[The effectiveness of cardiovascular education in the prevention of heart disease among the inhabitants of Lesser Poland]

OBJECTIVE

Introduction: Numerous risk factors for cardiovascular disease (CVD) are modifiable, therefore understanding their effects has a significant impact on lowering the incidence and mortality. The "Małopolska Cardiovascular Preventive Intervention Study (M-CARPI)" aims to educate the inhabitants of the voivodeship regarding preventative measures for developing CVD. The aim: To examine the effectiveness of the seminars regarding preventative measures for developing CVD according to the M-CAPRI among the inhabitants of Lesser Poland.

PATIENTS AND METHODS

Material and methods: The seminars were carried out by a doctor with a specialization in cardiology, in the form of presentations, based on materials prepared by experts in accordance with European and Polish guidelines. Both initially and after the course, participants completed questionnaires regarding the subjects discussed.

RESULTS

Results: The study covered 558 people (137 men, 411 women). The analysis was based on the sub-populations of retirees and non-retirees. The knowledge of risk factors was checked, the respondents most often indicated incorrect judgment of nutrition, physical activity and smoking (45.9%, 39%, 44.2% for non-retirees and 22.8%, 27.6%, 16.5% for retirees, respectively). A significant increase in the number of people who indicated individual risk factors after the training was found (p=0,047 for HDL level and for others).

CONCLUSION

Conclusions: Educating and creating awareness towards the prevention of CVD according to the M-CAPRI survey protocol is an effective tool for prevention. Due to the limited knowledge of cardiovascular risk factors, it is necessary to carry out activities to raise awareness of the importance of cardiological disease prevention. Preventive interventions are equally effective regardless of age or profession.

Assessment of Left Atrial Function in Patients with Paroxysmal, Persistent, and Permanent Atrial Fibrillation using Two-Dimensional Strain

Background and purpose

Atrial fibrillation (AF) has a progressive nature, leading to structural, functional, and electrical changes in the left atrium (LA). Enhanced response to treatment in patients with AF can be achieved through improved knowledge of atrial structure and a better understanding of its function. The aim of this study was to assess LA strain and its determinants in patients with paroxysmal (PAF), persistent (PsAF), and permanent AF (PmAF).

Methods

Fifty-eight patients with registered non-valvular AF were divided into 3 groups depending on the type of AF. The participants underwent transthoracic echocardiography to assess the anatomy and function of heart chambers. Left atrial longitudinal strain (LALS) was measured in four-chamber projections using two-dimensional speckle tracking echocardiography.

Results

Patients with PAF had higher LALS (15.7±12.0) when compared to those with PsAF (4.3±7.9) and PmAF (5.8±7.8, all P=0.003). Multiple linear regression showed that the independent predictors of LALS were diastolic blood pressure (β=0.95, R2=0.88) in the PAF group; left atrial area (β=-0.56) and creatinine (β=-0.63, R2=0.58) in the PsAF group; AF duration (β=0.89) in the PmAF group (R2=0.72).

Conclusion

LA strain has different determinants depending on AF type. LA size, renal function, and AF duration determine LALS in long-lasting AF. LA strain is a simple and accurate technique to estimate LA dysfunction in patients with long-lasting AF.

[Type and frequency of cardiac symptoms in patients with pulmonary sarcoidosis]

AIM

The aim of the study was to assess the type and frequency of prevalence of cardiac symptoms in patients with pulmonary sarcoidosis.

MATERIALS AND METHODS

The study group consisted of 54 patients (21 female, 33 male), with biopsy-proven pulmonary sarcoidosis. Mean age was 45.85 +/-11.77 years. According to time passed from diagnosis of sarcoidosis patients were divided into 2 subgroups. Additionally, age, sex, left ventricular ejection fraction, cigarette smoking and comorbidities were analyzed. Course and stage of sarcoidosis were also included in the analysis.

RESULTS

The frequency of cardiovascular symptoms in the study group was 87.04%. 59.26% of patients reported chest pain, the same subjects reported dyspnoea. 48.15% of respondents reported heart palpitations, 33.33% pre-syncope states, 12.96% syncope, and 37.04% edema of lower limbs. There were no statistically significant differences in the incidence of analyzed symptoms, depending on the duration of lung sarcoidosis.

CONCLUSIONS

Patients with pulmonary sarcoidosis who report cardiovascular symptoms require further diagnostics.

Knowledge of cardiovascular disease (CVD) risk factors in population of Małopolska voivodeship in two independent cross-sectional studies

INTRODUCTION

Low level of knowledge of cardiovascular disease (CVD) risk factors is related to higher risk of death and health educational programs are of particular importance in CVD prevention. Monitoring the level of knowledge of CVD risk factors is necessary to verify the effectiveness of education and to facilitate the right choice of education methods.

AIM

to compare the assessment of knowledge of CVD risk factors in the population of Małopolska Voivodeship from the two independent cross-sectional studies.

MATERIAL AND METHODS

Data of 973 respondents of M-CAPRI Study and 333 respondents of WOBASZ II Study, at age 20-69, were included to analysis. M-CAPRI study was carried out in 2014 and WOBASZ II - in the years 2013-2014. Knowledge of CVD risk factors was assessed by the same standard questionnaire in both studies. Multivariate logistic regression was used to assess the differences in knowledge of CVD risk factors between participants of M-CAPRI and WOBASZ II studies.

RESULTS

There were 80% of women and 71% of men, respondents of M-CAPRI Study who recognized theterm ,,risk factor” compared to 73% and 78% respectively in respondents of WOBASZ II Study. However, after adjustment for age and education the difference was statistically significant only in men. Respondents of M-CAPRI Study had knowledge of hypertension, high level of blood cholesterol, alcohol and unhealthy diet less frequently compared to respondents of WOBASZ II Study. Men from M-CAPRI Study had knowledge of diabetes and smoking less frequently but knowledge of low physical activity more frequently compared to men from WOBASZ II Study.

CONCLUSIONS

The use of standard questionnaire in two independent cross-sectional studies appeared to be not sufficient to obtain reliable information on knowledge of CVD risk factors in Małopolska Voivodeship. In the studies that differed in the method of recruitment, participation and the technique of interview, the differences in the assessment of knowledge were substantial and it is impossible to assess which assessment was closer to the reality. However, the results of both M-CAPRI and WOBASZ II studies indicate that knowledge of CVD risk factors in Małopolska Voivodship is poor and there is a strong need to intensify health education.

[Evaluation of the clinical suitability of automated left ventricle's fraction and volume measurements in 3-dimensional echocardiography compared to values obtained in magnetic resonance imaging (pilot study)]

Recently a lot of authors have been trying to determine the usefulness of 3-dimensional echocardiography (TTE 3D) in evaluation of ejection fraction and left ventricular volume, but few attempt to compare it to the current gold standard of cardiac magnetic resonance (CMR). 3D imaging technics allows to avoid errors caused by geometry of the heart chambers and foreshortened views. American Echocardiographic Guidelines recommend the use of 3-dimensional echocardiography in daily clinical practice.

AIM

The aim of the study was to establish clinical usefulness of automated 3D TTE software to calculate left ventricle ejection fraction (LVEF), left ventricle end diastolic volume (LVEDV) and left ventricle end systolic volume (LVESV), and to compare those measurements calculated in CMR and in 3D TTE.

MATERIALS AND METHODS

The aim of the study was to establish clinical usefulness of automated 3D TTE software to calculate left ventricle ejection fraction (LVEF), left ventricle end diastolic volume (LVEDV) and left ventricle end systolic volume (LVESV), and to compare those measurements calculated in CMR and in 3D TTE.

RESULTS

The mean LVEF in 3D TTE was 65% +/- 12%; LVEDV 123 ml +/- 67 ml, LVESV 42 ml +/- 29 ml. The CMR LVEF in the study group was 61% +/- 9%, LVEDV 134 ml +/- 51ml, LVESV 54 ml +/- 33 ml. Wilcoxon rank test showed no difference between medians of the measurements, the correlation coefficient between LVEF in 3D TTE and CMR was R = 0.84 (p = 0.036). LVEF calculated in 3D TTE shows good correlation with LVEF computed in CMR. However good visualization of the endocardium, especially in the apex, is essential. The volume of left ventricle is underestimated in 3D TTE. In previous studies underestimation of LVEDV and LVESV was explained by exclusion of endocardial trabeculae from the left ventricle cavity in automated measurement.

CONCLUSIONS

The automated 3D TTE software allows simple, fast and precise evaluation of parameters of the left ventricle - especially LVEF. Automated 3D TTE software gives hope for the inclusion of 3D TTE in routine clinical practice due to its repeatability and easy use of the Heart Model software.

Relationship between knowledge of cardiovascular disease risk factors and watching educational television materials. Małopolska CArdiovascular PReventive Intervention Study (M-‑CAPRI)

INTRODUCTION The current guidelines on cardiovascular disease (CVD) prevention in clinical practice emphasizes the importance of education in the media for population-‑based approaches. OBJECTIVES The aim of the study was to assess the relationship between knowledge of CVD risk factors and watching educational television materials in the adult population. PATIENTS AND METHODS After 22 months of repeated broadcasting of educational television materials, which addressed problems related to CVD, a postal survey was conducted on a random sample of 5000 persons aged 18 years or older. The questionnaire included information on demographics, personal and family history of CVD, educational materials, and knowledge of the risk factors. A multivariate logistic regression was used to assess the relationship between the knowledge of each risk factor and watching educational materials. RESULTS A total of 1129 questionnaires were sent back and used for the analysis. There were 208 participants (18%) who watched the educational materials. The median number of the risk factors listed was 4 (interquartile range, 2-5) for persons who watched the materials and 2 (interquartile range, 0-4) for those who did not watch them. After adjustment for age, sex, education, place of residence, and personal and family history of CVD, the participants who watched the educational materials were 2 to 5 times more likely to have knowledge on particular risk factors, with the exception of hypercholesterolemia for which the relationship was not significant. CONCLUSIONS A strong, plausible relationship revealed by our study supports the idea that in the adult population, better knowledge of CVD risk factors was the effect of watching educational materials.

[Exercise capacity in patients with pulmonary sarcoidosis]

Exertional dyspnea is a common manifestation of sarcoidosis. Cardiopulmonary exercise testing (CPET) is a useful tool to evaluate exercise tolerance of sarcoid patients.

AIM

The aim of the study was to evaluate of exercise capacity in patients with pulmonary sarcoidosis with regard to duration of the disease. Analysis of differences in physical tolerance between patients with cardiac sarcoidosis and without cardiac sarcoidosis.

MATERIALS AND METHODS

39 patients diagnosed with pulmonary sarcoidosis were enrolled to our study. Cardiopulmonary exercise test was used to assess exercise capacity. According to time passed from diagnosis of sarcoidosis patients were grouped into 2 groups. Cardiac sarcoidosis was diagnosed in 9 subjects (23.07%). The control group consisted of 33 healthy volunteers.

RESULTS

The results of the ergospirometry test in patients with lung sarcoidosis showed statistically significant differences in comparison to the control group. The age of patients with pulmonary sarcoidosis correlated negatively with maximal heart rate, oxygen consumption at peak exercise and at anaerobic threshold, breathing frequency at peak exercise, minute ventilation at peak exercise and metabolic equivalent. There was a negative, statistically significant correlation between the oxygen pulse at the peak of exercise and the treatment of steroids in the past.

CONCLUSIONS

Exercise limitation in patients with pulmonary sarcoidosis is a consequence of both ventilatory and cardiocirculatory impairment. Patients with longer disease history of sarcoidosis achieved worse results at cardiopulmonary exercise test than patients with shorter disease history. Trend towards worse exercise tolerance in patients with cardiac sarcoidosis compared to patients without cardiac sarcoidosis was observed.

[Prevalence and knowledge of modifiable cardiovascular risk factors among patients of primary health care. Małopolska CArdiovascular Preventive Intervention Study (M-CAPRI)]

INTRODUCTION

Cardiovascular diseases (CVD) are the main cause of death in Poland. The prevalence of CVD risk factors is regionally differentiated. Awareness of their presence in the population is crucial for identification of high-risk patients and implementation of appropriate preventive intervention. Therefore, the aim of our study was to assess the prevalence and knowledge of modifiable CVD risk factors among patients of primary health care in Malopolska.

MATERIAL AND METHODS

The study was conducted among participants of Małopolska CArdiovascular Preventive Intervention Study (M-CAPRI). Standardized questionnaire and clinical evaluation was conducted in a total of 978 consecutive patients (aged 45.7±13.0) without known CVD in randomly selected primary care units in Małopolska.

RESULTS

The most common major modifiable CVD risk factor was hypercholesterolemia (648; 66.3%) while predisposing was incorrect nutrition (890; 91.0%). The prevalence of hypertension, hypercholesterolemia, diabetes and obesity was increased with age but cigarette smoking, low physical activity and poor nutrition remain unchanged. CVD risk assessed using Pol-SCORE charts was high or very high in 104 (16.9%) and moderate in 369 (59.5%) patients. Each of the modifiable CVD risk factors was often identified by people with higher education and educated beforehand by a doctor or nurse. The presence of a particular CVD risk factor was not associated with better knowledge of it except for diabetes (OR 3.44, 95% CI 0.996-11.863).

CONCLUSIONS

Educated patients have better knowledge on CVD risk factors. Identification of CVD risk factors and education about them should be implemented during visits in primary health care.

[The influence of knowledge of cardiovascular risk factors for 1st and 6th year medical students' lifestyle]

BACKGROUND

The most important way to reduce the incidence of the atherosclerotic cardiovascular disease (CVD) is prevention, which should include modification of risk factors.

AIM

To define knowledge of primary CVD prevention, and to rate compliance with prevention rules among students'.

MATERIAL AND METHODS

The study included 275 first year (ly) students and 161 sixth year (6y) students of the Faculty of Medicine (303 Females and 133 Males; aged 18-29 years). Anonymous questionnaire on acquaintance with the primary prevention, compliance with it and correct values and units of blood pressure, blood glucose and cholesterol level was conducted among survey participants.

RESULTS

6y students indicated risk factors of CVD significantly more correctly than ly students. The proper value of male and female waist circumference was indicated correctly more often by 6y students than ly students. When compared to ly students, 6y students more often marked properly the heart attack symptoms, tests which are necessary to diagnose ACS, and markers of the myocardial necrosis. Respectively, among the ly and 6y students the mean BMI was: 20.82 kg/m2 vs. 21, 74 kg/m2, mean waist circumference: 70.00 cm vs.74.81 cm. 6y students more often than ly students eat regular meals, eat fruits and vegetables more than 4 times a week, exercise more than 30 minutes a day.

CONCLUSIONS

Sixth year medical students' knowledge about the prevention of CVD is greater than the first year students' but still is unsatisfactory. Sixth year students slightly often follow the rules of primary prevention than first year students.