Effect of myocardial infarction on the occurrence of erectile dysfunction

Aim To investigate etiological link between acute myocardial infarction (AMI) and the accompanying impotence/erectile dysfunction (ED). Methods Study included 99 male patients (48 who had AMI - patient group, and 51 healthy examinees without previous cardiovascular disease - control group). All patients completed a standardized questionnaire, the International Index of Erectile Function (IIEF-5). Results Older patients had significantly lower IIEF-5 score (negative correlation) (p <0.05), but higher ED degree (significant positive correlation) (rho=0.522; p=0.0001). In the patient group, 37 (77.1%) patients had ED, while in the control group it was found in 26 (51%) examinees (p<0.05). A clear correlation was found between incidence of ED and diabetes, dyslipidaemia, hypertension and positive family history (they were more common in patients with ED, with no statistically significant difference). There was no statistically significant difference between patients with ED and patients without ED according to the beta-blocker usage (p=0.824): ED was reported in 11 (68%) patients in the group who used carvedilol, 14 (82.3%) in the group who used metoprolol, and nine (81.8%) who used nebivolol. Conclusion Myocardial infarction as well as age are directly related to the occurrence of ED. Cardiovascular risk factors are in direct correlation for the occurrence of erectile dysfunction after myocardial infarction

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

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

Development of Software for Choosing Therapeutic Modalities in Atrial Fibrillation

Fibrilacija atrija (FA) najčešća je tahiaritmija koja zahtijeva liječenje te je stalni klinički problem za liječnike obiteljske medicine i kardiologe. Razvijeno je nekoliko algoritama za procjenu rizika krvarenja u bolesnika s FA-om. Među njima su HAS-BLED (arterijska hipertenzija, abnormalna funkcija jetre i bubrega, moždani udar, anamnestički podatci ili predispozicija za krvarenje, labilna vrijednost INR-a, dob >65 godina, istodobno konzumiranje droge i alkohola), ORBIT (starija životna dob, snižena vrijednost hemoglobina/ hematokrita/anemija, anamnestički podatci o krvarenju, snižena bubrežna funkcija, liječenje antitromboticima), ABC (životna dob, biomarkeri, anamnestički podatci), ATRIA (anemija, teško smanjenje bubrežne funkcije, dob >75 godina, prethodno krvarenje i dijagnosticirana arterijska hipertenzija) i HEMORR(2)HAGES (bolest jetre ili bubrega, alkoholizam, zloćudna bolest, starija životna dob, smanjen broj ili funkcija trombocita, ponovno krvarenje, arterijska hipertenzija, anemija, genski čimbenici, znatan rizik od pada i moždani udar). Primjena oralnih antikoagulanasa još je uvijek standard u prevenciji moždanog udara u FA, ali je treba uravnotežiti s rizikom od krvarenja koji je s njom povezan. Svrha je ovoga članka opisati razvoj sustava za podršku pri donošenju kliničkih odluka (CDSS; eng. clinical decision support system) koje bi liječnicima omogućile brzu procjenu rizika od krvarenja u bolesnika s FA-om kako bi optimizirali liječenje antikoagulansima. Spomenuti je računalni program razvijen u obliku mrežne aplikacije. Responzivni ustroj korisničkog sučelja bio je ključan u postizanju optimalne interakcije korisnika s programom te korisniku omogućuje potpunu kontrolu pri svakom koraku postupka neovisno o vrsti uređaja koja se primjenjuje, bilo to prijenosno računalo bilo pametni telefon. Pozadinski sustav aplikacije razvijen je u programskom jeziku Python. Preciznije rečeno, rabi se mrežni kostur zvan Flask. On se smatra dobrim izborom za brzo prototipiziranje, razvoj i uvođenje malih do srednjih aplikacija. Aplikacija razdvaja postupak odlučivanja u trima koracima. Prikaz prvog koraka traži od korisnika da izabere vrstu zbroja rizika koji želi izračunati. Sljedeći korak uključuje unošenje podataka o povijesti bolesti, laboratorijskim nalazima, simptomima i komorbiditetu. Posljednji ekran prikazuje izračunani zbroj rizika, koji pomaže korisniku u odabiru tijeka liječenja. Ovakav program nudi CDSS koji omogućuje bržu i lakšu procjenu rizika krvarenja u bolesnika s FA-om kako bi se postigao bolji terapijski modalitet. Responzivni ustroj i sučelje u obliku mrežne aplikacije osiguravaju lako pristupanje programu s pomoću širokog raspona uređaja.Atrial fibrillation (AF) is the most common tachyarrhythmia that requires treatment and represents constant clinical problem for general practitioners and cardiologists. Several bleeding risk scores have been developed for estimating bleeding risk in patients with AF. These include: HASBLED (hypertension, abnormal renal/liver function, stroke, bleeding history or predisposition, labile international normalized ratio, age >65 years, drugs/alcohol concomitantly), ORBIT (older age, reduced hemoglobin/hematocrit/anemia, bleeding history, insufficient kidney function, treatment with antiplatelets), ABC (age, biomarkers, clinical history), ATRIA (anemia, severe renal disease, age ≥75 years, previous hemorrhage, and diagnosed hypertension), and HEMORR(2)HAGES (Hepatic or Renal Disease, Ethanol Abuse, Malignancy, Older Age, Reduced Platelet Count or Function, Re-Bleeding, Hypertension, Anemia, Genetic Factors, Excessive Fall Risk, and Stroke). The use of oral anticoagulants is still the standard in stroke prevention in AF but should be balanced against the associated bleeding risk. The aim of this article was to describe the development of a clinical decision support system (CDSS) that will enable clinicians to perform a quick assessment of bleeding risk in patients with AF in order to optimize anticoagulation therapy in patients with AF. The software was developed in the form of a web application. The responsive design of the interface was key to optimal user interaction, providing seamless control of every step of the process regardless of the type of device used, whether a laptop or a smartphone. The backend of the application was developed in Python. More specifically, a web framework named Flask was utilized. It is considered to be a good choice for rapid prototyping and development and deployment of small- to medium-sized applications. The application separates the decision process into three steps. Displaying the first step prompts the user to select the type of score they want calculated. The following step includes entering anamnestic data, laboratory findings, symptoms, and comorbidities. The final screen displays the calculated score, which assists the user in determining the course of the treatment. This software represents a CDSS that enables faster and easier assessment of bleeding risk in patients with AF in order to achieve a better therapeutic modality. The responsive design and the web application format makes the software easily accessible on a wide range of devices

Relation between thyroid hormonal status, neutrophillymphocyte ratio and left ventricular systolic function in patients with acute coronary syndrome

Aim To examine a relation of thyroid function, neutrophil-lymphocyte ratio (NLR) with left ventricular function measured through the left ventricular ejection fraction (LVEF) in patients with acute myocardial infarction treated with percutaneous coronary intervention (PCI). Methods This prospective research involved 160 consecutive patients with acute myocardial infarction. Patients were divided into those with normal thyroid hormone status (n=80) and those with hypothyroidism (newly diagnosed) (n=80). Inflammatory parameters and parameters of hormonal status were taken for analysis: thyroid-stimulating hormone (TSH), thyroxine (T4), triiodothyronine (T3), free thyroxine (FT4), and free triiodothyronine (FT3). All patients underwent transthoracic echocardiographic examination (TTE) five days upon admission, and left ventricular ejection fraction (LVEF) was analysed. Results Significant difference between the two groups was verified in values of T3, T4, erythrocytes, haemoglobin, haematocrit, neutrophil, lymphocytes, NLR, C-reactive protein (CRP) and sedimentation rate. Patients with euthyroidism had a higher frequency of coronary single-vessel disease (p=0.035) and a significantly lower frequency of triple vessel disease (p=0.046), as well as a higher median value of LVEF (p=0.003). There was a significant correlation between LVEF with haemoglobin values (p=0.002), NLR (p=0.001), and CRP (p=001). Conclusion The altered status of the thyroid gland in acute myocardial infarction is associated with the severity of the coronary blood vessel lesion, LVEF and correlates with inflammatory response