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13 pages, 2204 KiB

Open AccessArticle

Platelet, Fibrinolytic and Other Coagulation Abnormalities in Newly-Diagnosed Patients with Chronic Thromboembolic Pulmonary Hypertension

by Eleni Vrigkou, Argirios Tsantes, Dimitrios Konstantonis, Evdoxia Rapti, Eirini Maratou, Athanasios Pappas, Panagiotis Halvatsiotis and Iraklis Tsangaris

Diagnostics 2022, 12(5), 1238; https://doi.org/10.3390/diagnostics12051238 - 16 May 2022

Cited by 7 | Viewed by 1606

Abstract

The pathophysiological background of chronic thromboembolic pulmonary hypertension (CTEPH) has not been fully elucidated. Evidence suggests that abnormal platelet function and ineffective fibrinolysis may play a key role in the development of the disease. The purpose of this study was to evaluate platelet [...] Read more.

The pathophysiological background of chronic thromboembolic pulmonary hypertension (CTEPH) has not been fully elucidated. Evidence suggests that abnormal platelet function and ineffective fibrinolysis may play a key role in the development of the disease. The purpose of this study was to evaluate platelet and coagulation function in CTEPH, using non-conventional global coagulation assays, and platelet activation and endothelial dysfunction laboratory markers. A total of 40 newly-diagnosed CTEPH patients were studied, along with 35 healthy controls. Blood samples from CTEPH patients were taken directly from the pulmonary artery. All subjects were assessed with platelet function analyzer-100, light transmission aggregometry, thromboelastometry, endogenous thrombin potential. von Willebrand antigen and activity, p-selectin, thromboxane A2 and serotonin levels were also assessed. The results showed that CTEPH patients present diminished platelet aggregation, presence of disaggregation, decreased rate of fibrinolysis, defective thrombin generation and increased levels of thromboxane A2, p-selectin, von Willebrand antigen and activity. Serotonin levels did not present any differences between the two groups. The results of this study suggest that CTEPH patients present platelet function, fibrinolytic, thrombin generation and other clot formation abnormalities. Well-designed clinical studies are needed to further evaluate the complex hemostatic abnormalities in the CTEPH setting and assess their potential clinical applications. Full article

(This article belongs to the Special Issue Cardiovascular Diseases: Diagnosis, Treatment, and Management—for the Up-to-Date Practitioner)

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11 pages, 878 KiB

Open AccessArticle

Performance of the Abbott Architect Immuno-Chemiluminometric NT-proBNP Assay

by Chin-Shern Lau, Ya Li Liang, Soon Kieng Phua, Gillian Murtagh, Imo E. Hoefer, Ron H. Stokwielder, Milica Kosevich, Jennifer Yen, Jaganathan Sickan, Christos Varounis and Tar-Choon Aw

Diagnostics 2022, 12(5), 1172; https://doi.org/10.3390/diagnostics12051172 - 08 May 2022

Cited by 6 | Viewed by 2234

Abstract

Background: We evaluated the performance of the Abbott N-terminal pro-brain natriuretic peptide (NT-proBNP) assay against the Roche NT-proBNP immunoassay across two sites. Methods: Precision, linearity, and sensitivity studies were performed. A combined method of comparison and regression analysis was performed between the Roche [...] Read more.

Background: We evaluated the performance of the Abbott N-terminal pro-brain natriuretic peptide (NT-proBNP) assay against the Roche NT-proBNP immunoassay across two sites. Methods: Precision, linearity, and sensitivity studies were performed. A combined method of comparison and regression analysis was performed between the Roche and Abbott assays using samples from both sites (n = 494). To verify biotin interference, lyophilised biotin powder was reconstituted and spiked into serum samples at two medical decision levels (final concentration 500/4250 ng/mL) and compared to controls. NT-proBNP was also measured in anonymised leftover sera (n = 388) in a cardio-renal healthy population and stratified into three age bands—<50 (n = 145), 50–75 (n = 183) and >75 (n = 60). Results: Between-run precision (CV%) for NT-proBNP was 4.17/4.50 (139.5/142.0 pg/mL), 3.83/2.17 (521.6/506.3), and 4.60/2.51 (5053/4973), respectively. The assay was linear from 0.7–41,501 pg/mL. The limit of blank/quantitation was 1.2/7.9 pg/mL. The assay showed no interference from biotin up to 4250 ng/mL. Passing–Bablok regression analysis showed excellent agreement between the two assays (r = 0.999, 95% CI 0.999 to 0.999, p < 0.0001). The Roche assay had a slightly persistent, negative bias across different levels of NT-proBNP. ESC age cut-offs for diagnosing acute heart failure are applicable for the Abbott assay, with the median NT-proBNP of subjects < 50 years old at 43.0 pg/mL (range 4.9–456 pg/mL), 50–75 years old at 95.1 pg/mL (range 10.5–1079 pg/mL), and >75 years old at 173.1 pg/mL (range 23.2–1948 pg/mL). Conclusions: The Abbott Architect NT-proBNP assay has good performance that agrees with the manufacturer’s specifications. ESC/AHA recommended NT-proBNP age groups for acute heart failure diagnosis are applicable to this assay. Full article

(This article belongs to the Special Issue Cardiovascular Diseases: Diagnosis, Treatment, and Management—for the Up-to-Date Practitioner)

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11 pages, 1351 KiB

Open AccessArticle

Validation of the 30-Year Framingham Risk Score in a German Population-Based Cohort

by Susanne Rospleszcz, Fabian Starnecker, Birgit Linkohr, Moritz von Scheidt, Christian Gieger, Heribert Schunkert and Annette Peters

Diagnostics 2022, 12(4), 965; https://doi.org/10.3390/diagnostics12040965 - 12 Apr 2022

Cited by 2 | Viewed by 1980

Abstract

The Framingham Risk Score to predict 30-year risk (FRS30y) of cardiovascular disease (CVD) constitutes an important tool for long-term risk prediction. However, due to its complex statistical properties and the paucity of large population-based cohorts with appropriate data, validation of the FRS30y is [...] Read more.

The Framingham Risk Score to predict 30-year risk (FRS30y) of cardiovascular disease (CVD) constitutes an important tool for long-term risk prediction. However, due to its complex statistical properties and the paucity of large population-based cohorts with appropriate data, validation of the FRS30y is lacking. A population-based cohort from Southern Germany (N = 3110, 1516 (48.7%) women) was followed up for a median time of 29.5 [18.7, 31.2] years. Discrimination and calibration were assessed for the original, recalibrated and refitted FRS30y version. During follow up, 620 incident CVD events (214 in women) occurred. The FRS30y showed adequate discrimination (original and recalibrated version: Area under the curve (AUC): 78.4 for women and 74.9 for men) but overestimated actual CVD risk (original version: discordance 45.4% for women and 37.3% for men, recalibrated version: 37.6% and 28.6%, respectively). Refitting showed substantial improvement in neither discrimination nor calibration. The performance of FRS30y is adequate for long-term CVD risk prediction and could serve as an important tool in risk communication, especially for younger audiences. Full article

(This article belongs to the Special Issue Cardiovascular Diseases: Diagnosis, Treatment, and Management—for the Up-to-Date Practitioner)

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9 pages, 2182 KiB

Open AccessArticle

Renin-Angiotensin-Aldosterone System Inhibitors and Risk of Cancer: A Population-Based Cohort Study Using a Common Data Model

by Seung-Hwa Lee, Jungchan Park, Rae Woong Park, Seo Jeong Shin, Jinseob Kim, Ji Dong Sung, Dae Jung Kim and Kwangmo Yang

Diagnostics 2022, 12(2), 263; https://doi.org/10.3390/diagnostics12020263 - 21 Jan 2022

Cited by 5 | Viewed by 2209

Abstract

Studies have reported conflicting results on the association between the use of renin-angiotensin-aldosterone system (RAAS) inhibitors and cancer development. We compared the incidence of cancer between patients using RAAS inhibitors and other antihypertensive drugs. This retrospective observational cohort study used data from seven [...] Read more.

Studies have reported conflicting results on the association between the use of renin-angiotensin-aldosterone system (RAAS) inhibitors and cancer development. We compared the incidence of cancer between patients using RAAS inhibitors and other antihypertensive drugs. This retrospective observational cohort study used data from seven hospitals in Korea that were converted for use in the Observational Medical Outcomes Partnership Common Data Model. A total of 166,071 patients on antihypertensive therapy across the databases of the seven hospitals were divided into two groups according to the use of RAAS inhibitors. The primary outcome was the occurrence of cancer. A total of 166,071 patients across the databases of the seven hospitals was included in the final analysis; 26,650 (16%) were in the RAAS inhibitors group and 139,421 (84%) in the other antihypertensive drugs group. The meta-analysis of the whole cohort showed a lower incidence of cancer occurrence in the RAAS inhibitor group (9.90 vs. 13.28 per 1000 person years; HR, 0.81; 95% confidence interval [CI], 0.75–0.88). After propensity-score matching, the RAAS inhibitor group consistently showed a lower incidence of cancer (9.90 vs. 13.28 per 1000 person years; HR, 0.86; 95% CI, 0.81–0.91). The patients using RAAS inhibitors showed a lower incidence of cancer compared with those using other antihypertensive drugs. These findings support the association between the use of RAAS inhibitors and cancer occurrence. Full article

(This article belongs to the Special Issue Cardiovascular Diseases: Diagnosis, Treatment, and Management—for the Up-to-Date Practitioner)

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10 pages, 922 KiB

Open AccessArticle

Association between Cardiologist Consultation and Mortality of Stable Patients with Elevated Cardiac Troponin at Admission

by Ah Ran Oh, Jungchan Park, Sooyeon Lee, Kwangmo Yang, Jin-Ho Choi, Kyunga Kim, Joonghyun Ahn, Ji Dong Sung and Seung-Hwa Lee

Diagnostics 2021, 11(12), 2229; https://doi.org/10.3390/diagnostics11122229 - 29 Nov 2021

Cited by 1 | Viewed by 1195

Abstract

Elevated cardiac troponin (cTn) showed associations with mortality even in stable patients, but management has not been established. We aimed to investigate whether consultation to cardiologists could reduce mortality of stable patients with cTn elevation at admission. We identified 1329 patients with elevated [...] Read more.

Elevated cardiac troponin (cTn) showed associations with mortality even in stable patients, but management has not been established. We aimed to investigate whether consultation to cardiologists could reduce mortality of stable patients with cTn elevation at admission. We identified 1329 patients with elevated cTn level at hospitalization from outpatient clinic to any department other than cardiology or cardiac surgery between April 2010 and December 2018. The patients were divided into two groups according to cardiologist consultation at admission. For primary outcome, mortality during one year was compared in the crude and propensity-score-matched populations. In 1329 patients, 397 (29.9%) were consulted to cardiologists and 932 (70.1%) were not. Mortality during the first year was significantly lower in patients consulted to cardiologists compared with those who were not (9.8% vs. 14.2%; hazard ratio (HR), 0.50; 95% confidence interval (CI), 0.35–0.72; p < 0.001). After propensity-score matching, 324 patients were in the cardiologist consultation group and 560 patients were in the no cardiologist consultation group. One-year mortality was consistently lower in the cardiologist consultation group (10.5% vs. 14.6%; HR, 0.58; 95% CI, 0.39–0.86; p = 0.01). Cardiologist consultation may be associated with lower mortality in stable patients with cTn elevation at admission. Further studies are needed to identify effective management strategies for stable patients with elevated cTn. Full article

(This article belongs to the Special Issue Cardiovascular Diseases: Diagnosis, Treatment, and Management—for the Up-to-Date Practitioner)

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14 pages, 2492 KiB

Open AccessArticle

Serum Osteoprotegerin and Carotid Intima-Media Thickness Are Related to High Arterial Stiffness in Heart Failure with Reduced Ejection Fraction

by Lajos Fehérvári, Attila Frigy, Lóránd Kocsis, István Adorján Szabó, Timea Magdolna Szabo, Melinda Urkon, Zita Jakó and Előd Ernő Nagy

Diagnostics 2021, 11(5), 764; https://doi.org/10.3390/diagnostics11050764 - 24 Apr 2021

Cited by 6 | Viewed by 2001

Abstract

Arterial stiffness (AS) is a complex vascular phenomenon with consequences for central hemodynamics and left-ventricular performance. Circulating biomarkers have been associated with AS; however, their value in heart failure is poorly characterized. Our aim was to evaluate the clinical and biomarker correlates of [...] Read more.

Arterial stiffness (AS) is a complex vascular phenomenon with consequences for central hemodynamics and left-ventricular performance. Circulating biomarkers have been associated with AS; however, their value in heart failure is poorly characterized. Our aim was to evaluate the clinical and biomarker correlates of AS in the setting of heart failure with reduced ejection fraction (HFrEF). In 78 hospitalized, hemodynamically stable patients (20 women, 58 men, mean age 65.8 ± 1.41 years) with HFrEF, AS was measured using aortic pulse wave velocity (PWV). Serum OPG, RANKL, sclerostin, and DKK-1 were determined, and the relationships between the clinical variables, vascular-calcification-related biomarkers, and PWV were evaluated by correlation analysis and linear and logistic regression models. OPG and the OPG/RANKL ratio were significantly higher in the group of patients (n = 37, 47.4%) with increased PWV (>10 m/s). PWV was positively correlated with age, left-ventricular ejection fraction, and carotid intima-media thickness (cIMT), and negatively correlated with the glomerular filtration rate. OPG and cIMT were significantly associated with PWV in the logistic regression models when adjusted for hypertension, EF, and the presence of atherosclerotic manifestations. Elevated serum OPG, together with cIMT, were significantly related to increased AS in the setting of HFrEF. Full article

(This article belongs to the Special Issue Cardiovascular Diseases: Diagnosis, Treatment, and Management—for the Up-to-Date Practitioner)

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13 pages, 1639 KiB

Open AccessArticle

Sex Difference in the Risk of Dementia in Patients with Atrial Fibrillation

by Yung-Lung Chen, Joseph Chen, Hui-Ting Wang, Ya-Ting Chang, Shaur-Zheng Chong, Shukai Hsueh, Chang-Ming Chung and Yu-Sheng Lin

Diagnostics 2021, 11(5), 760; https://doi.org/10.3390/diagnostics11050760 - 23 Apr 2021

Cited by 10 | Viewed by 2078

Abstract

Atrial fibrillation (AF) is one of the risk factors for dementia. Female sex is an inconsistent risk factor for dementia after adjusting for age in the general population, and there lacks research on its impact in developing dementia in patients with AF. This [...] Read more.

Atrial fibrillation (AF) is one of the risk factors for dementia. Female sex is an inconsistent risk factor for dementia after adjusting for age in the general population, and there lacks research on its impact in developing dementia in patients with AF. This paper aims to investigate whether female sex is a risk factor for dementia in AF patients. Data of patients with newly diagnosed AF between 2001–2013 were retrieved from Taiwan’s National Health Insurance Research Database. Exclusion criteria were: patients with incomplete demographic data, age < 20 years, rheumatic heart disease, hyperthyroidism, past valvular heart surgery, and a history of dementia. Propensity score matching (PSM) between sexes was performed, including comorbidities, medications and index date stratified by age. The primary outcome was a new diagnosis of dementia at follow-up. A total of 117,517 men and 156,705 women were eligible for analysis. After 1:1 PSM, both 100,065 men and women (aged 72.5 ± 12.5 years) were included for analysis. Dementia risk varied with age in women compared with men. The difference was negligible for ≤55 years (sub distribution HR (SHR) = 0.89, 95% CI 0.73–1.07), but increased between 56–65 years (SHR = 1.13, 95% CI 1.02–1.25), 66–75 years (SHR = 1.14, 95% CI 1.09–1.20), 75–85 years (SHR = 1.11, 95% CI 1.07–1.15) and >85 years (SHR 1.10, 95% CI 1.04–1.16) for females. This study establishes that female sex increases the risk of developing dementia compared to male sex in AF patients aged >56 years. However, the impact of female sex on dementia in AF patients differs between dementia types. Full article

(This article belongs to the Special Issue Cardiovascular Diseases: Diagnosis, Treatment, and Management—for the Up-to-Date Practitioner)

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13 pages, 1262 KiB

Open AccessArticle

Hyponatremia—Long-Term Prognostic Factor for Nonfatal Pulmonary Embolism

by Anca Ouatu, Madalina Stefana Mihai, Daniela Maria Tanase, Cristina Gena Dascalu, Nicoleta Dima, Lacramioara Ionela Serban, Ciprian Rezus and Mariana Floria

Diagnostics 2021, 11(2), 214; https://doi.org/10.3390/diagnostics11020214 - 01 Feb 2021

Cited by 2 | Viewed by 1739

Abstract

Over recent years, studies have shown that in patients with left-sided heart failure, arterial hypertension, and acute coronary syndrome, hyponatremia is a negative prognostic factor. In this context, there is raising interest in the association between hyponatremia and pulmonary embolism (PE). This retrospective [...] Read more.

Over recent years, studies have shown that in patients with left-sided heart failure, arterial hypertension, and acute coronary syndrome, hyponatremia is a negative prognostic factor. In this context, there is raising interest in the association between hyponatremia and pulmonary embolism (PE). This retrospective cohort study includes 404 consecutive patients with confirmed acute nonfatal pulmonary embolism divided into four groups according to their sodium fluctuation pattern. The primary outcome was all-cause mortality and determining the recurrence rate among patients with nonfatal PE using serum sodium levels as a continuous variable. Patients with acquired and persistent hyponatremia had a significantly higher rate of mortality rate than those in the normonatremia group (12.8% and 40.4%, OR- 7.206, CI: 2.383–21.791, p = 0.000 and OR-33.250, CI: 11.521–95.960, p = 0.000 vs. 2%, p < 0.001, respectively). Mean survival time decreases from 23.624 months (95% CI: (23.295–23.953)) in the normonatremia group to 16.426 months (95% CI: (13.17–19.134)) in the persistent hyponatremia group, statistically significant (p = 0.000). The mean survival time for all patients was 22.441 months (95% CI: (21.930–22.951)). The highest recurrence rate was recorded at 12 and 24 months in the acquired hyponatremia group (16.7% and 14.1%, respectively). Serum sodium determination is a simple and cost-effective approach in evaluating the short and long-term prognosis in patients with acute PE. Full article

(This article belongs to the Special Issue Cardiovascular Diseases: Diagnosis, Treatment, and Management—for the Up-to-Date Practitioner)

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12 pages, 1823 KiB

Open AccessArticle

Altered Expression of Circadian Clock Genes in Patients with Atrial Fibrillation Is Associated with Atrial High-Rate Episodes and Left Atrial Remodeling

by Yung-Lung Chen, Jiin-Haur Chuang, Hui-Ting Wang, Huang-Chung Chen, Wen-Hao Liu and Ming-Yu Yang

Diagnostics 2021, 11(1), 90; https://doi.org/10.3390/diagnostics11010090 - 07 Jan 2021

Cited by 10 | Viewed by 2191

Abstract

A prominent circadian variation is present in atrial fibrillation (AF) attacks that may be related to the expression of circadian clock genes. Little is known about the expression of circadian clock genes in AF. We prospectively enrolled 73 patients who had received pacemaker [...] Read more.

A prominent circadian variation is present in atrial fibrillation (AF) attacks that may be related to the expression of circadian clock genes. Little is known about the expression of circadian clock genes in AF. We prospectively enrolled 73 patients who had received pacemaker implantation, in order to define the burden of atrial high-rate episodes (AHREs) accurately. AF was diagnosed clinically in 43 (59%) patients (15 with persistent AF and 28 with paroxysmal AF). The expression levels of circadian clock genes of peripheral blood leukocytes were checked. There were more males and patients with a larger left atrial (LA) size and lower expression levels of BMAL1, CRY2, NR1D1, NR1D2, PER2, RORA, RORC, and TIM genes in persistent AF group than in other groups. There was a significant correlation between higher AHRE burden and larger LA size and between higher AHRE burden and decreased expression of circadian clock genes in patients with AF. LA volume and the expression of CRY1, NR1D1, and RORA are significantly associated with AHRE burden. However, the underlying mechanism needs to be elucidated in further studies. Full article

(This article belongs to the Special Issue Cardiovascular Diseases: Diagnosis, Treatment, and Management—for the Up-to-Date Practitioner)

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11 pages, 1851 KiB

Open AccessSystematic Review

Influencing Cardiovascular Outcomes through Heart Rate Variability Modulation: A Systematic Review

by Alexandru Burlacu, Crischentian Brinza, Iolanda Valentina Popa, Adrian Covic and Mariana Floria

Diagnostics 2021, 11(12), 2198; https://doi.org/10.3390/diagnostics11122198 - 25 Nov 2021

Cited by 11 | Viewed by 3424

Abstract

Psychological stress is a well-established risk factor for cardiovascular disease (CVD). Heart rate variability (HRV)-biofeedback could significantly reduce stress levels and improve autonomic nervous system function and cardiovascular endpoints. We aimed to systematically review the literature to investigate the impact of HRV modulation [...] Read more.

Psychological stress is a well-established risk factor for cardiovascular disease (CVD). Heart rate variability (HRV)-biofeedback could significantly reduce stress levels and improve autonomic nervous system function and cardiovascular endpoints. We aimed to systematically review the literature to investigate the impact of HRV modulation through HRV-biofeedback on clinical outcomes in patients with CVD. A literature search was performed in the following databases: MEDLINE (PubMed), Embase, and Cochrane from the inception until 1 October 2021. Patients in the HRV-biofeedback group had significantly lower rates of all-cause readmissions than patients who received psychological education (respectively, p = 0.028 and p = 0.001). Heart failure following HRV-biofeedback displayed an inverse association with stress and depression (respectively, p = 0.022 and p = 0.033). When stratified according to left ventricular ejection fraction (LVEF), patients with LVEF ≥ 31% showed improved values of the 6 min walk test after HRV-biofeedback interventions (p = 0.05). A reduction in systolic and diastolic blood pressure associated with HRV-biofeedback was observed (p < 0.01) in pre-hypertensive patients. HRV-biofeedback had beneficial effects on different cardiovascular diseases documented in clinical trials, such as arterial hypertension, heart failure, and coronary artery disease. A standard breathing protocol should be applied in future studies to obtain equivalent results and outcomes. However, data regarding mortality in patients with coronary artery disease are scarce and need further research. Full article

(This article belongs to the Special Issue Cardiovascular Diseases: Diagnosis, Treatment, and Management—for the Up-to-Date Practitioner)

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