Polskie Archiwum Medycyny Wewnętrznej
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Pol. Arch. Med. Wewn. · Oct 2021
The ratio of furosemide dosage to urinary sodium concentration predicts mortality in patients with chronic stable heart failure.
The urinary sodium (UNa) concentration is associated with outcomes in patients with acute heart failure (HF). Its impact in individuals with chronic HF is unknown. ⋯ Combining the diuretic dosage and measurement of UNa excretion can be used to refine risk stratification in chronic HF. The furosemide‑to‑UNa ratio can be a surrogate marker for diuretic resistance and has a prognostic impact in chronic HF.
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Pol. Arch. Med. Wewn. · Oct 2021
ReviewHow can exercise reduce cardiovascular disease risk? A primer for the clinician.
Despite advances in drug development and medical treatments, cardiovascular diseases (CVDs) remain a leading cause of mortality across the globe. Fortunately, CVD can be delayed by engaging in appropriate lifestyle behaviors. An abundance of epidemiological evidence supports a direct association between increased levels of physical activity or cardiovascular fitness and reduced premature CVD morbidity and mortality. ⋯ Thus, the purpose of this review is to highlight the cardioprotective effects of exercise training and to explore the underlying mechanistic pathways that might explain these benefits. The review will focus on those physiological pathways that are directly involved in atherosclerotic disease development. They include hypercholesterolemia, hypertension, chronic inflammation, and insulin resistance.
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Plant‑based diets are considered to improve cardiometabolic health and to protect against cardiovascular disease. Although they center around plant‑based foods, they do not necessarily exclude all animal products and comprise of a range of intakes that vary according to the type and the proportion of animal products included. Numerous metabolic pathways have been identified through which plant‑based diets can exert beneficial effects including improved body composition, lipid profile, and glucose metabolism and decreased inflammation and blood pressure. ⋯ Ample evidence for the effects of individual dietary components of plant‑based diets on thrombotic risk factors exists, but the effect of whole diets and / or dietary patterns remains less‑well explored with the existing literature reporting inconsistent and inconclusive findings. Here we aim to review the literature describing the effect of different plant‑based diets (vegan, lacto‑vegetarian, lacto‑ovo‑vegetarian, pescatarian, and flexitarian) and dietary patterns (Mediterranean, Nordic, Portfolio, and DASH) on specific thrombotic risk factors (fibrinogen, platelets, factor VII, fibrinolysis) in order to better clarify these relationships and to try to explain the apparent discrepant findings. We demonstrate that a one‑size‑fits-all conclusion cannot be drawn and that the potential antithrombotic effect of different plant‑based diets depends on the nutrient composition, the content of active antithrombotic dietary components, the relative absence of prothrombotic dietary factors as well as the degree of total caloric restriction.
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Pol. Arch. Med. Wewn. · Oct 2021
Computed tomography assessment of the aortic root morphology in predicting the development of paravalvular leak following transcatheter aortic valve implantation.
Introduction: Transcatheter aortic valve implantation (TAVI) is an effective treatment of significant aortic stenosis. Paravalvular leaks (PVLs) are one of the most common complications after the procedure. Objectives: The aim of this study was to assess whether the aortic root morphology affects the occurrence of PVL after TAVI. Patients and methods: We enrolled 50 patients with bicuspid and 50 patients with tricuspid aortic valve who underwent multislice computed tomography (MSCT) and transthoracic echocardiography prior to TAVI. ⋯ Patients were divided in 2 groups according to the PVL severity: less than moderate PVL (n = 80) and moderate or worse PVL (n = 20), and comparisons between the groups were performed. Results: Patients with at least moderate PVL, compared with those with less than moderate PVL, had greater mean (SD) area (5.2 [1.1] cm2 vs 4.7 [0.8] cm2; P = 0.02), perimeter (8.4 [0.9] cm vs 7.9 [0.7] cm; P = 0.01), and long axis (29.5 [2.7] mm vs 28 [2.7] mm; P = 0.04) of the aortic annulus and greater mean (SD) area (5.3 [1.3] cm2 vs 4.7 [1.1] cm2; P = 0.04) and perimeter (8.6 [1.1] cm vs 8.1 [0.9] cm; P = 0.02) of the left ventricular outflow tract. In multivariable analysis, bicuspid aortic valve disease, interventricular septum hypertrophy, greater left ventricular outflow tract, and postdilatation were significant predictors of moderate PVL following TAVI. Conclusions: The assessment of the aortic root morphology with MSCT can be helpful in predicting PVL after TAVI.
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Pol. Arch. Med. Wewn. · Oct 2021
Acidic urine as a novel risk factor for diuretic resistance and worse in-hospital prognosis in acute heart failure.
Introduction: Loop diuretic resistance (LDR) is a risk factor for poor prognosis in patients with acute heart failure (AHF). Acidic urine (pH <6) might be associated with diminished effect of diuretics and worse in-hospital course in this patient population. Objectives: The aim of the study was to assess the influence of acidic urine on in-hospital prognosis and diuretic efficacy in patients with AHF. Patients and methods: This was a retrospective analysis of hospitalizations due to AHF in patients with ejection fraction of 50% or less. Analyzed end points were: in-hospital death and composite end point (death, myocardial infarction, stroke, unplanned revascularization, or catecholamine infusion). ⋯ Acidic urine was found to be an independent risk factor for the composite end point. The threshold for LDR was set at 691.45 ml of diuresis/40 mg of intravenous furosemide. Low urine pH was found to be an independent risk factor for LDR. Conclusions: Low urine pH might be a useful marker identifying patients at high risk for LDR and adverse in-hospital outcome.