Triglyceride–Glucose Index Independently Predicts New-Onset Atrial Fibrillation After Septal Myectomy for Hypertrophic Obstructive Cardiomyopathy Beyond the Traditional Risk Factors

The triglyceride–glucose index is a valuable marker of insulin resistance. However, the predictive value of this index for postoperative atrial fibrillation in patients undergoing septal myectomy remains unclear. A total of 409 patients with hypertrophic obstructive cardiomyopathy who underwent septal myectomy were recruited in this study. The triglyceride–glucose index was calculated for all patients preoperatively. All patients underwent clinical data collection, blood sampling, and standard echocardiographic examinations during hospitalization. The prevalence of postoperative atrial fibrillation was approximately 15% in the present study. Multivariate logistic regression revealed that age (odds ratio [OR]: 1.053, 95% CI: 1.016–1.090, P = 0.004), hypertension (OR: 2.399, 95% CI: 1.228–4.686, P = 0.010), left atrial diameter (OR: 1.101, 95% CI: 1.050–1.155, P < 0.001), and triglyceride–glucose index (OR: 4.218, 95% CI: 2.381–7.473, P < 0.001) were independent risk factors for postoperative atrial fibrillation in patients undergoing septal myectomy. In receiver operating characteristic curve analysis, the triglyceride–glucose index could provide a moderate predictive value for postoperative atrial fibrillation after septal myectomy 0.723 (95% CI: 0.650–0.796, P < 0.001). Moreover, adding the triglyceride–glucose index to conventional risk factor model could numerically but not significantly increase our ability to predict postoperative atrial fibrillation (area under the receiver: 0.742 (0.671–0.814) vs. 0.793 (0.726–0.860), p = 0.065) after septal myectomy. In our retrospective cohort study, the triglyceride–glucose index was identified as an independent predictor of postoperative atrial fibrillation in patients undergoing septal myectomy.

Metabolic Abnormalities Rather Than BMI, Associated With Increased Risk of Recurrent Stroke in Chinese Hospitalized Stroke Patients: A Retrospective Study

Background Metabolic abnormalities and body mass index (BMI) are known as apparent risk factors of recurrent stroke, but which one is more likely related to recurrent stroke remains uncertain. This study aimed to compare the metabolic phenotypes and BMI as indicators of recurrent stroke in Chinese hospitalized stroke patients. Methods In this retrospective population-based study, 856 hospitalized stroke patients from the Third Affiliated Hospital of Soochow University were enrolled. Recurrent stroke was defined as newly-onset stroke patients with a history of previous stroke. Metabolic phenotypes were categorized based on Adult Treatment Panel III criteria. BMI ≥ 25kg/m2 was defined as obesity. Results Among the hospitalized stroke patients, the prevalence of recurrent stroke was 21.9%. Metabolic abnormalities rather than BMI were significantly associated with recurrent stroke. Compared with metabolically healthy patients, metabolically unhealthy ones had 72% (odds ratio [OR] = 1.72, 95% confidence interval [CI] 1.01–2.68) increased risk of recurrent stroke, regardless of BMI and other confounding factors. Whereas, no statistical association between BMI and recurrent stroke were found. Metabolic status significantly improved risk prediction of recurrent stroke when adding to the conventional-risk-factor model (net reclassification index 17.6%, P = 0.0047; integrated discrimination improvement 0.7%, P = 0.014), while BMI did not. Conclusions Recurrent stroke is likely associated with metabolic abnormalities rather than with BMI. For the secondary prevention of stroke, controlling metabolic abnormalities is a more crucial method then BMI controlling in stroke patients.

Cardiovascular Calcification as a Marker of Increased Cardiovascular Risk and a Surrogate for Subclinical Atherosclerosis: Role of Echocardiography

The risk prediction of future cardiovascular events is mainly based on conventional risk factor assessment by validated algorithms, such as the Framingham Risk Score, the Pooled Cohort Equations and the European SCORE Risk Charts. The identification of subclinical atherosclerosis has emerged as a promising tool to refine the individual cardiovascular risk identified by these models, to prognostic stratify asymptomatic individuals and to implement preventive strategies. Several imaging modalities have been proposed for the identification of subclinical organ damage, the main ones being coronary artery calcification scanning by cardiac computed tomography and the two-dimensional ultrasound evaluation of carotid arteries. In this context, echocardiography offers an assessment of cardiac calcifications at different sites, such as the mitral apparatus (including annulus, leaflets and papillary muscles), aortic valve and ascending aorta, findings that are associated with the clinical manifestation of atherosclerotic disease and are predictive of future cardiovascular events. The aim of this paper is to summarize the available evidence on clinical implications of cardiac calcification, review studies that propose semiquantitative ultrasound assessments of cardiac calcifications and evaluate the potential of ultrasound calcium scores for risk stratification and prevention of clinical events.

Associations of Sleep and Health Functioning with Premature Exit from Work: A Cohort Study with a Methodological Emphasis

Sleep and functioning are associated with a risk of early workforce exit. However, patterns of change in sleep and functioning through time have not been investigated using person-oriented approaches to show what features of sleep and functioning are associated with an early exit. We examined the pattern of interactions between sleep and health functioning characterizing homogenous subgroups of employees and their associations with premature work exit. An additional aim was to provide a tutorial providing detailed description on how to apply these models, compared to traditional variable based risk factors. We analyzed data from 5148 midlife employees of the City of Helsinki, Finland, surveyed over three phases (2000–02, 2007, and 2012). Using repeated measures latent class analyses (RMLCA) we classified people into groups based on their trajectories in sleep and functioning. We identified four longitudinal groups: (1) Stable good sleep and functioning (reference), (2) Persistent sleep problems and good or moderate functioning, (3) Poor functioning with good sleep, and (4) Problematic sleep and health functioning. Compared to group 1, elevated risk was found in all classes with group 4 being the worst. In conclusion, focusing on person-orientated patterns of interactions between sleep and functioning helped produce qualitatively different and quantitatively stronger predictions than using conventional risk factor methodology. Thus, longitudinal person-oriented approaches may be a more powerful method for quantifying the role of sleep and health functioning as risks for premature exit from work.

Uremic Toxins and Vascular Dysfunction

Vascular dysfunction is an essential element found in many cardiovascular pathologies and in pathologies that have a cardiovascular impact such as chronic kidney disease (CKD). Alteration of vasomotricity is due to an imbalance between the production of relaxing and contracting factors. In addition to becoming a determining factor in pathophysiological alterations, vascular dysfunction constitutes the first step in the development of atherosclerosis plaques or vascular calcifications. In patients with CKD, alteration of vasomotricity tends to emerge as being a new, less conventional, risk factor. CKD is characterized by the accumulation of uremic toxins (UTs) such as phosphate, para-cresyl sulfate, indoxyl sulfate, and FGF23 and, consequently, the deleterious role of UTs on vascular dysfunction has been explored. This accumulation of UTs is associated with systemic alterations including inflammation, oxidative stress, and the decrease of nitric oxide production. The present review proposes to summarize our current knowledge of the mechanisms by which UTs induce vascular dysfunction.

Studi seroepidemiologis Chlamydia pneumoniae dan beberapa mikroorganisme yang diduga menyebabkan infark miokard akut

Acute myocardial infarction (AMI) is still a major health problem. Approximately 20% of death in the world was caused by atherosclerotic diseases like stroke, myocardial infarct. Recent studies explain the role of infection in the pathogenicity of AMI. The purpose of this study was to examine seroepidemiological study of Chlamydia pneumoniae infection related to AMI and its occurrence as pathogen burden-infection with other microorganisms. Subjects for this study were patients diagnosed clinically and laboratorically as AMI, from RSUD Saiful Anwar and RS. Lavalette,Malang. Blood samples were collected from each subject and serum was analyzed for IgG antibodies against C. pneumoniae, CMV, H. pylori and S. mutans. Clinical status was analyzed to find IMA conventional risk factors, such as smoking, hypertension, hypercholesterolemia, and diabetes mellitus. The result showed that the average age of these patients were 55 years and men were more common than women. All of these patients were infected by microorganism. Patients with infection and conventional risk factors were 51,9%, infection without conventional risk factors was 48,2%, and conventional risk factors for IMA without infection was 51, 85%. The most common conventional risk factor was smoking (37, 0%). Infection by S. mutans was detected in all patients (100%), C. pneumoniae 92,6%, CMV 92,6%, H. pylori 77,8%; however multiple infections were observed in most of the patients. It was concluded that microorganisms played rolesin the pathogenicity of IMA. It was suggested that the development of IMA might be contributed by single infection as well as multiple infections. However, multiple infections tend to be observed in most of the patients.

Utilizing cultural and ethnic variables in a survey to identify individuals at high risk for gastric cancer.

23 Background: Absence of national US gastric cancer (GC) screening necessitates alternative methods like surveys to identify high-risk populations. Identification of high-risk persons may be enhanced by adding ethnic and cultural variables to more conventionally known risk factors for GC. Methods: Data from a prior case-control study of 40 GC cases and 100 controls were used. A "conventional" risk factor model (age, gender, family history of GC, body mass index, excessive salt intake, alcohol, smoking, blood type, H pylori) was compared to one incorporating ethnic and cultural variables (race, immigration, generation, cultural food at ages 15-18 years, acculturation and education) using model fit, sensitivity, specificity and expected positive predictive values (PPV). Stepwise regression was then used to create a model from this pool of variables. PPV was calculated using Bayes' Theorem applied to the baseline GC incidence in the US (7.2 per 100,000). Results: The "conventional" model required 14 questions and resulted in 25% sensitivity, 94% specificity, 28 per 100,000 PPV at the 70% probability cut-off, and AUC=0.871. The model incorporating ethnic and cultural variables required 38 questions and resulted in 48% sensitivity, 91% specificity, 38 per 100,000 PPV, and AUC =0.965. After eliminating items less predictive at p=0.2, age, gender, family history of GC, excessive salt intake, immigration, generation and race remained in the model. This model required 7 questions and resulted in 45% sensitivity, 96% specificity, 81 per 100,000 PPV and AUC=0.914. Conclusions: The model with the greatest ability to identify persons at risk of GC included ethnic and cultural variables. This model can be translated into a survey with few items that can serve as a highly scalable tool to identify high-risk individuals. Support: UG1CA189823 [Table: see text]