1
|
JIN X, WU B, WU H, XU D. Effectiveness of Shenshu Guanxin recipe granules for improving exercise tolerance in patients with stable angina pectoris: a randomized, double-blind, placebo-controlled trial. J TRADIT CHIN MED 2023; 43:1227-1233. [PMID: 37946485 PMCID: PMC10623256 DOI: 10.19852/j.cnki.jtcm.20231008.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Accepted: 05/13/2022] [Indexed: 11/12/2023]
Abstract
OBJECTIVE To assess the effectivess of Shenshu Guanxin recipe granules (, SGR) in improving exercise tolerance and the quality of life in patients with Stable Angina Pectoris (SAP). METHODS A total of 189 patients were consecutively enrolled between December 2012 and December 2014. The included patients were randomly assigned to SGR and placebo groups. The primary endpoints included mainly the results of treadmill exercise test and Seattle Angina Questionnaire (SAQ) during 12 weeks of treatment. RESULTS After 12 weeks of treatment, SGR extended the time of exercise-induced ST-segment depression of 0.1 MV, lowered the maximum ST-segment depression, and shortened the duration of ST-segment depression in patients with SAP in southern China. Besides, the study also proved that SGR could improve the quality of life and functional status of patients with SAP. CONCLUSIONS SGR showed a positive effect on exercise tolerance compared with the placebo besides optimal medical therapy. Also, the study proved that SGR could improve the SAQ score of the patients.
Collapse
Affiliation(s)
- Xiao JIN
- 1 Department of Traditional Chinese Medicine, the First Affiliated Hospital of Jinan University, Guangzhou 510630, China
| | - Bingxin WU
- 2 Department of Cardiology, Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou 510000, China
| | - Huanlin WU
- 3 Department of Cardiology, Dongzhimen Hosipital, Beijing 100029, China
| | - Danping XU
- 4 Department of Traditional Chinese Medicine, the Eighth Affiliated Hospital, Sun Yat-sen University, Shenzhen 518033, China
| |
Collapse
|
2
|
Chung C, Kim AR, Jang IY, Jo MW, Lee S, Kim D, Kwon H, Kang DY, Lee SW. Smartphone application-based rehabilitation in patients with chronic respiratory and cardiovascular diseases: a randomised controlled trial study protocol. BMJ Open 2023; 13:e072698. [PMID: 37730392 PMCID: PMC10514628 DOI: 10.1136/bmjopen-2023-072698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Accepted: 07/27/2023] [Indexed: 09/22/2023] Open
Abstract
INTRODUCTION Rehabilitation is well known to improve clinical symptoms and decrease the risk of mortality in patients with chronic respiratory or cardiovascular diseases. We will evaluate the efficacy of smartphone application-based rehabilitation programmes in patients with chronic respiratory or cardiovascular diseases. METHODS AND ANALYSIS This single-centre single-blind randomised controlled trial will recruit a total of 162 participants from Asan Medical Center (81 patients each for pulmonary and cardiac rehabilitation, respectively). Participants will be assigned to the pulmonary or cardiac rehabilitation groups based on their underlying disease. Participants will be allocated randomly into the intervention or control groups at the ratio of 2:1 (54 and 27 patients). The intervention group will be provided with a smartphone application and undergo smartphone application-based rehabilitation for 12 weeks. The control group will receive the usual outpatient medical treatment without rehabilitation. Participants will be evaluated at baseline and at the end of the rehabilitation. The primary outcomes will be exercise capacity, such as maximal oxygen consumption on cardiopulmonary exercise test for both groups, chronic obstructive pulmonary disease assessment test for the pulmonary rehabilitation group, and Health-related Quality of Life Instrument with 8 Items questionnaires for the cardiac rehabilitation group. The secondary outcomes will include quality of life questionnaires, symptom scores, pulmonary function test and limb muscle test. ETHICS AND DISSEMINATION The study protocol was approved by the Institutional Review Board of Asan Medical Center. Written informed consent will be obtained from all participants prior to inclusion. The findings from this study will be disseminated through peer-reviewed scientific journals and conferences. TRIAL REGISTRATION NUMBER NCT05610358.
Collapse
Affiliation(s)
- Chiwook Chung
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea (the Republic of)
- Department of Pulmonary and Critical Care Medicine, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea (the Republic of)
| | - Ah-Ram Kim
- Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea (the Republic of)
| | - Il-Young Jang
- Division of Geriatrics, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea (the Republic of)
| | - Min-Woo Jo
- Department of Preventive Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea (the Republic of)
| | - Seongho Lee
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea (the Republic of)
| | - Dongbum Kim
- LifeSemantics Corp, Seoul, Korea (the Republic of)
| | - Hee Kwon
- LifeSemantics Corp, Seoul, Korea (the Republic of)
| | - Do-Yoon Kang
- Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea (the Republic of)
| | - Sei Won Lee
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea (the Republic of)
| |
Collapse
|
3
|
Liang Q, Zhang Y, Liang J. Elevated Serum Total Bilirubin Might Indicate Poor Coronary Conditions for Unstable Angina Pectoris Patients beyond as a Cardiovascular Protector. Cardiovasc Ther 2023; 2023:5532917. [PMID: 37705934 PMCID: PMC10497366 DOI: 10.1155/2023/5532917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 06/26/2023] [Accepted: 07/11/2023] [Indexed: 09/15/2023] Open
Abstract
Backgrounds Serum total bilirubin (STB) is recently more regarded as an antioxidant with vascular protective effects. However, we noticed that elevated STB appeared in unstable angina pectoris (UAP) patients with diffused coronary lesions. We aimed to explore STB's roles in UAP patients, which have not been reported by articles. Methods and Results 1120 UAP patients were retrospectively screened, and 296 patients were finally enrolled. They were grouped by Canadian Cardiovascular Society (CCS) angina grades. The synergy between PCI with TAXUS stent and cardiac surgery score (SYNTAX score) and corrected thrombolysis in myocardial infarction flow count (CTFC) were adopted to profile coronary features. The results showed that STB, mean platelet volume (MPV), hs-CRP, fasting blood glucose (FBG), red blood cell width (RDW), and CTFC elevated significantly in the CCS high-risk group. STB (B = 0.59, 95% CI: 0.39-0.74, P < 0.01) and MPV (B = 0.86, 95% CI: 0.42-1.31, P < 0.01) could indicate SYNTAX score changes for these patients. STB (≥21.7 μmol/L) could even indicate a coronary slow flow condition (AUC: 0.88, 95% CI: 0.84-0.93, P < 0.01). Moreover, UAP patients with elevated STB had a lower event-free survival rate by the Kaplan-Meier curve. STB ≥21.7 μmol/L could reflect a poor coronary flow status and indicate 1-year poor outcomes for these patients (HR: 2.01, 95% CI: 1.06-3.84, P < 0.01). Conclusion Elevated STB in UAP patients has a close relationship with changes in SYNTAX score. STB (over 21.7 μmol/L) could even indicate a coronary slow flow condition and poor outcomes for the UAP patients.
Collapse
Affiliation(s)
- Qi Liang
- Department of Cardiology, First Affiliated Hospital of Xi'an Jiaotong University, No. 277 Yanta Rd, Shaanxi, Xi'an 710061, China
| | - Yongjian Zhang
- Department of Cardiology, First Affiliated Hospital of Xi'an Jiaotong University, No. 277 Yanta Rd, Shaanxi, Xi'an 710061, China
| | - Jin Liang
- Department of Medical Insurance, Xi'an Affiliated Hospital of the Shaanxi University of Chinese Medicine, China
| |
Collapse
|
4
|
Akkus O, Huzmeli I, Seker T, Bekler O, Sen F, Kaypakli O, Yildiz Ozer A, Yalcin F. Effectiveness of Device-Guided Breathing in Chronic Coronary Syndrome: A Randomized Controlled Study. ACTA CARDIOLOGICA SINICA 2023; 39:720-732. [PMID: 37720408 PMCID: PMC10499964 DOI: 10.6515/acs.202309_39(5).20230306e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 03/06/2023] [Indexed: 09/19/2023]
Abstract
Background Chronic coronary syndrome (CCS) is one of the most life-restricting coronary artery diseases, and symptom relief is the main goal in CCS patients who suffer from angina. Objectives To assess the potential benefits of device-guided breathing in CCS patients with angina in this randomized, controlled, single-blinded study. Methods Fifty-one patients with CCS received device-guided breathing for 7 days/8 weeks. Exercise capacity [exercise stress test], cardiac function [transthoracic echocardiography], and angina severity [Canadian Cardiovascular Society Classification] were evaluated initially and after the training. Device-guided breathing was performed at the lowest resistance of the device (POWERbreathe® Classic LR) for the control group (n = 17). The low load training group (LLTG; n = 18) and high load training group (HLTG; n = 16) were trained at 30% and 50% of maximal inspiratory pressure. Baseline characteristics were compared using one-way ANOVA and Kruskal-Wallis test. Categorical data were compared using the chi-square test. ANCOVA was performed to compare changes between three groups. A p value < 0.05 was considered statistically significant. Results Metabolic equivalent values were significantly improved in both HLTG and LLTG groups (p < 0.001, p = 0.003). The Duke treadmill score significantly improved and shifted to low-risk both in the HLTG (p < 0.001) and LLTG (p < 0.001) groups. Angina severity significantly alleviated after the training in both HLTG and LLTG groups (p < 0.001, p = 0.002). Conclusions An 8-week long program of short-term respiratory muscle training provided positive gains in exercise capacity and angina severity in CCS patients with angina. The effects of long-term training programs on CCS patients should be investigated clinically because of the possibility of helping to decrease the need for invasive treatments.
Collapse
Affiliation(s)
- Oguz Akkus
- Department of Cardiology, Tayfur Ata Sokmen Faculty of Medicine
| | - Irem Huzmeli
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Hatay Mustafa Kemal University, Hatay
| | - Taner Seker
- Department of Cardiology, Adana Health Practice and Research Center, University of Health Sciences, Adana
| | - Ozkan Bekler
- Department of Cardiology, Tayfur Ata Sokmen Faculty of Medicine
| | - Fatih Sen
- Department of Cardiology, Tayfur Ata Sokmen Faculty of Medicine
| | - Onur Kaypakli
- Department of Cardiology, Tayfur Ata Sokmen Faculty of Medicine
| | - Aysel Yildiz Ozer
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Marmara University, Istanbul, Turkey
| | - Fatih Yalcin
- Department of Cardiology, Tayfur Ata Sokmen Faculty of Medicine
| |
Collapse
|
5
|
Kaur G, Chand S, Rai D, Baibhav B, Blankstein R, Mukherjee D, Levy P, Gulati M. Contemporary Risk Stratification of Acute Coronary Syndrome. US CARDIOLOGY REVIEW 2022. [DOI: 10.15420/usc.2022.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Chest pain is one of the most common presenting concerns of patients seeking care in the emergency department, and the underlying etiology can range from acute coronary syndrome to various other non-cardiac causes. Initial evaluation should focus on characterizing symptoms and identifying risk factors, but further risk stratification using clinical decision pathways and biomarkers (cardiac troponin) is essential. The 2021 American Heart Association/American College of Cardiology guidelines for the evaluation and diagnosis of chest pain represent the first ever guidelines for the evaluation of patients with acute chest pain. The contemporary risk stratification methods described in these guidelines allow for the identification of patient subgroups: patients who do not require further testing, patients who should proceed directly to the cath lab, and patients who will benefit from further anatomic or functional testing. In this review, we describe contemporary risk stratification methods for acute coronary syndrome and summarize the recommendations put forth by the guidelines.
Collapse
Affiliation(s)
- Gurleen Kaur
- Department of Internal Medicine, Brigham and Women’s Hospital, Boston, MA
| | - Swati Chand
- Department of Internal Medicine, Rochester General Hospital, Rochester, NY
| | - Devesh Rai
- Department of Cardiology, Sands-Constellation Heart Institute, Rochester Regional Health, Rochester, NY
| | - Bipul Baibhav
- Department of Cardiology, Sands-Constellation Heart Institute, Rochester Regional Health, Rochester, NY
| | - Ron Blankstein
- Cardiovascular Division, Brigham and Women’s Hospital, Boston, MA
| | - Debabrata Mukherjee
- Division of Cardiovascular Diseases, Texas Tech University Health Sciences Center at El Paso, El Paso, TX
| | - Phillip Levy
- Department of Emergency Medicine, Wayne State University, Detroit, MI
| | - Martha Gulati
- Department of Cardiology, Barbra Streisand Women’s Heart Center, Cedars-Sinai Smidt Heart Institute, Los Angeles, CA
| |
Collapse
|
6
|
Buckley AJ, McCormick JP, Carey J, Armstrong R, Maree A, Hensey M, O'Connor S, Murphy R, Daly C, Cosgrave J, Pearson I. Intravascular lithotripsy-assisted PCI for severely calcified coronary lesions: evaluating the impact on quality of life and outcomes. Ir J Med Sci 2022:10.1007/s11845-022-03077-9. [PMID: 35809156 PMCID: PMC10111299 DOI: 10.1007/s11845-022-03077-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Accepted: 06/15/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Despite the increased uptake of intravascular lithotripsy (IVL) for treating severely calcified coronary lesions, there is limited patient-level data examining the effect of IVL on quality of life, symptomatology, and outcomes beyond 30 days. We sought to assess demographics, procedural characteristics, outcomes, and impact of IVL on patient-reported angina after a minimum of 6 months follow-up. METHODS A retrospective single-center study was conducted of patients treated with coronary IVL between January and October 2020. Baseline demographics were obtained from electronic patient records and SYNTAX scores were calculated from index coronary angiograms. Technical success and complications were assessed along with clinical outcomes, which included all-cause mortality, myocardial infarction (MI), target lesion revascularization (TLR), and MACE (composite of death, stroke, MI, and TLR). Canadian Cardiovascular Society (CCS) angina classification was assessed at virtual clinical follow-up. RESULTS Forty-seven consecutive patients were included. At a mean follow-up of 306 ± 74 days, the mean CCS angina score was reduced by 53% post-IVL-assisted PCI (2.9 vs 1.4, p < 0.001). Technical and procedural success were high (94% and 92%, respectively). One patient (2%) met the pre-specified criteria for in-hospital MACE and 4 (9%) met pre-specified MACE at follow-up, including 2 deaths and 2 TLR. Procedural complications included coronary dissection (11%) and coronary perforation (6%) and were managed either conservatively or with PCI. CONCLUSIONS Coronary IVL is a safe and effective adjunctive therapy for treating heavily calcified coronary lesions. This cohort shows high procedural success and a significant reduction in CCS angina at follow-up.
Collapse
Affiliation(s)
- Anthony J Buckley
- Department of Cardiology, St James's Hospital, Dublin, D08 NHY1, Ireland.
| | - John P McCormick
- Department of Cardiology, St James's Hospital, Dublin, D08 NHY1, Ireland
| | - James Carey
- Department of Cardiology, St James's Hospital, Dublin, D08 NHY1, Ireland
| | - Richard Armstrong
- Department of Cardiology, St James's Hospital, Dublin, D08 NHY1, Ireland
| | - Andrew Maree
- Department of Cardiology, St James's Hospital, Dublin, D08 NHY1, Ireland
| | - Mark Hensey
- Department of Cardiology, St James's Hospital, Dublin, D08 NHY1, Ireland
| | - Stephen O'Connor
- Department of Cardiology, St James's Hospital, Dublin, D08 NHY1, Ireland
| | - Ross Murphy
- Department of Cardiology, St James's Hospital, Dublin, D08 NHY1, Ireland
| | - Caroline Daly
- Department of Cardiology, St James's Hospital, Dublin, D08 NHY1, Ireland
| | - John Cosgrave
- Department of Cardiology, St James's Hospital, Dublin, D08 NHY1, Ireland
| | - Ian Pearson
- Department of Cardiology, St James's Hospital, Dublin, D08 NHY1, Ireland
| |
Collapse
|
7
|
Kotajärvi J, Tolppanen AM, Hartikainen J, Miettinen H, Viljakainen M, Martikainen J, Roine RP, Lavikainen P. Correlation of the disease-specific Canadian Cardiovascular Society (CCS) classification and health-related quality of life (15D) in coronary artery disease patients. PLoS One 2022; 17:e0266101. [PMID: 35363816 PMCID: PMC8975144 DOI: 10.1371/journal.pone.0266101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 03/15/2022] [Indexed: 11/29/2022] Open
Abstract
Background Generic health-related quality of life (HRQoL) and disease-specific instruments measure HRQoL from different aspects, although generic instruments often contain dimensions that reflect common symptoms. We evaluated how the change in 15D HRQoL and Canadian Cardiovascular Society (CCS) grading of angina severity correlate among coronary artery disease patients during 12-month follow-up. Methods Altogether 1 271 patients scheduled for coronary angiography between June 2015 and February 2017 returned the 15D HRQoL and CCS questionnaires before angiography and after one-year follow-up as a part of routine clinical practice. Spearman correlations between one-year changes in the CCS and the 15D and its dimensions were evaluated. Changes in 15D were classified into 5 categories based on the reported minimal important difference (MID) for the instrument. Results Change in the CCS grade correlated moderately with the MID-based change in the 15D (r = 0.33, 95% confidence interval 0.27–0.39). Correlations between these instruments were similar in different age groups, between sexes and treatment modalities. Of the individual 15D dimensions, changes in breathing (r = 0.40) and vitality (r = 0.30) had the strongest correlations with CCS change. Conclusion The symptom-based evaluation of the change in the CCS grade may not catch the full benefit or harm of the treatment and vice versa, a generic instrument, such as 15D, likely does not fully capture change in disease-specific symptoms. Thus, generic and disease-specific instruments are complementary and should be used in conjunction.
Collapse
Affiliation(s)
- Jarno Kotajärvi
- Department of Health and Social Management, University of Eastern Finland, Kuopio, Finland
| | - Anna-Maija Tolppanen
- Kuopio Research Centre of Geriatric Care, University of Eastern Finland, Kuopio, Finland
- School of Pharmacy, University of Eastern Finland, Kuopio, Finland
| | - Juha Hartikainen
- Heart Center, Kuopio University Hospital, Kuopio, Finland
- School of Medicine, University of Eastern Finland, Kuopio, Finland
| | | | | | | | - Risto P. Roine
- Department of Health and Social Management, University of Eastern Finland, Kuopio, Finland
- Kuopio University Hospital, Kuopio, Finland
| | - Piia Lavikainen
- School of Pharmacy, University of Eastern Finland, Kuopio, Finland
- Heart Center, Kuopio University Hospital, Kuopio, Finland
- * E-mail:
| |
Collapse
|
8
|
Maehl N, Bleckwenn M, Riedel-Heller SG, Mehlhorn S, Lippmann S, Deutsch T, Schrimpf A. The Impact of the COVID-19 Pandemic on Avoidance of Health Care, Symptom Severity, and Mental Well-Being in Patients With Coronary Artery Disease. Front Med (Lausanne) 2022; 8:760265. [PMID: 34977066 PMCID: PMC8714893 DOI: 10.3389/fmed.2021.760265] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 11/10/2021] [Indexed: 12/27/2022] Open
Abstract
The COVID-19 pandemic affected regular health care for patients with chronic diseases. However, the impact of the pandemic on primary care for patients with coronary artery disease (CAD) who are enrolled in a structured disease management program (DMP) in Germany is not clear. We investigated whether the pandemic affected primary care and health outcomes of DMP-CAD patients (n = 750) by using a questionnaire assessing patients' utilization of medical care, CAD symptoms, as well as health behavior and mental health since March 2020. We found that out of concern about getting infected with COVID-19, 9.1% of the patients did not consult a medical practitioner despite having CAD symptoms. Perceived own influence on infection risk was lower and anxiety was higher in these patients compared to symptomatic CAD patients who consulted a physician. Among the patients who reported chest pain lasting longer than 30 min, one third did not consult a medical practitioner subsequently. These patients were generally more worried about COVID-19. Patients with at least one worsening CAD symptom (chest pain, dyspnea, perspiration, or nausea without apparent reason) since the pandemic showed more depressive symptoms, higher anxiety scores, and were less likely to consult a doctor despite having CAD symptoms out of fear of infection. Our results provide evidence that the majority of patients received sufficient medical care during the COVID-19 pandemic in Germany. However, one in ten patients could be considered particularly at risk for medical undersupply and adverse health outcomes. The perceived infection risk with COVID-19 might have facilitated the decision not to consult a medical doctor.
Collapse
Affiliation(s)
- Nathalie Maehl
- Department of General Practice, Faculty of Medicine, Leipzig University, Leipzig, Germany
| | - Markus Bleckwenn
- Department of General Practice, Faculty of Medicine, Leipzig University, Leipzig, Germany
| | - Steffi G Riedel-Heller
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), Leipzig University, Leipzig, Germany
| | | | - Stefan Lippmann
- Department of General Practice, Faculty of Medicine, Leipzig University, Leipzig, Germany
| | - Tobias Deutsch
- Department of General Practice, Faculty of Medicine, Leipzig University, Leipzig, Germany
| | - Anne Schrimpf
- Department of General Practice, Faculty of Medicine, Leipzig University, Leipzig, Germany
| |
Collapse
|
9
|
Thuesen AL, Riber LP, Veien KT, Christiansen EH, Jensen SE, Modrau I, Andreasen JJ, Borregaard B, Junker A, Mortensen PE, Jensen LO. Health-Related Quality of Life and Angina in Fractional Flow Reserve- Versus Angiography-Guided Coronary Artery Bypass Grafting: FARGO Trial (Fractional Flow Reserve Versus Angiography Randomization for Graft Optimization). Circ Cardiovasc Qual Outcomes 2021; 14:e007302. [PMID: 34078097 DOI: 10.1161/circoutcomes.120.007302] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND In coronary artery bypass grafting (CABG), the use of fractional flow reserve (FFR) is insufficiently investigated. Stenosis assessment usually relies on visual estimates of lesion severity. This study evaluated health-related quality of life (HRQoL) and angina after FFR- versus angiography-guided CABG. METHODS One hundred patients referred for CABG were randomized to FFR- or angiography-guided CABG. In the FFR group, lesions with FFR>0.80 were deferred, while the surgeon was blinded to the FFR values in the angiography group. Before and 6 months after CABG, HRQoL was assessed by the health state classifier EQ-5D of the EuroQoL 5-level instrument and angina status based on the Canadian Cardiovascular Society classification system were registered. RESULTS Six-month angiography included FFR evaluations of deferred lesions. In total, completed EQ-5D of the EuroQoL 5-level instrument questionnaires were available in 86 patients (43 in the FFR versus 43 in the angiography-guided group). HRQoL was significantly improved and angina significantly decreased from baseline to 6 months after CABG with no difference between the randomization groups. Graft failure rates and clinical outcomes were similar in both groups. Patients with graft failure or FFR<0.80 of the previous deferred lesions had significantly lower visual analogue scale scores (78.7±14.2 versus 86.8±14.7, P=0.004) and more angina compared with patients without graft failure or FFR≥0.80 at 6-month follow-up. CONCLUSIONS FFR- versus angiography-guided CABG demonstrated similar improvements in HRQoL and angina 6 months after CABG. Graft failure or low FFR in deferred lesions were associated with low HRQoL and angina. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT02477371.
Collapse
Affiliation(s)
- Anne Langhoff Thuesen
- Department of Cardiology (A.L.T., K.T.V., B.B., A.J., L.O.J.), Odense University Hospital, Denmark.,Department of Cardiothoracic Surgery (A.L.T., L.P.R., P.E.M.), Odense University Hospital, Denmark
| | - Lars Peter Riber
- Department of Cardiothoracic Surgery (A.L.T., L.P.R., P.E.M.), Odense University Hospital, Denmark
| | - Karsten Tange Veien
- Department of Cardiology (A.L.T., K.T.V., B.B., A.J., L.O.J.), Odense University Hospital, Denmark
| | | | | | - Ivy Modrau
- Department of Cardiothoracic Surgery (I.M.), Aarhus University Hospital, Skejby, Denmark
| | - Jan Jesper Andreasen
- Department of Cardiothoracic Surgery, Aalborg University Hospital, Denmark (J.J.A.).,Department of Clinical Research, Aalborg University, Denmark (J.J.A.)
| | - Britt Borregaard
- Department of Cardiology (A.L.T., K.T.V., B.B., A.J., L.O.J.), Odense University Hospital, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark (B.B., L.O.J.)
| | - Anders Junker
- Department of Cardiology (A.L.T., K.T.V., B.B., A.J., L.O.J.), Odense University Hospital, Denmark
| | - Poul Erik Mortensen
- Department of Cardiothoracic Surgery (A.L.T., L.P.R., P.E.M.), Odense University Hospital, Denmark
| | - Lisette Okkels Jensen
- Department of Cardiology (A.L.T., K.T.V., B.B., A.J., L.O.J.), Odense University Hospital, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark (B.B., L.O.J.)
| |
Collapse
|
10
|
Alaarag A, Amin O. Blood pressure variability in patients with angina and non-obstructive coronary artery disease. J Hum Hypertens 2021; 35:1074-1080. [PMID: 33414504 DOI: 10.1038/s41371-020-00475-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 11/11/2020] [Accepted: 12/09/2020] [Indexed: 11/09/2022]
Abstract
There is a real challenge in the management of ischemia with non-obstructive coronary artery disease. So, we need to study the mechanisms of persistent angina and non-obstructive coronary artery (ANOCA) patients. One of those possible mechanisms is blood pressure variability (BPV). We aimed to study the relation between BPV and angina in patients with non-obstructive coronary artery disease. Our study included 150 patients with chest pain and positive non-invasive stress test suggestive of myocardial ischemia and normal coronary angiography or non-obstructive coronary artery disease. We used an ambulatory blood pressure monitoring device. We found a positive correlation between BPV as measured by average real variability (ARV) as well as standard deviation (SD) parameters and the severity of anginal symptoms with P values for all parameters was 0.001 except day systolic SD P-value was 0.021. We performed a regression analysis for all statistically significant parameters. We found that 24H diastolic ARV, day diastolic ARV, night diastolic ARV, 24H diastolic SD, day diastolic SD, and night diastolic SD were independent predictors of the severity of angina with P-values (0.015, 0.007, 0.011, 0.037, 0.014, and 0.029), respectively. We concluded that short-term BPV represented by ARV and SD had a consistent association with angina in patients with non-obstructive coronary artery disease. The diastolic parameters of ARV and SD were independent predictors of the severity of angina with non-obstructive coronary artery disease.
Collapse
Affiliation(s)
- Ahmed Alaarag
- Department of Cardiology, Tanta University, Tanta, Egypt.
| | - Osama Amin
- Department of Cardiology, Beni-Suef University, Beni Suef, Egypt
| |
Collapse
|
11
|
Acute Coronary Syndromes in Chronic Kidney Disease: Clinical and Therapeutic Characteristics. ACTA ACUST UNITED AC 2020; 56:medicina56030118. [PMID: 32182690 PMCID: PMC7143276 DOI: 10.3390/medicina56030118] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Revised: 02/29/2020] [Accepted: 03/05/2020] [Indexed: 01/24/2023]
Abstract
Background and Objectives: This study evaluated the clinical characteristics of the acute coronary syndromes (ACS) in chronic kidney disease (CKD) patients and established prognostic values of the biomarkers and echocardiography. Materials and Methods: 273 patients admitted to the cardiology department of the Clinical County Emergency Hospital of Oradea, Romania, with ACS diagnosis were studied. Two study groups were formed according to the presence of CKD (137 patients with ACS + CKD and 136 with ACS without CKD). Kidney Disease: Improving Global Outcomes (KDIGO) threshold was used to assess the stages of CKD. Results: Data regarding the medical history, laboratory findings, biomarkers, echocardiography, and coronary angiography were analysed for both groups. ACS parameters were represented by ST-segment elevation myocardial infarction (STEMI), which revealed a greater incidence in subjects without CKD (43.88%); non-ST-segment elevation myocardial infarction (NSTEMI), characteristic for the CKD group (28.47%, with statistically significance p = 0.04); unstable angina and myocardial infarction with nonobstructive coronary arteries (MINOCA). Diabetes mellitus, chronic heart failure, previous stroke, and chronic coronary syndrome were more prevalent in the ACS + CKD group (56.93%, p < 0.01; 41.61%, p < 0.01; 18.25%, p < 0.01; 45.26%, p < 0.01). N-terminal pro b-type natriuretic peptide (NT-proBNP) was statistically higher (p < 0.01) in patients with CKD; Killip class 3 was evidenced more frequently in the same group (p < 0.01). Single-vessel coronary artery disease (CAD) was statistically more frequent in the ACS without CKD group (29.41%, p < 0.01) and three-vessel CAD or left main coronary artery disease (LMCA) were found more often in the ACS + CKD group (27.01%, 14.6%). Conclusions: Extension of the CAD in CKD subjects revealed an increased prevalence of the proximal CAD, and the involvement of various coronary arteries is characteristic in these patients. Biomarkers and echocardiographic elements can outline the evolution and outcomes of ACS in CKD patients.
Collapse
|
12
|
Parag K, Govil N, Kumar B, Khandelwal H, Dua R, Sivaji P. Translation, cultural adaptation, and validation of the duke activity status index in the hindi language. Ann Card Anaesth 2020. [PMID: 32687089 PMCID: PMC7559948 DOI: 10.4103/aca.aca_25_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background: The Duke Activity Status Index (DASI) is a validated questionnaire in English to assess the functional capacity (FC) of patients with cardiovascular disease (CVD). Aim: The aim of the study is to translate, cross-culturally adapt, and validate the DASI in Hindi. Settings and Study Design: Observational validation study. Methodology: Different translators translated the DASI into Hindi and then back-translated it into English. Validation for feasibility and psychometric properties of translated questionnaire was done on 200 adults, Hindi-speaking patients with CVD, who were advised exercise testing by a cardiologist. Statistical Analysis: Internal consistency (Cronbach's α) and test–retest reliability (Pearson's correlation coefficient) were calculated. Construct (correlation with the Canadian Cardiovascular Society Classification [CCSC] for angina and exercise capacity with treadmill testing [TMT]) and content validity (time taken to fill the questionnaire, ease of understanding the questionnaire items, and comprehensibility) were calculated. P < 0.05 was considered significant. Results: The Cronbach's α for internal consistency was 0.78, which indicates adequate relatedness among the items of questionnaire, and the test–retest reliability was 0.65 (P < 0.05). A significant correlation between CCSC (r = −0.60) and TMT (r = 0.56) was found. The median time taken by the respondents to fill the questionnaire was 4 min. Of all the respondents, 95.74% of the respondents agreed that the Hindi questionnaire was easy to comprehend and 97.87% patients correlated the translated items to their daily physical activity. Conclusions: The Hindi translated and culturally adapted version of the DASI is reliable, valid, and feasible to assess the FC in the Hindi-speaking CVD patients.
Collapse
|
13
|
Parag K, Govil N, Kumar B, Khandelwal H, Dua R, Sivaji P. Translation, cultural adaptation, and validation of the duke activity status index in the hindi language. Ann Card Anaesth 2020; 23:315-320. [DOI: 10.4103/0971-9784.282667] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
14
|
Coronary Artery Disease: From Mechanism to Clinical Practice. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2020; 1177:1-36. [PMID: 32246442 DOI: 10.1007/978-981-15-2517-9_1] [Citation(s) in RCA: 66] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
In most developed countries, coronary artery disease (CAD), mostly caused by atherosclerosis of coronary arteries, is one of the primary causes of death. From 1990s to 2000s, mortality caused by acute MI declined up to 50%. The incidence of CAD is related with age, gender, economic, etc. Atherosclerosis contains some highly correlative processes such as lipid disturbances, thrombosis, inflammation, vascular smooth cell activation, remodeling, platelet activation, endothelial dysfunction, oxidative stress, altered matrix metabolism, and genetic factors. Risk factors of CAD exist among many individuals of the general population, which includes hypertension, lipids and lipoproteins metabolism disturbances, diabetes mellitus, chronic kidney disease, age, genders, lifestyle, cigarette smoking, diet, obesity, and family history. Angina pectoris is caused by myocardial ischemia in the main expression of pain in the chest or adjoining area, which is usually a result of exertion and related to myocardial function disorder. Typical angina pectoris would last for minutes with gradual exacerbation. Rest, sit, or stop walking are the usual preference for patients with angina, and reaching the maximum intensity in seconds is uncommon. Rest or nitroglycerin usage can relieve typical angina pectoris within minutes. So far, a widely accepted angina pectoris severity grading system included CCS (Canadian Cardiovascular Society) classification, Califf score, and Goldman scale. Patients with ST-segment elevated myocardial infarction (STEMI) may have different symptoms and signs of both severe angina pectoris and various complications. The combination of rising usage of sensitive MI biomarkers and precise imaging techniques, including electrocardiograph (ECG), computed tomography, and cardiac magnetic resonance imaging, made the new MI criteria necessary. Complications of acute myocardial infarction include left ventricular dysfunction, cardiogenic shock, structural complications, arrhythmia, recurrent chest discomfort, recurrent ischemia and infarction, pericardial effusion, pericarditis, post-myocardial infarction syndrome, venous thrombosis pulmonary embolism, left ventricular aneurysm, left ventricular thrombus, and arterial embolism.
Collapse
|
15
|
Bradley SM. Deafening Silence: The Lack of Structured Patient Symptoms in Clinical Documentation of Angina. J Am Heart Assoc 2019; 8:e013664. [PMID: 31364491 PMCID: PMC6761635 DOI: 10.1161/jaha.119.013664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
See Article Owlia et al
Collapse
Affiliation(s)
- Steven M. Bradley
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation Minneapolis MN
| |
Collapse
|
16
|
Owlia M, Dodson JA, King JB, Derington CG, Herrick JS, Sedlis SP, Crook J, DuVall SL, LaFleur J, Nelson R, Patterson OV, Shah RU, Bress AP. Angina Severity, Mortality, and Healthcare Utilization Among Veterans With Stable Angina. J Am Heart Assoc 2019; 8:e012811. [PMID: 31362569 PMCID: PMC6761668 DOI: 10.1161/jaha.119.012811] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Background Canadian Cardiovascular Society (CCS) angina severity classification is associated with mortality, myocardial infarction, and coronary revascularization in clinical trial and registry data. The objective of this study was to determine associations between CCS class and all‐cause mortality and healthcare utilization, using natural language processing to extract CCS classifications from clinical notes. Methods and Results In this retrospective cohort study of veterans in the United States with stable angina from January 1, 2006, to December 31, 2013, natural language processing extracted CCS classifications. Veterans with a prior diagnosis of coronary artery disease were excluded. Outcomes included all‐cause mortality (primary), all‐cause and cardiovascular‐specific hospitalizations, coronary revascularization, and 1‐year healthcare costs. Of 299 577 veterans identified, 14 216 (4.7%) had ≥1 CCS classification extracted by natural language processing. The mean age was 66.6±9.8 years, 99% of participants were male, and 81% were white. During a median follow‐up of 3.4 years, all‐cause mortality rates were 4.58, 4.60, 6.22, and 6.83 per 100 person‐years for CCS classes I, II, III, and IV, respectively. Multivariable adjusted hazard ratios for all‐cause mortality comparing CCS II, III, and IV with those in class I were 1.05 (95% CI, 0.95–1.15), 1.33 (95% CI, 1.20–1.47), and 1.48 (95% CI, 1.25–1.76), respectively. The multivariable hazard ratio comparing CCS IV with CCS I was 1.20 (95% CI, 1.09–1.33) for all‐cause hospitalization, 1.25 (95% CI, 0.96–1.64) for acute coronary syndrome hospitalizations, 1.00 (95% CI, 0.80–1.26) for heart failure hospitalizations, 1.05 (95% CI, 0.88–1.25) for atrial fibrillation hospitalizations, 1.92 (95% CI, 1.40–2.64) for percutaneous coronary intervention, and 2.51 (95% CI, 1.99–3.16) for coronary artery bypass grafting surgery. Conclusions Natural language processing–extracted CCS classification was positively associated with all‐cause mortality and healthcare utilization, demonstrating the prognostic importance of anginal symptom assessment and documentation. See Editorial Mehta and Bradley
Collapse
Affiliation(s)
- Mina Owlia
- Leon H. Charney Division of Cardiology Department of Medicine New York University School of Medicine New York NY
| | - John A Dodson
- Leon H. Charney Division of Cardiology Department of Medicine New York University School of Medicine New York NY.,Department of Population Health New York University School of Medicine New York NY
| | - Jordan B King
- Department of Population Health Sciences University of Utah Salt Lake City UT.,Department of Pharmacy Kaiser Permanente Colorado Aurora CO.,George E. Wahlen Department of Veterans Affairs Medical Center Salt Lake City UT
| | - Catherine G Derington
- Department of Pharmacy Kaiser Permanente Colorado Aurora CO.,Department of Clinical Pharmacy University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences Aurora CO
| | - Jennifer S Herrick
- Department of Population Health Sciences University of Utah Salt Lake City UT
| | - Steven P Sedlis
- Leon H. Charney Division of Cardiology Department of Medicine New York University School of Medicine New York NY.,Cardiology Section Veterans Affairs Medical Center Manhattan NY
| | - Jacob Crook
- Department of Internal Medicine University of Utah Salt Lake City UT.,George E. Wahlen Department of Veterans Affairs Medical Center Salt Lake City UT
| | - Scott L DuVall
- Department of Internal Medicine University of Utah Salt Lake City UT.,George E. Wahlen Department of Veterans Affairs Medical Center Salt Lake City UT
| | - Joanne LaFleur
- Department of Pharmacotherapy University of Utah Salt Lake City UT.,George E. Wahlen Department of Veterans Affairs Medical Center Salt Lake City UT
| | - Richard Nelson
- Department of Internal Medicine University of Utah Salt Lake City UT.,George E. Wahlen Department of Veterans Affairs Medical Center Salt Lake City UT
| | - Olga V Patterson
- Department of Internal Medicine University of Utah Salt Lake City UT.,George E. Wahlen Department of Veterans Affairs Medical Center Salt Lake City UT
| | - Rashmee U Shah
- Department of Internal Medicine University of Utah Salt Lake City UT
| | - Adam P Bress
- Department of Population Health Sciences University of Utah Salt Lake City UT.,Department of Internal Medicine University of Utah Salt Lake City UT.,George E. Wahlen Department of Veterans Affairs Medical Center Salt Lake City UT
| |
Collapse
|
17
|
Lapp L, Bouamrane MM, Kavanagh K, Roper M, Young D, Schraag S. Evaluation of Random Forest and Ensemble Methods at Predicting Complications Following Cardiac Surgery. Artif Intell Med 2019. [DOI: 10.1007/978-3-030-21642-9_48] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
|
18
|
Baniak LM, Chasens ER, Luyster FS, Strollo PJ, Thunström E, Peker Y. Obstructive sleep apnea and self-reported functional impairment in revascularized patients with coronary artery disease in the RICCADSA trial. Sleep Breath 2018; 22:1169-1177. [PMID: 30324547 DOI: 10.1007/s11325-018-1733-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 09/11/2018] [Accepted: 10/02/2018] [Indexed: 11/30/2022]
Abstract
PURPOSE Daytime sleepiness, a frequent symptom of obstructive sleep apnea (OSA), can impact functional status. In patients with coronary artery disease (CAD) and concomitant OSA, the distinction between sleep-related functional impairment from underlying CAD versus OSA is unclear. This study evaluated the impact of OSA on sleep-related functional impairment in patients with CAD and compared the effect of 1-year continuous positive airway pressure (CPAP) use on change in impairment between those with and without excessive daytime sleepiness (EDS) and OSA. We hypothesized that sleep-related functional impairment is impacted by EDS independent of OSA in patients with CAD. METHODS One hundred five CAD patients without OSA and 105 with moderate-to-severe OSA from the RICCADSA trial were matched on disease severity and included in the current substudy. Of those with OSA, 80 were allocated to CPAP. Functional Outcomes of Sleep Questionnaire (FOSQ) score < 17.9 corresponded to sleep-related functional impairment. RESULTS Following revascularization, CAD patients with and without OSA frequently report sleep-related functional impairment (35% and 27.3%, respectively; p = .29). Moderate-to-severe OSA was not related to baseline FOSQ scores < 17.9 in regression analyses; EDS was (OR 4.82, 95% CI 2.12-11.0; p < .001). CPAP use significantly improved FOSQ scores from baseline to 1-year follow-up in OSA patients with EDS (17.2 ± 2.0 to 18.15 ± 1.7, p = .002) despite suboptimal adherence. CONCLUSIONS Sleep-related functional impairment may be reflective of persistent EDS, independent of OSA. Diagnosing OSA and initiating treatment are worthwhile in individuals with CAD and EDS, as both are important to guide appropriate therapy in patients with CAD.
Collapse
Affiliation(s)
- Lynn M Baniak
- School of Nursing, University of Pittsburgh, 3500 Victoria Street, Victoria Building 415, Pittsburgh, PA, 15261, USA.
| | - Eileen R Chasens
- School of Nursing, University of Pittsburgh, 3500 Victoria Street, Victoria Building 415, Pittsburgh, PA, 15261, USA
| | - Faith S Luyster
- School of Nursing, University of Pittsburgh, 3500 Victoria Street, Victoria Building 415, Pittsburgh, PA, 15261, USA
| | - Patrick J Strollo
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.,VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
| | - Erik Thunström
- Department of Molecular and Clinical Medicine/Cardiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Cardiology, Sahlgrenska University Hospital/Ostra, Gothenburg, Sweden
| | - Yüksel Peker
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.,Department of Molecular and Clinical Medicine/Cardiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Pulmonary Medicine, School of Medicine, Koc University, Istanbul, Turkey.,Department of Clinical Sciences, Respiratory Medicine and Allergology, Faculty of Medicine, Lund University, Lund, Sweden
| |
Collapse
|
19
|
Gulizia MM, Colivicchi F, Abrignani MG, Ambrosetti M, Aspromonte N, Barile G, Caporale R, Casolo G, Chiuini E, Di Lenarda A, Faggiano P, Gabrielli D, Geraci G, La Manna AG, Maggioni AP, Marchese A, Massari FM, Mureddu GF, Musumeci G, Nardi F, Panno AV, Pedretti RFE, Piredda M, Pusineri E, Riccio C, Rossini R, di Uccio FS, Urbinati S, Varbella F, Zito GB, De Luca L. Consensus Document ANMCO/ANCE/ARCA/GICR-IACPR/GISE/SICOA: Long-term Antiplatelet Therapy in Patients with Coronary Artery Disease. Eur Heart J Suppl 2018; 20:F1-F74. [PMID: 29867293 PMCID: PMC5978022 DOI: 10.1093/eurheartj/suy019] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Dual antiplatelet therapy (DAPT) with aspirin and a P2Y12 receptor inhibitor is the cornerstone of pharmacologic management of patients with acute coronary syndrome (ACS) and/or those receiving coronary stents. Long-term (>1 year) DAPT may further reduce the risk of stent thrombosis after a percutaneous coronary intervention (PCI) and may decrease the occurrence of non-stent-related ischaemic events in patients with ACS. Nevertheless, compared with aspirin alone, extended use of aspirin plus a P2Y12 receptor inhibitor may increase the risk of bleeding events that have been strongly linked to adverse outcomes including recurrent ischaemia, repeat hospitalisation and death. In the past years, multiple randomised trials have been published comparing the duration of DAPT after PCI and in ACS patients, investigating either a shorter or prolonged DAPT regimen. Although the current European Society of Cardiology guidelines provide a backup to individualised treatment, it appears to be difficult to identify the ideal patient profile which could safely reduce or prolong the DAPT duration in daily clinical practice. The aim of this consensus document is to review contemporary literature on optimal DAPT duration, and to guide clinicians in tailoring antiplatelet strategies in patients undergoing PCI or presenting with ACS.
Collapse
Affiliation(s)
- Michele Massimo Gulizia
- U.O.C. di Cardiologia, Ospedale Garibaldi-Nesima, Azienda di Rilievo Nazionale e Alta Specializzazione “Garibaldi”, Catania, Italy
| | - Furio Colivicchi
- U.O.C. Cardiologia e UTIC, Ospedale San Filippo Neri, Roma, Italy
| | | | - Marco Ambrosetti
- Servizio di Cardiologia Riabilitativa, Clinica Le Terrazze Cunardo, Varese, Italy
| | - Nadia Aspromonte
- U.O. Scompenso e Riabilitazione Cardiologica, Polo Scienze Cardiovascolari, Toraciche, Policlinico Agostino Gemelli, Roma, Italy
| | | | - Roberto Caporale
- U.O.C. Cardiologia Interventistica, Ospedale Annunziata, Cosenza, Italy
| | - Giancarlo Casolo
- S.C. Cardiologia, Nuovo Ospedale Versilia, Lido di Camaiore (LU), Italy
| | - Emilia Chiuini
- Specialista Ambulatoriale Cardiologo, ASL Umbria 1, Perugia, Italy
| | - Andrea Di Lenarda
- S.C. Cardiovascolare e Medicina dello Sport, Azienda Sanitaria Universitaria Integrata di Trieste, Italy
| | | | - Domenico Gabrielli
- ASUR Marche - Area Vasta 4 Fermo, Ospedale Civile Augusto Murri, Fermo, Italy
| | - Giovanna Geraci
- U.O.C. Cardiologia Azienda Ospedali Riuniti Villa Sofia-Cervello, Palermo, Italy
| | | | | | | | - Ferdinando Maria Massari
- U.O.C. Malattie Cardiovascolari "Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milano, Italy
| | | | | | - Federico Nardi
- S.C. Cardiologia, Ospedale Santo Spirito, Casale Monferrato (AL), Italy
| | | | | | - Massimo Piredda
- Centro Cardiotoracico, Divisione di Cardiologia, Istituto Clinico Sant'Ambrogio, Milano, Italy
| | - Enrico Pusineri
- U.O.C. di Cardiologia, Ospedale Civile di Vigevano, A.S.S.T., Pavia, Italy
| | - Carmine Riccio
- Prevenzione e Riabilitazione Cardiopatico, AZ. Ospedaliera S. Anna e S. Sebastiano, Caserta, Italy
| | | | | | - Stefano Urbinati
- U.O.C. Cardiologia, Ospedale Bellaria, AUSL di Bologna, Bologna, Italy
| | | | | | - Leonardo De Luca
- U.O.C. Cardiologia, Ospedale San Giovanni Evangelista, Tivoli, Roma, Italy
| |
Collapse
|
20
|
Ischemic Heart Disease. PHYSICIAN ASSISTANT CLINICS 2017. [DOI: 10.1016/j.cpha.2017.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
|
21
|
Ozben V, Stocchi L, Ashburn J, Liu X, Gorgun E. Impact of a restrictive vs liberal transfusion strategy on anastomotic leakage and infectious complications after restorative surgery for rectal cancer. Colorectal Dis 2017; 19:772-780. [PMID: 28238216 DOI: 10.1111/codi.13641] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2016] [Accepted: 12/12/2016] [Indexed: 12/24/2022]
Abstract
AIM The aim of this study was to investigate the impact of a restrictive vs liberal transfusion strategy on anastomotic leakage and infectious complications after rectal cancer surgery. METHODS Patients undergoing restorative proctectomy for rectal cancer between January 2008 and December 2013 were divided into four groups according to the perioperative lowest haemoglobin (Hgb) level and transfusion status: group 1 with Hgb level ≥ 10 g/dl; group 2 with Hgb level ≥ 7 and < 10 g/dl who did not receive transfusion; and group 3 with Hgb level ≥ 7 and < 10 g/dl and group 4 with Hgb level < 7 g/dl, both of which received a transfusion. Clinical characteristics, anastomotic leakage and infectious complications within 30 days of surgery were compared. RESULTS There were 398 patients (66% men) with a mean age of 59.3 ± 11.9 years. Groups 1, 2, 3 and 4 included 162 (40.7%), 163 (41.0%), 47 (11.8%) and 26 (6.5%) patients, respectively. Perioperative characteristics were significantly different among groups regarding neoadjuvant chemo/radiotherapy use, preoperative albumin and Hgb levels, operative approach and blood loss, tumour size and stage, surgical margin involvement and histological differentiation. The unadjusted rates of overall infectious complications were 17.2%, 27.6%, 36.2% and 50% in groups 1, 2, 3 and 4, respectively (P = 0.001). In the multivariate analysis, compared to group 2, group 3 was associated with an increased likelihood of organ/space surgical site infections (SSIs) (OR 3.63, 95% CI 1.29-10.22, P = 0.01) with no significant differences in terms of anastomotic leakage, overall SSIs or overall infectious complications. CONCLUSION Blood transfusion of haemodynamically stable patients with Hgb level ≥ 7 g/dl is associated with increased organ/space SSIs in rectal cancer surgery.
Collapse
Affiliation(s)
- V Ozben
- Department of Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - L Stocchi
- Department of Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - J Ashburn
- Department of Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - X Liu
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio, USA
| | - E Gorgun
- Department of Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, Cleveland, Ohio, USA
| |
Collapse
|
22
|
Riccio C, Gulizia MM, Colivicchi F, Di Lenarda A, Musumeci G, Faggiano PM, Abrignani MG, Rossini R, Fattirolli F, Valente S, Mureddu GF, Temporelli PL, Olivari Z, Amico AF, Casolo G, Fresco C, Menozzi A, Nardi F. ANMCO/GICR-IACPR/SICI-GISE Consensus Document: the clinical management of chronic ischaemic cardiomyopathy. Eur Heart J Suppl 2017; 19:D163-D189. [PMID: 28533729 PMCID: PMC5421493 DOI: 10.1093/eurheartj/sux021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Stable coronary artery disease (CAD) is a clinical entity of great epidemiological importance. It is becoming increasingly common due to the longer life expectancy, being strictly related to age and to advances in diagnostic techniques and pharmacological and non-pharmacological interventions. Stable CAD encompasses a variety of clinical and anatomic presentations, making the identification of its clinical and anatomical features challenging. Therapeutic interventions should be defined on an individual basis according to the patient's risk profile. To this aim, management flow charts have been reviewed based on sustainability and appropriateness derived from recent evidence. Special emphasis has been placed on non-pharmacological interventions, stressing the importance of lifestyle changes, including smoking cessation, regular physical activity, and diet. Adherence to therapy as an emerging risk factor is also discussed.
Collapse
Affiliation(s)
- Carmine Riccio
- Cardiovascular Science Department, A.O. Sant’Anna e San Sebastiano, Via Palasciano, 1 81100 Caserta, Italy
| | - Michele Massimo Gulizia
- Department of Cardiology, Ospedale Garibaldi-Nesima, Azienda di Rilievo Nazionale e Alta Specializzazione “Garibaldi”, Catania, Italy
| | - Furio Colivicchi
- CCU Unit, Department of Cardiology, Presidio Ospedaliero San Filippo Neri, Rome, Italy
| | - Andrea Di Lenarda
- Cardiovascular Center, Azienda Sanitaria Universitaria Integrata, Trieste, Italy
| | | | | | | | - Roberta Rossini
- Cardiology Department, A.O. Santa Croce e Carle, Cuneo, Italy
| | | | - Serafina Valente
- Intensive Integrated Cardiology Department, AOU Careggi, Florence, Italy
| | - Gian Francesco Mureddu
- Cardiology and Cardiac Rehabilitation Department, A.O. San Giovanni-Addolorata, Rome, Italy
| | | | - Zoran Olivari
- Department of Cardiology, Ospedale Ca’ Foncello, Treviso, Italy
| | | | - Giancarlo Casolo
- Cardiology Unit, Nuovo Ospedale Versilia, Lido di Camaiore, Lucca, Italy
| | - Claudio Fresco
- Cardiology Unit, A.O.U. Santa Maria della Misericordia, Udine, Italy
| | - Alberto Menozzi
- Cardiology Unit, Azienda Ospedaliera Universitaria di Parma, Parma, Italy
| | | |
Collapse
|
23
|
Vibulchai N, Thanasilp S, Preechawong S, Broome ME. Validation of the Thai version of the Duke Activity Status Index in patients with a previous myocardial infarction. ASIAN BIOMED 2017. [DOI: 10.5372/1905-7415.0805.336] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Abstract
Background: The Duke Activity Status Index is a widely used instrument for measuring functional status in patients with cardiovascular disease. However, items and subscales on this instrument have not been validated for Thai patients with a previous myocardial infarction (MI).
Objective: To test the reliability and validity of the Thai version of the Duke Activity Status Index (DASI-T) in Thai patients with a previous MI using a cross-sectional study design.
Methods: The DASI-T was translated using forward and backward translation methods and administered to 100 MI patients from outpatient departments of two general hospitals in Thailand. Internal consistency was determined to test reliability. Two criterion measures (i.e. Canadian Cardiovascular Society (CCS) classification, SF-36 physical functioning subscale) were used to test the concurrent validity of the DASI-T. Age group and CCS classification were used to determine known-groups validity of the DASI-T.
Results: Cronbach’s α for the DASI-T total score was 0.76. No ceiling or floor effect was detected for the DASI-T total score. DASI-T total score was significantly correlated with the CCS classification (r = -0.68, P < 0.01) and SF-36 physical functioning subscale (r = 0.79, P < 0.01). DASI-T total scores could differentiate MI patients based on age (P = 0.040) or CCS classification (P = 0.000).
Conclusion: The DASI-T is a potentially reliable and valid instrument with which to assess functional status in MI patients and is also useful to evaluate a treatment effect and be a guideline for clinical purposes (i.e. exercise prescription, risk stratification).
Collapse
Affiliation(s)
| | | | | | - Marion E. Broome
- Indiana University School of Nursing, Indianapolis, Indiana 46202, United States of America
| |
Collapse
|
24
|
Bei Y, Yu P, Cretoiu D, Cretoiu SM, Xiao J. Exosomes-Based Biomarkers for the Prognosis of Cardiovascular Diseases. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2017; 998:71-88. [PMID: 28936733 DOI: 10.1007/978-981-10-4397-0_5] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Cardiovascular diseases (CVDs) have a high prevalence and annually increasing incidence with high mortality and morbidity. Identification of biomarkers with high sensitivity and specificity for assessing the prognosis of CVDs is necessary for optimizing personalized treatment and reducing mortality. Exosomes have been proved to be accessible in nearly all body fluids and they can reflect disease stage or progression. Here we summarized exosomes-based biomarkers for the prognosis of coronary artery diseases, heart failure, stroke, hypertension, cardiac arrhythmia, cardiomyopathy, valvular heart diseases and pulmonary arterial hypertension. If exosome-based biomarkers can achieve additionally benefits as compared to the present prognostic biomarkers remains to be determined and multicenter studies with large cohorts of patients are highly needed.
Collapse
Affiliation(s)
- Yihua Bei
- Cardiac Regeneration and Ageing Lab, School of Life Science, Shanghai University, 333 Nan Chen Road, Shanghai, 200444, China
| | - Pujiao Yu
- Department of Cardiology, Tongji Hospital, Tongji University School of Medicine, Shanghai, 200065, China
| | - Dragos Cretoiu
- Victor Babes National Institute of Pathology, Bucharest, 050096, Romania.,Division of Cellular and Molecular Biology and Histology, Carol Davila University of Medicine and Pharmacy, Bucharest, 050474, Romania
| | - Sanda Maria Cretoiu
- Victor Babes National Institute of Pathology, Bucharest, 050096, Romania.,Division of Cellular and Molecular Biology and Histology, Carol Davila University of Medicine and Pharmacy, Bucharest, 050474, Romania
| | - Junjie Xiao
- Cardiac Regeneration and Ageing Lab, School of Life Science, Shanghai University, 333 Nan Chen Road, Shanghai, 200444, China.
| |
Collapse
|
25
|
Schopfer DW, Regan M, Heidenreich PA, Whooley MA. Depressive Symptoms, Cardiac Disease Severity, and Functional Status in Patients With Coronary Artery Disease (from the Heart and Soul Study). Am J Cardiol 2016; 118:1287-1292. [PMID: 27665203 DOI: 10.1016/j.amjcard.2016.07.062] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Revised: 07/15/2016] [Accepted: 07/15/2016] [Indexed: 11/16/2022]
Abstract
Patient-reported health status is highly valued as a key measure of health care quality, yet little is known about the extent to which it is determined by subjective perception compared with objective measures of disease severity. We sought to compare the associations of depressive symptoms and objective measures of cardiac disease severity with perceived functional status in patients with stable coronary artery disease. We assessed depressive symptoms, severity of cardiovascular disease, and perceived functional status in a cross-sectional study of 1,023 patients with stable coronary artery disease. We compared the extent to which patient-reported functional status was influenced by depressive symptoms versus objective measures of disease severity. We then evaluated perceived functional status as a predictor of subsequent cardiovascular hospitalizations during 8.8 years of follow-up. Patients with depressive symptoms were more likely to report poor functional status than those without depressive symptoms (44% vs 17%; p <0.001). After adjustment for traditional risk factors and co-morbid conditions, independent predictors of poor functional status were depressive symptoms (odds ratio [OR] 2.68, 95% confidence interval [CI] 1.89 to 3.79), poor exercise capacity (OR 2.30, 95% CI 1.65 to 3.19), and history of heart failure (OR 1.61, 95% CI 1.12 to 2.29). Compared with patients who had class I functional status, those with class II functional status had a 96% greater rate (hazard ratio 1.96, 95% CI 1.15 to 3.34) and those with class III or IV functional status had a 104% greater rate (hazard ratio 2.04, 95% CI 1.12 to 3.73) of hospitalization for HF, adjusted for baseline demographic characteristics, co-morbidities, cardiac disease severity, and depressive symptoms. In conclusion, depressive symptoms and cardiac disease severity were independently associated with patient-reported functional status. This suggests that perceived functional status may be as strongly influenced by depressive symptoms as it is by cardiovascular disease severity.
Collapse
Affiliation(s)
- David W Schopfer
- Department of Medicine, University of California San Francisco, San Francisco, California; Department of Medicine, San Francisco VA Medical Center, San Francisco, California.
| | - Mathilda Regan
- Department of Medicine, San Francisco VA Medical Center, San Francisco, California
| | - Paul A Heidenreich
- Department of Cardiology, Stanford University, Palo Alto, California; Department of Cardiology, VA Palo Alto Healthcare System, Palo Alto, California
| | - Mary A Whooley
- Department of Medicine, University of California San Francisco, San Francisco, California; Department of Medicine, San Francisco VA Medical Center, San Francisco, California
| |
Collapse
|
26
|
Zimmerman L, Pozehl B, Vuckovic K, Barnason S, Schulz P, Seo Y, Ryan CJ, Zerwic JJ, DeVon HA. Selecting symptom instruments for cardiovascular populations. Heart Lung 2016; 45:475-496. [PMID: 27686695 DOI: 10.1016/j.hrtlng.2016.08.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Revised: 08/24/2016] [Accepted: 08/31/2016] [Indexed: 01/11/2023]
Abstract
The purpose of this review is to provide a guide for researchers and clinicians in selecting an instrument to measure four commonly occurring symptoms (dyspnea, chest pain, palpitations, and fatigue) in cardiac populations (acute coronary syndrome, heart failure, arrhythmia/atrial fibrillation, and angina, or patients undergoing cardiac interventions). An integrative review of the literature was conducted. A total of 102 studies summarizing information on 36 different instruments are reported in this integrative review. The majority of the instruments measured multiple symptoms and were used for one population. A majority of the symptom measures were disease-specific and were multi-dimensional. This review summarizes the psychometrics and defining characteristics of instruments to measure the four commonly occurring symptoms in cardiac populations. Simple, psychometrically strong instruments do exist and should be considered for use; however, there is less evidence of responsiveness to change over time for the majority of instruments.
Collapse
Affiliation(s)
- Lani Zimmerman
- University of Nebraska, College of Nursing, Lincoln, NE, 68588, USA.
| | - Bunny Pozehl
- University of Nebraska, College of Nursing, Lincoln, NE, 68588, USA
| | - Karen Vuckovic
- University of Illinois at Chicago, College of Nursing, Chicago, IL, 60612, USA
| | - Susan Barnason
- University of Nebraska, College of Nursing, Lincoln, NE, 68588, USA
| | - Paula Schulz
- University of Nebraska, College of Nursing, Lincoln, NE, 68588, USA
| | - Yaewon Seo
- University of Nebraska, College of Nursing, Lincoln, NE, 68588, USA
| | - Catherine J Ryan
- University of Illinois at Chicago, College of Nursing, Chicago, IL, 60612, USA
| | - Julie J Zerwic
- University of Illinois at Chicago, College of Nursing, Chicago, IL, 60612, USA
| | - Holli A DeVon
- University of Illinois at Chicago, College of Nursing, Chicago, IL, 60612, USA
| |
Collapse
|
27
|
Polese JC, Servio TC, Chaves GS, Britto RR, Teixeira-Salmela LF. Relationships between self-reported and performance-based measures of functional capacity in individuals with chronic stroke. J Phys Ther Sci 2016; 28:1208-12. [PMID: 27190454 PMCID: PMC4868214 DOI: 10.1589/jpts.28.1208] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Accepted: 12/26/2015] [Indexed: 11/30/2022] Open
Abstract
[Purpose] The aim of this study was to investigate the associations between self-reported
and valid performance-based measures of functional capacity in individuals with chronic
stroke. [Subjects and Methods] Self-reported measures of functional capacity of 31
individuals with chronic stroke were assessed by the Duke Activity Status Index scores,
whereas performance-based measures were assessed by the distance covered (in meters) and
oxygen consumption (relative oxygen consumption, in
ml·kg−1·min−1) during the six-minute walking
test. [Results] The subjects had a mean age of 58.6±13 years and a mean time since the
onset of stroke of 28.3±15.1 months. They had a mean Duke Activity Status Index of
27.3±14.4, mean distance covered of 325.2±140.2 m, and mean relative oxygen consumption of
9.6±2.3 ml·kg−1·min−1. Significant, positive, and
moderate to good correlation coefficients were found between the Duke Activity Status
Index scores and the distance covered during the six-minute walking test
(r=0.68). Significant, positive, and fair associations were also found
between the Duke Activity Status Index scores and relative oxygen consumption values
obtained during the six-minute walking test (r=0.45). [Conclusion] The
findings of the present study support the clinical use of the Duke Activity Status Index
as a tool to assist in clinical evaluations of functional capacity of individuals with
chronic stroke.
Collapse
Affiliation(s)
- Janaine Cunha Polese
- Department of Physical Therapy, Universidade Federal de Minas Gerais, Brazil; Department of Physical Therapy, Faculdade de Ciências Médicas de Minas Gerais, Brazil
| | - Thaianne C Servio
- Department of Physical Therapy, Universidade Federal de Minas Gerais, Brazil
| | - Gabriela Ss Chaves
- Department of Physical Therapy, Universidade Federal de Minas Gerais, Brazil
| | - Raquel R Britto
- Department of Physical Therapy, Universidade Federal de Minas Gerais, Brazil
| | | |
Collapse
|
28
|
Impact of Transfusion Threshold on Infectious Complications After Ileal Pouch-Anal Anastomosis. J Gastrointest Surg 2016; 20:343-50. [PMID: 26676931 DOI: 10.1007/s11605-015-3054-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Accepted: 12/04/2015] [Indexed: 01/31/2023]
Abstract
BACKGROUND This study was conducted to investigate the impact of different hemoglobin level-based transfusion practices on infectious complications after surgery for ulcerative colitis. METHODS Patients who underwent ileal pouch-anal anastomosis for ulcerative colitis between January 2008 and December 2013 were identified and divided into four groups: group 1 with hemoglobin ≥ 10 and group 2 with hemoglobin ≥ 7 and <10 g/dL who did not receive transfusion and group 3 with hemoglobin ≥ 7 and <10 and group 4 with hemoglobin < 7 g/dL who received transfusion. Clinical characteristics and septic complications within postoperative 30 days were compared. RESULTS There were 237, 341, 40, and 20 patients in groups 1, 2, 3, and 4, respectively. All the groups were comparable regarding perioperative characteristics except for age, gender, preoperative albumin and hemoglobin levels, and operative blood loss. The rates of overall septic complications were 18.6, 26.7, 47.5, and 40 % in the groups 1, 2, 3 and 4, respectively. In multivariate analysis, compared to group 2, group 3 was associated with an increased likelihood of developing organ/space (odds ratio (OR) = 4.34, p = 0.004) and overall surgical site infections (SSIs) (OR = 2.81, p = 0.01). CONCLUSION Blood transfusion decided based on a perioperative hemoglobin (Hgb) level above 7 mg/dL is associated with higher overall and organ/space SSIs.
Collapse
|
29
|
Ranolazine reduces angina frequency and severity and improves quality of life: Observational study in patients with chronic angina under ranolazine treatment in Greece (OSCAR-GR). Int J Cardiol 2016; 205:111-116. [DOI: 10.1016/j.ijcard.2015.10.180] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Revised: 10/22/2015] [Accepted: 10/24/2015] [Indexed: 11/23/2022]
|
30
|
|
31
|
Zhang C, Liu X, Wang X, Wang Q, Zhang Y, Ge Z. Efficacy of Enhanced External Counterpulsation in Patients With Chronic Refractory Angina on Canadian Cardiovascular Society (CCS) Angina Class: An Updated Meta-Analysis. Medicine (Baltimore) 2015; 94:e2002. [PMID: 26632696 PMCID: PMC5058965 DOI: 10.1097/md.0000000000002002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
A growing number of patients with chronic artery disease suffer from angina, despite the optimal medical management (ie, β-blockers, calcium channel blockers, and long-acting nitrates) and revascularization. Currently, enhanced external counterpulsation (EECP) therapy has been verified as a noninvasive, safe therapy for refractory angina. The study was designed to evaluate the efficacy of EECP in patients with chronic refractory angina according to Canadian Cardiovascular Society (CCS) angina class.We identified systematic literature through MEDLINE, EMBASE, the Cochrane Clinical Trials Register Database, and the ClinicalTrials. gov Website from 1990 to 2015. Studies were considered eligible if they were prospective and reported data on CCS class before and after EECP treatment. Meta-analysis was performed to assess the efficacy of EECP therapy by at least 1 CCS angina class improvement, and proportion along with the 95% confidence interval (CI) was calculated. Statistical heterogeneity was calculated by I statistic and the Q statistic. Sensitivity analysis was addressed to test the influence of trials on the overall pooled results. Subgroup analysis was applied to explore potential reasons for heterogeneity.Eighteen studies were enrolled in our meta-analysis. Pooled analysis showed 85% of patients underwent EECP had a reduction by at least one CCS class (95%CI 0.81-0.88, I = 58.5%, P < 0.001). The proportion of patients enrolled at primarily different studies with chronic heart failure (CHF) improved by at least 1 CCS class was about 84% after EECP (95%CI 0.81-0.88, I = 32.7%, P = 0.1668). After 3 large studies were excluded, the pooled proportion was 82% (95%CI 0.79-0.86, I = 18%, P = 0.2528). Funnel plot indicated that some asymmetry while the Begg and Egger bias statistic showed no publication bias (P = 0.1495 and 0.2859, respectively).Our study confirmed that EECP provided an effective treatment for patients who were unresponsive to medical management and/or invasive therapy. However, the long-term benefits of EECP therapy needed further studies to evaluate in the management of chronic refractory angina.
Collapse
Affiliation(s)
- Chunmei Zhang
- From the Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education and Chinese Ministry of Health, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | | | | | | | | | | |
Collapse
|
32
|
Nardi Gomes TJ, Martins de Albuquerque I, de Moraes Costa P, Cardoso DM, de Moraes Costa G, da Costa Vieira JL. Association between the ankle-brachial index, intermittent claudication, and physical activity level: what is the influence on the functional capacity of patients with or at high risk of cardiovascular disease? Int J Gen Med 2015; 8:55-62. [PMID: 25670912 PMCID: PMC4315558 DOI: 10.2147/ijgm.s76446] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Patients with or at high risk of cardiovascular disease have a poor functional capacity; however, the influence of association among intermittent claudication (IC), abnormal ankle–brachial index (ABI), and physical activity level on functional capacity of these patients has not been fully studied. Objective The primary objective of this study was to investigate the association between the ABI, IC, and physical activity level, and the influence of these variables on the functional capacity of patients with or at high risk of cardiovascular disease seen in a reference cardiology outpatient clinic in Southern Brazil. The secondary objective was to assess the prevalence of peripheral arterial disease (PAD) in this sample of patients. Patients and methods This was a prospective cross-sectional study in which 162 consecutive patients were evaluated and classified into three groups according to their ABI: normal ABI (n=104, values between 1.00 and 1.40); borderline PAD (n=23, values between 0.91 and 1.00); and patients with PAD (n=35, ≤0.90). The presence of IC was assessed using the Edinburgh Claudication Questionnaire. The level of physical activity was assessed by the short version of the International Physical Activity Questionnaire (IPAQ) and functional capacity was assessed by the 6-minute walk distance (6MWD). Results The prevalence of PAD was 21.6% in the total sample. The 6MWD showed strong correlation with the absence of IC (r=0.785; P<0.001), moderate correlation with age (r=−0.347; P<0.001), and weak correlations with IPAQ scores (r=0.164; P=0.038) and ABI (r=0.216; P=0.006). Age, ABI, and absence of IC were independently associated with the outcome (P=0.001, P=0.001, and P=0.028, respectively). Conclusion The current study demonstrates that 6MWD is associated with IPAQ scores, ABI, and absence of IC. Age, ABI and absence of IC were independently associated with functional capacity in patients with or at high risk of cardiovascular disease.
Collapse
Affiliation(s)
- Tiago José Nardi Gomes
- Department of Physiotherapy, UNIFRA, Centro Universitário Franciscano, Santa Maria, RS, Brazil
| | | | | | - Dannuey Machado Cardoso
- Department of Physiotherapy, Universidade de Santa Cruz do Sul, Santa Cruz do Sul, RS, Brazil
| | | | | |
Collapse
|
33
|
Froehner M, Kellner AE, Koch R, Baretton GB, Hakenberg OW, Wirth MP. A combined index to classify prognostic comorbidity in candidates for radical prostatectomy. BMC Urol 2014; 14:28. [PMID: 24678762 PMCID: PMC3986600 DOI: 10.1186/1471-2490-14-28] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2013] [Accepted: 03/18/2014] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND In patients with early prostate cancer, stratification by comorbidity could be of importance in clinical decision making as well as in characterizing patients enrolled into clinical trials. In this study, we investigated several comorbidity classifications as predictors of overall mortality after radical prostatectomy, searching for measures providing complementary prognostic information which could be combined into a single score. METHODS The study sample consisted of 2205 consecutive patients selected for radical prostatectomy with a mean age of 64 years and a mean follow-up of 9.2 years (median: 8.6). Seventy-four patients with incomplete tumor-related data were excluded. In addition to age and tumor-related parameters, six comorbidity classifications and the body mass index were assessed as possible predictors of overall mortality. Kaplan-Meier curves and Mantel-Haenszel hazard ratios were used for univariate analysis. The impact of different causes of death was analyzed by competing risk analysis. Cox proportional hazard models were calculated to analyze combined effects of variables. RESULTS Age, Gleason score, tumor stage, Charlson score, American Society of Anesthesiologists (ASA) physical status class and body mass index were identified a significant predictors of overall mortality in the multivariate analysis regardless whether two-sided and three-sided stratifications were used. Competing risk analysis revealed that the excess mortality in patients with a body mass index of 30 kg/m2 or higher was attributable to competing mortality including second cancers, but not to prostate cancer mortality. CONCLUSION Stratifying patients by a combined consideration of the comorbidity measures Charlson score, ASA classification and body mass index may assist clinical decision making in elderly candidates for radical prostatectomy.
Collapse
Affiliation(s)
- Michael Froehner
- Departments of Urology, University Hospital “Carl Gustav Carus”, Technische Universität Dresden, Dresden, Fetscherstrasse 74, D-01307 Dresden, Germany
| | - Anna-Elisa Kellner
- Departments of Urology, University Hospital “Carl Gustav Carus”, Technische Universität Dresden, Dresden, Fetscherstrasse 74, D-01307 Dresden, Germany
| | - Rainer Koch
- Department of Medical Statistics and Biometry, University Hospital “Carl Gustav Carus”, Technische Universität Dresden, Dresden, Fetscherstrasse 74, D-01307 Dresden, Germany
| | - Gustavo B Baretton
- Department of Pathology, University Hospital “Carl Gustav Carus”, Technische Universität Dresden, Fetscherstrasse 74, D-01307 Dresden, Germany
| | - Oliver W Hakenberg
- Department of Urology, University of Rostock, Ernst-Heydemann-Strasse 6, D-18055 Rostock, Germany
| | - Manfred P Wirth
- Departments of Urology, University Hospital “Carl Gustav Carus”, Technische Universität Dresden, Dresden, Fetscherstrasse 74, D-01307 Dresden, Germany
| |
Collapse
|
34
|
Fan X, Lee KS, Frazier SK, Lennie TA, Moser DK. Psychometric testing of the Duke Activity Status Index in patients with heart failure. Eur J Cardiovasc Nurs 2014; 14:214-21. [PMID: 24504873 DOI: 10.1177/1474515114523354] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2013] [Accepted: 01/20/2014] [Indexed: 11/17/2022]
Abstract
BACKGROUND Patients with heart failure (HF) experience difficulty performing activities of daily living. As impaired functional status is adversely associated with outcomes, it is important to accurately evaluate patient functional status. The Duke Activity Status Index (DASI) is a 12-item, self-administered questionnaire to measure functional status. However, its psychometric properties have not been determined in patients with HF. The purpose of this study was to examine the psychometric properties of the DASI in patients with HF. METHODS AND RESULTS We used data from 297 patients with a diagnosis of HF (age 61±11 years, 31% female) for psychometric testing. Internal consistency reliability of the DASI was high (Cronbach's alpha=0.86). Criterion-related validity was supported by significantly different DASI scores for each New York Heart Association classification. Construct validity was supported by significant correlation of DASI scores with health-related quality of life (r = -0.64), depressive symptoms (r = -0.44), and N-terminal B-type natriuretic peptide (r = -0.14). CONCLUSION Our data support the psychometric properties of the DASI as a measure of functional status in patients with HF. This instrument can be used to evaluate functional status and enhance health care provider understanding of functional status related to daily living from the patient perspective.
Collapse
|
35
|
Dagenais GR, Lu J, Faxon DP, Bogaty P, Adler D, Fuentes F, Escobedo J, Krishnaswami A, Slater J, Frye RL. Prognostic impact of the presence and absence of angina on mortality and cardiovascular outcomes in patients with type 2 diabetes and stable coronary artery disease: results from the BARI 2D (Bypass Angioplasty Revascularization Investigation 2 Diabetes) trial. J Am Coll Cardiol 2013; 61:702-11. [PMID: 23410541 DOI: 10.1016/j.jacc.2012.11.036] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2012] [Revised: 10/30/2012] [Accepted: 11/08/2012] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The purpose of this analysis was to assess in patients with type 2 diabetes and stable coronary artery disease (CAD) whether the risk of all-cause mortality and cardiovascular events varied according to the presence or absence of angina and angina equivalent symptoms. BACKGROUND Data on the prognostic value of symptoms in these patients are limited. METHODS Post-hoc analysis was performed in 2,364 patients with type 2 diabetes and documented CAD enrolled in the BARI 2D (Bypass Angioplasty Revascularization Investigation 2 Diabetes) trial to determine the occurrence of death and composite of death, myocardial infarction, and stroke during a 5-year follow-up according to cardiac symptoms at baseline. RESULTS There were 1,434 patients with angina (A), 506 with angina equivalents (E), and 424 with neither of these (N). The cumulative death rates (total 316) were 12% in A, 14% in E, and 10% in N (p = 0.3), and cardiovascular composite rates (total 548) were 24% in A, 24% in E, and 21% in N (p = 0.5). Compared with N, the hazard ratios adjusted for confounders were not different for death in A (1.11; 99% CI: 0.81 to 1.53) and E (1.17; 99% CI: 0.81 to 1.68) or for cardiovascular events in A (1.17; 99% CI: 0.92 to 1.50) and E (1.11; 99% CI: 0.84 to 1.48). CONCLUSIONS Whatever their symptom status, patients with type 2 diabetes and stable CAD were at similar risk of cardiovascular events and death. These findings suggest that these patients may be similarly managed in terms of risk stratification and preventive therapies. (Bypass Angioplasty Revascularization Investigation 2 Diabetes [BARI 2D]; NCT00006305).
Collapse
Affiliation(s)
- Gilles R Dagenais
- Quebec Heart and Lung University Institute, Quebec City, Quebec, Canada.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
36
|
Yang X, Gai L, Dong W, Liu H, Sun Z, Tian F, Chen Y. Characterization of culprit lesions in acute coronary syndromes compared with stable angina pectoris by dual-source computed tomography. Int J Cardiovasc Imaging 2012; 29:945-53. [PMID: 23224436 DOI: 10.1007/s10554-012-0165-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2012] [Accepted: 11/28/2012] [Indexed: 10/27/2022]
Abstract
To identify the characterization of culprit lesions in acute coronary syndrome (ACS) compared with stable angina pectoris (SAP) by dual-source computed tomography (DSCT). 65 patients with ACS and 75 controls with SAP and a similar atherosclerotic risk profile were studied. Computed tomography (CT) coronary angiography was performed using a DSCT scanner before invasive catheterization. Using DSCT and quantitative coronary angiography (QCA), lesion characteristics [luminal cross-section area (L-CSA), vascular cross-section area (V-CSA), plaque area and degree of stenosis) were detected. Plaque types, mean and minimum CT density (Hounsfield Unit; HU), remodeling index, and presence of "spotty" calcifications were analyzed using DSCT. A good correlation was observed between DSCT and QCA for all lesion characteristics (P < 0.05). Culprit lesions in ACS had much larger V-CSA (20.5 ± 6.0 vs. 14.8 ± 4.8 mm(2)), plaque area (15.3 ± 5.0 vs. 11.1 ± 3.3 mm(2)) and remodeling index (1.3 ± 0.2 vs. 1.0 ± 0.4) than stable lesions in SAP (P < 0.05). The prevalence of non-calcified/calcified/mixed plaque was 30/0/35 in ACS versus 25/15/35 stable lesions in SAP (P < 0.01). The proportion of "spotty" calcified plaques was 21.5 % in culprit lesions (14 of 65) versus 1.3 % in SAP (1 of 75). The mean/minimum HU of culprit lesions was 88.6 ± 43.2/154.2 ± 98.7 in ACS versus 45.9 ± 34.7/98.2 ± 76.8 in SAP (both P < 0.01). DSCT is a feasible means of detecting coronary stenosis with good accuracy compared with QCA. Culprit lesions in ACS display a greater proportion of non-calcified material with lower CT attenuation, "spotty" calcifications and higher remodeling index compared with SAP lesions.
Collapse
Affiliation(s)
- Xia Yang
- Department of Cardiology, Chinese PLA General Hospital, Beijing 100853, China
| | | | | | | | | | | | | |
Collapse
|