Cardiovascular psychiatry and neurology最新文献

Objective: This study investigated whether pretreatment oxidative stress, measured by lipid hydroperoxides (LPH), 4-hydroxy-2-nonenal (4-HNE), 8-isoprostane (8-ISO), and malondialdehyde (MDA), was associated with improvement in immediate recall among n-3 PUFA-treated coronary artery disease patients.

Methods: This was a secondary analysis of the CAROTID trial (NCT00981383). Composite immediate recall, measured using the California Verbal Learning Test, Second Edition, and the Brief Visuospatial Memory Test-Revised, was assessed. LPH, 4-HNE, 8-ISO, MDA, and n-3 PUFA concentrations were analysed from fasting blood. Patients then received either n-3 PUFA treatment or placebo for 12 weeks, after which composite immediate recall was reassessed. Linear regression was used to investigate relationships between lipid peroxidation markers and changes in composite immediate recall in each treatment group.

Results: Eighty-five patients (age = 61.1 ± 8.5, 77% male, mean years of education = 15.3 ± 3.4) were included (n = 46 placebo, n = 39 n-3 PUFA). After adjusting for multiple comparisons and potential confounders, greater baseline concentrations of LPH (β = 0.45, p = .002) and 4-HNE (β = 0.38, p = .005) were associated with greater improvement in composite immediate recall among n-3 PUFA-treated patients. No other associations were observed.

Conclusions: N-3 PUFA treatment may be more likely to improve immediate recall in patients with greater oxidative stress.

Neurologic stunned myocardium (NSM) is a phenomenon where neurologic events give rise to cardiac abnormalities. Neurologic events like stroke and seizures cause sympathetic storm and autonomic dysregulation that result in myocardial injury. The clinical presentation can involve troponin elevation, left ventricular dysfunction, and ECG changes. These findings are similar to Takotsubo cardiomyopathy and acute coronary syndrome. It is difficult to distinguish NSM from acute coronary syndrome based on clinical presentation alone. Because of this difficulty, a patient with NSM who is at high risk for coronary heart disease may undergo cardiac catheterization to rule out coronary artery disease. The objective of this review of literature is to enhance physician's awareness of NSM and its features to help tailor management according to the patient's clinical profile.

The purpose of this study was to examine the relationships among subclinical PTSD symptoms, blood pressure, and several variables linked to both frank PTSD and the basic psychobiological adaptation to stress. The authors recruited a sample of 91 healthy, young men and women between 18 and 35 years. We examined links among subclinical posttraumatic stress disorder symptoms, blood pressure, sleep quality, and hostility. Posttraumatic stress disorder symptoms were associated with poorer sleep quality and higher hostility scores in both women and men. In men, PTSD symptoms were also associated with elevated resting diastolic blood pressure, and sex was an important moderator of that relationship. Moreover, sleep quality and hostility are substantive mediators of the relationship between diastolic blood pressure and PTSD. Behavioral interventions designed to increase sleep quality and restructure hostile attitudes could potentially serve as preventive interventions for PTSD and the underlying cardiovascular comorbidities in young adults.

Severe aortic stenosis is the most common valvular heart disease in the elderly in the Western world and contributes to a large proportion of all deaths over the age of 70. Severe aortic stenosis is conventionally treated with surgical aortic valve replacement; however, the less invasive transcatheter aortic valve implantation (TAVI) is suggested for those at high surgical risk. While TAVI has been associated with improved survival and favourable outcomes, there is a higher incidence of cerebral microembolisms in TAVI patients. This finding is of concern given mechanistic links with cognitive decline, a symptom highly prevalent in those with cardiovascular disease. This paper reviews the literature assessing the possible link between TAVI and cognitive changes. Studies to date have shown that global cognition improves or remains unchanged over 3 months following TAVI while individual cognitive domains remain preserved over time. However, the association between TAVI and cognition remains unclear due to methodological limitations. Furthermore, while these studies have largely focused on memory, cognitive impairment in this population may be predominantly of vascular origin. Therefore, cognitive assessment focusing on domains important in vascular cognitive impairment, such as executive dysfunction, may be more helpful in elucidating the association between TAVI and cognition in the long term.

Background. Obstructive sleep apnea (OSA) syndrome is one of the most common respiratory disorders in humans. There is emerging evidence linking OSA to vascular disease, particularly hypertension. The underlying pathophysiological mechanisms that link OSA to cardiovascular diseases such as hypertension, congestive heart failure, and atrial fibrillation are not entirely understood. The aim of this study was to investigate the association of obstructive sleep apnea hypopnea syndrome (OSAHS) with coronary atherosclerotic disease (CAD). Methods. A questionnaire survey based on Berlin questionnaire and Epworth Sleepiness Scale (ESS) was conducted among 406 patients to assess demographic data and the symptoms, such as excessive daytime sleepiness and snoring. Epworth Sleepiness Scale and Berlin questionnaire were completed by all of the patients. Venous blood samples were obtained for biochemical tests. Characteristics of coronary arteries were collected from angiographies' reports. All patients were divided into two groups based on results from Berlin questionnaire: low risk patients for OSA and high risk patients for OSA. Data were analyzed by SPSS software version 13. Results. Mean age of patients was 61.8 ± 10.5. 212 (52.2%) patients were categorized as high risk group for apnea. Also, excessive daytime sleepiness was reported in 186 patients (45.8%). The severity of coronary artery involvement, daytime sleepiness, and electrocardiogram abnormalities was significantly higher in high risk patients for OSA compared with low risk patients. High risk patients had higher level of FBS and LDL and lower level of HDL cholesterol (P < 0.05). Conclusion. Our study found a strong correlation between the number of stenotic vessels and OSA. Based on our findings, OSA can be a predisposing factor for cardiac diseases.

Objective. The aim of this study was to investigate the relationship between gamma-glutamyl transferase (GGT) levels, cerebrovascular risk factors, and distribution of cerebral infarct areas in patients with acute ischemic stroke (AIS). Patients and Methods. Sixty patients with AIS and 44 controls who had not cerebrovascular disease were included in the study. The patients were divided into four groups according to the location of the infarct area and evaluated as for GGT levels and the presence of diabetes mellitus (DM), hypertension (HT), and hyperlipidemia (HL). Results. The frequency of DM, HT, and HL and gender distributions were similar. The mean GGT levels were significantly higher in patients with AIS and those with relatively larger areas of infarction (P < 0.05). Increased mean GGT levels were found in the subgroup with hypertension, higher LDL-cholesterol, and triglyceride levels among cases with AIS (P < 0.05). Conclusion. Higher GGT levels in AIS patients reinforce the relationship of GGT with inflammation and oxidative stress. The observation of higher GGT levels in patients with relatively larger areas of infarction is indicative of a positive correlation between increases in infarct areas and elevated GGT levels.

Introduction. Psychiatric problems and stresses may deteriorate the prognosis of patients with IHD. So evaluating their frequency possibly will promote our perspective regarding their vital importance in the field of consultation-liaison psychiatry. Method and Materials. One hundred and one (101) patients with IHD were interviewed in CCU of a general hospital by a psychiatrist to find whether there was any relationship between cardiac events and psychiatric problems or stresses. Results. Cardiac events were significantly more prevalent among patients with both psychiatric problems and biological risk factors (P < 0.05). Also, the number of patients suffering from psychiatric problems was significantly more than cases without that (P < 0.05). There was a significant difference between male and female patients regarding the type of stress (P < 0.01). 79% of total stresses were experienced by patients who had as well psychiatric problems (P < 0.0001). In addition, there was significantly more dysthymic disorder in the acute group of patients in comparison with major or minor depressive disorder in the chronic group (P < 0.001). Conclusion. The high prevalence of psychiatric problems and psychosocial stresses among patients with IHD deserves sufficient attention by clinicians for detection, monitoring, and management of them.