Particularities of traditional and novel atherosclerotic risk factors in women with peripheral arterial disease in a Romanian Rehabilitation Hospital

Introduction. The increasing prevalence of peripheral arterial disease (PAD) among women is becoming a general healthcare issue, as this populational group is still underrepresented in clinical trials and registries addressing this disease. The aim of this research is to determine women peculiarities in both classical and novel atherosclerosis risk factors in patients admitted in a Romanian Rehabilitation Hospital. Material and methods. 83 consecutive female patients with a mean age of 68.48±10.39 years, symptomatic PAD and a pathological ankle-brachial index were included in the analysis. Data regarding the traditional and novel cardiovascular risk factors, both clinical, biological and paraclinical parameters were all registered. A subgroup of 40 subjects had novel inflammatory markers (hs-CRP, IL-6 and TNF-α) measured, which were compared in a case-control manner to those of 17 agematched healthy controls. Results. Traditional risk factors most prevalent in our overall cohort were hypertension (85%), smoking (44.57%) and diabetes mellitus (45.7%). Mean ankle-brachial index was 0.47±0.17. Novel inflammatory markers were significantly higher in women with symptomatic PAD compared to healthy controls: hs-CRP (p<0.0001), IL-6 (p=0.0053 and TNF-α (p=0.005). Multivariate statistical analysis found ankle-brachial index (ABI)- (p<0.0001), diastolic blood pressure (p=0.0272), obesity (p=0.0445), LDL-cholesterol (p=0.0018), HDL-cholesterol (p=0.0092) and serum creatinine (p<0.0001) to be independent predictors for a more advanced PAD. 59% of the patients exhibited critical limb ischemia on admission, while 60.24% had at least one major arterial occlusion on angiography. Percutaneous revascularization was the most employed treatment method, with 42% of subjects receiving PTA compared to 21.7% in the surgical arm. Conclusion. Women with PAD have specific clinical and biological characteristics that ultimately affect treatment modality, prescription of a rehabilitation program and outcome

Inflammation and fibrosis in patients with atrial fibrillation and heart failure: is there a need for rehabilitation?

Background: Atrial fibrillation (AF) is increasingly prevalent among the general population as well as in those exhibiting heart failure (HF), and the symptomatology progressively worsens when both conditions are met. The aim of this study was to analyse the role of inflammation and fibrosis biomarkers in patients with AF and HF. Methods: 108 subjects with heart failure were enrolled in the study. All patients were evaluated clinically, biologically and echocardiographically. Plasma values of NT-proBNP, Gal-3 and sST2 were determined. Results: Out of all patients, 64.8% experienced at least one AF event. There were no differences in the mean left ventricular ejection fraction between the groups, which was 39.4 ± 11.2%. In terms of left atrium dimensions, the values in the AF group were significantly higher ( 51.19 ± 7.3 vs. 44.68 ± 7.16 mm, p<0.001). AF history was associated with a trend of decreased eGFR - 59,22±24,1 ml/min/1.73m3 vs 75,95±29,1 ml/min/1.73m3 (p=0.006). There was no statistically significant difference in the level of HF biomarkers (sST2, Galectin-3 and NT-pro BNP) between individuals with or without AF. Conclusion: Patients with HF are at greater risk to develop AF. HF biomarkers (sST2, Galectin-3 and NT-pro BNP) are not influenced by the presence of AF

The role of cardiopulmonary exercise testing in the initial evaluation of patients wearing intracardiac devices submitted to cardiac rehabilitation

Cardiopulmonary exercise testing(CPET) can be used to determine the maximum exercise capacity, to identify the factors that cause a limitation of the patient’s functional capacity, to evaluate symptoms triggered by physical exercise and to reveal specific complications related to intracardiac devices that might occur during the physical rehabilitation program. The rehabilitation of a patient that is wearing an intracardiac device raises some particular issues besides the ones that we meet in a conventionally treated cardiovascular patient. Several clinical studies have shown that the programming mode of the cardiac pacemakers can have a significant influence on the patients exercise capacity, a crucial element of any physical rehabilitation program. CPET is one of the most accurate and comprehensive methods for the evaluation of the pacemaker-wearing patients, being able to optimize their functional capacity and, therefore, should be recommended in all patients before inclusion in cardiac exercise rehabilitation programs

Secondary prevention- an essential component of the comprehensive rehabilitation of patients with heart failure

Heart failure is currently a real public health problem due to the extremely high morbidity and mortality of this disease. In this context, cardiovascular prevention measures should be implemented as early as possible. In addition to classic prevention measures, a number of extremely important specific recommendations should be considered: informing patients about their underlying disease, identifying the cardiovascular and non-cardiovascular factors that have led to cardiac decompensation, reducing daily salt consumption, monitoring body weight, forbidding smoking and recreational substances, conducting a regular exercise program under supervision, and increasing adherence to treatment

The effect of cardiac pacemaker implantation on cardiac performance – the experience of a Cardiology – Rehabilitation Department

Background. Although cardiac pacemakers can prevent the occurrence of heart failure secondary to low cardiac output in patients suffering from extreme bradycardia, they can also induce, in some circumstances, heart failure by decreasing the left ventricular stroke volume. In our study, we aim to describe the effect of permanent cardiac pacing on the evolution of patients with heart failure, objectively determined by the N-terminal pro b-type natriuretic peptide (NT-proBNP) dynamics. Material and methods. Complete clinical examination and determination of NT-proBNP were performed before and 5 days after pacemaker implantation. Results. We enrolled in our study 32 patients with an indication for permanent cardiac pacing in which we implanted 21 single-chamber ventricular pacemakers (VVI, 65.6%), 4 single-chamber atrial pacemakers (AAI, 12.5%) and 7 dual-chamber atrio-ventricular pacemakers (DDD, 21.9%). Patients with heart failure had an average NT-proBNP value of 2542.2±2311.12 pg/mL and patients without heart failure (control group), had an average NT-proBNP value of 190.58±98.16pg/mL. Patients in sinus rhythm that received a VVI pacemaker experienced an increase in NT-proBNP values of 103.73%, while patients in atrial fibrillation and VVI of only 0.27%. NT-proBNP values decreased in patients in sinus rhythm that received a DDD or AAI pacemaker by 20.94%. Conclusion. Permanent cardiac pacemakers are able to influence the clinical status of patients with heart failure, especially if they cause the loss of atrio-ventricular synchronis

The Role of IL-6 and ET-1 in the Diagnosis of Coronary MicroVascular Disease in Women

Background: Microvascular angina is a common clinical entity, with about a three-fold higher frequency in women. The pathogenesis of microvascular angina has not been much studied, but inflammation and endothelial dysfunction have been incriminated as the main mechanisms of this disease. Methoss: Our purpose was to analyze whether certain inflammatory markers, i.e., interleukin 6 (IL-6) and endothelin 1 (ET-1), can play a role in the diagnosis of microvascular angina in women. Results: Ninety women with ischemic heart disease were divided into two groups, based on their affliction with either microvascular or macrovascular disease. In general, the levels of IL6 and ET1 were similar between the two groups. Analyzing these marker levels according to the number of coronary lesions, we obtained an increased IL6 value that was similar for patients with microvascular angina, one-vessel, and two-vessel coronary disease, but significantly lower than in women with three-vessel coronary lesions. Also, in microvascular angina, IL6 level was correlated with the NYHA IV functional class. Unexpectedly, the level of ET1 was correlated with left ventricular systolic dysfunction. Conclusions: In women with an increased suspicion of microvascular angina, in whom microvascular dysfunction cannot be tested invasively, IL-6 level, unlike the ET-1 level, might be considered a diagnostic marker of this disease

THE PREVALENCE AND FEATURES OF ULTRASOUND PULMONARY ARTERIAL HYPERTENSION IN PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS

Background. Connective tissue diseases (CTDs) are an important cause of pulmonary arterial hypertension (PAH), which leads to worsening of prognosis especially in patients with systemic lupus erythematosus (SLE) and systemic sclerosis. However, studies on the prevalence of PAH in SLE scarce; our aim is to assess the prevalence and characteristics of PAH in a series of SLE inpatients of a tertiary Romanian SLE Center. Methods. The study included 54 consecutive SLE patients with a regular follow-up at the Department of Rheumatology Cluj-Napoca. The patients underwent physical examination and transthoracic echocardiography to evaluate systolic pulmonary arterial pressure (sPAP), left ventricular performance, and the presence of valvular heart disease. Patient characteristic, cumulative organ damage and laboratory were retrieved by medical chart review. Results. Within the cohort (mean age 43.7 ± 12.4 years, 90.8% women, median duration of disease 7 years), 11 (20.3%) patients were diagnosed with PAH, the majority of which (63.6%) were categorized as mild. The mean sPAP value was 45.54 mmHg and was associated with a history thromboembolic events (p=0.0067), antiphospholipid antibodies (aPL) (p=0.039), and cumulative organ damage (p=0.001). No significant associations with disease duration, Raynaud’s phenomenon, pericardial effusion or SLE-associated autoantibodies were found. Left ventricular diastolic dysfunction (LVDD) occurred more frequent in patients with PAH (p=0.008). Conclusion. Patients with SLE have an increased prevalence of PAH, which is generally asymptomatic and of low severity. PAH is associated with cumulative organ damage, LVDD, and antiphospholipid syndrome (likely reflecting secondary PAH to pulmonary embolism), but not with the disease duration and the Raynaud’s phenomenon or SLE specific autoantibodies