Prognostic implications of myocardial perfusion imaging and coronary calcium score in a Macedonian cohort of asymptomatic patients with type 2 diabetes

Aim: Type 2 diabetes is a risk factor for coronary artery disease; however, a number of studies have shown that patients are asymptomatic for coronary artery disease. The presence of coronary artery disease in asymptomatic patients with type 2 diabetes was evaluated to determine its impact on management decision and prognosis. Methods: A total of 75 patients underwent single-photon emission computed tomography myocardial perfusion imaging for detection of suspected coronary artery disease. We used 17-segment model for perfusion and function analysis. Multislice computed tomography was performed in 45 patients to assess coronary artery calcium. Complete laboratory analyses with lipid values and standard risk factors were analysed. Forward logistic regression analysis was used to assess predictive parameters for myocardial ischaemia during the follow-up period of 20 ± 4 months. Results and Conclusion: Silent myocardial ischaemia and subclinical coronary artery disease can be detected in a significant proportion of asymptomatic patients with type 2 diabetes. Diabetic patients with normal myocardial perfusion imaging had an excellent 2-year prognosis with optimal medical therapy and intensive risk factor control. In comparison, an abnormal myocardial perfusion imaging led to an increased risk of cardiovascular events. Myocardial perfusion imaging and coronary artery calcium are valuable tools for risk stratification and optimal treatment decision in this asymptomatic diabetic cohort of Macedonian patients. </jats:sec

DIFFERENT APPROACHES IN ANALYZING CHYMOSIN PURITY

Chymosin is a specific proteolytic enzyme found in rennet, and is the key enzyme in cheese production classified in the aspartic endopeptidases (EC 3.4.23.4). The aim of this study was to determine the purity of different commercially available chymosins and its equivalents using electrophoretic and chromatographic techniques. Chymosins produced by the company Chr. Hansen, CHY-MAX 200 and CHY-MAX Plus, CHY-MAX PowderExtra NB, as well as Maxiren 1800 Granulate from the company DSM, Sirnik from SZR – Travnik, Kraljevo and Planika from Mikroprocessing, Bileca were used as materials for this study. The purity level of the commercially available enzymes was analyzed using electrophoretic (sodium dodecyl sulfate polyacrylamide gel electrophoresis or SDS-PAGE) and chromatographic (Rapid Resolution Liquid Chromatography or RRLC) techniques. Results showed no presence of undeclared protein fractions due to inappropriate purification process in the samples except for CHY-MAX М 200 which had two protein fractions, most likely as a result of a polymorphism. All the CHY-MAX and Maxiren samples have chymosin as the active component (36 kDa), except for Planika and Sirnik which have a natural protease from R. miehei. Chromatographic analysis showed that beside the active component (chymosin), the preservative sodium benzoate was present in varying concentrations in all but CHY-MAX PowderExtra NB

The 'peptide for life' initiative in the emergency department study.

AIMS: Natriuretic peptide (NP) uptake varies in Emergency Departments (EDs) across Europe. The 'Peptide for Life' (P4L) initiative, led by Heart Failure Association, aims to enhance NP utilization for early diagnosis of heart failure (HF). We tested the hypothesis that implementing an educational campaign in Western Balkan countries would significantly increase NP adoption rates in the ED. METHODS AND RESULTS: This registry examined NP adoption before and after implementing the P4L-ED study across 10 centres in five countries: Bosnia and Herzegovina, Croatia, Montenegro, North Macedonia, and Serbia. A train-the-trainer programme was implemented to enhance awareness of NP testing in the ED, and centres without access received point-of-care instruments. Differences in NP testing between the pre-P4L-ED and post-P4L-ED phases were evaluated. A total of 2519 patients were enrolled in the study: 1224 (48.6%) in the pre-P4L-ED phase and 1295 (51.4%) in the post-P4L-ED phase. NP testing was performed in the ED on 684 patients (55.9%) during the pre-P4L-ED phase and on 1039 patients (80.3%) during the post-P4L-ED phase, indicating a significant absolute difference of 24.4% (95% CI: 20.8% to 27.9%, P < 0.001). The use of both NPs and echocardiography significantly increased from 37.7% in the pre-P4L-ED phase to 61.3% in the post-P4L-ED phase. There was an increased prescription of diuretics and SGLT2 inhibitors during the post-P4L-ED phase. CONCLUSIONS: By increasing awareness and providing resources, the utilization of NPs increased in the ED, leading to improved diagnostic accuracy and enhanced patient care

Sex- and age-related differences in the management and outcomes of chronic heart failure: an analysis of patients from the ESC HFA EORP Heart Failure Long-Term Registry

Aims: This study aimed to assess age- and sex-related differences in management and 1-year risk for all-cause mortality and hospitalization in chronic heart failure (HF) patients. Methods and results: Of 16 354 patients included in the European Society of Cardiology Heart Failure Long-Term Registry, 9428 chronic HF patients were analysed [median age: 66 years; 28.5% women; mean left ventricular ejection fraction (LVEF) 37%]. Rates of use of guideline-directed medical therapy (GDMT) were high (angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, beta-blockers and mineralocorticoid receptor antagonists: 85.7%, 88.7% and 58.8%, respectively). Crude GDMT utilization rates were lower in women than in men (all differences: P\ua0 64 0.001), and GDMT use became lower with ageing in both sexes, at baseline and at 1-year follow-up. Sex was not an independent predictor of GDMT prescription; however, age >75 years was a significant predictor of GDMT underutilization. Rates of all-cause mortality were lower in women than in men (7.1% vs. 8.7%; P\ua0=\ua00.015), as were rates of all-cause hospitalization (21.9% vs. 27.3%; P\ua075 years. Conclusions: There was a decline in GDMT use with advanced age in both sexes. Sex was not an independent predictor of GDMT or adverse outcomes. However, age >75 years independently predicted lower GDMT use and higher all-cause mortality in patients with LVEF 6445%

European Society of Cardiology: Cardiovascular Disease Statistics 2019

Aims The 2019 report from the European Society of Cardiology (ESC) Atlas provides a contemporary analysis of cardiovascular disease (CVD) statistics across 56 member countries, with particular emphasis on international inequalities in disease burden and healthcare delivery together with estimates of progress towards meeting 2025 World Health Organization (WHO) non-communicable disease targets. Methods and results In this report, contemporary CVD statistics are presented for member countries of the ESC. The statistics are drawn from the ESC Atlas which is a repository of CVD data from a variety of sources including the WHO, the Institute for Health Metrics and Evaluation, and the World Bank. The Atlas also includes novel ESC sponsored data on human and capital infrastructure and cardiovascular healthcare delivery obtained by annual survey of the national societies of ESC member countries. Across ESC member countries, the prevalence of obesity (body mass index ≥30 kg/m2) and diabetes has increased two- to three-fold during the last 30 years making the WHO 2025 target to halt rises in these risk factors unlikely to be achieved. More encouraging have been variable declines in hypertension, smoking, and alcohol consumption but on current trends only the reduction in smoking from 28% to 21% during the last 20 years appears sufficient for the WHO target to be achieved. The median age-standardized prevalence of major risk factors was higher in middle-income compared with high-income ESC member countries for hypertension {23.8% [interquartile range (IQR) 22.5–23.1%] vs. 15.7% (IQR 14.5–21.1%)}, diabetes [7.7% (IQR 7.1–10.1%) vs. 5.6% (IQR 4.8–7.0%)], and among males smoking [43.8% (IQR 37.4–48.0%) vs. 26.0% (IQR 20.9–31.7%)] although among females smoking was less common in middle-income countries [8.7% (IQR 3.0–10.8) vs. 16.7% (IQR 13.9–19.7%)]. There were associated inequalities in disease burden with disability-adjusted life years per 100 000 people due to CVD over three times as high in middle-income [7160 (IQR 5655–8115)] compared with high-income [2235 (IQR 1896–3602)] countries. Cardiovascular disease mortality was also higher in middle-income countries where it accounted for a greater proportion of potential years of life lost compared with high-income countries in both females (43% vs. 28%) and males (39% vs. 28%). Despite the inequalities in disease burden across ESC member countries, survey data from the National Cardiac Societies of the ESC showed that middle-income member countries remain severely under-resourced compared with high-income countries in terms of cardiological person-power and technological infrastructure. Under-resourcing in middle-income countries is associated with a severe procedural deficit compared with high-income countries in terms of coronary intervention, device implantation and cardiac surgical procedures. Conclusion A seemingly inexorable rise in the prevalence of obesity and diabetes currently provides the greatest challenge to achieving further reductions in CVD burden across ESC member countries. Additional challenges are provided by inequalities in disease burden that now require intensification of policy initiatives in order to reduce population risk and prioritize cardiovascular healthcare delivery, particularly in the middle-income countries of the ESC where need is greatest

Correlation between Thyroid Hormone Values and Carotid Intima Media Thickness in Patients with Subclinical Hypothyroidism

Purpose: The aim of the study was to investigate the influence of thyroid-stimulating (TSH) and free thyroxin (fT4) hormones on carotid intima media thickness (cIMT). Material and methods: Sixty nine consecutive patients who attended to the Department of University Clinic of Endocrinology, Diabetes and Metabolic disorders with newly diagnosed subclinical hypothyroidism (ScH) were evaluated for mean and maximal cIMT. ScH were defined as elevated TSH with normal fT4 serum values. Results: Mean TSH, fT4, cIMT, and max cIMT were: 7,9±3,6 mU/L, 14,5±2,8 pmol/L, 0,61±0,1 mm, and 0,65±0,1 mm, respectively. Statistically significant positive correlation were evaluated between TSH value and mean and max cIMT (r=0,28, and r=0,29, respectively p<0,05). While fT4 statistically significant negative correlated with mean and max cIMT (r=-0,35, and r=-0,33, respectively p<0,01). Conclusion: Thyroid hormone values are correlated with carotid intima media thickness in patients with subclinical hypothyroidism. Key words: carotid intima media thickness, thyroid-stimulating hormone, subclinical hypothyroidism

IN-HOUSE VALIDATION OF AN SPE-GC-FID METHOD FOR THE DETECTION OF FREE AND ESTERIFIED HYDROXYLATED MINOR COMPOUNDS IN VIRGIN OLIVE OILS

INTRODUCTION Virgin olive oils suffer from adulterations as observed in the EC reports related to food fraud [1]. In this context, the analytical evaluation of the composition of sterols is a well-established tool for assessing the purity of olive oils, as it depends on the botanical origin. The available official methods are suitable to determine the total composition of sterols, not depending on being in the free or in the esterified form [2, 3]. However, it should be highlighted that, in different vegetable oils, sterols can be differently distributed between these two forms. Information related to the esterified fraction of minor compounds (hydroxylated minor compounds, HMCs) in oil is inevitably lost when applying official procedures involving a saponification step. A method for the determination of the free and esterified minor components (waxes, alkyl esters, free fatty alcohols, free and esterified sterols, free and esterified triterpenic alcohols, sterenes, and free and esterified tocopherols) in olive and seed oils has been developed and in-house validated in this experimental work. The proposed offline SPE-GC-FID methodology, that takes inspiration from previous research works [4, 5], has been applied to pure olive and sunflower oil samples and tested for its ability to reveal extra virgin olive oil (EVOO) adulteration with small percentages (up to 10%, w/w) of refined sunflower oil (RSO). RESULTS A simplified method based on offline SPE-GC-FID for analysis of free and esterified HMCs in olive and seed oils has been developed and in-house validated. This method is accessible to most analytical laboratories and replace toxic solvents usually employed in sterol analysis while reducing at minimum the amounts of reagents needed. The procedure allows the conversion of free minor compounds into silyl derivatives, in such a way, their polarity become the same of esterified minor components. Oil is then fractioned by silica solid-phase extraction and the fraction with free and esterified minor compounds is analyzed by capillary GC with on column injection. The method has been optimized and then in-house validated using three different oils [EVOO, refined pomace oil (PO), and RSO] samples. The method has been applied to pure EVOO and RSO samples (see Figure). As an example, results showed three times higher level of esterified minor compounds in RSO compared to EVOO, thus confirming that the esterified fraction could represent the most diagnostic one for detecting the fraudulent addition of RSO to EVOO. Additionally, the ability of the method to quantify free and esterified HMCs has been investigated by analyzing EVOO samples added with small amounts of RSO

Echocardiographic findings on aortic stenosis: an observational, prospective, and multi-center registry

Background: The aim of this aortic stenosis registry was to investigate the changes of routine echocardiographic indices and strain in patients with moderate-to-severe aortic stenosis over a 6-month follow-up period. Methods: Our aortic stenosis registry is observational, prospective, multicenter registry of nine countries, with 197 patients with aortic valve area less than 1.5 cm2. The enrolment took place from January to August 2017. We excluded patients with uncontrolled atrial arrhythmias, pulmonary hypertension or cardiomyopathies, as well as those with hemodynamically significant valvular disease other than aortic stenosis. We included patients who did not require intervention and who had a complete follow-up study. Results: In patients with preserved ejection fraction, left ventricular mass has significantly increased between baseline and follow-up studies (218 ± 34 grams vs 253 ± 29 grams, p = 0.02). However, when indexed to body surface area, there was no significant difference. Left ventricular global longitudinal strain significantly decreased (-19.7 ± -4.8 vs (-16.4 vs -3.8, p = 0.01). Left atrial volume was significantly higher at follow-up (p = 0.035). Right ventricular basal diameter and mid-cavity diameter were greater at the follow-up (p = 0.04 and p = 0.035, respectively). Patients with low-flow low-gradient aortic stenosis had significantly lower global longitudinal strain (-12.3% ± -3.9% vs -19.7% ± -4.8%, p = 0.01). Conclusion: Left atrial dilatation is one of the first changes to take place in low-flow low-gradient aortic stenosis patients even when left ventricular dimensions and function remains intact. Global longitudinal strain is an important determinant of left ventricular systolic and diastolic dysfunction and right ventricular function is an important parameter of aortic stenosis assessment. Accordingly, our registry has further shed the light on these indices role as multisite follow-up of aortic stenosis