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Gómez-Mesa JE, Gutiérrez-Posso JM, Escalante-Forero M, Eraso-Bolaños DE, Drazner MH, Quesada-Chaves D, Romero-Guerra A, Perna ER, Álvarez-Sangabriel A, Rossel V, Alarco W, Speranza M. American registry of ambulatory and acute decompensated heart failure (AMERICCAASS registry): Rationale and design. ESC Heart Fail 2024. [PMID: 39014556 DOI: 10.1002/ehf2.14965] [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: 06/23/2023] [Revised: 06/12/2024] [Accepted: 06/24/2024] [Indexed: 07/18/2024] Open
Abstract
AIMS Heart failure (HF) is a highly prevalent and progressive condition associated with significant morbidity and mortality rates. Acute decompensated HF precipitates millions of hospitalizations each year. Despite therapeutic advances, the overall prognosis of HF is poor. The varying clinical courses and outcomes of patients with this disease may be due to region-specific gaps and since most HF studies are conducted in developed countries, the participation of Latin American and Caribbean countries is low. Considering this, the American Registry of Ambulatory and Acute Decompensated Heart Failure (AMERICCAASS) aims to characterize the population with ambulatory and acute decompensated HF in the American continent and to determine rehospitalization and survival outcomes during the 12 months of follow-up. METHODS AND RESULTS AMERICCAASS Registry is an observational, prospective, and hospital-based registry recruiting patients with ambulatory or acute decompensated HF. The registry plans to include between two and four institutions per country from at least 20 countries in the Americas, and at least 60 patients recruited from each participant institution regardless of their ambulatory or acutely decompensated condition. Ambulatory patients with confirmed HF diagnosis or inpatients presenting with acute decompensated HF will be included. Follow-up will be performed at 12 months in ambulatory patients or 1, 6, and 12 months after hospital discharge in acutely decompensated HF patients. This ongoing study began on 1 April 2022, with recruitment scheduled to end on 30 November 2023, and follow-up on 31 January 2025. Ethics approval was obtained from the Biomedical Research Ethics Committee of Fundación Valle del Lili. Data collected in the AMERICCAASS registry is being stored on the electronic platform REDCap (Research Electronic Data Capture), which allows different forms for patient groups to enable unbiased analyses. For quantitative variables comparison, we will use the Student's t-test or non-parametric tests accordingly. Categorical variables will be presented as proportions, and groups will be compared with Fisher's exact test. The significance level will be <0.05 for comparisons. Readmissions and post-discharge mortality will be calculated as proportions at 1, 6, and 12 months, with a survival analysis by conditional probability and the Kaplan-Meier method. CONCLUSIONS AMERICCAASS Registry is intended to be the most important registry of the continent for obtaining important information about demographics, aetiology, co-morbidities, and treatment received, either ambulatory or hospitalized. This registry may contribute to the optimization of national and regional evidence and public policies for the diagnosis and treatment of HF disease.
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Affiliation(s)
- Juan Esteban Gómez-Mesa
- Department of Cardiology, Fundación Valle del Lili, Cali, Colombia
- Department of Investigation and Innovation, Fundación Valle del Lili, Cali, Colombia
- Department of Health Sciences, Universidad Icesi, Cali, Colombia
- Consejo Interamericano de Falla Cardíaca e Hipertensión Pulmonar (CIFACAH) de la Sociedad Interamericana de Cardiología (SIAC), Mexico City, Mexico
| | | | | | | | - Mark H Drazner
- Department of Cardiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Daniel Quesada-Chaves
- Consejo Interamericano de Falla Cardíaca e Hipertensión Pulmonar (CIFACAH) de la Sociedad Interamericana de Cardiología (SIAC), Mexico City, Mexico
- Department of Cardiology, Hospital San Vicente de Paul, Heredia, Costa Rica
| | - Alexander Romero-Guerra
- Consejo Interamericano de Falla Cardíaca e Hipertensión Pulmonar (CIFACAH) de la Sociedad Interamericana de Cardiología (SIAC), Mexico City, Mexico
- Department of Cardiology, Hospital Santo Tomas, Panama City, Panama
| | - Eduardo R Perna
- Consejo Interamericano de Falla Cardíaca e Hipertensión Pulmonar (CIFACAH) de la Sociedad Interamericana de Cardiología (SIAC), Mexico City, Mexico
- Department of Heart Failure and Pulmonary Hypertension, Instituto De Cardiología J. F. Cabral, Corrientes, Argentina
| | - Amada Álvarez-Sangabriel
- Consejo Interamericano de Falla Cardíaca e Hipertensión Pulmonar (CIFACAH) de la Sociedad Interamericana de Cardiología (SIAC), Mexico City, Mexico
- Emergency Department and Coronary Care Unit, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico
| | - Víctor Rossel
- Consejo Interamericano de Falla Cardíaca e Hipertensión Pulmonar (CIFACAH) de la Sociedad Interamericana de Cardiología (SIAC), Mexico City, Mexico
- Department of Cardiology, Instituto Nacional del Tórax, Santiago, Chile
- Faculty of Medicine, Universidad de Chile, Santiago, Chile
| | - Walter Alarco
- Consejo Interamericano de Falla Cardíaca e Hipertensión Pulmonar (CIFACAH) de la Sociedad Interamericana de Cardiología (SIAC), Mexico City, Mexico
- Department of Cardiology, Instituto Nacional Cardiovascular INCOR, Lima, Peru
| | - Mario Speranza
- Consejo Interamericano de Falla Cardíaca e Hipertensión Pulmonar (CIFACAH) de la Sociedad Interamericana de Cardiología (SIAC), Mexico City, Mexico
- Department of Cardiology, Hospital Clínica Bíblica, San José, Costa Rica
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2
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Bocchi EA, Biselli B, Guimarães GV. Dilemmas in recommending exercise for prevention of heart failure with preserved ejection fraction. Eur J Heart Fail 2024. [PMID: 39014881 DOI: 10.1002/ejhf.3364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 02/07/2024] [Accepted: 06/21/2024] [Indexed: 07/18/2024] Open
Affiliation(s)
- Edimar Alcides Bocchi
- Heart Failure Clinics, Instituto do Coração (InCor) Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Bruno Biselli
- Heart Failure Clinics, Instituto do Coração (InCor) Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Guilherme Veiga Guimarães
- Heart Failure Clinics, Instituto do Coração (InCor) Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
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3
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Harikrishnan S, Rath PC, Bang V, McDonagh T, Ogola E, Silva H, Rajbanshi BG, Pathirana A, Ng GA, Biga C, Lüscher TF, Daggubati R, Adivi S, Roy D, Banerjee PS, Das MK. Heart failure, the global pandemic: A call to action consensus statement from the global presidential conclave at the platinum jubilee conference of cardiological society of India 2023. Indian Heart J 2024; 76:147-153. [PMID: 38609052 DOI: 10.1016/j.ihj.2024.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Revised: 03/26/2024] [Accepted: 04/08/2024] [Indexed: 04/14/2024] Open
Abstract
Heart failure (HF) is emerging as a major public health problem both in high- and low - income countries. The mortality and morbidity due to HF is substantially higher in low-middle income countries (LMICs). Accessibility, availability and affordability issues affect the guideline directed therapy implementation in HF care in those countries. This call to action urges all those concerned to initiate preventive strategies as early as possible, so that we can reduce HF-related morbidity and mortality. The most important step is to have better prevention and treatment strategies for diseases such as hypertension, ischemic heart disease (IHD), type-2 diabetes, and rheumatic heart disease (RHD) which predispose to the development of HF. Setting up dedicated HF-clinics manned by HF Nurses, can help in streamlining HF care. Subsidized in-patient care, financial assistance for device therapy, use of generic medicines (including polypill strategy) will be helpful, along with the use of digital technologies.
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Affiliation(s)
| | - Prathap Chandra Rath
- Apollo Health City, Jubilee Hills, Hyderabad, President, Cardiological Society of India (CSI), India
| | - Vijay Bang
- Lilavati Hospital, Bandra West, Mumbai, Immediate Past-President, CSI, India
| | | | - Elijah Ogola
- University of Nairobi (Kenya), President Pan African Society of Cardiology, Kenya
| | - Hugo Silva
- Hospital General de Agudos Dr. Cosme Argerich, Buenos Aires, Treasurer, Argentinian Cardiac Society, Argentina
| | - Bijoy G Rajbanshi
- Nepal Mediciti, Lalitpur, Past-President, Cardiac Society of Nepal, Nepal
| | - Anidu Pathirana
- National Hospital of SriLanka, Past-President SriLanka Heart Association, Sri Lanka
| | - G Andre Ng
- University of Leicester, President-Elect, British Cardiovascular Society, United Kingdom
| | - Cathleen Biga
- President and CEO of Cardiovascular Management of Illinois, Vice President, American College of Cardiology, USA
| | - Thomas F Lüscher
- Royal Brompton Hospital Imperial College London, London, President-Elect European Society of Cardiology, United Kingdom
| | - Ramesh Daggubati
- West Virginia University School of Medicine, Morgantown, WV, USA
| | - Shirley Adivi
- West Virginia University School of Medicine, Morgantown, WV, USA
| | - Debabrata Roy
- Rabindranath Tagore Institute of Cardiac Sciences, Kolkata, Hon. General Secretary, CSI, India
| | - P S Banerjee
- Manipal Hospital, Kolkata, Past-President, CSI, India
| | - M K Das
- B.M. Birla Heart Research Centre, Kolkata, Past-President CSI, India
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4
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Herrera CJ, Saldarriaga C, Feliz E, Bacal F, Piña P, Arias-Mendoza A. Heart Failure in Latin American Women: A Call for Action. J Card Fail 2024; 30:505-508. [PMID: 38199338 DOI: 10.1016/j.cardfail.2023.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Revised: 12/16/2023] [Accepted: 12/18/2023] [Indexed: 01/12/2024]
Affiliation(s)
- Cesar J Herrera
- CEDIMAT Cardiovascular Center, Santo Domingo, Dominican Republic.
| | | | - Edisson Feliz
- CEDIMAT Cardiovascular Center, Santo Domingo, Dominican Republic
| | - Fernando Bacal
- Heart Failure Department, Heart Institute (InCor), University of Sao Paulo Medical School, São Paulo, Brazil
| | - Pamela Piña
- CEDIMAT Cardiovascular Center, Santo Domingo, Dominican Republic
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5
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Shahid I, Khan MS, Fonarow GC, Butler J, Greene SJ. Bridging gaps and optimizing implementation of guideline-directed medical therapy for heart failure. Prog Cardiovasc Dis 2024; 82:61-69. [PMID: 38244825 DOI: 10.1016/j.pcad.2024.01.008] [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: 01/13/2024] [Accepted: 01/13/2024] [Indexed: 01/22/2024]
Abstract
Despite robust scientific evidence and strong guideline recommendations, there remain significant gaps in initiation and dose titration of guideline-directed medical therapy (GDMT) for heart failure (HF) among eligible patients. Reasons surrounding these gaps are multifactorial, and largely attributed to patient, healthcare professionals, and institutional challenges. Concurrently, HF remains a predominant cause of mortality and hospitalization, emphasizing the critical need for improved delivery of therapy to patients in routine clinical practice. To optimize GDMT, various implementation strategies have emerged in the recent decade such as in-hospital rapid initiation of GDMT, improving patient adherence, addressing clinical inertia, improving affordability, engagement in quality improvement registries, multidisciplinary clinics, and EHR-integrated interventions. This review highlights the current use and barriers to optimal utilization of GDMT, and proposes novel strategies aimed at improving GDMT in HF.
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Affiliation(s)
- Izza Shahid
- Division of Preventive Cardiology, Houston Methodist Academic Institute, Houston, TX, USA
| | | | - Gregg C Fonarow
- Division of Cardiology, Ahmanson-UCLA Cardiomyopathy Center, University of California Los Angeles Medical Center, Los Angeles, CA, USA
| | - Javed Butler
- Baylor Scott and White Research Institute, Dallas, TX, USA; Department of Medicine, University of Mississippi, Jackson, MS, USA
| | - Stephen J Greene
- Division of Cardiology, Duke University School of Medicine, Durham, NC, USA; Duke Clinical Research Institute, Durham, NC, USA.
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Hernández-Durán J, López-Gutiérrez LV, Palacio-Mejía MI, Aguilera L, Burgos L, Giraldo CIS. What Do We Know About Heart Failure in Latin American Women? Curr Probl Cardiol 2024; 49:102085. [PMID: 37716539 DOI: 10.1016/j.cpcardiol.2023.102085] [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: 09/11/2023] [Accepted: 09/12/2023] [Indexed: 09/18/2023]
Abstract
Data about heart failure in Latin America is scarce. Women living in this region of the world are exposed to a mix of traditional risk factors for heart failure, neglected diseases, and social determinants of health. The aim of this review is to present what we know about heart failure in Latin American women and to establish the needs for future research.
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Affiliation(s)
| | | | | | - Luisa Aguilera
- Puerta de Hierro Cardiovascular Institute, Zapopan, Mexico
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7
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Bocchi EA, Veiga Guimarães G, Espinoza Romero C, Sato PK, de Freitas VLT, Yamashiro Kanashiro EH, Furuchó CR, Das Dores Cruz F, Shimoda Nakanishi É, Busser FD, Bezerra RC, Westphalen EVN, Cisotto Rocha M, Shikanai Yasuda MA. Assessment of biomarkers and clinical parameters as predictors of survival in patients with chagasic heart failure. PLoS Negl Trop Dis 2023; 17:e0011847. [PMID: 38109427 PMCID: PMC10760923 DOI: 10.1371/journal.pntd.0011847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 01/02/2024] [Accepted: 12/06/2023] [Indexed: 12/20/2023] Open
Abstract
BACKGROUND Chagas disease, endemic in Latin America and spreading globally due to emigration, has a significant health burden, particularly in relation to chagasic heart failure (HF). Chagasic cardiomyopathy (CCM) is characterized by chronic inflammatory myocardial disease. This study aimed to identify inflammatory parameters and biomarkers that could aid in the management of patients with chagasic HF. METHODS AND FINDINGS A cohort study was conducted at a tertiary cardiology single-center over a mean follow-up period of 2.4 years. The study included patients with HF secondary to CCM enrolled between October 2013 and July 2017. Various clinical parameters, echocardiography findings, parasitemia status, brain natriuretic peptide (BNP) and troponin T (TnT) levels, and inflammatory biomarkers (IL-6, IL-10, IL-12p70, IL-17A, adiponectin, and IFN-γ) were assessed. The study encompassed a cohort of 103 patients, with a median age of 53 years and 70% being male. The left ventricular ejection fraction (LVEF) was 28%, with 40% of patients classified as NYHA II functional class. The median BNP level was 291 pg/ml. The observed mortality rate during the study period was 38.8%. Predictors of lower survival were identified as elevated levels of BNP, TnT, reduced LVEF, and increased adiponectin (thresholds: BNP > 309 pg/ml, TnT > 27.5 ng/ml, LVEF < 25.5%, adiponectin > 38 μg/mL). Notably, there was no evidence indicating a relationship between parasitemia and the inflammatory parameters with lower survival in these patients, including INF-γ, IL-6, IL-10, IL12-(p70), and IL17a. CONCLUSION Despite the presence of a chronic inflammatory process, the evaluated inflammatory biomarkers in this cohort were not predictive of survival in patients with chagasic HF with reduced ejection fraction (HFrEF). However, reduced LVEF, elevated BNP, adiponectin levels, and troponin T were identified as predictors of lower survival in these patients.
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Affiliation(s)
- Edimar Alcides Bocchi
- Heart Failure Clinics, Instituto do Coração Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Guilherme Veiga Guimarães
- Heart Failure Clinics, Instituto do Coração Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Cristhian Espinoza Romero
- Heart Failure Clinics, Instituto do Coração Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Paula Keiko Sato
- Laboratory of Medical Investigation in Immunology (LIM-48), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, Brazil
| | - Vera Lúcia Teixeira de Freitas
- Laboratory of Medical Investigation in Immunology (LIM-48), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, Brazil
- Departament of Infectious Diseases, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, São Paulo, Brazil
| | - Edite Hatsumi Yamashiro Kanashiro
- Laboratory of Medical Investigation in Immunology (LIM-48), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, Brazil
- Departament of Infectious Diseases, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, São Paulo, Brazil
| | - Célia Regina Furuchó
- Laboratory of Medical Investigation in Immunology (LIM-48), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, Brazil
| | - Fatima Das Dores Cruz
- Heart Failure Clinics, Instituto do Coração Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | | | - Felipe Delatorre Busser
- Departament of Infectious Diseases, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, São Paulo, Brazil
| | - Rita Cristina Bezerra
- Laboratory of Medical Investigation in Parasitology (LIM-46), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, Brazil
| | | | - Mussya Cisotto Rocha
- Laboratory of Medical Investigation in Immunology (LIM-48), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, Brazil
| | - Maria Aparecida Shikanai Yasuda
- Laboratory of Medical Investigation in Immunology (LIM-48), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, Brazil
- Departament of Infectious Diseases, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, São Paulo, Brazil
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Ledien J, Cucunubá ZM, Parra-Henao G, Rodríguez-Monguí E, Dobson AP, Adamo SB, Castellanos LG, Basáñez MG, Nouvellet P. From serological surveys to disease burden: a modelling pipeline for Chagas disease. Philos Trans R Soc Lond B Biol Sci 2023; 378:20220278. [PMID: 37598701 PMCID: PMC10440172 DOI: 10.1098/rstb.2022.0278] [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: 11/20/2022] [Accepted: 06/29/2023] [Indexed: 08/22/2023] Open
Abstract
In 2012, the World Health Organization (WHO) set the elimination of Chagas disease intradomiciliary vectorial transmission as a goal by 2020. After a decade, some progress has been made, but the new 2021-2030 WHO roadmap has set even more ambitious targets. Innovative and robust modelling methods are required to monitor progress towards these goals. We present a modelling pipeline using local seroprevalence data to obtain national disease burden estimates by disease stage. Firstly, local seroprevalence information is used to estimate spatio-temporal trends in the Force-of-Infection (FoI). FoI estimates are then used to predict such trends across larger and fine-scale geographical areas. Finally, predicted FoI values are used to estimate disease burden based on a disease progression model. Using Colombia as a case study, we estimated that the number of infected people would reach 506 000 (95% credible interval (CrI) = 395 000-648 000) in 2020 with a 1.0% (95%CrI = 0.8-1.3%) prevalence in the general population and 2400 (95%CrI = 1900-3400) deaths (approx. 0.5% of those infected). The interplay between a decrease in infection exposure (FoI and relative proportion of acute cases) was overcompensated by a large increase in population size and gradual population ageing, leading to an increase in the absolute number of Chagas disease cases over time. This article is part of the theme issue 'Challenges and opportunities in the fight against neglected tropical diseases: a decade from the London Declaration on NTDs'.
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Affiliation(s)
- Julia Ledien
- School of Life Sciences, University of Sussex, Falmer, Brighton BN1 9RH, UK
| | - Zulma M. Cucunubá
- Departamento de Epidemiología Clínica y Bioestadística, Facultad de Medicina, Universidad Pontificia Javeriana, 110231 Bogotá, Colombia
| | - Gabriel Parra-Henao
- Centro de Investigación en Salud para el Trópico, Universidad Cooperativa de Colombia, 470002, Santa Marta, Colombia
- National Institute of Health, 111321 Bogotá, Colombia
| | - Eliana Rodríguez-Monguí
- Departamento de Epidemiología Clínica y Bioestadística, Facultad de Medicina, Universidad Pontificia Javeriana, 110231 Bogotá, Colombia
- Independent consultant to the Neglected, Tropical and Vector Borne Diseases Program, Pan American Health Organization (PAHO), Colombia
| | - Andrew P. Dobson
- Department of Ecology and Evolutionary Biology, Princeton University, Princeton, NJ 08544, USA
| | - Susana B. Adamo
- Center for International Earth Science Information Network (CIESIN), Columbia Climate School, Columbia University, New York, NY 10025, USA
| | - Luis Gerardo Castellanos
- Department of Communicable Diseases and Environmental Determinants of Health, Pan American Health Organization (PAHO), Washington, DC 20037, USA
| | - María-Gloria Basáñez
- London Centre for Neglected Tropical Disease Research (LCNTDR) & MRC Centre for Global Infectious Disease Analysis (GIDA), Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London SW7 2AZ, UK
| | - Pierre Nouvellet
- School of Life Sciences, University of Sussex, Falmer, Brighton BN1 9RH, UK
- London Centre for Neglected Tropical Disease Research (LCNTDR) & MRC Centre for Global Infectious Disease Analysis (GIDA), Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London SW7 2AZ, UK
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9
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López-Ponce de Leon JD, Estacio M, Giraldo N, Escalante M, Rodas Y, Largo J, Lores J, Victoria MC, Argote D, Florez N, Carrillo D, Olaya P, Mejia M, Gomez JE. Hypertrophic Cardiomyopathy in a Latin American Center: A Single Center Observational Study. J Clin Med 2023; 12:5682. [PMID: 37685749 PMCID: PMC10489055 DOI: 10.3390/jcm12175682] [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: 06/08/2023] [Revised: 07/17/2023] [Accepted: 07/20/2023] [Indexed: 09/10/2023] Open
Abstract
BACKGROUND Hypertrophic cardiomyopathy (HCM) is a complex disorder that includes various phenotypes, leading to different manifestations. It also shares different disadvantages typical of rare diseases, including limited recognition, lack of prospective studies assessing treatment, and little or delayed access to advanced treatment options. Reliable data about the prevalence and natural history of cardiomyopathies in South America are lacking. This study summarizes the features and management of patients with HCM in a university hospital in Colombia. METHODS This was an observational retrospective cohort study of patients with HCM between January 2010 and December 2021. Patient data were analyzed from an institutional cardiomyopathy registry. Demographic, paraclinical, and outcome data were collected. RESULTS A total of 82 patients during the study period were enrolled. Of these, 67.1% were male, and the mean age at diagnosis was 49 years. Approximately 83% were in NYHA functional class I and II, and the most reported symptoms were dyspnea (38%), angina (20%), syncope (15%), and palpitations (11%). In addition, 89% had preserved left ventricular ejection fraction (LVEF) with an asymmetric septal pattern in 65%. Five patients (6%) had alcohol septal ablation and four (5%) had septal myectomy. One patient required heart transplantation during follow-up. Sudden cardiovascular death was observed in 2.6%. The overall mortality during follow-up was 7.3%. CONCLUSIONS HCM is a complex and heterogeneous disorder that presents with significant morbidity and mortality. Our registry provides comprehensive data on disease courses and management in a developing country.
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Affiliation(s)
- Juan David López-Ponce de Leon
- Departamento de Cardiología, Fundación Valle del Lili, Cali 760032, Colombia
- Facultad de Ciencias de la Salud, Universidad Icesi, Cali 760031, Colombia
| | - Mayra Estacio
- Centro de Investigaciones Clínicas, Fundación Valle del Lili, Cali 760032, Colombia
| | - Natalia Giraldo
- Departamento de Cardiología, Fundación Valle del Lili, Cali 760032, Colombia
- Facultad de Ciencias de la Salud, Universidad Icesi, Cali 760031, Colombia
| | - Manuela Escalante
- Centro de Investigaciones Clínicas, Fundación Valle del Lili, Cali 760032, Colombia
| | - Yorlany Rodas
- Centro de Investigaciones Clínicas, Fundación Valle del Lili, Cali 760032, Colombia
| | - Jessica Largo
- Centro de Investigaciones Clínicas, Fundación Valle del Lili, Cali 760032, Colombia
| | - Juliana Lores
- Facultad de Ciencias de la Salud, Universidad Icesi, Cali 760031, Colombia
| | | | - Diana Argote
- Facultad de Ciencias de la Salud, Universidad Icesi, Cali 760031, Colombia
| | - Noel Florez
- Departamento de Cardiología, Fundación Valle del Lili, Cali 760032, Colombia
- Facultad de Ciencias de la Salud, Universidad Icesi, Cali 760031, Colombia
| | - Diana Carrillo
- Departamento de Cardiología, Fundación Valle del Lili, Cali 760032, Colombia
- Facultad de Ciencias de la Salud, Universidad Icesi, Cali 760031, Colombia
| | - Pastor Olaya
- Departamento de Cardiología, Fundación Valle del Lili, Cali 760032, Colombia
- Facultad de Ciencias de la Salud, Universidad Icesi, Cali 760031, Colombia
| | - Mauricio Mejia
- Departamento de Radiología, Fundación Valle del Lili, Cali 760032, Colombia
| | - Juan Esteban Gomez
- Departamento de Cardiología, Fundación Valle del Lili, Cali 760032, Colombia
- Facultad de Ciencias de la Salud, Universidad Icesi, Cali 760031, Colombia
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Bravo Thompson H, Zúñiga Cisneros J, Cárdenas C, González E, Nichols E, Frago G, Romero Guerra A. Impact of a Nurse-Led Multidisciplinary Heart Failure Clinic in a Low-Resource Setting: Experience in a Latin American Public Healthcare System. CJC Open 2023; 5:585-592. [PMID: 37496785 PMCID: PMC10366629 DOI: 10.1016/j.cjco.2023.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 04/11/2023] [Indexed: 07/28/2023] Open
Abstract
Background Nurse-led multidisciplinary heart failure clinics (MDHFCs) play an important role in patient care in developed countries, due to their proven benefits relating to mortality, hospitalization, and quality of life. However, evidence is limited regarding the role of MDHFCs in a limited-resource setting. Methods Patients with heart failure (HF) with reduced ejection fraction (n = 89) were enrolled in a prospective, longitudinal cohort, from January 2018 to January 2019. The following endpoints were collected at baseline and after 6 months of follow-up: (i) quality of life, measured using the Minnesota Living with Heart Failure Questionnaire; (ii) medication adherence using the Morisky Medication Adherence Scale, 8-item; (iii) titration of HF medications; (iv) self-care behavior using the European Heart Failure Self-care Behavior Scale; and (v) mortality and hospitalizations up to 12 months after. Results The questionnaire score was reduced from 66.5 (interquartile range [IQR], 46-86) at baseline to 26 (IQR, 13-45) at 6 months (P < 0.001). New York Heart Association (NYHA) functional class improved at 6 months (NYHA I: 41.9%; NYHA II: 39.5%; NYHA III: 17.2%), compared to baseline (NYHA I: 20%; NYHA II: 49%; NYHA III: 31%; P < 0.001). Medication adherence using the 8-item Morisky Medication Adherence Scale improved the score from 6 (IQR, 4-7) at baseline to 7 (IQR, 6.25-8; P = 0.001) at 6 months. Uptitration of angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (25% vs 18% at target dose) and beta-blockers (25% vs 11% at target dose) was documented. After 6 months of follow-up, the European Heart Failure Self-care Behavior Scale was applied, showing a score of 18.5 (IQR, 15-22). The mortality reported at 12 months of follow-up was 9.7%, and the incidence of hospitalization was 44%. Conclusion An MDHFC is a feasible strategy to manage an HF clinic in a low-resource setting.
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Affiliation(s)
| | - Julio Zúñiga Cisneros
- School of Medicine, University of Panama, Panama City, Panama
- Internal Medicine Deparment, Santo Tomás Hospital, Panama City, Panama
| | - César Cárdenas
- School of Medicine, University of Panama, Panama City, Panama
| | - Eyleen González
- School of Medicine, University of Panama, Panama City, Panama
| | - Edna Nichols
- Department of Cardiology, Santo Tomas Hospital, Panama City, Panama
| | - Gabriel Frago
- Department of Cardiology, Santo Tomas Hospital, Panama City, Panama
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Couceiro SM, Sant’Anna LB, Sant’Anna MB, Menezes RSM, Mesquita ET, Sant’Anna FM. Auricular Vagal Neuromodulation and its Application in Patients with Heart Failure and Reduced Ejection Fraction. Arq Bras Cardiol 2023; 120:e20220581. [PMID: 37194830 PMCID: PMC10263391 DOI: 10.36660/abc.20220581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 12/29/2022] [Accepted: 02/15/2023] [Indexed: 05/18/2023] Open
Abstract
BACKGROUND The autonomic nervous system (ANS) imbalance in heart failure (HF) creates a vicious cycle, excess sympathetic activity, and decreased vagal activity contributing to the worsening of HF. Low-intensity transcutaneous electrical stimulation of the auricular branch of the vagus nerve (taVNS) is well tolerated and opens new therapeutic possibilities. OBJECTIVES To hypothesize the applicability and benefit of taVNS in HF through intergroup comparison of echocardiography parameters, 6-minute walk test, Holter heart rate variability (SDNN and rMSSD), Minnesota quality of life questionnaire, and functional class by the New York Heart Association. In comparisons, p values <0.05 were considered significant. METHODS Prospective, double-blind, randomized clinical study with sham methodology, unicentric. Forty-three patients were evaluated and divided into 2 groups: Group 1 received taVNS (frequencies 2/15 Hz), and Group 2 received sham. In comparisons, p values <0.05 were considered significant. RESULTS In the post-intervention phase, it was observed that Group 1 had better rMSSD (31 x 21; p = 0.046) and achieved better SDNN (110 vs. 84, p = 0.033). When comparing intragroup parameters before and after the intervention, it was observed that all of them improved significantly in group 1, and there were no differences in group 2. CONCLUSION taVNS is a safe to perform and easy intervention and suggests a probable benefit in HF by improving heart rate variability, which indicates better autonomic balance. New studies with more patients are needed to answer the questions raised by this study.
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Affiliation(s)
- Sergio Menezes Couceiro
- Universidade Federal FluminenseCabo FrioRJBrasilUniversidade Federal Fluminense, Cabo Frio, RJ – Brasil
- Clínica Santa Helena – CardiologiaCabo FrioRJBrasilClínica Santa Helena – Cardiologia, Cabo Frio, RJ – Brasil
| | - Lucas Bonacossa Sant’Anna
- Fundação Técnico-Educacional Souza MarquesEscola de Medicina Souza MarquesCabo FrioRJBrasilFundação Técnico-Educacional Souza Marques Escola de Medicina Souza Marques – Ensino e Graduação, Cabo Frio, RJ – Brasil
| | - Mariana Bonacossa Sant’Anna
- Fundação Técnico-Educacional Souza MarquesEscola de Medicina Souza MarquesCabo FrioRJBrasilFundação Técnico-Educacional Souza Marques Escola de Medicina Souza Marques – Ensino e Graduação, Cabo Frio, RJ – Brasil
| | | | - Evandro Tinoco Mesquita
- Complexo Hospitalar de NiteróiNiteróiRJBrasilComplexo Hospitalar de Niterói, Niterói, RJ – Brasil
- Universidade Federal FluminenseRio de JaneiroRJBrasilUniversidade Federal Fluminense, Rio de Janeiro, RJ – Brasil
| | - Fernando Mendes Sant’Anna
- Clínica Santa Helena – CardiologiaCabo FrioRJBrasilClínica Santa Helena – Cardiologia, Cabo Frio, RJ – Brasil
- Universidade Federal do Rio de JaneiroCampus Macaé – Ensino e GraduaçãoMacaéRJBrasilUniversidade Federal do Rio de Janeiro, Campus Macaé – Ensino e Graduação, Macaé, RJ – Brasil
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Effect of Sodium-Glucose Cotransporter 2 Inhibitors on Clinical and Laboratory Variables in Heart Failure Patients with Reduced Left Ventricular Ejection Fraction in a Latin American Hospital: A Retrospective Study. HEARTS 2023. [DOI: 10.3390/hearts4010003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2023] Open
Abstract
Heart failure (HF) is a syndrome suffered by more than 26 million people worldwide. SGLT2 inhibitors are drugs that have been shown to positively affect the management of HF patients, regardless of their diabetes status. A retrospective observational study was conducted on heart failure patients with reduced ejection fraction (HFrEF) enrolled at the HF clinic, who were on SGLT2 inhibitors. For these patients, baseline and follow-up data were collected and analyzed over time. Changes over time were quantified and statistical analysis was conducted to validate whether the changes were significant. After the screening of all the HF program patients, 24 met the inclusion criteria, with an average age of 68 years. Through the study, it was possible to find a statistically significant difference in the values of NT-ProBNP before and after adding a SGLT2 inhibitor in 14 patients (p = 0.0214). In addition, there was an improvement in the NYHA functional scale of 71% and no significant change in renal function or other laboratory values. Based on the studied parameters and throughout the clinical changes during the follow-up period, it was possible to establish an improvement in HFrEF patients on SGLT2 inhibitors as part of their therapy.
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Lynn MK, Dye-Braumuller KC, Beatty NL, Dorn PL, Klotz SA, Stramer SL, Townsend RL, Kamel H, Vannoy JM, Sadler P, Montgomery SP, Rivera HN, Nolan MS. Evidence of likely autochthonous Chagas disease in the southwestern United States: A case series of Trypanosoma cruzi seropositive blood donors. Transfusion 2022; 62:1808-1817. [PMID: 35895440 PMCID: PMC9543114 DOI: 10.1111/trf.17026] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 05/31/2022] [Accepted: 05/31/2022] [Indexed: 11/28/2022]
Abstract
Background Chagas disease is a parasitic infection that can insidiously cause non‐ischemic cardiomyopathy. Given the largely silent nature of this progressive disease, asymptomatic blood donors pose potential blood transfusion risk. Blood donation screening has become an unintentional form of Chagas disease surveillance, with thousands of new cases identified since national surveillance was initiated in 2007. Study Design and Methods We recruited T. cruzi‐positive blood donors identified from California and Arizona blood centers for confirmatory blood screening and assessment of lifetime infection risk. Results Among eight suspected cases, we identified four confirmed US autochthonous infections. The current manuscript details the transmission sources, healthcare‐seeking behaviors post‐blood donation resulting, and clinical course of disease among persons without any history of travel to endemic Latin American countries. Discussion This manuscript presents four additional US‐acquired Chagas disease cases and identifies an opportunity for blood centers to assist in confronting barriers surrounding Chagas disease in the US.
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Affiliation(s)
- Mary K Lynn
- Department of Epidemiology and Biostatistics Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - Kyndall C Dye-Braumuller
- Department of Epidemiology and Biostatistics Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - Norman L Beatty
- Division of Infectious Diseases & Global Medicine, Department of Medicine, University of Florida, Gainesville, Florida, USA.,Department of Medicine, University of Arizona, Tucson, Arizona, USA
| | - Patricia L Dorn
- Department of Biological Sciences, Loyola University New Orleans, New Orleans, Louisiana, USA
| | - Stephen A Klotz
- Department of Medicine, University of Arizona, Tucson, Arizona, USA
| | - Susan L Stramer
- Scientific Affairs, American Red Cross, Gaithersburg, Maryland, USA
| | | | - Hany Kamel
- Corporate Medical Affairs, Vitalant, Scottsdale, Arizona, USA
| | | | - Patrick Sadler
- Central California Blood Center, Fresno, California, USA
| | - Susan P Montgomery
- Division of Parasitic Diseases and Malaria, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Hilda N Rivera
- Division of Parasitic Diseases and Malaria, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Melissa S Nolan
- Department of Epidemiology and Biostatistics Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
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Three and two-dimensional cardiac mechanics by speckle tracking are predictors of outcomes in chagas heart disease. Sci Rep 2022; 12:12237. [PMID: 35856087 PMCID: PMC9293971 DOI: 10.1038/s41598-022-16379-w] [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: 11/04/2021] [Accepted: 07/08/2022] [Indexed: 11/23/2022] Open
Abstract
Chagas disease (CD) is a neglected infectious disease associated with early mortality and substantial disability. Three-dimensional speckle tracking (3D STE) may play a role in the evaluation of CD. We aim to characterize new echocardiographic variables in patients with CD and to assess the hypothesis that 3D STE may predict outcomes. Seventy-two patients with CD were included. Clinical and conventional 2D and 3D STE analysis were performed. Patients were followed up for 60 months. Clinical events were defined as hospitalization for heart failure, complex ventricular arrhythmias, heart transplant and all-cause death. Seventy-two patients were recruited and enrolled in three groups: left ventricular ejection fraction (LVEF) < 0.40 (N = 22; reduced LVEF or rLVEF); 0.40 ≤ LVEF ≤ 0.50 (N = 10; mildly reduced LVEF or mrLVEF) and LVEF > 0.50 (N = 30; preserved LVEF or pLVEF). After a Cox model analysis, the top predictors of composite endpoints were 2D LV global longitudinal strain (GLS) ≤ − 11.3% (AUC = 0.87), 2D LV global circumferential strain (GCS) ≤ − 10.1% (AUC = 0.79), 3D LV GLS ≤ − 13% (AUC = 0.82), 3D LV area strain ≤ − 16% (AUC = 0.81) and right ventricle (RV) GLS ≤ − 17.2% (AUC = 0.78). Patients with CD and mrLVEF were morphologically similar to the rLVEF patients despite the benign evolution as the pLVEF group. RV GLS, 2D LV GLS, 2D LV GCS, 3D LV GLS, and 3D LV area strain are strong predictors of 60 months outcomes in patients with CD.
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15
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Chacón-Diaz M, Laymito Quispe R, Hernández-Vásquez A, Vargas-Fernández R. Study Protocol for the Peruvian Registry of Advanced Heart Failure (REPICAV). Front Cardiovasc Med 2022; 9:896821. [PMID: 35711378 PMCID: PMC9194087 DOI: 10.3389/fcvm.2022.896821] [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: 03/15/2022] [Accepted: 05/06/2022] [Indexed: 11/18/2022] Open
Abstract
Background Heart failure (HF) is a global problem with a high mortality rate, and advanced HF (AHF) represents the stage with the highest morbidity and mortality. We have no local data on this population and its treatment. The aim of this study will be to determine the epidemiological, clinical, therapeutic, and annual survival characteristics of patients diagnosed with AHF treated in hospitals with HF units in the city of Lima, Peru. Methods and Analysis An observational, prospective, multicenter study will be conducted with evaluation at baseline and follow-up at 1, 3, 6, and 12 months after study entry. Patients over 18 years of age with AHF seen in referral health facilities in metropolitan Lima will be included. The cumulative mortality during follow-up will be estimated by the Kaplan-Meier method, and Cox regression models will calculate hazard ratios (HRs) and 95% confidence intervals (CI). Likewise, risk ratio (RR) and 95% CI will be estimated using generalized linear models with binomial family and log link function. This study was approved by the Ethics and Research Committee of the National Cardiovascular Institute (Instituto Nacional Cardiovascular “Carlos Alberto Peschiera Carrillo”—INCOR [in Spanish]; Approval report 46/2021-CEI). Discussion In Peru, there are no scientific data on the epidemiology of AHF in the population. This means that physicians are not adequately trained in the characteristics of the Peruvian population to identify patients who could be candidates for advanced therapies and to recognize the optimal time to refer these patients to more complex HF units. This study will be the first to examine the clinical-epidemiological characteristics of AHF in Peru with a follow-up of 1 year after the event and will provide relevant information on these observable characteristics for the management of high-complexity patients.
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Affiliation(s)
- Manuel Chacón-Diaz
- Facultad de Ciencias de la Salud, Universidad Científica del Sur, Lima, Peru
- Instituto Nacional Cardiovascular, EsSalud, Lima, Peru
| | | | - Akram Hernández-Vásquez
- Centro de Excelencia en Investigaciones Económicas y Sociales en Salud, Vicerrectorado de Investigación, Universidad San Ignacio de Loyola, Lima, Peru
- *Correspondence: Akram Hernández-Vásquez
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16
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Costa JO, Aidar FJ, Barbosa JS, Alves LVS, Oliveira VB, de Oliveira LMSM, Rocha RMS, Vieira DADS, Costa IMNBDC, de Souza MFC, Oliveira JLM, Baumworcel L, Neves EB, Díaz-de-Durana AL, Almeida-Santos MA, Sousa ACS. BALANCE Dietary Index in Patients with Heart Failure, and Its Adherence in Sergipe, Brazil. Clin Pract 2022; 12:383-395. [PMID: 35735662 PMCID: PMC9221597 DOI: 10.3390/clinpract12030043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 05/20/2022] [Accepted: 05/24/2022] [Indexed: 11/16/2022] Open
Abstract
Background: “The effective treatment of Heart Failure (HF) involves care with food intake. Recently, the Ministry of Health created the Brazilian Cardioprotective Diet and its dietary index, BALANCE, which assesses adherence to the standard’s recommendations”. Methods: This observational prospective study is part of the Congestive Heart Failure Registry (VICTIM-CHF) of Aracaju/SE. Observations and data collection took place from April 2018 to February 2021. Sociodemographic and clinical aspects and food consumption were evaluated. Food intake was determined using the food frequency questionnaire. Foods were categorized using the BALANCE dietary index into green, yellow, blue and red food groups. The BALANCE dietary index was obtained using median and interquartile ranges, scores of the Mann–Whitney U test, and associations between clinical variables and the index, through linear regression. Results: Participants included 240 patients with HF (61.12 ± 1.06 years), who were assisted by the Unified Health System (67.5%). Individuals with a partner showed greater adherence to the green food group recommendations (0.09; 0.00–0.17). The lowest adherence to recommendations regarding the blue food group was observed in individuals with excess weight, who had a higher consumption of foods rich in animal protein (0.54; 0.38–0.78). As for the red food group (ultra-processed foods) the highest adherence was observed by patients with diabetes mellitus (0.41; 0.05–0.77). The greatest adherence to the yellow food group, and a higher score, was observed in patients with the smallest left ventricular systolic diameter (LVSD). Conclusions: Being married was directly associated with the consumption of foods in the green group, while being overweight and having diabetes were inversely associated with adherence to the blue and red food groups, respectively. Greater adherence to the yellow food group recommendations was inversely associated with less change in the DSFVE.
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Affiliation(s)
- Jamille Oliveira Costa
- Graduate Program in Health Sciences, Federal University of Sergipe (UFS), Aracaju 49060-676, SE, Brazil; (J.S.B.); (L.V.S.A.); (V.B.O.); (L.M.S.M.d.O.); (R.M.S.R.); (J.L.M.O.); (A.C.S.S.)
- Correspondence:
| | - Felipe J. Aidar
- Group of Studies and Research in Performance, Sport, Health and Paralympic Sports—GEPEPS, Federal University of Sergipe (UFS), São Cristóvão 49100-000, SE, Brazil;
- Graduate Program in Physical Education, Federal University of Sergipe (UFS), São Cristóvão 49100-000, SE, Brazil
- Graduate Program in Physiological Science, Federal University of Sergipe (UFS), São Cristóvão 49100-000, SE, Brazil
| | - Juliana Santos Barbosa
- Graduate Program in Health Sciences, Federal University of Sergipe (UFS), Aracaju 49060-676, SE, Brazil; (J.S.B.); (L.V.S.A.); (V.B.O.); (L.M.S.M.d.O.); (R.M.S.R.); (J.L.M.O.); (A.C.S.S.)
| | - Luciana Vieira Sousa Alves
- Graduate Program in Health Sciences, Federal University of Sergipe (UFS), Aracaju 49060-676, SE, Brazil; (J.S.B.); (L.V.S.A.); (V.B.O.); (L.M.S.M.d.O.); (R.M.S.R.); (J.L.M.O.); (A.C.S.S.)
| | - Victor Batista Oliveira
- Graduate Program in Health Sciences, Federal University of Sergipe (UFS), Aracaju 49060-676, SE, Brazil; (J.S.B.); (L.V.S.A.); (V.B.O.); (L.M.S.M.d.O.); (R.M.S.R.); (J.L.M.O.); (A.C.S.S.)
| | - Larissa Marina Santana Mendonça de Oliveira
- Graduate Program in Health Sciences, Federal University of Sergipe (UFS), Aracaju 49060-676, SE, Brazil; (J.S.B.); (L.V.S.A.); (V.B.O.); (L.M.S.M.d.O.); (R.M.S.R.); (J.L.M.O.); (A.C.S.S.)
| | - Raysa Manuelle Santos Rocha
- Graduate Program in Health Sciences, Federal University of Sergipe (UFS), Aracaju 49060-676, SE, Brazil; (J.S.B.); (L.V.S.A.); (V.B.O.); (L.M.S.M.d.O.); (R.M.S.R.); (J.L.M.O.); (A.C.S.S.)
| | - Diva Aliete dos Santos Vieira
- Department of Nutrition, Campus Prof. Antônio Garcia Filho, Federal University of Sergipe (UFS), Lagarto 49400-000, SE, Brazil;
| | | | - Márcia Ferreira Cândido de Souza
- Graduate Program Professional in Management and Technological Innovation in Health, Federal University of Sergipe, Aracaju 49100-000, SE, Brazil;
| | - Joselina Luzia Menezes Oliveira
- Graduate Program in Health Sciences, Federal University of Sergipe (UFS), Aracaju 49060-676, SE, Brazil; (J.S.B.); (L.V.S.A.); (V.B.O.); (L.M.S.M.d.O.); (R.M.S.R.); (J.L.M.O.); (A.C.S.S.)
- Department of Medicine, Federal University of Sergipe (UFS), São Cristóvão 49100-000, SE, Brazil
- Division of Cardiology, University Hospital of Federal University of Sergipe (UFS), São Cristóvão 49100-000, SE, Brazil
- Clinic and Hospital São Lucas/Rede D’Or São Luiz, Aracaju 49060-676, SE, Brazil; (L.B.); (M.A.A.-S.)
| | - Leonardo Baumworcel
- Clinic and Hospital São Lucas/Rede D’Or São Luiz, Aracaju 49060-676, SE, Brazil; (L.B.); (M.A.A.-S.)
| | - Eduardo Borba Neves
- Graduate Program in Biomedical Engineering, Federal Technological University of Paraná (UTFPR), Curitiba 80230-901, PR, Brazil;
| | - Alfonso López Díaz-de-Durana
- Sports Department, Physical Activity and Sports Faculty-INEF, Universidad Politécnica de Madrid, 28040 Madrid, Spain;
| | - Marcos Antonio Almeida-Santos
- Clinic and Hospital São Lucas/Rede D’Or São Luiz, Aracaju 49060-676, SE, Brazil; (L.B.); (M.A.A.-S.)
- Graduate Program in Health and Environment, Tiradentes University (UNIT), Aracaju 49010-390, SE, Brazil
| | - Antônio Carlos Sobral Sousa
- Graduate Program in Health Sciences, Federal University of Sergipe (UFS), Aracaju 49060-676, SE, Brazil; (J.S.B.); (L.V.S.A.); (V.B.O.); (L.M.S.M.d.O.); (R.M.S.R.); (J.L.M.O.); (A.C.S.S.)
- Department of Medicine, Federal University of Sergipe (UFS), São Cristóvão 49100-000, SE, Brazil
- Division of Cardiology, University Hospital of Federal University of Sergipe (UFS), São Cristóvão 49100-000, SE, Brazil
- Clinic and Hospital São Lucas/Rede D’Or São Luiz, Aracaju 49060-676, SE, Brazil; (L.B.); (M.A.A.-S.)
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Mariño A, Garcia-Peña A, Muñoz-Velandia OM, Cita-Pardo JE, Betancourt C. Evaluation of Long-Term Kidney Function Following Orthotopic Heart Transplantation. Transplant Proc 2022; 54:769-773. [DOI: 10.1016/j.transproceed.2021.11.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 10/24/2021] [Accepted: 11/18/2021] [Indexed: 10/18/2022]
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Food Patterns of Hospitalized Patients with Heart Failure and Their Relationship with Demographic, Economic and Clinical Factors in Sergipe, Brazil. Nutrients 2022; 14:nu14050987. [PMID: 35267962 PMCID: PMC8912487 DOI: 10.3390/nu14050987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 02/16/2022] [Accepted: 02/23/2022] [Indexed: 02/01/2023] Open
Abstract
Background: The high rates of hospitalization and mortality caused by Heart Failure (HF) have attracted the attention of health sectors around the world. Dietary patterns that involve food combinations and preparations with synergistic or antagonistic effects of different dietary components can influence the worsening and negative outcomes of this disease. Objectives: To describe the dietary patterns of patients hospitalized for HF decompensation and associate them with demographic, economic, and clinical factors, and the type of care provided in Sergipe. Materials and Methods: Cross-sectional study that is part of the Congestive Heart Failure Registry (VICTIM-CHF)” of Aracaju/SE. Prospective data collection took place with all patients hospitalized between April 2018 and February 2021 in cardiology referral hospitals, 2 public and 1 private. The data collected were sociodemographic, clinical, lifestyle, anthropometric and food consumption variables. Daily dietary intake was estimated by applying a semiquantitative food frequency questionnaire. The extraction of dietary patterns, by exploratory factor analysis, was performed after grouping the foods according to the nutritional value and form of preparation into 34 groups. To assess the association between the factorial scores for adherence to the standards and the variables studied, the Mann-Whitney U test was applied. Linear regressions were also performed, considering the dietary pattern (one for each pattern) as a dependent variable. Results: The study included 240 patients hospitalized for HF decompensation, most of them elderly (mean age 61.12 ± 1.06 years), male (52.08%) and attended by the Unified Health System—SUS (67.5%). Three dietary patterns were identified, labeled “traditional” (typical foods of the Brazilian northeastern population added to ultra-processed foods), “Mediterranean” (foods recommended by the Mediterranean diet) and “dual” (healthy foods combined with fast and easy-to-prepare foods like snacks, bread, sweets and desserts). Adherence to the “traditional” pattern was greater among men (p < 0.031) and non-diabetics (p < 0.003). The “Mediterranean” was more consumed by the elderly (p < 0.001), with partners (p = 0.001) and a lower income (p < 0.001), assisted by the SUS (p < 0.001) and without hypertension (p = 0,04). The “dual” diet pattern had greater adherence by the elderly (p < 0.001), self-declared non-black (p = 0.012), with higher income (p < 0.001), assisted in the private sector (p < 0.001) and with less impaired functional capacity (p = 0.037). It was also observed that being female (p = 0.031) and being older reduced the average scores of performing the “traditional” pattern (p = 0.002). Regarding the type of service, being from the public service reduced the average scores for adhering to the “dual” pattern (p = 0.008). Conclusions: Three dietary patterns representative of the population were found, called traditional, Mediterranean and dual, which were associated with demographic, economic and clinical factors. Thus, these standards must be considered in the development of nutritional strategies and recommendations in order to increase adherence to diets that are more protective against cardiovascular diseases.
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Bosch-Nicolau P, Espinosa-Pereiro J, Salvador F, Sánchez-Montalvá A, Molina I. Association Between Trypanosoma cruzi DNA in Peripheral Blood and Chronic Chagasic Cardiomyopathy: A Systematic Review. Front Cardiovasc Med 2022; 8:787214. [PMID: 35174221 PMCID: PMC8841718 DOI: 10.3389/fcvm.2021.787214] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 12/28/2021] [Indexed: 11/13/2022] Open
Abstract
Chronic chagasic cardiomyopathy (CCC) is the most important complication of patients with Chagas disease (CD). The role of persistent detection of DNA in peripheral blood and its association to CCC is unknown. We performed a systematic review up to July 2021, including studies that reported ratios of CCC and PCR positivity among non-treated adult patients. We identified 749 records and selected 12 for inclusion corresponding to 1,686 patients. Eight studies were performed in endemic countries and 4 in non-endemic countries. Only two studies showed an association between CCC and Trypanosoma cruzi parasitemia by means of PCR detection. Six studies reported greater positive PCR ratios among patients with CCC than in the patients with indeterminate chagas disease (ICD) with no statistical significance. A significant risk of bias has been detected among most of the studies. Therefore, while we performed a meta-analysis, wide inter-study heterogeneity impeded its interpretation.ConclusionsWith the available information, we could not establish a correlation between PCR-detectable parasitemia and CCC.Systematic Review Registration:https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020216072, identifier: CRD42020216072.
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Affiliation(s)
- Pau Bosch-Nicolau
- Tropical Medicine & International Health Unit Vall d'Hebrón - Drassanes, Infectious Diseases Department, PROSICS Barcelona, University Hospital Vall d'Hebron, Barcelona, Spain
- Medicine Department, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Juan Espinosa-Pereiro
- Tropical Medicine & International Health Unit Vall d'Hebrón - Drassanes, Infectious Diseases Department, PROSICS Barcelona, University Hospital Vall d'Hebron, Barcelona, Spain
- Medicine Department, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Fernando Salvador
- Tropical Medicine & International Health Unit Vall d'Hebrón - Drassanes, Infectious Diseases Department, PROSICS Barcelona, University Hospital Vall d'Hebron, Barcelona, Spain
- Medicine Department, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Adrián Sánchez-Montalvá
- Tropical Medicine & International Health Unit Vall d'Hebrón - Drassanes, Infectious Diseases Department, PROSICS Barcelona, University Hospital Vall d'Hebron, Barcelona, Spain
- Medicine Department, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Israel Molina
- Tropical Medicine & International Health Unit Vall d'Hebrón - Drassanes, Infectious Diseases Department, PROSICS Barcelona, University Hospital Vall d'Hebron, Barcelona, Spain
- Medicine Department, Universitat Autònoma de Barcelona, Barcelona, Spain
- *Correspondence: Israel Molina
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Demissie BM, Bekele DM, Habte T, Wake AD. Knowledge, Attitude and Associated Factors Towards Heart Failure Management Among Nurses Working in the Cardiac Unit of Selected Government Hospitals in Addis Ababa, Ethiopia: A Cross-Sectional Study. NURSING: RESEARCH AND REVIEWS 2021. [DOI: 10.2147/nrr.s329363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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21
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Zhou G, Chen J, Wu C, Jiang P, Wang Y, Zhang Y, Jiang Y, Li X. Deciphering the Protein, Modular Connections and Precision Medicine for Heart Failure With Preserved Ejection Fraction and Hypertension Based on TMT Quantitative Proteomics and Molecular Docking. Front Physiol 2021; 12:607089. [PMID: 34721049 PMCID: PMC8552070 DOI: 10.3389/fphys.2021.607089] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 09/23/2021] [Indexed: 12/16/2022] Open
Abstract
Background: Exploring the potential biological relationships between heart failure with preserved ejection fraction (HFpEF) and concomitant diseases has been the focus of many studies for the establishment of personalized therapies. Hypertension (HTN) is the most common concomitant disease in HFpEF patients, but the functional connections between HFpEF and HTN are still not fully understood and effective treatment strategies are still lacking. Methods: In this study, tandem mass tag (TMT) quantitative proteomics was used to identify disease-related proteins and construct disease-related networks. Furthermore, functional enrichment analysis of overlapping network modules was used to determine the functional similarities between HFpEF and HTN. Molecular docking and module analyses were combined to identify therapeutic targets for HFpEF and HTN. Results: Seven common differentially expressed proteins (co-DEPs) and eight overlapping modules were identified in HFpEF and HTN. The common biological processes between HFpEF and HTN were mainly related to energy metabolism. Myocardial contraction, energy metabolism, apoptosis, oxidative stress, immune response, and cardiac hypertrophy were all closely associated with HFpEF and HTN. Epinephrine, sulfadimethoxine, chloroform, and prednisolone acetate were best matched with the co-DEPs by molecular docking analyses. Conclusion: Myocardial contraction, energy metabolism, apoptosis, oxidative stress, immune response, and cardiac hypertrophy were the main functional connections between HFpEF and HTN. Epinephrine, sulfadimethoxine, chloroform, and prednisolone acetate could potentially be effective for the treatment of HTN and HFpEF.
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Affiliation(s)
- Guofeng Zhou
- First Clinical Medical College, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Jiye Chen
- First Clinical Medical College, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Chuanhong Wu
- The Biomedical Sciences Institute of Qingdao University (Qingdao Branch of SJTU Bio-X Institutes), Qingdao University, Qingdao, China
| | - Ping Jiang
- First Clinical Medical College, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Yongcheng Wang
- Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Yongjian Zhang
- First Clinical Medical College, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Yuehua Jiang
- Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Xiao Li
- Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, China
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22
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Neves EGA, Koh CC, Padilha da Silva JL, Passos LSA, Villani FNA, Dos Santos JSC, Menezes CAS, Silva VR, Tormin JPAS, Evangelista GFB, Carvalho ATD, Rocha MODC, Nascimento B, Gollob KJ, Nunes MDCP, Dutra WO. Systemic cytokines, chemokines and growth factors reveal specific and shared immunological characteristics in infectious cardiomyopathies. Cytokine 2021; 148:155711. [PMID: 34592495 DOI: 10.1016/j.cyto.2021.155711] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 09/07/2021] [Accepted: 09/13/2021] [Indexed: 12/17/2022]
Abstract
Heart disease is a major cause of death worldwide. Chronic Chagas cardiomyopathy (CCC) caused by infection with Trypanosoma cruzi leading to high mortality in adults, and rheumatic heart disease (RHD), resulting from infection by Streptococcus pyogenes affecting mainly children and young adults, are amongst the deadliest heart diseases in low-middle income countries. Despite distinct etiology, the pathology associated with both diseases is a consequence of inflammation. Here we compare systemic immune profile in patients with these cardiopathies, to identify particular and common characteristics in these infectious heart diseases. We evaluated the expression of 27 soluble factors, employing single and multivariate analysis combined with machine-learning approaches. We observed that, while RHD and CCC display higher levels of circulating mediators than healthy individuals, CCC is associated with stronger immune activation as compared to RHD. Despite distinct etiologies, univariate analysis showed that expression of TNF, IL-17, IFN-gamma, IL-4, CCL4, CCL3, CXCL8, CCL11, CCL2, PDGF-BB were similar between CCC and RHD, consistent with their inflammatory nature. Network analysis revealed common inflammatory pathways between CCC and RHD, while highlighting the broader reach of the inflammatory response in CCC. The final multivariate model showed a 100% discrimination power for the combination of the cytokines IL-12p70, IL-1Ra, IL-4, and IL-7 between CCC and RHD groups. Thus, while clear immunological distinctions were identified between CCC and RHD, similarities indicate shared inflammatory pathways in these infectious heart diseases. These results contribute to understanding the pathogenesis of CCC and RHD and may impact the design of immune-based therapies for these and other inflammatory cardiopathies that may also share immunological characteristics.
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Affiliation(s)
- Eula G A Neves
- Cell-cell Interactions Laboratory, Department of Morphology, Institute of Biological Sciences, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
| | - Carolina C Koh
- Cell-cell Interactions Laboratory, Department of Morphology, Institute of Biological Sciences, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
| | | | - Lívia S A Passos
- Cell-cell Interactions Laboratory, Department of Morphology, Institute of Biological Sciences, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil; Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | | | | | - Cristiane A S Menezes
- Department of Clinical and Toxicological Analysis, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
| | - Vicente R Silva
- Graduate Program in Infectology and Tropical Medicine, School of Medicine, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
| | - Julia P A S Tormin
- Graduate Program in Infectology and Tropical Medicine, School of Medicine, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
| | | | | | - Manoel Otávio da Costa Rocha
- Graduate Program in Infectology and Tropical Medicine, School of Medicine, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
| | - Bruno Nascimento
- Graduate Program in Infectology and Tropical Medicine, School of Medicine, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
| | - Kenneth John Gollob
- Hospital Israelita Albert Einstein, São Paulo, SP, Brazil; Instituto Nacional de Ciência e Tecnologia em Doenças Tropicais, INCT-DT, Salvador, BA, Brazil
| | - Maria do Carmo P Nunes
- Graduate Program in Infectology and Tropical Medicine, School of Medicine, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
| | - Walderez O Dutra
- Cell-cell Interactions Laboratory, Department of Morphology, Institute of Biological Sciences, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil; Instituto Nacional de Ciência e Tecnologia em Doenças Tropicais, INCT-DT, Salvador, BA, Brazil.
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23
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A Novel High-Content Screening-Based Method for Anti- Trypanosoma cruzi Drug Discovery Using Human-Induced Pluripotent Stem Cell-Derived Cardiomyocytes. Stem Cells Int 2021; 2021:2642807. [PMID: 34434238 PMCID: PMC8380504 DOI: 10.1155/2021/2642807] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 07/05/2021] [Accepted: 08/01/2021] [Indexed: 11/18/2022] Open
Abstract
Chagas disease is caused by Trypanosoma cruzi infection and remains a relevant cause of chronic heart failure in Latin America. The pharmacological arsenal for Chagas disease is limited, and the available anti-T. cruzi drugs are not effective when administered during the chronic phase. Cardiomyocytes derived from human-induced pluripotent stem cells (hiPSC-CMs) have the potential to accelerate the process of drug discovery for Chagas disease, through predictive preclinical assays in target human cells. Here, we aimed to establish a novel high-content screening- (HCS-) based method using hiPSC-CMs to simultaneously evaluate anti-T. cruzi activity and cardiotoxicity of chemical compounds. To provide proof-of-concept data, the reference drug benznidazole and three compounds with known anti-T. cruzi activity (a betulinic acid derivative named BA5 and two thiazolidinone compounds named GT5A and GT5B) were evaluated in the assay. hiPSC-CMs were infected with T. cruzi and incubated for 48 h with serial dilutions of the compounds for determination of EC50 and CC50 values. Automated multiparametric analyses were performed using an automated high-content imaging system. Sublethal toxicity measurements were evaluated through morphological measurements related to the integrity of the cytoskeleton by phalloidin staining, nuclear score by Hoechst 33342 staining, mitochondria score following MitoTracker staining, and quantification of NT-pro-BNP, a peptide released upon mechanical myocardial stress. The compounds showed EC50 values for anti-T. cruzi activity similar to those previously described for other cell types, and GT5B showed a pronounced trypanocidal activity in hiPSC-CMs. Sublethal changes in cytoskeletal and nucleus scores correlated with NT-pro-BNP levels in the culture supernatant. Mitochondrial score changes were associated with increased cytotoxicity. The assay was feasible and allowed rapid assessment of anti-T. cruzi action of the compounds, in addition to cardiotoxicity parameters. The utilization of hiPSC-CMs in the drug development workflow for Chagas disease may help in the identification of novel compounds.
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Lima MM, Costa VMD, Palmeira SL, Castro APBD. [Stratification of priority territories for surveillance of chronic Chagas disease: multicriteria analysis for decision-making in health]. CAD SAUDE PUBLICA 2021; 37:e00175920. [PMID: 34190831 DOI: 10.1590/0102-311x00175920] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 09/28/2020] [Indexed: 11/21/2022] Open
Abstract
The identification of the magnitude of chronic Chagas disease in Brazil requires linking activities in health surveillance, seeking to develop a wide, hierarchically organized and geographically distributed network of services to provide care to thousands of individuals with Trypanosoma cruzi infection. The study aimed to elaborate a model for prioritization of municipalities for chronic Chagas disease, to offer comprehensive care for persons with the disease. A multicriteria analysis was thus performed using the PROMETHEÉ II algorithm, implemented in the Pradin software. The criteria for assessing the model consisted of three indices built from the following indicators: (a) epidemiological, directly related to chronic Chagas disease, (b) related to the evolution in chronic Chagas disease, and (c) related to access to health services. Saaty's Fundamental Scale was used to define the indicators' weights, with greater importance assigned to those directly related to chronic Chagas disease and to those with greater reliability and respective quality of information. Assessment of the models' consistency was based on comparison of the available data in historically endemic areas with the distribution of acute cases, besides other sensitivity analyses. The best model was defined by 1,345 municipalities with medium priority, 1,003 high priority, and 601 with very high priority for chronic Chagas disease, with the highest proportions in the Southeast and Northeast regions. Prioritization allows the administration to rationalize and channel resources, and it is essential to identify the territories where persons with chronic Chagas disease are living, to promote comprehensive care and improve quality of life.
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Affiliation(s)
- Mayara Maia Lima
- Secretaria de Vigilância em Saúde, Ministério da Saúde, Brasília, Brasil
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25
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Hoffman K, Liu Z, Hossain E, Bottazzi ME, Hotez PJ, Jones KM, McCall LI. Alterations to the Cardiac Metabolome Induced by Chronic T. cruzi Infection Relate to the Degree of Cardiac Pathology. ACS Infect Dis 2021; 7:1638-1649. [PMID: 33843195 PMCID: PMC8588157 DOI: 10.1021/acsinfecdis.0c00816] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Chronic Chagasic cardiomyopathy (CCC) is a Neglected Tropical Disease caused by the parasite Trypanosoma cruzi. The pathognomonic findings in symptomatic CCC patients and animal models includes diffuse cardiac fibrosis and inflammation with persistent parasite presence in the heart. This study investigated chemical alterations in different regions of the heart in relation to cardiac pathology indicators to better understand the long-term pathogenesis of this neglected disease. We used data from echocardiography, fibrosis biomarkers, and histopathological analysis to fully evaluate cardiac pathology. Metabolites isolated from the pericardial and endocardial sides of the right ventricular myocardium were analyzed by liquid chromatography tandem mass spectrometry. The endocardial sections contained significantly less cardiac inflammation and fibrosis than the pericardial sections. Cardiac levels of acylcarnitines, phosphocholines, and other metabolites were significantly disrupted in accordance with cardiac fibrosis, inflammation, and serum fibrosis biomarker levels. These findings have potential implications in treatment and monitoring for CCC patients.
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Affiliation(s)
- Kristyn Hoffman
- Department of Molecular Virology and Microbiology and Department of Pediatrics, Section of Tropical Medicine, Baylor College of Medicine, Houston, Texas 77030, United States
| | - Zongyuan Liu
- Department of Chemistry and Biochemistry and Laboratories of Molecular Anthropology and Microbiome Research, University of Oklahoma, Norman, Oklahoma 73019, United States
| | - Ekram Hossain
- Department of Chemistry and Biochemistry and Laboratories of Molecular Anthropology and Microbiome Research, University of Oklahoma, Norman, Oklahoma 73019, United States
| | - Maria Elena Bottazzi
- Department of Molecular Virology and Microbiology and Department of Pediatrics, Section of Tropical Medicine, Baylor College of Medicine, Houston, Texas 77030, United States; Texas Children’s Hospital Center for Vaccine Development, Houston, Texas 77030, United States; Department of Biology, Baylor University, Waco, Texas 76798, United States
| | - Peter J. Hotez
- Department of Molecular Virology and Microbiology and Department of Pediatrics, Section of Tropical Medicine, Baylor College of Medicine, Houston, Texas 77030, United States; Texas Children’s Hospital Center for Vaccine Development, Houston, Texas 77030, United States; Department of Biology, Baylor University, Waco, Texas 76798, United States
| | - Kathryn M. Jones
- Department of Molecular Virology and Microbiology and Department of Pediatrics, Section of Tropical Medicine, Baylor College of Medicine, Houston, Texas 77030, United States; Texas Children’s Hospital Center for Vaccine Development, Houston, Texas 77030, United States
| | - Laura-Isobel McCall
- Department of Chemistry and Biochemistry, Laboratories of Molecular Anthropology and Microbiome Research, and Department of Microbiology and Plant Biology, University of Oklahoma, Norman, Oklahoma 73019, United States
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26
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Sairras S, Baldew SS, van der Hilst K, Shankar A, Zijlmans W, Lichtveld M, Ferdinand K. Heart Failure Hospitalizations and Risk Factors among the Multi-Ethnic Population from a Middle Income Country: The Suriname Heart Failure Studies. J Natl Med Assoc 2021; 113:177-186. [PMID: 32928542 PMCID: PMC7486052 DOI: 10.1016/j.jnma.2020.08.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 08/09/2020] [Accepted: 08/18/2020] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Heart failure (HF) is an emerging epidemic with poor disease outcomes and differences in its prevalence, etiology and management between and within world regions. Hypertension (HT) and ischemic heart disease (IHD) are the leading causes of HF. In Suriname, South-America, data on HF burden are lacking. The aim of this Suriname Heart Failure I (SUHF-I) study, is to assess baseline characteristics of HF admitted patients in order to set up the prospective interventional SUHF-II study to longitudinally determine the effectiveness of a comprehensive HF management program in HF patients. METHODS A cross-sectional analysis was conducted of Thorax Center Paramaribo (TCP) discharge data from January 2013-December 2015. The analysis included all admissions with primary or secondary discharge of HF ICD-10 codes I50-I50.9 and I11.0 and the following variables: patient demographics (age, sex, and ethnicity), # of readmissions, risk factors (RF) for HF: HT, diabetes mellitus (DM), smoking, and left ventricle (LV) function. T-tests were used to analyze continuous variables and Chi-square test for categorical variables. Differences were considered statistically significant when a p-value <0.05 is obtained. RESULTS 895 patients (1:1 sex ratio) with either a primary (80%) or secondary HF diagnosis were admitted. Female patients were significantly older (66.2 ± 14.8 years, p < 0.01) at first admission compared to male patients (63.5 ± 13.7 years) and the majority of admissions were of Hindustani and Creole descent. HT, DM and smoking were highly prevalent respectively 62.6%, 38.9 and 17.3%. There were 379 readmissions (29.1%) and 7% of all admissions were readmissions within 30 days and 16% were readmissions for 31-365 day. IHD is more prevalent in patients from Asian descendant (52.2%) compared to African descendant (11.7%). Whereas, HT (39.3%) is more prevalent in African descendants compared to Asian descendants (12.7%). There were no statistically significant differences in age, sex, ethnicity, LV function and RFs between single admitted and readmitted patients. CONCLUSION RF prevalence, ethnic differences and readmission rates in Surinamese HF patients are in line with reports from other Caribbean and Latin American countries. These results are the basis for the SUHF-II study which will aid in identifying the country specific and clinical factors for the successful development of a multidisciplinary HF management program.
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Affiliation(s)
- Shellice Sairras
- Scientific Research Center Suriname (SRCS), Academic Hospital Paramaribo (AZP), Suriname.
| | - Se-Sergio Baldew
- Physical Therapy Department, Faculty of Medical Sciences, Anton de Kom University of Suriname, Paramaribo, Suriname
| | - Kwame van der Hilst
- Thorax Center Paramaribo, Academic Hospital Paramaribo, Suriname; Faculty of Medical Sciences, Anton de Kom University of Suriname, Paramaribo, Suriname
| | - Arti Shankar
- Department of Biostatistics, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Wilco Zijlmans
- Faculty of Medical Sciences, Anton de Kom University of Suriname, Paramaribo, Suriname; Department of Global Environmental Health Sciences, Tulane University, New Orleans, LA, USA
| | - Maureen Lichtveld
- Department of Global Environmental Health Sciences, Tulane University, New Orleans, LA, USA
| | - Keith Ferdinand
- John W. Deming Department of Medicine, Tulane University School of Medicine, New Orleans, LA, USA
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Issa VS, Ayub-Ferreira SM, Schroyens M, Chizzola PR, Soares PR, Lage SHG, Bocchi EA. The course of patients with Chagas heart disease during episodes of decompensated heart failure. ESC Heart Fail 2021; 8:1460-1471. [PMID: 33595916 PMCID: PMC8006612 DOI: 10.1002/ehf2.13232] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 07/04/2020] [Accepted: 01/19/2021] [Indexed: 11/11/2022] Open
Abstract
AIMS This study aimed to analyse the clinical presentation and prognosis of patients with Chagas cardiomyopathy and decompensated heart failure (HF), as compared with other aetiologies. METHODS AND RESULTS A prospective cohort of patients admitted with decompensated HF. We included 767 patients (63.9% male), with median age of 58 years [interquartile range 48.2-66.7 years]. Main aetiologies were non-Chagas/non-ischaemic cardiomyopathies in 389 (50.7%) patients, ischaemic disease in 209 (27.2%), and Chagas disease in 169 (22%). Median left ventricular ejection fraction was 26% (interquartile range 22-35%). Patients with Chagas differed from both patients with non-Chagas/non-ischaemic and ischaemic cardiomyopathies for a higher proportion of cardiogenic shock at admission (17.8%, 11.6%, and 11%, respectively, P < 0.001) and had lower blood pressure at admission (systolic blood pressure 90 [80-102.5], 100 [85-110], and 100 [88.2-120] mmHg, P < 0.001) and lower heart rate (heart rate 71 [60-80], 87 [70-102], and 79 [64-96.5] b.p.m., P < 0.001). Further, patients with Chagas had higher serum BNP level (1544 [734-3148], 1061 [465-239], and 927 [369-1455] pg/mL, P < 0.001), higher serum bilirubin (1.4 [0.922.44], 1.2 [0.77-2.19], and 0.84 [0.49-1.45] mg/dL, P < 0.001), larger left ventricular diameter (68 [63-73], 67 [58-74], and 62 [56.8-68.3] mm, respectively, P < 0.001), lower left ventricular ejection fraction (25 [21-30]%, 26 [22-35]%, and 30 [25-38]%, P < 0.001), and a higher proportion of patients with right ventricular function (48.8%, 40.7%, and 25.9%, P < 0.001). Patients with Chagas disease were more likely to receive inotropes than patients with non-Chagas/non-ischaemic and ischaemic cardiomyopathies (77.5%, 67.5%, and 62.5%, respectively, P = 0.007) and also to receive intra-aortic balloon pumping (30.8%, 16.2%, and 10.5%, P < 0.001). Overall, the rates of death or urgent transplant were higher among patients with Chagas than in other aetiologies, a difference that was driven mostly due to increased rate of heart transplant during hospital admission (20.2%, 10.3%, and 8.1%). The prognosis of patients at 180 days after hospital admission was worse for patients with Chagas disease as compared with other aetiologies. In patients with Chagas, age [odds ratio (OR) = 0.934, confidence interval (CI)95% 0.901-0.982, P = 0.005], right ventricular dysfunction by echocardiography (OR = 2.68, CI95% 1.055-6.81, P = 0.016), and urea (OR = 1.009, CI95% 1.001-1.018, P = 0.038) were significantly associated with prognosis. CONCLUSIONS Patients with Chagas cardiomyopathy and decompensated HF have a distinct clinical presentation and worse prognosis compared with other aetiologies.
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Affiliation(s)
- Victor Sarli Issa
- Department of Cardiology, Antwerp University Hospital, Wilrijkstraat 10, Edegem, 2650, Belgium
| | - Silvia Moreira Ayub-Ferreira
- Heart Institute (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Matthew Schroyens
- Department of Cardiology, Antwerp University Hospital, Wilrijkstraat 10, Edegem, 2650, Belgium
| | - Paulo Roberto Chizzola
- Heart Institute (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Paulo Rogerio Soares
- Heart Institute (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Silvia Helena Gelas Lage
- Heart Institute (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Edimar Alcides Bocchi
- Heart Institute (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
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Molano Barrera DY, González Consuegra RV. Relación entre la capacidad de agencia de autocuidado y la calidad de vida en personas con insuficiencia cardiaca. INVESTIGACIÓN EN ENFERMERÍA: IMAGEN Y DESARROLLO 2021. [DOI: 10.11144/javeriana.ie22.rcaa] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
Introducción. La persona con insuficiencia cardiaca enfrenta cambios biopsicosociales que deterioran su calidad de vida. Es necesario conocer la relación existente entre el autocuidado y la calidad de vida, lo que puede orientar al profesional de enfermería en el diseño de intervenciones efectivas. Objetivo. Determinar la relación existente entre la capacidad de agencia de autocuidado y la calidad de vida relacionada con la salud en las personas con insuficiencia cardiaca, que son atendidas en el programa multidisciplinario de insuficiencia cardiaca en una institución de salud de cuarto nivel en Bogotá, Colombia. Método. Estudio descriptivo correlacional de corte transversal, realizado entre mayo y agosto de 2018; utilizando los instrumentos Appraisal of Self-care Agency Scale y el Cuestionario de Cardiomiopatía de Kansas City; la muestra correspondió a 107 pacientes, mayores de edad, con insuficiencia cardiaca estadio C y D. Resultados. La capacidad de agencia de autocuidado se encontró en categorías alta con 63.55% y muy alta con 34.57%; la calidad de vida relacionada con la salud se encontró preservada, con un puntaje general de 73.33; la relación existente entre las dos variables, según el coeficiente de correlación de Spearman, fue 0.316 con un valor p = 0.002, relación débil pero significativa. Conclusiones. Existe una relación entre las variables de interés, que se reafirma con las correlaciones significativas identificadas entre las dimensiones que las conforman. Estos hallazgos resaltan la pertinencia de abordar, en las intervenciones, temáticas que fortalezcan la capacidad de agencia de autocuidado, contribuyendo a mejorar la calidad de vida de estas personas.
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Molano-Barrera D, González-Consuegra R. Factores deteriorantes de la calidad de vida en insuficiencia cardiaca: revisión integrativa. DUAZARY 2021. [DOI: 10.21676/2389783x.3889] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
La insuficiencia cardiaca es una enfermedad que aumenta la morbimortalidad, deteriora la calidad de vida de la persona que la padece e impacta negativamente en el sistema de salud. El propósito de esta revisión es explorar la literatura para determinar qué condiciones biopsicosociales del individuo pueden ser factores deteriorantes de la calidad de vida relacionada con la salud en esta población. Se realizó una revisión integrativa a partir de artículos publicados entre el 2014 y el 2018, en idioma español e inglés, los cuales se obtuvieron de la revisión de las bases de datos Ovid, Scopus, Scielo, Science direct, Redalyc, Lilacs, Dialnet y Pubmed, utilizando los descriptores de consulta Mesh: quality of life and heart failure. Se incluyeron en la revisión 24 artículos, en los cuales se identificaron 24 factores deteriorantes que fueron clasificados en las dimensiones biopsicosociales del individuo. Determinar la presencia de estos factores permite al profesional de salud obtener elementos claves para el establecimiento de un plan de atención individualizado que genere un impacto positivo en la condición de salud y en la calidad de vida de la persona. Esto exige un mayor desarrollo investigativo que permita conocer este fenómeno en el contexto colombiano y latinoamericano.
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Gallo-Bernal S, Calixto CA, Molano-González N, Moreno MPD, Tamayo MF, Contreras JP, Medina HM, Rodríguez MJ. Impact of a pharmacist-based multidimensional intervention aimed at decreasing the risk of hyperkalemia in heart failure patients: A Latin-American experience. Int J Cardiol 2021; 329:136-143. [PMID: 33412183 DOI: 10.1016/j.ijcard.2020.12.081] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 12/21/2020] [Accepted: 12/28/2020] [Indexed: 11/26/2022]
Abstract
AIMS Hyperkalemia is a potentially life-threatening condition associated with the use of heart failure (HF) medications, which can lead to increased morbidity and mortality. Novel approaches for hyperkalemia prevention are needed, especially in limited-resource settings. Despite multiple studies showing the beneficial impact of pharmaceutical-counseling in several outcomes, there is a knowledge-gap regarding its impact on hyperkalemia prevention. METHODS A case-control study was performed in patients from the Adult Heart Failure Clinic Registry in our institution. Cases were selected using a definition of serum potassium K+ ≥5.5 mmol/L. To study the association between hyperkalemia and relevant risk factors, we performed a multivariate logistic regression analysis using the Least Absolute Shrinkage and Selection Operator (LASSO) method for variable selection. We also fitted a Classification and Regression Tree (CART) to establish complex interactions and effect modifiers between the selected variables. RESULTS We matched 483 controls (eligible HF patients without hyperkalemia) to 132 cases (eligible HF patients with hyperkalemia based on age and calendar, yielding a total sample size of 615 patients (270 females) for this study. Cases had statistically significant lower odds of receiving a pharmacist-based multidimensional intervention (PBMI) (OR 0.57; 95% CI, 0.43-0.80) or having HF with reduced ejection fraction (OR 0.56; 95% CI, 0.18-0.72). On the other hand, patients who presented hyperkalemia had statistically significant higher odds of having a history of chronic kidney disease stage 4 (OR 4.97; 95% CI, 2.24-11.01) or 5 (OR 6.73; 95% CI, 1.69-26.84) and being on enalapril at doses =40 mg/day (OR, 9.90; 95% CI 5.81-16.87). CONCLUSIONS PBMI is a practical approach to prevent hyperkalemia in HF patients in a limited-resource setting. However, clinical trials are needed to assess its effectiveness.
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Affiliation(s)
- Sebastian Gallo-Bernal
- Division of Cardiology, Fundación Cardio-infantil - Instituto de Cardiología, Bogotá, Colombia; School of Medicine and Health Sciences, Universidad del Rosario, Bogotá, Colombia.
| | - Camilo A Calixto
- Division of Cardiology, Fundación Cardio-infantil - Instituto de Cardiología, Bogotá, Colombia; School of Medicine and Health Sciences, Universidad del Rosario, Bogotá, Colombia
| | | | | | - María Fernanda Tamayo
- Division of Cardiology, Fundación Cardio-infantil - Instituto de Cardiología, Bogotá, Colombia
| | | | - Hector M Medina
- Division of Cardiology, Fundación Cardio-infantil - Instituto de Cardiología, Bogotá, Colombia; School of Medicine and Health Sciences, Universidad del Rosario, Bogotá, Colombia
| | - María Juliana Rodríguez
- Division of Cardiology, Fundación Cardio-infantil - Instituto de Cardiología, Bogotá, Colombia.
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Leménager P, Franck YK, Corlin F, Bouscaren N, Nacher M, Adenis A. Aetiological and morphological spectrum of cardiomyopathies in French Guiana: a retrospective study. Open Heart 2020; 7:openhrt-2019-001206. [PMID: 32404486 PMCID: PMC7228657 DOI: 10.1136/openhrt-2019-001206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 03/18/2020] [Accepted: 04/13/2020] [Indexed: 11/24/2022] Open
Abstract
Introduction Cardiomyopathies are a heterogeneous heart diseases group in terms of morphology and aetiology. Hypothesising a tropical specificity and given an absence of data in French Guiana, the primary objective of our study was to describe morphologies and aetiologies of cardiomyopathies observed at Cayenne General Hospital. Methods A cross-sectional study was conducted in Cayenne Hospital from 1 January 2009 to 1 June 2014 in the hospital database. Only patients with the definition of the European Society of Cardiology (ESC) were included, based on the first transthoracic ultrasonography found during the study period. Medical files were consulted. Results With 182 patients included, the prevalence of cardiomyopathies among heart diseases was estimated at 4.3% (95% CI 3.7% to 4.9%). Twelve patients had a familial or genetic aetiology (6.6%) and 170 a non-familial or non-genetic aetiology (93.4%). The morphological spectrum was: dilated for 114 patients (62.6%), hypertrophic for 27 (14.8%), unclassified for 1 (0.5%) and non-classifiable for 13 (7.1%). This group was constituted of patients with a systolic and/or diastolic functional impairment without morphological abnormality. The aetiological spectrum found 184 aetiologies including: 70.9% undetermined, 8.7% infectious (with 6.5% chagasic and 0.5% related with human immunodeficiency virus) and 6.0% with toxins. Conclusions Cardiomyopthies are a common and severe clinical problem. The frequency of infectious aetiologies and dilated impairment are arguments for cardiomyopathies with tropical particularities. However, the preponderance of undetermined aetiologies justifies the development of further research programmes.
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Affiliation(s)
- Paul Leménager
- CIC INSERM 1424, Centre Hospitalier Andree Rosemon, Cayenne, French Guiana
| | - Yves-Kenol Franck
- Service de Cardiologie, Centre Hospitalier Andree Rosemon, Cayenne, French Guiana
| | - Florine Corlin
- CIC INSERM 1424, Centre Hospitalier Andree Rosemon, Cayenne, French Guiana
| | - Nicolas Bouscaren
- CIC INSERM 1424, Centre Hospitalier Andree Rosemon, Cayenne, French Guiana
| | - Mathieu Nacher
- CIC INSERM 1424, Centre Hospitalier Andree Rosemon, Cayenne, French Guiana
| | - Antoine Adenis
- CIC INSERM 1424, Centre Hospitalier Andree Rosemon, Cayenne, French Guiana
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González-Pacheco H, Álvarez-Sangabriel A, Martínez-Sánchez C, Briseño-Cruz JL, Altamirano-Castillo A, Mendoza-García S, Manzur-Sandoval D, Amezcua-Guerra LM, Sandoval J, Bojalil R, Araiza-Garaygordobil D, Sierra-Lara D, Guiza-Sánchez CA, Gopar-Nieto R, Cruz-Rodríguez C, Valdivia-Nuño JJ, Salas-Teles B, Arias-Mendoza A. Clinical phenotypes, aetiologies, management, and mortality in acute heart failure: a single-institution study in Latin-America. ESC Heart Fail 2020; 8:423-437. [PMID: 33179453 PMCID: PMC7835571 DOI: 10.1002/ehf2.13092] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 10/12/2020] [Accepted: 10/22/2020] [Indexed: 12/12/2022] Open
Abstract
Aims Little is known regarding acute heart failure (AHF) clinical characteristics and its hospital outcome in Latin America. This study sought to assess the prevalence of, and identify differences among, in‐hospital outcomes in patients hospitalized for AHF who were stratified by clinical phenotype at a hospital in Latin America. Methods and results This is a retrospective cohort study of patients with AHF who were hospitalized in the coronary care unit of a Latin American teaching hospital from January 2006 to December 2018. Cox regression analysis was used to identify predictors of mortality. Of 21 042 patients admitted, 7759 (36.6%) had AHF. Their median age was 62 years, and 35% were women. De novo heart failure was seen in 39.4% of patients. Most common was AHF‐associated acute coronary syndromes (ACS‐HF) in 43.0%, decompensated heart failure (DHF) in 33.7%, hypertensive heart failure (HT‐HF) in 11.8%, and cardiogenic shock (CS) in 5.2%. Pulmonary oedema (PO) (3.3%) and right heart failure (RHF) (3.0%) were least frequent. Coronary artery disease was the most frequent aetiology in 56.5% of patients, valvular heart disease in 22.4%, and cardiomyopathies in 12.3%. Other less frequent aetiology included adult congenital heart disease (2.5%), lung diseases (2.1%), acute aortic syndromes (1.4%), pericardial diseases (0.8%), and intracardiac tumours (0.3%). Aetiology could not be established in 1.6% of patients. Before admission, patients with worsening chronic heart failure and reduced ejection fraction were treated with renin–angiotensin system blockers (60.4%), beta‐blockers (42.5%), or spironolactone (34.4%). The percentages of patients given in‐hospital management with intravenous diuretics, vasodilators, inotropes, and vasopressors were 81.2%, 33.4%, 18.9%, and 20.4%, respectively. The overall in‐hospital mortality was 17.9% (71.3%, 43.9%, 23.8%, 14.9%, 13.6%, and 10.1% for CS, PO, RHF, DHF, ACS‐HF, and HT‐HF, respectively; P < 0.0001). Multivariate analysis revealed that PO (hazard ratio [HR] 2.68, 95% confidence interval [CI] 1.73–4.14, P < 0.0001) and CS (HR 3.37, 95% CI 2.12–5.35, P < 0.0001) were independent predictors of in‐hospital mortality. Use of intravenous diuretics was linked to reduction of in‐hospital mortality (HR 0.70, 95% CI 0.59–0.59, P < 0.0001). By contrast, increased in‐hospital mortality was associated with the use of intravenous inotrope or vasopressor (HR 1.49, 95% CI 1.27–1.76 and HR 2.91, 95% CI 2.41–3.51, P < 0.0001, respectively). Conclusions Real‐world evidence from a university hospital in Latin America shows that the high mortality among patients with AHF may depend, among other factors, on patients' AHF clinical phenotypes. The clinical characteristics and aetiologies of AHF appear to differ between these data from Mexico and those from European and US registries.
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Affiliation(s)
- Héctor González-Pacheco
- Coronary Care Unit, National Institute of Cardiology in Mexico City, Juan Badiano, Sección XVI, Tlalpan, Mexico City, 14080, Mexico
| | - Amada Álvarez-Sangabriel
- Heart Failure Clinic and Transplantation, National Institute of Cardiology in Mexico City, Mexico City, Mexico
| | - Carlos Martínez-Sánchez
- Coronary Care Unit, National Institute of Cardiology in Mexico City, Juan Badiano, Sección XVI, Tlalpan, Mexico City, 14080, Mexico
| | - José L Briseño-Cruz
- Coronary Care Unit, National Institute of Cardiology in Mexico City, Juan Badiano, Sección XVI, Tlalpan, Mexico City, 14080, Mexico
| | - Alfredo Altamirano-Castillo
- Coronary Care Unit, National Institute of Cardiology in Mexico City, Juan Badiano, Sección XVI, Tlalpan, Mexico City, 14080, Mexico
| | - Salvador Mendoza-García
- Coronary Care Unit, National Institute of Cardiology in Mexico City, Juan Badiano, Sección XVI, Tlalpan, Mexico City, 14080, Mexico
| | - Daniel Manzur-Sandoval
- Coronary Care Unit, National Institute of Cardiology in Mexico City, Juan Badiano, Sección XVI, Tlalpan, Mexico City, 14080, Mexico
| | - Luis M Amezcua-Guerra
- Department of Immunology, National Institute of Cardiology in Mexico City, Mexico City, Mexico
| | - Julio Sandoval
- Department of Immunology, National Institute of Cardiology in Mexico City, Mexico City, Mexico
| | - Rafael Bojalil
- Department of Immunology, National Institute of Cardiology in Mexico City, Mexico City, Mexico
| | - Diego Araiza-Garaygordobil
- Coronary Care Unit, National Institute of Cardiology in Mexico City, Juan Badiano, Sección XVI, Tlalpan, Mexico City, 14080, Mexico
| | - Daniel Sierra-Lara
- Coronary Care Unit, National Institute of Cardiology in Mexico City, Juan Badiano, Sección XVI, Tlalpan, Mexico City, 14080, Mexico
| | - Carlos A Guiza-Sánchez
- Heart Failure Clinic and Transplantation, National Institute of Cardiology in Mexico City, Mexico City, Mexico
| | - Rodrigo Gopar-Nieto
- Coronary Care Unit, National Institute of Cardiology in Mexico City, Juan Badiano, Sección XVI, Tlalpan, Mexico City, 14080, Mexico
| | - Camelia Cruz-Rodríguez
- Coronary Care Unit, National Institute of Cardiology in Mexico City, Juan Badiano, Sección XVI, Tlalpan, Mexico City, 14080, Mexico
| | - José J Valdivia-Nuño
- Coronary Care Unit, National Institute of Cardiology in Mexico City, Juan Badiano, Sección XVI, Tlalpan, Mexico City, 14080, Mexico
| | - Brandon Salas-Teles
- Coronary Care Unit, National Institute of Cardiology in Mexico City, Juan Badiano, Sección XVI, Tlalpan, Mexico City, 14080, Mexico
| | - Alexandra Arias-Mendoza
- Coronary Care Unit, National Institute of Cardiology in Mexico City, Juan Badiano, Sección XVI, Tlalpan, Mexico City, 14080, Mexico
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Fernandes ADF, Fernandes GC, Mazza MR, Knijnik LM, Fernandes GS, Vilela ATD, Badiye A, Chaparro SV. A 10-Year Trend Analysis of Heart Failure in the Less Developed Brazil. Arq Bras Cardiol 2020; 114:222-231. [PMID: 32215488 PMCID: PMC7077585 DOI: 10.36660/abc.20180321] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Accepted: 04/10/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Data on heart failure (HF) epidemiology in less developed areas of Brazil are scarce. OBJECTIVE Our aim was to determine the HF morbidity and mortality in Paraiba and Brazil and its 10-year trends. METHODS A retrospective search was conducted from 2008 to 2017 using the DATASUS database and included patients ≥ 15 years old with a primary diagnosis of HF. Data on in-hospital and population morbidity and mortality were collected and stratified by year, gender and age. Pearson correlation and linear-by-linear association test for trends were calculated, with a level of significance of 5%. RESULTS From 2008 to 2017, HF admissions decreased 62% (p = 0.004) in Paraiba and 34% (p = 0.004) in Brazil. The in-hospital mortality rate increased in Paraiba and Brazil [65.1% (p = 0.006) and 30.1% (p = 0.003), respectively], but the absolute in-hospital mortality had a significant decrease only in Paraiba [37.5% (p = 0.013)], which was maintained after age stratification, except for groups 15-19, 60-69 and > 80 years. It was observed an increase in the hospital stay [44% (p = 0.004) in Paraiba and 12.3% (p = 0.004) in Brazil]. From 2008 to 2015, mortality rate for HF in the population decreased 10.7% (p = 0.047) in Paraiba and 7.7% (p = 0.017) in Brazil. CONCLUSIONS Although HF mortality rate has been decreasing in Paraiba and Brazil, an increase in the in-hospital mortality rate and length of stay for HF has been observed. Hospital-based clinical studies should be performed to identify the causes for these trends of increase.
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Affiliation(s)
- Amanda D F Fernandes
- University of Miami Miller School of Medicine - Department of Medicine, Miami, Florida - USA
| | - Gilson C Fernandes
- University of Miami Miller School of Medicine - Division of Cardiology, Miami, Florida - USA
| | - Manuel Rivera Mazza
- University of Miami Miller School of Medicine - Department of Medicine, Miami, Florida - USA
| | - Leonardo M Knijnik
- University of Miami Miller School of Medicine - Department of Medicine, Miami, Florida - USA
| | | | | | - Amit Badiye
- University of Miami Miller School of Medicine - Division of Cardiology, Miami, Florida - USA
| | - Sandra V Chaparro
- University of Miami Miller School of Medicine - Division of Cardiology, Miami, Florida - USA
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34
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Imran T, Wong A, Schneeweiss S, Desai RJ. Statin Lipophilicity and the Risk of Incident Heart Failure. Cardiology 2020; 145:375-383. [PMID: 32289796 DOI: 10.1159/000506003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 01/19/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND To compare the risk of incident heart failure (HF) between initiators of hydrophilic and lipophilic statins. METHODS Using claims data for commercial health insurance program enrollees in the USA (2005-2014), we identified new initiators of hydrophilic or lipophilic statins. Follow-up for the primary outcome of incident HF began after a lag period of 1 year after statin initiation. The outcome was defined as 1 inpatient or 2 outpatient diagnosis codes for HF and the use of loop diuretics. Propensity scores (PS) were used to account for confounding. Hazard ratios (HR) for incident HF were computed separately for low and high-intensity statin users, and then pooled to provide dose-adjusted effect estimates. RESULTS A total of 7,820,204 patients met all our inclusion criteria for statin initiation (hydrophilic and lipophilic statins). Mean age was 58 years, 40% had hypertension, and 23% had diabetes mellitus. After PS matching, there were 691,584 patients in the low-intensity statin group and 807,370 patients in the high-intensity statin group. After a median follow-up of 725 days (IQR 500-1,153),there were 8,389 cases of incident HF (incidence rate 4.5/1,000 person years, 95% confidence interval [CI] 4.4-4.6). The unadjusted HR for the risk of HF was 0.77 (95% CI 0.76-0.79) and the pooled adjusted HR for incident HF after PS matching was 0.94 (95% CI 0.90-0.98) for hydrophilic versus lipophilic statins. The HR for incident HF was 1.06 (95% CI 1.00-1.12) for hydrophilic versus lipophilic statins for the low-intensity statin group and 0.82 (95% CI 0.78-0.87) for the high-intensity statin group. In subgroup analyses, a similar trend persisted for those younger and older than 65 years and when comparing rosuvastatin with atorvastatin. CONCLUSION In this observational cohort study, hydrophilic statins were associated with a modest risk reduction in incident HF as compared to lipophilic statins. Future research replicating these findings in different populations is recommended.
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Affiliation(s)
- Tasnim Imran
- Cardiology Section, Department of Medicine, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, USA.,Division of Aging, Department of Medicine, Brigham and Women's Hospital, and Harvard Medical School, Boston, Massachusetts, USA
| | - Adrian Wong
- Division of General Internal Medicine and Primary Care, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Sebastian Schneeweiss
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Rishi J Desai
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA,
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35
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Lopes RD, Gimpelewicz C, McMurray JJV. Chagas disease: still a neglected emergency? Lancet 2020; 395:1113-1114. [PMID: 32247391 DOI: 10.1016/s0140-6736(20)30171-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Accepted: 01/17/2020] [Indexed: 11/16/2022]
Affiliation(s)
- Renato D Lopes
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC 27701, USA.
| | - Claudio Gimpelewicz
- Department of Medicine, Division of Cardiology, Novartis Pharma, Basel, Switzerland
| | - John J V McMurray
- Institute of Cardiovascular and Medical Sciences, BHF Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
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36
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Agbor VN, Ntusi NAB, Noubiap JJ. An overview of heart failure in low- and middle-income countries. Cardiovasc Diagn Ther 2020; 10:244-251. [PMID: 32420107 PMCID: PMC7225422 DOI: 10.21037/cdt.2019.08.03] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Heart failure (HF) is a global public health concern with disproportionate socioeconomic, morbidity and mortality burden on low- and middle-income countries (LMICs). This review summarises contemporary data on the demographic and clinical characteristics, aetiologies, treatment, economic burden and outcomes of HF in LMICs. Patients with HF in LMICs are younger than those from high-income countries (HICs) and present at advanced stages of the disease. Hypertension, ischaemic heart disease (IHD), cardiomyopathy (CMO), and rheumatic heart disease (RHD) are the leading causes of HF in LMICs. The contribution of infectious diseases to HF remains prominent in many LMICs. Most health facilities in LMICs lack adequate diagnostic tools for HF, and the use of evidence-based medical and device therapies is suboptimal. Further, HF in LMICs is associated with prolonged hospital stay and high in-hospital and one-year mortality. Finally, HF has profound economic impact on individual patients who, mostly, have no health insurance, and on societies where patients are young, comprising those who have the greatest potential to contribute to economic productivity.
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Affiliation(s)
- Valirie N Agbor
- Ibal Sub-Divisional Hospital, Oku, Northwest Region, Cameroon
- Department of Clinical Research, Health Education and Research Organization (HERO), Buea, Cameroon
| | - Ntobeko A B Ntusi
- Division of Cardiology, Department of Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
- Cape Universities Body Imaging Center, University of Cape Town, Cape Town, South Africa
- Hatter Institute for Cardiovascular Research in Africa, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Jean Jacques Noubiap
- Division of Cardiology, Department of Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
- Centre for Heart Rhythm Disorders, South Australian Health and Medical Research Institute (SAHMRI), University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
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37
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Ajayi AA, Sofowora GG, Ladipo GO. Explaining Heart Failure Hyper-mortality in Sub Saharan Africa: Global Genomic and Environmental Contribution Review. J Natl Med Assoc 2020; 112:141-157. [PMID: 32165009 DOI: 10.1016/j.jnma.2020.02.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 02/05/2020] [Accepted: 02/11/2020] [Indexed: 12/11/2022]
Abstract
The annual heart failure (HF) mortality rate in Africa is 34% according to the INTERHF study. This is twice the world average of 16.5% and 3.7 times that of South America, 9%. We review evidence-based explanations for the Hyper-mortality of HF, by comparison of North American, Caribbean, Afro-Brazilian with Sub-Saharan African (SSA) nations profiles, and suggest amelioration. 1 year HF mortality rates in SSA ranged from 29% to 58%, and intra-hospital mortality rate from 8 to 26% (n = 8). A clustering of adverse genetic single nucleotide polymorphisms (SNP) predisposing to hypertension and/or left ventricular hypertrophy (LVH) in the black diaspora may contribute. A higher prevalence of HF with reduced Ejection Fraction (HF r EF) phenotype, which is associated with greater mortality is more common in SSA nations. Additionally, a worse co-morbidity burden, especially valvular regurgitations causing LV remodeling (LVR), chronic kidney disease (CKD), anemia, lung disease, infections, late presentation in NYHA III/IV, right ventricular disease (RVD) were also common in SSA. Geographic variation in SSA, HF risk factors and co-morbidity was observed. There was sub-optimal use of guideline directed medical therapy (GDMT) and intracardiac device (ICD) unavailability. Gross Domestic Product -per purchasing power parity (GDP-PPP), which is low in SSA, was inversely correlated both to higher intra-hospital mortality rate % (r = -0.73, r 2 = 0.54 p = 0.038) and higher 1 year HF mortality rate % (r = -0.62, r 2 = 0.38, = 0.098). Localized primary prevention, early detection and prompt treatment of hypertension, diabetes, rheumatic fever, early cardiac valve repair and use of cardiovascular polypill, optimal use of GDMT, national health insurance scheme are advocated to stem the dismal mortality and cost burden of HF.
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Affiliation(s)
- Adesuyi A Ajayi
- Adjunct Professor, Department of Medicine, Division of Hypertension and Clinical Pharmacology, Baylor College of Medicine, Houston, TX, 77060, USA.
| | - Gbemiga G Sofowora
- Associate Professor of Cardiology, Cardiovascular Medicine Division, Ohio State University Medical Center, Columbus, OH, 43210, USA
| | - Gani O Ladipo
- Retired Professor of Cardiology, Obafemi Awolowo University, Ile -ife, Osun State, Nigeria
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38
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Oliveira APDD, Cavalcante AMRZ, Carneiro CDS, Santos VB, Moorhead S, Lopes JDL, Barros ALBLD. Health education: the effectiveness of interventions in patients with heart failure. Rev Bras Enferm 2020; 73:e20180782. [PMID: 32159695 DOI: 10.1590/0034-7167-2018-0782] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Accepted: 04/26/2019] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES To evaluate the effectiveness of NIC interventions "Teaching: Disease Process", "Health Education" and "Cardiac Care" in the improvement of NOC results in individuals with Heart Failure (HF), and the Nursing Diagnosis (ND) "Ineffective Health Control". METHODS Retrospective cohort, conducted at a Health Education in Nursing outpatient clinic. Fourteen patients with HF had follow-up for one year in six bimonthly consultations. The effectiveness of interventions was verified through the change of the result scores through the Friedman's Non-Parametric Test and Analysis of Non-Parametric Variance for repeated measures. The level of significance was 5%. RESULTS The interventions were implemented in consultations in a variety of activities. There was a significant improvement in the result scores until the fourth visit (p<0.001). CONCLUSIONS The interventions were effective in improving outcomes in patients with HF and Ineffective Health Control.
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Affiliation(s)
| | | | | | | | - Sue Moorhead
- University of Iowa. Iowa, United States of America
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39
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Hoffman KA, Reynolds C, Bottazzi ME, Hotez P, Jones K. Improved Biomarker and Imaging Analysis for Characterizing Progressive Cardiac Fibrosis in a Mouse Model of Chronic Chagasic Cardiomyopathy. J Am Heart Assoc 2019; 8:e013365. [PMID: 31718442 PMCID: PMC6915297 DOI: 10.1161/jaha.119.013365] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Background Chronic chagasic cardiomyopathy (CCC), caused by Trypanosoma cruzi infection, is an important public health problem attributable to progressive cardiomyopathy in patients, for which there is no cure. Chronic chagasic cardiomyopathy is characterized by myocarditis and cardiac fibrosis, which leads to life‐threatening arrhythmogenic and circulatory abnormalities. This study aimed to investigate cardiac fibrosis progression in a mouse model of chronic chagasic cardiomyopathy. Methods and Results Cardiac cells infected with T cruzi produced significantly higher concentrations of transforming growth factor‐β (TGF‐β), connective tissue growth factor, endothelin‐1, and platelet‐derived growth factor‐D than noninfected controls. Female Balb/c mice infected with T cruzi were compared with naïve mice. TGF‐β genes and other TGF‐β superfamily genes, as well as connective tissue growth factor, endothelin‐1, and platelet‐derived growth factor, were upregulated in infected mouse hearts. Serum concentrations of TGF‐β, connective tissue growth factor, and platelet‐derived growth factor‐D were higher in infected mice and correlated with cardiac fibrosis. Strain analysis performed on magnetic resonance images at 111 and 140 days postinfection and echocardiography images at 212 days postinfection revealed significantly elevated left ventricular strain and cardiac fibrosis and concomitantly significantly decreased cardiac output in infected mice. Conclusions TGF‐β, connective tissue growth factor and platelet‐derived growth factor‐D are potentially useful biomarkers of cardiac fibrosis, as they correlate with cardiac fibrosis. Strain analysis allows for use of noninvasive methods to measure fibrosis in the chronic stages of chagasic cardiomyopathy in a mouse model. These findings can be applied as noninvasive tools to study the effects of interventions and/or therapeutics on cardiac fibrosis development when using a mouse model of chronic chagasic cardiomyopathy.
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Affiliation(s)
- Kristyn A Hoffman
- Department of Molecular Virology and Microbiology Baylor College of Medicine Houston TX.,Texas Children's Hospital Center for Vaccine Development Houston TX
| | - Corey Reynolds
- Department of Molecular Physiology Baylor College of Medicine Houston TX
| | - Maria Elena Bottazzi
- Department of Molecular Virology and Microbiology Baylor College of Medicine Houston TX.,Department of Pediatrics Section of Tropical Medicine Baylor College of Medicine Houston TX.,Texas Children's Hospital Center for Vaccine Development Houston TX.,Department of Biology Baylor University Waco TX
| | - Peter Hotez
- Department of Molecular Virology and Microbiology Baylor College of Medicine Houston TX.,Department of Pediatrics Section of Tropical Medicine Baylor College of Medicine Houston TX.,Texas Children's Hospital Center for Vaccine Development Houston TX.,Department of Biology Baylor University Waco TX
| | - Kathryn Jones
- Department of Molecular Virology and Microbiology Baylor College of Medicine Houston TX.,Department of Pediatrics Section of Tropical Medicine Baylor College of Medicine Houston TX.,Texas Children's Hospital Center for Vaccine Development Houston TX
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40
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Spadaro AG, Bocchi EA, Souza GE, Filho AE, Mariani J, Campos CM, Lemos PA. Renal denervation in patients with heart failure secondary to Chagas' disease: A pilot randomized controlled trial. Catheter Cardiovasc Interv 2019; 94:644-650. [PMID: 31334914 DOI: 10.1002/ccd.28393] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2019] [Accepted: 06/27/2019] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Chagas disease is one of the most relevant endemic parasitic diseases in Latin America, affecting approximately 6 million people. Overt Chagas heart disease is an ominous condition, occurring in 20-30% of infected individuals, which has besides the persistent myocarditis a peculiar intracardiac ganglionic neuronal depletion and dysautonomy. This study aims to evaluate the safety and feasibility of renal denervation for patients with advanced symptomatic Chagas cardiomyopathy. METHODS Open-label prospective pilot study that randomized patients with Chagas heart disease to either renal denervation or conservative treatment (2:1 ratio). The primary endpoint was the incidence of major adverse events at 9 months, defined as a composite of all-cause death, myocardial infarction, stroke, need for renal artery invasive treatment, or worsening renal function. RESULTS A total of 17 patients were allocated for renal denervation (n = 11) or conservative treatment (n = 6). Included patients had severe symptomatic heart disease, with markedly depressed left ventricular function (average ejection fraction 26.7 ± 4.9%). For patients randomized to renal denervation, the procedure was performed successfully and uneventfully. After 9 months, the primary endpoint occurred in 36.4% of patients in the renal denervation group and 50.0% in the control arm (p = .6). After 9 months, clinical, laboratory, functional, echocardiographic, and quality of life parameters were similar between groups. CONCLUSIONS This pilot study suggests that renal denervation is safe and feasible in patients with Chagas cardiomyopathy, warranting future studies to better evaluate the clinical efficacy of the interventional strategy in improving the prognosis of this high-risk population.
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Affiliation(s)
- André G Spadaro
- Heart Institute (InCor), University of São Paulo Medical School, São Paulo, São Paulo, Brazil
| | - Edimar A Bocchi
- Heart Institute (InCor), University of São Paulo Medical School, São Paulo, São Paulo, Brazil
| | - Germano E Souza
- Heart Institute (InCor), University of São Paulo Medical School, São Paulo, São Paulo, Brazil
| | - Antonio E Filho
- Heart Institute (InCor), University of São Paulo Medical School, São Paulo, São Paulo, Brazil
| | - José Mariani
- Heart Institute (InCor), University of São Paulo Medical School, São Paulo, São Paulo, Brazil.,Hospital Israelita Albert Einstein, São Paulo, São Paulo, Brazil
| | - Carlos M Campos
- Heart Institute (InCor), University of São Paulo Medical School, São Paulo, São Paulo, Brazil.,Hospital Israelita Albert Einstein, São Paulo, São Paulo, Brazil
| | - Pedro A Lemos
- Heart Institute (InCor), University of São Paulo Medical School, São Paulo, São Paulo, Brazil.,Hospital Israelita Albert Einstein, São Paulo, São Paulo, Brazil
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41
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Tromp J, Ferreira JP, Janwanishstaporn S, Shah M, Greenberg B, Zannad F, Lam CS. Heart failure around the world. Eur J Heart Fail 2019; 21:1187-1196. [DOI: 10.1002/ejhf.1585] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 05/23/2019] [Accepted: 07/17/2019] [Indexed: 12/19/2022] Open
Affiliation(s)
- Jasper Tromp
- National Heart Centre Singapore Singapore
- Duke‐NUS Medical School Singapore
- Department of Cardiology University Medical Centre Groningen, University of Groningen Groningen The Netherlands
| | - João Pedro Ferreira
- Université de Lorraine, Inserm, Centre d'Investigations Cliniques‐ Plurithématique 14‐33, and Inserm U1116, CHRU, F‐CRIN INI‐CRCT (Cardiovascular and Renal Clinical Trialists) Nancy France
| | - Satit Janwanishstaporn
- Division of Cardiology, Department of Medicine, Faculty of Medicine Siriraj Hospital Mahidol University Bangkok Thailand
| | | | - Barry Greenberg
- Division of Cardiovascular Medicine UC San Diego Health System La Jolla NC USA
| | - Faiez Zannad
- Université de Lorraine, Inserm, Centre d'Investigations Cliniques‐ Plurithématique 14‐33, and Inserm U1116, CHRU, F‐CRIN INI‐CRCT (Cardiovascular and Renal Clinical Trialists) Nancy France
| | - Carolyn S.P. Lam
- National Heart Centre Singapore Singapore
- Duke‐NUS Medical School Singapore
- Department of Cardiology University Medical Centre Groningen, University of Groningen Groningen The Netherlands
- The George Institute for Global Health Sydney Australia
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Martinez F, Perna E, Perrone SV, Liprandi AS. Chagas Disease and Heart Failure: An Expanding Issue Worldwide. Eur Cardiol 2019; 14:82-88. [PMID: 31360228 PMCID: PMC6659042 DOI: 10.15420/ecr.2018.30.2] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Accepted: 04/01/2019] [Indexed: 01/28/2023] Open
Abstract
Chagas disease, originally a South American endemic health problem, is expanding worldwide because of people migration. Its main impact is on the cardiovascular system, producing myocardial damage that frequently results in heart failure. Pathogenic pathways are mainly related to inmunoinflamatory reactions in the myocardium and, less frequently, in the gastrointestinal tract. The heart usually shows fibrosis, producing dilatation and damage of the electrogenic cardiac system. These changes result in cardiomyopathy with heart failure and frequent cardiac arrhythmias and heart blocks. Diagnosis of the disease must include a lab test to detect the parasite or its immune reactions and the usual techniques to evaluate cardiac function. Therapeutic management of Chagas heart failure does not differ significantly from the most common treatment for dilated cardiomyopathy, with special focus on arrhythmias and several degrees of heart block. Heart transplantation is reserved for end-stage cases. Major international scientific organisations are delivering recommendations for prevention and early diagnosis. This article provides an analysis of epidemiology, prevention, treatment and the relationship between Chagas disease and heart failure.
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Affiliation(s)
- Felipe Martinez
- Cordoba National University, Instituto DAMIC Córdoba, Argentina.,Docencia, Asistencia Médica e Investigación Clínica (DAMIC) Medical Institute, Rusculleda Foundation for Research Córdoba Argentina
| | - Eduardo Perna
- Coronary Care Unit and Heart Failure Division, Juana Cabral Cardiovascular Institute Corrientes, Argentina
| | - Sergio V Perrone
- El Cruce Hospital Buenos Aires, Argentina.,Argentine Catholic University Buenos Aires, Argentina
| | - Alvaro Sosa Liprandi
- Cardiovascular Division, Sanatorio Güemes Hospital Buenos Aires, Argentina.,Postgraduate Medical School in Cardiology Universidad de Buenos Aires, Argentina
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Lotz-Esquivel S, Matarrita-Quesada B, Monge-Bonilla C, Kuhn-Delgadillo K. Cirugía cardiaca en Costa Rica: caracterización de los pacientes en el Hospital San Juan de Dios del 2010 al 2015. CIRUGIA CARDIOVASCULAR 2019. [DOI: 10.1016/j.circv.2018.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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The Globalization of Health Information in Different Languages. J Am Coll Cardiol 2019; 73:375-377. [DOI: 10.1016/j.jacc.2018.11.021] [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: 11/18/2022]
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Sosa-Liprandi Á, Sosa Liprandi MI, Alexánderson E, Avezum Á, Lanas F, López-Jaramillo JP, Martínez F, Ponte-Negretti N CI, Wyss F, González Juanatey JR, Perel P. Clinical Impact of the Polypill for Cardiovascular Prevention in Latin America: A Consensus Statement of the Inter-American Society of Cardiology. Glob Heart 2018; 14:3-16.e1. [PMID: 30502220 DOI: 10.1016/j.gheart.2018.10.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Revised: 06/20/2018] [Accepted: 10/16/2018] [Indexed: 01/22/2023] Open
Abstract
The burden of cardiovascular diseases (CVD) is increasing, particularly in low-middle-income countries such as most of Latin America. This region presents specific socioeconomic characteristics, generating a high incidence of CVD despite efforts to control the problem. A consensus statement has been developed by Inter-American Society of Cardiology with the aim of answering some important questions related to CVD in this region and the role of the polypill in cardiovascular (CV) prevention as an intervention to address these issues. A multidisciplinary team composed of Latin American experts in the prevention of CVD was convened by the Inter-American Society of Cardiology and participated in the process and the formulation of statements. To characterize the prevailing situation in Latin American countries, we describe the most significant CV risk factors in the region. The barriers that impair the use of CV essential medications are also reviewed. The role of therapeutic adherence in CV prevention and how the polypill emerges as an effective strategy for optimizing adherence, accessibility, and affordability in the treatment of CVDs are discussed in detail. Clinical scenarios in which the polypill could represent an effective intervention in primary and secondary CV prevention are described. This initiative is expected to help professionals involved in the management of CVD and public health policymakers develop optimal strategies for the management of CVDs.
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Affiliation(s)
| | | | - Erick Alexánderson
- Department of Physiology, Faculty of Medicine, Universidad Nacional Autónoma de México, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico
| | - Álvaro Avezum
- Instituto Dante Pazzanese de Cardiología, Saõ Paulo, Brazil
| | | | - José Patricio López-Jaramillo
- Clínica Fundación Oftalmologica de Santander/Clínica Carlos Ardila Lulle, Bucaramanga, Colombia; Eugenio Espejo Faculty of Health Sciences, Universidad Tecnológica Equinoccial, Quito, Ecuador
| | | | | | - Fernando Wyss
- Servicios y Tecnología Cardiovascular de Guatemala S.A., CARDIOSOLUTIONS, Guatemala, Guatemala
| | | | - Pablo Perel
- Centre for Global Chronic Conditions, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Purinergic Antagonist Suramin Aggravates Myocarditis and Increases Mortality by Enhancing Parasitism, Inflammation, and Reactive Tissue Damage in Trypanosoma cruzi-Infected Mice. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2018; 2018:7385639. [PMID: 30364017 PMCID: PMC6186315 DOI: 10.1155/2018/7385639] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Accepted: 08/27/2018] [Indexed: 12/11/2022]
Abstract
Suramin (Sur) acts as an ecto-NTPDase inhibitor in Trypanosoma cruzi and a P2-purinoceptor antagonist in mammalian cells. Although the potent antitrypanosomal effect of Sur has been shown in vitro, limited evidence in vivo suggests that this drug can be dangerous to T. cruzi-infected hosts. Therefore, we investigated the dose-dependent effect of Sur-based chemotherapy in a murine model of Chagas disease. Seventy uninfected and T. cruzi-infected male C57BL/6 mice were randomized into five groups: SAL = uninfected; INF = infected; SR5, SR10, and SR20 = infected treated with 5, 10, or 20 mg/kg Sur. In addition to its effect on blood and heart parasitism, the impact of Sur-based chemotherapy on leucocytes myocardial infiltration, cytokine levels, antioxidant defenses, reactive tissue damage, and mortality was analyzed. Our results indicated that animals treated with 10 and 20 mg/kg Sur were disproportionally susceptible to T. cruzi, exhibiting increased parasitemia and cardiac parasitism (amastigote nests and parasite load (T. cruzi DNA)), intense protein, lipid and DNA oxidation, marked myocarditis, and mortality. Animals treated with Sur also exhibited reduced levels of nonprotein antioxidants. However, the upregulation of catalase, superoxide dismutase, and glutathione-S-transferase was insufficient to counteract reactive tissue damage and pathological myocardial remodeling. It is still poorly understood whether Sur exerts a negative impact on the purinergic signaling of T. cruzi-infected host cells. However, our findings clearly demonstrated that through enhanced parasitism, inflammation, and reactive tissue damage, Sur-based chemotherapy contributes to aggravating myocarditis and increasing mortality rates in T. cruzi-infected mice, contradicting the supposed relevance attributed to this drug for the treatment of Chagas disease.
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Bocchi EA, Rassi S, Veiga Guimarães G. Reply: Sacubitril/valsartan for Chagas' heart disease heart failure? ESC Heart Fail 2018; 5:1072-1073. [PMID: 30298997 PMCID: PMC6300805 DOI: 10.1002/ehf2.12344] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 06/22/2018] [Indexed: 01/04/2023] Open
Affiliation(s)
| | - Salvador Rassi
- Medical School, Federal University of Goias, Goiania, Brazil
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Bocchi EA, da Cruz FÁDD, BrandÃo SM, Issa V, Ayub-Ferreira SM, Brunner la Rocca HP, Wijk SS. Cost-Effectiveness Benefits of a Disease Management Program:The REMADHE Trial Results. J Card Fail 2018; 24:627-637. [DOI: 10.1016/j.cardfail.2018.04.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Revised: 04/16/2018] [Accepted: 04/25/2018] [Indexed: 01/16/2023]
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Bocchi EA, Rassi S, Guimarães GV. Safety profile and efficacy of ivabradine in heart failure due to Chagas heart disease: a post hoc analysis of the SHIFT trial. ESC Heart Fail 2018; 5:249-256. [PMID: 29266804 PMCID: PMC5933959 DOI: 10.1002/ehf2.12240] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2017] [Revised: 09/12/2017] [Accepted: 11/14/2017] [Indexed: 12/11/2022] Open
Abstract
AIMS The SHIFT trial showed that ivabradine reduced heart rate (HR) and the risk of cardiovascular outcomes. Concerns remain over the efficacy and safety of ivabradine on heart failure (HF) due to Chagas disease (ChD). We therefore conducted a post hoc analysis of the SHIFT trial to investigate the effect of ivabradine in these patients. METHODS AND RESULTS SHIFT was a randomized, double-blind, placebo-controlled trial in symptomatic systolic stable HF, HR ≥ 70 b.p.m., and in sinus rhythm. The ChD HF subgroup included 38 patients, 20 on ivabradine, and 18 on placebo. The ChD HF subgroup showed high prevalence of bundle branch right block and, compared with the overall SHIFT population, lower systolic blood pressure; higher use of diuretics, cardiac glycosides, and antialdosterone agents; and lower use of angiotensin-converting enzyme inhibitor/angiotensin II receptor blocker or target daily dose of beta-blocker. ChD HF presented a poor prognosis (all-cause mortality at 2 years was ~60%). The mean twice-daily dose of ivabradine was 6.26 ± 1.15 mg and placebo 6.43 ± 1.55 mg. Ivabradine reduced HR from 77.9 ± 3.8 to 62.3 ± 10.1 b.p.m. (P = 0.005) and improved functional class (P = 0.02). A trend towards reduction in all-cause death was observed in ivabradine arm vs. placebo (P = 0.07). Ivabradine was not associated with serious bradycardia, atrioventricular block, hypotension, or syncope. CONCLUSIONS ChD HF is an advanced form of HF with poor prognosis. Ivabradine was effective in reducing HR in these patients and improving functional class. Although our results are based on a very limited sample and should be interpreted with caution, they suggest that ivabradine may have a favourable benefit-risk profile in ChD HF patients.
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Affiliation(s)
- Edimar Alcides Bocchi
- Heart Institute (InCor)São Paulo University Medical School (HC‐FUMSP)Rua Dr Melo Alves 690, 4o andar, Bairro Cerqueira CesarSão PauloSão PauloCEP 014170‐010Brazil
| | - Salvador Rassi
- Medical SchoolFederal University of GoiásGoiâniaGoiásBrazil
| | - Guilherme Veiga Guimarães
- Heart Institute (InCor)São Paulo University Medical School (HC‐FUMSP)Rua Dr Melo Alves 690, 4o andar, Bairro Cerqueira CesarSão PauloSão PauloCEP 014170‐010Brazil
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Abstract
PURPOSE OF REVIEW Chronic breathlessness is common in patients with advanced illness who require palliative care. Achieving good symptom control can be challenging. More people with advanced illness live in low and middle income than in high-income countries, but they are much less likely to receive palliative care. Most of the emerging evidence for the palliative management of chronic breathlessness is from high-income countries. This review explores the context of chronic breathlessness in low-income settings, how evidence for control of chronic breathlessness might relate to these settings and where further work should be focused. RECENT FINDINGS Systems for control of noncommunicable diseases (NCDs) in these low-income contexts are poorly developed and health services are often overwhelmed with high levels both of NCD and communicable disease. Multidisciplinary and holistic approaches to disease management are often lacking in these settings. Developing an integrated primary care approach to NCD management is increasingly recognized as a key strategy and this should include palliative care. Most evidence-based approaches to the control of chronic breathlessness could be adapted for use in these contexts SUMMARY: Hand held fans, breathing techniques, graded exercise and use of low-dose morphine can all be used in low-income settings particularly in the context of holistic care. Research is needed into the most effective ways of implementing such interventions and palliative care needs to be promoted as a fundamental aspect of NCD management.
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