Pretest probability of coronary artery disease as a factor for optimizing invasive diagnostics in routine clinical practice

According to the European Society of Cardiology guidelines, patients with chest pain requires the calculation of pretest probability (PTP) of coronary artery disease (CAD), followed by the identification of diagnostic tactics.Aim. To analyze the registry of patients with stable CAD in order to assess the frequency of PTP calculation, as well as the validity of diagnostic tactics choice depending on its level.Material and methods. The data of the registry of patients with stable CAD for the periods from 2012 to 2014 and from 2017 to 2019 were analyzed. We assessed the number of CAD patients, proportion of men, and distribution of patients depending on angina functional class. In addition, data on PTP calculation, as well as distribution of patients and diagnostic strategy selected depending on its value was analyzed. To assess differences (p) in pairwise comparisons, Student’s t-test was used. Differences were considered significant at p<0,05. Statistical analysis was performed using Microsoft Office Excel 2010 (Microsoft, USA) and STATISTICA 6.0 (StatSoft Inc., USA).Results. In 2017-2019, the number of detected CAD cases and proportion of men increased. In both time periods, an insufficient level of calculating PTP of CAD remains. In patients with intermediate PTP, 15-85% of priority tactics are invasive interventions, and with high PTP, the percentage of invasive methods does not reach the proper level, which does not correspond to modern guidelines for the management of CAD patients and leads to misappropriation of funds and healthcare resources.Conclusion. According to medical records, PTP can be determined in less than half of patients. In CAD patients with intermediate PTP, non-invasive studies are not carried out in full, since coronary angiography is preferred. In patients with a high PTP, invasive diagnostics is insufficient

Combination of coronary heart disease, chronic heart failure, and anaemic syndrome: clinical features and prognostic impact of anaemia treatment

Practitioners are often faced with a combination of coronary heart disease (CHD), chronic heart failure (CHF), and anaemic syndrome. These patients are typically characterised by a worse prognosis of acute and chronic CHD, as well as by a rapid progression of CHF and chronic renal failure (CKF).This review is focussed on the epidemiology of anaemia in CHD and CHF patients; the aetiology and pathogenesis of anaemia in CHD and CHF; and the changes of cardiovascular parameters in patients with anaemic syndrome. Despite the abundance of studies on CHD and CHF clinical course and prognosis in anaemic syndrome, very little is known about the effects of anaemia treatment on the clinical course and prognosis of CHD. The review presents the external evidence and original results on the prognosis of acute and chronic CHD in anaemic patients. A modern view on anaemia treatment in various CHD forms is also presented

Heart failure and anemia in patients with acute myocardial infarction

In-hospital management of myocardial infarction was analyzed for 150 patients (54 women). Mean age was 59, 6+1, 1 years for men, and 69, 2+1, 1 years for women. All participants underwent thrombolysis. Patients with severe associated pathology and hemorrhage in anamnesis were excluded from the study. Red blood cell count and hemoglobin (Hb) level in capillary blood were measured at admission. Death, acute heart failure, left ventricular dysfunction (by echocardiography criteria) were registered. At discharge, anemia was observed in 42 participants. Individuals, who died from cardiogenic shock, had lowest Hb levels (128, 6 ± 4, 1 g/l), comparing to participants, who died from other causes (135, 3 ± 5, 7 g/l), and survivors (133, 1+1, 2 g/l). Anemia was an independent predictor of middle-term in-hospital mortality (odds ratio 4, 7; p < 0, 05). Predischarge ejection fraction was directly linked to Hb level at admission (t = 2, 34; p < 0, 05)

Short- and long-term prognosis in patients with unstable angina and anemia

Aim. To investigate correlation between anemia and long- and short-term prognosis in patients with unstable angina. Material and methods. The study included 96 patients (34 females), aged 63.3±10.3 years, with unstable angina. All patients received conservative treatment. Individuals with severe associated pathology and hemorrhages in anamnesis were excluded from the study. Anemia was diagnosed according to WHO criteria; unstable angina class was registered. Short-term, in-hospital prognosis assessment included registering severe, recurrent angina, myocardial infarction (MI), number of ischemic episodes during 24-hour ECG monitoring before discharge. Long-term prognosis was assessed during 6 post-discharge months: death, MI, and combined endpoint (cardiac death, MI, recurrent angina) were registered. Results. Anemia was diagnosed in 38 patients (39.58 %). Angina at rest was associated with lower mean hemoglobin (Hb) level and greater anemia prevalence (46%), comparing to the group of progressing effort angina (25%). Participants with prolonged angina episodes had significantly lower Hb level (122.23±13.3 g/l) than the others (130.9±13.56 g/l). Among patients with ischemic episodes at 24-hour ECG monitoring, anemia was registered in 50%, among individuals without such episodes – in 30.4%. Recurrent unstable angina during 6 post-discharge months was associated with higher anemia prevalence: 57.6% vs 21.05% in participants with better outcome. Logistic regression analysis demonstrated negative independent influence of anemia on combined endpoint. Conclusion. Patients with anemic syndrome were characterized by severe in-hospital course of unstable angina. Anemia was associated with increased risk of MI and recurrent unstable angina in the first 6 months after discharge

RED BLOOD VALUES CHANGES IN CARDIOVASCULAR PATIENTS — EPIDEMIOLOGY, PROGNOSIS AND TREATMENT APPROACHES

The review highlights a significance of anemic syndrome in cardiovascular patients, which is certainly negatively related to life quality and prognosis of patients. The main causes for its development are discussed, of those the main are hemodilution, inflammatory cytokines, iron deficiency. Also anemia correction is discussed and the main trials of this field are mentioned. The U-shaped relation is discussed for hemoglobin concentration and cardiovascular morbidity and mortality which reflect that higher levels of hemoglobin and hematocrit are associated with poorer outcome. There is lack of information on the prevalence and influence of hemoconcentration on prognosis in cardiological patients, as the data available is usually controversial. The conclusion is made that at the moment the problem of target hemoglobin and hematocrit levels definition for anemia treatment in cardiological patients, as also the data on the hemoconcentration influence of course and prognosis of cardiovascular diseases remains open