[Mechanisms of increase and diagnostic role of highly sensitive troponins in arterial hypertension]. / Mécanismes d'augmentation et rôle diagnostique des troponines hautement sensibles dans l'hypertension artérielle.

Improvement in immunochemical methods for the determination of key biomarkers of acute myocardial infarction has led not only to an improvement in the early diagnosis of acute myocardial infarction, but also to a change in many of our ideas about the biology and diagnostic role of cardiac troponins. Modern (highly and ultrasensitive) laboratory methods for the determination of cardiac troponin molecules in human biological fluids are highly sensitive, which makes it possible to detect even the smallest damage to cardiomyocytes that occur at the early stages of many pathologies of cardiac (coronary heart disease, arterial hypertension, etc.) and extracardiac etiology (renal failure, sepsis, chronic obstructive pulmonary disease and others), as well as under the influence of a number of physiological conditions, including the influence of physical exercises, psychoemotional stress, gender characteristics (higher levels of cardiac troponins in men, compared with women), age characteristics (an increase in the concentration of cardiac troponins with age) and circadian characterisics (prevalence of morning values of cardiac troponins concentration over evening ones). In this regard, the diagnostic capabilities of the use of highly sensitive cardiac troponins have been significantly expanded. One of the promising areas for the use of highly sensitive cardiac troponins includes the assessment of the risk of adverse cardiovascular events both in healthy patients and in patients with various risk factors for their development, one of which can be considered arterial hypertension. This article systematizes the results of clinical studies evaluating the diagnostic role of highly sensitive cardiac troponins in biological fluids (blood serum and urine) in hypertension and discusses in detail the mechanisms of increasing the levels of highly sensitive troponins in this pathological condition.

Physical Activity Is Associated With Sleep Quality: Results of the ESSE-RF Epidemiological Study.

BACKGROUND AND HYPOTHESIS: Physical activity (PA) is an important behavioral factor associated with the quality of life and healthy longevity. We hypothesize that extremely low and extremely high levels of daily PA (including occupational PA) may have a negative impact on sleep quality and psychological well-being. OBJECTIVE: The aim of the study is to investigate the association between the level and type of PA and sleep problems in adult population. MATERIALS AND METHODS: The sample of the study consisted of the participants from the population-based cohort of The Epidemiology of Cardiovascular Risk Factors and Diseases in Regions of the Russian Federation Study (ESSE-RF). The data of three regions (Saint Petersburg, Samara, Orenburg), varying in geographic, climatic, socioeconomic characteristics, was included into analysis. The total sample consisted of 4,800 participants (1,600 from each region; 1,926 males, 2,874 females), aged 25-64. The level of PA was evaluated using three parameters: the type of PA at work, the frequency of an intensive/high PA including sport (times a week), the mean duration of leisure-time walking (minutes a day). The measures of sleep quality were sleep duration and the frequency of difficulty falling asleep, difficulty maintaining sleep, daytime sleepiness, and sleep medication use. PA and sleep characteristics were assessed by interview carried by the trained medical staff. RESULTS: When controlling for gender, age and socioeconomic status (SES) extremely high occupational PA was a significant risk factor for difficulty falling asleep three or more times a week [OR(CI95%) = 1.9(1.2-3.0), p = 0.003] while working in a sitting position or having moderate physical load at work were not associated with sleep characteristics. Having a high physical load six or more times a week was a risk factor for difficulty falling asleep controlling for gender, age and SES [OR(CI95%) = 1.9(1.4-3.4), p = 0.001]. The association between leisure-time walking and sleep characteristics was insignificant. Walking less than an hour a day was associated with increased depression scores (46.5 vs. 41.9%, p = 0.006). CONCLUSION: High physical load at work and excessively frequent intensive PA are associated with difficulties initiating sleep and may represent a risk factor for insomnia.

2021 Asian Pacific Society of Cardiology Consensus Recommendations on the Use of P2Y12 Receptor Antagonists in the Asia-Pacific Region: Special Populations.

Advanced age, diabetes, and chronic kidney disease not only increase the risk for ischaemic events in chronic coronary syndromes (CCS) but also confer a high bleeding risk during antiplatelet therapy. These special populations may warrant modification of therapy, especially among Asians, who have displayed characteristics that are clinically distinct from Western patients. Previous guidance has been provided regarding the classification of high-risk CCS and the use of newer-generation P2Y12 inhibitors (i.e. ticagrelor and prasugrel) after acute coronary syndromes (ACS) in Asia. The authors summarise evidence on the use of these P2Y12 inhibitors during the transition from ACS to CCS and among special populations. Specifically, they present recommendations on the roles of standard dual antiplatelet therapy, shortened dual antiplatelet therapy and single antiplatelet therapy among patients with coronary artery disease, who are either transitioning from ACS to CCS; elderly; or with chronic kidney disease, diabetes, multivessel coronary artery disease and bleeding events during therapy.

The management of acute myocardial infarction in the Russian Federation: protocol for a study of patient pathways.

BACKGROUND: Death rates from cardiovascular disease in Russia are among the highest in the world. In recent years, the Russian government has invested substantially in the healthcare system, with a particular focus on improving access to advanced technology, especially for acute myocardial infarction (AMI). This protocol describes a study to understand the management of AMI in different Russian regions, investigating the role of patient, clinical, and health system characteristics. METHODS: A prospective observational study has recruited a representative sample of AMI patients from 16 hospitals in 13 regions across Russia. Criteria for inclusion are being aged 35-70 years with a confirmed diagnosis of AMI and surviving until the day after admission. Information being collected includes health system contacts and features of clinical management prior to the event and in the 12 months following discharge from hospital. Following initial exploration of the data to generate hypotheses, multilevel modelling will be applied to assess the role of these characteristics in both treatment decisions and any delays in time critical interventions. Between June 2015 and August 2016, 1,122 patients have been recruited at baseline and follow-up to 12 months post-discharge is scheduled to be completed by autumn 2017. The study is unique in examining patient factors, clinical management prior to admission and in hospital in the acute phase and throughout the critical first year of recovery across a diverse range of geographies and facilities. It uses standardized instruments to collect data from patients and health care providers and includes regions that are diverse in terms of geography and development of cardiology capacity. However, given the limited health services research capacity in the Russian Federation, it was not possible to obtain a sample that was truly nationally representative.

Value of syncope in patients with high-to-intermediate risk pulmonary artery embolism.

BACKGROUND: Syncope may develop in 9-35% of patients with pulmonary embolism (PE). Despite its severity and importance, the prognostic value of syncope in PE is unclear. We aimed to assess the value of syncope in patients with high-to-intermediate risk PE. METHODS: A total of 117 patients (62 males and 55 females, median age 51,86 ± 13,4 years) were enrolled into the study. According to the presence of syncope at the onset of PE, all patients were divided into two groups: the syncope group (SG) comprised 35 patients (48.8 ± 15.5 years, male 54.3%) who experienced at least one syncopal episode. The remaining 82 patients (53.4 ± 12.6 years, male 42.7%) without syncope comprised the control group (CG). RESULTS: The main predisposing risk factors of PE were the same except fewer recurrent episodes of PE (8.5 vs. 24.5% in patients from SG (p=0.048). Clinical probability of PE according to the Revised Geneva and Wells scores was high almost in every second patient in both groups (p=NS). There were twice as many patients with a high risk of fatal outcome among patients with syncope in comparison with CG patients (45.7 vs. 25.6%, respectively, p=0.032). Massive PE on computed tomography scans was found again significantly more frequently in patients with syncope (60 vs. 39%, p=0.036). The vast majority (60%) of patients with a history of syncope were treated by thrombolytic therapy (21/35) vs. only 29% of patients without syncopal events (24/82; p=0.001). In-hospital mortality was higher in patients with syncope than the control group (14.2 vs. 8.5%, p=NS). CONCLUSIONS: The history of syncope in patients with suspected PE should be considered as a possible criterion of high risk of fatal complications of in-hospital period due to frequent embolism of the pulmonary trunk and its main branches. The use of thrombolytic therapy showed a tendency in improving outcomes.

Syncope, seizure-induced bradycardia and asystole: two cases and review of clinical and pathophysiological features.

Episodes of transient loss of consciousness (TLOC) are commonly due to syncope or epileptic seizures. The distinction between both entities on clinical grounds and eyewitness accounts can be challenging and is often hampered by similar clinical features. We briefly summarize syncope-related symptoms and present the case of a female patient who suffered from TLOC episodes due to both reflex syncope and epileptic seizures. Seizure-induced syncope is a rare complication particularly of non-generalized temporal lobe seizures and may be suspected in people with epilepsy who report new semiological features with sudden onset of atonia, TLOC and seizure-related falls. We review epidemiological, clinical and electroencephalographic aspects of seizure-related asystole and syncope and discuss their clinical relevance. The implantation of a cardiac pacemaker appears to efficiently prevent seizure-related falls and consecutive injuries and is an important treatment option if full seizure-control cannot be achieved in these patients. We describe a second case of a patient with refractory temporal lobe epilepsy and seizure-related syncope which ceased after the implantation of a cardiac pacemaker.

Can the result of a tilt test be predicted in the first five minutes?

BACKGROUND: Head-up tilt testing (HUT) plays a pivotal role in the management of vasovagal syncope (VVS). Heart rate variability (HRV) is a well-known method used for noninvasive evaluation of autonomic nervous system activity. However, different results have been obtained in studies that have evaluated the HRV response to HUT in patients with VVS. METHODS: One hundred fourteen patients with recurrent VVS were enrolled in the study. According to the results of HUT, patients were divided into five groups: positive (n = 30) and negative (n = 23) Westminster; positive (n = 44) and negative (n = 11) Italian. Fourteen healthy volunteers with no history of syncope comprised the control group. Spectral indices of HRV variability were analyzed for three short-term intervals. RESULTS: Both protocols showed similar distribution of responses to tilt-testing. In the supine position, significant differences were observed between patients from groups 1, 2 and 3 in comparison with the control and Italian negative groups. They had significantly lower initial results of LF(1) [nu] and LF(1)/HF(1) ratio, and higher HF(1) [nu] values. The onset of HUT in patients with positive Westminster protocol was characterized by an almost two-fold increase in LF [nu] and decrease in HF [nu] compared to all other patients. LF(2)/HF(2) ratio in the Westminster positive group had increased more than five times since the baseline level, while during the last period, LF(3)/HF(3) ratio had increased more than six times. CONCLUSIONS: Patients with VVS have disturbed sympathovagal balance at rest. Our data suggests that the results of HUT could be predicted by analyzing the spectral parameters of HRV during the first five minutes of the test. The reaction to orthostasis in patients with syncope during the Westminster protocol was more severe compared to the Italian protocol group and the control group. Vasovagal response during the Italian protocol may be triggered by drug-induced vasodilatation.

Is it possible to accurately differentiate neurocardiogenic syncope from epilepsy?

Global cerebral hypoperfusion resulting in syncope, and asynchronous discharge of cerebral neurons leading to seizure, are two major mechanisms of transient loss of consciousness. They both have a lot in common in clinical and historical settings, although with a high prevalence of incorrect diagnosis, even by well-trained staff. The aim of this review was to try to combine data from both a cardiologist's and a neurologist's perspective (history taking, special questionnaires, serum prolactin, EEG, CT/MRI, tilt-testing, loop recorders).