The vicious cycle: a history of obesity and COVID-19.

Recently, we face a surge in the fast-forward Coronavirus Disease 2019 (COVID-19) pandemic with nearly 170 million confirmed cases and almost 3.5 million confirmed deaths at the end of May 2021. Obesity, also known as the pandemic of the 21st century, has been evolving as an adverse prognostic marker. Obesity is associated with a higher risk of being SARS-CoV-2-positive (46%), as well as hospitalization (113%) and death (48%) due to COVID-19. It is especially true for subjects with morbid obesity. Also, observational studies suggest that in the case of COVID-19, no favorable "obesity paradox" is observed. Therefore, it is postulated to introduce a new entity, i.e., coronavirus disease-related cardiometabolic syndrome (CIRCS). In theory, it applies to all stages of COVID-19, i.e., prevention, acute proceedings (from COVID-19 diagnosis to resolution or three months), and long-term outcomes. Consequently, lifestyle changes, glycemic control, and regulation of the renin-angiotensin-aldosterone pathway have crucial implications for preventing and managing subjects with COVID-19. Finally, it is crucial to use cardioprotective drugs such as angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers and statins. Nevertheless, there is the need to conduct prospective studies and registries better to evaluate the issue of obesity in COVID-19 patients.

Revisiting the use of the provocative acetylcholine test in patients with chest pain and nonobstructive coronary arteries: A five-year follow-up of the AChPOL registry, with special focus on patients with MINOCA.

This study aimed to assess the angiographic characteristics, feasibility and safety of the provocative test with acetylcholine (AChT), and the influence on further treatment and prognosis of Middle European patients in 5-year follow-up, especially focusing on those with a history of myocardial infarction (MI) with nonobstructive coronary arteries (MINOCA). The AChPOL Registry was an ongoing prospective single-center registry that included patients undergoing AChT from December 2010 to March 2013 for further diagnostic evaluation of a suspicious variant angina or coronary microvascular spasm, based on the COVADIS criteria. AChT was injected in incremental doses of 25, 50, and 75µg into the right coronary artery and 25, 50, and 100 µg into the left coronary artery, and the patients were followed up for 5 years. We enrolled 211 patients in the AChPOL Registry. Their mean age was 60.5 ± 7.8 years, with women accounting for 67.8%. The median follow-up was 56 months. AChT revealed variant angina in 99 patients (46.9%) and coronary microvascular spasm in the remaining 72 patients (34.1%). In patients with variant angina, spasm was most frequently observed in the left anterior descending artery (89.9%) and was most frequently diffuse (61.6%). In the microvascular spasm subgroup, there was a significantly higher rate of recurrent chest pain requiring hospitalization in the follow-up than in AChT negative patients. Interestingly, patients with a history of MINOCA had higher rates of MI and recurrent chest pain requiring hospitalization in the follow-up. We showed that AChT was safe in Middle European patients. In the follow-up patients with microvascular spasm and a history of MINOCA had the highest risk of MI and recurrent chest pain requiring hospitalization.

Carcinoid Heart Disease: How to Diagnose and Treat in 2020?

Neuroendocrine tumors (NETs, originally termed "carcinoids") create a relatively rare group of neoplasms with an approximate incidence rate of 2.5 to 5 cases per 100 000 persons. Roughly 30% to 40% of subjects with NETs develop carcinoid syndrome (CS), and 20% to 50% of subjects with CS are diagnosed with carcinoid heart disease (CaHD). The long-standing exposure to high serum serotonin concentration is one of the crucial factors in CaHD development. White plaque-like deposits on the endocardial surface of heart structures with valve leaflets and subvalvular apparatus thickening (fused and shortened chordae; thickened papillary muscles) are characteristic for CaHD. NT pro-BNP and 5-hydroxyindoleacetic acid are the 2 most useful screening markers. Long-acting somatostatin analogs are the standard of care in symptoms control. They are also the first-line treatment for tumor control in subjects with a metastatic somatostatin receptor avid disease. In cases refractory to somatostatin analogs, several options are available. We can increase a somatostatin analog to off-label doses, add telotristat ethyl or administer peptide receptor radionuclide therapy. Cardiac surgery, which mainly involves valve replacement, is presently the most efficient strategy in subjects with advanced CaHD and can relieve unmanageable symptoms or be partly responsible for better prognosis.

Conservative treatment as a therapeutic option for penetrating aortic ulcer of the aortic arch in a patient with bicuspid aortic valve.

Penetrating aortic ulcer (PAU) is ulceration of an aortic atherosclerotic plaque penetrating through the internal lamina into the media. PAU is a rare condition and occurs in 2% - 7% of acute aortic syndromes (AAS); however, the actual incidence is unknown because of asymptomatic patients. One may treat it conservatively as well as surgically. We present a case of a 54-year-old man, who was admitted to hospital due to the exaggeration of exertional chest pain and persistent headaches. During coronary angiography, the suspicion of PAU was raised. Contrast-enhanced computed tomography confirmed the diagnosis. Transesophageal echocardiography showed bicuspid aortic valve with minimal calcification, the dilated ascending aorta, large atherosclerotic plaques in the aortic arch with ulceration (thickness: 5.0 - 5.5mm, diameter: 5 - 6 mm, depth: 3 - 4 mm), without intramural hematoma. Conservative treatment was chosen with uneventful 2-year follow-up. Although surgical management is advocated for patients with PAU type A, we demonstrated that type A PAU can be successfully treated conservatively as well.

The influence of calcium-phosphate metabolism abnormalities on the quality of life in patients with hemodynamically significant mitral regurgitation.

BACKGROUND: In recent years, studies have indicated that vitamin D [25(OH)D3] and other calcium-phosphate (Ca-P) metabolism parameters and their disturbances might be potential new factors that may influence health-related quality of life (HRQoL). The aim of our study was to assess the extent of Ca-P metabolism abnormalities in patients with significant mitral regurgitation (MR) and their effect on patients' HRQoL. METHODS: We included 99 patients with significant MR (median age, 75 years [Q1-Q3, 66.0-81.5], 35.4% females). Hemodynamically significant MR was assessed using transthoracic echocardiography (vena contracta > 3 mm, effective orifice area > 0.2 cm2, and MR volume > 30 mL/s). HRQoL was evaluated using a cardiac-specific (MacNew) tool. RESULTS: A significant negative correlation between parathormone (PTH) levels and HRQoL was demonstrated (r = - 0.242, - 0.243, and - 0.255; p = 0.018, 0.018, and 0.013 for Global Scores, and physical and social domains, respectively). Additionally, we confirmed that patients with higher NT-proBNP levels, NYHA heart failure (HF) class, and larger left ventricles had poorer HRQoL. Moreover, patients with poorer HRQoL walked a shorter distance in a 6-min walking test. CONCLUSIONS: To the best of our knowledge, this report is the first to show that Ca-P abnormalities resulted in significantly worse HRQoL, especially in the physical domain, in a population of patients with hemodynamically significant MR.

Statins use and cancer: an update.

After initial concerns regarding the association of statins with increased incidences of cancer and elevated cancer-related mortality, there are now plenty of data on the antitumor, cytostatic and cytotoxic effectiveness of this class of drugs. Here, we present a short review of possible mechanisms of antineoplastic activity obtained from preclinical research and the influence of statins on cancer treatment. In the second part of the article, we focus on the most recent data from observational clinical trials, as well as meta-analyses regarding cancer incidence and mortality in patients treated with statins.

Disorders of calcium and phosphate metabolism in patients with significant mitral regurgitation.

INTRODUCTION    Although there are several known risk factors of cardiovascular diseases (CVDs), the search for new factors continues. In recent years, clinical trials have reported vitamin D and other calcium (Ca) and phosphate (P) metabolism disorders as potential new cardiovascular risk factors, but literature data on this association are limited. OBJECTIVES    We aimed to assess the extent of Ca and P metabolism disorders in patients with mitral regurgitation (MR) and potential role of these disorders as risk factors of CVD. PATIENTS AND METHODS    We enrolled adult patients with significant MR (vena contracta >3 mm, effective orifice area >0.2 cm2, and MR volume >30 ml/s) hospitalized in our department between July and September 2013. Anthropometric data were collected. Moreover, all patients underwent blood and urine analysis, transthoracic echocardiography, and 6­minute walking test. RESULTS    A total of 99 patients were enrolled (median age, 75 years; [Q1-Q3, 66.0-81.5]; women, 35.4%). The median serum Ca level corrected by albumin was 3.22 mmol/l [Q1-Q3, 3.14-3.27]. The mean (SD) serum ionized Ca level corrected by pH was 1.05 (0.08) mmol/l. The median levels of parathyroid hormone (PTH) and 25(OH)D3 were 63.10 pg/ml [Q1-Q3, 40.95-88.55] and 14.80 ng/ml [Q1-Q3, 9.93-20.12], respectively. Patients with a history of heart failure (HF) with reduced ejection fraction (New York Heart Association class IV), shorter distance in the 6­minute walking test, lower left ventricular ejection fraction, and larger left ventricular end­diastolic diameter had significantly higher probability of elevated PTH levels. CONCLUSIONS    Disorders of Ca and P metabolism in patients with significant MR are a noteworthy clinical problem. Our study is the first to systematically describe these disorders in patients with CVD. However, larger studies are needed to confirm the significance of our results.

[The influence of drugs used in the treatment of diabetes type 2 on the cardio-vascular risk].

With the obesity epidemic, we observe increase in the number of people suffering from diabetes mellitus type 2. This illness is considered cardiovascular disease equivalent, so influence of drugs used to manage diabetes on cardiovascular outcomes is important. Below we present review of main class of drugs used in diabetes treatment and summingup of trials conducted with their use to evaluate cardiovascular risk during treatment.

[New strategies for assessing the risk of sudden cardiac death in hypertrophic cardiomyopathy]. / Nowe strategie oceny ryzyka naglego zgonu sercowego w przebiegu kardiomiopatii przerostowej.

Hypertrophic cardiomyopathy (HCM) is characterized by a primarily increased ventricular wall thickness, usually caused by the mutations in genes encoding sarcomere proteins. Thanks to the growing awareness in the medical community as well as advances in diagnostic techniques HCM can be diagnosed at earlier stages than ever before. However, in some cases the first symptom of this disease is a sudden cardiac death (SCD) and diagnosis remains unknown until post-mortem examination. Implantation of a cardioverterdefibrillator (ICD) provides the most effective method of SCD prevention. Nevertheless, due to a number of risks associated with surgery as well as the possession of such devices, predictive factors of serious ventricular arrhythmia in individual patients have been sought for many years. The aim of this review is to present the current strategies of risk assessment and prevention of SCD in patients with HCM.

Transcatheter aortic valve implantation complicated by acute pericardial tamponade.

Transcatheter aortic valve replacement (TAVR) is now an accepted standard of care for patients with symptomatic severe aortic stenosis who are not candidates for surgery or have high surgical risk. Despite its more widespread adoption as a treatment option and increasing experience of centers, TAVR is still associated with several complications. We therefore report a case of TAVR complicated by acute pericardial tamponade, one of the most severe potential complications of this procedure. We describe the way we approached the problem and we try to give a potential take-home message for others who might encounter such a situation in their own cath lab.

Mitral annulus caseous calcification mimicking cardiac mass in asymptomatic patient - multimodality imaging approach to incidental echocardiographic finding.

BACKGROUND: Caseous calcification of mitral annulus is rather rare echocardiographic finding with prevalence of 0.6% in pts. with proven mitral annular calcification and 0.06% to 0.07% in large series of subjects in all ages. Echocardiographic images of caseous calcification are often heterogenous due to calcium and lipid deposits, and the masses show hyperechogenic and hypoechogenic areas. However the appearance of caseous calcification can imitate that of abscess, tumors and cysts, surgical treatment may not be needed when there is no obstruction. CASE REPORT: 76-year old obese (BMI 32 kg/m(2)), female patient with history of hypertension, stable coronary artery disease, diabetes type 2 and hyperlipidemia presented with no symptoms of mitral valve dysfunction and had no abnormalities on physical exam. Transesophageal echocardiography identified well-organized, composite, immobile lesion (22×15 mm) localized in the posterior part of the mitral annulus, with markedly calcified margins, and no significant impact on the valve function. In computed tomography (CT) lesion was described as calcified (24×22×17.5 mm), connected with posterior leaflet and posterior part of the mitral annulus, reducing posterior leaflet mobility. CT brought the suggestion of caseous mitral annular calcification. Coming to a conclusion, bearing in mind no mitral valve dysfunction at that time, patient was offered conservative treatment. CONCLUSIONS: Although caseous mitral annular calcification is typically an incidental finding, accurate recognition is needed to avoid mistaking the lesion for a tumor or abscess, which may result in unnecessary cardiac surgery. However this entity is diagnosed on cardiac MRI, multi-modality imaging, especially non-contrast CT, allows for the confident, prospective diagnosis.

Occult left atrial ball-like thrombus in a patient referred for surgical removal of suspected cerebellum tumor.

BACKGROUND: Atrial fibrillation and related cardio-embolic cerebrovascular accidents are two well-defined major healthcare problems worldwide. It has been approximated that 2.2 million people in America and 4.5 million in European Union have paroxysmal or persistent atrial fibrillation. And atrial fibrillation itself is an independent long-term risk factor of stroke. We present a case of patient referred to our center for surgical removal of suspected cerebellum tumor, a case that had a rather unexpected ending. CASE REPORT: A 58-year-old male patient with a history of atrial fibrillation, congestive heart failure (NYHA II/III), stable coronary artery disease, diabetes type 2 and hyperlipidemia presented with vertigo, headaches, mainly during physical activity and increased tiredness. Performed computer tomography revealed two lesions in the cerebellum and in the left lateral chamber. The diagnosis of a proliferative disease of the cerebellum was established and patient was referred to the Neurosurgical Department. Fortunately, before the operation the echocardiography was performed, which revealed two lesions in left atrium. The decision of the Heart Team was to refer the patient for an open-heart surgery, in which two thrombi were removed. Neurosurgeons decided to withdraw from further surgery and proceed with head MRI and conservative treatment, deciding that the lesion in the cerebellum was most likely an ischemic area. CONCLUSIONS: Looking at the brain lesion should always be done from the whole patient's perspective. And using mutlimodality imaging may lead to appropriate diagnosis, correct course of therapeutic action and unexpected ending of a rather non-extraordinary case.

Beneficial influence of carvedilol on urologic indices in patients with hypertension and benign prostatic hyperplasia: results of a randomized, crossover study.

OBJECTIVE: To assess the influence of carvedilol, an α- and ß-blocker, on lower urinary tract symptoms (LUTS) and urine flow in hypertensive patients with benign prostatic hyperplasia (BPH). METHODS: Fifty men were included in this double blind crossover study with placebo. After initial screening, participants were randomized to the carvedilol or the enalapril group, with cross over after 3 months. Doses of both drugs were uptitrated or additional therapy was introduced to ensure normal control of blood pressure (BP). Urologic assessment included uroflowmetry (average [Qavg] and maximum urinary flow rate [Qmax]), postvoid residual urine volume (PVR), International Prostate Symptom Score (IPSS), and prostate-specific antigen (PSA). RESULTS: After carvedilol or enalapril administration, BP values were significantly reduced, whereas heart rate decreased only in the carvedilol group. Basal urologic values for carvedilol and enalapril were similar: Qavg, 7.8 ± 0.9 and 8.1 ± 0.6 mL/s; Qmax, 13.2 ± 1.5 and 13.7 ± 0.9 mL/s; PVR, 86.1 ± 13.2 and 85.6 ± 11.7 mL; and IPSS, 13.2 ± 0.9 and 12.3 ± 0.8 points, respectively. After treatment with carvedilol, PVR and IPSS significantly decreased (48.2 ± 11.7 mL, 9.0 ± 0.8 points, respectively; P <.001), whereas Qavg and Qmax increased (10.3 ± 0.9 mL/s, 16.5 ± 1.4 mL/s, respectively; P <.001). In the enalapril group, all of these values remained unchanged. CONCLUSION: Carvedilol, compared with enalapril, has a positive influence on LUTS related to BPH in patients with hypertension. Thus, therapy with carvedilol may be considered in hypertensive patients with BPH. Further studies on the urologic benefit from long-term use of the drug are warranted.