28201
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Youn JC, Han S, Ryu KH. Toward a New Heart Failure Registry in Korea. Korean Circ J 2017; 47:316-317. [PMID: 28567080 PMCID: PMC5449524 DOI: 10.4070/kcj.2017.0075] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Accepted: 05/08/2017] [Indexed: 11/25/2022] Open
Affiliation(s)
- Jong-Chan Youn
- Division of Cardiology, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Korea
| | - Seongwoo Han
- Division of Cardiology, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Korea
| | - Kyu-Hyung Ryu
- Division of Cardiology, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Korea
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28202
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Abstract
A key feature of chronic heart failure (HF) is the sustained activation of endogenous neurohormonal systems in response to impaired cardiac pumping and/or filling properties. The clinical use of neurohormonal blockers has revolutionised the care of HF patients over the past three decades. Drug therapy that is active against imbalance in both the autonomic and renin-angiotensin-aldosterone systems consistently reduces morbidity and mortality in chronic HF with reduced left ventricular ejection fraction and in sinus rhythm. This article provides an assessment of the major neurohormonal systems and their therapeutic blockade in patients with chronic HF.
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Affiliation(s)
- Thomas G von Lueder
- Department of Cardiology, Oslo University Hospital UllevÅl, Oslo, Norway.,Monash Centre of Cardiovascular Research and Education in Therapeutics, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia and Alfred Hospital, Melbourne, Australia
| | - Dipak Kotecha
- Monash Centre of Cardiovascular Research and Education in Therapeutics, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia and Alfred Hospital, Melbourne, Australia.,University of Birmingham Institute of Cardiovascular Sciences, Birmingham, UK
| | - Dan Atar
- Department of Cardiology, Oslo University Hospital UllevÅl, Oslo, Norway
| | - Ingrid Hopper
- Monash Centre of Cardiovascular Research and Education in Therapeutics, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia and Alfred Hospital, Melbourne, Australia
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28203
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Parida S, Thangaswamy CR. Cardiac tachyarrhythmias and anaesthesia: General principles and focus on atrial fibrillation. Indian J Anaesth 2017; 61:712-720. [PMID: 28970629 PMCID: PMC5613596 DOI: 10.4103/ija.ija_383_17] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Cardiac tachyarrhythmias are encountered commonly during the perioperative period and need to be promptly identified and appropriately managed by the anaesthesiologist. This review intends to highlight important aspects of these tachyarrhythmias and explore a temporal relationship between common medications employed in the perioperative period and their causation. Mechanisms of initiation of tachyarrhythmias, drugs that can trigger those, as well as their diagnosis and management, are also parts of the current review. Cardiac tachyarrhythmias may not always require treatment, and sometimes, aggressive management can trigger more serious types of arrhythmias. A thorough understanding of these tachyarrhythmias and their pathogenesis enables adopting a more objective approach, eschewing risks of inappropriate or unnecessary management strategies. We performed a MEDLINE search using combinations of MeSH terms such as ‘cardiac’, ‘arrhythmias’, ‘anaesthesia’, ‘perioperative’, ‘tachyarrhythmias’ and ‘anaesthetic implications’. We reviewed the relevant publications with regard to cardiac tachyarrhythmias occurring in the perioperative period.
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Affiliation(s)
- Satyen Parida
- Department of Anesthesiology and Critical Care, JIPMER, Puducherry, India
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28204
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Obokata M, Kane GC, Reddy YNV, Olson TP, Melenovsky V, Borlaug BA. Role of Diastolic Stress Testing in the Evaluation for Heart Failure With Preserved Ejection Fraction: A Simultaneous Invasive-Echocardiographic Study. Circulation 2016; 135:825-838. [PMID: 28039229 DOI: 10.1161/circulationaha.116.024822] [Citation(s) in RCA: 385] [Impact Index Per Article: 48.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Accepted: 12/21/2016] [Indexed: 02/06/2023]
Abstract
BACKGROUND Diagnosis of heart failure with preserved ejection fraction (HFpEF) is challenging and relies largely on demonstration of elevated cardiac filling pressures (pulmonary capillary wedge pressure). Current guidelines recommend use of natriuretic peptides (N-terminal pro-B type natriuretic peptide) and rest/exercise echocardiography (E/e' ratio) to make this determination. Data to support this practice are conflicting. METHODS Simultaneous echocardiographic-catheterization studies were prospectively conducted at rest and during exercise in subjects with invasively proven HFpEF (n=50) and participants with dyspnea but no identifiable cardiac pathology (n=24). RESULTS N-Terminal pro-B type natriuretic peptide levels were below the level considered to exclude disease (≤125 pg/mL) in 18% of subjects with HFpEF. E/e' ratio was correlated with directly measured pulmonary capillary wedge pressure at rest (r=0.63, P<0.0001) and during exercise (r=0.57, P<0.0001). Although specific, current guidelines were poorly sensitive, identifying only 34% to 60% of subjects with invasively proven HFpEF on the basis of resting echocardiographic data alone. Addition of exercise echocardiographic data (E/e' ratio>14) improved sensitivity (to 90%) and thus negative predictive value, but decreased specificity (71%). CONCLUSIONS Currently proposed HFpEF diagnostic guidelines on the basis of resting data are poorly sensitive. Adding exercise E/e' data improves sensitivity and negative predictive value but compromises specificity, suggesting that exercise echocardiography may help rule out HFpEF. These results question the accuracy of current approaches to exclude HFpEF on the basis of resting data alone and reinforce the value of exercise testing using invasive and noninvasive hemodynamic assessments to definitively confirm or refute the diagnosis of HFpEF. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique Identifier: NCT01418248.
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Affiliation(s)
- Masaru Obokata
- From Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic Rochester, MN (M.O., G.C.K., Y.N.V.R., T.P.O., B.A.B.); and IKEM - Institute for Clinical and Experimental Medicine, Department of Cardiology, Prague, Czech Republic (V.M.)
| | - Garvan C Kane
- From Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic Rochester, MN (M.O., G.C.K., Y.N.V.R., T.P.O., B.A.B.); and IKEM - Institute for Clinical and Experimental Medicine, Department of Cardiology, Prague, Czech Republic (V.M.)
| | - Yogesh N V Reddy
- From Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic Rochester, MN (M.O., G.C.K., Y.N.V.R., T.P.O., B.A.B.); and IKEM - Institute for Clinical and Experimental Medicine, Department of Cardiology, Prague, Czech Republic (V.M.)
| | - Thomas P Olson
- From Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic Rochester, MN (M.O., G.C.K., Y.N.V.R., T.P.O., B.A.B.); and IKEM - Institute for Clinical and Experimental Medicine, Department of Cardiology, Prague, Czech Republic (V.M.)
| | - Vojtech Melenovsky
- From Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic Rochester, MN (M.O., G.C.K., Y.N.V.R., T.P.O., B.A.B.); and IKEM - Institute for Clinical and Experimental Medicine, Department of Cardiology, Prague, Czech Republic (V.M.)
| | - Barry A Borlaug
- From Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic Rochester, MN (M.O., G.C.K., Y.N.V.R., T.P.O., B.A.B.); and IKEM - Institute for Clinical and Experimental Medicine, Department of Cardiology, Prague, Czech Republic (V.M.).
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28205
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Prajapati H, Sharma R, Patel D. Carvedilol: a review of its use in the management of heart failure. DRUGS & THERAPY PERSPECTIVES 2016. [DOI: 10.1007/s40267-016-0370-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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28206
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Tanaka A, Node K. Emerging roles of sodium-glucose cotransporter 2 inhibitors in cardiology. J Cardiol 2016; 69:501-507. [PMID: 28043708 DOI: 10.1016/j.jjcc.2016.10.019] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Accepted: 10/27/2016] [Indexed: 12/18/2022]
Abstract
The ultimate goal of treatment in people with diabetes mellitus is to prevent development of cardiovascular (CV) disease, resulting in prolongation of healthy life expectancy. Although impaired glycemic metabolism has a central role in its pathology, a number of studies have demonstrated that remedy for its imbalance cannot necessarily be accomplished as a therapeutic goal. A comprehensive medical approach against multi-factorial pathologies in diabetes, such as insulin resistance, obesity, hypertension, and dyslipidemia, in addition to diet and exercise therapy should be rather performed in the routine clinical setting. Along with such conceptual transition, what is required in anti-diabetes agents has also changed, and several anti-diabetes agents have been newly placed on the market in this decade. Such agents are required to undergo global pre- or post-marketing clinical trials assessing CV safety. A growing body of clinical evidence from those trials is now accumulating, and empagliflozin, a sodium-glucose cotransporter 2 (SGLT2) inhibitor, has first demonstrated significant risk reduction, relative to placebo, in CV death, overall mortality, and hospitalization for worsened heart failure in high-risk patients with diabetes mellitus. An SGLT2 inhibitor is a unique glucose-lowering agent and at the same time has multifaceted effects on hemodynamic and metabolic parameters beyond glycemic control. A major mode of action of SGLT2 inhibitors appears to be 'glycosuria' and 'natriuresis,' leading to amelioration of systemic glycemic homeostasis and potential cardio-renal protection. However, the precise mechanisms by which SGLT2 inhibitors affect benefits on the CV systems are yet to be fully elucidated. Thus, although we are now facing several unanswered concerns lurking behind the successful trial, SGLT2 inhibitors surely play several important roles in high-quality management of not only diabetes, but also CV medicine. This review summarizes our current understandings and future perspectives of SGLT2 inhibitors in CV medicine.
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Affiliation(s)
- Atsushi Tanaka
- Department of Cardiovascular Medicine, Saga University, Saga, Japan
| | - Koichi Node
- Department of Cardiovascular Medicine, Saga University, Saga, Japan.
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28207
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Youn JC, Han S, Ryu KH. Temporal Trends of Hospitalized Patients with Heart Failure in Korea. Korean Circ J 2016; 47:16-24. [PMID: 28154584 PMCID: PMC5287180 DOI: 10.4070/kcj.2016.0429] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Revised: 12/08/2016] [Accepted: 12/15/2016] [Indexed: 11/11/2022] Open
Abstract
Heart failure (HF) is an important cardiovascular disease because of its increasing prevalence, significant morbidity, high mortality and rapidly expanding health care costs. The number of HF patients is increasing worldwide and Korea is no exception. Temporal trends of four representative Korean hospitalized HF registries-the Hallym HF study, the Korean Multicenter HF study, the Korean Heart Failure (KorHF) registry and the Korean Acute Heart Failure (KorAHF) registry showed mild survival improvement reflecting overall HF patient care development in Korea despite the increased severity of enrolled patients with higher incidence of multiple comorbidities. Moreover, device therapies such as implantable cardioverter defibrillator and cardiac resynchronization therapy and definitive treatment such as heart transplantation have been increasing in Korea as well. To prevent HF burden increase, it is essential to set up long term effective prevention strategies for better control of ischemic heart disease, hypertension and diabetes, which might be risk factors for HF development. Moreover, proper HF guidelines, performance measures, and performance improvement programs might be necessary to limit HF burden as well.
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Affiliation(s)
- Jong-Chan Youn
- Division of Cardiology, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Korea
| | - Seongwoo Han
- Division of Cardiology, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Korea
| | - Kyu-Hyung Ryu
- Division of Cardiology, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Korea
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28208
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Abstract
The novel combination sacubitril/valsartan represents a new therapeutic approach in the management of heart failure. With the simultaneous blockage of the enzyme neprilysin (by sacubitril) and angiotensin II receptors (by valsartan), this combination reduces the degradation of natriuretic peptides and other counterregulatory peptide systems while avoiding the deleterious effect of angiotensin II receptors activation and thereby encompasses a beneficial impact of 2 important neurohormonal pathways activated in heart failure. As opposed to previously tested neprilysin inhibitors, sacubitril/valsartan represents a more effective method in reducing morbidity and mortality in heart failure, while preserving a safety profile comparable to well-established, standard, angiotensin-converting enzyme inhibitor's therapy.
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Affiliation(s)
- Ofer Havakuk
- 1 Division of Cardiovascular Medicine, Department of Medicine, LAC/USC Medical Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Uri Elkayam
- 1 Division of Cardiovascular Medicine, Department of Medicine, LAC/USC Medical Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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28209
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Raeisi-Giglou P, Lam L, Tamarappoo BK, Newman J, Dweik RA, Tonelli AR. Evaluation of left ventricular diastolic function profile in patients with pulmonary hypertension due to heart failure with preserved ejection fraction. Clin Cardiol 2016; 40:356-363. [PMID: 28026030 DOI: 10.1002/clc.22664] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Revised: 11/22/2016] [Accepted: 11/24/2016] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Echocardiography plays an important role in the diagnostic work up of heart failure with preserved ejection fraction (HFpEF). We sought to determine the left ventricular (LV) diastolic profile by echocardiography in patients diagnosed with pulmonary hypertension (PH) due to PH-HFpEF. HYPOTHESIS The study of LV diastolic function by echocardiography has limitations in patients with HFpEF and PH, and certain LV diastolic determinations convey a worse prognosis. METHODS We included patients with postcapillary PH and diagnosis of PH-HFpEF. Investigators reviewed Doppler echocardiograms completed within 3 months of the diagnostic right heart catheterization. RESULTS We included 149 patients with a mean ± standard deviation age of 63 ± 14 years; 58% were women. LV diastolic function profile was determined as normal (41%), grade I (34%), and grade II and grade III (25%). Pulmonary artery pressure and pulmonary vascular resistance were higher and cardiac output lower in patients with LV diastolic dysfunction profile; however, pulmonary artery wedge pressure was not significantly different among grades of LV diastolic function. Although there was an association between the presence of LV diastolic dysfunction profile and long-term survival (P = 0.03), it disappeared when adjusting for age and gender. Right ventricular (RV) dysfunction, paradoxical septal motion, and higher RV systolic pressure remained the only variables significantly associated with poor survival. CONCLUSIONS The profile of LV diastolic dysfunction by conventional echocardiography is highly variable in patients with PH-HFpEF and has no significant impact on long-term survival. A more severe RV function and higher right ventricle systolic pressure were associated with worse survival.
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Affiliation(s)
| | - Louis Lam
- Department of Pulmonary, Allergy, and Critical Care Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, Ohio
| | - Balaji K Tamarappoo
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Jennie Newman
- Department of Pulmonary, Allergy, and Critical Care Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, Ohio
| | - Raed A Dweik
- Department of Pulmonary, Allergy, and Critical Care Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, Ohio
| | - Adriano R Tonelli
- Department of Pulmonary, Allergy, and Critical Care Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, Ohio
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28210
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Thrombin Generation in Acute Ischaemic Stroke. Stroke Res Treat 2016; 2016:7940680. [PMID: 28116215 PMCID: PMC5220518 DOI: 10.1155/2016/7940680] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Accepted: 11/28/2016] [Indexed: 01/21/2023] Open
Abstract
Introduction. Stroke remains a global leading cause of death and disability. Traditional description of plasma biology in the aftermath of acute ischaemic stroke favours development of hypercoagulability, resulting from complex interplay between plasma and endothelial factors. However, no single assay measures the overall global coagulation process. We postulate that thrombin generation would assist in identifying coagulation abnormalities after acute stroke. Aim. To investigate the coagulation abnormalities after acute ischaemic stroke using thrombin generation. Methods. We evaluated thrombin generation, measured with calibrated automated thrombography in stroke of different aetiological types (n = 170) within 48 hours of symptoms onset (baseline) and in the second week (time 2) and in normal healthy volunteers (n = 71). Results. Two-point thrombin generation assays showed prolonged lag time and time to peak at baseline (3.3 (2.9, 4.0) versus 3.6 (3.2, 4.7); p = 0.005) and (3.3 (2.9, 4.0) versus 3.6 (3.2, 4.7); p = 0.002), respectively, and at time 2 (3.5 (2.9, 4.2) versus 4.0 (3.1, 4.9); p = 0.004) and (5.9 (5.3, 6.6) versus 6.8 (5.8, 7.7) p = 0.05), respectively, in cardioembolic stroke (n = 39), when compared to noncardioembolic stroke (n = 117). The result was reproduced in multiple comparisons between acute ischaemic stroke subgroups and normal healthy volunteers. Endogenous thrombin potential and peak thrombin did not indicate hypercoagulability after acute ischaemic stroke, and thrombolytic therapy did not affect thrombin generation assays. Conclusion. Our findings suggest that thrombin generation in platelet poor plasma is not useful in defining hypercoagulability in acute ischaemic stroke. This is similar to observed trend in coronary artery disease and contrary to other hypercoagulable states.
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28211
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TREK-1 (K2P2.1) K+ channels are suppressed in patients with atrial fibrillation and heart failure and provide therapeutic targets for rhythm control. Basic Res Cardiol 2016; 112:8. [DOI: 10.1007/s00395-016-0597-7] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Accepted: 12/12/2016] [Indexed: 12/16/2022]
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28212
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Shahid F, Shantsila E, Lip GY. What do the guidelines suggest for non-vitamin K antagonist oral anticoagulant use for stroke prevention in atrial fibrillation? Eur Heart J Suppl 2016. [DOI: 10.1093/eurheartj/suw049] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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28213
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Verheugt FW. What are the effects of edoxaban in the general population and in the elderly? Eur Heart J Suppl 2016. [DOI: 10.1093/eurheartj/suw050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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28214
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Sinning C, Ojeda F, Wild PS, Schnabel RB, Schwarzl M, Ohdah S, Lackner KJ, Pfeiffer N, Michal M, Blettner M, Munzel T, Kempf T, Wollert KC, Kuulasmaa K, Blankenberg S, Salomaa V, Westermann D, Zeller T. Midregional proadrenomedullin and growth differentiation factor-15 are not influenced by obesity in heart failure patients. Clin Res Cardiol 2016; 106:401-410. [DOI: 10.1007/s00392-016-1066-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2016] [Accepted: 12/16/2016] [Indexed: 10/20/2022]
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28215
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Mid-range Ejection Fraction Does Not Permit Risk Stratification Among Patients Hospitalized for Heart Failure. ACTA ACUST UNITED AC 2016; 70:338-346. [PMID: 28011188 DOI: 10.1016/j.rec.2016.11.016] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Accepted: 08/29/2016] [Indexed: 11/21/2022]
Abstract
INTRODUCTION AND OBJECTIVES European Society of Cardiology heart failure guidelines include a new patient category with mid-range (40%-49%) left ventricular ejection fraction (HFmrEF). HFmrEF patient characteristics and prognosis are poorly defined. The aim of this study was to analyze the HFmrEF category in a cohort of hospitalized heart failure patients (REDINSCOR II Registry). METHODS A prospective observational study was conducted with 1420 patients classified according to ejection fraction as follows: HFrEF, < 40%; HFmrEF, 40%-49%; and HFpEF, ≥ 50%. Baseline patient characteristics were examined, and outcome measures were mortality and readmission for heart failure at 1-, 6-, and 12-month follow-up. Propensity score matching was used to compare the HFmrEF group with the other ejection fraction groups. RESULTS Among the study participants, 583 (41%) had HFrEF, 227 (16%) HFmrEF, and 610 (43%) HFpEF. HFmrEF patients had a clinical profile similar to that of HFpEF patients in terms of age, blood pressure, and atrial fibrillation prevalence, but shared with HFrEF patients a higher proportion of male participants and ischemic etiology, and use of class I drugs targeting HFrEF. All other features were intermediate, and comorbidities were similar among the 3 groups. There were no significant differences in all-cause mortality, cause of death, or heart failure readmission. The similar outcomes were confirmed in the propensity score matched cohorts. CONCLUSIONS The HFmrEF patient group has characteristics between the HFrEF and HFpEF groups, with more similarities to the HFpEF group. No between-group differences were observed in total mortality, cause of death, or heart failure readmission.
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28216
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Wolsk E, Bakkestrøm R, Thomsen JH, Balling L, Andersen MJ, Dahl JS, Hassager C, Møller JE, Gustafsson F. The Influence of Age on Hemodynamic Parameters During Rest and Exercise in Healthy Individuals. JACC-HEART FAILURE 2016; 5:337-346. [PMID: 28017352 DOI: 10.1016/j.jchf.2016.10.012] [Citation(s) in RCA: 91] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Revised: 10/20/2016] [Accepted: 10/21/2016] [Indexed: 01/01/2023]
Abstract
OBJECTIVES In this study, the authors sought to obtain hemodynamic estimates across a wide age span and in both sexes for future reference and compare these estimates with current guideline diagnostic hemodynamic thresholds for abnormal filling pressure and pulmonary hypertension. BACKGROUND At present, the influence of age on hemodynamic function is largely unknown. Because many diseases with proposed cardiac impact are more prevalent in the older population, it is pivotal to know how hemodynamic parameters are affected by age itself to discern the influence of disease from that of physiological aging. METHODS Sixty-two healthy participants, evenly distributed with respect to age (20 to 80 years) and sex (32 women/30 men), were prospectively enrolled in the study. Participants were all deemed healthy by medical history, echocardiography, exercise test, spirometry, blood tests, and electrocardiogram. Participants had hemodynamic parameters measured using right heart catheterization during rest, passive leg raise, and incremental exercise. RESULTS During rest, all hemodynamic parameters were similar between age groups, apart from blood pressure. During leg raise and incremental exercise, there was augmented filling pressure (p < 0.0001) and diminished cardiac output (p = 0.001) and hence a higher pressure:flow ratio (pulmonary artery pressure/capillary wedge pressure to cardiac output) with progressive age, evident from the earliest ages. All indexed hemodynamic measures were similar between sexes. The diagnostic threshold (pulmonary capillary wedge pressure ≥25 mm Hg) currently used during exercise testing to diagnose abnormal left ventricular filling pressure was measured in 30% of our healthy elderly participants. CONCLUSIONS Cardiac aging was progressive without sex differences in healthy participants. The hemodynamic reference values obtained suggest that the diagnostic threshold for abnormal filling pressure should be individually determined according to age of the patient.
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Affiliation(s)
- Emil Wolsk
- Department of Cardiology, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark.
| | - Rine Bakkestrøm
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Jacob H Thomsen
- Department of Cardiology, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark
| | - Louise Balling
- Department of Cardiology, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark
| | - Mads J Andersen
- Department of Cardiology, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark
| | - Jordi S Dahl
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Christian Hassager
- Department of Cardiology, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark
| | - Jakob E Møller
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Finn Gustafsson
- Department of Cardiology, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark
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28217
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Shahid F, Shantsila E, Lip GYH. Recent advances in the understanding and management of atrial fibrillation: a focus on stroke prevention. F1000Res 2016; 5:2887. [PMID: 28105320 PMCID: PMC5224684 DOI: 10.12688/f1000research.10176.1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/19/2016] [Indexed: 12/29/2022] Open
Abstract
Atrial fibrillation (AF) is associated with an increased risk of stroke compared with the general population. It is anticipated that by 2030 an estimated 14-17 million patients will be diagnosed with this most prevalent arrhythmia within the European Union. AF-related stroke confers a higher mortality and morbidity risk, and thus early detection and assessment for the initiation of effective stroke prevention with oral anticoagulation (OAC) is crucial. Recent guidelines point to the use of non-vitamin K antagonist OACs (NOACs) where appropriate in stroke prevention of patients with non-valvular AF. At present, there are four NOACS available, with no direct head-to-head comparisons to suggest the superiority of one drug over another. Simple and practical risk assessment tools have evolved over the years to facilitate stroke and bleeding risk assessment in busy clinics and wards to aid decision-making. At present, the CHA 2DS 2VASc (congestive heart failure, hypertension, age 65-74/>75, diabetes mellitus, stroke/transient ischemic attack/thromboembolism, vascular disease, female sex) score is recommended by many international guidelines as a simple and practical method of assessing stroke risk in such patients. Alongside this, use of the HAS BLED (hypertension systolic blood pressure >160 mmHg, abnormal liver/renal function [with creatinine ≥200 μmol/L], stroke, bleeding history or predisposition, labile international normalized ratio [range <60% of the time], elderly [>65], concomitant drugs/alcohol) score aims to identify patients at high risk of bleeding for more regular review and follow-up and draws attention to potentially reversible bleeding risk factors. The aim of this review article is to provide an overview of recent advances in the understanding and management of AF with a focus on stroke prevention.
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Affiliation(s)
- Farhan Shahid
- University of Birmingham Institute of Cardiovascular Sciences, Birmingham, UK
| | - Eduard Shantsila
- University of Birmingham Institute of Cardiovascular Sciences, Birmingham, UK
| | - Gregory Y H Lip
- University of Birmingham Institute of Cardiovascular Sciences, Birmingham, UK; Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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28218
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Cowie MR. Sleep apnea: State of the art. Trends Cardiovasc Med 2016; 27:280-289. [PMID: 28143688 DOI: 10.1016/j.tcm.2016.12.005] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Revised: 12/17/2016] [Accepted: 12/18/2016] [Indexed: 01/26/2023]
Abstract
Many patient with, or at risk of, cardiovascular disease have sleep disordered breathing (SDB), which can be either obstructive (with intermittent collapse of the upper airway) or central (episodic loss of respiratory drive). SDB is associated with sleep disturbance, hypoxemia, hemodynamic changes, and sympathetic activation. Such patients have a worse prognosis than those without SDB. Mask-based therapies of positive airway pressure targeted at SDB can improve measures of sleep quality and partially normalize the sleep and respiratory physiology, but recent randomized trials of cardiovascular outcomes in SDB have either been neutral (obstructive sleep apnea) or suggested the possibility of harm, likely from increased sudden death, in central sleep apnea. Alternative methods for the treatment of SDB are being explored, including implantable technologies, but these have not been studied in adequately powered randomized controlled studies. International guidelines recommend screening for SDB, which can be done easily in clinical practice, as there may be a role for the treatment of patients with obstructive sleep apnea and daytime sleepiness, or resistant hypertension, or atrial fibrillation. Further randomised outcome studies are required to determine whether mask-based treatment for SDB is appropriate for patients with chronic systolic heart failure and obstructive sleep apnea; for those with heart failure with preserved ejection fraction; and for those with decompensated heart failure. The case is made that no longer can the surrogate endpoints of improvement in respiratory and sleep metrics be taken as adequate therapeutic outcome measures in patients with sleep apnea and cardiovascular disease.
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Affiliation(s)
- Martin R Cowie
- Imperial College London, Royal Brompton Hospital, United Kingdom.
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28219
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Georgiopoulos G, Tsiachris D, Manolis AS. Cryoballoon ablation of atrial fibrillation: a practical and effective approach. Clin Cardiol 2016; 40:333-342. [PMID: 27991673 DOI: 10.1002/clc.22653] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Revised: 11/02/2016] [Accepted: 11/05/2016] [Indexed: 12/17/2022] Open
Abstract
Medical management of atrial fibrillation (AF), the most common arrhythmia in the general population, has had modest efficacy in controlling symptoms and restoring and maintaining sinus rhythm. Since the seminal observation in 1998 that pulmonary veins host the triggers of AF in the majority of cases, electrical isolation of all pulmonary veins constitutes the cornerstone of ablation in patients with symptomatic AF. However, due to the elaborate and tedious technique of the conventional point-by-point method with radiofrequency ablation guided by electroanatomical mapping, newer, more versatile single-shot techniques, such as cryoballoon ablation, have been sought and developed over recent years and are progressively prevailing. Cryoballoon ablation appears to be the most promising practical and effective approach, and we review it here by presenting all available relevant data from the literature as well as from our own experience in an attempt to apprise colleagues of the significant progress made over the last several years in this important field of electrophysiology.
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Affiliation(s)
- George Georgiopoulos
- Third Department of Cardiology, Athens University School of Medicine, Athens, Greece
| | - Dimitris Tsiachris
- Third Department of Cardiology, Athens University School of Medicine, Athens, Greece
| | - Antonis S Manolis
- Third Department of Cardiology, Athens University School of Medicine, Athens, Greece
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28220
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Ferguson C, Hendriks J. Partnering with patients in shared decision-making for stroke prevention in atrial fibrillation. Eur J Cardiovasc Nurs 2016; 16:178-180. [DOI: 10.1177/1474515116685193] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Caleb Ferguson
- Graduate School of Health, University of Technology Sydney, Australia
| | - Jeroen Hendriks
- Centre for Heart Rhythm Disorders, University of Adelaide, Royal Adelaide Hospital, SAHMRI, Australia
- Department of Medical and Health Sciences, Linköping University, Sweden
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28221
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Song F, Bachmann MO. Cumulative subgroup analysis to reduce waste in clinical research for individualised medicine. BMC Med 2016; 14:197. [PMID: 27974045 PMCID: PMC5157082 DOI: 10.1186/s12916-016-0744-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Accepted: 11/09/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Although subgroup analyses in clinical trials may provide evidence for individualised medicine, their conduct and interpretation remain controversial. METHODS Subgroup effect can be defined as the difference in treatment effect across patient subgroups. Cumulative subgroup analysis refers to a series of repeated pooling of subgroup effects after adding data from each of related trials chronologically, to investigate the accumulating evidence for subgroup effects. We illustrated the clinical relevance of cumulative subgroup analysis in two case studies using data from published individual patient data (IPD) meta-analyses. Computer simulations were also conducted to examine the statistical properties of cumulative subgroup analysis. RESULTS In case study 1, an IPD meta-analysis of 10 randomised trials (RCTs) on beta blockers for heart failure reported significant interaction of treatment effects with baseline rhythm. Cumulative subgroup analysis could have detected the subgroup effect 15 years earlier, with five fewer trials and 71% less patients, than the IPD meta-analysis which first reported it. Case study 2 involved an IPD meta-analysis of 11 RCTs on treatments for pulmonary arterial hypertension that reported significant subgroup effect by aetiology. Cumulative subgroup analysis could have detected the subgroup effect 6 years earlier, with three fewer trials and 40% less patients than the IPD meta-analysis. Computer simulations have indicated that cumulative subgroup analysis increases the statistical power and is not associated with inflated false positives. CONCLUSIONS To reduce waste of research data, subgroup analyses in clinical trials should be more widely conducted and adequately reported so that cumulative subgroup analyses could be timely performed to inform clinical practice and further research.
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Affiliation(s)
- Fujian Song
- Norwich Medical School, Faculty of Medicine and Health Science, University of East Anglia, Research Park, Norwich, Norfolk NR4 7TJ UK
| | - Max O. Bachmann
- Norwich Medical School, Faculty of Medicine and Health Science, University of East Anglia, Research Park, Norwich, Norfolk NR4 7TJ UK
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28222
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Bokeriya LA, Aronov DM. Russian clinical guidelines Coronary artery bypass grafting in patients with ischemic heart disease: rehabilitation and secondary prevention. ACTA ACUST UNITED AC 2016. [DOI: 10.26442/cs45210] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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28223
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Wienbergen H, Pfister O, Hochadel M, Michel S, Bruder O, Remppis BA, Maeder MT, Strasser R, von Scheidt W, Pauschinger M, Senges J, Hambrecht R. Usefulness of Iron Deficiency Correction in Management of Patients With Heart Failure [from the Registry Analysis of Iron Deficiency-Heart Failure (RAID-HF) Registry]. Am J Cardiol 2016; 118:1875-1880. [PMID: 27756479 DOI: 10.1016/j.amjcard.2016.08.081] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Revised: 08/30/2016] [Accepted: 08/30/2016] [Indexed: 01/28/2023]
Abstract
Iron deficiency (ID) has been identified as an important co-morbidity in patients with heart failure (HF). Intravenous iron therapy reduced symptoms and rehospitalizations of iron-deficient patients with HF in randomized trials. The present multicenter study investigated the "real-world" management of iron status in patients with HF. Consecutive patients with HF and ejection fraction ≤40% were recruited and analyzed from December 2010 to October 2015 by 11 centers in Germany and Switzerland. Of 1,484 patients with HF, iron status was determined in only 923 patients (62.2%), despite participation of the centers in a registry focusing on ID and despite guideline recommendation to determine iron status. In patients with determined iron status, a prevalence of 54.7% (505 patients) for ID was observed. Iron therapy was performed in only 8.5% of the iron-deficient patients with HF; 2.6% were treated with intravenous iron therapy. The patients with iron therapy were characterized by a high rate of symptomatic HF and anemia. In conclusion, despite strong evidence of beneficial effects of iron therapy on symptoms and rehospitalizations, diagnostic and therapeutic efforts on ID in HF are low in the actual clinical practice, and the awareness to diagnose and treat ID in HF should be strongly enforced.
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28224
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Serum-Sphingosine-1-Phosphate Concentrations Are Inversely Associated with Atherosclerotic Diseases in Humans. PLoS One 2016; 11:e0168302. [PMID: 27973607 PMCID: PMC5156421 DOI: 10.1371/journal.pone.0168302] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Accepted: 11/30/2016] [Indexed: 11/19/2022] Open
Abstract
Background and Objectives Atherosclerotic changes of arteries are the leading cause for deaths in cardiovascular disease and greatly impair patient’s quality of life. Sphingosine-1-phosphate (S1P) is a signaling sphingolipid that regulates potentially pro-as well as anti-atherogenic processes. Here, we investigate whether serum-S1P concentrations are associated with peripheral artery disease (PAD) and carotid stenosis (CS). Methods and Results Serum was sampled from blood donors (controls, N = 174) and from atherosclerotic patients (N = 132) who presented to the hospital with either clinically relevant PAD (N = 102) or CS (N = 30). From all subjects, serum-S1P was measured by mass spectrometry and blood parameters were determined by routine laboratory assays. When compared to controls, atherosclerotic patients before invasive treatment to restore blood flow showed significantly lower serum-S1P levels. This difference cannot be explained by risk factors for atherosclerosis (old age, male gender, hypertension, hypercholesteremia, obesity, diabetes or smoking) or comorbidities (Chronic obstructive pulmonary disease, kidney insufficiency or arrhythmia). Receiver operating characteristic curves suggest that S1P has more power to indicate atherosclerosis (PAD and CS) than high density lipoprotein-cholesterol (HDL-C). In 35 patients, serum-S1P was measured again between one and six months after treatment. In this group, serum-S1P concentrations rose after treatment independent of whether patients had PAD or CS, or whether they underwent open or endovascular surgery. Post-treatment S1P levels were highly associated to platelet numbers measured pre-treatment. Conclusions Our study shows that PAD and CS in humans is associated with decreased serum-S1P concentrations and that S1P may possess higher accuracy to indicate these diseases than HDL-C.
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28225
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Wigger O, Bloechlinger S, Berger D, Häner J, Zanchin T, Windecker S, Räber L, Schefold JC. Baseline serum bicarbonate levels independently predict short-term mortality in critically ill patients with ischaemic cardiogenic shock. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2016; 7:45-52. [PMID: 28838261 DOI: 10.1177/2048872616683526] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Cardiogenic shock is a feared complication of acute myocardial infarction with high mortality rates. Data on the predictive role of acid base dysregulation in this clinical setting are sparse. We therefore embarked on investigating the predictive role of serum bicarbonate in critically ill intensive care unit (ICU) patients with cardiogenic shock. METHODS A total of 165 ischaemic cardiogenic shock patients (118 men, aged 68.4 years (interquartile range 59.0-77.4), APACHE II score 26.0 (interquartile range 21.0-29.0), after percutaneous coronary intervention were included in a single-centre analysis. Percutaneous coronary intervention-related data such as left ventricular ejection fraction and laboratory indices were recorded and routine clinical follow-up was obtained at hospital discharge and at one year. All-cause mortality was assessed and data were analysed using univariate and multivariate models. RESULTS All-cause mortality was highest (17%) during the first 48 hours following ICU admission (28-day mortality rate 43%). In a multiple regression model, age (hazard ratio (HR) 1.035, 95% confidence interval (CI) 1.011-1.059, P=0.004), APACHE II score (HR 1.036, 95% CI 1.002-1.072, P=0.037) and baseline serum bicarbonate levels (HR 0.93, 95% CI 0.866-0.998, P=0.046) independently predicted 28-day mortality (overall model fit χ2 22.9, P<0.0001). The HR for patients in the lowest baseline serum bicarbonate tertile for 365-day mortality was HR 2.06 (95% CI 1.20-3.53). CONCLUSIONS In a large cohort of consecutive cardiogenic shock patients hospitalised in the ICU, low serum bicarbonate levels at admission independently predicted mortality. Given the widespread availability of blood gas analysers in ICUs, we propose baseline serum bicarbonate levels as an additional biomarker for identification and stratification of cardiogenic shock patients at risk.
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Affiliation(s)
- Olivier Wigger
- 1 Department of Cardiology, Bern University Hospital, Switzerland
| | - Stefan Bloechlinger
- 1 Department of Cardiology, Bern University Hospital, Switzerland
- 2 Department of Intensive Care Medicine, Bern University Hospital, Switzerland
| | - David Berger
- 3 Department of Intensive Care Medicine, Bern University Hospital, Switzerland
| | - Jonas Häner
- 1 Department of Cardiology, Bern University Hospital, Switzerland
| | - Thomas Zanchin
- 1 Department of Cardiology, Bern University Hospital, Switzerland
| | | | - Lorenz Räber
- 1 Department of Cardiology, Bern University Hospital, Switzerland
| | - Joerg C Schefold
- 3 Department of Intensive Care Medicine, Bern University Hospital, Switzerland
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28226
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Deguchi I, Tanahashi N, Takao M. Timing of Treatment Initiation With Oral Anticoagulants for Acute Ischemic Stroke in Patients With Nonvalvular Atrial Fibrillation. Circ J 2016; 81:180-184. [PMID: 27980235 DOI: 10.1253/circj.cj-16-0923] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Only a few studies have addressed the optimal start time for oral anticoagulants (OACs) after acute ischemic stroke in patients with nonvalvular atrial fibrillation (NVAF). The aim of this retrospective study was to analyze the time of OAC administration after stroke onset.Methods and Results:This study included 300 patients with NVAF who had acute ischemic stroke and were treated with OACs between April 2012 and March 2016. We investigated the time at which OACs were started by anticoagulant type and the relationship between the time of OAC administration and stroke severity (the National Institutes of Health Stroke Scale [NIHSS] score on admission). Of the 300 patients, 114 and 186 patients received warfarin and direct-acting OACs (DOACs), respectively. Patients in the DOAC group had OAC initiated therapy significantly sooner (3 days) than in the warfarin group (7 days; P<0.001). With regard to stroke severity (NIHSS score <8, mild; 8-16, moderate; >16, severe), the median time for starting therapy was 2, 7, and 11 days for mild, moderate, and severe stroke, respectively. Hemorrhagic events occurred in 3 patients in the warfarin group; however, no hemorrhagic events occurred in the DOAC group. CONCLUSIONS Our study revealed that neurologists began OACs earlier in patients with mild acute cerebral infarction. Even in patients with severe stroke, OACs were started earlier than expected.
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Affiliation(s)
- Ichiro Deguchi
- Department of Neurology, Saitama Medical University International Medical Center
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28227
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Effects of Active Components of Fuzi and Gancao Compatibility on Bax, Bcl-2, and Caspase-3 in Chronic Heart Failure Rats. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2016; 2016:7686045. [PMID: 28053643 PMCID: PMC5178377 DOI: 10.1155/2016/7686045] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Revised: 10/02/2016] [Accepted: 10/09/2016] [Indexed: 12/29/2022]
Abstract
Hypaconitine (HA) and glycyrrhetinic acid (GA) are active components of Fuzi (Aconitum carmichaelii) and Gancao (Glycyrrhiza uralensis Fisch); they have been used in compatibility for chronic heart failure (CHF) from ancient times. The purpose of the present research was to explore whether apoptosis pathways were related with the protective effects of HA + GA against CHF rats or not. The rats were progressed with transverse-aortic constriction (TAC) operation for 4 weeks to build the CHF state, and then the Digoxin (1 mg/kg), HA (2.07 mg/kg), GA (25 mg/kg), and HA (2.07 mg/kg) + GA (25 mg/kg) were orally administrated to rats for 1 week. The levels of BNP and cTnI in the plasma were decreased in the HA + GA group, and the heart/body weight ratio (H/B) and left ventricular (LV) parameters of transthoracic echocardiography were also declined; moreover, the expressions of Bax, Bcl-2, and caspase-3 were all improved in the HA + GA group than other groups in the immunohistochemistry and western blot methods. In general, the data suggested that Fuzi and Gancao compatibility could protect the CHF rats from apoptosis, which provided a strong evidence for further searching for mechanisms of them.
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28228
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Lüscher TF. Catheter-based and surgical interventions in cardiac and aortic conditions. Eur Heart J 2016; 37:3421-3424. [PMID: 28039217 DOI: 10.1093/eurheartj/ehw624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Thomas F Lüscher
- Editor-in-Chief, Zurich Heart House, Careum Campus, Moussonstrasse 4, 8091 Zurich, Switzerland
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28229
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28230
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Arrigo M, Parissis JT, Akiyama E, Mebazaa A. Understanding acute heart failure: pathophysiology and diagnosis. Eur Heart J Suppl 2016. [DOI: 10.1093/eurheartj/suw044] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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28231
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Riley JP, Masters J. Practical multidisciplinary approaches to heart failure management for improved patient outcome. Eur Heart J Suppl 2016. [DOI: 10.1093/eurheartj/suw046] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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28232
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Hamo CE, Butler J, Gheorghiade M, Chioncel O. The bumpy road to drug development for acute heart failure. Eur Heart J Suppl 2016. [DOI: 10.1093/eurheartj/suw045] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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28233
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André F, Robbers-Visser D, Helling-Bakki A, Föll A, Voss A, Katus HA, Helbing WA, Buss SJ, Eichhorn JG. Quantification of myocardial deformation in children by cardiovascular magnetic resonance feature tracking: determination of reference values for left ventricular strain and strain rate. J Cardiovasc Magn Reson 2016; 19:8. [PMID: 28103933 PMCID: PMC5248452 DOI: 10.1186/s12968-016-0310-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Accepted: 11/30/2016] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND The objective assessment of global and regional cardiac function in children has shown to be clinically relevant but is challenging to conduct. Cardiovascular magnetic resonance (CMR) has emerged as a valuable diagnostic modality especially in patients with cardiomyopathy or congenital heart disease. However, data on the normal cardiac deformation in children assessed by CMR is lacking at present. Thus, the aim of this study was to provide reference values for cardiac strain and strain rate in children and adolescents derived from CMR feature tracking (FT) measurements. METHODS In this binational study, eighty children and adolescents (age 0.4-18.0 years, 41 male, 39 female) free from cardiac diseases from two centers underwent CMR in 1.5 T whole-body scanners in supine position. Global peak radial, circumferential and longitudinal systolic strains as well as the corresponding early peak diastolic strain rates were assessed applying FT on short axis as well as 3- and 4-chamber views of standard cine steady-state free precession images. RESULTS The difference between genders yielded no significance for all assessed strains. Yet, all strains showed a significant parabolic relation to age and an even stronger one to body surface area (BSA). Therefore, BSA-specific reference values were determined using a polynomial regression model. The apical cardiac segments featured significant higher peak circumferential but lower peak radial systolic strains than the midventricular and basal segments (all p < 0.001). CONCLUSIONS The assessment of cardiac deformation by CMR-FT is feasible in children. This is the first CMR study providing specific reference values for FT-derived strain and strain rate in the pediatric age range.
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Affiliation(s)
- Florian André
- Department of Cardiology, Angiology and Pneumology, University of Heidelberg, Heidelberg, Germany
| | - Daniëlle Robbers-Visser
- Department of Pediatrics, Division of Pediatric Cardiology and Department of Radiology, Erasmus MC-Sophia Children’s Hospital, Rotterdam, The Netherlands
| | | | - Angela Föll
- Department of General Pediatrics, University of Heidelberg, Heidelberg, Germany
| | - Andreas Voss
- Institute of Psychology, University of Heidelberg, Heidelberg, Germany
| | - Hugo A. Katus
- Department of Cardiology, Angiology and Pneumology, University of Heidelberg, Heidelberg, Germany
| | - Willem A. Helbing
- Department of Pediatrics, Division of Pediatric Cardiology and Department of Radiology, Erasmus MC-Sophia Children’s Hospital, Rotterdam, The Netherlands
| | - Sebastian J. Buss
- Department of Cardiology, Angiology and Pneumology, University of Heidelberg, Heidelberg, Germany
| | - Joachim G. Eichhorn
- Klinikum Leverkusen, Children’s Hospital, Am Gesundheitspark 11, 51375 Leverkusen, Germany
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28234
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Perlini S, Mussinelli R, Salinaro F. New and Evolving Concepts Regarding the Prognosis and Treatment of Cardiac Amyloidosis. Curr Heart Fail Rep 2016; 13:267-272. [PMID: 27900617 DOI: 10.1007/s11897-016-0311-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Systemic amyloidoses are rare and proteiform diseases, caused by extracellular accumulation of insoluble misfolded fibrillar proteins. Prognosis is dictated by cardiac involvement, which is especially frequent in light chain (AL) and in transthyretin variants (ATTR, both mutated, (ATTRm), and wild-type, (ATTRwt)). Recently, ATTRwt has emerged as a potentially relevant cause of a heart failure with preserved ejection fraction (HFpEF). Cardiac amyloidosis is an archetypal example of restrictive cardiomyopathy, with signs and symptoms of global heart failure and diastolic dysfunction. Independent of the aetiology, cardiac amyloidosis is associated with left ventricular concentric "hypertrophy" (i.e. increased wall thickness), preserved (or mildly depressed) ejection fraction, reduced midwall fractional shortening and global longitudinal function, as well as evident diastolic dysfunction, up to an overly restrictive pattern of the left ventricular filling. Cardiac biomarkers such as troponins and natriuretic peptides are very robust and widely accepted diagnostic as well as prognostic tools. Owing to its dismal prognosis, accurate and early diagnosis is mandatory and potentially life-saving. Although pathogenesis is still not completely understood, direct cardiomyocyte toxicity of the amyloidogenic precursor proteins and/or oligomer aggregates adds on tissue architecture disruption caused by amyloid deposition. The clarification of mechanisms of cardiac damage is offering new potential therapeutic targets, and several treatment options with a relevant impact on prognosis are now available.
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Affiliation(s)
- Stefano Perlini
- Clinica Medica II, Department of Internal Medicine, University of Pavia, P. le Golgi 19, 27100, Pavia, Italy.
- Amyloidosis Research and Treatment Center, Fondazione Policlinico IRCCS San Matteo, University of Pavia, P. le Golgi 19, 27100, Pavia, Italy.
| | - Roberta Mussinelli
- Clinica Medica II, Department of Internal Medicine, University of Pavia, P. le Golgi 19, 27100, Pavia, Italy
| | - Francesco Salinaro
- Clinica Medica II, Department of Internal Medicine, University of Pavia, P. le Golgi 19, 27100, Pavia, Italy
- Experimental Medicine PhD Program, University of Pavia, Pavia, Italy
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28235
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Gasparini M, Galimberti P, Bragato R, Ghio S, Raineri C, Landolina M, Chieffo E, Lunati M, Mulargia E, Proclemer A, Facchin D, Rordorf R, Vicentini A, Marcantoni L, Zanon F, Klersy C. Multipoint Pacing versus conventional ICD in Patients with a Narrow QRS complex (MPP Narrow QRS trial): study protocol for a pilot randomized controlled trial. Trials 2016; 17:572. [PMID: 27927248 PMCID: PMC5143452 DOI: 10.1186/s13063-016-1698-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Accepted: 11/11/2016] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Despite an intensive search for predictors of the response to cardiac resynchronization therapy (CRT), the QRS duration remains the simplest and most robust predictor of a positive response. QRS duration of ≥ 130 ms is considered to be a prerequisite for CRT; however, some studies have shown that CRT may also be effective in heart failure (HF) patients with a narrow QRS (<130 ms). Since CRT can now be performed by pacing the left ventricle from multiple vectors via a single quadripolar lead, it is possible that multipoint pacing (MPP) might be effective in HF patients with a narrow QRS. This article reports the design of the MPP Narrow QRS trial, a prospective, randomized, multicenter, controlled feasibility study to investigate the efficacy of MPP using two LV pacing vectors in patients with a narrow QRS complex (100-130 ms). METHODS Fifty patients with a standard ICD indication will be enrolled and randomized (1:1) to either an MPP group or a Standard ICD group. All patients will undergo a low-dose dobutamine stress echo test and only those with contractile reserve will be included in the study and randomized. The primary endpoint will be the percentage of patients in each group that have reverse remodeling at 12 months, defined as a reduction in left ventricular end-systolic volume (LVESV) of >15% from the baseline. DISCUSSION This feasibility study will determine whether MPP improves reverse remodeling, as compared with standard ICD, in HF patients who have a narrow QRS complex (100-130 ms). TRIAL REGISTRATION ClinicalTrials.gov, NCT02402816 . Registered on 25 March 2015.
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Affiliation(s)
| | | | - Renato Bragato
- Humanitas Research Hospital, Via Manzoni 56, Rozzano, Italy
| | - Stefano Ghio
- Fondazione IRCCS Policlinico S. Matteo, Pavia, Italy
| | | | | | | | | | | | | | | | | | | | | | | | - Catherine Klersy
- Servizio di Biometria e Statistica, Fondazione IRCCS Policlinico S. Matteo, Pavia, Italy
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28236
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Salukhov VV, Demidova TY. Empagliflozin as a new management strategy on outcomes in patients with type 2 diabetes mellitus. DIABETES MELLITUS 2016. [DOI: 10.14341/dm8216] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Patients with type 2 diabetes mellitus have an increased risk of cardiovascular (CV) complications. Although hyperglycaemia contributes to the pathogenesis of atherosclerosis and heart failure in these patients, glucose-lowering strategies did not have a significant effect on reducing CV risk, particularly in patients with a long duration of type 2 diabetes mellitus and prevalent CV disease (CVD). Sodium-glucose linked transporter-2 (SGLT2) inhibitors are a new class of anti-hyperglycaemic medications that increase glycaemic control via insulin-dependent mechanism of action associated with increased urinary glucose excretion.In this review, we present an analysis of the Empa-Reg Outcomes investigation, focussed on assessing the CV safety of empagliflozin, an inhibitor of SGLT2. We discuss the impressive results of trials that provide evidence on the cardiac and renal properties of empagliflozin. We present and analyse the current hypothesis on the mechanism of action of glucose-lowering medication, which has such a severe and complex impact on outcomes in patients with type 2 diabetes at high CV risk.
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28237
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Dörr R, Maisch B. [Seeking Ariadne's thread in the labyrinth of guidelines]. Herz 2016; 41:653-654. [PMID: 27844138 DOI: 10.1007/s00059-016-4504-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- R Dörr
- Praxisklinik Herz und Gefäße, Heinrich-Cotta-Str. 12, 01324, Dresden, Deutschland.
| | - B Maisch
- Philipps Universität Marburg und Herz- und Gefäßzentrum Marburg, Marburg, Deutschland
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28238
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Santos IS, Goulart AC, Pereira AC, Lotufo PA, Benseñor IM. Association between Cardiovascular Health Score and Carotid Intima-Media Thickness: Cross-Sectional Analysis of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) Baseline Assessment. J Am Soc Echocardiogr 2016; 29:1207-1216.e4. [DOI: 10.1016/j.echo.2016.09.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Indexed: 12/22/2022]
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28239
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Martínez-Rubio A, Dan GA. Cardiovascular Pharmacotherapies Focus: Are low doses of direct-acting oral anticoagulants justified and appropriate in patients with nonvalvular atrial fibrillation? Eur Cardiol 2016; 11:115-117. [PMID: 30310458 PMCID: PMC6159536 DOI: 10.15420/ecr.2016.11.2.ed2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Antoni Martínez-Rubio
- President Elect of the International Society of Cardiovascular Pharmacotherapy, based at the Department of Cardiology, University Hospital of Sabadell and the Autonomous University of Barcelona, Barcelona, Spain
- Past President of the International Society of Cardiovascular Pharmacotherapy, based at the Department of Cardiology, Colentina University Hospital, Faculty of Medicine, University of Bucharest, Bucharest, Romania
| | - Gheorghe-Andrei Dan
- President Elect of the International Society of Cardiovascular Pharmacotherapy, based at the Department of Cardiology, University Hospital of Sabadell and the Autonomous University of Barcelona, Barcelona, Spain
- Past President of the International Society of Cardiovascular Pharmacotherapy, based at the Department of Cardiology, Colentina University Hospital, Faculty of Medicine, University of Bucharest, Bucharest, Romania
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28240
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Piamjariyakul U, Smith CE, Werkowitch M, Thompson N, Fox M, Williamson KP, Olson L. Designing and Testing an End-of-Life Discussion Intervention for African American Patients With Heart Failure and Their Families. J Hosp Palliat Nurs 2016; 18:528-535. [PMID: 29081717 PMCID: PMC5656294 DOI: 10.1097/njh.0000000000000290] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
There is an escalating prevalence of heart failure (HF) with high mortality. Compared with other races, African Americans face a higher incidence of HF at earlier age of onset, with more rapid progression, and with increased family care burden and greater care costs and disparity in health care services at the end of life (EOL). Concomitant out-of-pocket HF costs and care demands indicate the need for early discussion of palliative and EOL care needs. We therefore developed and pilot tested a culturally sensitive intervention specific to the needs of African American HF patients and their families at the EOL. Our pilot study findings encompass patient and caregiver perspectives and align with the state of EOL science. The ultimate long-term goal of this intervention strategy is to translate into practice the preferred, culturally sensitive, and most cost-efficient EOL care recommendations for HF patients and families.
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Affiliation(s)
- Ubolrat Piamjariyakul
- Research associate professor, School of Nursing, University of Kansas Medical Center
| | - Carol E Smith
- Professor, School of Nursing and PreventiveMedicine & Public Health, University of KansasMedical Center
| | - Marilyn Werkowitch
- Research assistant, School of Nursing, University of Kansas Medical Center
| | - Noreen Thompson
- Psychiatric nurse specialist, Department of Nursing Clinical Excellence, University of Kansas Medical Center
| | - Maria Fox
- Director, Advanced Practice Professionals, University of Kansas Health System
| | - Karin Porter Williamson
- Associate professor and senior scientist, Palliative Medicine, University of Kansas Medical Center
| | - Lori Olson
- Assistant professor and senior scientist, Internal Medicine, University of Kansas Medical Center
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28241
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Cardiac rehabilitation in Portugal: The situation in 2013-2014. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2016. [DOI: 10.1016/j.repce.2016.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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28242
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Wijesurendra RS, Rider OJ. Atrial remodeling in obesity and hypertension-What can we learn from the ECG? Obesity (Silver Spring) 2016; 24:2448. [PMID: 27813267 DOI: 10.1002/oby.21689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Accepted: 09/14/2016] [Indexed: 11/12/2022]
Affiliation(s)
- Rohan S Wijesurendra
- Radcliffe Department of Medicine, Division of Cardiovascular Medicine, OCMR, John Radcliffe Hospital, Oxford, UK
| | - Oliver J Rider
- Radcliffe Department of Medicine, Division of Cardiovascular Medicine, OCMR, John Radcliffe Hospital, Oxford, UK
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28243
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Galectin-3 Reflects Mitral Annular Plane Systolic Excursion Being Assessed by Cardiovascular Magnetic Resonance Imaging. DISEASE MARKERS 2016; 2016:7402784. [PMID: 28044067 PMCID: PMC5156816 DOI: 10.1155/2016/7402784] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/03/2016] [Accepted: 11/02/2016] [Indexed: 01/13/2023]
Abstract
Background. This study investigates whether serum levels of galectin-3 may reflect impaired mitral annular plane systolic excursion (MAPSE) in patients undergoing cardiac magnetic resonance imaging (cMRI). Methods. Patients undergoing cMRI during routine clinical care were included prospectively within an all-comers design. Blood samples for biomarker measurements were collected within 24 hours following cMRI. Statistical analyses were performed in all patients and in three subgroups according to MAPSE (MAPSE I: ≥11 mm, MAPSE II: ≥8 mm–<11 mm, and MAPSE III: <8 mm). Patients with right ventricular dysfunction (<50%) were excluded. Results. 84 patients were included in the study. Median LVEF was 59% (IQR 51–64%). Galectin-3 correlated significantly with NT-proBNP (r = 0.42, p = 0.0001). Galectin-3 increased significantly according to the different stages of impaired MAPSE (p = 0.006) and was able to discriminate both patients with impaired MAPSE <11 mm (area under the curve (AUC) = 0.645, p = 0.024) and <8 mm (AUC = 0.733, p = 0.003). Combining galectin-3 with NT-proBNP improved discrimination of MAPSE <8 mm (AUC 0.803, p = 0.0001). In multivariable logistic regression models galectin-3 was still associated with impaired MAPSE (MAPSE < 11 mm: odds ratio (OR) = 3.53, p = 0.018; MAPSE < 8 mm: OR = 3.18, p = 0.06). Conclusions. Galectin-3 reflects MAPSE being assessed by cardiac MRI.
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28244
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Herrmann E, Fichtlscherer S, Hohnloser SH, Zeiher AM, Aßmus B. [Implantable sensors for outpatient assessment of ventricular filling pressure in advanced heart failure : Which telemonitoring design is optimal?]. Herzschrittmacherther Elektrophysiol 2016; 27:371-377. [PMID: 27844194 DOI: 10.1007/s00399-016-0472-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Accepted: 09/27/2016] [Indexed: 06/06/2023]
Abstract
INTRODUCTION Patients with advanced heart failure suffer from frequent hospitalizations. Non-invasive hemodynamic telemonitoring for assessment of ventricular filling pressure has been shown to reduce hospitalizations. We report on the right ventricular (RVP), the pulmonary artery (PAP) and the left atrial pressure (LAP) sensor for non-invasive assessment of the ventricular filling pressure. METHODS A literature search concerning the available implantable pressure sensors for noninvasive haemodynamic telemonitoring in patients with advanced heart failure was performed. RESULTS Until now, only implantation of the PAP-sensor was able to reduce hospitalizations for cardiac decompensation and to improve quality of life. The right ventricular pressure sensor missed the primary endpoint of a significant reduction of hospitalizations, clinical data using the left atrial pressure sensor are still pending. CONCLUSION The implantation of a pressure sensor for assessment of pulmonary artery filling pressure is suitable for reducing hospitalizations for heart failure and for improving quality of life in patients with advanced heart failure.
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Affiliation(s)
- E Herrmann
- Universitätsklinikum Frankfurt, Med. Klinik III, Kardiologie, Theodor-Stern-Kai 7, 60590, Frankfurt/Main, Deutschland.
| | - S Fichtlscherer
- Universitätsklinikum Frankfurt, Med. Klinik III, Kardiologie, Theodor-Stern-Kai 7, 60590, Frankfurt/Main, Deutschland
| | - S H Hohnloser
- Universitätsklinikum Frankfurt, Med. Klinik III, Kardiologie, Theodor-Stern-Kai 7, 60590, Frankfurt/Main, Deutschland
| | - A M Zeiher
- Universitätsklinikum Frankfurt, Med. Klinik III, Kardiologie, Theodor-Stern-Kai 7, 60590, Frankfurt/Main, Deutschland
| | - B Aßmus
- Universitätsklinikum Frankfurt, Med. Klinik III, Kardiologie, Theodor-Stern-Kai 7, 60590, Frankfurt/Main, Deutschland
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28245
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Pimienta González R, Couto Comba P, Rodríguez Esteban M, Alemán Sánchez JJ, Hernández Afonso J, Rodríguez Pérez MDC, Marcelino Rodríguez I, Brito Díaz B, Elosua R, Cabrera de León A. Incidence, Mortality and Positive Predictive Value of Type 1 Cardiorenal Syndrome in Acute Coronary Syndrome. PLoS One 2016; 11:e0167166. [PMID: 27907067 PMCID: PMC5132196 DOI: 10.1371/journal.pone.0167166] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Accepted: 11/09/2016] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVES To determine whether the risk of cardiovascular mortality associated with cardiorenal syndrome subtype 1 (CRS1) in patients who were hospitalized for acute coronary syndrome (ACS) was greater than the expected risk based on the sum of its components, to estimate the predictive value of CRS1, and to determine whether the severity of CRS1 worsens the prognosis. METHODS Follow-up study of 1912 incident cases of ACS for 1 year after discharge. Cox regression models were estimated with time to event (in-hospital death, and readmission or death during the first year after discharge) as the dependent variable. RESULTS The incidence of CRS1 was 9.2/1000 person-days of hospitalization (95% CI = 8.1-10.5), but these patients accounted for 56.6% (95% CI = 47.4-65.) of all mortality. The positive predictive value of CRS1 was 29.6% (95% CI = 23.9-36.0) for in-hospital death, and 51.4% (95% CI = 44.8-58.0) for readmission or death after discharge. The risk of in-hospital death from CRS1 (RR = 18.3; 95% CI = 6.3-53.2) was greater than the sum of risks associated with either acute heart failure (RR = 7.6; 95% CI = 1.8-31.8) or acute kidney injury (RR = 2.8; 95% CI = 0.9-8.8). The risk of events associated with CRS1 also increased with syndrome severity, reaching a RR of 10.6 (95% CI = 6.2-18.1) for in-hospital death at the highest severity level. CONCLUSIONS The effect of CRS1 on in-hospital mortality is greater than the sum of the effects associated with each of its components, and it increases with the severity of the syndrome. CRS1 accounted for more than half of all mortality, and its positive predictive value approached 30% in-hospital and 50% after discharge.
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Affiliation(s)
- Raquel Pimienta González
- Servicio de Cardiología. Hospital Universitario Nuestra Señora de la Candelaria, Santa Cruz de Tenerife, Spain
| | - Patricia Couto Comba
- Servicio de Cardiología. Hospital Universitario Nuestra Señora de la Candelaria, Santa Cruz de Tenerife, Spain
| | - Marcos Rodríguez Esteban
- Servicio de Cardiología. Hospital Universitario Nuestra Señora de la Candelaria, Santa Cruz de Tenerife, Spain
| | - José Juan Alemán Sánchez
- Unidad de Investigación de Atención Primaria y del Hospital Universitario Nuestra Señora de la Candelaria, Santa Cruz de Tenerife, Spain
- Red de Investigación Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain
| | - Julio Hernández Afonso
- Servicio de Cardiología. Hospital Universitario Nuestra Señora de la Candelaria, Santa Cruz de Tenerife, Spain
| | - María del Cristo Rodríguez Pérez
- Unidad de Investigación de Atención Primaria y del Hospital Universitario Nuestra Señora de la Candelaria, Santa Cruz de Tenerife, Spain
- Red de Investigación Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain
| | - Itahisa Marcelino Rodríguez
- Unidad de Investigación de Atención Primaria y del Hospital Universitario Nuestra Señora de la Candelaria, Santa Cruz de Tenerife, Spain
- Red de Investigación Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain
| | - Buenaventura Brito Díaz
- Unidad de Investigación de Atención Primaria y del Hospital Universitario Nuestra Señora de la Candelaria, Santa Cruz de Tenerife, Spain
- Red de Investigación Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain
| | - Roberto Elosua
- Red de Investigación Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain
- Epidemiología Cardiovascular y Genética, IMIM. Barcelona, Spain
| | - Antonio Cabrera de León
- Unidad de Investigación de Atención Primaria y del Hospital Universitario Nuestra Señora de la Candelaria, Santa Cruz de Tenerife, Spain
- Red de Investigación Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain
- Área de Medicina Preventiva y Salud Pública, Universidad de La Laguna, La Laguna, Spain
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28246
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Carotid artery stenting outcomes in high-risk patients receiving best medical therapy: results from a single high-volume interventional cardiology practice. COR ET VASA 2016. [DOI: 10.1016/j.crvasa.2015.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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28247
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28248
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Simioniuc A, Carluccio E, Ghio S, Rossi A, Biagioli P, Reboldi G, Galeotti GG, Lu F, Zara C, Whalley G, Temporelli PL, Dini FL. Echo and natriuretic peptide guided therapy improves outcome and reduces worsening renal function in systolic heart failure: An observational study of 1137 outpatients. Int J Cardiol 2016; 224:416-423. [DOI: 10.1016/j.ijcard.2016.09.034] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Revised: 08/29/2016] [Accepted: 09/15/2016] [Indexed: 11/25/2022]
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28249
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Exercise training effects on elderly and middle-age patients with chronic heart failure after acute decompensation: A randomized, controlled trial. Int J Cardiol 2016; 225:313-323. [PMID: 27750131 DOI: 10.1016/j.ijcard.2016.10.026] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Revised: 10/06/2016] [Accepted: 10/09/2016] [Indexed: 12/21/2022]
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Gigli L, Ameri P, Secco G, De Blasi G, Miceli R, Lorenzoni A, Torre F, Chiarella F, Brunelli C, Canepa M. Clinical characteristics and prognostic impact of atrial fibrillation in patients with chronic heart failure. World J Cardiol 2016; 8:647-656. [PMID: 27957251 PMCID: PMC5124723 DOI: 10.4330/wjc.v8.i11.647] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Revised: 08/25/2016] [Accepted: 09/08/2016] [Indexed: 02/06/2023] Open
Abstract
AIM To assess the prevalence, clinical characteristics and independent prognostic impact of atrial fibrillation (AF) in chronic heart failure (CHF) patients, and the potential protective effect of disease-modifying medications, particularly beta-blockers (BB).
METHODS We retrospectively reviewed the charts of patients referred to our center since January 2004, and collected all clinical information available at their first visit. We assessed mortality to the end of June 2015. We compared patients with and without AF, and assessed the association between AF and all-cause mortality by multivariate Cox regression and Kaplan-Meyer analysis, particularly accounting for ongoing treatment with BB.
RESULTS A total of 903 patients were evaluated (mean age 68 ± 12 years, 73% male). Prevalence of AF was 19%, ranging from 10% to 28% in patients ≤ 60 and ≥ 77 years, respectively. Besides the older age, patients with AF had more symptoms (New York Heart Association II-III 60% vs 44%), lower prevalence of dyslipidemia (23% vs 37%), coronary artery disease (28% vs 52%) and left bundle branch block (9% vs 16%). On the contrary, they more frequently presented with an idiopathic etiology (50% vs 24%), a history of valve surgery (13% vs 4%) and received overall more devices implantation (31% vs 21%). The use of disease-modifying medications (i.e., BB and ACE inhibitors/angiotensin receptor blockers) was lower in patients with AF (72% vs 80% and 71% vs 79%, respectively), who on the contrary were more frequently treated with symptomatic and antiarrhythmic drugs including diuretics (87% vs 69%) and digoxin (51% vs 11%). At a mean follow-up of about 5 years, all-cause mortality was significantly higher in patients with AF as compared to those in sinus rhythm (SR) (45% vs 34%, P value < 0.05 for all previous comparisons). However, in a multivariate analysis including the main significant predictors of all-cause mortality, the univariate relationship between AF and death (HR = 1.49, 95%CI: 1.15-1.92) became not statistically significant (HR = 0.98, 95%CI: 0.73-1.32). Nonetheless, patients with AF not receiving BB treatment were found to have the worst prognosis, followed by patients with SR not receiving BB therapy and patients with AF receiving BB therapy, who both had similarly worse survival when compared to patients with SR receiving BB therapy.
CONCLUSION AF was highly prevalent and associated with older age, worse clinical presentation and underutilization of disease-modifying medications such as BB in a population of elderly patients with CHF. AF had no independent impact on mortality, but the underutilization of BB in this group of patients was associated to a worse long-term prognosis.
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