Presence Of Heart Failure Research Articles

Sex-specific associations between alcohol consumption, cardiac morphology, and function as assessed by magnetic resonance imaging: insights form the UK Biobank Population Study.

Data regarding the effects of regular alcohol consumption on cardiac anatomy and function are scarce. Therefore, we sought to determine the relationship between regular alcohol intake and cardiac structure and function as evaluated with cardiac magnetic resonance imaging. Participants of the UK Biobank who underwent cardiac magnetic resonance were enrolled in our analysis. Data regarding regular alcohol consumption were obtained from questionnaires filled in by the study participants. Exclusion criteria were poor image quality, missing, or incongruent data regarding alcohol drinking habits, prior drinking, presence of heart failure or angina, and prior myocardial infarction or stroke. Overall, 4335 participants (61.5 ± 7.5 years, 47.6% male) were analysed. We used multivariate linear regression models adjusted for age, ethnicity, body mass index, smoking, hypertension, diabetes mellitus, physical activity, cholesterol level, and Townsend deprivation index to examine the relationship between regular alcohol intake and cardiac structure and function. In men, alcohol intake was independently associated with marginally increased left ventricular end-diastolic volume [β = 0.14; 95% confidence interval (CI) = 0.05-0.24; P = 0.004], left ventricular stroke volume (β = 0.08; 95% CI = 0.03-0.14; P = 0.005), and right ventricular stroke volume (β = 0.08; 95% CI = 0.02-0.13; P = 0.006). In women, alcohol consumption was associated with increased left atrium volume (β = 0.14; 95% CI = 0.04-0.23; P = 0.006). Alcohol consumption is independently associated with a marginal increase in left and right ventricular volumes in men, but not in women, whereas alcohol intake showed an association with increased left atrium volume in women. Our results suggest that there is only minimal relationship between regular alcohol consumption and cardiac morphology and function in an asymptomatic middle-aged population.

The Optimal Haemoglobin Target in Dialysis Patients May Be Determined by Its Contrasting Effects on Arterial Stiffness and Pressure Pulsatility.

IntroductionIt remains unclear why the optimal haemoglobin target is lower in patients with chronic kidney disease (CKD) than in non-CKD persons. Arteriosclerosis and consequent impaired arterial function comprise a central cardiovascular risk mechanism in CKD. We hypothesized that the optimal haemoglobin target depends on its opposing effects on arterial stiffness and pressure pulsatility in CKD.MethodsArterial stiffness (aortic pulse wave velocity), wave reflection (augmentation index, reflected wave pressure and reflection magnitude), and pressure pulsatility (central systolic and pulse pressure, peripheral pulse pressure, pressure amplification and forward wave pressure) were assessed in 48 dialysis patients.ResultsIn established confounder and diabetes adjusted linear regression models, haemoglobin levels were directly associated with arterial stiffness (partial R=0.366, p=0.03) and inversely with central systolic pressure (partial R=−0.344, p=0.04), central pulse pressure (partial R=−0.403, p=0.01), peripheral pulse pressure (partial R=−0.521, p=0.001) and forward wave pressure (partial R=−0.544, p=0.001). The presence of heart failure and use of angiotensin converting enzyme inhibitors or angiotensin receptor blockers and erythropoietin stimulating agents did not materially alter these relationships upon further adjustment for the respective characteristics in the models, and in sensitivity analyses. In receiver operator characteristic curve analysis, the optimal haemoglobin concentration cut-off values in predicting arterial stiffness and increased central pulse pressure were remarkably similar at 10.95 g/dl and 10.85 g/dl, respectively, and with clinically useful sensitivities, specificities and positive and negative predictive values. In logistic regression models, a haemoglobin value of >10.9 mg/dl was associated with both arterial stiffness (>10 m/sec; OR (95% CI) = 10.48 (1.57–70.08), p=0.02) and normal central pulse pressure (>50 mmHg; OR (95% CI) = 7.55 (1.58–36.03), p=0.01).ConclusionThis study suggests that the optimal haemoglobin target in dialysis patients is ~11g/dl and determined by its differential and contrasting effects on arterial stiffness and pressure pulsatility.

Acil Serviste İnme Tanısı Alan Hastalarda Tam Kan Sayımı Parametreleri ve Erken Dönem Mortalite İlişkisi

ABSTRACT
 Background: Acute ischemic stroke is the most common cause of death after heart disease and cancer. We aimed to investigate the relationship between parameters of complete blood count in early period of ischemic stroke.
 Material Method: The study was organized as a retrospective-archive study. Patients applied Emergency Department and diagnosed as ischemic stroke were included. Demographic findings, complete blood count parameters, imaging tests, duration time in the emergency, hospitalization time were noted.
 Results: The mean age of 422 patients was 69.95 ± 12.26 years. Hypertension is the most common additional diseases, with the rate of 68.5%. While the mortality rate is 2.1% in the first 7 days, it was 5.2% in the first 30 days. The mean value of Neutrophil Lymphocyte Ratio (NLR) was significantly higher in patients who died within the first 7 days (p = 0.013). The sensitivity of NLR cut-off value, which was determined as 4.12 for death in the first 7 days, was 77.8% and specificity was 68.5%. Red Cell Distribution Width (RDW) values of patients who died within 30 days were found to be statistically significantly higher when compared to living patients. Advanced age, heart failure and atrial fibrillation were found to be significant risk factors for early mortality.
 Conclusion: In conclusion, NLR can be predictive for mortality within the first 7 days and RDW for mortality within the first 30 days. The presence of heart failure and / or atrial fibrillation and the age of 65 and above increase the risk of early mortality.
 
 Keywords: ischemic stroke, red cell distribution width, neutrophil lymphocyte ratio, early mortality

Аpplication of myocardial damage and heart failure biomarkers in preventive and early diagnosis of aki in acute coronary syndrome

INTRODUCTION . From 15 to 35% of cases of acute coronary syndrome (ACS) are complicated by the development of acute kidney injury (AKI), prevention and early intervention remain the most effective strategy for managing patients with AKI in ACS. THE AIM: This study aimed to explore a risk factors and biomarkers for predictive and early diagnostic of AKI in ACS. PATIENTS AND METHODS . The study included patients hospitalized with a diagnosis of ACS in Pavlov First Saint Petersburg State Medical University. In case of exclusion of ACS, patients were determined in the comparison group, in case of confirmation of the diagnosis of ACS – in the study group. Biomaterial (blood) was taken at admission (T1), 1 day after admission (T2) and 2 days after admission (T3). For the diagnosis of AKI, KDIGO 2012 criteria were used. The measured biomarkers at each point were sST2, troponin I, NTproBNP. RESULTS . The study included 132 patients, the diagnosis of ACS was confirmed in 91 patients and AKI development was in 30 patients, all from the ACS group. The most significant for predictive diagnosis was the assessment of GRACE score> 133 points (AUC=0.760, p=0.001), sST2 level> 27.2 ng / ml (AUC=0.737, p=0.001), Mehran score> 5 (AUC=0.916, p=0.001), modification of the Mehran score (adding 2 points if the patient has sST2> 27.2) increases the predictive ability of AKI, Mehran+sST2> 7 points – AUC=0.928, p=0.001. CONCLUSIONS . The use of a combination of clinical data (hemodynamic parameters, presence of heart failure, routine laboratory data, presence of AKI risk factors) and assessment of biomarkers level, in particular the sST2 level, seems to be an effective method for predictive diagnosis of AKI and requires further research.

Abstract 16002: Chronotropic Incompetence Limits Exercise Capacity in Patients Taking Beta-Blockers

Introduction: Chronotropic incompetence in patients taking beta-blockers is associated with poor prognosis; however, its impact on exercise capacity (EC) remains unclear. Hypothesis: We assessed the hypothesis that chronotropic incompetence is associated with decreased exercise capacity in patients taking beta-blockers. Methods: We retrospectively analyzed data from consecutive patients taking beta-blockers referred for cardiopulmonary exercise testing. EC was expressed as peak oxygen uptake (VO 2 peak; mL/kg/min). Chronotropic incompetence was defined as chronotropic index (CI) ≤ 62%. CI was calculated as [(HR at peak-resting HR) / (maximum predicted HR-resting HR)] х 100%. Results: Among 140 patients all taking beta-blockers (age 61 ± 9.7 years; 73% males), there were 113 (80.7%) patients with chronotropic incompetence. EC was lower in the group with chronotropic incompetence than the group without it, VO 2 peak 18.3 ± 5.7 vs. 24.0 ± 5.3 mL/kg/min, p < 0.001. In multivariate analysis ( Table ), EC correlated positively with CI (β = 0.14, p < 0.001) and male gender (β = 5.12, p < 0.001), and negatively with age (β = –0.17, p < 0.001) and presence of heart failure (β = –3.35, p < 0.001). Beta-blocker dose was not associated with EC. Partial correlation attributable to CI (partial R 2 = 24.7%) accounted for more than one-third of the variance in EC explained by the model (adjusted R 2 = 59.8%). Conclusions: In patients taking beta-blockers, the presence of chronotropic incompetence was associated with lower EC, regardless of the beta-blocker dose. CI accounted for more than one-third of EC variance explained by our model.

Abstract 14539: Incidence, Risk Factors, Natural History, and Outcomes of Atrial Fibrillation in Patients With Graves’ Disease

Background: Hyperthyroidism is associated with atrial fibrillation (AF) with a reported prevalence of 16-60%. However, risk factors for onset of AF with hyperthyroidism are not well defined. We sought to identify patients with hyperthyroidism most likely to develop AF. Methods: We reviewed the medical records of 1371 consecutive patients with GD evaluated at our clinic between 2009 and 2019. GD-related AF was defined as AF diagnosed up to 30 days before or at any time after Grave’s disease (GD). Spontaneous recovery was defined as sinus rhythm after attainment of euthyroidism without the need for pharmacologic or electrical cardioversion. Outcomes of major cardiovascular events, all-cause mortality, and cardiac hospitalizations were compared between cases and controls (GD without AF) matched 1:1 for age, gender, and history of coronary artery disease. Results: AF occurred in 140 patients with an incidence of 10.2%. Older age (RR 1.63 per 10 years, p <0.001), male gender (RR 2.06, p < 0.001), overt hyperthyroidism (RR 2.48, p = 0.002), COPD (RR 2.14, p =0.006), and higher BMI (RR 1.03 per unit, p=0.023) were independent risk factors for AF. Spontaneous AF recovery occurred in 44 of 128 (34.6%) patients with adequate follow up. The multivariate risk factor for failed recovery was the presence of heart failure (HF) (OR =3.52, p= 0.004). GD patients with AF had higher rates of cardiac hospitalizations (Figure) that persisted even after adjusting to HF presence (27.9% vs 2.9%, p < 0.001). Conclusion: Risk factors for AF in GD are similar to those in the general population, although overt hyperthyroidism conferred the highest risk. These data argue for careful monitoring of GD patients with multimorbidity who may be at high risk of developing AF.

The impact of ultrafiltration, diuretic therapy, heart failure and diabetes mellitus on sodium homeostasis in patients with ESRD: A cross-sectional analysis

Background: Sodium homeostasis is significantly altered in patients with End Stage Renal Disease (ESRD). Higher inter-dialytic weight gain, larger volume of ultrafiltration during hemodialysis, presence of heart failure and associated diabetes mellitus increase the risk of hyponatremia in these patients. Severity of hyponatremia can predict morbidity and mortality in ESRD. Objectives: To study the impact of average weight gain, average ultrafiltrate removed per dialysis, associated heart failure and diabetes mellitus on serum sodium levels in ESRD patients. Methods: We studied 60 patients of ESRD undergoing hemodialysis. History of co-morbidities, duration of hemodialysis, diuretic usage, dialysis records were obtained and their impact on serum sodium levels were analysed statistically. Results: Among 60 participants, 18% had mild, 38% had moderate and 44% had severe hyponatremia. The average inter-dialytic weight gain was 1.86±0.55 L in mild, 2.19±0.56 L in moderate and 2.80±0.44 L in severe hyponatremia groups (p=0.0001). The average ultrafiltration per hemodialysis was 1.69±0.56 L in mild, 2.02±0.53 L in moderate and 2.62±0.36 L in severe hyponatremia groups (p=0.0001). 53% patients were on furosemide out of whom 72% had severe hyponatremia (p=0.0001). 58% patients had chronic heart failure (CHF) out of whom 74% had severe hyponatremia (p=0.0001). 70% patients had diabetes mellitus (DM) out of whom 62% had severe hyponatremia (p=0.0001). Conclusion: There was a significant negative correlation between average weight gain/average ultrafiltration per dialysis and serum sodium levels. The study strongly established the impact of heart failure and diabetes mellitus on serum sodium levels in ESRD.

Mortality benefit of coronary angioplasty vs. conservative strategy in patients with prior coronary artery bypass surgery presenting with non-ST elevation myocardial infarction

Abstract Background Patients with prior coronary artery bypass graft (CABG) surgery have been excluded or under-represented in many of the trials of percutaneous coronary intervention (PCI) vs. conservative strategy in the management of patients presenting with non-ST elevation myocardial infarction (NSTEMI). Therefore, limited data supports the use of PCI in this context. Given the higher risk profile of these patients, clinicians may default to a conservative strategy given the lack of evidence of benefit of PCI. Our institution consists of one PCI and one non-PCI acute site and serves a population of 500 000 including a uniquely high proportion of the elderly with a high follow up rate and an ideal, interesting population to study with many patients offered a conservative strategy. Methodology Patients who presented over a 5 year period from Jan 2012 to Dec 2017 with NSTEMI and prior CABG were identified from Myocardial Ischaemia National Audit Project (MINAP) returns. Hospital records were reviewed to exclude patients with type 2 MI and ST elevation MI. We identified patients who were managed conservatively or with PCI and assessed outcomes at the end pf December 2019, giving a follow up range of 2–7 years. The primary outcome was all cause death or myocardial infarction. Secondary outcome measures included readmission at 30 days and 1 year, angina, need for revascularisation. Results 206 patients were identified (mean age 77.7y, 26% female) of whom 107 were managed medically and 99 underwent angiography. 74 (36%) of patients were admitted to the non-interventional site, of which 27 patients underwent angiography. Overall, 48 (23%) went on to have PCI (only 7% of patients from the non-PCI site). 29 patients had PCI to the native coronaries, 16 to a bypass graft and the remainder to both. Age and clinical frailty score (CFS) was significantly higher in patients managed conservatively. The primary end point occurred in a high proportion of patients (124, 74.6%) consisting of 28 MI and 96 deaths during the follow up period. Age at presentation, clinical frailty score (CFS), presence of heart failure and absence of statin use were were significantly associated with the primary outcome. There was a significant difference in the primary outcome in patients managed conservatively (113/158; 72%) compared to those who had PCI (11/48; 23%), P<0.001. Conclusion PCI in NSTEMI patients with prior CABG is significantly associated with improved survival and less myocardial infarction compared to a conservative strategy in this retrospective audit of our patient population, but PCI patients are younger and less frail, which, in themselves, could suggest treatment bias and might confer a survival benefit. PCI rates varied significantly when patients were assessed in non-interventional acute site compared to a PCI site which has important implications for service provision. A large-scale randomised control trial is warranted to guide best practice. Funding Acknowledgement Type of funding source: None

Nanopartículas y antibióticos: respuesta a la resistencia global bacteriana

Este artículo de revisión bibliográfica pretende identificar los factores que eventualmente pueden influir en la recuperación funcional de los pacientes adultos mayores, posterior a una fractura de cadera.
 Se concluye que el proceso de recuperación funcional es multifactorial y puede verse influido positiva o negativamente por factores tales como la edad, el estado funcional previo, el estado nutricional, el estado cognitivo, la presencia de depresión, la presencia de falla cardiaca, medicamentos prescritos, el miedo a caer posterior a la fractura, y los roles que tiene la persona en la vida cotidiana.

Factores que influyen en la recuperación funcional del paciente adulto mayor con fractura de cadera

Este artículo de revisión bibliográfica pretende identificar los factores que eventualmente pueden influir en la recuperación funcional de los pacientes adultos mayores, posterior a una fractura de cadera.
 Se concluye que el proceso de recuperación funcional es multifactorial y puede verse influido positiva o negativamente por factores tales como la edad, el estado funcional previo, el estado nutricional, el estado cognitivo, la presencia de depresión, la presencia de falla cardiaca, medicamentos prescritos, el miedo a caer posterior a la fractura, y los roles que tiene la persona en la vida cotidiana.

Treatment Dilemma in Systemic Lupus Erythematous Related Cardiomiopathy

Background Systemic Lupus Erythematous (SLE) is an autoimmune disease that is known to cause many cardiac complications including lesions of the valves, myocardium, pericardium, and the coronary vessel. However, the management of SLE induced cardiomyopathy remains controversial. Case presentation A 59-year-old African American woman with a medical history of hypertension presented with dyspnea on exertion for a few days. Physical exam revealed distended neck vein, lung crackles, and leg swelling. EKG showed normal sinus rhythm. Transthoracic echocardiogram (TTE) showed a left ventricular ejection fraction of 10% (LVEF). Decision-making The patient was treated with intravenous diuretic and improved symptomatically. She underwent a coronary angiogram, which showed normal coronary arteries and cardiac MRI didn't reveal any signs of myocarditis or infiltrative cardiomyopathy. We started guideline-directed medical therapy (GDMT) including losartan, carvedilol, and spironolactone, and titrated up accordingly. In a follow-up echocardiogram after 3 months, LVEF remained unchanged while on optimal GDMT. She developed a skin rash with fatigue and further investigations showed evidence of SLE. With the presence of heart failure and newly diagnosed SLE, the underlying cause of cardiomyopathy was most likely due to SLE. At this point, we were perplexed on how to approach SLE related cardiomyopathy and decided to treat underlying autoimmune disease with rituximab, hydroxychloroquine, and methylprednisolone. A follow-up TTE in a month disclosed LVEF of 40-45%. Conclusion The role of GDMT is unclear in SLE induced cardiomyopathy and has never been tested in randomized trials. However, treatment of SLE with immunomodulating therapies could ameliorate and even reverse the cardiomyopathy, which was demonstrated in our case. Early recognition of SLE and aggressive intervention is paramount for recovery in SLE related cardiomyopathy.

Неблагоприятное течение тромбоэмболии легочной артерии в течение года наблюдения

Цель исследования: изучение частоты и причины неблагоприятных исходов, а также факторов, с ними связанных, в течение года наблюдения у пациентов с тромбоэмболией легочной артерии (ТЭЛА). Материалы и методы: В одноцентровый регистр проспективного наблюдения методом сплошного включения включены 185 пациентов с ТЭЛА. Проводилось стандартное обследование пациентов, диагноз подтверждался по результатам мультиспиральной компьютерной томографии. Период наблюдения составил 12 мес, в течение которого отслеживали исходы пациентов, выписанных под амбулаторное наблюдение. Конечными точками являлись все случаи смерти и рецидивов ТЭЛА. Статистическую обработку результатов осуществляли с помощью пакета программ MedCalc Version 16.2.1 (Softwa, Бельгия). Результаты: Годовые исходы были определены у 161 пациента. Фатальный исход в течение года после выписки из стационара наступил у 22 (13,6%) больных ТЭЛА: у 45,5% по причине рецидива ТЭЛА, у 22,7% — онкологической патологии, у 13,6% — из-за острого нарушения мозгового кровообращения (ОНМК). Развитие летальных исходов было ассоциировано с такими факторами, как пожилой возраст, наличие ишемической болезни сердца, злокачественных новообразований, застойной сердечной недостаточности, ОНМК, а также со снижением глобальной сократимости миокарда левого желудочка, высоким риском по шкале PESI (англ. Pulmonary Embolism Severity Index) и отказом от антикоагулянтной терапии в течение первых 6 мес. Рецидив ТЭЛА в течение года наблюдения выявлен в 11,2% случаев и был связан с наличием тромбоза глубоких вен нижних конечностей, нижней полой вены и подвздошных вен, застойной сердечной недостаточностью и дилатацией правых отделов сердца. Установлено, что отказ от антикоагулянтной терапии в течение 11 мес после первичного эпизода повышает риск развития рецидива ТЭЛА. Заключение: У пациентов с ТЭЛА в течение первого года наблюдения летальный исход развился в 13,6% случаев, а рецидив ТЭЛА — в 11,2%. Наиболее значимым неблагоприятным фактором, связанным с данными конечными точками, являлся отказ от антикоагулянтной терапии ранее 6 мес после эпизода ТЭЛА. Objectives: to study the incidence, causes and factors associated with adverse outcomes in patients with pulmonary embolism (PE) during the year of observation. Patients/Methods: The single-center prospective follow-up register included 185 patients with PE. Standard examination was carried out; the diagnosis was confirmed by multispiral computed tomography. During follow-up period of 12 months we tracked outpatient outcomes. The endpoints were all-cause mortality and PE relapses. Statistical analysis was performed by MedCalc Version 16.2.1 software package (Softwa, Belgium). Results: Twelve-month outcomes were determined in 161 patients. Post-discharge fatal outcome within a year occurred in 22 (13.6%) patients with PE: in 45.5% due to PE relapse, in 22.7% due to oncological pathology, in 13.6% because of acute stroke. Lethal outcomes were associated with elderly age, ischemic heart disease, malignant neoplasms, congestive heart failure, stroke, reduction of left ventricular global myocardial contractility, a high risk according to PESI (Pulmonary Embolism Severity Index) scale and the refusal of anticoagulant therapy during the first 6 months. Within a year of observation PE relapse was detected in 11.2% of patients and was associated with deep vein thrombosis of the lower limbs, inferior vena cava and iliac veins, congestive heart failure and dilatation of right heart compartments. Refusal of anticoagulant therapy within 11 months after the initial episode increased the risk of PE relapse. Conclusions: In patients with PE during the first year of observation a fatal outcome occurred in 13.6% patients with PE and PE relapse — in 11.2%. Refusal of anticoagulant therapy earlier than 6 months after the episode of PE was the most significant adverse factor associated with these endpoints.

Twenty-four-hour ambulatory (Holter) electrocardiographic findings in 13 cats with non-hypertrophic cardiomyopathy

Detection and characterisation of cardiac arrhythmias in cats with hypertrophic cardiomyopathy (HCM) has already been documented in various studies. However, similar studies have not been reported for other forms of feline cardiomyopathy. The clinical records of 13 client-owned cats diagnosed with restrictive cardiomyopathy (RCM), arrhythmogenic right ventricular cardiomyopathy (ARVC) and non-specific cardiomyopathy (NSCM) that underwent Holter recording at the time of diagnosis were reviewed retrospectively.Eight cats had signs of congestive heart failure at presentation, one cat had a history of recurrent syncope and the remaining four cats were asymptomatic. The average heart rate was 138 ± 22 (range 97–181) beats per minute (bpm) with the lowest value (97 bpm) recorded in a cat with third degree atrioventricular block (3-AVB) and the highest value (181 bpm) observed in a cat with atrial fibrillation (AF). The median number of ventricular ectopic beats (VEB) over 24 h was 2031 (338–8305), mostly represented by single isolated VPCs (803, 123–2221). Cardiac pauses were observed in three cats, with the longest pause lasting more than 6 s. A survival analysis was not performed due to the small number of cats and limited follow-up information. Holter recording revealed cardiac arrhythmias in all 13 cats, while 8/13 cats (61.5%) had an unremarkable resting electrocardiogram (ECG). The average daily heart rate in these cats did not appear affected by the presence of heart failure, although periods of sinus arrhythmia were absent in all individuals.

Predictors of Heart Failure in Nigerian Children with Ostium Secundum Atrial Septal Defects and Associated Structural Defects

Background: Atrial septal defects are common congenital heart defects which could be discovered incidentally during cardiac screening of a child in heart failure. The aim of this study was to determine the predictors of heart failure in children with ostium secundum Atrial Septal Defects (os-sec ASD) and other associated structural lesions.
 Methods: Seventy-five children with os-sec ASD seen in two tertiary centres in Southern Nigeria were recruited prospectively. Details of age, gender, anthropometric parameters and echocardiographic findings were entered into a proforma. The sizes of the ASDs were categorized into 3 groups; small size=<5 mm, moderate size=5-9mm and large size=≥10 mm. The modified Ross Classification was used to determine the presence of heart failure. Data were analyzed using SPSS v 25.0 software.
 Results: The ages of the children ranged from 0.25 months to 242 months with a mean age of 3.2±1.7 months and a male: female ratio of 1.5:1. Forty (53.3%) children had isolated os-sec ASD while 35 (46.7%) children had os-sec ASD with other structural defects. Thirty-eight (50.7%) of the children had features of heart failure at presentation out of which 50% were infants and 88.0% were mildly wasted. There was no significant association between the presence of heart failure in the study subjects and age, gender or nutritional status (p> 0.05). There was however a significant association between the presence of heart failure and other structural defects co-existing with ASD (p = 0.038) and Large sized os-sec ASD of greater than 10mm (p = 0.0001) in those with isolated os-sec ASD.
 Conclusion: Children with ostium secundum Atrial septal defects could present with heart failure, which is more likely if the defect is >10mm or associated with other structural heart lesions.

Влияние наличия критериев метаболического синдрома на течение раннего и отдаленного постинфарктного периода у больных с инфарктом миокарда с элевацией сегмента ST

Цель работы – оценить клиническое значение наличия метаболического синдрома (МС) у больных с острым инфарктом миокарда (ОИМ) для течения постинфарктного периода и его влияния на прогноз на основе ретроспективного анализа сопоставимых пар пациентов. Материалы и методы. Ретроспективный анализ базы из 820 случаев ОИМ с элевацией сегмента ST включал: оценку наличия основных факторов риска согласно шкалам TIMI, GRACE, PURSUIT и компонентов МС при поступлении (наличие сахарного диабета и/или повышение уровня глюкозы > 7 ммоль/л, избыточная масса тела, артериальная гипертензия, нарушение липидного спектра крови), а также оценку показателей клинического течения госпитального периода ОИМ, лечения и результатов отдаленного наблюдения за пациентами с учетом случаев кардиальной смерти.Результаты и обсуждение. Путем автоматизированного подбора пар были сформированы группа 1 (n=41, пациенты с МС) и группа 2 (n=123, пациенты без МС), сопоставимые по следующим 13 факторам риска: возраст, рост, наличие сердечной недостаточности, курение, снижение систолического артериального давления в 1-е сутки ОИМ, локализация поражения по ЭКГ, пиковый уровень МВ-фракции креатинфосфокиназы и АСТ, наличие в анамнезе стенокардии напряжения и периода нестабильной стенокардии перед ОИМ, наличие инфаркта миокарда в анамнезе, частота сокращений сердца в 1-е сутки ОИМ, скорость клубочковой фильтрации по формуле CKD-EPI в 1-е сутки ОИМ, мужской пол. Группа 1 характеризовалась более тяжелым клиническим течением ОИМ, а также более интенсивной госпитальной терапией (включавшей более частое назначение ингибиторов ангиотензинпревращающего фермента и статинов). К 10-м суткам заболевания больные группы 1 имели более низкие показатели конечнодиастолического индекса ((59,1±2,55) по сравнению с (66,50±2,38) мл/м2 в группе 2; p<0,05), конечносистолического индекса ((31,90±1,79) по сравнению с (37,50±1,89) мл/м2 в группе 2; p<0,05) и тенденцию к более низкой 3-летней смертности (4,9 % по сравнению с 17,1 %; p=0,05).Выводы. Наличие у больных с ОИМ сопутствующего МС сопряжено с более тяжелым течением острого периода заболевания, но в силу более интенсивной кардиальной терапии в этой группе больных отмечается более благоприятное течение постинфарктного периода.

Is improvement in depression in patients attending cardiac rehabilitation with new-onset depressive symptoms determined by patient characteristics?

BackgroundPatients with cardiovascular disease (CVD) commonly experience depressive symptoms which is associated with adverse outcome and increased mortality. Examining the baseline characteristics of cardiac rehabilitation (CR) patients that determine Hospital Anxiety and Depression Scale (HADS) depression outcome may facilitate adjustments in CR programme delivery. This study aims to investigate whether comorbidities, demographic and clinical characteristics of patients, with new-onset post-cardiac event depressive symptoms, determine change in their depression following CR.MethodsAnalysing the routine practice data of British Heart Foundation National Audit of Cardiac Rehabilitation between April 2012 and March 2018, an observational study was conducted. Patients with new-onset post-cardiac event depressive symptoms and no previous documented history of depression constituted the study population.ResultsThe analyses included 64 658 CR patients (66.24±10.69 years, 75% male) with new-onset HADS measures, excluding patients with a history of depression. The comorbidities determining reduced likelihood of improvement in depression outcomes after CR were angina, diabetes, stroke, emphysema and chronic back problems. In addition, higher total number of comorbidities, increased weight, a higher HADS anxiety score, smoking at baseline, physical inactivity, presence of heart failure and being single were other significant determinants. However, receiving coronary artery bypass graft treatment was associated with better improvement.ConclusionThe study identified specific baseline comorbid conditions of patients with new-onset depressive symptoms including angina, diabetes, stroke, emphysema and chronic back problems that were determinants of poorer mental health outcomes (HADS) following CR. Higher total number of comorbidities, increased weight, physical inactivity, smoking, presence of heart failure and being single were other determinants of a negative change in depression. These findings could help CR programmes focus on tailoring the CR intervention around comorbidity, physical activity status, weight management and smoking cessation in patients with new-onset depressive symptoms.

Does Renal Function or Heart Failure Diagnosis Affect Primary Care Prescribing for Sodium-Glucose Co-Transporter2 Inhibitors in Type2 Diabetes?

IntroductionSodium-glucose co-transporter 2 inhibitors (SGLT2is) are a unique class of drugs currently used in the management of type 2 diabetes (T2D). There are emerging data from cardiovascular outcome trials confirming renal and heart failure benefits of these drugs independent of glucose lowering. By contrast, the current licencing indications of these drugs are mainly limited to their glucose-lowering effects, and not to renal or heart failure benefits. It is therefore timely to ascertain whether the presence of these clinical conditions may influence prescribing choices for patients with T2D. Our aims are to report prescribing of SGLT2is in people with T2D according to their renal function and presence of heart failure. Co-prescribing with diuretics will also be explored.MethodsWe will perform a cross-sectional analysis of people with T2D in the Royal College of General Practitioners (RCGP) Research and Surveillance Centre (RSC) network. The RCGP RSC includes more than 1500 volunteer practices throughout England and parts of Wales, and a representative sample of over 10 million patients. The proportion of adults with T2D ever prescribed an SGLT2i will be determined. Within this cohort, we will calculate the percentage of SGLT2is prescribed according to renal function, and the proportion of prescriptions in people with co-morbid heart failure, stratified by body mass index categories. The percentage of SGLT2is prescribed as an add-on to a diuretic or following discontinuation of prescribing for a diuretic will also be reported. Multilevel logistic regression will be performed to explore the association between heart failure and renal function, and propensity to prescribe SGLT2is.Planned OutputsThe study findings will be submitted to a primary care/diabetes-focused conference, and for publication in a peer reviewed journal.

Extracellular vesicle Cystatin C and CD14 are associated with both renal dysfunction and heart failure.

AimsExtracellular vesicles (EVs) are small double‐membrane plasma vesicles that play key roles in cellular crosstalk and mechanisms such as inflammation. The role of EVs in combined organ failure such as cardiorenal syndrome has not been investigated. The aim of this study is to identify EV proteins that are associated with renal dysfunction, heart failure, and their combination in dyspnoeic patients.Methods and resultsBlood samples were prospectively collected in 404 patients presenting with breathlessness at the emergency department at National University Hospital, Singapore. Renal dysfunction was defined as estimated glomerular filtration rate < 60 mL/min/1.73 m2. The presence of heart failure was independently adjudicated by two clinicians on the basis of the criteria of the European Society of Cardiology guidelines. Protein levels of SerpinG1, SerpinF2, Cystatin C, and CD14 were measured with a quantitative immune assay within three EV sub‐fractions and in plasma and were tested for their associations with renal dysfunction, heart failure, and the concurrence of both conditions using multinomial regression analysis, thereby correcting for confounders such as age, gender, ethnicity, and co‐morbidities. Renal dysfunction was found in 92 patients (23%), while heart failure was present in 141 (35%). In total, 58 patients (14%) were diagnosed with both renal dysfunction and heart failure. Regression analysis showed that Cystatin C was associated with renal dysfunction, heart failure, and their combination in all three EV sub‐fractions and in plasma. CD14 was associated with both renal dysfunction and the combined renal dysfunction and heart failure in all EV sub‐fractions, and with presence of heart failure in the high density lipoprotein sub‐fraction. SerpinG1 and SerpinF2 were associated with heart failure in, respectively, two and one out of three EV sub‐fractions and in plasma, but not with renal dysfunction.ConclusionsWe provide the first data showing that Cystatin C and CD14 in circulating EVs are associated with both renal dysfunction and heart failure in patients presenting with acute dyspnoea. This suggests that EV proteins may be involved in the combined organ failure of the cardiorenal syndrome and may represent possible targets for prevention or treatment.

Effect of intervention timing on one-year mortality in elderly non-ST-segment elevation myocardial infarction patients.

The best timing for early invasive therapy in non-ST-segment elevation myocardial infarction (NSTEMI) patients remains controversial. We sought to determine the optimal timing of early catheterization in order to improve long-term outcomes in elderly (>65 years old) patients with NSTEMI. Using data from the CRUSADE registry linked to Medicare claims, we evaluated the association of early catheterization within the first 24 h or earlier time cut-points of NSTEMI presentation with long-term mortality among older Medicare beneficiaries. Of 15 575 NSTEMI patients from 398 CRUSADE hospitals (2003-2006), 3880 (24.9%) received early (≤12 h) catheterization. Compared with those undergoing later catheterization, patients treated early were younger and had less comorbid illness. Relative to those treated later, patients receiving early catheterization had similar 1-year all-cause mortality (11.8% vs 11.9%, P = 0.90). Using on- vs off-hour presentation as an instrumental variable, balancing potential measured and unmeasured confounders, early and later catheterization patients had nonsignificant differences in 1-year mortality (+5.6% [-11.5%, +22.7%]). Similar results were observed in clinically relevant subgroups, such as age (< or ≥75 years), gender, diabetes status, Global Registry of Acute Coronary Events score (< or ≥140), presence of heart failure, and sensitivity analyses of alternative definitions of early catheterization (≤6 and ≤24 h). Among older NSTEMI patients, we found that <24 h or earlier (neither <6 nor 12 h) of catheterization timing were not significantly associated with differences in long-term mortality.

Improvements in exercise capacity of older adults during cardiac rehabilitation.

Cardiac rehabilitation plays a vital role in secondary prevention of cardiovascular patients. Female sex and higher age, however, are associated with non-referral to cardiac rehabilitation. Improving exercise capacity during cardiac rehabilitation is essential to reduce morbidity and mortality risks. The objective of this study was to closely examine the beneficial changes in exercise capacity of older patients of both sexes during cardiac rehabilitation and to identify the most important predictors of the change in exercise capacity. A sample of 13,612 patients (mean age = 69.10 ± 11.8 years, 63.7% men, 19% > 80 years) was analysed. Data were prospectively assessed from 2012-2018 in six Swiss in-patient cardiovascular rehabilitation clinics. Improvement in exercise capacity measured with the six-minute walking test represents the outcome variable. Univariate and multivariate analyses, as well as the random forest method were used to estimate variable importance. Mean improvement in the six-minute walking test was 113.5 ± 90.5 m (men = 118.7 ± 110.0; women = 104.4 ± 93.0, Cohen's d = 0.16). The presence of heart failure, diabetes mellitus and psychiatric diagnoses was related to reduced but nonetheless clinically relevant six-minute walking test improvement. Random forest analysis suggests that baseline exercise capacity, age, time in rehabilitation and heart failure were the most important predictors for improvement in exercise capacity. Clinically relevant improvements in exercise capacity (>45 m) were also present into old age (85 years) and for both sexes. As indicated by these results, efforts need to be increased to refer eligible patients to structured rehabilitation programmes, irrespective of patients' age and sex.