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Chen N, Xu Y, Xu C, Duan J, Zhou Y, Jin M, Xia H, Yuan W, Chen R. Effects of triglyceride glucose (TyG) and TyG-body mass index on sex-based differences in the early-onset heart failure of ST-elevation myocardial infarction. Nutr Metab Cardiovasc Dis 2024; 34:590-597. [PMID: 37996372 DOI: 10.1016/j.numecd.2023.09.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 08/20/2023] [Accepted: 09/28/2023] [Indexed: 11/25/2023]
Abstract
BACKGROUND AND AIM Heart failure (HF) is an important complication of ST-elevation myocardial infarction (STEMI), including early- and late-onset HF. This study aimed to investigate the association between insulin resistance (IR)-related parameters triglyceride glucose (TyG) and TyG-body mass index (TyG-BMI) index and early-onset HF in STEMI between sexes. METHODS AND RESULTS This cross-sectional study included patients with STEMI who underwent primary percutaneous coronary intervention (PCI) between January 2016 and September 2022. Patients were divided into tertiles according to TyG/TyG-BMI index levels in males and females. The presence of early-onset HF was compared between tertiles in both sexes. Moreover, patients were stratified according to the tertiles of TyG/Tyg-BMI index. Differences in early-onset HF of STEMI were compared between males and females in each tertile group. 1118 patients were included in this study, 20.3% of whom were females. The incidence rate of early-onset HF was significantly higher in females than in males (29% vs. 14.8%). TyG-BMI index was negatively correlated with early-onset HF. In both females and males, there was no difference in the occurrence of early-onset HF between the highest and lowest TyG/TyG-BMI index groups. Sex disparity was observed in females who had a significantly higher prevalence of early-onset HF than males in each TyG/TyG-BMI index tertile group; however, after adjustment, the differences disappeared. CONCLUSIONS For patients with STEMI who undergo primary PCI, the incidence of early-onset HF is higher in females than in males. The TyG/TyG-BMI index do not contribute to the difference in early-onset HF between sexes.
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Affiliation(s)
- Nan Chen
- Department of Cardiology, Affiliated Hospital of Jiangsu University, Zhenjiang, Jiangsu, China
| | - Yao Xu
- Department of Cardiology, Affiliated Hospital of Jiangsu University, Zhenjiang, Jiangsu, China
| | - Chong Xu
- Department of Cardiology, Affiliated Hospital of Jiangsu University, Zhenjiang, Jiangsu, China
| | - Junying Duan
- Department of Cardiology, Affiliated Hospital of Jiangsu University, Zhenjiang, Jiangsu, China
| | - Ye Zhou
- Department of Cardiology, Affiliated Hospital of Jiangsu University, Zhenjiang, Jiangsu, China
| | - Mingfeng Jin
- Department of Cardiology, Affiliated Hospital of Jiangsu University, Zhenjiang, Jiangsu, China
| | - Hao Xia
- Department of Cardiology, Affiliated People's Hospital of Jiangsu University, Zhenjiang, Jiangsu, China
| | - Wei Yuan
- Department of Cardiology, Affiliated Hospital of Jiangsu University, Zhenjiang, Jiangsu, China
| | - Rui Chen
- Department of Cardiology, Affiliated Hospital of Jiangsu University, Zhenjiang, Jiangsu, China.
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2
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Jaffer S, Noble M, Pozgay A, Randhawa V, Gulati M, Mensour E, Parast N, Tegg N, Theberge E, Harchaoui EK, Mulvagh SL. The Development of a Chest-Pain Protocol for Women Presenting to the Emergency Department. CJC Open 2024; 6:517-529. [PMID: 38487055 PMCID: PMC10935692 DOI: 10.1016/j.cjco.2023.12.003] [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: 08/10/2023] [Accepted: 12/02/2023] [Indexed: 03/17/2024] Open
Abstract
Cardiovascular disease (CVD) is the leading cause of death in women worldwide, and of premature death in women in Canada. Despite improvements in cardiovascular care over the past 15-20 years, acute coronary syndrome (ACS) and CVD mortality continue to increase among women in Canada. Chest pain is a common symptom leading to emergency department visits for both men and women. However, women with ACS experience worse outcomes. compared with those of men, due to misdiagnosis or lack of diagnosis resulting in delayed care and underuse of guideline-directed medical therapies. CVD mortality rates are highest in Indigenous and racialized women and those with a disproportionately high number of adverse social determinants of health. CVD remains underrecognized, underdiagnosed, undertreated, and underresearched in women. Moreover, a lack of awareness of unique symptoms, clinical presentations, and sex-and-gender specific CVD risk factors, by healthcare professionals, leads to outcome disparities. In response to this knowledge gap, in acute recognition and management of chest-pain syndromes in women, the Canadian Women's Heart Health Alliance performed a needs assessment and review of CVD risk factors and ACS pathophysiology, through a sex and gender lens, and then developed a unique chest-pain assessment protocol utilizing modified dynamic programming algorithmic methodology. The resulting algorithmic protocol is presented. The output is intended as a quick reference algorithm that could be posted in emergency departments and other acute-care settings. Next steps include protocol implementation evaluation and impact assessment on CVD outcomes in women.
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Affiliation(s)
- Shahin Jaffer
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Anita Pozgay
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Varinder Randhawa
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Martha Gulati
- Cedars-Sinai Heart Institute, Los Angeles, California, USA
| | - Emma Mensour
- Northern Ontario School of Medicine, Sudbury, Ontario, Canada
| | - Nazli Parast
- University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Nicole Tegg
- Faculty of Nursing, University of Alberta, Alberta, Ontario, Canada
| | - Emilie Theberge
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Sharon L. Mulvagh
- Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
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3
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Drury ER, Wu J, Gigliotti JC, Le TH. Sex differences in blood pressure regulation and hypertension: renal, hemodynamic, and hormonal mechanisms. Physiol Rev 2024; 104:199-251. [PMID: 37477622 PMCID: PMC11281816 DOI: 10.1152/physrev.00041.2022] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 06/06/2023] [Accepted: 07/16/2023] [Indexed: 07/22/2023] Open
Abstract
The teleology of sex differences has been argued since at least as early as Aristotle's controversial Generation of Animals more than 300 years BC, which reflects the sex bias of the time to contemporary readers. Although the question "why are the sexes different" remains a topic of debate in the present day in metaphysics, the recent emphasis on sex comparison in research studies has led to the question "how are the sexes different" being addressed in health science through numerous observational studies in both health and disease susceptibility, including blood pressure regulation and hypertension. These efforts have resulted in better understanding of differences in males and females at the molecular level that partially explain their differences in vascular function and renal sodium handling and hence blood pressure and the consequential cardiovascular and kidney disease risks in hypertension. This review focuses on clinical studies comparing differences between men and women in blood pressure over the life span and response to dietary sodium and highlights experimental models investigating sexual dimorphism in the renin-angiotensin-aldosterone, vascular, sympathetic nervous, and immune systems, endothelin, the major renal sodium transporters/exchangers/channels, and the impact of sex hormones on these systems in blood pressure homeostasis. Understanding the mechanisms governing sex differences in blood pressure regulation could guide novel therapeutic approaches in a sex-specific manner to lower cardiovascular risks in hypertension and advance personalized medicine.
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Affiliation(s)
- Erika R Drury
- Division of Nephrology, Department of Medicine, University of Rochester Medical Center, Rochester, New York, United States
| | - Jing Wu
- Division of Nephrology, Department of Medicine, University of Rochester Medical Center, Rochester, New York, United States
- Department of Pharmacology and Physiology, University of Rochester Medical Center, Rochester, New York, United States
| | - Joseph C Gigliotti
- Department of Integrative Physiology and Pharmacology, Liberty University College of Osteopathic Medicine, Lynchburg, Virginia, United States
| | - Thu H Le
- Division of Nephrology, Department of Medicine, University of Rochester Medical Center, Rochester, New York, United States
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4
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Sourij C, Aziz F, Tripolt NJ, Siller-Matula J, Pferschy PN, Kolesnik E, Wallner M, Eyileten C, Postula M, Oulhaj A, Sourij H, von Lewinski D. Effects of empagliflozin in women and men with acute myocardial infarction: An analysis from the EMMY trial. Hellenic J Cardiol 2024; 75:3-8. [PMID: 37236318 DOI: 10.1016/j.hjc.2023.05.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 05/11/2023] [Accepted: 05/23/2023] [Indexed: 05/28/2023] Open
Abstract
OBJECTIVE Women have a higher comorbidity burden and a lower survival rate after acute myocardial infarction (AMI) than men. This analysis aimed to investigate the impact of sex on the effect of treatment with the sodium glucose cotransporter 2 inhibitor (SGLT2i) empagliflozin immediately after an AMI. METHODS Participants were randomized to either empagliflozin or placebo and followed for 26 weeks after initiating the treatment no later than 72 hours after a percutaneous coronary intervention following an AMI. We analyzed the impact of sex on the beneficial effects of empagliflozin observed for heart failure biomarkers as well as structural and functional cardiac parameters. RESULTS Women had higher NT-proBNP levels at baseline (median 2117pg/mL, IQR 1383-3267 pg/mL versus 1137 pg/mL, IQR 695-2050 pg/mL; p < 0.001) and were older than men (median 61y, IQR 56-65y versus 56y, IQR 51-64y, p = 0.005). The beneficial effects of empagliflozin on NT-proBNP levels (Pinteraction = 0.984), left ventricular ejection fraction (Pinteraction = 0.812), left ventricular end systolic volume (Pinteraction = 0.183), or left ventricular end diastolic volume (Pinteraction = 0.676) were independent of sex. CONCLUSIONS Empagliflozin exhibited similar benefits in women and men when administered immediately after an AMI.
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Affiliation(s)
- Caren Sourij
- Division of Cardiology, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria
| | - Faisal Aziz
- Trials Unit for Interdisciplinary Metabolic Medicine, Division of Endocrinology and Diabetology, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria
| | - Norbert J Tripolt
- Trials Unit for Interdisciplinary Metabolic Medicine, Division of Endocrinology and Diabetology, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria
| | - Jolanta Siller-Matula
- Department of Cardiology, Medical University of Vienna, Währinger Gürtel 18-20 1090 Vienna, Austria
| | - Peter N Pferschy
- Trials Unit for Interdisciplinary Metabolic Medicine, Division of Endocrinology and Diabetology, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria
| | - Ewald Kolesnik
- Division of Cardiology, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria
| | - Markus Wallner
- Division of Cardiology, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria
| | - Ceren Eyileten
- Department of Experimental and Clinical Pharmacology, Medical University of Warsaw, Center for Preclinical Research and Technology CEPT, 61 Zwirki i Wigury Street, 02-091 Warsaw, Poland
| | - Marek Postula
- Department of Experimental and Clinical Pharmacology, Medical University of Warsaw, Center for Preclinical Research and Technology CEPT, 61 Zwirki i Wigury Street, 02-091 Warsaw, Poland
| | - Abderrahim Oulhaj
- Department of Epidemiology and Population Health, College of Medicine and Health Sciences, Khalifa University of Science and Technology, Abu Dhabi, UAE P O Box 127788, United Arab Emirates
| | - Harald Sourij
- Trials Unit for Interdisciplinary Metabolic Medicine, Division of Endocrinology and Diabetology, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria.
| | - Dirk von Lewinski
- Division of Cardiology, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria
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Shin J, Hong J, Edwards-Glenn J, Krukovets I, Tkachenko S, Adelus ML, Romanoski CE, Rajagopalan S, Podrez E, Byzova TV, Stenina-Adongravi O, Cherepanova OA. Unraveling the Role of Sex in Endothelial Cell Dysfunction: Evidence From Lineage Tracing Mice and Cultured Cells. Arterioscler Thromb Vasc Biol 2024; 44:238-253. [PMID: 38031841 PMCID: PMC10842863 DOI: 10.1161/atvbaha.123.319833] [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] [Received: 07/21/2023] [Accepted: 11/14/2023] [Indexed: 12/01/2023]
Abstract
BACKGROUND Biological sex differences play a vital role in cardiovascular diseases, including atherosclerosis. The endothelium is a critical contributor to cardiovascular pathologies since endothelial cells (ECs) regulate vascular tone, redox balance, and inflammatory reactions. Although EC activation and dysfunction play an essential role in the early and late stages of atherosclerosis development, little is known about sex-dependent differences in EC. METHODS We used human and mouse aortic EC as well as EC-lineage tracing (Cdh5-CreERT2 Rosa-YFP [yellow fluorescence protein]) atherosclerotic Apoe-/- mice to investigate the biological sexual dimorphism of the EC functions in vitro and in vivo. Bioinformatics analyses were performed on male and female mouse aortic EC and human lung and aortic EC. RESULTS In vitro, female human and mouse aortic ECs showed more apoptosis and higher cellular reactive oxygen species levels than male EC. In addition, female mouse aortic EC had lower mitochondrial membrane potential (ΔΨm), lower TFAM (mitochondrial transcription factor A) levels, and decreased angiogenic potential (tube formation, cell viability, and proliferation) compared with male mouse aortic EC. In vivo, female mice had significantly higher lipid accumulation within the aortas, impaired glucose tolerance, and lower endothelial-mediated vasorelaxation than males. Using the EC-lineage tracing approach, we found that female lesions had significantly lower rates of intraplaque neovascularization and endothelial-to-mesenchymal transition within advanced atherosclerotic lesions but higher incidents of missing EC lumen coverage and higher levels of oxidative products and apoptosis. RNA-seq analyses revealed that both mouse and human female EC had higher expression of genes associated with inflammation and apoptosis and lower expression of genes related to angiogenesis and oxidative phosphorylation than male EC. CONCLUSIONS Our study delineates critical sex-specific differences in EC relevant to proinflammatory, pro-oxidant, and angiogenic characteristics, which are entirely consistent with a vulnerable phenotype in females. Our results provide a biological basis for sex-specific proatherosclerotic mechanisms.
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Affiliation(s)
- Junchul Shin
- Department of Cardiovascular and Metabolic Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Junyoung Hong
- Department of Cardiovascular and Metabolic Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Jonnelle Edwards-Glenn
- Department of Medicine, School of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Irene Krukovets
- Department of Cardiovascular and Metabolic Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Svyatoslav Tkachenko
- Department of Genetics and Genome Sciences, Case Western Reserve University, Cleveland, OH, USA
| | - Maria L. Adelus
- Department of Cellular and Molecular Medicine, The University of Arizona, Tucson, AZ, USA
- Clinical Translational Sciences Graduate Program, The University of Arizona, Tucson, AZ, USA
| | - Casey E. Romanoski
- Department of Cellular and Molecular Medicine, The University of Arizona, Tucson, AZ, USA
| | - Sanjay Rajagopalan
- Department of Medicine, School of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Eugene Podrez
- Department of Inflammation and Immunity, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Tatiana V. Byzova
- Department of Neurosciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Olga Stenina-Adongravi
- Department of Cardiovascular and Metabolic Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Olga A. Cherepanova
- Department of Cardiovascular and Metabolic Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
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6
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Lou C, Xu T, Dong F, Xu Y, Zhang M, Xia S, Xu Y, Feng C. Gender Disparities in Patients' Decisions about the Management of Myocardial Infarction in East Chinese Province. Emerg Med Int 2023; 2023:8220308. [PMID: 38099235 PMCID: PMC10719869 DOI: 10.1155/2023/8220308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 10/31/2023] [Accepted: 11/02/2023] [Indexed: 12/17/2023] Open
Abstract
Background Previous studies showed that there are gender disparities in various respects of acute myocardial infarction (AMI), including risk factors, symptoms, and outcomes. However, few of them noticed the gender disparities in patients' decision about the management of AMI, which might also be associated with the outcome. Aims To identify gender disparities in patients' decisions about the management of myocardial infarction. Methods In this cohort study, the critical time points including the time of symptom onset, visiting hospital, diagnosis of AMI, consent to coronary angiography (CAG), beginning of CAG, and balloon dilation were recorded. Medication and major adverse cardiac event (MACE) within 6 months were also recorded. Results Female patients took more time from symptom onset to visiting hospital (P = 0.001), from diagnosis of AMI to consent to CAG (P < 0.05), and from door to needle/balloon than male (P < 0.05). Less female patients accepted CAG (P < 0.05) and coronary intervention/bypass grafting (P < 0.05). Less female patients kept good inherence to antiplatelet therapy (P < 0.05) and statins (P < 0.05) than male, more female preferred traditional Chinese medicine (TCM) than male patient (P < 0.05), and most of them had MACE within 6 months (P < 0.05). Patients' good adherence to antiplatelet therapy and statins and accepting coronary intervention/bypass grafting were associated with a reduced risk of MACE. Conclusion Female patients were more reluctant to make decisions about emergency management of AMI and tended to choose conservative treatment. More female patients preferred TCM than evidence-based medicine. Their reluctance about the critical management of AMI and poor adherence to evidence-based medicine were associated with an elevated risk of MACE.
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Affiliation(s)
- Chaobin Lou
- Department of Cardiology, The Fourth Affiliated Hospital of Zhejiang University, Yiwu 322000, Zhejiang, China
| | - Tao Xu
- Department of Cardiology, The Fourth Affiliated Hospital of Zhejiang University, Yiwu 322000, Zhejiang, China
| | - Fangying Dong
- Department of Cardiology, The Fourth Affiliated Hospital of Zhejiang University, Yiwu 322000, Zhejiang, China
- Department of Emergency Medicine, The Second Hospital of Jiaxing, The Second Affiliated Hospital of Jiaxing University, Jiaxing 314000, Zhejiang, China
| | - Yangmiao Xu
- Department of Cardiology, The Fourth Affiliated Hospital of Zhejiang University, Yiwu 322000, Zhejiang, China
| | - Muhua Zhang
- Department of Cardiology, The Fourth Affiliated Hospital of Zhejiang University, Yiwu 322000, Zhejiang, China
| | - Shudong Xia
- Department of Cardiology, The Fourth Affiliated Hospital of Zhejiang University, Yiwu 322000, Zhejiang, China
| | - Yinchuan Xu
- Department of Cardiology, The Second Affiliated Hospital of Zhejiang University, Hangzhou 310000, Zhejiang, China
| | - Chao Feng
- Department of Cardiology, The Fourth Affiliated Hospital of Zhejiang University, Yiwu 322000, Zhejiang, China
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7
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Ronco R, Rea F, Filippelli A, Maggioni AP, Corrao G. Sex-Related Differences in Outpatient Healthcare of Acute Coronary Syndrome: Evidence from an Italian Real-World Investigation. J Clin Med 2023; 12:jcm12082972. [PMID: 37109306 PMCID: PMC10140904 DOI: 10.3390/jcm12082972] [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: 03/22/2023] [Revised: 04/13/2023] [Accepted: 04/18/2023] [Indexed: 04/29/2023] Open
Abstract
At the time of first acute coronary syndrome (ACS) hospital admission, women are generally older and have more comorbidities than men, which may explain differences in their short-term prognosis. However, few studies have focused on differences in the out-of-hospital management of men and women. This study investigated (i) the risk of clinical outcomes, (ii) the use of out-of-hospital healthcare and (iii) the effects of clinical recommendations on outcomes in men vs. women. A total of 90,779 residents of the Lombardy Region (Italy) were hospitalized for ACS from 2011 to 2015. Exposure to prescribed drugs, diagnostic procedures, laboratory tests, and cardiac rehabilitation in the first year after ACS hospitalization were recorded. To evaluate whether sex can modify the relationship between clinical recommendations and outcomes, adjusted Cox models were separately fitted for men and women. Women were exposed to fewer treatments, required fewer outpatient services than men and had a lower risk of long-term clinical events. The stratified analysis showed an association between adherence to clinical recommendations and a lower risk of clinical outcomes in both sexes. Since improved adherence to clinical recommendations seems to be beneficial for both sexes, tight out-of-hospital healthcare control should be recommended to achieve favourable clinical benefits.
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Affiliation(s)
- Raffaella Ronco
- National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, 20126 Milan, Italy
- Unit of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, 20126 Milan, Italy
| | - Federico Rea
- National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, 20126 Milan, Italy
- Unit of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, 20126 Milan, Italy
| | - Amelia Filippelli
- National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, 20126 Milan, Italy
- Department of Medicine, Surgery, and Dentistry, University of Salerno, 84081 Baronissi, Italy
| | | | - Giovanni Corrao
- National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, 20126 Milan, Italy
- Unit of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, 20126 Milan, Italy
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8
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Helber AR, Helfer DR, Ferko AR, Klein DD, Elchediak D, Deaner TS, Slagle D, White WB, Buckler DG, Mitchell OJL, Fiorilli PN, Isenberg DL, Nomura JT, Murphy KA, Sigal A, Saif H, Reihart MJ, Vernon TM, Abella BS. Timing and Outcomes After Coronary Angiography Following Out-of-Hospital Cardiac Arrest Without Signs of ST-Segment Elevation Myocardial Infarction. J Emerg Med 2023; 64:439-447. [PMID: 36997434 DOI: 10.1016/j.jemermed.2023.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 12/15/2022] [Accepted: 01/06/2023] [Indexed: 03/30/2023]
Abstract
BACKGROUND There is broad consensus that resuscitated out-of-hospital cardiac arrest (OHCA) patients with ST-segment elevation myocardial infarction (STEMI) should receive immediate coronary angiography (CAG); however, factors that guide patient selection and optimal timing of CAG for post-arrest patients without evidence of STEMI remain incompletely described. OBJECTIVE We sought to describe the timing of post-arrest CAG in actual practice, patient characteristics associated with decision to perform immediate vs. delayed CAG, and patient outcomes after CAG. METHODS We conducted a retrospective cohort study at seven U.S. academic hospitals. Resuscitated adult patients with OHCA were included if they presented between January 1, 2015 and December 31, 2019 and received CAG during hospitalization. Emergency medical services run sheets and hospital records were analyzed. Patients without evidence of STEMI were grouped and compared based on time from arrival to CAG performance into "early" (≤ 6 h) and "delayed" (> 6 h). RESULTS Two hundred twenty-one patients were included. Median time to CAG was 18.6 h (interquartile range [IQR] 1.5-94.6 h). Early catheterization was performed on 94 patients (42.5%) and delayed catheterization was performed on 127 patients (57.5%). Patients in the early group were older (61 years [IQR 55-70 years] vs. 57 years [IQR 47-65] years) and more likely to be male (79.8% vs. 59.8%). Those in the early group were more likely to have clinically significant lesions (58.5% vs. 39.4%) and receive revascularization (41.5% vs. 19.7%). Patients were more likely to die in the early group (47.9% vs. 33.1%). Among survivors, there was no significant difference in neurologic recovery at discharge. CONCLUSIONS OHCA patients without evidence of STEMI who received early CAG were older and more likely to be male. This group was more likely to have intervenable lesions and receive revascularization.
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Affiliation(s)
- Andrew R Helber
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Center for Resuscitation Science, Department of Emergency Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - David R Helfer
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Center for Resuscitation Science, Department of Emergency Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Aarika R Ferko
- Department of Emergency Medicine, Reading Hospital, Reading, Pennsylvania
| | - Daniel D Klein
- Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania
| | - Daniel Elchediak
- Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania
| | - Traci S Deaner
- Department of Emergency Medicine, Reading Hospital, Reading, Pennsylvania
| | - Dustin Slagle
- Department of Emergency Medicine, ChristianaCare, Newark, Delaware
| | - William B White
- Department of Pulmonary and Critical Care, Maine Medical Center, Portland, Maine
| | - David G Buckler
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Oscar J L Mitchell
- Center for Resuscitation Science, Department of Emergency Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Paul N Fiorilli
- Department of Medicine, Division of Cardiology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Derek L Isenberg
- Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania
| | - Jason T Nomura
- Department of Emergency Medicine, ChristianaCare, Newark, Delaware
| | | | - Adam Sigal
- Center for Resuscitation Science, Department of Emergency Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Emergency Medicine, Reading Hospital, Reading, Pennsylvania
| | - Hassam Saif
- Lehigh Valley Heart and Vascular Institute, Allentown, Pennsylvania
| | - Michael J Reihart
- Department of Emergency Services, Penn State Health, Lancaster Medical Center, Lancaster, Pennsylvania
| | - Tawnya M Vernon
- Penn Medicine Lancaster General Hospital, Lancaster, Pennsylvania
| | - Benjamin S Abella
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Center for Resuscitation Science, Department of Emergency Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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9
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Perrier J, Renard M, Pariente A, Bezin J. Systematic review on sex differences for drug use after stroke. Therapie 2023; 78:213-224. [PMID: 36517302 DOI: 10.1016/j.therap.2022.11.007] [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: 08/23/2022] [Revised: 11/08/2022] [Accepted: 11/25/2022] [Indexed: 12/03/2022]
Abstract
INTRODUCTION Systematic reviews and meta-analyses have synthetized the existing knowledge on sex-differences for the risk of stroke, the most recent ones highlighting an increased risk of stroke for women. However, whether there are sex differences in post stroke treatment in real world setting is not known. We therefore conducted a systematic review on this subject. MATERIAL AND METHODS All observational studies on sex-differences in poststroke drug use published until 20/04/2021 were identified from PubMed and Scopus. Articles were selected and assessed by two independent readers; a third resolved disagreements. Data extraction was performed using a standardized form; articles quality was assessed using the STROBE guidelines. The study is registered on PROSPERO: CRD42021250256. RESULTS Of the 604 identified articles, 33 were included. Most were published before 2015 and presented methodological limitations. These limitations differentially affected studies with statistically significant and non-significant results, questioning the reliability of conflicting results. The exploration of sex-differences in drug use varied between therapeutic classes (articles focusing on thrombolytics: 25; antithrombotics: 23; on antihypertensive: 13; lipid-lowering drugs: 9). After stroke, women were found less likely to be prescribed antithrombotics in 48% of the articles investigating this class, and lipid-lowering drugs in 56%. Thirty-one percent of the studies concerning antihypertensive drugs reported the opposite. DISCUSSION/CONCLUSION In women, a lack of use of antithrombotics and lipid-lowering drugs after stroke seem to emerge from this review. Conflicting results regarding sex-differences might relate to methodological limitations in studies with no statistical differences, and advocate for the conduct of newer and more comprehensive research.
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Affiliation(s)
- Julia Perrier
- Université de Bordeaux, INSERM, BPH, équipe AHeaD, U1219, 33000 Bordeaux, France.
| | - Mathilde Renard
- Université de Bordeaux, INSERM, BPH, équipe AHeaD, U1219, 33000 Bordeaux, France
| | - Antoine Pariente
- Université de Bordeaux, INSERM, BPH, équipe AHeaD, U1219, 33000 Bordeaux, France; CHU de Bordeaux, service de pharmacologie médicale,INSERM, U1219, 33000 Bordeaux, France
| | - Julien Bezin
- Université de Bordeaux, INSERM, BPH, équipe AHeaD, U1219, 33000 Bordeaux, France; CHU de Bordeaux, service de pharmacologie médicale,INSERM, U1219, 33000 Bordeaux, France
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10
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Menezes HJ, D' Souza SRB, Padmakumar R, Babu AS, Rao RR, Kamath VG, Kamath A, Grace SL. Technology-based Comprehensive Cardiac Rehabilitation Therapy (TaCT) for women with cardiovascular disease in a middle-income setting: A randomized controlled trial protocol. Res Nurs Health 2023; 46:13-25. [PMID: 36371623 DOI: 10.1002/nur.22276] [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: 06/16/2022] [Revised: 10/12/2022] [Accepted: 10/27/2022] [Indexed: 11/15/2022]
Abstract
Women are underrepresented in cardiac rehabilitation (CR) despite the benefits, and this is exacerbated in lower-resource settings where CR is insufficiently available. In this randomized controlled trial, the effectiveness of the Technology-based Comprehensive Cardiac Rehabilitation Therapy (TaCT) electronic cardiac rehabilitation (eCR) intervention on functional capacity, risk factors, quality of life, heart-health behaviors, symptoms, and morbidity will be tested among women with CVD in a middle-income country. Following a pilot study, a single-center, single-blinded, 2 parallel-arm (1:1 SNOSE) superiority trial comparing an eCR intervention (TaCT) to usual care, with assessments pre-intervention and at 3 and 6 months will be undertaken. One hundred adult women will be recruited. Permuted block (size 10) randomization will be applied. The 6-month intervention comprises an app, website, SMS texts with generic heart-health management advice, and bi-weekly 1:1 telephone calls with a nurse trainee. Individualized exercise prescriptions will be developed based on an Incremental Shuttle Walk Test (primary outcome) and dietary plans based on 24 h dietary recall. A yoga/relaxation video will be provided via WhatsApp, along with tobacco cessation support and a moderated group chat. At 3 months, intervention engagement and acceptability will be assessed. Analyses will be conducted based on intent-to-treat. If results of this novel trial of women-focused eCR in a middle-income country demonstrate clinically-significant increases in functional capacity, this could represent an important development for the field considering this would be an important outcome for women and would translate to lower mortality.
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Affiliation(s)
- Henita Joshna Menezes
- Department of Obstetric and Gynecological Nursing, Manipal College of Nursing, Manipal Academy of Higher Education, Manipal, India
| | - Sonia R B D' Souza
- Department of Obstetric and Gynecological Nursing, Manipal College of Nursing, Manipal Academy of Higher Education, Manipal, India
| | - Ramachandran Padmakumar
- Department of Cardiology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India
| | - Abraham Samuel Babu
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, India
| | - Rohini R Rao
- Department of Computer Applications, Manipal Institute of Technology, Manipal Academy of Higher Education, Manipal, India
| | - Veena G Kamath
- Department of Community Medicine, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India
| | - Asha Kamath
- Department of Data Science, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Sherry L Grace
- Faculty of Health, York University, Toronto, Ontario, Canada.,KITE and Director Cardiac Rehabilitation Research, Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
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11
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Amoras TSG, Mendonça TS, Melo GS, Pereira KRP, Zaninotto CV, de Oliveira SS, da Silva RM, Gomes FC, de Melo Neto JS. Sociodemographic and clinical variables as determinants of mortality and survival in patients with acute ST-elevation myocardial infarction in the Eastern Amazon. J Public Health Res 2023; 12:22799036221150062. [PMID: 36686587 PMCID: PMC9846297 DOI: 10.1177/22799036221150062] [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: 08/10/2022] [Accepted: 12/21/2022] [Indexed: 01/18/2023] Open
Abstract
Background The aim of this study was to analyze the influence of sociodemographic and clinical variables as determinants of mortality and survival in patients with ST-segment elevation acute myocardial infarction in the Eastern Amazon. Design and methods This observational, longitudinal, and retrospective study was conducted at the Gaspar Vianna Clinical Hospital Foundation in patients hospitalized from January 2017 to June 2020. Patients were divided into two groups: those who survived (G1) (n = 646) and those who died (G2) (n = 37). Sociodemographic and clinical variables associated with mortality and survival in these two groups were analyzed. Results Patients with STEMI who had the highest risk of death were often the oldest (G1: 61.58 ± 10.74 years; G2: 69.57 ± 9.02 years; t = -4.492; p = 0.001), with Killip III-IV classifications (OR = 0.13; 95% CI = 0.02-0.71; p = 0.03), and with diseases such as heart failure (OR = 0.07; 95% CI = 0.004-1.50; p = 0.168) or renal failure (OR = 0.03; 95% CI = 0.006-0.16; p = 0.0001). In addition, female sex (hazard ratio = 2.073; 95% CI = 1.413-5.170), Killip III-IV classifications (hazard ratio = 4.041; 95% CI = 1.703-18.883) and the presence of heart failure (hazard ratio = 34.102; 95% CI = 4.410-263.684) or renal failure (hazard ratio = 14.278; 95% CI = 3.275-62.248) shortened in-hospital survival. Conclusions Specific sociodemographic and clinical aspects influenced mortality and survival in patients with acute ST -elevation myocardial infarction.
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Affiliation(s)
- Tárcio Sadraque Gomes Amoras
- Clinical and Experimental Research Unit
of the Urinary and Genital System (UPCEURG), Institute of Health Sciences (ICS),
Federal University of Pará (UFPA), Belém, Pará, Brazil
- Division of Cardiology, Gaspar Vianna
Clinical Hospital Foundation, Belém, Pará, Brazil
| | - Thalia Saraiva Mendonça
- Clinical and Experimental Research Unit
of the Urinary and Genital System (UPCEURG), Institute of Health Sciences (ICS),
Federal University of Pará (UFPA), Belém, Pará, Brazil
| | - Giovana Salomão Melo
- Clinical and Experimental Research Unit
of the Urinary and Genital System (UPCEURG), Institute of Health Sciences (ICS),
Federal University of Pará (UFPA), Belém, Pará, Brazil
| | | | | | | | | | | | - João Simão de Melo Neto
- Clinical and Experimental Research Unit
of the Urinary and Genital System (UPCEURG), Institute of Health Sciences (ICS),
Federal University of Pará (UFPA), Belém, Pará, Brazil
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12
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Ghisi GLDM, Marzolini S, Price J, Beckie TM, Mamataz T, Naheed A, Grace SL. Women-Focused Cardiovascular Rehabilitation: An International Council of Cardiovascular Prevention and Rehabilitation Clinical Practice Guideline. Can J Cardiol 2022; 38:1786-1798. [PMID: 36085185 DOI: 10.1016/j.cjca.2022.06.021] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 06/10/2022] [Accepted: 06/17/2022] [Indexed: 12/14/2022] Open
Abstract
Women-focused cardiovascular rehabilitation (CR; phase II) aims to better engage women, and might result in better quality of life than traditional programs. This first clinical practice guideline by the International Council of Cardiovascular Prevention and Rehabilitation (ICCPR) provides guidance on how to deliver women-focused programming. The writing panel comprised experts with diverse geographic representation, including multidisciplinary health care providers, a policy-maker, and patient partners. The guideline was developed in accordance with Appraisal of Guidelines for Research and Evaluation (AGREE) II and the Reporting Items for practice Guidelines in HealTh care (RIGHT). Initial recommendations were on the basis of a meta-analysis. These were circulated to a Delphi panel (comprised of corresponding authors from review articles and of programs delivering women-focused CR identified through ICCPR's audit; N = 76), who were asked to rate each on a 7-point Likert scale in terms of impact and implementability (higher scores positive). A Web call was convened to achieve consensus; 15 panelists confirmed strength of revised recommendations (Grading of Recommendations Assessment, Development, and Evaluation [GRADE]). The draft underwent external review from CR societies internationally and was posted for public comment. The 14 drafted recommendations related to referral (systematic, encouragement), setting (model choice, privacy, staffing), and delivery (exercise mode, psychosocial, education, self-management empowerment). Nineteen (25.0%) survey responses were received. For all but 1 recommendation, ≥ 75% voted to include; implementability ratings were < 5/7 for 4 recommendations, but only 1 for effect. Ultimately 1 recommendation was excluded, 1 separated into 2 and all revised (2 substantively); 1 recommendation was added. Overall, certainty of evidence for the final recommendations was low to moderate, and strength mostly strong. These recommendations and associated tools can support all programs to feasibly offer some women-focused programming.
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Affiliation(s)
- Gabriela Lima de Melo Ghisi
- KITE-Toronto Rehabilitation Institute, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Susan Marzolini
- KITE-Toronto Rehabilitation Institute, University Health Network, University of Toronto, Toronto, Ontario, Canada; Faculty of Health, York University, Toronto, Ontario, Canada
| | | | - Theresa M Beckie
- College of Nursing, Division of Cardiovascular Sciences, University of South Florida, Tampa, Florida, USA; College of Medicine, Division of Cardiovascular Sciences, University of South Florida, Tampa, Florida, USA
| | - Taslima Mamataz
- KITE-Toronto Rehabilitation Institute, University Health Network, University of Toronto, Toronto, Ontario, Canada; Faculty of Health, York University, Toronto, Ontario, Canada
| | - Aliya Naheed
- Initiative for Non-Communicable Diseases, Health System and Population Studies Division, International Centre for Diarrheal Diseases Research Bangladesh, Dhaka, Bangladesh
| | - Sherry L Grace
- KITE-Toronto Rehabilitation Institute, University Health Network, University of Toronto, Toronto, Ontario, Canada; Faculty of Health, York University, Toronto, Ontario, Canada; Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada.
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13
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Nurkkala J, Kauko A, Palmu J, Aittokallio J, Niiranen T. Sex differences in coronary artery bypass grafting-related morbidity and mortality. Front Cardiovasc Med 2022; 9:1021363. [DOI: 10.3389/fcvm.2022.1021363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 10/25/2022] [Indexed: 11/30/2022] Open
Abstract
BackgroundCoronary artery bypass grafting (CABG) is associated with both cardiovascular disease (CVD) and non-CVD traits. In addition, women’s prognosis after coronary events and revascularizations is worse than in men. As the course of CVD in women differs from that of men, we performed a phenome-wide analysis on the sex differences in CABG -related morbidity and mortality.Materials and methodsWe performed an untargeted analysis on the sex differences in predictors and outcomes of CABG. We studied a sample of 176,680 FinnGen participants, including 5,950 individuals who underwent CABG (4,988 men and 962 women) and were followed between 1998 and 2019. Over 1,100 different traits were analyzed for both sexes and the results were adjusted with age, smoking status and BMI. Cox proportional hazards models with sex-trait interactions were used to estimate the associations between (1) traits and incident CABG; and (2) CABG and incident traits.ResultsIn women, CABG was more strongly related to greater increases in risk of diseases such as hypertension, Alzheimer’s, aortic aneurysms, gout, and chronic kidney disease compared to risk increases observed in men (all interaction p-values < 0.03). After CABG, men had 2.5-fold (p = 3.1E−15) and women 6.3-fold (p = 9.4E−08) greater risk of cardiac death compared to same-sex individuals who did not undergo CABG (p for interaction 8.2E−4). Moreover, the risk of death in women remained higher even 12 years after CABG, whereas the long-term risk of death in men was not increased, compared to same-sex individuals who did not undergo CABG.ConclusionThe adverse outcomes after CABG, both quantity and quality, also appear to differ between men and women. In women, CABG is related to greater long-term increases in risk of cardiac death and several other disease states than in men. Consideration should therefore be given to whether women receive adequate long-term post-operative therapy and follow-up as CABG is not associated with equally improved cardiovascular disease prognosis in women than in men.
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14
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Hu MK, Yuan M, James S, Lee HP, Abdul F, Yousif A, Hassan A, Khan J, Connolly D, Sharma V. Positive remodelling of coronary arteries on computed tomography coronary angiogram: an observational study. ASIAINTERVENTION 2022; 8:110-115. [PMID: 36483287 PMCID: PMC9706778 DOI: 10.4244/aij-d-21-00045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 04/12/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND Coronary artery disease (CAD) due to atherosclerosis is projected to be the leading cause of morbidity and mortality worldwide until 2040. CAD affects approximately 2.6 million people in the United Kingdom (UK), and 1 in 4 of them do not experience any symptoms. AIMS The aim of this study was to assess the characteristics and outcomes of patients with plaque features of positive remodelling (PR) on their computed tomography coronary angiogram (CTCA) images. METHODS Patients who were referred for CTCA from June 2018 to January 2020 were retrospectively identified. Patients underwent prospective, gated 128-slice dual-source CTCA. Patients with PR were compared to those without PR for demographics and outcomes. RESULTS A total of 861 patients were included in our study; 241 (28%) had PR, and 620 (72%) had no PR. Patients with PR were older (PR: 63.9±11.0 years vs no PR: 62.1±11.2 years; p=0.04), more likely to be male (PR: 65.6% vs no PR: 55.8%; p=0.01) and underwent coronary angiography more frequently (PR: 25.7% vs no PR: 14.4%; p<0.01). There were also significant increases in subsequent acute coronary syndrome (ACS) events (PR: 2.5% vs no PR: 0.0%; p<0.01) and the need for revascularisation therapy (PR: 15.4% vs no PR: 7.8%; p<0.01) in patients with PR despite being on statins (not a high dose). There was no difference in all-cause mortality. CONCLUSIONS Detection of PR on CTCA is a reliable prognostic indicator of future cardiovascular events and presents a valuable opportunity for initiation of aggressive primary prevention therapy.
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Affiliation(s)
- May Khei Hu
- Department of Cardiology, Birmingham City Hospital, Birmingham, United Kingdom
| | - Mengshi Yuan
- Department of Cardiology, Birmingham City Hospital, Birmingham, United Kingdom
| | - Sunil James
- Department of Cardiology, Birmingham City Hospital, Birmingham, United Kingdom
| | - Hui Ping Lee
- Department of Cardiology, Birmingham City Hospital, Birmingham, United Kingdom
| | - Fairoz Abdul
- Department of Cardiology, Birmingham City Hospital, Birmingham, United Kingdom
| | - Abdel Yousif
- Department of Cardiology, Birmingham City Hospital, Birmingham, United Kingdom
| | - Ahmed Hassan
- Department of Cardiology, Birmingham City Hospital, Birmingham, United Kingdom
| | - Jawad Khan
- Department of Cardiology, Birmingham City Hospital, Birmingham, United Kingdom
| | - Derek Connolly
- Department of Cardiology, Birmingham City Hospital, Birmingham, United Kingdom
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Vinoda Sharma
- Department of Cardiology, Birmingham City Hospital, Birmingham, United Kingdom
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15
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Wang JL, He XQ, Guo CY, Chen H, Li HW, Zhao SM. Sex-related differences in clinical outcomes and predictive factors in the very elderly patients with ACS undergoing PCI. Front Cardiovasc Med 2022; 9:950165. [PMID: 36247454 PMCID: PMC9554146 DOI: 10.3389/fcvm.2022.950165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Accepted: 08/22/2022] [Indexed: 11/13/2022] Open
Abstract
Background As shown in previous studies, there may be sex-related differences in clinical outcomes in patients with acute coronary syndromes (ACS) after percutaneous coronary intervention (PCI). However, the benefits of PCI in very elderly ACS patients and the gender differences were poorly described and understood. We investigated the clinical characteristics and outcomes after PCI by sex stratification, and the predictive factors of major adverse cardiovascular and cerebrovascular events (MACCE) in this very elderly ACS cohort. Methods A total of 1,676 consecutive ACS patients (50.2% women) aged ≥80 years old between January 2013 and May 2020 were recruited in this study. All patients were divided into four groups according to gender and treatment: male PCI (n = 321) and conservative management groups (n = 513), and female PCI (n = 283) and conservative management groups (n = 559). Clinical and coronary lesion characteristics were compared among four groups, also the clinical outcomes. MACCE and their predictive factors were assessed using Kaplan–Meier curve and Cox regression analysis. Results PCI procedures were conducted in 604 patients, and 1,072 were conservative management. Men were most likely to present with prior myocardial infarction (MI), peripheral artery disease, and chronic total occlusion (CTO); women had a higher prevalence of hypertension and dyslipidemia. The proportion of men receiving PCI procedures was significantly higher than that of women (38.5 vs. 33.6%, p = 0.038). Compared to conservative management, successful PCI significantly improved composite MACCE in both men (33.9 vs. 18.4%, p < 0.001) and women (27.9 vs. 20.8%, p = 0.026). There were no differences between sex in the improvement of clinical outcomes after PCI. In addition, age, ST-segment elevation myocardial infarction (STEMI), log N-terminal pro-brain natriuretic peptide (NT-proBNP), P2Y12 receptor antagonist, and β-blocker were independently associated with the incidence of MACCE after PCI tested by the Cox regression model, but not gender (male: hazard ratio (HR) 1.275, 95% confidence interval (CI) 0.853–1.905, p = 0.236). Conclusion In this very elderly ACS cohort, men presented with more complex clinical conditions, and women were less likely to receive PCI treatment. Both women and men had similar benefits from the PCI procedure in the decrease of MACCE.
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Affiliation(s)
- Jia-li Wang
- Department of Cardiology, Cardiovascular Center, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Xiao-quan He
- Department of Cardiology, Cardiovascular Center, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Chun-yan Guo
- Department of Cardiology, Cardiovascular Center, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Hui Chen
- Department of Cardiology, Cardiovascular Center, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Hong-wei Li
- Department of Cardiology, Cardiovascular Center, Beijing Friendship Hospital, Capital Medical University, Beijing, China
- Department of Internal Medical, Medical Health Center, Beijing Friendship Hospital, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Metabolic Disorder Related Cardiovascular Disease, Beijing, China
| | - Shu-mei Zhao
- Department of Cardiology, Cardiovascular Center, Beijing Friendship Hospital, Capital Medical University, Beijing, China
- *Correspondence: Shu-mei Zhao
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16
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Pelà G, Goldoni M, Solinas E, Cavalli C, Tagliaferri S, Ranzieri S, Frizzelli A, Marchi L, Mori PA, Majori M, Aiello M, Corradi M, Chetta A. Sex-Related Differences in Long-COVID-19 Syndrome. J Womens Health (Larchmt) 2022; 31:620-630. [PMID: 35333613 DOI: 10.1089/jwh.2021.0411] [Citation(s) in RCA: 62] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Background: Sex differences have been demonstrated in the acute phase of COVID-19. Women (F) were found to be less prone to develop a severe disease than men (M), but few studies have assessed sex-differences in Long-COVID-19 syndrome. Methods: The aim of this prospective/retrospective study was to characterize the long-term consequences of this infection based on sex. For this purpose, we enrolled 223 patients (89 F and 134 M) who were infected by SARS-CoV-2. In the acute phase of the illness, F reported the following symptoms more frequently than M: weakness, dysgeusia, anosmia, thoracic pain, palpitations, diarrhea, and myalgia-all without significant differences in breathlessness, cough, and sleep disturbance. Results: After a mean follow-up time of 5 months after the acute phase, F were significantly more likely than M to report dyspnea, weakness, thoracic pain, palpitations, and sleep disturbance but not myalgia and cough. At the multivariate logistic regression, women were statistically significantly likely to experience persistent symptoms such as dyspnea, fatigue, chest pain, and palpitations. On the contrary, myalgia, cough, and sleep disturbance were not influenced by sex. Conclusion: We demonstrated that F were more symptomatic than M not only in the acute phase but also at follow-up. Sex was found to be an important determinant of Long-COVID-19 syndrome because it is a significant predictor of persistent symptoms in F, such as dyspnea, fatigue, chest pain, and palpitations. Our results suggest the need for long-term follow-up of these patients from a sex perspective to implement early preventive and personalized therapeutic strategies.
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Affiliation(s)
- Giovanna Pelà
- Department of Medicine and Surgery, University of Parma, Parma, Italy.,Department of General and Specialistic Medicine, University-Hospital of Parma, Parma, Italy
| | - Matteo Goldoni
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Emila Solinas
- Interventional Cardiology Unit, University-Hospital of Parma, Parma, Italy
| | - Chiara Cavalli
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Sara Tagliaferri
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Silvia Ranzieri
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Annalisa Frizzelli
- Department of Medicine and Surgery, University of Parma, Parma, Italy.,Department of Cardio-Thoracic and Vascular, Respiratory Disease and Lung Function Unit, University-Hospital of Parma, Parma, Italy
| | - Laura Marchi
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Pier Anselmo Mori
- Department of Cardio-Thoracic and Vascular, Pulmonology and Endoscopic Unit, University-Hospital of Parma, Parma, Italy
| | - Maria Majori
- Department of Cardio-Thoracic and Vascular, Pulmonology and Endoscopic Unit, University-Hospital of Parma, Parma, Italy
| | - Marina Aiello
- Department of Medicine and Surgery, University of Parma, Parma, Italy.,Department of Cardio-Thoracic and Vascular, Respiratory Disease and Lung Function Unit, University-Hospital of Parma, Parma, Italy
| | - Massimo Corradi
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Alfredo Chetta
- Department of Medicine and Surgery, University of Parma, Parma, Italy.,Department of Cardio-Thoracic and Vascular, Respiratory Disease and Lung Function Unit, University-Hospital of Parma, Parma, Italy
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17
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Plakht Y, Elkis Hirsch Y, Shiyovich A, Abu Tailakh M, Liberty IF, Gilutz H. Heterogenicity of diabetes as a risk factor for all-cause mortality after acute myocardial infarction: Age and sex impact. Diabetes Res Clin Pract 2021; 182:109117. [PMID: 34756959 DOI: 10.1016/j.diabres.2021.109117] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 09/29/2021] [Accepted: 10/15/2021] [Indexed: 10/20/2022]
Abstract
AIM Type 2 diabetes mellitus (T2DM) is a risk factor for mortality after acute myocardial infarction (AMI). We studied the impact of T2DM related to sex and age on post-AMI long-term mortality. METHODS A retrospective study included post-AMI patients. Data were obtained from electronic medical records. We defined the study groups by T2DM, stratified by age-sex. OUTCOME up-to-10 years post-discharge all-cause mortality. RESULTS 16,168 patients were analyzed, 40.3% had T2DM. Ten-year mortality rates were 50.3% with T2DM vs. 33.1% without T2DM, adjHR = 1.622 (p < 0.001). Females (adjHR = 1.085, p = 0.052) and increased age (adjHR = 1.056 for one-year increase, p < 0.001) were associated with a higher risk of mortality (borderline statistical significance for sex). The relationship between T2DM and mortality was stronger in females than in males at < 50 and 60-69 years (p-for-interaction 0.025 and 0.009 respectively), but not for other age groups. CONCLUSIONS The study implies heterogeneity in the impact of T2DM on mortality of post-AMI patients, being greater among young patients, particularly females, and no significant impact in octogenarians. That implies that young women with T2DM should have advanced measures for early detection of coronary artery disease and tight control of cardiovascular risk factors to lower the propensity to develop AMI.
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Affiliation(s)
- Ygal Plakht
- Department of Nursing, Faculty of Health Sciences, Ben-Gurion University of the Negev, P.O.B. 653, Beer-Sheva 84105, Israel; Department of Emergency Medicine, Soroka University Medical Center, P.O.B. 151, Beer-Sheva 84101, Israel.
| | - Yuval Elkis Hirsch
- Department of Nursing, Faculty of Health Sciences, Ben-Gurion University of the Negev, P.O.B. 653, Beer-Sheva 84105, Israel; Cardiothoracic Intensive Care Unit, Rabin Medical Center, Zeev Jabotinsky St., 39, Petah Tikva 49100, Israel
| | - Arthur Shiyovich
- Department of Cardiology, Rabin Medical Center, Zeev Jabotinsky St., 39, Petah Tikva 49100, Israel; Sackler Faculty of Medicine, Tel Aviv University, P.O.B. 39040, Ramat Aviv, 69978, Israel
| | - Muhammad Abu Tailakh
- Department of Nursing, Faculty of Health Sciences, Ben-Gurion University of the Negev, P.O.B. 653, Beer-Sheva 84105, Israel; Nursing Research Unit, Soroka University Medical Center, P.O.B. 151, Beer-Sheva 84101, Israel
| | - Idit F Liberty
- Diabetes Clinic, Soroka University Medical Center, P.O.B. 151, Beer-Sheva 84101, Israel; Goldman Medical School, Faculty of Health Sciences, Ben-Gurion University of the Negev, P.O.B. 653, Beer-Sheva 84105, Israel
| | - Harel Gilutz
- Goldman Medical School, Faculty of Health Sciences, Ben-Gurion University of the Negev, P.O.B. 653, Beer-Sheva 84105, Israel
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18
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Iglesias MJ, Kruse LD, Sanchez-Rivera L, Enge L, Dusart P, Hong MG, Uhlén M, Renné T, Schwenk JM, Bergstrom G, Odeberg J, Butler LM. Identification of Endothelial Proteins in Plasma Associated With Cardiovascular Risk Factors. Arterioscler Thromb Vasc Biol 2021; 41:2990-3004. [PMID: 34706560 PMCID: PMC8608011 DOI: 10.1161/atvbaha.121.316779] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Supplemental Digital Content is available in the text. Objective: Endothelial cell (EC) dysfunction is a well-established response to cardiovascular disease risk factors, such as smoking and obesity. Risk factor exposure can modify EC signaling and behavior, leading to arterial and venous disease development. Here, we aimed to identify biomarker panels for the assessment of EC dysfunction, which could be useful for risk stratification or to monitor treatment response. Approach and Results: We used affinity proteomics to identify EC proteins circulating in plasma that were associated with cardiovascular disease risk factor exposure. Two hundred sixteen proteins, which we previously predicted to be EC-enriched across vascular beds, were measured in plasma samples (N=1005) from the population-based SCAPIS (Swedish Cardiopulmonary Bioimage Study) pilot. Thirty-eight of these proteins were associated with body mass index, total cholesterol, low-density lipoprotein, smoking, hypertension, or diabetes. Sex-specific analysis revealed that associations predominantly observed in female- or male-only samples were most frequently with the risk factors body mass index, or total cholesterol and smoking, respectively. We show a relationship between individual cardiovascular disease risk, calculated with the Framingham risk score, and the corresponding biomarker profiles. Conclusions: EC proteins in plasma could reflect vascular health status.
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Affiliation(s)
- Maria J Iglesias
- Science for Life Laboratory, Department of Protein Science, CBH, KTH Royal Institute of Technology, Stockholm, Sweden (M.J.I., L.D.K., L.S.-R., L.E., P.D., M.G.H., M.U., J.M.S., J.O., L.M.B.).,Division of Internal Medicine, University Hospital of North Norway, Tromsø (M.J.I., J.O.)
| | - Larissa D Kruse
- Science for Life Laboratory, Department of Protein Science, CBH, KTH Royal Institute of Technology, Stockholm, Sweden (M.J.I., L.D.K., L.S.-R., L.E., P.D., M.G.H., M.U., J.M.S., J.O., L.M.B.)
| | - Laura Sanchez-Rivera
- Science for Life Laboratory, Department of Protein Science, CBH, KTH Royal Institute of Technology, Stockholm, Sweden (M.J.I., L.D.K., L.S.-R., L.E., P.D., M.G.H., M.U., J.M.S., J.O., L.M.B.)
| | - Linnea Enge
- Science for Life Laboratory, Department of Protein Science, CBH, KTH Royal Institute of Technology, Stockholm, Sweden (M.J.I., L.D.K., L.S.-R., L.E., P.D., M.G.H., M.U., J.M.S., J.O., L.M.B.)
| | - Philip Dusart
- Science for Life Laboratory, Department of Protein Science, CBH, KTH Royal Institute of Technology, Stockholm, Sweden (M.J.I., L.D.K., L.S.-R., L.E., P.D., M.G.H., M.U., J.M.S., J.O., L.M.B.)
| | - Mun-Gwan Hong
- Science for Life Laboratory, Department of Protein Science, CBH, KTH Royal Institute of Technology, Stockholm, Sweden (M.J.I., L.D.K., L.S.-R., L.E., P.D., M.G.H., M.U., J.M.S., J.O., L.M.B.)
| | - Mathias Uhlén
- Science for Life Laboratory, Department of Protein Science, CBH, KTH Royal Institute of Technology, Stockholm, Sweden (M.J.I., L.D.K., L.S.-R., L.E., P.D., M.G.H., M.U., J.M.S., J.O., L.M.B.)
| | - Thomas Renné
- Institute for Clinical Chemistry and Laboratory Medicine, University Medical Centre Hamburg-Eppendorf, Germany (T.R.).,Irish Centre for Vascular Biology, School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland (T.R.).,Centre for Thrombosis and Hemostasis (CTH), Johannes Gutenberg University Medical Center, Mainz, Germany (T.R.)
| | - Jochen M Schwenk
- Science for Life Laboratory, Department of Protein Science, CBH, KTH Royal Institute of Technology, Stockholm, Sweden (M.J.I., L.D.K., L.S.-R., L.E., P.D., M.G.H., M.U., J.M.S., J.O., L.M.B.)
| | - Göran Bergstrom
- Institute of Medicine, Sahlgrenska Academy at the University of Gothenburg, Sweden (G.B.)
| | - Jacob Odeberg
- Science for Life Laboratory, Department of Protein Science, CBH, KTH Royal Institute of Technology, Stockholm, Sweden (M.J.I., L.D.K., L.S.-R., L.E., P.D., M.G.H., M.U., J.M.S., J.O., L.M.B.).,Division of Internal Medicine, University Hospital of North Norway, Tromsø (M.J.I., J.O.).,Department of Clinical Medicine, The Arctic University of Norway, Tromsø (J.O., L.M.B.).,Coagulation Unit, Department of Hematology (J.O.), Karolinska University Hospital, Stockholm, Sweden
| | - Lynn M Butler
- Science for Life Laboratory, Department of Protein Science, CBH, KTH Royal Institute of Technology, Stockholm, Sweden (M.J.I., L.D.K., L.S.-R., L.E., P.D., M.G.H., M.U., J.M.S., J.O., L.M.B.).,Department of Clinical Medicine, The Arctic University of Norway, Tromsø (J.O., L.M.B.).,Clinical Chemistry, Karolinska University Laboratory (L.M.B.), Karolinska University Hospital, Stockholm, Sweden.,Clinical Chemistry and Blood Coagulation Research, Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden (L.M.B.)
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Biodata Mining of Differentially Expressed Genes between Acute Myocardial Infarction and Unstable Angina Based on Integrated Bioinformatics. BIOMED RESEARCH INTERNATIONAL 2021; 2021:5584681. [PMID: 34568491 PMCID: PMC8456013 DOI: 10.1155/2021/5584681] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Revised: 06/10/2021] [Accepted: 08/26/2021] [Indexed: 12/14/2022]
Abstract
Acute coronary syndrome (ACS) is a complex syndrome of clinical symptoms. In order to accurately diagnose the type of disease in ACS patients, this study is aimed at exploring the differentially expressed genes (DEGs) and biological pathways between acute myocardial infarction (AMI) and unstable angina (UA). The GSE29111 and GSE60993 datasets containing microarray data from AMI and UA patients were downloaded from the Gene Expression Omnibus (GEO) database. DEG analysis of these 2 datasets is performed using the “limma” package in R software. DEGs were also analyzed using protein-protein interaction (PPI), Molecular Complex Detection (MCODE) algorithm, Gene Ontology (GO), and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analysis. Correlation analysis and “cytoHubba” were used to analyze the hub genes. A total of 286 DEGs were obtained from GSE29111 and GSE60993, including 132 upregulated genes and 154 downregulated genes. Subsequent comprehensive analysis identified 20 key genes that may be related to the occurrence and development of AMI and UA and were involved in the inflammatory response, interaction of neuroactive ligand-receptor, calcium signaling pathway, inflammatory mediator regulation of TRP channels, viral protein interaction with cytokine and cytokine receptor, human cytomegalovirus infection, and cytokine-cytokine receptor interaction pathway. The integrated bioinformatical analysis could improve our understanding of DEGs between AMI and UA. The results of this study might provide a new perspective and reference for the early diagnosis and treatment of ACS.
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20
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Update: Gender differences in CABG outcomes-Have we bridged the gap? PLoS One 2021; 16:e0255170. [PMID: 34525123 PMCID: PMC8443029 DOI: 10.1371/journal.pone.0255170] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 07/11/2021] [Indexed: 11/19/2022] Open
Abstract
Background Appreciation of unique presentation, patterns and underlying pathophysiology of coronary artery disease in women has driven gender based risk stratification and risk reduction efforts over the last decade. Data regarding whether these advances have resulted in unequivocal improvements in outcomes of CABG in women is conflicting. The objective of our study was to assess gender differences in post-operative outcomes following CABG. Methods Retrospective analyses of institutional data housed in the Society of Thoracic Surgeons (STS) database for patients undergoing CABG between 2002 and 2020 were conducted. Multivariable regression analysis was conducted to investigate gender differences in post-operative outcomes. P-values were adjusted using Bonferroni correction to reduce type-I errors. Results Our final cohort of 6,250 patients had fewer women than men (1,339 vs. 4,911). more women were diabetic (52.0% vs. 41.2%, p<0.001) and hypertensive (89.1% vs. 84.0%, p<0.001). Women had higher adjusted odds of developing ventilator dependence >48 hours (OR: 1.65 [1.21, 2.45], p = 0.002) and cardiac readmissions (OR: 1.56 [1.27, 2.30], p = 0.003). After adjustment for comorbidity burden, mortality rates in women were comparable to those of age-matched men. Conclusion The findings of our study indicate that despite apparent reduction of differences in mortality, the burden of postoperative morbidity is still high among women.
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21
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Sex Differences in the Clinical Features and Outcomes of Patients with Acute Coronary Syndrome Treated with Two Generations (Absorb and Magmaris) of Bioresorbable Vascular Scaffolds. J Clin Med 2021; 10:jcm10173768. [PMID: 34501216 PMCID: PMC8432059 DOI: 10.3390/jcm10173768] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 08/15/2021] [Accepted: 08/20/2021] [Indexed: 11/24/2022] Open
Abstract
Background: Despite the developments in percutaneous coronary interventions (PCI), women are still more likely than men to have unfavorable outcomes after PCI performed in Acute Coronary Syndrome (ACS). The mechanisms of this phenomena are not fully understood. Potential benefits of bioresorbable scaffolds (BRS) may be particularly expressed in the female population. Nevertheless, the data available currently are inconsistent and limited. This study evaluated the gender-related differences in the short-term clinical outcomes in ACS patients treated with implantation of two generations of BRS (first generation, Absorb; second generation, Magmaris). Methods: The study was divided into two arms. To the first one, we qualified 160 patients with ACS treated with PCI who received 210 Absorb scaffolds. The second arm was composed of 193 patients with ACS who underwent PCI with Magmaris implantation. Results: There were no significant sex-related differences in primary endpoints (cardiovascular-death, myocardial infarction, in-stent thrombosis) or principal secondary endpoints (of target-lesion failure, scaffold restenosis, death from any reason, other cardiovascular events) in either generation of BRS in a 1-year follow-up. Conclusions: Both genders tended to have a similar outcome in routine clinical practice following BRS implantation due to ACS. The magnesium bioresorbable scaffold (Magmaris) early outcome seemed to be more favorable in comparison to the Absorb scaffold.
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22
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Ferreira MCM, Oliveira MVD, Paiva MSM, Lemke V, Mangione F, Oliveira GMMD. Closing the Gender Gap in Ischemic Heart Diseases and Myocardial Infarction. INTERNATIONAL JOURNAL OF CARDIOVASCULAR SCIENCES 2021. [DOI: 10.36660/ijcs.20210001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
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Haider A, Bengs S, Luu J, Osto E, Siller-Matula JM, Muka T, Gebhard C. Sex and gender in cardiovascular medicine: presentation and outcomes of acute coronary syndrome. Eur Heart J 2021; 41:1328-1336. [PMID: 31876924 DOI: 10.1093/eurheartj/ehz898] [Citation(s) in RCA: 156] [Impact Index Per Article: 52.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 09/01/2019] [Accepted: 12/02/2019] [Indexed: 12/14/2022] Open
Abstract
Although health disparities in women presenting with acute coronary syndrome (ACS) have received growing attention in recent years, clinical outcomes from ACS are still worse for women than for men. Women continue to experience higher patient and system delays and receive less aggressive invasive treatment and pharmacotherapies. Gender- and sex-specific variables that contribute to ACS vulnerability remain largely unknown. Notwithstanding the sex differences in baseline coronary anatomy and function, women and men are treated the same based on guidelines that were established from experimental and clinical trial data over-representing the male population. Importantly, younger women have a particularly unfavourable prognosis and a plethora of unanswered questions remains in this younger population. The present review summarizes contemporary evidence for gender and sex differences in vascular biology, clinical presentation, and outcomes of ACS. We further discuss potential mechanisms and non-traditional risk conditions modulating the course of disease in women and men, such as unrecognized psychosocial factors, sex-specific vascular and neural stress responses, and the potential impact of epigenetic modifications.
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Affiliation(s)
- Ahmed Haider
- Department of Nuclear Medicine, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland.,Center for Molecular Cardiology, University of Zurich, Wagistrasse 12, 8952 Schlieren, Switzerland
| | - Susan Bengs
- Department of Nuclear Medicine, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland.,Center for Molecular Cardiology, University of Zurich, Wagistrasse 12, 8952 Schlieren, Switzerland
| | - Judy Luu
- Division of Cardiology, Department of Internal Medicine, University of Manitoba, 820 Sherbrook Street, Winnipeg MB R3A, Manitoba, Canada
| | - Elena Osto
- Institute of Clinical Chemistry, University of Zurich and University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland.,Cardiology, University Heart Center, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland
| | - Jolanta M Siller-Matula
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria.,Centre for Preclinical Research and Technology, Department of Experimental and Clinical Pharmacology, Medical University of Warsaw, Zwirki i Wigury 61, 02-091 Warsaw, Poland
| | - Taulant Muka
- Institute of Social and Preventive Medicine, University of Bern, Mittelstrasse 43, 3012 Bern, Switzerland
| | - Catherine Gebhard
- Department of Nuclear Medicine, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland.,Center for Molecular Cardiology, University of Zurich, Wagistrasse 12, 8952 Schlieren, Switzerland.,Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
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Impact of sex on outcomes of bifurcation lesion percutaneous coronary intervention: results from a single-centre prospective registry. Coron Artery Dis 2021; 31:31-36. [PMID: 33826533 DOI: 10.1097/mca.0000000000001039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Coronary bifurcation lesions are technically and clinically more challenging compared to nonbifurcation lesions. Sex-related differences in diagnostic and invasive therapeutic coronary procedures have been described in the literature. Our objective was to assess the impact of sex on outcomes of bifurcation lesion percutaneous coronary intervention (PCI). METHODS Our data were taken from a prospective registry of consecutive patients undergoing PCI for bifurcation lesions at our medical centre between 2004 and 2019. We compared rates of death and major adverse cardiac events (MACE) between men and women at 1 year and 3 years. MACE comprised cardiac death, myocardial infarction, target vessel revascularization or stroke. RESULTS A total of 1209 patients were included, 948 (78.4%) were male and 261 (21.6%) were female. Women were older (mean age 69.7 ± 11 years vs. 63.1 ± 11 years, P < 0.01), and had more comorbidities than men. Female patients had more angiographically calcified (38.1% vs. 30.1%, P = 0.017) lesions. At 1-year follow up, there was no significant difference of MACE (18.8 vs. 15.2%, P = 0.183) or all-cause mortality (5.7% vs. 3.9%, P = 0.242) between sexes. At 3-year follow up, there was a significantly higher rate of MACE in women (29.1% vs. 22.5%, P = 0.026), this was driven by a significantly higher all-cause mortality (13.8% vs. 6.5%, P < 0.01). CONCLUSION Women undergoing bifurcation PCI are older and have more comorbidities than their male counterparts. Intermediate term follow-up outcomes are similar between sexes. Poorer long-term outcomes of women are likely due to baseline higher risk profile.
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Peacock WF, Baumann BM, Rivers EJ, Davis TE, Handy B, Jones CW, Hollander JE, Limkakeng AT, Mehrotra A, Than M, Cullen L, Ziegler A, Dinkel‐Keuthage C. Using Sex-specific Cutoffs for High-sensitivity Cardiac Troponin T to Diagnose Acute Myocardial Infarction. Acad Emerg Med 2021; 28:463-466. [PMID: 32726505 PMCID: PMC8247402 DOI: 10.1111/acem.14098] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 07/21/2020] [Accepted: 07/23/2020] [Indexed: 11/29/2022]
Affiliation(s)
- W. Frank Peacock
- From the Department of Emergency Medicine Baylor College of Medicine Houston TXUSA
| | - Brigitte M. Baumann
- the Department of Emergency Medicine Cooper Medical School of Rowan University Camden NJUSA
| | - E. Joy Rivers
- Agent representing Roche Diagnostics Indianapolis INUSA
| | - Thomas E. Davis
- the Indiana University School of Medicine Indianapolis INUSA
| | - Beverly Handy
- the Department of Laboratory Medicine University of Texas MD Anderson Cancer Center Houston TXUSA
| | - Christopher W. Jones
- the Department of Emergency Medicine Cooper Medical School of Rowan University Camden NJUSA
| | - Judd E. Hollander
- the Department of Emergency Medicine Thomas Jefferson University Philadelphia PAUSA
| | | | - Abhi Mehrotra
- the Department of Emergency Medicine University of North Carolina School of Medicine Chapel Hill NCUSA
| | - Martin Than
- the Emergency Department Christchurch Hospital Christchurch New Zealand
| | - Louise Cullen
- the Department of Emergency Medicine Royal Brisbane and Women's Hospital Brisbane QLD Australia
| | - André Ziegler
- Roche Diagnostics International Ltd Rotkreuz Switzerland
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Characterization and long-term outcomes of patients with myocarditis: a retrospective observational study. ADVANCES IN INTERVENTIONAL CARDIOLOGY 2021; 17:60-67. [PMID: 33868419 PMCID: PMC8039934 DOI: 10.5114/aic.2021.104770] [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: 10/31/2020] [Accepted: 11/30/2020] [Indexed: 11/17/2022] Open
Abstract
Introduction There is limited data on the long-term follow-up of patients with myocarditis. Aim To investigate the long-term follow-up of patients with myocarditis. Material and methods We performed a retrospective observational analysis on the clinical long-term outcomes of patients with myocarditis over a 10-year period. The primary outcome was mortality. We identified risk factors for mortality and adverse clinical outcomes. We also compared the characteristics and outcomes of patients presenting with fulminant myocarditis to those presenting with non-fulminant myocarditis. Results Between May 2004 and December 2014, 203 patients with myocarditis or perimyocarditis were admitted to our center. Most patients were male (87.7%) with a median age at presentation of 33 years (interquartile range: 25.4–38.9). The median follow-up period was 56.9 months (interquartile range 25.3–87.3 months), during which the overall mortality was 4.4% (9 patients). Fifteen patients presented with fulminant myocarditis. After multivariable analysis, older age (HR = 1.11, 95% CI: 1.05–1.16, p < 0.001) and a poorer New York Heart Association (NYHA) function class (HR = 4.6, 95% CI: 1.18–18, p = 0.028) were found to be independently associated with a higher risk of mortality, whereas higher albumin levels at presentation (HR = 0.2, 95% CI: 0.07–0.56, p = 0.002) were associated with decreased mortality. The group presenting with fulminant myocarditis had a more severe course of disease and a higher in-hospital mortality (13.3% vs. 0%, p = 0.005). Conclusions The overall prognosis of patients with myocarditis is good – in terms of both survival and recovery without residual left ventricular dysfunction.
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Gopal DP, Chetty U, O'Donnell P, Gajria C, Blackadder-Weinstein J. Implicit bias in healthcare: clinical practice, research and decision making. Future Healthc J 2021; 8:40-48. [PMID: 33791459 DOI: 10.7861/fhj.2020-0233] [Citation(s) in RCA: 76] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Bias is the evaluation of something or someone that can be positive or negative, and implicit or unconscious bias is when the person is unaware of their evaluation. This is particularly relevant to policymaking during the coronavirus pandemic and racial inequality highlighted during the support for the Black Lives Matter movement. A literature review was performed to define bias, identify the impact of bias on clinical practice and research as well as clinical decision making (cognitive bias). Bias training could bridge the gap from the lack of awareness of bias to the ability to recognise bias in others and within ourselves. However, there are no effective debiasing strategies. Awareness of implicit bias must not deflect from wider socio-economic, political and structural barriers as well ignore explicit bias such as prejudice.
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Affiliation(s)
- Dipesh P Gopal
- Barts and The London School of Medicine and Dentistry, London, UK
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Outcomes and Procedural Considerations for Women Undergoing PCI. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2021. [DOI: 10.1007/s11936-020-00888-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Microvascular changes of the retina in ankylosing spondylitis, and the association with cardiovascular disease - the eye for a heart study. Semin Arthritis Rheum 2020; 50:1535-1541. [PMID: 32967777 DOI: 10.1016/j.semarthrit.2020.08.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 08/05/2020] [Accepted: 08/10/2020] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Ankylosing spondylitis (AS) is associated with an increased risk of cardiovascular disease (CVD). Microvasculature changes can precede overt CVD, but have been studied poorly in AS. The retinal vasculature is easily accessible and changes are associated with CVD (e.g. arteriolar narrowing, venular widening, loss of tortuosity). This proof of concept study compared the retinal microvasculature of AS patients with healthy controls, and the influence of gender. METHODS Cross-sectional case-control study comparing AS patients with healthy controls. Main inclusion criteria were: age 50-75 years, no diabetes mellitus and, for AS, fulfillment of the modified New York criteria. All subjects underwent fundus photography, analyzed with Singapore I Vessel Assessment software, and Optical Coherence Tomography Angiography (OCTA). Subjects were compared with generalized estimating equations (GEE). Multivariable analyses were adjusted for demographics and cardiovascular risk, and stratified for gender. RESULTS Fifty-nine AS patients and 105 controls were included (50% women). Controls were significantly older than patients (68 versus 60, p<0.01), but did not differ in cardiovascular profile. Patients had a lower retinal arteriolar tortuosity (β ̶-0.1, 95%CI [-0.2; -0.01], p = 0.02), and higher vessel density (β 0.5, 95% CI [0.1; 0.9], p = 0.02). In addition, male AS patients showed a lower arteriovenular ratio compared to male controls (β -0.03, p = 0.04, 95%CI [-0.05; -0.001]). There were no differences found between women with and without AS. CONCLUSION This study detected several retinal microvascular changes, in AS patients compared to controls, which have been associated with CVD. Retinal imaging might be an interesting tool for future CVD screening.
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Relation between pharmacological stress ECG, 13NH3-PET/CT outcome and the occurrence of cardiac events during follow-up in women with chest pain. Nucl Med Commun 2020; 41:783-789. [DOI: 10.1097/mnm.0000000000001212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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31
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Bordoni L, Fedeli D, Piangerelli M, Pelikant-Malecka I, Radulska A, Samulak JJ, Sawicka AK, Lewicki L, Kalinowski L, Olek RA, Gabbianelli R. Gender-Related Differences in Trimethylamine and Oxidative Blood Biomarkers in Cardiovascular Disease Patients. Biomedicines 2020; 8:biomedicines8080238. [PMID: 32717906 PMCID: PMC7460342 DOI: 10.3390/biomedicines8080238] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 07/13/2020] [Accepted: 07/20/2020] [Indexed: 12/21/2022] Open
Abstract
Gender differences in the burden of cardiovascular disease (CVD) have been observed worldwide. In this study, plasmatic levels of trimethylamine (TMA) and blood oxidative biomarkers have been evaluated in 358 men (89 controls and 269 CVD patients) and 189 women (64 control and 125 CVD patients). The fluorescence technique was applied to determine erythrocyte membrane fluidity using 1,6-diphenyl-1,3,5-hexatriene (DPH) and Laurdan, while lipid hydroperoxides were assessed by diphenyl−1-pyrenylphosphine (DPPP). Results show that levels of plasmatic TMA were higher in healthy men with respect to healthy women (p = 0.0001). Significantly lower TMA was observed in male CVD patients (0.609 ± 0.104 μM) compared to healthy male controls (0.680 ± 0.118 μM) (p < 0.001), while higher levels of TMA were measured in female CVD patients (0.595 ± 0.115 μM) with respect to female controls (0.529 ± 0.073 μM) (p < 0.001). DPPP was significantly higher in healthy control men than in women (p < 0.001). Male CVD patients displayed a lower value of DPPP (2777 ± 1924) compared to healthy controls (5528 ± 2222) (p < 0.001), while no significant changes were measured in females with or without CVD (p > 0.05). Membrane fluidity was significantly higher (p < 0.001) in the hydrophobic bilayer only in control male subjects. In conclusion, gender differences were observed in blood oxidative biomarkers, and DPPP value might be suggested as a biomarker predictive of CVD only in men.
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Affiliation(s)
- Laura Bordoni
- Unit of Molecular Biology, School of Pharmacy, University of Camerino, 62032 Camerino, Italy; (L.B.); (D.F.)
| | - Donatella Fedeli
- Unit of Molecular Biology, School of Pharmacy, University of Camerino, 62032 Camerino, Italy; (L.B.); (D.F.)
| | - Marco Piangerelli
- Computer Science Division and Mathematics Division, School of Science and Technology, University of Camerino, 62032 Camerino, Italy;
| | - Iwona Pelikant-Malecka
- Department of Medical Laboratory Diagnostics, Medical University of Gdansk, 80-211 Gdansk, Poland; (I.P.-M.); (A.R.); (L.K.)
- Biobanking and Biomolecular Resources Research Infrastructure Poland (BBMRI.PL), 80-211 Gdansk, Poland
| | - Adrianna Radulska
- Department of Medical Laboratory Diagnostics, Medical University of Gdansk, 80-211 Gdansk, Poland; (I.P.-M.); (A.R.); (L.K.)
- Biobanking and Biomolecular Resources Research Infrastructure Poland (BBMRI.PL), 80-211 Gdansk, Poland
| | - Joanna J. Samulak
- Doctoral School for Physical Culture Sciences, 80-336 Gdansk, Poland; (J.J.S.); (A.K.S.)
| | - Angelika K. Sawicka
- Doctoral School for Physical Culture Sciences, 80-336 Gdansk, Poland; (J.J.S.); (A.K.S.)
- Department of Human Physiology, Faculty of Health Sciences, Medical University of Gdansk, 80-210 Gdansk, Poland
| | - Lukasz Lewicki
- University Center for Cardiology, Gdansk, Debinki 2, 80-211 Gdansk, Poland;
| | - Leszek Kalinowski
- Department of Medical Laboratory Diagnostics, Medical University of Gdansk, 80-211 Gdansk, Poland; (I.P.-M.); (A.R.); (L.K.)
- Biobanking and Biomolecular Resources Research Infrastructure Poland (BBMRI.PL), 80-211 Gdansk, Poland
- Gdansk University of Technology, Narutowicza 11/12, 80-233 Gdansk, Poland
| | - Robert A. Olek
- Department of Athletics, Strength and Conditioning, Poznan University of Physical Education, 61-871 Poznan, Poland
- Correspondence: (R.A.O.); (R.G.); Tel.: +48-61-8355270 (R.A.O.); +39-0737-403208 (R.G.)
| | - Rosita Gabbianelli
- Unit of Molecular Biology, School of Pharmacy, University of Camerino, 62032 Camerino, Italy; (L.B.); (D.F.)
- Correspondence: (R.A.O.); (R.G.); Tel.: +48-61-8355270 (R.A.O.); +39-0737-403208 (R.G.)
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O'Neil A, Scovelle AJ, Thomas E, Russell JD, Taylor CB, Hare DL, Toukhsati S, Oldroyd J, Rangani WPT, Dheerasinghe DSAF, Oldenburg B. Sex-Specific Differences in Percutaneous Coronary Intervention Outcomes After a Cardiac Event: A Cohort Study Examining the Role of Depression, Worry and Autonomic Function. Heart Lung Circ 2020; 29:1449-1458. [PMID: 32414636 DOI: 10.1016/j.hlc.2020.03.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Revised: 02/22/2020] [Accepted: 03/04/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND To determine whether differential all-cause hospital readmission exists for men and women 2 years after percutaneous coronary intervention (PCI) treatment for acute coronary syndrome (ACS), and to identify potential autonomic and psychological pathways contributing to this association. METHODS Four hundred and sixteen (416) patients admitted with ACS were recruited from coronary care wards. Participants attended the study centre at one (T0) and 12 (T1) months following discharge. Heart rate variability (HRV) was used to assess autonomic functioning measured via a three-lead electrocardiogram. Psychological variables of interest (pathological worry, depression and phobic anxiety) were measured using validated self-report questionnaires. Percutaneous coronary intervention treatment data were collected from hospital records. The primary outcome was 2-year all-cause hospital readmission (yes/no). Logistic regression modelling using both complete case analysis and multiple imputation analysis was applied. RESULTS Men who received PCI had a significant reduction in the odds of being rehospitalised over the following 2 years, relative to women who did not (OR=0.45, 95% CI=0.20, 0.98). No other group benefited to this extent. Adjustment for age, ACS severity and Very Low Frequency (VLF) Power appeared to strengthen the association in both the complete case analysis and multiple imputation analysis models. The inclusion of depression and worry also marginally explained these associations in the multiple imputation analysis model. CONCLUSIONS Men who receive PCI after ACS were less likely to be readmitted to hospital over the following 2 years than their female counterparts. The small sample size of women and observational study design limit interpretation of the findings. However, heart rate variability, specifically VLF power, requires further investigation as a driver of such sex-specific outcomes.
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Affiliation(s)
- Adrienne O'Neil
- Institute for Innovation in Mental and Physical Health and Clinical Treatment, Deakin University, Geelong, Vic, Australia; Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Vic, Australia.
| | - Anna J Scovelle
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Vic, Australia
| | - Emma Thomas
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Vic, Australia; Centre for Online Health, Centre for Health Services Research, The University of Queensland, Brisbane, Qld, Australia
| | - Josephine D Russell
- Institute for Innovation in Mental and Physical Health and Clinical Treatment, Deakin University, Geelong, Vic, Australia
| | - C Barr Taylor
- Department of Psychiatry, Stanford and Palo Alto Universities, Palo Alto, CA, USA
| | - David L Hare
- School of Medicine, The University of Melbourne, Melbourne, Vic, Australia; Department of Cardiology, Austin Hospital, Melbourne, Vic, Australia
| | - Samia Toukhsati
- School of Medicine, The University of Melbourne, Melbourne, Vic, Australia; Department of Cardiology, Austin Hospital, Melbourne, Vic, Australia; School of Health and Life Sciences, Federation University, Melbourne, Vic, Australia
| | - John Oldroyd
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Vic, Australia
| | - W P Thanuja Rangani
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Vic, Australia
| | - D S Anoja F Dheerasinghe
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Vic, Australia
| | - Brian Oldenburg
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Vic, Australia
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Bathini T, Thongprayoon C, Chewcharat A, Petnak T, Cheungpasitporn W, Boonpheng B, Prasitlumkum N, Chokesuwattanaskul R, Vallabhajosyula S, Kaewput W. Acute Myocardial Infarction among Hospitalizations for Heat Stroke in the United States. J Clin Med 2020; 9:jcm9051357. [PMID: 32384601 PMCID: PMC7290741 DOI: 10.3390/jcm9051357] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 04/26/2020] [Accepted: 05/02/2020] [Indexed: 12/15/2022] Open
Abstract
Background: This study aimed to assess the risk factors and impact of acute myocardial infarction on in-hospital treatments, complications, outcomes, and resource utilization in hospitalized patients for heat stroke in the United States. Methods: Hospitalized patients with a principal diagnosis of heat stroke were identified in the National Inpatient Sample dataset from the years 2003 to 2014. Acute myocardial infarction was identified using the hospital International Classification of Diseases, Ninth Revision (ICD-9), diagnosis of 410.xx. Clinical characteristics, in-hospital treatment, complications, outcomes, and resource utilization between patients with and without acute myocardial infarction were compared. Results: A total of 3372 heat stroke patients were included in the analysis. Of these, acute myocardial infarction occurred in 225 (7%) admissions. Acute myocardial infarction occurred more commonly in obese female patients with a history of chronic kidney disease, but less often in male patients aged <20 years with a history of hypothyroidism. The need for mechanical ventilation, blood transfusion, and renal replacement therapy were higher in patients with acute myocardial infarction. Acute myocardial infarction was associated with rhabdomyolysis, metabolic acidosis, sepsis, gastrointestinal bleeding, ventricular arrhythmia or cardiac arrest, renal failure, respiratory failure, circulatory failure, liver failure, neurological failure, and hematologic failure. Patients with acute myocardial infarction had 5.2-times greater odds of in-hospital mortality than those without myocardial infarction. The length of hospital stay and hospitalization cost were also higher when an acute myocardial infarction occurred while hospitalized. Conclusion: Acute myocardial infarction was associated with worse outcomes and higher economic burden among patients hospitalized for heat stroke. Obesity and chronic kidney disease were associated with increased risk of acute myocardial infarction, while young male patients and hypothyroidism were associated with decreased risk.
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Affiliation(s)
- Tarun Bathini
- Department of Internal Medicine, University of Arizona, Tucson, AZ 85721, USA
- Correspondence: (T.B.); (C.T.); (W.C.); (W.K.)
| | - Charat Thongprayoon
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA;
- Correspondence: (T.B.); (C.T.); (W.C.); (W.K.)
| | - Api Chewcharat
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA;
| | - Tananchai Petnak
- Division of Pulmonary and Critical Care Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand;
| | - Wisit Cheungpasitporn
- Division of Nephrology, Department of Internal Medicine, University of Mississippi Medical Center, Jackson, MS 39216, USA
- Correspondence: (T.B.); (C.T.); (W.C.); (W.K.)
| | - Boonphiphop Boonpheng
- Department of Medicine, University of California, Los Angeles, Los Angeles, CA 90095, USA;
| | | | | | | | - Wisit Kaewput
- Department of Military and Community Medicine, Phramongkutklao College of Medicine, Bangkok 10400, Thailand
- Correspondence: (T.B.); (C.T.); (W.C.); (W.K.)
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Abstract
BACKGROUND Despite advancements in treatment, acute myocardial infarction (AMI) remains a leading cause of morbidity and mortality in the elderly population. Previous research has highlighted long-standing sex disparities in the care of these patients. However, differences in the patterns of discharge are not well described. One key parameter is the destination of discharge, and in particular - discharge to skilled nursing facilities (SNFs), a factor associated with worse prognosis and greater costs to the healthcare system. Our aim, therefore, was to observe destination differences after AMI on the basis of sex and other baseline characteristics. MATERIALS AND METHODS From a cohort of 143 180 claims, we carried out an observational analysis of 6123 Medicare beneficiaries discharged following AMI during the first quarter of 2016. RESULTS For patients who were referred from SNF, the rates of in-hospital death are higher, even after adjustment for baseline characteristics (odds ratio: 1.78, 95% confidence interval: 1.17-2.70). Of those discharged to SNF or home, 36.33% of the female patients were discharged to an SNF versus 25.12% (P<0.01) of the male patients. After adjusting for baseline characteristics, discharge to SNF remained significantly higher among female patients (odds ratio: 1.57, 95% confidence interval: 1.27-1.94). CONCLUSION Discharge to SNF following AMI is more frequent for female patients, even after adjustment for risk factors. Our findings highlight the need to better characterize this unique patient population and understand the cycle of care that they receive following AMI.
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Summary of the Symposium of Sex and Gender in Physiology and Pharmacology Held at the Royal Swedish Academy of Sciences in Stockholm, October 2018. GENDER AND THE GENOME 2019. [DOI: 10.1177/2470289719838097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Kytö V, Prami T, Khanfir H, Hasvold P, Reissell E, Airaksinen J. Usage of PCI and long-term cardiovascular risk in post-myocardial infarction patients: a nationwide registry cohort study from Finland. BMC Cardiovasc Disord 2019; 19:123. [PMID: 31117956 PMCID: PMC6532224 DOI: 10.1186/s12872-019-1101-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Accepted: 05/07/2019] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Despite currently available treatments, the burden of myocardial infarction (MI) morbidity and mortality remains prominent. The aim of this was to investigate the risk of developing subsequent cardiovascular events in MI patients. METHODS This was an observational, retrospective cohort database linkage study using patient level data from Finland. Cox proportional hazards models were used to assess the association of risk between the preselected covariates and incidence of specific outcomes. The primary endpoints were new MI, stroke, cardiovascular mortality and overall mortality. RESULTS Finnish adult MI patients alive 7 days after discharge in 2009-2012 were included. The study cohort consisted of 32,909 MI patients, of whom 25,875 (79%) survived 12 months without subsequent MI or stroke. ST-elevation MI (STEMI) was associated with lower risk of subsequent MI and overall mortality compared to non-STEMI patients. Percutaneous coronary intervention (PCI) was used two times more often in STEMI patients, but patients with prior stroke were more than two times less likely to have PCI. Dementia/Alzheimer's disease decreased the use of PCI as much as age over 85 years. Female sex was an independent factor for not undergoing PCI (OR 0.75, P < 0.001 compared to men) but was nevertheless associated with lower risk of new MI and mortality (HR 0.8-0.9, P < 0.001 for all). Increased age was associated with increased event risk and PCI with decreased event risk. CONCLUSIONS Risk of cardiovascular events and mortality after MI increases steeply with age. Although at higher risk, aging patients and those with cardiovascular comorbidities are less likely to receive PCI after MI. Female sex is associated with better survival after MI regardless of less intensive treatment in women.
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Affiliation(s)
- Ville Kytö
- Turku University Hospital and University of Turku, Heart Center, PO Box 52, 20521 Turku, Finland
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland
| | | | | | - Pål Hasvold
- AstraZeneca Nordic Baltic, Södertälje, Sweden
| | - Eeva Reissell
- National Institute for Health and Welfare, Helsinki, Finland
| | - Juhani Airaksinen
- Turku University Hospital and University of Turku, Heart Center, PO Box 52, 20521 Turku, Finland
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Sriha Belguith A, Beltaief K, Msolli MA, Bouida W, Abroug H, Ben Fredj M, Zemni I, Grissa MH, Boubaker H, Hsairi M, Nouira S. Management of acute coronary syndrome in emergency departments: a cross sectional multicenter study (Tunisia). BMC Emerg Med 2018; 18:50. [PMID: 30509187 PMCID: PMC6276213 DOI: 10.1186/s12873-018-0201-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Accepted: 11/15/2018] [Indexed: 01/25/2023] Open
Abstract
Background We aimed to describe diagnosed acute coronary syndrome (ACS) and its care management and outcomes in emergency departments (EDs) and to determine related cardiovascular risk factors (CVRFs). Methods We conducted a cross sectional multicenter study that included 1173 adults admitted to EDs for acute chest pain (ACP) in 2015 at 14 sites in Tunisia. Data included patients’ baseline characteristics, diagnosis, treatment and output. Results ACS represented 49.7% of non-traumatic chest pain [95% CI: 46.7–52.6]; 74.2% of ACS cases were unstable angina/non-ST-segment-elevation myocardial infarction (UA/NSTEMI). Males represented 67.4% of patients with ACS (p < 0.001). The median age was 60 years (IQR 52–70). Emergency medical service transportation was used in 11.9% of cases. The median duration between chest pain onset and ED arrival was two hours (Inter quartile ranges (IQR) 2–4 h). The age-standardized prevalence rate was 69.9/100,000 PY; the rate was 96.24 in men and 43.7 in women. In the multivariable analysis, CVRFs related to ST segment elevation myocardial infarction were age correlated to sex and active smoking. CVRFs related to UA/NSTEMI were age correlated to sex, familial and personal vascular history and type 2 diabetes. We reported 27 cases of major adverse cardiovascular events (20.0%) in patients with STEMI and 36 in patients with UA/NSTEMI (9.1%). Conclusion Half of the patients consulting EDs with ACP had ACS. Emergency medical service transportation calls were rare. Management delays were acceptable. The risk of developing an UA/NSTEMI was equal to the number of CVRFs + 1. To improve patient outcomes, it is necessary to increase adherence to international management guidelines.
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Affiliation(s)
- Asma Sriha Belguith
- Epidemiology and Preventive Medicine Department, University Hospital of Monastir, Monastir, Tunisia.
| | - Kaouthar Beltaief
- Research Laboratory (LR12SP18), University of Monastir, Monastir, Tunisia
| | | | - Wahid Bouida
- Research Laboratory (LR12SP18), University of Monastir, Monastir, Tunisia
| | - Hela Abroug
- Epidemiology and Preventive Medicine Department, University Hospital of Monastir, Monastir, Tunisia
| | - Manel Ben Fredj
- Epidemiology and Preventive Medicine Department, University Hospital of Monastir, Monastir, Tunisia
| | - Imen Zemni
- Epidemiology and Preventive Medicine Department, University Hospital of Monastir, Monastir, Tunisia
| | | | - Hamdi Boubaker
- Research Laboratory (LR12SP18), University of Monastir, Monastir, Tunisia
| | | | | | - Samir Nouira
- Research Laboratory (LR12SP18), University of Monastir, Monastir, Tunisia
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Ruge T, Carlsson AC, Jansson JH, Söderberg S, Larsson A, Ärnlöv J. The association between circulating endostatin levels and incident myocardial infarction. SCAND CARDIOVASC J 2018; 52:315-319. [PMID: 30474426 DOI: 10.1080/14017431.2018.1547839] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Increased levels of circulating endostatin have been observed in patients with prevalent ischemic heart disease. However, the association between circulating endostatin, and incident myocardial infarction (MI) is less studied. Our main aim was to study the association between circulating endostatin and incident MI in the community adjusted for established cardiovascular risk factors in men and women. DESIGN Circulating endostatin was measured in a nested case control study based on three large community-based Swedish cohorts, including 533 MI cases, and 1003 age-, sex- and cohort-matched controls. Odds ratios (OR) with 95% confidence intervals (CI) were calculated with adjustments for established cardiovascular risk factors. RESULTS Higher endostatin was associated with a higher incidence of MI independently of established cardiovascular risk factors (OR 1.19, 95% CI 1.03-1.37, p = .02), but this association was abolished after additional adjustment for C-reactive protein. Sex-stratified analyses suggest that the association was substantially stronger in women as compared to men. CONCLUSIONS In our community based sample, higher endostatin predicted incident myocardial infarction predominantly in women but not independently of CRP. Thus, our findings do not support a broad utility of endostatin measurements for the prediction of incident myocardial infarction in clinical practice.
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Affiliation(s)
- Toralph Ruge
- a Department of Emergency Medicine , Karolinska University Hospital , Stockholm , Sweden.,b Department of Medicine , Solna, Karolinska Institutet , Stockholm , Sweden
| | - Axel C Carlsson
- c Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society , Karolinska Institutet , Stockholm , Sweden.,d Department of Medical Sciences, Cardiovascular Epidemiology , Uppsala University , Uppsala , Sweden
| | - Jan-Håkan Jansson
- e Department of Public Health and Clinical Medicine, Research unit Skellefteå , Umeå University , Umeå , Sweden
| | - Stefan Söderberg
- f Department of Public Health and Clinical Medicine, Heart Centre , Umeå University , Umeå , Sweden
| | - Anders Larsson
- g Department of Medical Sciences , Uppsala University , Uppsala , Sweden
| | - Johan Ärnlöv
- c Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society , Karolinska Institutet , Stockholm , Sweden.,h School of Health and Social Sciences , Dalarna University , Falun , Sweden
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Abstract
PURPOSE OF REVIEW Sex differences are pervasive in metabolic and cardiovascular traits, yet they have often been ignored in human and animal model research. Sex differences can arise from reversible hormonal effects, from irreversible organizational (developmental) processes, and from gene expression differences from the X and Y chromosomes. We briefly review our current understanding of the impact of these factors in metabolic traits and disorders, with an emphasis on the recent literature. RECENT FINDINGS Novel sex differences continue to be identified for metabolic and cardiovascular traits. For example, it is now clear that gut microbiota tend to differ between men and women, with potentially large implications for disease susceptibility. Also, tissue-specific gene regulation differs between men and women, contributing to differential metabolism. These new insights will open up personalized therapeutic avenues for cardiometabolic diseases. SUMMARY Sex differences in body fat distribution, glucose homeostasis, insulin signaling, ectopic fat accumulation, and lipid metabolism during normal growth and in response to hormonal or nutritional imbalance are mediated partly through sex hormones and the sex chromosome complement. Most of these differences are mediated in a tissue-specific manner. Important future goals are to better understand the interactions between genetic variation and sex differences, and to bring an understanding of sex differences into clinical practice.
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Affiliation(s)
| | | | - Aldons J. Lusis
- Department of Medicine/Division of Cardiology
- Department of Micro-biology, Immunology and Molecular Genetics
- Department of Human Genetics, David Geffen School of Medicine, University of California, Los Angeles, California, USA
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Kerkmeijer LS, Claessen BE, Baber U, Sartori S, Chandrasekhar J, Stefanini GG, Stone GW, Steg PG, Chieffo A, Weisz G, Windecker S, Mikhail GW, Kastrati A, Morice MC, Dangas GD, de Winter RJ, Mehran R. Incidence, determinants and clinical impact of definite stent thrombosis on mortality in women: From the WIN-DES collaborative patient-level pooled analysis. Int J Cardiol 2018; 263:24-28. [DOI: 10.1016/j.ijcard.2018.04.047] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 04/06/2018] [Accepted: 04/10/2018] [Indexed: 11/30/2022]
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Levels of soluble tumor necrosis factor receptor 1 and 2, gender, and risk of myocardial infarction in Northern Sweden. Atherosclerosis 2018; 272:41-46. [DOI: 10.1016/j.atherosclerosis.2018.03.020] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Revised: 01/23/2018] [Accepted: 03/08/2018] [Indexed: 01/29/2023]
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Gender is Not a Predictor of Mortality or Major Adverse Cardiovascular Events in Patients Undergoing Percutaneous Coronary Intervention for Acute Coronary Syndromes. Heart Lung Circ 2018; 28:727-734. [PMID: 29705386 DOI: 10.1016/j.hlc.2018.03.020] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 03/02/2018] [Accepted: 03/20/2018] [Indexed: 11/24/2022]
Abstract
BACKGROUND Historically, studies of percutaneous coronary intervention (PCI) for acute coronary syndrome (ACS) have reported worse outcomes for women. We sought to determine if contemporary PCI techniques eliminate gender differences in PCI outcomes. METHODS This was a retrospective study of 4,776 consecutive patients who underwent PCI for acute coronary syndromes between January 2008 and July 2015. Primary outcomes studied were major adverse cardiovascular events (MACE) and death at 1year. RESULTS Percutaneous coronary intervention success was similar in men and women (97.8% v 97.7%, p=0.76). There was no significant gender difference in the number of vessels attempted (1.14 vs 1.12, p=0.25), mean number of lesions treated (1.34 vs 1.32, p=0.21) or the mean number of stents used (1.32 vs 1.30, p=0.31). There was equivalent use of drug eluting stents (38.2% vs 38.3%, p=0.94). Women with ST-elevation myocardial infarction STEMI had longer median symptom-to-door time (111 vs 90 mins, p=0.0411) but there was no gender difference in door-to-balloon time or symptom-to-balloon time. There was no significant difference in percentages of women and men <75years treated with prasugrel or ticagrelor (11.1% vs 13.4%, p=0.092). Unadjusted 1-year mortality was 6.4% for women and 4% for men (p=0.0012), but on multivariate analysis, female sex was not a predictor of death. There was no significant gender difference in the overall incidence of unadjusted 1-year MACE (11.6% vs 10.8%, p=0.434). CONCLUSIONS When contemporary PCI techniques are applied equally to men and women with ACS there is no gender difference in mortality or MACE at 1year.
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Kitakata H, Kohno T, Kohsaka S, Fujino J, Nakano N, Fukuoka R, Yuasa S, Maekawa Y, Fukuda K. Patient confidence regarding secondary lifestyle modification and knowledge of 'heart attack' symptoms following percutaneous revascularisation in Japan: a cross-sectional study. BMJ Open 2018; 8:e019119. [PMID: 29549203 PMCID: PMC5857652 DOI: 10.1136/bmjopen-2017-019119] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To assess patient perspectives on secondary lifestyle modification and knowledge of 'heart attack' after percutaneous coronary intervention (PCI) for coronary artery disease (CAD). DESIGN Observational cross-sectional study. SETTING A single university-based hospital centre in Japan. PARTICIPANTS In total, 236 consecutive patients with CAD who underwent PCI completed a questionnaire (age, 67.4±10.1 years; women, 14.8%; elective PCI, 75.4%). The survey questionnaire included questions related to confidence levels about (1) lifestyle modification at the time of discharge and (2) appropriate recognition of heart attack symptoms and reactions to these symptoms on a four-point Likert scale (1=not confident to 4=completely confident). PRIMARY OUTCOME MEASURE The primary outcome assessed was the patients' confidence level regarding lifestyle modification and the recognition of heart attack symptoms. RESULTS Overall, patients had a high level of confidence (confident or completely confident,>75%) about smoking cessation, alcohol restriction and medication adherence. However, they had a relatively low level of confidence (<50%) about the maintenance of blood pressure control, healthy diet, body weight and routine exercise (≥3 times/week). After adjustment, male sex (OR 3.61, 95% CI 1.11 to 11.8) and lower educational level (OR 3.25; 95% CI 1.70 to 6.23) were identified as factors associated with lower confidence levels. In terms of confidence in the recognition of heart attack, almost all respondents answered 'yes' to the item 'I should go to the hospital as soon as possible when I have a heart attack'; however, only 28% of the responders were confident in their ability to distinguish between heart attack symptoms and other conditions. CONCLUSIONS There were substantial disparities in the confidence levels associated with lifestyle modification and recognition/response to heart attack. These gaps need to be studied further and disseminated to improve cardiovascular care.
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Affiliation(s)
- Hiroki Kitakata
- Division of Cardiology, Department of Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Takashi Kohno
- Division of Cardiology, Department of Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Shun Kohsaka
- Division of Cardiology, Department of Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Junko Fujino
- Division of Cardiology, Department of Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Naomi Nakano
- Division of Cardiology, Department of Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Ryoma Fukuoka
- Division of Cardiology, Department of Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Shinsuke Yuasa
- Division of Cardiology, Department of Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Yuichiro Maekawa
- Division of Cardiology, Department of Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Keiichi Fukuda
- Division of Cardiology, Department of Medicine, Keio University School of Medicine, Tokyo, Japan
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Schlögl M, Hofmänner D, Manka R, Keller DI. A foreign older diabetic woman with an acute myocardial infarction: when cognitive biases in clinical decision-making become especially important. BMJ Case Rep 2018; 2018:bcr-2017-223135. [PMID: 29437739 DOI: 10.1136/bcr-2017-223135] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
We present a case of an 80-year-old Turkish female patient with diabetes who suffered an acute myocardial infarction (AMI) and underwent percutaneous coronary balloon angioplasty (PTCA)/stenting. Due to new ischaemic episodes, a second PTCA/stenting had to be preformed 6 days later, which revealed a partial restent thrombosis. This case report raises several important issues. First, language problems are an important barrier for safety and quality in healthcare. Second, gender, ethnicity and age differences in patients with AMI need to be considered in order to eliminate inequities in clinical practice. Third, strategies to raise the awareness of cognitive biases as well as professional training about critical thinking and decision-making skills are needed.
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Affiliation(s)
- Mathias Schlögl
- Department of Geriatrics and Aging Research, University Hospital Zurich, Zurich, Switzerland.,Emergency Department, University Hospital Zurich, Zurich, Switzerland
| | - Daniel Hofmänner
- Emergency Department, University Hospital Zurich, Zurich, Switzerland
| | - Robert Manka
- University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Dagmar I Keller
- Emergency Department, University Hospital Zurich, Zurich, Switzerland
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Robinet P, Milewicz DM, Cassis LA, Leeper NJ, Lu HS, Smith JD. Consideration of Sex Differences in Design and Reporting of Experimental Arterial Pathology Studies-Statement From ATVB Council. Arterioscler Thromb Vasc Biol 2018; 38:292-303. [PMID: 29301789 DOI: 10.1161/atvbaha.117.309524] [Citation(s) in RCA: 197] [Impact Index Per Article: 32.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Accepted: 12/20/2017] [Indexed: 12/15/2022]
Abstract
There are many differences in arterial diseases between men and women, including prevalence, clinical manifestations, treatments, and prognosis. The new policy of the National Institutes of Health, which requires the inclusion of sex as a biological variable for preclinical studies, aims to foster new mechanistic insights and to enhance our understanding of sex differences in human diseases. The purpose of this statement is to suggest guidelines for designing and reporting sex as a biological variable in animal models of atherosclerosis, thoracic and abdominal aortic aneurysms, and peripheral arterial disease. We briefly review sex differences of these human diseases and their animal models, followed by suggestions on experimental design and reporting of animal studies for these vascular pathologies.
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Affiliation(s)
- Peggy Robinet
- From the Department of Cellular and Molecular Medicine, Cleveland Clinic, OH (P.R., J.D.S.); Division of Medical Genetics, Department of Internal Medicine, McGovern Medical School, University of Texas Health Science Center at Houston (D.M.M.); Department of Pharmacology and Nutritional Sciences (L.A.C.) and Saha Cardiovascular Research Center and Department of Physiology (H.S.L.), University of Kentucky, Lexington; and Division of Vascular Surgery, Department of Surgery, Stanford University, CA (N.J.L.)
| | - Dianna M Milewicz
- From the Department of Cellular and Molecular Medicine, Cleveland Clinic, OH (P.R., J.D.S.); Division of Medical Genetics, Department of Internal Medicine, McGovern Medical School, University of Texas Health Science Center at Houston (D.M.M.); Department of Pharmacology and Nutritional Sciences (L.A.C.) and Saha Cardiovascular Research Center and Department of Physiology (H.S.L.), University of Kentucky, Lexington; and Division of Vascular Surgery, Department of Surgery, Stanford University, CA (N.J.L.)
| | - Lisa A Cassis
- From the Department of Cellular and Molecular Medicine, Cleveland Clinic, OH (P.R., J.D.S.); Division of Medical Genetics, Department of Internal Medicine, McGovern Medical School, University of Texas Health Science Center at Houston (D.M.M.); Department of Pharmacology and Nutritional Sciences (L.A.C.) and Saha Cardiovascular Research Center and Department of Physiology (H.S.L.), University of Kentucky, Lexington; and Division of Vascular Surgery, Department of Surgery, Stanford University, CA (N.J.L.)
| | - Nicholas J Leeper
- From the Department of Cellular and Molecular Medicine, Cleveland Clinic, OH (P.R., J.D.S.); Division of Medical Genetics, Department of Internal Medicine, McGovern Medical School, University of Texas Health Science Center at Houston (D.M.M.); Department of Pharmacology and Nutritional Sciences (L.A.C.) and Saha Cardiovascular Research Center and Department of Physiology (H.S.L.), University of Kentucky, Lexington; and Division of Vascular Surgery, Department of Surgery, Stanford University, CA (N.J.L.)
| | - Hong S Lu
- From the Department of Cellular and Molecular Medicine, Cleveland Clinic, OH (P.R., J.D.S.); Division of Medical Genetics, Department of Internal Medicine, McGovern Medical School, University of Texas Health Science Center at Houston (D.M.M.); Department of Pharmacology and Nutritional Sciences (L.A.C.) and Saha Cardiovascular Research Center and Department of Physiology (H.S.L.), University of Kentucky, Lexington; and Division of Vascular Surgery, Department of Surgery, Stanford University, CA (N.J.L.)
| | - Jonathan D Smith
- From the Department of Cellular and Molecular Medicine, Cleveland Clinic, OH (P.R., J.D.S.); Division of Medical Genetics, Department of Internal Medicine, McGovern Medical School, University of Texas Health Science Center at Houston (D.M.M.); Department of Pharmacology and Nutritional Sciences (L.A.C.) and Saha Cardiovascular Research Center and Department of Physiology (H.S.L.), University of Kentucky, Lexington; and Division of Vascular Surgery, Department of Surgery, Stanford University, CA (N.J.L.).
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46
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Knol RJJ, Kan H, Wondergem M, Cornel JH, Umans VAWM, van der Ploeg T, van der Zant FM. Exercise Electrocardiogram Neither Predicts Nor Excludes Coronary Artery Disease in Women with Low to Intermediate Risk. J Womens Health (Larchmt) 2018; 27:476-484. [PMID: 29297745 DOI: 10.1089/jwh.2017.6433] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
AIM The value of exercise electrocardiogram (ExECG) in symptomatic female patients with low to intermediate risk for significant coronary artery disease (CAD) has been under debate for many years, and nondiagnostic or even erroneous test results are frequently encountered. Cardiac-CT may be more appropriate to exclude CAD in women. This study compares the results of ExECGs with those of cardiac-CTs, performed within a time frame of 1 month in an all-comers female chest pain population. PATIENTS AND METHODS Five hundred fifty-one consecutive female patients from a patient registry were included. ExECGs were negative in 324 (59%), positive in 14 (3%), and nondiagnostic in 213 (39%) patients. CAD was revealed by cardiac-CT in 57% of the women with negative ExECG. No signs of CAD were present on cardiac-CT in 64% of the women with a positive ExECG. Cardiac-CT showed presence of CAD in 268/551 (49%) patients, of whom 56/268 (21%) was diagnosed with ≥50% stenosis. The ExECG of the latter group was negative in 26 (46%), inconclusive in 29 (52%), and positive in 1 (2%). Considering ≥50% stenosis at cardiac-CT as the reference, sensitivity, specificity, PPV, and NPV of ExECG for the present population were 3.7%, 95.7%, 7.1%, and 91.7%, respectively. Similar diagnostic performance was calculated when considering ≥70% stenosis at cardiac-CT as the reference. CONCLUSION ExECG failed to detect CAD in more than half of this cohort and in almost half of women with >50% stenosis at cardiac-CT. Importantly, no CAD was detected by cardiac-CT in 64% of women with a positive ExECG. ExECG is therefore questionable as a diagnostic strategy in women with low-to-intermediate risk of CAD, although prospective studies are warranted to determine whether replacing ExECG by cardiac-CT provides better prognoses.
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Affiliation(s)
- Remco J J Knol
- 1 Cardiac Imaging Division Alkmaar, Northwest Clinics , Alkmaar, The Netherlands .,2 Department of Nuclear Medicine, Northwest Clinics , Alkmaar, The Netherlands
| | - Huub Kan
- 1 Cardiac Imaging Division Alkmaar, Northwest Clinics , Alkmaar, The Netherlands .,2 Department of Nuclear Medicine, Northwest Clinics , Alkmaar, The Netherlands
| | - Maurits Wondergem
- 1 Cardiac Imaging Division Alkmaar, Northwest Clinics , Alkmaar, The Netherlands .,2 Department of Nuclear Medicine, Northwest Clinics , Alkmaar, The Netherlands
| | - Jan H Cornel
- 1 Cardiac Imaging Division Alkmaar, Northwest Clinics , Alkmaar, The Netherlands .,3 Department of Cardiology, Northwest Clinics , Alkmaar, The Netherlands
| | - Victor A W M Umans
- 1 Cardiac Imaging Division Alkmaar, Northwest Clinics , Alkmaar, The Netherlands .,3 Department of Cardiology, Northwest Clinics , Alkmaar, The Netherlands
| | - Tjeerd van der Ploeg
- 4 Department of Statistics and Clinical Epidemiology, Northwest Clinics , Alkmaar, The Netherlands
| | - Friso M van der Zant
- 1 Cardiac Imaging Division Alkmaar, Northwest Clinics , Alkmaar, The Netherlands .,2 Department of Nuclear Medicine, Northwest Clinics , Alkmaar, The Netherlands
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47
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Whyte EM, Scherf KS. Gaze Following is Related to the Broader Autism Phenotype in a Sex-Specific Way: Building the Case for Distinct Male and Female Autism Phenotypes. Clin Psychol Sci 2017; 6:280-287. [PMID: 29576931 DOI: 10.1177/2167702617738380] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
The search for a female autism phenotype is difficult, given the low diagnostic rates in females. Here, we studied potential sex differences in a core feature of autism, difficulty with eye gaze processing, among typically developing individuals who vary in the broad autism phenotype, which includes autistic-like traits that are common, continuously distributed, and similarly heritable in males and females. Participants viewed complex images of an actor in a naturalistic scene looking at one of many possible objects and had to identify the target gazed-at object. Among males, those high in autistic-like traits exhibited worse eye gaze following performance than did those low in these traits. Among females, eye gaze following behavior did not vary with autistic-like traits. These results suggest that deficient eye gaze following behavior is part of the broader autism phenotype for males, but may not be a part of the female autism phenotype.
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Affiliation(s)
| | - K Suzanne Scherf
- Dept. of Psychology, Pennsylvania State University.,Dept. of Neuroscience, Pennsylvania State University
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48
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Hubbard RT, Arciniegas Calle MC, Barros-Gomes S, Kukuzke JA, Pellikka PA, Gulati R, Villarraga HR. 2-Dimensional Speckle Tracking Echocardiography predicts severe coronary artery disease in women with normal left ventricular function: a case-control study. BMC Cardiovasc Disord 2017; 17:231. [PMID: 28836949 PMCID: PMC5571591 DOI: 10.1186/s12872-017-0656-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Accepted: 08/03/2017] [Indexed: 02/07/2023] Open
Abstract
Background Women who have coronary artery disease (CAD) often present with atypical symptoms that may lead to misdiagnosis. We assessed strain, systolic strain rate and left ventricular dyssynchrony with 2- dimensional- speckle tracking echocardiography to evaluate its use as a non-invasive method for detecting CAD in women with normal ejection fraction compared with healthy women controls with a normal angiogram. Methods We included 35 women with CAD confirmed by coronary angiography and a positive exercise stress echocardiography and 35 women in a control group with a low pretest probability of CAD, normal angiogram and a normal stress echocardiography with normal EF. Results Statistically significant 2D-STE findings for the CAD vs control groups were as follows for the mean of: global circumferential strain (CS) (−19.4% vs −22.4%, P = .02); global radial S (49% vs 34%, P = .03); global radial SR (2.4 s−1 vs 1.9 s−1, P = .05); global longitudinal LV S (GLS) (−14.3% vs −17.2%, P < .001). For mechanical dyssynchrony, SD of the GLS time-to-peak (TTP) was computed (99 vs 33 ms, P < .001). The receiver operating characteristic and area under the curve (AUC) were calculated. A cutoff value of 45 ms for 1 SD of the longitudinal S TTP had 97% sensitivity and 89% specificity (AUC, 0.96). GLS cutoff value of −15.87% had 71% sensitivity and 74% specificity; AUC, 0.74 in differentiating CAD and control groups. The combined GLS, CS, and SD of the longitudinal S TTP had an AUC of 0.96 (sensitivity 97%, specificity 86%). Interclass correlations of the GLS segment and GLS TTP measurements were 0.49 (95% CI, 0.227-0.868) and 0.74 (95% CI, 0.277-0.926), respectively. Conclusion In women with a normal echocardiogram and LVEF, CAD can be identified by dyssynchrony and abnormal strain values, as evidenced by 2D-STE.
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Affiliation(s)
- Ryan T Hubbard
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN, USA
| | | | - Sergio Barros-Gomes
- Department of Cardiovascular Diseases, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
| | - Joyce A Kukuzke
- Department of Orthopedic Research, Mayo Clinic, Rochester, MN, USA
| | - Patricia A Pellikka
- Department of Cardiovascular Diseases, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
| | - Rajiv Gulati
- Department of Cardiovascular Diseases, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
| | - Hector R Villarraga
- Department of Cardiovascular Diseases, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA.
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49
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Chronic Subdural Hematoma in Women. World Neurosurg 2017; 105:47-52. [PMID: 28559067 DOI: 10.1016/j.wneu.2017.05.105] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Revised: 05/17/2017] [Accepted: 05/18/2017] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Sex differences in various diseases recently have been recognized as an important factor in the approach to more efficient preventive and therapeutic medicine. We clarified sex differences in the clinical characteristics of chronic subdural hematoma (CSDH) by comparing men and women with CSDH, as there is a well-known male predominance in the prevalence of CSDH. METHODS Clinical factors and computed tomography findings were investigated retrospectively in 490 consecutive patients admitted to our hospital between 2006 and 2015 who were diagnosed with CSDH. RESULTS On univariate analysis, women were significantly older than men (P < 0.05). In women, premorbid impaired activities of daily living, consciousness disturbance, acute-to-chronic subdural hematoma, and death as outcomes at discharge were significantly more frequent than in men (P < 0.05). In contrast, women had less frequent instances of good recovery and less alcohol intake (P < 0.05). Multivariate analysis demonstrated female sex as an independent predictor of consciousness disturbance at admission. Female sex also was identified as a predictor of death at discharge. CONCLUSIONS We demonstrated sex differences in the clinical characteristics of CSDH. In the future, management of patients with CSDH with regard to sex differences in disease characteristics could be expected to improve the outcomes of women, which have been worse than in men.
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50
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Scott G, Clawson JJ, Gardett I, Broadbent M, Williams N, Fivaz C, Marshall G, Barron T, Olola C. 9-1-1 Triage of Non-Traumatic Chest Pain: Association with Hospital Diagnosis. PREHOSP EMERG CARE 2017; 21:525-534. [PMID: 28409655 DOI: 10.1080/10903127.2017.1302530] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Chest pain is one of the most common reasons people seek emergency care-and one of the most critical. In the United States, chest pain is the second most common reason for emergency department (ED) visits. A patient's primary complaint of "chest pain" may reflect a broad range of underlying causes; therefore, it is important that emergency medical service (EMS) agencies gain a thorough understanding of these cases, beginning with the initial management of chest pain in the 9-1-1 center. The primary objective of this study was to compare hospital-confirmed patient discharge diagnoses to all calls handled by emergency medical dispatchers (EMDs) using the Chest Pain/Chest Discomfort (Non-Traumatic) Chief Complaint Protocol. METHODS The retrospective descriptive study utilized emergency medical dispatch, EMS, and hospital datasets, collected at two emergency communication centers in North America, from January 1, 2013 to December 31, 2014. Patients who were dispatched using the Chest Pain/Chest Discomfort Chief Complaint Protocol and matched to hospital datasets were included. The primary outcome was the number and percentage of cases classified as ischemic heart disease (IHD), other cardiac-related conditions, or non-cardiac-related conditions associated with chest pain. We also evaluated the distribution of causes of chest pain across demographic indicators and dispatch determinants. RESULTS 3,007 cases were identified as "chest pain" at dispatch for which corresponding hospital records were identified. Cases in the study were obtained by linking EMS/Hospital and Emergency Medical Dispatch datasets. Of these cases, 47.1% (n = 1,417) were due to cardiac-related causes of chest pain, 61.5% of which were Ischemic Heart Disease (IHD), while the rest had other cardiac-related causes. Of the IHDs, 32.1% were Acute Myocardial Infarction (AMI). CONCLUSIONS Underlying causes of non-traumatic chest pain reported to 9-1-1 demonstrate a wide range of etiologies, with a mix similar to that of chest pain patients in several other healthcare settings, including hospital emergency departments. Most IHD events are triaged by EMDs to the (highest) DELTA priority level, while the CHARLIE level captures nearly all of the remaining IHD cases.
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