TEI INDEX MIGHT BE THE UNIQUE ECHOCARDIOGRAPHIC PARAMETER THAT DETECTS HYPERVISCOSITY SYNDROME: ACASE REPORT

Abstract: Hyperviscosity syndromes are disorders of infrequent prevalence in which changes of rheological characteristics cause increased resistance to blood flow, endothelial dysfunction, tissue ischemia and bleeding. Signs of hyperviscosity syndrome become clinically overt at the point of 4 centipoise units. We present a case of patient with hyperviscosity syndrome due to Waldenstrom’s macroglobulinemia with negative records on earlier cardiovascular illnesses. Laboratory diagnostic and standard echocardiography did not show any deviation towards increased cardiovascular risk, heart failure or ischemic heart disease. However, unique clinically significant change that could be indirectly related to hyperviscosity syndrome was found with the myocardium performance index (MPI). Tei-index showed median value of 0.75 corresponding to severe grades of myocardial dysfunction earlier described in the literature for other entities. Comprehensive roles of rheological changes in relation to echocardiography, pathophysiology of myocardial performance and cardiovascular continuum might be interesting point for further investigations

Impact of COVID-19 on cardiovascular testing in the United States versus the rest of the world

Objectives: This study sought to quantify and compare the decline in volumes of cardiovascular procedures between the United States and non-US institutions during the early phase of the coronavirus disease-2019 (COVID-19) pandemic. Background: The COVID-19 pandemic has disrupted the care of many non-COVID-19 illnesses. Reductions in diagnostic cardiovascular testing around the world have led to concerns over the implications of reduced testing for cardiovascular disease (CVD) morbidity and mortality. Methods: Data were submitted to the INCAPS-COVID (International Atomic Energy Agency Non-Invasive Cardiology Protocols Study of COVID-19), a multinational registry comprising 909 institutions in 108 countries (including 155 facilities in 40 U.S. states), assessing the impact of the COVID-19 pandemic on volumes of diagnostic cardiovascular procedures. Data were obtained for April 2020 and compared with volumes of baseline procedures from March 2019. We compared laboratory characteristics, practices, and procedure volumes between U.S. and non-U.S. facilities and between U.S. geographic regions and identified factors associated with volume reduction in the United States. Results: Reductions in the volumes of procedures in the United States were similar to those in non-U.S. facilities (68% vs. 63%, respectively; p = 0.237), although U.S. facilities reported greater reductions in invasive coronary angiography (69% vs. 53%, respectively; p < 0.001). Significantly more U.S. facilities reported increased use of telehealth and patient screening measures than non-U.S. facilities, such as temperature checks, symptom screenings, and COVID-19 testing. Reductions in volumes of procedures differed between U.S. regions, with larger declines observed in the Northeast (76%) and Midwest (74%) than in the South (62%) and West (44%). Prevalence of COVID-19, staff redeployments, outpatient centers, and urban centers were associated with greater reductions in volume in U.S. facilities in a multivariable analysis. Conclusions: We observed marked reductions in U.S. cardiovascular testing in the early phase of the pandemic and significant variability between U.S. regions. The association between reductions of volumes and COVID-19 prevalence in the United States highlighted the need for proactive efforts to maintain access to cardiovascular testing in areas most affected by outbreaks of COVID-19 infection

The Changing Landscape for Stroke\ua0Prevention in AF: Findings From the GLORIA-AF Registry Phase 2

Background GLORIA-AF (Global Registry on Long-Term Oral Antithrombotic Treatment in Patients with Atrial Fibrillation) is a prospective, global registry program describing antithrombotic treatment patterns in patients with newly diagnosed nonvalvular atrial fibrillation at risk of stroke. Phase 2 began when dabigatran, the first non\u2013vitamin K antagonist oral anticoagulant (NOAC), became available. Objectives This study sought to describe phase 2 baseline data and compare these with the pre-NOAC era collected during phase&nbsp;1. Methods During phase 2, 15,641 consenting patients were enrolled (November 2011 to December 2014); 15,092 were eligible. This pre-specified cross-sectional analysis describes eligible patients\u2019 baseline characteristics. Atrial fibrillation&nbsp;disease characteristics, medical outcomes, and concomitant diseases and medications were collected. Data were analyzed using descriptive statistics. Results Of the total patients, 45.5% were female; median age was 71 (interquartile range: 64, 78) years. Patients were from Europe (47.1%), North America (22.5%), Asia (20.3%), Latin America (6.0%), and the Middle East/Africa (4.0%). Most had high stroke risk (CHA2DS2-VASc [Congestive heart failure, Hypertension, Age&nbsp; 6575 years, Diabetes mellitus, previous Stroke, Vascular disease, Age 65 to 74 years, Sex category] score&nbsp; 652; 86.1%); 13.9% had moderate risk (CHA2DS2-VASc&nbsp;= 1). Overall, 79.9% received oral anticoagulants, of whom 47.6% received NOAC and 32.3% vitamin K antagonists (VKA); 12.1% received antiplatelet agents; 7.8% received no antithrombotic treatment. For comparison, the proportion of phase 1 patients (of N&nbsp;= 1,063 all eligible) prescribed VKA was 32.8%, acetylsalicylic acid 41.7%, and no therapy 20.2%. In Europe in phase 2, treatment with NOAC was more common than VKA (52.3% and 37.8%, respectively); 6.0% of patients received antiplatelet treatment; and 3.8% received no antithrombotic treatment. In North America, 52.1%, 26.2%, and 14.0% of patients received NOAC, VKA, and antiplatelet drugs, respectively; 7.5% received no antithrombotic treatment. NOAC use was less common in Asia (27.7%), where 27.5% of patients received VKA, 25.0% antiplatelet drugs, and 19.8% no antithrombotic treatment. Conclusions The baseline data from GLORIA-AF phase 2 demonstrate that in newly diagnosed nonvalvular atrial fibrillation patients, NOAC have been highly adopted into practice, becoming more frequently prescribed than VKA in&nbsp;Europe and North America. Worldwide, however, a large proportion of patients remain undertreated, particularly in&nbsp;Asia&nbsp;and North America. (Global Registry on Long-Term Oral Antithrombotic Treatment in Patients With Atrial Fibrillation [GLORIA-AF]; NCT01468701

Związek między stanem odżywienia a stosowaniem inhibitorów pompy protonowej u pacjentów poddawanych rehabilitacji kardiologicznej po leczeniu niedokrwiennej i zastawkowej choroby serca

Background: Multiple and yet uncertain connections exist between cardiovascular diseases and the nutritional status of patients, particularly in relation to cardiovascular treatments. Proton pump inhibitors (PPI) are among the most commonly used group of drugs. Aim: To analyse utilisation of PPI in association with nutritional risk of patients scheduled for rehabilitation after treatment for ischaemic and valvular heart disease. Methods: Retrospective analyses on a consecutive sample of patients, which included drug utilisation of PPI and nutritional risk screening, using a standardised NRS-2002 tool. The patients (n = 536) were divided into groups based on previous cardiovascular treatments and use of PPI. Results: Nearly half of the patients (244, 46.1%) had PPI in their chronic therapy despite the clinically negligible prevalence of conditions that are their fundamental indications. The odds for using PPI in patients with increased nutritional risk, estimated by logistic regression, were 3.34 (95% confidence intervals [CI] 2.26–4.94), p &lt; 0.001. Receiver operating curve analyses also revealed significant differences of PPI utilisation in connection with NRS-2002 &gt; 3: positive likelihood-ratio (LR) 2.35 (95% CI 2.10–2.60); negative LR 0.46 (95% CI 0.4–0.6); area under the curve (AUC) 0.720; p &lt; 0.001; as well as the percentage weigh loss history &gt; 6.36% (positive LR 2.22 [95% CI 2.00–2.50]; negative LR 0.41 [95% CI 0.30–0.50]; AUC 0.707; p &lt; 0.001). Conclusions: Utilisation of PPI was found to be of relatively high prevalence and significantly associated with parameters of nutritional risk screening. Furthermore, it was in correlation with the age of patients and the existence of chronic kidney disease, which are well-established predispositions for poor nutritional status. Nutritional risk seems to be additionally negatively challenged by utilisation of PPI due to gastric malabsorption and anaemia.Wstęp: Istnieją liczne i nieustalone w pełni powiązania między chorobami sercowo-naczyniowymi a stanem odżywienia chorych, zwłaszcza w przypadku stosowania leków działających na układ sercowo-naczyniowy. Do grupy najczęściej wykorzystywanych preparatów należą inhibitory pompy protonowej (PPI). Cel: Celem badania było przeanalizowanie zależności między stosowaniem PPI a ryzykiem związanym ze stanem odżywienia pacjentów poddawanych rehabilitacji kardiologicznej po leczeniu choroby niedokrwiennej i zastawkowej serca. Metody: Przeprowadzono retrospektywną analizę kolejnych prób chorych obejmującą stosowanie PPI i badanie przesiewowe w kierunku ryzyka związanego ze stanem odżywienia, wykorzystując wystandaryzowane narzędzie NRS-2002. Pacjentów (n = 536) podzielono na grupy w zależności od wcześniejszego leczenia chorób sercowo-naczyniowych i stosowania PPI. Wyniki: Prawie połowa chorych (244 osoby, 46,1%) przyjmowała PPI w ramach długookresowej terapii, mimo że zaburzenia stanowiące podstawowe wskazania do ich stosowania występowały u niewielkiego (nieistotnego klinicznie) odsetka badanych. Prawdopodobieństwo stosowania PPI u chorych obciążonych zwiększonym ryzykiem związanym ze stanem odżywienia oszacowane metodą regresji logistycznej wynosiło 3,34 (95% przedział ufności [CI] 2,26–4,94), p &lt; 0,001. Analiza krzywej ROC również wykazała istotną różnicę w stosowaniu PPI w związku z NRS-2002 &gt; 3: iloraz prawdopodobieństwa (LR) otrzymania wyniku dodatniego: 2,35 (95% CI 2,10–2,60); LR otrzymania wyniku ujemnego: 0,46 (95% CI 0,4–0,6); pole pod krzywą (AUC): 0,720; p &lt; 0,001; oraz procentowa utrata masy ciała &gt; 6,36% (LR wyniku dodatniego: 2,22 [95% CI 2,00–2,50]; LR wyniku ujemnego: 0,41 [95% CI 0,30–0,50]; AUC: 0,707; p &lt; 0,001. Wnioski: Stwierdzono, że leki z grupy PPI były wykorzystywane stosunkowo często. Terapia tymi preparatami wiązała się istotnie z parametrami oceny ryzyka związanego ze stanem odżywienia, a także korelowała z wiekiem pacjentów i obecnością przewlekłej choroby nerek, będących uznanymi czynnikami predysponującymi do złego stanu odżywienia. Wydaje się, że stosowanie PPI dodatkowo zwiększa ryzyko związane ze stanem odżywienia ze względu na zmniejszenie wchłaniania w żołądku i niedokrwistość

ANALYZES OF ANTIPLATELETS AND ANTICOAGULANTS UTILIZATION IN PATIENTS TREATED IN CARDIOVASCULAR REHABILITATION CENTER FROM CROATIA

Purpose: Discordance with the guidelines and underutilization of pharmacotherapy for secondary prevention frequently exists in clinical practice. Aim of our study was to assess the prescription routine and drug utilization patterns for antiplatelets and peroral anticoagulants in tertiary medical center specialized for cardiovascular rehabilitation. Methods: study included 96 consecutive patients scheduled for cardiovascular rehabilitation in period 1-6 months after the acute treatment for ischemic 87(80.2%) and valvular heart disease 18(19.8%). Patients were divided according to etiology of heart disease and type of acute cardiovascular treatments (conservative, percutaneous coronary interventions (PCI) and surgery). Results: Dual antiplatelet therapy was the most commonly applied regimen in 84(87.5%) of conservatively treated myocardial infarctions, 47(61.9%) of percutaneous coronary interventions (PCI) and 13(58.9%) of surgically treated group (p>0.05). Among studied group of patients significant differences in utilization were found for warfarin, or combinations of antiplatelets with warfarin(p<0.001), as well as studied etiologies of heart disease(p<0.001), whilst there were no differences for those groups for studied antiplatelets drugs(p>0.05). All four of patients that received triple therapy (4.17%) were from surgical group. Underutilization of antiplatelets in ischemic heart disease was at 11(14.3%) what was congruent with the developed industrial nations. Conclusions: Acute cardiovascular treatment type, but not heart disease etiology, had significant influence on subsequent prescription routine. Decreased use of pharmacological agents for secondary prevention in surgical patients was revealed. Drug utilization analyzes can offer improvement in optimizing medical treatments, quality of care and decrease unnecessary polypragmasia, as well as improve economical efficiency of medical management

Muscle strength differ between patients with diabetes and controls following heart surgery

The aim of our study was to analyze muscle strength in patients with recent surgical treatment for ischemic and combined ischemic- valvular heart disease, based on existence of diabetes mellitus. Connections existing between muscle strength and patient characteristics or conventional diagnostic tests were analyzed as well. Study prospectively included consecutive patients scheduled for cardiovascular rehabilitation 0–3 months after heart surgery. Diagnostics covered drug utilization, anthropometrics, demographics, echocardiography, conventional laboratory, echocardiography, bioelectrical impedance analysis (BIA), and hand grip test (HGT). HGT was analyzed for dominant hand. Patients with diabetes had significantly weaker muscle strength on HGT than controls ; 29.4 ± 12.2 kg vs. 38.2 ± 14.7 kg (p = 0.029), respectively. ROC analysis for HGT and existence of diabetes mellitus were significant ; ≤ 40 kg had sensitivity of 89.7% (95%CI: 72.6–97.8), specificity 43.7% (31.9– 56.0) ; AUC 0.669 (0.568–0.760) ; p = 0.002. HGT significantly correlated with hematocrit (Rho CC = 0.247 ; p = 0.013), whilst other laboratory or echocardiographic parameters were insignificant (all p > 0.05). HGT also correlated with body weight (Rho CC = 0.510 ; p < 0.001) ; height (Rho CC = 0.632 ; p < 0.001) ; waist circumference (Rho CC = 0.388 ; p < 0.001) ; waist-to-hip ratio (Rho CC = 0.274 ; p = 0.006) and BIA (Rho CC = − 0.412 ; p < 0.001). In postoperative recovery of patients with diabetes, muscle strength assessed by HGT is decreased and in relation with nutritional status. Clinically resourceful connections of HGT were also found to hematocrit and utilization of loop diuretics

Clinical and Seasonal Variations of Nutritional Risk Screening in Patients Scheduled for Rehabilitation after Heart Surgery

Background: Current knowledge on the pervasiveness of increased nutritional risk in cardiovascular diseases is limited. Our aim was to analyze the characteristics of nutritional risk screening in patients scheduled for rehabilitation after heart surgery. Prevalence and extent of nutritional risk were studied in connection with patients' characteristics and seasonal climate effects on weight loss dynamics. Methods: The cohort included 65 consecutive patients with an age range of 25-84 years, 2-6 months after surgical treatment for ischemic or valvular heart disease. Nutritional risk screening was appraised using a standardized NRS-2002 questionnaire. Groups were analyzed according to a timeline of rehabilitation according to the "cold" and "warm" seasons of the moderate Mediterranean climate in Opatija, Croatia. Results: Increased nutritional risk scores (NRS-2002) of >3 were found in 96% of studied patients. Mean NRS-2002 of patients was 5.0 +/- 1.0, with a percentage weight loss history of 11.7% +/- 2.2% (4.6-19.0). Risk was found to be more pronounced during the warmer season, with NRS-2002 scores of 5.3 +/- 0.7 versus 4.8 +/- 1.1 (P = 0.136) and greater loss of weight of 13.0% +/- 3.2% versus 10.6% +/- 3% (P = 0.005), respectively. Increased nutritional risk correlated significantly with creatinine concentrations (rho = 0.359; P = 0.034 versus 0.584; P = 0.001, respectively). Significant discordance in correlations was found between NRS-2002 and the decrease in left ventricle systolic function (rho correlation coefficient [rho-cc] = -0.428; P = 0.009), the increase in glucose concentrations (cc = 0.600; P < 0.001), and the decrease in erythrocyte counts (cc = -0.520; P = 0.001) during the colder season. Conclusion: Increased nutritional risk was found to be frequently expressed in the course of rehabilitation after heart surgery. Although seasonal climate effects influenced the weight loss dynamics, the impact on reproducibility of NRS-2002 was clinically less important. Further studies on the connection of nutritional risk with composited end points might offer improvements in overall quality of treatment