Clinical and metabolic characteristics of treated hyperlipidemic patients additionally affected by subclinical hyperglycemia

Background Impaired glucose regulation (IGR) and hyperlipidemia (HL) are associated with an increased risk of developing a cardiovascular disease. Hyperlipidemic patients were shown to bear a greater risk for an increased intima media thickness (IMT). However little is known about differences between treated hyperlipidemic patients (HL) with normal (NGR) or impaired (IGR) glucose regulation. Methods We performed a cross-sectional study, involving 96 non-diabetic HL patients with IGR (fasting plasma glucose of 100 mg/dl and <126 mg/dl or/and HbA1c-level of 5.7 and <6.5 %) or with NGR (HbA1c-level of <5.7 % and a fasting glucose <100 mg/dl). We compared metabolic characteristics and the IMT between the two groups. Insulin sensitivity in fasting conditions was described by HOMA-IR and QUICKI. Results HL-IGR patients were older (57.6 10.4 vs. 49.1 8.7, p < 0.001), had higher carotid IMT measurements (IMT average: 0.68 0.14 vs. 0.60 0.09, p = 0.002; IMT right: 0.67 0.15 vs. 0.60 0.10, p = 0.013; IMT left: 0.63 vs. 0.57, p = 0.009), as well as a higher chance to exceed a cut-off value of 0.8 mm or insignificant stenosis within this investigation (OR: 3.9, 95 % CI: 1.15-13.22, p = 0.029) compared to HL-NGR-patients. Furthermore HL-IGR patients were characterised by a higher waist circumference (100.6 10.1 vs. 91.6 13.3, p < 0.001), higher fasting plasma glucose-levels (100.1 10.8 vs. 88.1 6.6, p < 0.001), higher HbA1c concentrations (5.8 0.33 vs. 5.3 0.24, p < 0.001) and C-peptide levels (2.70 vs. 2.10, p = 0.012). Age and CVD status were in general the only two variables which independently explained IMT. Conclusion Our study showed that among patients with treated hyperlipidemia the presence of IGR characterised subjects who were older and had a significantly higher risk for an increased IMT compared with those maintaining NGR. Further studies are necessary to evaluate if this specific subpopulation with IGR can benefit from a more strict multifactorial management and perhaps from an additional early antihyperglycaemic treatment.(VLID)511297

Long-term outcome of combined (percutaneous intramyocardial and intracoronary) application of autologous bone marrow mononuclear cells post myocardial infarction: the 5-year MYSTAR study

OBJECTIVE: The long-term (5-year) outcome of early (3-6 weeks after acute myocardial infarction [AMI], BM-MNC Early group) and late (3-4 months after AMI, BM-MNC Late group) combined (percutaneous intramyocardial and intracoronary) delivery of autologous bone marrow mononuclear cells (BM-MNCs) was evaluated in patients with ejection fractions (EF) between 30-45% post-AMI. METHODS: Major adverse cardiac and cerebrovascular events (MACCE) and hospitalization were recorded. Left (LV) and right (RV) ventricular function were measured by transthoracic echocardiography. Cardiac magnetic resonance imaging (MRI) and myocardial single photon emission computed tomography was performed in a subgroup of patients. Pre-cell therapy myocardial voltage values of treated areas (assessed by NOGA mapping) were correlated with clinical outcome. RESULTS: Five-year MACCE incidences (7.4%. vs 24.1%) and the composite of all adverse events (11.1% vs 27.6%) were not different between the Early and Late treatment groups. The significant LV-EF increase at 1-year follow-up was preserved at the 5-year control (from baseline to 5-year: 5.3%, 95% CI:0.5-10.1, and 5.7%, 95% CI:1.7-9.6, p<0.05 in the Early and Late groups, respectively), with no significant changes between 1- and 5-year follow-ups. Similarly, RVEF increased significantly from baseline to the 5-year follow-up (Early group: 5.4%, 95% CI:1.0-9.6; and Late group: 8.4%, 95% CI:4.5-12.3). Lower baseline levels of myocardial viability of the treated cardiac area (6.3+/-2.4 vs 8.2+/-3.0 mV, p<0.05) were associated with incidence of MACCE. CONCLUSIONS: Percutaneous combined delivery of autologous BM-MNCs is feasible and safe after 5 years, and may result in sustained improvement of cardiac function at 5 years in patients with low EF post-AMI (Clinicaltrials.gov NCT01395212)

Cardiopulmonary Long-Term Sequelae in Patients after Severe COVID-19 Disease

We aimed to identify cardiopulmonary long-term effects after severe COVID-19 disease as well as predictors of Long-COVID in a prospective registry. A total of 150 consecutive, hospitalized patients (February 2020 and April 2021) were included six months post hospital discharge for a clinical follow-up. Among them, 49% experienced fatigue, 38% exertional dyspnea and 75% fulfilled criteria for Long-COVID. Echocardiography detected reduced global longitudinal strain (GLS) in 11% and diastolic dysfunction in 4%. Magnetic resonance imaging revealed traces of pericardial effusion in 18% and signs of former pericarditis or myocarditis in 4%. Pulmonary function was impaired in 11%. Chest computed tomography identified post-infectious residues in 22%. Whereas fatigue did not correlate with cardiopulmonary abnormalities, exertional dyspnea was associated with impaired pulmonary function (OR 3.6 [95% CI: 1.2–11], p = 0.026), reduced GLS (OR 5.2 [95% CI: 1.6–16.7], p = 0.003) and/or left ventricular diastolic dysfunction (OR 4.2 [95% CI: 1.03–17], p = 0.04). Predictors of Long-COVID included length of in-hospital stay (OR: 1.15 [95% CI: 1.05–1.26], p = 0.004), admission to intensive care unit (OR cannot be computed, p = 0.001) and higher NT-proBNP (OR: 1.5 [95% CI: 1.05–2.14], p = 0.026). Even 6 months after discharge, a majority fulfilled criteria for Long-COVID. While no associations between fatigue and cardiopulmonary abnormalities were found, exertional dyspnea correlated with impaired pulmonary function, reduced GLS and/or diastolic dysfunction

Secondary end points of patients with LV functional studies (n = 51) 5 years after cardiac bone-marrow mononuclear cell (BM-MNC) therapy.

<p>Secondary end points of patients with LV functional studies (n = 51) 5 years after cardiac bone-marrow mononuclear cell (BM-MNC) therapy.</p

Gated ⁹⁹m-Sestamibi myocardial scintigraphy of a patient with cardiac bone marrow mononuclear cell (BM-MNC) treatment.

<p>(A) and (B) Before combined cardiac delivery of autologous BM-MNC treatment; 3-dimensional calculation of LV volume (A) and polar map of infarct size (B). (C) and (D) At the 1-year follow-up, 3-dimensional calculation of LV volume (C) and polar map for infarct size (D). (E) and (F) At the 5-year follow-up, 3-dimensional calculation of LV volume (E) and polar map for infarct size (F).</p

Primary end point: occurrence of adverse events during the 5-year follow-up.

<p>In patients with multiple events during the 5-year FUP, the most serious major adverse event was entered as MACCE and the composite of all adverse events (one/patient) for each patient.</p

Segmental infarct transmurality determined by cardiac magnetic resonance imaging (n = 26).

<p>Segmental infarct transmurality determined by cardiac magnetic resonance imaging (n = 26).</p