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Wu XD, Ye XY, Liu XY, Lin Y, Lin X, Li YY, Ye BH, Sun JC. Benefits of intensive lipid-lowering therapies in patients with acute coronary syndrome: a systematic review and meta-analysis. Ann Med 2024; 56:2389470. [PMID: 39126262 PMCID: PMC11318487 DOI: 10.1080/07853890.2024.2389470] [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: 09/29/2023] [Revised: 04/23/2024] [Accepted: 07/12/2024] [Indexed: 08/12/2024] Open
Abstract
BACKGROUND Previous meta-analyses have investigated the efficacy of lipid-lowering therapies for atherosclerotic cardiovascular disease; however, few have focused on patients with acute coronary syndrome (ACS). This meta-analysis aimed to compare the benefits of intensive lipid-lowering therapy with those of background statin therapy in patients with ACS. METHODS Searches were performed on PubMed, Embase, the Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov databases for articles published until April 13, 2023. Randomized controlled trials that compared intensive lipid-lowering therapies and background statin therapies in patients with prior ACS and recorded the outcome of three-point major cardiovascular events (MACE) were included. The risk ratio (RR) with 95% confidence interval (CI) was used as a measure of primary and secondary outcomes. RESULTS Nine trials involving 38,640 patients with ACS were identified. Pooled results suggested that intensive lipid-lowering therapies are associated with a reduction in the risk of three-point MACE (RR, 0.88; 95% CI, 0.83-0.94; p < 0.001), recurrent ACS (RR, 0.82; 95% CI, 0.71-0.96; p = 0.013), nonfatal myocardial infarction (MI) (RR, 0.87; 95% CI, 0.81-0.93; p < 0.001), stroke (RR, 0.83; 95% CI, 0.73-0.94; p = 0.003), and unstable angina-related hospitalization (RR, 0.57; 95% CI, 0.33-0.99; p = 0.046), but not all-cause mortality (RR, 0.94; 95% CI, 0.82-1.07; p = 0.329), cardiovascular disease-related mortality (RR, 0.96; 95% CI, 0.88-1.06; p = 0.457) or coronary revascularization (RR, 0.89; 95% CI, 0.79-1.00; p = 0.057). CONCLUSIONS Intensive lipid-lowering therapies may reduce the risk of three-point MACE, recurrent ACS, nonfatal MI, stroke, and hospitalization for unstable angina in patients with ACS undergoing background statin therapy. These results may assist in clinical decision-making for the secondary prevention of cardiovascular events to initiate intensive lipid-lowering therapies immediately after ACS.
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Affiliation(s)
- Xian-Dan Wu
- Department of General Medicine, The First people’s hospital of Wenling, Taizhou, Zhejiang, China
| | - Xin-Yue Ye
- Shanghai Jiao Tong University, Shanghai, China
| | - Xuan-Yan Liu
- Department of General Medicine, The First people’s hospital of Wenling, Taizhou, Zhejiang, China
| | - Yue Lin
- Department of General Medicine, The First people’s hospital of Wenling, Taizhou, Zhejiang, China
| | - Xian Lin
- Department of General Medicine, The First people’s hospital of Wenling, Taizhou, Zhejiang, China
| | - Yan-Yan Li
- Department of General Medicine, The First people’s hospital of Wenling, Taizhou, Zhejiang, China
| | - Bin-Hua Ye
- Department of General Medicine, The First people’s hospital of Wenling, Taizhou, Zhejiang, China
| | - Jing-Chao Sun
- Department of Cardiology, Taizhou Municipal Hospital, Taizhou, Zhejiang, China
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Vink CEM, de Jong EAM, Woudstra J, Molenaar M, Kamp O, Götte MJW, van Raalte DH, Serné E, van de Hoef TP, Chamuleau SAJ, Eringa EC, Appelman Y. The role of myocardial blood volume in the pathophysiology of angina with non-obstructed coronary arteries: The MICORDIS study. Int J Cardiol 2024; 415:132479. [PMID: 39181410 DOI: 10.1016/j.ijcard.2024.132479] [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: 05/24/2024] [Revised: 08/14/2024] [Accepted: 08/20/2024] [Indexed: 08/27/2024]
Abstract
BACKGROUND Angina with Non-Obstructed Coronary Arteries (ANOCA) involves abnormal vasomotor responses. While reduced coronary flow is an established contributor to myocardial hypoxia, myocardial blood volume (MBV) independently regulates myocardial oxygen uptake but its role in ANOCA remains unclear. OBJECTIVES We hypothesized that reduced MBV contributes to ANOCA, and associates with insulin resistance in ANOCA. METHODS MBV in ANOCA patients was compared to age- and sex-matched healthy controls. ANOCA patients underwent coronary angiography with invasive coronary function testing (CFT) to identify vasospasm and coronary microvascular dysfunction. In all subjects MBV was quantified at baseline, during hyperinsulinemia and during dobutamine-induced stress using myocardial contrast echocardiography (MCE). The hyperinsulinemic-euglycemic clamp was used to assess insulin resistance. RESULTS Twenty-eight ANOCA patients (21% men, 56.8 ± 8.6 years) and 28 healthy controls (21% men, 56.5 ± 7.0 years) were included. During CFT 11% of patients showed epicardial vasospasm, 39% microvascular vasospasm, 25% coronary microvascular dysfunction, and 11% of patients had a negative CFT. ANOCA patients had significant lower insulin-sensitivity (p < 0.01). During MCE, ANOCA patients showed a significantly lower MBV at baseline (0.388 vs 0.438 mL/mL, p = 0.04), during hyperinsulinemia (0.395 vs 0.447 mL/mL, p = 0.02), and during dobutamine-induced stress (0.401 vs 0.476 mL/mL, p = 0.030). CONCLUSIONS In ANOCA patients MBV is diminished at baseline, during hyperinsulinemia and dobutamine-induced stress in the absence of differences in microvascular recruitment. These findings support the presence of capillary rarefaction in ANOCA patients. ANOCA patients showed metabolic insulin resistance, but insulin did not acutely alter myocardial perfusion.
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Affiliation(s)
- Caitlin E M Vink
- Amsterdam UMC Heart Centre, Department of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
| | - Elize A M de Jong
- Amsterdam UMC Heart Centre, Department of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands; Department of Cardiology, University Medical Center Utrecht, the Netherlands
| | - Janneke Woudstra
- Amsterdam UMC Heart Centre, Department of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
| | - Mitchel Molenaar
- Amsterdam UMC Heart Centre, Department of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
| | - Otto Kamp
- Amsterdam UMC Heart Centre, Department of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
| | - Marco J W Götte
- Amsterdam UMC Heart Centre, Department of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
| | - Daniel H van Raalte
- Diabetes Center, Department of Internal Medicine, Amsterdam UMC, the Netherlands
| | - Erik Serné
- Diabetes Center, Department of Internal Medicine, Amsterdam UMC, the Netherlands
| | - Tim P van de Hoef
- Department of Cardiology, University Medical Center Utrecht, the Netherlands
| | - Steven A J Chamuleau
- Amsterdam UMC Heart Centre, Department of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
| | - Etto C Eringa
- Amsterdam Cardiovascular Sciences, Department of Physiology, Amsterdam UMC, Amsterdam, the Netherlands; Maastricht University, Cardiovascular Research Institute Maastricht, Department of Physiology, Maastricht, the Netherlands
| | - Yolande Appelman
- Amsterdam UMC Heart Centre, Department of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands.
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3
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Frates B, Ortega HA, Freeman KJ, Co JPT, Bernstein M. Lifestyle Medicine in Medical Education: Maximizing Impact. Mayo Clin Proc Innov Qual Outcomes 2024; 8:451-474. [PMID: 39263429 PMCID: PMC11387546 DOI: 10.1016/j.mayocpiqo.2024.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Revised: 06/19/2024] [Accepted: 07/01/2024] [Indexed: 09/13/2024] Open
Abstract
The relationship between lifestyle behaviors and common chronic conditions is well established. Lifestyle medicine (LM) interventions to modify health behaviors can dramatically improve the health of individuals and populations. There is an urgent need to meaningfully integrate LM into medical curricula horizontally across the medical domains and vertically in each year of school and training. Including LM content in medical and health professional curricula and training programs has been challenging. Barriers to LM integration include lack of awareness and prioritization of LM, limited time in the curricula, and too few LM-trained faculty to teach and role model the practice of LM. This limits the ability of health care professionals to provide effective LM and precludes the wide-reaching benefits of LM from being fully realized. Early innovators developed novel tools and resources aligned with current evidence for introducing LM into didactic and experiential learning. This review aimed to examine the educational efforts in each LM pillar for undergraduate and graduate medical education. A PubMed-based literature review was undertaken using the following search terms: lifestyle medicine, education, medical school, residency, and healthcare professionals. We map the LM competencies to the core competency domains of the Accreditation Council for Graduate Medical Education. We highlight opportunities to train faculty, residents, and students. Moreover, we identify available evidence-based resources. This article serves as a "call to action" to incorporate LM across the spectrum of medical education curricula and training.
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Affiliation(s)
- Beth Frates
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charleston, MA
- American College of Lifestyle Medicine, Chesterfield, MO
- Harvard Medical School, Boston, MA
| | - Hugo A Ortega
- Albert Einstein College of Medicine, Bronx, NY
- Montefiore Moses/Weiler Internal Medicine Residency, Bronx, NY
| | - Kelly J Freeman
- Department of Practice Advancement/Workforce Development, American College of Lifestyle Medicine, Chesterfield, MO
| | - John Patrick T Co
- Graduate Medical Education, Mass General Brigham, Boston, MA
- Department of Pediatrics, Boston, MA
- Harvard Medical School, Boston, MA
| | - Melissa Bernstein
- Department of Nutrition, College of Health Professions, Chicago Medical School, Rosalind Franklin University of Medicine and Science, Chicago, IL
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4
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Marcy F, Goettfried K, Enghard P, Piper SK, Kunz JV, Schroeder T. Impact of AKI on metabolic compensation for respiratory acidosis in ICU patients with AECOPD. J Crit Care 2024; 83:154846. [PMID: 38936337 DOI: 10.1016/j.jcrc.2024.154846] [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: 01/03/2024] [Revised: 05/28/2024] [Accepted: 06/08/2024] [Indexed: 06/29/2024]
Abstract
PURPOSE Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) can result in severe respiratory acidosis. Metabolic compensation is primarily achieved by renal retention of bicarbonate. The extent to which acute kidney injury (AKI) impairs the kidney's capacity to compensate for respiratory acidosis remains unclear. MATERIALS AND METHODS This retrospective analysis covers clinical data between January 2009 and December 2021 for 498 ICU patients with AECOPD and need for respiratory support. RESULTS 278 patients (55.8%) presented with or developed AKI. Patients with AKI exhibited higher 30-day-mortality rates (14.5% vs. 4.5% p = 0.001), longer duration of mechanical ventilation (median 90 h vs. 14 h; p = 0.001) and more severe hypercapnic acidosis (pH 7.23 vs. 7.28; pCO2 68.5 mmHg vs. 61.8 mmHg). Patients with higher AKI stages exhibited lower HCO3-/pCO2 ratios and did not reach expected HCO3- levels. In a mixed model analysis with random intercept per patient we analyzed the association of pCO2 (independent) and HCO3- (dependent variable). Lower estimates for averaged change in HCO3- were observed in patients with more severe AKI. CONCLUSION AKI leads to poor outcomes and compromises metabolic compensation of respiratory acidosis in ICU patients with AECOPD. While buffering agents may aid compensation for severe AKI, their use should be approached with caution.
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Affiliation(s)
- Florian Marcy
- Charité - Universitätsmedizin Berlin, Department of Nephrology and Medical Intensive Care Medicine, Berlin, Germany.
| | - Katharina Goettfried
- Charité - Universitätsmedizin Berlin, Department of Nephrology and Medical Intensive Care Medicine, Berlin, Germany
| | - Philipp Enghard
- Charité - Universitätsmedizin Berlin, Department of Nephrology and Medical Intensive Care Medicine, Berlin, Germany
| | - Sophie K Piper
- Charité - Universitätsmedizin Berlin, Institute of Biometry and Clinical Epidemiology, Berlin, Germany; Berlin Institute of Health (BIH), Anna-Louisa-Karsch-Strasse 2, 10178 Berlin, Germany; Charité - Universitätsmedizin Berlin, Institute of Medical Informatics Berlin, Germany
| | - Julius Valentin Kunz
- Charité - Universitätsmedizin Berlin, Department of Nephrology and Medical Intensive Care Medicine, Berlin, Germany
| | - Tim Schroeder
- Charité - Universitätsmedizin Berlin, Department of Nephrology and Medical Intensive Care Medicine, Berlin, Germany
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5
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Handelsman Y, Anderson JE, Bakris GL, Ballantyne CM, Bhatt DL, Bloomgarden ZT, Bozkurt B, Budoff MJ, Butler J, Cherney DZI, DeFronzo RA, Del Prato S, Eckel RH, Filippatos G, Fonarow GC, Fonseca VA, Garvey WT, Giorgino F, Grant PJ, Green JB, Greene SJ, Groop PH, Grunberger G, Jastreboff AM, Jellinger PS, Khunti K, Klein S, Kosiborod MN, Kushner P, Leiter LA, Lepor NE, Mantzoros CS, Mathieu C, Mende CW, Michos ED, Morales J, Plutzky J, Pratley RE, Ray KK, Rossing P, Sattar N, Schwarz PEH, Standl E, Steg PG, Tokgözoğlu L, Tuomilehto J, Umpierrez GE, Valensi P, Weir MR, Wilding J, Wright EE. DCRM 2.0: Multispecialty practice recommendations for the management of diabetes, cardiorenal, and metabolic diseases. Metabolism 2024; 159:155931. [PMID: 38852020 DOI: 10.1016/j.metabol.2024.155931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Accepted: 04/30/2024] [Indexed: 06/10/2024]
Abstract
The spectrum of cardiorenal and metabolic diseases comprises many disorders, including obesity, type 2 diabetes (T2D), chronic kidney disease (CKD), atherosclerotic cardiovascular disease (ASCVD), heart failure (HF), dyslipidemias, hypertension, and associated comorbidities such as pulmonary diseases and metabolism dysfunction-associated steatotic liver disease and metabolism dysfunction-associated steatohepatitis (MASLD and MASH, respectively, formerly known as nonalcoholic fatty liver disease and nonalcoholic steatohepatitis [NAFLD and NASH]). Because cardiorenal and metabolic diseases share pathophysiologic pathways, two or more are often present in the same individual. Findings from recent outcome trials have demonstrated benefits of various treatments across a range of conditions, suggesting a need for practice recommendations that will guide clinicians to better manage complex conditions involving diabetes, cardiorenal, and/or metabolic (DCRM) diseases. To meet this need, we formed an international volunteer task force comprising leading cardiologists, nephrologists, endocrinologists, and primary care physicians to develop the DCRM 2.0 Practice Recommendations, an updated and expanded revision of a previously published multispecialty consensus on the comprehensive management of persons living with DCRM. The recommendations are presented as 22 separate graphics covering the essentials of management to improve general health, control cardiorenal risk factors, and manage cardiorenal and metabolic comorbidities, leading to improved patient outcomes.
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Affiliation(s)
| | | | | | - Christie M Ballantyne
- Department of Medicine, Baylor College of Medicine, Texas Heart Institute, Houston, TX, USA
| | - Deepak L Bhatt
- Mount Sinai Fuster Heart Hospital, Icahn School of Medicine at Mount Sinai, NY, New York, USA
| | - Zachary T Bloomgarden
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai, NY, New York, USA
| | - Biykem Bozkurt
- Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | | | - Javed Butler
- University of Mississippi Medical Center, Jackson, MS, USA
| | - David Z I Cherney
- Division of Nephrology, Department of Medicine, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Canada
| | | | - Stefano Del Prato
- Interdisciplinary Research Center "Health Science", Sant'Anna School of Advanced Studies, Pisa, Italy
| | - Robert H Eckel
- University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Gerasimos Filippatos
- Department of Cardiology, National and Kapodistrian University of Athens, Athens, Greece
| | | | | | | | - Francesco Giorgino
- Department of Precision and Regenerative Medicine and Ionian Area, University of Bari Aldo Moro, Bari, Italy
| | | | - Jennifer B Green
- Division of Endocrinology, Metabolism, and Nutrition, Duke University School of Medicine, Durham, NC, USA
| | - Stephen J Greene
- Division of Cardiology, Duke University School of Medicine, Durham, NC, USA
| | - Per-Henrik Groop
- Department of Nephrology, University of Helsinki, Finnish Institute for Health and Helsinki University HospitalWelfare, Folkhälsan Research Center, Helsinki, Finland; Department of Diabetes, Central Clinical School, Monash University, Melbourne, Australia
| | - George Grunberger
- Grunberger Diabetes Institute, Bloomfield Hills, MI, USA; Wayne State University School of Medicine, Detroit, MI, USA; Oakland University William Beaumont School of Medicine, Rochester, MI, USA; Charles University, Prague, Czech Republic
| | | | - Paul S Jellinger
- The Center for Diabetes & Endocrine Care, University of Miami Miller School of Medicine, Hollywood, FL, USA
| | | | - Samuel Klein
- Washington University School of Medicine, Saint Louis, MO, USA
| | - Mikhail N Kosiborod
- Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City, Kansas City, MO, USA
| | | | | | - Norman E Lepor
- David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
| | | | - Chantal Mathieu
- Department of Endocrinology, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Christian W Mende
- University of California San Diego School of Medicine, La Jolla, CA, USA
| | - Erin D Michos
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Javier Morales
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, Advanced Internal Medicine Group, PC, East Hills, NY, USA
| | - Jorge Plutzky
- Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA
| | | | | | | | | | - Peter E H Schwarz
- Department for Prevention and Care of Diabetes, Faculty of Medicine Carl Gustav Carus at the Technische Universität/TU Dresden, Dresden, Germany
| | - Eberhard Standl
- Munich Diabetes Research Group e.V. at Helmholtz Centre, Munich, Germany
| | - P Gabriel Steg
- Université Paris-Cité, Institut Universitaire de France, AP-HP, Hôpital Bichat, Cardiology, Paris, France
| | | | - Jaakko Tuomilehto
- University of Helsinki, Finnish Institute for Health and Welfare, Helsinki, Finland
| | | | - Paul Valensi
- Polyclinique d'Aubervilliers, Aubervilliers and Paris-Nord University, Paris, France
| | - Matthew R Weir
- Division of Nephrology, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - John Wilding
- University of Liverpool, Liverpool, United Kingdom
| | - Eugene E Wright
- Department of Medicine, Duke University Medical Center, Durham, NC, USA
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Chaiter Y, Fink DL, Machluf Y. Vascular medicine in the 21 st century: Embracing comprehensive vasculature evaluation and multidisciplinary treatment. World J Clin Cases 2024; 12:6032-6044. [DOI: 10.12998/wjcc.v12.i27.6032] [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: 01/29/2024] [Revised: 06/25/2024] [Accepted: 07/10/2024] [Indexed: 07/29/2024] Open
Abstract
The field of vascular medicine has undergone a profound transformation in the 21st century, transforming our approach to assessment and treatment. Atherosclerosis, a complex inflammatory disease that affects medium and large arteries, presents a major challenge for researchers and healthcare professionals. This condition, characterized by arterial plaque formation and narrowing, poses substantial challenges to vascular health at individual, national, and global scales. Its repercussions are far-reaching, with clinical outcomes including ischemic heart disease, ischemic stroke, and peripheral arterial disease—conditions with escalating global prevalence. Early detection of vascular changes caused by atherosclerosis is crucial in preventing these conditions, reducing morbidity, and averting mortality. This article underscored the imperative of adopting a holistic approach to grappling with the intricacies, trajectories, and ramifications of atherosclerosis. It stresses the need for a thorough evaluation of the vasculature and the implementation of a multidisciplinary treatment approach. By considering the entire vascular system, healthcare providers can explore avenues for prevention, early detection, and effective management of this condition, ultimately leading to improved patient outcomes. We discussed current practices and proposed new directions made possible by emerging diagnostic modalities and treatment strategies. Additionally, we considered healthcare expenditure, resource allocation, and the transformative potential of new innovative treatments and technologies.
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Affiliation(s)
- Yoram Chaiter
- The Israeli Center for Emerging Technologies in Hospitals and Hospital-Based Health Technology Assessment, Shamir (Assaf Harofeh) Medical Center, Zerifin 7030100, Israel
| | - Daniel Lyon Fink
- Department of Pediatric Cardiology Unit, HaEmek Medical Center, Afula 1834111, Israel
| | - Yossy Machluf
- Shamir Research Institute, University of Haifa, Kazerin 1290000, Israel
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Cigarroa N, Latif N, Maayah M, Khokhar A, Kunnirickal S, Schwann A, Maciejewski KR, Odanovic N, Mazure CM, Spatz E, Pfau S, Lansky A, Shah SM. Diagnostic Yield and Clinical Utility of Coronary Angiography Versus Coronary Function Testing in Women With Angina and Nonobstructive Coronary Arteries. J Am Heart Assoc 2024:e035852. [PMID: 39291500 DOI: 10.1161/jaha.124.035852] [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: 05/30/2024] [Accepted: 08/20/2024] [Indexed: 09/19/2024]
Abstract
BACKGROUND Approximately 50% of women referred for invasive coronary angiography have angina and nonobstructive coronary arteries, which includes coronary microvascular dysfunction, vasospastic angina, and other vasomotor disorders. We sought to determine the real-world diagnostic yield of invasive coronary angiography and coronary function testing in women with angina and nonobstructive coronary arteries. METHODS AND RESULTS From 2018 to 2023, we enrolled 198 women who underwent either coronary angiography (CA) alone (n=99) or coronary function testing (CFT; n=99). Mean±SD age was 62±10 years (CA alone) compared with 57±10 years (CFT). Coronary angiography was interpreted as nonobstructive coronary artery disease more frequently after CA alone (79% versus 52%). Of the women who underwent CFT, 82% (N=81) were found to have vasomotor disorders, including coronary microvascular dysfunction (27%), vasospastic angina (32%), mixed coronary microvascular dysfunction/vasospastic angina (16%), endothelial dysfunction (10%; without spasm), elevated resting flow (2%), or symptomatic myocardial bridging (4%). Compared with women undergoing CA alone, medications were changed more frequently after CFT at 24 hours (41% versus 65%; P=0.001) and between 24 hours and 30 days (30% versus 44%; P=0.04) with intensification of antianginal therapy (79% versus 92%; P<0.0001) and increased use of calcium channel blockers (36% versus 63%; P<0.0001). CONCLUSIONS Our findings demonstrate that women presenting with suspected ischemic heart disease undergoing CA alone only received an anatomic diagnosis, whereas >80% of women undergoing CFT received a specific diagnosis of a coronary vasomotor disorder and greater intensification of antianginal therapy.
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Affiliation(s)
| | - Nida Latif
- Section of Cardiovascular Medicine, Department of Internal Medicine Yale School of Medicine New Haven CT
| | - Marah Maayah
- Department of Psychiatry and Women's Health Research at Yale Yale University School of Medicine New Haven CT
| | | | | | | | | | - Natalija Odanovic
- Yale New Haven Hospital New Haven New Haven CT
- Institute for Cardiovascular Diseases "Dedinje" Belgrade Serbia
| | - Carolyn M Mazure
- Department of Psychiatry and Women's Health Research at Yale Yale University School of Medicine New Haven CT
| | - Erica Spatz
- Section of Cardiovascular Medicine, Department of Internal Medicine Yale School of Medicine New Haven CT
| | - Steven Pfau
- Section of Cardiovascular Medicine, Department of Internal Medicine Yale School of Medicine New Haven CT
- Veterans Affairs Connecticut Healthcare System West Haven CT
| | - Alexandra Lansky
- Section of Cardiovascular Medicine, Department of Internal Medicine Yale School of Medicine New Haven CT
| | - Samit M Shah
- Section of Cardiovascular Medicine, Department of Internal Medicine Yale School of Medicine New Haven CT
- Veterans Affairs Connecticut Healthcare System West Haven CT
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8
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Wilson T, James MT, Southern D, Har B, Graham MM, Brass N, Bainey K, Fedak PWM, Sajobi TT, Wilton SB. Hospital and Physician Variability in Revascularization Decisions and Outcomes for Patients With 3-Vessel and Left Main Coronary Artery Disease: A Population-Based Cohort Study. J Am Heart Assoc 2024; 13:e035356. [PMID: 39248266 DOI: 10.1161/jaha.123.035356] [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: 04/10/2024] [Accepted: 07/22/2024] [Indexed: 09/10/2024]
Abstract
BACKGROUND Hospital- and physician-level variation for selection of percutaneous coronary intervention versus coronary artery bypass grafting (CABG) for patients with coronary artery disease has been associated with outcome differences. However, most studies excluded patients treated medically. METHODS AND RESULTS From 2010 to 2019, adults with 3-vessel or left main coronary artery disease at 3 hospitals (A, B, C) in Alberta, Canada, were categorized by treatment with medical therapy, percutaneous coronary intervention, or CABG. Multilevel regression models determined the proportion of variation in treatment attributable to patient, physician, and hospital factors, and survival models assessed outcomes including death and major adverse cardiovascular events over 5 years. Of 22 580 patients (mean age, 67 years; 80% men): 6677 (29%) received medical management, 9171 (41%) percutaneous coronary intervention, and 6732 (30%) CABG. Hospital factors accounted for 10.8% of treatment variation. In adjusted models (site A as reference), patients at sites B and C had 49% (95% CI, 44%-53%) and 43% (95% CI, 37%-49%) lower rates of medical therapy, respectively, and 31% (95% CI, 24%-38%) and 32% (95% CI, 24%-40%) lower rates of CABG. During 5.0 years median follow-up, 3287 (14.6%) patients died, with no intersite mortality differences. There were no between-site differences in acute coronary syndromes or stroke; patients at sites B and C had 24% lower risk (95% CI, 13%-34% and 11%-35%, respectively) of heart failure hospitalization. CONCLUSIONS Hospital-level variation in selection of percutaneous coronary intervention, CABG, or medical therapy for patients with complex coronary artery disease was not associated with differences in 5-year mortality rates. Research and quality improvement initiatives comparing revascularization practices should include medically managed patients.
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Affiliation(s)
- Todd Wilson
- Department of Medicine University of Calgary Alberta Canada
- Department of Community Health Sciences University of Calgary Alberta Canada
- Libin Cardiovascular Institute, University of Calgary Alberta Canada
| | - Matthew T James
- Department of Medicine University of Calgary Alberta Canada
- Department of Community Health Sciences University of Calgary Alberta Canada
- Libin Cardiovascular Institute, University of Calgary Alberta Canada
| | - Danielle Southern
- Centre for Health Informatics, Cumming School of Medicine University of Calgary Alberta Canada
| | - Bryan Har
- Department of Cardiac Sciences University of Calgary Alberta Canada
- Libin Cardiovascular Institute, University of Calgary Alberta Canada
| | - Michelle M Graham
- Mazankowski Alberta Heart Institute, University of Alberta Edmonton Canada
| | - Neil Brass
- CKHui Heart Centre University of Alberta Alberta Canada
| | - Kevin Bainey
- Mazankowski Alberta Heart Institute, University of Alberta Edmonton Canada
| | - Paul W M Fedak
- Department of Cardiac Sciences University of Calgary Alberta Canada
- Libin Cardiovascular Institute, University of Calgary Alberta Canada
| | - Tolulope T Sajobi
- Department of Community Health Sciences University of Calgary Alberta Canada
- Libin Cardiovascular Institute, University of Calgary Alberta Canada
| | - Stephen B Wilton
- Department of Community Health Sciences University of Calgary Alberta Canada
- Department of Cardiac Sciences University of Calgary Alberta Canada
- Libin Cardiovascular Institute, University of Calgary Alberta Canada
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9
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Leiva O, Liu O, Zhou S, How J, Lee M, Hobbs G. Myeloproliferative Neoplasms and Cardiovascular Disease: A Review. Curr Treat Options Oncol 2024:10.1007/s11864-024-01255-8. [PMID: 39278999 DOI: 10.1007/s11864-024-01255-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/13/2024] [Indexed: 09/18/2024]
Abstract
OPINION STATEMENT Myeloproliferative neoplasms (MPN) are a heterogenous group of disorders of clonal hematopoiesis characterized by constitutive activation of the JAK/STAT signaling pathway leading to proliferation of blood cells. Cardiovascular disease (CVD) contributes significantly to the morbidity and mortality of patients with MPN. Particularly well-known CVD complications of MPNs are arterial and venous thrombotic events. However, MPNs are also associated with other forms of CVD including atrial fibrillation, heart failure, and pulmonary hypertension. Recent studies have characterized outcomes of patients with MPN and CVD, including acute myocardial infarction (AMI), heart failure, atrial fibrillation, and pulmonary hypertension. Additionally, optimal cardiovascular disease prevention strategies in patients with MPN are not yet clear. Further investigation is warranted to improve CVD outcomes in patients with MPN. Clinicians should be aware of cardiovascular complications of MPN, including thrombotic as well as non-thrombotic complications (heart failure, arrhythmias, pulmonary hypertension).
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Affiliation(s)
- Orly Leiva
- Department of Medicine, Division of Cardiology, New York University Grossman School of Medicine, New York, NY, USA.
- Department of Medicine, Section of Cardiology - Heart Failure, University of Chicago, 5841 S Maryland Ave, Chicago, IL, 60637, USA.
| | - Olivia Liu
- Department of Medicine, Division of Cardiology, New York University Grossman School of Medicine, New York, NY, USA
| | - Sophia Zhou
- Department of Medicine, Division of Cardiology, New York University Grossman School of Medicine, New York, NY, USA
| | - Joan How
- Department of Medicine, Division of Hematology and Oncology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Michelle Lee
- Department of Medicine, Division of Hematology and Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Gabriela Hobbs
- Department of Medicine, Division of Hematology and Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
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Zhang H, Hou X, Gou Y, Chen Y, An S, Wei Y, Jiang R, Tian Y, Yuan H. Association Between Prior Antiplatelet Therapy and Prognosis in Patients With Intracerebral Hemorrhage: A Systematic Review and Meta-Analysis. Clin Ther 2024:S0149-2918(24)00221-2. [PMID: 39271305 DOI: 10.1016/j.clinthera.2024.08.010] [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: 03/24/2024] [Revised: 07/16/2024] [Accepted: 08/12/2024] [Indexed: 09/15/2024]
Abstract
PURPOSE Approximately 20% to 30% of intracerebral hemorrhage (ICH) patients were reported to be on antiplatelet therapy (APT), and association between prior APT and prognosis was unclear. We aimed to clarify the impact of APT on the prognosis of ICH through an updated systematic review and meta-analysis, and to further compare the risk of single APT (SAPT) or dual APT (DAPT) prior to ICH as well as the risk associated with various antiplatelet drugs. METHODS EMBASE, MEDLINE via Ovid SP and Web of Science were searched from inception of each database to November 4, 2023. Included studies reported prognosis in both patients with prior APT and those without. FINDINGS A total of 433,103 patients from 43 studies were included in the meta-analysis. Both univariate and multivariate analyses demonstrated a significant association between prior-APT and an increased mortality risk (odd ratio [OR] 1.43, 95% confidence interval [CI] 1.28-1.59; OR 1.20, 95%CI 1.10-1.30, respectively). The risk was higher in short term follow-up (Univariate OR 1.73, 95%CI 1.22-2.46; Multivariate OR 1.94, 95%CI 1.48-2.55). A notably increased risk of hematoma expansion was also observed in patients previously treated with APT (Univariate OR 1.47, 95%CI 1.12-1.94; Multivariate OR 1.88, 95%CI 1.30-2.71), which were mainly attributed to events within 24 hours. The impact of prior-APT on poor functional outcome was inconsistent between univariate and multivariate analyses. Both direct and indirect comparisons showed that SAPT significantly reduced the risk of mortality (OR 0.67, 95%CI 0.64-0.70; OR 0.84, 95%CI 0.71-0.99) and poor functional outcome (OR 0.84, 95%CI 0.72-0.98; OR 0.81, 95%CI 0.72-0.91) compared to DAPT. IMPLICATIONS Prior-APT increased the risk of mortality and hematoma expansion in patients with ICH. The increased risk of mortality and hematoma expansion was more obvious in the short term follow-up and within 24 hours, respectively. The effect of APT on poor functional outcome exhibited inconsistency between univariate and multivariate analyses, suggesting that further investigation is warranted to clarify this relationship. In comparison with DAPT, SAPT could decrease the risk of mortality and poor functional outcome. Further studies focusing on antiplatelet drug response, racial differences, and specific APT regimens may help verify the influence.
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Affiliation(s)
- Hanxu Zhang
- Department of Pharmacy, Tianjin Medical University General Hospital, Tianjin, China
| | - Xiaoran Hou
- Department of Pharmacy, Tianjin Medical University General Hospital, Tianjin, China
| | - Yidan Gou
- Department of Pharmacy, Tianjin Medical University General Hospital, Tianjin, China
| | - Yanyan Chen
- Department of Pharmacy, Tianjin Medical University General Hospital, Tianjin, China
| | - Shuo An
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Yingsheng Wei
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Rongcai Jiang
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Ye Tian
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Hengjie Yuan
- Department of Pharmacy, Tianjin Medical University General Hospital, Tianjin, China.
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Li M, Wang B, Wang L, Tong L, Zhao G, Wang B, Guo J. Dynamic trends of ischemic heart disease mortality attributable to high low-density lipoprotein cholesterol: a joinpoint analysis and age-period-cohort analysis with predictions. Lipids Health Dis 2024; 23:292. [PMID: 39261844 PMCID: PMC11389117 DOI: 10.1186/s12944-024-02274-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: 07/26/2024] [Accepted: 08/28/2024] [Indexed: 09/13/2024] Open
Abstract
AIMS The purpose of this study was to analyze the dynamic trends of ischemic heart disease (IHD) mortality attributable to high low-density lipoprotein cholesterol (LDL-C). METHODS Data on IHD mortality attributable to high LDL-C from 1990 to 2021 were extracted from the global disease burden database. Joinpoint software was used to estimate the average annual percentage change (AAPC) in the age-standardized mortality rate (ASMR). An age‒period‒cohort model was used to analyze the impacts of age, period, and cohort on these changes. The Bayesian framework was used to predict IHD mortality attributable to high LDL-C from 2022 to 2040. RESULTS The overall ASMR of IHD attributable to high LDL-C decreased from 50. 479 per 100,000 people in 1990 to 32.286 per 100,000 people in 2021, and ASMR of IHD attributable to high LDL-C was higher in males than in females. The longitudinal age curves of the overall IHD mortality attributable to high LDL-C showed a monotonic upward trend, especially after 65 years of age. The period and cohort effect relative risk (RR) values of overall IHD mortality attributable to high LDL-C showed a downward trend. The overall ASMR of IHD attributable to high LDL-C is predicted to show a downward trend, and male IHD mortality attributable to high LDL-C is expected to be higher than that of females. CONCLUSION This study revealed a sustained decrease in IHD mortality attributable to high LDL-C over three decades, with a continued decline expected. Despite this, gender disparities persist, with males experiencing higher mortality rates and elderly individuals remaining a vulnerable group.
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Affiliation(s)
- Min Li
- Department of Cardiology, Shanxi Provincial People's Hospital, Fifth Hospital of Shanxi Medical University, Taiyuan, Shanxi, 030012, China
| | - Beibei Wang
- Department of Cardiology, The First People's Hospital of Jinzhong, Jinzhong, 030602, China
| | - Lan Wang
- School of Foreign Languages, Yantai University, Yantai, Shandong, 264005, China
| | - Ling Tong
- Department of Cardiology, Shanxi Provincial People's Hospital, Fifth Hospital of Shanxi Medical University, Taiyuan, Shanxi, 030012, China
| | - Gang Zhao
- Department of Cardiology, Shanxi Provincial People's Hospital, Fifth Hospital of Shanxi Medical University, Taiyuan, Shanxi, 030012, China
| | - Biao Wang
- Department of Cardiology, Wenshui People's Hospital, Wenshui, Shanxi, 032100, China
| | - Jingli Guo
- Medical Department, Shanghai Ashermed Medical Technology Co., Ltd, Shanghai, 200030, China.
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Johner N, Gencer B, Roffi M. Routine beta-blocker therapy after acute coronary syndromes: The end of an era? Eur J Clin Invest 2024:e14309. [PMID: 39257189 DOI: 10.1111/eci.14309] [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: 06/24/2024] [Accepted: 08/19/2024] [Indexed: 09/12/2024]
Abstract
BACKGROUND Beta-blocker therapy, a treatment burdened by side effects including fatigue, erectile dysfunction and depression, was shown to reduce mortality and cardiovascular events after acute coronary syndromes (ACS) in the pre-coronary reperfusion era. Potential mechanisms include protection from ventricular arrhythmias, increased ischaemia threshold and prevention of left ventricular (LV) adverse remodelling. With the advent of early mechanical reperfusion and contemporary pharmacologic secondary prevention, the benefit of beta-blockers after ACS in the absence of LV dysfunction has been challenged. METHODS The present narrative review discusses the contemporary evidence based on searching the PubMed database and references in identified articles. RESULTS Recently, the REDUCE-AMI trial-the first adequately powered randomized trial in the reperfusion era to test beta-blocker therapy after myocardial infarction with preserved left ventricular ejection fraction (LVEF)-showed no benefit on the composite of all-cause death or myocardial infarction over a median 3.5-year follow-up. While the benefit of beta-blockers in patients with reduced LVEF remains undisputed, their value in post-ACS patients with mildly reduced systolic function (LVEF 41%-49%) has not been studied in contemporary randomized trials; in this setting, observational studies have suggested a reduction in cardiovascular events with these agents. The adequate duration of beta-blocker therapy remains unknown, but observational data suggests that any mortality benefit may be lost beyond 1-12 months after ACS in patients with LVEF >40%. CONCLUSION We believe that there is sufficient evidence to abandon routine beta-blocker prescription in post-ACS patients with preserved LV systolic function.
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Affiliation(s)
- Nicolas Johner
- Cardiology Division, Geneva University Hospitals, Geneva, Switzerland
| | - Baris Gencer
- Cardiology Division, Geneva University Hospitals, Geneva, Switzerland
- Institute of Primary Healthcare (BIHAM), University of Bern, Bern, Switzerland
- Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Marco Roffi
- Cardiology Division, Geneva University Hospitals, Geneva, Switzerland
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13
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De Servi S, Landi A. Clopidogrel: Drug of the Past or Drug of the Future? Cardiovasc Drugs Ther 2024:10.1007/s10557-024-07629-2. [PMID: 39249196 DOI: 10.1007/s10557-024-07629-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/28/2024] [Indexed: 09/10/2024]
Affiliation(s)
- Stefano De Servi
- Department of Molecular Medicine, University of Pavia, 27100, Pavia, Italy.
| | - Antonio Landi
- Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale (EOC), CH-6900, Lugano, Switzerland
- Faculty of Biomedical Sciences, University of Italian Switzerland, Lugano, Switzerland
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14
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Wu S, Wang C, Liu C, He Q, Zhang Z, Ma T. Synergistic effects of xanthan gum and β-cyclodextrin on properties and stability of vegetable oil-based whipped cream. Int J Biol Macromol 2024; 279:135379. [PMID: 39244122 DOI: 10.1016/j.ijbiomac.2024.135379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2024] [Revised: 07/27/2024] [Accepted: 09/04/2024] [Indexed: 09/09/2024]
Abstract
The synergistic effects between xanthan gum (XG) and β-cyclodextrin (β-CD) on the properties and stability of vegetable oil-based whipped cream stabilized by kidney bean protein aggregates was investigated. The visual appearance, SEM, TEM, CLSM, FT-IR and LF-NMR results showed that when the ratio of XG to β-CD in the XG-β-CD complex was appropriate, the hydrogen bonding effect between β-CD and XG was significant enhanced, the three-dimensional network structure has the highest density, the emulsion droplets were the smallest and evenly distributed. The unique tapered microstructure of β-CD acted as a bridge between the hydrophilic and hydrophobic components, effectively preventing the aggregation of oil droplets and establishing a flexible support system between oil droplets; while the flexible molecular structure of XG could support Pickering emulsion system. The XG-β-CD complex had a synergistic effect with protein aggregates, making it ideal for use in whipped cream products. This study explored the stability mechanism of β-CD in the Pickering emulsion-based whipped cream system, providing valuable insights into producing whole plant-based whipped cream by texturizing highly unsaturated oils. This effectively solves the problem of inadequate intake of unsaturated oil for individuals who consume excessive amounts of animal-derived fats.
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Affiliation(s)
- Sisi Wu
- School of Food and Health, Beijing Higher Institution Engineering Research Center of Food Additives and Ingredients, Beijing Technology and Business University, Beijing 100048, China
| | - Chenqiang Wang
- Technology Center, Xinjiang Guannong Share Group Co., Ltd, Korla City, Xinjiang 841000, China
| | - Chunxiu Liu
- School of Food and Health, Beijing Higher Institution Engineering Research Center of Food Additives and Ingredients, Beijing Technology and Business University, Beijing 100048, China
| | - Qiuqiu He
- School of Food and Health, Beijing Higher Institution Engineering Research Center of Food Additives and Ingredients, Beijing Technology and Business University, Beijing 100048, China
| | - Zifan Zhang
- School of Food and Health, Beijing Higher Institution Engineering Research Center of Food Additives and Ingredients, Beijing Technology and Business University, Beijing 100048, China
| | - Tiezheng Ma
- School of Food and Health, Beijing Higher Institution Engineering Research Center of Food Additives and Ingredients, Beijing Technology and Business University, Beijing 100048, China.
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Bonekamp NE, Visseren FLJ, van der Schouw YT, van der Meer MG, Teraa M, Ruigrok YM, Geleijnse JM, Koopal C. Cost-effectiveness of Mediterranean diet and physical activity in secondary cardiovascular disease prevention: results from the UCC-SMART cohort study. Eur J Prev Cardiol 2024; 31:1460-1468. [PMID: 38547043 DOI: 10.1093/eurjpc/zwae123] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 02/07/2024] [Accepted: 03/24/2024] [Indexed: 09/07/2024]
Abstract
AIMS The efficacy of a healthy lifestyle in secondary prevention of cardiovascular disease (CVD) is well established and a first-line recommendation in CVD prevention guidelines. The aim of this study was to assess whether Mediterranean diet and physical activity are also cost-effective in patients with established CVD. METHODS AND RESULTS A cost-utility analysis (CUA) was performed comparing a combined Mediterranean diet and physical activity intervention to usual care in patients with CVD. The CUA had a healthcare perspective and lifetime horizon. Costs and utilities were estimated using a microsimulation on a cohort of 100 000 patients with CVD sampled from the Utrecht Cardiovascular Cohort-Secondary Manifestations of ARTerial disease study (n = 8947, mean age 62 ± 8.7 years, and 74% male). Cost-effectiveness was expressed as an incremental cost-effectiveness ratio (ICER), incremental net health benefit (INHB), and incremental net monetary benefit (INMB). Mediterranean diet and physical activity yielded 2.0 incremental quality-adjusted life years (QALYs) and cost reductions of €1236 per person compared with usual care, resulting in an ICER of €-626/QALY [95% confidence interval (CI) -1929 to 2673]. At a willingness-to-pay of €20 000/QALY, INHB was 2.04 (95% CI 0.99-3.58) QALYs and INMB was €40 757 (95% CI 19 819-71 605). The interventions remained cost-effective in a wide range of sensitivity analyses, including worst-case scenarios and scenarios with reimbursement for food and physical activity costs. CONCLUSION In patients with established CVD, a combined Mediterranean diet and physical activity intervention was cost-saving and highly cost-effective compared with usual care. These findings strongly advocate for the incorporation of lifestyle interventions as integral components of care for all patients with CVD.
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Affiliation(s)
- Nadia E Bonekamp
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, PO Box 85500, 3508 GA Utrecht, The Netherlands
| | - Frank L J Visseren
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, PO Box 85500, 3508 GA Utrecht, The Netherlands
| | - Yvonne T van der Schouw
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, PO Box 85500, 3508 GA Utrecht, The Netherlands
| | - Manon G van der Meer
- Department of Cardiology, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, PO Box 85500, 3508 GA Utrecht, The Netherlands
| | - Martin Teraa
- Department of Vascular Surgery, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, PO Box 85500, 3508 GA Utrecht, The Netherlands
| | - Ynte M Ruigrok
- UMC Utrecht Brain Center, Department of Neurology and Neurosurgery, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, PO Box 85500, 3508 GA Utrecht, The Netherlands
| | - Johanna M Geleijnse
- Division of Human Nutrition and Health, Wageningen University, Stippeneng 4, 6708 WE Wageningen, The Netherlands
| | - Charlotte Koopal
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, PO Box 85500, 3508 GA Utrecht, The Netherlands
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Feng T, Xu Q, Yu Z, Song F, Luo Q, Wang S, Tang H, Li H. Exploring the underlying mechanisms of Danshen-Shanzha Decoction on coronary heart disease: An integrated analysis combining pharmacoinformatics and experimental validation. JOURNAL OF ETHNOPHARMACOLOGY 2024; 337:118779. [PMID: 39244177 DOI: 10.1016/j.jep.2024.118779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Revised: 08/28/2024] [Accepted: 09/01/2024] [Indexed: 09/09/2024]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE The Danshen-Shanzha Decoction (DSD) is a renowned herbal combination consisting of the root of Salvia miltiorrhiza Bunge (known as Danshen in Chinese) and the fruits of Crataegus pinnatifida Bunge (known as Shanzha in Chinese), which has exhibited remarkable clinical efficacy in the treatment of coronary heart disease (CHD) in traditional Chinese medicine, with its earliest recorded application dating to around 202 BCE during the Han Dynasty. Despite significant advancements in the fundamental research and clinical applications of DSD over the past few decades, the precise bioactive components as well as the underlying mechanisms responsible for its protective effect on CHD remain unelucidated. AIM OF THE STUDY The present study was designed to elucidate the bioactive components and potential mechanism of DSD in the treatment of CHD using in silico technologies integrated with pharmacoinformatic methods and experimental validation. MATERIALS AND METHODS The chemical components of DSD were analyzed and identified using UPLC-Q-TOF-MS. Pharmacoinformatic-based methods were employed to comprehensively investigate the principal active components and targets of DSD for treating CHD. GO and KEGG pathway analyses were utilized to elucidate the underlying mechanism responsible for DSD's efficacy against CHD. Molecular docking and molecular dynamics simulation were performed to assess the binding affinity between active components and putative targets. Furthermore, surface plasmon resonance (SPR) was carried out to verify the affinity and kinetic characteristics of major components to STAT3 protein. Subsequently, a series of in vitro experiments, including cell viability test, flow cytometric analysis, ELISA and western blotting, were conducted to validate the predicted results in an oxygen-glucose deprivation (OGD)-stimulated H9c2 model. RESULTS A total of 96 compounds were characterized by UPLC-Q-TOF-MS, and 281 overlapping targets were identified through pharmacoinformatic-based methods. Among these, ten critical compounds were determined as the core active components of DSD. The core targets associated with the development of CHD included STAT3, SRC, TP53, JUN, and AKT1. Notably, Dihydrotanshinone I and (+)-Epicatechin exhibited strong binding affinity towards STAT3. The potential mechanisms by which DSD modulates the pathological progression of CHD were predicted to involve inflammation, oxidative stress, and apoptosis. Importantly, the cytoprotective effect of DSD against apoptosis was confirmed in OGD-stimulated H9c2 cells, as evidenced by the upregulation of Bcl-2 expression and downregulation of both Bax and cleaved caspase-3 expressions upon DSD treatment. Furthermore, DSD significantly enhanced the phosphorylated protein expressions of JAK2 and STAT3 compared to the OGD group, suggesting its potential role in modulating related signaling pathways. CONCLUSIONS The current study successfully fills the gap in the understanding of the chemical profiles of DSD, predicting its active components, potential targets, and molecular mechanisms in the treatment of CHD. These findings not only provide a valuable strategy but also robust data support for future investigations into DSD, thereby facilitating the identification of novel therapeutic targets for traditional Chinese medicines in the battle against CHD.
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Affiliation(s)
- Tian Feng
- Department of Chinese Materia Medica and Natural Medicines, School of Pharmacy, Air Force Medical University, Xi'an, 710032, China
| | - Qiong Xu
- Department of Chinese Materia Medica and Natural Medicines, School of Pharmacy, Air Force Medical University, Xi'an, 710032, China
| | - Zhe Yu
- Department of Pharmaceutical Analysis, School of Pharmacy, Air Force Medical University, Xi'an, 710032, China
| | - Fan Song
- Department of Chinese Materia Medica and Natural Medicines, School of Pharmacy, Air Force Medical University, Xi'an, 710032, China
| | - Qian Luo
- Department of Chinese Materia Medica and Natural Medicines, School of Pharmacy, Air Force Medical University, Xi'an, 710032, China; College of Life Science and Medicine, Northwest University, Xi'an, 710069, China
| | - Siwang Wang
- Department of Chinese Materia Medica and Natural Medicines, School of Pharmacy, Air Force Medical University, Xi'an, 710032, China; College of Life Science and Medicine, Northwest University, Xi'an, 710069, China
| | - Haifeng Tang
- Department of Chinese Materia Medica and Natural Medicines, School of Pharmacy, Air Force Medical University, Xi'an, 710032, China.
| | - Hua Li
- Department of Chinese Materia Medica and Natural Medicines, School of Pharmacy, Air Force Medical University, Xi'an, 710032, China.
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Bairey Merz CN. Vulnerable plaque and major adverse cardiovascular events: anatomy of a failure. Eur Heart J 2024:ehae553. [PMID: 39228369 DOI: 10.1093/eurheartj/ehae553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/05/2024] Open
Affiliation(s)
- C Noel Bairey Merz
- Barbra Streisand Women's Heart Center, Smidt Heart Institute, Cedars-Sinai Medical Center, 127 S. San Vicente Blvd., Los Angeles, CA 90048, USA
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Zhao Y, Zheng G, Yang S, Liu S, Wu Y, Miao Y, Liang Z, Hua Y, Zhang J, Shi J, Li D, Cheng Y, Zhang Y, Chen Y, Fan G, Ma C. The plant extract PNS mitigates atherosclerosis via promoting Nrf2-mediated inhibition of ferroptosis through reducing USP2-mediated Keap1 deubiquitination. Br J Pharmacol 2024. [PMID: 39228119 DOI: 10.1111/bph.17311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 06/04/2024] [Accepted: 06/23/2024] [Indexed: 09/05/2024] Open
Abstract
BACKGROUND AND PURPOSE Atherosclerosis is the basis of cardiovascular disease. Ferroptosis is a form of programmed cell death characterized by lipid peroxidation, which contributes to atherogenesis. The plant extract PNS (Panax notoginseng saponins), containing the main active ingredients of Panax notoginseng, exhibits anti-atherogenic properties. Herein, we determined whether PNS and its major components could attenuate atherosclerosis by suppressing ferroptosis and revealed the underlying mechanism(s). EXPERIMENTAL APPROACH The anti-atherogenic effects of PNS and their association with inhibition of ferroptosis was determined in apoE-/- mice. In vitro, the anti-ferroptotic effect and mechanism(s) of PNS components were demonstrated in the presence of ferroptosis inducers. Expression of ferroptosis markers and the ubiquitination of Keap1 were evaluated in USP2-/- macrophages. Finally, the anti-atherogenic effect of USP2 knockout was determined by using USP2-/- mice treated with high-fat diet (HFD) and AAV-PCSK9. KEY RESULTS PNS inhibited ferroptosis and atherosclerosis in vivo. PNS suppressed ferroptosis and ferroptosis-aggravated foam cell formation and inflammation in vitro. Mechanistically, PNS and its components activated Nrf2 by antagonizing Keap1, which was attributed to the inhibition of USP2 expression. USP2 knockout antagonized ferroptosis and ferroptosis-aggravated foam cell formation and inflammation, thus mitigating atherosclerosis. USP2 knockout abolished inhibitory effects of PNS on foam cell formation and inflammation in vitro. CONCLUSION AND IMPLICATIONS PNS reduced USP2-mediated Keap1 de-ubiquitination and promoted Keap1 degradation, thereby activating Nrf2, improving iron metabolism and reducing lipid peroxidation, thus contributing to an anti-atherosclerotic outcome. Our study revealed the mechanism(s) underlying inhibition of ferroptosis and atherosclerosis by PNS.
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Affiliation(s)
- Yun Zhao
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
| | - Guobin Zheng
- NHC Key Laboratory of Hormones and Development, Tianjin Key Laboratory of Metabolic Diseases, Chu Hsien-I Memorial Hospital & Tianjin Institute of Endocrinology, Tianjin Medical University, Tianjin, China
| | - Shu Yang
- Department of Geriatrics, The First Affiliated Hospital of Southern University of Science and Technology (Shenzhen People's Hospital), Shenzhen, China
| | - Shangjing Liu
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
| | - Yifan Wu
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
| | - Yaodong Miao
- Second Affiliated Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Zhen Liang
- Department of Geriatrics, The First Affiliated Hospital of Southern University of Science and Technology (Shenzhen People's Hospital), Shenzhen, China
| | - Yunqing Hua
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
| | - Jing Zhang
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
| | - Jia Shi
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
| | - Dan Li
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
| | - Yanfei Cheng
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
| | - Yunsha Zhang
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
| | - Yuanli Chen
- Anhui Provincial International Science and Technology Cooperation Base for Major Metabolic Diseases and Nutritional Interventions, Key Laboratory of Major Metabolic Diseases and Nutritional Regulation of Anhui Department of Education, School of Food and Biological Engineering, Hefei University of Technology, Hefei, China
| | - Guanwei Fan
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
| | - Chuanrui Ma
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
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Buch MH, Mallat Z, Dweck MR, Tarkin JM, O'Regan DP, Ferreira V, Youngstein T, Plein S. Current understanding and management of cardiovascular involvement in rheumatic immune-mediated inflammatory diseases. Nat Rev Rheumatol 2024:10.1038/s41584-024-01149-x. [PMID: 39232242 DOI: 10.1038/s41584-024-01149-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/22/2024] [Indexed: 09/06/2024]
Abstract
Immune-mediated inflammatory diseases (IMIDs) are a spectrum of disorders of overlapping immunopathogenesis, with a prevalence of up to 10% in Western populations and increasing incidence in developing countries. Although targeted treatments have revolutionized the management of rheumatic IMIDs, cardiovascular involvement confers an increased risk of mortality and remains clinically under-recognized. Cardiovascular pathology is diverse across rheumatic IMIDs, ranging from premature atherosclerotic cardiovascular disease (ASCVD) to inflammatory cardiomyopathy, which comprises myocardial microvascular dysfunction, vasculitis, myocarditis and pericarditis, and heart failure. Epidemiological and clinical data imply that rheumatic IMIDs and associated cardiovascular disease share common inflammatory mechanisms. This concept is strengthened by emergent trials that indicate improved cardiovascular outcomes with immune modulators in the general population with ASCVD. However, not all disease-modifying therapies that reduce inflammation in IMIDs such as rheumatoid arthritis demonstrate equally beneficial cardiovascular effects, and the evidence base for treatment of inflammatory cardiomyopathy in patients with rheumatic IMIDs is lacking. Specific diagnostic protocols for the early detection and monitoring of cardiovascular involvement in patients with IMIDs are emerging but are in need of ongoing development. This Review summarizes current concepts on the potentially targetable inflammatory mechanisms of cardiovascular pathology in rheumatic IMIDs and discusses how these concepts can be considered for the diagnosis and management of cardiovascular involvement across rheumatic IMIDs, with an emphasis on the potential of cardiovascular imaging for risk stratification, early detection and prognostication.
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Affiliation(s)
- Maya H Buch
- Centre for Musculoskeletal Research, Division of Musculoskeletal & Dermatological Sciences, Faculty of Biology, Medicine & Health, University of Manchester, Manchester, UK.
- NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK.
| | - Ziad Mallat
- Section of Cardiorespiratory Medicine, Victor Phillip Dahdaleh Heart & Lung Research Institute, University of Cambridge, Cambridge, UK
| | - Marc R Dweck
- Centre for Cardiovascular Science, Chancellors Building, Little France Crescent, University of Edinburgh, Edinburgh, UK
| | - Jason M Tarkin
- Section of Cardiorespiratory Medicine, Victor Phillip Dahdaleh Heart & Lung Research Institute, University of Cambridge, Cambridge, UK
| | - Declan P O'Regan
- MRC Laboratory of Medical Sciences, Imperial College London, London, UK
| | - Vanessa Ferreira
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Taryn Youngstein
- National Heart & Lung Institute, Imperial College London, London, UK
- Department of Rheumatology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Sven Plein
- Biomedical Imaging Science Department, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
- School of Biomedical Engineering and Imaging Sciences, Kings College London, London, UK
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20
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De Cock E, Kautbally S, Timmermans F, Bogaerts K, Hanet C, Desmet W, Gurné O, Vranckx P, Hiltrop N, Dujardin K, Vanduynhoven P, Vermeersch P, Pirlet C, Hermans K, Van Reet B, Ferdinande B, Aminian A, Dewilde W, Guédès A, Simon F, De Roeck F, De Vroey F, Jukema JW, Sinnaeve P, Buysschaert I. Low-dose colchicine for the prevention of cardiovascular events after percutaneous coronary intervention: rationale and design of the COL BE PCI trial: Short title: Rationale and design of the COL BE PCI trial. Am Heart J 2024:S0002-8703(24)00225-4. [PMID: 39233210 DOI: 10.1016/j.ahj.2024.08.022] [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: 07/12/2024] [Revised: 08/29/2024] [Accepted: 08/29/2024] [Indexed: 09/06/2024]
Abstract
Patients with coronary artery disease (CAD) remain vulnerable to future major atherosclerotic events after revascularization, despite effective secondary prevention strategies. Inflammation plays a central role in the pathogenesis of CAD and recurrent events. To date, there is no specific anti-inflammatory medicine available with proven effective, cost-efficient, and favorable benefit-risk profile, except for colchicine. Initial studies with colchicine have sparked major interest in targeting atherosclerotic events with anti-inflammatory agents, but further studies are warranted to enforce the role of colchicine role as a major treatment pillar in CAD. Given colchicine's low cost and established acceptable long-term safety profile, confirming its efficacy through a pragmatic trial holds the potential to significantly impact the global burden of cardiovascular disease. The COL BE PCI trial is an investigator-initiated, multicenter, double-blind, event-driven trial. It will enroll 2,770 patients with chronic or acute CAD treated with percutaneous coronary intervention (PCI) at 19 sites in Belgium, applying lenient in- and exclusion criteria and including at least 30% female participants. Patients will be randomized between 2 hours and 5 days post-PCI to receive either colchicine 0.5 mg daily or placebo on top of contemporary optimal medical therapy and without run-in period. All patients will have baseline hsCRP measurements and a Second Manifestations of Arterial Disease (SMART) risk score calculation. The primary endpoint is the time from randomization to the first occurrence of a composite endpoint consisting of all-cause death, spontaneous non-fatal myocardial infarction, non-fatal stroke, or coronary revascularization. The trial is event-driven and will continue until 566 events have been reached, providing 80% power to detect a 21 % reduction in the primary endpoint taking a premature discontinuation of 15% into account. We expect a trial duration of approximately 44 months. The COL BE PCI Trial aims to assess the effectiveness and safety of administering low-dose colchicine for the secondary prevention in patients with both chronic and acute coronary artery disease undergoing PCI. Trial registration: ClinicalTrials.gov: NCT06095765.
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Affiliation(s)
- Emmanuel De Cock
- Department of Cardiology, AZ Sint-Jan Brugge AV, Bruges, Belgium; Department of Cardiology, Ghent University Hospital, Ghent, Belgium
| | - Shakeel Kautbally
- Department of Cardiology, Cliniques Universitaires St-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Frank Timmermans
- Department of Cardiology, Ghent University Hospital, Ghent, Belgium
| | - Kris Bogaerts
- Department of Public Health and Primary Care, KU Leuven, I-BioStat, Leuven, Belgium and UHasselt, I-BioStat, Diepenbeek, Belgium
| | - Claude Hanet
- Department of Cardiology, Université Catholique de Louvain, Mont Godinne, Yvoir, Belgium
| | - Walter Desmet
- Department of Cardiovascular Sciences, University of Leuven, Leuven; Belgium & Department of Cardiovascular Medicine, University Hospitals Leuven, Belgium
| | - Olivier Gurné
- Department of Cardiology, Cliniques Universitaires St-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Pascal Vranckx
- Department of Cardiology and Intensive Care Medicine, Jessa Ziekenhuis, Hasselt, Belgium
| | - Nick Hiltrop
- Department of Cardiology, AZ Groeninge, Kortrijk, Belgium
| | - Karl Dujardin
- Department of Cardiology, AZ Delta, Roeselare, Belgium
| | | | - Paul Vermeersch
- Department of Cardiology, ZNA (Ziekenhuis Netwerk Antwerpen) Middelheim, Antwerp, Belgium
| | - Charles Pirlet
- Department of Cardiology, Citadelle Liège, Liège, Belgium
| | - Kurt Hermans
- Department of Cardiology, AZ Sint-Lucas Ghent, Ghent, Belgium
| | - Bert Van Reet
- Department of Cardiology, AZ Turnhout, Turnhout, Belgium
| | - Bert Ferdinande
- Department of Cardiology, Hospital Oost-Limburg, Genk, Belgium
| | - Adel Aminian
- Department of Cardiology, Centre Hospitalier Universitaire de Charleroi, Charleroi, Belgium
| | - Willem Dewilde
- Department of Cardiology, Imelda Hospital Bonheiden, Bonheiden, Belgium
| | - Antoine Guédès
- Department of Cardiology, Université Catholique de Louvain, Mont Godinne, Yvoir, Belgium
| | - François Simon
- Department of Cardiology, Clinique Saint-Luc Bouge, Namur, Belgium
| | - Frederic De Roeck
- Department of Cardiology, University Hospital Antwerp, Edegem, Belgium
| | - Frédéric De Vroey
- Department of Cardiology, Grand Hôpital de Charleroi, Charleroi, Belgium
| | - J Wouter Jukema
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands; Netherlands Heart Institute, Utrecht, the Netherlands
| | - Peter Sinnaeve
- Department of Cardiovascular Sciences, University of Leuven, Leuven
| | - Ian Buysschaert
- Department of Cardiology, AZ Sint-Jan Brugge AV, Bruges, Belgium.
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21
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Benenati S, Campo G, Seitun S, Caglioni S, Leone AM, Porto I. Ischemia with non-obstructive coronary artery (INOCA): Non-invasive versus invasive techniques for diagnosis and the role of #FullPhysiology. Eur J Intern Med 2024; 127:15-24. [PMID: 39039011 DOI: 10.1016/j.ejim.2024.07.017] [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: 04/22/2024] [Revised: 06/23/2024] [Accepted: 07/12/2024] [Indexed: 07/24/2024]
Abstract
Ischemia with non-obstructive coronary arteries (INOCA) is an increasingly recognized entity. It encompasses different pathophysiological subtypes (i.e., endotypes), including coronary microvascular dysfunction (CMD), vasospastic angina (VSA) and mixed entities resulting from the variable combination of both. Diagnosing INOCA and precisely characterizing the endotype allows for accurate medical treatment and has proven prognostic implications. A breadth of diagnostic technique is available, ranging from non-invasive approaches to invasive coronary angiography adjuvated by functional assessment and provocative tests. This review summarizes the strength and limitations of these methodologies and provides the rationale for the routine referral for invasive angiography and functional assessment in this subset of patients.
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Affiliation(s)
- Stefano Benenati
- Department of Internal Medicine (Di.M.I.), University of Genoa, Genoa, Italy
| | - Gianluca Campo
- Cardiology Unit, Azienda Ospedaliero Universitaria di Ferrara, Cona (FE), Italy
| | - Sara Seitun
- Department of Radiology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Serena Caglioni
- Cardiology Unit, Azienda Ospedaliero Universitaria di Ferrara, Cona (FE), Italy
| | - Antonio Maria Leone
- Catholic University of the Sacred Heart, Rome, Italy; Center of Excellence in Cardiovascular Sciences, Ospedale Isola Tiberina - Gemelli Isola, Roma
| | - Italo Porto
- Department of Internal Medicine (Di.M.I.), University of Genoa, Genoa, Italy; Cardiovascular Disease Unit, IRCCS Ospedale Policlinico San Martino, IRCCS Italian Cardiology Network, Genova, Italy.
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22
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Park D, Bea S, Bae JH, Lee H, Choe YJ, Shin JY, Kim H. PCSK9 Inhibitors and Infection-Related Adverse Events: A Pharmacovigilance Study Using the World Health Organization VigiBase. Drugs Real World Outcomes 2024; 11:465-475. [PMID: 38954190 PMCID: PMC11365897 DOI: 10.1007/s40801-024-00430-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/01/2024] [Indexed: 07/04/2024] Open
Abstract
AIMS Protein convertase subtilisin/kexin type 9 inhibitors (PCSK9i) are novel lipid-lowering agents used in patients with cardiovascular disease. Despite reassuring safety data from pivotal trials, increasing evidence from real-world studies suggests that PCSK9i increase the risk of bacterial and viral infections. Therefore, this study aimed to identify signals of infection-related adverse events (AEs) associated with PCSK9i. METHODS We performed an observational pharmacovigilance study using the World Health Organization's VigiBase, recorded up to December 2022. We included individual case safety reports (ICSRs) of PCSK9 inhibitors, alirocumab and evolocumab, and compared them with those of other drugs. Infection-related ICSRs were retrieved from the Medical Dictionary for Regulatory Activities System Organ Class 'infections and infestations.' RESULTS Among 114,293 reports (258,099 drug-AE pairs) related to PCSK9 inhibitors, 54% included female patients, 41% included patients aged ≥65 years, and 82% included patients who received evolocumab. Additionally, beyond AEs recognized by regulatory authorities, organ infections such as influenza (reporting odds ratio [ROR] 2.89, 95% confidence interval [CI] 2.74-3.05), gastric infections (ROR 2.47, 95% CI 1.63-3.75), and kidney infections (ROR 1.36, 95% CI 1.06-1.73) were observed. Sensitivity analysis indicated a heightened risk of infection-related AEs associated with PCSK9i regardless of the specific drug type. CONCLUSIONS In addition to the labelled respiratory infections, six infection-related symptoms in the gastrointestinal, urinary, and renal organs were identified. Our findings support the need for systematic surveillance of infections among PCSK9i users.
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Affiliation(s)
- Dahyun Park
- Department of Biohealth Regulatory Science, Sungkyunkwan University, Suwon, South Korea
| | - Sungho Bea
- School of Pharmacy, Sungkyunkwan University, 2066, Seobu-ro, Jangan-gu, Suwon, Gyeonggi-do, South Korea
| | - Ji-Hwan Bae
- School of Pharmacy, Sungkyunkwan University, 2066, Seobu-ro, Jangan-gu, Suwon, Gyeonggi-do, South Korea
| | - Hyesung Lee
- Department of Biohealth Regulatory Science, Sungkyunkwan University, Suwon, South Korea
- School of Pharmacy, Sungkyunkwan University, 2066, Seobu-ro, Jangan-gu, Suwon, Gyeonggi-do, South Korea
| | - Young June Choe
- Department of Paediatrics, Korea University Anam Hospital, Seoul, South Korea
| | - Ju-Young Shin
- Department of Biohealth Regulatory Science, Sungkyunkwan University, Suwon, South Korea.
- School of Pharmacy, Sungkyunkwan University, 2066, Seobu-ro, Jangan-gu, Suwon, Gyeonggi-do, South Korea.
- Department of Clinical Research Design and Evaluation, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University, Seoul, South Korea.
| | - Hoon Kim
- Department of Biohealth Regulatory Science, Sungkyunkwan University, Suwon, South Korea.
- School of Pharmacy, Sungkyunkwan University, 2066, Seobu-ro, Jangan-gu, Suwon, Gyeonggi-do, South Korea.
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23
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Lee J, Kang DY, Kim H, Choi Y, Jo S, Ahn JM, Kim S, Yoon YH, Hur SH, Lee CH, Kim WJ, Kang SH, Park CS, Lee BK, Suh JW, Choi JW, Kim KS, Lee SN, Park SJ, Park DW. Routine Stress Testing After PCI in Patients With and Without Acute Coronary Syndrome: A Secondary Analysis of the POST-PCI Randomized Clinical Trial. JAMA Cardiol 2024; 9:770-780. [PMID: 38922632 PMCID: PMC11209198 DOI: 10.1001/jamacardio.2024.1556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Accepted: 04/24/2024] [Indexed: 06/27/2024]
Abstract
Importance The appropriate follow-up surveillance strategy for patients with acute coronary syndrome (ACS) who have undergone percutaneous coronary intervention (PCI) remains unknown. Objective To assess clinical outcomes in patients with and without ACS who have undergone high-risk PCI according to a follow-up strategy of routine stress testing at 12 months after PCI vs standard care alone. Design, Setting, and Participants The POST-PCI (Pragmatic Trial Comparing Symptom-Oriented vs Routine Stress Testing in High-Risk Patients Undergoing Percutaneous Coronary Intervention) trial was a randomized clinical trial that compared follow-up strategies of routine functional testing vs standard care alone 12 months after high-risk PCI. Patients were categorized as presenting with or without ACS. Patients were enrolled in the trial from November 2017 through September 2019, and patients were randomized from 11 sites in South Korea; data analysis was performed in 2022. Intervention Patients categorized as presenting with or without ACS were randomized to either a routine functional testing or standard care alone follow-up strategy 12 months after high-risk PCI. Main Outcomes and Measures The primary outcome was a composite of death from any cause, myocardial infarction, or hospitalization for unstable angina at 2 years following randomization. Kaplan-Meier event rates through 2 years and Cox model hazard ratios (HRs) were generated, and interactions were tested. Results Of 1706 included patients, 350 patients (20.5%) were female, and the mean (SD) patient age was 64.7 (10.3) years. In total, 526 patients (30.8%) presented with ACS. Compared with those without ACS, patients with ACS had a 55% greater risk of the primary outcome (HR, 1.55; 95% CI, 1.03-2.33; P = .03) due to higher event rates in the first year. The 2-year incidences of the primary outcome were similar between strategies of routine functional testing or standard care alone in patients with ACS (functional testing: 16 of 251 [6.6%]; standard care: 23 of 275 [8.5%]; HR, 0.76; 95% CI, 0.40-1.44; P = .39) and in patients without ACS (functional testing: 30 of 598 [5.1%]; standard care: 28 of 582 [4.9%]; HR, 1.04; 95% CI, 0.62-1.74; P = .88) (P for interaction for ACS = .45). Although a landmark analysis suggested that the rates of invasive angiography and repeat revascularization were higher after 1 year in the routine functional testing group, the formal interactions between ACS status and either invasive angiography or repeat revascularization were not significant. Conclusion and Relevance Despite being at higher risk for adverse clinical events in the first year after PCI than patients without ACS, patients with ACS who had undergone high-risk PCI did not derive incremental benefit from routine surveillance stress testing at 12 months compared with standard care alone during follow-up. Trial Registration ClinicalTrials.gov Identifier: NCT03217877.
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Affiliation(s)
- Jinho Lee
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
- Division of Cardiology, KyungHee Medical Center, KyungHee University, Seoul, South Korea
| | - Do-Yoon Kang
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Hoyun Kim
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Yeonwoo Choi
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Sangyong Jo
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Jung-Min Ahn
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Seonok Kim
- Division of Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Yong-Hoon Yoon
- Division of Cardiology, Chungnam National University Sejong Hospital, Sejong, South Korea
| | - Seung-Ho Hur
- Division of Cardiology, Keimyung University Dongsan Hospital, Daegu, South Korea
| | - Cheol Hyun Lee
- Division of Cardiology, Keimyung University Dongsan Hospital, Daegu, South Korea
| | - Won-Jang Kim
- Division of Cardiology, CHA Bundang Medical Center, Seongnam, South Korea
| | - Se Hun Kang
- Division of Cardiology, CHA Bundang Medical Center, Seongnam, South Korea
| | - Chul Soo Park
- Cardiovascular Center and Cardiology Division, Yeouido St Mary’s Hospital, Seoul, South Korea
| | - Bong-Ki Lee
- Division of Cardiology, Kangwon National University Hospital, Chuncheon, South Korea
| | - Jung-Won Suh
- Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Jae Woong Choi
- Division of Cardiology, Eulji General Hospital, Seoul, South Korea
| | - Kee-Sik Kim
- Division of Cardiology, Daegu Catholic University Medical Center, Daegu, South Korea
| | - Su Nam Lee
- Division of Cardiology, St Vincent’s Hospital, Suwon, South Korea
| | - Seung-Jung Park
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Duk-Woo Park
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
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Brown L, Cambron C, Post WS, Brandt EJ. The Role of Social Determinants of Health in Atherosclerotic Cardiovascular Disease. Curr Atheroscler Rep 2024; 26:451-461. [PMID: 38980573 DOI: 10.1007/s11883-024-01226-2] [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] [Accepted: 06/24/2024] [Indexed: 07/10/2024]
Abstract
PURPOSE OF REVIEW This review seeks to provide important information on each of the major domains of social determinants of health (SDOH) in the context of atherosclerotic cardiovascular disease. RECENT FINDINGS SDOH can be classified into five domains: social and community context, health care access and quality, neighborhood and built environment, economic stability, and education access and quality. SDOH are major drivers for cardiovascular health outcomes that exceed the impact from traditional risk factors, and explain inequities in health outcomes observed across different groups of individuals. SDOH profoundly impacts healthcare's receipt, delivery, and outcomes. Many patients fall within various disenfranchised groups (e.g., identify with minority race, low socioeconomic status, low educational attainment, LGBTQ+), which impact overall health status and care. Learning to understand, recognize, and address SDOH as the driving force of disparities are critical for achieving health equity in the prevention and adequate treatment of ASCVD.
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Affiliation(s)
- Logan Brown
- University of Michigan Medical School, Ann Arbor, MI, USA
| | | | - Wendy S Post
- Division of Cardiology, Department of Medicine, Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Eric J Brandt
- Institute for Healthcare Policy and Innovation, University of Michigan, 24 Frank Lloyd Wright Dr, Lobby A, Ann Arbor, MI, 48103, USA.
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, 24 Frank Lloyd Wright Dr, Lobby A, Ann Arbor, MI, 48103, USA.
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25
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Greco A. Sodium-Glucose Cotransporter-2 Inhibitors: Elevating Standards in Cardiovascular Secondary Prevention. Am J Cardiovasc Drugs 2024; 24:625-628. [PMID: 39017985 DOI: 10.1007/s40256-024-00666-0] [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] [Accepted: 07/03/2024] [Indexed: 07/18/2024]
Affiliation(s)
- Antonio Greco
- Azienda Ospedaliero-Universitaria Policlinico "G. Rodolico, San Marco", University of Catania, Via Santa Sofia, 78, 95100, Catania, Italy.
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26
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Wang J, Salerno M. Deep learning-based rapid image reconstruction and motion correction for high-resolution cartesian first-pass myocardial perfusion imaging at 3T. Magn Reson Med 2024; 92:1104-1114. [PMID: 38576068 DOI: 10.1002/mrm.30106] [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: 12/11/2023] [Revised: 03/19/2024] [Accepted: 03/19/2024] [Indexed: 04/06/2024]
Abstract
PURPOSE To develop and evaluate a deep learning (DL) -based rapid image reconstruction and motion correction technique for high-resolution Cartesian first-pass myocardial perfusion imaging at 3T with whole-heart coverage for both single-slice (SS) and simultaneous multi-slice (SMS) acquisitions. METHODS 3D physics-driven unrolled network architectures were utilized for the reconstruction of high-resolution Cartesian perfusion imaging. The SS and SMS multiband (MB) = 2 networks were trained from 135 slices from 20 subjects. Structural similarity index (SSIM), peak SNR (PSNR), and normalized RMS error (NRMSE) were assessed, and prospective images were blindly graded by two experienced cardiologists (5, excellent; 1, poor). For respiratory motion correction, a 2D U-Net based motion corrected network was proposed, and the temporal fidelity and second-order derivative were calculated to assess the performance of the motion correction. RESULTS Excellent performance was demonstrated in the proposed technique with high SSIM and PSNR, and low NRMSE. Image quality scores were (4.3 [4.3, 4.4], 4.5 [4.4, 4.6], 4.3 [4.3, 4.4], and 4.5 [4.3, 4.5]) for SS DL and SS L1-SENSE, MB = 2 DL and MB = 2 SMS-L1-SENSE, respectively, showing no statistically significant difference (p > 0.05 for SS and SMS) between (SMS)-L1-SENSE and the proposed DL technique. The network inference time was around 4 s per dynamic perfusion series with 40 frames while the time of (SMS)-L1-SENSE with GPU acceleration was approximately 30 min. CONCLUSION The proposed DL-based image reconstruction and motion correction technique enabled rapid and high-quality reconstruction for SS and SMS MB = 2 high-resolution Cartesian first-pass perfusion imaging at 3T.
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Affiliation(s)
- Junyu Wang
- Department of Cardiovascular Medicine, Stanford University, Stanford, California, USA
| | - Michael Salerno
- Department of Cardiovascular Medicine, Stanford University, Stanford, California, USA
- Department of Radiology, Cardiovascular Imaging, Stanford University, Stanford, California, USA
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27
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Coriasso N, Daher E. Utility of magnetocardiography (MCG) in the assessment of obstructive coronary artery disease before and after percutaneous coronary intervention: A case series. AMERICAN HEART JOURNAL PLUS : CARDIOLOGY RESEARCH AND PRACTICE 2024; 45:100425. [PMID: 39139983 PMCID: PMC11321367 DOI: 10.1016/j.ahjo.2024.100425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/18/2024] [Revised: 07/03/2024] [Accepted: 07/04/2024] [Indexed: 08/15/2024]
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28
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Burish MJ, Guirguis AB, Schindler EAD. Managing Cluster Headache in Patients with Medical, Psychiatric, and Surgical Comorbidities. Curr Neurol Neurosci Rep 2024; 24:439-452. [PMID: 39017830 DOI: 10.1007/s11910-024-01362-x] [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] [Accepted: 07/06/2024] [Indexed: 07/18/2024]
Abstract
PURPOSE OF REVIEW What should a provider know about medications and other treatments in patients with cluster headache who have medical, psychiatric, and surgical comorbidities? What conversations should providers have with patients about living with and managing cluster headache? RECENT FINDINGS While the number of treatments used in cluster headache is relatively small, numerous considerations were identified related to managing patients with comorbidities. Many of these touch on cardiac, cardiovascular, and cerebrovascular health, but full histories are needed to guide safe and effective treatment. Both older and newer treatments may be contraindicated in certain patients with cluster headache or should be considered carefully. In addition to incorporating medical, psychiatric, and surgical histories in the management plan, collaboration with other providers may be beneficial. Providers should also inquire about patient practices and discuss participation in clinical trials that might be a good fit for the individual.
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Affiliation(s)
- Mark J Burish
- Department of Neurosurgery, McGovern Medical School at UTHealth Houston, Houston, TX, USA
| | - Alexander B Guirguis
- Veteran Health Administration Headache Center of Excellence, Veterans Affairs Connecticut Healthcare System, West Haven, CT, USA
| | - Emmanuelle A D Schindler
- Veteran Health Administration Headache Center of Excellence, Veterans Affairs Connecticut Healthcare System, West Haven, CT, USA.
- Department of Neurology, Yale University School of Medicine, New Haven, CT, USA.
- VA Connecticut Healthcare System, Neurology Service, MS 127, 950 Campbell Avenue, West Haven, CT, 06516, USA.
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29
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Wang EM, Asias-Dinh B, Rosario N. Review of Recent Literature and Updates in Nonstatin Cholesterol Management. Mayo Clin Proc 2024; 99:1449-1468. [PMID: 38912991 DOI: 10.1016/j.mayocp.2024.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 02/19/2024] [Accepted: 03/11/2024] [Indexed: 06/25/2024]
Abstract
The guidelines for cholesterol management have been updated over the years from treat-to-target using any drug class to emphasis on statins without treatment targets to a hybrid of the 2 approaches. The most recent guideline updates include newer nonstatin lipid-lowering therapies (LLTs), low-density lipoprotein cholesterol (LDL-C) reduction goals, and LDL-C thresholds considering secondary prevention and cardiovascular risk. Although statins have been the mainstay of LLT for years, newer pharmacological agents such as proprotein convertase subtilisin-kexin type 9 inhibitor(s) (PCSK9i) monoclonal antibodies, small interfering RNA PCSK9i, and bempedoic acid to optimize LDL-C levels may be underutilized in clinical practice. To provide an updated review for clinicians, we performed a literature search in PubMed for articles published from January 1, 2000, to August 31, 2023, that included the terms cholesterol, LLT, bempedoic acid, inclisiran, or PCSK9 inhibitor. Studies were selected for inclusion according to relatedness to cholesterol management and outcomes with novel LLT agents. Optimization of statins can improve the lipid profile and contribute to primary and secondary atherosclerotic cardiovascular disease (ASCVD) prevention. The newest guidance combines anticipated LDL-C reduction from statins and LDL-C thresholds for primary and secondary prevention. Nonstatin agents such as PCSK9i monoclonal antibodies, small interfering RNA PCSK9i, and bempedoic acid are safe and effective LLTs that can be used in addition to statin therapy for additional LDL-C lowering and prevention of ASCVD. Additionally, these nonstatin agents are reasonable to initiate in patients who have not been able to tolerate statins due to myalgias, rhabdomyolysis, or contraindications. Cost may be a barrier to initiating these agents for patients who are underinsured or uninsured. Clinicians should reference the most up-to-date guidance for LLT for primary and secondary prevention of ASCVD. Additionally, clinicians must diligently continue to optimize statin and nonstatin LLT to improve cardiovascular health outcomes.
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Affiliation(s)
- Elisabeth M Wang
- Department of Pharmacy Practice and Translational Research, University of Houston College of Pharmacy, Houston TX; Michael E. DeBakey VA Medical Center, Houston, TX
| | - Bernadette Asias-Dinh
- Department of Pharmacy Practice and Translational Research, University of Houston College of Pharmacy, Houston TX; Denver Harbor Family Health Center, Vecino Health Centers, Houston, TX
| | - Natalie Rosario
- Department of Pharmacy Practice and Translational Research, University of Houston College of Pharmacy, Houston TX; Denver Harbor Family Health Center, Vecino Health Centers, Houston, TX
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Saraste A, Knuuti J. Value of Ischemia in Prognosis and Guiding Revascularization Among Patients With Chronic Coronary Artery Disease. Circ Cardiovasc Imaging 2024; 17:e017378. [PMID: 39247986 DOI: 10.1161/circimaging.124.017378] [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: 09/10/2024]
Affiliation(s)
- Antti Saraste
- Heart Center (A.S.), Turku University Hospital and University of Turku, Finland
- PET Centre (A.S., J.K.), Turku University Hospital and University of Turku, Finland
| | - Juhani Knuuti
- PET Centre (A.S., J.K.), Turku University Hospital and University of Turku, Finland
- Department of Clinical Physiology, Nuclear Medicine and PET, Turku University Hospital, Finland (J.K.)
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d'Entremont MA, Lee SF, Mian R, Kedev S, Montalescot G, Cornel JH, Stankovic G, Moreno R, Storey RF, Henry TD, Skuriat E, Tyrwhitt J, Mehta SR, Devereaux PJ, Eikelboom J, Cairns JA, Pitt B, Jolly SS. Design and rationale of the CLEAR SYNERGY (OASIS 9) trial: A 2x2 factorial randomized controlled trial of colchicine versus placebo and spironolactone vs placebo in patients with myocardial infarction. Am Heart J 2024; 275:173-182. [PMID: 38936755 DOI: 10.1016/j.ahj.2024.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Revised: 06/19/2024] [Accepted: 06/20/2024] [Indexed: 06/29/2024]
Abstract
BACKGROUND Patients experiencing myocardial infarction (MI) remain at high risk of future major adverse cardiovascular events (MACE). While low-dose colchicine and spironolactone have been shown to decrease post-MI MACE, more data are required to confirm their safety and efficacy in an unselected post-MI population. Therefore, we initiated the CLEAR SYNERGY (OASIS 9) trial to address these uncertainties. METHODS The CLEAR SYNERGY trial is a 2 × 2 factorial randomized controlled trial of low-dose colchicine 0.5 mg daily versus placebo and spironolactone 25 mg daily versus placebo in 7,062 post-MI participants who were within 72 hours of the index percutaneous coronary intervention (PCI). We blinded participants, healthcare providers, research personnel, and outcome adjudicators to treatment allocation. The primary outcome for colchicine is the first occurrence of the composite of cardiovascular death, recurrent MI, stroke, or unplanned ischemia-driven revascularization. The coprimary outcomes for spironolactone are (1) the composite of the total numbers of cardiovascular death or new or worsening heart failure and (2) the first occurrence of the composite of cardiovascular death, new or worsening heart failure, recurrent MI or stroke. We finished recruitment with 7,062 participants from 104 centers in 14 countries on November 8, 2022, and plan to present the results in the fall of 2024. CONCLUSIONS CLEAR SYNERGY is a large international randomized controlled trial that will inform the effects of low-dose colchicine and spironolactone in largely unselected post-MI patients who undergo PCI. (ClinicalTrials.gov Identifier: NCT03048825).
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Affiliation(s)
- Marc-André d'Entremont
- Population Health Research Institute, Hamilton, Canada; McMaster University, Hamilton, Canada; Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Canada.
| | - Shun Fu Lee
- Population Health Research Institute, Hamilton, Canada; McMaster University, Hamilton, Canada
| | - Rajibul Mian
- Population Health Research Institute, Hamilton, Canada; McMaster University, Hamilton, Canada
| | - Sasko Kedev
- University Ss. Cyril and Methodius, Skopje, North Macedonia
| | | | - Jan Hein Cornel
- Dutch Network for Cardiovascular Research, Utrecht, The Netherlands; Radboud University Medical Center, Nijmegen, The Netherlands; Northwest Clinics, Alkmaar, The Netherlands
| | - Goran Stankovic
- University Clinical Center of Serbia, University of Belgrade, Belgrade, Serbia
| | | | - Robert F Storey
- NIHR Sheffield Biomedical Research Centre, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom; Division of Clinical Medicine, University of Sheffield, Sheffield, United Kingdom
| | - Timothy D Henry
- The Caril and Edyth Lindner Center for Research and Education, The Christ Hospital Health Network, Cincinnati, Ohio, United States of America
| | | | | | - Shamir R Mehta
- Population Health Research Institute, Hamilton, Canada; McMaster University, Hamilton, Canada
| | - P J Devereaux
- Population Health Research Institute, Hamilton, Canada; McMaster University, Hamilton, Canada
| | - John Eikelboom
- Population Health Research Institute, Hamilton, Canada; McMaster University, Hamilton, Canada
| | - John A Cairns
- Vancouver Coastal Health Research Institute, Vancouver, Canada
| | - Bertram Pitt
- University of Michigan, Ann Arbor, Michigan, United States of America
| | - Sanjit S Jolly
- Population Health Research Institute, Hamilton, Canada; McMaster University, Hamilton, Canada
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Gaalema DE, Khadanga S, Savage PD, Yant B, Katz BR, DeSarno M, Ades PA. Improving Cardiac Rehabilitation Adherence in Patients With Lower Socioeconomic Status: A Randomized Clinical Trial. JAMA Intern Med 2024; 184:1095-1104. [PMID: 39037811 PMCID: PMC11264079 DOI: 10.1001/jamainternmed.2024.3338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Accepted: 05/27/2024] [Indexed: 07/24/2024]
Abstract
Importance Participation in cardiac rehabilitation is associated with significant decreases in morbidity and mortality. Despite the proven benefits, cardiac rehabilitation is severely underutilized in certain populations, specifically those with lower socioeconomic status (SES). Objective To assess the efficacy of early case management and/or financial incentives for increasing cardiac rehabilitation adherence among patients with lower SES. Design, Setting, and Participants This randomized clinical trial enrolled patients from December 2018 to December 2022. Participants were followed up for 1 year with assessors and cardiac rehabilitation staff blinded to study condition. Patients with lower SES with a cardiac rehabilitation-qualifying diagnosis (myocardial infarction, coronary artery bypass graft, percutaneous coronary intervention, heart valve replacement/repair, or stable systolic heart failure) were recruited. Then patients attended one of 3 cardiac rehabilitation programs at 1 university or 2 community-based hospitals. A consecutively recruited sample was randomized and stratified by age (<57 vs ≥57 years) and smoking status (current smoker vs nonsmoker or former smoker). Intervention Participants were randomized 2:3:3:3 to either a usual care control, case management starting in-hospital, financial incentives for completing cardiac rehabilitation sessions, or both interventions (case management plus financial incentives). Interventions were in place for 4 months following informed consent. Main Outcomes and Measures The main outcome was cardiac rehabilitation adherence (proportion of patients completing ≥30 sessions). The a priori hypothesis was that interventions would improve adherence, with the combined intervention performing best. Results Of 314 individuals approached, 11 were ineligible, and 94 declined participation. Of the 209 individuals who were randomized, 17 were withdrawn. A total of 192 individuals (67 [35%] female; mean [SD] age, 58 [11] years) were included in the analysis. Interventions significantly improved cardiac rehabilitation adherence with 4 of 36 (11%), 13 of 51 (25%), 22 of 53 (42%), and 32 of 52 (62%) participants completing at least 30 sessions in the usual care, case management, financial incentives, and case management plus financial incentives conditions, respectively. The financial incentives and case management plus financial incentives conditions significantly improved cardiac rehabilitation adherence vs usual care (adjusted odds ratio [AOR], 5.1 [95% CI, 1.5-16.7]; P = .01; AOR, 13.2 [95% CI, 4.0-43.5]; P < .001, respectively), and the case management plus financial incentives condition was superior to both case management or financial incentives alone (AOR, 5.0 [95% CI, 2.1-11.9]; P < .001; AOR, 2.6 [95% CI, 1.2-5.9]; P = .02, respectively). Interventions were received well by participants: 86 of 105 (82%) in the financial incentives conditions earned at least some incentives, and 96 of 103 participants (93%) assigned to a case manager completed the initial needs assessment. Conclusion and Relevance In this randomized clinical trial, financial incentives improved cardiac rehabilitation adherence in a population with higher risk and lower SES with additional benefit from adding case management. Trial Registration ClinicalTrials.gov Identifier: NCT03759873.
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Affiliation(s)
- Diann E. Gaalema
- Department of Psychiatry, University of Vermont Larner College of Medicine, Burlington
- Department of Medicine, Division of Cardiology, University of Texas Medical Branch, Galveston
| | - Sherrie Khadanga
- Department of Medicine, Division of Cardiology, University of Vermont, Burlington
| | - Patrick D. Savage
- Department of Medicine, Division of Cardiology, University of Vermont, Burlington
| | - Blair Yant
- Department of Psychiatry, University of Vermont Larner College of Medicine, Burlington
| | - Brian R. Katz
- Department of Psychiatry, University of Vermont Larner College of Medicine, Burlington
| | - Michael DeSarno
- Biomedical Statistics Research Core, University of Vermont, Burlington
| | - Philip A. Ades
- Department of Medicine, Division of Cardiology, University of Vermont, Burlington
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Boden WE, De Caterina R. ORBITA Trials Are Not Justification to Promote a PCI-First Strategy in Nonacute Myocardial Ischemic Syndromes. Circ Cardiovasc Qual Outcomes 2024; 17:e011268. [PMID: 39288214 DOI: 10.1161/circoutcomes.124.011268] [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: 09/19/2024]
Affiliation(s)
- William E Boden
- Cardiology Section, Department of Medicine, VA Boston Healthcare System (W.E.B.)
| | - Raffaele De Caterina
- University of Pisa and Division of Cardiology, Pisa University Hospital, Italy (R.D.C.)
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Sibbing D, Nicolas J, Spirito A, Vogel B, Cao D, Stipek W, Kasireddy E, Qian A, Khan I, Mehran R. Clopidogrel Versus Aspirin as Monotherapy Following Dual Antiplatelet Therapy in Patients With Acute Coronary Syndrome Receiving a Drug-Eluting Stent: A Systematic Literature Review and Meta-Analysis. Clin Cardiol 2024; 47:e24326. [PMID: 39206792 PMCID: PMC11358762 DOI: 10.1002/clc.24326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2024] [Revised: 07/04/2024] [Accepted: 07/05/2024] [Indexed: 09/04/2024] Open
Abstract
OBJECTIVE This study aimed to evaluate the comparative effectiveness and safety of clopidogrel versus aspirin as monotherapy following adequate dual antiplatelet therapy (DAPT) in patients with acute coronary syndrome (ACS). METHODS MEDLINE, Embase, and CENTRAL were searched from database inception to September 1, 2023. Randomized controlled trials (RCTs) and observational studies evaluating the effectiveness or safety of clopidogrel versus aspirin as monotherapy following DAPT in patients with ACS who received a drug-eluting stent were included. Random-effects meta-analyses were conducted to compare risks of major adverse cardiovascular events (MACE) and clinically relevant bleeding. RESULTS Of 6242 abstracts identified, three unique studies were included: one RCT and two retrospective cohort studies. Studies included a total of 7081 post-percutaneous coronary intervention ACS patients, 4260 of whom received aspirin monotherapy and 2821 received clopidogrel monotherapy. Studies included variable proportions of patients with ST-elevation myocardial infarction (STEMI), non-STEMI, and unstable angina. From the meta-analysis, clopidogrel was associated with a 28% reduction in the risk of MACE compared with aspirin (hazard ratio [HR]: 0.72; 95% confidence interval [CI]: 0.54, 0.98), with no significant difference in clinically relevant bleeding (HR: 0.92; 95% CI: 0.68, 1.24). CONCLUSION Despite the paucity of published evidence on the effectiveness and safety of clopidogrel versus aspirin in patients with ACS post-drug-eluting stent implantation, this meta-analysis suggests that clopidogrel versus aspirin may result in a lower risk of MACE, with a similar risk of major bleeding. The present results are hypothesis-generating and further large RCTs comparing antiplatelet monotherapy options in ACS patients are warranted.
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Affiliation(s)
- Dirk Sibbing
- Department of Internal MedicineLudwig‐Maximilians‐Universität MünchenMunichGermany
| | - Johny Nicolas
- Division of CardiologyIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - Alessandro Spirito
- Division of CardiologyIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - Birgit Vogel
- Division of CardiologyIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - Davide Cao
- Division of CardiologyIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | | | - Ellen Kasireddy
- Evidinno Research Outcomes Inc.VancouverBritish ColumbiaCanada
| | - Andi Qian
- Evidinno Research Outcomes Inc.VancouverBritish ColumbiaCanada
| | | | - Roxana Mehran
- Division of CardiologyIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
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Oliveira KKDS, Torres DJL, Barros MDS, Rafael Moreira L, Junior CDDS, Soares AKDA, de Albuquerque MDPCR, Cavalcante MDGAM, Junior WADO, Rabello MCDS, de Lorena VMB. Vitamin D treatment distinctly modulates cytokine production by peripheral blood mononuclear cells among patients with chronic cardiac and indeterminate clinical forms of Chagas disease. Immun Inflamm Dis 2024; 12:e1330. [PMID: 39267468 PMCID: PMC11393450 DOI: 10.1002/iid3.1330] [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: 03/23/2023] [Revised: 06/17/2024] [Accepted: 06/18/2024] [Indexed: 09/17/2024] Open
Abstract
INTRODUCTION Chagas disease is caused by the protozoan Trypanosoma cruzi and is clinically divided into acute and chronic phases. Chronic Chagas cardiomyopathy is the most studied manifestation of the disease. Vitamin D deficiency has been suggested as a risk factor for cardiovascular disease. No studies demonstrate the action of this hormone in the cells of patients with chronic Chagas heart disease. OBJECTIVE To evaluate the in vitro immunomodulatory effect of vitamin D on peripheral blood mononuclear cells of patients with the different chronic clinical forms of Chagas disease. Evaluating vitamin D's in vitro effect on blood cells by producing cytokines. METHODS Thirteen patients of the undetermined form (IND), 13 of the mild cardiac form (CARD1) and 14 of the severe cardiac form (CARD2) of Chagas disease, and 12 with idiopathic heart disease (CARDid) were included. The cells obtained from peripheral blood were treated in vitro with vitamin D (1 × 10-7 M) for 24 h and cytokines were dosed in the culture supernatant. RESULTS Although it was not possible to demonstrate statistically significant differences between the groups studied, our data showed that the cells treated with vitamin D modify (p < .05) the production of interferon-γ (IFN-γ) (decrease in IND), tumor necrosis factor-α (TNF-α) (decreased in CARD1 and CARDid), interleukin (IL)-6 (increased in all groups), and IL-10 (decreased in CARD1, CARD2, and CARDid) when compared to untreated cells. CONCLUSION In vitro treatment with vitamin D distinctly modulated the production of cytokines by mononuclear cells of peripheral blood among patients with chronic and indeterminate cardiac clinical forms of Chagas disease.
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Affiliation(s)
| | - Diego José Lira Torres
- Institute Aggeu Magalhães, Laboratory of Immunoparasitology, Oswaldo Cruz Foundation-FIOCRUZ, Recife, Pernambuco, Brazil
- Tropical Medicine Department, Federal University of Pernambuco (UFPE), Recife, Pernambuco, Brazil
| | - Michelle da Silva Barros
- Institute Aggeu Magalhães, Laboratory of Immunoparasitology, Oswaldo Cruz Foundation-FIOCRUZ, Recife, Pernambuco, Brazil
| | - Leyllane Rafael Moreira
- Institute Aggeu Magalhães, Laboratory of Immunoparasitology, Oswaldo Cruz Foundation-FIOCRUZ, Recife, Pernambuco, Brazil
- Tropical Medicine Department, Federal University of Pernambuco (UFPE), Recife, Pernambuco, Brazil
| | - Claudeir Dias da Silva Junior
- Institute Aggeu Magalhães, Laboratory of Immunoparasitology, Oswaldo Cruz Foundation-FIOCRUZ, Recife, Pernambuco, Brazil
- Tropical Medicine Department, Federal University of Pernambuco (UFPE), Recife, Pernambuco, Brazil
| | | | | | | | - Wilson Alves de Oliveira Junior
- Chagas disease and Heart Failure Outpatient Clinic of the Pronto Socorro Cardiológico de Pernambuco, University of Pernambuco (UPE), Recife, Pernambuco, Brazil
| | | | - Virginia Maria Barros de Lorena
- Institute Aggeu Magalhães, Laboratory of Immunoparasitology, Oswaldo Cruz Foundation-FIOCRUZ, Recife, Pernambuco, Brazil
- Tropical Medicine Department, Federal University of Pernambuco (UFPE), Recife, Pernambuco, Brazil
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Cho MS, Kang DY, Ahn JM, Yun SC, Oh YS, Lee CH, Choi EK, Lee JH, Kwon CH, Park GM, Choi HO, Park KH, Park KM, Hwang J, Yoo KD, Cho YR, Kim JH, Hwang KW, Jin ES, Kwon O, Kim KH, Park SJ, Park DW, Nam GB. Edoxaban Antithrombotic Therapy for Atrial Fibrillation and Stable Coronary Artery Disease. N Engl J Med 2024. [PMID: 39225258 DOI: 10.1056/nejmoa2407362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/04/2024]
Abstract
BACKGROUND Despite consistent recommendations from clinical guidelines, data from randomized trials on a long-term antithrombotic treatment strategy for patients with atrial fibrillation and stable coronary artery disease are still lacking. METHODS We conducted a multicenter, open-label, adjudicator-masked, randomized trial comparing edoxaban monotherapy with dual antithrombotic therapy (edoxaban plus a single antiplatelet agent) in patients with atrial fibrillation and stable coronary artery disease (defined as coronary artery disease previously treated with revascularization or managed medically). The risk of stroke was assessed on the basis of the CHA2DS2-VASc score (scores range from 0 to 9, with higher scores indicating a greater risk of stroke). The primary outcome was a composite of death from any cause, myocardial infarction, stroke, systemic embolism, unplanned urgent revascularization, and major bleeding or clinically relevant nonmajor bleeding at 12 months. Secondary outcomes included a composite of major ischemic events and the safety outcome of major bleeding or clinically relevant nonmajor bleeding. RESULTS We assigned 524 patients to the edoxaban monotherapy group and 516 patients to the dual antithrombotic therapy group at 18 sites in South Korea. The mean age of the patients was 72.1 years, 22.9% were women, and the mean CHA2DS2-VASc score was 4.3. At 12 months, a primary-outcome event had occurred in 34 patients (Kaplan-Meier estimate, 6.8%) assigned to edoxaban monotherapy and in 79 patients (16.2%) assigned to dual antithrombotic therapy (hazard ratio, 0.44; 95% confidence interval [CI], 0.30 to 0.65; P<0.001). The cumulative incidence of major ischemic events at 12 months appeared to be similar in the trial groups. Major bleeding or clinically relevant nonmajor bleeding occurred in 23 patients (Kaplan-Meier estimate, 4.7%) in the edoxaban monotherapy group and in 70 patients (14.2%) in the dual antithrombotic therapy group (hazard ratio, 0.34; 95% CI, 0.22 to 0.53). CONCLUSIONS In patients with atrial fibrillation and stable coronary artery disease, edoxaban monotherapy led to a lower risk of a composite of death from any cause, myocardial infarction, stroke, systemic embolism, unplanned urgent revascularization, or major bleeding or clinically relevant nonmajor bleeding at 12 months than dual antithrombotic therapy. (Funded by the CardioVascular Research Foundation and others; EPIC-CAD ClinicalTrials.gov number, NCT03718559.).
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Affiliation(s)
- Min Soo Cho
- From the Department of Cardiology (M.S.C., D.-Y.K., J.-M.A., S.-J.P., D.-W.P., G.-B.N.) and the Division of Biostatics (S.-C.Y.), Asan Medical Center, University of Ulsan College of Medicine, the Department of Cardiology, Seoul St. Mary's Hospital, College of Medicine, Catholic University of Korea (Y.-S.O.), the Department of Cardiology, Veterans Health Service Medical Center (C.H.L.), the Department of Internal Medicine, Seoul National University College of Medicine and Seoul National University Hospital (E.-K.C.), the Division of Cardiology, Department of Internal Medicine, Konkuk University Medical Center, Konkuk University School of Medicine (C.H.K.), the Division of Cardiology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine (K.-M.P.), the Department of Cardiology, Kyung Hee University Hospital at Gangdong, Kyung Hee University Medical College (E.-S.J.), and the Division of Cardiology, Department of Internal Medicine, Eunpyeong St. Mary's Hospital, College of Medicine, Catholic University of Korea (O.K.), Seoul, the Cardiovascular Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam (J.H.L.), the Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan (G.-M.P.), the Department of Cardiology, Soon Chun Hyang University Hospital Bucheon, Bucheon (H.O.C.), the Department of Cardiology, Hallym University Medical Center, Anyang (K.-H.P.), the Department of Cardiology, Keimyung University Dongsan Hospital, Daegu (J.H.), the Department of Cardiology, St. Vincent's Hospital, College of Medicine, Catholic University of Korea, Suwon (K.-D.Y.), the Department of Cardiology, Dong-A University Hospital, Dong-A University College of Medicine (Y.-R.C.), and the Department of Cardiology, Haeundae Paik Hospital, Inje University College of Medicine (K.-H.K.), Busan, the Department of Cardiology, Dongguk University Ilsan Hospital, Goyang (J.H.K.), and the Department of Cardiology, Pusan National University Yangsan Hospital, Pusan National University of Medicine, Yangsan (K.W.H.) - all in South Korea
| | - Do-Yoon Kang
- From the Department of Cardiology (M.S.C., D.-Y.K., J.-M.A., S.-J.P., D.-W.P., G.-B.N.) and the Division of Biostatics (S.-C.Y.), Asan Medical Center, University of Ulsan College of Medicine, the Department of Cardiology, Seoul St. Mary's Hospital, College of Medicine, Catholic University of Korea (Y.-S.O.), the Department of Cardiology, Veterans Health Service Medical Center (C.H.L.), the Department of Internal Medicine, Seoul National University College of Medicine and Seoul National University Hospital (E.-K.C.), the Division of Cardiology, Department of Internal Medicine, Konkuk University Medical Center, Konkuk University School of Medicine (C.H.K.), the Division of Cardiology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine (K.-M.P.), the Department of Cardiology, Kyung Hee University Hospital at Gangdong, Kyung Hee University Medical College (E.-S.J.), and the Division of Cardiology, Department of Internal Medicine, Eunpyeong St. Mary's Hospital, College of Medicine, Catholic University of Korea (O.K.), Seoul, the Cardiovascular Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam (J.H.L.), the Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan (G.-M.P.), the Department of Cardiology, Soon Chun Hyang University Hospital Bucheon, Bucheon (H.O.C.), the Department of Cardiology, Hallym University Medical Center, Anyang (K.-H.P.), the Department of Cardiology, Keimyung University Dongsan Hospital, Daegu (J.H.), the Department of Cardiology, St. Vincent's Hospital, College of Medicine, Catholic University of Korea, Suwon (K.-D.Y.), the Department of Cardiology, Dong-A University Hospital, Dong-A University College of Medicine (Y.-R.C.), and the Department of Cardiology, Haeundae Paik Hospital, Inje University College of Medicine (K.-H.K.), Busan, the Department of Cardiology, Dongguk University Ilsan Hospital, Goyang (J.H.K.), and the Department of Cardiology, Pusan National University Yangsan Hospital, Pusan National University of Medicine, Yangsan (K.W.H.) - all in South Korea
| | - Jung-Min Ahn
- From the Department of Cardiology (M.S.C., D.-Y.K., J.-M.A., S.-J.P., D.-W.P., G.-B.N.) and the Division of Biostatics (S.-C.Y.), Asan Medical Center, University of Ulsan College of Medicine, the Department of Cardiology, Seoul St. Mary's Hospital, College of Medicine, Catholic University of Korea (Y.-S.O.), the Department of Cardiology, Veterans Health Service Medical Center (C.H.L.), the Department of Internal Medicine, Seoul National University College of Medicine and Seoul National University Hospital (E.-K.C.), the Division of Cardiology, Department of Internal Medicine, Konkuk University Medical Center, Konkuk University School of Medicine (C.H.K.), the Division of Cardiology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine (K.-M.P.), the Department of Cardiology, Kyung Hee University Hospital at Gangdong, Kyung Hee University Medical College (E.-S.J.), and the Division of Cardiology, Department of Internal Medicine, Eunpyeong St. Mary's Hospital, College of Medicine, Catholic University of Korea (O.K.), Seoul, the Cardiovascular Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam (J.H.L.), the Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan (G.-M.P.), the Department of Cardiology, Soon Chun Hyang University Hospital Bucheon, Bucheon (H.O.C.), the Department of Cardiology, Hallym University Medical Center, Anyang (K.-H.P.), the Department of Cardiology, Keimyung University Dongsan Hospital, Daegu (J.H.), the Department of Cardiology, St. Vincent's Hospital, College of Medicine, Catholic University of Korea, Suwon (K.-D.Y.), the Department of Cardiology, Dong-A University Hospital, Dong-A University College of Medicine (Y.-R.C.), and the Department of Cardiology, Haeundae Paik Hospital, Inje University College of Medicine (K.-H.K.), Busan, the Department of Cardiology, Dongguk University Ilsan Hospital, Goyang (J.H.K.), and the Department of Cardiology, Pusan National University Yangsan Hospital, Pusan National University of Medicine, Yangsan (K.W.H.) - all in South Korea
| | - Sung-Cheol Yun
- From the Department of Cardiology (M.S.C., D.-Y.K., J.-M.A., S.-J.P., D.-W.P., G.-B.N.) and the Division of Biostatics (S.-C.Y.), Asan Medical Center, University of Ulsan College of Medicine, the Department of Cardiology, Seoul St. Mary's Hospital, College of Medicine, Catholic University of Korea (Y.-S.O.), the Department of Cardiology, Veterans Health Service Medical Center (C.H.L.), the Department of Internal Medicine, Seoul National University College of Medicine and Seoul National University Hospital (E.-K.C.), the Division of Cardiology, Department of Internal Medicine, Konkuk University Medical Center, Konkuk University School of Medicine (C.H.K.), the Division of Cardiology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine (K.-M.P.), the Department of Cardiology, Kyung Hee University Hospital at Gangdong, Kyung Hee University Medical College (E.-S.J.), and the Division of Cardiology, Department of Internal Medicine, Eunpyeong St. Mary's Hospital, College of Medicine, Catholic University of Korea (O.K.), Seoul, the Cardiovascular Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam (J.H.L.), the Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan (G.-M.P.), the Department of Cardiology, Soon Chun Hyang University Hospital Bucheon, Bucheon (H.O.C.), the Department of Cardiology, Hallym University Medical Center, Anyang (K.-H.P.), the Department of Cardiology, Keimyung University Dongsan Hospital, Daegu (J.H.), the Department of Cardiology, St. Vincent's Hospital, College of Medicine, Catholic University of Korea, Suwon (K.-D.Y.), the Department of Cardiology, Dong-A University Hospital, Dong-A University College of Medicine (Y.-R.C.), and the Department of Cardiology, Haeundae Paik Hospital, Inje University College of Medicine (K.-H.K.), Busan, the Department of Cardiology, Dongguk University Ilsan Hospital, Goyang (J.H.K.), and the Department of Cardiology, Pusan National University Yangsan Hospital, Pusan National University of Medicine, Yangsan (K.W.H.) - all in South Korea
| | - Yong-Seog Oh
- From the Department of Cardiology (M.S.C., D.-Y.K., J.-M.A., S.-J.P., D.-W.P., G.-B.N.) and the Division of Biostatics (S.-C.Y.), Asan Medical Center, University of Ulsan College of Medicine, the Department of Cardiology, Seoul St. Mary's Hospital, College of Medicine, Catholic University of Korea (Y.-S.O.), the Department of Cardiology, Veterans Health Service Medical Center (C.H.L.), the Department of Internal Medicine, Seoul National University College of Medicine and Seoul National University Hospital (E.-K.C.), the Division of Cardiology, Department of Internal Medicine, Konkuk University Medical Center, Konkuk University School of Medicine (C.H.K.), the Division of Cardiology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine (K.-M.P.), the Department of Cardiology, Kyung Hee University Hospital at Gangdong, Kyung Hee University Medical College (E.-S.J.), and the Division of Cardiology, Department of Internal Medicine, Eunpyeong St. Mary's Hospital, College of Medicine, Catholic University of Korea (O.K.), Seoul, the Cardiovascular Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam (J.H.L.), the Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan (G.-M.P.), the Department of Cardiology, Soon Chun Hyang University Hospital Bucheon, Bucheon (H.O.C.), the Department of Cardiology, Hallym University Medical Center, Anyang (K.-H.P.), the Department of Cardiology, Keimyung University Dongsan Hospital, Daegu (J.H.), the Department of Cardiology, St. Vincent's Hospital, College of Medicine, Catholic University of Korea, Suwon (K.-D.Y.), the Department of Cardiology, Dong-A University Hospital, Dong-A University College of Medicine (Y.-R.C.), and the Department of Cardiology, Haeundae Paik Hospital, Inje University College of Medicine (K.-H.K.), Busan, the Department of Cardiology, Dongguk University Ilsan Hospital, Goyang (J.H.K.), and the Department of Cardiology, Pusan National University Yangsan Hospital, Pusan National University of Medicine, Yangsan (K.W.H.) - all in South Korea
| | - Chang Hoon Lee
- From the Department of Cardiology (M.S.C., D.-Y.K., J.-M.A., S.-J.P., D.-W.P., G.-B.N.) and the Division of Biostatics (S.-C.Y.), Asan Medical Center, University of Ulsan College of Medicine, the Department of Cardiology, Seoul St. Mary's Hospital, College of Medicine, Catholic University of Korea (Y.-S.O.), the Department of Cardiology, Veterans Health Service Medical Center (C.H.L.), the Department of Internal Medicine, Seoul National University College of Medicine and Seoul National University Hospital (E.-K.C.), the Division of Cardiology, Department of Internal Medicine, Konkuk University Medical Center, Konkuk University School of Medicine (C.H.K.), the Division of Cardiology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine (K.-M.P.), the Department of Cardiology, Kyung Hee University Hospital at Gangdong, Kyung Hee University Medical College (E.-S.J.), and the Division of Cardiology, Department of Internal Medicine, Eunpyeong St. Mary's Hospital, College of Medicine, Catholic University of Korea (O.K.), Seoul, the Cardiovascular Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam (J.H.L.), the Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan (G.-M.P.), the Department of Cardiology, Soon Chun Hyang University Hospital Bucheon, Bucheon (H.O.C.), the Department of Cardiology, Hallym University Medical Center, Anyang (K.-H.P.), the Department of Cardiology, Keimyung University Dongsan Hospital, Daegu (J.H.), the Department of Cardiology, St. Vincent's Hospital, College of Medicine, Catholic University of Korea, Suwon (K.-D.Y.), the Department of Cardiology, Dong-A University Hospital, Dong-A University College of Medicine (Y.-R.C.), and the Department of Cardiology, Haeundae Paik Hospital, Inje University College of Medicine (K.-H.K.), Busan, the Department of Cardiology, Dongguk University Ilsan Hospital, Goyang (J.H.K.), and the Department of Cardiology, Pusan National University Yangsan Hospital, Pusan National University of Medicine, Yangsan (K.W.H.) - all in South Korea
| | - Eue-Keun Choi
- From the Department of Cardiology (M.S.C., D.-Y.K., J.-M.A., S.-J.P., D.-W.P., G.-B.N.) and the Division of Biostatics (S.-C.Y.), Asan Medical Center, University of Ulsan College of Medicine, the Department of Cardiology, Seoul St. Mary's Hospital, College of Medicine, Catholic University of Korea (Y.-S.O.), the Department of Cardiology, Veterans Health Service Medical Center (C.H.L.), the Department of Internal Medicine, Seoul National University College of Medicine and Seoul National University Hospital (E.-K.C.), the Division of Cardiology, Department of Internal Medicine, Konkuk University Medical Center, Konkuk University School of Medicine (C.H.K.), the Division of Cardiology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine (K.-M.P.), the Department of Cardiology, Kyung Hee University Hospital at Gangdong, Kyung Hee University Medical College (E.-S.J.), and the Division of Cardiology, Department of Internal Medicine, Eunpyeong St. Mary's Hospital, College of Medicine, Catholic University of Korea (O.K.), Seoul, the Cardiovascular Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam (J.H.L.), the Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan (G.-M.P.), the Department of Cardiology, Soon Chun Hyang University Hospital Bucheon, Bucheon (H.O.C.), the Department of Cardiology, Hallym University Medical Center, Anyang (K.-H.P.), the Department of Cardiology, Keimyung University Dongsan Hospital, Daegu (J.H.), the Department of Cardiology, St. Vincent's Hospital, College of Medicine, Catholic University of Korea, Suwon (K.-D.Y.), the Department of Cardiology, Dong-A University Hospital, Dong-A University College of Medicine (Y.-R.C.), and the Department of Cardiology, Haeundae Paik Hospital, Inje University College of Medicine (K.-H.K.), Busan, the Department of Cardiology, Dongguk University Ilsan Hospital, Goyang (J.H.K.), and the Department of Cardiology, Pusan National University Yangsan Hospital, Pusan National University of Medicine, Yangsan (K.W.H.) - all in South Korea
| | - Ji Hyun Lee
- From the Department of Cardiology (M.S.C., D.-Y.K., J.-M.A., S.-J.P., D.-W.P., G.-B.N.) and the Division of Biostatics (S.-C.Y.), Asan Medical Center, University of Ulsan College of Medicine, the Department of Cardiology, Seoul St. Mary's Hospital, College of Medicine, Catholic University of Korea (Y.-S.O.), the Department of Cardiology, Veterans Health Service Medical Center (C.H.L.), the Department of Internal Medicine, Seoul National University College of Medicine and Seoul National University Hospital (E.-K.C.), the Division of Cardiology, Department of Internal Medicine, Konkuk University Medical Center, Konkuk University School of Medicine (C.H.K.), the Division of Cardiology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine (K.-M.P.), the Department of Cardiology, Kyung Hee University Hospital at Gangdong, Kyung Hee University Medical College (E.-S.J.), and the Division of Cardiology, Department of Internal Medicine, Eunpyeong St. Mary's Hospital, College of Medicine, Catholic University of Korea (O.K.), Seoul, the Cardiovascular Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam (J.H.L.), the Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan (G.-M.P.), the Department of Cardiology, Soon Chun Hyang University Hospital Bucheon, Bucheon (H.O.C.), the Department of Cardiology, Hallym University Medical Center, Anyang (K.-H.P.), the Department of Cardiology, Keimyung University Dongsan Hospital, Daegu (J.H.), the Department of Cardiology, St. Vincent's Hospital, College of Medicine, Catholic University of Korea, Suwon (K.-D.Y.), the Department of Cardiology, Dong-A University Hospital, Dong-A University College of Medicine (Y.-R.C.), and the Department of Cardiology, Haeundae Paik Hospital, Inje University College of Medicine (K.-H.K.), Busan, the Department of Cardiology, Dongguk University Ilsan Hospital, Goyang (J.H.K.), and the Department of Cardiology, Pusan National University Yangsan Hospital, Pusan National University of Medicine, Yangsan (K.W.H.) - all in South Korea
| | - Chang Hee Kwon
- From the Department of Cardiology (M.S.C., D.-Y.K., J.-M.A., S.-J.P., D.-W.P., G.-B.N.) and the Division of Biostatics (S.-C.Y.), Asan Medical Center, University of Ulsan College of Medicine, the Department of Cardiology, Seoul St. Mary's Hospital, College of Medicine, Catholic University of Korea (Y.-S.O.), the Department of Cardiology, Veterans Health Service Medical Center (C.H.L.), the Department of Internal Medicine, Seoul National University College of Medicine and Seoul National University Hospital (E.-K.C.), the Division of Cardiology, Department of Internal Medicine, Konkuk University Medical Center, Konkuk University School of Medicine (C.H.K.), the Division of Cardiology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine (K.-M.P.), the Department of Cardiology, Kyung Hee University Hospital at Gangdong, Kyung Hee University Medical College (E.-S.J.), and the Division of Cardiology, Department of Internal Medicine, Eunpyeong St. Mary's Hospital, College of Medicine, Catholic University of Korea (O.K.), Seoul, the Cardiovascular Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam (J.H.L.), the Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan (G.-M.P.), the Department of Cardiology, Soon Chun Hyang University Hospital Bucheon, Bucheon (H.O.C.), the Department of Cardiology, Hallym University Medical Center, Anyang (K.-H.P.), the Department of Cardiology, Keimyung University Dongsan Hospital, Daegu (J.H.), the Department of Cardiology, St. Vincent's Hospital, College of Medicine, Catholic University of Korea, Suwon (K.-D.Y.), the Department of Cardiology, Dong-A University Hospital, Dong-A University College of Medicine (Y.-R.C.), and the Department of Cardiology, Haeundae Paik Hospital, Inje University College of Medicine (K.-H.K.), Busan, the Department of Cardiology, Dongguk University Ilsan Hospital, Goyang (J.H.K.), and the Department of Cardiology, Pusan National University Yangsan Hospital, Pusan National University of Medicine, Yangsan (K.W.H.) - all in South Korea
| | - Gyung-Min Park
- From the Department of Cardiology (M.S.C., D.-Y.K., J.-M.A., S.-J.P., D.-W.P., G.-B.N.) and the Division of Biostatics (S.-C.Y.), Asan Medical Center, University of Ulsan College of Medicine, the Department of Cardiology, Seoul St. Mary's Hospital, College of Medicine, Catholic University of Korea (Y.-S.O.), the Department of Cardiology, Veterans Health Service Medical Center (C.H.L.), the Department of Internal Medicine, Seoul National University College of Medicine and Seoul National University Hospital (E.-K.C.), the Division of Cardiology, Department of Internal Medicine, Konkuk University Medical Center, Konkuk University School of Medicine (C.H.K.), the Division of Cardiology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine (K.-M.P.), the Department of Cardiology, Kyung Hee University Hospital at Gangdong, Kyung Hee University Medical College (E.-S.J.), and the Division of Cardiology, Department of Internal Medicine, Eunpyeong St. Mary's Hospital, College of Medicine, Catholic University of Korea (O.K.), Seoul, the Cardiovascular Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam (J.H.L.), the Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan (G.-M.P.), the Department of Cardiology, Soon Chun Hyang University Hospital Bucheon, Bucheon (H.O.C.), the Department of Cardiology, Hallym University Medical Center, Anyang (K.-H.P.), the Department of Cardiology, Keimyung University Dongsan Hospital, Daegu (J.H.), the Department of Cardiology, St. Vincent's Hospital, College of Medicine, Catholic University of Korea, Suwon (K.-D.Y.), the Department of Cardiology, Dong-A University Hospital, Dong-A University College of Medicine (Y.-R.C.), and the Department of Cardiology, Haeundae Paik Hospital, Inje University College of Medicine (K.-H.K.), Busan, the Department of Cardiology, Dongguk University Ilsan Hospital, Goyang (J.H.K.), and the Department of Cardiology, Pusan National University Yangsan Hospital, Pusan National University of Medicine, Yangsan (K.W.H.) - all in South Korea
| | - Hyung Oh Choi
- From the Department of Cardiology (M.S.C., D.-Y.K., J.-M.A., S.-J.P., D.-W.P., G.-B.N.) and the Division of Biostatics (S.-C.Y.), Asan Medical Center, University of Ulsan College of Medicine, the Department of Cardiology, Seoul St. Mary's Hospital, College of Medicine, Catholic University of Korea (Y.-S.O.), the Department of Cardiology, Veterans Health Service Medical Center (C.H.L.), the Department of Internal Medicine, Seoul National University College of Medicine and Seoul National University Hospital (E.-K.C.), the Division of Cardiology, Department of Internal Medicine, Konkuk University Medical Center, Konkuk University School of Medicine (C.H.K.), the Division of Cardiology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine (K.-M.P.), the Department of Cardiology, Kyung Hee University Hospital at Gangdong, Kyung Hee University Medical College (E.-S.J.), and the Division of Cardiology, Department of Internal Medicine, Eunpyeong St. Mary's Hospital, College of Medicine, Catholic University of Korea (O.K.), Seoul, the Cardiovascular Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam (J.H.L.), the Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan (G.-M.P.), the Department of Cardiology, Soon Chun Hyang University Hospital Bucheon, Bucheon (H.O.C.), the Department of Cardiology, Hallym University Medical Center, Anyang (K.-H.P.), the Department of Cardiology, Keimyung University Dongsan Hospital, Daegu (J.H.), the Department of Cardiology, St. Vincent's Hospital, College of Medicine, Catholic University of Korea, Suwon (K.-D.Y.), the Department of Cardiology, Dong-A University Hospital, Dong-A University College of Medicine (Y.-R.C.), and the Department of Cardiology, Haeundae Paik Hospital, Inje University College of Medicine (K.-H.K.), Busan, the Department of Cardiology, Dongguk University Ilsan Hospital, Goyang (J.H.K.), and the Department of Cardiology, Pusan National University Yangsan Hospital, Pusan National University of Medicine, Yangsan (K.W.H.) - all in South Korea
| | - Kyoung-Ha Park
- From the Department of Cardiology (M.S.C., D.-Y.K., J.-M.A., S.-J.P., D.-W.P., G.-B.N.) and the Division of Biostatics (S.-C.Y.), Asan Medical Center, University of Ulsan College of Medicine, the Department of Cardiology, Seoul St. Mary's Hospital, College of Medicine, Catholic University of Korea (Y.-S.O.), the Department of Cardiology, Veterans Health Service Medical Center (C.H.L.), the Department of Internal Medicine, Seoul National University College of Medicine and Seoul National University Hospital (E.-K.C.), the Division of Cardiology, Department of Internal Medicine, Konkuk University Medical Center, Konkuk University School of Medicine (C.H.K.), the Division of Cardiology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine (K.-M.P.), the Department of Cardiology, Kyung Hee University Hospital at Gangdong, Kyung Hee University Medical College (E.-S.J.), and the Division of Cardiology, Department of Internal Medicine, Eunpyeong St. Mary's Hospital, College of Medicine, Catholic University of Korea (O.K.), Seoul, the Cardiovascular Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam (J.H.L.), the Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan (G.-M.P.), the Department of Cardiology, Soon Chun Hyang University Hospital Bucheon, Bucheon (H.O.C.), the Department of Cardiology, Hallym University Medical Center, Anyang (K.-H.P.), the Department of Cardiology, Keimyung University Dongsan Hospital, Daegu (J.H.), the Department of Cardiology, St. Vincent's Hospital, College of Medicine, Catholic University of Korea, Suwon (K.-D.Y.), the Department of Cardiology, Dong-A University Hospital, Dong-A University College of Medicine (Y.-R.C.), and the Department of Cardiology, Haeundae Paik Hospital, Inje University College of Medicine (K.-H.K.), Busan, the Department of Cardiology, Dongguk University Ilsan Hospital, Goyang (J.H.K.), and the Department of Cardiology, Pusan National University Yangsan Hospital, Pusan National University of Medicine, Yangsan (K.W.H.) - all in South Korea
| | - Kyoung-Min Park
- From the Department of Cardiology (M.S.C., D.-Y.K., J.-M.A., S.-J.P., D.-W.P., G.-B.N.) and the Division of Biostatics (S.-C.Y.), Asan Medical Center, University of Ulsan College of Medicine, the Department of Cardiology, Seoul St. Mary's Hospital, College of Medicine, Catholic University of Korea (Y.-S.O.), the Department of Cardiology, Veterans Health Service Medical Center (C.H.L.), the Department of Internal Medicine, Seoul National University College of Medicine and Seoul National University Hospital (E.-K.C.), the Division of Cardiology, Department of Internal Medicine, Konkuk University Medical Center, Konkuk University School of Medicine (C.H.K.), the Division of Cardiology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine (K.-M.P.), the Department of Cardiology, Kyung Hee University Hospital at Gangdong, Kyung Hee University Medical College (E.-S.J.), and the Division of Cardiology, Department of Internal Medicine, Eunpyeong St. Mary's Hospital, College of Medicine, Catholic University of Korea (O.K.), Seoul, the Cardiovascular Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam (J.H.L.), the Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan (G.-M.P.), the Department of Cardiology, Soon Chun Hyang University Hospital Bucheon, Bucheon (H.O.C.), the Department of Cardiology, Hallym University Medical Center, Anyang (K.-H.P.), the Department of Cardiology, Keimyung University Dongsan Hospital, Daegu (J.H.), the Department of Cardiology, St. Vincent's Hospital, College of Medicine, Catholic University of Korea, Suwon (K.-D.Y.), the Department of Cardiology, Dong-A University Hospital, Dong-A University College of Medicine (Y.-R.C.), and the Department of Cardiology, Haeundae Paik Hospital, Inje University College of Medicine (K.-H.K.), Busan, the Department of Cardiology, Dongguk University Ilsan Hospital, Goyang (J.H.K.), and the Department of Cardiology, Pusan National University Yangsan Hospital, Pusan National University of Medicine, Yangsan (K.W.H.) - all in South Korea
| | - Jongmin Hwang
- From the Department of Cardiology (M.S.C., D.-Y.K., J.-M.A., S.-J.P., D.-W.P., G.-B.N.) and the Division of Biostatics (S.-C.Y.), Asan Medical Center, University of Ulsan College of Medicine, the Department of Cardiology, Seoul St. Mary's Hospital, College of Medicine, Catholic University of Korea (Y.-S.O.), the Department of Cardiology, Veterans Health Service Medical Center (C.H.L.), the Department of Internal Medicine, Seoul National University College of Medicine and Seoul National University Hospital (E.-K.C.), the Division of Cardiology, Department of Internal Medicine, Konkuk University Medical Center, Konkuk University School of Medicine (C.H.K.), the Division of Cardiology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine (K.-M.P.), the Department of Cardiology, Kyung Hee University Hospital at Gangdong, Kyung Hee University Medical College (E.-S.J.), and the Division of Cardiology, Department of Internal Medicine, Eunpyeong St. Mary's Hospital, College of Medicine, Catholic University of Korea (O.K.), Seoul, the Cardiovascular Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam (J.H.L.), the Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan (G.-M.P.), the Department of Cardiology, Soon Chun Hyang University Hospital Bucheon, Bucheon (H.O.C.), the Department of Cardiology, Hallym University Medical Center, Anyang (K.-H.P.), the Department of Cardiology, Keimyung University Dongsan Hospital, Daegu (J.H.), the Department of Cardiology, St. Vincent's Hospital, College of Medicine, Catholic University of Korea, Suwon (K.-D.Y.), the Department of Cardiology, Dong-A University Hospital, Dong-A University College of Medicine (Y.-R.C.), and the Department of Cardiology, Haeundae Paik Hospital, Inje University College of Medicine (K.-H.K.), Busan, the Department of Cardiology, Dongguk University Ilsan Hospital, Goyang (J.H.K.), and the Department of Cardiology, Pusan National University Yangsan Hospital, Pusan National University of Medicine, Yangsan (K.W.H.) - all in South Korea
| | - Ki-Dong Yoo
- From the Department of Cardiology (M.S.C., D.-Y.K., J.-M.A., S.-J.P., D.-W.P., G.-B.N.) and the Division of Biostatics (S.-C.Y.), Asan Medical Center, University of Ulsan College of Medicine, the Department of Cardiology, Seoul St. Mary's Hospital, College of Medicine, Catholic University of Korea (Y.-S.O.), the Department of Cardiology, Veterans Health Service Medical Center (C.H.L.), the Department of Internal Medicine, Seoul National University College of Medicine and Seoul National University Hospital (E.-K.C.), the Division of Cardiology, Department of Internal Medicine, Konkuk University Medical Center, Konkuk University School of Medicine (C.H.K.), the Division of Cardiology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine (K.-M.P.), the Department of Cardiology, Kyung Hee University Hospital at Gangdong, Kyung Hee University Medical College (E.-S.J.), and the Division of Cardiology, Department of Internal Medicine, Eunpyeong St. Mary's Hospital, College of Medicine, Catholic University of Korea (O.K.), Seoul, the Cardiovascular Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam (J.H.L.), the Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan (G.-M.P.), the Department of Cardiology, Soon Chun Hyang University Hospital Bucheon, Bucheon (H.O.C.), the Department of Cardiology, Hallym University Medical Center, Anyang (K.-H.P.), the Department of Cardiology, Keimyung University Dongsan Hospital, Daegu (J.H.), the Department of Cardiology, St. Vincent's Hospital, College of Medicine, Catholic University of Korea, Suwon (K.-D.Y.), the Department of Cardiology, Dong-A University Hospital, Dong-A University College of Medicine (Y.-R.C.), and the Department of Cardiology, Haeundae Paik Hospital, Inje University College of Medicine (K.-H.K.), Busan, the Department of Cardiology, Dongguk University Ilsan Hospital, Goyang (J.H.K.), and the Department of Cardiology, Pusan National University Yangsan Hospital, Pusan National University of Medicine, Yangsan (K.W.H.) - all in South Korea
| | - Young-Rak Cho
- From the Department of Cardiology (M.S.C., D.-Y.K., J.-M.A., S.-J.P., D.-W.P., G.-B.N.) and the Division of Biostatics (S.-C.Y.), Asan Medical Center, University of Ulsan College of Medicine, the Department of Cardiology, Seoul St. Mary's Hospital, College of Medicine, Catholic University of Korea (Y.-S.O.), the Department of Cardiology, Veterans Health Service Medical Center (C.H.L.), the Department of Internal Medicine, Seoul National University College of Medicine and Seoul National University Hospital (E.-K.C.), the Division of Cardiology, Department of Internal Medicine, Konkuk University Medical Center, Konkuk University School of Medicine (C.H.K.), the Division of Cardiology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine (K.-M.P.), the Department of Cardiology, Kyung Hee University Hospital at Gangdong, Kyung Hee University Medical College (E.-S.J.), and the Division of Cardiology, Department of Internal Medicine, Eunpyeong St. Mary's Hospital, College of Medicine, Catholic University of Korea (O.K.), Seoul, the Cardiovascular Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam (J.H.L.), the Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan (G.-M.P.), the Department of Cardiology, Soon Chun Hyang University Hospital Bucheon, Bucheon (H.O.C.), the Department of Cardiology, Hallym University Medical Center, Anyang (K.-H.P.), the Department of Cardiology, Keimyung University Dongsan Hospital, Daegu (J.H.), the Department of Cardiology, St. Vincent's Hospital, College of Medicine, Catholic University of Korea, Suwon (K.-D.Y.), the Department of Cardiology, Dong-A University Hospital, Dong-A University College of Medicine (Y.-R.C.), and the Department of Cardiology, Haeundae Paik Hospital, Inje University College of Medicine (K.-H.K.), Busan, the Department of Cardiology, Dongguk University Ilsan Hospital, Goyang (J.H.K.), and the Department of Cardiology, Pusan National University Yangsan Hospital, Pusan National University of Medicine, Yangsan (K.W.H.) - all in South Korea
| | - Ji Hyun Kim
- From the Department of Cardiology (M.S.C., D.-Y.K., J.-M.A., S.-J.P., D.-W.P., G.-B.N.) and the Division of Biostatics (S.-C.Y.), Asan Medical Center, University of Ulsan College of Medicine, the Department of Cardiology, Seoul St. Mary's Hospital, College of Medicine, Catholic University of Korea (Y.-S.O.), the Department of Cardiology, Veterans Health Service Medical Center (C.H.L.), the Department of Internal Medicine, Seoul National University College of Medicine and Seoul National University Hospital (E.-K.C.), the Division of Cardiology, Department of Internal Medicine, Konkuk University Medical Center, Konkuk University School of Medicine (C.H.K.), the Division of Cardiology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine (K.-M.P.), the Department of Cardiology, Kyung Hee University Hospital at Gangdong, Kyung Hee University Medical College (E.-S.J.), and the Division of Cardiology, Department of Internal Medicine, Eunpyeong St. Mary's Hospital, College of Medicine, Catholic University of Korea (O.K.), Seoul, the Cardiovascular Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam (J.H.L.), the Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan (G.-M.P.), the Department of Cardiology, Soon Chun Hyang University Hospital Bucheon, Bucheon (H.O.C.), the Department of Cardiology, Hallym University Medical Center, Anyang (K.-H.P.), the Department of Cardiology, Keimyung University Dongsan Hospital, Daegu (J.H.), the Department of Cardiology, St. Vincent's Hospital, College of Medicine, Catholic University of Korea, Suwon (K.-D.Y.), the Department of Cardiology, Dong-A University Hospital, Dong-A University College of Medicine (Y.-R.C.), and the Department of Cardiology, Haeundae Paik Hospital, Inje University College of Medicine (K.-H.K.), Busan, the Department of Cardiology, Dongguk University Ilsan Hospital, Goyang (J.H.K.), and the Department of Cardiology, Pusan National University Yangsan Hospital, Pusan National University of Medicine, Yangsan (K.W.H.) - all in South Korea
| | - Ki Won Hwang
- From the Department of Cardiology (M.S.C., D.-Y.K., J.-M.A., S.-J.P., D.-W.P., G.-B.N.) and the Division of Biostatics (S.-C.Y.), Asan Medical Center, University of Ulsan College of Medicine, the Department of Cardiology, Seoul St. Mary's Hospital, College of Medicine, Catholic University of Korea (Y.-S.O.), the Department of Cardiology, Veterans Health Service Medical Center (C.H.L.), the Department of Internal Medicine, Seoul National University College of Medicine and Seoul National University Hospital (E.-K.C.), the Division of Cardiology, Department of Internal Medicine, Konkuk University Medical Center, Konkuk University School of Medicine (C.H.K.), the Division of Cardiology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine (K.-M.P.), the Department of Cardiology, Kyung Hee University Hospital at Gangdong, Kyung Hee University Medical College (E.-S.J.), and the Division of Cardiology, Department of Internal Medicine, Eunpyeong St. Mary's Hospital, College of Medicine, Catholic University of Korea (O.K.), Seoul, the Cardiovascular Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam (J.H.L.), the Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan (G.-M.P.), the Department of Cardiology, Soon Chun Hyang University Hospital Bucheon, Bucheon (H.O.C.), the Department of Cardiology, Hallym University Medical Center, Anyang (K.-H.P.), the Department of Cardiology, Keimyung University Dongsan Hospital, Daegu (J.H.), the Department of Cardiology, St. Vincent's Hospital, College of Medicine, Catholic University of Korea, Suwon (K.-D.Y.), the Department of Cardiology, Dong-A University Hospital, Dong-A University College of Medicine (Y.-R.C.), and the Department of Cardiology, Haeundae Paik Hospital, Inje University College of Medicine (K.-H.K.), Busan, the Department of Cardiology, Dongguk University Ilsan Hospital, Goyang (J.H.K.), and the Department of Cardiology, Pusan National University Yangsan Hospital, Pusan National University of Medicine, Yangsan (K.W.H.) - all in South Korea
| | - Eun-Sun Jin
- From the Department of Cardiology (M.S.C., D.-Y.K., J.-M.A., S.-J.P., D.-W.P., G.-B.N.) and the Division of Biostatics (S.-C.Y.), Asan Medical Center, University of Ulsan College of Medicine, the Department of Cardiology, Seoul St. Mary's Hospital, College of Medicine, Catholic University of Korea (Y.-S.O.), the Department of Cardiology, Veterans Health Service Medical Center (C.H.L.), the Department of Internal Medicine, Seoul National University College of Medicine and Seoul National University Hospital (E.-K.C.), the Division of Cardiology, Department of Internal Medicine, Konkuk University Medical Center, Konkuk University School of Medicine (C.H.K.), the Division of Cardiology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine (K.-M.P.), the Department of Cardiology, Kyung Hee University Hospital at Gangdong, Kyung Hee University Medical College (E.-S.J.), and the Division of Cardiology, Department of Internal Medicine, Eunpyeong St. Mary's Hospital, College of Medicine, Catholic University of Korea (O.K.), Seoul, the Cardiovascular Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam (J.H.L.), the Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan (G.-M.P.), the Department of Cardiology, Soon Chun Hyang University Hospital Bucheon, Bucheon (H.O.C.), the Department of Cardiology, Hallym University Medical Center, Anyang (K.-H.P.), the Department of Cardiology, Keimyung University Dongsan Hospital, Daegu (J.H.), the Department of Cardiology, St. Vincent's Hospital, College of Medicine, Catholic University of Korea, Suwon (K.-D.Y.), the Department of Cardiology, Dong-A University Hospital, Dong-A University College of Medicine (Y.-R.C.), and the Department of Cardiology, Haeundae Paik Hospital, Inje University College of Medicine (K.-H.K.), Busan, the Department of Cardiology, Dongguk University Ilsan Hospital, Goyang (J.H.K.), and the Department of Cardiology, Pusan National University Yangsan Hospital, Pusan National University of Medicine, Yangsan (K.W.H.) - all in South Korea
| | - Osung Kwon
- From the Department of Cardiology (M.S.C., D.-Y.K., J.-M.A., S.-J.P., D.-W.P., G.-B.N.) and the Division of Biostatics (S.-C.Y.), Asan Medical Center, University of Ulsan College of Medicine, the Department of Cardiology, Seoul St. Mary's Hospital, College of Medicine, Catholic University of Korea (Y.-S.O.), the Department of Cardiology, Veterans Health Service Medical Center (C.H.L.), the Department of Internal Medicine, Seoul National University College of Medicine and Seoul National University Hospital (E.-K.C.), the Division of Cardiology, Department of Internal Medicine, Konkuk University Medical Center, Konkuk University School of Medicine (C.H.K.), the Division of Cardiology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine (K.-M.P.), the Department of Cardiology, Kyung Hee University Hospital at Gangdong, Kyung Hee University Medical College (E.-S.J.), and the Division of Cardiology, Department of Internal Medicine, Eunpyeong St. Mary's Hospital, College of Medicine, Catholic University of Korea (O.K.), Seoul, the Cardiovascular Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam (J.H.L.), the Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan (G.-M.P.), the Department of Cardiology, Soon Chun Hyang University Hospital Bucheon, Bucheon (H.O.C.), the Department of Cardiology, Hallym University Medical Center, Anyang (K.-H.P.), the Department of Cardiology, Keimyung University Dongsan Hospital, Daegu (J.H.), the Department of Cardiology, St. Vincent's Hospital, College of Medicine, Catholic University of Korea, Suwon (K.-D.Y.), the Department of Cardiology, Dong-A University Hospital, Dong-A University College of Medicine (Y.-R.C.), and the Department of Cardiology, Haeundae Paik Hospital, Inje University College of Medicine (K.-H.K.), Busan, the Department of Cardiology, Dongguk University Ilsan Hospital, Goyang (J.H.K.), and the Department of Cardiology, Pusan National University Yangsan Hospital, Pusan National University of Medicine, Yangsan (K.W.H.) - all in South Korea
| | - Ki-Hun Kim
- From the Department of Cardiology (M.S.C., D.-Y.K., J.-M.A., S.-J.P., D.-W.P., G.-B.N.) and the Division of Biostatics (S.-C.Y.), Asan Medical Center, University of Ulsan College of Medicine, the Department of Cardiology, Seoul St. Mary's Hospital, College of Medicine, Catholic University of Korea (Y.-S.O.), the Department of Cardiology, Veterans Health Service Medical Center (C.H.L.), the Department of Internal Medicine, Seoul National University College of Medicine and Seoul National University Hospital (E.-K.C.), the Division of Cardiology, Department of Internal Medicine, Konkuk University Medical Center, Konkuk University School of Medicine (C.H.K.), the Division of Cardiology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine (K.-M.P.), the Department of Cardiology, Kyung Hee University Hospital at Gangdong, Kyung Hee University Medical College (E.-S.J.), and the Division of Cardiology, Department of Internal Medicine, Eunpyeong St. Mary's Hospital, College of Medicine, Catholic University of Korea (O.K.), Seoul, the Cardiovascular Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam (J.H.L.), the Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan (G.-M.P.), the Department of Cardiology, Soon Chun Hyang University Hospital Bucheon, Bucheon (H.O.C.), the Department of Cardiology, Hallym University Medical Center, Anyang (K.-H.P.), the Department of Cardiology, Keimyung University Dongsan Hospital, Daegu (J.H.), the Department of Cardiology, St. Vincent's Hospital, College of Medicine, Catholic University of Korea, Suwon (K.-D.Y.), the Department of Cardiology, Dong-A University Hospital, Dong-A University College of Medicine (Y.-R.C.), and the Department of Cardiology, Haeundae Paik Hospital, Inje University College of Medicine (K.-H.K.), Busan, the Department of Cardiology, Dongguk University Ilsan Hospital, Goyang (J.H.K.), and the Department of Cardiology, Pusan National University Yangsan Hospital, Pusan National University of Medicine, Yangsan (K.W.H.) - all in South Korea
| | - Seung-Jung Park
- From the Department of Cardiology (M.S.C., D.-Y.K., J.-M.A., S.-J.P., D.-W.P., G.-B.N.) and the Division of Biostatics (S.-C.Y.), Asan Medical Center, University of Ulsan College of Medicine, the Department of Cardiology, Seoul St. Mary's Hospital, College of Medicine, Catholic University of Korea (Y.-S.O.), the Department of Cardiology, Veterans Health Service Medical Center (C.H.L.), the Department of Internal Medicine, Seoul National University College of Medicine and Seoul National University Hospital (E.-K.C.), the Division of Cardiology, Department of Internal Medicine, Konkuk University Medical Center, Konkuk University School of Medicine (C.H.K.), the Division of Cardiology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine (K.-M.P.), the Department of Cardiology, Kyung Hee University Hospital at Gangdong, Kyung Hee University Medical College (E.-S.J.), and the Division of Cardiology, Department of Internal Medicine, Eunpyeong St. Mary's Hospital, College of Medicine, Catholic University of Korea (O.K.), Seoul, the Cardiovascular Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam (J.H.L.), the Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan (G.-M.P.), the Department of Cardiology, Soon Chun Hyang University Hospital Bucheon, Bucheon (H.O.C.), the Department of Cardiology, Hallym University Medical Center, Anyang (K.-H.P.), the Department of Cardiology, Keimyung University Dongsan Hospital, Daegu (J.H.), the Department of Cardiology, St. Vincent's Hospital, College of Medicine, Catholic University of Korea, Suwon (K.-D.Y.), the Department of Cardiology, Dong-A University Hospital, Dong-A University College of Medicine (Y.-R.C.), and the Department of Cardiology, Haeundae Paik Hospital, Inje University College of Medicine (K.-H.K.), Busan, the Department of Cardiology, Dongguk University Ilsan Hospital, Goyang (J.H.K.), and the Department of Cardiology, Pusan National University Yangsan Hospital, Pusan National University of Medicine, Yangsan (K.W.H.) - all in South Korea
| | - Duk-Woo Park
- From the Department of Cardiology (M.S.C., D.-Y.K., J.-M.A., S.-J.P., D.-W.P., G.-B.N.) and the Division of Biostatics (S.-C.Y.), Asan Medical Center, University of Ulsan College of Medicine, the Department of Cardiology, Seoul St. Mary's Hospital, College of Medicine, Catholic University of Korea (Y.-S.O.), the Department of Cardiology, Veterans Health Service Medical Center (C.H.L.), the Department of Internal Medicine, Seoul National University College of Medicine and Seoul National University Hospital (E.-K.C.), the Division of Cardiology, Department of Internal Medicine, Konkuk University Medical Center, Konkuk University School of Medicine (C.H.K.), the Division of Cardiology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine (K.-M.P.), the Department of Cardiology, Kyung Hee University Hospital at Gangdong, Kyung Hee University Medical College (E.-S.J.), and the Division of Cardiology, Department of Internal Medicine, Eunpyeong St. Mary's Hospital, College of Medicine, Catholic University of Korea (O.K.), Seoul, the Cardiovascular Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam (J.H.L.), the Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan (G.-M.P.), the Department of Cardiology, Soon Chun Hyang University Hospital Bucheon, Bucheon (H.O.C.), the Department of Cardiology, Hallym University Medical Center, Anyang (K.-H.P.), the Department of Cardiology, Keimyung University Dongsan Hospital, Daegu (J.H.), the Department of Cardiology, St. Vincent's Hospital, College of Medicine, Catholic University of Korea, Suwon (K.-D.Y.), the Department of Cardiology, Dong-A University Hospital, Dong-A University College of Medicine (Y.-R.C.), and the Department of Cardiology, Haeundae Paik Hospital, Inje University College of Medicine (K.-H.K.), Busan, the Department of Cardiology, Dongguk University Ilsan Hospital, Goyang (J.H.K.), and the Department of Cardiology, Pusan National University Yangsan Hospital, Pusan National University of Medicine, Yangsan (K.W.H.) - all in South Korea
| | - Gi-Byoung Nam
- From the Department of Cardiology (M.S.C., D.-Y.K., J.-M.A., S.-J.P., D.-W.P., G.-B.N.) and the Division of Biostatics (S.-C.Y.), Asan Medical Center, University of Ulsan College of Medicine, the Department of Cardiology, Seoul St. Mary's Hospital, College of Medicine, Catholic University of Korea (Y.-S.O.), the Department of Cardiology, Veterans Health Service Medical Center (C.H.L.), the Department of Internal Medicine, Seoul National University College of Medicine and Seoul National University Hospital (E.-K.C.), the Division of Cardiology, Department of Internal Medicine, Konkuk University Medical Center, Konkuk University School of Medicine (C.H.K.), the Division of Cardiology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine (K.-M.P.), the Department of Cardiology, Kyung Hee University Hospital at Gangdong, Kyung Hee University Medical College (E.-S.J.), and the Division of Cardiology, Department of Internal Medicine, Eunpyeong St. Mary's Hospital, College of Medicine, Catholic University of Korea (O.K.), Seoul, the Cardiovascular Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam (J.H.L.), the Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan (G.-M.P.), the Department of Cardiology, Soon Chun Hyang University Hospital Bucheon, Bucheon (H.O.C.), the Department of Cardiology, Hallym University Medical Center, Anyang (K.-H.P.), the Department of Cardiology, Keimyung University Dongsan Hospital, Daegu (J.H.), the Department of Cardiology, St. Vincent's Hospital, College of Medicine, Catholic University of Korea, Suwon (K.-D.Y.), the Department of Cardiology, Dong-A University Hospital, Dong-A University College of Medicine (Y.-R.C.), and the Department of Cardiology, Haeundae Paik Hospital, Inje University College of Medicine (K.-H.K.), Busan, the Department of Cardiology, Dongguk University Ilsan Hospital, Goyang (J.H.K.), and the Department of Cardiology, Pusan National University Yangsan Hospital, Pusan National University of Medicine, Yangsan (K.W.H.) - all in South Korea
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Vallée A, Rahmouni K, Ponnambalam M, Issa H, Ruel M. Left main revascularization guidelines: navigating the data. Curr Opin Cardiol 2024; 39:437-443. [PMID: 38904280 DOI: 10.1097/hco.0000000000001160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/22/2024]
Abstract
PURPOSE OF REVIEW This article explores recent developments in left main revascularization, with a focus on appraising the latest American and European guidelines. RECENT FINDINGS Recent pooled data analysis from four major randomized controlled trials (RCTs) for left main coronary artery stenosis indicate an advantage for CABG over PCI in regard to freedom from major adverse cardiovascular events, despite no significant difference in mortality observed at 5 years. Additional data support the use of CABG for patients with left ventricular dysfunction, complex left main lesions, diffuse coronary disease, and diabetes. SUMMARY The data underpinning the guidelines on each revascularization modality (PCI versus CABG) must consider factors such as lesion complexity, diabetes, and left ventricular dysfunction. Additionally, the findings of the four major RCTs upon which the guidelines are based must be ascertained in light of the latest advancements in these revascularization techniques.
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Affiliation(s)
- Aurelien Vallée
- University of Ottawa Heart Institute, University of Ottawa, Ottawa, Ontario, Canada
- Cardiac and Vascular Surgery Department, Marie Lannelongue Hospital, GHPSJ, Le Plessis Robinson, France
| | - Kenza Rahmouni
- University of Ottawa Heart Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Menaka Ponnambalam
- University of Ottawa Heart Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Hugo Issa
- University of Ottawa Heart Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Marc Ruel
- University of Ottawa Heart Institute, University of Ottawa, Ottawa, Ontario, Canada
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Li H, Yang W, Shang Z, Lu Y, Shen A, Chen D, Lin G, Li M, Li R, Wu M, Guo Z, Qu H, Fu C, Yu Z, Chen K. Dehydrocorydaline attenuates myocardial ischemia-reperfusion injury via the FoXO signalling pathway: A multimodal study based on network pharmacology, molecular docking, and experimental study. JOURNAL OF ETHNOPHARMACOLOGY 2024; 337:118738. [PMID: 39222757 DOI: 10.1016/j.jep.2024.118738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2024] [Revised: 08/08/2024] [Accepted: 08/23/2024] [Indexed: 09/04/2024]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Dehydrocorydaline (DHC), an active component of Corydalis yanhusuo (Y.H. Chou & Chun C. Hsu) W.T. Wang ex Z.Y. Su & C.Y. Wu (Papaveraceae), exhibits protective and pain-relieving effects on coronary heart disease, but the underlying mechanism still remains unknown. AIM OF THE STUDY Network pharmacology and experimental validation both in vivo and in vitro were applied to assess whether DHC can treat myocardial ischemia-reperfusion injury (MIRI) by regulating the forkhead box O (FoxO) signalling pathway to inhibit apoptosis. MATERIALS AND METHODS DHC and MIRI targets were retrieved from various databases. Molecular docking and microscale thermophoresis (MST) determined potential binding affinity. An in vivo mouse model of MIRI was established by ligating the left anterior descending coronary artery. C57BL/6N mice were divided into sham, MIRI, and DHC (intraperitoneal injection of 5 mg/kg DHC) groups. Haematoxylin and eosin, Masson, and immunohistochemical stainings verified DHC treatment effects and the involved signalling pathways. In vitro, H9c2 cells were incubated with DHC and underwent hypoxia/reoxygenation. TUNEL, JC-1, and reactive oxygen species stainings and western blots were used to explore the protective effects of DHC and the underlying mechanisms. RESULTS Venny analysis identified 120 common targets from 121 DHC and 23,354 MIRI targets. DHC exhibited high affinity for CCND1, CDK2, and MDM2 (<-7 kcal/mol). In vivo, DHC attenuated decreases in left ventricular ejection fraction and fractional shortening, reduced infarct sizes, and decreased cTnI and lactate dehydrogenase levels. In vitro, DHC alleviated apoptosis and oxidative stress in the hypoxia/reoxygenation model by attenuating ΔΨm disruption; reducing the production of reactive oxygen species; upregulating Bax and CCND1 via the FoxO signalling pathway, as well as cleaved-caspase 8; downregulating the apoptosis-associated proteins Bcl-2, Bid, cleaved-caspase 3, and cleaved-caspase 9; and promoting the phosphorylation of FOXO1A and MDM2. CONCLUSION By upregulating the FoxO signaling pathway to inhibit apoptosis, DHC exerts a cardioprotective effect, which could serve as a potential therapeutic option for MIRI.
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Affiliation(s)
- Hongzheng Li
- Guang'anmen Hospital, China Academy of Chinese Medical Science, Beijing, 100053, China.
| | - Wenwen Yang
- Xiyuan Hospital, China Academy of Chinese Medical Science, Beijing, 100091, China.
| | - Zucheng Shang
- Academy of Integrative Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, 350122, China.
| | - Yingdong Lu
- Guang'anmen Hospital, China Academy of Chinese Medical Science, Beijing, 100053, China.
| | - Aling Shen
- Academy of Integrative Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, 350122, China.
| | - Daxin Chen
- Academy of Integrative Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, 350122, China.
| | - Guosheng Lin
- Academy of Integrative Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, 350122, China.
| | - Mengfan Li
- Academy of Integrative Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, 350122, China.
| | - Renfeng Li
- Academy of Integrative Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, 350122, China.
| | - Meizhu Wu
- Academy of Integrative Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, 350122, China.
| | - Zhi Guo
- Academy of Integrative Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, 350122, China.
| | - Hua Qu
- Xiyuan Hospital, China Academy of Chinese Medical Science, Beijing, 100091, China.
| | - Changgeng Fu
- Xiyuan Hospital, China Academy of Chinese Medical Science, Beijing, 100091, China.
| | - Zikai Yu
- Xiyuan Hospital, China Academy of Chinese Medical Science, Beijing, 100091, China.
| | - Keji Chen
- Xiyuan Hospital, China Academy of Chinese Medical Science, Beijing, 100091, China.
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Boden WE, De Caterina R, Kaski JC, Merz NB, Berry C, Marzilli M, Pepine CJ, Barbato E, Stefanini G, Prescott E, Steg PG, Bhatt DL, Hill JA, Crea F. Myocardial ischaemic syndromes: a new nomenclature to harmonize evolving international clinical practice guidelines. Eur Heart J 2024:ehae278. [PMID: 39211956 DOI: 10.1093/eurheartj/ehae278] [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: 04/15/2024] [Accepted: 04/22/2024] [Indexed: 09/04/2024] Open
Abstract
Since the 1960s, cardiologists have adopted several binary classification systems for acute myocardial infarction (MI) that facilitated improved patient management. Conversely, for chronic stable manifestations of myocardial ischaemia, various classifications have emerged over time, often with conflicting terminology-e.g. 'stable coronary artery disease' (CAD), 'stable ischaemic heart disease', and 'chronic coronary syndromes' (CCS). While the 2019 European guidelines introduced CCS to impart symmetry with 'acute coronary syndromes' (ACS), the 2023 American guidelines endorsed the alternative term 'chronic coronary disease'. An unintended consequence of these competing classifications is perpetuation of the restrictive terms 'coronary' and 'disease', often connoting only a singular obstructive CAD mechanism. It is now important to advance a more broadly inclusive terminology for both obstructive and non-obstructive causes of angina and myocardial ischaemia that fosters conceptual clarity and unifies dyssynchronous nomenclatures across guidelines. We, therefore, propose a new binary classification of 'acute myocardial ischaemic syndromes' and 'non-acute myocardial ischaemic syndromes', which comprises both obstructive epicardial and non-obstructive pathogenetic mechanisms, including microvascular dysfunction, vasospastic disorders, and non-coronary causes. We herein retain accepted categories of ACS, ST-segment elevation MI, and non-ST-segment elevation MI, as important subsets for which revascularization is of proven clinical benefit, as well as new terms like ischaemia and MI with non-obstructive coronary arteries. Overall, such a more encompassing nomenclature better aligns, unifies, and harmonizes different pathophysiologic causes of myocardial ischaemia and should result in more refined diagnostic and therapeutic approaches targeted to the multiple pathobiological precipitants of angina pectoris, ischaemia and infarction.
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Affiliation(s)
- William E Boden
- VA Boston Healthcare System, Boston University School of Medicine, 150 S. Huntington Avenue, Boston, MA 02130, USA
| | - Raffaele De Caterina
- Division of Cardiology, University of Pisa and Pisa University Hospital, Pisa, Italy
| | - Juan Carlos Kaski
- Molecular and Clinical Sciences Research Institute, St. George's University of London, London, UK
| | - Noel Bairey Merz
- Barbra Streisand Women's Heart Center, Cedars-Sinai Smidt Heart Institute, Los Angeles, CA, USA
| | - Colin Berry
- British Heart Foundation, Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | - Mario Marzilli
- Division of Cardiology, University of Pisa and Pisa University Hospital, Pisa, Italy
| | - Carl J Pepine
- Division of Cardiovascular Medicine, University of Florida School of Medicine, Gainesville, FL, USA
| | - Emanuele Barbato
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, Rome, Italy
| | - Giulio Stefanini
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
- Humanitas Research Hospital IRCCS, Milan, Italy
| | - Eva Prescott
- Centre for Cardiovascular Research, Bispebjerg Frederiksberg University Hospital, Copenhagen, Denmark
| | - Philippe Gabriel Steg
- Université Paris-Cité, Assistance Publique-Hôpitaux de Paris, FACT and INSERM U1148, Paris, France
| | - Deepak L Bhatt
- Mount Sinai Heart, Icahn School of Medicine at Mount Sinai Health System, New York City, NY, USA
| | - Joseph A Hill
- Department of Medicine, UT Southwestern Medical Center, Dallas, TX, USA
| | - Filippo Crea
- Department of Cardiovascular Sciences, Università Cattolica del Sacro Cuore, Rome, Italy
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Silvain J, Cayla G, Ferrari E, Range G, Puymirat E, Delarche N, Guedeney P, Cuisset T, Ivanes F, Lhermusier T, Petroni T, Lemesle G, Bresoles F, Labeque JN, Pommier T, Dillinger JG, Leclercq F, Boccara F, Lim P, Besseyre des Horts T, Fourme T, Jourda F, Furber A, Lattuca B, Redjimi N, Thuaire C, Deharo P, Procopi N, Dumaine R, Slama M, Payot L, El Kasty M, Aacha K, Diallo A, Vicaut E, Montalescot G. Beta-Blocker Interruption or Continuation after Myocardial Infarction. N Engl J Med 2024. [PMID: 39213187 DOI: 10.1056/nejmoa2404204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/04/2024]
Abstract
BACKGROUND The appropriate duration of treatment with beta-blocker drugs after a myocardial infarction is unknown. Data are needed on the safety and efficacy of the interruption of long-term beta-blocker treatment to reduce side effects and improve quality of life in patients with a history of uncomplicated myocardial infarction. METHODS In a multicenter, open label, randomized, noninferiority trial conducted at 49 sites in France, we randomly assigned patients with a history of myocardial infarction, in a 1:1 ratio, to interruption or continuation of beta-blocker treatment. All the patients had a left ventricular ejection fraction of at least 40% while receiving long-term beta-blocker treatment and had no history of a cardiovascular event in the previous 6 months. The primary end point was a composite of death, nonfatal myocardial infarction, nonfatal stroke, or hospitalization for cardiovascular reasons at the longest follow-up (minimum, 1 year), according to an analysis of noninferiority (defined as a between-group difference of <3 percentage points for the upper boundary of the two-sided 95% confidence interval). The main secondary end point was the change in quality of life as measured by the European Quality of Life-5 Dimensions questionnaire. RESULTS A total of 3698 patients underwent randomization: 1846 to the interruption group and 1852 to the continuation group. The median time between the last myocardial infarction and randomization was 2.9 years (interquartile range, 1.2 to 6.4), and the median follow-up was 3.0 years (interquartile range, 2.0 to 4.0). A primary-outcome event occurred in 432 of 1812 patients (23.8%) in the interruption group and in 384 of 1821 patients (21.1%) in the continuation group (risk difference, 2.8 percentage points; 95% confidence interval [CI], <0.1 to 5.5), for a hazard ratio of 1.16 (95% CI, 1.01 to 1.33; P = 0.44 for noninferiority). Beta-blocker interruption did not seem to improve the patients' quality of life. CONCLUSIONS In patients with a history of myocardial infarction, interruption of long-term beta-blocker treatment was not found to be noninferior to a strategy of beta-blocker continuation. (Funded by the French Ministry of Health and ACTION Study Group; ABYSS ClinicalTrials.gov number, NCT03498066; EudraCT number, 2017-003903-23.).
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Affiliation(s)
- Johanne Silvain
- From Sorbonne Université, ACTION Group, INSERM Unité Mixte de Recherche (UMRS) 1166, Hôpital Pitié-Salpêtrière Assistance Publique-Hôpitaux de Paris (AP-HP) (J.S., P.G., N.P., K.A., G.M.), the Department of Cardiology, Hôpital Européen Georges Pompidou, AP-HP, Université Paris Cité (E.P.), FACT (French Alliance for Cardiovascular Trials) (G.L.), the Department of Cardiology, Université Paris Cité, Hôpital Lariboisière, AP-HP, INSERM Unité 942 (J.-G.D.), the Cardiology Department, Hôpital Saint-Antoine, ACTION Group, Sorbonne Université, INSERM UMRS 938 (F. Boccara), the Cardiology Department Hôpital Bichat, AP-HP (M.S.), Unité de Recherche Clinique, ACTION Group, Hôpital Fernand Widal (AP-HP) (A.D., E.V.), and SAMM (Statistique, Analyse et Modélisation Multidisciplinaire) EA 4543, Université Paris 1 Panthéon Sorbonne (A.D., E.V.), Paris, the Cardiology Department, Nimes University Hospital, Montpellier University, ACTION Group, Nimes (G.C., B.L.), the Cardiology Department, Pasteur University Hospital, Nice (E.F., N.R.), the Cardiology Department, Hôpitaux de Chartres, ACTION Group, Hôpital Louis Pasteur, Chartres (G.R., C.T.), Cardiology Department, Hôpital Centre François Mitterrand de Pau, Pau (N.D.), Département de Cardiologie, Centre Hospitalo-Universitaire (CHU) La Timone, ACTION Group, Marseille University, INSERM, Marseille (T.C., P.D.), the Cardiology Department, CHU Tours, INSERM Unité 1327 ISCHEMIA, Université de Tours, Tours (F.I.), the Cardiology Department, CHU de Toulouse, Toulouse (T.L.), the Cardiology Department, Clinique du Pont de Chaume, Montauban (T. Petroni), the Heart and Lung Institute, University Hospital of Lille, and Institut Pasteur of Lille, INSERM Unité 1011-EGID, Lille (G.L.), the Cardiology Department, CHU d'Avignon, Avignon (F. Bresoles), the Cardiology Group of the Côte Basque, Bayonne (J.-N.L.), the Cardiology Department, CHU de Dijon Bourgogne, Dijon (T. Pommier), the Cardiology Department, CHU de Montpellier, Montpellier (F.L.), the Cardiology Department, CHU Henri Mondor, Créteil (P.L.), the Cardiology Department, Centre Hospitalier (CH) Métropole-Savoie (Hôpital Chambéry), Chambéry (T.B.H.), the Cardiology Department, Groupe Hospitalier Mutualiste (GHM) de Grenoble, Grenoble (T.F.), the Cardiology Department, CHU d'Auxerre, Auxerre (F.J.), Cardiology Department, CHU Angers et UMR Centre National de la Recherche Scientifique (CNRS) 6015, INSERM Unité 1083 Equipe Physiopathologie Cardiovasculaire, Unité de Formation et de Recherche (UFR) Santé, Angers (A.F.), Grands Prés Cardiac Rehabilitation Centre, St. Denis (R.D.), the Cardiology Department, General Hospital Yves Le Foll, Saint-Brieuc (L.P.), and the Cardiology Department, Grand Hôpital de l'Est Francilien Site Marne-La-Vallée, Jossigny (M.E.K.) - all in France
| | - Guillaume Cayla
- From Sorbonne Université, ACTION Group, INSERM Unité Mixte de Recherche (UMRS) 1166, Hôpital Pitié-Salpêtrière Assistance Publique-Hôpitaux de Paris (AP-HP) (J.S., P.G., N.P., K.A., G.M.), the Department of Cardiology, Hôpital Européen Georges Pompidou, AP-HP, Université Paris Cité (E.P.), FACT (French Alliance for Cardiovascular Trials) (G.L.), the Department of Cardiology, Université Paris Cité, Hôpital Lariboisière, AP-HP, INSERM Unité 942 (J.-G.D.), the Cardiology Department, Hôpital Saint-Antoine, ACTION Group, Sorbonne Université, INSERM UMRS 938 (F. Boccara), the Cardiology Department Hôpital Bichat, AP-HP (M.S.), Unité de Recherche Clinique, ACTION Group, Hôpital Fernand Widal (AP-HP) (A.D., E.V.), and SAMM (Statistique, Analyse et Modélisation Multidisciplinaire) EA 4543, Université Paris 1 Panthéon Sorbonne (A.D., E.V.), Paris, the Cardiology Department, Nimes University Hospital, Montpellier University, ACTION Group, Nimes (G.C., B.L.), the Cardiology Department, Pasteur University Hospital, Nice (E.F., N.R.), the Cardiology Department, Hôpitaux de Chartres, ACTION Group, Hôpital Louis Pasteur, Chartres (G.R., C.T.), Cardiology Department, Hôpital Centre François Mitterrand de Pau, Pau (N.D.), Département de Cardiologie, Centre Hospitalo-Universitaire (CHU) La Timone, ACTION Group, Marseille University, INSERM, Marseille (T.C., P.D.), the Cardiology Department, CHU Tours, INSERM Unité 1327 ISCHEMIA, Université de Tours, Tours (F.I.), the Cardiology Department, CHU de Toulouse, Toulouse (T.L.), the Cardiology Department, Clinique du Pont de Chaume, Montauban (T. Petroni), the Heart and Lung Institute, University Hospital of Lille, and Institut Pasteur of Lille, INSERM Unité 1011-EGID, Lille (G.L.), the Cardiology Department, CHU d'Avignon, Avignon (F. Bresoles), the Cardiology Group of the Côte Basque, Bayonne (J.-N.L.), the Cardiology Department, CHU de Dijon Bourgogne, Dijon (T. Pommier), the Cardiology Department, CHU de Montpellier, Montpellier (F.L.), the Cardiology Department, CHU Henri Mondor, Créteil (P.L.), the Cardiology Department, Centre Hospitalier (CH) Métropole-Savoie (Hôpital Chambéry), Chambéry (T.B.H.), the Cardiology Department, Groupe Hospitalier Mutualiste (GHM) de Grenoble, Grenoble (T.F.), the Cardiology Department, CHU d'Auxerre, Auxerre (F.J.), Cardiology Department, CHU Angers et UMR Centre National de la Recherche Scientifique (CNRS) 6015, INSERM Unité 1083 Equipe Physiopathologie Cardiovasculaire, Unité de Formation et de Recherche (UFR) Santé, Angers (A.F.), Grands Prés Cardiac Rehabilitation Centre, St. Denis (R.D.), the Cardiology Department, General Hospital Yves Le Foll, Saint-Brieuc (L.P.), and the Cardiology Department, Grand Hôpital de l'Est Francilien Site Marne-La-Vallée, Jossigny (M.E.K.) - all in France
| | - Emile Ferrari
- From Sorbonne Université, ACTION Group, INSERM Unité Mixte de Recherche (UMRS) 1166, Hôpital Pitié-Salpêtrière Assistance Publique-Hôpitaux de Paris (AP-HP) (J.S., P.G., N.P., K.A., G.M.), the Department of Cardiology, Hôpital Européen Georges Pompidou, AP-HP, Université Paris Cité (E.P.), FACT (French Alliance for Cardiovascular Trials) (G.L.), the Department of Cardiology, Université Paris Cité, Hôpital Lariboisière, AP-HP, INSERM Unité 942 (J.-G.D.), the Cardiology Department, Hôpital Saint-Antoine, ACTION Group, Sorbonne Université, INSERM UMRS 938 (F. Boccara), the Cardiology Department Hôpital Bichat, AP-HP (M.S.), Unité de Recherche Clinique, ACTION Group, Hôpital Fernand Widal (AP-HP) (A.D., E.V.), and SAMM (Statistique, Analyse et Modélisation Multidisciplinaire) EA 4543, Université Paris 1 Panthéon Sorbonne (A.D., E.V.), Paris, the Cardiology Department, Nimes University Hospital, Montpellier University, ACTION Group, Nimes (G.C., B.L.), the Cardiology Department, Pasteur University Hospital, Nice (E.F., N.R.), the Cardiology Department, Hôpitaux de Chartres, ACTION Group, Hôpital Louis Pasteur, Chartres (G.R., C.T.), Cardiology Department, Hôpital Centre François Mitterrand de Pau, Pau (N.D.), Département de Cardiologie, Centre Hospitalo-Universitaire (CHU) La Timone, ACTION Group, Marseille University, INSERM, Marseille (T.C., P.D.), the Cardiology Department, CHU Tours, INSERM Unité 1327 ISCHEMIA, Université de Tours, Tours (F.I.), the Cardiology Department, CHU de Toulouse, Toulouse (T.L.), the Cardiology Department, Clinique du Pont de Chaume, Montauban (T. Petroni), the Heart and Lung Institute, University Hospital of Lille, and Institut Pasteur of Lille, INSERM Unité 1011-EGID, Lille (G.L.), the Cardiology Department, CHU d'Avignon, Avignon (F. Bresoles), the Cardiology Group of the Côte Basque, Bayonne (J.-N.L.), the Cardiology Department, CHU de Dijon Bourgogne, Dijon (T. Pommier), the Cardiology Department, CHU de Montpellier, Montpellier (F.L.), the Cardiology Department, CHU Henri Mondor, Créteil (P.L.), the Cardiology Department, Centre Hospitalier (CH) Métropole-Savoie (Hôpital Chambéry), Chambéry (T.B.H.), the Cardiology Department, Groupe Hospitalier Mutualiste (GHM) de Grenoble, Grenoble (T.F.), the Cardiology Department, CHU d'Auxerre, Auxerre (F.J.), Cardiology Department, CHU Angers et UMR Centre National de la Recherche Scientifique (CNRS) 6015, INSERM Unité 1083 Equipe Physiopathologie Cardiovasculaire, Unité de Formation et de Recherche (UFR) Santé, Angers (A.F.), Grands Prés Cardiac Rehabilitation Centre, St. Denis (R.D.), the Cardiology Department, General Hospital Yves Le Foll, Saint-Brieuc (L.P.), and the Cardiology Department, Grand Hôpital de l'Est Francilien Site Marne-La-Vallée, Jossigny (M.E.K.) - all in France
| | - Grégoire Range
- From Sorbonne Université, ACTION Group, INSERM Unité Mixte de Recherche (UMRS) 1166, Hôpital Pitié-Salpêtrière Assistance Publique-Hôpitaux de Paris (AP-HP) (J.S., P.G., N.P., K.A., G.M.), the Department of Cardiology, Hôpital Européen Georges Pompidou, AP-HP, Université Paris Cité (E.P.), FACT (French Alliance for Cardiovascular Trials) (G.L.), the Department of Cardiology, Université Paris Cité, Hôpital Lariboisière, AP-HP, INSERM Unité 942 (J.-G.D.), the Cardiology Department, Hôpital Saint-Antoine, ACTION Group, Sorbonne Université, INSERM UMRS 938 (F. Boccara), the Cardiology Department Hôpital Bichat, AP-HP (M.S.), Unité de Recherche Clinique, ACTION Group, Hôpital Fernand Widal (AP-HP) (A.D., E.V.), and SAMM (Statistique, Analyse et Modélisation Multidisciplinaire) EA 4543, Université Paris 1 Panthéon Sorbonne (A.D., E.V.), Paris, the Cardiology Department, Nimes University Hospital, Montpellier University, ACTION Group, Nimes (G.C., B.L.), the Cardiology Department, Pasteur University Hospital, Nice (E.F., N.R.), the Cardiology Department, Hôpitaux de Chartres, ACTION Group, Hôpital Louis Pasteur, Chartres (G.R., C.T.), Cardiology Department, Hôpital Centre François Mitterrand de Pau, Pau (N.D.), Département de Cardiologie, Centre Hospitalo-Universitaire (CHU) La Timone, ACTION Group, Marseille University, INSERM, Marseille (T.C., P.D.), the Cardiology Department, CHU Tours, INSERM Unité 1327 ISCHEMIA, Université de Tours, Tours (F.I.), the Cardiology Department, CHU de Toulouse, Toulouse (T.L.), the Cardiology Department, Clinique du Pont de Chaume, Montauban (T. Petroni), the Heart and Lung Institute, University Hospital of Lille, and Institut Pasteur of Lille, INSERM Unité 1011-EGID, Lille (G.L.), the Cardiology Department, CHU d'Avignon, Avignon (F. Bresoles), the Cardiology Group of the Côte Basque, Bayonne (J.-N.L.), the Cardiology Department, CHU de Dijon Bourgogne, Dijon (T. Pommier), the Cardiology Department, CHU de Montpellier, Montpellier (F.L.), the Cardiology Department, CHU Henri Mondor, Créteil (P.L.), the Cardiology Department, Centre Hospitalier (CH) Métropole-Savoie (Hôpital Chambéry), Chambéry (T.B.H.), the Cardiology Department, Groupe Hospitalier Mutualiste (GHM) de Grenoble, Grenoble (T.F.), the Cardiology Department, CHU d'Auxerre, Auxerre (F.J.), Cardiology Department, CHU Angers et UMR Centre National de la Recherche Scientifique (CNRS) 6015, INSERM Unité 1083 Equipe Physiopathologie Cardiovasculaire, Unité de Formation et de Recherche (UFR) Santé, Angers (A.F.), Grands Prés Cardiac Rehabilitation Centre, St. Denis (R.D.), the Cardiology Department, General Hospital Yves Le Foll, Saint-Brieuc (L.P.), and the Cardiology Department, Grand Hôpital de l'Est Francilien Site Marne-La-Vallée, Jossigny (M.E.K.) - all in France
| | - Etienne Puymirat
- From Sorbonne Université, ACTION Group, INSERM Unité Mixte de Recherche (UMRS) 1166, Hôpital Pitié-Salpêtrière Assistance Publique-Hôpitaux de Paris (AP-HP) (J.S., P.G., N.P., K.A., G.M.), the Department of Cardiology, Hôpital Européen Georges Pompidou, AP-HP, Université Paris Cité (E.P.), FACT (French Alliance for Cardiovascular Trials) (G.L.), the Department of Cardiology, Université Paris Cité, Hôpital Lariboisière, AP-HP, INSERM Unité 942 (J.-G.D.), the Cardiology Department, Hôpital Saint-Antoine, ACTION Group, Sorbonne Université, INSERM UMRS 938 (F. Boccara), the Cardiology Department Hôpital Bichat, AP-HP (M.S.), Unité de Recherche Clinique, ACTION Group, Hôpital Fernand Widal (AP-HP) (A.D., E.V.), and SAMM (Statistique, Analyse et Modélisation Multidisciplinaire) EA 4543, Université Paris 1 Panthéon Sorbonne (A.D., E.V.), Paris, the Cardiology Department, Nimes University Hospital, Montpellier University, ACTION Group, Nimes (G.C., B.L.), the Cardiology Department, Pasteur University Hospital, Nice (E.F., N.R.), the Cardiology Department, Hôpitaux de Chartres, ACTION Group, Hôpital Louis Pasteur, Chartres (G.R., C.T.), Cardiology Department, Hôpital Centre François Mitterrand de Pau, Pau (N.D.), Département de Cardiologie, Centre Hospitalo-Universitaire (CHU) La Timone, ACTION Group, Marseille University, INSERM, Marseille (T.C., P.D.), the Cardiology Department, CHU Tours, INSERM Unité 1327 ISCHEMIA, Université de Tours, Tours (F.I.), the Cardiology Department, CHU de Toulouse, Toulouse (T.L.), the Cardiology Department, Clinique du Pont de Chaume, Montauban (T. Petroni), the Heart and Lung Institute, University Hospital of Lille, and Institut Pasteur of Lille, INSERM Unité 1011-EGID, Lille (G.L.), the Cardiology Department, CHU d'Avignon, Avignon (F. Bresoles), the Cardiology Group of the Côte Basque, Bayonne (J.-N.L.), the Cardiology Department, CHU de Dijon Bourgogne, Dijon (T. Pommier), the Cardiology Department, CHU de Montpellier, Montpellier (F.L.), the Cardiology Department, CHU Henri Mondor, Créteil (P.L.), the Cardiology Department, Centre Hospitalier (CH) Métropole-Savoie (Hôpital Chambéry), Chambéry (T.B.H.), the Cardiology Department, Groupe Hospitalier Mutualiste (GHM) de Grenoble, Grenoble (T.F.), the Cardiology Department, CHU d'Auxerre, Auxerre (F.J.), Cardiology Department, CHU Angers et UMR Centre National de la Recherche Scientifique (CNRS) 6015, INSERM Unité 1083 Equipe Physiopathologie Cardiovasculaire, Unité de Formation et de Recherche (UFR) Santé, Angers (A.F.), Grands Prés Cardiac Rehabilitation Centre, St. Denis (R.D.), the Cardiology Department, General Hospital Yves Le Foll, Saint-Brieuc (L.P.), and the Cardiology Department, Grand Hôpital de l'Est Francilien Site Marne-La-Vallée, Jossigny (M.E.K.) - all in France
| | - Nicolas Delarche
- From Sorbonne Université, ACTION Group, INSERM Unité Mixte de Recherche (UMRS) 1166, Hôpital Pitié-Salpêtrière Assistance Publique-Hôpitaux de Paris (AP-HP) (J.S., P.G., N.P., K.A., G.M.), the Department of Cardiology, Hôpital Européen Georges Pompidou, AP-HP, Université Paris Cité (E.P.), FACT (French Alliance for Cardiovascular Trials) (G.L.), the Department of Cardiology, Université Paris Cité, Hôpital Lariboisière, AP-HP, INSERM Unité 942 (J.-G.D.), the Cardiology Department, Hôpital Saint-Antoine, ACTION Group, Sorbonne Université, INSERM UMRS 938 (F. Boccara), the Cardiology Department Hôpital Bichat, AP-HP (M.S.), Unité de Recherche Clinique, ACTION Group, Hôpital Fernand Widal (AP-HP) (A.D., E.V.), and SAMM (Statistique, Analyse et Modélisation Multidisciplinaire) EA 4543, Université Paris 1 Panthéon Sorbonne (A.D., E.V.), Paris, the Cardiology Department, Nimes University Hospital, Montpellier University, ACTION Group, Nimes (G.C., B.L.), the Cardiology Department, Pasteur University Hospital, Nice (E.F., N.R.), the Cardiology Department, Hôpitaux de Chartres, ACTION Group, Hôpital Louis Pasteur, Chartres (G.R., C.T.), Cardiology Department, Hôpital Centre François Mitterrand de Pau, Pau (N.D.), Département de Cardiologie, Centre Hospitalo-Universitaire (CHU) La Timone, ACTION Group, Marseille University, INSERM, Marseille (T.C., P.D.), the Cardiology Department, CHU Tours, INSERM Unité 1327 ISCHEMIA, Université de Tours, Tours (F.I.), the Cardiology Department, CHU de Toulouse, Toulouse (T.L.), the Cardiology Department, Clinique du Pont de Chaume, Montauban (T. Petroni), the Heart and Lung Institute, University Hospital of Lille, and Institut Pasteur of Lille, INSERM Unité 1011-EGID, Lille (G.L.), the Cardiology Department, CHU d'Avignon, Avignon (F. Bresoles), the Cardiology Group of the Côte Basque, Bayonne (J.-N.L.), the Cardiology Department, CHU de Dijon Bourgogne, Dijon (T. Pommier), the Cardiology Department, CHU de Montpellier, Montpellier (F.L.), the Cardiology Department, CHU Henri Mondor, Créteil (P.L.), the Cardiology Department, Centre Hospitalier (CH) Métropole-Savoie (Hôpital Chambéry), Chambéry (T.B.H.), the Cardiology Department, Groupe Hospitalier Mutualiste (GHM) de Grenoble, Grenoble (T.F.), the Cardiology Department, CHU d'Auxerre, Auxerre (F.J.), Cardiology Department, CHU Angers et UMR Centre National de la Recherche Scientifique (CNRS) 6015, INSERM Unité 1083 Equipe Physiopathologie Cardiovasculaire, Unité de Formation et de Recherche (UFR) Santé, Angers (A.F.), Grands Prés Cardiac Rehabilitation Centre, St. Denis (R.D.), the Cardiology Department, General Hospital Yves Le Foll, Saint-Brieuc (L.P.), and the Cardiology Department, Grand Hôpital de l'Est Francilien Site Marne-La-Vallée, Jossigny (M.E.K.) - all in France
| | - Paul Guedeney
- From Sorbonne Université, ACTION Group, INSERM Unité Mixte de Recherche (UMRS) 1166, Hôpital Pitié-Salpêtrière Assistance Publique-Hôpitaux de Paris (AP-HP) (J.S., P.G., N.P., K.A., G.M.), the Department of Cardiology, Hôpital Européen Georges Pompidou, AP-HP, Université Paris Cité (E.P.), FACT (French Alliance for Cardiovascular Trials) (G.L.), the Department of Cardiology, Université Paris Cité, Hôpital Lariboisière, AP-HP, INSERM Unité 942 (J.-G.D.), the Cardiology Department, Hôpital Saint-Antoine, ACTION Group, Sorbonne Université, INSERM UMRS 938 (F. Boccara), the Cardiology Department Hôpital Bichat, AP-HP (M.S.), Unité de Recherche Clinique, ACTION Group, Hôpital Fernand Widal (AP-HP) (A.D., E.V.), and SAMM (Statistique, Analyse et Modélisation Multidisciplinaire) EA 4543, Université Paris 1 Panthéon Sorbonne (A.D., E.V.), Paris, the Cardiology Department, Nimes University Hospital, Montpellier University, ACTION Group, Nimes (G.C., B.L.), the Cardiology Department, Pasteur University Hospital, Nice (E.F., N.R.), the Cardiology Department, Hôpitaux de Chartres, ACTION Group, Hôpital Louis Pasteur, Chartres (G.R., C.T.), Cardiology Department, Hôpital Centre François Mitterrand de Pau, Pau (N.D.), Département de Cardiologie, Centre Hospitalo-Universitaire (CHU) La Timone, ACTION Group, Marseille University, INSERM, Marseille (T.C., P.D.), the Cardiology Department, CHU Tours, INSERM Unité 1327 ISCHEMIA, Université de Tours, Tours (F.I.), the Cardiology Department, CHU de Toulouse, Toulouse (T.L.), the Cardiology Department, Clinique du Pont de Chaume, Montauban (T. Petroni), the Heart and Lung Institute, University Hospital of Lille, and Institut Pasteur of Lille, INSERM Unité 1011-EGID, Lille (G.L.), the Cardiology Department, CHU d'Avignon, Avignon (F. Bresoles), the Cardiology Group of the Côte Basque, Bayonne (J.-N.L.), the Cardiology Department, CHU de Dijon Bourgogne, Dijon (T. Pommier), the Cardiology Department, CHU de Montpellier, Montpellier (F.L.), the Cardiology Department, CHU Henri Mondor, Créteil (P.L.), the Cardiology Department, Centre Hospitalier (CH) Métropole-Savoie (Hôpital Chambéry), Chambéry (T.B.H.), the Cardiology Department, Groupe Hospitalier Mutualiste (GHM) de Grenoble, Grenoble (T.F.), the Cardiology Department, CHU d'Auxerre, Auxerre (F.J.), Cardiology Department, CHU Angers et UMR Centre National de la Recherche Scientifique (CNRS) 6015, INSERM Unité 1083 Equipe Physiopathologie Cardiovasculaire, Unité de Formation et de Recherche (UFR) Santé, Angers (A.F.), Grands Prés Cardiac Rehabilitation Centre, St. Denis (R.D.), the Cardiology Department, General Hospital Yves Le Foll, Saint-Brieuc (L.P.), and the Cardiology Department, Grand Hôpital de l'Est Francilien Site Marne-La-Vallée, Jossigny (M.E.K.) - all in France
| | - Thomas Cuisset
- From Sorbonne Université, ACTION Group, INSERM Unité Mixte de Recherche (UMRS) 1166, Hôpital Pitié-Salpêtrière Assistance Publique-Hôpitaux de Paris (AP-HP) (J.S., P.G., N.P., K.A., G.M.), the Department of Cardiology, Hôpital Européen Georges Pompidou, AP-HP, Université Paris Cité (E.P.), FACT (French Alliance for Cardiovascular Trials) (G.L.), the Department of Cardiology, Université Paris Cité, Hôpital Lariboisière, AP-HP, INSERM Unité 942 (J.-G.D.), the Cardiology Department, Hôpital Saint-Antoine, ACTION Group, Sorbonne Université, INSERM UMRS 938 (F. Boccara), the Cardiology Department Hôpital Bichat, AP-HP (M.S.), Unité de Recherche Clinique, ACTION Group, Hôpital Fernand Widal (AP-HP) (A.D., E.V.), and SAMM (Statistique, Analyse et Modélisation Multidisciplinaire) EA 4543, Université Paris 1 Panthéon Sorbonne (A.D., E.V.), Paris, the Cardiology Department, Nimes University Hospital, Montpellier University, ACTION Group, Nimes (G.C., B.L.), the Cardiology Department, Pasteur University Hospital, Nice (E.F., N.R.), the Cardiology Department, Hôpitaux de Chartres, ACTION Group, Hôpital Louis Pasteur, Chartres (G.R., C.T.), Cardiology Department, Hôpital Centre François Mitterrand de Pau, Pau (N.D.), Département de Cardiologie, Centre Hospitalo-Universitaire (CHU) La Timone, ACTION Group, Marseille University, INSERM, Marseille (T.C., P.D.), the Cardiology Department, CHU Tours, INSERM Unité 1327 ISCHEMIA, Université de Tours, Tours (F.I.), the Cardiology Department, CHU de Toulouse, Toulouse (T.L.), the Cardiology Department, Clinique du Pont de Chaume, Montauban (T. Petroni), the Heart and Lung Institute, University Hospital of Lille, and Institut Pasteur of Lille, INSERM Unité 1011-EGID, Lille (G.L.), the Cardiology Department, CHU d'Avignon, Avignon (F. Bresoles), the Cardiology Group of the Côte Basque, Bayonne (J.-N.L.), the Cardiology Department, CHU de Dijon Bourgogne, Dijon (T. Pommier), the Cardiology Department, CHU de Montpellier, Montpellier (F.L.), the Cardiology Department, CHU Henri Mondor, Créteil (P.L.), the Cardiology Department, Centre Hospitalier (CH) Métropole-Savoie (Hôpital Chambéry), Chambéry (T.B.H.), the Cardiology Department, Groupe Hospitalier Mutualiste (GHM) de Grenoble, Grenoble (T.F.), the Cardiology Department, CHU d'Auxerre, Auxerre (F.J.), Cardiology Department, CHU Angers et UMR Centre National de la Recherche Scientifique (CNRS) 6015, INSERM Unité 1083 Equipe Physiopathologie Cardiovasculaire, Unité de Formation et de Recherche (UFR) Santé, Angers (A.F.), Grands Prés Cardiac Rehabilitation Centre, St. Denis (R.D.), the Cardiology Department, General Hospital Yves Le Foll, Saint-Brieuc (L.P.), and the Cardiology Department, Grand Hôpital de l'Est Francilien Site Marne-La-Vallée, Jossigny (M.E.K.) - all in France
| | - Fabrice Ivanes
- From Sorbonne Université, ACTION Group, INSERM Unité Mixte de Recherche (UMRS) 1166, Hôpital Pitié-Salpêtrière Assistance Publique-Hôpitaux de Paris (AP-HP) (J.S., P.G., N.P., K.A., G.M.), the Department of Cardiology, Hôpital Européen Georges Pompidou, AP-HP, Université Paris Cité (E.P.), FACT (French Alliance for Cardiovascular Trials) (G.L.), the Department of Cardiology, Université Paris Cité, Hôpital Lariboisière, AP-HP, INSERM Unité 942 (J.-G.D.), the Cardiology Department, Hôpital Saint-Antoine, ACTION Group, Sorbonne Université, INSERM UMRS 938 (F. Boccara), the Cardiology Department Hôpital Bichat, AP-HP (M.S.), Unité de Recherche Clinique, ACTION Group, Hôpital Fernand Widal (AP-HP) (A.D., E.V.), and SAMM (Statistique, Analyse et Modélisation Multidisciplinaire) EA 4543, Université Paris 1 Panthéon Sorbonne (A.D., E.V.), Paris, the Cardiology Department, Nimes University Hospital, Montpellier University, ACTION Group, Nimes (G.C., B.L.), the Cardiology Department, Pasteur University Hospital, Nice (E.F., N.R.), the Cardiology Department, Hôpitaux de Chartres, ACTION Group, Hôpital Louis Pasteur, Chartres (G.R., C.T.), Cardiology Department, Hôpital Centre François Mitterrand de Pau, Pau (N.D.), Département de Cardiologie, Centre Hospitalo-Universitaire (CHU) La Timone, ACTION Group, Marseille University, INSERM, Marseille (T.C., P.D.), the Cardiology Department, CHU Tours, INSERM Unité 1327 ISCHEMIA, Université de Tours, Tours (F.I.), the Cardiology Department, CHU de Toulouse, Toulouse (T.L.), the Cardiology Department, Clinique du Pont de Chaume, Montauban (T. Petroni), the Heart and Lung Institute, University Hospital of Lille, and Institut Pasteur of Lille, INSERM Unité 1011-EGID, Lille (G.L.), the Cardiology Department, CHU d'Avignon, Avignon (F. Bresoles), the Cardiology Group of the Côte Basque, Bayonne (J.-N.L.), the Cardiology Department, CHU de Dijon Bourgogne, Dijon (T. Pommier), the Cardiology Department, CHU de Montpellier, Montpellier (F.L.), the Cardiology Department, CHU Henri Mondor, Créteil (P.L.), the Cardiology Department, Centre Hospitalier (CH) Métropole-Savoie (Hôpital Chambéry), Chambéry (T.B.H.), the Cardiology Department, Groupe Hospitalier Mutualiste (GHM) de Grenoble, Grenoble (T.F.), the Cardiology Department, CHU d'Auxerre, Auxerre (F.J.), Cardiology Department, CHU Angers et UMR Centre National de la Recherche Scientifique (CNRS) 6015, INSERM Unité 1083 Equipe Physiopathologie Cardiovasculaire, Unité de Formation et de Recherche (UFR) Santé, Angers (A.F.), Grands Prés Cardiac Rehabilitation Centre, St. Denis (R.D.), the Cardiology Department, General Hospital Yves Le Foll, Saint-Brieuc (L.P.), and the Cardiology Department, Grand Hôpital de l'Est Francilien Site Marne-La-Vallée, Jossigny (M.E.K.) - all in France
| | - Thibault Lhermusier
- From Sorbonne Université, ACTION Group, INSERM Unité Mixte de Recherche (UMRS) 1166, Hôpital Pitié-Salpêtrière Assistance Publique-Hôpitaux de Paris (AP-HP) (J.S., P.G., N.P., K.A., G.M.), the Department of Cardiology, Hôpital Européen Georges Pompidou, AP-HP, Université Paris Cité (E.P.), FACT (French Alliance for Cardiovascular Trials) (G.L.), the Department of Cardiology, Université Paris Cité, Hôpital Lariboisière, AP-HP, INSERM Unité 942 (J.-G.D.), the Cardiology Department, Hôpital Saint-Antoine, ACTION Group, Sorbonne Université, INSERM UMRS 938 (F. Boccara), the Cardiology Department Hôpital Bichat, AP-HP (M.S.), Unité de Recherche Clinique, ACTION Group, Hôpital Fernand Widal (AP-HP) (A.D., E.V.), and SAMM (Statistique, Analyse et Modélisation Multidisciplinaire) EA 4543, Université Paris 1 Panthéon Sorbonne (A.D., E.V.), Paris, the Cardiology Department, Nimes University Hospital, Montpellier University, ACTION Group, Nimes (G.C., B.L.), the Cardiology Department, Pasteur University Hospital, Nice (E.F., N.R.), the Cardiology Department, Hôpitaux de Chartres, ACTION Group, Hôpital Louis Pasteur, Chartres (G.R., C.T.), Cardiology Department, Hôpital Centre François Mitterrand de Pau, Pau (N.D.), Département de Cardiologie, Centre Hospitalo-Universitaire (CHU) La Timone, ACTION Group, Marseille University, INSERM, Marseille (T.C., P.D.), the Cardiology Department, CHU Tours, INSERM Unité 1327 ISCHEMIA, Université de Tours, Tours (F.I.), the Cardiology Department, CHU de Toulouse, Toulouse (T.L.), the Cardiology Department, Clinique du Pont de Chaume, Montauban (T. Petroni), the Heart and Lung Institute, University Hospital of Lille, and Institut Pasteur of Lille, INSERM Unité 1011-EGID, Lille (G.L.), the Cardiology Department, CHU d'Avignon, Avignon (F. Bresoles), the Cardiology Group of the Côte Basque, Bayonne (J.-N.L.), the Cardiology Department, CHU de Dijon Bourgogne, Dijon (T. Pommier), the Cardiology Department, CHU de Montpellier, Montpellier (F.L.), the Cardiology Department, CHU Henri Mondor, Créteil (P.L.), the Cardiology Department, Centre Hospitalier (CH) Métropole-Savoie (Hôpital Chambéry), Chambéry (T.B.H.), the Cardiology Department, Groupe Hospitalier Mutualiste (GHM) de Grenoble, Grenoble (T.F.), the Cardiology Department, CHU d'Auxerre, Auxerre (F.J.), Cardiology Department, CHU Angers et UMR Centre National de la Recherche Scientifique (CNRS) 6015, INSERM Unité 1083 Equipe Physiopathologie Cardiovasculaire, Unité de Formation et de Recherche (UFR) Santé, Angers (A.F.), Grands Prés Cardiac Rehabilitation Centre, St. Denis (R.D.), the Cardiology Department, General Hospital Yves Le Foll, Saint-Brieuc (L.P.), and the Cardiology Department, Grand Hôpital de l'Est Francilien Site Marne-La-Vallée, Jossigny (M.E.K.) - all in France
| | - Thibault Petroni
- From Sorbonne Université, ACTION Group, INSERM Unité Mixte de Recherche (UMRS) 1166, Hôpital Pitié-Salpêtrière Assistance Publique-Hôpitaux de Paris (AP-HP) (J.S., P.G., N.P., K.A., G.M.), the Department of Cardiology, Hôpital Européen Georges Pompidou, AP-HP, Université Paris Cité (E.P.), FACT (French Alliance for Cardiovascular Trials) (G.L.), the Department of Cardiology, Université Paris Cité, Hôpital Lariboisière, AP-HP, INSERM Unité 942 (J.-G.D.), the Cardiology Department, Hôpital Saint-Antoine, ACTION Group, Sorbonne Université, INSERM UMRS 938 (F. Boccara), the Cardiology Department Hôpital Bichat, AP-HP (M.S.), Unité de Recherche Clinique, ACTION Group, Hôpital Fernand Widal (AP-HP) (A.D., E.V.), and SAMM (Statistique, Analyse et Modélisation Multidisciplinaire) EA 4543, Université Paris 1 Panthéon Sorbonne (A.D., E.V.), Paris, the Cardiology Department, Nimes University Hospital, Montpellier University, ACTION Group, Nimes (G.C., B.L.), the Cardiology Department, Pasteur University Hospital, Nice (E.F., N.R.), the Cardiology Department, Hôpitaux de Chartres, ACTION Group, Hôpital Louis Pasteur, Chartres (G.R., C.T.), Cardiology Department, Hôpital Centre François Mitterrand de Pau, Pau (N.D.), Département de Cardiologie, Centre Hospitalo-Universitaire (CHU) La Timone, ACTION Group, Marseille University, INSERM, Marseille (T.C., P.D.), the Cardiology Department, CHU Tours, INSERM Unité 1327 ISCHEMIA, Université de Tours, Tours (F.I.), the Cardiology Department, CHU de Toulouse, Toulouse (T.L.), the Cardiology Department, Clinique du Pont de Chaume, Montauban (T. Petroni), the Heart and Lung Institute, University Hospital of Lille, and Institut Pasteur of Lille, INSERM Unité 1011-EGID, Lille (G.L.), the Cardiology Department, CHU d'Avignon, Avignon (F. Bresoles), the Cardiology Group of the Côte Basque, Bayonne (J.-N.L.), the Cardiology Department, CHU de Dijon Bourgogne, Dijon (T. Pommier), the Cardiology Department, CHU de Montpellier, Montpellier (F.L.), the Cardiology Department, CHU Henri Mondor, Créteil (P.L.), the Cardiology Department, Centre Hospitalier (CH) Métropole-Savoie (Hôpital Chambéry), Chambéry (T.B.H.), the Cardiology Department, Groupe Hospitalier Mutualiste (GHM) de Grenoble, Grenoble (T.F.), the Cardiology Department, CHU d'Auxerre, Auxerre (F.J.), Cardiology Department, CHU Angers et UMR Centre National de la Recherche Scientifique (CNRS) 6015, INSERM Unité 1083 Equipe Physiopathologie Cardiovasculaire, Unité de Formation et de Recherche (UFR) Santé, Angers (A.F.), Grands Prés Cardiac Rehabilitation Centre, St. Denis (R.D.), the Cardiology Department, General Hospital Yves Le Foll, Saint-Brieuc (L.P.), and the Cardiology Department, Grand Hôpital de l'Est Francilien Site Marne-La-Vallée, Jossigny (M.E.K.) - all in France
| | - Gilles Lemesle
- From Sorbonne Université, ACTION Group, INSERM Unité Mixte de Recherche (UMRS) 1166, Hôpital Pitié-Salpêtrière Assistance Publique-Hôpitaux de Paris (AP-HP) (J.S., P.G., N.P., K.A., G.M.), the Department of Cardiology, Hôpital Européen Georges Pompidou, AP-HP, Université Paris Cité (E.P.), FACT (French Alliance for Cardiovascular Trials) (G.L.), the Department of Cardiology, Université Paris Cité, Hôpital Lariboisière, AP-HP, INSERM Unité 942 (J.-G.D.), the Cardiology Department, Hôpital Saint-Antoine, ACTION Group, Sorbonne Université, INSERM UMRS 938 (F. Boccara), the Cardiology Department Hôpital Bichat, AP-HP (M.S.), Unité de Recherche Clinique, ACTION Group, Hôpital Fernand Widal (AP-HP) (A.D., E.V.), and SAMM (Statistique, Analyse et Modélisation Multidisciplinaire) EA 4543, Université Paris 1 Panthéon Sorbonne (A.D., E.V.), Paris, the Cardiology Department, Nimes University Hospital, Montpellier University, ACTION Group, Nimes (G.C., B.L.), the Cardiology Department, Pasteur University Hospital, Nice (E.F., N.R.), the Cardiology Department, Hôpitaux de Chartres, ACTION Group, Hôpital Louis Pasteur, Chartres (G.R., C.T.), Cardiology Department, Hôpital Centre François Mitterrand de Pau, Pau (N.D.), Département de Cardiologie, Centre Hospitalo-Universitaire (CHU) La Timone, ACTION Group, Marseille University, INSERM, Marseille (T.C., P.D.), the Cardiology Department, CHU Tours, INSERM Unité 1327 ISCHEMIA, Université de Tours, Tours (F.I.), the Cardiology Department, CHU de Toulouse, Toulouse (T.L.), the Cardiology Department, Clinique du Pont de Chaume, Montauban (T. Petroni), the Heart and Lung Institute, University Hospital of Lille, and Institut Pasteur of Lille, INSERM Unité 1011-EGID, Lille (G.L.), the Cardiology Department, CHU d'Avignon, Avignon (F. Bresoles), the Cardiology Group of the Côte Basque, Bayonne (J.-N.L.), the Cardiology Department, CHU de Dijon Bourgogne, Dijon (T. Pommier), the Cardiology Department, CHU de Montpellier, Montpellier (F.L.), the Cardiology Department, CHU Henri Mondor, Créteil (P.L.), the Cardiology Department, Centre Hospitalier (CH) Métropole-Savoie (Hôpital Chambéry), Chambéry (T.B.H.), the Cardiology Department, Groupe Hospitalier Mutualiste (GHM) de Grenoble, Grenoble (T.F.), the Cardiology Department, CHU d'Auxerre, Auxerre (F.J.), Cardiology Department, CHU Angers et UMR Centre National de la Recherche Scientifique (CNRS) 6015, INSERM Unité 1083 Equipe Physiopathologie Cardiovasculaire, Unité de Formation et de Recherche (UFR) Santé, Angers (A.F.), Grands Prés Cardiac Rehabilitation Centre, St. Denis (R.D.), the Cardiology Department, General Hospital Yves Le Foll, Saint-Brieuc (L.P.), and the Cardiology Department, Grand Hôpital de l'Est Francilien Site Marne-La-Vallée, Jossigny (M.E.K.) - all in France
| | - François Bresoles
- From Sorbonne Université, ACTION Group, INSERM Unité Mixte de Recherche (UMRS) 1166, Hôpital Pitié-Salpêtrière Assistance Publique-Hôpitaux de Paris (AP-HP) (J.S., P.G., N.P., K.A., G.M.), the Department of Cardiology, Hôpital Européen Georges Pompidou, AP-HP, Université Paris Cité (E.P.), FACT (French Alliance for Cardiovascular Trials) (G.L.), the Department of Cardiology, Université Paris Cité, Hôpital Lariboisière, AP-HP, INSERM Unité 942 (J.-G.D.), the Cardiology Department, Hôpital Saint-Antoine, ACTION Group, Sorbonne Université, INSERM UMRS 938 (F. Boccara), the Cardiology Department Hôpital Bichat, AP-HP (M.S.), Unité de Recherche Clinique, ACTION Group, Hôpital Fernand Widal (AP-HP) (A.D., E.V.), and SAMM (Statistique, Analyse et Modélisation Multidisciplinaire) EA 4543, Université Paris 1 Panthéon Sorbonne (A.D., E.V.), Paris, the Cardiology Department, Nimes University Hospital, Montpellier University, ACTION Group, Nimes (G.C., B.L.), the Cardiology Department, Pasteur University Hospital, Nice (E.F., N.R.), the Cardiology Department, Hôpitaux de Chartres, ACTION Group, Hôpital Louis Pasteur, Chartres (G.R., C.T.), Cardiology Department, Hôpital Centre François Mitterrand de Pau, Pau (N.D.), Département de Cardiologie, Centre Hospitalo-Universitaire (CHU) La Timone, ACTION Group, Marseille University, INSERM, Marseille (T.C., P.D.), the Cardiology Department, CHU Tours, INSERM Unité 1327 ISCHEMIA, Université de Tours, Tours (F.I.), the Cardiology Department, CHU de Toulouse, Toulouse (T.L.), the Cardiology Department, Clinique du Pont de Chaume, Montauban (T. Petroni), the Heart and Lung Institute, University Hospital of Lille, and Institut Pasteur of Lille, INSERM Unité 1011-EGID, Lille (G.L.), the Cardiology Department, CHU d'Avignon, Avignon (F. Bresoles), the Cardiology Group of the Côte Basque, Bayonne (J.-N.L.), the Cardiology Department, CHU de Dijon Bourgogne, Dijon (T. Pommier), the Cardiology Department, CHU de Montpellier, Montpellier (F.L.), the Cardiology Department, CHU Henri Mondor, Créteil (P.L.), the Cardiology Department, Centre Hospitalier (CH) Métropole-Savoie (Hôpital Chambéry), Chambéry (T.B.H.), the Cardiology Department, Groupe Hospitalier Mutualiste (GHM) de Grenoble, Grenoble (T.F.), the Cardiology Department, CHU d'Auxerre, Auxerre (F.J.), Cardiology Department, CHU Angers et UMR Centre National de la Recherche Scientifique (CNRS) 6015, INSERM Unité 1083 Equipe Physiopathologie Cardiovasculaire, Unité de Formation et de Recherche (UFR) Santé, Angers (A.F.), Grands Prés Cardiac Rehabilitation Centre, St. Denis (R.D.), the Cardiology Department, General Hospital Yves Le Foll, Saint-Brieuc (L.P.), and the Cardiology Department, Grand Hôpital de l'Est Francilien Site Marne-La-Vallée, Jossigny (M.E.K.) - all in France
| | - Jean-Noël Labeque
- From Sorbonne Université, ACTION Group, INSERM Unité Mixte de Recherche (UMRS) 1166, Hôpital Pitié-Salpêtrière Assistance Publique-Hôpitaux de Paris (AP-HP) (J.S., P.G., N.P., K.A., G.M.), the Department of Cardiology, Hôpital Européen Georges Pompidou, AP-HP, Université Paris Cité (E.P.), FACT (French Alliance for Cardiovascular Trials) (G.L.), the Department of Cardiology, Université Paris Cité, Hôpital Lariboisière, AP-HP, INSERM Unité 942 (J.-G.D.), the Cardiology Department, Hôpital Saint-Antoine, ACTION Group, Sorbonne Université, INSERM UMRS 938 (F. Boccara), the Cardiology Department Hôpital Bichat, AP-HP (M.S.), Unité de Recherche Clinique, ACTION Group, Hôpital Fernand Widal (AP-HP) (A.D., E.V.), and SAMM (Statistique, Analyse et Modélisation Multidisciplinaire) EA 4543, Université Paris 1 Panthéon Sorbonne (A.D., E.V.), Paris, the Cardiology Department, Nimes University Hospital, Montpellier University, ACTION Group, Nimes (G.C., B.L.), the Cardiology Department, Pasteur University Hospital, Nice (E.F., N.R.), the Cardiology Department, Hôpitaux de Chartres, ACTION Group, Hôpital Louis Pasteur, Chartres (G.R., C.T.), Cardiology Department, Hôpital Centre François Mitterrand de Pau, Pau (N.D.), Département de Cardiologie, Centre Hospitalo-Universitaire (CHU) La Timone, ACTION Group, Marseille University, INSERM, Marseille (T.C., P.D.), the Cardiology Department, CHU Tours, INSERM Unité 1327 ISCHEMIA, Université de Tours, Tours (F.I.), the Cardiology Department, CHU de Toulouse, Toulouse (T.L.), the Cardiology Department, Clinique du Pont de Chaume, Montauban (T. Petroni), the Heart and Lung Institute, University Hospital of Lille, and Institut Pasteur of Lille, INSERM Unité 1011-EGID, Lille (G.L.), the Cardiology Department, CHU d'Avignon, Avignon (F. Bresoles), the Cardiology Group of the Côte Basque, Bayonne (J.-N.L.), the Cardiology Department, CHU de Dijon Bourgogne, Dijon (T. Pommier), the Cardiology Department, CHU de Montpellier, Montpellier (F.L.), the Cardiology Department, CHU Henri Mondor, Créteil (P.L.), the Cardiology Department, Centre Hospitalier (CH) Métropole-Savoie (Hôpital Chambéry), Chambéry (T.B.H.), the Cardiology Department, Groupe Hospitalier Mutualiste (GHM) de Grenoble, Grenoble (T.F.), the Cardiology Department, CHU d'Auxerre, Auxerre (F.J.), Cardiology Department, CHU Angers et UMR Centre National de la Recherche Scientifique (CNRS) 6015, INSERM Unité 1083 Equipe Physiopathologie Cardiovasculaire, Unité de Formation et de Recherche (UFR) Santé, Angers (A.F.), Grands Prés Cardiac Rehabilitation Centre, St. Denis (R.D.), the Cardiology Department, General Hospital Yves Le Foll, Saint-Brieuc (L.P.), and the Cardiology Department, Grand Hôpital de l'Est Francilien Site Marne-La-Vallée, Jossigny (M.E.K.) - all in France
| | - Thibaut Pommier
- From Sorbonne Université, ACTION Group, INSERM Unité Mixte de Recherche (UMRS) 1166, Hôpital Pitié-Salpêtrière Assistance Publique-Hôpitaux de Paris (AP-HP) (J.S., P.G., N.P., K.A., G.M.), the Department of Cardiology, Hôpital Européen Georges Pompidou, AP-HP, Université Paris Cité (E.P.), FACT (French Alliance for Cardiovascular Trials) (G.L.), the Department of Cardiology, Université Paris Cité, Hôpital Lariboisière, AP-HP, INSERM Unité 942 (J.-G.D.), the Cardiology Department, Hôpital Saint-Antoine, ACTION Group, Sorbonne Université, INSERM UMRS 938 (F. Boccara), the Cardiology Department Hôpital Bichat, AP-HP (M.S.), Unité de Recherche Clinique, ACTION Group, Hôpital Fernand Widal (AP-HP) (A.D., E.V.), and SAMM (Statistique, Analyse et Modélisation Multidisciplinaire) EA 4543, Université Paris 1 Panthéon Sorbonne (A.D., E.V.), Paris, the Cardiology Department, Nimes University Hospital, Montpellier University, ACTION Group, Nimes (G.C., B.L.), the Cardiology Department, Pasteur University Hospital, Nice (E.F., N.R.), the Cardiology Department, Hôpitaux de Chartres, ACTION Group, Hôpital Louis Pasteur, Chartres (G.R., C.T.), Cardiology Department, Hôpital Centre François Mitterrand de Pau, Pau (N.D.), Département de Cardiologie, Centre Hospitalo-Universitaire (CHU) La Timone, ACTION Group, Marseille University, INSERM, Marseille (T.C., P.D.), the Cardiology Department, CHU Tours, INSERM Unité 1327 ISCHEMIA, Université de Tours, Tours (F.I.), the Cardiology Department, CHU de Toulouse, Toulouse (T.L.), the Cardiology Department, Clinique du Pont de Chaume, Montauban (T. Petroni), the Heart and Lung Institute, University Hospital of Lille, and Institut Pasteur of Lille, INSERM Unité 1011-EGID, Lille (G.L.), the Cardiology Department, CHU d'Avignon, Avignon (F. Bresoles), the Cardiology Group of the Côte Basque, Bayonne (J.-N.L.), the Cardiology Department, CHU de Dijon Bourgogne, Dijon (T. Pommier), the Cardiology Department, CHU de Montpellier, Montpellier (F.L.), the Cardiology Department, CHU Henri Mondor, Créteil (P.L.), the Cardiology Department, Centre Hospitalier (CH) Métropole-Savoie (Hôpital Chambéry), Chambéry (T.B.H.), the Cardiology Department, Groupe Hospitalier Mutualiste (GHM) de Grenoble, Grenoble (T.F.), the Cardiology Department, CHU d'Auxerre, Auxerre (F.J.), Cardiology Department, CHU Angers et UMR Centre National de la Recherche Scientifique (CNRS) 6015, INSERM Unité 1083 Equipe Physiopathologie Cardiovasculaire, Unité de Formation et de Recherche (UFR) Santé, Angers (A.F.), Grands Prés Cardiac Rehabilitation Centre, St. Denis (R.D.), the Cardiology Department, General Hospital Yves Le Foll, Saint-Brieuc (L.P.), and the Cardiology Department, Grand Hôpital de l'Est Francilien Site Marne-La-Vallée, Jossigny (M.E.K.) - all in France
| | - Jean-Guillaume Dillinger
- From Sorbonne Université, ACTION Group, INSERM Unité Mixte de Recherche (UMRS) 1166, Hôpital Pitié-Salpêtrière Assistance Publique-Hôpitaux de Paris (AP-HP) (J.S., P.G., N.P., K.A., G.M.), the Department of Cardiology, Hôpital Européen Georges Pompidou, AP-HP, Université Paris Cité (E.P.), FACT (French Alliance for Cardiovascular Trials) (G.L.), the Department of Cardiology, Université Paris Cité, Hôpital Lariboisière, AP-HP, INSERM Unité 942 (J.-G.D.), the Cardiology Department, Hôpital Saint-Antoine, ACTION Group, Sorbonne Université, INSERM UMRS 938 (F. Boccara), the Cardiology Department Hôpital Bichat, AP-HP (M.S.), Unité de Recherche Clinique, ACTION Group, Hôpital Fernand Widal (AP-HP) (A.D., E.V.), and SAMM (Statistique, Analyse et Modélisation Multidisciplinaire) EA 4543, Université Paris 1 Panthéon Sorbonne (A.D., E.V.), Paris, the Cardiology Department, Nimes University Hospital, Montpellier University, ACTION Group, Nimes (G.C., B.L.), the Cardiology Department, Pasteur University Hospital, Nice (E.F., N.R.), the Cardiology Department, Hôpitaux de Chartres, ACTION Group, Hôpital Louis Pasteur, Chartres (G.R., C.T.), Cardiology Department, Hôpital Centre François Mitterrand de Pau, Pau (N.D.), Département de Cardiologie, Centre Hospitalo-Universitaire (CHU) La Timone, ACTION Group, Marseille University, INSERM, Marseille (T.C., P.D.), the Cardiology Department, CHU Tours, INSERM Unité 1327 ISCHEMIA, Université de Tours, Tours (F.I.), the Cardiology Department, CHU de Toulouse, Toulouse (T.L.), the Cardiology Department, Clinique du Pont de Chaume, Montauban (T. Petroni), the Heart and Lung Institute, University Hospital of Lille, and Institut Pasteur of Lille, INSERM Unité 1011-EGID, Lille (G.L.), the Cardiology Department, CHU d'Avignon, Avignon (F. Bresoles), the Cardiology Group of the Côte Basque, Bayonne (J.-N.L.), the Cardiology Department, CHU de Dijon Bourgogne, Dijon (T. Pommier), the Cardiology Department, CHU de Montpellier, Montpellier (F.L.), the Cardiology Department, CHU Henri Mondor, Créteil (P.L.), the Cardiology Department, Centre Hospitalier (CH) Métropole-Savoie (Hôpital Chambéry), Chambéry (T.B.H.), the Cardiology Department, Groupe Hospitalier Mutualiste (GHM) de Grenoble, Grenoble (T.F.), the Cardiology Department, CHU d'Auxerre, Auxerre (F.J.), Cardiology Department, CHU Angers et UMR Centre National de la Recherche Scientifique (CNRS) 6015, INSERM Unité 1083 Equipe Physiopathologie Cardiovasculaire, Unité de Formation et de Recherche (UFR) Santé, Angers (A.F.), Grands Prés Cardiac Rehabilitation Centre, St. Denis (R.D.), the Cardiology Department, General Hospital Yves Le Foll, Saint-Brieuc (L.P.), and the Cardiology Department, Grand Hôpital de l'Est Francilien Site Marne-La-Vallée, Jossigny (M.E.K.) - all in France
| | - Florence Leclercq
- From Sorbonne Université, ACTION Group, INSERM Unité Mixte de Recherche (UMRS) 1166, Hôpital Pitié-Salpêtrière Assistance Publique-Hôpitaux de Paris (AP-HP) (J.S., P.G., N.P., K.A., G.M.), the Department of Cardiology, Hôpital Européen Georges Pompidou, AP-HP, Université Paris Cité (E.P.), FACT (French Alliance for Cardiovascular Trials) (G.L.), the Department of Cardiology, Université Paris Cité, Hôpital Lariboisière, AP-HP, INSERM Unité 942 (J.-G.D.), the Cardiology Department, Hôpital Saint-Antoine, ACTION Group, Sorbonne Université, INSERM UMRS 938 (F. Boccara), the Cardiology Department Hôpital Bichat, AP-HP (M.S.), Unité de Recherche Clinique, ACTION Group, Hôpital Fernand Widal (AP-HP) (A.D., E.V.), and SAMM (Statistique, Analyse et Modélisation Multidisciplinaire) EA 4543, Université Paris 1 Panthéon Sorbonne (A.D., E.V.), Paris, the Cardiology Department, Nimes University Hospital, Montpellier University, ACTION Group, Nimes (G.C., B.L.), the Cardiology Department, Pasteur University Hospital, Nice (E.F., N.R.), the Cardiology Department, Hôpitaux de Chartres, ACTION Group, Hôpital Louis Pasteur, Chartres (G.R., C.T.), Cardiology Department, Hôpital Centre François Mitterrand de Pau, Pau (N.D.), Département de Cardiologie, Centre Hospitalo-Universitaire (CHU) La Timone, ACTION Group, Marseille University, INSERM, Marseille (T.C., P.D.), the Cardiology Department, CHU Tours, INSERM Unité 1327 ISCHEMIA, Université de Tours, Tours (F.I.), the Cardiology Department, CHU de Toulouse, Toulouse (T.L.), the Cardiology Department, Clinique du Pont de Chaume, Montauban (T. Petroni), the Heart and Lung Institute, University Hospital of Lille, and Institut Pasteur of Lille, INSERM Unité 1011-EGID, Lille (G.L.), the Cardiology Department, CHU d'Avignon, Avignon (F. Bresoles), the Cardiology Group of the Côte Basque, Bayonne (J.-N.L.), the Cardiology Department, CHU de Dijon Bourgogne, Dijon (T. Pommier), the Cardiology Department, CHU de Montpellier, Montpellier (F.L.), the Cardiology Department, CHU Henri Mondor, Créteil (P.L.), the Cardiology Department, Centre Hospitalier (CH) Métropole-Savoie (Hôpital Chambéry), Chambéry (T.B.H.), the Cardiology Department, Groupe Hospitalier Mutualiste (GHM) de Grenoble, Grenoble (T.F.), the Cardiology Department, CHU d'Auxerre, Auxerre (F.J.), Cardiology Department, CHU Angers et UMR Centre National de la Recherche Scientifique (CNRS) 6015, INSERM Unité 1083 Equipe Physiopathologie Cardiovasculaire, Unité de Formation et de Recherche (UFR) Santé, Angers (A.F.), Grands Prés Cardiac Rehabilitation Centre, St. Denis (R.D.), the Cardiology Department, General Hospital Yves Le Foll, Saint-Brieuc (L.P.), and the Cardiology Department, Grand Hôpital de l'Est Francilien Site Marne-La-Vallée, Jossigny (M.E.K.) - all in France
| | - Franck Boccara
- From Sorbonne Université, ACTION Group, INSERM Unité Mixte de Recherche (UMRS) 1166, Hôpital Pitié-Salpêtrière Assistance Publique-Hôpitaux de Paris (AP-HP) (J.S., P.G., N.P., K.A., G.M.), the Department of Cardiology, Hôpital Européen Georges Pompidou, AP-HP, Université Paris Cité (E.P.), FACT (French Alliance for Cardiovascular Trials) (G.L.), the Department of Cardiology, Université Paris Cité, Hôpital Lariboisière, AP-HP, INSERM Unité 942 (J.-G.D.), the Cardiology Department, Hôpital Saint-Antoine, ACTION Group, Sorbonne Université, INSERM UMRS 938 (F. Boccara), the Cardiology Department Hôpital Bichat, AP-HP (M.S.), Unité de Recherche Clinique, ACTION Group, Hôpital Fernand Widal (AP-HP) (A.D., E.V.), and SAMM (Statistique, Analyse et Modélisation Multidisciplinaire) EA 4543, Université Paris 1 Panthéon Sorbonne (A.D., E.V.), Paris, the Cardiology Department, Nimes University Hospital, Montpellier University, ACTION Group, Nimes (G.C., B.L.), the Cardiology Department, Pasteur University Hospital, Nice (E.F., N.R.), the Cardiology Department, Hôpitaux de Chartres, ACTION Group, Hôpital Louis Pasteur, Chartres (G.R., C.T.), Cardiology Department, Hôpital Centre François Mitterrand de Pau, Pau (N.D.), Département de Cardiologie, Centre Hospitalo-Universitaire (CHU) La Timone, ACTION Group, Marseille University, INSERM, Marseille (T.C., P.D.), the Cardiology Department, CHU Tours, INSERM Unité 1327 ISCHEMIA, Université de Tours, Tours (F.I.), the Cardiology Department, CHU de Toulouse, Toulouse (T.L.), the Cardiology Department, Clinique du Pont de Chaume, Montauban (T. Petroni), the Heart and Lung Institute, University Hospital of Lille, and Institut Pasteur of Lille, INSERM Unité 1011-EGID, Lille (G.L.), the Cardiology Department, CHU d'Avignon, Avignon (F. Bresoles), the Cardiology Group of the Côte Basque, Bayonne (J.-N.L.), the Cardiology Department, CHU de Dijon Bourgogne, Dijon (T. Pommier), the Cardiology Department, CHU de Montpellier, Montpellier (F.L.), the Cardiology Department, CHU Henri Mondor, Créteil (P.L.), the Cardiology Department, Centre Hospitalier (CH) Métropole-Savoie (Hôpital Chambéry), Chambéry (T.B.H.), the Cardiology Department, Groupe Hospitalier Mutualiste (GHM) de Grenoble, Grenoble (T.F.), the Cardiology Department, CHU d'Auxerre, Auxerre (F.J.), Cardiology Department, CHU Angers et UMR Centre National de la Recherche Scientifique (CNRS) 6015, INSERM Unité 1083 Equipe Physiopathologie Cardiovasculaire, Unité de Formation et de Recherche (UFR) Santé, Angers (A.F.), Grands Prés Cardiac Rehabilitation Centre, St. Denis (R.D.), the Cardiology Department, General Hospital Yves Le Foll, Saint-Brieuc (L.P.), and the Cardiology Department, Grand Hôpital de l'Est Francilien Site Marne-La-Vallée, Jossigny (M.E.K.) - all in France
| | - Pascal Lim
- From Sorbonne Université, ACTION Group, INSERM Unité Mixte de Recherche (UMRS) 1166, Hôpital Pitié-Salpêtrière Assistance Publique-Hôpitaux de Paris (AP-HP) (J.S., P.G., N.P., K.A., G.M.), the Department of Cardiology, Hôpital Européen Georges Pompidou, AP-HP, Université Paris Cité (E.P.), FACT (French Alliance for Cardiovascular Trials) (G.L.), the Department of Cardiology, Université Paris Cité, Hôpital Lariboisière, AP-HP, INSERM Unité 942 (J.-G.D.), the Cardiology Department, Hôpital Saint-Antoine, ACTION Group, Sorbonne Université, INSERM UMRS 938 (F. Boccara), the Cardiology Department Hôpital Bichat, AP-HP (M.S.), Unité de Recherche Clinique, ACTION Group, Hôpital Fernand Widal (AP-HP) (A.D., E.V.), and SAMM (Statistique, Analyse et Modélisation Multidisciplinaire) EA 4543, Université Paris 1 Panthéon Sorbonne (A.D., E.V.), Paris, the Cardiology Department, Nimes University Hospital, Montpellier University, ACTION Group, Nimes (G.C., B.L.), the Cardiology Department, Pasteur University Hospital, Nice (E.F., N.R.), the Cardiology Department, Hôpitaux de Chartres, ACTION Group, Hôpital Louis Pasteur, Chartres (G.R., C.T.), Cardiology Department, Hôpital Centre François Mitterrand de Pau, Pau (N.D.), Département de Cardiologie, Centre Hospitalo-Universitaire (CHU) La Timone, ACTION Group, Marseille University, INSERM, Marseille (T.C., P.D.), the Cardiology Department, CHU Tours, INSERM Unité 1327 ISCHEMIA, Université de Tours, Tours (F.I.), the Cardiology Department, CHU de Toulouse, Toulouse (T.L.), the Cardiology Department, Clinique du Pont de Chaume, Montauban (T. Petroni), the Heart and Lung Institute, University Hospital of Lille, and Institut Pasteur of Lille, INSERM Unité 1011-EGID, Lille (G.L.), the Cardiology Department, CHU d'Avignon, Avignon (F. Bresoles), the Cardiology Group of the Côte Basque, Bayonne (J.-N.L.), the Cardiology Department, CHU de Dijon Bourgogne, Dijon (T. Pommier), the Cardiology Department, CHU de Montpellier, Montpellier (F.L.), the Cardiology Department, CHU Henri Mondor, Créteil (P.L.), the Cardiology Department, Centre Hospitalier (CH) Métropole-Savoie (Hôpital Chambéry), Chambéry (T.B.H.), the Cardiology Department, Groupe Hospitalier Mutualiste (GHM) de Grenoble, Grenoble (T.F.), the Cardiology Department, CHU d'Auxerre, Auxerre (F.J.), Cardiology Department, CHU Angers et UMR Centre National de la Recherche Scientifique (CNRS) 6015, INSERM Unité 1083 Equipe Physiopathologie Cardiovasculaire, Unité de Formation et de Recherche (UFR) Santé, Angers (A.F.), Grands Prés Cardiac Rehabilitation Centre, St. Denis (R.D.), the Cardiology Department, General Hospital Yves Le Foll, Saint-Brieuc (L.P.), and the Cardiology Department, Grand Hôpital de l'Est Francilien Site Marne-La-Vallée, Jossigny (M.E.K.) - all in France
| | - Timothée Besseyre des Horts
- From Sorbonne Université, ACTION Group, INSERM Unité Mixte de Recherche (UMRS) 1166, Hôpital Pitié-Salpêtrière Assistance Publique-Hôpitaux de Paris (AP-HP) (J.S., P.G., N.P., K.A., G.M.), the Department of Cardiology, Hôpital Européen Georges Pompidou, AP-HP, Université Paris Cité (E.P.), FACT (French Alliance for Cardiovascular Trials) (G.L.), the Department of Cardiology, Université Paris Cité, Hôpital Lariboisière, AP-HP, INSERM Unité 942 (J.-G.D.), the Cardiology Department, Hôpital Saint-Antoine, ACTION Group, Sorbonne Université, INSERM UMRS 938 (F. Boccara), the Cardiology Department Hôpital Bichat, AP-HP (M.S.), Unité de Recherche Clinique, ACTION Group, Hôpital Fernand Widal (AP-HP) (A.D., E.V.), and SAMM (Statistique, Analyse et Modélisation Multidisciplinaire) EA 4543, Université Paris 1 Panthéon Sorbonne (A.D., E.V.), Paris, the Cardiology Department, Nimes University Hospital, Montpellier University, ACTION Group, Nimes (G.C., B.L.), the Cardiology Department, Pasteur University Hospital, Nice (E.F., N.R.), the Cardiology Department, Hôpitaux de Chartres, ACTION Group, Hôpital Louis Pasteur, Chartres (G.R., C.T.), Cardiology Department, Hôpital Centre François Mitterrand de Pau, Pau (N.D.), Département de Cardiologie, Centre Hospitalo-Universitaire (CHU) La Timone, ACTION Group, Marseille University, INSERM, Marseille (T.C., P.D.), the Cardiology Department, CHU Tours, INSERM Unité 1327 ISCHEMIA, Université de Tours, Tours (F.I.), the Cardiology Department, CHU de Toulouse, Toulouse (T.L.), the Cardiology Department, Clinique du Pont de Chaume, Montauban (T. Petroni), the Heart and Lung Institute, University Hospital of Lille, and Institut Pasteur of Lille, INSERM Unité 1011-EGID, Lille (G.L.), the Cardiology Department, CHU d'Avignon, Avignon (F. Bresoles), the Cardiology Group of the Côte Basque, Bayonne (J.-N.L.), the Cardiology Department, CHU de Dijon Bourgogne, Dijon (T. Pommier), the Cardiology Department, CHU de Montpellier, Montpellier (F.L.), the Cardiology Department, CHU Henri Mondor, Créteil (P.L.), the Cardiology Department, Centre Hospitalier (CH) Métropole-Savoie (Hôpital Chambéry), Chambéry (T.B.H.), the Cardiology Department, Groupe Hospitalier Mutualiste (GHM) de Grenoble, Grenoble (T.F.), the Cardiology Department, CHU d'Auxerre, Auxerre (F.J.), Cardiology Department, CHU Angers et UMR Centre National de la Recherche Scientifique (CNRS) 6015, INSERM Unité 1083 Equipe Physiopathologie Cardiovasculaire, Unité de Formation et de Recherche (UFR) Santé, Angers (A.F.), Grands Prés Cardiac Rehabilitation Centre, St. Denis (R.D.), the Cardiology Department, General Hospital Yves Le Foll, Saint-Brieuc (L.P.), and the Cardiology Department, Grand Hôpital de l'Est Francilien Site Marne-La-Vallée, Jossigny (M.E.K.) - all in France
| | - Thierry Fourme
- From Sorbonne Université, ACTION Group, INSERM Unité Mixte de Recherche (UMRS) 1166, Hôpital Pitié-Salpêtrière Assistance Publique-Hôpitaux de Paris (AP-HP) (J.S., P.G., N.P., K.A., G.M.), the Department of Cardiology, Hôpital Européen Georges Pompidou, AP-HP, Université Paris Cité (E.P.), FACT (French Alliance for Cardiovascular Trials) (G.L.), the Department of Cardiology, Université Paris Cité, Hôpital Lariboisière, AP-HP, INSERM Unité 942 (J.-G.D.), the Cardiology Department, Hôpital Saint-Antoine, ACTION Group, Sorbonne Université, INSERM UMRS 938 (F. Boccara), the Cardiology Department Hôpital Bichat, AP-HP (M.S.), Unité de Recherche Clinique, ACTION Group, Hôpital Fernand Widal (AP-HP) (A.D., E.V.), and SAMM (Statistique, Analyse et Modélisation Multidisciplinaire) EA 4543, Université Paris 1 Panthéon Sorbonne (A.D., E.V.), Paris, the Cardiology Department, Nimes University Hospital, Montpellier University, ACTION Group, Nimes (G.C., B.L.), the Cardiology Department, Pasteur University Hospital, Nice (E.F., N.R.), the Cardiology Department, Hôpitaux de Chartres, ACTION Group, Hôpital Louis Pasteur, Chartres (G.R., C.T.), Cardiology Department, Hôpital Centre François Mitterrand de Pau, Pau (N.D.), Département de Cardiologie, Centre Hospitalo-Universitaire (CHU) La Timone, ACTION Group, Marseille University, INSERM, Marseille (T.C., P.D.), the Cardiology Department, CHU Tours, INSERM Unité 1327 ISCHEMIA, Université de Tours, Tours (F.I.), the Cardiology Department, CHU de Toulouse, Toulouse (T.L.), the Cardiology Department, Clinique du Pont de Chaume, Montauban (T. Petroni), the Heart and Lung Institute, University Hospital of Lille, and Institut Pasteur of Lille, INSERM Unité 1011-EGID, Lille (G.L.), the Cardiology Department, CHU d'Avignon, Avignon (F. Bresoles), the Cardiology Group of the Côte Basque, Bayonne (J.-N.L.), the Cardiology Department, CHU de Dijon Bourgogne, Dijon (T. Pommier), the Cardiology Department, CHU de Montpellier, Montpellier (F.L.), the Cardiology Department, CHU Henri Mondor, Créteil (P.L.), the Cardiology Department, Centre Hospitalier (CH) Métropole-Savoie (Hôpital Chambéry), Chambéry (T.B.H.), the Cardiology Department, Groupe Hospitalier Mutualiste (GHM) de Grenoble, Grenoble (T.F.), the Cardiology Department, CHU d'Auxerre, Auxerre (F.J.), Cardiology Department, CHU Angers et UMR Centre National de la Recherche Scientifique (CNRS) 6015, INSERM Unité 1083 Equipe Physiopathologie Cardiovasculaire, Unité de Formation et de Recherche (UFR) Santé, Angers (A.F.), Grands Prés Cardiac Rehabilitation Centre, St. Denis (R.D.), the Cardiology Department, General Hospital Yves Le Foll, Saint-Brieuc (L.P.), and the Cardiology Department, Grand Hôpital de l'Est Francilien Site Marne-La-Vallée, Jossigny (M.E.K.) - all in France
| | - François Jourda
- From Sorbonne Université, ACTION Group, INSERM Unité Mixte de Recherche (UMRS) 1166, Hôpital Pitié-Salpêtrière Assistance Publique-Hôpitaux de Paris (AP-HP) (J.S., P.G., N.P., K.A., G.M.), the Department of Cardiology, Hôpital Européen Georges Pompidou, AP-HP, Université Paris Cité (E.P.), FACT (French Alliance for Cardiovascular Trials) (G.L.), the Department of Cardiology, Université Paris Cité, Hôpital Lariboisière, AP-HP, INSERM Unité 942 (J.-G.D.), the Cardiology Department, Hôpital Saint-Antoine, ACTION Group, Sorbonne Université, INSERM UMRS 938 (F. Boccara), the Cardiology Department Hôpital Bichat, AP-HP (M.S.), Unité de Recherche Clinique, ACTION Group, Hôpital Fernand Widal (AP-HP) (A.D., E.V.), and SAMM (Statistique, Analyse et Modélisation Multidisciplinaire) EA 4543, Université Paris 1 Panthéon Sorbonne (A.D., E.V.), Paris, the Cardiology Department, Nimes University Hospital, Montpellier University, ACTION Group, Nimes (G.C., B.L.), the Cardiology Department, Pasteur University Hospital, Nice (E.F., N.R.), the Cardiology Department, Hôpitaux de Chartres, ACTION Group, Hôpital Louis Pasteur, Chartres (G.R., C.T.), Cardiology Department, Hôpital Centre François Mitterrand de Pau, Pau (N.D.), Département de Cardiologie, Centre Hospitalo-Universitaire (CHU) La Timone, ACTION Group, Marseille University, INSERM, Marseille (T.C., P.D.), the Cardiology Department, CHU Tours, INSERM Unité 1327 ISCHEMIA, Université de Tours, Tours (F.I.), the Cardiology Department, CHU de Toulouse, Toulouse (T.L.), the Cardiology Department, Clinique du Pont de Chaume, Montauban (T. Petroni), the Heart and Lung Institute, University Hospital of Lille, and Institut Pasteur of Lille, INSERM Unité 1011-EGID, Lille (G.L.), the Cardiology Department, CHU d'Avignon, Avignon (F. Bresoles), the Cardiology Group of the Côte Basque, Bayonne (J.-N.L.), the Cardiology Department, CHU de Dijon Bourgogne, Dijon (T. Pommier), the Cardiology Department, CHU de Montpellier, Montpellier (F.L.), the Cardiology Department, CHU Henri Mondor, Créteil (P.L.), the Cardiology Department, Centre Hospitalier (CH) Métropole-Savoie (Hôpital Chambéry), Chambéry (T.B.H.), the Cardiology Department, Groupe Hospitalier Mutualiste (GHM) de Grenoble, Grenoble (T.F.), the Cardiology Department, CHU d'Auxerre, Auxerre (F.J.), Cardiology Department, CHU Angers et UMR Centre National de la Recherche Scientifique (CNRS) 6015, INSERM Unité 1083 Equipe Physiopathologie Cardiovasculaire, Unité de Formation et de Recherche (UFR) Santé, Angers (A.F.), Grands Prés Cardiac Rehabilitation Centre, St. Denis (R.D.), the Cardiology Department, General Hospital Yves Le Foll, Saint-Brieuc (L.P.), and the Cardiology Department, Grand Hôpital de l'Est Francilien Site Marne-La-Vallée, Jossigny (M.E.K.) - all in France
| | - Alain Furber
- From Sorbonne Université, ACTION Group, INSERM Unité Mixte de Recherche (UMRS) 1166, Hôpital Pitié-Salpêtrière Assistance Publique-Hôpitaux de Paris (AP-HP) (J.S., P.G., N.P., K.A., G.M.), the Department of Cardiology, Hôpital Européen Georges Pompidou, AP-HP, Université Paris Cité (E.P.), FACT (French Alliance for Cardiovascular Trials) (G.L.), the Department of Cardiology, Université Paris Cité, Hôpital Lariboisière, AP-HP, INSERM Unité 942 (J.-G.D.), the Cardiology Department, Hôpital Saint-Antoine, ACTION Group, Sorbonne Université, INSERM UMRS 938 (F. Boccara), the Cardiology Department Hôpital Bichat, AP-HP (M.S.), Unité de Recherche Clinique, ACTION Group, Hôpital Fernand Widal (AP-HP) (A.D., E.V.), and SAMM (Statistique, Analyse et Modélisation Multidisciplinaire) EA 4543, Université Paris 1 Panthéon Sorbonne (A.D., E.V.), Paris, the Cardiology Department, Nimes University Hospital, Montpellier University, ACTION Group, Nimes (G.C., B.L.), the Cardiology Department, Pasteur University Hospital, Nice (E.F., N.R.), the Cardiology Department, Hôpitaux de Chartres, ACTION Group, Hôpital Louis Pasteur, Chartres (G.R., C.T.), Cardiology Department, Hôpital Centre François Mitterrand de Pau, Pau (N.D.), Département de Cardiologie, Centre Hospitalo-Universitaire (CHU) La Timone, ACTION Group, Marseille University, INSERM, Marseille (T.C., P.D.), the Cardiology Department, CHU Tours, INSERM Unité 1327 ISCHEMIA, Université de Tours, Tours (F.I.), the Cardiology Department, CHU de Toulouse, Toulouse (T.L.), the Cardiology Department, Clinique du Pont de Chaume, Montauban (T. Petroni), the Heart and Lung Institute, University Hospital of Lille, and Institut Pasteur of Lille, INSERM Unité 1011-EGID, Lille (G.L.), the Cardiology Department, CHU d'Avignon, Avignon (F. Bresoles), the Cardiology Group of the Côte Basque, Bayonne (J.-N.L.), the Cardiology Department, CHU de Dijon Bourgogne, Dijon (T. Pommier), the Cardiology Department, CHU de Montpellier, Montpellier (F.L.), the Cardiology Department, CHU Henri Mondor, Créteil (P.L.), the Cardiology Department, Centre Hospitalier (CH) Métropole-Savoie (Hôpital Chambéry), Chambéry (T.B.H.), the Cardiology Department, Groupe Hospitalier Mutualiste (GHM) de Grenoble, Grenoble (T.F.), the Cardiology Department, CHU d'Auxerre, Auxerre (F.J.), Cardiology Department, CHU Angers et UMR Centre National de la Recherche Scientifique (CNRS) 6015, INSERM Unité 1083 Equipe Physiopathologie Cardiovasculaire, Unité de Formation et de Recherche (UFR) Santé, Angers (A.F.), Grands Prés Cardiac Rehabilitation Centre, St. Denis (R.D.), the Cardiology Department, General Hospital Yves Le Foll, Saint-Brieuc (L.P.), and the Cardiology Department, Grand Hôpital de l'Est Francilien Site Marne-La-Vallée, Jossigny (M.E.K.) - all in France
| | - Benoit Lattuca
- From Sorbonne Université, ACTION Group, INSERM Unité Mixte de Recherche (UMRS) 1166, Hôpital Pitié-Salpêtrière Assistance Publique-Hôpitaux de Paris (AP-HP) (J.S., P.G., N.P., K.A., G.M.), the Department of Cardiology, Hôpital Européen Georges Pompidou, AP-HP, Université Paris Cité (E.P.), FACT (French Alliance for Cardiovascular Trials) (G.L.), the Department of Cardiology, Université Paris Cité, Hôpital Lariboisière, AP-HP, INSERM Unité 942 (J.-G.D.), the Cardiology Department, Hôpital Saint-Antoine, ACTION Group, Sorbonne Université, INSERM UMRS 938 (F. Boccara), the Cardiology Department Hôpital Bichat, AP-HP (M.S.), Unité de Recherche Clinique, ACTION Group, Hôpital Fernand Widal (AP-HP) (A.D., E.V.), and SAMM (Statistique, Analyse et Modélisation Multidisciplinaire) EA 4543, Université Paris 1 Panthéon Sorbonne (A.D., E.V.), Paris, the Cardiology Department, Nimes University Hospital, Montpellier University, ACTION Group, Nimes (G.C., B.L.), the Cardiology Department, Pasteur University Hospital, Nice (E.F., N.R.), the Cardiology Department, Hôpitaux de Chartres, ACTION Group, Hôpital Louis Pasteur, Chartres (G.R., C.T.), Cardiology Department, Hôpital Centre François Mitterrand de Pau, Pau (N.D.), Département de Cardiologie, Centre Hospitalo-Universitaire (CHU) La Timone, ACTION Group, Marseille University, INSERM, Marseille (T.C., P.D.), the Cardiology Department, CHU Tours, INSERM Unité 1327 ISCHEMIA, Université de Tours, Tours (F.I.), the Cardiology Department, CHU de Toulouse, Toulouse (T.L.), the Cardiology Department, Clinique du Pont de Chaume, Montauban (T. Petroni), the Heart and Lung Institute, University Hospital of Lille, and Institut Pasteur of Lille, INSERM Unité 1011-EGID, Lille (G.L.), the Cardiology Department, CHU d'Avignon, Avignon (F. Bresoles), the Cardiology Group of the Côte Basque, Bayonne (J.-N.L.), the Cardiology Department, CHU de Dijon Bourgogne, Dijon (T. Pommier), the Cardiology Department, CHU de Montpellier, Montpellier (F.L.), the Cardiology Department, CHU Henri Mondor, Créteil (P.L.), the Cardiology Department, Centre Hospitalier (CH) Métropole-Savoie (Hôpital Chambéry), Chambéry (T.B.H.), the Cardiology Department, Groupe Hospitalier Mutualiste (GHM) de Grenoble, Grenoble (T.F.), the Cardiology Department, CHU d'Auxerre, Auxerre (F.J.), Cardiology Department, CHU Angers et UMR Centre National de la Recherche Scientifique (CNRS) 6015, INSERM Unité 1083 Equipe Physiopathologie Cardiovasculaire, Unité de Formation et de Recherche (UFR) Santé, Angers (A.F.), Grands Prés Cardiac Rehabilitation Centre, St. Denis (R.D.), the Cardiology Department, General Hospital Yves Le Foll, Saint-Brieuc (L.P.), and the Cardiology Department, Grand Hôpital de l'Est Francilien Site Marne-La-Vallée, Jossigny (M.E.K.) - all in France
| | - Nassim Redjimi
- From Sorbonne Université, ACTION Group, INSERM Unité Mixte de Recherche (UMRS) 1166, Hôpital Pitié-Salpêtrière Assistance Publique-Hôpitaux de Paris (AP-HP) (J.S., P.G., N.P., K.A., G.M.), the Department of Cardiology, Hôpital Européen Georges Pompidou, AP-HP, Université Paris Cité (E.P.), FACT (French Alliance for Cardiovascular Trials) (G.L.), the Department of Cardiology, Université Paris Cité, Hôpital Lariboisière, AP-HP, INSERM Unité 942 (J.-G.D.), the Cardiology Department, Hôpital Saint-Antoine, ACTION Group, Sorbonne Université, INSERM UMRS 938 (F. Boccara), the Cardiology Department Hôpital Bichat, AP-HP (M.S.), Unité de Recherche Clinique, ACTION Group, Hôpital Fernand Widal (AP-HP) (A.D., E.V.), and SAMM (Statistique, Analyse et Modélisation Multidisciplinaire) EA 4543, Université Paris 1 Panthéon Sorbonne (A.D., E.V.), Paris, the Cardiology Department, Nimes University Hospital, Montpellier University, ACTION Group, Nimes (G.C., B.L.), the Cardiology Department, Pasteur University Hospital, Nice (E.F., N.R.), the Cardiology Department, Hôpitaux de Chartres, ACTION Group, Hôpital Louis Pasteur, Chartres (G.R., C.T.), Cardiology Department, Hôpital Centre François Mitterrand de Pau, Pau (N.D.), Département de Cardiologie, Centre Hospitalo-Universitaire (CHU) La Timone, ACTION Group, Marseille University, INSERM, Marseille (T.C., P.D.), the Cardiology Department, CHU Tours, INSERM Unité 1327 ISCHEMIA, Université de Tours, Tours (F.I.), the Cardiology Department, CHU de Toulouse, Toulouse (T.L.), the Cardiology Department, Clinique du Pont de Chaume, Montauban (T. Petroni), the Heart and Lung Institute, University Hospital of Lille, and Institut Pasteur of Lille, INSERM Unité 1011-EGID, Lille (G.L.), the Cardiology Department, CHU d'Avignon, Avignon (F. Bresoles), the Cardiology Group of the Côte Basque, Bayonne (J.-N.L.), the Cardiology Department, CHU de Dijon Bourgogne, Dijon (T. Pommier), the Cardiology Department, CHU de Montpellier, Montpellier (F.L.), the Cardiology Department, CHU Henri Mondor, Créteil (P.L.), the Cardiology Department, Centre Hospitalier (CH) Métropole-Savoie (Hôpital Chambéry), Chambéry (T.B.H.), the Cardiology Department, Groupe Hospitalier Mutualiste (GHM) de Grenoble, Grenoble (T.F.), the Cardiology Department, CHU d'Auxerre, Auxerre (F.J.), Cardiology Department, CHU Angers et UMR Centre National de la Recherche Scientifique (CNRS) 6015, INSERM Unité 1083 Equipe Physiopathologie Cardiovasculaire, Unité de Formation et de Recherche (UFR) Santé, Angers (A.F.), Grands Prés Cardiac Rehabilitation Centre, St. Denis (R.D.), the Cardiology Department, General Hospital Yves Le Foll, Saint-Brieuc (L.P.), and the Cardiology Department, Grand Hôpital de l'Est Francilien Site Marne-La-Vallée, Jossigny (M.E.K.) - all in France
| | - Christophe Thuaire
- From Sorbonne Université, ACTION Group, INSERM Unité Mixte de Recherche (UMRS) 1166, Hôpital Pitié-Salpêtrière Assistance Publique-Hôpitaux de Paris (AP-HP) (J.S., P.G., N.P., K.A., G.M.), the Department of Cardiology, Hôpital Européen Georges Pompidou, AP-HP, Université Paris Cité (E.P.), FACT (French Alliance for Cardiovascular Trials) (G.L.), the Department of Cardiology, Université Paris Cité, Hôpital Lariboisière, AP-HP, INSERM Unité 942 (J.-G.D.), the Cardiology Department, Hôpital Saint-Antoine, ACTION Group, Sorbonne Université, INSERM UMRS 938 (F. Boccara), the Cardiology Department Hôpital Bichat, AP-HP (M.S.), Unité de Recherche Clinique, ACTION Group, Hôpital Fernand Widal (AP-HP) (A.D., E.V.), and SAMM (Statistique, Analyse et Modélisation Multidisciplinaire) EA 4543, Université Paris 1 Panthéon Sorbonne (A.D., E.V.), Paris, the Cardiology Department, Nimes University Hospital, Montpellier University, ACTION Group, Nimes (G.C., B.L.), the Cardiology Department, Pasteur University Hospital, Nice (E.F., N.R.), the Cardiology Department, Hôpitaux de Chartres, ACTION Group, Hôpital Louis Pasteur, Chartres (G.R., C.T.), Cardiology Department, Hôpital Centre François Mitterrand de Pau, Pau (N.D.), Département de Cardiologie, Centre Hospitalo-Universitaire (CHU) La Timone, ACTION Group, Marseille University, INSERM, Marseille (T.C., P.D.), the Cardiology Department, CHU Tours, INSERM Unité 1327 ISCHEMIA, Université de Tours, Tours (F.I.), the Cardiology Department, CHU de Toulouse, Toulouse (T.L.), the Cardiology Department, Clinique du Pont de Chaume, Montauban (T. Petroni), the Heart and Lung Institute, University Hospital of Lille, and Institut Pasteur of Lille, INSERM Unité 1011-EGID, Lille (G.L.), the Cardiology Department, CHU d'Avignon, Avignon (F. Bresoles), the Cardiology Group of the Côte Basque, Bayonne (J.-N.L.), the Cardiology Department, CHU de Dijon Bourgogne, Dijon (T. Pommier), the Cardiology Department, CHU de Montpellier, Montpellier (F.L.), the Cardiology Department, CHU Henri Mondor, Créteil (P.L.), the Cardiology Department, Centre Hospitalier (CH) Métropole-Savoie (Hôpital Chambéry), Chambéry (T.B.H.), the Cardiology Department, Groupe Hospitalier Mutualiste (GHM) de Grenoble, Grenoble (T.F.), the Cardiology Department, CHU d'Auxerre, Auxerre (F.J.), Cardiology Department, CHU Angers et UMR Centre National de la Recherche Scientifique (CNRS) 6015, INSERM Unité 1083 Equipe Physiopathologie Cardiovasculaire, Unité de Formation et de Recherche (UFR) Santé, Angers (A.F.), Grands Prés Cardiac Rehabilitation Centre, St. Denis (R.D.), the Cardiology Department, General Hospital Yves Le Foll, Saint-Brieuc (L.P.), and the Cardiology Department, Grand Hôpital de l'Est Francilien Site Marne-La-Vallée, Jossigny (M.E.K.) - all in France
| | - Pierre Deharo
- From Sorbonne Université, ACTION Group, INSERM Unité Mixte de Recherche (UMRS) 1166, Hôpital Pitié-Salpêtrière Assistance Publique-Hôpitaux de Paris (AP-HP) (J.S., P.G., N.P., K.A., G.M.), the Department of Cardiology, Hôpital Européen Georges Pompidou, AP-HP, Université Paris Cité (E.P.), FACT (French Alliance for Cardiovascular Trials) (G.L.), the Department of Cardiology, Université Paris Cité, Hôpital Lariboisière, AP-HP, INSERM Unité 942 (J.-G.D.), the Cardiology Department, Hôpital Saint-Antoine, ACTION Group, Sorbonne Université, INSERM UMRS 938 (F. Boccara), the Cardiology Department Hôpital Bichat, AP-HP (M.S.), Unité de Recherche Clinique, ACTION Group, Hôpital Fernand Widal (AP-HP) (A.D., E.V.), and SAMM (Statistique, Analyse et Modélisation Multidisciplinaire) EA 4543, Université Paris 1 Panthéon Sorbonne (A.D., E.V.), Paris, the Cardiology Department, Nimes University Hospital, Montpellier University, ACTION Group, Nimes (G.C., B.L.), the Cardiology Department, Pasteur University Hospital, Nice (E.F., N.R.), the Cardiology Department, Hôpitaux de Chartres, ACTION Group, Hôpital Louis Pasteur, Chartres (G.R., C.T.), Cardiology Department, Hôpital Centre François Mitterrand de Pau, Pau (N.D.), Département de Cardiologie, Centre Hospitalo-Universitaire (CHU) La Timone, ACTION Group, Marseille University, INSERM, Marseille (T.C., P.D.), the Cardiology Department, CHU Tours, INSERM Unité 1327 ISCHEMIA, Université de Tours, Tours (F.I.), the Cardiology Department, CHU de Toulouse, Toulouse (T.L.), the Cardiology Department, Clinique du Pont de Chaume, Montauban (T. Petroni), the Heart and Lung Institute, University Hospital of Lille, and Institut Pasteur of Lille, INSERM Unité 1011-EGID, Lille (G.L.), the Cardiology Department, CHU d'Avignon, Avignon (F. Bresoles), the Cardiology Group of the Côte Basque, Bayonne (J.-N.L.), the Cardiology Department, CHU de Dijon Bourgogne, Dijon (T. Pommier), the Cardiology Department, CHU de Montpellier, Montpellier (F.L.), the Cardiology Department, CHU Henri Mondor, Créteil (P.L.), the Cardiology Department, Centre Hospitalier (CH) Métropole-Savoie (Hôpital Chambéry), Chambéry (T.B.H.), the Cardiology Department, Groupe Hospitalier Mutualiste (GHM) de Grenoble, Grenoble (T.F.), the Cardiology Department, CHU d'Auxerre, Auxerre (F.J.), Cardiology Department, CHU Angers et UMR Centre National de la Recherche Scientifique (CNRS) 6015, INSERM Unité 1083 Equipe Physiopathologie Cardiovasculaire, Unité de Formation et de Recherche (UFR) Santé, Angers (A.F.), Grands Prés Cardiac Rehabilitation Centre, St. Denis (R.D.), the Cardiology Department, General Hospital Yves Le Foll, Saint-Brieuc (L.P.), and the Cardiology Department, Grand Hôpital de l'Est Francilien Site Marne-La-Vallée, Jossigny (M.E.K.) - all in France
| | - Niki Procopi
- From Sorbonne Université, ACTION Group, INSERM Unité Mixte de Recherche (UMRS) 1166, Hôpital Pitié-Salpêtrière Assistance Publique-Hôpitaux de Paris (AP-HP) (J.S., P.G., N.P., K.A., G.M.), the Department of Cardiology, Hôpital Européen Georges Pompidou, AP-HP, Université Paris Cité (E.P.), FACT (French Alliance for Cardiovascular Trials) (G.L.), the Department of Cardiology, Université Paris Cité, Hôpital Lariboisière, AP-HP, INSERM Unité 942 (J.-G.D.), the Cardiology Department, Hôpital Saint-Antoine, ACTION Group, Sorbonne Université, INSERM UMRS 938 (F. Boccara), the Cardiology Department Hôpital Bichat, AP-HP (M.S.), Unité de Recherche Clinique, ACTION Group, Hôpital Fernand Widal (AP-HP) (A.D., E.V.), and SAMM (Statistique, Analyse et Modélisation Multidisciplinaire) EA 4543, Université Paris 1 Panthéon Sorbonne (A.D., E.V.), Paris, the Cardiology Department, Nimes University Hospital, Montpellier University, ACTION Group, Nimes (G.C., B.L.), the Cardiology Department, Pasteur University Hospital, Nice (E.F., N.R.), the Cardiology Department, Hôpitaux de Chartres, ACTION Group, Hôpital Louis Pasteur, Chartres (G.R., C.T.), Cardiology Department, Hôpital Centre François Mitterrand de Pau, Pau (N.D.), Département de Cardiologie, Centre Hospitalo-Universitaire (CHU) La Timone, ACTION Group, Marseille University, INSERM, Marseille (T.C., P.D.), the Cardiology Department, CHU Tours, INSERM Unité 1327 ISCHEMIA, Université de Tours, Tours (F.I.), the Cardiology Department, CHU de Toulouse, Toulouse (T.L.), the Cardiology Department, Clinique du Pont de Chaume, Montauban (T. Petroni), the Heart and Lung Institute, University Hospital of Lille, and Institut Pasteur of Lille, INSERM Unité 1011-EGID, Lille (G.L.), the Cardiology Department, CHU d'Avignon, Avignon (F. Bresoles), the Cardiology Group of the Côte Basque, Bayonne (J.-N.L.), the Cardiology Department, CHU de Dijon Bourgogne, Dijon (T. Pommier), the Cardiology Department, CHU de Montpellier, Montpellier (F.L.), the Cardiology Department, CHU Henri Mondor, Créteil (P.L.), the Cardiology Department, Centre Hospitalier (CH) Métropole-Savoie (Hôpital Chambéry), Chambéry (T.B.H.), the Cardiology Department, Groupe Hospitalier Mutualiste (GHM) de Grenoble, Grenoble (T.F.), the Cardiology Department, CHU d'Auxerre, Auxerre (F.J.), Cardiology Department, CHU Angers et UMR Centre National de la Recherche Scientifique (CNRS) 6015, INSERM Unité 1083 Equipe Physiopathologie Cardiovasculaire, Unité de Formation et de Recherche (UFR) Santé, Angers (A.F.), Grands Prés Cardiac Rehabilitation Centre, St. Denis (R.D.), the Cardiology Department, General Hospital Yves Le Foll, Saint-Brieuc (L.P.), and the Cardiology Department, Grand Hôpital de l'Est Francilien Site Marne-La-Vallée, Jossigny (M.E.K.) - all in France
| | - Raphaelle Dumaine
- From Sorbonne Université, ACTION Group, INSERM Unité Mixte de Recherche (UMRS) 1166, Hôpital Pitié-Salpêtrière Assistance Publique-Hôpitaux de Paris (AP-HP) (J.S., P.G., N.P., K.A., G.M.), the Department of Cardiology, Hôpital Européen Georges Pompidou, AP-HP, Université Paris Cité (E.P.), FACT (French Alliance for Cardiovascular Trials) (G.L.), the Department of Cardiology, Université Paris Cité, Hôpital Lariboisière, AP-HP, INSERM Unité 942 (J.-G.D.), the Cardiology Department, Hôpital Saint-Antoine, ACTION Group, Sorbonne Université, INSERM UMRS 938 (F. Boccara), the Cardiology Department Hôpital Bichat, AP-HP (M.S.), Unité de Recherche Clinique, ACTION Group, Hôpital Fernand Widal (AP-HP) (A.D., E.V.), and SAMM (Statistique, Analyse et Modélisation Multidisciplinaire) EA 4543, Université Paris 1 Panthéon Sorbonne (A.D., E.V.), Paris, the Cardiology Department, Nimes University Hospital, Montpellier University, ACTION Group, Nimes (G.C., B.L.), the Cardiology Department, Pasteur University Hospital, Nice (E.F., N.R.), the Cardiology Department, Hôpitaux de Chartres, ACTION Group, Hôpital Louis Pasteur, Chartres (G.R., C.T.), Cardiology Department, Hôpital Centre François Mitterrand de Pau, Pau (N.D.), Département de Cardiologie, Centre Hospitalo-Universitaire (CHU) La Timone, ACTION Group, Marseille University, INSERM, Marseille (T.C., P.D.), the Cardiology Department, CHU Tours, INSERM Unité 1327 ISCHEMIA, Université de Tours, Tours (F.I.), the Cardiology Department, CHU de Toulouse, Toulouse (T.L.), the Cardiology Department, Clinique du Pont de Chaume, Montauban (T. Petroni), the Heart and Lung Institute, University Hospital of Lille, and Institut Pasteur of Lille, INSERM Unité 1011-EGID, Lille (G.L.), the Cardiology Department, CHU d'Avignon, Avignon (F. Bresoles), the Cardiology Group of the Côte Basque, Bayonne (J.-N.L.), the Cardiology Department, CHU de Dijon Bourgogne, Dijon (T. Pommier), the Cardiology Department, CHU de Montpellier, Montpellier (F.L.), the Cardiology Department, CHU Henri Mondor, Créteil (P.L.), the Cardiology Department, Centre Hospitalier (CH) Métropole-Savoie (Hôpital Chambéry), Chambéry (T.B.H.), the Cardiology Department, Groupe Hospitalier Mutualiste (GHM) de Grenoble, Grenoble (T.F.), the Cardiology Department, CHU d'Auxerre, Auxerre (F.J.), Cardiology Department, CHU Angers et UMR Centre National de la Recherche Scientifique (CNRS) 6015, INSERM Unité 1083 Equipe Physiopathologie Cardiovasculaire, Unité de Formation et de Recherche (UFR) Santé, Angers (A.F.), Grands Prés Cardiac Rehabilitation Centre, St. Denis (R.D.), the Cardiology Department, General Hospital Yves Le Foll, Saint-Brieuc (L.P.), and the Cardiology Department, Grand Hôpital de l'Est Francilien Site Marne-La-Vallée, Jossigny (M.E.K.) - all in France
| | - Michel Slama
- From Sorbonne Université, ACTION Group, INSERM Unité Mixte de Recherche (UMRS) 1166, Hôpital Pitié-Salpêtrière Assistance Publique-Hôpitaux de Paris (AP-HP) (J.S., P.G., N.P., K.A., G.M.), the Department of Cardiology, Hôpital Européen Georges Pompidou, AP-HP, Université Paris Cité (E.P.), FACT (French Alliance for Cardiovascular Trials) (G.L.), the Department of Cardiology, Université Paris Cité, Hôpital Lariboisière, AP-HP, INSERM Unité 942 (J.-G.D.), the Cardiology Department, Hôpital Saint-Antoine, ACTION Group, Sorbonne Université, INSERM UMRS 938 (F. Boccara), the Cardiology Department Hôpital Bichat, AP-HP (M.S.), Unité de Recherche Clinique, ACTION Group, Hôpital Fernand Widal (AP-HP) (A.D., E.V.), and SAMM (Statistique, Analyse et Modélisation Multidisciplinaire) EA 4543, Université Paris 1 Panthéon Sorbonne (A.D., E.V.), Paris, the Cardiology Department, Nimes University Hospital, Montpellier University, ACTION Group, Nimes (G.C., B.L.), the Cardiology Department, Pasteur University Hospital, Nice (E.F., N.R.), the Cardiology Department, Hôpitaux de Chartres, ACTION Group, Hôpital Louis Pasteur, Chartres (G.R., C.T.), Cardiology Department, Hôpital Centre François Mitterrand de Pau, Pau (N.D.), Département de Cardiologie, Centre Hospitalo-Universitaire (CHU) La Timone, ACTION Group, Marseille University, INSERM, Marseille (T.C., P.D.), the Cardiology Department, CHU Tours, INSERM Unité 1327 ISCHEMIA, Université de Tours, Tours (F.I.), the Cardiology Department, CHU de Toulouse, Toulouse (T.L.), the Cardiology Department, Clinique du Pont de Chaume, Montauban (T. Petroni), the Heart and Lung Institute, University Hospital of Lille, and Institut Pasteur of Lille, INSERM Unité 1011-EGID, Lille (G.L.), the Cardiology Department, CHU d'Avignon, Avignon (F. Bresoles), the Cardiology Group of the Côte Basque, Bayonne (J.-N.L.), the Cardiology Department, CHU de Dijon Bourgogne, Dijon (T. Pommier), the Cardiology Department, CHU de Montpellier, Montpellier (F.L.), the Cardiology Department, CHU Henri Mondor, Créteil (P.L.), the Cardiology Department, Centre Hospitalier (CH) Métropole-Savoie (Hôpital Chambéry), Chambéry (T.B.H.), the Cardiology Department, Groupe Hospitalier Mutualiste (GHM) de Grenoble, Grenoble (T.F.), the Cardiology Department, CHU d'Auxerre, Auxerre (F.J.), Cardiology Department, CHU Angers et UMR Centre National de la Recherche Scientifique (CNRS) 6015, INSERM Unité 1083 Equipe Physiopathologie Cardiovasculaire, Unité de Formation et de Recherche (UFR) Santé, Angers (A.F.), Grands Prés Cardiac Rehabilitation Centre, St. Denis (R.D.), the Cardiology Department, General Hospital Yves Le Foll, Saint-Brieuc (L.P.), and the Cardiology Department, Grand Hôpital de l'Est Francilien Site Marne-La-Vallée, Jossigny (M.E.K.) - all in France
| | - Laurent Payot
- From Sorbonne Université, ACTION Group, INSERM Unité Mixte de Recherche (UMRS) 1166, Hôpital Pitié-Salpêtrière Assistance Publique-Hôpitaux de Paris (AP-HP) (J.S., P.G., N.P., K.A., G.M.), the Department of Cardiology, Hôpital Européen Georges Pompidou, AP-HP, Université Paris Cité (E.P.), FACT (French Alliance for Cardiovascular Trials) (G.L.), the Department of Cardiology, Université Paris Cité, Hôpital Lariboisière, AP-HP, INSERM Unité 942 (J.-G.D.), the Cardiology Department, Hôpital Saint-Antoine, ACTION Group, Sorbonne Université, INSERM UMRS 938 (F. Boccara), the Cardiology Department Hôpital Bichat, AP-HP (M.S.), Unité de Recherche Clinique, ACTION Group, Hôpital Fernand Widal (AP-HP) (A.D., E.V.), and SAMM (Statistique, Analyse et Modélisation Multidisciplinaire) EA 4543, Université Paris 1 Panthéon Sorbonne (A.D., E.V.), Paris, the Cardiology Department, Nimes University Hospital, Montpellier University, ACTION Group, Nimes (G.C., B.L.), the Cardiology Department, Pasteur University Hospital, Nice (E.F., N.R.), the Cardiology Department, Hôpitaux de Chartres, ACTION Group, Hôpital Louis Pasteur, Chartres (G.R., C.T.), Cardiology Department, Hôpital Centre François Mitterrand de Pau, Pau (N.D.), Département de Cardiologie, Centre Hospitalo-Universitaire (CHU) La Timone, ACTION Group, Marseille University, INSERM, Marseille (T.C., P.D.), the Cardiology Department, CHU Tours, INSERM Unité 1327 ISCHEMIA, Université de Tours, Tours (F.I.), the Cardiology Department, CHU de Toulouse, Toulouse (T.L.), the Cardiology Department, Clinique du Pont de Chaume, Montauban (T. Petroni), the Heart and Lung Institute, University Hospital of Lille, and Institut Pasteur of Lille, INSERM Unité 1011-EGID, Lille (G.L.), the Cardiology Department, CHU d'Avignon, Avignon (F. Bresoles), the Cardiology Group of the Côte Basque, Bayonne (J.-N.L.), the Cardiology Department, CHU de Dijon Bourgogne, Dijon (T. Pommier), the Cardiology Department, CHU de Montpellier, Montpellier (F.L.), the Cardiology Department, CHU Henri Mondor, Créteil (P.L.), the Cardiology Department, Centre Hospitalier (CH) Métropole-Savoie (Hôpital Chambéry), Chambéry (T.B.H.), the Cardiology Department, Groupe Hospitalier Mutualiste (GHM) de Grenoble, Grenoble (T.F.), the Cardiology Department, CHU d'Auxerre, Auxerre (F.J.), Cardiology Department, CHU Angers et UMR Centre National de la Recherche Scientifique (CNRS) 6015, INSERM Unité 1083 Equipe Physiopathologie Cardiovasculaire, Unité de Formation et de Recherche (UFR) Santé, Angers (A.F.), Grands Prés Cardiac Rehabilitation Centre, St. Denis (R.D.), the Cardiology Department, General Hospital Yves Le Foll, Saint-Brieuc (L.P.), and the Cardiology Department, Grand Hôpital de l'Est Francilien Site Marne-La-Vallée, Jossigny (M.E.K.) - all in France
| | - Mohamad El Kasty
- From Sorbonne Université, ACTION Group, INSERM Unité Mixte de Recherche (UMRS) 1166, Hôpital Pitié-Salpêtrière Assistance Publique-Hôpitaux de Paris (AP-HP) (J.S., P.G., N.P., K.A., G.M.), the Department of Cardiology, Hôpital Européen Georges Pompidou, AP-HP, Université Paris Cité (E.P.), FACT (French Alliance for Cardiovascular Trials) (G.L.), the Department of Cardiology, Université Paris Cité, Hôpital Lariboisière, AP-HP, INSERM Unité 942 (J.-G.D.), the Cardiology Department, Hôpital Saint-Antoine, ACTION Group, Sorbonne Université, INSERM UMRS 938 (F. Boccara), the Cardiology Department Hôpital Bichat, AP-HP (M.S.), Unité de Recherche Clinique, ACTION Group, Hôpital Fernand Widal (AP-HP) (A.D., E.V.), and SAMM (Statistique, Analyse et Modélisation Multidisciplinaire) EA 4543, Université Paris 1 Panthéon Sorbonne (A.D., E.V.), Paris, the Cardiology Department, Nimes University Hospital, Montpellier University, ACTION Group, Nimes (G.C., B.L.), the Cardiology Department, Pasteur University Hospital, Nice (E.F., N.R.), the Cardiology Department, Hôpitaux de Chartres, ACTION Group, Hôpital Louis Pasteur, Chartres (G.R., C.T.), Cardiology Department, Hôpital Centre François Mitterrand de Pau, Pau (N.D.), Département de Cardiologie, Centre Hospitalo-Universitaire (CHU) La Timone, ACTION Group, Marseille University, INSERM, Marseille (T.C., P.D.), the Cardiology Department, CHU Tours, INSERM Unité 1327 ISCHEMIA, Université de Tours, Tours (F.I.), the Cardiology Department, CHU de Toulouse, Toulouse (T.L.), the Cardiology Department, Clinique du Pont de Chaume, Montauban (T. Petroni), the Heart and Lung Institute, University Hospital of Lille, and Institut Pasteur of Lille, INSERM Unité 1011-EGID, Lille (G.L.), the Cardiology Department, CHU d'Avignon, Avignon (F. Bresoles), the Cardiology Group of the Côte Basque, Bayonne (J.-N.L.), the Cardiology Department, CHU de Dijon Bourgogne, Dijon (T. Pommier), the Cardiology Department, CHU de Montpellier, Montpellier (F.L.), the Cardiology Department, CHU Henri Mondor, Créteil (P.L.), the Cardiology Department, Centre Hospitalier (CH) Métropole-Savoie (Hôpital Chambéry), Chambéry (T.B.H.), the Cardiology Department, Groupe Hospitalier Mutualiste (GHM) de Grenoble, Grenoble (T.F.), the Cardiology Department, CHU d'Auxerre, Auxerre (F.J.), Cardiology Department, CHU Angers et UMR Centre National de la Recherche Scientifique (CNRS) 6015, INSERM Unité 1083 Equipe Physiopathologie Cardiovasculaire, Unité de Formation et de Recherche (UFR) Santé, Angers (A.F.), Grands Prés Cardiac Rehabilitation Centre, St. Denis (R.D.), the Cardiology Department, General Hospital Yves Le Foll, Saint-Brieuc (L.P.), and the Cardiology Department, Grand Hôpital de l'Est Francilien Site Marne-La-Vallée, Jossigny (M.E.K.) - all in France
| | - Karim Aacha
- From Sorbonne Université, ACTION Group, INSERM Unité Mixte de Recherche (UMRS) 1166, Hôpital Pitié-Salpêtrière Assistance Publique-Hôpitaux de Paris (AP-HP) (J.S., P.G., N.P., K.A., G.M.), the Department of Cardiology, Hôpital Européen Georges Pompidou, AP-HP, Université Paris Cité (E.P.), FACT (French Alliance for Cardiovascular Trials) (G.L.), the Department of Cardiology, Université Paris Cité, Hôpital Lariboisière, AP-HP, INSERM Unité 942 (J.-G.D.), the Cardiology Department, Hôpital Saint-Antoine, ACTION Group, Sorbonne Université, INSERM UMRS 938 (F. Boccara), the Cardiology Department Hôpital Bichat, AP-HP (M.S.), Unité de Recherche Clinique, ACTION Group, Hôpital Fernand Widal (AP-HP) (A.D., E.V.), and SAMM (Statistique, Analyse et Modélisation Multidisciplinaire) EA 4543, Université Paris 1 Panthéon Sorbonne (A.D., E.V.), Paris, the Cardiology Department, Nimes University Hospital, Montpellier University, ACTION Group, Nimes (G.C., B.L.), the Cardiology Department, Pasteur University Hospital, Nice (E.F., N.R.), the Cardiology Department, Hôpitaux de Chartres, ACTION Group, Hôpital Louis Pasteur, Chartres (G.R., C.T.), Cardiology Department, Hôpital Centre François Mitterrand de Pau, Pau (N.D.), Département de Cardiologie, Centre Hospitalo-Universitaire (CHU) La Timone, ACTION Group, Marseille University, INSERM, Marseille (T.C., P.D.), the Cardiology Department, CHU Tours, INSERM Unité 1327 ISCHEMIA, Université de Tours, Tours (F.I.), the Cardiology Department, CHU de Toulouse, Toulouse (T.L.), the Cardiology Department, Clinique du Pont de Chaume, Montauban (T. Petroni), the Heart and Lung Institute, University Hospital of Lille, and Institut Pasteur of Lille, INSERM Unité 1011-EGID, Lille (G.L.), the Cardiology Department, CHU d'Avignon, Avignon (F. Bresoles), the Cardiology Group of the Côte Basque, Bayonne (J.-N.L.), the Cardiology Department, CHU de Dijon Bourgogne, Dijon (T. Pommier), the Cardiology Department, CHU de Montpellier, Montpellier (F.L.), the Cardiology Department, CHU Henri Mondor, Créteil (P.L.), the Cardiology Department, Centre Hospitalier (CH) Métropole-Savoie (Hôpital Chambéry), Chambéry (T.B.H.), the Cardiology Department, Groupe Hospitalier Mutualiste (GHM) de Grenoble, Grenoble (T.F.), the Cardiology Department, CHU d'Auxerre, Auxerre (F.J.), Cardiology Department, CHU Angers et UMR Centre National de la Recherche Scientifique (CNRS) 6015, INSERM Unité 1083 Equipe Physiopathologie Cardiovasculaire, Unité de Formation et de Recherche (UFR) Santé, Angers (A.F.), Grands Prés Cardiac Rehabilitation Centre, St. Denis (R.D.), the Cardiology Department, General Hospital Yves Le Foll, Saint-Brieuc (L.P.), and the Cardiology Department, Grand Hôpital de l'Est Francilien Site Marne-La-Vallée, Jossigny (M.E.K.) - all in France
| | - Abdourahmane Diallo
- From Sorbonne Université, ACTION Group, INSERM Unité Mixte de Recherche (UMRS) 1166, Hôpital Pitié-Salpêtrière Assistance Publique-Hôpitaux de Paris (AP-HP) (J.S., P.G., N.P., K.A., G.M.), the Department of Cardiology, Hôpital Européen Georges Pompidou, AP-HP, Université Paris Cité (E.P.), FACT (French Alliance for Cardiovascular Trials) (G.L.), the Department of Cardiology, Université Paris Cité, Hôpital Lariboisière, AP-HP, INSERM Unité 942 (J.-G.D.), the Cardiology Department, Hôpital Saint-Antoine, ACTION Group, Sorbonne Université, INSERM UMRS 938 (F. Boccara), the Cardiology Department Hôpital Bichat, AP-HP (M.S.), Unité de Recherche Clinique, ACTION Group, Hôpital Fernand Widal (AP-HP) (A.D., E.V.), and SAMM (Statistique, Analyse et Modélisation Multidisciplinaire) EA 4543, Université Paris 1 Panthéon Sorbonne (A.D., E.V.), Paris, the Cardiology Department, Nimes University Hospital, Montpellier University, ACTION Group, Nimes (G.C., B.L.), the Cardiology Department, Pasteur University Hospital, Nice (E.F., N.R.), the Cardiology Department, Hôpitaux de Chartres, ACTION Group, Hôpital Louis Pasteur, Chartres (G.R., C.T.), Cardiology Department, Hôpital Centre François Mitterrand de Pau, Pau (N.D.), Département de Cardiologie, Centre Hospitalo-Universitaire (CHU) La Timone, ACTION Group, Marseille University, INSERM, Marseille (T.C., P.D.), the Cardiology Department, CHU Tours, INSERM Unité 1327 ISCHEMIA, Université de Tours, Tours (F.I.), the Cardiology Department, CHU de Toulouse, Toulouse (T.L.), the Cardiology Department, Clinique du Pont de Chaume, Montauban (T. Petroni), the Heart and Lung Institute, University Hospital of Lille, and Institut Pasteur of Lille, INSERM Unité 1011-EGID, Lille (G.L.), the Cardiology Department, CHU d'Avignon, Avignon (F. Bresoles), the Cardiology Group of the Côte Basque, Bayonne (J.-N.L.), the Cardiology Department, CHU de Dijon Bourgogne, Dijon (T. Pommier), the Cardiology Department, CHU de Montpellier, Montpellier (F.L.), the Cardiology Department, CHU Henri Mondor, Créteil (P.L.), the Cardiology Department, Centre Hospitalier (CH) Métropole-Savoie (Hôpital Chambéry), Chambéry (T.B.H.), the Cardiology Department, Groupe Hospitalier Mutualiste (GHM) de Grenoble, Grenoble (T.F.), the Cardiology Department, CHU d'Auxerre, Auxerre (F.J.), Cardiology Department, CHU Angers et UMR Centre National de la Recherche Scientifique (CNRS) 6015, INSERM Unité 1083 Equipe Physiopathologie Cardiovasculaire, Unité de Formation et de Recherche (UFR) Santé, Angers (A.F.), Grands Prés Cardiac Rehabilitation Centre, St. Denis (R.D.), the Cardiology Department, General Hospital Yves Le Foll, Saint-Brieuc (L.P.), and the Cardiology Department, Grand Hôpital de l'Est Francilien Site Marne-La-Vallée, Jossigny (M.E.K.) - all in France
| | - Eric Vicaut
- From Sorbonne Université, ACTION Group, INSERM Unité Mixte de Recherche (UMRS) 1166, Hôpital Pitié-Salpêtrière Assistance Publique-Hôpitaux de Paris (AP-HP) (J.S., P.G., N.P., K.A., G.M.), the Department of Cardiology, Hôpital Européen Georges Pompidou, AP-HP, Université Paris Cité (E.P.), FACT (French Alliance for Cardiovascular Trials) (G.L.), the Department of Cardiology, Université Paris Cité, Hôpital Lariboisière, AP-HP, INSERM Unité 942 (J.-G.D.), the Cardiology Department, Hôpital Saint-Antoine, ACTION Group, Sorbonne Université, INSERM UMRS 938 (F. Boccara), the Cardiology Department Hôpital Bichat, AP-HP (M.S.), Unité de Recherche Clinique, ACTION Group, Hôpital Fernand Widal (AP-HP) (A.D., E.V.), and SAMM (Statistique, Analyse et Modélisation Multidisciplinaire) EA 4543, Université Paris 1 Panthéon Sorbonne (A.D., E.V.), Paris, the Cardiology Department, Nimes University Hospital, Montpellier University, ACTION Group, Nimes (G.C., B.L.), the Cardiology Department, Pasteur University Hospital, Nice (E.F., N.R.), the Cardiology Department, Hôpitaux de Chartres, ACTION Group, Hôpital Louis Pasteur, Chartres (G.R., C.T.), Cardiology Department, Hôpital Centre François Mitterrand de Pau, Pau (N.D.), Département de Cardiologie, Centre Hospitalo-Universitaire (CHU) La Timone, ACTION Group, Marseille University, INSERM, Marseille (T.C., P.D.), the Cardiology Department, CHU Tours, INSERM Unité 1327 ISCHEMIA, Université de Tours, Tours (F.I.), the Cardiology Department, CHU de Toulouse, Toulouse (T.L.), the Cardiology Department, Clinique du Pont de Chaume, Montauban (T. Petroni), the Heart and Lung Institute, University Hospital of Lille, and Institut Pasteur of Lille, INSERM Unité 1011-EGID, Lille (G.L.), the Cardiology Department, CHU d'Avignon, Avignon (F. Bresoles), the Cardiology Group of the Côte Basque, Bayonne (J.-N.L.), the Cardiology Department, CHU de Dijon Bourgogne, Dijon (T. Pommier), the Cardiology Department, CHU de Montpellier, Montpellier (F.L.), the Cardiology Department, CHU Henri Mondor, Créteil (P.L.), the Cardiology Department, Centre Hospitalier (CH) Métropole-Savoie (Hôpital Chambéry), Chambéry (T.B.H.), the Cardiology Department, Groupe Hospitalier Mutualiste (GHM) de Grenoble, Grenoble (T.F.), the Cardiology Department, CHU d'Auxerre, Auxerre (F.J.), Cardiology Department, CHU Angers et UMR Centre National de la Recherche Scientifique (CNRS) 6015, INSERM Unité 1083 Equipe Physiopathologie Cardiovasculaire, Unité de Formation et de Recherche (UFR) Santé, Angers (A.F.), Grands Prés Cardiac Rehabilitation Centre, St. Denis (R.D.), the Cardiology Department, General Hospital Yves Le Foll, Saint-Brieuc (L.P.), and the Cardiology Department, Grand Hôpital de l'Est Francilien Site Marne-La-Vallée, Jossigny (M.E.K.) - all in France
| | - Gilles Montalescot
- From Sorbonne Université, ACTION Group, INSERM Unité Mixte de Recherche (UMRS) 1166, Hôpital Pitié-Salpêtrière Assistance Publique-Hôpitaux de Paris (AP-HP) (J.S., P.G., N.P., K.A., G.M.), the Department of Cardiology, Hôpital Européen Georges Pompidou, AP-HP, Université Paris Cité (E.P.), FACT (French Alliance for Cardiovascular Trials) (G.L.), the Department of Cardiology, Université Paris Cité, Hôpital Lariboisière, AP-HP, INSERM Unité 942 (J.-G.D.), the Cardiology Department, Hôpital Saint-Antoine, ACTION Group, Sorbonne Université, INSERM UMRS 938 (F. Boccara), the Cardiology Department Hôpital Bichat, AP-HP (M.S.), Unité de Recherche Clinique, ACTION Group, Hôpital Fernand Widal (AP-HP) (A.D., E.V.), and SAMM (Statistique, Analyse et Modélisation Multidisciplinaire) EA 4543, Université Paris 1 Panthéon Sorbonne (A.D., E.V.), Paris, the Cardiology Department, Nimes University Hospital, Montpellier University, ACTION Group, Nimes (G.C., B.L.), the Cardiology Department, Pasteur University Hospital, Nice (E.F., N.R.), the Cardiology Department, Hôpitaux de Chartres, ACTION Group, Hôpital Louis Pasteur, Chartres (G.R., C.T.), Cardiology Department, Hôpital Centre François Mitterrand de Pau, Pau (N.D.), Département de Cardiologie, Centre Hospitalo-Universitaire (CHU) La Timone, ACTION Group, Marseille University, INSERM, Marseille (T.C., P.D.), the Cardiology Department, CHU Tours, INSERM Unité 1327 ISCHEMIA, Université de Tours, Tours (F.I.), the Cardiology Department, CHU de Toulouse, Toulouse (T.L.), the Cardiology Department, Clinique du Pont de Chaume, Montauban (T. Petroni), the Heart and Lung Institute, University Hospital of Lille, and Institut Pasteur of Lille, INSERM Unité 1011-EGID, Lille (G.L.), the Cardiology Department, CHU d'Avignon, Avignon (F. Bresoles), the Cardiology Group of the Côte Basque, Bayonne (J.-N.L.), the Cardiology Department, CHU de Dijon Bourgogne, Dijon (T. Pommier), the Cardiology Department, CHU de Montpellier, Montpellier (F.L.), the Cardiology Department, CHU Henri Mondor, Créteil (P.L.), the Cardiology Department, Centre Hospitalier (CH) Métropole-Savoie (Hôpital Chambéry), Chambéry (T.B.H.), the Cardiology Department, Groupe Hospitalier Mutualiste (GHM) de Grenoble, Grenoble (T.F.), the Cardiology Department, CHU d'Auxerre, Auxerre (F.J.), Cardiology Department, CHU Angers et UMR Centre National de la Recherche Scientifique (CNRS) 6015, INSERM Unité 1083 Equipe Physiopathologie Cardiovasculaire, Unité de Formation et de Recherche (UFR) Santé, Angers (A.F.), Grands Prés Cardiac Rehabilitation Centre, St. Denis (R.D.), the Cardiology Department, General Hospital Yves Le Foll, Saint-Brieuc (L.P.), and the Cardiology Department, Grand Hôpital de l'Est Francilien Site Marne-La-Vallée, Jossigny (M.E.K.) - all in France
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Yu X, Guan L, Su P, Zhang Q, Guo X, Li T, Zhang J, Ji Y, Zhang H. Study on OSA screening and influencing factors in community-based elderly hypertensive patients based on single-lead wearable ECG devices. Sleep Breath 2024:10.1007/s11325-024-03136-8. [PMID: 39207664 DOI: 10.1007/s11325-024-03136-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2024] [Revised: 07/30/2024] [Accepted: 08/05/2024] [Indexed: 09/04/2024]
Abstract
PURPOSE Assessing whether single-lead ECG can be effectively and relatively inexpensively used in large-scale OSA screening, and identifying factors influencing moderate-to-severe OSA among elderly hypertensive patients without atypical symptoms in primary care. METHODS The study gathered data from 15 medical institutions in Ningxia between January and December 2022 using cloud platforms. The dataset included basic information and 72-h ECG monitoring for 2573 hypertensive patients over 65. OSA screening was conducted using the single-lead wearable ECG devices based on the ACAT algorithm. A multivariable logistic regression identified the main factors affecting OSA severity in these patients, and the AUC was used to assess the model's predictive accuracy. RESULTS The study found an OSA detection rate of 87.10%, with 55.42% being moderate to severe cases. Key risk factors associated with developing moderate-to-severe OSA included cardiac irregularities like supraventricular extrasystole and atrioventricular block, male gender, lifestyle factors like alcohol consumption and smoking, and health indicators such as SDNN ≤ 100 ms, abnormal LF/HF ratio, BMI, and age. The model's accuracy for predicting OSA, indicated by a ROAUC of 0.625, was moderate. Factors like gender, tea consumption, stroke history, and ventricular tachycardia were also independently linked to OSA severity. CONCLUSION This study combines single-lead wearable ECG devices with the ACAT algorithm for OSA screening in Ningxia, China. Initial screening identified 87.10% of participants as having OSA, with 55.42% being moderate to severe cases. This suggests a convenient, low-cost, and repeatable ECG-based method for OSA screening, potentially improving early detection and management of OSA by identifying potential risk factors.
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Affiliation(s)
- Xinyan Yu
- The First People's Hospital of Yinchuan, Yinchuan, Ningxia Hui Autonomous Region, China
| | - Linger Guan
- Department of Cardiology, Peking University People's Hospital, Beijing, China
| | - Peng Su
- School of public health, North China University of Science and Technology, Tang Shan city, Hebei Province, China
| | - Qinghong Zhang
- Lijing Yaju Community Health Service Station, The First People's Hospital of Yinchuan, Yinchuan City, Ningxia Hui Autonomous Region, China
| | - Xuan Guo
- Ninghua Road Community Health Service Center, Yinchuan City, Ningxia Hui Autonomous Region, China
| | - Ting Li
- Daba Town Health Center, Qingtongxia City, Ningxia Hui Autonomous Region, China
| | - Jing Zhang
- Yingshuiqiao Town Health Center, Shapotou District, Zhongwei City, Ningxia Hui Autonomous Region, China
| | - Yongli Ji
- Jingyuan Community Health Service Station, Shizuishan City, Ningxia Hui Autonomous Region, China
| | - Haicheng Zhang
- Department of Cardiology, Peking University People's Hospital, Beijing, China.
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42
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Yamazaki T, Saito Y, Nakamura S, Tanabe Y, Kitahara H, Kobayashi Y. Combined assessment of fractional flow reserve, resting full-cycle ratio, and resting ratio of distal coronary to aortic pressure for clinical outcomes. J Cardiol 2024:S0914-5087(24)00169-2. [PMID: 39214509 DOI: 10.1016/j.jjcc.2024.08.009] [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: 05/22/2024] [Revised: 08/11/2024] [Accepted: 08/21/2024] [Indexed: 09/04/2024]
Abstract
BACKGROUND Fractional flow reserve (FFR) and non-hyperemic indices are invasive standards for evaluating functional significance of coronary stenosis. However, data are limited about outcomes in vessels with concordant and discordant physiological results, particularly with a ratio of distal coronary to aortic pressure (Pd/Pa) at rest. METHODS This was a single-center, retrospective, observational study. Coronary physiological indices including FFR, resting full-cycle ratio (RFR), and resting Pd/Pa were invasively evaluated in vessels with intermediate coronary artery stenosis. FFR ≤0.80, RFR ≤0.89, and resting Pd/Pa ≤0.92 were considered physiologically positive. Vessels were divided into three groups according to the results of FFR, RFR, and resting Pd/Pa: concordant positive (all positive for FFR, RFR, and resting Pd/Pa), concordant negative (all negative for FFR, RFR, and resting Pd/Pa), and discordant groups. The primary endpoint was target vessel failure (TVF) defined as a composite of cardiac death and target vessel myocardial infarction and unplanned revascularization. RESULTS Of 987 vessels included, 311 (31.5 %), 263 (26.6 %), and 413 (41.9 %) were in the concordant positive, discordant, and concordant negative groups. During a median follow-up period of 417 (208-756) days, TVF occurred more frequently in the concordant positive group, followed by the discordant and concordant negative groups (7.7 % vs. 4.6 % vs. 2.4 %, p = 0.004). TVF increasingly accrued during long-term follow-up, while discordant results of RFR and resting Pd/Pa did not result in worse outcomes compared with negative RFR and resting Pd/Pa. CONCLUSION The combined assessment of FFR with RFR and resting Pd/Pa stratified TVF risks in vessels with intermediate coronary stenosis.
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Affiliation(s)
- Tatsuro Yamazaki
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Yuichi Saito
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan.
| | - Shunsuke Nakamura
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Yuya Tanabe
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Hideki Kitahara
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Yoshio Kobayashi
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan
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Lin Z, Song Y, Yuan S, He J, Dou K. Prognostic value of the stress-hyperglycaemia ratio in patients with moderate-to-severe coronary artery calcification: Insights from a large cohort study. Diabetes Obes Metab 2024. [PMID: 39188235 DOI: 10.1111/dom.15894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2024] [Revised: 07/29/2024] [Accepted: 08/06/2024] [Indexed: 08/28/2024]
Abstract
AIM To evaluate the relationship between the stress-hyperglycaemia ratio (SHR) and the clinical prognosis of patients with moderate-to-severe coronary artery calcification (MSCAC). METHODS We consecutively enrolled 3841 patients with angiography-detected MSCAC. The individuals were categorized into three groups based on SHR tertiles: T1 (SHR ≤ 0.77), T2 (0.77 < SHR ≤ 0.89) and T3 (SHR > 0.89). The SHR value was calculated using the formula SHR = [admission glucose (mmol/L)]/[1.59 × HbA1c (%) - 2.59]. The primary outcomes were major adverse cardiovascular and cerebrovascular events (MACCEs), including all-cause death, non-fatal myocardial infarction and non-fatal stroke. RESULTS During a median follow-up of 3.11 years, 241 MACCEs were recorded. Kaplan-Meier survival analysis showed that the SHR T3 group had the highest incidence of MACCEs (P < .001). Moreover, findings from the restricted cubic spline analysis showed a significant and positive association between the SHR and MACCEs. This correlation remained consistent even after considering other variables that could potentially impact the results (Pnon-linear = .794). When comparing SHR T1 with SHR T3, it was found that SHR T3 was significantly associated with an increased risk of the primary outcome (adjusted hazard ratio = 1.50; 95% confidence interval: 1.10-2.03). CONCLUSIONS Patients with MSCAC showed a positive correlation between the SHR and MACCE rate over a 3-year follow-up period. The study showed that an SHR value of 0.83 is the key threshold, indicating a poor prognosis. Future large-scale multicentre investigations should be conducted to determine the predictive value of the SHR in patients with MSCAC.
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Affiliation(s)
- Zhangyu Lin
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Cardiometabolic Medicine Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- State Key Laboratory of Cardiovascular Disease, Beijing, China
| | - Yanjun Song
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Cardiometabolic Medicine Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- State Key Laboratory of Cardiovascular Disease, Beijing, China
| | - Sheng Yuan
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Cardiometabolic Medicine Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- State Key Laboratory of Cardiovascular Disease, Beijing, China
| | - Jining He
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Cardiometabolic Medicine Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- State Key Laboratory of Cardiovascular Disease, Beijing, China
| | - Kefei Dou
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Cardiometabolic Medicine Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- State Key Laboratory of Cardiovascular Disease, Beijing, China
- National Clinical Research Center for Cardiovascular Diseases, Beijing, China
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Wu Y, Qiu J, Sha X, Gong B, Wang J, Yuan W, Lin J, Wang L, Zhang Q. Comparative Effectiveness of Interventional Therapy versus Exercise Rehabilitation in Stable Angina Patients with Severe Coronary Artery Stenosis. Clin Interv Aging 2024; 19:1471-1478. [PMID: 39206053 PMCID: PMC11352617 DOI: 10.2147/cia.s474811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2024] [Accepted: 08/20/2024] [Indexed: 09/04/2024] Open
Abstract
Background Management strategies for stable angina include pharmacotherapy, revascularization, and exercise-based cardiac rehabilitation (CR). The optimal treatment for stable angina patients with severe coronary artery stenosis remains unclear. This study aimed to compare interventional therapy with exercise rehabilitation in this population. Methods Fifty stable angina patients with severe coronary stenosis who underwent stent implantation were included in the optimal medical therapy (OMT) plus percutaneous coronary intervention (PCI) group, and 50 patients who did not undergo interventional treatment were included in OMT plus CR group receiving exercise rehabilitation guidance for one year. Cardiovascular composite endpoint events, cardiopulmonary fitness, and quality of life scale scores were assessed after one year. Results No significant difference in incidence of cardiovascular composite endpoint events was observed between OMT plus PCI group with OMT plus CR group (20.0% vs 14.6%) after one year. Cardiopulmonary fitness represented as peak VO2 (19.2±3.5 vs 17.6±3.2 mL/kg/min), peak load (120±19 vs 108±20 W), and AT (13.5±1.5 vs 12.1±1.3 mL/kg/min) were significantly higher in the rehabilitation group than the intervention group after one year. Both groups showed improvement in their quality of life, but the rehabilitation group improved in more scales. Conclusion Interventional therapy did not reduce cardiovascular events compared to exercise-based rehabilitation in stable angina patients with severe coronary artery stenosis, but the rehabilitation can improve cardiovascular fitness and quality of life more.
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Affiliation(s)
- Yucheng Wu
- Department of Cardiology, Taizhou School of Clinical Medicine, Nanjing Medical University, The Affiliated Taizhou People’s Hospital of Nanjing Medical University, Taizhou, Jiangsu Province, 225300, People’s Republic of China
| | - Jie Qiu
- Department of Cardiology, Taizhou School of Clinical Medicine, Nanjing Medical University, The Affiliated Taizhou People’s Hospital of Nanjing Medical University, Taizhou, Jiangsu Province, 225300, People’s Republic of China
| | - Xiang Sha
- Department of Cardiology, Taizhou School of Clinical Medicine, Nanjing Medical University, The Affiliated Taizhou People’s Hospital of Nanjing Medical University, Taizhou, Jiangsu Province, 225300, People’s Republic of China
| | - Benbingdi Gong
- Department of Cardiology, Taizhou School of Clinical Medicine, Nanjing Medical University, The Affiliated Taizhou People’s Hospital of Nanjing Medical University, Taizhou, Jiangsu Province, 225300, People’s Republic of China
| | - Jian Wang
- Department of Cardiology, Taizhou School of Clinical Medicine, Nanjing Medical University, The Affiliated Taizhou People’s Hospital of Nanjing Medical University, Taizhou, Jiangsu Province, 225300, People’s Republic of China
| | - Wei Yuan
- Department of Cardiology, Taizhou School of Clinical Medicine, Nanjing Medical University, The Affiliated Taizhou People’s Hospital of Nanjing Medical University, Taizhou, Jiangsu Province, 225300, People’s Republic of China
| | - Jie Lin
- Department of Cardiology, Taizhou School of Clinical Medicine, Nanjing Medical University, The Affiliated Taizhou People’s Hospital of Nanjing Medical University, Taizhou, Jiangsu Province, 225300, People’s Republic of China
| | - Lichun Wang
- Department of Cardiology, Taizhou School of Clinical Medicine, Nanjing Medical University, The Affiliated Taizhou People’s Hospital of Nanjing Medical University, Taizhou, Jiangsu Province, 225300, People’s Republic of China
| | - Qingqing Zhang
- Panvascular Management Center, Taizhou School of Clinical Medicine, Nanjing Medical University, The Affiliated Taizhou People’s Hospital of Nanjing Medical University, Taizhou, Jiangsu Province, 225300, People’s Republic of China
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Huang Y, Huang X, Zhong L, Yang J. Glycated haemoglobin index is a new predictor for all-cause mortality and cardiovascular mortality in the adults. Sci Rep 2024; 14:19629. [PMID: 39179628 PMCID: PMC11343730 DOI: 10.1038/s41598-024-70666-2] [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: 01/12/2024] [Accepted: 08/20/2024] [Indexed: 08/26/2024] Open
Abstract
Glycosylated haemoglobin index (HGI) has been shown to correlate with the prognosis of metabolic diseases, but the relationship with mortality remains unclear. This study included 18,285 US adults who participated in the National Health and Nutrition Examination Survey (NHANES) between 1999 and 2018. During the median follow-up period of 115 months, a total of 2572 all-cause deaths and 671 cardiovascular disease (CVD) deaths occurred. The restricted cubic spline revealed a U-shaped correlation between HGI and all-cause and CVD mortality. After adjusting for all covariates, the optimal inflection point values in all-cause and CVD deaths were 0.17 and 0.02, respectively. In the left side of the inflection point, the risk of all-cause mortality and CVD mortality decreased by approximately 24% (HR 0.76, 95% CI 0.69, 0.84) and 25% (HR 0.75, 95% CI 0.60, 0.96) with the increase in HGI. Conversely, in the right of the inflection point, an increase of 1 unit in the HGI was linked with a 17% (HR 1.17, 95% CI 1.07, 1.27) and 31% (HR 1.31, 95% CI 1.15, 1.49) increase in all-cause and CVD mortality. Our study showed that HGI is an important tool for predicting the risk of all-cause mortality and CVD death in US adults and there is a U-shaped relationship between HGI and mortality.
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Affiliation(s)
- Yi Huang
- School of Pharmacy, Jiangxi University of Traditional Chinese Medicine, Nanchang, Jiangxi, China
| | - Xiantao Huang
- Department of Cardiovascular Medicine, Jiangxi Provincial People's Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, Jiangxi, China
| | - Lingyun Zhong
- School of Pharmacy, Jiangxi University of Traditional Chinese Medicine, Nanchang, Jiangxi, China.
| | - Jingqi Yang
- Department of Cardiovascular Medicine, Jiangxi Provincial People's Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, Jiangxi, China.
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Jukema RA, Dahdal J, Kooijman EM, Wahedi E, de Winter RW, Guglielmo M, Cramer MJ, van der Harst P, Remmelzwaal S, Raijmakers P, Knaapen P, Danad I. Diagnostic accuracy of non-invasive cardiac imaging modalities in patients with a history of coronary artery disease: a meta-analysis. Heart 2024:heartjnl-2024-324248. [PMID: 39179368 DOI: 10.1136/heartjnl-2024-324248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Accepted: 08/03/2024] [Indexed: 08/26/2024] Open
Abstract
BACKGROUND The diagnostic performance of non-invasive imaging techniques for detecting obstructive coronary artery disease (CAD) in patients with a history of myocardial infarction or percutaneous coronary intervention has not been comprehensively evaluated. This meta-analysis assesses the diagnostic value of coronary CT angiography (CCTA), CCTA combined with CT perfusion (CCTA+CTP), cardiac MRI (CMR) and single-photon emission CT (SPECT) compared with invasive reference standards. METHODS We systematically searched PubMed, Embase, Web of Science and the Cochrane Library from 2005 to September 2022 for prospective, blinded studies including populations with ≥50% prior CAD. RESULTS We identified 18 studies encompassing 3265 patients, with obstructive CAD present in 64%. The per-patient sensitivity of CCTA (0.95; 95% CI 0.92 to 0.98), CCTA+CTP (0.93; 95% CI 0.84 to 0.98) and CMR (0.91; 95% CI 0.86 to 0.94) was high, while SPECT showed lower sensitivity (0.63; 95% CI 0.52 to 0.73). SPECT had higher specificity compared with CCTA (0.66; 95% CI 0.56 to 0.76 vs 0.37; 95% CI 0.29 to 0.46), but was comparable to CCTA+CTP (0.59; 95% CI 0.49 to 0.69) and CMR (0.69; 95% CI 0.53 to 0.81). The area under the curve for SPECT was the lowest (0.70; 95% CI 0.58 to 0.87), while CCTA (0.91; 95% CI 0.86 to 0.98), CCTA+CTP (0.89; 95% CI 0.73 to 1.00) and CMR (0.91; 95% CI 0.80 to 1.00) showed similar high values. CONCLUSIONS In patients with prior CAD, CCTA, CCTA+CTP and CMR demonstrated high diagnostic performance, whereas SPECT had lower sensitivity. These findings can guide the selection of non-invasive imaging techniques in this high-risk population. PROSPERO REGISTRATION NUMBER CRD42022322348.
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Affiliation(s)
- Ruurt A Jukema
- Department of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Jorge Dahdal
- Department of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Medicine, Hospital del Salvador, Santiago, Chile
| | - Eline M Kooijman
- Department of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Ellaha Wahedi
- Department of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Ruben W de Winter
- Department of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Marco Guglielmo
- Division of Heart and Lungs, Department of Cardiology, Utrecht University Medical Center, Utrecht, The Netherlands
| | - Maarten Jan Cramer
- Division of Heart and Lungs, Department of Cardiology, Utrecht University Medical Center, Utrecht, The Netherlands
| | - Pim van der Harst
- Division of Heart and Lungs, Department of Cardiology, Utrecht University Medical Center, Utrecht, The Netherlands
| | - Sharon Remmelzwaal
- Epidemiology and Biostatistics, Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | - Pieter Raijmakers
- Department of Radiology, Nuclear Medicine & PET Research, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Paul Knaapen
- Department of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Ibrahim Danad
- Department of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Division of Heart and Lungs, Department of Cardiology, Utrecht University Medical Center, Utrecht, The Netherlands
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De Santis GA, De Ferrari T, Parisi F, Franzino M, Molinero AE, Di Carlo A, Pistelli L, Vetta G, Parlavecchio A, Torre M, Parollo M, Mansi G, Tamborrino PP, Canu A, Grifoni G, Segreti L, Di Cori A, Viani SM, Zucchelli G. Ranolazine Unveiled: Rediscovering an Old Solution in a New Light. J Clin Med 2024; 13:4985. [PMID: 39274195 PMCID: PMC11396555 DOI: 10.3390/jcm13174985] [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: 07/09/2024] [Revised: 08/13/2024] [Accepted: 08/20/2024] [Indexed: 09/16/2024] Open
Abstract
Ranolazine is an anti-anginal medication that has demonstrated antiarrhythmic properties by inhibiting both late sodium and potassium currents. Studies have shown promising results for ranolazine in treating both atrial fibrillation and ventricular arrhythmias, particularly when used in combination with other medications. This review explores ranolazine's mechanisms of action and its potential role in cardiac arrhythmias treatment in light of previous clinical studies.
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Affiliation(s)
- Giulia Azzurra De Santis
- Cardiology Unit, Department of Clinical and Experimental Medicine, University of Messina, 98122 Messina, Italy
| | - Tommaso De Ferrari
- Cardiology Unit, Department of Clinical and Experimental Medicine, University of Messina, 98122 Messina, Italy
| | - Francesca Parisi
- Clinical Cardiology and Heart Failure Unit, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (ISMETT), 90127 Palermo, Italy
| | - Marco Franzino
- S.C. Cardiologia, Ospedale Sant'Andrea, 13100 Vercelli, Italy
| | - Agustin Ezequiel Molinero
- Cardiology Unit, Department of Clinical and Experimental Medicine, University of Messina, 98122 Messina, Italy
| | - Alessandro Di Carlo
- Cardiology Unit, Department of Clinical and Experimental Medicine, University of Messina, 98122 Messina, Italy
| | - Lorenzo Pistelli
- Second Division of Cardiology, Cardio-Thoracic and Vascular Department, Pisa University Hospital, 56124 Pisa, Italy
| | - Giampaolo Vetta
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, 1050 Brussels, Belgium
| | - Antonio Parlavecchio
- Cardiology Unit, Department of Clinical and Experimental Medicine, University of Messina, 98122 Messina, Italy
| | - Marco Torre
- Second Division of Cardiology, Cardio-Thoracic and Vascular Department, Pisa University Hospital, 56124 Pisa, Italy
| | - Matteo Parollo
- Second Division of Cardiology, Cardio-Thoracic and Vascular Department, Pisa University Hospital, 56124 Pisa, Italy
| | - Giacomo Mansi
- Second Division of Cardiology, Cardio-Thoracic and Vascular Department, Pisa University Hospital, 56124 Pisa, Italy
| | - Pietro Paolo Tamborrino
- Second Division of Cardiology, Cardio-Thoracic and Vascular Department, Pisa University Hospital, 56124 Pisa, Italy
| | - Antonio Canu
- Second Division of Cardiology, Cardio-Thoracic and Vascular Department, Pisa University Hospital, 56124 Pisa, Italy
| | - Gino Grifoni
- Second Division of Cardiology, Cardio-Thoracic and Vascular Department, Pisa University Hospital, 56124 Pisa, Italy
| | - Luca Segreti
- Second Division of Cardiology, Cardio-Thoracic and Vascular Department, Pisa University Hospital, 56124 Pisa, Italy
| | - Andrea Di Cori
- Second Division of Cardiology, Cardio-Thoracic and Vascular Department, Pisa University Hospital, 56124 Pisa, Italy
| | - Stefano Marco Viani
- Second Division of Cardiology, Cardio-Thoracic and Vascular Department, Pisa University Hospital, 56124 Pisa, Italy
| | - Giulio Zucchelli
- Second Division of Cardiology, Cardio-Thoracic and Vascular Department, Pisa University Hospital, 56124 Pisa, Italy
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Toval A, Solis-Urra P, Bakker EA, Sánchez-Aranda L, Fernández-Ortega J, Prieto C, Alonso-Cuenca RM, González-García A, Martín-Fuentes I, Fernandez-Gamez B, Olvera-Rojas M, Coca-Pulido A, Bellón D, Sclafani A, Sanchez-Martinez J, Rivera-López R, Herrera-Gómez N, Peñafiel-Burkhardt R, López-Espinosa V, Corpas-Pérez S, García-Ortega MB, Vega-Cordoba A, Barranco-Moreno EJ, Morales-Navarro FJ, Nieves R, Caro-Rus A, Amaro-Gahete FJ, Mora-Gonzalez J, Vidal-Almela S, Carlén A, Migueles JH, Erickson KI, Moreno-Escobar E, García-Orta R, Esteban-Cornejo I, Ortega FB. Exercise and brain health in patients with coronary artery disease: study protocol for the HEART-BRAIN randomized controlled trial. Front Aging Neurosci 2024; 16:1437567. [PMID: 39246594 PMCID: PMC11377337 DOI: 10.3389/fnagi.2024.1437567] [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: 05/23/2024] [Accepted: 07/25/2024] [Indexed: 09/10/2024] Open
Abstract
Introduction Patients with coronary artery disease (CAD) have a higher risk of developing cognitive impairment and mental health disorders compared to the general population. Physical exercise might improve their brain health. The overall goal of the HEART-BRAIN randomized controlled trial (RCT) is to investigate the effects of different types of exercise on brain health outcomes in patients with CAD, and the underlying mechanisms. Methods This three-arm, single-blinded RCT will include 90 patients with CAD (50-75 years). Participants will be randomized into: (1) control group-usual care (n = 30), (2) aerobic high-intensity interval training (HIIT) (n = 30), or (3) HIIT combined with resistance exercise training (n = 30). The 12-week intervention includes 3 supervised sessions (45-min each) per week for the exercise groups. Outcomes will be assessed at baseline and post-intervention. The primary outcome is to determine changes in cerebral blood flow assessed by magnetic resonance imaging. Secondary outcomes include changes in brain vascularization, cognitive measures (i.e., general cognition, executive function and episodic memory), and cardiorespiratory fitness. Additional health-related outcomes, and several potential mediators and moderators will be investigated (i.e., brain structure and function, cardiovascular and brain-based biomarkers, hemodynamics, physical function, body composition, mental health, and lifestyle behavior). Conclusion The HEART-BRAIN RCT will provide novel insights on how exercise can impact brain health in patients with CAD and the potential mechanisms explaining the heart-brain connection, such as changes in cerebral blood flow. The results may have important clinical implications by increasing the evidence on the effectiveness of exercise-based strategies to delay cognitive decline in this high-risk population. Clinical trial registration ClinicalTrials.gov, identifier [NCT06214624].
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Affiliation(s)
- Angel Toval
- Department of Physical and Sports Education, Sport and Health University Research Institute (iMUDS), Faculty of Sport Sciences, University of Granada, Granada, Spain
| | - Patricio Solis-Urra
- Department of Physical and Sports Education, Sport and Health University Research Institute (iMUDS), Faculty of Sport Sciences, University of Granada, Granada, Spain
- Faculty of Education and Social Sciences, University Andres Bello, Viña del Mar, Chile
| | - Esmée A Bakker
- Department of Physical and Sports Education, Sport and Health University Research Institute (iMUDS), Faculty of Sport Sciences, University of Granada, Granada, Spain
- Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, Netherlands
| | - Lucía Sánchez-Aranda
- Department of Physical and Sports Education, Sport and Health University Research Institute (iMUDS), Faculty of Sport Sciences, University of Granada, Granada, Spain
| | - Javier Fernández-Ortega
- Department of Physical and Sports Education, Sport and Health University Research Institute (iMUDS), Faculty of Sport Sciences, University of Granada, Granada, Spain
| | - Carlos Prieto
- Department of Physical and Sports Education, Sport and Health University Research Institute (iMUDS), Faculty of Sport Sciences, University of Granada, Granada, Spain
| | - Rosa María Alonso-Cuenca
- Department of Physical and Sports Education, Sport and Health University Research Institute (iMUDS), Faculty of Sport Sciences, University of Granada, Granada, Spain
- Cardiology Service, San Cecilio Clinical University Hospital, Granada, Spain
| | | | - Isabel Martín-Fuentes
- Department of Physical and Sports Education, Sport and Health University Research Institute (iMUDS), Faculty of Sport Sciences, University of Granada, Granada, Spain
| | - Beatriz Fernandez-Gamez
- Department of Physical and Sports Education, Sport and Health University Research Institute (iMUDS), Faculty of Sport Sciences, University of Granada, Granada, Spain
| | - Marcos Olvera-Rojas
- Department of Physical and Sports Education, Sport and Health University Research Institute (iMUDS), Faculty of Sport Sciences, University of Granada, Granada, Spain
| | - Andrea Coca-Pulido
- Department of Physical and Sports Education, Sport and Health University Research Institute (iMUDS), Faculty of Sport Sciences, University of Granada, Granada, Spain
| | - Darío Bellón
- Department of Physical and Sports Education, Sport and Health University Research Institute (iMUDS), Faculty of Sport Sciences, University of Granada, Granada, Spain
| | - Alessandro Sclafani
- Department of Physical and Sports Education, Sport and Health University Research Institute (iMUDS), Faculty of Sport Sciences, University of Granada, Granada, Spain
| | - Javier Sanchez-Martinez
- Department of Physical and Sports Education, Sport and Health University Research Institute (iMUDS), Faculty of Sport Sciences, University of Granada, Granada, Spain
| | | | - Norberto Herrera-Gómez
- Department of Physical and Sports Education, Sport and Health University Research Institute (iMUDS), Faculty of Sport Sciences, University of Granada, Granada, Spain
- Cardiology Service, San Cecilio Clinical University Hospital, Granada, Spain
| | | | | | - Sara Corpas-Pérez
- Cardiology Service, San Cecilio Clinical University Hospital, Granada, Spain
| | | | | | - Emilio J Barranco-Moreno
- Department of Physical and Sports Education, Sport and Health University Research Institute (iMUDS), Faculty of Sport Sciences, University of Granada, Granada, Spain
| | - Francisco J Morales-Navarro
- Department of Physical and Sports Education, Sport and Health University Research Institute (iMUDS), Faculty of Sport Sciences, University of Granada, Granada, Spain
| | - Raúl Nieves
- Department of Physical and Sports Education, Sport and Health University Research Institute (iMUDS), Faculty of Sport Sciences, University of Granada, Granada, Spain
| | - Alfredo Caro-Rus
- Department of Physical and Sports Education, Sport and Health University Research Institute (iMUDS), Faculty of Sport Sciences, University of Granada, Granada, Spain
| | - Francisco J Amaro-Gahete
- Department of Physiology, Faculty of Medicine, University of Granada, Granada, Spain
- CIBER de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Granada, Spain
- Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain
| | - Jose Mora-Gonzalez
- Department of Physical and Sports Education, Sport and Health University Research Institute (iMUDS), Faculty of Sport Sciences, University of Granada, Granada, Spain
| | - Sol Vidal-Almela
- Department of Physical and Sports Education, Sport and Health University Research Institute (iMUDS), Faculty of Sport Sciences, University of Granada, Granada, Spain
| | - Anna Carlén
- Department of Physical and Sports Education, Sport and Health University Research Institute (iMUDS), Faculty of Sport Sciences, University of Granada, Granada, Spain
- Department of Clinical Physiology in Linköping, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Jairo H Migueles
- Department of Physical and Sports Education, Sport and Health University Research Institute (iMUDS), Faculty of Sport Sciences, University of Granada, Granada, Spain
| | - Kirk I Erickson
- AdventHealth Research Institute, Neuroscience, Orlando, FL, United States
| | - Eduardo Moreno-Escobar
- Cardiology Service, San Cecilio Clinical University Hospital, Granada, Spain
- Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain
| | - Rocío García-Orta
- Cardiology Service, Virgen de Las Nieves University Hospital, Granada, Spain
- Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain
| | - Irene Esteban-Cornejo
- Department of Physical and Sports Education, Sport and Health University Research Institute (iMUDS), Faculty of Sport Sciences, University of Granada, Granada, Spain
- CIBER de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Granada, Spain
- Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain
| | - Francisco B Ortega
- Department of Physical and Sports Education, Sport and Health University Research Institute (iMUDS), Faculty of Sport Sciences, University of Granada, Granada, Spain
- CIBER de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Granada, Spain
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
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German CA, Davis AM, Polonsky TS. Management of Patients With Chronic Coronary Disease. JAMA 2024; 332:585-586. [PMID: 39046710 DOI: 10.1001/jama.2024.9813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/25/2024]
Abstract
This JAMA Clinical Guidelines Synopsis summarizes the 2023 American Heart Association (AHA)/American College of Cardiology (ACC) guideline on management of patients with chronic coronary disease.
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Affiliation(s)
- Charles A German
- Section of Cardiology, Department of Medicine, University of Chicago, Chicago, Illinois
| | - Andrew M Davis
- Section of General Internal Medicine, Department of Medicine, University of Chicago, Chicago, Illinois
| | - Tamar S Polonsky
- Section of Cardiology, Department of Medicine, University of Chicago, Chicago, Illinois
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Shahian DM, Paone G, Habib RH, Krohn C, Bollen BA, Jacobs JP, Bowdish ME, Kertai MD. The Society of Thoracic Surgeons Preoperative Beta Blocker Working Group Interim Report. Ann Thorac Surg 2024:S0003-4975(24)00670-2. [PMID: 39159910 DOI: 10.1016/j.athoracsur.2024.06.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2024] [Revised: 06/26/2024] [Accepted: 06/26/2024] [Indexed: 08/21/2024]
Abstract
BACKGROUND Atrial fibrillation (AF) occurs commonly after cardiac surgery and is associated with multiple adverse outcomes. Older randomized trials suggested that perioperative β- blockade reduced postoperative AF, and The Society of Thoracic Surgeons (STS) coronary artery bypass grafting (CABG) composite measure includes β-blocker administration preoperatively within 24 hours of surgery and at discharge. However, some more recent studies suggest preoperative β-blockade has limited value and question its continuation as an STS quality measure. METHODS In 2022, an STS Preoperative Beta Blocker Working Group was formed with representatives from the STS and the Society of Cardiovascular Anesthesiologists. Published randomized trials, observational studies, societal guidelines, and the current state of available data from the STS Adult Cardiac Surgery Database (ACSD) were reviewed. RESULTS Review of existing studies reveals substantial heterogeneity or insufficient detail regarding specific β-blockers used, timing of initiation, management of patients on chronic β-blockade, and whether other proarrhythmic or antiarrhythmic drugs were used concurrently. Further, β-blocker data currently collected in the STS ACSD lack sufficient granularity. CONCLUSIONS Because a new randomized trial seems unlikely, the Working Group believes that more granular data on real-world practice would facilitate assessment of the value of preoperative β-blockade in the current era, development of best practice recommendations, and evaluation of their continued appropriateness as an STS quality metric. STS ACSD participants have been invited to participate in a voluntary survey whose additional data, when linked to STS ACSD records, will better delineate contemporary β-blocker practice and outcomes.
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Affiliation(s)
- David M Shahian
- Division of Cardiac Surgery, Massachusetts General Hospital, Boston, Massachusetts.
| | - Gaetano Paone
- Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia
| | | | - Carole Krohn
- The Society of Thoracic Surgeons, Chicago, Illinois
| | - Bruce A Bollen
- Missoula Anesthesiology PC, St. Patrick Hospital, Providence Heart Center, Missoula, Montana
| | - Jeffrey P Jacobs
- Division of Cardiovascular Surgery, Department of Surgery, University of Florida, Gainesville, Florida
| | - Michael E Bowdish
- Department of Cardiac Surgery, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Miklos D Kertai
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee
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