Patients with Atrial Fibrillation and Chronic Kidney Disease More Often Undergo Angioplasty of Left Main Coronary Artery – a 867 Patient Study

Background/Aims: Several studies have implicated atrial fibrillation (AF) as a contributing factor in chronic kidney disease (CKD) and cardiovascular events. The prevalence of coronary artery disease (CAD) in patients with AF varies substantially from 17% to 46.5%. There are only few studies concerning renal function in population with AF undergoing coronary angiography. The aim of the present study was to assess which type of AF is dominant in CKD population scheduled for coronary angiography and if it can influence patients’ outcome, the association between renal impairment and the type of coronary procedures in AF patients and the influence of renal function on in-hospital mortality. Methods: We retrospectively studied 867 patients with AF hospitalized due to coronary angiography in two year time. The cut off value of CKD was eGFR ≤ 60 ml/min./1.73m2 evaluated by CKD-EPI formula. Results: A total of 867 patients with AF (44% women; mean age 72±10 years) were included in the analysis. The mean eGFR was 44±11ml/min./1.73m2 in patients with CKD and 89±18 ml/min./1.73m2 in patients with preserved renal function. Patients with CKD and AF were older (p< 0.001), had more often diabetes (p=0.009), heart failure (p< 0.001) and anaemia (p< 0.001). Patients with CKD and AF had more often permanent type of AF (p< 0.001). In CKD patients CHA2DS2VASc score was 4.3±1.5 and HAS-BLED score was 2.0±1.2 and it was significantly higher as compared to population with preserved renal function (p< 0.001, p=0.02, respectively). The use of oral anticoagulation was less frequent in CKD group (p< 0.001) although these patients had higher CHA2DS2VASc score. Patients with AF and CKD were more often admitted due to myocardial infarction (STEMI or NSTEMI) (p=0.02, p< 0.001, respectively) and more often underwent percutaneous coronary intervention (PCI) (p=0.01). Among coronary arteries the percutaneous coronary intervention (PCI) of left main artery was done more frequently in CKD patients (p=0.01). Among CKD population in-hospital mortality was significantly higher in patients with eGFR < 30 ml/min (p< 0.001). Conclusion: Patients with CKD had more often permanent type of AF. Percutaneous interventions of the left main coronary artery, the only elective procedures influencing patients’ prognosis, were done more frequently in CKD patients with AF. In-hospital mortality was significantly higher in patients with severe renal impairment. Despite the higher risk of ischaemic stroke in CKD group the use of oral anticoagulation therapy was significantly less frequent and the patients were deprived of the confirmed benefits of such treatment

The Changing Landscape for Stroke\ua0Prevention in AF: Findings From the GLORIA-AF Registry Phase 2

Background GLORIA-AF (Global Registry on Long-Term Oral Antithrombotic Treatment in Patients with Atrial Fibrillation) is a prospective, global registry program describing antithrombotic treatment patterns in patients with newly diagnosed nonvalvular atrial fibrillation at risk of stroke. Phase 2 began when dabigatran, the first non\u2013vitamin K antagonist oral anticoagulant (NOAC), became available. Objectives This study sought to describe phase 2 baseline data and compare these with the pre-NOAC era collected during phase 1. Methods During phase 2, 15,641 consenting patients were enrolled (November 2011 to December 2014); 15,092 were eligible. This pre-specified cross-sectional analysis describes eligible patients\u2019 baseline characteristics. Atrial fibrillation disease characteristics, medical outcomes, and concomitant diseases and medications were collected. Data were analyzed using descriptive statistics. Results Of the total patients, 45.5% were female; median age was 71 (interquartile range: 64, 78) years. Patients were from Europe (47.1%), North America (22.5%), Asia (20.3%), Latin America (6.0%), and the Middle East/Africa (4.0%). Most had high stroke risk (CHA2DS2-VASc [Congestive heart failure, Hypertension, Age  6575 years, Diabetes mellitus, previous Stroke, Vascular disease, Age 65 to 74 years, Sex category] score  652; 86.1%); 13.9% had moderate risk (CHA2DS2-VASc = 1). Overall, 79.9% received oral anticoagulants, of whom 47.6% received NOAC and 32.3% vitamin K antagonists (VKA); 12.1% received antiplatelet agents; 7.8% received no antithrombotic treatment. For comparison, the proportion of phase 1 patients (of N = 1,063 all eligible) prescribed VKA was 32.8%, acetylsalicylic acid 41.7%, and no therapy 20.2%. In Europe in phase 2, treatment with NOAC was more common than VKA (52.3% and 37.8%, respectively); 6.0% of patients received antiplatelet treatment; and 3.8% received no antithrombotic treatment. In North America, 52.1%, 26.2%, and 14.0% of patients received NOAC, VKA, and antiplatelet drugs, respectively; 7.5% received no antithrombotic treatment. NOAC use was less common in Asia (27.7%), where 27.5% of patients received VKA, 25.0% antiplatelet drugs, and 19.8% no antithrombotic treatment. Conclusions The baseline data from GLORIA-AF phase 2 demonstrate that in newly diagnosed nonvalvular atrial fibrillation patients, NOAC have been highly adopted into practice, becoming more frequently prescribed than VKA in Europe and North America. Worldwide, however, a large proportion of patients remain undertreated, particularly in Asia and North America. (Global Registry on Long-Term Oral Antithrombotic Treatment in Patients With Atrial Fibrillation [GLORIA-AF]; NCT01468701

Η ΔΙΑΓΝΩΣΤΙΚΗ ΑΞΙΑ ΤΗΣ ΔΙΑΔΕΡΜΙΚΗΣ ΒΙΟΨΙΑΣ ΗΠΑΤΟΣ ΜΕ ΒΕΛΟΝΑ ΣΕ ΜΙΑ ΓΕΝΙΚΗ ΠΑΘΟΛΟΓΙΚΗ ΚΛΙΝΙΚΗ

OUR RESULTS OF THIS STUDY ARE: 1) LIVER BIOPSY MAY BE UNDERTAKEN IN SMALL GENERAL HOSPITALS, BECAUSE: A) IT CAN BE PERFORMED BY DOCTORS IN INTERNAL MEDICINETRAINING AT THE PATIENTS BEDSIDE. B) THE PUNCTURE APPARATUS (MENGHINI NEEDLE)IS SIMPLE, INEXPENSIVE AND HAS A LOW FAILURE RATE IN OBTAINING A SATISFACTORYSPECIMEN. 2) WHEN THE PATIENTS ARE CAREFULLY SELECTED IT IS A RELATIVELY SAFEPROCEDURE. IN OUR COUNTRY THE POSSIBILITY OF HEPATIC HYDATIC CYSTS MUST BE EXCLUDED. 3) HISTOLOGICAL FEATURES CONSISTENT WITH NON-SPECIFIC REACTIVE HEPATITIS ARE SUGGESTIVE OF EXTRAHEPATIC NEOPLASM OR INFECTION. 4) IT IS INVALUABLE IN THE DIAGNOSIS OF CHRONIC ACTIVE HEPATITIS AND PRIMARY BILLIARY CIRRHOSIS. 5)IT IS HELPFUL IN THE PROGNOSIS AND TREATMENT BY DEFINING THE STAGE OF KNOWN DISEASES.ΤΑ ΣΥΜΠΕΡΑΣΜΑΤΑ ΑΠΟ ΑΥΤΗ ΤΗΝ ΕΜΠΕΙΡΙΑ ΜΑΣ ΕΙΝΑΙ: 1. Η ΒΙΟΨΙΑ ΤΟΥ ΗΠΑΤΟΣ ΜΕ ΒΕΛΟΝΑ ΜΠΟΡΕΙ ΝΑ ΧΡΗΣΙΜΟΠΟΙΗΘΕΙ ΣΕ ΓΕΝΙΚΗ ΠΑΘΟΛΟΓΙΚΗ ΚΛΙΝΙΚΗ, ΑΦΟΥ ΜΠΟΡΕΙ ΝΑ ΓΙΝΕΙ ΑΠΟ ΚΑΘΕ ΕΙΔΙΚΕΥΟΜΕΝΟ ΓΙΑΤΡΟ ΣΤΟ ΚΡΕΒΑΤΙ ΤΟΥ ΑΡΡΩΣΤΟΥ, ΧΩΡΙΣ ΙΔΙΑΙΤΕΡΕΣ ΕΥΚΟΛΙΕΣ ΜΕ ΜΙΚΡΟ ΠΟΣΟΣΤΟ ΑΠΟΤΥΧΙΑΣ ΚΑΙ ΜΕ ΑΣΗΜΑΝΤΟ ΚΟΣΤΟΣ. 2. ΔΕΝ ΕΧΕΙ ΣΠΟΥΔΑΙΕΣ ΕΠΙΠΛΟΚΕΣ ΟΤΑΝ ΓΙΝΕΤΑΙ ΠΡΟΣΕΚΤΙΚΑ Η ΕΠΙΛΟΓΗ ΤΩΝ ΑΡΡΩΣΤΩΝ ΚΑΙ ΑΦΟΥ ΑΠΟΚΛΕΙΣΘΕΙ ΜΕ ΣΧΟΛΑΣΤΙΚΟ ΕΛΕΓΧΟ Η ΠΕΡΙΠΤΩΣΗ ΕΧΙΝΟΚΟΚΚΙΑΣΗΣ, ΠΟΥ ΤΟΣΟ ΣΥΧΝΗ ΕΙΝΑΙ ΣΤΟΝ ΤΟΠΟ ΜΑΣ. 3. ΣΕ ΑΡΡΩΣΤΟΥΣ ΠΟΥ Η ΙΣΤΟΛΟΓΙΚΗ ΕΚΘΕΣΗ ΔΕΙΧΝΕΙ ΜΗ ΕΙΔΙΚΗ ΑΝΤΙΔΡΑΣΤΙΚΗ ΗΠΑΤΙΤΙΔΑ (Μ.Ε.Α.Η.) ΧΩΡΙΣ ΑΛΛΑ ΣΗΜΕΙΑ ΗΠΑΤΙΚΗΣ ΠΡΟΣΒΟΛΗΣ, ΠΡΕΠΕΙ ΝΑ ΣΚΕΠΤΟΜΑΣΤΕ ΕΞΩΗΠΑΤΙΚΗ ΚΑΚΟΗΘΕΙΑ Η ΛΟΙΜΩΞΗ. 4. ΕΙΝΑΙ ΠΟΛΥΤΙΜΗ ΚΑΙ ΑΝΑΝΤΙΚΑΤΑΣΤΑΤΗ ΔΙΑΓΝΩΣΤΙΚΗ ΜΕΘΟΔΟΣ ΓΙΑ ΜΕΡΙΚΕΣ ΠΑΘΗΣΕΙΣ ΤΟΥ ΗΠΑΤΟΣ. 5. ΕΙΝΑΙ ΧΡΗΣΙΜΗ ΓΙΑ ΤΗΝ ΠΡΟΓΝΩΣΗ ΚΑΙ ΤΗΝ ΘΕΡΑΠΕΙΑ ΑΦΟΥ ΜΠΟΡΕΙ ΝΑ ΚΑΘΟΡΙΣΕΙ ΤΟ ΣΤΑΔΙΟ ΤΩΝ ΠΑΘΗΣΕΩΝ

The contribution of left heart disease in COPD patients with pulmonary hypertension

Background: Pulmonary hypertension (PH), regardless of its etiology, is associated with an impaired outcome in patients with chronic obstructive pulmonary disease (COPD). The aim of our study was to determine the incidence, cause, and effect of PH as detected by echocardiography in COPD patients. Methods: Patients with confirmed COPD of any stage were evaluated by echocardiography for the likelihood of PH according to the proposed criteria. Patients with possible/likely to have PH underwent right heart catheterization, upon agreement, to confirm the presence, severity, and cause of PH. Results: Of 91 patients, 39 were in stable condition (group A) and 52 with COPD exacerbation (group B). Group B patients presented with PH and left ventricular diastolic dysfunction more often than group A patients. One of two fulfilled the criteria for possible/likely PH. The incidence of likely/possible PH was significantly higher in group B. Nineteen group B patients with likely/possible PH underwent RHC, and PH was confirmed in 15 cases and in 73.3% was associated with left heart disease. The presence of possible/likely PH was associated with a statistically significant increase in mortality compared to those with unlikely PH. Conclusions: The use of echocardiographic criteria for the presence of PH is adequate for the screening of COPD patients. Patients with acute exacerbation of COPD and possible/likely PH demonstrate worse mortality compared to patients unlikely to have PH. Keywords: pulmonary disease, echocardiography, diastolic heart failure, systolic heart failure, pulmonary hypertensio

Circulating progenitor cells and their interaction with platelets in patients with an acute coronary syndrome

CD34+ cells expressing KDR (CD34+/KDR+) represent a small proportion of circulating progenitor cells that have the capacity to interact with platelets and to differentiate into mature endothelial cells, thus contributing to vascular homeostasis and regeneration as well as to re-endothelialization. We investigated the levels of CD34+ and CD34+/KDR+ progenitor cells as well as their interaction with platelets in acute coronary syndrome (ACS) patients before the initiation (baseline) of their treatment with a P2Y12 receptor antagonist, and at 5-days post-treatment (follow-up). Sixty-seven consecutive ACS patients and thirty healthy subjects (controls) participated in the study. On admission, all patients received 325 mg aspirin, followed by 100 mg/day and then were loaded either with 600 mg clopidogrel or 180 mg ticagrelor, followed by 75 mg/day (n = 36) or 90 mg × 2/day (n = 31), respectively. The levels of circulating CD34+ and CD34+/KDR+ progenitor cells, as well as their interaction with platelets, were determined by flow cytometry, before and after activation with ADP, in vitro. The circulating levels of CD34+ and CD34+/KDR+ cells in both patient groups at baseline were lower compared with controls while they were significantly increased at 5-days of follow-up in both groups, this increase being more pronounced in the ticagrelor group. The platelet/CD34+ (CD61+/CD34+) conjugates were higher at baseline and reduced at follow-up while the platelet/KDR+ (CD61+/KDR+) conjugates were lower at baseline and increased at follow-up, both changes being more pronounced in the ticagrelor group. ADP activation of control samples significantly increased the KDR expression by CD34+ cells and the CD61+/KDR+ conjugates, these parameters being unaffected in patients at baseline but increased at follow-up. Short-term dual antiplatelet therapy in ACS patients restores the low platelet/KDR+ conjugates and CD34+ cell levels and improves the low membrane expression levels of KDR in these cells, an effect being more pronounced in ticagrelor-treated patients. This may represent a pleiotropic effect of antiplatelet therapy towards vascular endothelial regeneration