scholarly journals TWO-DIMENSIONAL ECHOCARDIOGRAPHIC CHARACTERISTICS IN PRE-ADOLESCENT ATHLETES

2016 ◽  
Vol 3 (3) ◽  
pp. 138-141
Author(s):  
O. Onikiienko
Keyword(s):  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Myocardial Remodeling ◽  
Two Dimensional ◽  
Ventricular Ejection Fraction ◽  
Cardiac Adaptation ◽  
Group 3 ◽  
Group 2 ◽  
Sports Activities ◽  
Group 1

Data of echocardiographic characteristics of 59 children 10-11 years old, involved in football is presented in article. Depending on the duration of sports activities the children were divided into 3 groups: group 1 - children who play football up to 3 years (24 children), Group 2 - children who play football from 3 to 5 years (23 children), Group 3 - training duration over 5 years (12 children). It was found that the linear sizes of the heart were not significantly different in the groups studied, which may indicate that myocardial remodeling as cardiac adaptation to sporting loads takes more time. It was revealed that more trained children (group 3) have significantly higher left ventricular ejection fraction compared with group 1 (p = 0.05) and Group 2 (p = 0.0051). Keywords: athletes, children, echocardiography РезюмеО. ОникиенкоДвумерные эхокардиографические характеристики препубертатных спортсменов В статье приведены результаты ультразвукового обследования 59 детей 10-11 лет, занимающихся футболом. В зависимости от длительности занятий спортом дети были разделены на 3 группы: группа 1 – дети со стажем до 3 лет (24 ребенка), группа 2  - стаж занятий от 3 до 5 лет (23 ребенка), группа 3 – стаж занятий более 5 лет (12 детей). Установлено, что линейные размеры сердца достоверно не отличались в группах обследованных, что может свидетельствовать о более длительном процессе ремоделирования миокарда как адаптации сердца к спортивным нагрузкам. Выявлено, что у более тренированных детей (группа 3) достоверно выше фракция выброса левого желудочка по сравнению с группой 1 (p = 0.05) и с группой 2 (p = 0.0051). Ключевые слова: спортсмены, дети, эхокардиография   РезюмеО. ОнікієнкоДвовимірні ехокардіографічні характеристики препубертатних спортсменівУ статті наведено результати ультразвукового обстеження 59 дітей 10-11 років, які займаються футболом. Залежно від тривалості занять спортом діти були розділені на 3 групи: група 1 - діти зі стажем до 3 років (24 дитини), група 2 - стаж занять від 3 до 5 років (23 дитини), група 3 - стаж занять більше 5 років (12 дітей). Встановлено, що лінійні розміри серця достовірно не відрізнялися в групах обстежених, що може свідчити про більшу тривалість ремоделювання міокарда як адаптації серця до спортивних навантажень. Виявлено, що у більш тренованих дітей (група 3) достовірно вища фракція викиду лівого шлуночка в порівнянні з групою 1 (p = 0.05) і з групою 2 (p = 0.0051). Ключові слова: спортсмени, діти, ехокардіографія

scholarly journals Comorbidities Associated with One-Year Mortality in Patients with Atrial Fibrillation and Heart Failure

Healthcare ◽  
2021 ◽  
Vol 9 (7) ◽  
pp. 830
Author(s):  
Ruxandra Nicoleta Horodinschi ◽  
Camelia Cristina Diaconu
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Ejection Fraction ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Group 3 ◽  
Group 2 ◽  
One Year ◽  
Group 1

Background: Heart failure (HF) and atrial fibrillation (AF) commonly coexist and patients with both diseases have a worse prognosis than those with HF or AF alone. The objective of our study was to identify the factors associated with one-year mortality in patients with HF and AF, depending on the left ventricular ejection fraction (LVEF). Methods: We included 727 patients with HF and AF consecutively admitted in a clinical emergency hospital between January 2018 and December 2019. The inclusion criteria were age of more than 18 years, diagnosis of chronic HF and AF (paroxysmal, persistent, permanent), and signed informed consent. The exclusion criteria were the absence of echocardiographic data, a suboptimal ultrasound view, and other cardiac rhythms than AF. The patients were divided into 3 groups: group 1 (337 patients with AF and HF with reduced ejection fraction (HFrEF)), group 2 (112 patients with AF and HF with mid-range ejection fraction (HFmrEF)), and group 3 (278 patients with AF and HF with preserved ejection fraction (HFpEF)). Results: The one-year mortality rates were 36.49% in group 1, 27.67% in group 2, and 27.69% in group 3. The factors that increased one-year mortality were chronic kidney disease (OR 2.35, 95% CI 1.45–3.83), coronary artery disease (OR 1.67, 95% CI 1.06–2.62), and diabetes (OR 1.66, 95% CI 1.05–2.67) in patients with HFrEF; and hypertension in patients with HFpEF (OR 2.45, 95% CI 1.36–4.39). Conclusions: One-year mortality in patients with HF and AF is influenced by different factors, depending on the LVEF.

scholarly journals The outcome of patients with myocardial infarction with non-obstructive coronary arteries (MINOCA) and impaired kidney function: a 3-year observational study

2021 ◽  
Author(s):  
Malgorzata Zalewska-Adamiec ◽  
Jolanta Malyszko ◽  
Ewelina Grodzka ◽  
Lukasz Kuzma ◽  
Slawomir Dobrzycki ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Incidence Rate ◽  
Kidney Function ◽  
Coronary Arteries ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Risk Of Death ◽  
Group 2 ◽  
Group 1

Abstract Background Myocardial infarction with nonobstructive coronary arteries (MINOCA) constitutes about 10% of the cases of acute coronary syndromes (ACS). It is a working diagnosis and requires further diagnostics to determine the cause of ACS. Methods In this study, 178 patients were initially diagnosed with MINOCA over a period of 3 years at the Department of Invasive Cardiology of the University Clinical Hospital in Białystok. The value of estimated glomerular filtration rate (eGFR) was calculated for all patients. The patients were divided into 2 groups depending on the value of eGFR: group 1—53 patients with impaired kidney function (eGFR < 60 mL/min/1.73 m2; 29.8%) and group 2—125 patients with normal kidney function (eGFR ≥ 60 mL/min/1.73 m2; 70.2%). Results In group 1, the mean age of patients was significantly higher than that of group 2 patients (77.40 vs 59.27; p < 0.0001). Group had more women than group 2 (73.58% vs 49.60%; p = 0.003). Group 1 patients had higher incidence rate of arterial hypertension (92.45% vs 60.80%; p < 0.0001) and diabetes (32.08% vs 9.60%; p = 0.0002) and smoked cigarettes (22.64% vs 40.80%; p = 0.020). Group 1 patients had higher incidence rate of pulmonary edema, cardiogenic shock, sudden cardiac arrest (13.21% vs 4.00%; p = 0.025), and pneumonia (22.64% vs 6.40%; p = 0.001). After the 37-month observation, the mortality rate of the patients with MINOCA was 16.85%. Among group two patients, more of them became deceased during hospitalization (7.55% vs 0.80%; p = 0.012), followed by after 1 year (26.42% vs 7.20%; p = 0.0004) and after 3 years (33.96% vs 9.6%; p < 0.0001). Multivariate analysis revealed that the factors increasing the risk of death in MINOCA are as follows: older age, low eGFR, higher creatinine concentration, low left ventricular ejection fraction, and ST elevation in ECG. Conclusion Impaired kidney function is diagnosed in every third patient with MINOCA. Early and late prognosis of patents with MINOCA and renal dysfunction is poor, and their 3-year mortality is comparable to patients with myocardial infarction with significant stenosis of the coronary arteries and impaired kidney function.

scholarly journals Epicardial Adipose Tissue Role as a Marker of Higher Vulnerability in Patients with Coronary Artery Disease

2018 ◽  
Vol 3 (2) ◽  
pp. 77-83 ◽  
Author(s):  
Tiberiu Nyulas ◽  
Mirabela Morariu ◽  
Nora Rat ◽  
Emese Marton ◽  
Victoria Ancuta Rus ◽  
...  
Keyword(s):  
Adipose Tissue ◽  
Left Ventricular Ejection Fraction ◽  
Left Ventricle ◽  
Epicardial Adipose Tissue ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
The Mean ◽  
Group 2 ◽  
Group 1

Abstract Background: Epicardial adipose tissue (EAT) has been recently identified as a major player in the development of the atherosclerotic process. This study aimed to investigate the role of EAT as a marker associated with a higher vulnerability of atheromatous coronary plaques in patients with acute myocardial infarction (AMI) as compared to patients with stable angina. Material and methods: This analysis enrolled a total of 89 patients, 47 with stable angina (SA) and 42 with AMI, who underwent echocardiographic investigations and epicardial fat measurement in 2D-parasternal long axis view. The study lot was divided as follows: Group 1 included patients with prior AMI, and Group 2 included patients with SA. Results: There were no significant differences between the two groups regarding cardiovascular risk factors, excepting smoking status, which was recorded more frequently in Group 1 as compared to Group 2 (36.17% vs. 11.63%, p = 0.02). The mean epicardial fat diameter was 9.12 ± 2.28 mm (95% CI: 8.45–9.79 mm) in Group 1 and 6.30 ± 2.03 mm (95% CI: 5.675–6.93 mm) in Group 2, the difference being highly significant statistically (p <0.0001). The mean value of left ventricular ejection fraction was significantly lower in patients with AMI (Group 1 – 47.60% ± 7.96 vs. Group 2 – 51.23% ± 9.05, p = 0.04). EAT thickness values showed a weak but significant positive correlation with the level of total cholesterol (r = −0.22, p = 0.03) and with the value of end-systolic left ventricle diameter (r = 0.33, = 0.001). Conclusions: The increased thickness of EAT was associated with other serum- or image-based biomarkers of disease severity, such as the left ventricular ejection fraction, end-systolic diameter of the left ventricle, and total cholesterol. Our results indicate that EAT is significantly higher in patients with acute coronary syndrome, proving that EAT could serve as a marker of vulnerability in cardiovascular diseases.

Abstract 18942: Is Bilirubin Protective Against Anthracycline-induced Cardiomyopathy?

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Trinity Vera ◽  
Timothy M Morgan ◽  
Jennifer H Jordan ◽  
Matthew C Whitlock ◽  
Dalane Kitzman ◽  
...  
Keyword(s):  
Medical Center ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Categorical Variables ◽  
Response Analysis ◽  
Linear Regression Models ◽  
Ventricular Ejection Fraction ◽  
Therapeutic Implications ◽  
Group 3 ◽  
Group 1

Introduction: Reductions in left ventricular ejection fraction (LVEF) may occur after the administration of anthracycline-based chemotherapeutic regimens. Oxidative stress at the myocellular level has been implicated in these reductions, and as a consequence, we hypothesized that bilirubin, an effective endogenous anti-oxidant, would ameliorate some of the reductions in LVEF associated with anthracyline administration. Methods: From 1/1/2002 to 12/31/2012, we identified 751 consecutive individuals who were treated with anthracyclines at Wake Forest Baptist Medical Center, received serial LVEF measures, and exhibited basal serum bilirubin levels < 2mg/dl prior to their treatment for cancer. The correlation between pre-chemotherapy bilirubin levels and serial pre- to post-chemotherapy changes in LVEF was analyzed using linear regression models. For dose response analysis, the participants were divided into 3 groups based on their bilirubin levels. ANOVA was used to test for the difference in the mean LVEF change across groups. Tukey’s Studentized Range test was used in pairwise comparisons. Chi-square test was used for categorical variables. Results: There were 65 (35%), 86 (30%) and 68 (24%) participants whose LVEF decreased by more than 15% in Group 1 (bilirubin ≤0.5mg/dl), Group2 (bilirubin 0.6 - 0.8mg/dl) and Group 3 (bilirubin 0.9 - 1.9mg/dl) respectively (Table 1). On pairwise comparison, there was a significant decrease in LVEF between Group 1 and Group 3 (2.9, 95% CI: 0.15 - 5.7). After adjusting for age, BMI, race, CAD/MI, diabetes, hematocrit and medications; increased bilirubin and reduced BMI were associated with LVEF preservation (p = 0.028 and 0.033 respectively). Conclusions: In patients treated with anthracyclines, bilirubin level was negatively correlated with reduction in LVEF. These results have potential therapeutic implications for preserving left ventricular function in patients treated with anthracyclines.

Features of the clinical picture and outcomes in patients from a heart transplantation waiting list with different causes of heart failure

Kardiologiia ◽  
2020 ◽  
Vol 60 (7) ◽  
pp. 15-19
Author(s):  
A. N. Kostomarov ◽  
M. A. Simonenko ◽  
M. A. Fedorova ◽  
P. A. Fedotov
Keyword(s):  
Heart Failure ◽  
Heart Transplantation ◽  
Death Rate ◽  
Left Ventricular ◽  
Waiting List ◽  
Left Ventricular Ejection ◽  
Circulatory Support ◽  
Ventricular Ejection Fraction ◽  
Group 2 ◽  
Group 1

Aim To identify clinical differences between patients on the heart transplant waiting list (HTWL) in the origin of chronic heart failure (CHF).Materials and methods From January 2010 through September 2019, 235 patients (age, 47+13 years (from 10 to 67 years); men, 79% (n=186)) were included in the HTWL. The patients were divided into two groups; group 1 (n=104, 44 %) consisted of patients with ischemic heart disease (IHD); group 2 (n=131, 56 %) included patients with noncoronarogenic CHF. Clinical and instrumental data and frequency of the mechanical circulatory support (MCS) as a “bridge” to heart transplantation (HT) were retrospectively evaluated.Results Group 1 included more male patients than group 2 [97 % (n=101) and 82 % (n=85), р<0.0001]; patients were older (54±8 and 42±14 years, р=0.0001). On inclusion into the HTWL, the CHF functional class was comparable in the groups, III [III;IV]; there were more patients of the UNOS 2 class in group 1 than in group 2 [75 % (n=78) and 57 % (n=75), р=0.005]. Patient distribution in UNOS 1B and 1A classes was comparable in the groups: 21% (n=22) and 3% (n=4) in group 1 and 33 % (n=43) and 10 % (n=13) in group 2. According to echocardiography patients of group 1 compared to group 2 showed a tendency towards higher values of left ventricular ejection fraction (Simpson method) [22 [18;26] % and 19 [15;24] %, р=0.37] and stroke volume [59 [44;72] % and 50 [36;67] %, р=0.07]. Numbers of patients with a cardioverter defibrillator or a cardiac resynchronization device with a defibrillator function were comparable in the groups [35 % (n=36) and 34 % (n=45)]. Comparison of comorbidities in groups 1 and 2 showed higher incidences of pulmonary hypertension [55 % (n=57) and 36 % (n=47), р=0.005], obesity [20 % (n=21) and 10 % (n=13), р=0.03], and type 2 diabetes mellitus [29 % (n=30) and 10 % (n=13), р=0.0004]. Rates of chronic obstructive lung disease, stroke, chronic kidney disease and other diseases were comparable. Duration of staying on the HTWL was comparable (104 [34; 179] and 108 [37; 229] days). During staying on the HTWL, patients of group 1 less frequently required MCS implantation [3 % (n=3) and 28 % (n=21), р=0.0009]. HT was performed for 59 % patients (n=61) in group 2 and 52 % (n=69) patients in group 2. Death rate in the HTWL was lower in group 1 [13 % (n=14) and 27 % (n=35), р<0.01].Conclusion On inclusion into the HTWL, patients with noncoronarogenic CHF had more pronounced CHF manifestations and a more severe UNOS class but fewer comorbidities than patients with CHF of ischemic origin. With a comparable duration of waiting for HT, patients with noncoronarogenic CHD more frequently required MCS implantation and had a higher death rate.

Functional Significance of Collateral Circulation in Patients with Total Coronary Occlusion

1993 ◽  
Vol 1 (4) ◽  
pp. 156-162
Author(s):  
Ha Jong Won ◽  
Cho Seung Yun ◽  
Jang Yang Soo ◽  
Chung Nam Sik ◽  
Shim Won Hewn ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Collateral Circulation ◽  
Coronary Occlusion ◽  
Artery Occlusion ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Segmental Wall Motion ◽  
Group 2 ◽  
Group 1

Functional significance of collateral circulation was evaluated in 125 patients with total coronary occlusion. Patients were classified into 2 groups: group 1, patients without myocardial infarction; and group 2, patients with a first transmural myocardial infarction occurring within 3 months of symptom onset. There was a higher prevalence of well-developed collaterals and multivessel disease in patients without myocardial infarction than in those with myocardial infarction. The left ventricular ejection fraction, left ventricular enddiastolic pressure, and segmental wall motion scores were significantly better in group 1 than group 2. Despite total coronary occlusion, 61% of group 1 had a normal resting electrocardiogram; however, 96% of patients who underwent treadmill tests proved positive. The proportions of well-developed collaterals in 3 groups, divided according to the internal between onset of myocardial infarction and angiography (within 1 day of operation, 2 to 14 days, or 15 days to 3 months), were 13%, 54%, and 60%. There were no significant differences in left ventricular ejection fraction, segmental wall motion score, and left ventricular enddiastolic pressure in myocardial infarction patients with poorly developed collaterals and well-developed collaterals. The degree of collateral development is higher in myocardial infarction with right coronary artery occlusion compared with that of left anterior descending artery occlusion, without regarding the dominancy or length. Collateral circulation can prevent myocardial ischemia and present myocardial function in a significant number of patients without infarction; however, it does not provide protection against exercise-induced myocardial ischemia in the majority of patients from group 1. Although well-developed collaterals are not usually present within 1 day after myocardial infarction, they are generally present after 2 weeks. Collateral vessels in patients with myocardial infarction have no beneficial effects on preserving myocardial function.

scholarly journals Effect of late culprit coronary artery revascularization on prognosis of patients with ST-elevation myocardial infarction

2020 ◽  
Vol 25 (8) ◽  
pp. 3796
Author(s):  
A. A. Frolov ◽  
K. V. Kuzmichev ◽  
I. G. Pochinka ◽  
E. G. Sharabrin ◽  
A. G. Savenkov
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery ◽  
Left Ventricular Ejection Fraction ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Coronary Artery Revascularization ◽  
St Elevation ◽  
Group 2 ◽  
Group 1

Aim. To evaluate the effect of culprit coronary artery revascularization after 48 hours from the symptoms’ onset on the prognosis of patients with ST-elevation myocardial infarction (STEMI).Material and methods. Of the 1172 patients admitted to City Clinical Hospital № 13 in 2018 due to STEMI, 43 patients (4%) were included in the retrospective study. There were following inclusion criteria: hospitalization after 48 hours from the symptoms’ onset, no clinical signs of myocardial ischemia, and complete coronary artery occlusion according to angiography. The mean age of the subjects was 61,3±10,6 years, 34 (79%) men and 9 (21%) women. The subjects were divided into two groups: group 1 (n=22) — management with percutaneous coronary intervention (PCI), group 2 (n=21) — management with medications. The groups differ only in the severity of coronary atherosclerosis according to SYNTAX score: group 1 — 14,0 [11.0; 19.5], group 2 — 26,0 [16,5; 31,0] (p=0,009). At the end of inpatient treatment, patients underwent echocardiography. Death and myocardial infarction were monitored during hospitalization and for 12 months after discharge.Results. During hospitalization, 2 patients died (4,7%; one in each group, p=1,00). No recurrent MI were reported. The left ventricular ejection fraction in the PCI group was 50 [46; 54] %, in the group with drug therapy — 43 [38; 50] % (p=0,01). Out of 43 included patients, long-term outcomes were followed up in 32 (74%). Among them, 1 (5,8%) patient died in group 1, 6 (33,3%) patients — in group 2 (p=0,04). In total, death or recurrent MI in the first group was observed in 2 (12%) patients, in the second group — in 5 (33%) patients (p=0,14).Conclusion. Revascularization of a fully occluded culprit coronary artery in stable patients with STEMI after 48 hours of symptoms’ onset is associated with a higher inhospital left ventricular ejection fraction and a decrease in 12-month mortality.

scholarly journals The prognostic value of the NT-proBNP biomarkers and Fas ligand in assessing the risk of cardiotoxicity of anthracycline chemotherapy

2019 ◽  
Vol 18 (1) ◽  
pp. 127-133
Author(s):  
A. T. Teplyakov ◽  
S. N. Shilov ◽  
A. A. Popova ◽  
E. N. Berezikova ◽  
M. N. Neupokoeva ◽  
...  
Keyword(s):  
Left Ventricular Ejection Fraction ◽  
Ejection Fraction ◽  
Fas Ligand ◽  
Left Ventricular ◽  
Ventricular Ejection ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Group 2 ◽  
Anthracycline Chemotherapy ◽  
Group 1

Aim. To study the mechanisms, features of clinical manifestations and predicting of cardiotoxicity resulting from anthracycline chemotherapy.Material and methods. We examined 176 women with breast cancer who received anthracycline antibiotics as part of polychemotherapeutic (PCT) treatment. Patients were divided into 2 groups: with the development of cardiotoxic remodeling — group 1 (n=52) and with preserved heart function — group 2 (n=124). We conducted echocardiographic (EchoCG) tests before the start, during and after anthracycline chemotherapy. In the serum after the termination of PCT treatment, the concentrations of N-terminal prohormone of brain natriuretic peptide (NT-proBNP) and soluble Fas ligand (sFas-L) were determined.Results. Analysis of EchoCG parameters in patients after 12 months of PCT finish, showed a significant difference in the final systolic and end diastolic sizes, as well as a significant decrease in the left ventricular ejection fraction in group 1 compared with those before the start of treatment. A direct correlation was found between the end-systolic and end-diastolic volumes and inverse correlation between left ventricular ejection fraction and the resulting summary dose of doxorubicin. EchoCG changes in women of group 1 after the first course of PCT treatment were recorded in 49% of cases and 11% of cases — in group 2. The concentrations of sFas-L and NT-proBNP after PCT therapy finish in group 1 were significantly higher compared with group 2. Patients with significantly elevated NT-proBNP levels were had a high risk of heart disease developing during 12 months follow-up. A high concentration of NT-proBNP is a predictor of cardiovascular complications, which is more sensitive than EchoCG.Conclusion. Fas-associated apoptosis plays an important role in the pathogenesis of anthracycline cardiotoxicity. NT-proBNP may be an important biomarker for cardiotoxicity development, which already effective when EchoCG or clinical signs is absent.

Analysis of the compliance of the prescribed therapy with the EURO FORTA system in polymorbidic patients of elderly and old age with CHF

Kardiologiia ◽  
2021 ◽  
Vol 61 (11) ◽  
pp. 57-64
Author(s):  
E. I. Tarlovskaya ◽  
Yu. V. Omarova
Keyword(s):  
Left Ventricular Ejection Fraction ◽  
Outpatient Treatment ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Class A ◽  
Class D ◽  
Group 3 ◽  
Class C ◽  
Group 2

Aim      To study the consistency of the prescribed therapy with the EURO FORTA (2018) system in polymorbid patients with chronic heart failure (CHF) according to data of the local registry.Material and methods  The study included 313 patients with CHF aged 75±8.2 years. The Charlson Comorbidity Index (CCI) and the number of diseases (1–2, 3–5, >5) were calculated for all patients. Inpatient and outpatient treatment was assessed according to the EURO FORTA (2018) system based on polymorbidity degree, age, gender, and CHF type and severity.Results For the retrospective analysis of outpatient treatment, 5 groups of patients were isolated based on the drug class in the EURO FORTA system: group 1, patients treated only with class A drugs (3.51 %); group 2, class A and B drugs (22.36 %); group 3, class A, B, and C drugs (17.25 %); group 4, class A, B, C, and D drugs 10.86 % (А, В, С, D) and 16.31 % (А, В, D); and group 5, patients without an outpatient drug therapy (29.71 %). For the analysis of inpatient treatment, 4 groups of patients were isolated based on the drug class in the EURO FORTA system: group 1, patients treated only with class A drugs (0.32 %); group 2, class A and B drugs (15.97 %); group 3, class A, B, and C drugs (57.19 %); and group 4, separately analyzed patients treated with class C and D drugs or only D in combination with class A and B drugs. Thus, 28.11 % of patients at the outpatient stage and 82.75 % of patients at the inpatient stage received drugs with questionable efficacy/safety profiles (class C); 27.17 % of patients at the outpatient stage and 26.52 % at the inpatient stage received potentially inappropriate drugs (class D). At the outpatient stage in groups 2-4, most of patients (51.43–70.59 %) had >5 diseases (pmg=0.020). At the inpatient stage, there were no significant differences between groups in the number of diseases (pmg=0.349). The groups were comparable in the left ventricular ejection fraction depending on the CHF type (pmg=0.027 and pmg=0.778) at both stages of treatment. For instance, the same patient with preserved left ventricular ejection fraction could be included into EURO FORTA group 2 for the analysis of outpatient treatment while after prescription of the inpatient treatment, he/she could be included into group 3; pmg (intergroup, detecting differences for comparison of 3 groups) exceeded 0.017; therefore, the groups were comparable in the number of CHF patients with reduced, mid-range, and preserved left ventricular ejection fraction.Conclusion      Every second patient of the study had more than 5 diseases. Every third patient did not take any drugs at the outpatient stage. 28.11 % of patients received EURO FORTA class C drugs and 27.17% of patients received class D drugs at the outpatient stage. The drugs to be avoided in CHF, included primarily nonsteroid anti-inflammatory drugs (NSAIDs) and class I and III anti-arrhythmic medications (except for amiodarone). At the inpatient stage, 82.75 % of patients received EURO FORTA class C drugs and 26.52 % of patients received class D drugs. NSAIDs and ciprofloxacin prevailed among the drugs to be avoided in CHF.

scholarly journals Soluble ST2 is a Useful Biomarker for Grading Cerebral–Cardiac Syndrome in Patients after Acute Ischemic Stroke

2020 ◽  
Vol 9 (2) ◽  
pp. 489
Author(s):  
Pei-Hsun Sung ◽  
Hung Sheng Lin ◽  
Kuan-Hung Chen ◽  
John Y. Chiang ◽  
Sheung-Fat Ko ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Flow Cytometric Analysis ◽  
Left Ventricular ◽  
Inflammatory Biomarkers ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Cardiac Syndrome ◽  
Group 3 ◽  
Group 1

This study tested whether the soluble (s)ST2 is a superb biomarker predictive of moderate to severe cerebral–cardiac syndrome (CCS) (defined as coexisting National Institute of Health Stroke Scale (NIHSS) >8 and left-ventricular ejection fraction (LVEF) <60%) in patients after acute ischemic stroke (IS). Between November 2015 and October 2017, a total of 99 IS patients were prospectively enrolled and categorized into three groups based on NIHSS, i.e., group 1 (NIHSS ≤ 8, n = 66), group 2 (NIHSS = 9-15, n = 14) and group 3 (NIHSS ≥ 16, n = 19), respectively. Blood samples were collected immediately after hospitalization, followed by transthoracic echocardiographic examination. The results showed that the flow cytometric analysis for assessment of inflammatory biomarkers of TLR2+/CD14+cells, TLR4+/CD14+cells, Ly6g+/CD14+cells, and MPO+/CD14+cells, and ELISA assessment for circulatory level of sST2 were significantly higher in groups 2/3 than in group 1 (all p < 0.01). However, these parameters did not show significant differences between groups 2 and 3 (all p > 0.05). The LVEF was significantly lower in group 3 than in group 1 (p < 0.001), but it displayed no difference between groups 1/2 or between groups 2/3. These inflammatory biomarkers ((TLR2+/CD14+cells// TLR4+/CD14+cells// MPO+/CD14+cells) and sST2)) were significantly positively correlated to NIHSS and strongly negatively correlated to LVEF (all p < 0.05). Multivariate analysis demonstrated that both MPO/CD14+cells >20% (p = 0.027) and sST2 ≥ 17,600 (p = 0.004) were significantly and independently predictive of moderate-severe CCS after acute IS. Receiver operating characteristic curve analysis demonstrated that sST2 was the most powerful predictor of CCS with a sensitivity of 0.929 and a specificity of 0.731 (p < 0.001). In conclusion, sST2 is a useful biomarker for prediction of CCS severity in patients after acute IS.

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