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Mallabone M, Labib D, Abdelhaleem A, Dykstra S, Thompson RB, Paterson DI, Thompson SK, Hasanzadeh F, Mikami Y, Rivest S, Flewitt J, Feng Y, Macdonald M, King M, Bristow M, Kolman L, Howarth AG, Lydell CP, Miller RJ, Fine NM, White JA. Sex-based Differences in the Phenotypic Expression and Prognosis of Idiopathic Non-ischemic Cardiomyopathy: A Cardiovascular Magnetic Resonance Study. Eur Heart J Cardiovasc Imaging 2024:jeae014. [PMID: 38236156 DOI: 10.1093/ehjci/jeae014] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 12/16/2023] [Accepted: 01/03/2024] [Indexed: 01/19/2024] Open
Abstract
AIMS We sought to characterize sex-related differences in CMR-based cardiovascular phenotypes and prognosis in patients with idiopathic non-ischemic cardiomyopathy (NICM). METHODS AND RESULTS Patients with NICM enrolled in the Cardiovascular Imaging Registry of Calgary (CIROC) between 2015 and 2021 were identified. Z-score values for chamber volumes and function were calculated as standard deviation from mean values of 157 sex-matched healthy volunteers, ensuring reported differences were independent of known sex-dependencies. Patients were followed for the composite outcome of all-cause mortality, heart failure admission, or ventricular arrhythmia.A total of 747 patients were studied, 531 (71%) males. By Z-score values, females showed significantly higher left ventricular (LV) ejection fraction (EF; median difference 1 SD) and right ventricular (RV) EF (difference 0.6 SD) with greater LV mass (difference 2.1 SD; p-value<0.01 for all) versus males despite similar chamber volumes. Females had a significantly lower prevalence of mid-wall striae (MWS) fibrosis (23% versus 36%; p-value<0.001). Over a median follow-up of 4.7 years, 173 patients (23%) developed the composite outcome, with equal distribution in males and females. LV EF and MWS were significant independent predictors of the outcome (respective HR [95% CI] 0.97 [0.95-0.99] and 1.6 [1.2-2.3]; p-value=0.003 and 0.005). There was no association of sex with the outcome. CONCLUSIONS In a large contemporary cohort, NICM was uniquely expressed in females versus males. Despite similar chamber dilation, females demonstrated greater concentric remodelling, lower reductions in bi-ventricular function, and a lower burden of replacement fibrosis. Overall, their prognosis remained similar to male patients with NICM.
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Affiliation(s)
- Maggie Mallabone
- Stephenson Cardiac Imaging Centre, University of Calgary, Calgary, Alberta, Canada
| | - Dina Labib
- Stephenson Cardiac Imaging Centre, University of Calgary, Calgary, Alberta, Canada
- Libin Cardiovascular Institute of Alberta, Calgary, AB, Canada
- Department of Cardiovascular Medicine, Cairo University, Cairo, Egypt
| | | | - Steven Dykstra
- Stephenson Cardiac Imaging Centre, University of Calgary, Calgary, Alberta, Canada
- Libin Cardiovascular Institute of Alberta, Calgary, AB, Canada
| | - Richard B Thompson
- Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, Canada
| | - D Ian Paterson
- Ottawa Heart Institute, Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Sam K Thompson
- Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, Canada
| | - Fereshteh Hasanzadeh
- Stephenson Cardiac Imaging Centre, University of Calgary, Calgary, Alberta, Canada
- Libin Cardiovascular Institute of Alberta, Calgary, AB, Canada
| | - Yoko Mikami
- Stephenson Cardiac Imaging Centre, University of Calgary, Calgary, Alberta, Canada
- Libin Cardiovascular Institute of Alberta, Calgary, AB, Canada
| | - Sandra Rivest
- Stephenson Cardiac Imaging Centre, University of Calgary, Calgary, Alberta, Canada
| | - Jacqueline Flewitt
- Stephenson Cardiac Imaging Centre, University of Calgary, Calgary, Alberta, Canada
- Libin Cardiovascular Institute of Alberta, Calgary, AB, Canada
| | - Yuanchao Feng
- Libin Cardiovascular Institute of Alberta, Calgary, AB, Canada
| | | | - Melanie King
- Libin Cardiovascular Institute of Alberta, Calgary, AB, Canada
| | - Michael Bristow
- Stephenson Cardiac Imaging Centre, University of Calgary, Calgary, Alberta, Canada
- Libin Cardiovascular Institute of Alberta, Calgary, AB, Canada
- Department of Diagnostic Imaging, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Louis Kolman
- Stephenson Cardiac Imaging Centre, University of Calgary, Calgary, Alberta, Canada
- Libin Cardiovascular Institute of Alberta, Calgary, AB, Canada
- Department of Cardiac Science, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Andrew G Howarth
- Stephenson Cardiac Imaging Centre, University of Calgary, Calgary, Alberta, Canada
- Libin Cardiovascular Institute of Alberta, Calgary, AB, Canada
- Department of Cardiac Science, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Carmen P Lydell
- Stephenson Cardiac Imaging Centre, University of Calgary, Calgary, Alberta, Canada
- Libin Cardiovascular Institute of Alberta, Calgary, AB, Canada
- Department of Diagnostic Imaging, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Robert Jh Miller
- Libin Cardiovascular Institute of Alberta, Calgary, AB, Canada
- Department of Cardiac Science, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Nowell M Fine
- Libin Cardiovascular Institute of Alberta, Calgary, AB, Canada
- Department of Cardiac Science, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - James A White
- Stephenson Cardiac Imaging Centre, University of Calgary, Calgary, Alberta, Canada
- Libin Cardiovascular Institute of Alberta, Calgary, AB, Canada
- Department of Diagnostic Imaging, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Cardiac Science, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
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Raisi-Estabragh Z, Kobo O, Freeman P, Petersen SE, Kolman L, Miller RJH, Roguin A, Van Spall HGC, Vuong J, Yang EH, Mamas MA. Temporal trends in disease-specific causes of cardiovascular mortality amongst patients with cancer in the USA between 1999 and 2019. Eur Heart J Qual Care Clin Outcomes 2022; 9:54-63. [PMID: 35435219 PMCID: PMC9745666 DOI: 10.1093/ehjqcco/qcac016] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 04/06/2022] [Accepted: 04/11/2022] [Indexed: 12/15/2022]
Abstract
AIMS We report disease-specific cardiovascular causes of mortality among cancer patients in the USA between 1999 and 2019, considering temporal trends by age, sex, and cancer site. METHODS AND RESULTS We used the Multiple Cause of Death database, accessed through the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research resource. We included 629 308 decedents with cardiovascular disease (CVD) recorded as the primary cause of death and active malignancy listed as a contributing cause of death. We created disease-specific CVD categories and grouped cancers by site. We calculated the proportion of CVD deaths attributed to each disease category stratified by sex, age, and cancer site. We also examined disease-specific temporal trends by cancer site. Ischaemic heart disease (IHD) was the most common cardiovascular cause of death across all cancer types (55.6%), being more common in men (59.8%), older ages, and in those with lung (67.8%) and prostate (58.3%) cancers. Cerebrovascular disease (12.9%) and hypertensive diseases (7.6%) were other common causes of death. The proportion of deaths due to heart failure was greatest in haematological (7.7%) and breast (6.3%) cancers. There was a decreasing temporal trend in the proportion of cardiovascular deaths attributed to IHD across all cancer types. The proportion of deaths due to hypertensive diseases showed the greatest percentage increase, with the largest change in breast cancer patients (+191.1%). CONCLUSION We demonstrate differential cardiovascular mortality risk by cancer site and demographics, providing insight into the evolving healthcare needs of this growing high-cardiovascular risk population.
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Affiliation(s)
- Zahra Raisi-Estabragh
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, London, UK
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, West Smithfield, London EC1A 7BE, UK
| | - Ofer Kobo
- Department of Cardiology, Hillel Yaffe Medical Center, Hadera, Israel
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Keele University, Keele, UK
| | - Phillip Freeman
- Cardiology Department, Aalborg University Hospital, Hobrovej 18-22, 9100 Aalborg, Denmark
| | - Steffen E Petersen
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, London, UK
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, West Smithfield, London EC1A 7BE, UK
- Health Data Research UK, London, UK
| | - Louis Kolman
- Libin Cardiovascular Institute of Alberta, Calgary, AB, Canada
| | | | - Ariel Roguin
- Department of Cardiology, Hillel Yaffe Medical Center, Hadera, Israel
| | - Harriette G C Van Spall
- Department of Health Research Methods, Evidence, and Impact, Department of Medicine, Population Health Research Institute, Research Institute of St. Joe's, McMaster University, Hamilton, ON, Canada
| | - Jacqueline Vuong
- UCLA Cardio-Oncology Program, Division of Cardiology, Department of Medicine, University of California, Los Angeles, CA, USA
| | - Eric H Yang
- UCLA Cardio-Oncology Program, Division of Cardiology, Department of Medicine, University of California, Los Angeles, CA, USA
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Keele University, Keele, UK
- Department of Cardiology, Thomas Jefferson University, Philadelphia, PA, USA
- Institute of Population Health, University of Manchester, Manchester, UK
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Mustafa Alhussein M, Rabbani M, Sarak B, Dykstra S, Labib D, Flewitt J, Lydell CP, Howarth AG, Filipchuck N, Kealey A, Colbert J, Guron N, Kolman L, Merchant N, Bandali M, Bristow M, White JA. Natural History of Myocardial Injury After COVID-19 Vaccine-Associated Myocarditis. Can J Cardiol 2022; 38:1676-1683. [PMID: 35944800 PMCID: PMC9356639 DOI: 10.1016/j.cjca.2022.07.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 05/11/2022] [Revised: 06/26/2022] [Accepted: 07/13/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Acute myocarditis is a rare complication of mRNA-based COVID-19 vaccination. Little is known about the natural history of this complication. METHODS Baseline and convalescent (≥ 90 days) cardiac magnetic resonance (CMR) imaging assessments were performed in 20 consecutive patients meeting Updated Lake Louise Criteria for acute myocarditis within 10 days of mRNA-based vaccination. CMR-based changes in left ventricular volumes, mass, ejection fraction (LVEF), markers of tissue inflammation (native T1 and T2 mapping), and fibrosis (late gadolinium enhancement [LGE] and extracellular volume [ECV]) were assessed between baseline and convalescence. Cardiac symptoms and clinical outcomes were captured. RESULTS Median age was 23.1 years (range 18-39 years), and 17 (85%) were male. Convalescent evaluations were performed at a median (IQR) 3.7 (3.3-6.2) months. The LVEF showed a mean 3% absolute improvement, accompanied by a 7% reduction in LV end-diastolic volume and 5% reduction in LV mass (all P < 0.015). Global LGE burden was reduced by 66% (P < 0.001). Absolute reductions in global T2, native T1, and ECV of 2.1 ms, 58 ms, and 2.9%, repectively, were documented (all P ≤ 0.001). Of 5 patients demonstrating LVEF ≤ 50% at baseline, all recovered to above this threshold in convalescence. A total of 18 (90%) patients showed persistence of abnormal LGE although mean fibrosis burden was < 5% of LV mass in 85% of cases. No patient experienced major clinical outcomes. CONCLUSIONS COVID-19 mRNA vaccine-associated myocarditis showed rapid improvements in CMR-based markers of edema, contractile function, and global LGE burden beyond 3 months of recovery in this young patient cohort. However, regional fibrosis following edema resolution was commonly observed, justifying need for ongoing surveillance.
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Affiliation(s)
- Muhammad Mustafa Alhussein
- Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
| | - Mohamad Rabbani
- Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
| | - Bradley Sarak
- Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
| | - Steven Dykstra
- Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
| | - Dina Labib
- Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
| | - Jacqueline Flewitt
- Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
| | - Carmen P. Lydell
- Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada,Department of Diagnostic Imaging, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Andrew G. Howarth
- Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada,Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Neil Filipchuck
- Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada,Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Angela Kealey
- Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Jillian Colbert
- Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Nita Guron
- Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Louis Kolman
- Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada,Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Naeem Merchant
- Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada,Department of Diagnostic Imaging, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Murad Bandali
- Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada,Department of Diagnostic Imaging, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Mike Bristow
- Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada,Department of Diagnostic Imaging, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - James A. White
- Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada,Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada,Department of Diagnostic Imaging, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada,Corresponding author: Dr James A. White, Stephenson Cardiac Imaging Centre, #0700, SSB, Foothills Medical Centre, 1403-29th St NW, Calgary, Alberta T2N 2T9, Canada. Tel.: +1-403-944-8806; fax: +1-403-944-8510
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4
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Labib D, Dykstra S, Satriano A, Mikami Y, Prosia E, Flewitt J, Howarth AG, Lydell CP, Kolman L, Paterson DI, Oudit GY, Pituskin E, Cheung WY, Lee J, White JA. Prevalence and predictors of right ventricular dysfunction in cancer patients treated with cardiotoxic chemotherapy – a prospective cardiovascular magnetic resonance study. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2878] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Right ventricular (RV) function has an established incremental prognostic value in cardiomyopathy. Studies on cancer therapeutics-related cardiac dysfunction (CTRCD) primarily focused on the left ventricle (LV), with conflicting results from small studies dedicated to RV dysfunction.
Purpose
We sought to investigate the influence of chemotherapy on RV function relative to LV function using serial cardiac magnetic resonance (CMR).
Methods
Patients were enrolled as part of Cardiotoxicity Prevention Research Initiative (CAPRI) Registry aimed at evaluating CMR-based markers for surveillance of CTRCD. Patients underwent non-contrast CMR imaging prior to initiation of anthracyclines and/or trastuzumab and serially every 3 months during the first year, then annually thereafter. We included patients who had a baseline and ≥1 follow-up scan and excluded those with baseline LV ejection fraction (EF)<50%, providing 320 patients completing 1,453 CMR studies. Cine images were analysed to calculate chamber volumes indexed to body surface area and EF. We defined LV CTRCD using CMR modality specific criteria of a drop in LV EF ≥5% from baseline to <57%; RV CTRCD as a drop ≥5% to <49% in females and <47% in males. We used linear mixed models to study the changes in ventricular volumes and EF with time.
Results
The majority of patients were females (80%), had breast cancer (68%) or lymphoma (32%), with a mean age of 52.7±13 years. Figure 1 shows temporal changes in mean ventricular volumes and function over the first year. Mean changes in RV function followed those of the LV, with the nadir of EF and maximum of volumes occurring at 6 months. Respective values for mean decrease in LV and RV EF at this time point versus baseline were 4.1 and 2.9% (p<0.001). Concomitant mean increase in indexed RV end-diastolic (ED) and end-systolic (ES) volumes were 1.6 and 2.7 ml/m2 (p=0.2 and <0.001). There was significant interaction of chemotherapy regimen with time for RV volumes (p=0.001 and 0.003), but not RV EF (p=0.7), with worst changes occurring with combined anthracyclines and trastuzumab. In all, 70 (22%) and 28 (9%) patients met criteria for LV and RV CTRCD, respectively. Among those who developed RV CTRCD, 10 had persistently normal LV function. Figure 2 shows the results of logistic regression to predict RV CTRCD. Significant univariable predictors included combined chemotherapy regimen and baseline LV and RV volumes and LV EF. Adjusting for age, sex, and chemotherapy regimen, baseline RV ED volume remained associated with RV CTRCD (odds ratio 1.6; p=0.005).
Conclusion
In this large study, RV volumes and function were similarly influenced by chemotherapy versus comparable LV-based measures. Using similar threshold criteria, the incidence of RV CTRCD was lower than for LV CTRCD; however, one third of those who develop RV CTRCD showed normal LV function. Future studies are warranted to study the prognostic influence of RV injury in cancer patients.
Funding Acknowledgement
Type of funding sources: Other. Main funding source(s): Alberta InnovatesGenome Alberta Figure 1. Temporal changes in LV & RV functionFigure 2. Predictors of RV CTRCD
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Affiliation(s)
- D Labib
- Libin Cardiovascular Institute of Alberta, Stephenson Cardiac Imaging Centre, Calgary, Canada
| | - S Dykstra
- Libin Cardiovascular Institute of Alberta, Stephenson Cardiac Imaging Centre, Calgary, Canada
| | - A Satriano
- Libin Cardiovascular Institute of Alberta, Stephenson Cardiac Imaging Centre, Calgary, Canada
| | - Y Mikami
- Libin Cardiovascular Institute of Alberta, Stephenson Cardiac Imaging Centre, Calgary, Canada
| | - E Prosia
- Libin Cardiovascular Institute of Alberta, Stephenson Cardiac Imaging Centre, Calgary, Canada
| | - J Flewitt
- Libin Cardiovascular Institute of Alberta, Stephenson Cardiac Imaging Centre, Calgary, Canada
| | - A G Howarth
- Libin Cardiovascular Institute of Alberta, Stephenson Cardiac Imaging Centre, Calgary, Canada
| | - C P Lydell
- Libin Cardiovascular Institute of Alberta, Stephenson Cardiac Imaging Centre, Calgary, Canada
| | - L Kolman
- Libin Cardiovascular Institute of Alberta, Stephenson Cardiac Imaging Centre, Calgary, Canada
| | - D I Paterson
- University of Alberta, Department of Medicine, Edmonton, Canada
| | - G Y Oudit
- University of Alberta, Department of Medicine, Edmonton, Canada
| | - E Pituskin
- University of Alberta, Department of Oncology, Edmonton, Canada
| | - W Y Cheung
- University of Calgary, Department of Oncology, Calgary, Canada
| | - J Lee
- University of Calgary, Departments of Community Health Sciences & Cardiac Sciences, Calgary, Canada
| | - J A White
- Libin Cardiovascular Institute of Alberta, Stephenson Cardiac Imaging Centre, Calgary, Canada
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Matetic A, Mohamed M, Miller RJH, Kolman L, Lopez-Mattei J, Cheung WY, Brenner DR, Van Spall HGC, Graham M, Bianco C, Mamas MA. Impact of cancer diagnosis on causes and outcomes of 5.9 million US patients with cardiovascular admissions. Int J Cardiol 2021; 341:76-83. [PMID: 34333019 DOI: 10.1016/j.ijcard.2021.07.054] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 07/11/2021] [Accepted: 07/26/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION There are limited data on causes of cardiovascular (CV) admissions and associated outcomes among patients with different cancers. METHODS All CV admissions from the US National Inpatient Sample between October 2015 to December 2017 were stratified by cancer type as well as metastatic status. Multivariable logistic regression was performed to determine the adjusted odds ratios (aOR) of in-hospital mortality in different groups. RESULTS From 5,936,014 eligible CV admissions, cancer was present in 265,221 (4.5%) hospitalizations. There was significant variation in the admission diagnoses among the different cancers, with hematological malignancies being principally associated with heart failure (HF), lung cancer with atrial fibrillation (AF), and colorectal and prostate cancer with acute myocardial infarction (AMI). Admission with haemorrhagic stroke has the highest associated mortality across cancers (20.0-38.4%). In-hospital mortality was higher in cancer than non-cancer patients across most CV admissions (P < 0.001) with AF having the worst prognosis. Compared to group without any cancer, the greatest aOR of mortality was associated with lung cancer in AMI (aOR 2.32, 95% CI 2.18-2.47), ischemic stroke (aOR 2.21, 95%CI 2.08-2.34), AF (aOR 4.69, 95%CI 4.32-5.10) and HF (aOR 2.07, 95%CI 1.89-2.27). CONCLUSIONS The most common causes of CV admission to hospital vary in patients with different types of cancer, with AMI being most common in patients with colon cancer, HF in patients with hematological malignancies and AF in patients with lung cancer. Patients with cancer, particularly lung cancer, have greater mortality than non-cancer patients after admissions with a CV cause.
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Affiliation(s)
- Andrija Matetic
- Keele Cardiovascular Research Group, Keele University, Stoke on Trent, UK; Department of Cardiology, University Hospital of Split, Split, Croatia
| | - Mohamed Mohamed
- Keele Cardiovascular Research Group, Keele University, Stoke on Trent, UK
| | - Robert J H Miller
- Department of Cardiac Sciences, University of Calgary, Calgary, Canada
| | - Louis Kolman
- Department of Cardiac Sciences, University of Calgary, Calgary, Canada
| | - Juan Lopez-Mattei
- Department of Cardiology, Division of Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Winson Y Cheung
- Department of Medicine and Oncology, University of Calgary, Calgary, Canada
| | - Darren R Brenner
- Departments of Oncology and Community Health Sciences, University of Calgary, Calgary, Canada
| | - Harriette G C Van Spall
- Division of Cardiology, Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada
| | - Michelle Graham
- Division of Cardiology, University of Alberta, Edmonton, Canada
| | - Christopher Bianco
- Division of Cardiology, West Virginia University School of Medicine, Morgantown, WV, USA
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, Keele University, Stoke on Trent, UK; Department of Cardiology, Thomas Jefferson University, Philadelphia, USA.
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Labib D, Satriano A, Dykstra S, Hansen R, Mikami Y, Guzzardi DG, Slavikova Z, Feuchter P, Flewitt J, Rivest S, Sandonato R, Lydell CP, Howarth AG, Kolman L, Clarke B, Paterson DI, Oudit GY, Pituskin E, Cheung WY, Lee J, White JA. Effect of Active Cancer on the Cardiac Phenotype: A Cardiac Magnetic Resonance Imaging-Based Study of Myocardial Tissue Health and Deformation in Patients With Chemotherapy-Naïve Cancer. J Am Heart Assoc 2021; 10:e019811. [PMID: 33878890 PMCID: PMC8200726 DOI: 10.1161/jaha.120.019811] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Background The overlap between cancer and cardiovascular care continues to expand, with intersections emerging before, during, and following cancer therapies. To date, emphasis has been placed on how cancer therapeutics influence downstream cardiac health. However, whether active malignancy itself influences chamber volumes, function, or overall myocardial tissue health remains uncertain. We sought to perform a comprehensive cardiovascular magnetic resonance‐based evaluation of cardiac health in patients with chemotherapy‐naïve cancer with comparison with a healthy volunteer population. Methods and Results Three‐hundred and eighty‐one patients with active breast cancer or lymphoma before cardiotoxic chemotherapy exposure were recruited in addition to 102 healthy volunteers. Both cohorts underwent standardized cardiovascular magnetic resonance imaging with quantification of chamber volumes, ejection fraction, and native myocardial T1. Left ventricular mechanics were incrementally assessed using three‐dimensional myocardial deformation analysis, providing global longitudinal, circumferential, radial, and principal peak‐systolic strain amplitude and systolic strain rate. The mean age of patients with cancer was 53.8±13.4 years; 79% being women. Despite similar left ventricular ejection fraction, patients with cancer showed smaller chambers, increased strain amplitude, and systolic strain rate in both conventional and principal directions, and elevated native T1 versus sex‐matched healthy volunteers. Adjusting for age, sex, hypertension, and diabetes mellitus, the presence of cancer remained associated with these cardiovascular magnetic resonance parameters. Conclusions The presence of cancer is independently associated with alterations in cardiac chamber size, function, and objective markers of tissue health. Dedicated research is warranted to elucidate pathophysiologic mechanisms underlying these findings and to explore their relevance to the management of patients with cancer referred for cardiotoxic therapies.
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Affiliation(s)
- Dina Labib
- Stephenson Cardiac Imaging Centre Libin Cardiovascular Institute of Alberta University of Calgary Alberta Canada.,Department of Cardiovascular Medicine Cairo University Cairo Egypt
| | - Alessandro Satriano
- Stephenson Cardiac Imaging Centre Libin Cardiovascular Institute of Alberta University of Calgary Alberta Canada
| | - Steven Dykstra
- Stephenson Cardiac Imaging Centre Libin Cardiovascular Institute of Alberta University of Calgary Alberta Canada
| | - Reis Hansen
- Stephenson Cardiac Imaging Centre Libin Cardiovascular Institute of Alberta University of Calgary Alberta Canada
| | - Yoko Mikami
- Stephenson Cardiac Imaging Centre Libin Cardiovascular Institute of Alberta University of Calgary Alberta Canada
| | - David G Guzzardi
- Stephenson Cardiac Imaging Centre Libin Cardiovascular Institute of Alberta University of Calgary Alberta Canada
| | - Zdenka Slavikova
- Stephenson Cardiac Imaging Centre Libin Cardiovascular Institute of Alberta University of Calgary Alberta Canada
| | - Patricia Feuchter
- Stephenson Cardiac Imaging Centre Libin Cardiovascular Institute of Alberta University of Calgary Alberta Canada
| | - Jacqueline Flewitt
- Stephenson Cardiac Imaging Centre Libin Cardiovascular Institute of Alberta University of Calgary Alberta Canada
| | - Sandra Rivest
- Stephenson Cardiac Imaging Centre Libin Cardiovascular Institute of Alberta University of Calgary Alberta Canada
| | - Rosa Sandonato
- Stephenson Cardiac Imaging Centre Libin Cardiovascular Institute of Alberta University of Calgary Alberta Canada
| | - Carmen P Lydell
- Stephenson Cardiac Imaging Centre Libin Cardiovascular Institute of Alberta University of Calgary Alberta Canada.,Department of Diagnostic Imaging Cumming School of Medicine University of Calgary Alberta Canada
| | - Andrew G Howarth
- Stephenson Cardiac Imaging Centre Libin Cardiovascular Institute of Alberta University of Calgary Alberta Canada.,Department of Cardiac Sciences Cumming School of Medicine University of Calgary Alberta Canada
| | - Louis Kolman
- Stephenson Cardiac Imaging Centre Libin Cardiovascular Institute of Alberta University of Calgary Alberta Canada
| | - Brian Clarke
- Department of Cardiac Sciences Cumming School of Medicine University of Calgary Alberta Canada
| | - D Ian Paterson
- Department of Medicine University of Alberta Edmonton Alberta Canada.,Mazankowski Alberta Heart InstituteUniversity of Alberta Edmonton Alberta Canada
| | - Gavin Y Oudit
- Department of Medicine University of Alberta Edmonton Alberta Canada.,Mazankowski Alberta Heart InstituteUniversity of Alberta Edmonton Alberta Canada
| | - Edith Pituskin
- Department of Oncology University of Alberta Edmonton Alberta Canada
| | - Winson Y Cheung
- Departments of Medicine and Oncology Cumming School of Medicine University of Calgary Alberta Canada
| | - Joon Lee
- Department of Cardiac Sciences Cumming School of Medicine University of Calgary Alberta Canada.,Department of Community Health Sciences Cumming School of Medicine University of Calgary Alberta Canada
| | - James A White
- Stephenson Cardiac Imaging Centre Libin Cardiovascular Institute of Alberta University of Calgary Alberta Canada.,Department of Diagnostic Imaging Cumming School of Medicine University of Calgary Alberta Canada.,Department of Cardiac Sciences Cumming School of Medicine University of Calgary Alberta Canada
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Wong JA, Duff HJ, Yuen T, Kolman L, Exner DV, Weeks SG, Gerull B. Phenotypic analysis of arrhythmogenic cardiomyopathy in the Hutterite population: role of electrocardiogram in identifying high-risk desmocollin-2 carriers. J Am Heart Assoc 2014; 3:e001407. [PMID: 25497880 PMCID: PMC4338736 DOI: 10.1161/jaha.114.001407] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background The p.Gln554X mutation in desmocollin‐2 (DSC2) is prevalent in ≈10% of the
Hutterite population. While the homozygous mutation causes severe biventricular arrhythmogenic right
ventricular cardiomyopathy, the phenotypic features and prognosis of heterozygotes remain
incompletely understood. Methods and Results Eleven homozygotes (mean age 32±8 years, 45% female), 28 heterozygotes (mean age
40±15 years, 50% female), and 22 mutation‐negatives (mean age 43±17
years, 41% female) were examined. Diagnostic testing was performed as per the arrhythmogenic
right ventricular cardiomyopathy modified Task Force Criteria. Inverted T waves in the right
precordial leads on ECG were seen in all homozygotes but not in their counterparts
(P<0.001). Homozygotes had higher median daily premature ventricular complex
burden than did heterozygotes or mutation‐negatives (1407 [IQR 1080 to 2936] versus 2 [IQR 0
to 6] versus 6 [IQR 0 to 214], P=0.0002). Ventricular tachycardia was
observed in 60% of homozygotes but in none of the remaining individuals
(P<0.001). On cardiac magnetic resonance imaging, homozygotes had
significantly larger indexed end‐diastolic volumes (right ventricular: 122±24 versus
83±17 versus 83±12 mL/m2, P<0.0001; left
ventricular: 93±18 versus 76±13 versus 80±11 mL/m2,
P=0.0124) and lower ejection fraction values compared with heterozygotes and
mutation‐negatives (right ventricular ejection fraction: 41±9% versus
59±9% versus 61±6%, P<0.0001; left ventricular
ejection fraction: 53±8% versus 65±5% versus 64±5%,
P<0.0001). Most affected individuals lacked right ventricular wall motion
abnormalities. Thus, few met cardiac magnetic resonance imaging task force criteria. Conclusions The ECG reliably identifies homozygous p.Gln554X carriers and may be useful as an initial step in
the screening of high‐risk Hutterites. The cardiac phenotype of heterozygotes appears benign,
but further prospective follow‐up of their arrhythmic risk is needed.
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Affiliation(s)
- Jorge A Wong
- Libin Cardiovascular Institute of Alberta & Department of Cardiac Sciences, University of Calgary, Alberta, Canada (J.A.W., H.J.D., T.Y., L.K., D.V.E., S.G.W., B.G.)
| | - Henry J Duff
- Libin Cardiovascular Institute of Alberta & Department of Cardiac Sciences, University of Calgary, Alberta, Canada (J.A.W., H.J.D., T.Y., L.K., D.V.E., S.G.W., B.G.)
| | - Tiffany Yuen
- Libin Cardiovascular Institute of Alberta & Department of Cardiac Sciences, University of Calgary, Alberta, Canada (J.A.W., H.J.D., T.Y., L.K., D.V.E., S.G.W., B.G.)
| | - Louis Kolman
- Libin Cardiovascular Institute of Alberta & Department of Cardiac Sciences, University of Calgary, Alberta, Canada (J.A.W., H.J.D., T.Y., L.K., D.V.E., S.G.W., B.G.)
| | - Derek V Exner
- Libin Cardiovascular Institute of Alberta & Department of Cardiac Sciences, University of Calgary, Alberta, Canada (J.A.W., H.J.D., T.Y., L.K., D.V.E., S.G.W., B.G.)
| | - Sarah G Weeks
- Libin Cardiovascular Institute of Alberta & Department of Cardiac Sciences, University of Calgary, Alberta, Canada (J.A.W., H.J.D., T.Y., L.K., D.V.E., S.G.W., B.G.)
| | - Brenda Gerull
- Libin Cardiovascular Institute of Alberta & Department of Cardiac Sciences, University of Calgary, Alberta, Canada (J.A.W., H.J.D., T.Y., L.K., D.V.E., S.G.W., B.G.)
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Mikami Y, Kolman L, Joncas SX, Stirrat J, Scholl D, Rajchl M, Lydell CP, Weeks SG, Howarth AG, White JA. Accuracy and reproducibility of semi-automated late gadolinium enhancement quantification techniques in patients with hypertrophic cardiomyopathy. J Cardiovasc Magn Reson 2014; 16:85. [PMID: 25315701 PMCID: PMC4189726 DOI: 10.1186/s12968-014-0085-x] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2014] [Accepted: 09/23/2014] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND The presence and extent of late gadolinium enhancement (LGE) has been associated with adverse events in patients with hypertrophic cardiomyopathy (HCM). Signal intensity (SI) threshold techniques are routinely employed for quantification; Full-Width at Half-Maximum (FWHM) techniques are suggested to provide greater reproducibility than Signal Threshold versus Reference Mean (STRM) techniques, however the accuracy of these approaches versus the manual assignment of optimal SI thresholds has not been studied. In this study, we compared all known semi-automated LGE quantification techniques for accuracy and reproducibility among patients with HCM. METHODS Seventy-six HCM patients (51 male, age 54 ± 13 years) were studied. Total LGE volume was quantified using 7 semi-automated techniques and compared to expert manual adjustment of the SI threshold to achieve optimal segmentation. Techniques tested included STRM based thresholds of >2, 3, 4, 5 and 6 SD above mean SI of reference myocardium, the FWHM technique, and the Otsu-auto-threshold (OAT) technique. The SI threshold chosen by each technique was recorded for all slices. Bland-Altman analysis and intra-class correlation coefficients (ICC) were reported for each semi-automated technique versus expert, manually adjusted LGE segmentation. Intra- and inter-observer reproducibility assessments were also performed. RESULTS Fifty-two of 76 (68%) patients showed LGE on a total of 202 slices. For accuracy, the STRM >3SD technique showed the greatest agreement with manual segmentation (ICC = 0.97, mean difference and 95% limits of agreement = 1.6 ± 10.7 g) while STRM >6SD, >5SD, 4SD and FWHM techniques systematically underestimated total LGE volume. Slice based analysis of selected SI thresholds similarly showed the STRM >3SD threshold to most closely approximate manually adjusted SI thresholds (ICC = 0.88). For reproducibility, the intra- and inter-observer reproducibility of the >3SD threshold demonstrated an acceptable mean difference and 95% limits of agreement of -0.5 ± 6.8 g and -0.9 ± 5.6 g, respectively. CONCLUSIONS FWHM segmentation provides superior reproducibility, however systematically underestimates total LGE volume compared to manual segmentation in patients with HCM. The STRM >3SD technique provides the greatest accuracy while retaining acceptable reproducibility and may therefore be a preferred approach for LGE quantification in this population.
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Affiliation(s)
- Yoko Mikami
- Stephenson Cardiac Imaging Centre at the Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, AB, Canada.
| | - Louis Kolman
- Stephenson Cardiac Imaging Centre at the Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, AB, Canada.
| | - Sebastien X Joncas
- Stephenson Cardiac Imaging Centre at the Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, AB, Canada.
| | - John Stirrat
- Imaging Research Laboratory - Robarts Research Institute, Western University, London, ON, Canada.
| | - David Scholl
- Imaging Research Laboratory - Robarts Research Institute, Western University, London, ON, Canada.
| | - Martin Rajchl
- Imaging Research Laboratory - Robarts Research Institute, Western University, London, ON, Canada.
| | - Carmen P Lydell
- Stephenson Cardiac Imaging Centre at the Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, AB, Canada.
- Diagnostic Imaging, University of Calgary, Calgary, AB, Canada.
| | - Sarah G Weeks
- Stephenson Cardiac Imaging Centre at the Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, AB, Canada.
- Cardiac Sciences, University of Calgary, Calgary, AB, Canada.
| | - Andrew G Howarth
- Stephenson Cardiac Imaging Centre at the Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, AB, Canada.
- Cardiac Sciences, University of Calgary, Calgary, AB, Canada.
| | - James A White
- Stephenson Cardiac Imaging Centre at the Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, AB, Canada.
- Cardiac Sciences, University of Calgary, Calgary, AB, Canada.
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Joncas S, Kolman L, Mikami Y, Howarth A, Fine N, White J. FEATURE TRACKING-BASED STRAIN ANALYSIS PREDICTS THE PRESENCE OF MYOCARDIAL FIBROSIS AMONG PATIENTS WITH NON-ISCHEMIC CARDIOMYOPATHY. Can J Cardiol 2014. [DOI: 10.1016/j.cjca.2014.07.276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Mikami Y, Kolman L, Joncas SX, Lydell C, Weeks S, White JA. Precision and reproducibility of semi-automated late gadolinium enhancement quantification techniques in patients with hypertrophic cardiomyopathy. J Cardiovasc Magn Reson 2014. [PMCID: PMC4043403 DOI: 10.1186/1532-429x-16-s1-p340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Joncas SX, Kolman L, Lydell C, Weeks S, Howarth AG, Merchant N, White JA. Differentiation of physiologic versus pathologic basal septal fibrosis: Proposed diagnostic criteria and associations with clinical and CMR-based markers of cardiovascular disease. J Cardiovasc Magn Reson 2014. [PMCID: PMC4045057 DOI: 10.1186/1532-429x-16-s1-p104] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Kolman L, Stirrat J, Rajchl M, Joncas SX, Mikami Y, Tweedie EJ, Flewitt J, Lydell C, Howarth AG, White JA. Myocardial T2 signal enhancement in hypertrophic cardiomyopathy: prevalence, clinical profile and pathologic correlation. J Cardiovasc Magn Reson 2014. [PMCID: PMC4043200 DOI: 10.1186/1532-429x-16-s1-o85] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Kolman L, Hu YC, Montgomery DG, Gordon K, Eagle KA, Jackson EA. Prognostic value of admission fasting glucose levels in patients with acute coronary syndrome. Am J Cardiol 2009; 104:470-4. [PMID: 19660596 DOI: 10.1016/j.amjcard.2009.04.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2009] [Revised: 04/06/2009] [Accepted: 04/06/2009] [Indexed: 01/08/2023]
Abstract
Data are limited regarding the best prognostic glucose measure for patients admitted for an acute coronary event. We examined the admission fasting glucose levels among patients with acute coronary syndrome (ACS) from the University of Michigan ACS registry. The glucose levels were grouped into 3 categories (> or =70 to <100, 100 to <126, and > or =126 mg/dl). The primary outcome measures included mortality and a composite end point (stroke, recurrent infarction, and death) in hospital and at 6 months after the ACS event. Of the 1,525 patients (29% with diabetes) for whom glucose levels were available, a fasting glucose level of > or =100 mg/dl was associated with increased in-hospital mortality, after adjusting for the Global Registry of Acute Coronary Events risk score and gender. A fasting glucose level of > or =126 mg/dl in patients with no known history of diabetes was associated with in-hospital adverse events (odds ratio 3.37, 95% confidence interval 1.51 to 7.51). The fasting glucose level was associated with an increased risk of 6-month mortality among nondiabetics (odds ratio 3.03, 95% confidence interval 1.35 to 6.81 for patients with a glucose level of 100 to 125 mg/dl; and odds ratio 2.81, 95% confidence interval 1.07 to 7.36 for patients with a glucose level of > or =126 mg/dl) but not for diabetic patients. In conclusion, we observed a strong association between the admission fasting glucose level and mortality, particularly among nondiabetic patients. Whether improving the diagnosis and treatment of hyperglycemia would result in reductions in adverse events after ACS remains unclear.
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DeEugenio D, Kolman L, DeCaro M, Andrel J, Chervoneva I, Duong P, Lam L, McGowan C, Lee G, DeCaro M, Ruggiero N, Singhal S, Greenspon A. Risk of major bleeding with concomitant dual antiplatelet therapy after percutaneous coronary intervention in patients receiving long-term warfarin therapy. Pharmacotherapy 2007; 27:691-6. [PMID: 17461704 DOI: 10.1592/phco.27.5.691] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
STUDY OBJECTIVES To characterize the safety of concomitant aspirin, clopidogrel, and warfarin therapy after percutaneous coronary intervention (PCI), and to identify patient characteristics that increase the risk of hemorrhage. DESIGN Retrospective, matched cohort study. SETTING Academic medical center and affiliated outpatient offices. PATIENTS The active group consisted of 97 patients who underwent PCI from January 1, 2000-September 30, 2005, and received warfarin, aspirin, and clopidogrel; the control group consisted of 97 patients who were individually matched to patients in the active group by procedure type, procedure year, age, and sex. Control patients received aspirin and clopidogrel. MEASUREMENTS AND MAIN RESULTS Clinical data were collected from inpatient records, outpatient physician office records, and telephone surveys administered to patients or caregivers. The primary end point was major bleeding. The median duration of follow-up after index procedure was 182 days (range 0-191 days) in the active group and 182 days (range 0-213 days) in the control group. Fifty-seven (59%) of the 97 patients in the active group received warfarin for atrial fibrillation. There were 14 major bleeds in the active group (including 1 death) and 3 major bleeds in the control group during the study period. Mean international normalized ratio at the time of bleeding was 3.4. Hazard ratio for major bleeding was 5.0 in patients receiving warfarin therapy (95% confidence interval 1.4-17.8, p=0.012). Aspirin dose, age, sex, body mass index, history of hypertension, diabetes mellitus, intraprocedural glycoprotein IIb-IIIa or anticoagulant type, and postprocedural anticoagulant use did not have a significant effect on the risk of major bleeding. CONCLUSION Warfarin was an independent predictor of major bleeding after PCI in patients receiving dual antiplatelet therapy. Prospective data to further characterize the safety of concomitant warfarin and dual antiplatelet therapy after PCI are needed.
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Affiliation(s)
- Deborah DeEugenio
- Department of Pharmacy Practice, College of Pharmacy, Temple University, Philadelphia, Pennsylvania, USA.
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Abstract
Artifactual water signal intensity loss can be observed on fat-saturation magnetic resonance (MR) images of inhomogeneous regions such as the thorax. Magnetic effects of air inclusions on fat-saturation pulses were investigated as the possible origin of this artifact. Computer simulation results agreed well with observed production of water saturation by means of nominal fat suppression in MR imaging of phantoms and a representative clinical example.
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Affiliation(s)
- L Axel
- Department of Radiology, University of Pennsylvania Medical Center, 3400 Spruce St, Philadelphia, PA 19104, USA.
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