Aim To evaluate the prevalence of left ventricular hypertrophy (LVH) and its relationship with renal function parameters in patients with chronic kidney disease (CKD). Material and methods This cross-sectional retrospective cohort study included 1,080 patients with pre-dialysis CKD. The mean age was 39.0±12.9 years (17-74 years; median, 38 [28-49 years]). Patients were divided into three groups: Group 1 (n=381; GFR ≥60 mL/min/1.73 m²), Group 2 (n=181; GFR 59-30 mL/min/1.73 m²), and Group 3 (n=518; GFR ≤29 mL/min/1.73 m²). All patients underwent clinical and laboratory evaluation and echocardiography. Statistical analysis was performed using STATISTICA 10.0, utilizing Student's t -test, Mann-Whitney U test, ANOVA, and Spearman's correlation. Differences were considered statistically significant at p <0.05. Results The LV linear dimensions and mass index were significantly greater in patients with more pronounced renal impairment. Signs of LVH were identified in 489 patients (45.2%). The prevalence of LVH increased alongside the progression of CKD, reaching 8.8%, 26.5%, 35.5%, 35.1%, 52.7%, and 76.4% in stages C1-C5, respectively. Eccentric LVH was more prevalent than concentric LVH. LV mass index and relative wall thickness correlated significantly with both GFR and proteinuria levels. Conclusion Patients with CKD exhibit a high prevalence of LVH, which rises as the GFR declines and peaks at the advanced stages of the disease. LVH is predominantly eccentric. There is a statistically significant relationship between LV remodeling parameters and renal function, specifically GFR and proteinuria.
Background The age, creatinine, and left ventricular ejection fraction (ACEF) score is recognized as an effective predictor of poor in-hospital outcome across various clinical settings. However, its predictive utility for hospitalized heart failure (HF) patients with ejection fraction (EF) <50 %, i.e., HF with non-preserved EF, has not been validated. This is despite the critical need for simple risk stratification tools for this high-risk subgroup. Thus, this study aimed to evaluate the ability of the ACEF score to predict all-cause in-hospital mortality in patients hospitalized with HF and EF <50 %. Material and methods This retrospective analysis included 628 HF patients with EF <50 % who were admitted to the Cardiovascular Medicine and Intensive Care Medicine Department of the People's Hospital of Chongqing Liang Jiang New Area between January 2021 and June 2023. The ACEF score was calculated using the formula: ACEF = age (yrs) /EF (%) + 1 point if serum creatinine >= 176.8 & micro;mol / l (2.0 mg / dl). Multivariate logistic regression and receiver operating characteristic (ROC) curve analysis were employed to assess the association between the ACEF score and all-cause in-hospital mortality after adjusting for significant covariates identified through univariate screening and stepwise selection. Results Ofthe 628 included patients, 65 (10.35 %) died during hospitalization. The ACEF score was 1.75 (1.53-2.04) in the non-death group and 2.55 (1.7-2.85) in the death group (p<0.001), Multivariate logistic regression confirmed that the ACEF score was a significant predictor of in-hospital mortality (adjusted odds ratio = 5.106, 95 % confidence interval: 2.690-9.692, p<0.001). ROC analysis showed that an ACEF score >2.46 predicted mortality risk with an area under the curve of 0.732 (95 % CI: 0.696-0.766, p<0.001), yielding a sensitivity of 53.85 % and specificity of 91.12 %. Conclusion The ACEF score demonstrated high predictive utility for all-cause in-hospital mortality in HF patients and EF <50 %. Specificity was 91.12 % and sensitivity was 53.85 % at the optimal threshold of 2.46. The ACEF score should be valuable for risk-stratification of hospitalized HF patients with EF <50 %.
Background Cardiovascular metabolic diseases (CMD) are major global health challenges. Insulin resistance (IR) surrogates predict CMD progression, but existing evidence regarding the prognostic value of these surrogates for mortality in CMD populations is inconsistent. This study investigated the association between six IR surrogate indices and all-cause and cardiovascular disease (CVD) mortality in CMD patients, and it also evaluated the prognostic value of the IR surrogate indices. Material and methods Data of 2,944 patients with CMD were analyzed. Coxproportional hazards models and restricted cubic splines were employed to assess the associations between the IR surrogate indices: 1) Estimated glucose disposal rate (eGDR); 2) Visceral adiposity index (VAI); 3) Triglyceride-glucose index (TyG); 4) Triglyceride-glucose body mass index (TyG-BMI); 5) Metabolic score for insulin resistance (METS-IR); 6) Atherogenic index of plasma (AIP) and both all-cause mortality and CVD mortality. ROC curve analysis was used to compare the prognostic value of the IR surrogate indices. Results Among the CMD patients, eGDR, VAI, TyG, TyG-BMI, METS-IR, and AIP were all associated with all-cause mortality (all p < 0.050), with TyG-BMI and METS-IR showing the highest prognostic performance (AUC: 0.743 and 0.743, respectively). TyG and AIP were associated with CVD mortality (both p<0.050), with TyG and AIP both demonstrating the prognostic performance (AUC: 0.734 and 0.733, respectively). Conclusion In a CMD population, TyG-BMI and METS-IR demonstrated superior prognostic performance for all-cause mortality. TyG and AIP demonstrated the prognostic performance for CVD mortality.
Background Heart failure with reduced ejection fraction (HFrEF) is a heterogeneous syndrome in which symptom severity does not consistently correlate with left ventricular (LV) ejection fraction (LVEF). This study aimed to evaluate echocardiographic and clinical determinants of heart failure-related functional limitation in HFrEF. Material and methods 121 patients with HFrEF (LVEF <= 40 %) were retrospectively analyzed. The patients were stratified by New York Heart Association (NYHA) class into moderate (NYHA class I-II) and high (NYHA class III-IV) functional limitation groups and by etiology into ischemic HFrEF and nonischemic cardiomyopathy (NICM) groups. Echocardiographic parameters and clinical characteristics were compared. Multivariable logistic regression was used to identify independent predictors of advanced functional limitation. Results Patients in higher NYHA classes demonstrated larger ventricular dimensions, higher LV Mass, lower relative LV wall thickness, more severe atrioventricular valve regurgitation, elevated LV filling pressures, and impaired right ventriculoarterial coupling compared to those with mild functional limitation. NICM was associated with a greater prevalence of higher NYHA classes and eccentric remodeling, whereas LVEF did not differ significantly between the etiologies. In the multivariable analysis, the tricuspid annular plane systolic excursion / systolic pulmonary artery pressure ratio (TAPSE /sPAP) (odds ratio (OR) 0.589, 95 % confidence interval (CI)=0.374-0.928, p=0.022) and the early diastolic mitral inflow velocity/early diastolic mitral annular velocity ratio (E /e ') (OR=1.018, 95 % CI=1.000-1.390, p=0.048) emerged as independent predictors of advanced functional limitation. Conclusion In HFrEF, functional limitation severity is more closely related to indices of diastolic function and right ventriculoarterial coupling than to LVEF alone. Echocardiographic assessment of both left and right heart function, including E /e ' and TAPSE /sPAP, may more accurately reflect functional status.
Aim To evaluate the clinical, demographic, and molecular genetic characteristics of patients with homozygous familial hypercholesterolemia (HoFH), as well as the effectiveness of lipid-lowering therapy and the incidence of cardiovascular complications, based on the RENAISSANCE registry (Registry of patiENts with FH and very high cArdIovaScular riSk pAtients with iNuffiCient rEsponse to lipid-lowering therapy). Material and methods The RENAISSANCE registry is an open-label, national observational study involving patients with FH. The diagnosis of HoFH was established according to the 2014 European Atherosclerosis Society criteria. The study accounted for atherosclerosis risk factors, physical examination findings, cardiovascular history, and current lipid-lowering therapy. Lipid profile parameters included concentrations of total cholesterol, triglycerides, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol (LDL-C), and lipoprotein(a). Most patients underwent genetic testing for hypercholesterolemia. The study's endpoint comprised fatal and non-fatal cardiovascular events. Results The study included 6 children and 13 adults (6 males) with HoFH. The mean age was 26±14 years; an average follow-up period in the registry was 5.3±2.8 years. Tendon xanthomas were observed in 68% of patients, cutaneous xanthomas in 74%, and corneal arcus in 47%. The mean age of cardiovascular disease onset was 22 ± 8 years. Ischemic heart disease was diagnosed in 63% of patients, and 47% had undergone cardiovascular interventions (arterial revascularization, aortic valve replacement). The mortality rate reached 21%. Peak LDL-C level was 17.7±4.0 mmol/L. By the final visit, LDL-C had decreased by 46% to 9.6±5.6 mmol/L, though only four patients (21%) achieved an LDL-C level ≤3 mmol/L. The median lipoprotein(a) concentration was 100 [27; 145] mg/dL, with elevated levels (≥30 mg/dL) identified in 10 patients (67%). Treatment regimens included statins (95%), ezetimibe (95%), PCSK9 inhibitors (37%), and lomitapide (21%); 53% of patients underwent lipoprotein apheresis. During the follow-up period, 14 cardiovascular events occurred across 7 patients (including one child): 4 coronary artery bypass grafts, 6 aortic valve replacements, and 4 deaths. Conclusion In the registry-based observational study of patients with HoFH, there was an increase in the use of complex combination therapies, including lipoprotein apheresis and lomitapide. However, reaching target LDL-C levels remains challenging, and the incidence of cardiovascular complications remains high.
Aim Assessment of the relationship between Wnt signaling pathway proteins (Wnt1 and Wnt3a) and matrix metalloproteinases (MMP-1, -9, -14) in patients with stable coronary artery disease (CAD) and various patterns of coronary artery involvement. Material and methods This cross-sectional study included 94 patients divided into two groups based on the severity of CA lesions as determined by coronary angiography or computer tomography angiography. Group 1 consisted of 32 patients with non-obstructive CAD (NOCAD, CA stenosis <50%), including 20 (62.5%) women, with a median age of 63.5 [55.3; 71.7] years and a BMI of 28.1 [23.7; 32.5] kg/m². Group 2 included 62 patients with obstructive CAD (OCAD, CA stenosis >50%), including 43 (69.4%) men, with a median age of 64.0 [55.2; 72.8] years and a BMI of 27.5 [23.2; 31.8] kg/m². All patients underwent standard laboratory and instrumental examinations. Plasma concentrations of Wnt1, Wnt3a, MMP-1, MMP-9, and MMP-14 were measured using enzyme-linked immunosorbent assay. Statistical analysis was performed using parametric and non-parametric methods, ROC analysis, and binary logistic regression. Results In patients with OCAD, concentrations of Wnt1, Wnt3a, and MMP-9 were significantly higher compared to the NOCAD group. MMP-9 concentrations were 7.20 (4.20-10.80) ng/mL in OCAD vs. 3.58 (1.95-6.47) ng/mL in NOCAD ( p <0.001); Wnt1 was 0.19 (0.19-0.22) ng/mL and 0.15 (0.15-0.16) ng/mL, respectively ( p <0.001); and Wnt3a was 0.23 (0.18-0.28) ng/mL compared to 0.11 (0.05-0.14) ng/mL ( p <0.001). Significant positive correlations were found between the biomarkers MMP-9 and Wnt1 ( r =0.449, p <0.001), and Wnt1 and Wnt3a ( r =0.691, p <0.001). According to ROC analysis, Wnt1 demonstrated the highest diagnostic efficiency (AUC=0.975). A multivariate model including MMP-9, Wnt1, and Wnt3a showed a high predictive value (sensitivity 94.9%, specificity 95.2%). Conclusion This study is the first to demonstrate a statistically significant correlation between Wnt cascade markers (Wnt1, Wnt3a) and MMP-9 in patients with stable CAD across various CA lesion patterns. We observed a marked increase in plasma concentrations for MMP-9 (twofold), Wnt1 (1.3-fold), and Wnt3a (2.1-fold) in patients with OCAD. Consequently, the combination of Wnt and MMP-9 biomarkers may serve as a potential tool for differentiating between types of CA involvement.
Aim This study aimed to evaluate ventricular arrhythmia risk among patients who developed myocardial injury due to gastrointestinal bleeding by using the Tp-e interval, a predictive marker of ventricular arrhythmia. It is known that myocardial injury may develop secondary to gastrointestinal bleeding. This condition has been linked to an elevated risk of cardiac arrhythmia, a condition for which the Tp-e interval on electrocardiography is a marker. Material and methods The study included patients who presented to the emergency department with subsequently confirmed gastrointestinal bleeding. Based on high-sensitivity troponin T (hs-TnT) concentrations at presentation, two groups were formed: Patients with myocardial injury (hs-TnT >14 ng / l) and those without injury (hs-TnT <= 14 ng / l). Ventricular repolarization markers were measured to explore the association between these parameters and myocardial injury. Results Among cases of gastrointestinal bleeding, those presenting with myocardial injury exhibited significantly elevated Tp-e interval (73.5 +/- 9.1 vs. 62.1 +/- 6.8 msec, p<0.001) and Tp-e / QTc (0.16 +/- 0.02 vs. 0.13 +/- 0.07, p<0.001) values compared to those without myocardial injury. Myocardial injury correlated positively with the Tp-e interval and Tp-e / QTc (r=0.577 and r=0.528, respectively; p<0.001 for each). Conclusion In cases of gastrointestinal bleeding, myocardial injury was positively correlated with prolonged Tp-e interval and increased Tp-e / QTc, parameters associated with elevated risk of ventricular arrhythmia. The clinical significance of this association remains uncertain and requires confirmation and further assessment in future studies.
Aim To investigate plasma levels of omega-3, -6, and -9 unsaturated fatty acids (UFAs) in men with a history of myocardial infarction (MI) or stroke, and to evaluate the associations between specific UFAs and presence/absence of these cardiovascular events in history. Material and methods Participants enrollment and data collection were conducted as part of the multicenter, cross-sectional epidemiological ESSE-RF3 study. The sample included 900 men aged 35-74 years (600 from Novosibirsk and 300 from rural areas of the Novosibirsk region). Plasma UFA concentrations were measured using gas chromatography with mass-selective detection. Results In rural men, a history of MI was positively associated with plasma concentrations of arachidonic UFA (C20:4 n-6) and inversely associated with concentrations of docosahexaenoic (C22:6 n-3) and linoleic (C18:2 n-6) UFAs. In urban men, concentrations of oleic (C18:1 n-9) and mead (C20:3 n-9) UFAs were positively associated with a history of stroke. Conclusion This comparative study demonstrates distinct plasma UFA profiles in men aged 35–74 depending on the presence/absence of a history of vascular complications.
Aim To evaluate the impact of remote patient monitoring (RPM) via an artificial intelligence (AI)-driven voice robotic assistant (VRA) on markers of visceral adiposity (lipid accumulation product [LAP] index and visceral adiposity index [VAI]), glycemic control, and quality of life in patients with type 2 diabetes mellitus (T2DM) and obesity. Material and methods This prospective, open-label, comparative study included 121 patients with obesity and T2DM. Participants were divided into an observation group (n=71; standard care + daily AI-assisted monitoring) and a control group (n=50; standard care only). The follow-up period was one month. Results After one month, the observation group showed a statistically significant reduction in the LAP index by 25.9% (p<0.001) and VAI by 31.2% (p<0.001). Fasting blood glucose concentrations decreased by 15.1% (p<0.001). No significant changes were observed in the control group at one month. Intergroup differences at one month were statistically significant for both the LAP index (p=0.004) and VAI (p=0.007). Quality of life (SF-36) also improved significantly in the observation group (+7 points vs. +1 point in the control group; p<0.001). Conclusion Implementing a RPM program integrated with an AI-driven voice assistant for patients with obesity and T2DM significantly enhances the control of visceral obesity markers, glycemic levels, and quality of life, which effectively mitigates the risk of cardiometabolic disorders.
Objective To investigate the correlation between three-dimensional speckle tracking echocardiography (3D-STE) parameters and degree of myocardial fibrosis in patients with hypertrophic cardiomyopathy (HCM), and to evaluate the prognostic value of 3D-STR. Material and methods A retrospective analysis of 300 HCM patients diagnosed between January 2022 and December 2024 was conducted. All the patients had been examined with 3D-STE and cardiac magnetic resonance (CMR) with late gadolinium enhancement (LGE). Based on the LGE percentage. the patients were stratified into mild fibrosis (LGE%<15 %, n=168) and moderate-to-severe fibrosis groups (LGE% >= 15 %, n=115). Pearson / Spearman correlation analysis was used to assess the relationship between 3D-STE parameters and LGE%, ROC curve analysis to evaluate the diagnostic performance of 3D-STE, and Cox regression analysis to determine the prognostic value 3D-STE. The primary composite end- diogenic syncope, and stroke. Results 283 patients completed a median follow-up of 18.0 mos. The 3D-GS absolute value demonstrated a strong correlation with LGE% findings (r=-0.714, p<0.001), outperforming other strain and tor- sion parameters. Multivariate linear regression identified the 3D-GS absolute value as an independent predictor of myocardial fibrosis (as quantified by LGE%) (beta=-0.486, p<0.001). The AUC of 3D-GS absolute value for predicting moderate-to-severe fibrosis was 0.896 (95 % CI: 0.860-0.932), with an optimal cutoff value of 12.1 % (sensitivity 86.1 %, specificity 82.7 %). During follow-up, 92 patients (32.5 %) experienced primary composite endpoint events. Multivariate Cox regression revealed that the 3D-GS absolute value independently predicted major adverse cardiovascular events (HR=0.754, p<0.001), with a model C-index of 0.824. Conclusion 3D-STE parameters, particularly 3D-GS, demonstrate close correlation with the degree of myocardial fibrosis in HCM patients. It exhibited excellent diagnostic performance and prognostic value and may serve as a practical, non-invasive tool for assessment of myocardial fibrosis.
Objective To explore the association among epicardial adipose tissue (EAT), inflammatory markers, and coronary microvascular dysfunction (CMD) in patients with non-obstructive coronary artery disease (NOCAD) and to determine independent risk factors for CMD in patients with non-obstructive coronary artery disease. Material and methods We retrospectively analyzed clinical data from 286 NOCAD patients who underwent coronary angiography between January 2022 and June 2024. The patients were stratified into a CMD group (n=152) and a non-CMD group (n=134), according to coronary flow reserve (CFR) greater than 2.0 and / or an index of microcirculatory resistance (IMR) greater or equal to 25 (units). Quantitative measure- ments of EAT volume and area were obtained by coronary computed tomography angiography, and serum concentrations of inflammatory markers were assessed. Correlation analysis and multivariate logistic regression analysis identified independent predictors of CMD, and receiver operating charac- teristic curves evaluated predictive performance. A combined predictive model was constructed based on the multivariate logistic regression equation, and predicted probabilities were calculated for each patient. Receiver operating characteristic (ROC) curve analysis was then performed using the predict- ed probabilities of the model. Results the CMD group had significantly higher EAT volume and mean EAT area compared to the non-CMD group (both p<0.001). Patients in the CMD group exhibited elevated hs-CRP, IL-6, TNF-alpha, and monocyte chemoattractant protein-1 (MCP-1) along with reduced adiponectin (all p<0.001). IL-1 beta concentrations showed no significant intergroup difference (p=0.055). EAT volume correlated negatively with CFR (r=-0.542) and positively with IMR (r=0.518), while demonstrating positive associations with major pro-inflammatory markers and negative correlation with adiponectin (all p<0.001). MCP-1 (OR=1.012), and EAT volume (OR=1.028) as independent risk factors for CMD, whereas adiponectin (OR=0.682) was identified as a protective factor (all p<0.05). The combined predictive model demonstrated an area under the curve of 0.912, with 86.2 % sensitivity and 83.6 % specificity. Conclusion Increased EAT in NOCAD patients is closely associated with CMD, potentially mediated through inflammatory pathways. EAT and specific inflammatory markers, may function as biomarkers for early CMD identification, and EAT may represent a potential therapeutic target.
