Impact of anxiety and depression disorders on adherence to anticoagulant therapy among patients with atrial fibrillation

Aim. To determine the possible impact of anxiety and depression disorders on the adherence of patients with atrial fibrillation (AF) to anticoagulant the rapy.Material and methods. The study included outpatients with AF of any type. After signing the informed consent, patients filled out questionnaires and scales that determined the level of anxiety and personal predisposition (MMAS-8, MMAS-4, SF-36, SHAI, STAI, HADS, NEO-FFI).Results. A total of 117 outpatients treated for AF were included. The mean age of patients was 74±5 years (men, 38%). Based on MMAS-4 and MMAS-8 results, adherent and non-adherent cohorts of patients were formed. Low adherence group had significantly higher situational anxiety according to STAI (45,9±9,9 vs 41,1±10,7, p=0,045) and depression according to HADS (7,9±3,6 vs 5,9±3,5, p=0,018). SF 36 showed that non-adherent patients had a lower general health (41,6±12,9 vs 52,2±20,0, p=0,01). Five-factor model revealed an association between low compliance and low extraversion (21,3±6,6 vs 26,4±7,2, p=0,002). Pharmacokinetic data on blood concentrations of anticoagulants or its metabolites at the second visit were available in 76 (67%) patients. Assessment of pharmacokinetic and compliance data revealed a moderate direct correlation (Matthews correlation coefficient (MCC), 0,345) and a weak direct correlation with the MMAS-8 (MCC, 0,177). The difference in MMAS-4 and MMAS-8 scores between high and low pharmacokinetic adherence groups was significant on both scales (p=0,011 and 0,015, respectively).Conclusion. The rationale for widespread introduction of standardized questionnaires and scales (MMAS 4, MMAS 8, STAI, HADS, SF 36, Big 5) was shown in order to early identify patients with low adherence to treatment. The results highlight the need for further study of the contribution of psychiatric disorders to low compliance to anticoagulant therapy

Возможности портативного регистратора электрокардиограммы и пульсовой волны в выявлении систолической дисфункции левого желудочка

Highlights. The article presents a novel and unique method for assessment of left ventricular systolic disfunction using electrocardiography and photoplethysmography data. This method will improve and simplify the detection of cardiovascular diseases.Aim. To evaluate left ventricular (LV) systolic function using electrocardiogram (ECG) and photoplethysmogram (PPG) signals recorded by a single-channel ECG and PPG-based monitor.Methods. The prospective study included 489 patients over 18 years old with various cardiovascular diseases. All participants underwent echocardiography to determine the main indicators of LV systolic function: LV ejection fraction (EF), LV outflow tract velocity time integral (LVOT VTI), and global longitudinal strain (GLS). Moreover, all patients underwent 1-lead ECG and PPG recording using a single-channel ECG and PPG-based monitor (CardioQvark). The obtained data were analyzed, and ROC curve analysis was performed.Results. We have identified ECG and PPG parameters associated with a decrease in LV contractile function. During the analysis, the ECG, T-wave amplitude (TA) and RonsF parameters showed the highest diagnostic accuracy. With EF below 55%, the area under the ROC curve (AUC) was 0.822, sensitivity (Se) 80%, specificity (Sp) 69% in EF below 55% in TA; in RonsF AUC was 0.743, Se 81%, Sp 77%. With EF below 40%, AUC was 0.915, Se 85%, Sp 83% in TA, and in RonsF AUC was 0.844, Se 82%, Sp 82%. Diagnostic accuracy of ECG signals in case of LVOT VTI lower than 16 cm was measured: TA (AUC 0.755, Se 82%, Sp 70%), RonsF (AUC 0.620, Se 77%, Sp 72%). PPG signals were not significantly associated with reduced EF; however, the pulse wave parameters were associated with lower LVOT VTI: in DP-B0 AUC was 0.687, Se 71%, Sp 74%. The combination of ECG and PPG signals was significantly associated with EF below 40% (RonsF * DP-SEP (AUC 0.877, Se 86%, Sp 85%). ECG and PPG signals were not associated with LV GLS.Conclusion. Assessment of LV systolic function can be performed by analyzing ECG and PPG signals recorded using a portable single-channel CardioQvark monitor.Основные положения. Описана возможность диагностики снижения систолической функции левого желудочка по данным электро- и фотоплетизмограммы. Разработка метода оценки систолической функции левого желудочка на основе электро- и фотоплетизмограммы позволит улучшить и упростить выявление сердечно-сосудистых заболеваний. Метод оценки систолической функции сердца, изложенный в исследовании, представлен впервые и является уникальным.Цель. Оценка систолической функции левого желудочка (ЛЖ) на основе параметров электро- (ЭКГ) и фотоплетизмограммы (ФПГ), зарегистрированных одноканальным монитором ЭКГ с функцией фотоплетизмографии.Материалы и методы. В проспективное исследование включено 489 пациентов в возрасте старше 18 лет, имеющих заболевания сердечно-сосудистой системы. Всем участникам исследования выполнена эхокардиография с определением основных показателей систолической функции ЛЖ: фракции выброса (ФВ) ЛЖ, интеграла линейной скорости кровотока в выносящем тракте ЛЖ (VTI в ВТЛЖ), глобальной деформации ЛЖ (GLS). Также всем больным проведена регистрация ЭКГ в I отведении и ФПГ с использованием монитора ЭКГ с функцией фотоплетизмографии (CardioQVARK). Проведены расчет всех полученных параметров, затем ROC-анализ данных.Результаты. Выявлены параметры ЭКГ и ФПГ, ассоциированные со снижением сократительной функции ЛЖ. При анализе ЭКГ параметры TA (амплитуда T-волны) и RonsF (частота максимальной энергии переднего фронта R-волны) имели наибольшую диагностическую точность. При ФВ менее 55% для TA площадь под ROC-кривой (AUC) составила 0,822, чувствительность (Se) 80%, специфичность (Sp) 69%, а для параметра RonsF – AUC 0,743, Se 81%, Sp 77%. При ФВ менее 40%: AUC для TA составила 0,915, Se 85%, Sp 83%, для RonsF – AUC 0,844, Se 82%, Sp 82%. Диагностическая точность параметров ЭКГ при снижении VTI в ВТЛЖ менее 16 см: TA (AUC 0,755, Se 82%, Sp 70%), RonsF (AUC 0,620, Se 77%, Sp 72%). При оценке параметров ФПГ достоверной взаимосвязи со снижением ФВ не выявлено, однако параметры пульсовой волны ассоциированы с уменьшением VTI в ВТЛЖ: для DP-B0 AUC 0,687, Se 71%, Sp 74%. Комбинации параметров ЭКГ и ФПГ достоверно взаимосвязаны со значением ФВ менее 40% (RonsF*DP-SEP (AUC 0,877, Se 86%, Sp 85%)). Взаимосвязи параметров ЭКГ и ФПГ со значением GLS ЛЖ не обнаружено.Заключение. Определение систолической функции ЛЖ возможно при анализе параметров ЭКГ и ФПГ, зарегистрированных с помощью портативного одноканального монитора CardioQVARK

MATHEMATICAL MODELLING OF CIRCULATION IN EXTRACRANIAL BRACHOCEPHALIC ARTERIES AT P RE-OPERATION STAGE IN CAROTID ENDARTERECTOMY

Aim. Hemodynamic shifts in the brain, developing due to carotid surgery (carotid endarterectomy or stenting) might be the cause of perioperation strokes. Assessment for hemodynamic shifts is important. The aim of current study was to develop methodics of cerebral hemodynamics assessment at pre-operation and post-operation periods of carotid endarterectomy.Material and methods. The authors propose a mathematical model for preoperation analysis of hemodynamics changes in extracranial regions of brachiocephalic arteries after carotid endarterctomy. The development of mathematical model was based upon the data from pre- and postsurgery duplex scan and CT-angiography.Results. The results showed good prediction capacity for the shifts in cerebral hemodynamics, using the developed mathematical model.Conclusion. Study results make it to assess cerebral hemodynamis without supplementary investigations. The model includes and represents real anatomy and quantitative hemodynamics parameters by the CT-angiography and duplex scan of the vessels

Non-invasive fractional flow reserve: a comparison of one-dimensional and three-dimensional mathematical modeling effectiveness

Aim. Comparative analysis of the diagnostic effectiveness of onedimensional (1-D) and three-dimensional (3-D) non-invasive methods for coronary fractional flow reserve (FFR) assessment based on the coronary computed tomography angiography (CCTA).Material and methods. We carried out a retrospective analysis of CCTA data for 13 patients (men — 9, mean age — 61,07±9,73). In the original research, coronary FFR of those patients was evaluated using the original 3-D HeartFlow® Analysis followed by a standard invasive FFR assessment. We estimated coronary FFR using the 1-D algorithm of the Laboratory of Mathematical Modeling (Sechenov University) and compared the diagnostic effectiveness of these methods.Results. In per-vessel analysis, the sensitivity and specificity of the 3-D approach were 90,91% (95% confidence interval (CI) 62,26-99,53) and 20% (95% CI 0,01026-62,46, p>0,9999), respectively; in per-patient analysis — 90% (95% CI 59,58-99,49) and 0% (95% CI 0-56,15, p>0,9999), respectively; area under the ROC curve was 93,75% (95% CI 80,26-100), p=2,0431e-10. For the 1-D approach, the same parameters in per-patient analysis were 88,89 % (95% CI 56,50-99,43) and 25% (95% CI 0,01282-69,94, p>0,9999), respectively; in per-vessel analysis — 100% (95% CI 72,25-100) and 33,33% (95% CI 0,05923-70, p=0,1250), respectively; area under the ROC curve was 84,54% (95% CI 63,93-100), p=0,001. Spearman’s rank correlation coefficient between the 3-D and 1-D techniques was 0,7326 (95% CI 0,35810,9041), p=0,0017.Conclusion. Although we have obtained lower values of area under the ROC curve, the sensitivity and specificity of experimental approach, as well as the correlation coefficient between models were rather high. However, further studies with higher statistical power are required

Clinical presentation, disease course, and outcome of COVID-19 in hospitalized patients with and without pre-existing cardiac disease: a cohort study across 18 countries

Aims Patients with cardiac disease are considered high risk for poor outcomes following hospitalization with COVID-19. The primary aim of this study was to evaluate heterogeneity in associations between various heart disease subtypes and in-hospital mortality. Methods and results We used data from the CAPACITY-COVID registry and LEOSS study. Multivariable Poisson regression models were fitted to assess the association between different types of pre-existing heart disease and in-hospital mortality. A total of 16 511 patients with COVID-19 were included (21.1% aged 66-75 years; 40.2% female) and 31.5% had a history of heart disease. Patients with heart disease were older, predominantly male, and often had other comorbid conditions when compared with those without. Mortality was higher in patients with cardiac disease (29.7%; n= 1545 vs. 15.9%; n= 1797). However, following multivariable adjustment, this difference was not significant [adjusted risk ratio (aRR) 1.08, 95% confidence interval (CI) 1.02-1.15; P = 0.12 (corrected for multiple testing)]. Associations with in-hospital mortality by heart disease subtypes differed considerably, with the strongest association for heart failure (aRR 1.19, 95% CI 1.10-1.30; P <0.018) particularly for severe (New York Heart Association class III/IV) heart failure (aRR 1.41, 95% CI 1.20-1.64; P < 0.018). None of the other heart disease subtypes, including ischaemic heart disease, remained significant after multivariable adjustment. Serious cardiac complications were diagnosed in <1% of patients. Conclusion Considerable heterogeneity exists in the strength of association between heart disease subtypes and in-hospital mortality. Of all patients with heart disease, those with heart failure are at greatest risk of death when hospitalized with COVID-19. Serious cardiac complications are rare during hospitalization. [GRAPHICS]

Clinical presentation, disease course, and outcome of COVID-19 in hospitalized patients with and without pre-existing cardiac disease : a cohort study across 18 countries

AIMS: Patients with cardiac disease are considered high risk for poor outcomes following hospitalization with COVID-19. The primary aim of this study was to evaluate heterogeneity in associations between various heart disease subtypes and in-hospital mortality. METHODS AND RESULTS: We used data from the CAPACITY-COVID registry and LEOSS study. Multivariable Poisson regression models were fitted to assess the association between different types of pre-existing heart disease and in-hospital mortality. A total of 16 511 patients with COVID-19 were included (21.1% aged 66-75 years; 40.2% female) and 31.5% had a history of heart disease. Patients with heart disease were older, predominantly male, and often had other comorbid conditions when compared with those without. Mortality was higher in patients with cardiac disease (29.7%; n = 1545 vs. 15.9%; n = 1797). However, following multivariable adjustment, this difference was not significant [adjusted risk ratio (aRR) 1.08, 95% confidence interval (CI) 1.02-1.15; P = 0.12 (corrected for multiple testing)]. Associations with in-hospital mortality by heart disease subtypes differed considerably, with the strongest association for heart failure (aRR 1.19, 95% CI 1.10-1.30; P < 0.018) particularly for severe (New York Heart Association class III/IV) heart failure (aRR 1.41, 95% CI 1.20-1.64; P < 0.018). None of the other heart disease subtypes, including ischaemic heart disease, remained significant after multivariable adjustment. Serious cardiac complications were diagnosed in <1% of patients. CONCLUSION: Considerable heterogeneity exists in the strength of association between heart disease subtypes and in-hospital mortality. Of all patients with heart disease, those with heart failure are at greatest risk of death when hospitalized with COVID-19. Serious cardiac complications are rare during hospitalization

Clinical presentation, disease course, and outcome of COVID-19 in hospitalized patients with and without pre-existing cardiac disease: a cohort study across 18 countries

AIMS: Patients with cardiac disease are considered high risk for poor outcomes following hospitalization with COVID-19. The primary aim of this study was to evaluate heterogeneity in associations between various heart disease subtypes and in-hospital mortality. METHODS AND RESULTS: We used data from the CAPACITY-COVID registry and LEOSS study. Multivariable Poisson regression models were fitted to assess the association between different types of pre-existing heart disease and in-hospital mortality. A total of 16 511 patients with COVID-19 were included (21.1% aged 66-75 years; 40.2% female) and 31.5% had a history of heart disease. Patients with heart disease were older, predominantly male, and often had other comorbid conditions when compared with those without. Mortality was higher in patients with cardiac disease (29.7%; n = 1545 vs. 15.9%; n = 1797). However, following multivariable adjustment, this difference was not significant [adjusted risk ratio (aRR) 1.08, 95% confidence interval (CI) 1.02-1.15; P = 0.12 (corrected for multiple testing)]. Associations with in-hospital mortality by heart disease subtypes differed considerably, with the strongest association for heart failure (aRR 1.19, 95% CI 1.10-1.30; P < 0.018) particularly for severe (New York Heart Association class III/IV) heart failure (aRR 1.41, 95% CI 1.20-1.64; P < 0.018). None of the other heart disease subtypes, including ischaemic heart disease, remained significant after multivariable adjustment. Serious cardiac complications were diagnosed in <1% of patients. CONCLUSION: Considerable heterogeneity exists in the strength of association between heart disease subtypes and in-hospital mortality. Of all patients with heart disease, those with heart failure are at greatest risk of death when hospitalized with COVID-19. Serious cardiac complications are rare during hospitalization