BackgroundAtrial fibrillation is associated with higher mortality. Identification of causes of death and contemporary risk factors for all‐cause mortality may guide interventions.Methods and ResultsIn the Rivaroxaban Once Daily Oral Direct Factor Xa Inhibition Compared with Vitamin K Antagonism for Prevention of Stroke and Embolism Trial in Atrial Fibrillation (ROCKET AF) study, patients with nonvalvular atrial fibrillation were randomized to rivaroxaban or dose‐adjusted warfarin. Cox proportional hazards regression with backward elimination identified factors at randomization that were independently associated with all‐cause mortality in the 14 171 participants in the intention‐to‐treat population. The median age was 73 years, and the mean CHADS 2 score was 3.5. Over 1.9 years of median follow‐up, 1214 (8.6%) patients died. Kaplan–Meier mortality rates were 4.2% at 1 year and 8.9% at 2 years. The majority of classified deaths (1081) were cardiovascular (72%), whereas only 6% were nonhemorrhagic stroke or systemic embolism. No significant difference in all‐cause mortality was observed between the rivaroxaban and warfarin arms (P=0.15). Heart failure (hazard ratio 1.51, 95% CI 1.33–1.70, P<0.0001) and age ≥75 years (hazard ratio 1.69, 95% CI 1.51–1.90, P<0.0001) were associated with higher all‐cause mortality. Multiple additional characteristics were independently associated with higher mortality, with decreasing creatinine clearance, chronic obstructive pulmonary disease, male sex, peripheral vascular disease, and diabetes being among the most strongly associated (model C‐index 0.677).ConclusionsIn a large population of patients anticoagulated for nonvalvular atrial fibrillation, ≈7 in 10 deaths were cardiovascular, whereas <1 in 10 deaths were caused by nonhemorrhagic stroke or systemic embolism. Optimal prevention and treatment of heart failure, renal impairment, chronic obstructive pulmonary disease, and diabetes may improve survival.Clinical Trial Registration URL: https://www.clinicaltrials.gov/. Unique identifier: NCT00403767.

This study was carried out to compare cardiac structure and function and blood lipids among Strongmen, sedentary controls, and marathoners. Echocardiography was performed, and endothelial function, blood lipids and maximal oxygen uptake were measured in 27 Caucasian adult men (8 Strongmen, 10 marathoners, 9 controls). Absolute cardiac size parameters such as left ventricular (LV) diameter and wall thickness of Strongmen were higher (p < 0.05), but relative (body surface area indexed) parameters were not different between controls and Strongmen. In Strongmen, the relative LV diameter (p < 0.05), wall thickness (p < 0.001), and LV mass index (p < 0.01) were lower than in marathoners. The absolute but not relative right ventricular diameter was larger in Strongmen as compared with controls, whereas all of the measured relative cardiac size parameters were higher in marathoners as opposed to in controls. The endothelial function and the ratio of wall thickness to chamber diameter were similar among the groups (p > 0.05). Maximal oxygen uptake of Strongmen was lower than in controls (p < 0.05) and marathoners (p < 0.001). Global diastolic LV function of Strongmen was impaired in comparison to controls (p < 0.05) and marathoners (p < 0.05). Plasma lipids were not different between Strongmen and sedentary controls, but in comparison to runners, Strongmen had higher low-density lipoprotein-cholesterol (p < 0.05) and lower high-density lipoprotein cholesterol (p < 0.01). Participation in Strongmen sport is associated with higher absolute but not relative cardiac size parameters, impaired myocardial relaxation, and low cardiorespiratory fitness. Therefore, Strongmen may demand greater attention as an extreme group of athletes with regard to cardiovascular risk.

Regular basketball training results in moderate cardiac hypertrophy in adolescents and adult athletes due to thickening of myocardial walls.

Raktažodžiai: lėtinis širdies nepakankamumas, lėtinis nuovargis, kairiojo skilvelio išstūmimo frakcija, deguonies sunaudojimas. Santrauka. Tyrimo tikslas. Ištirti sergančiųjų lėtiniu III-IV Niujorko ĮvadasSergančiųjų lėtiniu širdies nepakankamumu (ŠN) simptomai ir funkcinis pajėgumas yra glaudžiai susiję su hemodinamikos rodikliais. Kai nuolatos yra sutrikusi širdies funkcija, aktyvuojasi renino-angiotenzinoaldosterono ir simpatinė nervų sistema. Tai sąlygoja širdies išstumiamo kraujo tūrio mažėjimą ir tolesnį širdies nepakankamumo simptomų: nuovargio ir dusulio progresavimą. Lėtinis nuovargis blogina tokių ligonių gyvenimo kokybę ir gali būti invalidumo priežastimi (1). Svarbūs simpatinio aktyvumo hormonaikatecholaminai išskiriami šerdinėje antinksčių dalyje. Kortikosteroidai yra išskiriami žievinėje antinksčių dalyje. Ten pat išskiriamas ir aldosteronas, kuris svarbus renino-angiotenzino-aldosterono grandinėje ir są-lygoja hemodinamikos rodiklius. Tyrimai rodo, kad ŠN simptomų ir prognozės pagerėjimas ypač gerai koreliuoja su neurohormoniniu gydymu beta adrenoblokatoriais, AKF inhibitoriais, angiotenzino 1 receptorių I blokatoriais, aldosterono antagonistais (2-4). Manoma, kad medikamentai negali užblokuoti visų simpatinio aktyvumo padidėjimą lemiančių grandžių ir dėl to, kad biologiškai aktyvių medžiagų yra daugiau nei veikia vaistai, ir dėl to, kad negalima skirti didesnių vaistų dozių dėl jų šalutinio veikimo.Sergančiųjų lėtiniu nuovargiu (LN) ir lėtiniu nuovargio sindromu (LNS) etiologijos veiksniai yra polimorfiniai. Galima teigti, kad LN ir sunkesnę ligos

The aim of this study was to assess the possible reasons for not returning to work after coronary artery bypass surgery. A total of 134 patients (aged 65 years and younger) who underwent coronary bypass surgery in 2003 were examined. The analysis was performed in three groups of the patients: Group I, patients who were employed before surgery and returned to work after it (n=51); Group II, patients who were employed before surgery but did not return to work after surgery (n=55); and Group III, patients who were unemployed before and remained unemployed after surgery due to health problems (n=28). Number of injured coronary arteries, the extent of operation, postoperative complications, risk factors for ischemic heart disease, clinical status of patients (angina pain and heart failure), physical tolerance, and return to work within one year after coronary bypass surgery were analyzed. It was found that 48.1% of patients who were employed before surgery returned to work after myocardial revascularization. About 30% of patients experienced recurrent symptoms of angina after 12 months. Logistic regression analysis revealed that return to work was significantly influenced by female gender, physical pattern of work, age, and severity of heart failure.