Svetlana Kostić

Impact of depression on sexual dysfunction and HRQoL in CAD patients

BackgroundThe aim of this study was to assess the impact of the depression on sexual dysfunction and the health-related quality of life (HRQoL) in coronary artery disease (CAD) patients admitted for cardiovascular rehabilitation within 3 months after an acute myocardial infarction (AMI). Methods. In all, 745 consecutive CAD patients (502 men and 243 women, aged 60.9 ± 9.3 years) admitted for cardiovascular rehabilitation within 3 months after an AMI, were enrolled in the study and divided into 4 groups according to Beck depression inventory (BDI) score range. HRQoL was estimated using the SF-36 questionnaire for total QoL and dimensions for physical and mental health [physical and mental component summary scores (PCS, MCS)]. Sexual dysfunction was assessed using the ASEX scale.ResultsThe HRQoL decreased following the range of depression, as demonstrated for significantly higher PCS in minimal compared to mild, moderate and severe depression groups (P<0.001). The MCS was significantly higher in minimal compared to mild, moderate and severe depression groups (P<0.001). The ASEX score was significantly higher in minimal, compared to mild, moderate and severe depression groups, as well as in mild and moderate compared to severe depression group. A significant association was found between depression score range and age, self-reported regular exercise, type 2 diabetes mellitus, and cigarette smoking.ConclusionsDepression significantly affected HRQoL and sexual dysfunction in CAD patients, as demonstrated by the significant decrease of PCS, MCS, and significant increase of ASEX score following the range of the depression according to BDI.

Correlation between total cardiovascular risk and bone density in postmenopausal women

The aim of the paper was to examine the correlation between the total risk of cardiovascular events, determined by the SCORE (Systematic Coronary Risk Evaluation) system, and bone density in postmenopausal women. Examinees and method: The research involved 300 postmenopausal women. On the basis of bone density measurements, the participants were divided into three groups: group I — 84 examinees had osteoporosis, group II — 115 examinees had osteopenia, and group III — 101 examinees had normal bone mineral density (BMD). Results: Participants with high SCORE risk were statistically significantly older compared to low-risk women (60±3 vs. 55±5; p<0.001). They had significantly lower BMD and T scores (−1.09±0.94 vs. −2.86±0.63; p<0.001). Elevation of the SCORE risk by 1% caused a BMD decrease of 0.033 g/cm2(0.029 to 0.036 gr/cm2). Multivariate logistic regression analysis showed that the following factors caused a significant increase in the risk of decreasing BMD: every year of life by 20%, menopause duration by 26%, increase in systolic blood pressure (BP) by 1 mm Hg by 7%, increase in SCORE risk by 1% by 5.31 times, physical inactivity by 5.96 times, and osteoporosis in the family history by 3.91 times. Conclusion: Postmenopausal women who are at high risk for cardiovascular diseases have a lower BMD than those who are not at high risk for cardiovascular diseases.

QTc dispersion and Cornell duration product can predict 10-year outcomes in hypertensive patients with left ventricular hypertrophy

Persistent and adequate treatment of patients with arterial hypertension leads to more favorable disease outcome.

Health-related quality of life in patients with coronary artery disease after coronary revascularization

The aim of this study was to investigate the quality of life (HRQoL) in coronary artery disease(CAD) patients, admitted for rehabilitation within 3 months after an acute coronary event, in relation to treatment strategy [conservative treatment without revascularization (WR), percutaneous transluminal coronary angioplasty (PTCA), coronary artery bypass graft (CABG)]. Methods: Overall 719 consecutive CAD patients were involved in the study: WR (n=170), PTCA (n=226), CABG (n=323). HRQoL was estimated using the SF-36 questionnaire for total QoL and its two dimensions for physical and mental health [physical and mental component scores (PCS, MCS)]. Sexual dysfunction was assessed using the ASEX scale. Results: Significantly higher PCS, MCS and total SF-36, but lower ASEX score, were found in men compared with women. The ASEX score was significantly affected by age. Significantly higher PCS was found in PTCA group compared with that of CABG group. In multivariate analysis a significant positive association was obtained between PCS/MCS and male sex, between regular exercise, hyperlipoproteinemia, and permanent stress. ASEX was significantly positively associated with the age, CHF and non smoking. Conclusion: The results of this study have demonstrated significantly better HRQoL in men, younger CAD patients, patients who underwent PTCA and in patients without self-reported exposition to stress.

Significance of asymptomatic hyperuricemia in patients after coronary events

Abstract The goal of the present study was to determine the prevalence of hyperuricemia in patients with coronary artery disease (CAD), within three months after coronary events. Also, we aimed to determine whether the presence of hyperuricemia holds correlation with severe CAD, overall heart functioning and risk factors for CAD. The study included 505 consecutive CAD patients, 385 males and 120 females, aged 60.9u2009±u20099.6 years, with a mean body mass index (BMI) 28.0u2009±u20093.7u2009kg/m2. All patients were admitted to specialized cardiovascular rehabilitation within three months post-acute myocardial infarction (AMI) without revascularization (32.6%), percutaneous coronary intervention (PCI) with myocardial infarction (32.1%) and with coronary bypass graft (35.3%). The mean value of serum acidum uricum (SUA) was 345.5u2009±u2009100.3 µmol/L, where 115 (22.8%) patients had asymptomatic hyperuricemia. Patients with asymptomatic hyperuricemia had significantly higher average number of risk factors, lower HDL cholesterol and higher creatinine and triglycerides levels, lower ejection fraction (EF). Multivariate stepwise analysis revealed that five parameters were capable to predict SUA levels. We can conclude that in patients with CAD, SUA levels are independently associated with BMI, triglyceride and creatinine levels and negatively with EF. Thus, one can say that asymptomatic hyperuricemia is not significantly associated with the severity of CAD.

THE EFFECT OF DEGREE AND TYPE OF LEFT VENTRICULAR HYPERTROPHY ON VENTRICULAR ARRHYTHMIAS IN HYPERTENSION

Finding the arrythmogenic potential in patients with arterial hypertension as well as its correlation with left ventricular hypertrophy (LVH), and its type and degree. The research included 109 hypertensive patients (pts) (54 male and 55 female), 54.2 ± 7.9 years oldxa0 without symptomatic coronary disease, myocardial infarction andxa0 systolic dysfunction. All the pts had a clinical examination, ECG, 24 h Holter monitoring with Lown classification of ventricular arrhythmias, an echocardiogram with left ventricular mass index (LVMI) and a specific type of LVH. QT interval dispersion (QTd) was calculated on 12 leads standard ECG. 75 pts had LVH (LVMI: 172.6 ± 42.95 g/m2) while 35 pts were without LVH (109.3 ± 15.9 g/m2). Non sustained ventricular tachycardia was registered in 13 pts (17.6%) with LVH and 1 female patient without LVH (2.9%). Patients with VT had a considerably higher ILVM (214.9 ± 6.8 vs. 151.9 ± 47.2 g/m2) than the average and higher QTd (73.7 ± 19.1 vs. 55.2 ± 20.2). VT was registered in 3/19 (15.8%) with eccentric nedilated type LVH, 6/38 (15.8%) with concentric LVH, 1/11 (9.1) (disproportional septal LVH) and 3/5 ( 60%) with dilated LVH. Univariate analysis showed a considerable correlation between the degree of arrhythmias and ILVM (p<0.001) and QTd (p=0.012). Ventricular arrhythmias in patients with arterial hypertension are considerably correlated to the degree of LVH expressed in ILVM and QTd.

AB0832 Increased Serum Uric Acid (SUA) Levels Are A Common Finding in Patients with High Blood Pressure, Insulin Resistance, Obesity and Cardiovascular (CV) Disease

Objectives To evaluate the connection between SUA and severity of coronary heart disease (CHD) assessed by angiography in patients with CHD. Methods 198 patients (75.8% men) undergoing cardiovascular rehabilitation at the Institute “Niska Banja” from October 1, 2014, to January 31, 2015, were evaluated. Mean (SD) patient age (62.1±10.4), prevalence of patients with 3-vessel coronary artery disease with stenosis >70% (31.3%), coronary artery bypass grafting (CABG) (37.4%), percutaneus coronary intervention (PCI) (38.9%), primary PCI (32.8%), mean ejection fraction (50% ±11). Prevalence of hyperuricemia (>386 μmol/l) 33.3%, hypertension 85.9%, hypelipoproteinemia 81.8%, diabetes mellitus 24%, family history of CHD (47%) and mean number risk factors 2.65. Patients were separated into a normal SUA group (n=132, with SUA <386 μmol/L) and a high SUA group (n=66, with SUA ≥386 μmol/L). Results Patients with high SUA had significantly higher 3-vessel coronary artery disease with stenosis >70% (40.9% vs. 26.5%; P=0.04), low ejection fraction (EF<34%)(19.7% vs. 8.3%; p=0.021), obesity (27% vs. 14.4; P=0.03), significantly higher triglycerides (2.38±1.7 vs. 1.88±1.44; P=0.028) and serum creatinine (111.5±46 vs. 90±21; p<0.001). Conclusions SUA levels were independently associated with EF in patients with CHD. Hyperuricemia is associated with severity of CAD- 3-vessel coronary artery disease with stenosis >70%. Disclosure of Interest None declared

FRI0292 Osteoporosis –A Risk Factor for Cardiovascular Diseases (A Follow-Up Study)

Background Cardiovascular (CV) diseases and bone fractures due to osteoporosis are the leading causes of death in the elderly. Objectives The aim of this study was to demonstrate a correlation between the overall risk for CV events, and low bone density in postmenopausal women, and its impact on the incidence of serious CV events. Methods Our prospective study involved 300 postmenopausal women. All the examinees were divided into three groups based on their measured bone density: Group I – 84 examinees with osteoporosis; Group II – 115 examinees with osteopenia; and Group III – 101 examinees with normal bone density. In all examinees the overall ten-year risk for a fatal CV event was calculated using the SCORE system tables. Results After a 36-month follow-up, CV events occurred in 19 (6.3%) examinees. Significant differences in the incidence of CV events were demonstrated between the patients with osteoporosis, osteopenia, and normal bone density (χ2=28.7; p<0.001), as well as between those with a high and low CV risk (χ2=22.6; p<0.001). Multivariate logistic regression analysis showed that smoking (OR: 2.23; 95% CI: 1.02 to 6.19; p=0.035), and increase of overall CV score (OR: 1.36; 95% CI: 1.17 to 1.58; p<0.001) are associated with increased CV event risk, while the increase of T score value is associated with decreased risk of CV event (OR: 0.42; 95% CI: 0.25 to 0.73; p=0.002). Conclusions Measurement of bone density with a standard assessment of the total CV risk could be useful for selecting women who need intensive prevention and treatment of atherosclerosis. Disclosure of Interest None declared

Association of the thickness of carotid intima-media complex and ancle brachial index with coronary disease severity

AbstractOur aim was to establish the association of carotid intima-media thickness (CIMT) and ankle-brachial index(ABI) with the severity of coronary artery dissease (CAD). The study enrolled 150 examinees and divided them into two groups. The patients with stenotic changes in the coronary artery, constituted the first group (CP)(n=100); the second group consisted of the examinees without CAD — control goup (CG) (n=50). The following methods were used in the study: Color Doppler sonography of the carotid arteries, ABI, calculation of SCORE risk and coronary angiography.ResultsThe number of coronary blood vessels affected by atherosclerosis was significantly higher with the increase of CIMT, CV risk score, and waist-hip ratio by one measurement unit: CIMT by 0.729; p<0.05; CV risk score by 0.033; p<0.05; and waist-hip ratio by 3.182; p<0.01. With each increase of ABI value by one measurement unit, the number of involved blood vessels dropped by 0.844; p<0.05.ConclusionsOur results demonstrated that reduced ABI value, increased CIMT and number of plaques in the carotid arteries were in correlation with the severity of coronary artery disease.

Administration and effects of secondary prevention measures in coronary heart disease patients from Serbia according to gender and cardiometabolic risk.

BACKGROUNDnThe EUROASPIRE surveys showed high rates of modifiable cardiovascular risk factors in patients with coronary heart disease, identified after coronary artery bypass graft, percutaneous coronary intervention or myocardial infarction, with time trends in preventive cardiology over more than a decade.nnnAIMnThe aim of this study was to test the implementation of European recommendations for cardiac rehabilitation and secondary risk prevention programmes in the population of coronary heart disease patients from Serbia.nnnSUBJECTS AND METHODSnA total of 665 consecutive coronary heart disease patients (432 men, 233 women, aged 59.43 +/- 11.62 years), admitted for specialized cardiovascular rehabilitation, interviewed and examined in relation to the presence of coronary risk factors and administration of secondary prevention measures, were enrolled in the study.nnnRESULTSnHigh rates of smoking (27.67%), central obesity (58.05%), physical inactivity (61.50%) and adverse dietary habits (61.50%) were observed, as well as low frequency of patients who have reached recommended targets for waist circumference (41.95%), total cholesterol (40%), LDL-cholesterol (39.25%), HDL-cholesterol (59.69%) and triglycerides (59.25%), while systolic (82.26%) and diastolic blood pressures (95.49%) were well regulated. A significantly lower rate of achieved therapeutic targets, despite widely used cardioprotective drugs, was observed in diabetic patients and patients with the metabolic syndrome.nnnCONCLUSIONnThe results have shown a low proportion of coronary heart disease patients, especially with diabetes mellitus and metabolic syndrome, who reached the recommended therapeutic targets for cardiometabolic risk profile parameters, in spite of widely used cardioprotective drugs, and therefore clearly demonstrated the compelling need for more effective lifestyle management in the secondary prevention of coronary heart disease.