Relationship key factor of inflammation and the development of complications in the late period of myocardial infarction in patients with visceral obesity

BACKGROUND: Cytokines play an significant role in regulating non-specific inflammatory response involved in many pathological processes. The current study tested the hypothesis that myocardial infarction in patients with obesity can lead to increased production of proinflammatory cytokines and unfavorable course of the pathological process. METHODS: The study recruited 232 male patients with ST-elevated myocardial infarction. The mean age of the patients was 58.7 (52.2-69.9) years. All the patients were assigned to two groups according to the computed tomography findings: 1 (n = 160) patients with visceral obesity (VO), and 2 (n = 72) patients without VO. Interleukins were measured in blood serum on days 1 and 12 after MI. RESULTS: All patients with MI demonstrated elevated levels of proinflammatory markers and reduced anti-inflammatory markers in the in-hospital period. The results suggested that among all studied inflammatory markers IL-6 (OR 1.9; 95% CI (1.6–2.8) and CRP (OR 1.3; 95% CI (1.1–1.8) were closely related to VO. One year after MI adverse cardiovascular outcome frequently occurred in patients with VO. There were two cardiac deaths (3.1%), 6 cases (9.3%) of recurrent MI, 19 cases (29.6%) of repeated hospitalizations for unstable angina, whereas only 2 patients without VO (6.6%) were hospitalized for unstable angina. The results of the logistic regression analysis demonstrated that IL-6, IL-12, and IL-10 had the highest predictive value for occurrence of adverse cardiovascular events in patients with VO. CONCLUSION: Cytokine profile in MI patients with VO is characterized by an imbalance caused by elevated pro-inflammatory interleukins and decreased anti-inflammatory interleukins. Obesity in patients was associated with a marked increase in IL-6 and CRP levels

Impact of COVID-19 on cardiovascular testing in the United States versus the rest of the world

Objectives: This study sought to quantify and compare the decline in volumes of cardiovascular procedures between the United States and non-US institutions during the early phase of the coronavirus disease-2019 (COVID-19) pandemic. Background: The COVID-19 pandemic has disrupted the care of many non-COVID-19 illnesses. Reductions in diagnostic cardiovascular testing around the world have led to concerns over the implications of reduced testing for cardiovascular disease (CVD) morbidity and mortality. Methods: Data were submitted to the INCAPS-COVID (International Atomic Energy Agency Non-Invasive Cardiology Protocols Study of COVID-19), a multinational registry comprising 909 institutions in 108 countries (including 155 facilities in 40 U.S. states), assessing the impact of the COVID-19 pandemic on volumes of diagnostic cardiovascular procedures. Data were obtained for April 2020 and compared with volumes of baseline procedures from March 2019. We compared laboratory characteristics, practices, and procedure volumes between U.S. and non-U.S. facilities and between U.S. geographic regions and identified factors associated with volume reduction in the United States. Results: Reductions in the volumes of procedures in the United States were similar to those in non-U.S. facilities (68% vs. 63%, respectively; p = 0.237), although U.S. facilities reported greater reductions in invasive coronary angiography (69% vs. 53%, respectively; p < 0.001). Significantly more U.S. facilities reported increased use of telehealth and patient screening measures than non-U.S. facilities, such as temperature checks, symptom screenings, and COVID-19 testing. Reductions in volumes of procedures differed between U.S. regions, with larger declines observed in the Northeast (76%) and Midwest (74%) than in the South (62%) and West (44%). Prevalence of COVID-19, staff redeployments, outpatient centers, and urban centers were associated with greater reductions in volume in U.S. facilities in a multivariable analysis. Conclusions: We observed marked reductions in U.S. cardiovascular testing in the early phase of the pandemic and significant variability between U.S. regions. The association between reductions of volumes and COVID-19 prevalence in the United States highlighted the need for proactive efforts to maintain access to cardiovascular testing in areas most affected by outbreaks of COVID-19 infection

Pulmonary Veins Morphometric Characteristics and Spatial Orientation Influence on Its Cryoballoon Isolation Results

The aim of this paper is to evaluate the effect of pulmonary vein (PV) morphometric characteristics and spatial orientation on the results of cryoballoon ablation (CBA). Methods: A randomized, prospective, single-center controlled study was conducted, enrolling 230 patients with drug-refractory atrial fibrillation (AF). We compared procedural and long-term outcomes in patients who underwent their first procedure of pulmonary vein isolation (PVI) for AF with either radiofrequency ablation (RFA) (n = 108) or CBA (n = 122) and assessed their interaction with the different pattern of PV anatomy, morphometric characteristics, and spatial orientation. The primary efficacy endpoint was any documented atrial arrhythmia recurrence (AF, atrial flutter, or atrial tachycardia) lasting over 30 s during a 12-month follow-up after a 90-day blanking period and discontinuation of antiarrhythmic drugs. The procedure&rsquo;s endpoint was the achievement of PVI. Before the intervention, all patients underwent computed tomography (CT) to assess the PV anatomical variant, maximum and minimum diameters of the PV&rsquo;s ostia, their cross-sectional area, orifice ovality index, and PV tilt angles. Results: The mean follow-up period was 14 months (12; 24). Long-term efficacy in the cryoablation group was 78.8% and in the RFA group&mdash;83.3% (OR = 0.74; 95% CI 0.41&ndash;1.3; p = 0.31). The RFA results did not depend on PV anatomy. The &laquo;difficult&raquo; occlusion of the right inferior PV (RIPV) occurred in 12 patients and was associated with a more horizontal PV position in the frontal plane; the mean tilt angle was &minus;15.2 &plusmn; 6.2&deg; versus &minus;26.5 &plusmn; 6.3&deg; in the absence of technical difficulties (p = 0.0001). In 11 cases (9%), during ablation of the right superior PV (RSPV), phrenic nerve injury (PNI) occurred and was associated with the maximum and minimum RSPV diameter, 20.0&ndash;20.4 mm (OR = 13.2; 95% CI: 4.7&ndash;41.9, p &lt; 0.05) and 17.5&ndash;20 mm (OR = 12.5; 95% CI 3.4&ndash;51, p &lt; 0.05), respectively. Patients with arrhythmia recurrence were characterized by significantly larger diameters and ovality of the left superior PV (LSPV). The spatial orientation of the PV does not affect the long-term results of cryoablation. Conclusion: Preprocedural evaluation of PV morphology and orientation using cardiac CT might help choose the optimal technology for the individual patient

Pulmonary Veins Morphometric Characteristics and Spatial Orientation Influence on Its Cryoballoon Isolation Results

The aim of this paper is to evaluate the effect of pulmonary vein (PV) morphometric characteristics and spatial orientation on the results of cryoballoon ablation (CBA). Methods: A randomized, prospective, single-center controlled study was conducted, enrolling 230 patients with drug-refractory atrial fibrillation (AF). We compared procedural and long-term outcomes in patients who underwent their first procedure of pulmonary vein isolation (PVI) for AF with either radiofrequency ablation (RFA) (n = 108) or CBA (n = 122) and assessed their interaction with the different pattern of PV anatomy, morphometric characteristics, and spatial orientation. The primary efficacy endpoint was any documented atrial arrhythmia recurrence (AF, atrial flutter, or atrial tachycardia) lasting over 30 s during a 12-month follow-up after a 90-day blanking period and discontinuation of antiarrhythmic drugs. The procedure’s endpoint was the achievement of PVI. Before the intervention, all patients underwent computed tomography (CT) to assess the PV anatomical variant, maximum and minimum diameters of the PV’s ostia, their cross-sectional area, orifice ovality index, and PV tilt angles. Results: The mean follow-up period was 14 months (12; 24). Long-term efficacy in the cryoablation group was 78.8% and in the RFA group—83.3% (OR = 0.74; 95% CI 0.41–1.3; p = 0.31). The RFA results did not depend on PV anatomy. The «difficult» occlusion of the right inferior PV (RIPV) occurred in 12 patients and was associated with a more horizontal PV position in the frontal plane; the mean tilt angle was −15.2 ± 6.2° versus −26.5 ± 6.3° in the absence of technical difficulties (p = 0.0001). In 11 cases (9%), during ablation of the right superior PV (RSPV), phrenic nerve injury (PNI) occurred and was associated with the maximum and minimum RSPV diameter, 20.0–20.4 mm (OR = 13.2; 95% CI: 4.7–41.9, p &lt; 0.05) and 17.5–20 mm (OR = 12.5; 95% CI 3.4–51, p &lt; 0.05), respectively. Patients with arrhythmia recurrence were characterized by significantly larger diameters and ovality of the left superior PV (LSPV). The spatial orientation of the PV does not affect the long-term results of cryoablation. Conclusion: Preprocedural evaluation of PV morphology and orientation using cardiac CT might help choose the optimal technology for the individual patient.</jats:p

Prognostic significance of equivalent density of calcium deposits of coronary arteries in men with osteopenic syndrome and prior coronary artery bypass grafting: prospective study

Aim. Determination of the clinical and prognostic value of the equivalent density of calcium deposits (EDCD) of coronary arteries in patients with stable coronary heart disease (CHD) and concomitant osteopenic syndrome (OS) after coronary artery bypass grafting (CABG), based on five-year follow-up.&#x0D; Materials and methods. A prospective study included 393 patients with stable CHD hospitalized for CABG. All patients underwent multispiral computed tomography of coronary arteries to assess the degree of calcification and EDCD, and Х-ray absorptiometry. During the five-year observation we studied mortality and adverse cardiovascular events. The average duration of the observation period was 58.91.8 months.&#x0D; Results. Data were obtained on the correlation of EDCD with the presence of OS (r=0.19; p0.001), a decrease in the T-criterion of the thigh (r=-0.21; p0.001) and lumbar vertebrae (r=-0.19; p0.001). With a decrease in the EDCD of coronary arteries below the level of 0.19 mg/mm3, an increased mortality risk is noted (odds ratio 2.84, 95% confidence interval 1.545.25). Linear regression analysis revealed that predictors of adverse outcomes over the course of a follow-up were the presence of carotid artery stenosis 30%, low left ventricular contractility, elevated triglyceride levels, and low EDCD.&#x0D; Conclusion. According to the results of the study the negative prognostic significance of the low EDCD of coronary arteries in relation to mortality, myocardial infarction, and revascularization in patients after CABG, regardless of the presence of concomitant OS.</jats:p

Mechanical function of left atrium and pulmonary vein sleeves before and after their antrum isolation

Background and objective: Pulmonary vein (PV) sleeves are established as the main substrate taking part in the mechanisms of atrial fibrillation (AF) initiation. However, we have extremely few data concerning their physiological role in the heart contractility. The aim of the study was to estimate the mechanical function of the left atrium (LA) and PV sleeves before and early after their isolation. Materials and methods: A total of 17 patients with a mean age of 57.4 ± 8.3 years who underwent PVs isolation due to AF were enrolled in the study. A day before the procedure a computed tomography (CT) of the LA and PVs and dopplerography of transmitral flow were performed. During the procedure the mechanical function of the LA and PV sleeves were estimated by transesophageal echocardiography and manometry in the left heart chambers. Results: During the invasive study the patterns of the heart chambers and PV sleeves pressure were identified. These patterns confirmed the active role of the PV sleeves in LA filling and active LA relaxation during left ventricular systole. After PV isolation an alteration of transmitral blood flow and increase of LA pressure were registered. However, diastolic dysfunction was ruled out by LV manometry, thereby testifying LA mechanical function disturbance. The change in PV hemodynamics also occurred as a result of the decrease in PV sleeves contractility, revealed by manometry and paired CT scans. Conclusions: The PVs take an active part in left atrial filling by contraction of their sleeves. Antrum isolation of the PVs leads to the deterioration of their contractility and LA reservoir function

Relationship between epicardial and perivascular fatty tissue and adipokine-cytokine level in coronary artery disease patients.

The aim of this study was to determine the relationship between the thickness of epicardial adipose tissue (EAT) and perivascular adipose tissue (PVAT) and the adipokine-cytokine profile of patients with coronary heart disease, which can be of significant importance for predicting the course of cardiovascular disease (CVD). Eighty-four patients with CVD were assessed and divided into two groups based on the presence of visceral obesity (VO). In patients with VO, the thickness of the epicardial deposits of the left and right ventricles were 1.75 and 1.43 times greater, respectively, than in patients without VO. For patients with VO, the prevalence of the volume of the left anterior descending artery was 10% higher, and the middle third of the envelope artery was 28% higher, when compared to patients without VO. When evaluating inflammatory status, it was established that the concentration of tumor necrosis factor-α, interleukin (IL)-1β, and leptin in the blood serum of patients with VO exceeded the values of patients without VO. The level of anti-inflammatory IL-10 was 2-times lower in patients with VO. The findings of this study show that increased EAT and PVAT are independent risk factors of CVD, as well as a possible model for the assessment of drug effectiveness for CVD

Relationship of visceral obesity and coronary calcinosis in ischemic heart disease

Aim. To assess the relationship between the prevalence of visceral obesity (VO) and the severity of coronary calcification (CC) in patients with verified coronary artery disease (CAD).&#x0D; Materials and methods. 125 patients with CAD were examined. Assessment of the morphometric characteristics of visceral adipose tissue (VAT) and CC was perform using multislice computed tomography (MSCT). The calcium index (CI) of the coronary arteries (CA) was determine by the Agatston method. Statistical analysis was perform using Statistica 10.0.&#x0D; Results. VO was detect in 82 (65.6%) patients with CAD. In the presence of VO, higher CC values were observed in the projection of the envelope (p=0.00014), right coronary (p=0.00002) arteries, total CI (p=0.0003), and the prevalence of massive CC. Correlation analysis showed the relationship between the area of VAT and the CC of all the studied localizations. According to the ROC analysis, VO is a significant predictor of massive CC (area under the ROC curve AUC 0.72, 95% CI 0.560.89), in contrast to body mass index BMI (AUC 0.56, 95% CI 0.310.82).&#x0D; Conclusion. The index of the ratio of VAT to subcutaneous adipose tissue (VAT/SAT), but not BMI, had a direct correlation with CC. Morphology of VAT may be a significant diagnostic sign of massive CC in patients with CAD, as a factor affecting treatment and prognosis.</jats:p

Relationships between epicardial adipose tissue thickness and adipo-fibrokine indicator profiles post-myocardial infarction

Abstract Background Determination of the impact of visceral obesity and epicardial adipose tissue thickness on stimulating growth factor levels during hospitalization for myocardial infarction is of potential importance for predicting outcomes and assessing the development of cardiofibrotic changes associated with maladaptive myocardial remodeling. In this study, we aimed to investigate the relationships between epicardial adipose tissue thickness, adipokine profiles, and the stimulating growth factor 2/interleukin-33 signaling system during hospitalization for myocardial infarction, and with the cardiac fibrosis extent 1-year post-MI in patients with visceral obesity. Methods Eighty-eight patients with myocardial infarction were grouped based on their visceral obesity. Serum leptin, adiponectin, stimulating growth factor 2, and interleukin-33 levels were measured on days 1 and 12 and at 1 year. The epicardial adipose tissue widths and the cardiac fibrosis areas were measured on day 12 and at 1 year. Results Visceral obesity was associated with epicardial adipose tissue thickness increases, adipokine imbalances, elevated leptin levels, and lower adiponectin levels during early hospitalization, and cardiac fibrosis development. Patients without visceral obesity had higher interleukin-33 and stimulating growth factor 2 levels during early hospitalization and lower cardiac fibrosis rates. Epicardial adipose tissue thickness was positively associated with cardiac fibrosis prevalence and interleukin-33 levels and negatively associated with stimulating growth factor 2 levels. The cardiac fibrosis extent was negatively associated with interleukin-33 levels and positively associated with stimulating growth factor 2 levels. Conclusions Increases in epicardial adipose tissue thickness are associated with cardiac fibrosis development 1-year post-myocardial infarction and are higher in patients with visceral obesity. The metabolic activity of the epicardial adipose tissue is associated with elevated interleukin-33 and reduced stimulating growth factor 2 levels