Sex-dependent differences in clinical characteristics and in-hospital outcomes in patients with takotsubo syndrome.

INTRODUCTION: Takotsubo syndrome (TTS) is an acute reversible left ventricular dysfunction, which occurs mainly in postmenopausal women. OBJECTIVES: The goal of this study was to compare the course of the disease and prognoses in men and women with TTS in 2 large Polish university hospitals. PATIENTS AND METHODS: The analysis included 232 patients (211 women and 21 men) hospitalized at the 1st Chair and Department of Cardiology at the Medical University of Warsaw and at the 1st Department of Cardiology at the Medical University of Gdansk. RESULTS: Men who developed TTS were more likely to live alone than women. Physical stress triggered TTS more often in men than in women. There were no differences in the prevalence of risk factors and comorbidities, except for a higher prevalence of smoking in men. With regard to the cardiac biomarkers, both admission and peak levels of N­terminal prohormone of brain natriuretic peptide were higher in women. ST­segment depression was found more frequently in men than in women (25% vs 6.2%). Despite the same length of hospitalization, ejection fraction at discharge was lower in men than in women (50% vs 60%). In­hospital outcomes (arrhythmias, mechanical complications, cardiogenic shock, mortality rate) were similar in both groups. ß-Adrenolytics and statins were more often prescribed to women than to men (74.5% vs 52.4% and 68.3% vs 38.1%). Moreover, there was a tendency toward more frequent use of P2Y12 inhibitors in men than in women (23.8% vs 10.4%). CONCLUSIONS: Differences occurred in the clinical course of TTS between men and women. However, in­hospital outcomes were similar in both groups.

The Association Between Dental Status and Risk of Acute Myocardial Infarction Among Poles: Case-control Study.

BACKGROUND: Results of scientific research on the effects of periodontitis on the incidence of myocardial infarction (MI) are ambiguous. OBJECTIVES: The aim of this study was to investigate the association of the severity and extent of periodontitis with acute MI in Poles. MATERIAL AND METHODS: This case-control study included 134 cases hospitalized with acute MI under the age of 70 years and 155 controls drawn from the general population with no MI history. Sociodemographic, cardiologic and periodontal variables were assessed. Three periodontal indicators were evaluated: (1) the severity of periodontitis classified in accordance with Page and Eke definition, (2) the extent of periodontitis determined on the basis of the percentage of sites with CAL ≥ 3 mm (Arbes Index) and (3) tooth loss (> 10 teeth). In a logistic regression model, the association of periodontal parameters with MI occurrence was evaluated after adjusting for well-known cardiovascular risk factors. RESULTS: The extent of periodontitis was significantly associated with the risk of acute MI even after adjusting for age, sex, tobacco smoking, hypertension, diabetes, BMI, education and income (odds ratio [OR] = 2.4; 95% confidence interval [CI] = 1.1 to 5.2; p = 0.0203). However, the severity of periodontitis was associated with MI after adjusting for age and sex (OR = 2.0; 95% CI = 1.2-3.5; p = 0.0109), but not after adjusting for the other above-mentioned risk factors. The association between the number of lost teeth and acute MI was significant after adjusting for age, sex, tobacco smoking, arterial hypertension and diabetes mellitus (OR = 2.1; 95% CI = 1.2-5.9; p = 0.0151). CONCLUSIONS: This study proves the positive association between periodontitis and acute MI in Poles. This association seems to be stronger with regard to the extent rather than to the severity of periodontitis.

The Association Between Dental Status and Systemic Lipid Profile and Inflammatory Mediators in Patients After Myocardial Infarction.

BACKGROUND: Many epidemiological studies have proven that local infection may influence the levels of systemic lipid profile and inflammatory mediators. OBJECTIVES: The aim of this research was to evaluate the association between the state of the oral cavity, lipids and inflammatory mediator concentrations in Poles after acute myocardial infarction (MI). MATERIAL AND METHODS: A total of 134 subjects with a mean age of 54.3 years (± 8.1) were included in the study. Sociodemographic and cardiologic variables were gathered. Subsequently, serum samples were collected for estimation of total cholesterol (TC), triglycerides (TG), low-density lipoprotein (LDL-C), high-density lipoprotein (HDL-C), high-sensitivity C-reactive protein (hsCRP), fibrinogen and white blood cell counts (WBC). The periodontal parameters measured included bleeding on probing index (BoP), pocket depth (PD), clinical attachment level (CAL), the number of bleeding periodontal pockets (bPP) and the number of lost teeth. RESULTS: Overall, patients shared high levels of periodontal inflammation and tissue breakdown. Multivariate analysis revealed a significant association between the serum concentration of LDL-C and bPP (standardized coefficient b = 0.3179; p = 0.0009) and PD (b = 0.3186; p = 0.0015); the level of fibrinogen and the number of lost teeth (b = 0.3669; p = 0.0013); WBC and bPP (b = 0.2726; p = 0.0035) independent of age, sex, income, education, atherosclerotic disease in the family, tobacco smoking, arterial hypertension, diabetes mellitus and BMI. No correlations were found regarding hsCRP serum concentration. CONCLUSIONS: To our knowledge, this study demonstrated for the first time that local inflammatory processes in the oral cavity are positively associated with the systemic levels of LDL-C, fibrinogen and WBC in adult Poles. This may underscore relationships between periodontitis and MI as well as potentially impinge on atherosclerotic processes and MI prognosis.

CHA2DS2-VASc and R2CHA2DS2-VASc scores have predictive value in patients with acute coronary syndromes.

INTRODUCTION: The CHA2DS2-VASc and R2CHA2DS2-VASc scoring systems were designed to stratify thromboembolic risk in patients with atrial fibrillation. The R2CHA2DS2-VASc score, compared with the CHA2DS2-VASc, was modified by adding reduced creatinine clearance. OBJECTIVES: The aim of the study was to assess the long-term predictive value of these scores in patients with acute coronary syndrome (ACS) and to compare their utility with TIMI and GRACE scores in this patient group. PATIENTS AND METHODS: We performed a pooled analysis of 5 independent populations with ACS with a long-term follow-up available. The primary endpoint was defined as all-cause mortality. The following risk scores were calculated: TIMI-STEMI or TIMI-NSTEMI, GRACE, CHA2DS2-VASc, and R2CHA2DS2-VASc RESULTS: A total of 2557 patients were included in the final analysis with a median follow-up of about 5 years. The CHA2DS2-VASc and R2CHA2DS2 -VASc scores were significant predictors of total mortality in the pooled analysis. After correction for heart rate and systolic blood pressure on admission as well as previous myocardial infarction, the scores were still significantly predictive of mortality (hazard ratio [HR], 1.47; 95% confidence interval [CI], 1.39­1.54; P <0.0001 for CHA2DS2-VASc; and HR, 1.41; 95%CI, 1.35­1.47; P <0.0001 for R2CHA2DS2-VASc). At all time points (1, 3, and 5 years), the TIMI-STEMIscore was a significantly better predictor than the CHA2DS2-VASc and R2CHA2DS2-VASc scores. The predictive value of the R2CHA2DS2-VASc score was comparable to that of the GRACE score at 3 and 5 years. CONCLUSIONS: The CHA2DS2-VASc and R2CHA2DS2-VASc scores are significant predictors of all-cause mortality in a long-term follow-up in patients with ACS. These simple risk scores may be easily applied in clinical practice in this patient group.