Blood Test-Based Age Acceleration Is Inversely Associated with High-Volume Sports Activity.

PURPOSE: We develop blood test-based aging clocks and examine how these clocks reflect high-volume sports activity. METHODS: We use blood tests and body metrics data of 421 Hungarian athletes and 283 age-matched controls (mean age, 24.1 and 23.9 yr, respectively), the latter selected from a group of healthy Caucasians of the National Health and Nutrition Examination Survey (NHANES) to represent the general population ( n = 11,412). We train two age prediction models (i.e., aging clocks) using the NHANES dataset: the first model relies on blood test parameters only, whereas the second one additionally incorporates body measurements and sex. RESULTS: We find lower age acceleration among athletes compared with the age-matched controls with a median value of -1.7 and 1.4 yr, P < 0.0001. BMI is positively associated with age acceleration among the age-matched controls ( r = 0.17, P < 0.01) and the unrestricted NHANES population ( r = 0.11, P < 0.001). We find no association between BMI and age acceleration within the athlete dataset. Instead, age acceleration is positively associated with body fat percentage ( r = 0.21, P < 0.05) and negatively associated with skeletal muscle mass (Pearson r = -0.18, P < 0.05) among athletes. The most important blood test features in age predictions were serum ferritin, mean cell volume, blood urea nitrogen, and albumin levels. CONCLUSIONS: We develop and apply blood test-based aging clocks to adult athletes and healthy controls. The data suggest that high-volume sports activity is associated with slowed biological aging. Here, we propose an alternative, promising application of routine blood tests.

[Non-ST-elevation infarction, the stepchild of interventional myocardial salvage: experience of a single institute]. / Nem ST-elevációs infarktus ­ az intervenciós szívizommentés mostohagyereke.

INTRODUCTION: The diagnosis of acute myocardial infarction is based on ECG abnormalities besides to chest pain and dyspnea. It is caused by myocardial hypoperfusion, in most patients due to severe coronary artery narrowing or occlusion, but it can also occur without visible coronary artery changes. The non-ST-elevation form (NSTEMI) is usually associated with less complaints compared to the ST-elevation form (STEMI), the ECG changes are not so typical, so its recognition is more difficult in the early stage. Possibility of myocardial cell damage reduction is the restoration of perfusion with coronary intervention. OBJECTIVE: To investigate how much time elapses in acute NSTEMI from the onset of the complaint to the opening of the coronary vasodilator balloon. METHOD: From 3733 acute coronary interventions performed in NSTEMI between 01. 01. 2016 and 12. 31. 2020, in 1376 patients who underwent percutaneous intervention for the first time, the onset of the complaints, the date of the first medical contact and opening of the balloon, as well as the 30-day or 1-year mortality were known. The median values of the time differences and the mortality data were compared with the similar data of 1718 STEMI patients of this period. The median times were given in hours:minutes, incidence in percent, a two-sample t-test was calculated for the comparison of mortality data. RESULTS: In NSTEMI, the median time between the first medical contact (5:35 vs. 2:05 h:min) and PTCA balloon opening (18:12 vs. 4:05 h:min) was longer compared to the onset of the complaint as in STEMI. Within 2 hours, 21.3% of NSTEMI patients reached the first medical contact and 1.2% had the PTCA balloon opened, in STEMI this ratios were 48.7% and 11.7%. Within 4 hours, these were in NSTEMI 36.3% and 6.1%, in STEMI 64.1% and 46.8%. The 30-day mortality rate in NSTEMI was lower than in STEMI (5.9% vs. 7.9%, p = 0.03), the 1-year rate was higher (16.1% vs. 12.5%, p = 0.004). In 554 primarily admitted patients who met the study criteria, the median P-B time intervals were shorter (10:55 h:min), the mortality data showed a mild but statistically insignificant difference (5.6% at 30 days, 13.9% at 1 year). CONCLUSION: Based on the 1-year mortality data, NSTEMI cannot be considered less harmful compared to STEMI. After the onset of hypoperfusion, myocardium necrosis proportional to the elapsed time increases the likelihood of subsequent heart failure. For this reason, it seems advisable for patients to reach the intervention center earlier than at present due to the invasive diagnostic and therapeutic options. Orv Hetil. 2023; 164(47): 1865-1870.

Survival of Myocardial Infarction Patients with Diabetes Mellitus at the Invasive Era (Results from the Városmajor Myocardial Infarction Registry).

Due to the lifelong nature of diabetes mellitus (DM), it has been demonstrated to have significant effects on patients' morbidity and mortality. The present study aimed to assess the effects of DM on the clinical outcome and survival in patients who underwent percutaneous coronary intervention (PCI) due to myocardial infarction (MI) and to examine the relationship of DM to the type of the MI and to left ventricular (LV) and renal functions. A total of 12,270 patients with ST-elevation MI (STEMI) or non-ST-elevation MI (NSTEMI) were revascularized at our Institution between 2005 and 2013. In this pool of patients, 4388 subjects had DM, while 7018 cases had no DM. In both STEMI and NSTEMI, the 30-day and 1-year survival were worse in diabetic patients as compared to non-diabetic cases. In the patients with DM, NSTEMI showed worse prognosis within 1-year than STEMI similarly to non-diabetic subjects. Regarding survival, the presence of DM seemed to be more important than the type of MI. Regardless of the presence of DM, reduced LV function was a maleficent prognostic sign and DM significantly reduced the prognosis both in case of reduced and normal LV function. Survival is primarily affected by LV function, rather than DM. Worse renal function is associated with worse 30-day and 1-year survival in both cases with and without DM. Considering different renal functions, the presence of DM worsens both short- and long-term survival. Survival is primarily affected by renal function, rather than DM. The results from a high-volume PCI center confirm significant the negative prognostic impact of DM on survival in MI patients. DM is a more important prognostic factor than the type of the MI. However, survival is primarily affected by LV and renal functions, rather than DM. These results could highlight our attention on the importance of recent DM treatment with new drugs including SGLT-2 inhibitors and GLP-1 antagonists with beneficial effects on survival.

The effect of COVID-19 pandemic on myocardial infarction care and on its prognosis - Experience at a high volume Hungarian cardiovascular center.

Introduction: The COVID-19 pandemic has impacted many aspects of acute myocardial infarction. Based on literature data, the prognosis of COVID+, STEMI patients is significantly worse than that of COVID- STEMI patients. On the other hand, physicians report fewer acute coronary syndrome (ACS) patients presenting to hospitals in countries severely affected by the pandemic. It is concerning that patients with life-threatening illness can suffer more complications or die due to their myocardial infarction. We aimed to investigate the changes in myocardial infarction care in the country's biggest PCI-center and to compare total 30-day mortality in COVID+ and COVID-patients with acute myocardial infarction treated at the Semmelweis University Heart and Vascular Center, and to investigate risk factors and complications in these two groups. Methods: Between 8 October 2020 and 30 April 2021, 43 COVID+, in 2018-2019, 397 COVID-patients with acute myocardial infarction were admitted. Total admission rates pre- and during the pandemic were compared. Results: Within 30 days, 8 of 43 patients in the COVID+ group (18.60%), and 40 of the 397 patients in the control group (10.07%) died (P = 0.01). Regarding the comorbidities, more than half of COVID+ patients had a significantly reduced ejection fraction (EF≤ 40%), and the prevalence of heart failure was significantly higher in this group (51.16% vs. 27.84%, P = 0.0329). There was no significant difference between the two patient groups in the incidence of STEMI and NSTEMI. Although there was no significant difference, VF (11.63% vs. 6.82%), resuscitation (23.26% vs. 10.08%), and ECMO implantation (2.38% vs. 1.26%) were more common in the COVID+ group. The mean age was 68.8 years in the COVID+ group and 67.6 years in the control group. The max. Troponin also did not differ significantly between the two groups (1,620 vs. 1,470 ng/L). There was a significant decline in admission rates in the first as well as in the second wave of the pandemic. Conclusions: The 30-day total mortality of COVID+ patients was significantly higher, and a more severe proceeding of acute myocardial infarction and a higher incidence of complications can be observed. As the secondary negative effect of the pandemic serious decline in admission rates can be detected.

The associations of long-COVID symptoms, clinical characteristics and affective psychological constructs in a non-hospitalized cohort.

Objective: The effects of COVID-19, especially long-COVID, on the psychological health is incompletely understood. We aimed to evaluate the mid-term associations of the long-COVID symptoms and affective factors in a cohort of non-hospitalized patients. Method: A total of 166 patients were enrolled in this study, including 119 sedentary/non-athlete and 47 athlete subjects at the Post-COVID Outpatient Clinic of Semmelweis University. Clinical data regarding acute and long-term symptoms were obtained and detailed laboratory testing was carried out. Demographic data and psychological tests were collected. Results: We found a positive association between the level of depressive symptoms and anxiety and long-COVID symptom count, while life satisfaction and social support correlated negatively with the long-COVID symptom count. Higher haemoglobin levels and lower LDL-cholesterol were also shown to be moderating factors. A regression model showed that symptoms during acute infection, depression, age, and life satisfaction are predictors of the long-COVID symptom count. The presence of pre-existing affective or anxiety problems was also associated with higher reported long-COVID symptom count. Furthermore, we found significant association between pre-existing mental health problems and the investigated psychological constructs. Conclusion: It appears that long COVID-19 is associated with acute symptoms and mental factors. Depression and anxiety have been shown to have a negative effect on symptom perception, and also contribute to a higher number of symptoms in a non-hospitalized sample. Our study suggests bi-directional interconnection between clinical and psychological factors.

Prognosis of the non-ST elevation myocardial infarction complicated with early ventricular fibrillation at higher age.

Early ventricular fibrillation (EVF) predicts mortality in ST-segment elevation myocardial infarction (STEMI) patients. Data are lacking about prognosis and management of non-ST-segment elevation myocardial infarction (NSTEMI) EMI with EVF, especially at higher age. In the daily clinical practice, there is no clear prognosis of patients surviving EVF. The present study aimed to investigate the risk factors and factors influencing the prognosis of NSTEMI patients surviving EVF, especially at higher age. Clinical data, including 30-day and 1-year mortality of 6179 NSTEMI patients, were examined; 2.44% (n=151) survived EVF and were further analyzed using chi-square test and uni- and multivariate analyses. Patients were divided into two age groups below and above the age of 70 years. Survival time was compared with Kaplan-Meier analysis. EVF was an independent risk factor for mortality in NSTEMI patients below (HR: 2.4) and above the age of 70 (HR: 2.1). Mortality rates between the two age groups of NSTEMI patients with EVF did not differ significantly: 30-day mortality was 24% vs 40% (p=0.2709) and 1-year mortality was 39% vs 55% (p=0.2085). Additional mortality after 30 days to 1 year was 15% vs 14.6% (p=0.9728). Clinical characteristics of patients with EVF differed significantly from those without in both age groups. EVF after revascularization-within 48 h-had 11.2 OR for 30-day mortality above the age of 70. EVF in NSTEMI was an independent risk factor for mortality in both age groups. Invasive management and revascularization of NSTEMI patients with EVF is highly recommended. Closer follow-up and selection of patients (independent of age) for ICD implantation in the critical first month is essential.

Primary coronary intervention in ST-elevation myocardial infarction / Primer coronariaintervenció ST-elevációs infarktusban.

Összefoglaló. Bevezetés: Heveny myocardialis infarctusban a szívizommentés sikere, a beteg életkilátása nagymértékben függ a panasz kezdete és az elzáródott koszorúér rekanalizálása között eltelt ischaemiás idotol. Jelenleg az ér nyitása optimális esetben minden betegnél koszorúér-intervencióval történik. Célkituzés: Annak vizsgálata, hogy öt év alatt mennyit változtak az ischaemiás ido összetevoi, és miben változott az elzáródott ér nyitásának módszere ST-elevációs myocardialis infarctus (STEMI) miatt végzett primer coronariaintervencióban. Módszer: 2014. 01. 01. és 2018. 12. 31. között 1663, STEMI miatt koszorúér-intervencióval kezelt betegnél (1173 férfi és 490 no) vizsgáltuk évenkénti bontásban a panasztól a koszorúér nyitásáig eltelt ido összetevoit és a 30 napos halálozást. Eredmények: Öt év alatt a panasztól az elso egészségügyi kontaktusig medián 2:53 vs. 2:10 óra (p = 0,0132), ettol az intervenciós centrumba történt felvételig medián 1:17 vs. 1:03 óra (p = 0,009), a felvételtol a ballon nyitásáig medián 0:31 vs. 0:29 óra (p = ns) telt el. A panasztól a ballon nyitásáig eltelt ido (medián 5:29 vs. 4:07 óra, p = 0,0001) rövidült, döntoen 2014 és 2015 között. A gyógyszerkibocsátó stent beültetése 15%-ról 96%-ra nott. A vizsgált években a légzés/keringés támogatás aránya 8,2-10,6-13,9-7,6-8,4, a 30 napos halálozásé 4,1-6,8-11,1-7,4-5,7% volt; a két érték korrelációt mutat (p = 0,827). Következtetés: Öt év alatt a panasztól az elso egészségügyi kontaktusig és a kórházi beszállításig eltelt ido rövidült, de az Európai Kardiológiai Társaság ajánlásához képest hosszú; a kórházi felvételtol a ballon nyitásáig eltelt ido megfelelo. A négy órán belüli reperfúzió a betegek közel felében valósult meg. Az intervenciós centrumba való gyorsabb bekerülés javíthatna az eredményen. Orv Hetil. 2021; 162(13): 497-503. INTRODUCTION: In acute myocardial infarction, the heart muscle salvage, the patient's life expectancy is highly dependent on the elapsed ischaemic time from the onset of complaint to target vessel recanalisation. Nowadays, target vessel recanalisation is performed with coronary intervention in all patients in optimal case. OBJECTIVE: To examine how the components of ischemic time and the opening procedure of the occluded coronary have changed over five years in primary intervention done in acute ST-elevation myocardial infarction (STEMI). METHOD: Authors studied data of 1663 (1173 male and 480 female) STEMI patients in annual breakdowns treated with coronary intervention between 01. 01. 2014 and 31. 12. 2018, time from complaint to coronary artery opening, details of intervention and 30 days mortality rate. RESULTS: During the five years, time intervals were as follows: from onset of complaint to first medical contact: median 2:53 vs. 2:10 hours (p = 0.0132), from this to admission in the interventional centre: median 1:17 vs. 1:03 hours (p = 0.009), from hospital admission to balloon opening: median 0:31 vs. 0:29 hours (p = ns). In total, the complaint to balloon opening time (median 5:29 vs. 4:07 hours, p = 0.0001) diminished, decisively from 2014 to 2015. Ratio of drug-eluting stent implantation increased from 15% to 96%. In the investigated years, the need of respiratory and/or circulatory device support ratio was 8.2-10.6-13.9-7.6-8.4, 30-day mortality rate between 4.1-6.8-11.1-7.4-5.7%; these two values showed a correlation (p = 0.827). CONCLUSION: The time from complaint to first medical contact and transfer to hospital against the significant decrease is still longer than the recommendation of the European Society of Cardiology. The time from hospital admission to balloon opening is adequate. Reperfusion within four hours was achieved in half of the patients in total. Faster hospitalization may improve results. Orv Hetil. 2021; 162(13): 497-503.

Needle in the heart: a rare case of cardiac tamponade caused by a migrated foreign body and mimicking ST segment elevation myocardial infarction.

BACKGROUND: Pericardial tamponade is a serious condition which may eventually lead to severe haemodynamic disturbances and cardiac arrest. It is most often caused by the accumulation of fluid inside the pericardium, as a result of different aetiological factors such as pericarditis, neoplastic diseases, lymphatic dysfunctions, or idiopathic pericardial disease. Pericardial tamponade can develop after cardiac surgical procedures or as a complication of myocardial infarction. Collection of blood inside the pericardial sack can be the result of pericardial or cardiac trauma. It is exceedingly rare for the injury to be caused by a migrating foreign body. Although a typical picture of pericardial tamponade has been previously described, the disorder may clinically resemble an acute myocardial infarction. CASE PRESENTATION: We report the case of a 58-year-old female patient complaining of new onset thoracic pain and shortness of breath. Electrocardiographic examination results were suggestive of an acute inferior myocardial infarction. However, echocardiography revealed significant pericardial tamponade. The cause was found to be a needle which remained inside the pelvis following a previous cesarean delivery, which the patient had undergone 18 years prior. In emergency setting, the needle was removed and the pericardial tamponade was resolved. Due to the prompt and efficient management, the patient had an uneventful postoperative recovery and presented no recurrence at the follow-up examinations. CONCLUSIONS: The migration of foreign bodies through tissues is exceedingly rare. If present, it may cause life-threatening complications. Since the aetiology of pericardial tamponade is vast, a thorough assessment is highly important. Therefore, echocardiography is the imaging modality of choice. We wish to highlight the possibility of migrating foreign bodies as probable cause for pericardial tamponade, as well as the importance of echocardiographic methods in the fast-track evaluation of such critical conditions.

Prognosis and clinical characteristics of patients with early ventricular fibrillation in the 6-week guideline-offered time period: is it safe to wait 6 weeks with the assessment? (results from the VMAJOR-MI Registry).

BACKGROUND: The most common, potentially fatal complication following an acute myocardial infarction (AMI) is early ventricular fibrillation (EVF). According to the guidelines, the assessment of implanting an implantable cardioverter defibrillator (ICD) is sufficient 6 weeks after the event, in patients with reduced left ventricular ejection fraction (LVEF), regardless of VF. The present study aimed to evaluate the 6-week prognosis of patients surviving an EVF. We divided the patients in two group based on their general condition at the time they left the hospital. We investigated the clinical characteristics of patients discharged in good general health but still dying within 6 weeks. METHODS: The present study comprised 12,270 patients with AMI following their primary revascularization in the first 12 h of symptom onset. Five hundred and forty-seven of them suffered EVF due to the AMI. Clinical and 6-week mortality data were examined. RESULTS: Poor general condition correlates with multiple comorbidities, higher troponin levels, more severe complications after the event. Patients leaving in good condition thought to be low risk, from dying. But low LVEF, high blood sugar, high cardiac biomarker level, poor renal function elevates the risk of dying within 6 weeks. However, there is no difference in clinical characteristics between EVF- cases and EVF+ cases in good condition who dies within 6 weeks. CONCLUSIONS: According to our study we can select patients who are safe in the critical 6-week period and those who need closer follow-up despite leaving in good general condition.