Changing Face of Inflammatory Activation in Complex Coronary Artery Disease during the COVID-19 Pandemic.

INTRODUCTION: The COVID-19 pandemic has changed the immunological status of the population, indicating increased activation. The aim of the study was to compare the degree of inflammatory activation in patients admitted for surgical revascularization in the period before and during the COVID-19 pandemic. MATERIALS AND METHODS: This retrospective analysis included an analysis of inflammatory activation assessed on the basis of whole blood counts in 533 patients (435 (82%) male and 98 (18%) female) with a median age of 66 (61-71) years who underwent surgical revascularization, including 343 and 190 patients operated on in 2018 and 2022, respectively. RESULTS: The compared groups were matched by propensity score matching analysis, obtaining 190 patients in each group. Significantly higher values of preoperative monocyte count (p = 0.015), monocyte-to-lymphocyte ratio (p = 0.004) and systemic inflammatory response index (p = 0.022) were found in the during-COVID subgroup. The perioperative and 12-month mortality rates were comparable, with 1% (n = 4) in 2018 vs. 1% (n = 2) in 2022 (p = 0.911), and 5.6 % (n = 11 patients) vs. 7% (n = 13 patients) (p = 0.413), in the pre-COVID and during-COVID subgroups, respectively. CONCLUSIONS: Simple whole blood analysis in patients with complex coronary artery disease performed before and during the COVID-19 pandemic indicates excessive inflammatory activation. However, the immune variation did not interfere with one-year mortality rate after surgical revascularization.

Patients with alopecia areata are at risk of endothelial dysfunction: results of a case-control study.

BACKGROUND: Alopecia areata (AA) is an autoimmune form of hair loss, which may affect any hair-bearing area. It has been suggested that AA is associated with an increased risk of metabolic and cardiovascular comorbidities. AIM: To evaluate the early predictors of cardiovascular disease [endothelial function (EF) and arterial stiffness (AS)] in patients with AA without prior cardiovascular disease, and compare with healthy controls (HCs). METHODS: In total, 52 patients with AA (38 women and 14 men; mean age 41 years, range 30-52 years) and 34 HCs, matched for age, sex and body mass index, were enrolled in the study. EF, expressed as reactive hyperaemia index (RHI), and AS, identified by augmentation index at 75 beats/min (AI@75) were assessed with the use of the Endo-PAT 2000 device. Endothelial dysfunction (ED) was defined as RHI value ≤1.67. RESULTS: ED was observed in 22 of 52 patients with AA (42%) and in 4 of 34 HCs (12%) (P < 0.01). Moreover, mean RHI was lower in patients with AA compared with HCs (1.90 ± 0.31 vs. 2.11 ± 0.45; P = 0.03). There was no significant difference in AI@75 between patients with AA and HCs. CONCLUSIONS: Patients with AA show abnormalities in early predictors of cardiovascular diseases. Regular cardiovascular screening might be appropriate for patients with AA.

How to Maintain Safety and Maximize the Efficacy of Cardiopulmonary Resuscitation in COVID-19 Patients: Insights from the Recent Guidelines.

Since December 2019, the novel coronavirus disease 2019 (COVID-19) caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) has remained a challenge for governments and healthcare systems all around the globe. SARS-CoV-2 infection is associated with increased rates of hospital admissions and significant mortality. The pandemic increased the rate of cardiac arrest and the need for cardiopulmonary resuscitation (CPR). COVID-19, with its pathophysiology and detrimental effects on healthcare, influenced the profile of patients suffering from cardiac arrest, as well as the conditions of performing CPR. To ensure both the safety of medical personnel and the CPR efficacy for patients, resuscitation societies have published modified guidelines addressing the specific reality of the COVID-19 pandemic. In this review, we briefly describe the transmission and pathophysiology of COVID-19, present the challenges of CPR in SARS-CoV-2-infected patients, summarize the current recommendations regarding the algorithms of basic life support (BLS), advanced life support (ALS) and pediatric life support, and discuss other aspects of CPR in COVID-19 patients, which potentially affect the risk-to-benefit ratio of medical procedures and therefore should be considered while formulating further recommendations.

Atherosclerosis Pathways are Activated in Pericoronary Adipose Tissue of Patients with Coronary Artery Disease.

PURPOSE: Perivascular release of inflammatory mediators may accelerate coronary lesion formation and contribute to plaque instability. Accordingly, we compared gene expression in pericoronary adipose tissue (PCAT) in patients with advanced coronary artery disease (CAD) and non-CAD controls. PATIENTS AND METHODS: PCAT samples were collected during coronary bypass grafting from CAD patients (n = 21) and controls undergoing valve replacement surgery, with CAD excluded by coronary angiography (n = 19). Gene expression was measured by GeneChip™ Human Transcriptome Array 2.0. Obtained list of 1348 transcripts (2.0%) that passed the filter criteria was further analyzed by Ingenuity Pathway Analysis software, identifying 735 unique differentially expressed genes (DEGs). RESULTS: Among the CAD patients, 416 (30.9%) transcripts were upregulated, and 932 (69.1%) were downregulated, compared to controls. The top upregulated genes were involved in inflammation and atherosclerosis (chemokines, interleukin-6, selectin E and low-density lipoprotein cholesterol (LDL-C) receptor), whereas the downregulated genes were involved in cardiac ischaemia and remodelling, platelet function and mitochondrial function (miR-3671, miR-4524a, multimerin, biglycan, tissue factor pathway inhibitor (TFPI), glucuronidases, miR-548, collagen type I, III, IV). Among the top upstream regulators, we identified molecules that have proinflammatory and atherosclerotic features (High Mobility Group Box 2 (HMGB2), platelet-derived growth platelet (PDGF) and evolutionarily conserved signaling intermediate in Toll pathways (ESCIT)). The activated pathway related to DEGs consisted of molecules with well-established role in the pathogenesis of atherosclerosis (TFPI, plasminogen activator, plasminogen activator, urokinase receptor (PLAUR), thrombomodulin). Moreover, we showed that 22 of the altered genes form a pro-atherogenic network. CONCLUSION: Altered gene expression in PCAT of CAD patients, with genes upregulation and activation of pathway involved in inflammation and atherosclerosis, may be involved in CAD development and progression.

Correlation between takotsubo cardiomyopathy and SARS-CoV-2 infection.

Takotsubo cardiomyopathy (TTS), known as stress cardiomyopathy, is a rare disorder characterized by acute and transient left ventricular systolic and diastolic dysfunction, often associated with a stressful, emotional or physical event. TTS may be closely related to SARS-CoV-2 infection and the ongoing pandemic. The enormous emotional stress caused by the pandemic and respiratory infections caused by SARS-CoV-2 could be potential triggers for TTS. The case series cited above implicates that TTS should be considered in the differential diagnosis across the entire spectrum of myocardial injury in SARS-CoV-2 infected patients. Myocardial damage associated with SARS-CoV-2 infection is usually attributed to sepsis, hypoxemia, coronary artery disease, and myocarditis. We hypothesize that TTS may also play a role among these lesions.

Comparative effectiveness of N95 respirators and surgical/face masks in preventing airborne infections in the era of SARS-CoV2 pandemic: A meta-analysis of randomized trials.

BACKGROUND: Recently, several randomized controlled trials (RCTs) have evaluated the effect of N95 respirators compared with medical masks to protect against acute respiratory infections. However, these studies are limited by modest sample sizes and inconclusive results. Therefore, the goal of the present study was to review the relevant and available published RCTs with the aid of the increased power of meta-analytic methods in order to assess the effectiveness of medical masks and N95 respirators in reducing the risk of respiratory infections. METHODS: This meta-analysis follows the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement for conducting and reporting results. We searched PubMed, Web of Science, Embase, and Cochrane databases from inception through April 1, 2020 to identify potentially relevant studies. Two authors (LS and JS) independently searched the titles and abstracts of the potentially eligible articles. They independently retrieved required data from the eligible trials; the data were initially tabulated for statistical analysis. Two authors (JRL and LS) independently assessed the methodological quality of the included RCTs using the Cochrane Collaboration's tool for assessing risk of bias. RESULTS: Six articles met the inclusion criteria. The pooled analysis showed that N95 respirators did not reduce the risk of infection with respiratory viruses compared with medical/surgical masks (5.7% vs. 7.9%; RR = 1.12; 95% CI: 0.88-1.41; p = 0.36); however, there was no statistically significant difference in laboratory-confirmed influenza between N95 and medical masks (RR = 0.91; 95% CI: 0.77-1.07; p = 0.26). Medical masks provided similar protection against other viruses, including coronavirus (RR = 0.74; 95% CI: 0.32-1.73; p = 0.49). Respiratory illness, as well as influenza-like illness were less frequently observed with N95 respirators. CONCLUSIONS: Our meta-analysis suggests that there are insufficient data to definitively determine whether N95 respirators are superior to medical masks in protection against transmissible acute respiratory infections. Further randomized trials are necessary to compare the above methods of respiratory protection in the context of COVID-19 incidence.

Targeted deep resequencing of ALOX5 and ALOX5AP in patients with diabetes and association of rare variants with leukotriene pathways.

The aim of the present study was to investigate a possible association between the accumulation of rare coding variants in the genes for arachidonate 5-lipoxygenase (ALOX5) and ALOX5-activating protein (ALOX5AP), and corresponding production of leukotrienes (LTs) in patients with type 2 diabetes mellitus (T2DM) receiving acetylsalicylic therapy. Twenty exons and corresponding introns of the selected genes were resequenced in 303 DNA samples from patients with T2DM using pooled polymerase chain reaction amplification and next-generation sequencing, using an Illumina HiSeq 2000 sequencing system. The observed non-synonymous variants were further confirmed by individual genotyping of DNA samples comprising of all individuals from the original discovery pools. The association between the investigated phenotypes was based on LTB4 and LTE4 concentrations, and the accumulation of rare missense variants (genetic burden) in investigated genes was evaluated using statistical collapsing tests. A total of 10 exonic variants were identified for each resequenced gene, including 5 missense and 5 synonymous variants. The rare missense variants did not exhibit statistically significant differences in the accumulation pattern between the patients with low and high LTs concentrations. As the present study only included patients with T2DM, it is unclear whether the absence of observed association between the accumulation of rare missense variants in investigated genes and LT production is associated with diabetic populations only or may also be applied to other populations.

Quality of life in patients with ST-segment elevation myocardial infarction undergoing percutaneous coronary intervention--radial versus femoral access (from the OCEAN RACE Trial).

Numerous studies have compared transradial (TR) versus transfemoral (TF) access for percutaneous coronary intervention (PCI) in patients with acute ST-segment elevation myocardial infarction. These studies have focused on clinical efficacy and safety; yet little is known about the effect of the vessel access on the health-related quality of life (HRQoL). In the present study, patients were randomly assigned to TR (n = 52) or TF (n = 51) access groups. Generic (EQ-5D-3L) and cardiac-specific (Quality of Life Index and MacNew) tools were used to assess HRQoL before PCI and 2 hours and 4 days after PCI. Baseline HRQoL was comparable in both groups and improved after PCI. The mean ± SD EQ-5D-3L health utility score 2 hours after PCI was 0.46 ± 0.291 and was higher in the TR group (TR: 0.60 ± 0.299 versus TF: 0.32 ± 0.283, p <0.001). Patients in the TR group reported fewer problems with mobility (TR: 71.7% vs TF: 94.4%, p <0.01) and self-care (TR: 62.5% vs TF: 97.2%, p <0.001). At day 4, fewer patients reported problems with anxiety and/or depression in the TR group than in the TF group (TR: 42.9% vs TF: 75.0%, p <0.001); no differences between groups in other measures were observed (Quality of Life Index and MacNew). The N-terminal of the prohormone brain natriuretic peptide levels were inversely correlated with EQ-5D-3L visual analog scale (r = -0.348, p <0.05) and EQ-5D-3L health utility score (r = -0.322, p <0.05). There was a correlation between in-hospital mortality and 2 MacNew domains: physical (r = -0.329, p <0.05) and emotional (r = -0.374, p <0.01). In conclusion, radial access should be the preferred approach in patients with ST-segment elevation myocardial infarction undergoing PCI when considering HRQoL. Radial access is associated with fewer problems with mobility and self-care and better psychological outcome after PCI.

[Sexual dysfunction in men in the first 9 months after myocardial infarction]. / Dysfunkcje seksualne u mezczyzn w ciagu pierwszych 9 miesiecy po przebytym zawale serca.

OBJECTIVES: The aim of the study is to assess the frequency of sexual dysfunction in men after myocardial infarction (MI). METHODS: 62 men were asked to fill IIEF 15 to assess sexual dysfunction 3 and 9 months after MI. RESULTS. Erectile dysfunction (ED), orgasmic dysfunction, decreased sexual desire, decreased intercourse satisfaction, decreased overall satisfaction were recognized respectively by: 61.3%, 24.2%, 62.9%, 71%, 54.8% of men 3 months after MI, and 51.6%, 17.7%, 58.1%, 77.4%, 59.7% of men 9 months after MI. Men with ED had higher serum CRP (5.8 vs. 3.8; p = 0.04) and creatinine (1 vs. 0.9; p = 0.04) levels in the peri-infarction period and higher serum BNP (47.4 vs. 24.6; p = 0.04) measured 3 months after MI than men without ED. They had also higher serum testosterone levels than men without ED (12.6 vs. 10.6; p = 0.03). Men with decreased sexual desire had significantly lower serum DHEAs (dehydroepiandrosterone sulfate) levels in the peri-infarction period than men with normal sexual desire (191.1 vs. 224.3; p = 0.044). Men with ED 9 months after MI had higher serum CRP levels in the peri-infarction period (7.5 vs. 4.6; p = 0.0371). Men with orgasmic dysfunction had lower left ventricular ejection fraction (EF) measured in the peri-infarction period (0.4 vs. 0.5; p = 0.0318). CONCLUSIONS: 1. Men with ED have higher serum CRP and creatinine levels in the peri-infarction period. 2. DHEAs level has an influence on sexual desire and on erectile function after MI. 3. BNP level in post-MI patients affects erectile function. 4. EF has an impact on orgasmic function.

Increased B-type natriuretic peptide levels in patients with apical ballooning syndrome - consecutive cases report.

We investigated B-type natriuretic peptide (BNP) levels in 10 consecutive patients (all women, mean age 60.4+/-7.8 years) with apical ballooning syndrome. Mean baseline plasma BNP level was 272.6+/-170.4 pg/ml and exceeded the normal range in 8 (80%) patients. When normal levels were adjusted for age and gender, all 10 patients had elevated BNP. Two patients with the highest BNP levels (630 and 423 pg/ml) presented with significant hemodynamic compromise. BNP levels correlated negatively with left ventricular ejection fraction. Increase in BNP levels in apical ballooning syndrome may support the neurohormonal etiology in these patients and requires further studies.