Subxiphoid echocardiographic evaluation of right heart function in patients with chronic obstructive pulmonary disease

PURPOSE: The purpose of this study is to evaluate by subxiphoid echocardiography the sensitivity and specificity of various echocardiographic parameters for early diagnosis and survival of patients with chronic obstructive pulmonary disease (COPD).MATERIAL AND METHODS: Subxiphoid echocardiography was performed in 75 COPD patients to evaluate inferior vena cava dimension (IVCD), its collapsibility index (CI), end-diastolic right ventricular dimension (EDRVD), end-diastolic right ventricular thickness (EDRVT) (M-mode), right atrial area (RAA), right ventricular areas and right ventricular area shortening fraction. Results were compared to those of 30 healthy controls. Patients in sinus rhythm were divided in two according to there NYHA class (I+II and III+IV) an in three according to there acid-base blood gases status.RESULTS: All the indexes were equally and significantly changed in the patients with RVH/PH and those with COPD and atrial fibrillation (AF) when compared to controls. COPD patients with neither ECG criteria for RV hypertrophy (RVH), nor x-ray evidence of pulmonary hypertension (PH) presented with significantly greater EDRVA and RAA and normal IVC/CI. In both cases, according to cardiac and respiratory severity status subdivision, significant changes in any indexes with worsening of cardiac and respiratory failure were observed. Best sensitivity, specificity and predictive accuracy for early diagnosis were established for IVCD/CI and EDRVT. During the two-year study period, seven (9%) patients died in end stage respiratory and heart failure because of considerably reduced right heart performance.CONCLUSION: Subxiphoid echocardiography may be used for early detection of cor pulmonale, evaluation of right heart dysfunction and prognosis in COPD patients.Scripta Scientifica Medica 2013; 45(2): 55-60

Assessment Of Renal Function In Patients With Type 2 Diabetes Mellitus And Heart Failure With Preserved Ejection Fraction In Treatment With Empagliflozin

Introduction: Еmpagliflozin belongs to SGLT2 inhibitors which are a new class anti-diabetic drugs. Thanks to their unique mechanism to induce osmotic diuresis they play an important role in the prevention of diabetic kidney disease.Aim: The aim of this article is to monitor the renal function of patients with type 2 diabetes mellitus and heart failure with preserved ejection fraction treated with empagliflozin 10 mg. daily for 3 months.Materials and Methods: The study includes 50 patients with type 2 diabetes mellitus and heart failure with preserved ejection fraction (EF > 40 %) aged between 44 to 86 years, mean 66.8 ± 8.13, of whom 18 women and 32 men.Results: In all participants the following parameters were observed—ACR in first sample morning urine and eGFR. There was a reduction of albuminuria during the third month of the treatment with the SGLT2 inhibitor empagliflozin compared to the initial values of the study group

Risk of hyperkalemia in heart failure patients and new treatment approaches

IntroductionHyperkalemia is a serious medical condition that can cause muscle weakness, paralysis and cardiac arrhythmias. In heart failure (HF), hyperkalemia is a frequent problem, because of several factors, such as chronic kidney disease (CKD), and because of medications, used to treat HF - angiotensin-converting enzyme inhibitors (ACEi)/Angiotensin II receptor blockers (ARBs) and mineralocorticoid receptor inhibitors (MRIs) that increase the serum potassium level, leading to a risk of hyperkalemia.Materials and Methods This is a retrospective study.  The risk factors, leading to hyperkalemia among 535 patients, hospitalized for HF at the St. Marina University Hospital in Varna in the period January 2010 - December 2014 were analyzed. ResultsSignificant part of the patients with HF have CKD as a comorbidity (56.3%), but they are treated with ACEi/ARBs (70.8%) and MRIs (34.2%), taking medications that increase the serum potassium level, leading to a risk of hyperkalemia. There are also a few patients per year (2.2%) who have hyperkalemia as a comorbidity, but they also must be treated with the same medications- ACEi/ARBs (91.7%) and MRIs (8.3%).ConclusionTwo new potassium binders - patiromer and sodium zirconium cyclosilicate, are included in the current guidelines (2016) as medications under consideration for regulatory approval. They are new therapeutic options for managing hyperkalemia in patients with HF and a risk of hyperkalemia. The current study reveals the importance of minimizing this adverse effect in order to provide optimal pharmacological treatment for patients with HF

Medicament therapy tendencies in hospitalized patients with chronic acute heart failure with preserved and reduced ejection fraction

Въведение / целиЦелта на нашето проучване беше да се установят тенденциите в прилаганото медикаментозно лечение при хоспитализирани по повод на сърдечна недостатъчност (СН) пациенти със запазена и потисната фракция на изтласкване. Това е постигнато чрез обобщаване и сравняване на информацията за предписваните медикаменти и потенциалните противопоказания и причини за неспазване препоръките за лечение на сърдечна недостатъчност.Материали и методиТова е ретроспективно проучване, обхващащо 535 пациенти, хоспитализирани в УМБАЛ „Света Марина` - Варна за периода от януари 2010 до декември 2014 година с диагноза хронична обострена сърдечна недостатъчност. Сравнени са процентите на предписваните кардиоактивни медикаменти - блокери на РААС, бета-блокери, антагонисти на минералкортикоидните рецептори и калциеви антагонисти при пациенти с хронична СН и редуцирана и запазена ФИ.РезултатиЗа последната 2014 година пациентите със СН са били предимно възрастни (средна възраст 72 години) жени (54.5%), по-често със СНзФИ (37.6%). При пациентите със запазена ФИ (сравнени с тези с редуцирана) приеманите бета-блокери, блокери на РААС и антагонисти на минералкортикоидните рецептори са били значимо по-малко (82.3%, 58.1% и 25.8% спрямо 84.6%, 64.1% и 64.1%), докато процентът на приеманите калциеви антагонисти - по-голям (40.3% спрямо 38.5%) в сравнение с групата със СНрФИ. Процентът на неспазване на препоръките за лечение на СНрФИ с оглед на противопоказанията е 25.6%, 12.8% и 17.9% съответно за блокери на РААС, бета-блокери и антагонисти на минералкортикоидните рецептори.ЗаключениеИма съществени разлики в лечението на СНрФИ и СНзФИ. Пациентите със СНзИФ приемат по-малко бета-блокери, блокери на РААС и антагонисти на минералкортикоидните рецептори, a повече калциеви антагонисти. Висок е процентът на неспазване на препоръките за лечение на СНрФИ спрямо останалата част от Европа, съобразен с противопоказанията. Тенденцията на хоспитализации по повод на СН е да са по-възрастни пациенти, с преобладаващ женски пол и СНзФИ.Introduction/AimThe aim of our research was to establish the trends in the applied medicament therapy in hospitalized patients with heart failure (HF) and preserved and reduced ejection fraction (EF). The results were achieved by summarizing and comparing the information about the prescribed medicaments and the potential contraindications and reasons for not adhering to the recommendations for heart failure treatment.Materials and MethodsThis is a retrospective study involving 535 patients hospitalized at the St. Marina University Hospital in Varna for the period from January, 2010 to December, 2014. All of them were diagnosed with chronic acute heart failure. The comparison included the percentages of the prescribed cardioactive medicaments - renin-angiotensin system (RAS) blockers, beta blockers, mineralcorticoid receptor antagonists and calcium antagonists in patients with chronic HF and reduced and preserved EF.ResultsFor the last year, 2014, the HF patients were predominantly older (average age of 72 years) women (54.5%), more frequently with HF with preserved EF (HFpEF) (37.6%). Among the patients with preserved EF (compared with those with reduced one), the intake of beta blockers, RAS blockers and mineralcorticoid receptor antagonists was significantly lower (82.3%, 58.1% and 25.8%, compared with 84.6%, 64.1% and 64.1%), whereas the percentage of the intake of calcium antagonists was higher (40.3% compared with 38.5%) than that of the group with HF with reduced EF (HFrEF). The percentage of non-adherence to the therapy recommendations for HFrEF, considering the contraindications, was 25.6%, 12.8% and 17.9%, respectively for RAS blockers, beta blockers and mineralcorticoid receptor antagonists.ConclusionThere are significant differences in the treatment of HFrEF and HFpEF. The HFpEF patients take less beta blockers, RAS blockers and mineralcorticoid receptor blockers, but more calcium antagonists. There is a high percentage of non-adherence to the therapy recommendations for HFrEF compared with the rest of Europe, considering the contraindications. The tendency in hospitalizations due to HF is for the patients to be older, predominantly female and with HFpEF

Type 2 diabetes mellitus is associated with increased arterial stiffness measured by the echo-tracking method

INTRODUCTION: Data for arterial stiffness (АS) in type 2 diabetes mellitus (Т2DM) patients is important for better management of cardiovascular complications and early therapeutic approach.AIM: The aim of this article is to obtain data for pulse wave velocity (PWVβ) and other AS parameters in patients with T2DM without cardiovascular atherosclerotic disease and compare them with controls.MATERIALS AND METHODS: This cross-sectional clinical investigation involves a sample of 100 patients with T2DM without cardiovascular complications and a control group of 30 healthy subjects.  In all patients one-point echo-tracking measurement of carotid artery (CA) stiffness with Aloka Prosound α7 machine were conducted and pulse wave velocity (PWVβ), β-stiffness index, arterial compliance (АС), augmentation index (AI), Peterson’s modulus (Ep) were measured.  RESULTS AND CONCLUSION: Our results showed the mean value of PWVβ on the left CA (L) in the group of patients with T2DM is 7.37 ± 1.32 m/sec and on the right CA (R) is 7.42 ± 1.33 m/sec. The performed t-test showed statistical significance of the differences of PWVβ (L) and PWVβ (R) in the studied group, compared to the control group (t = 3.764; p = 0.001 and t = 3.561; p = 0.001). The data showed significantly higher values of β-stiffness index (p = 0.001) and Ep (p = 0.001) in patients with T2DM compared to controls. AC was significantly lower in T2DM, when it is measured on the left CA (p = 0.001). AI was significantly higher in T2DM when it is measured on the right CA (p = 0.009).Patients with T2DM are associated with significantly increased AS parameters compared to controls

A case of non-compaction cardiomyopathy

The aim of this case report was to present a rare myocardial disease, the so-called isolated non-compaction cardiomyopathy (NCCM). This disorder, a primary genetic cardiomyopathy, attracts increasing attention. A woman with a sudden onset of shortness of breath and isolated NCCM is described. Criteria for diagnosis as well as echocardiographic findings and magnetic resonance imaging of the heart are presented. Although rare, a new option of myocardial disease with various modes of clinical presentation but, most commonly, with acute or chronic heart failure should be taken into consideration. Multiple imaging modalities are available and should be used for proper diagnosis.Scripta Scientifica Medica 2013; 45(3): 86-89

POTENTIAL DRUG-DRUG INTERACTIONS IN HEART FAILURE PATIENTS

Objective: The aim of the present study was to assess the prevalence, risk rating and the severity of hazardous pDDIs (potential drug-drug interactions) in the prescribed pharmacotherapy in the hospital discharged heart failure (HF) patients, primarily with co-administered drugs with narrow therapeutic index (statins, anticoagulants, antithrombotic drugs). Methods: The prescriptions of chronic heart failure patients for one year (January-December 2014) were analyzed for pDDIs through Lexi-interact® software. DDIs belonging to the categories D (Consider therapy modification) and X (Avoid combination) and/or severity of drug interaction-major, were selected for the study. Results: After reviewing the medical records of 985 patients, 239 patients were selected based on the criteria mentioned above. The average number of prescription drugs at hospital discharge was 7.27 medications (±1.84 SD) per patient. The total number of pDDIs was 1483 or approximately 6.2 (±3.89 SD) pDDIs per patient. With respect to the risk rating, in categories D and X were detected 76 (5.12 %) and 2 (0.13 %) pDDI, respectively. The major pDDIs were 108 (7.28 %). Conclusion: HF patients are at high risk of pDDIs. Screening of prescriptions for pDDIs and monitoring of pharmacotherapy in terms of response and associated adverse drug events will contribute to patient safety

Levels of carboxylated and undercarboxylated osteocalcin in patients with type 2 diabetes

Introduction: Osteocalcin (OC) is a bone-derived protein that undergoes vitamin K-dependent carboxylation. The undercarboxylated form of the protein (ucOC) is released in the circulation during the process of bone resorption. Experimental studies on mice and rats have revealed that ucOC is involved in the regulation of energy homeostasis, linking in this way the bone, pancreas, and adipose tissue metabolism. Experimental studies suggest no hormonal role for the carboxylated form (cOC) of the protein.Aim: In the current study we aimed to examine the levels of OC in its carboxylated and undercarboxylated form in patients with type 2 diabetes and control subjects, and to compare the vitamin K status between the two groups. Materials and Methods: The present cross-sectional study involved a sample of 46 adults type 2 diabetes patients and a control group of 19 individuals. The carboxylated and undercarboxylated forms of OC were measured in serum by using highly sensitive sandwich-type enzyme immunoassay kits. Vitamin K status was evaluated by the ratio ucOC/cOC. Student’s two-tailed unpaired t-test was used to compare the groups.Results: UcOC and cOC serum levels were significantly lower in patients with type 2 diabetes compared to controls. We found no difference in the vitamin K status between the groups.Conclusion: Our results show that OC might be involved in the regulation of carbohydrate metabolism. In humans, it appears that the carboxylation state might not be essential for the hormonal role of the protein as in mice and rats

SNARE MANEUVER FOR MANAGEMENT OF LOW TAVI IMPLANTATION - CLINICAL CASE

Even though TAVI is a relatively new procedure it managed to become the default method for treatment of aortic stenosis in patients with high surgical risk. It is minimally invasive but not entirely free of complications. One of those is a paravalvular leak following a low implantation. In this article we present the different courses of action in this situation and share our experience on one such occasion