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Number of results: 6
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Abstract

Introduction: The COVID-19 pandemic has put healthcare systems worldwide under huge strain, resulting in a significant loss of their capacity and availability. Patients have become more reluctant to contact their doctors or call an ambulance in case of myocardial infarction (MI) symptoms onset. It has been accompanied by a significant decrease in the number of coronary angiography and PCI procedures performed.
Objectives: The aim of the study is to evaluate the role of online health information in the patient- dependent phase of MI management during the COVID-19 lockdown in Europe.
Methods: We analyzed Google Trends data on the popularity of phrases related to MI symptoms, respiratory tract infection, urological complaints, and terms unrelated to health, for the period of the first COVID-19 lockdown, along with the data from the corresponding weeks from 2017–2019 in seven European countries.
Results: The search volume for particular symptoms of myocardial infarction increased in all studied countries, compared to the analogous period from 2017–2019, with a significant increase in for chest pain, shortness of breath, fear, and palpitations in most countries. These changes have not been accompanied by increased interest in terms related to respiratory tract infection symptoms and urological complaints.
Conclusions: Our findings suggest that during lockdown, patients with MI symptoms may have tried to manage their complaints on their own, using information from the Internet. This demonstrates the growing role of the Internet in the patient’s decision-making process in the emergency situation, indicating a grow-ing need for reliable and freely available online information provided by healthcare professionals.
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Authors and Affiliations

Dominik Felkle
1
Michał Ł. Korman
1
Andrzej Surdacki
2

  1. Students’ Scientific Group at Second Department of Cardiology, Institute of Cardiology, Faculty of Medicine, Jagiellonian University Medical College, Kraków, Poland
  2. Second Department of Cardiology, Institute of Cardiology, Faculty of Medicine, Jagiellonian University Medical College, Kraków, Poland
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Abstract

Intensive hypoglycemic treatment is the strongest preventive strategy against the development of microvascular complications of type 2 diabetes (T2DM), including diabetic nephropathy. However, some antidiabetic drugs, i.e. sodium-glucose cotransporter-2 inhibitors (SGLT-2i) and glucagon-like peptide-1 receptor agonists (GLP1-RA) have an additional renoprotective effect beyond glucose control by itself. Similar, both SGLT-2i and GLP1-RA have been demonstrated to decrease the risk of adverse cardiovascular (CV) events in CV outcome trials. Nevertheless, there are relevant differences in CV and renal effects of SGLT-2i and GLP1-RA. First, SGLT2i reduced the incidence and progression of albuminuria and prevented loss of kidney function, while predominant renal benefits of GLP1-RA were driven by albuminuria outcomes. Second, the risk of heart failure (HF) hospitalizations decreased on SGLT2i but not on GLP1-RA, which gives priority to SGLT2i in T2DM and HF, especially with depressed EF. Third, either GLP1-RA (reducing predominantly atherosclerosis-dependent events) or SGLT-2i, should be used in T2DM and established atherosclerotic CV disease (ASCVD) or other indicators of high CV risk. In this review, we have briefly compared clinical practice guidelines of the American Diabetes Association (2020 and 2021 versions), Polish Diabetes Association (2020) and the European Society of Cardiology/European Association for the Study of Diabetes (2019), with a focus on the choice between SGLT-2i and GLP1-RA in patients with diabetic kidney disease.
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Bibliography

1. American Diabetes Association: Microvascular complications and foot care: Standards of Medical Care in Diabetes-2021. Standards of Medical Care in Diabetes–2020. Diabetes Care. 2020; 43 (Suppl 1): S135–S151.
2. American Diabetes Association: Pharmacologic approaches to glycemic treatment: Standards of Medical Care in Diabetes-2020. Diabetes Care. 2020; 43 (Suppl 1): S98–S110.
3. American Diabetes Association: Pharmacologic approaches to glycemic treatment: Standards of Medical Care in Diabetes-2021. Diabetes Care. 2021; 44 (Suppl 1): S111–S124.
4. Williams D.M., Nawaz A., Evans M.: Renal outcomes in type 2 diabetes: A review of cardiovascular and renal outcome trials. Diabetes Ther. 2020; 11: 369–386.
5. Heerspink H.J.L., Stefánsson, B.V., Correa-Rotter, et al.: Dapagliflozin in patients with chronic kidney disease. N Engl J Med. 2020; 383: 1436–1446.
6. Jhund P.S., Solomon S.D., Docherty K.F., et al.: Efficacy of dapagliflozin on renal function and outcomes in patients with heart failure with reduced ejection fraction: Results of DAPA-HF. Circulation 2020 Oct 12; doi: 10.1161/CIRCULATIONAHA.120.050391.
7. Packer M., Anker S.D., Butler J., et al.: Cardiovascular and renal outcomes with empagliflozin in heart failure. N Engl J Med. 2020; 383: 1413–1424.
8. American Diabetes Association: Pharmacologic approaches to glycemic treatment: Standards of Medical Care in Diabetes-2019. Diabetes Care. 2019; 42 (Suppl 1): S90–S102.
9. Diabetes Poland (Polish Diabetes Association): 2020 Guidelines on the management of diabetic patients: A position of Diabetes Poland. Clin Diabetol. 2020; 9: 1–101.
10. Cosentino F., Grant P.J., Aboyans V., et al.: 2019 ESC Guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in collaboration with the EASD. Eur Heart J. 2020; 41: 255–323.
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Authors and Affiliations

Ewa Wieczorek-Surdacka
1
Andrzej Surdacki
2
Jolanta Świerszcz
3
Bernadeta Chyrchel
4

  1. Chair and Department of Nephrology, Faculty of Medicine, Jagiellonian University Medical College, Kraków, Poland
  2. Second Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, Kraków, Poland
  3. Department of Medical Education, Faculty of Medicine, Jagiellonian University Medical College, Kraków, Poland
  4. Second Department of Cardiology, Institute of Cardiology, Faculty of Medicine, Jagiellonian University Medical College, Kraków, Poland
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Abstract

Introduction: Seasonal variation has been observed for bacterial and viral infections (e.g., COVID-19 [1]), but also for numerous cardiac problems. However, little information is available on the seasonality of infectious endocarditis (IE), a rare disease that is usually linked to a bacterial origin. Data from the Polish population are lacking.
Materials and Methods: Our retrospective study focused on the identification of patients with IE, who were hospitalized at the University Hospital in Krakow between 2005–2022. For this purpose, we searched the medical records system using the ICD-10 code. We decided to divide our patients into four groups (winter, spring, summer, autumn), based on the date of admission to the hospital. Comparison of the distribution of IE incidents by season was performed with the ch2 test.
Results: One hundred and ten patients were included in the study (median age 62.5 years (range 20–94), 72 men (65.45%)). The left native valve IE was diagnosed in 49% of the patients, the prosthetic valve IE in 16%, the right valve IE in 27% and the implantable cardiac electronic devices IE in 12% of the subjects. The outcomes comprised of cardiac surgery (n = 53), embolism (n = 16), death (n = 15) and metastatic infections (n = 5). No differences in the incidence of IE by season were observed.
Conclusions: In the preliminary observation of IE cases of patients admitted to the University Hospital in Krakow, Poland no seasonal pattern of IE was detected. Therefore, IE should be taken into account in the differential diagnosis at any time of the year.
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Authors and Affiliations

Anna Tofilska
1
Katarzyna Zięba
1
Andrzej Surdacki
2
Marek Rajzer
3
Agnieszka Olszanecka
3

  1. Students’ Scientific Group at the First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University Medical College, Kraków, Poland
  2. Second Department of Cardiology, Faculty of Medicine, Jagiellonian University Medical College, Kraków, Poland
  3. First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University Medical College, Kraków, Poland
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Abstract

Microvascular angina (MVA) is a condition characterized by the presence of angina-like chest pain, a positive response to exercise stress tests, and no significant stenosis of coronary arteries in coronary angiography, with absence of any other specific cardiac diseases. The etiology of this syndrome is still not known and it is probably multifactorial. Coronary microvascular dysfunction is proposed as the main pathophysiological mechanism in the development of MVA. Altered somatic and visceral pain perception and autonomic imbalance, in addition to myocardial ischemia, has been observed in subjects with MVA, involving dynamic variations in the vasomotor tone of coronary microcirculation with consequent tran-sient ischemic episodes. Other theories suggest that MVA may be a result of a chronic inflammatory state in the body that can negatively influence the endothelium or a local imbalance of factors regulating its function. This article presents the latest information about the epidemiology, diagnostics, etiopathogen-esis, prognosis, and treatment of patients with MVA.
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Authors and Affiliations

Jarosław Jarczewski
1
Aleksandra Jarczewska
1
Andrzej Boryczko
1
Adrian Poniatowski
1
Agata Furgała
1
Andrzej Surdacki
2
Krzysztof Gil
1

  1. Department of Pathophysiology, Faculty of Medicine, Jagiellonian University Medical College, Kraków, Poland
  2. Second Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, Kraków, Poland
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Abstract

B a c k g r o u n d: Stress is a major risk factor for cardiovascular (CV) disease. We hypothesized that past strong experiences might modulate acute CV autonomic responses to an unexpected acoustic stimulus.
A i m: The study’s aim was to compare acute CV autonomic responses to acoustic stress between students with and without a past strong experience associated with the acoustic stimulus.
M a t e r i a l s and M e t h o d s: Twenty five healthy young volunteers — medical and non-medical students — were included in the study. CV hemodynamic parameters, heart rate (HR), and blood pressure (BP) variability were assessed for 10 min at rest and for 10 min after two different acoustic stimuli: a standard sound signal and a specific sound signal used during a practical anatomy exam (so-called “pins”).
R e s u l t s: Both sounds stimulated the autonomic nervous system. The “pins” signal caused a stronger increase in HR in medical students (69 ± 10 vs. 73 ± 13 bpm, p = 0.004) when compared to non-medical students (69 ± 6 vs. 70 ± 10, p = 0.695). Rises in diastolic BP, observed 15 seconds after sound stressors, were more pronounced after the “pins” sound than after the standard sound signal only in medical students (3.1% and 1.4% vs. 3% and 4.4%), which was also reflected by low-frequency diastolic BP variability (medical students: 6.2 ± 1.6 vs. 4.1 ± 0.8 ms2, p = 0.04; non-medical students: 6.0 ± 4.3 vs. 4.1 ± 2.6 ms2, p = 0.06).
C o n c l u s i o n s: The “pins” sound, which medical students remembered from their anatomy practical exam, provoked greater sympathetic activity in the medical student group than in their non-medical peers. Thus, past strong experiences modulate CV autonomic responses to acute acoustic stress.
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Bibliography

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2. Björ B., Burström L., Karlsson M., Nilsson T., Näslund U., Wiklund U.: Acute effects on heart rate variability when exposed to hand transmitted vibration and noise. Int Arch Occup Environ Health. 2007 Nov; 81 (2): 193–199.
3. Koelsch S., Jäncke L.: Music and the heart. Eur Heart J. 2015 Nov 21; 36 (44): 3043– 3049.
4. Ekuni D., Tomofuji T., Takeuchi N., Morita M.: Gum chewing modulates heart rate variability under noise stress. Acta Odontol Scand. 2012 Dec; 70 (6): 491–496.
5. Cheng T.H., Tsai C.G.: Female Listeners’ Autonomic Responses to Dramatic Shifts Between Loud and Soft Music/Sound Passages: A Study of Heavy Metal Songs. Front Psychol. 2016 Feb 17; 7: 182.
6. Walker E.D., Brammer A., Cherniack M.G., Laden F., Cavallari J.M.: Cardiovascular and stress responses to short-term noise exposures-A panel study in healthy males. Environ Res. 2016 Oct; 150: 391–397.
7. Berntson G.G., Bigger J.T. Jr, Eckberg D.L., et al.: Heart rate variability: origins, methods, and interpretive caveats. Psychophysiology. 1997; Nov; 34 (6): 623–648.
8. Cygankiewicz I., Zareba W.: Heart rate variability. Handb Clin Neurol. 2013; 117: 379–393.
9. Sacha J.: Interaction between heart rate and heart rate variability. Ann Noninvasive Electrocardiol. 2014 May; 19 (3): 207–216.
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11. Buccelletti F., Bocci M.G., Gilardi E., et al.: Linear and nonlinear heart rate variability indexes in clinical practice. Comput Math Methods Med. 2012; 2012: 219080.
12. Goldberger A.L.: Non-linear dynamics for clinicians: chaos theory, fractals, and complexity at the bedside. Lancet. 1996; 347: 1312–1314.
13. Sassi R., Cerutti S., Lombardi F., et al.: Advances in heart rate variability signal analysis: joint position statement by the e-Cardiology ESC Working Group and the European Heart Rhythm Association co-endorsed by the Asia Pacific Heart Rhythm Society. Europace. 2015 Sep; 17 (9): 1341–1353.
14. Adlan A.M., Veldhuijzen van Zanten J.J.C.S., Lip G.Y.H., Paton J.F.R., Kitas G.D., Fisher J.P.: Acute hydrocortisone administration reduces cardiovagal baroreflex sensitivity and heart rate variability in young men. J Physiol. 2018; 596: 4847–4861.
15. Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology Heart rate variability: standards of measurement, physiological interpretation and clinical use. Circulation. 1996 Mar 1; 93 (5): 1043– 1065.
16. Iyengar N., Peng C.K., Morin R., Goldberger A.L., Lipsitz L.A.: Age-related alterations in the fractal scaling of cardiac interbeat interval dynamics. Am J Physiol. 1996 Oct; 271 (4 Pt 2): R1078-84.
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19. de Castro B.C., Guida H.L., Roque A.L., et al.: Auditory stimulation with music influences the geometric indices of heart rate variability in response to the postural change maneuver. Noise Health. 2014; Jan–Feb; 16 (68): 57–62.
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Authors and Affiliations

Michał Jurczyk
1
Andrzej Boryczko
1
Agata Furgała
1
Adrian Poniatowski
1
Andrzej Surdacki
2
Krzysztof Gil
1

  1. Department of Pathophysiology, Jagiellonian University Medical College, Kraków, Poland
  2. Second Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, Kraków, Poland
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Abstract

B a c k g r o u n d: A novel paradigm of diastolic heart failure with preserved ejection fraction (HFpEF) proposed the induction of coronary microvascular dysfunction by HFpEF comorbidities via a systemic pro-infl ammatory state and associated oxidative stress. Th e consequent nitric oxide deficiency would increase diastolic tension and favor fi brosis of adjacent myocardium, which implies not only left ventricular (LV), but all-chamber myocardial stiff ening. Our aim was to assess relations between low-grade chronic systemic infl ammation and left atrial (LA) pressure-volume relations in real-world HFpEF patients.

Me t h o d s: We retrospectively analyzed medical records of 60 clinically stable HpEFF patients in sinus rhythm with assayed high-sensitive C-reactive protein (CRP) during the index hospitalization. Subjects with CRP >10 mg/L or coexistent diseases, including coronary artery disease, were excluded. LV and LA diameters and mitral E/E’ ratio (an index of LA pressure) were extracted from routine echocardiographic 46 Cyrus M. Sani, Elahn P.L. Pogue, et al. records. A surrogate measure of LA stiff ness was computed as the averaged mitral E/e’ ratio divided by LA diameter.

R e s u l t s: With ascending CRP tertiles, we observed trends for elevated mitral E/e’ ratio (p <0.001), increased relative LV wall thickness (p = 0.01) and higher NYHA functional class (p = 0.02). Th e LA stiffness estimate and log-transformed CRP levels (log-CRP) were interrelated (r = 0.38, p = 0.003). On multivariate analysis, the LA stiff ness index was independently associated with log-CRP (β ± SEM: 0.21 ± 0.07, p = 0.007) and age (β ± SEM: 0.16 ± 0.07, p = 0.03), which was maintained upon adjustment for LV mass index and relative LV wall thickness.

C o n c l u s i o n s: Low-grade chronic infl ammation may contribute to LA stiff ening additively to age and regardless of the magnitude of associated LV hypertrophy and concentricity. LA stiff ening can exacerbate symptoms of congestion in HFpEF jointly with LV remodeling.

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Authors and Affiliations

Cyrus M. Sani
Elahn P.L. Pogue
Joanna B. Hrabia
Alexander G. Zayachkowski
Magdaline M. Zawadka
Adrian G. Poniatowski
Dorota Długosz
Wiktoria Leśniak
Olga Kruszelnicka
Bernadeta Chyrchel
Andrzej Surdacki

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