1
|
Zhou R, Pan D. Association between admission heart rate and in-hospital mortality in patients with acute exacerbation of chronic obstructive pulmonary disease and respiratory failure: a retrospective cohort study. BMC Pulm Med 2024; 24:111. [PMID: 38443791 PMCID: PMC10913584 DOI: 10.1186/s12890-024-02934-w] [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: 09/12/2023] [Accepted: 02/26/2024] [Indexed: 03/07/2024] Open
Abstract
BACKGROUND Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) combined with respiratory failure (RF) is a chronic respiratory disease that seriously endangers human health. This study aimed to specifically evaluate the relationship between admission heart rate (AHR) and in-hospital mortality in patients with combined AECOPD and RF to better inform clinical treatment. METHODS This retrospective cohort study included 397 patients admitted to a Chinese hospital between January 2021 and March 2023. The primary outcome measure was all-cause in-hospital mortality. Multivariate logistic regression analyses were performed to calculate adjusted hazard ratios (OR) with corresponding 95% confidence intervals (CI), and curve fitting and threshold effect were performed to address nonlinear relationships. RESULTS In total, 397 patients with AECOPD/RF were screened. The mean (± SD) age of the study cohort was 72.6 ± 9.5 years, approximately 49.4% was female, and the overall in-hospital mortality rate was 5%. Multivariate logistic regression analysis and smooth curve fitting revealed a nonlinear association between AHR and in-hospital mortality in the study population, with 100 beats/min representing the inflection point. Left of the inflection point, the effect size (OR) was 0.474 (95% CI 0.016 ~ 13.683; p = 0.6635). On the right side, each 1 beat/min increase in AHR resulted in an effect size (OR) of 1.094 (95% CI 1.01 ~ 1.186; p = 0.0281). CONCLUSIONS Results of the present study demonstrated a nonlinear relationship between AHR and in-hospital mortality in patients with AECOPD/RF. When AHR was < 100 beats/min, it was not statistically significant; however, AHR > 100 beats/min was a predictor of potential mortality, which increased by 9.4% for every 1 beat/min increase in AHR.
Collapse
Affiliation(s)
- Ruoqing Zhou
- Department of Respiratory Medicine, The First Affiliated Hospital of Jinzhou Medical University, Jinzhou, China
| | - Dianzhu Pan
- Department of Respiratory Medicine, The First Affiliated Hospital of Jinzhou Medical University, Jinzhou, China.
| |
Collapse
|
2
|
El Hussein MT, Job D, Hakkola J. Aortic Regurgitation: Review of Current Management. Dimens Crit Care Nurs 2024; 43:80-86. [PMID: 38271313 DOI: 10.1097/dcc.0000000000000628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2024] Open
Abstract
ABSTRACT Aortic regurgitation (AR) is a valvular disease characterized by retrograde blood flow from the aorta to the left ventricle. Various etiologies result in either an acute or chronic clinical presentation of AR and affect the severity of disease progression. Acute AR is a medical emergency caused by sudden increases in left ventricular volume. Immediate surgical intervention, vasoactive agents, and antibiotics are crucial for management. Chronic AR progresses gradually, leading to heart failure symptoms due to left ventricular remodeling. Diagnoses of both acute and chronic AR rely on electrocardiography, chest radiographs, and echocardiography. Cardiac magnetic resonance imaging may be incorporated in chronic AR diagnosis. Medical management of chronic AR aims to control hypertension and delay left ventricular dysfunction. Angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, and potentially calcium-channel blockers are recommended for chronic AR. β-Blockers are cautioned against because of their potential negative effects. This article emphasizes the importance of early diagnosis and prompt surgical intervention in AR. This review provides a comprehensive overview of the pathophysiology and clinical manifestations of acute and chronic AR and a medication regimen for treating chronic AR in the adult population.
Collapse
|
3
|
Ranard LS, Bonow RO, Nishimura R, Mack MJ, Thourani VH, Bavaria J, O'Gara PT, Bax JJ, Blanke P, Delgado V, Leipsic J, Lang RM, Michelena HI, Cavalcante JL, Vahl TP, Leon MB, Rigolin VH. Imaging Methods for Evaluation of Chronic Aortic Regurgitation in Adults: JACC State-of-the-Art Review. J Am Coll Cardiol 2023; 82:1953-1966. [PMID: 37940233 DOI: 10.1016/j.jacc.2023.08.051] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 08/21/2023] [Indexed: 11/10/2023]
Abstract
A global multidisciplinary workshop was convened to discuss the multimodality diagnostic evaluation of aortic regurgitation (AR). Specifically, the focus was on assessment tools for AR severity and analyzing evolving data on the optimal timing of aortic valve intervention. The key concepts from this expert panel are summarized as: 1) echocardiography is the primary imaging modality for assessment of AR severity; however, when data is incongruent or incomplete, cardiac magnetic resonance may be helpful; 2) assessment of left ventricular size and function is crucial in determining the timing of intervention; 3) recent evidence suggests current cutpoints for intervention in asymptomatic severe AR patients requires further scrutiny; 4) left ventricular end-systolic volume index has emerged as an additional parameter that has promise in guiding timing of intervention; and 5) the role of additional factors (including global longitudinal strain, regurgitant fraction, and myocardial extracellular volume) is worthy of future investigation.
Collapse
Affiliation(s)
- Lauren S Ranard
- Division of Cardiology, Columbia University Irving Medical Center, New York, New York, USA
| | - Robert O Bonow
- Division of Cardiology, Northwestern University Feinberg School of Medicine, Northwestern Memorial Hospital, Chicago, Illinois, USA
| | - Rick Nishimura
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Michael J Mack
- Division of Cardiothoracic Surgery, Heart Hospital Baylor Plano, Baylor Healthcare System, Plano, Texas, USA
| | - Vinod H Thourani
- Department of Cardiovascular Surgery, Marcus Valve Center, Piedmont Heart Institute, Atlanta, Georgia, USA
| | - Joseph Bavaria
- Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Patrick T O'Gara
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Centre, Leiden, the Netherlands
| | - Philipp Blanke
- Department of Radiology, St Paul's Hospital & University of British Columbia, Vancouver, British Columbia, Canada
| | - Victoria Delgado
- Department of Cardiology, Hospital University Germans Trias i Pujol, Badalona, Spain
| | - Jonathon Leipsic
- Department of Radiology, St Paul's Hospital & University of British Columbia, Vancouver, British Columbia, Canada
| | - Roberto M Lang
- Section of Cardiology, Heart and Vascular Center, University of Chicago Medical Center, Chicago, Illinois, USA
| | - Hector I Michelena
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - João L Cavalcante
- Division of Cardiology, Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Torsten P Vahl
- Division of Cardiology, Columbia University Irving Medical Center, New York, New York, USA
| | - Martin B Leon
- Division of Cardiology, Columbia University Irving Medical Center, New York, New York, USA
| | - Vera H Rigolin
- Division of Cardiology, Northwestern University Feinberg School of Medicine, Northwestern Memorial Hospital, Chicago, Illinois, USA.
| |
Collapse
|
4
|
Olshansky B, Ricci F, Fedorowski A. Importance of resting heart rate. Trends Cardiovasc Med 2023; 33:502-515. [PMID: 35623552 DOI: 10.1016/j.tcm.2022.05.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 05/20/2022] [Accepted: 05/20/2022] [Indexed: 11/30/2022]
Abstract
Resting heart rate is a determinant of cardiac output and physiological homeostasis. Although a simple, but critical, parameter, this vital sign predicts adverse outcomes, including mortality, and development of diseases in otherwise normal and healthy individuals. Temporal changes in heart rate can have valuable predictive capabilities. Heart rate can reflect disease severity in patients with various medical conditions. While heart rate represents a compilation of physiological inputs, including sympathetic and parasympathetic tone, aside from the underlying intrinsic sinus rate, how resting heart rate affects outcomes is uncertain. Mechanisms relating resting heart rate to outcomes may be disease-dependent but why resting heart rate in otherwise healthy, normal individuals affects outcomes remains obscure. For specific conditions, physiologically appropriate heart rate reductions may improve outcomes. However, to date, in the normal population, evidence that interventions aimed at reducing heart rate improves outcomes remains undefined. Emerging data suggest that reduction in heart rate via vagal activation and/or sympathetic inhibition is propitious.
Collapse
Affiliation(s)
- Brian Olshansky
- Division of Cardiology, Department of Internal Medicine, University of Iowa, Iowa City, IA 52242, USA.
| | - Fabrizio Ricci
- Department of Neuroscience, Imaging and Clinical Sciences, "G.d'Annunzio" University of Chieti-Pescara, Via dei Vestini, 33, Chieti 66100, Italy; Department of Clinical Sciences, Lund University, 214 28 Malmö, Sweden
| | - Artur Fedorowski
- Department of Clinical Sciences, Lund University, 214 28 Malmö, Sweden; Department of Cardiology, Karolinska University Hospital, and Department of Medicine, Karolinska Institute, 171 76 Stockholm, Sweden
| |
Collapse
|
5
|
Reil JC, Saisho H, Jockwer A, Fujita B, Paluszkiewicz L, Reil GH, Ensminger S, Scharfschwerdt M, Aboud A. Impact of heart rate, aortic compliance and stroke volume on the aortic regurgitation fraction studied in an ex vivo pig model. Open Heart 2023; 10:e002319. [PMID: 37696617 PMCID: PMC10496650 DOI: 10.1136/openhrt-2023-002319] [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: 03/25/2023] [Accepted: 08/18/2023] [Indexed: 09/13/2023] Open
Abstract
INTRODUCTION Drug therapy to reduce the regurgitation fraction (RF) of high-grade aortic regurgitation (AR) by increasing heart rate (HR) is generally recommended. However, chronic HR reduction in HFREF patients can significantly improve aortic compliance and thereby potentially decrease RF. To clarify these contrasts, we examined the influence of HR, aortic compliance and stroke volume (SV) on RF in an ex vivo porcine model of severe AR. METHODS Experiments were performed on porcine ascending aorta with aortic valves (n=12). Compliance was varied by inserting a Dacron graft close to the aortic valve. Both tube systems were connected to a left heart simulator varying HR and SV. AR was accomplished by punching a 0.3 cm2 hole in one aortic cusp. Flow, RF, SV and aortic pressure were measured, aortic compliance with transoesophageal ultrasound probes. RESULTS Compliance of the aorta was significantly reduced after Dacron graft insertion (0.55%±0.21%/mm Hg vs 0.01%±0.007%/mm Hg, p<0.001, respectively). With increasing HR, RF was significantly reduced in each steady state of the native aorta (HR 40 bpm: 88%±7% vs HR 120 bpm: 42%±10%; p<0.001), but Dacron tube did not affect RF (HR 40 bpm: 87%±8%; p=0.79; HR 120 bpm: 42%±3%; p=0.86). Increasing SV also reduced RF independent of the stiff Dacron graft. CONCLUSION Aortic compliance did not affect AR in the ex vivo porcine model of AR. RF was significantly reduced with increasing HR and SV. These results affirm that HR lowering and negative inotropic drugs should be avoided to treat severe AR.
Collapse
Affiliation(s)
- Jan Christian Reil
- Cardiology, Herz- und Diabeteszentrum Nordrhein-Westfalen, Bad Oeynhausen, Germany
| | - Hiroyuki Saisho
- Cardiothoracic Surgery, Universitätsklinikum Schleswig-Holstein Universitäres Herzzentrum Lübeck, Lubeck, Germany
| | - Antonia Jockwer
- Cardiothoracic Surgery, Universitätsklinikum Schleswig-Holstein Universitäres Herzzentrum Lübeck, Lubeck, Germany
| | - Buntaro Fujita
- Cardiothoracic Surgery, Universitätsklinikum Schleswig-Holstein Universitäres Herzzentrum Lübeck, Lubeck, Germany
| | - Lech Paluszkiewicz
- Cardiothoracic Surgery, Herz- und Diabeteszentrum Nordrhein-Westfalen, Bad Oeynhausen, Germany
| | | | - Stephan Ensminger
- Cardiothoracic Surgery, Universitätsklinikum Schleswig-Holstein Universitäres Herzzentrum Lübeck, Lubeck, Germany
| | - Michael Scharfschwerdt
- Cardiothoracic Surgery, Universitätsklinikum Schleswig-Holstein Universitäres Herzzentrum Lübeck, Lubeck, Germany
| | - Anas Aboud
- Cardiothoracic Surgery, Universitätsklinikum Schleswig-Holstein Universitäres Herzzentrum Lübeck, Lubeck, Germany
| |
Collapse
|
6
|
Anand V, Hu H, Weston AD, Scott CG, Michelena HI, Pislaru SV, Carter RE, Pellikka PA. Machine learning-based risk stratification for mortality in patients with severe aortic regurgitation. EUROPEAN HEART JOURNAL. DIGITAL HEALTH 2023; 4:188-195. [PMID: 37265866 PMCID: PMC10232267 DOI: 10.1093/ehjdh/ztad006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 12/06/2022] [Indexed: 06/03/2023]
Abstract
Aims The current guidelines recommend aortic valve intervention in patients with severe aortic regurgitation (AR) with the onset of symptoms, left ventricular enlargement, or systolic dysfunction. Recent studies have suggested that we might be missing the window of early intervention in a significant number of patients by following the guidelines. Methods and results The overarching goal was to determine if machine learning (ML)-based algorithms could be trained to identify patients at risk for death from AR independent of aortic valve replacement (AVR). Models were trained with five-fold cross-validation on a dataset of 1035 patients, and performance was reported on an independent dataset of 207 patients. Optimal predictive performance was observed with a conditional random survival forest model. A subset of 19/41 variables was selected for inclusion in the final model. Variable selection was performed with 10-fold cross-validation using random survival forest model. The top variables included were age, body surface area, body mass index, diastolic blood pressure, New York Heart Association class, AVR, comorbidities, ejection fraction, end-diastolic volume, and end-systolic dimension, and the relative variable importance averaged across five splits of cross-validation in each repeat were evaluated. The concordance index for predicting survival of the best-performing model was 0.84 at 1 year, 0.86 at 2 years, and 0.87 overall, respectively. Conclusion Using common echocardiographic parameters and patient characteristics, we successfully trained multiple ML models to predict survival in patients with severe AR. This technique could be applied to identify high-risk patients who would benefit from early intervention, thereby improving patient outcomes.
Collapse
Affiliation(s)
- Vidhu Anand
- Corresponding author. Tel: +507 284 4441, Fax: +507 266 0228,
| | - Hanwen Hu
- Department of Quantitative Health Sciences Research, Mayo Clinic, Jacksonville, FL 32202, USA
| | - Alexander D Weston
- Department of Quantitative Health Sciences Research, Mayo Clinic, Jacksonville, FL 32202, USA
| | - Christopher G Scott
- Department of Quantitative Health Science, Mayo Clinic, Rochester, MN 55905, USA
| | - Hector I Michelena
- Department of Cardiovascular Medicine, Mayo Clinic Rochester Minnesota, 200 First Street SW, Rochester, MN 55905, USA
| | - Sorin V Pislaru
- Department of Cardiovascular Medicine, Mayo Clinic Rochester Minnesota, 200 First Street SW, Rochester, MN 55905, USA
| | - Rickey E Carter
- Department of Quantitative Health Sciences Research, Mayo Clinic, Jacksonville, FL 32202, USA
| | | |
Collapse
|
7
|
Huntley GD, Bird JG, Lo YC, Bagameri G, Michelena HI. Raphal Cord Rupture: A Rare Mechanism of Aortic Regurgitation in Bicuspid Aortic Valve. JACC Case Rep 2023; 11:101791. [PMID: 37077439 PMCID: PMC10107042 DOI: 10.1016/j.jaccas.2023.101791] [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: 11/29/2022] [Revised: 01/30/2023] [Accepted: 01/31/2023] [Indexed: 04/21/2023]
Abstract
A 70-year-old male with chronic aortic regurgitation was referred with abrupt worsening heart failure. Late referral markers were pulmonary hypertension, mitral regurgitation, and tricuspid regurgitation. Evaluation revealed rupture of a raphal cord or fenestrated raphe from the conjoined cusp of a congenitally bicuspid aortic valve, a rare mechanism of aortic regurgitation. (Level of Difficulty: Intermediate.).
Collapse
Affiliation(s)
- Geoffrey D. Huntley
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Jared G. Bird
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Ying-Chun Lo
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Gabor Bagameri
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Hector I. Michelena
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
- Address for correspondence: Dr Hector I. Michelena, Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905, USA. @michelenahector
| |
Collapse
|
8
|
Chen Z, Pan W, Cao J, Dai X, Lin W, Chen H, Yi K, Yu M. Admission Heart Rate and Mortality in Critically Ill Patients with Acute Aortic Dissection. Int Heart J 2023; 64:44-52. [PMID: 36725077 DOI: 10.1536/ihj.22-346] [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] [Indexed: 02/01/2023]
Abstract
The association between admission heart rate (HR) and the mortality of critically ill patients with acute aortic dissection (AAD) remains unclear.The data were extracted from the Medical Information Mart for Intensive Care (MIMIC-III) database. Cox regression models and Kaplan-Meier (KM) survival curve were used to explore the association between admission HR and 90-day, 1-year, and 3-year mortality in patients with AAD. Sensitivity analyses were conducted to assess potential bias.A total of 374 eligible AAD patients were included and divided in 4 groups according to admission HR (HR ≤ 70, 71-80, 81-90, and > 90 beats per minute (bpm) ). The patients with AAD in the group with HR > 90 bpm had higher 90-day, 1-year, and 3-year mortality than those in the groups with HR ≤ 70, 71-80, and 81-90 bpm. After adjusting for age, sex, BMI, systolic blood pressure, diastolic blood pressure, SOFA score, SAPSII score, Stanford type, hypertension, coronary artery disease, liver disease, atrial fibrillation, valvular disease, intensive care unit mechanical ventilation, aortic surgery, and thoracic endovascular aortic repair, patients with admission HR > 90 bpm had a higher risk of 90-day, 1-year, and 3-year mortality [adjusted hazard ratio, 95% confidence interval, 5.14 (2.22-11.91) P < 0.001; 4.31 (2.10-8.84) P < 0.001; 3.01 (1.66-5.46) P < 0.001] than those with HR 81-90 bpm. The 90-day, 1-year, and 3-year mortality were similar among the groups with HR ≤ 70, 71-80, and 81-90 bpm.Admission HR > 90 bpm was independently associated with all-cause mortality in critically ill AAD patients, either type A or B aortic dissection.
Collapse
Affiliation(s)
- Zeliang Chen
- Department of Cardiology, The First Affiliated Hospital, Shantou University Medical College
- Department of Cardiology, Jieyang People's Hospital
| | - Wei Pan
- Department of Cardiology, Jieyang People's Hospital
- Department of Gynecologic Oncology, The Cancer Hospital of Shantou University Medical College
| | - Jing Cao
- Department of Cardiology, The First Affiliated Hospital, Shantou University Medical College
| | - Xiaoqing Dai
- Department of Cardiology, The First Affiliated Hospital, Shantou University Medical College
| | - Wan Lin
- Department of Cardiology, The First Affiliated Hospital, Shantou University Medical College
| | - Hongjuan Chen
- Department of Cardiology, The First Affiliated Hospital of Henan University of Science and Technology
| | - Kaihong Yi
- Department of Cardiology, The First Affiliated Hospital, Shantou University Medical College
| | - Min Yu
- Department of Cardiology, The First Affiliated Hospital, Shantou University Medical College
| |
Collapse
|
9
|
Luo C, Duan Z, Xia Z, Li Q, Wang B, Zheng T, Wang D, Han D. Minimum heart rate and mortality after cardiac surgery: retrospective analysis of the Multi-parameter Intelligent Monitoring in Intensive Care (MIMIC-III) database. Sci Rep 2023; 13:2597. [PMID: 36788332 PMCID: PMC9929057 DOI: 10.1038/s41598-023-29703-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 02/09/2023] [Indexed: 02/16/2023] Open
Abstract
Low heart rate is a risk factor of mortality in many cardiovascular diseases. However, the relationship of minimum heart rate (MHR) with outcomes after cardiac surgery is still unclear, and the association between optimum MHR and risk of mortality in patients receiving cardiac surgery remains unknown. In this retrospective study using the Multi-parameter Intelligent Monitoring in Intensive Care (MIMIC-III) database, 8243 adult patients who underwent cardiac surgery were included. The association between MHR and the 30-day, 90-day, 180-day, and 1-year mortality of patients undergoing cardiac surgery was analyzed using multivariate Cox proportional hazard analysis. As a continuous variable, MHR was evaluated using restricted cubic regression splines, and appropriate cut-off points were determined. Kaplan-Meier curve was used to further explore the relationship between MHR and prognosis. Subgroup analyses were performed based on age, sex, hypertension, diabetes, and ethnicity. The rates of the 30-day, 90-day, 180-day, and 1-year mortalities of patients in the low MHR group were higher than those in the high MHR group (4.1% vs. 2.9%, P < 0.05; 6.8% vs. 5.3%, P < 0.05; 8.9% vs. 7.0%, P < 0.05, and 10.9% vs. 8.8%, P < 0.05, respectively). Low MHR significantly correlated with the 30-day, 90-day, 180-day, and 1-year mortality after adjusting for confounders. A U-shaped relationship was observed between the 30-day, 90-day, 180-day, and 1-year mortality and MHR, and the mortality was lowest when the MHR was 69 bpm. Kaplan-Meier curve analysis also indicated that low MHR had poor prognosis in patients undergoing cardiac surgery. According to subgroup analyses, the effect of low MHR on post-cardiac surgery survival was restricted to patients who were < 75 years old, male, without hypertension and diabetes, and of White ethnicity. MHR (69 bpm) was associated with better 30-day, 90-day, 180-day, and 1-year survival in patients after cardiac surgery. Therefore, effective HR control strategies are required in this high-risk population.
Collapse
Affiliation(s)
- Chaodi Luo
- Department of Cardiology, First Affiliated Hospital of Xi'an Jiaotong University, Yanta West Road 277, Xi'an, 710061, China
| | - Zhenzhen Duan
- Department of Perivascular Surgery, Honghui Hospital of Xi'an Jiaotong University, Youyi East Road 555, Xi'an, 710054, China
| | - Ziheng Xia
- School of Electronic Engineering, Xidian University, Taibai South Road 2, Xi'an, 710071, China
| | - Qian Li
- Department of Cardiology, First Affiliated Hospital of Xi'an Jiaotong University, Yanta West Road 277, Xi'an, 710061, China
| | - Boxiang Wang
- Department of Cardiology, First Affiliated Hospital of Xi'an Jiaotong University, Yanta West Road 277, Xi'an, 710061, China
| | - Tingting Zheng
- Department of Cardiology, First Affiliated Hospital of Xi'an Jiaotong University, Yanta West Road 277, Xi'an, 710061, China
| | - Danni Wang
- Department of Cardiology, First Affiliated Hospital of Xi'an Jiaotong University, Yanta West Road 277, Xi'an, 710061, China
| | - Dan Han
- Department of Cardiovascular Surgery, First Affiliated Hospital of Xi'an Jiaotong University, Yanta West Road 277, Xi'an, 710061, Shaanxi, China.
| |
Collapse
|
10
|
Heart rate and diastolic arterial pressure in cardiac arrest patients: A nationwide, multicenter prospective registry. PLoS One 2022; 17:e0274130. [PMID: 36103505 PMCID: PMC9473410 DOI: 10.1371/journal.pone.0274130] [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: 03/16/2022] [Accepted: 08/22/2022] [Indexed: 11/19/2022] Open
Abstract
Background
Guidelines have recommended monitoring mean arterial pressure (MAP) and systolic arterial pressure (SAP) in cardiac arrest patients, but there has been relatively little regard for diastolic arterial pressure (DAP) and heart rate (HR). We aimed to determine the prognostic significance of hemodynamic parameters at all time points during targeted temperature management (TTM).
Methods
We reviewed the SAP, DAP, MAP, and HR data in out-of-hospital cardiac arrest (OHCA) survivors from the prospective multicenter registry of 22 teaching hospitals. This study included 1371 patients who underwent TTM among 10,258 cardiac arrest patients. The hemodynamic parameters were recorded every 6 hours from the return of spontaneous circulation (ROSC) to 4 days. The risks of those according to time points during TTM were compared.
Results
Of the included patients, 943 (68.8%) had poor neurological outcomes. The predictive ability of DAP surpassed that of SAP and MAP at all time points, and among the hemodynamic variables HR/DAP was the best predictor of the poor outcome. The risks in patients with DAP < 55 to 70 mmHg and HR > 70 to 100 beats/min were steeply increased for 2 days after ROSC and correlated with the poor outcome at all time points. Bradycardia showed lower risks only at 6 hours to 24 hours after ROSC.
Conclusion
Hemodynamic parameters should be intensively monitored especially for 2 days after ROSC because cardiac arrest patients may be vulnerable to hemodynamic instability during TTM. Monitoring HR/DAP can help access the risks in cardiac arrest patients.
Collapse
|
11
|
Guo S, Zhang B, Ye Y, Li Z, Liu Q, Zhao Z, Wang W, Yu Z, Zhang H, Zhao Q, Duan Z, Lv J, Zhang E, Wang B, Zhao Y, Gao R, Xu H, Wu Y. Prognostic value of blood pressure and resting heart rate in patients with tricuspid regurgitation. Front Cardiovasc Med 2022; 9:937412. [PMID: 35990948 PMCID: PMC9385404 DOI: 10.3389/fcvm.2022.937412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 06/30/2022] [Indexed: 11/18/2022] Open
Abstract
Background The prognostic value of blood pressure (BP) and resting heart rate (RHR) in tricuspid regurgitation (TR) patients is unknown. Aims This study aimed to investigate the associations of BP and RHR with all-cause mortality in patients with TR. Methods A total of 2,013 patients with moderate or severe TR underwent echocardiography and BP measurement. The associations of routinely measured BP and RHR with 2-year all-cause mortality were analyzed. Results The cohort had 45.9% male patients and a mean age of 62.5 ± 15.9 years. At the 2-year follow-up, 165 patient deaths had occurred. The risk of death decreased rapidly, negatively correlating with systolic blood pressure (SBP) up to 120 mmHg and diastolic blood pressure (DBP) up to 70 mmHg. For RHR, the risk increased in direct proportion, starting at 80 beats per min. After adjusting for age, sex, body mass index (BMI), diabetes, coronary heart disease, pulmonary hypertension, estimated glomerular filtration rate (eGFR), and NYHA class, SBP [hazard ratio (HR):0.89; 95% CI:0.823-0.957 per 10 mmHg increase; P =0.002], DBP (HR:0.8; 95% CI:0.714-0.908 per 10 mmHg increase; P < 0.001), and RHR (HR: 1.1; 95% CI: 1.022-1.175 per 10 beats per min increase; P = 0.011) were independently associated with all-cause mortality. These associations persisted after further adjustments for echocardiographic indices, medications, serological tests, and etiologies. Conclusion In this cohort of patients with TR, routinely measured BP and RHR were associated with all-cause mortality independently. However, further large-scale, high-quality studies are required to validate our findings.
Collapse
Affiliation(s)
- Shuai Guo
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Bin Zhang
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yunqing Ye
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhe Li
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Qingrong Liu
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhenyan Zhao
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Weiwei Wang
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zikai Yu
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Haitong Zhang
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Qinghao Zhao
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhenya Duan
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Junxing Lv
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Erli Zhang
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Bincheng Wang
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yanyan Zhao
- Medical Research and Biometrics Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Runlin Gao
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Haiyan Xu
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yongjian Wu
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| |
Collapse
|
12
|
Thongsroy J, Mutirangura A. The association between Alu hypomethylation and the severity of hypertension. PLoS One 2022; 17:e0270004. [PMID: 35802708 PMCID: PMC9269909 DOI: 10.1371/journal.pone.0270004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 06/02/2022] [Indexed: 11/18/2022] Open
Abstract
Introduction Epigenetic changes that cause genomic instability may be the basis of pathogenic processes of age-associated noncommunicable diseases (NCDs). Essential hypertension is one of the most common NCDs. Alu hypomethylation is an epigenetic event that is commonly found in elderly individuals. Epigenomic alterations are also found in age-associated NCDs such as osteoporosis and diabetes mellitus. Alu methylation prevents DNA from being damaged. Therefore, Alu hypomethylated DNA accumulates DNA damage and, as a result, causes organ function deterioration. Here, we report that Alu hypomethylation is a biomarker for essential hypertension. Results We investigated Alu methylation levels in white blood cells from normal controls, patients with prehypertension, and patients with hypertension. The hypertension group possessed the lowest Alu methylation level when classified by systolic blood pressure and diastolic blood pressure (P = 0.0002 and P = 0.0088, respectively). In the hypertension group, a higher diastolic blood pressure and a lower Alu methylation level were observed (r = -0.6278). Moreover, we found that changes in Alu hypomethylation in the four years of follow-up in the same person were directly correlated with increased diastolic blood pressure. Conclusions Similar to other age-associated NCDs, Alu hypomethylation is found in essential hypertension and is directly correlated with severity, particularly with diastolic blood pressure. Therefore, Alu hypomethylation may be linked with the molecular pathogenesis of high blood pressure and can be used for monitoring the clinical outcome of this disease.
Collapse
Affiliation(s)
- Jirapan Thongsroy
- School of Medicine, Walailak University, Nakhon Si Thammarat, Thailand
- * E-mail:
| | - Apiwat Mutirangura
- Center of Excellence in Molecular Genetics of Cancer and Human Disease, Department of Anatomy, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| |
Collapse
|
13
|
Nardi F, Pino PG, De Luca L, Riccio C, Cipriani M, Corda M, Francese GM, Gabrielli D, Oliva F, Gulizia MM, Colivicchi F. ANMCO position paper: 2022 focused update of appropriate use criteria for multimodality imaging: aortic valve disease. Eur Heart J Suppl 2022; 24:C289-C297. [PMID: 35602253 PMCID: PMC9117909 DOI: 10.1093/eurheartj/suac027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
This document addresses the evaluation of the Appropriate Use Criteria (AUC) of multimodality imaging in the diagnosis and management of aortic valve disease. The goal of this AUC document is to provide a comprehensive resource for multimodality imaging in the context of aortic valve disease, encompassing multiple imaging modalities. Clinical scenarios are developed in a simple way to illustrate patient presentations encountered in everyday practice.
Collapse
Affiliation(s)
- Federico Nardi
- Cardiology Department, Ospedale Santo Spirito, Via Giolitti 2, Casale Monferrato 15033, AL, Italy
| | - Paolo Giuseppe Pino
- Consultant Cardiologist of the Echo-Lab, Ospedale Santo Spirito, Casale Monferrato, AL, Italy
| | - Leonardo De Luca
- Department of Cardio-Thoraco-Vascular, Azienda Ospedaliera San Camillo Forlanini, Roma, Italy
| | - Carmine Riccio
- Cardio-Vascular Department, AORN Sant'Anna and San Sebastiano, Caserta, Italy
| | - Manlio Cipriani
- Cardiology 2-Heart Failure and Transplants, Dipartimento Cardiotoracovascolare “A. De Gasperis”, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - Marco Corda
- Cardiology Department, Azienda Ospedaliera G. Brotzu, Cagliari, Italy
| | - Giuseppina Maura Francese
- Cardiology Department, Ospedale Garibaldi-Nesima—Azienda Rilievo Nazionale e Alta Specializzazione “Garibaldi”, Catania, Italy
| | - Domenico Gabrielli
- Department of Cardio-Thoraco-Vascular, Azienda Ospedaliera San Camillo Forlanini, Roma, Italy
| | - Fabrizio Oliva
- Unit of Intensive Cardiological Care, Cardiology 1-Hemodynamics, Cardiothoracovascular Department “A. De Gasperis”, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - Michele Massimo Gulizia
- Cardiology Department, Ospedale Garibaldi-Nesima—Azienda Rilievo Nazionale e Alta Specializzazione “Garibaldi”, Catania, Italy
- Fondazione per il Tuo cuore—Heart Care Foundation, Firenze, Italy
| | | |
Collapse
|
14
|
Xu S, Lin Y, Lin L, Peng Y, Chen L. Predictive Value of Increased Perioperative Heart Rate for All-Cause Mortality After Cardiac Surgery: A Systematic Review and Meta-Analysis. Biol Res Nurs 2022; 24:379-387. [PMID: 35437047 DOI: 10.1177/10998004221085986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: Accumulated studies have revealed that heart rates are associated with all-cause mortality in cardiac surgery patients, but the results remain controversial. This meta-analysis aimed to evaluate the predictive value of increased perioperative heart rate for all-cause mortality after cardiac surgery. Methods: We searched PubMed, Embase, Web of Science, and Cumulative Index of Nursing and Allied Health Literature (CINAHL) databases for studies from inception to October 11, 2021. Two researchers independently screened the studies. Titles, authors, publication years, and hazard ratios were extracted. We used a random-effects model to combine the HRs and 95% confidence intervals. Several subgroup analyses were conducted. Statistical significance was set at p < .05. Results: Eleven studies were included in the meta-analysis of 33,849 patients and 3166 (9.4%) deaths. The HR of higher perioperative heart rates was 2.09 (95% CI 1.53-2.86, p < .001, I2 = 81%). The HR with a 10-bpm increase in preoperative heart rate was 1.19 (95% CI 1.11-1.26, p < .001, I2 = 51%). Subgroup analysis showed patients with higher preoperative heart rates had an HR of 1.88 (95% CI 1.51-2.34, p < .001, I2 = 0%), and patients with a higher postoperative heart rate had an HR of 2.29 (95% CI 1.28- 4.09, p < .0001, I2 = 91%) compared to patients with lower postoperative heart rates. Conclusion: Increased perioperative heart rate is associated with all-cause mortality in patients undergoing cardiac surgery.
Collapse
Affiliation(s)
- Shurong Xu
- School of Nursing, 74551Fujian Medical University, Fuzhou, China
| | - Yanjuan Lin
- Department of Nursing, Union Hospital, 117890Fujian Medical University, Fuzhou, China
| | - Lingyu Lin
- School of Nursing, 74551Fujian Medical University, Fuzhou, China
| | - Yanchun Peng
- Department of Cardiac Surgery, Union Hospital, 117890Fujian Medical University, Fuzhou, China
| | - Liangwan Chen
- Department of Cardiac Surgery, Union Hospital, 117890Fujian Medical University, Fuzhou, China
| |
Collapse
|
15
|
Yang LT, Takeuchi M, Scott CG, Thapa P, Wang TD, Villarraga HR, Padang R, Enriquez-Sarano M, Michelena HI. Automated Global Longitudinal Strain Exhibits a Robust Association with Death in Asymptomatic Chronic Aortic Regurgitation. J Am Soc Echocardiogr 2022; 35:692-702.e8. [PMID: 35341954 DOI: 10.1016/j.echo.2021.10.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 09/13/2021] [Accepted: 10/31/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Whether automated left ventricular global longitudinal strain (LVGLS) is associated with outcomes in asymptomatic aortic regurgitation (AR) is unknown. OBJECTIVE To explore the impact of automated LVGLS on survival and compare it with conventional LV parameters in chronic asymptomatic AR. METHODS LVGLS (presented as absolute value) was measured using fully-automated two-dimensional strain software in consecutive patients with isolated chronic ≥moderate-severe AR between 2004 and 2020; incremental value of LVGLS was assessed. Limited correction of endocardial border tracking was performed if needed. RESULTS Of 550 asymptomatic patients (age 60±17 years; 86% men), average LVGLS was 17±3% (1st and 2nd tertile, 15.8% and 18.5%). In 16% cases, tracking border was partially corrected; average time for analysis was 25±5 seconds. At a median (interquartile range) of 4.8(1.5-9.9) years, 87 patients had died (19 died after aortic-valve surgery [AVS]). Separate multivariable models adjusted for age, sex, Charlson index, AR severity and time-dependent AVS demonstrated that LVEF(hazard ratio[HR] per 10%: 0.9), LV end-systolic volume index(LVESVi; HR per 5ml/m2: 1.08) and LVGLS(HR per unit: 0.87) were independently associated with death(all p≤0.018); however, LVGLS remained statistically significant (HR: 0.86-0.9; P≤0.007) as compared head-to-head to LVEF, LVESVi and LV end-systolic dimension index(LVESDi). The association of LVGLS and mortality was consistent across all subgroups (P for interaction all≥0.08). Spline curves showed that continuous risk of death rose at LVGLS <15%. Those with LVGLS <15% had 2.6-fold risk of death [95% CI 1.54-4.23] while those with LVGLS <15% plus LVESVi≥45ml/m2 had 3.96-fold risk[95% CI 1.94-8.03]. CONCLUSION In this large cohort of asymptomatic patients with ≥moderate-severe AR, automated LVGLS was feasible, efficient, and independently associated with death on head-to-head comparison with conventional LVEF, LVESDi, and LVESVi. The automated-LVGLS threshold of <15% alone or combined with LVESVi≥45ml/m2, was significantly associated with increased mortality risk and may be considered in early surgery decision-making.
Collapse
Affiliation(s)
- Li-Tan Yang
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester Minnesota; Cardiovascular Center and Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan.
| | - Masaaki Takeuchi
- Department of Laboratory and Transfusion Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Christopher G Scott
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester Minnesota
| | - Prabin Thapa
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester Minnesota
| | - Tzung-Dau Wang
- Cardiovascular Center and Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | | | - Ratnasari Padang
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester Minnesota
| | | | - Hector I Michelena
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester Minnesota.
| |
Collapse
|
16
|
Wang Z, Chen X, Wu Y, Jiang W, Yang L, Wang H, Liu S, Liu Y. Admission Resting Heart Rate as an Independent Predictor of All-Cause Mortality in Elderly Patients with Hip Fracture. Int J Gen Med 2021; 14:7699-7706. [PMID: 34764683 PMCID: PMC8575447 DOI: 10.2147/ijgm.s333971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 10/27/2021] [Indexed: 11/26/2022] Open
Abstract
Purpose To investigate the relationship between admission resting heart rate (RHR) and all-cause mortality in elderly patients with hip fracture. Methods A retrospective cohort study with 837 patients based on the established hip fracture database was conducted. Admission RHR was measured via electrocardiogram, and patients were grouped by the median RHR value (beats per minute, bpm). The main outcomes were 1-year and total all-cause mortality. Cox proportional hazard models and restricted cubic spline were used to assess the relationship between RHR and mortality. Sensitivity analyses were further performed to determine whether the results were stable. Results The mean and median RHR were 82.3 and 80.0 bpm, respectively. After a median follow-up of 31.8 months, the 1-year and total all-cause mortality were 17.6% and 31.2%. Multivariable Cox analyses showed that high RHR was an independent risk factor for 1-year mortality (HR = 1.51; 95% CI: 1.08–2.13; p = 0.016), and total mortality (HR = 1.44; 95% CI: 1.12–1.85; p = 0.005). For each 10 bpm increase in RHR, the risk of 1-year death increased by 23.0% (HR = 1.23; 95% CI: 1.09–1.39; p = 0.001), and total death increased by 21.0% (HR = 1.21; 95% CI: 1.09–1.34; p < 0.001). A typical J-shaped curve was observed in the restricted cubic spline for the association between RHR and 1-year mortality, with the lowest mortality risk at 70 bpm. Sensitivity analyses yielded similar findings. Conclusion An increase in RHR was independently associated with all-cause mortality, and may be a useful prognostic predictor for elderly patients with hip fracture.
Collapse
Affiliation(s)
- Zhicong Wang
- Orthopaedic Center of Deyang City, Department of Orthopedics, Deyang People's Hospital, Deyang, Sichuan, People's Republic of China
| | - Xi Chen
- Orthopaedic Center of Deyang City, Department of Orthopedics, Deyang People's Hospital, Deyang, Sichuan, People's Republic of China
| | - Yuxuan Wu
- Orthopaedic Center of Deyang City, Department of Orthopedics, Deyang People's Hospital, Deyang, Sichuan, People's Republic of China
| | - Wei Jiang
- Orthopaedic Center of Deyang City, Department of Orthopedics, Deyang People's Hospital, Deyang, Sichuan, People's Republic of China
| | - Ling Yang
- Orthopaedic Center of Deyang City, Department of Orthopedics, Deyang People's Hospital, Deyang, Sichuan, People's Republic of China
| | - Hong Wang
- Orthopaedic Center of Deyang City, Department of Orthopedics, Deyang People's Hospital, Deyang, Sichuan, People's Republic of China
| | - Shuping Liu
- Orthopaedic Center of Deyang City, Department of Orthopedics, Deyang People's Hospital, Deyang, Sichuan, People's Republic of China
| | - Yuehong Liu
- Orthopaedic Center of Deyang City, Department of Orthopedics, Deyang People's Hospital, Deyang, Sichuan, People's Republic of China
| |
Collapse
|
17
|
Zhou Y, Luo Q, Guo X, Wang H, Jia Y, Cao L, Wang Y, Yan F, Yu C, Yuan S. Predictive value of heart rate in patients with acute type A aortic dissection: a retrospective cohort study. BMJ Open 2021; 11:e047221. [PMID: 34764163 PMCID: PMC8587588 DOI: 10.1136/bmjopen-2020-047221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE Heart rate (HR) is a risk factor of mortality in many cardiovascular diseases but no clinical studies have focused on the association between HR and prognosis in patients with acute type A aortic dissection (ATAAD). This study aimed to evaluate the association between HR and long-term mortality and establish the criteria of HR in patients with ATAAD who underwent total aortic arch replacement combined with the frozen elephant trunk (TAR+FET). DESIGN, SETTING AND PARTICIPANTS Retrospective cohort study that studied all consecutive patients with ATAAD who underwent TAR+FET in the Fuwai Hospital between 2009 and 2015. MAIN OUTCOMES AND MEASURES 30-day postoperative, and estimated long-term mortality. RESULTS Overall, 707 patients with ATAAD who underwent TAR+FET were followed up for a median duration of 29 months (range, 5-77 months). In multivariate logistic analysis, HR (p<0.001), age (p<0.001), renal insufficiency (p=0.033), ejection fraction (p=0.005), cardiopulmonary bypass time (p<0.001) and intraoperative blood loss (p=0.002) were significantly associated with 30-day postoperative and estimated long-term mortalities. A hinge point with a sharp increase in estimated long-term mortality was identified at 80 beats/min (bpm), and compared with HR ≤80 bpm, HR >80 bpm was associated with an almost threefold higher long-term mortality. HRs ≤60, 60-70, 70-80, 80-90, 90-100, 100-110 and >110 bpm were associated with 3.9%, 4.0%, 3.8%, 7.2%, 9.5%, 10.1% and 14.4% yearly risks of death, respectively. CONCLUSIONS HR is a powerful predictor of long-term mortality in patients with ATAAD undergoing TAR+FET. HR >80 bpm is independently associated with elevated long-term mortality for patients with ATAAD.
Collapse
Affiliation(s)
- Yong Zhou
- Anaesthesiology, Chinese Academy of Medical Sciences & Peking Union Medical College Fuwai Hospital, Xicheng District, Beijing, China
| | - Qipeng Luo
- Pain Medicine, Peking University Third Hospital, Beijing, China
| | - Xiaoxiao Guo
- Cardiology, Peking Union Medical College Hospital, Dongcheng District, Beijing, China
| | - Hongbai Wang
- Anaesthesiology, Chinese Academy of Medical Sciences & Peking Union Medical College Fuwai Hospital, Xicheng District, Beijing, China
| | - Yuan Jia
- Anaesthesiology, Chinese Academy of Medical Sciences & Peking Union Medical College Fuwai Hospital, Xicheng District, Beijing, China
| | - Liang Cao
- Anaesthesiology, Chinese Academy of Medical Sciences & Peking Union Medical College Fuwai Hospital, Xicheng District, Beijing, China
| | - Yang Wang
- Medical Research and Biometrics Center, National Centre for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, Beijing, China
| | - Fuxia Yan
- Anaesthesiology, Chinese Academy of Medical Sciences & Peking Union Medical College Fuwai Hospital, Xicheng District, Beijing, China
| | - Cuntao Yu
- Cardiovascular Surgery, Chinese Academy of Medical Sciences & Peking Union Medical College Fuwai Hospital, Xicheng District, Beijing, China
| | - Su Yuan
- Anaesthesiology, Chinese Academy of Medical Sciences & Peking Union Medical College Fuwai Hospital, Xicheng District, Beijing, China
| |
Collapse
|
18
|
Parikh PB, Romeiser JL, Dhautel B, Mitchell D, Holecek W, Bilfinger T, Poppers J, Bennett-Guerrero E. Predictors and impact of low diastolic blood pressure and widened pulse pressure following transcatheter aortic valve replacement. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2021; 39:20-25. [PMID: 34764032 DOI: 10.1016/j.carrev.2021.10.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Revised: 10/11/2021] [Accepted: 10/25/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND The association between post-operative diastolic blood pressure (DBP) and pulse pressure (PP) with outcomes following transcatheter aortic valve replacement (TAVR) remains unclear. We sought to assess the prevalence, predictors, and impact of post-operative DBP and PP on presence of post-procedural aortic insufficiency (AI) and mortality in adults undergoing TAVR. METHODS The study population included 194 patients who underwent TAVR from 2016 to 2017 at an academic tertiary medical center, of which 176 had invasive arterial pressures available postoperatively. Low DBP and widened PP were defined as ≤40 mmHg and ≥80 mmHg respectively on invasive arterial line on post-operative day 1. Clinical outcomes of interest included post-procedural AI and 1-year all-cause mortality. RESULTS Post-operative low DBP and widened PP were noted in 32.4% and 58.5% of the study population. No significant association between post-operative AI and low DBP (p = 0.82) or widened PP (p = 0.32) was noted. There was a trend toward higher rates of mortality in patients with low DBP (19.3% vs 9.2%, p = 0.06) but no difference in mortality in patients with widened PP (10.7% vs 15.1%, p = 0.39) or those with ≥1+ post-procedural AI (16.7% vs 10.7%, p = 0.32). In multivariable analysis, low DBP was associated with a trend toward higher rates of 1-year mortality [odds ratio (OR) 2.43, 95% confidence interval (CI) 0.97-6.11, p = 0.06]. When excluding patients with a post-operative invasive systolic blood pressure < 80 mmHg, low DBP was associated with significantly higher risk-adjusted mortality at 1 year [OR 2.75, 95% CI (1.07-7.07), p = 0.04]. CONCLUSIONS In this contemporary study of adults undergoing TAVR, low DBP and widened PP were widely prevalent post TAVR. Low DBP was associated with a trend toward higher rates of 1-year mortality but not with post-procedural AI.
Collapse
Affiliation(s)
- Puja B Parikh
- Department of Medicine, Stony Brook Renaissance School of Medicine, Stony Brook, NY, United States of America.
| | - Jamie L Romeiser
- Department of Anesthesiology, Stony Brook Renaissance School of Medicine, Stony Brook, NY, United States of America
| | - Britney Dhautel
- Department of Anesthesiology, Stony Brook Renaissance School of Medicine, Stony Brook, NY, United States of America
| | - Duran Mitchell
- Department of Anesthesiology, Stony Brook Renaissance School of Medicine, Stony Brook, NY, United States of America
| | - William Holecek
- Department of Surgery, Stony Brook Renaissance School of Medicine, Stony Brook, NY, United States of America
| | - Thomas Bilfinger
- Department of Surgery, Stony Brook Renaissance School of Medicine, Stony Brook, NY, United States of America
| | - Jeremy Poppers
- Department of Anesthesiology, Stony Brook Renaissance School of Medicine, Stony Brook, NY, United States of America
| | - Elliott Bennett-Guerrero
- Department of Anesthesiology, Stony Brook Renaissance School of Medicine, Stony Brook, NY, United States of America
| |
Collapse
|
19
|
Yang LT, Enriquez-Sarano M, Pellikka PA, Thapa P, Scott CG, Hung JW, Michelena HI. Sex Differences in Outcomes of Patients With Chronic Aortic Regurgitation: Closing the Mortality Gap. Mayo Clin Proc 2021; 96:2145-2156. [PMID: 34353469 DOI: 10.1016/j.mayocp.2020.11.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 11/23/2020] [Accepted: 11/24/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To examine contemporary clinical differences between men and women with hemodynamically significant chronic aortic regurgitation (AR). PATIENTS AND METHODS We retrospectively identified 1072 consecutive patients with moderate to severe or severe AR diagnosed between February 21, 2004, and April 29, 2019. Echocardiographic data, aortic valve surgical intervention (AVS), and all-cause death were analyzed. RESULTS At baseline, the 189 women in the study group were older than the 883 men (mean ± SD age, 64±18 years vs 58±17 years), had more advanced symptoms, and had larger left ventricular end-systolic dimension index (LVESDi) (all P<.001) despite similar AR severity. An LVESDi of greater than 20 mm/m2 was noted in 60 of 92 asymptomatic women (65%) vs 225 of 559 asymptomatic men (40%) (P<.001). Median follow-up was 5.6 years (interquartile range, 2.5 to 10.0 years). Female sex was associated with less AVS (P=.009), and overall 10-year survival was better in men (76%±2%) than in women (64%±5%) (P=.004). However, 10-year post-AVS survival was similar between the sexes (P=.86), and women had better left ventricular reverse remodeling than men regarding end-diastolic dimension (P=.02). Multivariable independent predictors of death were age, advanced symptoms, LVESDi, ejection fraction, and AVS (all P≤.03) but not female sex. When compared with the age-matched US population, women exhibited a 1.3-fold increased relative risk of death (P=.0383) while men had similar survival (P=.11). CONCLUSION In contemporary practice, women with AR continue to exhibit an overall survival penalty not related to female sex but to late referral markers, including more advanced symptoms, larger LVESDi, and less AVS. Nonetheless, women in our study exhibited outstanding post-AVS left ventricular remodeling and had good post-AVS survival, a step forward toward closing the sex-related mortality gap. The high percentage of LVESDi of 20 mm/m2 or greater in asymptomatic women represents a window of opportunity for advanced-symptom prevention and timely AR surgical correction that may close the mortality gap.
Collapse
Affiliation(s)
- Li-Tan Yang
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN; Department of Internal Medicine, Division of Cardiology, National Taiwan University Hospital, Taipei, Taiwan
| | | | | | - Prabin Thapa
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN
| | - Christopher G Scott
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN
| | - Judy W Hung
- Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | | |
Collapse
|
20
|
Yang LT, Anand V, Zambito EI, Pellikka PA, Scott CG, Thapa P, Padang R, Takeuchi M, Nishimura RA, Enriquez-Sarano M, Michelena HI. Association of Echocardiographic Left Ventricular End-Systolic Volume and Volume-Derived Ejection Fraction With Outcome in Asymptomatic Chronic Aortic Regurgitation. JAMA Cardiol 2021; 6:189-198. [PMID: 33146680 DOI: 10.1001/jamacardio.2020.5268] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Volumetric measurements by transthoracic echocardiogram may better reflect left ventricular (LV) remodeling than conventional linear LV dimensions. However, the association of LV volumes with mortality in patients with chronic hemodynamically significant aortic regurgitation (AR) is unknown. Objective To assess whether LV volumes and volume-derived LV ejection fraction (Vol-LVEF) are determinants of mortality in AR. Design, Setting, and Participants This cohort study included consecutive asymptomatic patients with chronic moderately severe to severe AR from a tertiary referral center (January 2004 through April 2019). Exposures Clinical and echocardiographic data were analyzed retrospectively. Aortic regurgitation severity was graded by comprehensive integrated approach. De novo disk-summation method was used to derive LV volumes and Vol-LVEF. Main Outcome and Measures Associations between all-cause mortality under medical surveillance and the following LV indexes: linear LV end-systolic dimension index (LVESDi), linear LVEF, LV end-systolic volume index (LVESVi), and Vol-LVEF. Results Of 492 asymptomatic patients (mean [SD] age, 60 [17] years; 425 men [86%]), ischemic heart disease prevalence was low (41 [9%]), and 453 (92.1%) had preserved linear LVEF (≥50%) with mean (SD) LVESVi of 41 (15) mL/m2. At a median (interquartile range) of 5.4 (2.5-10.1) years, 66 patients (13.4%) died under medical surveillance; overall survival was not different than the age- and sex-matched general population (P = .55). Separate multivariate models, adjusted for age, sex, Charlson Comorbidity Index, and AR severity, demonstrated that in addition to linear LVEF and LVESDi, LVESVi and Vol-LVEF were independently associated with mortality under surveillance (all P < .046) with similar C statistics (range, 0.83-0.84). Spline curves showed that continuous risks of death started to rise for both linear LVEF and Vol-LVEF less than 60%, LVESVi more than 40 to 45 mL/m2, and LVESDi above 21 to 22 mm/m2. As dichotomized variables, patients with LVESVi more than 45 mL/m2 exhibited increased relative death risk (hazard ratio, 1.93; 95% CI, 1.10-3.38; P = .02) while LVESDi more than 20 mm/m2 did not (P = .32). LVESVi more than 45 mL/m2 showed a decreased survival trend compared with expected population survival. Conclusions and Relevance In this large asymptomatic cohort of patients with hemodynamically significant AR, LVESVi and Vol-LVEF worked equally as well as LVESDi and linear LVEF in risk discriminating patients with excess mortality. A LVESVi threshold of 45 mL/m2 or greater was significantly associated with an increased mortality risk.
Collapse
Affiliation(s)
- Li-Tan Yang
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota.,Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Vidhu Anand
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Elena I Zambito
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | | | - Christopher G Scott
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota
| | - Prabin Thapa
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota
| | - Ratnasari Padang
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Masaaki Takeuchi
- Department of Laboratory and Transfusion Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Rick A Nishimura
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | | | - Hector I Michelena
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| |
Collapse
|
21
|
Abdurashidova T, Monney P, Tzimas G, Soborun N, Regamey J, Daux A, Barras N, Kirsch M, Müller M, Hullin R. Non-severe aortic regurgitation increases short-term mortality in acute heart failure with preserved ejection fraction. ESC Heart Fail 2020; 7:3901-3909. [PMID: 33026164 PMCID: PMC7754983 DOI: 10.1002/ehf2.12983] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 07/15/2020] [Accepted: 08/13/2020] [Indexed: 12/26/2022] Open
Abstract
AIMS Mild or moderate aortic regurgitation (AR) has only little effect on cardiovascular outcome in people with normal left ventricular ejection fraction (EF); therefore, it is not perceived as a major clinical problem. This study investigates whether mild or moderate AR is associated with increased short-term mortality in patients hospitalized for treatment of acute heart failure (AHF) and whether mild or moderate AR impacts differently on short-term mortality in AHF patients with reduced EF (AHFrEF), mid-range EF (AHFmrEF), or preserved EF (AHFpEF). METHODS AND RESULTS This mono-centric study included 505 consecutive adult patients hospitalized for de novo or worsening chronic HF not related to acute ischaemia or severe valvular pathology in the echocardiogram at index hospitalization. Cox regression analysis studied the impact of AR on all-cause mortality (ACM) over the 150 days' study period. Mild or moderate AR was associated with increased ACM (HR 1.75 [95% CI: 1.1-2.7]; P = 0.009). The prevalence of mild or moderate AR in the study population was 42% and not significantly different between AHFpEF (n = 227), AHFmrEF (n = 86), and AHFrEF (n = 192) study participants (37.9% vs. 50.0% vs. 42.7%; P = 0.144). In AHFpEF patients, the age-adjusted hazard for ACM was increased in patients with AR compared with patients without AR (HR 2.17 [95% CI: 1.1-4.2]; P = 0.002). The age-adjusted hazard for ACM was increased by a trend in AHFmrEF with AR (HR 7.11, [95% CI: 0.9-57.8]; P = 0.067) and not different between the AHFrEF groups (HR 0.95 [95% CI: 0.5-1.8]; P = 0.875). CONCLUSIONS Mild or moderate AR increased ACM only in AHFpEF patients, highlighting a distinct clinical relevance.
Collapse
Affiliation(s)
- Tamila Abdurashidova
- Cardiology, Cardiovascular DepartmentLausanne University HospitalRue du Bugnon 46LausanneSwitzerland
| | - Pierre Monney
- Cardiology, Cardiovascular DepartmentLausanne University HospitalRue du Bugnon 46LausanneSwitzerland
| | - Georgios Tzimas
- Cardiology, Cardiovascular DepartmentLausanne University HospitalRue du Bugnon 46LausanneSwitzerland
| | - Nisha Soborun
- Cardiac Surgery, Cardiovascular DepartmentLausanne University HospitalRue du Bugnon 46LausanneSwitzerland
| | - Julien Regamey
- Cardiology, Cardiovascular DepartmentLausanne University HospitalRue du Bugnon 46LausanneSwitzerland
| | - Aurelien Daux
- Cardiology, Cardiovascular DepartmentLausanne University HospitalRue du Bugnon 46LausanneSwitzerland
| | - Nicolas Barras
- Cardiology, Cardiovascular DepartmentLausanne University HospitalRue du Bugnon 46LausanneSwitzerland
| | - Matthias Kirsch
- Cardiac Surgery, Cardiovascular DepartmentLausanne University HospitalRue du Bugnon 46LausanneSwitzerland
| | - Martin Müller
- Department of Emergency Medicine, InselspitalUniversity Hospital Bern and University of BernBernSwitzerland
| | - Roger Hullin
- Cardiology, Cardiovascular DepartmentLausanne University HospitalRue du Bugnon 46LausanneSwitzerland
| |
Collapse
|
22
|
Yang LT, Benfari G, Eleid M, Scott CG, Nkomo VT, Pellikka PA, Anavekar NS, Enriquez-Sarano M, Michelena HI. Contemporary differences between bicuspid and tricuspid aortic valve in chronic aortic regurgitation. Heart 2020; 107:916-924. [PMID: 33109713 DOI: 10.1136/heartjnl-2020-317466] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 09/15/2020] [Accepted: 09/19/2020] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To comprehensively explore contemporary differences between bicuspid aortic valve (BAV) and tricuspid aortic valve (TAV) patients with chronic haemodynamically significant aortic regurgitation (AR). METHODS Consecutive patients with chronic ≥moderate-severe AR from a tertiary referral centre (2006-2017) were included. All-cause mortality, surgical indications and aortic valve surgery (AVS) were analysed. RESULTS Of 798 patients (296 BAV-AR, age 46±14 years; 502 TAV-AR, age 67±14 years, p<0.0001) followed for 5.5 (IQR: 2.9-9.2) years, 403 underwent AVS (repair in 96) and 154 died during follow-up. The 8-year AVS incidence was 60%±3% versus 53%±3% for BAV-AR and TAV-AR, respectively (p=0.014). The unadjusted (real-life) 8-year total survival was 93%±7% versus 71%±2% for BAV-AR and TAV-AR, respectively (p<0.0001), and became statistically insignificant after sole adjustment for age (p=0.14). The within-group relative risk of death in BAV-AR patients demonstrated a large age-dependent increase (two fold at 50-55 years, up to 10-fold at 70 years). The presence of baseline symptoms was significantly associated with death for both BAV-AR (p=0.039) and TAV-AR (p<0.0001), but the strength of the association decreased with age adjustment for BAV-AR (age-adjusted HR 2.43 (0.92-6.39), p=0.07) and not for TAV-AR (age-adjusted HR, 2.3 (1.6-3.3), p<0.0001). As compared with general population, TAV-AR exhibited baseline excess risk which further increased at left ventricular ejection fraction (LVEF) <60% and left ventricular end-systolic dimension index (LVESDi) >20 mm/m2; similar thresholds were observed for BAV-AR patients. CONCLUSION BAV-AR patients were two decades younger than TAV-AR and underwent AVS more frequently, resulting in a considerable real-life survival advantage for BAV-AR that was determined primarily by age and not valve anatomy. Pragmatically, regardless of valve anatomy, patients with haemodynamically significant AR and age >50-55 years require a low-threshold for surgical referral to prevent symptom development where LVEF <60% and LVESDi >20 mm/m2 seem appropriate referral thresholds.
Collapse
Affiliation(s)
- Li-Tan Yang
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester Minnesota, Rochester, New York, USA.,Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Giovanni Benfari
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester Minnesota, Rochester, New York, USA
| | - Mackram Eleid
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester Minnesota, Rochester, New York, USA
| | - Christopher G Scott
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota, USA
| | - Vuyisile T Nkomo
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester Minnesota, Rochester, New York, USA
| | - Patricia A Pellikka
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester Minnesota, Rochester, New York, USA
| | - Nandan S Anavekar
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester Minnesota, Rochester, New York, USA
| | - Maurice Enriquez-Sarano
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester Minnesota, Rochester, New York, USA
| | - Hector I Michelena
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester Minnesota, Rochester, New York, USA
| |
Collapse
|
23
|
Concomitant Mitral Regurgitation in Patients With Chronic Aortic Regurgitation. J Am Coll Cardiol 2020; 76:233-246. [DOI: 10.1016/j.jacc.2020.05.051] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 05/18/2020] [Accepted: 05/19/2020] [Indexed: 11/23/2022]
|
24
|
Yang LT, Scott CG, Enriquez-Sarano M, Michelena HI. Reply: Mortality-Association of Diastolic Blood Pressure and Heart Rate in Aortic Regurgitation: A Matter of Fact. J Am Coll Cardiol 2020; 75:2276-2278. [PMID: 32354391 DOI: 10.1016/j.jacc.2020.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 03/01/2020] [Indexed: 11/30/2022]
|
25
|
Aloia E. Resting Heart Rate and Diastolic Blood Pressure in AR: Still a Matter of Debate. J Am Coll Cardiol 2020; 75:2276. [PMID: 32354392 DOI: 10.1016/j.jacc.2020.01.062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 01/28/2020] [Indexed: 11/17/2022]
|
26
|
Jiang X, Zhang Y, Gu T. Cardiac Output and Blood Supply of Cardiomyocytes May Be Determinants of Clinical Outcomes in AR. J Am Coll Cardiol 2020; 75:2275-2276. [PMID: 32354390 DOI: 10.1016/j.jacc.2020.01.063] [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: 01/14/2020] [Accepted: 01/21/2020] [Indexed: 10/24/2022]
|
27
|
Chambers J. Aortic Regurgitation: The Value of Clinical Signs. J Am Coll Cardiol 2020; 75:40-41. [PMID: 31918833 DOI: 10.1016/j.jacc.2019.11.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 11/18/2019] [Indexed: 10/25/2022]
Affiliation(s)
- John Chambers
- Cardiothoracic Centre, Guy's and St Thomas' Hospitals, London, United Kingdom.
| |
Collapse
|