Ischemic Heart Disease Patients Research Articles

Association of serum Sodium with mortality in patients of Congestive heart failure

Objectives: To determine the association of serum Sodium with mortality in patients of Congestive heart failure. Study Design: Prospective observational study Settings and Duration of study: Department of Medicine, Sir Ganga Ram Hospital, Lahore. ( 22-12-2021 to 22-6-2022 ). Methods: Sample size of 100 patients; 50 in each group in calculated with 90% power of study, 5% significance level and taking percentage of mortality i.e. 24.75% patients with low serum sodium level and in 4.21% patients with normal serum sodium level. Sample Selection: Inclusion Criteria: Patients aged between 30-70 years, both genders, Patients with congestive heart failure ,Group I: with serum sodium level <135 mEq/L, Group II: with serum sodium level ≥135 mEq/L. Exclusion Criteria: Liver disorders (AST>25IU, ALT>30IU, hepatitis B or C), renal disorders (eGFR ˂ 30 mL/min/1.73 m2 or creatinine >2.0mg/dl or on hemodialysis), any malignancy, anemia (Hb<9 g/dl), due to inherited hemoglobinopathy such as; sickle cell disease, and thalassemia, Patients with recurrent congestive heart failure or already taking treatment for deranged sodium level , valvular heart disease. Results: Patients in exposed group had 52% mortality rate as compared to unexposed group in which mortality rate was only 18% respective. Value of relative risk showed that patients in exposed group had 2.88 times higher chances of mortality as compared to those patients in unexposed group. Similarly, elderly patients (Relative Risk=3.23), Male patients (Relative Risk= 3.37), Overweight patients (Relative Risk=3.54), non-diabetic patients (Relative Risk=3.50), hypertensive patients (Relative Risk=2.95), ischemic heart disease patients (Relative Risk=4.12), Smoker (Relative risk=4.41) and duration of congestive HF as 0.5-3.5 (Relative Risk= 3.03) had higher risk for mortality. Conclusion: Results obtained from this study showed that low serum sodium level had significant impact on patients of congestive HF in terms of mortality. Keeping its prognostic importance, congestive HF patients should be strictly monitored for electrolyte imbalance. Key Words: Serum sodium, Prognostic, Indicator, Mortality,Congestive Heart Failure.

How to assess atherosclerotic plaque activity in ischemic heart disease patients?

How to assess atherosclerotic plaque activity in ischemic heart disease patients?

Assessment of the Level of Matrix Metalloproteinases, VEGF and MicroRNA-34a in Patients With Non-obstructive and Obstructive Lesions of the Coronary Arteries.

To assess the levels of matrix metalloproteinases (MMP), vascular endothelial growth factor (VEGF), and miRNA-34a expression in patients with ischemic heart disease (IHD) and obstructive and nonobstructive coronary artery (CA) disease. This cross-sectional observational study included 64 patients with IHD (diagnosis verified by coronary angiography or multislice computed tomography coronary angiography), of which 33 (51.6%) were men aged 64.9±8.1 years. 20 patients had nonobstructive CA disease (stenosis <50%), and 44 had hemodynamically significant stenoses. The control group consisted of 30 healthy volunteers. MMP-1, -9, -13, and -14, miRNA-34a, and VEGF were measured in all patients. The concentration of MMP-1 was significantly higher in patients with ischemia and nonobstructive CA disease (INOCAD) (p=0.016), and the concentration of MMP-9 was the highest in the group with obstructive CA disease (p<0.001). The concentrations of MMP-13 and MMP-14 did not differ significantly between the groups. The highest VEGF concentrations were observed in the INOCAD group (p<0.001). The expression of miRNA-34a significantly differed between the IHD groups with different types of CA disease and controls (p <0.001). Patients with hemodynamically significant stenosis showed moderate relationships between the concentrations of MMP-14 and VEGF (ρ=0.418; p=0.024), as well as between VEGF and miRNA-34a (ρ=0.425; p=0.022). Patients with INOCAD had a significant negative correlation between the concentrations of MMP-13 and VEGF (ρ= -0.659; p=0.003). Correlation analysis showed in all IHD patients a moderate relationship of the concentrations of MMP-1 and MMP-14 with VEGF (ρ=0.449; p=0.002 and p=0.341; p=0.019, respectively). According to ROC analysis, a MMP-9 concentration above 4.83 ng/ml can be a predictor for the presence of hemodynamically significant CA obstruction in IHD patients; a VEGF concentration higher than 27.23 pg/ml suggests the absence of hemodynamically significant CA stenosis. IHD patients with INOCAD had the greatest increase in MMP-1, whereas patients with obstructive CA disease had the highest level of MMP-9. According to our data, concentrations of MMP-9 and VEGF can be used to predict the degree of CA obstruction. The expression of miRNA-34a was significantly higher in IHD patients with INOCAD and CA obstruction than in the control group, which suggested a miRNA-34a contribution to the development and progression of coronary atherosclerosis. In the future, it may be possible to use this miRNA as a diagnostic marker for IHD.

Associiattiion of Cycllooxygenase 1 ((COX1)) Pollymorphiism att SNP RS1330344 wiitth Aspiiriin Resiisttance iin Pakiisttanii Pattiientts Of Ischemiic Heartt Diisease

Objective: To find an association between a single nucleotide polymorphism (SNP) rs1330344 in cyclooxygenase-1 gene with Aspirin resistance in patients with cardiovascular disease in the Pakistani population. Study Design: Cross-sectional study Place and Duration: Pharmacology Department, National University of Medical Sciences, Pakistan, in collaboration with the National Institute of Heart Diseases and Institute of Biomedical and Genetic Engineering Islamabad, Pakistan, from Oct 2018 to Dec 2021. Methodology: The Study was conducted on 384 patients (272 males and 112 females) with ischemic heart disease. Patients on Aspirin for at least seven days were selected. Platelet aggregation was performed using a Light Transmission Aggregatometer and arachidonic acid as an agonist. DNA extraction was done using the kit method (Invitrogen, Thermofisher). Then, Polymerase Chain Reaction, Restriction Fragment Length Polymorphism, and gel electrophoresis were used to identify SNP rs1330344. Results: In this study, 14.0% (n=54) and 86.0% (n=330) of ischemic heart disease patients were resistant to Aspirin and Aspirin, respectively. The genotyping of Cyclooxygenase 1, SNP rs1330344 showed 24.41% (n=94),17.56% (n=67), and 57.98% (n=223) patients had wild type allele (CC), homozygous (TT) and heterozygous (CT) genotype respectively. Gel electrophoresis results for allelic identification were correlated with the anti-platelet efficacy of Aspirin among ischemic heart disease patients. No association was found between a polymorphic form in SNP and the development of aspirin resistance. Conclusion: Aspirin resistance is not associated with any specific polymorphic form of Cyclooxygenase-1 at SNP rs1330344 in the Pakistani population.

Frequency of Coronary Artery Disease in Patients Undergoing Valvular Heart Surgery: A Retrospective Observational Study

Objectives: Valvular heart disease (VHD) significantly impacts patients' lives and often necessitates cardiac surgery. This study aimed to assess the frequency of ischemic heart disease in patients undergoing valvular heart surgery. Methodology: This observational study analyzed the records of 204 consecutive patients presenting to the Peshawar Institute of Cardiology between January 2021 and December 2022. All patients underwent screening angiography before surgery according to the American College of Cardiology (ACC) criteria. Results: Among the 204 patients studied, 57.4% were male, with a mean age of 53.16 ± 12.708 years. Hypertension was the most common comorbid condition (38.2%). Mitral valve pathology was the predominant indication for valvular surgery, while isolated aortic stenosis was the most common valvular lesion observed (25%). Out of the 204 patients who underwent screening angiography, 23% had significant coronary artery disease (CAD), defined as luminal narrowing >50%. Patients younger than 40 years had a lower prevalence of significant CAD (9.8%) compared to older patients (p = 0.003). Angiographic findings revealed single-vessel disease as the most common coronary lesion (16.7%), followed by double-vessel disease (12.7%), with triple-vessel disease observed in 5.4% of cases. Conclusion: The frequency of coronary artery disease was lower in patients younger than 40 years compared to older patients. Noninvasive investigations such as CT coronary angiography may serve as an alternative to invasive coronary angiography as a screening tool prior to cardiac surgery in older patients, if needed.

Contribution of high-technology procedures to public healthcare expenditures: the case of ischemic heart disease in Portugal, 2002-2015.

The magnitude of the impact of technological innovations on healthcare expenditure is unclear. This paper estimated the impact of high-technology procedures on public healthcare expenditure for patients with ischemic heart disease (IHD) in Portugal. The Blinder-Oaxaca decomposition method was applied to Portuguese NHS administrative data for IHD discharges during two periods, 2008-2015 vs. 2002-2007 (N = 434,870). We modelled per episode healthcare expenditures on the introduction of new technologies, adjusting for GDP, patient age, and comorbidities. The per episode healthcare expenditure was significantly higher in 2008-2015 compared to 2002-2007 for IHD discharges. The increase in the use of high-technology procedures contributed to 28.6% of this growth among all IHD patients, and to 18.4%, 6.8%, 11.1%, and 29.2% for acute myocardial infarction, unstable angina, stable angina, and other IHDs, respectively. Changes in the use of stents and embolic protection and/or coronary brachytherapy devices were the largest contributors to expenditure growth. High-technology procedures were confirmed as a key driver of public healthcare expenditure growth in Portugal, contributing to more than a quarter of this growth.

Characteristics of neurovegetative disorders in ischemic heart disease patients after coronavirus disease 2019 (COVID-19)

The aim of the study. To examine the frequency and spectrum of cognitive, anxiety-depressive, autonomic disorders and their interrelationship in patients with coronary heart disease (CHD) after COVID-19 infection. Materials and methods. The study involved 71 patients with CHD, stable angina pectoris FC II–III (age 69.0 [64.0; 76.0] years): group 1 (main) – 31 CHD patients after COVID-19; group 2 (comparison) – 40 CHD patients without COVID-19 history. Spectral and temporal HRV parameters were assessed using 24-hour Holter ECG monitoring, anxiety-depressive disorders (ADD) – using the HADS scale, cognitive status of patients – according to the MoCa scale. Results. CHD patients after COVID-19 had a higher frequency of ADD detection and a greater anxiety level (16 [10; 24] versus 10 [9; 13] points, p < 0.05), depression (14 [8; 20] versus 11 [10; 12] points, p < 0.05) as compared to patients without previous history of COVID-19. At the same time, the predominance of the anxiety component over the depressive one in patients of both groups has been revealed. In CHD patients after COVID-19, a decrease in the total MoCa scale score has been found as compared to patients without COVID-19: 24 [22; 26] versus 28 [26; 30] points, p < 0.05. There was an association between the total level of anxiety and depression and the severity of cognitive impairment (r = -0.36, p < 0.05). CHD patients exposed to COVID-19 showed an increased sympathetic and parasympathetic tone of the central nervous system within 24 hours, an increased LF/HF ratio during the active period, activation of slow-acting humoral regulation mechanisms amid increasing stress index and centralization index. In the group of patients with CHD after COVID-19, a wide range of correlations between the rate of ADD, cognitive disorders and HRV parameters has been found. Conclusions. Patients with coronary heart disease recovered from COVID-19 have shown an increase in the incidence and degree of ADD and cognitive disorder manifestations which was accompanied by autonomic dysfunction resulting in stress on the functional and adaptive state of the cardiovascular system. The association between ADD, autonomic and cognitive disorders in patients with coronary heart disease after COVID-19 has confirmed the common pathogenetic links of the disorders found.

Machine learning to identify a composite indicator to predict cardiac death in ischemic heart disease

BackgroundMachine learning (ML) employs algorithms that learn from data, building models with the potential to predict events by aggregating a large number of variables and assessing their complex interactions. The aim of this study is to assess ML potential in identifying patients with ischemic heart disease (IHD) at high risk of cardiac death (CD). Methods3987 (mean age 68 ± 11) hospitalized IHD patients were enrolled. We implemented and compared various ML models and their combination into ensembles. Model output constitutes a new ML indicator to be employed for stratification. Primary variable importance was assessed with ablation tests. ResultsAn ensemble classifier combining three ML models achieved the best performance to predict CD (AUROC of 0.830, F1-macro of 0.726). ML indicator use through Cox survival analysis outperformed the 18 variables individually, producing a better stratification compared to standard multivariate analysis (improvement of ∼20%). Patients in the low risk group defined through ML indicator had a significantly higher survival (88.8% versus 29.1%). The main variables identified were Dyslipidemia, LVEF, Previous CABG, Diabetes, Previous Myocardial Infarction, Smoke, Documented resting or exertional ischemia, with an AUROC of 0.791 and an F1-score of 0.674, lower than that of 18 variables. Both code and clinical data are freely available with this article. ConclusionML may allow a faster, low-cost and reliable evaluation of IHD patient prognosis by inclusion of more predictors and identification of those more significant, improving outcome prediction towards the development of precision medicine in this clinical field.

Non-HDL cholesterol and residual cardiovascular risk in statin-treated patients with and without diabetes: The Western Denmark Heart Registry.

Assessment of residual cardiovascular risk in statin-treated patients with atherosclerotic cardiovascular disease (ASCVD) is pivotal for optimising secondary preventive therapies. This study investigates if non-high-density lipoprotein cholesterol (non-HDL-C) is associated with residual ASCVD risk in statin-treated ischemic heart disease (IHD) patients with and without diabetes. Using the Western Denmark Heart Registry, we identified statin-treated patients with IHD examined by coronary angiography (CAG) from 2011-2020. Non-HDL-C was assessed within one year after CAG. Outcomes were ASCVD (myocardial infarction, ischemic stroke, and cardiovascular death) and all-cause death. Cox regression analyses obtained hazard ratios adjusted for age, sex, smoking, and hypertension. A total of 42,057 patients were included; 8,196 patients with diabetes and 33,861 without diabetes. During median 4.6 years of follow-up event rates per 1000 person-years of ASCVD were 28.8 (27.1-30.5) and 17.2 (16.5-17.8) among patients with and without diabetes. In patients with diabetes the adjusted hazard ratios (HR) of ASCVD as compared with non-HDL-C <25th percentile were 1.0 (0.9-1.2), 1.3 (1.1-1.6), and 1.6 (1.2-2.1) for patients in the 25th-74th, 75th-94th, and ≥95th percentile. In patients without diabetes corresponding adjusted HRs were 1.1 (0.9-1.1), 1.2 (1.1-1.4), and 1.7 (1.4-2.0). Results were consistent across sex, age, clinical presentation, and low-density lipoprotein cholesterol strata. In statin-treated IHD patients with and without diabetes non-HDL-C, especially above the 75th percentile, is associated with residual cardiovascular risk. These results have implications for secondary prevention targeting patients who may benefit most from intensified preventive therapy.

Differences in Attitudes and Barriers Towards Advance Care Planning Amongst Ischemic Heart Disease Patients: A Cross-Sectional Study.

Perceptions towards advanced care planning (ACP) amongst individuals with Ischemic Heart Disease before or after a life-threatening Acute Myocardial Infarction event is underexamined and could impact the appropriate timing for ACP advocacy. This cross-sectional study assessed awareness and intentions regarding ACP in individuals with Ischemic Heart Disease, both before and after an Acute Myocardial Infarction, and explored the motivating effect of a near-fatal Acute Myocardial Infarction event on its engagement. This study was conducted from 24 August 2021 through 13 March 2023, whereby patients were administered a one-time questionnaire with no follow-up required. Patients with either chronic Ischemic Heart Disease (group A) or a recent Acute Myocardial Infarction event (group B) were recruited from the outpatient National University Heart Centre, Singapore. 101 patients (n = 51 for Group A, n = 50 for Group B) were recruited. Mean age (SD) was 59 (10.5) years and 84 were male (83.2%). Between both groups, patients in group B reported significantly higher scores on 'Lack of information' and 'Self-efficacy' domains, and had no ACP awareness nor plans of doing an ACP compared to group A. ACP awareness was the sole significant predictor of intentions of doing an ACP in the final regression model (P < .05). Interestingly, this study suggests that surviving a potentially life-threatening heart condition did not result in higher intention of doing an ACP. Thus, advocacy of ACP in the community should simply start by raising awareness levels widely and may not need to be focused on individuals' state of health.

A novel preliminary metabolomic panel for IHD diagnostics and pathogenesis

Cardiovascular disease (CVD) represents one of the main causes of mortality worldwide and nearly a half of it is related to ischemic heart disease (IHD). The article represents a comprehensive study on the diagnostics of IHD through the targeted metabolomic profiling and machine learning techniques. A total of 112 subjects were enrolled in the study, consisting of 76 IHD patients and 36 non-CVD subjects. Metabolomic profiling was conducted, involving the quantitative analysis of 87 endogenous metabolites in plasma. A novel regression method of age-adjustment correction of metabolomics data was developed. We identified 36 significantly changed metabolites which included increased cystathionine and dimethylglycine and the decreased ADMA and arginine. Tryptophan catabolism pathways showed significant alterations with increased levels of serotonin, intermediates of the kynurenine pathway and decreased intermediates of indole pathway. Amino acid profiles indicated elevated branched-chain amino acids and increased amino acid ratios. Short-chain acylcarnitines were reduced, while long-chain acylcarnitines were elevated. Based on these metabolites data, machine learning algorithms: logistic regression, support vector machine, decision trees, random forest, and gradient boosting, were used for IHD diagnostic models. Random forest demonstrated the highest accuracy with an AUC of 0.98. The metabolites Norepinephrine; Xanthurenic acid; Anthranilic acid; Serotonin; C6-DC; C14-OH; C16; C16-OH; GSG; Phenylalanine and Methionine were found to be significant and may serve as a novel preliminary panel for IHD diagnostics. Further studies are needed to confirm these findings.

Retrospective Evaluation of Risk Factors for Ischemic Heart Disease in Patients with Dermatitis Herpetiformis

Background and Purpose: Some have proposed that the cardiovascular risk among individuals with DH differs from that of the general population. This study aimed to analyze cardiovascular risk factors in DH patients and compare them to a matched control group without DH or celiac disease.&#x0D; &#x0D; Methods: This was a retrospective hospital-based study involving patients diagnosed with DH, both clinically and histopathologically, along with age- and sex-matched control subjects without the disease. The presence of ischemic heart disease, and the risk factors including laboratory values, treatment and comorbidity histories were evaluated comparatively. (SPSS version 28.0). &#x0D; &#x0D; Results: Thirty-five patients with DH and 49 controls were included. No significant difference was found between the DH patients and controls regarding the prevalence of ischemic heart disease (22.9% vs. 14.3%, p:0.312). Diabetes mellitus was significantly higher and HDL cholesterol levels were significantly lower in the DH group (respectively, p: 0.044 and p: 0.018). Celiac autoantibodies, the laboratory values, or treatments did not show any significant correlation with heart disease in DH.&#x0D; &#x0D; Conclusion: This study revealed that HDL cholesterol were significantly lower in DH patients compared to general population. More research is needed to optimize the cardiovascular health of DH patients.

GCN5L1-mediated acetylation prevents Rictor degradation in cardiac cells after hypoxic stress

Cardiomyocyte apoptosis and cardiac fibrosis are the leading causes of mortality in patients with ischemic heart disease. As such, these processes represent potential therapeutic targets to treat heart failure resulting from ischemic insult. We previously demonstrated that the mitochondrial acetyltransferase protein GCN5L1 regulates cardiomyocyte cytoprotective signaling in ischemia-reperfusion injury in vivo and hypoxia-reoxygenation injury in vitro. The current study investigated the mechanism underlying GCN5L1-mediated regulation of the Akt/mTORC2 cardioprotective signaling pathway. Rictor protein levels in cardiac tissues from human ischemic heart disease patients were significantly decreased relative to non-ischemic controls. Rictor protein levels were similarly decreased in cardiac AC16 cells following hypoxic stress, while mRNA levels remained unchanged. The reduction in Rictor protein levels after hypoxia was enhanced by the knockdown of GCN5L1, and was blocked by GCN5L1 overexpression. These findings correlated with changes in Rictor lysine acetylation, which were mediated by GCN5L1 acetyltransferase activity. Rictor degradation was regulated by proteasomal activity, which was antagonized by increased Rictor acetylation. Finally, we found that GCN5L1 knockdown restricted cytoprotective Akt signaling, in conjunction with decreased mTOR abundance and activity. In summary, these studies suggest that GCN5L1 promotes cardioprotective Akt/mTORC2 signaling by maintaining Rictor protein levels through enhanced lysine acetylation.

Induced Pluripotent Stem Cell-Derived Cardiomyocytes Therapy for Ischemic Heart Disease in Animal Model: A Meta-Analysis.

Ischemic heart disease (IHD) poses a significant challenge in cardiovascular health, with current treatments showing limited success. Induced pluripotent derived-cardiomyocyte (iPSC-CM) therapy within regenerative medicine offers potential for IHD patients, although its clinical impacts remain uncertain. This study utilizes meta-analysis to assess iPSC-CM outcomes in terms of efficacy and safety in IHD animal model studies. A meta-analysis encompassing PUBMED, ScienceDirect, Web of Science, and the Cochrane Library databases, from inception until October 2023, investigated iPSC therapy effects on cardiac function and safety outcomes. Among 51 eligible studies involving 1012 animals, despite substantial heterogeneity, the iPSC-CM transplantation improved left ventricular ejection fraction (LVEF) by 8.23% (95% CI, 7.15 to 9.32%; p < 0.001) compared to control groups. Additionally, cell-based treatment reduced the left ventricle fibrosis area and showed a tendency to reduce left ventricular end-systolic volume (LVESV) and end-diastolic volume (LVEDV). No significant differences emerged in mortality and arrhythmia risk between iPSC-CM treatment and control groups. In conclusion, this meta-analysis indicates iPSC-CM therapy's promise as a safe and beneficial intervention for enhancing heart function in IHD. However, due to observed heterogeneity, the efficacy of this treatment must be further explored through large randomized controlled trials based on rigorous research design.

Cardiovascular diseases burden attributed to low physical activity in China, 1990-2019

Objective: To analyze the burden of cardiovascular disease (CVD) attributed to low physical activity (LPA) and its changing trends in China from 1990 to 2019. Methods: On the basis of the province results of the Study of Global Burden of Disease 2019 in China, we described the distribution of CVD death and disability-adjusted life year (DALY) attributed to LPA by sex, age and province. Joinpoint 4.9.1.0 was used to calculate the average annual percentage change. Results: In 2019, the number of CVD deaths and DALY attributed to LPA in people aged ≥25 years were 0.127 million and 1.863 million person-years in China, respectively, The age-standardized mortality rate (ASMR) and standardized DALY rate of CVD attributed to LPA were slightly higher in men than in women, and much higher in ischemic heart disease patients than in ischemic stroke patients. The ASMR (8.85/100 000) and the standardized DALY rate (112.34/100 000) of CVD attributed to LPA in China in 2019 showed no obvious change compared with 1990, while decreased in the last decade. The largest increases in the mortality rate and DALY rate were observed in people aged ≥75 years from 1990 to 2019 (26.89%, 15.61%), but the mortality rate and DALY rate in people aged 60-74 years showed a decreasing trend. The mortality rate and DALY rate in men aged 25- 44 years showed the largest increases (37.50%, 35.49%), while women aged ≥75 years had the largest increases (31.00%, 18.02%). In 2019, the highest ASMR and standardized DALY rate of CVD attributed to LPA were found in Jilin, Inner Mongolia and Hebei. The largest increases were found in Qinghai (182.41%, 154.70%), Gansu (181.29%, 152.77%), and Chongqing (132.01%, 102.79%) and the largest decreases were found in Beijing (59.11%, 62.09%), Macau (41.89%, 39.37%) and Guangdong (36.93%, 40.72%) from 1990 to 2019. Conclusion: The disease burden of CVD attributed to LPA in China was quite high and showed gender, age and area specific differences.

Evaluation of Iron Profiles and Coagulation Profiles in Ischemic Heart Diseases Patients in Elmek Nimir Hospital, Sudan

Background: Ischemic heart disease (IHD) is a constellation of diseases that includes stable angina, unstable angina, myocardial infarction, and sudden cardiac death. It belongs to the group of cardiovascular diseases and is the most common type among them. Iron is an essential trace element. It plays an important role in maintaining various cellular functions and enzymatic reactions. On the other hand, excessive intake of iron is known to be a risk factor for the progression of atherosclerosis. Abnormal iron deposition in the heart causes hemochromatosis and dilated cardiomyopathy, which leads to ischemic heart disease. Objective: This study aims to investigate the role of serum iron, serum ferritin, total iron-binding capacity (TIBC), PT, and PTT in ischemic heart disease (IHD) and their relationship with other risk factors for IHD. Methods: This is a prospective, case-control, cross-sectional analytical study conducted at Elmek Nimir University Hospital, Shendi City, to assess the iron profile and coagulation profile of patients with ischemic heart disease. The study included (30) patients diagnosed with ischemic heart disease and the study group was compared with the mean of the control group (20). Serum iron, ferritin, and TIBC were estimated using a spectrophotometer, and PT and PTT were estimated using manual methods. Data were collected using a structured personal questionnaire and the program (SPSS) version (11.5) was used for data analysis. Results: In this study, patients with ischemic heart disease were (40%) male and (60%) female. In this study, iron averaged (41.0) ug/dl (P. value 0.010), ferritin averaged (233.0) ug/dl (P. value 0.000), and TIBC averaged (44.0) µg/dl. Was shown. (P. value 0.000) compared to mean controls (27.0), (162.0), (56.0). A significant difference was found between the iron profile and his IHD. This study showed the mean PT, PTT for cases (13.4), (40.4) (P-value 0.024), (P. value 0.009) compared with the mean for controls (12.0), (35.1). A significant difference was found between the coagulation profile and IHD. Conclusions: This study concluded that serum levels of iron, ferritin, TIBC, PT, and PTT may be associated with Ischemic heart disease.

Interrupting Effect of Social Distancing on Ischemic Heart Disease, Asthma, Stroke, and Suicide Attempt Patients by PM2.5 Exposure.

This study aimed to examine the interrupting effect of social distancing (SD) on emergency department (ED) patients with ischemic heart disease (IHD), stroke, asthma, and suicide attempts by PM2.5 exposure in eight Korean megacities from 2017 to 2020. The study used National Emergency Department Information System and AirKorea data. A total of 469014 patients visited EDs from 2017 to 2020. Interrupted time series analysis was employed to examine changes in the level and slope of the time series, relative risk, and confidence intervals (CIs) by PM2.5 exposure. The SD level was added to the sensitivity analysis. The interrupted time series analysis demonstrated a significant increase in the ratio of relative risk (RRR) of IHD patients in Seoul (RRR=1.004, 95% CI: 1.001, 1.006) and Busan (RRR=1.007, 95% CI: 1.002, 1.012) post-SD. Regarding stroke, only patients in Seoul exhibited a significant decrease post-SD (RRR=0.995, 95% CI: 0.991, 0.999). No significant changes were observed for asthma in any of the cities. In the case of suicide attempts, Ulsan demonstrated substantial pre-SD (RR=0.827, 95% CI: 0.732, 0.935) and post-SD (RRR=1.200, 95% CI: 1.057, 1.362) differences. While the interrupting effect of SD was not as pronounced as anticipated, this study did validate the effectiveness of SD in modifying health behaviors and minimizing avoidable visits to EDs in addition to curtailing the occurrence of infectious diseases.

Preoperative Anemia as a Negative Risk Factor for Coronary Artery Bypass Grafting Surgery: A Retrospective Study

OBJECTIVES The objective of this study is to check the effects of Anemia on mortality and morbidity in patients having ischemic heart disease and undergoing coronary artery bypass graft surgery (CABG). METHODOLOGY The study involved all the patients who underwent isolated coronary artery bypass graft surgery from July 2019 to December 2022. The clinical data of patients was retrospectively collected from the departmental data pool and was then analyzed using the chi-square test and t-test. A p-value of less than 0.05 was considered significant. RESULTSThe study included 2570 patients who underwent isolated CABG; 78.2% of patients were males with a mean age of 57.87±9.20. Hypertension was the most common comorbidity (68.9%), followed by dyslipidemia (53.7%) &amp; Diabetes mellitus (49.9%). The preoperative mean hematocrit was 30.05±17.85. Of these 2570 patients, 52.37% were anaemic with a mean age of 58.69±9.05. Anemic patients had a significantly higher rate of IABP insertion (P 0.02) and intra-operative blood product transfusion (P &lt;0.001). Anemic patients had a significantly higher incidence of in-hospital mortality (P 0.04) and a higher rate of postoperative blood product transfusion (P &lt;0.001). There is no significant difference in terms of prolonged ventilation, reintubation, or readmission to ICU; however, nonanemic patients have a significantly higher rate of re-opening for bleeding/ tamponade (P 0.01). CONCLUSION Preoperative anaemia increases the mortality and morbidity in ischemic heart disease patients undergoing coronary artery bypass grafting. To improve the outcomes in CABG surgery, preoperative anaemia should be thoroughly investigated and treated to improve the outcomes of surgery.

Treatment-related cardiovascular events in patients with non-small cell lung cancer: Evidence from real-world data with a competing risks approach.

Understanding cancer treatment-related cardiovascular (CV) events is important for cancer care; however, comprehensive evaluation of CV events in patients with lung cancer is limited. This study aimed to assess the cumulative incidence and associated risks of various CV event types in patients with non-small cell lung cancer (NSCLC). A total of 7868 individuals aged 40years and older, recently diagnosed with NSCLC (2007-2018), were assessed with data obtained from the National Cancer Center, Korea. This study included nine types of CV events. A 2-year cumulative incidence function (CIF) of CV events was estimated, with death as a competing event. The associated risks were assessed by subdistribution hazard ratio (sHR) in the Fine-Gray competing risks model. CV events were observed in 7.8% of patients with NSCLC, with the most frequently observed types being atrial fibrillation and flutter (AF) (2.7%), venous thromboembolic disease (2.0%), and cerebrovascular disease (CeVD) (1.5%). Overall, all CV events were highest in the group treated with systemic therapy (CIF, 10.6%; 95% confidence interval [CI], 9.5%-11.8%), followed by those treated with surgery (CIF, 10.0%; 95% CI, 8.6%-11.6%); the incidence of AF (CIF, 5.7%; 95% CI, 4.6%-7.0%) was highest in patients treated with surgery. Individuals treated with systemic therapy were found to exhibit a higher CeVD risk than those treated with surgery (sHR, 4.12; 95% CI, 1.66-10.23). Among the patients who underwent surgery, those with lobectomy and pneumonectomy had a higher AF risk (vs. wedge resection/segmentectomy; sHR, 7.79; 95% CI, 1.87-32.42; sHR, 8.10; 95% CI, 1.60-40.89). These findings revealed treatment-related CV event risks in patients with NSCLC, which suggests that the risk of AF in surgery and CeVD in systemic therapy should be paid more attention to achieve a better prognosis and improve cancer survivorship outcomes. Atrial fibrillation and flutter (AF) is the most common cardiovascular event, particularly at a high risk in patients with non-small cell lung cancer (NSCLC) undergoing surgery. Patients receiving surgery with poor performance status, diagnosed with regional stage, and undergoing lobectomy or pneumonectomy are at a high risk of AF. Systemic/radiotherapy is associated with cerebrovascular and ischemic heart disease in patients with NSCLC.

ANGIOGRAPHIC FINDINGS IN PATIENTS PRESENTING WITH CHEST PAIN IN EASTERN ZONE OF AFGHANISTAN

Aim: Coronary artery disease is the leading cause of mortality and morbidity globally. Its diagnosis starts with workup of routine examinations and is confirmed by coronary angiography. The main purpose of the study was to find out angiographic findings in patients presenting with chest pain with or without electrocardiogram abnormalities.&#x0D; Methods: It was a retrospective descriptive single setting hospital based study conducted at Afghan Momand Medical complex, a tertiary care center in Nangarhar, Afghanistan. The study included 372 patients with chest pain with or without electrocardiogram abnormalities.&#x0D; Results: Mean age of the study population was 56.6 ± 11.7 years. 50 (13.4%) patients with chest pain had normal coronary angiography (CAG) while 64 (17.2%) patient had non critical CAG and the rest had significant disease on CAG described as64 (17.2%) patients had single vessel disease (SVD) while 40 (10.8%)had double vessel disease (DVD) and the rest 82 (22%) had triple vessel disease (TVD). Left anterior descending coronary artery was the leading involved artery (206, 45%) followed by right coronary artery (133, 29%) and left circumflex (119, 26%) respectively. Incidences of TVD increased with increasing age as it was not involved in the lowest two age groups (0. 0%) while it was in involved in 24 (29.3%), 33 (40.2%), and 15 (18.3%) in the age groups 50-59, 60-69, and 70 through highest age groups respectively.&#x0D; Conclusion: We concluded that coronary angiography precisely prescribed is a gold standard investigation to find out ischemic heart disease in patients with chest pain and/or electrocardiogram abnormalities. In fact, left anterior descending coronary artery was the most leading diseased artery in the forms of both single vessel disease and multiple vessel disease. Moreover, prevalence of triple vessel disease significantly increased with increasing age. Angioplasty was a matter of concern which needs to be evaluated with further researches about why some patients with single vessel disease did not undergo subsequent angioplasty and some with triple vessel disease underwent angioplasty.