Newly detected diabetes mellitus patients with acute coronary syndrome have an adverse cardiometabolic profile similar to patients with prior diabetes and a more extensive ischemic myocardial insult.

AIMS: The impact of newly detected diabetes mellitus (NDDM) on metabolic parameters and extent of myocardial necrosis in patients with acute coronary syndrome (ACS) is not fully explored. We examined the impact of NDDM on cardiometabolic characteristics and myocardial necrosis in ACS patients. METHODS: CALLINICUS-Hellas Registry is an ongoing prospective multicenter observational study evaluating the adherence to lipid-lowering therapy (LLT) among ACS patients in Greece. Three groups were created: a) patients with NDDM (abnormal fasting glucose, HbA1c ≥ 6.5 % and no previous history of DM), b) patients without known DM and HbA1c < 6.5 % (non-DM) and c) patients with prior DM. RESULTS: The prevalence of NDDM among 1084 patients was 6.9 %. NDDM patients had lower HDL-C [38 (32-45) vs 42 (36-50) mg/dL] and higher triglycerides levels [144 (104-231) vs 115 (87-152) mg/dL] compared to non-DM patients (p < 0.05). NDDM patients featured both higher body mass index [29.5 (26.4-34.3) vs 27.1 (24.9-29.9) kg/m2] and waist circumference [107 (100-114) vs 98 (91-106) cm] compared to non-DM patients (p < 0.05). In addition, NDDM patients had more extensive myocardial necrosis than patients with prior DM. CONCLUSIONS: ACS patients with NDDM have an adverse cardiometabolic profile similar to patients with prior DM and have more extensive myocardial insult.

CPAP therapy induces favorable short-term changes in epicardial fat thickness and vascular and metabolic markers in apparently healthy subjects with obstructive sleep apnea-hypopnea syndrome (OSAHS).

BACKGROUND: Obstructive sleep apnea-hypopnea syndrome (OSAHS) is an independent risk factor for hypertension, coronary artery disease, and diabetes mellitus. Epicardial fat has been recently recognized as a new risk factor and active participant on cardiometabolic risk. The aim of this study was to assess an independent relationship between sleep apnea severity, metabolic and vascular markers, and epicardial fat, at baseline and after 3 months of continuous positive airway pressure (CPAP) therapy. MATERIALS AND METHOD: Our study group consisted of 48 patients with suspected OSAHS and no prior history of cardiovascular disease or diabetes mellitus. All patients underwent full overnight polysomnography. Thickness of epicardial and visceral adipose tissue, brachial artery flow-mediated dilation (FMD), carotid intima media thickness (cIMT), pulse wave velocity (PWV), plasma C-reactive protein (CRP) levels, fasting glucose levels, HbA1c, homeostatic model assessment of insulin resistance index (HOMA), and lipid profile were measured at baseline and after 3 months of CPAP use in patients with moderate to severe OSAHS. RESULTS: In OSAHS patients (Apnea-hypopnea index (AHI) ≥15/h, N = 28), epicardial fat correlated with fasting glucose (rho = 0.406, p = 0.04) and HOMA (rho = 0.525, p = 0.049) but was not associated with visceral fat (rho = 0.126, p = 0.595). Epicardial adipose tissue (EAT) (p = 0.022) increased across AHI severity along with PWV (p = 0.045) and carotid intima media thickness (IMT) (p = 0.034) while FMD (p = 0.017) decreased. Therapy with CPAP reduced both epicardial (p < 0.001) and visceral fat (p = 0.001). Alterations in epicardial fat across the follow-up were associated with changes in PWV (p = 0.026) and HOMA (p = 0.037) independently of major confounders. CONCLUSIONS: Epicardial fat thickness was associated with OSA severity and may be an additional marker of cardiovascular risk as well as of future diabetes in these patients. CPAP therapy reduced epicardial fat, suggesting its potentially beneficial role in reducing cardiometabolic risk in OSA patients.

Sex differences of continuous positive airway pressure treatment on flow-mediated dilation in patients with obstructive sleep apnea syndrome.

INTRODUCTION: There is growing research evidence suggesting the presence of endothelial dysfunction and systemic inflammation in patients with obstructive sleep apnea syndrome (OSAS). Continuous positive airway pressure (CPAP) is the most effective method for treating OSAS; nonetheless, the effects of CPAP on the aforementioned pathophysiologic pathways as well as on the systemic disease that result or coexist with the OSAS remain elusive. AIM: To assess the effect of 3-month CPAP therapy on endothelial-dependent dilation, plasma levels of inflammatory markers, blood pressure (BP), and glucose control on male and female patients with OSAS. METHODS: Our study group consisted of 40 (24 males and 16 females) patients with no prior history of cardiovascular disease, with an apnea-hypopnea index ≥15, who were assigned to receive CPAP treatment. Measurements of flow-mediated dilation (FMD), 24-hour ambulatory BP, and blood analysis were performed at baseline and 3 months after CPAP therapy. RESULTS: Baseline FMD values were negatively correlated with the apnea-hypopnea index (r=-0.55, P=0.001). After 3 months of CPAP, there was an increase in the FMD values (5.40%±2.91% vs 3.13%±3.15%, P<0.05) and a significant reduction in the patients' 24-hour systolic BP (122.82±11.88 mmHg vs 130.24±16.75 mmHg, P<0.05), diastolic BP (75.44±9.14 mmHg vs 79.68±11.09 mmHg, P<0.05), and pulse pressure (47.38±9.77 mmHg vs 52.72±11.38 mmHg, P<0.05); daytime systolic BP (125.76±12.69 mmHg vs 132.55±17.00 mmHg, P<0.05) and diastolic BP (77.88±10.39 mmHg vs 82.25±11.01 mmHg, P<0.05); nighttime systolic BP (118.17±13.16 mmHg vs 126.22±17.42 mmHg, P<0.05) and pulse pressure (46.61±10.76 mmHg vs 52.66±11.86 mmHg, P<0.05); and C-reactive protein and HbA1c levels (0.40 [0.40-0.70] mg/L vs 0.60 [0.40-0.84] mg/L and 5.45%±0.70% vs 5.95%±1.08%, respectively; P<0.05). When divided by sex, only male patients produced similar statistically significant results, while female patients failed to show such associations. CONCLUSION: Our results suggest that CPAP therapy improves the endothelial function, the BP, and the glucose control in male patients with OSAS. Further research is warranted in order to verify these results and to further elucidate the impact of CPAP on the cardiovascular risk of male and female patients with OSAS.

Measurement of exhaled alveolar nitrogen oxide in patients with lung cancer: a friend from the past still precious today.

Nitric oxide (NO) is a marker of airway inflammation and indirectly a general indicator of inflammation and oxidative stress. NO is a contributing factor in lung cancer at an early stage and also after chemotherapy treatment of lung cancer. We studied whether exhaled NO levels were altered by three cycles of chemotherapy at diagnosis and after chemotherapy, and whether, directly or indirectly, these changes were related to the course of disease. Also, a correlation of NO levels with other markers of inflammation was performed. We studied 42 patients diagnosed early: 26 men and 16 women with lung cancer. We analyzed blood tests for control of inflammatory markers, functional pulmonary tests, and alveolar exhaled NO. We recorded a decrease in exhaled NO after three cycles of chemotherapy in all patients, regardless of histological type and stage: there were 42 patients with mean 9.8 NO after three cycles (average 7.7). Also, a strong correlation appeared between NO measurements before and after chemotherapy and C-reactive protein (P < 0.05, r = 0.42, before) and (P < 0.045, r = 0.64, after). NO alveolar measurement as an indicator of airway inflammation indicates response to chemotherapy in lung cancer. Also, the inflammatory process in lung cancer was confirmed and indicated response to chemotherapy through an index that is sensitive to inflammatory disease of the airways.

Effect of CPAP treatment on endothelial function and plasma CRP levels in patients with sleep apnea.

BACKGROUND: Continuous positive airway pressure (CPAP) is the most effective method for treating obstructive sleep apnea syndrome (OSAS) and alleviating symptoms. Improved sleep quality with effective CPAP therapy might also contribute to attenuated systemic inflammation and improved endothelial function, with subsequent reduction of cardiovascular risk. The aim of this study was to assess the effect of 3-month CPAP therapy on brachial artery flow-mediated dilation (FMD) and plasma C-reactive protein (CRP) levels in patients with OSAS. MATERIAL/METHODS: Our study group consisted of 38 male patients with no prior history of cardiovascular disease. Twenty patients with an Apnea-Hypopnea Index (AHI) ≥15 were assigned to receive CPAP treatment and 18 subjects with an AHI<5 were included in the control group. Six patients failed to comply with the CPAP treatment. Measurement of FMD and blood analysis was performed at baseline and 3 months after CPAP therapy. RESULTS: Baseline FMD values were negatively correlated with age, BMI, AHI, DSI,% of time <90% Sa02, and CRP (p<0.05). Plasma CRP values were positively correlated with BMI, AHI, DSI and% of time <90% Sa02 (p<0.05). In the group of patients who complied with the CPAP treatment, there was a significant increase in the FMD values (9.18 ± 0.55 vs. 6.27 ± 0.50) and a decrease in the levels of CRP (0.67 ± 0.15 vs. 0.84 ± 0.18) (p<0.05). CONCLUSIONS: Appropriate CPAP therapy improved both CRP and FMD values, suggesting its potentially beneficial role in reducing cardiovascular risk in OSAS patients.

An ontology-based framework aiming to support personalized exercise prescription: application in cardiac rehabilitation.

Exercise constitutes an important intervention aiming to improve health and quality of life for several categories of patients. Personalized exercise prescription is a rather complicated issue, requiring several aspects to be taken into account, e.g. patient's medical history and response to exercise, medication treatment, personal preferences, etc. The present work proposes an ontology-based framework designed to facilitate healthcare professionals in personalized exercise prescription. The framework encapsulates the necessary domain knowledge and the appropriate inference logic, so as to generate exercise plan suggestions based on patient's profile. It also supports readjustments of a prescribed plan according to the patient's response with respect to goal achievement and changes in physical-medical status. An instantiation of the proposed framework for cardiac rehabilitation illustrates the virtue and the applicability of this work.

The Contribution of the Left Atrioventricular Plane Displacement During Low Dose Dobutamine Stress Echocardiography in Predicting Recovery of Left Ventricular Dyssynergies.

The aim of this study was to assess the significance of the left systolic atrioventricular (AV) plane displacement during low dose dobutamine stress echocardiography (DSE), in predicting the recovery of left ventricular dyssynergies after revascularization. In 30 infarctiers with left ventricular dysfunction scheduled for RE (14 percutaneous transluminal coronary angioplasty and 16 coronary artery bypass graft) and in 25 age- and sex-matched healthy subjects, a DSE, using a 16 ventricular segment model and a four-grade scoring system for the assessment of regional wall motion of the left ventricle was performed. Prior and during DSE, the left systolic AV plane displacement was recorded from the apical four- and two-chamber views, by M-mode echo, at four left ventricular sites, corresponding to the septal, lateral, anterior, and inferior walls, both in patients and controls. The study was repeated in all patients 101 +/- 14 days after successful revascularization. Healthy subjects showed a significant increase of left systolic AV plane displacement at all left ventricular sites during dobutamine infusion (DI) (P < 0.001). Patients also exhibited a significant maximum increase of left systolic AV plane displacement during DSE only in the dyssynergic sites with functional improvement in the postrevascularization echocardiogram (P < 0.001). In the remaining dyssynergic sites, without functional improvement after revascularization, the left systolic AV plane displacement did not change (P > 0.05). Selecting a maximum LAVPD increase of >2 mm at any site of the left ventricule to predict recovery of the regional ventricular dyssynergies, results in a sensitivity of 91%, specificity of 83%, positive predictive value of 88%, and negative predictive value of 87%. When two-dimensional DSE was used for the detection of reversible dysfunction, sensitivity and specificity were found to be 81.5% and 87.5%, respectively, while the positive and negative predictive values were 90% and 78%, respectively. When the two methods were in agreement the sensitivity was 90%, the specificity 100%, and the positive and negative predictive values were 100% and 84.2%, respectively. The assessment of left systolic AV plane displacement during DI constitutes a new, simple, and accurate method in the prediction of left ventricular dyssynergy recovery after revascularization. The combination of this method and two-dimensional DSE are basic predictor markers of viability of dysfunctional myocardium. (ECHOCARDIOGRAPHY, Volume 13, November 1996)