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Sumner JA, Kim ESH, Wood MJ, Chi G, Nolen J, Grodzinsky A, Gornik HL, Kadian-Dodov D, Wells BJ, Hess CN, Lewey J, Tam L, Henkin S, Orford J, Wells G, Kumbhani DJ, Lindley KJ, Gibson CM, Leon KK, Naderi S. Posttraumatic Stress Disorder After Spontaneous Coronary Artery Dissection: A Report of the International Spontaneous Coronary Artery Dissection Registry. J Am Heart Assoc 2024; 13:e032819. [PMID: 38533943 DOI: 10.1161/jaha.123.032819] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 02/06/2024] [Indexed: 03/28/2024]
Abstract
BACKGROUND Myocardial infarction secondary to spontaneous coronary artery dissection (SCAD) can be traumatic and potentially trigger posttraumatic stress disorder (PTSD). In a large, multicenter, registry-based cohort, we documented prevalence of lifetime and past-month SCAD-induced PTSD, as well as related treatment seeking, and examined a range of health-relevant correlates of SCAD-induced PTSD. METHODS AND RESULTS Patients with SCAD were enrolled in the iSCAD (International SCAD) Registry. At baseline, site investigators completed medical report forms, and patients reported demographics, medical/SCAD history, psychosocial factors (including SCAD-induced PTSD symptoms), health behaviors, and health status via online questionnaires. Of 1156 registry patients, 859 patients (93.9% women; mean age, 52.3 years) completed questionnaires querying SCAD-induced PTSD. Nearly 35% (n=298) of patients met diagnostic criteria for probable SCAD-induced PTSD in their lifetime, and 6.4% (n=55) met criteria for probable past-month PTSD. Of 811 patients ever reporting any SCAD-induced PTSD symptoms, 34.8% indicated seeking treatment for this distress. However, 46.0% of the 298 patients with lifetime probable SCAD-induced PTSD diagnoses reported never receiving trauma-related treatment. Younger age at first SCAD, fewer years since SCAD, being single, unemployed status, more lifetime trauma, and history of anxiety were associated with greater past-month PTSD symptom severity in multivariable regression models. Greater past-month SCAD-induced PTSD symptoms were associated with greater past-week sleep disturbance and worse past-month disease-specific health status when adjusting for various risk factors. CONCLUSIONS Given the high prevalence of SCAD-induced PTSD symptoms, efforts to support screening for these symptoms and connecting patients experiencing distress with empirically supported treatments are critical next steps. REGISTRATION URL: https://www.clinicaltrials.gov; Unique identifier: NCT04496687.
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Affiliation(s)
- Jennifer A Sumner
- Department of Psychology University of California, Los Angeles Los Angeles CA USA
| | - Esther S H Kim
- Division of Cardiovascular Medicine, Department of Medicine Vanderbilt University Medical Center Nashville TN USA
| | - Malissa J Wood
- Division of Cardiology Massachusetts General Hospital and Harvard Medical School Boston MA USA
| | - Gerald Chi
- PERFUSE Study Group, Cardiovascular Division, Department of Medicine Beth Israel Deaconess Medical Center, Harvard Medical School Boston MA USA
| | | | - Anna Grodzinsky
- Saint Luke's Mid America Heart Institute, Muriel I. Kauffman Women's Heart Center University of Missouri-Kansas City Kansas City MO USA
| | - Heather L Gornik
- Harrington Heart & Vascular Institute, University Hospitals, Division of Cardiovascular Medicine Case Western Reserve University Cleveland OH USA
| | - Daniella Kadian-Dodov
- Zena and Michael A. Wiener Cardiovascular Institute and Marie-Josée and Henry R. Kravis Center for Cardiovascular Health Icahn School of Medicine at Mount Sinai New York NY USA
| | - Bryan J Wells
- Division of Cardiology, Department of Medicine Emory University School of Medicine Atlanta GA USA
| | - Connie N Hess
- Division of Cardiology, Department of Medicine University of Colorado School of Medicine Aurora CO USA
| | - Jennifer Lewey
- Division of Cardiovascular Medicine University of Pennsylvania Perelman School of Medicine Philadelphia PA USA
| | - Lori Tam
- Providence Heart Institute Portland OR USA
| | - Stanislav Henkin
- Heart and Vascular Center Dartmouth-Hitchcock Medical Center Lebanon NH USA
| | - James Orford
- Intermountain Heart Institute, Intermountain Medical Center Murray UT USA
| | - Gretchen Wells
- Division of Cardiovascular Medicine, Department of Medicine University of Kentucky Lexington KY USA
| | - Dharam J Kumbhani
- Division of Cardiology, Department of Internal Medicine UT Southwestern Medical Center Dallas TX USA
| | - Kathryn J Lindley
- Division of Cardiovascular Medicine, Department of Medicine Vanderbilt University Medical Center Nashville TN USA
| | - C Michael Gibson
- PERFUSE Study Group, Cardiovascular Division, Department of Medicine Beth Israel Deaconess Medical Center, Harvard Medical School Boston MA USA
| | | | - Sahar Naderi
- Division of Cardiology Kaiser Permanente San Francisco CA USA
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2
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Honigberg MC, Economy KE, Pabón MA, Wang X, Castro C, Brown JM, Divakaran S, Weber BN, Barrett L, Perillo A, Sun AY, Antoine T, Farrohi F, Docktor B, Lau ES, DeFaria Yeh D, Natarajan P, Sarma AA, Weisbrod RM, Hamburg NM, Ho JE, Roh JD, Wood MJ, Scott NS, Di Carli MF. Coronary Microvascular Function Following Severe Preeclampsia. Hypertension 2024. [PMID: 38563161 DOI: 10.1161/hypertensionaha.124.22905] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 03/20/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND Preeclampsia is a pregnancy-specific hypertensive disorder associated with an imbalance in circulating proangiogenic and antiangiogenic proteins. Preclinical evidence implicates microvascular dysfunction as a potential mediator of preeclampsia-associated cardiovascular risk. METHODS Women with singleton pregnancies complicated by severe antepartum-onset preeclampsia and a comparator group with normotensive deliveries underwent cardiac positron emission tomography within 4 weeks of delivery. A control group of premenopausal, nonpostpartum women was also included. Myocardial flow reserve, myocardial blood flow, and coronary vascular resistance were compared across groups. sFlt-1 (soluble fms-like tyrosine kinase receptor-1) and PlGF (placental growth factor) were measured at imaging. RESULTS The primary cohort included 19 women with severe preeclampsia (imaged at a mean of 15.3 days postpartum), 5 with normotensive pregnancy (mean, 14.4 days postpartum), and 13 nonpostpartum female controls. Preeclampsia was associated with lower myocardial flow reserve (β, -0.67 [95% CI, -1.21 to -0.13]; P=0.016), lower stress myocardial blood flow (β, -0.68 [95% CI, -1.07 to -0.29] mL/min per g; P=0.001), and higher stress coronary vascular resistance (β, +12.4 [95% CI, 6.0 to 18.7] mm Hg/mL per min/g; P=0.001) versus nonpostpartum controls. Myocardial flow reserve and coronary vascular resistance after normotensive pregnancy were intermediate between preeclamptic and nonpostpartum groups. Following preeclampsia, myocardial flow reserve was positively associated with time following delivery (P=0.008). The sFlt-1/PlGF ratio strongly correlated with rest myocardial blood flow (r=0.71; P<0.001), independent of hemodynamics. CONCLUSIONS In this exploratory cross-sectional study, we observed reduced coronary microvascular function in the early postpartum period following preeclampsia, suggesting that systemic microvascular dysfunction in preeclampsia involves coronary microcirculation. Further research is needed to establish interventions to mitigate the risk of preeclampsia-associated cardiovascular disease.
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Affiliation(s)
- Michael C Honigberg
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston. (M.C.H., C.C., T.A., E.S.L., D.D.Y., P.N., A.A.S., J.D.R., M.J.W., N.S.S.)
- Program in Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA (M.C.H., P.N.)
| | - Katherine E Economy
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA. (K.E.E.)
| | - Maria A Pabón
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA. (M.A.P., X.W., J.M.B., S.D., B.N.W., F.F., B.D., M.F.D.C.)
| | - Xiaowen Wang
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA. (M.A.P., X.W., J.M.B., S.D., B.N.W., F.F., B.D., M.F.D.C.)
| | - Claire Castro
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston. (M.C.H., C.C., T.A., E.S.L., D.D.Y., P.N., A.A.S., J.D.R., M.J.W., N.S.S.)
| | - Jenifer M Brown
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA. (M.A.P., X.W., J.M.B., S.D., B.N.W., F.F., B.D., M.F.D.C.)
- Cardiovascular Imaging Program, Departments of Radiology and Medicine and Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA. (J.M.B., S.D., B.N.W., L.B., A.P., A.Y.S., M.F.D.C.)
| | - Sanjay Divakaran
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA. (M.A.P., X.W., J.M.B., S.D., B.N.W., F.F., B.D., M.F.D.C.)
- Cardiovascular Imaging Program, Departments of Radiology and Medicine and Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA. (J.M.B., S.D., B.N.W., L.B., A.P., A.Y.S., M.F.D.C.)
| | - Brittany N Weber
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA. (M.A.P., X.W., J.M.B., S.D., B.N.W., F.F., B.D., M.F.D.C.)
- Cardiovascular Imaging Program, Departments of Radiology and Medicine and Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA. (J.M.B., S.D., B.N.W., L.B., A.P., A.Y.S., M.F.D.C.)
| | - Leanne Barrett
- Cardiovascular Imaging Program, Departments of Radiology and Medicine and Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA. (J.M.B., S.D., B.N.W., L.B., A.P., A.Y.S., M.F.D.C.)
| | - Anna Perillo
- Cardiovascular Imaging Program, Departments of Radiology and Medicine and Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA. (J.M.B., S.D., B.N.W., L.B., A.P., A.Y.S., M.F.D.C.)
| | - Anina Y Sun
- Cardiovascular Imaging Program, Departments of Radiology and Medicine and Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA. (J.M.B., S.D., B.N.W., L.B., A.P., A.Y.S., M.F.D.C.)
| | - Tajmara Antoine
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston. (M.C.H., C.C., T.A., E.S.L., D.D.Y., P.N., A.A.S., J.D.R., M.J.W., N.S.S.)
| | - Faranak Farrohi
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA. (M.A.P., X.W., J.M.B., S.D., B.N.W., F.F., B.D., M.F.D.C.)
| | - Brenda Docktor
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA. (M.A.P., X.W., J.M.B., S.D., B.N.W., F.F., B.D., M.F.D.C.)
| | - Emily S Lau
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston. (M.C.H., C.C., T.A., E.S.L., D.D.Y., P.N., A.A.S., J.D.R., M.J.W., N.S.S.)
| | - Doreen DeFaria Yeh
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston. (M.C.H., C.C., T.A., E.S.L., D.D.Y., P.N., A.A.S., J.D.R., M.J.W., N.S.S.)
| | - Pradeep Natarajan
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston. (M.C.H., C.C., T.A., E.S.L., D.D.Y., P.N., A.A.S., J.D.R., M.J.W., N.S.S.)
- Program in Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA (M.C.H., P.N.)
| | - Amy A Sarma
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston. (M.C.H., C.C., T.A., E.S.L., D.D.Y., P.N., A.A.S., J.D.R., M.J.W., N.S.S.)
| | - Robert M Weisbrod
- Whitaker Cardiovascular Institute, Boston University School of Medicine, MA (R.M.W., N.M.H.)
| | - Naomi M Hamburg
- Whitaker Cardiovascular Institute, Boston University School of Medicine, MA (R.M.W., N.M.H.)
| | - Jennifer E Ho
- Division of Cardiovascular Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston. (J.E.H.)
| | - Jason D Roh
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston. (M.C.H., C.C., T.A., E.S.L., D.D.Y., P.N., A.A.S., J.D.R., M.J.W., N.S.S.)
| | - Malissa J Wood
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston. (M.C.H., C.C., T.A., E.S.L., D.D.Y., P.N., A.A.S., J.D.R., M.J.W., N.S.S.)
- Lee Health Heart Institute, Fort Myers, FL (M.J.W.)
| | - Nandita S Scott
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston. (M.C.H., C.C., T.A., E.S.L., D.D.Y., P.N., A.A.S., J.D.R., M.J.W., N.S.S.)
| | - Marcelo F Di Carli
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA. (M.A.P., X.W., J.M.B., S.D., B.N.W., F.F., B.D., M.F.D.C.)
- Cardiovascular Imaging Program, Departments of Radiology and Medicine and Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA. (J.M.B., S.D., B.N.W., L.B., A.P., A.Y.S., M.F.D.C.)
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3
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Honigberg MC, Economy KE, Pabón MA, Wang X, Castro C, Brown JM, Divakaran S, Weber BN, Barrett L, Perillo A, Sun AY, Antoine T, Farrohi F, Docktor B, Lau ES, Yeh DD, Natarajan P, Sarma AA, Weisbrod RM, Hamburg NM, Ho JE, Roh JD, Wood MJ, Scott NS, Carli MFD. Coronary Microvascular Function Following Severe Preeclampsia. medRxiv 2024:2024.03.04.24303728. [PMID: 38496439 PMCID: PMC10942503 DOI: 10.1101/2024.03.04.24303728] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
Background Preeclampsia is a pregnancy-specific hypertensive disorder associated with an imbalance in circulating pro- and anti-angiogenic proteins. Preclinical evidence implicates microvascular dysfunction as a potential mediator of preeclampsia-associated cardiovascular risk. Methods Women with singleton pregnancies complicated by severe antepartum-onset preeclampsia and a comparator group with normotensive deliveries underwent cardiac positron emission tomography (PET) within 4 weeks of delivery. A control group of pre-menopausal, non-postpartum women was also included. Myocardial flow reserve (MFR), myocardial blood flow (MBF), and coronary vascular resistance (CVR) were compared across groups. Soluble fms-like tyrosine kinase receptor-1 (sFlt-1) and placental growth factor (PlGF) were measured at imaging. Results The primary cohort included 19 women with severe preeclampsia (imaged at a mean 16.0 days postpartum), 5 with normotensive pregnancy (mean 14.4 days postpartum), and 13 non-postpartum female controls. Preeclampsia was associated with lower MFR (β=-0.67 [95% CI -1.21 to -0.13]; P=0.016), lower stress MBF (β=-0.68 [95% CI, -1.07 to -0.29] mL/min/g; P=0.001), and higher stress CVR (β=+12.4 [95% CI 6.0 to 18.7] mmHg/mL/min/g; P=0.001) vs. non-postpartum controls. MFR and CVR after normotensive pregnancy were intermediate between preeclamptic and non-postpartum groups. Following preeclampsia, MFR was positively associated with time following delivery (P=0.008). The sFlt-1/PlGF ratio strongly correlated with rest MBF (r=0.71; P<0.001), independent of hemodynamics. Conclusions In this exploratory study, we observed reduced coronary microvascular function in the early postpartum period following severe preeclampsia, suggesting that systemic microvascular dysfunction in preeclampsia involves the coronary microcirculation. Further research is needed to establish interventions to mitigate risk of preeclampsia-associated cardiovascular disease.
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Affiliation(s)
- Michael C. Honigberg
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA
- Program in Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA
| | - Katherine E. Economy
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| | - Maria A. Pabón
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| | - Xiaowen Wang
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| | - Claire Castro
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Jenifer M. Brown
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
- Cardiovascular Imaging Program, Departments of Radiology and Medicine, and Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| | - Sanjay Divakaran
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
- Cardiovascular Imaging Program, Departments of Radiology and Medicine, and Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| | - Brittany N. Weber
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
- Cardiovascular Imaging Program, Departments of Radiology and Medicine, and Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| | - Leanne Barrett
- Cardiovascular Imaging Program, Departments of Radiology and Medicine, and Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| | - Anna Perillo
- Cardiovascular Imaging Program, Departments of Radiology and Medicine, and Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| | - Anina Y. Sun
- Cardiovascular Imaging Program, Departments of Radiology and Medicine, and Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| | - Tajmara Antoine
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Faranak Farrohi
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| | - Brenda Docktor
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| | - Emily S. Lau
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Doreen DeFaria Yeh
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Pradeep Natarajan
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA
- Program in Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA
| | - Amy A. Sarma
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Robert M. Weisbrod
- Whitaker Cardiovascular Institute, Boston University School of Medicine, Boston, MA
| | - Naomi M. Hamburg
- Whitaker Cardiovascular Institute, Boston University School of Medicine, Boston, MA
| | - Jennifer E. Ho
- Division of Cardiovascular Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Jason D. Roh
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Malissa J. Wood
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA
- Lee Health Heart Institute, Fort Myers, FL
| | - Nandita S. Scott
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Marcelo F. Di Carli
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
- Cardiovascular Imaging Program, Departments of Radiology and Medicine, and Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
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4
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Schuermans A, Truong B, Ardissino M, Bhukar R, Slob EAW, Nakao T, Dron JS, Small AM, Cho SMJ, Yu Z, Hornsby W, Antoine T, Lannery K, Postupaka D, Gray KJ, Yan Q, Butterworth AS, Burgess S, Wood MJ, Scott NS, Harrington CM, Sarma AA, Lau ES, Roh JD, Januzzi JL, Natarajan P, Honigberg MC. Genetic Associations of Circulating Cardiovascular Proteins With Gestational Hypertension and Preeclampsia. JAMA Cardiol 2024; 9:209-220. [PMID: 38170504 PMCID: PMC10765315 DOI: 10.1001/jamacardio.2023.4994] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Accepted: 11/01/2023] [Indexed: 01/05/2024]
Abstract
Importance Hypertensive disorders of pregnancy (HDPs), including gestational hypertension and preeclampsia, are important contributors to maternal morbidity and mortality worldwide. In addition, women with HDPs face an elevated long-term risk of cardiovascular disease. Objective To identify proteins in the circulation associated with HDPs. Design, Setting, and Participants Two-sample mendelian randomization (MR) tested the associations of genetic instruments for cardiovascular disease-related proteins with gestational hypertension and preeclampsia. In downstream analyses, a systematic review of observational data was conducted to evaluate the identified proteins' dynamics across gestation in hypertensive vs normotensive pregnancies, and phenome-wide MR analyses were performed to identify potential non-HDP-related effects associated with the prioritized proteins. Genetic association data for cardiovascular disease-related proteins were obtained from the Systematic and Combined Analysis of Olink Proteins (SCALLOP) consortium. Genetic association data for the HDPs were obtained from recent European-ancestry genome-wide association study meta-analyses for gestational hypertension and preeclampsia. Study data were analyzed October 2022 to October 2023. Exposures Genetic instruments for 90 candidate proteins implicated in cardiovascular diseases, constructed using cis-protein quantitative trait loci (cis-pQTLs). Main Outcomes and Measures Gestational hypertension and preeclampsia. Results Genetic association data for cardiovascular disease-related proteins were obtained from 21 758 participants from the SCALLOP consortium. Genetic association data for the HDPs were obtained from 393 238 female individuals (8636 cases and 384 602 controls) for gestational hypertension and 606 903 female individuals (16 032 cases and 590 871 controls) for preeclampsia. Seventy-five of 90 proteins (83.3%) had at least 1 valid cis-pQTL. Of those, 10 proteins (13.3%) were significantly associated with HDPs. Four were robust to sensitivity analyses for gestational hypertension (cluster of differentiation 40, eosinophil cationic protein [ECP], galectin 3, N-terminal pro-brain natriuretic peptide [NT-proBNP]), and 2 were robust for preeclampsia (cystatin B, heat shock protein 27 [HSP27]). Consistent with the MR findings, observational data revealed that lower NT-proBNP (0.76- to 0.88-fold difference vs no HDPs) and higher HSP27 (2.40-fold difference vs no HDPs) levels during the first trimester of pregnancy were associated with increased risk of HDPs, as were higher levels of ECP (1.60-fold difference vs no HDPs). Phenome-wide MR analyses identified 37 unique non-HDP-related protein-disease associations, suggesting potential on-target effects associated with interventions lowering HDP risk through the identified proteins. Conclusions and Relevance Study findings suggest genetic associations of 4 cardiovascular disease-related proteins with gestational hypertension and 2 associated with preeclampsia. Future studies are required to test the efficacy of targeting the corresponding pathways to reduce HDP risk.
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Affiliation(s)
- Art Schuermans
- Program in Medical and Population Genetics and Cardiovascular Disease Initiative, Broad Institute of Harvard and MIT, Cambridge, Massachusetts
- Cardiovascular Research Center, Massachusetts General Hospital, Boston
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Buu Truong
- Program in Medical and Population Genetics and Cardiovascular Disease Initiative, Broad Institute of Harvard and MIT, Cambridge, Massachusetts
- Cardiovascular Research Center, Massachusetts General Hospital, Boston
| | - Maddalena Ardissino
- BHF Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Rohan Bhukar
- Program in Medical and Population Genetics and Cardiovascular Disease Initiative, Broad Institute of Harvard and MIT, Cambridge, Massachusetts
- Cardiovascular Research Center, Massachusetts General Hospital, Boston
| | - Eric A. W. Slob
- MRC Biostatistics Unit, University of Cambridge, Cambridge, United Kingdom
- Department of Applied Economics, Erasmus School of Economics, Erasmus University Rotterdam, Rotterdam, the Netherlands
- Erasmus University Rotterdam Institute for Behavior and Biology, Erasmus University Rotterdam, Rotterdam, the Netherlands
| | - Tetsushi Nakao
- Program in Medical and Population Genetics and Cardiovascular Disease Initiative, Broad Institute of Harvard and MIT, Cambridge, Massachusetts
- Cardiovascular Research Center, Massachusetts General Hospital, Boston
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Jacqueline S. Dron
- Program in Medical and Population Genetics and Cardiovascular Disease Initiative, Broad Institute of Harvard and MIT, Cambridge, Massachusetts
- Cardiovascular Research Center, Massachusetts General Hospital, Boston
| | - Aeron M. Small
- Program in Medical and Population Genetics and Cardiovascular Disease Initiative, Broad Institute of Harvard and MIT, Cambridge, Massachusetts
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
- Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - So Mi Jemma Cho
- Program in Medical and Population Genetics and Cardiovascular Disease Initiative, Broad Institute of Harvard and MIT, Cambridge, Massachusetts
- Cardiovascular Research Center, Massachusetts General Hospital, Boston
- Integrative Research Center for Cerebrovascular and Cardiovascular Diseases, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Zhi Yu
- Program in Medical and Population Genetics and Cardiovascular Disease Initiative, Broad Institute of Harvard and MIT, Cambridge, Massachusetts
- Cardiovascular Research Center, Massachusetts General Hospital, Boston
| | - Whitney Hornsby
- Program in Medical and Population Genetics and Cardiovascular Disease Initiative, Broad Institute of Harvard and MIT, Cambridge, Massachusetts
- Cardiovascular Research Center, Massachusetts General Hospital, Boston
| | - Tajmara Antoine
- Program in Medical and Population Genetics and Cardiovascular Disease Initiative, Broad Institute of Harvard and MIT, Cambridge, Massachusetts
- Cardiovascular Research Center, Massachusetts General Hospital, Boston
| | - Kim Lannery
- Program in Medical and Population Genetics and Cardiovascular Disease Initiative, Broad Institute of Harvard and MIT, Cambridge, Massachusetts
- Cardiovascular Research Center, Massachusetts General Hospital, Boston
| | - Darina Postupaka
- Program in Medical and Population Genetics and Cardiovascular Disease Initiative, Broad Institute of Harvard and MIT, Cambridge, Massachusetts
- Cardiovascular Research Center, Massachusetts General Hospital, Boston
| | - Kathryn J. Gray
- Division of Maternal-Fetal Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Qi Yan
- Department of Obstetrics and Gynecology, Columbia University, New York, New York
| | - Adam S. Butterworth
- BHF Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
- BHF Centre of Research Excellence, University of Cambridge, Cambridge, United Kingdom
- National Institute for Health Research Cambridge Biomedical Research Centre, University of Cambridge and Cambridge University Hospitals, Cambridge, United Kingdom
- Health Data Research UK Cambridge, Wellcome Genome Campus and University of Cambridge, Cambridge, United Kingdom
- National Institute for Health Research Blood and Transplant Research Unit in Donor Health and Genomics, University of Cambridge, Cambridge, United Kingdom
| | - Stephen Burgess
- MRC Biostatistics Unit, University of Cambridge, Cambridge, United Kingdom
| | - Malissa J. Wood
- Department of Medicine, Harvard Medical School, Boston, Massachusetts
- Cardiology Division, Massachusetts General Hospital, Boston
- Lee Health, Fort Myers, Florida
| | - Nandita S. Scott
- Department of Medicine, Harvard Medical School, Boston, Massachusetts
- Cardiology Division, Massachusetts General Hospital, Boston
| | - Colleen M. Harrington
- Department of Medicine, Harvard Medical School, Boston, Massachusetts
- Cardiology Division, Massachusetts General Hospital, Boston
| | - Amy A. Sarma
- Department of Medicine, Harvard Medical School, Boston, Massachusetts
- Cardiology Division, Massachusetts General Hospital, Boston
| | - Emily S. Lau
- Cardiovascular Research Center, Massachusetts General Hospital, Boston
- Department of Medicine, Harvard Medical School, Boston, Massachusetts
- Cardiology Division, Massachusetts General Hospital, Boston
| | - Jason D. Roh
- Department of Medicine, Harvard Medical School, Boston, Massachusetts
- Cardiology Division, Massachusetts General Hospital, Boston
| | - James L. Januzzi
- Department of Medicine, Harvard Medical School, Boston, Massachusetts
- Cardiology Division, Massachusetts General Hospital, Boston
- Baim Institute for Clinical Research, Boston, Massachusetts
| | - Pradeep Natarajan
- Program in Medical and Population Genetics and Cardiovascular Disease Initiative, Broad Institute of Harvard and MIT, Cambridge, Massachusetts
- Cardiovascular Research Center, Massachusetts General Hospital, Boston
- Department of Medicine, Harvard Medical School, Boston, Massachusetts
- Cardiology Division, Massachusetts General Hospital, Boston
| | - Michael C. Honigberg
- Program in Medical and Population Genetics and Cardiovascular Disease Initiative, Broad Institute of Harvard and MIT, Cambridge, Massachusetts
- Cardiovascular Research Center, Massachusetts General Hospital, Boston
- Department of Medicine, Harvard Medical School, Boston, Massachusetts
- Cardiology Division, Massachusetts General Hospital, Boston
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5
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Ludmir J, Suero-Abreu GA, Gonzalez de la Nuez A, Robles M, Wood MJ, Del Carmen MG, Wasfy JH. Building a post-myocardial infarction discharge intervention program for Hispanic patients. Healthc (Amst) 2024; 12:100730. [PMID: 38087744 DOI: 10.1016/j.hjdsi.2023.100730] [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] [Received: 08/14/2023] [Revised: 11/08/2023] [Accepted: 12/03/2023] [Indexed: 03/12/2024]
Abstract
Hispanic patients disproportionally suffer from disparities in care delivery in the setting of acute myocardial infarction (AMI). More specifically, Hispanic patients have higher 30-day readmission rates post-AMI and are less likely to be referred to cardiac rehab. Because of the challenges Hispanic patients face with post-AMI care, the Hispanic Acute Myocardial Infarction Discharge Intervention Study (HAMIDI) was launched to provide a culturally sensitive discharge framework to improve readmission and mortality rates in this population. Patients enrolled in this study participate in a comprehensive post-discharge program involving follow-up with a Spanish-speaking cardiologist, a two-part educational virtual group visit program, and access to support throughout the study. During the initial year of the study, 35 patients enrolled and successfully participated in the program. This case study reviews the implementation process, initial outcomes, challenges, and future plans of the program.
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Affiliation(s)
- Jonathan Ludmir
- Corrigan Minehan Heart Center, Massachusetts General Hospital, Harvard Medical School, USA.
| | - Giselle A Suero-Abreu
- Corrigan Minehan Heart Center, Massachusetts General Hospital, Harvard Medical School, USA
| | | | - Martin Robles
- Department of Internal Medicine, University of California, San Francisco, Fresno, USA
| | - Malissa J Wood
- Corrigan Minehan Heart Center, Massachusetts General Hospital, Harvard Medical School, USA
| | - Marcela G Del Carmen
- Department of Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, USA
| | - Jason H Wasfy
- Corrigan Minehan Heart Center, Massachusetts General Hospital, Harvard Medical School, USA
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6
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Sarma AA, Lau ES, Sharma G, King LP, Economy KE, Wood R, Wood MJ, Feinberg L, Isselbacher EM, Hameed AB, DeFaria Yeh D, Scott NS. Maternal Cardiovascular Health Post-Dobbs. NEJM Evid 2024; 3:EVIDra2300273. [PMID: 38320493 DOI: 10.1056/evidra2300273] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Abstract
Maternal Cardiovascular Health Post-DobbsPregnancy is associated with increasing morbidity and mortality in the United States. In the post-Dobbs era, many pregnant patients at highest risk no longer have access to abortion, which has been a crucial component of standard medical care.
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Affiliation(s)
- Amy A Sarma
- Division of Cardiology, Massachusetts General Hospital, Boston
| | - Emily S Lau
- Division of Cardiology, Massachusetts General Hospital, Boston
| | - Garima Sharma
- Inova Schar Heart and Vascular, Inova Health System, Falls Church, VA
| | - Louise P King
- Division of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston
| | | | - Rachel Wood
- Division of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston
| | | | - Loryn Feinberg
- Division of Cardiology, Beth Israel Deaconess Medical Center, Boston
| | | | | | | | - Nandita S Scott
- Division of Cardiology, Massachusetts General Hospital, Boston
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7
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Gibson LE, Davis EF, Ponzini F, Wood MJ. Longitudinal Strain Patterns in Stress (Takotsubo) Cardiomyopathy: Evidence of Global Myocardial Injury and Incomplete Recovery. Am J Cardiol 2024; 211:193-198. [PMID: 37949337 DOI: 10.1016/j.amjcard.2023.10.091] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 10/16/2023] [Accepted: 10/28/2023] [Indexed: 11/12/2023]
Abstract
Stress cardiomyopathy develops after abrupt sympathetic stimulation, likely from catecholamine-induced myocardial toxicity. The evolution of myocardial strain during and after an episode have not been previously characterized. We aimed to determine whether preexisting contractile abnormalities may explain the observed regional dysfunction during an acute episode and to investigate the persistence of strain abnormalities after clinical recovery. We identified patients who were diagnosed with stress cardiomyopathy and had an echocardiogram performed before their episode, during their episode, and within 1 year after. The diagnosis was confirmed based on the absence of obstructive coronary lesions. Left ventricular (LV) longitudinal strain was calculated using speckle-tracking software and compared between baseline, episode, and follow-up echocardiograms. The LV strain analysis was performed on 23 patients. The LV ejection fraction was 64 ± 8.7% at baseline, 45 ± 12% during the episode, and 5 9 ± 10% after a median follow-up of 46 days. The LV global longitudinal strain was 24 ± 4.7% at baseline, 11 ± 4.9% during the episode, and 19 ± 4.6% after the follow-up. The mean ejection fraction (p <0.01) and global longitudinal strain (p <0.001) remained below baseline levels at follow-up. Longitudinal strain was reduced (<18%) in 80 ± 23% of myocardial segments during an episode and 41 ± 21% of myocardial segments at follow-up. During the acute episode, 35 ± 6% of the abnormal segments were in the base, outside of the region of ballooning. Our findings suggests that stress cardiomyopathy is associated with global rather than regional myocardial injury and that contractile abnormalities persist after clinical improvement. These findings challenge our previous understanding of stress cardiomyopathy and may guide future pathophysiologic understanding of this complex disease.
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Affiliation(s)
- Lauren E Gibson
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts.
| | - Esther F Davis
- Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts; Victorian Heart Institute & Monash Health Heart, Victorian Heart Hospital, Monash University, Clayton, Australia
| | - Francesca Ponzini
- Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Malissa J Wood
- Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts
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8
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Seegers LM, Yeh DD, Wood MJ, Yonetsu T, Minami Y, Araki M, Nakajima A, Yuki H, Ako J, Soeda T, Kurihara O, Higuma T, Kimura S, Adriaenssens T, Nef HM, Lee H, McNulty I, Sugiyama T, Kakuta T, Jang IK. Cardiovascular Risk Factors and Culprit Plaque Characteristics in Women With Acute Coronary Syndromes. Am J Cardiol 2023; 207:13-20. [PMID: 37722196 DOI: 10.1016/j.amjcard.2023.08.152] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Revised: 08/22/2023] [Accepted: 08/23/2023] [Indexed: 09/20/2023]
Abstract
Outcomes after myocardial infarction in women remain poor. The number of cardiovascular risk factors in women increase with age, however the relation between risk factors and culprit plaque characteristics in this population is poorly understood. The aim of the study was to investigate the relation between risk factors and culprit plaque characteristics in women with acute coronary syndrome (ACS). A total of 382 women who presented with ACS and underwent pre-intervention optical coherence tomography imaging of the culprit lesion were included in this analysis. The culprit plaques were categorized as plaque rupture, plaque erosion or calcified plaque, and then stratified by age and risk factors. The predominant pathology of ACS was plaque erosion in young patients (<60 years), which decreased with age (p <0.001). Current smokers had a high prevalence of plaque rupture (60%) and lipid plaque (79%). Women with diabetes tended to have more lipid plaque (70%) even at a young age. In women with hyperlipidemia, the prevalence of lipid plaques was modest in younger ages, but rose gradually with age (p <0.001). An increasing age trend for lipid plaque was also observed in women with hypertension (p = 0.03) and current smokers (p = 0.01). In conclusion, early treatment of risk factors such as diabetes in young women might be important before accelerated progression of atherosclerosis begins as age advances. Clinical trial registration: http://www.clinicaltrials.gov, NCT01110538, NCT03479723 and NCT02041650.
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Affiliation(s)
- Lena Marie Seegers
- Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Doreen DeFaria Yeh
- Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Malissa J Wood
- Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Taishi Yonetsu
- Department of Interventional Cardiology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yoshiyasu Minami
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Japan
| | - Makoto Araki
- Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Akihiro Nakajima
- Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Haruhito Yuki
- Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Junya Ako
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Japan
| | - Tsunenari Soeda
- Department of Cardiovascular Medicine, Nara Medical University, Kashihara, Japan
| | - Osamu Kurihara
- Cardiovascular Center, Nippon Medical School, Chiba Hokusoh Hospital, Inzai, Japan
| | - Takumi Higuma
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Shigeki Kimura
- Division of Cardiology, Kameda Medical Center, Kamogawa, Japan
| | - Tom Adriaenssens
- Department of Cardiovascular Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Holger M Nef
- Department of Cardiology, University of Giessen, Giessen, Germany
| | - Hang Lee
- Biostatistics Center, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Iris McNulty
- Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Tomoyo Sugiyama
- Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Tsuchiura, Japan
| | - Tsunekazu Kakuta
- Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Tsuchiura, Japan
| | - Ik-Kyung Jang
- Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA; Division of Cardiology, Kyung Hee University Hospital, Seoul, Korea.
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9
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Alkhaibari AM, Wood MJ, Yavasoglu SI, Bull JC, Butt TM. Optimizing the Application Timing and Dosage of Metarhizium brunneum (Hypocreales: Clavicipitaceae) as a Biological Control Agent of Aedes aegypti (Diptera: Culicidae) Larvae. J Med Entomol 2023; 60:339-345. [PMID: 36539333 PMCID: PMC9989833 DOI: 10.1093/jme/tjac186] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Indexed: 06/02/2023]
Abstract
Aedes aegypti (Diptera: Culicidae) is the principal vector of dengue and other viruses that cause disease among 100 to 400 million people each year. The recent development of widespread insecticidal resistance has led to the rapid development of biological control solutions aimed at larval control. While the efficacy of Metarhizium brunneum has been shown against Aedes larvae, the impact of larval population dynamics will need to be determined to formulate effective control strategies. In this study, larvae were subjected to four concentrations of M. brunneum (105, 106, 107, 108 conidia ml-1). Larvae were found to be susceptible to M. brunneum with dose-dependent efficacy. When constant larval immigration was added as a parameter, peak mortality was consistently found to occur on the fourth day, before a significant reduction in control efficacy linked to a decline in conidial availability within the water column. This suggests that M. brunneum treatments should be applied at a concentration 1 × 107 conidia ml-1 every four days to effectively control mosquito larvae in the field, regardless of the fungal formulation, water volume, or larval density. Understanding fungal-mosquito dynamics is critical in developing appropriate control programs as it helps optimize the fungal control agent's dose and frequency of application.
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Affiliation(s)
| | | | - S I Yavasoglu
- Department of Biology, Faculty of Science, Aydın Adnan Menderes University, 09100, Aydın, Turkiye
| | - J C Bull
- Department of Biosciences, Faculty of Science and Engineering, Swansea University, Singleton Park, Swansea SA2 8PP, UK
| | - T M Butt
- Department of Biosciences, Faculty of Science and Engineering, Swansea University, Singleton Park, Swansea SA2 8PP, UK
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10
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Mehta PK, Levit RD, Wood MJ, Aggarwal N, O'Donoghue ML, Lim SS, Lindley K, Gaignard S, Quesada O, Vatsa N, Leon A, Volgman AS, Malas W, Pepine CJ. Chronic rheumatologic disorders and cardiovascular disease risk in women. Am Heart J Plus 2023; 27:100267. [PMID: 38511090 PMCID: PMC10945906 DOI: 10.1016/j.ahjo.2023.100267] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 01/18/2023] [Accepted: 02/02/2023] [Indexed: 03/22/2024]
Abstract
Cardiovascular disease (CVD) is a major health threat to women worldwide. In addition to traditional CVD risk factors, autoimmune conditions are increasingly being recognized as contributors to adverse CVD consequences in women. Chronic systemic autoimmune and inflammatory disorders can trigger premature and accelerated atherosclerosis, microvascular dysfunction, and thrombosis. The presence of comorbid conditions, duration of the autoimmune condition, disease severity, and treatment of underlying inflammation are all factors that impact CVD risk and progression. Early identification and screening of CVD risk factors in those with underlying autoimmune conditions may attenuate CVD in this population. Treatment with non-steroidal anti-inflammatory drugs, corticosteroids, disease modifying agents and biologics may influence CVD risk factors and overall risk. Multi-disciplinary and team-based care, clinical trials, and collaborative team-science studies focusing on systemic autoimmune conditions will be beneficial to advance care for women.
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Affiliation(s)
- Puja K. Mehta
- Emory Women's Heart Center, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, USA
| | - Rebecca D. Levit
- Emory Women's Heart Center, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, USA
| | - Malissa J. Wood
- Division of Cardiology, Massachusetts General Hospital, Boston, MA, USA
| | - Niti Aggarwal
- Department of Cardiovascular Disease, Mayo Clinic, Rochester, MN, USA
| | - Michelle L. O'Donoghue
- TIMI Study Group, Cardiovascular Division, Brigham and Women's Hospital, Boston, MA, USA
| | - S. Sam Lim
- Division of Rheumatology, Department of Medicine, Emory University, Atlanta, GA, USA
| | - Kate Lindley
- Cardiovascular Division, Washington University in St. Louis, USA
| | - Scott Gaignard
- J. Willis Hurst Internal Medicine Residency Program, Emory University, Atlanta, GA, USA
| | - Odayme Quesada
- Women's Heart Center, The Christ Hospital Heart and Vascular Institute, Cincinnati, OH, USA
| | - Nishant Vatsa
- J. Willis Hurst Internal Medicine Residency Program, Emory University, Atlanta, GA, USA
| | - Ana Leon
- Emory University School of Medicine, Atlanta, GA, USA
| | | | - Waddah Malas
- Loyola University Internal Medicine Residency Program, Chicago, IL, USA
| | - Carl J. Pepine
- Division of Cardiovascular Medicine, University of Florida, Gainesville, FL, USA
| | - American College of Cardiology Cardiovascular Disease in Women Committee
- Emory Women's Heart Center, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, USA
- Division of Cardiology, Massachusetts General Hospital, Boston, MA, USA
- Department of Cardiovascular Disease, Mayo Clinic, Rochester, MN, USA
- TIMI Study Group, Cardiovascular Division, Brigham and Women's Hospital, Boston, MA, USA
- Division of Rheumatology, Department of Medicine, Emory University, Atlanta, GA, USA
- Cardiovascular Division, Washington University in St. Louis, USA
- J. Willis Hurst Internal Medicine Residency Program, Emory University, Atlanta, GA, USA
- Women's Heart Center, The Christ Hospital Heart and Vascular Institute, Cincinnati, OH, USA
- Emory University School of Medicine, Atlanta, GA, USA
- Section Division of Cardiology, Rush University Medical Center, Chicago, IL, USA
- Loyola University Internal Medicine Residency Program, Chicago, IL, USA
- Division of Cardiovascular Medicine, University of Florida, Gainesville, FL, USA
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11
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Sharma G, Rao SJ, Douglas PS, Rzeszut A, Itchhaporia D, Wood MJ, Nasir K, Blumenthal RS, Poppas A, Kuvin J, Miller AP, Mehran R, Valentine M, Summers RF, Mehta LS. Prevalence and Professional Impact of Mental Health Conditions Among Cardiologists. J Am Coll Cardiol 2023; 81:574-586. [PMID: 36585350 DOI: 10.1016/j.jacc.2022.11.025] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 10/18/2022] [Accepted: 11/04/2022] [Indexed: 12/29/2022]
Abstract
BACKGROUND Mental illness among physicians is an increasingly recognized concern. Global data on mental health conditions (MHCs) among cardiologists are limited. OBJECTIVES The purpose of this study was to investigate the global prevalence of MHCs among cardiologists and its relationships to professional life. METHODS The American College of Cardiology conducted an online survey with 5,931 cardiologists globally in 2019. Data on demographics, practice, MHC, and association with professional activities were analyzed. The P values were calculated using the chi-square, Fischer exact, and Mann-Whitney U tests. Univariate and multivariate logistic regression analysis determined the association of characteristics with MHC. RESULTS Globally, 1 in 4 cardiologists experience any self-reported MHC, including psychological distress, or major or other psychiatric disorder. There is significant geographic variation in MHCs, with highest and lowest prevalences in South America (39.3%) and Asia (20.1%) (P < 0.001). Predictors of MHCs included experiencing emotional harassment (OR: 2.81; 95% CI: 2.46-3.20), discrimination (OR: 1.85; 95% CI: 1.61-2.12), being divorced (OR: 1.85; 95% CI: 1.27-2.36), and age <55 years (OR: 1.43; 95% CI: 1.24-1.66). Women were more likely to consider suicide within the past 12 months (3.8% vs 2.3%), but were also more likely to seek help (42.3% vs 31.1%) as compared with men (all P < 0.001). Nearly one-half of cardiologists reporting MHCs (44%) felt dissatisfied on at least one professional metric including feeling valued, treated fairly, and adequate compensation. CONCLUSIONS More than 1 in 4 cardiologists experience self-reported MHCs globally, and the association with adverse experiences in professional life is substantial. Dedicated efforts toward prevention and treatment are needed to maximize the contributions of affected cardiologists.
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Affiliation(s)
- Garima Sharma
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA; Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
| | - Shiavax J Rao
- Department of Medicine, MedStar Union Memorial Hospital, Baltimore, Maryland, USA
| | - Pamela S Douglas
- Division of Cardiology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Anne Rzeszut
- American College of Cardiology, Washington, DC, USA
| | - Dipti Itchhaporia
- Division of Cardiology, University of California, Irvine, School of Medicine, Irvine, California, USA
| | - Malissa J Wood
- Division of Cardiology, Massachusetts General Hospital, Harvard University, Boston, Massachusetts, USA
| | - Khurram Nasir
- Division of Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas, USA
| | - Roger S Blumenthal
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Athena Poppas
- Division of Cardiology, Brown University, Providence, Rhode Island, USA
| | - Jeffrey Kuvin
- Department of Cardiology at Northwell, Zucker School of Medicine, Hempstead, New York, USA
| | | | - Roxana Mehran
- Division of Cardiology, Ichan School of Medicine, Mount Sinai University, New York, New York, USA
| | - Michael Valentine
- Division of Cardiology, Department of Medicine, University of Virginia, Charlottesville, Virginia, USA
| | - Richard F Summers
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Laxmi S Mehta
- Division of Cardiology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.
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12
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Sarma AA, Hsu S, Januzzi JL, Goldfarb IT, Thadhani R, Wood MJ, Powe CE, Scott NS. First Trimester Cardiac Biomarkers among Women with Peripartum Cardiomyopathy: Are There Early Clues to This Late-Pregnancy Phenomenon? Am J Perinatol 2023; 40:137-140. [PMID: 35523213 DOI: 10.1055/s-0042-1748159] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 01/04/2023]
Abstract
OBJECTIVE Whether biomarkers may enable early identification of women who develop peripartum cardiomyopathy (PPCM) prior to disease onset remains a question of interest. STUDY DESIGN A retrospective nested case-control study was conducted to determine whether first trimester N-terminal pro-B type natriuretic peptide (NT-proBNP) or high sensitivity cardiac troponin I (hs-cTnI) differed among women who developed PPCM versus unaffected pregnancies. Cases were matched to unaffected women by age, race, parity, and gestational age of sample (control A) and then further by blood pressure and pregnancy weight gain (control B). RESULTS First trimester NT-proBNP concentrations were numerically higher among women who subsequently developed PPCM (116 pg/mL [83-177]) as compared with women in control A (56.1 pg/mL [38.7-118.7], p = 0.3) or control B (37.6 [23.3 - 53.8], p <0.05). A higher proportion of women who subsequently developed PPCM (50%) had detectable levels of hs-cTnI as compared with control A (0%, p = 0.03) or control B (18.8%, p = 0.52). Among both cases and controls, hs-cTnI values were low and often below the limit of detection. CONCLUSION There were differences in first trimester NT-proBNP and hs-cTnI concentrations between women who subsequently developed PPCM and those who did not, raising the possibility the early pregnancy subclinical myocardial dysfunction may be associated with this late-pregnancy disease. KEY POINTS · First trimester NT-proBNP is numerically higher among women who subsequently develop PPCM.. · First trimester hs-cTnI was nominally higher among women who developed PPCM versus those who did not.. · A significant proportion of normal pregnant women have undetectable hs-cTnI..
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Affiliation(s)
- Amy A Sarma
- Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - Sarah Hsu
- Division of Endocrinology, Diabetes Unit, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - James L Januzzi
- Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - Ilona T Goldfarb
- Harvard Medical School, Boston, Massachusetts.,Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, Massachusetts
| | - Ravi Thadhani
- Harvard Medical School, Boston, Massachusetts.,Division of Nephrology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Malissa J Wood
- Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - Camille E Powe
- Harvard Medical School, Boston, Massachusetts.,Division of Endocrinology, Diabetes Unit, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Nandita S Scott
- Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
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13
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Raparelli V, Wright CX, Corica B, Sharma G, Lindley K, Brackett A, Pilote L, Wood MJ, Dreyer RP. Interventions Targeted to Address Social Determinants of Health in Ischemic Heart Disease: A Sex- and Gender-Oriented Scoping Review. Can J Cardiol 2022; 38:1881-1892. [PMID: 35809812 DOI: 10.1016/j.cjca.2022.06.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 06/21/2022] [Accepted: 06/28/2022] [Indexed: 12/14/2022] Open
Abstract
The burden of ischemic heart disease (IHD) is a major health problem worldwide. The detrimental effect of gendered (ie, unevenly distributed between female and male) socioeconomic determinants of health (SDOH) on outcomes has been demonstrated, more so in female individuals. Therefore, addressing SDOH is a priority for the care implementation of patients with IHD. We conducted a scoping review to identify the types of SDOH-tailored interventions tested in randomised controlled trials (RCTs) among IHD patients, and whether the reporting of findings was sex-unbiased. We identified 8 SDOH domains: education, physical environment, health care system, economic stability, social support, sexual orientation, culture/language, and systemic racism. A total of 28 RCTs (2 ongoing) were evaluated. Since the 1990s, 26 RCTs have been conducted, mainly in the Middle East and Asia, and addressed only education, physical environment, health care system, and social support. The 77% of studies focused on patient-education interventions, and around 80% on SDOH-based interventions achieved positive effects on a variety of primary outcome(s). Among the limitations of the conducted RCTs, the most relevant were an overall low participation of female and racial/ethnical minority participants, a lack of sex-stratified analyses, and a missing opportunity of tailoring some SDOH interventions relevant for health. The SDOH-tailored interventions tested so far in RCTs, enrolling predominantly male patients and mainly targeting education and health literacy, were effective in improving outcomes among patients with IHD. Future studies should focus on a wider range of SDOH with an adequate representation of female and minority patients who would most benefit from such interventions.
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Affiliation(s)
- Valeria Raparelli
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy; University Centre for Studies on Gender Medicine, University of Ferrara, Ferrara, Italy; Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Catherine X Wright
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Bernadette Corica
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Garima Sharma
- Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Kathryn Lindley
- Cardiovascular Division, Washington University School of Medicine, St Louis, Missouri, USA
| | - Alexandria Brackett
- Harvey Cushing/John Hay Whitney Medical Library, Yale University, New Haven, Connecticut, USA
| | - Louise Pilote
- Centre for Outcomes Research and Evaluation, McGill University Health Centre Research Institute, Montréal, Québec, Canada; Divisions of Clinical Epidemiology and General Internal Medicine, McGill University Health Centre Research Institute, Montréal, Québec, Canada
| | - Malissa J Wood
- Massachusetts General Hospital Corrigan Minehan Heart Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Rachel P Dreyer
- Center for Outcomes Research and Evaluation, New Haven, Connecticut, USA; Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut, USA; Department of Biostatistics (Health Informatics), Yale School of Public Health, New Haven, Connecticut, USA.
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York M, Douglas PS, Damp JB, Fraiche AM, Gillam LD, Hayes SN, Rzeszut AK, Sulistio MS, Wood MJ. Professional Preferences and Perceptions of Cardiology Among Internal Medicine Residents: Temporal Trends Over the Past Decade. JAMA Cardiol 2022; 7:1253-1258. [PMID: 36223091 PMCID: PMC9558028 DOI: 10.1001/jamacardio.2022.3485] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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: 02/07/2022] [Accepted: 08/19/2022] [Indexed: 01/13/2023]
Abstract
Importance Internal medicine residents' professional development preferences were discordant with their perceptions of cardiology in a survey circulated a decade ago; no contemporary data exist. This information is important for effective recruitment and retention of a highly talented and diverse future cardiology workforce. Objective To identify residents' professional development preferences and cardiology perceptions, in relation to specialty choice, and compare the findings with those from a decade prior. Design, Setting, and Participants The original survey from the 2010 study was updated and sent to US internal medicine programs. Respondents (ie, internal medicine residents) rated 38 professional development preferences and 20 cardiology perceptions. Data were collected in 2020 and compared with survey results from the prior 2010 study. Multivariable models were created for specialty choice using scaled independent variables dichotomized using the top 2 options; categorical variables were recoded into binary variables for analysis. Main Outcomes and Measures Multivariable models were used to determine the association of demographic characterisitcs and survey responses with prospective career choice. Responses were examined by total group, by gender, by self-reported consideration of entering cardiology as a profession, and by comparison with a decade prior both as a group and by gender. Results A total of 840 residents (mean [SD] age, 29.24 [2.82] years; 49.8% male; 55.4% White) completed the survey. The survey incorporated a 5-point Likert scale of 1 (not important) to 5 (extremely important) for some of the questions, with additional questions on demographic characteristics. The most important professional development preferences by descending Likert score were as follows: positive role models (4.56), stimulating career (3.81), and family friendly (3.78). The cardiology perception statements with the highest agreement were as follows: interferes with family life during training (3.93) and having met positive role models or having positive views of cardiovascular disease as a topic (3.85). Multivariable analysis yielded a 22-element model predicting cardiology as career choice. Compared with the 2010 survey, the findings of this survey indicated increased importance of work-life balance components for both male and female residents, with a greater change in male residents. Contemporary residents were more likely than their predecessors to agree with negative perceptions of cardiology. Conclusions and Relevance This survey study found that both male and female residents place a high value on support for optimal work-life balance; these preferences have intensified over the past decade and factor into career choice. Negative perceptions of cardiology persist and, in some aspects, are worsening. Improving the culture of cardiology may make this specialty a more attractive career choice for all.
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Affiliation(s)
- Meghan York
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | | | - Julie B. Damp
- Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Ariane M. Fraiche
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Linda D. Gillam
- Department of Cardiovascular Medicine, Gagnon Cardiovascular Institute, Morristown Medical Center/Atlantic Health System, Morristown, New Jersey
| | - Sharonne N. Hayes
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | | | - Melanie S. Sulistio
- Department of Internal Medicine, Division of Cardiology, University of Texas Southwestern, Dallas
| | - Malissa J. Wood
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
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15
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Gaine SP, Sharma G, Tower-Rader A, Botros M, Kovell L, Parakh A, Wood MJ, Harrington CM. Multimodality Imaging in the Detection of Ischemic Heart Disease in Women. J Cardiovasc Dev Dis 2022; 9:jcdd9100350. [PMID: 36286302 PMCID: PMC9604786 DOI: 10.3390/jcdd9100350] [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] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 10/04/2022] [Accepted: 10/10/2022] [Indexed: 11/07/2022] Open
Abstract
Women with coronary artery disease tend to have a worse short and long-term prognosis relative to men and the incidence of atherosclerotic cardiovascular disease is increasing. Women are less likely to present with classic anginal symptoms when compared with men and more likely to be misdiagnosed. Several non-invasive imaging modalities are available for diagnosing ischemic heart disease in women and many of these modalities can also assist with prognostication and help to guide management. Selection of the optimal imaging modality to evaluate women with possible ischemic heart disease is a scenario which clinicians often encounter. Earlier modalities such as exercise treadmill testing demonstrate significant performance variation in men and women, while newer modalities such as coronary CT angiography, myocardial perfusion imaging and cardiac magnetic resonance imaging are highly specific and sensitive for the detection of ischemia and coronary artery disease with greater parity between sexes. Individual factors, availability, diagnostic performance, and female-specific considerations such as pregnancy status may influence the decision to select one modality over another. Emerging techniques such as strain rate imaging, CT-myocardial perfusion imaging and cardiac magnetic resonance imaging present additional options for diagnosing ischemia and coronary microvascular dysfunction.
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Affiliation(s)
- Sean Paul Gaine
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Garima Sharma
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Albree Tower-Rader
- Department of Radiology, Massachusetts General Hospital, Boston, MA 02114, USA
- Division of Cardiology, Massachusetts General Hospital, Boston, MA 02214, USA
| | - Mina Botros
- Department of Medicine, University of Massachusetts Medical School, Worcester, MA 01605, USA
| | - Lara Kovell
- Department of Medicine, University of Massachusetts Medical School, Worcester, MA 01605, USA
| | - Anushri Parakh
- Department of Radiology, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Malissa J. Wood
- Division of Cardiology, Massachusetts General Hospital, Boston, MA 02214, USA
| | - Colleen M. Harrington
- Department of Medicine, University of Massachusetts Medical School, Worcester, MA 01605, USA
- Corrigan Women’s Heart Health Program, Massachusetts General Hospital, Boston, MA 02214, USA
- Correspondence:
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16
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Fry ETA, Wood MJ, Walsh MN. Maternal Health: The Heart of the Matter. J Am Coll Cardiol 2022; 80:1107-1109. [PMID: 36075681 PMCID: PMC9443929 DOI: 10.1016/j.jacc.2022.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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17
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Coursen J, Simpson CE, Mukherjee M, Vaught AJ, Kutty S, Al-Talib TK, Wood MJ, Scott NS, Mathai SC, Sharma G. Pregnancy Considerations in the Multidisciplinary Care of Patients with Pulmonary Arterial Hypertension. J Cardiovasc Dev Dis 2022; 9:jcdd9080260. [PMID: 36005424 PMCID: PMC9409449 DOI: 10.3390/jcdd9080260] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 07/26/2022] [Accepted: 08/08/2022] [Indexed: 11/30/2022] Open
Abstract
Pulmonary arterial hypertension (PAH) is a vasoconstrictive disease of the distal pulmonary vasculature resulting in adverse right heart remodeling. Pregnancy in PAH patients is associated with high maternal morbidity and mortality as well as neonatal and fetal complications. Pregnancy-associated changes in the cardiovascular, pulmonary, hormonal, and thrombotic systems challenge the complex PAH physiology. Due to the high risks, patients with PAH are currently counseled against pregnancy based on international consensus guidelines, but there are promising signs of improving outcomes, particularly for patients with mild disease. For patients who become pregnant, multidisciplinary care at a PAH specialist center is needed for peripartum monitoring, medication management, delivery, postpartum care, and complication management. Patients with PAH also require disease-specific counseling on contraception and breastfeeding. In this review, we detail the considerations for reproductive planning, pregnancy, and delivery for the multidisciplinary care of a patient with PAH.
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Affiliation(s)
- Julie Coursen
- Department of Medicine, Johns Hopkins University, Baltimore, MD 21218, USA
| | - Catherine E. Simpson
- Divisions of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University, Baltimore, MD 21218, USA
| | - Monica Mukherjee
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, MD 21218, USA
| | - Arthur J. Vaught
- Division of Maternal Fetal Medicine, Department of Gynecology Obstetrics, Johns Hopkins University, Baltimore, MD 21218, USA
| | - Shelby Kutty
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, MD 21218, USA
| | - Tala K. Al-Talib
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, MD 21218, USA
| | - Malissa J. Wood
- Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Nandita S. Scott
- Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Stephen C. Mathai
- Divisions of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University, Baltimore, MD 21218, USA
| | - Garima Sharma
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, MD 21218, USA
- Correspondence:
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O’Kelly AC, Ludmir J, Wood MJ. Acute Coronary Syndrome in Pregnancy and the Post-Partum Period. J Cardiovasc Dev Dis 2022; 9:jcdd9070198. [PMID: 35877560 PMCID: PMC9319853 DOI: 10.3390/jcdd9070198] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 06/14/2022] [Accepted: 06/16/2022] [Indexed: 11/16/2022] Open
Abstract
Cardiovascular disease is the leading cause of maternal mortality in the United States. Acute coronary syndrome (ACS) is more common in pregnant women than in non-pregnant controls and contributes to the burden of maternal mortality. This review highlights numerous etiologies of chest discomfort during pregnancy, as well as risk factors and causes of ACS during pregnancy. It focuses on the evaluation and management of ACS during pregnancy and the post-partum period, including considerations when deciding between invasive and non-invasive ischemic evaluations. It also focuses specifically on the management of post-myocardial infarction complications, including shock, and outlines the role of mechanical circulatory support, including veno-arterial extracorporeal membrane oxygenation (VA-ECMO). Finally, it offers additional recommendations for navigating delivery in women who experienced pregnancy-associated myocardial infarction and considerations for the post-partum patient who develops ACS.
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Lau ES, Wang D, Roberts M, Taylor CN, Murugappan G, Shadyab AH, Schnatz PF, Farland LV, Wood MJ, Scott NS, Eaton CB, Ho JE. Infertility and Risk of Heart Failure in the Women's Health Initiative. J Am Coll Cardiol 2022; 79:1594-1603. [PMID: 35450577 PMCID: PMC9377329 DOI: 10.1016/j.jacc.2022.02.020] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 02/08/2022] [Indexed: 12/20/2022]
Abstract
BACKGROUND There is growing recognition that reproductive factors are associated with increased risk of future cardiovascular disease. Infertility has been less well studied, although emerging data support its association with increased risk of cardiovascular disease. Whether infertility is associated with future risk of heart failure (HF) is not known. OBJECTIVES This study sought to examine the development of HF and HF subtypes in women with and without history of infertility. METHODS We followed postmenopausal women from the Women's Health Initiative prospectively for the development of HF. Infertility was self-reported at study baseline. Multivariable cause-specific Cox models were used to evaluate the association of infertility with incident overall HF and HF subtypes (heart failure with preserved ejection fraction [HFpEF]: left ventricular ejection fraction of ≥50% vs heart failure with reduced ejection fraction [HFrEF]: left ventricular ejection fraction of <50%]). RESULTS Among 38,528 postmenopausal women (mean age: 63 ± 7 years), 5,399 (14%) participants reported a history of infertility. Over a median follow-up of 15 years, 2,373 developed incident HF, including 807 with HFrEF and 1,133 with HFpEF. Infertility was independently associated with future risk of overall HF (HR: 1.16; 95% CI: 1.04-1.30; P = 0.006). Notably, when examining HF subtypes, infertility was associated with future risk of HFpEF (HR: 1.27; 95% CI: 1.09-1.48; P = 0.002) but not HFrEF (HR: 0.97; 95% CI: 0.80-1.18). CONCLUSIONS Infertility was significantly associated with incident HF. This was driven by increased risk of HFpEF, but not HFrEF, and appeared independent of traditional cardiovascular risk factors and other infertility-related conditions. Future research should investigate mechanisms that underlie the link between infertility and HFpEF.
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Affiliation(s)
- Emily S Lau
- Cardiology Division, Massachusetts General Hospital, Boston, Massachusetts, USA; Cardiovascular Research Center, Massachusetts General Hospital, Boston, Massachusetts, USA.
| | - Dongyu Wang
- CardioVascular Institute and Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Mary Roberts
- Department of Family Medicine, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Christy N Taylor
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Gayathree Murugappan
- Department of Obstetrics and Gynecology, Stanford University Medical Center, Stanford, California, USA
| | - Aladdin H Shadyab
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla, California, USA
| | - Peter F Schnatz
- Department of Obstetrics and Gynecology, The Reading Hospital/Tower Health, Reading, Pennsylvania, USA
| | - Leslie V Farland
- Department of Epidemiology and Biostatistics, University of Arizona, Tucson, Arizona, USA; Department of Obstetrics and Gynecology, College of Medicine-Tucson, Tucson, Arizona, USA
| | - Malissa J Wood
- Cardiology Division, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Nandita S Scott
- Cardiology Division, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Charles B Eaton
- Department of Family Medicine, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Jennifer E Ho
- CardioVascular Institute and Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA. https://twitter.com/JenHoCardiology
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20
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Gulati M, Korn RM, Wood MJ, Sarma A, Douglas PS, Singh T, Merz NB, Lee J, Mehran R, Andrews OA, Williams JC. Childbearing Among Women Cardiologists: The Interface of Experience, Impact, and the Law. J Am Coll Cardiol 2022; 79:1076-1087. [PMID: 35300820 DOI: 10.1016/j.jacc.2021.12.034] [Citation(s) in RCA: 12] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 11/30/2021] [Accepted: 12/14/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Maternity leave is highly variable in the United States given the lack of a federal workforce mandate. OBJECTIVES The purpose of this study was to describe the experiences and impact of childbearing on women cardiologists and their careers, within a legal framework. METHODS A survey was sent to women cardiologists, asking about their experiences while pregnant and on maternity leave. The incidence of complications and career impacts on the cardiologists was assessed. RESULTS Of 323 respondents who had been pregnant as a practicing cardiologist, extra service or call before maternity leave was required in 37.2%. Of those who performed extra service or call, 17.5% were placed on bedrest before delivery, compared with 7.4% who did not perform extra service or call (P = 0.005). During the year of pregnancy, 41.2% experienced a salary decrease; only 7.4% had their relative value units prorated for time on maternity leave; 23.2% had no paid maternity leave. Self-reported pregnancy complications occurred in 36.5%, those with complications had a 60% greater chance of reporting that pregnancy adversely affected their career, compared with those without complications. Nearly three-fourths (237 respondents) reported experiencing at least one of several troubling practices that are illegal in many circumstances. CONCLUSIONS Women cardiologists report wide variances in maternity leave in the United States, with many experiencing likely violations of the Family and Medical Leave Act or other statues. Childbearing issues in cardiologists should be addressed to improve the professional and personal lives of women cardiologists and the attractiveness of cardiology to potential trainees.
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Affiliation(s)
- Martha Gulati
- Division of Cardiology, University of Arizona, Phoenix, Arizona, USA. https://twitter.com/drmarthagulati
| | - Rachel M Korn
- Center for WorkLife Law, University of California, Hastings College of the Law, San Francisco, California, USA
| | - Malissa J Wood
- Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Amy Sarma
- Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Pamela S Douglas
- Division of Cardiology, Duke University, Durham, North Carolina, USA
| | - Toniya Singh
- Department of Cardiology, St Louis Heart and Vascular, St Louis, Missouri, USA
| | - Noel Bairey Merz
- Department of Cardiology, Barbra Streisand Women's Heart Center, Cedars-Sinai Smidt Heart Institute, Los Angeles, California, USA.
| | - Jessica Lee
- Center for WorkLife Law, University of California, Hastings College of the Law, San Francisco, California, USA
| | - Roxana Mehran
- Division of Cardiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Olivia A Andrews
- Center for WorkLife Law, University of California, Hastings College of the Law, San Francisco, California, USA
| | - Joan C Williams
- Center for WorkLife Law, University of California, Hastings College of the Law, San Francisco, California, USA
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21
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Wells BJ, Wood MJ, Grodzinsky A, Gornik HL, Kadian-Dodov D, Taylor AM, Hess CN, Lewey J, Henkin S, Wells GL, Tam L, Vitarello C, Alkhalfan F, Chi G, Gibson CM, Leon K, Naderi S, Kim SH. MIGRAINE HEADACHE IN PATIENTS WITH SPONTANEOUS CORONARY ARTERY DISSECTION: A REPORT OF THE ISCAD REGISTRY. J Am Coll Cardiol 2022. [DOI: 10.1016/s0735-1097(22)02796-6] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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22
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Kim SH, Naderi S, Grodzinsky A, Gornik HL, Wells BJ, Taylor A, Lewey J, Hess CN, Henkin S, Kadian-Dodov D, Wells GL, Tam L, Vitarello C, Alkhalfan F, Chi G, Gibson CM, Leon K, Wood MJ. PREVALENCE OF POTENTIAL TRIGGERS AND UNDERLYING MEDICAL CONDITIONS IN SPONTANEOUS CORONARY ARTERY DISSECTION: A REPORT OF THE ISCAD REGISTRY. J Am Coll Cardiol 2022. [DOI: 10.1016/s0735-1097(22)01961-1] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Davis E, Afari H, James K, Thaweethai T, Honigberg M, Hung JW, Wood MJ, Powe CE, Sarma A. ADVERSE CARDIAC REMODELLING BY ECHOCARDIOGRAPHY FOLLOWING HYPERTENSIVE DISORDERS OF PREGNANCY. J Am Coll Cardiol 2022. [DOI: 10.1016/s0735-1097(22)02946-1] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Stevens CJ, Shaffer JA, Edwards KS, Masters KS, Leon KK, Wood MJ, Pittman Wagers T. Younger Age Impacts Perceptions of Care Received in the Emergency Department Among Women with Spontaneous Coronary Artery Dissection. J Womens Health (Larchmt) 2022; 31:1165-1172. [PMID: 35172115 PMCID: PMC9378767 DOI: 10.1089/jwh.2021.0162] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Spontaneous coronary artery dissection (SCAD) is a nonatherosclerotic etiology of acute coronary syndrome (ACS) that primarily affects younger women with few traditional cardiovascular disease risk factors. The primary objective of this study was to evaluate how younger age impacts the perception of care women receive in the emergency department (ED) at the time of their first or only SCAD. Methods: SCAD survivors were recruited using SCAD Alliance social media platforms to complete a one-time online survey regarding their experiences of seeking treatment for SCAD in the ED and their post-SCAD recovery. A total of 409 participants consented to participate in the parent study and data collected from the 367 participants who reported female gender were further analyzed. Results: Fewer participants <50 years old than would be expected under the null hypothesis (i.e., 65.5% observed vs. 71.2% expected, p = 0.009) reported perceived serious treatment by ED staff, more participants <50 years than would be expected under the null hypothesis (i.e., 12.0% observed vs. 9.3% expected, p = 0.049) reported perceived dismissive treatment by ED staff, and more participants <50 years than would be expected under the null hypothesis (i.e., 13.3% observed vs. 10.8% expected, p = 0.02) reported discharge from the ED without a diagnosis. Conclusions: Results of this study highlight the different experiences of younger SCAD survivors' engaging with providers in the ED. Further research regarding strategies for increasing ED providers' clinical interrogation of SCAD when treating and evaluating younger female patients presenting with ACS symptoms is indicated.
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Affiliation(s)
- Courtney J Stevens
- Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, Colorado, USA
| | - Jonathan A Shaffer
- Department of Psychology, University of Colorado Denver, Denver, Colorado, USA
| | | | - Kevin S Masters
- Department of Psychology, University of Colorado Denver, Denver, Colorado, USA.,Anschutz Health and Wellness Center, Anschutz Medical Campus, University of Colorado Denver, Aurora, Colorado, USA
| | | | - Malissa J Wood
- Department of Medicine, Massachusetts General Hospital, Harvard University, Boston, Massachusetts, USA
| | - Tina Pittman Wagers
- Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, Colorado, USA
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Lindley KJ, Aggarwal NR, Briller JE, Davis MB, Douglass P, Epps KC, Fleg JL, Hayes S, Itchhaporia D, Mahmoud Z, Moraes De Oliveira GM, Ogunniyi MO, Quesada O, Russo AM, Sharma J, Wood MJ. Socioeconomic Determinants of Health and Cardiovascular Outcomes in Women: JACC Review Topic of the Week. J Am Coll Cardiol 2021; 78:1919-1929. [PMID: 34736568 DOI: 10.1016/j.jacc.2021.09.011] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [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: 06/28/2021] [Revised: 09/07/2021] [Accepted: 09/13/2021] [Indexed: 10/20/2022]
Abstract
Socioeconomic disparities in cardiovascular risk factors and outcomes exist among women, particularly those of minority racial or ethnic backgrounds. Barriers to optimal cardiovascular health begin early in life-with inadequate access to effective contraception, postpartum follow-up, and maternity leave-and result in excess rates of myocardial infarction, stroke, and cardiovascular death in at-risk populations. Contributing factors include reduced access to care, low levels of income and social support, and lack of diversity among cardiology clinicians and within clinical trials. These barriers can be mitigated by optimizing care access via policy change and improving physical access to care in women with geographic or transportation limitations. Addressing structural racism through policy change and bolstering structured community support systems will be key to reducing adverse cardiovascular outcomes among women of racial and ethnic minorities. Diversification of the cardiology workforce to more closely represent the patients we serve will be beneficial to all women.
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Affiliation(s)
- Kathryn J Lindley
- Cardiovascular Division, Department of Medicine, Washington University School of Medicine, St Louis, Missouri, USA.
| | - Niti R Aggarwal
- Department of Cardiovascular Disease, Mayo Clinic, Rochester, Minnesota, USA. https://twitter.com/NitiCardio
| | - Joan E Briller
- Division of Cardiology, Department of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Melinda B Davis
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA. https://twitter.com/MelindaDavisMD
| | - Paul Douglass
- Division of Cardiology, Wellstar Atlanta Medical Center, Atlanta, Georgia, USA
| | - Kelly C Epps
- Inova Heart and Vascular Institute, Falls Church, Virginia, USA
| | - Jerome L Fleg
- National Heart, Lung, and Blood Institute, Bethesda, Maryland, USA
| | - Sharonne Hayes
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Dipti Itchhaporia
- Jeffrey M. Carlton Heart & Vascular Institute, Hoag Memorial Hospital Presbyterian, Newport Beach, California, USA
| | - Zainab Mahmoud
- Cardiovascular Division, Department of Medicine, Washington University School of Medicine, St Louis, Missouri, USA
| | | | - Modele O Ogunniyi
- Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA. https://twitter.com/modeldoc
| | - Odayme Quesada
- Women's Heart Center, The Christ Hospital Heart and Vascular Institute, Cincinnati, Ohio, USA. https://twitter.com/odayme
| | - Andrea M Russo
- Cardiovascular Division, Department of Medicine, Cooper Medical School of Rowan University, Camden, New Jersey, USA. https://twitter.com/AndreaRussoEP
| | - Jyoti Sharma
- Division of Cardiology, Piedmont Heart Institute, Atlanta, Georgia, USA
| | - Malissa J Wood
- Corrigan Minehan Heart Center, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA. https://twitter.com/drmalissawood
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Zureigat H, Frank R, Shah VS, Makarenko V, Hucker W, Ho JE, Wood MJ, Osborne MT. Cardiac Sarcoidosis Initially Diagnosed as Spontaneous Coronary Artery Dissection. JACC Case Rep 2021; 3:1656-1660. [PMID: 34766013 PMCID: PMC8571720 DOI: 10.1016/j.jaccas.2021.05.017] [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: 01/20/2021] [Revised: 04/19/2021] [Accepted: 05/28/2021] [Indexed: 11/30/2022]
Abstract
We present the case of a woman who developed presumed spontaneous coronary artery dissection of a septal branch. She later developed high-grade atrioventricular block that led to a diagnosis of cardiac sarcoidosis involving the interventricular septum. This case illustrates a rare and challenging presentation of cardiac sarcoidosis. (Level of Difficulty: Beginner.)
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Key Words
- AVB, atrioventricular block
- CAD, coronary artery disease
- CAG, coronary angiography
- CS, cardiac sarcoidosis
- CT, computed tomography
- ECG, electrocardiogram
- FDG, 18F-fluorodeoxyglucose
- IVS, interventricular septum
- PET, positron emission tomography
- SCAD, spontaneous coronary artery dissection
- TTE, transthoracic echocardiogram
- bradycardia
- cardiomyopathy
- imaging
- palpitations
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Affiliation(s)
- Hadil Zureigat
- Cardiovascular Imaging Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Rachel Frank
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Viral S Shah
- Pulmonary and Critical Care Unit, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Vladislav Makarenko
- Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - William Hucker
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Jennifer E Ho
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Malissa J Wood
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Michael T Osborne
- Cardiovascular Imaging Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA.,Cardiology Division, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
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Raber I, Al Rifai M, McCarthy CP, Vaduganathan M, Michos ED, Wood MJ, Smyth YM, Ibrahim NE, Asnani A, Mehran R, McEvoy JW. Gender Differences in Medicare Payments Among Cardiologists. JAMA Cardiol 2021; 6:1432-1439. [PMID: 34495296 DOI: 10.1001/jamacardio.2021.3385] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 02/01/2023]
Abstract
Importance Women cardiologists receive lower salaries than men; however, it is unknown whether US Centers for Medicare & Medicaid Services (CMS) reimbursement also differs by gender and contributes to the lower salaries. Objective To determine whether gender differences exist in the reimbursements, charges, and reimbursement per charge from CMS. Design, Setting, and Participants This cross-sectional analysis used the CMS database to obtain 2016 reimbursement data for US cardiologists. These included reimbursements to cardiologists, charges submitted, and unique billing codes. Gender differences in reimbursement for evaluation and management and procedural charges from both inpatient and outpatient settings were also assessed. Analysis took place between April 2019 and December 2020. Main Outcomes and Measures Outcomes included median CMS payments received and median charges submitted in the inpatient and outpatient settings in 2016. Results In 2016, 17 524 cardiologists (2312 women [13%] and 15 212 men [87%]) received CMS payments in the inpatient setting, and 16 929 cardiologists (2151 women [13%] and 14 778 men [87%]) received CMS payments in the outpatient setting. Men received higher median payments in the inpatient (median [interquartile range], $62 897 [$30 904-$104 267] vs $45 288 [$21 371-$73 191]; P < .001) and outpatient (median [interquartile range], $91 053 [$34 820-$196 165] vs $51 975 [$15 622-$120 175]; P < .001) practice settings. Men submitted more median charges in the inpatient (median [interquartile range], 1190 [569-2093] charges vs 959 [569-2093] charges; P < .001) and outpatient settings (median [interquartile range], 1685 [644-3328] charges vs 870 [273-1988] charges; P < .001). In a multivariable-adjusted linear regression analysis, women received less CMS payments compared with men (log-scale β = -0.06; 95% CI, -0.11 to -0.02) after adjustment for number of charges, number of unique billing codes, complexity of patient panel, years since graduation of physicians, and physician subspecialty. Payment by billing codes, both inpatient and outpatient, did not differ by gender. Conclusions and Relevance There may be potential differences in CMS payments between men and women cardiologists, which appear to stem from gender differences in the number and types of charges submitted. The mechanisms behind these differences merit further research, both to understand why such gender differences exist and also to facilitate reductions in pay disparities.
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Affiliation(s)
- Inbar Raber
- Cardiovascular Institute, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Mahmoud Al Rifai
- Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Cian P McCarthy
- Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Muthiah Vaduganathan
- Brigham and Women's Hospital Heart and Vascular Center, Harvard Medical School, Boston, Massachusetts
| | - Erin D Michos
- Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Malissa J Wood
- Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Yvonne M Smyth
- Division of Cardiology, Department of Medicine, Saolta University Healthcare Group, University College Hospital Galway, National University of Ireland, Galway, Ireland
| | - Nasrien E Ibrahim
- Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Aarti Asnani
- Cardiovascular Institute, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Roxana Mehran
- Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - John W McEvoy
- Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.,Division of Cardiology, Department of Medicine, Saolta University Healthcare Group, University College Hospital Galway, National University of Ireland, Galway, Ireland.,National Institute for Prevention and Cardiovascular Health, National University of Ireland, Galway, Ireland
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28
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Crousillat DR, Wood MJ. Echocardiography in Women: How Are Mars and Venus Different? Curr Cardiol Rep 2021; 23:149. [PMID: 34427784 DOI: 10.1007/s11886-021-01562-8] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/14/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE OF REVIEW Sex is an important determinant of cardiac structure and function. We review key sex differences in universal echocardiographic parameters and discuss the clinical implications of using sex-specific algorithms to increase the diagnostic accuracy of echocardiography and improve the timely treatment of common cardiovascular disorders, and the unique role of echocardiography in pregnancy and the evaluation of ischemic heart disease. RECENT FINDINGS Emerging echocardiographic findings have begun to define important sex-based differences in chamber size and ventricular function. We advocate for additional research and the consideration of sex-specific algorithms in future expert consensus guidelines for the diagnosis and treatment of valvular heart disease, heart failure, and thoracic aortic disease. Echocardiography is an essential diagnostic tool in our armamentarium of imaging modalities for the sex-specific diagnosis and guidance of treatment for a broad spectrum of cardiovascular disorders.
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Affiliation(s)
- Daniela R Crousillat
- Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street Blake 256, Boston, MA, 02114, USA
| | - Malissa J Wood
- Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street Blake 256, Boston, MA, 02114, USA.
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29
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DeFilippis EM, Collins BL, Singh A, Biery DW, Fatima A, Qamar A, Berman AN, Gupta A, Cawley M, Wood MJ, Klein J, Hainer J, Gulati M, Taqueti VR, Di Carli MF, Nasir K, Bhatt DL, Blankstein R. Women who experience a myocardial infarction at a young age have worse outcomes compared with men: the Mass General Brigham YOUNG-MI registry. Eur Heart J 2021; 41:4127-4137. [PMID: 33049774 DOI: 10.1093/eurheartj/ehaa662] [Citation(s) in RCA: 53] [Impact Index Per Article: 17.7] [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: 12/09/2019] [Revised: 04/08/2020] [Accepted: 07/29/2020] [Indexed: 12/14/2022] Open
Abstract
AIMS There are sex differences in presentation, treatment, and outcomes of myocardial infarction (MI) but less is known about these differences in a younger patient population. The objective of this study was to investigate sex differences among individuals who experience their first MI at a young age. METHODS AND RESULTS Consecutive patients presenting to two large academic medical centres with a Type 1 MI at ≤50 years of age between 2000 and 2016 were included. Cause of death was adjudicated using electronic health records and death certificates. In total, 2097 individuals (404 female, 19%) had an MI (mean age 44 ± 5.1 years, 73% white). Risk factor profiles were similar between men and women, although women were more likely to have diabetes (23.7% vs. 18.9%, P = 0.028). Women were less likely to undergo invasive coronary angiography (93.5% vs. 96.7%, P = 0.003) and coronary revascularization (82.1% vs. 92.6%, P < 0.001). Women were significantly more likely to have MI with non-obstructive coronary disease on angiography (10.2% vs. 4.2%, P < 0.001). They were less likely to be discharged with aspirin (92.2% vs. 95.0%, P = 0.027), beta-blockers (86.6% vs. 90.3%, P = 0.033), angiotensin-converting enzyme inhibitors/angiotensin-receptor blockers (53.4% vs. 63.7%, P < 0.001), and statins (82.4% vs. 88.4%, P < 0.001). There was no significant difference in in-hospital mortality; however, women who survived to hospital discharge experienced a higher all-cause mortality rate (adjusted HR = 1.63, P = 0.01; median follow-up 11.2 years) with no significant difference in cardiovascular mortality (adjusted HR = 1.14, P = 0.61). CONCLUSIONS Women who experienced their first MI under the age of 50 were less likely to undergo coronary revascularization or be treated with guideline-directed medical therapies. Women who survived hospitalization experienced similar cardiovascular mortality with significantly higher all-cause mortality than men. A better understanding of the mechanisms underlying these differences is warranted.
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Affiliation(s)
- Ersilia M DeFilippis
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston 02115, MA, USA.,New York Presbyterian-Columbia University Irving Medical Center, New York City, New York, NY, USA
| | - Bradley L Collins
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston 02115, MA, USA.,New York Presbyterian-Columbia University Irving Medical Center, New York City, New York, NY, USA
| | - Avinainder Singh
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston 02115, MA, USA.,Yale University School of Medicine, New Haven, CT, USA
| | - David W Biery
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston 02115, MA, USA
| | - Amber Fatima
- Department of Medicine, Tufts Medical Center, Boston, MA, USA
| | - Arman Qamar
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston 02115, MA, USA
| | - Adam N Berman
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston 02115, MA, USA
| | - Ankur Gupta
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston 02115, MA, USA.,Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston 02115, MA, USA
| | - Mary Cawley
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston 02115, MA, USA
| | - Malissa J Wood
- Massachusetts General Hospital Heart Center, Harvard Medical School, Boston, MA, USA
| | - Josh Klein
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston 02115, MA, USA
| | - Jon Hainer
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston 02115, MA, USA
| | - Martha Gulati
- Cardiovascular Division, Department of Medicine, UA College of Medicine, Phoenix, AZ, USA
| | - Viviany R Taqueti
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston 02115, MA, USA
| | - Marcelo F Di Carli
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston 02115, MA, USA.,Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston 02115, MA, USA
| | - Khurram Nasir
- Division of Cardiovascular Disease Prevention and Wellness, Houston Methodist De Bakey Heart and Vascular Center, Houston, TX, USA
| | - Deepak L Bhatt
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston 02115, MA, USA
| | - Ron Blankstein
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston 02115, MA, USA.,Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston 02115, MA, USA
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30
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Radfar A, Abohashem S, Osborne MT, Wang Y, Dar T, Hassan MZO, Ghoneem A, Naddaf N, Patrich T, Abbasi T, Zureigat H, Jaffer J, Ghazi P, Scott JA, Shin LM, Pitman RK, Neilan TG, Wood MJ, Tawakol A. Stress-associated neurobiological activity associates with the risk for and timing of subsequent Takotsubo syndrome. Eur Heart J 2021; 42:1898-1908. [PMID: 33768230 PMCID: PMC8121551 DOI: 10.1093/eurheartj/ehab029] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 01/15/2021] [Accepted: 01/25/2021] [Indexed: 12/11/2022] Open
Abstract
AIMS Activity in the amygdala, a brain centre involved in the perception of and response to stressors, associates with: (i) heightened sympathetic nervous system and inflammatory output and (ii) risk of cardiovascular disease. We hypothesized that the amygdalar activity (AmygA) ratio is heightened among individuals who develop Takotsubo syndrome (TTS), a heart failure syndrome often triggered by acute stress. We tested the hypotheses that (i) heightened AmygA precedes development of TTS and (ii) those with the highest AmygA develop the syndrome earliest. METHODS AND RESULTS Individuals (N=104, median age 67.5 years, 72% female, 86% with malignancy) who underwent clinical 18 F-FDG-PET/CT imaging were retrospectively identified: 41 who subsequently developed TTS and 63 matched controls (median follow-up 2.5 years after imaging). AmygA was measured using validated methods. Individuals with (vs. without) subsequent TTS had higher baseline AmygA (P=0.038) after adjusting for TTS risk factors. Further, AmygA associated with the risk for subsequent TTS after adjustment for risk factors [standardized hazard ratio (95% confidence interval): 1.643 (1.189, 2.270), P=0.003]. Among the subset of individuals who developed TTS, those with the highest AmygA (>mean + 1 SD) developed TTS ∼2 years earlier after imaging vs. those with lower AmygA (P=0.028). CONCLUSION Higher AmygA associates with an increased risk for TTS among a retrospective population with a high rate of malignancy. This heightened neurobiological activity is present years before the onset of TTS and may impact the timing of the syndrome. Accordingly, heightened stress-associated neural activity may represent a therapeutic target to reduce stress-related diseases, including TTS.
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Affiliation(s)
- Azar Radfar
- Cardiology Division, Massachusetts General Hospital and Harvard Medical School, MA, USA
- Cardiovascular Imaging Research Center, Boston, MA, USA
| | - Shady Abohashem
- Cardiology Division, Massachusetts General Hospital and Harvard Medical School, MA, USA
- Cardiovascular Imaging Research Center, Boston, MA, USA
| | - Michael T Osborne
- Cardiology Division, Massachusetts General Hospital and Harvard Medical School, MA, USA
- Cardiovascular Imaging Research Center, Boston, MA, USA
| | - Ying Wang
- Cardiovascular Imaging Research Center, Boston, MA, USA
- Department of Nuclear Medicine, First Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Tawseef Dar
- Cardiology Division, Massachusetts General Hospital and Harvard Medical School, MA, USA
- Cardiovascular Imaging Research Center, Boston, MA, USA
| | | | - Ahmed Ghoneem
- Cardiovascular Imaging Research Center, Boston, MA, USA
| | - Nicki Naddaf
- Cardiovascular Imaging Research Center, Boston, MA, USA
| | - Tomas Patrich
- Cardiovascular Imaging Research Center, Boston, MA, USA
| | - Taimur Abbasi
- Cardiology Division, Massachusetts General Hospital and Harvard Medical School, MA, USA
- Cardiovascular Imaging Research Center, Boston, MA, USA
| | | | - James Jaffer
- Cardiovascular Imaging Research Center, Boston, MA, USA
| | | | - James A Scott
- Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Lisa M Shin
- Department of Psychology, Tufts University, Medford, MA, USA
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Roger K Pitman
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Tomas G Neilan
- Cardiology Division, Massachusetts General Hospital and Harvard Medical School, MA, USA
- Cardiovascular Imaging Research Center, Boston, MA, USA
| | - Malissa J Wood
- Cardiology Division, Massachusetts General Hospital and Harvard Medical School, MA, USA
| | - Ahmed Tawakol
- Cardiology Division, Massachusetts General Hospital and Harvard Medical School, MA, USA
- Cardiovascular Imaging Research Center, Boston, MA, USA
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31
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Lau ES, Hayes SN, Volgman AS, Lindley K, Pepine CJ, Wood MJ. Does Patient-Physician Gender Concordance Influence Patient Perceptions or Outcomes? J Am Coll Cardiol 2021; 77:1135-1138. [PMID: 33632488 DOI: 10.1016/j.jacc.2020.12.031] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 12/08/2020] [Indexed: 11/26/2022]
Affiliation(s)
- Emily S Lau
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Sharonne N Hayes
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Annabelle Santos Volgman
- Division of Cardiology, Department of Medicine, Rush University Medical Center, Chicago, Illinois, USA
| | - Kathryn Lindley
- Cardiovascular Division, Department of Internal Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Carl J Pepine
- Division of Cardiovascular Medicine, Department of Medicine, University of Florida, Gainesville, Florida, USA
| | - Malissa J Wood
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.
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32
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DeFilippis EM, Sinnenberg L, Mahmud N, Wood MJ, Hayes SN, Michos ED, Reza N. Gender Differences in Publication Authorship During COVID-19: A Bibliometric Analysis of High-Impact Cardiology Journals. J Am Heart Assoc 2021; 10:e019005. [PMID: 33619980 PMCID: PMC8174290 DOI: 10.1161/jaha.120.019005] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [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 purpose of this study was to examine gender differences in authorship of manuscripts in select high-impact cardiology journals during the early coronavirus disease 2019 (COVID-19) pandemic. Methods and Results All manuscripts published between March 1, 2019 to June 1, 2019 and March 1, 2020 to June 1, 2020 in 4 high-impact cardiology journals (Journal of the American College of Cardiology, Circulation, JAMA Cardiology, and European Heart Journal) were identified using bibliometric data. Authors' genders were determined by matching first name with predicted gender using a validated multinational database (Genderize.io) and manual adjudication. Proportions of women and men first, co-first, senior, and co-senior authors, manuscript types, and whether the manuscript was COVID-19 related were recorded. In 2019, women were first authors of 176 (22.3%) manuscripts and senior authors of 99 (15.0%) manuscripts. In 2020, women first authored 230 (27.4%) manuscripts and senior authored 138 (19.3%) manuscripts. Proportions of woman first and senior authors were significantly higher in 2020 compared with 2019. Women were more likely to be first authors if the manuscript's senior author was a woman (33.8% for woman first/woman senior versus 23.4% for woman first/man senior; P<0.001). Women were less likely to be first authors of COVID-19-related original research manuscripts (P=0.04). Conclusions Representation of women as key authors of manuscripts published in major cardiovascular journals increased during the early COVID-19 pandemic compared with similar months in 2019. However, women were significantly less likely to be first authors of COVID-19-related original research manuscripts. Future investigation into the gender-disparate impacts of COVID-19 on academic careers is critical.
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Affiliation(s)
| | - Lauren Sinnenberg
- Department of Medicine Brigham and Women's HospitalHarvard Medical School Boston MA
| | - Nadim Mahmud
- Division of Gastroenterology Department of Medicine Perelman School of Medicine at the University of Pennsylvania Philadelphia PA
| | - Malissa J Wood
- Division of Cardiology Massachusetts General Hospital Boston MA
| | | | - Erin D Michos
- Ciccarone Center for the Prevention of Cardiovascular Disease Johns Hopkins School of Medicine Baltimore MD
| | - Nosheen Reza
- Division of Cardiovascular Medicine Department of Medicine Perelman School of Medicine at the University of Pennsylvania Philadelphia PA
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33
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Gupta S, Meyersohn NM, Wood MJ, Steigner ML, Blankstein R, Ghoshhajra BB, Hedgire SS. Role of Coronary CT Angiography in Spontaneous Coronary Artery Dissection. Radiol Cardiothorac Imaging 2020; 2:e200364. [PMID: 33778640 PMCID: PMC7978024 DOI: 10.1148/ryct.2020200364] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 08/30/2020] [Accepted: 09/25/2020] [Indexed: 05/04/2023]
Abstract
Spontaneous coronary artery dissection (SCAD) is more common than previously thought and is present in up to 4% of patients presenting with acute coronary syndrome. SCAD predominantly occurs in relatively young women and is an important cause of myocardial infarction in young patients without traditional risk factors of atherosclerotic coronary artery disease. There have been substantial improvements in spatial and temporal resolution and reduction in ionizing radiation dose with new generation scanners. The risk of dissection propagation with an invasive coronary angiogram, improved CT scanner parameters, and predominantly conservative management of SCAD make coronary CT angiography a useful noninvasive imaging modality for the assessment of SCAD. © RSNA, 2020.
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34
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Honigberg MC, Pirruccello JP, Aragam K, Sarma AA, Scott NS, Wood MJ, Natarajan P. Menopausal age and left ventricular remodeling by cardiac magnetic resonance imaging among 14,550 women. Am Heart J 2020; 229:138-143. [PMID: 32827459 DOI: 10.1016/j.ahj.2020.08.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 08/06/2020] [Indexed: 11/25/2022]
Abstract
The present study included 14,550 postmenopausal female participants in the UK Biobank who completed cardiac magnetic resonance imaging. Earlier age at menopause was significantly and independently associated with smaller left ventricular end-diastolic volume and smaller stroke volume, a pattern suggesting acceleration of previously described age-related left ventricular remodeling. These findings may have implications for understanding mechanisms of heart failure, specifically heart failure with preserved ejection fraction, among women with early menopause.
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35
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van den Hoogen IJ, Gianni U, Wood MJ, Taqueti VR, Lin FY, Hayes SN, Feuchtner GM, van Rosendael AR, Wenger NK, Wei J, Bairey Merz CN, Pepine CJ, Shaw LJ. The Clinical Spectrum of Myocardial Infarction and Ischemia With Nonobstructive Coronary Arteries in Women. JACC Cardiovasc Imaging 2020; 14:1053-1062. [PMID: 33011128 DOI: 10.1016/j.jcmg.2020.06.044] [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: 11/26/2019] [Revised: 05/18/2020] [Accepted: 06/15/2020] [Indexed: 11/28/2022]
Abstract
Women exhibit less burden of anatomic obstructive coronary atherosclerotic disease as compared with men of the same age, but contradictorily show similar or higher cardiovascular mortality rates. The higher prevalence of nonexertional cardiac symptoms and nonobstructive coronary atherosclerotic disease in women may lead to lack of recognition and appropriate management, resulting in undertesting and undertreatment. Leaders in women's health from the American College of Cardiology's Cardiovascular Disease in Women Committee present novel imaging cases that may provoke thought regarding the broad clinical spectrum of myocardial infarction and ischemia with nonobstructive coronary arteries in women. These unique imaging approaches are based on the concept of targeting sex-specific differences in acute and stable ischemic heart disease.
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Affiliation(s)
- Inge J van den Hoogen
- Dalio Institute of Cardiovascular Imaging, Department of Radiology, NewYork-Presbyterian Hospital and Weill Cornell Medical College, New York, New York, USA; Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands, USA
| | - Umberto Gianni
- Dalio Institute of Cardiovascular Imaging, Department of Radiology, NewYork-Presbyterian Hospital and Weill Cornell Medical College, New York, New York, USA
| | - Malissa J Wood
- Cardiovascular Research Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Viviany R Taqueti
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA; Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Fay Y Lin
- Dalio Institute of Cardiovascular Imaging, Department of Radiology, NewYork-Presbyterian Hospital and Weill Cornell Medical College, New York, New York, USA
| | | | - Gudrun M Feuchtner
- Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Alexander R van Rosendael
- Dalio Institute of Cardiovascular Imaging, Department of Radiology, NewYork-Presbyterian Hospital and Weill Cornell Medical College, New York, New York, USA; Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands, USA
| | - Nanette K Wenger
- Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Janet Wei
- Barbara Streisand Women's Heart Center, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - C Noel Bairey Merz
- Barbara Streisand Women's Heart Center, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Carl J Pepine
- Division of Cardiovascular Medicine, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Leslee J Shaw
- Dalio Institute of Cardiovascular Imaging, Department of Radiology, NewYork-Presbyterian Hospital and Weill Cornell Medical College, New York, New York, USA.
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36
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Gibson LE, Klinker MR, Wood MJ. Variants of Takotsubo syndrome in the perioperative period: A review of potential mechanisms and anaesthetic implications. Anaesth Crit Care Pain Med 2020; 39:647-654. [PMID: 32920217 DOI: 10.1016/j.accpm.2020.01.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 10/31/2019] [Revised: 01/29/2020] [Accepted: 01/29/2020] [Indexed: 01/27/2023]
Abstract
Takotsubo syndrome (TS) is a condition of transient cardiac dysfunction that develops in the setting of abrupt sympathetic stimulation. Although classically identified by ballooning of the apical segment, TS can also present in atypical forms with abnormalities of the basal, mid-ventricular, or other focal segments. In the perioperative setting, anaesthetic effects and physiologic perturbations from surgery can further confound the diagnosis. We present a narrative review of the most recent evidence for underlying pathophysiologic mechanisms of the variable ballooning patterns and highlight important anaesthetic considerations in the diagnosis and management of these patients.
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Affiliation(s)
- Lauren E Gibson
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA, United States.
| | - Mark R Klinker
- Concord Hospital Cardiac Associates, Concord, NH, United States
| | - Malissa J Wood
- Division of Cardiology, Massachusetts General Hospital, Boston, MA, United States
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Honigberg MC, Riise HKR, Daltveit AK, Tell GS, Sulo G, Igland J, Klungsøyr K, Scott NS, Wood MJ, Natarajan P, Rich-Edwards JW. Heart Failure in Women With Hypertensive Disorders of Pregnancy: Insights From the Cardiovascular Disease in Norway Project. Hypertension 2020; 76:1506-1513. [PMID: 32829667 DOI: 10.1161/hypertensionaha.120.15654] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Hypertensive disorders of pregnancy (HDP) have been associated with heart failure (HF). It is unknown whether concurrent pregnancy complications (small-for-gestational-age or preterm delivery) or recurrent HDP modify HDP-associated HF risk. In this cohort study, we included Norwegian women with a first birth between 1980 and 2004. Follow-up occurred through 2009. Cox models examined gestational hypertension and preeclampsia in the first pregnancy as predictors of a composite of HF-related hospitalization or HF-related death, with assessment of effect modification by concurrent small-for-gestational-age or preterm delivery. Additional models were stratified by final parity (1 versus ≥2 births) and tested associations with recurrent HDP. Among 508 422 women, 565 experienced incident HF over a median 11.8 years of follow-up. After multivariable adjustment, gestational hypertension in the first birth was not significantly associated with HF (hazard ratio, 1.41 [95% CI, 0.84-2.35], P=0.19), whereas preeclampsia was associated with a hazard ratio of 2.00 (95% CI, 1.50-2.68, P<0.001). Among women with HDP, risks were not modified by concurrent small-for-gestational-age or preterm delivery (Pinteraction=0.42). Largest hazards of HF were observed in women whose only lifetime birth was complicated by preeclampsia and women with recurrent preeclampsia. HF risks were similar after excluding women with coronary artery disease. In summary, women with preeclampsia, especially those with one lifetime birth and those with recurrent preeclampsia, experienced increased HF risk compared to women without HDP. Further research is needed to clarify causal mechanisms.
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Affiliation(s)
- Michael C Honigberg
- From the Cardiology Division (M.C.H., N.S.S., M.J.W., P.N.), Massachusetts General Hospital, Harvard Medical School, Boston.,Department of Medicine (M.C.H., N.S.S., M.J.W., P.N.), Massachusetts General Hospital, Harvard Medical School, Boston.,Corrigan Women's Heart Health Program, Cardiology Division (M.C.H., N.S.S., M.J.W.), Massachusetts General Hospital, Harvard Medical School, Boston.,Program in Medical and Population Genetics, Broad Institute of Harvard and MIT, Cambridge, MA (M.C.H., P.N.).,Cardiovascular Research Center and Center for Genomic Medicine, Massachusetts General Hospital, Boston (M.C.H., P.N.)
| | | | - Anne Kjersti Daltveit
- Division of Mental and Physical Health, Norwegian Institute of Public Health, Bergen (A.K.D., G.S.T., G.S., J.I., K.K.)
| | - Grethe S Tell
- Division of Mental and Physical Health, Norwegian Institute of Public Health, Bergen (A.K.D., G.S.T., G.S., J.I., K.K.).,Department of Global Public Health and Primary Care, Bergen, Norway (G.S.T., K.K.)
| | - Gerhard Sulo
- Division of Mental and Physical Health, Norwegian Institute of Public Health, Bergen (A.K.D., G.S.T., G.S., J.I., K.K.)
| | - Jannicke Igland
- Division of Mental and Physical Health, Norwegian Institute of Public Health, Bergen (A.K.D., G.S.T., G.S., J.I., K.K.)
| | - Kari Klungsøyr
- Division of Mental and Physical Health, Norwegian Institute of Public Health, Bergen (A.K.D., G.S.T., G.S., J.I., K.K.).,Department of Global Public Health and Primary Care, Bergen, Norway (G.S.T., K.K.)
| | - Nandita S Scott
- From the Cardiology Division (M.C.H., N.S.S., M.J.W., P.N.), Massachusetts General Hospital, Harvard Medical School, Boston.,Department of Medicine (M.C.H., N.S.S., M.J.W., P.N.), Massachusetts General Hospital, Harvard Medical School, Boston.,Corrigan Women's Heart Health Program, Cardiology Division (M.C.H., N.S.S., M.J.W.), Massachusetts General Hospital, Harvard Medical School, Boston
| | - Malissa J Wood
- From the Cardiology Division (M.C.H., N.S.S., M.J.W., P.N.), Massachusetts General Hospital, Harvard Medical School, Boston.,Department of Medicine (M.C.H., N.S.S., M.J.W., P.N.), Massachusetts General Hospital, Harvard Medical School, Boston.,Corrigan Women's Heart Health Program, Cardiology Division (M.C.H., N.S.S., M.J.W.), Massachusetts General Hospital, Harvard Medical School, Boston
| | - Pradeep Natarajan
- From the Cardiology Division (M.C.H., N.S.S., M.J.W., P.N.), Massachusetts General Hospital, Harvard Medical School, Boston.,Program in Medical and Population Genetics, Broad Institute of Harvard and MIT, Cambridge, MA (M.C.H., P.N.).,Cardiovascular Research Center and Center for Genomic Medicine, Massachusetts General Hospital, Boston (M.C.H., P.N.)
| | - Janet W Rich-Edwards
- Division of Women's Health, Department of Medicine, Brigham and Women's Hospital, Boston (J.W.R.-E.).,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA (J.W.R.-E.)
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Honigberg MC, Chaffin M, Aragam K, Bhatt DL, Wood MJ, Sarma AA, Scott NS, Peloso GM, Natarajan P. Genetic Variation in Cardiometabolic Traits and Medication Targets and the Risk of Hypertensive Disorders of Pregnancy. Circulation 2020; 142:711-713. [PMID: 32804569 DOI: 10.1161/circulationaha.120.047936] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Michael C Honigberg
- Cardiology Division (M.C.H., K.A., M.J.W., A.A.S., N.S.S., P.N.), Massachusetts General Hospital, Harvard Medical School, Boston
- Department of Medicine (M.C.H., K.A., M.J.W., A.A.S., N.S.S., P.N.), Massachusetts General Hospital, Harvard Medical School, Boston
- Program in Medical and Population Genetics, Broad Institute of Harvard and MIT, Cambridge, MA (M.C.H., M.C., K.A., P.N.)
- Cardiovascular Research Center and Center for Genomic Medicine (M.C.H., K.A., P.N.), Massachusetts General Hospital, Boston
| | - Mark Chaffin
- Program in Medical and Population Genetics, Broad Institute of Harvard and MIT, Cambridge, MA (M.C.H., M.C., K.A., P.N.)
| | - Krishna Aragam
- Cardiology Division (M.C.H., K.A., M.J.W., A.A.S., N.S.S., P.N.), Massachusetts General Hospital, Harvard Medical School, Boston
- Department of Medicine (M.C.H., K.A., M.J.W., A.A.S., N.S.S., P.N.), Massachusetts General Hospital, Harvard Medical School, Boston
| | - Deepak L Bhatt
- Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, MA (D.L.B.)
| | - Malissa J Wood
- Cardiology Division (M.C.H., K.A., M.J.W., A.A.S., N.S.S., P.N.), Massachusetts General Hospital, Harvard Medical School, Boston
- Department of Medicine (M.C.H., K.A., M.J.W., A.A.S., N.S.S., P.N.), Massachusetts General Hospital, Harvard Medical School, Boston
- Corrigan Women's Heart Health Program (M.C.H., M.J.W., A.A.S., N.S.S.), Massachusetts General Hospital, Boston
| | - Amy A Sarma
- Cardiology Division (M.C.H., K.A., M.J.W., A.A.S., N.S.S., P.N.), Massachusetts General Hospital, Harvard Medical School, Boston
- Department of Medicine (M.C.H., K.A., M.J.W., A.A.S., N.S.S., P.N.), Massachusetts General Hospital, Harvard Medical School, Boston
- Corrigan Women's Heart Health Program (M.C.H., M.J.W., A.A.S., N.S.S.), Massachusetts General Hospital, Boston
| | - Nandita S Scott
- Cardiology Division (M.C.H., K.A., M.J.W., A.A.S., N.S.S., P.N.), Massachusetts General Hospital, Harvard Medical School, Boston
- Department of Medicine (M.C.H., K.A., M.J.W., A.A.S., N.S.S., P.N.), Massachusetts General Hospital, Harvard Medical School, Boston
- Corrigan Women's Heart Health Program (M.C.H., M.J.W., A.A.S., N.S.S.), Massachusetts General Hospital, Boston
| | - Gina M Peloso
- Department of Biostatistics, Boston University School of Public Health, MA (G.M.P.)
| | - Pradeep Natarajan
- Cardiology Division (M.C.H., K.A., M.J.W., A.A.S., N.S.S., P.N.), Massachusetts General Hospital, Harvard Medical School, Boston
- Department of Medicine (M.C.H., K.A., M.J.W., A.A.S., N.S.S., P.N.), Massachusetts General Hospital, Harvard Medical School, Boston
- Cardiovascular Research Center and Center for Genomic Medicine (M.C.H., K.A., P.N.), Massachusetts General Hospital, Boston
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Elkaryoni A, Kennedy KF, Grodzinsky A, Naderi S, Wood MJ, Kim ESS, Stevens T, Arnold SV. Abstract 105: Rehospitalization After Admission With Myocardial Infarction and Spontaneous Coronary Artery Dissection. Circ Cardiovasc Qual Outcomes 2020. [DOI: 10.1161/hcq.13.suppl_1.105] [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: 11/16/2022]
Abstract
Introduction:
Spontaneous coronary artery dissection (SCAD) is one of the most common non-atherosclerotic causes of myocardial infarction (MI) in young patients, yet little is known about post-discharge outcomes. Given the high psychological stress of a SCAD diagnosis, we sought to understand the rehospitalization burden after SCAD so as to provide more prognostic data to SCAD patients.
Methods:
Using data from the Nationwide Readmission Database 2010-16, we identified patients 18-55 years of age hospitalized with MI with and without SCAD. We compared readmission over 1 year after index hospitalization for all-cause, MI, chest pain without MI, and heart failure. Cox proportional regression was used to examine factors associated with readmission, and we explored interactions of patient factors*SCAD to identify factors associated with differential risk of readmission in patients with SCAD.
Results:
Among 327,227 young patients admitted with an MI, 3704 (1.1%) had a diagnosis of SCAD. Patients with SCAD were more likely to be younger, women, have a higher burden of anxiety or depression, and longer length of stay compared with those without SCAD. While the risk of all-cause rehospitalization over 1 year was similar in those with versus without SCAD (KM-estimated rates: 22.3% vs. 24.1%; log-rank p=0.596, Figure), patients with SCAD were more likely to be rehospitalized for MI (4.9% vs. 4.2%, log-rank p=0.012) and chest pain without MI (3.6% vs. 2.8%, log-rank p=0.060) but less likely to be rehospitalized for heart failure (1.0 % vs. 1.8%, log-rank p=0.005). In the multivariable model, a diagnosis of SCAD was not associated with risk of rehospitalization (HR 1.00, 95% CI 0.92-1.08) nor was a diagnosis of SCAD associated with a differential effect of any of the patient factors on the risk of rehospitalization (all interaction p-values >0.05).
Conclusion:
Although patients with SCAD had a similar risk of rehospitalization compared with young patients with MI but without SCAD, we identified different patterns of hospitalization, which may be explained by the different underlying conditions. Further studies are needed to investigate possible interventions to reduce the high burden of post-SCAD rehospitalizations.
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Affiliation(s)
| | | | | | | | | | | | - Tracy Stevens
- Saint Luke's Mid-America Heart Institute, Kansas City, MO
| | - Suzanne V Arnold
- Saint Luke's Mid-America Heart Institute and UMKC, Kansas City, MO
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Raber I, McCarthy CP, Al Rifai M, Vaduganathan M, Michos ED, Wood MJ, Smyth YM, Ibrahim NE, DeFaria Yeh D, Asnani A, Mehran R, McEvoy JW. Gender differences in industry payments among cardiologists. Am Heart J 2020; 223:123-131. [PMID: 31926591 DOI: 10.1016/j.ahj.2019.11.021] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [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: 08/18/2019] [Accepted: 11/10/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND There is a wage gap among men and women practicing cardiology. Differences in industry funding can be both a consequence of and a contributor to gender differences in salaries. We sought to determine whether gender differences exist in the distribution, types, and amounts of industry payments among men and women in cardiology. METHODS In this cross-sectional analysis, we used the Centers for Medicare & Medicaid Services Open Payment program database to obtain 2016 industry payment data for US cardiologists. We also used UK Disclosure data to obtain 2016 industry payments to UK cardiologists. Outcomes included the proportions of male and female cardiologists receiving industry funding and the mean industry payment amounts received by male and female cardiologists. Where possible, we also assessed 2014 and 2015 data in both locations. RESULTS Of the 22,848 practicing Centers for Medicare & Medicaid Services US cardiologists in 2016, 20,037 (88%) were men and 2,811 (12%) were women. Proportionally more men than women received industry payments in 2016 (78.0% vs 68.5%, respectively; P < .001). Men received higher overall mean industry payments than women ($6,193.25 vs. $2,501.55, P < .001). Results were similar in 2014 and 2015. Among UK cardiologists, more men (24.4%) than women (13.5%) received industry payments in 2016 (P < .001). However, although the difference in overall industry payments was numerically larger among men compared to women, this did not achieve statistical significance (£2,348.31 vs £1,501.37, respectively, P = .35). CONCLUSIONS Industry payments to cardiologists are common, and there are gender differences in these payments on both sides of the Atlantic.
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Affiliation(s)
- Inbar Raber
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.
| | - Cian P McCarthy
- Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Mahmoud Al Rifai
- Department of Cardiology, Baylor College of Medicine, Houston, TX
| | - Muthiah Vaduganathan
- Brigham and Women's Hospital Heart and Vascular Center, Harvard Medical School, Boston, MA
| | - Erin D Michos
- Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, MD
| | - Malissa J Wood
- Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Yvonne M Smyth
- Division of Cardiology, Department of Medicine, Saolta University Healthcare Group, University College Hospital Galway, National University of Ireland, Galway, Ireland
| | - Nasrien E Ibrahim
- Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Doreen DeFaria Yeh
- Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Aarti Asnani
- Cardiovascular Institute, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Roxana Mehran
- Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - John W McEvoy
- Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, MD; Division of Cardiology, Department of Medicine, Saolta University Healthcare Group, University College Hospital Galway, National University of Ireland, Galway, Ireland; National Institute for Prevention and Cardiovascular Health, National University of Ireland, Galway, Ireland
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Wei J, Wood MJ, Dubreuil M, Tomasson G, LaRochelle MR, Zeng C, Lu N, Lin J, Choi HK, Lei G, Zhang Y. Association of tramadol with risk of myocardial infarction among patients with osteoarthritis. Osteoarthritis Cartilage 2020; 28:137-145. [PMID: 31629022 PMCID: PMC7047659 DOI: 10.1016/j.joca.2019.10.001] [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] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 09/26/2019] [Accepted: 10/02/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Tramadol has been widely used among patients with osteoarthritis (OA); however, there is paucity of information on its cardiovascular risk. We aimed to examine the association of tramadol with risk of myocardial infarction (MI) among patients with OA. DESIGN Among OA patients aged 50-90 years without history of MI, cancer, or opioid use disorder in The Health Improvement Network database in the United Kingdom (2000-2016), three sequential propensity-score matched cohort studies were assembled, i.e., (1) patients who initiated tramadol or naproxen (negative comparator); (2) patients who initiated tramadol or diclofenac (positive comparator); and (3) patients who initiated tramadol or codeine (a commonly used weak opioid). The outcome was incident MI over six-months. RESULTS Among tramadol and naproxen initiators (n = 33,024 in each cohort), 77 (4.8/1000 person-years) and 46 (2.8/1000 person-years) incident MI occurred, respectively. The rate difference (RD) and hazard ratios (HR) for incident MI with tramadol initiation were 1.9 (95% confidence interval [CI] 0.6 to 2.3)/1000 person-years and 1.68 (95% CI 1.16 to 2.41) relative to naproxen initiation, respectively. Among tramadol and diclofenac initiators (n = 18,662 in each cohort), 58 (6.4/1000 person-years) and 47 (5.1/1000 person-years) incident MIs occurred, respectively. The corresponding RD and HR for incident MI were 1.2 (95%CI -2.1 to 14.1)/1000 person-years and 1.24 (95%CI 0.84 to 1.82), respectively. Among tramadol and codeine initiators (n = 42,722 in each cohort), 127 (6.1/1000 person-years) and 103 (5.0/1000 person-years) incident MI occurred, respectively, and the corresponding RD and HR were 1.1 (95%CI:-0.3 to 2.5)/1000 person-years and 1.23 (95%CI:0.95 to 1.60), respectively. CONCLUSIONS In this population-based cohort of patients with OA, the six-month risk of MI among initiators of tramadol was higher than that of naproxen, but comparable to, if not lower than, those of diclofenac or codeine.
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Affiliation(s)
- Jie Wei
- Health Management Center, Xiangya Hospital, Central South University, Changsha, Hunan, China,Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA,The Mongan Institute, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Malissa J Wood
- Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Maureen Dubreuil
- Boston University School of Medicine, Boston, Massachusetts, USA,VA Boston Healthcare System, Boston, Massachusetts, USA
| | - Gunnar Tomasson
- Department of Public Health Sciences, University of Iceland, Stapi Hringbraut, 101 Reykjavik, Iceland
| | - Marc R. LaRochelle
- Clinical Addiction Research and Education Unit at Boston University School of Medicine and Boston Medical Center, Boston, Massachusetts, USA
| | - Chao Zeng
- Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA,The Mongan Institute, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA,Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Na Lu
- Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA,Arthritis Research Canada, Richmond, British Columbia, Canada
| | - Jianhao Lin
- Department of Orthopaedic Surgery, Peking University People’s Hospital, Beijing, China
| | - Hyon K. Choi
- Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA,The Mongan Institute, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Guanghua Lei
- Department of Orthopaedic Surgery, Peking University People’s Hospital, Beijing, China,National Clinical Research Center of Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China,Correspondence to: Guanghua Lei, Department of Orthopaedics, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan, China, 410008, ; Yuqing Zhang, Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, Massachusetts, USA, 02114,
| | - Yuqing Zhang
- Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA,The Mongan Institute, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA,Correspondence to: Guanghua Lei, Department of Orthopaedics, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan, China, 410008, ; Yuqing Zhang, Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, Massachusetts, USA, 02114,
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Aggarwal NR, Patel HN, Mehta LS, Sanghani RM, Lundberg GP, Lewis SJ, Mendelson MA, Wood MJ, Volgman AS, Mieres JH. Sex Differences in Ischemic Heart Disease: Advances, Obstacles, and Next Steps. Circ Cardiovasc Qual Outcomes 2019; 11:e004437. [PMID: 29449443 DOI: 10.1161/circoutcomes.117.004437] [Citation(s) in RCA: 164] [Impact Index Per Article: 32.8] [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] [Indexed: 02/07/2023]
Abstract
Evolving knowledge of sex-specific presentations, improved recognition of conventional and novel risk factors, and expanded understanding of the sex-specific pathophysiology of ischemic heart disease have resulted in improved clinical outcomes in women. Yet, ischemic heart disease continues to be the leading cause of morbidity and mortality in women in the United States. The important publication by the Institute of Medicine titled "Women's Health Research-Progress, Pitfalls, and Promise," highlights the persistent disparities in cardiovascular disease burden among subgroups of women, particularly women who are socially disadvantaged because of race, ethnicity, income level, and educational attainment. These important health disparities reflect underrepresentation of women in research, with the resultant unfavorable impact on diagnosis, prevention, and treatment strategies in women at risk for cardiovascular disease. Causes of disparities are multifactorial and related to differences in risk factor prevalence, access to care, use of evidence-based guidelines, and social and environmental factors. Lack of awareness in both the public and medical community, as well as existing knowledge gap regarding sex-specific differences in presentation, risk factors, pathophysiology, and response to treatment for ischemic heart disease, further contribute to outcome disparities. There is a critical need for implementation of sex- and gender-specific strategies to improve cardiovascular outcomes. This review is tailored to meet the needs of a busy clinician and summarizes the contemporary trends, characterizes current sex-specific outcome disparities, delineates challenges, and proposes transformative solutions for improvement of the full spectrum of ischemic heart disease clinical care and research in women.
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Affiliation(s)
- Niti R Aggarwal
- From Division of Cardiovascular Medicine, Department of Medicine and Radiology, the University of Wisconsin School of Medicine & Public Health, Madison (N.R.A.); Division of Cardiology, Department of Internal Medicine, Rush University Medical Center, Chicago, IL (H.N.P., R.M.S., A.S.V.); Division of Cardiology, Department of Internal Medicine, The Ohio State University, Columbus (L.S.M.); Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA (G.P.L.); Division of Cardiology, The Oregon Clinic, Portland, OR (S.J.L.); Department of Medicine, Division of Cardiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL (M.A.M.); Division of Cardiology, Department of Medicine, Harvard Medical School, Massachusetts General Hospital, Boston, MA (M.J.W.); and Department of Cardiology, Hofstra Northwell School of Medicine, Hempstead, New York (J.H.M.).
| | - Hena N Patel
- From Division of Cardiovascular Medicine, Department of Medicine and Radiology, the University of Wisconsin School of Medicine & Public Health, Madison (N.R.A.); Division of Cardiology, Department of Internal Medicine, Rush University Medical Center, Chicago, IL (H.N.P., R.M.S., A.S.V.); Division of Cardiology, Department of Internal Medicine, The Ohio State University, Columbus (L.S.M.); Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA (G.P.L.); Division of Cardiology, The Oregon Clinic, Portland, OR (S.J.L.); Department of Medicine, Division of Cardiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL (M.A.M.); Division of Cardiology, Department of Medicine, Harvard Medical School, Massachusetts General Hospital, Boston, MA (M.J.W.); and Department of Cardiology, Hofstra Northwell School of Medicine, Hempstead, New York (J.H.M.)
| | - Laxmi S Mehta
- From Division of Cardiovascular Medicine, Department of Medicine and Radiology, the University of Wisconsin School of Medicine & Public Health, Madison (N.R.A.); Division of Cardiology, Department of Internal Medicine, Rush University Medical Center, Chicago, IL (H.N.P., R.M.S., A.S.V.); Division of Cardiology, Department of Internal Medicine, The Ohio State University, Columbus (L.S.M.); Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA (G.P.L.); Division of Cardiology, The Oregon Clinic, Portland, OR (S.J.L.); Department of Medicine, Division of Cardiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL (M.A.M.); Division of Cardiology, Department of Medicine, Harvard Medical School, Massachusetts General Hospital, Boston, MA (M.J.W.); and Department of Cardiology, Hofstra Northwell School of Medicine, Hempstead, New York (J.H.M.)
| | - Rupa M Sanghani
- From Division of Cardiovascular Medicine, Department of Medicine and Radiology, the University of Wisconsin School of Medicine & Public Health, Madison (N.R.A.); Division of Cardiology, Department of Internal Medicine, Rush University Medical Center, Chicago, IL (H.N.P., R.M.S., A.S.V.); Division of Cardiology, Department of Internal Medicine, The Ohio State University, Columbus (L.S.M.); Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA (G.P.L.); Division of Cardiology, The Oregon Clinic, Portland, OR (S.J.L.); Department of Medicine, Division of Cardiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL (M.A.M.); Division of Cardiology, Department of Medicine, Harvard Medical School, Massachusetts General Hospital, Boston, MA (M.J.W.); and Department of Cardiology, Hofstra Northwell School of Medicine, Hempstead, New York (J.H.M.)
| | - Gina P Lundberg
- From Division of Cardiovascular Medicine, Department of Medicine and Radiology, the University of Wisconsin School of Medicine & Public Health, Madison (N.R.A.); Division of Cardiology, Department of Internal Medicine, Rush University Medical Center, Chicago, IL (H.N.P., R.M.S., A.S.V.); Division of Cardiology, Department of Internal Medicine, The Ohio State University, Columbus (L.S.M.); Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA (G.P.L.); Division of Cardiology, The Oregon Clinic, Portland, OR (S.J.L.); Department of Medicine, Division of Cardiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL (M.A.M.); Division of Cardiology, Department of Medicine, Harvard Medical School, Massachusetts General Hospital, Boston, MA (M.J.W.); and Department of Cardiology, Hofstra Northwell School of Medicine, Hempstead, New York (J.H.M.)
| | - Sandra J Lewis
- From Division of Cardiovascular Medicine, Department of Medicine and Radiology, the University of Wisconsin School of Medicine & Public Health, Madison (N.R.A.); Division of Cardiology, Department of Internal Medicine, Rush University Medical Center, Chicago, IL (H.N.P., R.M.S., A.S.V.); Division of Cardiology, Department of Internal Medicine, The Ohio State University, Columbus (L.S.M.); Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA (G.P.L.); Division of Cardiology, The Oregon Clinic, Portland, OR (S.J.L.); Department of Medicine, Division of Cardiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL (M.A.M.); Division of Cardiology, Department of Medicine, Harvard Medical School, Massachusetts General Hospital, Boston, MA (M.J.W.); and Department of Cardiology, Hofstra Northwell School of Medicine, Hempstead, New York (J.H.M.)
| | - Marla A Mendelson
- From Division of Cardiovascular Medicine, Department of Medicine and Radiology, the University of Wisconsin School of Medicine & Public Health, Madison (N.R.A.); Division of Cardiology, Department of Internal Medicine, Rush University Medical Center, Chicago, IL (H.N.P., R.M.S., A.S.V.); Division of Cardiology, Department of Internal Medicine, The Ohio State University, Columbus (L.S.M.); Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA (G.P.L.); Division of Cardiology, The Oregon Clinic, Portland, OR (S.J.L.); Department of Medicine, Division of Cardiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL (M.A.M.); Division of Cardiology, Department of Medicine, Harvard Medical School, Massachusetts General Hospital, Boston, MA (M.J.W.); and Department of Cardiology, Hofstra Northwell School of Medicine, Hempstead, New York (J.H.M.)
| | - Malissa J Wood
- From Division of Cardiovascular Medicine, Department of Medicine and Radiology, the University of Wisconsin School of Medicine & Public Health, Madison (N.R.A.); Division of Cardiology, Department of Internal Medicine, Rush University Medical Center, Chicago, IL (H.N.P., R.M.S., A.S.V.); Division of Cardiology, Department of Internal Medicine, The Ohio State University, Columbus (L.S.M.); Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA (G.P.L.); Division of Cardiology, The Oregon Clinic, Portland, OR (S.J.L.); Department of Medicine, Division of Cardiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL (M.A.M.); Division of Cardiology, Department of Medicine, Harvard Medical School, Massachusetts General Hospital, Boston, MA (M.J.W.); and Department of Cardiology, Hofstra Northwell School of Medicine, Hempstead, New York (J.H.M.)
| | - Annabelle S Volgman
- From Division of Cardiovascular Medicine, Department of Medicine and Radiology, the University of Wisconsin School of Medicine & Public Health, Madison (N.R.A.); Division of Cardiology, Department of Internal Medicine, Rush University Medical Center, Chicago, IL (H.N.P., R.M.S., A.S.V.); Division of Cardiology, Department of Internal Medicine, The Ohio State University, Columbus (L.S.M.); Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA (G.P.L.); Division of Cardiology, The Oregon Clinic, Portland, OR (S.J.L.); Department of Medicine, Division of Cardiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL (M.A.M.); Division of Cardiology, Department of Medicine, Harvard Medical School, Massachusetts General Hospital, Boston, MA (M.J.W.); and Department of Cardiology, Hofstra Northwell School of Medicine, Hempstead, New York (J.H.M.)
| | - Jennifer H Mieres
- From Division of Cardiovascular Medicine, Department of Medicine and Radiology, the University of Wisconsin School of Medicine & Public Health, Madison (N.R.A.); Division of Cardiology, Department of Internal Medicine, Rush University Medical Center, Chicago, IL (H.N.P., R.M.S., A.S.V.); Division of Cardiology, Department of Internal Medicine, The Ohio State University, Columbus (L.S.M.); Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA (G.P.L.); Division of Cardiology, The Oregon Clinic, Portland, OR (S.J.L.); Department of Medicine, Division of Cardiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL (M.A.M.); Division of Cardiology, Department of Medicine, Harvard Medical School, Massachusetts General Hospital, Boston, MA (M.J.W.); and Department of Cardiology, Hofstra Northwell School of Medicine, Hempstead, New York (J.H.M.)
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Kaadan MI, MacDonald C, Ponzini F, Duran J, Newell K, Pitler L, Lin A, Weinberg I, Wood MJ, Lindsay ME. Prospective Cardiovascular Genetics Evaluation in Spontaneous Coronary Artery Dissection. Circ Genom Precis Med 2019; 11:e001933. [PMID: 29650765 DOI: 10.1161/circgenetics.117.001933] [Citation(s) in RCA: 67] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Previous studies describing genetics evaluation in spontaneous coronary artery dissection (SCAD) have been retrospective in nature or presented as single case reports. As part of a dedicated clinical program, we evaluated patients in cardiovascular genetics clinic to determine the role of genetically triggered vascular disease and genetic testing in SCAD. METHODS AND RESULTS Patient data were entered prospectively into the Massachusetts General Hospital SCAD registry database from July 2013 to September 2017. Clinically indicated genetic testing was conducted based on patient imaging, family history, physical examination, and patient preference. Of the 107 patients enrolled in the registry, 73 underwent cardiovascular genetics evaluation at our center (average age, 45.3±9.4 years; 85.3% female), and genetic testing was performed for 44 patients. A family history of aneurysm or dissection was not a prevalent feature in the study population, and only 1 patient had a family history of SCAD. Six patients (8.2%) had identifiable genetically triggered vascular disease: 3 with vascular Ehlers-Danlos syndrome (COL3A1), 1 with Nail-patella syndrome (LMX1B), 1 with autosomal dominant polycystic kidney disease (PKD1), and 1 with Loeys-Dietz syndrome (SMAD3). None of these 6 had radiographic evidence of fibromuscular dysplasia. CONCLUSIONS In this series, 8.2% of the SCAD patients evaluated had a molecularly identifiable disorder associated with vascular disease. The most common diagnosis was vascular Ehlers-Danlos syndrome. Patients with positive gene testing were significantly younger at the time of their first SCAD event. A low threshold for genetic testing should be considered in patients with SCAD.
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Poh KK, Ngiam N, Wood MJ. Left ventricular vortex formation time in elite athletes: novel predictor of myocardial performance. Heart Asia 2019; 11:e011188. [PMID: 31244916 DOI: 10.1136/heartasia-2019-011188] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Revised: 03/21/2019] [Accepted: 03/31/2019] [Indexed: 11/04/2022]
Abstract
Background Efficient transportation of blood through the left ventricle (LV) during diastole depends on vortex formation. Vortex formation time (VFT) can be measured by echocardiography as a dimensionless index. As elite athletes have supranormal diastolic LV function, we aim to assess resting and post-exercise VFT in these athletes and hypothesised that VFT may predict myocardial performance immediately post-exercise. Method Subjects were world class speedskaters training for the Winter Olympic Games. Echocardiographic measurements were obtained before and immediately after 3000 m of racing. VFT was computed as 4×(1-β)/π×α³×left ventricle ejection fraction where β is the fraction of diastolic stroke volume contributed by atrial contraction, α is the biplane end diastolic volume (EDV)1/3 divided by mitral annular diameter during early diastole. Results Baseline VFT was 2.6±0.7 (n=24, age 22±3 years, 67% males). Post-exercise, heart rates increased (64±10 vs 89±12 beats/min, p<0.01); however, VFT was unchanged (2.9±1.0, p>0.05). VFT at rest correlated modestly with post-exertion early diastolic mitral in-flow velocity (E; r=0.59, p=0.01), tissue Doppler-derived early mitral annular velocity (E'; septal and lateral, both r=0.59, p=0.01) and systolic annular velocity (S'; septal: r=0.46, p=0.02 and lateral: r=0.48, p=0.02) but not late diastolic mitral in-flow velocity (A; r=0.06, p>0.05) or annular velocity (A'; septal: r=0.34, p=NS and lateral: r=0.35, p>0.05). Conclusion There was no significant difference between VFT at rest and immediately post-exercise. However, VFT at rest correlated with immediate post-exercise augmented systolic and early diastolic tissue Doppler indicators of myocardial performance in elite athletes.
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Affiliation(s)
- Kian Keong Poh
- Department of Cardiology, National University Heart Centre, National University Health System, Singapore, Singapore
| | - Nicholas Ngiam
- Department of Medicine, National University Health System, Singapore City, Singapore
| | - Malissa J Wood
- Department of Cardiology, Massachusetts General Hospital Heart Center, Boston, Massachusetts, USA
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Abstract
Vortex formation time (VFT) is a continuous measure of the left ventricular (LV) filling that integrates all phases of diastole. This has been previously studied in patients with heart failure. This study examined the differences in VFT between healthy controls and elite athletes. We compared echocardiographic indices between elite male athletes (n = 41) and age-, weight- and sex-matched sedentary volunteers (n = 22). VFT was obtained using the validated formula: 4 × (1 - β)/π × α3 × LVEF, where β is the fraction of total transmitral diastolic stroke volume contributed by atrial contraction (assessed by time velocity integral of the mitral E- and A-waves) and α is the biplane end-diastolic volume (EDV)1/3 divided by mitral annular diameter during early diastole. Diastolic function was measured by the ratio of mitral peak velocity of early filling (E) to early diastolic mitral annular velocity (e') (E/e' ratio) and the ratio of E to mitral peak velocity of late filling (A) (E/A ratio). The heart rate was lower (63 ± 10 vs. 74 ± 6 beats per minute, p < 0.001) and the LV end diastolic diameter was larger in athletes as compared to controls (56 ± 3 vs. 50 ± 4 mm, p < 0.001). The VFT was lower in the sedentary group compared to athletes (3.1 ± 0.4 vs. 4.0 ± 0.8, p < 0.001). Similarly, E/e' was higher in sedentary controls compared to athletes (7.5 ± 1.8 vs 4.2 ± 1.0, p < 0.001). Furthermore, there was a modest correlation between VFT and E/A (r = 0.47, p < 0.001) as well as E/e' (r = - 0.33, p = 0.012). In conclusion, the VFT was elevated among elite athletes compared to healthy sedentary controls.
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Affiliation(s)
- Gerard King
- Eaglelodge Cardiology, O'Connell Avenue, Limerick, Ireland
| | - Nicholas Ngiam
- Department of Medicine, National University Health System, Singapore, Singapore
| | - John Clarke
- Eaglelodge Cardiology, O'Connell Avenue, Limerick, Ireland
| | - Malissa J Wood
- Department of Cardiology, Massachusetts General Hospital, Boston, MA, USA
| | - Kian-Keong Poh
- Department of Cardiology, National University Heart Centre Singapore, National University Health System, Singapore, 1E Kent Ridge Rd, NUHS Tower Block, Level 9, Singapore, 119228, Singapore.
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Affiliation(s)
- Ersilia M DeFilippis
- Division of Cardiology, Columbia University Irving Medical Center, New York, NY 10032, USA.
| | - Emily S Lau
- Division of Cardiology, Massachusetts General Hospital, Boston MA, USA
| | - Janet Wei
- Division of Cardiology, Cedars-Sinai Heart Institute, Los Angeles, CA, USA
| | - Sharonne N Hayes
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Malissa J Wood
- Division of Cardiology, Massachusetts General Hospital, Boston MA, USA
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Abstract
PURPOSE OF REVIEW Cardiovascular disease (CVD) is the leading cause of mortality worldwide, accounting for one third of all deaths in 2015. Alarmingly, there has been slowing of the decline in age-standardized CVD mortality over the last 5 years compared to the previous 25 years. RECENT FINDINGS Given the increasing global CVD burden, in 2011, the United Nations declared the goal to reduce premature mortality from the four main non-communicable diseases by 25% from 2010 to 2025, abbreviated as the 25 × 25 goal. The United Nations has further created nine targets to achieve the 25 × 25 goal. These targets emphasize risk factor modification and strengthening of healthcare delivery systems. Achieving the nine targets and 25 × 25 goal set by the United Nations will undoubtedly benefit the world as a whole. However, women face additional, unacceptable, disproportionate CVD risk factors that need to be addressed, including psychological stressors contributing to ischemic heart disease, pregnancy-related CVD, environmental and infectious exposures in low socioeconomic settings, and limited healthcare access and delivery. This paper highlights global CVD gender disparities in order to stimulate awareness and discussion of potential interventions to address the rapidly growing burden of heart disease in women.
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Affiliation(s)
- Shilpa Sharma
- Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Malissa J Wood
- Division of Cardiology, Massachusetts General Hospital, 55 Fruit Street, Blake 256, Boston, MA, 02114-2696, USA.
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Hayes SN, Kim ESH, Saw J, Adlam D, Arslanian-Engoren C, Economy KE, Ganesh SK, Gulati R, Lindsay ME, Mieres JH, Naderi S, Shah S, Thaler DE, Tweet MS, Wood MJ. Spontaneous Coronary Artery Dissection: Current State of the Science: A Scientific Statement From the American Heart Association. Circulation 2018; 137:e523-e557. [PMID: 29472380 PMCID: PMC5957087 DOI: 10.1161/cir.0000000000000564] [Citation(s) in RCA: 658] [Impact Index Per Article: 109.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Spontaneous coronary artery dissection (SCAD) has emerged as an important cause of acute coronary syndrome, myocardial infarction, and sudden death, particularly among young women and individuals with few conventional atherosclerotic risk factors. Patient-initiated research has spurred increased awareness of SCAD, and improved diagnostic capabilities and findings from large case series have led to changes in approaches to initial and long-term management and increasing evidence that SCAD not only is more common than previously believed but also must be evaluated and treated differently from atherosclerotic myocardial infarction. High rates of recurrent SCAD; its association with female sex, pregnancy, and physical and emotional stress triggers; and concurrent systemic arteriopathies, particularly fibromuscular dysplasia, highlight the differences in clinical characteristics of SCAD compared with atherosclerotic disease. Recent insights into the causes of, clinical course of, treatment options for, outcomes of, and associated conditions of SCAD and the many persistent knowledge gaps are presented.
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Abstract
The recruitment and advancement of women in cardiology is an important priority for the cardiology community. Despite improvements in sex disparities over the last 2 decades, women remain a small minority in cardiology. Recent studies have revealed key obstacles facing female cardiologists including radiation exposure, family responsibilities, unequal financial compensations, and lack of career advancement. To attract and retain more women into the field of cardiology, the cardiology community, including professional society leaders, division chiefs, and program directors, must all work to overcome these barriers.
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Affiliation(s)
- Emily S Lau
- Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Malissa J Wood
- Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts
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