Prevalence of obstructive sleep apnea in patients with peripheral arterial diseases.

BACKGROUND: The presence of obstructive sleep apnea (OSA), a novel cardiovascular risk factor, contributes to the development of peripheral arterial diseases (PAD). There is a lack of data showing how often these diseases coexist. AIMS: The aim of the study was to determine the prevalence of OSA in the population of patients with PAD. METHODS: Patients previously qualified for the first revascularization due to PAD were included in the study. All patients underwent an overnight sleep study to detect OSA. Diagnosis of OSA was made when the apnea-hypopnea index (AHI) was ≥5 per hour. RESULTS: From 141 patients (60% men, age 69.6 ± 9.5 years), OSA was diagnosed in 68 patients (48%). OSA occurred in mild form (5 ≤ AHI < 15/h) in 39 cases (28%), in moderate form (15 ≤ AHI < 30/h) in 21 cases (15%), and in severe form (AHI ≥ 30/h) in 8 cases (6%). Patients without OSA had significantly lower body mass index (BMI; 26.9 ± 5.5 vs. 27.7 ± 5.3 kg/m2, p = 0.01) and lower hip circumference (97.4 ± 11.7 vs. 98.7 ± 7.4, p = 0.04). There were no differences in the distribution of other investigated cardiovascular risk factors and diseases between these groups. There were no significant differences in OSA distribution or its severity between patients with lower extremity artery disease and carotid artery disease. CONCLUSIONS: The prevalence of OSA in patients with PAD is very high, affecting nearly half of the studied population.

CHA2DS2-VASc score and fibrinogen concentration in patients with atrial fibrillation.

BACKGROUND: Assessment of thromboembolic risk is crucial in choosing appropriate treatment in atrial fibrillation (AF). Current guidelines recommend basing the decision on the CHA2DS2-VASc score. However, the score is based only on clinical parameters and therefore its relationship with laboratory-assessed coagulation status might not always be objective. OBJECTIVES: The aim of this study was to assess if the CHA2DS2-VASc score is associated with blood parameters in AF patients. MATERIAL AND METHODS: Patients with continuous AF prequalified for catheter ablation were enrolled into the study and had CHA2DS2-VASc calculated and blood taken for coagulation parameters. RESULTS: The study population comprised of 266 patients (65.0% males; age 57.6 ±10.1 years). Patients were divided into those with CHA2DS2-VASc score 0, and those with ≥1 points, respectively requiring and not requiring anticoagulation treatment. The group with CHA2DS2-VASc = 0 (12% of patients) compared to those with CHA2DS2-VASc ≥ 1 had a significantly lower fibrinogen concentration (285.6 ±82.0 vs 322.6 ±76.4 mg/dL; p = 0.02). Partial thromboplastin time was not significantly different between groups (p > 0.05). Differences were noticed in parameters concerning red blood cells. Lower risk patients had a lower red blood cell count (4.9 ±0.4 vs 5.1 ±6.0 106/µL); p = 0.03), higher hemoglobin concentration (14.9 ±1.0 vs 14.3 ±1.4 g/dL; p = 0.04), and higher hematocrit (43.5 ±2.6 vs 41.7 ±4.7%; p = 0.001). It was observed that along with the increase in CHA2DS2-VASc score mean fibrinogen concentration increased (p-value for trend = 0.04). CONCLUSIONS: In summary, a higher CHA2DS2-VASc score is independently associated with an increase in fibrinogen concentration. Further research is needed to assess the value of fibrinogen in thromboembolic risk assessment.

Peripheral ARtery Atherosclerotic DIsease and SlEep disordered breathing (PARADISE) trial - protocol for an observational cohort study.

BACKGROUND: Peripheral arterial disease (PAD) is in fact a group of disease entities with different symptoms and course but a common underlying cause, i.e. atherosclerosis. Atherosclerosis is known to be aggravated by several cardiovascular risk factors, including obstructive sleep apnoea (OSA). AIM: Following paper is a protocol for the Peripheral ARtery Atherosclerotic DIsease and SlEep disordered breathing (PARADISE) trial, which aims to describe the prevalence of OSA in PAD patients scheduled for revascularisation, and to determine the effect of OSA on the procedure outcomes. METHODS: The PARADISE study is an observational cohort trial. It plans to include 200 consecutive patients hospitalised for revascularisation due to PAD. In every patient an overnight sleep study will be performed to diagnose sleep disorders. Accord¬ing to the results of the test, patients will be divided into two groups: group A - patients with OSA, and group B - patients without OSA (control group). All patients will also be screened for classical and non-classical cardiovascular risk factors. In some of the patients, during surgery, a fragment of atherosclerotic plaque will be collected for further testing. Patients will be followed for one year for adverse events and end-points. Primary end-point of the study will be the failure of revascularisa¬tion defined as recurrence or new onset of the symptoms of ischaemia from the treated region, a need for re-operation or procedure revision, or recurrence of ischaemia signs on the imaging tests. DISCUSSION: The data obtained will help determine the incidence of OSA in the population of patients with PAD. The au¬thors expect to show that, as with other cardiovascular diseases associated with atherosclerosis, also in patients with PAD the incidence of undiagnosed OSA is high and its presence is associated with elevated cholesterol, inflammatory markers, and higher prevalence of arterial hypertension and poor control of other cardiovascular risk factors. In addition, due to increased oxidative stress and vascular endothelial injury associated with OSA, patients afflicted with this condition will not only have more advanced atherosclerotic lesions, but also in their histopathological examination their atherosclerotic plaque will exhibit evidence of greater instability and adverse morphology. We also expect to show that in patients with OSA, achieving cor¬rect control of cardiovascular risk factors will be more difficult. The study may improve PAD control through assuring better multispecialty care in PAD patients.

Release kinetics of circulating miRNA-208a in the early phase of myocardial infarction.

BACKGROUND: The biochemical confirmation of myocardial infarction is based on cardiac troponin (cTnI or cTnT) determination. Recent scientific results suggested that microRNAs (miRNAs) might become a new biomarker of tissue injury. AIM: To evaluate the release kinetics of circulating heart-specific miRNA-208a and also to test the hypothesis that miRNA-208a can serve as an accessible, diagnostically sensitive plasma biomarker of ST-elevation acute myocardial infarction (STEMI). METHODS: Nineteen STEMI patients (four women and 15 men, aged 44-85 years), 12 patients with stable coronary artery disease (CAD), and eight patients with a negative observation of CAD as a control group were studied. Blood samples were collected on admission and at three, six, 12, 24, and 48 h afterwards; in the CAD and control group blood samples were taken only once. Plasma levels of miRNA-208a determined by real-time polymerase chain reaction and their relative fold changes were calculated. cTnI and creatinine kinase (CK)-MB mass were also measured in the patients' serum samples. RESULTS: miRNA-208a was increased in STEMI patients at the time of admission and nearly undetectable in CAD patients and controls. The peak of miRNA-208a was observed at 3 h after reperfusion (p < 0.001). The traditional biomarkers (cTnI and CK-MBmass), which increase later in comparison to miRNA-208a reaching the maximum concentrations 6 h after reperfusion, were observed. Circulating miRNA-208a levels strongly correlated with cTnI and CK-MBmass released from the infarcted area. CONCLUSIONS: These results demonstrate that plasma miRNA-208a is an interesting and promising candidate for a new biomarker released early after onset of myocardial infarction.