Utječu li hormon rasta i inzulinu sličan čimbenik rasta 1 na prognozu u bolesnika s akutnim infarktom miokarda klase killip I-II?

We investigated concentrations and roles of insulin-like growth factor 1 (IGF-1) and its binding protein (IGF1BP-3), growth hormone (GH), insulin, and markers of insulin resistance and inflammation in acute myocardial infarction (AMI). We aimed to assess any possible association between serum GH/IGF-1 axis following AMI and short-term survival rates. A follow up study was performed in 2010. Study group consisted of 75 patients with Killip I and II class AMI. There were 30 control subjects. Blood samples were obtained within 24 hours of admission and analyzed for the aforementioned hormones. Patients were followed-up during 6 months for new cardiac events. Median GH was higher in AMI (0.96; range 0.6-2.4) than in controls (0.26; p<0.001). IGF-1 was significantly lower in AMI (123 vs. 132; p<0.05), and so was the IGF-1/GH ratio (p<0.001) and IGF1BP-3. Insulin was higher in study group, but without statistical significance. However, we found significant between-group differences in other markers of insulin resistance (HbA1c, glycemia, HOMA-IR) and inflammation. Simple linear correlation showed positive correlation between GH and C-reactive protein. All patients with new cardiac events had IGF-1 below median and lower left ventricular ejection fraction. In conclusion, IGF-1 may affect outcome of AMI. GH resistance might be a result of inflammatory/immune response and therefore it could be a useful prognostic marker.Istraživali smo uloge inzulinu sličnog čimbenika rasta (IGF-1), njegovog vezujućeg proteina (IGF1BP-3), hormona rasta (growth hormone, GH), inzulina, biljega inzulinske rezistencije i upale u akutnom infarktu miokarda (AIM). Cilj je bio utvrditi utjecaj osovine IGF-1/GH na kratkoročnu prognozu AIM. U istraživanje provedeno tijekom 2010. godine bilo je uključeno 75 bolesnika s dijagnozom AIM (ispitna skupina) i 30 ispitanika kao kontrolna skupina. Uzorci krvi su uzimani unutar 24 h od prijma i potom analizirani na navedene hormone. Tijekom šestomjesečnog razdoblja pratili smo hoće li doći do pojave novih srčanih događaja; ultrazvučno se određivala ejekcijska frakcija (EF). Medijan GH bio je veći u skupini s AIM nego u kontrolnoj skupini (0,96 prema 0,26; p<0,001); medijan IGF-1 bio je znatno manji u ispitnoj skupini (123 prema 132; p<0,05), baš kao i omjer IGF-1/GH (p<0,001) i IGF-1BP-3. Inzulin je bio viši u ispitnoj skupini, ali razlika nije bila statistički značajna. Utvrđena je statistički značajna razlika u drugim glikemijskim parametrima (glukoza, HbA1c, HOMA IR) i nespecifičnim biljezima upale. Utvrdili smo pozitivnu linearnu korelaciju između GH i C-reaktivnog proteina. Svi bolesnici s novim koronarnim događajima imali su IGF-1 ispod medijana, te nižu EF. U zaključku, IGF-1 bi mogao utjecati na prognozu bolesnika s AIM. Rezistencija na GH je rezultat upalnog/imunog odgovora i mogla bi biti koristan prognostički biljeg

European Society of Cardiology: Cardiovascular Disease Statistics 2019

Aims The 2019 report from the European Society of Cardiology (ESC) Atlas provides a contemporary analysis of cardiovascular disease (CVD) statistics across 56 member countries, with particular emphasis on international inequalities in disease burden and healthcare delivery together with estimates of progress towards meeting 2025 World Health Organization (WHO) non-communicable disease targets. Methods and results In this report, contemporary CVD statistics are presented for member countries of the ESC. The statistics are drawn from the ESC Atlas which is a repository of CVD data from a variety of sources including the WHO, the Institute for Health Metrics and Evaluation, and the World Bank. The Atlas also includes novel ESC sponsored data on human and capital infrastructure and cardiovascular healthcare delivery obtained by annual survey of the national societies of ESC member countries. Across ESC member countries, the prevalence of obesity (body mass index ≥30 kg/m2) and diabetes has increased two- to three-fold during the last 30 years making the WHO 2025 target to halt rises in these risk factors unlikely to be achieved. More encouraging have been variable declines in hypertension, smoking, and alcohol consumption but on current trends only the reduction in smoking from 28% to 21% during the last 20 years appears sufficient for the WHO target to be achieved. The median age-standardized prevalence of major risk factors was higher in middle-income compared with high-income ESC member countries for hypertension {23.8% [interquartile range (IQR) 22.5–23.1%] vs. 15.7% (IQR 14.5–21.1%)}, diabetes [7.7% (IQR 7.1–10.1%) vs. 5.6% (IQR 4.8–7.0%)], and among males smoking [43.8% (IQR 37.4–48.0%) vs. 26.0% (IQR 20.9–31.7%)] although among females smoking was less common in middle-income countries [8.7% (IQR 3.0–10.8) vs. 16.7% (IQR 13.9–19.7%)]. There were associated inequalities in disease burden with disability-adjusted life years per 100 000 people due to CVD over three times as high in middle-income [7160 (IQR 5655–8115)] compared with high-income [2235 (IQR 1896–3602)] countries. Cardiovascular disease mortality was also higher in middle-income countries where it accounted for a greater proportion of potential years of life lost compared with high-income countries in both females (43% vs. 28%) and males (39% vs. 28%). Despite the inequalities in disease burden across ESC member countries, survey data from the National Cardiac Societies of the ESC showed that middle-income member countries remain severely under-resourced compared with high-income countries in terms of cardiological person-power and technological infrastructure. Under-resourcing in middle-income countries is associated with a severe procedural deficit compared with high-income countries in terms of coronary intervention, device implantation and cardiac surgical procedures. Conclusion A seemingly inexorable rise in the prevalence of obesity and diabetes currently provides the greatest challenge to achieving further reductions in CVD burden across ESC member countries. Additional challenges are provided by inequalities in disease burden that now require intensification of policy initiatives in order to reduce population risk and prioritize cardiovascular healthcare delivery, particularly in the middle-income countries of the ESC where need is greatest

Do growth hormone and insulin-like growth factor 1 affect prognosis in patients with killip I and II class acute myocardial infarction?

We investigated concentrations and roles of insulin-like growth factor 1 (IGF-1) and its binding protein (IGF1BP-3), growth hormone (GH), insulin, and markers of insulin resistance and inflammation in acute myocardial infarction (AMI). We aimed to assess any possible association between serum GH/IGF-1 axis following AMI and short-term survival rates. A follow up study was performed in 2010. Study group consisted of 75 patients with Killip I and II class AMI. There were 30 control subjects. Blood samples were obtained within 24 hours of admission and analyzed for the aforementioned hormones. Patients were followed-up during 6 months for new cardiac events. Median GH was higher in AMI (0.96; range 0.6-2.4) than in controls (0.26; p<0.001). IGF-1 was significantly lower in AMI (123 vs. 132; p<0.05), and so was the IGF-1/GH ratio (p<0.001) and IGF1BP-3. Insulin was higher in study group, but without statistical significance. However, we found significant between-group differences in other markers of insulin resistance (HbA1c, glycemia, HOMA-IR) and inflammation. Simple linear correlation showed positive correlation between GH and C-reactive protein. All patients with new cardiac events had IGF-1 below median and lower left ventricular ejection fraction. In conclusion, IGF-1 may affect outcome of AMI. GH resistance might be a result of inflammatory/immune response and therefore it could be a useful prognostic marker

Correlation Between Interleukin 6 and Interleukin 10 in Acute Myocardial Infarction

The aim of this study was to analyze (i) ratios between pro-inflammatory cytokines interleukin 6 (IL-6), interleukin 1 (IL-1), tumour necrosis factor α (TNF-α) and anti-inflammatory cytokine interleukin 10 (IL-10) in patients with acute myocardial infarction (AMI) and stable angina pectoris (ii) as well as correlation between IL-6 and IL-10 in AMI and (iii) correlation between IL-6 and lipoproteins in AMI. The total of 71 patients were enrolled in this study, 41 of them with AMI (study group) and 30 with stable angina pectoris (control group). The concentrations of cytokines and lipoproteins were measured from blood samples. Pro-inflammatory to anti-inflammatory cytokine ratios were calculated by dividing concentrations of pro-inflammatory cytokines with IL-10. In statistical analyses we used descriptive statistics, normality tests and analysis of correlation. IL-6: IL-10 ratio is significantly higher in AMI than in stable angina (P < 0,001), TNF-α: IL-10 is also higher in study group but the difference is not significant. We found positive linear correlation between IL-6 and IL-10 (r =0,43; p = 0,015) and negative linear correlation between IL-6 and high density lipoprotein HDL (r = -0,47; p= 0,008) in AMI. IL-6: IL-10 ratio is higher in AMI than in stable angina. There is linear correlation between IL-6 and IL-10 and IL-6 and HDL in AMI

Left ventricular diastolic function in acute myocardial infarction

Poremećaj dijastoličke funkcije lijeve klijetke (LK) je jedan od prvih poremećaja funkcije LK, koji se registriraju prije poremećaja regionalnog kontraktiliteta, EKG promjena i bola u prsnom košu, što bitno mijenja prognozu pacijenata sa akutnim koronarnim sindromom. Poremećaj relaksacije LK često se registrira u pacijenata s akutnim infarktom miokarda (AIM), a poremećaj krutosti LK u pacijenata s AIM prednje stijenke. Najizraženija dijastolička abnormalnost uzrokovana ishemijom miokarda je produžena i usporena relaksacija miokarda. Ehokardiografske tehnike omogućavaju evaluaciju dijastoličkog punjenja obje pretklijetke i klijetke. Cilj ovog rada je bio utvrditi dijastoličku funkciju LK u bolesnika s AIM i usporediti varijable dijastoličke funkcije u skupinama bolesnika s AIM anteroseptalne i inferiorne stijenke. U prospektivno istraživanje uključeno je 60 bolesnika (37 muškaraca, prosječne životne dobi 59±10 godina) s prvim AIM koji su podijeljeni u dvije skupine prema lokalizaciji EKG promjena (anteroseptalna naspram inferiorne stijenke). Praćene su varijable dijastoličke funkcije LK koje su analizirane kontinuiranom (mitralni protok) i pulsnom kolor Doppler ehokardiografskom tehnikom (protok u plućnim venama i pokreti mitralnog prstena). Vrijednosti brzina ranog dijastoličkog punjenja nije se statistički značajno razlikovala u obje skupine, ali je bila niža u odnosu na prosječnu vrijednost brzine ranog dijastoličkog punjenja LK kod zdravih osoba. U maksimalnoj brzini sistoličkog protoka plućnih vena registrirana je statistički značajna razlika (p<0,05) između ispitivanih skupina. U prvoj skupini iznosila je 0,48±0,10, a u drugoj skupini iznosila je 0,57±0,14. Maksimalna brzina dijastoličkog protoka plućnih vena u prvoj skupini iznosila je 0,37±0,09, a u drugoj skupini iznosila je 0,43±0,16. Odnos maksimalne brzine sistoličkog i dijastoličkog protoka plućnih vena je nešto veći nego kod zdravih osoba. U bolesnika s AIM dominira (70%) dijastolička disfunkcija tipa poremećaja relaksacije LK. U ispitivanoj skupini bolesnika s anteroseptalnim AIM dijastolička disfunkcija tipa poremećaja relaksacije je dominantna, odnosno registrirana je statistički značajna razlika u odnosu na očuvanu dijastoličku funkciju i na dijastoličku disfunkciju tipa poremećaja restrikcije LK (p<0,05). Zaključno, kod AIM, kako anteroseptalne tako i inferiorne stijenke, promijenjeni su parametri dijastoličke funkcije, odnosno prisutna su sva tri stupnja dijastoličke disfunkcije LK. Dominira dijastolička disfunkcija tipa poremećaja relaksacije miokarda. U AIM anteroseptalne stijenke najviše je prisutna dijastolička disfunkcija tipa poremećaja relaksacije, odnosno postoji dobra korelacija s infarciranom zonom u odnosu na inferiornu stijenku.Left ventricular (LV) diastolic function disorder is one of the first LV function disorders, which is detected before the regional disorder of contractility, ECG changes and chest pains, which significantly changes the prognosis of patients with acute coronary syndrome. The disorder of LV relaxation is often detected in patients with acute myocardial infarction (AMI), a disorder of LV stiffness in patients with anterior wall AMI. The most pronounced diastolic abnormality caused by myocardial ischemia is prolonged and delayed myocardial relaxation. Echocardiographic techniques allow the evaluation of diastolic filling of the both atria and ventricles. The aim of this study was to determine the LV diastolic function in patients with AMI and compare the diastolic function variables in the groups of patients with anteroseptal and inferior wall AMI. The prospective trial included 60 patients (37 men; mean age 59 ± 10) with first AMI who were divided into two groups according to the localization of ECG changes (anteroseptal vs. inferior wall). LV diastolic function variables were monitored that were analyzed by continuous (mitral flow) and pulsed color Doppler echocardiography technique (flow in the pulmonary veins and mitral ring motions). The value ​​of velocity of early diastolic filling was not statistically significantly different in the both groups, but it was lower compared to the average value of the velocity of the early diastolic filling of LV in healthy persons. In the maximum velocity of systolic pulmonary venous flow, a statistically significant difference was recorded (p <0.05) among the groups of patiets. In the first group it was 0.48±0.10, while in the second group it was 0.57 ± 0.14. Maximum velocity of diastolic pulmonary venous flow in the first group was 0.37±0.09, while in the second group it was 0.43±0.16. The ratio of maximum velocity of systolic and diastolic pulmonary venous flow was slightly higher than in healthy individuals. In patients with AMI, diastolic dysfunction of the LV relaxation disorder type prevails (70%). In the examined group of patients with anteroseptal AMI, diastolic dysfunction of the relaxation disorder type prevails, that is, a statistically significant difference compared to the preserved diastolic function and diastolic dysfunction of the LV restriction disorder type (p <0.05) is recorded. Finally, in case of anteroseptal and inferior wall AMI, the parameters of diastolic function are changed, that is, all three degrees of LV diastolic dysfunction are present. Diastolic dysfunction of myocardial relaxation disorder type prevails. In anteroseptal wall AMI, diastolic dysfunction of relaxation disorder type is present, that is, there is a good correlation with infarcated zone in relation to the inferior wall

Left ventricular diastolic function in acute myocardial infarction

Poremećaj dijastoličke funkcije lijeve klijetke (LK) je jedan od prvih poremećaja funkcije LK, koji se registriraju prije poremećaja regionalnog kontraktiliteta, EKG promjena i bola u prsnom košu, što bitno mijenja prognozu pacijenata sa akutnim koronarnim sindromom. Poremećaj relaksacije LK često se registrira u pacijenata s akutnim infarktom miokarda (AIM), a poremećaj krutosti LK u pacijenata s AIM prednje stijenke. Najizraženija dijastolička abnormalnost uzrokovana ishemijom miokarda je produžena i usporena relaksacija miokarda. Ehokardiografske tehnike omogućavaju evaluaciju dijastoličkog punjenja obje pretklijetke i klijetke. Cilj ovog rada je bio utvrditi dijastoličku funkciju LK u bolesnika s AIM i usporediti varijable dijastoličke funkcije u skupinama bolesnika s AIM anteroseptalne i inferiorne stijenke. U prospektivno istraživanje uključeno je 60 bolesnika (37 muškaraca, prosječne životne dobi 59±10 godina) s prvim AIM koji su podijeljeni u dvije skupine prema lokalizaciji EKG promjena (anteroseptalna naspram inferiorne stijenke). Praćene su varijable dijastoličke funkcije LK koje su analizirane kontinuiranom (mitralni protok) i pulsnom kolor Doppler ehokardiografskom tehnikom (protok u plućnim venama i pokreti mitralnog prstena). Vrijednosti brzina ranog dijastoličkog punjenja nije se statistički značajno razlikovala u obje skupine, ali je bila niža u odnosu na prosječnu vrijednost brzine ranog dijastoličkog punjenja LK kod zdravih osoba. U maksimalnoj brzini sistoličkog protoka plućnih vena registrirana je statistički značajna razlika (p<0,05) između ispitivanih skupina. U prvoj skupini iznosila je 0,48±0,10, a u drugoj skupini iznosila je 0,57±0,14. Maksimalna brzina dijastoličkog protoka plućnih vena u prvoj skupini iznosila je 0,37±0,09, a u drugoj skupini iznosila je 0,43±0,16. Odnos maksimalne brzine sistoličkog i dijastoličkog protoka plućnih vena je nešto veći nego kod zdravih osoba. U bolesnika s AIM dominira (70%) dijastolička disfunkcija tipa poremećaja relaksacije LK. U ispitivanoj skupini bolesnika s anteroseptalnim AIM dijastolička disfunkcija tipa poremećaja relaksacije je dominantna, odnosno registrirana je statistički značajna razlika u odnosu na očuvanu dijastoličku funkciju i na dijastoličku disfunkciju tipa poremećaja restrikcije LK (p<0,05). Zaključno, kod AIM, kako anteroseptalne tako i inferiorne stijenke, promijenjeni su parametri dijastoličke funkcije, odnosno prisutna su sva tri stupnja dijastoličke disfunkcije LK. Dominira dijastolička disfunkcija tipa poremećaja relaksacije miokarda. U AIM anteroseptalne stijenke najviše je prisutna dijastolička disfunkcija tipa poremećaja relaksacije, odnosno postoji dobra korelacija s infarciranom zonom u odnosu na inferiornu stijenku.Left ventricular (LV) diastolic function disorder is one of the first LV function disorders, which is detected before the regional disorder of contractility, ECG changes and chest pains, which significantly changes the prognosis of patients with acute coronary syndrome. The disorder of LV relaxation is often detected in patients with acute myocardial infarction (AMI), a disorder of LV stiffness in patients with anterior wall AMI. The most pronounced diastolic abnormality caused by myocardial ischemia is prolonged and delayed myocardial relaxation. Echocardiographic techniques allow the evaluation of diastolic filling of the both atria and ventricles. The aim of this study was to determine the LV diastolic function in patients with AMI and compare the diastolic function variables in the groups of patients with anteroseptal and inferior wall AMI. The prospective trial included 60 patients (37 men; mean age 59 ± 10) with first AMI who were divided into two groups according to the localization of ECG changes (anteroseptal vs. inferior wall). LV diastolic function variables were monitored that were analyzed by continuous (mitral flow) and pulsed color Doppler echocardiography technique (flow in the pulmonary veins and mitral ring motions). The value ​​of velocity of early diastolic filling was not statistically significantly different in the both groups, but it was lower compared to the average value of the velocity of the early diastolic filling of LV in healthy persons. In the maximum velocity of systolic pulmonary venous flow, a statistically significant difference was recorded (p <0.05) among the groups of patiets. In the first group it was 0.48±0.10, while in the second group it was 0.57 ± 0.14. Maximum velocity of diastolic pulmonary venous flow in the first group was 0.37±0.09, while in the second group it was 0.43±0.16. The ratio of maximum velocity of systolic and diastolic pulmonary venous flow was slightly higher than in healthy individuals. In patients with AMI, diastolic dysfunction of the LV relaxation disorder type prevails (70%). In the examined group of patients with anteroseptal AMI, diastolic dysfunction of the relaxation disorder type prevails, that is, a statistically significant difference compared to the preserved diastolic function and diastolic dysfunction of the LV restriction disorder type (p <0.05) is recorded. Finally, in case of anteroseptal and inferior wall AMI, the parameters of diastolic function are changed, that is, all three degrees of LV diastolic dysfunction are present. Diastolic dysfunction of myocardial relaxation disorder type prevails. In anteroseptal wall AMI, diastolic dysfunction of relaxation disorder type is present, that is, there is a good correlation with infarcated zone in relation to the inferior wall

The 'peptide for life' initiative in the emergency department study

Aims: Natriuretic peptide (NP) uptake varies in Emergency Departments (EDs) across Europe. The 'Peptide for Life' (P4L) initiative, led by Heart Failure Association, aims to enhance NP utilization for early diagnosis of heart failure (HF). We tested the hypothesis that implementing an educational campaign in Western Balkan countries would significantly increase NP adoption rates in the ED. Methods and results: This registry examined NP adoption before and after implementing the P4L-ED study across 10 centres in five countries: Bosnia and Herzegovina, Croatia, Montenegro, North Macedonia, and Serbia. A train-the-trainer programme was implemented to enhance awareness of NP testing in the ED, and centres without access received point-of-care instruments. Differences in NP testing between the pre-P4L-ED and post-P4L-ED phases were evaluated. A total of 2519 patients were enrolled in the study: 1224 (48.6%) in the pre-P4L-ED phase and 1295 (51.4%) in the post-P4L-ED phase. NP testing was performed in the ED on 684 patients (55.9%) during the pre-P4L-ED phase and on 1039 patients (80.3%) during the post-P4L-ED phase, indicating a significant absolute difference of 24.4% (95% CI: 20.8% to 27.9%, P < 0.001). The use of both NPs and echocardiography significantly increased from 37.7% in the pre-P4L-ED phase to 61.3% in the post-P4L-ED phase. There was an increased prescription of diuretics and SGLT2 inhibitors during the post-P4L-ED phase. Conclusions: By increasing awareness and providing resources, the utilization of NPs increased in the ED, leading to improved diagnostic accuracy and enhanced patient care