volume-10-issue-4-december-2024 – JCE – Journal of Cardiovascular Emergencies

The Impact of Nutritional Status and Nutritional Intervention Strategies on Acute Coronary Syndrome

Cristina Dina, Victoria Ancuta Nyulas, Ada Radu, Simona Gabriela Bungău — Thu, 05 Dec 2024 11:03:05 +0000

ABSTRACT:
Cardiovascular diseases, including acute coronary syndrome, remain the main cause of mortality and a major cause of morbidity in Europe and worldwide. Also, in Romania, more than half of all registered deaths are cardiovascular deaths. Numerous modifiable and non-modifiable risk factors contribute to the incidence of cardiovascular illnesses. A general understanding of heart disease prevention is required in order to be able to modify and address the present circumstances. The role that nutrition plays in mitigating modifiable cardiovascular risk factors and the role that nutritional intervention plays in preventing inflammation linked to acute cardiac pathology will be the main topics of this article. The relationship between these two concepts is still poorly understood. Therefore, further research is necessary in this direction.
Keywords: nutritional status, nutritional intervention, inflammation, acute coronary syndrome

Predictors and Consequences of Subclinical Renal Impairment in Patients with Vascular Disease

Wed, 04 Dec 2024 08:17:24 +0000

ABSTRACT
Background: The estimated glomerular filtration rate (eGFR) is the most widely used biomarker of kidney function. However, measurement of biomarkers more sensitive than eGFR may be required to detect subtle renal changes and to identify additional predictors and consequences of kidney injury. Aim of the study: In the present study, we aimed to identify predictors and consequences of subclinical renal impairment, as reflected by the levels of neutrophil gelatinase-associated lipocalin (NGAL) and cystatin C. Material and Methods: We carried out a cross-sectional study involving 71 consecutive patients with vascular disease. Demographic and anthropometric data, medical history, and ongoing drug therapy were recorded for each patient. Total blood count, hemoglobin, plasma potassium, glucose, cholesterol, triglycerides, total protein, albumin, serum creatinine, uric acid, NGAL and cystatin C levels, and eGFR were evaluated in all patients. Potential predictors and consequences of increased NGAL and cystatin C levels were assessed. Results: History of hypertension, diabetes, and ongoing diuretic therapy were the only independent predictors of decreased eGFR (all p < 0.05). Meanwhile, increased white blood cell count and diuretic usage were independently associated with higher NGAL and cystatin C levels, respectively, and increased uric acid levels were independently associated with higher levels of both biomarkers of kidney injury (all p < 0.05). Furthermore, increased NGAL and cystatin C levels were independently associated with lower albumin and HDL-C levels, and increased cystatin C levels were also associated with
higher serum potassium (all p < 0.05). Conclusions: In this study, eGFR values were independently associated with widely known risk factors for impaired renal function. Meanwhile, NGAL and cystatin C evaluation identified more subtle hematologic and biochemical changes related to subclinical kidney injury. These data reinforce the role of NGAL and cystatin C as not only biomarkers of subclinical kidney injury, but also as predictors of subclinical kidney
injury-related abnormalities.

Lipoprotein (a) screening, and what’s next?

Anna Pasławska, Agnieszka Radom, Przemysław Tomasik — Tue, 03 Dec 2024 07:55:43 +0000

ABSTRACT:
Lipoprotein (a) (Lp(a)) is a low-density lipoprotein (LDL) in which the apolipoprotein B100
molecule is bound to a highly polymorphic, plasminogen-like apolipoprotein (a). The concentration of Lp(a) is predominantly genetically determined, governed by the expression of the LPA gene, and remains relatively stable from early adulthood. The physiological function of Lp(a) is unknown. Lp(a) is recognized as a main carrier of oxidized phospholipids and has strong atherogenic, prothrombotic, and pro-inflammatory properties. Elevated levels of Lp(a) above 75 nmol/l (30 mg/dl) are an independent risk factor for cardiovascular diseases. According to the recommendations of the Polish Lipid Association, Lp(a) should be measured once in a lifetime. This study presents an analysis of the results of Lp(a) screening among adult patients from southeastern Poland (Nowy Sącz county) and evaluates further diagnostic andtherapeutic measures for patients with elevated Lp(a) levels. Among the 231 patients screened, 48 individuals (20.8%) had increased Lp(a) levels above 75 nmol/l. Patients with elevated Lp(a) concentration were invited to participate in a survey, in which 31 individuals ultimately took part. Of these, 4 individuals were classified into the moderate risk group, 25 into the high-risk group, and 2 into the very high-risk group for cardiovascular diseases. The pharmacotherapy directly targeting the reduction of Lp(a) is currently undergoing clinical trials. Its effectiveness in decreasing Lp(a) concentrations, along with demonstrating desirable and positive effects on cardiovascular disease outcomes, requires further investigation due to the lack of conclusive evidence. Diet and physical activity have limited impact on Lp(a) concentration. It is recommended to expand preventive programs, including for younger populations, which could help identify patients with genetically determined cardiovascular risk. Additionally, there is a necessity to educate the medical personnel and patients about the significance of Lp(a) and the implementation of guidelines for managing patients with elevated Lp(a) levels.
Keywords: lipoprotein (a), apolipoprotein (a), cardiovascular diseases, atherosclerosis, lipid disorder

The Link Between Periostin Serum Levels and Inflammation in Patients with Acute Coronary Syndrome

Mon, 02 Dec 2024 07:26:30 +0000

ABSTRACT

Background: Acute coronary syndrome (ACS) remains the leading cause of cardiovascular morbidity and mortality and is considered an inflammatory disease, characterized by elevated levels of inflammation biomarkers. Periostin (Pn) is a novel biomarker involved in inflammation and myocardial recovery processes following an ACS. However, the relationship between Pn and inflammatory biomarkers in ACS has not yet been fully elucidated. The aim of this study was to evaluate the effect of serum Pn levels on the inflammatory response following an ACS, to assess the association between Pn and systemic inflammatory biomarkers, and to examine the impact of increased inflammation on the immediate outcomes following an ACS. Methods: This study was an observational prospective study that enrolled 92 patients with ACS. Based on the median Pn value (set at 30.63 ng/ml), the study population was divided into two groups: Group 1 included 46 patients with low Pn levels, and Group 2 included 46 patients with high Pn levels. Inflammatory status was assessed. For CRP, values were recorded at baseline and on day 7. Results: ST-elevation myocardial infarction occurred more frequently among patients with high Pn levels (p = 0.0004), who also had significantly higher levels of MMP-9 (132.7 ± 112.2 pg/ ml vs. 201 ± 69.37 pg/ml; p = 0.003). However, serum CRP levels were significantly lower among patients in Group 2 at baseline (26.61 ± 25.59 mg/dl vs. 9.2 ± 12.87 mg/dl; p = 0.0009) and on day 7 (31.84 ± 29.4 mg/dl vs. 19.25 ± 26.77 mg/dl; p = 0.04). Conclusions: Pn levels in patients with ACS are associated with more severe inflammation and worse outcomes.

Difficult Course of a Teenager’s Cardiogenic Shock

Sun, 01 Dec 2024 06:26:17 +0000

ABSTRACT
Fulminant myocarditis is a peculiar condition characterized by sudden-onset diffuse myocardial inflammation leading to hemodynamic compromise. We report the case of a 15-year old male adolescent, without any cardiovascular history, who presented sudden-onset severe biventricular systolo-diastolic dysfunction leading to cardiogenic shock, 2 weeks after an episode of respiratory tract infection. A comprehensive treatment regimen was initiated including heart failure treatment, inotropic and vasoactive support, antibiotics, antiviral treatment, intravenous immunoglobulin, and glucocorticoids, but with poor evolution. Bridgetotransplantation therapy was taken into consideration for hemodynamic stabilization. Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) support was initiated, first peripherally, via femoral artery and femoral vein access, but secondary to left ventricle (LV) distension, the patient developed pulmonary edema. To decompress the LV, an echocardiography-guided atrial septostomy was performed, and after 2 days, central cannulation (right atrium – ascending aorta) with another cannula for left atrial venting was done, and the patient remained with open sternum. Five days from the initiation of VA-ECMO the patient underwent an orthotopic heart transplantation by bicaval technique with favorable evolution in the follow-up period. Early initiation of VA-ECMO is a salvage intervention in pediatric patients with fulminant myocarditis, but with multiple possible complications. This paper highlights strategies for the optimization of VA-ECMO.