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Jiang Y, Yang Z, Shao L, Shen H, Teng X, Chen Y, Ding Y, Fan J, Yu Y, Shen Z. Clinical Outcomes by Consolidation of Bone Marrow Stem Cell Therapy and Coronary Artery Bypass Graft in Patients With Heart Failure With Reduced Ejection Fraction: A Meta-analysis. Cell Transplant 2023; 32:9636897231152381. [PMID: 36786355 PMCID: PMC9932762 DOI: 10.1177/09636897231152381] [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] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 01/04/2023] [Accepted: 01/06/2023] [Indexed: 02/15/2023] Open
Abstract
Bone marrow stem cell (BMSC) transplantation during coronary artery bypass graft (CABG) is an innovative treatment for ischemic heart disease (IHD). We conduct a meta-analysis to examine whether patients with IHD presenting heart failure with reduced ejection fraction (HFrEF) can be beneficent from CABG with additional BMSC transplantation. Electronic searches were performed on PubMed, EMBASE, Cochrane Library, and ClinicalTrials.gov from their inception to July 2021. The efficacy was based on left ventricular ejection fraction (LVEF), left ventricular end-diastolic diameter (LVEDD), left ventricular end-diastolic volume (LVEDV), left ventricular end-diastolic volume index (LVEDVi), left ventricular end-systolic volume index (LVESVi), and 6-min walk test (6MWT) change after treatment. Eight randomized-controlled trials (RCTs) were included in this meta-analysis, with a total of 350 patients. Results showed BMSC transplantation significantly improved the LVEF [mean difference (MD) = 6.23%, 95% confidence interval (CI): 3.22%-9.24%, P < 0.0001], LVEDVi (MD = -20.15 ml/m2, 95% CI: -30.49 to -9.82 ml/m2, P < 0.00001), and LVESVi (MD = -17.69 ml/m2, 95% CI: -25.24 to -10.14 ml/m2, P < 0.00001). There was no statistically significant difference in the improvement of LVEDD, LVEDV, and 6MWT between the cell transplantation group and control groups. Subgroup analysis revealed that the intervention for control group could affect the efficacy of BMSC transplantation. Sensitivity analysis found the conclusion of LVEDD, LVEDV, and 6MWT changes was not stable. Therefore, among patients with IHD presenting HFrEF, BMSC transplantation during CABG is promising to be beneficial for postoperative left ventricular (LV) function improvement. However, according to the unstable results of the sensitivity analysis, it cannot be concluded whether the extra step has a positive effect on left ventricular remodeling and exercise capacity. RCTs with larger cohorts and more strict protocols are needed to validate these conclusions.
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Affiliation(s)
- Yinhao Jiang
- Department of Cardiovascular Surgery of
the First Affiliated Hospital & Institute for Cardiovascular Science, Soochow
University, Suzhou, People’s Republic of China
| | - Ziying Yang
- Department of Cardiovascular Surgery of
the First Affiliated Hospital & Institute for Cardiovascular Science, Soochow
University, Suzhou, People’s Republic of China
| | - Lianbo Shao
- Department of Cardiovascular Surgery of
the First Affiliated Hospital & Institute for Cardiovascular Science, Soochow
University, Suzhou, People’s Republic of China
| | - Han Shen
- Department of Cardiovascular Surgery of
the First Affiliated Hospital & Institute for Cardiovascular Science, Soochow
University, Suzhou, People’s Republic of China
| | - Xiaomei Teng
- Department of Cardiovascular Surgery of
the First Affiliated Hospital & Institute for Cardiovascular Science, Soochow
University, Suzhou, People’s Republic of China
| | - Yihuan Chen
- Department of Cardiovascular Surgery of
the First Affiliated Hospital & Institute for Cardiovascular Science, Soochow
University, Suzhou, People’s Republic of China
| | - Yinglong Ding
- Department of Cardiovascular Surgery of
the First Affiliated Hospital & Institute for Cardiovascular Science, Soochow
University, Suzhou, People’s Republic of China
| | - Jiaming Fan
- Department of Cardiovascular Surgery of
the First Affiliated Hospital & Institute for Cardiovascular Science, Soochow
University, Suzhou, People’s Republic of China
| | - You Yu
- Department of Cardiovascular Surgery of
the First Affiliated Hospital & Institute for Cardiovascular Science, Soochow
University, Suzhou, People’s Republic of China
| | - Zhenya Shen
- Department of Cardiovascular Surgery of
the First Affiliated Hospital & Institute for Cardiovascular Science, Soochow
University, Suzhou, People’s Republic of China
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Butt JH, Sørensen R, Bäck C, Olsen PS, Thorsteinsson K, Torp-Pedersen C, Gislason GH, Køber L, Fosbøl EL. Short- and long-term cause of death in patients undergoing isolated coronary artery bypass grafting: A nationwide cohort study. J Thorac Cardiovasc Surg 2018; 156:54-60.e4. [PMID: 29627184 DOI: 10.1016/j.jtcvs.2018.01.106] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2017] [Revised: 12/18/2017] [Accepted: 01/29/2018] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Knowledge of the association between time and causes of death after coronary artery bypass grafting is sparse. We examined short- and long-term mortality and cause of death in patients undergoing coronary artery bypass grafting. METHODS With the use of Danish nationwide registries, we identified all patients undergoing isolated coronary artery bypass grafting from 1998 to 2014. Cause of death was classified as cardiovascular or noncardiovascular according to death certificates. Landmark analyses of the cumulative incidences of cardiovascular and noncardiovascular mortality after 1, 3, and 5 years after coronary artery bypass grafting were performed. Multivariable cause-specific Cox regression models were used to evaluate changes over time in the risk of all-cause, cardiovascular, and noncardiovascular mortality after 1 and 7 years after coronary artery bypass grafting, respectively. RESULTS Among 37,495 included patients, 12,230 (32.6%) died during a median follow-up of 7.4 years. Causes of death were classified as cardiovascular in 6459 patients (52.8%) and noncardiovascular in 5771 patients (47.2%). Within the first year, the incidence of cardiovascular death was higher compared with noncardiovascular death (3.9% vs 1.1%, P < .001). The cumulative incidences of cardiovascular and noncardiovascular were deaths similar in the periods 1 to 3 years (2.3% vs 2.6%, P = .004), 3 to 5 years (3.1% vs 3.2%, P = .75), and 5 to 7 years postsurgery (3.7% vs 4.0%, P = .07). The crude rates and adjusted risks of short- and long-term all-cause and cardiovascular mortality decreased during the study period despite an increase in age and burden of comorbidities. CONCLUSIONS In patients undergoing coronary artery bypass grafting, cardiovascular causes were responsible for the majority of deaths within the first year. Deaths due to noncardiovascular causes gained importance over time elapsed since coronary artery bypass grafting.
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Affiliation(s)
- Jawad H Butt
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
| | - Rikke Sørensen
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Caroline Bäck
- Department of Cardiothoracic Surgery, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Peter Skov Olsen
- Department of Cardiothoracic Surgery, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | | | | | - Gunnar H Gislason
- Department of Cardiology, Herlev and Gentofte University Hospital, Hellerup, Denmark; The Danish Heart Foundation, Copenhagen, Denmark; The National Institute of Public Health, University of Southern Denmark, Odense, Denmark
| | - Lars Køber
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Emil L Fosbøl
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
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Kinno M, Nagpal P, Horgan S, Waller AH. Comparison of Echocardiography, Cardiac Magnetic Resonance, and Computed Tomographic Imaging for the Evaluation of Left Ventricular Myocardial Function: Part 1 (Global Assessment). Curr Cardiol Rep 2017; 19:9. [PMID: 28176279 DOI: 10.1007/s11886-017-0815-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Assessing left ventricular function is an essential part of the cardiovascular evaluation as it plays an important role in managing the patient and predicting prognosis. Recent advances in the imaging modalities currently allow a non-invasive comprehensive assessment of cardiac mechanics and precise estimation of cardiovascular hemodynamics. In this review, we will discuss and compare the currently available techniques and novel approaches utilized by echocardiography, cardiac magnetic resonance, and computed tomography for the assessment of global left ventricular performance.
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Affiliation(s)
- Menhel Kinno
- Division of Cardiology, Department of Medicine, Rutgers New Jersey Medical School, Rutgers, The State University of New Jersey, 185 South Orange Avenue, Newark, NJ, 07103, USA
| | - Prashant Nagpal
- Department of Radiology, Carver College of Medicine, University of Iowa, Iowa City, IA, USA
| | - Stephen Horgan
- Department of Cardiovascular Medicine, Morristown Medical Center, Gagnon Cardiovascular Institute, Morristown, NJ, USA
| | - Alfonso H Waller
- Division of Cardiology, Department of Medicine, Rutgers New Jersey Medical School, Rutgers, The State University of New Jersey, 185 South Orange Avenue, Newark, NJ, 07103, USA.
- Department of Radiology, Rutgers New Jersey Medical School, Rutgers, The State University of New Jersey, Newark, NJ, USA.
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Gandji W, Azarnoush K, Mulliez A, Innorta A, Farhat M, Combaret N, Durel N, Souteyrand G, Lusson JR, Camilleri L. [Impact of transcatheter aortic valve implantation in the treatment of aortic valve disease after previous coronary artery bypass]. Ann Cardiol Angeiol (Paris) 2015; 65:7-14. [PMID: 25641084 DOI: 10.1016/j.ancard.2015.01.006] [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: 09/29/2014] [Accepted: 01/02/2015] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Patients with a history of coronary artery bypass and aortic valve disease constitute a high-risk group for conventional redo surgery. The transcatheter aortic valve implantation (TAVI) may be an alternative for high-risk patients. The purpose of this study is to evaluate the impact of TAVI in the treatment of aortic valve disease after previous surgical coronary artery revascularization. PATIENTS AND METHODS This is a single-center retrospective, observational study, including 87 patients undergoing surgery for surgical heart valve replacement or TAVI from January 2007 to December 2013. RESULTS The introduction of transcatheter aortic valve implantation techniques has doubled the number of redo patients treated for aortic valve disease. From 2010 to 2013, the patients treated by conventional surgery diminished by 30%, with improved postoperative outcomes. This study allowed us to notice differences in patient's in terms of operative risk factors. For the same reasons no comparison was possible between 2 subgroup of patients. Hospital mortality was 6.4% for conventional aortic surgery and 20% for transcatheter aortic valve treatment. CONCLUSION Surgery remains the standard treatment for aortic valve disease even in redo patients, but TAVI becomes a very interesting tool as it may represent a tailored approach for our patients.
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Affiliation(s)
- W Gandji
- Pôle cardiologie médicale et chirurgicale, CHU de Clermont-Ferrand, place H.-Dunant, B.P. 69, 63000 Clermont-Ferrand, France
| | - K Azarnoush
- Pôle cardiologie médicale et chirurgicale, CHU de Clermont-Ferrand, place H.-Dunant, B.P. 69, 63000 Clermont-Ferrand, France; Inra, UMR 1019 nutrition humaine, 63122 Saint-Genès-Champanelle, France.
| | - A Mulliez
- Bio-statistics unit, délégation recherche clinique & innovation. CHU de Clermont-Ferrand, place H.-Dunant, B.P. 69, 63000 Clermont-Ferrand, France
| | - A Innorta
- Pôle cardiologie médicale et chirurgicale, CHU de Clermont-Ferrand, place H.-Dunant, B.P. 69, 63000 Clermont-Ferrand, France
| | - M Farhat
- Pôle cardiologie médicale et chirurgicale, CHU de Clermont-Ferrand, place H.-Dunant, B.P. 69, 63000 Clermont-Ferrand, France
| | - N Combaret
- Pôle cardiologie médicale et chirurgicale, CHU de Clermont-Ferrand, place H.-Dunant, B.P. 69, 63000 Clermont-Ferrand, France
| | - N Durel
- Service de cardiologie, pôle santé république, 105, avenue de la République, 63050 Clermont-Ferrand, France
| | - G Souteyrand
- Pôle cardiologie médicale et chirurgicale, CHU de Clermont-Ferrand, place H.-Dunant, B.P. 69, 63000 Clermont-Ferrand, France
| | - J R Lusson
- Pôle cardiologie médicale et chirurgicale, CHU de Clermont-Ferrand, place H.-Dunant, B.P. 69, 63000 Clermont-Ferrand, France
| | - L Camilleri
- Pôle cardiologie médicale et chirurgicale, CHU de Clermont-Ferrand, place H.-Dunant, B.P. 69, 63000 Clermont-Ferrand, France
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PPAR Gamma Expression Levels during Development of Heart Failure in Patients with Coronary Artery Disease after Coronary Artery Bypass-Grafting. PPAR Res 2014; 2014:242790. [PMID: 25371662 PMCID: PMC4211148 DOI: 10.1155/2014/242790] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2014] [Revised: 09/07/2014] [Accepted: 09/21/2014] [Indexed: 11/17/2022] Open
Abstract
Genetic research has elucidated molecular mechanisms of heart failure (HF). Peroxisome proliferator-activated receptors (PPARs) seem to be important in etiology of HF. The aim of study was to find the correlation between PPARγ expression during development of HF in patients and coronary artery disease (CAD) after coronary artery bypass-grafting (CABG). Methods and Results. We followed up 157 patients (mean age 63) with CAD without clinical, laboratory, or echo parameters of HF who underwent CABG. Clinical and laboratory status were assessed before CABG and at 1, 12, and 24 months. During CABG slices of aorta (Ao) and LV were collected for genetic research. HF was defined as LVEF <40% or NT-proBNP >400 pg/mL or 6MWT <400 m. Patients were divided into 2 groups: with and without HF. PPARγ expression in Ao and LV was not increased in both groups at 2-year follow-up. Sensitivity of PPARγ expression in Ao above 1.1075 in detection of HF was 20.5% (AUC 0.531, 95% CI 0.442–0.619). Positive predictive value (Ppv) was 85.7%. Sensitivity and specificity of PPARγ expression in the LV in detection of HF were 58% and 92.9%, respectively (AUC 0.540, 95% CI 0.452–0.626). Ppv was 73.2%. Conclusion. PPARγ expression in Ao and LV was comparable and should not be used as predictive factor for development of HF in patients with CAD after CABG.
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Panza JA, Velazquez EJ, She L, Smith PK, Nicolau JC, Favaloro RR, Gradinac S, Chrzanowski L, Prabhakaran D, Howlett JG, Jasinski M, Hill JA, Szwed H, Larbalestier R, Desvigne-Nickens P, Jones RH, Lee KL, Rouleau JL. Extent of coronary and myocardial disease and benefit from surgical revascularization in ischemic LV dysfunction [Corrected]. J Am Coll Cardiol 2014; 64:553-61. [PMID: 25104523 DOI: 10.1016/j.jacc.2014.04.064] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2014] [Revised: 04/17/2014] [Accepted: 04/21/2014] [Indexed: 12/22/2022]
Abstract
BACKGROUND Patients with ischemic left ventricular dysfunction have higher operative risk with coronary artery bypass graft surgery (CABG). However, those whose early risk is surpassed by subsequent survival benefit have not been identified. OBJECTIVES This study sought to examine the impact of anatomic variables associated with poor prognosis on the effect of CABG in ischemic cardiomyopathy. METHODS All 1,212 patients in the STICH (Surgical Treatment of IsChemic Heart failure) surgical revascularization trial were included. Patients had coronary artery disease (CAD) and ejection fraction (EF) of ≤35% and were randomized to receive CABG plus medical therapy or optimal medical therapy (OMT) alone. This study focused on 3 prognostic factors: presence of 3-vessel CAD, EF below the median (27%), and end-systolic volume index (ESVI) above the median (79 ml/m(2)). Patients were categorized as having 0 to 1 or 2 to 3 of these factors. RESULTS Patients with 2 to 3 prognostic factors (n = 636) had reduced mortality with CABG compared with those who received OMT (hazard ratio [HR]: 0.71; 95% confidence interval [CI]: 0.56 to 0.89; p = 0.004); CABG had no such effect in patients with 0 to 1 factor (HR: 1.08; 95% CI: 0.81 to 1.44; p = 0.591). There was a significant interaction between the number of factors and the effect of CABG on mortality (p = 0.022). Although 30-day risk with CABG was higher, a net beneficial effect of CABG relative to OMT was observed at >2 years in patients with 2 to 3 factors (HR: 0.53; 95% CI: 0.37 to 0.75; p<0.001) but not in those with 0 to 1 factor (HR: 0.88; 95% CI: 0.59 to 1.31; p = 0.535). CONCLUSIONS Patients with more advanced ischemic cardiomyopathy receive greater benefit from CABG. This supports the indication for surgical revascularization in patients with more extensive CAD and worse myocardial dysfunction and remodeling. (Comparison of Surgical and Medical Treatment for Congestive Heart Failure and Coronary Artery Disease [STICH]; NCT00023595).
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Affiliation(s)
- Julio A Panza
- Westchester Medical Center and New York Medical College, Valhalla, New York.
| | - Eric J Velazquez
- Duke Clinical Research Institute, Department of Medicine-Cardiology, Duke University School of Medicine, Durham, North Carolina
| | - Lilin She
- Duke Clinical Research Institute, Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC
| | - Peter K Smith
- Duke Clinical Research Institute, Department of Surgery-Cardiothoracic, Duke University School of Medicine, Durham, North Carolina
| | - José C Nicolau
- InCor Heart Institute, University of São Paulo Medical School, São Paulo, Brazil
| | | | | | | | | | | | | | - James A Hill
- Shands Hospital at the University of Florida, Gainesville, Florida
| | | | | | | | - Robert H Jones
- Duke Clinical Research Institute, Department of Surgery-Cardiothoracic, Duke University School of Medicine, Durham, North Carolina
| | - Kerry L Lee
- Duke Clinical Research Institute, Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC
| | - Jean L Rouleau
- Montréal Heart Institute, Université de Montréal, Montréal, Quebec, Canada
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Ambrosetti M, Griffo R, Tramarin R, Fattirolli F, Temporelli PL, Faggiano P, De Feo S, Vestri AR, Giallauria F, Greco C. Prevalence and 1-year prognosis of transient heart failure following coronary revascularization. Intern Emerg Med 2014; 9:641-7. [PMID: 24146110 DOI: 10.1007/s11739-013-1006-y] [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: 06/21/2013] [Accepted: 10/07/2013] [Indexed: 10/26/2022]
Abstract
The occurrence of heart failure during the whole pre-discharge course of coronary revascularization, as far as its influence on subsequent prognosis, is poorly understood. The present study examined the effect of transient heart failure (THF) developing in the acute and rehabilitative phase on survival after coronary artery bypass graft surgery (CABG) and percutaneous coronary intervention (PCI). Patients in the Italian survey on cardiac rehabilitation and secondary prevention after cardiac revascularization (ICAROS) were analyzed for THF, the latter being defined either as signs and symptoms consistent with decompensation or cardiogenic shock. ICAROS was a prospective, multicenter registry of 1,262 consecutive patients discharged from 62 cardiac rehabilitation (CR) facilities, providing data on risk factors, lifestyle habits, drug treatments, and major cardiovascular events (MACE) during a 1-year follow-up. Records were linked to the official website of the Italian Association of Cardiovascular Prevention and Rehabilitation (GICR-IACPR). The overall prevalence of pre-discharge THF was 7.6%, with 69.8% of cases in acute wards, 22.9% during CR, and 7.3% in both settings. THF affected more frequently patients with chronic cardiac condition (42.7 vs. 30.6%; p < 0.05), age ≥75 years (33.3 vs. 23.1%; p < 0.005), COPD (19.8 vs. 12.3%; p < 0.05), and chronic kidney disease (17.7 vs. 7%; p < 0.001). After discharge, THF patients showed good maintenance rates of RAAS modulators (90.6%) and beta-blockers (83.3%), while statin therapy significantly decreased from 81.3 to 64.6% (p < 0.05). The pursuit of secondary prevention targets, as far as self-reported drug adherence, was not different among groups. Patients with THF had increased 1-year mortality (8.3 vs. 1.6%, p < 0.001). Moreover, THF independently predicted adverse outcome with OR for recurrent events (mainly further episodes of decompensation) of 2.4 (CI 1.4-4.3). Patients who experienced THF after coronary revascularization had increased post-discharge mortality and cardiovascular events. Hemodynamic instability, rather than recurrent myocardial ischemia, seems to be linked with worse prognosis.
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Affiliation(s)
- Marco Ambrosetti
- Cardiovascular Rehabilitation Unit, Le Terrazze Clinic, Cunardo, Italy,
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Persson A, Hartford M, Herlitz J, Karlsson T, Omland T, Caidahl K. Long-term prognostic value of mitral regurgitation in acute coronary syndromes. Heart 2010; 96:1803-8. [PMID: 20876739 PMCID: PMC2976074 DOI: 10.1136/hrt.2010.203059] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Objectives To determine the additional prognostic value of mitral regurgitation (MR) over B-type natriuretic peptide (BNP), left ventricular ejection fraction (LVEF) and clinical characteristics in patients with acute coronary syndromes (ACS). Design Long-term follow-up in a prospective ACS cohort with Doppler-assessed MR, echocardiographically-determined LVEF and plasma BNP levels by ELISA. Setting Single-centre university hospital. Patients 725 patients with ACS. Main outcome measures Death and readmission for congestive heart failure. Results During a median follow-up of 98 months, 235 patients (32%) died. Significant MR (grade >1 of 4) was found in 90 patients (12%). In a multivariate model including MR grade >1, LVEF <0.40 and BNP >373 pg/ml (75th percentile), MR was significantly associated with long-term mortality (HR 2.28, 95% CI 1.67 to 3.12; p<0.0001). When also adjusting for conventional risk factors, MR remained significantly associated with mortality (HR 1.53, 95% CI 1.06 to 2.19; p=0.02), as well as with congestive heart failure (HR 2.08, 95% CI 1.29 to 3.35; p=0.003). Conclusions MR is common in patients with ACS, provides independent risk information and should be taken into account in the evaluation of the long-term prognosis.
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Affiliation(s)
- Anita Persson
- Department of Clinical Physiology, Sahlgrenska Academy and University Hospital, Gothenburg, Sweden
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Hu FB, Tamai H, Kosuga K, Kyo E, Hata T, Okada M, Nakamura T, Fujita S, Tsuji T, Takeda S, Motohara S, Uehata H. Predictors of improvement in left ventricular function after initially successful angioplasty of unprotected left main coronary artery stenoses. ACTA ACUST UNITED AC 2009; 6:119-27. [PMID: 16146904 DOI: 10.1080/14628840410030423] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Percutaneous coronary intervention (PCI) has been increasingly applied to unprotected left main coronary artery (LMCA) lesions, with varied procedural success and clinical outcomes. However, the effect of PCI on left ventricular performance is still unclear, and there are no clinical studies assessing factors that influence left ventricular ejection fraction (LVEF) in these cases. METHODS Between April 1986 and August 2002, de novo PCI was performed for unprotected LMCA stenoses in 199 patients. Close clinical and angiographic follow-up were conducted after the procedure. RESULTS One hundred eighty patients survived over six months and analysis of paired left ventriculography was possible in 175 patients. Improvement in LVEF was observed in the entire population (52.9 +/- 15.7% to 56.1 +/- 14.3%, p = 0.048). The LVEF change was 6.7 +/- 9.5% (p < 0.01) in group with baseline LVEF < or = 50% and 0.7 +/- 6.7 % (p = NS) in group with LVEF > 50%. There was significant intergroup difference (p < 0.001). Patients with baseline diameter stenosis > or = 60% had an improvement of 5.3 +/- 8.3% (p < 0.05) whereas those with stenosis < 60% had no improvement (2.0 +/- 8.4%, p = NS). CK-MB elevation > or = 3 times normal after PCI had a significant inverse association with improvement in LVEF (p < 0.05). Multivariate analysis revealed baseline LVEF < or = 50% was the only independent predictor of improvement in LVEF (standard estimate = 3.509, 95% CI: 2.164-4.854, p < 0.001). CONCLUSIONS Successful PCI procedure is associated with significant improvement in LVEF, especially in patients with depressed left ventricular function.
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Affiliation(s)
- Fang-Bin Hu
- Department of Cardiology, Shiga Medical Center for Adults, Moriyama, Shiga, Japan
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Sayyed SH, Cassidy MM, Hadi MA. Use of multidetector computed tomography for evaluation of global and regional left ventricular function. J Cardiovasc Comput Tomogr 2009; 3:S23-34. [DOI: 10.1016/j.jcct.2008.10.016] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2008] [Revised: 10/17/2008] [Accepted: 10/25/2008] [Indexed: 10/21/2022]
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Holper EM, Brooks MM, Kim LJ, Detre KM, Faxon DP. Effects of heart failure and diabetes mellitus on long-term mortality after coronary revascularization (from the BARI Trial). Am J Cardiol 2007; 100:196-202. [PMID: 17631069 DOI: 10.1016/j.amjcard.2007.02.082] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2006] [Revised: 02/15/2007] [Accepted: 02/15/2007] [Indexed: 11/29/2022]
Abstract
This study evaluated the effect of heart failure (HF) and ejection fraction (EF) at baseline on long-term cardiac mortality in patients undergoing coronary revascularization and investigated the effect of diabetes mellitus (DM) on mortality. We evaluated long-term outcomes of patients without HF, HF and a preserved EF, and HF and a decreased EF who underwent revascularization with percutaneous transluminal coronary angioplasty or coronary artery bypass graft surgery after enrollment in the Bypass Angioplasty Revascularization Investigation (BARI) trial. Ten years after initial revascularization, cumulative rates of freedom from cardiac death were 90% in patients without HF, 75% in patients with HF and a preserved EF, and 59% in patients with HF and a decreased EF (p <0.001, 3-way comparison). In diabetic patients with HF and a preserved EF, there was a significant increase in cardiac mortality compared with patients without HF (p <0.001); however, this relation was not seen in patients without DM. In conclusion, patients with HF and a preserved EF have increased mortality over 10 years compared with those without HF. Only in patients with DM did HF with preserved EF confer additional risk.
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Affiliation(s)
- Elizabeth M Holper
- Department of Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
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Herd JA, Hoogwerf BJ, Barton F, Terrin ML, Czajkowski SM, Lindquist R, Dupuis G. Heart rate and blood pressure responses to mental stress and clinical cardiovascular events in men and women after coronary artery bypass grafting: the Post Coronary Artery Bypass Graft (Post-CABG) biobehavioral study. Am Heart J 2003; 146:273-9. [PMID: 12891195 DOI: 10.1016/s0002-8703(03)00182-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND The Post-Coronary Artery Bypass Graft (CABG) biobehavioral study measured the heart rate (HR) and blood pressure (BP) responses to mental stress testing (MST) after surgery and prospectively observed the clinical events in patients who had undergone recent CABG surgery. To the extent that CABG surgery restores myocardial blood flow and prevents myocardial ischemia, patients who have recently recovered from CABG surgery may have nearly normal HR and BP responses to MST. METHODS A study population of 521 patients (351 men,170 women) from the cohort of 759 patients in the Post-CABG biobehavioral Study was monitored during a mirror tracing test (MTT) and a speech test task (STT) at the 6-month post-CABG surgery follow-up. Medical status for as long as 3 years after CABG surgery was ascertained from questionnaires and medical records. RESULTS The HR and BP responses during MTT and STT were similar to those reported in other studies of healthy individuals and patients without myocardial ischemia during MST. In contrast to results from other studies of patients with coronary artery disease, the quartile of Post-CABG biobehavioral study patients with the greatest responses in HR, systolic BP (SBP) and diastolic BP (DBP) during MST had half the rate of clinical events (10% in 3 years) as the quartile (20%) with the lowest changes in HR and BP (HR, P =.01; SBP, P =.07; DBP, P =.01). CONCLUSIONS Vigorous HR and BP responses to MST may be markers for a lower risk of incidence of clinical cardiovascular events among patients who have undergone recent CABG surgery.
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Affiliation(s)
- J Alan Herd
- Department of Medicine, Baylor College of Medicine, Houston, Tex, USA
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MADIT II, the Multi-center Autonomic Defibrillator Implantation Trial II stopped early for mortality reduction, has ICD therapy earned its evidence-based credentials? Int J Cardiol 2002. [DOI: 10.1016/s0167-5273(01)00629-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Couffinhal T, Dufourcq P, Daret D, Duplaà C. [The mechanisms of angiogenesis. Medical and therapeutic applications]. Rev Med Interne 2001; 22:1064-82. [PMID: 11817119 DOI: 10.1016/s0248-8663(01)00472-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
PURPOSE Endothelial and smooth muscle cells interact with each other to form new blood vessels. In this review, the cellular and molecular mechanism underlying the formation of the primary vascular plexus (vasculogenesis), the sprouting of further blood vessels (angiogenesis) and their maturation via recruitment of smooth muscle cells (arteriogenesis) during physiological and pathological conditions are summarized. CURRENT KNOWLEDGE AND KEY POINT The concept of angiogenesis is studied in tumoral and cardiovascular pathology. Promoting the formation of new collateral vessels in ischemic tissues using angiogenic growth factors (therapeutic angiogenesis) is a promising approach in cardiovascular diseases. Conversely, inhibition of the action of key regulators of angiogenesis is a new pathway for the treatment of solid tumors and metastasis. FUTURE PROSPECTS AND PROJECTS These concepts are being tested now in clinical trials in the oncology or cardiovascular fields. Some trials are reported in this review with their potential adverse effects, limits and developments in the future.
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Affiliation(s)
- T Couffinhal
- Service de cardiologie et de maladies vasculaires, hôpital cardiologique, avenue de Magellan, 33604 Pessac, France.
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