Cardiologia Croatica. 2021;16(7-8):237-284.

Objective

A multicenter study to evaluate the prevalence and cardiovascular outcomes of diabetic cardiomyopathy in type II diabetic patients.

Patients and Methods

Two hundred participants with type II diabetes mellitus (DM) were included, while participants with coronary artery disease (CAD), valvular heart disease, or history of alcohol or drug abuse were excluded. Participants were subjected to history taking for age, gender, body mass index, smoking, dyslipidemia, medications, DM, Framingham diagnostic criteria of heart failure (HF), comprehensive clinical examination, 12 leads resting electrocardiogram, transthoracic echocardiography and one of the following laboratory investigations: glycated hemoglobin, random blood sugar, fasting blood sugar, or 2-hour 75-gram oral glucose tolerance test.

Results

The prevalence of diabetic cardiomyopathy versus (vs) no diabetic cardiomyopathy, left ventricular (LV) diastolic dysfunction grade II and III, systolic dysfunction, and hypertrophy in the study population was 23.0% vs 77.0%, 18.5%, 5.0%, and 8.0%, respectively. There was a highly significant difference between LV diastolic dysfunction grade II and III, systolic dysfunction, and hypertrophy in the diabetic cardiomyopathy group vs no diabetic cardiomyopathy group, with an absolute risk increase of 80%, 22%, and 35% in the diabetic cardiomyopathy group, respectively. There was a highly significant difference between the mean ejection fraction (EF) in the diabetic cardiomyopathy group vs the no diabetic cardiomyopathy group. The mean EF for the diabetic cardiomyopathy group was 5.5% lower than the mean EF for the no diabetic cardiomyopathy group. The prevalence of HF and pre-clinical HF in the diabetic cardiomyopathy group was 65% and 35%, respectively. The mean age for HF was 4.1 years older than the mean age for pre-clinical HF in the diabetic cardiomyopathy group. Smoking was significantly and strongly associated with HF vs pre-clinical HF in the diabetic cardiomyopathy group.

Conclusions

Diabetic cardiomyopathy was prevalent in an Egyptian type II diabetic patient population and could be considered a primary myocardial disease predisposing to HF in type II DM.

Introduction

Infective endocarditis (IE) is a focus infection caused by bacterial, viral, or fungal microorganisms within the heart that involves the endocardium and heart valves. Streptococcus alactolyticus, classified under DNA cluster IV of the S. bovis/S. equinus complex, is a sparse isolated bacterium that rarely cause IE in humans. Kocuria kristinae is a gram-positive bacteria. Until now, there have been only six IE cases caused by K. kristinae infections reported in the literature. Thrombocytopenia and platelet dysfunction can manifest in IE cases and are related to the clinical outcome. Different mechanisms have been hypothesized to explain thrombocytopenia in IE.

Case report

We report the case of a 25-year-old female patient who complained of palpitation two weeks before admission. Initially, the patient complained of fever arising six months before admission. Blood cultures showed S. alactolyticus and K. kristinae. Echocardiography examination showed vegetation on anterior and posterior mitral valves with severe mitral regurgitation. During hospitalization, the patient also suffered from severe thrombocytopenia without bleeding signs. On day 16 after hospitalization, the patient suddenly complained of abdominal pain and dyspnea. The patient was declared deceased with cause of death due to septic emboli.

Conclusion

We reported a case of IE caused by rare bacterial pathogens, S. alactolyticus and K. kristinae, which were aggravated by thrombocytopenia. Management of IE with thrombocytopenia requires caution because it is associated with poor outcomes. In this case, poor outcomes can be connected to thrombocytopenia coupled with the presence of specific bacteria, S. alactolyticus, which is known as a bacterium that often causes septic embolism.

Pulmonary embolism (PE) is a common and potentially fatal condition. Despite advances in diagnostic procedures, late detection and non-detection of this condition is also not uncommon. In patients with PE, recurrent embolisms and death can be prevented with prompt diagnosis and adequate treatment. Due to presentation with a non-specific clinical picture and symptomatology, unfortunately almost one third of the patients remain undiagnosed and untreated. We know that there is a large difference in outcome between treated and untreated patients with PE (25-30% mortality in untreated and 2-8% in treated patients). We present a case of PE in the era of the COVID-19 pandemic in an adult patient with acute dyspnea, vomiting, presyncope, chest pain, and shock.

Aim

To determine whether there are differences between serum creatinine levels, estimated glomerular filtration rate (GFR) according to the Modification of Diet in Renal Disease Study (MDRD) equation, creatinine clearance, and estimated GFR obtained by the Cockcroft-Gault method related to age, stage, and duration of arterial hypertension.

Patients and Methods

The study included 124 patients with arterial hypertension who were examined at the Clinic for Heart, Rheumatism and Blood Vessels, Clinical Center University of Sarajevo. All patients were examined, and data about the duration and stage of hypertension were taken. Kidney function was assessed using serum creatinine, estimated GFR according to the MDRD equation, creatinine clearance estimated by the Cockcroft-Gault method (eCrClCG) and its corrections for body surface area (eCrClCG1.73), body mass index (eCrClCGBMI), both body surface area and body mass index (eCrClCGBMI1.73), and estimated GFR using the Cockcroft-Gault method (eGFRCGBMI1.73).

Results

There was a significant difference in values in MDRD equation estimated GFR, eCrClCGBMI, eCrClCGBMI1.73, and eGFRCGBMI1.73in patients with different stages and durations of hypertension, which was not found by analysis of serum creatinine values.

Conclusion

Estimated GFR and eCrCl are more sensitive markers of kidney impairment than serum creatinine values, and their assessment should be introduced as a routine screening in the detection of early stages of chronic kidney disease in primary care settings, especially in patients with arterial hypertension.

Dual antiplatelet therapy (DAPT) forms the basis for the treatment of all patients undergoing percutaneous coronary intervention (PCI) and patients who suffered acute coronary syndrome (ACS). Prasugrel and ticagrelor are potent P2Y receptor inhibitors that have demonstrated their superiority in patients with ACS in comparison with clopidogrel in multiple clinical trials. In a recent randomized clinical trial called ISAR REACT 5, prasugrel provided a statistically significant reduction in the rate of ischemic outcomes without an increase in bleeding complications, in comparison with ticagrelor. Similar results were also presented in a subsequent meta-analysis. Considering the above and according to current guidelines for non-ST elevation ACS, prasugrel is the P2Y inhibitor of choice in the treatment of patients undergoing PCI. On the other hand, ticagrelor is the treatment of choice in cases when prasugrel is contraindicated. However, in some patient populations (patients older than 75 and weighing less than 60 kg) and clinical scenarios (delayed invasive treatment), no clear recommendations can be made regarding therapy or treatment of choice due to inadequate evidence. Both agents are also indicated in situations when prolonged DAPT is required, although ticagrelor is the preferred choice. Finally, randomized studies on P2Y inhibitor monotherapy after 1 to 3 months of DAPT following PCI indicate a reduction in bleeding complications, but without any significant increase in ischemic complications, compared with classic DAPT. However, additional research is required in this area before introducing any changes to everyday clinical practice.