Evaluation of the Modified SAMe-TT2R2 Score to Predict Good Anticoagulation Control with Warfarin Among non-valvular Atrial Fibrillation Patients

Background: The SAMe-TT2 R2 Score was developed to identify vitamin K antagonists control outliers before non-valvular atrial fibrillation (AF) patients start treatment. SAMe-TT2 R2 Score was derived and validated using a primarily white Caucasian population to predict TTR. Given that non-Caucasian race already confers 2 points in this score, the SAMe-TT2 R2 score requires validation and/or re-calibration despite race of population. Method: We conducted a cohort retrospective study that included all non-valvular atrial fibrillation patients who were on warfarin therapy from January to December 2019. Then we calculated the modified SAMe-TT2 R2 and SAMe-TT2 R2 for all study populations and we correlated the result with patients' TTR. The TTR was calculated through the Rosendaal's method. Results: We had 662 patient using warfarin therapy, among those 662, 60.9% were under cardiology and using it for cardiac indication, and only 18.1% diagnosed to have non-valvular AF. Modified SAMe-TT2 R2 score has good relation to original SAMe-TT2 R2 score as showed 75.71% (95% CI. 63.99 to 85.17%), 100% (95% CI. 92.89 to 100%) and 15% (95% CI. 3.21 to 77.95%); accuracy, sensitivity and specificity in relation to SAMe-TT2 R2 respectively. In addition to that in this small cohort we found that there is universal relationship between SAMe-TT2 R2 score, Modified SAMe-TT2 R2 score and TTR; TTR >=65% associate with low score (<2) of both SAMe-TT2 R2 , Modified SAMe-TT2 R2 score. Conclusion: The use of Modified SAMe-TT2 R2 score allows clinicians to make an informed decision on whether to start vitamin K antagonist or other non-vitamin K antagonist oral anticoagulant despite the race of the patients.

Sex Differences in Association of Depression with Self-Rated Health and Awareness of Cardiovascular Preventive Measures

Aim: To determine gender differences in the relationship between depression and self-rated health and awareness of measures for cardiovascular prevention in an open population of 25-4 years in Russia/Siberia (Novosibirsk). Methods: Under the screening based on the budgetary theme No. AAAA-A17-117112850280-2, a random representative sample of the male and female population who were residents in one of the districts in Novosibirsk was examined in 2013-2016 (n=975, 43.8% males, mean age 34.5±0.4 years). Selfassessment of health and awareness of preventive measures was assessed using the questionnaire "Knowledge and attitude to own health". Depression was assessed using the depression scale based on the adapted MMPI questionnaire. Results: There was a linear increase in the proportion of those who considered themselves "not entirely healthy" or "sick" with an increase in the level of depression in 25-34 and 35-44 years age groups of studied population. Women aged 35-44 years with a moderate level of depression are 15-20% more likely than men to report that they are “not entirely healthy” and “sick” and have health complaints (p <0.05). Men aged 25-34y with major depression were more likely to report negative self-esteem and health complaints but these differences were not statistically significant. In both age groups, with an increase in the level of depression by 20-40%, the proportion of people who “clearly did not take care of their health” among men and women increased. However, the presence of depression eliminate statistical gender differences. In the presence of depression, women are 16% more likely than men to consider it highly likely to develop a serious illness in the next 5-10 years, while they are 10% less likely to have regular health checks. Women were 4-12% more likely than men to doubt the possibilities of preventive medicine, regardless of the level of depression. Conclusions: As depression rises, self-rated health falls and confidence in the effectiveness of preventive measures among both sexes decreases. And while women are more likely to report pessimistic responses to health and prevention, the presence of high levels of depression deletes gender differences.

Personal Digital Health Assistants

The Aim: To determine gender differences in the dynamic of job stress indicators in an open population of 25-64 years over a long-term period - 29 years in Russia / Siberia (Novosibirsk). Methods: Within the framework of the screening in 1988-89 under the WHO MONICA-psychosocial (MOPSY) program (n=1676, 49.5% males, mean age 44.1±0.4 years), in 2003-2005 under the international project HAPIEE (n=1650, 34.9% males, mean age 54.25±0.2 years), in 2013-2016 (n=975, 43.8% males, mean age 34.5±0,4 years) and 2016-2017 (n=663, 41.3% males, mean age 51.95±0.32 years) within the framework of the budgetary theme No. AAAA-A17-117112850280-2, random representative samples of men and women in one of districts in Novosibirsk were examined. Job stress indicators were assessed using the Karasek’s scale adopted by MONICA-MOPSY. Results: About 40% of male and female population in 1988 reported a change in occupation in the previous 12 years. The highest proportion of such persons was observed in the younger age groups and significant gender differences were also found there. By 2016-17, the proportion of those who changed their specialty decreased but gender differences were not determined. In 2016-17, the proportion of men and women who enjoy their job increased slightly compared to 1988, but the gender difference was insignificant. Responsibility at work increased up to 58.2% and 54.5%, respectively in dynamics among young men and women. In 2016-17, the perception of responsibility at the workplace returned to the semblance of 1988 without gender differences. Regarding changes in the workplace, in 1988, the most frequent were "change of salary" and "change of workplace" for both sexes. Men more often than women indicated conflicts with their superiors and subordinates. In 2013, the change of workplace was reported more often than changes in salary (especially in the youngest group of 25-34 years old) but in 2017 these answers correlated with each other, amounting to 11-12%. No gender differences were observed. In 2013-16, share of men and women who reduced their workload increased to 20%. This proportion decreased in 2016-17. And the trend towards an increase in workload at the workplace moved at a faster pace, especially among middle-aged and older men. The proportion of women who cannot relax and rest after usual working day in the period from 1988 to 2013-16 was stable at 38-39%; but by 2016-2017 it decreased by a third. The proportion of such men has been growing over 29 years and began to exceed women by 10% in 2016-17. Conclusions: Both genders began to perform additional work tasks more often and to assess their responsibility at work as high over 29 years of observations. There is a trend towards eliminating of sex differences.

The Correlation between the Right Ventricular Strain and the Severity of Right Coronary Artery Lesions in Patients with Stable Coronary Artery Disease

Background A recent study demonstrated that in patients with stable coronary artery disease who were indicated for coronary angiography and it resulted in single proximal RCA significant lesion and 2D echocardiography was normal, speckle tracking on RV free wall detected significant impact on its segments and its global strain. Aim of the Work: To correlate between the RV strain and the degree of RCA stenosis in patients with stable Angina. Methods: a prospective observational study done included large number of persons complaining of typical anginal pain indicated for coronary angiography. Conventional 2D TTE was done and we excluded patients with RV dysfunction or RV dilatation. Speckle tracking on RV was done before doing coronary angiography. Patients with single ostial, para ostial or proximal dominant RCA lesions were chose to correlate their degree of stenosis with right ventricular free wall and RV global strain speckle tracking. Also, control group with normal speckle tracking and normal coronary angiography was taken in the study. Data was collected & coded using Microsoft Office Excel Worksheet while statistical analysis was performed using statistical package for social sciences (SPSS) version Results: The study showed that regarding the Echocardiography parameters, there were statistically significant difference between the 2 groups regarding the B RVFW, MRVFW, APRVFW and GLsRV. Significant relation was detected between degree of the proximal RCA stenotic lesion and speckle tracking parameters of RVFW and GLsRV. Conclusion: RVFWLS and GLsRV has highly significant correlation with the degree of the proximal stenotic lesion.

The Covid-19 Effects on the Cardiovascular System; A Focus on Myocarditis

The WHO declared COVID 19 a global pandemic on March 11, 2020. The effect the virus has created in various aspects of our lives has made it of primary importance that we understand its pathophysiology, complication, preventive care, and treatment. A significant number of COVID patients develop some form of cardiac injury, whether while infected or after recovery. In this article, we aim to discuss these aspects and expand further on the cardiovascular effects seen in COVID 19 infected patients, emphasizing myocarditis. We discuss the case of a patient who developed cardiac injuries while infected with COVID 19, which she contacted 18 days after receiving the first dose of the COVID mRNA vaccine. This article provides more understanding of the relationship between COVID-19 and the heart.

Relationship between Epicardial Adipose Tissue and High-Risk Coronary Plaque Features in Patients with Suspected Acute Coronary Syndrome

Objective: To evaluate the association between EAT volume and attenuation and high-risk coronary plaque (HRP) in patients with suspected acute coronary syndrome (ACS). Material and Methods: In this prospective study were enrolled, from November 2020 to August 2021, consecutive patients who underwent cardiac computed tomography (CCT) for suspected ACS. All exams were performed using a 2x192-slice dual source CT scanner. EAT volume and attenuation were evaluated in all patients. HRP was defined as plaque with more than 2 high-risk features (low attenuation plaque, positive remolding, napkin-ring sign, spotty calcification) on CCT image. Based on the presence or absence of HRP patients were divided into two groups and EAT volume and attenuation were compared. Results: In this study were enrolled 106 patients: 37 with HRP and 69 without HRP. Patients with HRP have higher EAT volume and attenuation than those without HRP, respectively, 119.0±14.0 cm3 vs 96.3±8.3 cm3 (p<0.0001) and -85.7±15.7 HU vs -95.0±18.4 HU (p=0.0108). After adjustment by coronary calcium score (CCS) and coronary stenosis, EAT volume and attenuation were independent risk predictors of presence of HRP. Conclusions: Higher EAT volume and attenuation are associated with HRP in patient with ACS and are independent of CCS and coronary stenosis.

Risk Factors Associated with Congenital Heart Disease in Patients Presenting to Aljalila Cardiology Clinic between January 2020- May 2020: A Case Control Study

Objective: To investigate the association of maternal diabetes, maternal smoking and syndromes with congenital heart disease (CHD) in patients attending Aljalila cardiology clinic between January 2020 and May of 2020. Methods: A case control study to assess the association of maternal diabetes, maternal smoking and syndromes with CHD. All patients that presented to the clinic between January 2020 and May of 2020 were included. An interviewer administered questionnaire was used to record the presence of maternal diabetes, maternal smoking, and the type of syndrome and type of CHD. Patients with CHD were included in the case group and patients who did not have CHD were in the control group. Age, gender, and nationality were also collected from the hospital records. Fisher exact test and logistic regression was used to analyze the results. Results: A total of 177 cases and 211 controls were recruited. All the risk factors increase the risk of CHD, with maternal diabetes (OR 6.3, 95% CI 2.7-14.6) having the strongest association, then syndromes (OR 5.1, 95% CI 2.3-11.3) and lastly maternal smoking (OR 4.0, 95% CI 1.0-16.3). The most common type of CHD is ventricular septal defect. Conclusion: Maternal diabetes, maternal smoking and syndromes are significant risk factors of CHD in children visiting Aljalila cardiology clinic. Action needs to be taken in order to decrease these risk factors and so, decrease the incidence of CHD in the future. Clearly, more research is needed in order to identify other risk factors for patients in the United Arab Emirates (UAE)