Physical and psychological functioning of patients with chronic limb ischemia during a 1-year period after endovascular revascularization.

OBJECTIVE: Symptoms of peripheral artery disease (PAD) and patients' physical and psychological status are related in a vicious circle. The aim of this study was to determine the relationships between improvement in parameters of PAD after endovascular procedures and changes in patients' physical and psychological status. METHODS: We studied 140 consecutive patients with PAD: 50 patients with chronic limb-threatening ischemia (CLTI), 50 patients with intermittent claudication (IC) undergoing an endovascular procedure, and 40 patients with IC who were not qualified for leg revascularization. All participating patients were assessed at the beginning of the study and at 3 and 12 months of follow-up; scores taken included ankle-brachial index, 6-minute walking test distance, Barthel Index, activities of daily living index, instrumental activities of daily living (IADL) index, Mini-Mental State Examination, and Hospital Anxiety and Depression Scale. RESULTS: After 12 months of follow-up, an improvement in PAD-related symptoms following leg revascularization had been maintained in 56% of the patients with CLTI and in 68% of those with IC. Twelve months after endovascular leg revascularization, the scores in respect of activities of daily living, IADL, and Mini-Mental State Examination had increased, and scores for Hospital Anxiety and Depression Scale had decreased in patients with both CLTI and IC. A higher baseline score in the IADL index was associated with a reduction in the 1-year cardiovascular event risk (odds ratio, 95% confidence interval, 0.70; 0.54-0.91; P < .01). CONCLUSIONS: In patients with PAD, endovascular procedures not only improved PAD-related symptoms, but also ameliorated patients' physical state, improved cognitive function, and reduced depression.

Health-related Quality of Life after a one-year follow-up of patients undergoing endovascular leg revascularization.

BACKGROUND: Lower limb revascularization not only improves walking distance, but also disease-specific and general health-related Quality of Life (HRQoL). Therefore, we analyzed changes in HRQoL after endovascular leg revascularization in patients with chronic lower limb ischemia during a one-year follow-up. METHODS: The WHOQOL-BREF questionnaire was completed by 50 patients with intermittent claudication (IC) and 50 patients with chronic limb-threatening ischemia (CLTI) who underwent endovascular revascularization with a stent implantation, as well as 40 patients with IC not requiring endovascular intervention who received medical management only. The survey was completed before and then 3 and 12 months after an intervention. RESULTS: Patients with CLTI before endovascular intervention had the lowest HRQoL in the somatic, psychological, social, and environmental domains. After endovascular revascularization, these patients achieved the greatest improvement in HRQoL. Scores in the HRQoL domains correlated with Rutherford class, ankle-brachial index, and walking distance. The initial score in the somatic domain predicted the risk of target lesion revascularization (TLR) during the one-year follow-up. CONCLUSIONS: Endovascular leg revascularization improved patients' functioning, not only in the physical, but also in the psychological, environmental, and social domains of HRQoL. A higher score in the somatic domain of HRQoL before and at 3 months after an intervention predicted the risk of TLR during the one-year follow-up. It is recommended that scores for general HRQoL domains are added to the standard measures of the direct outcome of leg revascularization due to their one-year prognostic value.

Blood adipocytokine concentration in patients with peripheral artery disease.

BACKGROUND: Inflammatory responses mediated by adipocytokines may affect both atherosclerosis development and progression, as well as the risk of in-stent restenosis. The aim of this study was to determine the relationships between blood leptin, adiponectin and tumor necrosis factor-α (TNF-α) concentrations and the 1-year outcome of superficial femoral artery (SFA) stenting. METHODS: Blood concentrations of leptin, adiponectin and TNF-α were determined in 70 patients undergoing SFA stenting due to intermittent claudication and in 40 patients undergoing carotid artery stenting (CAS). All subjects were followed up for at least 1 year in relation to the occurrence of clinically driven target lesion revascularization (TLR) or a major adverse cardiovascular event (MACE). RESULTS: Patients undergoing SFA stenting and CAS had similar blood adipocytokine concentrations. Patients with diabetes mellitus presented a higher leptin concentration, lower adiponectin-to-leptin ratio, and lower blood adiponectin concentration indexed to fat mass (FM) and to visceral adiposity score (VAS). In Kaplan-Meier analysis, blood concentration of TNF-α indexed to FM and to VAS was higher in patients who underwent TLR and MACE. However, in multifactorial analysis, the severity of atherosclerosis lesions in the femoropopliteal vascular region, estimated in relation to TASC-II classification, was the only predictor of TLR. CONCLUSIONS: Circulating adipocytokines did not distinguish patients with different clinical manifestations of atherosclerosis. Higher ratios of TNF-α -to-FM and to VAS before SFA stenting were related to TLR and MACE occurrence. Dysregulation in adipocytokine secretion may be a potential mediator of a proatherogenic action of diabetes mellitus in patients with peripheral artery disease.

Total blood lymphocyte count as a prognostic factor among unselected inpatients.

PURPOSE: The aim of this study was to determine the relationships between total lymphocyte count (TLC) and prognosis among inpatients. PATIENTS AND METHODS: We retrospectively analyzed data from electronic medical documentation of 54 976 inpatients hospitalized in an urban university hospital during 3 consecutive years (2014-2017). RESULTS: TLC was available for 12 651 (23.01%) of the inpatients. Patients with TLC <0.8 G/L constituted about 15% of the inpatients studied and had the highest risk of death, hospital readmission within 14 days, hospital readmission within 30 days and hospital readmission within 1 year, the lowest values for biochemical parameters of nutritional status assessment, and the highest C-reactive protein levels. An increase in TLC was associated with reduced risk of in-hospital death (odds ratio [OR]; 95% confidence interval [CI]): 0.31; 0.27-0.36 and 14-day readmission: 0.78; 0.72-0.86. The risk of in-hospital death associated with the Nutritional Risk Screening 2002 (NRS-2002) score, blood albumin concentration, and the score for the combined values of hemoglobin, TLC, albumin and neutrophils (HLAN) was (OR; 95% CI): 2.44; 2.35-2.53; 0.32; 0.28-0.36; and 0.96; 0.94-0.97; respectively. CONCLUSIONS: TLC < 0.8 G/L is associated with the highest risk of in-hospital death, 14-day and 30-day readmission, and longer in-hospital stay. An increase in TLC predicted in-hospital survival and freedom from early readmission with a power similar to or greater than a number of prognostic formulas based on questionnaires (e.g. NRS-2002), biochemical parameters (e.g. albumin) and formulas composed of multiple parameters (e.g. HLAN).

Body Composition in Patients with Atrial Fibrillation.

BACKGROUND: Obesity is a risk factor for cardiovascular diseases, however evidence is mainly based on body mass index (BMI) analysis. The aim of this study was to estimate body composition using bioelectrical impedance analysis (BIA) and its prognostic value in patients with atrial fibrillation (AF) during one year of follow-up. METHODS: Medical history, anthropometric and biochemical examinations, and BIA were performed in 120 inpatients with AF and 240 patients hospitalized due to other cardiovascular disorders. RESULTS: Compared to the control group, the patients with AF had a significantly greater body mass, BMI, excess body mass in relation to ideal body mass, larger waist circumference, higher values of BIA parameters such as fat and fat-free mass, visceral adiposity, total body water (total water content in the body), metabolic rate and age, and lower percentage of skeletal muscle mass. Higher prevalence rates of obesity and sarcopenia were observed in the patients with AF compared to the control group, and in the patients with the paroxysmal form compared to those with the permanent form of AF. In logistic regression analysis, the percentage of fat mass was associated with a higher risk of AF (odds ratio, 1.10; 95% confidence interval, 1.05-1.15; p < 0.001). CONCLUSIONS: Body composition parameters were associated with the occurrence and form of AF in our study cohort. However, further studies are needed to clarify the relationships due to an imbalance in comorbidities.

Blood albumin as a prognostic factor among unselected medically treated inpatients.

Aim: The aim of this study is to determine the prognostic value of blood albumin (BA) in an unselected population of inpatients. Materials & methods: We performed prospective analysis of the medical documentation of 7279 patients hospitalized between July 2014 and September 2017. Results: Individuals with BA ≥3.35 mg/dl had significantly lower risk of in-hospital death (odds ratio [OR]: 0.22; 95% CI: 0.19-0.27; p < 0.001) and 14-day readmission (OR: 0.64; 95% CI: 0.55-0.77; p < 0.0001). BA concentration was the strongest favorable factor predicting inpatient survival in a Cox hazard regression model (OR: 0.43; 95% CI: 0.36-0.50; p < 0.001), did not correlate with body mass index and actual-to-ideal bodyweight ratio and was strongly affected by numerous non-nutrient factors. Conclusion: BA concentration showed similar or better predictive and diagnostic power in relation to all-cause in-hospital mortality and 14-day readmission among inpatients than selected multifactorial scores.

Leptin, adiponectin, tumor necrosis factor α, and irisin concentrations as factors linking obesity with the risk of atrial fibrillation among inpatients with cardiovascular diseases.

BACKGROUND: The endocrine function of adipose tissue and skeletal muscles mediates the risk of cardiovascular complications of obesity. AIMS: The aim of this study was to determine the associations of leptin, adiponectin (ADA), tumor necrosis factor α (TNF­α), and irisin levels with the diagnosis of atrial fibrillation (AF) on admission to the hospital as well as parameters of transthoracic echocardiography among inpatients with cardiovascular diseases (CVDs). METHODS: The study included 80 consecutive patients hospitalized due to paroxysmal or persistent AF and a control group of 165 age- and sex­matched individuals admitted due to exacerbation of chronic CVD. In all participants, we assessed serum leptin, ADA, TNF­α, and irisin concentrations, body composition determined by bioelectrical impedance analysis, and transthoracic echocardiographic parameters. RESULTS: Compared with controls, patients with AF had greater fat mass (FM), higher serum leptin levels and lower levels of ADA, TNF­α, and irisin when indexed to body surface area, FM, and visceral adiposity. Hyperleptinemia slightly increased the risk of AF (odds ratio [OR], 1.02; 95% CI, 1.01-1.03; P <0.01). The correlation was stronger after indexation to FM (OR, 1.34; 95% CI, 1.01-1.81; P <0.05). The coefficients of significant correlations with echocardiographic parameters were stronger for irisin than for adipocytokines: 0.16 to 0.35 and 0.12 to 0.22, respectively. CONCLUSIONS: Adipocytokines and irisin exert a significant but weak effect on heart chamber size and affect the risk of AF occurrence. Their blood concentrations do not seem to be related simply to body composition but probably depend on individual variations in adipocytokine and myokine secretion as a result of numerous factors.