Učinkovitost i sigurnost kombinacije atorvastatina/amlodipina u jednoj tableti kod bolesnika s arterijskom hipertenzijom i dislipidemijom

The aim was to evaluate the efficacy of a single-pill combination of atorvastatin/amlodipine in patients with arterial hypertension, dyslipidemia and moderate to high cardiovascular risk. This prospective study included 243 patients with arterial hypertension, dyslipidemia and moderate to high cardiovascular risk, mean age 63.3±9.8 years. All patients were prescribed a treatment with one of the following doses of a single-pill combination of atorvastatin/amlodipine: 10/5, 10/10, 20/5 or 20/10 mg daily. The follow-up period was 3 months. The mean baseline values of the systolic and diastolic blood pressure were 155.7±16.2 and 92.0±9.2 mm Hg, respectively. At month 3, the respective mean systolic and diastolic blood pressure values were 136.9±26.9 and 80.6±5.1 mm Hg. The mean baseline values of total cholesterol and low-density lipoprotein cholesterol were 6.6±1.2 and 4.4±1.1 mmol/L, respectively. At month 3, the respective mean values of total cholesterol and low-density lipoprotein cholesterol were 5.1±0.9 and 2.9±1.0 mmol/L. Treatment was discontinued in 9 (3.7%) patients due to adverse events. In conclusion, treatment with the single-pill combination of atorvastatin/amlodipine was effective and well tolerated by the patients with arterial hypertension, dyslipidemia and moderate to high cardiovascular risk.Cilj ovoga istraživanja je bio ocijeniti učinkovitost kombinacije atorvastatina/amlodipina u jednoj tableti kod bolesnika s arterijskom hipertenzijom, dislipidemijom i umjerenim do visokim kardiovaskularnim rizikom. Ovo prospektivno istraži­vanje obuhvatilo je 243 bolesnika s arterijskom hipertenzijom, dislipidemijom i umjerenim do visokim kardiovaskularnim rizikom, srednje dobi od 63,3±9,8 godina. Bolesnicima je propisana terapija jednim od sljedećih režima doziranja kombinacije atorvastatina/amlodipina u jednoj tableti: 10/5, 10/10, 20/5 ili 20/10 mg na dan. Razdoblje praćenja bilo je 3 mjeseca. Srednje početne vrijednosti sistoličkog i dijastoličkog tlaka bile su 155,7±16,2 i 92,0±92,0 mm Hg. Krajem 3. mjeseca vrijednosti sistoličkog i dijastoličkog tlaka bile su 136,9±26,9 i 80,6±5,0 mg Hg. Srednje početne vrijednosti ukupnog kolesterola i kolesterola niske gustoće bile su 6,6±1,2 i 4,4±1,1 mmol/L. Krajem 3. mjeseca vrijednosti ukupnog kolesterola i kolesterola niske gustoće bile su 5,1±0,9 i 2,9±1,0 mmol/L. Terapija analiziranom kombinacijom lijekova prekinuta je kod 9 (3,7%) bolesnika zbog neželjenih nuspojava. U zaključku, terapija kombinacijom atorvastatina/amlodipina u jednoj tableti visoko je učinkovita i dobro ju podnose bolesnici s arterijskom hipertenzijom, dislipidemijom i umjerenim do visokim kardiovaskularnim rizikom

Effect of easily biodegradable amendments on heavy metal solubilization and accumulation in technical crops ‐ a field trial

Heavy‐metal soil pollution is a common environmental problem all over the world. In the induced phytoextraction process plants can transport and translocate to their above‐ground tissues significant concentration of contaminants. Since some heavy metals are mostly presented in non‐soluble state, the application of chelating agents is needed. In this study we introduced into the rhizosphere of maize (var. Kneja 530) and sunflower (var. Favorit) plants 1 and 5 mmol l−1 of EDDS and NTA, and 5 g kg−1 of nutrients to enhance the accumulated concentrations of cadmium, lead and zinc. The fraction of CaCl2‐extractable metals increased incrementing the concentration of chelates. This was clearly pronounced for all the metals in the treatments with NTA and for Pb in those with EDDS. Generally, under all the experimental conditions the accumulated heavy‐metal concentrations were found to be significantly higher than in the control. Thus, in the case of higher concentration of NTA and EDDS, the accumulated Cd in the leaves of sunflower was found to be threefold higher. The highest accumulation of Pb in the leaves of maize was observed when nutrients were added (62 mg kg−1). On the other hand, negative effects of the used chelating agents on soil bacteria and fungi at plant harvest were not observed. Moreover, when nutrients were added, the number of studied microorganisms significantly increased. Lengvai biodegradavimą pagerinančių pataisymų priemonių poveikis sunkiųjų metalų tirpumui ir akumuliacijai techniniuose pasėliuose – lauko bandymai Santrauka Dirvožemio užterštumas sunkiaisiais metalais yra dažna aplinkos problema visame pasaulyje. Inicijuotas fitoekstrakcijos procesas augaluose gali perkelti į jų antžeminius audinius dideles teršalų koncentracijas. Kadangi kai kurie sunkieji metalai dažniausiai esti netirpios būsenos, reikia pritaikyti chelatų agentus. Į kukurūzus buvo įterpta rizosfera (var. Kneja 530) ir saulėgrąžos (var. Favorit) EDDS bei NTA 1 ir 5 mmol–1 ir 5 g kg–1 mineralinių medžiagų, padidinant kadmio, švino ir cinko akumuliuotas koncentracijas. Ekstrahuotos CaCl2 metalo frakcijos padidino chelatų koncentracijos didėjimą. Tai pasireiškė visiems metalams, apdorotiems su NTA, ir švinui, paveiktam su EDDS. Visuose eksperimentuose akumuliuoto sunkiojo metalo koncentracijos buvo daug didesnės nei kontroliniame bandinyje. Vadinasi, didesnės NTA ir EDDS koncentracijos atveju akumuliuotas Cd saulėgrąžos lapuose buvo 3 kartus didesnis. Didžiausia Pb akumuliacija miežių lapuose išmatuota, pridėjus mineralinių medžiagų (62 mg kg–1). Kita vertus, neigiamas chelatų agentų naudojimo poveikis dirvožemio bakterijoms ir grybeliams augalų derliuje nebuvo nustatytas. Be to, kai buvo pridėta mineralinių medžiagų, padaugėjo nagrinėjamų mikroorganizmų. Reikšminiai žodžiai: sunkieji metalai, fitoekstrakcija, kviečiai, saulėgrąžos, EDDS, NTA, lauko bandymai, rizosferos mikroorganizmai. Полевые испытания влияния мер, способствующих деградации тяжелых металлов, их разложению и накапливанию в технических посевах Резюме Загрязнение почв тяжелыми металлами – наиболее часто отмечаемая проблема во всем мире. Инициированный процесс фитоэкстракции в растениях может способствовать переносу значительных концентраций загрязнителей в их поверхностные ткани. В связи с тем, что некоторые тяжелые металлы находятся в нерастворенном состоянии, необходимо применение агентов хелатов. В настоящем исследовании в кукурузу была введена ризосфера (вар. Kneja 530) и подсолнечник (вар. favorit) EDDS и NTA 1 и 5 ммоль–1 ir 5 г кг–1 минеральных веществ для увеличения аккумулированных концентраций кадмия, свинца и цинка. Экстрагированные фракции металла CaCl2 способствовали увеличению концентрации хелатов. Это подтверждено исследованием всех металлов, подвергшихся воздействию NTA, и свинца, обработанного с помощью EDDS. Во всех экспериментах концентрации аккумулированного тяжелого металла были значительно больше, чем в контрольном образце. Следовательно, в случае большей концентрации NTA и EDDS содержание аккумулированного в листьях подсолнечника Cd было в три раза больше. Наибольшая аккумуляция Cd в листьях ячменя зафиксирована в случае добавления минеральных веществ (62 мг кг–1). Не было обнаружено и отрицательного воздействия от применения агентов хелатов на бактерии почвы и грибки в урожае растений. Кроме того, в результате добавления минеральных веществ количество исследуемых микроорганизмов увеличилось. Ключевые слова: тяжелые металлы, фитоэкстракция, ячмень, подсолнечник, NTA, EDDS полевые испытания, микроорганизмы ризосферы. First Published Online: 14 Oct 201

Dataset of manually measured QT intervals in the electrocardiogram

BACKGROUND: The QT interval and the QT dispersion are currently a subject of considerable interest. Cardiac repolarization delay is known to favor the development of arrhythmias. The QT dispersion, defined as the difference between the longest and the shortest QT intervals or as the standard deviation of the QT duration in the 12-lead ECG is assumed to be reliable predictor of cardiovascular mortality. The seventh annual PhysioNet/Computers in Cardiology Challenge, 2006 addresses a question of high clinical interest: Can the QT interval be measured by fully automated methods with accuracy acceptable for clinical evaluations? METHOD: The PTB Diagnostic ECG Database was given to 4 cardiologists and 1 biomedical engineer for manual marking of QRS onsets and T-wave ends in 458 recordings. Each recording consisted of one selected beat in lead II, chosen visually to have minimum baseline shift, noise, and artifact. In cases where no T wave could be observed or its amplitude was very small, the referees were instructed to mark a 'group-T-wave end' taking into consideration leads with better manifested T wave. A modified Delphi approach was used, which included up to three rounds of measurements to obtain results closer to the median. RESULTS: A total amount of 2*5*548 Q-onsets and T-wave ends were manually marked during round 1. To obtain closer to the median results, 8.58 % of Q-onsets and 3.21 % of the T-wave ends had to be reviewed during round 2, and 1.50 % Q-onsets and 1.17 % T-wave ends in round 3. The mean and standard deviation of the differences between the values of the referees and the median after round 3 were 2.43 ± 0.96 ms for the Q-onset, and 7.43 ± 3.44 ms for the T-wave end. CONCLUSION: A fully accessible, on the Internet, dataset of manually measured Q-onsets and T-wave ends was created and presented in additional file: 1 (Table 4) with this article. Thus, an available standard can be used for the development of automated methods for the detection of Q-onsets, T-wave ends and for QT interval measurements

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 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 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  6575 years, Diabetes mellitus, previous Stroke, Vascular disease, Age 65 to 74 years, Sex category] score  652; 86.1%); 13.9% had moderate risk (CHA2DS2-VASc = 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 = 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 Europe and North America. Worldwide, however, a large proportion of patients remain undertreated, particularly in Asia and North America. (Global Registry on Long-Term Oral Antithrombotic Treatment in Patients With Atrial Fibrillation [GLORIA-AF]; NCT01468701

Risk Factors, Co-Morbidities and Treatment of In-Hospital Patients with Atrial Fibrillation in Bulgaria

Background and objectives: Atrial fibrillation (AF) is the most common arrhythmia worldwide and a major risk factor for cardiovascular complications. Our study aimed to investigate the prevalence, risk factors, demographics, co-morbidities and treatment of AF among in-hospital Bulgarian patients. Materials and Methods: A cross-sectional study including 1027 consecutive patients (n = 516, 50.2% males) with a mean age of 67.6 ± 11.3 years, hospitalized for any reason from 1 May until 31 December 2016 in one of the largest internal clinics in Bulgaria, was carried out. Results: Atrial fibrillation was diagnosed in 634 (61.7%) patients. The prevalence of modifiable AF risk factors was as follows: heart failure, 98.9%; arterial hypertension (HTN), 93.5%; valvular heart disease, 40.9%; chronic lung disease, 26.7%; type 2 diabetes mellitus, 24.9%; thyroid disease, 16.9%; and ischemic heart disease, 11.2%. Univariate logistic regression analysis identified the following risk factors with strongest impact on AF: left ventricular ejection fraction <40% (odds ratio (OR) = 1.951, 95% confidence interval (CI) 1.208–3.151), valvular heart disease (OR = 1.926, 95% CI 1.134–3.862), left ventricular ejection fraction 40–49% (OR = 1.743, 95% CI 1.248–3.017), HTN (OR = 1.653, 95% CI 1.092–3.458). History of ischemic stroke was present in 14.4% of the patients with AF. Oral antithrombotic drugs were prescribed to 85.7%: direct oral anticoagulants to 37.9%, vitamin K antagonists to 43.2%, and antiplatelets to 4.6%. Heart rate control medications and antiarrhythmics were prescribed to 75.4% and 40.2%, respectively. Conclusions: Atrial fibrillation was highly prevalent among our study population. Reduced and mid-range left ventricular ejection fraction, valvular heart disease, and HTN were the risk factors with the strongest association with AF. Although a large number of our AF patients were administered antithrombotic treatment, the prescription rate of oral anticoagulants should be further improved

Recognition of Supraventricular Arrhythmias in Holter ECG Recordings by ECHOView Color Map: A Case Series Study

Ambulatory 24–72 h Holter ECG monitoring is recommended for patients with suspected arrhythmias, which are often transitory and might remain unseen in resting standard 12-lead ECG. Holter manufacturers provide software diagnostic tools to assist clinicians in evaluating these large amounts of data. Nevertheless, the identification of short arrhythmia events and differentiation of the arrhythmia type might be a problem in limited Holter ECG leads. This observational clinical study aims to explore a novel and weakly investigated ECG modality integrated into a commercial diagnostic tool ECHOView (medilog DARWIN 2, Schiller AG, Switzerland), while used for the interpretation of long-term Holter-ECG records by a cardiologist. The ECHOView transformation maps the beat waveform amplitude to a color-coded bar. One ECHOView page integrates stacked color bars of about 1740 sequential beats aligned by R-peak in a window (R ± 750 ms). The collected 3-lead Holter ECG recordings from 86 patients had a valid duration of 21 h 20 min (19 h 30 min–22 h 45 min), median (quartile range). The ECG rhythm was reviewed with 3491 (3192–3723) standard-grid ECG pages and a substantially few number of 51 (44–59) ECHOView pages that validated the ECHOView compression ratio of 67 (59–74) times. Comments on the ECG rhythm and ECHOView characteristic patterns are provided for 14 examples representative of the most common rhythm disorders seen in our population, including supraventricular arrhythmias (supraventricular extrasystoles, paroxysmal supraventricular arrhythmia, sinus tachycardia, supraventricular tachycardia, atrial fibrillation, and flutter) and ventricular arrhythmias (ventricular extrasystoles, non-sustained ventricular tachycardia). In summary, the ECHOView color map transforms the ECG modality into a novel diagnostic image of the patient’s rhythm that is comprehensively interpreted by a cardiologist. ECHOView has the potential to facilitate the manual overview of Holter ECG recordings, to visually identify short-term arrhythmia episodes, and to refine the diagnosis, especially in high-rate arrhythmias

Efficacy and Safety of a Single-Pill Combination of Atorvastatin/Amlodipine in Patients with Arterial Hypertension and Dyslipidemia

The aim was to evaluate the efficacy of a single-pill combination of atorvastatin/amlodipine in patients with arterial hypertension, dyslipidemia and moderate to high cardiovascular risk. This prospective study included 243 patients with arterial hypertension, dyslipidemia and moderate to high cardiovascular risk, mean age 63.3±9.8 years. All patients were prescribed a treatment with one of the following doses of a single-pill combination of atorvastatin/amlodipine: 10/5, 10/10, 20/5 or 20/10 mg daily. The follow-up period was 3 months. The mean baseline values of the systolic and diastolic blood pressure were 155.7±16.2 and 92.0±9.2 mm Hg, respectively. At month 3, the respective mean systolic and diastolic blood pressure values were 136.9±26.9 and 80.6±5.1 mm Hg. The mean baseline values of total cholesterol and low-density lipoprotein cholesterol were 6.6±1.2 and 4.4±1.1 mmol/L, respectively. At month 3, the respective mean values of total cholesterol and low-density lipoprotein cholesterol were 5.1±0.9 and 2.9±1.0 mmol/L. Treatment was discontinued in 9 (3.7%) patients due to adverse events. In conclusion, treatment with the single-pill combination of atorvastatin/amlodipine was effective and well tolerated by the patients with arterial hypertension, dyslipidemia and moderate to high cardiovascular risk

Pericardial Effusion in Obstructive Sleep Apnea without Pulmonary Arterial Hypertension and Daily Hypoxemia - is it Unusual?

Background: Pericardial effusion in chronic hypoxemic lung diseases, such as Obstructive Sleep Apnea syndrome, usually occurs after the development of severe pulmonary arterial hypertension. However, data about the frequency of pericardial effusions in Obstructive Sleep Apnea syndrome without pulmonary arterial hypertension and/or daytime hypoxemia are still scarce, and their pathogenesis is unclear. Aims: To assess the prevalence of pericardial effusions and their volume and location in patients with obesity and Obstructive Sleep Apnea syndrome without pulmonary arterial hypertension and/or hypoxemia. Study Design: Cross-sectional study. Methods: We included 279 consecutive patients (162 males) with newly diagnosed Obstructive Sleep Apnea syndrome having a mean age of 42.8±12.4 years and a mean body mass index of 37.3±7.8 kg/m2. Obstructive Sleep Apnea syndrome was confirmed by polysomnography. Main exclusion criteria were concomitant inflammatory diseases, thyroid dysfunction, daytime hypoxemia, nephrotic syndrome, left ventricular systolic dysfunction and pulmonary arterial hypertension. Results: Pericardial effusion was found in 102 (36.56%) -all of them with moderate to severe obstructive Sleep Apnea syndrome. The mean effusion volume was mild to moderate (up to 250 mL). In 36 patients (35.3%) the pericardial effusion was diffuse, in 42 (41.2%), the pericardial effusion was located in front of the right atrium and the right ventricle, and in 24 (23.5%) the pericardial effusion was situated in front of the right cardiac cavities and the left atrium. We found a significant positive correlation between the presence of pericardial effusion and apnea-hypopnea index (r=0.374, p<0.001), body mass index (r=0.473, p<0.001), and desaturation time during sleep (r=0.289, p<0.001). Conclusion: Pericardial effusion in patients with obesity and moderate to severe Obstructive Sleep Apnea syndrome without daily hypoxemia and/or pulmonary hypertension is a relatively common finding. The occurrence of pericardial effusions is dependent mostly on the grade of Obstructive Sleep Apnea syndrome, degree of obesity, and duration of sleep desaturation

Application of Dense Neural Networks for Detection of Atrial Fibrillation and Ranking of Augmented ECG Feature Set

Considering the significant burden to patients and healthcare systems globally related to atrial fibrillation (AF) complications, the early AF diagnosis is of crucial importance. In the view of prominent perspectives for fast and accurate point-of-care arrhythmia detection, our study optimizes an artificial neural network (NN) classifier and ranks the importance of enhanced 137 diagnostic ECG features computed from time and frequency ECG signal representations of short single-lead strips available in 2017 Physionet/CinC Challenge database. Based on hyperparameters’ grid search of densely connected NN layers, we derive the optimal topology with three layers and 128, 32, 4 neurons per layer (DenseNet-3@128-32-4), which presents maximal F1-scores for classification of Normal rhythms (0.883, 5076 strips), AF (0.825, 758 strips), Other rhythms (0.705, 2415 strips), Noise (0.618, 279 strips) and total F1 relevant to the CinC Challenge of 0.804, derived by five-fold cross-validation. DenseNet-3@128-32-4 performs equally well with 137 to 32 features and presents tolerable reduction by about 0.03 to 0.06 points for limited input sets, including 8 and 16 features, respectively. The feature reduction is linked to effective application of a comprehensive method for computation of the feature map importance based on the weights of the activated neurons through the total path from input to specific output in DenseNet. The detailed analysis of 20 top-ranked ECG features with greatest importance to the detection of each rhythm and overall of all rhythms reveals DenseNet decision-making process, noticeably corresponding to the cardiologists’ diagnostic point of view

Physicians’ Perceptions of Their Patients’ Attitude and Knowledge of Long-Term Oral Anticoagulant Therapy in Bulgaria

Background and Objectives: Oral anticoagulation (OAC) is widely used in daily clinical practice worldwide for various indications. We aimed to explore the perception of Bulgarian clinicians about their patients&rsquo; attitude and knowledge of long-term OAC, prescribed for atrial fibrillation (AF) and/or known deep venous thrombosis (DVT)/pulmonary embolism (PE). Materials and Methods: We performed a cross-sectional study that involved 226 specialists: 187 (82.7%) cardiologists, 23 (10.2%) neurologists, and 16 (7.1%) vascular surgeons. They filled in a questionnaire, specially designed for our study, answering various questions regarding OAC treatment in their daily clinical practice. Results: The mean prescription rate of OACs in AF patients was 80.3% and in DVT/PE&mdash;88.6%. One hundred and eighty-seven (82.7%) of the participants stated they see their patients on OAC at least once per month. According to more than one-third of the inquired clinicians, the patients did not understand well enough the provided information concerning net clinical benefit of OAC treatment. About 68% of the clinicians declared that their patients would prefer a &ldquo;mutual&rdquo; approach, discussing with the physician the OAC options and taking together the final decision, whereas according to 43 (19.0%), the patients preferred the physician to take a decision for them. Patients&rsquo; OAC treatment had been interrupted at least once within the last year due to a physician&rsquo;s decision by 178 (78.8%) of the participants and the most common reason was elective surgery. The most influential factors for a patient&rsquo;s choice of OAC were the need of a specific diet to be kept, intake frequency, and possible adverse reactions. Conclusions: Our results suggest that a clinician&rsquo;s continuous medical education, shared decision-making, and appropriate local strategies for improved awareness of AF/DVT/PE patients are key factors for improvement of OAC management