Male Cardiac Patients Research Articles

Impact of gender on outcome of adult cardiac surgery

Background: Objective of the study was to identify differences in preoperative, intraoperative, and postoperative parameters between female and male cardiac surgical patients. Methods: This is a prospective observational analysis of adult cardiac surgical patients presenting for cardiac surgery at Queen Alia Heart Institute in the period between September 2023 and January 2024. Patients’ demographics, type of surgery (cardiac pathology), comorbidities, and perioperative, parameters were recorded and analysed. Males and females were compared according to their age at time of surgery, operative time, intensive care unit (ICU) stay, hospitalisation time and mortality. Male and female patients undergoing coronary surgery were compared. Results: Data from 166 adult cardiac surgical patients was analysed. They constituted 135 males and 31 females. Male to female ratio was 4.4:1. When considering all types of cardiac surgery, female patients had longer duration of hospitalisation (13.1 days) than males (11.5 days). Moreover, mortality was higher in the female subpopulation (12.9%) than the male subpopulation (8.1%). Only 14% of coronary artery bypass grafting (CABG) patients were females and they had higher in-hospital mortality (20%) versus 7.4% in males. Conclusions: Female patients present for CABG less commonly than males and at more advanced age. Mortality rates are higher in females and hospitalisation time is longer.

Days alive and out of hospital for adult female and male cardiac surgery patients: a population-based cohort study

BackgroundResearch shows women experience higher mortality than men after cardiac surgery but information on sex-differences during postoperative recovery is limited. Days alive and out of hospital (DAH) combines death, readmission and length of stay, and may better quantify sex-differences during recovery. This main objective is to evaluate (i) how DAH at 30-days varies between sex and surgical procedure, (ii) DAH responsiveness to patient and surgical complexity, and (iii) longer-term prognostic value of DAH.MethodsWe evaluated 111,430 patients (26% female) who underwent one of three types of cardiac surgery (isolated coronary artery bypass [CABG], isolated non-CABG, combination procedures) between 2009 – 2019. Primary outcome was DAH at 30 days (DAH30), secondary outcomes were DAH at 90 days (DAH90) and 180 days (DAH180). Data were stratified by sex and surgical group. Unadjusted and risk-adjusted analyses were conducted to determine the association of DAH with patient-, surgery-, and hospital-level characteristics. Patients were divided into two groups (below and above the 10th percentile) based on the number of days at DAH30. Proportion of patients below the 10th percentile at DAH30 that remained in this group at DAH90 and DAH180 were determined.ResultsDAH30 were lower for women compared to men (22 vs. 23 days), and seen across all surgical groups (isolated CABG 23 vs. 24, isolated non-CABG 22 vs. 23, combined surgeries 19 vs. 21 days). Clinical risk factors including multimorbidity, socioeconomic status and surgical complexity were associated with lower DAH30 values, but women showed lower values of DAH30 compared to men for many factors. Among patients in the lowest 10th percentile at DAH30, 80% of both females and males remained in the lowest 10th percentile at 90 days, while 72% of females and 76% males remained in that percentile at 180 days.ConclusionDAH is a responsive outcome to differences in patient and surgical risk factors. Further research is needed to identify new care pathways to reduce disparities in outcomes between male and female patients.

Investigating Gender Disparities in the Relationships between Psychological Hardiness and Subjective Well-being in Cardiac Patients: The Mediating Role of Resilience

Background: Health psychologists are constructively playing their role to help us know the causes of psychobiological disorders that affect human physical and psychological health Objective: The existing study was designed to investigate the gender differences among cardiac patients in terms of psychological hardiness, subjective well-being, and resilience in cardiac patients. Methods: Gender differences among cardiac patients were investigated using a cross-sectional study approach. The research comprised 75 cardiac patients (43 male and 32 female) ranging in age from 27 + to 65 years. Participants were briefed about the significance of the research, informed consent was obtained, and data were collected using valid, indigenously translated research instruments. Patient anonymity was maintained, and responses were evaluated using SPSS-23 and AMOS-20 statistical tools. Results: Results from the independent sample t-test revealed that male cardiac patients exhibited a significantly higher level of psychological hardiness (t=4.46, p<.05) and resilience (t=7.51, p<.05) compared to their female counterparts. However, the study found no statistically significant gender differences in subjective well-being. (t=.08, p>.05). Moreover, path analysis was conducted through structure equational modelling, unveiled that resilience played a significant role in the connection between psychological hardiness and subjective well-being in the patients (χ2=1.82, p<.05, RMSEA=.07, RMR=.20, CFI=.97, GFI=.98, and TLI=.93). The determined value of chi-square (χ2/pdf) 1.82 is acceptable for model fit indexes parameters. The multiple linear regression analysis findings revealed that resilience and psychological hardiness were significant (p<.05) predictors of subjective well-being in cardiac patients. Conclusion: This research emphasizes the vital role of psychological hardiness in cardiac patients' lives, showcasing its adaptive function. The study's findings will contribute to the existing literature, providing valuable guidance for medical professionals, health/clinical psychologists, and the families of patients. This information aims to enhance rehabilitation strategies and promote improved well-being for individuals with cardiac patients.

Small Differences in Vitamin D Levels between Male Cardiac Patients in Different Stages of Coronary Artery Disease.

Cardiovascular diseases are the main cause of mortality in males older than 65 years of age. The prevalent vitamin D deficiency in the worldwide population may have multiple effects on the cardiovascular system. This study sought to determine the association between serum levels of 25-hydroxyvitamin D (25(OH)D) and the stage of coronary artery disease (CAD) in Polish male subjects. Additionally, subjects with a history of myocardial infarction (MI) were analyzed for potential differences in 25(OH)D levels in comparison with those diagnosed with stable CAD. The study was conducted prospectively in a group of 669 male patients subjected to coronarography examination. CAD stage was defined using the Coronary Artery Surgery Study Score. Patients without significant coronary lesions had significantly higher 25(OH)D levels than patients with single-, double-, or triple-vessel disease (median, 17 vs. 15 ng/mL; p < 0.01). Significantly lower levels of 25(OH)D were apparent when MI was identified as the cause of the then-current hospitalization in comparison with stable CAD, as well as in patients with a history of MI; all of these cases had lower levels of 25(OH)D in comparison with patients with no such history. Male patients with single-, double-, or triple-vessel CAD, acute coronary syndrome, or a history of MI presented lower serum 25(OH)D.

Gender-related dynamics of exercise tolerance in patients with acute coronary syndrome undergoing the outpatient phase of rehabilitation

Background. The relevance of the comparative study of exercise tolerance in male and female cardiac patients is due to the need to individualize physical rehabilitation programs.&#x0D; Aims: to study the impact of gender on exercise tolerance in patients with acute coronary syndrome undergoing a course of rehabilitation in a day hospital.&#x0D; Methods. 110 patients with acute coronary syndrome were examined: 81 men (73.6%) aged 34 to 75 years and 29 women (26.4%) aged 44 to 74 years. In accordance with the purpose of the study, all patients were exposed to stress testing before and after the end of the three-week rehabilitation course.&#x0D; Results. According to the analysis of the six-minute walk test and the Bicycle ergometric test, men had better physical endurance than women. Features of hemodynamic indicators during physical activity also correlate with gender: in comparison with men, the maximum physical load in women was accompanied by higher heart rate values. At the end of the rehabilitation course, women had a more pronounced improvement of Bicycle ergometry indicators: a greater increase in maximum power and the percentage of load performed during the test.&#x0D; Conclusions. The gender differences in exercise tolerance in cardiac patients identified in the study should be taken into account when designing rehabilitation programs.

Relationship of Vitamin D Levels with Simultaneous Occurrence of Periodontal and Cardiac Diseases

Objective: To observe relationship of vitamin D levels with the severity of periodontal disease and also with the occurrence of cardiac diseases. Study design: A cross-sectional study. Place and duration of study: Nishtar institute of dentistry, Multan from March 5th, 2019 to December 1st, 2019. Methodology: Total 150 subjects were enrolled in the study, of which half were suffering from cardiac and periodontal diseases and one third were only affected by periodontitis. Twenty five subjects were normal. Vitamin D and calcium levels were recorded from the blood samples. Mean and standard deviation were calculated between the groups with 2 sample t- test using SPSS v.23.0. The significance of difference was taken at p?0.05. Results: Vitamin D levels were 24.98±4.53ng/ml and 41.95±1.42ng/ml in patients with high and low intensity of periodontal disease, rspectively (p=0.22). Calcium levels were 8.43±0.14nmol/L and 8.69±0.28nmol/L in patients with high and low intensity of periodontal disease, rspectively (p=0.437). Among the male cardiac patients, vitamin D levels were 20.96±2.39ng/ml and 41.67±4.78ng/ml in high and low severity of periodontal disease cases (p=0.002), whereas calcium levels were 8.03±0.30nmol/L and 8.95±0.77nmol/L in high and low severity of periodontal disease cases (p=0.075). Among the female cardiac patients, vitamin D levels were 17.5±4.93ng/ml and 21.55±18.12ng/ml (p=0.83), while calcium levels were 8.4±0.33nmol/L and 8.57±0.24nmol/L in high and low severity of periodontal disease cases, respectively (p=0.677).

The use of data science to analyse physiology of oxygen delivery in the extracorporeal circulation

BackgroundRecent scientific reports have brought into light a new concept of goal-directed perfusion (GDP) that aims to recreate physiological conditions in which the risk of end-organ malperfusion is minimalized. The aim of our study was to analyse patients’ interim physiology while on cardiopulmonary bypass based on the haemodynamic and tissue oxygen delivery measurements. We also aimed to create a universal formula that may help in further implementation of the GDP concept.MethodsWe retrospectively analysed patients operated on at the Wroclaw University Hospital between June 2017 and December 2018. Since our observations provided an extensive amount of data, including the patients’ demographics, surgery details and the perfusion-related data, the Data Science methodology was applied.ResultsA total of 272 (mean age 62.5 ± 12.4, 74% male) cardiac surgery patients were included in the study. To study the relationship between haemodynamic and tissue oxygen parameters, the data for three different values of DO2i (280 ml/min/m2, 330 ml/min/m2 and 380 ml/min/m2), were evaluated. Each set of those lines showed a descending function of CI in Hb concentration for the set DO2i.ConclusionsModern calculation tools make it possible to create a common data platform from a very large database. Using that methodology we created models of haemodynamic compounds describing tissue oxygen delivery. The obtained unique patterns may both allow the adaptation of the flow in relation to the patient’s unique morphology that changes in time and contribute to wider and safer implementation of perfusion strategy which has been tailored to every patient’s individual needs.

Mediators of gender effects on depression among cardiovascular disease patients in Palestine

BackgroundAmong patients suffering from coronary heart disease (CHD) and comorbid depression, women experience a higher burden compared to men. Little is known on the characteristics that differentiate men and women with both diseases and whether these factors mediate gender effects on depression. This study assessed whether women are more likely to suffer from depression and which characteristics mediate gender effects on depression among a cardiac population in Palestine, specifically addressing the role of post-traumatic stress disorder (PTSD).MethodsUsing a cross-sectional design, patients consecutively admitted with a CHD to one of the four main hospitals in Nablus, Palestine, were interviewed using a structured questionnaire with validated instruments. Data was also obtained from hospital medical records. Patients were assessed for depression using the Cardiac Depression Scale (CDS). Bivariate analysis was conducted to compare characteristics of women and men with and without depressive symptoms. Mediators (direct and indirect effects) of the association between gender and depression were evaluated using a structural equation model (SEM).ResultsWomen were more likely to suffer from severe depression than men (28.7% vs. 18.8%). Female gender was positively associated with higher PTSD symptoms, comorbidities, somatic symptoms and income, and with lower resilience, self-esteem, quality of life, education, prevalence of smoking and physical activity. Structural equation modeling revealed negative indirect effects of gender on depression (CDS score) through resilience, self-esteem and physical activity, whereas positive indirect effects of gender on depression were observed through PTSD, comorbidities, somatic symptoms and smoking. There was no direct effect of gender on depression.ConclusionThis study found a higher prevalence of severe depression in female patients with cardiac disease compared to male cardiac patients. Our findings provide novel information on mediating factors of the association between gender and depression among cardiac patients, in particular PTSD. The results emphasize the need for further research on potential mediating factors that could account for gender differences in depression and the need to provide support programs for female patients with comorbid CHD and depression to improve their psycho-social well-being.

Social inhibition in population-based and cardiac patient samples: Robustness of inhibition, sensitivity and withdrawal as distinct facets

ObjectiveBehavioral inhibition plays a key role in animal stress research and developmental research in children. Therefore, we examined the robustness of our multifaceted model of adult social inhibition that comprises behavioral inhibition, interpersonal sensitivity, and social withdrawal components. MethodA total of 899 adults completed the 15-item Social Inhibition Questionnaire (SIQ15) and measures of emotional distress. Confirmatory Factor Analysis (CFA), reliability estimates, and correlational and second-order factor analyses were used to examine the robustness of our model. ResultsCFA (RMSEA = 0.052; NFI = 0.938; CFI = 0.957) and Cronbach's α estimates ≥0.87 confirmed the robustness of our multi-facet social inhibition model based on three correlated inhibition, sensitivity, and withdrawal factors in 560 adults from the general population and in 194 undergraduate students. Inhibition, sensitivity, and withdrawal were stable over time (3-month test-retest correlations ≥ 0.78), and were closely related to the Gest Behavioral Inhibition and PID-5 Withdrawal measures in a clinical sample of 145 cardiac patients. Of note, male cardiac patients reported more inhibition and withdrawal than female patients. Across samples, social inhibition was distinctly different from negative affectivity. ConclusionsOur 3-facet model of inhibition, sensitivity and withdrawal was robust across samples, and may promote research on adult social inhibition in population-based and clinical studies.

ASSESSMENT OF POTENTIAL DRUG INTERACTIONS AMONG HOSPITALIZED PATIENTS AT THE CARDIAC AND PULMONARY DEPARTMENTS IN TERTIARY CARE HOSPITALS

Objective: The aim of this study was to assess the potential drug interactions among hospitalized patients in cardiac and pulmonary wards in three tertiary care hospitals.Methods: A prospective, observational study was carried out for 12 months. A sample of 1150 patients were assessed for potential drug-drug interactions (pDDIs) using Micromedex®- 2.7 and Drugs.com.Results: A total of 1150 patients were analyzed, and it was found that 685 were cardiac and 465 were pulmonary patients. The study identified 524 (76.49%) cardiac patients and 345 (74.19%) pulmonary patients, with pDDIs higher in male cardiac (298 [56.87%]) and male pulmonary (199 [57.68%]) patients, compared to females. Incidences of pDDIs were found to be higher in the age group of 60–70 years in cardiac (193 [36.83%]) and pulmonary (146 [42.31%]) patients and incidences of interactions based on duration of 4–6 days’ hospital stays in cardiac were 380 (72.53%) and 215 (62.31%) in pulmonary patients, respectively. Moreover, 51.90% of cardiac patients and 56.52% of pulmonary patients were found to be prescribed with more number of drugs (cardiac 7 drugs and pulmonary 5–6 drugs) causing higher incidences of pDDIs. Some of the most common drug interacting pair was aspirin and clopidogrel combination observed in 245 cardiac patients, whereas in the pulmonary department, it was ranitidine-theophylline combination with a frequency of 195 pDDIs. Drug-food interactions were found with atorvastatin–citrus fruits in cardiac and theophylline–caffeine in pulmonary patients. The most common drug-disease interaction was found to be isosorbide dinitrate–myocardial infarction in cardiac and diazepam–COPD in pulmonary, respectively.Conclusion: Pharmacists must take responsibility in the monitoring of drug interactions and notifying the physician and patient about potential problems. With their detailed knowledge of drugs, pharmacists have the ability to relate unexpected symptoms experienced by patients to possible adverse effects of their drug therapy.

Fabry Disease: prevalence of affected males and heterozygotes with pathogenic GLA mutations identified by screening renal, cardiac and stroke clinics, 1995–2017

BackgroundFabry Disease (FD), an X linked lysosomal storage disease due to pathogenic α-galactosidase A (GLA) mutations, results in two major subtypes, the early-onset Type 1 ‘Classic’ and the Type 2...

Is Serum Uric Acid Independently Associated With Left Ventricular Mass Index, Ejection Fraction, and B-Type Natriuretic Peptide Among Female and Male Cardiac Patients?

Mean serum uric acid (SUA) levels are higher in men than women. In addition, recent studies have suggested that the SUA threshold at which the cardiovascular risk might increase may vary between women and men. In the current retrospective study, by analyzing the data from 219 female and 519 male patients who were free from uric acid-lowering medication, we investigated whether SUA is associated with left ventricular mass index (LVMI), left ventricular ejection fraction (LVEF), and plasma levels of B-type natriuretic peptide (BNP) independent of confounding factors, such as serum calcium, inorganic phosphate, and fibroblast growth factor 23 (FGF23), in a gender-specific manner.In multivariate stepwise linear regression analysis in which age, blood pressure, eGFR, corrected calcium, inorganic phosphate, and FGF23 were entered as potential covariates, SUA was selected as a factor significantly associated with LVEF, LVMI, and plasma levels of BNP in both genders. On the other hand, however, after adding diuretic use as a potential covariate, the association between SUA and LVEF lost statistical significance in both genders, and that between SUA and BNP lost significance among female patients. These findings suggest that diuretic use is a non-negligible confounder in understanding the observed association between SUA and cardiac dysfunction and heart failure.In summary, SUA is associated with left ventricular hypertrophy independent of confounding factors including FGF23 and diuretic use in female and male patients. Whether lowering SUA can influence the progression of cardiac remodeling awaits further investigation.

Sexual health of male cardiac patients - present status and expectations of patients with coronary heart disease.

IntroductionDue to the pathogenetic association between erectile disorders and cardiovascular diseases, cardiologists consult many patients with erectile dysfunction (ED). The aim of the study was to evaluate sexual function in patients with coronary heart disease (CHD) and the use of sexual knowledge in cardiology practice, both current use and that expected by patients.Material and methodsOne thousand one hundred and thirty-six patients (average age: 60.73 ±9.20) underwent a dedicated survey which encompassed demographic data and the presence of modifiable ED risk factors. The presence of ED was assessed using the International Index of Erectile Function (IIEF-5) Questionnaire.ResultsSexual problems were discussed by cardiologists with 45 (3.96%) patients. The frequency of initiating the topic was significantly associated with the respondents’ education level (p = 0.0031); however, it was not associated with the patients’ age, duration of CHD, presence of ED, or modifiable risk factors. Four hundred and sixteen (36.62%) respondents indicated that they expect their cardiologist to take an interest in their ED. Nine hundred and twenty-six (81.51%) patients claimed good sexual function to be important or very important to them. Attitude to sexual function was significantly associated with age (p < 0.0001), duration of CHD (p = 0.0018), education (p = 0.0011), presence of ED (p = 0.0041), diabetes (p = 0.0283) and hyperlipidaemia (p = 0.0014).ConclusionsThe low frequency with which cardiologists initiate the topic of ED is in contrast to the expectations of patients with CHD. The majority of these patients regard good sexual maintenance as an important part of their life.

Association of Vitamin D Deficiency and Degree of Coronary Artery Disease in Cardiac Patients with Type 2 Diabetes.

Several modifiable factors may influence cardiac function in diabetic patients. The aim of the study was to evaluate the influence of vitamin D level on the stage of coronary atherosclerosis in cardiac patients diagnosed with type 2 diabetes. The study was performed in 337 consecutive patients undergoing coronarography. The stage of atherosclerosis was evaluated using Coronary Artery Surgery Study Score. The plasma 25(OH)D concentration was determined by an electrochemiluminescence method. Patients without significant lesions in coronary arteries presented the highest 25(OH)D level, significantly higher than patients with one-, two-, and three-vessel coronary artery disease (CAD) (p < 0.01). Significantly lower level of the 25(OH)D was observed in patients hospitalized due to acute coronary syndrome (ACS) in comparison to patients hospitalized due to stable CAD (p < 0.001). Lower 25(OH)D levels were observed in patients with the history of myocardial infarction (MI) in comparison to patients without previous MI (p < 0.001). In cardiac patients with diabetes, the higher number of stenotic coronary arteries is associated with lower values of the 25(OH)D. A group of male cardiac patients with diabetes with significant stenosis in three coronary arteries, hospitalized due to acute coronary syndrome, with a history of previous MI and hyperlipidemia presented the lowest vitamin D level.

Energy expenditure estimation in beta-blocker-medicated cardiac patients by combining heart rate and body movement data.

Accurate assessment of energy expenditure provides an opportunity to monitor physical activity during cardiac rehabilitation. However, the available assessment methods, based on the combination of heart rate (HR) and body movement data, are not applicable for patients using beta-blocker medication. Therefore, we developed an energy expenditure prediction model for beta-blocker-medicated cardiac rehabilitation patients. Sixteen male cardiac rehabilitation patients (age: 55.8 ± 7.3 years, weight: 93.1 ± 11.8 kg) underwent a physical activity protocol with 11 low- to moderate-intensity common daily life activities. Energy expenditure was assessed using a portable indirect calorimeter. HR and body movement data were recorded during the protocol using unobtrusive wearable devices. In addition, patients underwent a symptom-limited exercise test and resting metabolic rate assessment. Energy expenditure estimation models were developed using multivariate regression analyses based on HR and body movement data and/or patient characteristics. In addition, a HR-flex model was developed. The model combining HR and body movement data and patient characteristics showed the highest correlation and lowest error (r2 = 0.84, root mean squared error = 0.834 kcal/minute) with total energy expenditure. The method based on individual calibration data (HR-flex) showed lower accuracy (i2 = 0.83, root mean squared error = 0.992 kcal/minute). Our results show that combining HR and body movement data improves the accuracy of energy expenditure prediction models in cardiac patients, similar to methods that have been developed for healthy subjects. The proposed methodology does not require individual calibration and is based on the data that are available in clinical practice.

Sarcopenia and physical activity in older male cardiac patients

BackgroundThere is little information on the association of sarcopenia with physical activity in elderly cardiac patients.This study determined differences in physical activity and cutoff values for physical activity according to the presence or absence of sarcopenia in elderly male cardiac patients. Methods and resultsSixty-seven consecutive men aged ≥65 years with cardiac disease were enrolled. We defined sarcopenia using the European Working Group on Sarcopenia in Older People algorithm. Patients were divided into the sarcopenia group (n=25) and the non-sarcopenia group (n=42). In the patients with and without sarcopenia of physical activities were evaluated to determine cutoff values of physical activity. ResultsAfter adjusting for patient characteristics, both the average daily number of steps (3361.43±793.23 vs. 5991.55±583.57 steps, P=0.021) and the average daily energy expenditure of physical activity (71.84±22.19 vs. 154.57±16.18kcal, P=0.009) were significantly lower in the sarcopenia versus non-sarcopenia group. Receiver-operating characteristic analysis identified a cutoff value for steps of physical activity of 3551.80steps/day for 1 week, with a sensitivity of 0.73 and 1-specificity of 0.44 and a cutoff value for energy expenditure of physical activity of 85.17kcal/day for 1 week, with a sensitivity of 0.73 and 1-specificity of 0.27. ConclusionsPhysical activity in the male cardiac patients with sarcopenia was significantly lower than that in those without sarcopenia. The cutoff values reported here may be useful values to aid in the identification of elderly male cardiac patients with sarcopenia.

Respiratory muscle strength in relation to sarcopenia in elderly cardiac patients.

Little information exists on the relation between respiratory muscle strength such as maximum inspiratory muscle pressure (MIP) and sarcopenia in elderly cardiac patients. The present study aimed to determine the differences in MIP, and cutoff values for MIP according to sarcopenia in elderly cardiac patients. We enrolled 63 consecutive elderly male patients aged ≥65years with cardiac disease in this cross-sectional study. Sarcopenia was defined based on the European Working Group on Sarcopenia in Older People algorithm, and, accordingly, the patients were divided into two groups: the sarcopenia group (n=24) and non-sarcopenia group (n=39). The prevalence of sarcopenia in cardiac patients and MIP in the patients with and without sarcopenia were assessed to determine cutoff values of MIP. After adjustment for body mass index, the MIP in the sarcopenia group was significantly lower than that in the non-sarcopenia group (54.7±36.8cmH2O; 95% CI 42.5-72.6 vs. 80.7±34.7cmH2O; 95% CI 69.5-92.0; F=4.89, p=0.029). A receiver-operating characteristic curve analysis of patients with and without sarcopenia identified a cutoff value for MIP of 55.6cmH2O, with a sensitivity of 0.76, 1-specificity of 0.37, and AUC of 0.70 (95% CI 0.56-0.83; p=0.01) in the study patients. Compared with elderly cardiac patients without sarcopenia, MIP in those with sarcopenia may be negatively affected. The MIP cutoff value reported here may be a useful minimum target value for identifying elderly male cardiac patients with sarcopenia.

Relationship of thresholds of physical performance to nutritional status in older hospitalized male cardiac patients

Nutrition is the focus of a new treatment target in older hospitalized cardiac patients. However, little is known about the differences in nutritional status in relation to physical performance in these inpatients. We determined the differences in physical performance based on the Geriatric Nutritional Risk Index (GNRI) and physical performance cut-off values according to the GNRI in older male cardiac inpatients. We enrolled 251 Japanese male inpatients aged ≥65 years (mean age 74.7 years) with cardiac disease in the present cross-sectional study. We divided the patients into two groups according to GNRI: high-GNRI group (≥92 points; n=178) and low-GNRI group (<92 points; n=73). In-hospital physical performance as measured by handgrip strength (HG), knee extensor muscle strength (KEMS), gait speed (GS), and one-leg standing time (OLST) was assessed and compared between the two groups to determine cut-off values of physical performance. After adjustment for age, HG, KEMS, GS and OLST were significantly lower in the low-GNRI versus high-GNRI group. Cut-off values by receiver operating characteristic curve analysis were 25.75 kgf (area under the curve [AUC]=0.740; P<0.001) for HG strength, 46.1% for bodyweight (AUC=0.742; P<0.01) for KEMS, 1.45 m/s (AUC=0.782; P<0.01) for GS and 11.32 s (AUC=0.705; P<0.01) for OLST. The risk of poor nutrition, as shown by a low GNRI, could be a useful predictor of physical performance. The cut-off values determined in the present study might be expected minimum target values that can be attained by Japanese older male cardiac inpatients.

Pilot study of the effect of lipophilic vs. hydrophilic beta-adrenergic blockers being taken at time of intracardiac defibrillator discharge on subsequent PTSD symptoms

A pathophysiological model of posttraumatic stress disorder (PTSD) posits that an overly strong stress response at the time of the traumatic event leads to overconsolidation of the event’s memory in part through a central β-adrenergic mechanism. We hypothesized that the presence of a β-blocker in the patient’s brain at the time of the traumatic event would reduce the PTSD outcome by blocking this effect. The unpredictable, uncontrollable discharge of an implantable intracardiac defibrillator (ICD) is experienced by most patients as highly stressful, and it has previously been shown to be capable of causing PTSD symptoms. The present pilot study evaluated a convenience sample of 18 male cardiac patients who had been taking either a lipophilic β-blocker (which penetrates the blood-brain barrier) or a hydrophilic β-blocker (which does not) at the time of a discharge of their ICD. The self- report PTSD Checklist-Specific Version quantified 17 PTSD symptoms pertaining to the ICD discharge during the month preceding the evaluation. There was a statistical trend for patients who had been taking a lipophilic β-blocker at the time of the ICD discharge to have (35%) less severe PTSD symptoms than patients who had been taking a hydrophilic β-blocker (one-tailed p=0.07, g=0.64). Further, prospective, randomized, controlled studies are suggested.

Serum Uric Acid Is Associated with Left Ventricular Hypertrophy Independent of Serum Parathyroid Hormone in Male Cardiac Patients

BackgroundSeveral studies have shown that serum uric acid (UA) is associated with left ventricular (LV) hypertrophy. Serum levels of parathyroid hormone (PTH), which has bbe shown to be correlated with UA, is also known to be associated with cardiac hypertrophy; however, whether the association between UA and cardiac hypertrophy is independent of PTH remains unknown.PurposeWe investigated whether the relationship between serum uric acid (UA) and LV hypertrophy is independent of intact PTH and other calcium-phosphate metabolism-related factors in cardiac patients.Methods and ResultsIn a retrospective study, the association between UA and left ventricular mass index was assessed among 116 male cardiac patients (mean age 65±12 years) who were not taking UA lowering drugs. The median UA value was 5.9 mg/dL. Neither age nor body mass index differed significantly among the UA quartile groups. Patients with higher UA levels were more likely to be taking loop diuretics. UA showed a significant correlation with intact PTH (R = 0.34, P<0.001) but not with other calcium-phosphate metabolism-related factors. Linear regression analysis showed that log-transformed UA showed a significant association with left ventricular mass index, and this relationship was found to be significant exclusively in patients who were not taking loop and/or thiazide diuretics. Multivariate logistic regression analysis showed that log-transformed UA was independently associated with LV hypertrophy with an odds ratio of 2.79 (95% confidence interval 1.48–5.28, P = 0.002 per one standard deviation increase).ConclusionsAmong cardiac patients, serum UA was associated with LV hypertrophy, and this relationship was, at least in part, independent of intact PTH levels, which showed a significant correlation with UA in the same population.