Inflammation – ABC CARDIOL

IJCS

Original Article

Association Between Inflammatory Hematologic Indices and Acute Coronary Syndrome Phenotypes

Fabiele de Lima Righi et al. Gustavo Sugai Paula Araujo Renato Jorge Alves

Abstract

Background:

The systemic immune-inflammation index (SII) and the systemic inflammation response index (SIRI) are inflammatory biomarkers derived from neutrophil (N), platelet (P), lymphocyte (L), and monocyte (M) counts. These indices have been associated with prognostic value in patients with coronary artery disease (CAD) and may contribute to risk stratification in acute coronary syndrome (ACS).

Objectives:

To evaluate the independent association between inflammatory hematologic indices and ACS phenotypes and to explore their relationship with cardiovascular risk factors.

Methods:

This retrospective study analyzed data collected from medical records between July 2022 and July 2023, including 333 patients aged ≥ 18 years of both sexes diagnosed with ACS and admitted to the emergency department of a public hospital in the state of São Paulo, Brazil. Sample was divided into two groups: i) ST-segment elevation myocardial infarction (STEMI) and ii) non-ST-segment elevation myocardial infarction plus unstable angina (NSTEMI+UA). SII was calculated as N × P / L and SIRI as N × M / L. The association between inflammatory indices and ACS phenotypes was assessed using multivariable logistic regression models. Statistical significance was set at 5%.

Results:

Higher values of the inflammatory indices SII (odds ratio [OR], 2.27; 95%CI, 1.66-3.10) and SIRI (OR, 2.92; 95%CI, 2.15-3.96), as well as a history of smoking, were independently associated with a higher likelihood of STEMI diagnosis. Additionally, the STEMI group showed significantly higher values of SII, SIRI, MLR, NLR, and PLR compared with the NSTEMI+UA group.

Conclusions:

Higher SII and SIRI values were independently associated with STEMI diagnosis, which suggests these indices may reflect differences in the inflammatory profile across ACS phenotypes.

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Original Article

Low-Dose Colchicine for Secondary Prevention: A Systematic Review and Meta-Analysis of Randomized Clinical Trials

Rita Barbosa Sousa et al. Joana Certo Pereira João Presume Daniel A. Gomes … Afonso Félix de Oliveira Jorge Ferreira

Introduction

Inflammation is recognized as a probable causal factor in recurrence of atherosclerotic events, making it a promising therapeutic target.^, Plasma C-reactive protein, a marker of systemic inflammation, has been shown to predict the risk of cardiovascular events regardless of cholesterol and other traditional risk factors.^, In the Antiinflammatory Therapy with Canakinumab for Atherosclerotic Disease (CANTOS) trial, inhibition of interleukin-1β demonstrated a reduction in cardiovascular events. Afterwards, colchicine, an inexpensive anti-inflammatory drug, emerged as a promising treatment to target residual inflammatory risk. Its primary mechanism involves inhibiting the NLRP3 inflammasome, which plays a crucial role in atherosclerosis-associated inflammation by producing pro-inflammatory cytokines like interleukin-1β.

The Efficacy and Safety of Low-Dose Colchicine after Myocardial Infarction (COLCOT) and the Colchicine in Patients with Chronic Coronary Disease (LoDoCo2) trials demonstrated a reduction in major adverse cardiovascular events (MACE).^, A meta-analysis of these two major trials and several smaller randomized controlled trials (RCTs) concluded that colchicine reduces MACE, myocardial infarction (MI), coronary revascularization, and stroke in secondary prevention, although it did not improve cardiovascular mortality. Consequently, colchicine is now recommended for secondary prevention by European guidelines for managing acute and chronic coronary syndromes and by American guidelines for chronic coronary disease.^–

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IJCS

Review Article

The Role of Platelets in Long COVID Development: A Literature Review

Gabriel Ferreira Lima et al. Lucas Miossi Amanda Gonçalves Jesus Silva Olivia Barros Pedreira Novais Fernanda Carla Ferreira Brito

Abstract

At its peak during the pandemic, coronavirus disease 2019 profoundly impacted global populations and introduced numerous post-infection complications, collectively referred to as long coronavirus disease. The mechanisms underlying the syndrome’s chronicity are multifaceted; however, a notable aspect of long coronavirus disease pathophysiology is its intricate association with platelets. The chronic inflammatory response triggered by severe acute respiratory syndrome coronavirus 2 is closely related to platelet activity, wherein inflammatory molecules bind to specific platelet receptors, inducing the release of platelet granules containing procoagulant and proinflammatory molecules. Consequently, there is a marked elevation in coagulation-related proteins, fostering the development of abnormal microthrombi and a dysfunctional fibrinolytic system. All these changes are indicative of an imbalance in coagulation regulation. Therefore, investigating pharmacological targets linked to this process is crucial for syndrome management, aiming to enhance the quality of life for affected individuals. This review aimed to highlight the importance of platelet function and activity in the pathophysiology of long coronavirus disease, as well as to identify molecular targets directly related to long coronavirus disease or coronavirus disease 2019–related disturbances in platelet homeostasis.

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Original Article

Systemic Inflammation, Fibrinogen, and Lipoprotein(a) as Composite Predictors of Peripheral Arterial Disease

Alim Namitokov et al. Karina Karabakhtsieva Irina Gilevich

Abstract

Background:

Early detection of peripheral atherosclerosis remains a clinical challenge, especially in asymptomatic individuals. This study aimed to evaluate the predictive value of systemic inflammatory indices and lipid-related biomarkers for early atherosclerosis.

Objectives:

To investigate the diagnostic value of systemic inflammation indices, fibrinogen, and lipoprotein(a) as individual biomarkers and as a combined predictive model for early peripheral arterial disease.

Methods:

A prospective case-control study was conducted in 54 individuals: 20 patients diagnosed with early peripheral atherosclerosis (<55 years) and 34 healthy controls. Laboratory data included complete blood count, lipid profile, fibrinogen, lipoprotein(a), angiopoietin-like protein 3 (ANGPTL3), and Lp-PLA₂. Inflammatory indices, including NLR, PLR, SII, SIRI, AISI, and MLR, were calculated. Logistic regression and ROC analysis were performed. A two-sided p-value < 0.05 was considered statistically significant.

Results:

SIRI (1.70 vs. 0.93, p = 0.0039) and AISI (431.6 vs. 236.4, p = 0.0128) were significantly higher in the atherosclerosis group. Fibrinogen showed the most robust association (5.46 vs. 3.71 g/L, p < 0.00001). Lp(a) alone was not statistically different between groups but improved the multivariate model (AUC 0.85 vs. 0.82). The final model, including age, inflammatory indices, LDL, Lp (a), and fibrinogen, achieved an AUC of 0.91.

Conclusion:

Systemic inflammation and fibrinogen levels are strongly associated with early atherosclerosis. Their combination with lipoprotein(a) enhances diagnostic performance, offering a simple, cost-effective strategy for early vascular risk assessment.

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Editorial

What Can Inflammatory Markers Tell Us About Tachycardia in Children?

Irving Gabriel Araújo Bispo et al. Eloisa Faggiani Santos Ana Beatriz Aparecida Rocha Millene Gonzalez Manente Marina Guerriero Morata

The supraventricular tachycardia (SVT) can be described as an irregular heart rhythm with an increased heart rate originating above the bundle of His. The heart rate is > 100 bpm. This condition can be particularly distressing for children and their families.

The incidence estimate of SVT in children is inaccurate because symptoms are usually nonspecific, such as sweating, pallor, apathy, inappetence, and tachycardia. Furthermore, spontaneous resolution can occur in some cases. Nonetheless, studies estimate that in children without congenital heart pathologies, the incidence is 24.4 per 100,000 live births. Still, the incidence is lower than in adults, and SVT emergencies are rare.

[…]

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Original Article

The Relationship Between Inflammatory Markers and Supraventricular Tachycardia in Children

Sevval Durgut et al. Hikmet Kıztanır Yasin Yıldız

Abstract

Background

Supraventricular tachycardia (SVT) is a common arrhythmia in pediatric patients. Emerging evidence suggests a link between systemic inflammation and cardiovascular diseases.

Objectives

This study aims to investigate the relationship between the monocyte/lymphocyte ratio (MLR) and neutrophil/lymphocyte ratio (NLR) with SVT in pediatric patients. Methods: We conducted a retrospective study at Rize Education and Research Hospital’s Pediatric Health and Diseases Department, including 33 patients diagnosed with SVT and 33 control subjects without sinus tachycardia. Hemogram (CBC) parameters, electrocardiography (ECG), and echocardiography (ECHO) were evaluated. NLR and MLR were calculated. The unpaired t-test is designed to compare the means of continuous variables between two groups, while the Mann-Whitney U test was applied for data not following a normal distribution. Correlations between values were analyzed through Pearson correlation. A significance level of p <0.05 was accepted.

Results

There was no significant difference between the groups in terms of age, lymphocyte count, hemoglobin, hematocrit, platelet count, and NLR. However, leukocyte count, monocyte count, and MLR showed significant differences (p<0.05). The SVT group had higher MLR values compared to the control group.

Conclusions

Our study found that MLR was significantly higher in pediatric patients with SVT compared to controls, suggesting a potential role of inflammation in SVT pathogenesis. Further large-scale, prospective, and multicenter studies are needed to confirm these findings and clarify the relationship between inflammation markers and SVT.

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Editorial

COVID-19 and History of Coronary Artery Bypass Surgery

María del Carmen Lacy-Niebla et al. Alfonso Buendia-Hernandez

In this study conducted in Brazil, a group of patients with a history of coronary artery bypass surgery with or without COVID-19 disease was analyzed to determine if their quality of life significantly changed after infection. They observed that patients with a history of COVID-19 infection had a worse quality of life during the four years of follow-up. No significant differences were found in the incidence of acute myocardial infarction, cerebral vascular events or thromboembolism, which is surprising and differs from what was expected.

On March 11, 2019, the World Health Organization declared the COVID-19 disease a pandemic. From that moment on, we believed that COVID-19 mainly affected the respiratory system and that in approximately 20% of patients, the disease was very serious with a high mortality rate. Over time we learned that COVID-19 is a multisystem inflammatory disease that is associated with cardiovascular manifestations. About half of patients hospitalized for COVID-19 have cardiovascular conditions that include coronary heart disease or a history of cerebral ischemic event, and 15-20% of them have complications like myocardial ischemia, heart failure, arrhythmias and dysautonomia.^– Patients with previous cardiovascular disease may become unstable when COVID-19 occurs, mainly due to a decrease in myocardial reserve and increase in oxygen consumption and metabolic demands.

[…]

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Original Article

Is Trimethylamine N-oxide (TMAO) Associated with NF-κB mRNA Expression in Patients with Coronary Artery Disease?

Beatriz Da Cruz et al. Karen Salve Coutinho-Wolino Ludmila Cardozo Aline D'Avila Pereira … Claudio Tinoco Mesquita Peter Stenvinkel Peter Bergman Denise Mafra Milena Barcza Stockler-Pinto

Abstract

Background:

Trimethylamine N-oxide (TMAO), a gut microbiota metabolite, is associated with cardiovascular disease (CVD) development. TMAO can trigger an inflammatory response by inducing the nuclear factor-kappa B (NF-κB) signaling cascade and increasing the expression of pro-inflammatory cytokines, contributing to the worsening of CVD. This study aimed to evaluate the association between TMAO plasma levels and inflammation in patients with coronary artery disease (CAD).

Methods:

A cross-sectional study was carried out including 29 patients with CAD. Peripheral blood mononuclear cells (PBMC) were isolated from fasting blood samples, and NF-κB and vascular cell adhesion protein 1 (VCAM1) mRNA expression were estimated using real-time quantitative PCR. We determined TMAO plasma levels by LC-MS/MS and TNF-α by ELISA. Routine biochemical parameters were evaluated using an automatic biochemical analyzer. Correlations were estimated by Spearman or Pearson test. Statistical significance was set at the level of p < 0.05.

Results:

All patients presented TMAO levels within the normal range according to EUTox (normal range: 2.83 ± 1.53 mg/L; CAD patients: 0.2 [0.1 to 0.2] ng/μL). TMAO plasma levels were positively correlated with NF-κB mRNA expression (0.555; p = 0.002).

Conclusion:

TMAO plasma levels may be associated with NF-κB mRNA expression in patients with CAD and may contribute to the pathogenesis of this disease.

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Editorial

Inflammatory Indices Derived from Hemogram as Prognostic Markers of Cardiovascular Outcome

Gulali Aktas et al. Burcin Atak Tel Tuba Taslamacioglu Duman

In parallel with the increasing incidence of metabolic disorders, such as obesity and type 2 diabetes mellitus, which increase the incidence of cardiovascular diseases, the incidence of heart conditions is also growing. Many markers are being investigated for the prediction of the prognosis of cardiovascular diseases. In a recent work, Kilic et al. have studied the association of the hemoglobin to red cell distribution width (Hb/RDW) ratio with the long-term survival of patients with acute coronary syndrome.

Acute coronary syndrome is one of the leading causes of death worldwide. Coronary artery disease is one of the most important causes of mortality and morbidity, responsible for approximately 7 million deaths and morbidity in 129 million people annually. The highest increases in the cardiac disease incidence worldwide have occurred in Latin America, the Middle East, and, to a lesser extent, in the Far East, but it varies by region.

[…]

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Original Article

Hemoglobin/Red Cell Distribution Width Ratio is Associated With Poor Prognosis in Patients With Acute Coronary Syndrome in Long-Term Follow-Up

Oğuz Kılıç et al. Mehmet Mustu Hakan Suygun Enes Con … Ahmet Karakurt Sümeyye Fatma Özer

Abstract

Background

Acute coronary syndrome (ACS) is the most common subtype of coronary artery disease (CAD). It is one of the main reasons affecting the expected life expectancy and quality of life.

Objetives

In this study, we aimed to investigate the relationship between major adverse cardiac events (MACE) and Hemoglobin (Hb)/Red cell distribution width (RDW) in long-term follow-up after ACS.

Methods

A total of 1,146 ACS patients were included in the study, being classified according to the type of myocordial infarction (MI). MACE were recorded in long-term follow-up. The relationship between Hb/RDW and MACE was investigated. The statistical analyses of Mann-Whitney U test for comparison of two independent groups and chi-square test for categorical variables were used. In order to determine the diagnostic feature of the HB/RDW ratio, the diagnostic ratios were calculated by applying Receiver Operating Characteristic Curve (ROC) analysis. A p < 0.05 value was considered statistically significant in all analyses. Results: When the patients were analyzed according to MI types — ST segment elevation myocardial infarction (STEMI)/Non-ST segment elevation myocardial infarction (NSTEMI) —, it was observed that Hb/RDW (p = 0.038) was significantly higher in the STEMI group. The Hb/RDW ratio was statistically significant in predicting mortality. As a result of ROC analysis, Area Under the Curve (AUC) = 0.654 (p < 0.001) was found. The cut-off value for the Hb/RDW ratio was calculated as 0.947. The sensitivity and specificity of 76.9% and 48.4% for the diagnostic rates obtained were moderately acceptable.

Conclusion

The Hb/RDW-long-term mortality relationship was found to be significant in ROC analysis. It can be used in clinical practice as it is cheap, easy to apply, and reduces possible bias in post-ACS follow-up.

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Original Article

Increased Circulating Fetuin-A Levels in Patients with Atrial Fibrillation

Gülaçan Tekin et al. Yusuf Kenan Tekin Hüseyin Aydın Naim Nur

Abstract

Background

Biomarkers related to the pathogenesis of atrial fibrillation (AF) have attracted the attention of experts. One of these recently studied biomarkers is Fetuin-A.

Objectives

This study aimed to evaluate the relationship between serum Fetuin-A levels and AF.

Methods

This study used the convenience sampling method, based on inclusion criteria and consent to participate in the study. The Shapiro-Wilk test was used to confirm the normal distribution of all continuous variables. Categorical variables were presented using absolute and relative frequencies. Both groups (48 patients with AF and 47 controls) were compared in terms of biochemical, hematological, and echocardiographic findings and Fetuin-A. the Chi-square or Fisher’s exact test were used to compare groups concerning categorical variables. Continuous variables were compared using the independent samples t-test. P<0.05 was considered statistically significant.

Results

Serum Fetuin-A values increased in AF patients when compared to the controls (544±49 μg/mL versus 484±46 μg/mL, p=0.001). Moreover, Fetuin-A level was independently associated with AF — AOR = 0.978, 95%; confidence interval (CI) 0.969-988, p 511.80 μg/mL with a sensitivity of 75% and a specificity of 73% — area under the curve (AUC) = 0.804, 95% CI = 0.715 – 0.892.

Conclusions

According to this study, there was a relationship between serum Fetuin-A levels and AF, regardless of conventional cardiovascular risk factors. Therefore, Fetuin-A may play a role in the pathophysiology of AF. Prospectively designed cohort studies are necessary to assess whether or not the results can be generalized for other populations.

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Original Article

The Relationship Between Carcinoembryonic Antigen and Epicardial Adipose Tissue

Abdulrahman Naser et al. Khagani Isgandarov Tolga Sinan Güvenç İbrahim Demir … Murat Kirişci Ahmet Ekmekçi Müslüm Şahin

Abstract

Background:

Inflammation, which is associated with an unhealthy lifestyle, plays a critical role in the development of both cardiometabolic diseases (CMD) and cancer. Carcinoembryonic antigen (CEA) is a tumor marker which also has proinflammatory properties. Recent studies have reported CEA to be associated with atherosclerosis, metabolic syndrome, and visceral adiposity. Epicardial adipose tissue (EAT) can exhibit highly inflammatory and pathogenic properties, and is a known risk factor for CMD. However, its relationship with CEA is still unknown.

Objectives:

This study aimed to investigate the possible association of CEA with EAT.

Methods:

A total of 134 Caucasian (males = 56, females = 78) individuals, aged (22-83 years), who were admitted for routine health control, were enrolled in this cross-sectional study. CEA was measured with chemiluminescent microparticle immunoassay (CMIA). EAT was measured by transthoracic echocardiography, and the visceral fat rating (VFR) was assessed by a body composition analyzing machine. The p-value <0.05 was considered statistically significant.

Results:

CEA levels were categorized as tertiles: T1, 0.5-1.04; T2, 1.06–1.69; and T3, ≥1.7 ng/ml. The mean age, weight, VFR, EAT, and fasting glucose, as well as the median of systolic blood pressure (SBP), creatinine, and AST increased with the increasing CEA tertiles. CEA was significantly associated with EAT (r = 0.55, P<0.001) and VFR (r = 0.36, P<0.001). Multivariate linear regression analysis confirmed that gender, age, and EAT were the significant independent variables associated with CEA.

Conclusion:

Individuals with increased EAT have higher levels of CEA, suggesting that this biomarker is most likely produced by EAT; however, additional investigations are required to improve the present work.

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Original Article

Association of Dietary Inflammatory Potential in Metabolically Healthy and Metabolically Unhealthy Obese Individuals

Lara Ribeiro Pinto et al. Luciana Nicolau Aranha Ronir Raggio Luiz Gláucia Maria Moraes de Oliveira Glorimar Rosa

Abstract

Introduction:

Currently, two types of phenotypes have been recognized in individuals who are obese. Among the factors related to lifestyle, diet has a relevant influence, although there is no consensus regarding the role of diet in metabolic phenotypes; furthermore, diet is a strong moderator of chronic systemic inflammation.

Objective:

Investigate dietary inflammatory potential between metabolic phenotypes and to compare the differences between anti-inflammatory and pro-inflammatory diets in individuals with the same phenotype.

Methods:

This is a cross-sectional observational study that utilized the database of 533 individuals divided into 4 groups, according to metabolic phenotype and dietary inflammatory characteristic. Sociodemographic, clinical, anthropometric and biochemical characteristics were evaluated and the inflammatory index of the diet was calculated.

Results:

The mean Dietary Inflammatory index (DII) of the total sample was 0.974±1.02, with a maximum of 4.34 and a minimum of −1.74. In the metabolically unhealthy groups, we found a statistical difference in relation to systolic blood pressure when comparing the anti-inflammatory [median 120 (110.0-130.0)] and pro-inflammatory diets [median 130 (120.0-140.0); p = 0.022], and mean isoprostane concentrations were lower in the metabolically healthy group with anti-inflammatory diet. In regression analysis, the only variable that demonstrated a higher risk of alterations in all groups when compared to the metabolically healthy and anti-inflammatory group were isoprostane concentrations.

Conclusion:

We are able to conclude that an anti-inflammatory diet is associated with lower oxidative stress in metabolically healthy obese, and a pro-inflammatory diet is associated with higher systolic blood pressure values.

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Original Article

Food Consumption and Health Outcomes in Women During the COVID-19 Pandemic

Mariana Barbosa Lopes et al. Luciana Nicolau Aranha Lara Ribeiro Pinto Paula Critina Moreira dos Santos Lino … Ronir Raggio Luiz Gláucia Maria Moraes de Oliveira Glorimar Rosa

Abstract

Background

The COVID-19 pandemic has changed food consumption.

Objective

Evaluate the association between metabolic phenotypes, changes in food consumption during the pandemic, and health outcomes in obese women.

Methods

Cross-sectional observational study including 491 women without previous diagnosis of chronic diseases, evaluated according to metabolic phenotype. During the pandemic, a subsample was re-evaluated by online questionnaires via Google Forms. Analyzed anthropometric, biochemical, and dietary data as well as health outcomes (coronary artery disease, type 2 diabetes, hypertension, dyslipidemia or death). Information on mortality was collected from the Internal Affairs Office of the State of Rio de Janeiro and the Health Department of the State of Rio de Janeiro. Statistical analysis was performed using the statistical program SPSS 21, with Mann-Whitney test, Pearson’s chi-squared, Spearman correlation, and binary logistic regression, at a significance level of 5%.

Results

The anthropometric, glucose, and lipid profiles showed significant differences between the metabolically healthy and metabolically unhealthy groups (p = 0.00). Before the pandemic, women in the metabolically unhealthy group had higher dietary intakes of lipids (p = 0.01), saturated fat (p = 0.01) and sodium (p = 0.04), during the pandemic, they consumed more energy (p = 0.04), lipids (p = 0.02), saturated fat (p = 0.02), proteins (p = 0.03) and sodium from ultra-processed foods (p = 0.03). Consequently, health outcomes were more prevalent in the metabolically unhealthy group (p = 0.00).

Conclusion

Observed that metabolically healthy women had qualitatively better food intake and fewer health outcomes throughout the study.

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Original Article

Effects of Physical Exercise on Lipid and Inflammatory Profile of Women Using Combined Oral Contraceptive: A Cross-Over Study

Vinícius Afonso Gomes et al. Marvyn de Santana do Sacramento Lucas Mendes Santa Cecilia Daniela Santos de Jesus … Juliane Santos Barbosa Fernanda Oliveira Baptista de Almeida Elaine Carvalho de Oliveira Jefferson Petto

Abstract

Background:

The use of combined oral contraceptives (COC) is a risk factor for atherosclerotic disease, and physical exercise can minimize this condition.

Objective:

To verify if high intensity interval training (HIIT) promotes changes in the lipid and inflammatory profile of women using COC.

Methods:

Sequential crossover study with women aged 20-30 years, classified as irregularly active by the international physical activity questionnaire (IPAQ), when using COC. A physical-clinical assessment was performed with anthropometric measurements, VO_2max, and analysis of lipid and inflammatory profile. Participants were divided into 2 groups: the initial intervention group (GII), which began practicing HIIT for 2 months, and the posterior intervention group (GIP), which remained inactive for the same period. The GII and GIP would then alternate their conditions. The collected data was divided into: Initial moment (IM), post-exercise moment (PEM) and post-inactivity (PIM). The statistical analyses were performed using the Statistical Package for the Social Sciences, adopting a significance level of p <0.05 .

Results:

Twelve women were evaluated. After crossing the GII and GIP data, there was a difference in the C-reactive protein values between the IM of 4 (1.6-6.3 mg/dL) vs. PEM 2 (1.5-5 mg/dL); as well as between the PEM vs. the PIM= 4 (1.5-5.8 mg/dL), with a p -value = 0.04 in the comparisons. There was no change between the “moments” of the lipid profile, although it was possible to notice a reduction in resting HR and an increase in indirect VO_2max.

Conclusion:

The HIIT program was able to reduce the inflammatory profile, but it did not alter the lipid profile of irregularly active women using COC.

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Original Article

Epicardial Fat Tissue Thickness and Omentin in Patients with Atrial Fibrillation

Ibrahim Etem Dural et al. Ersel Onrat Sefa Çelik Serkan Gokaslan … Ayhan Vurmaz Sadık Volkan Emren Zafer Yalım Alaeddin Avşar

Abstract

Background:

Although electrical and structural remodeling has been recognized to be important in the pathophysiology of atrial fibrillation, the mechanisms underlying remodeling process are unknown. There has been increasing interest in the involvement of inflammatory molecules and adipokines released from the epicardial fat tissue in the pathophysiology of atrial fibrillation.

Objectives:

In our study, we aimed to investigate the relationship of atrial fibrillation with increased epicardial adipose tissue, inflammatory molecules released from this tissue and omentin.

Methods:

Thirty-six patients who were followed up with a diagnosis of permanent AF at the cardiology outpatient clinic 33 individuals without atrial fibrillation (controls) were included in the study. Epicardial adipose tissue thickness of patients was measured by echocardiography. Serum omentin, IL 6, IL 1 beta, TNF alpha and CRP levels were measured. Man-Whitney U test was performed for comparisons and significance was established at 5% (p<0.05).

Results:

Epicardial adipose tissue thickness was significantly greater in the patient group (6mm [4-5.5]) than controls (4mm [3-5.5]) (p <0.001). No significant difference was found in the concentrations of omentin or inflammatory molecules between the groups.

Conclusion:

No relationship was found between atrial fibrillation and serum levels or omentin or inflammatory markers. A relationship between epicardial adipose tissue thickness measured by echocardiography and atrial fibrillation was determined.

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Editorial

Abdominal Subcutaneous Adipose Tissue, Diet, and Risk of Cardiovascular Disease: What do we Know?

Camila Weschenfelder et al. Penny M. Kris-Etherton

Excess adiposity increases the risk of cardiovascular disease (CVD) due to dyslipidemia, systemic inflammation and other risk factors. The distribution of body fat depots, and central adiposity in particular, is related to cardiometabolic diseases. The different adipose tissue depots in the body, ie, epicardial adipose tissue, visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT), have different biochemical characteristics and produce unique biologically active molecules that affect normal and pathological processes related to CVD risk.^, Abdominal SAT is classified as superficial or deep. Deep subcutaneous adipose tissue (DSAT) has a higher ratio of saturated to monounsaturated fatty acids, and, consequently, is more saturated than superficial subcutaneous adipose tissue (SSAT). Despite being in the subcutaneous compartment, DSAT differs from VAT because of differences in gene transcription, having different metabolic functions than SSAT.

In Acute Coronary Syndrome (ACS) patients, coronary plaque instability is related to abnormal abdominal fat distribution. Analyses of the abdominal fat distribution of ACS patients have demonstrated that both VAT and SAT are positively correlated with vessel and plaque volumes, but not with plaque tissue components, the fibrous and lipid content of plaque. However, considering coronary plaque characteristics, a higher VAT/SAT ratio was independently associated with a higher percentage of plaque lipid content, with a lower percentage of fibrous volumes and a thinner fibrous cap thickness, characteristics that define greater plaque rupture vulnerability and a high risk for coronary events.

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Original Article

Inflammation and Nocturnal Pattern of Blood Pressure in Normotensives

Seyda Gunay et al. Serhat Çalışkan Deniz Sigirli

Abstract

Background:

In most healthy individuals, blood pressure (BP) shows a circadian rhythm. Being non-dipper increases cardiovascular risk in normotensive and hypertensive individuals. Nocturnal dipping shows a correlation with the state of inflammation.

Objetive:

To investigate the relationship between inflammation-based indexes and nocturnal BP pattern in normotensive individuals.

Method:

This is a retrospective study that included patients evaluated with ambulatory BP monitoring (ABPM). A total of 131 normotensive individuals were included and grouped as dippers and non-dippers. The normality of the data was verified with a Shapiro-Wilk test. We compared ABPM variables and inflammation-based indexes derived from blood tests (monocyte to high-density lipoprotein ratio [MHR], platelet to lymphocyte ratio [PLR], neutrophil to lymphocyte ratio [NLR], and systemic immune-inflammation index [SII]) between groups. The independent samples t-test and Mann-Whitney U test were used for comparing variables with normal and non-normal distributions, respectively. The Pearson’s chi-squared test was used to compare categorical variables, and Spearman’s correlation coefficient was used to examine the relationships between variables. A receiver operating characteristic (ROC) curve was used to evaluate the diagnostic performances of inflammation-based indexes. The level of statistical significance was 5%.

Results:

The study included 131 patients (mean±standard deviation [SD] age 49.2±15.1 years, 58 [76.0%] of which were women). SII was significantly higher in the non-dipper group (p=0.033). Significant negative correlations were observed between the change in systolic BP [ΔSBP] and SII (r=-0.172, p=0.049) and between ΔSBP and PLR (r=-0.179, p=0.040).

Conclusion:

SII is a predictor of nocturnal BP pattern in normotensives.

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Viewpoint

Association between Periodontitis and Myocardial Infarction: Systematic Review and Meta-Analysis

Luiz Carlos Bodanese et al. Gabriel Campos Louzeiro Gabriela Agne Magnus Ângela Hamann Baptista … Fernanda Gonçalves Salum Rita Mattiello

Abstract

The association between periodontitis and myocardial infarction remains unclear in the literature. Few studies have addressed periodontitis exposure as a predisposing factor for the development of myocardial infarction. Therefore, the present systematic review aims to analyze the association between periodontitis and myocardial infarction. This meta-analysis systematically searched MEDLINE, EMBASE, The Cochrane Controlled Trials Register, SCIELO, LILACS, CINAHL, Scopus, Web of Science and grey literature for studies estimating the association between periodontitis and myocardial infarction. Quality of evidence was assessed for all studies. The meta-analysis was conducted using random-effects models. Four of the six studies selected were included in the meta-analysis, including 1,035,703 subjects. The association between periodontitis and myocardial infarction was: RR: 5.99 (95% CI: 1.17-30.68), but with high heterogeneity (I² = 100%; p <0.01). The results including only the highest quality articles, was lower: RR: 2.62 (95% CI: 1.47-4.70 3.83), but with lower heterogeneity (I² = 85.5%; p < 0.01).The present systematic review with meta-analysis showed an association between periodontitis and acute myocardial infarction, but with a high level of heterogeneity.

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Original Article

Cardiovascular Risk Assessment after COVID-19 Infection before Resuming Sports Activities – Practical Flowchart and Meta-Analysis

Luís Puga et al. Paulo Dinis Rogério Teixeira Joana Maria Ribeiro … Hélder Dores Lino Gonçalves

Abstract

Background:

The risk of sports-related sudden cardiac arrest after COVID-19 infection can be a serious problem. There is an urgent need for evidence-based criteria to ensure patient safety before resuming exercise.

Objective:

To estimate the pooled prevalence of acute myocardial injury caused by COVID-19 and to provide an easy-to-use cardiovascular risk assessment toolkit prior to resuming sports activities after COVID-19 infection.

Methods:

We searched the Medline and Cochrane databases for articles on the prevalence of acute myocardial injury associated with COVID-19 infection. The pooled prevalence of acute myocardial injury was calculated for hospitalized patients treated in different settings (non-intensive care unit [ICU], ICU, overall hospitalization, and non-survivors). Statistical significance was accepted for p values <0.05. We propose a practical flowchart to assess the cardiovascular risk of individuals who recovered from COVID-19 before resuming sports activities.

Results:

A total of 20 studies (6,573 patients) were included. The overall pooled prevalence of acute myocardial injury in hospitalized patients was 21.7% (95% CI 17.3-26.5%). The non-ICU setting had the lowest prevalence (9.5%, 95% CI 1.5-23.4%), followed by the ICU setting (44.9%, 95% CI 27.7-62.8%), and the cohort of non-survivors (57.7% with 95% CI 38.5-75.7%). We provide an approach to assess cardiovascular risk based on the prevalence of acute myocardial injury in each setting.

Conclusions:

Acute myocardial injury is frequent and associated with more severe disease and hospital admissions. Cardiac involvement could be a potential trigger for exercise-induced clinical complications after COVID-19 infection. We created a toolkit to assist with clinical decision-making prior to resuming sports activities after COVID-19 infection.

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IJCS

Review Article

Inflammation in Cardiovascular Disease: From Basic Concepts to Clinical Application

David D. Waters

Abstract

Although low-density lipoprotein cholesterol is central to the development and progression of atherosclerosis, the role of inflammation in the atherosclerotic process is becoming better understood and appreciated. Chronic inflammatory conditions such as rheumatoid arthritis, lupus, psoriasis, HIV infection, and inflammatory bowel disease have all been shown to be associated with an increased blood levels of inflammatory biomarkers and increased risk of cardiovascular events. Evidence from observational studies suggests that anti-inflammatory therapy decreases this risk in these conditions. Clinical trials of anti-inflammatory drugs in patients with coronary disease have yielded mixed results. Drugs that have failed in recent trials include the P38 MAP kinase inhibitor losmapimod, the phospholipase A2 inhibitors darapladib and varespladib, and methotrexate. Canakinumab, an interleukin-1β inhibitor, reduced cardiovascular events in patients with coronary disease in the Canakinumab Anti-inflammatory Thrombosis Outcome Study (CANTOS). Canakinumab increased the rate of fatal infections in CANTOS and is very expensive; it is thus unlikely to be widely used for risk reduction in cardiology. On the other hand, colchicine is a safe and inexpensive anti-inflammatory drug. In the Colchicine Cardiovascular Outcomes Trial (COLCOT), where patients within 30 days of a myocardial infarction were randomized to low-dose colchicine or placebo and followed for a median of almost 2 years, colchicine treatment was associated with a 23% reduction (p=0.02) in cardiovascular events. Newer studies with anti-inflammatory drugs have the potential to improve outcomes of patients with atherosclerosis, just as low-density lipoprotein cholesterol-lowering drugs have done over the past two decades.

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IJCS

Editorial

Psoriatic March, Skin Inflammation and Cardiovascular Events – Two Plaques for one Syndrome

José Laerte Boechat

Traditionally, psoriasis has been regarded as a disease affecting only the skin and joints. Unfortunately, this is still the view among many doctors.

In this issue, Campos et al., published an interesting observational study on cardiovascular (CV) risk factors and risk measurement in patients with psoriatic arthritis, which allow us, in this editorial, to put the spotlight on some points of great interest in this area.

[…]

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IJCS

Original Article

Cardiovascular Risk Factors and Risk Measurement in Patients with Psoriatic Arthritis in a University Hospital

Beatriz Pinto e Siqueira Campos et al. Gustavo Daniel dos Santos Gomes Alessandra de Sousa Braz Andre Telis de Vilela

Abstract

Background:

Psoriatic Arthritis is the spondyloarthritis associated with psoriasis, which is often related to high mortality due to cardiovascular causes.

Objectives:

To quantify cardiovascular risk factors (hypertension, diabetes, dyslipidemia, obesity and smoking) and to measure risk by the Global Cardiovascular Risk Score in patients with psoriatic arthritis.

Methods:

Patients with psoriatic arthritis according to the Classification Criteria for Psoriatic Arthritis, aged between 30 and 74 years and without any other clinically manifest chronic inflammatory disease, atherosclerotic disease or heart failure were included. After an interview, clinical examination and data extraction from medical records, risk stratification was performed using a calculator available on the online platform of the Framingham Heart Study. We considered p < 0.05 as significant. Chi-square test and Fisher’s exact test were used to compare frequencies, as well as correlation measurements.

Results:

45 patients were included, 68,9% of which were women and the mean age was 53,94 years. Dyslipidemia was confirmed in approximately 93%, hypertension in 46%, obesity in 40%, 33.3% were diabetics and, 13.3%, smokers; 95% had increased abdominal circumference. It was observed that 53% had high cardiovascular risk, 29% had intermediate risk and 18% had low risk. Individuals with altered C-reactive protein and erythrocyte sedimentation rate presented, respectively, higher levels of LDL-C and total cholesterol.

Conclusions:

There was a high occurrence of risk factors and the majority of the sample was stratified into high or intermediate cardiovascular risk.

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ABC

Original Article

Plasma levels of immunoinflammatory markers in De Novo coronary atherosclerosis and coronary restenosis postangioplasty

Alexandre Schaan de Quadros et al. Jorge Pinto Ribeiro Waldomiro Carlos Manfroi Cristiane Leitão … Karen Ordovás Letícia Weiss Nadine Clausell

OBJECTIVE: To compare circulating plasma levels of immunoinflammatory markers in patients with known de novo coronary artery disease and patients with postangioplasty restenosis. METHODS: Using enzymatic immunoabsorbent assay, we measured plasma levels of soluble interleukin-2 receptosr, tumor necrosis factor alpha, and soluble tumor necrosis alpha receptors I and II in 11 patients with restenosis postcoronary angioplasty (restenosis group), in 10 patients with primary atherosclerosis (de novo group) who were referred for coronary angiography because of stable or unstable angina, and in 9 healthy volunteers (control group). Levels of soluble interleukin-2 receptors were significantly higher in the de novo group compared with that in the restenosis and control groups. Levels were also higher in the restenosis group compared with that in the control group. Plasma levels of tumor necrosis alpha and receptor levels were significantly higher in the de novo group compared to with that in the restenosis and control groups, but levels in the restenosis group were not different from that in the controls. CONCLUSION: Coronary artery disease, either primary or secondary to restenosis, is associated with significant immunoinflammatory activity, which can be assessed by examining the extent of circulating plasma levels of inflammatory markers. Moreover, patients with de novo lesions appear to have increased inflammatory activity compared with patients with restenosis.

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