Occurrence Of Adverse Cardiovascular Events Research Articles

Sex differences in delay times in ST-segment elevation myocardial infarction: A cohort study

BackgroundThe present study analyzes a cohort of consecutive patients with ST-segment elevation acute myocardial infarction (STEMI), evaluating the ischemia–reperfusion times from the perspective of gender differences (females versus males), with a long-term follow-up. MethodsSingle-center analytical cohort study of patients with STEMI in a tertiary hospital, between January 2015 and December 2020. ResultsA total of 2668 patients were included, 2002 (75%) men and 666 (25%) women. The time elapsed from the onset of symptoms to the opening of the artery was 197min (IQR 140–300) vs 220min (IQR 152–340), p=0.004 in men and women respectively. A delay in health care significantly impacts the occurrence of cardiovascular adverse events at follow-up, HR 1.34 [95%CI 1.06–1.70]; p=0.015. ConclusionsWomen took longer to go to health care services and had a longer delay both in the diagnosis of STEMI and in coronary reperfusion. It is imperative to emphasize the necessity of educating women about the recognition of ischemic heart disease symptoms, empowering them to raise early alarms and seek timely medical attention.

The Impact of Patient Adherence to Dual Antiplatelet Medication Following Percutaneous Coronary Intervention on the Occurrence of Adverse Cardiovascular Events.

The objective of this study is to examine the impact of medication adherence on the timing of non-cardiovascular serious events (NCDS) onset in patients with acute coronary syndrome (ACS) after percutaneous coronary intervention (PCI). This prospective study was conducted at a single center and involved 220 ACS patients who underwent sequential PCI with stenting. The Morisky Green Levine Medication Adherence Scale was employed to assess adherence to dual antiplatelet therapy (DAPT) and its impact on NCDS occurrence. Early in their hospitalization, all patients received education at the Coronary Heart Disease School. The survival rates of patients in both the main group and a control group (n=355) were subsequently evaluated. The study findings indicated an inverse relationship between stent thrombosis development (Rho=-0.334; p=0.001) and the timing of recurrent myocardial ischemia. There was also an inverse correlation between patient adherence and stent thrombosis development (Rho=-0.275; p=0.009). Non-adherent individuals had a 16.8 times higher likelihood of experiencing stent thrombosis compared to compliant patients (p<0.001). Following participation in the CHD School program, treatment adherence increased from 56.5% to 88.2%. Education for ACS patients post-stenting was significantly associated with all-cause mortality within the first 6 months (p=0.040). Secondary preventive measures, including education, impact the success of endovascular interventions in both the early hospital phase and the long term. Patient education can serve as a supplementary intervention to enhance DAPT adherence, thus diminishing the risk of recurrent cardiovascular events and mortality post endovascular intervention.

Pitavastatin calcium significantly improves glucose and lipid metabolism of patients with coronary atherosclerosis and reduces the occurrence of adverse cardiovascular events

Purpose: To determine the efficacy of pitavastatin calcium and atorvastatin calcium on coronary atherosclerosis (CA) and compare the influence of the two schemes on adverse cardiovascular events.&#x0D; Methods: The medical records of 198 patients with CA admitted at Affiliated Hospital of Jiangsu University, China from August 2019 to May 2011 were analyzed retrospectively. The patients were grouped into pitavastatin calcium group (n = 102) and atorvastatin calcium group (n = 96). The efficacy, incidence of adverse cardiovascular events, as well as changes in blood lipid metabolism and blood glucose metabolism indices before and after therapy were recorded and compared.&#x0D; Results: Compared with atorvastatin calcium group, pitavastatin calcium group yielded a significantly higher overall response rate (ORR, p &lt; 0.05) and presented a significantly lower total incidence of cardiovascular adverse events (p &lt; 0.05). After therapy, pitavastatin calcium group displayed significantly lower triglyceride, total cholesterol and low-density lipoprotein-cholesterol levels (p &lt; 0.05), and also presented significantly higher high-density lipoprotein-cholesterol levels (p &lt; 0.05) in contrast to atorvastatin calcium group. Furthermore, pitavastatin calcium group presented significantly lower fasting blood glucose and glycosylated hemoglobin levels than atorvastatin calcium group (p &lt; 0.05).&#x0D; Conclusion: Compared with atorvastatin calcium, pitavastatin calcium displays a better therapeutic effect in patients with CA, lowers the incidence of adverse cardiovascular events and improves glucose and lipid metabolism of patients. Future studies will focus on longer follow-up sessions to better understand the impact of the drugs on patient’s prognosis.

Comparative analysis of in-hospital and long-term results of patients with acute dysfunction of coronary bypass grafts depending on treatment tactics

Comparative analysis of in-hospital and long-term mortality of patients in whom acute dysfunction of coronary bypass grafts was detected in the early postoperative period depending on conservative or surgical tactics. The study is a retrospective analysis of data from 8801 patients who underwent elective coronary artery bypass grafting (CABG) between 2011 and 2022 at the Federal Center for Cardiovascular Surgery (Russia, Chelyabinsk). Among them, 196 patients underwent emergency coronary artery bypass grafting due to suspected perioperative myocardial infarction in the early postoperative period. In 119 patients, dysfunction of coronary bypass grafts was detected, in 77 patients no pathological changes were found. The criteria for inclusion in the study were patients with dysfunction of coronary bypass grafts (n=119). The 1st group included patients who underwent conservative therapy (n=33), the 2nd group (n=86) included those who underwent repeated myocardial revascularization. The primary endpoint was hospital mortality, secondary endpoints were long-term mortality and adverse cardiovascular events (myocardial infarction, stroke, repeat myocardial revascularization). Patients were surveyed via telephone. In-hospital mortality in the group of surgical reintervention was 8.1%, in the group of conservative treatment - 9.1% (p=0.867). According to the results of multivariate analysis, predictors of hospital mortality in patients of both groups were extracorporeal membrane oxygenation (p=0.014), time of artificial circulation (p=0.031), duration of artificial ventilation (p=0.001), number of days in intensive care (p<0.001). When analyzing long-term mortality using the Kaplan-Meier method in group 1 and group 2, no statistically significant differences were found; in the group of conservative therapy - 85±9.6 [66.2-103.7] months versus 108.2±4.8 [98.8-117.6] months in the surgery group (log-rank p=0.06). When analyzing long-term mortality from cardiovascular causes and the occurrence of adverse cardiovascular events, statistically significant differences were determined: in the group of conservative therapy - 92.5±9.3 [74.2-110.7] months versus 117.8±3.3 [111.2-124.3] months in the surgical treatment group (log-rank p=0.007) and 78.1±9.2 [60-96.3] months versus 98.9±3.9 [91.3-106.5] months (log-rank p=0.008), respectively. In-hospital mortality was comparable between groups. Long-term mortality from cardiovascular causes and the number of adverse cardiovascular events were significantly higher in the conservative therapy group. With timely detection of acute dysfunction of coronary bypass grafts, an active surgical approach has an advantage over conservative tactics and can improve the long-term prognosis of patients.

Analysis the Relationship between Clonal Hematopoiesis and Cardiovascular Events in Chronic Myeloid Leukemia Based on Next-Generation Sequencing Technology

B ackground With the development and clinical application of high-throughput sequencing technologies and cytogenetics, the genetic complexity of hematopoiesis is better understood. Studies have found that there are gene mutations in hematopoietic stem cells that leading to subsequent clonal hematopoiesis (CH) phenomenon. Moreover, several recent studies have linked the occurrence of cardiovascular events with CH, and individuals with CH had a doubled risk of coronary heart disease and a fourfold increased risk of myocardial infarction. CH also exists in CML, and with the widespread application of second- and third-generation TKIs, the occurrence of cardiovascular adverse events had become one of the difficulties in the management of CML patients. Therefore, analyzing the relationship between additional gene mutations and cardiovascular adverse events in CML patients based on Next-Generation Sequencing (NGS) technology will provide new directions and ideas for the precise management of CML patients. O bjective Analyzing the relationship between clonal hematopoiesis and cardiovascular events in CML patients based on NGS technology. Method Using NGS technology to find hematological tumor-related gene mutations in CML patients, and analyzing their relationship with cardiovascular adverse events in CML patients. R esult A total of 149 CML patients were tested by NGS in this study, and were detected 152 clinically significant mutations. The mutations mainly involved genes related to epigenetic and activated signaling pathways, most of which were detected only in patients with drug resistance/intolerance to tyrosine kinase inhibitors (TKIs). The genes with higher mutation frequency were FAT1, GSTM1, ABL1, CUX1, EP300, ASXL1, TET2, CEBPA and so on. In this study, a total of 40 patients had cardiovascular events during treatment. When analyzing the risk factors of cardiovascular events in CML patients, it was found that patients with cardiovascular events were older [the median age were 58 (23-74) years vs 39 (16-73) years, P&amp;lt;0.001], and the duration of taking second-generation TKIs was also longer [the median time were 38 (0-102) months vs 16 (0-66) months, P=0.001]. When analyzing the relationship between gene mutations and cardiovascular events in CML, it was found that ASXL1, DNMT3A, EZH2 and other genes were more frequently detected in CML patients with cardiovascular events. Among them，DNMT3A mutation was associated with the occurrence of cardiovascular events in CML patients (RR 23.3, P=0.003). In addition, we also found that CCND1, CYP2C19 and NTRK2 gene mutations were only detected in patients without cardiovascular events significantly. C onclusion CML patients with cardiovascular events are older, take second-generation TKIs for a longer time, and have a higher incidence of DNMT3A gene mutation; CCND1, CYP2C19, NTRK2 gene mutation may be a protective factor for cardiovascular events in CML patients.

Frontline Combination of 3 rd Generation TKI Olverembatinib and Blinatumomab for Ph+/Ph-like ALL Patients

Background The combination of dasatinib and blinatumomab represented a chemotherapy-free treatment approach, which had been employed in the management of newly diagnosed Philadelphia chromosome-positive acute lymphoblastic leukemia (ALL). A recent study demonstrated that combination therapy of ponatinib with blinatumomab may achieve better efficacy, with a complete molecular response (CMR) rate of 87%. However, some patients required dose reduction or even discontinuation of ponatinib for the occurrence of cardiovascular adverse events. Olverembatinib, a potent third-generation tyrosine kinase inhibitor (TKI), showed both favorable tolerability and significant efficacy in patients with TKI-resistant chronic myeloid leukemia. But its effectiveness in ALL remained unaddressed. Our recent study, a frontline combination of Olverembatinib and PDT-ALL-2016 regime in Ph+ALL, had shown a promising outcome, achieving a complete molecular response (CMR) rate of 84.6% at day 90. Herein, we explored the clinical efficacy of the frontline combination of Olverembatinib and blinatumomab for the treatment of Ph+ and ABL-class Ph-like ALL. Methods From April 2022 to May 2023, 13 patients with Ph+/Ph-like ALL treated with olverembatinib (40mg once every other day) and blinatumomab (administered for a total of 2 weeks followed by 2 weeks of break) were enrolled (Figure 1a). Two patients (15.4%, 2/13) were in Ph-like ALL group with TEL-ABL and EBF1-PDGFRB fusion gene. Five patients (38.5%, 5/13), with a median age of 58 years old, were received ≥2 cycles and eight patients (61.5%, 8/13), with a median age of 34.5 years old, were treated with 1 cycle before HSCT. Result With a median follow-up of 7 months, all patients (100%, 13/13) achieved complete remission (CR) after one cycle of treatment. Among them, nine patients (72.7%, 9/13) achieved complete molecular remission (CMR) after one cycle, and ten patients (90.1%, 10/13) after two cycles. Notably, all patients (100%, 13/13) achieved CMR within three months of olverembatinib and blinatumomab treatment (Figure 1b). The 6-month overall survival (OS) rate was 100% and the 6-month event-free survival (EFS) rate was 87.5% (Figure 1 c and d). One patient with ABL mutation EE255V died due to relapse after HSCT. The regimen was overall well tolerated. For hematologic toxicity, one patient (7.7%, 1/13) experienced grade 1 neutrophil decrease. Regarding non-hematologic toxicity, five patients (38.4%, 5/13) developed infections during treatment, including COVID-19 and herpes zoster. Five patients (38.4%, 5/13) experienced decreased levels of immunoglobulins. Ten patients (76.9%, 10/13) experienced grade 1 cytokine release syndrome (CRS). Importantly, there were no interruptions in dosing of olverembatinib during treatment while no cardiovascular adverse events were observed. Conclusion This is the first report on the combination of olverembatinib with blinatumomab for the treatment of Ph+/Ph-like ALL. Among the 13 patients enrolled, a notable rate of CR and CMR was observed, which holds promise for improved long-term survival. Additionally, the combination of olverembatinib and blinatumomab exhibited minimal adverse events, both in terms of hematologic and non-hematologic toxicities. Notably, fewer cardiovascular adverse events that required discontinuation of treatment compared to ponatinib were observed. Altogether, these findings strongly indicated that combination therapy of olverembatinib with blinatumomab has the potential to become a new standard of care in the frontline treatment of Ph+/Ph-like ALL. However, further clinical trials are needed to definitively establish the efficacy of this treatment approach and validate the potential benefits. This research was supported by the National Natural Science Foundation of China(NFSC82170163, 81970147), Clinical Study of Nanfang Hospital(LC2016ZD009/2019CR012).

Abstract 18533: Exploring the Rising Incidence of Myocarditis and Other Cardiovascular Adverse Events of Nivolumab and Ipilimumab: Analysis of FDA Adverse Event Reporting System Database

Introduction: Nivolumab and Ipilimumab are human monoclonal antibodies that target cell surface PD1 and anti-CTLA-4 receptors respectively. Nivolumab and ipilimumab combination is used for metastatic small cell lung carcinoma, advanced renal cell carcinoma and metastatic melanoma. The pre-approval CHECKMATE trials have underestimated the occurrence of cardiovascular adverse events (AEs). In contradiction, post-marketing studies have demonstrated a higher incidence of cardiac AEs, particularly myocarditis.Therefore, it is important to establish a post-marketing safety profile of these medications. Methods: We investigated the cardiovascular AEs of nivolumab and ipilimumab using U.S. Food and Drug Administration Adverse Event Reporting System (FAERS). Healthcare professionals (HCPs) reported 79.73% and 80.92% of AEs until March 2023 for nivolumab and ipilimumab respectively. We conducted further subgroup analysis of cardiovascular AEs in male, females as well as in three age groups: 18-64, 65-85 and &gt;85 years. Results: Amongst the cardiovascular AEs reported by HCPs, myocarditis was reported in 905 (1.55 %) in nivolumab vs 445 (1.72%) in ipilimumab group. There were higher reports of other cardiovascular AEs including heart failure (1.15% vs 0.74%), pericarditis/pericardial effusion (1.19% vs 0.6% ), myocardial infarction (0.18% vs 0.71%), cardiomyopathy (0.36% vs 0.29%), cardiac arrest (0.41% vs 0.53%) and cardiac death (0.01% vs 0.02%) in nivolumab vs ipilimumab. On sub-group analysis, we observed higher incidence of myocarditis in females (1.54% vs 1.6%) males (1.73% vs. 1.84%) and in patient with age 18-65 years (1.17% vs 1.15%) in both nivolumab vs ipilimumab group as compared to previous studies. Conclusions: The reported events of myocarditis were significantly higher in FAERS reporting as compared to the CHECKMATE trials (&lt;1%) in both nivolumab and ipilimumab groups. Clinicians need to be vigilant in detecting immune-mediated myocarditis, as it often manifests with nonspecific symptoms, with early onset and rapid progression. Given the growing utilization of these medications, it is imperative to conduct additional randomized controlled trials to gain a better understanding of their cardiovascular safety profile.

A causal relationship between irritability and cardiovascular diseases: a Mendelian randomization study.

Observational studies have suggested that irritability is associated with a higher risk of cardiovascular disease (CVD). However, the potential causal association is not clear. Therefore, we used Mendelian randomization (MR) analysis to assess the causal association of irritability with CVD risk. A two-sample MR analysis was performed to confirm the causal association of irritability with the risk of several common CVDs. The exposure data were derived from the UK biobank involving 90,282 cases and 232,386 controls, and outcome data were collected from the published genome-wide association studies (GWAS) and FinnGen database. Inverse-variance weighted (IVW), MR-Egger, and weighted median methods were performed to assess the causal association. Furthermore, the mediating effect of smoking, insomnia, and depressed affect was explored by using a two-step MR. The MR analysis indicated that genetically predicted irritability increased the risk of CVD, including coronary artery disease (CAD) (Odds ratio, OR: 2.989; 95% confidence interval, CI: 1.521-5.874, p = 0.001), myocardial infarction (MI) (OR: 2.329, 95% CI: 1.145-4.737, p = 0.020), coronary angioplasty (OR: 5.989, 95% CI: 1.696-21.153, p = 0.005), atrial fibrillation (AF) (OR: 4.646, 95% CI: 1.268-17.026, p = 0.02), hypertensive heart disease (HHD) (OR: 8.203; 95% CI: 1.614-41.698, p = 0.011), non-ischemic cardiomyopathy (NIC) (OR: 5.186; 95% CI: 1.994-13.487, p = 0.001), heart failure (HF) (OR: 2.253; 95% CI: 1.327-3.828, p = 0.003), stroke (OR: 2.334; 95% CI: 1.270-4.292, p = 0.006), ischemic stroke (IS) (OR: 2.249; 95% CI: 1.156-4.374, p = 0.017), and ischemic stroke of large-artery atherosclerosis ISla (OR: 14.326; 95% CI: 2.750-74.540, p = 0.002). The analysis also indicated that smoking, insomnia, and depressed affect play an important role in the process of irritability leading to cardiovascular disease. Our findings support the first genetic evidence of the causality of genetically predicted irritability with the risk of developing into CVDs. Our results deliver a viewpoint that more early active interventions to manage an individual's anger and related unhealthy lifestyle habits are needed to prevent the occurrence of adverse cardiovascular events.

P27 DOPPLER ULTRASOUND SELECTION AND FOLLOW–UP OF THE INTERNAL MAMMARY ARTERY AS CORONARY GRAFT

Abstract The impact of coronary artery disease (CAD) on all–cause mortality and overall disabilities is well–established. Percutaneous and/or surgical coronary revascularization procedures dramatically reduced the occurrence of adverse cardiovascular events in patients suffering with atherosclerosis. Specifically, guidelines from the European Society of Cardiology on the management of myocardial revascularization promoted coronary artery by–pass graft (CABG) intervention in patients with specific alterations in coronary tree due to higher beneficial effects of this procedure as compared to percutaneous one. Left internal mammary artery (LIMA) is one of the best–performing vessels in CABG procedures due to its location and its own structural characteristics. Nevertheless, non–invasive assessment of its patency is challenging. Doppler Ultrasonography (DU) might perform as a reliable technique for non–invasive evaluation of the patency of LIMA. Data from literature revealed that DU may detect severe (&amp;gt;70%) stenosis of the LIMA graft. In this case, pulsed–wave Doppler might show peak diastolic velocity/peak systolic velocity &amp;lt; 0.5 and diastolic fraction &amp;lt; 50%). Stress test might also be adopted for the evaluation of patency of LIMA through DU. The aim of this narrative review is to evaluate the impact of DU on the evaluation of the patency of LIMA graft in patients who undergo follow–up after CABG intervention. The aim of this narrative review is to evaluate the impact of DU on the evaluation of the patency of LIMA graft in patients who undergo follow–up after CABG intervention.

Esketamine versus Sufentanil Applied Prior to Placement of Suspension Laryngoscope.

In laryngeal microsurgery, the insertion of the suspension laryngoscope is a strong stimulus that may cause hemodynamic fluctuations and adverse cardiovascular events. The purpose of this study was to compare the effect of preemptive treatment with esketamine and sufentanil on maintaining hemodynamics and reducing the occurrence of adverse cardiovascular events during the insertion of suspension laryngoscope. In this double-blind randomized controlled trial, patients undergoing general anesthesia for laryngeal microsurgery were randomly assigned (1:1) to esketamine 0.5 mg kg-1 (esketamine group) and sufentanyl 0.125 μg kg-1 (sufentanil group) before inserting the laryngoscope, respectively. During the insertion of suspension laryngoscope, the incidence of bradycardia (HR < 60 beats/min) was 39.3% (22/56) in esketamine group, lower than 60.0% (33/55) in sufentanil group (odds ratio [OR], 2.32 [95% CI, 1.11-5.08]; p = 0.029). The incidence of hypotension (MAP <65 mmHg) was 33.9% (19/56) in esketamine group, lower than 56.4% (31/55) in sufentanil group (odds ratio [OR], 2.52 [95% CI, 1.91-5.27]; p = 0.018). The frequency of hypotension in esketamine group was lower than that in sufentanil group (0.36 ± 0.52 vs. 0.56 ± 0.50, p = 0.035). The time-weighted average of HR dropping above 30% of baseline was smaller in esketamine group than in sufentanil group (0.52 ± 2.06 vs. 1.08 ± 2.77, p = 0.006). These findings showed that compared with preemptive treatment of sufentanil (0.125 μg kg-1 ), esketamine (0.5 mg kg-1 ) was effective in reducing the incidence of cardiovascular adverse events, including bradycardia and hypotension induced by the insertion of suspension laryngoscope during the laryngeal microsurgery. 2 Laryngoscope, 133:3021-3027, 2023.

Association of stress hyperglycemia with clinical outcomes in patients with ST-elevation myocardial infarction undergoing percutaneous coronary intervention: a cohort study

BackgroundIn recent years, several studies have demonstrated that stress hyperglycemia is significantly associated with poor prognosis in patients diagnosed with acute coronary syndrome (ACS). In the present study, we aimed to investigate the potential associations between various markers of stress hyperglycemia, such as admission blood glucose (ABG), fasting blood sugar (FBS), and stress hyperglycemia ratio (SHR) with different definitions, and the occurrence of adverse cardiovascular events in patients diagnosed with ST-elevation myocardial infarction (STEMI) who have undergone percutaneous coronary intervention (PCI).MethodsOur study enrolled a total of 1099 patients diagnosed with STEMI who underwent PCI from 2016 to 2021. The primary outcomes of this study were in-hospital death and all-cause mortality.ResultsStress hyperglycemia was associated with a higher incidence of in-hospital death (ABG OR: 1.27 95% CI 1.19–1.36; FBS OR: 1.25 95% CI 1.16–1.35; SHR1 OR: 1.61 95% CI 1.21–2.14; SHR2 OR: 1.57, 95%CI 1.22–2.01; SHR3 OR: 1.59, 95%CI 1.24–2.05) and all-cause mortality (ABG HR: 1.10, 95% CI 1.07–1.14; FBS HR: 1.12, 95 CI 1.07–1.17; SHR1 HR: 1.19 95% CI 1.03–1.39; SHR2 HR: 1.28, 95%CI 1.14–1.44; SHR3 HR: 1.29, 95%CI 1.14–1.45) after adjusting for ischemic time, age, gender, BMI, hypertension, hyperlipidemia, diabetes mellitus (DM), current smoking history, chronic kidney disease (CKD), previous history of coronary artery disease (CAD), atrial fibrillation (AF), heart failure (HF), stroke, cancer, culprit vessel, multi-vessel disease. These associations exhibited a non-linear, J-shaped pattern, wherein the risk significantly increased when the ABG and FBS levels exceeded 5mmol/L. Moreover, the inflection point for SHR was estimated to be 1.2.ConclusionsStress hyperglycemia was significantly associated with an increased risk of in-hospital death and all-cause mortality in STEMI patients treated with PCI. Stress hyperglycemia should be considered a high-risk prognostic marker in all STEMI patients, regardless of with or without diabetes.

Correlation between smoking and serum lipoprotein-associated phospholipase A2 level in overweight and obese men.

Lipoprotein-associated phospholipase A2 (Lp-PLA2) is a vaso-specific inflammatory marker that exacerbates atherosclerotic through inflammatory responses. It can be used to predict the occurrence of adverse cardiovascular events and to assess the residual risk of cardiovascular diseases. This study aims to investigate the correlation between smoking and serum Lp-PLA2 levels in overweight and obese men, and to provide evidence for preventing the cardiovascular diseases. Male subjects, who participated in health examination at the Health Management Center, Third Xiangya Hospital, Central South University from May 1, 2020 to April 30, 2021, were selected. The smoking status and other information were collected by the Self-test Scale of Physical Examination. According to the smoking status, they were divided into a never-smoking group, a current smoking group, a quit smoking group and a passive smoking group. According to the daily smoking amount, the current smoking subjects were divided into a <10 cigarettes group, a 10 to 20 cigarettes group, a 21 to 30 cigarettes group, and a >30 cigarettes group. According to the smoking years, the current smoking subjects were divided into a <5 years group, a 5 to 10 years group, a 11 to 20 years group, and a >20 years group.Serum Lp-PLA2 levels and other clinical indexes in different smoking groups were measured and compared, the correlation between smoking and serum Lp-PLA2 levels in overweight and obese men was analyzed by logistic regression analysis. Serum Lp-PLA2 levels were significantly different between the never-smoking group and the current smoking group (P<0.05). Logistic regression analysis showed that, before adjusting other influencing factors and in terms of smoking status, the current smoking group (OR=1.81, 95% CI 1.27 to 2.58, P<0.01) and the quit smoking group (OR=2.09, 95% CI 1.12 to 3.90, P<0.05) were positively correlated with serum Lp-PLA2 levels compared with the never-smoking group, while the passive smoking group had no correlation with serum Lp-PLA2 levels (OR=1.27, 95% CI 0.59 to 2.73, P>0.05). In terms of daily smoking amount, the 10 to 20 cigarettes group (OR=2.09, 95% CI 1.40 to 3.12, P<0.001) and the 21 to 30 cigarettes group (OR=1.98, 95% CI 1.22 to 3.20, P<0.01) were positively correlated with serum Lp-PLA2 levels compared with the never-smoking group, while the <10 cigarettes group (OR=1.45, 95% CI 0.81 to 2.60, P>0.05) and the >30 cigarettes group (OR=1.17, 95% CI 0.60 to 2.28, P>0.05) had no correlation with serum Lp-PLA2 levels. In terms of smoking years, the 5 to 10 years group (OR=1.94, 95% CI 1.07 to 3.53, P<0.05), the 11 to 20 years group (OR=2.06, 95% CI 1.33 to 3.18, P<0.01), and the >20 years group (OR=1.66, 95% CI 1.11 to 2.47, P<0.05) were positively correlated with serum Lp-PLA2 levels compared with the never-smoking group, while the <5 years group had no correlation with serum Lp-PLA2 levels (OR=1.12, 95% CI 0.38 to 3.33, P>0.05). After adjusting for age and other indicators, the correlation between smoking years and serum Lp-PLA2 levels was the same as before adjustment among the above smoking groups, except that the correlation between the smoking 5 to 10 years group and serum Lp-PLA2 levels was not significant (OR=1.77, 95% CI 0.95 to 3.29, P>0.05). Smoking is correlated with serum Lp-PLA2 levels in overweight and obese men.

Short and Long-Term Cardiovascular Sequelae after SARS-CoV-2 Infection: A Narrative Review Focusing on Athletes.

Cardiovascular (CV) involvement after severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) infection was found to be frequent among the general population, especially in the pre-vaccination era, and particularly for hospitalized patients or those who experienced a more severe course of the disease. The spectrum of CV disease varies; however, acute myocarditis is particularly fearsome for the athletic population due to the possible associated risk of malignant arrhythmias during training. Alarming percentages of CV injuries, even in young and healthy athletes with a benign course of the disease, arose from a few initial studies limited to case series. Subsequent single-center studies and larger observational registries reported a lower prevalence of SARS-CoV2 CV involvement in athletes. Studies showing the occurrence of CV adverse events during follow-up periods are now available. The objective of our narrative review is to provide an updated summary of the literature on CV involvement after coronavirus disease 2019, both in the early post-infection period and over a longer period of time, with a focus on athletic populations.

Efficacy of Psycho-Cardiology therapy in patients with acute myocardial infarction complicated with mild anxiety and depression.

To evaluate the efficacy of Psycho-Cardiology therapy among patients with acute myocardial infarction (AMI) complicated with mild anxiety and depression. Two hundred and fifty-six patients with AMI who were admitted to the Cardiovascular Department of Chenzhou First People's Hospital from January 2018 to January 2020 were selected as subjects, and randomly divided into the control group (n = 128) and the Psycho-Cardiology treatment group (n = 128). Prior to the intervention, the general clinical data of the enrolled patients, such as gender, age, comorbidities (hypertension, diabetes) and smoking history, were compared, which revealed no statistical differences between the two groups (P > 0.05). The control group was given routine treatments such as reperfusion and secondary prevention of coronary heart disease, while the treatment group was given Psycho-Cardiology intervention in addition to the aforementioned treatments. No significant differences in PHQ-9 and GAD-7 scores were observed between the control and treatment groups at admission (P > 0.05). After the Psycho-Cardiology treatment, the PHQ-9 and GAD-7 scores of the treatment group decreased significantly. Based on the 1-year post-treatment comparison, the left ventricular ejection fraction was improved more significantly in the Psycho-Cardiology treatment group, showing statistical significance (P < 0.05). The treatment group exhibited statistically significantly low incidences of adverse cardiovascular events, such as recurrent angina pectoris, heart failure, malignant arrhythmia, recurrent myocardial infarction and death (P < 0.05). Psycho-Cardiology therapy is remarkably efficacious in improving the anxiety, depression, cardiac function and reducing the occurrence of adverse cardiovascular events, which can better improve the long-term prognosis of patients with AMI compared to the traditional treatments.

Značaj nivoa serumske mokraćne kiseline i sintaks skora u dugoročnom preživljavanju kardiohirurških bolesnika - mokraćna kiselina kod kardiohirurških bolesnika

Introduction: The connection between serum uric acid (SUA) and the occurrence of cardiovascular diseases has long been known. Despite the SYNTAX score emerging as useful for risk identification and stratification in the clinical practice of interventional cardiology, it has not been proven useful in cardiac surgical clinical practice. The aim of the paper is to examine the significance of SUA levels, the significance of the SYNTAX score and the Clinical SYNTAX score in predicting the long-term survival of cardiac surgery patients. Methods: A retrospective analysis of 160 cardiac surgery patients operated on between 2013 and 2014 was conducted. SUA, SYNTAX and clinical SYNTAX score was measured. In the follow-up period of 3 years, clinical outcomes of patients were tracked. Results: The average SYNTAX score was 25.2 ± 11.4, the average Clinical SYNTAX score was 26.9 ± 8.3. The average preoperative SUA level was 361 ± 94.1 mg/ dL. No statistically significant difference was found in the values of the ejection fraction, end-diastolic and end-systolic dimensions of the left ventricle in relation to the treatment outcome in the long-term follow-up (p &gt; 0.05). Preoperative left atrial diameter was significantly higher in deceased patients (p = 0.013). No statistically significant difference was found in the average values of the syntax score in relation to the treatment outcome in the long-term follow-up (p = 0.388), while a statistically significant difference was found in the values of the clinical SYNTAX score (p = 0.029). A statistically significant difference was found in the preoperative values of SUA in relation to the postoperative occurrence of adverse cardiovascular events (p = 0.035). Conclusion: Significant predictors of mortality in the long-term follow-up of cardiac surgery patients were left atrial diameter and clinical SYNTAX score. Predictors of adverse cardiovascular outcomes were left atrial diameter, clinical SYNTAX score and preoperative serum uric acid level.

Doppler Ultrasound Selection and Follow-Up of the Internal Mammary Artery as Coronary Graft.

The impact of coronary artery disease (CAD) on all-cause mortality and overall disabilities is well-established. Percutaneous and/or surgical coronary revascularization procedures dramatically reduced the occurrence of adverse cardiovascular events in patients suffering from atherosclerosis. Specifically, guidelines from the European Society of Cardiology on the management of myocardial revascularization promoted coronary artery by-pass graft (CABG) intervention in patients with specific alterations in the coronary tree due to the higher beneficial effects of this procedure as compared to the percutaneous one. The left internal mammary artery (LIMA) is one of the best-performing vessels in CABG procedures due to its location and its own structural characteristics. Nevertheless, the non-invasive assessment of its patency is challenging. Doppler ultrasonography (DU) might perform as a reliable technique for the non-invasive evaluation of the patency of LIMA. Data from the literature revealed that DU may detect severe (&gt;70%) stenosis of the LIMA graft. In this case, pulsed-wave Doppler might show peak diastolic velocity/peak systolic velocity &lt; 0.5 and diastolic fraction &lt; 50%. A stress test might also be adopted for the evaluation of patency of LIMA through DU. The aim of this narrative review is to evaluate the impact of DU on the evaluation of the patency of LIMA graft in patients who undergo follow-up after CABG intervention.

Untargeted metabolomics identified kynurenine as a predictive prognostic biomarker in acute myocardial infarction.

The occurrence of cardiovascular adverse events in the first year after ST-acute myocardial infarction (STEMI) remains high; therefore, identification of patients with poor prognosis is essential for early intervention. This study aimed to evaluate the prognostic value of metabolomics-based biomarkers in STEMI patients and explore their functional mechanisms. Metabolite profiling was performed using nuclear magnetic resonance. The plasma concentration of Kynurenine (Kyn) was measured using ultraperformance liquid chromatography/electrospray ionization quadruple time-of-flight mass spectrometry. Major adverse cardiac and cerebral events were assessed for 1 year. A functional metabolomics strategy was proposed for investigating the role of Kyn in both vitro and vivo models. The adjusted hazard ratios in STEMI patients for Kyn in the 4th quartile 7.12(5.71-10.82) was significantly higher than that in the 3rd quartile 3.03(2.62-3.74), 2nd quartile 1.86(1.70-2.03), and 1st quartile 1.20(0.93-1.39).The incidence of MACCE was significantly different among Kyn quartiles and the highest incidence of MACCE was observed in the 4th quartile when compared with the 1st quartile (9.84% vs.2.85%, P<0.001).Immunofluorescence staining indicated that indoleamine-pyrrole 2,3-dioxygenase (IDO1) was located in the CD68 positive staining area of thrombi from STEMI patients and Kyn was induced in the early phase after myocardial infarction. Kyn could trigger inflammation and oxidative stress of macrophage cells by activation of the Sirt3-acSOD2/IL-1β signaling pathway in vitro. Plasma Kyn levels were positively associated with the occurrence of STEMI. Kyn could induce macrophage cells inflammation and oxidative stress by activating the Sirt3-acSOD2/IL-1β pathway following myocardial ischemia injury. Kyn could be a robust biomarker for STEMI prognosis and reduction of Kyn could be beneficial in STEMI patients.

Glycaemic variability and risk of adverse cardiovascular events in acute coronary syndrome.

The relationship between different glycaemic variability (GV) indexes and adverse cardiovascular outcomes is not well understood. This study aims to determine whether GV is related to the occurrence of adverse cardiovascular events in patients with acute coronary syndrome (ACS). PubMed, EMBASE, and Web of Science were comprehensively searched from the establishment of databases to 29 June 2022. The relationship between two important GV indexes, including the mean amplitude of glycemic excursion (MAGE) and standard deviation (SD), and the adverse cardiovascular events in ACS patients were evaluated, respectively. A total of 11 studies with 3709 ACS patients were included. Pooled results showed that patients with higher GV had significantly increased risk of adverse cardiovascular events, including MAGE (relative risk [RR] = 1.76, 95% CI: 1.40 to 2.22, p < 0.001, I2 = 25%) and SD (RR = 2.14, 95% CI: 1.73 to 2.66, p < 0.001, I2 = 0%). Increased GV is related to the poor prognosis in patients with ACS. Additionally, more well-designed studies comparing different indicators of GV with adverse cardiovascular events in ACS patients are still warranted.

Sleep apnea and temporal changes in cardiac repolarization in patients undergoing coronary artery bypass grafting

Abstract Background In coronary artery bypass grafting (CABG), despite re-establishing coronary reperfusion, myocardial recovery and restoration of contractility often occur later, and the risk of adverse cardiovascular events persists during the post-CABG period. The occurrence of adverse cardiovascular events is linked to abnorm-al cardiac repolarisation that can be measured by surface electrocardiograms (ECGs). Sleep apnoea is an emerging cardiovascular risk factor. The relationship between sleep apnoea, abnorm-al cardiac repolarisation, and the occurrence of adverse cardiovascular events is not well studied. Purpose We investigated the impact of sleep apnoea on the change in repolarisation after CABG, and if the change in repolarisation is associated with the occurrence of major adverse cardiac and cerebrovascular events (MACCE). Methods Between November 2013 and December 2018, 1007 patients from 4 hospitals underwent an overnight sleep study prior to a non-emergent CABG. ECGs were acquired prospectively within 48h before the CABG (T1), and within 24h after the CABG (T2). QTc intervals were measured in three consecutive heart beats in one lead - the preferential lead measurements were lead II, followed by lead V5. QTc intervals were measured using the BRAVO algorithm by Analysing Medical Parameters for Solutions (AMPS) LLC. The change of T2 from T1 for QTc (ΔQTc) was derived. The mean follow-up duration was 2.1 years. MACCE was a composite of cardiovascular death, myocardial infarction, stroke, and unplanned revascularisation. Results A total of 954 patients (median age: 62 years; male: 86%) survived the initial 24 hours and had quality ECGs for analysis. Lead II and V5 were measured in 72% and 25% of the cohort, respectively. A total of 115 patients developed MACCE (MACCE group). Compared with the non-MACCE group, the MACCE group was older, had (a) a higher prevalence of smoking, hypertension, diabetes mellitus, and chronic kidney disease, (b) higher apnoea-hypopnoea index (AHI) and oxygen desaturation index (ODI), and (c) a smaller ΔQTc (Table). In Cox regression analysis, a smaller ΔQTc was independently associated with occurrence of MACCE (HR: 1.003; 95% CI: 1.000–1.006; p=0.032). Older age, history of previous stroke, chronic kidney disease, more severe sleep apnoea (higher AHI, ODI, and severe oxygen desaturation) were associated with smaller ΔQTc. After adjusting for the effects of confounding variables, a higher ODI was independently associated with a smaller ΔQTc (correlation coefficient: −0.58; p&amp;lt;0.001). Conclusions In patients undergoing a non-emergent CABG, a smaller ΔQTc during the first 24 hours after the CABG is associated with a higher incidence of MACCE. A higher pre-operative ODI based on a sleep study is an independent predictor of a smaller ΔQTc. This suggests that change in QTc within 24 hours after CABG could be due to sleep apnoea, and it is a novel predictor of occurrence of MACCE at medium term follow-up. Funding Acknowledgement Type of funding sources: Public Institution(s). Main funding source(s): Transition Award and Clinician Scientist Award from the National Medical Research Council of Singapore (award numbers: NMRC/TA/012/2012; NMRC/CSA-INV/002/2015)

Analysis of the Clinical Effect of Implementing Health Education in the Process of Ministration Elderly Hypertensive Sufferers.

The clinical effect of implementing health education in ministration elderly hypertensive sufferers is analyzed. Two hundred hypertensive sufferers admitted to our hospital from February 2020 to April 2021 are selected. The two sets of sufferers are randomly divided into the examination set and the control set using the random number table method, with 100 cases in each set. The control set is given routine ministration care, and the examination set is given routine ministration to implement health education; these indicators include: the blood pressure control compliance, Self-rating Anxiety Scale (SAS), Self-rating Depression Scale (SDS), and the Chinese version of Perceived Stress Scale (CPSS) scores; the compliance rate of health knowledge score, serum Angiotensin II (Ang II), Endothelin-1 (ET-1) and Superoxide Dismutase (SOD) standards, medication compliance, prognosis quality of life, and cumulative occurrence of MACCE are compared. The experimental results show that the application of health education in the ministration process of elderly hypertensive sufferers can effectively enhance the blood pressure of the sufferers, reduce the negative emotions and psychological pressure of the sufferers, enhance the quality of life of the sufferers, and reduce the prognosis of recurrence and the occurrence of adverse cardiovascular events.