Predictor Of Cardiovascular Complications Research Articles

#1688 Association of baseline serum activin levels with left atrial diameter at 5 years post-kidney transplantation: results from the KNOW-KT

Abstract Background and Aims Serum activin A inhibits muscle growth, promotes apoptosis, and impairs heart function. However, the role of serum activin remains unclear in kidney transplant patients, where cardiovascular complications are a significant cause of morbidity and mortality. In this multicenter, observational cohort study, we investigated a potential association of pre-transplant serum activin levels with the left atrial (LA) diameter, an indicator of diastolic burden and a predictor of cardiovascular complications, to indirectly assess the impact of pre-transplant activin levels on heart function in kidney transplant patients. Method Overall, 602 kidney transplant patients from KNOW-KT (Korean cohort study for outcome in patients with kidney transplantation) were analyzed. Activin levels were measured at baseline immediately before kidney transplantation (KT). The primary outcome was the LA diameter that was measured by transthoracic echocardiography at 5 years after KT. Results The mean age of study population was 45.4 years and 221 (46.7%) patients were men. Pre-transplant serum activin levels were 718.4 ± 363.2 (mean ± standard deviation). When activin levels were divided into categorical variables according to the median value, the ejection fraction of LV showed a lower tendency in the high-activin group (64.3 ± 7.0) compared to the low-activin group (65.3 ± 6.2); however, there was no statistical significance (P=0.069). LV diastolic dimension was significantly higher in the high-activin group (47.3 ± 5.3) compared to the low-activin group (46.3 ± 5.5) (P=0.021). Notably, the post-transplant LA diameter was 37.0 ± 7.0 mm in the low-activin group and 39.1 ± 6.5 mm in the high-activin group, showing a significant difference (P<0.001). The multivariate linear regression coefficient for association between activin groups and LA diameter was 1.08 (95% confidence interval [CI], 0.67-2.10, P=0.037). In an additional logistic regression analysis of LA diameter groups, the high activin group was significantly associated with the high LA diameters compared to the low-activin group in multivariate analysis (adjusted odds ratio [OR], 2.04; 95% CI, 1.34-3.09, P=0.001). When activin levels were used as a continuous variable, adjusted ORs of activin for high LA diameters were 1.29 (95% CI, 1.04-1.60, P=0.018). Conclusion Pre-transplant serum activin levels were independently associated with a higher post-transplant LA diameter, suggesting that activin may negatively affect heart functions in kidney transplant patients. Therefore, activin may be a potential prognostic and therapeutic target in kidney transplant patients.

The Impact of Medical Physical Training and a Structured Personalized Exercise Training Program on Hemodynamic Parameters and Arterial Stiffness in Pregnant Women.

In developed countries, heart disease is the primary cause of maternal mortality during pregnancy. Arterial stiffness, an independent risk factor for atherosclerosis and a predictor of cardiovascular complications, can be assessed using the augmentation index (AIx) and pulse wave velocity (PWV). In this prospective study, we aimed to evaluate diverse hemodynamic parameters and arterial stiffness in pregnant women before and after participating in a structured, personalized exercise training program. Forty healthy pregnant women, non-smokers, who agreed to participate daily for 12 weeks in a physical exercise training program under the supervision of a team made up of an obstetrician, a cardiologist, and a physiotherapist were included. Anthropometric characteristics, arterial function, and physical activity data were collected from the participants at two different time points: at the beginning of the exercise training program (T0) and at the end, after 12 weeks (T1). Upon conducting a statistical analysis, it was discovered that there were noteworthy disparities (p = 0.05) in body mass index, brachial AIx, systolic blood pressure, and pulse pressure values between the two time points. The regression analysis for the AIx brachial values and the PWVao values from Trim II (T0) and Trim III (T1) showed major differences between these two time points; the association between the AIx brachial values in the second and third trimesters of pregnancy revealed a strong direct significant correlation (p < 0.001), and the correlation between the PWVao values in the second (T0) and third trimester (T1) of pregnancy was weak and insignificant (p = 0.12). The findings of our study indicate that a personalized exercise training program positively impacts the physical and psychological well-being of pregnant women, leading to a reduction in PWV.

Troponin I, Hyperlipidemia and Obesity as Predictor of Cardiovascular Complications: A Cross Sectional Study

High levels of Troponin I, cholesterol, triglycerides, Low Density Lipoprotein (LDL), High Density Lipoprotein (HDL) and Body Mass Index (BMI) are predictor of cardiac complications. Objective: To investigate the predictive efficacy of Troponin I, BMI, and lipid profiles in detecting cardiovascular problems. Methods: 300 male and female individuals were selected for current study. 100 normal individuals were in Control Group A, while 100 participants were placed in Group B all the individuals of Group B have the indications of different cardiac medical complications. BMI, systolic, diastolic blood pressure, Troponin I, cholesterol, triglycerides, LDL, HDL levels were measured respectively. Results: In present study BMI, systolic blood pressure, diastolic blood pressure, Troponin I, cholesterol, triglycerides, LDL, HDL blood serum levels of male and female in Group A and Group B were measured, the comparative analysis of above biomarkers showed a significant p-Value ≤ 0.05 change (0.02 ± 0.01, 183.01 ± 0.02, 120.01 ± 0.02, 87.01 ± 0.03, 44.01 ± 0.01), (0.02 ± 0.01, 172.01 ± 0.02, 130.01 ± 0.01, 88.01 ± 0.03, 42.01 ± 0.04), (0.39 ± 0.04, 272.01 ± 0.02, 180.01 ± 0.01, 138.01 ± 0.03, 37.01 ± 0.01) and ( 0.37 ± 0.04, 282.01 ± 0.02, 184.01 ± 0.01, 141.01 ± 0.03, 36.01 ± 0.01) were measured respectively. Conclusions: The present study found that there were notable significant p-value &lt;0.05 differences in the blood serum levels of BMI, systolic and diastolic blood pressure, Troponin I, cholesterol, triglycerides, LDL, and HDL in both the male and female groups in Groups A and B

Predictive significance of modern echocardiographic parameters, stress ultrasound of the lungs in patients with acute myocardial infarction and percutaneous coronary intervention

Abstract Introduction Improving the EF can reduce the risk of cardiovascular complications (CVC) in postinfarction period. Short-term periprocedural dynamics (PPD) of EF and its prognostic value in patients with first acute myocardial infarction (AMI) and percutaneous coronary intervention (PCI) have not been studied. Stress lung ultrasound (LUS) can be used as an initial step in heart failure (HF) risk stratification. Speckle tracking Echo with assessment of myocardial work (MW) is promising in relation to the prediction of CVC in patients with AMI. The predictive abilities of 3D Echo deformity and rotation in patients with AMI are not well studied. Purpose Determination of the value of PPD EF, subclinical pulmonary congestion (PC) in stress LUS, parameters of MW and 3D-Echo in the prognosis of the development of CVC in long-term period in patients with the first AMI and PCI. Methods In 131 patients (89 men, mean age: 61.7±11.45 years, Me EF admission: 48%, multivessel coronary artery disease 66.4%) with a first MI without a history of HF with successful PCI, EF was assessed before PCI and at discharge, MW parameters, 3D-Echo parameters were determined, and stress LUS with physical activity was performed. An increase in EF&amp;gt;5% and an achievement of 50% or more were taken as a criterion for a positive PPD. After 3 months, the dynamics of 2- and 3D-Echo were evaluated. The observation period was 550 days. Hospitalization with HF, CV death, and composite point were assessed. Results Upon admission baseline EF&amp;lt;50% was detected in 56.5% of cases. 47.3% of patients from the group with baseline EF &amp;lt;50% did not have PPD EF after PCI, which is associated with an increased risk of hospitalization with HF (HR=7.13 p=0.004). An increase in PPD by 1% reduces the risks of hospitalization with HF by 1.31 times (p=0.013). According to the stress LUS, subclinical PC was detected in 99.1% of patients. In patients with baseline EF &amp;lt;50%, the sum of B-lines ≥10 during exercise increases the risks of hospitalization with HF by 2.4 times, and its combination with the absence of PPD - by 7.45 times during 1.5 years. With GLS&amp;lt;13.7%, the risk of hospitalization with HF increases by 2.34 times (p=0.048), GWW&amp;gt;161.5 mmHg% - by 2.65 times (p=0.028). The model for calculating the risk of hospitalization with HF included GLS (OR 0.75; p=0.006), GCW (OR 0.85; p=0.036) and ΔEF (OR 0.88; p=0.040). Patients hospitalized with HF after AMI showed a significant increase in the LV sphericity index after 3 months. The predictors of hospitalization with HF according to 3D Echo were indicators of circumflexial strain (CS)(OR 0.76; p=0.026), areal strain (AS)(OR 0.60; p=0.012), radial strain (RS)(OR 0.91; p=0.039), area strain dynamics over 3 months (HR 0.702; р=0.025). Conclusion In patients with the first AMI, it is advisable to conduct a comprehensive Echo with an assessment of MW, stress LUS to identify high-risk patients for the development of HF in the postinfarction period.

Blood Pressure Variability: Marker or Predictor of Cardiovascular Risk?

Background: Regardless of the mean blood pressure value, short-term and long-term BP variability (BPV) are associated with the development and progression of target organ damage and predictors of cardiovascular complications and mortality. The purpose of the present study was to evaluate the prognostic significance of increased BPV in patients with arterial hypertension (AH). Methods and Results: The study consisted of two stages. In the first stage, a retrospective analysis of 365 ABPM results was carried out. As a result of the analysis, 271 patients aged 56.1±10.0 years with uncontrolled AH Grades 1-3 (ESC/ESH, 2018) were included in this study. Depending on the values of BPV, AH patients were divided into two groups: Group 1 consisted of patients with normal BPV (n=145), and Group 2 consisted of patients with increased BPV (n=126). The second stage included 91 patients with uncontrolled hypertension without permanent antihypertensive therapy who had increased BPV. We found statistically significant differences in BP between the AH patients with normal BPV and increased BPV. Thus, in the group with normal BPV, compared with increased BPV, the parameters of the average 24-h systolic BP (SBP), daytime SBP, and nighttime SBP were statistically lower (141±14.6 vs. 147.2±20.2 mmHg, P&lt;0.004; 142.8±15.1 vs. 148.4±20.7 mmHg, P&lt;0.01; and 136.2±15.5 vs. 143.8±21.4 mmHg, P&lt;0.001; respectively). A statistically significant moderate direct correlation was found between the average 24-h SBP and the average 24-h and daytime SBP variability (SBPV) (rs=0.49 and rs=0.40 respectively, P&lt;0.001 in all cases). A statistically significant moderate to weak direct correlation also was found between the average daytime SBP, and the average 24-h and daytime SBPV (rs=0.45 and rs=0.37, respectively, P&lt;0.001 in all cases). A moderate direct correlation was found between nighttime SBP and 24-hour SBPV (rs=0.52, P&lt;0.001) and between nighttime SBP and daytime SBPV (rs=0.42, P&lt;0.001). Weak direct correlations were found between the average 24-h SBPV and central SBP (SBPc) (rs=0.34, P&lt;0.001), as well as between the average 24-h and daytime SBPV and central pulse pressure (PPc) (rs=0.33 and rs=0.32, respectively, P&lt;0.001 in all cases). A weak direct correlation was found between carotid intima-media thickness (CIMT) and the average 24-h and daytime SBPV (rs=0.37 [P&lt;0.001] and rs=0.3 [P=0.04]). Conclusion: The increased BPV is associated with impaired diurnal blood pressure profile (DBPP) and structural and functional changes in blood vessels, in particular, an increase in SBPc and PP in the aorta, and CIMT thickening, which characterizes increased BPV as a predictor of vascular remodeling in patients with uncontrolled AH.

Assessment of the risk of cardiovascular complications in cancer surgery

Cardiac complications of non-cardiac surgeries are an actual and unresolved interdisciplinary problem of clinical medicine today. The incidence of cardiovascular events after non-cardiac surgery is higher than in the general population and does not tend to decrease. The risk of cardiac complications in cancer surgery is the highest. Evidence-based approaches to risk assessment and prevention of cardiovascular events in surgical patients with malignant neoplasms have not been developed. In current clinical guidelines on the prevention, prognosis and treatment of cardiac complications of non-cardiac surgeries, the aspects of this problem in surgical oncology are not considered separately.The aim of this review was to analyze the current sources of literature on the prediction of cardiovascular complications in surgical treatment of cancer patients. The distinctive features of cancer surgery and additional factors causing an increased risk of adverse cardiac outcomes in patients with malignant neoplasms are described. The article presents the results of large cohort studies on the search for reliable predictors of cardiac complications in non-cardiac surgery and on the development of stratification scales and algorithms for preoperative risk assessment. Particular attention is paid to the possibilities and prospects of using these predictive tools in the surgical treatment of cancer. The surgical risks of interventions for malignant neoplasms are described, as well as methods for calculating cardiac risk and functional status assessment that have been validated in oncological patients cohorts. The data of recent studies on the role of serum biomarkers of myocardial damage and increased cardiovascular risk (cardiac troponins and brain natriuretic peptide) in predicting postoperative cardiac events in non-cardiac surgery are presented. Further prospects for the inclusion of biomarkers in risk stratification systems in patients with malignant neoplasms are discussed.

Use of peripheral perfusion index (PI) as a predictor of cardiovascular complications in hospitalised Covid 19 patients - A pilot study

Introduction and Aim: Cardiovascular complications have been associated with fatality in Covid-19 patients. Reduced peripheral perfusion is a marker for cardiovascular dysfunction. Peripheral Perfusion Index (PI) is a non-invasive measure of microvascular perfusion with regards to pulsatile arterial blood flow. The study was aimed at finding the utility of PI as a hemodynamic marker in Covid-19. Materials and Methods: Observational study done on 58 hospitalised adult Covid-19 patients over a span of 6 days. Each day the hemodynamic parameters such as pulse rate, SpO2 and Peripheral Perfusion Index (PI) were measured using a finger pulse oximeter. Peripheral Blood pressure was measured using automated BP apparatus. Mean Arterial Pressure (MAP) and pulse pressure (PP) was calculated. Results: Correlation between PI and other parameters checked using Pearson’s test. There was significant positive correlation between PI and PP in day wise analysis during first 2 days with linear regression showing PP can be predicted as a dependant function from PI. This shows the association between PI and systemic cardiovascular function. Conclusion: PI is a useful measure of peripheral microvascular perfusion and relates to systemic PP. It can be predicted from the results that PI can act as a reliable guide to predict the cardiovascular condition of the patient. As PI is measured from finger pulse oximeter, it is a non-invasive and easy-to-record method, which can be used by untrained personnel in Covid-19 patients.

Information Value of Calculated Hematological Indices in the Assessment of Cardiac Risk in Oncological Surgery

The objective: to study information value of the neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) in the cardiac risk assessment in abdominal oncological surgery.Subjects and Methods. 94 patients of 68 [62‒73] years old who underwent elective surgery were examined.Results. Cardiovascular comortbidity was diagnosed in 69 (73.4%) patients. 11 (11.7%) perioperative cardiovascular complications were registered. Cardiac mortality was 4.3%. Hematological indices were not associated with cardiovascular diseases (NLR: OR = 0.59‒1.42; 95% CI 0.14‒2.60; p = 0.29‒0.74, PLR: OR = 0.99‒1.00; 95% CI 0.97‒1.01; p = 0.31‒0.99). NLR and PLR were not predictors of cardiovascular complications (OR = 0.67; 95% CI 0.19‒2.37; p = 0.46 and OR = 1.00; 95% CI 0.99‒1.01; p = 0.68) and cardiac death (OR = 0.21; 95% CI 0.01‒8.05; p = 0.23 and OR = 0.99; 95% CI 0.98‒1.01; p = 0.79).Conclusion. NLR and PLR cannot be recommended for the cardiac risk assessment in abdominal oncological surgery.

Retinal artery occlusion as indicator of stroke in diabetes

Abstract Background Diabetes is associated with multiple complications in organs throughout the body, including an increased risk cardiovascular disease (1). Furthermore, an association between retinal artery occlusion and diabetes have been described as well (1,2). Early predictors of complications associated with diabetes would be useful for a better prognosis of the disease. Purpose Based on data from the Danish registries, the aim of this study was to investigate whether RAO is a predictor of stroke in diabetic patients. Methods We included 992 diabetic patients with incident RAO from the Danish National Patient Register with incident RAO between 1st of January 2000 and 31st of December 2018. Each of these cases were matched on age at index, sex, and time since diabetes diagnosis with 5 random diabetes patients with no subsequent diagnosis of RAO. Survival analyses were used to estimate and contrast the risk of stroke in diabetic RAO patients compared to diabetic patients with no prior diagnosis of RAO. The included analyses were all performed at 1 and 5-year follow-up. Results At 1-year follow-up, the incidence rate of stroke in diabetic RAO patients was 10.0 per 100 person years (PY) (95% CI: 8.13–12.10). The incidence for the controls at this time point was much lower at 1.82 per 100 PY (95% CI: 1.47–2.25). After 5-years of follow-up a large difference persisted, where the cumulative incidence was 19.3% (95% CI: 16.5–22.2%) for the RAO patients compared to 7.4% (95% CI: 6.5–8.2%) for the controls. The hazard rate ratio for stroke was 5.48 (95% CI: 4.06–7.39) after 1-year follow-up and 3.17 (95% CI: 2.60–3.86) after 5-year follow-up. The results support the use of RAO as a predictor of stroke in diabetic patients. Cardiovascular diseases contribute substantially to the morbidity and mortality in diabetic patients (3,4), underlining the need for especially a predictor of cardiovascular complications in these patients. To our knowledge, the predictive usage of RAO for cardiovascular complications in diabetic patients have not been investigated previously. Small occlusions, which could indicate systemic atherosclerosis, may not always be symptomatic. Therefore, the condition may not be diagnosed before more severe events occur. Conversely, RAO usually cause visual impairments, making RAO suitable as a potential predictor of subsequent cardiovascular events. The incidence rates of stroke suggest that diabetic RAO patients should be especially monitored the first year after their RAO diagnosis, but the monitoring would be beneficial even 5 years after the RAO diagnosis to continuously evaluate risk factors and instigate early intensified treatment. Conclusion The data of this study identified a substantial larger risk of stroke in diabetic RAO patients than diabetic patients with no RAO diagnosis, indicating RAO could be a predictor of stroke in diabetic patients. Funding Acknowledgement Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): The Obel Family Foundation

Роль біомаркерів NT-proBNP та ST2 у стратифікації ризику ускладнень у пацієнтів з гострим інфарктом міокарда та ожирінням

Мета роботи – з’ясувати діагностичну цінність показників NT-proBNP (N-кінцевий фрагмент попередника мозкового натрійуретичного пептиду) та ST2 (стимулювальний фактор росту, що експресується геном 2) і визначити їх прогностичне значення щодо виникнення серцево-судинних ускладнень (ССУ) у пацієнтів з гострим інфарктом міокарда (ГІМ) з елевацією сегмента ST за наявності ожиріння.Матеріали і методи. Усі пацієнти були розподілені на три групи залежно від маси тіла: І групу становили 52 пацієнти з нормальною масою тіла (середній вік (60,83±11,94) року); ІІ групу – 51 пацієнт з надлишковою масою тіла (середній вік (62,04±8,55) року); ІІІ групу – 55 пацієнтів з ожирінням І–ІІІ ступеня (середній вік (60,96±11,31) року). Для детальнішого дослідження було відібрано 60 пацієнтів, у яких додатково визначали концентрацію NT-proBNP та ST2 у сироватці крові імуноферментним методом за допомогою тест-систем виробництва Biomedica і Presage ST2 assay при госпіталізації і на 10-ту добу захворювання.Результати та обговорення. Залежно від перебігу захворювання впродовж стаціонарного лікування вибірку із загальної групи ретельно обстежених пацієнтів (n=60) було розподілено на дві групи: А (n=22) – особи, в яких перебіг захворювання ускладнився появою серцево-судинних подій, Б (n=38) – пацієнти, у яких ГІМ був без ускладнень. При госпіталізації середні показники NT-proBNP були незначно вищими в пацієнтів із ССУ (група А) (612,8 [489,5; 860,4] пг/мл) порівняно з пацієнтами без ССУ (група Б) (598,6 [326,6; 913,1] пг/мл, р&gt;0,05). При повторному визначенні біомаркера NT-proBNP в обох групах пацієнтів спостерігали суттєве його зниження (р&lt;0,01) незалежно від перебігу ГІМ: на 44,52 % – у групі А та 68,24 % – у групі Б. Однак рівні NT-proBNP у пацієнтів групи А на 10-ту добу спостереження статистично значуще переважали відповідні показники осіб групи Б (р&lt;0,05). При госпіталізації середні показники ST2 були статистично значуще вищими в пацієнтів із виявленими ССУ (61,1 [44,8; 133,6] нг/мл – група А) порівняно з пацієнтами без ускладнень (40,8 [33,1; 64,3] нг/мл – група Б, p&lt;0,05). При повторному визначенні біомаркера ST2 в обох групах пацієнтів спостерігали значне (p&lt;0,001) його зниження: відповідно до 23,7 [18,8; 28,3] нг/мл і 24 [19,7; 28,7] нг/мл, без статистично значущої різниці між групами.Висновки. Біомаркер ST2 можна розглядати як предиктор виникнення ССУ в пацієнтів із ГІМ з елевацією сегмента ST у ранній післяінфарктний період. Значення NT-proBNP у пацієнтів, в яких виникали ускладнення в ранній післяінфарктний період, залишаються на 10-ту добу спостереження статистично значуще вищими порівняно з відповідними в пацієнтів, у яких небажані події не виникали. Наявність ожиріння погіршує перебіг ГІМ з елевацією сегмента ST: у таких пацієнтів вищі значення біомаркерів ремоделювання міокарда NT-proBNP та ST2 (у дебюті захворювання) і частіше виникають ускладнення в ранній післяінфарктний період (у групі з ускладненнями ожиріння відзначали статистично значуще частіше, ніж серед осіб групи без ускладнень, р=0,02).

Prediction of cardiovascular complications and progression of renal failure in pediatric patients with chronic kidney disease according to NKF-K/DOQI (2002) and KDIGO (2012) classifications

Chronic kidney disease in pediatric and adult patients is an overarching global problem. Stratification of chronic kidney disease C1–5 severity by classifications of the National Kidney Foundation’s Kidney Disease Outcomes Quality Initiative (NKF-K/DOQI) (2002) and Kidney Disease: Improving Global Outcomes (KDIGO) (2012) carried out in pediatric patients over the age of 2 years old, taking into account the low glomerular filtration rate at the age of 0 to 2 years. Differences were found in the prognosis of cardiovascular complications and the progression of renal failure in adult patients with chronic kidney disease at stages С3а and C3b according to KDIGO (2012). The literature data demonstrate different risks of cardiovascular complications and progression of renal functions by stages of chronic kidney disease in accordance with the NKF-K/DOQI (2002) and KDIGO (2012) classifications in pediatric patients. The results indicate that children with chronic kidney disease in the pre-dialysis stages C2–4 form a high-risk group, while those on C4–5 dialysis form a group of very high risk of cardiovascular complications.

Calculated Hematological Indices as Predictors of Cardiovascular Complications in Noncardiac Surgery (Pilot Study)

The objective: to study the prognostic significance of the ratio of the absolute number of neutrophils to lymphocytes (NLR) and platelets to lymphocytes (PLR) in assessing the risk of cardiovascular complications in non-cardiac surgical interventions.Subjects and Methods. 85 patients aged 66 [61‒70] years who underwent elective vascular surgery were examined.Results. Concomitant circulatory diseases were diagnosed in 98.8%. PLR &lt; 91.2 with the sensitivity of 60% and the specificity of 67.8% was associated with diabetes mellitus (AUC – 0.686; 95% CI 0.576‒0.783, p = 0.0022). Cardiovascular complications were registered in 9.3% of patients. NLR was an independent predictor of cardiovascular complications: OR – 5.216; 95% CI 1.246‒21.826, p = 0.005. NLR &gt; 2.1 discriminated cardiovascular complications with the sensitivity of 75% and specificity of 75% (AUC – 0.827; 95% CI 0.690–0.921; p = 0.004). PLR was also a predictor of cardiovascular complications: OR – 1.0111; 95% CI 1.0001–1.0223; p = 0.027. PLR &gt; 105.5 allowed identifying patients with NT-proBNP &gt; 650 pg/ml with the sensitivity of 75.0% and the specificity of 61.8% (AUC – 0.740; 95% CI 0.630‒0.832; p = 0.0308).Conclusion. NLR and PLR can be used to identify patients with increased cardiac risk when undergoing vascular surgery. Further research in this field is advisable.

Динаміка показників кардіогемодинаміки у хворих на гострий інфаркт міокарда з супутнім цукровим діабетом 2 типу протягом 6 місяців спостереження

The purpose of the study was to monitor the dynamics of cardiohemodynamics in patients with acute myocardial infarction in combination with type 2 diabetes mellitus during 6 months of follow-up. Materials and methods. The study involved 120 patients: group 1 – patients with acute myocardial infarction with type 2 diabetes mellitus (n = 70), group 2 – patients with acute myocardial infarction (n = 50). The control group included 20 healthy individuals. All patients underwent general instrumental and clinical examinations. In the course of echocardiographic (echocardiography) study, the parameters of the left ventricle were determined and calculated: end diastolic volume, end systolic volume, end diastolic size, end systolic size, posterior thickness, the thickness of the interventricular septum, the ejection fraction of the left ventricle, the size of the left atrium, the size of the aorta, stroke volume. Results and discussion. The average indicators of cardiohemodynamics on the first day of hospitalization were as follows: end diastolic volume in patients of the 1st group was 165.85±36.22 ml; of the 2nd – 133.44±27.19 ml; control – 54.54±21.48 ml; end systolic volume – 104.57±28.86 ml; 77.93±21.56 ml; 21.69±7.49 ml, respectively; end diastolic size – 5.74±0.6 ml; 5.22±0.49 ml; 3.55±0.58 ml, respectively; end systolic size – 4.66±0.62 ml; 4.11±0.52 ml; 2.41±0.32 ml, respectively; the ejection fraction of the left ventricle – 37.51±6.27%; 42.9±7.45%; 56.75±7.22%, respectively; posterior thickness – 1.37±0.13 cm; 1.32±0.13 cm; 1.07±0.08 cm, respectively; the thickness of the interventricular septum – 1.26±0.11 cm; 1.27±0.11 cm; 1.13±0.08 cm, respectively; the size of the left atrium – 4.07±0.31 cm; 3.75±0.46 cm; 3.19±0.15 cm, respectively; the size of the aorta – 3.39±0.27 cm; 3.3±0.22 cm; 2.97±0.16 cm, respectively; stroke volume – 60.27±13.3 cm3; 2nd – 57.01±10.72 cm3; 28.39±12.38 cm3, respectively. Six months after acute myocardial infarction, a positive trend in cardiohemodynamic parameters was observed, maintaining a tendency for worse indicators in the presence of acute myocardial infarction. Conclusion. Thus, impaired carbohydrate metabolism in the form of insulin resistance, hyperinsulinemia and stress hyperglycemia on the background of coronary events in type 2 diabetes mellitus leads to negative changes in geometry, mass, systolic and diastolic function of the left ventricle, which must be paid special attention to hemodynamic predictors of cardiovascular complications and heart failure

MO556: Markers of Oxidative Stress and Coronary Calcifications in Chronic Hemodialysis Patients

Abstract BACKGROUND AND AIMS Cardiovascular morbidity and mortality are increased in hemodialysis patients. Oxidative stress is considered to be an important factor in these cardiovascular complications in these patients. The aim of this research is to establish the link between the levels of advanced oxidation protein products (AOPP) in the serum of hemodialysis patients and coronary calcifications. METHOD This is a longitudinal study involving 67 hemodialysis patients, all patients underwent a Coro-CT scan to assess coronary calcifications according to the Agatston coronary calcium score (SCCA). We divided the patients into three groups according to their low (0–100), medium (101–400) and severe calcification score &amp;gt; 400, we measured the levels of AOPP in the three groups and we studied the correlation between the rate of AOPP at the level of the different groups. RESULTS The mean age of the patients is 55 ± 12.5 years, the sex ratio is 1.3, the mean us-CRP level is 12.5 mg/L, the mean NO, AOPP, MDA level, MPO and LDLox are respectively (62.188 ± 5.598, 70.82 ± 10, 6.97 ± 0.488 µmol/L, 61.466 ± 8.82 IU/mL and 31.755 ± 3.9 µmol/l), we divided the patients into three groups according to the agtston coronary calcium score (SCCA), we found 27% of the patients had a low score (0–100), 48% had a moderate sore (101–400) and 25% had a severe score &amp;gt;400. We found that the rate of oxidative stress markers worsened with increasing calcification score, patients with a low score had levels of NO, AOPP, MDA, MPO and LDLox are respectively (67.2 ± 6.5, 64.9 ± 7, 3.24 ± 0.32, 57.8 ± 6.9 IU/mL and 10.17 ± 1.9 µmol/l), the mean score had respective levels of NO, AOPP, MDA, MPO and LDLox are respectively (62.5 ± 3.2, 72.7 ± 12, 7.2 ± 0.24 µmol/L, 60.34 ± 5.7 IU/mL and 27.6 ± 2.1 µmol/L) and patients with a severe calcification score had NO, AOPP, MDA, MPO and LDLox levels respectively (59.3 ± 2.4, 82.82 ± 12, 9.45 ± 0.34 µmol/L, 74.23 ± 9.7 IU/mL and 42.89 ± 5.19 µmol/L), there are positive correlations between the rate of coronary calcifications and the levels of markers oxidative stress NO, AOPP, MDA, MPO and LDLox) which are respectively (r = 0744, P = 0.0001; r = 0.777, P = 0.000; r = 0.318, P = 0.000; r = 0.620, P = 0.000; r = 0.526, P = 0.0001). CONCLUSION Markers of oxidative stress are higher in hemodialysis patients with vascular calcifications, they can be predictors of cardiovascular complications in hemodialysis patients.

Chronic heart failure in association with diabetes mellitus

Aim. To present clinical and functional characteristics of chronic heart failure in association with diabetes mellitus type 2.Material and methods. 105 patients with a verified diagnosis of chronic heart failure in association with diabetes mellitus type 2 who were hospitalized at the cardiology department of State Institution “RCRC” of Ministry of Health and Social Welfare of RT during the period 01.09.2020 - 01.08.2021 were examined. Of them, men were 48 (45.7%), women 57 (54.3%). All patients underwent general clinical, laboratory, instrumental, as well as functional examinations.Results and discussion. Complex evaluation of patients with chronic heart failure in association with diabetes mellitus type 2 (n=105) showed that the majority of patients (96,2%) had metabolic subcompensation of carbohydrate metabolism - HbA1c&gt;7%. The results of assessing the severity of clinical symptoms according to the clinical evaluation scale, indicators of renal function, and hemodynamic parameters of the heart in the group of patients with chronic heart failure in association with type 2 diabetes mellitus with arterial hypertension + coronary heart disease were significantly different from the group of patients with chronic heart failure in association with type 2 diabetes mellitus also with arterial hypertension and chronic heart failure in association with coronary heart disease.Conclusion. The etiology of chronic heart failure in our study group is CHD and arterial hypertension, which have distinctive features depending on gender and age. The degree of clinical symptomatology manifestation is directly dependent on the functional class of chronic heart failure. The most frequent companions of chronic heart failure in association with type 2 diabetes mellitus are obesity and chronic kidney disease. Left ventricular hypertrophy is considered to be one of the unfavorable predictors of cardiovascular complications, and its fluctuations were observed in our patients.

The role of thrombin in the pathogenesis of atherosclerosis and its complications

Thrombin is a key regulator of the homeostasis system. Also, it actively participates in progression of various systemic diseases, including atherosclerosis. There is a large amount of experimental and clinical data on the involvement of thrombin in the pathogenesis of ischemic heart disease (IHD). Thus, studying thrombin activity regulation is promising. Also, the question whether it is possible to use biomarkers of thrombin activity as predictors of cardiovascular complications in IHD patients is relevant. The present review focuses on major mechanisms of thrombin functioning, its role in development and progression of atherosclerosis, and available tests for evaluation of thrombin functional activity. Major clinical studies are discussed that evaluated the efficacy of thrombin inhibitors and protease-activated receptor antagonists.

Abstract EP51: Trends, Predictors And Outcomes Of Cardiovascular Complications Associated With Polycystic Ovary Syndrome During Delivery Hospitalizations-A United States National Database Analysis (2002-2019)

Background: Women with polycystic ovary syndrome (PCOS) have increased risk of pregnancy-associated complications. However, there is scarcity of data on the trends, outcomes, and predictors of cardiovascular (CV) complications associated with PCOS diagnosis during delivery hospitalizations in the United States. Methods and Results: We used data from the National Inpatient Sample. ICD-9 or ICD-10 codes were used to identify delivery hospitalizations and PCOS diagnosis. A total of 71,436,308 weighted US hospitalizations for deliveries were identified from 2002 to 2019. Of the included hospitalizations, 0.3% were among women with PCOS (n=195,675). PCOS women were older (mean 30 vs 28 years, p&lt;0.01) and had higher prevalence of diabetes, obesity, and dyslipidemia. After adjustment for age, race/ethnicity, comorbidities, insurance status and median household income, PCOS remained an independent predictor of CV complications at delivery including preeclampsia (aOR 1.56, 95% CI 1.54-1.59, p&lt;0.01), eclampsia (aOR 1.58, 95% CI 1.54-1.59, p&lt;0.01), peripartum cardiomyopathy (aOR 1.79, 95% CI 1.49-2.13, p&lt;0.01), and heart failure (aOR 1.76, 95% CI 1.27-2.45, p&lt;0.01) (Figure, Panel A), compared to no PCOS. An increase in overall prevalence of PCOS, and of obesity among those with PCOS, was also observed during the study period (Figure, Panel B). Moreover, delivery hospitalizations with PCOS diagnosis were associated with increased length (3 vs 2 days, p&lt;0.01) and cost of hospitalization ($6,310 vs $4,468, p&lt;0.01). Conclusions: Over a 17-year period, prevalence of PCOS and obesity increased among childbearing U.S. women. Women with PCOS had higher risks of preeclampsia/eclampsia, peripartum cardiomyopathy, heart failure, pulmonary edema, and venous thromboembolism. Moreover, delivery hospitalizations with PCOS diagnosis were associated with increased length and cost of hospitalization. Strategies to optimize pre-pregnancy cardiometabolic health may be particularly important to improve maternal CV outcomes.

Predictors of cardiovascular complications in patients with coronary heart disease, atrial fibrillation and various comorbidities

Predictors of cardiovascular complications in patients with coronary heart disease, atrial fibrillation and various comorbidities

Predictors of cardiovascular complications in patients with arterial hypertension and comorbid pathology

Aim. To study the relationship between central arterial pressure (BP) and cystatin C in patients with arterial hypertension and comorbid pathology, depending on gender differences.&#x0D; Materials and methods. The study involved 162 patients aged 39 to 82 years, suffering from hypertension and comorbid pathology. The average age of the surveyed was 58.610.3 years. The following nosological forms were revealed: coronary heart disease 40.7% of the examined, overweight 33.9%, 1st degree obesity 30.8%, type 2 diabetes mellitus 29.0%, chronic obstructive disease lungs 16.6%, cerebrovascular diseases 13.5%. All participants underwent general clinical examinations. The concentration of the lipid spectrum was investigated: the levels of total cholesterol, triglycerides, cholesterol high density lipoproteins (HDL cholesterol) and low density lipoprotein cholesterol (LDL cholesterol) and plasma cystatin C. Glomerular filtration rate (GFR) was calculated according to F. Hoek's formula (80.35/cystatin C 4.32=GFR). Study of central aortic pressure (CAP), mm Hg Art., was carried out using the device "AngioScan". Echocardiography was performed on a "Vivid q" apparatus (USA, 2014) according to the generally accepted technique. All examined patients were divided into 2 subgroups. The 1st subgroup includes women, the 2nd men.&#x0D; Results. In patients with hypertension and comorbid pathology, the most common abnormalities were an increased level of LDL cholesterol (58%), a decreased level of HDL cholesterol (51.8%), hypercholesterolemia (54.3%), hypertriglyceridemia (43.8%) and tachycardia (40.7%). In 51.8% of the surveyed, and more among males, the achievement of the target blood pressure level was detected. In women, the indicators of average age, body mass index, the content of total cholesterol, LDL cholesterol and HDL cholesterol were significantly higher. In male patients, the indicators of the diameter of the aortic outflow tract, end systolic and diastolic dimensions of the left ventricle (LV) significantly exceeded those of women, and the ejection fraction of the LV was significantly lower. The prevalence of LV hypertrophy (LVH) was 37% in the total sample, and it was higher in women than in men (45.9 and 26.6%, respectively, p=0.012). At the same time, the frequencies of concentric and eccentric types of LVH in both subgroups were similar. The incidence of LV concentric remodeling in women and men was 5.7 and 13.3%, respectively (p=0.001). In both subgroups, a negative correlation was found between the LV myocardial mass index and the calculated GFR. A positive correlation was noted between the levels of systolic blood pressure and CAP, the concentrations of cystatin C and plasma triglycerides.&#x0D; Conclusion. In hypertension, the structure of comorbid pathology is dominated by coronary heart disease, obesity and type 2 diabetes mellitus, when hyper- and dyslipidemia were often detected. The incidence of LVH in the general group of subjects was 37.0%, and in women this indicator was higher. In the subgroup of men, cases of LV concentric remodeling were significantly more frequent. An increase in the level of CAP and systolic blood pressure, as well as the concentration of cystatin C, was associated with an increase in the LV myocardial mass index, especially in the subgroup of women.

Association between preoperative baseline pulse pressure and estimated pulse wave velocity and acute renal failure and mortality following colorectal surgery. A single-centre observational study.

Elevated pulse wave velocity is a haemodynamic parameter considered to be a risk factor for the development of cardiovascular alterations, while pulse pressure is a predictor of cardiovascular complications and development of acute renal failure after both cardiac and non-cardiac surgery. Our objective was to determine whether baseline pulse pressure and estimated pulse wave velocity are associated with renal failure and 30-day mortality following colorectal surgery. Retrospective observational study. A total of 816 adult patients undergoing elective colorectal surgery were evaluated by performing multivariable logistic regression analysis to determine whether baseline pulse pressure and estimated pulse wave velocity were independently associated with complications, specifically renal failure and 30-day postoperative mortality, and whether pulse pressure and estimated pulse wave velocity thresholds correlated with outcomes. Baseline pulse pressure was 56.00 mmHg (45.00;68.00) and estimated pulse wave velocity was 13.16 m/s (10.76;14.85). Baseline pulse pressure was not associated with acute renal failure or mortality in the univariate model. Baseline estimated pulse wave velocity was not associated with complications, acute renal failure, or mortality. An estimated pulse wave velocity of 13.78 m/s significantly predicted acute renal failure (AUC 0.654 [0.588-0.720]) and mortality (AUC 0.698 [0.600-0.796]). Neither pulse pressure nor preoperative baseline estimated pulse wave velocity were associated with acute renal failure or postoperative mortality. The preoperative estimated pulse wave velocity threshold of 13.78 m/s predicted an increased risk of acute renal failure and postoperative mortality.