Occurrence Of Adverse Cardiovascular Events Research Articles

Recuento leucocitario y riesgo cardiovascular tras un síndrome coronario agudo

Leukocytosis occurs as a response to a variety of inflammatory processes.To determine if white blood cell count (WBCC) at admission among patients who suffer an acute coronary syndrome (ACS) has an independent prognostic value for the occurrence of new cardiovascular adverse events (CAE).Prospective study of 558 patients aged 68 +/- 13 years (122 women) admitted to the hospital for an acute coronary syndrome. WBCC was measured at admission. A logistic regression model was used to assess the association of WBCC with the occurrence of CAE during the next six months after admission (post infarction angina, re-infarction, cardiac failure and mortality).An univariate analysis showed that patients with a WBCC > 15.000 cell/mm(3) had a significantly higher mortality and occurrence of CAE. The multivariate analysis showed that subjects with WBCC < 10.000 cell/mm(3) experienced fewer CAE than subjects with a WBCC > 15.000 cell/mm(3), with an odds ratio of 0.46 (95% confidence intervals = 0.21-0.97, p = 0,042).An elevated WBCC at admission among patients with an ACS is associated with a higher incidence of CAE in the ensuing six months.

Valvoplastia mitral percutânea: 30 anos de experiência

Mitral Valve; Balloon Dilatation / history. In 1982, Kanjii Inoue, a Japanese cardiac surgeon, developed the concept that a thickened and deteriorated mitral valve could be widened as a synthetic balloon. This concept was similar to the one used in the surgical closed mitral commissurotomy1. Subsequently, the double-balloon technique was introduced in Saudi Arabia as an alternative method to the valvoplasty with Inoue balloon2. Nowadays, the Inoue technique became the most used method for the accomplishment of percutaneous mitral valvoplasty. In comparison to the double-balloon technique, it has similar efficacy with the additional benefit of presenting lower peri-procedures risks3. If contrasted with the surgical mitral commissurotomy, mitral valvoplasty with balloon shows similar or superior successfull rates4,5, with equivalent restenosis averages5. Randomized studies, which compared the mitral valvoplasty with balloon to the surgical closed commissurotomy, have demonstrated that the percutaneous technique overpasses surgery for it results in a larger valve area with a superior duration at long term6. In this edition of the Archives, Cardoseo et al7 present the immediate and the latest results of the percutaneous mitral valvoplasty in patients with mitral stenosis, in a series of 330 consecutive patients that were followed during 47±36 months, evaluating the factors related to the procedure success, restenosis and the latest adverse clinical events7. The authors have concluded that mitral valvoplasty with balloon is an effective procedure, since more than 60% of the patients were free of events at the end of the follow-up. The echocardiographic score below 8 points was the only variable with independent predictive value for immediate success. The multivariate analysis also showed that the preprocedure mitral valve area and the presence of accentuated mitral calcification were the only independent predictors of post-procedure restenosis. With regard to the occurrence of adverse cardiovascular events, more advanced age; less pre-procedure mitral valve area; and major value of medium transvalve mitral gradient in the immediate post-procedure were considered as independent indicators. It is a highly laudable, observational study because it portrays the results of mitral valvoplasty in an essential number of patients, who were followed during a notable long period. If the procedure’s efficacy had already been established through the randomized studies, its effectiveness in the so called “real world” is now unequivocally documented.

Lack of supervision after residential cardiac rehabilitation increases cardiovascular risk factors

Cardiovascular rehabilitation (CR) is an important component of care for patients with cardiovascular disease (CVD) and has been well documented and promoted by various health organizations and position statements worldwide. The purpose of this study was to investigate whether patients readmitted to CR on average 16 months after their previous discharge, maintained the reduction in CVD risk factors, maintained or improved functional capacity, occurrence of adverse cardiovascular events, and possible modifications in prescribed medications. Five hundred and seventy patients (60+/-10 years) underwent cycle ergometry and blood sampling at the beginning, the end of 21+/-2 days of the previous CR, and again at readmission to CR. The CR consisted of cycling for 17+/-4 min at frequency of six times a week and daily walking for 45 min at 60-70% of the maximal individual heart rate. Blood total cholesterol, low-density lipoprotein-cholesterol, triglycerides, and body mass index decreased significantly during CR. Resting blood pressure, maximal performance (watts), maximal oxygen uptake, and heart rate recovery improved significantly in 1 min (P<0.001). At readmission, all traditional CVD risk factors increased significantly, although medication was unchanged and angiotensin-converting enzyme inhibitors were partly replaced by angiotensin II receptor antagonists. Exercise performance remained unchanged. At readmission, we observed an increase in CVD risk factors, although, physical fitness remained stable. Thus, failure of lifestyle modification after CR indicates the cause for concern. Reinforcement of home setting sessions of CR patients or other strategies to enhance long-term compliance to lifestyle changes could reduce the observed attrition in CR benefits.

Regression of Echocardiographic Left Ventricular Hypertrophy After 2 Years of Therapy Reduces Cardiovascular Risk in Patients with Essential Hypertension

There is still ambiguity about the prognostic relevance of regression of left ventricular hypertrophy (LVH) (as revealed by echocardiography) in a large population of subjects with hypertension, with and without evidence of LVH in their electrocardiograms (ECGs). This holds true even after adjusting for various confounders including in treatment ambulatory blood pressure (BP). The most suitable time point for a follow-up echocardiography also remains a matter for debate. In this study, we investigated the prognostic relevance of regression of LVH after 2 years of therapy, in a large population of subjects with hypertension, and possessing the aforesaid characteristics. The occurrence of adverse cardiovascular events was evaluated in 387 patients with LVH shown by echocardiography at baseline, and these patients were studied again after 2 years of therapy. At the second examination, 245 subjects showed regression of LVH, whereas 142 did not. During the time period before the subsequent follow up (6.2 +/- 3 years, range 1.9-12.9 years), 59 first adverse events (26 cardiac and 33 cerebrovascular) had occurred among these subjects. The event rates per 100 patient-years in patients with and without LVH regression were 1.06 and 4.4, respectively. After adjusting for several covariates at the 2-year visit, including in treatment ambulatory BP, Cox regression analysis showed that cardiovascular risk was significantly lower in patients with LVH regression than in those without (RR 0.36, 95% CI 0.19-0.68, P = 0.002). When left ventricular (LV) mass index reduction was analyzed instead of LVH status, it was found to be significantly associated with reduced risk (RR 0.62 per 1-s.d. decrease, 95% CI 0.44-0.88, P = 0.01). Regression of LVH, as revealed by echocardiography after 2 years of therapy, is associated with reduced cardiovascular risk in patients with hypertension, whether or not LVH was revealed in their ECGs. This holds true even after adjusting for various confounders including in treatment ambulatory BP.

Abstract 3734: Glucose-Insulin-Potassium Infusion in Patients with Acute Myocardial Infarction treated with Reperfusion Therapy Does Not Reduce the Risk of Cardiovascular Events: A Pooled Meta-analysis of Randomized Controlled Trials

Background: Metabolic modulation of ischemic myocardium using a glucose-insulin-potassium (GIK) infusion has been studied in patients with acute myocardial infarction treated with reperfusion therapy, but the results have been conflicting. We conducted a systematic review and meta-analysis of randomized placebo-controlled trials evaluating the utility of GIK in the prevention of adverse cardiovascular outcomes in patients with acute myocardial infarction who underwent reperfusion therapy. Methods: A total of 19,222 patients from 6 randomized placebo-controlled clinical trials were analyzed using pooled meta-analysis techniques, and relative risks at the end of one month were computed for various adverse cardiovascular outcomes. Statistical significance was determined using the z -test (two-sided alpha-error &lt;0.05). Results: The use of GIK did not significantly reduce the risk of death within the first month among patients with acute myocardial infarction treated with reperfusion therapy (p=0.40), and did not differ among those treated with thrombolytic agents (p=0.54) or those treated with primary coronary angioplasty (p=0.38). The risk of re-infarction within the first month was also not significantly reduced (p=0.32), nor were the risk of development of heart failure (p=0.40) or the need for invasive coronary revascularization (p=0.76). Conclusions: Among patients with acute myocardial infarction who are treated with reperfusion therapy, the use of GIK infusion has no significant effect on mortality or the occurrence of adverse cardiovascular events within the first month.

Myocardial infarction after meningococcal infection: A potential inflammatory link or a challenging puzzle?

There is evidence that systemic inflammatory response and infectious diseases are associated with an increased risk of vascular events such as stroke and myocardial infarction in humans. However, the potential triggering effect of infectious diseases in carciovascular phenomena is typically underreported, overlooked and unexplored. The remarkable discovery of the link between cytokine networks and the pathophysiology of infectious diseases, together with studies of the CD14+ Toll-like receptor 4 (TLR4), has increased our knowledge of the inflammatory cascade within the vascular compartment as well as of coronary artery disease. In addition, meningococcal sepsis can trigger an important host inflammatory response characterized by systemic production of cytokines and chemokines, as well as activation of complement and nitric oxide pathways. However, the exact mechanism involved and the multiple pathogenic links by which infection influences acute cardiovascular events have not been explored, presenting a challenging puzzle for researchers. Determining cytokine concentrations could prove to be a valuable tool in evaluating the pathophysiology of myocardial infarction during infectious processes. The knowledge gained could guide the development of new strategies for reducing the occurrence of adverse cardiovascular events.

Resistance to antiplatelet drugs: current status and future research

Platelet reactivity and activation are important factors during the development of atherothrombotic processes and subsequent ischaemic complications. Pharmacological agents that suppress platelet function are proved to be the most efficient in the prevention and treatment of thrombotic complications. As the activation of platelets during thrombus generation involves many complex and redundant pathways, simultaneous use of different antiplatelet drugs that are directed against different targets have been effective in reducing adverse clinical events. The main antiplatelet drugs are aspirin (which inhibits thromboxane synthesis), thienopyridines (which block P2Y12 receptors) and glycoprotein IIb/IIIa antagonists (which block glycoprotein IIb/IIIa receptors). In recent years, resistance or nonresponsiveness to antiplatelet therapy has been reported and, more importantly, are linked to the occurrence of adverse cardiovascular events. New treatment strategies to overcome nonresponsiveness are being sought. A focus on the development of simple, reproducible and user friendly point-of-care methods to determine aspirin/clopidogrel responsiveness should be undertaken to assist clinicians in tailoring antiplatelet therapy to the individual patient.

Emerging, noninvasive surrogate markers of atherosclerosis.

Noninvasive surrogate markers of atherosclerosis allow the physician to identify subclinical disease before the occurrence of adverse cardiovascular events, thereby limiting the need to perform invasive diagnostic procedures. Imaging modalities, such as carotid artery ultrasound, two-dimensional echocardiography, coronary artery calcium imaging, cardiac magnetic resonance imaging, ankle-brachial indices, brachial artery reactivity testing, and epicardial coronary flow reserve measurements, provide information that may improve the predictive value of a person's risk of developing clinically significant atherosclerotic disease. Newer imaging modalities have also emerged to bring insight into the pathophysiology and treatment of atherosclerosis.

Heart rate dynamics in refractory and well controlled temporal lobe epilepsy

Objectives: Disorders of cardiovascular and other autonomic nervous system functions are often found in patients with temporal lobe epilepsy (TLE). Cardiovascular dysregulation in TLE has previously been quantified assessing traditional...