Five-year prognosis of patients with acute myocardial infarction and out-of-hospital cardiac arrest.

OBJECTIVES: This study aimed to assess the mortality and prognosis of acute myocardial infarction (AMI) patients with out-of-hospital cardiac arrest (OHCA) initially admitted to Department of Anesthesiology and Intensive Care in comparison with patients initially admitted to Cardiac Centre (CC). BACKGROUND: Global acute coronary syndrome (ACS) registries often omit patients with OHCA initially admitted to anaesthesiology and intensive care units. This exclusion may lead to underestimated mortality rates in patients following acute MI worldwide. METHODS: A retrospective analysis was conducted in patients admitted in 2014 to the (Department of Anesthesiology and Intensive Care) at a single center, J.A. Reiman Teaching Hospital in Presov, Slovakia. Survival rates were evaluated in-hospital, at 30 days, and annually over a five-year period. Patients with STEMI and NSTEMI were analyzed separately, particularly during the early in-hospital phase. RESULTS: In the OHCA group, 52% of STEMI patients experienced in-hospital mortality, whereas the CC group reported only 3% mortality. The total hospital mortality for STEMI patients was 6.69%. Among NSTEMI patients in the OHCA group, in-hospital mortality reached 50%, compared to 4.33% in the CC group. The total center mortality for all NSTEMI patients was 6.09%. CONCLUSION: Although the short-term prognosis for MI patients with OHCA is unfavorable, with a 30-day mortality rate of 54.9%, for those who survive the initial 30 days following cardiac arrest and are successfully discharged from the hospital, the long-term prognosis aligns with MI patients without OHCA. In light of these findings, the inclusion of all patients with MI (from both OHCA and CC groups) in global ACS registries could significantly raise in-hospital and 30-day mortality rates (Tab. 3, Fig. 4, Ref. 21).

Possibility of Utilization of Gate Geometry to Modify the Mechanical and Structural Properties of Castings on the Al-Si Basis.

The mechanical properties of die castings correlate with the inner structure of a casting, distribution of the eutectic phases, and with the content and distribution of porous cavities in the casting volume. This submitted paper deals with the issue of the possibility to influence the basic parameters affecting the quality of castings through structural modifications of the gating system. The structural parameter under assessment is the gate height. In the case of the diverse height of the gate, five sets of castings were produced. The individual sets of castings were subjected to examination of selected mechanical properties, i.e., of permanent deformation and surface hardness. At the same time, the individual sets of castings were subjected to metallographic examination of the eutectic structure of the casting. It was proved that the gate height influences the aforementioned properties of the castings and significantly affects the ratio of the eutectic phases in the volume of the casting. The conclusion describes the mutual correlation between the gate structure, the mechanical properties of the casting, and its structural composition.

Significant benefits of new communication technology for time delay management in STEMI patients.

BACKGROUND: In the acute phase of STEMI, the length of the total ischemic interval is the principal factor affecting both short- and long-term mortality. The length of the interval remains a global problem, and in EU countries these figures vary between 160 and 325 min. METHODS AND RESULTS: The aim of our research was to assess the benefit of the systematic implementation of the new smartphone-based communication technology "STEMI" enabling immediate ECG picture and voice consultation between an EMS crew in the field and a cardiologist in the PCI-center. The transfer of ECG was associated with 92% technical success. 5 Monthly data from 2016 were compared from the reference2 monthly data set in 2015 when the data in the same area was collected in the SLOVAKS registry. The 5-months data from 2016 were compared to the reference group from 2015, when similar 2-months data in the same area in SLOVAKS registry was collected but communication technology "STEMI" technology was not used. In the monitored period in 2016 we recorded a significant decrease in unwanted secondary STEMI transportations (34.32% vs. 12.9%, p<0.001) and a significant reduction in the total ischemic interval (241 min vs. 181 min, p = 0.03). There was no significant decrease in the subinterval of "admission-pPCI" (28min vs. 23 min, p = 0.144). CONCLUSION: The systematic use of smartphone-based communication technology "STEMI" enabling remote ECG picture consultation between an EMS crew and a cardiologist in PCI-center had a positive impact on the quality of care for patients with acute STEMI and brought clinical practice closer to the current ESC Guidelines. It significantly decreased the ratio of unwanted secondary transportations and led to a significant reduction in the total ischemic interval.

Finding the candidate sequence variants for diagnosis of hypertrophic cardiomyopathy in East Slovak patients.

BACKGROUND: Hypertrophic cardiomyopathy is a heterogeneous myocardial disease. Mutations appearing in several genes might be a potential cause of the disease. The aim of the study was to analyze selected exons of the sarcomeric and non-sarcomeric genes, with the purpose to identify potential candidate genetic variants and to understand etiopathogenetic mechanisms of hypertrophic cardiomyopathy in East Slovak patients. METHODS: This study recruited 23 unrelated patients with hypertrophic cardiomyopathy, namely, 13 men and 10 women (mean age of 58.09±15.82 years) and 25 healthy controls in order to determine the candidate sequence variants, in the selected exons of six cardiomyopathy genes (MYBPC3, MYH7, NEBL, SCN5A, TNNI3, TNNT2), by conventional capillary-based Sanger sequencing method and standard protocols. RESULTS: Molecular genetic results confirmed the presence of 43 sequence variants in the selected exons of six cardiomyopathy genes, 58.14% of detected variants were novel. The majority of detected sequence variants were confirmed within exon 23 of MYH7 gene. Only 11 genetic alterations were predicted to be potentially pathogenic. CONCLUSIONS: In our study, we identified known and novel sequence variants in 23 unrelated patients with hypertrophic cardiomyopathy, but we did not observe any strong mutation hotspot. The results of our study assumed that exon 23 of MYH7 gene can be in potential affinity to hypertrophic cardiomyopathy in our cohort of patients. The sequence variants identified in this study may be further investigated in order to determine their functions in disease pathogenesis and improve management, diagnosis, and treatment in Slovak patients.

Analysis of selected genes associated with cardiomyopathy by next-generation sequencing.

BACKGROUND: As the leading cause of congestive heart failure, cardiomyopathy represents a heterogenous group of heart muscle disorders. Despite considerable progress being made in the genetic diagnosis of cardiomyopathy by detection of the mutations in the most prevalent cardiomyopathy genes, the cause remains unsolved in many patients. High-throughput mutation screening in the disease genes for cardiomyopathy is now possible because of using target enrichment followed by next-generation sequencing. The aim of the study was to analyze a panel of genes associated with dilated or hypertrophic cardiomyopathy based on previously published results in order to identify the subjects at risk. METHODS: The method of next-generation sequencing by IlluminaHiSeq 2500 platform was used to detect sequence variants in 16 individuals diagnosed with dilated or hypertrophic cardiomyopathy. Detected variants were filtered and the functional impact of amino acid changes was predicted by computational programs. RESULTS: DNA samples of the 16 patients were analyzed by whole exome sequencing. We identified six nonsynonymous variants that were shown to be pathogenic in all used prediction softwares: rs3744998 (EPG5), rs11551768 (MGME1), rs148374985 (MURC), rs78461695 (PLEC), rs17158558 (RET) and rs2295190 (SYNE1). Two of the analyzed sequence variants had minor allele frequency (MAF)<0.01: rs148374985 (MURC), rs34580776 (MYBPC3). CONCLUSION: Our data support the potential role of the detected variants in pathogenesis of dilated or hypertrophic cardiomyopathy; however, the possibility that these variants might not be true disease-causing variants but are susceptibility alleles that require additional mutations or injury to cause the clinical phenotype of disease must be considered.

Analysis of SCN5A Gene Variants in East Slovak Patients with Cardiomyopathy.

OBJECTIVE: Mutations in ion channels genes are potential cause of cardiomyopathy. The SCN5A gene (sodium channel, voltage gated, type V alpha subunit gene; 3p21) belongs to the family of cardiac sodium channel genes. Mutations in SCN5A gene lead to decreased Na+ current and ion unbalance. The SCN5A gene mutations are found in approximately 2% of patients with dilated cardiomyopathy (DCM), and they may be potential phenotype modifiers in hypertrophic cardiomyopathy (HCM). The role of SCN5A gene mutations in cardiomyopathy is not fully elucidated. METHODS: Three selected exons (12, 20, and 21) of the SCN5A gene in the cohort of 58 East Slovak patients with dilated and HCM were analyzed by the Sanger sequencing method in order to detect etiopathogenic mutations associated with dilated and HCM. RESULTS: The mutation screening of three selected exons of SCN5A gene in the cohort of 27 DCM, 12 HCM patients, and 16 controls identified 10 missense genetic variants. Three of them (T1247I, A1260D, and G1262S), all in exon 21 of the SCN5A gene, were potentially damaging and disease-causing variants. CONCLUSION: Data from this study demonstrate that SCN5A gene variants have important role in the etiopathogenesis of dilated and HCM.

Usage of neural network to predict aluminium oxide layer thickness.

This paper shows an influence of chemical composition of used electrolyte, such as amount of sulphuric acid in electrolyte, amount of aluminium cations in electrolyte and amount of oxalic acid in electrolyte, and operating parameters of process of anodic oxidation of aluminium such as the temperature of electrolyte, anodizing time, and voltage applied during anodizing process. The paper shows the influence of those parameters on the resulting thickness of aluminium oxide layer. The impact of these variables is shown by using central composite design of experiment for six factors (amount of sulphuric acid, amount of oxalic acid, amount of aluminium cations, electrolyte temperature, anodizing time, and applied voltage) and by usage of the cubic neural unit with Levenberg-Marquardt algorithm during the results evaluation. The paper also deals with current densities of 1 A · dm(-2) and 3 A · dm(-2) for creating aluminium oxide layer.

Prevalence of cardiovascular risk factors in relation to metabolic syndrome in the Roma population compared with the non-Roma population in the eastern part of Slovakia.

BACKGROUND: Obesity-induced metabolic syndrome is a multiple risk factor for cardiovascular (CV) risk factors and type 2 diabetes, and ethnic minorities seem to have unfavourable medical risk factors in general more frequently than majority populations. OBJECTIVE: The aim of this study was to evaluate the prevalence of cardiovascular risk factors in relation to metabolic syndrome in the Roma population compared with the non-Roma population residing in the eastern part of Slovakia. RESULTS: 123 Roma and 79 non-Roma patients with metabolic syndrome were evaluated. Men between 40-55 years of age had 4.76-times higher odds and women 5.26-times higher odds for metabolic sydrome compared with the younger population. We found statistically significant higher waist circumference in the Roma subpopulation and higher body mass index as well, although in selected population with metabolic syndrome. HDL cholesterol was significantly lower in both Roma men and women, and LDL cholesterol was not significant in men and women with metabolic syndrome. Triglycerides levels were significantly higher in non-Roma women only. High-sensitivity C-reactive protein (hsCRP) values were not in correlation with age but were associated with the increasing number of fulfilled criteria for metabolic syndrome in both subgroups (Roma, non-Roma), independently of gender. CONCLUSION: Our study confirmed higher prevalence of obesity, metabolic syndrome and other CV risk factors associated with metabolic syndrome among younger Roma population, which may be associated with increased cardiovascular disease (CVD) morbidity and mortality among elderly Roma compared with non-Roma.

Clinical and biochemical determinants of metabolic syndrome among Roma and non-Roma subjects in the eastern part of Slovakia.

BACKGROUND: The metabolic syndrome (MS) is a clustering of cardiovascular risk. The high prevalence of metabolic syndrome among populations of lower socioeconomic status is a cause of concern and calls for an effective public health response. OBJECTIVES: The aim of this study was to determine the prevalence of metabolic syndrome in the Roma population compared with the non-Roma population in the eastern part of Slovakia and to determine the parameter which has the strongest association with metabolic syndrome. RESULTS: 123 Roma and 79 non-Roma patients with metabolic syndrome were evaluated. In the subgroup of Roma men, we found that waist circumference conferred the highest chance of MS (more than 12-times), followed by triglycerides (TG) (3.670-times). In the subgroup of non-Roma men, we found that waist circumference conferred the highest chance of MS (more than 16-times), followed by high-density lipoprotein (HDL) (4.348-times increased risk per one unit decrease in HDL). In the subgroup of Roma women as well as non-Roma women, we found that serum TG conferred the highest chance of MS, followed by waist circumference for Roma women. Comparing non-classical risk factors for MS we found that only age (with OR 1.977) and high-sensitivity C-reactive protein (hsCRP) (OR 1.887) were significant and independent predictors of MS in Roma men. Among Roma women apolipoprotein B100 was also found to be an independent predictor of MS, besides age and hsCRP. CONCLUSION: Our study confirmed that the prevalence of metabolic syndrome is strongly associated with hypertriglyceridemic waist, besides other risk factors, a marker of the atherogenic metabolic triad among younger Roma population, which may be the reason for the increased cardiovascular (CV) morbidity and mortality in elderly Roma compared with non-Roma. In light of these results, better prevention of CV events for Roma minority settlements in Slovakia should be provided.

Slovak trial on cardiovascular risk reduction following national guidelines with CaDUET® (the STRONG DUET study).

INTRODUCTION: The efficacy and safety of single-pill amlodipine/atorvastatin for reducing blood pressure (BP), low-density lipoprotein cholesterol (LDLC), and predicted 10-year cardiovascular (CV) risk have been demonstrated in low CV risk countries. The Slovak Trial on Cardiovascular Risk Reduction Following National Guidelines with CaDUET® (amlodipine besylate/atorvastatin calcium; Pfizer, Morrisville, PA, USA; STRONG DUET) study evaluated its clinical utility in Slovakia, one of the highest CV risk regions in Europe. METHODS: This was a two-phase study involving 100 outpatient cardiologist and internist departments in Slovakia. Phase 1 assessed BP control and CV risk profiles in adults with treated hypertension, and phase 2 was an open-label, multicenter, observational study. In the phase 2 study, patients with treated but uncontrolled hypertension and three or more coronary heart disease risk factors received single-pill amlodipine/atorvastatin (5/10 or 10/10 mg) for 12 weeks. Major outcomes were the percentage of patients achieving target BP (≤140/90 mmHg) and/or LDL-C (≤3 mmol/L) and reductions in predicted 10-year CV risk. RESULTS: Of the 4,672 phase 1 patients, 80.8% had uncontrolled hypertension and 61.4% had dyslipidemia. Of the 1,406 phase 2 patients, 90.3% of patients achieved target BP at week 12, 66.3% achieved target LDL-C, and 60.7% achieved both. The mean 10-year CV risk was reduced by 49% (P < 0.0001); treatment was well-tolerated and safe. CONCLUSION: Single-pill amlodipine/atorvastatin was associated with significant improvements in BP, LDL-C target attainment, and 10-year CV risk in patients with uncontrolled hypertension in Slovakia. The treatment was well-tolerated and safe. Use of single-pill amlodipine/atorvastatin in high CV-risk countries could lead to significant improvements in CV risk management.