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Maraey A, Chacko P, Moukarbel GV. Thoracic impedance monitoring in heart failure: from theory to practice. Expert Rev Med Devices 2024. [PMID: 38655906 DOI: 10.1080/17434440.2024.2347412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2024] [Accepted: 04/22/2024] [Indexed: 04/26/2024]
Affiliation(s)
- Ahmed Maraey
- Division of Cardiovascular Medicine, University of Toledo Medical Center, Toledo, OH
| | - Paul Chacko
- Division of Cardiovascular Medicine, University of Toledo Medical Center, Toledo, OH
| | - George V Moukarbel
- Division of Cardiovascular Medicine, University of Toledo Medical Center, Toledo, OH
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Restrepo-Córdoba MA, Chmielewski P, Truszkowska G, Peña-Peña ML, Kubánek M, Krebsová A, Lopes LR, García-Ropero Á, Merlo M, Paldino A, Peters S, Jurcut R, Barriales-Villa R, Zorio E, Hazebroek M, Mogensen J, García-Pavía P. Pregnancy in women with dilated cardiomyopathy genetic variants. Rev Esp Cardiol (Engl Ed) 2024:S1885-5857(24)00128-2. [PMID: 38641168 DOI: 10.1016/j.rec.2024.04.002] [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] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 04/02/2024] [Indexed: 04/21/2024]
Abstract
INTRODUCTION AND OBJECTIVES Limited information is available on the safety of pregnancy in patients with genetic dilated cardiomyopathy (DCM) and in carriers of DCM-causing genetic variants without the DCM phenotype. We assessed cardiac, obstetric, and fetal or neonatal outcomes in this group of patients. METHODS We studied 48 women carrying pathogenic or likely pathogenic DCM-associated variants (30 with DCM and 18 without DCM) who had 83 pregnancies. Adverse cardiac events were defined as heart failure (HF), sustained ventricular tachycardia, ventricular assist device implantation, heart transplant, and/or maternal cardiac death during pregnancy, or labor and delivery, and up to the sixth postpartum month. RESULTS A total of 15 patients, all with DCM (31% of the total cohort and 50% of women with DCM) experienced adverse cardiac events. Obstetric and fetal or neonatal complications were observed in 14% of pregnancies (10 in DCM patients and 2 in genetic carriers). We analyzed the 30 women who had been evaluated before their first pregnancy (12 with overt DCM and 18 without the phenotype). Five of the 12 (42%) women with DCM had adverse cardiac events despite showing NYHA class I or II before pregnancy. Most of these women had a history of cardiac events before pregnancy (80%). Among the 18 women without phenotype, 3 (17%) developed DCM toward the end of pregnancy. CONCLUSIONS Cardiac complications during pregnancy and postpartum were common in patients with genetic DCM and were primarily related to HF. Despite apparently good tolerance of pregnancy in unaffected genetic carriers, pregnancy may act as a trigger for DCM onset in a subset of these women.
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Affiliation(s)
- María Alejandra Restrepo-Córdoba
- Servicio de Cardiología, Hospital Universitario Puerta de Hierro, IDIPHISA, Madrid, España; Servicio de Cardiología, Instituto Cardiovascular, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Hospital Clínico San Carlos, Madrid, España
| | - Przemyslaw Chmielewski
- Unit for Screening Studies in Inherited Cardiovascular Diseases National Institute of Cardiology, Varsovia, Polonia
| | - Grażyna Truszkowska
- Department of Medical Biology, National Institute of Cardiology, Varsovia, Polonia
| | - María Luisa Peña-Peña
- Unidad de Imagen y Cardiopatías Familiares, Servicio de Cardiología, Hospital Universitario Virgen del Rocío, Sevilla, España
| | - Miloš Kubánek
- Department of Cardiology, Institute for Clinical and Experimental Medicine, Praga, Republica Checa
| | - Alice Krebsová
- Department of Cardiology, Institute for Clinical and Experimental Medicine, Praga, Republica Checa
| | - Luis R Lopes
- Institute of Cardiovascular Science, University College London, Londres, Reino Unido; St. Bartholomew's Hospital, Barts Heart Centre, Barts NHS Trust, Londres, Reino Unido
| | - Álvaro García-Ropero
- Guy's and St. Thomas' NHS Foundation Trust, Londres, Reino Unido; Lewisham and Greenwich NHS Trust, Londres, Reino Unido
| | - Marco Merlo
- Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI) e Università degli Studi di Trieste, Trieste, Italia
| | - Alessia Paldino
- Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI) e Università degli Studi di Trieste, Trieste, Italia
| | - Stacey Peters
- Department of Cardiology, Royal Melbourne Hospital, Victoria, Australia
| | - Ruxandra Jurcut
- Expert Center for Rare Genetic Cardiovascular Diseases, Emergency Institute for Cardiovascular Diseases Prof. Dr. C.C. Iliescu, UMF Carol Davila, Bucarest, Rumanía
| | - Roberto Barriales-Villa
- Unidad de Cardiopatías Familiares, Servicio de Cardiología, Complexo Hospitalario Universitario A Coruña, Instituto de Investigación Biomédica de A Coruña (INIBIC), A Coruña, España; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, España
| | - Esther Zorio
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, España; Unidad de Cardiopatías Familiares, Muerte Súbita y Mecanismos de Enfermedad (CaFaMuSMe), Instituto de Investigación Sanitaria La Fe, Servicio de Cardiología, Hospital La Fe, Valencia, España; Unidad de Cardiopatías Familiares, Servicio de Cardiología, Hospital Universitario y Politécnico La Fe, Valencia, España
| | - Mark Hazebroek
- Department of Cardiology, Maastricht University Medical Center, Maastricht, Países Bajos
| | - Jens Mogensen
- Department of Cardiology, Aalborg University Hospital, Hobrovej r-bb, Dinamarca
| | - Pablo García-Pavía
- Servicio de Cardiología, Hospital Universitario Puerta de Hierro, IDIPHISA, Madrid, España; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, España; Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, España; Universidad Francisco de Vitoria (UFV), Pozuelo de Alarcón, Madrid, España.
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3
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Gündüz E. Noncardiac Surgery in Patients with Left Ventricular Assist Devices: A 11-Year Institutional Experience. Braz J Cardiovasc Surg 2024; 39:e20230258. [PMID: 38630058 PMCID: PMC11021120 DOI: 10.21470/1678-9741-2023-0258] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 08/15/2023] [Indexed: 04/19/2024] Open
Abstract
INTRODUCTION Limited options in the end-stage treatment of heart failure have led to increased use of left ventricular assist devices. For this reason, the rate of non-cardiac surgeries in patients with left ventricular assist devices is also increasing. Our study aims to analyze surgical rate, anesthesia management, and results by reviewing our 11-year experience with patients who underwent non-cardiac surgery receiving left ventricular assist devices support. METHODS We retrospectively evaluated 57 patients who underwent non-cardiac surgery and 67 non-cardiac surgical procedures among 274 patients who applied between January 2011 and December 2022 and underwent left ventricular assist devices implantation with end-stage heart failure. RESULTS Fifty (74.6%) patients with left ventricular assist devices admitted to the hospital for non-cardiac surgery were emergency interventions. The most common reasons for admission were general surgery (52.2%), driveline wound revision (22.3%), and neurological surgery (14.9%). This patient group has the highest in-hospital mortality rate (12.8%) and the highest rate of neurological surgery (8.7%). While 70% of the patients who underwent neurosurgery were taken to surgery urgently, the International Normalized Ratio values of these patients were between 3.5 and 4.5 at the time of admission to the emergency department. CONCLUSION With a perioperative multidisciplinary approach, higher morbidity and mortality risks can be reduced during emergencies and major surgical procedures.
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Affiliation(s)
- Emel Gündüz
- Department of Anesthesiology and Reanimation, Faculty of Medicine,
Akdeniz University, Antalya, Turkey
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4
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Krumerman A, Di Biase L, Gerstenfeld E, Dickfeld T, Verma N, Liberman L, Amara R, Kacorri A, Crosson L, Wilk A, Ferrick KJ. Premature Ventricular Complexes: Assessing Burden Density in a Large National Cohort to Better Define Optimal ECG Monitoring Duration. Heart Rhythm 2024:S1547-5271(24)02393-2. [PMID: 38641221 DOI: 10.1016/j.hrthm.2024.04.066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Revised: 04/11/2024] [Accepted: 04/15/2024] [Indexed: 04/21/2024]
Abstract
BACKGROUND Premature ventricular contractions (PVCs) burden is a risk factor for heart failure and cardiovascular death in patients with structural heart disease. Long-term ECG monitoring can have a significant impact on PVC burden evaluation by further defining PVC distribution patterns. OBJECTIVE This study aimed to ascertain the optimal duration of ECG monitoring to characterize PVC burden and understand clinical characteristics associated with frequent PVCs and NSVT in a large US cohort. METHODS Commercial data (iRhythm's Zio patch) from June 2011 to April 2022 were analyzed. Inclusion criteria were age >18 years, PVC burden ≥5%, and wear period ≥13 days. PVC burden cutoffs were determined based on AHA/ACC/HRS guidelines for very frequent PVCs (10,000-20,000 over 24 hours). Patients were categorized by PVC densities : Low (<10%), Moderate (10% to <20%) and High (≥20%). Mean measured error was assessed at baseline and daily until wear period's end for overall PVC Burden and different PVC densities. RESULTS Analysis of 106,705 patch monitors revealed a study population with mean age of 70.6±14.6 years; 33.6% female. PVC burden was higher in males and those >65 years of age. PVC burden mean error decreased from 2.9% at 24 hours to 1.3% at 7 days, and 0.7% at 10 days. Number of VT episodes per patient increased with increasing PVC burden (p<0.0001). CONCLUSION Extending ambulatory monitoring beyond 24 hours to 7 days or more, improves accuracy of assessing PVC burden. VT frequency and duration vary based on initial PVC density, highlighting the need for prolonged cardiac monitoring.
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Affiliation(s)
| | | | | | - Timm Dickfeld
- University of Maryland Medical Center, Baltimore, MD
| | | | | | - Richard Amara
- University of Maryland Medical Center, Baltimore, MD
| | | | | | - Alan Wilk
- iRhythm Technologies, San Francisco, CA
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5
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Umapathi P, Aggarwal A, Zahra F, Narayanan B, Zachara NE. The Multifaceted Role of Intracellular Glycosylation in Cytoprotection and Heart Disease. J Biol Chem 2024:107296. [PMID: 38641064 DOI: 10.1016/j.jbc.2024.107296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 04/09/2024] [Accepted: 04/11/2024] [Indexed: 04/21/2024] Open
Abstract
The modification of nuclear, cytoplasmic, and mitochondrial proteins by O-linked β-N-acetylglucosamine (O-GlcNAc) is an essential post-translational modification common in metazoans. O-GlcNAc is cycled on and off proteins in response to environmental and physiological stimuli impacting protein function, which, in turn, tunes pathways that include transcription, translation, proteostasis, signal transduction, and metabolism. One class of stimulus that induces rapid and dynamic changes to O-GlcNAc is cellular injury, resulting from environmental stress (for instance, heat shock), hypoxia/reoxygenation injury, ischemia reperfusion injury (heart attack, stroke, trauma hemorrhage), and sepsis. Acute elevation of O-GlcNAc before or after injury reduces apoptosis and necrosis, suggesting that injury-induced changes in O-GlcNAcylation regulate cell fate decisions. However, prolonged elevation or reduction in O-GlcNAc leads to a maladaptive response and is associated with pathologies such as hypertrophy and heart failure. In this review, we discuss the impact of O-GlcNAc in both acute and prolonged models of injury with a focus on the heart and biological mechanisms that underpin cell survival.
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Affiliation(s)
- Priya Umapathi
- Division of Cardiology, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD 21205.
| | - Akanksha Aggarwal
- Department of Biological Chemistry, The Johns Hopkins University School of Medicine, Baltimore, MD 21205
| | - Fiddia Zahra
- Department of Biological Chemistry, The Johns Hopkins University School of Medicine, Baltimore, MD 21205
| | - Bhargavi Narayanan
- Department of Biological Chemistry, The Johns Hopkins University School of Medicine, Baltimore, MD 21205
| | - Natasha E Zachara
- Department of Biological Chemistry, The Johns Hopkins University School of Medicine, Baltimore, MD 21205; Department of Oncology, The Johns Hopkins University School of Medicine, Baltimore, MD 21205.
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Tütüncü S, Olma MC, Kunze C, Dietzel J, Schurig J, Rosenkranz M, Stingele R, Maschke M, Heuschmann PU, Kirchhof P, Laufs U, Nabavi DG, Röther J, Thomalla G, Veltkamp R, Endres M, Haeusler KG. Heart failure, recurrent vascular events and death in patients with ischemic stroke-results of the MonDAFIS study. Intern Emerg Med 2024:10.1007/s11739-024-03594-8. [PMID: 38619714 DOI: 10.1007/s11739-024-03594-8] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 03/20/2024] [Indexed: 04/16/2024]
Abstract
Heart failure (HF) is associated with poor outcome after stroke, but data from large prospective trials are sparse.We assessed the impact of HF on clinical endpoints in patients hospitalized with acute ischemic stroke or transient ischemic attack (TIA) enrolled in the prospective, multicenter Systematic Monitoring for Detection of Atrial Fibrillation in Patients with Acute Ischemic Stroke (MonDAFIS) trial. HF was defined as left ventricular ejection fraction (LVEF) < 55% or a history of HF on admission. The composite of recurrent stroke, major bleeding, myocardial infarction, and all-cause death, and its components during the subsequent 24 months were assessed. We used estimated hazard ratios in confounder-adjusted models. Overall, 410/2562 (16.0%) stroke patients fulfilled the HF criteria (i.e. 381 [14.9%] with LVEF < 55% and 29 [1.9%] based on medical history). Patients with HF had more often diabetes, coronary and peripheral arterial disease and presented with more severe strokes on admission. HF at baseline correlated with myocardial infarction (HR 2.21; 95% CI 1.02-4.79), and all-cause death (HR 1.67; 95% CI 1.12-2.50), but not with major bleed (HR 1.93; 95% CI 0.73-5.06) or recurrent stroke/TIA (HR 1.08; 95% CI 0.75-1.57). The data were adjusted for age, stroke severity, cardiovascular risk factors, and randomization. Patients with ischemic stroke or TIA and comorbid HF have a higher risk of myocardial infarction and death compared with non-HF patients whereas the risk of recurrent stroke or major hemorrhage was similar. Trial registration number Clinicaltrials.gov NCT02204267.
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Affiliation(s)
- Serdar Tütüncü
- Center for Stroke Research Berlin, Charité, Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany.
| | - Manuel C Olma
- Center for Stroke Research Berlin, Charité, Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
- Klinik und Hochschulambulanz für Neurologie mit Abteilung für Experimentelle Neurologie, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Claudia Kunze
- Center for Stroke Research Berlin, Charité, Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Joanna Dietzel
- Center for Stroke Research Berlin, Charité, Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Johannes Schurig
- Center for Stroke Research Berlin, Charité, Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Michael Rosenkranz
- Klinik für Neurologie und Neurologische Frührehabilitation, Albertinen-Krankenhaus Hamburg, Hamburg, Germany
| | - Robert Stingele
- Department of Neurology, German Red Cross Hospital Berlin Köpenick, Berlin, Germany
| | - Matthias Maschke
- Krankenhaus der Barmherzigen Brüder Trier, Klinik für Neurologie und Neurophysiologie, Trier, Germany
| | - Peter U Heuschmann
- Institute of Clinical Epidemiology and Biometry, University Würzburg, Würzburg, Germany
- Comprehensive Heart Failure Center & Clinical Trial Centre Würzburg, University Hospital Würzburg, Würzburg, Germany
| | - Paulus Kirchhof
- German Atrial Fibrillation Network (AFNET), Münster, Germany
- Institute of Cardiovascular Sciences, College of Medical and Dental Sciences, Medical School, University of Birmingham, Birmingham, UK
- Department of Cardiology, UHB and SWBH NHS Trusts, Birmingham, UK
- University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - Ulrich Laufs
- Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig, Leipzig, Germany
| | - Darius G Nabavi
- Department of Neurology, Vivantes Klinikum Neukölln, Berlin, Germany
| | - Joachim Röther
- Department of Neurology, Asklepios Klinik Altona, Hamburg, Germany
| | - Götz Thomalla
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Roland Veltkamp
- Department of Neurology, Alfried Krupp Krankenhaus, Essen, Germany
- Department of Brain Sciences, Imperial College London, London, UK
| | - Matthias Endres
- Center for Stroke Research Berlin, Charité, Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
- Klinik und Hochschulambulanz für Neurologie mit Abteilung für Experimentelle Neurologie, Charité-Universitätsmedizin Berlin, Berlin, Germany
- German Center for Neurodegenerative Diseases, Partner Site Berlin, Berlin, Germany
- German Center for Cardiovascular Diseases, Partner Site Berlin, Berlin, Germany
- Excellence Cluster NeuroCure, Berlin, Germany
- Berlin Institute of Health (BIH), Berlin, Germany
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Sandek A, Edelmann F, Gertler C, Friede T, Wachter R, Hasenfuß G. Transition from asymptomatic to symptomatic systolic chronic heart failure: rationale and design of TransitionCHF. ESC Heart Fail 2024. [PMID: 38606543 DOI: 10.1002/ehf2.14783] [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: 12/15/2023] [Revised: 03/05/2024] [Accepted: 03/16/2024] [Indexed: 04/13/2024] Open
Abstract
AIMS Chronic systolic heart failure (CHF) is a major health burden. A relevant number of patients shows asymptomatic left ventricular dysfunction (ALVSD) before symptomatic CHF or becomes asymptomatic after initiating heart failure therapy. Clinical course, prognosis, and response to pharmacological and device-based treatment are largely unknown in these two distinct groups of patients. Current pharmacological and interventional therapies do neither properly address the underlying pathophysiology nor prevent malignant loss of function. New therapeutic paradigms are needed to stop the progression from asymptomatic to symptomatic heart failure. Key questions are what causes progression of clinically asymptomatic New York Heart Association (NYHA) I heart failure to overt heart failure (>NYHA I) in some but not all patients and the underlying reasons for this transition. This requires the identification of disease mechanisms and biomarkers that predict outcome in well-defined cohorts for innovative preclinical and clinical trials. METHODS AND RESULTS TransitionCHF is a prospective, multicentre, longitudinal pathophysiological evaluation cohort study in patients with asymptomatic systolic dysfunction NYHA I and left ventricular ejection fraction ≤40%. The cohort comprises both incidental findings and patients who had become asymptomatic after a previous symptomatic event. TransitionCHF has recruited 1000 patients with ALVSD caused by various aetiologies in 20 university heart failure clinics across Germany. Both patients with and without comorbidities at study entry will be recruited. Patients will be systematically investigated and followed up annually over the course of the study. The primary composite endpoint is time to hospitalization for heart failure and cardiovascular death. The secondary endpoints assess time to all-cause mortality, to cardiovascular mortality, to heart failure mortality, to all-cause hospitalization, to heart failure hospitalization, and to recurrent heart failure hospitalizations, as well as time to assist device implantation/transplantation. Additional investigations focusing on biomarkers, comorbidities, gender aspects, nutrition, and functional parameters including quality of life will be performed. CONCLUSIONS TransitionCHF will provide a more thorough pathophysiological understanding of the progression of asymptomatic systolic dysfunction into symptomatic heart failure that will help develop therapies tailored to prevent progressive heart failure.
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Affiliation(s)
- Anja Sandek
- Clinic for Cardiology and Pneumology, Heart Research Center, University Medical Center Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany
- German Centre for Cardiovascular Research (DZHK), Göttingen, Germany
| | - Frank Edelmann
- Department of Internal Medicine and Cardiology, German Heart Center Charité, Charité-University Medicine Berlin, Berlin, Germany
- German Centre for Cardiovascular Research (DZHK), Berlin, Germany
| | - Christoph Gertler
- Clinic for Cardiology and Pneumology, Heart Research Center, University Medical Center Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany
- German Centre for Cardiovascular Research (DZHK), Göttingen, Germany
| | - Tim Friede
- German Centre for Cardiovascular Research (DZHK), Göttingen, Germany
- Department of Medical Statistics, University Medical Center Göttingen, Göttingen, Germany
| | - Rolf Wachter
- Clinic for Cardiology and Pneumology, Heart Research Center, University Medical Center Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany
- German Centre for Cardiovascular Research (DZHK), Göttingen, Germany
- Clinic and Policlinic for Cardiology, University Hospital Leipzig, Leipzig, Germany
| | - Gerd Hasenfuß
- Clinic for Cardiology and Pneumology, Heart Research Center, University Medical Center Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany
- German Centre for Cardiovascular Research (DZHK), Göttingen, Germany
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Bone R, Walthall H. The findings of a service evaluation on the practice of assessment and treatment of iron deficiency in people admitted to a UK hospital with decompensated Heart Failure. Heart Lung 2024; 66:94-102. [PMID: 38598979 DOI: 10.1016/j.hrtlng.2024.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 03/19/2024] [Accepted: 04/02/2024] [Indexed: 04/12/2024]
Abstract
BACKGROUND Iron Deficiency (ID) is common in Heart Failure (HF) and associated with poor outcomes. Replacement with intravenous (IV) iron can improve functional status, quality of life and risk of unplanned admission. In 2015/16 a local service evaluation was performed which found that of people admitted with HF, only 27.5 % had assessment of iron status, and when identified, replacement occurred in fewer than half. Education strategies were employed to increase awareness of the importance of assessment and correction. OBJECTIVES To assess if practice had improved following education strategies. METHODS A review of 220 patient records for people admitted with HF in 2020/21 to establish if iron status assessed, presence of ID, and whether if ID identified it was treated, and by which route. Trends in 2020/21 data were explored in sub-groups by age, sex, type of HF, anaemia status, input from HF specialists and type of ID. RESULTS Compared to 2015/16, more assessments of iron status were performed (45% vs 27.5 %), ID was corrected more frequently (57% vs 46 %) and increased use of the IV route for replacement (83% vs 58 %) CONCLUSIONS: Despite the impact of COVID-19 on usual care in 2020/21, improvement was seen in proportion of assessment and treatment of ID following simple education strategies for key stakeholders. There may be scope to improve practice further if the findings remain similar post pandemic. If so, a formal Quality Improvement approach may be helpful.
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Affiliation(s)
- Rebecca Bone
- Cardiology Ward, Oxford Heart Centre, John Radcliffe Hospital, Headley Way, Headington, Oxford OX3 9DU, UK.
| | - Helen Walthall
- Corporate Nursing Office, Level 3, John Radcliffe Hospital, Headley Way, Headington, Oxford OX3 9DU, UK; Oxford Biomedical Research Centre.
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9
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Bews H, Jia S, Liu Y, Sklar J, Ducas J, Kirkpatrick I, Tam JW, Shah AH. High output cardiac state: evaluating the incidence, plausible etiologies and outcomes. Curr Probl Cardiol 2024; 49:102561. [PMID: 38599560 DOI: 10.1016/j.cpcardiol.2024.102561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Accepted: 04/07/2024] [Indexed: 04/12/2024]
Abstract
INTRODUCTION The high output cardiac state (HOCS) [cardiac index (CI) >4 L/min/m2 ], primarily driven by abnormally low systemic vascular resistance (SVR), is a relatively under-recognized condition. Although, majority of these patients meet criteria for heart failure (HF), their treatment should be aimed at the primary pathology, as the majority of guideline directed HF therapies can reduce SVR further. OBJECTIVES To characterize patients with HOCS and provide valuable insight into the condition. METHODS Patients investigated by right heart catheterization (RHC) at the St. Boniface Hospital, Winnipeg, Canada between January 2009 and November 2021 were reviewed. Two groups of patients were included: 1) HOCS [CI >4 L/min/m2], and 2) pre-HOCS [CI between 3.8-4.0 L/min/m2]. Their medical records were reviewed to identify plausible etiologies, relevant investigations, and outcomes. RESULTS 177/2950 (6 %) patients met criteria for inclusion: 144/177 (81 %) with HOCS [mean age 51 years (range 19 - 82); 67/144 (47 %) female] and 33/177 (19 %) with pre-HOCS [mean age 55 years (range 30 - 83); 6/33 (18 %) female]. The most common plausible etiologies for the HOCS included anemia (36 %), obesity (34 %), cirrhosis (17 %), and lung disease (32 %). Trans-thoracic echocardiography and magnetic resonance imaging findings were non-specific and predominantly described preserved left ventricular ejection fraction, and pulmonary hypertension. The population experienced high rates of hospitalization, and significantly high mortality [36/144 (25 %) of HOCS at a median follow-up of 31.5 months, and 13/33 (39 %) of pre-HOCS at a median follow-up of 17 months]. CONCLUSIONS HOCS is not an uncommon condition and is associated with high mortality. Current HF guideline should incorporate such evaluation into the diagnostic criteria.
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Affiliation(s)
- Hilary Bews
- Section of Cardiology, Department of Internal Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Sangyang Jia
- Department of Internal Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Yixiu Liu
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Jaime Sklar
- Department of Internal Medicine, University of Toronto, Toronto, Ontario, Canada
| | - John Ducas
- Section of Cardiology, Department of Internal Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Iain Kirkpatrick
- Department of Radiology, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - James W Tam
- Section of Cardiology, Department of Internal Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Ashish H Shah
- Section of Cardiology, Department of Internal Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.
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Sher T, Noom M, Ganam S, Sujka J, Rinde-Hoffman D, DuCoin C. Temporary Mechanical Circulatory Support During Bariatric Surgery: A Novel Bridge to Durable Left Ventricular Assist Device and Cardiac Transplantation. Am Surg 2024:31348241244637. [PMID: 38578069 DOI: 10.1177/00031348241244637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2024]
Abstract
Advanced heart failure (HF) with comorbid severe obesity presents a unique surgical dilemma: bariatric surgery may help patients meet cardiac transplantation body mass index (BMI) criteria, but poor cardiac function puts them at increased intraoperative risk. Per International Society for Heart and Lung Transplantation (ISHLT) guidelines BMI > 35 is a contraindication for orthotopic heart transplantation. Temporary mechanical circulatory support (MCS) with Impella 5.5 during bariatric surgery, as presented in this report, may help solve this dilemma for some patients. We present three patients with severe obesity and advanced heart failure (HF) who underwent successful bariatric surgery while supported by Impella 5.5 (Abiomed, Inc., Danvers, MA).
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Affiliation(s)
- Theo Sher
- University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Madison Noom
- University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Samer Ganam
- University of South Florida Morsani College of Medicine, Tampa, FL, USA
- Department of Surgery, University of South Florida, Tampa, FL, USA
| | - Joseph Sujka
- University of South Florida Morsani College of Medicine, Tampa, FL, USA
- Department of Surgery, University of South Florida, Tampa, FL, USA
| | - Debbie Rinde-Hoffman
- University of South Florida Morsani College of Medicine, Tampa, FL, USA
- Heart Failure Center of Excellence, Heart and Vascular Institute, Tampa General Medical Group/University of South Florida, Tampa, FL, USA
| | - Christopher DuCoin
- University of South Florida Morsani College of Medicine, Tampa, FL, USA
- Department of Surgery, University of South Florida, Tampa, FL, USA
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11
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Edmonston D, Fuchs MAA, Burke EJ, Isakova T, Wolf M. Klotho and Clinical Outcomes in CKD. Am J Kidney Dis 2024:S0272-6386(24)00690-5. [PMID: 38583756 DOI: 10.1053/j.ajkd.2024.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 02/08/2024] [Accepted: 02/09/2024] [Indexed: 04/09/2024]
Abstract
RATIONALE & OBJECTIVE Klotho deficiency may affect clinical outcomes in chronic kidney disease (CKD) through fibroblast growth factor-23 (FGF23)-dependent and independent pathways. However, the association between circulating Klotho and clinical outcomes in CKD remains unresolved and was the focus of this study. STUDY DESIGN Prospective observational study. SETTING & PARTICIPANTS 1088 participants of the Chronic Renal Insufficiency Cohort (CRIC) Study with estimated glomerular filtration rate (eGFR) 20-70 ml/min/1.73m2. EXPOSURE Plasma Klotho level at the year-1 study visit. OUTCOMES 5-year risks of all-cause mortality, heart failure hospitalization, atherosclerotic cardiovascular events, and a composite kidney endpoint comprised of a sustained 50% decline in eGFR, dialysis, kidney transplantation, or eGFR <15 ml/min/1.73 m2. ANALYTICAL APPROACH We divided Klotho into six groups to account for its non-normal distribution. We used Cox proportional hazards regression and subdistribution hazards models to compare survival and clinical outcomes, respectively, between Klotho groups. We sequentially adjusted for demographics, kidney function, cardiovascular risk factors, sample age, and FGF23. RESULTS Mean eGFR was 42 ml/min/1.73m2, and median Klotho was 0.31 ng/ml (interquartile range 0.10-3.27 ng/ml). When compared to the lowest Klotho group, survival (hazard ratio [HR] 0.77, 95% confidence interval [CI] 0.32-1.89), heart failure hospitalization (HR 1.10, 95% CI 0.38-3.17), atherosclerotic cardiovascular events (HR 1.19, 95% CI 0.57-2.52), and CKD progression (HR 1.05, 95% CI 0.58-1.91) did not differ in the high Klotho group. In contrast, FGF23 was significantly associated with mortality and heart failure hospitalization independent of Klotho levels. LIMITATIONS Despite adjustments, we cannot exclude potential influence of residual confounding or sample storage on the results. A single measurement of plasma Klotho may not capture Klotho patterns over time. CONCLUSIONS In a large, diverse, well-characterized CKD cohort, Klotho was not associated with clinical outcomes, and Klotho deficiency did not confound the association of FGF23 with mortality or heart failure hospitalization.
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Affiliation(s)
- Daniel Edmonston
- Division of Nephrology, Department of Medicine, Duke University School of Medicine, Durham, NC, USA; Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA.
| | - Michaela A A Fuchs
- Division of Nephrology, Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Emily J Burke
- Division of Nephrology, Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Tamara Isakova
- Division of Nephrology and Hypertension, Department of Medicine and Center for Translational Metabolism and Health, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Myles Wolf
- Division of Nephrology, Department of Medicine, Duke University School of Medicine, Durham, NC, USA; Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
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12
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Wijayanto MA, Myrtha R, Lukas GA, Rahma AA, Hanifa SN, Zahira HA, Ilyas MF. Outcomes of subsequent pregnancy in women with peripartum cardiomyopathy: a systematic review and meta-analysis. Open Heart 2024; 11:e002626. [PMID: 38569669 PMCID: PMC10989162 DOI: 10.1136/openhrt-2024-002626] [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: 01/31/2024] [Accepted: 03/26/2024] [Indexed: 04/05/2024] Open
Abstract
INTRODUCTION The primary concern for women who have experienced peripartum cardiomyopathy (PPCM) is the safety of a subsequent pregnancy (SSP). To maximie decision-making, facilitate effective patient counselling, and ultimately improve maternal and fetal outcomes as a whole, it is critical to comprehend the outcomes of SSP in women who have previously experienced PPCM. This study aimed to evaluate the outcomes of SSP in women with PPCM. METHODS Three databases (PubMed, Scopus, and ScienceDirect) were used to identify relevant studies prior to 17 October 2023. A total of 662 studies were reviewed. Following the abstract and full-text screenings, 18 observational studies were included, out of which 2 were deemed suitable for inclusion in this meta-analysis. The quality assessment was conducted using the Newcastle-Ottawa Scale. RESULTS This study has a total of 487 SSPs. Although recovered left ventricular (LV) function before entering SSP has the potential to be a beneficial prognostic factor, recovered LV function still has a substantial risk of relapse. The mortality rate of PPCM in an SSP ranged from 0% to 55.5%. Persistent LV dysfunction was significantly associated with an increased mortality rate (OR 13.17; 95% CI 1.54 to 112.28; p=0.02) and lower LV ejection fraction (MD -12.88; 95% CI -21.67 to -4.09; p=0.004). Diastolic and right ventricular functions remained unchanged before SSP and at follow-up. The majority of the SSP was observed alongside hypertension, while pre-eclampsia emerged as the predominant hypertensive complication in most studies. CONCLUSION SSP increases the risk of relapse and mortality in women with a previous history of PPCM. Persistent LV dysfunction prior to the SSP has a higher mortality risk compared with recovered LV function. SSP was also associated with the worsening of LV echocardiography parameters.
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Affiliation(s)
| | - Risalina Myrtha
- Department of Cardiology and Vascular Medicine, Universitas Sebelas Maret Hospital, Sukoharjo, Indonesia
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13
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Suominen A, Saldo Rubio G, Ruohonen S, Szabó Z, Pohjolainen L, Ghimire B, Ruohonen ST, Saukkonen K, Ijas J, Skarp S, Kaikkonen L, Cai M, Wardlaw SL, Ruskoaho H, Talman V, Savontaus E, Kerkelä R, Rinne P. α-Melanocyte-stimulating hormone alleviates pathological cardiac remodeling via melanocortin 5 receptor. EMBO Rep 2024; 25:1987-2014. [PMID: 38454158 PMCID: PMC11014855 DOI: 10.1038/s44319-024-00109-6] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 01/23/2024] [Accepted: 02/16/2024] [Indexed: 03/09/2024] Open
Abstract
α-Melanocyte-stimulating hormone (α-MSH) regulates diverse physiological functions by activating melanocortin receptors (MC-R). However, the role of α-MSH and its possible target receptors in the heart remain completely unknown. Here we investigate whether α-MSH could be involved in pathological cardiac remodeling. We found that α-MSH was highly expressed in the mouse heart with reduced ventricular levels after transverse aortic constriction (TAC). Administration of a stable α-MSH analog protected mice against TAC-induced cardiac hypertrophy and systolic dysfunction. In vitro experiments revealed that MC5-R in cardiomyocytes mediates the anti-hypertrophic signaling of α-MSH. Silencing of MC5-R in cardiomyocytes induced hypertrophy and fibrosis markers in vitro and aggravated TAC-induced cardiac hypertrophy and fibrosis in vivo. Conversely, pharmacological activation of MC5-R improved systolic function and reduced cardiac fibrosis in TAC-operated mice. In conclusion, α-MSH is expressed in the heart and protects against pathological cardiac remodeling by activating MC5-R in cardiomyocytes. These results suggest that analogs of naturally occurring α-MSH, that have been recently approved for clinical use and have agonistic activity at MC5-R, may be of benefit in treating heart failure.
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Affiliation(s)
- Anni Suominen
- Research Centre for Integrative Physiology & Pharmacology, Institute of Biomedicine, University of Turku, Turku, Finland
- Drug Research Doctoral Programme (DRDP), University of Turku, Turku, Finland
| | - Guillem Saldo Rubio
- Research Centre for Integrative Physiology & Pharmacology, Institute of Biomedicine, University of Turku, Turku, Finland
| | - Saku Ruohonen
- Research Centre for Integrative Physiology & Pharmacology, Institute of Biomedicine, University of Turku, Turku, Finland
| | - Zoltán Szabó
- Research Unit of Biomedicine and Internal Medicine, Department of Pharmacology and Toxicology, University of Oulu, Oulu, Finland
| | - Lotta Pohjolainen
- Drug Research Program and Division of Pharmacology and Pharmacotherapy, Faculty of Pharmacy, University of Helsinki, Helsinki, Finland
| | - Bishwa Ghimire
- Institute for Molecular Medicine Finland (FIMM), HiLIFE Helsinki Institute of Life Science, University of Helsinki, Helsinki, Finland
- Faculty of Medicine, University of Turku, Turku, Finland
| | - Suvi T Ruohonen
- Research Centre for Integrative Physiology & Pharmacology, Institute of Biomedicine, University of Turku, Turku, Finland
| | - Karla Saukkonen
- Research Centre for Integrative Physiology & Pharmacology, Institute of Biomedicine, University of Turku, Turku, Finland
| | - Jani Ijas
- Research Centre for Integrative Physiology & Pharmacology, Institute of Biomedicine, University of Turku, Turku, Finland
| | - Sini Skarp
- Research Unit of Biomedicine and Internal Medicine, Department of Pharmacology and Toxicology, University of Oulu, Oulu, Finland
| | - Leena Kaikkonen
- Research Unit of Biomedicine and Internal Medicine, Department of Pharmacology and Toxicology, University of Oulu, Oulu, Finland
| | - Minying Cai
- Department of Chemistry and Biochemistry, University of Arizona, Tucson, AZ, USA
| | - Sharon L Wardlaw
- Department of Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Heikki Ruskoaho
- Drug Research Program and Division of Pharmacology and Pharmacotherapy, Faculty of Pharmacy, University of Helsinki, Helsinki, Finland
| | - Virpi Talman
- Drug Research Program and Division of Pharmacology and Pharmacotherapy, Faculty of Pharmacy, University of Helsinki, Helsinki, Finland
| | - Eriika Savontaus
- Research Centre for Integrative Physiology & Pharmacology, Institute of Biomedicine, University of Turku, Turku, Finland
- Turku Center for Disease Modeling, University of Turku, Turku, Finland
- Unit of Clinical Pharmacology, Turku University Hospital, Turku, Finland
| | - Risto Kerkelä
- Research Unit of Biomedicine and Internal Medicine, Department of Pharmacology and Toxicology, University of Oulu, Oulu, Finland
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
- Biocenter Oulu, University of Oulu, Oulu, Finland
| | - Petteri Rinne
- Research Centre for Integrative Physiology & Pharmacology, Institute of Biomedicine, University of Turku, Turku, Finland.
- Turku Center for Disease Modeling, University of Turku, Turku, Finland.
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14
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Diaz JC, Duque M, Miranda-Arboleda AF, Koplan BA, Marín JE, Aristizabal JM, Niño CD, Bastidas O, Hincapie D, Hoyos C, Matos CD, Lopez-Cabanillas N, Jaraba E, Moreno S, Caceres M, Ruiz LM, Sauer WH, Romero JE. Single-/dual-chamber vs cardiac resynchronization pacemakers for cardiac resynchronization. Heart Rhythm 2024; 21:499-501. [PMID: 38181988 DOI: 10.1016/j.hrthm.2023.12.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 12/27/2023] [Accepted: 12/29/2023] [Indexed: 01/07/2024]
Affiliation(s)
- Juan C Diaz
- Cardiac Arrhythmia and Electrophysiology Service, Division of Cardiology, Clinica Las Vegas, Universidad CES Medical School, Medellin, Colombia.
| | - Mauricio Duque
- Cardiac Arrhythmia Service, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Andres F Miranda-Arboleda
- Cardiac Arrhythmia and Electrophysiology Service, Hospital San Vicente Fundación, Rionegro, Colombia
| | - Bruce A Koplan
- Cardiac Arrhythmia and Electrophysiology Service, Hospital San Vicente Fundación, Rionegro, Colombia
| | - Jorge E Marín
- Cardiac Arrhythmia and Electrophysiology Service, Division of Cardiology, Department of Medicine, Clinica Las Americas, Medellin, Colombia
| | - Julian M Aristizabal
- Cardiac Arrhythmia and Electrophysiology Service, Hospital San Vicente Fundación, Rionegro, Colombia
| | - Cesar D Niño
- Cardiac Arrhythmia and Electrophysiology Service, Clinica SOMER, Rionegro, Antioquia, Colombia
| | - Oriana Bastidas
- Cardiac Arrhythmia and Electrophysiology Service, Division of Cardiology, Clinica Las Vegas, Universidad CES Medical School, Medellin, Colombia
| | - Daniela Hincapie
- Cardiac Arrhythmia and Electrophysiology Service, Hospital San Vicente Fundación, Rionegro, Colombia
| | - Carolina Hoyos
- Cardiac Arrhythmia and Electrophysiology Service, Hospital San Vicente Fundación, Rionegro, Colombia
| | - Carlos D Matos
- Cardiac Arrhythmia and Electrophysiology Service, Hospital San Vicente Fundación, Rionegro, Colombia
| | | | - Elmer Jaraba
- Cardiac Arrhythmia and Electrophysiology Service, Division of Cardiology, Department of Medicine, Clinica Las Americas, Medellin, Colombia
| | | | | | | | - William H Sauer
- Cardiac Arrhythmia and Electrophysiology Service, Hospital San Vicente Fundación, Rionegro, Colombia
| | - Jorge E Romero
- Cardiac Arrhythmia and Electrophysiology Service, Hospital San Vicente Fundación, Rionegro, Colombia
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15
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Garg PK, Ji Y, Wang W, Hof JV, Decker J, Inciardi RM, Lutsey PL, Alonso A, Shah AM, Solomon S, Selvin E, Chen LY. Association of diabetes and glycemic control with left atrial function: The Atherosclerosis Risk in Communities (ARIC) study. Nutr Metab Cardiovasc Dis 2024; 34:972-979. [PMID: 38161132 PMCID: PMC10947889 DOI: 10.1016/j.numecd.2023.11.010] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Revised: 10/31/2023] [Accepted: 11/15/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND AND AIMS Although glycemic status is associated with impaired cardiac structure and function, less is known on left atrial (LA) function across the glycemic spectrum. We evaluated the association of diabetes and glycemic control with LA function in a community-based cohort of older adults. METHODS AND RESULTS This cross-sectional analysis included 5075 participants from the Atherosclerosis Risk in Communities Study (mean age 75.5 years, 58 % women, and 20 % Black adults) with echocardiographic strain data for LA reservoir, conduit, and contractile function. Multivariable linear regression was used to assess associations of diabetes status and glycemic control with LA function. In participants without diabetes, we used ordinal linear regression to evaluate associations of fasting glucose and HbA1c with LA function. Compared to individuals with a normal fasting glucose, prevalent diabetes was associated with 0.68 % lower LA conduit function (95 % confidence interval (CI): 1.11 to -0.25) and prediabetes a 0.47 % reduction (95 % CI: 0.85 to -0.09) in fully adjusted analyses. Persons with diabetes and high HbA1c (HgbA1c ≥ 7 % vs <7 %) had 1.05 % lower LA conduit function (95 % CI: 1.63, -0.48). Among individuals without diagnosed diabetes, higher fasting glucose, but not HbA1c, was significantly associated with worse LA conduit function. No significant associations were observed for LA reservoir and contractile function. CONCLUSIONS A history of diabetes, prediabetes, and higher fasting glucose levels in persons without diabetes were associated with worse LA conduit function. Corroborative research is needed in prospective cohorts as well as studies that explore underlying mechanisms.
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Affiliation(s)
- Parveen K Garg
- Division of Cardiology, USC Keck School of Medicine, Los Angeles, CA, USA.
| | - Yuekai Ji
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Wendy Wang
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Jeremy Van't Hof
- Lillehei Heart Institute and Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Joseph Decker
- Lillehei Heart Institute and Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Riccardo M Inciardi
- Institute of Cardiology Department of Medical and Surgical Specialties Radiological Sciences and Public Health University of Brescia, Brescia Italy
| | - Pamela L Lutsey
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Alvaro Alonso
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Amil M Shah
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Scott Solomon
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Elizabeth Selvin
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Lin Yee Chen
- Lillehei Heart Institute and Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis, MN, USA
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16
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Tao M, Dhaliwal S, Ghosalkar D, Sheng S, Dianati-Maleki N, Tam E, Rahman T, Mann N, Kort S. Utility of native T1 mapping and myocardial extracellular volume fraction in patients with nonischemic dilated cardiomyopathy: A systematic review and meta-analysis. Int J Cardiol Heart Vasc 2024; 51:101339. [PMID: 38371310 PMCID: PMC10873728 DOI: 10.1016/j.ijcha.2024.101339] [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: 08/10/2023] [Revised: 10/06/2023] [Accepted: 10/07/2023] [Indexed: 02/20/2024]
Abstract
Background Cardiac magnetic resonance imaging (CMR) based T1 mapping and extracellular volume fraction (ECV) are powerful tools for identifying myocardial fibrosis. This systematic review and meta-analysis aims to characterize the utility of native T1 mapping and ECV in patients with non-ischemic cardiomyopathy (NICM) and to clarify the prognostic significance of elevated values. Methods A literature search was conducted for studies reporting on use of CMR-based native T1 mapping and ECV measurement in NICM patients and their association with major adverse cardiac events (MACE), ventricular arrhythmias (VAs), and left ventricular reverse remodeling (LVRR). Databases searched included: Ovid MEDLINE, EMBASE, Web of Science, and Google Scholar. The search was not restricted to time or publication status. Results Native T1 and ECV were significantly higher in NICM patients compared to controls (MD 78.80, 95 % CI 50.00, 107.59; p < 0.01; MD 5.86, 95 % CI 4.55, 7.16; p < 0.01). NICM patients who experienced MACE had higher native T1 and ECV (MD 52.87, 95 % CI 26.59, 79.15; p < 0.01; MD 6.03, 95 % CI 3.79, 8.26; p < 0.01). There was a non-statistically significant trend toward higher native T1 time in NICM patients who experienced VAs. NICM patients who were poor treatment responders had higher baseline native T1 and ECV (MD 40.58, 95 % CI 12.90, 68.25; p < 0.01; MD 3.29, 95 % CI 2.25, 4.33; p < 0.01). Conclusions CMR-based native T1 and ECV quantification may be useful tools for risk stratification of patients with NICM. They may provide additional diagnostic utility in combination with LGE, which poorly characterizes fibrosis in patients with diffuse myocardial involvement.
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Affiliation(s)
- Michael Tao
- Department of Medicine, Division of Cardiology, Stony Brook University Hospital, Stony Brook, NY 11794, USA
| | - Simrat Dhaliwal
- Department of Medicine, Division of Cardiology, Stony Brook University Hospital, Stony Brook, NY 11794, USA
| | - Dhairyasheel Ghosalkar
- Department of Medicine, Division of Cardiology, Stony Brook University Hospital, Stony Brook, NY 11794, USA
| | - Siyuan Sheng
- Department of Medicine, Division of Cardiology, Stony Brook University Hospital, Stony Brook, NY 11794, USA
| | - Neda Dianati-Maleki
- Department of Medicine, Division of Cardiology, Stony Brook University Hospital, Stony Brook, NY 11794, USA
| | - Edlira Tam
- Department of Medicine, Division of Cardiology, Stony Brook University Hospital, Stony Brook, NY 11794, USA
| | - Tahmid Rahman
- Department of Medicine, Division of Cardiology, Stony Brook University Hospital, Stony Brook, NY 11794, USA
| | - Noelle Mann
- Department of Medicine, Division of Cardiology, Stony Brook University Hospital, Stony Brook, NY 11794, USA
| | - Smadar Kort
- Department of Medicine, Division of Cardiology, Stony Brook University Hospital, Stony Brook, NY 11794, USA
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17
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Wahadneh OA, Alitter Q, Raju A, Alziadin N, Alshurafa AH, Aldabbas HO, Shaik I. Prevalence and impact of pulmonary hypertension on acute decompensated heart failure with preserved ejection fraction hospitalizations: A five-year retrospective analysis. Curr Probl Cardiol 2024; 49:102537. [PMID: 38522770 DOI: 10.1016/j.cpcardiol.2024.102537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Accepted: 03/20/2024] [Indexed: 03/26/2024]
Abstract
Heart Failure with Preserved Ejection Fraction (HFpEF) is a major and common cardiovascular condition with widely variable clinical outcomes. Pulmonary hypertension (PH) often co-exists with HFpEF and tends to affect patient outcomes; this study aims to identify the impact of PH on the clinical outcome of patients admitted to the hospital with acute HFpEF exacerbations. We analyzed data from the National Inpatient Sample between 2016 and 2020, focusing on 464,438 acute HFpEF exacerbation hospitalizations. Outcomes were compared between those with PH (27.1 %) and those without PH (72.9 %). HFpEF hospitalizations with PH exhibited elevated in-hospital mortality (adjusted odds ratio [aOR]: 1.20, 95 % confidence interval [95 CI]: 1.08-1.31, P < 0.05), prolonged length of stay (adjusted β: 0.90 days, P < 0.05), and increased overall costs (adjusted β: $2,858, P < 0.05). Furthermore, HFpEF hospitalizations with PH demonstrated higher rates of atrial fibrillation, ventricular tachycardia, right ventricular failure, and conduction abnormalities. This population also displayed an increased incidence of acute hypoxic respiratory failure, necessitating increased non-invasive and mechanical ventilation. The co-existence of PH in HFpEF presents an increased risk of mortality and morbidity, with higher healthcare costs and the need for ventilatory support, in addition to higher risks of cardiovascular and pulmonary complications. Therefore, an early diagnosis of PH in patients with HFpEF is crucial, and further research is required to determine appropriate management.
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Affiliation(s)
- Omar Al Wahadneh
- Department of Internal Medicine, Carle Foundation Hospital, Urbana, IL, USA.
| | - Qusai Alitter
- Department of Pulmonary & Critical Care, Hackensack University Medical Center, Hackensack, New Jersey, USA
| | - Apoorva Raju
- Department of Internal Medicine, Carle Foundation Hospital, Urbana, IL, USA
| | - Nmair Alziadin
- Department of Internal Medicine, HCA Healthcare/Tufts University School of Medicine: Portsmouth Regional Hospital, Portsmouth, NH, USA
| | | | | | - Ibrahim Shaik
- Cardiovascular Medicine, Advocate Lutheran General Hospital, Park Ridge, Illinois, USA
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18
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Couch LS, Garrard JW, Henry JA, Kotronias RA, Alaour B, De Maria GL, Channon KM, Banning AP, Lyon AR, Marber M, Kaier TE. Comparison of troponin and natriuretic peptides in Takotsubo syndrome and acute coronary syndrome: a meta-analysis. Open Heart 2024; 11:e002607. [PMID: 38508657 PMCID: PMC10952941 DOI: 10.1136/openhrt-2024-002607] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Accepted: 01/16/2024] [Indexed: 03/22/2024] Open
Abstract
OBJECTIVE Takotsubo syndrome (TTS) is an acute heart failure syndrome which resembles acute coronary syndrome (ACS) at presentation. Differentiation requires coronary angiography, but where this does not occur immediately, cardiac biomarkers may provide additional utility. We performed a meta-analysis to compare troponin and natriuretic peptides (NPs) in TTS and ACS to determine if differences in biomarker profile can aid diagnosis. METHODS We searched five literature databases for studies reporting NPs (Brain NP (BNP)/NT-pro-BNP) or troponin I/T in TTS and ACS, identifying 28 studies for troponin/NPs (5618 and 1145 patients, respectively). RESULTS Troponin was significantly lower in TTS than ACS (standardised mean difference (SMD) -0.86; 95% CI, -1.08 to -0.64; p<0.00001), with an absolute difference of 75 times the upper limit of normal (×ULN) higher in ACS than TTS. Conversely, NPs were significantly higher in TTS (SMD 0.62; 95% CI, 0.44 to 0.80; p<0.00001) and 5.8×ULN greater absolutely. Area under the curve (AUC) for troponin in ACS versus TTS was 0.82 (95% CI, 0.70 to 0.93), and 0.92 (95% CI, 0.80 to 1.00) for ST-segment elevation myocardial infarction versus TTS. For NPs, AUC was 0.69 (95% CI, 0.48 to 0.89). Combination of troponin and NPs with logistic regression did not improve AUC. Recursive Partitioning and Regression Tree analysis calculated a troponin threshold ≥26×ULN that identified 95% cases as ACS where and specificity for ACS were 85.71% and 53.57%, respectively, with 94.32% positive predictive value and 29.40% negative predictive value. CONCLUSIONS Troponin is lower and NPs higher in TTS versus ACS. Troponin had greater power than NPs at discriminating TTS and ACS, and with troponin ≥26×ULN patients are far more likely to have ACS.
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Affiliation(s)
- Liam Steven Couch
- King's College London BHF Centre, The Rayne Institute, St Thomas' Hospital, London, UK
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - James W Garrard
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - John A Henry
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - Rafail A Kotronias
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - Bashir Alaour
- King's College London BHF Centre, The Rayne Institute, St Thomas' Hospital, London, UK
| | - Giovanni Luigi De Maria
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - Keith M Channon
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - Adrian P Banning
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | | | - Michael Marber
- King's College London BHF Centre, The Rayne Institute, St Thomas' Hospital, London, UK
| | - Thomas Edward Kaier
- King's College London BHF Centre, The Rayne Institute, St Thomas' Hospital, London, UK
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19
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Iannaccone M, Gamardella M, Chieffo A. Inclusivity in randomised clinical trials: myth or reality? Heart 2024; 110:459-460. [PMID: 38199671 DOI: 10.1136/heartjnl-2023-323703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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] [Indexed: 01/12/2024] Open
Affiliation(s)
- Mario Iannaccone
- Cath Lab, Unit of Cardiology, Ospedale San Giovanni Bosco, Torino, Italy
| | - Marco Gamardella
- Vita-Salute San Raffaele University, Milano, Italy
- IRCCS Ospedale San Raffaele, Milano, Italy
| | - Alaide Chieffo
- Vita-Salute San Raffaele University, Milano, Italy
- IRCCS Ospedale San Raffaele, Milano, Italy
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20
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Doherty DJ, Docherty KF, Gardner RS. Review of the National Institute for Health and Care Excellence guidelines on chronic heart failure. Heart 2024; 110:466-475. [PMID: 38191272 DOI: 10.1136/heartjnl-2022-322164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 11/10/2023] [Indexed: 01/10/2024] Open
Abstract
Guidelines are more accessible than ever and represent an important tool in clinical practice. The National Institute for Health and Care Excellence (NICE) has developed recommendations for heart failure diagnosis and management based not only on morbidity and mortality trial outcome data but also in-depth economic analysis, with a focus on generalisability to UK National Health Service clinical practice. There is broad consistency in structure and content between NICE guidelines and those produced by major cardiovascular organisations such as the American College of Cardiology/American Heart Association and the European Society of Cardiology. However, important differences do exist-largely attributable to publication timing-a factor that is enhanced by the rapid pace of heart failure research. This article reviews the most recent iteration of NICE chronic heart failure guidelines and compares them with major guidelines on an international scale. Variations in recommendations will be explored including implications for NICE guideline updates in the future.
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Affiliation(s)
- Daniel J Doherty
- School of Cardiovascular & Metabolic Health, University of Glasgow, Glasgow, UK
| | - Kieran F Docherty
- School of Cardiovascular & Metabolic Health, University of Glasgow, Glasgow, UK
| | - Roy S Gardner
- Scottish National Advanced Heart Failure Service, Golden Jubilee National Hospital, Clydebank, UK
- School of Cardiovascular & Metabolic Health, University of Glasgow, Glasgow, UK
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21
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Mehmood Z, Assadi H, Grafton-Clarke C, Li R, Matthews G, Alabed S, Girling R, Underwood V, Kasmai B, Zhao X, Ricci F, Zhong L, Aung N, Petersen SE, Swift AJ, Vassiliou VS, Cavalcante J, Geest RJVD, Garg P. Validation of 2D flow MRI for helical and vortical flows. Open Heart 2024; 11:e002451. [PMID: 38458769 PMCID: PMC10928773 DOI: 10.1136/openhrt-2023-002451] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Accepted: 11/09/2023] [Indexed: 03/10/2024] Open
Abstract
PURPOSE The main objective of this study was to develop two-dimensional (2D) phase contrast (PC) methods to quantify the helicity and vorticity of blood flow in the aortic root. METHODS This proof-of-concept study used four-dimensional (4D) flow cardiovascular MR (4D flow CMR) data of five healthy controls, five patients with heart failure with preserved ejection fraction and five patients with aortic stenosis (AS). A PC through-plane generated by 4D flow data was treated as a 2D PC plane and compared with the original 4D flow. Visual assessment of flow vectors was used to assess helicity and vorticity. We quantified flow displacement (FD), systolic flow reversal ratio (sFRR) and rotational angle (RA) using 2D PC. RESULTS For visual vortex flow presence near the inner curvature of the ascending aortic root on 4D flow CMR, sFRR demonstrated an area under the curve (AUC) of 0.955, p<0.001. A threshold of >8% for sFRR had a sensitivity of 82% and specificity of 100% for visual vortex presence. In addition, the average late systolic FD, a marker of flow eccentricity, also demonstrated an AUC of 0.909, p<0.001 for visual vortex flow. Manual systolic rotational flow angle change (ΔsRA) demonstrated excellent association with semiautomated ΔsRA (r=0.99, 95% CI 0.9907 to 0.999, p<0.001). In reproducibility testing, average systolic FD (FDsavg) showed a minimal bias at 1.28% with a high intraclass correlation coefficient (ICC=0.92). Similarly, sFRR had a minimal bias of 1.14% with an ICC of 0.96. ΔsRA demonstrated an acceptable bias of 5.72°-and an ICC of 0.99. CONCLUSION 2D PC flow imaging can possibly quantify blood flow helicity (ΔRA) and vorticity (FRR). These imaging biomarkers of flow helicity and vorticity demonstrate high reproducibility for clinical adoption. TRIALS REGISTRATION NUMBER NCT05114785.
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Affiliation(s)
- Zia Mehmood
- Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | - Hosamadin Assadi
- Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
- Department of Cardiovascular and Metabolic Health, University of East Anglia Norwich Medical School, Norwich, UK
| | - Ciaran Grafton-Clarke
- Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
- Department of Cardiovascular and Metabolic Health, University of East Anglia, Norwich, UK
| | - Rui Li
- Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
- Department of Cardiovascular and Metabolic Health, University of East Anglia, Norwich, UK
| | - Gareth Matthews
- Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
- Department of Cardiovascular and Metabolic Health, University of East Anglia, Norwich, UK
| | - Samer Alabed
- Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Rebekah Girling
- Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | - Victoria Underwood
- Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | - Bahman Kasmai
- Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
- Department of Cardiovascular and Metabolic Health, University of East Anglia, Norwich, UK
| | | | - Fabrizio Ricci
- Neuroscience, Imaging and Clinical Sciences, Gabriele d'Annunzio University of Chieti and Pescara, Chieti Scalo, Italy
| | | | - Nay Aung
- Queen Mary University of London, London, UK
| | - Steffen Erhard Petersen
- Advanced Cardiovascular Imaging William Harvey Research Institute, The London Chest Hospital, London, UK
| | | | - Vassilios S Vassiliou
- Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
- Department of Cardiovascular and Metabolic Health, University of East Anglia, Norwich, UK
| | - João Cavalcante
- Cardiovascular, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | | | - Pankaj Garg
- Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
- Department of Cardiovascular and Metabolic Health, University of East Anglia, Norwich, UK
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22
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Bae NY, Rhee TM, Park CS, Choi YJ, Lee HJ, Choi HM, Park JB, Yoon YE, Kim YJ, Cho GY, Hwang IC, Kim HK. Mildly Reduced Renal Function Is Associated With Increased Heart Failure Admissions in Patients With Hypertrophic Cardiomyopathy. J Korean Med Sci 2024; 39:e80. [PMID: 38442721 PMCID: PMC10911940 DOI: 10.3346/jkms.2024.39.e80] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 12/28/2023] [Indexed: 03/07/2024] Open
Abstract
BACKGROUND The association between renal dysfunction and cardiovascular outcomes has yet to be determined in patients with hypertrophic cardiomyopathy (HCM). We aimed to investigate whether mildly reduced renal function is associated with the prognosis in patients with HCM. METHODS Patients with HCM were enrolled at two tertiary HCM centers. Patients who were on dialysis, or had a previous history of heart failure (HF) or stroke were excluded. Patients were categorized into 3 groups by estimated glomerular filtration rate (eGFR): stage I (eGFR ≥ 90 mL/min/1.73 m², n = 538), stage II (eGFR 60-89 mL/min/1.73 m², n = 953), and stage III-V (eGFR < 60 mL/min/1.73 m², n = 265). Major adverse cardiovascular events (MACEs) were defined as a composite of cardiovascular death, hospitalization for HF (HHF), or stroke during median 4.0-year follow-up. Multivariable Cox regression model was used to adjust for covariates. RESULTS Among 1,756 HCM patients (mean 61.0 ± 13.4 years; 68.1% men), patients with stage III-V renal function had a significantly higher risk of MACEs (adjusted hazard ratio [aHR], 2.71; 95% confidence interval [CI], 1.39-5.27; P = 0.003), which was largely driven by increased incidence of cardiovascular death and HHF compared to those with stage I renal function. Even in patients with stage II renal function, the risk of MACE (vs. stage I: aHR, 2.21' 95% CI, 1.23-3.96; P = 0.008) and HHF (vs. stage I: aHR, 2.62; 95% CI, 1.23-5.58; P = 0.012) was significantly increased. CONCLUSION This real-world observation showed that even mildly reduced renal function (i.e., eGFR 60-89 mL/min/1.73 m²) in patients with HCM was associated with an increased risk of MACEs, especially for HHF.
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Affiliation(s)
- Nan Young Bae
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Tae-Min Rhee
- Department of Internal Medicine, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, Korea
| | - Chan Soon Park
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - You-Jung Choi
- Department of Internal Medicine, Korea University Guro Hospital, Seoul, Korea
| | - Hyun-Jung Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Hong-Mi Choi
- Cardiovascular Center and Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jun-Bean Park
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Yeonyee E Yoon
- Cardiovascular Center and Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Yong-Jin Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Goo-Yeong Cho
- Cardiovascular Center and Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - In-Chang Hwang
- Cardiovascular Center and Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.
| | - Hyung-Kwan Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea.
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23
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Dankano A, Prather R, Lozinski B, Divo E, Kassab A, DeCampli W. Tailoring left ventricular assist device cannula implantation using coupled multi-scale multi-objective optimization. Med Eng Phys 2024; 125:104124. [PMID: 38508801 DOI: 10.1016/j.medengphy.2024.104124] [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] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Revised: 01/17/2024] [Accepted: 02/15/2024] [Indexed: 03/22/2024]
Abstract
BACKGROUND The frequent occurrence of thromboembolic cerebral events continues to limit the widespread implementation of Ventricular Assist Devices (VAD) despite continued advancements in VAD design and anti-coagulation treatments. Recent studies point to the optimal positioning of the outflow graft (OG) as a potential mitigator of post implantation thromboembolism. OBJECTIVE This study aims to examine the tailoring of the OG implantation orientation with the goal of minimizing the number of thrombi reaching the cerebral vessels by means of a formal shape optimization scheme incorporated into a multi-scale hemodynamics analysis. METHODS A 3-D patient-specific computational fluid dynamics model is loosely coupled in a two-way manner to a 0-D lumped parameter model of the peripheral circulation. A Lagrangian particle-tracking scheme models and tracks thrombi as non-interacting solid spheres. The loose coupling between CFD and LPM is integrated into a geometric shape optimization scheme which aims to optimize an objective function that targets a drop in cerebral embolization, and an overall reduction in particle residence times. RESULTS The results elucidate the importance of OG anastomosis orientation and placement particularly in the case that studied particle release from the OG, as a fivefold decrease in cerebral embolization was observed between the optimal and non-optimal implantations. Another case considered particle release from the ventricle and aortic root walls, in which optimal implantation was achieved with a shallow insertion angle. Particle release from all three origins was investigated in the third case, demonstrating that the optimal configurations were generally characterized by VAD flow directed along the central lumen of the aortic arch. Because optimal configurations depended on the anatomic origin of the thrombus, it is important to determine, in clinical studies, the most likely sites of thrombus formation in VAD patients.
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Affiliation(s)
- Abubakar Dankano
- Department of Mechanical and Aerospace Engineering, University of Central Florida, 4000 Central Florida Blvd, Orlando, FL 32816, United States.
| | - Ray Prather
- Arnold Palmer Children's Hospital, 92 West Miller St, Orlando, FL 32806, United States
| | - Blake Lozinski
- Department of Mechanical and Aerospace Engineering, University of Central Florida, 4000 Central Florida Blvd, Orlando, FL 32816, United States
| | - Eduardo Divo
- Department of Mechanical Engineering, Embry-Riddle Aeronautical University, 600 South Clyde Morris Blvd, Daytona Beach, FL 32114, United States
| | - Alain Kassab
- Department of Mechanical and Aerospace Engineering, University of Central Florida, 4000 Central Florida Blvd, Orlando, FL 32816, United States
| | - William DeCampli
- College of Medicine, University of Central Florida, Arnold Palmer Children's Hospital, 92 West Miller St, Orlando, FL 32806, United States
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24
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Soma J. Can the hemodynamic model in heart failure be restored based on analysis of ventricular-arterial coupling? Heart Fail Rev 2024; 29:463-464. [PMID: 38040918 DOI: 10.1007/s10741-023-10374-7] [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: 11/23/2023] [Indexed: 12/03/2023]
Abstract
The hemodynamic model was inappropriate to explain the disappointing effect of vasodilation and the beneficial effect of beta-blockade in chronic heart failure. A more nuanced hemodynamic analysis, taking both steady and pulsatile hemodynamics into consideration, improves insight into these apparently enigmatic effects. Of particular interest is the velocity of early systolic flow as a determinant of left ventricular afterload. Several drugs, in particular beta-blockers, directly or indirectly, influence the velocity of early systolic flow. Thus, the hemodynamic model in heart failure may deserve reconsideration.
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Affiliation(s)
- Johannes Soma
- Consulting Cardiologist, Medical Department, Section of Cardiology, Central Hospital Vestfold, Tønsberg, 3103, Norway.
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25
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Pérez-Sanz TM, Gómez-Salvador I, Codina P, Calvo Antón B, de la Torre Carpente MM, Redondo Bermejo B, Tapia Ballesteros C. Soluble ST2, BCN-Bio-HF calculator and MAGGIC-HF score in long-term risk prediction after an urgent visit for heart failure. Heart Vessels 2024; 39:216-225. [PMID: 37872307 DOI: 10.1007/s00380-023-02327-9] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Accepted: 09/28/2023] [Indexed: 10/25/2023]
Abstract
Soluble ST2 (sST2) is the expression of a pathogenic process related to adverse remodeling that ultimately leads to increased mortality in heart failure (HF). Risk score models provide a comprehensive approach for mortality prediction, beyond the use of biomarkers alone. The objective was to determine the additional value of sST2 and two well-validated contemporary risk scores, BCN-Bio-HF and MAGGIC-HF, in predicting mortality and readmission in the acute setting. This prospective study included 129 patients (mean age 75 ± 9 years; 52% males) after an urgent HF visit. Baseline sST2 levels were measured and the two risk scores were calculated. The primary endpoint was all-cause mortality, and the secondary endpoint was HF readmissions. The follow-up period was 3.6 ± 1.9 years. Patients who died (46%) had higher sST2 concentrations (80.5 vs. 42.7 ng/ml; p < 0.001). The BCN-Bio-HF calculator with sST2 demonstrated the best discriminative ability for mortality prediction (area under the ROC curve: 0.792; p < 0.001). In multivariate analysis for each risk score, the MAGGIC-HF score retained its predictive value only in the model without sST2 (3-year risk: HR = 1.036; 95% CI 1.019-1.054; p < 0.001). However, the BCN-Bio-HF score maintained its prognostic value with sST2 (HR = 1.032; 95%CI 1.020-1.044; p < 0.001), as well as without sST2 (HR = 1.035; 95% CI 1.021-1.049; p < 0.001). sST2 was not associated with readmission, and only the BCN-Bio-HF risk of HF hospitalization showed independent predictive value (OR = 1.040; 95% CI 1.005-1.076; p = 0.023). For predicting long-term mortality in HF in the emergency department, the BCN-Bio-HF calculator with sST2 demonstrated superior discrimination and allows estimation of the risk of HF hospitalizations.
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Affiliation(s)
- Teresa Miriam Pérez-Sanz
- Cardiology Service, University Hospital Río Hortega, Valladolid, Spain.
- Department of Medicine, Universidad de Valladolid, Valladolid, Spain.
| | - Itziar Gómez-Salvador
- Cardiology Service, CIBERCV (Biomedical Research Centre in the Cardiovascular Diseases Network), University Clinic Hospital, Valladolid, Spain
| | - Pau Codina
- Heart Failure Clinic and Cardiology Service, University Hospital Germans Trias I Pujol, Badalona, Spain
- Department of Medicine, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Beatriz Calvo Antón
- Clinical Analysis Service, University Hospital Río Hortega, Valladolid, Spain
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Sarkar A, Sanchez-Nadales A, Kunutsor SK, Hanna MA, Asher CR, Wolinsky DG. Outcomes of Octogenarian Patients Treated with Tafamidis for Transthyretin Amyloid Cardiomyopathy. Am J Cardiol 2024; 214:144-148. [PMID: 38306809 DOI: 10.1016/j.amjcard.2023.08.036] [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: 06/25/2023] [Revised: 07/28/2023] [Accepted: 08/01/2023] [Indexed: 02/04/2024]
Abstract
Patients with transthyretin amyloid cardiomyopathy (ATTR-CM) benefit from disease-modifying agents such as tafamidis. However, the survival benefit of tafamidis in elderly patients (age ≥80 years) is not reported. This study aimed to assess the survival of patients with ATTR-CM aged 80 years and older who were treated with tafamidis compared with patients aged <80 years. We conducted a retrospective analysis of patients with ATTR-CM who underwent tafamidis treatment, aged 45 to 97 years at the time of diagnosis between January 1, 2008, and May 31, 2021. A total of 484 patients were included, with 208 in the ≥80 years group and 276 in the <80 years group. The cohort was followed up for mortality outcomes, and hazard ratios with 95% confidence intervals were calculated. After a median follow-up of 18.5 months, 72 deaths were recorded in the entire cohort. Kaplan-Meier curves showed no differences in survival probability between the 2 groups at 30 months (p for log-rank test = 0.76). The survival rates for patients aged ≥80 years who underwent treatment at 1, 2, 3, 4, and 5 years were 94.7%, 86.0%, 77.0%, 77.0%, and 38.5%, respectively. The corresponding rates for patients aged <80 years who underwent treatment were 93.2, 84.8, 74.4, 68.2, and 64.6%, respectively. In the multivariable analysis, the hazard ratio (95% confidence interval) of the mortality comparing treatment patients aged ≥80 years with those aged <80 years was 0.81 (0.41 to 1.61). In conclusion, tafamidis treatment is associated with similar reductions in mortality in older and younger patients with ATTR-CM.
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Affiliation(s)
- Abdullah Sarkar
- Robert and Suzanne Tomsich Department of Cardiovascular Disease, Sydell and Arnold Miller Family Heart, Vascular and Thoracic Institute, Cleveland Clinic Florida, Weston, Florida
| | - Alejandro Sanchez-Nadales
- Robert and Suzanne Tomsich Department of Cardiovascular Disease, Sydell and Arnold Miller Family Heart, Vascular and Thoracic Institute, Cleveland Clinic Florida, Weston, Florida
| | - Setor K Kunutsor
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Gwendolen Road, Leicester, United Kingdom
| | - Mazen A Hanna
- Section of Heart Failure and Cardiac Transplantation Medicine, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Craig R Asher
- Robert and Suzanne Tomsich Department of Cardiovascular Disease, Sydell and Arnold Miller Family Heart, Vascular and Thoracic Institute, Cleveland Clinic Florida, Weston, Florida
| | - David G Wolinsky
- Robert and Suzanne Tomsich Department of Cardiovascular Disease, Sydell and Arnold Miller Family Heart, Vascular and Thoracic Institute, Cleveland Clinic Florida, Weston, Florida.
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27
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Jamialahmadi T, Hasanpour M, Vakilian F, Penson PE, Iranshahy M, Sahebkar A. Evaluation of Urolithin A Efficacy in Heart Failure Patients with Reduced Ejection Fraction: A Randomized, Double-blind, Crossover, Placebo-controlled Clinical Trial. Rev Recent Clin Trials 2024; 19:RRCT-EPUB-138631. [PMID: 38415449 DOI: 10.2174/0115748871279354240209101604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 01/16/2024] [Accepted: 01/23/2024] [Indexed: 02/29/2024]
Abstract
BACKGROUND Mitochondrial dysfunction and impaired mitophagy are integral to myocyte loss and the progression of heart failure. Urolithin A (UA), a microbiota-produced metabolite of ellagitannins and ellagic acid, is a known stimulator of mitophagy and mitochondrial biogenesis that has shown cardioprotective effects in experimental models. METHODS A randomized, double-blind, placebo-controlled 2×2 crossover trial was conducted on 10 patients with HF with reduced ejection fraction (HFrEF). The trial design involved two 4- week intervention periods of UA (500 mg BID) and placebo, separated by a 2-week washout phase. The patients underwent two-dimensional echocardiogram examination as well as blood sampling at the beginning and end of each period. RESULTS All patients completed the study. The results failed to reveal any significant effect of UA supplementation on echocardiographic measures (LVEF, LVEDD, LVESV, and TAPSE). Plasma concentrations of pro-BNP, glucose, and CRP (p >0.05) were also not altered. Serum HDL-C levels were increased with UA compared with placebo (+6.46±2.33 mg/dL, p =0.026), whereas other lipid indices (LDL-C, triglycerides, total cholesterol, and VLDL-C) remained unchanged (p >0.05). CONCLUSION The results of the present study do not support any positive effect of UA supplementation in improving echocardiographic and biochemical indices of HFrEF. Further studies with higher doses of UA and longer supplementation duration are encouraged to be conducted. CLINICAL TRIAL REGISTRATION NUMBER IRCT20210216050375N1.
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Affiliation(s)
- Tannaz Jamialahmadi
- Medical Toxicology Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Maede Hasanpour
- Biotechnology Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran
- Department of Pharmacognosy and Medicinal Plants Research Center, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Farveh Vakilian
- Atherosclerosis Prevention Research Centre, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Peter E Penson
- School of Pharmacy and Biomolecular Sciences, Liverpool John Moores University, Liverpool, United Kingdom
| | - Milad Iranshahy
- Department of Pharmacognosy, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Amirhossein Sahebkar
- Applied Biomedical Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
- Biotechnology Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran
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28
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Berthelot E, Eliahou L, Jagu A, Damy T, Hanon O, Hulot JS, Meune C, Roig C, Roubille F, Sabouret P, Logeart D, Mewton N. [Natriuretic peptides in the diagnosis and monitoring of heart failure]. Rev Prat 2024; 74:185-193. [PMID: 38415425] [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] [Subscribe] [Scholar Register] [Indexed: 02/29/2024]
Abstract
NATRIURETIC PEPTIDES IN THE DIAGNOSIS AND MONITORING OF CARDIAC FAILURE. Heart failure (HF) is a serious and common disease requiring a prompt diagnosis for appropriate management. Natriuretic peptides, such as BNP and NT-proBNP, play a crucial role in diagnosing HF due to their s pecificity and reproducibility. It is important to measuring natriuretic peptides, especially in cases of acute dyspnea, to differentiate cardiac causes from others. Specific thresholds are recommended, with high values strongly suggest HF, while normal levels rule out the diagnosis. Clinical characteristics, such as age, renal function, atrial fibrillation, obesity, and gender, influence natriuretic peptides levels and should be considered in interpretation. For diabetic, hypertensive, and obese patients, early screening for HF through natriuretic peptides measurement is crucial. Furthermore, these natriuretic peptides are useful for monitoring chronic heart failure patients. They assist in confirming decompensation, titrating treatment, evaluating treatment response, and establishing prognosis. However, it's essential to choose a single biomarker (BNP or NT-proBNP) to avoid confusion.
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Affiliation(s)
| | - Ludivine Eliahou
- Centre national de référence pour le syndrome de Marfan et les maladies apparentées, VASCERN HTAD European Reference Centre, AP-HP, hôpital Bichat-Claude-Bernard, Paris, France. Service de cardiologie, AP-HP, hôpital Bichat-Claude-Bernard, Paris, France
| | - Annabelle Jagu
- Service de cardiologie, groupe hospitalier Paris Saint-Joseph, Paris, France
| | - Thibaud Damy
- Service de cardiologie, Center for Cardiac Amyloidosis, GRC Amyloid Research Institute, DHU A-TVB, AP-HP CHU Henri-Mondor et université Paris-Est Créteil, France
| | - Olivier Hanon
- EA4468 université de Paris, service de gériatrie, hôpital Broca, AP-HP, Hôpitaux universitaires Paris Centre, France
| | | | - Christophe Meune
- Service de cardiologie, hôpital Avicenne, AP-HP, université de Paris, Paris, France
| | - Clemence Roig
- Service de cardiologie, Institut mutualiste Montsouris, Paris, France
| | - François Roubille
- INSERM U661, Montpellier, France. hôpital Arnaud-de-Villeneuve, université de Montpellier-1 et 2, Montpellier, France
| | - Pierre Sabouret
- Département de cardiologie médicale de l'Institut de cardiologie de Paris et Collège national des cardiologues français, hôpital La Pitié-Salpêtrière, université La Sorbonne, Paris, France
| | - Damien Logeart
- Service de cardiologie, AP-HP, hôpital Lariboisière, Paris, France, université de Paris, Paris, France
| | - Nathan Mewton
- Hôpital cardiovasculaire Louis-Pradel, centre d'investigation clinique INSERM 1407, service insuffisance cardiaque, Hospices civils de Lyon ; université Claude-Bernard Lyon-1, INSERM U1060 CarMeN, Lyon, France
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Zhang H, Zhao L, Wang H, Yi Y, Hui K, Zhang C, Ma X. Radiomics from Cardiovascular MR Cine Images for Identifying Patients with Hypertrophic Cardiomyopathy at High Risk for Heart Failure. Radiol Cardiothorac Imaging 2024; 6:e230323. [PMID: 38385758 PMCID: PMC10912890 DOI: 10.1148/ryct.230323] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Revised: 12/07/2023] [Accepted: 01/17/2024] [Indexed: 02/23/2024]
Abstract
Purpose To develop a model integrating radiomics features from cardiac MR cine images with clinical and standard cardiac MRI predictors to identify patients with hypertrophic cardiomyopathy (HCM) at high risk for heart failure (HF). Materials and Methods In this retrospective study, 516 patients with HCM (median age, 51 years [IQR: 40-62]; 367 [71.1%] men) who underwent cardiac MRI from January 2015 to June 2021 were divided into training and validation sets (7:3 ratio). Radiomics features were extracted from cardiac cine images, and radiomics scores were calculated based on reproducible features using the least absolute shrinkage and selection operator Cox regression. Radiomics scores and clinical and standard cardiac MRI predictors that were significantly associated with HF events in univariable Cox regression analysis were incorporated into a multivariable analysis to construct a combined prediction model. Model performance was validated using time-dependent area under the receiver operating characteristic curve (AUC), and the optimal cutoff value of the combined model was determined for patient risk stratification. Results The radiomics score was the strongest predictor for HF events in both univariable (hazard ratio, 10.37; P < .001) and multivariable (hazard ratio, 10.25; P < .001) analyses. The combined model yielded the highest 1- and 3-year AUCs of 0.81 and 0.80, respectively, in the training set and 0.82 and 0.77 in the validation set. Patients stratified as high risk had more than sixfold increased risk of HF events compared with patients at low risk. Conclusion The combined model with radiomics features and clinical and standard cardiac MRI parameters accurately identified patients with HCM at high risk for HF. Keywords: Cardiomyopathies, Outcomes Analysis, Cardiovascular MRI, Hypertrophic Cardiomyopathy, Radiomics, Heart Failure Supplemental material is available for this article. © RSNA, 2024.
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Affiliation(s)
- Hongbo Zhang
- From the Department of Interventional Diagnosis and Treatment (H.Z.,
K.H., C.Z., X.M.) and Department of Radiology (H.Z., L.Z., Y.Y., K.H.), Beijing
Anzhen Hospital, Capital Medical University, 2nd Anzhen Road, Chaoyang District,
Beijing 100020, China; and Department of Radiology, Children’s Hospital
of Chongqing Medical University, National Clinical Research Center for Child
Health and Disorders, Ministry of Education Key Laboratory of Child Development
and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
(H.W.)
| | - Lei Zhao
- From the Department of Interventional Diagnosis and Treatment (H.Z.,
K.H., C.Z., X.M.) and Department of Radiology (H.Z., L.Z., Y.Y., K.H.), Beijing
Anzhen Hospital, Capital Medical University, 2nd Anzhen Road, Chaoyang District,
Beijing 100020, China; and Department of Radiology, Children’s Hospital
of Chongqing Medical University, National Clinical Research Center for Child
Health and Disorders, Ministry of Education Key Laboratory of Child Development
and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
(H.W.)
| | - Haoru Wang
- From the Department of Interventional Diagnosis and Treatment (H.Z.,
K.H., C.Z., X.M.) and Department of Radiology (H.Z., L.Z., Y.Y., K.H.), Beijing
Anzhen Hospital, Capital Medical University, 2nd Anzhen Road, Chaoyang District,
Beijing 100020, China; and Department of Radiology, Children’s Hospital
of Chongqing Medical University, National Clinical Research Center for Child
Health and Disorders, Ministry of Education Key Laboratory of Child Development
and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
(H.W.)
| | - Yuhan Yi
- From the Department of Interventional Diagnosis and Treatment (H.Z.,
K.H., C.Z., X.M.) and Department of Radiology (H.Z., L.Z., Y.Y., K.H.), Beijing
Anzhen Hospital, Capital Medical University, 2nd Anzhen Road, Chaoyang District,
Beijing 100020, China; and Department of Radiology, Children’s Hospital
of Chongqing Medical University, National Clinical Research Center for Child
Health and Disorders, Ministry of Education Key Laboratory of Child Development
and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
(H.W.)
| | - Keyao Hui
- From the Department of Interventional Diagnosis and Treatment (H.Z.,
K.H., C.Z., X.M.) and Department of Radiology (H.Z., L.Z., Y.Y., K.H.), Beijing
Anzhen Hospital, Capital Medical University, 2nd Anzhen Road, Chaoyang District,
Beijing 100020, China; and Department of Radiology, Children’s Hospital
of Chongqing Medical University, National Clinical Research Center for Child
Health and Disorders, Ministry of Education Key Laboratory of Child Development
and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
(H.W.)
| | - Chen Zhang
- From the Department of Interventional Diagnosis and Treatment (H.Z.,
K.H., C.Z., X.M.) and Department of Radiology (H.Z., L.Z., Y.Y., K.H.), Beijing
Anzhen Hospital, Capital Medical University, 2nd Anzhen Road, Chaoyang District,
Beijing 100020, China; and Department of Radiology, Children’s Hospital
of Chongqing Medical University, National Clinical Research Center for Child
Health and Disorders, Ministry of Education Key Laboratory of Child Development
and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
(H.W.)
| | - Xiaohai Ma
- From the Department of Interventional Diagnosis and Treatment (H.Z.,
K.H., C.Z., X.M.) and Department of Radiology (H.Z., L.Z., Y.Y., K.H.), Beijing
Anzhen Hospital, Capital Medical University, 2nd Anzhen Road, Chaoyang District,
Beijing 100020, China; and Department of Radiology, Children’s Hospital
of Chongqing Medical University, National Clinical Research Center for Child
Health and Disorders, Ministry of Education Key Laboratory of Child Development
and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
(H.W.)
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Rivera-Toquica A, Saldarriaga C, Buelvas-Herazo J, Rolong B, Manzur-Jatin F, Mosquera-Jimenez JI, Pacheco-Jimenez OA, Rodriguez-Ceron AH, Rodriguez-Gomez P, Rivera-Toquica F, Trout-Guardiola G G, De Leon-Espitia MA, Castro-Osorio EE, Echeverria LE, Gomez-Mesa JE. Characteristics and Outcomes of Atrial Fibrillation in Chronic Heart Failure Patients: A Comprehensive Analysis of the Colombian Heart Failure Registry. Cardiol Res 2024; 15:37-46. [PMID: 38464710 PMCID: PMC10923258 DOI: 10.14740/cr1589] [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: 10/30/2023] [Accepted: 12/02/2023] [Indexed: 03/12/2024] Open
Abstract
Background Heart failure (HF) and atrial fibrillation (AF) represent conditions that commonly coexist. The impact of AF in HF has yet to be well studied in Latin America. This study aimed to characterize the sociodemographic and clinical features, along with patients' outcomes with AF and HF from the Colombian Heart Failure Registry (RECOLFACA). Methods Patients with ambulatory HF and AF were included in RECOLFACA, mainly with persistent or permanent AF. A 6-month follow-up was performed. Primary outcome was all-cause mortality. To assess the impact of AF on mortality, we used a logistic regression model. A P value of < 0.05 was considered significant. All statistical tests were two-tailed. Results Of 2,528 patients with HF in the registry, 2,514 records included information regarding AF diagnosis. Five hundred sixty (22.3%) were in AF (mean age 73 ± 11, 56% men), while 1,954 had no AF (mean age 66 ± 14 years, 58% men). Patients with AF were significantly older and had a different profile of comorbidities and implanted devices compared to non-AF patients. Moreover, AF diagnosis was associated with lower quality of life score (EuroQol-5D), mainly in mobility, personal care, and daily activity. AF was prevalent in patients with preserved ejection fraction (EF), while no significant differences in N-terminal prohormone of brain natriuretic peptide (NT-proBNP) levels were observed. Although higher mortality was observed in the AF group compared to individuals without AF (8.9% vs. 6.1%, respectively; P = 0.016), this association lost statistical significance after adjusting by age in a multivariate regression model (odds ratio (OR): 1.35; 95% confidence interval (CI): 0.95 - 1.92). Conclusions AF is more prevalent in HF patients with higher EF, lower quality of life and different clinical profiles. Similar HF severity and non-independent association with mortality were observed in our cohort. These results emphasize the need for an improved understanding of the AF and HF coexistence phenomenon.
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Affiliation(s)
- Alex Rivera-Toquica
- Department of Cardiology, Centro Medico para el Corazon, Pereira, Colombia
- Department of Cardiology, Clinica Los Rosales S.A., Pereira, Colombia
- Department of Cardiology, Universidad Tecnologica de Pereira, Pereira, Colombia
| | | | | | - Balkis Rolong
- Department of Cardiology, Cardiologia Integral, Barranquilla, Colombia
| | | | | | | | | | | | - Fernando Rivera-Toquica
- Department of Internal Medicine, Clinica Los Rosales S.A., Pereira, Colombia
- Department of Internal Medicine, IPS Virrey Solis, Pereira, Colombia
| | | | | | | | | | - Juan Esteban Gomez-Mesa
- Department of Cardiology, Fundacion Valle del Lili, Cali, Colombia
- Department of Health Sciences, Universidad Icesi, Cali, Colombia
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Cheng R, Kittleson MM, Wechalekar AD, Alvarez-Cardona J, Mitchell JD, Scarlatelli Macedo AV, Dutra JPP, Campbell CM, Liu JE, Landau HJ, Davis MK, Morrissey S, Casselli S, Lousada I, Seabra-Garcez JD, Szor RS, Ganatra S, Trachtenberg B, Maurer MS, Stockerl-Goldstein K, Lenihan D. Moving towards establishing centres of excellence in cardiac amyloidosis: an International Cardio-Oncology Society statement. Heart 2024:heartjnl-2023-323502. [PMID: 38267197 DOI: 10.1136/heartjnl-2023-323502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Accepted: 01/11/2024] [Indexed: 01/26/2024] Open
Abstract
The prevalence of amyloidosis has been increasing, driven by a combination of improved awareness, evolution of diagnostic pathways, and effective treatment options for both transthyretin and light chain amyloidosis. Due to the complexity of amyloidosis, centralised expert providers with experience in delineating the nuances of confirmatory diagnosis and management may be beneficial. There are many potential benefits of a centre of excellence designation for the treatment of amyloidosis including recognition of institutions that have been leading the way for the optimal treatment of this condition, establishing the expectations for any centre who is engaging in the treatment of amyloidosis and developing cooperative groups to allow more effective research in this disease space. Standardising the expectations and criteria for these centres is essential for ensuring the highest quality of clinical care and community education. In order to define what components are necessary for an effective centre of excellence for the treatment of amyloidosis, we prepared a survey in cooperation with a multidisciplinary panel of amyloidosis experts representing an international consortium. The purpose of this position statement is to identify the essential elements necessary for highly effective clinical care and to develop a general standard with which practices or institutions could be recognised as a centre of excellence.
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Affiliation(s)
- Richard Cheng
- Division of Cardiology, University of Washington, Seattle, Washington, USA
| | | | - Ashutosh D Wechalekar
- National Amyloidosis Centre, University College London (Royal Free Campus), London, UK
| | - Jose Alvarez-Cardona
- Cardiology, New York University Grossman School of Medicine, New York, New York, USA
| | - Joshua D Mitchell
- Cardiology/IM, Washington University in St Louis, St Louis, Missouri, USA
| | | | - Joao Pedro Passos Dutra
- Center for Oncological Research (CEPON) and SOS Cardio Hospital in Florianópolis, Santa Catarina, Brazil
| | - Courtney M Campbell
- Baylor Scott and White Heart and Vascular Hospital, Baylor University Medical Center, Dallas, Texas, USA
| | - Jennifer E Liu
- Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Heather J Landau
- Oncology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Margot K Davis
- Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
| | | | | | | | | | | | - Sarju Ganatra
- Lahey Hospital and Medical Center, Burlington, Massachusetts, USA
| | | | - Mathew S Maurer
- Center for Advanced Cardiac Care, Columbia University Medical Center, New York, New York, USA
| | | | - Daniel Lenihan
- Cardiology, International Cardio-Oncology Society and St Frances Healthcare, Cape Girardeau, Missouri, USA
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Iddagoda Hewage Don SP, Kuruppu KCN, Dunuwille A, Wijewardena A, Gunawardena R. Clinical characteristics and outcome of cardiac resynchronization therapy for heart failure in National Hospital of Sri Lanka from year 2005 to 2020 - a retrospective observational study. BMC Cardiovasc Disord 2024; 24:69. [PMID: 38262994 PMCID: PMC10804476 DOI: 10.1186/s12872-024-03719-z] [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] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 01/06/2024] [Indexed: 01/25/2024] Open
Abstract
BACKGROUND Cardiac resynchronization therapy (CRT) has been a well-established treatment modality for moderate to severe left ventricular systolic dysfunction with left ventricular desynchrony. This is the pioneering study that analyses the cohort who underwent CRT implantation at the National Hospital of Sri Lanka (NHSL) in Colombo from 2005 to 2020. OBJECTIVES This study was carried out to describe socio-demographic factors, improvements in clinical outcome (symptoms, electrocardiographic, and echocardiographic features), and post-CRT complications in the study population, as well as to determine the efficacy of CRT in heart failure. METHOD A retrospective observational study was conducted on all the living patients who had undergone CRT implantation from 2005 to 2020. The data was gathered from all the consented patients who visited the device programming clinic using a physician-administered questionnaire and clinical records. Data was analyzed using SPSS 25, and significant statistics were assessed with the McNemer test, the Student T test, and the Chi-Squared test. RESULTS The study included 50 patients with a mean age of 52.82+/- 11.66 years and female predominance (56%, n = 28). Idiopathic dilated cardiomyopathy (50%, n = 25) was the leading etiological factor, followed by ischemic cardiomyopathy (28%, n = 14). Clinical symptoms have improved significantly with CRT implantation (p < 0.001). A significant improvement was found in NYHA functional class (p < 0.001, 95% CI = 0.072 to 0.284), QRS width (p < 0.001, 95% CI = 0.229 to 0.534), ejection fraction (p < 0.001, 95% CI = - 16.437 to - 8.504), and LV EDD (p < 0.001, 95% CI = 2.89 to 9.24). Post-CRT complications included lead malfunction (6%, n = 3) and chronic (14%, n = 7), bleeding or hematoma (2%, n = 1), pocket erosion or infection (6%, n = 3), and infective endocarditis (2%, n = 1). CONCLUSION According to the study, CRT significantly improves both clinical and functional outcomes in patients with moderate to severe heart failure.
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Affiliation(s)
| | | | - Asunga Dunuwille
- Cardiac Electrophysiology Unit, Institute of Cardiology, National Hospital of Sri Lanka, Colombo, Sri Lanka
| | - Asanka Wijewardena
- Cardiac Electrophysiology Unit, Institute of Cardiology, National Hospital of Sri Lanka, Colombo, Sri Lanka
| | - Rohan Gunawardena
- Cardiac Electrophysiology Unit, Institute of Cardiology, National Hospital of Sri Lanka, Colombo, Sri Lanka
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Han D, Kim SH, Shin DG, Kang MK, Choi S, Lee N, Kim BK, Joo HJ, Chang K, Park Y, Song YB, Ahn SG, Suh JW, Lee SY, Her AY, Jeong YH, Kim HS, Kim MH, Lim DS, Shin ES, Cho JR. Prognostic Implication of Platelet Reactivity According to Left Ventricular Systolic Dysfunction Status in Patients Treated With Drug-Eluting Stent Implantation: Analysis of the PTRG-DES Consortium. J Korean Med Sci 2024; 39:e27. [PMID: 38258362 PMCID: PMC10803212 DOI: 10.3346/jkms.2024.39.e27] [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: 05/17/2023] [Accepted: 11/08/2023] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND Coronary artery disease patients undergoing percutaneous coronary intervention (PCI) often exhibit reduced left ventricular ejection fraction (LVEF). However, the impact of LV dysfunction status in conjunction with platelet reactivity on clinical outcomes has not been previously investigated. METHODS From the multicenter PTRG-DES (Platelet function and genoType-Related long-term prognosis in DES-treated patients) consortium, the patients were classified as preserved-EF (PEF: LVEF ≥ 50%) and reduced-EF (REF: LVEF< 5 0%) group by echocardiography. Platelet reactivity was measured using VerifyNow P2Y12 assay and high platelet reactivity (HPR) was defined as PRU ≥ 252. The major adverse cardiac and cerebrovascular events (MACCEs) were a composite of death, myocardial infarction, stent thrombosis and stroke at 5 years after PCI. Major bleeding was defined as Bleeding Academic Research Consortium bleeding types 3-5. RESULTS A total of 13,160 patients from PTRG-DES, 9,319 (79.6%) patients with the results of both PRU and LVEF were analyzed. The incidence of MACCE and major bleeding was higher in REF group as compared with PEF group (MACCEs: hazard ratio [HR] 2.17, P < 0.001, 95% confidence interval [CI] 1.85-2.55; major bleeding: HR 1.78, P < 0.001, 95% CI 1.39-2.78). The highest rate of MACCEs was found in patients with REF and HPR, and the difference between the groups was statistically significant (HR 3.14 in REF(+)/HPR(+) vs. PEF(+)/HPR(-) group, P < 0.01, 95% CI 2.51-3.91). The frequency of major bleeding was not associated with the HPR in either group. CONCLUSION LV dysfunction was associated with an increased incidence of MACCEs and major bleeding in patients who underwent PCI. The HPR status further exhibited significant increase of MACCEs in patients with LV dysfunction in a large, real-world registry. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT04734028.
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Affiliation(s)
- Donghoon Han
- Cardiology Division, Department of Internal Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Sun-Hwa Kim
- Department of Internal Medicine, Seoul National University College of Medicine and Department of Cardiology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Dong Geum Shin
- Cardiology Division, Department of Internal Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Min-Kyung Kang
- Cardiology Division, Department of Internal Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Seonghoon Choi
- Cardiology Division, Department of Internal Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Namho Lee
- Cardiology Division, Department of Internal Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Byeong-Keuk Kim
- Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Hyung Joon Joo
- Department of Cardiology, Cardiovascular Center, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Kiyuk Chang
- Division of Cardiology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Yongwhi Park
- Department of Internal Medicine, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Jinju, Korea
| | - Young Bin Song
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sung Gyun Ahn
- Department of Cardiology, Yonsei University Wonju Severance Christian Hospital, Wonju, Korea
| | - Jung-Won Suh
- Department of Internal Medicine, Seoul National University College of Medicine and Department of Cardiology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Sang Yeub Lee
- Division of Cardiology, Chung-Ang University Gwangmyeong Hospital, Gwangmyeong and Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Korea
| | - Ae-Young Her
- Division of Cardiology, Department of Internal Medicine, Kangwon National University College of Medicine, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Young-Hoon Jeong
- Division of Cardiology, Chung-Ang University Gwangmyeong Hospital, Gwangmyeong and Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Korea
| | - Hyo-Soo Kim
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Korea
| | - Moo Hyun Kim
- Department of Cardiology, Dong-A University Hospital, Busan, Korea
| | - Do-Sun Lim
- Department of Cardiology, Cardiovascular Center, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Eun-Seok Shin
- Division of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Jung Rae Cho
- Cardiology Division, Department of Internal Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea.
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Forsyth P, Young S, Hughes K, James R, Oxley C, Kelly R, Jones R, Briggs S, Mackay-Thomas L, Millerick Y, Simpson M, Taylor CJ, Beggs S, Piper S, Duckett S. Multiprofessional heart failure self-development framework. Open Heart 2024; 11:e002554. [PMID: 38242561 PMCID: PMC10806483 DOI: 10.1136/openhrt-2023-002554] [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: 12/25/2023] [Indexed: 01/21/2024] Open
Abstract
OBJECTIVE Heart failure remains a key public health priority across the globe. The median age of people with heart failure admitted to hospital in the UK is 81 years old. Many such patients transcend the standard interventions that are well characterised and evidenced in guidelines, into holistic aspects surrounding frailty, rehabilitation and social care. Previous published competency frameworks in heart failure have focused on the value of doctors, nurses and pharmacists. We aimed to provide an expert consensus on the minimum heart failure-specific competencies necessary for multiple different healthcare professionals, including physiotherapists, occupational therapists, dietitians and cardiac physiologists. METHODS The document has been developed focussing on four main parts, (1) establishing a project working group of expert professionals, (2) a literature review of previously existing published curricula and competency frameworks, (3) consensus building, which included developing a structure to the framework with ongoing review of the contents to adapt and be inclusive for each specialty and (4) write up and dissemination to widen the impact of the project. RESULTS The final competency framework displays competencies across seven sections; knowledge (including subheadings on heart failure syndrome, diagnosis and clinical management); general skills; heart failure-specific skills; clinical autonomy; multidisciplinary team working; teaching and education; and research and development. CONCLUSION People with heart failure can be complex and have needs that require input from a broad range of specialties. This publication focuses on the vital impact of wider multidisciplinary groups and should help define the generic core heart failure-specific competencies needed to support future pipelines of professionals, who regularly interact with and deliver care for patients with heart failure.
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Affiliation(s)
- Paul Forsyth
- Pharmacy, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Susan Young
- Physiotherapy, Aneurin Bevan University Health Board, Newport, UK
| | - Kirsty Hughes
- Physiotherapy, Forth Valley Royal Hospital, Larbert, UK
| | - Ruby James
- Occupational Therapy, Cwm Taf Morgannwg University Health Board, Abercynon, UK
| | - Cheryl Oxley
- Cardiac Physiology Services, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, UK
| | - Ruth Kelly
- Cardiac Physiology Services, Golden Jubilee National Hospital, Clydebank, UK
| | - Rebecca Jones
- Dietetics, St George's University Hospitals NHS Foundation Trust, London, UK
| | | | | | | | | | - Clare J Taylor
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | | | - Susan Piper
- Cardiology, King's College Hospital, London, UK
| | - Simon Duckett
- Department of Cardiology, Royal Stoke University Hospital, Stoke-on-Trent, UK
- Department of Cardiology, Keele University, Keele, UK
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Nurzhanova M, Musagaliyeva A, Zhakypova R, Senkibayeva D, Rakisheva A. Use of sacubitril/valsartan early after CABG. Open Heart 2024; 11:e002492. [PMID: 38238027 PMCID: PMC10806467 DOI: 10.1136/openhrt-2023-002492] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 01/03/2024] [Indexed: 01/23/2024] Open
Abstract
BACKGROUND Heart failure (HF) remains a major public health problem with a high mortality and morbidity worldwide. Currently, there is no optimal revascularisation strategy for patients with ischaemic cardiomyopathy despite suggestions that coronary artery bypass graft (CABG) may be superior to medical therapy in improving survival. However, CABG may be associated with substantial risk in HF subjects. We therefore aimed to evaluate the safety and efficacy of the early initiation of sacubitril/valsartan in haemodynamically stabilised patients with HF with reduced ejection fraction (HFrEF) after early CABG. METHODS This was an open-label study in which ~80 patients after CABG were randomised either to the early or late initiation of the sacubitril-valsartan. The study included patients >40 years with left ventricular ejection fraction <45% and New York Heart Association (NYHA) class II-IV at the early stage after CABG. Patients underwent intervention, the starting dose of sacubitril/valsartan (24/26 mg or 49/51 mg two times per day). The follow-up took place every 4 weeks except the first visit, which took place in 2 weeks after initiation. The primary endpoint assessed the key safety outcomes, the secondary endpoints were: the quality of life measured, the N-terminal pro-B-type natriuretic peptide (NT-proBNP) changes and 6 min walk test (6MWT). RESULTS In total, 83 patients were screened and 77 patients were enrolled. The majority of patients (84.4%) were in the NYHA class III at randomisation. The number of patients who discontinued the study was low in both groups (2.5%, 5.2%), and renal function, hyperkalaemia and symptomatic hypotension rarely seen in both groups did not differ significantly. The improvement in quality of life and distance at the 6MWT in both groups was significant (p<0.001). The NT-proBNP concentration decreased in both groups, the significant reduction was in the early group (p<0.001) versus the postdischarge group. CONCLUSIONS The early initiation of sacubitril/valsartan in patients after CABG with HFrEF is safe and effective. Adverse events and permanent discontinuation were low. The NT-proBNP concentration reduced significantly with the early in-hospital initiation.
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Affiliation(s)
- Madina Nurzhanova
- Scientific Research Institute of Cardiology and Internal Diseases, Almaty, Kazakhstan
- Kazakhstan Medical University 'Graduate School of Public Health', Almaty, Kazakhstan
| | - Aisulu Musagaliyeva
- Scientific Research Institute of Cardiology and Internal Diseases, Almaty, Kazakhstan
| | - Raushan Zhakypova
- Scientific Research Institute of Cardiology and Internal Diseases, Almaty, Kazakhstan
| | - Daniya Senkibayeva
- Scientific Research Institute of Cardiology and Internal Diseases, Almaty, Kazakhstan
| | - Amina Rakisheva
- Scientific Research Institute of Cardiology and Internal Diseases, Almaty, Kazakhstan
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Abdul khalek E, Abdel-Khalek El-Bahnasy H, Alshahat Omar M, Ibrahim Elraghy M, Ahmed Dabash TA, S. Berengy M, Abozid E, Reihan MS. Heart Failure and Echocardiography Derived Myocardial Wall Stress Link in Diabetic Cases with Acute Myocardial Infarction Managed by Revascularization. Med J Islam Repub Iran 2024; 38:3. [PMID: 38434228 PMCID: PMC10907044 DOI: 10.47176/mjiri.38.3] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Indexed: 03/05/2024] Open
Abstract
Background Diabetes is associated with left ventricular remodeling. Myocardial wall stress is a measurable factor connected to the ventricular breadth and force and is related to myocardial thickness; it can be measured by echocardiography. The present study aimed to assess the link between heart failure (HF) and echocardiography-derived myocardial wall stress in diabetic patients with ST elevation myocardial infarction (STEMI) who were managed with revascularization. Methods This study was a comparative prospective study that took place between February 2022 and February 2023. It included 100 diabetic patients presented with STEMI and managed by percutaneous coronary intervention (PCI). Patients were selected from the cardiology departments at Al-Azhar University Hospital, Damietta, Egypt. During the hospital stay, patients were checked for HF symptoms and signs. They were also observed for 3 months after discharge for detection of HF. Those who did not develop HF were assigned to group I, and those with HF were assigned to group II. Results The mean value of end-systolic wall stress (ESWS) was 77.09 ± 12.22 and 97 ± 13.44, and the mean value of end-diastolic wall stress (EDWS) was 12.61 ± 2.76 and 15.87 ± 2.86 in groups I and II respectively, with significant differences between the 2 groups. The cutoff point to detect HF was 88 KPa for ESWS and 13.5 KPa for EDWS, with a sensitivity of 70% and 79% and a specificity of 80% and 61% for ESWS and EDWS, respectively. Conclusion Elevated left ventricle (LV) myocardial stress is related to increased HF in diabetic patients whose HF was managed by PCI after STEMI. LV wall stress is a potentially helpful risk stratification tool using routine echocardiography to determine the treatment plane according to the risk status.
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Affiliation(s)
- Elshazly Abdul khalek
- Department of Cardiology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
- King Abdulaziz Specialist Hospital, Taif, Saudi Arabia
| | | | - Mohamad Alshahat Omar
- Department of Cardiology, Damietta Faculty of Medicine, Al-Azhar University, Damietta, Egypt
| | - Mohamed Ibrahim Elraghy
- Department of Cardiology, Damietta Faculty of Medicine, Al-Azhar University, Damietta, Egypt
| | | | - Mahmoud S. Berengy
- Department of Internal Medicine, Damietta Faculty of Medicine, Al-Azhar University, Damietta, Egypt
| | - Elsayed Abozid
- Department of Internal Medicine, Damietta Faculty of Medicine, Al-Azhar University, Damietta, Egypt
| | - Muhammad Saad Reihan
- Department of Cardiology, Faculty of Medicine, Al-Azhar University, Damietta, Egypt
- Department of Medicine, Medicine Program, Batterjee Medical College, Jeddah 21442, Saudi Arabia
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Gaur A, Carr F, Warriner D. Cardiogeriatrics: the current state of the art. Heart 2024:heartjnl-2022-322117. [PMID: 38212100 DOI: 10.1136/heartjnl-2022-322117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 12/12/2023] [Indexed: 01/13/2024] Open
Abstract
It is estimated that by 2050, 17% of the world's population will be greater than 85 years old, which, combined with cardiovascular disease (CVD) being the leading cause of death and disability, sets an unprecedented burden on our health and care systems. This perfect storm will be accompanied by a rise in the prevalence of CVD due to increased survival of patients with pre-existing CVD and the incidence of CVD that is associated with the process of ageing. In this review, we will focus on the diagnosis and management of common CVD conditions in old age, namely: heart failure (HF), coronary artery disease (CAD), atrial fibrillation (AF) and valvular heart disease (VHD). Despite limited evidence, clinical guidelines are increasingly considering the complexity of management of these conditions in the older person, which often coexist, for example, AF and HF or CAD and VHD. Furthermore, they, in turn, need specific consideration in the context of comorbidities, polypharmacy, frailty and impaired cognition found in this age group. Hence, the emerging role of the geriatric cardiologist is therefore vital in performing comprehensive geriatric assessment, attending multidisciplinary team meetings and ultimately considering the patient and the sum of their diseases in their totality. There have been recent advances in CVD management but how we apply these to deliver integrated care to the elderly population is key. This review article aims to bring together emerging studies and guidelines on assessment and management of CVD in the elderly, summarising latest definitions, diagnostics, therapeutics and future challenges.
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Affiliation(s)
- Akshay Gaur
- Department of Cardiology, Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust, Doncaster, UK
| | - Fiona Carr
- Department of Cardiology, Northern General Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
- Department of Geriatrics, Northern General Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
- Department of Infection, Immunity & Cardiovascular Disease, The Univsersity of Sheffield, Sheffield, UK
| | - David Warriner
- Department of Cardiology, Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust, Doncaster, UK
- Department of Infection, Immunity & Cardiovascular Disease, The Univsersity of Sheffield, Sheffield, UK
- Department of Adult Congenital Cardiology, Leeds General Infirmary, Leeds Teaching Hospital NHS Trust, Leeds, UK
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Kim ES, Park SK, Youn JC, Lee HS, Lee HY, Cho HJ, Choi JO, Jeon ES, Lee SE, Kim MS, Kim JJ, Hwang KK, Cho MC, Chae SC, Kang SM, Park JJ, Choi DJ, Yoo BS, Cho JY, Kim KH, Oh BH, Greenberg B, Baek SH. Real-World Eligibility and Cost-Effectiveness Analysis of Empagliflozin for Heart Failure in Korea. J Korean Med Sci 2024; 39:e8. [PMID: 38193327 PMCID: PMC10782045 DOI: 10.3346/jkms.2024.39.e8] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 10/16/2023] [Indexed: 01/10/2024] Open
Abstract
BACKGROUND The US Food and Drug Administration (FDA) and European Medicines Agency (EMA) approved empagliflozin for reducing cardiovascular mortality and heart failure (HF) hospitalization in patients with both HF with reduced ejection fraction (HFrEF) and HF with preserved ejection fraction (HFpEF). However, limited data are available on the generalizability of empagliflozin to clinical practice. Therefore, we evaluated real-world eligibility and potential cost-effectiveness based on a nationwide prospective HF registry. METHODS A total of 3,108 HFrEF and 2,070 HFpEF patients from the Korean Acute Heart Failure (KorAHF) registry were analyzed. Eligibility was estimated by inclusion and exclusion criteria of EMPagliflozin outcomE tRial in Patients With chrOnic heaRt Failure With Reduced Ejection Fraction (EMPEROR-Reduced) and EMPagliflozin outcomE tRial in Patients With chrOnic heaRt Failure With Preserved Ejection Fraction (EMPEROR-Preserved) trials and by FDA & EMA label criteria. The cost-utility analysis was done using a Markov model to project the lifetime medical cost and quality-adjusted life year (QALY). RESULTS Among the KorAHF patients, 91.4% met FDA & EMA label criteria, while 44.7% met the clinical trial criteria. The incremental cost-effectiveness ratio of empagliflozin was calculated at US$6,764 per QALY in the overall population, which is far below a threshold of US$18,182 per QALY. The cost-effectiveness benefit was more evident in patients with HFrEF (US$5,012 per QALY) than HFpEF (US$8,971 per QALY). CONCLUSION There is a large discrepancy in real-world eligibility for empagliflozin between FDA & EMA labels and clinical trial criteria. Empagliflozin is cost-effective in HF patients regardless of ejection fraction in South Korea health care setting. The efficacy and safety of empagliflozin in real-world HF patients should be further investigated for a broader range of clinical applications. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT01389843.
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Affiliation(s)
- Eui-Soon Kim
- Graduate School of Medical Science and Engineering, Korea Advanced Institute of Science and Technology, Daejeon, Korea
| | - Sun-Kyeong Park
- College of Pharmacy, The Catholic University of Korea, Bucheon, Korea
| | - Jong-Chan Youn
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary's Hospital, Catholic Research Institute for Intractable Cardiovascular Disease, College of Medicine, The Catholic University of Korea, Seoul, Korea.
| | - Hye Sun Lee
- Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, Korea
| | - Hae-Young Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
- Seoul National University School of Medicine, Seoul, Korea
| | - Hyun-Jai Cho
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
- Seoul National University School of Medicine, Seoul, Korea
| | - Jin-Oh Choi
- Department of Internal Medicine, Sungkyunkwan University College of Medicine, Seoul, Korea
| | - Eun-Seok Jeon
- Department of Internal Medicine, Sungkyunkwan University College of Medicine, Seoul, Korea
| | - Sang Eun Lee
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Min-Seok Kim
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jae-Joong Kim
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Kyung-Kuk Hwang
- Department of Internal Medicine, Chungbuk National University Hospital, Cheongju, Korea
| | - Myeong-Chan Cho
- Department of Internal Medicine, Chungbuk National University Hospital, Cheongju, Korea
| | - Shung Chull Chae
- Department of Internal Medicine, Kyungpook National University College of Medicine, Daegu, Korea
| | - Seok-Min Kang
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Jin Joo Park
- Seoul National University School of Medicine, Seoul, Korea
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Dong-Ju Choi
- Seoul National University School of Medicine, Seoul, Korea
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Byung-Su Yoo
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Jae Yeong Cho
- Department of Cardiovascular Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Kye Hun Kim
- Department of Cardiovascular Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Byung-Hee Oh
- Department of Cardiovascular medicine, Incheon Sejong Hospital, Incheon, Korea
| | - Barry Greenberg
- Department of Cardiology, UC San Diego Health System, La Jolla, CA, USA
| | - Sang Hong Baek
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary's Hospital, Catholic Research Institute for Intractable Cardiovascular Disease, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Hawkins NM, Nordon C, Rhodes K, Talukdar M, McMullen S, Ekwaru P, Pham T, Randhawa AK, Sin DD. Heightened long-term cardiovascular risks after exacerbation of chronic obstructive pulmonary disease. Heart 2024:heartjnl-2023-323487. [PMID: 38182279 DOI: 10.1136/heartjnl-2023-323487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 11/27/2023] [Indexed: 01/07/2024] Open
Abstract
OBJECTIVE To examine the risk of adverse cardiovascular (CV) events following an exacerbation of chronic obstructive pulmonary disease (COPD). METHODS This retrospective cohort study identified patients with COPD using administrative data from Alberta, Canada from 2014 to 2019. Exposure periods were 12 months following moderate or severe exacerbations; the reference period was time preceding a first exacerbation. The primary outcome was the composite of all-cause death or a first hospitalisation for acute coronary syndrome, heart failure (HF), arrhythmia or cerebral ischaemia. Time-dependent Cox regression models estimated covariate-adjusted risks associated with six exposure subperiods following exacerbation. RESULTS Among 1 42 787 patients (mean age 68.1 years and 51.7% men) 61 981 (43.4%) experienced at least one exacerbation and 34 068 (23.9%) died during median follow-up of 64 months. The primary outcome occurred in 43 564 (30.5%) patients with an incidence rate prior to exacerbation of 5.43 (95% CI 5.36 to 5.50) per 100 person-years. This increased to 95.61 per 100 person-years in the 1-7 days postexacerbation (adjusted HR 15.86, 95% CI 15.17 to 16.58) and remained increased for up to 1 year. The risk of both the composite and individual CV events was increased following either a moderate or a severe exacerbation, though greater and more prolonged following severe exacerbation. The highest magnitude of increased risk was observed for HF decompensation (1-7 days, HR 72.34, 95% CI 64.43 to 81.22). CONCLUSION Moderate and severe COPD exacerbations are independent risk factors for adverse CV events, especially HF decompensation. The impact of optimising COPD management on CV outcomes should be evaluated.
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Affiliation(s)
- Nathaniel M Hawkins
- Centre for Cardiovascular Innovation, Division of Cardiology, The University of British Columbia, Vancouver, British Columbia, Canada
| | | | | | | | | | - Paul Ekwaru
- Medlior Health Outcomes Research Ltd, Calgary, Alberta, Canada
| | - Tram Pham
- Medlior Health Outcomes Research Ltd, Calgary, Alberta, Canada
| | | | - Don D Sin
- UBC Centre for Heart Lung Innovation and Department of Medicine (Respirology), The University of British Columbia, Vancouver, British Columbia, Canada
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Chenaghlou M, Mahzoon FA, Hamzehzadeh S, Norouzi A, Sahrai H, Mohammadi N, Haghighi NK, Abdollahi M, Sadeghi MT, Banisefid E. Could admission level of uric acid predict total diuretic dose in acute heart failure? BMC Cardiovasc Disord 2024; 24:30. [PMID: 38172681 PMCID: PMC10765671 DOI: 10.1186/s12872-023-03687-w] [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] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 12/21/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Recent studies have shown that increases in serum UA levels are associated with adverse clinical outcomes in patients with chronic heart failure (CHF); the aim of this study was to determine the relationship between serum uric acid and total diuretic dose received during hospitalization in hospitalized patients with acute exacerbation of heart failure. The main purpose of this study is to determine the role of uric acid as a biomarker that can be a substitute for pro-BNP in clinical evaluation and the need for diuretics in hospitalized patients with acute heart failure. METHODS After approving the plan in the Research Council of the Heart Department and obtaining an ethical code from the Regional Committee on Research Ethics (Human Subjects Studies), the researcher referred to the archives of our center, the case of 100 patients diagnosed with acute heart failure. Cardiac patients were selected, and the information required for the study was collected using a pre-prepared data collection form, and the information was entered into SPSS software after categorization and appropriate analysis and statistical tests were performed on it. Were performed and in all statistical tests the statistical significance level was considered 0.05: RESULTS: 100 patients with acute heart failure were included in this study with a mean age of 63.43 ± 14.78 years. 66% of them were men. The mean dose of furosemide in these patients was 680.92 ± 377.47 mg and the mean serum uric acid level in these patients was 8.55 ± 2.50 mg / dL. In the study of the relationship between the variables, there was a significant relationship between the dose of furosemide received with the serum level of serum uric acid (P = 0.017, r = 0.248 and P = 0.009, r = -0.267, respectively). There is also a significant relationship between serum uric acid level and patient mortality (P = 0.013, r = 0.247). However this relationship lost its significance after multivariate analysis. CONCLUSION There is a significant relationship between serum uric acid level and diuretic use. However, in-hospital mortality is not related to uric acid levels at admission.
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Affiliation(s)
- Maryam Chenaghlou
- Cardiovascular research center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Fatemeh Abedi Mahzoon
- Student research committee, Tabriz University of Medical Sciences, Tabriz, 5166614756, Iran
| | - Sina Hamzehzadeh
- Student research committee, Tabriz University of Medical Sciences, Tabriz, 5166614756, Iran.
| | - Ali Norouzi
- Student research committee, Tabriz University of Medical Sciences, Tabriz, 5166614756, Iran
| | - Hadi Sahrai
- Student research committee, Tabriz University of Medical Sciences, Tabriz, 5166614756, Iran
| | - Nasibeh Mohammadi
- Faculty of medicine, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Negin Khadem Haghighi
- Student research committee, Tabriz University of Medical Sciences, Tabriz, 5166614756, Iran
| | - Mirsaeed Abdollahi
- Student research committee, Tabriz University of Medical Sciences, Tabriz, 5166614756, Iran
| | | | - Erfan Banisefid
- Student research committee, Tabriz University of Medical Sciences, Tabriz, 5166614756, Iran.
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Wu Y, Pei Z, Qu P. NAD +-A Hub of Energy Metabolism in Heart Failure. Int J Med Sci 2024; 21:369-375. [PMID: 38169534 PMCID: PMC10758143 DOI: 10.7150/ijms.89370] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 11/27/2023] [Indexed: 01/05/2024] Open
Abstract
Heart failure is a condition where reduced levels of adenosine triphosphate (ATP) affect energy supply in myocardial cells. Nicotinamide adenine dinucleotide (NAD+) plays a crucial role as a coenzyme for electron transfer in energy metabolism. Decreased NAD+ levels in myocardial cells lead to inadequate ATP production and increased susceptibility to heart failure. Researchers are exploring ways to increase NAD+ levels to alleviate heart failure. Targets such as sirtuin2 (sirt2), sirtuin3 (sirt3), Poly (ADP-ribose) polymerase (PARP), and diastolic regulatory proteins are being investigated. NAD+ supplementation has shown promise, even in heart failure with preserved ejection fraction (HFpEF). By focusing on NAD+ as a central component of energy metabolism, it is possible to improve myocardial activity, heart function, and address energy deficiency in heart failure.
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Affiliation(s)
- Yaoxin Wu
- Faculty of Medicine, Dalian University of Technology, 116024, Dalian, China
| | - Zuowei Pei
- Faculty of Medicine, Dalian University of Technology, 116024, Dalian, China
- Department of Cardiology, Central Hospital of Dalian University of Technology, Dalian, 116033, China
| | - Peng Qu
- Faculty of Medicine, Dalian University of Technology, 116024, Dalian, China
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Balaguer J, García-Foncillas J, Tuñón J. Natriuretic peptides: Another tool for the management of cancer? Crit Rev Oncol Hematol 2024; 193:104219. [PMID: 38029944 DOI: 10.1016/j.critrevonc.2023.104219] [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] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Revised: 11/20/2023] [Accepted: 11/23/2023] [Indexed: 12/01/2023] Open
Abstract
The connection between heart failure (HF) and cancer through multiple pathways such as inflammation, oxidative stress, and neurohormonal activation, among others, is well established. As a consequence, increases in plasma levels of several biomarkers have been described in both disorders. The most consistent information is related to natriuretic peptides (NPs). Although they are known to be produced in the ventricles as a response to myocardial distension, and thus can be useful for the diagnosis and prognosis of HF, and also for the management of chemotherapy-induced myocardial damage, they are also produced by tumour cells. In this regard, increased plasma levels of NPs have been described in patients with multiple malignancies in the absence of volume overload. Natriuretic peptide levels have been shown to correlate directly with the extension of tumours and with poorer outcomes. Moreover, some data indicate that they may help in the detection of subclinical tumours. Given that these peptides have been described to have anti-proliferative and anti-angiogenic effects, a plausible hypothesis is that they may be produced by tumours as a negative feed-back mechanism to avoid tumour progression. This would lead to increased levels of NPs in plasma that could be potentially useful for early detection of malignancies as well as for a prognostic assessment. Nevertheless, since the sample size of many studies published so far is limited, more data are needed to provide consistent data in order to confirm or rule out this hypothesis.
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Affiliation(s)
- Jorge Balaguer
- Division of Cardiology, IIS-Fundación Jiménez Díaz, Madrid, Spain
| | - Jesús García-Foncillas
- Division of Oncology, IIS-Fundación Jiménez Díaz, Madrid, Spain; School of Medicine, Autónoma University, Madrid, Spain
| | - José Tuñón
- Division of Cardiology, IIS-Fundación Jiménez Díaz, Madrid, Spain; School of Medicine, Autónoma University, Madrid, Spain; Laboratory of Vascular Pathology, IIS-Fundación Jiménez Díaz, Madrid, Spain; CIBERCV, ISCIII, Madrid, Spain.
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Catalán Cabrera A, Condori Alvino K. Aortic valvuloplasty under echocardiographic guidance in a minor infant at a national referral center in Peru: case report. Arch Peru Cardiol Cir Cardiovasc 2024; 5:54-58. [PMID: 38596611 PMCID: PMC10999313 DOI: 10.47487/apcyccv.v5i1.316] [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] [Figures] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 12/21/2023] [Indexed: 04/11/2024]
Abstract
Aortic valve stenosis is a congenital heart defect that causes a fixed left ventricular outflow obstruction with a progressive course. Symptomatology in neonates and young infants resembles congestive heart failure. In addition, the diagnosis of this condition is made by imaging, through echocardiography. On the other hand, treatment can be surgical or interventional under fluoroscopic guidance, depending on the hospital in which it is performed. We describe the case of a minor infant patient who presented severe aortic valve stenosis; however, the fluoroscopy equipment was not available at the time of the emergency to perform the appropriate procedure, therefore, an aortic valvuloplasty was performed under echocardiographic guidance without complications.
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Affiliation(s)
- Alex Catalán Cabrera
- Área de Cateterismo Cardiaco Pediátrico, Instituto Nacional de Salud del Niño de San Borja, Lima, Peru.Área de Cateterismo Cardiaco PediátricoInstituto Nacional de Salud del Niño de San BorjaLimaPeru
| | - Karen Condori Alvino
- Área de Cateterismo Cardiaco Pediátrico, Instituto Nacional de Salud del Niño de San Borja, Lima, Peru.Área de Cateterismo Cardiaco PediátricoInstituto Nacional de Salud del Niño de San BorjaLimaPeru
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Louis M, Hwang R, Sabapathy S, Roberts LA, Morris NR. High-Intensity Small Muscle Mass Training in Patients With Heart Failure: Rationale and Design of a Randomized Controlled Trial. Phys Ther 2024; 104:pzad130. [PMID: 37758445 DOI: 10.1093/ptj/pzad130] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 06/20/2023] [Accepted: 09/22/2023] [Indexed: 10/03/2023]
Abstract
OBJECTIVE Small muscle mass training localized to the quadriceps femoris muscle group has been proposed as an intervention to reverse heart failure-related skeletal muscle impairments. Although this training paradigm has demonstrated efficacy in heart failure, it remains to be evaluated in a conventional clinical context. Hence, the aim of this proposed study is to determine the effects of integrating high-intensity small muscle mass training (HISMT) isolated to the knee extensor muscles within a standard heart failure rehabilitation program. METHODS This single-blind, randomized controlled trial will aim to recruit 70 participants with heart failure. Participants will be randomized to either (1) standard training: combination of upper and lower extremity cardiovascular and resistance-based exercises, or (2) HISMT plus modified standard training: bilateral knee extensor HISMT and a modified version of the standard training, so that the total volume of work will be similar to standard training alone. The training interventions will be undertaken twice weekly for 12 weeks in an outpatient clinical setting. Outcome measurements will be performed at baseline and after the 12-week intervention period. The primary outcome will be exercise capacity (6-Minute Walk Test), with secondary outcomes being physical performance measures, muscle strength, and health-related quality of life. Data will be analyzed using the intention-to-treat principle. IMPACT This study will address a gap in the literature regarding the efficacy of small muscle training under routine clinical conditions for individuals with heart failure. The findings will also provide insight into the effects of HISMT within a heart failure rehabilitation program, thus enabling the optimization of exercise prescription for this patient population.
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Affiliation(s)
- Menaka Louis
- Chronic Disease and Post-Acute Programs, Gold Coast Hospital and Health Service, Robina Health Precinct, Robina, Queensland, Australia
- School of Health Sciences and Social Work, Griffith University, Southport, Queensland, Australia
| | - Rita Hwang
- School of Health Sciences and Social Work, Griffith University, Southport, Queensland, Australia
- Department of Physiotherapy, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
| | - Surendran Sabapathy
- School of Health Sciences and Social Work, Griffith University, Southport, Queensland, Australia
| | - Llion Arwyn Roberts
- School of Health Sciences and Social Work, Griffith University, Southport, Queensland, Australia
- School of Human Movement and Nutrition Sciences, University of Queensland, St Lucia, Queensland, Australia
| | - Norman Rolston Morris
- School of Health Sciences and Social Work, Griffith University, Southport, Queensland, Australia
- The Menzies Health Institute, Griffith University, Southport, Queensland, Australia
- Allied Health Research Collaborative, The Prince Charles Hospital, Chermside, Queensland, Australia
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Thomas J, Snih SA. Original Article: Liver disease, heart failure, and 13-year mortality among Mexican American older adults: Nativity differences. Ann Epidemiol 2023:S1047-2797(23)00229-6. [PMID: 38141743 DOI: 10.1016/j.annepidem.2023.12.004] [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: 06/08/2023] [Revised: 12/13/2023] [Accepted: 12/19/2023] [Indexed: 12/25/2023]
Abstract
PURPOSE To examine nativity differences of co-occurring liver disease (LD) and heart failure (HF) on 13-year mortality among Mexican American older adults. METHODS Prospective cohort study of 1,601 Mexican Americans aged ≥75 years from the Hispanic Established Population for the Epidemiologic Study of the Elderly (2004/05-2016). Participants were grouped into four groups: no LD and no HF (n=1,138), LD only (n=53), HF only (n=382), and both LD and HF (n=28). We used Cox proportional hazards regression model to estimate the hazard ratio (HR) and 95% confidence interval (CI) of death over time. RESULTS The HR of death, as a function of HF only, was 1.32 (95% CI=1.07-1.62) among US-born and 1.36 (95% CI=1.04-1.78) among foreign-born participants, vs. those with no LD and no HF. Among foreign-born participants, the HR of death as a function of LD and HF was 3.39 (95% CI=1.65-6.93) vs. those without either. LD alone was not associated with mortality in either group. Among US-born, co-occurring LD and HF was not associated with mortality. CONCLUSIONS Foreign-born participants with both LD and HF were at higher risk of mortality over 13 years of follow up.
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Affiliation(s)
- Janice Thomas
- John Sealy School of Medicine, The University of Texas Medical Branch, 301 University Blvd., Galveston, TX, 77555, USA; Department of Population Health and Health Disparities/School of Public and Population Health. The University of Texas Medical Branch, 301 University Blvd., Galveston, TX, 77555, USA.
| | - Soham Al Snih
- Department of Population Health and Health Disparities/School of Public and Population Health. The University of Texas Medical Branch, 301 University Blvd., Galveston, TX, 77555, USA; Division of Geriatrics & Palliative Medicine/Department of Internal Medicine. The University of Texas Medical Branch, 301 University Blvd., Galveston, TX, 77555, USA; Sealy Center on Aging. The University of Texas Medical Branch, 301 University Blvd., 77555, Galveston, TX, USA.
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Yogeswaran V, Hidano D, Diaz AE, Van Spall HGC, Mamas MA, Roth GA, Cheng RK. Regional variations in heart failure: a global perspective. Heart 2023; 110:11-18. [PMID: 37353316 DOI: 10.1136/heartjnl-2022-321295] [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: 11/27/2022] [Accepted: 06/06/2023] [Indexed: 06/25/2023] Open
Abstract
Heart failure (HF) is a global public health concern that affects millions of people worldwide. While there have been significant therapeutic advancements in HF over the last few decades, there remain major disparities in risk factors, treatment patterns and outcomes across race, ethnicity, socioeconomic status, country and region. Recent research has provided insight into many of these disparities, but there remain large gaps in our understanding of worldwide variations in HF care. Although the majority of the global population resides across Asia, Africa and South America, these regions remain poorly represented in epidemiological studies and HF trials. Recent efforts and registries have provided insight into the clinical profiles and outcomes across HF patterns globally. The prevalence of HF and associated risk factors has been reported and varies by country and region ranges, with minimal data on regional variations in treatment patterns and long-term outcomes. It is critical to improve our understanding of the different factors that contribute to global disparities in HF care so we can build interventions that improve our general cardiovascular health and mitigate the social and economic cost of HF. In this narrative review, we hope to provide an overview of the global and regional variations in HF care and outcomes.
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Affiliation(s)
| | - Danelle Hidano
- Division of Cardiology, University of Washington, Seattle, Washington, USA
| | - Andrea E Diaz
- Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Harriette G C Van Spall
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, Keele University, Newcastle, UK
| | - Gregory A Roth
- Division of Cardiology, University of Washington, Seattle, Washington, USA
| | - Richard K Cheng
- Division of Cardiology, University of Washington, Seattle, Washington, USA
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Thomas C. Heart failure: it's time to finally change the F-word. Open Heart 2023; 10:e002546. [PMID: 38101859 PMCID: PMC10729177 DOI: 10.1136/openhrt-2023-002546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/09/2023] [Indexed: 12/17/2023] Open
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McConnell T, Blair C, Burden J, Duddy C, Hill L, Howie C, Jones B, Ruane B, Wong G, Reid J. Integrating palliative care and heart failure: a systematic realist synthesis (PalliatHeartSynthesis). Open Heart 2023; 10:e002438. [PMID: 38097362 PMCID: PMC10729146 DOI: 10.1136/openhrt-2023-002438] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Accepted: 11/10/2023] [Indexed: 12/18/2023] Open
Abstract
OBJECTIVES (1) Develop a programme theory of why, for whom and in what contexts integrated palliative care (PC) and heart failure (HF) services work/do not work; (2) use the programme theory to co-produce with stakeholders, intervention strategies to inform best practice and future research. METHODS A systematic review of all published articles and grey literature using a realist logic of analysis. The search strategy combined terms significant to the review questions: HF, PC and end of life. Documents were included if they were in English and provided data relevant to integration of PC and HF services. Searches were conducted in November 2021 in EMBASE, MEDLINE, PsycINFO, AMED, HMIC and CINAHL. Further relevant documents were identified via monthly alerts (up until April 2023) and the project stakeholder group (patient/carers, content experts and multidisciplinary practitioners). RESULTS 130 documents were included (86 research, 22 literature reviews, 22 grey literature). The programme theory identified intervention strategies most likely to support integration of PC and HF services. These included protected time for evidence-based PC and HF education from undergraduate/postgraduate level and continuing professional practice; choice of educational setting (eg, online, face-to-face or hybrid); increased awareness and seeing benefits of PC for HF management; conveying the emotive and intellectual need for integrating PC and HF via credible champions; and prioritising PC and HF guidelines in practice. CONCLUSIONS The review findings outline the required steps to take to increase the likelihood that all key players have the capacity, opportunity and motivation to integrate PC into HF management. PROSPERO REGISTRATION NUMBER CRD42021240185.
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Affiliation(s)
- Tracey McConnell
- School of Nursing and Midwifery, Queen's University Belfast Faculty of Medicine, Health and Life Sciences, Belfast, UK
| | - Carolyn Blair
- School of Nursing and Midwifery, Queen's University Belfast Faculty of Medicine, Health and Life Sciences, Belfast, UK
| | - John Burden
- Patient and Public Involvement Network members, British Heart Foundation, London, UK
| | - Claire Duddy
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Loreena Hill
- School of Nursing and Midwifery, Queen's University Belfast Faculty of Medicine, Health and Life Sciences, Belfast, UK
| | - Clare Howie
- School of Nursing and Midwifery, Queen's University Belfast Faculty of Medicine, Health and Life Sciences, Belfast, UK
| | - Bob Jones
- Patient and Public Involvement Network members, British Heart Foundation, London, UK
| | - Bob Ruane
- Patient and Public Involvement Network members, British Heart Foundation, London, UK
| | - Geoff Wong
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Joanne Reid
- School of Nursing and Midwifery, Queen's University Belfast Faculty of Medicine, Health and Life Sciences, Belfast, UK
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49
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Ziapour A, Lebni JY, Mohammadkhah F, Chaboksavar F, Janjani P, Yıldırım M. Challenging experiences of the elderly with heart failure in the COVID-19 pandemic: a phenomenological study in Iran. BMC Geriatr 2023; 23:834. [PMID: 38082444 PMCID: PMC10712086 DOI: 10.1186/s12877-023-04568-9] [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] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 12/05/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Patients with heart failure (HF), especially the elderly, faced many challenges during the COVID-19 pandemic, which need to be explored. The present study aimed to analyse the challenging experiences facing the elderly with heart failure during the pandemic in Iran. To achieve this aim, a qualitative approach to research was employed. METHODS The present qualitative research employed a phenomenological approach to study 12 elderly with heart failure visiting Imam Ali Hospital during the COVID-19 pandemic in Kermanshah, Iran. The data collection occurred between August 5, 2022, and November 21, 2022. The participants were selected through a purposive sampling method and interviewed using a semi-structured interview. MAXQDA10 software was used for data organisation and the Colizzi analytical technique for data analysis. Guba and Lincoln's criteria were also used to evaluate the trustworthiness of the qualitative research. RESULTS A total of two categories, 8 subcategories, and 110 primary codes were extracted from the data. The two categories were challenges and coping strategies. The former included the sub-categories of economic issues, fear, anxiety, and fear of death; limited access to health care; quarantine issues; disruption of family life; and medication non-adherence. The subcategories of the latter were faith in God, social support, and self-care behaviors. CONCLUSIONS The present study revealed the challenges experienced and the coping strategies employed by elderly patients with heart failure during the pandemic in Iran. A knowledge of these challenges and experiences during the COVID-19 pandemic can raise healthcare workers' awareness of the elderly patients' strategies used to cope with the virus.
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Affiliation(s)
- Arash Ziapour
- Cardiovascular Research Center, Health Institute, Imam-Ali Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Javad Yoosefi Lebni
- Social Determinants of Health Research Center, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Fatemeh Mohammadkhah
- Nursing Care Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, I.R. of Iran
| | - Fakhreddin Chaboksavar
- Nursing Care Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, I.R. of Iran
| | - Parisa Janjani
- Cardiovascular Research Center, Health Institute, Imam-Ali Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran.
| | - Murat Yıldırım
- Department of Psychology, Faculty of Science and Letters, Agri Ibrahim Cecen University, Ağrı, Türkiye, Turkey
- Graduate Studies and Research, Lebanese American University, Beirut, Lebanon
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50
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Helberg J, Bensimhon D, Katsadouros V, Schmerge M, Smith H, Peck K, Williams K, Winfrey W, Nanavati A, Knapp J, Schmidt M, Curran L, McCarthy M, Sawulski M, Harbrecht L, Santos I, Masoudi E, Narendra N. Heart failure management at home: a non-randomised prospective case-controlled trial (HeMan at Home). Open Heart 2023; 10:e002371. [PMID: 38065589 PMCID: PMC10711907 DOI: 10.1136/openhrt-2023-002371] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 11/05/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND/OBJECTIVES Heart failure (HF) is a growing clinical and economic burden for patients and health systems. The COVID-19 pandemic has led to avoidance and delay in care, resulting in increased morbidity and mortality among many patients with HF. The increasing burden of HF during the COVID-19 pandemic led us to evaluate the quality and safety of the Hospital at Home (HAH) for patients presenting to their community providers or emergency department (ED) with symptoms of acute on chronic HF (CHF) requiring admission. DESIGN/OUTCOMES A non-randomised prospective case-controlled of patients enrolled in the HAH versus admission to the hospital (usual care, UC). Primary outcomes included length of stay (LOS), adverse events, discharge disposition and patient satisfaction. Secondary outcomes included 30-day readmission rates, 30-day ED usage and ED dwell time. RESULTS Sixty patients met inclusion/exclusion criteria and were included in the study. Of the 60 patients, 40 were in the HAH and 20 were in the UC group. Primary outcomes demonstrated that HAH patients had slightly longer LOS (6.3 days vs 4.7 days); however, fewer adverse events (12.5% vs 35%) compared with the UC group. Those enrolled in the HAH programme were less likely to be discharged with postacute services (skilled nursing facility or home health). HAH was associated with increased patient satisfaction compared with Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) score in North Carolina. Secondary outcomes of 30-day readmission and ED usage were similar between HAH and UC. CONCLUSIONS The HAH pilot programme was shown to be a safe and effective alternative to hospitalisation for the appropriately selected patient presenting with acute on CHF.
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Affiliation(s)
- Justin Helberg
- Internal Medicine Teaching Service, Cone Health, Greensboro, North Carolina, USA
| | | | - Vasili Katsadouros
- Internal Medicine Teaching Service, Cone Health, Greensboro, North Carolina, USA
| | - Michelle Schmerge
- Remote Health Services, PLLC, Greensboro, North Carolina, USA
- Remote Health Services, PLLC, Greensboro, North Carolina, USA
| | - Heather Smith
- Remote Health Services, PLLC, Greensboro, North Carolina, USA
| | - Kelly Peck
- Triad Healthcare Network, Greensboro, North Carolina, USA
| | - Kim Williams
- Remote Health Services, PLLC, Greensboro, North Carolina, USA
| | - William Winfrey
- Internal Medicine Teaching Service, Cone Health, Greensboro, North Carolina, USA
| | | | - Jon Knapp
- Cone Health, Greensboro, North Carolina, USA
| | | | - Lisa Curran
- Cone Health, Greensboro, North Carolina, USA
| | | | | | - Lawrence Harbrecht
- Internal Medicine Teaching Service, Cone Health, Greensboro, North Carolina, USA
| | - Idalys Santos
- Internal Medicine Teaching Service, Cone Health, Greensboro, North Carolina, USA
| | - Ellie Masoudi
- Internal Medicine Teaching Service, Cone Health, Greensboro, North Carolina, USA
| | - Nischal Narendra
- Internal Medicine Teaching Service, Cone Health, Greensboro, North Carolina, USA
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