Prognostic role of epicardial adipose tissue thickness in STEMI patients treated with percutaneous coronary intervention

Background: Epicardial adipose tissue (EAT) is suggested to play an important role as a marker of development of cardiovascular disease. Purpose: To determine predictive value of EAT thickness in patients with STEMI after percutaneous coronary intervention (PCI). Methods: Retrospective study of STEMI patients treated with PCI 2014-2016. EAT thickness was measured from transthoracic echocardiography at end-diastole. Patients were divided in two groups according to median: thin EAT group (<2.27mm, n=270) and thick EAT group (≥2.27mm, n=223). Results: Total 492 patients (332 males, 66.62±12.24 year-old) were enrolled. Killip class ≥III was more frequent (17.6 vs. 10.3%, p=0.02) in thicker EAT group. Univariate analysis revealed that higher body mass index (BMI) (β=0.064, p=0.002), high density lipoprotein cholesterol (HDL-C) ≤1mmol/l (β=0.575, p=0.008), male gender (β=0.426, p=0.046) and severe (≥2 affected vessels) coronary artery disease (CAD) (β=0.725, p=0.001) were associated with thicker EAT. Results of multivariate regression are demonstrated in table. Conclusions: Higher BMI, decreased HDL-C, increased LDL-C and male gender are an independent predictors of thicker EAT. Thicker EAT is related with severe CAD, impairment of left ventricular function (according to Killip) and increased risk of recurrent MI in STEMI patients. Multivariable regression Parameter β P value LDL-C, mmol/l 0.578 0.016 BMI, kg/m² 0.050 0.017 Recurent MI 0.607 0.05 Severe CAD 0.712 0.00

Išemine širdies liga sergančių pacientų identifikavimas pagal CYP2C19*2 genotipą

Išemine širdies liga sergantiems pacientams, ku-riems išsivysto stento trombozė arba gydant anti-agregantais nustatomas didelis trombocitų reakty-vumas, siekėme nustatyti patologinį CYP2C19*2 alelį, taikydami naują greitai genotipą nustatantį metodą. Iš viso tyrime dalyvavo 35 pacientai. Visi pacientai buvo ištirti dėl CYP2C19*2 naudojant Spartan RX CYP2C19 tyrimų paketą. CYP2C19*1*1 genetinis variantas nustatytas 63 %, *1*2 – 34 %, *2*2 – 2 % tirtų pacientų. Vyrų ir moterų grupėse skirtingi genotipai pasiskirstė panašiai. CYP2C19*2 alelį, lemiantį blogesnį klopidogrelio antitromboci-tinį efektą, greitu genotipo identifikacijos metodu galima nustatyti greičiau nei per valandąObjective. The task was to identify the defective CYP2C19*2 allele by using a novel fast-genotyping method in the patients having coronary artery disease who developed stent thrombosis or high on-treatment platelet reactivity. Materials and methods. A total of 35 patients were included in the study. All the patients were screened for CYP2C19*2 using Spartan RX CYP2C19 Assay Package. Results. CYP2C19*1*1 variant was found in 63%, *1*2 in 34%, *2*2 in 3% of patients. The distribution of genotypes was similar in men and women. Conclusions. By using the bedside technique, CYP2C19*2, which is responsible for a poorer effect of clopidogrel, might be identified in less than an hourBiologijos katedraLietuvos sveikatos mokslų universitetasVytauto Didžiojo universiteta

N-carboxymethyllysine as a biomarker for coronary artery disease and age-related macular degeneration

Background and objective: An association between coronary artery disease (CAD) and agerelated macular degeneration (ARMD) has long been postulated, but exact mechanisms remain unclear. The global prevalence of CAD and ARMD increases and early biomarkers for early diagnosis of these diseases are necessary. The aim of this study was to investigate the plasma level of oxidative stress biomarker CML in patients with and without angiographic findings of atherosclerosis in the coronary arteries (CADath+ and CADath, respectively) and to assess if there was an association of CAD with ARMD. Materials and methods: The study enrolled 233 subjects. Based on cardiologic and ophthal- mologic examinations, the patients were divided into four subgroups: CADath+ARMD+, CADath+ARMD−, CADath−ARMD+, and CADath−ARMD−. The enzyme-linked immunosorbent assay was used for the measurement of plasma CML levels. Serum lipid levels were determined by an automatic analyzer using conventional enzymatic methods. Results: CADath+ patients had higher CML concentration compared to CADath subjects (1.04 ± 0.6 vs. 0.83 ± 0.4 ng/mL, P &lt; 0.001). The highest mean CML level (1.12 ± 0.7 ng/mL) was found in CADath+ARMD+ patients. The mean plasma CML concentration was higher in subjects with any of the analyzed diseases compared to CADath−ARMD− subjects. A significant positive association of CADath+ (OR = 2.50, 95% CI 1.60–3.90, P = 0.0001), ARMD (OR = 2.08, 95% CI 1.40–3.11, P = 0.0001) and both analyzed diseases (OR = 4.67, 95% CI 2.29– 9.53, P = 0.0001) with an increased level of plasma CML in a logistic regression model adjusting by age was identified. Conclusions: The level of CML, an oxidative stress biomarker, reflects the presence of atherosclerosis in coronary arteries and shows a possible link between ARMD and CADath+ via oxidative status

Importance of Thyroid Hormone Level and Genetic Variations in Deiodinases for Patients After Acute Myocardial Infarction: A Longitudinal Observational Study

This study aimed to examine the influence of thyroid hormone (TH) levels and genetic polymorphisms of deiodinases on long-term outcomes after acute myocardial infarction (AMI). In total, 290 patients who have experienced AMI were evaluated for demographic, clinical characteristics, risk factors, TH and NT-pro-BNP. Polymorphisms of TH related genes were included deiodinase 1 (DIO1) (rs11206244-C/T, rs12095080-A/G, rs2235544-A/C), deiodinase 2 (DIO2) (rs225015-G/A, rs225014-T/C) and deiodinase 3 (DIO3) (rs945006-T/G). Both all-cause and cardiac mortality was considered key outcomes. Cox regression model showed that NT-pro-BNP (HR = 2.11; 95% CI = 1.18- 3.78; p = 0.012), the first quartile of fT3, and DIO1 gene rs12095080 were independent predictors of cardiac-related mortality (HR = 1.74; 95% CI = 1.04-2.91; p = 0.034). The DIO1 gene rs12095080 AG genotype (OR = 3.97; 95% CI = 1.45-10.89; p = 0.005) increased the risk for cardiac mortality. Lower fT3 levels and the DIO1 gene rs12095080 are both associated with cardiac-related mortality after AMI

Prevalence of metabolic syndrome components in patients with acute coronary syndromes

Objective. Many studies report that the components of the metabolic syndrome – arterial hypertension, abdominal obesity, diabetes mellitus, and atherogenic dyslipidemia – are associated with an increased risk of cardiovascular disease. We investigated the prevalence of different components of the metabolic syndrome and frequency of their combinations and acute hyperglycemia among patients with acute coronary syndromes. Methods and results. The study population consisted of 2756 patients (1670 men and 1086 women with a mean age of 63.3±11.3 years) with acute coronary syndromes: Q-wave myocardial infarction was present in 41.8% of patients; non-Q-wave MI, in 30.7%; and unstable angina pectoris, in 27.5%. The metabolic syndrome was found in 59.6% of the patients according to modified NCEP III guidelines. One component of the metabolic syndrome was found in 13.5% of patients; two, in 23.0%; and none, in 3.9%. Less than one-third (29.2%) of the patients had three components of the metabolic syndrome, and 30.4% of the patients had four or five components. Arterial hypertension and abdominal obesity were the most common components of the metabolic syndrome (82.2% and 65.8%, respectively). Nearly half of the patients had hypertriglyceridemia and decreased level of high-density lipoprotein cholesterol (55.0% and 51.1%, respectively), and 23.9% of patients had diabetes mellitus. Acute hyperglycemia (≥6.1 mmol/L) without known diabetes mellitus was found in 38.1% of cases. The combination of arterial hypertension and abdominal obesity was reported in 57.8% of patients in the case of combinations of two-five metabolic syndrome components. Conclusion. More than half of patients with acute coronary syndromes had three or more components of the metabolic syndrome, and arterial hypertension and abdominal obesity were the most prevalent components of the metabolic syndrome

Sergančiųjų išemine širdies liga vėlyvųjų baigčių prognozavimas

Širdies ir kraujagyslių ligos, tarp jų ir išeminė širdies liga (IŠL) dažniausia vidutinio ir vyresnio amžiaus suaugusiųjų mirties priežastis daugelyje Europos šalių. 2005 m. Lietuvos sveikatos mokslų universiteto ligoninės Kauno klinikų (tuometinių Kauno medicinos universiteto klinikų) Kardiologijos klinikoje pradėta kaupti sergančiųjų ūminiais ir lėtiniais išeminiais sindromais klinikinius duomenis pagal tarptautinį CARDS (Cardiology Audit Registration Data Standarts for Coronary Care Unit (CCU)/Acute Coronary Syndrome (ACS) admissions) standartizuotą klausimyną. Tyrimo tikslas. Įvertinti rizikos grupių pacientų vienerių metų išgyvenamumą ir mirštamumą po skirtingų rizikos grupių stacionarinio gydymo dėl ūminių ir lėtinių išeminių sindromų. Tirtųjų kontingentas ir tyrimo metodai. Atsitiktinės atrankos būdu atrinkti 3268 pacientai, kurie gydyti dėl IŠL (ūminio miokardo infarkto), nestabiliosios krūtinės anginos, stabiliosios krūtinės anginos Kardiologijos klinikoje 2005 m. 1908 pacientai buvo pakartotinai apklausti po vienerių metų, įvertinti vyraujantys simp- tomai, metų laikotarpiu taikytas gydymas, baigtys. Rezultatai. Kompleksinės mirties vienerių metų laikotarpiu rizikos analizė parodė, jog didžiausią įtaką mirštamumui, persirgus ūminiais išeminiais sindromais, turi amžius, t. y. 70–80 metų, insultas anamnezėje, sumažėjusi IF (70 k/min). Išvada. Sudaryta rizikos skaičiuoklė mirštamumui vienerių metų laikotarpiu įvertinti sergantiesiems ūminiais ir lėtiniais išeminiais sindromais, kuri gali būti naudinga kardiologams ir šeimos gydytojams ver- tinant paciento riziką stacionare [...]Cardiovascular disease, including coronary heart disease (CHD), is the leading cause of death among elderly adults across many European countries. In 2005, the Clinic of Car- diology, Hospital of Lithuanian University of Health Sciences (former Kaunas University of Medi- cine), started to gather the clinical data of patients with acute and chronic coronary syndromes according to the standards set by the Cardiology Audit and Registration Data Standards Project. The aim of our study was to evaluate one-year mortality after inpatient treatment for acute and chronic coronary syndromes in different risk groups. Material and methods. A total of 3268 patients who were treated for coronary heart disease - acute myocardial infarction, unstable angina, stable angina – at the Clinic of Cardiology, Hospital of Lithuanian University of Health Sciences (former Kaunas University of Medicine) in 2005 were randomly selected. Clinical data of the patients were collected by means of a standardized question- naire. After one year, 1908 patients were reexamined, and predominant symptoms, treatment during one-year period, outcomes were evaluated. Results. Multiple logistic regression analysis revealed that one-year mortality after acute coro- nary syndromes was most influenced by age of 70–80 years, history of stroke, Killip class III-IV, and reduced high-density lipoprotein cholesterol levels. For patients who were treated for chronic coronary syndromes, reduced EF (70 beats per minute) were the strongest independent predictors of one-year mortality. Conclusion. A scoring system for the assessment of mortality risk within one year for patients with acute and chronic coronary syndromes was constructed, which could be useful for cardiologists as well as family physicians for risk evaluation in inpatient and outpatient settingsAplinkotyros katedraLietuvos sveikatos mokslų universitetasVytauto Didžiojo universiteta

Relationship between the metabolic syndrome, endothelial function and intima–media thickness in asymptomatic middle-aged individuals

Objective. To evaluate the relation between cardiovascular risk factors, metabolic syndrome, endothelial function and carotid intima–media thickness in asymptomatic middle-aged individuals. Materials and methods. A total of 180 subjects (86 men and 94 women, mean age 38.8±0.3 years) have been investigated. Anthropometric, blood pressure measurements have been performed and lipid as well as high sensitivity C-reactive protein blood levels have been tested. The endothelial function was assessed by measuring the vasodilatation of the brachial artery. The carotid intima-media thickness was measured with high resolution B-mode ultrasound imaging. Metabolic syndrome was diagnosed using International Diabetes Federation definition criteria (2005). Results. The metabolic syndrome has been diagnosed in 48 (26.7%) individuals: 28 (32.6%) males and 20 (21.3%) females. Significantly reduced endothelial function has been established in asymptomatic men when compared to women. However, statistically significant decrease (4.84%) in endothelial function in metabolic individuals was detected only among males. In the metabolic patients intima–media of common carotid artery, carotid bulb and internal carotid artery was thicker than in those without metabolic syndrome (0.006, 0.007 and 0.007 cm, respectively) (a=0.000, b=0.01). Endothelial dysfunction and intima–media thickening correlated with increased blood pressure, abdominal circumference and body mass index as well as with elevated blood triglyceride and glucose levels. Intima–media thickness was greater in individuals with impaired endothelial function in all carotid segments tested. No relationship has been observed between total or low-density lipoprotein cholesterol concentrations and endothelial function, intima–media thickening or high sensitivity C-reactive protein levels [...]

The prevalence of metabolic syndrome in middle-aged in Kaunas population

Aim. To assess the prevalence of the metabolic syndrome among middle-aged Kaunas population. Material and methods. A total of 433 (192 males and 241 females, mean age 38.8±0.3 years) asymptomatic individuals have been investigated. Metabolic syndrome was diagnosed using International Diabetes Federation definition criteria – central obesity (the waist circumference ≥94 cm for men and ≥80 cm for women) plus any two of the following four factors: elevated triglycerides (Tg) (≥1.7 mmol/L), low high-density lipoprotein cholesterol (HDL-C) levels (130 mmHg or a diastolic pressure >85 mmHg) or hyperglycemia (≥5.6 mmol/L). Results. The metabolic syndrome was present in 21.7% (28.1% among males and 16.6% among females) of individuals. Furthermore, 41.1% had an increased waist circumference, 56.4% had elevated BP (130/85 or higher), 31.2% had elevated plasma glucose concentration, 19.9% had low HDL-C cholesterol values and 14.1% had increased Tg values. Significantly higher concentration (1.16 mg/L, α3 mg/L) of high-sensitivity C-reactive protein was more prevalent (17.3%) in the cohort with metabolic syndrome. Concentration of high-sensitivity C-reactive protein directly correlated with the waist and hips circumference, body mass index, concentration of Tg, glucose and BP. Conclusions. The prevalence of the metabolic syndrome among middle-aged Kaunas residents was 22%. Metabolic syndrome and central obesity correlated with elevated concentration of high-sensitivity C-reactive protein. Moderately (1–3 mg/L) and severely (>3 mg/L) elevated high-sensitivity C-reactive protein levels increase the chance of metabolic syndrome by 4.15 and 7.39 times, respectively (p=0,000) [...]

Does matrix metalloproteinase-3 polymorphism play a role in age-related macular degeneration in patients with myocardial infarction?

Objective. The aim of our study was to determine if the genotype of the matrix metalloproteinase- 3 (MMP-3) gene might carry the risk of age-related macular degeneration (ARMD) in patients with myocardial infarction. Material and Methods. A total of 499 patients with an acute myocardial infarction or with a history of myocardial infarction were enrolled into the study. They were subdivided into 2 groups: 273 patients with ARMD and 226 patients without ARMD. The control group comprised 560 persons from a random sample of the Lithuanian population. DNA was analyzed using real-time polymerase chain reaction to genotype polymorphism 5A/6A at a position –1171 of the MMP-3 gene promoter. Results. Of the 499 patients with myocardial infarction, 47% had early-stage ARMD. The patients with ARMD were older than the patients in the group without ARMD (62.1±10.8 vs. 59.6±11.1, P<0.01). The analysis of MMP-3 gene polymorphism did not reveal any differences in the distribution of 5A/5A, 5A/6A, and 6A/6A genotypes between the ARMD group, non-ARMD group, and the control group (24.2%, 52.5%, and 23.3% in the ARMD group; 28.7%, 51.9%, and 19.4% in non-ARMD group; and 25.7%, 49.3% and 25.0%, in the control group, respectively). Conclusions. MMP-3 gene polymorphism had no predominant effect on the development of ARMD in patients with myocardial infarction