Corrigendum to ``Person-centered analysis of psychological traits to explain heterogeneity in patient-reported outcomes of coronary artery disease– the THORESCI study'' [Journal of Affective Disorders (2018) 15;236:14–22]

Introduction: Cardiopulmonary exercise testing (CPET) provides a non-invasive evaluation of exercise physiology via ventilatory gas exchange (VGE). We do not know how these assessments correlate with myocardial ischemia or angina symptoms in patients with stable single-vessel coronary artery disease (CAD). In this analysis, we use randomised, blinded data from the ORBITA trial to investigate the association between VGE, ischemia and symptoms in patients with severe single-vessel CAD. Methods: Patients underwent treadmill CPET using the smoothed-modified Bruce protocol, after a 6-week medical optimisation phase during which antianginals were uptitrated. Symptoms were assessed using the Seattle Angina Questionnaire (SAQ), EuroQOL 5 and Canadian Cardiovascular Society (CCS) angina class. Ischemia was quantified using fractional flow reserve (FFR), instantaneous wave-free ratio (iFR) and dobutamine stress echocardiography (DSE). Results: We assessed 195 patients [mean age 66.1±9.1, 143 (73.3%) male]. We found a significant association between peak oxygen uptake (VO 2 ) and minute ventilation to carbon dioxide (VE/VCO 2 ) slope, and physician assessed CCS class [P correlation(cor) <0.0001(Figure 1), P cor <0.0001, respectively], patient-reported SAQ angina frequency score [P cor <0.011(Figure 1), P cor <0.0001], physical limitation (P cor <0.0001, P cor =0.0001) and EuroQOL 5 visual analogue score (P cor = 0.0011, P cor =0.0019). There was no detectable relationship between peak VO 2 or VE/VCO 2 slope, and FFR, iFR or DSE (p>0.05, for all). Patients with an oxygen pulse plateau however, had higher dobutamine stress echo score compared to those without (+0.71; 95%CI 0.22-1.21, p=0.0049). Conclusions: The association between VGE and angina symptoms is stronger than its ability to detect severity of myocardial ischemia. This analysis highlights the complexity of the relationship between symptoms, functional capacity and myocardial ischemia.

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Case Report - Unstable Angina, Coronary Artery Disease, and Cannabis

10.20944/preprints202011.0668.v1 ◽

2020 ◽

Author(s):

Brian Entler ◽

Brian Shaffer ◽

Garrison Davis ◽

Marc Incitti ◽

Brian Piper

Keyword(s):

Coronary Artery Disease ◽

Coronary Artery ◽

Unstable Angina ◽

Case Reports ◽

Endocannabinoid System ◽

Percutaneous Transluminal Coronary Angioplasty ◽

Care Physician ◽

Medical Cannabis ◽

Patient Reported ◽

Artery Disease

Rationale:First discovered in 1990, the endocannabinoid system (ECS) was initially shown to have an intimate relationship with central areas of the nervous system associated with pain, reward, and motivation. Recently, however, the ECS has been extensively implicated in the cardiovascular system with contractility, heart rate, blood pressure, and vasodilation. Emerging data demonstrates modulation of the ECS plays an essential role in cardio metabolic risk, atherosclerosis, and can even limit damage to cardiomyocytes during ischemic events.Patient Concerns:This case describes a 63-year-old male who presented to a primary care physician for a medical cannabis (MC) consult due to unstable angina (UA) not relieved by morphine or cardiac medications; having failed all first- and second-line poly-pharmaceutical therapies. The patient reported frequent, unprovoked, angina and exertional dyspnea.Diagnosis:Having a complex cardiac history, the patient first presented 22 years ago after a suspected myocardial infarction (MI). He re-presented in 2010 and underwent stent placement at that time for inoperable triple-vessel coronary artery disease (CAD) which was identified via percutaneous transluminal coronary angioplasty. UA developed on follow up and, despite medical management over the past 6 years, his UA became progressively debilitating.Interventions and Outcomes:In conjunction with his standard cardiac care, patient had a gradual lessening of UA related pain, including frequency and character, after using an edible form of medical cannabis (MC) (1:1 CBD:THC). Following continued treatment, he ceased long term morphine treatment and describes the pain as no longer crippling. As demonstrated by his exercise tolerance tests, the patient experienced an improved functional capacity and reported an increase in his daily functioning, and overall activity.Lessons:This case uniquely highlights MC in possibly reducing the character, quality, and frequency of UA; while concordantly improving functional cardiac capacity in a patient with CAD. Additional case reports are necessary to verify this.

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CLINICAL-DYNAMIC AND BIOLOGICAL ASPECTS OF POLYMORPHISM AND EFFICACY OF THERAPY OF MOOD DISORDERS

Siberian Medical Journal ◽

10.29001/2073-8552-2018-33-3-86-92 ◽

2018 ◽

Vol 33 (3) ◽

pp. 86-92

Author(s):

E. D. Schastnyy ◽

G. G. Simutkin ◽

E. V. Lebedeva ◽

A. L. Yakovleva ◽

I. S. Losenkov ◽

...

Keyword(s):

Coronary Artery Disease ◽

Coronary Artery ◽

Personality Disorders ◽

Affective Disorders ◽

Depressive Disorders ◽

Specific Weight ◽

Social Adaptation ◽

Control Group ◽

Chronic Coronary Artery Disease ◽

Artery Disease

Objective: to study clinical-biological features of affective disorders including their comorbidity with coronary artery disease and personality disorders and efficacy of psychopharmacotherapy in these patients.Material and Methods. In the first group at a heart station 290 patients with chronic coronary artery disease and affective disorders (209 men and 81 women) were fully examined. The second group included 120 patients (40 men and 80 women) of a psychiatric hospital with affective disorder comorbid with personality disorders. The third group included the study of 29 patients with depressive disorders and a control group (n=21).Results. Data on significant clinical-dynamic, biological and therapeutic features of affective disorders comorbid with coronary artery disease were obtained. It was revealed that presence of a comorbid personality disorder in the case of affective disorders causes the necessity to use a combined psychopharmacotherapy more frequently, worsens indicators of the efficacy of the psychopharmacotherapy of current episode of depression, and increases negative estimation of their social adaptation by these patients. Dysregulation of the processes of programmed cell death in patients with depressive disorders was found.Conclusion. Obtained data testified to the high degree of comorbidity of affective disorders with coronary artery disease and personality disorders which worsened the prediction of the course and indicators of the efficacy of psychopharmacotherapy of these disorders. In patients with depressive disorders the specific weight of mononuclears of peripheral blood was increased in the state of apoptosis.

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