Epidemiology of hospitalized patients with peripheral arterial disease in Bosnia and Herzegovina

Aim To investigate a profile of patients with peripheral artery disease (PAD) in Bosnia and Herzegovina. Methods This observational study included 1022 patients hospitalized at the Clinical Centre University of Sarajevo in a 5-year period, 2015 to 2019. Results Disease prevalence rises sharply after the age of 50. Most patients, 797 (78%) had proximal PAD; 658 (64.4%) were males. The death occurred in 73 (7.1%) patients, more often in females (66- 10%), and in patients with chronic kidney disease (10- 23.8%). Amputation occurred in 153 (15%) patients, where 102 (66.7%) patients had diabetes. Other surgical procedures were more common in males and smokers. Necrosis and phlegmon on lower extremities were found in 563 (55.1%) and 43 (4.2%) patients, respectively. History of tobacco use was noted in 620 (60.2%) patients, and 414 (40.8%) patients were current smokers. More than a half of patients had hypertension and diabetes, 596 (58.3%) and 513 (50.2%), respectively. One in 10 patients had a history of myocardial infarction or stroke. Most patients had high fibrinogen and blood glucose and low high-density lipoprotein (HDL). Conclusion Patients with PAD have multiple comorbidities and risk for various complications. Primary and secondary prevention of risk factors is the mainstay of treatment

The serum triglyceride to high-density lipoprotein (HDL) ratio in patients with acute coronary syndrome with and without renal dysfunction

Aim To assess triglyceride – to high-density lipoprotein cholesterol (TG/HDL)-C ratio in patients with acute coronary syndrome (ACS) and to verify its association with renal dysfunction. Methods A cross sectional study included 85 ACS patients divided in two groups with (ACS – RD) and without (ACS-nRD) presence of renal dysfunction, and 35 healthy subjects. Blood pressure, blood glucose, C-reactive protein, urea, creatinine, eGFR and serum lipids levels (total cholesterol, triglycerides, LDL-C, HDL-C) was measured in all participants. Based on the values of the measured lipid fractions TG/HDLc ratio was calculated. Results Patients in ACS group had significantly lower HDL-C level (p<0.0005) but significantly higher TG level (p=0.046) and TG/HDL-C ratio (p<0.0005) than controls. There was a significant increase (p<0.0005) in TG/HDL-C ratio in ACS-RD group compared to ACS-nRD group. The ACS-RD group had significantly higher level of TG (p=0.001), serum urea (p=0.02) and creatinine (p<0.0005) compared to the ACS-nRD group. With a cut-off level of 1.135 TG/HDL-C ratio had a sensitivity of 77.6% and a specificity of 62.9% in distinguishing between ACS patients and healthy subjects. With cut-off value of 1.905 TG/HDL-C ratio had a sensitivity of 75.9% and a specificity of 78.6% in distinguishing between ACS patients with and without renal dysfunction. Conclusion This study confirms the reliability of the TG/HDL-C ratio as a simple, low cost and useful marker in distinguishing between patients with ACS and healthy subjects and ACS patients with and without renal dysfunction

Survival of heart failure patients with reduced and preserved ejection fraction is not different!

Introduction: A progress in the management of cardiovascular disease leads to a decrease in mortality, but heart failure (HF) seems to be an exception. Today, the rate of rehospitalization and mortality after acute heart failure is still very high. Lower ejection fraction (EF) means worse prognosis, but recent studies are reporting that HF patients with preserved EF have no better survival compared to patients with reduced EF1. Goal: to investigate a possible difference in the outcome of HF patients with reduced (HFREF) and preserved ejection fraction (HFPEF). Patients and Methods: In 222 patients hospitalized in acute HF (138 with reduced EF and 74 with preserved EF) were determined routine laboratory test, including BNP. The LVEF cutoff for diagnosing of HFPEF was above 45 %. Patients were followed for the next 18 months for the occurrence of 1. readmission due to repeat decompensation and 2. mortality. Results: BNP at discharge was higher in HFREF compared to HFPEF group [699.3 (271.8-1519.1) pg/ml vs 263.3 (134.4-502.2) pg/ ml, p <0.001]. During 18-month follow-up 129 patients (58.11%) were readmitted due to decompensation, but there was no significant difference between group: in HFREF group was hospitalized 87 (63.04%) patients compared to 42 (50%) patients in HFPEF group (p=0.077). There was no difference in the rate of readmission in 1-month (p=0.7), 6-month (p=0.24), and 12-month follow up (p=0.16) in HFREF vs HFPEF group. In Kaplan-Meier curve there was no significant difference in the mean time of the occurrence of readmission due to decompensation: in HFREF group 2.2 (95% CI=1.58- 2.8) months and in HFPEF group 2.33 (95% CI=1.3-3.4) months (p=0.89) (Figure 1). In HFREF 18-month survival was 43.5% (60/138) and in HFPEF group was 56.0 % (47/84) and the difference was not significant (p=0,096). In the Kaplan-Meier curve, there was no difference in time of survival in 18-month follow-up (p=0.9): mean time of survival in HFREF was 3.8 (95% CI=3.0-4.7) months and in HFPEF 3.75 (95% CI=2.5-5.0) months (Figure 2). There was no difference in mortality in 1-month (p=0.8), 6-month (p=0.16) and 12-month follow up (p=0.08). Conclusion: Rate of rehospitalization due to decompensation and mortality is not different between HFREF and HFPEF group. Preserved EF is not related to better survival in patients with HF

Relationship between depression and quality of life after myocardial infarction

Aim To examine the prevalence of depression in patients after acute myocardial infarction (AMI), as well as the relationship between the depression and quality of life. Methods The survey was conducted via sociodemographic questionnaire, Beck Depression Inventory (BDI), and Short Form 36 Health Survey questionnaire (SF-36). The result of SF-36 is expressed in subscales that make up the health status profile, i.e. physical functioning, physical role, emotional role, social functioning, mental health, vitality, pain and general health. Results The study included 120 patients, of which 70 males and 50 females aged between 41 and 88 years (mean 64.73±11.218). All patients were hospitalized at the Clinical Centre of the University of Sarajevo, Clinic for Cardiovascular Disease and Rheumatism, due to complications caused by AMI. After AMI 59 (49.17%) patients had depression. Depression was negatively associated with physical functioning, physical role, emotional role, social functioning, mental health, vitality, pain and general health. Physical functioning (r= -0.701; p<0.01) and physical role (r = -0.538; p<0.01) had the highest correlation with depression. Conclusion The evaluation of depressive symptoms after AMI is imperative, because the appearance of symptoms could have an effect on the patient's quality of life

Biphasic and Monophasic Pattern of Brain Natriuretic Peptide Release in Acute Myocardial Infarction

This study evaluated brain natriuretic peptide (BNP) release in acute myocardial infarction (AMI), absolute values as well as pattern of its release. There are two different patterns of BNP release in AMI; monophasic pattern – concentration in the first measurement is higher than in the second one, and biphasic pattern – concentration in the first measurement is lower than in the second one. We observed significance of biphasic and monophasic pattern of BNP release related to diagnostic and prognostic value. We included in this prospective observational study total of 75 AMI patients, 52 males and 23 females, average age of 62.3±10.9 years with range of 42 to 79 years. BNP was measured and pattern of its release was evaluated. In AMI group BNP levels were significantly higher than in controls (462.88 pg/mL vs. 35.36 pg/mL, p<0.001). We found statistically significant real negative correlation (p<0.05) between BNP concentration and left ventricle ejection fraction (LVEF) with high correlation coefficient (r=–0.684). BNP concentrations were significantly higher among patients in Killip class II and III compared to Killip class I; Killip class I BNP=226.18 pg/mL vs. Killip class II 622.51 pg/mL vs. Killip class III 1530.28 pg/mL, p<0.001. BNP concentrations were significantly higher in patients with; (i) myocardial infarction vs. controls; (BNP 835.80 pg/mL vs. 243.03 pg/mL); (ii) in pts with positive major adverse cardiac events (MACE) vs. negative MACE (BNP 779.08 pg/mL vs. 242.28 pg/mL, p<0.001); (iii) in pts with positive compared to negative left ventricle (LV) remodelling (BNP 840.77 pg/mL vs. 341.41 pg/mL, p<0.001). Group with biphasic pattern of BNP release had significantly higher BNP concentration compared to monophasic pattern group. In biphasic pattern group we found significant presence of lower LVEF, Killip class II and III, LV remodelling and MACE. We found that BNP is strong marker of adverse cardiac events in patients presenting with a myocardial infarction. In our AMI group we found significant elevation of BNP and it is suspected that second peak secretion is not only due to systolic dysfunction and subsequent remodeling of LV but also due to impact of ischaemia. Patients with biphasic pattern probably have worse prognosis due to severe coronary heart disease. Besides its diagnostic role as a simple blood marker of systolic function, BNP is also important prognostic marker who helps making clinical decision about early invasive vs. conservative management

Changes in Serum Homocysteine Level Follow Two Different Trends in Patients During Early Post Myocardial Infarction Period

The evolution of homocysteine (Hcy) changes after acute myocardial infarction is still not elucidated. Serum Hcy concentration has been shown to increase between acute and convalescent period after myocardial infarction and stroke, Also a decrease in serum Hcy during acute phase was observed, It is still not clear whether the Hcy is a culprit or an innocent bystander in cardiovascular diseases, Addressing the discrepancies in Hcy changes in patients with acute myocardial infarction might give insight in Hcy role in cardiovascular diseases and offer implications both for the clinical interpretation and patients risk stratification, The aim of the study was to evaluate serum Hcy concentration changes during early post myocardial infarction, The study included 55 patients with AMI from the Clinics for Heart Diseases and Rheumatism at University of Sarajevo Clinics Centre, For Hcy analysis blood was collected on day 2 and 5 after the AMI onset, Serum Hcy concentration was determined quantitatively with fluorescent polarisation immunoassay on AxSYM system, Cluster analysis revealed two groups ofAMI patients with different trends of serum Hcy changes, Increase in serum Hcy concentration was observed in 33 (60,0%) patients (AMI 1 group), while in 22 (40,0%) patients a decrease was observed (AMI 2 group), On day 2, patients in AMI 2 group had significantly higher mean Hcy concentration compared to AMI 1 group of patients (15,27±0,96 and 11,59±0,61 μmol/L p<0,05), On day 5, no significant difference in mean Hcy level between AMI 1 and AMI 2 group of patients was observed (14,86±1,1 vs, 12,75±0,74 μmol/L respectively), Significant differences between AMI 1 and AMI 2 patients were observed in VLDLC levels and CK-MB activity on day 2, Patients in AMI 1 group had significant increase in platelets count from day 2 to day 5 (230,1±11,6 vs. 244,2±11,0; p<0,05). Our study of serial Hcy changes in patients with AMI revealed two different patterns of Hcy changes in early post infarction period which might reflect two distinct populations of AMI patients. Although further research is necessary, possible explanation for the observed findings could be a different genetic background, vitamin and oxidative status of patients with AMI