POST-COVID syndrome and heart failure events

Universitatea de Stat de Medicină şi Farmacie „Nicolae Testemiţanu”, Chişinău, Republica MoldovaIntroducere. Pandemia COVID-19 are un impact asupra managementului IC (insuficienței cardiace), ceea ce poate duce la o creștere a mortalității IC, iar antecedentele IC reprezintă un factor de risc pentru o evoluție clinică mai severă a COVID-19. Scopul studiului nostru este de a analiza interconexiunea complexă dintre POST-COVID-19 și evenimentele asociate IC. Material si metode. Cercetarea a inclus 178 de pacienți cu POST-COVID-19, internați în secția de cardiologie cu vârsta de 18-91 ani, vârsta medie fiind de 67,23±13,20 ani, 47% (42 pts.) bărbați și 53% (47 pts.) femei. S-a efectuat examenul fizic, ECG și ecocardiografie, parametrii de laborator: hemoleucograma, peptide natriuretice, aspartat aminotransferaza (AST), alaninaminotransferaza (ALT), albumina, creatinina, sodiul și potasiul seric, D-dimeri și INR. Rezultate. Dintre pacienții din cohorta FRCV (factori de risc cardiovasculari), 26 (15%) au prezentat evenimente IC la internare sau în timpul spitalizării, 80 (46%) din subgrupul IC și 14 (8%) în subgrup non-IC, acesta din urmă reprezentând 40% din toate evenimentele IC. În cohorta FRCV, pacienții cu evenimente IC au avut un risc de două ori mai mare de mortalitate în spital în comparație cu cei fără evenimente IC, P <0,001, OR 3,10 [2,24–4,29]), după ajustarea pentru vârstă, sex, FR și comorbidități. Interacțiunea pentru evenimentele IC și vârstă a fost semnificativă (P = 0,023). Vârsta, bolile CV, factorii de risc CV, antecedentele de IC, fibrilația atrială și BCR au fost asociate semnificativ cu evenimentele IC. Concluzie. Studiul demonstrează o mortalitate mai mare pentru pacienții spitalizați cu POST-COVID-19 și IC comparativ cu cei fără IC, și după ajustarea pentru alte condiții și comorbidități.Background. Although COVID 19 was initially considered a respiratory disease, it has rapidly become clear that a multiorgan involvement was common In particular, the heart often represents a target organ and patients may develop heart failure. Thus, the aim of our study is to analyze the complex interconnection between the POST-COVID 19 and heart failure events. Material and methods. The research included 178 post-COVID-19 patients, admitted to the cardiology department 18-91 years, the mean age being of 67.23±13.2 years, whereas 47% (42 pts) were men and 53% (47 pts) were women. Physical examination, ECG and echocardiography, laboratory parameters were collected: general blood count, natriuretic peptides, aspartate aminotransferase (AST), alanine aminotransferase (ALT), albumin, creatinine, serum sodium and potassium, D-dimers, and INR. Results. Of all patients in the CVDRF (cardiovascular disease risk factors) cohort, 26 (15%) patients experienced, HF events at admission or during hospitalization, of which 80 (46%) patients in the HF subgroup and 14 (8%) in the non-HF subgroup, the latter accounting for 40% of all observed HF events. In the CVDRF cohort, patients with an HF event were at a two-fold increased risk for in-hospital mortality compared with those without HF events, P < 0.001, OR 3.10 [2.24–4.29]), even after adjustment for age, sex, risk factors, and co-morbidities. Interaction for HF events and age was significant (P = 0.023). Age, CV diseases, CV risk factors, history of HF, atrial fibrillation, and CKD were significantly associated with HF events. Conclusion. This study demonstrates a higher mortality for hospitalized POST-COVID-19 patients with HF compared with patients without HF, even after adjustment for other conditions and co-morbidities

Indicele de rezistență carotidian la pacienții cu hipertensiune arterial

Background. The resistance index is a parameter that reflects the goal of vascular resistance of the arterial vascular bed. The aim of our study is to evaluate the correlation of indices of resistance determined in carotid arteries with hypertension (HTN) mediated organ damage (HMOD). Material and methods: The study included 84 patients (40 women and 44 men, mean age 42.26 ± 11.2 years) with grade II-III HTN. Physical examination was performed, biochemical tests, echocardiography and carotid Doppler ultrasonography to assess the resistive index (CRI) of both common carotid arteries (CCA) and intimate-medium thickness (IMT). Results. Mean values for CRI were 0.81 ± 0.07, IMT was 1.18 ± 0.28, mean 24-hour systolic blood pressure (SBP) was 142.2 ± 15.8 mmHg, and mean 24-hour diastolic blood pressure (DBP) was 77.1 ± 22.4 mmHg. The mean pulse pressure (PP) was 59.10 ± 22.90 mmHg. The mean 24-hour heart rate (HR) was 75.14 ± 26.86 beats / minute. CRI was positively correlated with 24 hours SBP (r = 0.44), 24 hours DBP (r = 0.15), LVMI (r = 0.127), RWT (r = 0.311), carotid IM (r = 0.672)) and a negative correlation found between IRC and FCC (r = -0.389). In the multiple regression analysis, an important interconnection between CRI and IMT was found, as well as the fact that the mean 24 hours SBP, LVMI, RWT, and carotid IMT were the main determinants of CRI. Conclusions. The results of the study highlight the interconnection between systemic atherosclerotic burden, HMOD, and carotid circulation, suggesting that hemodynamic factors significantly influence systemic arterial patterns.Introducere. Indicele de rezistență este un parametru ce reflectă obiectiv rezistența vasculară a patului vascular arterial. Scopul studiului nostru este de a evalua corelația indicilor de rezistență determinați la arterele carotide cu afectarea organelor țintă mediată de hipertensiunea (AOTMH) arterială (HTA). Material și metode. Studiul a inclus 84 de pacienți (40 de femei și 44 de bărbați, vârsta medie 42,26 ± 11,2 ani) cu HTA de gradul II-III. S-a efectuat examenul fizic, au fost colectate teste biochimice, ecocardiografia și ultrasonografia Doppler carotidian pentru a evalua indicele de rezistență a ambelor artere carotide comune (IRC) grosimea intimă-medie (IM). Rezultate. Valorile medii pentru IRC au fost de 0,81 ± 0,07, grosimea IM a fost de 1,18 ± 0,28, tensiunea arterială sistolică medie în 24 de ore (TAS) a fost de 142,2 ± 15,8 mmHg, tensiunea arterială diastolică (TAD) medie în 24 de ore a fost de 77,1 ± 22,4 mmHg. Presiunea medie a impulsului (PP) a fost de 59,10 ± 22,90 mmHg. Frecvența contracțiilor cardiace medie în 24 de ore (FCC) a fost de 75,14 ± 26,86 bătăi / minut. IRC a fost pozitiv corelată cu TAS in 24 ore (r = 0,44), TAD în 24 ore (r = 0,15), MVS (r = 0,127), GPR (r = 0,311), IM carotidă (r = 0,672) și o corelație negativă găsit între IRC și FCC (r = -0,389). În analiza de regresie multiplă, s-a relevat o interconectare importantă între IRC și IM, precum și faptul că media TAS medie în 24 ore, MVS, GPR și IM carotidă au fost principalii factori determinanți ai IRC. Concluzii. Rezultatele studiului subliniază interconectarea dintre povara aterosclerotică sistemică, AOTMH și circulația carotidiană, sugerând că factorii hemodinamici influențează semnificativ tiparele arteriale sistemice

Hemodinamica intrarenală și variabilitatea tensiunii arteriale în insuficiența cardiacă

Cardiology Discipline, USMF „Nicolae Testemiţanu”, Institute of CardiologyBackground. Blood pressure variability (BPV) has been proved to be promising in providing a great influence on the target organ damage (TOD) and intrarenal circulation. Objective of the study. Thus, the aim of our study is to analyze the complex interconnection between the intrarenal hemodynamics (IRH), TOD and BPV. Material and Methods. We included 30 patients aged 18-75 years, 53% were men and 47% were women. Patients underwent physical examination, blood biochemistry, echocardiography, 24-hours ambulatory blood pressure monitoring (ABPM), intrarenal Doppler obtaining: renal resistive index (RRI), renal pulsatile index (RPI), acceleration time (AT), carotid Doppler ultrasound on internal and common carotid arteries (ICA, CCA) Results. The comparative analysis of nictemeral SBP and DBP variations with IRH parameters revealed that RRI recorded the highest values in night-peakers followed by non-dippers, dippers, whereas the lowest being in extreme dippers (0,679 ± 0,0452 vs. 0,675 ± 0,0373 vs. 0,662 ± 0,0321 vs. 0,641 ± 0,0256, p ˂ 0,01). Similar correlations were assessed for RPI and AT but statistically insignificant (p > 0,05). The comparative analysis of HMOD parameters, left ventricle mass index (LVMI) and the indexed volume of the LA (left atrium) with SBP nictemeral variability patterns showed statistically significant differences in LVMI values that depend upon the assessed profile. Conclusion. The results of our study show the strong connection between IRH, TOD and BPV definitively shifting the paradigm to the complex evaluation of the cardiovascular patient (including ABPM, IRH and the careful evaluation of the TOD).Introducere. Variabilitatea tensiunii arteriale (VTA) s-a dovedit a fi promițătoare în furnizarea unei influențe mari asupra afectării organelor țintă (AOT) și a circulației intrarenale. Scopul lucrării. Astfel, scopul studiului nostru este de a analiza interconexiunea complexă dintre hemodinamica intrarenală (HIR), AOT și VTA. Material și Metode. Am inclus 30 de pacienți cu vârsta de 18-75 de ani, 53% bărbați și 47% femei. A fost efectuată analiza biochimică a sângelui, ecocardiografia, monitorizarea ambulatorie a tensiunii arteriale 24 de ore (MATA), Doppler intrarenal, HIR: indicele de rezistență renal (IRR), indicele pulsatil renal (IPR), timpul de accelerație (TA), ecografia Doppler carotidian (ACC, ACI). Rezultate. Analiza comparativă a variațiilor nictemerale a TAS și TAD cu parametrii HIR a relevant, că IRR a înregistrat cele mai mari valori la night-peakeri, urmați de non-dipperi, dipperi, în timp ce cele mai scăzute fiind la extrem dipperi (0,679 ± 0,0452 vs. 0,675 ± 0, 0373 vs. 0,662 ± 0,0321 vs. 0,641 ± 0,0256, p ˂ 0,01). Corelații similare au fost evaluate pentru IPR și TA, dar statistic nesemnificative (p> 0,05). Analiza comparativă a parametrilor AOT, indicele de masă al ventriculului stâng (IMVS) și volumul indexat al atriului stâng cu modele de variabilitate nictemerală TAS au arătat diferențe semnificative statistic în valorile IMVS care depind de profilul evaluat. Concluzii. Rezultatele studiului nostru arată interconexiunea semnificativă dintre HIR, AOT și VAT, deplasând definitiv paradigma către evaluarea complexă a pacientului cardiovascular (inclusiv MATA, HIR și evaluarea minuțioasă a AOT) ca algoritm obligatoriu în stratificarea prognostică

Carotid resistive index in patients with arterial hypertension

Introduction. The resistive index is a parameter that reflects the goal of vascular resistance of the arterial vascular bed. Purpose. The aim of our study is to evaluate the correlation of indices of resistance determined in carotid arteries with hypertension (HTN) mediated organ damage (HMOD). Results. Mean values for CRI were 0.81 ± 0.07, IMT was 1.18 ± 0.28, mean 24-hour systolic blood pressure (SBP) was 142.2 ± 15,8 mmHg, mean 24-hour diastolic blood pressure (DBP) was 77.1 ± 22.4 mmHg. The mean pulse pressure (PP) was 59.10 ± 22.90 mmHg. The mean 24- hour heart rate (HR) was 75.14 ± 26.86 beats / minute. CRI was positively correlated with 24 hours SBP (r = 0.44), 24 hours DBP (r = 0.15), LVMI (r = 0.127), RWT (r = 0.311), carotid IM (r = 0.672 ). ) and a negative correlation found between IRC and FCC (r = -0.389). In the multiple regression analysis, an important interconnection between CRI and IMT was found, as well as the fact that the mean 24 hours SBP, LVMI, RWT and carotid IMT were the main determinants of CRI. Material and methods. The study included 84 patients (40 women and 44 men, mean age 42.26 ± 11.2 years) with grade II-III HTN. Physical examination was performed, biochemical tests, echocardiography and carotid Doppler ultrasonography to assess the resistive index (CRI) of both common carotid arteries (CCA) and intimate-medium thickness (IMT). Conclusions. The results of the study highlight the interconnection between systemic atherosclerotic burden, HMOD and carotid circulation, suggesting that hemodynamic factors significantly influence systemic arterial patterns

Intrarenal hemodynamics and blood pressure variability in heart failure

Universitatea de Stat de Medicină şi Farmacie „Nicolae Testemiţanu”, Disciplina de cardiologieIntroduction Blood pressure variability (BPV) has been proved to be promising in providing a great influence on the target organ damage (TOD) and intrarenal circulation. Purpose The aim of our study is to analyze the complex interconnection between the intrarenal hemodynamics (IRH), TOD and BPV. Material and methods We included 30 patients aged 18-75 years, 53% were men and 47% were women. Patients underwent physical examination, blood biochemistry, echocardiography, 24- hours ambulatory blood pressure monitoring (ABPM), intrarenal Doppler obtaining: renal resistive index (RRI), renal pulsatile index (RPI), acceleration time (AT), carotid Doppler ultrasound on internal and common carotid arteries (ICA, CCA). Results The study of nictemeral BP patterns revealed four major phenotypes: dipper, non-dipper, reverse-dipper and extreme-dipper. according to SBP data, 3% of the studied population were assessed as night-peakers, 47%- non-dippers, 43% were dippers and 7 % - extreme dippers. The analysis of DBP variations included 3% of night-peakers, 43% - non-dippers, 40% - dippers and 13% of patients were assessed as extreme dippers. The comparative analysis of nictemeral SBP and DBP variations with IRH parameters revealed that RRI recorded the highest values in night-peakers followed by non-dippers, dippers, whereas the lowest being in extreme dippers (0,679 ± 0,0452 vs. 0,675 ± 0,0373 vs. 0,662 ± 0,0321 vs. 0,641 ± 0,0256, p ˂ 0,01). Similar correlations were assessed for RPI and AT but statistically insignificant (p > 0,05). The comparative analysis of HMOD parameters, left ventricle mass index (LVMI) and the indexed volume of the LA (left atrium) with SBP nictemeral variability patterns showed statistically significant differences in LVMI values that depend upon the assessed profile. Thus, the highest values for LVMI were found in patients with night-peaker patterns, followed by non-dippers and the lowest in extreme-dippers (105,75 vs 104,149 vs 102,247 vs 100,286, p ˂0,05); the assessment of IMT in both CCA and ICA showed the highest values for both CCA and ICA variables in patients with night-peaker patterns, whereas the lowest CCA values were found in dippers (1,1 vs 1,074 vs. 1,021 vs 1,057, p ˂0,05). The selective analysis of LVMI, IMT CCA and IMT ICA, and fasting glucose with nictemeral DBP variations revealed similarities with SBP variability. Conclusions The results of our study show the strong connection between IRH, TOD and BPV definitively shifting the paradigm to the complex evaluation of the cardiovascular patient (including ABPM, IRH and the careful evaluation of the TOD), from present status of research issue to being acknowledged as a compulsory algorithm in the prognostic stratification of hypertensive patient