Development Of Adverse Cardiovascular Events Research Articles

Short and Long-Term Prognostic Significance of Galectin-3 in Patients with ST-Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention.

This study evaluated the short and long-term prognostic value of galectin-3 in patients with ST-segment elevation myocardial infarction (STEMI) who underwent primary percutaneous coronary intervention (PCI). Patients (n = 143) were admitted with STEMI and followed up for 2years. The study population was divided into high and low galectin-3 groups based on the admission median value of serum galectin-3. Primary clinical outcomes consisted of cardiovascular (CV) mortality, non-fatal reinfarction, stroke, and target vessel revascularization (TVR). CV events were recorded in hospital and at 1 and 2years. The primary clinical outcomes (in-hospital, 1year and 2year) were significantly higher in the high galectin-3 group. (P = .008, P = .004, P = .002, respectively). High galectin-3 levels were also associated with heart failure development and re-hospitalization at both 1year (P = .029, P = .009, respectively) and 2years (P = .019, P = .036, respectively). According to Cox multivariate analysis, left ventricular ejection fraction (LVEF) was an independent predictor of 2-year cardiovascular mortality (P = .009), whereas galectin-3 was not (P = .291). Although high galectin-3 levels were not independent predictors of long-term CV mortality in patients with acute STEMI who underwent primary PCI, it was associated with short-term and long-term development of adverse CV events, heart failure, and re-hospitalization.

Prognostic value of vascular remodeling parameters in the development of adverse cardiovascular events in patients with gastric cancer

Aim. To determine a possible prognostic marker for adverse cardiovascular events in patients with gastric cancer by studying the early and long-term effects of multiagent chemotherapy (MAC) on the structural and functional vascular wall parameters.Material and methods. The study included 25 patients with newly diagnosed gastric cancer who received courses of chemotherapy with platinum-based agents and fluoropyrimidines. All patients before, immediately after MAC courses and in the long-term period underwent a non-invasive assessment of vascular wall and endothelial function (photoplethysmography (PPG)). In the survivors’ cohort, a correlation analysis was performed to assess the risk of future cardiovascular events depending on changes of PPG parameters.Results. Before the MAC courses, cancer patients had endothelial dysfunction (mean occlusion index, 1,7 (1,4; 1,9), N>1,8) and structural vascular wall disorders (mean stiffness index, 8,9 m/s (7,7; 9,7), N<8 m/s, mean reflection index, 32,4% (27,5; 37,7), N<30%). All indicators significantly worsened after MAC in the form of endothelial dysfunction progression and vascular remodeling: mean occlusion index, 1,3 (1,2; 1,5) (p<0,0002), stiffness index, 10,3 m/s (9,5; 11,2) (p<0,0001), reflection index, 40,2% (35,5; 43,6) (p<0,001). Long-term follow-up averaged 2,9 years (2,3-3,7 years). All-cause and cardiovascular mortality was 32% and 12%, respectively. Nine patients developed a cardiovascular events (CVEs) (de novo, progression of prior CVD). Significant changes of vascular indicators in the long-term period was not revealed. A trend towards association between increased reflection index and a higher probability of cardiovascular pathology was revealed (OR 1,20, 95% CI 1,01-1,55, p=0,081).Conclusion. In this study, for the first time, a comprehensive assessment of the effect of MAC on endothelial dysfunction and vascular stiffness, including, in the long-term follow-up period, was carried out in patients with gastric cancer. A significant aggravation of all parameters of vascular remodeling immediately after treatment in the absence of their significant dynamics in the future has been proven. A possible prognostic marker, namely the reflection index, of an unfavorable cardiac outcome in patients with gastric cancer has been identified, which requires further study.

Prognostic Significance of Hypertriglyceridemia in Patients at High and Very High Cardiovascular Risk Depending on the Concentration of Highsensitivity C-reactive Protein.

It has been established that an increase in triglyceride-rich lipoprotein levels is associated with the development of systemic low-grade inflammation. Data on the prognostic role of hypertriglyceridemia (HTG) dependent on the state of low-grade inflammation are limited. The study's objective was to evaluate the predictive value of mild-to-moderate HTG (2.3- 11.2 mmol/L) regarding the development of cardiovascular events in patients at high and very high cardiovascular risk (CVR), depending on the high-sensitivity C-reactive protein (hsCRP) values. The study included 185 patients with high and very high CVR. The concentration of hsCRP in blood serum was measured using an enzyme-linked immunosorbent assay kit. The combined endpoint was cardiovascular death, nonfatal myocardial infarction or unstable angina (which required hospitalization), nonfatal stroke, and coronary revascularization. HTG was revealed in 17.3% of the patients. An increase in hsCRP ≥2.0 mg/L was observed in 51.9% of the patients. The event-free survival of patients with HTG was not statistically different from that in patients with TG <2.3 mmol/L (RR 1.61; 95% CI 0.86-3.00; p=0.133). In the subgroup of patients with hsCRP <2.0 mg/L, patients with HTG were not significantly different from patients without HTG. In the subgroup of patients with hsCRP≥2.0 mg/L, the presence of HTG was associated with a 4.63 times increase in the RR of adverse cardiovascular events (95% CI 1.35-15.8; p=0.015) after adjusting for potential confounders. In patients with high and very high CVR, an increase in TG ≥2.3 mmol/L was associated with the development of adverse cardiovascular events only in the subgroup of patients with an increase in hsCRP ≥2.0 mg/L. The presence of HTG was associated with a 4.63 times increase in RR of adverse cardiovascular events (95% CI 1.35-15.8; p=0.015).

Osteopontin as a Predictor of Adverse Events in Patients with Comorbid Pathology

Information about the results of the examination of 78 women aged 50 to 65 years is given. The nature of comorbid pathology was studied: chronic heart failure, type 2 diabetes mellitus and osteoporosis. It has been established that osteopontin is an independent risk factor for the development of adverse cardiovascular events and bone fractures in women with comorbid pathology. During 36 months of prospective follow-up, patients with comorbid pathology and OPN level &gt;21.4 ng/ml were significantly more likely to have adverse cardiovascular events and osteoporotic fractures. In patients of the 2nd group with an AKI level of &gt;21.4 ng/ml compared with the group with an AKI concentration of ≤21.4 ng/ml, the risk of cumulative (combined frequency of the combined end point of cardiovascular events) was increased (OR = 6.200 [95% CI 2.258-17.024; p=0.001]). Separate analysis showed a significant increase in the risk of adverse events within 36 months at an AKI concentration of &gt;21.4 ng/ml: progression of CHF (OR=4.073 [95% CI 1.575–10.531; p=0.023]) and osteoporotic bone fractures (OR=0 .81 [95% CI 0.72-0.90; p=0.01]); risks of MI (OR=4.343 [95% CI 0.463-40.751; p=0.162]), stroke (OR=1.178 [95% CI 0.315-31.860; p=0.498]), and decompensation of CHF (OR=1.938 [95% CI 0.696-5.391; p=0.083]) increased insignificantly. The level of acute renal failure &gt;21.4 ng/ml (sensitivity-83%, specificity-62%) makes it possible to predict the onset of adverse cardiovascular events in patients with coronary artery disease with type 2 diabetes and osteoporosis with a high probability.

Abstract 14508: Association of Multi-Ethnic Genome-Wide Blood Pressure Polygenic Risk Score With Adverse Cardiovascular Events

Background: Traditional cardiovascular (CV) risk factors and the underlying genetic risk of elevated blood pressure (BP) determine an individual’s composite risk of developing adverse CV events. We evaluated the relative contributions of the traditional CV risk factors to the development of adverse CV events in the context of varying BP polygenic risk score (PRS) profiles among multiethnic population-based cohorts (ARIC, MESA, JHS, FHS, CARDIA, and CHS cohort). Methods: Multiethnic genome-wide BP PRS was constructed among participants with WGS data through TOPMed program and were stratified into high, intermediate, and low genetic risk (&gt;80 th , 20-80 th , &lt;20 th centile). Based on the ACC/AHA Pooled Cohorts Equation (PCE), participants were stratified into low and high (10y-ASCVD risk: &lt;10% or ≥10%) CV risk factor profile groups. Cox regression was used to assess the risk of adverse CV events (incident HF, CHD, and stroke) and its components. Results: Among 21,899 American adults (mean age: 56 years; 56% women; 36% non-White race), 1 SD increase in the BP PRS computed using 1.1 million variants was associated with systolic BP (β: 4.7, 95% CI: 4.5-5.0) and HTN (OR: 1.09, 95% CI: 1.09-1.10), respectively. This association was robustly seen across racial/ethnic groups. Each SD increase in BP PRS was associated with a higher risk of the primary outcome (HR: 1.08 [1.05-1.11]) after controlling for ACC/AHA PCE risk score. Among individuals with a high BP PRS, low ASCVD risk was associated with a 69% lower hazard for the primary outcome (HR: 0.31, [0.27-0.35]) compared with those with high ASCVD risk. A similar pattern was noted in intermediate and low BP PRS groups. Comparable results were noted for all the secondary outcomes. Conclusions: In a multiethnic cohort of &gt;21,000 US adults, genome-wide BP PRS was associated with BP traits and adverse CV events. Adequate CV risk factor control may reduce this increased predisposition to adverse CV events by 69% in those with high BP PRS.

Association of a Multiancestry Genome-Wide Blood Pressure Polygenic Risk Score With Adverse Cardiovascular Events.

Traditional cardiovascular risk factors and the underlying genetic risk of elevated blood pressure (BP) determine an individual's composite risk of developing adverse cardiovascular events. We sought to evaluate the relative contributions of the traditional cardiovascular risk factors to the development of adverse cardiovascular events in the context of varying BP genetic risk profiles. Genome-wide polygenic risk score (PRS) was computed using multiancestry genome-wide association estimates among US adults who underwent whole-genome sequencing in the Trans-Omics for Precision program. Individuals were stratified into high, intermediate, and low genetic risk groups (>80th, 20-80th, and <20th centiles of systolic BP [SBP] PRS). Based on the ACC/AHA Pooled Cohort Equations, participants were stratified into low and high (10 year-atherosclerotic cardiovascular disease [CVD] risk: <10% or ≥10%) cardiovascular risk factor profile groups. The primary study outcome was incident cardiovascular event (composite of incident heart failure, incident stroke, and incident coronary heart disease). Among 21 897 US adults (median age: 56 years; 56.0% women; 35.8% non-White race/ethnicity), 1 SD increase in the SBP PRS, computed using 1.08 million variants, was associated with SBP (β: 4.39 [95% CI, 4.13-4.65]) and hypertension (odds ratio, 1.50 [95% CI, 1.46-1.55]), respectively. This association was robustly seen across racial/ethnic groups. Each SD increase in SBP PRS was associated with a higher risk of the incident CVD (multivariable-adjusted hazards ratio, 1.07 [95% CI, 1.04-1.10]) after controlling for ACC/AHA Pooled Cohort Equations risk scores. Among individuals with a high SBP PRS, low atherosclerotic CVD risk was associated with a 58% lower hazard for incident CVD (multivariable-adjusted hazards ratio, 0.42 [95% CI, 0.36-0.50]) compared to those with high atherosclerotic CVD risk. A similar pattern was noted in intermediate and low genetic risk groups. In a multiancestry cohort of >21 000 US adults, genome-wide SBP PRS was associated with BP traits and adverse cardiovascular events. Adequate control of modifiable cardiovascular risk factors may reduce the predisposition to adverse cardiovascular events among those with a high SBP PRS.

Impacts of Educational Interventions with Support of Mobile App versus Booklet for Patients with Hypertension and Metabolic Syndrome: A Secondary Data Analysis.

Background: Hypertension comorbid with metabolic syndrome could increase the development of adverse cardiovascular events. Educational interventions were effective to improve outcomes in patients. Methods: This was a secondary data analysis of participants with hypertension. The original randomized controlled trial aimed to examine the effect of app and booklet versus control among individuals diagnosed with metabolic syndrome living in the community. A 30-min health education was provided to each participant. In addition to the education, the app group received a mobile app while the booklet group received a booklet. Data were collected at baseline, week 4, week 12, and week 24. Intention-to-treat principle was followed, and generalized estimating equations was employed for data analysis. Results: A total of 118 participants with hypertension and metabolic syndrome were extracted from the three-arm trial data. The sample size was 36, 42, and 40 in the app group, booklet group, and control group, respectively. Compared to the control group, the app group showed a significant reduction on body weight and waist circumference at week 24, while the total exercise and self-efficacy for exercise were increased at week 12 and week 24 but no significant findings were observed in the booklet group. Conclusions: The educational intervention supported with app was superior to the booklet support on the outcomes of body weight, waist circumference, total exercise, and self-efficacy for exercise among patients with hypertension and metabolic syndrome in the community.

The association of coronary non-calcified plaque loading based on coronary computed tomography angiogram and adverse cardiovascular events in patients with unstable coronary heart disease-a retrospective cohort study.

BackgroundCoronary computed tomography angiogram (CCTA) has the characteristics of non-invasive, high resolution, and can accurately determine the characteristics of tubular wall plaques. The non-calcified plaque loading of the coronary arteries is unstable and prone to shedding, leading to adverse cardiovascular events. However, few studies focused on the predictive value of non-calcified plaque loading for adverse cardiovascular events in patients with unstable coronary heart disease (CHD). The present study was conducted to investigate the association of coronary non-calcified plaque loading based on CCTA and adverse cardiovascular events in patients with unstable CHD.MethodsA total of 206 patients with unstable CHD were collected and followed up for 1 year. The patients were divided into an observation group (n=56) and a control group (n=150) according to whether adverse cardiovascular events occurred or not. We analyzed the predictive value of coronary artery non-calcified plaque loading for adverse cardiovascular events in unstable CHD using receiver operating characteristic and multivariate logistics regression analysis.ResultsCompared with the control group, the non-calcified plaque volume in the observation group was increased (160.10±44.02 vs. 128.06±42.22 mm3, P=0.000); non-calcified plaque loading increased (26.93%±7.98% vs. 21.46%±7.62%, P=0.000); carotid intima-media thickness increased (1.49±0.17 vs. 1.40%±0.18 mm, P=0.001); and left ventricular ejection fraction (LVEF) was significantly reduced (53.28%±7.39% vs. 58.02%±7.91%, P=0.000). Non-calcified plaque volume and non-calcified plaque loading have certain diagnostic value for recurrence of adverse cardiovascular events within 1 year (P<0.05). A non-calcified plaque volume >145.58 mm3 is a risk factor for recurrence of adverse cardiovascular events (P<0.05).ConclusionsIncreased non-calcified plaque volume in patients with unstable CHD is associated with the development of adverse cardiovascular events in patients with unstable CHD.

Association of increased oncostatin M with adverse left ventricular remodeling in patients with myocardial infarction.

The study of laboratory biomarkers that reflect the development of adverse cardiovascular events in the postinfarction period is of current relevance. The aim of the present study was evaluation of oncostatin M (OSM) concentration changes in the early and late stages of myocardial infarction and evaluation of the possibility of its use in prediction of adverse left ventricular (LV) remodeling in patients with myocardial infarction with ST-elevated segment (STEMI). The study involved 31 patients with STEMI admitted in the first 24 hours after the onset of MI and 30 patients with chronic coronary artery disease as a control group. Echocardiographic study was performed on day 3 and in 6 months after STEMI. The serum levels of biomarkers were evaluated on the day of hospital admission and 6 months after MI using multiplex immunoassay. OSM level increased during the first 24 h after the onset of the disease, with the following decrease in 6 months. OSM concentration at admission had correlated with echocardiography parameters and Nt-proBNP, troponin I, CK-MB levels. Our study has demonstrated association of the increased levels of OSM at the early stages of STEMI with development of the adverse LV remodeling in 6 months after the event. Elevation of OSM levels in the first 24 h after STEMI is associated with the development of the adverse LV remodeling in the long-term post-infarction period.

Results of different kinds of carotid endarterectomy in patients with and without type 2 diabetes mellitus

BACKGROUND: Type 2 diabetes mellitus (DM) is one of the important markers for the development of adverse cardiovascular events after carotid endarterectomy (CEE). However, studies on this issue are based on small sample of patients and do not take into account the type of surgery as an additional factor of potentially negative impact on the course of the postoperative period.AIM: Analysis of hospital and long-term results of eversion and classical CEE with plastic surgery of the reconstruction zone with a biological patch in patients with type 2 diabetes and without it.MATERIALS AND METHODS: In this multicenter retrospective study from January 2010 to December 2020. included 5731 patients. Depending on the presence / absence of type 2 diabetes and the type of implemented CEE, 4 groups were formed: group 1 — 12.2% (n = 702) — patients with type 2 diabetes and eversion CEE; Group 2 — 55.0% (n = 3153) patients without type 2 diabetes and eversion CEE; Group 3 — 8.5% (n = 484) patients with type 2 diabetes and classical CEE; Group 4 — 24.3% (n = 1392) patients without type 2 diabetes and classical CEE. The duration of postoperative follow-up was 78.6 ± 39.2 months.RESULTS: At the long-term follow-up stage, patients with type 2 diabetes after the classical surgical technique demonstrated the highest rates of all types of complications: death (p &lt;0.0001), MI (p = 0.011), ischemic stroke (p &lt;0.0001), restenosis / occlusion of the ICA (p &lt;0.0001), combined end point (p &lt;0.0001). At the same time, the group of eversion CEE with impaired carbohydrate metabolism took the second position in terms of the prevalence of adverse events. These circumstances demonstrate that patch implantation is accompanied by an increased risk of developing not only myocardial infarction, but also restenosis of the reconstruction zone, as well as the associated ischemic stroke, which was demonstrated by our results.CONCLUSION: Patients with type 2 diabetes and a history of CEE are at increased risk of ischemic stroke at the hospital stage of observation and all unfavorable cardiovascular conditions (death, myocardial infarction, ischemic stroke, restenosis or ICA occlusion in the reconstruction zone) in the long-term postoperative period.

Oncostatin M is associated with adverse left ventricular remodeling in patients with ST-segment elevation myocardial infarction

Abstract Introduction The development of adverse left ventricular remodeling (LVR) after myocardial infarction (MI) remains a significant problem despite current achievements in invasive and pharmacological treatment. A large number of biomarkers are known that reflect various processes and pathophysiological mechanisms of the pathogenesis of MI and the development of adverse cardiovascular events in the post-infarction period. Oncostatin M (OSM) is a cytokine of the interleukin-6 family that is involved in the pathophysiology of cardiovascular diseases and takes part in processes of inflammation, tissue regeneration, cell development and growth. Purpose To assess the dynamics of serum levels of OSM and its association with the development of adverse left ventricular remodeling in the long-term post-infarction period in patients with acute primary myocardial infarction with ST-segment elevation (STEMI). Methods Subjects were 21 patients (59.2±8.1 y.o.) with STEMI, who underwent percutaneous coronary intervention during the first 24 h of the onset of MI. The serum level of OSM and echocardiography with 2D speckle tracking imaging were assessed at days 1 and 6 months after STEMI. The criterion of adverse LVR is an increased of end-diastolic (EDV) or/and end-systolic (ESV) volume more than 20% from admission to 6 month period. Results A significant increase of the serum levels of OSM during the first 24 hours of MI was detected [46.9 (18.9; 75.7)] pg/ml. A decrease of the OSM levels in 6 months after STEMI was revealed [13.1 (6.9; 19.6)] pg/ml (p&amp;lt;0.0005). Correlation analysis showed strong positive association between the values of OSM with Troponin I (R=0.797 p=0.0001) and Nt-proBNP (R=0,713 p=0.0013). The relationship between OSM and Troponin I persisted in the long-term post-infarction period (R=0.751, p=0.0005). An inverse correlation between the OSM, measured at admission to hospital and the left ventricular ejection fraction at day 7 after MI was found (R=−0.63, p=0.023). Logistic regression analysis showed that the values of OSM at day 1 of the MI were associated with development of adverse LVR in the long term after STEMI. OSM level of more than 18.4 pg/ml at a time of admission was associated with the increased of ESV in 6 months after STEMI by more than 20% (p&amp;lt;0.05). Conclusions Our study showed the serum levels of OSM statistically significantly decreased in 6 months after STEMI. The content of OSM was positive associated with Troponin I and Nt-proBNP. Elevated levels of OSM were associated with an increase of ESV in 6 months after STEMI. The serum levels of OSM can be used to predict of adverse remodeling in patients undergoing STEMI. Funding Acknowledgement Type of funding sources: Public Institution(s). Main funding source(s): Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Science

High Platelet Reactivity Despite Taking Adenosine Diphosphate Receptor Inhibitors: Do We Need to Care?

Platelet activation and aggregation play a key role in the development of adverse cardiovascular events after endovascular treatment of peripheral arterial disease (PAD). Adenosine diphosphate (ADP) receptor (P2Y12) inhibitors such as clopidogrel, prasugrel, and ticagrelor are used increasingly as single treatment or in conjunction with aspirin (dual antiplatelet therapy [DAPT]). However, the antiplatelet activity varies significantly among individuals, and firm evidence for use after peripheral endovascular procedures is lacking.

Prediction of Resthenosis After Carotid Endarterectomy by the Method of Computer Simulation

The article describes a computer modeling technique that allows predicting the development of restenosis of the internal carotid artery after carotid endarterectomy (CEE). A clinical case has been demonstrated that proves the effectiveness of the developed method. It is indicated that for the correct formation of the geometric model, data from multispiral computed tomography with angiography of the patient after CEE with a layer thickness of 0.6 mm and a current of 355 mA are required. To build a flow model, data of color duplex scanning in three sections are required: 1. In the proximal section of the common carotid artery (3 cm proximal to the bifurcation); 2. In the section of the external carotid artery, 2 cm distal to the carotid sinus; 3. In the section of the internal carotid artery, 2 cm distal to the carotid sinus. The result of computer calculations using specialized software (Sim Vascular, Python, Open Foam) is a mathematical model of blood flow in a vessel. It is an array of calculated data describing the speed and other characteristics of the flow at each point of the artery. Based on the analysis of RRT and TAWSS indicators, a computer model of bifurcation is formed, which makes it possible to predict areas of increased risk of restenosis development. Thus, the developed technique is able to identify a cohort of patients after CEE, subjected to a high probability of loss of the vessel lumen. Such an opportunity will provide a more precise supervision of these patients in the postoperative period with the aim of early diagnosis of restenosis and timely prevention of the development of adverse cardiovascular events.

Results of carotidal endarterectomy in different age group

Background. Carotid endarterectomy is an effective and safe operation aimed at treating patients with hemo-dynamically significant stenosis of the carotid arteries, the outcomes of which are well studied, and the permissible levels of postoperative complications are presented in the current recommendations. Nevertheless, the issues related to the incidence of cardiovascular accidents in different age groups of patients have not been sufficiently studied. Objective. Analysis of hospital outcomes of carotid endarterectomy in different age groups. Design and methods. The study included 1416 patients who were operated on for stenotic lesions of the internal carotid arteries. According to the WHO classification, patients were divided into groups depending on age: up to 44 years — young age (n = 76); 45-59 years old — average age (n = 291); 60-74 — old age (n = 835); over 75 years old — old age (n = 214). The compensatory capabilities of cerebral blood flow were assessed by invasive measurement of the retrograde pressure in the internal carotid artery. The endpoints were death, myocardial infarction, acute cerebrovascular accident, transient ischemic attack, hemorrhagic complications, cranial nerve damage, combined endpoint. Results. There were no significant differences in the incidence of all cardiovascular events. In the group of young patients, no lethal outcomes, myocardial infarction, acute cerebrovascular accident, or transient ischemic attack were recorded. All deaths were caused by the development of ischemic stroke as a result of distal embolization. In cases of non-fatal acute disorders of cerebral circulation, transient ischemic attacks in 1 patient of the 60-74 year group, the catastrophe developed against the background of thrombosis of the internal carotid arteries. In other 3 cases, on the background of the development of hyperperfusion syndrome. In 1 patient of the 60-74 year group, hemorrhagic transformation of the old ischemic focus with the development of intracerebral hematoma was recorded. There was also no significant intergroup difference in the incidence of hemorrhagic complications. The total number of all cardiovascular events in each group and the sample as a whole did not exceed one and a half percent, which corresponded to the standards described in the current recommendations. Conclusion. There was no statistically significant difference in the development of adverse cardiovascular events depending on the patient’s age.

Clinical significance and prospects of using ST2 in isсhemic heart failure patients

Objective: The objective of this study is to assess the role of soluble ST2 (sST2) in developing adverse cardiovascular events (ACE) and fatal outcomes in patients with chronic heart failure (HF) during 18 [12.5; 35.5]-month follow-up period.Results. Depending on the median of baseline sST2 levels, all patients were retrospectively divided into two groups: group 1 enrolled patients with sST2 levels &lt; 31.5 ng/mL (n = 22); and group 2 comprised patients with sST2 levels ≥ 31.5 ng/mL (n = 26). In group 1, the sST2 levels were 27.27 [23.94; 29.23] ng/mL, which was 33.9% higher (p &lt; 0.0000001) than in group 2 (41.28 [34.86; 50.17] ng/mL). ACEs were registered in 9 cases (40.9%) in group 1 and in 17 cases (65.4%) in group 2 (p = 0.025). Based on ROC-analysis, baseline ST2 levels ≥ 33.53 ng/mL were considered a biomarker to predict an unfavorable course of ischemic heart failure during 18 [12.5; 35.5] months of follow-up period with sensitivity of 78.9% and specificity of 62.2% (AUC 0.719; 95% CI 0.562–0.845; p = 0.0059).Conclusion. The baseline sST2 levels may be considered a non-invasive biomarker allowing to predict the development of adverse cardiovascular events (ACE) and fatal outcomes in patients with chronic heart failure (HF) during 18 [12.5; 35.5] months of follow-up in addition to traditional risk factors.

Incidence and Implications of Atrial Fibrillation/Flutter in Hypertension: Insights From the SPRINT Trial.

We evaluated the impact of intensive blood pressure control on the incidence of new-onset atrial fibrillation/flutter (AF) and the prognostic implications of preexisting and new-onset AF in SPRINT (Systolic Blood Pressure Intervention Trial) participants. New-onset AF was defined as occurrence of AF in 12-lead electrocardiograms after randomization in participants free of AF at baseline. Poisson regression modeling was used to calculate incident rates of new-onset AF. Multivariable-adjusted Cox proportional hazard models were used to evaluate the risk of adverse cardiovascular events (composite of myocardial infarction, non-myocardial infarction acute coronary syndrome, stroke, heart failure, or cardiovascular death). In 9327 participants, 8.45% had preexisting AF, and 1.65% had new-onset AF. The incidence of new-onset AF was 4.53 per 1000-person years, with similar rates in the standard and intensive treatment arms (4.95 versus 4.11 per 1000-person years; adjusted P=0.14). Participants with preexisting AF (adjusted hazard ratio, 1.83 [95% CI, 1.46-2.31]; P<0.001) and new-onset AF (adjusted hazard ratio, 2.45 [95% CI, 1.58-3.80]; P<0.001) had a greater risk for development of adverse cardiovascular events compared with those with no AF. Participants with preexisting AF who achieved blood pressure <120/80 mm Hg at 3 months continued have a poor prognosis (adjusted hazard ratio, 1.88 [95% CI, 1.32-2.70]; P=0.001) compared with those with no AF. Intensive blood pressure control does not diminish the incidence of new-onset AF in an older, high-risk, nondiabetic population. Both preexisting and new-onset AF have adverse prognostic implications. In participants with preexisting AF, residual cardiovascular risk is evident even with on-treatment blood pressure <120/80 mm Hg. Registration- URL: https://www.clinicaltrials.gov; Unique identifier: NCT01206062.

Detección temprana de la falla cardiaca en pacientes diabéticos: Más allá de la fracción de eyección

Heart failure is one of the main causes of death in diabetic patients. The left ventricular ejection fraction compromise is delayed. The assessment of other parameters of myocardial dysfunction, like the longitudinal deformation of the left ventricle, diastolic function, and left atrial function, can help in the timely identification of myocardial compromise. This allows the necessary measures to be adopted in order to reduce the development of adverse cardiovascular events in this population group.

Клінічний прогноз упродовж 12 місяців та його предиктори в пацієнтів із хронічною серцевою недостатністю і зниженою фракцією викиду лівого шлуночка

Мета роботи – встановити клініко-інструментальні параметри, які асоціюються з розвитком несприятливих серцево-судинних подій (смерть або госпіталізація) у пацієнтів із хронічною серцевою недостатністю (ХСН) і фракцією викиду лівого шлуночка ≤ 35 % при спостереженні упродовж 12 місяців, та визначити їх граничні значення.Матеріали і методи. Обстежено 120 гемодинамічно стабільних пацієнтів віком 18–75 років із ХСН, II–IV функціональних класів за NYHA, з фракцією викиду лівого шлуночка ≤ 35 %. Пацієнтів залучали в дослідження у фазу клінічної компенсації. Кінцева точка була комбінованою і визначалася як час до першої госпіталізації у зв’язку з декомпенсацією ХСН або смерті. Період спостереження становив 12 міс, середній час до настання комбінованої критичної події – 8,67 міс. Пошук граничних значень предикторів було здійснено за допомогою кластерного аналізу за двома змінними.Результати та обговорення. За результатами кластерного аналізу, інформативними предикторами досягнення комбінованої кінцевої точки пацієнтами із ХСН протягом 12 міс є кількість втрачених кілограмів за останні 6 міс &gt; 4,5 кг або втрата маси тіла &gt; 6,03 %, окружність плеча ненапруженої руки ≤ 32,5 см, напруженої руки ≤ 35 см, стегна ≤ 50 см, товщина шкірно-жирової складки над трицепсом ≤ 24 мм та в паховій ділянці ≤ 8,5 мм, відсоток жирової маси тіла ≤ 16,7 %, індекс м’язової маси кінцівок ≤ 8,96 кг/м2, індекс маси тіла ≤ 31,2 кг/м2, рівень С-реактивного білка &gt; 4,52 мг/мл, вміст холестерину крові ≤ 4,5 ммоль/л, показник потокозалежної вазодилатації ≤ 9,09 %, показник систолічної екскурсії площини трикуспідального кільця (TAPSE) ≤ 11 мм та відношення TAPSE до рівня систолічного тиску в легеневій артерії ≤ 0,27, сума балів за Міннесотським опитувальником &gt; 61 бала, за шкалою DEFS &gt; 22 бали, за анкетою Університету Дюка ≤ 8,575 бала, дистанція тесту із 6-хвилинною ходьбою ≤ 255 м та показник тесту з розгинанням нижньої кінцівки ≤ 22.Висновки. Результати вимірювання антропометричних показників, що відображають стан нутритивного статусу пацієнтів із ХСН, мають перевагу над результатами денситометричного визначення тканинних складових тіла у стратифікації їх довготермінового клінічного ризику.

Impact of DAA-Based Regimens on HCV-Related Extra-Hepatic Damage: A Narrative Review.

Two-third of patients with chronic hepatitis C show extrahepatic manifestations due to HCV infection of B lymphocytes, such as mixed cryoglobulinemia and non-Hodgkin B-cell lymphoma, or develop a chronic inflammatory status that may favor the development of adverse cardiovascular events, kidney diseases or metabolic abnormalities.DAAs treatments induce HCV eradication in 95% of treated patients, which also improves the clinical course of extrahepatic manifestations, but with some limitations. After HCV eradication a good compensation of T2DM has been observed, but doubts persist about the possibility of obtaining a stable reduction in fasting glucose and HbA1c levels.Chronic HCV infection is associated with low total and LDL cholesterol serum levels, which however increase significantly after HCV elimination, possibly due to the disruption of HCV/lipid metabolism interaction. Despite this adverse effect, HCV eradication exerts a favorable action on cardiovascular system, possibly by eliminating numerous other harmful effects exerted by HCV on this system.DAA treatment is also indicated for the treatment of patients with mixed cryoglobulinemia syndrome, since HCV eradication results in symptom reduction and, in particular, is effective in cryoglobulinemic vasculitis. Furthermore, HCV eradication exerts a favorable action on HCV-related lymphoproliferative disorders, with frequent remission or reduction of clinical manifestations.There is also evidence that HCV clearance may improve impaired renal functions, but same conflicting data persist on the effect of some DAAs on eGFR.

Предиктори довгострокового клінічного прогнозу в пацієнтів з хронічною серцевою недостатністю та зниженою фракцією викиду лівого шлуночка

Мета роботи – визначити прогностичні фактори розвитку несприятливих серцево-судинних подій (смерті та госпіталізації) у пацієнтів із хронічною серцевою недостатністю (ХСН) та фракцією викиду лівого шлуночка (ФВЛШ) ≤ 35 % при довгостроковому спостереженні.Матеріали і методи. Обстежено 120 гемодинамічно стабільних пацієнтів з ХСН, віком 18–75 років, II–IV функціональних класів за NYHA, з ФВЛШ ≤ 35 %. За допомогою множинної логістичної регресії за методом Кокса аналізували незалежні фактори, що впливають на довгостроковий прогноз пацієнтів із ХСН. Результати та обговорення. За період спостереження із 120 обстежуваних 61 пацієнт досяг комбінованої критичної точки (ККТ). В уніваріантній регресійній моделі предикторами досягнення ККТ виявилися функціональний клас за NYHA, втрата маси тіла за останні 6 місяців ≥ 6 %, систолічний і діастолічний артеріальний тиск, наявність у пацієнта інфаркту міокарда в анамнезі та стенокардії, анемія, кількість госпіталізацій за останній рік та параметри, що відображають функціональний стан пацієнта (дистанція 6-хвилинної ходьби, кількість розгинань нижньої кінцівки). Ризик розвитку ККТ статистично значуще вищий у пацієнтів із меншими значеннями індексу маси тіла, окружності плеча напруженої та ненапруженої руки, стегна, товщини шкірно-жирової складки над біцепсом і трицепсом, розрахункової частки жирової маси тіла. Предикторами досягнення ККТ є вищі рівні сечової кислоти і С-реактивного білка. Ехокардіографічними предикторами настання ККТ виявилися ФВЛШ, розмір лівого передсердя, показник TAPSE, а також його співвідношення до систолічного тиску в легеневій артерії, індекс кінцеводіастолічного тиску в лівому шлуночку. Також ризик досягнення ККТ є більшим при менших значеннях показника потокозалежної вазодилатації плечової артерії (ПЗВД ПА). Незалежними предикторами настання ККТ виявилися окружність плеча ненапруженої руки, рівень С-реактивного білка у крові і показник ПЗВД ПА. При аналізі показників у 77 пацієнтів, яким була проведена денситометрія, виявлено, що на досягнення ККТ впливають показник Е/E´, індекс м’язової тканини кінцівок, індекс жирової маси і відношення жирової маси до зросту. При мультиваріантному аналізі з урахуванням показників денситометрії незалежними предикторами настання ККТ виявилися розмір лівого передсердя, індекс м’язової маси кінцівок, показник ПЗВД ПА і наявність інфаркту міокарда в анамнезі.Висновки. Незалежними предикторами досягнення ККТ пацієнтами з ХСН і ФВЛШ ≤ 35 % є наявність інфаркту міокарда в анамнезі, менші показники окружності плеча ненапруженої руки, індексу м’язової маси кінцівок, потокозалежної вазодилататорної відповіді, вищі рівні С-реактивного білка, розміри лівого передсердя.