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Open access

Raina G. Ardasheva, Mariana D. Argirova, Valentin I. Turiiski and Athanas D. Krustev

Abstract

Background: Increased intra-abdominal pressure (IAP) causes tissue ischemia, subsequent hypoxia, and impairment of normal tissue metabolism. Elevation of IAP above 20 mmHg leads to progression of abdominal compartment syndrome (ACS) that is associated with organ dysfunction or failure not previously manifested. Aim: To evaluate the eff ects of diff erent grades and time of exposure to IAP on biochemical parameters and oxidative stress in organs aff ected by ischemia using previously developed rat model. Results: Three experimental groups exposed to diff erent IAP and time frames were tested for liver, kidney, and pancreas injury by measuring the activities of tissue specifi c enzymes in blood serum. Elevated activities of aspartate aminotransferase, pancreatic amylase, lipase, and higher concentrations of D-lactate, urea, and creatinine were found in some of the experimental groups compared to a control group of animals not subjected to increased IAP. Increased levels of biomarkers of oxidative stress as well as decrease in concentration of the major cellular antioxidant glutathione indicated the presence of oxidative injury as a result of elevated IAP. Conclusions: The developed rat model is appropriate to study the mechanism and manifestation of tissue injury during diff erent grades of elevated IAP but also to test approaches aimed to attenuate the detrimental eff ects of ACS. This study also underlines the necessity of using not a single but a set of biochemical parameters in order to assess the severity of tissue injury during elevated IAP and progression to ACS.

Open access

Hektor Sula, Rudin Domi, Arben Beqiri and Andi Koraqi

Abdominal Compartment Syndrome as an Independent Mortality Predictor Factor During Acute Pancreatitis

Aim: The aim was to study the role of abdominal compartment syndrome and intra-abdominal hypertension (IAH) as indipendent predictor factors on outcome and mortality in patients during early phase of acute pancreatitis (AP).

Material and Methods: According the IAP 102 patients with medically treated AP were divided: in the first group (N = 32 patients) the IAP was over 12 mmHg, in second group (N = 27 patients) the IAP was over 20 mmHg (ACS), and the third group (N = 43 patients) with normal pressure. There were recorded APACHE 2 score in admission, the incidence of multiorganic dysfunction syndrome and mortality.

Results: No statistical significance is observed between three groups regarding age, gender, APACHE II score, Ranson score, CTSI. Kruskal-Wallis test resulted positive for all variables suggesting a statistically significant difference between groups. The pairwise test for comparison of subgroups according to Conover, yielded a statistically significant difference of ACS (p<0.05). ACS group resulted with more early deaths (13 patients) and total deaths (15 patients).

Conlusion: The abdominal compartment syndrome and increased intrabdominal pressure occurred during the early fase of AP may be predictors of increased MODS and mortality.

Open access

Johann Trutz, Aurel Babeş and Katalin Babeş

Abstract

Background and Aims. The identification of type 2 diabetes mellitus (T2DM) patients with high cardio-vascular risk became more crucial, especially in patients with known coronary artery disease (CAD). Our study is focusing on T2DM patients who suffered recently an acute coronary syndrome (ACS), and evaluates the importance of albuminuria and NT-proBNP level as risk factors for short-term recurrence.

Material and methods. 221 T2DM patients with recent ACS were evaluated 1 month after discharge, assessing NT-proBNP and albuminuria level and followed for 12 months for major adverse cardiac events (MACE).

Results. Patients who reached the endpoint (33%) presented significantly higher levels of NT-proBNP (458.5 vs. 207.4 pg/ml, p<0.0001) and urinary albumin/creatinine ratio (80 vs. 27 mg/g, p<0.0001) than those who did not present a MACE in the follow-up period. Comparison of the MACE-free survival curves revealed that NT-proBNP has a better power than albuminuria in the prediction of the short-term outcome: hazard ratio (HR)=1.6176 (95%CI: 1.0047-2.6044), p=0.0433 vs. HR=1.4813 (95%CI: 0.8497-2.5824), p=0.1921. Only the NT-proBNP level entered the multivariable regression model besides age and represents an independent risk factor (HR=1.0025, 95%CI: 1.0014-1.0035, p=0.0036).

Conclusion. NT-proBNP provides excellent prognostic information in patients with diabetes mellitus who recently suffered an ACS. Albuminuria wasn’t an independent risk factor in this cohort.

Open access

Diana Opincariu and Iulia Monica Chițu

ABSTRACT

Atrial fibrillation (AF) is an increasingly widespread healthcare problem. AF can frequently present as a complication in acute coronary syndromes (ACS), especially in ST-elevation acute myocardial infarction (AMI), in which case it is the most frequent supraventricular rhythm disturbance with an estimated incidence of 6.8-21%. The presence of AF in ACS heralds worse outcomes in comparison to subjects in sinus rhythm, and several studies have shown that in AMI patients, both new-onset and pre-existing AF are associated with a higher risk of major adverse cardiovascular and cerebrovascular events during hospitalization. The cause of newonset AF in AMI is multifactorial. Although still incompletely understood, the mechanisms involved in the development of AF in acute myocardial ischemic events include the neurohormonal activation of the sympathetic nervous system that accompanies the AMI, ischemic involvement of the atrial myocytes, ventricular dysfunction, and atrial overload. The identification of patients at risk for AF is of great significance as it may lead to prompt therapeutic interventions and closer follow-up, thus improving prognosis and decreasing cardiovascular and cerebrovascular events. The present manuscript aims to summarize the current research findings related to new-onset AF in AMI patients, as well as the predictors and prognostic impact of this comorbid association.

Open access

Borysław Paulewicz, Agata Blaut and Joanna Kłosowska

Abstract

Attentional bias is assumed to be partly responsible for the onset and maintenance of anxiety by major cognitive theories of emotional disorders. Although much is already known about the therapeutic effects of attentional bias training, only a few studies have examined the mechanism responsible for these effects. In order to test if low-level, cognitive effects of attentional bias training depend on attentional control, 73 participants, who completed the STAI-x2 and the ACS questionnaires, were randomly assigned to a control (n = 37) or attentional training group (n = 36). The attentional manipulation was followed by a search task, during which novel neutral or negative faces could be presented within an array of all-neutral, all-negative or all-positive faces. It was found that individuals with higher ACS score displayed stronger attentional training effects, i.e., they were less accurate in detecting distinctive negative faces, and this effect was not found to be associated with STAI-x2 score. These results show that there is individual variability even in immediate, cognitive effects of attentional bias modification and that special abilities, such as attentional control, might be required for attentional training to be efficient.

Open access

Małgorzata Fajkowska and Douglas Derryberry

Psychometric properties of Attentional Control Scale: The preliminary study on a Polish sample

The presented study was focused primarily on a psychometric analysis of the Attentional Control Scale (ACS), but they also enhanced the understanding of the role of effortful attentional skills in determining the individual well-being, general adaptation or emotional disorders. The analyses included basic item and scale descriptions as well as convergent and discriminant validity. 218 Polish undergraduate students completed the battery of the self-report techniques and two paper —pencil attentional tests. Data revealed a unidimensional of a 20-item ACS. It can be used validly to assess long-term individual differences in attentional skills related to the voluntary executive functions. The analysis of content, internal and construct validity as well as reliability provided evidence of the scale's significant convergent and discriminant validity when correlated with attentional tests and other personality techniques. We found strong, systematic relations between the attentional control and selected measures of temperament, arousal, emotionality, and motivation. The results allow assuming that good attentional control, may protect individuals from the emotional disorders by regulating perceptual, conceptual, and response processing.

Open access

Jakó Beáta, Benedek Theodora, Suciu Zsuzsanna and Benedek I

Abstract

Introduction: Coronary calcium score, as determined by Angio CT multislice, has been proved to represent a reliable parameter which reflects the global cardiovascular risk. We aimed to study the characteristics of culprit lesions in Acute Coronary Syndrome (ACS) patients with low versus high calcium score. Material and methods: A total of 45 patients with ACS underwent 64-slice CCTA. Group 1 - 19 patients with Ca score below 400HU, Group 2 - 26 patients with calcium score >400HU. In all patients a complex CT analysis of the culprit plaque was performed. Results: There were no significant differences between the groups at baseline as regard to age, gender, cardiovascular risk factors (p>0.2). In patients with high calcium score, culprit lesions presented a significantly larger amount of plaque burden than in patients with low calcium score (82.8ml versus 131.81ml, p <0.0001). This was also true when assessing in a subanalysis different cut-off points for definition of relatively higher calcium score (89.66ml versus 137.93ml, p <0.0001, for calcium score cut off 600HU, 97.88ml versus 137.57ml, p<0.0001 for calcium score cut-off of 1000HU). Conclusion: Our data shows that patients with high calcium score who develop an acute coronary syndrome present larger atheromatous plaque than those with low calcium scores, and theseverity of the culprit lesions correlates with global cardiovascular risk as expressed by a high calcium score

Open access

Grazyna Sypniewska, Marcin Sawicki, Magdalena Krintus, Marek Kozinski and Jacek Kubica

The Use of Biochip Cardiac Array Technology for Early Diagnosis of Acute Coronary Syndromes

Serum troponin is the best biomarker for the diagnosis of acute coronary syndrome, but it takes considerable time before a definitive diagnosis is available. The purpose of this study was to evaluate whether a multimarker approach, using the biochip cardiac array, would facilitate the early diagnosis. Serum biomarkers were determined on admission (≤6 hrs) and after 6 hours in 42 patients suspected for ACS. Cardiac troponin I was measured by a sensitive assay (STATcTnI) and cardiac markers (H-FABP, myoglobin, cTnI, CK-MB mass, carbonic anhydrase III) were assayed with the use of Biochip Array Technology. STATcTnI concentrations, within the first 6 hours, were elevated >99th percentile for the reference population in 83.3% of subjects, but none reached the cut-off for AMI. On admission H-FABP was the only marker with 90.5% sensitivity in all ACS cases and 100% sensitivity in STEMI/NSTEMI patients. The sensitivity of myoglobin at presentation was 71.4% in ACS, however, combined sensitivity of myoglobin and H-FABP reached 95.2%. Lowering the cut-off for cTnI allowed early diagnosis (≤6 hrs) in only 26.2% of ACS patients and 95.2% after the next 6 hours. In unstable angina the cardiac panel was not sufficiently accurate for early risk stratification. In conclusion, testing for both markers, H-FABP and sensitive cardiac troponin, available with the cardiac array may facilitate the early detection of myocardial injury in clinical practice.

Open access

Pēteris Tretjakovs, Antra Jurka, Inga Bormane, Indra Miķelsone, Dace Reihmane, Gita Krieviņa, Iveta Marksa, Karlīna Elksne, Jurijs Verbovenko and Guntis Bahs

Neopterin, cellular adhesion molecules and myeolperoxidase in patients with stable and unstable angina pectoris

Recent data indicate that the serum level of neopterin, a marker of inflammation and immune modulator secreted by monocytes/macrophages, is elevated in patients with acute coronary syndrome (ACS) and seems to be a prognostic marker for major cardiovascular events. Soluble cellular adhesion molecules (sCAMs) and myeloperoxidase (MPO) levels are also related to ACS. The aim of the present study was to evaluate differences in serum levels of neopterin, sCAMs and MPO between coronary artery disease and metabolic syndrome (CAD-MetS) patients with stable and unstable angina pectoris (SAP, UAP), and to clarify the relationships between neopterin and other biomarkers. The study included 60 patients with CAD-MetS who were classified into two groups, 30 patients with SAP and 30 patients with UAP. Twenty healthy subjects were selected as controls (C). Serum soluble vascular cell adhesion molecule-1 (sVCAM-1), intercellular cell adhesion molecule-1 (sICAM-1), sE-selectin and MPO levels were measured by Luminex xMAP technology, and serum neopterin concentrations were measured by radioimmunoassay. Results: Serum levels of neopterin, MPO, sVCAM-1, sICAM-1, and sE-selectin were significantly higher in patients with UAP in comparison with the group of healthy controls (P < 0.05). Patients with SAP also had higher levels of these biomarkers than those in healthy controls (P < 0.05), except for sE-selectin. The biomarker level did not differ between the two patient groups, except for MPO, which was significantly higher in the USP group (P < 0.05). Neopterin was significantly correlated only with sVCAM-1 (P < 0.05). In conclusion, CAD-Met patients with SAP had more apparent raised levels of serum sICAM-1 and sVCAM-1, simultaneously with higher MPO and neopterin concentrations, in comparison to those in healthy subjects. However, UAP is also associated with more substantial changes in MPO and significantly increased sE-selectin levels. Neopterin concentration was had a close correlation only with sVCAM-1.

Open access

Theodora Benedek, András Mester, Annabell Benedek, Nora Rat, Diana Opincariu and Monica Chițu

Abstract

The aim of this systematic review was to analyze studies characterizing vulnerable coronary plaques using optical coherence tomography (OCT) and intravascular ultrasound (IVUS), in order to identify the most efficient invasive technique permitting plaque characterization in patients with acute myocardial infarction.

Method: A total number of 432 studies were identified, 420 through database searching and 12 through manual searching. Eight duplicate studies were removed, leaving a total number of 424 studies to be screened. Twenty-six studies only available in Abstract-only form were excluded, resulting in 398 studies checked for eligibility. Eleven studies fulfilled the eligibility criteria and were included in this systematic analysis. Plaque vulnerability was investigated in plaques with thin cap fibroatheroma (TCFA) versus those with thick cap fibroatheroma, in ruptured coronary plaques versus non-ruptured coronary plaques, in culprit versus non-culprit lesions and in lipid-rich versus non-lipid-rich plaques.

Results: A total of 1,568 coronary plaques in 1,225 patients with acute coronary syndromes (ACS) who underwent both IVUS and OCT for analysis of plaque features were included in the final analysis. The review identified the following IVUS-derived features as significantly correlated with plaque vulnerability: plaque burden (p <0.001), remodeling index (p <0.001), external elastic membrane cross-sectional area (p <0.001), and the amount of necrotic core (p <0.001), while OCT-derived features characterizing unstable plaque were TCFA (p <0.001), lipid arch (p <0.001), accumulation of macrophages (p = 0.03), and presence of intracoronary thrombus (p <0.001).

Conclusion: Both IVUS and OCT are invasive imaging techniques able to provide relevant information on the vulnerability of coronary atheromatous plaques, identifying, as they do, various plaque features significantly associated with unstable plaques. Information provided by the two techniques is complementary, and both methods can serve as a useful clinical diagnostic tool, especially in cases of ACS patients undergoing a revascularization procedure.