Despite the known association of chronic cardiovascular diseases and more severe courses of COVID-19, little is known about individual risk perception of patients with a history of acute myocardial ...infarction (AMI) and resulting preventive behaviours. In May 2020, a postal survey was conducted, including 150 patients with previous AMI from the myocardial infarction registry Augsburg. The study objective was to assess COVID-19 knowledge, individual risk perception, worries, infection likelihood and preventive behaviours in this patient cohort. From the 100 respondents, 69.7% perceived themselves to be at high risk of developing a severe course of COVID-19. There was a significant positive correlation between dangerousness assessment and knowledge on COVID-19. Despite a majority (70%) of patients rating their susceptibility for an infection as moderate to very high, the individual likelihood of being infected was rated at only 3%. Almost 70% of patients with previous MI classified themselves at high risk for a severe course of COVID-19 infection. As seen in other risk groups as well, the availability of valuable information sources as well as the support in individual risk reduction strategies and psychological coping mechanisms are mandatory, especially since higher knowledge correlates with dangerousness assessment and might lead to better compliance with preventive behaviours.
While the N-terminal pro-brain-type natriuretic peptide (NT-proBNP) at rest is known to be associated with prognosis in pulmonary arterial hypertension (PAH), it is unclear if the NT-proBNP response ...to exercise (ΔNT-proBNP) can contribute to a better assessment of disease severity.
We investigated the association of NT-proBNP values at rest and during peak exercise with hemodynamics and cardiopulmonary exercise testing parameters in 63 therapy-naive PAH patients.
The median NT-proBNP increases from 1414 at rest to 1500 pg/ml at peak exercise. The ΔNT-proBNP is baseline-dependent in PAH. Both, NT-proBNP at rest and NT-proBNP at peak exercise, are significantly correlated with hemodynamics and functional capacity. However, neither NT-proBNP at peak exercise nor ΔNT-proBNP correlated better with surrogate markers of disease severity than NT-proBNP at rest.
The ΔNT-proBNP does not contribute to a better assessment of disease severity in PAH.
N-terminal pro-brain-type natriuretic peptide (NT-proBNP) is currently used as a surrogate marker for disease severity in pulmonary hypertension (PH). However, NT-proBNP tends to have a high ...variability and may insufficiently correlate with hemodynamics and exercise capacity.
To investigate the association of NT-proBNP with hemodynamics and cardio-pulmonary exercise testing (CPET) in 84 therapy-naive patients with precapillary PH.
NT-proBNP levels were significantly correlated with hemodynamics and CPET parameters except for cardiac index, diffusion capacity, PaO
at peak exercise, and peak minute ventilation. NT-proBNP correlated best with hemodynamics and CPET in women and patients >65 years. NT-proBNP correlated better with CPET in pulmonary arterial hypertension compared to chronic thromboembolic PH (CTEPH).
NT-proBNP is associated with disease severity in precapillary PH. The association might be age- and gender-dependent. NT-proBNP may insufficiently correlate with disease severity in CTEPH, possibly due to comorbidity.
Background
Obstructive sleep apnea (OSA) might be an independent risk factor for acute pulmonary embolism (APE).
Aim of the study
A prospective cohort study was conducted to investigate if APE is ...sleep-related in untreated OSA syndrome or not.
Methods
206 APE patients were evaluated by portable monitoring and polysomnography. APE symptoms which caused an arousal from sleep or occurred within the first hour after wake-up were considered to be sleep-related.
Results
APE manifestation is significantly more often sleep-related in patients with moderate or severe OSA compared to subjects with an apnea–hypopnea index ≤15/h (
p
< 0.001). The relative risk of sleep-related APE increases with the severity of OSA.
Conclusions
OSA might trigger APE, possibly reflecting a pathophysiological relationship between these two conditions.
Low-temperature specific heat measurements and dielectric spectroscopy have been performed on polycrystalline and single-crystalline FeCr2S4, the single crystals showing a transition into a ...low-temperature orbital glass phase. The freezing of the orbital moments is revealed by a glasslike specific heat anomaly and by a clear relaxational behavior of the dielectric permittivity, exhibiting several hallmark features of glassy dynamics. The orbital relaxation dynamics continuously slows down over six decades in time, before at the lowest temperatures the glass transition becomes suppressed by quantum tunneling.
Background
Limited data exist regarding baseline characteristics and management of heart failure with reduced ejection fraction (EF) in tertiary care facilities.
Methods
EVITA-HF comprises web-based ...case report data on demography, comorbidities, diagnostic and therapy measures, quality of life, adverse events and 1-year follow-up of patients hospitalized for chronic heart failure and an ejection fraction of less than 40 %.
Results
Between February 2009 and June 2011, a total of 1,853 consecutive, hospitalized patients (pts) were included in 16 centers in Germany. Mean age was 70 years, 76 % were male. Median EF was 30 %, and 63 % were in NYHA III/IV. Ischemic cardiomyopathy was present in 56 %, history of hypertension in 76 %, diabetes in 39 %, impaired renal function in 33 %, thyroid dysfunction in 12 %, and malignoma in 7 %. Sixty-eight percent of pts had a non-elective admission. Rhythm was sinus/atrial fibrillation or flutter/pacemaker in 64, 28 and 11 %, respectively. Median heart rate amounted to 80 bpm, median blood pressure to 122/74 mmHg. LBBB was present in 26 % of non-pacemaker pts. Eighteen percent had an ICD or CRT-D. Medication (admission vs. discharge) consisted of ACEI or ARB in 73 vs. 88 %, β-blocker in 71 vs. 89 %, mineral corticosteroid receptor antagonist (MRA) in 32 vs. 57 %, diuretics in 68 vs. 83 % (
p
< 0.001 for each). Forty-two percent of pts received a specific treatment procedure beyond pharmacotherapy, of these 48 % revascularization, 39 % device therapy, 14 % electrical cardioversion, 5 % ablation procedures, 9 % valvular procedures, 6 % iv inotropes, 1.8 % IABP or LVAD implantation. At discharge, 33 % of survivors had ICD- or CRT-D implants. One-year mortality amounted to 16.8 %, and death or rehospitalization to 56 %. NYHA class III/IV was found in 30 % (
p
< 0.001 vs. index admission), general health status was improved in 45 % and unchanged in 36 % of patients. Eighty-five percent of pts took ACEI or ARB, 86 % β-blockers, 47 % MRA, and 78 % diuretics (
p
< 0.001 vs. index discharge for all).
Conclusion
Patients with chronic heart failure and low ejection fraction represent an elderly and multimorbid population. While hospitalized, they experience a significant optimization of prognosis-relevant medication, revascularization and device therapy. After 1 year, mortality is moderate; drug adherence is high and NYHA status favourable. The EVITA-HF registry is able to reflect coherently the real-world management, efforts and follow-up in heart failure pts managed in tertiary care facilities.
.
Objectives. To examine the extent to which evidence‐based beneficial therapy is applied in practice, whether this is changing over time and is associated with improved outcomes.
Background. ...Randomized trials have proved efficacy of several treatments for acute myocardial infarction (AMI) with ST‐elevation (STEMI), non‐ST‐elevation (NSTEMI) and bundle branch block (BBB).
Design and Setting. We prospectively examined all 6748 consecutive patients with AMI aged 25–74 years hospitalized in the study region’s major clinic stratified into four time‐periods: 1985–1989 (n = 1622), 1990–1994 (n = 1588), 1995–1999 (n = 1450) and 2000–2004 (n = 2088).
Results. The increase in numbers of AMI in the last period was mainly, but not exclusively driven by NSTEMI cases. Evidence‐based pharmacological therapy increased steeply over time. Invasive procedures increased mainly in the last period with percutaneous coronary intervention and coronary artery bypass graft performed in 30% and 15% in 1998 and 66.0% and 22%, respectively, in 2004. In‐hospital complications and 28‐day‐case fatality decreased significantly from period 1 to period 4 in all patients with AMI. Marked reductions in 28‐day‐case fatality were mostly seen in BBB patients during the last period (25.3% vs. 10.3%, P < 0.001). Of interest, the odds in 28‐day‐case fatality reduction was diminished after correction for recanalization therapy (from 0.35, 95% CI: 0.16–0.74 to 0.52, 95% CI: 0.19–1.45).
Conclusions. Over the past 20 years, there were substantial changes in pharmacological and interventional therapies in AMI accompanied by reductions in in‐hospital complications and 28‐day‐case fatality in all infarction types with marked reductions in 28‐day‐case fatality in BBB patients. The latter observation may mainly be because of the increased use of interventional therapy.
Crystal structure, magnetic susceptibility, and specific heat were measured in the normal cubic spinel compounds MnSc2S4 and FeSc2S4. Down to the lowest temperatures, both compounds remain cubic and ...reveal strong magnetic frustration. Specifically the Fe compound is characterized by a Curie-Weiss (CW) temperature ThetaCW = -45 K and does not show any indications of order down to 50 mK. In addition, the Jahn-Teller ion Fe2+ is orbitally frustrated. Hence, FeSc2S4 belongs to the rare class of spin-orbital liquids. MnSc2S4 is a spin liquid for temperatures T>TN approximately 2 K.
The potential influence of lunar phases on the occurrence of myocardial infarction is still controversial. The purpose of the present study was to investigate the association of the lunar cycle on ...the occurrence of fatal and non-fatal myocardial infarction based on a myocardial infarction registry.
We studied 15,985 patients consecutively hospitalised with an acute myocardial infarction (AMI) between 1 January 1985 and 31 December 2007 with a known date of symptom onset who were recruited from a population-based myocardial infarction registry. The exact hour of AMI onset was known for 9813 events. Poisson regression analysis was performed to examine the relation between the lunar cycle and the occurrence of AMI. There was no association between new moon, full moon, waning moon and waxing moon and the occurrence of AMI. However, we observed that the three days after a new moon may be significantly protective for the occurrence of AMI, rate ratio (RR) 0.94 (95% CI 0.91-0.98), and the day before a new moon had a slightly negative effect (RR 1.06, 95% CI 1.00-1.12). Stratified analysis did not reveal any susceptible subgroups.
The moon phases did not show any apparent association with AMI occurrence. However, there might be a 'cardioprotective' time three days after a new moon.
Coronary artery disease in the transplanted heart limits the long-term
success of cardiac transplantation. Intravascular ultrasound studies reveal a
dual morphology with donor-transmitted and de novo ...plaques. Coronary vasomotor
dysfunction may occur independently of morphological alterations. The disease
is characterized by the interaction of activated T lymphocytes with cytokines
and donor epicardial and microvascular endothelium. Various noxious stimuli
contribute to the continuing inflammatory response. Consequently, adhesion
molecule expression is upregulated, leukocytes migrate into the allograft,
thrombocytes accumulate, and growth factors are expressed, finally resulting in
functional and morphological chronic allograft lesions. Blocking the activation
of T cells, CD4+ cytokines, and adhesion molecules may prevent endothelial
injury and subsequent intimal thickening. Strategies to decrease the formation
of antiendothelial and anti-HLA-DR antibodies may also be protective, as may
antiproliferative drugs, augmentation of endogenous nitric oxide bioactivity,
and new immunosuppressive regimens. Revascularization procedures have a limited
role in treating significant focal lesions. Retransplantation, the only
definitive treatment, remains ethically controversial.
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