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Abusafieh AM, Shajrawi AM, Al-Smadi AM, Saleh A, Masa'deh R, Ismaile S, Abdelhaq MJ. The Relationship Between Self-Efficacy and Functional Capacity Among Discharged Heart Failure Patients in Jordan. Dimens Crit Care Nurs 2024; 43:136-145. [PMID: 38564456 DOI: 10.1097/dcc.0000000000000633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND Self-efficacy is an important factor associated with healthy lifestyle changes in heart failure treatment. Functional capacity testing of heart failure patients (HFPs) can stratify prognosis. Reduced functional capacities in HFPs are linked to a poor heart failure prognosis. Limited research has examined the potential relationship between self-efficacy and functional capacity. AIM The aims of this study were to assess self-efficacy level and functional capacity among HFPs after hospitalization, and examine whether there is a relationship between them. METHODS A descriptive correlational design was used. A convenience sample of 220 HFPs was recruited from 2 hospitals in Jordan. The Arabic version of Cardiac Self-Efficacy Questionnaire was used to assess self-efficacy, the 6-Minute Walking Test (6-MWT) was used to assess functional capacity, and the Borg rating of perceived exertion scale (Borg Scale) was used to assess exertion during 6-MWT. RESULT The sample included 46.8% male (n = 103) and 53.2% female (n = 117). The mean age was 52.66 ± 8.91 years. Most of the HFPs were categorized based on New York Heart Association classification as class I, 35.9% (n = 79), and class II, 41.4% (n = 91). The mean ejection fraction was 41.46 ± 9.44. The global self-efficacy was moderate (32.98 ± 9.92), and the mean score for the 6-MWT was 494.35 ± 143.37. The Borg Scale mean was 10.94 ± 3.34. In addition, there was a positive relationship between self-efficacy and 6-MWT (r = 0.63, n = 220, P = .01). CONCLUSION This study provides baseline data for further research on treatment of HFPs, and the development of evidence-based tailored health interventions to maintain and improve self-efficacy and functional capacity among these service users. Moreover, replicated researches can test the study results considering different methodologies, such as using objective functional capacity tool and longer follow-up periods.
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Patil D, Tang HJ, Kuo FH, Toh HS, Yang IN, Chang WT, Lee MC, Chung KN, Huang CY, Hsu WH, Chang TC, Shih JY, Liao CT. Assessing the diversity and determinants of health-related quality of life measures in patients with acute heart failure. ESC Heart Fail 2024. [PMID: 38509031 DOI: 10.1002/ehf2.14745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Revised: 02/04/2024] [Accepted: 02/19/2024] [Indexed: 03/22/2024] Open
Abstract
AIMS Heart failure with reduced ejection fraction (HFrEF) significantly impacts health-related quality of life (HR-QoL). Existing HR-QoL questionnaires can show inconsistencies, potentially misrepresenting patient self-reports. This study examines the variation in HR-QoL measurement tools for HFrEF patients, identifying related determinants. METHODS AND RESULTS We retrospectively analysed 134 hospitalized patients with acute decompensated HFrEF at a Taiwanese tertiary centre's Heart Failure Post-Acute-Care (HF-PAC) programme. Participants completed the EuroQol-5 dimension (EQ-5D) questionnaire, the EQ-5D visual analogue scale (VAS), and the Minnesota Living with Heart Failure Questionnaire (MLHFQ). Utility values were obtained from the EQ-5D questionnaire. Demographic features were depicted using descriptive statistics, while multivariate regression was used to ascertain relationships between HR-QoL measurements and determinants. Average scores for EQ-5D, MLHFQ, EQ-5D utility, and VAS were 6.1 ± 1.6, 21.8 ± 21.3, 81.7 ± 27.0, and 59.5 ± 14.6, respectively. Significant correlations were observed among the three tools. The New York Heart Association functional class showed a notable association with all tool scores. Other associations encompassed EQ-5D with coronary artery disease, mineralocorticoid receptor antagonists, and the 6 min walk test; EQ-5D VAS with chronic kidney disease; and MLHFQ with age. CONCLUSIONS This study illuminates the variance in HR-QoL measurement tools for Taiwanese HFrEF patients. Using a range of these tools is beneficial in unveiling diverse determinants and approaching comprehensive patient-centred care. However, for a more precise HR-QoL assessment in Taiwanese HFrEF patients, recalibrating the EQ-5D-derived utility scores might be necessary, emphasizing the importance of patient-specific considerations within the HF-PAC programme.
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Affiliation(s)
- Dhrumil Patil
- Baroda Medical College, Vadodara, India
- World Youth Heart Federation, Vadodara, India
| | - Hsin-Ju Tang
- Department of Nursing, Chang Gung University of Science and Technology, Chronic Diseases and Health Promotion Research Center, Chiayi, Taiwan
| | - Fang-Hsiu Kuo
- Division of Cardiology, Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan
| | - Han Siong Toh
- Department of Intensive Care Medicine, Chi Mei Medical Center, Tainan, Taiwan
- Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Department of Health and Nutrition, Chia Nan University of Pharmacy and Science, Tainan, Taiwan
| | - I-Ning Yang
- Division of Nephrology, Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan
- Institute of Clinical Pharmacy and Pharmaceutical Sciences, National Cheng Kung University, Tainan, Taiwan
| | - Wei-Ting Chang
- Division of Cardiology, Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan
| | - Mei-Chuan Lee
- Department of Pharmacy, Chi Mei Medical Center, Tainan, Taiwan
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Kai-Ning Chung
- Division of Cardiology, Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan
| | - Chi-Ya Huang
- Division of Nephrology, Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan
| | - Wan-Hsuan Hsu
- Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan
| | - Ting-Chia Chang
- Division of Chest Medicine, Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan
| | - Jhih-Yuan Shih
- Division of Cardiology, Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan
- Department of Health and Nutrition, Chia Nan University of Pharmacy and Science, Tainan, Taiwan
| | - Chia-Te Liao
- Division of Cardiovascular Medicine, Chi Mei Medical Center, School of Medicine, College of Medicine, National Sun Yat-sen University, Kaohsiung, Taiwan
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Cheng CH, Hsu CH, Sie JR, Tsay SL, Tung HH. The Relationship Between Resilience and Health-Related Quality of Life Among Heart Failure Patients in New York Heart Association Functional Classes II and III. J Nurs Res 2024; 32:e312. [PMID: 38271064 DOI: 10.1097/jnr.0000000000000594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2024] Open
Abstract
BACKGROUND Heart failure is an intense, unpredictable, and stressful chronic disease caused by the decline in cardiac pumping function. The influence of heart failure affects patients not only in terms of physical capabilities but also in terms of their emotional and social dimensions, with patients in different functional classes experiencing different levels of effect. Although resilience and health-related quality of life have been studied in populations with heart failure, the scholarly understanding of different functional classes is limited. PURPOSE This study was designed to investigate the relationship between resilience and health-related quality of life among patients with heart failure in different physical functional classes in Taiwan. METHODS A cross-sectional design was applied to study patients with heart failure in northern Taiwan. Two structured questionnaires, including the Resilience Scale for Adults and the 12-item Short Form Health Survey, were used to assess resilience and health-related quality of life. New York Heart Association functional class was used to determine physical function status, and canonical correlation analysis was used to determine the weight of each resilience and quality-of-life domain for the different functional classes. RESULTS The 100 participants had an average age of 65.52 years. Slightly over half (56%) were classified as Functional Class II. A group difference in health-related quality of life was observed. Personal strength (rs = .759) and social competence (rs = -.576) were found to influence the resilience and emotional role dimension of quality of life (rs = -.996) in the Functional Class II group. In addition, family cohesion (rs = -.922), dominant resilience, physical function (rs = .467), and bodily pain (rs = .465) were found to influence quality of life in the Functional Class III group. CONCLUSIONS/IMPLICATIONS FOR PRACTICE The efficacy of measures taken to increase resilience to heart failure varied in patients in different functional classes. Functional Class II individuals were better able to manage the disease using their personal strength, whereas Functional Class III individuals relied more heavily on family support and assistance for this effort. Furthermore, participant feelings about quality of life also varied by functional class, with physical function and bodily pain taking on significantly more importance for Functional Class III individuals.
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Affiliation(s)
- Ching-Hui Cheng
- MSN, RN, Deputy Chief of Cardiac Nursing Department, Heart Center, Cheng-Hsin General Hospital, Taiwan, ROC
| | - Ching-Hwa Hsu
- PhD, RN, NP, Assistant Professor, School of Nursing, College of Medicine, Chang Gung University, Taiwan, ROC
| | - Jia-Rong Sie
- MSN, RN, NP, Doctoral Student, Department of Nursing, National Yang Ming Chiao Tung University, and Nurse Practitioner, Department of Emergency Medicine, National Taiwan University Hospital, Taiwan, ROC
| | - Shiow-Luan Tsay
- PhD, RN, APN, Professor, College of Nursing & Health Sciences, Da-Yeh University, Taiwan, ROC
| | - Heng-Hsin Tung
- PhD, RN, FNP, DNP, Distinguished Professor, Department of Nursing, National Yang Ming Chiao Tung University, and Adjunct Nursing Consultant, Tungs' Taichung MetroHarbor Hospital, Taiwan, ROC
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O'Dowling R. Semaglutide and Heart Failure with Preserved Ejection Fraction and Obesity. N Engl J Med 2023; 389:2398. [PMID: 38118036 DOI: 10.1056/nejmc2312296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2023]
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Agdamag AC, Van Iterson EH, Tang WHW, Finet JE. Prognostic Role of Metabolic Exercise Testing in Heart Failure. J Clin Med 2023; 12:4438. [PMID: 37445473 DOI: 10.3390/jcm12134438] [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: 05/22/2023] [Revised: 06/28/2023] [Accepted: 06/29/2023] [Indexed: 07/15/2023] Open
Abstract
Heart failure is a clinical syndrome with significant heterogeneity in presentation and severity. Serial risk-stratification and prognostication can guide management decisions, particularly in advanced heart failure, when progression toward advanced therapies or end-of-life care is warranted. Each currently utilized prognostic marker carries its own set of challenges in acquisition, reproducibility, accuracy, and significance. Left ventricular ejection fraction is foundational for heart failure syndrome classification after clinical diagnosis and remains the primary parameter for inclusion in most clinical trials; however, it does not consistently correlate with symptoms and functional capacity, which are also independently prognostic in this patient population. Utilizing the left ventricular ejection fraction as the sole basis of prognostication provides an incomplete characterization of this condition and is prone to misguide medical decision-making when used in isolation. In this review article, we survey and exposit the important role of metabolic exercise testing across the heart failure spectrum, as a complementary diagnostic and prognostic modality. Metabolic exercise testing, also known as cardiopulmonary exercise testing, provides a comprehensive evaluation of the multisystem (i.e., neurological, respiratory, circulatory, and musculoskeletal) response to exercise performance. These differential responses can help identify the predominant contributors to exercise intolerance and exercise symptoms. Additionally, the aerobic exercise capacity (i.e., oxygen consumption during exercise) is directly correlated with overall life expectancy and prognosis in many disease states. Specifically in heart failure patients, metabolic exercise testing provides an accurate, objective, and reproducible assessment of the overall circulatory sufficiency and circulatory reserve during physical stress, being able to isolate the concurrent chronotropic and stroke volume responses for a reliable depiction of the circulatory flow rate in real time.
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Affiliation(s)
- Arianne Clare Agdamag
- Section of Heart Failure and Transplantation Medicine, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Miller Family Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Erik H Van Iterson
- Section of Preventive Cardiology and Rehabilitation, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Miller Family Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH 44195, USA
| | - W H Wilson Tang
- Section of Heart Failure and Transplantation Medicine, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Miller Family Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH 44195, USA
| | - J Emanuel Finet
- Section of Heart Failure and Transplantation Medicine, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Miller Family Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH 44195, USA
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Zimerman A, da Silveira AD, Borges MS, Engster PH, Schaan TU, de Souza GC, de Souza IP, Ritt LEF, Stein R, Berwanger O, Vaduganathan M, Rohde LE. Functional assessment based on cardiopulmonary exercise testing in mild heart failure: A multicentre study. ESC Heart Fail 2023; 10:1689-1697. [PMID: 36808902 PMCID: PMC10192241 DOI: 10.1002/ehf2.14287] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 10/25/2022] [Accepted: 01/09/2023] [Indexed: 02/23/2023] Open
Abstract
AIMS In this multicentre study, we compared cardio-pulmonary exercise test (CPET) parameters between heart failure (HF) patients classified as New York Heart Association (NYHA) class I and II to assess NYHA performance and prognostic role in mild HF. METHODS AND RESULTS We included consecutive HF patients in NYHA class I or II who underwent CPET in three Brazilian centres. We analysed the overlap between kernel density estimations for the per cent-predicted peak oxygen consumption (VO2 ), minute ventilation/carbon dioxide production (VE/VCO2 ) slope, and oxygen uptake efficiency slope (OUES) by NYHA class. Area under the receiver-operating characteristic curve (AUC) was used to assess the capacity of per cent-predicted peak VO2 to discriminate between NYHA class I and II. For prognostication, time to all-cause death was used to produce Kaplan-Meier estimates. Of 688 patients included in this study, 42% were classified as NYHA I and 58% as NYHA II, 55% were men, and mean age was 56 years. Median global per cent-predicted peak VO2 was 66.8% (IQR 56-80), VE/VCO2 slope was 36.9 (31.6-43.3), and mean OUES was 1.51 (±0.59). Kernel density overlap between NYHA class I and II was 86% for per cent-predicted peak VO2 , 89% for VE/VCO2 slope, and 84% for OUES. Receiving-operating curve analysis showed a significant, albeit limited performance of per cent-predicted peak VO2 alone to discriminate between NYHA class I vs. II (AUC 0.55, 95% CI 0.51-0.59, P = 0.005). Model accuracy for probability of being classified as NYHA class I (vs. NYHA class II) across the spectrum of the per cent-predicted peak VO2 was limited, with an absolute probability increment of 13% when per cent-predicted peak VO2 increased from 50% to 100%. Overall mortality in NYHA class I and II was not significantly different (P = 0.41), whereas NYHA class III patients displayed a distinctively higher death rate (P < 0.001). CONCLUSIONS Patients with chronic HF classified as NYHA I overlapped substantially with those classified as NYHA II in objective physiological measures and prognosis. NYHA classification may represent a poor discriminator of cardiopulmonary capacity in patients with mild HF.
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Affiliation(s)
- André Zimerman
- Post‐Graduate Program in Cardiology and Cardiovascular Sciences, Medical SchoolUniversidade Federal do Rio Grande do SulPorto AlegreBrazil
- Cardiovascular DivisionHospital de Clínicas de Porto AlegrePorto AlegreBrazil
| | - Anderson D. da Silveira
- Post‐Graduate Program in Cardiology and Cardiovascular Sciences, Medical SchoolUniversidade Federal do Rio Grande do SulPorto AlegreBrazil
- Cardiovascular DivisionHospital de Clínicas de Porto AlegrePorto AlegreBrazil
| | - Marina S. Borges
- Cardiovascular DivisionHospital de Clínicas de Porto AlegrePorto AlegreBrazil
| | - Pedro H.B. Engster
- Cardiovascular DivisionHospital de Clínicas de Porto AlegrePorto AlegreBrazil
| | - Thomas U. Schaan
- Cardiovascular DivisionHospital de Clínicas de Porto AlegrePorto AlegreBrazil
| | - Gabriel C. de Souza
- Cardiovascular DivisionHospital de Clínicas de Porto AlegrePorto AlegreBrazil
| | | | | | - Ricardo Stein
- Post‐Graduate Program in Cardiology and Cardiovascular Sciences, Medical SchoolUniversidade Federal do Rio Grande do SulPorto AlegreBrazil
- Cardiovascular DivisionHospital de Clínicas de Porto AlegrePorto AlegreBrazil
| | - Otavio Berwanger
- Academic Research Organization, Hospital Israelita Albert EinsteinSão PauloBrazil
| | | | - Luis Eduardo Rohde
- Post‐Graduate Program in Cardiology and Cardiovascular Sciences, Medical SchoolUniversidade Federal do Rio Grande do SulPorto AlegreBrazil
- Cardiovascular DivisionHospital de Clínicas de Porto AlegrePorto AlegreBrazil
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7
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van der Stam JA, Bouwmeester S, van Loon SLM, van Riel NAW, Dekker LR, Boer AK, Houthuizen P, Scharnhorst V. Prognostic Value of Combined Biomarkers in Patients With Heart Failure: The Heartmarker Score. Ann Lab Med 2023; 43:253-262. [PMID: 36544337 PMCID: PMC9791008 DOI: 10.3343/alm.2023.43.3.253] [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: 07/21/2022] [Revised: 09/06/2022] [Accepted: 11/07/2022] [Indexed: 12/24/2022] Open
Abstract
Background Heart failure (HF) biomarkers have prognostic value. The aim of this study was to combine HF biomarkers into an objective classification system for risk stratification of patients with HF. Methods HF biomarkers were analyzed in a population of HF outpatients and expressed relative to their cut-off values (N-terminal pro-B-type natriuretic peptide [NT-proBNP] >1,000 pg/mL, soluble suppression of tumorigenesis-2 [ST2] >35 ng/mL, growth differentiation factor-15 [GDF-15] >2,000 pg/mL, and fibroblast growth factor-23 [FGF-23] >95.4 pg/mL). Biomarkers that remained significant in multivariable analysis were combined to devise the Heartmarker score. The performance of the Heartmarker score was compared to the widely used New York Heart Association (NYHA) classification based on symptoms during ordinary activity. Results HF biomarkers of 245 patients were analyzed, 45 (18%) of whom experienced the composite endpoint of HF hospitalization, appropriate implantable cardioverter-defibrillator shock, or death. HF biomarkers were elevated more often in patients that reached the composite endpoint than in patients that did not reach the endpoint. NT-proBNP, ST2, and GDF-15 were independent predictors of the composite endpoint and were thus combined as the Heartmarker score. The event-free survival and distance covered in 6 minutes of walking decreased with an increasing Heartmarker score. Compared with the NYHA classification, the Heartmarker score was better at discriminating between different risk classes and had a comparable relationship to functional capacity. Conclusions The Heartmarker score is a reproducible and intuitive model for risk stratification of outpatients with HF, using routine biomarker measurements.
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Affiliation(s)
- Jonna A. van der Stam
- Clinical Laboratory, Catharina Hospital Eindhoven, Eindhoven, the Netherlands,Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands,Expert Center Clinical Chemistry Eindhoven, Eindhoven, the Netherlands,Corresponding author: Jonna A. van der Stam, M.Sc. Clinical Laboratory, Catharina Hospital Eindhoven, Michelangelolaan 2, 5623 EJ, Eindhoven, the Netherlands Tel: +31-40-239-8675 Fax: +31-40-239-8637 E-mail:
| | - Sjoerd Bouwmeester
- Department of Cardiology, Catharina Hospital, Eindhoven, the Netherlands
| | - Saskia L. M. van Loon
- Clinical Laboratory, Catharina Hospital Eindhoven, Eindhoven, the Netherlands,Expert Center Clinical Chemistry Eindhoven, Eindhoven, the Netherlands
| | - Natal A. W. van Riel
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands,Expert Center Clinical Chemistry Eindhoven, Eindhoven, the Netherlands,Department of Vascular Medicine, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - Lukas R. Dekker
- Department of Cardiology, Catharina Hospital, Eindhoven, the Netherlands,Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands
| | - Arjen-Kars Boer
- Clinical Laboratory, Catharina Hospital Eindhoven, Eindhoven, the Netherlands,Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands,Expert Center Clinical Chemistry Eindhoven, Eindhoven, the Netherlands
| | - Patrick Houthuizen
- Department of Cardiology, Catharina Hospital, Eindhoven, the Netherlands
| | - Volkher Scharnhorst
- Clinical Laboratory, Catharina Hospital Eindhoven, Eindhoven, the Netherlands,Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands,Expert Center Clinical Chemistry Eindhoven, Eindhoven, the Netherlands
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Chen X, Guo X, Zheng Y, Lv C. Heart function grading evaluation based on heart sounds and convolutional neural networks. Phys Eng Sci Med 2023; 46:279-288. [PMID: 36625996 DOI: 10.1007/s13246-023-01216-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 11/22/2022] [Accepted: 01/02/2023] [Indexed: 01/11/2023]
Abstract
Accurate and rapid cardiac function assessment is critical for disease diagnosis and treatment strategy. However, the current cardiac function assessment methods have their adaptability and limitations. Heart sounds (HS) can reflect changes in heart function. Therefore, HS signals were proposed to assess cardiac function, and a specially designed pruning convolutional neural network (CNN) was applied to recognize subjects' cardiac function at different levels in this paper. Firstly, the adaptive wavelet denoising algorithm and logistic regression based hidden semi-Markov model were utilized for signal denoising and segmentation. Then, the continuous wavelet transform (CWT) was employed to convert the preprocessed HS signals into spectra as input to the convolutional neural network, which can extract features automatically. Finally, the proposed method was compared with AlexNet, Resnet50, Xception, GhostNet and EfficientNet to verify the superiority of the proposed method. Through comprehensive comparison, the proposed approach achieves the best classification performance with an accuracy of 94.34%. The study indicates HS analysis is a non-invasive and effective method for cardiac function classification, which has broad research prospects.
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Affiliation(s)
- Xiao Chen
- Key Laboratory of Biorheology Science and Technology, Ministry of Education, College of Bioengineering, Chongqing University, 400044, Chongqing, China
| | - Xingming Guo
- Key Laboratory of Biorheology Science and Technology, Ministry of Education, College of Bioengineering, Chongqing University, 400044, Chongqing, China.
| | - Yineng Zheng
- Department of Radiology, the First Affiliated Hospital of Chongqing Medical University, 400016, Chongqing, China
| | - Chengcong Lv
- Key Laboratory of Biorheology Science and Technology, Ministry of Education, College of Bioengineering, Chongqing University, 400044, Chongqing, China
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9
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Wang L, Chen H, Ding Z, Ma L, Sun Y, Jiang L. Associations of microcirculation damage on nailfold capillaroscopy with supra-aortic severe ischemic events in patients with Takayasu arteritis. Clin Rheumatol 2023; 42:1625-1634. [PMID: 36787036 DOI: 10.1007/s10067-023-06527-6] [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: 10/31/2022] [Revised: 12/19/2022] [Accepted: 01/27/2023] [Indexed: 02/15/2023]
Abstract
OBJECTIVE To evaluate the clinical characteristics and nailfold microcirculation and explore the associations with severe ischemic events (SIEs) in Takayasu arteritis (TA) with supra-aortic involvement. METHODS Eighty-one patients with supra-aortic artery involvement who underwent nailfold video-capillaroscopy (NVC) of their hands were enrolled from the East China TA (ECTA) cohort between August and December 2021. Clinical features and capillaroscopy variables associated with supra-aortic SIEs were analyzed by multivariate logistic regression. RESULTS Overall, 71 patients were female, and 42 experienced supra-aortic SIEs, among whom there was a higher prevalence of hypertension and the number of supra-aortic artery stenosis (P = 0.005, and 0.003, respectively). Furthermore, intergroup differences in capillary density (P < 0.001) and minor morphology abnormalities (P < 0.001) were significant. After adjustment for all confounders, multivariate logistic regression revealed hypertension (odds ratio [OR]: 7.3, 95% confidence interval [CI]: 1.6-33.7, P = 0.011), the number of supra-aortic arteries stenosis (≥4, OR: 6.8, 95% CI: 1.4-34.6, P = 0.020), capillary density (≤7.2/mm, OR: 43.0, 95% CI: 7.0-264.6, P < 0.001) and minor abnormalities (OR: 34.2, 95% CI: 3.6-325.1; P = 0.002) were independent risk factors for supra-aortic SIEs. capillary density (≤7.2/mm) and minor abnormalities or combined with at least two of the three items in the matrix model showed the probability of supra-aortic SIEs was 61.2-87.6%. CONCLUSION Decreased capillary density and morphologic abnormalities indicated that hypoperfusion was more likely to be observed in supra-aortic SIEs patients. Combined NVC indicators could be instrumental for early identification of supra-aortic SIEs. Key Points • Minor morphological abnormalities and hemorrhages were only observed in supra-aortic SIEs patients. • Capillaroscopic density and minor morphological abnormalities or combined with at least two of the three items in the matrix model showed the probability occurrence of supra-aortic SIEs was 61.2-87.6%.
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Affiliation(s)
- Li Wang
- Department of Rheumatology, Zhongshan Hospital Fudan University, Shanghai, 200032, China
| | - Huiyong Chen
- Department of Rheumatology, Zhongshan Hospital Fudan University, Shanghai, 200032, China
| | - Zhenqi Ding
- Department of Rheumatology, Zhongshan Hospital Fudan University, Shanghai, 200032, China
| | - Lingying Ma
- Department of Rheumatology, Zhongshan Hospital Fudan University, Shanghai, 200032, China
| | - Ying Sun
- Department of Rheumatology, Zhongshan Hospital Fudan University, Shanghai, 200032, China.
- Evidence-based Medicine Center, Zhongshan Hospital Fudan University, Shanghai, China.
| | - Lindi Jiang
- Department of Rheumatology, Zhongshan Hospital Fudan University, Shanghai, 200032, China.
- Evidence-based Medicine Center, Zhongshan Hospital Fudan University, Shanghai, China.
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Savarese G, Lindenfeld J, Stolfo D, Adams K, Ahmad T, Desai NR, Ammirati E, Gottlieb SS, Psotka MA, Rosano GMC, Allen LA. Use of patient-reported outcomes in heart failure: from clinical trials to routine practice. Eur J Heart Fail 2023; 25:139-151. [PMID: 36644876 DOI: 10.1002/ejhf.2778] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 12/06/2022] [Accepted: 01/08/2023] [Indexed: 01/17/2023] Open
Abstract
Heart failure (HF) is a complex syndrome that affects mortality/morbidity and acts at different levels in the patient's life, resulting in a drastic impairment in multiple aspects of daily activities (e.g. physical, mental/emotional, and social) and leading to a reduction in quality of life. The definition of disease status and symptom severity has been traditionally based on the physician assessment, while the patient's experience of disease has been long overlooked. The active participation of patients in their own care is necessary to better understand the perception of disease and the multiple aspects of life affected, and to improve adherence to treatments. Patient-reported outcomes (PROs) aim to switch traditional care to a more patient-centred approach. Although PROs demonstrated precision in the evaluation of disease status and have a good association with prognosis in several randomized controlled trials, their implementation into clinical practice is limited. This review discusses the modalities of use of PROs in HF, summarizes the most largely adopted PROs in HF care, and provides an overview on the application of PROs in trials and the potential for their transition to clinical practice. By discussing the advantages and the disadvantages of their use, the reasons limiting their application in daily clinical routine, and the strategies that may promote their implementation, this review aims to foster the systematic integration of the patient's standpoint in HF care.
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Affiliation(s)
- Gianluigi Savarese
- Division of Cardiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Joann Lindenfeld
- Vanderbilt Heart and Vascular Institute, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Davide Stolfo
- Division of Cardiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
- Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy
| | - Kirkwood Adams
- Division of Cardiology, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Tariq Ahmad
- Yale School of Medicine, Section of Cardiovascular Medicine, New Haven, CT, USA
| | - Nihar R Desai
- Yale School of Medicine, Section of Cardiovascular Medicine, New Haven, CT, USA
| | - Enrico Ammirati
- De Gasperis Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Stephen S Gottlieb
- Division of Cardiovascular Medicine, University of Maryland School of Medicine and Baltimore Veterans Administration Medical Center, Baltimore, MD, USA
| | | | - Giuseppe M C Rosano
- Centre for Clinical & Basic Research, IRCCS San Raffaele Pisana, Rome, Italy
| | - Larry A Allen
- Division of Cardiology, Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA
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11
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Use of Sacubitril/Valsartan Prior to Primary Prevention Implantable Cardioverter Defibrillator Implantation. CJC Open 2023; 5:93-98. [PMID: 36700186 PMCID: PMC9869356 DOI: 10.1016/j.cjco.2022.10.005] [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: 07/27/2022] [Accepted: 10/03/2022] [Indexed: 11/07/2022] Open
Abstract
Background Implantable cardioverter defibrillators (ICDs) are an adjunct to guideline-directed medical therapy for heart failure with reduced ejection fraction. The uptake of sacubitril/valsartan in this population is not well described. We report the uptake and factors associated with sacubitril/valsartan use in patients with left ventricular dysfunction undergoing ICD implantation. Methods A retrospective chart review was performed on all patients with left ventricular dysfunction who underwent de novo primary prevention ICD implantation between October 2015 and December 2021 (n = 422) at Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada. Pre-procedure sacubitril/valsartan use was determined. Logistic regression analysis was performed to examine factors associated with sacubitril/valsartan use. A Bayesian estimator of abrupt change was employed to determine a time period in which a change in the rate of sacubitril/valsartan use occurred. Results Loop diuretic use (odds ratio [OR] = 2.20) and higher severity of New York Heart Association class symptoms (OR = 1.62) were associated with sacubitril/valsartan use. Sacubitril/valsartan use increased during the study period, to 59% in December 2021. This increase was larger among those aged ≥ 65 years (OR = 1.09). A change in the rate of sacubitril/valsartan use occurred 3 years after drug approval, 1 year after provincial drug coverage became available, and 6 months after being strongly recommended in clinical guidelines. Conclusions In a contemporary cohort of ICD patients, sacubitril/valsartan use increased between 2015 and 2021, notably in those aged ≥ 65 years and after government drug coverage became available. Understanding barriers to sacubitril/valsartan use in ICD patients is recommended to improve clinical outcomes and survival in this population.
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12
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Khan MS, Anker SD, Friede T, Jankowska EA, Metra M, Piña IL, Coats AJS, Rosano G, Roubert B, Goehring UM, Dorigotti F, Comin-Colet J, Van Veldhuisen DJ, Filippatos GS, Ponikowski P, Butler J. Minimal Clinically Important Difference for Six-minute Walk Test in Patients with HFrEF and Iron Deficiency. J Card Fail 2022; 29:760-770. [PMID: 36332897 DOI: 10.1016/j.cardfail.2022.10.423] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 09/15/2022] [Accepted: 10/10/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND The 6-minute walk test (6MWT) is widely used to measure exercise capacity; however, the magnitude of change that is clinically meaningful for individuals is not well established in heart failure with reduced ejection fraction (HFrEF). OBJECTIVE To calculate the minimal clinically important difference (MCID) for change in exercise capacity in the 6MWT in iron-deficient populations with HFrEF. METHODS In this pooled secondary analysis of the FAIR-HF and CONFIRM-HF trials, mean changes in the 6MWT from baseline to weeks 12 and 24 were calculated and calibrated against the Patient Global Assessment (PGA) tool (clinical anchor) to derive MCIDs in improvement and deterioration. RESULTS Of 760 patients included in the 2 trials, 6MWT and PGA data were available for 680 (89%) and 656 (86%) patients at weeks 12 and 24, respectively. The mean 6MWT distance at baseline was 281 ± 103 meters. There was a modest correlation between changes in 6MWT and PGA from baseline to week 12 (r = 0.31; P < 0.0001) and week 24 (r = 0.43; P < 0.0001). Respective estimates (95% confidence intervals) of MCID in 6MWT at weeks 12 and 24 were 14 meters (5;23) and 15 meters (3;27) for a "little improvement" (vs no change), 20 meters (10;30) and 24 meters (12;36) for moderate improvement vs a "little improvement,", -11 meters (-32;9.2) and -31 meters (-53;-8) for a "little deterioration" (vs no change), and -84 meters (-144;-24) and -69 meters (-118;-20) for "moderate deterioration" vs a "little deterioration". CONCLUSIONS The MCID for improvement in exercise capacity in the 6MWT was 14 meters-15 meters in patients with HFrEF and iron deficiency. These MCIDs can aid clinical interpretation of study data.
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Huang J, McDonnell BJ, Lawley JS, Byrd J, Stöhr EJ, Cornwell WK. Impact of Mechanical Circulatory Support on Exercise Capacity in Patients With Advanced Heart Failure. Exerc Sport Sci Rev 2022; 50:222-229. [PMID: 36095073 PMCID: PMC9475848 DOI: 10.1249/jes.0000000000000303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Approximately 6 million individuals have heart failure in the United States alone and 15 million in Europe. Left ventricular assist devices (LVAD) improve survival in these patients, but functional capacity may not fully improve. This article examines the hypothesis that patients supported by LVAD experience persistent reductions in functional capacity and explores mechanisms accounting for abnormalities in exercise tolerance.
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Affiliation(s)
- Janice Huang
- Department of Medicine-Cardiology. University of Colorado Anschutz Medical Campus, Aurora CO
| | - Barry J. McDonnell
- School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff UK
| | - Justin S. Lawley
- Department of Sport Science, University of Innsbruck, Innsbruck Austria
| | - Jessica Byrd
- Department of Medicine-Cardiology. University of Colorado Anschutz Medical Campus, Aurora CO
| | - Eric J. Stöhr
- Faculty of Philosophical Sciences, Institute of Sport Science, Leibniz University Hannover, Hannover, Germany
- Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center, New York City, NY, USA
| | - William K. Cornwell
- Department of Medicine-Cardiology. University of Colorado Anschutz Medical Campus, Aurora CO
- Clinical Translational Research Center, University of Colorado Anschutz Medical Campus, Aurora CO
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14
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Braun T, Wiegard A, Geritz J, Hansen C, Tan KE, Hildesheim H, Kudelka J, Maetzler C, Welzel J, Romijnders R, Maetzler W, Bergmann P. Association between heart failure severity and mobility in geriatric patients: an in-clinic study with wearable sensors. J Geriatr Cardiol 2022; 19:660-674. [PMID: 36284678 PMCID: PMC9548060 DOI: 10.11909/j.issn.1671-5411.2022.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023] Open
Abstract
BACKGROUND Individuals with heart failure (HF) frequently experience limitations in mobility, but specific aspects of these limitations are not well understood. This study investigated the association of HF severity, based on the New York Heart Association (NYHA) classes, with digital mobility outcomes (DMOs) and handgrip strength in older inpatients with HF. METHODS For this explorative analysis, hospital admission and discharge data from an ongoing, prospective cohort study were used. The sample included older participants with HF and a sub-sample of heart-healthy individuals. Participants were equipped with a wearable inertial measurement unit (IMU) system during mobility performance (balancing, sit-to-stand transfer, walking). We analyzed the association between 17 DMOs and HF severity with multiple linear regression models. RESULTS The total sample included 61 older participants (65-97 years of age, 55.7% female). Of all DMOs, only sway path in a semi-tandem stance position (m/s²) showed a relevant association with NYHA classes (admission: β = -0.28, P = 0.09; discharge: β = -0.39, P = 0.02). Handgrip strength showed a trend towards a significant association (admission: β = -0.15, P = 0.10; discharge: β = -0.15, P = 0.19). CONCLUSIONS This is to our best knowledge the first analysis on the association of HF severity and IMU-based DMOs. Sway path and handgrip strength may be the most promising parameters for monitoring mobility aspects in treatment of HF.
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Affiliation(s)
- Tobias Braun
- Department of Neurology, Kiel University, Arnold-Heller-Straße 3, 24105 Kiel, Germany
- Department of Applied Health Sciences, Division of Physiotherapy, Hochschule für Gesundheit (University of Applied Sciences), Gesundheitscampus 6-8, 44801 Bochum, Germany
- HSD Hochschule Döpfer (University of Applied Sciences), Waidmarkt 3 und 9, 50676 Cologne, Germany
| | - Anna Wiegard
- Department of Neurology, Kiel University, Arnold-Heller-Straße 3, 24105 Kiel, Germany
| | - Johanna Geritz
- Department of Neurology, Kiel University, Arnold-Heller-Straße 3, 24105 Kiel, Germany
| | - Clint Hansen
- Department of Neurology, Kiel University, Arnold-Heller-Straße 3, 24105 Kiel, Germany
| | - Kim Eng Tan
- Department of Neurology, Kiel University, Arnold-Heller-Straße 3, 24105 Kiel, Germany
| | - Hanna Hildesheim
- Department of Neurology, Kiel University, Arnold-Heller-Straße 3, 24105 Kiel, Germany
| | - Jennifer Kudelka
- Department of Neurology, Kiel University, Arnold-Heller-Straße 3, 24105 Kiel, Germany
| | - Corina Maetzler
- Department of Neurology, Kiel University, Arnold-Heller-Straße 3, 24105 Kiel, Germany
| | - Julius Welzel
- Department of Neurology, Kiel University, Arnold-Heller-Straße 3, 24105 Kiel, Germany
| | - Robbin Romijnders
- Department of Neurology, Kiel University, Arnold-Heller-Straße 3, 24105 Kiel, Germany
| | - Walter Maetzler
- Department of Neurology, Kiel University, Arnold-Heller-Straße 3, 24105 Kiel, Germany
| | - Philipp Bergmann
- Department of Internal Medicine I, Christian-Albrechts-University of Kiel, Arnold-Heller-Straße 3, 24105 Kiel, Germany
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15
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Substitute parameters of exercise-induced pulmonary hypertension and usefulness of low workload exercise stress echocardiography in mitral regurgitation. Sci Rep 2022; 12:15977. [PMID: 36155621 PMCID: PMC9510128 DOI: 10.1038/s41598-022-19987-8] [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: 06/11/2022] [Accepted: 09/07/2022] [Indexed: 11/18/2022] Open
Abstract
In asymptomatic patients with mitral regurgitation (MR), data of exercise-induced pulmonary hypertension (EIPH) are limited, and feasibility of evaluating EIPH is not high. We aimed to investigate prognostic impact of EIPH and its substitute parameters. Exercise stress echocardiography (ESE) were performed in 123 consecutive patients with moderate to severe degenerative MR. The endpoint was a composite of death, hospitalization for heart failure, and worsening of symptoms. EIPH [tricuspid regurgitation peak gradient (TRPG) at peak workload ≥ 50 mmHg] was shown in 57 patients (46%). TRPG at low workload was independently associated with TRPG at peak workload (β = 0.67, p < 0.001). Early surgical intervention (within 6 months after ESE) was performed in 65 patients. Of the remaining 58 patients with the watchful waiting strategy, the event free survival was lower in patients with EIPH than in patients without EIPH (48.1 vs. 97.0% at 1-year, p < 0.001). TRPG at low workload ≥ 35.0 mmHg as well as EIPH were associated with poor prognosis in patients with the watchful waiting strategy. In conclusion, the importance of ESE and evaluating EIPH in patients with MR was re-acknowledged. TRPG at peak workload can be predicted by TRPG at low workload, and TRPG at low workload may be useful in real-world clinical settings.
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16
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Sanna GD, Moccia E, Canonico ME, Sanna S, De Toni C, Santoro C, Masia SL, Saderi L, Sotgiu G, Parodi G. Left atrial remodeling in heart failure: the role of sphericity index (the SPHERICAT-HF study). THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2022; 38:1723-1732. [PMID: 35212852 DOI: 10.1007/s10554-022-02562-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 02/07/2022] [Indexed: 11/05/2022]
Abstract
Left atrial sphericity index (LASI) is an echocardiographic index easily obtained; its use in patients with heart failure (HF) has never been investigated so far. This single-centre study aimed to investigate the usefulness of LASI in an unselected cohort of patients hospitalized for acute HF, and its potential correlation with the amino-terminal portion of pro-B-type natriuretic peptide (NT-proBNP) levels and with New York Heart Association (NYHA) functional class. Ninety-four consecutive HF patients underwent a transthoracic echocardiogram with a detailed study of the left atrium (LA) including LASI (calculated from the apical four-chamber view as the ratio between the transverse and longitudinal diameters), and blood tests (including NT-proBNP) on the same day. Median age was 75.5 (interquartile range-IQR 62-82) years and 55% were males, 58.5% had a NYHA class III-IV, and median NT-proBNP was 3284 (IQR 1215-7055) pg/ml. The LA was dilated in 94%, and median biplane LA volume index was 62 ml/m2. Patients with advanced NYHA class showed more advanced LA remodeling. Mean LASI was 0.78 ± 0.09 and did not correlate with NT-proBNP levels (r 0.03; p 0.75) or with patient NYHA class (R2 0.011; p 0.287). None of the echocardiographic indices of LA structural and functional remodeling proved to be independently associated with a high NYHA class on multivariate regression analysis. In conclusion, LA remodeling is almost invariably present in patients with HF. LASI does not correlate with NT-proBNP levels or with NYHA functional class. Further studies are needed to describe the complex patterns of atrial remodeling in HF.
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Affiliation(s)
- Giuseppe D Sanna
- Clinical and Interventional Cardiology, Sassari University Hospital, Via Enrico De Nicola, 07100, Sassari, Italy.
| | - Eleonora Moccia
- The Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Mario Enrico Canonico
- The Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
- Department of Advanced Biomedical Sciences, Federico II University Hospital, Naples, Italy
| | - Silvia Sanna
- The Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Chiara De Toni
- The Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Ciro Santoro
- Department of Advanced Biomedical Sciences, Federico II University Hospital, Naples, Italy
| | - Stefano L Masia
- Clinical and Interventional Cardiology, Sassari University Hospital, Via Enrico De Nicola, 07100, Sassari, Italy
| | - Laura Saderi
- Clinical Epidemiology and Medical Statistics Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Giovanni Sotgiu
- Clinical Epidemiology and Medical Statistics Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Guido Parodi
- The Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
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17
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Giner-Soriano M, Díaz Baena D, Ouchi D, Gomez-Lumbreras A, Morros R. [Pharmacological treatment of the heart failure according to the ventricular ejection fraction in primary care]. Aten Primaria 2022; 54:102362. [PMID: 35777241 PMCID: PMC9251560 DOI: 10.1016/j.aprim.2022.102362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 03/07/2022] [Accepted: 03/30/2022] [Indexed: 11/19/2022] Open
Abstract
Objetivo Aunque se dispone de mejores diagnósticos y tratamientos, la insuficiencia cardíaca (IC) es una causa importante de muerte en España. El objetivo de este estudio es describir el tratamiento y las características de la población con IC crónica, clasificada según la fracción de eyección del ventrículo izquierdo (FEVI). Diseño Estudio observacional de cohortes de base poblacional en atención primaria (AP). Emplazamiento Cataluña, 2014-2018. Participantes Se incluyeron pacientes adultos con diagnóstico incidente de IC clasificada según la FEVI. Intervención Análisis de los datos de salud registrados en la base de datos Sistema de Información para el Desarrollo de la Investigación en AP (SIDIAP). Variables principales Demográficas, FEVI, comorbilidades y uso de fármacos para la IC. Resultados Se incluyeron 10.130 pacientes; el 18,9% con FEVI < 40 (ICFEr), el 15,9% con FEVI 40-49 (ICFEi) y el 65,2% con FEVI ≥ 50 (ICFEp), este último grupo con mayor proporción de mujeres (57,5%) y una mayor edad media (80,2 años). La población con ICFEi era similar a la de ICFEr en edad, género, comorbilidades o tratamiento. Las comorbilidades más frecuentes eran la hipertensión (78.3%), la dislipemia (54%) y la fibrilación auricular (41,5%). Los tratamientos más frecuentes fueron los β-bloqueantes, con diferencias según la FEVI (FEVIr 1.515 [79,2%], FEVIi 1.142 [70,8%] y FEVIp 3.371 [51,0%]), seguido de los diuréticos de asa (65,7%). Conclusiones El tratamiento farmacológico de la IC varía en función de la FEVI. El tratamiento y las características poblacionales de los pacientes con ICFEi son similares a aquellos con ICFEr.
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Affiliation(s)
- Maria Giner-Soriano
- Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, España; Universitat Autònoma de Barcelona, Bellaterra, Cerdanyola del Vallès, Barcelona, España
| | - Dioselina Díaz Baena
- Universitat Autònoma de Barcelona, Bellaterra, Cerdanyola del Vallès, Barcelona, España; UCEVA Unidad Central del Valle del Cauca, Tuluá, Valle del Cauca, Colombia
| | - Dan Ouchi
- Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, España; Universitat Autònoma de Barcelona, Bellaterra, Cerdanyola del Vallès, Barcelona, España
| | - Ainhoa Gomez-Lumbreras
- College of Pharmacy, Department of Pharmacotherapy, University of Utah, Salt Lake City, Utah, EE. UU..
| | - Rosa Morros
- Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, España; Universitat Autònoma de Barcelona, Bellaterra, Cerdanyola del Vallès, Barcelona, España; Institut Català de la Salut, Departament de Salut, Generalitat de Catalunya, Barcelona, España
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18
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Fifteen-year mortality and prognostic factors in patients with dilated cardiomyopathy: persistent standardized application of drug therapy and strengthened management may bring about encouraging change in an aging society. J Geriatr Cardiol 2022; 19:335-342. [PMID: 35722031 PMCID: PMC9170907 DOI: 10.11909/j.issn.1671-5411.2022.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND There is scarce data on the long-term mortality and associated prognostic factors in patients with dilated cardiomyopathy (DCM). The study aimed to investigate the all-cause mortality up to 15 years (mean 7.9 ± 5.7 years) in such patients, and the independent prognostic factors influencing their long-term mortality. METHODS One hundred and sixty-six consecutive patients with DCM were prospectively enrolled from 2002 to 2003. The mean age of patients was 59.5 ± 10.4 years, and approximately 57% were male. They were followed up by telephone or outpatient visit at least every three months until 2019 or all-cause death occurred. Predictors of mortality were identified using multivariate logistic regression analysis. RESULTS During the 15 years of follow-up, five patients were lost to follow-up, and the complete data records of 161 patients were included in the analysis. Patients were treated with angiotensin-converting-enzyme inhibitors (ACEI) or angiotensin-receptor blocker (ARB), β-blockers, mineralocorticoid receptor antagonist (MRA), diuretics and digitalis from 2002 to 2004, and maintained at the maximum tolerated doses between 2004 and 2019. Our safety targets to maintain heart rate and blood pressure at 60-80 beats/min and 90-120/60-80 mmHg, respectively. All-cause mortality in the first five years was 55.9%. The independent risk factors for the 5-year mortality were age ≥ 70 years old (OR = 5.45, P = 0.006), systolic blood pressure (SBP) > 120 mmHg (OR = 3.63, P = 0.004), 6-minute walk distance (6MWD) < 450 m (OR = 3.84, P = 0.001). 15-year all-cause mortality was 65.8%. The independent risk factors for 15-year mortality were age ≥ 70 years old (OR = 16.07, P = 0.009), LVEF ≤ 35% (OR = 5.69, P = 0.003), and SBP > 120 mmHg (OR = 9.56, P < 0.001). CONCLUSIONS This study was the first to demonstrate the 15-year survival rate of 34% in DCM patients. The DCM patients' first five-year all-cause mortality decreased significantly after continuous standardized treatment and intensive management. The mortality then plateaued in the following 10 years. Age ≥ 70 years, LVEF ≤ 35%, and SBP > 120 mmHg were independent predictors of 15-year all-cause mortality.
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Charfeddine S, Ibnhadjamor H, Jdidi J, Torjmen S, Kraiem S, Bahloul A, Makni A, Kallel N, Moussa N, Boudaya M, Touil I, Ghrab A, Elghoul J, Meddeb Z, Thabet Y, Ben Salem K, Addad F, Bouslama K, Milouchi S, Hammami R, Abdessalem S, Abid L. Sulodexide Significantly Improves Endothelial Dysfunction and Alleviates Chest Pain and Palpitations in Patients With Long-COVID-19: Insights From TUN-EndCOV Study. Front Cardiovasc Med 2022; 9:866113. [PMID: 35647070 PMCID: PMC9133483 DOI: 10.3389/fcvm.2022.866113] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Accepted: 03/23/2022] [Indexed: 01/02/2023] Open
Abstract
Objective Non-respiratory long-coronavirus disease 2019 (COVID-19) symptoms are mainly related to a long-lasting endothelial dysfunction and microcirculation impairment. We hypothesized that Sulodexide, a purified glycosaminoglycan mixture with a beneficial endothelial effect in arterial and venous peripheral diseases, may be effective in a subset of patients with long COVID-19. Approach and Results We conducted a multicenter prospective quasi-experimental study. A total of 290 patients from the TUN-EndCOV study with long-COVID-19 symptoms and endothelial dysfunction were included. The endothelial function was clinically assessed using a post-occlusive reactive hyperemia protocol with finger thermal monitoring device. Endothelial quality index (EQI) was assessed at inclusion and at 21 days later. The study population was assigned to a sulodexide group (144 patients) or a no-medical treatment group (146 patients). Clinical characteristics were similar at inclusion in the two groups. Fatigue, shortness of breath, and chest pain were the most common symptoms, respectively, 54.5, 53.8, and 28.3%. At 21 days, the sulodexide group improved significantly better than the no-medical treatment group in chest pain (83.7 vs. 43.6%, p < 10−3), palpitations (85.2 vs. 52.9%, p = 0.009), and endothelial function [median delta-EQI 0.66 (0.6) vs. 0.18 (0.3); p < 10−3]. Endothelial function improvement was significantly correlated with chest pain and palpitations recovery (AUC, i.e., area under the curve = 0.66, CI [0.57– 0.75], p = 0.001 and AUC = 0.60, CI [0.51– 0.69], p = 0.03, respectively). Conclusion Sulodexide significantly improves long-lasting post-COVID-19 endothelial dysfunction and alleviates chest pain and palpitations.
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Affiliation(s)
- Salma Charfeddine
- Cardiology Department, Hedi Chaker University Hospital, Sfax, Tunisia
- Faculty of Medicine, University of Sfax, Sfax, Tunisia
- *Correspondence: Salma Charfeddine
| | | | - Jihen Jdidi
- Faculty of Medicine, University of Sfax, Sfax, Tunisia
- Preventive Medicine Department, Hedi Chaker University Hospital, Sfax, Tunisia
| | - Slim Torjmen
- Faculty of Medicine, University of Sfax, Sfax, Tunisia
- Pneumology Department, Hedi Chaker University Hospital, Sfax, Tunisia
| | - Salma Kraiem
- Cardiology Department, Tahar Sfar Hospital, Mahdia, Tunisia
| | - Amine Bahloul
- Cardiology Department, Hedi Chaker University Hospital, Sfax, Tunisia
- Faculty of Medicine, University of Sfax, Sfax, Tunisia
| | - Ahmed Makni
- Cardiology Department, Hedi Chaker University Hospital, Sfax, Tunisia
- Faculty of Medicine, University of Sfax, Sfax, Tunisia
| | - Nesrine Kallel
- Faculty of Medicine, University of Sfax, Sfax, Tunisia
- Pneumology Department, Hedi Chaker University Hospital, Sfax, Tunisia
| | - Nedia Moussa
- Faculty of Medicine, University of Sfax, Sfax, Tunisia
- Pneumology Department, Hedi Chaker University Hospital, Sfax, Tunisia
| | - Mariem Boudaya
- Faculty of Medicine, University of Sfax, Sfax, Tunisia
- Biochemistry Laboratory, Hedi Chaker University Hospital, Sfax, Tunisia
| | - Imen Touil
- Pneumology Department, Tahar Sfar Hospital, Mahdia, Tunisia
| | - Aiman Ghrab
- Faculty of Medicine, University of Sfax, Sfax, Tunisia
- Cardiology Department, Habib Bourguiba Hospital Medenine, Medenine, Tunisia
| | - Jamel Elghoul
- Faculty of Medicine, University of Sfax, Sfax, Tunisia
- Pneumology Department, Habib Bourguiba Hospital Medenine, Medenine, Tunisia
| | - Zeineb Meddeb
- Internal Medicine Department, Mongi Slim LaMarsa Hospital, Tunis, Tunisia
| | - Yamina Thabet
- Internal Medicine Department, Mongi Slim LaMarsa Hospital, Tunis, Tunisia
| | | | | | - Kamel Bouslama
- Internal Medicine Department, Mongi Slim LaMarsa Hospital, Tunis, Tunisia
| | - Sami Milouchi
- Faculty of Medicine, University of Sfax, Sfax, Tunisia
- Cardiology Department, Habib Bourguiba Hospital Medenine, Medenine, Tunisia
| | - Rania Hammami
- Cardiology Department, Hedi Chaker University Hospital, Sfax, Tunisia
- Faculty of Medicine, University of Sfax, Sfax, Tunisia
| | | | - Leila Abid
- Cardiology Department, Hedi Chaker University Hospital, Sfax, Tunisia
- Faculty of Medicine, University of Sfax, Sfax, Tunisia
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20
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Anker SD, Ponikowski P, Khan MS, Friede T, Jankowska EA, Fabien V, Goehring UM, Metra M, Piña IL, Coats AJS, Rosano G, Dorigotti F, Comin-Colet J, Van Veldhuisen DJ, Filippatos GS, Butler J. Responder analysis for improvement in 6-min walk test with ferric carboxymaltose in patients with heart failure with reduced ejection fraction and iron deficiency. Eur J Heart Fail 2022; 24:833-842. [PMID: 35334136 PMCID: PMC9321075 DOI: 10.1002/ejhf.2491] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 03/17/2022] [Accepted: 03/22/2022] [Indexed: 11/24/2022] Open
Abstract
AIM Improving functional capacity is a key goal in heart failure (HF). This pooled analysis of FAIR-HF and CONFIRM-HF assessed the likelihood of improvement or deterioration in 6-min walk test (6MWT) among iron-deficient patients with chronic HF with reduced ejection fraction (HFrEF) receiving ferric carboxymaltose (FCM). METHODS AND RESULTS Data for 760 patients (FCM: n = 454; placebo: n = 306) were analysed. The proportions of patients receiving FCM or placebo who had ≥20, ≥30, and ≥40 m improvements or ≥10 m deterioration in 6MWT at 12 and 24 weeks were assessed. Patients receiving FCM experienced a mean (standard deviation) 31.1 (62.3) m improvement in 6MWT versus 0.1 (77.1) m improvement for placebo at week 12 (difference in mean changes 26.8 [16.6-37.0]). At week 12, the odds [95% confidence interval] of 6MWT improvements of ≥20 m (odds ratio 2.16 [1.57-2.96]; p < 0.0001), ≥30 m (2.00 [1.44-2.78]; p < 0.0001), and ≥40 m (2.29 [1.60-3.27]; p < 0.0001) were greater with FCM versus placebo, while the odds of a deterioration ≥10 m were reduced with FCM versus placebo (0.55 [0.38-0.80]; p = 0.0019). Among patients who experienced 6MWT improvements of ≥20, ≥30, or ≥40 m with FCM at week 12, more than 80% sustained this improvement at week 24. CONCLUSION Ferric carboxymaltose resulted in a significantly higher likelihood of improvement and a reduced likelihood of deterioration in 6MWT versus placebo among iron-deficient patients with HF. Of the patients experiencing clinically significant improvements at week 12, the majority sustained this improvement at week 24. These results are supportive of FCM to improve exercise capacity in HF.
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Affiliation(s)
- Stefan D Anker
- Department of Cardiology (CVK); and Berlin Institute of Health Center for Regenerative Therapies (BCRT); German Center for Cardiovascular Research (DZHK) partner site Berlin, Charité Universitätsmedizin Berlin, Berlin, Germany.,Institute of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland.,Institute of Heart Diseases, University Hospital in Wroclaw, Poland
| | - Piotr Ponikowski
- Institute of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland
| | | | - Tim Friede
- Göttingen, Germany; DZHK (German Center for Cardiovascular Research), Göttingen partner site, University Medical Center Göttingen, Göttingen, Germany
| | - Ewa A Jankowska
- Institute of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland
| | | | | | - Marco Metra
- Cardiology, University and Civil Hospital, Brescia, Italy
| | - Ileana L Piña
- Central Michigan University, Mount Pleasant, MI, USA
| | | | - Giuseppe Rosano
- Centre for Clinical and Basic Research, Department of Medical Sciences, IRCCS San Raffaele Pisana, Rome, Italy
| | | | - Josep Comin-Colet
- Department of Cardiology, Bellvitge University Hospital; IDIBELL, University of Barcelona, Hospitalet de Llobregat, Barcelona, Spain
| | - Dirk J Van Veldhuisen
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Gerasimos S Filippatos
- Medical School University of Cyprus, Nicosia, Cyprus.,School of Medicine of National and Kapodistrian University of Athens, Athens University Hospital Attikon, Athens, Greece
| | - Javed Butler
- Department of Medicine, University of Mississippi, Jackson, MS, USA
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21
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Ritt LEF, Ribeiro RS, Souza IPMAD, Ramos JVSP, Ribeiro DS, Feitosa GF, Oliveira QBD, Stein R, Darzé ES. Low Concordance between NYHA Classification and Cardiopulmonary Exercise Test Variables in Patients with Heart Failure and Reduced Ejection Fraction. Arq Bras Cardiol 2022; 118:S0066-782X2022005003201. [PMID: 35384966 PMCID: PMC9345141 DOI: 10.36660/abc.20210222] [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: 03/12/2021] [Revised: 08/08/2021] [Accepted: 09/01/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The New York Heart Association (NYHA) functional classification is the most commonly used classification system for heart failure (HF), whereas cardiopulmonary exercise testing (CPET) is the gold standard for functional status evaluation in HF. OBJECTIVE This study aimed to analyze correlation and concordance between NYHA classes and CPET variables. METHODS HF patients with clinical indication for CPET and ejection fraction (EF) < 50% were selected. Correlation (Spearman coefficient) and concordance (kappa) between NYHA classification and CPET-based classifications were analyzed. A p < 0.05 was accepted as significant. RESULTS In total, 244 patients were included. Mean age was 56 ± 14 years, and mean EF was 35.5% ± 10%. Distribution of patients according to NYHA classification was 31.2%% class I, 48.3% class II, 19.2% class III, and 1.3% class IV. Correlation (r) between NYHA and Weber classes was 0.489 (p < 0.001), and concordance was 0.231 (p < 0.001). Correlation (r) between NYHA and ventilatory classes (minute ventilation/carbon dioxide production [VE/VCO2] slope) was 0.218 (p < 0.001), and concordance was 0.002 (p = 0.959). Spearman correlation between NYHA and CPET score classes was 0.223 (p = 0.004), and kappa concordance was 0.027 (p = 0.606). CONCLUSION There was a moderate association between NYHA and Weber classes, although concordance was low. Ventilatory (VE/VCO2slope) and CPET score classes had a weak association and a low concordance with NYHA classes.
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Affiliation(s)
- Luiz Eduardo Fonteles Ritt
- Instituto D'or de Pesquisa e Ensino (IDOR), Hospital Cárdio Pulmonar, Salvador, BA - Brasil
- Escola Bahiana de Medicina e Saúde Pública, Salvador, BA - Brasil
| | | | - Isabela Pilar Moraes Alves de Souza
- Instituto D'or de Pesquisa e Ensino (IDOR), Hospital Cárdio Pulmonar, Salvador, BA - Brasil
- Escola Bahiana de Medicina e Saúde Pública, Salvador, BA - Brasil
| | | | | | | | | | - Ricardo Stein
- Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS - Brasil
| | - Eduardo Sahade Darzé
- Instituto D'or de Pesquisa e Ensino (IDOR), Hospital Cárdio Pulmonar, Salvador, BA - Brasil
- Escola Bahiana de Medicina e Saúde Pública, Salvador, BA - Brasil
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22
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Lenasi H, Novak A, Jug B, Dervišević E, Karpljuk D, Videmšek M, Sorić M, Hadžić V. An Alternative Prediction Equation for Evaluation of Six-Minute Walk Distance in Stable Coronary Artery Disease Patients. Front Physiol 2022; 13:844847. [PMID: 35432004 PMCID: PMC9008480 DOI: 10.3389/fphys.2022.844847] [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: 12/28/2021] [Accepted: 03/17/2022] [Indexed: 11/13/2022] Open
Abstract
Background: As cardio-vascular diseases are the leading cause of death worldwide, establishing measures to improve cardiovascular health is of crucial importance. Exercise plays an essential role in cardiac rehabilitation of patients with coronary artery disease (CAD), in whom an evaluation of the cardiorespiratory fitness (CRF) is necessary. CRF of CAD patients could be assessed using 6-min walk test (6MWT), and the results interpreted by using Enright-Sherill prediction equation which has mainly been designed and evaluated for a healthy population. Hypothesizing that the Enright-Sherill prediction equation might not be best suited for CAD patients, our aim was to reevaluate this equation in CAD patients, and potentially establish a more accurate 6MWD prediction equation to be applied in these patients.Methods: 6MWD was measured in a cross-sectional study in 67 CAD patients (44 women) who were members of the Coronary club Ljubljana, Slovenia. In addition, the predicted 6MWD was calculated for men and women using Enright-Sherill gender specific regression equation. Multivariate regression analysis was used to obtain a new prediction equation, and the agreement between the measured and the predicted 6MWD analyzed using the repeated measures ANOVA.Results: Men achieved 451 ± 122 m and women 485 ± 69 m without significant differences between sexes (F = 0.022, p = 0.882) when adjusted for age, height, body mass, and waist circumference. When comparing the measured (473 ± 91 m) and the predicted (422 ± 57 m) values of 6MWD in CAD patients we found that the Enright-Sherill prediction equation significantly (F = 27.734, p < 0.001) underestimated the 6MWD by 52 ± 81 m. A significant regression equation was established [F (3,63) = 44.663, p < 0.001], with a R2 of 0.680 where 6MWD equals 1,057 m—4.966 x age (years)—0.614 x WC (cm)–68.629 x NYHA class.Conclusion: The results of this study stress the importance of regular and actual walking ability testing in patients with stable CAD to obtain their CRF, rather than simply predicting it from regression equations obtained from non-representative or non-comparable samples. Our developed prediction equation warrants additional validation and may represent a good substitute for currently used predictions obtained from a healthy population.
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Affiliation(s)
- Helena Lenasi
- Institute of Physiology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Ana Novak
- Sports & Medicine Department, Faculty of Sport, University of Ljubljana, Ljubljana, Slovenia
| | - Borut Jug
- Department of Vascular Diseases, Division of Internal Medicine, University Medical Center, Ljubljana, Slovenia
| | - Edvin Dervišević
- Sports & Medicine Department, Faculty of Sport, University of Ljubljana, Ljubljana, Slovenia
| | - Damir Karpljuk
- Sports & Medicine Department, Faculty of Sport, University of Ljubljana, Ljubljana, Slovenia
| | - Mateja Videmšek
- Sports & Medicine Department, Faculty of Sport, University of Ljubljana, Ljubljana, Slovenia
| | - Maroje Sorić
- Department of Sport and Exercise Medicine, Faculty of Kinesiology, University of Zagreb, Zagreb, Croatia
| | - Vedran Hadžić
- Sports & Medicine Department, Faculty of Sport, University of Ljubljana, Ljubljana, Slovenia
- *Correspondence: Vedran Hadžić,
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23
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Scrutinio D, Guida P, Ruggieri R, Passantino A. Prognostic value of functional capacity after transitional rehabilitation in older patients hospitalized for heart failure. J Am Geriatr Soc 2022; 70:1774-1784. [PMID: 35266550 PMCID: PMC9311803 DOI: 10.1111/jgs.17736] [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: 12/21/2021] [Revised: 02/15/2022] [Accepted: 02/18/2022] [Indexed: 11/29/2022]
Abstract
Background Poor functional status is highly prevalent among older patients hospitalized for HF and marks a downward inflection point in functional and prognostic trajectories. We assessed the prognostic value of 6‐min walk test after transitional cardiac rehabilitation in older patients hospitalized for heart failure (HF). Methods We studied 759 patients aged ≥60 years who had been transferred to six inpatient rehabilitation facilities (IRF) from acute care hospitals after a hospitalization for acute HF. The primary outcome was 3‐year all‐cause mortality. We used multivariable Cox analysis to determine the association between 6‐min walk distance (6MWD) at discharge from the IRFs and the primary outcome, adjusting for established predictors of death. The optimal cutoff for 6MWD was considered as the one that maximized the chi‐square statistic. Results Mean age was 75 ± 8 years. 6MWD significantly increased from admission to discharge (145 to 210 m; p < 0.001). The optimal cutoff for 6MWD was 198 m. After full adjustment, the hazard ratio for each 50 m‐increase in discharge 6MWD was 0.90 (0.87–0.94; p < 0.001) and that for discharge 6MWD dichotomized at the optimal cutoff 0.48 (0.38–0.60; p < 0.001). The incidence rate of death/100 person‐years for the patients who walked >198 m was 13.0 (10.0–15.5) compared with 30.8 (26.9–35.4) for those who walked <198 m. A statistically significant interaction of discharge 6MWD with left ventricular ejection fraction (EF) on the risk of death was observed (p value for interaction 0.047). Conclusions A rehabilitation intervention provided in the critical hospital‐to‐home transition period to older patients hospitalized for HF resulted in improved functional capacity. Increasing levels of functional capacity following rehabilitation were closely associated with decreasing risk of death; this association was significantly stronger for the subgroup with preserved EF.
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Affiliation(s)
- Domenico Scrutinio
- Department of Cardiac Rehabilitation, Istituti Clinici Scientifici Maugeri SpA SB, IRCCS, Institute of Bari, Bari, Italy
| | - Pietro Guida
- Department of Cardiac Rehabilitation, Istituti Clinici Scientifici Maugeri SpA SB, IRCCS, Institute of Bari, Bari, Italy
| | - Roberta Ruggieri
- Department of Cardiac Rehabilitation, Istituti Clinici Scientifici Maugeri SpA SB, IRCCS, Institute of Bari, Bari, Italy
| | - Andrea Passantino
- Department of Cardiac Rehabilitation, Istituti Clinici Scientifici Maugeri SpA SB, IRCCS, Institute of Bari, Bari, Italy
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24
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Ramos Garzón JX, Achury Beltrán LF, Rojas LZ. Cardiotoxicidad por antraciclinas en supervivientes de cáncer durante la infancia. AVANCES EN ENFERMERÍA 2022. [DOI: 10.15446/av.enferm.v40n2.90007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023] Open
Abstract
Introducción: a nivel mundial, cada año cerca de 300.000 niños entre 0 y 19 años son diagnosticados con cáncer. El porcentaje de supervivientes va en aumento, llegando a 80 % en países desarrollados y 60 % en América Latina. Sin embargo, la expectativa y la calidad de vida de estas personas pueden verse comprometidas ante el desarrollo de cardiotoxicidad, un efecto adverso asociado al uso de algunos agentes antineoplásicos, como los antracíclicos.Objetivo: resaltar los aspectos clínicos relevantes para la prevención, detección oportuna, tratamiento y seguimiento de la cardiotoxicidad secundaria a la administración de antraciclinas durante la infancia.Síntesis de contenido: reflexión teórica que presenta consideraciones clínicas relevantes para guiar las acciones de enfermería y del equipo multidisciplinario en la atención y el cuidado de la salud cardiovascular de los supervivientes de cáncer a cualquier edad. Es importante destacar que en población pediátrica la única estrategia efectiva de prevención primaria para cardiotoxicidad por antraciclinas es la administración de dexrazoxano, mientras que la prevención secundaria debe incluir detección oportuna, control y seguimiento de las alteraciones de la función cardíaca y de los factores de riesgo cardiovascular. Por su parte, la prevención terciaria se centra en el control de la enfermedad y el manejo farmacológico. Conclusiones: no existe un tratamiento estándar para la cardiotoxicidad inducida por quimioterapia o radioterapia, siendo el objetivo principal de este tipo de tratamientos prevenir o retrasar la remodelación del ventrículo izquierdo. Todos los supervivientes requieren seguimiento vitalicio y búsqueda activa de signos de cardiotoxicidad, siendo fundamental la acción conjunta de diferentes profesionales y la consolidación de los servicios de cardio-oncología.
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25
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Lewis GD, Docherty KF, Voors AA, Cohen-Solal A, Metra M, Whellan DJ, Ezekowitz JA, Ponikowski P, Böhm M, Teerlink JR, Heitner SB, Kupfer S, Malik FI, Meng L, Felker GM. Developments in Exercise Capacity Assessment in Heart Failure Clinical Trials and the Rationale for the Design of METEORIC-HF. Circ Heart Fail 2022; 15:e008970. [PMID: 35236099 DOI: 10.1161/circheartfailure.121.008970] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Heart failure with reduced ejection fraction (HFrEF) is a highly morbid condition for which exercise intolerance is a major manifestation. However, methods to assess exercise capacity in HFrEF vary widely in clinical practice and in trials. We describe advances in exercise capacity assessment in HFrEF and a comparative analysis of how various therapies available for HFrEF impact exercise capacity. Current guideline-directed medical therapy has indirect effects on cardiac performance with minimal impact on measured functional capacity. Omecamtiv mecarbil is a novel selective cardiac myosin activator that directly increases cardiac contractility and in a phase 3 cardiovascular outcomes study significantly reduced the primary composite end point of time to first heart failure event or cardiovascular death in patients with HFrEF. The objective of the METEORIC-HF trial (Multicenter Exercise Tolerance Evaluation of Omecamtiv Mecarbil Related to Increased Contractility in Heart Failure) is to assess the effect of omecamtiv mecarbil versus placebo on multiple components of functional capacity in HFrEF. The primary end point is to test the effect of omecamtiv mecarbil compared with placebo on peak oxygen uptake as measured by cardiopulmonary exercise testing after 20 weeks of treatment. METEORIC-HF will provide state-of-the-art assessment of functional capacity by measuring ventilatory efficiency, circulatory power, ventilatory anaerobic threshold, oxygen uptake recovery kinetics, daily activity, and quality-of-life assessment. Thus, the METEORIC-HF trial will evaluate the potential impact of increased myocardial contractility with omecamtiv mecarbil on multiple important measures of functional capacity in ambulatory patients with symptomatic HFrEF. Registration: URL: https://clinicaltrials.gov; Unique identifier: NCT03759392.
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Affiliation(s)
- Gregory D Lewis
- Division of Cardiology, Massachusetts General Hospital, Boston (G.D.L.)
| | - Kieran F Docherty
- BHF Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Scotland (K.F.D.)
| | - Adriaan A Voors
- Department of Cardiology, University Medical Center Groningen, the Netherlands (A.A.V.)
| | - Alain Cohen-Solal
- Paris University, UMR-S 942, Department of Cardiology, Lariboisiere Hospital, Assistance Publique Hopitaux de Paris, France (A.C.-S.)
| | - Marco Metra
- Cardiology, ASST Spedali Civili, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Italy (M.M.)
| | - David J Whellan
- Department of Medicine, Sidney Kimmel Medical College, Thomas Jefferson University Hospital, Philadelphia, PA (D.J.W.)
| | | | - Piotr Ponikowski
- Department of Heart Diseases, Wrocław Medical University, Poland (P.P.)
| | - Michael Böhm
- Department of Internal Medicine, Saarland University, Homburg, Germany. (M.B.).,Department of Cardiology, Saarland University, Homburg, Germany. (M.B.)
| | - John R Teerlink
- Section of Cardiology, San Francisco Veterans Affairs Medical Center and University of California San Francisco (J.R.T.)
| | - Stephen B Heitner
- Cytokinetics Inc, South San Francisco, CA (S.B.H., S.K., F.I.M., L.M.)
| | - Stuart Kupfer
- Cytokinetics Inc, South San Francisco, CA (S.B.H., S.K., F.I.M., L.M.)
| | - Fady I Malik
- Cytokinetics Inc, South San Francisco, CA (S.B.H., S.K., F.I.M., L.M.)
| | - Lisa Meng
- Cytokinetics Inc, South San Francisco, CA (S.B.H., S.K., F.I.M., L.M.)
| | - G Michael Felker
- Division of Cardiology, School of Medicine, Duke University Medical Center, Durham, NC (G.M.F.)
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26
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Zhou X, Yi F, Peng L, Jiang J, Lan L. The value of soluble suppression of tumorigenesis-2 (sST2) in the maintenance of hemodialysis patients with heart failure. Hippokratia 2022; 26:19-24. [PMID: 37124282 PMCID: PMC10132390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
BACKGROUND Patients with end-stage renal disease are prone to develop heart failure (HF). The N-terminal pro-brain natriuretic peptide (NT-proBNP, BNP) is regarded as the gold standard for diagnosing HF. However, its prognostic sensitivity in patients with end-stage renal disease is sub-optimal. Soluble suppression of tumorigenesis-2 (sST2) has been well studied in HF but rarely in patients with maintenance hemodialysis (MHD). This study aimed to evaluate the value of sST2 in predicting HF in MHD patients. METHODS Twenty-three patients with New York Heart Association (NYHA) class III-IV were included in the HF group and 88 NYHA class I-II patients in the non-heart failure (NHF) group. sST2 and laboratory indexes were compared between the two groups. RESULTS The HF group, compared with the NHF group, presented with higher sST2, more advanced age, higher incidence of coronary heart disease (CHD), left ventricle end-diastolic diameter (LVEDD), and pulmonary artery pressure (PAP), and unchanged parathyroid hormone (iPTH). The HF group also had lower ejection fraction (EF), uric acid, inorganic phosphorus, 25-OH VitD3, and serum albumin. Multivariate logistic regression indicated that age, BNP, and sST2 were independent risk factors of HF in MHD patients. Spearman analysis defined that sST2 was positively correlated with PAP (r =0.283, p =0.003) and C-reactive protein (r =0.354, p <0.001); and negatively correlated with sex (r =-0.255, p =0.007), albumin (r =-0.366, p <0.001), uric acid (r =-0.213, p =0.025), 25-OH VitD3 (r =-0.216, p =0.04), calcium (r =-0.219, p =0.021), and inorganic phosphorus (r =-0.256, p =0.007). Receiver operating characteristic curve analysis determined a positive association between BNP and sST2 (r =0.373, p <0.001), with the area under the curve (AUC) of BNP being 0.822 (sensitivity: 0.783, specificity: 0.830) and the AUC of sST2 being 0.841 (sensitivity: 0.913, specificity: 0.761). The AUC of sST2 was 0.841, and the cut-value was 42.840 (sensitivity: 0.913, specificity: 0.761). CONCLUSION sST2 can predict HF in MHD patients and facilitate early diagnosis and prevention of HF in MHD patients. HIPPOKRATIA 2022, 26 (1):19-24.
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Affiliation(s)
- X Zhou
- Department of Nephrology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China
| | - F Yi
- Department of Nephrology, The Lu'an Hospital Affiliated to Anhui Medical University, The Lu'an People's Hospital, Lu'an, Anhui, China
| | - L Peng
- Department of Nephrology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China
| | - J Jiang
- Department of Nephrology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China
| | - L Lan
- Department of Nephrology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China
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27
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Charfeddine S, Ibn Hadj Amor H, Jdidi J, Torjmen S, Kraiem S, Hammami R, Bahloul A, Kallel N, Moussa N, Touil I, Ghrab A, Elghoul J, Meddeb Z, Thabet Y, Kammoun S, Bouslama K, Milouchi S, Abdessalem S, Abid L. Long COVID 19 Syndrome: Is It Related to Microcirculation and Endothelial Dysfunction? Insights From TUN-EndCOV Study. Front Cardiovasc Med 2021; 8:745758. [PMID: 34917659 PMCID: PMC8670225 DOI: 10.3389/fcvm.2021.745758] [Citation(s) in RCA: 83] [Impact Index Per Article: 27.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 10/28/2021] [Indexed: 12/25/2022] Open
Abstract
The COVID-19 disease is a multisystem disease due in part to the vascular endothelium injury. Lasting effects and long-term sequelae could persist after the infection and may be due to persistent endothelial dysfunction. Our study focused on the evaluation of endothelial quality index (EQI) by finger thermal monitoring with E4 diagnosis Polymath in a large cohort of long COVID-19 patients to determine whether long-covid 19 symptoms are associated with endothelial dysfunction. This is a cross-sectional multicenter observational study with prospective recruitment of patients. A total of 798 patients were included in this study. A total of 618 patients (77.4%) had long COVID-19 symptoms. The mean EQI was 2.02 ± 0.99 IC95% [1.95-2.08]. A total of 397 (49.7%) patients had impaired EQI. Fatigue, chest pain, and neuro-cognitive difficulties were significantly associated with endothelium dysfunction with an EQI <2 after adjustment for age, sex, diabetes, hypertension, dyslipidemia, coronary heart disease, and the severity of acute COVID-19 infection. In multivariate analysis, endothelial dysfunction (EQI <2), female gender, and severe clinical status at acute COVID-19 infection with a need for oxygen supplementation were independent risk factors of long COVID-19 syndrome. Long COVID-19 symptoms, specifically non-respiratory symptoms, are due to persistent endothelial dysfunction. These findings allow for better care of patients with long COVID-19 symptoms.
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Affiliation(s)
- Salma Charfeddine
- Cardiology Department, Hedi Chaker University Hospital Sfax, Sfax, Tunisia.,University of Medicine of Sfax, University of Sfax, Sfax, Tunisia
| | | | - Jihen Jdidi
- University of Medicine of Sfax, University of Sfax, Sfax, Tunisia.,Department of Preventive Medicine, Hedi Chaker University Hospital Sfax, Sfax, Tunisia
| | - Slim Torjmen
- Cardiology Department, Hedi Chaker University Hospital Sfax, Sfax, Tunisia.,University of Medicine of Sfax, University of Sfax, Sfax, Tunisia
| | - Salma Kraiem
- Department of Cardiology, Tahar Sfar Hospital Mahdia, Sfax, Tunisia
| | - Rania Hammami
- Cardiology Department, Hedi Chaker University Hospital Sfax, Sfax, Tunisia.,University of Medicine of Sfax, University of Sfax, Sfax, Tunisia
| | - Amine Bahloul
- Cardiology Department, Hedi Chaker University Hospital Sfax, Sfax, Tunisia.,University of Medicine of Sfax, University of Sfax, Sfax, Tunisia
| | - Nesrine Kallel
- University of Medicine of Sfax, University of Sfax, Sfax, Tunisia.,Department of Pneumology, Hedi Chaker University Hospital Sfax, Sfax, Tunisia
| | - Nedia Moussa
- University of Medicine of Sfax, University of Sfax, Sfax, Tunisia.,Department of Pneumology, Hedi Chaker University Hospital Sfax, Sfax, Tunisia
| | - Imen Touil
- Department of Pneumology, Tahar Sfar Hospital Mahdia, Mahdia, Tunisia
| | - Aiman Ghrab
- Department of Cardiology, Habib Bourguiba Hospital Medenine, Sfax, Tunisia
| | - Jamel Elghoul
- University of Medicine of Sfax, University of Sfax, Sfax, Tunisia.,Department of Pneumology, Habib Bourguiba Hospital Medenine, Sfax, Tunisia
| | - Zineb Meddeb
- Department of Internal Medicine, Mongi Slim LaMarsa Hospital, Tunis, Tunisia
| | - Yamina Thabet
- Department of Internal Medicine, Mongi Slim LaMarsa Hospital, Tunis, Tunisia
| | - Samir Kammoun
- Cardiology Department, Hedi Chaker University Hospital Sfax, Sfax, Tunisia.,University of Medicine of Sfax, University of Sfax, Sfax, Tunisia
| | - Kamel Bouslama
- Department of Internal Medicine, Mongi Slim LaMarsa Hospital, Tunis, Tunisia
| | - Sami Milouchi
- University of Medicine of Sfax, University of Sfax, Sfax, Tunisia.,Department of Cardiology, Habib Bourguiba Hospital Medenine, Sfax, Tunisia
| | | | - Leila Abid
- Cardiology Department, Hedi Chaker University Hospital Sfax, Sfax, Tunisia.,University of Medicine of Sfax, University of Sfax, Sfax, Tunisia
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Pascual-Figal D, Bayés-Genis A, Beltrán-Troncoso P, Caravaca-Pérez P, Conde-Martel A, Crespo-Leiro MG, Delgado JF, Díez J, Formiga F, Manito N. Sacubitril-Valsartan, Clinical Benefits and Related Mechanisms of Action in Heart Failure With Reduced Ejection Fraction. A Review. Front Cardiovasc Med 2021; 8:754499. [PMID: 34859070 PMCID: PMC8631913 DOI: 10.3389/fcvm.2021.754499] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 10/06/2021] [Indexed: 12/11/2022] Open
Abstract
Heart failure (HF) is a clinical syndrome characterized by the presence of dyspnea or limited exertion due to impaired cardiac ventricular filling and/or blood ejection. Because of its high prevalence, it is a major health and economic burden worldwide. Several mechanisms are involved in the pathophysiology of HF. First, the renin-angiotensin-aldosterone system (RAAS) is over-activated, causing vasoconstriction, hypertension, elevated aldosterone levels and sympathetic tone, and eventually cardiac remodeling. Second, an endogenous compensatory mechanism, the natriuretic peptide (NP) system is also activated, albeit insufficiently to counteract the RAAS effects. Since NPs are degraded by the enzyme neprilysin, it was hypothesized that its inhibition could be an important therapeutic target in HF. Sacubitril/valsartan is the first of the class of dual neprilysin and angiotensin receptor inhibitors (ARNI). In patients with HFrEF, treatment with sacubitril/valsartan has demonstrated to significantly reduce mortality and the rates of hospitalization and rehospitalization for HF when compared to enalapril. This communication reviews in detail the demonstrated benefits of sacubitril/valsartan in the treatment of patients with HFrEF, including reduction of mortality and disease progression as well as improvement in cardiac remodeling and quality of life. The hemodynamic and organic effects arising from its dual mechanism of action, including the impact of neprilysin inhibition at the renal level, especially relevant in patients with type 2 diabetes mellitus, are also reviewed. Finally, the evidence on the demonstrated safety and tolerability profile of sacubitril/valsartan in the different subpopulations studied has been compiled. The review of this evidence, together with the recommendations of the latest clinical guidelines, position sacubitril/valsartan as a fundamental pillar in the treatment of patients with HFrEF.
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Affiliation(s)
- Domingo Pascual-Figal
- Cardiology Department, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain.,Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
| | - Antoni Bayés-Genis
- Heart Institute, Hospital Universitari Germans Trias i Pujol, Badalona, Spain.,Department of Medicine, Centro de Investigación Biomédica en Red, Enfermedades Cardiovasculares, Autonomous University of Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red, Enfermedades Cardiovasculares, Carlos III Institute of Health, Madrid, Spain
| | | | - Pedro Caravaca-Pérez
- Centro de Investigación Biomédica en Red, Enfermedades Cardiovasculares, Carlos III Institute of Health, Madrid, Spain.,Cardiology Service, Hospital Universitario 12 de Octubre, Madrid, Spain.,Faculty of Medicine, Complutense University of Madrid, Madrid, Spain
| | | | - Maria G Crespo-Leiro
- Advanced Heart Failure and Heart Transplant Unit, Cardiology Department, Complexo Hospitalario Universitario A Coruña, A Coruña, Spain.,Institute of Biomedical Research (INIBIC), A Coruña, Spain
| | - Juan F Delgado
- Centro de Investigación Biomédica en Red, Enfermedades Cardiovasculares, Carlos III Institute of Health, Madrid, Spain.,Cardiology Service, Hospital Universitario 12 de Octubre, Madrid, Spain.,Faculty of Medicine, Complutense University of Madrid, Madrid, Spain
| | - Javier Díez
- Centro de Investigación Biomédica en Red, Enfermedades Cardiovasculares, Carlos III Institute of Health, Madrid, Spain.,Cardiovascular Diseases Programme, Centre of Applied Medical Research, University of Navarra, Pamplona, Spain.,Departments of Nephrology, Cardiology, and Cardiac Surgery, University of Navarra Clinic, Pamplona, Spain.,Navarra Institute for Health Research, Pamplona, Spain
| | - Francesc Formiga
- Internal Medicine Department, Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain
| | - Nicolás Manito
- Heart Failure and Heart Transplantation Unit, Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain
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29
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Kong X, Zhang J, Lin J, Lv P, Chen H, Ji Z, Dai X, Jin X, Ma L, Jiang L. Pulmonary findings on high-resolution computed tomography in Takayasu arteritis. Rheumatology (Oxford) 2021; 60:5659-5667. [PMID: 33590834 DOI: 10.1093/rheumatology/keab163] [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: 08/18/2020] [Accepted: 02/10/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE This study aimed to describe pulmonary high-resolution CT (HRCT) findings in Takayasu arteritis (TA) and to determine possible causes. METHODS A total of 243 TA patients were enrolled from a prospective cohort after excluding patients with other pulmonary disorders or incomplete data. Patients were divided into two groups: those with normal lung HRCT and those with abnormal lung HRCT. Clinical characteristics were compared between groups and binary logistic regression analysis was applied to identify possible causes of the lung lesions. Follow-up HRCT (obtained in 64 patients) was analysed to study changes in pulmonary lesions after treatment. RESULTS Of the 243 patients, 107 (44.0%) had normal lung HRCT while 136 (56.0%) had abnormal lung HRCT, including stripe opacity (60.3%), nodules (44.9%), patchy opacity (25.0%), pleural thickening (15.4%), pleural effusion (10.3%), ground-glass opacity (8.1%), pulmonary infarction (6.6%), mosaic attenuation (4.4%), bronchiectasis (3.7%) and pulmonary oedema (2.2%). Patients with abnormal HRCT were significantly more likely to have type II arterial involvement (25% vs 12.2%, P = 0.04), pulmonary arterial involvement (PAI; 21.3% vs 5.6%, P < 0.001), pulmonary hypertension (20.6% vs 8.4%, P = 0.01) and abnormal heart function (27.9% vs 7.6%, P < 0.001). Logistic regression analysis demonstrated that PAI, worsened heart function and age were associated with presence of pulmonary lesions. Pulmonary infarction, pleural effusion and patchy opacities improved partially after treatment. CONCLUSION Pulmonary lesions are not rare in patients with TA. Age, PAI and worsened heart function are potential risk factors for presence of pulmonary lesions in TA.
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Affiliation(s)
| | | | | | | | | | | | | | - Xuejuan Jin
- Department of Clinical Epidemiology Center, Zhongshan Hospital.,Center of Clinical Epidemiology and Evidence-based Medicine, Fudan University, Shanghai, China
| | - Lili Ma
- Department of Rheumatology.,Center of Clinical Epidemiology and Evidence-based Medicine, Fudan University, Shanghai, China
| | - Lindi Jiang
- Department of Rheumatology.,Center of Clinical Epidemiology and Evidence-based Medicine, Fudan University, Shanghai, China
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30
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The Relationship between Serum Uric Acid and Ejection Fraction of the Left Ventricle. J Clin Med 2021; 10:jcm10174026. [PMID: 34501474 PMCID: PMC8432558 DOI: 10.3390/jcm10174026] [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: 06/24/2021] [Revised: 08/09/2021] [Accepted: 09/03/2021] [Indexed: 11/29/2022] Open
Abstract
Study basis: As a byproduct of protein metabolism, serum uric acid is a controversial risk factor and is the focus of several recent studies in the field of cardiovascular disease. Whether serum uric acid is involved in the development of these pathologies alone or in conjunction with other factors is a matter of debate. Objective: The objective of this study is to assess the direct relationship between serum uric acid and the ejection fraction. Methods: A retrospective study of 303 patients with heart failure, classified according to the ESC guidelines, was conducted, and several parameters, along with the relationship between serum uric acid and ejection fraction, were characterized. Results: A direct relationship between the level of serum uric acid and the ejection fraction was established (p = 0.03); patients with higher uric acid had an increased risk of having a lower ejection fraction. Conclusions: Serum uric acid, even when asymptomatic, is linked with the level of the ejection fraction of the left ventricle.
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31
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Yuan S, Schmidt HM, Wood KC, Straub AC. CoenzymeQ in cellular redox regulation and clinical heart failure. Free Radic Biol Med 2021; 167:321-334. [PMID: 33753238 DOI: 10.1016/j.freeradbiomed.2021.03.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 02/22/2021] [Accepted: 03/08/2021] [Indexed: 12/12/2022]
Abstract
Coenzyme Q (CoQ) is ubiquitously embedded in lipid bilayers of various cellular organelles. As a redox cycler, CoQ shuttles electrons between mitochondrial complexes and extramitochondrial reductases and oxidases. In this way, CoQ is crucial for maintaining the mitochondrial function, ATP synthesis, and redox homeostasis. Cardiomyocytes have a high metabolic rate and rely heavily on mitochondria to provide energy. CoQ levels, in both plasma and the heart, correlate with heart failure in patients, indicating that CoQ is critical for cardiac function. Moreover, CoQ supplementation in clinics showed promising results for treating heart failure. This review provides a comprehensive view of CoQ metabolism and its interaction with redox enzymes and reactive species. We summarize the clinical trials and applications of CoQ in heart failure and discuss the caveats and future directions to improve CoQ therapeutics.
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Affiliation(s)
- Shuai Yuan
- Heart, Lung, Blood and Vascular Medicine Institute, University of Pittsburgh, Pittsburgh, PA, USA
| | - Heidi M Schmidt
- Heart, Lung, Blood and Vascular Medicine Institute, University of Pittsburgh, Pittsburgh, PA, USA; Department of Pharmacology and Chemical Biology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Katherine C Wood
- Heart, Lung, Blood and Vascular Medicine Institute, University of Pittsburgh, Pittsburgh, PA, USA
| | - Adam C Straub
- Heart, Lung, Blood and Vascular Medicine Institute, University of Pittsburgh, Pittsburgh, PA, USA; Department of Pharmacology and Chemical Biology, University of Pittsburgh, Pittsburgh, PA, USA.
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32
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Roibal Pravio J, Barge Caballero E, Barbeito Caamaño C, Paniagua Martin MJ, Barge Caballero G, Couto Mallon D, Pardo Martinez P, Grille Cancela Z, Blanco Canosa P, García Pinilla JM, Vázquez Rodríguez JM, Crespo Leiro MG. Determinants of maximal oxygen uptake in patients with heart failure. ESC Heart Fail 2021; 8:2002-2008. [PMID: 33773098 PMCID: PMC8120347 DOI: 10.1002/ehf2.13275] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 02/09/2021] [Accepted: 02/11/2021] [Indexed: 12/28/2022] Open
Abstract
Aims Maximum oxygen uptake (VO2max) is an essential parameter to assess functional capacity of patients with heart failure (HF). We aimed to identify clinical factors that determine its value, as they have not been well characterized yet. Methods We conducted a retrospective, observational, single‐centre study of 362 consecutive patients with HF who underwent cardiopulmonary exercise testing (CPET) as part of standard clinical assessment since 2009–2019. CPET was performed on treadmill, according to Bruce's protocol (n = 360) or Naughton's protocol (n = 2). We performed multivariable linear regression analyses in order to identify independent clinical predictors associated with peak VO2max. Results Mean age of study patients was 57.3 ± 10.9 years, mean left ventricular ejection fraction was 32.8 ± 14.2%, and mean VO2max was 19.8 ± 5.2 mL/kg/min. Eighty‐nine (24.6%) patients were women, and 114 (31.5%) had ischaemic heart disease. Multivariable linear regression analysis identified six independent clinical predictors of VO2max, including NYHA class (B coefficient = −2.585; P < 0.001), age (B coefficient per 1 year = −0.104; P < 0.001), tricuspid annulus plane systolic excursion (B coefficient per 1 mm = +0.209; P < 0.001), body mass index (B coefficient per 1 kg/m2 = −0.172; P = 0.002), haemoglobin (B coefficient per 1 g/dL = +0.418; P = 0.007) and NT‐proBNP (B coefficient per 1000 pg/mL = −0.142; P = 0.019). Conclusions The severity of HF (NYHA class, NT‐proBNP) as well as age, body composition and haemoglobin levels influence significantly exercise capacity. In patients with HF, the right ventricular systolic function is of greater importance for the physical capacity than the left ventricular systolic function.
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Affiliation(s)
| | - Eduardo Barge Caballero
- Department of Cardiology, Complexo Hospitalario Universitario A Coruña, Instituto Investigación Biomedica A Coruña, A Coruña, Spain.,Centro Investigación Biomédica en Red Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain
| | - Cayetana Barbeito Caamaño
- Department of Cardiology, Complexo Hospitalario Universitario A Coruña, Instituto Investigación Biomedica A Coruña, A Coruña, Spain
| | - Maria Jesus Paniagua Martin
- Department of Cardiology, Complexo Hospitalario Universitario A Coruña, Instituto Investigación Biomedica A Coruña, A Coruña, Spain.,Centro Investigación Biomédica en Red Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain
| | - Gonzalo Barge Caballero
- Department of Cardiology, Complexo Hospitalario Universitario A Coruña, Instituto Investigación Biomedica A Coruña, A Coruña, Spain.,Centro Investigación Biomédica en Red Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain
| | - David Couto Mallon
- Department of Cardiology, Complexo Hospitalario Universitario A Coruña, Instituto Investigación Biomedica A Coruña, A Coruña, Spain.,Centro Investigación Biomédica en Red Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain
| | - Patricia Pardo Martinez
- Department of Cardiology, Complexo Hospitalario Universitario A Coruña, Instituto Investigación Biomedica A Coruña, A Coruña, Spain
| | - Zulaika Grille Cancela
- Department of Cardiology, Complexo Hospitalario Universitario A Coruña, Instituto Investigación Biomedica A Coruña, A Coruña, Spain.,Centro Investigación Biomédica en Red Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain
| | - Paula Blanco Canosa
- Department of Cardiology, Complexo Hospitalario Universitario A Coruña, Instituto Investigación Biomedica A Coruña, A Coruña, Spain
| | - Jose Manuel García Pinilla
- Centro Investigación Biomédica en Red Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain.,Unidad de Insuficiencia Cardiaca y Cardiopatias Familiares, Servicio de Cardiología, Hospital Universitario Virgen de la Victoria, Instituto de Investigación Biomédica de Málaga, Málaga, Spain
| | - Jose Manuel Vázquez Rodríguez
- Department of Cardiology, Complexo Hospitalario Universitario A Coruña, Instituto Investigación Biomedica A Coruña, A Coruña, Spain.,Centro Investigación Biomédica en Red Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain
| | - Maria Generosa Crespo Leiro
- Department of Cardiology, Complexo Hospitalario Universitario A Coruña, Instituto Investigación Biomedica A Coruña, A Coruña, Spain.,Centro Investigación Biomédica en Red Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain
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33
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Manukhina EB, Tseilikman VE, Komelkova MV, Lapshin MS, Goryacheva AV, Kondashevskaya MV, Mkhitarov VA, Lazuko SS, Tseilikman OB, Sarapultsev AP, Dmitrieva YA, Strizhikov VK, Kuzhel OP, Downey HF. Сardiac injury in rats with experimental posttraumatic stress disorder and mechanisms of its limitation in experimental posttraumatic stress disorder-resistant rats. J Appl Physiol (1985) 2021; 130:759-771. [PMID: 33411642 DOI: 10.1152/japplphysiol.00694.2019] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Traumatic stress causes posttraumatic stress disorder (PTSD). PTSD is associated with cardiovascular diseases and risk of sudden cardiac death in some subjects. We compared effects of predator stress (PS, cat urine scent, 10 days) on mechanisms of cardiac injury and protection in experimental PTSD-vulnerable (PTSD) and -resistant (PTSDr) rats. Fourteen days post-stress, rats were evaluated with an elevated plus-maze test, and assigned to PTSD and PTSDr groups according to an anxiety index calculated from the test results. Cardiac injury was evaluated by: 1) exercise tolerance; 2) ECG; 3) myocardial histomorphology; 4) oxidative stress; 5) pro- and anti-inflammatory cytokines. Myocardial heat shock protein 70 (HSP70) was also measured. Experimental PTSD developed in 40% of rats exposed to PS. Exercise tolerance of PTSD rats was 25% less than control rats and 21% less than PTSDr rats. ECG QRS, QT, and OTc intervals were significantly longer in PTSD rats than in control and PTSDr rats. Only cardiomyocytes of PTSD rats had histomorphological signs of metabolic and hypoxic injury and impaired contractility. Oxidative stress markers were higher in PTSD than in PTSDr rats. Pro-inflammatory IL-6 was higher in PTSD rats than in control and PTSDr rats, and anti-inflammatory IL-4 was lower in PTSD than in control and PTSDr rats. Myocardial HSP70 was lower in PTSD rats than in PTSDr and control rats. Our conclusion was that rats with PTSD developed multiple signs of cardiac injury. PTSDr rats were resistant also to cardiac injury. Factors that limit cardiac damage in PS rats include reduced inflammation and oxidative stress and increased protective HSP70.NEW & NOTEWORTHY For the first time, rats exposed to stress were segregated into experimental PTSD (ePTSD)-susceptible and ePTSD-resistant rats. Cardiac injury, ECG changes, and impaired exercise tolerance were more pronounced in ePTSD-susceptible rats. Resistance to ePTSD was associated with decreased inflammation and oxidative stress and with increased protective heat shock protein 70. Results may help identify individuals at high risk of PTSD and also provide a foundation for developing preventive and therapeutic means to restrict PTSD-associated cardiac morbidity.
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Affiliation(s)
- Eugenia B Manukhina
- School of Medical Biology, South Ural State University, Chelyabinsk, Russian Federation.,Laboratory for Regulatory Mechanisms of Stress and Adaptation, Institute of General Pathology and Pathophysiology, Moscow, Russian Federation.,Department of Physiology and Anatomy, University of North Texas Health Science Center, Fort Worth, Texas
| | - Vadim E Tseilikman
- School of Medical Biology, South Ural State University, Chelyabinsk, Russian Federation
| | - Maria V Komelkova
- School of Medical Biology, South Ural State University, Chelyabinsk, Russian Federation
| | - Maxim S Lapshin
- School of Medical Biology, South Ural State University, Chelyabinsk, Russian Federation
| | - Anna V Goryacheva
- Laboratory for Regulatory Mechanisms of Stress and Adaptation, Institute of General Pathology and Pathophysiology, Moscow, Russian Federation
| | - Marina V Kondashevskaya
- Laboratory for Immunomorphology of Inflammation, Research Institute of Human Morphology, Moscow, Russian Federation
| | - Vladimir A Mkhitarov
- Laboratory for Immunomorphology of Inflammation, Research Institute of Human Morphology, Moscow, Russian Federation
| | - Svetlana S Lazuko
- Department of Normal Physiology, Vitebsk State Medical University, Vitebsk, Republic of Belarus
| | - Olga B Tseilikman
- School of Medical Biology, South Ural State University, Chelyabinsk, Russian Federation.,School of Basic Medicine, Chelyabinsk State University, Chelyabinsk, Russian Federation
| | - Alexey P Sarapultsev
- School of Medical Biology, South Ural State University, Chelyabinsk, Russian Federation.,Laboratory of Immunopathophysiology, Institute of Immunology and Physiology of RAS, Ekaterinburg, Russian Federation
| | - Yulia A Dmitrieva
- School of Medical Biology, South Ural State University, Chelyabinsk, Russian Federation
| | - Viktor K Strizhikov
- Department of Morphology and Histology, South Ural State Agricultural University, Troitsk, Russian Federation
| | - Olga P Kuzhel
- Department of Normal Physiology, Vitebsk State Medical University, Vitebsk, Republic of Belarus
| | - H Fred Downey
- School of Medical Biology, South Ural State University, Chelyabinsk, Russian Federation.,Department of Physiology and Anatomy, University of North Texas Health Science Center, Fort Worth, Texas
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34
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Bunsawat K, Ratchford SM, Alpenglow JK, Park SH, Jarrett CL, Stehlik J, Smith AS, Richardson RS, Wray DW. Sacubitril-valsartan improves conduit vessel function and functional capacity and reduces inflammation in heart failure with reduced ejection fraction. J Appl Physiol (1985) 2021; 130:256-268. [PMID: 33211601 PMCID: PMC7944927 DOI: 10.1152/japplphysiol.00454.2020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 11/11/2020] [Accepted: 11/11/2020] [Indexed: 12/11/2022] Open
Abstract
The Prospective comparison of ARNI with angiotensin-converting enzyme inhibitor to Determine Impact on Global Mortality and morbidity in Heart Failure trial identified a marked reduction in the risk of death and hospitalization for heart failure in patients with heart failure with reduced ejection fraction (HFrEF) treated with sacubitril-valsartan (trade name Entresto), but the physiological processes underpinning these improvements are unclear. We tested the hypothesis that treatment with sacubitril-valsartan improves peripheral vascular function, functional capacity, and inflammation in patients with HFrEF. We prospectively studied patients with HFrEF (n = 11, 10 M/1 F, left ventricular ejection fraction = 27 ± 8%) on optimal, guideline-directed medical treatment who were subsequently prescribed sacubitril-valsartan (open-label, uncontrolled, and unblinded). Peripheral vascular function [brachial artery flow-mediated dilation (FMD, conduit vessel function) and reactive hyperemia (RH, microvascular function)], functional capacity [six-minute walk test (6MWT) distance], and the proinflammatory biomarkers tumor necrosis factor-α (TNF-α) and interleukin-18 (IL-18) were obtained at baseline and at 1, 2, and 3 mo of treatment. %FMD improved after 1 mo of treatment, and this favorable response persisted for months 2 and 3 (baseline: 3.25 ± 1.75%; 1 mo: 5.23 ± 2.36%; 2 mo: 5.81 ± 1.79%; 3 mo: 6.35 ± 2.77%), whereas RH remained unchanged. 6MWT distance increased at months 2 and 3 (baseline: 420 ± 92 m; 1 mo: 436 ± 98 m; 2 mo: 465 ± 115 m; 3 mo: 460 ± 110 m), and there was a sustained reduction in TNF-α (baseline: 2.38 ± 1.35 pg/mL; 1 mo: 2.06 ± 1.52 pg/mL; 2 mo: 1.95 ± 1.34 pg/mL; 3 mo: 1.92 ± 1.37 pg/mL) and a reduction in IL-18 at month 3 (baseline: 654 ± 150 pg/mL; 1 mo: 595 ± 140 pg/mL; 2 mo: 601 ± 176 pg/mL; 3 mo: 571 ± 127 pg/mL). This study provides new evidence for the potential of this new drug class to improve conduit vessel function, functional capacity, and inflammation in patients with HFrEF.NEW & NOTEWORTHY We observed an approximately twofold improvement in conduit vessel function (brachial artery FMD), increased functional capacity (6MWT distance), and a reduction in inflammation (TNF-α and IL-18) following 3 mo of sacubitril-valsartan therapy. These findings provide important new information concerning the physiological mechanisms by which this new drug class provokes favorable changes in HFrEF pathophysiology.
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Affiliation(s)
- Kanokwan Bunsawat
- Division of Geriatrics, Department of Internal Medicine, University of Utah, Salt Lake City, Utah
| | - Stephen M Ratchford
- Division of Geriatrics, Department of Internal Medicine, University of Utah, Salt Lake City, Utah
- Geriatric Research, Education, and Clinical Center, George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, Utah
- Department of Health & Exercise Science, Appalachian State University, Boone, North Carolina
| | - Jeremy K Alpenglow
- Department of Nutrition and Integrative Physiology, University of Utah, Salt Lake City, Utah
| | - Soung Hun Park
- Department of Nutrition and Integrative Physiology, University of Utah, Salt Lake City, Utah
| | - Catherine L Jarrett
- Division of Geriatrics, Department of Internal Medicine, University of Utah, Salt Lake City, Utah
- Geriatric Research, Education, and Clinical Center, George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, Utah
| | - Josef Stehlik
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Utah, Salt Lake City, Utah
| | - Adam S Smith
- Department of Pharmacy Services, University of Utah, Salt Lake City, Utah
| | - Russell S Richardson
- Division of Geriatrics, Department of Internal Medicine, University of Utah, Salt Lake City, Utah
- Geriatric Research, Education, and Clinical Center, George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, Utah
- Department of Nutrition and Integrative Physiology, University of Utah, Salt Lake City, Utah
| | - D Walter Wray
- Division of Geriatrics, Department of Internal Medicine, University of Utah, Salt Lake City, Utah
- Geriatric Research, Education, and Clinical Center, George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, Utah
- Department of Nutrition and Integrative Physiology, University of Utah, Salt Lake City, Utah
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35
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Blacher M, Zimerman A, Engster PHB, Grespan E, Polanczyk CA, Rover MM, Neto JADF, Danzmann LC, Bertoldi EG, Simões MV, Beck-da-Silva L, Biolo A, Rohde LE. Revisiting heart failure assessment based on objective measures in NYHA functional classes I and II. Heart 2020; 107:1487-1492. [PMID: 33361353 DOI: 10.1136/heartjnl-2020-317984] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 11/11/2020] [Accepted: 11/16/2020] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVE New York Heart Association (NYHA) functional class plays a central role in heart failure (HF) assessment but might be unreliable in mild presentations. We compared objective measures of HF functional evaluation between patients classified as NYHA I and II in the Rede Brasileira de Estudos em Insuficiência Cardíaca (ReBIC)-1 Trial. METHODS The ReBIC-1 Trial included outpatients with stable HF with reduced ejection fraction. All patients had simultaneous protocol-defined assessment of NYHA class, 6 min walk test (6MWT), N-terminal pro-brain natriuretic peptide (NT-proBNP) levels and patient's self-perception of dyspnoea using a Visual Analogue Scale (VAS, range 0-100). RESULTS Of 188 included patients with HF, 122 (65%) were classified as NYHA I and 66 (35%) as NYHA II at baseline. Although NYHA class I patients had lower dyspnoea VAS Scores (median 16 (IQR, 4-30) for class I vs 27.5 (11-49) for class II, p=0.001), overlap between classes was substantial (density overlap=60%). A similar profile was observed for NT-proBNP levels (620 pg/mL (248-1333) vs 778 (421-1737), p=0.015; overlap=78%) and for 6MWT distance (400 m (330-466) vs 351 m (286-408), p=0.028; overlap=64%). Among NYHA class I patients, 19%-34% had one marker of HF severity (VAS Score >30 points, 6MWT <300 m or NT-proBNP levels >1000 pg/mL) and 6%-10% had two of them. Temporal change in functional class was not accompanied by variation on dyspnoea VAS (p=0.14). CONCLUSIONS Most patients classified as NYHA classes I and II had similar self-perception of their limitation, objective physical capabilities and levels of natriuretic peptides. These results suggest the NYHA classification poorly discriminates patients with mild HF.
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Affiliation(s)
- Mariana Blacher
- Post-Graduate Program in Cardiology and Cardiovascular Sciences, Faculdade de Medicina da Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Cardiovascular Division, Hospital Moinhos de Vento, Porto Alegre, Brazil
| | - André Zimerman
- Post-Graduate Program in Cardiology and Cardiovascular Sciences, Faculdade de Medicina da Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Cardiovascular Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Pedro H B Engster
- Cardiovascular Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Eduardo Grespan
- Cardiovascular Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Carisi A Polanczyk
- Post-Graduate Program in Cardiology and Cardiovascular Sciences, Faculdade de Medicina da Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Cardiovascular Division, Hospital Moinhos de Vento, Porto Alegre, Brazil.,Cardiovascular Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | | | | | - Luiz C Danzmann
- Universidade Luterana do Brasil, Canoas, Rio Grande do Sul, Brazil
| | | | | | - Luis Beck-da-Silva
- Post-Graduate Program in Cardiology and Cardiovascular Sciences, Faculdade de Medicina da Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Cardiovascular Division, Hospital Moinhos de Vento, Porto Alegre, Brazil.,Cardiovascular Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Andréia Biolo
- Post-Graduate Program in Cardiology and Cardiovascular Sciences, Faculdade de Medicina da Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Cardiovascular Division, Hospital Moinhos de Vento, Porto Alegre, Brazil.,Cardiovascular Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Luis E Rohde
- Post-Graduate Program in Cardiology and Cardiovascular Sciences, Faculdade de Medicina da Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil .,Cardiovascular Division, Hospital Moinhos de Vento, Porto Alegre, Brazil.,Cardiovascular Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
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Shah N, Beenhouwer D, Broder MS, Bronte-Hall L, De Castro LM, Gibbs SN, Gordeuk VR, Kanter J, Klings ES, Lipato T, Manwani D, Scullin B, Yermilov I, Smith WR. Development of a Severity Classification System for Sickle Cell Disease. CLINICOECONOMICS AND OUTCOMES RESEARCH 2020; 12:625-633. [PMID: 33149635 PMCID: PMC7604906 DOI: 10.2147/ceor.s276121] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Accepted: 10/16/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose There is no well-accepted classification system of overall sickle cell disease (SCD) severity. We sought to develop a system that could be tested as a clinical outcome predictor. Patients and Methods Using validated methodology (RAND/UCLA modified Delphi panel), 10 multi-disciplinary expert clinicians collaboratively developed 180 simplified patient histories and rated each on multiple axes (estimated clinician follow-up frequency, risk of complications or death, quality of life, overall disease severity). Using ratings on overall disease severity, we developed a 3-level severity classification system ranging from Class I (least severe) to Class III (most severe). Results The system defines patients as Class I who are 8-40 years with no end organ damage, no chronic pain, and ≤4 unscheduled acute care visits due to vaso-occlusive crises (VOC) in the last year. Patients <8 or >40 years with no end organ damage, no chronic pain, and <2 unscheduled acute care visits are also considered Class I. Patients any age with ≥5 unscheduled acute care visits and/or with severe damage to bone, retina, heart, lung, kidney, or brain are classified as Class III (except patients ≥25 years with severe retinopathy, no chronic pain, and 0-1 unscheduled acute care visits, who are considered Class II). Patients not meeting these Class I or III definitions are classified as Class II. Conclusion This system consolidates patient characteristics into homogenous groups with respect to disease state to support clinical decision-making. The system is consistent with existing literature that increased unscheduled acute care visits and organ damage translate into clinically significant patient morbidity. Studies to further validate this system are planned.
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Affiliation(s)
- Nirmish Shah
- Department of Medicine, Duke University, Durham, NC, USA
| | - David Beenhouwer
- Partnership for Health Analytic Research (PHAR), LLC, Beverly Hills, CA, USA
| | - Michael S Broder
- Partnership for Health Analytic Research (PHAR), LLC, Beverly Hills, CA, USA
| | | | - Laura M De Castro
- Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Sarah N Gibbs
- Partnership for Health Analytic Research (PHAR), LLC, Beverly Hills, CA, USA
| | - Victor R Gordeuk
- Department of Medicine, University of Illinois at Chicago, Chicago, IL, USA
| | - Julie Kanter
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Elizabeth S Klings
- Department of Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Thokozeni Lipato
- Department of Internal Medicine, Virginia Commonwealth University, Richmond, VA, USA
| | - Deepa Manwani
- Department of Pediatrics, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Brigid Scullin
- Department of Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Irina Yermilov
- Partnership for Health Analytic Research (PHAR), LLC, Beverly Hills, CA, USA
| | - Wally R Smith
- Department of Internal Medicine, Virginia Commonwealth University, Richmond, VA, USA
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Chen L, Jin C, Chen L, Li M, Zhong Y, Xu Y. Value of microalbuminuria in the diagnosis of heart failure with preserved ejection fraction. Herz 2020; 46:215-221. [PMID: 33118081 DOI: 10.1007/s00059-020-04985-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 07/30/2020] [Accepted: 09/04/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Elevated microalbuminuria (MAU) levels have been demonstrated in patients with heart failure with reduced ejection fraction (HFrEF). However, nothing is known about MAU levels in patients with heart failure with preserved ejection fraction (HFpEF). Therefore, the aim of our study was to explore the relationship between MAU levels and HFpEF. METHODS The MAU and N‑terminal B‑type natriuretic peptide (NT-proBNP) concentrations were examined in 260 participants, including 160 patients with HFpEF and 100 control subjects without HF. Echocardiography was performed on all study participants. The patients with HFpEF were divided into class II, III, or IV according to the New York Heart Association (NYHA) classification. RESULTS The MAU levels in the HFpEF group were significantly higher than those in the non-HF group (58.97 ± 89.84 vs. 19.56 ± 29.34, p > 0.05). However, there was no significant difference in the levels of MAU among NYHA class II-IV patients in the HFpEF group (p > 0.05). In Pearson linear correlation analysis, MAU levels in the HFpEF group were positively correlated with left atrial diameter (LAD; r = 0.344, p < 0.05), but negatively correlated with hemoglobin (r = - 0.233, p < 0.05). The area under the ROC curve (AUC) of MAU for the diagnosis of HFpEF was 0.83 (95% CI [0.76, 0.90], p < 0.05), the sensitivity was 72.50%, and the specificity was 82.0%. The AUC of NT-proBNP was 0.88 (95% CI [0.83, 0.94], p < 0.05), the sensitivity was 82%, and the specificity was 73.8%. The AUC of MAU combined with NT-proBNP was 0.91 (95% CI [0.86, 0.96], p < 0.05). CONCLUSION Our results show that MAU can be used as a biomarker for the diagnosis of HFpEF. Combined detection of MAU with NT-proBNP has clinical value in improving the accuracy of diagnosis of HFpEF. However, there is no significant correlation between MAU levels and the severity of HFpEF.
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Affiliation(s)
- Liuying Chen
- Zhejiang Chinese Medical University, Hangzhou, China.,Department of Cardiology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Chaolun Jin
- Nanjing Medical University, Nanjing, China.,Department of Cardiology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Lijun Chen
- Zhejiang Chinese Medical University, Hangzhou, China.,Department of Cardiology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Miaofu Li
- Nanjing Medical University, Nanjing, China.,Department of Cardiology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yigang Zhong
- Department of Cardiology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China.
| | - Yizhou Xu
- Nanjing Medical University, Nanjing, China. .,Department of Cardiology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China.
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Greene SJ, Adusumalli S, Albert NM, Hauptman PJ, Rich MW, Heidenreich PA, Butler J. Building a Heart Failure Clinic: A Practical Guide from the Heart Failure Society of America. J Card Fail 2020; 27:2-19. [PMID: 33289664 DOI: 10.1016/j.cardfail.2020.10.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 10/13/2020] [Indexed: 01/09/2023]
Abstract
Heart failure (HF) remains a leading cause of mortality and morbidity and a primary driver of health care resource use in the United States. As such, there continues to be much interest in the development and refinement of HF clinics that manage patients with HF in a guideline-directed, technology-enabled, and coordinated approach. Optimization of resource use and maintenance of collaboration with other providers are also important themes when considering implementation of HF clinics. Through this document, the Heart Failure Society of America aims to provide a contemporary, practical guide to creating and sustaining a HF clinic. The guide discusses (1) patient care considerations for delivering guideline-directed and patient-centered care, and (2) operational considerations including development of a HF clinic business plan, setting goals, leadership support, triggers for patient referral and patient follow-up, patient population served, optimal clinic staffing models, relationships with subspecialists, and continuous quality improvement. This document was developed to empower providers and clinicians who wish to build and sustain community-based, successful HF clinics.
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Affiliation(s)
- Stephen J Greene
- Duke Clinical Research Institute, Durham, North Carolina, USA; Division of Cardiology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Srinath Adusumalli
- Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA; Cardiovascular Outcomes, Quality, and Evaluative Research Center, University of Pennsylvania, Philadelphia, Pennsylvania, USA; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Nancy M Albert
- Nursing Institute and Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio USA
| | - Paul J Hauptman
- University of Tennessee Graduate School of Medicine, Knoxville, Tennessee, USA
| | - Michael W Rich
- Washington University School of Medicine, St. Louis, Missouri, USA
| | | | - Javed Butler
- University of Mississippi Medical Center, Jackson, Mississippi, USA.
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Bubnova MG, Persiyanova-Dubrova AL. Six-minute walk test in cardiac rehabilitation. КАРДИОВАСКУЛЯРНАЯ ТЕРАПИЯ И ПРОФИЛАКТИКА 2020. [DOI: 10.15829/1728-8800-2020-2561] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Six-minute walk test (6MWT) is a simple and safe tool for assessing exercise tolerance in various categories of patients. Currently, 6MWT is used to assess the functional status of a patient and determine the strategy of increasing physical activity, primarily in patients with reduced exercise tolerance and contraindications for cardiopulmonary exercise test. The basic requirements for the 6MWT are presented, taking into account the factors affecting its informativeness and accuracy, as well as the interpretation of results. The diagnostic and prognostic value of 6MWT in different categories of patients are discussed. The prospects for 6MWT use in cardiac rehabilitation for planning rehabilitation program, prescribing exercises, determining the risk of complications, and evaluating the effectiveness are considered. The limitations of 6MWT and ways to overcome it, as well as directions for further research are presented.
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Affiliation(s)
- M. G. Bubnova
- National Medical Research Center for Therapy and Preventive Medicine
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Lautamatti E, Sumanen M, Raivio R, Mattila KJ. Continuity of care is associated with satisfaction with local health care services. BMC FAMILY PRACTICE 2020; 21:181. [PMID: 32887566 PMCID: PMC7487808 DOI: 10.1186/s12875-020-01251-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 08/25/2020] [Indexed: 11/29/2022]
Abstract
Background Satisfaction is a major element in assessing quality of care. It has decreased in Finland in recent decades as well as continuity of care. We investigated which demographic, health-related, and local health care service factors, especially continuity of care, are associated with the population’s satisfaction with local health care services. Methods The data are part of the Health and Social Support (HeSSup) study’s follow-up questionnaire in 2012. The study is based on a random Finnish population sample. Satisfaction was studied based on the question “How satisfied are you with your local health care services?” Demographic factors, obesity, self-assessed health status, depressive mood (BDI-12 questionnaire), New York Heart Association class, and chronic diseases were asked in the questionnaire. Questions describing local health care services were also presented. We assessed the association of an assigned and named GP and the respondents’ proactivity in contacting the same doctor with satisfaction. We used crosstabulation and binary logistic regression in the analyses. Results The Health and Social Support study was answered in 2012 by 15,993 participants (45.4%) and majority (61.3%) was satisfied with their local health care services. An assigned and named GP (OR 1.79; 95% CI 1.67–1.92) and the respondent’s proactivity in contacting the same doctor (OR 1.23; 95% CI 1.15–1.32) were associated with satisfaction in the adjusted multivariate analysis. BDI score < 19 had the strongest association with satisfaction (OR 1.91; 95% CI 1.65–2.23). Older participants, males, and those in a relationship were more likely to be satisfied. Conclusions A named GP in primary care proved to have a positive correlation with patient satisfaction. Depression was associated with decreased satisfaction. A named GP indicates continuity of care, and it should be seriously considered when planning treatment for patients with chronic conditions.
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Affiliation(s)
- E Lautamatti
- Faculty of Medicine and Health Technology, Tampere University, Tampere and Centre for General Practice of the Pirkanmaa Hospital District, Tampere, Finland.
| | - M Sumanen
- Faculty of Medicine and Health Technology, Tampere University, Tampere and Centre for General Practice of the Pirkanmaa Hospital District, Tampere, Finland
| | - R Raivio
- Päijät-Häme Joint Authority for Health and Wellbeing, Primary Health Care, Lahti, Finland
| | - K J Mattila
- Faculty of Medicine and Health Technology, Tampere University, Tampere and Centre for General Practice of the Pirkanmaa Hospital District, Tampere, Finland
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41
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Barrios V, Escobar C, Ortiz Cortés C, Cosín Sales J, Pascual Figal D, García-Moll Marimón X. Management of patients with heart failure treated in cardiology consultations: IC-BERG Study. Rev Clin Esp 2020. [DOI: 10.1016/j.rceng.2019.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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42
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Barrios V, Escobar C, Ortiz Cortés C, Cosín Sales J, Pascual Figal D, García-Moll Marimón X. Manejo de los pacientes con insuficiencia cardiaca atendidos en la consulta de cardiología: Estudio IC-BERG. Rev Clin Esp 2020; 220:339-349. [DOI: 10.1016/j.rce.2019.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 10/30/2019] [Accepted: 10/31/2019] [Indexed: 10/24/2022]
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43
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Kong X, Ma L, Lv P, Cui X, Chen R, Ji Z, Chen H, Lin J, Jiang L. Involvement of the pulmonary arteries in patients with Takayasu arteritis: a prospective study from a single centre in China. Arthritis Res Ther 2020; 22:131. [PMID: 32503678 PMCID: PMC7275430 DOI: 10.1186/s13075-020-02203-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Accepted: 04/28/2020] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Takayasu arteritis (TA) is a large vessel vasculitis that can involve pulmonary arteries (PAs). We studied multiple clinical characteristics related to pulmonary artery involvement (PAI) in TA patients. METHODS We enrolled 216 patients with TA from a large prospective cohort. PAI was assessed in each patient based on data from magnetic resonance angiography/computed tomography angiography. Pulmonary hypertension, cardiac function, and pulmonary parenchymal lesions were evaluated further in patients with PAI based on echocardiography, the New York Heart Association Functional Classification, and pulmonary computed tomography, respectively. These abnormalities related to PAI were followed up to evaluate treatment effects. RESULTS PAI was detected in 56/216 (25.93%) patients, which involved the pulmonary trunk, main PAs, and small vessels in the lungs. Among patients with PAI, 28 (50%) patients were accompanied by pulmonary hypertension, which was graded as 'severe' in 9 (16.07%), 'moderate' in 10 (17.86%), and mild in 9 (16.07%). Twenty-six (46.43%) patients showed advanced NYHA function (III, 20, 35.71%; IV, 6, 10.71%). Furthermore, 21 (37.50%) patients presented with abnormal pulmonary parenchymal lesions in the area corresponding to PAI (e.g. the mosaic sign, infarction, bronchiectasis). During follow-up, two patients died due to heart failure and pulmonary thrombosis. In the remaining patients, the abnormalities mentioned above improved partially after routine treatment. CONCLUSIONS PAI is common in TA patients. PAI can cause pulmonary hypertension, cardiac insufficiency, and pulmonary parenchymal lesions, which worsen patients' prognosis.
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Affiliation(s)
- Xiufang Kong
- Department of Rheumatology, Zhongshan Hospital Affiliated to Fudan University, Shanghai, China
| | - Lili Ma
- Department of Rheumatology, Zhongshan Hospital Affiliated to Fudan University, Shanghai, China
| | - Peng Lv
- Department of Radiology, Zhongshan Hospital Affiliated to Fudan University, Shanghai, China
| | - Xiaomeng Cui
- Department of Rheumatology, Zhongshan Hospital Affiliated to Fudan University, Shanghai, China
| | - Rongyi Chen
- Department of Rheumatology, Zhongshan Hospital Affiliated to Fudan University, Shanghai, China
| | - Zongfei Ji
- Department of Rheumatology, Zhongshan Hospital Affiliated to Fudan University, Shanghai, China
| | - Huiyong Chen
- Department of Rheumatology, Zhongshan Hospital Affiliated to Fudan University, Shanghai, China
| | - Jiang Lin
- Department of Radiology, Zhongshan Hospital Affiliated to Fudan University, Shanghai, China
| | - Lindi Jiang
- Department of Rheumatology, Zhongshan Hospital Affiliated to Fudan University, Shanghai, China. .,Center of Clinical Epidemiology and Evidence-based Medicine, Fudan University, Shanghai, China.
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Takagi H, Kato M, Hari Y, Nakashima K, Kuno T, Ando T. Gait and fate: Baseline gait speed and mortality after transcatheter aortic valve implantation. J Cardiol 2020; 75:600-605. [DOI: 10.1016/j.jjcc.2020.01.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Revised: 12/04/2019] [Accepted: 01/21/2020] [Indexed: 01/30/2023]
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Camacho OM, Hedge A, Lowe F, Newland N, Gale N, McEwan M, Proctor C. Statistical analysis plan for "A randomised, controlled study to evaluate the effects of switching from cigarette smoking to using a tobacco heating product on health effect indicators in healthy subjects". Contemp Clin Trials Commun 2020; 17:100535. [PMID: 32072070 PMCID: PMC7013164 DOI: 10.1016/j.conctc.2020.100535] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 01/10/2020] [Accepted: 01/26/2020] [Indexed: 02/06/2023] Open
Abstract
Tobacco harm reduction strategies aim to substitute smoking with potentially reduced risk products (PRRPs) such as e-cigarettes and tobacco-heating products (THPs). The health benefits of switching from smoking to PRRPs is unknown. A randomised controlled trial is being conducted to increase understanding of the health effects of switching from smoking to a THP in a 12-month long ambulatory study (ISRCTN81075760). Here we describe the study endpoints and the statistical analysis plan. Endpoints are divided into biomarkers of exposure (BoE) to tobacco smoke constituents and health effect indicators related to risk of lung cancer, cardiovascular and obstructive lung disease. These have been selected on the basis of extensive literature evidence. Three primary endpoints, augmentation index (risk factor for cardiovascular disease), total NNAL (linked to lung cancer) and 8-Epi-PGF2α type III (indicator of oxidative stress linked to various diseases), and multiple secondary endpoints will be analysed at 90, 180, and 360 days. Changes from baseline will be compared between study arms by specific contrasts in mixed models. Study wise multiple comparisons adjustments will be performed to account for multiplicity of timepoints and comparisons within timepoints. Generalisability of outcomes will be tested by a sensitivity analysis adjusting for age and gender. Importantly, an ancillary analysis will be performed to assess product compliance during the study based on plasma levels of CEVal, a surrogate marker for acrylonitrile exposure. The rationale underlying the selection of BoEs and health effect indicators, coupled with the statistical analysis plan will be central to understanding the potential health effects of replacing smoking with THP use for one year.
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Affiliation(s)
- Oscar M. Camacho
- British American Tobacco Investments Ltd, Regents Park Road, Southampton, Hampshire, SO15 8TL, UK
| | - Andrew Hedge
- Covance Clinical Research Unit Ltd, Springfield House, Hyde Street, Leeds, Yorkshire, LS2 9LH, UK
| | - Frazer Lowe
- British American Tobacco Investments Ltd, Regents Park Road, Southampton, Hampshire, SO15 8TL, UK
| | - Nik Newland
- British American Tobacco Investments Ltd, Regents Park Road, Southampton, Hampshire, SO15 8TL, UK
| | - Nathan Gale
- British American Tobacco Investments Ltd, Regents Park Road, Southampton, Hampshire, SO15 8TL, UK
| | - Mike McEwan
- British American Tobacco Investments Ltd, Regents Park Road, Southampton, Hampshire, SO15 8TL, UK
| | - Christopher Proctor
- British American Tobacco Investments Ltd, Regents Park Road, Southampton, Hampshire, SO15 8TL, UK
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How to develop a national heart failure clinics network: a consensus document of the Hellenic Heart Failure Association. ESC Heart Fail 2020; 7:15-25. [PMID: 32100972 PMCID: PMC7083479 DOI: 10.1002/ehf2.12558] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 08/01/2019] [Accepted: 10/31/2019] [Indexed: 12/26/2022] Open
Abstract
Heart failure (HF) is rapidly growing, conferring considerable mortality, morbidity, and costs. Dedicated HF clinics improve patient outcomes, and the development of a national HF clinics network aims at addressing this need at national level. Such a network should respect the existing health care infrastructures, and according to the capacities of hosting facilities, it can be organized into three levels. Establishing the continuous communication and interaction among the components of the network is crucial, while supportive actions that can enhance its efficiency include involvement of multidisciplinary health care professionals, use of structured HF‐specific documents, such as discharge notes, patient information leaflets, and patient booklets, and implementation of an HF‐specific electronic health care record and database platform.
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Zhang J, Hu G, Yang S. Intracoronary Sarcoplasmic Reticulum Calcium-ATPase Gene Therapy in Advanced Heart Failure Patients with reduced Ejection Fraction: A Prospective Cohort Study. Clinics (Sao Paulo) 2020; 75:e1530. [PMID: 32187281 PMCID: PMC7061318 DOI: 10.6061/clinics/2020/e1530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2019] [Accepted: 01/07/2020] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE Heart failure is a progressive and debilitating disease. Intracoronary sarcoplasmic reticulum calcium-ATPase gene therapy may improve the function of cardiac muscle cells. This study aimed to test the hypothesis that intracoronary sarcoplasmic reticulum calcium-ATPase gene therapy can improve outcomes and reduce the number of recurrent and terminal events in advanced heart failure patients with reduced ejection fraction. METHODS A total of 768 heart failure patients with reduced ejection fraction and New York Heart Association classification II to IV were included in this prospective cohort study. Patients either underwent intracoronary sarcoplasmic reticulum calcium-ATPase gene therapy (CA group, n=384) or received oral placebo (PA group; n=384). Data regarding recurrent and terminal event(s), treatment-emergent adverse effects, and outcome measures were collected and analyzed. RESULTS After a follow-up period of 18 months, intracoronary sarcoplasmic reticulum calcium-ATPase gene therapy reduced the number of hospital admissions (p=0.001), ambulatory treatments (p=0.0004), and deaths (p=0.024). Additionally, intracoronary sarcoplasmic reticulum calcium-ATPase gene therapy improved the left ventricular ejection fraction (p<0.0001) and Kansas City Cardiomyopathy Questionnaire score (p<0.0001). The number of recurrent and terminal events/patients were higher in the PA group than in the CA group after the follow-up period of 18 months (p=0.015). The effect of the intracoronary sarcoplasmic reticulum calcium-ATPase gene therapy was independent of the confounding variables. No new arrhythmias were reported in the CA group. CONCLUSIONS Intracoronary sarcoplasmic reticulum calcium-ATPase gene therapy reduces the number of recurrent and terminal events and improves the clinical course of advanced heart failure patients with reduced ejection fraction.
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Affiliation(s)
- Jianfeng Zhang
- Cardio-Pulmonary Rehabilitation Inpatient Area, The Second Rehabilitation Hospital of Shanghai, Shanghai 200431, China
- *Corresponding author. E-mail:
| | - Guojin Hu
- Cardio-Pulmonary Rehabilitation Inpatient Area, The Second Rehabilitation Hospital of Shanghai, Shanghai 200431, China
| | - Shengyong Yang
- Cardio-Pulmonary Rehabilitation Inpatient Area, The Second Rehabilitation Hospital of Shanghai, Shanghai 200431, China
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García-Olmos L, Batlle M, Aguilar R, Porro C, Carmona M, Alberquilla A, Sánchez-Gómez LM, Monge E, López-Rodríguez AB, Benito L, Baños N, Simón A, Martínez-Álvarez MA, Luque EM, García-Benito C. Disability and quality of life in heart failure patients: a cross-sectional study. Fam Pract 2019; 36:693-698. [PMID: 31044230 DOI: 10.1093/fampra/cmz017] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Although both hospitalization and mortality due to heart failure (HF) have been widely studied, less is known about the impact of HF on disability and quality of life. AIM To assess the degree of disability and quality of life in HF patients attended at family medicine centres. DESIGN AND SETTING Cross-sectional study of a cohort of HF patients attended at family medicine centres. METHODS Disability was assessed with the WHODAS 2 questionnaire, which provides a global and six domain scores that is understanding and communication, getting around, self-care, getting along with people, life activities and participation in society. Quality of life was assessed with the Minnesota Living with Heart Failure Questionnaire, which furnishes a global and two domain scores, physical and emotional. RESULTS A breakdown of the results showed that 28% of patients had moderate disability and 16.7% had severe disability, with the most important areas affected being: life activities, 8.9% extreme disability and 30.3% severe disability; getting around, 34.6% severe disability and 2% extreme disability; and participation in society, 53.3% moderate-severe disability. Quality of life was mildly affected. New York Heart Association (NYHA) Functional Classification and sex were the major determinants of disability and quality of life. Angiotensin-converting enzyme inhibitors and angiotensin II receptor antagonists were associated with better scores in the "getting around" and "life activity" domains. CONCLUSION HF patients in primary care show an important degree of disability and an acceptable quality of life.
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Affiliation(s)
- Luis García-Olmos
- Multiprofessional Education Unit for Family and Community Care (South-east), Madrid.,Health Service Research Network for Chronic Diseases (Red de Investigación en Servicios de Salud en Enfermedades Crónicas/REDISSEC), Madrid
| | - Maurice Batlle
- Cardiology Department, University of Henares Teaching Hospital, Madrid
| | - Rio Aguilar
- Cardiology Department, La Princesa University Teaching Hospital, Madrid
| | - Carlos Porro
- Cardiology Department, University of Henares Teaching Hospital, Madrid
| | - Montse Carmona
- Health Service Research Network for Chronic Diseases (Red de Investigación en Servicios de Salud en Enfermedades Crónicas/REDISSEC), Madrid.,Agency for Health Technology Assessment, Carlos III Institute of Health (Instituto de Salud Carlos III/ISCIII), Madrid
| | - Angel Alberquilla
- Health Service Research Network for Chronic Diseases (Red de Investigación en Servicios de Salud en Enfermedades Crónicas/REDISSEC), Madrid.,Multiprofessional Education Unit for Family and Community Care (Centre), Madrid
| | - Luis M Sánchez-Gómez
- Health Service Research Network for Chronic Diseases (Red de Investigación en Servicios de Salud en Enfermedades Crónicas/REDISSEC), Madrid.,Agency for Health Technology Assessment, Carlos III Institute of Health (Instituto de Salud Carlos III/ISCIII), Madrid
| | - Elena Monge
- Ciudad San Pablo Health Centre, Coslada, Madrid
| | | | - Luis Benito
- San Fernando Health Centre, San Fernando de Henares, Madrid
| | | | - Amaya Simón
- Los Alperchines Health Centre, San Fernando de Henares, Madrid
| | | | - Eva M Luque
- San Fernando Health Centre, San Fernando de Henares, Madrid
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Surrogates for myocardial power and power efficiency in patients with aortic valve disease. Sci Rep 2019; 9:16407. [PMID: 31712631 PMCID: PMC6848480 DOI: 10.1038/s41598-019-52909-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Accepted: 10/12/2019] [Indexed: 01/05/2023] Open
Abstract
We aimed to assess surrogate markers for left ventricular (LV) myocardial power and efficiency in patients with isolated aortic stenosis (AS) and combined stenosis/regurgitation (AS/AR). In AS (n = 59), AS/AR (n = 21) and controls (n = 14), surrogates for LV myocardial power and circulatory/external myocardial efficiency were obtained from cardiac MRI. Median surrogate LV myocardial power was increased in AS, 7.7 W/m2 (interquartile range 6.0–10.2; p = 0.010) and AS/AR, 10.8 W/m2 (8.9–13.4; p < 0.001) when compared to controls, 5.4 W/m2 (4.2–6.5), and was lower in AS than AS/AR (p < 0.001). Surrogate circulatory efficiency was decreased in AS, 8.6% (6.8–11.1; p < 0.001) and AS/AR, 5.4% (4.1–6.2; p < 0.001) when compared to controls, 11.8% (9.8–16.9). Surrogate external myocardial efficiency was higher in AS, 15.2% (11.9–18.6) than in AS/AR, 12.2% (10.1–14.2; p = 0.031) and was significantly lower compared to controls, 12.2% (10.7–18.1) in patients with reduced ejection fraction (EF), 9.8% (8.1–11.7; p = 0.025). In 16% of all cases, left ventricular mass/volume indices and EF were within normal ranges, wheras surrogate LV myocardial power was elevated and patients were symptomatic. Although influenced by pressure/volume load, the myocardium is additionally affected by remodelling processes. Surrogates for circulatory efficiency and LV myocardial power gradually reflect alterations in patients with AS and AS/AR, even when surrogate external myocardial efficiency, EF, mass and volume indices still remain compensated.
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Teramatsu H, Shiraishi J, Matsushima Y, Araki M, Okazaki T, Saeki S. Using Physical Function to Predict Hospital Readmission within 1 Year in Patients with Heart Failure. Prog Rehabil Med 2019; 4:20190018. [PMID: 32789265 PMCID: PMC7365195 DOI: 10.2490/prm.20190018] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Accepted: 10/01/2019] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE The aim of this study was to investigate which method of evaluating physical function could predict 1-year readmission due to worsening of heart failure (HF) in newly diagnosed HF patients. METHODS One hundred sixteen consecutive patients with HF who underwent cardiac rehabilitation at our hospital between May 2012 and September 2015 were retrospectively enrolled. Participants were divided into two groups based on whether they were readmitted for worsening HF within 1 year. Logistic regression analysis was used to evaluate whether physical function at the time of discharge was related to HF readmission within 1 year. RESULTS After a mean follow-up period of 327 days, 22 patients were readmitted because of worsening HF. In the readmission group, the results of the 6-Minute Walk Test (6MWT), One-Leg Standing Test, and 30-Second Chair-Stand Test at initial discharge were significantly worse than those in the non-readmission group. In a multivariable logistic regression model, after adjusting for age and sex, a lower 6MWT distance was independently associated with increased risk of readmission within 1 year (odds ratio: 0.990, 95% confidence interval: 0.985-0.996). The 6MWT showed better prognostic value (area under the receiver operating characteristic curve: 0.696) than other evaluation methods of physical function. The 1-year non-readmission rates were 90% for 6MWT ≥382.5 m, 68% for 6MWT <382.5 m, and 53% for those unable to walk 200 m independently (P <0.001). CONCLUSION Physical function, particularly the 6MWT distance at time of discharge, can be used to predict the likelihood of readmission within 1 year for patients with HF.
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Affiliation(s)
- Hiroaki Teramatsu
- Department of Rehabilitation, University Hospital of
Occupational and Environmental Health, Kitakyushu, Japan
| | - Junichiro Shiraishi
- Department of Rehabilitation Medicine, University of
Occupational and Environmental Health, Kitakyushu, Japan
| | - Yasuyuki Matsushima
- Department of Rehabilitation Medicine, University of
Occupational and Environmental Health, Kitakyushu, Japan
| | - Masaru Araki
- Second Department of Internal Medicine, University of
Occupational and Environmental Health, Kitakyushu, Japan
| | - Tetsuya Okazaki
- Department of Rehabilitation Medicine, Hakuaikai Hospital,
Fukuoka, Japan
| | - Satoru Saeki
- Department of Rehabilitation Medicine, University of
Occupational and Environmental Health, Kitakyushu, Japan
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