In-hospital and short-term predictors of mortality in patients with intermediate-high risk pulmonary embolism

Introduction: The aim of this study was to evaluate the in-hospital and short-term predictive factors of mortality in intermediate-high risk acute pulmonary embolism (PE) patients with right ventricle (RV) dysfunction and myocardial injury.Methods: In this retrospective study, the medical records of 187 patients with a diagnosis of intermediatehigh risk acute PE were evaluated. A contrast-enhanced multi-detector pulmonary angiography was used to confirm diagnosis in all cases. All-cause mortality was determined by obtaining both in-hospital and 30 days follow-up data of patients from medical records.Results: During the in-hospital stay (9.5 +/- 4.72 days), 7 patients died, resulting in an acute PE related in-hospital mortality of 3.2%. Admission heart rate (HR), (Odds ratio (OR), 1.028 95% Confidence interval (CI), 0.002-1.121; P = 0.048) and blood urea nitrogen (BUN) (OR, 1.028 95% CI, 0.002-1.016; P = 0.044) were found to be independent predictors for in-hospital mortality in a multivariate logistic regression analysis. In total, 32 patients (20.9%) died during 30 days follow-up.The presence of congestive heart failure (OR, 0.015, 95%CI, 0.001-0.211; P = 0.002) and dementia (OR, 0.029, 95%CI, 0.002-0.516; P = 0.016) as well as low albumin level (OR, 0.049 95%CI, 0.006-0.383; P = 0.049) were associated with 30 days mortality.Conclusion: HR and BUN were independent predictors of in-hospital mortality and the presence of congestive heart failure, dementia, and low albumin levels were associated with higher 30 days mortality

Generalized Vieta-Jacobsthal and Vieta-Jacobsthal-Lucas polynomials

In this paper generalized Vieta-Jacobsthal and Vieta-Jacobsthal-Lucas polynomials are introduced. The Binet form and some of their recursive features are given. Various families of multilinear and multilateral generating functions for these polynomials are derived. Furthermore, some special cases of the results are presented in this study

Impaired fasting glucose is associated with increased perioperative cardiovascular event rates in patients undergoing major non-cardiothoracic surgery

<p>Abstract</p> <p>Background</p> <p>Diabetes mellitus (DM) is a well-established risk factor for perioperative cardiovascular morbidity and mortality in patients undergoing noncardiac surgery. However, the impact of preoperative glucose levels on perioperative cardiovascular outcomes in patients undergoing nonemergent, major noncardiothoracic surgery is unclear.</p> <p>Methods and Results</p> <p>A total of 680 patients undergoing noncardiothoracic surgery were prospectively evaluated. Patients older than 18 years who underwent an elective, nonday case, open surgical procedure were enrolled. Electrocardiography and cardiac biomarkers were obtained 1 day before surgery, and on days 1, 3 and 7 after surgery. Preoperative risk factors and laboratory test results were measured and evaluated for their association with the occurrence of in-hospital perioperative cardiovascular events. Impaired fasting glucose (IFG) defined as fasting plasma glucose values of 100 to 125 mg/dl; DM was defined as fasting plasma glucose ≥ 126 mg/dl and/or plasma glucose ≥ 200 mg/dl or the current use of blood glucose-lowering medication, and glucose values below 100 mg/dl were considered normal. Plasma glucose levels were significantly higher in patients with perioperative cardiovascular events (n = 80, 11.8%) in comparison to those without cardiovascular events (131 ± 42.5 <it>vs </it>106.5 ± 37.5, p < 0.0001). Multivariate analysis revealed that patients with IFG and DM were at 2.1- and 6.4-fold increased risk of perioperative cardiovascular events, respectively. Every 10 mg/dl increase in preoperative plasma glucose levels was related to a 11% increase for adverse perioperative cardiovascular events.</p> <p>Conclusions</p> <p>Not only DM but also IFG is associated with increased perioperative cardiovascular event rates in patients undergoing noncardiothoracic surgery.</p

Impairment of the left ventricular systolic and diastolic function in patients with non-alcoholic fatty liver disease

Background: Non-alcoholic fatty liver disease (NAFLD) is considered the liver component of the metabolic syndrome. We investigated the diastolic and systolic functional parameters of patients with NAFLD and the impact of metabolic syndrome on these parameters. Methods: Thirty-five non-diabetic, normotensive NAFLD patients, and 30 controls, were included in this study. Each patient underwent transthoracic conventional and tissue Doppler echocardiography (TDI) for the assessment of left ventricular (LV) diastolic and systolic function. Study patients were also evaluated with 24-hour ambulatory blood pressure monitoring. Results: NAFLD patients had higher blood pressures, increased body mass indices, and more insulin resistance than controls. TDI early diastolic velocity (E&#8217; on TDI) values were lower in NAFLD patients than the controls (11.1 &#177; 2.1 vs 15.3 &#177; 2.7; p < 0.001). TDI systolic velocity (S&#8217; on TDI) values were lower in NAFLD patients than the controls (9.34 &#177; 1.79 vs 10.6 &#177; 1.52; p = 0.004). E&#8217; on TDI and S&#8217; on TDI values were moderately correlated with night-systolic blood pressure, night-diastolic blood pressure, and night-mean blood pressure in NAFLD patients. Conclusions: Patients with NAFLD have impaired LV systolic and diastolic function even in the absence of morbid obesity, hypertension, or diabetes. (Cardiol J 2010; 17, 5: 457-463

Epikardiyal yağ kalınlığının artışı şiddetli koroner arter hastalığı varlığının bir belirteci midir?

Fat is mainly deposited in subcutaneous tissue, but it also accumulates in the abdominal or thoracal region (1). Other major sites of fat accumulation are visceral and cardiac areas; Cardiac fat deposition is now recognized as a new cardiometabolic risk marker, as it is associated with increased insulin resistance, cardiovascular risk factors, as their measurement is practical (2). Fat accumulation in the heart appears in three different types: intracellular, epicardial and pericardial. Intracellular fat is the microscopic lipid accumulation within the cytoplasm of cardiac muscle and can be the result of myocardial ischemia, cell damage or cell death. Epicardial fat is located between the outer wall of the myocardium and the visceral layer of pericardium (3). Pericardial fat exists anterior to the epicardial fat layer and therefore located between visceral and parietal pericardium. Due to the close anatomic relation between myocardium and the epicardial fat, the two tissues share the same microcirculation (4). In previous studies have been reported that epicardial fat is metabolically active and is the source for several adipokines. Potential interactions through paracrine or vasocrine mechanisms between epicardial fat and myocardium are strongly suggested (4)

The association of epicardial fat thickness with blunted heart rate recovery in patients with metabolic syndrome

WOS: 000294273000003PubMed ID: 21737994Epicardial fat tissue has unique endocrine and paracrine functions that affect the cardiac autonomic system. Epicardial fat thickness (EFT) and blunted heart rate recovery (HRR) are newly identified cardiovascular risk factors in patients with metabolic syndrome (MS). The objective of this study is to evaluate the association between EFT and HRR in patients with MS. Forty patients with MS and 36 healthy controls were included in the study. Echocardiographic EFT and HRR at 1min after exercise termination (HRR-1) are measured and compared between the two groups. HRR-1 equal to or lower than 18 beats is considered as blunted HRR. EFT was increased (7.2 +/- 2 vs. 5.6 +/- 1.8 mm; p = 0.001) and HRR-1 was significantly reduced in patients with MS compared to control group (21 +/- 8 vs. 26 +/- 9; p = 0.006). Among the MS patients, subjects with blunted HRR had increased EFT compared to patients without blunted HRR (8.5 +/- 2.0 vs. 5.9 +/- 1.1 mm, p < 0.001). In multivariate analysis, EFT was the only independent predictor of blunted HRR in patients with MS (95% confidence interval = 1.42-3.87, OR = 2.34, p = 0.001). Furthermore, EFT of equal to or thicker than 5.5 mm was associated with the blunted HRR with 84% sensitivity and 52% specificity (ROC area under curve: 0.84, 95% confidence interval = 0.70-0.96, p < 0.001). In conclusion, EFT is an independent predictor of blunted HRR, a novel cardiovascular risk factor, in patients with MS

Sürekli ayaktan periton diyalizi hastalarında kardiyak troponin T'nin kardiyak olayları göstermede prognostik değeri

SUMMARY Cardiovascular disease is the leading cause of morbidity and mortality in patients with end-stage renal disease. Cardiac troponins have recently been shown to predict cardiovascular events (CVE) in chronic hemodialysis patients. The aim of this study was to investigate the value of cardiac troponin T (cTnT) as a predictor of subsequent CVE in patients on continuous ambulatory peritoneal dialysis (CAPD). Sixty-five CAPD patients over 35 year old (29 females, mean age 56 ± 12 yrs) without any evidence of an acute coronary syndrome in the last 28 days were prospectively included and followed-up for 12 months. Ten (% 15) of these patients had previously documented coronary artery disease, which was either asymptomatic or clinically stable. Baseline cTnT was measured by the 3rd generation assay using electrochemiluminescence immunassay (ECLIA) method on the ELECSYS 2010 (Roche Diagnostics, Boehringer Mannheim, Germany). Study endpoints were defined as new myocardial infarction, unstable angina pectoris, coronary revascularization procedures including percutaneous coronary intervention or coronary artery by-pass graft surgery and sudden and nonsudden cardiovascular death. No correlation could be found between serum cTnT levels and serum urea, creatinine, CK, CK-MB levels, and the duration of dialysis. Twelve patients (18 %) had CVE, including 7 myocardial infarctions, 2 coronary revascularization procedures, 1 unstable angina, 1 sudden cardiac death, and 1 fatal peripheral vascular event. Twenty-three patients had cTnT levels a 0.05 ng/ml and of these 12 had CVE. Thus the sensitivity of cTnT s. 0.05 ng/ml in predicting CVE was 100 % and specificity was 79 %. The positive and negative predictive values were 52 % and 100 %, respectively (p < 0.0001). On the other hand 15 patients had cTnT levels â 0.144 ng/ml; 9 of these suffering CVE. With this cut-off level, sensitivity was 75 %, however specificity improved to 89 %. The positive and negative predictive values were 60 % and 94 %, respectively (p < 0.0001). These results imply that a high baseline serum cTnT level (&0.05 ng/ml) is highly sensitive and reasonably specific in predicting CVE within 12 months in CAPD patients either asymptomatic or stable of cardiovascular symptoms. cTnT levels equal or above 0.1 ng/ml have a lower sensitivity but a remarkable specificity

Sürekli ayaktan periton diyalizi hastalarında kardiyak troponin T'nin kardiyak olayları göstermede prognostik değeri

SUMMARY Cardiovascular disease is the leading cause of morbidity and mortality in patients with end-stage renal disease. Cardiac troponins have recently been shown to predict cardiovascular events (CVE) in chronic hemodialysis patients. The aim of this study was to investigate the value of cardiac troponin T (cTnT) as a predictor of subsequent CVE in patients on continuous ambulatory peritoneal dialysis (CAPD). Sixty-five CAPD patients over 35 year old (29 females, mean age 56 ± 12 yrs) without any evidence of an acute coronary syndrome in the last 28 days were prospectively included and followed-up for 12 months. Ten (% 15) of these patients had previously documented coronary artery disease, which was either asymptomatic or clinically stable. Baseline cTnT was measured by the 3rd generation assay using electrochemiluminescence immunassay (ECLIA) method on the ELECSYS 2010 (Roche Diagnostics, Boehringer Mannheim, Germany). Study endpoints were defined as new myocardial infarction, unstable angina pectoris, coronary revascularization procedures including percutaneous coronary intervention or coronary artery by-pass graft surgery and sudden and nonsudden cardiovascular death. No correlation could be found between serum cTnT levels and serum urea, creatinine, CK, CK-MB levels, and the duration of dialysis. Twelve patients (18 %) had CVE, including 7 myocardial infarctions, 2 coronary revascularization procedures, 1 unstable angina, 1 sudden cardiac death, and 1 fatal peripheral vascular event. Twenty-three patients had cTnT levels a 0.05 ng/ml and of these 12 had CVE. Thus the sensitivity of cTnT s. 0.05 ng/ml in predicting CVE was 100 % and specificity was 79 %. The positive and negative predictive values were 52 % and 100 %, respectively (p < 0.0001). On the other hand 15 patients had cTnT levels â 0.1 44 ng/ml; 9 of these suffering CVE. With this cut-off level, sensitivity was 75 %, however specificity improved to 89 %. The positive and negative predictive values were 60 % and 94 %, respectively (p < 0.0001). These results imply that a high baseline serum cTnT level (&0.05 ng/ml) is highly sensitive and reasonably specific in predicting CVE within 12 months in CAPD patients either asymptomatic or stable of cardiovascular symptoms. cTnT levels equal or above 0.1 ng/ml have a lower sensitivity but a remarkable specificity