Comparative effectiveness of initial computed tomography and invasive coronary angiography in women and men with stable chest pain and suspected coronary artery disease: multicentre randomised trial

To assess the comparative effectiveness of computed tomography and invasive coronary angiography in women and men with stable chest pain suspected to be caused by coronary artery disease

The Quality of anticoagulation therapy among warfarin-treated patients with atrial fibrillation in a primary health care setting

Background and objectives: Long-term therapy with oral anticoagulants is recommended for stroke prevention in patients with atrial fibrillation (AF). This study evaluated the quality of anticoagulation therapy among warfarin-treated AF patients in selected primary health care centres in Lithuania. Materials and Methods: This was a retrospective study conducted in nine primary health care centres in Lithuania. Existing medical records of randomly selected adult patients with AF who were treated with warfarin for at least 12 months were reviewed and analysed. Physicians’ decisions to adjust warfarin dose were considered as consistent with the approved warfarin posology if warfarin dose was increased in case of international normalized ratio (INR) 3.0 or unchanged in case of INR within 2.0 to 3.0. Results: The study population included 406 patients. The mean duration of treatment with warfarin was 5.4 years. The median number of INR measurements per patient per year was 8.0. More than half (57.3%) of available INR values were outside the target range, with 13.6% INR values being above 3.0 and 43.7% INR values—below 2.0. The median time in therapeutic range (TTR) was 40.0%; only 20% of patients had TTR of 65%. In about 40% of the cases with INR values outside the target range, no dose corrections were implemented. About 27% of decisions on warfarin dose adjustment were not consistent with the recommended warfarin posology. The median number of INR measurements was lower among patients living in urban areas, while the median TTR was significantly higher in urban patients than in rural patients. In the multivariate regression model, gender, HAS-BLED score and warfarin treatment duration were associated with a TTR of 65%. Conclusions: Anticoagulation control is suboptimal in routine clinical practice with a median TTR of 40%. [...]

Related links between quality of life and perception and knowledge of the disease in patients with arterial hypertension.

Tikslas – išanalizuoti sergančiųjų arterine hipertenzija su sveikata susijusios gyvenimo kokybės sąsajas su ligos suvokimu ir žiniomis apie ją. Metodika. Naudota apklausos anketa sudaryta iš 3 klausimynų: Arterinės hipertenzijos žinių lygio skalė; Ligos suvokimo klausimynas; Su sveikata susijusios gyvenimo kokybės klausimynas. Imtį sudarė 389 respondentai – 180 vyrų, 209 moterys. Duomenų analizė atlikta statistinių programų paketu SPSS 17.0.1 for Windows. Tyrimas atliktas laikantis etikos principų. Rezultatai. Nustatyta, kad tiriamieji gerai suvokė ligos kontrolę ir jos riziką sveikatai. Moterų žinios buvo reikšmingai (p<0,001) geresnės, nei vyrų. Gyvenimo kokybę neigiamai veikia ligos keliami sunkumai, teigiamai – geresnis ligos kontrolės būtinumo suvokimas. Visose gyvenimo kokybės srityse, susijusiose su fizine sveikata ir energingumu (gyvybingumu), geresni vertinimai susiję su geresnėmis žiniomis apie arterinę hipertenziją. Išvada. Žinios ir suvokimas apie ligą skirtingai veikia su sveikata susijusią gyvenimo kokybę. Pacientai, turintys daugiau žinių apie ligą, geriau vertina su sveikata susijusią gyvenimo kokybę, o turintys geresnį suvokimą apie ligą – blogiau.The aim of this study was to analyze the health - related links between quality of life and perception and knowledge of the disease in patients with arterial hypertension. The study consisted of 3 questionnaires: "Arterial Hypertension Knowledge Level Scale"; "Perception of Disease Questionnaire"; "Health-Related Quality of Life Questionnaire". There were 389 respondents: 180 men and 209 women. Data analysis was conducted using the statistical software package "SPSS 17.0.1 for Windows". The research was conducted in accordance with ethical principles. It was found that those who participated in the study were well aware of their disease control and risk. Women‘s knowledge was noticeably (p <0.001) better than men‘s. The results showed that the quality of life is negatively affected by the difficulties caused by the disease, and positively by the perception of the need for better disease control. In all areas of quality of life related to physical health and energy/vitality, better evaluations are associated with better knowledge of arterial hypertension. Knowledge and perception of the disease have a profound effect on health-related quality of life. Patients with more knowledge about the disease have better assessment of health-related quality of life, and those with less perception of the disease have worse

The Association between phenomena on the Sun, geomagnetic activity, meteorological variables, and cardiovascular characteristic of patients with myocardial infarction

It has been found that solar and geomagnetic activity affects the cardiovascular system. Some evidence has been reported on the increase in the rate of myocardial infarction, stroke and myocardial infarction related deaths during geomagnetic storms. We investigated the association between cardiovascular characteristics of patients, admitted for myocardial infarction with ST elevation (STEMI), and geomagnetic activity (GMA), solar proton events (SPE), solar flares, and meteorological variables during admission. The data of 1,979 patients hospitalized at the Hospital of Lithuanian University of Health Sciences (Kaunas) were analyzed. We evaluated the association between environmental variables and patient's characteristics by multivariate logistic regression, controlling patient's gender and age. Two days after geomagnetic storms the risk of STEMI was over 1.5 times increased in patients who had a medical history of myocardial infarction, stable angina, renal or pulmonary diseases. The dose-response association between GMA level and STEMI risk for patients with renal diseases in history was observed. Two days after SPE the risk of STEMI in patients with stable angina in anamnesis was increased over 1.5 times, adjusting by GMA level. The SPE were associated with an increase of risk for patients with renal diseases in history. This study confirms the strongest effect of phenomena in the Sun in high risk patientsAplinkotyros katedraLietuvos sveikatos mokslų universitetasVytauto Didžiojo universiteta

Coronary CT Value in Quantitative Assessment of Intermediate Stenosis

Background and Objectives: Cardiac computed tomography angiography (CCTA) is an excellent non-invasive imaging tool to evaluate coronary arteries and exclude coronary artery disease (CAD). Managing intermediate coronary artery stenosis with negative or inconclusive functional tests is still a challenge. A regular stenosis evaluation together with high-risk plaque features, using semi-automated programs, are becoming promising tools. This case&ndash;control study was designed to evaluate the intermediate lesion features&rsquo; impact on CAD outcomes, using a semi-automated CCTA atherosclerotic plaque analysis program. Materials and Methods: We performed a single-center, prospective cohort study. A total of 133 patients with low to intermediate risk of CAD, older than 18 years with no previous history of CAD and good quality CCTA images were included in the study, and 194 intermediate stenosis (CAD-RADS 3) were analyzed. For more detailed morphological analysis, we used semi-automated CCTA-dedicated software. Enrolled patients were prospectively followed-up for 2 years. Results: Agatston score was significantly higher in the major adverse cardiovascular events (MACE) group (p = 0.025). Obstruction site analysis showed a significantly lower coronary artery remodeling index (RI) among patients with MACE (p = 0.037); nonetheless RI was negative in both groups. Plaque consistency analysis showed significantly bigger necrotic core area in the MACE group (p = 0.049). In addition, unadjusted multivariate analysis confirmed Agatston score and RI as significant MACE predictors. Conclusions: The Agatston score showes the total area of calcium deposits and higher values are linked to MACE. Higher plaque content of necrotic component is also associated with MACE. Additionally, negatively remodeled plaques are linked to MACE and could be a sign of advanced CAD. The Agatston score and RI are significant in risk stratification for the development of MACE

The Complexity of the Arterial Blood Pressure Regulation during the Stress Test

In this study, two categories of persons with normal and high ABP are subjected to the bicycle stress test (9 persons with normal ABP and 10 persons with high ABP). All persons are physically active men but not professional sportsmen. The mean and the standard deviation of age is 41.11 &plusmn; 10.21 years; height 178.88 &plusmn; 0.071 m; weight 80.53 &plusmn; 10.01 kg; body mass index 25.10 &plusmn; 2.06 kg/m2. Machine learning algorithms are employed to build a set of rules for the classification of the performance during the stress test. The heart rate, the JT interval, and the blood pressure readings are observed during the load and the recovery phases of the exercise. Although it is obvious that the two groups of persons will behave differently throughout the bicycle stress test, with this novel study, we are able to detect subtle variations in the rate at which these changes occur. This paper proves that these differences are measurable and substantial to detect subtle differences in the self-organization of the human cardiovascular system. It is shown that the data collected during the load phase of the stress test plays a more significant role than the data collected during the recovery phase. The data collected from the two groups of persons are approximated by Gaussian distribution. The introduced classification algorithm based on the statistical analysis and the triangle coordinate system helps to determine whether the reaction of the cardiovascular system of a new candidate is more pronounced by an increased heart rate or an increased blood pressure during the stress test. The developed approach produces valuable information about the self-organization of human cardiovascular system during a physical exercise

Evaluation of left ventricular longitudinal function and synchrony after dual chamber pacemaker implantation

Background and objective: To evaluate left ventricular (LV) longitudinal function and dyssynchrony mechanisms after dual chamber pacemaker implantation. Materials and methods: The speckle tracking imaging technique was used for quantification of global longitudinal function of the left ventricle and for dyssynchrony evaluation before pacemaker implantation and after 3-month follow-up. The study group consisted of 98 patients with conventional indications for dual chamber pacemaker implantation. Results: Speckle tracking echocardiographic methods and image postprocessing revealed impairment of global longitudinal strain and significant LV dyssynchrony derived from 12 basal and mid-septum segments usually untraceable with conventional echocardiographic methods. Despite good physical performance and ejection fraction, global longitudinal strain significantly decreased in all patients from −15.08 ± 0.46 to −13.56 ± 0.5 (P &lt; 0.05) as well as mitral annulus movement decreased from 11.57 ± 2.41 to 8.46 ± 1.74 cm/s (P &lt; 0.001) and from 12.55 ± 2.75 to 10.78 ± 2.82 mm (P &lt; 0.001). It was expected that patients with dual chamber pacemaker will develop inter- and intraventricular dyssynchrony, but our study showed that pacing lead position did not prevent from LV dysynchronisation and only changed the mechanism. Conclusions: Global longitudinal strain and LV dyssynchrony assessment enables us to detect early signs of LV dysfunction. Mechanisms of dyssynchrony development will be useful for pacemaker programing choices in order to prevent further dyssynchronisation

Effects of weather and heliophysical conditions on emergency ambulance calls for elevated arterial blood pressure

We hypothesized that weather and space weather conditions were associated with the exacerbation of essential hypertension. The study was conducted during 2009–2010 in the city of Kaunas, Lithuania. We analyzed 13,475 cards from emergency ambulance calls (EACs), in which the conditions for the emergency calls were made coded I.10–I.15. The Kaunas Weather Station provided daily records of air temperature (T), wind speed (WS), relative humidity, and barometric pressure (BP). We evaluated the associations between daily weather variables and daily number of EACs by applying a multivariate Poisson regression. Unfavorable heliophysical conditions (two days after the active-stormy geomagnetic field or the days with solar WS > 600 km/s) increased the daily number of elevated arterial blood pressure (EABP) by 12% (RR = 1.12; 95% confidence interval (CI) 1.04–1.21); and WS ≥ 3.5 knots during days of T < 1.5 °C and T ≥ 12.5 °C by 8% (RR = 1.08; CI 1.04–1.12). An increase of T by 10 °C and an elevation of BP two days after by 10 hPa were associated with a decrease in RR by 3%. An additional effect of T was detected during days of T ≥ 17.5 °C only in females. Women and patients with grade III arterial hypertension at the time of the ambulance call were more sensitive to weather conditions. These results may help in the understanding of the population’s sensitivity to different weather conditionsAplinkotyros katedraKauno miesto greitosios medicinos pagalbos stotisLietuvos sveikatos mokslų universitetasVytauto Didžiojo universiteta

Association of Whole-Heart Myocardial Mechanics by Transthoracic Echocardiography with Presence of Late Gadolinium Enhancement by CMR in Non-Ischemic Dilated Cardiomyopathy

Background: In patients with non-ischemic dilated cardiomyopathy (NIDCM), myocardial fibrosis (MF) is related to adverse cardiovascular outcomes. The purpose of this study was to evaluate the potential relationship between the myocardial mechanics of different chambers of the heart and the presence of MF and to determine the accuracy of the whole-heart myocardial strain parameters to predict MF in patients with NIDCM. Methods: We studied 101 patients (64% male; 50 &plusmn; 11 years) with a first-time diagnosis of NIDCM who were referred for a clinical cardiovascular magnetic resonance (CMR) and speckle tracking 2D echocardiography examination. We analyzed MF by late gadolinium enhancement (LGE), and the whole-heart myocardial mechanics were assessed by speckle tracking. The presence of MF was related to worse strain parameters in both ventricles and atria. The strongest correlations were found between MF and left ventricle (LV) global longitudinal strain (GLS) (r = &minus;0.586, p &lt; 0.001), global circumferential strain (GCS) (r = &minus;0.609, p &lt; 0.001), LV ejection fraction (LVEF) (r = 0.662, p &lt; 0.001), and left atrial strain during the reservoir phase (LASr) (r = 0.588, p &lt; 0.001). However, the binary logistic regression analysis revealed that only LV GLS, GCS, and LASr were independently associated with the presence of MF (area under the curves of 0.84, 0.85, and 0.64, respectively). None of the echocardiographic parameters correlated with fibrosis localization. Conclusions: In NIDCM patients, MF is correlated with reduced mechanical parameters in both ventricles and atria. LV GLS, LASr, and LV GCS are the most accurate 2D echocardiography predictive factors for the presence of MF

Factors Determining Ticagrelor-Induced Dyspnea in Patients with Acute Coronary Syndrome

(1) Background: The aim of this study was to determine clinical and genetic factors predicting the development of dyspnea in patients receiving ticagrelor. (2) Methods: A total of 277 patients with acute myocardial infarction (with and without ST-segment elevation), who underwent coronary angiography and PTCA with stent implantation and treated with antiplatelet drugs (ticagrelor and aspirin), were enrolled in this study. Platelet aggregation (induction with high-sensitivity ADP, ADP HS) testing was performed using a MULTIPLATE analyzer and reagents for the determination of P2Y12 receptor activity. Venous blood samples were collected for genotyping. (3) Results: Patients experiencing ticagrelor-related dyspnea had lower ADP HS. ROC curve analysis showed that an ADP HS cut-off of ≤19.5 U was associated with the development of dyspnea. The ADP HS value of ≤19.5 U and any dose of atorvastatin lower than 80 mg (or no atorvastatin) increased the risk of dyspnea by more than 4 and 2 times, respectively (OR = 4.07, p ≤ 0.001 and OR = 2.25; p = 0.008). (4) Conclusion: A lower ADP HS value possibly indicates greater ticagrelor activity and a higher plasma concentration of this drug. Atorvastatin might have an impact on the occurrence of ticagrelor-related dyspnea by affecting ticagrelor metabolism. No impact of any genetic variant on the development of dyspnea was determined