Nicolás Francisco Narvaez Linares’s research while affiliated with University of Ottawa and other places

Aim This study intended to explore associations of reverse triiodothyronine (rT3) with emotional disturbances and health-related quality of life (HRQoL) after experiencing acute ischemic stroke (AIS). Materials and methods Serum samples from individuals with AIS were collected on admission to three Lithuania stroke centers and investigated for free tetraiodothyronine, free triiodothyronine (fT3), rT3, and thyroid stimulating hormone levels. At discharge, emotional disturbance was evaluated using the Hospital Depression and Anxiety Scale (HADS), and HRQoL using the EQ-5D-5L scale. Results Analyses included 159 individuals (59.7% male and 40.3% female; mean (SD) aged 66.4 [10.3] years), 52.83% of which showed increased rT3 levels upon admission. After adjustment for age, sex, National Institutes of Health Stroke Scale scores, previous stroke, modified Rankin Scale before AIS ≤ 2, and diabetes mellitus, multivariable linear regression revealed negative associations of rT3 with HADS total score (β = −0.163; p = 0.046) and HADS-D subscale score (β = −0.187; p = 0.019). Analyses supported a positive relationship between the fT3 ratio to rT3 with HADS-D score (β = 0.157; p = 0.046) and rT3, rT3 × fT3 product with EQ-5D index score (β = 0.157; p = 0.044 and β = 0.179; p = 0.023, respectively). Conclusion We found that individuals who experienced AIS and had higher levels of rT3 at hospital admission had less emotional disturbance and better HRQoL when discharged.

Objective Myocardial infarction (MI) is the primary cause of mortality and morbidity in women, but its sequelae remain largely understudied. Given the heart–brain relationship, our study aimed to further understand stress’s impact on regulating cognitive function post-MI. Specifically, our study evaluated the effect of stress induced using the Trier Social Stress Test (TSST), on neuropsychological function in women who have or have not experienced MI. Methodology To do so, women (mean age = 59.41 yrs) with (WHxMI = 13) or without (${\rm{WH}}{{\rm{x}}_{\overline {\rm{s}} {\rm{MI}}}}\, = \,16$) a history of MI were exposed to the TSST prior to completion of a series of standardized neuropsychological tests: the Montreal Cognitive Assessment (MoCA), Control Oral Word Association (COWA), Rey Complex Figure and Recognition (RCFT), Trail Making Test (TMT), and Auditory Consonant Triagrams (ACT). Results Our findings support MI to be associated with impairments in working memory affecting immediate recall of ACT, as well as visuospatial impairments in the RCFT copy trial, marked by poorer drawing accuracy and incorrect placement of figure elements. Overall, WHxMI required more time to complete the neuropsychological assessment (WHxMI 166.57 ± 12, ${\rm{WH}}{{\rm{x}}_{\overline {\rm{s}} {\rm{MI}}}}$ 155.00 ± 6.57; p < 0.01). Conclusion Together, these findings support cognitive impairments noted following a social stressor to remain subtle in WHxMI. Our study highlights the need for the development of more sensitive tools to screen for neuropsychological impairments in women with MI and the importance of assessing performance in a variety of testing conditions.

Introduction Our exploratory study aimed to determine whether obstructive sleep apnoea (OSA) could affect cognitive functioning in males with coronary artery disease (CAD), and whether such impact could be associated with changes in thyroid hormones and inflammatory marker regulation on cognitive functioning. Method We evaluated different endocrine and inflammatory biomarkers, including free triiodothyronine [fT3], free tetraiodothyronine [fT4], N-terminal pro-B-type natriuretic peptide [NT-pro-BNP], and high-sensitivity C-reactive protein [hs-CRP] serum levels in 328 males (x¯ = 57 ± 10 years), undergoing cardiac rehabilitation after an acute coronary event. Participants underwent full-night polysomnography and were classified in mild/non-OSA (n = 253) and OSA (n = 75) according to an apnoea-hypopnoea index ≥ 15 event/h. Cognitive functioning testing included the Digit Span Test, Digit Symbol Test (DSST), and Trail Making Test. Analyses of variance assessed the impact of OSA on cognitive functioning and possible relationships of fT3/fT4, NT-pro-BNP and with hs-CRP on cognitive measures. Results Significant group (OSA, mild/non-OSA) × NT-pro-BNP (<157.0 vs. ≥157.0, ng/L) interactions were found for the DSST raw score (F(2,324) = 3.58, p = 0.014). Decomposition of interactions showed that the DSST scores of the OSA group with NT-pro-BNP ≥ 157.0 ng/L (M = 33.2; SD = 8.1) were significantly lower, p = 0.031, than those of the mild/non-OSA with NT-pro-BNP < 157.0 ng/L (M = 37.7; SD = 8.9). Conclusion These findings indicate that males with OSA and clinically elevated NT-pro-BNP levels experienced inferior psychomotor performance compared to those without OSA and reduced NT-pro-BNP levels.

Coronary heart disease (CHD), of which myocardial infarction (MI) is a subtype, is the leading cause of death for women. Nonetheless, women remain neglected in CHD research, resulting in treatments and recommendations being primarily based on data collected in men. Pre-clinical and clinical studies have supported dysregulation of the hypothalamic-pituitary-adrenal axis (HPAA) following cardiac arrest and MI to promote the development of mental health disorders (e.g., major depressive disorder, post-traumatic stress disorder). However, studies addressing changes in HPAA activation under basal and stress-induced conditions in women samples have been lacking. Thus, we conducted this study to determine basal and stress-induced changes in heart rate, respiration and cortisol secretion (via 8 saliva samples) in a sample of women with a history of MI (n = 13) and a control group (n = 16). We measured altered stress reactivity through exposure to the Trier Social Stress Test. In addition, participants completed questionnaires assessing perceived stress and mental health status (i.e., anxiety and mood). Overall, our findings indicated comparable assessments of perceived situational stress in both groups. Interestingly, salivary cortisol secretion support reduced stress-induced HPAA activation related to TSST exposure in MI women compared to control counterparts. Our observations are consistent with findings supporting glucocorticoid resistance noted following MI and cardiac arrest. Akin to cardiac arrest survivors, HPAA dysregulation in MI survivors could have an impact on the development of mental health disorders. More studies are needed to address this critical question.

Background: Emerging studies suggest an association exists between coronary artery disease (CAD) and the development of neurodegenerative diseases, with CAD acting as a precursor. Nevertheless, no research was found that address the relationship between baseline measures of cognitive functioning and long-term health-related quality of life (HRQoL) with individuals with CAD with specification to Type D personality traits and sex. Methods: This prospective observational cohort study consisted of 864 participants (mean age 58 SD = 9 years, 74.0 % men) with CAD after acute coronary syndrome. Baseline characteristics included comprehensive cognitive testing, measures of sociodemographic and clinical factors, and psychological assessment scales, such as Type D personality scale and the Hospital Anxiety and Depression scale. The Minnesota Living with Heart Failure Questionnaire assessed participants' HRQoL, conducted through phone interviews at baseline, every six months for up to two years, and after five years. Results: Cognitive functioning correlated with HRQoL at all time intervals over the five-year follow-up. Regarding sex and Type D personality, significant differences emerged in associations between impaired cognitive functioning at baseline and HRQoL measured over the period of five years. Men participants with characteristics of Type D personality were especially vulnerable for impaired cognitive functioning to affect the five-year quality of life. Conclusions: Men with CAD who obtained scores indicating characteristics of Type D personality were significantly more likely to have lower baseline cognitive functions and long-term HRQoL outcomes. This information could inform healthcare practitioners to screen for personality characteristics and closely follow-up those at a greater risk.

BACKGROUND For decades, women have been neglected in cardiovascular research. With growing evidence to support a connection between the heart and the brain, we systematically reviewed the status of women included in experimental research assessing the impact of coronary heart disease (CHD) on neuropsychological functions. METHODS AND RESULTS We conducted a systematic review and used the PRISMA guidelines to report our findings. We screened a total of 26,843 references, of which 418 remained for full-text screening and only 13 were included in the final analysis. Throughout the screening process, we excluded studies which did not include women or participants with CHD or its subtypes (e.g., myocardial infarction, angina pectoris), or did not perform a neuropsychological – or variant - assessment. During the full-text screening, we excluded studies that did not perform separate statistical analyses for sexes or for conditions (e.g., combining CHD and heart failure participants). Close to half of the studies (161 studies; 46.60%) were excluded during the full-text screening phase because there was no separate analysis for women, exhibiting the underwhelming attention given to sex differences in CHD research. Of the 13 studies kept, 11 had samples composed of 36% or fewer women, and all studies, except one, failed to report the power and effect size of their sample. Furthermore, only one study considered menstrual cycle/menopause status, although it is known to influence performance on cognitive testing and CHD progression. Demographic variables that are commonly acknowledged to be cardiovascular risk factors (e.g. cholesterol, hypertension, smoking, etc.) were often measured but rarely compared between sexes, providing an incomplete picture of the underlying factors which affect the women included in these studies. CONCLUSION Our systematic review shows that women are still strikingly underrepresented in CHD research. Based on our findings, we propose the following guidelines: 1) the number of women included in CHD research should be similar to the CHD prevalence in the general population; 2) researchers should calculate the power and effect size of their samples; 3) menstrual cycle or menopausal status should be taken into account; and 4) all demographic variables should be reported separately for men and women. These guidelines aim to improve cardiovascular research in women, so that future research trials can better represent them. Natural Sciences and Engineering Research Council (NSERC)

Studies are lacking assessments of impairments in women having experienced Myocardial infarction (MI). This study focuses on the physiological response in MI-women versus non-MI women exposed to a social stressor. The study included women ages 45-74 years old (N=29) which composed an MI (n=13) and a non-MI (n=16) group. Participants were stressed using the Trier Social Stress Test (TSST). Saliva samples were collected at eight time intervals, enabling to measure changes in basal and stress-induced cortisol secretion. An ELISA assay determined unbound cortisol concentration in the saliva samples. Analyses revealed statistically significant group difference was found, F(3, 88) =3.190, p =0.023, partial η2 = 0.109, mainly attributable to reduced cortisol concentration in the MI compared to non-MI group at the fourth and seventh collection intervals (1.40%; SE = 12.43 and 35.71%; SE = 7.53; respectively). Reduced unbound cortisol concentrations could be attributable to dysregulation of the hypothalamic-pituitary adrenal axis (HPAA) related to MI.

Heart disease, such as coronary heart disease (CHD), is the leading cause of death among aging women. However, over the past years, the mortality rate has declined, resulting in an increased number of CHD survivors. In this context, research has uncovered relationships between cardiovascular disease (CVD) and the development of neurodegenerative diseases, suggesting that CHD can act as a precursor. Despite heart disease affecting both sexes, CVD research has significantly neglected women. Therefore, we conducted the first systematic review of neuropsychological sequelae of CHD in women to gain a clear portrait of the current knowledge of the association of CHD on women’s neuropsychological status. We found that studies continue to include an insufficient number of women in their research. Our work also uncovered that there is variability in the definition of CHD by researchers (i.e., operationalization of the variable), which could explain inconsistencies across studies. Overall, we found evidence that supports the heart-brain disease hypothesis. To conclude, we provide several guidelines for future research involving the impact of CHD in women.

Complete search strategy (Initial search on August 15, 2018 (T1) and second search on July 23, 2020 [T2])

Abstract Up to 15% of mothers experience postpartum depression (PPD) symptoms. Using a pre—post design, results from two 8-week psychoeducational group programs for mothers with moderate levels of PPD symptoms are presented. Findings show the low-cost program to be a promising secondary preventative intervention for an undertreated population. Résumé Jusqu’à 15 % des mères éprouvent des symptômes de dépression postpartum (DPP). En utilisant un modèle pré-post, les résultats de deux groupes psychoéducatifs observés sur une période de 8 semaines pour les mères ayant des symptômes modérés de DPP sont présentés. Les résultats montrent que le programme à faible coût est une intervention secondaire préventive prometteuse pour une population recevant peu de traitements.