The Coronary Arteries in Adults after the Arterial Switch Operation: A Systematic Review

Coronary artery status in adults long after the arterial switch operation (ASO) is unclear. We conducted a systematic review to provide an overview of coronary complications during adulthood and to evaluate the value of routine coronary imaging in adults after ASO, in light of current guidelines. Articles were screened for the inclusion of adult ASO patients and data on coronary complications and findings of coronary imaging were collected. A total of 993 adults were followed with a median available follow-up of only 2.0 years after reaching adulthood. Myocardial ischemia was suspected in 17/192 patients (8.9%). The number of coronary interventions was four (0.4%), and coronary death was reported in four (0.4%) patients. A lack of ischemia-related symptoms cannot be excluded because innervation studies indicated deficient cardiac innervation after ASO, although data is limited. Anatomical high-risk features found by routine coronary computed tomography (cCT) included stenosis (4%), acute angle (40%), kinking (24%) and inter-arterial course (11%). No coronary complications were reported during pregnancy (n = 45), although, remarkably, four (9%) patients developed heart failure. The 2020 European Society of Cardiology (ESC) guidelines state that routine screening for coronary pathologies is questionable. Based on current findings and in line with the 2018 American ACC/AHA guidelines a baseline assessment of the coronary arteries in all ASO adults seems justifiable. Thereafter, an individualized coronary follow-up strategy is advisable at least until significant duration of follow-up is available.

Brugada syndrome in the practice of a cardiologist. Case report

Cardiovascular mortality occupies a leading position in the structure of total mortality. Brugada syndrome is one of the syndromes associated with the risk of sudden non-coronary death at a young age. However, the prevalence of this syndrome and its clinical manifestations are underestimated due to low detectability. This article presents a clinical case of the diagnosis of Brugada syndrome with the installation of a cardioverter-defibrillator in the practice of a cardiologist and a brief literature review of this syndrome.

Immunohistochemical diagnosis of the viability of the strangulation furrow

The aim of the research was to study the possibility of using immunohistochemical markers for the diagnosis of intravital stangulation. Materials and methods: Fragments of the neck skin from the strnaglulation zone were selected as objects of research. The main study group included 20 deaths due to hanging (10 men and 10 women). For the control group, 10 cases of acute coronary death (5 men and 5 women) were used. Using a complex of IHC markers, the labeling of the epidermis and epithelial structures, the features of cellular immune responses, the manifestation of oxidative steress were studied. Results: Peculiarities of morphological manifestations of strangulation furrow in mechanical asphyxia were studied. It is established that the key link of its morphogenesis is impaired vascular wall permeability with loss of type IV collagen in the basement membranes of epithelium and skin vessels, migration into tissues of activated CD15+ granulocytes, CD68+ macrophages and CD117+ labrocytes, endothelial nitric oxide synthase (eNOS), inducible nitric oxide synthase (iNOS), fibrinogen protein and transforming growth factor β1. Conclusion: Such changes in the tinctorial properties of skin and subcutaneous adipose tissue can be recorded by immunohistochemical (IHC) and serve as an important diagnostic criterion for the viability of the formation of the strangulation furrow.

Plaque rupture and erosion

Despite improvement in the treatment, prevention, and risk factor management of atherosclerosis, the most frequent cause of death globally remains coronary artery disease. Therefore, it is essential to understand the underlying mechanisms involved in the manifestation of acute coronary syndromes, sudden cardiac death, or stable ischaemic heart disease. Coronary atherothrombosis is the main underlying cause of acute coronary syndromes. This chapter discusses the two most frequent causes of atherothrombosis, that is, plaque rupture and plaque erosion, in patients presenting with acute myocardial infarction or sudden coronary death, including differences in the incidence, aetiology, morphological features, and risk factors that lead to plaque rupture and erosion.

An Early-Onset Subgroup of Type 2 Diabetes: A Multi-Generational, Prospective Analysis in the Framingham Heart Study

<b>Objective:</b> To assess the influence of type 2 diabetes occurring earlier (age <55 years) versus later in life, on the risk of cardiovascular death, and of diabetes in offspring. <p><b>Research Design and Methods: </b>In the Framingham Heart Study, a community-based prospective cohort study, glycemic status was ascertained at serial examinations over six decades among 5571 first- and second-generation participants with mortality data; and 2123 initially non-diabetic second-generation participants with data on parental diabetes status. We assessed cause of death in a case (cardiovascular death) - control (non-cardiovascular death) design, and incident diabetes in offspring in relation to parental early-onset diabetes. </p> <p><b>Results:</b> Of the participants in two generations (N=5571), there were 1822 cardiovascular deaths (including 961 coronary deaths). The odds of cardiovascular versus non-cardiovascular death increased with decreasing age of diabetes onset (<i>P</i><0.001 trend). Compared with persons who never developed diabetes, early-onset diabetes conferred a 1.81-fold odds (95% confidence interval [CI] 1.10-2.97, <i>P=</i>0.02) of cardiovascular death and 1.75-fold (0.96-3.21,<i> P=</i>0.07) odds of coronary death, whereas later-onset diabetes was not associated with greater risk for either (<i>P</i>=0.09 for cardiovascular death; <i>P=</i>0.51 for coronary death). In second-generation participants, having a parent with early-onset diabetes increased diabetes risk by 3.24-fold (1.73-6.07) whereas having one or both parents with late-onset diabetes increased diabetes risk by 2.19-fold (1.50-3.19).</p> <b>Conclusions</b>: Our findings provide evidence for a diabetes subgroup with an early onset, a stronger association with cardiovascular death, and higher transgenerational transmission.

An Early-Onset Subgroup of Type 2 Diabetes: A Multi-Generational, Prospective Analysis in the Framingham Heart Study

<b>Objective:</b> To assess the influence of type 2 diabetes occurring earlier (age <55 years) versus later in life, on the risk of cardiovascular death, and of diabetes in offspring. <p><b>Research Design and Methods: </b>In the Framingham Heart Study, a community-based prospective cohort study, glycemic status was ascertained at serial examinations over six decades among 5571 first- and second-generation participants with mortality data; and 2123 initially non-diabetic second-generation participants with data on parental diabetes status. We assessed cause of death in a case (cardiovascular death) - control (non-cardiovascular death) design, and incident diabetes in offspring in relation to parental early-onset diabetes. </p> <p><b>Results:</b> Of the participants in two generations (N=5571), there were 1822 cardiovascular deaths (including 961 coronary deaths). The odds of cardiovascular versus non-cardiovascular death increased with decreasing age of diabetes onset (<i>P</i><0.001 trend). Compared with persons who never developed diabetes, early-onset diabetes conferred a 1.81-fold odds (95% confidence interval [CI] 1.10-2.97, <i>P=</i>0.02) of cardiovascular death and 1.75-fold (0.96-3.21,<i> P=</i>0.07) odds of coronary death, whereas later-onset diabetes was not associated with greater risk for either (<i>P</i>=0.09 for cardiovascular death; <i>P=</i>0.51 for coronary death). In second-generation participants, having a parent with early-onset diabetes increased diabetes risk by 3.24-fold (1.73-6.07) whereas having one or both parents with late-onset diabetes increased diabetes risk by 2.19-fold (1.50-3.19).</p> <b>Conclusions</b>: Our findings provide evidence for a diabetes subgroup with an early onset, a stronger association with cardiovascular death, and higher transgenerational transmission.

Changes in the management of patients with acute coronary syndrome – have the disease outcomes changed?

Aim To analyze results of changing the management tactics in patients with acute coronary syndrome (ACS) in clinical practice from 2004 through 2018 expressed as improvement in prognosis.Material and methods Results of two observational studies were analyzed: ORACLE I (2004–2007), which included 1193 patients with ACS (mean age, 61.1±11.69 years; men, 63.3 %) and ORACLE II (2014–2017), which included 1652 patients from 4 vascular centers (mean age, 64.61±12.67 years; men, 62.3 %).Results Patients included into the ORACLE II study in 2014 were significantly older and the proportion of patients with diabetes mellitus was greater than in the ORACLE I study (14.7 and 22.6 %, respectively). After matching the groups by major clinical characteristics, it was found that introducing the invasive management tactics for ACS patients was associated with a reduced rate of all-cause death (from 8.2 to 6.1 % for one year), a tendency towards decreased number of coronary death cases (from 5.6 to 4.0 %), and a decrease in risk of recurrent coronary complications (from 17.4 to 7.7 %).Conclusion Implementing the vascular program statistically significantly decreased the total death rate for at least one-year observation in comparable patient groups.

Prevalence, incidence, and outcomes across cardiovascular diseases in homeless individuals using national linked electronic health records

Aims The risk and burden of cardiovascular disease (CVD) are higher in homeless than in housed individuals but population-based analyses are lacking. The aim of this study was to investigate prevalence, incidence and outcomes across a range of specific CVDs among homeless individuals. Methods and results Using linked UK primary care electronic health records (EHRs) and validated phenotypes, we identified homeless individuals aged ≥16 years between 1998 and 2019, and age- and sex-matched housed controls in a 1:5 ratio. For 12 CVDs (stable angina; unstable angina; myocardial infarction; sudden cardiac death or cardiac arrest; unheralded coronary death; heart failure; transient ischaemic attack; ischaemic stroke; subarachnoid haemorrhage; intracerebral haemorrhage; peripheral arterial disease; abdominal aortic aneurysm), we estimated prevalence, incidence, and 1-year mortality post-diagnosis, comparing homeless and housed groups. We identified 8492 homeless individuals (32 134 matched housed individuals). Comorbidities and risk factors were more prevalent in homeless people, e.g. smoking: 78.1% vs. 48.3% and atrial fibrillation: 9.9% vs. 8.6%, P &lt; 0.001. CVD prevalence (11.6% vs. 6.5%), incidence (14.7 vs. 8.1 per 1000 person-years), and 1-year mortality risk [adjusted hazard ratio 1.64, 95% confidence interval (CI) 1.29–2.08, P &lt; 0.001] were higher, and onset was earlier (difference 4.6, 95% CI 2.8–6.3 years, P &lt; 0.001), in homeless, compared with housed people. Homeless individuals had higher CVD incidence in all three arterial territories than housed people. Conclusion CVD in homeless individuals has high prevalence, incidence, and 1-year mortality risk post-diagnosis with earlier onset, and high burden of risk factors. Inclusion health and social care strategies should reflect this high preventable and treatable burden, which is increasingly important in the current COVID-19 context.