Institute Of Cardiology Research Articles

A retrospective analysis of patients with very HIGH level of LDL-C and the predictors of mortality (HIGH-LDL-PM Registry)

Abstract Introduction Elevated levels of LDL cholesterol (LDL-C) significantly contribute to the development and progression of cardiovascular diseases (CVDs). In HIGH-LDL-PM Registry, we aimed to investigate the demographics and clinical characteristics of patients with very high level of LDL-C and the predictors of mortality, retrospectively. Methods We retrospectively searched the electronic database of Istanbul University-Cerrahpasa Institute of Cardiology and included patients with very high level of LDL-C (>190 mg/dl) in HIGH-LDL-PM registry. The study group were classified as patients with high probability of familial hypercholesterolemia (FH) and low probability of FH according to Dutch Lipid Clinic Network Score (DLCNS). Results The study group were consisted of 1127 patients and almost two thirds (61.5%) were female. The mean age was 56.5 12.2 years. Hypertension, diabetes, chronic kidney disease (CKD) were seen in 55.8%, 23.5% and 3.7%, respectively. One third of study group (31.1%) had coronary artery disease (CAD) and rest of them were primary prevention patients. the main rhythm was sinus in most of the patients (92,2) and 7.8% patients had atrial fibrillation (AF). Only minority of patients (3.9%) had stigmata for elevated cholesterol levels. While 41.8% of patients had high clinical probability for FH, 58.2% of them had low probability according to DLCNS. While 69% of patients were using lipid lowering treatments (LLTs), 42% of them had drug adherence. High dose (HD) statins (atorvastatin 40-80 and rosuvastatin 20-40 mg) were prescribed in more than half (55.2%) of patients with LLTs. Ezetimibe was the preferred agent as combination therapy in 6.9% and PCSK-9is were prescribed only in 2.5% of patients with LLTs. In 38.8% of study population, ASA was prescribed. 50% decrease in LDL-C levels or decreasing LDL-C below 70 or 100 mg/dl as a treatment goal were achieved in 37.1% and 15% of study population. MACE (MI, stroke, PCI or peripheral revascularization) was recorded in 21% of study population and the mortality rate was 10.4% at 12-years FU (6-145 months). Patients with low probability of FH had better survival than patient with high probability (91.4% vs 88.4%). The age, low dose statin use and higher level of LDL-C at FU were predictors of mortality in Cox-regression analysis. Conclusion Our retrospective analysis of patients with very high levels of LDL-C underscores the multifaceted nature of dyslipidemia management and its impact on cardiovascular outcomes. Despite advancements in pharmacotherapy, suboptimal adherence to lipid-lowering treatments remains a significant challenge, contributing to a notable burden of major adverse cardiovascular events and mortality. Identification of predictors of mortality, such as age, statin dosage, and LDL-C levels, highlights the importance of individualized risk assessment and tailored treatment approaches in this high-risk population.

Aortic root parameter analysis for transcatheter aortic valve implantation in the Pakistani population: a retrospective study

BackgroundTranscatheter aortic valve implantation (TAVI) is a growing treatment for aortic stenosis, but anatomical variations exist across populations. Asians tend to have smaller aortic annuli and higher bicuspid valve morphology compared to Westerners, potentially impacting TAVI valve selection and outcomes. This study analyzes aortic root parameters in Pakistani patients undergoing TAVI.ResultsWe conducted a retrospective analysis of 78 patients who underwent TAVI at the Peshawar Institute of Cardiology from January 2021 to March 2024. Pre-procedural CT scans were analyzed for aortic annulus diameters, area, and other relevant parameters. The mean age was 72.41 years (SD ± 11.99), and 61.5% were male. Aortic annulus diameters (minimum, mean, maximum) were 21.18 mm (SD ± 3.99), 24.21 mm (SD ± 3.93), and 27.49 mm (SD ± 4.43), respectively. Bicuspid aortic valves were present in 34.61% of patients.ConclusionsOur findings suggest that Pakistani patients undergoing TAVI may have aortic root dimensions comparable to Western populations, with a substantial prevalence of bicuspid valves. However, coronary heights were similar to those reported in Asian populations with smaller annuli. Further studies are needed to assess TAVI outcomes in Pakistani patients and determine if tailored valve sizing strategies are required.

OUTCOMES OF PROVISIONAL STENTING WITH VERSUS WITHOUT SIDE BRANCH INTERVENTION IN PATIENTS WITH BIFURCATION LESION-RELATED ST-SEGMENT ELEVATION MYOCARDIAL INFARCTION

Bifurcation lesions in patients with ST-segment elevation myocardial infarction (STEMI) present a unique challenge in interventional cardiology. The need for side-branch intervention during provisional stenting in such cases remains a subject of debate. Objective: This study aimed to provide robust evidence on the necessity of side-branch intervention during provisional stenting in patients with STEMI and bifurcation lesions. Methods: This observational study was conducted at the Peshawar Institute of Cardiology from August 2023 to August 2024. A total of 248 patients diagnosed with STEMI and bifurcation lesions were included. The patients were divided into two groups: those who underwent side-branch intervention (n = 112) and those managed without side-branch intervention (n = 136). Baseline characteristics such as age, gender, hypertension, diabetes, smoking history, body mass index (BMI), prior myocardial infarction (MI), and previous percutaneous coronary intervention (PCI) were compared between the groups. Statistical analysis was performed to identify significant differences. Results: The baseline characteristics of the two groups were similar, with no statistically significant differences. The average age was 58.7 ± 10.9 years in the side-branch intervention group and 58.3 ± 11.4 years in the no-intervention group. The male proportion was also comparable between the two groups (69% vs. 71%). Both groups had an equal prevalence of hypertension (62%) and similar rates of diabetes (29% vs. 28%) and smoking history (36% vs. 34%). Other factors such as BMI, previous MI, and previous PCI showed no significant differences. Conclusion: This study concludes that provisional stenting without routine side-branch intervention is a safe and effective strategy for managing bifurcation lesion-related STEMI. Given the comparable outcomes between the two groups, routine side-branch intervention may not be necessary, thus simplifying the treatment approach and reducing procedural complexities.

Implementation and development of hospital-based health technology assessment in Poland from the perspective of hospital representatives: qualitative research.

The analysis of health technologies in Poland has so far mainly concerned drugs assessed by the Agency for Health Technology Assessment and Tariffication, which was established for this purpose. Due to the implementation of various forms of investment (hardware, diagnostic, and organizational) in hospitals, and the growing need to properly assess the costs of implemented solutions, Hospital-Based Health Technology Assessment (HB-HTA) began to develop. In order to implement HB-HTA in the Polish healthcare system, in 2019-2022 a project was carried out, the consortium members of which were: the National Health Fund (NHF), the National Institute of Cardiology in Warsaw (NIKARD), and Lazarski University (UŁ). Analyzing the possibilities of developing HB-HTA in Polish hospitals based on the experiences of the study participants. Presenting benefits and barriers for HB-HTA units implementation to Polish hospitals. Qualitative analysis of in-depth interviews with the representatives of hospitals that participated in the HB-HTA project using the Nvivo12 program. A specially prepared questionnaire with questions regarding the pre-project, design, and post-project phases was presented to respondents from five of the seven hospitals participating in the pilot phase of the project, during which HB-HTA reports were prepared for selected medical technologies. The remaining two facilities that were invited refused to participate in the study. The Ethics Committee of the Jagiellonian University Medical College gave consent to conduct the study. Hospital representatives indicate that the HB-HTA methodology allows for the assessment of investments in facilities based on appropriate data. Thanks to the project, employees of hospital units gained new skills, such as becoming familiar with literature reviews in medical bibliographic databases. However, HB-HTA in Poland has not been fully implemented because facilities do not obtain adequate benefits from the implementation of HB-HTA at the organizational and financial level. According to the study participants, the methodology itself should be modified to take into account the needs of the facility. The hospitals participating in the HB-HTA project are developing the field of analyzing how innovative solutions are implemented in their facilities, but not to the extent that was intended in the project design.

Effects of preoperative respiratory muscle training for improvement of postoperative health related quality of life in mitral valve replacement patients.

A patient's defective mitral valve is replaced as part of a treatment called mitral valve replacement (MVR) with a mechanical or biological (bioprosthetic) valve. To evaluate the effects of preoperative respiratory muscle training (RMT) on the improvement of postoperative Health related quality of life in MVR patients. A quasi-experimental study was conducted at Faisalabad Institute of Cardiology. A Sample of 40 adult patients aged 25-50years of both genders who underwent MVR was selected and divided into two groups Group 1 (Respiratory Muscle Training Group) was received RMT consisting of 10-15 repetitions a day for 5days; for 3weeks. Whereas Group 2 (Conventional Group) was receive breathing exercise consisting of 10-12 repetitions a day for 5days; for 3weeks. Modified Healthy Heart Questionnaire (HHQ-GP-1) was used as screening tool. In outcome measuring tools Health Related Quality of life Questionnaire (EuroQol), New York Heart Association, was used at baseline, 3rd week and postoperatively. Duration of Postoperative Mechanical Ventilation (hours) and Hospital Stay was also noted as outcome measures of this study. Results obtained indicate that level of Self-Care in EuroQol-5-D-5L has improved in group 1 3.35±1.03 to 1.35±0.48 showing significant improvement similarly in case of Hospital Length of Stay, Mechanical ventilation 4.05±0.68 to 5.05±0.51 and Pain 65.25±8.34 to 71.50±6.70 has improved. It was concluded that Respiratory Muscle Training and Conventional Muscle Training both are effective in MVR patients. But RMT is more effective in improving self-care, reducing pain, Hospital Length of Stay and Mechanical Ventilation in postoperative period as compared to Conventional Muscle Treatment.

Assessment of the Level of Knowledge and Attitude Regarding Advanced Life Support Skills among Nurses Working in the Critical Areas (CCU, ICU and ER) of Punjab Institute of Cardiology, Lahore

Advance life support is the basic intervention to deal with cardiac arrest. Cardiac arrest has no time, place, or personal boundaries. According to WHO, it is estimated that about 23 million of people will die every year due to cardiovascular diseases and the chances of cardiac arrest are greater in people who have history of cardiovascular diseases. Advanced life support training consists of a set of life-saving protocols, interventions, and skills. Objectives: To determine the level of knowledge and attitude of critical care nurses regarding Advanced Life Support (ALS) skills and to assess association between level of knowledge and attitude and demographic characteristics of nurses. Methods: A descriptive cross-sectional study was conducted among critical care nurses of Punjab Institute of Cardiology. About 115 nurses were selected through convenient sampling method. The study was completed in four months from October 2023 to January 2024. Data were analyzed using SPSS Version 25. Results: Findings of study showed that 18 participants were male and 97 were female. Overall results indicated that 8.7% (n=10) nurses have poor knowledge, 39.1% (n=45) have average knowledge, 43.5% (n=50) have a good knowledge and only 8.7% (n=10) have excellent knowledge. On the other side, 71.3% (n=82) have a positive attitude and 28.7% (n=33) have negative attitude regarding ALS. Conclusions: A significant proportion of nurses have average to good knowledge and positive attitude. Only a few nurses have poor knowledge and negative attitude.

Conventional Machine Learning and Ensemble Learning Techniques in Cardiovascular Disease Prediction and Analysis

Cardiovascular diseases, which significantly affect the heart and blood vessels, are one of the leading causes of death worldwide. Early diagnosis and treatment of these diseases, which cause approximately 19.1 million deaths, are essential. Many problems, such as coronary artery disease, blood vessel disease, irregular heartbeat, heart muscle disease, heart valve problems, and congenital heart defects, are included in this disease definition. Today, researchers in the field of cardiovascular disease are using approaches based on diagnosis-oriented machine learning. In this study, feature extraction is performed for the detection of cardiovascular disease, and classification processes are performed with a Support Vector Machine, Naive Bayes, Decision Tree, K-Nearest Neighbor, Bagging Classifier, Random Forest, Gradient Boosting, Logistic Regression, AdaBoost, Linear Discriminant Analysis and Artificial Neural Networks methods. A total of 918 observations from Cleveland, Hungarian Institute of Cardiology, University Hospitals of Switzerland, and Zurich, VA Medical Center were included in the study. Principal Component Analysis, a dimensionality reduction method, was used to reduce the number of features in the dataset. In the experimental findings, feature increase with artificial variables was also performed and used in the classifiers in addition to feature reduction. Support Vector Machines, Decision Trees, Grid Search Cross Validation, and existing various Bagging and Boosting techniques have been used to improve algorithm performance in disease classification. Gaussian Naïve Bayes was the highest-performing algorithm among the compared methods, with 91.0% accuracy on a weighted average basis as a result of a 3.0% improvement.

Incidence of Clinical Outcomes in Minimally Invasive Valvular Surgery at the Ignacio Chávez National Institute of Cardiology.

Minimally invasive cardiac valve replacement surgery (MICS) is a technique that has reported equivalent rates of mortality and reintervention when compared to conventional median sternotomy (CS). Additionally, MICS has inconsistently been reported to be associated with fewer postoperative complications, better cosmetic outcomes, and shorter hospital stays at the expense of longer surgical time, aortic clamp time, and extracorporeal circulation time. When comparing populations undergoing MICS vs CS at the Ignacio Chávez National Institute of Cardiology (INCICh), it was proven that there is a longer surgical, extracorporeal circulation, and aortic clamp durations in the MICS intervention, but no statistically significant difference in global mortality. MICS was also associated with a shorter hospital stay and less surgical discomfort. MICS can be considered an alternative and equivalent approach to CS for patients undergoing aortic and mitral valve replacement surgery in the Mexican population.

Transforming healthcare performance monitoring - A cutting-edge approach with generalized additive profiles: GAMs for healthcare quality monitoring.

Recent findings indicate a growing trend in data analysis within healthcare using statistical process control. However, the diversity of variables involved necessitates the expansion of new process control methodologies. This study examined control chart applications in cardiology by using generalized additive models (GAMs) to construct profiles while involving multiple healthcare variables (08). Two distinct statistics: deviation (D), and Hotelling (T2) were employed for constructing control charts: a commonly used single-variable statistic for nonparametric profiles and an innovative multivariate statistic that assesses the contribution of each element to process changes. These statistics were tested for monitoring ischemic and hemorrhagic strokes in 1-year acute stroke (369) patients at the Faisalabad Institute of Cardiology. Demographic parameters (age, gender), vascular risk factors (diabetes, family history, sleep), socioeconomic variables (smoking, location), and blood pressure are included in the model. The research includes the computation of zero-state average run length (ARL) for assessing the performance of control charts. The characteristics of the proposed profile were analyzed, such as the T2 control chart, performing better than the D chart for medium-to-large shifts (δ ≥ 0.50). On the other hand, for small δ = 0.25, the D control chart produces smaller ARL values but more significant standard deviations. While both statistics contribute to profile monitoring, T2 is more effective at identifying and tracing medium and large shifts. In conclusion, such handy tools may aid healthcare performance monitoring, especially for complicated predictor-response relationships. Monitored profiles demonstrated that GAMs are useful for healthcare analysis and process monitoring.

Diagnostic and therapeutic differences in ST-segment elevation acute myocardial infarction according to sex

Introduction: Acute myocardial infarction (AMI) is a manifestation of coronary artery disease, a determinant of mortality for men and women in the fifth decade of life. Objective: To identify the differences in diagnostic and therapeutic tests according to sex in patients with ST-elevation myocardial infarction. Methods: quantitative, cross-sectional, retrospective investigation in 155 patients, 97 men and 58 women, admitted to Coronary Intensive Care, Institute of Cardiology and Cardiovascular Surgery with ST-segment elevation myocardial infarction, January 2020-December 2021. Variables related to diagnosis and treatment were explored. Results: on admission, more than 55% of the patients attended underwent reperfusion treatment, which was a very effective therapy in all cases. Women were more often reperfused by PCI (50 %) and men by thrombolysis (15.5 %). During hospitalization, 77.32 % of men required a second PCI and 52.6 % a PTCA, while 65.52 % of women and 43.10 % of men required a second PCI and 52.6 % a PTCA. 67.7 % (130 cases) with transthoracic ECHO performed were normal, the more severe degrees of involvement of the left ventricular ejection fraction was decreased. Conclusions: There were diagnostic and therapeutic differences according to sex. The left ventricular ejection fraction was more affected in men and a greater number of altered complements. It is necessary to improve the early identification and management of women with ST-segment elevation myocardial infarction

Sex differences in ST-segment elevation acute myocardial infarction

Introduction: Acute ST-segment elevation myocardial infarction constitutes a health problem in the world and in Cuba, with differences according to sex in clinical and laboratory findings, complications and therapeutic response. Objective: to identify sex differences in ST-segment elevation myocardial infarction. Methods: quantitative, cross-sectional, retrospective study of 155 patients, 97 men and 58 women, from the Coronary Intensive Care Unit of the Institute of Cardiology and Cardiovascular Surgery, from January 2020-December 2021. The following variables were explored: general, admission, hospitalization and complications. Results: the following were statistically significant: men developed infarction earlier than women (65±13 vs 71±11.9); of the known coronary risk factors, arterial hypertension predominated (61.3%); smoking prevailed in men (53%) and 54% of the patients with an anterior-extensive topographic location died (80% in men and 100% in women). In addition, there was a predominance of Killip-Kimball IV classification (15.5%), right coronary artery as the responsible vessel (29.9%), heart failure as a complication (26.8%) and death (15.5%) in men. However, in women, the anterior descending coronary artery prevailed as the vessel responsible for the lesion (34.4%). Conclusions: there are differences between men and women in age, risk factors and clinical manifestations of ST-segment elevation myocardial infarction. Women were more likely to present extensive anterior myocardial infarction, a topography that had a greater incidence of mortality as a complication

P104 MEDICAL TREATMENT IN PATIENTS WITH HEART FAILURE WITH REDUCED EJECTION FRACTION HOSPITALIZED AT RESEARCH INSTITUTE OF CARDIOLOGY DURING 1 YEAR (FROM SEPTEMBER 2022 TO SEPTEMBER 2023)

Objective: Patients with heart failure remain most challenging group of patients with cardiovascular diseases. Hospital period of these patients is important period of their life. Therefore evaluation of the level of in- hospital care and treatment options represents valuable information. Design and method: 477 patients (pts), 13% female,87% male with HFrEF hospitalized at Research Institute of Cardiology during 1 year (September 2022 – September 2023) represented study population. Consecutive patients’ data was extracted from the archive of Institute and evaluated. Results: Majority of pts had NYHA III-IV and mean ejection fraction (EF) of 35% (26-43%).Atrial fibrillation (AF) observed in 17,8% out of 477 pts. Myocardial infarction (MI) in anamnesis was in 82%. Systolic Blood Pressure (SBP) – mean 137 mm.Hg(min 80-max 240),Diastolic Blood Pressure(DBP) – mean 84 mm.Hg(min 50 – max 140).Arterial Hypertension(AH) had 61,4%. Type 2 Diabetes (T2D) – 51%.Chronic Kidney Disease had 22,9%.Pulmonary artery hypertension – 33%.Hb<12 g/l had 22,4%.ACE inhibitors or ARB mainly in form of fix combination with thiazide diuretics received 34% out of 477pts. ARNI were used in 27,7% of pts.B-blockers-55%. MRA – 89%. SGLT2 inh – 17,4%.Loop diuretics-86,2%.Digoxin-28,8%.Amiodarone – 22,9%.Ivabradine – 6%. Lab, tests: К+ mean 4,4 (2,9-6,2). Na+, mean 140,4 (133- 155). NT-proBNP, mean 2246.39 pg/ml (10.0-30000.0). Conclusion: In significant number of patients with HFrEF hospitalized to Research Institute of Cardiology during the period from September 2022- September 2023 medical therapy was almost adequately adherent to modern international guidelines on management of heart failure. In some cases’ limitations for indication because of low blood pressure, low eGFR and high serum kalium level took place.

COVID-19 in patients with pre-existing cardiovascular disease: a series of cases during the fourth epidemiologic wave in Mexico City

SARS-CoV-2 infection induces an immune response that causes excessive inflammation damaging cardiac tissue and vascular endothelium. The objective of this study is to review a series of cases of hospitalized patients with pre-existing cardiac disease to describe the clinical behavior and highlight the low frequency of morbidity and mortality. Retrospective study of 17 patients with a confirmed diagnosis of COVID-19 by polymerase chain reaction test or antigen test, a history of cardiovascular disease with or without comorbidities, and a history of at least one dose of the vaccine for COVID-19, during the period between December 30, 2021 and March 17, 2022 at the Ignacio Chávez National Institute of Cardiology in Mexico City. The most frequent cardiac pathology was acute myocardial infarction (31.25%) and the most common arrhythmia was atrial fibrillation (25%). The median number of days of hospital stay was 10 days (interquartile range: 4-14). Regarding the outcomes, 94% of the patients were discharged due to clinical improvement, and only one patient died during his hospitalization. It is crucial to continue investigating SARS-CoV-2 effects in patients pre-existing heart disease and in those with persistent symptoms after infection. This will allow the development of more effective strategies for the treatment and prevention of cardiovascular complications associated with COVID-19.

Vascular Reactivity during Cardiopulmonary Bypass in Patients at Punjab Institute of Cardiology and Shalamar Hospital Lahore, Pakistan

Background: The operative treatment of cardiac diseases remains associated with systemic inflammation and a suboptimal outcome in many patients. These inflammatory changes are manifested by systemic hypotension, myocardial failure, increased vascular permeability and consequent dysfunction of organs such as the lungs, gut and brain. In general terms, sympathetic innervations of the small arteries and arterioles allows vasoconstriction, thereby increasing resistance to blood flow, whereas innervations of the large arteries and veins decreases the volume in these vessels, resulting in the redistribution of blood volume. This study was conducted to determine the effect of vasodilator drugs on duration of vasodilatation in patients undergoing coronary artery bypass grafting (CABG) with Cardiopulmonary bypass (CPB).Methods: We evaluated prospectively the effect of vasodilator medications before CABG surgery on hemodynamic variables and use of vasoactive drugs. We studied 30 patients with good left ventricular function allocated randomly to continue vasodilator drugs before cardiac surgery. Arterial pressure, Cardiac output, systemic vascular resistance and use of vasoactive drugs were recorded during anaesthesia, perioperative and in the early postoperative period.Results: Patients who using vasodilator drugs before cardiac surgery had not significant relationship between vasodilator drugs and vessels reactivity (vasoconstriction & vasodilatation). However, these patients required more vasodilator drugs to control hypertension after CPB and in the early postoperative period.Conclusion: There was no difference in hypotension at the onset of CPB or in the use of vasodilator drugs before cardiac surgery. We conclude that vasodilator drugs before cardiac surgery did not have sufficient effect to be recommended routinely.

The Role of Alcohol Ablation Therapy in Hypertrophic Obstructive Cardiomyopathy Management

Objectives: The following study aims to investigate alcohol septal ablation’s (ASA) role in hypertrophic obstructive cardiomyopathy (HOCM) management, focusing on in-hospital outcomes, efficacy in reducing left ventricular outflow tract (LVOT) obstruction, and safety profiles. Methods: The study, conducted at the Institute of Cardiology, National Hospital of Sri Lanka, included a total of nine HOCM patients. Participants with exercise-induced symptoms, dyspnea/angina, and specific ventricular gradients were included; unidentified septal branches led to exclusion. Diagnostic assessments, including electrocardiogram, contrast echocardiography, and cardiac catheterization, confirmed HOCM. ASA procedures involved careful target septal branch selection, alcohol injection, and post-procedure care with temporary pacemaker monitoring. Results: The study population (N=9) comprised seven males and two females, with a mean age of 40. Pre- and post-ablation measurements showed 78% reduction in LVOT gradient. Immediate complications included chest pain (100%), while 22.2% developed complete heart block. Notably, no mortality occurred during the study. Conclusion: ASA proved safe and effective in managing HOCM, with significant mean reduction in post-ablation LVOT gradient (78%). Complications were generally minor, emphasizing ASA’s viability for symptomatic HOCM patients. While acknowledging the absence of randomized controlled trials comparing ASA with alternative techniques, this study contributes valuable insights to guide collaborative treatment decisions by specialists.

Prognostic echocardiographic parameters in hospitalized patients with pulmonary embolism

Pulmonary embolism (PE) is considered one of the most common cardiovascular diseases with considerable mortality. Echocardiography remains an important investigation in the evaluation of these patients, with some echocardiographic parameters playing an incremental role in prognostic evaluation.Objectives: To determine the spectrum of echocardiographic changes in patients hospitalized with pulmonary embolism at the Institute of Cardiology of the Republic of Moldova and to highlight parameters with significant prognostic value in relation to risk scores for mortality stratification in PE. Materials and methods: We prospectively enrolled 168 patients admitted to the Institute of Cardiology. All patients were evaluated by transthoracic echocardiography. Results: Parameters most associated with in-hospital mortality at 30 days were: right atrial area (RA) >18cm2 (p=0.007), tricuspid valve regurgitation (TR) grade (p=0.002), tissue systolic velocity of the anterior wall of the right ventricle (RV) (p=0.03), inferior vena cava diameter (p=0.04), RV/LV ratio >1.0 (p=0.04), and TAPSE/PSAP index <0.4 (p<0.008). Conclusions: Echocardiographic parameters such as tricuspid valve regurgitation grade, RA area, tissue systolic velocity of the anterior RV wall, TAPSE/PSAP index, and interventricular ratio have additive value in evaluating prognosis in patients with PE.

Long-term prognosis in patients with pulmonary embolism

Venous thromboembolism (VTE), clinically expressed as deep vein thrombosis (DVT) or pulmonary embolism (PE), is, globally, the third most common acute cardiovascular syndrome after myocardial infarction and stroke. Pulmonary embolism is associated with high morbidity and mortality. The long-term prognosis of these patients is insufficiently studied.Aim: To analyze mortality and clinical events at long-term follow-up in patients with confirmed PE. Material and methods: The study included 168 patients with PE, 53% men and 47% women, mean age 61.2±12.8 years, consecutively hospitalized in the Institute of Cardiology. Patients were classified into four risk groups according to the 2019 European Society of Cardiology Guidelines. Patients were followed-up for a mean period of 11.4±0.9 months. Results. During the study period died 23 people (13.7%), 8 of them during hospitalization and another 15 - after discharge from the hospital; in the latter, death occurred suddenly - in 4 cases (26.6%), it was due to cardiovascular causes- in 4 cases (26.6%), through cancer - in 5 (30%) people and from other causes - in 2 (13.3%) patients. Recurrent VTE was observed in 4 (2.5%) subjects, including PE - in 3 and DVT in 1 patient. During the surveillance period 4 (2.5%) patients developed stroke, 5 (3.1%) - acute myocardial infarction, 1 (0.2%) patient - another arterial event. Hemorrhagic complications suffered 20 patients. Chronic thromboembolic pulmonary hypertension was detected in 12.4% of people over 5.4±2.8 months after primary PE. Newly diagnosed cancer was observed in 2 (1.25%) people.Conclusions. The mortality rate in PE patients over an average period of 11.4±0.9 months was 13.7%, including 4.7% - in hospital and 8.9% - at long-term follow-up; in-hospital death was significantly higher in patients in the high and intermediate high risk category compared to those with intermediate-low and low risk and no statistically significant differences were established between these groups in the long-term mortality rate; the main cause of death in the hospital was PE, and during the surveillance period death from cardiovascular causes predominated, followed by death from cancer.

Developmental aspects of metabolic syndrome in children under treatment with gastrointestinal lipase inhibitors

Alongside the increasing trends in obesity rates, there is a documented rise in the prevalence of metabolic syndrome (MetS) in children, dictating that each component of MetS should be identified as early as possible;and the treatment goal consists of reducing obesity, managing metabolic complications, insulin resistance, and also addressing hypertension (HTN).Aim of the study. To determine risk factors, the role of certain proinflammatory markers (TNF α, hs-CRP), and adipokines (leptin, adiponectin) in the onset of MetS in children and their evolution under treatment with gastrointestinal lipase inhibitors (GLI). Material and methods. The presented results were obtained as part of a project within the State Program 2020-2023 titled “Evolutionary Aspects of Metabolic Syndrome in Children Under Treatment with Gastrointestinal Lipase Inhibitors”, project number 20.80009.8007.33. The study included 57 children with MS (IDF, 2007). Depending on the pharmacological therapy associated with non-pharmacological treatment, the children in the research were divided into 3 groups: Group I- 23 children who received orlistat (orlip) - GLI, Group II - 15 children who received Angiotensin Converting Enzyme Inhibitors (ACEIs), and Group III - 19 children who received both GLI and ACEIs. The control group consisted of 50 normotensive and normal-weight children of similar age (gender ratio: 1:1). Risk factors, body mass index (BMI), waist circumference (WC), blood pressure values, total cholesterol (TC), LDL-C, HDL-C, triglycerides (TG), basal glycemia (BG), serum insulin, TNFα, hs-CRP, leptin, and adiponectin were analyzed initially and at the 3-month interval.The study protocol was approved by the Medical Ethics Committee of the Institute of Cardiology, Republic of Moldova (minutes no.2 dated February 20, 2020).Results: The majority of children in the study had a history of hereditary aggravated HTN and obesity, were sedentary or moderately sedentary, and had poor dietary habits. Among the components of MetS (IDF, 2007) associated with abdominal obesity, the following predominated: hypertension in 38 (66.7%) children, hypertriglyceridemia - 32 (56.1%%) children, increased basal blood glucose (BG) - 17(29.8%) children and hypo-HDL-C - 11 (19.3%) children. BMI at the 3-month interval from the initiation of medication decreased most significantly in group I (-4.025±1.267 kg/ m2), followed by group II (-3.33±0.972 kg/m2), and III (-3.046±0.840 kg/m2). WC decreased most notably in group III (-10.63±3.732 cm) compared to group II (-9.167±1.783 cm) and group I (-4.700±2.352 cm). Similar trends were observed for blood pressure values: group III (-18.75±1.897 mm Hg) vs group II (-12.167±1.359 mm Hg) vs group I (-3.900±4.613 mm Hg). LDL-C decreased essentially in group II (-0.46±0.211 mmol/l), while TG decreased in group III (-0.77±0.325 mmol/l) and II (-0.53±0.112 mmol/l). HDL-C increased by +0.60±0.274 mmol/l in group I, by +0.15±0.066 mmol/l in group II, and by +0.12±0.031 mmol/l in group III. Serum insulin decreased predominantly in group III (-9.36±4.53 µU/ mL). Similar trends were observed for BG (group III -1.24±0.322 mmol/l). TNF α decreased most significantly in group III (-2.65±0.911 pg/ml) compared to group I (-1.24±0.508 pg/ml) and group II (-1.61±1.018 pg/ml). hs-CRP decreased mainly in group I (-0.69±0.785 mg/l) and group II (-0.74±0.593 mg/l) compared to group III (-0.42±0.617 mg/l). Leptin values decreased significantly in all study groups at the 3-month interval from the initiation of medication (group I by-8.80±3.64 ng/ml, group II by -10.92±4.084 ng/ml, group III by -9.75±6.172 ng/ml). Adiponectin values increased by+1.83±1.087 µg/L in group III of the study.Conclusion: In combination with a calorie-restricted diet, regular physical exercise, and behavioral modifications, treatment with ILG and ACEIs in children with MetS in the study contributed to a decrease in the degree of obesity, blood pressure values, and normalization of the lipid and glucose profile, respectively. Additionally, it highlighted both the importance of prevention, early detection, and management of obesity, as well as the causal link between obesity, hypertension, and chronic inflammation.

Effect of Maximal Exercise on the Heart Rate, Blood Pressure and Level of Cardiac Remolding in Elite Athletes

Aim / Objective: The purpose of this study was to determine how intense exercise effect the blood pressure, heart rate and the extent upto, which the cardiac remolding may occur in elite athletes. Location of Study: This study was conducted in the Department of Physiology, Army Medical College, along with the Armed Forces Institute of Cardiology (AFIC) in Rawalpindi. Methodology: There were 40 control participants and 40 elite endurance athletes. Clinical tests were performed on all the subjects to rule out an underlying medical condition or disease. Auscultatory method was used to measure the heart rate before exercise and immediately after exercise, Similarly the blood pressure was examined before and within 3 minutes after the physical activity. The left ventricular end-diastolic internal diameter (LVIDd), diastolic posterior wall thickness (PWTd), diastolic interventricular septal thickness (IVSTd), and left ventricular mass (LVM) were measured by echocardiography and determined using the Devereux formula. Before breakfast, the participants engaged in maximum physical activity on an electronic ergometer cycle until they were exhausted. Results: It was observed that when compared to the control group, the heart rates and blood pressure of athletes were noticeably lower. In contrast, LVIDd, IVSTd, PWTd, and LVM were higher in athletes than in healthy controls... Conclusion: The long term athletic training causes remodeling of the heart with increased dimensions of the left ventricle which reduces the heart rate and blood pressure in endurance trained athletes.

Prevalence of Fibromyalgia among Ischemic Heart Disease Patients in Lahore

Background: Fibromyalgia (FM) is a chronic pain disorder often coexisting with other conditions, complicating diagnosis, and management. Ischemic heart disease (IHD) patients may exhibit FM symptoms, which can affect their overall health and treatment outcomes. Understanding the prevalence and severity of FM in IHD patients can improve clinical approaches and patient care. Objective: To determine the prevalence of fibromyalgia among ischemic heart disease patients in Lahore and to assess the severity of associated somatic symptoms. Methods: This cross-sectional study included 158 participants diagnosed with ischemic heart disease, recruited through non-probability sampling from the Punjab Institute of Cardiology. The age range of participants was 30-60 years, with a mean age of 2.2595±0.75865. Both genders were included, with 62 males (39.2%) and 96 females (60.8%). Participants were categorized into three age groups for analysis. Data collection involved administering a fibromyalgia screening questionnaire to participants who provided informed consent. Exclusion criteria included diabetes, autoimmune diseases, immunosuppressive diseases, liver diseases, cancer, and history of substance abuse. Ethical approval was obtained according to the Declaration of Helsinki. Data were analyzed using SPSS version 25.0, with descriptive statistics (means, standard deviations, frequencies) and inferential statistics employed to explore associations between fibromyalgia and ischemic heart disease. Results: Among the 158 IHD patients, 61.4% reported fibromyalgia symptoms, while 38.6% did not. Fibromyalgia symptoms were reported in the upper extremities by 93.7% of patients, in the lower extremities by 86%, in the face by 50%, in the front areas by 64.6%, and in the upper and lower back by 61.4%. Additionally, 62.7% of IHD patients reported somatic symptoms beyond musculoskeletal pain. Severity of symptoms included 55% reporting moderate to extreme fatigue, 58% reporting moderate to extreme difficulty waking refreshed, and 30% reporting slight cognitive changes. Conclusion: The study identified a significant prevalence of fibromyalgia symptoms among ischemic heart disease patients, with considerable severity of symptoms and additional somatic complaints. These findings highlight the importance of screening for fibromyalgia in IHD patients to improve diagnosis and treatment strategies, ultimately enhancing patient outcomes.