RESUMO
OBJECTIVES: Adult-onset Still's disease (AOSD) is increasingly viewed as autoinflammatory disease associated with the so-called inflammasomopathy. Proinflammatory cytokines, such as IL-18 and IL-1ß, processed through the inflammasome machinery, play an important role in the pathogenesis of AOSD. AOSD is heterogenous, therefore there are two subtypes of the disease, systemic and articular, which probably imply different approaches for the treatment. Over 20% of patients with systemic AOSD have serositis. Recently, colchicine in combination with non-steroidal anti-inflammatory drugs (NSAIDs) has become the "gold standard" for recurrent pericarditis treatment. However, data on this combination therapy in AOSD are scarce. METHODS: In this retrospective case series study, we assessed the medical history of 20 patients with a systemic form of AOSD. All patients had pericarditis and received а combination of NSAIDs (in most cases ibuprofen 600-800 mg x3 daily) and colchicine (1 mg daily) for treatment. RESULTS: 13/20 (65%) of patients responded to this combination of anti-inflammatory drugs. Of note, not only pericarditis, but also other manifestations were improved such as arthritis, rash, hepatomegaly, acute phase reactants, and abnormal liver tests. CONCLUSIONS: The low cost, safety and wide availability of such therapy make this option relevant and determine the need for further study.
Assuntos
Pericardite , Serosite , Doença de Still de Início Tardio , Adulto , Anti-Inflamatórios/uso terapêutico , Anti-Inflamatórios não Esteroides/uso terapêutico , Colchicina/efeitos adversos , Humanos , Pericardite/complicações , Pericardite/tratamento farmacológico , Estudos Retrospectivos , Doença de Still de Início Tardio/complicações , Doença de Still de Início Tardio/diagnóstico , Doença de Still de Início Tardio/tratamento farmacológicoRESUMO
ЦелÑ: ÐзÑÑение оÑобенноÑÑей клиниÑеÑкого ÑеÑÐµÐ½Ð¸Ñ Ð½Ð¾Ð²Ð¾Ð¹ коÑонавиÑÑÑной инÑекÑии и влиÑÐ½Ð¸Ñ ÑопÑÑÑÑвÑÑÑÐ¸Ñ Ð·Ð°Ð±Ð¾Ð»ÐµÐ²Ð°Ð½Ð¸Ð¹ на иÑÑ Ð¾Ð´ Ð·Ð°Ð±Ð¾Ð»ÐµÐ²Ð°Ð½Ð¸Ñ Ñ Ð³Ð¾ÑпиÑализиÑованнÑÑ Ð±Ð¾Ð»ÑнÑÑ Ñ Ð¸Ð½ÑекÑией SARS-CoV-2 в пеÑвÑÑ Ð¸ вÑоÑÑÑ Ð²Ð¾Ð»Ð½Ñ Ð¿Ð°Ð½Ð´ÐµÐ¼Ð¸Ð¸.ÐеÑÐ¾Ð´Ñ Ð¸ ÑезÑлÑÑаÑÑ. ÐÐ»Ñ Ð¾Ñенки оÑобенноÑÑей ÑеÑÐµÐ½Ð¸Ñ COVID-19 в ÐвÑазийÑком Ñегионе бÑли ÑÐ¾Ð·Ð´Ð°Ð½Ñ Ð¼ÐµÐ¶Ð´ÑнаÑоднÑе ÑегиÑÑÑÑ ÐÐТÐÐ 1 и во вÑÐµÐ¼Ñ Ð²ÑоÑой Ð²Ð¾Ð»Ð½Ñ Ð¿Ð°Ð½Ð´ÐµÐ¼Ð¸Ð¸ ÐÐТÐÐ 2. ÐÐ°Ð±Ð¾Ñ Ð±Ð¾Ð»ÑнÑÑ Ð² ÑегиÑÑÑ ÐÐТÐÐ 1 пÑоводили Ñ 29.06.20 по 29.10.20, набÑано 5 397 паÑиенÑов. ÐÑием паÑиенÑов на ÑÑÐµÑ Ð² ÐÐТÐÐ 2 пÑоводили Ñ 01.11.20 до 30.03.21, набÑано 2 665 болÑнÑÑ .РезÑлÑÑаÑÑ. ÐоÑпиÑалÑÐ½Ð°Ñ Ð»ÐµÑалÑноÑÑÑ ÑнизилаÑÑ Ð² пеÑиод вÑоÑой Ð²Ð¾Ð»Ð½Ñ Ð¿Ð°Ð½Ð´ÐµÐ¼Ð¸Ð¸ и ÑоÑÑавила 4,8 % пÑоÑив 7,6 % в пеÑиод пеÑвой волнÑ. РпеÑиод вÑоÑой Ð²Ð¾Ð»Ð½Ñ Ð¿Ð°ÑиенÑÑ Ð±Ñли ÑÑаÑÑе, имели болÑÑе ÑопÑÑÑÑвÑÑÑÐ¸Ñ Ð·Ð°Ð±Ð¾Ð»ÐµÐ²Ð°Ð½Ð¸Ð¹ и поÑÑÑпали в ÑÑаÑÐ¸Ð¾Ð½Ð°Ñ Ð² более ÑÑжелом ÑоÑÑоÑнии, паÑиенÑÑ Ð¸Ð¼ÐµÐ»Ð¸ более вÑÑокий ÑÑÐ¾Ð²ÐµÐ½Ñ Ð¿Ð¾Ð»Ð¸Ð¼Ð¾ÑбидноÑÑи. РпеÑиод вÑоÑой Ð²Ð¾Ð»Ð½Ñ Ð¿Ð°Ð½Ð´ÐµÐ¼Ð¸Ð¸ ÑвелиÑилаÑÑ Ð·Ð°Ð±Ð¾Ð»ÐµÐ²Ð°ÐµÐ¼Ð¾ÑÑÑ Ð±Ð°ÐºÑеÑиалÑной пневмонией и ÑепÑиÑом, но Ñеже вÑÑÑеÑалиÑÑ ÑÑÐ¾Ð¼Ð±Ð¾Ð·Ñ Ð³Ð»ÑÐ±Ð¾ÐºÐ¸Ñ Ð²ÐµÐ½ и «ÑиÑокиновÑй ÑÑоÑм¼. Ðаиболее неблагопÑиÑÑнÑми Ð´Ð»Ñ Ð¿Ñогноза ÑмеÑÑноÑÑи, как в пеÑвÑÑ, Ñак и во вÑоÑÑÑ Ð²Ð¾Ð»Ð½Ñ Ñпидемии бÑли ÑоÑеÑÐ°Ð½Ð¸Ñ ÑопÑÑÑÑвÑÑÑÐ¸Ñ Ð·Ð°Ð±Ð¾Ð»ÐµÐ²Ð°Ð½Ð¸Ð¹: аÑÑеÑиалÑÐ½Ð°Ñ Ð³Ð¸Ð¿ÐµÑÑÐµÐ½Ð·Ð¸Ñ (ÐÐ) + Ñ ÑониÑеÑÐºÐ°Ñ ÑеÑдеÑÐ½Ð°Ñ Ð½ÐµÐ´Ð¾ÑÑаÑоÑноÑÑÑ (ХСÐ) + ÑÐ°Ñ Ð°ÑнÑй Ð´Ð¸Ð°Ð±ÐµÑ (СÐ) + ожиÑение, ÐÐ + иÑемиÑеÑÐºÐ°Ñ Ð±Ð¾Ð»ÐµÐ·Ð½Ñ ÑеÑдÑа (ÐÐС) + ХСР+ СÐ, ÐÐ + ÐÐС + ХСР+ ожиÑение.ÐаклÑÑение. У паÑиенÑов во вÑоÑÑÑ Ð²Ð¾Ð»Ð½Ñ Ð¿Ð°Ð½Ð´ÐµÐ¼Ð¸Ð¸ наблÑдалоÑÑ Ð±Ð¾Ð»ÐµÐµ обÑиÑное поÑажение Ñкани Ð»ÐµÐ³ÐºÐ¸Ñ , ÑаÑе возникала ÑебÑилÑÐ½Ð°Ñ Ð»Ð¸Ñ Ð¾Ñадка, бÑли вÑÑе ÑÑовни С-ÑеакÑивного белка и ÑÑопонина, ниже ÑÑовни гемоглобина и лимÑоÑиÑов. ÐÑо, веÑоÑÑно, ÑвÑзано Ñ ÑазлиÑной ÑакÑикой гоÑпиÑализаÑии паÑиенÑов в пеÑвÑÑ Ð¸ вÑоÑÑÑ Ð²Ð¾Ð»Ð½Ñ Ð¿Ð°Ð½Ð´ÐµÐ¼Ð¸Ð¸ в ÑÑÑÐ°Ð½Ð°Ñ , пÑинÑвÑÐ¸Ñ ÑÑаÑÑие в ÑоÑмиÑовании ÑегиÑÑÑов ÐÐТÐÐ 1 и ÐÐТÐÐ 2.
Assuntos
COVID-19 , Síndrome do Intestino Irritável , Humanos , SARS-CoV-2RESUMO
ЦелÑ: ÐзÑÑение оÑобенноÑÑей клиниÑеÑкого ÑеÑÐµÐ½Ð¸Ñ Ð½Ð¾Ð²Ð¾Ð¹ коÑонавиÑÑÑной инÑекÑии и влиÑÐ½Ð¸Ñ ÑопÑÑÑÑвÑÑÑÐ¸Ñ Ð·Ð°Ð±Ð¾Ð»ÐµÐ²Ð°Ð½Ð¸Ð¹ на иÑÑ Ð¾Ð´ Ð·Ð°Ð±Ð¾Ð»ÐµÐ²Ð°Ð½Ð¸Ñ Ñ Ð³Ð¾ÑпиÑализиÑованнÑÑ Ð±Ð¾Ð»ÑнÑÑ Ñ Ð¸Ð½ÑекÑией SARS-CoV-2 в пеÑвÑÑ Ð¸ вÑоÑÑÑ Ð²Ð¾Ð»Ð½Ñ Ð¿Ð°Ð½Ð´ÐµÐ¼Ð¸Ð¸.ÐеÑÐ¾Ð´Ñ Ð¸ ÑезÑлÑÑаÑÑ. ÐÐ»Ñ Ð¾Ñенки оÑобенноÑÑей ÑеÑÐµÐ½Ð¸Ñ COVID-19 в ÐвÑазийÑком Ñегионе бÑли ÑÐ¾Ð·Ð´Ð°Ð½Ñ Ð¼ÐµÐ¶Ð´ÑнаÑоднÑе ÑегиÑÑÑÑ ÐÐТÐÐ 1 и во вÑÐµÐ¼Ñ Ð²ÑоÑой Ð²Ð¾Ð»Ð½Ñ Ð¿Ð°Ð½Ð´ÐµÐ¼Ð¸Ð¸ ÐÐТÐÐ 2. ÐÐ°Ð±Ð¾Ñ Ð±Ð¾Ð»ÑнÑÑ Ð² ÑегиÑÑÑ ÐÐТÐÐ 1 пÑоводили Ñ 29.06.20 по 29.10.20, набÑано 5 397 паÑиенÑов. ÐÑием паÑиенÑов на ÑÑÐµÑ Ð² ÐÐТÐÐ 2 пÑоводили Ñ 01.11.20 до 30.03.21, набÑано 2 665 болÑнÑÑ .РезÑлÑÑаÑÑ. ÐоÑпиÑалÑÐ½Ð°Ñ Ð»ÐµÑалÑноÑÑÑ ÑнизилаÑÑ Ð² пеÑиод вÑоÑой Ð²Ð¾Ð»Ð½Ñ Ð¿Ð°Ð½Ð´ÐµÐ¼Ð¸Ð¸ и ÑоÑÑавила 4,8 % пÑоÑив 7,6 % в пеÑиод пеÑвой волнÑ. РпеÑиод вÑоÑой Ð²Ð¾Ð»Ð½Ñ Ð¿Ð°ÑиенÑÑ Ð±Ñли ÑÑаÑÑе, имели болÑÑе ÑопÑÑÑÑвÑÑÑÐ¸Ñ Ð·Ð°Ð±Ð¾Ð»ÐµÐ²Ð°Ð½Ð¸Ð¹ и поÑÑÑпали в ÑÑаÑÐ¸Ð¾Ð½Ð°Ñ Ð² более ÑÑжелом ÑоÑÑоÑнии, паÑиенÑÑ Ð¸Ð¼ÐµÐ»Ð¸ более вÑÑокий ÑÑÐ¾Ð²ÐµÐ½Ñ Ð¿Ð¾Ð»Ð¸Ð¼Ð¾ÑбидноÑÑи. РпеÑиод вÑоÑой Ð²Ð¾Ð»Ð½Ñ Ð¿Ð°Ð½Ð´ÐµÐ¼Ð¸Ð¸ ÑвелиÑилаÑÑ Ð·Ð°Ð±Ð¾Ð»ÐµÐ²Ð°ÐµÐ¼Ð¾ÑÑÑ Ð±Ð°ÐºÑеÑиалÑной пневмонией и ÑепÑиÑом, но Ñеже вÑÑÑеÑалиÑÑ ÑÑÐ¾Ð¼Ð±Ð¾Ð·Ñ Ð³Ð»ÑÐ±Ð¾ÐºÐ¸Ñ Ð²ÐµÐ½ и «ÑиÑокиновÑй ÑÑоÑм¼. Ðаиболее неблагопÑиÑÑнÑми Ð´Ð»Ñ Ð¿Ñогноза ÑмеÑÑноÑÑи, как в пеÑвÑÑ, Ñак и во вÑоÑÑÑ Ð²Ð¾Ð»Ð½Ñ Ñпидемии бÑли ÑоÑеÑÐ°Ð½Ð¸Ñ ÑопÑÑÑÑвÑÑÑÐ¸Ñ Ð·Ð°Ð±Ð¾Ð»ÐµÐ²Ð°Ð½Ð¸Ð¹: аÑÑеÑиалÑÐ½Ð°Ñ Ð³Ð¸Ð¿ÐµÑÑÐµÐ½Ð·Ð¸Ñ (ÐÐ) + Ñ ÑониÑеÑÐºÐ°Ñ ÑеÑдеÑÐ½Ð°Ñ Ð½ÐµÐ´Ð¾ÑÑаÑоÑноÑÑÑ (ХСÐ) + ÑÐ°Ñ Ð°ÑнÑй Ð´Ð¸Ð°Ð±ÐµÑ (СÐ) + ожиÑение, ÐÐ + иÑемиÑеÑÐºÐ°Ñ Ð±Ð¾Ð»ÐµÐ·Ð½Ñ ÑеÑдÑа (ÐÐС) + ХСР+ СÐ, ÐÐ + ÐÐС + ХСР+ ожиÑение.ÐаклÑÑение. У паÑиенÑов во вÑоÑÑÑ Ð²Ð¾Ð»Ð½Ñ Ð¿Ð°Ð½Ð´ÐµÐ¼Ð¸Ð¸ наблÑдалоÑÑ Ð±Ð¾Ð»ÐµÐµ обÑиÑное поÑажение Ñкани Ð»ÐµÐ³ÐºÐ¸Ñ , ÑаÑе возникала ÑебÑилÑÐ½Ð°Ñ Ð»Ð¸Ñ Ð¾Ñадка, бÑли вÑÑе ÑÑовни С-ÑеакÑивного белка и ÑÑопонина, ниже ÑÑовни гемоглобина и лимÑоÑиÑов. ÐÑо, веÑоÑÑно, ÑвÑзано Ñ ÑазлиÑной ÑакÑикой гоÑпиÑализаÑии паÑиенÑов в пеÑвÑÑ Ð¸ вÑоÑÑÑ Ð²Ð¾Ð»Ð½Ñ Ð¿Ð°Ð½Ð´ÐµÐ¼Ð¸Ð¸ в ÑÑÑÐ°Ð½Ð°Ñ , пÑинÑвÑÐ¸Ñ ÑÑаÑÑие в ÑоÑмиÑовании ÑегиÑÑÑов ÐÐТÐÐ 1 и ÐÐТÐÐ 2.
Assuntos
COVID-19 , Síndrome do Intestino Irritável , Humanos , Pandemias , SARS-CoV-2RESUMO
Finland provides unique opportunities to investigate population and medical genomics because of its adoption of unified national electronic health records, detailed historical and birth records, and serial population bottlenecks. We assembled a comprehensive view of recent population history (≤100 generations), the timespan during which most rare-disease-causing alleles arose, by comparing pairwise haplotype sharing from 43,254 Finns to that of 16,060 Swedes, Estonians, Russians, and Hungarians from geographically and linguistically adjacent countries with different population histories. We find much more extensive sharing in Finns, with at least one ≥ 5 cM tract on average between pairs of unrelated individuals. By coupling haplotype sharing with fine-scale birth records from more than 25,000 individuals, we find that although haplotype sharing broadly decays with geographical distance, there are pockets of excess haplotype sharing; individuals from northeast Finland typically share several-fold more of their genome in identity-by-descent segments than individuals from southwest regions. We estimate recent effective population-size changes through time across regions of Finland, and we find that there was more continuous gene flow as Finns migrated from southwest to northeast between the early- and late-settlement regions than was dichotomously described previously. Lastly, we show that haplotype sharing is locally enriched by an order of magnitude among pairs of individuals sharing rare alleles and especially among pairs sharing rare disease-causing variants. Our work provides a general framework for using haplotype sharing to reconstruct an integrative view of recent population history and gain insight into the evolutionary origins of rare variants contributing to disease.
Assuntos
Doença/genética , Genética Populacional , Haplótipos/genética , Finlândia , Fluxo Gênico , Variação Genética , Geografia , Migração Humana , Humanos , Parto , Densidade Demográfica , Fatores de TempoRESUMO
PURPOSE: Blood pressure telemonitoring and remote counselling (BPTM) improves blood pressure (BP) control in patients with hypertension (HTN). Studies assessing the efficacy of BPTM from a value-based perspective are lacking. We investigated whether BPTM fits all principles of the value-based approach (clinical and economic effectiveness, improvement in patient-reported outcome/experience measures (PROM/PREM)). MATERIALS AND METHODS: Two hundred and forty ambulatory patients with uncontrolled HTN were randomised in a 2: 1 manner to BPTM (n = 160, mean age 47 y.o.) and usual care (UC, n = 80; 49 y.o.) with baseline and 3-month follow-up clinic visits. BPTM employed a mobile application (for patients) and a desktop version (for clinician), which allowed communication and exchange of medical data. The main outcomes were changes in office and ambulatory systolic (S) BPs, rate of BP control. The incremental cost-effectiveness ratio (ICER) and incremental cost-utility ratio (ICUR) were evaluated in economic analysis. The MOS SF-36 score was taken as a PROM, and the PEQ score was used as a PREM. RESULTS: Larger decreases in office and ambulatory SBPs (-16.8 and -8.9 mm Hg, respectively; p < .05) was achieved in BPTM group while the treatment intensity was equal (2.4 drugs). The ICER 11.1 EUR/-1 mm Hg 24-hour SBP/1 year was 75% effective as per willingness-to-pay threshold. BPTM improved PROM (+2.1 in mean MOS SF-36; p = .04), reduced long-term mortality (+0.11 life years gained), leading to +0.49 quality-adjusted life years (QALYs) gained as compared with UC. The ICUR was 4 169.4 EUR/QALY gained. Patient-reported experience was higher in the BPTM (+10 PEQ, p = .01). The UC group showed minor changes in MOS SF-36 and PEQ (+1.3; +6, respectively; p n.s.). CONCLUSIONS: Being cost-effective, BPTM incorporates both clinical benefits and patient-perceived value. Larger randomised studies are needed to confirm our findings.
Assuntos
Pressão Sanguínea , Hipertensão/diagnóstico , Hipertensão/terapia , Telemedicina , Análise Custo-Benefício , Gerenciamento Clínico , Seguimentos , Humanos , Hipertensão/economia , Cadeias de Markov , Pessoa de Meia-Idade , Aplicativos Móveis , Anos de Vida Ajustados por Qualidade de Vida , Consulta Remota/economia , Telemedicina/economiaRESUMO
Endogenous cardiotonic steroid, marinobufagenin (MBG), induces Fli1-dependent tissue fibrosis. We hypothesized that an increase in MBG initiates the development of aortic fibrosis in salt-loaded rats with type 2 diabetes mellitus (DM2) via pressure-independent mechanism. DM2 was induced by a single intraperitoneal administration of 65 mg/kg streptozotocin to neonatal (4-5 days) male Wistar rats. Eight-week-old DM2 rats received water or 1.8% NaCl (DM-NaCl) solution for 4 weeks (n = 16); half of DM-NaCl rats were treated with anti-MBG monoclonal antibody (mAb) (DM-NaCl-AB) during week 4 of salt loading; control intact rats received water (n = 8/group). Blood pressure, MBG, erythrocyte Na/K-ATPase activity, aortic weights, levels of fibrosis markers (Fli1, protein kinase Cδ, transforming growth factor-ß1, receptors of the transforming growth factor beta5, fibronectin, collagen-1), and sensitivity of the aortic explants to the vasorelaxant effect of sodium nitroprusside were assessed. No changes in systolic blood pressure were observed while erythrocyte Na/K-ATPase was inhibited by 30%, plasma MBG was doubled, and aortic markers of fibrosis became elevated in DM-NaCl rats versus control. Treatment of DM-NaCl rats with anti-MBG mAb activated Na/K-ATPase, prevented increases in aortic weights, and the levels of fibrosis markers returned to the control levels. The responsiveness of the aortic rings from DM-NaCl rats to the relaxant effect of sodium nitroprusside was reduced (half maximal effective concentration (EC50) = 29 nmol/L) versus control rings (EC50 = 7 nmol/L) and was restored by anti-MBG mAb (EC50 = 9 nmol/L). Our results suggest that in salt-loaded diabetic rats, MBG stimulates aortic collagen synthesis in a pressure-independent fashion and that 2 profibrotic mechanisms, Fli1 dependent and transforming growth factor-ß dependent, underlie its effects.
Assuntos
Aorta/efeitos dos fármacos , Doenças da Aorta/induzido quimicamente , Bufanolídeos/farmacologia , Diabetes Mellitus Experimental/complicações , Diabetes Mellitus Tipo 2/complicações , Hipertensão/complicações , Cloreto de Sódio , Remodelação Vascular/efeitos dos fármacos , Rigidez Vascular/efeitos dos fármacos , Animais , Aorta/metabolismo , Aorta/patologia , Aorta/fisiopatologia , Doenças da Aorta/metabolismo , Doenças da Aorta/patologia , Doenças da Aorta/fisiopatologia , Pressão Sanguínea , Colágeno/metabolismo , Diabetes Mellitus Experimental/metabolismo , Diabetes Mellitus Experimental/fisiopatologia , Diabetes Mellitus Tipo 2/metabolismo , Diabetes Mellitus Tipo 2/fisiopatologia , Eritrócitos/efeitos dos fármacos , Eritrócitos/enzimologia , Fibrose , Hipertensão/metabolismo , Hipertensão/fisiopatologia , Masculino , Proteína Proto-Oncogênica c-fli-1/metabolismo , Ratos Wistar , Transdução de Sinais , ATPase Trocadora de Sódio-Potássio/sangue , Fator de Crescimento Transformador beta1/metabolismoRESUMO
The study addresses the association of marinobufagenin (MBG), a natriuretic and vasoconstrictor steroid, and Na/K-ATPase (NKA) activity with pressor response to salt-loading and arterial stiffness in resistant hypertension (RH). Thirty-four patients (18 males and 16 females; 56±8 years) with RH on a combined (lisnopril/amlodipine/hydrochlorothiazide) therapy and 11 healthy age-matched normotensive subjects (7 males and 4 females; 54±2 years) were enrolled in this study. Salt-loading was performed via intravenous infusion of 1000mL saline (0.9% NaCl) for 1h. Arterial stiffness was measured by Sphygmocor Px device with a calculation of pulse-wave velocity (PWV). Activity of NKA was measured in erythrocytes. We demonstrated that plasma levels of MBG and magnitude of NaCl-induced MBG-dependent NKA inhibition are associated with PWV, and that this association has gender- and age-specific fashion in RH patients.
Assuntos
Glicosídeos Cardíacos/farmacologia , Hipertensão/fisiopatologia , Cloreto de Sódio/farmacologia , Resistência Vascular/efeitos dos fármacos , Envelhecimento/metabolismo , Envelhecimento/fisiologia , Bufanolídeos/metabolismo , Feminino , Humanos , Hipertensão/metabolismo , Masculino , Pessoa de Meia-Idade , Análise de Onda de Pulso , Caracteres SexuaisRESUMO
Elevated blood pressure (BP) is a growing burden worldwide, leading to over 10 million deaths each year. May Measurement Month (MMM) is a global initiative by the International Society of Hypertension aimed at raising awareness of high BP and to act as a temporary solution to the lack of screening programs worldwide. The most recent publication compared data from three surveys performed in Russian population aged 25-64 showed that the prevalence of hypertension increased by approximately 20% from 2003 to 2013. This study presents screening data collected in 2017 though the MMM17 initiative in Russia. An opportunistic cross-sectional survey of volunteers aged ≥18 was carried out in May 2017 in 19 Russian cities. Blood pressure measurement, the definition of hypertension, and statistical analysis followed the standard MMM protocol. The recruitment of MMM17 participants in Russia occurred in shopping malls, colleges and universities, supermarkets, business centres, parks, and squares. Russian young cardiologists as an official section of Russian Society of Cardiology was actively involved. A total of 5660 individuals were screened. After multiple imputation, 2709 (47.9%) had hypertension. Of individuals not receiving antihypertensive medication, 753 (20.3%) were hypertensive. Of individuals receiving antihypertensive medication, 1094 (55.9%) had uncontrolled BP. Comparing with the worldwide results of MMM17 screening, Russian participants had a higher proportion of hypertension, comparable antihypertensive prescription rate, and worse hypertension control. Thus, the MMM17 project appears to be an important step in evaluating hypertension burden in Russia and emphasizes the further need to improve hypertension awareness, treatment, and control.
RESUMO
BACKGROUND: To assess the association of metabolic syndrome (MS) and its components with target organ damage in a follow-up study of relatively healthy bank employers. METHODS: Out of 1600 random samples of office workers in Saint Petersburg (Russia), a group of 383 participants with at least one component of MS and without cardiovascular complications was selected (mean age 46.6 ± 9.0 years, 214 females (64.6%)). Follow-up visit was performed in 331 subjects. Target organ damage (TOD) was assessed by echocardiography, carotid ultrasound, applanational tonometry, brachial-ankle index, and urine albumin excretion measurements. Anthropometry, vital signs, and biochemistry were performed according to standard protocols. RESULTS: Presence of MS was not associated with higher probability of TOD. Multiple linear regression revealed significant association of all markers of TOD with older age. Hypertension was a significant predictor of left ventricular hypertrophy (LVH), increased arterial stiffness, and early signs of carotid atherosclerosis in logistic regression adjusted for age and gender. During follow-up, proportion of patients with LVH significantly decreased (from 46.7% to 32.9%, Ñ = 0.003) and prevalence of patients with IMT > 0.09 Ñm increased (from 24.5% to 44.1%, p < 0.001) accompanying by significant declining of office blood pressure (BP) and total cholesterol. CONCLUSIONS: MS per se is not related to increased probability to TOD. Hypertension, female gender, and older age are main determinants of subclinical changes. After 2-years follow-up, significant LVH and renal damage regression was observed probably owing to BP reduction. Alternatively, early signs of carotid atherosclerosis increase with aging despite decreasing of the prevalence of hypercholesterolemia.
Assuntos
Doenças das Artérias Carótidas/etiologia , Hipertensão/complicações , Hipertrofia Ventricular Esquerda/etiologia , Síndrome Metabólica/complicações , Adulto , Fatores Etários , Albuminúria/urina , Índice Tornozelo-Braço , Pressão Sanguínea , Espessura Intima-Media Carotídea , Colesterol/sangue , Ecocardiografia , Feminino , Seguimentos , Humanos , Hipertensão/fisiopatologia , Hipertrofia Ventricular Esquerda/diagnóstico por imagem , Masculino , Síndrome Metabólica/fisiopatologia , Pessoa de Meia-Idade , Prevalência , Rigidez VascularRESUMO
INTRODUCTION: The aim of the study was to estimate the prevalence of metabolically healthy obese (MHO) and metabolically unhealthy non-obese (MUNO) phenotypes in Russian population. DESIGN AND METHODS: In cross-sectional epidemiology survey "Epidemiology of cardiovascular diseases and its risk factors in some regions of the Russian Federation" a random sampling of 21,121 subjects (25-65 years), stratified by age and sex was involved. Anthropometry, blood pressure (BP) measurement and fasting blood-tests (glucose, lipids) were performed according to standard protocols. Criteria for MHO-body mass index (BMI) ≥30 kg/m2 and ≤2 of markers: HDL < 1.30 (females)/1.04 (males) mmol/l; triglycerides ≥1.7 mmol/l; glucose ≥5.6 mmol/l or treatment; waist >88 (females)/102 (males) cm and BP ≥ 130/85 mm Hg or therapy. Criteria for MUNO was BMI < 30 kg/m2 and ≥2 markers listed above. Simple tabulations, descriptive statistics, post-stratification weights and logistic regression were used for analyses. RESULTS: MHO phenotype was detected in 2856 (41.5%) obese people; MUNO phenotype-in 4762 (34.4%) non-obese subjects. Aging was negatively associated with MHO and positively with MUNO prevalence. Gender was registered as determinant only of MUNO probability. No dramatic differences in lifestyle risk factors between 3 BMI groups (lean, overweight, obese) were found out. CONCLUSION: Half of obese Russian inhabitants are metabolically healthy. At the same time, metabolic abnormalities were detected in one third of non-obese participants with a shift to male gender.
Assuntos
Glicemia , Nível de Saúde , Obesidade/sangue , Obesidade/epidemiologia , Triglicerídeos/sangue , Adulto , Fatores Etários , Idoso , Índice de Massa Corporal , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Fatores de Risco , Federação Russa/epidemiologia , Fatores SexuaisRESUMO
OBJECTIVES: This analysis compared adherence, cardiovascular (CV) events and all-cause mortality incidence, and healthcare costs among hypertensive patients treated with perindopril (PER)/indapamide (IND)/amlodipine (AML) in single-pill combination (SPC) vs. multiple-pill combination, in a real-world setting in Italy. METHODS: In this observational retrospective analysis of Italian administrative databases, adult patients treated with PER/IND/AML between 2010 and 2020 were divided into two cohorts: single-pill vs. multiple-pill. Patient data were available for at least one year before and after index date. Propensity score matching (PSM) was applied to reduce selection bias. Adherence was defined as proportion of days covered: non-adherence, <40%; partial adherence, 40-79%, and adherence ≥80%. Mortality incidence and CV events as single, or composite, endpoints were evaluated after first year of follow-up. Healthcare cost analyses were performed from the perspective of the Italian National Health Service. RESULTS: Following PSM, the single-pill cohort included 12 150 patients, and the multiple-pill cohort, 6105. The SPC cohort had a significantly higher percentage of adherent patients vs. the multiple-pill cohort (59.9% vs. 26.9%, P â<â0.001). Following the first year of follow-up, incidence of all-cause mortality, and combined endpoint of all-cause mortality and CV events were lower in the SPC cohort compared with multiple-pill cohort. Average annual direct healthcare costs were lower in the single-pill cohort (2970) vs. multiple-pill cohort (3642); cost of all drugs and all-cause hospitalizations were major contributors. CONCLUSION: The SPC of PER/IND/AML, compared with multiple-pill combination, is associated with higher adherence to medication, lower incidence of CV events and mortality, and reduced healthcare costs.
Assuntos
Hipertensão , Indapamida , Leucemia Mieloide Aguda , Adulto , Humanos , Perindopril/uso terapêutico , Indapamida/uso terapêutico , Anti-Hipertensivos/uso terapêutico , Estudos Retrospectivos , Medicina Estatal , Adesão à Medicação , Anlodipino/uso terapêutico , Hipertensão/tratamento farmacológico , Hipertensão/epidemiologia , Combinação de Medicamentos , Custos de Cuidados de Saúde , Leucemia Mieloide Aguda/tratamento farmacológicoRESUMO
OBJECTIVES: In hemodialysis patients, central hemodynamics, stiffness, and wave reflections assessed through ambulatory blood pressure monitoring (ABPM) showed superior prognostic value for cardiovascular (CV) events than peripheral blood pressures (BPs). No such evidence is available for lower-risk hypertensive patients. METHODS: In 591 hypertensive patients (mean age 58â±â14âyears, 49% males), ambulatory brachial and central BP, pulse wave velocity (PWV), and augmentation index (AIx) were obtained with a validated upper arm cuff-based pulse wave analysis technology. Information on treatment for hypertension (73% of patients), dyslipidemia (27%), diabetes (8%), CV disease history (25%), was collected. Patients were censored for CV events or all-cause death over 4.2âyears. RESULTS: One hundred and four events (24 fatal) were recorded. Advanced age [hazard ratio and 95% confidence interval: 1.03 (1.01, 1.05), P â=â0.0001], female sex [1.57 (1.05, 2.33), P â=â0.027], CV disease [2.22 (1.50, 3.29), P â=â0.0001], increased 24-h central pulse pressure (PP) [1.56 (1.05, 2.31), P â=â0.027], PWV [1.59 (1.07, 2.36), P â=â0.022], or AIx [1.59 (1.08, 2.36), P â=â0.020] were significantly associated with a worse prognosis (univariate Cox regression analysis). The prognostic power of peripheral and central BPs was lower. However, PWV [1.02 (0.64, 1.63), P â=â0.924], AIx [1.06 (0.66, 1.69), P â=â0.823], and central PP [1.18 (0.76, 1.82), P â=â0.471], were not significant predictors in multivariate analyses. CONCLUSIONS: In hypertensive patients, ambulatory central PP, PWV, and AIx are associated with an increased risk of CV morbidity and all-cause mortality. However, this association is not independent of other patient characteristics.
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Doenças Cardiovasculares , Hemodinâmica , Rigidez Vascular , Humanos , Feminino , Masculino , Pessoa de Meia-Idade , Idoso , Doenças Cardiovasculares/mortalidade , Doenças Cardiovasculares/fisiopatologia , Rigidez Vascular/fisiologia , Sistema de Registros , Análise de Onda de Pulso , Monitorização Ambulatorial da Pressão Arterial , Hipertensão/fisiopatologia , Hipertensão/mortalidade , Hipertensão/complicações , Adulto , Pressão Sanguínea/fisiologiaRESUMO
BACKGROUND: The cardio-ankle vascular index (CAVI) measure of arterial stiffness is associated with prevalent cardiovascular risk factors, while its predictive value for cardiovascular events remains to be established. The aim was to determine associations of CAVI with cardiovascular morbimortality (primary outcome) and all-cause mortality (secondary outcome), and to establish the determinants of CAVI progression. METHODS: TRIPLE-A-Stiffness, an international multicentre prospective longitudinal study, enrolled >2000 subjects ≥40 years old at 32 centres from 18 European countries. Of these, 1250 subjects (55% women) were followed for a median of 3.82 (2.81-4.69) years. FINDINGS: Unadjusted cumulative incidence rates of outcomes according to CAVI stratification were higher in highest stratum (CAVI > 9). Cox regression with adjustment for age, sex, and cardiovascular risk factors revealed that CAVI was associated with increased cardiovascular morbimortality (HR 1.25 per 1 increase; 95% confidence interval, CI: 1.03-1.51) and all-cause mortality (HR 1.37 per 1 increase; 95% CI: 1.10-1.70) risk in subjects ≥60 years. In ROC analyses, CAVI optimal threshold was 9.25 (c-index 0.598; 0.542-0.654) and 8.30 (c-index 0.565; 0.512-0.618) in subjects ≥ or <60 years, respectively, to predict increased CV morbimortality. Finally, age, mean arterial blood pressure, anti-diabetic and lipid-lowering treatment were independent predictors of yearly CAVI progression adjusted for baseline CAVI. INTERPRETATION: The present study identified additional value for CAVI to predict outcomes after adjustment for CV risk factors, in particular for subjects ≥60 years. CAVI progression may represent a modifiable risk factor by treatments. FUNDING: International Society of Vascular Health (ISVH) and Fukuda Denshi, Japan.
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Índice Vascular Coração-Tornozelo , Doenças Cardiovasculares , Rigidez Vascular , Humanos , Feminino , Masculino , Pessoa de Meia-Idade , Idoso , Doenças Cardiovasculares/mortalidade , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/etiologia , Estudos Prospectivos , Progressão da Doença , Fatores de Risco , Curva ROC , Adulto , Estudos Longitudinais , Prognóstico , Fatores de Risco de Doenças CardíacasRESUMO
The population of Russia consists of more than 150 local ethnicities. The ethnic diversity and geographic origins, which extend from eastern Europe to Asia, make the population uniquely positioned to investigate the shared properties of inherited disease risks between European and Asian ancestries. We present the analysis of genetic and phenotypic data from a cohort of 4,145 individuals collected in three metro areas in western Russia. We show the presence of multiple admixed genetic ancestry clusters spanning from primarily European to Asian and high identity-by-descent sharing with the Finnish population. As a result, there was notable enrichment of Finnish-specific variants in Russia. We illustrate the utility of Russian-descent cohorts for discovery of novel population-specific genetic associations, as well as replication of previously identified associations that were thought to be population-specific in other cohorts. Finally, we provide access to a database of allele frequencies and GWAS results for 464 phenotypes.
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Frequência do Gene , Estudo de Associação Genômica Ampla , Humanos , Federação Russa/epidemiologia , Masculino , Polimorfismo de Nucleotídeo Único , Feminino , Predisposição Genética para Doença , Genética Populacional , Fenótipo , População Branca/genética , Finlândia , Povo Asiático/genética , Variação Genética , Estudos de Coortes , Herança Multifatorial/genética , Etnicidade/genética , População do Leste EuropeuRESUMO
The availability of patient-reported experience measures (PREM) is an unmet need in Russian healthcare. Objective: To translate, adapt culturally, and validate PREM for outpatients. Methods: A core set of questions from the Patient Experience Questionnaire (PEQ, in Norwegian, available in English) was translated to Russian (forward-backward translation). Acceptability, construct validity, and reliability were assessed. Patients aged ≥18 y.o. were invited to complete the questionnaire via QR-code within 24 h after a medical encounter. Results: A questionnaire with adequate conceptual and linguistic equivalence was obtained. For four questions, a rating scale was replaced by Likert-type. A total of 308 responses were received (median age 55 y.o., 52% females). The correlation matrix was factorable. Four factors were extracted using varimax rotation: 1) outcome of this specific visit; 2) communication experiences; 3) communication competency; 4) emotions after this visit. These explained 65.4% of the total variance. Three items were excluded. The model was confirmed to be adequate. The Cronbach alpha was >0.9. Item-total correlation confirmed discriminative validity. Conclusion: These preliminary results show that the Russian version of PEQ, adapted to national features, shows good psychometric properties. External validation is needed for the broad implementation of this PREM. Innovation: This research is first attempt to use PREM in the Russian Federation. The use of quick response codes is feasible and eases survey conduction. The more PREMs are used the higher the quality of healthcare.
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INTRODUCTION: Single-pill combination therapy for hypertension is recognized to improve adherence to treatment. However, less is known about the benefits of triple single-pill combinations. This retrospective observational analysis aimed to assess changes in adherence when treatment was switched from perindopril (PER)/indapamide (IND) + amlodipine (AML) to PER/IND/AML single-pill combination, in Italian clinical practice. METHODS: This analysis used data extracted from administrative databases of Italian healthcare entities. Adult patients receiving PER/IND/AML were selected, and the prescription date was considered as the index date. Among them, those who had a prescription for PER/IND + AML during the 12 months before the index date and a prescription of PER/IND/AML during 6 months of follow-up were included. Adherence was calculated as the proportion of days covered (PDC: PDC < 40%, non-adherent; PDC = 40-79%, partially adherent; PDC ≥ 80%, adherent). RESULTS: Among the identified patients, 158 were exposed users and were included in the analysis. When patients were compared before and after switch to triple single-pill combination, the proportion of adherent patients was significantly higher with PER/IND/AML single-pill combination (75.3%) than with PER/IND + AML combination (44.3%) (P < 0.05). Conversely, the proportion of non-adherent patients was lower with the PER/IND/AML single-pill combination (14.6%) vs PER/IND + AML (17.7%) (P < 0.001). CONCLUSION: This real-world analysis showed that switching to a triple single-pill combination could offer an opportunity to improve adherence to antihypertensive treatment in real-life clinical practice.
Medication adherence is defined by the World Health Organization as the "extent to which a person's behavior (in taking medication) corresponds with agreed recommendations from a healthcare provider". Low levels of medication adherence in hypertension have been linked with increased disease burden and with higher costs for patients. Patients with hypertension whose blood pressure is poorly controlled often need to receive more than one pill. Nevertheless, having to take many pills may result in poor adherence, i.e., patients not taking their treatment as prescribed. Combining multiple drugs into a single pill for the management of hypertension is known to improve adherence; however, limited evidence exists about the benefits of triple single-pill combinations compared with equivalent free combinations in real clinical practice. This analysis evaluated changes in adherence before and after patients switched from a three-drug therapy of perindopril/indapamide single-pill + amlodipine (PER/IND + AML) to perindopril/indapamide/amlodipine (PER/IND/AML) taken as a single pill. In this analysis, real-world data from Italian administrative databases covering around 11% of the Italian population were used. Overall, 158 patients were included. More patients were found to be adherent after switch to PER/IND/AML single pill (75.3% vs 44.3% of PER/IND + AML combination). Partially adherent and poorly adherent patients were fewer with PER/IND/AML single-pill combination (10.1% and 14.6%, respectively) compared to PER/IND + AML combination (38.0% and 17.7%, respectively). These findings indicate that switching to a simplified therapy in which all three drugs are taken in one pill may offer an opportunity for increasing the number of patients that are adherent to their medication.
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Hipertensão , Indapamida , Leucemia Mieloide Aguda , Adulto , Humanos , Anlodipino/uso terapêutico , Perindopril/uso terapêutico , Indapamida/uso terapêutico , Estudos Retrospectivos , Pressão Sanguínea , Anti-Hipertensivos/uso terapêutico , Hipertensão/tratamento farmacológico , Combinação de Medicamentos , Adesão à Medicação , Leucemia Mieloide Aguda/tratamento farmacológicoRESUMO
Famine exposure during early life development can affect disease risk in late-life period, yet, transmission of phenotypic features from famine-exposed individuals to the next generations has not been well characterized. The purpose of our case-control study was to investigate the association of parental starvation in the perinatal period and the period of early childhood with the phenotypic features observed in two generations of descendants of Leningrad siege survivors. We examined 54 children and 30 grandchildren of 58 besieged Leningrad residents who suffered from starvation in early childhood and prenatal age during the Second World War. Controls from the population-based national epidemiological ESSE-RF study (n = 175) were matched on sex, age and body mass index (BMI). Phenotypes of controls and descendants (both generations, children and grandchildren separately) were compared, taking into account multiple testing. Comparison of two generations descendants with corresponding control groups revealed significantly higher creatinine and lower glomerular filtration rate (GFR), both in meta-analysis and in independent analyses. The mean values of GFR for all groups were within the normal range (GFR less than 60 mL/min/1.73 m2 was recorded in 2 controls and no one in DLSS). Additionally, independent of the creatinine level, differences in the eating pattern were detected: insufficient fish and excessive red meat consumption were significantly more frequent in the children of the Leningrad siege survivors compared with controls. Blood pressure, blood lipids and glucose did not differ between the groups. Parental famine exposure in early childhood may contribute to a decrease in kidney filtration capacity and altered eating pattern in the offspring of famine-exposed individuals.
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Fome Epidêmica , Inanição , Pré-Escolar , Humanos , Animais , Feminino , Gravidez , Estudos de Casos e Controles , Creatinina , Pressão SanguíneaRESUMO
BACKGROUND: Few studies have compared COVID-19 patients from different waves. This study aims to conduct a clinical and morphological analysis of patients who died from COVID-19 during four waves. METHODS: The study involved 276 patients who died from COVID-19 during four waves, including 77 patients in the first wave, 119 patients in the second wave, and 78 patients in the third wave. We performed a histological examination of myocardium samples from autopsies and additionally analyzed the samples by PCR. We conducted immunohistochemistry of the myocardium for 21 samples using antibodies against CD3, CD45, CD8, CD68, CD34, Ang1, VWF, VEGF, HLA-DR, MHC1, C1q, enteroviral VP1, and SARS-CoV-2 spike protein. We also did immunofluorescent staining of three myocardial specimens using VP1/SARS-CoV-2 antibody cocktails. Further, we ran RT-ddPCR analysis for 14 RNA samples extracted from paraffin-embedded myocardium. Electron microscopic studies of the myocardium were also performed for two samples from the fourth wave. RESULTS: Among the 276 cases, active myocarditis was diagnosed in 5% (15/276). Of these cases, 86% of samples expressed VP1, and individual cells contained SARS-CoV-2 spike protein in 22%. Immunofluorescence confirmed the co-localization of VP1 and SARS-CoV-2 spike proteins. ddPCR did not confidently detect SARS-CoV-2 RNA in the myocardium in any myocarditis cases. However, the myocardium sample from wave IV detected a sub-threshold signal of SARS-CoV-2 by qPCR, but myocarditis in this patient was not confirmed. Electron microscopy showed several single particles similar to SARS-CoV-2 virions on the surface of the endothelium of myocardial vessels. A comparison of the cardiovascular complication incidence between three waves revealed that the incidence of hemorrhage (48 vs. 24 vs. 17%), myocardial necrosis (18 vs. 11 vs. 4%), blood clots in the intramural arteries (12 vs. 7 vs. 0%), and myocarditis (19 vs. 1 vs. 6%) decreased over time, and CD8-T-killers appeared. Immunohistochemistry confirmed the presence of endotheliitis in all 21 studied cases. CONCLUSIONS: This study compared myocardial damage in patients who died during three COVID-19 waves and showed a decrease in the incidence of endotheliitis complications (thrombosis, hemorrhage, necrosis) and myocarditis over time. However, the connection between myocarditis and SARS-CoV-2 infection remains unproven.
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BACKGROUND: Bromhexine hydrochloride has been suggested as a TMPRSS2 protease blocker that precludes the penetration of SARS-CoV-2 into cells. We aimed to assess the preventive potential of regular bromhexine hydrochloride intake for COVID-19 risk reduction in medical staff actively involved in the evaluation and treatment of patients with confirmed or suspected SARS-CoV-2 infection. METHODS: In a single-centre randomized open-label study, medical staff managing patients with suspected and confirmed COVID-19 were enrolled and followed up for 8 weeks. The study began at the initiation of COVID-19 management in the clinic. The study was prematurely terminated after the enrollment of 50 participants without a history of SARS-CoV-2 infection: 25 were assigned to bromhexine hydrochloride treatment (8 mg 3 times per day), and 25 were controls. The composite primary endpoint was a positive nasopharyngeal swab polymerase chain reaction (PCR) test for SARS-CoV-2 or signs of clinical infection within 28 days and at week 8. Secondary endpoints included time from the first contact with a person with COVID-19 to the appearance of respiratory infection symptoms; the number of days before a first positive SARS-CoV-2 test; the number of asymptomatic participants with a positive nasopharyngeal swab test; the number of symptomatic COVID-19 cases; and adverse events. RESULTS: The rate of the combined primary endpoint did not differ significantly between the active treatment group (2/25 [8%]) and control group (7/25 [28%]); P=0.07. A fewer number of participants developed symptomatic COVID-19 in the treatment group compared to controls (0/25 vs. 5/25; P=0.02). CONCLUSION: Although the study was underpowered, it showed that Bromhexine hydrochloride prophylaxis was associated with a reduced rate of symptomatic COVID-19. The prophylactic treatment was not associated with a lower combined primary endpoint rate, a positive swab PCR test, or COVID-19 (ClinicalTrials.gov number, NCT04405999).
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Cardiac fibrosis is the basis of structural and functional disorders in patients with diabetes mellitus (T2DM). A wide range of laboratory and instrumental methods is used for its prediction. The study aimed to identify simple predictors of cardiac fibrosis in patients with T2DM based on the analysis of circulating fibrosis biomarkers and arterial stiffness. The study included patients with T2DM (n = 37) and cardiovascular risk factors (RF, n = 27) who underwent ECHO, cardiac magnetic resonance imaging (MRI), pulse wave analysis (PWV), reactive hyperemia (RH), peripheral arterial tonometry, carotid ultrasonography, and assessment of serum fibrosis biomarkers. As a control group, 15 healthy subjects were examined. Left ventricular concentric hypertrophy was accompanied by an increased serum galectin-3 level in T2DM patients. There was a relationship between the PICP and HbA1c levels in both main groups (R2 = 0.309; p = 0.014). A negative correlation between PICP level and the global longitudinal strain (GLS) was found (r = −0.467; p = 0.004). The RH index had a negative correlation with the duration of diabetes (r = −0.356; p = 0.03), the carotid-femoral PWV (r = −0.371; p = 0.024), and the carotid intima-media thickness (r = −0.622; p < 0.001). The late gadolinium-enhanced (LGE) cardiac MRI was detected in 22 (59.5%) T2DM and in 4 (14.85%) RF patients. Diabetes, its baseline treatment with metformin, HbA1c and serum TIMP-1 levels, and left ventricle hypertrophy had moderate positive correlations with LGE findings (p < 0.05). Using the multivariate regression analysis, increased TIMP-1 level was identified as an independent factor associated with cardiac fibrosis.