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The effectiveness of eHealth self-management interventions in patients with chronic heart failure: Protocol for a systematic review and meta-analysis. PLoS One 2022; 17:e0268446. [PMID: 36174002 PMCID: PMC9522291 DOI: 10.1371/journal.pone.0268446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 04/29/2022] [Indexed: 12/04/2022] Open
Abstract
Purpose The objective of this paper is to design a protocol for a systematic review and meta-analysis on the effectiveness of self-management interventions in patients with chronic heart failure. Methods The protocol is developed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The protocol has been registered in PROSPERO (CRD42021246973). Base on the population, intervention, comparator, and outcome (PICO) framework, our research questions are: 1) What are the effects of eHealth self-management interventions on patients with chronic heart failure? 2) What factors of interventions might affect outcomes? The process includes: 1) search strategy and inclusion criteria; 2) data extraction; 3) risk of bias assessment and 4) data analysis. Searching process and data extraction will be guided by Cochrane Handbook for Systematic Reviews of Interventions. We will use Cochrane Risk of Bias tool to assess the risk of bias. The data analysis will be performed using Metafor package in R. Conclusions This systemic review will synthesize the current evidence and identify gaps. Findings in the meta-analysis will provide guidance for designing a more effective self-management intervention for patients with chronic heart failure in future.
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302
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Fukuta H, Hagiwara H, Kamiya T. Hypoxia-inducible factor prolyl hydroxylase inhibitors for anemia in heart failure patients: A protocol for systematic review and meta-analysis. PLoS One 2022; 17:e0275311. [PMID: 36170343 PMCID: PMC9518850 DOI: 10.1371/journal.pone.0275311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 09/08/2022] [Indexed: 11/19/2022] Open
Abstract
Background
Anemia is common in heart failure (HF) patients with chronic kidney disease (CKD) and is associated with worse outcomes. Iron supplementation improves symptoms and is associated with reduced risk of hospitalization for HF in iron-deficiency HF patients. However, iron deficiency is present in <30% of anemic HF patients. Erythropoiesis stimulating agents (ESAs) improve symptoms but are associated with increased risk of thromboembolic events in anemic HF patients with CKD. Hypoxia-inducible factor prolyl hydroxylase (HIF-PH) inhibitors are a new class of agents for the treatment of anemia. These agents work by stabilizing the HIF complex, thereby stimulating endogenous erythropoietin production. We hypothesized that HIF-PH inhibitors may be associated with reduced risk of cardiovascular outcomes compared with ESAs in anemic HF patients with CKD. Accordingly, we aim to perform the meta-analysis of studies on the efficacy and safety of HIF-PH inhibitors compared with ESAs in anemic HF patients with CKD.
Methods
This meta-analysis will include prospective cohort studies and randomized controlled trials on the effect of HIF-PH inhibitors compared with ESAs in anemic HF patients with CKD. Information of studies will be collected from PubMed, Web of Science, Cochrane Library, and ClinicalTrials.gov. The primary outcome will be cardiovascular death. The secondary outcomes will be all-cause death, hospitalization for HF, HF symptoms, exercise capacity, health-related quality of life, and hemoglobin levels.
Discussion
This meta-analysis will evaluate the effect of HIF-PH inhibitors in anemic HF patients with CKD, providing evidence regarding the use of HIF-PH inhibitors in these patients.
Systematic review registration
INPLASY202230103.
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Affiliation(s)
- Hidekatsu Fukuta
- Core Laboratory, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
- * E-mail:
| | - Hiromi Hagiwara
- Department of Medical Innovation, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Takeshi Kamiya
- Department of Medical Innovation, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
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Bhalla S, AlQabandi Y, Nandula SA, Boddepalli CS, Gutlapalli SD, Lavu VK, Abdelwahab Mohamed Abdelwahab R, Huang R, Potla S, Hamid P. Potential Benefits of Sodium-Glucose Transporter-2 Inhibitors in the Symptomatic and Functional Status of Patients With Heart Failure: A Systematic Review and Meta-Analysis. Cureus 2022; 14:e29579. [DOI: 10.7759/cureus.29579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 09/25/2022] [Indexed: 11/05/2022] Open
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Diamond J, DeVore AD. New Strategies to Prevent Rehospitalizations for Heart Failure. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2022; 24:199-212. [PMID: 36164396 PMCID: PMC9493159 DOI: 10.1007/s11936-022-00969-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/08/2022] [Indexed: 11/24/2022]
Affiliation(s)
- Jamie Diamond
- Division of Cardiology and Department of Medicine, Duke University School of Medicine, 200 Trent Drive, 4th FloorRoom #4225, Orange ZoneDurham, NC 27710 USA
| | - Adam D. DeVore
- Division of Cardiology and Department of Medicine, Duke University School of Medicine, 200 Trent Drive, 4th FloorRoom #4225, Orange ZoneDurham, NC 27710 USA
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC USA
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Shi Y, Liu J, Liu C, Shuang X, Yang C, Qiao W, Dong G. Diagnostic and prognostic value of serum soluble suppression of tumorigenicity-2 in heart failure with preserved ejection fraction: A systematic review and meta-analysis. Front Cardiovasc Med 2022; 9:937291. [PMID: 36204571 PMCID: PMC9530661 DOI: 10.3389/fcvm.2022.937291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 08/29/2022] [Indexed: 11/13/2022] Open
Abstract
Background Heart failure (HF) with preserved ejection fraction (HFpEF) is a growing public health burden, with mortality and rehospitalization rates comparable to HF with reduced ejection fraction (HFrEF). The evidence for the clinical usefulness of soluble suppression of tumorigenicity 2 (sST2) in HFpEF is contradictory. Therefore, we conducted the following systematic review and meta-analysis to assess the diagnostic and prognostic value of serum sST2 in HFpEF. Methods PubMed and Scopus were searched exhaustively from their inception until March 15, 2022. In diagnostic analysis, we compared the diagnostic value of serum sST2 in HFpEF to NT pro-BNP. We separately pooled the unadjusted and multivariate-adjusted hazard ratios (HRs) and the corresponding 95% confidence intervals (CIs) in prognostic analysis. Results A total of 16 publications from 2008 to 2021 were examined. The results of this analysis were as follow: Firstly, compared with NT pro-BNP, sST2 obtains poor diagnostic performance in independently identifying HFpEF from healthy controls, hypertensive patients, and HFrEF patient. Nevertheless, it may provide incremental value to other biomarkers for diagnosing HFpEF and deserves further investigation. Secondly, log sST2 was independently associated with adverse endpoints on multivariable analysis after adjusting for variables such as age, sex, race, and NYHA class. Per log unit rise in sST2, there was a 2.76-fold increased risk of all-cause death [HR:2.76; 95% CI (1.24, 6.16); p = 0.516, I2 = 0%; P = 0.013] and a 6.52-fold increased risk in the composite endpoint of all-cause death and HF hospitalization [HR:6.52; 95% CI (2.34, 18.19); p = 0.985, I2 = 0%; P = 0.000]. Finally, the optimal threshold levels of serum sST2 need further determined. Conclusions Higher sST2 was strongly linked to an increased risk of adverse outcomes in HFpEE. Especially, log sST2 independently predicted all-cause death and the composite endpoint of all-cause death and HF hospitalization. However, prospective and multicenter studies with large-sample and extended follow-up periods are required to validate our results due to limitations in our research.
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Affiliation(s)
- Yujiao Shi
- Department of Post-graduate Institute, Chinese Academy of Traditional Chinese Medicine, Beijing, China
| | - Jiangang Liu
- National Clinical Research Center for Chinese Medicine Cardiology, Xiyuan Hospital, Chinese Academy of Traditional Chinese Medicine, Beijing, China
| | - Chunqiu Liu
- Department of Post-graduate Institute, Chinese Academy of Traditional Chinese Medicine, Beijing, China
| | - Xiong Shuang
- Department of Post-graduate Institute, Chinese Academy of Traditional Chinese Medicine, Beijing, China
| | - Chenguang Yang
- Department of Post-graduate Institute, Chinese Academy of Traditional Chinese Medicine, Beijing, China
| | - Wenbo Qiao
- Department of Post-graduate Institute, Chinese Academy of Traditional Chinese Medicine, Beijing, China
| | - Guoju Dong
- National Clinical Research Center for Chinese Medicine Cardiology, Xiyuan Hospital, Chinese Academy of Traditional Chinese Medicine, Beijing, China
- Department of Cardiovascular Internal Medicine, Xiyuan Hospital, Chinese Academy of Traditional Chinese Medicine, Beijing, China
- *Correspondence: Guoju Dong
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Dmitrieva NI, Liu D, Wu CO, Boehm M. Middle age serum sodium levels in the upper part of normal range and risk of heart failure. Eur Heart J 2022; 43:3335-3348. [PMID: 35348651 PMCID: PMC10263272 DOI: 10.1093/eurheartj/ehac138] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 02/01/2022] [Accepted: 03/03/2022] [Indexed: 07/29/2023] Open
Abstract
AIMS With increasing prevalence of heart failure (HF) owing to the ageing population, identification of modifiable risk factors is important. In a mouse model, chronic hypohydration induced by lifelong water restriction promotes cardiac fibrosis. Hypohydration elevates serum sodium. Here, we evaluate the association of serum sodium at middle age as a measure of hydration habits with risk to develop HF. METHODS AND RESULTS We analysed data from Atherosclerosis Risk in Communities study with middle age enrolment (45-66 years) and 25 years of follow-up. Participants without water balance dysregulation were selected: serum sodium within normal range (135-146 mmol/L), not diabetic, not obese and free of HF at baseline (N = 11 814). In time-to-event analysis, HF risk was increased by 39% if middle age serum sodium exceeded 143 mmol/L corresponding to 1% body weight water deficit [hazard ratio 1.39, 95% confidence interval (CI) 1.14-1.70]. In a retrospective case-control analysis performed on 70- to 90-year-old attendees of Visit 5 (N = 4961), serum sodium of 142.5-143 mmol/L was associated with 62% increase in odds of left ventricular hypertrophy (LVH) diagnosis [odds ratio (OR) 1.62, 95% CI 1.03-2.55]. Serum sodium above 143 mmol/L was associated with 107% increase in odds of LVH (OR 2.07, 95% CI 1.30-3.28) and 54% increase in odds of HF (OR 1.54, 95% CI 1.06-2.23). As a result, prevalence of HF and LVH was increased among 70- to 90-year-old participants with higher middle age serum sodium. CONCLUSION Middle age serum sodium above 142 mmol is a risk factor for LVH and HF. Maintaining good hydration throughout life may slow down decline in cardiac function and decrease prevalence of HF.
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Affiliation(s)
- Natalia I Dmitrieva
- The Laboratory of Cardiovascular Regenerative Medicine, National Heart Lung and Blood Institute, Bethesda, MD 20892, USA
| | - Delong Liu
- The Laboratory of Vascular and Matrix Genetics, National Heart Lung and Blood Institute, Bethesda, MD 20892, USA
| | - Colin O Wu
- Office of Biostatistics Research, National Heart Lung and Blood Institute, Bethesda, MD 20892, USA
| | - Manfred Boehm
- The Laboratory of Cardiovascular Regenerative Medicine, National Heart Lung and Blood Institute, Bethesda, MD 20892, USA
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Zhang S, Zhou Y, Ma Y, Li Z, Hou Y. The diagnostic value of peroxisome proliferator-activated receptor-γ coactivator-1α in identifying different chronic heart failure phenotypes. Front Cardiovasc Med 2022; 9:973705. [PMID: 36148072 PMCID: PMC9485562 DOI: 10.3389/fcvm.2022.973705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 08/18/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundDespite advances in diagnosing and treating chronic heart failure (HF), the underlying mechanisms in different HF phenotypes remain unclear. Mitochondrial energy metabolism is crucial in HF etiology. Our study aimed to explore the value of metabolic-associated biomarker peroxisome proliferator-activated receptor-γ coactivator-1α (PGC1α) in identifying different HF phenotypes.MethodsA total of 172 participants were enrolled in the Affiliated Hospital of Xuzhou Medical University and were subsequently divided into four groups based on the European Society of Cardiology HF management guideline: the non-HF control (Control, N = 46), heart failure with reduced ejection fraction (HFrEF, N = 54), heart failure with mildly reduced ejection fraction (HFmrEF, N = 22), and heart failure with preserved ejection fraction (HFpEF, N = 50) groups. Each participant’s baseline data were recorded, blood samples were taken, and echocardiography was conducted. The level of PGC1α expression was determined using an enzyme-linked immunosorbent assay (ELISA) kit. The receiver operative characteristics (ROC) curve was further established in the four groups to assess the diagnostic value for overall HF and each HF phenotype with the calculation of the area under the curve (AUC) and 95% confidence interval (CI).ResultsPGC1α expression was significantly increased in HF patients (315.0 ± 69.58 nmol/L) compared to non-HF participants (233.3 ± 32.69 nmol/L). Considering different HF phenotypes, PGC1α expression was considerably higher in the HFmrEF group (401.6 ± 45.1 nmol/L)than in the other two phenotypes (299.5 ± 62.27 nmol/L for HFrEF and 293.5 ± 56.37 nmol/L for HFpEF, respectively).Furthermore, the AUCs of PGC1α in overall HF and each HF phenotype were all over 0.8, showing the ideal diagnostic value. Additionally, we provided the cut-off criteria for clinical use, which needs further validation. There was no significant correlation between PGC1α and N-terminal (NT)-prohormone B-type natriuretic peptide (BNP)/blood glucose, suggesting that PGC1α might exert a unique function in HF yet in a different pattern.ConclusionWe discovered that PGC1α could be used as a potential biomarker for differentiating HF patients from those without HF and for distinguishing HFmrEF from HFrEF and HFpEF.
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Affiliation(s)
- Shiwen Zhang
- Department of Cardiology, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, China
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Yufei Zhou
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital and Institutes of Biomedical Sciences, Fudan University, Shanghai, China
| | - Yanfang Ma
- Graduate School, Xuzhou Medical University, Xuzhou, China
| | - Zhan Li
- Shandong Medicine and Health Key Laboratory of Cardiac Electrophysiology and Arrhythmia, Department of Cardiology, Shandong Provincial Qianfoshan Hospital, The First Affiliated Hospital of Shandong First Medical University, Jinan, China
| | - Yinglong Hou
- Department of Cardiology, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, China
- Shandong Medicine and Health Key Laboratory of Cardiac Electrophysiology and Arrhythmia, Department of Cardiology, Shandong Provincial Qianfoshan Hospital, The First Affiliated Hospital of Shandong First Medical University, Jinan, China
- *Correspondence: Yinglong Hou,
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308
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Kim J, Chang Y, Hwang Y, Kim S, Oh YK, Kim J. Graphene Nanosheets Mediate Efficient Direct Reprogramming into Induced Cardiomyocytes. J Biomed Nanotechnol 2022. [DOI: 10.1166/jbn.2022.3416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
In vivo cardiac reprogramming is a potential therapeutic strategy to replace cardiomyocytes in patients with myocardial infarction. However, low conversion efficiency is a limitation of In vivo cardiac reprogramming for heart failure. In this study, we showed that graphene
nanosheets mediated efficient direct reprogramming into induced cardiomyocytes In vivo. We observed that the administration of graphene nanosheets led to the accumulation of H3K4me3, which resulted in direct cardiac reprogramming. Importantly, the administration of graphene nanosheets
combined with cardiac reprogramming factors in a mouse model of myocardial infarction enhanced the effectiveness of directly reprogrammed cell-based cardiac repair. Collectively, our findings suggest that graphene nanosheets can be used as an excellent biomaterial to promote cardiac cell fate
conversion and provide a robust reprogramming platform for cardiac regeneration in ischemic heart disease.
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Affiliation(s)
- Junyeop Kim
- Department of Chemistry and Biomedical Engineering, Dongguk University, Seoul, 04620, Republic of Korea
| | - Yujung Chang
- Department of Chemistry and Biomedical Engineering, Dongguk University, Seoul, 04620, Republic of Korea
| | - Yerim Hwang
- Department of Chemistry and Biomedical Engineering, Dongguk University, Seoul, 04620, Republic of Korea
| | - Sumin Kim
- Department of Chemistry and Biomedical Engineering, Dongguk University, Seoul, 04620, Republic of Korea
| | - Yu-Kyoung Oh
- College of Pharmacy and Research Institute of Pharmaceutical Sciences, Seoul National University, Seoul, 08826, Republic of Korea
| | - Jongpil Kim
- Department of Chemistry and Biomedical Engineering, Dongguk University, Seoul, 04620, Republic of Korea
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Analysis of the Application Value of Echocardiography Combined with CK-MB, Alb, and CysC in the Prognosis Assessment of Patients with Chronic HF. CONTRAST MEDIA & MOLECULAR IMAGING 2022; 2022:3986646. [PMID: 36110978 PMCID: PMC9448626 DOI: 10.1155/2022/3986646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Revised: 07/17/2022] [Accepted: 07/27/2022] [Indexed: 11/17/2022]
Abstract
In order to evaluate the diagnostic and prognostic value of echocardiography combined with serum creatine kinase-MB (CK-MB), albumin (Alb), and cystatin C (CysC) in patients with chronic heart failure (HF), 93 patients diagnosed with chronic HF in our hospital from March 2019 to January 2020 are retrospectively analyzed and included in the HF group. Another 100 healthy subjects who come to our hospital for general physical examination are selected as the control group. Echocardiography is used to detect the cardiac parameters of each group. The experimental results show that echocardiography parameters combined with CK-MB, Alb, and CysC have high application value in diagnosis and evaluation of patients with chronic HF, which can provide theoretical basis for improving the prognosis of patients with chronic HF through real-time monitoring of the above indicators.
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310
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Gomes FAR, Noronha SISR, Silva SCA, Machado-Júnior PA, Ostolin TLVDP, Chírico MTT, Ribeiro MC, Reis AB, Cangussú SD, Montano N, Silva VJD, de Menezes RCA, Silva FCS, Chianca DA. Ivabradine treatment lowers blood pressure and promotes cardiac and renal protection in spontaneously hypertensive rats. Life Sci 2022; 308:120919. [PMID: 36049530 DOI: 10.1016/j.lfs.2022.120919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 08/10/2022] [Accepted: 08/24/2022] [Indexed: 11/28/2022]
Abstract
Hypertension is linked to hyperpolarization-activated cyclic nucleotide-gated (HCN) function, expressed in excitable and non-excitable cells. Considering that the reduction in heart rate (HR) improves coronary perfusion and cardiac performance, ivabradine (IVA) emerged as an important drug for the treatment of cardiovascular diseases. AIM Evaluate if IVA chronic treatment effect can mitigate hypertension and reverse the cardiac and renal damage in SHR. MAIN METHODS Rats were divided into 4 groups treated for 14 days with PBS (1 ml/kg; i.p) or IVA (1 mg/kg; i.p): 1) WKY PBS; 2) SHR PBS; 3) WKY IVA; and 4) SHR IVA. The systolic blood pressure (SBP) was measured, indirectly, before and during the treatment period with IVA (day 0, 1, 7 and 11). Rats were subjected to artery cannulation for direct blood pressure (BP) measurement. Morphofunctional and gene expression were evaluated in the heart and kidneys. KEY FINDINGS IVA reduced SBP only in SHR on the 7th day. Direct blood pressure measurement showed that IVA chronic treatment reduced HR in the SHR. Interestingly, mean arterial pressure (MAP) was reduced in SHR IVA when compared to SHR PBS. Serum and urinary biochemical data were not altered by IVA. Moreover, IVA reduced the renal inflammatory infiltrates and increased glomerular density, besides preventing the cardiac inflammatory and hypertrophic responses. SIGNIFICANCE IVA treatment lowered blood pressure, improved cardiac remodeling and inflammation, as well as decreasing renal damage in SHR. Further, IVA increased renal HCN2 mRNA and reduced cardiac HCN4 mRNA.
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Affiliation(s)
- Fabiana A R Gomes
- Laboratory of Cardiovascular Physiology, Department of Biological Sciences, Institute of Exact and Biological Sciences, Federal University of Ouro Preto, Ouro Preto, Brazil; Graduate Program in Biological Sciences - CBIOL/NUPEB, Federal University of Ouro Preto, Ouro Preto, Brazil.
| | - Sylvana I S R Noronha
- Laboratory of Cardiovascular Physiology, Department of Biological Sciences, Institute of Exact and Biological Sciences, Federal University of Ouro Preto, Ouro Preto, Brazil; Graduate Program in Biological Sciences - CBIOL/NUPEB, Federal University of Ouro Preto, Ouro Preto, Brazil
| | - Sabrina C A Silva
- Laboratory of Cardiovascular Physiology, Department of Biological Sciences, Institute of Exact and Biological Sciences, Federal University of Ouro Preto, Ouro Preto, Brazil; Graduate Program in Biological Sciences - CBIOL/NUPEB, Federal University of Ouro Preto, Ouro Preto, Brazil.
| | - Pedro A Machado-Júnior
- Graduate Program in Biological Sciences - CBIOL/NUPEB, Federal University of Ouro Preto, Ouro Preto, Brazil; Laboratory of Experimental Pathophysiology, Department of Biological Sciences, Institute of Exact and Biological Sciences, Federal University of Ouro Preto, Ouro Preto, Brazil.
| | - Thais Lopes Valentim Di Paschoale Ostolin
- Graduate Program in Biological Sciences - CBIOL/NUPEB, Federal University of Ouro Preto, Ouro Preto, Brazil; Laboratory of Immunophatology, Department of Biological Sciences, Institute of Exact and Biological Sciences, Federal University of Ouro Preto, Ouro Preto, Brazil
| | - Máira Tereza Talma Chírico
- Laboratory of Cardiovascular Physiology, Department of Biological Sciences, Institute of Exact and Biological Sciences, Federal University of Ouro Preto, Ouro Preto, Brazil; Graduate Program in Biological Sciences - CBIOL/NUPEB, Federal University of Ouro Preto, Ouro Preto, Brazil
| | - Marcelo C Ribeiro
- Statistics Department, Department of Biological Sciences, Institute of Exact and Biological Sciences, Federal University of Ouro Preto, Ouro Preto, Brazil.
| | - Alexandre Barbosa Reis
- Graduate Program in Biological Sciences - CBIOL/NUPEB, Federal University of Ouro Preto, Ouro Preto, Brazil; Laboratory of Immunophatology, Department of Biological Sciences, Institute of Exact and Biological Sciences, Federal University of Ouro Preto, Ouro Preto, Brazil.
| | - Silvia D Cangussú
- Laboratory of Cardiovascular Physiology, Department of Biological Sciences, Institute of Exact and Biological Sciences, Federal University of Ouro Preto, Ouro Preto, Brazil; Laboratory of Experimental Pathophysiology, Department of Biological Sciences, Institute of Exact and Biological Sciences, Federal University of Ouro Preto, Ouro Preto, Brazil.
| | - Nicola Montano
- Department of Clinical Sciences and Community Health, IRCCS Ca' Granda Foundation, Ospedale Maggiore Policlinico, University of Milan, Milan, Italy.
| | - Valdo J D Silva
- Department of Physiology, Institute of Biological and Natural Sciences, Federal University of Triângulo Mineiro, Uberaba, Brazil.
| | - Rodrigo C A de Menezes
- Laboratory of Cardiovascular Physiology, Department of Biological Sciences, Institute of Exact and Biological Sciences, Federal University of Ouro Preto, Ouro Preto, Brazil; Graduate Program in Biological Sciences - CBIOL/NUPEB, Federal University of Ouro Preto, Ouro Preto, Brazil.
| | - Fernanda C S Silva
- Laboratory of Cardiovascular Physiology, Department of Biological Sciences, Institute of Exact and Biological Sciences, Federal University of Ouro Preto, Ouro Preto, Brazil; Graduate Program in Biological Sciences - CBIOL/NUPEB, Federal University of Ouro Preto, Ouro Preto, Brazil.
| | - Deoclécio A Chianca
- Laboratory of Cardiovascular Physiology, Department of Biological Sciences, Institute of Exact and Biological Sciences, Federal University of Ouro Preto, Ouro Preto, Brazil; Graduate Program in Biological Sciences - CBIOL/NUPEB, Federal University of Ouro Preto, Ouro Preto, Brazil.
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Wang L, Liu T, Wang C, Xuan H, Xu X, Yin J, Li X, Chen J, Li D, Xu T. Development and validation of a predictive model for adverse left ventricular remodeling in NSTEMI patients after primary percutaneous coronary intervention. BMC Cardiovasc Disord 2022; 22:386. [PMID: 36030211 PMCID: PMC9420298 DOI: 10.1186/s12872-022-02831-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 08/22/2022] [Indexed: 11/21/2022] Open
Abstract
Introduction To develop and validate clinical evaluators that predict adverse left ventricular remodeling (ALVR) in non-ST-elevation myocardial infarction (NSTEMI) patients after primary percutaneous coronary intervention (PCI). Methods The retrospective study analyzed the clinical data of 507 NSTEMI patients who were treated with primary PCI from the Affiliated Hospital of Xuzhou Medical University and the Second Affiliated Hospital of Xuzhou Medical University, between January 1, 2019 and September 31, 2021. The training cohort consisted of patients admitted before June 2020 (n = 287), and the remaining patients (n = 220) were assigned to an external validation cohort. The endpoint event was the occurrence of ALVR, which was described as an increase ≥ 20% in left ventricular end-diastolic volume (LVEDV) at 3–4 months follow-up CMR compared with baseline measurements. The occurrence probability of ALVR stemmed from the final model, which embodied independent predictors recommended by logistic regression analysis. The area under the receiver operating characteristic curve (AUC), Calibration plot, Hosmer–Lemeshow method, and decision curve analysis (DCA) were applied to quantify the performance. Results Independent predictors for ALVR included age (odds ratio (OR): 1.040; 95% confidence interval (CI): 1.009–1.073), the level of neutrophil to lymphocyte ratio (OR: 4.492; 95% CI: 1.906–10.582), the cardiac microvascular obstruction (OR: 3.416; 95% CI: 1.170–9.970), peak global longitudinal strain (OR: 1.131; 95% CI: 1.026–1.246), infarct size (OR: 1.082; 95% CI: 1.042–1.125) and left ventricular ejection fraction (OR: 0.925; 95% CI: 0.872–0.980), which were screened by regression analysis then merged into the nomogram model. Both internal validation (AUC: 0.805) and external validation (AUC: 0.867) revealed that the prediction model was capable of good discrimination. Calibration plot and Hosmer–Lemeshow method showed high consistency between the probabilities predicted by the nomogram (P = 0.514) and the validation set (P = 0.762) and the probabilities of actual occurrence. DCA corroborated the clinical utility of the nomogram. Conclusions In this study, the proposed nomogram model enabled individualized prediction of ALVR in NSTEMI patients after reperfusion and conduced to guide clinical therapeutic schedules.
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Affiliation(s)
- Lili Wang
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221000, Jiangsu, China
| | - Tao Liu
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221000, Jiangsu, China
| | - Chaofan Wang
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221000, Jiangsu, China
| | - Haochen Xuan
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221000, Jiangsu, China
| | - Xianzhi Xu
- School of Stomatology, Xuzhou Medical University, Xuzhou, 221000, Jiangsu, China
| | - Jie Yin
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221000, Jiangsu, China
| | - Xiaoqun Li
- Department of General Practice, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221000, Jiangsu, China
| | - Junhong Chen
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221000, Jiangsu, China
| | - Dongye Li
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221000, Jiangsu, China
| | - Tongda Xu
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221000, Jiangsu, China.
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312
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Barbosa JS, de Souza MFC, Costa JO, Alves LVS, de Oliveira LMSM, de Almeida RR, Oliveira VB, Pereira LMC, Rocha RMS, Costa IMNBDC, Vieira DADS, Baumworcel L, Almeida-Santos MA, Oliveira JLM, Neves EB, Díaz-de-Durana AL, Merino-Fernández M, Aidar FJ, Sousa ACS. Assessment of Malnutrition in Heart Failure and Its Relationship with Clinical Problems in Brazilian Health Services. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:10090. [PMID: 36011722 PMCID: PMC9408367 DOI: 10.3390/ijerph191610090] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 08/08/2022] [Accepted: 08/09/2022] [Indexed: 06/15/2023]
Abstract
Malnutrition in heart failure (HF) is frequent and associated with a worse prognosis. Due to differences in investment and the profile of those assisted, the objective of this study was to evaluate the frequency of malnutrition in hospitalized patients with HF and its association with clinical outcomes in the public and private health systems. Methodology: A cross-sectional study, with 247 volunteers hospitalized with HF in three public hospitals and one private hospital in Aracaju, SE, Brazil. A subjective global nutritional assessment (SGA) and mini nutritional assessment (MNA) were performed. Results: Sample with 72.5% users of the public health system and 75.3% with malnutrition (public = 74.9%; private = 76.5%; p = 0.793). Regardless of the healthcare system, hospital stay (>14 days) was longer (p = 0.020) among those with malnutrition (48.4%) than well-nourished patients (29.5%). Malnutrition in the public system had higher mortality (7.5%; 5.8%; p < 0.001) and hospital transfer rate (21.1%; 0.0%; p < 0.001) than those in the private system. Death after discharge was observed only in the public system (p = 0.039). Conclusion: Malnutrition was frequent in both systems and was associated with longer hospital stays and, in the public hospital, in-hospital death and transfers.
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Affiliation(s)
- Juliana Santos Barbosa
- Graduate Program in Health Sciences, Federal University of Sergipe (UFS), Aracaju 49060-676, Brazil
| | - Márcia Ferreira Cândido de Souza
- Graduate Program Professional in Management and Technological Innovation in Health, Federal University of Sergipe, Aracaju 49100-000, Brazil
| | - Jamille Oliveira Costa
- Graduate Program in Health Sciences, Federal University of Sergipe (UFS), Aracaju 49060-676, Brazil
| | | | | | - Rebeca Rocha de Almeida
- Graduate Program in Health Sciences, Federal University of Sergipe (UFS), Aracaju 49060-676, Brazil
| | - Victor Batista Oliveira
- Graduate Program in Health Sciences, Federal University of Sergipe (UFS), Aracaju 49060-676, Brazil
| | | | | | | | - Diva Aliete dos Santos Vieira
- Department of Nutrition, Campus Prof. Antônio Garcia Filho, Federal University of Sergipe (UFS), Lagarto 49400-000, Brazil
| | - Leonardo Baumworcel
- Clinic and Hospital São Lucas/Division, Rede D’Or São Luiz, Aracaju 49060-676, Brazil
| | - Marcos Antonio Almeida-Santos
- Clinic and Hospital São Lucas/Division, Rede D’Or São Luiz, Aracaju 49060-676, Brazil
- Graduate Program in Health and Environment, Tiradentes University (UNIT), Aracaju 49032-490, Brazil
| | - Joselina Luzia Menezes Oliveira
- Graduate Program in Health Sciences, Federal University of Sergipe (UFS), Aracaju 49060-676, Brazil
- Clinic and Hospital São Lucas/Division, Rede D’Or São Luiz, Aracaju 49060-676, Brazil
- Department of Medicine, Federal University of Sergipe (UFS), São Cristovão 49100-000, Brazil
- Division of Cardiology, University Hospital of Federal University of Sergipe (UFS), São Cristovão 49100-000, Brazil
| | - Eduardo Borba Neves
- Graduate Program in Biomedical Engineering, Federal Technological University of Paraná (UTFPR), Curitiba 80230-901, Brazil
| | - Alfonso López Díaz-de-Durana
- Sports Department, Physical Activity and Sports Faculty—INEF, Universidad Politécnica de Madrid, 28040 Madrid, Spain
| | | | - Felipe J. Aidar
- Group of Studies and Research in Performance, Sport, Health and Paralympic Sports—GEPEPS, Federal University of Sergipe (UFS), São Cristovão 49100-000, Brazil
- Graduate Program in Physical Education, Federal University of Sergipe (UFS), São Cristovão 49100-000, Brazil
- Graduate Program in Physiological Science, Federal University of Sergipe (UFS), São Cristovão 49100-000, Brazil
| | - Antônio Carlos Sobral Sousa
- Graduate Program in Health Sciences, Federal University of Sergipe (UFS), Aracaju 49060-676, Brazil
- Clinic and Hospital São Lucas/Division, Rede D’Or São Luiz, Aracaju 49060-676, Brazil
- Department of Medicine, Federal University of Sergipe (UFS), São Cristovão 49100-000, Brazil
- Division of Cardiology, University Hospital of Federal University of Sergipe (UFS), São Cristovão 49100-000, Brazil
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313
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Morfino P, Aimo A, Castiglione V, Vergaro G, Emdin M, Clerico A. Biomarkers of HFpEF: Natriuretic Peptides, High-Sensitivity Troponins and Beyond. J Cardiovasc Dev Dis 2022; 9:jcdd9080256. [PMID: 36005420 PMCID: PMC9409788 DOI: 10.3390/jcdd9080256] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 08/02/2022] [Accepted: 08/04/2022] [Indexed: 11/28/2022] Open
Abstract
Heart failure (HF) is a significant cause of morbidity and mortality worldwide. HF with preserved ejection fraction (HFpEF) is a complex syndrome, often participated by several cardiac and extracardiac conditions, including chronic kidney disease, pulmonary disease, anaemia and advanced age. Circulating biomarkers reflecting pathophysiological pathways involved in HFpEF development and progression may assist clinicians in early diagnosis and management of this condition. Natriuretic peptides (NPs) are cardioprotective hormones released by cardiomyocytes in response to pressure or volume overload and in response to activation of neuro-endocrine-immune system. The relevance of B-type NP (BNP) and N-terminal pro-B-type NP (NT-proBNP) for diagnosis and risk stratification has been extensively demonstrated, and these biomarkers are emerging tools for population screening and as guides to the start of treatment in subclinical HF. On the contrary, conflicting evidence exists on the value of NPs to guide HF therapy. Among the other biomarkers, high-sensitivity troponins and soluble suppression of tumorigenesis-2 are the most promising biomarkers for risk stratification, predicting outcome independently from NPs. In this review, some novel biomarkers are being tested in such clinical scenario, more tightly linked to specific pathophysiological processes of cardiac damage.
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Affiliation(s)
- Paolo Morfino
- Interdisciplinary Center of Health Sciences, Scuola Superiore Sant’Anna, 56127 Pisa, Italy
| | - Alberto Aimo
- Interdisciplinary Center of Health Sciences, Scuola Superiore Sant’Anna, 56127 Pisa, Italy
- Cardiology Division, Fondazione Toscana Gabriele Monasterio, 56127 Pisa, Italy
| | - Vincenzo Castiglione
- Interdisciplinary Center of Health Sciences, Scuola Superiore Sant’Anna, 56127 Pisa, Italy
- Cardiology Division, Fondazione Toscana Gabriele Monasterio, 56127 Pisa, Italy
| | - Giuseppe Vergaro
- Interdisciplinary Center of Health Sciences, Scuola Superiore Sant’Anna, 56127 Pisa, Italy
- Cardiology Division, Fondazione Toscana Gabriele Monasterio, 56127 Pisa, Italy
| | - Michele Emdin
- Interdisciplinary Center of Health Sciences, Scuola Superiore Sant’Anna, 56127 Pisa, Italy
- Cardiology Division, Fondazione Toscana Gabriele Monasterio, 56127 Pisa, Italy
| | - Aldo Clerico
- Interdisciplinary Center of Health Sciences, Scuola Superiore Sant’Anna, 56127 Pisa, Italy
- Cardiology Division, Fondazione Toscana Gabriele Monasterio, 56127 Pisa, Italy
- Correspondence:
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314
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Kunutsor SK, Voutilainen A, Kurl S, Laukkanen JA. Serum copper-to-zinc ratio is associated with heart failure and improves risk prediction in middle-aged and older Caucasian men: A prospective study. Nutr Metab Cardiovasc Dis 2022; 32:1924-1935. [PMID: 35680488 DOI: 10.1016/j.numecd.2022.05.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 05/06/2022] [Accepted: 05/12/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND AND AIMS Serum copper (Cu) and zinc (Zn) may play a role in the development of adverse cardiovascular outcomes including heart failure (HF). Serum Cu/Zn-ratio has been shown to be a risk indicator for cardiovascular disease, but its relationship with HF has not been previously investigated. We aimed to assess the association between Cu/Zn-ratio and incident HF risk using a prospective cohort study. METHODS AND RESULTS Study participants were recruited in eastern Finland with baseline examinations carried out between March 1998 and December 2001. Serum levels of Cu and Zn were measured using atomic absorption spectrometry in 1866 men aged 42-61 years without a history of HF at baseline. Multivariable-adjusted hazard ratios (HRs) with confidence intervals (CIs) were calculated for incident HF. During 26.5 years median follow-up, 365 HF cases occurred. Restricted cubic splines suggested linear relationships of serum Cu/Zn-ratio, Cu and Zn with HF risk. A unit increase in Cu/Zn-ratio was associated with an increased HF risk in analysis adjusted for several potential confounders including nutritional factors such as total energy intake, intake of fruits, berries and vegetables, and red meat (HR 1.63; 95% CI 1.06-2.51). The corresponding multivariable-adjusted HRs (95% CIs) for serum Cu and Zn were 2.42 (1.32-4.44) and 1.34 (0.50-3.63), respectively. Addition of Cu/Zn-ratio to a HF risk prediction model was associated with improved risk prediction. CONCLUSION In middle-aged and older Finnish men, increased serum Cu/Zn-ratio is associated with an increased risk of HF in a linear dose-response fashion and might improve HF risk assessment.
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Affiliation(s)
- Setor K Kunutsor
- National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and the University of Bristol, Bristol, UK; Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Learning & Research Building (Level 1), Southmead Hospital, Bristol, UK; Central Finland Health Care District Hospital District, Department of Medicine, Finland District, Jyväskylä, Finland; Diabetes Research Centre, University of Leicester, Leicester General Hospital, Gwendolen Road, Leicester, LE5 4WP, UK.
| | - Ari Voutilainen
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - Sudhir Kurl
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - Jari A Laukkanen
- Central Finland Health Care District Hospital District, Department of Medicine, Finland District, Jyväskylä, Finland; Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland; Institute of Clinical Medicine, Department of Medicine, University of Eastern Finland, Kuopio, Finland
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315
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Sadeghi MM. Beyond perfusion imaging. J Nucl Cardiol 2022; 29:1485-1486. [PMID: 35790690 DOI: 10.1007/s12350-022-03050-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Accepted: 06/18/2022] [Indexed: 10/17/2022]
Affiliation(s)
- Mehran M Sadeghi
- Cardiovascular Molecular Imaging Laboratory, Section of Cardiovascular Medicine and Yale Cardiovascular Research Center, Yale University School of Medicine, 300 George Street, Room 770G, New Haven, CT, 06511, USA.
- Veterans Affairs Connecticut Healthcare System, West Haven, CT, USA.
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316
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Boriani G, Vitolo M, Imberti JF. Effectiveness of atrial fibrillation ablation in heart failure across the entire spectrum of left ventricular ejection fraction. Eur J Heart Fail 2022; 24:1647-1651. [PMID: 35906807 DOI: 10.1002/ejhf.2642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 07/25/2022] [Indexed: 11/11/2022] Open
Affiliation(s)
- Giuseppe Boriani
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
| | - Marco Vitolo
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy.,Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
| | - Jacopo F Imberti
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy.,Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
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317
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Mueller PS. Ethical and Legal Concerns Associated With Withdrawing Mechanical Circulatory Support: A U.S. Perspective. Front Cardiovasc Med 2022; 9:897955. [PMID: 35958394 PMCID: PMC9360408 DOI: 10.3389/fcvm.2022.897955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 05/06/2022] [Indexed: 11/13/2022] Open
Abstract
Hundreds of thousands of Americans have advanced heart failure and experience severe symptoms (e. g., dyspnea) with minimal exertion or at rest despite optimal management. Although heart transplant is an effective treatment for advanced heart failure, the demand for organs far exceeds the supply. Another option for these patients is mechanical circulatory support (MCS) provided by devices such as the ventricular assist device and total artificial heart. MCS alleviates symptoms, prolongs life, and provides a “bridge to transplant” or a decision regarding future management such as “destination therapy,” in which the patient receives lifelong MCS. However, a patient receiving MCS, or his/her surrogate decision-maker, may conclude ongoing MCS is burdensome and no longer consistent with the patient's healthcare-related values, goals, and preferences and, as a result, request withdrawal of MCS. Likewise, the patient's clinician and care team may conclude ongoing MCS is medically ineffective and recommend its withdrawal. These scenarios raise ethical and legal concerns. In the U.S., it is ethically and legally permissible to carry out an informed patient's or surrogate's request to withdraw any treatment including life-sustaining treatment (LST) if the intent is to remove a treatment perceived by the patient as burdensome and not to terminate intentionally the patient's life. Under these circumstances, death that follows withdrawal of the LST is due to the underlying disease and not a form of physician-assisted suicide or euthanasia. In this article, frequently encountered ethical and legal concerns regarding requests to withdraw MCS are reviewed: the ethical and legal permissibility of withholding or withdrawing LSTs from patients who no longer want such treatments; what to do if the clinician concludes ongoing LST will not result in achieving clinical goals (i.e., medically ineffective); responding to requests to withdraw LST; the features of patients who undergo withdrawal of MCS; the rationale for advance care planning in patients being considered for, or receiving, MCS; and other related topics. Notably, this article reflects a U.S. perspective.
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318
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Ben Halima H, Bellagambi F, Hangouet M, Alcacer A, Pfeiffer N, Heuberger A, Zine N, Bausells J, Elaissari A, ERRACHID A. A novel IMFET biosensor strategy for Interleukin‐10 quantification for early screening heart failure disease in saliva. ELECTROANAL 2022. [DOI: 10.1002/elan.202200141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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319
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Zaki HA, Bashir K, Iftikhar H, Salem W, Mohamed EH, Elhag HM, Hendy M, Kassem AAO, Salem EED, Elmoheen A. An Integrative Comparative Study Between Digoxin and Amiodarone as an Emergency Treatment for Patients With Atrial Fibrillation With Evidence of Heart Failure: A Systematic Review and Meta-Analysis. Cureus 2022; 14:e26800. [PMID: 35971374 PMCID: PMC9372377 DOI: 10.7759/cureus.26800] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/13/2022] [Indexed: 11/06/2022] Open
Abstract
The emergency treatment of atrial fibrillation (AF) involves utilizing two strategies. The first strategy normally involves permitting the atrial fibrillation to persevere as the ventricular rate is controlled. The other method involves utilizing anti-arrhythmic drugs in cardioversion and attempting to maintain sinus rhythm. Different pharmacological treatments, including digoxin and amiodarone, have been used to manage AF. A literature review on amiodarone and digoxin in the treatment of AF among patients with heart failure (HF) has shown that both drugs have potential risks. Therefore, we are conducting this systematic review and meta-analysis to compare the effectiveness of amiodarone and digoxin in the treatment of AF among patients with evidence of HF. A literature search of relevant articles was conducted on six electronic databases (PubMed, Web of Science, Medline, ScienceDirect, Cochrane Library, and Google Scholar) from 2000 to 2022. The search yielded seven studies that had met the inclusion criteria. Our meta-analysis of four studies showed that there was no significant difference in the reduction of heart rate after treatment with either amiodarone or digoxin (mean difference (MD): -5.44; 95% confidence interval (CI): -9.53 to -1.34; I2 = 25%; p = 0.26). On the other hand, the statistical analysis showed that amiodarone had a better effect on the conversion to sinus rhythm than digoxin (63% versus 35%, respectively). Based on evidence from our meta-analysis, the clinical effect of amiodarone and digoxin in the emergency treatment of AF on heart rate control was unclear. However, amiodarone has a significant impact on the restoration of sinus rhythm compared with digoxin and can be considered the first-line drug regimen in conversion to sinus rhythm for AF patients with evidence of heart failure. However, the use of amiodarone and digoxin is complicated by adverse events and all-cause mortality.
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320
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Magkoutas K, Arm P, Meboldt M, Schmid Daners M. Physiologic Data-Driven Iterative Learning Control for Left Ventricular Assist Devices. Front Cardiovasc Med 2022; 9:922387. [PMID: 35911509 PMCID: PMC9326058 DOI: 10.3389/fcvm.2022.922387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Accepted: 06/20/2022] [Indexed: 11/25/2022] Open
Abstract
Continuous flow ventricular assist devices (cfVADs) constitute a viable and increasingly used therapy for end-stage heart failure patients. However, they are still operating at a fixed-speed mode that precludes physiological cfVAD response and it is often related to adverse events of cfVAD therapy. To ameliorate this, various physiological controllers have been proposed, however, the majority of these controllers do not account for the lack of pulsatility in the cfVAD operation, which is supposed to be beneficial for the physiological function of the cardiovascular system. In this study, we present a physiological data-driven iterative learning controller (PDD-ILC) that accurately tracks predefined pump flow trajectories, aiming to achieve physiological, pulsatile, and treatment-driven response of cfVADs. The controller has been extensively tested in an in-silico environment under various physiological conditions, and compared with a physiologic pump flow proportional-integral-derivative controller (PF-PIDC) developed in this study as well as the constant speed (CS) control that is the current state of the art in clinical practice. Additionally, two treatment objectives were investigated to achieve pulsatility maximization and left ventricular stroke work (LVSW) minimization by implementing copulsation and counterpulsation pump modes, respectively. Under all experimental conditions, the PDD-ILC as well as the PF-PIDC demonstrated highly accurate tracking of the reference pump flow trajectories, outperforming existing model-based iterative learning control approaches. Additionally, the developed controllers achieved the predefined treatment objectives and resulted in improved hemodynamics and preload sensitivities compared to the CS support.
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Affiliation(s)
| | | | | | - Marianne Schmid Daners
- Product Development Group Zurich, Department of Mechanical and Process Engineering, ETH Zurich, Zurich, Switzerland
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321
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Guo HX, Wang JR, Peng GC, Li P, Zhu MJ. A Data Mining-Based Study on Medication Rules of Chinese Herbs to Treat Heart Failure with Preserved Ejection Fraction. Chin J Integr Med 2022; 28:847-854. [PMID: 35829954 DOI: 10.1007/s11655-022-2892-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/25/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To summarize the medication rules of Chinese herbs to treat heart failure with preserved ejection fraction (HFPEF) based on data mining and to provide references for clinical utilization. METHODS The China National Knowledge Infrastructure (CNKI), Wanfang database (Wanfang), VIP database (VIP), Chinese Biomedical Literature (CBM), PubMed, Embase, and Cochrane Library databases were searched from inception to October 2021 to identify relevant literature on treating HFPEF with Chinese herbs. Microsoft Excel 2019 was used to set up a database, and then, association rule analysis and hierarchical cluster analysis were performed by using apriori algorithm and hclust function respectively in R-Studio (Version 4.0.3). RESULTS A total of 182 qualified papers were included, involving a total of 92 prescriptions, 130 Chinese herbs, and 872 individual herbs prescribed, with an average of 9.5 herbs per prescription. The six most frequently prescribed herbs were Astragali Radix (Huangqi), Salviae Miltiorrhizae Radix Et Rhizoma (Danshen), Poria (Fuling), Glycyrrhizae Radix Et Rhizoma (Gancao), Cinnamomi Ramulus (Guizhi), and Ginseng Radix Et Rhizoma (Renshen). There were 35 herbs used more than 5 times, involving 11 efficacy categories. The top three categories were deficiency-tonifying herbs, blood-activating and stasis-removing herbs, and dampness-draining diuretic herbs. The most commonly used herbs were mainly warm and sweet. The primary meridian tropisms were Lung Meridian, Heart Meridian and Spleen Meridian. Association rule analysis yielded 26 association rules, such as Astragali Radix (Huangqi) & Salviae Miltiorrhizae Radix Et Rhizoma (Danshen), Poria (Fuling), Cinnamomi Ramulus (Guizhi) & Atractylodis Macrocephalae Rhizoma (Baizhu). Hierarchical cluster analysis yielded four herb classes, and their functions were mainly qi-replenishing and yang-warming, blood-activating and diuresis-inducing. CONCLUSIONS HFPEF is the syndrome of root vacuity and tip repletion, and its core pathogenesis is "deficiency", "stasis", and "water", with "deficiency" being the most principal, which is closely related to Xin (heart), Fei (Lung), and Pi (Spleen). The treatment of this disease occurs by improving qi, warming yang, activating blood and inducing diuresis. Astragali Radix (Huangqi) with Salviae Miltiorrhizae Radix Et Rhizoma (Danshen) is the basic combination of herbs applied.
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Affiliation(s)
- Hong-Xin Guo
- Henan University of Chinese Medicine, Zhengzhou, 450046, China
- The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, 450099, China
| | - Jian-Ru Wang
- The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, 450099, China
| | - Guang-Cao Peng
- The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, 450099, China
| | - Ping Li
- Henan University of Chinese Medicine, Zhengzhou, 450046, China
| | - Ming-Jun Zhu
- The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, 450099, China.
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322
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Park F. The heart is where AAV9 lies. Physiol Genomics 2022; 54:316-318. [PMID: 35816650 DOI: 10.1152/physiolgenomics.00102.2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Frank Park
- The University of Tennessee Health Science Center, Department of Pharmaceutical Sciences, Memphis, TN, United States
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323
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Pinnamaneni JP, Singh VP, Kim MB, Ryan CT, Pugazenthi A, Sanagasetti D, Mathison M, Yang J, Rosengart TK. p63 silencing induces epigenetic modulation to enhance human cardiac fibroblast to cardiomyocyte-like differentiation. Sci Rep 2022; 12:11416. [PMID: 35794145 PMCID: PMC9259667 DOI: 10.1038/s41598-022-15559-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 06/27/2022] [Indexed: 11/09/2022] Open
Abstract
Direct cell reprogramming represents a promising new myocardial regeneration strategy involving in situ transdifferentiation of cardiac fibroblasts into induced cardiomyocytes. Adult human cells are relatively resistant to reprogramming, however, likely because of epigenetic restraints on reprogramming gene activation. We hypothesized that modulation of the epigenetic regulator gene p63 could improve the efficiency of human cell cardio-differentiation. qRT-PCR analysis demonstrated significantly increased expression of a panel of cardiomyocyte marker genes in neonatal rat and adult rat and human cardiac fibroblasts treated with p63 shRNA (shp63) and the cardio-differentiation factors Hand2/Myocardin (H/M) versus treatment with Gata4, Mef2c and Tbx5 (GMT) with or without shp63 (p < 0.001). FACS analysis demonstrated that shp63+ H/M treatment of human cardiac fibroblasts significantly increased the percentage of cells expressing the cardiomyocyte marker cTnT compared to GMT treatment with or without shp63 (14.8% ± 1.4% versus 4.3% ± 1.1% and 3.1% ± 0.98%, respectively; p < 0.001). We further demonstrated that overexpression of the p63-transactivation inhibitory domain (TID) interferes with the physical interaction of p63 with the epigenetic regulator HDAC1 and that human cardiac fibroblasts treated with p63-TID+ H/M demonstrate increased cardiomyocyte marker gene expression compared to cells treated with shp63+ H/M (p < 0.05). Whereas human cardiac fibroblasts treated with GMT alone failed to contract in co-culture experiments, human cardiac fibroblasts treated with shp63+ HM or p63-TID+ H/M demonstrated calcium transients upon electrical stimulation and contractility synchronous with surrounding neonatal cardiomyocytes. These findings demonstrate that p63 silencing provides enhanced rat and human cardiac fibroblast transdifferentiation into induced cardiomyocytes compared to a standard reprogramming strategy. p63-TID overexpression may be a useful reprogramming strategy for overcoming epigenetic barriers to human fibroblast cardio-differentiation.
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Affiliation(s)
- Jaya Pratap Pinnamaneni
- grid.39382.330000 0001 2160 926XMichael E. De Bakey Department of Surgery, Baylor College of Medicine, 1 Moursund St, Houston, TX-77030 USA
| | - Vivek P. Singh
- grid.39382.330000 0001 2160 926XMichael E. De Bakey Department of Surgery, Baylor College of Medicine, 1 Moursund St, Houston, TX-77030 USA
| | - Mary B. Kim
- grid.416167.30000 0004 0442 1996Department of Surgery, Mount Sinai Hospital, New York, NY 10029 USA
| | - Christopher T. Ryan
- grid.39382.330000 0001 2160 926XMichael E. De Bakey Department of Surgery, Baylor College of Medicine, 1 Moursund St, Houston, TX-77030 USA
| | - Aarthi Pugazenthi
- grid.39382.330000 0001 2160 926XMichael E. De Bakey Department of Surgery, Baylor College of Medicine, 1 Moursund St, Houston, TX-77030 USA
| | - Deepthi Sanagasetti
- grid.39382.330000 0001 2160 926XMichael E. De Bakey Department of Surgery, Baylor College of Medicine, 1 Moursund St, Houston, TX-77030 USA
| | - Megumi Mathison
- grid.39382.330000 0001 2160 926XMichael E. De Bakey Department of Surgery, Baylor College of Medicine, 1 Moursund St, Houston, TX-77030 USA
| | - Jianchang Yang
- grid.39382.330000 0001 2160 926XMichael E. De Bakey Department of Surgery, Baylor College of Medicine, 1 Moursund St, Houston, TX-77030 USA
| | - Todd K. Rosengart
- grid.39382.330000 0001 2160 926XMichael E. De Bakey Department of Surgery, Baylor College of Medicine, 1 Moursund St, Houston, TX-77030 USA
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324
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Adams J, Mosler C. Safety and efficacy considerations amongst the elderly population in the updated treatment of heart failure: a review. Expert Rev Cardiovasc Ther 2022; 20:529-541. [PMID: 35786091 DOI: 10.1080/14779072.2022.2098118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
INTRODUCTION Heart failure is one of the cardiovascular diseases that impacts the geriatric population. As new clinical trials investigating heart failure are conducted, groundbreaking information is assessable to further evolve the treatment. To correctly improve the quality of life of elderly patients, it is critical to evaluate the safety and efficacy of new and improved therapy regimens. AREAS COVERED In reviewal of the 2021 and 2022 updated guidelines, the safety and efficacy of the newly indicated medications will be addressed. The new indications cover sacubitril/valsartan and two SGLT2 inhibitors: dapagliflozin and empagliflozin. An introduction to the medications discussed covers the pharmacology before addressing the efficacy and safety considerations in the elderly population. Furthermore, prime drug-drug interactions associated with the two classes of medications will be considered as well as providing possible solutions to further create the safest drug therapy for geriatric patients with common comorbidities. EXPERT OPINION The two classes of medications, the ARNI and SGLT2 inhibitors, are well-tolerated amongst the elderly population. With the release of new guidelines, the updated medications will provide safer and better therapy in this disease state for geriatrics. One major limitation includes the high cost of these brand-named medications.
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Affiliation(s)
- Jack Adams
- College of Pharmacy, The University of Findlay, Findlay, OH, 45840
| | - Charles Mosler
- College of Pharmacy, The University of Findlay, Findlay, OH, 45840
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325
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Zeng Y, Yang S, Yu X, Lin W, Wang W, Tong J, Xia S. A multimodal parallel method for left ventricular dysfunction identification based on phonocardiogram and electrocardiogram signals synchronous analysis. MATHEMATICAL BIOSCIENCES AND ENGINEERING : MBE 2022; 19:9612-9635. [PMID: 35942775 DOI: 10.3934/mbe.2022447] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Heart failure (HF) is widely acknowledged as the terminal stage of cardiac disease and represents a global clinical and public health problem. Left ventricular ejection fraction (LVEF) measured by echocardiography is an important indicator of HF diagnosis and treatment. Early identification of LVEF reduction and early treatment is of great significance to improve LVEF and the prognosis of HF. This research aims to introduce a new method for left ventricular dysfunction (LVD) identification based on phonocardiogram (ECG) and electrocardiogram (PCG) signals synchronous analysis. In the present study, we established a database called Synchronized ECG and PCG Database for Patients with Left Ventricular Dysfunction (SEP-LVDb) consisting of 1046 synchronous ECG and PCG recordings from patients with reduced (n = 107) and normal (n = 699) LVEF. 173 and 873 recordings were available from the reduced and normal LVEF group, respectively. Then, we proposed a parallel multimodal method for LVD identification based on synchronous analysis of PCG and ECG signals. Two-layer bidirectional gate recurrent unit (Bi-GRU) was used to extract features in the time domain, and the data were classified using residual network 18 (ResNet-18). This research confirmed that fused ECG and PCG signals yielded better performance than ECG or PCG signals alone, with an accuracy of 93.27%, precision of 93.34%, recall of 93.27%, and F1-score of 93.27%. Verification of the model's performance with an independent dataset achieved an accuracy of 80.00%, precision of 79.38%, recall of 80.00% and F1-score of 78.67%. The Bi-GRU model outperformed Bi-directional long short-term memory (Bi-LSTM) and recurrent neural network (RNN) models with a best selection frame length of 3.2 s. The Saliency Maps showed that SEP-LVDPN could effectively learn features from the data.
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Affiliation(s)
- Yajing Zeng
- The Fourth Affiliated Hospital Zhejiang University School of Medicine, Jinhua 321000, China
| | - Siyu Yang
- School of Information and Technology, Zhejiang Sci-Tech University, Hangzhou 310000, China
| | - Xiongkai Yu
- The Fourth Affiliated Hospital Zhejiang University School of Medicine, Jinhua 321000, China
| | - Wenting Lin
- The Fourth Affiliated Hospital Zhejiang University School of Medicine, Jinhua 321000, China
| | - Wei Wang
- The Fourth Affiliated Hospital Zhejiang University School of Medicine, Jinhua 321000, China
| | - Jijun Tong
- School of Information and Technology, Zhejiang Sci-Tech University, Hangzhou 310000, China
| | - Shudong Xia
- The Fourth Affiliated Hospital Zhejiang University School of Medicine, Jinhua 321000, China
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326
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Kuang J, Huang T, Pei D. The Art of Reprogramming for Regenerative Medicine. Front Cell Dev Biol 2022; 10:927555. [PMID: 35846373 PMCID: PMC9280648 DOI: 10.3389/fcell.2022.927555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Accepted: 06/08/2022] [Indexed: 11/13/2022] Open
Abstract
Traditional pharmaceuticals in the forms of small chemical compounds or macromolecules such as proteins or RNAs have provided lifesaving solutions to many acute and chronic conditions to date. However, there are still many unmet medical needs, especially those of degenerative nature. The advent of cell-based therapy holds the promise to meet these challenges. In this review, we highlight a relatively new paradigm for generating or regenerating functional cells for replacement therapy against conditions such as type I diabetes, myocardial infarction, neurodegenerative diseases and liver fibrosis. We focus on the latest progresses in cellular reprogramming for generating diverse functional cell types. We will also discuss the mechanisms involved and conclude with likely general principles underlying reprogramming.
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Affiliation(s)
- Junqi Kuang
- Institute of Biology, Westlake Institute for Advanced Study, Hangzhou, China
- Laboratory of Cell Fate Control, School of Life Sciences, Westlake University, Hangzhou, China
| | - Tao Huang
- Institute of Biology, Westlake Institute for Advanced Study, Hangzhou, China
- Laboratory of Cell Fate Control, School of Life Sciences, Westlake University, Hangzhou, China
- College of Life Sciences, Zhejiang University, Hangzhou, China
| | - Duanqing Pei
- Institute of Biology, Westlake Institute for Advanced Study, Hangzhou, China
- Laboratory of Cell Fate Control, School of Life Sciences, Westlake University, Hangzhou, China
- *Correspondence: Duanqing Pei,
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Gonzalez-Loyola FE, Muñoz MA, Navas E, Real J, Vinyoles E, Verdú-Rotellar JM. Burden of heart failure in primary healthcare. Aten Primaria 2022; 54:102413. [PMID: 35777242 PMCID: PMC9251565 DOI: 10.1016/j.aprim.2022.102413] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 05/24/2022] [Accepted: 06/02/2022] [Indexed: 01/08/2023] Open
Abstract
Objectives To determine the epidemiology of heart failure registered in primary healthcare clinical records in Catalunya, Spain, between 2010 and 2014, focusing on incidence, mortality, and resource utilization. Design Retrospective observational cohort study. Setting Study was carried out in primary care setting. Participants and interventions Patients registered as presenting a new heart failure diagnosis. The inclusion period ran from 1st January 2010 to 31st December 2013, but patients were followed until 31st December 2013 in order to analyze mortality. Main measures Information came from electronic medical records. Results A total of 64 441 patients were registered with a new diagnosis of heart failure (2.76 new cases per 1000 persons-year). Among them, 85.8% were ≥65 years. The number of cases/1000 persons-year was higher in men in all age groups. Incidence ranged from 0.04 in women <45 years to 27.61 in the oldest group, and from 0.08 in men <45 years to 28.52 in the oldest group. Mortality occurred in 16 305 (25.3%) patients. Primary healthcare resource utilization increased after the occurrence of heart failure, especially the number of visits made by nurses to the patients’ homes. Conclusion Heart failure incidence increases with age, is greater in men, and remains stable. Mortality continues to be high in newly diagnosed patients in spite of the current improvements in treatment. Home visits represent the greatest cost for the management of this disease in primary care setting.
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Affiliation(s)
- Felipe-Estuardo Gonzalez-Loyola
- Unitat de Suport a la Recerca de Barcelona, Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain; Departament de Pediatría, Obstetricia i Ginecología i Medicina Preventiva, Programa de Doctorat en Metodología de la Recerca BIomèdica, Facultat de Medicina, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Miguel-Angel Muñoz
- Unitat de Suport a la Recerca de Barcelona, Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain; Gerència d'Àmbit d'Atenció Primària Barcelona Ciutat, Institut Català de la Salut, Barcelona, Spain; Department of Experimental and Health Sciences, Universitat Pompeu Fabra, Barcelona, Spain.
| | - Elena Navas
- Unitat de Suport a la Recerca de Barcelona, Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
| | - Jordi Real
- Unitat de Suport a la Recerca de Barcelona, Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
| | - Ernest Vinyoles
- Unitat de Suport a la Recerca de Barcelona, Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain; Gerència d'Àmbit d'Atenció Primària Barcelona Ciutat, Institut Català de la Salut, Barcelona, Spain
| | - José-Maria Verdú-Rotellar
- Unitat de Suport a la Recerca de Barcelona, Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain; Gerència d'Àmbit d'Atenció Primària Barcelona Ciutat, Institut Català de la Salut, Barcelona, Spain; Department of Experimental and Health Sciences, Universitat Pompeu Fabra, Barcelona, Spain
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328
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Maffei S, Forini F, Canale P, Nicolini G, Guiducci L. Gut Microbiota and Sex Hormones: Crosstalking Players in Cardiometabolic and Cardiovascular Disease. Int J Mol Sci 2022; 23:ijms23137154. [PMID: 35806159 PMCID: PMC9266921 DOI: 10.3390/ijms23137154] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 06/23/2022] [Accepted: 06/24/2022] [Indexed: 01/27/2023] Open
Abstract
The available evidence indicates a close connection between gut microbiota (GM) disturbance and increased risk of cardiometabolic (CM) disorders and cardiovascular (CV) disease. One major objective of this narrative review is to discuss the key contribution of dietary regimen in determining the GM biodiversity and the implications of GM dysbiosis for the overall health of the CV system. In particular, emerging molecular pathways are presented, linking microbiota-derived signals to the local activation of the immune system as the driver of a systemic proinflammatory state and permissive condition for the onset and progression of CM and CV disease. We further outline how the cross-talk between sex hormones and GM impacts disease susceptibility, thereby offering a mechanistic insight into sexual dimorphism observed in CVD. A better understanding of these relationships could help unravel novel disease targets and pave the way to the development of innovative, low-risk therapeutic strategies based on diet interventions, GM manipulation, and sex hormone analogues.
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Affiliation(s)
- Silvia Maffei
- Department of Gynecological and Cardiovascular Endocrinology, CNR-Tuscany Region, G. Monasterio Foundation, Via G. Moruzzi 1, 56124 Pisa, Italy;
| | - Francesca Forini
- CNR Institute of Clinical Physiology, Via G Moruzzi 1, 56124 Pisa, Italy; (P.C.); (G.N.); (L.G.)
- Correspondence:
| | - Paola Canale
- CNR Institute of Clinical Physiology, Via G Moruzzi 1, 56124 Pisa, Italy; (P.C.); (G.N.); (L.G.)
| | - Giuseppina Nicolini
- CNR Institute of Clinical Physiology, Via G Moruzzi 1, 56124 Pisa, Italy; (P.C.); (G.N.); (L.G.)
| | - Letizia Guiducci
- CNR Institute of Clinical Physiology, Via G Moruzzi 1, 56124 Pisa, Italy; (P.C.); (G.N.); (L.G.)
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Theofilis P, Sagris M, Oikonomou E, Antonopoulos AS, Siasos G, Tsioufis K, Tousoulis D. Pleiotropic effects of SGLT2 inhibitors and heart failure outcomes. Diabetes Res Clin Pract 2022; 188:109927. [PMID: 35577035 DOI: 10.1016/j.diabres.2022.109927] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 04/14/2022] [Accepted: 05/09/2022] [Indexed: 12/25/2022]
Abstract
Heart failure (HF) represents a major public health concern with increasing prevalence among aging populations, with multifactorial pathophysiology including inflammation, oxidative stress, endothelial dysfunction, and fibrosis, among others. Lately, the use of sodium-glucose cotransporter-2 (SGLT2) inhibitors, originally destined for the treatment of type 2 diabetes mellitus, have revolutionized the treatment of HF. In this review article, we provide the milestones and the latest mechanistic evidence of SGLT2 inhibition in HF. Owing to the results of experimental studies, several pleiotropic effects of SGLT2 inhibitors have been proposed, including the restoration of autophagy which may be significant in the reversal of the aforementioned HF pathophysiology according to a latest hypotheses. Additional mechanisms consist of the regulation of inflammatory, oxidative, and fibrotic pathways, together with the improvement of endothelial function and reduction of epicardial adipose tissue. Other than their role as antidiabetic agents, a reduction in heart failure hospitalizations has been noted following their use in clinical trials, irrespective of DM status and degree of systolic dysfunction. Upcoming randomized trials are expected to additional clinical and mechanistic evidence regarding the diverse effects of SGLT2 inhibition across the spectrum of heart failure.
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Affiliation(s)
- Panagiotis Theofilis
- 1(st) Cardiology Department, Hippokration General Hospital, University of Athens Medical School, Athens, Greece
| | - Marios Sagris
- 1(st) Cardiology Department, Hippokration General Hospital, University of Athens Medical School, Athens, Greece
| | - Evangelos Oikonomou
- 1(st) Cardiology Department, Hippokration General Hospital, University of Athens Medical School, Athens, Greece; 3(rd) Cardiology Department, Thoracic Diseases Hospital "Sotiria", University of Athens Medical School, Athens, Greece
| | - Alexios S Antonopoulos
- 1(st) Cardiology Department, Hippokration General Hospital, University of Athens Medical School, Athens, Greece
| | - Gerasimos Siasos
- 1(st) Cardiology Department, Hippokration General Hospital, University of Athens Medical School, Athens, Greece; 3(rd) Cardiology Department, Thoracic Diseases Hospital "Sotiria", University of Athens Medical School, Athens, Greece
| | - Kostas Tsioufis
- 1(st) Cardiology Department, Hippokration General Hospital, University of Athens Medical School, Athens, Greece
| | - Dimitris Tousoulis
- 1(st) Cardiology Department, Hippokration General Hospital, University of Athens Medical School, Athens, Greece.
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330
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Kang C, Lamb YN. Vericiguat: A Review in Chronic Heart Failure with Reduced Ejection Fraction. Am J Cardiovasc Drugs 2022; 22:451-459. [PMID: 35624347 DOI: 10.1007/s40256-022-00538-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/20/2022] [Indexed: 11/01/2022]
Abstract
Vericiguat (Verquvo®) is the first oral soluble guanylate cyclase (sGC) stimulator to be approved for the treatment of adults with symptomatic, chronic heart failure with reduced ejection fraction (HFrEF). In the phase III VICTORIA trial, vericiguat added to standard of care (SOC) was associated with a significantly lower risk of the primary composite endpoint of death from cardiovascular (CV) causes or first hospitalization from heart failure (HHF) than placebo added to SOC in adults with chronic HFrEF. The risk of all-cause mortality or first HHF (secondary composite endpoint) and the total number of HHF were also statistically significantly reduced by vericiguat therapy. Vericiguat showed no benefit with respect to the primary endpoint in a subgroup of patients with grossly elevated N-terminal pro-brain natriuretic peptide levels. Vericiguat was generally well tolerated; the most common treatment-related adverse event (AE) was hypotension. AEs of special interest included symptomatic hypotension and syncope, which occurred with low incidences that were similar between treatment groups. Thus, vericiguat is an effective and generally well-tolerated treatment option in patients with symptomatic, chronic HFrEF who have experienced a recent worsening event, expanding the options currently available for chronic HFrEF management.
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331
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Berisha-Muharremi V, Henein MY, Dini FL, Haliti E, Bytyçi I, Ibrahimi P, Poniku A, Batalli A, Tafarshiku R, Elezi S, Bajraktari G. Diabetes Is the Strongest Predictor of Limited Exercise Capacity in Chronic Heart Failure and Preserved Ejection Fraction (HFpEF). Front Cardiovasc Med 2022; 9:883615. [PMID: 35694665 PMCID: PMC9178085 DOI: 10.3389/fcvm.2022.883615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 04/21/2022] [Indexed: 11/24/2022] Open
Abstract
Background and Aim Type 2 diabetes mellitus (T2DM) is a known risk factor in patients with heart failure (HF), but its impact on phenotypic presentations remains unclear. This study aimed to prospectively examine the relationship between T2DM and functional exercise capacity, assessed by the 6-min walk test (6-MWT) in chronic HF. Methods We studied 344 chronic patients with HF (mean age 61 ± 10 years, 54% female) in whom clinical, biochemical, and anthropometric data were available and all patients underwent an echo-Doppler study and a 6-MWT on the same day. The 6-MWT distance divided the cohort into; Group I: those who managed ≤ 300 m and Group II: those who managed >300 m. Additionally, left ventricular (LV) ejection fraction (EF), estimated using the modified Simpson's method, classified patients into HF with preserved EF (HFpEF) and HF with reduced EF (HFrEF). Results The results showed that 111/344 (32%) patients had T2DM, who had a higher prevalence of arterial hypertension (p = 0.004), higher waist/hips ratio (p = 0.041), higher creatinine (p = 0.008) and urea (p = 0.003), lower hemoglobin (p = 0.001), and they achieved shorter 6-MWT distance (p < 0.001) compared with those with no T2DM. Patients with limited exercise (<300 m) had higher prevalence of T2DM (p < 0.001), arterial hypertension (p = 0.004), and atrial fibrillation (p = 0.001), higher waist/hips ratio (p = 0.041), higher glucose level (p < 0.001), lower hemoglobin (p < 0.001), larger left atrium (LA) (p = 0.002), lower lateral mitral annular plane systolic excursion (MAPSE) (p = 0.032), septal MAPSE (p < 0.001), and tricuspid annular plane systolic excursion (TAPSE) (p < 0.001), compared with those performing >300 m. In the cohort as a whole, multivariate analysis, T2DM (p < 0.001), low hemoglobin (p = 0.008), atrial fibrillation (p = 0.014), and reduced septal MAPSE (p = 0.021) independently predicted the limited 6-MWT distance. In patients with HFpEF, diabetes [6.083 (2.613–14.160), p < 0.001], atrial fibrillation [6.092 (1.769–20.979), p = 0.002], and septal MAPSE [0.063 (0.027–0.184), p = 0.002], independently predicted the reduced 6-MWT, whereas hemoglobin [0.786 (0.624–0.998), p = 0.049] and TAPSE [0.462 (0.214–0.988), p = 0.041] predicted it in patients with HFrEF. Conclusion Predictors of exercise intolerance in patients with chronic HF differ according to LV systolic function, demonstrated as EF. T2DM seems the most powerful predictor of limited exercise capacity in patients with HFpEF.
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Affiliation(s)
- Venera Berisha-Muharremi
- Medical Faculty, University of Prishtina, Prishtina, Kosovo
- Clinic of Endocrinology, University Clinical Centre of Kosova, Prishtina, Kosovo
| | - Michael Y. Henein
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Frank L. Dini
- Cardiovascular Diseases Unit 1, Cardiac, Thoracic and Vascular Department, University of Pisa, Pisa, Italy
| | - Edmond Haliti
- Medical Faculty, University of Prishtina, Prishtina, Kosovo
- Clinic of Cardiology, University Clinical Centre of Kosova, Prishtina, Kosovo
| | - Ibadete Bytyçi
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
- Clinic of Cardiology, University Clinical Centre of Kosova, Prishtina, Kosovo
| | - Pranvera Ibrahimi
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
- Clinic of Cardiology, University Clinical Centre of Kosova, Prishtina, Kosovo
| | - Afrim Poniku
- Medical Faculty, University of Prishtina, Prishtina, Kosovo
- Clinic of Cardiology, University Clinical Centre of Kosova, Prishtina, Kosovo
| | - Arlind Batalli
- Medical Faculty, University of Prishtina, Prishtina, Kosovo
- Clinic of Cardiology, University Clinical Centre of Kosova, Prishtina, Kosovo
| | - Rina Tafarshiku
- Medical Faculty, University of Prishtina, Prishtina, Kosovo
- Clinic of Endocrinology, University Clinical Centre of Kosova, Prishtina, Kosovo
| | - Shpend Elezi
- Medical Faculty, University of Prishtina, Prishtina, Kosovo
- Clinic of Cardiology, University Clinical Centre of Kosova, Prishtina, Kosovo
| | - Gani Bajraktari
- Medical Faculty, University of Prishtina, Prishtina, Kosovo
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
- Clinic of Cardiology, University Clinical Centre of Kosova, Prishtina, Kosovo
- *Correspondence: Gani Bajraktari
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Berezin AE, Berezin AA. Point-of-care heart failure platform: where are we now and where are we going to? Expert Rev Cardiovasc Ther 2022; 20:419-429. [PMID: 35588730 DOI: 10.1080/14779072.2022.2080657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Heart failure (HF) remains a leading cause of cardiovascular (CV) mortality in patients with CV disease. The point-of-care (POC) HF platform seems to be an ideal non-invasive workflow-adapted system for personally adjusted management of patients with HF. AREAS COVERED In the present manuscript, we reviewed the literature covering some relevant studies regarding the role of point-of care heart failure platform in the risk stratification, earlier diagnosis and prognostically beneficial treatment of patients with different phenotypes of HF. EXPERT OPINION POC HF platform including personal consultation, optimization of the comorbidity treatment, step-by-step HF diagnostic algorithm, single biomarker measurements, has also partially been provided in the current guidelines. Although there are several obstacles to implement POC in routine practice, such as education level, aging, affordability of health care, even partial implementation of POC can also improve clinical outcomes. POC seems to be an evolving model, more research studies are required to clearly see whether it helps to make better decisions with diagnosis and care of HF, as well helps to achieve better clinical outcomes.In summary, the POC HF platform is considered to be a more effective tool than conventional algorithm of HF management.
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Affiliation(s)
- Alexander E Berezin
- Internal Medicine Department, Zaporozhye State Medical University, 26, Mayakovsky av., Zaporozhye, Ukraine
| | - Alexander A Berezin
- Internal Medicine Department, Zaporozhye Medical Academy of Postgraduate Education, Zaporozhye, Ukraine
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Heart Failure—Do We Need New Drugs or Have Them Already? A Case of Coenzyme Q10. J Cardiovasc Dev Dis 2022; 9:jcdd9050161. [PMID: 35621872 PMCID: PMC9143244 DOI: 10.3390/jcdd9050161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 05/08/2022] [Accepted: 05/13/2022] [Indexed: 12/04/2022] Open
Abstract
Heart failure (HF) is a global epidemic that contributes to the deterioration of quality of life and its shortening in 1–3% of adult people in the world. Pharmacotherapy of HF should rely on highly effective drugs that improve prognosis and prolong life. Currently, the ESC guidelines from 2021 indicate that ACEI, ARNI, BB, and SGLT2 inhibitors are the first-line drugs in HF. It is also worth remembering that the use of coenzyme Q10 brought many benefits in patients with HF. Coenzyme Q10 is a very important compound that performs many functions in the human body. The most important function of coenzyme Q10 is participation in the production of energy in the mitochondria, which determines the proper functioning of all cells, tissues, and organs. The highest concentration of coenzyme Q10 is found in the tissue of the heart muscle. As the body ages, the concentration of coenzyme Q10 in the tissue of the heart muscle decreases, which makes it more susceptible to damage by free radicals. It has been shown that in patients with HF, the aggravation of disease symptoms is inversely related to the concentration of coenzyme Q10. Importantly, the concentration of coenzyme Q10 in patients with HF was an important predictor of the risk of death. Long-term coenzyme Q10 supplementation at a dose of 300 mg/day (Q-SYMBIO study) has been shown to significantly improve heart function and prognosis in patients with HF. This article summarizes the latest and most important data on CoQ10 in pathogenesis.
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Serezhina EK, Obrezan AG. [Applicability of the load dynamometric test and speckle tracking echocardiography in the heart failure with preserved ejection fraction diagnosis]. KARDIOLOGIIA 2022; 62:36-43. [PMID: 35569162 DOI: 10.18087/cardio.2022.4.n1804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 11/14/2021] [Accepted: 11/26/2021] [Indexed: 06/15/2023]
Abstract
Aim To compare myocardial deformation properties in patients with heart failure (HF) with preserved left ventricular ejection fraction (HFpEF) and in healthy volunteers at rest and during a dynamometric test; to determine a possibility of using this method for diagnosing HSpEF.Material and methods STE with simultaneous electrocardiogram recording was performed for patients with HSpEF and healthy volunteers of the control group at rest and during a dynamometric test. The subjects were instructed to maintain a submaximal compression of a hand dynamometer for 3 min and to apply a maximum effort during the last 30 sec while continuing to breathe regularly. Concentrations of markers for myocardial injury and HF were measured. Statistical analytical methods are provided in Results. For other calculations, a MS Office (Microsoft Excel) application software package was used.Results Differences in myocardial deformation variables between healthy volunteers and HF patients were more obvious during exercise, including changes of the variables from the resting values. As compared with the control group, patients with HFpEF had considerable deviations of the heart rate and the left ventricular global longitudinal strain (GLSLV) (significance of differences calculated with ANOVA was higher than 95% and 80%; p<0.05 and p<0.2, respectively). Patients with a significant change in the strain, regardless of the direction of the change, showed a decrease in the left ventricular ejection fraction (EFLV) during the test with a probability above 95% according to the Fischer test. Also, patients with HFpEF had higher concentrations of N-terminal pro-brain natriuretic peptide and symptoms of HF. Compared to evaluation of overall GLSLV, calculation of deformation variables by segment detected more differences between patients with HFpEF and control subjects.Conclusion STE with a dynamometric test is an effective, noninvasive method for diagnosing HFpEF that is easy to perform in the outpatient conditions.
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Fu Z, An L, Lu X, Sheng L, Liu H. Serum Chloride Is Inversely Associated With 3 Months Outcomes in Chinese Patients With Heart Failure, a Retrospective Cohort Study. Front Cardiovasc Med 2022; 9:855053. [PMID: 35571169 PMCID: PMC9096445 DOI: 10.3389/fcvm.2022.855053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 03/29/2022] [Indexed: 11/30/2022] Open
Abstract
Background Serum chloride was recently found to be associated with prognosis of heart failure in western countries. However, the evidence was scarce in Asia. We aimed to investigated the relationship between serum chloride and clinical outcomes in a Chinese cohort with hospitalized heart failure. Methods We retrospectively analyzed the data from PhysioNet, involving 1996 patients who were admitted with heart failure between December 2016 and June 2019. Outcome was a composite endpoint of all-cause death or rehospitalization at 3 months. Results The incidence of the composite endpoint was 26.8% (535/1,996); it was 32.2% (213/662), 25.0% (165/661), and 23.3% (157/673) by chloride tertiles (from the lowest to the highest), respectively. The serum chloride at admission was independently and inversely associated with the composite endpoint risk (hazard ratio: 0.967; 95% confidence interval: 0.939 to 0.996; p = 0.026) in contrast to sodium, which was no longer significant (p > 0.05) after multivariable adjustment. Pearson correlation between serum chloride and sodium was 0.747 (p < 0.001). However, an increased AUC was not observed by adding sodium to model composed of age, sex, NYHA class, diabetes, log BNP and chloride (0.620 vs. 0.612, p = 0.132). Subgroup analysis showed the presence or absence of hyponatremia did not affect the association between chloride and composite endpoint risk. Conclusions Low serum chloride at admission was associated with poor outcomes in Chinese hospitalized patients with heart failure. These findings warrant future studies for tackling the potential pathophysiological mechanisms and correction methods of hypochloremia in heart failure.
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Affiliation(s)
- Zhiqing Fu
- Department of Cardiology, The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China
| | - Li An
- Department of Respiratory and Critical Care Medicine, The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China
| | - Xiaochun Lu
- Department of Cardiology, The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China
| | - Li Sheng
- Department of Cardiology, The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China
- *Correspondence: Li Sheng
| | - Hongbin Liu
- Department of Cardiology, The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China
- Hongbin Liu
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336
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Reeder KM, Peek GM, Nazir N. Prehospitalization Symptom Perceptions, Lay Consultations, and Treatment-Seeking for Acute Decompensating Heart Failure: Implications for Nursing Practice. Crit Care Nurs Clin North Am 2022; 34:129-140. [DOI: 10.1016/j.cnc.2022.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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337
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Cao Y, Li P, Li Y, Han Y. Sodium-glucose cotransporter-2 inhibitors in heart failure: an updated meta-analysis. ESC Heart Fail 2022; 9:1942-1953. [PMID: 35338608 PMCID: PMC9065870 DOI: 10.1002/ehf2.13905] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Revised: 02/10/2022] [Accepted: 03/07/2022] [Indexed: 01/10/2023] Open
Abstract
Aims We aimed to examine efficacy and safety outcomes of sodium‐glucose cotransporter‐2 inhibitor (SGLT2i) for the treatment of heart failure (HF), especially in patients with heart failure with preserved ejection fraction (HFpEF). Methods and results PubMed, Web of Science, and Cochrane Library were searched to identify randomized controlled trials comparing SGLT2i vs. placebo in HF patients. A total of 10 studies with 23 852 HF patients were eventually included. Compared with placebo, SGLT2i is associated with a lower incidence of composite of first hospitalization for heart failure (HHF) or cardiovascular death (CV death) [hazard ratio (HR) = 0.76 95% confidence interval (CI) = 0.71–0.81], which is consistent regardless of the diabetes status, type of gliflozines used, and follow‐up duration. SGLT2i can reduce the risk of total HHF or CV death (HR = 0.74, 95%CI = 0.68–0.81), first HHF (HR = 0.69, 95%CI = 0.64–0.75), CV death (HR = 0.88, 95%CI = 0.80–0.96), any death (HR = 0.90, 95%CI = 0.83–0.97), and any serious events (HR = 0.90, 95%CI = 0.87–0.93) in HF patients, at the cost of increased risk of urinary tract infections (risk ratio = 1.17, 95%CI = 1.03–1.33). In HFpEF patients, SGLT2i is associated with a significant reduction of composite of first HHF or CV death (HR = 0.81, 95%CI = 0.73–0.91), first HHF (HR = 0.71, 95%CI = 0.62–0.82), and total HHF or CV death (HR = 0.61, 95%CI = 0.43–0.86). Conclusions Sodium‐glucose cotransporter‐2 inhibitor contributed to better efficacy outcomes in overall HF patients and showed an inspiring breakthrough in the treatment of HFpEF.
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Affiliation(s)
- Yang Cao
- The Department of Cardiology, Xijing Hospital, Air Force Medical University, Xi'an, China.,The Department of Cardiology, General Hospital of Northern Theater Command, 83 Wenhua Road, Shenyang, 110016, China
| | - Pengxiao Li
- The Department of Cardiology, Xijing Hospital, Air Force Medical University, Xi'an, China.,The Department of Cardiology, General Hospital of Northern Theater Command, 83 Wenhua Road, Shenyang, 110016, China
| | - Yi Li
- The Department of Cardiology, General Hospital of Northern Theater Command, 83 Wenhua Road, Shenyang, 110016, China
| | - Yaling Han
- The Department of Cardiology, General Hospital of Northern Theater Command, 83 Wenhua Road, Shenyang, 110016, China
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338
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Muñoz M, Eren Cimenci C, Goel K, Comtois-Bona M, Hossain M, McTiernan C, Zuñiga-Bustos M, Ross A, Truong B, Davis DR, Liang W, Rotstein B, Ruel M, Poblete H, Suuronen EJ, Alarcon EI. Nanoengineered Sprayable Therapy for Treating Myocardial Infarction. ACS NANO 2022; 16:3522-3537. [PMID: 35157804 DOI: 10.1021/acsnano.1c08890] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
We report the development, as well as the in vitro and in vivo testing, of a sprayable nanotherapeutic that uses surface engineered custom-designed multiarmed peptide grafted nanogold for on-the-spot coating of an infarcted myocardial surface. When applied to mouse hearts, 1 week after infarction, the spray-on treatment resulted in an increase in cardiac function (2.4-fold), muscle contractility, and myocardial electrical conductivity. The applied nanogold remained at the treatment site 28 days postapplication with no off-target organ infiltration. Further, the infarct size in the mice that received treatment was found to be <10% of the total left ventricle area, while the number of blood vessels, prohealing macrophages, and cardiomyocytes increased to levels comparable to that of a healthy animal. Our cumulative data suggest that the therapeutic action of our spray-on nanotherapeutic is highly effective, and in practice, its application is simpler than other regenerative approaches for treating an infarcted heart.
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Affiliation(s)
- Marcelo Muñoz
- BEaTS Research, Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, Ontario K1Y 4W7, Canada
| | - Cagla Eren Cimenci
- BEaTS Research, Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, Ontario K1Y 4W7, Canada
- Department of Cellular and Molecular Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Ontario K1H 8M5, Canada
| | - Keshav Goel
- BEaTS Research, Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, Ontario K1Y 4W7, Canada
| | - Maxime Comtois-Bona
- BEaTS Research, Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, Ontario K1Y 4W7, Canada
| | - Mahir Hossain
- BEaTS Research, Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, Ontario K1Y 4W7, Canada
| | - Christopher McTiernan
- BEaTS Research, Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, Ontario K1Y 4W7, Canada
| | - Matias Zuñiga-Bustos
- Departamento de Bioinformática, Centro de Bioinformática, Simulación y Modelado (CBSM), Facultad de Ingeniería, Universidad de Talca, Campus Talca, 2 Norte 685, 3460000, Talca, Chile
| | - Alex Ross
- BEaTS Research, Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, Ontario K1Y 4W7, Canada
| | - Brenda Truong
- BEaTS Research, Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, Ontario K1Y 4W7, Canada
| | - Darryl R Davis
- University of Ottawa Heart Institute, Division of Cardiology, Department of Medicine, University of Ottawa, Ottawa, Ontario K1Y 4W7, Canada
- Cardiac Electrophysiology Lab, University of Ottawa, Ottawa, Ontario K1Y 4W7, Canada
| | - Wenbin Liang
- University of Ottawa Heart Institute, Division of Cardiology, Department of Medicine, University of Ottawa, Ottawa, Ontario K1Y 4W7, Canada
- Cardiac Electrophysiology Lab, University of Ottawa, Ottawa, Ontario K1Y 4W7, Canada
| | - Benjamin Rotstein
- Department of Biochemistry, Microbiology, and Immunology, Faculty of Medicine, University of Ottawa, Ottawa, Ontario K1H 8M5, Canada
- Molecular Imaging Probes and Radiochemistry Laboratory, University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, Ontario K1Y 4W7, Canada
| | - Marc Ruel
- BEaTS Research, Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, Ontario K1Y 4W7, Canada
- Department of Cellular and Molecular Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Ontario K1H 8M5, Canada
| | - Horacio Poblete
- Departamento de Bioinformática, Centro de Bioinformática, Simulación y Modelado (CBSM), Facultad de Ingeniería, Universidad de Talca, Campus Talca, 2 Norte 685, 3460000, Talca, Chile
- Millennium Nucleus of Ion Channels-Associated Diseases (MiNICAD), Universidad de Talca, 2 Norte 685, 3460000 Talca, Chile
| | - Erik J Suuronen
- BEaTS Research, Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, Ontario K1Y 4W7, Canada
- Department of Cellular and Molecular Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Ontario K1H 8M5, Canada
| | - Emilio I Alarcon
- BEaTS Research, Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, Ontario K1Y 4W7, Canada
- Molecular Imaging Probes and Radiochemistry Laboratory, University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, Ontario K1Y 4W7, Canada
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339
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Prediction of Adverse Post-Infarction Left Ventricular Remodeling Using a Multivariate Regression Model. Diagnostics (Basel) 2022; 12:diagnostics12030770. [PMID: 35328323 PMCID: PMC8947346 DOI: 10.3390/diagnostics12030770] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 03/13/2022] [Accepted: 03/17/2022] [Indexed: 11/17/2022] Open
Abstract
Background. In order to provide personalized medicine and improve cardiovascular outcomes, a method for predicting adverse left ventricular remodeling (ALVR) after ST-segment elevation myocardial infarction (STEMI) is needed. Methods. A total of 125 STEMI patients, mean age 51.2 (95% CI 49.6; 52.7) years were prospectively enrolled. The clinical, laboratory, and instrumental examinations were performed between the 7th and 9th day, and after 24 and 48 weeks, including plasma analysis of brain natriuretic peptide (BNP), transthoracic echocardiography, analysis of left ventricular-arterial coupling, applanation tonometry, ultrasound examination of the common carotid arteries with RF signal amplification. Results. Patients were divided into 2 groups according to echocardiography: “ALVR” (n = 63)—end-diastolic volume index (EDVI) >20% and/or end-systolic volume index (ESVI) >15% after 24 weeks compared with initial values; “non-ALVR” (n = 62)—EDVI <20% and ESVI <15%. In the ALVR group, hard endpoints (recurrent myocardial infarction, unstable angina, hospitalization for decompensated heart failure, ventricular arrhythmias, cardiac surgery, cardiovascular death) were detected in 19 people (30%). In the non-ALVR group, hard endpoints were noted in 3 patients (5%). The odds ratio of developing an adverse outcome in ALVR vs. non-ALVR group was 8.5 (95% CI 2.4−30.5) (p = 0.0004). According to the multivariate analysis, the contribution of each of the indicators to the relative risk (RR) of adverse cardiac remodeling: waist circumference, RR = 1.02 (95% CI 1.001−1.05) (p = 0.042), plasma BNP—RR = 1.81 (95% CI 1.05−3.13) (p = 0.033), arterial elastance to left ventricular end-systolic elastance (Ea/Ees)—RR = 1.96 (95% CI 1.11−3.46) (p = 0.020). Conclusion. Determining ALVR status in early stages of the disease can accurately predict and stratify the risk of adverse outcomes in STEMI patients.
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340
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Berezin AE, Mozos I, Petrovič D. Editorial: Epigenetics in Heart Failure Developing: The Orchestra of Etiology and Comorbidities. Front Cardiovasc Med 2022; 9:869613. [PMID: 35369300 PMCID: PMC8971835 DOI: 10.3389/fcvm.2022.869613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 02/14/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Alexander E Berezin
- Internal Medicine Department, Zaporozhye State Medical University, Zaporozhye, Ukraine
| | - Ioana Mozos
- Department of Functional Science, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania
| | - Daniel Petrovič
- Faculty of Medicine, Institute of Histology and Embryology, University of Ljubljana, Ljubljana, Slovenia
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341
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Differences in Outpatient Health Care Utilization 12 Months after COVID-19 Infection by Race/Ethnicity and Community Social Vulnerability. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19063481. [PMID: 35329165 PMCID: PMC8949439 DOI: 10.3390/ijerph19063481] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 03/09/2022] [Accepted: 03/10/2022] [Indexed: 01/27/2023]
Abstract
Ensuring access to high-quality outpatient care is an important strategy to improve COVID-19 outcomes, reduce social inequities, and prevent potentially expensive complications of disease. This study assesses the equity of health care response to COVID-19 by examining outpatient care utilization by factors at the individual and community levels in the 12 months prior to and following COVID-19 diagnosis. Employing a retrospective, observational cohort design, we analyzed electronic health record data from a sample of 11,326 adults diagnosed with COVID-19 between March and July 2020. We used two-part models to estimate changes in use of primary and specialty care by race/ethnicity and community social vulnerability in the year before and after COVID-19 diagnosis. Our findings showed that while overall probability and counts of primary and specialty care visits increased following a positive COVID-19 diagnosis, disparities in care utilization by race/ethnicity and living in a socially vulnerable community persisted in the year that followed. These findings reiterate the need for strategic approaches to improve access to and utilization of care among those diagnosed with COVID-19, especially for individuals who are traditionally undeserved by the health system. Our findings also highlight the importance of systematic approaches for addressing social inequity in health care.
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342
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Inflammatory Markers and Risk of Heart Failure With Reduced to Preserved Ejection Fraction. Am J Cardiol 2022; 167:68-75. [PMID: 34986991 DOI: 10.1016/j.amjcard.2021.11.045] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 11/23/2021] [Accepted: 11/29/2021] [Indexed: 12/12/2022]
Abstract
Chronic systemic inflammation is associated with an increased risk of heart failure (HF). We sought to determine the association between biomarkers of systemic inflammation interleukin (IL)-6, IL-2, tumor necrosis factor alpha (TNF-α), and C-reactive protein (CRP) with those of HF and its subtypes. We hypothesize that inflammatory biomarkers IL-6, IL-2, TNF-α, and CRP are associated with HF and its subtypes. We included participants from the Multi-Ethnic Study of Atherosclerosis (a prospective population-based cohort study [2000 to 2002]), without a history of HF, and with available baseline inflammatory biomarkers. We explored the association of IL-6, IL-2, TNF-α, and CRP with incident HF, HF with reduced ejection fraction (left ventricular ejection fraction [LVEF] <40%, HFrEF), HF with midrange EF (LVEF 40% to 50%, HFmrEF), and HF with preserved ejection fraction (LVEF >50%, HFpEF). Among 6,814 participants, 195 developed HF over 10.9 years (56 HFrEF, 30 HFmrEF, and 57 HFpEF). In the models adjusted for clinical risk factors of HF, IL-6 (hazard ratio [HR] 1.33 per doubling; 95% confidence interval [CI] 1.10 to 1.60), TNF-α (HR 2.49 per doubling; 95% CI 1.18 to 5.28), and CRP (HR 1.18 per doubling; 95% CI 1.06 to 1.30) were associated with all HF, and IL-6 (HR 1.51 per doubling; 95% CI 1.09 to 2.10) and CRP (HR 1.21 per doubling; 95% CI: 1.01 to 1.45) were associated with incident HFpEF, whereas none of the examined biomarkers were associated with HFmrEF or HFrEF. In conclusion, inflammatory biomarkers (IL-6, TNF-α, and CRP) are independently associated with incident HF. IL-6 and CRP are associated with incident HFpEF but not HFrEF or HFmrEF. These findings suggest that activation of the IL-6/CRP pathway (as cause, consequence, or epiphenomenon) may be unique to HFpEF.
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343
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Obi CA, Mostertz WC, Griffin JM, Judge DP. ATTR Epidemiology, Genetics, and Prognostic Factors. Methodist Debakey Cardiovasc J 2022; 18:17-26. [PMID: 35414855 PMCID: PMC8932385 DOI: 10.14797/mdcvj.1066] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 12/23/2021] [Indexed: 01/15/2023] Open
Affiliation(s)
- Chukwuemeka A. Obi
- Division of Cardiology, Medical University of South Carolina, Charleston, South Carolina, US
| | - William C. Mostertz
- Division of Cardiology, Medical University of South Carolina, Charleston, South Carolina, US
| | - Jan M. Griffin
- Division of Cardiology, Medical University of South Carolina, Charleston, South Carolina, US
- Division of Cardiology, Columbia University Irving Medical Center, New York, New York, US
| | - Daniel P. Judge
- Division of Cardiology, Medical University of South Carolina, Charleston, South Carolina, US
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344
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Zheng J, Heidenreich PA, Kohsaka S, Fearon WF, Sandhu AT. Variability in Coronary Artery Disease Testing for Patients With New-Onset Heart Failure. J Am Coll Cardiol 2022; 79:849-860. [PMID: 35241218 PMCID: PMC9031351 DOI: 10.1016/j.jacc.2021.11.061] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 11/08/2021] [Accepted: 11/09/2021] [Indexed: 01/01/2023]
Abstract
BACKGROUND Coronary artery disease (CAD) is the most common cause of new-onset heart failure (HF). Although guidelines recommend ischemic evaluation in this population, testing has historically been underutilized. OBJECTIVES This study aimed to identify contemporary trends in CAD testing for patients with new-onset HF, particularly after publication of the STICHES (Surgical Treatment for Ischemic Heart Failure Extension Study), and to characterize geographic and clinician-level variability in testing patterns. METHODS We determined the proportion of patients with incident HF who received CAD testing from 2004 to 2019 using an administrative claims database covering commercial insurance and Medicare. We identified demographic and clinical predictors of CAD testing during the 90 days before and after initial diagnosis. Patients were grouped by their county of residence to assess national variation. Patients were then linked to their primary care physician and/or cardiologist to evaluate variation across clinicians. RESULTS Among 558,322 patients with new-onset HF, 34.8% underwent CAD testing and 9.3% underwent revascularization. After multivariable adjustment, patients who underwent CAD testing were more likely to be younger, male, diagnosed in an acute care setting, and have systolic dysfunction or recent cardiogenic shock. Incidence of CAD testing remained flat without significant change post-STICHES. Covariate-adjusted testing rates varied from 20% to 45% across counties. The likelihood of testing was higher among patients co-managed by a cardiologist (adjusted OR: 5.12; 95% CI: 4.98-5.27) but varied substantially across cardiologists (IQR: 50.9%-62.4%). CONCLUSIONS Most patients with new-onset HF across inpatient and outpatient settings did not receive timely testing for CAD. Substantial variability in testing persists across regions and clinicians.
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Affiliation(s)
- Jimmy Zheng
- Stanford University School of Medicine, Stanford, California, USA.
| | - Paul A Heidenreich
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University, Stanford, California, USA; Department of Medicine, Palo Alto VA Veteran's Affairs Hospitals, Palo Alto, California, USA. https://twitter.com/paheidenreich
| | - Shun Kohsaka
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - William F Fearon
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University, Stanford, California, USA; Department of Medicine, Palo Alto VA Veteran's Affairs Hospitals, Palo Alto, California, USA. https://twitter.com/wfearonmd
| | - Alexander T Sandhu
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University, Stanford, California, USA. https://twitter.com/ATSandhu
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345
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Januzzi JL, Ohman EM. Underdiagnosis of Ischemic Heart Disease in New-Onset Heart Failure: A Call to Action. J Am Coll Cardiol 2022; 79:861-863. [PMID: 35241219 DOI: 10.1016/j.jacc.2022.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 01/10/2022] [Accepted: 01/11/2022] [Indexed: 10/19/2022]
Affiliation(s)
- James L Januzzi
- Massachusetts General Hospital, Harvard Medical School and Baim Institute for Clinical Research, Boston, Massachusetts, USA.
| | - E Magnus Ohman
- Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina, USA
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346
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Zhang X, Wang T, Chen Z, Wang H, Yin Y, Wang L, Wang Y, Xu B, Xu W. HMGB1‐Promoted Neutrophil Extracellular Traps Contribute to Cardiac Diastolic Dysfunction in Mice. J Am Heart Assoc 2022; 11:e023800. [PMID: 35156391 PMCID: PMC9245819 DOI: 10.1161/jaha.121.023800] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Background Heart failure with preserved ejection fraction (HFpEF) remains an increasing public health problem with substantial morbidity and mortality but with few effective treatments. A novel inflammatory mechanism has been proposed, but the inflammatory signals promoting the development of HFpEF remain greatly unknown. Methods and Results Serum of patients with HFpEF was collected for measurement of circulating neutrophils and markers of neutrophil extracellular traps (NETs). To induce HFpEF phenotype, male C57BL/6 mice underwent uninephrectomy, received a continuous infusion of d‐aldosterone for 4 weeks, and maintained on 1.0% sodium chloride drinking water. Heart tissues were harvested, immune cell types determined by flow cytometry, NETs formation by immunofluorescence, and western blotting. Differentiated neutrophils were cultured to investigate the effect of HMGB1 (high mobility group protein B1) and SGLT2 (sodium‐glucose cotransporter‐2) inhibitor on NETs formation in vitro. Circulating neutrophils and NETs markers are elevated in patients with HFpEF, as are cardiac neutrophils and NETs formation in HFpEF mice. NETs inhibition with deoxyribonuclease 1 in experimental HFpEF mice reduces heart macrophages infiltration and inflammation and ameliorates cardiac fibrosis and diastolic function. Damage‐associated molecular pattern HMGB1 expression is elevated in cardiac tissue of HFpEF mice, and HMGB1 inhibition reduces heart neutrophil infiltration and NETs formation and ameliorates diastolic function. Lastly, SGLT2 inhibitor empagliflozin down‐regulates heart HMGB1 expression, attenuates NETs formation and cardiac fibrosis, and improves diastolic function in HFpEF mice. Conclusions NETs contribute to the pathogenesis of HFpEF, which can be ameliorated by HMGB1 inhibition and SGLT2 inhibitors. Thus, HMGB1 and NETs may represent novel therapeutic targets for the treatment of HFpEF.
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Affiliation(s)
- Xin‐Lin Zhang
- Department of Cardiology Affiliated Drum Tower Hospital Nanjing University School of Medicine Nanjing China
| | - Ting‐Yu Wang
- Central for Translational Medicine Nanjing University School of Medicine Nanjing China
- State Key Laboratory of Analytical Chemistry for Life Science & Jiangsu Key Laboratory of Molecular Medicine Nanjing University School of Medicine Nanjing China
| | - Zheng Chen
- Department of Cardiology Affiliated Drum Tower Hospital Nanjing University School of Medicine Nanjing China
| | - Hong‐Wei Wang
- Central for Translational Medicine Nanjing University School of Medicine Nanjing China
- State Key Laboratory of Analytical Chemistry for Life Science & Jiangsu Key Laboratory of Molecular Medicine Nanjing University School of Medicine Nanjing China
| | - Yong Yin
- Department of Cardiology Affiliated Drum Tower Hospital Nanjing University School of Medicine Nanjing China
| | - Lian Wang
- Department of Cardiology Affiliated Drum Tower Hospital Nanjing University School of Medicine Nanjing China
| | - Yong Wang
- Central for Translational Medicine Nanjing University School of Medicine Nanjing China
- State Key Laboratory of Analytical Chemistry for Life Science & Jiangsu Key Laboratory of Molecular Medicine Nanjing University School of Medicine Nanjing China
| | - Biao Xu
- Department of Cardiology Affiliated Drum Tower Hospital Nanjing University School of Medicine Nanjing China
| | - Wei Xu
- Department of Cardiology Affiliated Drum Tower Hospital Nanjing University School of Medicine Nanjing China
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347
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Bagherieh S, Ghoshouni H, Bostan F, Afshari-Safavi A, Badihian S, Barzegar M, Shaygannejad V, Mirmosayyeb O. Incidence, Prevalence, and Characteristics of Heart Failure Among Patients with Multiple Sclerosis; A Systematic Review and Meta-Analysis. Mult Scler Relat Disord 2022; 59:103665. [DOI: 10.1016/j.msard.2022.103665] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 01/17/2022] [Accepted: 02/03/2022] [Indexed: 11/24/2022]
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348
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Riascos-Bernal DF, Sibinga NE. Neutrophil extracellular traps in cardiac hypertrophy: a KLF2 perspective. J Clin Invest 2022; 132:e156453. [PMID: 35104806 PMCID: PMC8803320 DOI: 10.1172/jci156453] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
About 6 million adults in the United States have heart failure, and the mortality five years after diagnosis remains high at approximately 50%. Incomplete understanding of disease pathogenesis limits therapeutics, especially in the case of heart failure with preserved ejection fraction, a condition commonly associated with cardiac hypertrophy. Neutrophils, the most abundant leukocyte in blood, have functions beyond antimicrobial activity and participate in both sterile inflammation and disease; however, their role in nonischemic cardiac hypertrophy and heart failure is underexplored. In this issue of the JCI, Tang et al. show that neutrophil extracellular trap (NET) formation contributes to cardiac hypertrophy and dysfunction in a mouse model of angiotensin II-induced cardiomyopathy, and that Krüppel-like factor 2 (KLF2) functions in neutrophils to oppose this process. Whether a neutrophil-centered strategy may benefit patients with cardiac hypertrophy and failure deserves further investigation.
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Affiliation(s)
- Dario F. Riascos-Bernal
- Department of Medicine (Cardiology) and Wilf Family Cardiovascular Research Institute and
- Department of Developmental and Molecular Biology, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Nicholas E.S. Sibinga
- Department of Medicine (Cardiology) and Wilf Family Cardiovascular Research Institute and
- Department of Developmental and Molecular Biology, Albert Einstein College of Medicine, Bronx, New York, USA
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349
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Hussain A, Misra A, Bozkurt B. Endpoints in Heart Failure Drug Development. Card Fail Rev 2022; 8:e01. [PMID: 35111335 PMCID: PMC8790723 DOI: 10.15420/cfr.2021.13] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 10/16/2021] [Indexed: 11/17/2022] Open
Abstract
Heart failure (HF) is a major health problem worldwide. The development of effective drug and/or device therapy is crucial to mitigate the significant morbidity, mortality and healthcare costs associated with HF. The choice of endpoint in clinical trials has important practical and clinical implications. Outcomes of interest including mortality and HF hospitalisations provide robust evidence for regulatory approval granted there is sufficiency of safety data. At the same time, it is important to recognise that HF patients experience significant impairments in functional capacity and quality of life, underscoring the need to incorporate parameters of symptoms and patient-reported outcomes in clinical trials. In this review, the authors summarise the evolution and definition of cardiovascular endpoints used in clinical trials, discuss approaches to study design to allow the incorporation of mortality, morbidity and functional endpoints and, finally, examine the current challenges and suggest steps for the development of cardiovascular endpoints that are effective, meaningful and meet the needs of all relevant stakeholders, including patients, physicians regulators and sponsors.
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Affiliation(s)
- Aliza Hussain
- Winters Center for Heart Failure, Cardiology, Baylor College of Medicine and Michael E DeBakey VA Medical Center, Houston, TX, US
| | - Arunima Misra
- Winters Center for Heart Failure, Cardiology, Baylor College of Medicine and Michael E DeBakey VA Medical Center, Houston, TX, US
| | - Biykem Bozkurt
- Winters Center for Heart Failure, Cardiology, Baylor College of Medicine and Michael E DeBakey VA Medical Center, Houston, TX, US; Cardiovascular Research Institute, Baylor College of Medicine, Houston, TX, US
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350
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Poletti V, Pagnini F, Banfi P, Volpato E. The Role of Depression on Treatment Adherence in Patients with Heart Failure-a Systematic Review of the Literature. Curr Cardiol Rep 2022; 24:1995-2008. [PMID: 36327056 PMCID: PMC9747824 DOI: 10.1007/s11886-022-01815-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/14/2022] [Indexed: 11/06/2022]
Abstract
INTRODUCTION Although poor medication adherence is considered an impacting risk factor for worsening heart failure (HF) outcomes, adherence rates in HF patients continue to be considerably low. To improve this condition, several studies investigated the impact of many determinants on medication adherence; however, few authors explored the role of depression on it. PURPOSE OF REVIEW The purpose of this systematic review was to explore the association between depressive symptoms and medication adherence in HF patients. In particular, the research question was is depression a barrier to medication adherence in HF patients? METHODS A systematic review of quantitative analysis studies was undertaken. Six electronic databases were searched between the end of October and March 2022. Thirty-one trials were included, all of them assessed depression, adherence to medication, and their possible relationship. RESULTS As was intended, findings showed that the impact of a mild to moderate level of depression was significant on adherence to treatment in HF patients. However, many other risk factors emerged, like family support and health practices (es. low sodium diet). CONCLUSION The detection of depression in the setting of HF should be crucial to HF patients' physical health and quality of life. Future research should take depression into account, exploring this area through self-report and qualitative interview as well.
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Affiliation(s)
- Valentina Poletti
- Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy
| | - Francesco Pagnini
- Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy
- Department of Psychology, Harvard University, Cambridge, MA USA
| | | | - Eleonora Volpato
- Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy
- IRCCS Fondazione Don Gnocchi, Milan, Italy
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