The monocyte/high-density lipoprotein ratio predicts coronary artery disease in heart failure

Background

The monocyte/high density lipoprotein ratio (MHR) is a combined inflammatory marker implicated in atherosclerosis. MHR predicts cerebrovascular disease (CVD) and chronic kidney disease (CKD); it correlates with coronary artery disease (CAD) severity and has been shown to be a prognostic predictor in patients with myocardial infarction. The role of MHR in chronic heart failure (HF) is largely unknown.

Purpose

Assess the ability of MHR to predict CAD in patients with HF

Methods

We conducted a retrospective cohort study in ambulatory patients with HF with left ventricular systolic dysfunction (LVSD) that were followed in our HF clinic from January/2012 to May/2018. We selected all the patients that had performed a diagnostic/therapeutic coronary angiography. Patients with missing data concerning monocyte counts or high-density lipoprotein levels were excluded. The endpoint under analysis was the presence of CAD on coronary angiography. A ROC curve was used to study the ability of MHR to predict CAD. The association of MHR with CAD was assessed by a logistic-regression analysis. A multivariate model was built accounting for age, sex, comorbidities [hypertension, diabetes, peripheral artery disease (PAD), CVD, CKD and inflammatory/auto-immune disease], low-density lipoprotein value, haemoglobin, brain-type natriuretic peptide (BNP), severe LVSD and segmental contractility defects in the echocardiogram. MHR was analysed both as continuous and categorical variable; the cut-off of 16 was chosen based on the ROC curve.

Results

We studied 295 chronic HF patients with LSVD who underwent coronary angiography. Mean age was 67±12 years, 70.8% men and 55.9% with CAD. Patients with CAD were older (69 against 64 years), had significantly higher MHR (19±9 vs. 16±7), higher prevalence of hypertension, diabetes, PAD and CVD, and worse renal function. The area under the curve for the association between MHR and CAD was 0.68 (0.62–0.74), p<0.001. The best MHR cut-off for CAD prediction was 16 - sensitivity: 66.7%, specificity: 65.4%, positive predictive value: 71.0% and negative predictive value: 60.8%. This association was independent of potential confounders. Patients with MHR≥16 had a multivariate-adjusted OR of having CAD of 5.41 (95% CI: 2.40–12.20), p<0.001 when compared to those with lower MHR. When MHR was analysed as a continuous variable the association remained significant.

Conclusions

The MHR is an independent predictor of CAD in chronic HF. Patients with MHR ≥16 have a 71% probability of presenting CAD and a more than 5-fold higher risk compared with those with lower MHR. It is sometimes difficult to ascertain ischemic disease/aetiology in HF patients, particularly in the elderly, frail and/or with advanced CKD. This simple, inexpensive and harmless marker can help clinicians identify patients most likely to have CAD and decide treatment in accordance.

Funding Acknowledgement

Type of funding sources: None.

The prognostic value of monocyte/ high-density lipoprotein ratio in chronic heart failure

Background

The monocyte-high density lipoprotein ratio (MHR) is an inflammation marker that combines monocyte counts, increased in inflammatory states, and high-density lipoprotein (HDL) levels, that appear to have protective and anti-inflammatory properties. It has been studied in chronic kidney disease, primary hypertension, cerebrovascular disease and coronary artery disease (CAD), and has been shown to be positively correlated with disease severity and worse prognosis. Although inflammation is thought to be implicated in heart failure's (HF) pathophysiology, little is known about the role of MHR in the HF setting.

Purpose

To study the prognostic impact of MHR in chronic HF.

Methods

We conducted a retrospective cohort study in ambulatory patients with HF with left ventricular systolic dysfunction (LVSD) that were followed in our HF clinic from January/2012 to May/2018. Patients with no data on monocyte counts or HDL levels in the first appointment were excluded. Endpoint under analysis: all-cause mortality. Patients were categorized according to MHR quartiles: 1st quartile <11, 2nd quartile ≥11 to <15, 3rd quartile ≥15 to <20 and 4th quartile ≥20. A Cox-regression analysis was used to assess association between MHR and all-cause mortality. A multivariate model was built adjusting for age, sex, hypertension, diabetes mellitus (DM), CAD, obstructive sleep apnea, inflammatory/autoimmune disease, atrial fibrillation, anaemia, renal dysfunction, brain-type-natriuretic peptide (BNP), New York Heart Association (NYHA) class, low-density lipoprotein value, prognostic modifying therapy and severe LVSD.

Results

We studied 560 chronic HF patients with LVSD, mean age 70±12 years, 67.5% men, 37.1% in NYHA class I, 44.8% in NYHA class II and the remaining in higher classes. Patients with MHR≥20 (last quartile) were mostly men with higher prevalence of DM and CAD, they more often presented in higher NYHA classes and with worse renal function and higher BNP. No difference existed concerning doses of evidence based-drugs. During a median follow-up of 53 (32–88) months from the index medical appointment 256 patients (45.7%) died. Mortality was similar in the lower three MHR quartiles, being statistically higher in the last quartile. Considering only two groups - MHR <20 and MHR ≥20 - the all-cause mortality rate was of 41.6 vs. 57.6%, respectively, p=0,001. MHR was independently associated with poor survival. In patients presenting with MHR ≥20, the HR of long-term all-cause mortality was 1.42 (95% CI: 1.04–1.93), p=0.03 when compared with those with lower MHR.

Conclusions

Chronic HF patients with MHR ≥20 have a significant 42% increased risk of long-term all-cause death. We reinforce the role of inflammation in chronic HF. The MHR is a practical, inexpensive and widely available parameter that can help clinicians in the identification of chronic HF patients at higher risk of death.

Funding Acknowledgement

Type of funding sources: None.

Assessment of the uterine dose in digital mammography and digital breast tomosynthesis

INTRODUCTION

Digital Mammography (DM-2D) and more recently Digital Breast Tomosynthesis (DBT), are two of the most effective imaging modalities for breast cancer detection, often used in screening programmes. It may happen that exams using these two imaging modalities are inadvertently performed to pregnant women. The objective of this study is to assess the dose in the uterus due to DM-2D and DBT exams, according to two main irradiation scenarios: in the 1st scenario the exposure parameters were pre-selected directly by the imaging system, while in the 2nd scenario, the maximum exposure parameters were chosen.

METHODS

The mammography equipment used was a Siemens Mammomat Inspiration. A physical anthropomorphic phantom, PMMA plates (simulating a breast thickness of 6 cm) and thermoluminescent dosimeters (TLDs) were used to measure entrance air kerma values on the phantom's breast and abdomen in order to successively estimate the mean glandular dose (MGD) and the dose in the uterus. For the two irradiation scenarios chosen, two-breast imaging modalities were selected: 1) DBT in Cranio-Caudal (CC) view (with 28 kV and 160 mAs as exposure parameters), 2) DBT and DM in Medio Lateral-Oblique (MLO) and CC views (with 34 kV and 250 mAs as exposure parameters).

RESULTS

In the 1st scenario, the TLD measurements did not detect significant dose values in the abdomen whereas the MGD estimated using the D.R. Dance model was in close agreement with data available in the literature. In the 2nd scenario, there was no significant difference in MGD estimation between the different views, whereas the air kerma values in the abdomen (in DBT mode, CC and MLO) were 0.049 mGy and 0.004 mGy respectively. In CC DM-2D mode the abdomen air kerma value was 0.026 mGy, with no significant detected value in MLO view.

CONCLUSIONS

For the dose in the uterus, the obtained values seem to indicate that DM-2D and DBT examinations inadvertently performed during pregnancy do not pose a significant radiological risk, even considering the case of overexposure in both breasts.

IMPLICATIONS FOR PRACTICE

The accurate knowledge of the doses in DM-2D and DBT will contribute to raise the awareness among medical practitioners involved in breast imaging empowering them to provide accurate information about dose levels in the uterus, improving their radiation risk communication skills and consequently helping to reduce the anxiety of pregnant women undergoing this type of examinations.

Patient experiences with hidradenitis suppurativa: the Hidradenitis Patient Experience survey

BACKGROUND

Better understanding of the experience of people living with hidradenitis suppurativa (HS) is essential to identify gaps in current patient care and inform healthcare decision-making.

AIM

To describe the patient experience of individuals with HS, including their path to diagnosis, symptom control, treatments, healthcare utilization, patient needs and impact on quality of life.

METHODS

The Hidradenitis Suppurativa Patient Experience survey was created, extensively reviewed and disseminated through engaging HS-related patient organizations, physician groups and social media groups.

RESULTS

In total, 537 respondents completed the survey; the mean age was 38 years (range 14-73 years) and 95% (510 of 537) were female. The mean number of treatment types per respondent was 15, and included antibacterial soaps (93.3%; 431 of 462), avoidance of tight clothing (90.9%; 419 of 462), use of oral antibiotics (79.7%; 368 of 462), nonprescription drugs (79.7%; 368 of 462) and topical antibiotics (77.1%; 356 of 262). Pain was poorly controlled in 46% of respondents (184 of 401). HS had a negative impact on the ability to work and attend school for 81% of respondents (337 of 415), with 59% (245 of 415) missing at least 2 days of work a month and 16% (66 of 415) missing > 11 days of work. The mean number of misdiagnoses per respondent was three and the median time to diagnosis was 10 years.

CONCLUSION

Individuals with HS experience a delay in diagnosis and have suboptimal control of the disease. We propose 11 recommendations to improve diagnosis, treatment and quality of life for individuals living with HS.

Removal of Imidacloprid from Water by Microalgae Nannochloropsis sp. and Its Determination by a Validated RP-HPLC Method

The large-scale use of pesticides is one of the main causes of the dramatic degradation of our environment. Pesticides such as imidacloprid (IMID) have been linked to declines in bee health and toxicity to other beneficial insects. They pose a threat to human health due to their persistence in the environment and accumulation in the food chain. Therefore, it is essential to test possible environmentally-friendly solutions for their elimination. The present study evaluates the efficiency of microalgae Nannochloropsis sp. for the removal of IMID from synthetic wastewater. The influence of aeration, light, and the presence of UV radiation on the degradation of IMID were factors considered in the study. A rapid RP-HPLC method was developed and validated for the analysis and quantification of IMID in the context of bioremediation with microalgae. Nannochloropsis sp. removed 4.39 µg mL^-1 from an initial content of 9.59 µg mL^-1 (reaching approximately 50%) of IMID in the first 20 h. This study demonstrated that the removal of IMID by the marine microalgae Nannochloropsis sp. is both effective and light-dependent.

New ^{59}Fe Stellar Decay Rate with Implications for the ^{60}Fe Radioactivity in Massive Stars

The discrepancy between observations from γ-ray astronomy of the ^{60}Fe/^{26}Al γ-ray flux ratio and recent calculations is an unresolved puzzle in nuclear astrophysics. The stellar β-decay rate of ^{59}Fe is one of the major nuclear uncertainties impeding us from a precise prediction. The important Gamow-Teller strengths from the low-lying states in ^{59}Fe to the ^{59}Co ground state are measured for the first time using the exclusive measurement of the ^{59}Co(t,^{3}He+γ)^{59}Fe charge-exchange reaction. The new stellar decay rate of ^{59}Fe is a factor of 3.5±1.1 larger than the currently adopted rate at T=1.2  GK. Stellar evolution calculations show that the ^{60}Fe production yield of an 18 solar mass star is decreased significantly by 40% when using the new rate. Our result eliminates one of the major nuclear uncertainties in the predicted yield of ^{60}Fe and alleviates the existing discrepancy of the ^{60}Fe/^{26}Al ratio.