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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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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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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: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [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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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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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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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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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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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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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: 11] [Impact Index Per Article: 11.0] [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
| | - Zaryab Umar
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai/NYC Health+Hospitals Queens, New York, NY 11432, United States
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Pai RG, Varadarajan P. Importance of concomitant functional mitral regurgitation on survival in severe aortic stenosis patients undergoing aortic valve replacement. World J Cardiol 2023; 15:253-261. [PMID: 37274375 PMCID: PMC10237009 DOI: 10.4330/wjc.v15.i5.253] [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: 12/20/2022] [Revised: 03/20/2023] [Accepted: 04/25/2023] [Indexed: 05/19/2023] [Imported: 07/20/2023] Open
Abstract
BACKGROUND Mitral regurgitation (MR) is commonly seen in patients with severe aortic stenosis (AS) undergoing aortic valve replacement (AVR). But the long-term implications of MR in AS are unknown.
AIM To investigate MR’s impact on survival of patients undergoing surgical AVR for severe AS.
METHODS Of the 740 consecutive patients with severe AS evaluated between 1993 and 2003, 287 underwent AVR forming the study cohort. They were followed up to death or till the end of 2019. Chart reviews were performed for clinical, echocardiographic, and therapeutic data. MR was graded on a 1-4 scale. Mortality data was obtained from chart review and the Social Security Death Index. Survival was analyzed as a function of degree of MR.
RESULTS The mean age of the severe AS patients who had AVR (n = 287) was 72 ± 13 years, 46% women. Over up to 26 years of follow up, there were 201 (70%) deaths, giving deep insights into the determinants of survival of severe AS who had AVR. The 5, 10 and 20 years survival rates were 75%, 45% and 25% respectively. Presence of MR was associated with higher mortality in a graded fashion (P = 0.0003). MR was significantly associated with lower left ventricular (LV) ejection fraction and larger LV size. Impact of MR on mortality was partially mediated through lower LV ejection fraction and larger LV size. By Cox regression, MR, lower ejection fraction (EF) and larger LV end-systolic dimension were independent predictors of higher mortality (χ2 = 33.2).
CONCLUSION Presence of greater than 2+ MR in patients with severe AS is independently associated with reduced survival in surgically managed patients, an effect incremental to reduced EF and larger LV size. We suggest that aortic valve intervention should be considered in severe AS patients when > 2+ MR occurs irrespective of EF or symptoms.
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Affiliation(s)
- Ramdas G Pai
- Department of Cardiology, University of California Riverside School of Medicine, Riverside/St. Bernardine Medical Center, San Bernardino, Riverside, CA 92521, United States
| | - Padmini Varadarajan
- Department of Cardiology, University of California Riverside School of Medicine, Riverside, CA 92521, United States
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Dasari M, Arun Kumar P, Singh Y, Ramsaran E. New scoring system for acute chest pain risk stratification: Is it worth SVEAT-ing it? World J Cardiol 2023; 15:200-204. [PMID: 37124978 PMCID: PMC10130892 DOI: 10.4330/wjc.v15.i4.200] [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: 01/22/2023] [Revised: 03/28/2023] [Accepted: 04/10/2023] [Indexed: 04/20/2023] [Imported: 07/20/2023] Open
Abstract
The emergency room is a very potent environment in the hospital. With the growing demands of the population, improved accessibility to health resources, and the onslaught of the triple pandemic, it is extremely crucial to triage patients at presentation. In the spectrum of complaints, chest pain is the commonest. Despite it being a daily ailment, chest pain brings concern to every physician at first. Chest pain could span from acute coronary syndrome, pulmonary embolism, and aortic dissection (all potentially fatal) to reflux, zoster, or musculoskeletal causes that do not need rapid interventions. We often employ scoring systems such as GRACE/PURSUIT/TIMI to assist in clinical decision-making. Over the years, the HEART score became a popular and effective tool for predicting the risk of 30-d major adverse cardiovascular events. Recently, a new scoring system called SVEAT was developed and compared to the HEART score. We have attempted to summarize how these scoring systems differ and their generalizability. With an increasing number of scoring systems being introduced, one must also prevent anchorage bias; i.e., tools such as these are only diagnosis-specific and not organ-specific, and other emergent differential diagnoses must also be kept in mind before discharging the patient home without additional workup.
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Affiliation(s)
- 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
| | - Yuvaraj Singh
- Department of Internal Medicine, Saint Vincent Hospital, Worcester, MA 01608, United States
| | - Eddison Ramsaran
- Department of Cardiology, Saint Vincent Hospital, Worcester, MA 01608, United States
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Kalinin R, Suchkov I, Povarov V, Mzhavanadze N, Zhurina O. Perioperative coagulation activation after permanent pacemaker placement. World J Cardiol 2023; 15:174-183. [PMID: 37124977 PMCID: PMC10130890 DOI: 10.4330/wjc.v15.i4.174] [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: 03/05/2023] [Accepted: 04/12/2023] [Indexed: 04/20/2023] [Imported: 07/20/2023] Open
Abstract
BACKGROUND Bradyarrhythmias are typically treated with permanent pacemakers (PM). The elimination of bradyarrhythmia by PM implantation improves the patient's quality of life and prognosis, but it can also result in a number of sequalae. It is still unclear how PM implantation affects the hemostasis system's parameters and how such parameters relate to different consequences after PM placement.
AIM To assess the blood coagulation factor activity in PM patients throughout the perioperative period.
METHODS Patients treated in the Department of Surgical Therapy of Cardiac Arrhythmias and Pacing at the Ryazan State "Regional Clinical Cardiology Dispensary" from April 2020 to December 2021 were included in the study. Before surgery, 7 and 30 d after PM placement, peripheral venous blood samples were withdrawn to measure the level of blood coagulation factor I (FI) and the activity of blood coagulation factors II (FII), V (FV), VII (FVII), VIII (FVIII), IX (FIX), X (FX), XI (FXI), XII (FXII). We used an automatic coagulometer Sysmex CA 660 (Sysmex Europe, Germany) and reagents from Siemens (Siemens Healthcare Diagnostics Products GmbH, Germany).
RESULTS The study included 146 patients. The activity of factors FV [147.7 (102.1-247.55)% vs 103.85 (60-161.6)% vs 81.8 (67.15-130.65)%, P = 0.002], FVIII [80.4 (60.15-106.25)% vs 70.3 (48.5-89.1)% vs 63.7 (41.6-88.25)%, P = 0.039], FIX [86.2 (70.75-102.95)% vs 75.4 (59.2-88.3)% vs 73.9 (56.45-93.05)%, P = 0.014], FX [188.9 (99.3-308.18)% vs 158.9 (83.3-230)% vs 127.2 (95.25-209.35)%, P = 0.022], FXI [82.6 (63.9-103.6)% vs 69.75 (53.8-97.6)% vs 67.3 (54.25-98.05)%, P = 0.002], FXII [87.6 (67.15-102.3)% vs 78.9 (63.4-97.05)% vs 81.2 (62.15-97.4)%, P < 0.001] decreased at 7 and 30 d after surgery; FII activity [157.9 (109.7-245.25)% vs 130 (86.8-192.5)% vs 144.8 (103.31-185.6)%, P = 0.021] decreased at 7 d and increased at 30 d postoperatively. There were no statistically significant changes in the FVII activity within 30 d after PM placement [182.2 (85.1-344.8)% vs 157.2 (99.1-259)% vs 108.9 (74.9-219.8)%, P = 0.128]. Subgroup analysis revealed similar changes only in patients on anticoagulant therapy. FXII activity decreased in patients on antiplatelet therapy [82 (65.8-101.9)% vs 79.9 (63.3-97.1)% vs 89.7 (75.7-102.5)%, P = 0.01] 7 d after surgery, returning to baseline values at 30 d postoperatively.
CONCLUSION PM placement and anticoagulant therapy were associated with decreased activity of clotting factors FV, FVIII, FIX, FX, FXI, FXII in the postoperative period. FVII activity did not decrease within 30 d after PM placement, which may indicate endothelial injury caused by lead placement.
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Affiliation(s)
- Roman Kalinin
- Department of Cardiovascular, Endovascular Surgery and Diagnostic Radiology, Ryazan State Medical University, Ryazan 390026, Russia
| | - Igor Suchkov
- Department of Cardiovascular, Endovascular Surgery and Diagnostic Radiology, Ryazan State Medical University, Ryazan 390026, Russia
| | - Vladislav Povarov
- Department of Cardiovascular, Endovascular Surgery and Diagnostic Radiology, Ryazan State Medical University, Ryazan 390026, Russia
- Department of Surgical Treatment of Cardiac Arrhythmias and Cardiac Pacing, Ryazan State "Regional Clinical Cardiology Dispensary", Ryazan 390026, Russia
| | - Nina Mzhavanadze
- Department of Cardiovascular, Endovascular Surgery and Diagnostic Radiology, Ryazan State Medical University, Ryazan 390026, Russia
| | - Olga Zhurina
- Scientific and Clinical Center for Hematology, Oncology and Immunology, Ryazan State Medical University, Ryazan 390026, Russia
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Vidal-Perez R, Vazquez-Rodriguez JM. Role of artificial intelligence in cardiology. World J Cardiol 2023; 15:116-118. [PMID: 37124979 PMCID: PMC10130891 DOI: 10.4330/wjc.v15.i4.116] [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: 11/28/2022] [Revised: 01/19/2023] [Accepted: 04/10/2023] [Indexed: 04/20/2023] [Imported: 07/20/2023] Open
Abstract
Artificial intelligence (AI) is the process of having a computational program that can perform tasks of human intelligence by mimicking human thought processes. AI is a rapidly evolving transdisciplinary field which integrates many elements to develop algorithms that aim to simulate human intuition, decision-making, and object recognition. The overarching aims of AI in cardiovascular medicine are threefold: To optimize patient care, improve efficiency, and improve clinical outcomes. In cardiology, there has been a growth in the potential sources of new patient data, as well as advances in investigations and therapies, which position the field well to uniquely benefit from AI. In this editorial, we highlight some of the main research priorities currently and where the next steps are heading us.
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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, A Coruña, Spain
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Gioscia R, Castagno C, Verdoia M, Conti B, Forliti E, Rognoni A. Optimization of the pharmacological therapy in patients with poly-vascular disease: A multidisciplinary approach. World J Cardiol 2023; 15:142-153. [PMID: 37124976 PMCID: PMC10130889 DOI: 10.4330/wjc.v15.i4.142] [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: 01/03/2023] [Revised: 03/27/2023] [Accepted: 04/07/2023] [Indexed: 04/20/2023] [Imported: 07/20/2023] Open
Abstract
The recent shift of the concept of cardiovascular disease as a chronic progressive condition, potentially involving multiple districts, has driven attention to the optimal management of patients with concomitant coronary and peripheral artery disease, representing a subset of patients with an increased risk of events and impaired survival. Recent pharmacological achievements in terms of antithrombotic therapy and lipid-lowering drugs allow multiple therapeutical combinations, thus requiring optimizing the treatment in a tailored fashion according to patients’ risk profiles. Nevertheless, data dedicated to this specific subset of patients are still modest. We summarize currently available strategies and indications for the management of antithrombotic and lipid-lowering drugs in patients with the poly-vascular disease.
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Affiliation(s)
- Rocco Gioscia
- Department of Cardiology, Nuovo Ospedale Degli Infermi, Biella 13900, Italy
| | - Claudio Castagno
- Department of Vascular Surgery, Nuovo Ospedale Degli Infermi, Biella 13900, Italy
| | - Monica Verdoia
- Department of Cardiology, Nuovo Ospedale Degli Infermi, Biella 13900, Italy
| | - Barbara Conti
- Department of Vascular Surgery, Nuovo Ospedale Degli Infermi, Biella 13900, Italy
| | - Enzo Forliti
- Department of Vascular Surgery, Nuovo Ospedale Degli Infermi, Biella 13900, Italy
| | - Andrea Rognoni
- Department of Cardiology, Nuovo Ospedale Degli Infermi, Biella 13900, Italy
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Lazzeri C, Bonizzoli M, Batacchi S, Cianchi G, Franci A, Socci F, Chiostri M, Peris A. Right ventricle dysfunction does not predict mortality in patients with SARS-CoV-2-related acute respiratory distress syndrome on extracorporeal membrane oxygenation support. World J Cardiol 2023; 15:165-173. [PMID: 37124973 PMCID: PMC10130894 DOI: 10.4330/wjc.v15.i4.165] [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: 11/19/2022] [Revised: 12/15/2022] [Accepted: 03/17/2023] [Indexed: 04/20/2023] [Imported: 07/20/2023] Open
Abstract
BACKGROUND The prognostic role of right ventricle dilatation and dysfunction (RVDD) has not been elucidated in patients with coronavirus disease (COVID)-related respiratory failure refractory to standard treatment needing extracorporeal membrane oxygenation (ECMO) support.
AIM To assess whether pre veno-venous (VV) ECMO RVDD were related to in-intensive care unit (ICU) mortality.
METHODS We enrolled 61 patients with COVID-related acute respiratory distress syndrome refractory to conventional treatment submitted to VV ECMO and consecutively admitted to our ICU (an ECMO referral center) from 31th March 2020 to 31th August 2021. An echocardiographic exam was performed immediately before VV ECMO implantation.
RESULTS Males were prevalent (73.8%) and patients with a body mass index > 30 kg/m2 were the majority (46/61, 75%). The overall in-ICU mortality rate was 54.1% (33/61). RVDD was detectable in more than half of the population (34/61, 55.7%) and associated with higher simplified organ functional assessment (SOFA) values (P = 0.029) and a longer mechanical ventilation duration prior to ECMO support (P = 0.046). Renal replacement therapy was more frequently needed in RVDD patients (P = 0.002). A higher in-ICU mortality (P = 0.024) was observed in RVDD patients. No echo variables were independent predictors of in-ICU death.
CONCLUSION In patients with COVID-related respiratory failure on ECMO support, RVDD (dilatation and dysfunction) is a common finding and identifies a subset of patients characterized by a more severe disease (as indicated by higher SOFA values and need of renal replacement therapy) and by a higher in-ICU mortality. RVDD (also when considered separately) did not result independently associated with in-ICU mortality in these patients.
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Francisco Pascual J, Jordan Marchite P, Rodríguez Silva J, Rivas Gándara N. Arrhythmic syncope: From diagnosis to management. World J Cardiol 2023; 15:119-141. [PMID: 37124975 PMCID: PMC10130893 DOI: 10.4330/wjc.v15.i4.119] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 02/02/2023] [Accepted: 04/10/2023] [Indexed: 04/20/2023] [Imported: 07/20/2023] Open
Abstract
Syncope is a concerning symptom that affects a large proportion of patients. It can be related to a heterogeneous group of pathologies ranging from trivial causes to diseases with a high risk of sudden death. However, benign causes are the most frequent, and identifying high-risk patients with potentially severe etiologies is crucial to establish an accurate diagnosis, initiate effective therapy, and alter the prognosis. The term cardiac syncope refers to those episodes where the cause of the cerebral hypoperfusion is directly related to a cardiac disorder, while arrhythmic syncope is cardiac syncope specifically due to rhythm disorders. Indeed, arrhythmias are the most common cause of cardiac syncope. Both bradyarrhythmia and tachyarrhythmia can cause a sudden decrease in cardiac output and produce syncope. In this review, we summarized the main guidelines in the management of patients with syncope of presumed arrhythmic origin. Therefore, we presented a thorough approach to syncope work-up through different tests depending on the clinical characteristics of the patients, risk stratification, and the management of syncope in different scenarios such as structural heart disease and channelopathies.
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Affiliation(s)
- Jaume Francisco Pascual
- Unitat d’Arritmies Servei de Cardiologia VHIR, Hospital Universitari Vall d’Hebron, Barcelona 08035, Spain
- Grup de Recerca Cardiovascular, Vall d’Hebron Institut de Recerca, Barcelona 08035, Spain
- CIBER de Enfermedades Cardiovasculares, Instituto de Salud Carlos III, Madrid 28029, Spain
- Departament de Medicina, Universitat Autònoma de Barcelona, Bellaterra 08193, Spain
| | - Pablo Jordan Marchite
- Unitat d’Arritmies Servei de Cardiologia VHIR, Hospital Universitari Vall d’Hebron, Barcelona 08035, Spain
| | - Jesús Rodríguez Silva
- Unitat d’Arritmies Servei de Cardiologia VHIR, Hospital Universitari Vall d’Hebron, Barcelona 08035, Spain
| | - Nuria Rivas Gándara
- Unitat d’Arritmies Servei de Cardiologia VHIR, Hospital Universitari Vall d’Hebron, Barcelona 08035, Spain
- CIBER de Enfermedades Cardiovasculares, Instituto de Salud Carlos III, Madrid 28029, Spain
- Departament de Medicina, Universitat Autònoma de Barcelona, Bellaterra 08193, Spain
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Teragawa H, Oshita C, Uchimura Y. Vasospastic angina in women: Clinical backgrounds and prognoses of patients younger than and older than 60 years. World J Cardiol 2023; 15:154-164. [PMID: 37124972 PMCID: PMC10130895 DOI: 10.4330/wjc.v15.i4.154] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 02/06/2023] [Accepted: 04/07/2023] [Indexed: 04/20/2023] [Imported: 07/20/2023] Open
Abstract
BACKGROUND We frequently encounter cases of women with vasospastic angina (VSA). Additionally, some women with VSA are younger than 60 years old. However, it is unknown whether the characteristics of VSA in women aged < 60 years are different from those in women aged ≥ 60 years.
AIM To investigate and compare the clinical characteristics and prognosis of VSA in women aged < 60 years from those in women aged ≥ 60 years.
METHODS We enrolled 94 women with VSA who were diagnosed using the spasm provocation test. According to the age at diagnosis, the patients were divided into two groups: Group Y (age < 60 years, n = 17) and Group O (age ≥ 60 years, n = 77). Flow-mediated dilation (FMD) and nitroglycerin (NTG)-induced dilation (NID) of the brachial artery were performed and assessed using brachial ultrasonography. Moreover, conventional coronary risk factors, such as atherosclerotic lesions (stenosis > 20%) detected using coronary angiography and focal spasms (coronary spasm within one segment of one coronary artery), and major cardiovascular adverse events (MACE) were assessed in both groups.
RESULTS Smoking was more prevalent in Group Y than in Group O (P = 0.04). FMD was similar in both groups (Group O: 4.3% ± 3.2%, Group Y: 4.5% ± 3.3%; P = 0.75), whereas NID was higher in Group Y (20.5% ± 8.6%) than in Group O (13.6% ± 5.3%, P < 0.01). Atherosclerosis was not detected in Group Y but was detected in Group O (61%, P < 0.01). Focal spasms were less frequent in Group Y (12%) than in Group O (38%, P = 0.04). The incidence of major adverse cardiac events did not differ between the two groups (P = 0.40).
CONCLUSION Women aged < 60 years with VSA have less atherosclerotic lesions and focal spasms. These characteristics may be affected by smoking habits and vascular smooth muscle dysfunction.
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Affiliation(s)
- Hiroki Teragawa
- Department of Cardiovascular Medicine, JR Hiroshima Hospital, Hiroshima 732-0057, Japan
| | - Chikage Oshita
- Department of Cardiovascular Medicine, JR Hiroshima Hospital, Hiroshima 732-0057, Japan
| | - Yuko Uchimura
- Department of Cardiovascular Medicine, JR Hiroshima Hospital, Hiroshima 732-0057, Japan
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Kourek C, Karatzanos E, Raidou V, Papazachou O, Philippou A, Nanas S, Dimopoulos S. Effectiveness of high intensity interval training on cardiorespiratory fitness and endothelial function in type 2 diabetes: A systematic review. World J Cardiol 2023; 15:184-199. [PMID: 37124974 PMCID: PMC10130888 DOI: 10.4330/wjc.v15.i4.184] [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: 01/29/2023] [Revised: 02/22/2023] [Accepted: 03/29/2023] [Indexed: 04/20/2023] [Imported: 07/20/2023] Open
Abstract
BACKGROUND Type 2 diabetes mellitus (T2DM) is a chronic metabolic syndrome characterized by insulin resistance and hyperglycemia that may lead to endothelial dysfunction, reduced functional capacity and exercise intolerance. Regular aerobic exercise has been promoted as the most beneficial non-pharmacological treatment of cardiovascular diseases. High intensity interval training (HIIT) seems to be superior than moderate-intensity continuous training (MICT) in cardiovascular diseases by improving brachial artery flow-mediated dilation (FMD) and cardiorespiratory fitness to a greater extent. However, the beneficial effects of HIIT in patients with T2DM still remain under investigation and number of studies is limited.
AIM To evaluate the effectiveness of high intensity interval training on cardiorespiratory fitness and endothelial function in patients with T2DM.
METHODS We performed a search on PubMed, PEDro and CINAHL databases, selecting papers published between December 2012 and December 2022 and identified published randomized controlled trials (RCTs) in the English language that included community or outpatient exercise training programs in patients with T2DM. RCTs were assessed for methodological rigor and risk of bias via the Physiotherapy Evidence Database (PEDro). The primary outcome was peak VO2 and the secondary outcome was endothelial function assessed either by FMD or other indices of microcirculation.
RESULTS Twelve studies were included in our systematic review. The 12 RCTs resulted in 661 participants in total. HIIT was performed in 310 patients (46.8%), MICT to 271 and the rest 80 belonged to the control group. Peak VO2 increased in 10 out of 12 studies after HIIT. Ten studies compared HIIT with other exercise regimens (MICT or strength endurance) and 4 of them demonstrated additional beneficial effects of HIIT over MICT or other exercise regimens. Moreover, 4 studies explored the effects of HIIT on endothelial function and FMD in T2DM patients. In 2 of them, HIIT further improved endothelial function compared to MICT and/or the control group while in the rest 2 studies no differences between HIIT and MICT were observed.
CONCLUSION Regular aerobic exercise training has beneficial effects on cardiorespiratory fitness and endothelial function in T2DM patients. HIIT may be superior by improving these parameters to a greater extent than MICT.
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Affiliation(s)
- Christos Kourek
- Clinical Ergospirometry, Exercise and Rehabilitation Laboratory, 1st Critical Care Medicine Department, Evangelismos Hospital, Athens 10676, Greece
- Department of Cardiology, 417 Army Share Fund Hospital of Athens, Athens 11521, Greece
| | - Eleftherios Karatzanos
- Clinical Ergospirometry, Exercise and Rehabilitation Laboratory, 1st Critical Care Medicine Department, Evangelismos Hospital, Athens 10676, Greece
| | - Vasiliki Raidou
- Clinical Ergospirometry, Exercise and Rehabilitation Laboratory, National and Kapodistrian University of Athens, Athens 10676, Greece
| | - Ourania Papazachou
- Department of Cardiology, "Helena Venizelou" Hospital, Athens 10676, Greece
| | - Anastassios Philippou
- Clinical Ergospirometry, Exercise and Rehabilitation Laboratory, 1st Critical Care Medicine Department, Evangelismos Hospital, Athens 10676, Greece
- Department of Physiology, School of Medicine, National and Kapodistrian University of Athens, Athens 11527, Greece
| | - Serafim Nanas
- Clinical Ergospirometry, Exercise and Rehabilitation Laboratory, 1st Critical Care Medicine Department, Evangelismos Hospital, Athens 10676, Greece
| | - Stavros Dimopoulos
- Clinical Ergospirometry, Exercise and Rehabilitation Laboratory, 1st Critical Care Medicine Department, Evangelismos Hospital, Athens 10676, Greece
- Cardiac Surgery Intensive Care Unit, Onassis Cardiac Surgery Center, Athens 17674, Greece
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Abdelmegid MAKF, Bakr MM, Shams-Eddin H, Youssef AA, Abdel-Galeel A. Effect of reperfusion strategy on QT dispersion in patients with acute myocardial infarction: Impact on in-hospital arrhythmia. World J Cardiol 2023; 15:106-115. [PMID: 37033680 PMCID: PMC10074997 DOI: 10.4330/wjc.v15.i3.106] [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: 12/12/2022] [Revised: 01/24/2023] [Accepted: 02/22/2023] [Indexed: 03/21/2023] [Imported: 07/20/2023] Open
Abstract
BACKGROUND Myocardial ischemia and ST-elevation myocardial infarction (STEMI) increase QT dispersion (QTD) and corrected QT dispersion (QTcD), and are also associated with ventricular arrhythmia. AIM To evaluate the effects of reperfusion strategy [primary percutaneous coronary intervention (PPCI) or fibrinolytic therapy] on QTD and QTcD in STEMI patients and assess the impact of the chosen strategy on the occurrence of in-hospital arrhythmia. METHODS This prospective, observational, multicenter study included 240 patients admitted with STEMI who were treated with either PPCI (group I) or fibrinolytic therapy (group II). QTD and QTcD were measured on admission and 24 hr after reperfusion, and patients were observed to detect in-hospital arrhythmia. RESULTS There were significant reductions in QTD and QTcD from admission to 24 hr in both group I and group II patients. QTD and QTcD were found to be shorter in group I patients at 24 hr than those in group II (53 ± 19 msec vs 60 ± 18 msec, P = 0.005 and 60 ± 21 msec vs 69+22 msec, P = 0.003, respectively). The occurrence of in-hospital arrhythmia was significantly more frequent in group II than in group I (25 patients, 20.8% vs 8 patients, 6.7%, P = 0.001). Furthermore, QTD and QTcD were higher in patients with in-hospital arrhythmia than those without (P = 0.001 and P = 0.02, respectively). CONCLUSION In STEMI patients, PPCI and fibrinolytic therapy effectively reduced QTD and QTcD, with a higher observed reduction using PPCI. PPCI was associated with a lower incidence of in-hospital arrhythmia than fibrinolytic therapy. In addition, QTD and QTcD were shorter in patients not experiencing in-hospital arrhythmia than those with arrhythmia.
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Affiliation(s)
- Mohamed Aboel-Kassem F Abdelmegid
- Department of Cardiovascular Medicine, Assiut University Heart Hospital, Assiut University, Assiut 71526, Egypt
- Department of Cardiology, Sohag Heart and GIT Center, Sohag 85264, Egypt
| | - Mohamed M Bakr
- Department of Cardiology, Assiut Police Hospital, Assiut 71526, Egypt
| | - Hamdy Shams-Eddin
- Department of Cardiovascular Medicine, Assiut University Heart Hospital, Assiut University, Assiut 71526, Egypt
| | - Amr A Youssef
- Department of Cardiovascular Medicine, Assiut University Heart Hospital, Assiut University, Assiut 71526, Egypt
| | - Ahmed Abdel-Galeel
- Department of Cardiovascular Medicine, Assiut University Heart Hospital, Assiut University, Assiut 71526, Egypt
- Department of Cardiology, Qena General Hospital, Qena 92354, Egypt.
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Agasthi P, Ashraf H, Pujari SH, Girardo M, Tseng A, Mookadam F, Venepally N, Buras MR, Abraham B, Khetarpal BK, Allam M, MD SKM, Eleid MF, Greason KL, Beohar N, Sweeney J, Fortuin D, Holmes DRJ, Arsanjani R. Prediction of permanent pacemaker implantation after transcatheter aortic valve replacement: The role of machine learning. World J Cardiol 2023; 15:95-105. [PMID: 37033682 PMCID: PMC10074998 DOI: 10.4330/wjc.v15.i3.95] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 01/04/2023] [Accepted: 03/01/2023] [Indexed: 03/21/2023] [Imported: 07/20/2023] Open
Abstract
BACKGROUND Atrioventricular block requiring permanent pacemaker (PPM) implantation is an important complication of transcatheter aortic valve replacement (TAVR). Application of machine learning could potentially be used to predict pre-procedural risk for PPM.
AIM To apply machine learning to be used to predict pre-procedural risk for PPM.
METHODS A retrospective study of 1200 patients who underwent TAVR (January 2014-December 2017) was performed. 964 patients without prior PPM were included for a 30-d analysis and 657 patients without PPM requirement through 30 d were included for a 1-year analysis. After the exclusion of variables with near-zero variance or ≥ 50% missing data, 167 variables were included in the random forest gradient boosting algorithm (GBM) optimized using 5-fold cross-validations repeated 10 times. The receiver operator curve (ROC) for the GBM model and PPM risk score models were calculated to predict the risk of PPM at 30 d and 1 year.
RESULTS Of 964 patients included in the 30-d analysis without prior PPM, 19.6% required PPM post-TAVR. The mean age of patients was 80.9 ± 8.7 years. 42.1 % were female. Of 657 patients included in the 1-year analysis, the mean age of the patients was 80.7 ± 8.2. Of those, 42.6% of patients were female and 26.7% required PPM at 1-year post-TAVR. The area under ROC to predict 30-d and 1-year risk of PPM for the GBM model (0.66 and 0.72) was superior to that of the PPM risk score (0.55 and 0.54) with a P value < 0.001.
CONCLUSION The GBM model has good discrimination and calibration in identifying patients at high risk of PPM post-TAVR.
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Affiliation(s)
- Pradyumna Agasthi
- Department of Cardiology, Mayo Clinic, Phoenix, AZ 85054, United States
| | - Hasan Ashraf
- Department of Cardiology, Mayo Clinic, Phoenix, AZ 85054, United States
| | - Sai Harika Pujari
- Department of Internal Medicine, The Brooklyn Hospital Center, Brooklyn, NY 11201, United States
| | - Marlene Girardo
- Department of Biostatistics, Mayo Clinic, Phoenix, AZ 85054, United States
| | - Andrew Tseng
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN 55905, United States
| | - Farouk Mookadam
- Department of Cardiology, Mayo Clinic, Phoenix, AZ 85054, United States
| | - Nithin Venepally
- Department of Cardiology, Mayo Clinic, Phoenix, AZ 85054, United States
| | - Matthew R Buras
- Department of Statistics, Mayo Clinic, Phoenix, AZ 85054, United States
| | - Bishoy Abraham
- Department of Cardiology, Mayo Clinic, Phoenix, AZ 85054, United States
| | | | - Mohamed Allam
- Department of Cardiology, Mayo Clinic, Phoenix, AZ 85054, United States
| | - Siva K Mulpuru MD
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN 55905, United States
| | - Mackram F Eleid
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN 55905, United States
| | - Kevin L Greason
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN 55905, United States
| | - Nirat Beohar
- Mount Sinai Medical Center, Columbia University, Miami Beach, FL 33138, United States
| | - John Sweeney
- Department of Cardiology, Mayo Clinic, Phoenix, AZ 85054, United States
| | - David Fortuin
- Department of Cardiology, Mayo Clinic, Phoenix, AZ 85054, United States
| | - David R Jr Holmes
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN 55905, United States
| | - Reza Arsanjani
- Department of Cardiology, Mayo Clinic, Phoenix, AZ 85054, United States
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Bacharaki D, Petrakis I, Stylianou K. Redefying the therapeutic strategies against cardiorenal morbidity and mortality: Patient phenotypes. World J Cardiol 2023; 15:76-83. [PMID: 37033683 PMCID: PMC10074996 DOI: 10.4330/wjc.v15.i3.76] [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: 10/02/2022] [Revised: 12/31/2022] [Accepted: 02/22/2023] [Indexed: 03/21/2023] [Imported: 07/20/2023] Open
Abstract
Chronic kidney disease (CKD) patients face an unacceptably high morbidity and mortality, mainly from cardiovascular diseases. Diabetes mellitus, arterial hypertension and dyslipidemia are highly prevalent in CKD patients. Established therapeutic protocols for the treatment of diabetes mellitus, arterial hypertension, and dyslipidemia are not as effective in CKD patients as in the general population. The role of non-traditional risk factors (RF) has gained interest in the last decades. These entail the deranged clinical spectrum of secondary hyperparathyroidism involving vascular and valvular calcification, under the term “CKD-mineral and bone disorder” (CKD-MBD), uremia per se, inflammation and oxidative stress. Each one of these non-traditional RF have been addressed in various study designs, but the results do not exhibit any applied clinical benefit for CKD-patients. The “crusade” against cardiorenal morbidity and mortality in CKD-patients is in some instances, derailed. We propose a therapeutic paradigm advancing from isolated treatment targets, as practiced today, to precision medicine involving patient phenotypes with distinct underlying pathophysiology. In this regard we propose two steps, based on current stratification management of corona virus disease-19 and sepsis. First, select patients who are expected to have a high mortality, i.e., a prognostic enrichment. Second, select patients who are likely to respond to a specific therapy, i.e., a predictive enrichment.
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Affiliation(s)
- Dimitra Bacharaki
- Nephrology Unit, 2nd Department of Internal Medicine, Attikon University Hospital, Chaidari 12462, Greece
| | - Ioannis Petrakis
- Department of Nephrology, Heraklion University Hospital, University of Crete, Heraklion 71500, Greece
| | - Kostas Stylianou
- Department of Nephrology, Heraklion University Hospital, University of Crete, Heraklion 71500, Greece
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Garg N, Chawla R, Tandon V, Garg D, Parshottam N, Vani P, Neuss M. Real-world five-year outcomes of FlexyRap ® cobalt-chromium rapamycin-eluting stents with biodegradable polymer in patients with de-novo coronary artery disease. World J Cardiol 2023; 15:84-94. [PMID: 37033681 PMCID: PMC10074995 DOI: 10.4330/wjc.v15.i3.84] [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: 11/06/2022] [Revised: 01/27/2023] [Accepted: 03/03/2023] [Indexed: 03/21/2023] [Imported: 07/20/2023] Open
Abstract
BACKGROUND The use of biodegradable polymer drug-eluting stents (BP-DES) has been proven to minimize restenosis and stent thrombosis. The current post-marketing monitoring was observed at the 5-year clinical outcomes of individuals who had been treated with FlexyRap® DES in the real world.
AIM To assess the safety and effectiveness of FlexyRap® DES at the 5-year follow-up in real-world settings.
METHODS Findings from a retrospective, multi-center, observational, post-market clinical follow-up study of patients treated with FlexyRap® DES for de novo coronary artery disease (CAD) were reported. During the 12-mo follow-up, the primary endpoint was target lesion failure, which was defined as the composite of cardiovascular death, target vessel myocardial infarction (TV-MI), and clinically driven target lesion revascularization.
RESULTS The data of 500 patients received with FlexyRap® DES was obtained at the completion of the surveillance timeline of 5-year. After the implantation of FlexyRap® DES, the device success rate was 100%. Adverse events that led to major bleeding, permanent disability, or death were not experienced in the patients. The major adverse cardiac event rate at 12-mo, 3-year, and 5-year follow-up was 1 (0.2%), 0 (0%), and 1 (0.2%) respectively with 0 (0%) cardiovascular death, 2 (0.4%) TV-MI, and 0 (0%) TLR compositely. Furthermore, late stent thrombosis was found in 2 (0.4%) patients at the follow-up of 12-mo, very late stent thrombosis was observed in 2 patients (0.4%) at 3-year follow-up.
CONCLUSION FlexyRap® DES was proved to be safe and efficacious in real-world patients with de novo CAD, indicating a lowered rate of cardiac events and stent thrombosis at 5-year follow-up.
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Affiliation(s)
- Nitish Garg
- Department of Interventional Cardiology, Cardinova Hospital, Jalandhar 144001, India
| | - Raman Chawla
- Department of Interventional Cardiology, CareMax Hospital, Jalandhar 144001, India
| | - Vivek Tandon
- Department of Interventional Cardiology, EMC Hospital, Amritsar 143001, India
| | - Deepak Garg
- Department of Interventional Cardiology, Moga Medicity Hospital, Moga 142001, India
| | - Nilesh Parshottam
- Department of Interventional Cardiology, Sunshine Global Hospital, Surat 394370, India
| | - Preeti Vani
- Medical Division, Sahajanand Laser Technology Ltd., Gandhinagar, Gujarat, 382028, India
| | - Malte Neuss
- Medical Division, Sahajanand Laser Technology Ltd., Gandhinagar, Gujarat, 382028, India
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Bhuiya T, Roman S, Aydin T, Patel B, Zeltser R, Makaryus AN. Utility of short-term telemetry heart rhythm monitoring and CHA 2DS 2-VASc stratification in patients presenting with suspected cerebrovascular accident. World J Cardiol 2023; 15:56-63. [PMID: 36911749 PMCID: PMC9993929 DOI: 10.4330/wjc.v15.i2.56] [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: 09/26/2022] [Revised: 01/10/2023] [Accepted: 02/07/2023] [Indexed: 02/21/2023] [Imported: 07/20/2023] Open
Abstract
BACKGROUND Inpatient telemetry heart rhythm monitoring overuse has been linked to higher healthcare costs.
AIM To evaluate if CHA2DS2-VASc score could be used to indicate if a patient admitted with possible cerebrovascular accident (CVA) or transient ischemic attack (TIA) requires inpatient telemetry monitoring.
METHODS A total of 257 patients presenting with CVA or TIA and placed on telemetry monitoring were analyzed retrospectively. We investigated the utility of telemetry monitoring to diagnose atrial fibrillation/flutter and the CHA2DS2-VASc scoring tool to stratify the risk of having CVA/TIA in these patients.
RESULTS In our study population, 63 (24.5%) of the patients with CVA/TIA and telemetry monitoring were determined to have no ischemic neurologic event. Of the 194 (75.5) patients that had a confirmed CVA/TIA, only 6 (2.3%) had an arrhythmia detected during their inpatient telemetry monitoring period. Individuals with a confirmed CVA/TIA had a statistically significant higher CHA2DS2-VASc score compared to individuals without an ischemic event (3.59 vs 2.61, P < 0.001).
CONCLUSION Given the low percentage of inpatient arrhythmias identified, further research should focus on discretionary use of inpatient telemetry on higher risk patients to diagnose the arrhythmias commonly leading to CVA/TIA. A prospective study assessing event rate of CVA/TIA in patients with higher CHA2DS2-VASc score should be performed to validate the CHA2DS2-VASc score as a possible risk stratifying tool for patients at risk for CVA/TIA.
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Affiliation(s)
- Tanzim Bhuiya
- Department of Cardiology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY 11553, United States
| | - Sherif Roman
- Department of Cardiology, St. Joseph’s University Medical Center, Paterson, NJ 07503, United States
| | - Taner Aydin
- Department of Cardiology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY 11553, United States
| | - Bhakti Patel
- Department of Cardiology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY 11553, United States
| | - Roman Zeltser
- Department of Cardiology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY 11553, United States
- Department of Cardiology, Nassau University Medical Center, East Meadow, NY 11554, United States
| | - Amgad N Makaryus
- Department of Cardiology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY 11553, United States
- Department of Cardiology, Nassau University Medical Center, East Meadow, NY 11554, United States
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Agasthi P, Sridhara S, Rattanawong P, Venepally N, Chao CJ, Ashraf H, Pujari SH, Allam M, Almader-Douglas D, Alla Y, Kumar A, Mookadam F, Packer DL, Holmes DR, Hagler DJ, Fortuin FD, Arsanjani R. Safety and efficacy of balloon angioplasty compared to stent-based-strategies with pulmonary vein stenosis: A systematic review and meta-analysis. World J Cardiol 2023; 15:64-75. [PMID: 36911751 PMCID: PMC9993931 DOI: 10.4330/wjc.v15.i2.64] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 11/17/2022] [Accepted: 02/08/2023] [Indexed: 02/21/2023] [Imported: 07/20/2023] Open
Abstract
BACKGROUND Pulmonary vein stenosis (PVS) is an uncommon but known cause of morbidity and mortality in adults and children and can be managed with percutaneous re-vascularization strategies of pulmonary vein balloon angioplasty (PBA) or pulmonary vein stent implantation (PSI).
AIM To study the safety and efficacy outcomes of PBA vs PSI in all patient categories with PVS.
METHODS We performed a literature search of all studies comparing outcomes of patients evaluated by PBA vs PSI for PVS. We selected all published studies comparing PBA vs PSI for PVS with reported outcomes of restenosis and procedure-related complications in all patient categories. In adults, PVS following atrial fibrillation ablation and in children PVS related to congenital etiology or post-procedural PVS following total or partial anomalous pulmonary venous return repair were included. The patient-centered outcomes were risk of restenosis requiring re-intervention and procedural-related complications. The meta-analysis was performed by computing odds ratios (ORs) using the random effects model based on underlying statistical heterogeneity.
RESULTS Eight observational studies treating 768 severe PVS in 487 patients met our inclusion criteria. The age range of patients was 6 months to 70 years and 67% were males. The primary outcome of the re-stenosis requiring re-intervention occurred in 196 of 325 veins in the PBA group and 111 of 443 veins in the PSI group. Compared to PSI, PBA was associated with a significantly increased risk of re-stenosis (OR 2.91, 95%CI: 1.15-7.37, P = 0.025, I2 = 79.2%). Secondary outcomes of the procedure-related complications occurred in 7 of 122 patients in the PBA group and 6 of 69 in the PSI group. There were no statistically significant differences in the safety outcomes between the two groups (OR: 0.94, 95%CI: 0.23-3.76, P = 0.929), I2 = 0.0%).
CONCLUSION Across all patient categories with PVS, PSI is associated with reduced risk of re-intervention and is as safe as PBA and should be considered first-line therapy for PVS.
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Affiliation(s)
- Pradyumna Agasthi
- Department of Cardiovascular Diseases, Mayo Clinic, Scottsdale, AZ 85259, United States
| | - Srilekha Sridhara
- Department of Internal Medicine, Banner Heart Hospital, Mesa, AZ 85054, United States
| | - Pattara Rattanawong
- Department of Cardiovascular Diseases, Mayo Clinic, Scottsdale, AZ 85259, United States
| | - Nithin Venepally
- Department of Cardiovascular Diseases, Mayo Clinic, Scottsdale, AZ 85259, United States
| | - Chieh-Ju Chao
- Department of Cardiovascular Diseases, Mayo Clinic, Scottsdale, AZ 85259, United States
| | - Hasan Ashraf
- Department of Cardiovascular Diseases, Mayo Clinic, Scottsdale, AZ 85259, United States
| | - Sai Harika Pujari
- Department of Cardiovascular Diseases, Mayo Clinic, Scottsdale, AZ 85259, United States
| | - Mohamed Allam
- Department of Cardiovascular Diseases, Mayo Clinic, Scottsdale, AZ 85259, United States
| | | | - Yamini Alla
- Department of Medicine, Bronx Lebanon Hospital, Bronx, NY 10457, United States
| | - Amit Kumar
- Department of Cardiovascular Diseases, Mayo Clinic, Scottsdale, AZ 85259, United States
| | - Farouk Mookadam
- Department of Cardiovascular Diseases, Mayo Clinic, Scottsdale, AZ 85259, United States
| | - Douglas L Packer
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN 55905, United States
| | - David R Holmes Jr
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN 55905, United States
| | - Donald J Hagler
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN 55905, United States
| | - Floyd David Fortuin
- Department of Cardiovascular Diseases, Mayo Clinic, Scottsdale, AZ 85259, United States
| | - Reza Arsanjani
- Department of Cardiovascular Diseases, Mayo Clinic, Scottsdale, AZ 85259, United States
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Latsios G, Leopoulou M, Synetos A, Karanasos A, Papanikolaou A, Bounas P, Stamatopoulou E, Toutouzas K, Tsioufis K. Cardiac arrest and cardiopulmonary resuscitation in “hostile” environments: Using automated compression devices to minimize the rescuers’ danger. World J Cardiol 2023; 15:45-55. [PMID: 36911750 PMCID: PMC9993930 DOI: 10.4330/wjc.v15.i2.45] [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: 12/03/2022] [Revised: 01/25/2023] [Accepted: 02/15/2023] [Indexed: 02/21/2023] [Imported: 07/20/2023] Open
Abstract
Mechanical automated compression devices are being used in cardiopulmonary resuscitation instead of manual, “hands-on”, rescuer-delivered chest compressions. The -theoretical- advantages include high-quality non-stop compressions, thus freeing the rescuer performing the compressions and additionally the ability of the rescuer to stand reasonably away from a potentially “hazardous” victim, or from hazardous and/or difficult resuscitation conditions. Such circumstances involve cardiopulmonary resuscitation (CPR) in the Cardiac Catheterization Laboratory, especially directly under the fluoroscopy panel, where radiation is well known to cause detrimental effects to the rescuer, and CPR during/after land or air transportation of cardiac arrest victims. Lastly, CPR in a coronavirus disease 2019 patient/ward, where the danger of contamination and further serious illness of the health provider is very existent. The scope of this review is to review and present literature and current guidelines regarding the use of mechanical compressions in these “hostile” and dangerous settings, while comparing them to manual compressions.
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Affiliation(s)
- George Latsios
- 1st University Department of Cardiology, "Hippokration" University Hospital, Athens Medical School, Athens 11527, Greece
| | - Marianna Leopoulou
- 1st Cardiology Clinic, 'Hippokration' University Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens 11527, Greece
- Department of Cardiology, "Elpis" Athens General Hospital, Athens 11522, Greece
| | - Andreas Synetos
- 1st Department of Cardiology, Athens Medical School, University Athens, Hippokrat Hospital, Athens 11527, Greece
| | - Antonios Karanasos
- 1st University Department of Cardiology, "Hippokration" University Hospital, Athens Medical School, Athens 11527, Greece
| | - Angelos Papanikolaou
- 1st Cardiology Department Athens Medical School, Hippokration General Hospital, Athens 11527, Greece
| | - Pavlos Bounas
- Department of Cardiology, “Thriasio” General Hospital, Thriasio General Hospital, Elefsina 19600, Greece
| | - Evangelia Stamatopoulou
- CathLab, 2nd Department of Cardiology, Medical School, National and Kapodistrian University of Athens, “Attikon” University Hospital, Attikon University Hospital, Athens 12462, Greece
| | | | - Kostas Tsioufis
- 1st Department of Cardiology, Medical School, National and Kapodistrian University of Athens, “Hippokration” General Hospital, "Hippokration" University Hospital, Athens 11527, Greece
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Teragawa H, Oshita C, Uchimura Y. Does the intracoronary pressure differ according to two types (diffuse or focal) of coronary spasm? World J Cardiol 2023; 15:1-12. [PMID: 36714369 PMCID: PMC9850670 DOI: 10.4330/wjc.v15.i1.1] [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: 08/29/2022] [Revised: 12/04/2022] [Accepted: 12/21/2022] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Several reports show that two types of coronary vasospasm (diffuse and focal spasm) are associated with the severity or prognosis of coronary spasm in patients with vasospastic angina (VSA). It is unclear whether intracoronary pressure differs between the two spasm types.
AIM To investigate such relationships using a pressure wire during the spasm provocation test (SPT) in patients with VSA.
METHODS Eighty-seven patients with VSA (average age: 67 years; 50 men, 37 women) underwent SPT. During the SPT, a pressure wire was advanced into the distal portion of the right coronary artery and left anterior descending coronary artery, and the ratio of the intracoronary pressure to the aortic pressure (Pd/Pa) was continuously monitored. An SPT was performed using acetylcholine (ACh), and the presence of coronary spasm was defined as the presence of > 90% arterial narrowing in response to an ACh infusion, with the usual chest symptoms and/or ischemic ECG changes. Focal spasm was defined as total or subtotal spasm within one segment of the AHA classification, while diffuse spasm was defined as > 90% spasm with two or more segments.
RESULTS Among 87 patients, the frequencies of metabolic syndrome and having coronary atherosclerosis were higher in the focal group (n = 33) than in the diffuse spasm group (n = 54, P < 0.05). In the vessel analyses, in these 134 spastic segments, diffuse and focal spasms were detected in 100 and 34 vessels, respectively. The Pd/Pa at baseline was similar in both groups (diffuse: 0.96 ± 0.05, focal: 0.95 ± 0.05, P = 0.35); however, the Pd/Pa during coronary spasm was lower in focal spastic vessels (0.66 ± 0.20) than in diffuse spastic vessels (0.76 ± 0.11, P < 0.01), and the reduction in Pd/Pa during an SPT was also lower in focal spastic vessels (-0.29 ± 0.20) than in diffuse spastic vessels (-0.18 ± 0.11, P < 0.01). The presence of focal spasm was a significant factor responsible for reduction in Pd/Pa during SPT.
CONCLUSION These findings suggest that focal spasm may be more severe than diffuse spasm, judging from the intracoronary pressure during coronary spasm.
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Affiliation(s)
- Hiroki Teragawa
- Department of Cardiovascular Medicine, JR Hiroshima Hospital, Hiroshima 732-0057, Japan
| | - Chikage Oshita
- Department of Cardiovascular Medicine, JR Hiroshima Hospital, Hiroshima 732-0057, Japan
| | - Yuko Uchimura
- Department of Cardiovascular Medicine, JR Hiroshima Hospital, Hiroshima 732-0057, Japan
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80
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Makkar K, Sharma YP, Batta A, Hatwal J, Panda PK. Role of fibrinogen, albumin and fibrinogen to albumin ratio in determining angiographic severity and outcomes in acute coronary syndrome. World J Cardiol 2023; 15:13-22. [PMID: 36714367 PMCID: PMC9850671 DOI: 10.4330/wjc.v15.i1.13] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 11/08/2022] [Accepted: 12/23/2022] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) pandemic unmasked the huge deficit in healthcare resources worldwide. It highlighted the need for efficient risk stratification in management of cardiovascular emergencies.
AIM To study the applicability of the old, available and affordable nonconventional biomarkers: albumin and fibrinogen in their ability to predict angiographic severity and clinical outcomes in patients with acute coronary syndrome (ACS).
METHODS In this prospective, observational study, 166 consecutive patients with ACS were enrolled. Fibrinogen, albumin and their ratio were determined from serum. Patients with underlying chronic liver disease, active malignancy, autoimmune disease, active COVID-19 infection and undergoing thrombolysis were excluded.
RESULTS Mean age of the population was 60.5 ± 1.5 years, 74.1% being males. ST elevation myocardial infarction (STEMI) was most common presentation of ACS seen in 57% patients. Fibrinogen albumin ratio (FAR) ≥ 19.2, had a sensitivity of 76.9% and specificity of 78.9 % [area under the receiver operating characteristic curves (AUROC) = 0.8, P = 0.001] to predict ≤ thrombolysis in myocardial infarction (TIMI) 1 flow in culprit artery in STEMI patients. Even in non-STEMI patients, FAR ≥ 18.85 predicted the same with 80% sensitivity and 63% specificity (AUROC = 0.715, P = 0.006).
CONCLUSION Novel biomarkers, with their high cost, lack of availability and long turn over time are impractical for real-world use. Identifying ≤ TIMI 1 flow in the culprit artery has significant impact of management and outcome. Our study has shown that readily available biomarkers like fibrinogen and albumin can help identify these high-risk patients with good accuracy. This allows risk-stratification and individualization of treatment in ACS.
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Affiliation(s)
- Kunaal Makkar
- Department of Cardiology, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Yash Paul Sharma
- Department of Cardiology, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - 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 and Research, Chandigarh 160012, India
| | - Prashant Kumar Panda
- Department of Cardiology, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
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Sethi R, Mohan L, Vishwakarma P, Singh A, Sharma S, Bhandari M, Shukla A, Sharma A, Chaudhary G, Pradhan A, Chandra S, Narain VS, Dwivedi SK. Feasibility and efficacy of delayed pharmacoinvasive therapy for ST-elevation myocardial infarction. World J Cardiol 2023; 15:23-32. [PMID: 36714366 PMCID: PMC9850672 DOI: 10.4330/wjc.v15.i1.23] [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: 07/18/2022] [Revised: 11/14/2022] [Accepted: 12/14/2022] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND ST-elevation myocardial infarction (STEMI) refers to a clinical syndrome that features symptoms of myocardial ischemia with consequent ST-elevation on electrocardiography and an associated rise in cardiac biomarkers. Rapid restoration of brisk flow in the coronary vasculature is critical in reducing mortality and morbidity. In patients with STEMI who could not receive primary percutaneous coronary intervention (PCI) on time, pharmacoinvasive strategy (thrombolysis followed by timely PCI within 3-24 h of its initiation) is an effective option.
AIM To analyze the role of delayed pharmacoinvasive strategy in the window period of 24-72 h after thrombolysis.
METHODS This was a physician-initiated, single-center prospective registry between January 2017 and July 2017 which enrolled 337 acute STEMI patients with partially occluded coronary arteries. Patients received routine pharmacoinvasive therapy (PCI within 3-24 h of thrombolysis) in one group and delayed pharmacoinvasive therapy (PCI within 24-72 h of thrombolysis) in another group. The primary endpoint was major adverse cardiac and cerebrovascular events (MACCE) within 30 d of the procedure. The secondary endpoints included major bleeding as defined by Bleeding Academic Research Consortium classification, angina, and dyspnea within 30 d.
RESULTS The mean age in the two groups was comparable (55.1 ± 10.1 years vs 54.2 ± 10.5 years, P = 0.426). Diabetes was present among 20.2% and 22.1% of patients in the routine and delayed groups, respectively. Smoking rate was 54.6% and 55.8% in the routine and delayed groups, respectively. Thrombolysis was initiated within 6 h of onset of symptoms in both groups (P = 0.125). The mean time from thrombolysis to PCI in the routine and delayed groups was 16.9 ± 5.3 h and 44.1 ± 14.7 h, respectively. No significant difference was found for the occurrence of measured clinical outcomes in the two groups within 30 d (8.7% vs 12.9%, P = 0.152). Univariate analysis of demographic characteristics and risk factors for patients who reported MACCE in the two groups did not demonstrate any significant correlation. Secondary endpoints such as angina, dyspnea, and major bleeding were non-significantly different between the two groups.
CONCLUSION Delayed PCI pharmacoinvasive strategy in a critical diseased but not completely occluded artery beyond 24 h in patients who have been timely thrombolyzed seems a reasonable strategy.
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Affiliation(s)
- Rishi Sethi
- Department of Cardiology, King George's Medical University, Lucknow 226003, Uttar Pradesh, India
| | - Lalit Mohan
- Department of Cardiology, King George's Medical University, Lucknow 226003, Uttar Pradesh, India
| | - Pravesh Vishwakarma
- Department of Cardiology, King George's Medical University, Lucknow 226003, Uttar Pradesh, India
| | - Abhishek Singh
- Department of Cardiology, King George's Medical University, Lucknow 226003, Uttar Pradesh, India
| | - Swati Sharma
- Department of Cardiology, King George's Medical University, Lucknow 226003, Uttar Pradesh, India
| | - Monika Bhandari
- Department of Cardiology, King George's Medical University, Lucknow 226003, Uttar Pradesh, India
| | - Ayush Shukla
- Department of Cardiology, King George's Medical University, Lucknow 226003, Uttar Pradesh, India
| | - Akhil Sharma
- Department of Cardiology, King George's Medical University, Lucknow 226003, Uttar Pradesh, India
| | - Gaurav Chaudhary
- Department of Cardiology, King George's Medical University, Lucknow 226003, Uttar Pradesh, India
| | - Akshyaya Pradhan
- Department of Cardiology, King George's Medical University, Lucknow 226003, Uttar Pradesh, India
| | - Sharad Chandra
- Department of Cardiology, King George's Medical University, Lucknow 226003, Uttar Pradesh, India
| | - Varun Shankar Narain
- Department of Cardiology, King George's Medical University, Lucknow 226003, Uttar Pradesh, India
| | - Sudhanshu Kumar Dwivedi
- Department of Cardiology, King George's Medical University, Lucknow 226003, Uttar Pradesh, India
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Mishra AK, George AA, John KJ, Arun Kumar P, Dasari M, Afraz Pasha M, Hadley M. Takotsubo cardiomyopathy following envenomation: An updated review. World J Cardiol 2023; 15:33-44. [PMID: 36714368 PMCID: PMC9850669 DOI: 10.4330/wjc.v15.i1.33] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 09/11/2022] [Revised: 11/15/2022] [Accepted: 01/05/2023] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Takotsubo cardiomyopathy (TTC) can be diagnosed in patients presenting with clinical features of acute coronary syndrome (ACS) by using Mayo clinic criteria. Multiple precipitators have been attributed to causing TTC. Rarely it has been reported to occur following an acute envenomation.
AIM This review describes the various patterns, mechanisms, and outcomes of envenomation induced TTC.
METHODS In this review, we included all studies on “TTC” and “envenomation “published in the various databases before June 2022. To be included in the review articles had to have a distinct diagnosis of TTC and an envenomation
RESULTS A total of 20 patients with envenomation induced TTC were identified. Most episodes of envenomation induced TTC were reported following a bee sting, scorpion sting, and snake envenomation. Fear and anxiety related to the sting, direct catecholamine toxicity and administration of exogenous beta-adrenergic agents have been commonly postulated to precipitate TTC in these patients. 95% of these patients presented with a clinical picture of ACS. Most of these patients also fulfill at least 3 out of 4 criteria of Mayo clinic criteria for TTC. Echocardiographic evidence of Apical TTC was noted in 72% of patients. 94% of these patients had clinical improvement following optimal management and 35% of these patients were treated with guideline directed medications for heart failure.
CONCLUSION Envenomation following multiple insect stings and reptile bites can precipitate TTC. Most reported envenomation related TTC has been due to bee stings and scorpion bites. Common mechanisms causing TTC were fear, anxiety, and stress of envenomation. Most of these patients present with clinical presentation of ACS, ST elevation, and elevated troponin. The most common type of TTC in these patients is Apical, which improved following medical management.
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Affiliation(s)
- Ajay K Mishra
- Division of Cardiology, Saint Vincent Hospital, Worcester, MA 01608, United States
| | - Anu A George
- Department of Medicine, Saint Vincent Hospital, Worcester, MA 01608, United States
| | - Kevin John John
- Department of Medicine, Tufts Medical Center, Boston, MA 02111, United States
| | - Pramukh Arun Kumar
- Department of Medicine, Saint Vincent Hospital, Worcester, MA 01608, United States
| | - Mahati Dasari
- Department of Medicine, Saint Vincent Hospital, Worcester, MA 01608, United States
| | - Mohammed Afraz Pasha
- Department of Medicine, North Alabama Medical Center, Florence, AL 35630, United States
| | - Michelle Hadley
- Division of Cardiology, Saint Vincent Hospital, Worcester, MA 01608, United States
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Boda I, Farhoud H, Dalia T, Goyal A, Shah Z, Vidic A. Early and aggressive presentation of wild-type transthyretin amyloid cardiomyopathy: A case report. World J Cardiol 2022; 14:657-664. [PMID: 36605423 PMCID: PMC9808025 DOI: 10.4330/wjc.v14.i12.657] [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: 09/08/2022] [Revised: 11/03/2022] [Accepted: 11/23/2022] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Wild-type transthyretin amyloidosis (ATTRwt) is the most common form of transthyretin amyloid cardiomyopathy, occurring mostly over age of 60 years (mean age of 80 years). Mean survival without treatment is 3.6 years, making early detection imperative. We report an unusual case of a 58-year-old patient with ATTRwt cardiomyopathy requiring heart transplantation.
CASE SUMMARY A 58-year-old male presented with progressive fatigue, shortness of breath, weight gain, leg swelling, orthopnoea, and paroxysmal nocturnal dyspnoea for several months. Approximately ten months before this clinical presentation, the patient had first received a diagnosis of heart failure with reduced ejection fraction (EF) of 15% to 20%. The patient was started on appropriate guideline-directed medical therapy with only mild improvement in his EF. Upon further investigation, echocardiogram, technetium pyrophosphate scan (Tc PYP), and cardiac magnetic resonance imaging (cMRI) suggested a diagnosis of amyloidosis, and ATTRwt was subsequently confirmed with native heart tissue biopsy, congo red staining, liquid chromatography-tandem mass spectrometry, and genetic testing. The patient was successfully treated with heart transplantation and is doing well post-transplant.
CONCLUSION Wild-type ATTR amyloidosis should be kept on differentials in all patients (even less than 60 years old) with non-ischemic cardiomyopathy, especially in the setting of increased ventricular wall thickness and other classic echocardiogram, cMRI, and Tc PYP findings. Early diagnosis and management can be consequential in improving patient outcomes.
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Affiliation(s)
- Ilham Boda
- Department of Internal Medicine, University of Kansas Medical Center, Kansas City, KS 66160, United States
| | - Hassan Farhoud
- School of Medicine, University of Kansas Medical Center, Kansas City, KS 66160, United States
| | - Tarun Dalia
- Department of Cardiovascular Medicine, University of Kansas Medical Center, Kansas City, KS 66160, United States
| | - Amandeep Goyal
- Department of Cardiovascular Medicine, University of Kansas Medical Center, Kansas City, KS 66160, United States
| | - Zubair Shah
- Department of Cardiovascular Medicine, University of Kansas Medical Center, Kansas City, KS 66160, United States
| | - Andrija Vidic
- Department of Cardiovascular Medicine, University of Kansas Medical Center, Kansas City, KS 66160, United States
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Andrianto A, Ardiana M, Nugraha RA, Yutha A, Khrisna BPD, Putra TS, Shahab AR, Andrianto H, Kikuko IH, Puspitasari AN, Hajjrin MR. Impact of the virtual anti-hypertensive educational campaign towards knowledge, attitude, and practice of hypertension management during the COVID-19 pandemic. World J Cardiol 2022; 14:626-639. [PMID: 36605422 PMCID: PMC9808026 DOI: 10.4330/wjc.v14.i12.626] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Revised: 09/11/2022] [Accepted: 11/23/2022] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND One of the efforts to reduce hypertension rates in the community is through an educational campaign that refers to the NIH's National Heart, Lung, and Blood Institute curricula or abbreviated as NHLBI. However, during the coronavirus disease 2019 (COVID-19) pandemic, one of the hardest hit areas is health promotion, and there is a significant obstacle regarding the most effective way to transfer knowledge, attitude and practice towards society without transmitting the virus.
AIM To evaluate the impact of the virtual anti-hypertensive educational campaign towards knowledge, attitude, and the practice of hypertension management in the primary care setting during the COVID-19 pandemic.
METHODS An online action research with a randomized crossover-controlled trial using a pretest-posttest control group design. The study was conducted in October 2020-April 2021. The population in this study were patients with hypertension who were treated in the Mojo primary health care setting. A purposive sampling technique was done to receive 110 participants using an online questionnaire and invitation letter.
RESULTS A total of 110 participants were included in the analysis, 55 in the intervention group and 55 in the control group. Following the Virtual Anti-Hypertensive Educational Campaign implementation, the only parameter that showed significant improvement was knowledge and attitude (P < 0.001). There is no significant change in the practice parameters (P = 0.131).
CONCLUSION The Virtual Anti-Hypertensive Educational Campaign implementation in our study population seems to be effective to improve knowledge and attitude of participants, nevertheless, this program seems to be ineffective to improve the practice of hypertension management aspect in participants. Future study with longer durations and more comprehensive programs need to be done to scrutinize the clinical impact of this program nationwide.
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Affiliation(s)
- Andrianto Andrianto
- Department of Cardiology and Vascular Medicine, Universitas Airlangga, Surabaya 60286, East Java, Indonesia
| | - Meity Ardiana
- Department of Cardiology and Vascular Medicine, Universitas Airlangga, Surabaya 60286, East Java, Indonesia
| | - Ricardo Adrian Nugraha
- Department of Cardiology and Vascular Medicine, Universitas Airlangga, Surabaya 60286, East Java, Indonesia
| | - Alqi Yutha
- Department of Cardiology and Vascular Medicine, Universitas Airlangga, Surabaya 60286, East Java, Indonesia
| | - Bagus Putra Dharma Khrisna
- Department of Cardiology and Vascular Medicine, Universitas Airlangga, Surabaya 60286, East Java, Indonesia
| | - Tony Santoso Putra
- Department of Cardiology and Vascular Medicine, Universitas Airlangga, Surabaya 60286, East Java, Indonesia
| | - Achmad Rizal Shahab
- Department of Cardiology and Vascular Medicine, Universitas Airlangga, Surabaya 60286, East Java, Indonesia
| | - Henny Andrianto
- Department of Cardiology and Vascular Medicine, Universitas Airlangga, Surabaya 60286, East Java, Indonesia
| | - Irawati Hajar Kikuko
- Department of Cardiology and Vascular Medicine, Universitas Airlangga, Surabaya 60286, East Java, Indonesia
| | | | - Maltadilla Ratu Hajjrin
- Department of Cardiology and Vascular Medicine, Universitas Airlangga, Surabaya 60286, East Java, Indonesia
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Nikoo MH, Sadeghi A, Estedlal A, Fereidooni R, Dehdari Ebrahimi N, Maktabi A, Kamgar M, Mehran F, Mehdibeygi O, Esfandiari H, Taherinezhad Tayebi M, Heydari ST. Conduction system disorders and electro cardiographic findings in COVID-19 deceased patients in 2021, Shiraz, Iran. World J Cardiol 2022; 14:617-625. [PMID: 36605421 PMCID: PMC9808027 DOI: 10.4330/wjc.v14.i12.617] [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: 09/05/2022] [Revised: 10/21/2022] [Accepted: 10/31/2022] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Cardiac conduction disorders and electrocardiographic (ECG) changes may occur as a manifestation of coronavirus disease 2019 (COVID-19), especially in severe cases.
AIM To describe conduction system disorders and their association with other electrocardiographic parameters in patients who died of COVID-19.
METHODS In this cross-sectional study, electrocardiographic and clinical data of 432 patients who expired from COVID-19 between August 1st, 2021, and December 1st, 2021, in a tertiary hospital were reviewed.
RESULTS Among 432 patients who died from COVID-19, atrioventricular block (AVB) was found in 40 (9.3%). Among these 40 patients, 28 (6.5%) suffered from 1st degree AVB, and 12 (2.8%) suffered from complete heart block (CHB). Changes in ST-T wave, compatible with myocardial infarction or localized myocarditis, appeared in 189 (59.0%). Findings compatible with myocardial injury, such as fragmented QRS and prolonged QTc, were found in 91 patients (21.1%) and 28 patients (6.5%), respectively. In patients who died of COVID-19, conduction disorder was unrelated to any underlying medical condition. Fragmented QRS, axis deviation, and ST-T changes were significantly related to conduction system disorder in patients who died of COVID-19 (P value < 0.05).
CONCLUSION Conduction system disorders are associated with several other ECG abnormalities, especially those indicative of myocardial ischemia or inflammation. Most patients (73.14%) who died of COVID-19 demonstrated at least one ECG abnormality parameter. Since a COVID-19 patient's ECG gives important information regarding their cardiac health, our findings can help develop a risk stratification method for at-risk COVID-19 patients in future studies.
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Affiliation(s)
- Mohammad Hossein Nikoo
- Non-communicable Diseases Research Centre, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Alireza Sadeghi
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Alireza Estedlal
- Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Reza Fereidooni
- Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Amirhossein Maktabi
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mahtab Kamgar
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Fatemeh Mehran
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Omid Mehdibeygi
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Haleh Esfandiari
- Non-communicable Diseases Research Centre, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Seyed Taghi Heydari
- Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
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Umeh CA, Torbela A, Saigal S, Kaur H, Kazourra S, Gupta R, Shah S. Telemonitoring in heart failure patients: Systematic review and meta-analysis of randomized controlled trials. World J Cardiol 2022; 14:640-656. [PMID: 36605424 PMCID: PMC9808028 DOI: 10.4330/wjc.v14.i12.640] [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: 08/28/2022] [Revised: 11/02/2022] [Accepted: 11/30/2022] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Home telemonitoring has been used as a modality to prevent readmission and improve outcomes for patients with heart failure. However, studies have produced conflicting outcomes over the years.
AIM To determine the aggregate effect of telemonitoring on all-cause mortality, heart failure-related mortality, all-cause hospitalization, and heart failure-related hospitalization in heart failure patients.
METHODS We conducted a systematic review and meta-analysis of 38 home telemonitoring randomized controlled trials involving 14993 patients. We also conducted a sensitivity analysis to examine the effect of telemonitoring duration, recent heart failure hospitalization, and age on telemonitoring outcomes.
RESULTS Our study demonstrated that home telemonitoring in heart failure patients was associated with reduced all-cause [relative risk (RR) = 0.83, 95% confidence interval (CI): 0.75-0.92, P = 0.001] and cardiovascular mortality (RR = 0.66, 95%CI: 0.54-0.81, P < 0.001). Additionally, telemonitoring decreased the all-cause hospitalization (RR = 0.87, 95%CI: 0.80-0.94, P = 0.002) but did not decrease heart failure-related hospitalization (RR = 0.88, 95%CI: 0.77-1.01, P = 0.066). However, prolonged home telemonitoring (12 mo or more) was associated with both decreased all-cause and heart failure hospitalization, unlike shorter duration (6 mo or less) telemonitoring.
CONCLUSION Home telemonitoring using digital/broadband/satellite/wireless or blue-tooth transmission of physiological data reduces all-cause and cardiovascular mortality in heart failure patients. In addition, prolonged telemonitoring (≥ 12 mo) reduces all-cause and heart failure-related hospitalization. The implication for practice is that hospitals considering telemonitoring to reduce heart failure readmission rates may need to plan for prolonged telemonitoring to see the effect they are looking for.
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Affiliation(s)
| | - Adrian Torbela
- Internal Medicine, Hemet Global Medical Center, Hemet, CA 92543, United States
| | - Shipra Saigal
- Internal Medicine, Hemet Global Medical Center, Hemet, CA 92543, United States
| | - Harpreet Kaur
- Internal Medicine, Hemet Global Medical Center, Hemet, CA 92543, United States
| | - Shadi Kazourra
- Internal Medicine, Hemet Global Medical Center, Hemet, CA 92543, United States
| | - Rahul Gupta
- Internal Medicine, Hemet Global Medical Center, Hemet, CA 92543, United States
| | - Shivang Shah
- Department of Cardiology, Loma Linda University School of Medicine, Loma Linda, CA 92350, United States
- Department of Cardiology, University of California Riverside School of Medicine, Riverside, CA 92507, United States
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Abrignani MG, Lombardo A, Braschi A, Renda N, Abrignani V, Lombardo RM. Time trends in antithrombotic therapy prescription patterns: Real-world monocentric study in hospitalized patients with atrial fibrillation. World J Cardiol 2022; 14:576-598. [PMID: 36483763 PMCID: PMC9724000 DOI: 10.4330/wjc.v14.i11.576] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Revised: 07/04/2022] [Accepted: 10/28/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Since 2010, the European Society of Cardiology has extended prescription criteria for oral antithrombotic therapy (OAT) in atrial fibrillation (AF). Direct oral anticoagulants (DOACs) were upgraded from an IIAa recommendation in 2012 to an IA in 2016. In real-world scenarios, however, OAC prescription is still suboptimal, mainly for DOACs.
AIM To evaluate OAT temporal prescription patterns in a cohort of patients hospitalized with AF in a Cardiology Department.
METHODS A retrospective observational study was conducted on a cohort of hospitalized patients in a secondary setting (Trapani, Italy) from 2010 to 2021 with AF as the main or secondary diagnosis. For 4089 consecutive patients, the variables extracted from the Cardiology department database were: Sex, age, time of hospitalization, antithrombotic therapy (warfarin, acenocoumarol, apixaban, dabigatran, edoxaban, rivaroxaban, aspirin, clopidogrel, other antiplatelet agents, low molecular weight heparin, and fondaparinux), diagnosis at discharge and used resources. Basal features are presented as percentage values for categorized variables and as mean +/- SD for categorized once.
RESULTS From January 1st, 2010 to October 6th, 2021, 25132 patients were hospitalized in our department; 4089 (16.27%, mean age 75.59+/-10.82) were discharged with AF diagnosis; of them, 2245 were males (54.81%, mean age 73.56+/-11.45) and 1851 females (45.19%, mean age 78.06+/-9.47). Average length of stay was 5.76+/-4.88 days; 154 patients died and 88 were moved to other Departments/Structures. AF was the main diagnosis in 899 patients (21.94%). The most frequent main diagnosis in patients with AF was acute myocardial infarction (1973 discharges, 48.19%). The most frequent secondary cardiac diagnosis was chronic coronary syndrome (1864 discharges, 45.51%), and the most frequent secondary associated condition was arterial hypertension (1010 discharges, 24.66%). For the analysis of antithrombotic treatments, the final sample included 3067 patients, after excluding in-hospital deaths, transferred out or self-discharged patients, as well as discharges lacking indications for prescribed treatments. OAC treatment increased significantly (35.63% in 2010-2012 vs 61.18% in 2019-2021, +25.55%, P < 0.0001), in spite of any antiplatelet agent use. This rise was due to increasing use of DOACs, with or without antiplatelet agents, from 3.04% in 2013-2015 to 50.06% in 2019-2021 (+47.02%, P < 0.0001) and was greater for factor Xa inhibitors, especially apixaban. In addition, treatment with a vitamin K antagonist, in spite of any antiplatelet agent use, decreased from 35.63% in 2010-2012 to 11.12% in 2019-2021 (-24.48%, P < 0.0001), as well as any antiplatelet therapy, alone or in double combination, (49.18% in 2010-2012 vs 34.18% in 2019-2021, -15.00%, P < 0.0001); and patients not receiving antithrombotic therapy declined with time (14.58% in 2010-2012 vs 1.97% in 2021, P < 0.0001).
CONCLUSION Real-world patients with AF are elderly and affected by cardiovascular and non-cardiovascular diseases. The percentage of patients on OAT and DOACs increased. These data suggest a slow, gradual guidelines implementation process.
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Affiliation(s)
- Maurizio Giuseppe Abrignani
- Operative Unit of Cardiology, Department of Medicine, S. Antonio Abate Hospital of Trapani, ASP Trapani, Trapani 91100, Trapani, Italy
| | - Alberto Lombardo
- Operative Unit of Cardiology, Department of Medicine, S. Antonio Abate Hospital of Trapani, ASP Trapani, Trapani 91100, Trapani, Italy
| | - Annabella Braschi
- Department of Psychology, Educational Science and Human Movement, University of Palermo, Palermo 90100, Palermo, Italy
| | - Nicolò Renda
- Department of Medicine and Surgery, University of Parma, Parma 43100, Parma, 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, Palermo, Italy
| | - Renzo M Lombardo
- Department of Cardiology, Operative Unit of Cardiology, Department of Medicine, S. Antonio Abate Hospital of Trapani, Trapani 91100, Trapani, Italy
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Shafiq M, Mazzotti DR, Gibson C. Risk stratification of patients who present with chest pain and have normal troponins using a machine learning model. World J Cardiol 2022; 14:565-575. [PMID: 36483764 PMCID: PMC9723999 DOI: 10.4330/wjc.v14.i11.565] [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: 06/15/2022] [Revised: 09/18/2022] [Accepted: 10/18/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Risk stratification tools exist for patients presenting with chest pain to the emergency room and have achieved the recommended negative predictive value (NPV) of 99%. However, due to low positive predictive value (PPV), current stratification tools result in unwarranted investigations such as serial laboratory tests and cardiac stress tests (CSTs).
AIM To create a machine learning model (MLM) for risk stratification of chest pain with a better PPV.
METHODS This retrospective cohort study used de-identified hospital data from January 2016 until November 2021. Inclusion criteria were patients aged > 21 years who presented to the ER, had at least two serum troponins measured, were subsequently admitted to the hospital, and had a CST within 4 d of presentation. Exclusion criteria were elevated troponin value (> 0.05 ng/mL) and missing values for body mass index. The primary outcome was abnormal CST. Demographics, coronary artery disease (CAD) history, hypertension, hyperlipidemia, diabetes mellitus, chronic kidney disease, obesity, and smoking were evaluated as potential risk factors for abnormal CST. Patients were also categorized into a high-risk group (CAD history or more than two risk factors) and a low-risk group (all other patients) for comparison. Bivariate analysis was performed using a χ2 test or Fisher’s exact test. Age was compared by t test. Binomial regression (BR), random forest, and XGBoost MLMs were used for prediction. Bootstrapping was used for the internal validation of prediction models. BR was also used for inference. Alpha criterion was set at 0.05 for all statistical tests. R software was used for statistical analysis.
RESULTS The final cohort of the study included 2328 patients, of which 245 (10.52%) patients had abnormal CST. When adjusted for covariates in the BR model, male sex [risk ratio (RR) = 1.52, 95% confidence interval (CI): 1.2-1.94, P < 0.001)], CAD history (RR = 4.46, 95%CI: 3.08-6.72, P < 0.001), and hyperlipidemia (RR = 3.87, 95%CI: 2.12-8.12, P < 0.001) remained statistically significant. Incidence of abnormal CST was 12.2% in the high-risk group and 2.3% in the low-risk group (RR = 5.31, 95%CI: 2.75-10.24, P < 0.001). The XGBoost model had the best PPV of 24.33%, with an NPV of 91.34% for abnormal CST.
CONCLUSION The XGBoost MLM achieved a PPV of 24.33% for an abnormal CST, which is better than current stratification tools (13.00%-17.50%). This highlights the beneficial potential of MLMs in clinical decision-making.
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Affiliation(s)
- Muhammad Shafiq
- Division of General and Geriatric Medicine, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, KS 66160, United States
| | - Diego Robles Mazzotti
- Division of Medical Informatics & Division of Pulmonary Critical Care and Sleep Medicine, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, KS 66160, United States
| | - Cheryl Gibson
- Division of General and Geriatric Medicine, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, KS 66160, United States
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Olagunju A, Yamani N, Kenny D, Mookadam M, Mookadam F, Unzek S. Potential for sodium-glucose cotransporter-2 inhibitors in the management of metabolic syndrome: A systematic review and meta-analysis. World J Cardiol 2022; 14:599-616. [PMID: 36483765 PMCID: PMC9724001 DOI: 10.4330/wjc.v14.i11.599] [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: 07/03/2022] [Revised: 09/17/2022] [Accepted: 10/28/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Landmark trials have established the benefits of sodium-glucose cotransporter-2 inhibitors (SGLT2-Is) in cardiovascular disease including heart failure with reduced and preserved ejection fraction and renal diseases regardless of the presence of diabetes mellitus. However, studies evaluating the role of SGLT2-Is in metabolic syndrome (MetS) are limited.
AIM This study primarily aimed to evaluate the impact of SGLT2-Is on the components of MetS.
METHODS Two independent reviewers and an experienced librarian searched Medline, Scopus and the Cochrane central from inception to December 9, 2021 to identify placebo controlled randomized controlled trials that evaluated the impact of SGLT2-Is on the components of MetS as an endpoint. Pre- and post-treatment data of each component were obtained. A meta-analysis was performed using the RevMan (version 5.3; Copenhagen: The Nordic Cochrane Center, The Cochrane Collaboration).
RESULTS Treatment with SGLT2-Is resulted in a decrease in fasting plasma glucose (–18.07 mg/dL; 95%CI: -25.32 to –10.82), systolic blood pressure (–1.37 mmHg; 95%CI: -2.08 to –0.65), and waist circumference (–1.28 cm; 95%CI: -1.39 to –1.18) compared to placebo. The impact on high-density lipoprotein cholesterol was similar to placebo (0.01 mg/dL; 95%CI: -0.05 to 0.07).
CONCLUSION SGLT2-Is have a promising role in the management of MetS.
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Affiliation(s)
- Abdulbaril Olagunju
- Internal Medicine, Creighton University School of Medicine, Phoenix, AZ 85013, United States
| | - Naser Yamani
- Cardiology, Heart Center, University of Arizona College of Medicine-Phoenix, Banner University Medical Center, Phoenix, AZ 85006, United States
| | - Dorothy Kenny
- Internal Medicine, Creighton University School of Medicine, Phoenix, AZ 85013, United States
| | - Martina Mookadam
- Department of Family Medicine, Mayo Clinic, Scottsdale, AZ 85260, United States
| | - Farouk Mookadam
- Cardiology, Heart Center, University of Arizona College of Medicine-Phoenix, Banner University Medical Center, Phoenix, AZ 85006, United States
| | - Samuel Unzek
- Cardiology, Heart Center, University of Arizona College of Medicine-Phoenix, Banner University Medical Center, Phoenix, AZ 85006, United States
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90
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Scagliola R, Rosa GM. Is Takotsubo cardiomyopathy still looking for its own nosological identity? World J Cardiol 2022; 14:557-560. [PMID: 36339885 PMCID: PMC9627353 DOI: 10.4330/wjc.v14.i10.557] [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: 05/07/2022] [Revised: 05/31/2022] [Accepted: 10/06/2022] [Indexed: 02/05/2023] Open
Abstract
Despite several efforts to provide a proper nosological framework for Takotsubo cardiomyopathy (TCM), this remains an unresolved matter in clinical practice. Several clinical, pathophysiologic and histologic findings support the conceivable hypothesis that TCM could be defined as a unique pathologic entity, rather than a distinct subset of myocardial infarction with non-obstructive coronary arteries. Further investigations are needed in order to define TCM with the most appropriate disease taxonomy.
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Affiliation(s)
- Riccardo Scagliola
- Cardiovascular Disease Unit, IRCCS Ospedale Policlinico San Martino, Genoa 16132, Italy
| | - Gian Marco Rosa
- Cardiovascular Disease Unit, IRCCS Ospedale Policlinico San Martino, Genoa 16132, Italy
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91
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Lionakis N, Briasoulis A, Zouganeli V, Dimopoulos S, Kalpakos D, Kourek C. Spontaneous coronary artery dissection: A review of diagnostic methods and management strategies. World J Cardiol 2022; 14:522-536. [PMID: 36339886 PMCID: PMC9627356 DOI: 10.4330/wjc.v14.i10.522] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 09/14/2022] [Accepted: 10/06/2022] [Indexed: 02/05/2023] Open
Abstract
Spontaneous coronary artery dissection (SCAD) is a rare non-atherosclerotic cause of acute coronary syndromes defined as non-iatrogenic, non-traumatic separation of the coronary artery wall. The most common profile is a middle-aged woman between 44 and 53 years with few cardiovascular risk factors. SCAD is frequently linked with predisposing factors, such as postpartum, fibromuscular dysplasia or other vasculopathies, connective tissue disease and hormonal therapy, and it is often triggered by intense physical or emotional stress, sympathomimetic drugs, childbirth and activities increasing shear stress of the coronary artery walls. Patients with SCAD usually present at the emergency department with chest discomfort, chest pain, and rapid heartbeat or fluttery. During the last decades, the most common problem of SCAD was the lack of awareness about this condition which has led to significant underdiagnosis and misdiagnosis. However, modern imaging techniques such as optical coherence tomography, intravascular ultrasound, coronary angiography or magnetic resonance imaging have contributed to the early diagnosis of the disease. Treatment of SCAD remains controversial, especially during the last years, where invasive techniques are being used more often and in more emergent cardiac syndromes. Although conservative treatment combining aspirin and beta-blocker remains the recommended strategy in most cases, revascularization could also be suggested as a method of treatment in specific indications, but with a higher risk of complications. The prognosis of SCAD is usually good and long-term mortality seems to be low in these patients. Follow-up should be performed on a regular basis.
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Affiliation(s)
- Nikolaos Lionakis
- Department of Cardiology, 417 Army Share Fund Hospital of Athens (NIMTS), Athens 11521, Greece
| | - Alexandros Briasoulis
- Department of Clinical Therapeutics, Alexandra Hospital, Faculty of Medicine, National and Kapodistrian University of Athens, Athens 11528, Greece
- Division of Cardiovascular Medicine, Section of Heart Failure and Transplantation, University of Iowa Hospitals and Clinics, IA 52242, United States
| | - Virginia Zouganeli
- Second Cardiology Department, Attikon University Hospital, Faculty of Medicine, National and Kapodistrian University of Athens, Athens 12462, Greece
| | - Stavros Dimopoulos
- Clinical Ergospirometry, Exercise & Rehabilitation Laboratory, 1st Department of Critical Care Medicine, Evangelismos Hospital, Faculty of Medicine, National and Kapodistrian University of Athens, Athens 10676, Greece
- Cardiac Surgery Intensive Care Unit, Onassis Cardiac Surgery Center, Athens 17674, Greece
| | - Dionisios Kalpakos
- Department of Cardiology, 417 Army Share Fund Hospital of Athens (NIMTS), Athens 11521, Greece
| | - Christos Kourek
- Department of Cardiology, 417 Army Share Fund Hospital of Athens (NIMTS), Athens 11521, Greece
- Clinical Ergospirometry, Exercise & Rehabilitation Laboratory, 1st Department of Critical Care Medicine, Evangelismos Hospital, Faculty of Medicine, National and Kapodistrian University of Athens, Athens 10676, Greece
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92
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Lakušić N, Sopek Merkaš I, Slišković AM, Cerovec D. Euglycemic diabetic ketoacidosis: A rare but serious side effect of sodium-glucose co-transporter 2 inhibitors. World J Cardiol 2022; 14:561-564. [PMID: 36339887 PMCID: PMC9627354 DOI: 10.4330/wjc.v14.i10.561] [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: 07/10/2022] [Revised: 08/29/2022] [Accepted: 09/21/2022] [Indexed: 02/05/2023] Open
Abstract
Sodium-glucose co-transporter 2 (SGLT2) inhibitors are an insulin-independent class of oral antihyperglycemic medication and from recently established therapy in chronic heart failure patients. A rare, but potentially life-threatening complication of SGLT2 inhibitor use is euglycemic diabetic ketoacidosis. We described a case of a middle-aged male patient with type 2 diabetes who developed metabolic ketoacidosis after a few days of empagliflozin administration. SGLT2 inhibitor related ketoacidosis presents with euglycemia or only modestly elevated glucose blood concentrations, which causes delayed detection and treatment of ketoacidosis. There are multiple possible risk factors and mechanism that might contribute to the pathogenesis of ketoacidosis. It is implied that SGLT2 inhibitor use and prescription by non-diabetologists (cardiologists, nephrologists, family physicians, etc.) will continue to grow in the future. It is important to inform the general cardiac public about this rare but serious side effect of SGLT2 inhibitors.
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Affiliation(s)
- Nenad Lakušić
- Department of Cardiology, Special Hospital for Medical Rehabilitation Krapinske Toplice, Krapinske Toplice 49217, Croatia
- Department of Clinical Medicine, Faculty of Dental Medicine and Health Osijek, Osijek 31000, Croatia
- Department of Internal Medicine, Family Medicine and History of Medicine, Faculty of Medicine Osijek, Osijek 31000, Croatia
| | - Ivana Sopek Merkaš
- Department of Cardiology, Special Hospital for Medical Rehabilitation Krapinske Toplice, Krapinske Toplice 49217, Croatia
| | - Ana Marija Slišković
- Department of Cardiology, University Hospital Centre Zagreb, Zagreb 10000, Croatia
| | - Dora Cerovec
- Department of Cardiology, Special Hospital for Medical Rehabilitation Krapinske Toplice, Krapinske Toplice 49217, Croatia
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Olagunju A, Martinez J, Kenny D, Gideon P, Mookadam F, Unzek S. Virulent endocarditis due to Haemophilus parainfluenzae: A systematic review of the literature. World J Cardiol 2022; 14:546-556. [PMID: 36339888 PMCID: PMC9627352 DOI: 10.4330/wjc.v14.i10.546] [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: 07/02/2022] [Revised: 08/27/2022] [Accepted: 09/16/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Haemophilus parainfluenzae (HPI) belongs to the HACEK (Haemophilus spp., Aggregatibacter spp., Cardiobacterium spp., Eikenella spp., and Kingella spp.) group of organisms. The HACEK group of organisms are a part of the oropharyngeal flora and can cause invasive opportunistic infection such infective endocarditis (IE) in hosts with compromised immunological barriers.
AIM To perform a 20-year systematic review of the literature characterizing the clinical presentation, epidemiology and prognosis of HPI IE.
METHODS We performed a systematic review of Medline, Pubmed, Scopus and Embase from 2000 to 2022 to identify all cases of HPI IE.
RESULTS Thirty-nine adult cases were identified. HPI IE was found to affect males slightly more than females and is common in patients with predisposing risk factors such as underlying valvular abnormalities. It mostly affected the mitral valve and had an indolent course; significantly sized vegetations (> 1 cm) developed in most cases. Central nervous system septic embolization was common. It had a favorable prognosis compared to staphylococcal and streptococcal IE.
CONCLUSION Clinicians should be attentive to the indolent course of HPI IE and the presence of predisposing risk factors in order to allow for timely management.
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Affiliation(s)
- Abdulbaril Olagunju
- Department of Internal Medicine, Creighton University School of Medicine, Phoenix, AZ 85013, United States
| | - Jake Martinez
- Department of Cardiology, Heart Center, University of Arizona College of Medicine-Phoenix, Banner University Medical Center, Phoenix, AZ 85006, United States
| | - Dorothy Kenny
- Department of Internal Medicine, Creighton University School of Medicine, Phoenix, AZ 85013, United States
| | - Philip Gideon
- Department of Cardiology, Heart Center, University of Arizona College of Medicine-Phoenix, Banner University Medical Center, Phoenix, AZ 85006, United States
| | - Farouk Mookadam
- Department of Cardiology, Heart Center, University of Arizona College of Medicine-Phoenix, Banner University Medical Center, Phoenix, AZ 85006, United States
- Department of Cardio-oncology, Banner MD Anderson Cancer Center, Phoenix, AZ 85006, United States
| | - Samuel Unzek
- Department of Cardiology, Heart Center, University of Arizona College of Medicine-Phoenix, Banner University Medical Center, Phoenix, AZ 85006, United States
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Al-Seykal I, Bose A, Chevli PA, Hashmath Z, Sharma N, Mishra AK, Laidlaw D. Role of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers in cryoballoon ablation outcomes for paroxysmal atrial fibrillation. World J Cardiol 2022; 14:537-545. [PMID: 36339889 PMCID: PMC9627355 DOI: 10.4330/wjc.v14.i10.537] [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: 05/29/2022] [Revised: 06/18/2022] [Accepted: 09/06/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Cryoballoon ablation (CBA) is recommended for patients with paroxysmal atrial fibrillation (AF) refractory to antiarrhythmic drugs. However, only 80% of patients benefit from initial CBA. There is growing evidence that pretreatment with angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) decreases the recurrence of AF postablation, particularly in nonparoxysmal AF undergoing radiofrequency ablation. The role of ACEIs and ARBs in patients with paroxysmal AF in CBA remains unknown. We decided to investigate the role of ACEIs and ARBs in preventing the recurrence of atrial arrhythmia (AA) following CBA for paroxysmal AF.
AIM To investigate the role of ACEIs and ARBs in preventing recurrence of AA following CBA for paroxysmal AF.
METHODS We followed 103 patients (age 60.6 ± 9.1 years, 29% women) with paroxysmal AF undergoing CBA 1-year post procedure. Recurrence was assessed by documented AA on electrocardiogram or any form of long-term cardiac rhythm monitoring. A multivariable Cox proportional hazard model was used to assess if ACEI or ARB treatment predicted the risk of AA recurrence.
RESULTS After a 1-year follow-up, 19 (18.4%) participants developed recurrence of AA. Use of ACEI or ARB therapy was noted in the study population. Patients on ACEI/ARB had a greater prevalence of hypertension and coronary artery disease. On a multivariate model adjusted for baseline demographics and risk factors for AF, ACEI or ARB therapy did not prevent recurrence of AA following CBA (P = 0.72). Similarly, on Kaplan–Meier analysis pretreatment with ACEI/ARB did not predict the time to first recurrence of AA (P = 0.2173).
CONCLUSION In our study population, preablation treatment with an ACEI or ARB had no influence on the recurrence of AA following CBA for paroxysmal AF.
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Affiliation(s)
- Ibragim Al-Seykal
- Department of Medicine, Division of Cardiology, Saint Vincent Hospital, Worcester, MA 01608, United States
| | - Abhishek Bose
- Department of Medicine, Division of Cardiology, University of Massachusetts Chan School of Medicine, Worcester, MA 01608, United States
| | - Parag A Chevli
- Section on Hospital Medicine, Department of Medicine, Wake Forest School of Medicine, Winston-Salem, NC 27101, United States
| | - Zeba Hashmath
- Department of Medicine, Division of Cardiology, East Carolina University, Greenville, NC 27858, United States
| | - Nitish Sharma
- Department of Medicine, Division of Cardiology, Saint Vincent Hospital, Worcester, MA 01608, United States
| | - Ajay K Mishra
- Department of Medicine, Division of Cardiology, Saint Vincent Hospital, Worcester, MA 01608, United States
| | - Douglas Laidlaw
- Department of Medicine, Division of Cardiology, Saint Vincent Hospital, Worcester, MA 01608, United States
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Barbiero G, Maiolino G, Argiolas A, Testolin L, De Conti G. Intra-atrial course of right coronary artery: A case report. World J Cardiol 2022; 14:514-521. [PMID: 36187427 PMCID: PMC9523268 DOI: 10.4330/wjc.v14.i9.514] [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: 07/16/2022] [Revised: 08/11/2022] [Accepted: 08/31/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Intra-atrial right coronary artery (RCA) is a rare and generally asymptomatic anomaly of development of the coronary arteries. This malformation could potentially expose the patient to a catastrophic outcome in the case of injury during interventional or surgical procedures. Currently, only a few case reports and no systematic reviews are available in the literature.
CASE SUMMARY We report the case of a 54-year-old man with atypical chest pain who underwent multi-detector computed tomography angiography (MDCTA). The exam revealed no significant coronary artery stenoses; however, an intra-atrial course of mid RCA was evident. Medical therapy was administered, and the patient was discharged to home without undergoing a conventional angiography. Previously reported autoptic and clinical cases were retrieved from the PubMed literature database to compare the clinicopathological features of this case.
CONCLUSION MDCTA depicted the abnormal course of the coronary artery in this patient as an intra-atrial course of the mid RCA. Finding this abnormality was crucial to avoid an inadvertent injury during interventional or surgical procedures.
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Affiliation(s)
- Giulio Barbiero
- Department of Integrated Diagnostic Services, DIDAS, Radiology Unit, University Hospital of Padua, Padua 35128, Italy
| | - Giuseppe Maiolino
- Department of Medicine, Medical Clinic 3, University Hospital of Padua, Padua 35128, Italy
| | - Anna Argiolas
- Department of Integrated Diagnostic Services, DIDAS, Radiology Unit, University Hospital of Padua, Padua 35128, Italy
| | - Luca Testolin
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Cardiac Surgery, University Hospital of Padua, Padua 35128, Italy
| | - Giorgio De Conti
- Department of Integrated Diagnostic Services, DIDAS, Radiology Unit, University Hospital of Padua, Padua 35128, Italy
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Bazoukis G, Garcia-Zamora S, Çinier G, Lee S, Elvin Gul E, Álvarez-García J, Miana G, Hayıroğlu Mİ, Tse G, Liu T, Baranchuk A. Association of electrocardiographic markers with myocardial fibrosis as assessed by cardiac magnetic resonance in different clinical settings. World J Cardiol 2022; 14:483-495. [PMID: 36187429 PMCID: PMC9523270 DOI: 10.4330/wjc.v14.i9.483] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Revised: 05/31/2022] [Accepted: 08/17/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Cardiac magnetic resonance (CMR) is a unique tool for non-invasive tissue characterization, especially for identifying fibrosis.
AIM To present the existing data regarding the association of electrocardiographic (ECG) markers with myocardial fibrosis identified by CMR - late gadolinium enhancement (LGE).
METHODS A systematic search was performed for identifying the relevant studies in Medline and Cochrane databases through February 2021. In addition, we conducted a relevant search by Reference Citation Analysis (RCA) (https://www.referencecitationanalysis.com).
RESULTS A total of 32 studies were included. In hypertrophic cardiomyopathy (HCM), fragmented QRS (fQRS) is related to the presence and extent of myocardial fibrosis. fQRS and abnormal Q waves are associated with LGE in ischemic cardiomyopathy patients, while fQRS has also been related to fibrosis in myocarditis. Selvester score, abnormal Q waves, and notched QRS have also been associated with LGE. Repolarization abnormalities as reflected by increased Tp-Te, negative T-waves, and higher QT dispersion are related to myocardial fibrosis in HCM patients. In patients with Duchenne muscular dystrophy, a significant correlation between fQRS and the amount of myocardial fibrosis as assessed by LGE-CMR was observed. In atrial fibrillation patients, advanced inter-atrial block is defined as P-wave duration ≥ 120 ms, and biphasic morphology in inferior leads is related to left atrial fibrosis.
CONCLUSION Myocardial fibrosis, a reliable marker of prognosis in a broad spectrum of cardiovascular diseases, can be easily understood with an easily applicable ECG. However, more data is needed on a specific disease basis to study the association of ECG markers and myocardial fibrosis as depicted by CMR.
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Affiliation(s)
- George Bazoukis
- Department of Cardiology, Larnaca General Hospital, Larnaca 6036, Cyprus
- Department of Basic and Clinical Sciences, University of Nicosia Medical School, Nicosia 2414, Cyprus
| | | | - Göksel Çinier
- Department of Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Center, Istanbul 34668, Turkey
| | - Sharen Lee
- Cardiovascular Analytics Group, Laboratory of Cardiovascular Physiology, Hong Kong 999077, China
| | - Enes Elvin Gul
- Division of Cardiac Electrophysiology, Madinah Cardiac Centre, Madinah 42351, Saudi Arabia
| | - Jesús Álvarez-García
- Department of Cardiology, Ramon y Cajal University Hospital, Madrid 28034, Spain
| | - Gabi Miana
- Telehealth Center of Hospital das Clínicas, Hong Kong 999077, China
| | - Mert İlker Hayıroğlu
- Department of Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Center, Istanbul 34668, Turkey
| | - Gary Tse
- Kent and Medway Medical School, Canterbury, Canterbury CT2 7FS, United Kingdom
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin, Tianjin Medical University, Tianjin 300211, China
| | - Tong Liu
- Department of Cardiology, The Second Hospital of Tianjin Medical University, Tianjin 300211, China
| | - Adrian Baranchuk
- Department of Cardiology, Queen's University, Ontario K7L 3N6, Canada
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Pradhan A, Vishwakarma P, Bhandari M, Sethi R. Intravascular lithotripsy for coronary calcium: A case report and review of the literature. World J Cardiol 2022; 14:496-507. [PMID: 36187430 PMCID: PMC9523272 DOI: 10.4330/wjc.v14.i9.496] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 07/06/2022] [Accepted: 08/26/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Coronary calcium poses a challenge for the interventional cardiologist often leading to stent under-expansion and subsequent ischemic events. Aggressive balloon post-dilatation though helpful is usually inadequate. Multiple plaque ablation techniques are in vogue, but they are technically demanding and are not without complications. Shockwave intravascular lithotripsy (S-IVL) has emerged as a user-friendly and effective mechanism for calcium management with a high safety margin. A series of trials (DISRUPT CAD I-IV) have demonstrated both short-term and long-term safety and efficacy of the technique. As experience with the technique grows more and more, therapy areas like stent restenosis are being covered by the S-IVL.
CASE SUMMARY We report a series of 2 cases successfully managed with S-IVL therapy at our center. The first case is of a 57-year-old smoker who presented with acute coronary syndrome. His left anterior descending coronary artery revealed calcified 90% stenosis on angiogram and a combination of superficial-deep calcium on intracoronary imaging. The calcium was treated with 20 pulses of S-IVL to create discontinuity and a sirolimus eluting drug-eluting stent was successfully implanted. The second case is that of an elderly lady who presented with stable angina and demonstrated diffuse calcified lesions in the left anterior descending artery on angiogram. She also demonstrated a mixture of superficial and deep seated calcium zones on imaging. S-IVL therapy was applied to generate fractures in calcium, and two overlapping drug-eluting stents were implanted successfully without any complications.
CONCLUSION S-IVL is an emerging, efficient, user-friendly and safe therapy for managing intracoronary calcium in routine interventional practice.
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Affiliation(s)
- Akshyaya Pradhan
- Department of Cardiology, King George Medical University, Lucknow 226006, Uttar Pradesh, India
| | - Pravesh Vishwakarma
- Department of Cardiology, King George Medical University, Lucknow 226006, Uttar Pradesh, India
| | - Monika Bhandari
- Department of Cardiology, King George Medical University, Lucknow 226006, Uttar Pradesh, India
| | - Rishi Sethi
- Department of Cardiology, King George Medical University, Lucknow 226006, Uttar Pradesh, India
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Jha AK, Ojha CP, Krishnan AM, Paul TK. Thirty-day readmission in patients with heart failure with preserved ejection fraction: Insights from the nationwide readmission database. World J Cardiol 2022; 14:473-482. [PMID: 36187428 PMCID: PMC9523271 DOI: 10.4330/wjc.v14.i9.473] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 06/16/2022] [Accepted: 07/27/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND There are rising numbers of patients who have heart failure with preserved ejection fraction (HFpEF). Poorly understood pathophysiology of heart failure with preserved and reduced ejection fraction and due to a sparsity of studies, the management of HFpEF is challenging.
AIM To determine the hospital readmission rate within 30 d of acute or acute on chronic heart failure with preserved ejection fraction and its effect on mortality and burden on health care in the United States.
METHODS We performed a retrospective study using the Agency for Health-care Research and Quality Health-care Cost and Utilization Project, Nationwide Readmissions Database for the year 2017. We collected data on hospital readmissions of 60514 adults hospitalized for acute or acute on chronic HFpEF. The primary outcome was the rate of all-cause readmission within 30 d of discharge. Secondary outcomes were cause of readmission, mortality rate in readmitted and index patients, length of stay, total hospitalization costs and charges. Independent risk factors for readmission were identified using Cox regression analysis.
RESULTS The thirty day readmission rate was 21%. Approximately 9.17% of readmissions were in the setting of acute on chronic diastolic heart failure. Hypertensive chronic kidney disease with heart failure (1245; 9.7%) was the most common readmission diagnosis. Readmitted patients had higher in-hospital mortality (7.9% vs 2.9%, P = 0.000). Our study showed that Medicaid insurance, higher Charlson co-morbidity score, patient admitted to a teaching hospital and longer hospital stay were significant variables associated with higher readmission rates. Lower readmission rate was found in residents of small metropolitan or micropolitan areas, older age, female gender, and private insurance or no insurance were associated with lower risk of readmission.
CONCLUSION We found that patients hospitalized for acute or acute on chronic HFpEF, the thirty day readmission rate was 21%. Readmission cases had a higher mortality rate and increased healthcare resource utilization. The most common cause of readmission was cardio-renal syndrome.
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Affiliation(s)
- Anil Kumar Jha
- Internal Medicine, Lowell General Hospital, Lowell, MA 01852, United States
| | - Chandra P Ojha
- Department of Medicine, Texas Tech University Health Sciences Center, El Paso, TX 79905, United States
| | - Anand M Krishnan
- Department of Cardiovascular Disease, Larner College of Medicine at the University of Vermont, Burlington, VT 05405, United States
| | - Timir K Paul
- Department of Clinical Education, University of Tennessee Health Sciences Center at Nashville, Nashville, TN 37025, United States
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Goyal A, Dalia T, Bhyan P, Farhoud H, Shah Z, Vidic A. Rare case of chronic Q fever myocarditis in end stage heart failure patient: A case report. World J Cardiol 2022; 14:508-513. [PMID: 36187426 PMCID: PMC9523269 DOI: 10.4330/wjc.v14.i9.508] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 06/30/2022] [Accepted: 08/18/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Q fever myocarditis is a rare disease manifestation of Q fever infection caused by Coxiella burnetii. It is associated with significant morbidity and mortality if left untreated. Prior studies have reported myocarditis in patients with acute Q fever. We present the first case of chronic myocarditis in an end-stage heart failure patient with chronic Q fever infection.
CASE SUMMARY A 69-year-old male was admitted with dyspnea on exertion, hypotension and bilateral lower extremity edema for a few months. He has a past medical history of ischemic cardiomyopathy with left ventricular ejection fraction of 25%, implantable cardioverter defibrillator in place, bioprosthetic aortic valve and mitral valve replacement. He continued to have shortness of breath despite diuresis along with low grade fevers. Initial infectious work up came back negative. On further questioning, the patient was found to have close contact with farm animals and the recurrent fevers prompted the work-up for Q fever. Q fever serologies and cardiac positron emission tomography confirmed the diagnosis of chronic Q fever myocarditis. He was then successfully treated with doxycycline and hydroxychloroquine for 18 mo.
CONCLUSION Chronic Q fever myocarditis, if left untreated, carries a poor prognosis. It should be kept in differentials, especially in patients with recurrent fevers and contact with farm animals.
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Affiliation(s)
- Amandeep Goyal
- Department of Cardiovascular Medicine, University of Kansas Medical Center, Kansas City, KS 66160, United States
| | - Tarun Dalia
- Department of Cardiovascular Medicine, University of Kansas Medical Center, Kansas City, KS 66160, United States
| | - Poonam Bhyan
- Department of Internal Medicine, Cape Fear Valley Hospital, Fayetteville, NC 28304, United States
| | - Hassan Farhoud
- School of Medicine, University of Kansas Medical Center, Kansas City, KS 66160, United States
| | - Zubair Shah
- Department of Cardiovascular Medicine, University of Kansas Medical Center, Kansas City, KS 66160, United States
| | - Andrija Vidic
- Department of Cardiovascular Medicine, University of Kansas Medical Center, Kansas City, KS 66160, United States
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Gupta Y, Goyal A, Kalaivani M, Tandon N. Cardiometabolic risk factors in young Indian men and their association with parameters of insulin resistance and beta-cell function. World J Cardiol 2022; 14:462-472. [PMID: 36160812 PMCID: PMC9453255 DOI: 10.4330/wjc.v14.i8.462] [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: 03/01/2022] [Revised: 04/29/2022] [Accepted: 07/22/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND There is an unmet need to evaluate the burden of cardiometabolic risk factors in young South Asian adults, who are not preselected for glycaemia.
AIM To evaluate young North Indian men (aged 20-50 years) for burden of cardiometabolic risk factors, in relation to parameters of homeostatic model assessment for insulin resistance (HOMA-IR) and beta-cell function (oral disposition index [oDI]).
METHODS Study participants were invited in a fasting state. Sociodemographic, anthropometric, and medical data were collected, and 75 g oral glucose tolerance test was performed with serum insulin and plasma glucose estimation at 0, 30, and 120 min. Participants were divided into quartiles for HOMA-IR and oDI (category 1: Best HOMA-IR/oDI quartile; category 3: Worst HOMA-IR/oDI quartile) and composite HOMA-IR/oDI phenotypes (phenotype 1: Best quartile for both HOMA-IR and oDI; phenotype 4: Worst quartile for both HOMA-IR and oDI) were derived.
RESULTS We evaluated a total of 635 men at a mean (± SD) age of 33.9 ± 5.1 years and body mass index of 26.0 ± 3.9 kg/m2. Diabetes and prediabetes were present in 34 (5.4%) and 297 (46.8%) participants, respectively. Overweight/obesity, metabolic syndrome, and hypertension were present in 388 (61.1%), 258 (40.6%), and 123 (19.4%) participants, respectively. The prevalence of dysglycaemia, metabolic syndrome, and hypertension was significantly higher in participants belonging to the worst HOMA-IR and oDI quartiles, either alone (category 3 vs 1) or in combination (phenotype 4 vs 1). The adjusted odds ratios for dysglycaemia (6.5 to 7.0-fold), hypertension (2.9 to 3.6-fold), and metabolic syndrome (4.0 to 12.2-fold) were significantly higher in individuals in the worst quartile of HOMA-IR and oDI (category 3), compared to those in the best quartile (category 1). The adjusted odds ratios further increased to 21.1, 5.6, and 13.7, respectively, in individuals with the worst, compared to the best composite HOMA-IR/oDI phenotypes (phenotype 4 vs 1).
CONCLUSION The burden of cardiometabolic risk factors is high among young Asian Indian men. Our findings highlight the importance of using parameters of insulin resistance and beta-cell function in phenotyping individuals for cardiometabolic risk.
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Affiliation(s)
- Yashdeep Gupta
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi 110029, Delhi, India
| | - Alpesh Goyal
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi 110029, Delhi, India
| | - Mani Kalaivani
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi 110029, Delhi, India
| | - Nikhil Tandon
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi 110029, Delhi, India
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