Excessive daytime sleepiness, morning tiredness and major adverse cardiovascular events in patients with chronic coronary syndrome.

BACKGROUND: Sleep-related breathing disorders (SRBDs), particularly obstructive sleep apnoea, are associated with increased cardiovascular (CV) risk. However, it is not known whether individual questions used for SRBD screening are associated with major adverse CV events (MACE) and death specifically in patients with chronic coronary syndrome (CCS). METHODS: Symptoms associated with SRBD were assessed by a baseline questionnaire in 15,640 patients with CCS on optimal secondary preventive therapy in the STABILITY trial. The patients reported the frequency (never/rarely, sometimes, often and always) of: 1) loud snoring; 2) more than one awakening/night; 3) morning tiredness (MT); 4) excessive daytime sleepiness (EDS); or 5) gasping, choking or apnoea when asleep. In adjusted Cox regression models, associations between the frequency of SRBD symptoms and CV outcomes were assessed with never/rarely as reference. RESULTS: During a median follow-up time of 3.7 years, 1,588 MACE events (541 CV deaths, 749 nonfatal myocardial infarctions [MI] and 298 nonfatal strokes) occurred. EDS was associated (hazard ratio [HR], 95% confidence interval [CI]) with increased risk of MACE (sometimes 1.14 [1.01-1.29], often 1.19 [1.01-1.40] and always 1.43 [1.15-1.78]), MI (always 1.61 [1.17-2.20]) and all-cause death (often 1.26 [1.05-1.52] and always 1.71 [1.35-2.15]). MT was associated with higher risk of MACE (often 1.23 [1.04-1.45] and always 1.46 [1.18-1.81]), MI (always 1.61 [1.22-2.14]) and all-cause death (always 1.54 [1.20-1.98]). The other SRBD-related questions were not consistently associated with worse outcomes. CONCLUSIONS: In patients with CCS, gradually higher levels of EDS and MT were independently associated with increased risk of MACE, including mortality.

[HISTORY OF GYNECOLOGICAL DISORDERS, OBSTERIC PATHOLOGY AND ANDROGEN LEVELS AS PROGNOSTIC FACTORS AND INDICES OF MYOCARDIAL INJURY AMONG POSTMENOPAUSAL WOMEN WITH ACUTE CORONARY SYNDROME.]

The study ob]ective was assessment of pathogenetic and prognostic significance of gynecologic and obstetrical pathology and the concentrations of sex steroids in adult women with acute coronaty syndrome (ACS). The study group included 120 postmenopausal women with ACS treated in the Clinic of Cardiology, University Hospital "Alexandrovska" between 2011 and 2013. Sex hormones were measured in 57 patients. Enzyme, electrochemiluminescent, enzyme-linked immunologic and immunoturbodimeric methods were used for the examined indices assessment. The history for gynecologic disorders and pregnancy complications was associated with coronaiy atherosclerotic burden (SYNTAX score - 4,6+/-8,8 vs 8,5+/-9,3, p=0,003), gynecologic history only - with lower 17Beta-estradiol levels (139,01+/-167,66 vs 113,51+/-304,1, p=0,004) and coronaly atherosclerosis severity (5,5+/-9,3 vs 8,0+/-10,3, p=0,058). Abnormally high endogenous concentrations of androgens were found among the patients with ACS with ST elevation, STEMI (27,5% vs 77,8%, p=0,004), with significantly more intense acute infiammatoty response (8,7+/-3,21 vs 11,07+/-2,85, p=0,044 3a WBC) and more extensive acute myocardial damage (57,8+/-12,6 vs 45,3 ml, p=O,OO8 for e]ection fraction 33,7+/-37,4 vs 117+/-144,22 U/L, p=0,031 for CPK-MB; 0,89+/-8 18 vs 1,87+/-0,4 ng/ml, p=0,009 for hsTnT). The gynecologic and obstetrical history and hyperandrogenism are related to the extent and severity of coronary atherosclerosis, occurrence of STEMI, more intense acute inflammatory response and myocardial injury among postmenopausal women with ACS.

[The effect of an aortocoronary bypass on the physical capacity of drug-stabilized patients with unstable angina pectoris]. / Efekt na aorto-koronarniia bai-pas vurkhu fizicheskiia kapatsitet pri medikamentozno stabilizirani bolni ot nestabilna angina pectoris.

To 51 patients with unstable angina pectoris a submaximum symptom-limited bicycle ergometry [correction of veloergometric] test was performed 3 to 6 days after stabilization by medicamentous treatment was achieved and 2 to 6 months after an aortocoronary bypass had been accomplished. During the first veloergometric test myocardial ischemia was induced in all patients--9 patients were in the IV, 18--in the III and 24--in the II functional class according to NYHA. During the second veloergometric test myocardial ischemia was induced only in 5 patients. At the end of the first year after the aortocoronary bypass had been performed 45 (88.2%) of the patients were without complaints. The predictive value of the positive veloergometric test after an aortocoronary bypass for a poor prognosis is 80% and that of the veloergometric test without induced myocardial ischemia for a favorable prognosis is 95.6%. Aortocoronary bypass in combination with medicamentous treatment improves the symptomatic state, physical capacity and the prognosis of patients with unstable angina pectoris up to the end of the first year to a considerably greater degree than the medicamentous treatment alone.

[The early bicycle ergometry test in drug-stabilized patients with unstable angina pectoris--the correlation with coronary angiography]. / Ranen veloergometrichen test pri medikamentozno stabilizirani bolni ot nestabilna angina pectoris--korelatsiia s koronarnata angiografiia.

The relation between the results of the early submaximal symptom-limited bicycle ergometry [correction of veloergometric] test and coronary angiography were examined in 127 patients with unstable angina pectoris stabilized by medicaments. In 19 (15.0%) patients the test was negative and in 108 (85%) patients the test was positive (angina pectoris and/or ST depression greater than or equal to 0.1 mV at 80 ms after the point J of the ECG). Between the results of the early bicycle ergometry [correction of veloergometric] test and the coronary angiography, performed soon after the test, there was a close correlation. By using strict criteria or a combination of criteria for assessment of residual ischemia the test can with great accuracy differentiate the patients with multivascular from those with monovascular disease or with healthy coronary vessels.

[Fibrinopeptide A and protein C in heart patients with acute coronary syndromes]. / Fibrinopeptid A i protein C pri surdechno bolni s ostri koronarni sindromi.

In order to determine the role of thrombosis in the acute coronary syndromes the blood levels of fibrinopeptide A and protein C were examined with an enzyme-immune test in 48 patients treated in the cardiological clinic of the National Centre for Cardiovascular Diseases. 27 patients were with transmural myocardial infarction and 21 patients were with non-transmural myocardial infarction. The average time of the test from the onset of pain is 18.4 +/- 12.2 hours (from 3 up to 72 hours). The mean level for fibrinopeptide A for the whole group of patients is 4.95 +/- 3.1 ng/ml and that of protein C is 70.1 +/- 9.8%. For the group of patients with transmural myocardial infarction the level of fibrinopeptide A is 6.09 +/- 3.49 ng/ml and of protein C is 65.3 +/- 8.0%. For the patients with nontransmural myocardial infarction the levels are respectively 3.49 +/- 1.7 ng/ml for fibrinopeptide A and 76.3 +/- 8.3% for protein C. The difference between the two groups is statistically significant (p less than 0.005). In the patients with non-transmural myocardial infarction from whom the blood for the test was taken before the 24th hour the fibrinopeptide A level is 4.8 +/- 2.4 ng/ml and the protein C level is 69.0 +/- 7.8%. The deviations from the reference group are statistically significant (p less than 0.04). The practical importance of these results is discussed.

[Preoperative clinical and hemodynamic assessment of patients for surgical revascularization of the myocardium]. / Predoperativna klinichna i khemodinamichna otsenka na bolni s khirurgichna revaskularizatsiia na miokarda.

A group of 35 patients with ischemic heart disease (IHD) and 6 patients with aquired heart defects, with established significant coronary obstruction were studied. The clinical picture of the patients with IHD is dominated by severe, refractory to treatment angina pectoris with extensive and high-degree stenosing coronary angina pectoris in combination with a relatively preserved left ventricular function. The patients with aquired defects have no anginal complaints. The aortic-coronary by-pass is justified in the light of the modern studies in the world. The necessity of rapid advancement of coronary surgery in Bulgaria is underlined.

[Clinical and hemodynamic characteristics of the decompensation syndrome in patients with congestive cardiomyopathy]. / Klinichna i khemodinamichna kharakteristika na dekompensatsionniia sindrom pri bolni s kongestivna kardiomiopatiia.

Thirty seven patients were clinically and hemodynamically studied under hospital conditions. The stage of cardiomegaly, the stasis in the pulmonary and systemic circulations were followed up as well as the presence of manifestations of pulse deficit, incidence of gallop rhythm manifestation. It was established that in the patients with II-A stage of decompensation of circulation, a decreased cardiac output was found, enhanced peripheral resistance and normovolemia. In the patients with II-B stage of circulation decompensation, further decrease of stroke and minute volume was found as well as moderately slowed down blood flow in the pulmonary and systemic circulation and normal peripheral vascular resistance. Conclusions were drawn, on the base of the data obtained, about the optimal treatment depending on the circulation decompensation stage.