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Miura H, Koseki M, Ide S, Asaumi Y, Morita Y, Ohta Y, Tanaka K, Okada T, Omatsu T, Ogata S, Fukuda T, Sakata Y, Noguchi T. Stronger positive correlation of the left ventricular mass index and extracellular volume fraction with diastolic function in diabetic patients without myocardial infarction. Int J Cardiol 2024; 408:132099. [PMID: 38663814 DOI: 10.1016/j.ijcard.2024.132099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Revised: 03/25/2024] [Accepted: 04/22/2024] [Indexed: 05/12/2024]
Abstract
BACKGROUND The structural and functional characteristics of the heart in patients with diabetes mellitus (DM) and without myocardial infarction (MI) are not fully understood. METHODS We retrospectively analysed the data of patients with left ventricular ejection fraction (LVEF) ≥ 40% who underwent contrast-enhanced cardiac magnetic resonance imaging (CMR), which was also used to exclude MI, at two hospitals. Volumetric data and extracellular volume fraction (ECVf) of the myocardium evaluated using CMR were compared between patients with and without DM, and their association with diastolic function was evaluated. RESULTS Among 322 analysed patients, 53 had DM. CMR revealed that the left ventricular mass index (LVMi) and ECVf were increased while LVEF was decreased in patients with DM after adjusting for patient characteristics (all P < 0.05). A stronger positive correlation was observed between LVMi and the early diastolic transmitral flow velocity to early diastolic mitral annular velocity ratio (E/e') in patients with DM than in those without DM (correlation coefficient [R] = 0.46, p = 0.001; R = 0.15, p = 0.021, respectively; p for interaction = 0.011). ECVf correlated with E/e' only in patients with DM (R = 0.61, p = 0.004). CONCLUSIONS Patients with DM have increased LVMi and ECVf. Importantly, there was a difference between patients with and without DM in the relationship between these structural changes and E/e', with a stronger relationship in patients with DM. Furthermore, DM is associated with mildly reduced LVEF even in the absence of MI.
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Affiliation(s)
- Hiroyuki Miura
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Centre, 6-1 Kishibe-Shimmachi, Suita, Osaka 564-8565, Japan; Division of Cardiovascular Medicine, Department of Medicine, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan
| | - Masahiro Koseki
- Division of Cardiovascular Medicine, Department of Medicine, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan.
| | - Seiko Ide
- Division of Cardiovascular Medicine, Department of Medicine, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan
| | - Yasuhide Asaumi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Centre, 6-1 Kishibe-Shimmachi, Suita, Osaka 564-8565, Japan
| | - Yoshiaki Morita
- Department of Radiology, National Cerebral and Cardiovascular Centre, 6-1 Kishibe-Shimmachi, Suita, Osaka 564-8565, Japan
| | - Yasutoshi Ohta
- Department of Radiology, National Cerebral and Cardiovascular Centre, 6-1 Kishibe-Shimmachi, Suita, Osaka 564-8565, Japan
| | - Katsunao Tanaka
- Division of Cardiovascular Medicine, Department of Medicine, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan
| | - Takeshi Okada
- Division of Cardiovascular Medicine, Department of Medicine, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan
| | - Takashi Omatsu
- Division of Cardiovascular Medicine, Department of Medicine, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan
| | - Soshiro Ogata
- Department of Preventive Medicine and Epidemiology, National Cerebral and Cardiovascular Centre, 6-1 Kishibe-Shimmachi, Suita, Osaka 564-8565, Japan
| | - Tetsuya Fukuda
- Department of Radiology, National Cerebral and Cardiovascular Centre, 6-1 Kishibe-Shimmachi, Suita, Osaka 564-8565, Japan
| | - Yasushi Sakata
- Division of Cardiovascular Medicine, Department of Medicine, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan
| | - Teruo Noguchi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Centre, 6-1 Kishibe-Shimmachi, Suita, Osaka 564-8565, Japan
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Cavus E, Schneider JN, di Carluccio E, Ziegler A, Haack A, Ojeda F, Chevalier C, Jahnke C, Riedl KA, Radunski UK, Twerenbold R, Kirchhof P, Blankenberg S, Adam G, Tahir E, Lund GK, Muellerleile K. Unrecognized myocardial scar by late-gadolinium-enhancement cardiovascular magnetic resonance: Insights from the population-based Hamburg City Health Study. J Cardiovasc Magn Reson 2024; 26:101008. [PMID: 38341145 PMCID: PMC10944257 DOI: 10.1016/j.jocmr.2024.101008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 12/19/2023] [Accepted: 02/03/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND The presence of myocardial scar is associated with poor prognosis in several underlying diseases. Late-gadolinium-enhancement (LGE) cardiovascular magnetic resonance (CMR) imaging reveals clinically silent "unrecognized myocardial scar" (UMS), but the etiology of UMS often remains unclear. This population-based CMR study evaluated prevalence, localization, patterns, and risk factors of UMS. METHODS The study population consisted of 1064 consecutive Hamburg City Health Study participants without a history of coronary heart disease or myocarditis. UMS was assessed by standard-phase-sensitive-inversion-recovery LGE CMR. RESULTS Median age was 66 [quartiles 59, 71] years and 37% (388/1064) were females. UMS was detected in 244 (23%) participants. Twenty-five participants (10%) had ischemic, and 217 participants (89%) had non-ischemic scar patterns, predominantly involving the basal inferolateral left-ventricular (LV) myocardium (75%). Two participants (1%) had coincident ischemic and non-ischemic scar. The presence of any UMS was independently associated with LV ejection fraction (odds ratios (OR) per standard deviation (SD) 0.77 (confidence interval (CI) 0.65-0.90), p = 0.002) and LV mass (OR per SD 1.54 (CI 1.31-1.82), p < 0.001). Ischemic UMS was independently associated with LV ejection fraction (OR per SD 0.58 (CI 0.39-0.86), p = 0.007), LV mass (OR per SD 1.74 (CI 1.25-2.45), p = 0.001), and diabetes (OR 4.91 (CI 1.66-13.03), p = 0.002). Non-ischemic UMS was only independently associated with LV mass (OR per SD 1.44 (CI 1.24-1.69), p < 0.001). CONCLUSION UMS, in particular with a non-ischemic pattern, is frequent in individuals without known cardiac disease and predominantly involves the basal inferolateral LV myocardium. Presence of UMS is independently associated with a lower LVEF, a higher LV mass, and a history of diabetes.
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Affiliation(s)
- Ersin Cavus
- Department of Cardiology, University Heart and Vascular Center Hamburg Eppendorf, Hamburg, Germany; Deutsches Zentrum für Herz-Kreislauf-Forschung e.V. (German Center for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Germany, Hamburg, Germany.
| | - Jan N Schneider
- Department of Cardiology, University Heart and Vascular Center Hamburg Eppendorf, Hamburg, Germany
| | - Eleonora di Carluccio
- Department of Cardiology, University Heart and Vascular Center Hamburg Eppendorf, Hamburg, Germany; Cardio-Care, Medizincampus Davos, Davos, Switzerland
| | - Andreas Ziegler
- Department of Cardiology, University Heart and Vascular Center Hamburg Eppendorf, Hamburg, Germany; Cardio-Care, Medizincampus Davos, Davos, Switzerland; School of Mathematics, Statistics and Computer Science, University of KwaZulu-Natal, Pietermaritzburg, South Africa
| | - Alena Haack
- Department of Cardiology, University Heart and Vascular Center Hamburg Eppendorf, Hamburg, Germany
| | - Francisco Ojeda
- Department of Cardiology, University Heart and Vascular Center Hamburg Eppendorf, Hamburg, Germany
| | - Celeste Chevalier
- Department of Cardiology, University Heart and Vascular Center Hamburg Eppendorf, Hamburg, Germany
| | - Charlotte Jahnke
- Department of Cardiology, University Heart and Vascular Center Hamburg Eppendorf, Hamburg, Germany
| | - Katharina A Riedl
- Department of Cardiology, University Heart and Vascular Center Hamburg Eppendorf, Hamburg, Germany; Deutsches Zentrum für Herz-Kreislauf-Forschung e.V. (German Center for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Germany, Hamburg, Germany
| | - Ulf K Radunski
- Department of Cardiology, University Heart and Vascular Center Hamburg Eppendorf, Hamburg, Germany
| | - Raphael Twerenbold
- Department of Cardiology, University Heart and Vascular Center Hamburg Eppendorf, Hamburg, Germany; Deutsches Zentrum für Herz-Kreislauf-Forschung e.V. (German Center for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Germany, Hamburg, Germany; University Center of Cardiovascular Science, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Paulus Kirchhof
- Department of Cardiology, University Heart and Vascular Center Hamburg Eppendorf, Hamburg, Germany; Deutsches Zentrum für Herz-Kreislauf-Forschung e.V. (German Center for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Germany, Hamburg, Germany
| | - Stefan Blankenberg
- Department of Cardiology, University Heart and Vascular Center Hamburg Eppendorf, Hamburg, Germany; Deutsches Zentrum für Herz-Kreislauf-Forschung e.V. (German Center for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Germany, Hamburg, Germany
| | - Gerhard Adam
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Hospital Hamburg Eppendorf, Hamburg, Germany
| | - Enver Tahir
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Hospital Hamburg Eppendorf, Hamburg, Germany
| | - Gunnar K Lund
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Hospital Hamburg Eppendorf, Hamburg, Germany
| | - Kai Muellerleile
- Department of Cardiology, University Heart and Vascular Center Hamburg Eppendorf, Hamburg, Germany; Deutsches Zentrum für Herz-Kreislauf-Forschung e.V. (German Center for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Germany, Hamburg, Germany
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Zhang P, Zhang Z, Zhong J, Zheng X, Zhou J, Sun W. Cardiovascular diseases consequences of type 1, type 2 diabetes mellitus and glycemic traits: A Mendelian randomization study. Diabetes Res Clin Pract 2024; 208:111094. [PMID: 38224876 DOI: 10.1016/j.diabres.2024.111094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Revised: 12/29/2023] [Accepted: 01/09/2024] [Indexed: 01/17/2024]
Abstract
OBJECTIVE This Mendelian randomization (MR) study aimed to investigate the relationships between type 1 diabetes (T1D), type 2 diabetes (T2D), and glycemic traits, including fasting insulin, fasting glucose, and HbA1c, with cardiovascular diseases (CVDs). METHODS We selected genetic instruments for predisposition to T1D, T2D, fasting insulin, fasting glucose, and HbA1c based on published genome-wide association studies. Using a 2-Sample MR approach, we assessed associations with 12 common CVDs sourced from the FinnGen and UK Biobank studies, along with stroke subtypes obtained from the GIGASTROKE and MEGASTROKE Consortium. RESULTS T1D was associated with SVS. T2D showed associations with AIS, LAA, CES, SVS, coronary heart disease, myocardial infarction, pulmonary embolism, DVT of lower extremities, peripheral vascular diseases. Genetically predicted higher HbA1c levels were associated with eight CVDs. The results of MVMR aligned with the primary findings for T1D and T2D. CONCLUSIONS T1D and T2D exhibit different genetic predisposition to CVDs. BMI, LDL, and HDL play intermediary roles in connecting TID and T2D to specific types of CVDs, providing insights into the potential underlying pathways and mechanisms involved in these relationships. Strategies aimed at achieving sustained reductions in HbA1c levels may offer potential for reducing the risk of various CVDs.
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Affiliation(s)
- Pan Zhang
- Department of Neurology, Centre for Leading Medicine and Advanced Technologies of IHM, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui 230001, China
| | - Zihang Zhang
- Department of Cardiovascular Surgery ICU, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230001, China
| | - Jinghui Zhong
- Department of Neurology, Centre for Leading Medicine and Advanced Technologies of IHM, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui 230001, China
| | - Xueying Zheng
- Department of Endocrinology, Institute of Endocrine and Metabolic Diseases, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, Clinical Research Hospital of Chinese Academy of Sciences (Hefei), University of Science and Technology of China, Hefei, China
| | - Junling Zhou
- Department of Cardiology, The First Affiliated Hospital of USTC, Division of Life Science and Medicine, University of Science and Technology of China, Hefei, Anhui, China.
| | - Wen Sun
- Department of Neurology, Centre for Leading Medicine and Advanced Technologies of IHM, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui 230001, China.
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Boccalini S, Teulade M, Paquet E, Si-Mohamed S, Rapallo F, Moreau-Triby C, Charrière S, Mewton N, Boussel L, Bergerot C, Douek P, Moulin P. Silent myocardial infarction fatty scars detected by coronary calcium score CT scan in diabetic patients without history of coronary heart disease. Eur Radiol 2024; 34:214-225. [PMID: 37530810 DOI: 10.1007/s00330-023-09940-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 05/14/2023] [Accepted: 05/16/2023] [Indexed: 08/03/2023]
Abstract
OBJECTIVES To evaluate the prevalence of intra-myocardial fatty scars (IMFS) most likely indicating previous silent myocardial infarction (SMI), as detected on coronary artery calcium (CAC) computed tomography (CT) scans in diabetic patients without history of coronary heart disease (CHD). METHODS Diabetic patients screened for silent coronary insufficiency in a tertiary-care, university hospital between Jan-2015 and Dec-2016 were categorized according to their CAC score in two groups comprising 242 patients with CACS = 0 and 145 patients with CACS ≥ 300. CAC-CT scans were retrospectively evaluated for subendorcardial and transmural IMFS of the left ventricle. Adipose remodeling, patients' characteristics, cardiovascular risk factors and metabolic profile were compared between groups. RESULTS Eighty-three (21%) patients with IMFS were identified, 55 (37.9%) in the group CACS ≥ 300 and 28 (11.6%) in the CACS = 0 (OR = 4.67; 95% CI = 2.78-7.84; p < 0.001). Total and average surface of IMFS and their number per patient were similar in both groups (p = 0.55; p = 0.29; p = 0.61, respectively). In the group CACS ≥ 300, patients with IMFS were older (p = 0.03) and had longer-lasting diabetes (p = 0.04). Patients with IMFS were older and had longer history of diabetes, reduced glomerular filtration rate, more coronary calcifications (all p < 0.05), and higher prevalence of carotid plaques (OR = 3.03; 95% CI = 1.43-6.39, p = 0.004). After correction for other variables, only a CACS ≥ 300 (OR = 5.12; 95% CI = 2.66-9.85; p < 0.001) was associated with an increased risk of having IMFS. CONCLUSIONS In diabetic patients without known CHD, IMFSs were found in patients without coronary calcifications, although not as frequently as in patients with heavily calcified coronary arteries. It remains to be established if this marker translates in an upwards cardiovascular risk restratification especially in diabetic patients with CACS = 0. CLINICAL RELEVANCE STATEMENT In diabetic patients without history of coronary heart disease, intramyocardial fatty scars, presumably of post-infarction origin, can be detected on coronary artery calcium CT scans more frequently, but not exclusively, if the coronary arteries are heavily calcified as compared to those without calcifications. KEY POINTS • Intramyocardial fatty scars (IMFS), presumably of post-infarction origin, can be detected on coronary artery calcium (CAC) CT scans more frequently, but not exclusively, in diabetic patients with CACS ≥ 300 as compared to patients CACS = 0. • Patients with IMFS were older and had longer history of diabetes, reduced glomerular filtration rate, and more coronary calcifications. • Carotid plaques and CACS ≥ 300 were associated with an increased risk of having IMFS, about three and five folds respectively.
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Affiliation(s)
- Sara Boccalini
- Department of Cardiovascular Radiology, Hôpital Pradel, Hospices Civils de Lyon, Lyon, France.
- University Claude Bernard Lyon 1, Lyon, France.
| | - Marie Teulade
- University Claude Bernard Lyon 1, Lyon, France
- Department of Endocrinology Louis Pradel University Hospital, Hospices Civils de Lyon, INSERM UMR 1060, Carmen, Lyon, France
| | - Emilie Paquet
- Department of Nuclear Medicine, Hôpital Louis Pradel, Hospices Civils de Lyon, Lyon, France
| | - Salim Si-Mohamed
- Department of Cardiovascular Radiology, Hôpital Pradel, Hospices Civils de Lyon, Lyon, France
- University Claude Bernard Lyon 1, Lyon, France
| | - Fabio Rapallo
- Department of Economics, University of Genova, Genoa, Italy
| | - Caroline Moreau-Triby
- Department of Nuclear Medicine, Hôpital Louis Pradel, Hospices Civils de Lyon, Lyon, France
| | - Sybil Charrière
- University Claude Bernard Lyon 1, Lyon, France
- Department of Endocrinology Louis Pradel University Hospital, Hospices Civils de Lyon, INSERM UMR 1060, Carmen, Lyon, France
| | - Nathan Mewton
- University Claude Bernard Lyon 1, Lyon, France
- Department of Cardiology, Hôpital Louis Pradel, Hospices Civils de Lyon, Lyon, France
| | - Loic Boussel
- Department of Radiology, Hôpital de la Croix Rousse, Hospices Civils de Lyon, Lyon, France
| | - Cyrille Bergerot
- Department of Cardiology, Hôpital Louis Pradel, Hospices Civils de Lyon, Lyon, France
| | - Philippe Douek
- Department of Cardiovascular Radiology, Hôpital Pradel, Hospices Civils de Lyon, Lyon, France
- University Claude Bernard Lyon 1, Lyon, France
| | - Philippe Moulin
- University Claude Bernard Lyon 1, Lyon, France
- Department of Endocrinology Louis Pradel University Hospital, Hospices Civils de Lyon, INSERM UMR 1060, Carmen, Lyon, France
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Blaszczyk E, Hellwig S, Saad H, Ganeshan R, Stengl H, Nolte CH, Fiebach JB, Endres M, Kuhnt J, Gröschel J, Schulz-Menger J, Scheitz JF. Myocardial injury in patients with acute ischemic stroke detected by cardiovascular magnetic resonance imaging. Eur J Radiol 2023; 165:110908. [PMID: 37315403 DOI: 10.1016/j.ejrad.2023.110908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 04/29/2023] [Accepted: 05/30/2023] [Indexed: 06/16/2023]
Abstract
BACKGROUND Patients with acute ischemic stroke (AIS) are at high risk of adverse cardiovascular events. Until now, the burden of myocardial injury derived from cardiovascular magnetic resonance imaging (CMR) has not been established in this population. METHODS Patients with AIS underwent CMR at 3 Tesla within 120 h after the index stroke as part of a prospective, single-center study. Patients with persistent atrial fibrillation were excluded. Morphology and function of both cardiac chambers and atria were assessed applying SSFP cine. Myocardial tissue differentiation was based on native and contrast-enhanced imaging including late gadolinium enhancement (LGE) after 0.15 mmol/kg gadobutrol for focal fibrosis and parametric T2- and T1-mapping for diffuse findings. To detect myocardial deformation global longitudinal (GLS), circumferential (GCS) and radial (GRS) strain was measured applying feature tracking. Cardiac troponin was measured using a high-sensitivity assay (99th percentile upper reference limit 14 ng/L). T2 mapping values were compared with 20 healthy volunteers. RESULTS CMR with contrast media was successfully performed in 92 of 115 patients (mean age 74 years, 40% female, known myocardial infarction 6%). Focal myocardial fibrosis (LGE) was detected in 31 of 92 patients (34%) of whom 23/31 (74%) showed an ischemic pattern. Patients with LGE were more likely to have diabetes, prior myocardial infarction, prior ischemic stroke, and to have elevated troponin levels compared to those without. Presence of LGE was accompanied by diffuse fibrosis (increased T1 native values) even in remote cardiac areas as well as reduced global radial, circumferential and longitudinal strain values. In 14/31 (45%) of all patients with LGE increased T2-mapping values were detectable. CONCLUSIONS More than one-third of patients with AIS have evidence of focal myocardial fibrosis on CMR. Nearly half of these changes may have acute or subacute onset. These findings are accompanied by diffuse myocardial changes and reduced myocardial deformation. Further studies, ideally with serial CMR measurements during follow-up, are required to establish the impact of these findings on long-term prognosis after AIS.
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Affiliation(s)
- E Blaszczyk
- Charité Universitätsmedizin Berlin, Working Group on Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center a joint cooperation between the Charité Medical Faculty and the Max-Delbrueck Center for Molecular Medicine , HELIOS Klinikum Berlin Buch, Cardiology, Berlin, Germany; DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany
| | - S Hellwig
- Klinik für Neurologie mit Experimenteller Neurologie, Charité Universitätsmedizin Berlin und Centrum für Schlaganfallforschung, Berlin, Germany
| | - H Saad
- Charité Universitätsmedizin Berlin, Working Group on Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center a joint cooperation between the Charité Medical Faculty and the Max-Delbrueck Center for Molecular Medicine , HELIOS Klinikum Berlin Buch, Cardiology, Berlin, Germany
| | - R Ganeshan
- Klinik für Neurologie mit Experimenteller Neurologie, Charité Universitätsmedizin Berlin und Centrum für Schlaganfallforschung, Berlin, Germany
| | - H Stengl
- Klinik für Neurologie mit Experimenteller Neurologie, Charité Universitätsmedizin Berlin und Centrum für Schlaganfallforschung, Berlin, Germany
| | - C H Nolte
- Klinik für Neurologie mit Experimenteller Neurologie, Charité Universitätsmedizin Berlin und Centrum für Schlaganfallforschung, Berlin, Germany; DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany; Berlin Institute of Health (BIH), Germany
| | - J B Fiebach
- Klinik für Neurologie mit Experimenteller Neurologie, Charité Universitätsmedizin Berlin und Centrum für Schlaganfallforschung, Berlin, Germany
| | - M Endres
- Klinik für Neurologie mit Experimenteller Neurologie, Charité Universitätsmedizin Berlin und Centrum für Schlaganfallforschung, Berlin, Germany; DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany; ExcellenceCluster NeuroCure, Germany; German Center for Neurodegenerative Diseases (DZNE), partner site Berlin, Germany; Berlin Institute of Health (BIH), Germany
| | - J Kuhnt
- Charité Universitätsmedizin Berlin, Working Group on Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center a joint cooperation between the Charité Medical Faculty and the Max-Delbrueck Center for Molecular Medicine , HELIOS Klinikum Berlin Buch, Cardiology, Berlin, Germany
| | - J Gröschel
- Charité Universitätsmedizin Berlin, Working Group on Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center a joint cooperation between the Charité Medical Faculty and the Max-Delbrueck Center for Molecular Medicine , HELIOS Klinikum Berlin Buch, Cardiology, Berlin, Germany; DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany
| | - J Schulz-Menger
- Charité Universitätsmedizin Berlin, Working Group on Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center a joint cooperation between the Charité Medical Faculty and the Max-Delbrueck Center for Molecular Medicine , HELIOS Klinikum Berlin Buch, Cardiology, Berlin, Germany; DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany
| | - J F Scheitz
- Klinik für Neurologie mit Experimenteller Neurologie, Charité Universitätsmedizin Berlin und Centrum für Schlaganfallforschung, Berlin, Germany; DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany.
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Zeng G, An H, Li W, Fang D, Sun M, Zheng Q, Wang TJ. Correlation between Glycated Haemoglobin Level, Cardiac Function, and Prognosis in Patients with Diabetes Mellitus Combined with Myocardial Infarction. Disease Markers 2022; 2022:1-7. [PMID: 36193498 PMCID: PMC9525741 DOI: 10.1155/2022/2191294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 08/23/2022] [Accepted: 08/29/2022] [Indexed: 11/24/2022]
Abstract
Objective This study was to investigate the correlation between glycated haemoglobin (HbA1c) level, cardiac function, and prognosis in patients with diabetes mellitus combined with myocardial infarction. Methods Ninety-three patients with type 2 diabetes mellitus combined with acute myocardial infarction who were hospitalized and treated in our hospital from January 2021 to June 2021 were recruited for prospective analysis and equally divided into group A (HbA1c < 6.5%), group B (6.5% ≤ HbA1c ≤ 8.5%), and group C (HbA1c > 8.5%) using the random number table method, with 31 patients in each group. General data of patients were collected on admission and blood glucose and cardiac function indexes were measured; the incidence of myocardial infarction and death during the follow-up period was recorded at 6 months after discharge. Results There was a significant difference in blood glucose (FBG) and HbA1c levels at fasting between the three groups (P < 0.05). There were statistically significant differences in plasma levels of N-terminal probrain natriuretic peptide (NT-proBNP) and uric acid (UA), left ventricular end diastolic diameter (LVEDD), left ventricular end systolic volume (LVESV), left ventricular ejection fraction (LVEF), and cardiac function classification of the New York Heart Association (NYHA) among the three groups (P < 0.05). By statistical analysis, the HbA1c level was positively correlated with FBG, NT-proBNP, UA, LVEDD, LVESD, and NYHA grades but negatively correlated with LVEF (P < 0.05). The incidence rate of myocardial infarction and mortality was significantly higher in group C than in groups A and B (P < 0.05). Conclusion HbA1c level in patients with diabetes mellitus combined with myocardial infarction is closely related to the degree of cardiac function damage. Glycated haemoglobin levels are associated with the development of cardiac insufficiency in patients with acute myocardial infarction; glycated haemoglobin is also an independent predictor of major adverse cardiovascular events. Reasonable and effective blood glucose control is of great significance to the prognosis of patients.
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Marin GH, Giangreco L, Marin L, Bruzzoni-Giovanelli H, Marin G, Vetere P. [Implementation of a support system for isolated elderly people to limit the consequences of the Covid-19 epidemic in Buenos Aires]. Soins Gerontol 2022; 27:30-38. [PMID: 35393033 DOI: 10.1016/j.sger.2021.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
The Covid-19 pandemic with its associated quarantine and isolation has had a dramatic impact on the elderly. In order to mitigate this, the National University of La Plata and the Agence Universitaire de la Francophonie set up a health surveillance and early warning project for the elderly in Buenos Aires, Argentina. This interventional study, has included 1,964 people. A general health and quality of life questionnaire was completed by all participants at the beginning of the isolation, and another time a year later.
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Affiliation(s)
- Gustavo H Marin
- Universidad nacional de La Plata, Facultad de ciencias médicas, calle 60 y 120, 1900 La Plata, Buenos Aires, Argentine.
| | - Lucia Giangreco
- Universidad nacional de La Plata, Facultad de ciencias médicas, calle 60 y 120, 1900 La Plata, Buenos Aires, Argentine
| | - Lupe Marin
- Universidad nacional de La Plata, Facultad de ciencias médicas, calle 60 y 120, 1900 La Plata, Buenos Aires, Argentine
| | - Heriberto Bruzzoni-Giovanelli
- Centre d'investigations cliniques-1427, Institut national de la santé et de la recherche médicale, hôpital Saint-Louis, Assistance publique-Hôpitaux de Paris, universite de Paris, 1 avenue Claude-Vellefaux, 75010 Paris, France
| | - Gina Marin
- Universidad nacional de La Plata, Facultad de ciencias médicas, calle 60 y 120, 1900 La Plata, Buenos Aires, Argentine
| | - Pablo Vetere
- Universidad nacional de La Plata, Facultad de ciencias médicas, calle 60 y 120, 1900 La Plata, Buenos Aires, Argentine
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Yang Z, Xu R, Wang JR, Xu HY, Fu H, Xie LJ, Yang MX, Zhang L, Wen LY, Liu H, Li H, Yang ZG, Guo YK. Association of myocardial fibrosis detected by late gadolinium-enhanced MRI with clinical outcomes in patients with diabetes: a systematic review and meta-analysis. BMJ Open 2022; 12:e055374. [PMID: 35017252 PMCID: PMC8753417 DOI: 10.1136/bmjopen-2021-055374] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE This meta-analysis assessed the associations of myocardial fibrosis detected by late gadolinium-enhanced (LGE)-MRI with the risk of major adverse cardiac and cerebrovascular events (MACCEs) and major adverse cardiac events (MACEs) in patients with diabetes. DESIGN Systematic review and meta-analysis reported in accordance with the guidelines of the Meta-analysis of Observational Studies in Epidemiology statement. DATA SOURCES We searched the Medline, Embase and Cochrane by Ovid databases for studies published up to 27 August 2021. ELIGIBILITY CRITERIA Prospective or respective cohort studies were included if they reported the HR and 95% CIs for MACCEs/MACEs in patients with either type 1 or 2 diabetes and LGE-MRI-detected myocardial fibrosis compared with patients without LGE-MRI-detected myocardial fibrosis and if the articles were published in the English language. DATA EXTRACTION AND SYNTHESIS Two review authors independently extracted data and assessed the quality of the included studies. Pooled HRs and 95% CIs were analysed using a random effects model. Heterogeneity was assessed using forest plots and I2 statistics. RESULTS Eight studies with 1121 patients with type 1 or type 2 diabetes were included in this meta-analysis, and the follow-up ranged from 17 to 70 months. The presence of myocardial fibrosis detected by LGE-MRI was associated with an increased risk for MACCEs (HR: 2.58; 95% CI 1.42 to 4.71; p=0.002) and MACEs (HR: 5.28; 95% CI 3.20 to 8.70; p<0.001) in patients with diabetes. Subgroup analysis revealed that ischaemic fibrosis detected by LGE was associated with MACCEs (HR 3.80, 95% CI 2.38 to 6.07; p<0.001) in patients with diabetes. CONCLUSIONS This study demonstrated that ischaemic myocardial fibrosis detected by LGE-MRI was associated with an increased risk of MACCEs/MACEs in patients with diabetes and may be an imaging biomarker for risk stratification. Whether LGE-MRI provides incremental prognostic information with respect to MACCEs/MACEs over risk stratification by conventional cardiovascular risk factors requires further study.
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Affiliation(s)
- Zhi Yang
- Department of Radiology, Key Laboratory of Birth Defects and Related Diseases of Women and Children of Ministry of Education, Sichuan University West China Second University Hospital, Chengdu, China
- Department of Radiology, Chengdu Fifth People's Hospital, Chengdu, Sichuan, China
| | - Rong Xu
- Department of Radiology, Key Laboratory of Birth Defects and Related Diseases of Women and Children of Ministry of Education, Sichuan University West China Second University Hospital, Chengdu, China
| | - Jia-Rong Wang
- Department of Radiology, Sichuan University West China Hospital, Chengdu, Sichuan, China
| | - Hua-Yan Xu
- Department of Radiology, Key Laboratory of Birth Defects and Related Diseases of Women and Children of Ministry of Education, Sichuan University West China Second University Hospital, Chengdu, China
| | - Hang Fu
- Department of Radiology, Key Laboratory of Birth Defects and Related Diseases of Women and Children of Ministry of Education, Sichuan University West China Second University Hospital, Chengdu, China
| | - Ling-Jun Xie
- Department of Radiology, Key Laboratory of Birth Defects and Related Diseases of Women and Children of Ministry of Education, Sichuan University West China Second University Hospital, Chengdu, China
| | - Meng-Xi Yang
- Department of Radiology, Sichuan University West China Hospital, Chengdu, Sichuan, China
| | - Lu Zhang
- Department of Radiology, Key Laboratory of Birth Defects and Related Diseases of Women and Children of Ministry of Education, Sichuan University West China Second University Hospital, Chengdu, China
| | - Ling-Yi Wen
- Department of Radiology, Key Laboratory of Birth Defects and Related Diseases of Women and Children of Ministry of Education, Sichuan University West China Second University Hospital, Chengdu, China
| | - Hui Liu
- Department of Radiology, Key Laboratory of Birth Defects and Related Diseases of Women and Children of Ministry of Education, Sichuan University West China Second University Hospital, Chengdu, China
| | - Hong Li
- Key Laboratory of Obstetrics & Gynecology and Pediatric Disease and Birth Defects of Ministry of Education, Sichuan University West China Second University Hospital, Chengdu, China
| | - Zhi-Gang Yang
- Department of Radiology, Sichuan University West China Hospital, Chengdu, Sichuan, China
| | - Ying-Kun Guo
- Department of Radiology, Key Laboratory of Birth Defects and Related Diseases of Women and Children of Ministry of Education, Sichuan University West China Second University Hospital, Chengdu, China
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Joseph JJ, Deedwania P, Acharya T, Aguilar D, Bhatt DL, Chyun DA, Di Palo KE, Golden SH, Sperling LS. Comprehensive Management of Cardiovascular Risk Factors for Adults With Type 2 Diabetes: A Scientific Statement From the American Heart Association. Circulation 2022; 145:e722-e759. [PMID: 35000404 DOI: 10.1161/cir.0000000000001040] [Citation(s) in RCA: 171] [Impact Index Per Article: 85.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Cardiovascular disease remains the leading cause of death in patients with diabetes. Cardiovascular disease in diabetes is multifactorial, and control of the cardiovascular risk factors leads to substantial reductions in cardiovascular events. The 2015 American Heart Association and American Diabetes Association scientific statement, "Update on Prevention of Cardiovascular Disease in Adults With Type 2 Diabetes Mellitus in Light of Recent Evidence," highlighted the importance of modifying various risk factors responsible for cardiovascular disease in diabetes. At the time, there was limited evidence to suggest that glucose-lowering medications reduce the risk of cardiovascular events. At present, several large randomized controlled trials with newer antihyperglycemic agents have been completed, demonstrating cardiovascular safety and reduction in cardiovascular outcomes, including cardiovascular death, myocardial infarction, stroke, and heart failure. This AHA scientific statement update focuses on (1) the evidence and clinical utility of newer antihyperglycemic agents in improving glycemic control and reducing cardiovascular events in diabetes; (2) the impact of blood pressure control on cardiovascular events in diabetes; and (3) the role of newer lipid-lowering therapies in comprehensive cardiovascular risk management in adults with diabetes. This scientific statement addresses the continued importance of lifestyle interventions, pharmacological therapy, and surgical interventions to curb the epidemic of obesity and metabolic syndrome, important precursors of prediabetes, diabetes, and comorbid cardiovascular disease. Last, this scientific statement explores the critical importance of the social determinants of health and health equity in the continuum of care in diabetes and cardiovascular disease.
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Lu L, Ma J, Liu Y, Shao Y, Xiong X, Duan W, Gao E, Yang Q, Chen S, Yang J, Ren J, Zheng Q, Liu J. FSTL1-USP10-Notch1 Signaling Axis Protects Against Cardiac Dysfunction Through Inhibition of Myocardial Fibrosis in Diabetic Mice. Front Cell Dev Biol 2021; 9:757068. [PMID: 34957094 PMCID: PMC8695978 DOI: 10.3389/fcell.2021.757068] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 11/17/2021] [Indexed: 12/11/2022] Open
Abstract
The incidence of type 2 diabetes mellitus (T2DM) has been increasing globally, and T2DM patients are at an increased risk of major cardiac events such as myocardial infarction (MI). Nevertheless, the molecular mechanisms underlying MI injury in T2DM remain elusive. Ubiquitin-specific protease 10 (USP10) functions as a NICD1 (Notch1 receptor) deubiquitinase that fine-tunes the essential myocardial fibrosis regulator Notch signaling. Follistatin-like protein 1 (FSTL1) is a cardiokine with proven benefits in multiple pathological processes including cardiac fibrosis and insulin resistance. This study was designed to examine the roles of FSTL1/USP10/Notch1 signaling in MI-induced cardiac dysfunction in T2DM. High-fat-diet-treated, 8-week-old C57BL/6J mice and db/db T2DM mice were used. Intracardiac delivery of AAV9-FSTL1 was performed in T2DM mice following MI surgery with or without intraperitoneal injection of crenigacestat (LY3039478) and spautin-1. Our results demonstrated that FSTL1 improved cardiac function following MI under T2DM by reducing serum lactate dehydrogenase (LDH) and myocardial apoptosis as well as cardiac fibrosis. Further in vivo studies revealed that the protective role of FSTL1 against MI injury in T2DM was mediated by the activation of USP10/Notch1. FSTL1 protected cardiac fibroblasts (CFs) against DM-MI-induced cardiofibroblasts injury by suppressing the levels of fibrosis markers, and reducing LDH and MDA concentrations in a USP10/Notch1-dependent manner. In conclusion, FSTL1 treatment ameliorated cardiac dysfunction in MI with co-existent T2DM, possibly through inhibition of myocardial fibrosis and apoptosis by upregulating USP10/Notch1 signaling. This finding suggests the clinical relevance and therapeutic potential of FSTL1 in T2DM-associated MI and other cardiovascular diseases.
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Affiliation(s)
- Linhe Lu
- Department of Cardiovascular Surgery, Xijing Hospital, The Air Force Medical University, Xi’an, China
| | - Jipeng Ma
- Department of Cardiovascular Surgery, Xijing Hospital, The Air Force Medical University, Xi’an, China
| | - Yang Liu
- Department of Cardiovascular Surgery, Xijing Hospital, The Air Force Medical University, Xi’an, China
| | - Yalan Shao
- Department of Cardiovascular Surgery, Xijing Hospital, The Air Force Medical University, Xi’an, China
| | - Xiang Xiong
- Department of Cardiovascular Surgery, Xijing Hospital, The Air Force Medical University, Xi’an, China
| | - Weixun Duan
- Department of Cardiovascular Surgery, Xijing Hospital, The Air Force Medical University, Xi’an, China
| | - Erhe Gao
- Center for Translational Medicine, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, United States
| | - Qianli Yang
- Department of Ultrasound, Xijing Hospital, The Air Force Medical University, Xi’an, China
| | - Shasha Chen
- Department of Ultrasound, Xijing Hospital, The Air Force Medical University, Xi’an, China
| | - Jian Yang
- Department of Cardiovascular Surgery, Xijing Hospital, The Air Force Medical University, Xi’an, China
| | - Jun Ren
- Department of Cardiology and Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital Fudan University, Shanghai, China
- Department of Clinical Medicine and Pathology, University of Washington, Seattle, WA, United States
- *Correspondence: Jun Ren, ; Qijun Zheng, ; Jincheng Liu,
| | - Qijun Zheng
- Department of Cardiovascular Surgery, Shenzhen People’s Hospital, The Second Clinical Medical College, Jinan University, Shenzhen, China
- *Correspondence: Jun Ren, ; Qijun Zheng, ; Jincheng Liu,
| | - Jincheng Liu
- Department of Cardiovascular Surgery, Xijing Hospital, The Air Force Medical University, Xi’an, China
- *Correspondence: Jun Ren, ; Qijun Zheng, ; Jincheng Liu,
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11
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Zhan C, Zhang Y, Liu X, Wu R, Zhang K, Shi W, Shen L, Shen K, Fan X, Ye F, Shen B. MIKB: A manually curated and comprehensive knowledge base for myocardial infarction. Comput Struct Biotechnol J 2021; 19:6098-6107. [PMID: 34900127 PMCID: PMC8626632 DOI: 10.1016/j.csbj.2021.11.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 11/11/2021] [Accepted: 11/11/2021] [Indexed: 02/08/2023] Open
Abstract
Myocardial infarction knowledge base (MIKB; http://www.sysbio.org.cn/mikb/; latest update: December 31, 2020) is an open-access and manually curated database dedicated to integrating knowledge about MI to improve the efficiency of translational MI research. MIKB is an updated and expanded version of our previous MI Risk Knowledge Base (MIRKB), which integrated MI-related risk factors and risk models for providing help in risk assessment or diagnostic prediction of MI. The updated MIRKB includes 9701 records with 2054 single factors, 209 combined factors, 243 risk models, 37 MI subtypes and 3406 interactions between single factors and MIs collected from 4817 research articles. The expanded functional module, i.e. MIGD, is a database including not only MI associated genetic variants, but also the other multi-omics factors and the annotations for their functional alterations. The goal of MIGD is to provide a multi-omics level understanding of the molecular pathogenesis of MI. MIGD includes 1782 omics factors, 28 MI subtypes and 2347 omics factor-MI interactions as well as 1253 genes and 6 chromosomal alterations collected from 2647 research articles. The functions of MI associated genes and their interaction with drugs were analyzed. MIKB will be continuously updated and optimized to provide precision and comprehensive knowledge for the study of heterogeneous and personalized MI.
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Affiliation(s)
- Chaoying Zhan
- Institutes for Systems Genetics, Frontiers Science Center for Disease-related Molecular Network, West China Hospital, Sichuan University, Sichuan 610212, China
| | - Yingbo Zhang
- Institutes for Systems Genetics, Frontiers Science Center for Disease-related Molecular Network, West China Hospital, Sichuan University, Sichuan 610212, China
- Tropical Crops Genetic Resources Institute, Chinese Academy of Tropical Agricultural Sciences, Haikou 571101, China
| | - Xingyun Liu
- Institutes for Systems Genetics, Frontiers Science Center for Disease-related Molecular Network, West China Hospital, Sichuan University, Sichuan 610212, China
| | - Rongrong Wu
- Institutes for Systems Genetics, Frontiers Science Center for Disease-related Molecular Network, West China Hospital, Sichuan University, Sichuan 610212, China
| | - Ke Zhang
- Institutes for Systems Genetics, Frontiers Science Center for Disease-related Molecular Network, West China Hospital, Sichuan University, Sichuan 610212, China
| | - Wenjing Shi
- Institutes for Systems Genetics, Frontiers Science Center for Disease-related Molecular Network, West China Hospital, Sichuan University, Sichuan 610212, China
| | - Li Shen
- Institutes for Systems Genetics, Frontiers Science Center for Disease-related Molecular Network, West China Hospital, Sichuan University, Sichuan 610212, China
| | - Ke Shen
- Institutes for Systems Genetics, Frontiers Science Center for Disease-related Molecular Network, West China Hospital, Sichuan University, Sichuan 610212, China
| | - Xuemeng Fan
- Institutes for Systems Genetics, Frontiers Science Center for Disease-related Molecular Network, West China Hospital, Sichuan University, Sichuan 610212, China
| | - Fei Ye
- Institutes for Systems Genetics, Frontiers Science Center for Disease-related Molecular Network, West China Hospital, Sichuan University, Sichuan 610212, China
| | - Bairong Shen
- Institutes for Systems Genetics, Frontiers Science Center for Disease-related Molecular Network, West China Hospital, Sichuan University, Sichuan 610212, China
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12
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Li Y, Cui J, Liu Y, Chen K, Huang L, Liu Y. Development and Validation of Risk Prediction Model for New-Onset Diabetes After Percutaneous Coronary Intervention (NODAP): A Study Protocol for a Retrospective, Multicenter Analysis. Front Cardiovasc Med 2021; 8:748256. [PMID: 34708095 PMCID: PMC8542850 DOI: 10.3389/fcvm.2021.748256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 08/25/2021] [Indexed: 11/30/2022] Open
Abstract
Background: Type 2 Diabetes mellitus (T2DM) is a major risk factor for cardiovascular diseases and increase mortality. Clinical outcomes of patients after percutaneous coronary intervention (PCI) were worse in T2DM patients than those without T2DM. New-onset diabetes after PCI (NODAP) is often observed during long-term follow-up and this further aggravates cardiovascular diseases. Several studies had focused on patients after PCI with known T2DM. Previous studies showed that impaired glucose tolerance and aging are risk factors that promote NODAP. Considering the unique characteristics of patients after PCI, we will further study relevant risk factors. We sought to investigate the potential predictors of acute coronary syndrome patients with NODAP by a multicenter retrospective cohort study. Methods: This is a multicenter retrospective cohort study including patients after PCI. Clinical medical records of these patients were collected from four hospitals in different areas in China, from 2010 to 2021. Patients' demographic information, medical history, diagnostic testing, PCI-related information, medication situation will be summarized using descriptive statistics, and correlation analysis was performed on the development of new-onset diabetes. Variation will be described and evaluated using χ2 test or Kreskas-Wallis test. The prediction model will be verified by a validation set. Discussion: A novel diabetes prediction model for patients after PCI is established, and this study can achieve advanced intervention for the occurrence of NODAP. Owing to its retrospective nature, this study has some limitations, but it will be further studied through supplement data collection or prospective study. The study has been registered for clinical trials by the Chinese Clinical Trial Registry (ChiCTR2100047241).
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Affiliation(s)
- Yiwen Li
- National Clinical Research Center for TCM Cardiology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Jing Cui
- National Clinical Research Center for TCM Cardiology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Yanfei Liu
- The Second Department of Geriatrics, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Keji Chen
- National Clinical Research Center for TCM Cardiology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Luqi Huang
- China Center for Evidence-based Medicine of TCM, China Academy of Chinese Medical Sciences, Beijing, China
| | - Yue Liu
- National Clinical Research Center for TCM Cardiology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
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13
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Cui J, Liu Y, Li Y, Xu F, Liu Y. Type 2 Diabetes and Myocardial Infarction: Recent Clinical Evidence and Perspective. Front Cardiovasc Med 2021; 8:644189. [PMID: 33718461 PMCID: PMC7943438 DOI: 10.3389/fcvm.2021.644189] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Accepted: 01/19/2021] [Indexed: 12/12/2022] Open
Abstract
Type 2 diabetes mellitus (T2DM) and its complications are seriously affecting public health worldwide. Myocardial infarction (MI) is the primary cause of death in patients with T2DM. T2DM patients without a history of coronary artery disease (CAD) have the same risk of major coronary events as those with CAD; T2DM patients with a history of MI have >40% risk of recurrence of MI. Thus, CAD in patients with T2DM needs to be treated actively to reduce the risk of MI. The cardiology community focused on the role of T2DM in the development of CAD and on the related issues of T2DM and MI with respect to comorbidities, prognosis, drug therapy, and heredity. In this mini review, the latest progress of clinical evidence-based research between T2DM and MI in recent years was reviewed, and the possible research directions in this field were considered and prospected.
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Affiliation(s)
- Jing Cui
- Cardiovascular Centre of Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China.,National Clinical Research Centre for Chinese Medicine Cardiology, Beijing, China
| | - Yanfei Liu
- Institute of Clinical Pharmacology, Xiyuan Hospital of China Academy of Chinese Medical Sciences, Beijing, China
| | - Yiwen Li
- Cardiovascular Centre of Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China.,National Clinical Research Centre for Chinese Medicine Cardiology, Beijing, China.,China Center for Evidence-Based Medicine of Chinese Medicine, Beijing, China
| | - Fengqin Xu
- National Clinical Research Centre for Chinese Medicine Cardiology, Beijing, China.,China Center for Evidence-Based Medicine of Chinese Medicine, Beijing, China
| | - Yue Liu
- Cardiovascular Centre of Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China.,National Clinical Research Centre for Chinese Medicine Cardiology, Beijing, China.,China Center for Evidence-Based Medicine of Chinese Medicine, Beijing, China
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14
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Abstract
Background Although silent myocardial infarction (SMI) is prognostically important, the risk of sudden cardiac death (SCD) among patients with incident SMI is not well established. Methods and Results We examined 2 community-based cohorts: the ARIC (Atherosclerosis Risk in Communities) study (n=13 725) and the CHS (Cardiovascular Health Study) (n=5207). Incident SMI was defined as electrocardiographic evidence of new myocardial infarction during follow-up visits that was not present at the baseline. The primary study end point was physician-adjudicated SCD. In the ARIC study, 513 SMIs, 441 clinically recognized myocardial infarctions (CMIs), and 527 SCD events occurred during a median follow-up of 25.4 years. The multivariable hazard ratios of SMI and CMI for SCD were 5.20 (95% CI, 3.81-7.10) and 3.80 (95% CI, 2.76-5.23), respectively. In the CHS, 1070 SMIs, 632 CMIs, and 526 SCD events occurred during a median follow-up of 12.1 years. The multivariable hazard ratios of SMI and CMI for SCD were 1.70 (95% CI, 1.32-2.19) and 4.08 (95% CI, 3.29-5.06), respectively. The pooled hazard ratios of SMI and CMI for SCD were 2.65 (2.18-3.23) and 3.99 (3.34-4.77), respectively. The risk of SCD associated with SMI is stronger with White individuals, men, and younger age. The population-attributable fraction of SCD was 11.1% for SMI, and SMI was associated with an absolute risk increase of 8.9 SCDs per 1000 person-years. Addition of SMI significantly improved the predictive power for both SCD and non-SCD. Conclusions Incident SMI is independently associated with an increased risk of SCD in the general population. Additional research should address screening for SMI and the role of standard post-myocardial infarction therapy.
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Affiliation(s)
- Yun-Jiu Cheng
- Department of Cardiology The First Affiliated HospitalSun Yat-Sen University Guangzhou China.,Key Laboratory of Assisted Circulation NHC Guangzhou China
| | - Yu-He Jia
- State Key Laboratory of Cardiovascular Disease Cardiac Arrhythmia Center Fuwai HospitalNational Center for Cardiovascular DiseasesChinese Academy of Medical Sciences and Peking Union Medical College Beijing China
| | - Feng-Juan Yao
- Department of Medical Ultrasonics The First Affiliated Hospital of Sun Yat-Sen University Guangzhou China
| | - Wei-Yi Mei
- Department of Cardiology The First Affiliated HospitalSun Yat-Sen University Guangzhou China.,Key Laboratory of Assisted Circulation NHC Guangzhou China
| | - Yuan-Sheng Zhai
- Department of Cardiology The First Affiliated HospitalSun Yat-Sen University Guangzhou China.,Key Laboratory of Assisted Circulation NHC Guangzhou China
| | - Ming Zhang
- Department of Cardiology Beijing Anzhen HospitalCapital Medical University Beijing China
| | - Su-Hua Wu
- Department of Cardiology The First Affiliated HospitalSun Yat-Sen University Guangzhou China.,Key Laboratory of Assisted Circulation NHC Guangzhou China
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15
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Yang Z, Fu H, Li H, Wang JR, Xu HY, Xie LJ, Yang MX, Zhang L, Yang ZG, Guo YK. Late gadolinium enhancement is a risk factor for major adverse cardiac events in unrecognised myocardial infarction without apparent symptoms: a meta-analysis. Clin Radiol 2020; 76:79.e1-79.e11. [PMID: 33012499 DOI: 10.1016/j.crad.2020.07.038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 07/28/2020] [Indexed: 02/08/2023]
Abstract
AIM To assess the prognostic role of unrecognised myocardial infarction (UMI) detected at late gadolinium enhancement cardiac magnetic resonance imaging (LGE-CMRII). MATERIALS AND METHODS Electronic databases including PubMed, EMBASE, Medline, and Cochrane were searched systematically for studies exploring the predictive value of UMI detected by LGE-CMRI for major adverse cardiac events (MACEs) and all-cause mortality in patients without apparent symptoms. Pooled hazard ratios (HRs) along with their 95% confidence intervals (CIs) were obtained from a random-effects model. Subgroup analyses were performed according to the different participants and outcomes. RESULTS Eight studies (2,009 participants) were identified comprising 442 patients with UMI detected at LGE-CMRI and 1,567 without UMI. The presence of UMI on LGE was associated with a significantly increased risk for MACEs (HRs: 3.44, 95% CI: 2.06 to 5.75; p<0.001) and all-cause mortality (HRs: 2.43, 95% CI: 1.00 to 5.87; p=0.05). In the subgroup analysis, the presence of UMI on LGE remained significantly associated with the risk of MACEs in patients with suspected coronary artery disease (HRs: 3.82, 95% CI: 2.49 to 5.85; p<0.01) and diabetes mellitus (HRs: 4.97, 95% CI: 3.02 to 8.18; p<0.01). CONCLUSION The presence of UMI detected by LGE-CMRI is associated with an increased risk of MACEs and all-cause mortality in patients without symptoms. LGE-CMRI could provide important prognostic information and guide risk stratification in patients with UMI.
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Affiliation(s)
- Z Yang
- Department of Radiology, Key Laboratory of Birth Defects and Related Diseases of Women and Children of Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China; Department of Radiology, Chengdu Fifth People's Hospital, Chengdu, China
| | - H Fu
- Department of Radiology, Key Laboratory of Birth Defects and Related Diseases of Women and Children of Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China
| | - H Li
- Key Laboratory of Obstetrics & Gynecology and Pediatric Disease and Birth Defects of Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China
| | - J-R Wang
- Department of Radiology, Key Laboratory of Birth Defects and Related Diseases of Women and Children of Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China
| | - H-Y Xu
- Department of Radiology, Key Laboratory of Birth Defects and Related Diseases of Women and Children of Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China
| | - L-J Xie
- Department of Radiology, Key Laboratory of Birth Defects and Related Diseases of Women and Children of Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China
| | - M-X Yang
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
| | - L Zhang
- Department of Radiology, Key Laboratory of Birth Defects and Related Diseases of Women and Children of Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Z-G Yang
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China.
| | - Y-K Guo
- Department of Radiology, Key Laboratory of Birth Defects and Related Diseases of Women and Children of Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China.
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Yang Y, Li W, Zhu H, Pan XF, Hu Y, Arnott C, Mai W, Cai X, Huang Y. Prognosis of unrecognised myocardial infarction determined by electrocardiography or cardiac magnetic resonance imaging: systematic review and meta-analysis. BMJ 2020; 369:m1184. [PMID: 32381490 PMCID: PMC7203874 DOI: 10.1136/bmj.m1184] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVE To evaluate the prognosis of unrecognised myocardial infarction determined by electrocardiography (UMI-ECG) or cardiac magnetic resonance imaging (UMI-CMR). DESIGN Systematic review and meta-analysis of prospective studies. DATA SOURCES Electronic databases, including PubMed, Embase, and Google Scholar. STUDY SELECTION Prospective cohort studies were included if they reported adjusted relative risks, odds ratios, or hazard ratios and 95% confidence intervals for all cause mortality or cardiovascular outcomes in participants with unrecognised myocardial infarction compared with those without myocardial infarction. DATA EXTRACTION AND SYNTHESIS The primary outcomes were composite major adverse cardiac events, all cause mortality, and cardiovascular mortality associated with UMI-ECG and UMI-CMR. The secondary outcomes were the risks of recurrent coronary heart disease or myocardial infarction, stroke, heart failure, and atrial fibrillation. Pooled hazard ratios and 95% confidence intervals were reported. The heterogeneity of outcomes was compared in clinically recognised and unrecognised myocardial infarction. RESULTS The meta-analysis included 30 studies with 253 425 participants and 1 621 920 person years of follow-up. UMI-ECG was associated with increased risks of all cause mortality (hazard ratio 1.50, 95% confidence interval 1.30 to 1.73), cardiovascular mortality (2.33, 1.66 to 3.27), and major adverse cardiac events (1.61, 1.38 to 1.89) compared with the absence of myocardial infarction. UMI-CMR was also associated with increased risks of all cause mortality (3.21, 1.43 to 7.23), cardiovascular mortality (10.79, 4.09 to 28.42), and major adverse cardiac events (3.23, 2.10 to 4.95). No major heterogeneity was observed for any primary outcomes between recognised myocardial infarction and UMI-ECG or UMI-CMR. The absolute risk differences were 7.50 (95% confidence interval 4.50 to 10.95) per 1000 person years for all cause mortality, 11.04 (5.48 to 18.84) for cardiovascular mortality, and 27.45 (17.1 to 40.05) for major adverse cardiac events in participants with UMI-ECG compared with those without myocardial infarction. The corresponding data for UMI-CMR were 32.49 (6.32 to 91.58), 37.2 (11.7 to 104.20), and 51.96 (25.63 to 92.04), respectively. CONCLUSIONS UMI-ECG or UMI-CMR is associated with an adverse long term prognosis similar to that of recognised myocardial infarction. Screening for unrecognised myocardial infarction could be useful for risk stratification among patients with a high risk of cardiovascular disease.
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Affiliation(s)
- Yu Yang
- Department of Geriatrics, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Wensheng Li
- Department of Cardiology, Shunde Hospital, Southern Medical University, Jiazhi Road 1, Lunjiao Town, Shunde District, Foshan, 528300, China
| | - Hailan Zhu
- Department of Cardiology, Shunde Hospital, Southern Medical University, Jiazhi Road 1, Lunjiao Town, Shunde District, Foshan, 528300, China
| | - Xiong-Fei Pan
- Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Yunzhao Hu
- Department of Cardiology, Shunde Hospital, Southern Medical University, Jiazhi Road 1, Lunjiao Town, Shunde District, Foshan, 528300, China
| | - Clare Arnott
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Weiyi Mai
- Department of Cardiology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Xiaoyan Cai
- Department of Scientific Research and Education, Shunde Hospital, Southern Medical University, Foshan, China
| | - Yuli Huang
- Department of Cardiology, Shunde Hospital, Southern Medical University, Jiazhi Road 1, Lunjiao Town, Shunde District, Foshan, 528300, China
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
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17
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Bencsik P, Gömöri K, Szabados T, Sántha P, Helyes Z, Jancsó G, Ferdinandy P, Görbe A. Myocardial ischaemia reperfusion injury and cardioprotection in the presence of sensory neuropathy: Therapeutic options. Br J Pharmacol 2020; 177:5336-5356. [PMID: 32059259 PMCID: PMC7680004 DOI: 10.1111/bph.15021] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Revised: 01/29/2020] [Accepted: 01/29/2020] [Indexed: 12/12/2022] Open
Abstract
During the last decades, mortality from acute myocardial infarction has been dramatically reduced. However, the incidence of post‐infarction heart failure is still increasing. Cardioprotection by ischaemic conditioning had been discovered more than three decades ago. Its clinical translation, however, is still an unmet need. This is mainly due to the disrupted cardioprotective signalling pathways in the presence of different cardiovascular risk factors, co‐morbidities and the medication being taken. Sensory neuropathy is one of the co‐morbidities that has been shown to interfere with cardioprotection. In the present review, we summarize the diverse aetiology of sensory neuropathies and the mechanisms by which these neuropathies may interfere with ischaemic heart disease and cardioprotective signalling. Finally, we suggest future therapeutic options targeting both ischaemic heart and sensory neuropathy simultaneously. LINKED ARTICLES This article is part of a themed issue on Risk factors, comorbidities, and comedications in cardioprotection. To view the other articles in this section visit http://onlinelibrary.wiley.com/doi/10.1111/bph.v177.23/issuetoc
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Affiliation(s)
- Péter Bencsik
- Cardiovascular Research Group, Department of Pharmacology and Pharmacotherapy, Faculty of Medicine, University of Szeged, Szeged, Hungary.,Pharmahungary Group, Szeged, Hungary
| | - Kamilla Gömöri
- Cardiovascular Research Group, Department of Pharmacology and Pharmacotherapy, Faculty of Medicine, University of Szeged, Szeged, Hungary.,Pharmahungary Group, Szeged, Hungary
| | - Tamara Szabados
- Cardiovascular Research Group, Department of Pharmacology and Pharmacotherapy, Faculty of Medicine, University of Szeged, Szeged, Hungary.,Pharmahungary Group, Szeged, Hungary
| | - Péter Sántha
- Department of Physiology, Faculty of Medicine, University of Szeged, Szeged, Hungary
| | - Zsuzsanna Helyes
- Department of Pharmacology and Pharmacotherapy, Medical School, University of Pécs, Pécs, Hungary.,Molecular Pharmacology Research Group, Centre for Neuroscience, János Szentágothai Research Centre, University of Pécs, Pécs, Hungary
| | - Gábor Jancsó
- Department of Physiology, Faculty of Medicine, University of Szeged, Szeged, Hungary
| | - Péter Ferdinandy
- Pharmahungary Group, Szeged, Hungary.,Department of Pharmacology and Pharmacotherapy, Semmelweis University, Budapest, Hungary
| | - Anikó Görbe
- Cardiovascular Research Group, Department of Pharmacology and Pharmacotherapy, Faculty of Medicine, University of Szeged, Szeged, Hungary.,Pharmahungary Group, Szeged, Hungary.,Department of Pharmacology and Pharmacotherapy, Semmelweis University, Budapest, Hungary
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18
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Rodriguez-Granillo GA, Nieman K, Carrascosa P, Campisi R, Ambrose JA. Anatomic or functional testing in stable patients with suspected CAD: contemporary role of cardiac CT in the ISCHEMIA trial era. Int J Cardiovasc Imaging 2020; 36:1351-1362. [PMID: 32180079 DOI: 10.1007/s10554-020-01815-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 03/07/2020] [Indexed: 11/30/2022]
Abstract
One of the foundations of the management of patients with suspected coronary artery disease (CAD) is to avoid unnecessary invasive coronary angiography (ICA) referrals. However, the diagnostic yield of ICA following abnormal conventional stress testing is low. The ability of ischemia testing to predict subsequent myocardial infarction and death is currently being challenged, and more than half of cardiac events among stable patients with suspected CAD occur in those with normal functional tests. The optimal management of patients with stable CAD remains controversial and ischemia-driven interventions, though improving anginal symptoms, have failed to reduce the risk of hard cardiovascular events. In this context, there is an ongoing debate whether the initial diagnostic test among patients with stable suspected CAD should be a functional test or coronary computed tomography angiography. Aside from considering the specific characteristics of individual patients and local availability and conditions, the choice of the initial test relates to whether the objective concerns its role as gatekeeper for ICA, prognosis, or treatment decision-making. Therefore, the aim of this review is to provide a contemporary overview of these issues and discuss the emerging role of CCTA as the upfront imaging tool for most patients with suspected CAD.
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Affiliation(s)
- Gaston A Rodriguez-Granillo
- Department of Cardiovascular Imaging, Instituto Medico Eneri, Clinica La Sagrada Familia, Av. Libertador 6647 (C1428ARJ), Buenos Aires, Argentina. .,Consejo Nacional de Investigaciones Cientificas y Tecnicas (CONICET), Buenos Aires, Argentina.
| | - Koen Nieman
- Stanford University School of Medicine, Cardiovascular Institute, Stanford, CA, USA
| | - Patricia Carrascosa
- Department of Cardiovascular Imaging, Diagnostico Maipu, Buenos Aires, Argentina
| | - Roxana Campisi
- Department of Nuclear Medicine, Diagnostico Maipu, Buenos Aires, Argentina
| | - John A Ambrose
- Division of Cardiology, Department of Internal Medicine, University of California San Francisco-Fresno, Fresno, USA
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19
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Elliott MD, Heitner JF, Kim H, Wu E, Parker MA, Lee DC, Kaufman DB, Bonow RO, Judd R, Kim RJ. Response to Comment on Elliott et al. Prevalence and Prognosis of Unrecognized Myocardial Infarction in Asymptomatic Patients With Diabetes: A Two-Center Study With Up to 5 Years of Follow-up. Diabetes Care 2019;42:1290-1296. Diabetes Care 2019; 42:e156. [PMID: 31431498 PMCID: PMC7210005 DOI: 10.2337/dci19-0031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Michael D Elliott
- Duke Cardiovascular Magnetic Resonance Center and Division of Cardiology, Duke University Medical Center, Durham, NC
| | - John F Heitner
- Duke Cardiovascular Magnetic Resonance Center and Division of Cardiology, Duke University Medical Center, Durham, NC
| | - Han Kim
- Duke Cardiovascular Magnetic Resonance Center and Division of Cardiology, Duke University Medical Center, Durham, NC
| | - Edwin Wu
- Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Michelle A Parker
- Duke Cardiovascular Magnetic Resonance Center and Division of Cardiology, Duke University Medical Center, Durham, NC
| | - Daniel C Lee
- Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Dixon B Kaufman
- Division of Organ Transplantation, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Robert O Bonow
- Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Robert Judd
- Duke Cardiovascular Magnetic Resonance Center and Division of Cardiology, Duke University Medical Center, Durham, NC
| | - Raymond J Kim
- Duke Cardiovascular Magnetic Resonance Center and Division of Cardiology, Duke University Medical Center, Durham, NC
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20
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Milei J, Azzato F, Rodriguez-Granillo GA. Comment on Elliott et al. Prevalence and Prognosis of Unrecognized Myocardial Infarction in Asymptomatic Patients With Diabetes: A Two-Center Study With Up to 5 Years of Follow-up. Diabetes Care 2019;42:1290-1296. Diabetes Care 2019; 42:e155. [PMID: 31431497 DOI: 10.2337/dc19-1069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- José Milei
- Instituto de Investigaciones Cardiológicas "Prof. A.C. Taquini," Universidad de Buenos Aires-Consejo Nacional de Investigaciones Científicas y Técnicas, Buenos Aires, Argentina
| | - Francisco Azzato
- Instituto de Investigaciones Cardiológicas "Prof. A.C. Taquini," Universidad de Buenos Aires-Consejo Nacional de Investigaciones Científicas y Técnicas, Buenos Aires, Argentina
| | - Gastón A Rodriguez-Granillo
- Instituto de Investigaciones Cardiológicas "Prof. A.C. Taquini," Universidad de Buenos Aires-Consejo Nacional de Investigaciones Científicas y Técnicas, Buenos Aires, Argentina .,Department of Cardiovascular Imaging, Diagnóstico Maipú, Buenos Aires, Argentina
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