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Hu Y, Liang L, Liu S, Kung JY, Banh HL. Angiotensin-converting enzyme inhibitor induced cough compared with placebo, and other antihypertensives: A systematic review, and network meta-analysis. J Clin Hypertens (Greenwich) 2023; 25:661-688. [PMID: 37417783 PMCID: PMC10423763 DOI: 10.1111/jch.14695] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 06/21/2023] [Accepted: 06/22/2023] [Indexed: 07/08/2023]
Abstract
Studies have shown that angiotensin converting enzyme inhibitors (ACEIs) are superior in primary and secondary prevention for cardiac mortality and morbidity to angiotensin receptor blocker (ARBs). One of the common side effects from ACEI is dry cough. The aims of this systematic review, and network meta-analysis are to rank the risk of cough induced by different ACEIs and between ACEI and placebo, ARB or calcium channel blockers (CCB). We performed a systematic review, and network meta-analysis of randomized controlled trials to rank the risk of cough induced by each ACEI and between ACEI and placebo, ARB or CCB. A total of 135 RCTs with 45,420 patients treated with eleven ACEIs were included in the analyses. The pooled estimated relative risk (RR) between ACEI and placebo was 2.21 (95% CI: 2.05-2.39). ACEI had more incidences of cough than ARB (RR 3.2; 95% CI: 2.91, 3.51), and pooled estimated of RR between ACEI and CCB was 5.30 (95% CI: 4.32-6.50) Moexipril ranked as number one for inducing cough (SUCRA 80.4%) and spirapril ranked the least (SUCRA 12.3%). The order for the rest of the ACEIs are as follows: ramipril (SUCRA 76.4%), fosinopril (SUCRA 72.5%), lisinopril (SUCRA 64.7%), benazepril (SUCRA 58.6%), quinapril (SUCRA 56.5%), perindopril (SUCRA 54.1%), enalapril (SUCRA 49.7%), trandolapril (SUCRA 44.6%) and, captopril (SUCRA 13.7%). All ACEI has the similar risk of developing a cough. ACEI should be avoided in patients who have risk of developing cough, and an ARB or CCB is an alternative based on the patient's comorbidity.
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Affiliation(s)
- Yiyun Hu
- Department of PharmacySecond Xiangya Hospital of Central South UniversityChangshaChina
| | - Ling Liang
- Department of CardiologyThe Third Clinical Medical College, Fujian Medical UniversityFuzhouChina
- Department of CardiologyThe First Affiliated Hospital of Xiamen UniversityXiamenChina
| | - Shuang Liu
- Medical Affairs Management DepartmentSecond Xiangya Hospital of Central South UniversityChangshaChina
| | - Janice Y. Kung
- University of Alberta, John W. Scott Health Sciences LibraryEdmontonCanada
| | - Hoan Linh Banh
- Faculty of Medicine and DentistryDepartment of Family MedicineUniversity of AlbertaEdmontonCanada
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Uzel R, Bruno RR, Jung C, Lang C, Hoi H, Grünbart M, Datz C, Hoppichler F, Wernly B. Clinical Impact of ACE-I/ARB for Conservatively Treated Patients with Moderate to Severe Mitral Regurgitation: A Single Center Observational Study. J Cardiovasc Dev Dis 2023; 10:177. [PMID: 37103056 PMCID: PMC10142284 DOI: 10.3390/jcdd10040177] [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: 02/06/2023] [Revised: 04/15/2023] [Accepted: 04/17/2023] [Indexed: 04/28/2023] Open
Abstract
(1) Background: Mitral regurgitation (MR) is associated with increased mortality and frequent hospital admissions. Although mitral valve intervention offers improved clinical outcomes for MR, it is not feasible in many cases. Moreover, conservative therapeutic opportunities remain limited. The aim of this study was to evaluate the impact of ACE inhibitors and angiotensin receptor blockers (ACE-I/ARB) on elderly patients with moderate-to-severe MR and mildly reduced to preserved ejection fraction. (2) Methods: In total, 176 patients were included in our hypothesis-generating, single-center observational study. Hospitalization for heart failure and all-cause death have been defined as the combined 1-year primary endpoint. (3) Results: Patients treated with ACE-I/ARB showed a lower risk for the combined endpoint of death and heart failure-related readmission (HR 0.52 95%CI 0.27-0.99; p = 0.046), even after adjustment for EUROScoreII and frailty (HR 0.52 95%CI 0.27-0.99; p = 0.049) (4) Conclusions: The use of an ACE-I/ARB in patients with moderate-to-severe MR and preserved to mildly reduced left-ventricular ejection fraction (LVEF) significantly associates with improved clinical outcome and might be indicated as a valuable therapeutic option in conservatively treated patients.
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Affiliation(s)
- Robert Uzel
- Department of Internal Medicine, Saint John of God Hospital, Teaching Hospital of the Paracelsus Medical Private University, Kajetanerplatz 1, 5020 Salzburg, Austria
- Department of Cardiology, Klinik Floridsdorf, Brünner Straße 68, 1210 Vienna, Austria
| | - Raphael R. Bruno
- Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine-University Duesseldorf, Moorenstraße 5, 40225 Duesseldorf, Germany
| | - Christian Jung
- Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine-University Duesseldorf, Moorenstraße 5, 40225 Duesseldorf, Germany
| | - Christian Lang
- Department of Pulmonology, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Hannes Hoi
- Department of Surgery, Saint John of God Hospital, Teaching Hospital of the Paracelsus Medical Private University, Kajetanerplatz 1, 5020 Salzburg, Austria
| | - Martin Grünbart
- Department of Surgery, Saint John of God Hospital, Teaching Hospital of the Paracelsus Medical Private University, Kajetanerplatz 1, 5020 Salzburg, Austria
| | - Christian Datz
- Department of Internal Medicine, General Hospital Oberndorf, Teaching Hospital of the Paracelsus Medical Private University, Paracelsusstraße 37, 5110 Oberndorf, Austria
| | - Friedrich Hoppichler
- Department of Internal Medicine, Saint John of God Hospital, Teaching Hospital of the Paracelsus Medical Private University, Kajetanerplatz 1, 5020 Salzburg, Austria
- Special Institute for Preventive Cardiology and Nutrition, SIPCAN—Initiative für ein gesundes Leben, 5020 Salzburg, Austria
| | - Bernhard Wernly
- Department of Internal Medicine, General Hospital Oberndorf, Teaching Hospital of the Paracelsus Medical Private University, Paracelsusstraße 37, 5110 Oberndorf, Austria
- Institute of General Practice, Family Medicine and Preventive Medicine, Paracelsus Medical University, Strubergasse 21, 5020 Salzburg, Austria
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Rheumatic Heart Disease: JACC Focus Seminar 2/4. J Am Coll Cardiol 2023; 81:81-94. [PMID: 36599614 DOI: 10.1016/j.jacc.2022.09.050] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 08/11/2022] [Accepted: 09/13/2022] [Indexed: 01/04/2023]
Abstract
It is a sad reality that although eminently preventable, and despite possessing such knowledge for >70 years, rheumatic heart disease (RHD) remains the most common cause of cardiovascular morbidity and early mortality in young people worldwide. A disease of the poor, RHD is one of the most neglected diseases. Several challenges are unique to the acute rheumatic fever/RHD continuum and contribute to its persistence, including its sequestration among the poorest, its protracted natural history, the erratic availability of penicillin, and the lack of a concerted effort in endemic regions. However, there is cause for optimism following a resurgence in scientific interest over the last 15 years. This review presents the latest advancements in epidemiology, diagnosis, and management. It also discusses pressing research questions on disease pathophysiology, the barriers to implementation of effective management strategies, and pragmatic policy solutions required for translation of current knowledge into meaningful action.
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Kumar RK, Antunes MJ, Beaton A, Mirabel M, Nkomo VT, Okello E, Regmi PR, Reményi B, Sliwa-Hähnle K, Zühlke LJ, Sable C. Contemporary Diagnosis and Management of Rheumatic Heart Disease: Implications for Closing the Gap: A Scientific Statement From the American Heart Association. Circulation 2020; 142:e337-e357. [PMID: 33073615 DOI: 10.1161/cir.0000000000000921] [Citation(s) in RCA: 68] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The global burden of rheumatic heart disease continues to be significant although it is largely limited to poor and marginalized populations. In most endemic regions, affected patients present with heart failure. This statement will seek to examine the current state-of-the-art recommendations and to identify gaps in diagnosis and treatment globally that can inform strategies for reducing disease burden. Echocardiography screening based on World Heart Federation echocardiographic criteria holds promise to identify patients earlier, when prophylaxis is more likely to be effective; however, several important questions need to be answered before this can translate into public policy. Population-based registries effectively enable optimal care and secondary penicillin prophylaxis within available resources. Benzathine penicillin injections remain the cornerstone of secondary prevention. Challenges with penicillin procurement and concern with adverse reactions in patients with advanced disease remain important issues. Heart failure management, prevention, early diagnosis and treatment of endocarditis, oral anticoagulation for atrial fibrillation, and prosthetic valves are vital therapeutic adjuncts. Management of health of women with unoperated and operated rheumatic heart disease before, during, and after pregnancy is a significant challenge that requires a multidisciplinary team effort. Patients with isolated mitral stenosis often benefit from percutaneous balloon mitral valvuloplasty. Timely heart valve surgery can mitigate the progression to heart failure, disability, and death. Valve repair is preferable over replacement for rheumatic mitral regurgitation but is not available to the vast majority of patients in endemic regions. This body of work forms a foundation on which a companion document on advocacy for rheumatic heart disease has been developed. Ultimately, the combination of expanded treatment options, research, and advocacy built on existing knowledge and science provides the best opportunity to address the burden of rheumatic heart disease.
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Abstract
Rheumatic heart disease (RHD) remains the most common cause of cardiovascular morbidity and mortality globally in children and young adults. This article focuses on prevention and management of RHD. Pregnancy can unmask previously undiagnosed RHD and poses high risk for mother and fetus. Management of anticoagulation is important. Definitive catheter and surgical intervention are the only treatments that can improve outcomes of patients with moderate or severe RHD. Access to intervention remains very limited in RHD endemic regions. There are ongoing global efforts to increase awareness, public policy adoption, and greater access to treatment.
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Affiliation(s)
- Craig Sable
- Cardiology, Children's National Hospital, 111 Michigan Avenue, Northwest, Washington, DC 20010, USA.
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Porro B, Songia P, Myasoedova VA, Valerio V, Moschetta D, Gripari P, Fusini L, Cavallotti L, Canzano P, Turnu L, Alamanni F, Camera M, Cavalca V, Poggio P. Endothelial Dysfunction in Patients with Severe Mitral Regurgitation. J Clin Med 2019; 8:jcm8060835. [PMID: 31212807 PMCID: PMC6616454 DOI: 10.3390/jcm8060835] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 06/07/2019] [Accepted: 06/10/2019] [Indexed: 01/05/2023] Open
Abstract
Mitral valve prolapse (MVP) is the most common cause of severe mitral regurgitation. It has been reported that MVP patients—candidates for mitral valve repair (MVRep)—showed an alteration in the antioxidant defense systems as well as in the L-arginine metabolic pathway. In this study, we investigate if oxidative stress and endothelial dysfunction are an MVP consequence or driving factors. Forty-five patients undergoing MVRep were evaluated before and 6 months post surgery and compared to 29 controls. Oxidized (GSSG) and reduced (GSH) forms of glutathione, and L-arginine metabolic pathway were analyzed using liquid chromatography-tandem mass spectrometry methods while osteoprotegerin (OPG) through the ELISA kit and circulating endothelial microparticles (EMP) by flow cytometry. Six-month post surgery, in MVP patients, the GSSG/GSH ratio decreased while symmetric and asymmetric dimethylarginines levels remained comparable to the baseline. Conversely, OPG levels significantly increased when compared to their baseline. Finally, pre-MVRep EMP levels were significantly higher in patients than in controls and did not change post surgery. Overall, these results highlight that MVRep completely restores the increased oxidative stress levels, as evidenced in MVP patients. Conversely, no amelioration of endothelial dysfunction was evidenced after surgery. Thus, therapies aimed to restore a proper endothelial function before and after surgical repair could benefit MVP patients.
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Affiliation(s)
- Benedetta Porro
- Centro Cardiologico Monzino, I.R.C.C.S., 20138 Milan, Italy.
| | - Paola Songia
- Centro Cardiologico Monzino, I.R.C.C.S., 20138 Milan, Italy.
| | | | - Vincenza Valerio
- Centro Cardiologico Monzino, I.R.C.C.S., 20138 Milan, Italy.
- Dipartimento di Medicina Clinica e Chirurgia, Università degli Studi di Napoli Federico II, 80138 Naples, Italy.
| | | | - Paola Gripari
- Centro Cardiologico Monzino, I.R.C.C.S., 20138 Milan, Italy.
| | - Laura Fusini
- Centro Cardiologico Monzino, I.R.C.C.S., 20138 Milan, Italy.
| | | | - Paola Canzano
- Centro Cardiologico Monzino, I.R.C.C.S., 20138 Milan, Italy.
| | - Linda Turnu
- Centro Cardiologico Monzino, I.R.C.C.S., 20138 Milan, Italy.
| | | | - Marina Camera
- Centro Cardiologico Monzino, I.R.C.C.S., 20138 Milan, Italy.
- Department of Pharmacological and Biomolecular Sciences, Università degli Studi di Milano, 20133 Milan, Italy.
| | - Viviana Cavalca
- Centro Cardiologico Monzino, I.R.C.C.S., 20138 Milan, Italy.
| | - Paolo Poggio
- Centro Cardiologico Monzino, I.R.C.C.S., 20138 Milan, Italy.
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Feitosa-Filho GS, Peixoto JM, Pinheiro JES, Afiune Neto A, Albuquerque ALTD, Cattani ÁC, Nussbacher A, Camarano AA, Sichinels AH, Sousa ACS, de Alencar Filho AC, Gravina CF, Sobral Filho DC, Pitthan E, Costa EFDA, Duarte EDR, Freitas EVD, Moriguchi EH, Mesquita ET, Fernandes F, Fuchs FC, Feitosa GS, Pierre H, Pereira Filho I, Helber I, Borges JL, Garcia JMDA, Souza JAGD, Zanon JCDC, Alves JDC, Mohallem KL, Chaves LMDSM, Moura LAZ, Silva MCAD, Toledo MADV, Assunção MELSDM, Wajngarten M, Gonçalves MJO, Lopes NHM, Rodrigues NL, Toscano PRP, Rousseff P, Maia RAR, Franken RA, Miranda RD, Gamarski R, Rosa RF, Santos SCDM, Galera SC, Grespan SMDS, Silva TCRD, Esteves WADM. Updated Geriatric Cardiology Guidelines of the Brazilian Society of Cardiology - 2019. Arq Bras Cardiol 2019; 112:649-705. [PMID: 31188969 PMCID: PMC6555565 DOI: 10.5935/abc.20190086] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Affiliation(s)
| | - José Maria Peixoto
- Universidade José do Rosário Vellano (UNIFENAS), Belo Horizonte, MG - Brazil
| | | | - Abrahão Afiune Neto
- Universidade Federal de Goiás (UFG), Goiânia, GO - Brazil
- UniEVANGÉLICA, Anápolis, GO - Brazil
| | | | | | | | | | | | | | | | | | - Dario Celestino Sobral Filho
- Universidade de Pernambuco (UPE), Recife, PE - Brazil
- Pronto-Socorro Cardiológico Universitário de Pernambuco (PROCAPE), Recife, PE - Brazil
| | - Eduardo Pitthan
- Universidade Federal da Fronteira Sul (UFFS), Chapecó, SC - Brazil
| | - Elisa Franco de Assis Costa
- Sociedade Brasileira de Geriatria e Gerontologia (SBGG), Rio de Janeiro, RJ - Brazil
- Universidade Federal de Goiás (UFG), Goiânia, GO - Brazil
| | | | | | | | | | - Fábio Fernandes
- Instituto do Coração (Incor) da Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP - Brazil
- Departamento de Insuficiência Cardíaca (DEIC) da Sociedade Brasileira de Cardiologia (SBC), Rio de Janeiro, RJ - Brazil
| | - Felipe Costa Fuchs
- Universidade Federal do Rio Grande do Sul (UFRS), Porto Alegre, RS - Brazil
| | | | - Humberto Pierre
- Universidade Federal de São Paulo (UNIFESP), São Paulo, SP - Brazil
| | | | - Izo Helber
- Universidade Federal de São Paulo (UNIFESP), São Paulo, SP - Brazil
| | | | | | | | | | | | | | | | | | - Márcia Cristina Amélia da Silva
- Universidade de Pernambuco (UPE), Recife, PE - Brazil
- Pronto-Socorro Cardiológico Universitário de Pernambuco (PROCAPE), Recife, PE - Brazil
| | | | | | | | | | - Neuza Helena Moreira Lopes
- Instituto do Coração (Incor) da Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP - Brazil
| | | | | | | | | | | | | | - Roberto Gamarski
- Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ - Brazil
| | | | | | | | | | | | - William Antonio de Magalhães Esteves
- Hospital Vera Cruz, Belo Horizonte, MG - Brazil
- Hospital das Clínicas da Universidade Federal de Minas Gerais, Belo Horizonte, MG - Brazil
- Universidade de Itaúna, Itaúna, MG - Brazil
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Katsi V, Georgiopoulos G, Magkas N, Oikonomou D, Virdis A, Nihoyannopoulos P, Toutouzas K, Tousoulis D. The Role of Arterial Hypertension in Mitral Valve Regurgitation. Curr Hypertens Rep 2019; 21:20. [PMID: 30820680 DOI: 10.1007/s11906-019-0928-9] [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: 10/27/2022]
Abstract
PURPOSE OF REVIEW To review medical literature for evidence of association between hypertension and mitral regurgitation (MR) and summarize potential favorable effects of antihypertensive drugs on MR natural history and treatment. RECENT FINDINGS Hypertension and MR are common diseases affecting a large proportion of the general population. Contemporary evidence suggests that hypertension may worsen the progression and prognosis of MR through augmented mechanical stress and increased regurgitation volume. Renin-angiotensin axis inhibitors, beta-blockers, and vasodilators have been tested in order to prevent or decrease primary or secondary MR. Although antihypertensive agents may improve hemodynamic parameters and left ventricular remodeling in primary MR, there is no strong evidence of benefit on clinical outcomes. On the other hand, a beneficial effect of these drugs on secondary MR is better established. Moreover, there are no studies evaluating a possible benefit of lower blood pressure targets in MR. Randomized controlled trials are warranted to elucidate the precise role of antihypertensive therapy on treatment of MR.
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Affiliation(s)
- Vasiliki Katsi
- First Department of Cardiology, 'Hippokration' Hospital, University of Athens, Medical School, 21 Orfanidou Street, 11142, Athens, Greece
| | - Georgios Georgiopoulos
- First Department of Cardiology, 'Hippokration' Hospital, University of Athens, Medical School, 21 Orfanidou Street, 11142, Athens, Greece.
| | - Nikolaos Magkas
- First Department of Cardiology, 'Hippokration' Hospital, University of Athens, Medical School, 21 Orfanidou Street, 11142, Athens, Greece
| | | | - Agostino Virdis
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Petros Nihoyannopoulos
- First Department of Cardiology, 'Hippokration' Hospital, University of Athens, Medical School, 21 Orfanidou Street, 11142, Athens, Greece
| | - Konstantinos Toutouzas
- First Department of Cardiology, 'Hippokration' Hospital, University of Athens, Medical School, 21 Orfanidou Street, 11142, Athens, Greece
| | - Dimitrios Tousoulis
- First Department of Cardiology, 'Hippokration' Hospital, University of Athens, Medical School, 21 Orfanidou Street, 11142, Athens, Greece
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10
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de Melo ALS, de Lira YFB, Lima LAB, Vieira FC, Dias AS, de Andrade LB. EXERCISE TOLERANCE, PULMONARY FUNCTION, RESPIRATORY MUSCLE STRENGTH, AND QUALITY OF LIFE IN CHILDREN AND ADOLESCENTS WITH RHEUMATIC HEART DISEASE. REVISTA PAULISTA DE PEDIATRIA : ORGAO OFICIAL DA SOCIEDADE DE PEDIATRIA DE SAO PAULO 2018; 36:199-206. [PMID: 29617473 PMCID: PMC6038777 DOI: 10.1590/1984-0462/;2018;36;2;00012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Accepted: 06/18/2017] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Despite the high prevalence of rheumatic heart disease in Brazil, the occurrence of functional impairment in children and adolescents with rheumatic heart disease is not clear. The aim of this study was to evaluate exercise tolerance, respiratory muscle strength, lung function, and quality of life of children and adolescents with rheumatic heart disease. METHODS Cross-sectional study, conducted from August to December 2014 with children and adolescents with rheumatic heart disease aged 8 to 16 years. The participants, after completing the socioeconomic, clinical, and quality of life questionnaires were tested by spirometry, manovacuometry and in a 6-minute walk test. The variables and their reference values were compared using the paired Student's t-test. Comparisons between predicted and observed walking distance were done also by Student's t-test, consdiering the categorization of the participants. Correlations between these differences and quantitative variables were assessed by Pearson's coefficient, being significant p<0.05. RESULTS All 56 participants had a walked distance lower than predicted (p<0.001). The differences between predicted and observed distances were positively correlated with the baseline heart rate (r=0.3545; p=0.007). Expiratory muscle strength was also lower than the predicted values (p<0,001). Regarding quality of life assessment, the mean scores were 70, 77 and 67% for general, physical, and psychosocial aspects, respectively. CONCLUSIONS Children and adolescents with rheumatic heart disease have reduced exercise tolerance, which is related to their higher baseline heart rate; they also show impaired expiratory strength and quality of life.
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Abstract
Primarily affecting the young, rheumatic heart disease (RHD) is a neglected chronic disease commonly causing premature morbidity and mortality among the global poor. Standard clinical prevention and treatment is based on studies from the early antimicrobial era, as research investment halted soon after the virtual eradication of the disease from developed countries. The emergence of new global data on disease burden, new technologies, and a global health equity platform have revitalized interest and investment in RHD. This review surveys past and current evidence for standard RHD diagnosis and treatment, highlighting gaps in knowledge.
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Affiliation(s)
- Shanti Nulu
- Section of Cardiovascular Medicine, Yale School of Medicine, 789 Howard Avenue, New Haven, CT 06519, USA
| | - Gene Bukhman
- Division of Global Health Equity, Brigham and Women's Hospital, 641 Huntington Avenue, Boston, MA 02115, USA; Department of Global Health and Social Medicine, Harvard Medical School, 641 Huntington Avenue, Boston, MA 02115, USA
| | - Gene F Kwan
- Department of Global Health and Social Medicine, Harvard Medical School, 641 Huntington Avenue, Boston, MA 02115, USA; Section of Cardiovascular Medicine, Boston University Medical Center, Boston University School of Medicine, 88 East Newton Street, D8, Boston, MA 02118, USA.
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12
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Yasumura Y. [Valvular Heart Disease: Current Treatment and Future Perspectives. Topics: II. Usefulness and limitation of drug therapy for heart valve disease]. NIHON NAIKA GAKKAI ZASSHI. THE JOURNAL OF THE JAPANESE SOCIETY OF INTERNAL MEDICINE 2016; 105:199-205. [PMID: 27228716 DOI: 10.2169/naika.105.199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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13
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Abstract
Valvular heart diseases (VHDs) are progressive. When not caused by acute comorbidities they are generally characterized by long asymptomatic phases during which hemodynamic severity may progress leading to morbidity and mortality. Treatment depends on VHD type and severity but when severe and symptomatic, usually involves mechanical intervention. Asymptomatic patients, and those who lack objective descriptors associated with high risk, are closely observed clinically with optimization of associated cardiovascular risk factors until surgical indications develop. Though often prescribed based on theory, no rigorous evidence supports pharmacological therapy in most chronic situations though drugs may be appropriate in acute valvular diseases, or as a bridge to surgery in severely decompensated patients. Herein, we examine evidence supporting drug use for chronic VHDs.
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Affiliation(s)
- Jeffrey S Borer
- From Division of Cardiovascular Medicine, The Howard Gilman Institute for Heart Valve Diseases and the Schiavone Institute for Cardiovascular Translational Research, SUNY Downstate Medical Center, Brooklyn and New York, NY.
| | - Abhishek Sharma
- From Division of Cardiovascular Medicine, The Howard Gilman Institute for Heart Valve Diseases and the Schiavone Institute for Cardiovascular Translational Research, SUNY Downstate Medical Center, Brooklyn and New York, NY
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The levels of renin-angiotensin related components are modified in the hippocampus of rats submitted to pilocarpine model of epilepsy. Neurochem Int 2012; 61:54-62. [PMID: 22542773 DOI: 10.1016/j.neuint.2012.04.012] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2011] [Revised: 04/09/2012] [Accepted: 04/11/2012] [Indexed: 01/09/2023]
Abstract
We previously showed that patients with temporal lobe epilepsy (TLE) present an increased expression of angiotensin II (AngII) AT1 and AT2 receptors in the hippocampus, supporting the idea of an upregulation of renin-angiotensin system (RAS) in this disease. This study aimed to verify the relationship between the RAS and TLE during epileptogenesis. Levels of the peptides angiotensin I (AngI), angiotensin II (AngII) and angiotensin 1-7 (Ang 1-7), were detected by HPLC assay. Angiotensin AT1 and AT2 receptors, Mas mRNA receptors and angiotensin converting enzyme (ACE), tonin and neutral endopeptidase (NEP) mRNA were also quantified at the hippocampus of Wistar rats by real time PCR, during acute (n=10), silent (n=10) and chronic (n=10) phases of pilocarpine-induced epilepsy. We observed an increased peptide level of Ang1-7 into acute and silent phases, decreasing importantly (p≤0.05) in the chronic phase, suggesting that AngI may be converted into Ang 1-7 by NEP, which is present in high levels in these periods. Our results also showed increased peptide level of AngII in the chronic phase of this model. In contraposition, the ACE expression is reduced in all periods. These data suggest that angiotensinogen or AngI may be cleaved to AngII by tonin, which showed increased expression in all phases. We found changes in AT1, AT2 and Mas mRNA receptors levels suggesting that Ang1-7 could act at Mas receptor during the silent period. Herein, we demonstrated for the first time, changes in angiotensin-related peptides, their receptors as well as the releasing enzymes in the hippocampus of rats during pilocarpine-induced epilepsy.
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Martínez-Sellés M, García-Fernández MA, Larios E, Moreno M, Pinto A, García-Robles JA, Pérez-David E, Fernández-Avilés F. Etiology and short-term prognosis of severe mitral regurgitation. Int J Cardiovasc Imaging 2008; 25:121-6. [PMID: 18777106 DOI: 10.1007/s10554-008-9363-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2008] [Accepted: 08/13/2008] [Indexed: 11/24/2022]
Abstract
PURPOSE To describe the etiology and to document the course of severe mitral regurgitation (MR). METHODS Prospective registry of 272 patients diagnosed with chronic severe MR in an echocardiographic study. RESULTS Mean age was 70.2 +/- 13.8 years and 143 patients were women (53%). The most frequent causes of regurgitation were rheumatic disease (72 patients; 26%), ischemic etiology (58; 21%), valve prolapse (57; 21%), and dilated cardiomyopathy (49; 18%). A total of 43 patients (16%) died during follow-up (mean 0.9 +/- 0.3 years, total 2,785 patient-months): 30 from cardiac causes, 9 from non-cardiac causes, and 4 from unknown causes. Actuarial transplant-free survival was 87% at 6 months, and 81% at 1 year. Renal disease, previous stroke, ischemic etiology, and poor left ventricular ejection fraction were independent predictors of mortality. CONCLUSIONS Rheumatic disease is still the main cause of severe MR in Spain. Patients with severe MR have advanced age and present poor short-term prognosis.
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Affiliation(s)
- Manuel Martínez-Sellés
- Cardiology Department, Hospital Universitario Gregorio Marañón, Dr. Esquerdo, 46, 28007 Madrid, Spain.
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Pouchelon JL, Jamet N, Gouni V, Tissier R, Serres F, Carlos Sampedrano C, Castaignet M, Lefebvre HP, Chetboul V. Effect of Benazepril on Survival and Cardiac Events in Dogs with Asymptomatic Mitral Valve Disease: A Retrospective Study of 141 Cases. J Vet Intern Med 2008; 22:905-14. [DOI: 10.1111/j.1939-1676.2008.0105.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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18
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Kim DH, Kwak YL, Lee JH, Shim JK, Cha JH, Bang SO. Effect of Preoperative Renin-Angiotensin System Antagonists on the Difference between Radial and Femoral Arterial Pressure after Cardiopulmonary Bypass in Patients Undergoing Valvular Heart Surgery. Korean J Anesthesiol 2007. [DOI: 10.4097/kjae.2007.53.2.199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- Dae Hee Kim
- Department of Anesthesiology and Pain Medicine, Gil Medical Center, Gachon University of Medicine and Science, Incheon, Korea
| | - Young Lan Kwak
- Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Korea
- Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea
- Yonsei Cardiorascular Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Jong Hwa Lee
- Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Korea
- Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea
- Yonsei Cardiorascular Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Jae Kwang Shim
- Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Korea
- Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea
- Yonsei Cardiorascular Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Jae Ho Cha
- Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Sou Ouk Bang
- Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Korea
- Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea
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Borer JS, Herrold EM, Carter JN, Catanzaro DF, Supino PG. Cellular and Molecular Basis of Remodeling in Valvular Heart Diseases. Heart Fail Clin 2006; 2:415-24. [PMID: 17448428 DOI: 10.1016/j.hfc.2007.02.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Jeffrey S Borer
- The Howard Gilman Institute for Valvular Heart Diseases, Weill Medical College of Cornell University, New York, NY 10021, USA.
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