Novel Biomarkers and Their Role in the Diagnosis and Prognosis of Acute Coronary Syndrome

The burden of cardiovascular diseases and the critical role of acute coronary syndrome (ACS) in their progression underscore the need for effective diagnostic and prognostic tools. Biomarkers have emerged as crucial instruments for ACS diagnosis, risk stratification, and prognosis assessment. Among these, high-sensitivity troponin (hs-cTn) has revolutionized ACS diagnosis due to its superior sensitivity and negative predictive value. However, challenges regarding specificity, standardization, and interpretation persist. Beyond troponins, various biomarkers reflecting myocardial injury, neurohormonal activation, inflammation, thrombosis, and other pathways are being explored to refine ACS management. This review article comprehensively explores the landscape of clinically used biomarkers intricately involved in the pathophysiology, diagnosis, and prognosis of ACS (i.e., troponins, creatine kinase MB (CK-MB), B-type natriuretic peptides (BNP), copeptin, C-reactive protein (CRP), interleukin-6 (IL-6), d-dimers, fibrinogen), especially focusing on the prognostic role of natriuretic peptides and of inflammatory indices. Research data on novel biomarkers (i.e., endocan, galectin, soluble suppression of tumorigenicity (sST2), microRNAs (miRNAs), soluble oxidized low-density lipoprotein receptor-1 (sLOX-1), F2 isoprostanes, and growth differentiation factor 15 (GDF-15)) are further analyzed, aiming to shed light on the multiplicity of pathophysiologic mechanisms implicated in the evolution of ACS. By elucidating the complex interplay of these biomarkers in ACS pathophysiology, diagnosis, and outcomes, this review aims to enhance our understanding of the evolving trajectory and advancements in ACS management. However, further research is necessary to establish the clinical utility and integration of these biomarkers into routine practice to improve patient outcomes.

Predictors of recurrence after catheter ablation and electrical cardioversion of atrial fibrillation: an umbrella review of meta-analyses

AIMS

The recurrence rates after catheter ablation (CA) and direct current (DC) cardioversion remain high, although they have been established treatments of rhythm control of atrial fibrillation (AF). This umbrella review systematically appraises published meta-analyses of both observational and randomized controlled trials (RCTs) for the association of risk and protective factors for arrhythmia recurrence after CA and DC cardioversion of AF.

METHODS AND RESULTS

Three bibliographic databases were searched up to June 2021. Evidence of association was rated as convincing, highly suggestive, suggestive, weak, or not significant with respect to observational studies and as high, moderate, low, or very low with respect to RCTs, according to established criteria. Thirty-one meta-analyses were included. Of the 28 associations between CA and the risk of arrhythmia recurrence, none presented convincing evidence, and only the time from diagnosis to ablation over 1 year provided highly suggestive evidence. The association between hypertension and metabolic profile provided suggestive evidence. The associations of Class IC and III antiarrhythmic drugs use with the recurrence after DC cardioversion were supported by an intermediate level of evidence.

CONCLUSION

Although AF is a major health issue, few risk- and protective factors for AF recurrence have been identified. None of these factors examined were supported by convincing evidence, whereas established factors such as female gender and left atrial volume showed only weak association. An early CA strategy combined with treatment of metabolic syndrome and hypertension prior to CA may reduce the risk of arrhythmia recurrence. The use of antiarrhythmics can increase the success rate of DC cardioversion.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO registry number: CRD42021270613.

The association between depression and quality of life in the elderly

Background

Depression is the most common cause of emotional disorder in older adults causing functional impairment and leading to lower quality of life (QOL). The aim of the study was to investigate the prevalence of depression, measure the perceived QOL and evaluate the impact of depression on life quality of older people in the community.

Methods

We conducted a cross-sectional study in older people, enrolled in open day care centers and other healthcare facilities. To all participants the Greek validated version of the Geriatric Depression Scale (GDS-15) was applied to screen for depressive symptoms and the EQ-5D-5L scale to estimate their self-reported health status.

Results

A total of 634 seniors participated in the study, 53% were females, mean age 78 years. 45.6% of the participants showed moderate to severe depression. Those who suffered from at least two chronic diseases (75.6%) were more likely to develop moderate or severe depressive symptoms compared to those with only one (19.3%) or none (2.2%) chronic disease. Increased risk of depression was observed in people with Parkinson’s disease (56.5%), mental illness (47.1%), respiratory disease (40%) and stroke (35.1%). Regarding the EQ-5D-5L scale, 72% reported slight to extreme anxiety or depression, 68.2% slight to extreme pain or discomfort, 59.8% slight to extreme problems in performing usual activities, 59.8% in mobility and 40.1% in self-care, respectively. Significant differences were found between people with or without depression. Specifically, participants who reported slight to severe problems in all five domains of the EQ-5D-5L, showed higher levels of depression in the GDS-15.

Conclusions

Our results revealed that elderly with depressive symptoms have a lower quality of life. Given the mutual relationship between chronic diseases, lower life quality and depression, assessment of depressive symptoms are needed in elderly population, mainly in people with multiple chronic diseases.

Key messages

• Depression can be a predictor of poorer quality of life in older population.

Differential Expression of microRNAs in acute and chronic heart Failure

BACKGROUND

MicroRNAs modify protein expression at a post-transcriptional level and their circulating levels may express the underlying molecular pathways.

OBJECTIVE

The purpose of this study was to assess the differential expression of microRNAs related to myocardial cell energy substrate, autophagy, and ischaemia in chronic and acute heart failure (HF).

METHODS

In this case-control study, we studied 19 patients with acute HF (AHF) and 19 patients with chronic HF (CHF). Basic demographic and clinical characteristics were collected from the patients upon arrival, at 48 hours, and at 120 hours. Blood samples for microRNAs measurements (miR-22, -92a, and -499), b type natriuretic peptide (BNP), C reactive protein, and high sensitivity cardiac troponin I were collected in all study points. In this study, we included subjects with a left ventricular ejection fraction of <40%.

RESULTS

At baseline circulating miR-22 levels were 1.9-fold higher (p<0.001), miR-92a levels were 1.25-fold higher (p=0.003), and miR-499 were 5-times lower (p<0.001) in AHF compared to CHF. Interestingly, circulating miR-499 was found to be associated with BNP levels (r=0.47, p=0.01). At follow-up there was a stepwise increase in the levels of all three examined microRNAs (miR-22, p=0.001, miR-92a, p=0.001, and miR-499, p<0.001) for AHF but not for CHF subjects.

CONCLUSIONS

MicroRNAs -22, -92a, and -499 are differentially expressed in chronic and acute HF subjects. MicroRNAs signatures are also differentially expressed up to the patients' discharge. These findings may have important implications in diagnosis, progression, and treatment in patients with chronic and acute heart failure.

Endothelial dysfunction in acute and long standing COVID−19: A prospective cohort study

Background

Coronavirus disease-19 (COVID-19) is implicated by active endotheliitis, and cardiovascular morbidity. The long-COVID-19 syndrome implications in atherosclerosis have not been elucidated yet. We assessed the immediate, intermediate, and long-term effects of COVID-19 on endothelial function.

Methods

In this prospective cohort study, patients hospitalized for COVID-19 at the medical ward or Intensive Care Unit (ICU) were enrolled and followed up to 6 months post-hospital discharge. Medical history and laboratory examinations were performed while the endothelial function was assessed by brachial artery flow-mediated dilation (FMD). Comparison with propensity score-matched cohort (control group) was performed at the acute (upon hospital admission) and follow-up (1 and 6 months) stages.

Results

Seventy-three patients diagnosed with COVID-19 (37% admitted in ICU) were recruited. FMD was significantly (p < 0.001) impaired in the COVID-19 group (1.65 ± 2.31%) compared to the control (6.51 ± 2.91%). ICU-treated subjects presented significantly impaired (p = 0.001) FMD (0.48 ± 1.01%) compared to those treated in the medical ward (2.33 ± 2.57%). During hospitalization, FMD was inversely associated with Interleukin-6 and Troponin I (p < 0.05 for all). Although, a significant improvement in FMD was noted during the follow-up (acute: 1.75 ± 2.19% vs. 1 month: 4.23 ± 2.02%, vs. 6 months: 5.24 ± 1.62%; p = 0.001), FMD remained impaired compared to control (6.48 ± 3.08%) at 1 month (p < 0.001) and 6 months (p = 0.01) post-hospital discharge.

Conclusion

COVID-19 patients develop a notable endothelial dysfunction, which is progressively improved over a 6-month follow-up but remains impaired compared to healthy controls subjects. Whether chronic dysregulation of endothelial function following COVID-19 could be accompanied by a residual risk for cardiovascular and thrombotic events merits further research.

The Role of Endothelial Related Circulating Biomarkers in COVID-19. A Systematic Review and Meta-analysis

BACKGROUND

Several studies have revealed the link between Coronavirus Disease 2019 (COVID-19) and endothelial dysfunction. To better understand the global pattern of this relationship, we conducted a meta-analysis on endothelial biomarkers related to COVID-19 severity.

METHODS

We systematically searched the literature up to March 10, 2021, for studies investigating the association between COVID-19 severity and the following endothelial biomarkers: Intercellular Adhesion Molecule 1 (ICAM-1), Vascular Cell Adhesion Molecule 1 (VCAM-1), E-selectin, P-selectin, Von Willebrand Factor Antigen (VWF-Ag), soluble Thrombomodulin (sTM), Mid-regional pro-adrenomedullin (MR-proADM), and Angiopoietin-2 (Ang-2). Pooled estimates and mean differences (PMD) for each biomarker were reported.

RESULTS

A total of 27 studies (n=2213 patients) were included. Critically ill patients presented with higher levels of MR-proADM (PMD: 0.71 nmol/L, 95% CI: 0.22 to 1.20 nmol/L, p=0.02), E-selectin (PMD: 13,32 pg/ml, 95% CI: 4,89 to 21,75 pg/ml, p=0.008), VCAM-1 (PMD: 479 ng/ml, 95% CI: 64 to 896 ng/ml, p=0.03), VWF-Ag (PMD: 110.5 IU/dl, 95% CI: 44.8 to 176.1 IU/dl, p=0.04) and Ang-2 (PMD: 2388 pg/ml, 95% CI: 1121 to 3655 pg/ml, p=0.003), as compared to non-critically ill ones. ICAM-1, P-selectin and thrombomodulin did not differ between the two groups (p>0.05).

CONCLUSION

Endothelial biomarkers display significant heterogeneity in COVID-19 patients, with higher MR-proADM, E-selectin, VCAM-1, VWF-Ag, and Ang-2 levels being associated with increased severity. These findings strengthen the evidence on the key role of endothelial dysfunction in disease progress.

Women’s knowledge, awareness and prevention of cervical cancer and infection from HPV in Greece

Background

Cervical cancer prevention can be obtained by regular screening with Papanicolaou test. However, in recent years HPV DNA test and mRNA HPV test are available for the screening for cervical cancer. The HPV vaccine helps protect against HPV- related cancers. Our aim was to investigate the beliefs and knowledge of women living in a city in northwestern Thessaly, Greece, regarding the prevention of cervical cancer.

Methods

A cross sectional study was conducted among 119 women, 18-65 years old and living in Trikala, Greece. They completed a 45-item self-administered questionnaire, investigating their knowledge, perceptions, and behaviors regarding the prevention of cervical cancer, the infection with HPV, the Papanicolaou test and vaccination. Furthermore, associations between knowledge and behaviors as well as with various demographic factors were explored.

Results

Most of the women had at least university education (77%). More than 90% declared to visit an obstetrician-gynecologist at least once a year and 68.4% regularly have a Pap smear once a year. 95.8% were aware of the importance of a Pap smear and 82% declared a positive attitude regarding HPV vaccination. Higher knowledge regarding examination and vaccination, was associated with marital status (married) (p = 0.002) and educational level (higher educational level) (p = 0.001).

Conclusions

The majority of women in our sample know why they should do the Pap test; however, they need to be further informed with additional details about the diagnostic test. Although most of the women were aware about the importance of testing, one third of them were not regularly tested for cervical cancer detection or had lacked knowledge about vaccination.

Key messages

A high percentage of women is aware about the benefits of cervical cancer screening. However, information campaigns and establishment of national screening programs are required to facilitate the access to such programs for all women.

Monitoring the health status of the elderly in an urban area in Athens, Greece

Background

Aging of population brings changes in needs and capacities. People live longer and chronic diseases appear to be a potential risk of major causes of disability and functional dependency. The aim of this study was to investigate the physical and mental health of the elderly residing in an urban area in Athens,Greece.

Methods

In this population-based study using a convenience sampling, seniors aged ≥65 years old, under no medical treatment were selected from Korydalos area, Athens, Greece. A translated version of the General Health Questionnaire (GHQ-28) was used and associations with other parameters were performed. Higher GHQ-28 scores indicate higher levels of distress.

Results

A total of 100 seniors participated in the study, 64% females, mean age 71.4 years. 51% were married, 40% lived alone and 82% had primary or secondary education. 59% received a pension from the state, out of them 42% between 601-1000 euros and 33% between 301-600 euros, monthly. The mean GHQ-28 score, for a potential mental disorder in the somatization, anxiety, social dysfunction, and depression factors, was 24.3, 29.1, 42.9 and 10.2, respectively. Females presented higher scores in total GHQ score (p = 0.018), in somatization (p = 0.019) and in social dysfunction (p = 0.001). Higher age was associated with higher total GHQ score (p = 0.001), higher anxiety (p = 0,006) and higher dysfunction (p = 0.006). Seniors with lower educational level had higher total GHQ score (p = 0.032) and higher social dysfunction (p &lt; 0.001). Low financial status was associated with higher social dysfunction (p = 0.005).

Conclusions

The study revealed an overall moderate emotional distress in elderly. However, a high risk in social dysfunction is obvious, whereas risk of depression is very low. Age, educational level and financial status are associated with various dimensions of distress and psychiatric disorders. GHQ-28 is a suitable screening tool and can be used to prevent chronic disease and mental disorder

Key messages

GHQ-28 can be used as a screening tool in elderly in urban communities to assess psychological well-being and detect possible psychiatric morbidity and to improve their overall health.

Women’s postnatal care satisfaction during COVID-19 pandemic in public hospitals in Northwest Greece

Background

Patient satisfaction is an important process for investigating patients' needs, views, and suggestions about the health services provided by a health care facility. The aim of this study was to investigate women's postnatal satisfaction with healthcare services during COVID-19 pandemic, provided at two regional public hospitals in Ioannina, Greece.

Methods

Using a purposive and snowball sampling technique, a cross-sectional study was performed among women who gave birth in two regional Greek hospitals, during October 2020. An online self-administered 32-item questionnaire was distributed personally, as well as, in social media groups related to young mothers and baby feeding.

Results

A total of 106 women answered the questionnaire, mean age 34 years old, 58.5% had higher education and for 40.6% it was the first birth. 63.2% declared having visited the same hospital already in the past for gynecological services and 69.6% being satisfied with doctors' and nurses' communication, their interaction, behavior giving guidance, and the time they dedicated to the mothers. 60% were satisfied with hospital cleanliness, organization, adequacy, easy access, orientation and 63.6% from the administrative services. 23.8% were not satisfied with waiting times between appointment schedule and medical examination; however, 61.6% indicated that they would either use or suggest the services again. Higher satisfaction was associated with being married and employed, having no previous experience, and being in good health status.

Conclusions

In general, a moderate satisfaction with various dimensions of provided health services was observed. The study highlights the importance of the postnatal care provided by healthcare professionals and health services. Improving the parameters which affect women's satisfaction would increase the quality of postnatal care.

Key messages

Assessing patient satisfaction is an important indicator of measuring the quality of health services.

MiRNAs as Biomarkers in Hypertrophic Cardiomyopathy: Current State of the Art

BACKGROUND

Hypertrophic Cardiomyopathy (HCM) is the most common inherited Cardiomyopathy. The hallmark of HCM is myocardial fibrosis that contributes to heart failure, arrhythmias and sudden cardiac death.

OBJECTIVE

Currently there are no reliable serum biomarkers for detection of myocardial fibrosis, while cardiac magnetic resonance (CMR) is an imaging technique to detect myocardial fibrosis. MicroRNAs (miRNAs) have been increasingly suggested as biomarkers in cardiovascular diseases. However, in HCM there is as yet no identified and verified specific circulating miRNA signature.

METHODS

We conducted a review of literature to identify the studies that indicate the possible roles of miRNAs in HCM.

RESULTS

From studies in transgenic mice with HCM, miR-1, -133 may identify HCM in the early asymptomatic phase. Human miR-29a could be used as a circulating biomarker for detection of both myocardial hypertrophy and fibrosis in HCM, while it could also have a possible additional role in discrimination of hypertrophic obstructive cardiomyopathy from non-obstructive HCM. Additionally, miR-29a-3p is associated with diffuse myocardial fibrosis in HCM while miR-1-3p could discriminate end-stage HCM from dilated cardiomyopathy and left ventricle dilation. Another role of miRNAs could also be the contribution in differential diagnosis between HCM and phenocopies. Moreover, miRNA-targeted therapy (miR-133 mimics) is promising in inhibiting cardiac hypertrophy but this is still in the early stages.

CONCLUSION

A more reliable and specific signature of miRNAs is expected with forthcoming studies in samples from HCM patients and correlation of miRNAs with CMR and serum markers of fibrosis may implicate novel diagnostic and therapeutic pathways.

Active perception during angiogenesis: filopodia speed up Notch selection of tip cells in silico and in vivo

How do cells make efficient collective decisions during tissue morphogenesis? Humans and other organisms use feedback between movement and sensing known as 'sensorimotor coordination' or 'active perception' to inform behaviour, but active perception has not before been investigated at a cellular level within organs. Here we provide the first proof of concept in silico/in vivo study demonstrating that filopodia (actin-rich, dynamic, finger-like cell membrane protrusions) play an unexpected role in speeding up collective endothelial decisions during the time-constrained process of 'tip cell' selection during blood vessel formation (angiogenesis). We first validate simulation predictions in vivo with live imaging of zebrafish intersegmental vessel growth. Further simulation studies then indicate the effect is due to the coupled positive feedback between movement and sensing on filopodia conferring a bistable switch-like property to Notch lateral inhibition, ensuring tip selection is a rapid and robust process. We then employ measures from computational neuroscience to assess whether filopodia function as a primitive (basal) form of active perception and find evidence in support. By viewing cell behaviour through the 'basal cognitive lens' we acquire a fresh perspective on the tip cell selection process, revealing a hidden, yet vital time-keeping role for filopodia. Finally, we discuss a myriad of new and exciting research directions stemming from our conceptual approach to interpreting cell behaviour. This article is part of the theme issue 'Basal cognition: multicellularity, neurons and the cognitive lens'.

MicroRNAs in the Management of Heart Failure

BACKGROUND

In recent years much research has been devoted to the deployment of biomarkers in the field of heart failure; Objectives: To study the potential of post-transcriptional regulation by microRNAs on the diagnosis, management and therapy of heart failure.

METHODS

Literature search focus on the role of microRNAs in heart failure.

RESULTS

MicroRNAs are expressed and regulated in the course of the pathological manifestations of heart failure (HF). This wide and uncharted area of genetic imprints consisting of small non-coding RNA molecules, is upregulated and released into blood stream from organs under certain conditions and or stress. The use of genetically based strategies for the management of HF have gained great interest in the field of biomedical science because they can be used as biomarkers providing information regarding cardiac status and function. They also appear as promising tools with therapeutic potential because of their ability to induce changes at the cellular level without creating alterations in the gene sequence. In addition, with the advances in genomic sequencing, quantification and synthesis in technologies of microRNAs identification as well as the growing knowledge of the biology of miRNAs and their involvement in HF, it is expected to favorably affect the prognosis of HF patients.

CONCLUSION

MicroRNAs are involved in the regulation of multi biological processes involved in the progress of heart failure. More studies are needed to achieve a clinical valuable implementation of microRNAs in the management of HF.

Association of Soluble Suppression of Tumorigenesis-2 (ST2) with Endothelial Function in Patients with Ischemic Heart Failure

Soluble suppression of tumorigenesis-2 (sST2) has been introduced as a marker associated with heart failure (HF) pathophysiology and status. Endothelial dysfunction is a component underlying HF pathophysiology. Therefore, we examined the association of arterial wall properties with sST2 levels in patients with HF of ischemic etiology. We enrolled 143 patients with stable HF of ischemic etiology and reduced left ventricular ejection fraction (LVEF) and 77 control subjects. Flow-mediated dilation (FMD) was used to evaluate endothelial function and pulse wave velocity (PWV) to assess arterial stiffness. Although there was no significant difference in baseline demographic characteristics, levels of sST2 were increased in HF compared to the control (15.8 (11.0, 21.8) ng/mL vs. 12.5 (10.4, 16.3) ng/mL; p < 0.001). In the HF group, there was a positive correlation of sST2 levels with age (rho = 0.22; p = 0.007) while there was no association of LVEF with sST2 (rho = −0.119; p = 0.17) nor with PWV (rho = 0.1; p = 0.23). Interestingly, sST2 was increased in NYHA III [20.0 (12.3, 25.7) ng/mL] compared to patients with NYHA II (15.0 (10.4, 18.2) ng/mL; p = 0.003) and inversely associated with FMD (rho = −0.44; p < 0.001) even after adjustment for possible confounders. In patients with chronic HF of ischemic etiology, sST2 levels are increased and are associated with functional capacity. There is an inverse association between FMD and sST2 levels, highlighting the interplay between the dysfunctional endothelium and HF pathophysiologic mechanisms.

Osteoprotegerin and Osteopontin Serum Levels are Associated with Vascular Function and Inflammation in Coronary Artery Disease Patients

BACKGROUND

Osteoprotegerin and osteopontin have recently emerged as key factors in both vascular remodelling and atherosclerosis progression. Interleukin-6 (IL-6) is an inflammatory cytokine with a key role in atherosclerosis. The relationship of osteoprotegerin, osteopontin, and IL-6 serum levels with endothelial function and arterial stiffness was evaluated in patients with coronary artery disease (CAD).

METHODS

We enrolled 219 patients with stable CAD and 112 control subjects. Osteoprotegerin, osteopontin and IL-6 serum levels were measured using an ELISA assay. Endothelial function was evaluated by flow-mediated dilation (FMD) in the brachial artery and carotid-femoral pulse wave velocity (PWV) was measured as an index of aortic stiffness.

RESULTS

There was no significant difference between control subjects and CAD patients according to age and sex. Compared with control subjects, CAD patients had significantly impaired FMD (p<0.001) and increased PWV (p=0.009). CAD patients also had significantly higher levels of osteoprotegerin (p<0.001), osteopontin (p<0.001) and IL-6 (p=0.03), compared with control subjects. Moreover, IL-6 levels were correlated with osteoprotegerin (r=0.17, p=0.01) and osteopontin (r=0.30, p<0.001) levels. FMD was correlated with osteoprotegerin levels independent of possible confounders [b coefficient= - 0.79, 95% CI (-1.54, -0.05), p=0.04].

CONCLUSION

CAD patients have increased osteoprotegerin, osteopontin and IL-6 levels. Moreover, there is a consistent association between osteoprotegerin and osteopontin serum levels, vascular function and inflammation in CAD patients. These findings suggest another possible mechanism linking osteoprotegerin and osteopontin serum levels with CAD progression through arterial wall stiffening and inflammation.

Hospital attendance and admission trends for cardiac diseases during the COVID-19 outbreak and lockdown in Greece

Objectives

The coronavirus disease 2019 (COVID-19) outbreak, along with implementation of lockdown and strict public movement restrictions, in Greece has affected hospital visits and admissions. We aimed to investigate trends of cardiac disease admissions during the outbreak of the pandemic and possible associations with the applied restrictive measures.

Study design

This is a retrospective observational study.

Methods

Data for 4970 patients admitted via the cardiology emergency department (ED) across 3 large-volume urban hospitals in Athens and 2 regional/rural hospitals from February 3, 2020, up to April 12 were recorded. Data from the equivalent (for the COVID-19 outbreak) time period of 2019 and from the postlockdown time period were also collected.

Results

A falling trend of cardiology ED visits and hospital admissions was observed starting from the week when the restrictive measures due to COVID-19 were implemented. Compared with the pre–COVID-19 outbreak time period, acute coronary syndrome (ACS) [145 (29/week) vs. 60 (12/week), −59%, P < 0.001], ST elevation myocardial infarction [46 (9.2/week) vs. 21 (4.2/week), −54%, P = 0.002], and non-ST elevation ACS [99 cases (19.8/week) vs. 39 (7.8/week), −60% P < 0.001] were reduced at the COVID-19 outbreak time period. Reductions were also noted for heart failure worsening and arrhythmias. The ED visits in the postlockdown period were significantly higher than in the COVID-19 outbreak time period (1511 vs 660; P < 0.05).

Conclusion

Our data show significant drops in cardiology visits and admissions during the COVID-19 outbreak time period. Whether this results from restrictive measures or depicts a true reduction of cardiac disease cases warrants further investigation.

•

The coronavirus disease 2019 (COVID-19) outbreak has led to an unprecedented health system overload.

•

The restrictive measures in Greece resulted in a low number of COVID-19 cases.

•

Hospital visits and cardiovascular events have diminished after implementation of restrictive measures.

•

Acute coronary syndromes reduced by approximately 55%, despite limited incidence of COVID-19.

•

The multifactorial etiology of this finding should be thoroughly investigated.

High-Intensity Endurance and Strength Training in Water Polo Olympic Team Players: Impact on Arterial Wall Properties

INTRODUCTION

Regular physical activity is recommended to minimize health risk. However, the upper intensity threshold associated with the best health outcomes is difficult to be determined. Water polo (WP) Olympic athletes present unique characteristics such as high-intensity exercise, long training sessions, and a combination of endurance and strength training. Therefore, we examined in which way the long-term, intense, mixed endurance and strength training affects the peripheral and central hemodynamics.

METHODS

The study population consisted of 20 WP Olympic team players, 20 matched recreationally active (RA) subjects, and 20 sedentary control subjects (Cl). Reflected waves were assessed with the augmentation index (AIx), central aortic stiffness with pulse wave velocity (PWV), and endothelial function with flow-mediated dilation (FMD).

RESULTS

Amongst Cl subjects, RA subjects, and WP players, there was no difference in age (p = 0.33) as well as in brachial systolic pressure (p = 0.52), while there was a stepwise decrease in aortic systolic pressure (116 ± 16 mm Hg vs. 107 ± 14 mm Hg vs. 106 ± 6 mm Hg, p = 0.03). There was also a stepwise improvement in AIx (-4.22 ± 9.97% vs. -6.97 ± 11.28% vs. -12.14 ± 6.62%, p = 0.03) and FMD (6.61 ± 1.78% vs. 7.78 ± 1.98% vs. 8.3 ± 2.05%, p = 0.04) according to the intensity of exercise, with WP players having lower AIx and higher FMD compared to RA subjects and Cl subjects. No difference was found in PWV (Cl: 5.88 ± 0.72 m/s vs. RA: 6.04 ± 0.75 m/s vs. WP: 5.97 ± 1.09 m/s, p = 0.82) among the three studied groups.

CONCLUSIONS

Young WP Olympic team players depict improved arterial wall properties and endothelial function compared to RA and Cl subjects.

Galectin-3 and Arterial Stiffness in Patients with Heart Failure: A Pilot Study

BACKGROUND

Cardiac performance depends on optimum ventriculoarterial coupling which is impaired in patients with heart failure (HF). Galectin-3 is a mediator of myocardial fibrosis and remodeling, and is associated with clinical status in patients with chronic HF. We examined the association of arterial stiffness with galectin-3 levels in patients with HF of ischemic etiology.

METHODS

We consecutively enrolled 40 patients with stable ischemic HF and reduced ejection fraction. Central aortic stiffness was evaluated non-invasively by measuring carotid femoral pulse wave velocity (PWV). Among other factors, serum levels of galectin-3 and b-type natriuretic peptide (BNP) were measured.

RESULTS

The median galectin-3 levels in our study population were 12.9 (10.8-18.7) ng/ml and the mean PWV was 9.31±2.79 m/sec. There was significant association of galectin-3 levels with age (r=0.48, p=0.003), creatinine clearance (r=-0.66, p<0.001) and BNP levels (r=0.36, p=0.05). There was a significant association of galectin-3 levels with PWV (r=0.37, p=0.03) and patients with PWV above median also had significantly increased levels of galectin-3 compared with patients with lower values of PWV [16.1(11.8-25.2) vs. 12.1(10.5-14) ng/ml, p=0.03].

CONCLUSION

We found an association of arterial stiffness and PWV with galectin-3 levels in patients with chronic HF of ischemic etiology. These findings suggest a pathway driving arterial stiffening and myocardial remodelling in HF. This may provide insight into the mechanism determining prognosis and clinical status of patients with HF.

Cardiovascular effects of electronic cigarettes: A systematic review and meta-analysis

AIMS

The electronic cigarette is marketed as a safe alternative to tobacco smoking, but electronic cigarette cardiovascular effects remain largely unknown. We systematically reviewed and meta-analysed published literature to investigate the cardiovascular effects and associated risk from electronic cigarette use.

METHODS AND RESULTS

We searched PubMed from January 2000 to November 2017 for published studies assessing the cardiovascular effects of the electronic cigarette. Evidence suggests that the electronic cigarette negatively affects endothelial function, arterial stiffness and the long-term risk for coronary events, but these findings are from single study reports and have not been confirmed in additional studies. Conflicting evidence exists on the effects of the electronic cigarette on heart rate and blood pressure, which is mainly based on non-randomized clinical studies of moderate quality. The meta-analysis of 14 studies (N + 441 participants) suggested that despite the negative acute effects of the electronic cigarette on heart rate (pooled mean difference (MD) + 2.27, 95% confidence interval (CI): 1.64 to 2.89, p < 0.001), diastolic (pooled MD + 2.01 mmHg, 95% CI: 0.62 to 3.39, p + 0.004) and systolic blood pressure (pooled MD + 2.02 mmHg, 95% CI: 0.07 to 3.97, p + 0.042), benefits may be observed in terms of blood pressure regulation when switching from tobacco smoking to chronic electronic cigarette use (systolic blood pressure pooled MD + -7.00, 95% CI: -9.63 to -4.37, p < 0.001; diastolic blood pressure pooled MD + -3.65, 95% CI: -5.71 to -1.59, p + 0.001).

CONCLUSIONS

The existing evidence on the cardiovascular effects of the electronic cigarette is concerning, with several unexplored issues. Unless supported by stronger evidence, the electronic cigarette should not be labelled as a cardiovascular safe product. Future studies should delineate whether electronic cigarette use is less hazardous to cardiovascular health than conventional cigarette smoking.

Critical care usage after major gastrointestinal and liver surgery: a prospective, multicentre observational study

BACKGROUND

Patient selection for critical care admission must balance patient safety with optimal resource allocation. This study aimed to determine the relationship between critical care admission, and postoperative mortality after abdominal surgery.

METHODS

This prespecified secondary analysis of a multicentre, prospective, observational study included consecutive patients enrolled in the DISCOVER study from UK and Republic of Ireland undergoing major gastrointestinal and liver surgery between October and December 2014. The primary outcome was 30-day mortality. Multivariate logistic regression was used to explore associations between critical care admission (planned and unplanned) and mortality, and inter-centre variation in critical care admission after emergency laparotomy.

RESULTS

Of 4529 patients included, 37.8% (n=1713) underwent planned critical care admissions from theatre. Some 3.1% (n=86/2816) admitted to ward-level care subsequently underwent unplanned critical care admission. Overall 30-day mortality was 2.9% (n=133/4519), and the risk-adjusted association between 30-day mortality and critical care admission was higher in unplanned [odds ratio (OR): 8.65, 95% confidence interval (CI): 3.51-19.97) than planned admissions (OR: 2.32, 95% CI: 1.43-3.85). Some 26.7% of patients (n=1210/4529) underwent emergency laparotomies. After adjustment, 49.3% (95% CI: 46.8-51.9%, P<0.001) were predicted to have planned critical care admissions, with 7% (n=10/145) of centres outside the 95% CI.

CONCLUSIONS

After risk adjustment, no 30-day survival benefit was identified for either planned or unplanned postoperative admissions to critical care within this cohort. This likely represents appropriate admission of the highest-risk patients. Planned admissions in selected, intermediate-risk patients may present a strategy to mitigate the risk of unplanned admission. Substantial inter-centre variation exists in planned critical care admissions after emergency laparotomies.

The association among biomarkers of renal and heart function in patients with heart failure: the role of NGAL

AIM

The NGAL is a biomarker of renal injury associated with the progression of heart failure (HF). We examine the association of NGAL with galectin-3 in patients with chronic HF.

METHODS

We consecutively enrolled 115 subjects with stable ischemic HF of reduced ejection fraction. Serum levels of galectin-3, b-type natriuretic peptide and NGAL were measured.

RESULTS

NGAL levels were positively correlated with galectin-3 (rho = 0.26; p = 0.04) and b-type natriuretic peptide levels (rho = 0.30; p = 0.005) and inversely correlated with ejection fraction (rho = -0.31; p = 0.02) and creatinine clearance levels. The NGAL was independently associated with galectin-3 levels.

CONCLUSION

A positive correlation between NGAL and galectin-3 in HF patients was found, revealing a potential association between renal injury and myocardial fibrosis and remodeling in HF.

Effects of Newer Antidiabetic Drugs on Endothelial Function and Arterial Stiffness: A Systematic Review and Meta-Analysis

BACKGROUND

Newer antidiabetic drugs, i.e., dipeptidyl peptidase-4 (DPP-4) inhibitors, sodium-glucose cotransporter-2 (SGLT-2) inhibitors, and glucagon-like peptide-1 receptor agonists (GLP-1 RAs) may exert distinct cardiovascular effects. We sought to explore their impact on vascular function.

METHODS

Published literature was systematically searched up to January 2018 for clinical studies assessing the effects of DPP-4 inhibitors, GLP-1 RAs, and SGLT-2 inhibitors on endothelial function and arterial stiffness, assessed by flow-mediated dilation (FMD) of the brachial artery and pulse wave velocity (PWV), respectively. For each eligible study, we used the mean difference (MD) with 95% confidence intervals (CIs) for FMD and PWV. The pooled MD for FMD and PWV were calculated by using a random-effect model. The presence of heterogeneity among studies was evaluated by the I ² statistic.

RESULTS

A total of 26 eligible studies (n = 668 patients) were included in the present meta-analysis. Among newer antidiabetic drugs, only SGLT-2 inhibitors significantly improved FMD (pooled MD 1.14%, 95% CI: 0.18 to 1.73, p = 0.016), but not DPP-4 inhibitors (pooled MD = 0.86%, 95% CI: -0.15 to 1.86, p = 0.095) or GLP-1 RA (pooled MD = 2.37%, 95% CI: -0.51 to 5.25, p = 0.107). Both GLP-1 RA (pooled MD = -1.97, 95% CI: -2.65 to -1.30, p < 0.001) and, to a lesser extent, DPP-4 inhibitors (pooled MD = -0.18, 95% CI: -0.30 to -0.07, p = 0.002) significantly decreased PWV.

CONCLUSIONS

Newer antidiabetic drugs differentially affect endothelial function and arterial stiffness, as assessed by FMD and PWV, respectively. These findings could explain the distinct effects of these drugs on cardiovascular risk of patients with type 2 diabetes.

Postpartum Depression in a Public Hospital in Cyprus. Prevalence, Risk Factors

Introduction

Postpartum depression (PPD) is a serious mental health condition. Untreated PPD places the mother and infant at risk and is associated with significant long-term effects on child development and behavior.

Objectives

Appropriate screening for and prompt recognition and treatment of depression after the birth of a child are essential for maternal and child well-being.

Aims

The purpose of the present study was to estimate the prevalence of PPD in the first 5 days after the birth of a neonate and to investigate associations with several risk factors.

Methods

A cross-sectional study was conducted among 150 mothers, in a public obstetric hospital in Nicosia, Cyprus. A questionnaire was administered including socio-demographic characteristics. The Greek version of the Edinburgh postnatal depression scale (EPDS), a 10–item questionnaire to identifying women who are at risk of PPD, was used to estimate depression among the participants.

Results

According to EPDS, 42% of the mothers screened positive for risk of developing PPD. Higher risk was observed in very young mothers (<20 years) (66.6% vs 15%), in women with history of psychological disorders (86.95% vs 33.85%), in single mothers (71.69% vs 22.8%), in women with serious problems during the pregnancy (74% vs 23.95%) and in mothers with not healthy neonate (75.7% vs 32.4%).

Conclusion

The study reveals a high prevalence of PPD and identifies various risk factors associated with developing PPD. The use of maternal depression screening programs such as the EPDS may help to recognize an elevated risk of postpartum depression and to ensure a healthier mother-child relationship.

The impact of emotional intelligence on the emotional state of nurses in public hospitals in Cyprus

Introduction

The term emotional intelligence (EI) has gained more and more popularity in the last two decades and has been studied in various workplace settings.

Objectives/aims

The purpose of the present study was to estimate the EI in nursing personnel, to examine which factors are associated with EI and how EI correlates with their emotional state.

Methods

A cross-sectional study was conducted from April to May 2016 in a representative sample of nursing personnel from seven public hospitals of Cyprus. A total of 585 nurses completed the Greek Emotional Intelligence Scale (GEIS), consisting of 52 items measuring four basic emotional skills and scored on a 5-point Likert scale (from low (52) to high (260) EI). Furthermore, the Depression, Anxiety, and Stress Scale (DASS 21) was applied. Statistical analyses were performed using the SPSS v.20.0.

Results

Overall mean EI scores were 184.11 for males and 184.82 for females. Being married and having children as well as having leading position was associated with higher EI (P = 0.024, P = 0.002, P = 0.012, respectively). The highest EI scores were identified between the middle aged nurses (36–50 years, EI = 191.5, P = 0.000) and nurses with more years of work (> 12 years, EI = 189.59, P = 0.000). The overall EI scores have moderate negative correlation with the emotional state of the nurses (P = 0.000).

Conclusions

The present study reveals under-optimal EI scores and confirms the negative relationship with the emotional state of nurses. Based on the literature, the EI can be developed, thus suitable programs could substantially improve the emotional skills in nursing personnel.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Frequency of depressive disorders in a representative sample of Nicosia, Cyprus

Introduction

“Health Profile” of Nicosia was conducted in 2013–2014, within the framework of the program “Healthy Cities” in order to collect and analyse information on the state of health and health-related behaviors of the citizens of Nicosia in Cyprus.

Aims

To estimate the frequency of self-reported depressive disorders and examine burdening as well as factors influencing it.

Methods

Based on the 2011 census, a cross-sectional study was carried out on a representative random stratified sample, which was selected to be interviewed, including 477 men and 525 women, from the city area. Participants answered a questionnaire, which required among other items on self-perceived physical and mental health. Participants were also asked the following questions: “Do you have/had in the past depression or/and anxiety?” and “Have you received a medical diagnosis for this disorder?”

Results

Approximately 70% of the sample reported they had experienced anxiety and depression (37% moderate and 33% severe episodes). Diagnosed depression was reported by 4%. Severe depressive disorders were more frequently reported by women (41%, P < 0.001), older aged citizens (70.2%, P < 0.001) widowed/divorced (45.5%, P < 0.001), persons with lower family income (< 1000 €, 79.7%, P < 0.001) and among people with chronic diseases (45.3%, P < 0.001).

Conclusions

The self-reported prevalence of anxiety and depression in the citizens of Nicosia is very high – probably reflecting a negative effect of the economic crisis –, and contrariwise diagnosis of the disorder is rarely provided and consequently therapy rarely offered. Specific population groups, such as women, elderly citizens, patients with chronic diseases are more vulnerable to depressive disorders requiring specialized medical attention.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Jejunojejunal lipoma causing intussusception

Jejunojejunal intussusception and jejunojejunal lipomas are both very rare clinical entities. The present case report describes this event in an adult patient with severe episodes of hematochezia and colicky upper abdominal pain. The diagnosis was not made preoperatively, as none of the endoscopic findings were pathognomonic and, furthermore, CT scans could not rule out malignancy. Exploratory laparotomy was mandatory and at surgery a jejunojejunal intussusception secondary to a lipoma was found. Segmental resection and primary reanastomosis were performed in the presence of evidence of bowel ischemia.