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1

Coronary artery atherosclerosis in patients with the initial and the early stage of chronic renal failure

100%

Bartnicki P. , Stolarek R. , Rysz J.

Open Medicine

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2009

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tom 4

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nr 1

32-36

EN

The recent clinical data indicate that the initial and the early stages of chronic renal failure (CRF) may lead to increased incidence of cardiovascular complications and increased extent of coronary artery disease (CAD). This retrospective study was aimed to determine the effects of coexisting diabetes mellitus type 2 (DM-2) and the extent of atherosclerosis in coronary vessels in patients with mildly reduced kidney function (glomerular filtration rate GFR = 89–60 ml/min) and moderately reduced kidney function (GFR = 59–30 ml/min). The study patients included 53 subjects with creatinine concentration above 120 μmol/l as a cut-off level for the initial stage and compensated CRF. The distributions of coronary artery stenosis were also analysed with respect to DM-2 coexistence and levels of haemoglobin glikolised (HbA1c). The odds ratio of pathological changes in coronary arteries in patients with GFR = 44–30 ml/min, with respect to the number of affected vessels - only one, more than one or more than two - were 7.22, 4.90 and 3.55, respectively. In CRF patients with GFR = 60–89 ml/min the odds ratio of one, more than one and more than two vessels with stenosis and CAD was 1.93, 1.70 and 1.53, respectively. DM-2 was not related to the risk of significant coronary artery stenosis and did not enhance the pre-existing changes in the study setting. Our results demonstrate that the initial and the early stages of CRF were significant risk factors for coronary stenoses and for enhancing the pre-existing changes.

2

SAECG in exercise test for prediction of diabetic coronary artery disease

80%

Bigi M. , Aslani A. , Aslani A.

Open Medicine

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2010

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tom 5

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nr 3

298-302

EN

Signal averaged electrocardiogram (SAECG) is considered an important noninvasive indicator identifying patients at risk for ventricular arrhythmias. The aim of this study was to improve noninvasive prediction of CAD by integrating SAECG with the result of exercise tests in diabetic patients. Diabetic patients with stable angina pectoris underwent exercise testing and SAECG. Then a diagnostic score was derived that combined results of exercise testing and SAECG. A diagnostic score (0 to 2 points) was calculated by assigning 1 point for a positive exercise test result and 1 point for a positive SAECG. One hundred and seventy patients were included in the study. In patients with a score of 0, the likelihood of CAD is 18% whereas the likelihood of CAD is 95% in patients with a score of 2. Triple vessel CAD is present in 54%, 7% and only 1.5% of patients with score 2, 1 and 0 respectively. Therefore, patients with score 2 have a poor prognosis compared with score 1 or 0. A diagnostic score combining exercise testing and SAECG can distinguish patients with CAD from those without CAD with high accuracy in diabetic patients.

3

Epicardial adipose tissue and relationship with coronary artery disease

80%

Silaghi A. , Pais R. , Valea A. , Mironiuc A. , Silaghi H.

Open Medicine

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2011

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tom 6

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nr 3

251-262

EN

Epicardial adipose tissue (EAT) is metabolically active tissue that accumulates around the coronary arteries. Epicardial fat is a rich source of free fatty acids and may contribute to local inflammatory load by increased synthesis of inflammatory cytokines. Direct passage of bioactive molecules into the coronary arteries due to close contact with the vascular wall and the lack of fascia may contribute to the pathogenesis of coronary artery disease. Direct correlation between visceral fat and EAT defines the latter as an indirect marker of intra-abdominal visceral adiposity. EAT is related to anthropometric and clinical features of the metabolic syndrome (MS) and to hepatic transaminases as markers of steatohepatitis. An increase in EAT thickness is related to an increase in left ventricular mass and is correlated with atrial enlargement and impairment in diastolic filling in obesity. Echocardiographic study of EAT is an easy and reliable imaging indicator of visceral adiposity and cardiovascular risk. EAT is an independent factor strongly correlated with significant coronary stenosis. A level of EAT above an established average value can be considered a predictive marker of cardiovascular risk. We review the most recent studies proving the specific active role of EAT in the development of cardiac disease.

4

Association of the thickness of carotid intima-media complex and ancle brachial index with coronary disease severity

80%

Kostić S. , Tasić I. , Mijalković D. , Lović D. , Djordjević D. , Savić T. , Tasić N. , Aranđelović A.

Open Medicine

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2014

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tom 9

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nr 5

601-608

5

Impact of depression on sexual dysfunction and HRQoL in CAD patients

80%

Tasic I. , Lazarevic G. , Kostic S. , Djordjevic D. , Simonovic D. , Rihter M. , Vulic D. , Stefanovic V.

Open Medicine

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2014

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tom 9

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nr 1

54-63

6

Association between periodontal disease and coronary artery disease

80%

Zibaeenezhad M.

Open Medicine

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2008

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tom 3

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nr 3

308-314

EN

The etiology of coronary artery disease (CAD) is multifunctional. There is increasing evidence that dental infections could play a role in the initiation and development of CAD. In a case control double blind study, one hundred male and female (mean age 51 ± 9.4) angiographically documented CAD, compared with one hundred male and female patients (mean age 50.6 ± 9) with angiographically negative coronary artery. All the patients (cases and control) underwent dental examination for the presence and severity of periodontitis by a dentist who was oblivious the result of the angiography performed. The association between periodontal disease status and CAD was significant (P=0.011); periodontitis was apparently more frequent in CAD positive patients than in control (86% versus 61%). Adjustment of coronary risk factors (smoking, DM, hypertension and hyperlipidemia) in both cases and control groups suggests that the association between periodontitis and CAD in our study was independent of coronary risk factors. There is increasing evidence that dental infection, especially aerobic organisms which have capability of aggregation of platelets, is the most important cause. Dental infection would be an independent risk factor for CAD.

7

Association between Helicobacter. pylori and coronary artery disease

80%

Davoudi S. , Omran A. , Boroumand M. , Rahimian N. , Saadat S.

Open Medicine

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2011

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tom 6

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nr 1

107-112

EN

The high prevalence of both Helicobacter.pylori infection and coronary atherosclerosis in our country prompted us to assess the probable association between both conditions. This cross-sectional study recruited 153 patients scheduled to undergo coronary artery angiography. Patients were divided into two groups on the basis of coronary angiography results. Sixty-nine patients had coronary atherosclerosis and the 84 remaining patients were normal. Characteristics and pre-angiographic serum levels of triglyceride, low-density lipoprotein cholesterol, high-density lipoprotein, and Helicobacter.pylori IgG antibody were assessed in the patients and compared between the groups. Helicobacter.pylori infection occurred in 88 (57.51%) patients: 40 (58%) in the atherosclerotic group and 48 (57.1%) in the control group with no significant differences (P=0.918). Our multivariable analysis revealed that Helicobacter.pylori infection was not an independent predictive factor for coronary artery disease (P =0.915). Also, the prevalence of atherosclerosis risk factors with respect to the seropositive and seronegative Helicobacter.pylori infection was assessed in the case group, which showed no significant difference. Furthermore, the prevalence of seropositive Helicobacter.pylori infection in terms of the number of diseased coronary vessels was evaluated, this demonstrated no significant association between the number of the diseased vessels and Helicobacter.pylori infection. This study demonstrated that Helicobacter.pylori infection was not an independent predictive factor of atherosclerosis.

8

80%

Tasić I. , Lazarević G. , Stojanović M. , Kostić S. , Rihter M. , Djordjević D. , Simonović D. , Vulić D. , Stefanović V.

Open Medicine

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2013

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tom 8

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nr 5

618-626

EN

The aim of this study was to investigate the quality of life (HRQoL) in coronary artery disease(CAD) patients, admitted for rehabilitation within 3 months after an acute coronary event, in relation to treatment strategy [conservative treatment without revascularization (WR), percutaneous transluminal coronary angioplasty (PTCA), coronary artery bypass graft (CABG)]. Methods: Overall 719 consecutive CAD patients were involved in the study: WR (n=170), PTCA (n=226), CABG (n=323). HRQoL was estimated using the SF-36 questionnaire for total QoL and its two dimensions for physical and mental health [physical and mental component scores (PCS, MCS)]. Sexual dysfunction was assessed using the ASEX scale. Results: Significantly higher PCS, MCS and total SF-36, but lower ASEX score, were found in men compared with women. The ASEX score was significantly affected by age. Significantly higher PCS was found in PTCA group compared with that of CABG group. In multivariate analysis a significant positive association was obtained between PCS/MCS and male sex, between regular exercise, hyperlipoproteinemia, and permanent stress. ASEX was significantly positively associated with the age, CHF and non smoking. Conclusion: The results of this study have demonstrated significantly better HRQoL in men, younger CAD patients, patients who underwent PTCA and in patients without self-reported exposition to stress.

9

Risk assessment in coronary patients undergoing abdominal nonvascular surgery

80%

Karapandzic V. , Matic M. , Pesko P. , Rankovic V. , Milicic B.

Open Medicine

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2009

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tom 4

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nr 4

459-466

EN

The aim of our study was to establish that the incidence of perioperative cardiac complications were in direct correlation with level of operative risk in coronary patients undergoing open abdominal nonvascular surgery with general anesthesia. Our prospective observational clinical study was composed of a group of 111 consecutive patients with angiographically-verified coronary artery disease, who were operated on at the University Clinical Center of Serbia. The patients were classified into four stratification subgroups by “Goldman’s Cardiac Risk Index” (CRI) in relation to the incidence of perioperative cardiac complications. Electrocardiography was performed immediately after surgery, on postoperative days 1, 2, 7 and one day before discharge from the hospital. All patients were followed to postoperative day 30. Statistical design was presented by Pearson’s χ2 test and binomial logistic regression. The main result was significant difference between the four stratification subgroups of coronary patients in the incidence of cardiac death up to the 30th postoperative day: I - 0/17 (0.0%) vs. II - 0/40 (0.0%) vs. III - 1/37 (2.7%) vs. IV - 2/17 (11.8%), (p<0.05). We concluded that the incidence of perioperative cardiac complications significantly increased with the degree of Goldman’s CRI. There was significant difference in the incidence of perioperative cardiac complications between the four Goldman’s stratification subgroups.

10

Indirect costs in patients with coronary artery disease and mental disorders: A systematic review and meta-analysis

70%

Haschke A. , Hutter N. , Baumeister H.

International Journal of Occupational Medicine and Environmental Health

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2012

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tom 25

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nr 4

319-329

EN

The aim of the present study was to systematically review the association of comorbid mental disorders with indirect health care costs in patients with coronary artery disease (CAD). A comprehensive database search was conducted for studies investigating persons with CAD and comorbid mental disorders (Medline, EMBASE, PsycINFO, Psyndex, EconLit, IBSS). All studies were included, which allowed for a comparison of indirect health care costs between CAD patients with comorbid mental disorders and CAD patients without mental disorders. The literature search revealed 4962 potentially relevant studies, out of which 13 primary studies met the inclusion criteria. Depression was investigated most often (N = 10), followed by anxiety disorders (N = 3) and any mental disorder not further specifi ed (N = 3). All studies focused on return to work as indirect cost outcome. CAD patients with depression showed diminished odds for return to work, compared to CAD patients without depression (OR = 0.37; 95% CI: 0.27-0.51). The fi ndings for comorbid anxiety and any mental disorder were inconsistent. Indirect health care costs were exclusively assessed by a patient self-report (N = 13). There is strong evidence for diminished odds of return to work in CAD patients with comorbid depression, highlighting the need for integrated CAD and depression care. With regard to other comorbid mental disorders, however, the evidence is sparse and inconclusive.

11

Neoangiogenesis after direct intramyocardial implantation of bone marrow-derived stem cells in a patient with severe coronary artery disease ineligible for percutaneous or surgical revascularization

70%

Harmandar B. , Tansel T. , Onursal E. , Gurses N. , Besisik S. , Sargin D.

Open Medicine

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2009

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tom 4

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nr 3

279-285

EN

Bone marrow-derived stem cells (BMSC) may be an alternative for the treatment of patients with severe coronary artery disease ineligible for either percutaneous or surgical revascularization. This case report presents a 65-year-old male patient with untreatable angina pectoris (Canadian Cardiovascular Society Class III) and severe coronary artery disease. A mixture of BMSC containing approximately 3×106 CD34+ cells was directly injected into preoperatively determined ischemic regions of the myocardium by median sternotomy. At baseline, at 3 months, and at 1 year of follow-up, echocardiography (demonstrating wall motions of 16 segments), single-photon emission computed tomography, and coronary angiography (at baseline and at 1 year) were performed to assess myocardial perfusion, left ventricular (LV) function and coronary anatomy. The patient reached Canadian Cardiovascular Society Class I after 6 months of cell implantation. The ejection fraction increased from 34% to 37% at the third month and 40% at 1 year of follow-up. At 1 year of follow-up, preoperatively akinetic mid-base septum and anteroseptal regions progressed to mild hipokinesia and severe hypokinetic mid-base-apical anterior regions and apical lateral-inferior regions became normokinesia. Single-photon emission computed tomography revealed a visible improvement in anterior and lateral segments at 1 year of follow-up. Coronary angiography showed newly developed collateral arteries at 1 year of follow-up. BMSC transplantation in a patient with severe coronary artery disease resulted in increase of LV ejection fraction, an increase of the perfusion of ischemic myocardial regions, and improvement in wall motion defects without any adverse events.

12

The impact of professional status on the effects of and adherence to the outpatient followed by home-based telemonitored cardiac rehabilitation in patients referred by a social insurance institution

60%

Szalewska D. , Niedoszytko P. , Gierat-Haponiuk K.

International Journal of Occupational Medicine and Environmental Health

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2015

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tom 28

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nr 4

761-770

EN

Objectives Legislators and policymakers have expressed strong interest in intervention programs to reduce dependence on social disability benefits. Hybrid: ambulatory followed by home-based cardiac telerehabilitation – hybrid cardiac rehabilitation (HCR) seems to be a novel alternative for standard cardiac rehabilitation for patients with cardiovascular diseases (CVD) as a form of pension prevention paid by the Social Insurance Institution (SII). The kind of professional status may bias the motivation to return to work after HCR. The aim of our study was to evaluate whether the professional status can affect the effects of HCR. Material and Methods One hundred fifty-two patients with CVD referred by the SII for a 5-week HCR were qualified for the study. Patients (87.7% males), aged 57.31±5.61 years, were divided into 2 subgroups: W) white-collar employees (N = 22) and B) blue-collar employees (N = 130). To evaluate functional capacity, an exercise test on a treadmill was used. Results The number of days of absence in the cardiac rehabilitation program did not differ between the groups (mean ± standard deviation – B: 1.09±3.10 days, W: 1.95±3.64 days). There were significant improvements (p < 0.05) in measured variables after HCR in both (W and B) groups (max workload: 8.21±2.88 METs (measured in metabolic equivalents) vs. 9.6±2.49 METs, 7.76±2.51 METs vs. 8.73±2.7 METs, resting heart rate (RHR): 77±16.22 bpm vs. 69.94±12.93 bpm, 79.59±14 bpm vs. 75.24±11.87 bpm; double product, i.e., product of heart rate and systolic BP (DP rest) 10 815.22±2968.24 vs. 9242.94±1923.08, 10 927.62±2508.47 vs. 9929.7±2304.94). In group B, a decrease in systolic blood pressure (BP syst. – 137.03±17.14 mm Hg vs. 131.82±21.13 mm Hg), heart rate recovery in the 1st minute after the end of peak exercise (HRR1) (99.38±19.25 vs. 93.9±19.48) and New York Heart Association (NYHA) class (1.22±0.53 vs. 1.11±0.36) was observed. In group W, a decrease in diastolic blood pressure (BP diast.) at rest was observed (88.28±9.79 mm Hg vs. 83.39±8.95 mm Hg). The decrease in resting HR was significantly greater in group W (69.94±12.93 vs. 75.24±11.87, p = 0.034). Conclusions Hybrid cardiac rehabilitation is feasible and safe with high adherence to the program regardless of the patient’s professional status. Professional status did not influence the beneficial effect of HCR on exercise tolerance.