Independent Predictor Of Cardiovascular Complications Research Articles

The incidence of cardiovascular conditions in patients admitted to hospital with and without COVID-19 in the South-East of Scotland

Abstract Background Multiple studies have reported an increased risk of acute myocardial infarction, cardiac arrhythmia, heart failure, myocarditis, and venous thromboembolism in patients admitted to hospital with COVID-19 infection. Whether the incidence of these cardiovascular conditions differ in patients hospitalised with COVID-19 compared to those who have COVID-19 excluded is not clear. Methods In a prospective, multi-centre, cohort study in secondary and tertiary care hospitals in Scotland, consecutive adults with symptoms of suspected COVID-19 were identified by the attending clinician using an electronic form integrated into the care pathway. Using linked electronic health record data, we evaluated the incidence of acute myocardial infarction, atrial fibrillation, heart failure hospitalisation, myocarditis, and venous thromboembolism during the index admission and the first 90 days following the index admission. In multivariable regression models the frequency of cardiovascular conditions at 90 days were compared in patients with confirmed COVID-19 infection defined by RT-PCR test with those in whom COVID-19 was excluded. Results Between April 2020 and May 2022, 53,644 (median age 68 [interquartile range, IQR 49-90] years, 54% women) consecutive patients were hospitalised and underwent RT-PCR for suspected COVID-19 infection. In total, 4,365 (8%) had COVID-19 confirmed and 49,279 (92%) had COVID-19 excluded. At 90 daythe myocardial infarction was less common (2% versus 5%) and venous thromboembolism was more common (6% versus 4%) in patients with COVID-19 compared to those without, but the proportion with atrial fibrillation (15% versus 14%), heart failure hospitalisation (10% versus 9%), and myocarditis (<0.1% versus <0.1%) were similar. Overall, the proportion with a cardiovascular condition at 90 days did not differ in patients with or without COVID-19 (Figure). Age (over 65 years, adjusted hazard ratio [aHR] 2.75, 95% confidence interval [CI] 2,61 to 2.89), male sex (aHR 1.35, 1.30 to 1.40), and risk factors (diabetes [aHR 1.13, 1.08 to 1.19], hyperlipidaemia [aHR 1.09, 1.01 to 1.18], hypertension [aHR 1.45, 1.39 to 1.52]) were independent predictors of cardiovascular complications, whilst COVID-19 status was not associated with increased risk (aHR 0.94, 0.88 to 1.01). Conclusion Cardiovascular conditions are common in patients hospitalised with suspected COVID-19, however the incidence at 90 days does not differ in those with or without COVID-19 and COVID-19 infection does not confer an increase in risk.

Analysis of laboratory and instrumental data in young patients with COVID-19 and cardiovascular disorders

Introduction. Despite significant information on cardiovascular damage in older patients with COVID- 19, there is no clear understanding of the variability of cardiac diseases manifestations in young patients. Additionally, summarized data characterizing the severity of myocardial damage in these patients is lacking.Aim. To compare laboratory and functional study data and identify predictors of cardiovascular damage in young patients with COVID-19.Materials and methods. An analysis of 4,453 medical records from 2020 to 2022 was conducted. The focus was on patient age (18- 44 years), primary diagnosis, severity of COVID-19, comorbid conditions, timing of cardiovascular symptom onset, and laboratory and functional study data characterizing cardiovascular system damage. According to the inclusion and exclusion criteria, 132 medical records of patients aged 18 to 44 years with moderate COVID-19 were selected, including 49 with cardiovascular issues and 83 without cardiovascular pathology.Results. Comparative analysis showed that cardiovascular system damage in young patients with moderate COVID-19, compared to those without cardiovascular pathology, was associated with elevated levels of C-reactive protein (CRP) (p=0.001), brain natriuretic peptide (NTproBNP) (p<0.0001), D-dimer (p<0.0001), and troponin I (p<0.0001). CRP levels in patients with pericarditis and acute myocardial infarction (AMI) were higher than in those with acute cerebrovascular accident (ACVA) (p=0.001). No differences in D-dimer levels were found between subgroups (p>0.05). Troponin I and NTproBNP levels in the AMI subgroup were higher than in the pericarditis (p<0.0001 and p=0.047, respectively) and ACVA (p=0.001 and p=0.043, respectively) subgroups. Patients with cardiovascular disorders had a reduced left ventricular ejection fraction (LVEF) (p=0.005) without significant changes in left ventricular end-systolic (p=0.200) and end-diastolic volumes (p=0.119). The lowest LVEF was found in the AMI and ACVA subgroups (p=0.001). Correlation-regression analysis revealed associations between cardiovascular complications and NTproBNP (r=0.673, p<0.001), troponin I (r=0.543, p<0.001), and D-dimer (r=0.363, p<0.001), as well as LVEF (r=-0.341, p<0.001). Significant stochastic relationships were also found between D-dimer and troponin I (r=0.532, p<0.001), NTproBNP (r=0.545, p<0.001); and between LVEF and troponin I (r=-0.420, p<0.001), NTproBNP (r=-0.314, p<0.001). Multivariate regression analysis showed that NTproBNP, with a sensitivity of 86.5% and specificity of 81.9%, is an independent predictor of cardiovascular complications in young patients with moderate COVID-19 (OR=1.175, p=0.001).Conclusion. The results indicate that the severity of COVID-19, regardless of patient age and comorbidities, can be a factor in the development of cardiovascular complications. NTproBNP levels in the blood of COVID-19 patients can be an early marker of cardiovascular risk. However, further research is needed to confirm the pathogenetic role of cardiotropic protein in the development of pericarditis, AMI, and ACVA in these patients.

Type-2 diabetes mellitus with or without metabolic syndrome and their associated critical factors: A study from Northern India.

Diabetes mellitus is associated with carbohydrate, lipid and protein metabolism abnormalities. Uncontrolled hyperglycaemia can result in dysfunction of various organs such as eyes, kidneys, nerves, and heart and blood vessels leading to long-term complications like nephropathy, neuropathy, retinopathy, stroke and ischaemia. The main objective of the study was to identify critical factors in Type 2 diabetes mellitus (Type 2 DM) with metabolic syndrome (mets) compared with Type 2 DM without mets and their association in the development of Type 2 DM to Type 2 DM with mets and cardiovascular complications. This can aid in improving the clinical management and the consequences of the disease. The present study was conducted in the Department of Biochemistry, a tertiary care centre in Northern India. All patients who were aged between 35 and 65 years of age were enrolled. Enrolled subjects were divided into three groups, Group I: 50 healthy people; Group II: 50 Type 2 DM without mets; and Group III: 50 Type 2 DM with mets. These patients were subjected to Anthropometric and biochemical parameter assessment. On comparing Group III with control and Group II significant difference was observed in these parameters, that is, elevated TGs (P = 0.001), reduced high-density lipoprotein (HDL) level (P = 0.001), elevated high-sensitivity C-reactive protein (hs-CRP) (0.011), high serum insulin fasting (P = 0.010), weight (P = 0.021), waist circumference (P = 0.001) and BMI (P = 0.001). In the control group, head circumference was significantly lower compared to Group II (P = 0.001) and Group III (P = 0.001). On the basis of observed observation, it has been suggested that low enzymatic activity with poor glycaemic control may further progress Type 2 DM into Type 2 DM with metabolic syndrome and cardiovascular complications. High hs-CRP concentration and high fasting insulin can be independent predictor of cardiovascular complications.

Trends, Predictors and Outcomes of Cardiovascular Complications at Delivery Associated with Gestational Diabetes Mellitus-a National Inpatient Sample Analysis (2004-2019)

BACKGROUNDWomen with gestational diabetes mellitus (GDM) have an increased risk of pregnancy-associated complications and long-term risk of cardiovascular (CV) disease. However, data on in-hospital peripartum CV complications remain limited. Hence, we investigated trends, outcomes, and predictors of CV complications associated with GDM diagnosis during delivery hospitalizations in the United States. METHODS AND RESULTSWe used data from the National Inpatient Sample (2004-2019). ICD-9 or ICD-10 codes were used to identify delivery hospitalizations and GDM diagnosis. A total of 63,115,002 hospitalizations for deliveries were identified, of which 3.9% were among women with GDM (n=2,435,301). The prevalence of GDM, and of obesity increased during the study period (p-trend<0.01) (Figure A). Women with GDM were older (median 32 vs 28 years, p<0.01) and had higher prevalence of obesity, and dyslipidemia. After adjustment for age, race/ethnicity, comorbidities, and insurance/income, GDM remained an independent predictor of CV complications including preeclampsia [aOR 2.02 (95% CI 2.01-2.03), p<0.01], eclampsia [aOR 1.68 (1.64-1.72), p<0.01], peripartum cardiomyopathy [aOR 1.15 (1.08-1.22), p<0.01], acute kidney injury [aOR 1.16 (1.11-1.21), p<0.01], stroke [aOR 1.15 (1.09-1.23), p<0.01] and cardiac arrhythmias [aOR 1.48 (1.46-1.50), p<0.01], compared to no GDM (Figure B). Delivery hospitalizations among women with GDM were associated with increased length (3 vs 2 days, p<0.01) and cost of hospitalization ($4,909 vs $3,682, p<0.01). CONCLUSIONSWomen with GDM had higher risk of preeclampsia/eclampsia, peripartum cardiomyopathy, acute kidney injury, stroke, and cardiac arrhythmias during delivery hospitalizations. Moreover, delivery hospitalizations among women with GDM diagnosis were associated with increased length and cost of hospitalization.

Study protocol for an observational cohort evaluating incidence and clinical relevance of perioperative elevation of high-sensitivity troponin I and N-terminal pro-brain natriuretic peptide in patients undergoing lung resection

IntroductionMyocardial injury after non-cardiac surgery has been defined as myocardial injury due to ischaemia, with or without additional symptoms or ECG changes occurring during or within 30 days after non-cardiac...

Trends, Predictors, and Outcomes of Cardiovascular Complications Associated With Polycystic Ovary Syndrome During Delivery Hospitalizations: A National Inpatient Sample Analysis (2002-2019).

BackgroundWomen with polycystic ovary syndrome (PCOS) have an increased risk of pregnancy‐associated complications. However, data on peripartum cardiovascular complications remain limited. Hence, we investigated trends, outcomes, and predictors of cardiovascular complications associated with PCOS diagnosis during delivery hospitalizations in the United States.Methods and ResultsWe used data from the National Inpatient Sample (2002–2019). International Classification of Diseases, Ninth Revision (ICD‐9), or International Classification of Diseases, Tenth Revision (ICD‐10), codes were used to identify delivery hospitalizations and PCOS diagnosis. A total of 71 436 308 weighted hospitalizations for deliveries were identified, of which 0.3% were among women with PCOS (n=195 675). The prevalence of PCOS, and obesity among those with PCOS, increased during the study period. Women with PCOS were older (median, 31 versus 28 years; P<0.01) and had a higher prevalence of diabetes, obesity, and dyslipidemia. After adjustment for age, race and ethnicity, comorbidities, insurance, and income, PCOS remained an independent predictor of cardiovascular complications, including preeclampsia (adjusted odds ratio [OR], 1.56 [95% CI, 1.54–1.59]; P<0.01), eclampsia (adjusted OR, 1.58 [95% CI, 1.54–1.59]; P<0.01), peripartum cardiomyopathy (adjusted OR, 1.79 [95% CI, 1.49–2.13]; P<0.01), and heart failure (adjusted OR, 1.76 [95% CI, 1.27–2.45]; P<0.01), compared with no PCOS. Moreover, delivery hospitalizations among women with PCOS were associated with increased length (3 versus 2 days; P<0.01) and cost of hospitalization ($4901 versus $3616; P<0.01).ConclusionsWomen with PCOS had a higher risk of preeclampsia/eclampsia, peripartum cardiomyopathy, and heart failure during delivery hospitalizations. Moreover, delivery hospitalizations among women with PCOS diagnosis were associated with increased length and cost of hospitalization. This signifies the importance of prepregnancy consultation and optimization for cardiometabolic health to improve maternal and neonatal outcomes.

Valor predictivo de las alteraciones electrocardiográficas en la ocurrencia de complicaciones cardiovasculares en el síndrome coronario agudo sin elevación del segmento ST

IntroductionCardiovascular diseases cause approximately 18 million deaths annually, especially in developed or developing countries where life expectancy is usually higher. Material and methodProspective analytical cohort study in 598 patients diagnosed with non-ST segment elevation acute coronary syndrome who were admitted to a secondary level hospital between 2016 and 2020. ResultsST segment alteration was identified as a variable independent predictor of non-fatal cardiovascular complications with RR: 2.59 (95% CI: 1.64-4.10; p<.001) as well as haemodynamic complications, RR: 3.48 (95% CI: 2, 04-5.94, p<.001). In the particular case of patients with electrocardiographic abnormalities and cardiovascular complications, survival was significantly lower, HR: 3.01 (95% CI: 1.84-4.95; p<.001). ConclusionsAntecedent ST segment abnormalities were independent predictors of cardiovascular complications.

Calculated Hematological Indices as Predictors of Cardiovascular Complications in Noncardiac Surgery (Pilot Study)

The objective: to study the prognostic significance of the ratio of the absolute number of neutrophils to lymphocytes (NLR) and platelets to lymphocytes (PLR) in assessing the risk of cardiovascular complications in non-cardiac surgical interventions.Subjects and Methods. 85 patients aged 66 [61‒70] years who underwent elective vascular surgery were examined.Results. Concomitant circulatory diseases were diagnosed in 98.8%. PLR &lt; 91.2 with the sensitivity of 60% and the specificity of 67.8% was associated with diabetes mellitus (AUC – 0.686; 95% CI 0.576‒0.783, p = 0.0022). Cardiovascular complications were registered in 9.3% of patients. NLR was an independent predictor of cardiovascular complications: OR – 5.216; 95% CI 1.246‒21.826, p = 0.005. NLR &gt; 2.1 discriminated cardiovascular complications with the sensitivity of 75% and specificity of 75% (AUC – 0.827; 95% CI 0.690–0.921; p = 0.004). PLR was also a predictor of cardiovascular complications: OR – 1.0111; 95% CI 1.0001–1.0223; p = 0.027. PLR &gt; 105.5 allowed identifying patients with NT-proBNP &gt; 650 pg/ml with the sensitivity of 75.0% and the specificity of 61.8% (AUC – 0.740; 95% CI 0.630‒0.832; p = 0.0308).Conclusion. NLR and PLR can be used to identify patients with increased cardiac risk when undergoing vascular surgery. Further research in this field is advisable.

Analysis of clinical and anamnestic factors affecting endothelial glycocalyx condition in patients with active rheumatoid arthritis

Background . Endothelial dysfunction (ED) involved in the pathogenesis of rheumatoid arthritis (RA) is more associated with the endothelial glycocalyx (EGC) condition. EGC thinning is an independent predictor of cardiovascular complications that is why it is important to determine the risk factors (RF) that most affect EGC in RA. Objective . To study the relationship between the endothelium condition and RF for an RA unfavourable course and cardiovascular risk (CVR). Design and methods . The study involved 103 patients aged 18 to 69 years of both sexes with active RA. A dark-field microscope was used to assess the EGC condition. In the microcirculatory bed, it allows you to evaluate the depth of erythrocyte perfusion in the EGC thickness (PBR), micro vessel density (VMD) and the number of erythrocytes in them (RBC Filling). An increase in PBR indicates EGC thinning and is a marker of ED. A decrease in RBC Filling and VMD indicates a decrease in the functioning vessels number. Circulating syndecan1 (Sdc1) was assessed as a laboratory EGC damage marker. As a result of a two-step cluster analysis, based on dark-field microscopy, two clusters were identified in the study cohort. They were compared in terms of RF for an unfavourable course of RA and CVR. Results . Patients belonging to cluster 1 had thinner EGC (high PBR), low perfusion (low RBC Filling) and density (low VMD) of microvessels, higher levels of Sdc1 than in cluster 2. This indicates a significant impairment of microcirculation in cluster 1. Among the studied RF for an unfavorable course of RA and CVR, cluster 1 differed only in a lower frequency of taking disease-modifying antirheumatic drugs (DMARDs) compared to the other cluster. In the future, it was associated with the 3,6-fold greater need for DMARD therapy modification. Conclusions . The lack of DMARD therapy, compared with the other RF for the unfavorable course of RA and CVR, makes the greatest contribution to EGC damage and microcirculation disorders in patients with active RA. The revealed changes confirm relationship between endothelial disorders and the pathogenesis of this disease and determine the leading role of DMARD therapy in the RA treatment.

Abstract EP51: Trends, Predictors And Outcomes Of Cardiovascular Complications Associated With Polycystic Ovary Syndrome During Delivery Hospitalizations-A United States National Database Analysis (2002-2019)

Background: Women with polycystic ovary syndrome (PCOS) have increased risk of pregnancy-associated complications. However, there is scarcity of data on the trends, outcomes, and predictors of cardiovascular (CV) complications associated with PCOS diagnosis during delivery hospitalizations in the United States. Methods and Results: We used data from the National Inpatient Sample. ICD-9 or ICD-10 codes were used to identify delivery hospitalizations and PCOS diagnosis. A total of 71,436,308 weighted US hospitalizations for deliveries were identified from 2002 to 2019. Of the included hospitalizations, 0.3% were among women with PCOS (n=195,675). PCOS women were older (mean 30 vs 28 years, p&lt;0.01) and had higher prevalence of diabetes, obesity, and dyslipidemia. After adjustment for age, race/ethnicity, comorbidities, insurance status and median household income, PCOS remained an independent predictor of CV complications at delivery including preeclampsia (aOR 1.56, 95% CI 1.54-1.59, p&lt;0.01), eclampsia (aOR 1.58, 95% CI 1.54-1.59, p&lt;0.01), peripartum cardiomyopathy (aOR 1.79, 95% CI 1.49-2.13, p&lt;0.01), and heart failure (aOR 1.76, 95% CI 1.27-2.45, p&lt;0.01) (Figure, Panel A), compared to no PCOS. An increase in overall prevalence of PCOS, and of obesity among those with PCOS, was also observed during the study period (Figure, Panel B). Moreover, delivery hospitalizations with PCOS diagnosis were associated with increased length (3 vs 2 days, p&lt;0.01) and cost of hospitalization ($6,310 vs $4,468, p&lt;0.01). Conclusions: Over a 17-year period, prevalence of PCOS and obesity increased among childbearing U.S. women. Women with PCOS had higher risks of preeclampsia/eclampsia, peripartum cardiomyopathy, heart failure, pulmonary edema, and venous thromboembolism. Moreover, delivery hospitalizations with PCOS diagnosis were associated with increased length and cost of hospitalization. Strategies to optimize pre-pregnancy cardiometabolic health may be particularly important to improve maternal CV outcomes.

Adding objectivity to submaximal exercise testing by assessment of heart rate recovery in healthy volunteers (SEARCH-II)

Submaximal exercise tests (SETs) offer a cheaper, easier to conduct, and better tolerated alternative to ‘maximal’ cardiopulmonary exercise testing as a preoperative risk assessment tool.1 Quantifying HR recovery (HRR) is a potentially objective method for assessing cardiopulmonary fitness after SETs. HRR1 and HRR2 (calculated as HR on exercise cessation minus HR at 1 and 2 min of rest) are commonly used methods for quantifying HRR. Impaired HRR1 after SETs has been shown to be an independent predictor of cardiovascular complications after thoracic surgery.

Pulse wave velocity and its diagnostic value in cardiovascular diseases. Literature review and results of own observations

Over the past decade, in connection with the continuous increase of mortality from cardiovascular diseases, attention of scientists was tied down to the early reveal of vascular lesions and search for new biomarkers. Generally known, that an adequate hemodynamics is determined by damping properties of the great vessels, therefore their viscoelasticity properties are of particular interest. It is important to identify the changes in the arteries’ structure prior to onset of clinical symptoms of vascular disease. The measurement of pulse wave velocity (PWV) is one of main investigational methods for arteries’ properties; based on experts’ data it serves as an independent predictor of cardiovascular complications. The methods of estimation of elasticity or stiffness of arteries wall acquire all greater popularity, so as they allow to estimate not only structure but function of vessels. For the estimation of the structural‑functional state of major vessels, direct visualizing (USI, МRT) and indirect technique (contour analysis of pulse wave, plethysmography, sphygmography etc.) are used. In clinical and outpatient practice, the most popular are non‑invasive, affordable and easily reproducible techniques. The authors presented methods for determining the increased local and regional stiffness of the arterial wall using such devices as Complior, SphygmoCor, PulsePen, PolySpectr SPV, VaSera‑1000 and other. However, a demand exists today for novel methods for estimation of vascular stiffness. To simplify and improve the determination of the pulse wave velocity, the authors have proposed a method based on photoplethysmography and elucidated the main advantages and shortcomings, reveled during investigation. The aim of this publication was to inform the physicians about the importance of researches of arterial wall stiffness, the most widespread and demanded in clinical practice methods of its determination, about conditions, where vascular stiffness should be assessed, the existing limitations, as well as issues, still unsolved in this area.

Transforming Growth Factor-β1, Arterial Stiffness and Vascular Age in Patients With Uncontrolled Arterial Hypertension

Lack of blood pressure control leads to a higher incidence of hypertension-mediated target organ damage (HMOD). One of the markers of HMOD is an increased arterial stiffness, an independent predictor of cardiovascular complications. However, abstract numbers showing the level of arterial stiffness do not give patients a clear understanding of the risk of their condition. In order to increase patient compliance, the term "vascular age" (VA) was introduced. Arteriosclerosis plays the main role in increasing VA. The greatest interest, according to the literature, in the study of this issue is in arteriosclerosis caused by transforming growth factor β1 (TGF-β1)-the effect of TGF-β1 on the culture of smooth muscle cells leads to their proliferation and growth; also, TGF-β1 increases the amount of collagen and accelerates the degradation of elastin. We included 140 people in the study: 80 patients with controlled arterial hypertension (CAH), 30 with uncontrolled arterial hypertension (UAH), and 30 patients who formed the control group. All patients underwent a determination of arterial stiffness and VA using the cardio-ankle vascular index (CAVI), a corrected (blood-pressure independent) cardio-ankle vascular index (CAVI0) and the concentration of TGF-β1 was measured. The TGF-β1 value in the UAH group was 22.6 (25th percentile=20.6; 75th percentile=25.6) ng/mL, and in the control group it was 17.4 (25th percentile=11.8; 75th percentile=19.3) ng/mL. In the CAH group, an intermediate value was noted-19.2 (25th percentile=17.2; 75th percentile=24.7) ng/mL. The CAVI in the UAH group was 9.2 (25th percentile=8.5; 75th percentile=9.9), in the control group-7 (25th percentile=6.5; 75th percentile=7.5). In the CAH group, the average CAVI was 7.8 (25th percentile=7.0; 75th percentile=8.5). The CAVI 0 in the UAH group was 14.8 (25th percentile=12.0; 75th percentile=15.6), in the control group - 9.7 (25th percentile=8.8; 75th percentile=9.7). In the CAH group, the average CAVI was 11.1 (25th percentile=10.1; 75th percentile=13.6). Vascular age in the UAH group was 71.5 (25th percentile=64; 75th percentile=74) years, in the CAH group 59 (25th percentile=49; 75th percentile=69) years, and in both groups (UAH, CAH), VA was significantly higher than the chronological age (p<0.05). In the control group, the VA did not significantly differ from the chronological age (p>0.05) and it was 54 (25th percentile=44; 75th percentile=59) years. A significant relationship was found between the TGF-β1 level and CAVI (CAH r=0.777; UAH r=0.753; p<0.05), CAVI 0 (CAH r=0.625; UAH r=0.502; p<0.05) and VA in patients with AH (CAH r=0.649; UAH r=0.753; p<0.05). In patients in the UAH group, there was an increase in the concentration of TGF-β1, an increase in the arterial stiffness and in VA in comparison with patients in the CAH group and the control group. The relationship between TGF-β1 and the arterial stiffness and VA was revealed in patients with hypertension.

RAISED LEVEL OF LIPOPROTEIDE(A) AS A PREDICTOR OF CARDIOVASCULAR COMPLICATION POST REVASCULARIZATION OF THE LOWER ExTREMETIES ARTERIES

Aim. Lipoproteide (a) (Lpa) is a pathogenetic risk factor of cardiovascular atherosclerotic disease. On the role of Lpa in the development of cardiovascular complications (CVC) after lower limbs arteries revascularization, there is lack of data. The aim of the study was assessment of Lpa relation to CVC occurrence after revascularization of lower extremities during 1 year follow-up.Material and methods. In the study, 111 patients were included (97 males, 14 females, mean age 66±9 y.o.), who had undergone revascularization of lower libms arteries due to atherosclerosis. As CVC during 1 year follow-up, the following were taken: recurrent intermittent claudication, lower extremity amputation, ischemic stroke, transient cerebral ischemia, non-fatal myocardial infarction, unstable angina, repeat revascularization and cardiovascular death. In all patients, in the blood serum, there were measured lipids and Lpa.Results. Within 1 year after revascularization there were 45 (41%) CVC. In the group with raised Lpa ≥30 mg/dL there were more CVC than in Lpa &lt;30 mg/dL: relative risk 2,1 (95% CI 1,3-3,5; p=0,004). Hence the increased level of Lpa is an independent predictor of CVC after revascularization of lower extremities arteries.Conclusion. In prospective study, during 1 year after revascularization the level of Lpa ≥30 mg/dL is associated with double increase of the risk of CVC.

High levels of preoperative and postoperative N terminal B-type natriuretic propeptide influence mortality and cardiovascular complications after noncardiac surgery: A prospective cohort study.

Major noncardiac surgery is associated with a 5% incidence of serious cardiovascular complications and with a 1 to 2% probability of death from cardiac causes. Over the last few decades, researchers have assessed the perioperative predictive power of several risk indices. Research is currently focused on the evaluation of biomarkers. The objective was to determine the incidence of high serum levels of N terminal B-type natriuretic propeptide (NT-proBNP) before and after surgery in adults undergoing elective major noncardiac procedures and to evaluate its relationship with mortality and cardiovascular complications occurring up to 30 days after surgery. Prospective cohort study. Enrolment was undertaken at a university hospital from October 2011 to July 2013. A total of 304 adults with cardiovascular risk factors who underwent noncardiac elective surgery. The relationship between preoperative and postoperative NT-proBNP serum levels and the emergence of cardiovascular complications, including all-cause mortality, during the first 30 days after surgery. The incidence of cardiovascular complications was 7.8% (n = 25), and the mortality rate was 4.3% (n = 13). Higher-than-normal NT-proBNP serum levels were found before surgery in 48.4% (n = 147) and after surgery in 50.7% (n = 154) of patients. The variables found to be independent predictors of cardiovascular complications, including all-cause 30-day mortality, were levels of NT-proBNP more than 300 pg ml before surgery and levels more than 1000 pg ml both before and after surgery. High levels of preoperative and postoperative NT-proBNP are predictors of cardiovascular complications, including all-cause mortality, during the first 30 days after noncardiac surgery in adults with cardiovascular risk factors.

Myocardial and Arterial Stiffness Important Determinant of NT-ProBNP at Development of Heart Failure in Survivors of Myocardial Infarction

To study diagnostic value of myocardial-arterial stiffness (MAS) as a determinant of N-terminal pro-brain natriuretic peptide (NT-proBNP) expression in patients with chronic heart failure (CHF) with ischemic or postinfarction left ventricular (LV) dysfunction. We analyzed 6 months prognosis of 54 patients (mean age 61.7+/-8.6 years) with II-III NYHA class CHF divided into 2 groups: (I, n=18) with class II CHF and preserved LV ejection fraction (EF) (55+/-10.4%), (II, n=36) with class III CHF and low LF EF (30.4+/-6.8%). MAS was measured by echocardiography as ratio of arterial elasticity (Ea) and end-systolic elasticity of LV myocardium (Es). Serum NT-proBNP was measured by immunoenzyme assay. During 6 months follow-up one group II patient with initial NT-proBNP level 2020 rg/ml died. NT-proBNP level in group I was significantly lower than in group II (313 and 647 rg/ml, respectively). Ea/Es ratio was significantly higher (p=0.001) in group II. Multifactorial analysis demonstrated moderate correlation of NT-proBNP with Ea/Es ratio (r=0.50, p=0.0001) and negative correlation with LVEF (r=-0.45, =0.003) among patients with II-III class CHF. As correlation between symptoms and severity of clinical manifestations of ischemic or postinfarction cardiac dysfunction at development of CHF was not high it appears rational to consider MAS estimated by Ea/Es ratio as independent predictor of cardiovascular complications. Sufficiently close correlation between NT-proBNP and Ea/Es ratio allows to improve stratification of risk and to assess objectively prognosis of the disease using easier obtainable parameter Ea/Es in cases when possibility to measure NT-proBNP is not available.

Osteoprotegerin Is an Independent Predictor of Vascular Events in Finnish Adults With Type 1 Diabetes

OBJECTIVEOsteoprotegerin (OPG) is involved in the process of vascular calcification. We investigated whether OPG is associated with the development and progression of diabetes complications in adults with type 1 diabetes (T1D).RESEARCH DESIGN AND METHODSSerum OPG was measured in 1,939 adults with T1D participating in the Finnish Diabetic Nephropathy (FinnDiane) Study. Patients with end-stage renal disease (dialysis or transplantation) at baseline were excluded from analysis. Data on cardiovascular (CV) events and mortality during follow-up were verified from hospital discharge registries (ICD codes) and the Finnish National Death Registry, respectively. The follow-up time was 10.4 ± 2.0 (mean ± SD) years.RESULTSOnly patients with macroalbuminuria and/or renal impairment had elevated OPG concentrations, when compared with participants without overt kidney disease. Patients with retinopathy or CV disease also had higher OPG concentrations, but this was attributable to their higher frequency of chronic kidney disease. OPG predicted an incident CV event (hazard ratio 1.21 [95% CI 1.01–1.45]; P = 0.035) and peripheral vascular disease/amputation events (1.46 [1.13–1.88]; P = 0.004) during follow-up.CONCLUSIONSWe showed that serum OPG is an independent predictor of CV complications. OPG may be directly involved in extraosseous calcification, resulting in stiffening of the arteries and subsequent vascular insufficiency in patients with T1D.

Cardiovascular complications in patients with megaesophagus due to Chagas disease undergoing the Serra-Dória operation

The Serra-Dória procedure has been used in the treatment of advanced or relapsed megaesophagus due to Chagas disease. Little is known, however, about cardiovascular complications following this procedure. The purpose of this study was to settle independent predictors of cardiovascular complications following the Serra-Dória procedure in patients with megaesophagus secondary to chronic Chagas disease. A total of 76 patients who underwent the Serra-Dória operation for Chagas disease megaesophagus from 1998 to 2010 were included. A multivariate stepwise logistic regression analysis was performed to identify predictors of cardiovascular complications. Mean age was 61±10 years; 55% were male. Advanced megaesophagus (grades III/IV) were found in 65 (86%) of patients. Twenty-two (29%) patients had one comorbidity, and five (7%) three co-morbidities before operation. Two (3%) patients died following the operation. Twenty-nine (38%) patients presented cardiovascular complication following the Serra-Dória procedure; 15 (44%) were mild, 7 (21%) moderate, and 12 (35%) severe. Age>61 years was the only independent predictor of cardiovascular complication following Serra-Dória procedure. In patients with megaesophagus secondary to chronic Chagas disease, the Serra-Dória procedure is associated with a low mortality rate and a high frequency of cardiac complication.

Identifying risk factors for postoperative cardiovascular and respiratory complications after major oral cancer surgery

Surgical resection of oral cancer can be associated with significant postoperative cardiovascular and respiratory complications that require more sensitive predictors. All patients with oral squamous cell carcinoma treated from July 2005 to April 2008 were retrospectively reviewed. The Goldman Revised Cardiac Risk Index (GRCRI) was used to predict cardiovascular complications. Other evidence-based a priori predictors were applied in an h-fold cross-validation model. Operating room (OR) time was an independent predictor of cardiovascular complications (odds ratio = 1.54, p = .002, 95% confidence interval [CI] = 1.18-2.02) and respiratory complications (odds ratio = 1.3, p = .06, 95% CI = 0.99-1.64) after multivariate adjustment. OR time and estimated blood loss predicted cardiovascular complications with 73% sensitivity. The GRCRI achieved 37% sensitivity. OR time and tracheostomy predicted respiratory complications with 75% sensitivity. The GRCRI was not prognostic for cardiovascular complications in patients with oral cancer. The most sensitive predictors for cardiovascular complications were OR time and estimated blood loss; for respiratory complications they were OR time and tracheostomy.

Passive Vibration Reduces Leg and Systemic Arterial Stiffness

Arterial stiffness (pulse wave velocity, PWV) is an independent predictor of cardiovascular complications. Leg and systemic PWV decrease after a bout of static squat with whole-body vibration in healthy young men. Passive vibration (PV) increases skin blood flow; however, the effects of PV on PWV responses are unknown. PURPOSE: To test the hypothesis that PV reduces leg and systemic PWV. METHODS: Thirteen healthy young (23 ± 3 years) participants (10 females) were randomly assigned to either a PV or a control (C) trial in two separate days, at least 48 hours apart. Subjects rested in the supine position with legs over a vibration platform. The PV trial intensity was set at a frequency of 25Hz and amplitude of 5.0 mm for continuous 10 min. After each trial, mean arterial pressure (MAP), heart rate (HR), brachial-ankle pulse wave velocity (baPWV, systemic), heart-femoral PWV (hfPWV, aortic), and femoral-ankle PWV (faPWV, leg) were measured at rest and 3 min (P3), 15 min (P15), and 30min (P30) post-intervention in the supine position. Trial comparisons were made using a two way ANOVA with repeated measures. RESULTS: Both, MAP and hfPWV were not affected by PV and C. Significant time-by-trial-interactions (P<0.01) were identified for baPWV at P3 and P15 and for faPWV at the 3 time points. PV decreased both baPWV (P<0.05) and faPWV (P<0.05) at P3, P15, and P30. CONCLUSIONS: These findings suggest that passive vibration decreases leg and systemic arterial stiffness in healthy individuals. Passive vibration may have potential applications for decreasing arterial stiffness in clinical populations.