Non-invasive nuclear myocardial perfusion imaging improves the diagnostic yield of invasive coronary angiography

Aims Several studies reported on the moderate diagnostic yield of elective invasive coronary angiography (ICA) regarding the presence of coronary artery disease (CAD), but limited data are available on how prior testing for ischaemia may contribute to improve the diagnostic yield in an every-day clinical setting. This study aimed to assess the value and use of cardiac myocardial perfusion single photon emission computed tomography (MPS) in patient selection prior to elective ICA. Methods and results The rate of MPS within 90 days prior to elective ICA was assessed and the non-invasive test results were correlated with the presence of obstructive CAD on ICA (defined as stenosis of ≥50% of a major epicardial coronary vessel). Multivariate logistic regression analysis was performed to identify predictors of obstructive CAD. A total of 7530 consecutive patients were included. At catheterization, 3819 (50.7%) were diagnosed as having obstructive CAD. Patients with a positive result on MPS (performed in 23.5% of patients) were significantly more likely to have obstructive CAD as assessed by ICA than those who did not undergo non-invasive testing (74.4 vs. 45.6%, P < 0.001). Furthermore, a pathological MPS result was a strong, independent predictor for CAD findings among traditional risk factors and symptoms. Conclusion In an every-day clinical setting, the use of MPS substantially increases the diagnostic yield of elective ICA and provides incremental value over clinical risk factors and symptoms in predicting obstructive CAD, thus emphasizing its importance in the decision-making process leading to the use of diagnostic catheterizatio

Pacjent z migotaniem przedsionków leczony nowym doustnym antykoagulantem po epizodzie krwawienia z przewodu pokarmowego

Anticoagulation increases three times the risk of major gastrointestinal bleeding. We present a case of a patient with chronic atrial fibrilation treated with novel oral anticoagulant who was admitted to hospital because of another episode of gastrointestinal bleeding.Leczenie przeciwzakrzepowe 3-krotnie zwiększa ryzyko poważnych krwawień z przewodu pokarmowego. Poniżej przedstawiono przypadek pacjenta z utrwalonym migotaniem przedsionków leczonego nowym doustnym antykoagulantem, którego przyjęto do szpitala z powodu kolejnego epizodu krwawienia z przewodu pokarmowego

Could autonomic nervous system parameters be still helpful in identifying patients with left ventricular systolic dysfunction at the highest risk of all-cause mortality?

Background: Autonomic imbalance is associated with poor prognosis of patients with systolic dysfunction. Most of the previous data were written several years ago and constituted to cardiovascular or arrhythmic mortality. Current treatment of these patients has improved substantially over the last decades, and thus, the population at risk of death may have altered as well. Consequently, data on high-risk patients with systolic dysfunction in the modern era are sparse and those from previous trials may no longer be applicable. The aim herein, was to verify whether well-known autonomic indices — baroreflex sensitivity (BRS) and heart rate variability (HRV) — remain accurate predictors of mortality in patients with systolic dysfunction. Methods: Non-invasively obtained BRS and HRV were analyzed in 205 clinically stable patients with left ventricular ejection fraction (LVEF) ≤ 40%. 28 patients died within 28 ± 9 month follow-up. Results: Baroreflex sensitivity, low-frequency (LF) in normalized units, LF to high-frequency ratio and standard deviation of average R-R intervals were significantly associated with mortality; cut-off values of the highest discriminatory power for abovementioned parameters were ≤ 3.0 ms/mmHg, ≤ 41, ≤ 0.7 and ≤ 25 ms, respectively. In bivariate Cox analyses (adjusted for LVEF, New York Heart Association [NYHA] or absence of implantable cardioverter-defibrillator [ICD]) autonomic indices remain significant predictors of death. Conclusions: Baroreflex sensitivity and HRV — may still be helpful in identifying patients with left ventricular systolic dysfunction at the highest risk of all-cause mortality, independently of LVEF, NYHA class and ICD implantation

Artificial intelligence models in prediction of response to cardiac resynchronization therapy: a systematic review

The aim of the presented review is to summarize the literature data on the accuracy and clinical applicability of artificial intelligence (AI) models as a valuable alternative to the current guidelines in predicting cardiac resynchronization therapy (CRT) response and phenotyping of patients eligible for CRT implantation. This systematic review was performed according to the PRISMA guidelines. After a search of Scopus, PubMed, Cochrane Library, and Embase databases, 675 records were identified. Twenty supervised (prediction of CRT response) and 9 unsupervised (clustering and phenotyping) AI models were analyzed qualitatively (22 studies, 14,258 patients). Fifty-five percent of AI models were based on retrospective studies. Unsupervised AI models were able to identify clusters of patients with significantly different rates of primary outcome events (death, heart failure event). In comparison to the guideline-based CRT response prediction accuracy of 70%, supervised AI models trained on cohorts with > 100 patients achieved up to 85% accuracy and an AUC of 0.86 in their prediction of response to CRT for echocardiographic and clinical outcomes, respectively. AI models seem to be an accurate and clinically applicable tool in phenotyping of patients eligible for CRT implantation and predicting potential responders. In the future, AI may help to increase CRT response rates to over 80% and improve clinical decision-making and prognosis of the patients, including reduction of mortality rates. However, these findings must be validated in randomized controlled trials

Baroreflex sensitivity but not microvolt T-wave alternans can predict major adverse cardiac events in ischemic heart failure

Background: Major adverse cardiovascular events (MACE) constitutes the main cause of morbidity and mortality in ischemic heart failure (HF) patients. The prognostic value of the autonomic nervous system (ANS) parameters and microvolt T-wave alternans (MTWA) in this issue has not been identified to date. The aim herein, was to assess the usefulness of the abovementioned parameters in the prediction of MACE in HF patients with left ventricular systolic dysfunction of ischemic origin. Methods: Baroreflex sensitivity (BRS), heart rate variability (HRV), MTWA and other well-known clinical parameters were analyzed in 188 ischemic HF outpatients with left ventricular ejection fraction (LVEF) ≤ 50%. During 34 (14–71) months of follow-up, 56 (30%) endpoints were noted. Results: Univariate Cox analyses revealed BRS (but not HRV), MTWA, age, New York Heart Association III, LVEF, implantable cardioverter-defibrillator presence, use of diuretics and antiarrhythmic drugs, diabetes, and kidney insufficiency were defined as significant predictors of MACE. Pre-specified cut-off values for MACE occurrence for the aforementioned continuous parameters (age, LVEF, and BRS) were: ≥ 72 years, ≤ 33%, and ≤ 3 ms/mmHg, respectively. In a multivariate Cox analysis only BRS (HR 2.97, 95% CI 1.35–6.36, p &lt; 0.006), and LVEF (HR 1.98, 95% CI 0.61–4.52, p &lt; 0.038) maintained statistical significance in the prediction of MACE. Conclusions: BRS and LVEF are independent of other well-known clinical parameters in the prediction of MACE in patients with HF of ischemic origin and LVEF up to 50%. BRS ≤ 3 ms/mmHg and LVEF ≤ 33% identified individuals with the highest probability of MACE during the follow-up period

Children’s Education Program on Prevention of Hypertension and Blood Pressure Measurement — SOPKARD Junior Project

Wstęp Nadciśnienie tętnicze (NT) jest główną przyczynąchorób serca i naczyń w Polsce i na świecie.Dlatego edukację o zachowaniach prozdrowotnychi profilaktyce NT należy rozpoczynać jak najwcześniej.Podstawa programowa Ministerstwa EdukacjiNarodowej (MEN) zakłada takie działania jużu dzieci w szkole podstawowej.Celem projektu była ocena wiedzy dzieci klas V i VIszkoły podstawowej w zakresie prewencji choróbukładu krążenia oraz opracowanie i sprawdzenieprzydatności dla edukacji prozdrowotnej multimedialnychinteraktywnych warsztatów dla dzieci.Materiał i metody Projektem objęto 74 dzieci w wieku11–12 lat. Sprawdzono ich wiedzę w relacji dopodstawy programowej MEN. Następnie dzieciwzięły udział w warsztatach edukacyjnych złożonychz 6 jednostek lekcyjnych w podgrupach 5–6osobowych. Na koniec przeprowadzono monitorowanieefektów edukacji. Odpowiednio wyszkolonedzieci mierzyły ciśnienie swoim rodzicom podczaswywiadówek.Wyniki W teście przed warsztatami średni wynikwynosił 65% prawidłowych odpowiedzi, aż 30%dzieci odpowiedziało poprawnie na mniej niż połowępytań. Test sprawdzający po zakończeniu kursuwykazał 90% dobrych odpowiedzi, a najniższy wynikwynosił 82%. U rodziców i pracowników szkoływ pomiarach wykonanych przez dzieci 22% badanychmiało nowo wykryte podwyższone wartości ciśnienia.Wnioski 1. Wiedza prozdrowotna dzieci ze szkołypodstawowej w stosunku do podstawy programowejw zakresie edukacji zdrowotnej MEN jest niedostateczna.2. Dzieci bardzo chętnie i aktywnie uczestnicząw multimedialnych, interaktywnych warsztatach edukacyjnychw zakresie prozdrowotnego stylu życiai profilaktyki NT. Monitorowanie efektów takichwarsztatów wykazało bardzo duże zmiany poziomuwiedzy i świadomości dzieci, włącznie z umiejętnościąsamodzielnych pomiarów ciśnienia tętniczego.Background Arterial hypertension (AH) is the main causeof cardiovascular diseases in Poland and all over the world.That is why education on health supporting and prophylacticactivities concerning AH should be implemented assoon as possible. According to the program of Ministry ofNational Education (MEN) these activities should bestarted in primary schools.The aim of the project was to evaluate knowledge of childrenin class V and VI and to elaborate health supportingmultimedia and interactive workshops for primary schoolchildren.Material and methods Seventy four (74) children aged11–12 years have been included in the study. Their knowledgehas been tested in relation to the program of MEN.The studied children took part in the educational workshops composed of six lesson modules in subgroups of 5–6persons. Finally monitoring of the educational effects hasbeen performed. Well trained children also did measurearterial blood pressure of their parents during school–parentsmeetings.Results In the test performed before the workshops a meanresult was equal to 65% of good answers, about 30% ofchildren answered correctly in less than 50% of questions.The test performed after the workshops showed 90% ofcorrect answers; the worst result was 82%. Among the examinedparents and school employees 22% of them hadnewly detected increased blood pressure.Conclusions1. Health supporting knowledge among primary school childrenis unsatisfactory in relation to the program of MEN.2. Children readily and actively participate in the multimediainteractive educational workshops on health supportingand prophylactic activities concerning AH. Monitoringof the effects of such workshops showed increasedknowledge and answers concerning issues of AH includingability of arterial blood pressure measurement

Protection from ultraviolet damage and photocarcinogenesis by vitamin d compounds

© Springer Nature Switzerland AG 2020. Exposure of skin cells to UV radiation results in DNA damage, which if inadequately repaired, may cause mutations. UV-induced DNA damage and reactive oxygen and nitrogen species also cause local and systemic suppression of the adaptive immune system. Together, these changes underpin the development of skin tumours. The hormone derived from vitamin D, calcitriol (1,25-dihydroxyvitamin D3) and other related compounds, working via the vitamin D receptor and at least in part through endoplasmic reticulum protein 57 (ERp57), reduce cyclobutane pyrimidine dimers and oxidative DNA damage in keratinocytes and other skin cell types after UV. Calcitriol and related compounds enhance DNA repair in keratinocytes, in part through decreased reactive oxygen species, increased p53 expression and/or activation, increased repair proteins and increased energy availability in the cell when calcitriol is present after UV exposure. There is mitochondrial damage in keratinocytes after UV. In the presence of calcitriol, but not vehicle, glycolysis is increased after UV, along with increased energy-conserving autophagy and changes consistent with enhanced mitophagy. Reduced DNA damage and reduced ROS/RNS should help reduce UV-induced immune suppression. Reduced UV immune suppression is observed after topical treatment with calcitriol and related compounds in hairless mice. These protective effects of calcitriol and related compounds presumably contribute to the observed reduction in skin tumour formation in mice after chronic exposure to UV followed by topical post-irradiation treatment with calcitriol and some, though not all, related compounds