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Umeh CA, Maoz H, Obi J, Dakoria R, Patel S, Maity G, Barve P. Remdesivir, dexamethasone and angiotensin-converting enzyme inhibitors use and mortality outcomes in COVID-19 patients with concomitant troponin elevation. World J Cardiol 2023; 15:427-438. [DOI: 10.4330/wjc.v15.i9.427] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 07/12/2023] [Accepted: 08/17/2023] [Indexed: 09/21/2023] [Imported: 09/21/2023] Open
Abstract
BACKGROUND There are indications that viral myocarditis, demand ischemia, and renin-angiotensin-aldosterone system pathway activation play essential roles in troponin elevation in coronavirus disease 2019 (COVID-19) patients. Antiviral medications and steroids are used to treat viral myocarditis, but their effect in patients with elevated troponin, possibly from myocarditis, has not been studied.
AIM To evaluate the effect of dexamethasone, remdesivir, and angiotensin-converting enzyme (ACE) inhibitors (ACEI) on mortality in COVID-19 patients with elevated troponin.
METHODS Our retrospective observational study involved 1788 COVID-19 patients at seven hospitals in Southern California, United States. We did a backward selection Cox multivariate regression analysis to determine predictors of mortality in our study population. Additionally, we did a Kaplan Meier survival analysis in the subset of patients with elevated troponin, comparing survival in patients that received dexamethasone, remdesivir, and ACEI with those that did not.
RESULTS The mean age was 66 years (range 20-110), troponin elevation was noted in 11.5% of the patients, and 29.9% expired. The patients' age [hazard ratio (HR) = 1.02, P < 0.001], intensive care unit admission (HR = 5.07, P < 0.001), and ventilator use (HR = 0.68, P = 0.02) were significantly associated with mortality. In the subset of patients with elevated troponin, there was no statistically significant difference in survival in those that received remdesivir (0.07), dexamethasone (P = 0.63), or ACEI (P = 0.8) and those that did not.
CONCLUSION Although elevated troponin in COVID-19 patients has been associated with viral myocarditis and ACE II receptors, conventional viral myocarditis treatment, including antiviral and steroids, and ACEI did not show any effect on mortality in these patients.
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Affiliation(s)
- Chukwuemeka A Umeh
- Internal Medicine, Hemet Global Medical Center, Hemet, CA 92543, United States
| | - Heather Maoz
- Internal Medicine, Hemet Global Medical Center, Hemet, CA 92543, United States
| | - Jessica Obi
- Internal Medicine, Hemet Global Medical Center, Hemet, CA 92543, United States
| | - Ruchi Dakoria
- Internal Medicine, Hemet Global Medical Center, Hemet, CA 92543, United States
| | - Smit Patel
- Internal Medicine, Hemet Global Medical Center, Hemet, CA 92543, United States
| | - Gargi Maity
- Internal Medicine, Hemet Global Medical Center, Hemet, CA 92543, United States
| | - Pranav Barve
- Internal Medicine, Hemet Global Medical Center, Hemet, CA 92543, United States
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Tampakis K, Pastromas S, Sykiotis A, Kampanarou S, Kourgiannidis G, Pyrpiri C, Bousoula M, Rozakis D, Andrikopoulos G. Real-time cardiovascular magnetic resonance-guided radiofrequency ablation: A comprehensive review. World J Cardiol 2023; 15:415-426. [DOI: 10.4330/wjc.v15.i9.415] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 08/10/2023] [Accepted: 08/31/2023] [Indexed: 09/21/2023] [Imported: 09/21/2023] Open
Abstract
Cardiac magnetic resonance (CMR) imaging could enable major advantages when guiding in real-time cardiac electrophysiology procedures offering high-resolution anatomy, arrhythmia substrate, and ablation lesion visualization in the absence of ionizing radiation. Over the last decade, technologies and platforms for performing electrophysiology procedures in a CMR environment have been developed. However, performing procedures outside the conventional fluoroscopic laboratory posed technical, practical and safety concerns. The development of magnetic resonance imaging compatible ablation systems, the recording of high-quality electrograms despite significant electromagnetic interference and reliable methods for catheter visualization and lesion assessment are the main limiting factors. The first human reports, in order to establish a procedural workflow, have rationally focused on the relatively simple typical atrial flutter ablation and have shown that CMR-guided cavotricuspid isthmus ablation represents a valid alternative to conventional ablation. Potential expansion to other more complex arrhythmias, especially ventricular tachycardia and atrial fibrillation, would be of essential impact, taking into consideration the widespread use of substrate-based strategies. Importantly, all limitations need to be solved before application of CMR-guided ablation in a broad clinical setting.
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Affiliation(s)
- Konstantinos Tampakis
- Department of Pacing & Electrophysiology, Henry Dunant Hospital Center, Athens 11526, Greece
| | - Sokratis Pastromas
- Department of Pacing & Electrophysiology, Henry Dunant Hospital Center, Athens 11526, Greece
| | - Alexandros Sykiotis
- Department of Pacing & Electrophysiology, Henry Dunant Hospital Center, Athens 11526, Greece
| | | | - Georgios Kourgiannidis
- Department of Pacing & Electrophysiology, Henry Dunant Hospital Center, Athens 11526, Greece
| | - Chrysa Pyrpiri
- Department of Radiology, Henry Dunant Hospital Center, Athens 11526, Greece
| | - Maria Bousoula
- Department of Anesthesiology, Henry Dunant Hospital Center, Athens 11526, Greece
| | - Dimitrios Rozakis
- Department of Anesthesiology, Henry Dunant Hospital Center, Athens 11526, Greece
| | - George Andrikopoulos
- Department of Pacing & Electrophysiology, Henry Dunant Hospital Center, Athens 11526, Greece
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Solangi BA, Shah JA, Kumar R, Batra MK, Ali G, Butt MH, Nisar A, Qamar N, Saghir T, Sial JA. Immediate in-hospital outcomes after percutaneous revascularization of acute myocardial infarction complicated by cardiogenic shock. World J Cardiol 2023; 15:439-447. [DOI: 10.4330/wjc.v15.i9.439] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 07/31/2023] [Accepted: 08/29/2023] [Indexed: 09/21/2023] [Imported: 09/21/2023] Open
Abstract
BACKGROUND Cardiogenic shock (CS) is a life-threatening complication of acute myocardial infarction with high morbidity and mortality rates. Primary percutaneous coronary intervention (PCI) has been shown to improve outcomes in patients with CS.
AIM To investigate the immediate mortality rates in patients with CS undergoing primary PCI and identify mortality predictors.
METHODS We conducted a retrospective analysis of 305 patients with CS who underwent primary PCI at the National Institute of Cardiovascular Diseases, Karachi, Pakistan, between January 2018 and December 2022. The primary outcome was immediate mortality, defined as mortality within index hospitalization. Univariate and multivariate logistic regression analyses were performed to identify predictors of immediate mortality.
RESULTS In a sample of 305 patients with 72.8% male patients and a mean age of 58.1 ± 11.8 years, the immediate mortality rate was found to be 54.8% (167). Multivariable analysis identified Killip class IV at presentation [odds ratio (OR): 2.0; 95% confidence interval (CI): 1.2-3.4; P = 0.008], Multivessel disease (OR: 3.5; 95%CI: 1.8-6.9; P < 0.001), and high thrombus burden (OR: 2.6; 95%CI: 1.4-4.9; P = 0.003) as independent predictors of immediate mortality.
CONCLUSION Immediate mortality rate in patients with CS undergoing primary PCI remains high despite advances in treatment strategies. Killip class IV at presentation, multivessel disease, and high thrombus burden (grade ≥ 4) were identified as independent predictors of immediate mortality. These findings underscore the need for aggressive management and close monitoring of patients with CS undergoing primary PCI, particularly in those with these high-risk characteristics.
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Affiliation(s)
- Bashir Ahmed Solangi
- Department of Adult Cardiology, National Institute of Cardiovascular Diseases, Karachi 75510, Pakistan
| | - Jehangir Ali Shah
- Department of Adult Cardiology, National Institute of Cardiovascular Diseases, Karachi 75510, Pakistan
| | - Rajesh Kumar
- Department of Adult Cardiology, National Institute of Cardiovascular Diseases, Karachi 75510, Pakistan
| | - Mahesh Kumar Batra
- Department of Adult Cardiology, National Institute of Cardiovascular Diseases, Karachi 75510, Pakistan
| | - Gulzar Ali
- Department of Adult Cardiology, National Institute of Cardiovascular Diseases, Karachi 75510, Pakistan
| | - Muhammad Hassan Butt
- Department of Adult Cardiology, National Institute of Cardiovascular Diseases, Karachi 75510, Pakistan
| | - Ambreen Nisar
- Department of Adult Cardiology, National Institute of Cardiovascular Diseases, Karachi 75510, Pakistan
| | - Nadeem Qamar
- Department of Adult Cardiology, National Institute of Cardiovascular Diseases, Karachi 75510, Pakistan
| | - Tahir Saghir
- Department of Adult Cardiology, National Institute of Cardiovascular Diseases, Karachi 75510, Pakistan
| | - Jawaid Akbar Sial
- Department of Adult Cardiology, National Institute of Cardiovascular Diseases, Karachi 75510, Pakistan
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Obi MF, Sharma M, Namireddy V, Gargiulo P, Noel C, Hyun C, Gale BD. Variant of Wellen’s syndrome in type 1 diabetic patient: A case report. World J Cardiol 2023; 15:462-468. [DOI: 10.4330/wjc.v15.i9.462] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 06/29/2023] [Accepted: 08/17/2023] [Indexed: 09/21/2023] [Imported: 09/21/2023] Open
Abstract
BACKGROUND Wellen’s syndrome is a form of acute coronary syndrome associated with proximal left anterior descending artery (LAD) stenosis and characteristic electrocardiograph (ECG) patterns in pain free state. The abnormal ECG pattern is classified into type A (biphasic T waves) and type B (deeply inverted T waves), based on the T wave pattern seen in the pericodial chest leads.
CASE SUMMARY We present the case of a 37-year-old male with history of type 1 diabetes mellitus (T1DM), gastroparesis, mild peripheral artery disease and right toe cellulitis on IV antibiotics who presented to the emergency department with nausea, vomiting and abdominal pain for 3 d and as a result couldn’t take his insulin. Noted to have fasting blood sugar 392 mg/dL. Admitted for diabetic gastroparesis. During the hospital course, the patient was asymptomatic and denied any chest pain. On admission, No ECG and troponin draws were performed. On day 2, the patient became hypoxic with oxygen saturation 80% on room air, intermittent mild right-sided chest pain which he attributed to vomiting from his gastroparesis. Initial ECG done was significant for Biphasic T wave changes in leads V2 and V3 and elevated high sensitivity troponin. Patient was transitioned to cardiac intensive care unit and cardiac catheterization performed with result significant for extensive coronary artery disease.
CONCLUSION This case highlights an exceptional manifestation of Wellen's syndrome, wherein the right coronary artery and circumflex artery display a remarkable 100% constriction, alongside a proximal LAD stenosis of 90%-95%. Notably, this occurrence transpired in a patient grappling with extensive complications arising from T1DM. Moreover, it underscores the utmost significance of promptly recognizing the presence of Wellen's syndrome and swiftly initiating appropriate medical intervention.
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Affiliation(s)
- Mukosolu Florence Obi
- Internal Medicine, Wyckoff Heights Medical Center, Brooklyn, NY 11237, United States
| | - Manjari Sharma
- Internal Medicine, Wyckoff Heights Medical Center, Brooklyn, NY 11237, United States
| | - Vikhyath Namireddy
- Clinical Rotations, St Georges University, School of Medicine, True Blue 96038, Grenada
| | - Paul Gargiulo
- Internal Medicine, Wyckoff Heights Medical Center, Brooklyn, NY 11237, United States
| | - Chelsea Noel
- Clinical Rotations, St Georges University, School of Medicine, True Blue 96038, Grenada
| | - Cho Hyun
- Internal Medicine, Wyckoff Heights Medical Center, Brooklyn, NY 11237, United States
| | - Blossom De Gale
- Clinical Rotations, St Georges University, School of Medicine, True Blue 96038, Grenada
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Shoura SJ, Teaima T, Sana MK, Abbasi A, Atluri R, Yilmaz M, Hammo H, Ali L, Kanitsoraphan C, Park DY, Alyousef T. Outcomes in patients with COVID-19 and new onset heart blocks: Insight from the National Inpatient Sample database. World J Cardiol 2023; 15:448-461. [DOI: 10.4330/wjc.v15.i9.448] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 06/14/2023] [Accepted: 07/17/2023] [Indexed: 09/21/2023] [Imported: 09/21/2023] Open
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has resulted in a worldwide health crisis since it first appeared. Numerous studies demonstrated the virus’s predilection to cardiomyocytes; however, the effects that COVID-19 has on the cardiac conduction system still need to be fully understood.
AIM To analyze the impact that COVID-19 has on the odds of major cardiovascular complications in patients with new onset heart blocks or bundle branch blocks (BBB).
METHODS The 2020 National Inpatient Sample (NIS) database was used to identify patients admitted for COVID-19 pneumonia with and without high-degree atrioventricular blocks (HDAVB) and right or left BBB utilizing ICD-10 codes. The patients with pre-existing pacemakers, suggestive of a prior diagnosis of HDAVB or BBB, were excluded from the study. The primary outcome was inpatient mortality. Secondary outcomes included total hospital charges (THC), the length of hospital stay (LOS), and other major cardiac outcomes detailed in the Results section. Univariate and multivariate regression analyses were used to adjust for confounders with Stata version 17.
RESULTS A total of 1058815 COVID-19 hospitalizations were identified within the 2020 NIS database, of which 3210 (0.4%) and 17365 (1.6%) patients were newly diagnosed with HDAVB and BBB, respectively. We observed a significantly higher odds of in-hospital mortality, cardiac arrest, cardiogenic shock, sepsis, arrythmias, and acute kidney injury in the COVID-19 and HDAVB group. There was no statistically significant difference in the odds of cerebral infarction or pulmonary embolism. Encounters with COVID-19 pneumonia and newly diagnosed BBB had a higher odds of arrythmias, acute kidney injury, sepsis, need for mechanical ventilation, and cardiogenic shock than those without BBB. However, unlike HDAVB, COVID-19 pneumonia and BBB had no significant impact on mortality compared to patients without BBB.
CONCLUSION In conclusion, there is a significantly higher odds of inpatient mortality, cardiac arrest, cardiogenic shock, sepsis, acute kidney injury, supraventricular tachycardia, ventricular tachycardia, THC, and LOS in patients with COVID-19 pneumonia and HDAVB as compared to patients without HDAVB. Likewise, patients with COVID-19 pneumonia in the BBB group similarly have a higher odds of supraventricular tachycardia, atrial fibrillation, atrial flutter, ventricular tachycardia, acute kidney injury, sepsis, need for mechanical ventilation, and cardiogenic shock as compared to those without BBB. Therefore, it is essential for healthcare providers to be aware of the possible worse predicted outcomes that patients with new-onset HDAVB or BBB may experience following SARS-CoV-2 infection.
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Affiliation(s)
- Sami J Shoura
- Department of Internal Medicine, John H. Stroger Jr. Hospital of Cook County, Chicago, IL 60612, United States
| | - Taha Teaima
- Department of Internal Medicine, John H. Stroger Jr. Hospital of Cook County, Chicago, IL 60612, United States
| | - Muhammad Khawar Sana
- Department of Internal Medicine, John H. Stroger Jr. Hospital of Cook County, Chicago, IL 60612, United States
| | - Ayesha Abbasi
- Department of Internal Medicine, John H. Stroger Jr. Hospital of Cook County, Chicago, IL 60612, United States
| | - Ramtej Atluri
- Department of Internal Medicine, John H. Stroger Jr. Hospital of Cook County, Chicago, IL 60612, United States
| | - Mahir Yilmaz
- Department of Internal Medicine, John H. Stroger Jr. Hospital of Cook County, Chicago, IL 60612, United States
| | - Hasan Hammo
- Department of Internal Medicine, John H. Stroger Jr. Hospital of Cook County, Chicago, IL 60612, United States
| | - Laith Ali
- Department of Cardiology, John H. Stroger Jr Hospital of Cook County, Chicago, IL 60612, United States
| | - Chanavuth Kanitsoraphan
- Department of Cardiology, John H. Stroger Jr Hospital of Cook County, Chicago, IL 60612, United States
| | - Dae Yong Park
- Department of Internal Medicine, John H. Stroger Jr. Hospital of Cook County, Chicago, IL 60612, United States
| | - Tareq Alyousef
- Department of Cardiology, John H. Stroger Jr Hospital of Cook County, Chicago, IL 60612, United States
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Bhanushali A, Kohli M, Prakash A, Sarvepalli SR, Pandey A, Odugbemi O, Reyaz N, Trambadia B, Reddy SA, Chauhan S, Desai R. Spontaneous coronary artery dissection-associated takotsubo syndrome: A systematic review of case reports. World J Cardiol 2023; 15:406-414. [DOI: 10.4330/wjc.v15.i8.406] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 06/24/2023] [Accepted: 07/19/2023] [Indexed: 08/21/2023] [Imported: 08/21/2023] Open
Abstract
BACKGROUND Spontaneous coronary artery dissection (SCAD) is underdiagnosed and requires comprehensive angiographic findings. Few SCAD occurrences have a comparable clinical appearance as takotsubo syndrome (TTS) or exist simultaneously, making it challenging for clinicians to treat and manage. Case reports lack consolidated data. We examined SCAD-TTS case reports.
AIM To conduct a systematic review of available case reports on SCAD in order to investigate its potential association with TTS.
METHODS SCAD-associated TTS case reports were reviewed after thoroughly screening PubMed, EMBASE, Scopus, and Google Scholar databases till January 2023. Case reports described demographics, comorbidities, imaging, management, and results.
RESULTS Twelve articles about 20 female patients were analyzed. 30% of patients (n = 6, > 60 years) were elderly (mean age 56.2 ± 9.07 years, range 36-70 years). Canada has 9 cases, United States 3, Australia 3, Sweden 2, Japan, Denmark, and France 1. Only 5 reports identified emotional stressors in these cases while 4 reports showed physical triggers for TTS. Nine had hypertension, 2 had hyperlipidemia, and 1 had prediabetes. 5 patients (25%) smoked. 10 (50%) troponin-positive myocardial infarction patients reported chest discomfort. 11 (55%) of 20 instances had TTS/SCAD. 12 (60%) of 20 patients exhibited ST elevation and 3 (15%) had T wave inversion on electrocardiogram. 19/20 patients had elevated troponin. 9 (45%) of 20 people had apical akinesis with TTS ballooning on cardiac imaging. All 20 exhibited echocardiographic wall motion abnormalities. 19 (95%) of 20 coronary angiography cases had SCAD. 10 of 19 SCAD patients had left anterior descending, 2 diagonal, and 2 left circumflex coronary artery involvement. 7 of 20 patients had left ventricular ejection fraction (LVEF) data. LVEF averaged 38.78 ± 7.35%. 5 (25%) of the 20 cases underwent dual antiplatelet therapy. Three (15%) of 20 cases experienced occasional ectopic ventricular complexes, Mobitz ll AV block, and paroxysmal atrial fibrillation. All 20 cases recovered and survived.
CONCLUSION Given the clinical similarities and challenges in detecting TTS and SCAD, this subset needs more research to raise awareness and reduce morbidity.
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Affiliation(s)
- Aditi Bhanushali
- Department of Internal Medicine, Mayo Clinic, Rochester, MN 55902, United States
| | - Muskan Kohli
- Department of Population Health & Leadership, University of New Haven, West Haven, CT 06516, United States
| | - Ananya Prakash
- Department of Medicine, Vydehi Institute of Medical Sciences and Research Center, Bangalore 560066, Karnataka, India
| | - Svaapnika Rao Sarvepalli
- Department of Population Health & Leadership, University of New Haven, West Haven, CT 06516, United States
| | - Anchal Pandey
- Department of Medicine, G.S.V.M. Medical College, Kanpur 208002, Uttar Pradesh, India
| | - Olufemi Odugbemi
- Department of Internal Medicine, Lincoln Medical and Mental Health Centre, Bronx, NY 10451, United States
| | - Nafisa Reyaz
- Department of Medicine, Jawaharlal Nehru Medical College & Hospital, Aligarh 202002, UP, India
| | - Bansi Trambadia
- Master of Public Health, Mount Sinai, New York, NY 10029, United States
| | | | - Shaylika Chauhan
- Department of Internal Medicine, Geisinger Health System, Wikes-Barre, PA 18702, United States
| | - Rupak Desai
- Independent Researcher, Independent Researcher, Atlanta, GA 30079, United States
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Umeh CA, Stratton A, Wagner T, Saigal S, Sood K, Dhawan R, Wagner C, Obi J, Kumar S, Ching THS, Gupta R. Use of intravascular lithotripsy in non-coronary artery lesions. World J Cardiol 2023; 15:395-405. [DOI: 10.4330/wjc.v15.i8.395] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Revised: 06/25/2023] [Accepted: 07/24/2023] [Indexed: 08/21/2023] [Imported: 08/21/2023] Open
Abstract
BACKGROUND Intravascular lithotripsy (IVL) is a novel technique increasingly used for plaque modification and endovascular revascularization in patients with severe calcification and peripheral artery disease. However, much of the available literature on IVL is focused on its use in coronary arteries, with relatively limited data on non-coronary artery use.
AIM To analyze the safety and efficacy of current IVL use in non-coronary artery lesions, as reported in case reports and case series.
METHODS We searched EMBASE, PubMed, and Reference Citation Analysis databases for case reports and case series on IVL use in peripheral artery disease. We then extracted variables of interest and calculated the mean and proportions of these variables.
RESULTS We included 60 patients from 33 case reports/case series. Ninety-eight percent of the cases had IVL usage in only one blood vessel, while four had the IVL used in two vessels (2.0%), resulting in 64 Lesions treated with IVL. The mean age of the patients was 73.7 (SD 10.9). IVL was successfully used in severe iliofemoral artery stenosis (51.6%), severe innominate, subclavian, and carotid artery stenosis (26.7% combined), and severe mesenteric vessel stenosis (9.4%). Additionally, IVL was successfully used in severe renal (7.8%) and aortic artery (4.7%) stenosis. There were complications in 12% of the cases, with dissection being the commonest.
CONCLUSION IVL has successfully used in plaque modification and endovascular revascularization in severely calcified and challenging lesions in the iliofemoral, carotid, subclavian, aorta, renal, and mesenteric vessels. The most severe but transient complications were with IVL use in the aortic arch and neck arteries.
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Affiliation(s)
| | - Ashley Stratton
- Internal Medicine, Hemet Global Medical Center, Hemet, CA 92543, United States
| | - Tifani Wagner
- Internal Medicine, Hemet Global Medical Center, Hemet, CA 92543, United States
| | - Shipra Saigal
- Internal Medicine, Hemet Global Medical Center, Hemet, CA 92543, United States
| | - Krystal Sood
- Internal Medicine, Hemet Global Medical Center, Hemet, CA 92543, United States
| | - Raghav Dhawan
- Internal Medicine, Hemet Global Medical Center, Hemet, CA 92543, United States
| | - Cory Wagner
- Internal Medicine, Hemet Global Medical Center, Hemet, CA 92543, United States
| | - Jessica Obi
- Internal Medicine, Hemet Global Medical Center, Hemet, CA 92543, United States
| | - Sabina Kumar
- Department of Cardiology, Mclaren Macomb-Oakland/Michigan State University, Macomb, MI 48043, United States
| | | | - Rahul Gupta
- Internal Medicine, University of California, San Diego, CA 92122, United States
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Abrignani MG, Lombardo A, Braschi A, Renda N, Abrignani V. Proton pump inhibitors and gastroprotection in patients treated with antithrombotic drugs: A cardiologic point of view. World J Cardiol 2023; 15:375-394. [DOI: 10.4330/wjc.v15.i8.375] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Revised: 06/23/2023] [Accepted: 08/08/2023] [Indexed: 08/21/2023] [Imported: 08/21/2023] Open
Abstract
Aspirin, other antiplatelet agents, and anticoagulant drugs are used across a wide spectrum of cardiovascular and cerebrovascular diseases. A concomitant proton pump inhibitor (PPI) treatment is often prescribed in these patients, as gastrointestinal complications are relatively frequent. On the other hand, a potential increased risk of cardiovascular events has been suggested in patients treated with PPIs; in particular, it has been discussed whether these drugs may reduce the cardiovascular protection of clopidogrel, due to pharmacodynamic and pharmacokinetic interactions through hepatic metabolism. Previously, the concomitant use of clopidogrel and omeprazole or esomeprazole has been discouraged. In contrast, it remains less known whether PPI use may affect the clinical efficacy of ticagrelor and prasugrel, new P2Y12 receptor antagonists. Current guidelines recommend PPI use in combination with antiplatelet treatment in patients with risk factors for gastrointestinal bleeding, including advanced age, concurrent use of anticoagulants, steroids, or non-steroidal anti-inflammatory drugs, and Helicobacter pylori (H. pylori) infection. In patients taking oral anticoagulant with risk factors for gastrointestinal bleeding, PPIs could be recommended, even if their usefulness deserves further data. H. pylori infection should always be investigated and treated in patients with a history of peptic ulcer disease (with or without complication) treated with antithrombotic drugs. The present review summarizes the current knowledge regarding the widespread combined use of platelet inhibitors, anticoagulants, and PPIs, discussing consequent clinical implications.
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Affiliation(s)
| | - Alberto Lombardo
- Operative Unit of Cardiology, S. Antonio Abate Hospital, ASP Trapani, Erice 91100, Trapani, Italy
| | - Annabella Braschi
- Department of Psychology, Educational Science and Human Movement, University of Palermo, Palermo 90100, Italy
| | - Nicolò Renda
- Department of Direction, CTA Salus, Gibellina 91024, Trapani, Italy
| | - Vincenzo Abrignani
- Operative Unit of Internal Medicine with Stroke Care, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (ProMISE) “G. D’Alessandro”, University of Palermo, Palermo 90100, Italy
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Kamarul Zaman M, Teng NIMF, Kasim SS, Juliana N, Alshawsh MA. Effects of time-restricted eating with different eating duration on anthropometrics and cardiometabolic health: A systematic review and meta-analysis. World J Cardiol 2023; 15:354-374. [PMID: 37576544 PMCID: PMC10415860 DOI: 10.4330/wjc.v15.i7.354] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 06/20/2023] [Accepted: 07/03/2023] [Indexed: 07/25/2023] Open
Abstract
BACKGROUND Time-restricted eating (TRE) is a dietary approach that limits eating to a set number of hours per day. Human studies on the effects of TRE intervention on cardiometabolic health have been contradictory. Heterogeneity in subjects and TRE interventions have led to inconsistency in results. Furthermore, the impact of the duration of eating/fasting in the TRE approach has yet to be fully explored. AIM To analyze the existing literature on the effects of TRE with different eating durations on anthropometrics and cardiometabolic health markers in adults with excessive weight and obesity-related metabolic diseases. METHODS We reviewed a series of prominent scientific databases, including Medline, Scopus, Web of Science, Academic Search Complete, and Cochrane Library articles to identify published clinical trials on daily TRE in adults with excessive weight and obesity-related metabolic diseases. Randomized controlled trials were assessed for methodological rigor and risk of bias using version 2 of the Cochrane risk-of-bias tool for randomized trials (RoB-2). Outcomes of interest include body weight, waist circumference, fat mass, lean body mass, fasting glucose, insulin, HbA1c, homeostasis model assessment for insulin resistance (HOMA-IR), lipid profiles, C-reactive protein, blood pressure, and heart rate. RESULTS Fifteen studies were included in our systematic review. TRE significantly reduces body weight, waist circumference, fat mass, lean body mass, blood glucose, insulin, and triglyceride. However, no significant changes were observed in HbA1c, HOMA-IR, total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, heart rate, systolic and diastolic blood pressure. Furthermore, subgroup analyses based on the duration of the eating window revealed significant variation in the effects of TRE intervention depending on the length of the eating window. CONCLUSION TRE is a promising chrononutrition-based dietary approach for improving anthropometric and cardiometabolic health. However, further clinical trials are needed to determine the optimal eating duration in TRE intervention for cardiovascular disease prevention.
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Affiliation(s)
- Mazuin Kamarul Zaman
- Centre of Dietetics Studies, Faculty of Health Sciences, Universiti Teknologi MARA Cawangan Selangor, Puncak Alam 42300, Selangor, Malaysia
| | - Nur Islami Mohd Fahmi Teng
- Centre of Dietetics Studies, Faculty of Health Sciences, Universiti Teknologi MARA Cawangan Selangor, Puncak Alam 42300, Selangor, Malaysia.
| | - Sazzli Shahlan Kasim
- Department of Cardiology, Faculty of Medicine, Hospital Universiti Teknologi MARA (HUiTM), Puncak Alam 42300, Selangor, Malaysia
| | - Norsham Juliana
- Department of Physiology, Faculty of Medicine and Health Sciences, Universiti Sains Islam Malaysia, Nilai 71800, Malaysia
| | - Mohammed Abdullah Alshawsh
- Department of Pharmacology, Faculty of Medicine, Universiti Malaya, Kuala Lumpur 50603, Malaysia
- School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton 3168, Victoria, Australia
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10
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Arriola-Montenegro J, Beas R, Cerna-Viacava R, Chaponan-Lavalle A, Hernandez Randich K, Chambergo-Michilot D, Flores Sanga H, Mutirangura P. Therapies for patients with coexisting heart failure with reduced ejection fraction and non-alcoholic fatty liver disease. World J Cardiol 2023; 15:328-341. [PMID: 37576545 PMCID: PMC10415861 DOI: 10.4330/wjc.v15.i7.328] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 06/09/2023] [Accepted: 06/21/2023] [Indexed: 07/25/2023] Open
Abstract
Heart failure with reduced ejection fraction (HFrEF) and nonalcoholic fatty liver disease (NAFLD) are two common comorbidities that share similar pathophysiological mechanisms. There is a growing interest in the potential of targeted therapies to improve outcomes in patients with coexisting HFrEF and NAFLD. This manuscript reviews current and potential therapies for patients with coexisting HFrEF and NAFLD. Pharmacological therapies, including angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, mineralocorticoids receptor antagonist, and sodium-glucose cotransporter-2 inhibitors, have been shown to reduce fibrosis and fat deposits in the liver. However, there are currently no data showing the beneficial effects of sacubitril/valsartan, ivabradine, hydralazine, isosorbide nitrates, digoxin, or beta blockers on NAFLD in patients with HFrEF. This study highlights the importance of considering HFrEF and NAFLD when developing treatment plans for patients with these comorbidities. Further research is needed in patients with coexisting HFrEF and NAFLD, with an emphasis on novel therapies and the importance of a multidisciplinary approach for managing these complex comorbidities.
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Affiliation(s)
- Jose Arriola-Montenegro
- Department of Internal Medicine, University of Minnesota, Minneapolis, MN 55455, United States.
| | - Renato Beas
- Department of Medicine, Indiana University School of Medicine, Indiana, IN 46202, United States
| | | | | | | | | | - Herson Flores Sanga
- Department of Telemedicine, Cardiology, Hospital Nacional Carlos Alberto Seguin Escobedo, Arequipa 8610, Peru
| | - Pornthira Mutirangura
- Department of Medicine, University of Minnesota, Minneapolis, MN 55415, United States
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11
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Gabulova R, Marzà-Florensa A, Rahimov U, Isayeva M, Alasgarli S, Musayeva A, Gahramanova S, Ibrahimov F, Aliyev F, Imanov G, Rasulova R, Vaartjes I, Klipstein-Grobusch K, Graham I, Grobbee DE. Risk factors in cardiovascular patients: Challenges and opportunities to improve secondary prevention. World J Cardiol 2023; 15:342-353. [PMID: 37576543 PMCID: PMC10415862 DOI: 10.4330/wjc.v15.i7.342] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Revised: 06/14/2023] [Accepted: 07/03/2023] [Indexed: 07/25/2023] Open
Abstract
BACKGROUND Effective management of major cardiovascular risk factors is of great importance to reduce mortality from cardiovascular disease (CVD). The Survey of Risk Factors in Coronary Heart Disease (SURF CHD) II study is a clinical audit of the recording and management of CHD risk factors. It was developed in collaboration with the European Association of Preventive Cardiology and the European Society of Cardiology (ESC). Previous studies have shown that control of major cardiovascular risk factors in patients with established atherosclerotic CVD is generally inadequate. Azerbaijan is a country in the South Caucasus, a region at a very high risk for CVD. AIM To assess adherence to ESC recommendations for secondary prevention of CVD based on the measurement of both modifiable major risk factors and their therapeutic management in patients with confirmed CHD at different hospitals in Baku (Azerbaijan). METHODS Six tertiary health care centers participated in the SURF CHD II study between 2019 and 2021. Information on demographics, risk factors, physical and laboratory data, and medications was collected using a standard questionnaire in consecutive patients aged ≥ 18 years with established CHD during outpatient visits. Data from 687 patients (mean age 59.6 ± 9.58 years; 24.9% female) were included in the study. RESULTS Only 15.1% of participants were involved in cardiac rehabilitation programs. The rate of uncontrolled risk factors was high: Systolic blood pressure (BP) (SBP) (54.6%), low-density lipoprotein cholesterol (LDL-C) (86.8%), diabetes mellitus (DM) (60.6%), as well as overweight (66.6%) and obesity (25%). In addition, significant differences in the prevalence and control of some risk factors [smoking, body mass index (BMI), waist circumference, blood glucose (BG), and SBP] between female and male participants were found. The cardiovascular health index score (CHIS) was calculated from the six risk factors: Non- or ex-smoker, BMI < 25 kg/m2, moderate/vigorous physical activity, controlled BP (< 140/90 mmHg; 140/80 mmHg for patients with DM), controlled LDL-C (< 70 mg/dL), and controlled BG (glycohemoglobin < 7% or BG < 126 mg/dL). Good, intermediate, and poor categories of CHIS were identified in 6%, 58.3%, and 35.7% of patients, respectively (without statistical differences between female and male patients). CONCLUSION Implementation of the current ESC recommendations for CHD secondary prevention and, in particular, the control rate of BP, are insufficient. Given the fact that patients with different comorbid pathologies are at a very high risk, this is of great importance in the management of such patients. This should be taken into account by healthcare organizers when planning secondary prevention activities and public health protection measures, especially in the regions at a high risk for CVD. A wide range of educational products based on the Clinical Practice Guidelines should be used to improve the adherence of healthcare professionals and patients to the management of CVD risk factors.
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Affiliation(s)
- Rahima Gabulova
- Teaching-Therapeutical Hospital, Azerbaijan Medical University, Baku AZ1022, Azerbaijan.
| | - Anna Marzà-Florensa
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht 3508 GA, Netherlands
| | - Uzeyir Rahimov
- Department of Cardiology, Baku Medical Plaza, Baku AZ1014, Azerbaijan
| | - Mahluga Isayeva
- Department of CHD and Arrhythmias, Scientific-Research Institute of Cardiology, Baku AZ1072, Azerbaijan
| | - Shahana Alasgarli
- Department of Cardiology, Central Clinic Hospital, Baku AZ1006, Azerbaijan
| | - Afag Musayeva
- Heart Center, Baku Health Center, Baku AZ1072, Azerbaijan
| | - Sona Gahramanova
- Teaching-Therapeutical Hospital, Azerbaijan Medical University, Baku AZ1022, Azerbaijan
| | - Firdovsi Ibrahimov
- Department of Cardiology, Central Clinic Hospital, Baku AZ1006, Azerbaijan
| | - Farid Aliyev
- Heart Center, Baku Health Center, Baku AZ1072, Azerbaijan
| | - Galib Imanov
- Teaching-Surgical Hospital, Azerbaijan Medical University, Baku AZ1022, Azerbaijan
| | - Rahmana Rasulova
- Department of Public Health, Azerbaijan Medical University, Baku AZ1022, Azerbaijan
| | - Ilonca Vaartjes
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht 3508 GA, Netherlands
| | - Kerstin Klipstein-Grobusch
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht 3508 GA, Netherlands
| | - Ian Graham
- Department of Cardiology, Trinity College Dublin, Dublin Dublin-2, Ireland
| | - Diederick E Grobbee
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht 3508 GA, Netherlands
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12
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Khedr A, Hennawi HA, Khan MK, Elbanna M, Jama AB, Proskuriakova E, Mushtaq H, Mir M, Boike S, Rauf I, Eissa A, Urtecho M, Koritala T, Jain N, Goyal L, Surani S, Khan SA. Effect of fibrinolytic therapy on ST-elevation myocardial infarction clinical outcomes during the COVID-19 pandemic: A systematic review and meta-analysis. World J Cardiol 2023; 15:309-323. [PMID: 37397830 PMCID: PMC10308269 DOI: 10.4330/wjc.v15.i6.309] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 03/30/2023] [Accepted: 05/19/2023] [Indexed: 06/26/2023] [Imported: 06/26/2023] Open
Abstract
BACKGROUND ST-elevation myocardial infarction (STEMI) is the result of transmural ischemia of the myocardium and is associated with a high mortality rate. Primary percutaneous coronary intervention (PPCI) is the recommended first-line treatment strategy for patients with STEMI. The timely delivery of PPCI became extremely challenging for STEMI patients during the coronavirus disease 2019 (COVID-19) pandemic, leading to a projected steep rise in mortality. These delays were overcome by the shift from first-line therapy and the development of modern fibrinolytic-based reperfusion. It is unclear whether fibrinolytic-based reperfusion therapy is effective in improving STEMI endpoints.
AIM To determine the incidence of fibrinolytic therapy during the COVID-19 pandemic and its effects on STEMI clinical outcomes.
METHODS PubMed, Google Scholar, Scopus, Web of Science, and Cochrane Central Register of Controlled Trials were queried from January 2020 up to February 2022 to identify studies investigating the effect of fibrinolytic therapy on the prognostic outcome of STEMI patients during the pandemic. Primary outcomes were the incidence of fibrinolysis and the risk of all-cause mortality. Data were meta-analyzed using the random effects model to derive odds ratios (OR) and 95% confidence intervals. Quality assessment was carried out using the Newcastle-Ottawa scale.
RESULTS Fourteen studies including 50136 STEMI patients (n = 15142 in the pandemic arm; n = 34994 in the pre-pandemic arm) were included. The mean age was 61 years; 79% were male, 27% had type 2 diabetes, and 47% were smokers. Compared with the pre-pandemic period, there was a significantly increased overall incidence of fibrinolysis during the pandemic period [OR: 1.80 (1.18 to 2.75); I2= 78%; P = 0.00; GRADE: Very low]. The incidence of fibrinolysis was not associated with the risk of all-cause mortality in any setting. The countries with a low-and middle-income status reported a higher incidence of fibrinolysis [OR: 5.16 (2.18 to 12.22); I2 = 81%; P = 0.00; GRADE: Very low] and an increased risk of all-cause mortality in STEMI patients [OR: 1.16 (1.03 to 1.30); I2 = 0%; P = 0.01; GRADE: Very low]. Meta-regression analysis showed a positive correlation of hyperlipidemia (P = 0.001) and hypertension (P < 0.001) with all-cause mortality.
CONCLUSION There is an increased incidence of fibrinolysis during the pandemic period, but it has no effect on the risk of all-cause mortality. The low- and middle-income status has a significant impact on the all-cause mortality rate and the incidence of fibrinolysis.
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Affiliation(s)
- Anwar Khedr
- Department of Internal Medicine, BronxCare Health System, Bronx, NY 10457, United States
| | - Hussam Al Hennawi
- Department of Internal Medicine, Jefferson Abington Hospital, Abington, PA 19001, United States
| | - Muhammed Khuzzaim Khan
- Department of Internal Medicine, Dow University of Health Science, Karachi 74200, Pakistan
| | - Mostafa Elbanna
- Department of Internal Medicine, Rochester Regional Health, Rochester, NY 14621, United States
| | - Abbas B Jama
- Department of Critical Care, Mayo Clinic Health System, Mankato, MN 56001, United States
| | | | - Hisham Mushtaq
- Department of Internal Medicine, St. Vincent's Medical Center, Bridgeport, CT 06606, United States
| | - Mikael Mir
- Department of Medicine, University of Minnesota, Minneapolis, MN 55455, United States
| | - Sydney Boike
- Department of Medicine, University of Minnesota, Minneapolis, MN 55455, United States
| | - Ibtisam Rauf
- Department of Medicine, St. George's University, School of Medicine, St George SW17 0RE, Grenada
| | - Aalaa Eissa
- Department of Medicine, KFS University, KFS 33511, Egypt
| | - Meritxell Urtecho
- Department of Medicine, Robert D and Patricia E. Kern Center of Health Care Delivery, Mayo Clinic, Rochester, MN 55905, United States
| | - Thoyaja Koritala
- Department of Hospital Medicine, Mayo Clinic Health System, Mankato, MN 56001, United States
| | - Nitesh Jain
- Department of Medicine, Mayo Clinic Health System, Mankato, MN 56001, United States
| | - Lokesh Goyal
- Department of Hospital Medicine, Christus Sphon Hospital-shoreline, Corpus Christo, TX 78404, United States
| | - Salim Surani
- Department of Pulmonary, Critical Care & Sleep Medicine, Texas A&M University, College Station, TX 77843, United States
| | - Syed A Khan
- Department of Critical Care Medicine, Mayo Clinic Health System, Mankato, MN 56001, United States
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13
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Wang R, Yang YM. Identification of potential biomarkers for idiopathic pulmonary fibrosis and validation of TDO2 as a potential therapeutic target. World J Cardiol 2023; 15:293-308. [PMID: 37397828 PMCID: PMC10308271 DOI: 10.4330/wjc.v15.i6.293] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 06/01/2023] [Accepted: 06/13/2023] [Indexed: 06/26/2023] [Imported: 06/26/2023] Open
Abstract
BACKGROUND Idiopathic pulmonary fibrosis (IPF) is a progressive interstitial lung disease with a high mortality rate. On this basis, exploring potential therapeutic targets to meet the unmet needs of IPF patients is important.
AIM To explore novel hub genes for IPF therapy.
METHODS Here, we used public datasets to identify differentially expressed genes between IPF patients and healthy donors. Potential targets were considered based on multiple bioinformatics analyses, especially the correlation between hub genes and carbon monoxide diffusing capacity of carbon monoxide, forced vital capacity, and patient survival rate. The mRNA levels of the hub genes were determined through quantitative real-time polymerase chain reaction.
RESULTS We found that TDO2 was upregulated in IPF patients and predicted poor prognosis. Surprisingly, single-cell RNA sequencing data analysis revealed significant enrichment of TDO2 in alveolar fibroblasts, indicating that TDO2 may participate in the regulation of proliferation and survival. Therefore, we verified the upregulated expression of TDO2 in an experimental mouse model of transforming growth factor-β (TGF-β)-induced pulmonary fibrosis. Furthermore, the results showed that a TDO2 inhibitor effectively suppressed TGF-β-induced fibroblast activation. These findings suggest that TDO2 may be a potential target for IPF treatment. Based on transcription factors-microRNA prediction and scRNA-seq analysis, elevated TDO2 promoted the IPF proliferation of fibroblasts and may be involved in the P53 pathway and aggravate ageing and persistent pulmonary fibrosis.
CONCLUSION We provided new target genes prediction and proposed blocking TGF-β production as a potential treatment for IPF.
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Affiliation(s)
- Ru Wang
- Henan University of Chinese Medicine, Collaborative Innovation Centre for Chinese Medicine and Respiratory Diseases, Zhengzhou 450046, Henan Province, China
| | - Yan-Mei Yang
- Zhengzhou University, Research Centre of Basic Medicine, Academy of Medical Sciences, Zhengzhou 450000, Henan Province, China
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14
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Yukselen Z, Singh Y, Malempati S, Dasari M, Arun Kumar P, Ramsaran E. Virtual patient education for hypertension: The truth about behavioral change. World J Cardiol 2023; 15:324-327. [PMID: 37397829 PMCID: PMC10308268 DOI: 10.4330/wjc.v15.i6.324] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Revised: 05/11/2023] [Accepted: 05/22/2023] [Indexed: 06/26/2023] [Imported: 06/26/2023] Open
Abstract
Anti-hypertensive education is an important public health intervention to decrease the mortality and burden of the disease. Using digital technologies for education as a part of preventive measures for hypertension is a cost-effective approach and helps low-income communities and vulnerable populations overcome barriers to healthcare access. The coronavirus disease 19 pandemic further highlighted the need of new health interventions to address health inequalities. Virtual education is helpful to improve awareness, knowledge, and attitude toward hypertension. However, given the complexity of behavioral change, educational approaches do not always provide a change in behavior. Some of the obstacles in online hypertensive education could be time limitations, not being tailored to individual needs and not including the different elements of behavioral models to enhance behavior change. Studies regarding virtual education should be encouraged and involve lifestyle modifications emphasizing the importance of Dietary Approaches to Stop Hypertension diet, salt restriction, and exercise and should be used adjunct to in-person visits for the management of hypertension. Additionally, to stratify patients according to hypertension type (essential or secondary) would be useful to create specific educational materials. Virtual hypertension education is promising to increase awareness regarding risk factors and most importantly motivate patients to be more compliant with management helping to decrease hypertension related complications and hospitalizations.
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Affiliation(s)
- Zeynep Yukselen
- Department of Internal Medicine, Saint Vincent Hospital, Worcester, MA 01608, United States
- School of Public Health and Health Sciences, University of Massachusetts, Amherst, MA 01003, United States
| | - Yuvaraj Singh
- Department of Internal Medicine, Saint Vincent Hospital, Worcester, MA 01608, United States
| | - Sarat Malempati
- Department of Internal Medicine, Saint Vincent Hospital, Worcester, MA 01608, United States
| | - Mahati Dasari
- Department of Internal Medicine, Saint Vincent Hospital, Worcester, MA 01608, United States
| | - Pramukh Arun Kumar
- Department of Internal Medicine, Saint Vincent Hospital, Worcester, MA 01608, United States
| | - Eddison Ramsaran
- Department of Cardiovascular Medicine, Saint Vincent Hospital, Worcester, MA 01608, United States
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15
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Vidal-Perez R, Grapsa J, Bouzas-Mosquera A, Fontes-Carvalho R, Vazquez-Rodriguez JM. Current role and future perspectives of artificial intelligence in echocardiography. World J Cardiol 2023; 15:284-292. [PMID: 37397831 PMCID: PMC10308270 DOI: 10.4330/wjc.v15.i6.284] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 05/02/2023] [Accepted: 06/21/2023] [Indexed: 06/26/2023] [Imported: 06/26/2023] Open
Abstract
Echocardiography is an essential tool in diagnostic cardiology and is fundamental to clinical care. Artificial intelligence (AI) can help health care providers serving as a valuable diagnostic tool for physicians in the field of echocardiography specially on the automation of measurements and interpretation of results. In addition, it can help expand the capabilities of research and discover alternative pathways in medical management specially on prognostication. In this review article, we describe the current role and future perspectives of AI in echocardiography.
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Affiliation(s)
- Rafael Vidal-Perez
- Servicio de Cardiología, Unidad de Imagen y Función Cardíaca, Complexo Hospitalario Universitario A Coruña Centro de Investigación Biomédica en Red-Instituto de Salud Carlos III, A Coruña 15006, Spain
| | - Julia Grapsa
- Department of Cardiology, Guys and St Thomas NHS Trust, London SE1 7EH, United Kingdom
| | - Alberto Bouzas-Mosquera
- Servicio de Cardiología, Unidad de Imagen y Función Cardíaca, Complexo Hospitalario Universitario A Coruña Centro de Investigación Biomédica en Red-Instituto de Salud Carlos III, A Coruña 15006, Spain
| | - Ricardo Fontes-Carvalho
- Cardiology Department, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vilanova de Gaia 4434-502, Portugal
- Cardiovascular R&D Centre - UnIC@RISE, Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto 4200-319, Portugal
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16
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Nelson JT, Liu L. Pharmacoepidemiologic study of association between apparent treatment resistant hypertension, cardiovascular disease and interaction effect by sex and age. World J Cardiol 2023; 15:262-272. [PMID: 37274374 PMCID: PMC10237003 DOI: 10.4330/wjc.v15.i5.262] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Revised: 03/31/2023] [Accepted: 04/18/2023] [Indexed: 05/19/2023] [Imported: 07/20/2023] Open
Abstract
BACKGROUND A limited number of studies have been conducted to test the magnitudes of the association between apparent treatment resistant hypertension (aTRH) and risk of cardiovascular disease (CVD).
AIM To investigate the association between aTRH and risk of CVD and examine whether sex and age modify this association.
METHODS We applied an observational analysis study design using data from the United States Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). ALLHAT recruited participants (n = 25516) from 625 primary care settings throughout the United States, Canada, Puerto Rico, and United States Virgin Islands, aged 55 and older with hypertension and at least one additional risk factor for heart disease. aTRH was assessed from the year 2 visit. CVD event was defined as one of the following from the year 2 follow-up visit: Fatal or non-fatal myocardial infarction, coronary revascularization, angina, stroke, heart failure, or peripheral artery disease. Cox proportional hazards regression was used to examine the effect of aTRH on CVD risk. Potential modifications of sex and age on this association were examined on the multiplicative scale by interaction term and additive scale by joint effects and relative excess risk for interaction.
RESULTS Of the total study participants (n = 25516), 5030 experienced a CVD event during a mean of 4.7 years follow-up. aTRH was associated with a 30% increase in risk of CVD compared to non-aTRH [hazards ratio (HR) = 1.3, 95%CI: 1.19-1.42]. Sex and age modified this relationship on both multiplicative and additive scales independently. Stratified by sex, aTRH was associated with a 64% increase in risk of CVD (HR = 1.64, 95%CI: 1.43–1.88) in women, and a 13% increase in risk of CVD (HR = 1.13, 95%CI: 1.01–1.27) in men. Stratified by age, aTRH had a stronger impact on the risk of CVD in participants aged < 65 (HR = 1.53, 95%CI: 1.32–1.77) than it did in those aged ≥ 65 (HR = 1.18, 95%CI: 1.05–1.32). Significant two-way interactions of sex and aTRH, and age and aTRH on risk of CVD were observed (P < 0.05). The observed joint effect of aTRH and ages ≥ 65 years (HR = 1.85, 95%CI: 1.22–2.48) in males was less than what was expected for both additive and multiplicative models (HR = 4.10, 95%CI: 3.63–4.57 and 4.88, 95%CI: 3.66–6.31), although three-way interaction of sex, age, and aTRH on the risk of CVD and coronary heart disease did not reach a statistical significance (P > 0.05).
CONCLUSION aTRH was significantly associated with an increased risk of CVD and this association was modified by both sex and age. Further studies are warranted to test these mechanisms.
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Affiliation(s)
- Julianne Theresa Nelson
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA 19104, United States
| | - Longjian Liu
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA 19104, United States
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17
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Urbani A, Pensotti F, Provera A, Galassi A, Guazzi M, Castini D. Extracorporeal veno-venous ultrafiltration in congestive heart failure: What’s the state of the art? A mini-review. World J Cardiol 2023; 15:205-216. [PMID: 37274372 PMCID: PMC10237006 DOI: 10.4330/wjc.v15.i5.205] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 01/19/2023] [Accepted: 04/24/2023] [Indexed: 05/19/2023] [Imported: 07/20/2023] Open
Abstract
Hospitalizations for heart failure exceed 1 million per year in both the United States and Europe and more than 90% are due to symptoms and signs of fluid overload. Rates of rehospitalizations or emergency department visit at 60 days are remarkable regardless of whether loop diuretics were administered at low vs high doses or by bolus injection vs continuous infusion. Ultrafiltration (UF) has been considered a promising alternative to stepped diuretic therapy and it consists in the mechanical, adjustable removal of iso-tonic plasma water across a semipermeable membrane with the application of hydrostatic pressure gradient generated by a pump. Fluid removal with ultrafiltration presents several advantages such as elimination of higher amount of sodium with less neurohormonal activation. However, the conflicting results from UF studies highlight that patient selection and fluid removal targets are not completely understood. The best way to assess fluid status and therefore establish the fluid removal target is also still a matter of debate. Herein, we provide an up-to-date systematic review about the role of ultrafiltration among patients with fluid overload and its gaps in daily practice.
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Affiliation(s)
- Andrea Urbani
- Cardiology Unit, Department of Health Sciences, San Paolo Hospital, University of Milan, Milan 20142, Italy
| | - Filippo Pensotti
- Cardiology Unit, Department of Health Sciences, San Paolo Hospital, University of Milan, Milan 20142, Italy
| | - Andrea Provera
- Cardiology Unit, Department of Health Sciences, San Paolo Hospital, University of Milan, Milan 20142, Italy
| | - Andrea Galassi
- Nephrology Unit, Department of Health Sciences, San Paolo Hospital, University of Milan, Milan 20142, Italy
| | - Marco Guazzi
- Cardiology Unit, Department of Health Sciences, San Paolo Hospital, University of Milan, Milan 20142, Italy
| | - Diego Castini
- Cardiology Unit, Department of Health Sciences, San Paolo Hospital, University of Milan, Milan 20142, Italy
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18
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Batta A, Hatwal J, Batta A, Verma S, Sharma YP. Atrial fibrillation and coronary artery disease: An integrative review focusing on therapeutic implications of this relationship. World J Cardiol 2023; 15:229-243. [PMID: 37274376 PMCID: PMC10237004 DOI: 10.4330/wjc.v15.i5.229] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 03/05/2023] [Accepted: 05/06/2023] [Indexed: 05/19/2023] [Imported: 07/20/2023] Open
Abstract
The incidence of both atrial fibrillation (AF) and coronary artery disease (CAD) increases with advancing age. They share common risk factors and very often coexist. Evidence points to an intricate relationship between atrial tissue excitability and neuronal remodeling with ischemia at the microcirculatory level. In this review, we delineated this complex relationship, identified a common theme between the two, and discussed how the knowledge of this relationship translates into a positive and meaningful impact in patient management. Recent research indicates a high prevalence of CAD among AF patients undergoing coronary angiography. Further, the incidence of AF is much higher in those suffering from CAD compared to age-matched adults without CAD underlying this reciprocal relationship. CAD adversely affects AF by promoting progression via re-entry and increasing excitability of atrial tissue as a result of ischemia and electrical inhomogeneity. AF in turn accelerates atherosclerosis via endothelial dysfunctional and inflammation and together with enhanced thrombogenicity and hypercoagulability contribute to micro and macrothrombi throughout cardiovascular system. In a nutshell, the two form a vicious cycle wherein one disease promotes the other. Most AF recommendations focuses on rate/rhythm control and prevention of thromboembolism. Very few studies have discussed the importance of unmasking coexistent CAD and how the treatment of underlying ischemia will impact the burden of AF in these patients. Inflammation and endothelial dysfunction remain central to both disease processes and form a handsome therapeutic target in the management of the two diseases. The relationship between AF and CAD is complex and much more than mere coincidence. The two diseases share common risk factor and pathophysiology. Hence, it is impractical to treat them in isolation. Accordingly, we share the implications of managing underlying ischemia and inflammation to positively impact and improve quality of life among AF patients.
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Affiliation(s)
- Akash Batta
- Department of Cardiology, Dayanand Medical College and Hospital, Ludhiana 141001, Punjab, India
| | - Juniali Hatwal
- Department of Internal Medicine, Post Graduate Institute of Medical Education & Research, Chandigarh 160012, India
| | - Akshey Batta
- Department of Medicine and Surgery, Sohana Multi Super Specialty Hospital, Mohali 160062, Punjab, India
| | - Samman Verma
- Department of Cardiology, Post Graduate Institute of Medical Education & Research, Chandigarh 160012, India
| | - Yash Paul Sharma
- Department of Cardiology, Post Graduate Institute of Medical Education & Research, Chandigarh 160012, India
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Grillo TG, Silveira CFDSMP, Quaglio AEV, Dutra RDM, Baima JP, Bazan SGZ, Sassaki LY. Acute heart failure as an adverse event of tumor necrosis factor inhibitor therapy in inflammatory bowel disease: A review of the literature. World J Cardiol 2023; 15:217-228. [PMID: 37274378 PMCID: PMC10237008 DOI: 10.4330/wjc.v15.i5.217] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 02/09/2023] [Accepted: 04/12/2023] [Indexed: 05/19/2023] [Imported: 07/20/2023] Open
Abstract
Tumor necrosis factor inhibitors (anti-TNFs) are widely used therapies for the treatment of inflammatory bowel diseases (IBD); however, their administration is not risk-free. Heart failure (HF), although rare, is a potential adverse event related to administration of these medications. However, the exact mechanism of development of HF remains obscure. TNFα is found in both healthy and damaged hearts. Its effects are concentration- and receptor-dependent, promoting either cardio-protection or cardiomyocyte apoptosis. Experimental rat models with TNFα receptor knockout showed increased survival rates, less reactive oxygen species formation, and improved diastolic left ventricle pressure. However, clinical trials employing anti-TNF therapy to treat HF had disappointing results, suggesting abolishment of the cardioprotective properties of TNFα, making cardiomyocytes susceptible to apoptosis and oxidation. Thus, patients with IBD who have risk factors should be screened for HF before initiating anti-TNF therapy. This review aims to discuss adverse events associated with the administration of anti-TNF therapy, with a focus on HF, and propose some approaches to avoid cardiac adverse events in patients with IBD.
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Affiliation(s)
- Thais Gagno Grillo
- Department of Internal Medicine, Medical School, São Paulo State University, Botucatu, Botucatu 18618686, Brazil
| | | | - Ana Elisa Valencise Quaglio
- Department of Biophysics and Pharmacology, Institute of Biosciences, São Paulo State University, Botucatu, Botucatu 18618689, Brazil
| | - Renata de Medeiros Dutra
- Department of Internal Medicine, Medical School, São Paulo State University, Botucatu, Botucatu 18618686, Brazil
| | - Julio Pinheiro Baima
- Department of Internal Medicine, Medical School, São Paulo State University, Botucatu, Botucatu 18618686, Brazil
| | - Silmeia Garcia Zanati Bazan
- Department of Internal Medicine, Medical School, São Paulo State University, Botucatu, Botucatu 18618686, Brazil
| | - Ligia Yukie Sassaki
- Department of Internal Medicine, Medical School, São Paulo State University, Botucatu, Botucatu 18618686, Brazil
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Christodoulou KC, Karangelis D, Efenti GM, Sdrevanos P, Browning JR, Konstantinou F, Georgakarakos E, Mitropoulos FA, Mikroulis D. Current knowledge and contemporary management of non-A non-B aortic dissections. World J Cardiol 2023; 15:244-252. [PMID: 37274377 PMCID: PMC10237007 DOI: 10.4330/wjc.v15.i5.244] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Revised: 04/10/2023] [Accepted: 04/25/2023] [Indexed: 05/19/2023] [Imported: 07/20/2023] Open
Abstract
Non-A non-B aortic dissection (AAD) is an infrequently documented condition, comprising of only a small proportion of all AADs. The unique anatomy of the aortic arch and the failure of the existing classifications to adequately define individuals with non-A non-B AAD, have led to an ongoing controversy around the topic. It seems that the clinical progression of acute non-A non-B AAD diverges from the typical type A and B dissections, frequently leading to serious complications and thus mandating early intervention. Currently, the available treatment methods in the surgical armamentarium are conventional open, endovascular techniques and combined hybrid methods. The optimum approach is tailored in every individual case and may be determined by the dissection’s location, extent, the aortic diameter, the associated complications and the patient’s status. The management of non-A non-B dissections still remains challenging and a unanimous consensus defining the gold standard treatment has yet to be reached. In an attempt to provide further insight into this perplexing entity, we performed a minireview of the literature, aiming to elucidate the epidemiology, clinical course and the optimal treatment modality.
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Affiliation(s)
- Konstantinos C Christodoulou
- Department of Cardiac Surgery, Democritus University of Thrace, University Hospital of Alexandroupolis, Alexandroupolis 68100, Greece
| | - Dimos Karangelis
- Department of Cardiac Surgery, Democritus University of Thrace, University Hospital of Alexandroupolis, Alexandroupolis 68100, Greece
| | | | | | - Jennifer R Browning
- Department of Cardiac Surgery, Democritus University of Thrace, University Hospital of Alexandroupolis, Alexandroupolis 68100, Greece
| | - Fotis Konstantinou
- Department of Cardiac Surgery, Democritus University of Thrace, University Hospital of Alexandroupolis, Alexandroupolis 68100, Greece
| | - Efstratios Georgakarakos
- Department of Vascular Surgery, University Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis 68100, Greece
| | | | - Dimitrios Mikroulis
- Department of Cardiac Surgery, Democritus University of Thrace, University Hospital of Alexandroupolis, Alexandroupolis 68100, Greece
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Bhangal R, Cancarevic I, Nassar M, Umar Z. Impact of erythropoietin therapy on cardiorenal syndrome: A systematic review with meta-analysis. World J Cardiol 2023; 15:273-283. [PMID: 37274373 PMCID: PMC10237005 DOI: 10.4330/wjc.v15.i5.273] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 03/07/2023] [Accepted: 04/04/2023] [Indexed: 05/19/2023] [Imported: 07/20/2023] Open
Abstract
BACKGROUND Heart and kidney dysfunction frequently coexist in patients with acute heart failure due to the overlap between these two organ systems. Cardiorenal syndrome (CRS) results from pathology occurring in the heart and kidneys along with the consequences of dysfunction in one organ contributing to dysfunction in the other and vice versa.
AIM To evaluate the use of erythropoietin (EPO) in patients with CRS and its effects on hemoglobin (Hb), major cardiovascular (CV) events, and hospitalization rates.
METHODS On February 24, 2022, searches were conducted using PubMed, MEDLINE, and EMBASE, and 148 articles were identified. A total of nine studies were considered in this systematic review. We assessed the included articles based on the National Heart, Lung, and Blood Institute quality assessment tools for controlled intervention and observational cohort or cross-sectional studies. An assessment of bias risk was conducted on the chosen studies, and data relevant to our review was extracted.
RESULTS The systematic review of these studies concluded that most existing literature indicates that EPO improves baseline Hb levels and decreases myocardial remodeling and left ventricular dysfunction without reducing CV mortality. In addition, the effect of EPO on the hospitalization rate of patients with CRS needs to be further studied since this relationship is unknown. Future studies, such as randomized controlled clinical trials and prospective cohort studies, should be conducted to enhance the literature on the potential of EPO therapy in patients with CRS.
CONCLUSION Our systematic review suggests that EPO therapy may have a significant role in managing CRS. The review highlights the potential benefits of EPO in improving baseline Hb levels, reducing the risk of major CV events, improving cardiac remodeling, myocardial function, New York Heart Association class, and B-type natriuretic peptide levels. However, the effect of EPO treatment on hospitalization remains unclear and needs further exploration.
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Affiliation(s)
- Rubal Bhangal
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai/NYC Health+Hospitals Queens, New York, NY 11432, United States
| | - Ivan Cancarevic
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai/NYC Health+Hospitals Queens, New York, NY 11432, United States
| | - Mahmoud Nassar
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States
- Department of Internal Medicine, NYC Health+Hospital Queens, New York, NY 11432, United States
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