Prognostic assessment of selected clinical and ultrasonographic indices in patients with non-critical lesions in coronary angiography.

BACKGROUND: Coronary heart disease is the leading cause of mortality, especially in industrialised countries. In the case of detection of significant lesions narrowing the vessel lumen, management is guided by recommendations of international cardiac societies, while in the case of non-critical lesions there are some doubts as to the further prognosis and identification of patients in whom accelerated progression of disease can be expected. AIM: The aim of this study was to evaluate the prognostic significance of selected clinical and ultrasonographic indices in patients with non-critical lesions in coronary angiography. METHODS: In 100 symptomatic patients with non-critical stenosis in coronary arteries, cardiovascular events after one and three years of follow-up were assessed and analysed compared to a control group. RESULTS: During the follow-up period there were no deaths. In univariate analysis, factors associated with need for revascularisation in 4% of patients after one year and 7% at three years were: age (odds ratio [OR] 1.16, confidence interval [CI] 0.98-1.35; p = 0.04), fibrinogen concentration (OR 1.01, CI 1.00-1.02; p = 0.05), isovolumetric relaxation time [ms] (OR 1.07, CI 0.79-0.98; p = 0.04), and transmitral flow propagation velocity [cm/s] (OR 0.88, CI 1.01-1.12; p = 0.01). Nearly one third of patients with non-critical lesions despite optimal pharmacotherapy reported symptoms deteriorating quality of life. CONCLUSIONS: Factors predisposing to the occurrence of cardiovascular events in the 12 months of follow-up were: older age, higher plasma fibrinogen concentration, and impaired left ventricular filling pattern.

Assessment of risk factors for mortality in patients with cardiovascular disease and a history of treatment for malignancy.

BACKGROUND: Patients with advanced cancer after radio- and/or chemotherapy are increasingly commonly hospitalised in cardiology units due to coexisting cardiovascular diseases (CVD). A rational assessment of mortality risk is an important part of patient preparation for invasive cardiac procedures. One disadvantage of cardiac risk scores is the fact that malignancies are not taken into account. At present, accurate estimation of life expectancy is possible in up to 20% of patients with an advanced malignancy. AIM: To evaluate the effect of selected clinical parameters on survival of patients with CVD and coexisting lung or breast cancer after radio- and/or chemotherapy. An additional aim was to identify patients with a high probability of surviving a year in a good general clinical condition. METHODS: The study group involved 326 subjects with established CVD and lung cancer (small-cell or non-small-cell) or breast cancer who were selected from the group of 7818 patients receiving palliative care in the Palium hospice in Czestochowa, Poland, in 2008-2012. The obtained data were collected in a database and subjected to a statistical analysis. RESULTS: The strongest factors associated with an increased risk of death among patients with CVD and coexisting advanced lung or breast cancer after chemo- and/or radiotherapy were the type and stage of malignancy, functional status according to the ECOG classification, and the presence of cachexia. Other factors that had a significant effect on survival included higher severity of heart failure symptoms as evaluated by the New York Heart Association class, decreased left ventricular ejection fraction, presence of ischaemic heart disease, chronic obstructive pulmonary disease, fasting hyperglycaemia, and the severity of fatigue, nausea, and pain. When the effects of drug treatment on survival were analysed, significantly increased survival was observed in patients treated with angiotensin-converting enzyme inhibitors while diuretic and glucocorticosteroid use was associated with decreased survival. Among the evaluated groups of patients with CVD and advanced malignancy after radio- and/or chemotherapy, the highest probability of surviving a year in a relatively good general clinical condition was noted in patients with stage 3 breast cancer without cachexia, ischaemic heart disease and persistent somatic symptoms who were treated with tamoxifen, angiotensin-converting enzyme inhibitors and megestrol acetate. CONCLUSIONS: This is the first study that evaluated the combined effect of oncological and cardiovascular risk factors on survival of patients with CVD and coexisting cancer after radio- and/or chemotherapy treatment. When the three groups of cancer patients with different prognosis were compared, the study revealed varying effects of each factor depending on the underlying malignancy. The analysis confirmed the significance of the cumulative risk. The present study showed that malignancy-related prognostic factors are important in the context of cardiac evaluation and treatment of cancer patients. It also showed that further research is needed to clarify these issues.