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Heart rate variability and levels of cytokines depending on the detection of cardiovascular disease in the working population of Russia
Abstracts
correlation between PH and HFpEF is now under investigation by various groups due to the possibility of PH to become a marker of symptomatic pulmonary congestion, distinguishing HFpEF from preclinical hypertensive heart disease. This study aims to report the prevalence, severity and significance of PH in heart failure with and without preserved ejection fraction. Methods: Retrospective analysis of 32 patients with PH that were admitted in an internal medicine department between January and April 30th of 2013. PASP was derived from the tricuspid regurgitation velocity and PH defined as PASP N35 mmHg in transthoracic echocardiogram. PH was considered severe when PASP value was equal or superior to 50 mmHg. Patients with PH due to other causes besides left heart dysfunction were excluded from this survey. Results: 32 patients with PH and HF. 5 males (average age of 70.6 years), 27 females (average age of 76.3 years). Two of the patients have both HF and chronic pulmonary obstructive disease; 15 patients have HF secondary to hypertensive cardiomyopathy; 7 patients have HF secondary to ischemic cardiomyopathy and 10 patients have HF due to valvular cardiomyopathy. When evaluated EF, 19 patients have normal EF (EF ≥ 55%), 7 patients have preserved EF (EF [40%,55%]) and 6 patients have impaired global systolic function with EF b40%. Among the 32 evaluated patients, 17 patients have mild tricuspid insufficiency (TI), 10 patients have moderate TI and 3 patients have severe TI. PH tends to be more severe in patients with normal (median PASP = 51.68 mmHg) and preserved (median PASP = 52.21 mmHg) EF, than in patients with reduced global systolic function (median PASP 44.17 mmHg). Conclusions: The results of our retrospective analysis support the ongoing studies in which patients with HFpEF accounted for a significant percentage of patients with PH and right-sided heart dysfunction. The processes underlying the development of PH in HFpEF are still unclear. doi:10.1016/j.ejim.2013.08.026
ID: 799 Cardiovascular risk factors in patients with acute coronary syndromes treated in non-academic hospitals — Incidence and awareness Z. Monharta, J. Reissigovab, H. Grunfeldovac, P. Janskyd, J. Zvarovab, P. Widimskye a
Internal Department, Hospital Znojmo, Znojmo, Czech Republic European Centre of Medical Informatics, Statistics and Epidemiology, Institute of Computer Science AS CR, Prague, Czech Republic c Internal Department, Hospital Caslav, Caslav, Czech Republic d Cardiovascular Centre, University Hospital Motol, Prague, Czech Republic e Cardiocenter, Third Faculty of Medicine, Charles University, Prague, Czech Republic b
Purpose: Cardiovascular risk factors (RF) – diabetes mellitus, hyperlipidemia, hypertension and smoking – increase a risk of ischemic cardiovascular events. An individual risk can be reduced by early intervention of these RF. Unfortunately in part of population these factors are not detected and thus not treated. The aim of our work is to describe incidence and awareness of these risk factors in population of patients admitted for acute coronary syndromes (ACS). Methods: Registry includes a total of 7240 data records (cases of ACS) treated during a 3-year period (7/2008–6/2011) in internal wards of 32 Czech nonacademic hospitals. We collected data about patient demographics, present risk factors, therapy and outcomes. 6236 cases of ACS were included in the analysis. Results: Out of 6236 patients discharged from hospital after ACS event 82.0% patients had arterial hypertension, 79% hyperlipidemia, and 36.0% diabetes mellitus. However, out of 5076 patients with arterial hypertension 467 (9.2%, 95% CI 8.4%– 10.0%) did not know about the hypertension before hospitalization for ACS. The most evident difference between previously known and newly
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diagnosed risk factor was seen in hyperlipidemia — 4857 patients had hyperlipidemia, but 1667 patients (34.3%, 95% CI 33.0%–35.7%) was not aware of this risk factor before admission. Concerning diabetes the proportion of newly diagnosed diabetes in the time of ACS event was minimal — only 93 (4.2%, 95% CI 3.4%–5.1%) cases of 2229 patients are with diabetes mellitus. Conclusions: Hyperlipidemia, arterial hypertension and diabetes mellitus are important risk factors of coronary artery disease. Nevertheless a significant proportion of patients admitted for ACS is not aware of the presence of these risk factors before the ACS event — particularly in the case of hyperlipidemia. More than one third (34.3%) of patients with hyperlipidemia in our ACS population did not know about the diagnosis before their ACS event. doi:10.1016/j.ejim.2013.08.027
ID: 13 Heart rate variability and levels of cytokines depending on the detection of cardiovascular disease in the working population of Russia Natalya Koryaginaa, Alla Petrischevaa, Luboiv Vasiletsb, Natalya Grigiriadib a
Department of Outpatient Therapy, Perm State Medical Academy, Perm, Russian Federation b Department of Hospital Therapy, Perm State Medical Academy, Perm, Russian Federation
Objective: To examine changes in heart rate variability in patients without cardiovascular disease (CVD) and the newly established CVD. Material and methods: Long-term ECG monitoring with the help of Astrocard® in persons 40–60 years of age, quantitative determination of TNF, IL-1, IL-6 using ELISA LLC “Protein contour”, St. Petersburg. First group — 200 people without a history of CVD, the 2nd group with newly diagnosed CVD — 183, 3rd group — 129 people hospitalized in the cardiology clinic. All groups were matched by sex and age. Evaluated the temporal parameters of HRV (SDNN, PNN50, RMSSD). Results: The greatest change indicator on the overall rate variability, SDNN was found in group 2 respondents with newly diagnosed CVD — 93.13 ± 25.02 ms, significantly different from 1 and 3 groups: 144.90 ± 44.95 ms and 135.27 ± 39.88 ms (p b 0.05). Indicators that are responsible for the influence of the parasympathetic component were within generally accepted standards in all three groups. But there were significant differences between groups 1 and 2: RMSSD 58.87 ± 15.74 ms 38.06 ± 15.0 ms, p b 0.0001; PNN50 40.21 ± 16.32% and 18.89 ± 12.67%, p b 0.0001, indicating reduced vagal influence. All the patients who had coronary artery disease have increased levels of cytokines IL1, IL6 and TNF, compared with respondents without cardiovascular disease. Intermediate values of these parameters showed a group of three respondents, who conducted drug correction of cardiovascular disease. Conclusions: 1. The revealed changes of time heart rate variability confirm the high prevalence of stiffness in the heart rate of cardiac pathology, and signs of systemic inflammation. 2. Early initiation of changes in HRV requires greater use of long-term ECG monitoring in patients of working age. 3. Drug correction is accompanied by improved CVD rate variability. doi:10.1016/j.ejim.2013.08.028
ID: 30 Prognostic value of changes in anthropometrics in heart failure elderly patients A. Casas Varaa, F. Santolaria Fernadezb, A. Fernadez Bereciartuaa, E. Gonzalez Reimersb, A. Martínez Rierab
correlation between PH and HFpEF is now under investigation by various groups due to the possibility of PH to become a marker of symptomatic pulmonary congestion, distinguishing HFpEF from preclinical hypertensive heart disease. This study aims to report the prevalence, severity and significance of PH in heart failure with and without preserved ejection fraction. Methods: Retrospective analysis of 32 patients with PH that were admitted in an internal medicine department between January and April 30th of 2013. PASP was derived from the tricuspid regurgitation velocity and PH defined as PASP N35 mmHg in transthoracic echocardiogram. PH was considered severe when PASP value was equal or superior to 50 mmHg. Patients with PH due to other causes besides left heart dysfunction were excluded from this survey. Results: 32 patients with PH and HF. 5 males (average age of 70.6 years), 27 females (average age of 76.3 years). Two of the patients have both HF and chronic pulmonary obstructive disease; 15 patients have HF secondary to hypertensive cardiomyopathy; 7 patients have HF secondary to ischemic cardiomyopathy and 10 patients have HF due to valvular cardiomyopathy. When evaluated EF, 19 patients have normal EF (EF ≥ 55%), 7 patients have preserved EF (EF [40%,55%]) and 6 patients have impaired global systolic function with EF b40%. Among the 32 evaluated patients, 17 patients have mild tricuspid insufficiency (TI), 10 patients have moderate TI and 3 patients have severe TI. PH tends to be more severe in patients with normal (median PASP = 51.68 mmHg) and preserved (median PASP = 52.21 mmHg) EF, than in patients with reduced global systolic function (median PASP 44.17 mmHg). Conclusions: The results of our retrospective analysis support the ongoing studies in which patients with HFpEF accounted for a significant percentage of patients with PH and right-sided heart dysfunction. The processes underlying the development of PH in HFpEF are still unclear. doi:10.1016/j.ejim.2013.08.026
ID: 799 Cardiovascular risk factors in patients with acute coronary syndromes treated in non-academic hospitals — Incidence and awareness Z. Monharta, J. Reissigovab, H. Grunfeldovac, P. Janskyd, J. Zvarovab, P. Widimskye a
Internal Department, Hospital Znojmo, Znojmo, Czech Republic European Centre of Medical Informatics, Statistics and Epidemiology, Institute of Computer Science AS CR, Prague, Czech Republic c Internal Department, Hospital Caslav, Caslav, Czech Republic d Cardiovascular Centre, University Hospital Motol, Prague, Czech Republic e Cardiocenter, Third Faculty of Medicine, Charles University, Prague, Czech Republic b
Purpose: Cardiovascular risk factors (RF) – diabetes mellitus, hyperlipidemia, hypertension and smoking – increase a risk of ischemic cardiovascular events. An individual risk can be reduced by early intervention of these RF. Unfortunately in part of population these factors are not detected and thus not treated. The aim of our work is to describe incidence and awareness of these risk factors in population of patients admitted for acute coronary syndromes (ACS). Methods: Registry includes a total of 7240 data records (cases of ACS) treated during a 3-year period (7/2008–6/2011) in internal wards of 32 Czech nonacademic hospitals. We collected data about patient demographics, present risk factors, therapy and outcomes. 6236 cases of ACS were included in the analysis. Results: Out of 6236 patients discharged from hospital after ACS event 82.0% patients had arterial hypertension, 79% hyperlipidemia, and 36.0% diabetes mellitus. However, out of 5076 patients with arterial hypertension 467 (9.2%, 95% CI 8.4%– 10.0%) did not know about the hypertension before hospitalization for ACS. The most evident difference between previously known and newly
e13
diagnosed risk factor was seen in hyperlipidemia — 4857 patients had hyperlipidemia, but 1667 patients (34.3%, 95% CI 33.0%–35.7%) was not aware of this risk factor before admission. Concerning diabetes the proportion of newly diagnosed diabetes in the time of ACS event was minimal — only 93 (4.2%, 95% CI 3.4%–5.1%) cases of 2229 patients are with diabetes mellitus. Conclusions: Hyperlipidemia, arterial hypertension and diabetes mellitus are important risk factors of coronary artery disease. Nevertheless a significant proportion of patients admitted for ACS is not aware of the presence of these risk factors before the ACS event — particularly in the case of hyperlipidemia. More than one third (34.3%) of patients with hyperlipidemia in our ACS population did not know about the diagnosis before their ACS event. doi:10.1016/j.ejim.2013.08.027
ID: 13 Heart rate variability and levels of cytokines depending on the detection of cardiovascular disease in the working population of Russia Natalya Koryaginaa, Alla Petrischevaa, Luboiv Vasiletsb, Natalya Grigiriadib a
Department of Outpatient Therapy, Perm State Medical Academy, Perm, Russian Federation b Department of Hospital Therapy, Perm State Medical Academy, Perm, Russian Federation
Objective: To examine changes in heart rate variability in patients without cardiovascular disease (CVD) and the newly established CVD. Material and methods: Long-term ECG monitoring with the help of Astrocard® in persons 40–60 years of age, quantitative determination of TNF, IL-1, IL-6 using ELISA LLC “Protein contour”, St. Petersburg. First group — 200 people without a history of CVD, the 2nd group with newly diagnosed CVD — 183, 3rd group — 129 people hospitalized in the cardiology clinic. All groups were matched by sex and age. Evaluated the temporal parameters of HRV (SDNN, PNN50, RMSSD). Results: The greatest change indicator on the overall rate variability, SDNN was found in group 2 respondents with newly diagnosed CVD — 93.13 ± 25.02 ms, significantly different from 1 and 3 groups: 144.90 ± 44.95 ms and 135.27 ± 39.88 ms (p b 0.05). Indicators that are responsible for the influence of the parasympathetic component were within generally accepted standards in all three groups. But there were significant differences between groups 1 and 2: RMSSD 58.87 ± 15.74 ms 38.06 ± 15.0 ms, p b 0.0001; PNN50 40.21 ± 16.32% and 18.89 ± 12.67%, p b 0.0001, indicating reduced vagal influence. All the patients who had coronary artery disease have increased levels of cytokines IL1, IL6 and TNF, compared with respondents without cardiovascular disease. Intermediate values of these parameters showed a group of three respondents, who conducted drug correction of cardiovascular disease. Conclusions: 1. The revealed changes of time heart rate variability confirm the high prevalence of stiffness in the heart rate of cardiac pathology, and signs of systemic inflammation. 2. Early initiation of changes in HRV requires greater use of long-term ECG monitoring in patients of working age. 3. Drug correction is accompanied by improved CVD rate variability. doi:10.1016/j.ejim.2013.08.028
ID: 30 Prognostic value of changes in anthropometrics in heart failure elderly patients A. Casas Varaa, F. Santolaria Fernadezb, A. Fernadez Bereciartuaa, E. Gonzalez Reimersb, A. Martínez Rierab