8 research outputs found
Relation between parameters of body composition and echocardiography in patients with nonvalvular atrial fibrillation
Purpose: Both nutritional status and echocardiographic parameters are associated with the risk of atrial fibrillation (AF). The aim of this study was to determine the relationships between parameters of transthoracic echocardiography and nutritional status assessment as risk factors for AF.Methods: This cross-sectional study considered 120 consecutive patients hospitalized due to AF and 240 inpatients admitted due to exacerbation of cardiovascular conditions. Echocardiographic parameters and parameters of nutritional status were determined for each patient.Results: Patients in the lowest body mass index (BMI) quartile and without visceral adiposity had the lowest standard echocardiographic parameters; however, the majority of these differences disappeared after the parameters were indexed to BSA. In logistic regression analysis, echocardiographic parameters were associated with slightly higher or similar AF risk comparing with parameters of nutritional status assessment. When the comparison was made in relation to cut-off values obtained in ROC analysis, then having a visceral adipose tissue (VAT) score ≥ 12 was associated with a lower increase in AF risk (odds ratio [OR]; 95% confidence interval [CI]: 3.09; 1.85–5.15) than the risk increase associated with e.g. left atrium diameter greater than 45mm ([OR; 95% CI] 10.483; 6.308–17.421).Conclusions: The unitary values of echocardiographic and body composition parameters only slightly differed in relation to the risk of AF occurrence, however, the use of cut-off values significantly increases an impact of echocardiography on the prediction of AF. The U-shaped relationships between a patient’s nutritional status and AF occurrence cannot be explained by the effect of body mass on cardiac structure and size
Relationship of serum leptin with parameters of nutritional status and body composition among patients with stable course of cardiovascular disorders
Background: Blood leptin concentration is related to fat mass, adipose cell and leptin receptor function, and
comorbidities. The aim of this study is to determine the relationships between blood leptin concentration
and nutritional status assessment among inpatients with stable cardiovascular disorders.
Materials and Methods: Blood leptin concentration and nutritional risk and status assessments using clinical,
anthropometric and biochemical parameters, as well bioelectrical impedance (BIA), were determined in
160 consecutive inpatients with mild exacerbation of cardiovascular diseases cardiovascular disorders
undergoing non-urgent hospitalization.
Results: Patients with lower values of Minimal Nutritional Assessment score had lower blood leptin concentration
and lower value of leptin to CRP ratio. Compared to patients with leptin concentration in the
upper quartiles, individuals in the lowest quartile had a lower BMI and fat mass, thinner skinfolds, greater
skeletal muscle mass and handgrip strength. In comparison with the values for leptin-to-CRP ratio, albumin,
albumin-to-CRP ratio and lymphocyte count, leptin explained a greater part of the variance in the majority
of parameters of nutritional status and body composition. Contrasting associations of leptin with ideal
(negative) and current (positive) body mass were found.
Conclusions: Leptin was associated with parameters of nutritional status assessments more strongly
than other biochemical parameters usually used. However, the use of leptin as a biomarker of nutritional
status should be approached carefully and needs further evaluation, especially in the context of its strong
association with both current and ideal body mass, the importance of receptors’ resistance to leptin, and
leptin’s negative relationships with muscle mass and strength
Soluble vascular cell adhesion molecule-1 in patients with non-valvular atrial fibrillation
Background: Disturbances in atrial microcirculation is recognized as a risk factor for atrial fibrillation (AF).Aim: The aim of this study was to determine the associations between circulating soluble vascular cell adhesion molecule-1 (sVCAM-1) and the risk of AF and a one-year prognosis among consecutive inpatients.Methods: Eighty consecutive inpatients hospitalized due to non-valvular AF and 80 consecutive inpatients admitted for exacerbation of chronic coronary syndrome (control group) were enrolled in the study. A cardiologic workup was performed and blood sVCAM-1 concentration was determined using the ELISA method.Results: Patients with AF had similar blood sVCAM-1 concentration compared to the control group. AF patients treated with new oral anticoagulants (NOACs) were significantly less likely to have a sVCAM-1 concentration elevated above the median value than patients treated with warfarin (34.2% vs 65.8%; p = 0.01). Patients with an increased percentage of fat mass (FM) had lower sVCAM-1 concentration. The risk of all-cause mortality and MACE during follow-up rose in individuals with elevated sVCAM-1 (≥ 1242 and ≥ 587 ng/ml, respectively) with (OR; 95%CI): 5.39; 1.57-18.45; p = 0.007, and 6.00; 1.18-30.37; p = 0.03, respectively. Risk of death rose with increase in the ratio of sVCAM-1 and FM (1.02; 1.00-1.04; p = 0.019).Conclusions: Elevated sVCAM-1 was associated with all-cause mortality and MACE during one-year follow- up, but do not links the risk of AF. Use of NOACs may favorable affect endothelial function, A lower level of sVCAM-1 in obese patients may mediate the phenomenon of the “obesity paradox” in patients with AF
Związek między migotaniem przedsionków a wskaźnikami stanu odżywienia u pacjentów hospitalizowanych — przekrojowa analiza dokumentacji medycznej
Background: Atrial fibrillation (AF) and nutrition status abnormalities are two of the most significant epidemics in current health care.
Aim: The aim of this study was to determine the relationship between the prevalence and outcome of AF, and the parameters of nutritional status among consecutive, real-life patients hospitalised in a university hospital.
Methods: Analysis of the medical documentation of 4930 consecutive patients aged ≥ 18 years hospitalised for more than one day with diagnoses of cardiovascular disorders.
Results: Patients admitted with a diagnosis of AF (n = 512) compared to their counterparts without AF less frequently had an NRS-2002 score ≥ 3, normal range of body mass index (BMI), higher blood haemoglobin, and lower low density lipoprotein cholesterol (LDL-C) concentration. In logistic regression analysis, the risk of a hospitalisation due to AF was negatively related to BMI, NRS-2002 score, and the value of the difference between ideal and actual body mass. Urgent admission and having an NRS-2002 score ≥ 3 remained the only significant variables determining the risk of in-hospital death. Blood concentration of LDL-C and urgent admission were the only significant variables determining risk of 30-day rehospitalisation in the studied population.
Conclusions: Inpatients with AF had a lower prevalence of normal body mass. Patients with an AF diagnosis had different risk factors for in-hospital death and 30-day rehospitalisation than their counterparts with diagnosis of cardiovascular diseases but without AF; however, the parameters of nutritional status played an important role in both patient groups. The obesity and cholesterol paradoxes were also observed.Wstęp: Migotanie przedsionków (AF) i nieprawidłowości stanu odżywienia są obecnie jednymi z dwóch najczęściej występujących problemów współczesnej opieki zdrowotnej. Związek między tymi stanami jest uwarunkowany wieloma czynnikami patofizjologicznymi, m.in. takimi jak: prozapalny efekt adipokin i cytokin produkowanych przez tkankę tłuszczową trzewną i okołosercową, zmiany aktywności autonomicznego układu nerwowego, zespół bezdechu sennego, zespół metaboliczny, refluks żołądkowo-przełykowy, powiększenie przedsionka, przerost mięśnia sercowego i zaburzenia przewodzenia wewnątrzsercowego.
Cel: Celem pracy była ocena związku między wartościami wskaźników stanu odżywienia pacjentów i zgonem wewnątrzszpitalnym a koniecznością rehospitalizacji w ciągu 30 dni u osób hospitalizowanych z powodu AF w porównaniu ze wszystkimi kolejnymi pacjentami hospitalizowanymi z powodu choroby sercowo-naczyniowej w jednym szpitalu uniwersyteckim w ciągu jednego roku.
Metody: Przeprowadzono analizę dokumentacji medycznej 4930 kolejnych pacjentów w wieku ≥ 18 lat hospitalizowanych w jednym szpitalu, w ciągu jednego roku kalendarzowego, na oddziałach internistycznych dłużej niż jeden dzień i wypisanych z rozpoznaniem sercowo-naczyniowej jednostki chorobowej jako schorzenia zasadniczego (kody I00-I99 w klasyfikacji ICD-10). Pacjentów z AF (n = 512) identyfikowano jako osoby z rozpoznaniem wypisowym I48 wg ICD-10. Grupę kontrolną stanowili pozostali chorzy (n = 4418), u których nie rozpoznano AF przy wypisaniu ze szpitala. Analizowano następujące wskaźniki stanu odżywienia: punktację w skali NRS-2002, wskaźnik masy ciała (BMI), obecność deficytu masy ciała względem wagi idealnej wyliczonej ze wzoru Lorentza, stężenie hemoglobiny, cholesterolu frakcji LDL (LDL-C), triglicerydów, glukozy, albumin, iloraz stężeń białka C-reaktywnego (CRP) i albumin oraz bezwzględną liczbę limfocytów krwi. Za mierzone punkty końcowe analizy przyjęto zgon wewnątrzszpitalny z jakiegokolwiek powodu i rehospitalizację w ciągu 30 dni.
Wyniki: Pacjenci przyjęci z powodu AF, w porównaniu z osobami z chorobami sercowo-naczyniowymi, ale bez AF, byli starsi, mieli niższą średnią punktację w kwestionariuszu oceny ryzyka związanego z niedożywieniem (NRS-2002), rzadziej uzyskiwali punktację NRS-2002 ≥ 3 (przyjęty powszechnie punkt odcięcia dla zwiększonego ryzyka związanego z niedożywieniem), charakteryzowali się większą średnią masą ciała i wartością BMI, istotnie rzadziej mieścili się w przedziale prawidłowych wartości BMI (18,5–25 kg/m2; 22,8% vs. 27,8%; p = 0,016) oraz mieli wyższe stężenie hemoglobiny przy przyjęciu i niższe stężenie LDL-C. Punktacja NRS-2002 ≥ 3 oraz niedobór masy ciała były jedynymi czynnikami predykcyjnymi zgonu u pacjentów z AF. U osób bez AF, oprócz tych parametrów kilka innych uzyskało znamienność statystyczną względem oceny ryzyka zgonu wewnątrzszpitalnego i rehospitalizacji w ciągu 30 dni. W analizie metodą regresji logistycznej ryzyko przyjęcia do szpitala z powodu AF było znamiennie statystycznie powiązane negatywnie z wartością BMI, punktacją w kwestionariuszu NRS-2002 oraz bezwzględną różnicą między idealną i aktualną masą ciała. Przyjęcie w trybie pilnym (tylko u pacjentów bez AF) oraz uzyskanie przynajmniej 3 punktów w skali NRS-2002 były jedynymi niezależnymi czynnikami ryzyka zgonu wewnątrzszpitalnego. Natomiast stężenie LDL-C (iloraz szans [OR] 0,99 ± 95% przedział ufności [CI] 0,98–0,995) i hospitalizacja w trybie pilnym (OR 5,98 ± 95% CI 2,15–16,66) były jedynymi znamiennymi czynnikami ryzyka rehospitalizacji w ciągu 30 dni w badanej grupie.
Wnioski: Pacjenci z AF, w porównaniu z pozostałymi hospitalizowanymi z powodu chorób sercowo-naczyniowych, ale bez AF, rzadziej prezentowali prawidłowy zakres BMI. Pacjenci z AF charakteryzowali się innymi czynnikami ryzyka zgonu wewnątrzszpitalnego i rehospitalizacji w ciągu 30 dni niż osoby przyjęte z innego powodu, w obu grupach jednak parametry stanu odżywienia odgrywały istotną rolę. Obserwowano także „paradoks otyłości” polegający na mniejszym ryzyku hospitalizacji z powodu AF i rehospitalizacji w ciągu 30 dni po wypisaniu z jakiegokolwiek powodu oraz „paradoks cholesterolowy” polegający na mniejszym ryzyku rehospitalizacji 30-dniowej u pacjentów z wyższym stężeniem LDL-C
Selected adipocytokine concentrations in patients hospitalized for exacerbated chronic heart failure
Introduction: The role of adipose tissue as energy storage and endocrine organ is an area of interest in the treatment of several diseases. This study aimed to to evaluate blood adiponectin (ADP), leptin, tumor necrosis factor type alpha (TNF-alpha) concentrations, and their prognostic value in patients with exacerbated chronic heart failure (CHF).
Methods and results: The following were assessed in 64 consecutive patients hospitalized for exacerbated CHF and a control group of 32 age and sex-matched individuals admitted due to life-limiting symptoms of peripheral artery disease: serum leptin, ADP, TNF-alpha concentrations, and body composition determined by bioelectrical impedance analysis. Compared to the control group, CHF patients had significantly higher blood ADP concentrations, a higher ratio of ADP to fat mass expressed as a percentage of body mass, and lower blood TNF-alpha concentrations and ratios of TNF-alpha to the visceral fat level (VFL). Compared to patients who survived, patients with CHF who died during the one-year follow-up had significantly higher values of ADP and higher ratios of ADP to body surface area. In the Cox regression model, blood ADP concentration was the only independent risk factor in respect of all-cause mortality during the one-year follow-up (HR; 95% CI: 1.16; 1.03-1.31).
Conclusions: Patients with CHF present dysregulation in the secretion of ADP and TNF-alpha. Increased blood ADP concentration was associated with an increase in one-year all-cause mortality by 16%
Leptin, adiponectin, tumor necrosis factor α, and irisin concentrations as factors linking obesity with the risk of atrial fibrillation among inpatients with cardiovascular diseases
Background: The endocrine function of adipose tissue and skeletal muscles mediates the risk of cardiovascular complications of obesity.
Aims: The aim of this study was to determine the associations of leptin, adiponectin (ADA), tumor necrosis factor α (TNF‑α), and irisin levels with the diagnosis of atrial fibrillation (AF) on admission to the hospital as well as parameters of transthoracic echocardiography among inpatients with cardiovascular diseases (CVDs).
Methods: The study included 80 consecutive patients hospitalized due to paroxysmal or persistent AF and a control group of 165 age- and sex‑matched individuals admitted due to exacerbation of chronic CVD. In all participants, we assessed serum leptin, ADA, TNF‑α, and irisin concentrations, body composition determined by bioelectrical impedance analysis, and transthoracic echocardiographic parameters.
Results: Compared with controls, patients with AF had greater fat mass (FM), higher serum leptin levels and lower levels of ADA, TNF‑α, and irisin when indexed to body surface area, FM, and visceral adiposity. Hyperleptinemia slightly increased the risk of AF (odds ratio [OR], 1.02; 95% CI, 1.01–1.03; P < 0.01). The correlation was stronger after indexation to FM (OR, 1.34; 95% CI, 1.01–1.81; P < 0.05). The coefficients of significant correlations with echocardiographic parameters were stronger for irisin than for adipocytokines: 0.16 to 0.35 and 0.12 to 0.22, respectively.
Conclusions: Adipocytokines and irisin exert a significant but weak effect on heart chamber size and affect the risk of AF occurrence. Their blood concentrations do not seem to be related simply to body composition but probably depend on individual variations in adipocytokine and myokine secretion as a result of numerous factors