardiovascular Disease Research Articles

Associations of C-reactive protein-albumin-lymphocyte (CALLY) index with cardiorenal syndrome: Insights from a population-based study

BackgroundCardiorenal syndrome (CRS) is a complex condition characterized by the interplay of immune imbalance and inflammation. The C-reactive protein-Albumin-lymphocyte (CALLY) CALLY index serves as a new immune-nutritional scoring system, but its predictive value for CRS remains to be established. MethodsIn this study, we analyzed data from 27,978 participants in National Health and Nutrition Examination Survey (NHANES) from 1999 to 2010. The CALLY index was calculated as the ratio of albumin to lymphocyte, divided by C-reactive protein (CRP) multiplied by 104. CRS was defined by the coexistence of cardiovascular disease and chronic kidney disease (eGFR <60 mL/min/1.73 m2). Multivariate weighted logistic regression models were employed to determine the odds ratio and 95 % confidence interval for the association between the CALLY index and CRS. Receiver operating characteristic (ROC) curves and restricted cubic spline (RCS) curves were used to assess the predictive efficacy and nonlinear relationship, respectively. ResultsThe prevalence of CRS in the study population was 1.22 %. Our findings revealed a significant inverse relationship between the CALLY index and CRS risk, with lower CALLY index values being associated with a higher likelihood of CRS (OR = 0.95, 95 % CI = 0.94–0.96, P < 0.001). Participants in higher quartiles of the CALLY index showed a progressively reduced risk of CRS (P for trend <0.001). Moreover, the CALLY index demonstrated superior predictive performance compared to other inflammatory indicators, such as systemic immune-inflammation index (SII), neutrophil/high-density lipoprotein ratio (NHR), lymphocyte/high-density lipoprotein ratio (LHR), monocyte/high-density lipoprotein ratio (MHR), and platelet/high-density lipoprotein ratio (PHR) (AUC = 0.672, 95 % CI = 0.643–0.701). ConclusionsThis study underscores the significant negative correlation between the CALLY index and the risk of cardiorenal syndrome. The CALLY index emerges as a robust and independent predictor of CRS, outperforming traditional inflammatory markers. This finding highlights the potential utility of the CALLY index as a clinical tool for identifying individuals at risk for CRS.

The pattern of the frailty syndrome in chronic heart failure

Introduction. The coexistence of cardiovascular diseases and frailty has been demonstrated, with the prevalence of frailty ranging from 19% to 76%. The presence of frailty significantly influences decision-making regarding the type and timing of diagnostic strategies. Objectives. To assess the features of frailty syndrome in patients with heart failure. Material and methods. A comprehensive search was conducted in PubMed, Google Search, and ResearchGate databases using the keywords “frailty”, “heart failure”, following the STROBE criteria and PRISMA recommendations. Outcomes. The first publication on frailty syndrome in patients with heart failure dates back to 2007, with research in this area peaking in 2021. The prevalence of frailty in heart failure varies due to differences in age groups, assessment methods, and study designs. Frailty affects approximately 70% of heart failure patients over 80 years of age, challenging the stereotype that frailty is solely associated with elderly individuals. Recently issued data by the World Health Organization (WHO) stated that although frailty and heart failure are common in older adults, the prevalence of frailty in this category of patients is independent of age. It is worth noting that frailty is more common in women, yet women tend to have a better prognosis. Diagnosing frailty in heart failure patients is challenging due to the overlap of clinical symptoms. The interaction between heart failure and frailty increases the risk of decompensation, dependency, and negative outcomes. Conclusions. Previous studies have primarily focused on frailty in elderly patients with heart failure. However, chronological age cannot represent an independent parameter in the assessment of frailty, and patients with heart failure should be assessed for the presence of frailty sovereignly of age for prudent risk stratification. Recognizing and early identification of frailty across all age groups will improve prognosis by reducing hospitalizations and enhancing quality of life.

Prescribing trends of glucose-lowering drugs in older adults from 2010 to 2021: A population-based study of Northern Italy

AimsTo describe glucose-lowering drugs prescribing pattern in a large population of older diabetics from 2010 to 2021. MethodsUsing linkable administrative health databases, we included patients aged 65–90 years treated with glucose-lowering drugs. Prevalence rate of drugs was collected within each study year. A stratified analysis by gender, age and coexistence of cardiovascular disease (CVD) was conducted. ResultsA total of 251 737 and 308 372 patients were identified in 2010 and 2021, respectively. Use of metformin (68.4% to 76.6%), DPP-4i (1.6% to 18.4%), GLP-1-RA (0.4% to 10.2%), SGLT2i (0.6% to 11.1%) increased, while sulfonylureas (53.6% to 20.7%) and glinides (10.5% to 3.5%) decreased over time. Metformin, glitazones, GLP1-RA, SGLT2i and DPP4i (except for 2021) usage decreased with aging, in contrast to sulfonylureas, glinides and insulin. The coexistence of CVD was associated with a higher prescription of glinides, insulin, DPP-4i, GLP1-RA and SGLT2i, particularly in 2021. ConclusionsWe found a significant increase in the prescriptions of GLP-1 RA and SGLT2i in older diabetics, mainly in those with CVD. However, drugs without CV benefits including sulfonylureas and DPP-4i continued to be highly prescribed in older patients. There is still room to improve the management in this population according to recommendations.

Abstract P6-08-04: Geographical variation of social deprivation, cardiovascular and other comorbidities in 226,516 patients with early breast cancer in England: results from a National Registry Dataset Analysis

Abstract Background In England, as for many countries, there are geographical variations in treatment uptake and outcomes for patients with early breast cancer (EBC). It is important such inequalities are addressed. The co-existence of cardiovascular disease (CVD) in patients with early breast cancer (EBC) may complicate treatment choices, lead to deviations from standard of care, and be associated with worse cancer and CVD outcomes. Social deprivation is also associated with increased incidence of co-morbidities, reduced cancer treatment rates, and worse cancer survival. If there are regional differences in rates of CVD/co-morbidities and social deprivation these may explain observed differences in treatment uptake and cancer outcomes in EBC. Therefore, in this analysis we evaluated rates of CVD and social deprivation in a large population of patients with EBC in 20 English Cancer Alliances. Methods Cancer registry data as part of The Virtual Cardio-Oncology Research Initiative (VICORI) were used to identify patients diagnosed with stage I-III breast cancer diagnosed between 2013 - 2018 in England. National data (hospital records and national cardiovascular audit databases) were used to describe CVD prevalence (CVDp), Index of Multiple Deprivation (IMD), and Charlson Comorbidity Index (CCI). Patient, disease, tumour, and treatment characteristics were allocated into Cancer Alliance tertiles according to CVDp (minimum (&amp;lt; 33.3rd percentile); middle (33.3rd – 66.6th percentile); maximum (&amp;gt;66.6th percentile)) with approximately equal patient numbers in each group. The disease burden was depicted in bar charts and regional variation as heat maps of England. The percentage of patients in the most deprived quintile of income domain of the IMD were plotted. Funnel plots were used to investigate variations in regional CVD rates based on a logistic regression model. Results Data from 226,516 patients with stage I-IIIA breast cancer with a mean age of 62.5 (+/- 13.7) were included in the analysis. 78,833 patients were assigned to the minimum (37.0%; 95% CI 36.7 – 37.2), 74,443 to the middle (35.5%; 95% CI 35.3 – 35.7), and 73,240 to the maximum (34.7%; 95% CI 34.5 – 34.9) tertile. Geographical variation between Cancer Alliances was demonstrated for CVDp (6% - 9.5%), IMD (2%- 30%), and CCI  4 (8.2% - 9.5%). Variation of CVDp revealed a South/North gradient between Cancer Alliances towards higher percentage, with centrifugal tendency from London. These findings were consistent with a similar pattern seen for variation in IMD quintiles with higher prevalence of most socioeconomic deprived patients located in cancer alliances in the North compared to the South of England. Regional variation was less obvious for CCI. After adjusting for age, TNM stage, IMD, and CCI, differences in the standardised CVD ratio persisted for some cancer alliances suggesting that other factors than those adjusted for are likely accountable for the higher CVDp seen in some Cancer Alliances. An adjusted ordinal logistic regression model demonstrated that older age (aged &amp;gt;75), white ethnicity, and social deprivation were associated with a higher risk of CVDp (p&amp;lt; 0.001). Conclusions This study highlights significant geographical variation of social deprivation, CVDp, and other comorbidities in early breast cancer patients in England which may contribute to the variability in treatment received and breast cancer survival in different regions within the country. Citation Format: Jasmin V Waterhouse, Catherine A. Welch, Nicolo M.L. Battisti, David Adlam, Michael J. Sweeting, Lizz Paley, Paul Lambert, John E. Deanfield, Mark de Belder, Michael D Peake, Alistair Ring. Geographical variation of social deprivation, cardiovascular and other comorbidities in 226,516 patients with early breast cancer in England: results from a National Registry Dataset Analysis [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P6-08-04.

Medical comorbidities as predictors of COVID-19 short-term mortality: A historical cohort study in Indonesia.

In this study, we aimed to evaluate the relation of comorbidities to coronavirus disease 2019 (COVID-19) short-term mortality. This was a single-center observational study with a historical cohort method at Bethesda Hospital Yogyakarta, Indonesia. COVID-19 diagnosis was made using reverse transcriptase-polymerase chain reaction on nasopharyngeal swabs. Patient data were obtained from digital medical records and used for Charlson Comorbidity Index assessments. Inhospital mortality was monitored throughout their hospital stay. This study enrolled 333 patients. According to the total number of comorbidities in Charlson, 11.7% (n = 39) of patients had no comorbidities; 30.9% (n = 103) of patients had one comorbidity; 20.1% (n = 67) of patients had two comorbidities; and 37.2% (n = 124) of patients had more than three comorbidities. In multivariate analysis, these variables were significantly related to short-term mortality in COVID-19 patients: older age (odds ratio [OR] per year: 1.64; 95% confidence interval [CI]: 1.23-2.19; P 0.001), myocardial infarction (OR: 3.57; 95% CI: 1.49-8.56; P: 0.004), diabetes mellitus (OR: 2.41; 95 CI: 1.17-4.97; P: 0.017), renal disease (OR: 5.18; 95% CI: 2.07-12.97; P < 0.001), and longer duration of stay (OR: 1.20; 95% CI: 1.08-1.32; P < 0.001). This study revealed multiple short-term mortality predictors in COVID-19 patients. The coexistence of cardiovascular disease, diabetes, and renal problem is a significant predictor of short-term mortality in COVID-19 patients.

Subretinal Drusenoid Deposits and Lower Serum High-Density Lipoprotein Cholesterol Levels Possess Latent Relation to Cardiovascular Disease and Can Be a Feasible Predictor.

Objective To ascertain whether lipid-related subretinal drusenoid deposits (SDD) are correlated with coexisting cardiovascular disease (CVD), as well as to reveal latent serum markers of CVD. Methods Patients older than 50 years and plagued by age-related macular degeneration (AMD) were included. Subjects with other retinal degenerations and vascular diseases, any recent treatment at other medical care institutions, and any previous oculopathy or ophthalmic surgery were excluded. All subjects were examined to ascertain whether they possess SDD, to analyze serum cholesterols, including low-density lipoprotein cholesterol (LDL), triglycerides (TG), high-density lipoprotein cholesterol (HDL), and total cholesterol (TC). Subjects were divided into SDD and non-SDD groups and further divided into subgroups by assessment of pump defect, valve defect, and carotid defect. Finally, logistic model trees and random forest algorithm analysis were performed. Results A total of 85 AMD patients including 43 with and 42 without SDD were involved. The 42 AMD (97.67%, 42/43) patients with SDD showed CVD, including 3 subjects presenting valve defect, 3 subjects presenting carotid defect, 8 subjects presenting pump defect, 14 subjects presenting both pump and valve defects, and 14 subjects presenting pump, valve, and carotid defects. By contrast, 5 AMD (11.90%, 5/42) patients without SDD showed CVD. Cholesterol level of SDD subjects presented significant higher TC (5.66 ± 1.01 vs. 5.58 ± 0.72, p = 0.032, Wilcoxon test) and lower HDL cholesterol (61 ± 17 vs. 70 ± 21, p = 0.031, Wilcoxon test) than that of non-SDD. The cases with HDL < 62 mg/dL were significantly related to CVD (p = 0.013, Wilcoxon test), and the cases with HDL < 40 mg/dL were not (p = 0.659, Wilcoxon test). Through machine learning based on the image from color fundus photography, the accuracy of predicting CVD was 95%. Conclusions The presence of SDD of AMD and lower serum HDL cholesterol level can predict certain CVD for AMD patients. The machine learning based on the SDD image and serum HDL cholesterol may open new avenue for the detection of CVD as a noninvasive approach.

Nomograms for Predicting Coexisting Cardiovascular Disease and Prognosis in Chronic Obstructive Pulmonary Disease: A Study Based on NHANES Data.

Background Chronic obstructive pulmonary disease (COPD) is a common chronic disease. Progression is further exacerbated by the coexistence of cardiovascular disease (CVD). We aim to construct a diagnostic nomogram for predicting the risk of coexisting CVD and a prognostic nomogram for predicting long-term survival in COPD. Methods The 540 eligible participants selected from the NHANES 2005–2010 were included in this study. Logistic regression analysis was used to construct a diagnostic nomogram for the diagnosis of coexisting CVD in COPD. Cox regression analyses were used to construct a prognostic nomogram for COPD. A risk stratification system was developed based on the total score generated from the prognostic nomogram. We used C-index and ROC curves to evaluate the discriminant ability of the newly built nomograms. The models were also validated utilizing calibration curves. Survival curves were made using the Kaplan–Meier method and compared by the Log-rank test. Results Logistic regression analysis showed that gender, age, neutrophil, RDW, LDH, and HbA1c were independent predictors of coexisting CVD and were included in the diagnostic model. Cox regression analysis indicated that CVD, gender, age, BMI, RDW, albumin, LDH, creatinine, and NLR were independent predictors of COPD prognosis and were incorporated into the prognostic model. The C-index and ROC curves revealed the good discrimination abilities of the models. And the calibration curves implied that the predicted values by the nomograms were in good agreement with the actual observed values. In addition, we found that coexisting with CVD had a worse prognosis compared to those without CVD, and the prognosis of the low-risk group was better than that of the high-risk group in COPD. Conclusions The nomograms we developed can help clinicians and patients to identify COPD coexisting CVD early and predict the 5-year and 10-year survival rates of COPD patients, which has some clinical practical values.

The incidence of acute kidney injury and its association with mortality in patients diagnosed with COVID-19 followed up in intensive care unit.

The kidneys are some of the most frequently affected organs during coronavirus disease 2019 (COVID-19). This multicenter study evaluated the incidence of and risk factors for acute kidney injury (AKI) in COVID-19 patients followed up in intensive care unit (ICU) and its association with mortality. Three hundred twenty-eight patients diagnosed with COVID-19 and hospitalized in ICU were included. Risk factors associated with AKI and mortality were evaluated. Eighty-eight patients (27.9%) were diagnosed with AKI. AKI was significantly associated with older age, higher baseline creatinine level, lower albumin level, and coexistence of cardiovascular disease and chronic obstructive pulmonary disease. Mortality in the entire study group was significantly associated with AKI, older age, requirement of invasive mechanical ventilation, higher neutrophil level, lower lymphocyte, and albumin levels. AKI is frequently seen during the course of COVID-19 and is associated with high mortality. Identifying AKI-related risk factors appears essential in the management of COVID-19 patients.

Surgeons have hesitated early cholecystectomy because of cardiovascular comorbidities during adoption of guidelines

The introduction of the guidelines has resulted in an increase of laparoscopic surgeries performed, but the rate of early surgery was still low. Here, the initial effect of the introduction of the guideline was confirmed in single center, and factors disturbing early cholecystectomy were analyzed. This study included 141 patients who were treated for acute cholecystitis from January 2010 to October 2014 at Kanazawa Medical Center. Each patient was assigned into a group according to when they received treatment. Patients in Group A were treated before the Tokyo Guidelines were introduced (n = 48 cases), those in Group B were treated after the introduction of the guidelines (93 cases). After the introduction of the guidelines, early laparoscopic cholecystectomy was significantly increased (P < 0.001), however, the rate of early operations was still 38.7% only. There are many cases with cardiovascular disease in delayed group, the prevalence had reached 50% as compared with early group of 24% (P < 0.01). Approximately 25% of patients continued antiplatelet or anticoagulant therapy. In the early days of guidelines introduction, the factor which most disturbed early surgery was the coexistence of cardiovascular disease. These contents could be described in the next revision of the guidelines.

Racial disparities in mortality outcomes among women diagnosed with breast cancer in Maryland: Impact of cardiovascular disease and clinical characteristics.

Although racial disparities in breast cancer (BC) mortality have been well documented in the United States, little is known about the impact of coexisting cardiovascular disease (CVD) and other clinical factors on Black-White survival disparities after the diagnosis of BC. This study examined the associations of race, CVD, and clinical factors at diagnosis with the hazard of BC and CVD-related mortality among patients with BC identified from the Maryland Cancer Registry. A total of 36,088 women (25,181 Whites and 10,907 Blacks) diagnosed with incident invasive BC between 2007 and 2017 were included. Subdistribution hazard ratios (sdHRs) for CVD-related and BC mortality were estimated with Fine and Gray regression models, which accounted for the influence of competing events. After a median follow-up of 5.8 years, 8019 deaths occurred; 3896 were BC deaths, and 1167 deaths were CVD-related. Black women had a higher hazard of BC mortality (sdHR, 1.66; 95% confidence interval [CI], 1.55-1.77) and CVD mortality (sdHR, 1.33; 95% CI, 1.17-1.51) in comparison with White women. Associations with CVD mortality were significantly stronger among Black women aged 50 to 59 years (sdHR, 2.86; 95% CI, 1.84-4.44; P for interaction < .001). Among Black women with CVD, the hazard of BC death was 41% higher in comparison with White women. By treatment, a significant association with CVD mortality was observed only among Black women undergoing surgery and radiation (sdHR, 1.61; 95% CI, 1.22-2.13). Clinicians should consider the impact of younger age, preexisting CVD, and BC treatments among Black patients. Early identification of those at risk for worse survival may improve surveillance and outcomes.

Predicting Stroke Complications in Hospital and Functional Status at Discharge by Clustering of Cardiovascular Diseases a Multi-Centre Registry-Based Study of Acute Stroke

ObjectiveIndicators for outcomes following acute stroke are lacking. We have developed novel evidence-based criteria for identifying outcomes of acute stroke using the presence of clusters of coexisting cardiovascular disease (CVD). Materials and methodsAnalysis of prospectively collected data from the Sentinel Stroke National Audit Programme (SSNAP). A total of 1656 men (mean age ±SD=73.1yrs±13.2) and 1653 women (79.3yrs±13.0) were admitted with acute stroke (83.3% ischaemic, 15.7% intracranial haemorrhagic), 1.0% unspecified) in four major UK hyperacute stroke units (HASU) between 2014 and 2016. Four categories from cardiovascular disease Congestive heart failure, Atrial fibrillation, pre-existing Stroke and Hypertension (CASH).were constructed: CASH-0 (no coexisting CVD); CASH-1 (any one coexisting CVD); CASH-2 (any two coexisting CVD); CASH-3 (any three or all four coexisting CVD). These were tested against outcomes, adjusted for age and sex. ResultsCompared to CASH-0, individuals with CASH-3 had greatest risks of in-hospital mortality (11.1% vs 24.5%, OR=1.8, 95%CI=1.3-2.7) and disability (modified Rankin Scale score ≥4) at discharge (24.2% vs 46.2%, OR=1.9, 95%CI=1.4-2.7), urinary tract infection (3.8% vs 14.6%, OR= 3.3, 95%CI= 1.9-5.5), and pneumonia (7.1% vs 20.6%, OR= 2.6, 95%CI= 1.7-4.0); length of stay on HASU >14 days (29.8% vs 39.3%, OR=1.8, 95%CI=1.3-2.6); and joint-care planning (20.9% vs 29.8%, OR=1.4, 95%CI=1.0-2.0). ConclusionsWe present a simple tool for estimating the risk of adverse outcomes of acute stroke including death, disability at discharge, nosocomial infections, prolonged length of stay, as well as any joint care planning. CASH-0 indicates a low level and CASH-3 indicates a high level of risk of such complications after stroke.

Cardiac Effects of Phosphodiesterase-5 Inhibitors: Efficacy and Safety.

The coexistence of cardiovascular disease and erectile dysfunction is widespread, possibly owing to underlying endothelial dysfunction in both diseases. Millions of patients with cardiovascular disease are prescribed phosphodiesterase-5 (PDE5) inhibitors for the management of erectile dysfunction. Although the role of PDE5 inhibitors in erectile dysfunction therapy is well established, their effects on the cardiovascular system are unclear. Preclinical studies investigating the effect of PDE5 inhibitors on ischemia-reperfusion injury, pressure overload-induced hypertrophy, and chemotoxicity suggested a possible clinical role for each of these medications; however, attempts to translate these findings to the bedside have resulted in mixed outcomes. In this review, we explore the biologic preclinical effects of PDE5 inhibitors in mediating cardioprotection. We then examine clinical trials investigating PDE5 inhibition in patients with heart failure, coronary artery disease, and ventricular arrhythmias and discuss why the studies likely have yet to show positive results and efficacy with PDE5 inhibition despite no safety concerns.

Exertional ventilation/carbon dioxide output relationship in COPD: from physiological mechanisms to clinical applications.

There is well established evidence that the minute ventilation (V'E)/carbon dioxide output (V'CO2 ) relationship is relevant to a number of patient-related outcomes in COPD. In most circumstances, an increased V'E/V'CO2 reflects an enlarged physiological dead space ("wasted" ventilation), although alveolar hyperventilation (largely due to increased chemosensitivity) may play an adjunct role, particularly in patients with coexistent cardiovascular disease. The V'E/V'CO2 nadir, in particular, has been found to be an important predictor of dyspnoea and poor exercise tolerance, even in patients with largely preserved forced expiratory volume in 1 s. As the disease progresses, a high nadir might help to unravel the cause of disproportionate breathlessness. When analysed in association with measurements of dynamic inspiratory constraints, a high V'E/V'CO2 is valuable to ascertain a role for the "lungs" in limiting dyspnoeic patients. Regardless of disease severity, cardiocirculatory (heart failure and pulmonary hypertension) and respiratory (lung fibrosis) comorbidities can further increase V'E/V'CO2 A high V'E/V'CO2 is a predictor of poor outcome in lung resection surgery, adding value to resting lung hyperinflation in predicting all-cause and respiratory mortality across the spectrum of disease severity. Considering its potential usefulness, the V'E/V'CO2 should be valued in the clinical management of patients with COPD.

1831P Prevalence of cardiovascular disease in patients diagnosed with six common curable malignancies: A Virtual Cardio-Oncology Research Institute (VICORI) national registry dataset analysis

The co-existence of cardiovascular disease (CVD) in cancer patients may explain treatment and outcomes disparities. However, CVD prevalence in cancer patients is unknown. We described CVD prevalence in adults with curable tumours and investigated factors associated with CVD.

Cardiovascular magnetic resonance-determined left ventricular myocardium impairment is associated with C-reactive protein and ST2 in patients with paroxysmal atrial fibrillation

BackgroundMyocardial strain assessed with cardiovascular magnetic resonance (CMR) feature tracking can detect early left ventricular (LV) myocardial deformation quantitatively in patients with a variety of cardiovascular diseases, but this method has not yet been applied to quantify myocardial strain in patients with atrial fibrillation (AF) and no coexistent cardiovascular disease, i.e., the early stage of AF. This study sought to compare LV myocardial strain and T1 mapping indices in AF patients and healthy subjects, and to investigate the associations of a portfolio of inflammation, cardiac remodeling and fibrosis biomarkers with LV myocardial strain and T1 mapping indices in AF patients with no coexistent cardiovascular disease.MethodsThe study consisted of 80 patients with paroxysmal AF patients and no coexistent cardiovascular disease and 20 age- and sex-matched healthy controls. Left atrial volume (LAV), LV myocardial strain and native T1 were assessed with CMR, and compared between the AF patients and healthy subjects. Biomarkers of C-reactive protein (CRP), transforming growth factor beta-1 (TGF-β1), collagen III N-terminal propeptide (PIIINP), and soluble suppression of tumorigenicity 2 (sST2) were obtained with blood tests, and compared between the AF patients and healthy controls. Associations of these biomarkers with those CMR-measured parameters were analyzed for the AF patients.ResultsFor the CMR-measured parameters, the AF patients showed significantly larger LAV and LV end-systolic volume, and higher native T1 than the healthy controls (max P = 0.027). The absolute values of the LV peak systolic circumferential strain and its rate as well as the LV diastolic circumferential strain rate were all significantly reduced in the AF patients (all P < 0.001). For the biomarkers, the AF patients showed significantly larger CRP (an inflammation biomarker) and sST2 (a myocardium stiffness biomarker) than the controls (max P = 0.007). In the AF patients, the five CMR-measured parameters of LAV, three LV strain indices and native T1 were all significantly associated with these two biomarkers of CRP and sST2 (max P = 0.020).ConclusionsIn patients with paroxysmal AF and no coexistent cardiovascular disease, LAV enlargement and LV myocardium abnormalities were detected by CMR, and these abnormalities were associated with biomarkers that reflect inflammation and myocardial stiffness.

Cardio-oncology discipline: focus on the necessities in developing countries.

Cardiovascular diseases constitute one of the main aetiologies of mortality among patients with cancer. Population ageing and cancer survival rate improvements have resulted in the coexistence of cardiovascular diseases and malignancies in an increasing number of patients. With the diversity in treatments and the introduction of new drug lines, multiple mechanisms of cardiovascular injury have been recognized in these patients.Cardio‐oncology is an emerging entity introduced to provide a proper solution to the several challenges encountered in the management of patients with cancer and cardiac involvement.This review will assess the logical grounds for establishing a cardio‐oncology unit, describe the main objectives and the detailed responsibilities in such systems, and outline the target population. Furthermore, the importance of research and appropriate data collection will be highlighted. Lastly, the special considerations and modifications required for setting up such centres in the developing countries are discussed.

The role of coexisting cardiovascular disease on disease severity in patients with inflammatory bowel disease.

Chronic inflammation has been implicated in the pathogenesis of atherosclerosis and cardiovascular disease. Data linking the severity of inflammatory bowel disease to coexisting cardiovascular disease are scarce. The aim of the present study was to investigate whether inflammatory bowel disease patients with coexistent cardiovascular disease have more severe disease. We included 103 inflammatory bowel disease patients with coexisting cardiovascular disease compared to 206 age- and sex-matched inflammatory bowel disease patients without cardiovascular disease derived from three referral inflammatory bowel disease Centers. Traditional cardiovascular disease factors and parameters of inflammatory bowel disease severity were compared between the two groups. Cardiovascular disease was diagnosed after the inflammatory bowel disease diagnosis in 56.6% of cases. No significant difference was found in the prevalence of surrogate markers of severity (inflammatory bowel disease-related surgeries, hospitalizations, biologics or immunosuppressants' use, and persistent CRP elevation) between inflammatory bowel disease patients with and without cardiovascular disease. There was no difference between cardiovascular disease patients diagnosed before and after inflammatory bowel disease onset. All traditional risk factors (hypertension, dyslipidemia, smoking, obesity, diabetes mellitus) were significantly more common in cardiovascular disease patients. Cardiovascular disease patients had a trend for lower rates of multiple hospitalizations (16.5% vs. 24.3%, P = 0.05) and inflammatory bowel disease-related surgeries (P = 0.09). The inflammatory burden possibly plays a less important role in the development of cardiovascular disease in inflammatory bowel disease patients but future larger prospective studies are needed.

Associations of cardiovascular disease and depression with memory related disease: A Chinese national prospective cohort study

BackgroundAssociation of cardiovascular disease (CVD) or depression and memory has been studied. But hardly any studies on the association of coexistence of CVD and depression and memory. MethodsThis is a prospective cohort study of a nationally representative sample of 12,272 adults aged 45 years and more who participated in the China health and retirement longitudinal study 2011 to 2015. All variables were acquired by self-reporting questions. The associations between coexistence of CVD and depression with memory related disease (MRD) were investigated by using Cox proportional hazards regression models. ResultsAmong the 12,272 participants (mean age 65.69 years; 46.8% male) in this study, 56.9% no CVD or depression and 6.7% coexistence of CVD and depression. After adjustment for age, sex, marriage, living place, registered permanent residence, education level, smoking status, alcoholic intake, sleep status, nap status, social communication, health before 15 years, life satisfaction, cognitive function, and 11 chronic diseases risk factors, depression alone was significantly high risk for MRD (HR:1.64; 95% CI: 1.09–2.49); coexistence of CVD and depression increased the risk for MRD significantly higher (HR: 4.72; 95%CI: 2.91–7.64). LimitationsDiseases were all self-reported and we couldn't adjust for all the potential confounders, which might be prone to information error and residual confounding. ConclusionsIn a nationally representative cohort with median 4 years of follow-up, depression alone and co-existence of depression and CVD could significantly increase the risk of MRD. Our study supports the idea of prevention of memory disease from a psycho-cardiology aspect.

Five-year outcomes of patients attending a diabetic foot clinic in a tertiary referral centre.

Diabetic foot ulcers (DFU) are associated with an increased risk of lower limb amputation and death. Reported mortality rates for patients with DFU are as high as 50% after 5 years. The aim of this retrospective study was to examine the 5-year clinical outcomes of patients with high-risk diabetic foot disease attending a specialist foot clinic in Beaumont Hospital between 2007 and 2010. Clinical information was obtained from the CELLMA electronic patient record and laboratory results were extracted from the Beaumont Hospital information system. In total, data from 98 patients, who attended the foot clinic over the 4-year period, was collected. The 5-year mortality rate was 13.3% with an amputation rate of 28.6%. A significant proportion of patients (33.7%) had recurrent/new DFU after 5 years of follow-up. In this cohort, there was no association between poor glycaemiccontrol, presence of co-existent cardiovascular disease or renal failure, and increased mortality or amputation. Diabetic foot disease is an important cause of morbidity and mortality in clinical practice. It remains to be seen whether implementation of the national model of foot care in 2011 will improve outcomes for patients with high-risk diabetic foot disease.

Associations of cardiovascular disease and depression with memory related disease: A Chinese national prospective cohort study

BackgroundAssociation of cardiovascular disease (CVD) or depression and memory has been studied. But hardly any studies on the association of coexistence of CVD and depression and memory. MethodsThis is a prospective cohort study of a nationally representative sample of 12,272 adults aged 45 years and more who participated in the China health and retirement longitudinal study 2011 to 2015. All Variables were acquired by self-reporting questions. The associations between coexistence of CVD and depression with memory related disease (MRD) were investigated by using Cox proportional hazards regression models. ResultsAmong the 12,272 participants (mean age 65.69 years; 46.8% male) in this study, 56.9% no CVD or depression and 6.7% coexistence of CVD and depression. After adjustment for age, sex, marriage, living place, registered permanent residence, education level, smoking status, alcoholic intake, sleep status, nap status, social communication, health before 15 years, life satisfaction, cognitive function, and 11 chronic diseases risk factors, depression alone was significantly high risk for MRD (HR:1.64; 95% CI: 1.09–2.49); coexistence of CVD and depression increased the risk for MRD significantly higher (HR: 4.72; 95%CI: 2.91–7.64). LimitationsDiseases were all self-reported and we couldn't adjust for all the potential confounders, which might be prone to information error and residual confounding. ConclusionsIn a nationally representative cohort with median 4 years of follow-up, depression alone and coexistence of depression and CVD could significantly increase the risk of MRD. Our study supports the idea of prevention of memory disease from a psycho-cardiology aspect.