Left Ventricular Function after Revascularization in Patients with Chronical Coronary Syndromes

Background: The purpose of this study was to determine the dynamics of morpho-functional and myocardial deformation characteristics of the left ventricle after revascularization in patients with chronic coronary syndromes (CCS). Methods and Results: The study included 136 CCS patients of both sexes with stable anginal symptoms [(i) clinical scenario] and asymptomatic coronary artery disease (CAD) at screening [(vi) clinical scenario]. Diagnosis of CCS was performed according to the 2019 ESC Guidelines for the diagnosis and management of chronic coronary syndromes. All patients underwent the following examinations: assessment of traditional risk factors, physical examination, general clinical and laboratory blood tests, 12-lead ECG, transthoracic echocardiography, two-dimensional speckle tracking echocardiography (STE), and coronary angiography (CAG). The SYNTAX score was calculated retrospectively according to the SYNTAX score algorithm. A total of 100 patients with CCS were enrolled in the main group (MG) and underwent revascularization by PCI with intracoronary stenting using drug-eluting stents. Among the main-group patients, one-vessel, two-vessel, and three-vessel CAD were detected in 36(26.5%), 34(25%), and 30(22.0%) cases, respectively. The comparison group (CG) included 36 CCS patients with hemodynamically non-significant coronary lesions (<50% stenosis). LVEF values were within the normal range in all groups, with the highest value in the CG, followed by the one-, two- and three-vessel lesion groups. LVEF obtained by the area-length method and modified biplane Simpson's method did not differ. The assessment of the contractile function of the LV myocardium was also obtained by assessing the global longitudinal strain (GLS) and global longitudinal strain rate (GLSR). The comparative analysis of the LV myocardial deformation properties in the studied groups showed that less negative GLS and GLSR were found in the three-vessel CAD, followed by the two-vessel and one-vessel CAD groups, and CG. CG demonstrated more negative GLS and GLSR than all MG subgroups. We analyzed the effect of revascularization on the GLS and found no statistically significant differences before and 48 hours after revascularization in all studied MG subgroups and CG. Thirty days after revascularization, GLS significantly showed more negative values in all MG subgroups: -18.12±0.63 versus -17.9±0.4 in one-vessel CAD, -16.13±0.71 versus -15.9±0.4 in two-vessel CAD and -13.91±1.25 versus -13.1±1.1 in three-vessel CAD. In CG with medical treatment only, GLS did not change statistically significantly but had more negative values than in the studied MG subgroups. Analysis of changes in LVEF after revascularization in the MG of patients with one-, two- and three-vessel CAD and in the CG after medical treatment did not reveal statistically significant dynamics. Conclusion: the results indicate the absence of statistically significant changes in myocardial deformation indicators and morpho-functional parameters of the left ventricle in CCS patients 48 hours after revascularization. Thirty days after revascularization, GLS significantly improves, while LVEF remains unchanged. GLS is superior to LVEF in visualizing improvement in LV function after revascularization in patients with CCS

Familial hypercholesterolaemia in children and adolescents from 48 countries: a cross-sectional study

Background Approximately 450 000 children are born with familial hypercholesterolaemia worldwide every year, yet only 2·1% of adults with familial hypercholesterolaemia were diagnosed before age 18 years via current diagnostic approaches, which are derived from observations in adults. We aimed to characterise children and adolescents with heterozygous familial hypercholesterolaemia (HeFH) and understand current approaches to the identification and management of familial hypercholesterolaemia to inform future public health strategies. Methods For this cross-sectional study, we assessed children and adolescents younger than 18 years with a clinical or genetic diagnosis of HeFH at the time of entry into the Familial Hypercholesterolaemia Studies Collaboration (FHSC) registry between Oct 1, 2015, and Jan 31, 2021. Data in the registry were collected from 55 regional or national registries in 48 countries. Diagnoses relying on self-reported history of familial hypercholesterolaemia and suspected secondary hypercholesterolaemia were excluded from the registry; people with untreated LDL cholesterol (LDL-C) of at least 13·0 mmol/L were excluded from this study. Data were assessed overall and by WHO region, World Bank country income status, age, diagnostic criteria, and index-case status. The main outcome of this study was to assess current identification and management of children and adolescents with familial hypercholesterolaemia. Findings Of 63 093 individuals in the FHSC registry, 11 848 (18·8%) were children or adolescents younger than 18 years with HeFH and were included in this study; 5756 (50·2%) of 11 476 included individuals were female and 5720 (49·8%) were male. Sex data were missing for 372 (3·1%) of 11 848 individuals. Median age at registry entry was 9·6 years (IQR 5·8–13·2). 10 099 (89·9%) of 11 235 included individuals had a final genetically confirmed diagnosis of familial hypercholesterolaemia and 1136 (10·1%) had a clinical diagnosis. Genetically confirmed diagnosis data or clinical diagnosis data were missing for 613 (5·2%) of 11 848 individuals. Genetic diagnosis was more common in children and adolescents from high-income countries (9427 [92·4%] of 10 202) than in children and adolescents from non-high-income countries (199 [48·0%] of 415). 3414 (31·6%) of 10 804 children or adolescents were index cases. Familial-hypercholesterolaemia-related physical signs, cardiovascular risk factors, and cardiovascular disease were uncommon, but were more common in non-high-income countries. 7557 (72·4%) of 10 428 included children or adolescents were not taking lipid-lowering medication (LLM) and had a median LDL-C of 5·00 mmol/L (IQR 4·05–6·08). Compared with genetic diagnosis, the use of unadapted clinical criteria intended for use in adults and reliant on more extreme phenotypes could result in 50–75% of children and adolescents with familial hypercholesterolaemia not being identified. Interpretation Clinical characteristics observed in adults with familial hypercholesterolaemia are uncommon in children and adolescents with familial hypercholesterolaemia, hence detection in this age group relies on measurement of LDL-C and genetic confirmation. Where genetic testing is unavailable, increased availability and use of LDL-C measurements in the first few years of life could help reduce the current gap between prevalence and detection, enabling increased use of combination LLM to reach recommended LDL-C targets early in life. Funding Pfizer, Amgen, Merck Sharp & Dohme, Sanofi–Aventis, Daiichi Sankyo, and Regeneron

Familial hypercholesterolaemia in children and adolescents from 48 countries: a cross-sectional study

Background: Approximately 450 000 children are born with familial hypercholesterolaemia worldwide every year, yet only 2·1% of adults with familial hypercholesterolaemia were diagnosed before age 18 years via current diagnostic approaches, which are derived from observations in adults. We aimed to characterise children and adolescents with heterozygous familial hypercholesterolaemia (HeFH) and understand current approaches to the identification and management of familial hypercholesterolaemia to inform future public health strategies. Methods: For this cross-sectional study, we assessed children and adolescents younger than 18 years with a clinical or genetic diagnosis of HeFH at the time of entry into the Familial Hypercholesterolaemia Studies Collaboration (FHSC) registry between Oct 1, 2015, and Jan 31, 2021. Data in the registry were collected from 55 regional or national registries in 48 countries. Diagnoses relying on self-reported history of familial hypercholesterolaemia and suspected secondary hypercholesterolaemia were excluded from the registry; people with untreated LDL cholesterol (LDL-C) of at least 13·0 mmol/L were excluded from this study. Data were assessed overall and by WHO region, World Bank country income status, age, diagnostic criteria, and index-case status. The main outcome of this study was to assess current identification and management of children and adolescents with familial hypercholesterolaemia. Findings: Of 63 093 individuals in the FHSC registry, 11 848 (18·8%) were children or adolescents younger than 18 years with HeFH and were included in this study; 5756 (50·2%) of 11 476 included individuals were female and 5720 (49·8%) were male. Sex data were missing for 372 (3·1%) of 11 848 individuals. Median age at registry entry was 9·6 years (IQR 5·8-13·2). 10 099 (89·9%) of 11 235 included individuals had a final genetically confirmed diagnosis of familial hypercholesterolaemia and 1136 (10·1%) had a clinical diagnosis. Genetically confirmed diagnosis data or clinical diagnosis data were missing for 613 (5·2%) of 11 848 individuals. Genetic diagnosis was more common in children and adolescents from high-income countries (9427 [92·4%] of 10 202) than in children and adolescents from non-high-income countries (199 [48·0%] of 415). 3414 (31·6%) of 10 804 children or adolescents were index cases. Familial-hypercholesterolaemia-related physical signs, cardiovascular risk factors, and cardiovascular disease were uncommon, but were more common in non-high-income countries. 7557 (72·4%) of 10 428 included children or adolescents were not taking lipid-lowering medication (LLM) and had a median LDL-C of 5·00 mmol/L (IQR 4·05-6·08). Compared with genetic diagnosis, the use of unadapted clinical criteria intended for use in adults and reliant on more extreme phenotypes could result in 50-75% of children and adolescents with familial hypercholesterolaemia not being identified. Interpretation: Clinical characteristics observed in adults with familial hypercholesterolaemia are uncommon in children and adolescents with familial hypercholesterolaemia, hence detection in this age group relies on measurement of LDL-C and genetic confirmation. Where genetic testing is unavailable, increased availability and use of LDL-C measurements in the first few years of life could help reduce the current gap between prevalence and detection, enabling increased use of combination LLM to reach recommended LDL-C targets early in life

Creation of Polymer Composites with Increased Performance Properties Based on Secondary Waste Raw Materials

The article analyzes the classification of polymer waste. The structure of production, processing of polymers and use of finished products is revealed. Particular attention is paid to ways of processing composites. Each of them is also briefly described

Creation of Polymer Composites with Increased Performance Properties Based on Secondary Waste Raw Materials

The article analyzes the classification of polymer waste. The structure of production, processing of polymers and use of finished products is revealed. Particular attention is paid to ways of processing composites. Each of them is also briefly described

Clinical Status of Patients with Coronary Artery Disease Post COVID-19

The main goal of our study was to identify the activity of cardiac dysfunction based on the analysis of the main cardiological methods of research, such as ECG, echocardiography, 24-hour ECG monitoring in conjunction with laboratory parameters in patients with coronary artery disease (CAD) who underwent mild and moderate COVID-19, without signs of residual effects of lung tissue damage (fibrotization). 52 patients with coronary artery disease were examined, which were divided into 2 groups depending on the past infection in history: 1 group without COVID-19 in history (n=26) (based on history and results of SARS-CoV-2 antibody titer), 2 a group with a history of COVID-19 (n=26), confirmed by relevant documents (tests), but without oxygen therapy and steroids, in order to avoid the influence of a serious illness and drug exposure. Conclusions: dynamic monitoring of hemostasis parameters after the hospital stage in patients with CAD should be carried out in order to prevent adverse cardiovascular outcomes, even with a history of moderate and mild coronavirus infection. One of the aspects of therapeutic rehabilitation in the post-COVID period in patients with IHD is the use of vitamin D preparations

Dual antiplatelet therapy duration after coronary stenting in clinical practice: results of an EAPCI survey

Aims: Our aim was to report on a survey initiated by the EuropeanAssociation of Percutaneous Cardiovascular Interventions (EAPCI) concerning opinion on the evidence relating to dual antiplatelet therapy (DAPT) duration after coronary stenting.Methods and results: Results from three randomised clinical trials were scheduled to be presented at the American Heart Association Scientific Sessions 2014 (ARIA 2014). A web-based survey was distributed to all individuals registered in the EuroIntervention mailing list (n=15,200) both before and after ARIA 2014. A total of 1,134 physicians responded to the first (i.e., before AHA 2014) and 542 to the second (i.e., after ARIA 2014) survey. The majority of respondents interpreted trial results consistent with a substantial equipoise regarding the benefits and risks of an extended versus a standard DAPT strategy. Two respondents out of ten believed extended DAFT should be implemented in selected patients. After ARIA 2014, 46.1% of participants expressed uncertainty about the available evidence on DAFT duration, and 40.0% the need for clinical guidance.Conclusions: This EAPCI survey highlights considerable uncertainty within the medical community with regard to the optimal duration of DAFT after coronary stenting in the light of recent reported trial results. Updated recommendations for practising physicians to guide treatment decisions in routine clinical practice should be provided by international societies