Background: The metabolic syndrome (MS) is a clustering of cardiovascular risk. The high prevalence of metabolic syndrome among populations of lower socioeconomic status is a cause of concern and calls for an effective public health response. Objectives: The aim of this study was to determine the prevalence of metabolic syndrome in the Roma population compared with the non-Roma population in the eastern part of Slovakia and to determine the parameter which has the strongest association with metabolic syndrome. Results: 123 Roma and 79 non-Roma patients with metabolic syndrome were evaluated. In the subgroup of Roma men, we found that waist circumference conferred the highest chance of MS (more than 12-times), followed by triglycerides (TG) (3.670-times). In the subgroup of non-Roma men, we found that waist circumference conferred the highest chance of MS (more than 16-times), followed by high-density lipoprotein (HDL) (4.348-times increased risk per one unit decrease in HDL). In the subgroup of Roma women as well as non-Roma women, we found that serum TG conferred the highest chance of MS, followed by waist circumference for Roma women. Comparing non-classical risk factors for MS we found that only age (with OR 1.977) and high-sensitivity C-reactive protein (hsCRP) (OR 1.887) were significant and independent predictors of MS in Roma men. Among Roma women apolipoprotein B100 was also found to be an independent predictor of MS, besides age and hsCRP. Conclusion: Our study confirmed that the prevalence of metabolic syndrome is strongly associated with hypertriglyceridemic waist, besides other risk factors, a marker of the atherogenic metabolic triad among younger Roma population, which may be the reason for the increased cardiovascular (CV) morbidity and mortality in elderly Roma compared with non-Roma. In light of these results, better prevention of CV events for Roma minority settlements in Slovakia should be provided.
Currently, just a few major parameters are used for cardiovascular (CV) risk quantification to identify many of the high-risk subjects; however, they leave a lot of them with an underestimated level of CV risk which does not reflect the reality.The submitted study design of the Kosice Selective Coronarography Multiple Risk (KSC MR) Study will use computer analysis of coronary angiography results of admitted patients along with broad patients' characteristics based on questionnaires, physical findings, laboratory and many other examinations.Obtained data will undergo machine learning protocols with the aim of developing algorithms which will include all available parameters and accurately calculate the probability of coronary artery disease.The KSC MR study results, if positive, could establisha base for development of proper software for revealing high-risk patients, as well as patients with suggested positive coronary angiography findings, based on the principles of personalised medicine.
We present a case of a 31-year-old patient, smoker, with no previous medical history, presenting with acute limb ischemia and infarction of the spleen due to peripheral embolism. The source of embolism was thrombi formations in the left ventricular cavity, located in the area of the regional wall motions abnormalities. CT and coronary angiography confirmed the total occlusion of the left anterior descending artery with collateralization. The patient underwent acute bilateral embolectomy of the iliac, femoral, and popliteal arteries. Subsequently, cardiothoracic surgery was indicated with coronary bypass surgery and extirpation of left ventricular masses, later confirmed as thrombus by pathology characteristics. Hematological examinations proved homozygous thrombophilia, and the patient was indicated for lifelong anticoagulation therapy.
Despite increased availability of effective drug therapy for treatment of heart failure (HF), the morbidity and mortality in chronic heart failure (CHF) are unacceptably high. Therefore, there is an urgent need to ascertain new imaging techniques to identify early sub-clinical forms of cardiac dysfunctions, to guide early relevant treatment. It seems that all the behavioral risk factors-such as tobacco, alcoholism, Western-type diet, sedentary behavior and obesity, emotional disorders, and sleep disorder are associated with early cardiac dysfunction, which may be identified by speckle-tracking echocardiography (STE). Cardiac remodeling can also occur chronologically in association with biological risk factors of CHF, such as diabetes mellitus (DM), hypertension, cardiomyopathy, valvular heart disease, and coronary artery disease (CAD). In these conditions, twisting and untwisting of the heart, cardiac fibrosis, and hypertrophy can be identified early and accurately with 2-Dimentional (2D) and 3D echocardiography (2D echo and 3D echo) with tissue Doppler imaging (TDI), strain imaging via STE, and cardiac magnetic resonance imaging (CMR). Both 2D and 3D echo with STE are also useful in the identification of myocardial damage during chemotherapy and in the presence of risk factors. It is possible that global longitudinal systolic strain (GLS) obtained by STE may be an accurate marker for early identification of the severity of CAD in patients with non-ST segment elevation MI. Left ventricular ejection fraction (LVEF) is not the constant indicator of HF and it is normal in early cardiac dysfunction. In conclusion, this review suggests that GLS can be a useful early diagnostic marker of early or pre-cardiac dysfunction which may be treated by suitable drug therapy of HF along with the causes of HF and adhere to prevention strategies for recurrence. In addition, STE may be a superior clinical tool in the identification of cardiac dysfunction in its early stages compared to ejection fraction (EF) based on conventional echocardiography. Therefore, it is suggested that the chances of either stalling or reversing HF are far better for patients who are identified at an early stage of the disease.
Background: Obesity-induced metabolic syndrome is a multiple risk factor for cardiovascular (CV) risk factors and type 2 diabetes, and ethnic minorities seem to have unfavourable medical risk factors in general more frequently than majority populations. Objective: The aim of this study was to evaluate the prevalence of cardiovascular risk factors in relation to metabolic syndrome in the Roma population compared with the non-Roma population residing in the eastern part of Slovakia. Results: 123 Roma and 79 non-Roma patients with metabolic syndrome were evaluated. Men between 40-55 years of age had 4.76-times higher odds and women 5.26-times higher odds for metabolic sydrome compared with the younger population. We found statistically significant higher waist circumference in the Roma subpopulation and higher body mass index as well, although in selected population with metabolic syndrome. HDL cholesterol was significantly lower in both Roma men and women, and LDL cholesterol was not significant in men and women with metabolic syndrome. Triglycerides levels were significantly higher in non-Roma women only. High-sensitivity C-reactive protein (hsCRP) values were not in correlation with age but were associated with the increasing number of fulfilled criteria for metabolic syndrome in both subgroups (Roma, non-Roma), independently of gender. Conclusion: Our study confirmed higher prevalence of obesity, metabolic syndrome and other CV risk factors associated with metabolic syndrome among younger Roma population, which may be associated with increased cardiovascular disease (CVD) morbidity and mortality among elderly Roma compared with non-Roma.
Background: Adrenomedullin (ADM), galectin-3 (Gal-3) and soluble ST2 (sST2) levels have been found elevated in heart failure (HF).Their relationship to coronary atherosclerosis and left ventricular hypertrophy (LVH) remains unclear.We evaluated the association of these biomarkers to the extent of coronary atherosclerosis and presence of LVH evaluated by multidetector computed tomography (MDCT) in hypertensive patients at risk of HF.Methods: The study group consisted of 67 hypertensives indicated for MDCT coronary angiography who underwent echocardiography and plasma biomarker evaluation.53 patienst had measurable for left ventricular mass indexed to body surface area (LVMI BSA ).The presence of ≥ 50% diameter stenosis was considered significant and LVH by MDCT was defined as LVMI BSA > 79.2g/m 2 in males and > 63.8g/m 2 in females.Results: Levels of Gal-3 were significantly higher in patients with coronary atherosclerosis compared to those without (11.09± 3.71 ng/ml vs. 8.71 ± 2.55 ng/ml; p=0.024).In multivariate logistic regression significant predictors of coronary atherosclerosis were levels of Gal-3 > 8.7 ng/ml (OR 3.71; p=0.045).Patients with LVH had significantly higher levels of sST2 than patients without (20.94± 6.99 vs. 16.79 ± 5.26 ng/ml; p=0.019).In multivariate logistic regression, significant predictors of LVH on MDCT were diabetes mellitus (OR 7.06; p=0.020) and sST2 (OR 1.14; 1.00 -1.30; p=0.043).Conclusion: Our results suggest the possible role of sST2 in pathophysiology of LVH, and galectin-3 as a marker of coronary atherosclerotic burden.Fig. 3, Tab.4, Ref. 37, PDF) www.cardiologyletters.sk
The purpose of the study was to compare the relationship between the dead space volume and tidal volume (VD/VT) using volumetric capnography (VCap) during pressure controlled (PCV) and pressure supported (PSV) ventilation mode in the postoperative period. Materials and methods. 30 randomly assigned cardiac surgical patients undergoing CABG (coronary artery bypass grafting) using ECC (extracorporeal circuit) were included in an observational, prospective study. Patients were connected to the ventilator immediately after ICU admission. After that, monitoring VD/VT, CO2 production (VECO2) as well as ventilation parameters was carried out. The parameters during PCV and PSV mode were statistically evaluated using t -test. Results. Expiratory CO2 (ETCO2) concentration were not significantly different in both PCV or PSV ( p =NS), although both VECO2 and minute ventilation (MV) increased during PSV mode ( p <0.01). VD/VT in PSV mode was lower than in PCV. Gas exchange represented by alveolar ventilation (VA) was better during PSV ( p <0.01). VA was also higher during PSV ( p <0.05). The calculated VD/VT ratio differed between PCV and PSV mode ( p <0.01). Conclusion. VCap represents a tool for monitoring of CO2 exchange effectivness. We registered a decrease in VD/VT with improved alveolar ventilation (VA) in PSV mode. VCap seems to be a suitable instrument for adjustment of protective lung ventilation.
Lymphedema, a chronic condition characterized by the accumulation of lymphatic fluid in the interstitial tissue, leads to swelling primarily in the extremities, though other parts of the body can be affected. This condition commonly arises following lymph node dissection, radiation therapy, or due to inherent defects in the lymphatic system. Effective management of lymphedema is crucial due to its impact on function and quality of life, with complete decongestive therapy (CDT) serving as the cornerstone of treatment. CDT, a multimodal approach involving manual lymphatic drainage (MLD), compression bandaging, skin care, and exercise, has been widely adopted. Research highlights the significance of early diagnosis and initiation of CDT to prevent irreversible lymphatic damage and worsening of symptoms. The predictors of successful outcomes in decongestive therapy include timely initiation of treatment, patient adherence to therapy regimens, and the comprehensive application of CDT components. Studies indicate that while all components of CDT are beneficial, the critical nature of compression therapy and exercise cannot be overstated, regardless of the MLD component's efficacy. Furthermore, recent inquiries into the impact of skin and fat tissue characteristics on the efficacy of decongestive therapy have yielded insightful findings. Increased skin thickness and adipose tissue accumulation, as measured by echogenicity and volumetric analysis respectively, have been shown to complicate the management of lymphedema. Particularly in advanced stages, where fibrosis and fat deposition are predominant, traditional CDT might require augmentation with more aggressive treatments like liposuction or advanced compression techniques. In this review we will discuss in detail how the success of decongestive therapy in lymphedema is influenced by multiple factors including the stage of lymphedema at diagnosis, the specific protocol employed, and individual patient factors such as skin and adipose tissue characteristics. Personalized treatment plans, early intervention, and consistent monitoring and adjustments based on patient response to therapy are essential for optimal management of this challenging condition. Further studies are warranted to explore the tailored approaches in lymphedema management, particularly in patients with significant changes in skin and subcutaneous tissue characteristics.
Background and Objectives: Metabolic syndrome (MS) represents several diseases encompassing a heterogeneous group of biochemical and physiological abnormalities characterized by structural and functional alterations in the myocardium, including the endothelium of the coronary arteries. MS also affects a substantial portion of the global population. Understanding the risk factors, the development and treatment associated with MS are of paramount importance for early identification, treatment and prevention. This study was designed to evaluate the role of the supplementation of omega-3 polyunsaturated fatty acids (n-3 PUFAs) on endothelial function in patients with MS. Materials and Methods: A total of 80 patients with MS were enrolled in two groups. The study evaluated endothelial function (EF) in subjects before and after a three-month treatment with n-3 PUFAs in a dose of 2.4 g daily (800 mg, three times a day) vs. placebo, using an Endo-PAT2000 device (Itamar Medical Ltd., Caesarea, Israel) measuring the reactive hyperemia index (a parameter of EF) and augmentation index (a parameter of arterial stiffness). Plasmatic levels of glutathione peroxidase, homocysteine, apolipoprotein B and lipoprotein were also evaluated for comparison. Results: The results showed that the average value of reactive hyperemia index before the treatment with n-3 PUFAs was 1.62 ± 0.42, compared to 1.96 ± 0.62 at the end of the study (p < 0.005). The augmentation index changed from 14.66 ± 19.55 to 9.21 ± 15.64 after the treatment (p = 0.003) with n-3 PUFA. The results also revealed a statistically significant decrease in apolipoprotein B (0.94 ± 0.36 vs. 1.13 ± 0.35, p = 0.001) and homocysteine (19.31 ± 5.29 vs. 13.78 ± 3.05, p = 0.001) and an increase in glutathione peroxidase plasma levels (41.65 ± 8.90 vs. 45.20 ± 8.01), p = 0.001. Conclusions: The results of this prospective study showed a significant improvement in EF in subjects with MS treated with n-3 PUFAs in a dose of 2.4 g daily.
