Awareness and knowledge of pneumococcal vaccination in cardiology outpatient clinics and impact of physicians' recommendation on vaccination rates

Funding Acknowledgements

Type of funding sources: None.

Background

Although there is not enough data on pneumococcal vaccination status in patients with cardiovascular disease and or risk factors in our country, it is known that vaccination rates are quite low in the current data.

Purpose

We aimed to evaluate the awareness of pneumococcal vaccination (PCV13, PPSV23) in general cardiology outpatient clinics and impact of physician’s recommendation (with educational brochures) on vaccination rate.

Methods

Awareness of vaccination, before COVID-19 pandemic, was measured in patients admitting to cardiology outpatient clinics from 40 center of our country by a questionnaire contained 19 questions. The demographics (including gender, age, educational level, awareness vaccination level) and comorbidities were obtained. The vaccination rates were calculated within 3-months follow-up from the admitting of patient to cardiology clinics.

Results

The 403 (18.2%) of patients with previous pneumococcal vaccination were excluded from the study. The mean age of study population (n=1808) was 61.9±12.1 years and 55.4% were male. The 58.7% had coronary artery disease, hypertension (74.1%) was the most common risk factor and 32.7% of the patients had never been vaccinated although they had information about vaccination before. The 98.5% were referred to family medicine (n=1412, 78.1%) or vaccination outpatient clinics (n=370, 20.5%) and the vaccination rate was 62.1% during the follow-up period. The differences between vaccinated and not-vaccinated patients are presented in Table 1.

The physician’s recommendation was positively correlated with vaccination intention and behavior in our participants. Multivariate logistic regression analysis showed a significant between vaccination and female sex [OR=1.55 (95% CI=1.25–1.92), p<0.001], higher education level [OR=1.49 (95% CI=1.15-1.92), p=0.002] patients’ knowledge [OR=1.93 (95% CI=1.56-2.40), p<0.001], and their physician’s recommendation [OR=5.12 (95% CI=1.92-13.68), p=0.001].

Conclusion

To our knowledge this is the first report about the awareness pneumococcal vaccination rates and impact of physician’s recommendation in patients with cardiovascular disease by high study population. These findings suggest providing information on the benefits of vaccination by physician’s and educational advice was significantly associated with an increase vaccination rate and have a key role.

Interaction between the genetic variant of rs696217-ghrelin and food intake and obesity and dyslipidemia

In this study, we aimed to investigate the relationship between the genetic variant of rs696217-ghrelin and fasted lipid profile, indices of obesity, and environmental parameters. Amplification refractory mutation system-polymerase chain reaction (ARMs-PCR) was used for genotyping 1118 individuals recruited as part of the Mashhad Stroke and Heart Atherosclerotic Disorder (MASHAD) cohort study. The interaction between the presence of the genetic variant of rs696217-ghrelin and nutritional intake and other major determinants of obesity and lipid profile was examined in the MASHAD study population. Individuals with the TT genotype at the locus had the lowest prevalence of obesity compared to other genotypes among the individuals. No significant relationship was found between the two groups regarding the lipid profile and TT genotype. Furthermore, no significant association was found between dietary intake and the genetic variant of rs696217-ghrelin in the population under study. Individuals with a TT or GT genotype appear to be at a higher risk of obesity, compared to those with a GG genotype. The results of the current study revealed a significant association between the genetic variant of rs696217-ghrelin and obesity; however, this gene did not correlate with the risk factors of cardiovascular diseases and dyslipidemia in the Iranian population.

Usefulness of novel martin/hopkins and sampson equations over friedewald equation in cardiology outpatient: CVSCORE-TR substudy

Funding Acknowledgements

Type of funding sources: None.

OnBehalf

CVSCORE-TR study group

Background

Friedewald equation (LDL-Cf) is known to produce inaccurate estimations of low-density lipoprotein cholesterol (LDL-C) when triglycerides are high (>400 mg/dl) or LDL-C is low (<70 mg/dl). Martin/Hopkins (LDL-Cmh) and Sampson (LDL-Cs) equations were developed to overcome these limitations, but few data are available whether these equations offer incremental usefulness over LDL-Cf.

Purpose

  In this pragmatic study, we aimed to evaluate the agreement between LDL-C calculated using LDL-Cmh, LDL-Cs and LDL-Cf equations and to understand whether using LDL-Cmh or LDL-Cs instead of LDL-Cf leads to significant changes on the clinical decision-making 

Methods

4196 cardiology outpatient cases that were included in a multicenter registry database were analyzed. Each case was assigned into a cardiovascular risk class using web-based SCORE (Systematic COronary Risk Evaluation) algorithm calibrated for high-risk European countries, and relevant European guidelines were used to assess LDL-C targets. LDL-Cf, LDL-Cs and LDL-Cmh were calculated as previously described. 

Results

Compared to LDL-Cmh and LDL-Cs, LDL-Cf was able to correctly identify 96.9%-98.08% of cases as within or out of LDL-C target, respectively, while 1.95%-2.8% of cases were falsely identified as within LDL-C target. Kappa coefficients for agreement between LDL-Cf vs. LDL-Cmh and LDL-Cf vs. LDL-Cs were 0.868 and 0.918 (p < 0.001 for both). For patients not on anticholesterolemic drugs, decision to initiate treatment would be different in 1.2%-1.8% of cases if LDL-Cs or LDL-Cmh were used, respectively. For those already on anticholesterolemic drugs, decisions regarding to treatment intensification would be different in 1.5%-2.4% of cases if LDL-Cs or LDL-Cmh were used.

Conclusions

Friedewald equation had an excellent degree of agreement with the novel Martin/Hopkins and Sampson formulas in most cardiology outpatients, especially those within the lower end of the cardiovascular risk spectrum. In selected patients, especially those with high or very high risk in whom LDL-Cf < 70 mg/dl or those with a TG > 400 mg/dl, agreement was far worse and thus novel equations might have an incremental usefulness for clinical decision making.

Table 1 Reference Comparison Correct estimation Underestimation Overestimation Kappa (p value) All patients that were not on cholesterol-lowering treatment LDL-Cmh LDL-Cf 2785 (98.1%) 51 (1.8%) 3 (0.1%) 0.962 (<0.001) LDL-Cs LDL-Cf 2804 (98.8%) 35 (1.2%) 0 (0.0%) 0.975 (<0.001) Agreement for the indication of cholesterol-lowering treatment for patients not already on cholesterol-lowering drugs. Leftmost column shows the reference method, and the second row shows equation which is compared to the reference method.

Abstract Figure

P3622Demographic and clinical characteristics of atrial fibrillation patients suffering from an ACS without prior revascularization history

Background

The incidence of atrial fibrillation in acute coronary syndromes (ACS) ranges from 3% to 25%. The purpose of the current study was to investigate the demographic and baseline clinical characteristics, cardiovascular risk factors and comorbid conditions between patients (pts) with concomitant atrial fibrillation (AF) to those without AF in patients suffering from ACS without previous coronary artery bypass graft (CABG) and/or percutaneous coronary intervention.

Methods

The MINOCA-TR study has a cross-sectional, multicenter, observational design and was conducted with 32 interventional cardiology centers in our country. Heart rhythm at emergency admission, demographical, clinical and angiographic data was recorded for each patient. Patients with stable coronary artery disease, unstable angina pectoris and with type 4/5 myocardial infarction were excluded from study population.

Results

A total of 1626 patients (male: 70.7%, mean age: 61.4±12.5 years) were classified according to the presence of AF. The rate of AF was 3.1% in study population. This group was older (73.4 vs. 61.0 years, p<0.001) and AF was more common among females (43.1% vs. 28.7%, p=0.027). The frequency of AF was slightly higher (7.8%) in MINOCA group (p=ns).

STEMI presentation was more common in patients without AF (31.3% vs. 46.9%, p=0.028). LVEF was significantly lower in ACS patients with AF (44.1% vs. 49.4%, p=0.039). The frequency of AF was significantly higher (3.7%) in MINOCA group.

AF vs. non-AF ACS pts w/o prior revasc Parameter ACS with AF ACS without AF p value Age (years) 73.4 (±9.4) 61.0 (±12.4) <0.001 Female (%) 43.1 28.7 0.027 cTnT levels (pg/dL) median (IQR) 15.2 (96) 15.3 (428) 0.421 STEMI (%) 31.3 46.9 0.028 LVEF (%) 44.1 (±12.2) 49.4 (±10.4) 0.039 MINOCA (%) 7.8 6.6 0.743 STEMI: ST-segment elevation MI; NSTEMI: Non-ST-segment elevation myocardial infarction; LVEF: left ventricular ejection fraction; MINOCA: Myocardial Infarction with Non-Obstructive Coronary Arteries.

Conclusions

The frequency of AF was relatively lower in patients suffering from an ACS without prior revascularization history. They were older than patients without AF and were common in females. Non-ST-segment elevation myocardial infarction was significantly higher in the AF. The presence of MINOCA was similar between 2 groups.

Influence of influenza vaccination on recurrent hospitalization in patients with heart failure

BACKGROUND

The current study aimed to evaluate the influence of regular annual influenza vaccinations on cardiovascular (CV) death and heart failure-related hospitalizations (HFrH) in stable outpatients with heart failure with reduced ejection fraction.

METHODS

The Turkish research team-HF (TREAT-HF) is a network undertaking multicenter, observational cohort studies in HF. This study is a subgroup analysis of TREAT-HF outpatient cohorts who completed a questionnaire on influenza vaccination status and for whom follow-up data were available. A total of 656 patients with available follow-up data for CV death and HFrH including recurrent hospitalization were included in the study. Patients were classified into two groups: those who received regular influenza vaccination (40 %) and those who did not receive vaccination.

RESULTS

During a mean follow-up of 15 ±6 months, 113 (18 %) patients had CV death and 471 (72 %) patients had at least one HFrH. The CV death rate was similar in both groups of patients (16 vs. 19 %, p = 0.37), whereas, HFrH and recurrent HFrH were significantly less frequently encountered in patients who received regular influenza vaccination than in those who did not receive vaccination (43 vs. 92 % and 16 vs. 66 %, p < 0.001, respectively). In a multivariate Cox proportional hazards model - in addition to a few clinical factors - vaccination status (HR = 0.30, 95 % CI = 0.17-0.51, p < 0.001) and graduation from university (HR = 0.35, 95 % CI = 0.17-0.72, p = 0.004) remained independently associated with the risk of recurrent HFrH.

CONCLUSION

Regular influenza vaccination does not influence CV deaths; however, it decreases HFrH including recurrent episodes of HFrH in outpatients with heart failure with reduced ejection fraction.

Comparison of heart transplantation patients with ischemic and idiopathic dilated cardiomyopathy

OBJECTIVE

We retrospectively analyzed our data to compare preoperative demographic, laboratory, echocardiographic, hemodynamic findings mortality and survival rates of heart transplantation patients with ischemic (ICM) and idiopathic dilated (IDCM) cardiomyopathy.

METHODS

The data of 144 patients transplanted from February 1998 to January 2011 were analyzed. 38 patients with ischemic ICM and 86 patients with IDCM were compared.

RESULTS

Recipient age, preoperative creatinine, recipient body mass index, intraoperative cross-clamp time, donor male sex ratio, recipient male sex ratio, hyperlipidemia ratio, and previous nitrate use were significantly higher and left ventricular end systolic diameter significantly lower in patients with ICM. Major causes of death after heart transplantation were infections (31.9%), right ventricle failure (14.8%), and sudden cardiac death (14.8%). Causes of death were not different between the groups. Overall mortality in the entire population was 37.9% (47/124), and it was not different between the groups (39.5% vs 37.2%; P=.48). Early mortality (<30 days) rate was 11.2% (14/124), late mortality rate was 26.6% (33/124), and no statistically significant difference was observed between the groups. Survival analysis showed that ICM patients were not associated with worse survival compared with IDCM (71.1% vs 81.1% after 1 year, 68.1% vs 73.0% at 2 years, and 54.2% vs 62.3% at 5 years; log rank=0.57). Multivariate analysis showed that the only predictor of mortality was preoperative urea level and that heart failure etiology was not a predictor of this end point.

CONCLUSIONS

Patients with ICM had similar survival and mortality rate compared with IDCM.

Are swimming or aerobic exercise better than conventional exercise in ankylosing spondylitis patients? A randomized controlled study

AIM

The aim of the study was to compare the effects of conventional exercise (CE), swimming and walking on the pulmonary functions, aerobic capacity, quality of life, Bath indexes and psychological symptoms in patients with ankylosing spondylitis (AS).

METHODS

Forty-five patients were randomised into either swimming (group 1), walking (group 2), CE group (group 3). Patients in Group 1 performed CE and swimming, patients in Group 2 performed CE and walking and patients in Group 3 performed CE only. Exercise sessions were performed three times a week for a period of six weeks. Patients were assessed before and after the rehabilitation program, with respect to, pulmonary function test (forced vital capacity [FVC, mL], forced expiration volume in one second [FEV1, mL], FEV1/FVC (%) and vital capacity [VC, mL]), maximal oxygen uptake (pV.O2), 6-minute walking test (6MWT), Bath Ankylosing Spondylitis Functional Index, Bath Ankylosing Spondylitis Disease Activity Index, Bath Ankylosing Spondylitis Metrology Index, Nottingham Health Profile and Beck Depression Inventory.

RESULTS

There were significant increases in pVO2 and 6MWT after treatment in Groups 1 and 2 (P<0.05). FeV1, FVC and VC improved significantly with treatment in all three groups (P<0.05). A statistically significant improvement was observed in energy, emotional reaction and physical mobility sub-scores of NHP in three exercise groups after completion of the exercise program (P<0.05).

CONCLUSIONS

Swimming, walking and CE had beneficial effects on the quality of life and pulmonary functions. Aerobic exercises such as swimming and walking in addition to CE increased functional capacities of patients.

Effect of levosimendan on right ventricular systolic and diastolic functions in patients with ischaemic heart failure

OBJECTIVES

Levosimendan is a novel positive inotropic calcium sensitiser agent used in acute left heart failure. In this study, the effect of levosimendan on the right ventricular systolic and diastolic functions was evaluated by tissue Doppler comparing them with dobutamine in patients with ischaemic heart failure.

METHODS

Patients having an acute decompensated heart failure with ischaemic cardiomyopathy and left ventricular ejection fraction <40% were included in the study. Before and 24-h after treatment, peak systolic (Sa), peak early (Ea), peak late (Aa) diastolic annular velocities and Ea/Aa ratio from tricuspid lateral annulus by tissue Doppler and systolic pulmonary artery pressure (SPAP) were measured.

RESULTS

Sa, Ea and the Ea/Aa ratio were significantly increased in the levosimendan group whereas SPAP was significantly reduced. In the dobutamine group, no significant differences were observed in the Sa, Ea, Aa and Ea/Aa ratio in spite of a significant reduction in SPAP. Decrease in SPAP was greater in the levosimendan group (p=0.002).

CONCLUSION

Levosimendan improves right ventricular systolic and diastolic functions.

Comparison of hospital-supervised exercise versus home-based exercise in patients after orthotopic heart transplantation: effects on functional capacity, quality of life, and psychological symptoms

In heart transplant patients it is common to observe a reduced exercise capacity and diminished quality of life. The objective of this study was to compare the effectiveness of a hospital-based exercise program versus that of a home-based exercise program on the functional capacity, quality of life, and psychological symptoms among heart transplant patients.

METHODS

Thirty-eight heart transplant patients were randomly placed into two groups: a hospital-based exercise program (group 1, n = 15) or a home-based exercise program (group 2, n = 13). All patients performed flexibility, stretching, aerobic, strengthening, breathing, and relaxation exercise programs for 8 weeks. We performed estimates of functional capacity (maximal oxygen consumption-pVO2), quality of life (Short Form-36-SF36), and psychological symptoms (Beck Depression Inventory-BDI, the State-Trait Anxiety Inventory-STAI).

RESULTS

In group 1, significant increases were observed in pVO2 and all SF36 subgroups, with the exception of vitality and social function subgroups (P < .05). Significant increases were not observed on the BDI or STAI (P > .05). Group 2 failed to show significant improvements in any variable, with the exception of the score on the bodily pain subgroup of the SF36 (P > .05).

CONCLUSION

Based on our clinical results, we recommend a well-organized exercise program performed in a rehabilitation unit to improve postoperative exercise capacity and quality of life among heart transplant patients.

Transbrachial coil occlusion of unligated thoracic side branch of arterial graft of internal mammary artery leading to silent ischemia in a diabetic patient

There is not an established consensus on the treatment of coronary steal syndrome caused by unligated thoracic side branches of internal mammary artery. Occlusion of thoracic side branch is not recommended without objective evidence of ischemia. This case report presents transbrachial coil occlusion of thoracic side branch of left internal mammary artery causing silent ischemia in a diabetic patient with atypical chest pain and palpitation.

Accuracy of an electromagnetic tracking device for measuring hip joint kinematics during gait: effects of metallic total hip replacement prosthesis, source-sensor distance and sensor orientation

The present study sought to investigate the effects of source-sensor distance, sensor orientation and the effects of metallic total hip replacement (THR) prostheses on the accuracy of the 3Space Tracker System (3STS). Using a simulated hip joint, the angles measured by the 3STS with six different source-sensor distances and two source-sensor orientations were recorded. Then the angles measured in the absence and presence of three different THR prostheses were compared. Both source-sensor distance and sensor orientation affects the accuracy of the 3STS. Measurements were only affected by the presence of one type of prosthesis. The 3STS was equally reliable, but less accurate with source-sensor distances of more than 25 cm. The small angular error and insensitivity of this device to the presence of some metallic THR prostheses make it a useful measurement tool for gait studies performed before and after THR surgery.

The efficacy of telmisartan compared with perindopril in patients with mild-to-moderate hypertension

In this study, efficacy of the angiotensin II type 1 receptor blocker telmisartan given as monotherapy was compared with that of perindopril monotherapy in patients with mild-to-moderate hypertension. After a 2-week, single-blind, placebo run-in period, 60 patients were randomised to double-blind, once-daily treatment with telmisartan 80 mg or perindopril 4 mg for 6 weeks. Clinic and ambulatory blood pressure measurements and clinical laboratory evaluation were performed at the end of the placebo run-in and active treatment phases. Both telmisartan and perindopril significantly (p < 0.0001) reduced clinic systolic blood pressure (SBP) and diastolic blood pressure (DBP) compared with baseline values. Also, both drugs significantly (p < 0.0001) reduced 24-h mean ambulatory SBP and DBP compared with baseline. Comparison of the mean hourly antihypertensive activities showed that the reduction in mean ambulatory DBP for the last 8 h of the dosing interval was significantly greater (p < 0.05) in telmisartan-treated patients. A 24-h mean DBP of <85 mmHg was observed in 66.6% of the telmisartan-treated patients but in only 46.6% of the perindopril-treated patients (p < 0.05). It is concluded that telmisartan and perindopril both produce significant reductions in clinic SBP and DBP, but the mean reduction in ambulatory DBP during the last 8 h of the dosing interval is greater in patients treated with telmisartan.

Right atrial and ventricular thrombi in Behçet's disease: a case report and review of literature

Behçet's disease is a chronic multi-system disease presenting with recurrent oral and genital ulceration, and relapsing uveitis. Cardiac involvement is an extremely rare manifestation of this disorder. We report an unusual case of Behçet's disease characterized by a mural cardiac thrombi in the right atrium and right ventricle along with transient protein C and S deficiency.

The state of lipid peroxidation and antioxidants following thrombolytic therapy with rt-PA and streptokinase in acute myocardial infarction

The role of reactive oxygen products in myocardial damage caused by ischemia-reperfusion has been established in a number of studies performed in animals models. However, studies showing the development of increased free radicals following effective myocardial reperfusion in humans are scarce. In the present study, both the increase of lipid peroxidation (LPO) following early stage thrombolytic therapy which is the current treatment issue performed after acute myocardial infarct (AMI) and the plasma levels of vitamin E and C (chain braker antioxidants) were investigated parallel to time. Forty patients with AMI who were admitted to hospital within six hours from the beginning of symptoms were included in the study and divided into two groups; group 1 (recombinant tissue-Plasminogen Activator, rt-PA group) and group 2 (streptokinase group). Serial serum specimens were drawn before and 30, 90 minutes and 24 hours after thrombolytic therapy for the investigation of LPO, vitamin E and C levels. Echocardiographic examination was performed on the tenth day to evaluate the functions of the left ventricle. Plasma levels of lipid peroxides (LPO) were found to increase 90 minutes after thrombolytic therapy in each group, while the levels of vitamins E and C showed significant decreases. The difference between the two groups was not significant. Similar to this finding, no significant difference in the ejection fraction values was observed between the groups. Further, no correlation was observed between the ejection fraction and LPO values at the 90th minute which is considered to be the time of successful thrombolysis. In conclusion, the occurrence of a series of biochemical changes confirming an increase in free radical development of peripheral blood was observed. Although the decrease in vitamin E and C levels suggests the need for supplementation of these vitamins along with the thrombolytic therapy, the fact that at least a week is needed for an increase of tissue levels of vitamin E confirms the opinion that the daily prophylactic doses of these vitamins is suitable for the decrease of AMI risk.

Large inferoposterior wall pseudoaneurysm of the left ventricle with a thrombus after myocardial infarction

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A three-dimensional morphometrical study of the distal human femur

The objective of this paper is to present a method to describe the three-dimensional variations of the geometry of the three portions forming the distal part of the human femur: the medial and lateral femoral condyles and the intercondylar fossa. The contours of equally spaced sagittal slices were digitized on the distal femur to determine its surface topography. Data collection was performed using a digitizer system which utilizes low-frequency, magnetic field technology to determine the position and orientation of a magnetic field sensor in relation to a specified reference frame. The generalized reduced gradient optimization method was used to reconstruct the profile of each slice utilizing two primitives: straight-line segments and circular arcs. The profile of each slice within the medial femoral condyle was reconstructed using two circular arcs: posterior and distal. The profile of each slice within the lateral femoral condyle was reconstructed using three circular arcs: posterior, distal and anterior. Finally, the profile of each slice within the intercondylar fossa was reconstructed using two circular arcs: proximal-posterior and anterior, and a distal-posterior straight-line segment tangent to the proximal-posterior circular arc. Combining the data describing the profiles of the different slices forming the distal femur, the posterior portions of each of the medial and lateral femoral condyles were modelled using parts of spheres having an average radius of 20 mm. The anterior portion of the lateral condyle was approximated to a right cylinder having its circular base parallel to the sagittal plane with an average radius of 26 mm. The anterior portion of the intercondylar fossa was modelled using an oblique cylinder having its circular base parallel to the sagittal plane with an average radius of 22 mm. Furthermore, it is suggested that the distal portion of the lateral femoral condyle could be modelled using parts of two oblique cones while the distal portion of the medial femoral condyle could be modelled using a part of a single oblique cone, all cones having their circular bases parallel to the sagittal plane. It is also suggested that the posterior portion of the intercondylar fossa could be modelled using two oblique cones: a proximal cone having its base parallel to the sagittal plane and a distal cone having its base parallel to the frontal plane.