Lipoprotein-Associated Phospholipase A2 Bound on High-Density Lipoprotein Is Associated With Lower Risk for Cardiac Death in Stable Coronary Artery Disease Patients A 3-Year Follow-Up

ObjectivesThe aim of this study was to examine the prognostic value of lipoprotein-associated phospholipase A2 (Lp-PLA2) associated with high-density lipoprotein (HDL) (HDL-Lp-PLA2) in patients with stable coronary artery disease (CAD).BackgroundLp-PLA2 is a novel risk factor for cardiovascular disease. It has been postulated that the role of Lp-PLA2 in atherosclerosis may depend on the type of lipoprotein with which it is associated.MethodsTotal plasma Lp-PLA2 and HDL-Lp-PLA2 mass and activity, lipids, and C-reactive protein were measured in 524 consecutive patients with stable CAD who were followed for a median of 34 months. The primary endpoint was cardiac death, and the secondary endpoint was hospitalization for acute coronary syndromes, myocardial revascularization, arrhythmic event, or stroke.ResultsFollow-up data were obtained from 477 patients. One hundred twenty-three patients (25.8%) presented with cardiovascular events (24 cardiac deaths, 47 acute coronary syndromes, 28 revascularizations, 22 arrhythmic events, and 2 strokes). Total plasma Lp-PLA2 mass and activity were predictors of cardiac death (hazard ratio [HR]: 1.013; 95% confidence interval [CI]: 1.005 to 1.021; p = 0.002; and HR: 1.040; 95% CI: 1.005 to 1.076; p = 0.025, respectively) after adjustment for traditional risk factors for CAD. In contrast, HDL-Lp-PLA2 mass and activity were associated with lower risk for cardiac death (HR: 0.972; 95% CI: 0.952 to 0.993; p = 0.010; and HR: 0.689; 95% CI: 0.496 to 0.957; p = 0.026, respectively) after adjustment for traditional risk factors for CAD.ConclusionsTotal plasma Lp-PLA2 is a predictor of cardiac death, while HDL-Lp-PLA2 is associated with lower risk for cardiac death in patients with stable CAD, independently of other traditional cardiovascular risk factors

A case-control validation of Type D personality in Greek patients with stable coronary heart disease

BACKGROUND: Type D personality has been associated with a variety of emotional and social difficulties as well as with poor prognosis in patients with established coronary heart disease (CHD). We examined the psychometric properties and validity of the Type D Scale-14 (DS14) and the prevalence of Type D personality among Greek patients with CHD while taking into account demographic; clinical, such as diabetes mellitus, hypertension, and hypercholesterolemia; as well as psychological variables such as depression, anxiety, and psychological stress. METHODS: Ninety-six patients with stable coronary heart disease and 80 healthy participants from the general population completed the Greek version of the DS14 and the Hospital Anxiety and Depression Scale (HADS). RESULTS: Cronbach's α coefficient for the negative affectivity (NA) and social inhibition (SI) subscales was 0.83 and 0.72 for the CHD and 0.88 and 0.76 for the control group, respectively. Internal-structural validity was assessed by a factor analysis (two-factor solution), and the factor structure of the original DS14 was replicated. Using the standardized cutoff point of NA ≥10 and SI ≥10, instead of the median scores, in order to have compatible results with the majority of studies, the prevalence of Type D personality was 51% for the CHD patients and 13% for the control group. Higher NA and SI were connected with higher anxiety, depression, and total psychological stress. Finally, more patients with CHD and Type D personality than those without were diagnosed with type 2 diabetes; however, no differences were observed in hypertension or hypercholesterolemia. CONCLUSIONS: These results indicate that the Type D construct is reliable and valid in a Greek population. The prevalence of Type D personality was higher in patients with stable coronary heart disease than in people from the general population. The DS14 subscales were positively correlated with higher anxiety, depression, and total psychological stress. Regarding other CHD risk factors, only diabetes mellitus was found more frequently in CHD patients with Type D personality

European Society of Cardiology: Cardiovascular Disease Statistics 2017

Background: The European Society of Cardiology (ESC) Atlas has been compiled by the European Heart Agency to document cardiovascular disease (CVD) statistics of the 56 ESC member countries. A major aim of this 2017 data presentation has been to compare high income and middle income ESC member countries, in order to identify inequalities in disease burden, outcomes and service provision. Methods: The Atlas utilizes a variety of data sources, including the World Health Organization, the Institute for Health Metrics and Evaluation, and the World Bank to document risk factors, prevalence and mortality of cardiovascular disease and national economic indicators. It also includes novel ESC sponsored survey data of health infrastructure and cardiovascular service provision provided by the national societies of the ESC member countries. Data presentation is descriptive with no attempt to attach statistical significance to differences observed in stratified analyses. Results: Important differences were identified between the high income and middle income member countries of the ESC with regard to CVD risk factors, disease incidence and mortality. For both women and men, the age-standardised prevalence of hypertension was lower in high income countries (18.3% and 27.3%) compared with middle income countries (23.5% and 30.3%). Smoking prevalence in men (not women) was also lower (26% vs 41.3%), and together these inequalities are likely to have contributed to the higher CVD mortality in middle income countries. Declines in CVD mortality have seen cancer becoming a more common cause of death in a number of high income member countries, but in middle income countries declines in CVD mortality have been less consistent where CVD remains the leading cause of death. Inequalities in CVD mortality are emphasised by the smaller contribution they make to potential years of life lost in high income compared with middle income countries both for women (13% vs. 23%) and men (20% vs. 27%). The downward mortality trends for CVD may, however, be threatened by the emerging obesity epidemic that is seeing rates of diabetes increasing across all ESC member countries. Survey data from the National Cardiac Societies (n=41) showed that rates of cardiac catheterization and coronary artery bypass surgery, as well as the number of specialist centres required to deliver them, were greatest in the high income member countries of the ESC. The Atlas confirmed that these ESC member countries, where the facilities for the contemporary treatment of coronary disease were best developed, were often those in which declines in coronary mortality have been most pronounced. Economic resources were not the only driver for delivery of equitable cardiovascular healthcare, as some middle income ESC member countries reported rates for interventional procedures and device implantations that matched or exceeded the rates in wealthier member countries. Conclusion: In documenting national CVD statistics, the Atlas provides valuable insights into the inequalities in risk factors, healthcare delivery and outcomes of CVD across ESC member countries. The availability of these data will underpin the ESC’s ambitious mission “to reduce the burden of cardiovascular disease” not only in its member countries, but also in nation states around the world

The prognostic significance of atrial arrhytmias recorded early after cardioversion for atrial fibrillation

Background Atrial fibrillation (AF) has a high risk of recurrence after electrical cardioversion (CV)The purpose of our study was to investigate prognostic factors, such as heart rate (HR) and atnalarrhythmias, measured during Holter recording for 24 hours after CVMethods We prospectively studied 117 consecutive patients (pts) (mean age±S D 61 6 ±10,8 years)subjected to CV, who successfully converted to sinus rhythm All underwent echocardiography and 24hour Holter after CV The majority of pts (60,7%) folio wed-up for one yearResults Thirty-seven pts (31 6%) recurred to AF during the first year of follow-up (group I) Thirty-fourpts (29 1%) remained in sinus rhythm at one year (group II) During one month of follow-up, 22 pts(18,8%) recurred to AF (group III) and the rest remained in sinus rhythm (group IV) Age, gender,underlying disease, left atrium size, fractional shortening, duration of AF and the medication taken weresimilar between the two groups (All P-values=NS) Group I had more atrial premature complexes perhour (APC/h) compared with group II and more APC/h in the first and second six-hour segment of theHolter (P10 APC/h hadhigh specificity but low sensitivity (91 2% και 32 4% respectively) Group III had more atnal prematurecomplexes per hour (APC/h) compared with pts of group IV and more APC/h in the first and second sixhoursegment of the Holter (P=0 002, P=0 057 and P=0 013, respectively) Cut-off analysis showed thatpts with more than 32 APC/h had 10 times higher risk of AF recurrence (OR=10 4 with 95% C 1=2 3-47 4) (sensitivity=75% specificity=77%) Group III pts had higher maximum, average and minimumheart rate compared to group IV (P=0 0013, P=0 0221 and P=0 0331, respectively) Cut-off analysisrevealed that pts with maximum heart rate (Max HR) more than 90 5 bpm had 6 7 times higher risk of AFrecurrence (OR=6 68 with 95% C 1=1 3-34 9) (sensitivity=69% specrficity=78%) Pts with combinationof Max HR more than 90 5 bpm and more than 32 APC/h had 25 2 times higher risk of AF relapse(OR=25 2 with 95% C 1=1 8-352 5)Conclusions Simple 24hour Holter may help to identify pts at higher risk of AF recurrence after CV.Σκοπός Μελετήσαμε την προγνωστική άξια των κολπικών αρρυθμιών και της καρδιακήςσυχνότητας, που καταγράφονται με ενα Holter 24ωρης καταγραφής αμέσως μετά απο επιτυχήηλεκτρική καρδιοαναταξη, ως προς την υποτροπή της αρρυθμίαςΜέθοδοι Μελετήσαμε 117 διαδοχικούς ασθενείς (μέση ηλικία ± SD 61,6±10,8 ετη, 53,8%άνδρες), οι οποίοι υπεβλήθησαν σε επιτυχή ηλεκτρική καρδιοαναταξη για KM Σε όλους τουςασθενείς τοποθετήθηκε Holter 24ωρης καταγραφής μετά απο την ηλεκτρική καρδιοαναταξη Το60,7% των ασθενών παρακολουθήθηκε για ενα έτος Οι υπόλοιποι ασθενείς παρακολουθήθηκανγια ενα μήναΑποτελέσματα Τριαντα-επτα (31,6%) ασθενείς υποτροπίασαν σε KM κατά τη διάρκεια τουπρώτου έτους παρακολούθησης (ομάδα Ι) Τριαντα-τεσσερις ασθενείς (29,1%) παρέμειναν σεφλεβοκομβικο ρυθμό το πρώτο έτος (ομάδα Π) Εικοσι-δυο ασθενείς (18,8%) υποτροπίασαν σεKM κατά τη διάρκεια του πρώτου μήνα παρακολούθησης (ομάδα III) Οι υπόλοιποι ασθενείςπαρέμειναν σε φλεβοκομβικο ρυθμό τον πρώτο μήνα (ομάδα IV) Οι ασθενείς της ομάδας Ισυγκρινόμενη με την ομάδα II είχαν μεγαλύτερο αριθμό έκτακτων κολπικών συστολών ανα ωρα(APC/h) για το σύνολο της καταγραφής Holter, για το πρώτο εξάωρο και για το δεύτερο εξάωρο(Ρ10 APC/h και η παρουσία SVT είχε υψηλήειδικότητα άλλα χαμηλή ευαισθησία (91,2% και 32,4% αντίστοιχα) Οι ασθενείς της ομάδας IIIσυγκρινόμενη με την ομάδα IV είχαν μεγαλύτερο αριθμό APC/h για το σύνολο της καταγραφήςHolter, για το πρώτο εξάωρο και για το δεύτερο εξάωρο (Ρ=0,002, Ρ=0,057 και Ρ=0,013,αντίστοιχα) Οι ασθενείς της ομάδας III συγκρινόμενη με την ομάδα IV είχαν μεγαλύτερη μέγιστη(max HR), μέση και ελάχιστη καρδιακή συχνότητα (Ρ=0,0013 Ρ=0 0221 και Ρ=0 0331αντίστοιχα) Οι ασθενείς με max HR>90,5 bpm είχαν 6,6 μεγαλύτερο κίνδυνο υποτροπής της KM(OR=6,68 με 95% CI 1 3-34,9) τον πρώτο μήνα (ευαισθησια=69%, ειδικοτητα=78%) Οσυνδυασμός max HR>90,5 bpm και >32 APC/h είχε 25,2 μεγαλύτερη πιθανότητα υποτροπής τηςKM τον πρώτο μήνα (OR=25,2 με 95% C Ι 1,8-352,5)Συμπεράσματα Με ενα απλό Holter 24ωρου μπορούμε να αναγνωρίσουμε ασθενείς με υψηλόκίνδυνο υποτροπής της κολπικής μαρμαρυγής μετά απο την ηλεκτρική καρδιοαναταξη

Laparoscopic sleeve gastrectomy in morbidly obese patients. Technique and short term results

Objective : To evaluate the efficacy of Laparoscopic Sleeve Gastrectomy (LSG) as a definitive procedure for morbidly obese patients. Design : This constitutes a prospective study carried out in a tertiary care private hospital and included 15 morbidly obese patients who underwent LSG. The operation was performed through two 12 mm and two 5 mm ports, using the Endo-GIA stapler to create a lesser curve gastric tube over a 36-Fr bougie. Results : Operative time, complication rates, hospital length of stay, Body Mass Index (BMI), % of Excess Weight Loss (EWL) and appetite were evaluated. There were six females and nine males, aged (mean +/- SD) 40.5 +/- 10.5 yrs and preoperative BMI 47.8 +/- 7.5 kg/m(2). The operative time was 147.7 +/- 43.2 min. There was one conversion to open surgery and one gastric leak with haemorrhage that led to gastric tube stenosis, ultimately requiring revision surgery. All patients, except these two, were discharged on the 2nd postoperative day after an upper GI series and the initiation of a clear liquid diet. At the follow-up (7.5 +/- 4.4 months post operatively), the % EWL was 35.7 +/- 10.1. Eight patients who received regular postoperative dietician counselling at follow-up did better than the others who did not (% EWL 40.4 +/- 3.8 vs 30.2 +/- 4.1, respectively). All patients reported significant loss of appetite. Conclusions : Although the number of patients is relatively small, the data of this study indicate that laparoscopic sleeve gastrectomy is effective in weight reduction, being an acceptable surgical option for morbidly obese patients. A higher number of patients and longer follow-up period will be necessary to evaluate long-term efficacy

Evaluation of the medication process in pediatric patients: a meta-analysis

OBJECTIVE: to meta-analyze studies that have assessed the medication errors rate in pediatric patients during prescribing, dispensing, and drug administration. SOURCES: searches were performed in the PubMed, Cochrane Library, and Trip databases, selecting articles published in English from 2001 to 2010. SUMMARY OF THE FINDINGS: a total of 25 original studies that met inclusion criteria were selected, which referred to pediatric inpatients or pediatric patients in emergency departments aged 0-16 years, and assessed the frequency of medication errors in the stages of prescribing, dispensing, and drug administration. CONCLUSIONS: the combined medication error rate for prescribing errors to medication orders was 0.175 (95% Confidence Interval: [CI] 0.108-0.270), the rate of prescribing errors to total medication errors was 0.342 (95% CI: 0.146-0.611), that of dispensing errors to total medication errors was 0.065 (95% CI: 0.026-0.154), and that ofadministration errors to total medication errors was 0.316 (95% CI: 0.148-0.550). Furthermore, the combined medication error rate for administration errors to drug administrations was 0.209 (95% CI: 0.152-0.281). Medication errors constitute a reality in healthcare services. The medication process is significantly prone to errors, especially during prescription and drug administration. Implementation of medication error reduction strategies is required in order to increase the safety and quality of pediatric healthcare

Cardiovascular Hypertensive Crisis: Recent Evidence and Review of the Literature

Despite the high prevalence of hypertension (HTN), only a small proportion of the hypertensive patients will ultimately develop hypertensive crisis. In fact, some patients with hypertensive crisis do not report a history of HTN or previous use of antihypertensive medication. The majority of the patients with hypertensive crisis often report non-specific symptoms, whereas heart-related symptoms (dyspnea, chest pain, arrhythmias, and syncope) are less common. Hypertensive crises can be divided into hypertensive emergencies or hypertensive urgencies according to the presence or absence of acute target organ damage, respectively. This differentiation is an extremely useful classification in clinical practice since a different management is needed, which in turn has a significant effect on the morbidity and mortality of these patients. Therefore, it is very crucial for the physician in the emergency department to identify the hypertensive emergencies and to manage them through blood pressure lowering medications in order to avoid further target organ damage or deterioration. The aim of this narrative review is to summarize the recent evidence in an effort to improve the awareness, recognition, risk stratification, and treatment of hypertensive crisis in patients referred to the emergency department

Low-Dose Dobutamine Stress Echocardiography for the Early Detection of Pulmonary Arterial Hypertension in Selected Patients with Systemic Sclerosis Whose Resting Echocardiography Is Non-Diagnostic for Pulmonary Hypertension

Background: Dobutamine stress echocardiography (DSE) has limited application in systemic sclerosis (SSc). We examined DSE usefulness in revealing pulmonary arterial hypertension (PAH) in selected SSc patients whose resting echocardiography for pulmonary hypertension (PH) was non-diagnostic. Methods: Forty SSc patients underwent right heart catheterization (RHC) and, simultaneously, low-dose DSE (incremental doses up to 20 mu g/kg/min). Inclusion criteria were: preserved left and right ventricular (RV) function (tricuspid annulus plane systolic excursion [TAPSE] >= 16 mm and tissue Doppler imaging-derived systolic velocity of tricuspid annulus [RVS’] > 10 cm/s), normal pulmonary function tests, and baseline maximal tricuspid regurgitation (TR) velocity of 2.7-3.2 m/s. Results: Of 36 patients who completed DSE, resting RHC diagnosed PAH in 12 patients (33.3%). At 20 mu g/kg/min, patients with PAH had higher TR velocity, higher pulmonary arterial pressure measured by RHC, and lower RV inotropic response compared with patients without PAH. A cut-off value of maximal TR velocity >3.1 m/s had a sensitivity of 80%, a specificity of 84.2%, and an accuracy of 82.4% for the detection of PAH. Conclusions: Low-dose DSE has a satisfactory diagnostic accuracy for the early detection of PAH in highly selected SSc patients whose baseline echocardiographic measurements for PH lie in the gray zone