Incidence Of Cardiovascular Complications Research Articles

Targeted treatment reverses increased left cardiac work in unilateral versus bilateral primary aldosteronism.

The incidence of cardiovascular complications may be higher in unilateral than in bilateral primary aldosteronism (PA). We compared non-invasive hemodynamics before and after targeted therapy of bilateral versus unilateral PA. Adrenal vein sampling was performed, and cardiovascular variables were recorded using radial artery pulse wave analysis and whole-body impedance cardiography (n=114). In a subset of 40 patients (adrenalectomy n=20, spironolactone-based treatment n=20), hemodynamic recordings were again performed after 33 months of targeted PA treatment. In initial cross-sectional analysis, 51 patients had bilateral and 63 had unilateral PA. The mean ages were 50.6 and 54.3 years (p=0.081), and body mass indexes were 30.3 and 30.6kg/m2 (p=0.724), respectively. Aortic blood pressure and cardiac output did not significantly differ between the groups, but evaluated left cardiac work was ~10% higher in unilateral PA (p=0.022). In the followup study, initial and final blood pressure levels in the aorta were not significantly different, while initial cardiac output (+13%, p=0.015) and left cardiac work (+17%, p=0.009) were higher in unilateral than in bilateral PA. After a median treatment time of 33 months, the differences in cardiac load were abolished, and extracellular water volume was reduced by 1.3 and 1.4 liters in bilateral versus unilateral PA, respectively (p=0.814). These results suggest that unilateral PA burdens the heart more than bilateral PA, providing a possible explanation for the higher incidence of cardiac complications in unilateral disease. A similar reduction in aldosterone-induced volume excess was obtained with targeted surgical and medical treatment of PA.

Targeted treatment reverses increased left cardiac work in unilateral versus bilateral primary aldosteronism.

The incidence of cardiovascular complications may be higher in unilateral than in bilateral primary aldosteronism (PA). We compared non-invasive hemodynamics before and after targeted therapy of bilateral versus unilateral PA. Adrenal vein sampling was performed, and cardiovascular variables were recorded using radial artery pulse wave analysis and whole-body impedance cardiography (n=114). In a subset of 40 patients (adrenalectomy n=20, spironolactone-based treatment n=20), hemodynamic recordings were again performed after 33 months of targeted PA treatment. In initial cross-sectional analysis, 51 patients had bilateral and 63 had unilateral PA. The mean ages were 50.6 and 54.3 years (p=0.081), and body mass indexes were 30.3 and 30.6kg/m2 (p=0.724), respectively. Aortic blood pressure and cardiac output did not significantly differ between the groups, but evaluated left cardiac work was ~10% higher in unilateral PA (p=0.022). In the followup study, initial and final blood pressure levels in the aorta were not significantly different, while initial cardiac output (+13%, p=0.015) and left cardiac work (+17%, p=0.009) were higher in unilateral than in bilateral PA. After a median treatment time of 33 months, the differences in cardiac load were abolished, and extracellular water volume was reduced by 1.3 and 1.4 liters in bilateral versus unilateral PA, respectively (p=0.814). These results suggest that unilateral PA burdens the heart more than bilateral PA, providing a possible explanation for the higher incidence of cardiac complications in unilateral disease. A similar reduction in aldosterone-induced volume excess was obtained with targeted surgical and medical treatment of PA.

ACUTE MYOCARDIAL INFARCTION DURING VRD CHEMOTHERAPY IN A PATIENT WITH MULTIPLE MYELOMA: A CLINICAL CASE

Acute myocardial infarction is a critical condition associated with significant morbidity and mortality rates. Myocardial infarction-related acute myocardial injury is characterized by a rapid elevation and subsequent decline in cardiac troponin concentration. According to the relevant data patients with multiple myeloma are in a high-risk category for venous and arterial thrombosis. Therefore, the incidence of cardiovascular complications, which include myocardial infarction, in these patients is higher than in the general population. The development of metaplastic anemia further compounds this risk by diminishing myocardial oxygen supply. Moreover, chemotherapy for oncohematological diseases carries the potential for cardiotoxic cardiovascular complications. Immunomodulator drugs like Thalidomide and Lenalidomide, frequently utilized in multiple myeloma treatment, have been associated with Lenalidomide-induced myocardial infarction—a prevalent adverse effect. The use of proteasome inhibitors such as Bortezomib and Carfilzomib poses an increased risk for myocardial infarction development. This clinical case presents an instance of acute myocardial infarction in a multiple myeloma patient during low cumulative chemotherapy dosage, comprising Lenalidomide and Bortezomib. It underscores the necessity for enhanced clinical, instrumental, and laboratory monitoring before each specific chemotherapy course in high-risk multiple myeloma patients. Such monitoring facilitates the early detection of chemotherapy-induced cardiotoxic effects, allowing for timely intervention and management.

Dynamics of modified cardiovascular risk factors in patients with rheumatoid arthritis on the background of 5-year therapy with an interleukin 6 receptor inhibitor

The effect of an inhibitor of interleukin (IL) 6 receptors on the state of the cardiovascular system in patients with rheumatoid arthritis (RA) remains poorly understood, especially with its long-term use.The aim – to study the effect of therapy with the IL-6 receptor inhibitor tocilizumab (TCZ) on the dynamics of modifiable risk factors (RF), total cardiovascular risk (CVR), structural changes in the carotid arteries (CA) and the incidence of cardiovascular complications (CVC) in patients with rheumatoid arthritis during the 260-week follow-up period.Material and methods. The study included 37 patients with active RA (32 women and 5 men) with ineffectiveness and/or intolerance to disease modifying anti-rheumatic drugs (DMARDs); median age was 56 [48; 68] years, disease duration was 92 [49; 158] months; DAS28 (Disease Activity Score 28) – 6.2 [5.5; 6.7] points; all patients were seropositive for rheumatoid factor (RF), 86% – for antibodies to cyclic citrullinated peptide (ACCP). Patients received TCZ therapy 8 mg/kg intravenously every 4 weeks; after 192 [176; 210] weeks, 60% of patients switched to subcutaneous administration of the drug at a dose of 162 mg once a week. In 51% of patients with RA, TCZ monotherapy was performed, in 49% – combination therapy of TCZ with DMARDs. Statins were received by 17 (46%) patients, including 7 patients before and 10 after inclusion in the study. All patients underwent an assessment of traditional risk factors, the total cardiovascular risk was calculated using the mSCORE scale, atherosclerotic vascular lesions were assessed by the detection of atherosclerotic plaques (ASP) of CA. The observation period was 260.4 [251.5; 283.4] weeks.Results. After 260 weeks of TCZ therapy, RA remission was observed in 32 (86%) patients, low activity – in 5 (14%) patients. During the observation period, the frequency of modified RF and the total CVR did not change significantly, an increase in body mass index (BMI) by 11% was recorded, the number of patients with hypercholesterolemia and a reduced level of HDL cholesterol (C) decreased. In patients without statin therapy, there were no significant changes in the blood lipid spectrum. In the group of patients receiving statins, there was an increase in HDL-C by 43%, a decrease in cholesterol levels by 15%, atherogenic index (AI) by 56% (p<0.01 in all cases) and associations between the dynamics of ∆cholesterol and ∆CRP (r=0.35; p=0.04), ∆LDL-C and ∆CRP (r=0.41; p=0.03). Significant structural changes in CA in RA patients by the end of 260 weeks of TCZ therapy were not identified. Initially, intima-media thickness (IMT) CA positively moderately correlated with age (r=0.7; p<0.01), BMI (r=0.37; p<0.01), systolic blood pressure (SBP) (r=0.62; p<0.01) and weakly with lipid spectrum parameters – cholesterol (r=0.29; p<0.01), LDL-C (r=0.36; p<0.01). No new associations of IMT CA by the end of the observation, as well as the relationship of the IMT CA value with the indicators of RA activity and the ongoing therapy, were identified. By the end of the study, the distribution of patients by mSCORE value and CVR level did not change significantly. The incidence of CVC was 0,54 per 100 patient-years over a 260-week period of TCZ use. Conclusion. Against the background of long-term TCZ therapy in RA patients, there was no increase in CVR and significant structural changes in CA. It is necessary to dynamically monitor the blood lipid profile and CVR in RA patients receiving TCZ therapy. Statin therapy can successfully control dyslipidemia in RA patients who receive long-term TCZ.

Application of Electrolyzed Hydrogen Water for Management of Chronic Kidney Disease and Dialysis Treatment-Perspective View.

Chronic kidney disease (CKD), which is globally on the rise, has become an urgent challenge from the perspective of public health, given its risk factors such as end-stage renal failure, cardiovascular diseases, and infections. The pathophysiology of CKD, including dialysis patients, is deeply associated with enhanced oxidative stress in both the kidneys and the entire body. Therefore, the introduction of a safe and widely applicable antioxidant therapy is expected as a measure against CKD. Electrolyzed hydrogen water (EHW) generated through the electrolysis of water has been confirmed to possess chemical antioxidant capabilities. In Japan, devices producing this water have become popular for household drinking water. In CKD model experiments conducted to date, drinking EHW has been shown to suppress the progression of kidney damage related to hypertension. Furthermore, clinical studies have reported that systemic oxidative stress in patients undergoing dialysis treatment using EHW is suppressed, leading to a reduction in the incidence of cardiovascular complications. In the future, considering EHW as one of the comprehensive measures against CKD holds significant importance. The medical utility of EHW is believed to be substantial, and further investigation is warranted.

Cardiovascular Complications in Pheochromocytoma and Paraganglioma: Does Phenotype Matter?

Adrenaline-producing tumors are mostly characterized by a sudden release of catecholamines with episodic symptoms. Noradrenergic ones are usually less symptomatic and characterized by a continuous overproduction of catecholamines that are released into the bloodstream. Their effects on the cardiovascular system can thus be different. The aim of this study was to determine the prevalence of cardiovascular complications by catecholamine phenotype. We retrospectively analyzed data on the prevalence of cardiovascular events in 341 consecutive patients with pheochromocytoma and paraganglioma treated from 1995 to 2023. Biochemical catecholamine phenotype was determined based on plasma or urinary catecholamines and metanephrines. According to the phenotype, 153 patients had noradrenergic pheochromocytoma and paraganglioma and 188 had adrenergic pheochromocytoma and paraganglioma. In the whole sample, the incidence of serious cardiovascular complications was 28% (95 patients), with no difference between the phenotypes or sexes. The noradrenergic phenotype had significantly more atherosclerotic complications (composite end point of type 1 myocardial infarction and symptomatic peripheral artery disease; odds ratio, 3.58 [95% CI, 1.59-8.83]; P=0.003), while the adrenergic phenotype more often had type 2 myocardial infarction and takotsubo-like cardiomyopathy (OR, 0.24 [95% CI, 0.09-0.57]; P=0.002). These changes remained even after adjustment for conventional risk factors of atherosclerosis. We found a 28% incidence of cardiovascular complications in a consecutive group of patients with pheochromocytoma and paraganglioma. Patients presenting with a noradrenergic phenotype have a higher incidence of atherosclerotic complications, while the adrenergic phenotype is associated with a higher incidence of acute myocardial damage due to takotsubo-like cardiomyopathy.

Comparative Study of Hypertension With Increasing Age of Elderly Postmenopausal Punjabi Women With Cardiovascular Disease: A Cross-sectional Study

Background: The incidence of cardiovascular complications may increase after menopause. Hypertension (HTN) is one of the most remarkable causes leading to heart disease. The increased prevalence of HTN is associated with aging, causing adverse cardiovascular events in postmenopausal elderly women. Objectives: The present study aimed to compare HTN with the increasing age of elderly postmenopausal women with cardiovascular disease (CVD) and then to find an association between estradiol (E2) levels and the increased prevalence of HTN in these women. Methods: The present cross-sectional study recruited 265 cases of menopausal women suffering from CVD and 258 controls as menopausal women not suffering from CVD. Serum E2 and serum follicle-stimulating hormone (FSH) were estimated by enzyme-linked immunosorbent assay kits. HTN was assessed in accordance with the guidelines of the Joint National Committee (VII) of high blood pressure. Anthropometric measurements such as weight, height, hip circumference, waist circumference (WC), waist-hip ratio, and body mass index (BMI) for all menopausal women were recorded according to the World Health Organization (WHO) (WHO) 2000 protocol. Results: Overall, cases of>45.1 years of the menopausal age group conferred more risk toward CVD as compared to cases of≤45 years of the menopausal age group. A significant positive correlation (P<0.05) was detected for E2 with HTN and obesity profile with increasing age at menopause. Conclusion: High prevalence of HTN irrespective of the early onset of menopause is one of the crucial risk factors for CVD. Our findings revealed a significant positive correlation of HTN with age at menopause>45.1 years, along with increased levels of E2. Women in this age group were observed to be obese.

Cardiovascular complications of respiratory viral infections

Despite significant progress in understanding the pathogenesis and treatment of viral diseases, the influenza virus alone causes up to three to five million severe cases and 250-500 thousand deaths annually. However, respiratory viruses can affect not only the respiratory system, but also cause complications in the cardiovascular system. For example, acute coronary syndrome, myocarditis, pericarditis, exacerbation of chronic heart failure, acute heart failure, pulmonary embolism, and arrhythmias. This review provides information on the incidence of cardiovascular complications that occurred in association with acute respiratory viral infections (COVID-19, influenza, respiratory syncytial virus infection, adenovirus, and rhinovirus infections), and the mechanisms of respiratory virus impact on the cardiovascular system. Understanding these mechanisms may allow to predict the potential cardiovascular complications in patients with respiratory infections and take prompt measures to prevent them as soon as possible especially in case of life-threatening events.

Predictors of Long-Term Outcomes after Surgical Myocardial Revascularization

High mortality from cardiovascular diseases (CVD) requires improved approaches to the treatment of this socially significant pathology. Wide implementation of surgical myocardial revascularization makes it possible to improve significantly both life quality and expectancy in patients with coronary heart disease. The aim of this work was to analyze the literature on the impact of preoperative, operative and postoperative factors on the long-term prognosis after coronary artery bypass grafting (CABG). The review refers to both recent and earlier informative works. The target groups for this article are therapists, cardiologists, rehabilitologists, who work with patients in the short and long term after CABG. Data of Russian and foreign literature show that the long-term prognosis after CABG is largely determined by preoperative factors, in particular – age, set of cardiovascular risk factors (RF) and comorbidity, specifically – severity of coronary and systemic atherosclerosis, incident cardiovascular complications, structural and functional state of the heart. In the aggregate these factors reflect the cumulative effect and further potential of actual cardiovascular RFs, affect longterm risk of adverse events, and determine the therapeutic targets of secondary prevention. Priority of arterial conduits and completeness of revascularization are the main operative factors that determine the course of the long-term period after CABG. Among the postoperative factors, the efficiency of secondary CVD prevention is of paramount importance, in particular – achievement of target RF levels, compensation of cardiac and extracardiac pathology, adherence to the long-term medical therapy, known to improve outcomes based on specific comorbidity. Efficiency of secondary CVD prevention largely depends on patient's health attitudes, the key influence on which beyond attending physician can be provided by participation in rehabilitation programs, teaching patients the meaning and essentials of lifestyle modification and cardiovascular RFs’ control.

Impact of Daily Step Count on Diabetes Management and Complications Among Elderly Individuals - Jiangsu Province, China, 2020-2022.

Current literature underscores the significance of appropriate physical activity in managing diabetes, primarily utilizing self-reported data. Yet, the impact of objectively measured physical activity in older diabetic populations remains unclear. Our research on elderly diabetic patients indicated a correlation between an increased number of daily steps and improved metabolic profiles, as well as a decrease in the incidence of cardiovascular complications. Elevated daily step counts may confer significant benefits to elderly individuals with diabetes. The use of devices to monitor these steps could serve as a potent cardiovascular marker, and hold great potential as a screening or intervention tool in community-oriented settings.

STUDY OF CLINICAL OUTCOME AND CARDIOVASCULAR SEQUELAE IN COVID-19 PATIENTS

Cardiovascular complications in COVID-19 include deep vein thrombosis, stroke, angina, myocardial infarction, heart failure and cardiogenic shock.ECG changes including sinus tachycardia, sinus bradycardia and atrial brillation . Incidence of cardiovascular complications is directly linked to severity of disease which in turn correlate with inammatory markers including CRP, LDH, Ferritin, D Dimer and IL-6. Raised Inammatory markers also suggest poor outcome of patients. Therefore it is advisable to do inammatory markers in admitted patients for management. Followup study at 3 and 6 months revealed new onset cardiovascular complications while no new complications were documented at 12months follow up.Thus regular health checkup is recommended post COVID infections for atleast 6months.

Kawasaki disease following SARS-CoV-2 infection: Stronger inflammation with no increase in cardiac complications.

Herein we investigate the difference between Kawasaki disease (KD) with and without a recent history of SARS-CoV-2 infection. We compared the clinical characteristics of patients with KD during the SARS-CoV-2 pandemic in a single children's hospital in Korea. Fifty-two patients were enrolled and divided into group 1 (with a history of COVID-19, n = 26) and group 2 (without a history of COVID-19, n = 26) according to whether or not they contracted COVID-19 within the 8 weeks before hospitalization. Data, including clinical features and laboratory results, were analyzed and compared between groups. The median age of patients was significantly higher in group 1 than in group 2 (53 months [IQR, 24-81] vs. 15 months [IQR, 6-33], p = 0.001). The incidence of cervical lymphadenopathy was significantly higher (p = 0.017), while that of BCGitis was significantly lower in group 1 (p = 0.023), and patients had a significantly longer hospital stay (5 days [IQR, 3-8] vs. 3 days [IQR, 3-4], p = 0.008). In group 1, platelet count was significantly lower (p = 0.006), and hemoglobin and ferritin levels were significantly higher (p = 0.013 and p = 0.001, respectively) on the first admission day. Following treatment with intravenous immunoglobulin (IVIG), the platelet count was significantly lower (p = 0.015), and the percentage of neutrophils and neutrophil-to-lymphocyte ratio were significantly higher in group 1 (p = 0.037 and p = 0.012). Although there was no statistical difference, patients requiring infliximab treatment due to prolonged fever was only in group 1. The incidence of cardiovascular complications did not differ between the groups. Post-COVID KD showed a stronger inflammatory response than KD-alone, with no differences in cardiac complications.

Inhibition of YAP by lenvatinib in endothelial cells increases blood pressure through ferroptosis

Lenvatinib, a multitarget tyrosine kinase inhibitor (TKI), increases the incidence of severe hypertension and thus the incidence of cardiovascular complications. Inhibition of ferroptosis, a newly recognized type of cell death, alleviates endothelial dysfunction. Here, we report that lenvatinib-induced hypertension is associated with ferroptosis of endothelial cells. RNA sequencing (RNA-seq) showed that lenvatinib led to ferroptosis of endothelial cells and that administration of mouse with ferrostatin-1 (Fer-1), a specific ferroptosis inhibitor, dramatically ameliorated lenvatinib-induced hypertension and reversed lenvatinib-induced impairment of endothelium-dependent relaxation (EDR). Furthermore, lenvatinib significantly reduced glutathione peroxidase 4 (GPX4) expressions in the mouse aorta and human umbilical vein endothelial cells (HUVECs) and increased lipid peroxidation, lactate dehydrogenase (LDH) release, and malondialdehyde (MDA) levels in HUVECs. Immunofluorescence and Western blotting showed that lenvatinib significantly reduced Yes-associated protein (YAP) nuclear translocation but not cytoplasmic YAP expression in HUVECs. The data, generated from both in vivo and in vitro, showed that lenvatinib reduced total YAP (t-YAP) expression and increased the phosphorylation of YAP at both Ser127 and Ser397, without affecting YAP mRNA levels in HUVECs. XMU-MP-1 mediated YAP activation or YAP overexpression effectively attenuated the lenvatinib-induced decrease in GPX4 expression and increases in LDH release and MDA levels. In addition, overexpression of YAP in HUVECs ameliorated lenvatinib-induced decrease in the mRNA and protein levels of spermidine/spermine N (1)-acetyltransferase-1 (SAT1), heme oxygenase-1 (HO-1), and ferritin heavy chain 1 (FTH1). Taken together, our data suggest that lenvatinib-induced inhibition of YAP led to ferroptosis of endothelial cells and subsequently resulted in vascular dysfunction and hypertension.

Effect of performing preoperative echocardiography in patients with cardiovascular risk on intraoperative anesthetic management and postoperative outcomes: A retrospective study.

Although echocardiography is widely used for preoperative cardiac risk evaluation, few studies have analyzed the effect of performing preoperative echocardiography on intraoperative anesthetic management and postoperative outcomes. We investigated the effect of performing echocardiography on intraoperative anesthetic management and postoperative outcomes in patients with cardiovascular risk. We retrospectively evaluated patients who had undergone major abdominal surgery and satisfied 2 or more of the following criteria: hypertension, diabetes mellitus, age ≥70 years, and previous cardiac disease. Patients were categorized into a group in which preoperative echocardiography was performed (echo) and a group in which it was not (non-echo). The primary outcomes were postoperative 30-day mortality and incidence of cardiovascular complications. Secondary outcomes were length of hospital stay, intraoperative incidence of hypotension, use of vasopressors, and findings on intraoperative invasive hemodynamic monitoring. There were no differences in 30-day mortality, incidence of postoperative cardiovascular complications, length of hospital stay, and intraoperative events between the groups. Only the incidence of cardiac output monitoring was lower in the echo group than in the non-echo group (59.6% vs 73.9%). Preoperative echocardiography does not affect postoperative outcomes, but it has the potential to affect intraoperative anesthetic management such as invasive hemodynamic monitoring during surgery.

CHRONOTHERAPY – NEW POSSIBILITIES FOR OPTIMIZING TREATMENT OF PATIENTS WITH ARTERIAL HYPERTENSION

The article is devoted to the topical issues of the chronotherapeutic approach in the treatment of patients with hypertension (AH). Based on the review of the modern scientific sources, the data about the potential of chronotherapy as a variant of the patient-oriented approach in the treatment of AH, which can positively influence both the efficiency of hypotensive therapy and the incidence of cardiovascular complications.
 Taking into account the prognostic significance of nocturnal blood pressure (BP) values, the interest in chronotherapeutic approach to prescription of hypotensive drugs in the treatment of AH has increased. Determination of the role of nocturnal BP changes as a predictor of overall cardiovascular mortality, myocardial infarction and stroke allowed to change the view on the existing traditional treatment regimen. In particular, the results of several studies have demonstrated a significant advantage of using antihypertensive drugs at night compared to the usual practice of taking all such drugs after awakening, both in terms of improving BP control and reducing the risk of cardiovascular complications and mortality.

Inclisiran - a new era in lipid-lowering therapy

Inclisiran is a novel hypolipidemic drug that inhibits synthesis of the PCSK9 protein through the process called RNA interference. Inclisiran is a double-stranded, modified RNA bound to the N-acetylgalactosamine (GalNAc) carbohydrate molecule, a ligand of the acialoglycoprotein receptor, that is expressed by hepatocytes. After entering hepatocytes, inclisiran cleaves matrix RNA and, thereby, reduces the PCSK9 protein synthesis. This, in turn, enhances the uptake of circulating low-density lipoproteins (LDL) by specific receptors on hepatocytes, thereby lowering LDL levels in circulation. Efficacy and safety of inclisiran for lowering LDL cholesterol (C) in blood and its effect on the risk of clinical complications of atherosclerosis have been studied in the ORION program that includes multiple clinical trials. According to results of this program, inclisiran effectively reduces both LDL-C levels and the incidence of cardiovascular complications in the absence of clinically significant adverse reactions. An important advantage of inclisiran compared with other lipid-lowering drugs is the administration schedule (twice a year), which allows a considerable improvement of patients' compliance with the treatment and also of the effectiveness of the hypolipidemic treatment.

IDF21-0231 Effect of multidisciplinary for improves diabetes outcomes: Diabetes Education, Awareness and Lifestyle modification

Background: There is a global pandemic of type2 diabetes mellitus (T2DM), mainly in Asia. Thailand has a prevalence of T2DM at 9.6%, which is higher than the world average of 8.9%. Multiple studies have shown that multidisciplinary, team-based, coordinated care has been associated with improved measures of quality care and reduced healthcare utilization. Patients with poor glycemic control and nephropathy are at the highest risk of developing cardiovascular complications and renal failure. Aim: In this study, we aimed to explore the impact of intensive multidisciplinary diabetes mellitus care with patient empowerment versus routine clinical care on the rate of progression of micro and macro vascular complications and peripheral atherosclerotic burden, as measured by change in arterial blood Index (ABI) in patients with persistently elevated HbA1c and nephropathy. Method: The study is randomized controlled trial (RCT) of intensive diabetes mellitus care with patient empowerment versus routine clinical care. Patient in the intensive arm will receive care from a multidisciplinary team consisting of an endocrinologist, diabetes nurse educator, dietitian, renal pharmacist and social worker for counseling. In addition, patients will be provided with tools for self-care empowerment such as glucometers, blood pressure monitors and calendar record to facilitate care, monitoring and education. Patients in the routine clinical care will receive standard clinical care. Follow up (FU) will be 2 years. Primary outcomes include cardiovascular events, rate of progression of nephropathy and development of end-stage renal disease. Secondary endpoints include the proportions of patients with documented improved control of cardiovascular risk factors (HbA1c, blood pressure, low density lipoprotein-(LDL-C), reduction in body weight), frequency of hypoglycemia, hospitalization days and change in ABI. We will also examine the prevalence of peripheral atherosclerosis and the predictive value and usability of lower extremity arterial ultrasound to predict cardio-cerebrovascular events, amputation and peripheral intervention. Results: The cumulative incidence of all events (DM-related complications and all-cause mortality) was 21.2% in the Trial-DM group and 40.6% in the usual care group. Trail-DM led to significantly greater reductions in cardiovascular disease (CVD) risk by 52.6% (95% CI 50.5, 54.6), micro vascular complications by 10.9% (95% CI 6.8, 14.6), mortality by 65.1% (95% CI 61.3, 62.9), specialist attendance by 31.0% (95% CI 30.6, 32.4), emergency attendance by 39.2% (95% CI 36.8, 40.5), and hospitalizations by 53.5% (95% CI 53.2, 56.7). Patients with low baseline CVD risks benefitted the most from Trail-DM, which decreased CVD and mortality risk by 58.4% (95% CI 50.8, 64.5) and 79.6% (95% CI 72.3, 81.0), respectively. Discussion: Diabetes mellitus carries significant health care cost. Patients with poorly glycemic control and nephropathy are at highest risk of developing cardiovascular complications and renal failure. Intensive diabetes mellitus care with patient empowerment may lead to sustained glycemic control, reduction of clinical complications and progression of nephropathy, and incidence of cardiovascular complications.

Cardiovascular Complications of Hospitalized Patients With Coronavirus Disease 2019 in a Japanese Registry in 2020.

Cardiovascular complications of coronavirus disease 2019 (COVID-19) are critical for prognosis but have not been elucidated in Japan.Methods and Results:The COVID-19 Registry Japan, which included data from 19,853 individuals at the end of 2020, was analyzed. The incidences of cardiovascular complications were 0.098% for myocarditis/pericarditis/cardiomyopathy, 0.48% for ventricular tachycardia/fibrillation, 0.17% for myocardial ischemia, 0.062% for endocarditis, 0.59% for deep vein thrombosis, 0.19% for pulmonary embolism, and 0.37% for cerebral infarction/hemorrhage. Excluding endocarditis, all complications were associated with increased in-hospital mortality. Cardiovascular complications of COVID-19 were infrequent in Japan but were associated with poor prognosis.

Different Modalities to Assess Right Ventricular Function in Post-COVID Taking ST-Elevation as a Gold Standard and Arrhythmias in Post-COVID

The COVID-19 caused by novel single-stranded RNA enveloped severe acute respiratory syndrome coronavirus-2 (SARS CoV-2) first appeared in Wuhan, China. A lot of focus has been given to pulmonary complications. According to several case reports, cardiovascular associated clinical manifestations include myocarditis, arrhythmias, veno-thromboembolic events, acute coronary syndrome (ACS), and pericarditis. Different modalities in diagnosis like 2D, doppler can help in the early diagnosis of right ventricular function. This study evaluates the cardiac changes in recovered COVID-19 positive patients by 2D echocardiogram and other modalities. In this prospective observational study, 139 participants recently recovered from COVID-19 illness were identified and recruited after obtaining the Informed concerned form (ICF). The patients once enrolled were subjected to 2D echo and ECG as part of routine clinical practice. Out of 139 patients, 89 (64.03%) were males, and the rest were females. Based on the severity scale, 13 (9.35%) participants had suffered a severe form of COVID-19 infection. Right ventricular functional assessment, right ventricular global strain (RVGLS) was abnormal in 72 (51.80%) participants. Arrhythmias were reported in 31 (22.30%) participants; among them, 30 participants had sinus bradycardia. Our study demonstrates the association between COVID-19 and cardiac changes/ incidence of cardiovascular complications in recovered COVID-19 patients. This study provides first-hand evidence of the incidence of abnormal LVGLS and RVGLS in COVID-19 recovered patients. In addition, there was a higher incidence of arrythmias.

Clinical challenges of stress cardiomyopathy during coronavirus 2019 epidemic

A type of viral pneumonia that broke out in Wuhan, China in December 2019, and new strains of it are spreading rapidly around the world, is called coronavirus disease 2019 (COVID-19). The incidence of cardiovascular complications has increased both in the general population and in patients diagnosed with the disease during the COVID-19 epidemic. One of the conditions is stress cardiomyopathy, which may be related to COVID-19. During the COVID-19 epidemic, stress cardiomyopathy may be present as a complication of acute infection or as an indirect consequence of quarantine. These conditions have created complications in patient care that have led to increased adverse outcomes, hospitalization, and medical costs. Stress cardiomyopathy is caused by various emotional and physical stressors such as anger, sadness, happiness, surgery, multiple medications, general anesthesia, and infectious diseases. The outbreak of the new coronavirus has posed an ongoing challenge for these patients with several medical and economic consequences. Providing useful information on stress and COVID-19 to people with heart disease and their families can be very important, and also, education and psychotherapy of heart patients can reduce the number of hospitalization and their complications.