The Influence of Frailty Syndrome and Dementia on the Convenience and Satisfaction with Oral Anticoagulation Treatment in Elderly Patients with Atrial Fibrillation.

Background: The impact of frailty syndrome (FS) and dementia on the convenience and satisfaction with oral anticoagulation (OAC) treatment in atrial fibrillation (AF) patients is not well-known. Aim: Assessment the impact of FS and dementia on the convenience and satisfaction with OAC treatment in 116 elderly (mean age 75.2, SD = 8.2) patients with AF. Methodology: A self-administered questionnaire was used in the study to collect basic socio-demographic and clinical data. Tilburg Frailty Indicator (TFI) questionnaire was used to assess the presence of FS, Mini Mental State Examination (MMSE) to assess cognitive impairment (CI), The Perception of Anticoagulant Treatment Questionnaire Part 2 (PACT-Q2) to assess convenience and satisfaction with OAC treatment, and the Arrhythmia-Specific Questionnaire in Tachycardia and Arrhythmia (ASTA) to assess quality of life (QoL). Results: Multivariable analysis as a significant, negative predictor of the convenience and satisfaction domain showed the occurrence of dementia (ß = −0.34; p < 0.001, ß = −0.41; p < 0.001, respectively) and prior major bleeding (ß = −0.30; p < 0.001, ß = −0.33; p < 0.001, respectively). Analysis showed a significant relationship between convenience and satisfaction and the overall result of the ASTA (r = −0.329; p < 0.001, r = −0.372; p < 0.001, respectively). Conclusions: Elements of geriatric syndrome, such as FS and dementia, adversely affect treatment convenience and satisfaction with OAC treatment in AF. It has been shown that better convenience and satisfaction with OAC treatment translates into better QoL. There were no differences between satisfaction and convenience and the type of OAC treatment (vitamin K antagonists (VKA) vs. novel oral anticoagulants (NOAC).

Pressure gradient measurement to verify hemodynamic results of the chimney endovascular aortic repair (chEVAR) technique.

PURPOSE: The use of the pressure gradient measurements to assess the renal artery flow hemodynamics after chimney endovascular aortic repair (chEVAR). METHODS: The study was a prospective analysis of 37 chEVAR procedures performend in 24 patients with perirenal aortic aneurysm. In all patients the measurement of: distal renal artery pressure (Pd), aortic pressure (Pa), Pd/Pa ratio (Pd/Pa) and mean gradient (MG) between the aorta and the distal renal artery were performed. Measurements were taken with 0.014 inch pressure wire catheter before and after the chEVAR procedure. MG greater than 9 mmHg and Pd/Pa ratio below 0.90 were considered as the measures of a significant decrease in distal pressure that limited flow in renal arteries. The 6 month follow-up computed tomographic angiography (CTA) was performed in all patients to diagnose potential endoleak presence and to verify the patency of the chimney stent-grafts. RESULTS: All procedures were successful, and no periprocedural complications were observed in any of the patients. The mean gradient values before and after the chimney implantation did not change significantly (6,2±2,0 mmHg and 6,8±2,2 mmHg, respectively). Similarly, no significant change in Pd/Pa values was noted with the value of 0.9 observed both before and after the procedure. All chimney stents were patent on the control CTA. Type Ia endoleak was found in 4 (10.8%) patients. CONCLUSIONS: The application of the described technique seems to be a safe method which allows a direct measurement of renal artery flow hemodynamics before and after chimney implantation during the chEVAR technique. The use of covered balloon expandable stents, ensures the proper blood flow in the renal arteries during the chEVAR technique.

Risk of Short-Term Mortality after Intracerebral Haemorrhage due to Weekend Hospital Admission in Poland.

BACKGROUND: The mortality rate for spontaneous intracerebral haemorrhage (ICH) has remained high and stable for many years. The unfavourable prognostic factors include age, bleeding volume, location of the haematoma, high blood pressure, and disturbed consciousness on admission. Other risk factors associated with medical care also deserve attention. The study aimed to analyse the relationship between day of admission, concerning other prognostic factors, and short-term mortality in ICH, in a Polish specialist stroke unit. METHODS: Medical records of 156 patients (74 males, 82 females, mean age 68.7 years) diagnosed with spontaneous ICH and admitted to a specialist stroke center were retrospectively analysed. Demographics, location, volume of bleeding, blood pressure values, and the Glasgow Coma Scale (GCS), as well as the day of admission, were determined. The relationships were analysed between these factors and 30-day mortality in the patients with ICH. RESULTS: A total of 83 patients were admitted to the hospital during weekdays (Monday 8 am to Friday 3 pm) and 73 during weekends or holidays. Of these, 65 patients died within 30 days. Patients admitted at weekends initially presented with lower GCS scores. Admission on Saturday was associated with an increased risk of death (OR 3.38, 95% CI 1.2-9.48, p < 0.05), but after correction for clinical state measured with the GCS and ICH score, the association was no longer significant. CONCLUSIONS: The time and mode of admission were not associated with increased risk of short-term mortality in ICH patients. Prehospital care issues should be additionally considered as prognostic factors of the outcome.

The relationship between event-related potentials, stress perception and personality type in patients with multiple sclerosis without cognitive impairment: A pilot study.

BACKGROUND: The clinical course of multiple sclerosis (MS) can vary significantly among patients and is affected by exogenous and endogenous factors. Among these, stress and personality type have been gaining more attention. OBJECTIVES: The aim of this study was to investigate the parameters of event-related potentials (ERPs) with regards to stress perception and personality type, as well as cognitive performance in MS patients. MATERIAL AND METHODS: The study group consisted of 30 MS patients and 26 healthy controls. Auditory ERPs were performed in both groups, including an analysis of P300 and N200 response parameters. The Perceived Stress Scale (PSS) was used in the MS group to measure the perception of stress. The D-type Scale (DS14) scale was used to determine the features of Type D personality, characterized by social inhibition and negative affectivity. RESULTS: The score on the PSS corresponded with a moderate or high level of stress perception in 63% of MS patients, while 23% of patients presented with a Type D personality. P300 latencies were significantly longer (p = 0.001), N200 amplitudes were significantly higher (p = 0.004), and N200 latencies were longer in MS patients than in the controls. Strong positive correlations were found between N200 and P300 amplitudes, as well as between the DS14 and PSS results. CONCLUSIONS: Most MS patients experience moderate to severe stress. ERP abnormalities were found in MS patients who did not have overt cognitive impairment and showed correlations with stress levels and negative affectivity. Event-related potentials may be useful in assessing the influence of stress and emotions on the course of MS.

Bachmann's Bundle Pacing not Only Improves Interatrial Conduction but Also Reduces the Need for Ventricular Pacing.

BACKGROUND: Patients treated for sick sinus syndrome may have interatrial conduction disorder leading to atrial fibrillation. OBJECTIVES: This study was aimed to assess the influence of the atrial pacing site on interatrial and atrioventricular conduction as well as the percentage of ventricular pacing in patients with sick sinus syndrome implanted with atrioventricular pacemaker. MATERIAL AND METHODS: The study population: 96 patients (58 females, 38 males) aged 74.1 ± 11.8 years were divided in two groups: Group 1 (n = 44) with right atrial appendage pacing and group 2 (n = 52) with Bachmann's area pacing. We assessed the differences in atrioventricular conduction in sinus rhythm and atrial 60 and 90 bpm pacing, P-wave duration and percentage of ventricular pacing. RESULTS: No differences in baseline P-wave duration in sinus rhythm between the groups (102.4 ± 17 ms vs. 104.1 ± 26 ms, p = ns.) were noted. Atrial pacing 60 bpm resulted in longer P-wave in group 1 vs. group 2 (138.3 ± 21 vs. 106.1 ± 15 ms, p < 0.01). The differences between atrioventricular conduction time during sinus rhythm and atrial pacing at 60 and 90 bpm were significantly longer in patients with right atrial appendage vs. Bachmann's pacing (44.1 ± 17 vs. 9.2 ± 7 ms p < 0.01 and 69.2 ± 31 vs. 21.4 ± 12 ms p < 0.05, respectively). The percentage of ventricular pacing was higher in group 1 (21 vs. 4%, p < 0.01). CONCLUSIONS: Bachmann's bundle pacing decreases interatrial and atrioventricular conduction delay. Moreover, the frequency-dependent atrioventricular conduction lengthening is much less pronounced during Bachmann's bundle pacing. Right atrial appendage pacing in sick sinus syndrome patients promotes a higher percentage of ventricular pacing.

Soluble Cell Adhesion Molecules - Does Estimating sVCAM-1 and sICAM-1 Concentration Provide Additional Information About Cardiovascular Risk in Patients with Coronary Artery Disease?

OBJECTIVES: Cell adhesion molecules (CAM) are thought to have a great impact on endothelium functioning. Interaction between CAM and a receptor may lead to macrophage activation and the release of multiple enzymes such as elastases and colagenases. These enzymes can, in turn, play a role in atherosclerotic plaque destabilization and initiation of acute coronary syndrome (ACS). The main aim of this study was to assess the role of sVCAM-1 and sICAM-1 in the risk stratification of ACS. MATERIAL AND METHODS: 63 patients - mean age 62.7 ± 9.5 years (26 women, 37 men) - were included in the study. Patients were divided into two groups: I - patients with acute coronary syndrome (ACS) diagnosed by coronary angiography (n = 45: 15 women; 30 men); and II - patients without apparent CAD in coronary angiography (n = 18: 11 women, 7 men). In both groups, samples required for sVCAM-1 and sICAM-1 level measurements were collected before the angiography. RESULTS: Mean age, prevalence of arterial hypertension, diabetes mellitus and chronic kidney disease did not differ between the groups. Levels of sVCAM-1 and sICAM-1 were significantly higher in group I (group I vs. group II: 850.3 ± 337.9 vs. 675.9 ± 178.8; p = 0.02 and 737.2 ± 353.5 vs. 428.5 ± 157.3; p = 0.001 respectively). ROC analysis revealed that there is significantly higher risk of ACS above the level of 700.15 ng/mL for sVCAM-1 and 407.8 ng/mL for sICAM-1. The level of sVCAM-1 was also found to be an independent risk factor of NSTEMI, OR 1.003 (95% CI: 1.0007-1.004); p = 0.007, but not of STEMI (p > 0.05). CONCLUSIONS: Levels of sVCAM-1 and sICAM-1 were found to be negative predictors of acute coronary syndrome. Further studies should assess the relationship between sVCAM-1 and sICAM-1 levels and the survival of patients suffering from CAD.

Evaluation of the significance of cystatin C levels in patients suffering from coronary artery disease.

OBJECTIVES: Cystatin C is a novel marker used in the diagnosis of preclinical chronic kidney disease (CKD). The aim of the study was to assess the role of cystatin C in the diagnosis of coronary artery disease. MATERIAL AND METHODS: The study involved 63 patients of a mean age of 62.7 ± 9.5 years. The population was divided into two groups: Group I were patients with angiographically diagnosed coronary artery disease (CAD) with their first acute coronary syndrome (ACS, n = 45); Group II were patients who had clinically diagnosed coronary disease but were negative on angiography (n = 18). Cystatin C levels were measured before angiography in both groups; in Group I they were also measured 6 months after discharge. RESULTS: Cystatin C levels were significantly higher in Group I (p = 0.01), and this depended on the type of CAD: non-ACS, non-ST elevated myocardial infarction (NSTEMI) or ST elevated myocardial infarction (STEMI) (p = 0.01). Cystatin C levels correlated inversely with the left ventricular ejection fraction in the whole study population (p = 0.003) and in patients with NSTEMI (p = 0.03). A high cystatin C level was found to be a risk factor for ACS (OR: 1.002 95% CI [1.00029-1.004], p = 0.02) and STEMI (OR: 1.0009 95% CI [0.99-1.002], p = 0.04) but not for NSTEMI (OR: 0.99 95% CI [0.99-1.0], p = 0.21. A ROC analysis revealed that there is a significantly higher risk of ACS above a cystatin C level of 727.85 ng/mL (OR: 5.5 CI [1.65-18.3], p = 0.004) and a significantly higher risk of STEMI above 915.22 ng/mL (OR: 5.9 CI [1.7-19.7], p = 0.003). CONCLUSIONS: The available data suggest that a high cystatin C level is a risk factor for ACS and STEMI. This could play an important role in the early diagnosis and prevention of adverse cardiovascular events.

Familial predisposition to vasovagal syncope.

OBJECTIVE: A handful of studies suggest a familial predisposition to vasovagal syncope (WS) but the scope of information available to date is poor. The aim of our study was to evaluate the prevalence of vasovagal syncope and its familial occurrence in the young. METHODS AND RESULTS: The studied group consisted of 281 women and 111 men, aged 18-32 years. Forty-seven percent of the population had one brother or sister, and the mean number of individuals per family was 4.4 +/- 1.0. The questionnaire consisted of 30 questions regarding syncopal history. Syncope was reported in 32.1% of the patients studied (36.7% in women vs. 20.7% in men; P < 0.05), 29.1% of mothers, 16.8% of fathers, 30.9% of sisters and 14.2% of brothers. Logistic regression analysis revealed that positive history regarding the syncope in the whole group of students was related to the female gender (OR 2.17; CI: 1.28-3.7), the history of a syncope in mother (OR 1.74; CI: 1.09-2.78) and the history of a syncope in father (OR 2.22; CI: 1.28-3.86; P < 0.001). CONCLUSIONS: A positive history of syncope in male relatives increases the risk of syncope in men and women, whereas a positive history of syncope in female relatives increases the risk of syncope in women only. Female gender independently of the family history increases the risk of syncope. The genetics of the vasovagal syncope could be polygenic but the mechanisms of a transmission remain unclear to date.