Weak diagnostic performance of resting ankle ABI compared with lower limb's arterial Doppler in the diagnosis of PAD in coronary patients: about a hospital serial study

Introduction. L’index de pression systolique (IPS) est considéré comme un outil indispensable, pour la prise en charge de l'artériopathie oblitérante des membres inférieurs (AOMI), cependant un complément d’exploration par les autres testes physiologiques, IPS au gros orteil et IPS effort s’impose afin de réduire le nombre des faux négatifs. Objectif. Démontrer le faible apport de l’IPS cheville de repos par rapport à l’échodoppler artériel des membres inférieurs dans le diagnostic de l’AOMI. Matériels et méthodes. Sur une série de 300 malades coronariens consécutifs durant l’année 2016 hospitalisés dans le service de cardiologie de l’hôpital universitaire de Constantine, un dépistage de l’AOMI a été réalisé par les investigations suivantes : Mesure de l’IPS à la cheville, compléter par la mesure de l’IPS a l’orteil si incompressibilité artérielle et par la mesure de l’IPS d’effort si l’IPS de repos est limite. Un échodoppler artériel des membres inférieurs a été réalisée par un échographe vividE9 General Electric pour l’ensemble de nos malades, en utilisant une sonde à balayage linéaire 12L, destinée à l’exploration vasculaire périphérique permettant d’obtenir un dépistage ciblé, Le traitement et l’exploitation des données ont fait appel au logiciel SPSS22. Résultats. Une sensibilité modérée de l’ordre de 50%, face à une spécificité élevée avoisinant 100% de l’IPS cheville de repos par rapport à l’échodoppler artériel des membres inférieurs. Sensibilité nettement améliorer après complément par les autres testes physiologiques qui sont la prise de l’IPS cheville effort et la mesure de l’index de pression systolique au gros orteil. Conclusion. L’examen vasculaire des membres inférieurs associe à la mesure de l’IPS cheville couplée aux autres testes physiologique (IPS au gros orteil et IPS effort) assurent une bonne sensibilité et spécificité diagnostiques de l’AOMI.

Evolution of Metabolic Phenotypes of Obesity in Coronary Patients after 5 Years of Dietary Intervention: From the CORDIOPREV Study

Background: Obesity phenotypes with different metabolic status have been described previously. We analyzed metabolic phenotypes in obese coronary patients during a 5-year follow-up, and examined the factors influencing this evolution. Methods: The CORDIOPREV study is a randomized, long-term secondary prevention study with two healthy diets: Mediterranean and low-fat. All obese patients were classified as either metabolically healthy obese (MHO) or metabolically unhealthy obese (MUO). We evaluated the changes in the metabolic phenotypes and related variables after 5 years of dietary intervention. Results: Initially, 562 out of the 1002 CORDIOPREV patients were obese. After 5 years, 476 obese patients maintained their clinical and dietary visits; 71.8% of MHO patients changed to unhealthy phenotypes (MHO-Progressors), whereas the MHO patients who maintained healthy phenotypes (MHO-Non-Progressors) lost more in terms of their body mass index (BMI) and had a lower fatty liver index (FLI-score) (p < 0.05). Most of the MUO (92%) patients maintained unhealthy phenotypes (MUO-Non-Responders), but 8% became metabolically healthy (MUO-Responders) after a significant decrease in their BMI and FLI-score, with improvement in all metabolic criteria. No differences were found among dietary groups. Conclusions: A greater loss of weight and liver fat is associated with a lower progression of the MHO phenotype to unhealthy phenotypes. Likewise, a marked improvement in these parameters is associated with regression from MUO to healthy phenotypes.

Low vitamin K status, high sclerostin and mortality risk of stable coronary heart disease patients

Aim: We explored whether matrix Gla protein (MGP, natural calcification inhibitor) and sclerostin (glycoprotein responsible for osteoblast differentiation) interact in terms of mortality risk in coronary patients. Methods: 945 patients after myocardial infarction and/or coronary revascularization were followed in a prospective study. All-cause death, fatal or nonfatal cardiovascular events and heart failure hospitalizations were registered. Results: Either high desphospho-uncarboxylated MGP (dp-ucMGP) or high sclerostin were independently associated with 5-year all-cause/cardiovascular mortality. However, we observed an additional mortality risk in the coincidence of both factors. Concomitantly high dp-ucMGP (≥884 pmol/l) plus sclerostin (≥589 ng/l) were associated with increased all-cause mortality risk compared with ‘normal’ concentration s of both factors (HRR 3.71 [95% CI: 2.07–6.62, p < 0.0001]), or if only one biomarker has been increased. A similar pattern was observed for fatal, but not for nonfatal cardiovascular events. Conclusion: Concomitantly high MGP and sclerostin indicate increased mortality risk, which probably reflects their role in cardiovascular calcifications.

The Importance of Echocardiography Assessment in Coronary Patients Subject to Cardiovascular Recovery Programs

Cardiovascular diseases cause approximately one-third of deaths worldwide and an increasing number of individuals with non-fatal ischemic heart disease live with chronic disabilities and impaired quality of life. Cardiac rehabilitation is designed to limit the physiological and psychological effects of cardiac illness, reduce the risk for sudden death or re-infarction, control cardiac symptoms and enhance the psychosocial and vocational status of selected patients. The study group included a group of 78 patients who had a coronary event no more than 3 months ago and who are included in cardio-vascular recovery programs. The patients were echocardiographic evaluated at the first admission and later at 6 months. The evolution of the patients was a favorable one, being objectified an increase of both the ejection fraction of the left ventricle, as well as an improvement of MAPSE and TAPSE.

Owning a Pet Is Associated with Changes in the Composition of Gut Microbiota and Could Influence the Risk of Metabolic Disorders in Humans

Pet ownership positively influences clinical outcomes in cardiovascular prevention. Additionally, cardiovascular disease (CVD) has been previously linked to microbiota dysbiosis. We evaluated the influence of owning a pet and its relationship with the intestinal microbiota. We analyzed the gut microbiota from 162 coronary patients from the CORDIOPREV study (NCT00924937) according to whether they owned pets (n = 83) or not (n = 79). The pet-owner group was further divided according to whether they owned dogs only (n = 28) or not (n = 55). A 7-item pet-owners test score was used. Patients who owned pets had less risk of metabolic syndrome (MetS) (OR = 0.462) and obesity (OR = 0.519) and were younger (p < 0.001) than patients who did not own pets. Additionally, patients who owned dogs had less risk of MetS (OR = 0.378) and obesity (OR = 0.418) and were younger (p < 0.001) than patients who did not own pets. A preponderance of the genera Serratia and Coprococcus was found in the group of owners, while the genera Ruminococcus, an unknown genus of Enterobacteriaceae and Anaerotruncus were preponderant in the group of non-owners. In patients who owned dogs, Methanobrevibacter and two more genera, Coprococcus and Oscillospira, were more common. Our study suggests that the prevalence of MetS and obesity in CVD patients is lower in pet owners, and that pet ownership could be a protective factor against MetS through the shaping of the gut microbiota. Thus, owning a pet could be considered as a protective factor against cardiometabolic diseases.

Homocysteine, a predictor of cardiovascular adverse events in coronary artery disease

Funding Acknowledgements Type of funding sources: None. OnBehalf GENEMACOR Introduction After the diagnosis of coronary artery disease (CAD), traditional risk factors such as diabetes mellitus, dyslipidemia, hypertension and smoking have been used to assess the risk of major cardiovascular adverse events (MACE). However, despite reduction of these factors, presence of MACE remains high. It is necessary to identify other causal risk factors for MACE in coronary patients and increased plasma Homocysteine (Hcy) level seems to be a likely candidate. However, the influence of Hcy levels in the prognosis of coronary patients presents a limited knowledge. Objective To evaluate the influence of high level of Hcy in MACE (defined as a composite endpoint of cardiovascular death, acute myocardial infarction, stroke, admission for heart failure and need to revascularization) of coronary artery patients. Materials and Methods Study analyses of 1687 patients selected from GENEMACOR study population, with at least one &gt; 75% coronary stenosis by angiography. That population was divided in three terciles according to the Hcy level and the population of the 2nd tercil (Hcy 11.1-13.6mmol/L) was excluded. The end population of 1118 patients was a median age of 53.1 ± 7.9 years and 77.6% were men. We compared patients in the 1st (Hcy &lt; 11.1mmol/L) and 3rd tercil (Hcy &gt; 13.6mmol/L) during a mean follow up of 5.0 ± 4.8 years. Results 560 (50.1%) patients were included in the 1st tercil group (median age 51.6 ± 3 years, 72.0% men) and 558 (49.9%) patients were in the 3rd tercil group (median age 54.6 ± 3 years, 83.3% men). In our population, high levels of Hcy were associated with MACE (OR 1.43, 95% CI: 1.12-1.83, p 0.004). Conclusion In our population a higher level of Hcy was associated with adverse prognosis and increased occurrence of MACE. Knowing that elevated homocysteine levels are associated with increased risk of MACE, in these patients is essential to have a more intensive therapeutic strategy.