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Yancy CW. Heart Failure in African American Individuals, Version 2.0. JAMA 2024; 331:1807-1808. [PMID: 38734951 DOI: 10.1001/jama.2024.5217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/13/2024]
Affiliation(s)
- Clyde W Yancy
- Division of Cardiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
- Deputy Editor, JAMA Cardiology
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Dawson LP, Carrington MJ, Haregu T, Nanayakkara S, Jennings G, Dart A, Stub D, Inouye M, Kaye D. Ten-Year Risk Equations for Incident Heart Failure in Established Atherosclerotic Cardiovascular Disease Populations. J Am Heart Assoc 2024; 13:e034254. [PMID: 38780153 DOI: 10.1161/jaha.124.034254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Accepted: 04/29/2024] [Indexed: 05/25/2024]
Abstract
BACKGROUND Ten-year risk equations for incident heart failure (HF) are available for the general population, but not for patients with established atherosclerotic cardiovascular disease (ASCVD), which is highly prevalent in HF cohorts. This study aimed to develop and validate 10-year risk equations for incident HF in patients with known ASCVD. METHODS AND RESULTS Ten-year risk equations for incident HF were developed using the United Kingdom Biobank cohort (recruitment 2006-2010) including participants with established ASCVD but free from HF at baseline. Model performance was validated using the Australian Baker Heart and Diabetes Institute Biobank cohort (recruitment 2000-2011) and compared with the performance of general population risk models. Incident HF occurred in 13.7% of the development cohort (n=31 446, median 63 years, 35% women, follow-up 10.7±2.7 years) and in 21.3% of the validation cohort (n=1659, median age 65 years, 25% women, follow-up 9.4±3.7 years). Predictors of HF included in the sex-specific models were age, body mass index, systolic blood pressure (treated or untreated), glucose (treated or untreated), cholesterol, smoking status, QRS duration, kidney disease, myocardial infarction, and atrial fibrillation. ASCVD-HF equations had good discrimination and calibration in development and validation cohorts, with superior performance to general population risk equations. CONCLUSIONS ASCVD-specific 10-year risk equations for HF outperform general population risk models in individuals with established ASCVD. The ASCVD-HF equations can be calculated from readily available clinical data and could facilitate screening and preventative treatment decisions in this high-risk group.
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Affiliation(s)
- Luke P Dawson
- Department of Cardiology The Alfred Hospital Melbourne Victoria Australia
- Faculty of Medicine Monash University Melbourne Victoria Australia
- Baker Heart and Diabetes Institute Melbourne Victoria Australia
| | | | - Tilahun Haregu
- Department of Cardiology The Alfred Hospital Melbourne Victoria Australia
- Baker Heart and Diabetes Institute Melbourne Victoria Australia
| | - Shane Nanayakkara
- Department of Cardiology The Alfred Hospital Melbourne Victoria Australia
- Baker Heart and Diabetes Institute Melbourne Victoria Australia
| | - Garry Jennings
- Department of Cardiology The Alfred Hospital Melbourne Victoria Australia
- Faculty of Medicine Monash University Melbourne Victoria Australia
- Baker Heart and Diabetes Institute Melbourne Victoria Australia
| | - Anthony Dart
- Department of Cardiology The Alfred Hospital Melbourne Victoria Australia
- Baker Heart and Diabetes Institute Melbourne Victoria Australia
| | - Dion Stub
- Department of Cardiology The Alfred Hospital Melbourne Victoria Australia
- Faculty of Medicine Monash University Melbourne Victoria Australia
- Baker Heart and Diabetes Institute Melbourne Victoria Australia
| | - Michael Inouye
- Baker Heart and Diabetes Institute Melbourne Victoria Australia
- Department of Public Health & Primary Care University of Cambridge Cambridge UK
| | - David Kaye
- Department of Cardiology The Alfred Hospital Melbourne Victoria Australia
- Faculty of Medicine Monash University Melbourne Victoria Australia
- Baker Heart and Diabetes Institute Melbourne Victoria Australia
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3
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Jia Y, Cui N, Jia T, Song J. Prognostic models for patients suffering a heart failure with a preserved ejection fraction: a systematic review. ESC Heart Fail 2024; 11:1341-1351. [PMID: 38318693 PMCID: PMC11098651 DOI: 10.1002/ehf2.14696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Revised: 01/02/2024] [Accepted: 01/09/2024] [Indexed: 02/07/2024] Open
Abstract
The purpose of this study was to systematically review the development, performance, and applicability of prognostic models developed for predicting poor events in patients with heart failure with preserved ejection fraction (HFpEF). Databases including Embase, PubMed, Web of Science Core Collection, the Cochrane Library, China National Knowledge Infrastructure, Wan Fang, Wei Pu, and China Biological Medicine were queried from their respective dates of inception to 1 June 2023, to examine multivariate models for prognostic prediction in HFpEF. Both forward and backward citations of all studies were included in our analysis. Two researchers individually used the Critical Appraisal and Data Extraction for Systematic Reviews of Prediction Modelling Studies (CHARMS) checklist to extract data and assess the quality of the models using the Predictive Mode Bias Risk Assessment Tool (PROBAST). Among the 6897 studies screened, 16 studies derived and/or validated a total of 39 prognostic models. The sample size ranges for model development, internal validation, and external validation are 119 to 5988, 152 to 1000, and 30 to 5957, respectively. The most frequently employed modelling technique was Cox proportional hazards regression. Six studies (37.50%) conducted internal validation of models; bootstrap and k-fold cross-validation were the commonly used methods for internal validation of models. Ten of these models (25.64%) were validated externally, with reported the c-statistic in the external validation set ranging from 0.70 to 0.96, while the remaining models await external validation. The MEDIA echo score and I-PRESERVE-sudden cardiac death prediction mode have been externally validated using multiple cohorts, and the results consistently show good predictive performance. The most frequently used predictors identified among the models were age, n-terminal pro-brain natriuretic peptide, ejection fraction, albumin, and hospital stay in the last 5 months owing to heart failure. All study predictor domains and outcome domains were at low risk of bias, high or unclear risk of bias of all prognostic models due to underreporting in the area of analysis. All studies did not evaluate the clinical utility of the prognostic models. Predictive models for predicting prognostic outcomes in patients with HFpEF showed good discriminatory ability but their utility and generalization remain uncertain due to the risk of bias, differences in predictors between models, and the lack of clinical application studies. Future studies should improve the methodological quality of model development and conduct external validation of models.
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Affiliation(s)
- Ying‐Ying Jia
- Department of NursingThe Second Affiliated Hospital of Zhejiang University School of MedicineHangzhouChina
- Department of NursingZhejiang University School of MedicineHangzhouChina
| | - Nian‐Qi Cui
- School of NursingKunming Medical UniversityKunmingChina
| | - Ting‐Ting Jia
- Department of General SurgeryGansu Provincial People's Hospital, Cadre WardLanzhouChina
| | - Jian‐Ping Song
- Department of NursingThe Second Affiliated Hospital of Zhejiang University School of MedicineHangzhouChina
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Spahillari A, Jackson L, Varrias D, Michelhaugh SA, Januzzi JL, Shahideh B, Daghfal D, Valkov N, Murtagh G, Das S. MicroRNAs are associated with cardiac biomarkers, cardiac structure and function and incident outcomes in heart failure. ESC Heart Fail 2024; 11:1400-1410. [PMID: 38321808 PMCID: PMC11098646 DOI: 10.1002/ehf2.14649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 12/09/2023] [Accepted: 12/11/2023] [Indexed: 02/08/2024] Open
Abstract
AIMS The association between microRNAs (miRNAs) and established cardiac biomarkers is largely unknown. We aimed to measure the association between plasma miRNAs and N-terminal pro-B-type natriuretic peptide (NT-proBNP), cardiac troponin I, soluble urokinase-type plasminogen activator receptor (suPAR), and galectin-3 with cardiac structure and function and clinical outcomes. METHODS AND RESULTS We quantified 32 plasma miRNAs using the FirePlex miRNA assay and measured biomarkers in 139 individuals with symptomatic heart failure (HF). We used principal component (PC) analysis and linear regression to evaluate the association between miRNAs and biomarkers with ventricular size and function by echocardiography and Cox modelling for the incidence of a first composite event of HF hospitalization, heart transplant, left ventricular assist device implant, or death. The mean (standard deviation) age at baseline was 64.3 (12.4) years, 33 (24%) were female, and 122 (88%) were White. A total of 45 events occurred over a median follow-up of 368 (interquartile range 234, 494) days. Baseline NT-proBNP (β = -2.0; P = 0.001) and miRNA PC2 (β = 2.6; P = 0.002) were associated with baseline left ventricular ejection fraction. NT-proBNP (β = 20.6; P = 0.0004), suPAR (β = -39.6; P = 0.005), and PC4 (β = 21.1; P = 0.02) were associated with baseline left ventricular end-diastolic volumes. NT-proBNP [hazard ratio (HR) 1.67, 95% confidence interval (CI) 1.28-2.18, P = 0.0002], galectin-3 (HR 2.02, 95% CI 1.05-3.91, P = 0.036), PC3 (HR 1.75, 95% CI 1.23-2.49, P = 0.002), and PC4 (HR 1.67, 95% CI 1.1-2.52, P = 0.016) were independently associated with incident events. CONCLUSIONS Biomarkers and miRNA PCs are associated with cardiac structure and function and incident cardiovascular outcomes. Combining information from miRNAs provides prognostic information beyond biomarkers in HF.
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Affiliation(s)
| | - Laurel Jackson
- Abbott Core DiagnosticsAbbott LaboratoriesAbbott ParkILUSA
| | | | | | - James L. Januzzi
- Department of Medicine, Division of CardiologyMassachusetts General Hospital, Harvard Medical School55 Fruit StBostonMA02114USA
| | - Bobby Shahideh
- Abbott Core DiagnosticsAbbott LaboratoriesAbbott ParkILUSA
| | - David Daghfal
- Abbott Core DiagnosticsAbbott LaboratoriesAbbott ParkILUSA
| | - Nedyalka Valkov
- Department of Medicine, Division of CardiologyMassachusetts General Hospital, Harvard Medical School55 Fruit StBostonMA02114USA
| | | | - Saumya Das
- Department of Medicine, Division of CardiologyMassachusetts General Hospital, Harvard Medical School55 Fruit StBostonMA02114USA
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Shi Y, Dong S, Xu Y, Ji D, Yang L, Zhao R. Acute kidney injury events in patients with diabetes using sodium glucose transporter 2 inhibitors: a meta-analysis of cohort studies. Acta Diabetol 2024; 61:755-764. [PMID: 38441621 DOI: 10.1007/s00592-024-02252-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 02/01/2024] [Indexed: 05/18/2024]
Abstract
AIMS To conduct a meta-analysis of cohort studies to explore the association between acute kidney injury (AKI) and the effect of sodium glucose transporter 2 inhibitors (SGLT2 inhibitors) in patients with type 2 diabetes mellitus (T2DM). MATERIALS AND METHODS PubMed, Embase, the Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov were comprehensively searched for eligible studies until April 4, 2023 on the association between AKI and use of SGLT2 inhibitors in T2DM patients. Odds ratios (ORs) and their 95% confidence intervals (CIs) were pooled using the Mantel-Haenszel method. RESULTS A total of 10 cohort studies (20 cohorts) and 526,863 participants were included in the meta-analysis. Compared with other glucose-lowering drugs (oGLDs), SGLT2 inhibitors were associated with a decreased risk of AKI (OR = 0.50, 95% CI 0.38-0.66, I2 = 96%). Meanwhile, SGLT2 inhibitors demonstrated a significant reduction in the incidence of AKI hospitalization compared with oGLDs (OR = 0.54, 95% CI 0.43-0.68, I2 = 92.0%). The result was consistent across different subgroups, and was robust to sensitivity analysis. CONCLUSIONS Compared with oGLDs, SGLT2 inhibitors reduced the risk of suffering AKI and AKI hospitalization in the real-world setting. Vigilance to the occurrence of AKI should not be an obstacle to discourage clinicians from prescribing SGLT2 inhibitors.
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Affiliation(s)
- Yanjing Shi
- Department of Pharmacy, Peking University Third Hospital, No.49 Huayuan North Road, Haidian District, Beijing, 100191, China
- Department of Pharmacy, The Affiliated Hospital of Chengde Medical College, Chengde, Hebei Province, China
| | - Shujie Dong
- Department of Pharmacy, Peking University Third Hospital, No.49 Huayuan North Road, Haidian District, Beijing, 100191, China
| | - Yang Xu
- Peking University Clinical Research Institute, Peking University First Hospital, Beijing, China
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden
| | - Dongze Ji
- Peking University Clinical Research Institute, Peking University First Hospital, Beijing, China
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden
| | - Li Yang
- Department of Pharmacy, Peking University Third Hospital, No.49 Huayuan North Road, Haidian District, Beijing, 100191, China
| | - Rongsheng Zhao
- Department of Pharmacy, Peking University Third Hospital, No.49 Huayuan North Road, Haidian District, Beijing, 100191, China.
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Aradhyula V, Vyas R, Dube P, Haller ST, Gupta R, Maddipati KR, Kennedy DJ, Khouri SJ. Novel insights into the pathobiology of pulmonary hypertension in heart failure with preserved ejection fraction. Am J Physiol Heart Circ Physiol 2024; 326:H1498-H1514. [PMID: 38639739 DOI: 10.1152/ajpheart.00068.2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Revised: 04/01/2024] [Accepted: 04/15/2024] [Indexed: 04/20/2024]
Abstract
Heart failure (HF) with preserved ejection fraction (HFpEF) is the most common cause of pulmonary hypertension (PH) worldwide and is strongly associated with adverse clinical outcomes. The American Heart Association recently highlighted a call to action regarding the distinct lack of evidence-based treatments for PH due to poorly understood pathophysiology of PH attributable to HFpEF (PH-HFpEF). Prior studies have described cardiophysiological mechanisms to explain the development of isolated postcapillary PH (ipc-PH); however, the consequent increase in pulmonary vascular (PV) resistance (PVR) may lead to the less understood and more fatal combined pre- and postcapillary PH (cpc-PH). Metabolic disease and inflammatory dysregulation have been suggested to predispose PH, yet the molecular mechanisms are unknown. Although PH-HFpEF has been studied to partly share vasoactive neurohormonal mediators with primary pulmonary arterial hypertension (PAH), clinical trials that have targeted these pathways have been unsuccessful. The increased mortality of patients with PH-HFpEF necessitates further study into viable mechanistic targets involved in disease progression. We aim to summarize the current pathophysiological and clinical understanding of PH-HFpEF, highlight the role of known molecular mechanisms in the progression of PV disease, and introduce a novel concept that lipid metabolism may be attenuating and propagating PH-HFpEF.NEW & NOTEWORTHY Our review addresses pulmonary hypertension (PH) attributable to heart failure (HF) with preserved ejection fraction (HFpEF; PH-HFpEF). Current knowledge gaps in PH-HFpEF pathophysiology have led to a lack of therapeutic targets. Thus, we address identified knowledge gaps in a comprehensive review, focusing on current clinical epidemiology, known pathophysiology, and previously studied molecular mechanisms. We also introduce a comprehensive review of polyunsaturated fatty acid (PUFA) lipid inflammatory mediators in PH-HFpEF.
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Affiliation(s)
- Vaishnavi Aradhyula
- Department of Medicine, University of Toledo College of Medicine and Life Sciences, Toledo, Ohio, United States
| | - Rohit Vyas
- Department of Medicine, University of Toledo College of Medicine and Life Sciences, Toledo, Ohio, United States
| | - Prabhatchandra Dube
- Department of Medicine, University of Toledo College of Medicine and Life Sciences, Toledo, Ohio, United States
| | - Steven T Haller
- Department of Medicine, University of Toledo College of Medicine and Life Sciences, Toledo, Ohio, United States
| | - Rajesh Gupta
- Department of Medicine, University of Toledo College of Medicine and Life Sciences, Toledo, Ohio, United States
| | - Krishna Rao Maddipati
- Department of Pathology, Lipidomics Core Facility, Wayne State University, Detroit, Michigan, United States
| | - David J Kennedy
- Department of Medicine, University of Toledo College of Medicine and Life Sciences, Toledo, Ohio, United States
| | - Samer J Khouri
- Department of Medicine, University of Toledo College of Medicine and Life Sciences, Toledo, Ohio, United States
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Ramalho SHR, de Albuquerque ALP. Chronic Obstructive Pulmonary Disease in Heart Failure: Challenges in Diagnosis and Treatment for HFpEF and HFrEF. Curr Heart Fail Rep 2024; 21:163-173. [PMID: 38546964 DOI: 10.1007/s11897-024-00660-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/20/2024] [Indexed: 05/14/2024]
Abstract
PURPOSE OF REVIEW Chronic obstructive pulmonary disease (COPD) is common in heart failure (HF), and it has a significant impact on the prognosis and quality of life of patients. Additionally, COPD is independently associated with lower adherence to first-line HF therapies. In this review, we outline the challenges of identifying and managing HF with preserved (HFpEF) and reduced (HFrEF) ejection fraction with coexisting COPD. RECENT FINDINGS Spirometry is necessary for COPD diagnosis and prognosis but is underused in HF. Therefore, misdiagnosis is a concern. Also, disease-modifying drugs for HF and COPD are usually safe but underprescribed when HF and COPD coexist. Patients with HF-COPD are poorly enrolled in clinical trials. Guidelines recommend that HF treatment should be offered regardless of COPD presence, but modern registries show that undertreatment persists. Treatment gaps could be attenuated by ensuring an accurate and earlier COPD diagnosis in patients with HF, clarifying the concerns related to pharmacotherapy safety, and increasing the use of non-pharmacologic treatments. Acknowledging the uncertainties, this review aims to provide key clinical resources to support better physician-patient co-decision-making and improve collaboration between health professionals.
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Affiliation(s)
- Sergio Henrique Rodolpho Ramalho
- Clinical Research Center, Hospital Brasília/DASA, Brasília, DF, Brazil.
- School of Medicine, UniCeub, Centro Universitário de Brasília, Brasília, DF, Brazil.
| | - André Luiz Pereira de Albuquerque
- Pulmonary Division, Heart Institute (InCor), Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
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Guan L, Wang CH, Sun H, Sun ZJ. Development and validation of a nomogram model for all-cause mortality risk in patients with chronic heart failure and atrial fibrillation. BMC Geriatr 2024; 24:470. [PMID: 38811919 PMCID: PMC11138095 DOI: 10.1186/s12877-024-05059-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Accepted: 05/08/2024] [Indexed: 05/31/2024] Open
Abstract
BACKGROUND As the global aging process continues to accelerate, heart failure (HF) has become an important cause of increased morbidity and mortality in elderly patients. Chronic atrial fibrillation (AF) is a major risk factor for HF. Patients with HF combined with AF are more difficult to treat and have a worse prognosis. The aim of this study was to explore the risk factors for 1-year mortality in patients with HF combined with AF and to develop a risk prediction assessment model. METHODS We recruited hospitalized patients with HF and AF who received standardized care in the Department of Cardiology at Shengjing Hospital of China Medical University from January 2013 to December 2018. The patients were randomly divided into modeling and internal validation groups using a random number generator at a 1:1 ratio. Multivariate Cox regression analysis was used to identify risk factors for all-cause mortality during a one-year follow-up period. Then, a nomogram was constructed based on the weights of each index and validated. Receiver operating characteristic curve, the area under the curve (AUC), decision curve, and calibration curve analyses for survival were used to evaluate the model's predictive and clinical validities and calibration. RESULTS We included 3,406 patients who met the eligibility criteria; 1,703 cases each were included in the modeling and internal validation groups. Eight statistically significant predictors were identified: age, sex, New York Heart Association cardiac function class III or IV, a history of myocardial infarction, and the albumin, triglycerides, N-terminal pro-b-type natriuretic peptide, and blood urea nitrogen levels. The AUCs were 0.793 (95% confidence interval: 0.763-0.823) and 0.794 (95% confidence interval: 0.763-0.823) in the modeling and validation cohorts, respectively. CONCLUSIONS We present a predictive model for all-cause mortality in patients with coexisting HF and AF comprising eight key factors. This model gives clinicians a simple assessment tool that may improve the clinical management of these patients.
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Affiliation(s)
- Lin Guan
- Department of Cardiology, Shengjing Hospital of China Medical University, 39 Huaxiang Road, Tiexi Zone, Shenyang, 110022, China
| | - Chuan-He Wang
- Department of Cardiology, Shengjing Hospital of China Medical University, 39 Huaxiang Road, Tiexi Zone, Shenyang, 110022, China
| | - Hao Sun
- Department of Clinical Epidemiology and Evidence-Based Medicine, the First Hospital of China Medical University, Shenyang, 110001, China.
| | - Zhi-Jun Sun
- Department of Cardiology, Shengjing Hospital of China Medical University, 39 Huaxiang Road, Tiexi Zone, Shenyang, 110022, China.
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Li J, Chen L, Wang L. Impact of Different Exercise Modalities on Physical Function and Quality of Life in Patients with Heart Failure. J Multidiscip Healthc 2024; 17:2551-2559. [PMID: 38803616 PMCID: PMC11129744 DOI: 10.2147/jmdh.s465578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Accepted: 05/07/2024] [Indexed: 05/29/2024] Open
Abstract
Heart failure, a chronic condition, often manifests with reduced physical function and an overall decline in quality of life. It is considered critical that patients with heart failure recover as soon as possible; exercise training, which includes aerobic exercise, resistance exercise, inspiratory muscle training, traditional mind-body exercise, and combined training, facilitates this. The research progress on the impact of various exercise modalities on the physical function and quality of life of patients with heart failure is systematically reviewed in this article. The objective is to augment the understanding of healthcare personnel regarding the status of implementation and outcomes associated with varied exercise modalities. This endeavor seeks to provide a point of reference for the development of exercise rehabilitation programs tailored to individuals contending with heart failure.
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Affiliation(s)
- Jiangying Li
- Department of Cardiology, The Affiliated Taizhou People’s Hospital of Nanjing Medical University, Taizhou School of Clinical Medicine, Nanjing Medical University, Taizhou, 225300, People’s Republic of China
| | - Lu Chen
- Department of Emergency, The Affiliated Taizhou People’s Hospital of Nanjing Medical University, Taizhou School of Clinical Medicine, Nanjing Medical University, Taizhou, 225300, People’s Republic of China
| | - Lichun Wang
- Department of Nursing, The Affiliated Taizhou People’s Hospital of Nanjing Medical University, Taizhou School of Clinical Medicine, Nanjing Medical University, Taizhou, 225300, People’s Republic of China
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Cheng RK, Kittleson MM, Beavers CJ, Birnie DH, Blankstein R, Bravo PE, Gilotra NA, Judson MA, Patton KK, Rose-Bovino L. Diagnosis and Management of Cardiac Sarcoidosis: A Scientific Statement From the American Heart Association. Circulation 2024; 149:e1197-e1216. [PMID: 38634276 DOI: 10.1161/cir.0000000000001240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/19/2024]
Abstract
Cardiac sarcoidosis is an infiltrative cardiomyopathy that results from granulomatous inflammation of the myocardium and may present with high-grade conduction disease, ventricular arrhythmias, and right or left ventricular dysfunction. Over the past several decades, the prevalence of cardiac sarcoidosis has increased. Definitive histological confirmation is often not possible, so clinicians frequently face uncertainty about the accuracy of diagnosis. Hence, the likelihood of cardiac sarcoidosis should be thought of as a continuum (definite, highly probable, probable, possible, low probability, unlikely) rather than in a binary fashion. Treatment should be initiated in individuals with clinical manifestations and active inflammation in a tiered approach, with corticosteroids as first-line treatment. The lack of randomized clinical trials in cardiac sarcoidosis has led to treatment decisions based on cohort studies and consensus opinions, with substantial variation observed across centers. This scientific statement is intended to guide clinical practice and to facilitate management conformity by providing a framework for the diagnosis and management of cardiac sarcoidosis.
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Wei L, Laukkanen JA, Li Y, Chen X, Li G. Association of High apoB/apoA1 Ratio with Increased Erythrocytes, Platelet/Lymphocyte Ratio, D-dimer, Uric Acid and Cardiac Remodeling in Elderly Heart Failure Patients: A Retrospective Study. Int J Gen Med 2024; 17:2151-2161. [PMID: 38766597 PMCID: PMC11099934 DOI: 10.2147/ijgm.s465053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Accepted: 05/04/2024] [Indexed: 05/22/2024] Open
Abstract
Background Previous studies have confirmed that high apolipoprotein B/apolipoprotein A1 (apoB/apoA1) ratio was associated with increased mortality from heart failure (HF). Furthermore, the association of plasma apoB/apoA1 ratio with clinical characteristics and adverse cardiac remodeling is still limited in chronic HF with mildly reduced ejection fraction (HFmrEF) elderly patients. Therefore, this study investigated the association of apoB/apoA1 ratio with clinical characteristics and adverse cardiac remodeling in chronic HFmrEF elderly patients. Methods A total of 587 Chinese elderly (≥65 years) with coronary heart disease (CHD), HFmrEF (EF 40-50%) and related blood biochemical data were collected retrospectively. The cross-sectional data of echocardiographic and blood parameters were compared between binary apoB/apoA1 groups. Results In the elderly CHD patients with chronic HFmrEF, the univariate correlation analysis showed that apoB/apoA1 was correlated with younger age, increased prevalence of type 2 diabetes, erythrocytes, platelet/lymphocyte ratio (PLR), D-dimer, fibrinogen, high sensitivity C-reactive protein and uric acid, and adverse cardiac remodeling (All P < 0.05). However, multivariate logistic binary regression analysis found that high apoB/apoA1 ratio (≥0.62) was independently correlated with younger age, increased erythrocytes, PLR, D-dimer and uric acid, and adverse cardiac remodeling (All P < 0.05). Conclusion In this retrospective study, the high apoB/apoA1 ratio is found to be associated with younger age, increased erythrocytes, PLR, D-dimer and uric acid, and adverse cardiac remodeling in Chinese CHD elderly with chronic HFmrEF.
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Affiliation(s)
- Linping Wei
- Division of Cardiology, Department of Geriatrics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, People’s Republic of China
| | - Jari A Laukkanen
- Institute of Clinical Medicine, Department of Medicine, University of Eastern Finland, Kuopio, 70211, Finland
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, 70211, Finland
- Wellbeing Services County of Central Finland, Department of Medicine, Jyväskylä, 40620, Finland
| | - Yufeng Li
- Division of Cardiology, Department of Geriatrics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, People’s Republic of China
| | - Xinrui Chen
- Division of Cardiology, Department of Geriatrics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, People’s Republic of China
| | - Gang Li
- Division of Cardiology, Department of Geriatrics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, People’s Republic of China
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Hamel C, Avard B, Isaac N, Jassal D, Kirkpatrick I, Leipsic J, Michaud A, Worrall J, Nguyen ET. Canadian Association of Radiologists Cardiovascular Imaging Referral Guideline. Can Assoc Radiol J 2024:8465371241246425. [PMID: 38733286 DOI: 10.1177/08465371241246425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2024] Open
Abstract
The Canadian Association of Radiologists (CAR) Cardiovascular Expert Panel is made up of physicians from the disciplines of radiology, cardiology, and emergency medicine, a patient advisor, and an epidemiologist/guideline methodologist. After developing a list of 30 clinical/diagnostic scenarios, a rapid scoping review was undertaken to identify systematically produced referral guidelines that provide recommendations for one or more of these clinical/diagnostic scenarios. Recommendations from 48 guidelines and contextualization criteria in the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) for guidelines framework were used to develop 125 recommendation statements across the 30 scenarios (27 unique scenarios as 2 scenarios point to the CAR Thoracic Diagnostic Imaging Referral Guideline and the acute pericarditis subscenario is included under 2 main scenarios). This guideline presents the methods of development and the referral recommendations for acute chest pain syndromes, chronic chest pain, cardiovascular screening and risk stratification, pericardial syndromes, intracardiac/pericardial mass, suspected valvular disease cardiomyopathy, aorta, venous thrombosis, and peripheral vascular disease.
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Affiliation(s)
- Candyce Hamel
- Canadian Association of Radiologists, Ottawa, ON, Canada
| | - Barb Avard
- North York General Hospital, Toronto, ON, Canada
| | - Neil Isaac
- Department of Medical Imaging, North York General Hospital, Toronto, ON, Canada
| | - Davinder Jassal
- Section of Cardiology, Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences University of Manitoba, Bergen Cardiac Care Centre St. Boniface Hospital, Winnipeg, MB, Canada
| | - Iain Kirkpatrick
- Max Rady College of Medicine, University of Manitoba, St. Boniface Hospital, Winnipeg, MB, Canada
| | - Jonathon Leipsic
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | | | - James Worrall
- Department of Emergency Medicine, The Ottawa Hospital, Ottawa, ON, Canada
| | - Elsie T Nguyen
- University Medical Imaging Toronto, University of Toronto, Toronto General Hospital, Peter Munk Cardiac Centre, Toronto, ON, Canada
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13
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Yang Z, Hu N, Zhang F, Gao Y, Zhang C, Wang A. A Practical Tool for Measuring Home-Based Cardiac Rehabilitation Self-Management Behavior: A Multiphase Cross-Sectional Study. J Am Heart Assoc 2024; 13:e034486. [PMID: 38639372 DOI: 10.1161/jaha.124.034486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 03/25/2024] [Indexed: 04/20/2024]
Abstract
BACKGROUND Optimal self-management is the key to home-based cardiac rehabilitation for patients with heart disease. At present, there is a lack of a specific assessment tool to evaluate the home-based cardiac rehabilitation self-management behavior in patients with heart disease. Therefore, the aim of this study was to develop the Home-Based Cardiac Rehabilitation Self-Management Scale and validate its psychometric properties among patients with coronary heart disease. METHODS AND RESULTS A multiphase cross-sectional study was conducted that study covered 3 phases: (1) item generation and revision, (2) item evaluation and preliminary exploration, and (3) assessment of the psychometric properties of the scale. A scale with 21 items was developed to measure the home-based cardiac rehabilitation self-management behavior. The content validity index of the scale was 0.980. In exploratory factor analysis, the 5-factor structure supported by eigenvalues and screen plot explained 74.326% of the total variation. In confirmatory factor analysis, all fitting indicators were acceptable, further supporting the construct validity of the scale. The criterion validity of the scale was 0.783. In the reliability analysis, the Cronbach's α coefficient of the scale was 0.882, with a dimensionality range of 0.780 to 0.936. The split-half reliability coefficient and test-retest reliability coefficient were 0.774 and 0.770, respectively. CONCLUSIONS This study is the first to develop and validate a practical tool. This scale can comprehensively and accurately assess the self-management behavior of patients with heart disease in a home-based cardiac rehabilitation environment.
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Affiliation(s)
- Zhen Yang
- The First Affiliated Hospital of China Medical University Shenyang Liaoning Province China
| | - Na Hu
- The First Affiliated Hospital of China Medical University Shenyang Liaoning Province China
| | - Fengpei Zhang
- The First Affiliated Hospital of China Medical University Shenyang Liaoning Province China
| | - Yu Gao
- The First Affiliated Hospital of Jinzhou Medical University Jinzhou Liaoning Province China
| | - Chunqi Zhang
- The First Affiliated Hospital of Jinzhou Medical University Jinzhou Liaoning Province China
| | - Aiping Wang
- The First Affiliated Hospital of China Medical University Shenyang Liaoning Province China
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14
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Ko H, Song J, Chi SA, Lee SY, Kim SJ, Lee CH, Park CS, Choi ES, An HS, Kang IS, Yoon JK, Baek JS, Lee JY, Lee J, Huh J, Ahn KJ, Jung SY, Cha SG, Kim YH, Lee YS. The long-term effects of the fenestration in patients with extracardiac Fontan circulation-a multicenter Korean cohort study based on national Fontan registry. Front Cardiovasc Med 2024; 11:1341882. [PMID: 38774663 PMCID: PMC11106450 DOI: 10.3389/fcvm.2024.1341882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 04/22/2024] [Indexed: 05/24/2024] Open
Abstract
Introduction The long-term effects of fenestration in patients with Fontan circulation remain unclear. We aim to evaluate the fenestration impact on early and late outcomes in patients with extracardiac Fontan (ECF) using a propensity score matching analysis. Methods We performed an extensive retrospective multicenter clinical data review of the Korean Fontan registry and included 1,233 patients with surgical ECF (779 fenestrated, 454 non-fenestrated). Demographics, baseline, and follow-up data were collected and comprehensively analyzed. Patients were divided into two groups according to the baseline presence or absence of surgical fenestration. Subsequently, patients were sub-divided according to the fenestration status at the last follow-up. Propensity-score matching was performed to account for collected data between the 2 groups using a multistep approach. The primary outcomes were survival and freedom from Fontan failure (FFF). We also looked at postoperative hemodynamics, cardiopulmonary exercise test results, oxygen saturations, and functional status. Results After propensity-score matching (454 matched pairs), there was no difference in survival or FFF between the 2 groups. However, ECF patients with baseline fenestration had significantly lower oxygen saturation (p = 0.001) and lower functional status (p < 0.001). Patients with fenestration had significantly longer bypass times, higher postoperative central venous pressure, higher postoperative left atrial pressure, and less prolonged pleural effusion in the early postoperative period. The propensity score matching according to the fenestration status at the last follow-up (148 matched pairs) showed that patients with a persistent fenestration had significantly lower oxygen saturation levels (p < 0.001). However there were no intergroup differences in the functional status, survival and FFF. Conclusions Our results showed no long-term benefits of the Fenestration in terms of survival and FFF. Patients with persistent fenestration showed oxygen desaturation but no difference in exercise intolerance was shown between the 2 groups.
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Affiliation(s)
- Hoon Ko
- Department of Pediatrics, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Republic of Korea
| | - Jinyoung Song
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Sang Ah Chi
- Department of Health Sciences and Technology, Samsung Advanced Institute for Health Sciences & Technology, Sungkyunkwan University, Seoul, Republic of Korea
- Biomedical Statistics Center, Samsung Medical Center, Research Institute for Future Medicine, Seoul, Republic of Korea
| | - Sang-Yun Lee
- Department of Pediatrics, College of Medicine, Seoul National University Children’s Hospital, Seoul, Republic of Korea
| | - Soo-Jin Kim
- Department of Pediatrics, Sejong General Hospital, Bucheon, Republic of Korea
| | - Chang-Ha Lee
- Department of Thoracic and Cardiovascular Surgery, Sejong General Hospital, Bucheon, Republic of Korea
| | - Chun Soo Park
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Eun Seok Choi
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Hyo Soon An
- Department of Pediatrics, College of Medicine, Seoul National University Children’s Hospital, Seoul, Republic of Korea
| | - I. Seok Kang
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Ja Kyoung Yoon
- Department of Pediatrics, Sejong General Hospital, Bucheon, Republic of Korea
| | - Jae-Suk Baek
- Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jae-Young Lee
- Department of Pediatrics, College of Medicine, Seoul St. Mary’s Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | - Joowon Lee
- Department of Pediatrics, College of Medicine, Seoul National University Bundang Hospital, Sungnam, Republic of Korea
| | - June Huh
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Kyung-Jin Ahn
- Department of Pediatric Cardiology, Gachon University Gil Medical Center, Incheon, Republic of Korea
| | - Se Yong Jung
- Department of Pediatrics, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Seul Gi Cha
- Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Yeo-Hyang Kim
- Department of Pediatrics, Kyungbook National University School of Medicine, Daegu, Republic of Korea
| | - Young-Seok Lee
- Department of Pediatrics, Dong-A University Hospital, Busan, Republic of Korea
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15
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Mukherjee M, Strom JB, Afilalo J, Hu M, Beussink-Nelson L, Kim J, Addetia K, Bertoni A, Gottdiener J, Michos ED, Gardin JM, Shah SJ, Freed BH. Normative Values of Echocardiographic Chamber Size and Function in Older Healthy Adults: The Multi-Ethnic Study of Atherosclerosis. Circ Cardiovasc Imaging 2024; 17:e016420. [PMID: 38716661 PMCID: PMC11108741 DOI: 10.1161/circimaging.123.016420] [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: 12/04/2023] [Accepted: 03/26/2024] [Indexed: 05/15/2024]
Abstract
BACKGROUND Echocardiographic (2-dimensional echocardiography) thresholds indicating disease or impaired functional status compared with normal physiological aging in individuals aged ≥65 years are not clearly defined. In the present study, we sought to establish standard values for 2-dimensional echocardiography parameters related to chamber size and function in older adults without cardiopulmonary or cardiometabolic conditions. METHODS In this cross-sectional study of 3032 individuals who underwent 2-dimensional echocardiography at exam 6 in the MESA (Multi-Ethnic Study of Atherosclerosis), 608 participants fulfilled our inclusion criteria of healthy aging, with normative values defined as the mean ± 1.96 standard deviation and compared across sex and race and ethnicity. Functional status measures included NT-proBNP (N-terminal pro-B-type natriuretic peptide), 6-minute walk distance, and Kansas City Cardiomyopathy Questionnaire. Prognostic performance using MESA cutoffs was compared with established guideline cutoffs using time-to-event analysis. RESULTS The normative aging cohort (69.5±7.0 years, 46.2% male, 47.5% White) had lower NT-proBNP, higher 6-minute walk distance, and higher (better) Kansas City Cardiomyopathy Questionnaire summary values. Women had significantly smaller chamber sizes and better biventricular systolic function. White participants had the largest chamber dimensions, whereas Chinese participants had the smallest, even after adjustment for body size. Current guidelines identified 81.6% of healthy older adults in MESA as having cardiac abnormalities. CONCLUSIONS Among a large, diverse group of healthy older adults, we found significant differences in cardiac structure and function by sex and race/ethnicity, which may signal sex-specific cardiac remodeling with advancing age. It is crucial for existing guidelines to consider the observed and clinically significant differences in cardiac structure and function associated with healthy aging. Our study highlights that existing guidelines, which grade abnormalities in echocardiographic cardiac chamber size and function based on younger individuals, may not adequately address the anticipated changes associated with normal aging.
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Affiliation(s)
| | | | | | - Mo Hu
- Northwestern University Feinberg School of Medicine,
Chicago, IL
| | | | - Jiwon Kim
- Weill Cornell Medicine, New York, NY
| | - Karima Addetia
- University of Chicago Pritzker School of Medicine, Chicago,
IL
| | | | | | - Erin D. Michos
- Johns Hopkins University School of Medicine, Baltimore,
MD
| | | | - Sanjiv J. Shah
- Northwestern University Feinberg School of Medicine,
Chicago, IL
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16
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Zhang T, Luo L, He Q, Xiao S, Li Y, Chen J, Qin T, Xiao Z, Ge Q. Research advances on molecular mechanism and natural product therapy of iron metabolism in heart failure. Eur J Med Res 2024; 29:253. [PMID: 38659000 PMCID: PMC11044586 DOI: 10.1186/s40001-024-01809-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 03/22/2024] [Indexed: 04/26/2024] Open
Abstract
The progression of heart failure (HF) is complex and involves multiple regulatory pathways. Iron ions play a crucial supportive role as a cofactor for important proteins such as hemoglobin, myoglobin, oxidative respiratory chain, and DNA synthetase, in the myocardial energy metabolism process. In recent years, numerous studies have shown that HF is associated with iron dysmetabolism, and deficiencies in iron and overload of iron can both lead to the development of various myocarditis diseases, which ultimately progress to HF. Iron toxicity and iron metabolism may be key targets for the diagnosis, treatment, and prevention of HF. Some iron chelators (such as desferrioxamine), antioxidants (such as ascorbate), Fer-1, and molecules that regulate iron levels (such as lactoferrin) have been shown to be effective in treating HF and protecting the myocardium in multiple studies. Additionally, certain natural compounds can play a significant role by mediating the imbalance of iron-related signaling pathways and expression levels. Therefore, this review not only summarizes the basic processes of iron metabolism in the body and the mechanisms by which they play a role in HF, with the aim of providing new clues and considerations for the treatment of HF, but also summarizes recent studies on natural chemical components that involve ferroptosis and its role in HF pathology, as well as the mechanisms by which naturally occurring products regulate ferroptosis in HF, with the aim of providing reference information for the development of new ferroptosis inhibitors and lead compounds for the treatment of HF in the future.
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Affiliation(s)
- Tianqing Zhang
- Department of Cardiology, Changde Hospital, Xiangya School of Medicine, Central South University, Hunan, China
| | - Li Luo
- Department of Cardiology, Changde Hospital, Xiangya School of Medicine, Central South University, Hunan, China
| | - Qi He
- People's Hospital of Ningxiang City, Ningxiang City, China
| | - Sijie Xiao
- Department of Cardiology, Changde Hospital, Xiangya School of Medicine, Central South University, Hunan, China
| | - Yuwei Li
- Department of Cardiology, Changde Hospital, Xiangya School of Medicine, Central South University, Hunan, China
| | - Junpeng Chen
- Department of Cardiology, Changde Hospital, Xiangya School of Medicine, Central South University, Hunan, China
| | - Tao Qin
- Department of Cardiology, Changde Hospital, Xiangya School of Medicine, Central South University, Hunan, China
| | - Zhenni Xiao
- Department of Cardiology, Changde Hospital, Xiangya School of Medicine, Central South University, Hunan, China
| | - Qingliang Ge
- Department of Cardiology, Changde Hospital, Xiangya School of Medicine, Central South University, Hunan, China.
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17
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Zhang A, Kalil R, Marzec A, Coulter SA, Virani S, Patel KV, Segar MW. Cardiovascular Disease Management With Sodium-Glucose Cotransporter-2 Inhibitors in Patients With Type 2 Diabetes: A Cardiology Primer. Tex Heart Inst J 2024; 51:e238375. [PMID: 38590152 DOI: 10.14503/thij-23-8375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/10/2024]
Abstract
Patients with type 2 diabetes face an elevated risk of cardiovascular disease. This review centers on sodium-glucose cotransporter-2 (SGLT2) inhibitors, a class of drugs that, according to a growing body of evidence, may have major potential for managing cardiovascular disease in patients with type 2 diabetes. This review presents findings from multiple clinical trials suggesting that SGLT2 inhibitors can not only serve as preventive therapeutic agents but also play a role in the active management of heart failure. The discussion includes the mechanism of action of SGLT2 inhibitors, emphasizing that they enhance urinary glucose excretion, which could lead to improved glycemic control and contribute to metabolic shifts beneficial to cardiac function. Alongside these cardiometabolic effects, safety concerns and practical considerations for prescribing these agents are addressed, taking into account potential adverse effects such as genitourinary infections and diabetic ketoacidosis as well as the financial implications for patients. Despite these drawbacks, therapeutic indications for SGLT2 inhibitors continue to expand, including for kidney protection, although further research is necessary to fully understand the mechanisms driving the cardioprotective and kidney-protective effects of SGLT2 inhibitors. By synthesizing current knowledge, this review intends to inform and guide clinical decision-making, thereby enhancing cardiovascular disease outcomes in patients with type 2 diabetes.
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Affiliation(s)
- Allan Zhang
- Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Ramsey Kalil
- Department of Cardiology, The Texas Heart Institute, Houston, Texas
| | - Alexander Marzec
- Department of Medicine, Baylor College of Medicine, Houston, Texas
| | | | - Salim Virani
- Department of Cardiology, The Texas Heart Institute, Houston, Texas
- Aga Khan University, Karachi, Pakistan
| | - Kershaw V Patel
- Department of Cardiology, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas
| | - Matthew W Segar
- Department of Cardiology, The Texas Heart Institute, Houston, Texas
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18
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Xu M, Ruan T, Huang X, Han B, Li Y, Ding Y, Zhu L. Care-seeking delay of patients with heart failure in China: a mixed-method study. ESC Heart Fail 2024. [PMID: 38567397 DOI: 10.1002/ehf2.14757] [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: 09/08/2023] [Revised: 02/24/2024] [Accepted: 02/29/2024] [Indexed: 04/04/2024] Open
Abstract
AIM This study aims to explore the duration and influencing factors of care-seeking delay among patients with heart failure (HF) in China. METHODS AND RESULTS A convergent mixed method containing a cross-sectional study and two parts of qualitative studies was designed, following the STROBE and COREQ guidelines. Convenience sampling was applied to recruit patients with HF from two general hospitals from December 2021 to December 2022. Purposive sampling was used to enrol healthcare professionals from two general hospitals and two community hospitals from June to November 2022. Among the 258 patients with HF in the cross-sectional study, the median duration of care-seeking delay was 7.5 days. The result integration indicated that the delay duration was influenced by the dyspnoea symptom burden, the oedema symptom burden, and the depression status. The lower dyspnoea symptom burden, the higher oedema symptom burden, and the higher depression score were related to the prolonged care-seeking delay duration. The duration was also affected by the COVID-19 pandemic, level of support from medical system, and the symptom management abilities of the caregivers. The COVID-19 pandemic, low level of support from medical system, and limited symptom management abilities of caregivers were related to the prolonged care-seeking delay duration. CONCLUSIONS Care-seeking delay among patients with HF needs attention in China. The duration of care-seeking delay of patients with HF was influenced by the dyspnoea symptom burden, the oedema symptom burden, and depression status, as well as the COVID-19 pandemic, level of support from medical system, and the symptom management abilities of the caregivers.
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Affiliation(s)
- Mengqi Xu
- Department of Nursing, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Tiantian Ruan
- School of Nursing, Shanghai Jiao Tong University, Shanghai, China
| | - Xiaoli Huang
- Department of Cardiology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Beibei Han
- Department of Cardiology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yingqi Li
- Department of Cardiology, Shanghai Eighth People's Hospital, Shanghai, China
| | - Yuan Ding
- School of Nursing, Shanghai Jiao Tong University, Shanghai, China
| | - Lingyan Zhu
- Department of Nursing, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
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19
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Tian J, Li W, Zeng L, Li Y, Du J, Li Y, Li B, Su G. HBI-8000 improves heart failure with preserved ejection fraction via the TGF-β1/MAPK signalling pathway. J Cell Mol Med 2024; 28:e18238. [PMID: 38509729 PMCID: PMC10955178 DOI: 10.1111/jcmm.18238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 01/18/2024] [Accepted: 02/09/2024] [Indexed: 03/22/2024] Open
Abstract
Heart failure with preserved ejection fraction (HFpEF) accounts for approximately 50% of total heart failure patients and is characterized by peripheral circulation, cardiac remodelling and comorbidities (such as advanced age, obesity, hypertension and diabetes) with limited treatment options. Chidamide (HBI-8000) is a domestically produced benzamide-based histone deacetylase isoform-selective inhibitor used for the treatment of relapsed refractory peripheral T-cell lymphomas. Based on our in vivo studies, we propose that HBI-8000 exerts its therapeutic effects by inhibiting myocardial fibrosis and myocardial hypertrophy in HFpEF patients. At the cellular level, we found that HBI-8000 inhibits AngII-induced proliferation and activation of CFs and downregulates the expression of fibrosis-related factors. In addition, we observed that the HFpEF group and AngII stimulation significantly increased the expression of TGF-β1 as well as phosphorylated p38MAPK, JNK and ERK, whereas the expression of the above factors was significantly reduced after HBI-8000 treatment. Activation of the TGF-β1/MAPK pathway promotes the development of fibrotic remodelling, and pretreatment with SB203580 (p38MAPK inhibitor) reverses this pathological change. In conclusion, our data suggest that HBI-8000 inhibits fibrosis by modulating the TGF-β1/MAPK pathway thereby improving HFpEF. Therefore, HBI-8000 may become a new hope for the treatment of HFpEF patients.
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Affiliation(s)
- Jing Tian
- Central Hospital Affiliated to Shandong First Medical UniversityJinanShandongChina
| | - Wenjing Li
- Central Hospital Affiliated to Shandong First Medical UniversityJinanShandongChina
| | - Lu Zeng
- Research Center of Translational Medicine, Jinan Central HospitalShandong First Medical UniversityJinanShandongChina
| | - Yang Li
- Central Hospital Affiliated to Shandong First Medical UniversityJinanShandongChina
| | - Jiamin Du
- Department of Cardiology, Jinan Central Hospital, Cheeloo College of MedicineShandong UniversityJinanShandongChina
| | - Ying Li
- Research Center of Translational Medicine, Jinan Central HospitalShandong First Medical UniversityJinanShandongChina
| | - Bin Li
- Central Hospital Affiliated to Shandong First Medical UniversityJinanShandongChina
- Research Center of Translational Medicine, Jinan Central HospitalShandong First Medical UniversityJinanShandongChina
| | - Guohai Su
- Central Hospital Affiliated to Shandong First Medical UniversityJinanShandongChina
- Research Center of Translational Medicine, Jinan Central HospitalShandong First Medical UniversityJinanShandongChina
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20
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Urey MA, Hibbert B, Jorde U, Eckman P, Simard T, Labinaz M, Nazer B, Wiley M, Gupta B, Sauer A, Shah H, Sorajja P, Pineda AM, Missov E, Mahmud E, Kahwash R, Lilly S, Latib A, Murthy S, Fam N, Garcia S, Chung ES, Klein L, Cheng R, Houston BA, Amoroso NS, Chang L, Gafoor S, Chaudhry SP, Hermiller J, Schwartz JG, Aldaia L, Koulogiannis K, Gray WA, Zahr F. Left atrial to coronary sinus shunting for treatment of heart failure with mildly reduced or preserved ejection fraction: The ALT FLOW Early Feasibility Study 1-year results. Eur J Heart Fail 2024; 26:1065-1077. [PMID: 38606485 DOI: 10.1002/ejhf.3241] [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: 03/14/2024] [Revised: 03/27/2024] [Accepted: 03/30/2024] [Indexed: 04/13/2024] Open
Abstract
AIMS Patients with heart failure and mildly reduced or preserved ejection fraction have limited therapeutic options. The ALT-FLOW Early Feasibility Study evaluated safety, haemodynamics and outcomes for the APTURE transcatheter shunt system, a novel left atrium to coronary sinus shunt in these patients. METHODS AND RESULTS Safety and shunt implantation success was evaluated for all 116 enrolled patients. An analysis population of implanted patients with a left ventricular ejection fraction (LVEF) >40% (n = 95) was chosen to assess efficacy via paired comparison between baseline and follow-up haemodynamic (3 and 6 months), and echocardiographic, clinical and functional outcomes (6 months and 1 year). Health status and quality of life outcomes were assessed using the Kansas City Cardiomyopathy Questionnaire overall summary score (KCCQ-OSS). The primary safety endpoint, major adverse cardiac, cerebral, and renal events, and reintervention through 30 days, occurred in 3/116 patients (2.6%). All implanted shunts were patent at 1 year. In patients with LVEF >40%, the mean (95% confidence interval) reduction in exercise pulmonary capillary wedge pressure (PCWP) at 20 W was -5.7 (-8.6, -2.9) mmHg at 6 months (p < 0.001). At baseline, 8% had New York Heart Association class I-II status and improved to 68% at 1 year (p < 0.001). KCCQ-OSS at baseline was 39 (35, 43) and improved at 6 months and 1 year by 25 (20-30) and 27 (22-32) points, respectively (both p < 0.0001). No adverse changes in haemodynamic and echocardiographic indices of right heart function were observed at 1 year. Overall, the reduction in PCWP at 20 W and improvement in KCCQ-OSS in multiple subgroups were consistent with those observed for the entire population. CONCLUSIONS In patients with heart failure and LVEF >40%, the APTURE shunt demonstrated an acceptable safety profile with significant sustained improvements in haemodynamic and patient-centred outcomes, underscoring the need for further evaluation of the APTURE shunt in a randomized trial.
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Affiliation(s)
- Marcus A Urey
- Division of Cardiovascular Medicine, University of California San Diego, La Jolla, CA, USA
| | - Benjamin Hibbert
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
- CAPITAL Research, Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Ulrich Jorde
- Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, The Bronx, NY, USA
| | - Peter Eckman
- Department of Cardiology, Allina Health Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis, MN, USA
| | - Trevor Simard
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Marino Labinaz
- CAPITAL Research, Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Babak Nazer
- Division of Cardiology, University of Washington Medical Center
| | - Mark Wiley
- Cardiovascular Medicine, University of Kansas Medical Center, Kansas City, KS, USA
| | - Bhanu Gupta
- Virginia Mason Franciscan Health, Seattle, WA, USA
| | - Andrew Sauer
- Saint Luke's Mid America Heart Institute, Kansas City, MO, USA
| | - Hirak Shah
- Cardiovascular Medicine, University of Kansas Medical Center, Kansas City, KS, USA
| | - Paul Sorajja
- Department of Cardiology, Allina Health Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis, MN, USA
| | - Andres M Pineda
- Division of Cardiology, Duke University Medical Center, Durham, NC, USA
| | - Emil Missov
- Division of Cardiology, University of Florida College of Medicine, Jacksonville, FL, USA
| | - Ehtisham Mahmud
- Division of Cardiovascular Medicine, University of California San Diego, La Jolla, CA, USA
| | - Rami Kahwash
- Division of Cardiovascular Medicine, The Ohio State University, Columbus, OH, USA
| | - Scott Lilly
- Division of Cardiovascular Medicine, The Ohio State University, Columbus, OH, USA
| | - Azeem Latib
- Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, The Bronx, NY, USA
| | - Sandhya Murthy
- Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, The Bronx, NY, USA
| | - Neil Fam
- St. Michael's Hospital Unity Health, Toronto, ON, Canada
| | - Santiago Garcia
- The Christ Hospital and The Carl and Edyth Lindner Center for Research and Education, Cincinnati, OH, USA
| | - Eugene S Chung
- Lindner Research Center at The Christ Hospital, Cincinnati, OH, USA
| | - Liviu Klein
- Advanced Heart Failure Comprehensive Care Center, Division of Cardiology, University of California San Francisco, San Francisco, CA, USA
| | - Richard Cheng
- Division of Cardiovascular Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Brian A Houston
- Division of Cardiology, Medical University of South Carolina, Charleston, SC, USA
| | - Nicholas S Amoroso
- Division of Cardiology, Medical University of South Carolina, Charleston, SC, USA
| | - Lee Chang
- Swedish Heart and Vascular, Seattle, WA, USA
| | - Sameer Gafoor
- Swedish Heart and Vascular, Seattle, WA, USA
- Cardiovascular Center Frankfurt, Frankfurt, Germany
| | - Sunit-Preet Chaudhry
- Ascension St. Vincent Heart Center, Indianapolis, Indiana and Ascension St. Vincent Cardiovascular Research Institute, Indianapolis, IN, USA
| | - James Hermiller
- Ascension St. Vincent Heart Center, Indianapolis, Indiana and Ascension St. Vincent Cardiovascular Research Institute, Indianapolis, IN, USA
| | | | - Lillian Aldaia
- Department of Cardiovascular Medicine, Gagnon Cardiovascular Institute, Morristown Medical Center, Morristown, NJ, USA
| | - Konstantinos Koulogiannis
- Department of Cardiovascular Medicine, Gagnon Cardiovascular Institute, Morristown Medical Center, Morristown, NJ, USA
| | | | - Firas Zahr
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, OR, USA
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Nakamaru R, Shiraishi Y, Kohno T, Nagatomo Y, Akiyama H, Motoya Y, Fukui M, Yajima T, Yoshikawa T, Kohsaka S. Treatment patterns and trajectories in patients after acute heart failure hospitalization. ESC Heart Fail 2024; 11:692-701. [PMID: 38098210 DOI: 10.1002/ehf2.14635] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 10/28/2023] [Accepted: 11/28/2023] [Indexed: 03/28/2024] Open
Abstract
AIMS The trajectories of systolic function after admission for acute heart failure (HF) and their effect on clinical outcomes have not been fully elucidated. We aimed to assess changes in left ventricular ejection fraction (LVEF) between the index and 1 year after discharge and to examine their prognostic implications. METHODS AND RESULTS We extracted data from a prospective multicentre registry of patients hospitalized for acute HF and identified 1636 patients with LVEF data at admission and 1 year after discharge. We categorized them into five groups based on LVEF changes: HF with unchanged-preserved EF [HFunc-pEF (EF ≥ 50%); N = 527, 32.2%], unchanged-mildly reduced EF [HFunc-mrEF (EF 41-49%); N = 86, 5.3%], unchanged-reduced EF [HFunc-rEF (EF ≤ 40%); N = 377, 23.0%], worsened EF (HFworEF; N = 83, 5.1%), and improved EF (HFimpEF; N = 563, 34.4%). We then evaluated the subsequent composite outcome of cardiovascular death and HF readmission. During 1 year after discharge, 53% of patients with HF with reduced EF and 67% of those with HF with mildly reduced EF (HFmrEF) transitioned to other categories, whereas 92% of those with HF with preserved EF (HFpEF) remained within the same category. Patients with HFimpEF were more likely to be younger and had relatively preserved renal function, whereas those with HFworEF were the oldest and had more comorbidities among the five groups. After multivariable adjustment, patients with HFimpEF and HFunc-pEF had a lower risk for composite outcomes when referenced to patients with HFunc-rEF [hazard ratio (95% confidence interval), P-value: 0.28 (0.16-0.49), P < 0.001, and 0.40 (0.25-0.63), P < 0.001, respectively]. Conversely, patients with HFunc-mrEF and HFworEF had a comparable risk [0.44 (0.18-1.07), P = 0.07, and 0.63 (0.29-1.39), P = 0.26, respectively]. CONCLUSIONS A substantial number of patients with HF experienced transitions to other categories after discharge. Notably, patients with decreased EF experienced a worse prognosis, even with slight decreases (e.g. HFpEF transitioning to HFmrEF). These findings emphasize the significance of longitudinal assessments of systolic function to better manage patients following acute decompensation.
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Affiliation(s)
- Ryo Nakamaru
- Department of Cardiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
- Department of Healthcare Quality Assessment, The University of Tokyo, Tokyo, Japan
| | - Yasuyuki Shiraishi
- Department of Cardiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Takashi Kohno
- Department of Cardiovascular Medicine, Kyorin University Faculty of Medicine, Tokyo, Japan
| | - Yuji Nagatomo
- Department of Cardiology, National Defense Medical College, Tokorozawa, Japan
| | | | | | | | | | | | - Shun Kohsaka
- Department of Cardiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
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22
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Wang Y, Xu X, Lv Q, Zhao Y, Zhang X, Zang X. Network analysis of symptoms, physiological, psychological and environmental risk factors based on unpleasant symptom theory in patients with chronic heart failure. Int J Nurs Pract 2024; 30:e13246. [PMID: 38389478 DOI: 10.1111/ijn.13246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 01/08/2024] [Accepted: 01/26/2024] [Indexed: 02/24/2024]
Abstract
BACKGROUND Somatic symptoms and related factors in patients with chronic heart failure have been extensively researched. However, more insight into the complex interconnections among these constructs is needed, as most studies focus on them independently from each other. AIMS The aim of this study is to gain a comprehensive understanding of how somatic symptoms and related factors are interconnected among patients with chronic heart failure. METHODS A total of 379 patients were enrolled. Network analysis was used to explore the interconnections among the somatic symptoms and related risk factors. RESULTS The four core symptoms of chronic heart failure were daytime dyspnea, dyspnea when lying down, fatigue and difficulty sleeping. Within the network, the edge weights of depression-anxiety, subjective social support-objective social support, and subjective social support-social support availability were more significant than others. Among physiological, psychological and environmental factors, the edge weights of NYHA-dyspnea, depression-difficulty sleeping, and social support availability-dyspnea when lying down were more significant than others. Depression and anxiety had the highest centrality, indicating stronger and closer connections with other nodes. CONCLUSIONS Psychological and environmental factors stood out in the network, suggesting the potential value of interventions targeting these factors to improve overall health.
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Affiliation(s)
- Yaqi Wang
- School of Nursing, Tianjin Medical University, Tianjin, China
| | - Xueying Xu
- School of Nursing, Tianjin Medical University, Tianjin, China
| | - Qingyun Lv
- School of Nursing, Tianjin Medical University, Tianjin, China
| | - Yue Zhao
- School of Nursing, Tianjin Medical University, Tianjin, China
| | - Xiaonan Zhang
- School of Nursing, Tianjin Medical University, Tianjin, China
| | - Xiaoying Zang
- School of Nursing, Tianjin Medical University, Tianjin, China
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23
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Lang FM, Teruya S, Weinsaft A, Cuomo M, Santos AM, Nalbandian A, Bampatsias D, Maurer MS. Sodium-glucose cotransporter 2 inhibitors for transthyretin amyloid cardiomyopathy: Analyses of short-term efficacy and safety. Eur J Heart Fail 2024; 26:938-947. [PMID: 38488292 PMCID: PMC11141726 DOI: 10.1002/ejhf.3198] [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: 08/28/2023] [Revised: 02/27/2024] [Accepted: 02/29/2024] [Indexed: 04/13/2024] Open
Abstract
AIMS Despite their potential, sodium-glucose cotransporter 2 inhibitors (SGLT2i) have not been well-studied in transthyretin amyloid cardiomyopathy (ATTR-CM) as randomized trials have excluded patients with this morbid disease. We performed a retrospective study assessing the short-term efficacy and safety of SGLT2i in ATTR-CM. METHODS AND RESULTS We screened consecutive patients seen at a tertiary care centre and identified 87 ATTR-CM patients treated with SGLT2i and 95 untreated control patients. Endpoints included changes in weight, loop diuretic dose, and cardiac/renal biomarkers. The median age of the overall population was 79 (interquartile range [IQR] 11) years. Nearly 90% of patients were male, and 93% were on a transthyretin stabilizer. Control patients demonstrated generally less severe disease at baseline compared to SGLT2i-treated patients, with lower median Columbia risk score (p < 0.001). Median follow-up time was 5.6 (IQR 5.2) and 8.4 (IQR 2.1) months in the SGLT2i and control cohorts, respectively. Compared with controls, SGLT2i treatment was associated with significantly greater reductions from baseline in weight, loop diuretic dose, and uric acid during follow-up (p < 0.001). While no significant between-group differences were observed on cardiac biomarkers, estimated glomerular filtration rate was significantly reduced versus controls 1 month after SGLT2i initiation (p = 0.002), but no significant differences were observed at later timepoints. Results were similar in a propensity score-matched analysis (n = 42 per cohort). A total of 10 (11.5%) patients discontinued SGLT2i, most commonly due to genitourinary symptoms. CONCLUSION Sodium-glucose cotransporter 2 inhibitors were well tolerated by most patients with ATTR-CM and appeared to improve volume status and combat diuretic resistance. Randomized studies are needed to confirm these findings.
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Affiliation(s)
- Frederick M. Lang
- Clinical Cardiovascular Research Laboratory for the Elderly (CCRLE), NewYork-Presbyterian/Columbia University Irving Medical Center, New York, NY 10032
| | - Sergio Teruya
- Clinical Cardiovascular Research Laboratory for the Elderly (CCRLE), NewYork-Presbyterian/Columbia University Irving Medical Center, New York, NY 10032
| | - Ariel Weinsaft
- Clinical Cardiovascular Research Laboratory for the Elderly (CCRLE), NewYork-Presbyterian/Columbia University Irving Medical Center, New York, NY 10032
| | - Margaret Cuomo
- Clinical Cardiovascular Research Laboratory for the Elderly (CCRLE), NewYork-Presbyterian/Columbia University Irving Medical Center, New York, NY 10032
| | - Alfonsina Mirabal Santos
- Clinical Cardiovascular Research Laboratory for the Elderly (CCRLE), NewYork-Presbyterian/Columbia University Irving Medical Center, New York, NY 10032
| | - Ani Nalbandian
- Clinical Cardiovascular Research Laboratory for the Elderly (CCRLE), NewYork-Presbyterian/Columbia University Irving Medical Center, New York, NY 10032
| | - Dimitrios Bampatsias
- Clinical Cardiovascular Research Laboratory for the Elderly (CCRLE), NewYork-Presbyterian/Columbia University Irving Medical Center, New York, NY 10032
| | - Mathew S. Maurer
- Clinical Cardiovascular Research Laboratory for the Elderly (CCRLE), NewYork-Presbyterian/Columbia University Irving Medical Center, New York, NY 10032
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24
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Wahid M, Islam S, Sepehrvand N, Dover DC, McAlister FA, Kaul P, Ezekowitz JA. Iron Deficiency, Anemia, and Iron Supplementation in Patients With Heart Failure: A Population-Level Study. Circ Heart Fail 2024; 17:e011351. [PMID: 38572652 DOI: 10.1161/circheartfailure.123.011351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 01/08/2024] [Indexed: 04/05/2024]
Abstract
BACKGROUND Studies have shown an association between iron deficiency (ID) and clinical outcomes in patients with heart failure (HF), irrespective of the presence of ID anemia (IDA). The current study used population-level data from a large, single-payer health care system in Canada to investigate the epidemiology of ID and IDA in patients with acute HF and those with chronic HF, and the iron supplementation practices in these settings. METHODS All adult patients with HF in Alberta between 2012 and 2019 were identified and categorized as acute or chronic HF. HF subtypes were determined through echocardiography data, and ID (serum ferritin concentration <100 μg/L, or ferritin concentration between 100 and 300 μg/L along with transferrin saturation <20%), and IDA through laboratory data. Broad eligibility for 3 clinical trials (AFFIRM-AHF [Study to Compare Ferric Carboxymaltose With Placebo in Patients With Acute HF and ID], IRONMAN [Intravenous Iron Treatment in Patients With Heart Failure and Iron Deficiency], and HEART-FID [Randomized Placebocontrolled Trial of Ferric Carboxymaltose as Treatment for HF With ID]) was determined. RESULTS Among the 17 463 patients with acute HF, 38.5% had iron studies tested within 30 days post-index-HF episode (and 34.2% of the 11 320 patients with chronic HF). Among tested patients, 72.6% of the acute HF and 73.9% of the chronic HF were iron-deficient, and 51.4% and 49.0% had IDA, respectively. Iron therapy was provided to 41.8% and 40.5% of patients with IDA and acute or chronic HF, respectively. Of ID patients without anemia, 19.9% and 21.7% were prescribed iron therapy. The most common type of iron therapy was oral (28.1% of patients). Approximately half of the cohort was eligible for each of the AFFIRM-AHF, intravenous iron treatment in patients with HF and ID, and HEART-FID trials. CONCLUSIONS Current practices for investigating and treating ID in patients with HF do not align with existing guideline recommendations. Considering the gap in care, innovative strategies to optimize iron therapy in patients with HF are required.
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Affiliation(s)
- Muizz Wahid
- Canadian VIGOUR Centre, University of Alberta, Edmonton, AB, Canada (M.W., S.I., N.S., D.C.D., F.A.M., P.K., J.A.E.)
- Department of Medicine (M.W., N.S., F.A.M., P.K.), University of Alberta, Edmonton, AB, Canada
| | - Sunjidatul Islam
- Canadian VIGOUR Centre, University of Alberta, Edmonton, AB, Canada (M.W., S.I., N.S., D.C.D., F.A.M., P.K., J.A.E.)
| | - Nariman Sepehrvand
- Canadian VIGOUR Centre, University of Alberta, Edmonton, AB, Canada (M.W., S.I., N.S., D.C.D., F.A.M., P.K., J.A.E.)
- Department of Medicine (M.W., N.S., F.A.M., P.K.), University of Alberta, Edmonton, AB, Canada
| | - Douglas C Dover
- Canadian VIGOUR Centre, University of Alberta, Edmonton, AB, Canada (M.W., S.I., N.S., D.C.D., F.A.M., P.K., J.A.E.)
| | - Finlay A McAlister
- Canadian VIGOUR Centre, University of Alberta, Edmonton, AB, Canada (M.W., S.I., N.S., D.C.D., F.A.M., P.K., J.A.E.)
- Department of Medicine (M.W., N.S., F.A.M., P.K.), University of Alberta, Edmonton, AB, Canada
- Alberta Strategy for Patient-Oriented Research Support Unit, Edmonton, AB, Canada (F.A.M.)
| | - Padma Kaul
- Canadian VIGOUR Centre, University of Alberta, Edmonton, AB, Canada (M.W., S.I., N.S., D.C.D., F.A.M., P.K., J.A.E.)
- Department of Medicine (M.W., N.S., F.A.M., P.K.), University of Alberta, Edmonton, AB, Canada
| | - Justin A Ezekowitz
- Canadian VIGOUR Centre, University of Alberta, Edmonton, AB, Canada (M.W., S.I., N.S., D.C.D., F.A.M., P.K., J.A.E.)
- Division of Cardiology, Department of Medicine (J.A.E.), University of Alberta, Edmonton, AB, Canada
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25
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Mahapatro A, Nobakht S, Mukesh S, Daryagasht AA, Korsapati AR, Jain SM, Soltani Moghadam S, Moosavi R, Javid M, Hassanipour S, Prabhu SV, Keivanlou MH, Amini-Salehi E, Nayak SS. Evaluating biomarkers for contrast-induced nephropathy following coronary interventions: an umbrella review on meta-analyses. Eur J Med Res 2024; 29:210. [PMID: 38561791 PMCID: PMC10983745 DOI: 10.1186/s40001-024-01782-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 03/10/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND Contrast-induced nephropathy (CIN) is a form of acute kidney injury (AKI) occurring in patients undergoing cardiac catheterization, such as coronary angiography (CAG) or percutaneous coronary intervention (PCI). Although the conventional criterion for CIN detection involves a rise in creatinine levels within 72 h after contrast media injection, several limitations exist in this definition. Up to now, various meta-analyses have been undertaken to assess the accuracy of different biomarkers of CIN prediction. However, the existing body of research lacks a cohesive overview. To address this gap, a comprehensive umbrella review was necessary to consolidate and summarize the outcomes of prior meta-analyses. This umbrella study aimed to offer a current, evidence-based understanding of the prognostic value of biomarkers in predicting CIN. METHODS A systematic search of international databases, including PubMed, Scopus, and Web of Science, from inception to December 12, 2023, was conducted to identify meta-analyses assessing biomarkers for CIN prediction. Our own meta-analysis was performed by extracting data from the included studies. Sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio were assessed using Meta-Disc and CMA softwares. RESULTS Twelve studies were ultimately included in the umbrella review. The results revealed that neutrophil gelatinase-associated lipocalin (NGAL) exhibited the highest area under the curve (AUC), followed by cystatin-C, urinary kidney injury molecule-1 (uKIM-1), and brain natriuretic peptide (BNP) with AUCs of 0.91, 0.89, 0.85, and 0.80, respectively. NGAL also demonstrated the highest positive likelihood ratio [effect size (ES): 6.02, 95% CI 3.86-9.40], followed by cystatin-C, uKIM-1, and BNP [ES: 4.35 (95% CI 2.85-6.65), 3.58 (95% CI 2.75-4.66), and 2.85 (95% CI 2.13-3.82), respectively]. uKIM-1 and cystatin-C had the lowest negative likelihood ratio, followed by NGAL and BNP [ES: 0.25 (95% CI 0.17-0.37), ES: 0.25 (95% CI 0.13-0.50), ES: 0.26 (95% CI 0.17-0.41), and ES: 0.39 (0.28-0.53) respectively]. NGAL emerged as the biomarker with the highest diagnostic odds ratio for CIN, followed by cystatin-C, uKIM-1, BNP, gamma-glutamyl transferase, hypoalbuminemia, contrast media volume to creatinine clearance ratio, preprocedural hyperglycemia, red cell distribution width (RDW), hyperuricemia, neutrophil-to-lymphocyte ratio, C-reactive protein (CRP), high-sensitivity CRP, and low hematocrit (P < 0.05). CONCLUSION NGAL demonstrated superior diagnostic performance, exhibiting the highest AUC, positive likelihood ratio, and diagnostic odds ratio among biomarkers for CIN, followed by cystatin-C, and uKIM-1. These findings underscore the potential clinical utility of NGAL, cystatin-C and uKIM-1 in predicting and assessing CIN.
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Affiliation(s)
| | - Sara Nobakht
- Guilan University of Medical Sciences, Rasht, Iran
| | - Sindu Mukesh
- Liaquat University of Medical and Health Sciences, Jamshoro, Pakistan
| | | | | | - Shika M Jain
- MVJ Medical College and Research Hospital, Bengaluru, India
| | | | | | - Mona Javid
- Guilan University of Medical Sciences, Rasht, Iran
| | - Soheil Hassanipour
- Gastrointestinal and Liver Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran.
| | | | | | | | - Sandeep S Nayak
- Department of Internal Medicine, Yale New Haven Health Bridgeport Hospital, Bridgeport CT, USA
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26
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Chen F, Li G, Zhang X, Shen Q, Wang F, Dong X, Zou Y, Chen W, Xu B, Wang J. impHFrEF trial: study protocol for an open-label, multicentre study of improvement the outcome of patients with heart failure in China using a mobile hEalth-supported platForm. BMJ Open 2024; 14:e081011. [PMID: 38553051 PMCID: PMC10982805 DOI: 10.1136/bmjopen-2023-081011] [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: 10/17/2023] [Accepted: 03/15/2024] [Indexed: 04/02/2024] Open
Abstract
BACKGROUND Patients with chronic heart failure (CHF) often have a long duration of illness, difficulty in attending follow-up visits, and poor adherence to treatment. As a result, they frequently cannot receive guideline-directed medical therapy (GDMT) at the desired or maximum tolerable drug dosage. This leads to high hospitalisation and mortality rates for HF patients. Therefore, effective management and monitoring of patients with HF to ensure they receive GDMT is crucial for improving the prognosis. DESIGN AND METHODS This is a multicentre, open-label, randomised, parallel-group study involving patients with CHF across five centres. The study aims to assess the impact of an optimised GDMT model for HF patients, established on a mobile health (mHealth) platform, compared with a control group. Patients must have a left ventricular ejection fraction of less than 50% and be receiving medication titration therapy that has not yet reached the target dose, with a modest increase in N-terminal pro-B-type natriuretic peptide level. The primary composite outcome is worsening HF events (hospitalisation or emergency treatment with intravenous fluids) or cardiovascular death. ETHICS AND DISSEMINATION On 22 December 2021, this study received ethical approval from the Ethics Review Board of the First Affiliated Hospital of Nanjing Medical University, with the ethics number 2021-SR-530. All study participants will be informed of the research purpose and their participation will be voluntary. Informed consent will be obtained by providing and signing an informed consent form. We will ensure compliance with relevant laws and regulations regarding privacy and data protection. The results of this study will be published in a peer-reviewed academic journal. We will ensure that the dissemination of study results is accurate, clear and timely. TRIAL REGISTRATION NUMBER ChiCTR2200056527.
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Affiliation(s)
- Fuzhong Chen
- Department of Cardiology, The First Affiliated Hospital with Nanjing Medical University, Nanjing, Jiangsu, China
| | - Guangjuan Li
- Department of Cardiology, The First Affiliated Hospital with Nanjing Medical University, Nanjing, Jiangsu, China
- Department of Cardiology, The Friendship Hospital of Ili Kazak Autonomous Prefecture, Yining, China
| | - Xinxin Zhang
- Department of Cardiology, Northern Jiangsu People's Hospital, Yangzhou, Jiangsu, China
| | - Qin Shen
- Department of Cardiology, The First Affiliated Hospital with Nanjing Medical University, Nanjing, Jiangsu, China
| | - Fangfang Wang
- Department of Cardiology, Changzhou No.2 People's Hospital, Changzhou, Jiangsu, China
| | - Xiaoyu Dong
- Department of Cardiology, The First Affiliated Hospital with Nanjing Medical University, Nanjing, Jiangsu, China
| | - Yu Zou
- Department of Cardiology, The First Affiliated Hospital with Nanjing Medical University, Nanjing, Jiangsu, China
| | - Wensen Chen
- Office of Infection Management, The First Affiliated Hospital with Nanjing Medical University, Nanjing, Jiangsu, China
- Department of Epidemiology and Biostatistics, School of Public Health, Xi'an Jiao tong University Health Science Center, Xi'an, Shanxi, China
| | - Bing Xu
- Department of Cardiology, Northern Jiangsu People's Hospital, Yangzhou, Jiangsu, China
| | - Junhong Wang
- Department of Cardiology, The First Affiliated Hospital with Nanjing Medical University, Nanjing, Jiangsu, China
- Jiangsu Health Administration and Development Research Center, Nanjing, China
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27
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Zhao M, Zheng Z, Peng S, Xu Y, Zhang J, Liu J, Pan W, Yin Z, Xu S, Wei C, Wang M, Wan J, Qin J. Epidermal Growth Factor-Like Repeats and Discoidin I-Like Domains 3 Deficiency Attenuates Dilated Cardiomyopathy by Inhibiting Ubiquitin Specific Peptidase 10 Dependent Smad4 Deubiquitination. J Am Heart Assoc 2024; 13:e031283. [PMID: 38456416 PMCID: PMC11010021 DOI: 10.1161/jaha.123.031283] [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: 06/05/2023] [Accepted: 12/20/2023] [Indexed: 03/09/2024]
Abstract
BACKGROUND Dilated cardiomyopathy (DCM) is the leading cause of heart failure with a poor prognosis. Recent studies suggest that endothelial to mesenchymal transition (EndMT) may be involved in the pathogenesis and cardiac remodeling during DCM development. EDIL3 (epidermal growth factor-like repeats and discoidin I-like domains 3) is an extracellular matrix glycoprotein that has been reported to promote EndMT in various diseases. However, the roles of EDIL3 in DCM still remain unclear. METHODS AND RESULTS A mouse model of DCM and human umbilical vein endothelial cells were used to explore the roles and mechanisms of EDIL3 in DCM. The results indicated that EndMT and EDIL3 were activated in DCM mice. EDIL3 deficiency attenuated cardiac dysfunction and remodeling in DCM mice. EDIL3 knockdown alleviated EndMT by inhibiting USP10 (ubiquitin specific peptidase 10) dependent Smad4 deubiquitination in vivo and in vitro. Recombinant human EDIL3 promoted EndMT via reinforcing deubiquitination of Smad4 in human umbilical vein endothelial cells treated with IL-1β (interleukin 1β) and TGF-β (transforming growth factor beta). Inhibiting USP10 abolished EndMT exacerbated by EDIL3. In addition, recombinant EDIL3 also aggravates doxorubicin-induced EndMT by promoting Smad4 deubiquitination in HUVECs. CONCLUSIONS Taken together, these results indicate that EDIL3 deficiency attenuated EndMT by inhibiting USP10 dependent Smad4 deubiquitination in DCM mice.
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Affiliation(s)
- Mengmeng Zhao
- Department of Cardiology, Renmin Hospital of Wuhan University, Department of GeriatricsZhongnan Hospital of Wuhan University, Wuhan UniversityWuhanChina
- Cardiovascular Research InstituteWuhan UniversityWuhanChina
- Hubei Key Laboratory of CardiologyWuhanChina
| | - Zihui Zheng
- Department of Cardiology, Renmin Hospital of Wuhan University, Department of GeriatricsZhongnan Hospital of Wuhan University, Wuhan UniversityWuhanChina
- Cardiovascular Research InstituteWuhan UniversityWuhanChina
- Hubei Key Laboratory of CardiologyWuhanChina
| | - Shanshan Peng
- Department of Cardiology, Renmin Hospital of Wuhan University, Department of GeriatricsZhongnan Hospital of Wuhan University, Wuhan UniversityWuhanChina
- Cardiovascular Research InstituteWuhan UniversityWuhanChina
- Hubei Key Laboratory of CardiologyWuhanChina
| | - Yao Xu
- Department of Cardiology, Renmin Hospital of Wuhan University, Department of GeriatricsZhongnan Hospital of Wuhan University, Wuhan UniversityWuhanChina
- Cardiovascular Research InstituteWuhan UniversityWuhanChina
- Hubei Key Laboratory of CardiologyWuhanChina
| | - Jishou Zhang
- Department of Cardiology, Renmin Hospital of Wuhan University, Department of GeriatricsZhongnan Hospital of Wuhan University, Wuhan UniversityWuhanChina
- Cardiovascular Research InstituteWuhan UniversityWuhanChina
- Hubei Key Laboratory of CardiologyWuhanChina
| | - Jianfang Liu
- Department of Cardiology, Renmin Hospital of Wuhan University, Department of GeriatricsZhongnan Hospital of Wuhan University, Wuhan UniversityWuhanChina
- Cardiovascular Research InstituteWuhan UniversityWuhanChina
- Hubei Key Laboratory of CardiologyWuhanChina
| | - Wei Pan
- Department of Cardiology, Renmin Hospital of Wuhan University, Department of GeriatricsZhongnan Hospital of Wuhan University, Wuhan UniversityWuhanChina
- Cardiovascular Research InstituteWuhan UniversityWuhanChina
- Hubei Key Laboratory of CardiologyWuhanChina
| | - Zheng Yin
- Department of Cardiology, Renmin Hospital of Wuhan University, Department of GeriatricsZhongnan Hospital of Wuhan University, Wuhan UniversityWuhanChina
- Cardiovascular Research InstituteWuhan UniversityWuhanChina
- Hubei Key Laboratory of CardiologyWuhanChina
| | - Shuwan Xu
- Department of Cardiology, Renmin Hospital of Wuhan University, Department of GeriatricsZhongnan Hospital of Wuhan University, Wuhan UniversityWuhanChina
- Cardiovascular Research InstituteWuhan UniversityWuhanChina
- Hubei Key Laboratory of CardiologyWuhanChina
| | - Cheng Wei
- Department of Cardiology, Renmin Hospital of Wuhan University, Department of GeriatricsZhongnan Hospital of Wuhan University, Wuhan UniversityWuhanChina
- Cardiovascular Research InstituteWuhan UniversityWuhanChina
- Hubei Key Laboratory of CardiologyWuhanChina
| | - Menglong Wang
- Department of Cardiology, Renmin Hospital of Wuhan University, Department of GeriatricsZhongnan Hospital of Wuhan University, Wuhan UniversityWuhanChina
- Cardiovascular Research InstituteWuhan UniversityWuhanChina
- Hubei Key Laboratory of CardiologyWuhanChina
| | - Jun Wan
- Department of Cardiology, Renmin Hospital of Wuhan University, Department of GeriatricsZhongnan Hospital of Wuhan University, Wuhan UniversityWuhanChina
- Cardiovascular Research InstituteWuhan UniversityWuhanChina
- Hubei Key Laboratory of CardiologyWuhanChina
| | - Juan‐Juan Qin
- Department of Cardiology, Renmin Hospital of Wuhan University, Department of GeriatricsZhongnan Hospital of Wuhan University, Wuhan UniversityWuhanChina
- Center for Healthy AgingWuhan University School of NursingWuhanChina
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28
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Alonso A, Morris AA, Naimi AI, Alam AB, Li L, Subramanya V, Chen LY, Lutsey PL. Use of Sodium-Glucose Cotransporter-2 Inhibitors and Angiotensin Receptor-Neprilysin Inhibitors in Patients With Atrial Fibrillation and Heart Failure From 2021 to 2022: An Analysis of Real-World Data. J Am Heart Assoc 2024; 13:e032783. [PMID: 38456406 PMCID: PMC11010035 DOI: 10.1161/jaha.123.032783] [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: 09/20/2023] [Accepted: 02/16/2024] [Indexed: 03/09/2024]
Abstract
BACKGROUND Contemporary use of sodium-glucose cotransporter-2 inhibitors (SGLT2i) and angiotensin receptor-neprilysin inhibitors (ARNi) in patients with atrial fibrillation (AF) and heart failure (HF) has not been described. METHODS AND RESULTS We analyzed the MarketScan databases for the period January 1, 2021 to July 30, 2022. Validated algorithms were used to identify patients with AF and HF, and to classify patients into HF with reduced ejection fraction (HFrEF) or HF with preserved ejection fraction (HFpEF). We assessed the prevalence of SGLT2i and ARNi use overall and by HF type. Additionally, we explored correlates of lower use, including demographics and comorbidities. The study population included 60 927 patients (mean age, 75 years; 43% women) diagnosed with AF and HF (85% with HFpEF, 15% with HFrEF). Prevalence of ARNi use was 11% overall (30% in HFrEF, 8% in HFpEF), whereas the corresponding figure was 6% for SGLT2i (13% in HFrEF, 5% in HFpEF). Use of both medications increased over the study period: ARNi from 9% to 12% (22%-29% in HFrEF, 6%-8% in HFpEF), and SGLT2i from 3% to 9% (6%-16% in HFrEF, 2%-7% in HFpEF). Female sex, older age, and specific comorbidities were associated with lower use of these 2 medication types overall and by HF type. CONCLUSIONS Use of ARNi and SGLT2i in patients with AF and HF is suboptimal, particularly among women and older individuals, though use is increasing. These results underscore the need for understanding reasons for these disparities and developing interventions to improve adoption of evidence-based therapies among patients with comorbid AF and HF.
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Affiliation(s)
- Alvaro Alonso
- Department of Epidemiology, Rollins School of Public HealthEmory UniversityAtlantaGAUSA
| | - Alanna A. Morris
- Department of Medicine, School of MedicineEmory UniversityAtlantaGAUSA
| | - Ashley I. Naimi
- Department of Epidemiology, Rollins School of Public HealthEmory UniversityAtlantaGAUSA
| | - Aniqa B. Alam
- Department of Epidemiology, Rollins School of Public HealthEmory UniversityAtlantaGAUSA
| | - Linzi Li
- Department of Epidemiology, Rollins School of Public HealthEmory UniversityAtlantaGAUSA
| | - Vinita Subramanya
- Department of Epidemiology, Rollins School of Public HealthEmory UniversityAtlantaGAUSA
| | - Lin Yee Chen
- Lillete Heart Institute and Department of MedicineUniversity of Minnesota School of MedicineMinneapolisMNUSA
| | - Pamela L. Lutsey
- Division of Epidemiology and Community Health, School of Public HealthUniversity of MinnesotaMinneapolisMNUSA
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Kourek C, Briasoulis A, Magouliotis DE, Skoularigis J, Xanthopoulos A. Latest updates on structure and recommendations of cardiac rehabilitation programs in chronic heart failure. World J Clin Cases 2024; 12:1382-1387. [PMID: 38576816 PMCID: PMC10989450 DOI: 10.12998/wjcc.v12.i8.1382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 01/24/2024] [Accepted: 02/25/2024] [Indexed: 03/12/2024] Open
Abstract
Chronic heart failure (HF) is a clinical syndrome with high morbidity and mortality worldwide. Cardiac rehabilitation (CR) is a medically supervised program designed to maintain or improve cardiovascular health of people living with HF, recommended by both American and European guidelines. A CR program consists of a multispecialty group including physicians, nurses, physiotherapists, trainers, nutritionists, and psychologists with the common purpose of improving functional capacity and quality of life of chronic HF patients. Physical activity, lifestyle, and psychological support are core components of a successful CR program. CR has been shown to be beneficial in all ejection fraction categories in HF and most patients, who are stable under medication, are capable of participating. An individualized exercise prescription should be developed on the basis of a baseline evaluation in all patients. The main modalities of exercise training are aerobic exercise and muscle strength training of different intensity and frequency. It is important to set the appropriate clinical outcomes from the beginning, in order to assess the effectiveness of a CR program. There are still significant limitations that prevent patients from participating in these programs and need to be solved. A significant limitation is the generally low quality of research in CR and the presence of negative trials, such as the rehabilitation after myocardial infarction trial, where comprehensive rehabilitation following myocardial infraction had no important effect on mortality, morbidity, risk factors, or health-related quality of life or activity. In the present editorial, we present all the updated knowledge and recommendations in CR programs.
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Affiliation(s)
- Christos Kourek
- Medical School of Athens, National and Kapodistrian University of Athens, Athens 15772, Greece
| | - Alexandros Briasoulis
- Department of Clinical Therapeutics, Alexandra Hospital, Faculty of Medicine, National and Kapodistrian University of Athens, Athens 11528, Greece
| | | | - John Skoularigis
- Department of Cardiology, University Hospital of Larissa, Larissa 41110, Greece
| | - Andrew Xanthopoulos
- Department of Cardiology, University Hospital of Larissa, Larissa 41110, Greece
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Yang C, Shi Z, Bao L, Xv X, Jiang D, You L. Targeted metabolomic analysis of serum amino acids in heart failure patients. Amino Acids 2024; 56:22. [PMID: 38483649 PMCID: PMC10940394 DOI: 10.1007/s00726-024-03385-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 02/01/2024] [Indexed: 03/17/2024]
Abstract
Heart failure (HF) has been recognized as a global epidemic with high rates of morbidity, hospitalization, and mortality. The role of amino acids, which provide the body with energy, in the development of HF is still unclear. The aim of this study was to explore changes in serum amino acids in patients with HF and identify potential biomarkers. First, the serum amino acid metabolism profiles of 44 patients with HF and 30 healthy controls (Con) were quantitatively measured. Then, candidate markers were identified through the utilization of T test, multivariate statistical analysis, and receiver operating characteristic (ROC) curve analysis. The results found that there were 11 amino acid levels that were significantly different between patients with HF and Con. Based on ROC curve analysis, the biomarkers of eight amino acids (Glutamic acid, Taurine, L-aspartic acid, L-ornithine, Ethanolamine, L-Serine, L-Sarcosine, and Cysteine) showed high sensitivity and specificity (AUC > 0.90), and binary logistic regression analysis was used in MetaboAnalyst 5.0. Among the amino acids examined, six exhibited notable alterations in accordance with the severity of HF. In conclusion, this study cannot only provide clinicians with an objective diagnostic approach for the early identification of HF, but also enhances comprehension of the underlying mechanisms involved in the pathogenesis of HF.
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Affiliation(s)
- Chunjing Yang
- Department of Pharmacy, Beijing Shijitan Hospital, Capital Medical University, Beijing, 100038, China
- Beijing Key Laboratory of Evaluation of Rational Drug Use, Beijing, 100038, China
| | - Zhengyuan Shi
- Department of Pharmacy, Beijing Shijitan Hospital, Capital Medical University, Beijing, 100038, China
- Beijing Key Laboratory of Evaluation of Rational Drug Use, Beijing, 100038, China
| | - Li Bao
- Department of Pharmacy, Beijing Shijitan Hospital, Capital Medical University, Beijing, 100038, China
- Beijing Key Laboratory of Evaluation of Rational Drug Use, Beijing, 100038, China
| | - Xiqiao Xv
- Department of Pharmacy, Beijing Shijitan Hospital, Capital Medical University, Beijing, 100038, China
- Beijing Key Laboratory of Evaluation of Rational Drug Use, Beijing, 100038, China
| | - Dechun Jiang
- Department of Pharmacy, Beijing Shijitan Hospital, Capital Medical University, Beijing, 100038, China
- Beijing Key Laboratory of Evaluation of Rational Drug Use, Beijing, 100038, China
| | - Longtai You
- National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, 100045, China.
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Dib M, Levin MG, Zhao L, Diab A, Wang Z, Ebert C, Salman O, Azzo JD, Gan S, Zamani P, Cohen JB, Gill D, Burgess S, Zagkos L, van Empel V, Richards AM, Doughty R, Rietzschel ER, Kammerhoff K, Kvikstad E, Maranville J, Schafer P, Seiffert DA, Ramirez‐Valle F, Gordon DA, Chang C, Javaheri A, Mann DL, Cappola TP, Chirinos JA. Proteomic Associations of Adverse Outcomes in Human Heart Failure. J Am Heart Assoc 2024; 13:e031154. [PMID: 38420755 PMCID: PMC10944037 DOI: 10.1161/jaha.123.031154] [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: 10/31/2023] [Accepted: 01/16/2024] [Indexed: 03/02/2024]
Abstract
BACKGROUND Identifying novel molecular drivers of disease progression in heart failure (HF) is a high-priority goal that may provide new therapeutic targets to improve patient outcomes. The authors investigated the relationship between plasma proteins and adverse outcomes in HF and their putative causal role using Mendelian randomization. METHODS AND RESULTS The authors measured 4776 plasma proteins among 1964 participants with HF with a reduced left ventricular ejection fraction enrolled in PHFS (Penn Heart Failure Study). Assessed were the observational relationship between plasma proteins and (1) all-cause death or (2) death or HF-related hospital admission (DHFA). The authors replicated nominally significant associations in the Washington University HF registry (N=1080). Proteins significantly associated with outcomes were the subject of 2-sample Mendelian randomization and colocalization analyses. After correction for multiple testing, 243 and 126 proteins were found to be significantly associated with death and DHFA, respectively. These included small ubiquitin-like modifier 2 (standardized hazard ratio [sHR], 1.56; P<0.0001), growth differentiation factor-15 (sHR, 1.68; P<0.0001) for death, A disintegrin and metalloproteinase with thrombospondin motifs-like protein (sHR, 1.40; P<0.0001), and pulmonary-associated surfactant protein C (sHR, 1.24; P<0.0001) for DHFA. In pathway analyses, top canonical pathways associated with death and DHFA included fibrotic, inflammatory, and coagulation pathways. Genomic analyses provided evidence of nominally significant associations between levels of 6 genetically predicted proteins with DHFA and 11 genetically predicted proteins with death. CONCLUSIONS This study implicates multiple novel proteins in HF and provides preliminary evidence of associations between genetically predicted plasma levels of 17 candidate proteins and the risk for adverse outcomes in human HF.
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Affiliation(s)
- Marie‐Joe Dib
- Division of Cardiovascular MedicineHospital of the University of PennsylvaniaPhiladelphiaPAUSA
- University of Pennsylvania Perelman School of MedicinePhiladelphiaPAUSA
| | - Michael G. Levin
- Division of Cardiovascular MedicineHospital of the University of PennsylvaniaPhiladelphiaPAUSA
- University of Pennsylvania Perelman School of MedicinePhiladelphiaPAUSA
| | - Lei Zhao
- Bristol‐Myers Squibb CompanyLawrencevilleNJUSA
| | - Ahmed Diab
- Washington University School of MedicineSt. LouisMOUSA
| | | | | | - Oday Salman
- University of Pennsylvania Perelman School of MedicinePhiladelphiaPAUSA
| | - Joe David Azzo
- University of Pennsylvania Perelman School of MedicinePhiladelphiaPAUSA
| | - Sushrima Gan
- Division of Cardiovascular MedicineHospital of the University of PennsylvaniaPhiladelphiaPAUSA
- University of Pennsylvania Perelman School of MedicinePhiladelphiaPAUSA
| | - Payman Zamani
- Division of Cardiovascular MedicineHospital of the University of PennsylvaniaPhiladelphiaPAUSA
- University of Pennsylvania Perelman School of MedicinePhiladelphiaPAUSA
| | - Jordana B. Cohen
- University of Pennsylvania Perelman School of MedicinePhiladelphiaPAUSA
- Renal‐Electrolyte and Hypertension Division, Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPAUSA
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPAUSA
| | - Dipender Gill
- Department of Epidemiology and Biostatistics, School of Public HealthImperial College LondonLondonUnited Kingdom
| | - Stephen Burgess
- MRC Integrative Epidemiology UnitUniversity of BristolUnited Kingdom
- Department of Public Health and Primary CareUniversity of CambridgeUnited Kingdom
| | - Loukas Zagkos
- Department of Epidemiology and Biostatistics, School of Public HealthImperial College LondonLondonUnited Kingdom
| | - Vanessa van Empel
- Department of CardiologyMaastricht University Medical CenterMaastrichtThe Netherlands
| | - A. Mark Richards
- Department of CardiologyMaastricht University Medical CenterMaastrichtThe Netherlands
- Cardiovascular Research InstituteNational University of SingaporeSingapore
| | - Rob Doughty
- Christchurch Heart InstituteUniversity of OtagoChristchurchNew Zealand
| | | | | | | | | | | | | | | | | | | | - Ali Javaheri
- Washington University School of MedicineSt. LouisMOUSA
- John J. Cochran Veterans HospitalSt. LouisMOUSA
| | | | - Thomas P. Cappola
- Division of Cardiovascular MedicineHospital of the University of PennsylvaniaPhiladelphiaPAUSA
- University of Pennsylvania Perelman School of MedicinePhiladelphiaPAUSA
| | - Julio A. Chirinos
- Division of Cardiovascular MedicineHospital of the University of PennsylvaniaPhiladelphiaPAUSA
- University of Pennsylvania Perelman School of MedicinePhiladelphiaPAUSA
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Serowik TC, Pantalone KM. The evolution of type 2 diabetes management: glycemic control and beyond with SGLT-2 inhibitors and GLP-1 receptor agonists. J Osteopath Med 2024; 124:127-135. [PMID: 37921061 DOI: 10.1515/jom-2023-0179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 10/03/2023] [Indexed: 11/04/2023]
Abstract
Diabetes mellitus (DM) is one of the most prevalent diseases encountered by the primary care physician on a daily basis. Complications associated with DM can include nephropathy, neuropathy, and retinopathy ("microvascular complications"), along with cardiovascular disease (CVD), which can include myocardial infarction (MI) and strokes ("macrovascular complications"). In the 1990s, landmark clinical trials demonstrated that intensive glycemic control can reduce the risk of developing microvascular complications, but reduction in macrovascular complications with intensive glycemic control was not clearly demonstrated. At this point, intensive glycemic control became the standard of care (SOC). In the 2000s, additional trials evaluating the effect of intensive glycemic control in patients with type 2 diabetes mellitus (T2D) and established CVD, or risk factors for CVD, subsequently failed to identify a macrovascular benefit from intensive glycemic control, and one of the trials was terminated early because of an increase in the risk of mortality observed among patients assigned to receive intensive glycemic control. These results led to less strict glycemic targets being recommended in older patients, particularly those with established CVD. In 2007, everything changed after a report surfaced suggesting that rosiglitazone was associated with a significant increase in the risk of MI, as well as an increase in the risk of cardiovascular death that was of borderline significance. As a result, in 2008, the FDA mandated that all new diabetes medications must exclude an unacceptable level of risk for atherosclerotic cardiovascular disease (ASCVD) prior to drug approval, and thus undergo additional cardiovascular safety trials. Accordingly, through these trials, some of the newer agents, particularly sodium-glucose cotransporter-2 inhibitors (SGLT-2i) and glucagon-like peptide-1 receptor agonists (GLP-1RA), were demonstrated to reduce the risk of major adverse cardiovascular events (MACEs), independent of their effect on glycemic control. These findings subsequently led to further trials to evaluate the effects of some of these therapies on the risk of chronic kidney disease (CKD) progression, as well as adverse heart failure-related outcomes. SGLT-2 inhibitors have been demonstrated to reduce the risk of CKD progression, as well as a reduction in the risk of cardiovascular death or hospitalization secondary to heart failure in patients with both reduced ejection and preserved ejection fractions. A trial evaluating the effects of GLP-1RA on CKD outcomes is ongoing. The aim of this narrative review article, compiled by identifying relevant studies via the utilization of PubMed, is to provide a broad overview over the various clinical trials and analyses that have led to current diabetes management guidelines, and ultimately, help guide primary care physicians in selecting therapies that will not only improve glycemic control and reduce the risk of microvascular complications, but also reduce the risk of macrovascular disease in their patients with T2D.
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Affiliation(s)
- Thomas C Serowik
- Ohio University Heritage College of Osteopathic Medicine, Athens, OH, USA
| | - Kevin M Pantalone
- Department of Endocrinology, Diabetes, and Metabolism, Cleveland Clinic, Cleveland, OH, USA
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Curaj A, Vanholder R, Loscalzo J, Quach K, Wu Z, Jankowski V, Jankowski J. Cardiovascular Consequences of Uremic Metabolites: an Overview of the Involved Signaling Pathways. Circ Res 2024; 134:592-613. [PMID: 38422175 DOI: 10.1161/circresaha.123.324001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
The crosstalk of the heart with distant organs such as the lung, liver, gut, and kidney has been intensively approached lately. The kidney is involved in (1) the production of systemic relevant products, such as renin, as part of the most essential vasoregulatory system of the human body, and (2) in the clearance of metabolites with systemic and organ effects. Metabolic residue accumulation during kidney dysfunction is known to determine cardiovascular pathologies such as endothelial activation/dysfunction, atherosclerosis, cardiomyocyte apoptosis, cardiac fibrosis, and vascular and valvular calcification, leading to hypertension, arrhythmias, myocardial infarction, and cardiomyopathies. However, this review offers an overview of the uremic metabolites and details their signaling pathways involved in cardiorenal syndrome and the development of heart failure. A holistic view of the metabolites, but more importantly, an exhaustive crosstalk of their known signaling pathways, is important for depicting new therapeutic strategies in the cardiovascular field.
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Affiliation(s)
- Adelina Curaj
- Institute of Molecular Cardiovascular Research, RWTH Aachen University, Germany (A.C., K.Q., Z.W., V.J., J.J.)
| | - Raymond Vanholder
- Department of Internal Medicine and Pediatrics, Nephrology Section, University Hospital, Ghent, Belgium (R.V.)
| | - Joseph Loscalzo
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (J.L.)
| | - Kaiseng Quach
- Institute of Molecular Cardiovascular Research, RWTH Aachen University, Germany (A.C., K.Q., Z.W., V.J., J.J.)
| | - Zhuojun Wu
- Institute of Molecular Cardiovascular Research, RWTH Aachen University, Germany (A.C., K.Q., Z.W., V.J., J.J.)
| | - Vera Jankowski
- Institute of Molecular Cardiovascular Research, RWTH Aachen University, Germany (A.C., K.Q., Z.W., V.J., J.J.)
| | - Joachim Jankowski
- Institute of Molecular Cardiovascular Research, RWTH Aachen University, Germany (A.C., K.Q., Z.W., V.J., J.J.)
- Experimental Vascular Pathology, Cardiovascular Research Institute Maastricht, University of Maastricht, the Netherlands (J.J.)
- Aachen-Maastricht Institute for Cardiorenal Disease, RWTH Aachen University, Aachen, Germany (J.J.)
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Rosso M, Ramaswamy S, Mulatu Y, Little JN, Kvantaliani N, Brahmaroutu A, Marczak I, Lewey J, Deo R, Messé SR, Cucchiara BL, Levine SR, Kasner SE. Rising Cardiac Troponin: A Prognostic Biomarker for Mortality After Acute Ischemic Stroke. J Am Heart Assoc 2024; 13:e032922. [PMID: 38348784 PMCID: PMC11010097 DOI: 10.1161/jaha.123.032922] [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: 09/30/2023] [Accepted: 01/04/2024] [Indexed: 02/21/2024]
Abstract
BACKGROUND Elevated cardiac troponin (cTn) is detected in 10% to 30% of patients with acute ischemic stroke (AIS) and correlates with poor functional outcomes. Serial cTn measurements differentiate a dynamic cTn pattern (rise/fall >20%), specific for acute myocardial injury, from elevated but stable cTn levels (nondynamic), typically attributed to chronic cardiac/noncardiac conditions. We investigated if the direction of the cTn change (rising versus falling) affects mortality and outcome. METHODS AND RESULTS We retrospectively screened consecutive patients with AIS admitted to 5 stroke centers for elevated cTn at admission and at least 1 additional cTn measurement within 48 hours. The pattern of cTn was defined as rising if >20% increase from baseline, falling if >20% decrease, or nondynamic if ≤20% change in either direction. Logistic regression analyses were performed to assess the association of cTn patterns and 7-day mortality and unfavorable discharge disposition. Of 3789 patients with AIS screened, 300 were included. Seventy-two had a rising pattern, 66 falling, and 162 nondynamic. In patients with AIS with rising cTn, acute ischemic myocardial infarction was present in 54%, compared with 33% in those with falling cTn (P<0.01). Twenty-two percent of patients with a rising pattern had an isolated dynamic cTn in the absence of any ECG or echocardiogram changes, compared with 53% with falling cTn. A rising pattern was associated with higher risk of 7-day mortality (adjusted odds ratio [OR]=32 [95% CI, 2.5-415.0] rising versus aOR=1.3 [95% CI, 0.1-38.0] falling versus nondynamic as reference) and unfavorable discharge disposition (aOR=2.5 [95% CI, 1.2-5.2] rising versus aOR=0.6 [95% CI, 0.2-1.5] versus falling). CONCLUSIONS Rising cTn is independently associated with increased mortality and unfavorable discharge disposition in patients with AIS.
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Affiliation(s)
- Michela Rosso
- Department of NeurologyUniversity of PennsylvaniaPhiladelphiaPAUSA
| | | | - Yohannes Mulatu
- Department of NeurologySUNY Downstate Health Sciences UniversityBrooklynNYUSA
| | | | | | | | - Izabella Marczak
- Department of NeurologySUNY Downstate Health Sciences UniversityBrooklynNYUSA
| | - Jennifer Lewey
- Division of Cardiology, Department of MedicineUniversity of PennsylvaniaPhiladelphiaPAUSA
| | - Rajat Deo
- Division of Cardiology, Department of MedicineUniversity of PennsylvaniaPhiladelphiaPAUSA
| | - Steven R. Messé
- Department of NeurologyUniversity of PennsylvaniaPhiladelphiaPAUSA
| | | | - Steven R. Levine
- Department of NeurologySUNY Downstate Health Sciences UniversityBrooklynNYUSA
| | - Scott E. Kasner
- Department of NeurologyUniversity of PennsylvaniaPhiladelphiaPAUSA
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Wu Y, Li T, Li P, Peng H, Gao A, Wang J, Zhu H, Wang X. Effects of Shenmai injection against chronic heart failure: a meta-analysis and systematic review of preclinical and clinical studies. Front Pharmacol 2024; 14:1338975. [PMID: 38385058 PMCID: PMC10880451 DOI: 10.3389/fphar.2023.1338975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 12/28/2023] [Indexed: 02/23/2024] Open
Abstract
Objective: This study aims to evaluate the clinical and preclinical efficacy of SMI in treating CHF, and to summarize the relevant mechanisms of action in order to provide evidence for its role in CHF treatment. Methods: A systematic computerized search of eight databases and three registry systems was performed, with the time frame spanning from the inception of the databases to 30 June 2023. Strict procedures were used for data extraction, quality assessment, and data analysis. The methodological quality of the included studies was assessed using RoB-2 and SYRCLE tools. Statistical analysis was performed using Rev Man 5.4 software, using either fixed-effects or random-effects models. Results: A total of 25 clinical trials (including test group 1,367 patients, control group 1,338 patients) and 11 animal studies (including 201 animals) were included in this review. The meta-analysis of clinical studies showed that SMI can improve cardiac function indicators (LVEF, LVFS, LVEDV, LVESV, LVEDD, LVESD) (p < 0.00001), reduce BNP/NT-proBNP levels (p < 0.01), and improve inflammatory markers (hs-CRP, TNF-α, IL-6) (p < 0.00001) and endothelin (ET) levels (p < 0.0001). In animal studies, SMI demonstrated improved cardiac function (LVEF, LVFS) (p < 0.05), and improved heart failure markers (NT-proBNP, p < 0.05) when compared to control groups. Conclusion: This study represents the first meta-analysis which includes both preclinical and clinical studies on SMI. Clinical and animal studies have shown that SMI can improve cardiac function in CHF patients through its anti-apoptotic effects, antioxidant activities, anti-inflammatory effects, and improvement of myocardial metabolism. This study has certain limitations in terms of literature quality, quantity, and follow-up time. Therefore, the conclusions drawn from this study may require further validation through larger-scale, high-quality RCT trials.
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Affiliation(s)
- Yang Wu
- Department of Cardiology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Tianli Li
- National Integrated Traditional and Western Medicine Center for Cardiovascular Disease, China-Japan Friendship Hospital, Beijing, China
| | - Pochen Li
- Department of Respiratory, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - HsuanChieh Peng
- Department of Respiratory, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Ang Gao
- Medical Services Section, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Jisheng Wang
- Department of Cardiology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Haiyan Zhu
- Department of Geriatrics, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Xian Wang
- Department of Cardiology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
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Khan SS, Matsushita K, Sang Y, Ballew SH, Grams ME, Surapaneni A, Blaha MJ, Carson AP, Chang AR, Ciemins E, Go AS, Gutierrez OM, Hwang SJ, Jassal SK, Kovesdy CP, Lloyd-Jones DM, Shlipak MG, Palaniappan LP, Sperling L, Virani SS, Tuttle K, Neeland IJ, Chow SL, Rangaswami J, Pencina MJ, Ndumele CE, Coresh J. Development and Validation of the American Heart Association's PREVENT Equations. Circulation 2024; 149:430-449. [PMID: 37947085 PMCID: PMC10910659 DOI: 10.1161/circulationaha.123.067626] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 11/03/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND Multivariable equations are recommended by primary prevention guidelines to assess absolute risk of cardiovascular disease (CVD). However, current equations have several limitations. Therefore, we developed and validated the American Heart Association Predicting Risk of CVD EVENTs (PREVENT) equations among US adults 30 to 79 years of age without known CVD. METHODS The derivation sample included individual-level participant data from 25 data sets (N=3 281 919) between 1992 and 2017. The primary outcome was CVD (atherosclerotic CVD and heart failure). Predictors included traditional risk factors (smoking status, systolic blood pressure, cholesterol, antihypertensive or statin use, and diabetes) and estimated glomerular filtration rate. Models were sex-specific, race-free, developed on the age scale, and adjusted for competing risk of non-CVD death. Analyses were conducted in each data set and meta-analyzed. Discrimination was assessed using the Harrell C-statistic. Calibration was calculated as the slope of the observed versus predicted risk by decile. Additional equations to predict each CVD subtype (atherosclerotic CVD and heart failure) and include optional predictors (urine albumin-to-creatinine ratio and hemoglobin A1c), and social deprivation index were also developed. External validation was performed in 3 330 085 participants from 21 additional data sets. RESULTS Among 6 612 004 adults included, mean±SD age was 53±12 years, and 56% were women. Over a mean±SD follow-up of 4.8±3.1 years, there were 211 515 incident total CVD events. The median C-statistics in external validation for CVD were 0.794 (interquartile interval, 0.763-0.809) in female and 0.757 (0.727-0.778) in male participants. The calibration slopes were 1.03 (interquartile interval, 0.81-1.16) and 0.94 (0.81-1.13) among female and male participants, respectively. Similar estimates for discrimination and calibration were observed for atherosclerotic CVD- and heart failure-specific models. The improvement in discrimination was small but statistically significant when urine albumin-to-creatinine ratio, hemoglobin A1c, and social deprivation index were added together to the base model to total CVD (ΔC-statistic [interquartile interval] 0.004 [0.004-0.005] and 0.005 [0.004-0.007] among female and male participants, respectively). Calibration improved significantly when the urine albumin-to-creatinine ratio was added to the base model among those with marked albuminuria (>300 mg/g; 1.05 [0.84-1.20] versus 1.39 [1.14-1.65]; P=0.01). CONCLUSIONS PREVENT equations accurately and precisely predicted risk for incident CVD and CVD subtypes in a large, diverse, and contemporary sample of US adults by using routinely available clinical variables.
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Affiliation(s)
- Sadiya S. Khan
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA (S Khan)
| | - Kunihiro Matsushita
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (K Matsushita, Y Sang, SH Ballew, ME Grams, A Surapaneni, J Coresh)
| | - Yingying Sang
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (K Matsushita, Y Sang, SH Ballew, ME Grams, A Surapaneni, J Coresh)
| | - Shoshana H Ballew
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (K Matsushita, Y Sang, SH Ballew, ME Grams, A Surapaneni, J Coresh)
| | - Morgan E. Grams
- New York University Grossman School of Medicine, Department of Medicine, Division of Precision Medicine, New York, New York, USA (M Grams, A Surapaneni)
| | - Aditya Surapaneni
- New York University Grossman School of Medicine, Department of Medicine, Division of Precision Medicine, New York, New York, USA (M Grams, A Surapaneni)
| | - Michael J. Blaha
- Johns Hopkins Ciccarone Center for Prevention of Cardiovascular Disease, Baltimore, MD (M Blaha)
| | - April P. Carson
- University of Mississippi Medical Center, Jackson (A Carson)
| | - Alexander R. Chang
- Departments of Nephrology and Population Health Sciences, Geisinger Health, Danville, Pennsylvania (AR Chang)
| | - Elizabeth Ciemins
- AMGA (American Medical Group Association), Alexandria, Virginia, USA (E Ciemins)
| | - Alan S. Go
- Division of Research, Kaiser Permanente Northern California, Oakland, California; Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California; Departments of Epidemiology, Biostatistics and Medicine, University of California, San Francisco, California; Department of Medicine (Nephrology), Stanford University School of Medicine, Palo Alto, California (A Go)
| | - Orlando M. Gutierrez
- Departments of Epidemiology and Medicine, University of Alabama at Birmingham, Birmingham, AL (OM Gutierrez)
| | - Shih-Jen Hwang
- National Heart, Lung, and Blood Institute, Framingham, Massachusetts (SJ Hwang)
| | - Simerjot K. Jassal
- Division of General Internal Medicine, University of California, San Diego and VA San Diego Healthcare, San Diego, California (SK Jassal)
| | - Csaba P. Kovesdy
- Medicine-Nephrology, Memphis Veterans Affairs Medical Center and University of Tennessee Health Science Center, Memphis, Tennessee (CP Kovesdy)
| | - Donald M. Lloyd-Jones
- Department of Preventive Medicine, Northwestern University, Chicago, Illinois (DM Lloyd-Jones)
| | - Michael G. Shlipak
- Department of Medicine, Epidemiology, and Biostatistics, University of California, San Francisco, and San Francisco VA Medical Center, San Francisco (M Shlipak)
| | - Latha P. Palaniappan
- Center for Asian Health Research and Education and the Department of Medicine, Stanford University School of Medicine, Stanford, California, USA. (LP Palaniappan)
| | - Laurence Sperling
- Department of Cardiology, Emory University, Atlanta, GA (L Sperling)
| | - Salim S. Virani
- Department of Medicine, The Aga Khan University, Karachi, Pakistan; Texas Heart Institute and Baylor College of Medicine, Houston, Texas (SS Virani)
| | - Katherine Tuttle
- Providence Medical Research Center, Providence Inland Northwest Health, Spokane, WA, USA; Kidney Research Institute and Institute of Translational Health Sciences, University of Washington, Seattle, WA, USA (K Tuttle)
| | - Ian J. Neeland
- UH Center for Cardiovascular Prevention, Translational Science Unit, Center for Integrated and Novel Approaches in Vascular-Metabolic Disease (CINEMA), Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA (I Neeland)
| | - Sheryl L. Chow
- Department of Pharmacy Practice and Administration, College of Pharmacy, Western University of Health Sciences, Pomona, CA (SL Chow)
| | - Janani Rangaswami
- Washington DC VA Medical Center and George Washington University School of Medicine, Washington, DC (J Rangaswami)
| | - Michael J. Pencina
- Department of Biostatistics, Duke University Medical Center, Durham, North Carolina (MJ Pencina)
| | - Chiadi E. Ndumele
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA (C Ndumele)
| | - Josef Coresh
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (K Matsushita, Y Sang, SH Ballew, ME Grams, A Surapaneni, J Coresh)
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Visker JR, Cluntun AA, Velasco-Silva JN, Eberhardt DR, Shankar TS, Hamouche R, Ling J, Kwak H, Hillas Y, Aist I, Tseliou E, Navankasattusas S, Chaudhuri D, Ducker GS, Drakos SG, Rutter J. Enhancing mitochondrial pyruvate metabolism ameliorates myocardial ischemic reperfusion injury. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.02.01.577463. [PMID: 38352459 PMCID: PMC10862804 DOI: 10.1101/2024.02.01.577463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/03/2024]
Abstract
The established clinical therapy for the treatment of acute myocardial infarction is primary percutaneous coronary intervention (PPCI) to restore blood flow to the ischemic myocardium. PPCI is effective at reperfusing the ischemic myocardium, however the rapid re-introduction of oxygenated blood also can cause ischemia-reperfusion (I/R) injury. Reperfusion injury is the culprit for up to half of the final myocardial damage, but there are no clinical interventions to reduce I/R injury. We previously demonstrated that inhibiting the lactate exporter, monocarboxylate transporter 4 (MCT4), and re-directing pyruvate towards oxidation can blunt isoproterenol-induced hypertrophy. Based on this finding, we hypothesized that the same pathway might be important during I/R. Here, we establish that the pyruvate-lactate metabolic axis plays a critical role in determining myocardial salvage following injury. Post-I/R injury, the mitochondrial pyruvate carrier (MPC), required for pyruvate oxidation, is upregulated in the surviving myocardium following I/R injury. MPC loss in cardiomyocytes caused more cell death with less myocardial salvage, which was associated with an upregulation of MCT4 in the myocardium at risk of injury. We deployed a pharmacological strategy of MCT4 inhibition with a highly selective compound (VB124) at the time of reperfusion. This strategy normalized reactive oxygen species (ROS), mitochondrial membrane potential (Δψ), and Ca 2+ , increased pyruvate entry to TCA cycle, and improved myocardial salvage and functional outcomes following I/R injury. Altogether, our data suggest that normalizing the pyruvate-lactate metabolic axis via MCT4 inhibition is a promising pharmacological strategy to mitigate I/R injury. GRAPHICAL ABSTRACT
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Rao BR, Dickert NW, Morris AA. Ethical Complexity of Medical Treatment Affordability and Clinical Trial Diversity in Heart Failure. Circ Cardiovasc Qual Outcomes 2024; 17:e010227. [PMID: 38377226 DOI: 10.1161/circoutcomes.123.010227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/22/2024]
Affiliation(s)
- Birju R Rao
- Division of Cardiology, Emory University School of Medicine, Atlanta, GA (B.R.R., N.W.D., A.A.M.)
| | - Neal W Dickert
- Division of Cardiology, Emory University School of Medicine, Atlanta, GA (B.R.R., N.W.D., A.A.M.)
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA (N.W.D.)
| | - Alanna A Morris
- Division of Cardiology, Emory University School of Medicine, Atlanta, GA (B.R.R., N.W.D., A.A.M.)
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Mizobuchi S, Saito Y, Kitano D, Toyama K, Miyagawa M, Koyama Y, Fujito H, Kojima K, Murata N, Fukamachi D, Okumura Y. Sodium-glucose co-transporter 2 inhibitors in acute heart failure: real-world prescription trends and outcomes analysis. ESC Heart Fail 2024; 11:410-421. [PMID: 38017700 PMCID: PMC10804185 DOI: 10.1002/ehf2.14597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Revised: 10/19/2023] [Accepted: 11/07/2023] [Indexed: 11/30/2023] Open
Abstract
AIMS Sodium-glucose co-transporter 2 (SGLT2) inhibitors have shown potential therapeutic benefits in heart failure (HF). However, data on their real-world usage and benefits in acute decompensated heart failure (ADHF) are limited. METHODS AND RESULTS We conducted a post hoc analysis of real-world data from 1108 patients with ADHF admitted to Nihon University Itabashi Hospital (Tokyo, Japan) between 2018 and 2022. Patients were divided into two groups based on the prescription of SGLT2 inhibitors during hospitalization: an SGLT2 inhibitor group (SGLT2i group) (n = 289) and a non-SGLT2i group (n = 819). The primary endpoints were death and rehospitalization for HF after discharge. The median age was 76 [interquartile range (IQR): 66, 83] years, and 732 patients (66%) were male. Data showed an increasing trend in the prescription of SGLT2 inhibitors since 2021. During a median follow-up period of 366 days (IQR: 116, 614), 458 (41.3%) patients reached the primary endpoint. The Kaplan-Meier analysis showed that the SGLT2i group had a significantly lower rate of composite events than the non-SGLT2i group, both overall (log-rank test, P < 0.001) and in the following left ventricular ejection fraction (LVEF) subgroups: HF with reduced ejection fraction (EF) (n = 413), HF with mildly reduced EF (n = 226), and HF with preserved EF (n = 466) (log-rank test; P = 0.044, P = 0.013, and P = 0.001, respectively). Furthermore, patients starting SGLT2 inhibitors during hospitalization had a significantly lower rate of composite events than those not using SGLT2 inhibitors (log-rank test, P < 0.001). This association was also significant in the LVEF subgroups (P = 0.005, P = 0.032, and P = 0.004, respectively). CONCLUSIONS The prescription and initiation of SGLT2 inhibitors during hospitalization are associated with improved post-discharge outcomes in patients with ADHF, irrespective of LVEF.
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Affiliation(s)
- Saki Mizobuchi
- Division of Cardiology, Department of MedicineNihon University School of Medicine30‐1 Ohyaguchi‐kamicho, Itabashi‐kuTokyo173‐8610Japan
| | - Yuki Saito
- Division of Cardiology, Department of MedicineNihon University School of Medicine30‐1 Ohyaguchi‐kamicho, Itabashi‐kuTokyo173‐8610Japan
| | - Daisuke Kitano
- Division of Cardiology, Department of MedicineNihon University School of Medicine30‐1 Ohyaguchi‐kamicho, Itabashi‐kuTokyo173‐8610Japan
| | - Kazuto Toyama
- Division of Cardiology, Department of MedicineNihon University School of Medicine30‐1 Ohyaguchi‐kamicho, Itabashi‐kuTokyo173‐8610Japan
| | - Masatsugu Miyagawa
- Division of Cardiology, Department of MedicineNihon University School of Medicine30‐1 Ohyaguchi‐kamicho, Itabashi‐kuTokyo173‐8610Japan
| | - Yutaka Koyama
- Division of Cardiology, Department of MedicineNihon University School of Medicine30‐1 Ohyaguchi‐kamicho, Itabashi‐kuTokyo173‐8610Japan
| | - Hidesato Fujito
- Division of Cardiology, Department of MedicineNihon University School of Medicine30‐1 Ohyaguchi‐kamicho, Itabashi‐kuTokyo173‐8610Japan
| | - Keisuke Kojima
- Division of Cardiology, Department of MedicineNihon University School of Medicine30‐1 Ohyaguchi‐kamicho, Itabashi‐kuTokyo173‐8610Japan
| | - Nobuhiro Murata
- Division of Cardiology, Department of MedicineNihon University School of Medicine30‐1 Ohyaguchi‐kamicho, Itabashi‐kuTokyo173‐8610Japan
| | - Daisuke Fukamachi
- Division of Cardiology, Department of MedicineNihon University School of Medicine30‐1 Ohyaguchi‐kamicho, Itabashi‐kuTokyo173‐8610Japan
| | - Yasuo Okumura
- Division of Cardiology, Department of MedicineNihon University School of Medicine30‐1 Ohyaguchi‐kamicho, Itabashi‐kuTokyo173‐8610Japan
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Zhang Z, Sun M, Jiang W, Yu L, Zhang C, Ma H. Myocardial Metabolic Reprogramming in HFpEF. J Cardiovasc Transl Res 2024; 17:121-132. [PMID: 37650988 DOI: 10.1007/s12265-023-10433-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Accepted: 08/22/2023] [Indexed: 09/01/2023]
Abstract
Heart failure (HF) caused by structural or functional cardiac abnormalities is a significant cause of morbidity and mortality worldwide. While HF with reduced ejection fraction (HErEF) is well understood, more than half of patients have HF with preserved ejection fraction (HFpEF). Currently, the treatment for HFpEF primarily focuses on symptom alleviation, lacking specific drugs. The stressed heart undergoes metabolic switches in substrate preference, which is a compensatory process involved in cardiac pathological remodeling. Although metabolic reprogramming in HF has gained attention in recent years, its role in HFpEF still requires further elucidation. In this review, we present a summary of cardiac mitochondrial dysfunction and cardiac metabolic reprogramming in HFpEF. Additionally, we emphasize potential therapeutic approaches that target metabolic reprogramming for the treatment of HFpEF.
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Affiliation(s)
- Zihui Zhang
- Xi'an Key Laboratory of Stem Cell and Regenerative Medicine, Institute of Medical Research, Northwestern Polytechnical University, Xi'an, Shaanxi, 710072, People's Republic of China
| | - Mingchu Sun
- Xi'an Key Laboratory of Stem Cell and Regenerative Medicine, Institute of Medical Research, Northwestern Polytechnical University, Xi'an, Shaanxi, 710072, People's Republic of China
| | - Wenhua Jiang
- Xi'an Key Laboratory of Stem Cell and Regenerative Medicine, Institute of Medical Research, Northwestern Polytechnical University, Xi'an, Shaanxi, 710072, People's Republic of China
| | - Lu Yu
- Department of Pathology, Xijing Hospital, Fourth Military Medical University, Xi'an, 710032, People's Republic of China
| | - Chan Zhang
- Xi'an Key Laboratory of Stem Cell and Regenerative Medicine, Institute of Medical Research, Northwestern Polytechnical University, Xi'an, Shaanxi, 710072, People's Republic of China.
| | - Heng Ma
- Xi'an Key Laboratory of Stem Cell and Regenerative Medicine, Institute of Medical Research, Northwestern Polytechnical University, Xi'an, Shaanxi, 710072, People's Republic of China.
- Department of Physiology and Pathophysiology, Fourth Military Medical University, Xi'an, 710032, People's Republic of China.
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Abdin A, Böhm M. [Therapy of heart failure with reduced pump function]. Dtsch Med Wochenschr 2024; 149:157-165. [PMID: 38286146 DOI: 10.1055/a-2054-9636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2024]
Abstract
HFrEF causes significant morbidity and mortality and represents a major public health burden. Recently, there have been significant scientific advances in the treatment of HFrEF, with ARNI, BB, MRA, and SGLT-2i forming the GDMT for HFrEF. Basic quadruple therapy has been shown to significantly reduce of HF hospitalizations, all-cause mortality, and cardiovascular mortality. In addition, new initiation and titration procedures have recently been introduced that may progressively improve the management and prognosis of HFrEF. Further efforts are also needed to improve the use of GDMT, which is currently underutilized.
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Besson FL, Treglia G, Bucerius J, Anagnostopoulos C, Buechel RR, Dweck MR, Erba PA, Gaemperli O, Gimelli A, Gheysens O, Glaudemans AWJM, Habib G, Hyafil F, Lubberink M, Rischpler C, Saraste A, Slart RHJA. A systematic review for the evidence of recommendations and guidelines in hybrid nuclear cardiovascular imaging. Eur J Nucl Med Mol Imaging 2024:10.1007/s00259-024-06597-x. [PMID: 38221570 DOI: 10.1007/s00259-024-06597-x] [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: 11/05/2023] [Accepted: 01/01/2024] [Indexed: 01/16/2024]
Abstract
OBJECTIVES This study aimed to evaluate the level of evidence of expert recommendations and guidelines for clinical indications and procedurals in hybrid nuclear cardiovascular imaging. METHODS From inception to August 2023, a PubMed literature analysis of the latest version of guidelines for clinical hybrid cardiovascular imaging techniques including SPECT(/CT), PET(/CT), and PET(/MRI) was performed in two categories: (1) for clinical indications for all-in primary diagnosis; subgroup in prognosis and therapy evaluation; and for (2) imaging procedurals. We surveyed to what degree these followed a standard methodology to collect the data and provide levels of evidence, and for which topic systematic review evidence was executed. RESULTS A total of 76 guidelines, published between 2013 and 2023, were included. The evidence of guidelines was based on systematic reviews in 7.9% of cases, non-systematic reviews in 47.4% of cases, a mix of systematic and non-systematic reviews in 19.7%, and 25% of guidelines did not report any evidence. Search strategy was reported in 36.8% of cases. Strengths of recommendation were clearly reported in 25% of guidelines. The notion of external review was explicitly reported in 23.7% of cases. Finally, the support of a methodologist was reported in 11.8% of the included guidelines. CONCLUSION The use of evidence procedures for developing for evidence-based cardiovascular hybrid imaging recommendations and guidelines is currently suboptimal, highlighting the need for more standardized methodological procedures.
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Affiliation(s)
- Florent L Besson
- Department of Nuclear Medicine-Molecular Imaging, DMU SMART IMAGING, Hôpitaux Universitaires Paris-Saclay, AP-HP, CHU Bicêtre, Le Kremlin Bicetre, France
- School of Medicine, Université Paris-Saclay, Le Kremlin-Bicetre, France
- Commissariat À L'énergie Atomique Et Aux Énergies Alternatives (CEA), Centre National de La Recherche Scientifique (CNRS), Inserm, BioMaps, Université Paris-Saclay, Le Kremlin-Bicetre, France
| | - Giorgio Treglia
- Division of Nuclear Medicine, Imaging Institute of Southern Switzerland, Ente Ospedaliero Cantonale, 6501, Bellinzona, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, 6900, Lugano, Switzerland
| | - Jan Bucerius
- Department of Nuclear Medicine, Georg-August University Göttingen, Universitätsmedizin Göttingen, Gottingen, Germany
| | | | - Ronny R Buechel
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Zurich, Switzerland
| | - Marc R Dweck
- British Heart Foundation Centre for Cardiovascular Science, Edinburgh Heart Centre, University of Edinburgh, Chancellors Building, Little France Crescent, Edinburgh, UK
| | - Paula A Erba
- Department of Medicine and Surgery, University of Milan Bicocca, and Nuclear Medicine Unit ASST Ospedale Papa Giovanni XXIII, Bergamo, Italy
| | | | | | - Olivier Gheysens
- Department of Nuclear Medicine, Cliniques Universitaires Saint-Luc, Institut Roi Albert II, Université Catholique de Louvain, 1200, Brussels, Belgium
| | - Andor W J M Glaudemans
- Department of Nuclear Medicine and Molecular Imaging, Medical Imaging Center, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Gilbert Habib
- Department of Cardiology, APHM, La Timone Hospital, Marseille, France
| | - Fabian Hyafil
- Department of Nuclear Medicine, DMU IMAGINA, Georges-Pompidou European Hospital, Assistance Publique - Hôpitaux de Paris, F75015, Paris, France
| | - Mark Lubberink
- Medical Imaging Centre, Uppsala University Hospital, Uppsala, Sweden
| | | | - Antti Saraste
- Heart Center, Turku University Hospital and University of Turku, Turku, Finland
| | - Riemer H J A Slart
- Department of Nuclear Medicine and Molecular Imaging, Medical Imaging Center, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
- Department of Biomedical Photonic Imaging, Faculty of Science and Technology, University of Twente, Enschede, the Netherlands.
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Chandra NV, Stroud S, Kamath MY. Case Implementing 2022 AHA/ACC/HFSA Guidelines: Heart Failure Management in Pregnancy: Early Planning, Close Surveillance, and Multidisciplinary Care. Circ Heart Fail 2024; 17:e010580. [PMID: 38088175 DOI: 10.1161/circheartfailure.123.010580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2024]
Affiliation(s)
- Neha V Chandra
- Division of Cardiology, Department of Medicine, University of California, Los Angeles (N.V.C., M.Y.K.)
| | - Steven Stroud
- Advanced Heart Failure Center, Department of Cardiology, Oklahoma Heart Institute, Tulsa (S.S.)
| | - Megan Y Kamath
- Division of Cardiology, Department of Medicine, University of California, Los Angeles (N.V.C., M.Y.K.)
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Kokkinos P, Faselis C, Pittaras A, Samuel IBH, Lavie CJ, Vargas JD, Lamonte M, Franklin B, Assimes TL, Murphy R, Zhang J, Sui X, Myers J. Cardiorespiratory fitness and risk of heart failure with preserved ejection fraction. Eur J Heart Fail 2023. [PMID: 38152843 DOI: 10.1002/ejhf.3117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 11/01/2023] [Accepted: 12/19/2023] [Indexed: 12/29/2023] Open
Abstract
AIMS Preventive strategies for heart failure with preserved ejection fraction (HFpEF) include pharmacotherapies and lifestyle modifications. However, the association between cardiorespiratory fitness (CRF) assessed objectively by a standardized exercise treadmill test (ETT) and the risk of HFpEF has not been evaluated. Thus, we evaluated the association between CRF and HFpEF incidence. METHODS AND RESULTS We assessed CRF in US Veterans (624 551 men; mean age 61.2 ± 9.7 years and 43 179 women; mean age 55.0 ± 8.9 years) by a standardized ETT performed between 1999 and 2020 across US Veterans Affairs Medical Centers. All had no evidence of heart failure or myocardial infarction prior to completion of the ETT. We assigned participants to one of five age- and gender-specific CRF categories (quintiles) based on peak metabolic equivalents (METs) achieved during the ETT and four categories based on CRF changes in those with two ETT evaluations (n = 139 434) ≥1.0 year apart. During a median follow-up of 10.1 years (interquartile range 6.0-14.3 years), providing 6 879 229 person-years, there were 16 493 HFpEF events with an average annual rate of 2.4 events per 1000 person-years. The adjusted risk of HFpEF decreased across CRF categories as CRF increased, independent of comorbidities. For fit individuals (≥10.5 METs) the hazard ratio (HR) was 0.48 (95% confidence interval [CI] 0.46-0.51) compared with least fit (≤4.9 METs; referent). Being unfit carried the highest risk (HR 2.88, 95% CI 2.67-3.11) of any other comorbidity. The risk of unfit individuals who became fit was 37% lower (HR 0.63, 95% CI 0.57-0.71), compared to those who remained unfit. CONCLUSIONS Higher CRF levels are independently associated with lower HFpEF in a dose-response manner. Changes in CRF reflected proportional changes in HFpEF risk, suggesting that the HFpEF risk was modulated by CRF.
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Affiliation(s)
- Peter Kokkinos
- Cardiology Division, DC Veterans Affairs Medical Center, Washington, DC, USA
- Department of Kinesiology and Health, School of Arts and Sciences, Rutgers University, New Brunswick, NJ, USA
- Department of Clinical Research and Leadership, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Charles Faselis
- DC Veterans Affairs Medical Center, Washington, DC, USA
- Department of Medicine, George Washington University School of Medicine, and Health Sciences, Washington, DC, USA
| | - Andreas Pittaras
- Cardiology Division, DC Veterans Affairs Medical Center, Washington, DC, USA
- Department of Medicine, George Washington University School of Medicine, and Health Sciences, Washington, DC, USA
| | - Immanuel Babu Henry Samuel
- War Related Illness and Injury Study Center, DC Veterans Affairs Medical Center, Washington, DC, USA
- The Henry Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
| | - Carl J Lavie
- John Ochsner Heart and Vascular Institute, Ochsner Clinical School, The University of Queensland School of Medicine, New Orleans, LA, USA
| | - Jose D Vargas
- Cardiology Division, DC Veterans Affairs Medical Center, Washington, DC, USA
| | - Michael Lamonte
- Department of Social and Preventive Medicine, University of Buffalo, Buffalo, NY, USA
| | - Barry Franklin
- Preventive Cardiology, William Beaumont Hospital, Royal Oak, MI, USA
| | | | - Rayelynn Murphy
- Cardiology Division, DC Veterans Affairs Medical Center, Washington, DC, USA
| | - Jiajia Zhang
- Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, SC, USA
| | - Xuemei Sui
- Department of Exercise Science, University of South Carolina System, Columbia, SC, USA
| | - Jonathan Myers
- Cardiology, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
- Department of Cardiology, Stanford University, Stanford, CA, USA
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Yang Z, Zheng X, Hu N, Zhang F, Wang A. "Challenges to Normalcy"- Perceived Barriers to Adherence to Home-Based Cardiac Rehabilitation Exercise in Patients with Chronic Heart Failure. Patient Prefer Adherence 2023; 17:3515-3524. [PMID: 38146500 PMCID: PMC10749573 DOI: 10.2147/ppa.s440984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 12/18/2023] [Indexed: 12/27/2023] Open
Abstract
Purpose The aim of this study was to explore perceived barriers to adherence to home-based cardiac rehabilitation exercise in patients with chronic heart failure. Patients and Methods A qualitative descriptive study was conducted in this study from May to July 2023. A purposive sampling approach was adopted to select patients with chronic heart failure. Semi-structured interviews were completed to collect qualitative data for exploring the perceived barriers. In addition, information saturation and validation strategies were adopted to prove the adequacy of qualitative data. Transcripts were analysed using thematic analysis. Results A total of 16 patients with chronic heart failure were included in this study. Analysis of the data revealed five main barriers to adherence to home-based cardiac rehabilitation in patients with chronic heart failure. These include (1) lack of knowledge, (2) activity intolerance, (3) exercise fear, (4) role conflict, and (5) lower exercise self-efficacy. Conclusion This study delved deeper into understanding the challenges faced by chronic heart failure patients in adhering to home-based cardiac rehabilitation exercise. The development of precise and effective management and intervention strategies based on these barriers is necessary to improve patient compliance with home-based cardiac rehabilitation exercise.
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Affiliation(s)
- Zhen Yang
- Department of Public Services, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning Province, People’s Republic of China
| | - Xutong Zheng
- Department of Public Services, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning Province, People’s Republic of China
| | - Na Hu
- Department of Public Services, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning Province, People’s Republic of China
| | - Fengpei Zhang
- Department of Public Services, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning Province, People’s Republic of China
| | - Aiping Wang
- Department of Public Services, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning Province, People’s Republic of China
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Kan A, Leng Y, Li S, Lin F, Fang Q, Tao X, Hu M, Gong L. The predictive value of coronary microvascular dysfunction for left ventricular reverse remodelling in dilated cardiomyopathy. Front Cardiovasc Med 2023; 10:1301509. [PMID: 38111885 PMCID: PMC10726051 DOI: 10.3389/fcvm.2023.1301509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 11/20/2023] [Indexed: 12/20/2023] Open
Abstract
Aims To evaluate the degree of coronary microvascular dysfunction (CMD) in dilated cardiomyopathy (DCM) patients by cardiac magnetic resonance (CMR) first-pass perfusion parameters and to examine the correlation between myocardial perfusion and left ventricle reverse remodelling (LVRR). Methods In this study, 94 DCM patients and 35 healthy controls matched for age and sex were included. Myocardial perfusion parameters, including upslope, time to maximum signal intensity (Timemax), maximum signal intensity (SImax), baseline signal intensity (SIbaseline), and the difference between maximum and baseline signal intensity (SImax-baseline) were measured. Additionally, left ventricular (LV) structure, function parameters, and late gadolinium enhancement (LGE) were also recorded. The parameters were compared between healthy controls and DCM patients. Univariable and multivariable logistic regression analyses were used to determine the predictors of LVRR. Results With a median follow-up period of 12 months [interquartile range (IQR), 8-13], 41 DCM patients (44%) achieved LVRR. Compared with healthy controls, DCM patients presented CMD with reduced upslope, SIbaseline, and increased Timemax (all p < 0.01). Timemax, SImax, and SImax-baseline were further decreased in LVRR than non-LVRR group (Timemax: 60.35 [IQR, 51.46-74.71] vs. 72.41 [IQR, 59.68-97.70], p = 0.017; SImax: 723.52 [IQR, 209.76-909.27] vs. 810.92 [IQR, 581.30-996.89], p = 0.049; SImax-baseline: 462.99 [IQR, 152.25-580.43] vs. 551.13 [IQR, 402.57-675.36], p = 0.038). In the analysis of multivariate logistic regression, Timemax [odds ratio (OR) 0.98; 95% confidence interval (CI) 0.95-1.00; p = 0.032)], heart rate (OR 1.04; 95% CI 1.01-1.08; p = 0.029), LV remodelling index (OR 1.73; 95% CI 1.06-3.00; p = 0.038) and LGE extent (OR 0.85; 95% CI 0.73-0.96; p = 0.021) were independent predictors of LVRR. Conclusions CMD could be found in DCM patients and was more impaired in patients with non-LVRR than LVRR patients. Timemax at baseline was an independent predictor of LVRR in DCM.
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Affiliation(s)
- Ao Kan
- Department of Radiology, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Yinping Leng
- Department of Radiology, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Shuhao Li
- Department of Radiology, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Fang Lin
- Department of Radiology, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Qimin Fang
- Department of Radiology, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Xinwei Tao
- Department of Medical, Bayer Healthcare, Shanghai, China
| | - Mengyao Hu
- Department of Radiology, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Lianggeng Gong
- Department of Radiology, The Second Affiliated Hospital of Nanchang University, Nanchang, China
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Matsukawa R, Okahara A, Tokutome M, Itonaga J, Koga E, Hara A, Kisanuki H, Sada M, Okabe K, Kawai S, Ogawa K, Matsuura H, Mukai Y. A scoring evaluation for the practical introduction of guideline-directed medical therapy in heart failure patients. ESC Heart Fail 2023; 10:3352-3363. [PMID: 37671603 PMCID: PMC10682854 DOI: 10.1002/ehf2.14524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 07/19/2023] [Accepted: 08/22/2023] [Indexed: 09/07/2023] Open
Abstract
AIMS The guideline-directed medical therapy (GDMT) has been recommended for heart failure (HF) with reduced ejection fraction (HFrEF) based on the accumulating clinical evidence. However, it is difficult to implement all the trial-proven medications for every patient in the real world. METHODS AND RESULTS A simple GDMT score was created, according to the combination of GDMT drugs (renin-angiotensin system inhibitors, beta-blockers, mineralocorticoid receptor antagonists, and sodium-glucose transporter 2 inhibitors) administration and their dosage (0-9 points). Its impact on the prognosis of HF patients was investigated. Admitted HF patients [HFrEF and HF with mildly reduced ejection fraction (HFmrEF), n = 1054] were retrospectively analysed (excluding those with in-hospital death and dialysis). A simple GDMT score ≥5, but not the number of medications, was significantly associated with a reduction of all-cause death, HF readmission, and composite outcome (HF readmission and all-cause death) (P < 0.001). Subgroup analysis showed that almost all groups with a simple GDMT score of 5 or higher had a better prognosis. CONCLUSIONS The developed simple GDMT score was associated with prognosis in HFrEF and HFmrEF patients. Even if all four drugs cannot be introduced for some reason, a regimen with a simple GDMT score ≥5 may lead to a prognosis in HF patients.
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Affiliation(s)
- Ryuichi Matsukawa
- Department of CardiologyJapanese Red Cross Fukuoka HospitalFukuokaJapan
| | - Arihide Okahara
- Department of CardiologyJapanese Red Cross Fukuoka HospitalFukuokaJapan
| | - Masaki Tokutome
- Department of CardiologyJapanese Red Cross Fukuoka HospitalFukuokaJapan
| | - Junpei Itonaga
- Department of CardiologyJapanese Red Cross Fukuoka HospitalFukuokaJapan
| | - Eiichi Koga
- Department of CardiologyJapanese Red Cross Fukuoka HospitalFukuokaJapan
| | - Ayano Hara
- Department of CardiologyJapanese Red Cross Fukuoka HospitalFukuokaJapan
| | - Hiroshi Kisanuki
- Department of CardiologyJapanese Red Cross Fukuoka HospitalFukuokaJapan
| | - Masashi Sada
- Department of CardiologyJapanese Red Cross Fukuoka HospitalFukuokaJapan
| | - Kousuke Okabe
- Department of CardiologyJapanese Red Cross Fukuoka HospitalFukuokaJapan
| | - Shunsuke Kawai
- Department of CardiologyJapanese Red Cross Fukuoka HospitalFukuokaJapan
| | - Kiyohiro Ogawa
- Department of CardiologyJapanese Red Cross Fukuoka HospitalFukuokaJapan
| | - Hirohide Matsuura
- Department of CardiologyJapanese Red Cross Fukuoka HospitalFukuokaJapan
| | - Yasushi Mukai
- Department of CardiologyJapanese Red Cross Fukuoka HospitalFukuokaJapan
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Shao J, Liu C, Wang J. Advances in research on molecular markers in immune checkpoint inhibitor-associated myocarditis. CANCER INNOVATION 2023; 2:439-447. [PMID: 38125765 PMCID: PMC10730003 DOI: 10.1002/cai2.100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 08/26/2023] [Accepted: 09/04/2023] [Indexed: 12/23/2023]
Abstract
Immune checkpoint inhibitors (ICIs) play a crucial role in the immunotherapy of malignant tumors, preventing immune evasion by tumor cells and activating autoimmune cells to eliminate the tumor. Despite their proven effectiveness in antitumor therapy, potential immune-related adverse effects must be recognized, particularly ICI-associated myocarditis (ICIAM). ICIAM is the most lethal form of organ immunotoxicity, with a significant impact on short-term mortality. However, ICIAM is predominantly asymptomatic or mildly nonspecific. It is difficult to diagnose, especially due to the lack of unique molecular markers. This article aims to provide a comprehensive overview of the progress made in identifying molecular markers for ICIAM.
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Affiliation(s)
- Jun Shao
- Department of General MedicineFirst Medical Center of PLA General HospitalBeijingChina
| | - Chuanbin Liu
- Western Medical Branch of PLA General HospitalBeijingChina
| | - Jing Wang
- Department of General MedicineFirst Medical Center of PLA General HospitalBeijingChina
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Kodsi M, Makarious D, Gan GC, Choudhary P, Thomas L. Cardiac reverse remodelling by imaging parameters with recent changes to guideline medical therapy in heart failure. ESC Heart Fail 2023; 10:3258-3275. [PMID: 37871982 PMCID: PMC10682888 DOI: 10.1002/ehf2.14555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 08/29/2023] [Accepted: 09/20/2023] [Indexed: 10/25/2023] Open
Abstract
Recently established heart failure therapies, including sodium glucose co-transporter 2 inhibitors, angiotensin-neprilysin inhibitors, and cardiac resynchronization therapy, have led to both clinical and structural improvements. Reverse remodelling describes the structural and functional responses to therapy and has been shown to correlate with patients' clinical response, acting as a biomarker for treatment success. The introduction of these new therapeutic agents in addition to advances in non-invasive cardiac imaging has led to an expansion in the evaluation and the validation of cardiac reverse remodelling. Methods including volumetric changes as well as strain and myocardial work have all been shown to be non-invasive end-points of reverse remodelling, correlating with clinical outcomes. Our review summarizes the current available evidence on reverse remodelling in heart failure by the non-invasive cardiac imaging techniques, in particular transthoracic echocardiography.
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Affiliation(s)
- Matthew Kodsi
- Department of CardiologyWestmead HospitalSydneyAustralia
| | - David Makarious
- Department of CardiologyWestmead HospitalSydneyAustralia
- Westmead Clinical School, Westmead HospitalUniversity of SydneySydneyAustralia
| | - Gary C.H. Gan
- Department of CardiologyWestmead HospitalSydneyAustralia
| | - Preeti Choudhary
- Department of CardiologyWestmead HospitalSydneyAustralia
- Westmead Clinical School, Westmead HospitalUniversity of SydneySydneyAustralia
| | - Liza Thomas
- Department of CardiologyWestmead HospitalSydneyAustralia
- Westmead Clinical School, Westmead HospitalUniversity of SydneySydneyAustralia
- South West clinical SchoolUniversity of New South WalesSydneyAustralia
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Kan A, Fang Q, Li S, Liu W, Tao X, Huang K, Hu M, Feng Z, Gong L. The potential predictive value of cardiac mechanics for left ventricular reverse remodelling in dilated cardiomyopathy. ESC Heart Fail 2023; 10:3340-3351. [PMID: 37697922 PMCID: PMC10682859 DOI: 10.1002/ehf2.14529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Revised: 06/21/2023] [Accepted: 08/30/2023] [Indexed: 09/13/2023] Open
Abstract
AIMS Left ventricular reverse remodelling (LVRR) is an important objective of optimal medical management for dilated cardiomyopathy (DCM) patients, as it is associated with favourable long-term outcomes. Cardiac magnetic resonance (CMR) can comprehensively assess cardiac structure and function. We aimed to assess the CMR parameters at baseline and investigate independent variables to predict LVRR in DCM patients. METHODS AND RESULTS Nighty-eight initially diagnosed DCM patients who underwent CMR and echocardiography examinations at baseline were included. CMR parameters and feature tracking (FT) based left ventricular (LV) global strain (nStrain) and nStrain indexed to LV cardiac mass index (rStrain) were measured. The predictors of LVRR were determined by multivariate logistic regression analyses. Receiver operating characteristic (ROC) curves were used to evaluate the diagnostic performance of CMR parameters and were compared by the DeLong test. At a median follow-up time of 9 [interquartile range, 7-12] months, 35 DCM patients (36%) achieved LVRR. The patients with LVRR had lower LV volume, mass, LGE extent and stroke volume index (LVSVi) and higher left ventricular remodelling index (LVRI), nStrains, rStrains, and peak systolic strain rate (PSSR) in the longitudinal direction and rStrains in the circumferential direction at baseline (all P < 0.05). In the multivariate logistic regression analyses, LVRI [per SD, odds ratio (OR) 1.79; 95% confidence interval (CI) 1.08-2.98; P = 0.024] and the ratio of global longitudinal peak strain (rGLPS) (per SD, OR 1.88; 95% CI 1.18-3.01; P = 0.008) were independent predictors of LVRR. The combination of LVSVi, LVRI, and rGLPS had a greater area under the curve (AUC) than the combination of LVSVi and LVRI (0.75 vs. 0.68), but not significantly (P = 0.09). CONCLUSIONS Patients with LVRR had a lower LV volume index, lower LVSV index, lower LGE extent, higher LVRI, and preserved myocardial deformation in the longitudinal direction at baseline. LVRI and rGLPS at baseline were independent determinants of LVRR.
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Affiliation(s)
- Ao Kan
- Department of RadiologyThe Second Affiliated Hospital of Nanchang UniversityNanchangChina
| | - Qimin Fang
- Department of RadiologyThe Second Affiliated Hospital of Nanchang UniversityNanchangChina
| | - Shuhao Li
- Department of RadiologyThe Second Affiliated Hospital of Nanchang UniversityNanchangChina
| | - Wenying Liu
- Department of RadiologyThe Second Affiliated Hospital of Nanchang UniversityNanchangChina
| | | | - Kaiyao Huang
- Department of RadiologyThe Second Affiliated Hospital of Nanchang UniversityNanchangChina
| | - Mengyao Hu
- Department of RadiologyThe Second Affiliated Hospital of Nanchang UniversityNanchangChina
| | - Zhaofeng Feng
- Department of RadiologyThe Second Affiliated Hospital of Nanchang UniversityNanchangChina
| | - Lianggeng Gong
- Department of RadiologyThe Second Affiliated Hospital of Nanchang UniversityNanchangChina
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