Continuity equation is the echocardiographic method of choice to assess degenerative mitral stenosis

We present a rare case of a patient with severe, symptomatic degenerative calcific mitral stenosis (MS). Calcification of mitral valve annulus (MVA) is a frequent finding in elderly patients. It can be isolated or associated more often with mitral valve insufficiency than MS. In rare cases, it results in severe MS. An accurate measurement of MVA in degenerative calcific MS is problematic because the limiting orifice is near the annulus and not at the leaflet tips as in rheumatic MS. Continuity equation is the best echocardiographic method to assess the MVA in degenerative MS, correlating well with invasive methods. Real-time three-dimensional echocardiography is a promising tool and provides an accurate measurement of MVA in calcific MS, with a very good correlation compared to continuity equation. On the other hand, the use of pressure half-time is often inaccurate and should be avoided, while two-dimensional planimetry is difficult and not reliable in degenerative MS. The values of mean gradient and systolic pulmonary artery pressure depend on several factors and should be only supportive signs and should not be considered as surrogate markers of the severity of MS. (Cardiol J 2011; 18, 5: 577–580

Inadequate management of cardiovascular risk factors prior to admission for an acute coronary event

Objectives: Optimal regulation of modifiable risk factors, has been proposed as the standard of care, both for primary and secondary prevention of cardiovascular disease (CVD). The aim of this study was to investigate at what extent individuals who experienced an acute coronary syndrome (ACS) had previously been receiving adequate preventive measures against classical risk factors for CVD. Methods: Data were analyzed for all 185 hospitalized patients with a diagnosis of ACS in the Cardiology department of our hospital during an annual period (1/7/2019 until 30/6/2020). The study population was divided in two groups, primary and secondary prevention subgroups, according to previous medical history of CAD. Results: The mean age of the participants was 65.5 ±12.2 years and most patients were male (81.6%). Fifty-seven patients (30.8%) had a history of diabetes mellitus (DM) and 97 (52.4%) had a history of dyslipidemia.  Hypertension was present in 101 (54.6%) patients and coronary artery disease (CAD) in 51 (27.9%). In the secondary prevention group, the LDL-C was on target in only one third, while one out of 5 patients did not use statins. The use of antiplatelet/anticoagulant agents was 94.5%. Among patients with diabetes, only one out of five patients had been using a GLP-1 receptor agonist or/and an SGLT-2 inhibitor, while the HbA1c was on target in half of them. One quarter of the patients were active smokers.In the primary prevention group, the use of statins was overall low (25.8%) but more frequent in patients with diabetes and those without diabetes at very high-risk (47.1% and 32.1% respectively). Overall, the LDL-C was on target in less than one quarter of patients. The use of antiplatelet/anticoagulant agents was low (20.1%), but higher in those with diabetes (52.9%). In the diabetic group, HbA1c was on target in 61.8%. Active smoking was practiced by more than one third of the patients. Conclusions: Our data show that in a substantial proportion of patients presenting with ACS, previous CVD prevention, both primary and secondary, fails to meet the current recommendations provided by scientific societies

Maritime Transport in a Life Cycle Perspective: How Fuels, Vessel Types, and Operational Profiles Influence Energy Demand and Greenhouse Gas Emissions

&ldquo Well-to-Propeller&rdquo Life Cycle Assessment of maritime transport was performed with a European geographical focus. Four typical types of vessels with specific operational profiles were assessed: a container vessel and a tanker (both with 2-stroke engines), a passenger roll-on/roll-off (Ro-Pax) and a cruise vessel (both with 4-stroke engines). All main engines were dual fuel operated with Heavy Fuel Oil (HFO) or Liquefied Natural Gas (LNG). Alternative onshore and offshore fuel supply chains were considered. Primary energy use and greenhouse gas emissions were assessed. Raw material extraction was found to be the most impactful life cycle stage (~90% of total energy use). Regarding greenhouse gases, liquefaction was the key issue. When transitioning from HFO to LNG, the systems were mainly influenced by a reduction in cargo capacity due to bunkering requirements and methane slip, which depends on the fuel supply chain (onshore has 64% more slip than offshore) and the engine type (4-stroke engines have 20% more slip than 2-stroke engines). The combination of alternative fuel supply chains and specific operational profiles allowed for a complete system assessment. The results demonstrated that multiple opposing drivers affect the environmental performance of maritime transport, a useful insight towards establishing emission abatement strategies. Document type: Articl

The Impact of Demographic Characteristics and Lifestyle in the Distribution of Cystatin C Values in a Healthy Greek Adult Population

Background. The aim of the present study was to examine sources of variation for serum cystatin C in a healthy Greek population. Methods. Cystatin C together with basic clinical chemistry tests was measured in a total of 490 adults (46 ± 16 yrs, 40% males) who underwent an annual health check. Demographic, anthropometric, and lifestyle characteristics were recorded. Results. Higher values of cystatin C were observed among males (P = .04), participants aged over 65 years (P < .001), current smokers (P = .001) and overweight/obese participants (P = .03). On the contrary, alcohol consumption and physical activity seemed to have no influence on cystatin C levels (P = .61; P = .95, resp.). Conclusions. In interpreting serum cystatin C values in a healthy adult population, age, gender, Body Mass Index, and cigarette smoking need to be considered, and determination of reference ranges among distinct subpopulations seem to be prudent

Stress echocardiography in elderly patients with coronary artery disease Applicability, safety and prognostic value of dobutamine and adenosine echocardiography in elderly patients

AbstractObjectives. Our aim was to determine the applicability, safety and prognostic value of adenosine and dobutamine stress echocardiography in patients ≥70 years old.Background. These tests are sometimes mandatory because of difficulties and inaccuracies in interpreting traditional electrocardiographic stress tests. Furthermore, if these tests could be used to avoid coronary arteriography and cardiac catheterization, they would become essential in the care of the elderly, whose numbers are increasing.Methods. We performed coronary arteriography and dobutamine and adenosine stress echocardiographic tests in 120 patients (72 men) ≥70 years old who entered the hospital because of chest pain and had known or suspected coronary artery disease. The stress tests were performed on separate days, within 2 weeks of coronary arteriography. Both the arteriograms and the echocardiograms were analyzed by two experts who had no knowledge of the patients' other data or the other interpreter's report. Tests were judged to have positive or negative results, and the patients were followed up for the development of cardiac events. Univariate and multivariate analyses and other statistical modalities were applied for comparisons.Results. Documented coronary artery disease was found in 89 patients. During the 14 ± 7 months of follow-up, cardiac events developed in 50 patients, including 3 (7.9%) of 38 patients with negative dobutamine and 12 (20.7%) of 58 patients with negative adenosine test results. Demonstration of any abnormality on stress echocardiography was an independent factor for cardiac events, both for dobutamine (relative risk 7.3) and for adenosine (relative risk 3.0). Both cessation of dobutamine or adenosine tests and diagnosis of disease in two or more coronary vessels were also independent predictors. ST segment depression ≥1 mm was related to future events only with the dobutamine test.Conclusions. These echocardiographic stress tests proved safe and well tolerated. They successfully stratified this cohort of elderly patients with coronary artery disease to low or high risk subgroups for subsequent cardiac events

Composição nutricional de biscoitos biofortificados com farinha de batata-doce / Nutritional composition of biofortified cookies with sweet potato flour

A batata-doce é uma das hortaliças mais consumidas no mundo e no Brasil devido sua qualidade nutricional e de ser uma fonte nutritiva barata de fácil aquisição. Objetivou-se desenvolver, caracterizar e analisar sensorialmente biscoitos com adição de 40% da farinha de batata-doce. Foram desenvolvidos biscoitos doces, salgados e tipos raivinhas. As análises microbiológicas foram feitas segundo a legislação. Foi feita a caraterização físico-química dos biscoitos em determinação de umidade, cinza, pH, sólidos solúveis, proteína, lipídeos, carboidratos e atividade de água. O teste de aceitação foi aplicado a um grupo de avaliadores não treinados (n=70) utilizando escala hedônica estruturada de nove pontos. Foram avaliados atributos com aparência, textura, sabor, aroma, cor e impressão global, e a intenção de compra. O resultado da analise microbiológico foi de acordo com o padrão. As amostras apresentaram uma diferença significativa (&lt;0,05) com exceção da umidade e teor de lipídeos. Todas os biscoitos apresentaram boa aceitação em todos os atributos avaliado, obtiveram notas maiores que 7 e uma boa intenção de compra com mais de 50% de certamente e provavelmente compraria os produtos

Influence of Protein Intake from Haem and Non-haem Animals and Plant Origin on Inflammatory Biomarkers among Apparently-healthy Adults in Greece

Intake of different types of protein may be associated with differences in biomarkers among various populations. This work investigated the influence of protein intake from haem and non-haem animals as well as protein from plants on haematological and biochemical parameters in inflammation among apparentlyhealthy adults living in Greece, a Mediterranean country. Four hundred and ninety apparently-healthy subjects (46\ub116 years, 40% men), who consecutively visited Polykliniki General Hospital for routine examinations, voluntarily agreed to participate in the study (participation rate 85%). Demographic, anthropometric and lifestyle characteristics were recorded. Participants completed a valid, semi-quantitative food frequency questionnaire. Protein intake was classified into three sources: protein from haem animals, protein from non-haem animals, and protein from plant origin. Fasting blood samples were taken from all participants; uric acid, creatinine, lipids, cystatin C, haptoglobin, haemoglobin, haematocrit, iron, ferritin, white blood cells, monocytes, platelets, and C-reactive protein were measured. Protein intake from only haem animals was associated with increased haemoglobin and haematocrit levels (p&lt;0.05) whereas intake of protein from non-haem animals and plant origin was not associated with the investigated haematological and biochemical markers of low-grade chronic inflammation when lifestyle factors and overall dietary habits were taken into account. Intake of protein from only haem animals seems to be consistently associated with haematological markers. The confounding role of dietary habits and lifestyle variables on the tested parameters deserves further attention in future research

An Atypical Case of Apical Hypertrophic Cardiomyopathy: Absence of Giant T Waves in spite of Extreme Apical Wall Hypertrophy

Apical hypertrophic cardiomyopathy is an uncommon variant of hypertrophic cardiomyopathy, with hypertrophy mainly affecting the apex of the left ventricle. We hereby describe a case of an octogenarian female patient who was randomly diagnosed with AHCM due to other comorbidities