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1.
Cardiovasc Diabetol ; 20(1): 162, 2021 08 04.
Artigo em Inglês | MEDLINE | ID: mdl-34348706

RESUMO

In a cohort study performed using primary care databases in a General Practitioners Network, Groenewegen et al. report a clear association between diabetes and incidence of the major chronic progressive heart diseases, notably heart failure (Groenewegen et al. in Cardiovasc Diabetol 20:123, 2021). However, no mention is made of body mass index and hypertension in the methods or in the results. Obesity is linked to hypertension and hypertension is a major risk factor for all cardiovascular diseases, and prospective studies have shown that obesity and hypertension contribute significantly to atrial fibrillation in persons with diabetes. The data would be improved by assessing the role of obesity and of hypertension in the incidence of heart diseases in these patients. This would also lead to a better and personalized treatment of patients with diabetes, for instance through weight loss and intensification of treatment of hypertension, to modify the incidence of atrial fibrillation, ischaemic heart disease and heart failure.


Assuntos
Fibrilação Atrial , Diabetes Mellitus , Insuficiência Cardíaca , Hipertensão , Isquemia Miocárdica , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/epidemiologia , Estudos de Coortes , Diabetes Mellitus/diagnóstico , Diabetes Mellitus/epidemiologia , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/epidemiologia , Humanos , Hipertensão/diagnóstico , Hipertensão/epidemiologia , Incidência , Isquemia Miocárdica/diagnóstico , Isquemia Miocárdica/epidemiologia , Obesidade/diagnóstico , Obesidade/epidemiologia , Estudos Prospectivos , Fatores de Risco
2.
Vasc Health Risk Manag ; 17: 337-348, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34135591

RESUMO

ß-blockers are a heterogeneous class of drugs, with varying selectivity/specificity for ß1 vs ß2 receptors, intrinsic sympathomimetic activity (ISA), and vasodilatory properties (through ß2 stimulation, α receptor blockade or nitric oxide release). These drugs are indicated for the management of arterial hypertension, heart failure or ischemic heart disease (IHD; eg angina pectoris or prior myocardial infarction). Most of the benefit of ß-blockade in these conditions arises from blockade of the ß1 receptor, and, in practice, the addition of ISA appears to reduce the potential for improved clinical outcomes in people with heart failure or IHD. Aspects of the benefit/risk balance of ß-blockers remain controversial, and recent meta-analyses have shed new light on this issue. We have reviewed the current place of cardioselective ß-blockade in hypertension, IHD and heart failure, with special reference to the therapeutic profile of a highly selective ß1-adrenoceptor blocker, bisoprolol.


Assuntos
Antagonistas Adrenérgicos beta/uso terapêutico , Insuficiência Cardíaca/tratamento farmacológico , Hipertensão/tratamento farmacológico , Isquemia Miocárdica/tratamento farmacológico , Antagonistas de Receptores Adrenérgicos beta 1/uso terapêutico , Antagonistas Adrenérgicos beta/efeitos adversos , Bisoprolol/uso terapêutico , Tomada de Decisão Clínica , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/fisiopatologia , Humanos , Hipertensão/diagnóstico , Hipertensão/fisiopatologia , Isquemia Miocárdica/diagnóstico , Isquemia Miocárdica/fisiopatologia , Medição de Risco , Fatores de Risco , Resultado do Tratamento
3.
Medicine (Baltimore) ; 100(24): e26007, 2021 Jun 18.
Artigo em Inglês | MEDLINE | ID: mdl-34128843

RESUMO

ABSTRACT: To improve the correct diagnosis rate of coronary heart disease and to explore the guiding value of electrocardiogram (ECG) ST-T ischemic changes in the clinical diagnosis of coronary heart disease.A retrospective analysis was conducted on a total of 310 cases who underwent a conventional 12-lead ECG, 12-lead dynamic ECG (DECG, Holter) with ST-T ischemic changes, and then coronary angiography (CA) within 1 week in Qingdao Sttarr Heart Hospital from June 2015 to April 2020 in the study. Ischemic ST-T changes were evaluated using conventional diagnostic criteria, and Judkins diagnostic criteria were used in CA. The sensitivity and specificity of ECG were analyzed.The specificity of ST-T changes in conventional ECG for the diagnosis of coronary heart disease is 33.7% and the sensitivity is 66.0%. The specificity of ST-T changes in Holter in the diagnosis of coronary heart disease is 55.6% and the sensitivity is 32.2%. The sensitivity of conventional ECG for the diagnosis of coronary heart disease is better than Holter, but its specificity is inferior to Holter. The negative likelihood ratios of the 2 ECGs for the diagnosis of coronary heart disease were 1.0 and 1.22, both >0.1, and the positive likelihood ratios were 0.99 and 0.73, both <10. The positive results of ST-T in conventional ECG were 128 males (65.7%), 77 females (66.9%), (P < .05), 148 cases (74.7%) in the group ≥60 years old, and 75 cases in the group less than 60 years (67%), (P > .05). The positive results of ST-T change of DECG were 135 males (69.2%), 69 females (60.0%), (P < .05), 152 cases (78.7%) in the group ≥60 years, and 83 cases (70.9%) in the group less than 60 years, (P > .05). Coronary heart disease-related factors: symptoms, hypertension, diabetes, cancer, family history, smoking history as independent variables, and a binary multivariate logistic regression analysis was performed.The sensitivity of DECG in the diagnosis of myocardial ischemia in women and the elderly was slightly higher than that in men and young cases. ST-T ischemic changes in ECG are more significant for the diagnosis of coronary heart disease in male patients. Smoking, hypertension, diabetes, and family history are all high-risk factors for coronary heart disease.


Assuntos
Angiografia Coronária/estatística & dados numéricos , Doença das Coronárias/diagnóstico , Eletrocardiografia/estatística & dados numéricos , Isquemia Miocárdica/diagnóstico , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Sensibilidade e Especificidade
4.
Medicine (Baltimore) ; 100(26): e26498, 2021 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-34190179

RESUMO

ABSTRACT: There was a controversy for the electrocardiogram (ECG) changes and their relationship with disease severity in old patients with acute cerebral ischemic stroke (CIS). This study was aim to provide referential data for this topic.Totally 200 old patients with acute CIS in our hospital from January 2017 to December 2019 were included into this study. According to the ST-T segment changes in ECG, these patients were divided into 3 groups: persistent ischemic group (n = 38), transient ischemic group (n = 106) and non-ischemic group (n = 56). The characteristics and incidence of abnormal ECG and their relationship with disease severity, infarct size and prognosis were respectively analyzed under the severe, moderate and mild type of disease.The ECG changes of patients were mainly characterized by myocardial ischemic ST-T segment changes with a abnormal ECG incidence of 72.00%, the arrhythmia with a abnormal ECG incidence of 9.50%, which were the second most common in clinical features. There were statistically significant differences of myocardial ischemic ST-T segment changes among different disease severity, infarct size and prognosis of acute CIS patients (P < .05). The ischemic ST-T segment changes of ECG reflected that the disease severity, and more ECG abnormalities indicated more severe pathological conditions in CIS patients.The characteristics of ischemic ST-T segment changes have important reference value in the evaluation of severity and prognosis of acute CIS in old patients.


Assuntos
Encéfalo , Eletrocardiografia , AVC Isquêmico , Isquemia Miocárdica , Acidente Vascular Cerebral , Idoso , Encéfalo/irrigação sanguínea , Encéfalo/diagnóstico por imagem , Encéfalo/patologia , Bloqueio de Ramo/diagnóstico , Bloqueio de Ramo/etiologia , China/epidemiologia , Correlação de Dados , Eletrocardiografia/métodos , Eletrocardiografia/estatística & dados numéricos , Feminino , Humanos , AVC Isquêmico/diagnóstico , AVC Isquêmico/epidemiologia , AVC Isquêmico/fisiopatologia , Síndrome do QT Longo/diagnóstico , Síndrome do QT Longo/etiologia , Masculino , Isquemia Miocárdica/diagnóstico , Isquemia Miocárdica/epidemiologia , Isquemia Miocárdica/fisiopatologia , Prognóstico , Índice de Gravidade de Doença , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/fisiopatologia
6.
BMC Geriatr ; 21(1): 357, 2021 06 10.
Artigo em Inglês | MEDLINE | ID: mdl-34112104

RESUMO

BACKGROUND: Frailty is increasingly reported among older adults with cardiovascular diseases and it has been demonstrated to increase negative health outcomes and mortality. To date, no systematic review of the evidence is available regarding the association between frailty and ischemic heart disease (IHD). We performed a systematic review of literature and a meta-analysis to assess the association between frailty and IHD. METHODS: We selected all the studies that provided information on the association between frailty and IHD, regardless of the study setting, study design, or definition of IHD and frailty. PubMed, Web of Science and Embase were searched for relevant papers. Studies that adopted the Fried definition for frailty were included in the meta-analyses. For each measure of interest (proportions and estimates of associations), a meta-analysis was performed if at least three studies used the same definition of frailty. Pooled estimates were obtained through random effect models and Mantel-Haenszel weighting. RESULTS: Thirty-seven studies were included. Of these, 22 adopted the Fried criteria to define frailty and provided estimates of prevalence and therefore they were included in meta-analyses. The pooled prevalence of IHD in frail individuals was 17% (95% Confidence Interval [95%CI] 11-23%) and the pooled prevalence of frailty in individuals with IHD was 19% (95% CI 15-24%). The prevalence of frailty among IHD patients ranged from 4 to 61%. Insufficient data were found to assess longitudinal association between frailty and IHD. CONCLUSIONS: Frailty is quite common in older persons with IHD. The identification of frailty among older adults with IHD should be considered relevant to provide individualized strategies of cardiovascular prevention and care. Further research should specifically explore the association between frailty and IHD and investigate the potential common biological ground.


Assuntos
Fragilidade , Isquemia Miocárdica , Idoso , Idoso de 80 Anos ou mais , Idoso Fragilizado , Fragilidade/diagnóstico , Fragilidade/epidemiologia , Humanos , Isquemia Miocárdica/diagnóstico , Isquemia Miocárdica/epidemiologia , Prevalência
7.
Angiol Sosud Khir ; 27(2): 114-120, 2021.
Artigo em Russo | MEDLINE | ID: mdl-34166351

RESUMO

Annually, up to 850 000 coronary aortic bypass graft operations are performed worldwide. Despite modern technical equipment ensuring a high level of safety of the procedure, currently important remains a problem related to intraoperative myocardial damage in using artificial circulation. Early detection and clinical assessment of myocardial ischaemia often present a difficult task. This article deals with clinical, instrumental and laboratory methods of diagnosis, aimed at verification of an intraoperative cardiac lesion associated with graft dysfunction in coronary artery bypass grafting. Isolated electrocardiographic and echocardiographic signs of myocardial ischaemia between the comparison groups did not differ significantly. Analysing the markers of myocardial lesions, statistically significant differences were obtained only after 48 hours which, from the point of view of saving viable myocardium, is an utterly long-term interval. Studying the findings of intraoperative flowmetry showed statistically significant dependence between velocity characteristics, pulse index of shunts and their patency on angiographic examination. Thus, only combination of diagnostic parameters makes it possible to detect myocardial damage related to shunt dysfunction. This enables early determination of indications for performing bypass angiography and selection of the required therapeutic policy. Timely coronary artery angiography makes it possible to reveal defects of shunts and to timely perform surgical correction, preventing myocardial infarction.


Assuntos
Infarto do Miocárdio , Isquemia Miocárdica , Angiografia Coronária , Ponte de Artéria Coronária/efeitos adversos , Humanos , Isquemia Miocárdica/diagnóstico , Isquemia Miocárdica/etiologia , Reologia
8.
J Interv Cardiol ; 2021: 5522707, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34007248

RESUMO

Background: The resting full-cycle ratio (RFR) is a novel resting index which in contrast to the gold standard (fractional flow reserve (FFR)) does not require maximum hyperemia induction. The objectives of this study were to evaluate the agreement between RFR and FFR with the currently recommended thresholds and to design a hybrid RFR-FFR ischemia detection strategy, allowing a reduction of coronary vasodilator use. Materials and Methods: Patients subjected to invasive physiological study in 9 Spanish centers were prospectively recruited between April 2019 and March 2020. Sensitivity and specificity studies were made to assess diagnostic accuracy between the recommended levels of RFR ≤0.89 and FFR ≤0.80 (primary objective) and to determine the RFR "grey zone" in order to define a hybrid strategy with FFR affording 95% global agreement compared with FFR alone (secondary objective). Results: A total of 380 lesions were evaluated in 311 patients. Significant correlation was observed (R 2 = 0.81; P < 0.001) between the two techniques, with 79% agreement between RFR ≤ 0.89 and FFR ≤ 0.80 (positive predictive value, 68%, and negative predictive value, 80%). The hybrid RFR-FFR strategy, administering only adenosine in the "grey zone" (RFR: 0.86 to 0.92), exhibited an agreement of over 95% with FFR, with high predictive values (positive predictive value, 91%, and negative predictive value, 92%), reducing the need for vasodilators by 58%. Conclusions: Dichotomous agreement between RFR and FFR with the recommended thresholds is significant but limited. The adoption of a hybrid RFR-FFR strategy affords very high agreement, with minimization of vasodilator use.


Assuntos
Adenosina/farmacologia , Angiografia Coronária/métodos , Estenose Coronária , Reserva Fracionada de Fluxo Miocárdico/fisiologia , Hiperemia , Isquemia Miocárdica , Idoso , Circulação Coronária/efeitos dos fármacos , Estenose Coronária/diagnóstico , Estenose Coronária/epidemiologia , Estenose Coronária/fisiopatologia , Correlação de Dados , Relação Dose-Resposta a Droga , Feminino , Humanos , Hiperemia/induzido quimicamente , Hiperemia/fisiopatologia , Masculino , Isquemia Miocárdica/diagnóstico , Isquemia Miocárdica/etiologia , Isquemia Miocárdica/fisiopatologia , Valor Preditivo dos Testes , Sensibilidade e Especificidade , Índice de Gravidade de Doença , Espanha/epidemiologia , Vasodilatadores/farmacologia
9.
Pan Afr Med J ; 38: 173, 2021.
Artigo em Francês | MEDLINE | ID: mdl-33995780

RESUMO

Introduction: cardiovascular complications have become the 3th cause of death and the 4th reason for hospitalization in HIV-infected patients. The purpose of this study was to determine the frequency of asymptomatic myocardial ischemia in HIV-infected patients on antiretroviral therapy. Methods: we conducted a descriptive cross-sectional study in November 2015. Asymptomatic HIV-1-infected patients on ARV treatment and followed up in the Day Hospital Unit of the Department of Infectious Diseases of the University Hospital Sanon Sourou of Bobo-Dioulasso were included in the study. Among enrolled patients data on cardiovascular risk factors were collected as well as two sitting blood pressure measurements after 10 minutes of rest were taken during consultations and resting 12-lead electrocardiogram (ECG) was performed. Results: a total of 123 HIV-1-infected patients with a median age of 42 years (IQR: 36-50), among whom 79% were female subjects, were included in the study. Cardiovascular risk factors included: PAH (31.7%), obesity (33%), dyslipidemia (10.57%), active smoking (0.8%) and diabetes (0.8%). All patients with hypertension (5.7%) were insufficiently treated. The median duration of ARV treatment was 5.3 years (IQR: 3-7.7). Repolarization disorders were found in 26 cases (21.13%). They were divided into subepicardial ischaemia in 20 cases (16.26%), subendocardial damage in 2 cases (1.63%) and sequelae of necrosis in 4 cases (3.25%). Left ventricular hypertrophy (LVH) was found in 12 cases (9.76%) and, in particular, in hypertensive patients. Prolonged QTc interval was found in 7 patients (5.69%) regardless of the ARV drugs given. Conclusion: this study of HIV-1-infected patients highlights that asymptomatic myocardial ischemia is common. Screening programmes should be improved through more effective ischemia tests in order to better determine its severity in this sub-population with increased cardiovascular risk.


Assuntos
Infecções por HIV/complicações , Programas de Rastreamento , Isquemia Miocárdica/epidemiologia , Adulto , Fármacos Anti-HIV/administração & dosagem , Burkina Faso/epidemiologia , Estudos Transversais , Eletrocardiografia , Feminino , Infecções por HIV/tratamento farmacológico , Fatores de Risco de Doenças Cardíacas , Hospitais Universitários , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Isquemia Miocárdica/diagnóstico
10.
Internist (Berl) ; 62(6): 665-671, 2021 Jun.
Artigo em Alemão | MEDLINE | ID: mdl-34041581

RESUMO

BACKGROUND: The electrocardiogram (ECG) represents an essential diagnostic tool in cardiology and beyond. Classical ECG devices enable the registration of up to 12 leads, whereas modern ECG systems enable additional leads even with a reduced number of electrodes. Additionally, "smart" devices even enable patients to record an ECG at home. OBJECTIVE: Evaluation of a potential additional benefit of using various modern ECG systems for the detection of ECG alterations typical for myocardial ischemia. MATERIAL AND METHODS: Presentation of various signs of ischemia in the ECG according to the latest guidelines. Demonstration of modern ECG systems and their potential advantage in the detection of signs of ischemia in the ECG based on current study results. RESULTS: Modern ECG systems with vector-based electrocardiography can facilitate and optimize the detection of ischemic ECG alterations. Smart nonvector-based devices for patients are primarily useful for detection of arrhythmias and do not replace the 12-lead ECG for detection of ischemia, even though they can be useful for documentation of temporary ECG alterations also within the ST-segment. CONCLUSION: The ECG systems based on vector electrocardiography can improve the detection of ECG alterations typical for ischemia compared to the conventional 12-lead ECG.


Assuntos
Doença da Artéria Coronariana , Isquemia Miocárdica , Arritmias Cardíacas , Eletrocardiografia , Humanos , Isquemia Miocárdica/diagnóstico
11.
Kardiologiia ; 61(3): 71-76, 2021 Mar 30.
Artigo em Russo, Inglês | MEDLINE | ID: mdl-33849422

RESUMO

Aim    To develop a new, modified protocol for transesophageal atrial electric stimulation (TEAES), which would significantly enhance the diagnostic value of stress echocardiography and reduce the duration of the test in patients with ischemic heart disease (IHD).Material and methods    This study included 101 patients (80 men and 21 women aged 55±9 years) with suspected or documented diagnosis of IHD who were divided into two homogenous groups. Group 1 (51 patients) underwent stress echocardiography (stress-EchoCG) according to a standard protocol (SP) for TEAES and group 2 (50 patients), underwent stress-EchoCG according to a modified protocol (MP). In addition to stress-EchoCG with TEAES, selective coronary angiography was performed for all patients. The development of the new method for evaluating occult coronary insufficiency was based on comparison of SP and MP for TEAES with stress-EchoCG with data of coronary angiography.Results    In both groups, significant differences in values of systolic and diastolic blood pressure were absent. However, the values of achieved heart rate were significantly different: 141±11 (TEAES SP) and 155±10 (TEAES MP) bpm (p=0.01). There was also a difference in the duration of the TEAES protocols: 15±3 and 5±2 min, respectively (p=0.006). The use of the modified TEAES protocol for detecting transient disorders of left ventricular myocardial local contractility increased the sensitivity, specificity and accuracy of the test from 76 %, 87 %, and 80 % to 83 %, 92 %, and 86 %, respectively. The most significant differences were found in the area supplied by the circumflex artery: the SP and MP sensitivities were 63 % and 75 %, respectively (p<0.05) and the SP and MP accuracies were 81 % and 90 %, respectively (p<0.05).Conclusion    Evaluation of occult coronary insufficiency by stress-EchoCG with the TEAES MP as compared to the TEAES SP provides a gentler procedure regimen for the patient due to a shorter duration of the test and at the same time improves the diagnostic significance of this method in IHD patients.


Assuntos
Doença das Coronárias , Isquemia Miocárdica , Angiografia Coronária , Ecocardiografia sob Estresse , Teste de Esforço , Feminino , Átrios do Coração , Humanos , Masculino , Pessoa de Meia-Idade , Isquemia Miocárdica/diagnóstico , Sensibilidade e Especificidade
12.
Sensors (Basel) ; 21(7)2021 Mar 26.
Artigo em Inglês | MEDLINE | ID: mdl-33810211

RESUMO

Cardiovascular Disease (CVD) is a primary cause of heart problems such as angina and myocardial ischemia. The detection of the stage of CVD is vital for the prevention of medical complications related to the heart, as they can lead to heart muscle death (known as myocardial infarction). The electrocardiogram (ECG) reflects these cardiac condition changes as electrical signals. However, an accurate interpretation of these waveforms still calls for the expertise of an experienced cardiologist. Several algorithms have been developed to overcome issues in this area. In this study, a new scheme for myocardial ischemia detection with multi-lead long-interval ECG is proposed. This scheme involves an observation of the changes in ischemic-related ECG components (ST segment and PR segment) by way of the Choi-Williams time-frequency distribution to extract ST and PR features. These extracted features are mapped to a multi-class SVM classifier for training in the detection of unknown conditions to determine if they are normal or ischemic. The use of multi-lead ECG for classification and 1 min intervals instead of beats or frames contributes to improved detection performance. The classification process uses the data of 92 normal and 266 patients from four different databases. The proposed scheme delivered an overall result with 99.09% accuracy, 99.49% sensitivity, and 98.44% specificity. The high degree of classification accuracy for the different and unknown data sources used in this study reflects the flexibility, validity, and reliability of this proposed scheme. Additionally, this scheme can assist cardiologists in detecting signal abnormality with robustness and precision, and can even be used for home screening systems to provide rapid evaluation in emergency cases.


Assuntos
Isquemia Miocárdica , Máquina de Vetores de Suporte , Algoritmos , Eletrocardiografia , Humanos , Isquemia Miocárdica/diagnóstico , Reprodutibilidade dos Testes
13.
Mayo Clin Proc ; 96(4): 1058-1070, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33814074

RESUMO

Sex matters in science. This particularly applies to ischemic heart disease, which displays key differences in pathophysiology, presentation, and effectiveness in diagnostic strategies and management between women and men. However, underrepresentation of women in randomized trials has led to an evidence gap in clinical practice. Nevertheless, it has become clear that women present with a higher burden of symptoms and comorbidities, experience worse outcomes, but are less likely to have flow-limiting stenosis in epicardial coronary arteries than men. A major contributor to this paradox is coronary microvascular disease, a heterogeneous disorder with multifactorial etiology that predominantly affects women. There is a significant interplay between coronary microvascular disease, obstructive coronary artery disease, and the cardiovascular risk associated with it, with impaired vasomotor function often preceding the development of advanced atheroma. This novel concept has recently been referred to as chronic coronary syndromes, which better meets the female phenotype of ischemic heart disease, questioning current management recommendations that still largely apply to flow-limiting stenoses in epicardial coronary arteries typically found in men. The goal of this review is to highlight the most recent scientific advances in understanding chronic coronary syndromes in women. It provides practical advice with focus on challenges in diagnosis and management, and discusses perspectives towards the implementation of sex-specific, safer, and more effective therapeutic strategies.


Assuntos
Doença Crônica/terapia , Isquemia Miocárdica/diagnóstico , Isquemia Miocárdica/fisiopatologia , Isquemia Miocárdica/terapia , Índice de Gravidade de Doença , Fatores Sexuais , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Isquemia Miocárdica/epidemiologia , Fatores de Risco , Estados Unidos/epidemiologia
14.
J Stroke Cerebrovasc Dis ; 30(7): 105786, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-33865231

RESUMO

OBJECTIVES: Non-emergency percutaneous coronary intervention (PCI) has lower risk of stroke than emergency PCI. With increasing elective PCI and increasing risk of stroke after PCI, risk factors for stroke or transient ischaemic attack (TIA) in non-emergency PCI and long-term outcomes needs to be better characterised. We aim to identify risk factors for cerebrovascular accidents in patients undergoing non-emergency PCI and long-term outcomes after stroke or TIA. MATERIALS AND METHODS: A retrospective cohort study was performed on 1724 consecutive patients who underwent non-emergency PCI for non-ST-segment elevation myocardial infarction (NSTEMI), unstable and stable angina. The primary outcomes measured were stroke or TIA, myocardial infarction (MI) and all-cause death. RESULTS: Upon mean follow-up of 3.71 (SD 0.97) years, 70 (4.1%) had subsequent ischaemic stroke or TIA, and they were more likely to present with NSTEMI (50 [71.4%] vs 892 [54.0%], OR 2.13 [1.26-3.62], p = 0.004) and not stable angina (19 [27.1%] vs 648 [39.2%], OR 0.58 [0.34-0.99]). Femoral access was associated with subsequent stroke or TIA compared to radial access (OR 2.10 [1.30-3.39], p < 0.002). Previous stroke/TIA was associated with subsequent stroke/TIA (p < 0.001), death (p < 0.001) and MI (p = 0.002). Furthermore, subsequent stroke/TIA was significantly associated with subsequent MI (p = 0.006), congestive cardiac failure (CCF) (p = 0.008) and death (p < 0.001). CONCLUSIONS: In patients undergoing non-emergency PCI, previous stroke/TIA predicted post-PCI ischaemic stroke/TIA, which was associated with death, MI, CCF.


Assuntos
Ataque Isquêmico Transitório/etiologia , Isquemia Miocárdica/terapia , Intervenção Coronária Percutânea/efeitos adversos , Acidente Vascular Cerebral/etiologia , Idoso , Feminino , Insuficiência Cardíaca/etiologia , Humanos , Ataque Isquêmico Transitório/diagnóstico , Ataque Isquêmico Transitório/mortalidade , Masculino , Pessoa de Meia-Idade , Isquemia Miocárdica/diagnóstico , Isquemia Miocárdica/mortalidade , Intervenção Coronária Percutânea/mortalidade , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/mortalidade , Fatores de Tempo , Resultado do Tratamento
17.
Ann Agric Environ Med ; 28(1): 107-113, 2021 Mar 18.
Artigo em Inglês | MEDLINE | ID: mdl-33775075

RESUMO

INTRODUCTION: Risk factors for ischemic heart disease (IHD) are very numerous and not fully defined. In addition to classic risk factors, different factors are also distinguished, among them psychological aspects chich have rarely been subject to detailed analyses. OBJECTIVE: The aim of study was an analysis of the anxiety structure, including the five factors of personality: neuroticism (NEU), extraversion (EXT), openness (OPE), agreeableness (AGR) and conscientiousness (CON), in women with IHD. MATERIAL AND METHODS: The study involved 140 women aged 37-74 years with IHD confirmed by coronary angiography. Psychological examination was conducted using R.B. Cattell's IPAT Anxiety Scale and P.T. Costa and R.R. McCrae's NEO-FFI Personality Inventory. RESULTS: The results obtained from the IPAT Anxiety Scale showed that the study group of 140 women with IHD had the correct level of internal integrity (Q3- ). The dominant factor in the anxiety structure in 88.7% of subjects was neurotic tension (Q4+). A lack of sense of safety was indicated by 72.6% of subjects (L+), 69.3% experienced a strong tendency to self-blame and experience a sense of guilt (O + ), and over 51.6% of women with IHD expressed decreased emotional stability (C - ). The level of general anxiety was high (GA=7.3). The analysis of the five factors of personality revealed that the dominant factors in the structure of personality of women with IHD were CON in 69.3%, AGR in 46.7% and EXT in 45.2%. NEU and OPE were moderately significant factors. CONCLUSIONS: Women with IHD are characterised by a high level of anxiety, increased neurotic tension, decreased emotional stability, auto-aggression and a sense of danger and distrust. Women with IHD demonstrate a high level of factors, such as extraversion, agreeableness and conscientiousness.


Assuntos
Isquemia Miocárdica/psicologia , Personalidade , Adulto , Idoso , Agressão , Ansiedade , Angiografia Coronária , Emoções , Feminino , Humanos , Pessoa de Meia-Idade , Isquemia Miocárdica/diagnóstico , Isquemia Miocárdica/diagnóstico por imagem , Inventário de Personalidade , Fatores de Risco , Confiança
18.
Front Public Health ; 9: 634778, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33748069

RESUMO

Cardiovascular diseases, including ischemic heart disease, are the most common causes of morbidity and death in the world, including Serbia, as a middle-income European country. The aim of the study was to determine the costs of preventive examinations for ischemic heart disease in active-duty military personnel, as well as to assess whether this was justified from the point of view of the limited health resources allocated for the treatment of the Republic of Serbia population. This is a retrospective cost-preventive study which included 738 male active-duty military personnel, aged from 23 to 58. The costs of primary prevention of ischemic heart disease in this population were investigated. Out of 738 subjects examined, arterial hypertension was detected in 101 subjects (in 74 of them, arterial hypertension was registered for the first time, while 27 subjects were already subjected to pharmacotherapy for arterial hypertension). Average costs of all services during the periodic-health-examination screening program were €76.96 per subject. However, average costs of all services during the periodic-health-examination screening program for patients with newfound arterial hypertension and poorly regulated arterial hypertension were €767.54 per patient and €2,103.63 per patient, respectively. Since periodic-health-examination screening program in military personnel enabled not only discovery of patient with newfound arterial hypertension but also regular monitoring of those who are already on antihypertensive therapy, significant savings of €690.58 per patient and €2,026.67 per patient can be achieved, respectively. As financial resources for providing health care in Serbia, as a middle-income country, are limited, further efforts should be put on screening programs for ischemic heart disease due to possible significant savings.


Assuntos
Militares , Isquemia Miocárdica , Idoso , Custos e Análise de Custo , Humanos , Masculino , Isquemia Miocárdica/diagnóstico , Estudos Retrospectivos , Sérvia
19.
BMC Cardiovasc Disord ; 21(1): 65, 2021 02 02.
Artigo em Inglês | MEDLINE | ID: mdl-33530933

RESUMO

BACKGROUND: Ischaemic heart disease (IHD) often develops after decades of preceding subclinical coronary atherosclerosis. Biomarkers are useful prognostic predictors of IHD, but their long-term predictive value in a general population has not been adequately studied. PURPOSE: To investigate the early predictive value of multi-modality biomarkers in addition to clinical risk factors in incident IHD in a random male general population sample followed from 50 to 71 years of age. METHOD: "The Study of Men Born in 1943" is a longitudinal cohort study during follow-up. All the men underwent a baseline examination in 1993, where a panel of biomarkers were analysed and incident IHD was registered during 21-year follow-ups. RESULTS: Of 739 participants, 97 men (13.1%) developed an IHD event. For time to first occurrence of IHD, univariable analyses showed that elevated levels of high sensitivity troponin T (hs-TNT), high sensitivity-C reactive protein (hs-CRP) and interleukin-6 (IL-6) were significant predictors of IHD. In addition, a high number of biomarkers with elevated levels (hs-TNT > 10 ng/L, hs-CRP > 1 mg/L, IL-6 > 8 ng/L and N-terminal pro b-type natriuretic peptide (NT-proBNP) > 100 pg/mL) increased predictive ability. In univariable and multivariable analysis high-density lipoprotein-cholesterol (HDL-C) had the highest predictive ability. Hs-TNT provided better predictive ability than smoking, body mass index and glucose, and was an independent significant predictor when adjusted for HDL-C, total cholesterol and hypertension. Addition of biomarkers on top of clinical risk factors provided significantly better prediction as tested by likelihood ratio test (p = 0.033), but did not significantly enhance the model's discriminative ability However, it appeared contributing to higher sensitivity in the late phase of follow-up. CONCLUSION: In this random, middle-aged male population sample, the addition of biomarker hs-TNT was an independent significant predictor of IHD and significantly improved prediction, indicating the probability of a better prediction of long-term risk of IHD in a low-risk population. TRIAL REGISTRATION: The study is registered at Clinical Trials.gov Identifier number: NCT03138122.


Assuntos
HDL-Colesterol/sangue , Isquemia Miocárdica/sangue , Troponina T/sangue , Fatores Etários , Idoso , Biomarcadores/sangue , Proteína C-Reativa/metabolismo , Diagnóstico Precoce , Seguimentos , Humanos , Incidência , Interleucina-6/sangue , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Isquemia Miocárdica/diagnóstico , Isquemia Miocárdica/epidemiologia , Peptídeo Natriurético Encefálico/sangue , Fragmentos de Peptídeos/sangue , Valor Preditivo dos Testes , Prognóstico , Medição de Risco , Fatores de Risco , Fatores Sexuais , Suécia/epidemiologia , Fatores de Tempo
20.
Eur J Clin Invest ; 51(4): e13509, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33548060

RESUMO

BACKGROUND: No data are available about whether Coronavirus disease 2019 (COVID-19) pandemic have led to changes in clinical profiles or results of exercise testing once the usual activity was reassumed, as well as if wearing a facemask has any impact on the tests. The aim of this study is to evaluate differences in the patients referred to exercise stress testing in the context of COVID-19 pandemic and analyse the feasibility and results of these tests wearing a facemask. METHODS: We included all patients referred for an exercise test from 1 June to 30 September 2020 and compared them with the patients attended within the same period in 2019 before and after propensity score matching. All patients referred in 2020 wore a facemask. RESULTS: A total of 854 patients were included: 398 in the 2020 group and 456 in 2019. No significant differences in baseline characteristics of the patients were observed, with the exception of dyspnoea, which was nearly twice as high in 2020 as compared with 2019. Regarding the results of the tests, no differences were observed, with almost 80% of maximal tests, similar functional capacity and over a 20% of positive exercise tests in both groups. These results remained after propensity score matching. CONCLUSION: COVID-19 pandemic has not changed the clinical profile of patients referred to exercise testing. In addition, performing exercise testing wearing a facemask is feasible, with no influence in functional capacity and clinical results.


Assuntos
COVID-19/prevenção & controle , Ecocardiografia sob Estresse/métodos , Eletrocardiografia , Teste de Esforço/métodos , Máscaras , Isquemia Miocárdica/diagnóstico , Idoso , Tolerância ao Exercício , Feminino , Humanos , Masculino , Equivalente Metabólico , Pessoa de Meia-Idade , Isquemia Miocárdica/fisiopatologia , Desempenho Físico Funcional , Pontuação de Propensão , Encaminhamento e Consulta , SARS-CoV-2 , Espanha
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