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Akhtar KH, Khan MS, Baron SJ, Zieroth S, Estep J, Burkhoff D, Butler J, Fudim M. The spectrum of post-myocardial infarction care: From acute ischemia to heart failure. Prog Cardiovasc Dis 2024; 82:15-25. [PMID: 38242191 DOI: 10.1016/j.pcad.2024.01.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 01/15/2024] [Indexed: 01/21/2024]
Abstract
Heart failure (HF) is the leading cause of mortality in patients with acute myocardial infarction (AMI), with incidence ranging from 14% to 36% in patients admitted due to AMI. HF post-MI develops due to complex inter-play between macrovascular obstruction, microvascular dysfunction, myocardial stunning and remodeling, inflammation, and neuro-hormonal activation. Cardiogenic shock is an extreme presentation of HF post-MI and is associated with a high mortality. Early revascularization is the only therapy shown to improve survival in patients with cardiogenic shock. Treatment of HF post-MI requires prompt recognition and timely introduction of guideline-directed therapies to improve mortality and morbidity. This article aims to provide an up-to-date review on the incidence and pathogenesis of HF post-MI, current strategies to prevent and treat onset of HF post-MI, promising therapeutic strategies, and knowledge gaps in the field.
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Affiliation(s)
- Khawaja Hassan Akhtar
- Department of Medicine, Section of Cardiovascular Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | | | - Suzanne J Baron
- Division of Cardiology, Massachusetts General Hospital, Boston, MA, USA
| | - Shelley Zieroth
- Section of Cardiology, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Jerry Estep
- Section of Heart Failure & Transplantation, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Daniel Burkhoff
- Cardiovascular Research Foundation, Columbia University Medical Center, New York City, NY, USA
| | - Javed Butler
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS, USA; Baylor Scott and White Research Institute, Dallas, TX, USA
| | - Marat Fudim
- Division of Cardiology, Duke University School of Medicine, Durham, NC, USA; Duke Clinical Research Institute, Durham, NC, USA; Institute of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland.
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Prytuliak O, Vakaliuk I, Nesterak R, Sovtus V, Haliuk N, Denina R. The Features of Post-infarction Period in Patients of Law Tolerance to Physical Activity and Chronic Heart Failure. ACTA BALNEOLOGICA 2022. [DOI: 10.36740/abal202206111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Aim: To determine the features of the early post-infarction period in patients after acute coronary syndrome with concomitant arterial hypertension, depending on the response to dosed physical activity.
Materials and Methods: 120 patients with a reduced response to dosed physical activity, with Q, QS MI and concomitant hypertension, who were at the stage of rehabilitation and recovery treatment, were examined.
Results: In the course of the study, during the 6-minute walk test, a decrease in oxygen consumption was found in the group of patients of an adequate tolerance to physical activity by 18.42% compared to 15.21% in the group of patients of low tolerance to activity. During the analysis of ABPM (Ambulatory Blood Pressure Monitoring) indicators, it was found that in patients who made up the group of low tolerance to DPA (Dosed Physical Activity), significantly higher average values of systolic blood pressure (SBP) (159.24}3.4) mm Hg and diastolic blood pressure (DBP) (96.26}2 .49) mm Hg, as well as heart rate. During urgent coronary angiography, it was found that in patients of an adequate response to DPA, one vascular lesion was detected in most cases (73.3%), in the group of patients of low tolerance to DPA, one vascular lesion of CA was detected in (14.5%), in (55.5%) recorded two vascular lesions of the CA, and (30%) patients had three or more vascular lesions of the CA. The level of troponin I in blood serum at the time of hospitalization in the group of patients of low tolerance to DPA was 36.38}6.79 ng/ml, the level of NT-proBNP – 726.4}36.32 pg/ml, the level of endothelin-1-9,37}1.34 pmol/L.
Conclusions: During the recovery period of treatment of patients after an acute myocardial infarction with concomitant arterial hypertension, a low tolerance to dosed physical activity occurs (in 63.7% of cases), which is accompanied by the appearance of anginal pain, changes in clinical indicators in the early and late post-infarction period and prevents the conducting a full range of rehabilitation measures.
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Affiliation(s)
- Oksana Prytuliak
- The Ivano-Frankivsk National Medical University, Ivano-Frankivsk, Ukraine
| | - Ihor Vakaliuk
- The Ivano-Frankivsk National Medical University, Ivano-Frankivsk, Ukraine
| | - Roksolana Nesterak
- The Ivano-Frankivsk National Medical University, Ivano-Frankivsk, Ukraine
| | - Volodymyra Sovtus
- The Ivano-Frankivsk National Medical University, Ivano-Frankivsk, Ukraine
| | - Nadiia Haliuk
- The Ivano-Frankivsk National Medical University, Ivano-Frankivsk, Ukraine
| | - Ruslana Denina
- The Ivano-Frankivsk National Medical University, Ivano-Frankivsk, Ukraine
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Bryndal A, Glowinski S, Grochulska A. Influence of Risk Factors on Exercise Tolerance in Patients after Myocardial Infarction—Early Cardiac Rehabilitation in Poland. J Clin Med 2022; 11:jcm11195597. [PMID: 36233465 PMCID: PMC9572875 DOI: 10.3390/jcm11195597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 09/15/2022] [Accepted: 09/20/2022] [Indexed: 11/16/2022] Open
Abstract
(1) Background: Prognosis in patients with cardiovascular diseases is significantly influenced by lifestyle and the control of risk factors. Patients after myocardial infarction require special care and promptly introduced cardiac rehabilitation. The primary aim of this study was to identify risk factors and their influence on exercise tolerance before and after cardiac rehabilitation (CR) provided under the Coordinated Specialist Care Programme—Infarct (CSC-Infarct). (2) Methods: The study was carried out at the Cardiac Rehabilitation Centre of Slupsk Specialist Hospital on a group of 112 patients aged 35–87 (62.78 ± 10.09 years) after myocardial infarction (MI), participating in CSC-Infarct. An exercise test (treadmill ECG test), the 6 min walk test (6MWT), echocardiography, blood test (total cholesterol, HDL, LDL, TG), measurement of diastolic pressure ratio (DPr), waist-to-hip ratio (WHR), and BMI were performed in participants on the first and last day of CR. Rating of perceived exertion was assessed with Borg’s scale. (3) Results: The overweight variable had the strongest effect on the increased value of initial: HR rest, HR max, and HR 1 min after exercise compared to subjects with normal BMI. DPr values before and after CR were also higher in overweight patients. Scores of 6MWT were higher in smokers compared to non-smokers. The final MET value was significantly higher in non-diabetic subjects. Hyperlipidaemia was associated with a higher initial HR max and initial HR 1 min after exercise. DPr before CR was also higher. The initial and final MET values were lower in hypertensive patients. Borg’s rating of perceived exertion measured after the final exercise test was also higher in hypertensive patients. Hypertension influenced the initial and final 6MWT scores, which were significantly higher in normotensive patients. (4) Conclusions: CR within CSC-infarction in patients after myocardial infarction improves exercise tolerance. Exercise tolerance in post-MI patients with concomitant risk factors is lower compared to post-MI patients without risk factors.
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Affiliation(s)
- Aleksandra Bryndal
- Department of Physiotherapy, Institute of Health Sciences, Slupsk Pomeranian University, 76200 Slupsk, Poland
- Correspondence:
| | - Sebastian Glowinski
- State Higher School of Vocational Education in Koszalin, 75-582 Koszalin, Poland
| | - Agnieszka Grochulska
- Department of Physiotherapy, Institute of Health Sciences, Slupsk Pomeranian University, 76200 Slupsk, Poland
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Freedman BL, Berg DD, Scirica BM, Bohula EA, Goodrich EL, Sabatine MS, Morrow DA, Bonaca MP. Epidemiology of heart failure hospitalization in patients with stable atherothrombotic disease: Insights from the TRA 2°P-TIMI 50 trial. Clin Cardiol 2022; 45:831-838. [PMID: 35855557 PMCID: PMC9346972 DOI: 10.1002/clc.23843] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 04/21/2022] [Accepted: 05/04/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Heart failure (HF) is a growing public health problem and ischemic heart disease is an important risk factor. Understanding the epidemiology of HF in patients with atherosclerosis may help identify subgroups at greater risk who have the potential to derive greater benefit from preventive strategies. METHODS AND RESULTS The TRA 2°P-TIMI 50 trial randomized 26,449 patients with stable atherosclerosis to the antiplatelet agent vorapaxar versus placebo. Hospitalization for HF (HHF) endpoints were adjudicated from serious adverse events by blinded structured review using established definitions. HHF incidence was estimated using Kaplan-Meier analysis. Independent predictors of HHF risk were identified using multivariable logistic regression. The effect of vorapaxar on HHF risk was explored using Cox regression. The estimated incidence of HHF at 3 years was 1.6%. Independent predictors of HHF included prior HF (adjusted odds ratio [adj-OR]: 8.31; 95% confidence interval [CI]: 6.56-10.54), age (adj-OR [per 10 years]: 1.67; 95% CI: 1.47-1.89), type 2 diabetes mellitus (T2DM; adj-OR: 2.55; 95% CI: 2.01-3.24), polyvascular disease (two-territory disease, adj-OR: 1.89; 95% CI: 1.46-2.44; three-territory disease, adj-OR: 2.68; 95% CI: 1.94-3.70), chronic kidney disease (CKD; adj-OR: 1.65; 95% CI: 1.30-2.11), body mass index (BMI; adj-OR [per 5 kg/m2 ]: 1.15; 95% CI: 1.03-1.27), prior myocardial infarction (MI) (adj-OR: 1.35; 95% CI: 1.03-1.78), and hypertension (adj-OR: 1.44; 95% CI: 1.02-2.04). Patients who experienced HHF during follow-up had higher rates of subsequent rehospitalization and death. Vorapaxar did not modify the risk of HHF. CONCLUSIONS In patients with stable atherosclerosis, prior HF, age, T2DM, polyvascular disease, CKD, BMI, prior MI, and hypertension are important predictors of HHF risk.
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Affiliation(s)
- Benjamin L. Freedman
- Department of MedicineBeth Israel Deaconess Medical Center, Harvard Medical SchoolBostonMassachusettsUSA
| | - David D. Berg
- TIMI Study GroupBrigham and Women's Hospital, Harvard Medical SchoolBostonMassachusettsUSA
| | - Benjamin M. Scirica
- TIMI Study GroupBrigham and Women's Hospital, Harvard Medical SchoolBostonMassachusettsUSA
| | - Erin A. Bohula
- TIMI Study GroupBrigham and Women's Hospital, Harvard Medical SchoolBostonMassachusettsUSA
| | - Erica L. Goodrich
- TIMI Study GroupBrigham and Women's Hospital, Harvard Medical SchoolBostonMassachusettsUSA
| | - Marc S. Sabatine
- TIMI Study GroupBrigham and Women's Hospital, Harvard Medical SchoolBostonMassachusettsUSA
| | - David A. Morrow
- TIMI Study GroupBrigham and Women's Hospital, Harvard Medical SchoolBostonMassachusettsUSA
| | - Marc P. Bonaca
- CPC Clinical ResearchUniversity of Colorado School of MedicineAuroraColoradoUSA
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Xu H, Wang Q, Liu Y, Meng L, Long H, Wang L, Liu D. U-Shaped Association Between Serum Uric Acid Level and Hypertensive Heart Failure: A Genetic Matching Case-Control Study. Front Cardiovasc Med 2021; 8:708581. [PMID: 34957229 PMCID: PMC8692761 DOI: 10.3389/fcvm.2021.708581] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 11/17/2021] [Indexed: 01/08/2023] Open
Abstract
Background: Heart failure (HF) is a global pandemic and lays an added burden on public healthcare. Previous studies indicated that high and low serum uric acid levels are associated with worse outcomes in many diseases. Reduced serum uric acid may not result in a better outcome. Methods: A comparative, matched cross-sectional study design was implemented. The matching variables were age, sex, BMI, BP, and histories of CKD, CVD, diabetes mellitus, stroke, hyperlipidemia. We reviewed the electronic medical records to identify patients diagnosed with hypertension or hypertensive heart failure (HHF) admitted to Beijing Hospital's cardiology department. Results: The median age of the two groups after matching are 71. There are 55.6% males in the hypertension group and 53.8% in the heart failure group. Univariate logistic regression analysis showed that UA's quadratic term is significant (OR = 1.00, 95% CI 1.00 to 1.00; P = 0.03), which indicated a u-shaped relationship between hypertension and HHF. FBS (OR = 0.22, 95% CI 0.05 to 0.95, p = 0.07) and HDL (OR = 1.23, 95% CI 1.00 to 1.54, P = 0.05) were not significant but close. Conclusion: Our results supported that both low and high uric acid levels were predictive of hypertensive heart failure. Besides, high-density lipoprotein cholesterol and fasting blood sugar were also associated with hypertensive heart failure. Low-density lipoprotein cholesterol was not associated with hypertensive heart failure.
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Affiliation(s)
- Hongxuan Xu
- Chinese Academy of Medical Sciences, National Center of Gerontology, National Health Commission, Department of Cardiology, Beijing Hospital, Institute of Geriatric Medicine, Beijing, China.,The Key Laboratory of Geriatrics, Chinese Academy of Medical Sciences, Beijing Institute of Geriatrics, Beijing Hospital National Center of Gerontology, Institute of Geriatric Medicine, Beijing, China
| | - Quan Wang
- Yuetan Community Health Center, Fuxing Hospital, Capital Medical University, Beijing, China
| | - Yunqing Liu
- Chinese Academy of Medical Sciences, National Center of Gerontology, National Health Commission, Department of Cardiology, Beijing Hospital, Institute of Geriatric Medicine, Beijing, China.,The Key Laboratory of Geriatrics, Chinese Academy of Medical Sciences, Beijing Institute of Geriatrics, Beijing Hospital National Center of Gerontology, Institute of Geriatric Medicine, Beijing, China
| | - Lingbing Meng
- Chinese Academy of Medical Sciences, National Center of Gerontology, National Health Commission, Department of Cardiology, Beijing Hospital, Institute of Geriatric Medicine, Beijing, China.,Chinese Academy of Medical Science, Peking Union Medical College, Beijing, China
| | - Huanyu Long
- The Key Laboratory of Geriatrics, Chinese Academy of Medical Sciences, Beijing Institute of Geriatrics, Beijing Hospital National Center of Gerontology, Institute of Geriatric Medicine, Beijing, China
| | - Li Wang
- The Key Laboratory of Geriatrics, Chinese Academy of Medical Sciences, Beijing Institute of Geriatrics, Beijing Hospital National Center of Gerontology, Institute of Geriatric Medicine, Beijing, China.,Chinese Academy of Medical Sciences, Departments of Neurology, National Center of Gerontology, Beijing Hospital, Institute of Geriatric Medicine, Beijing, China
| | - Deping Liu
- Chinese Academy of Medical Sciences, National Center of Gerontology, National Health Commission, Department of Cardiology, Beijing Hospital, Institute of Geriatric Medicine, Beijing, China.,Yuetan Community Health Center, Fuxing Hospital, Capital Medical University, Beijing, China.,Peking University Health Science Centre, Peking University Fifth School of Clinical Medicine, Beijing, China
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6
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The outcomes of acute myocardial infarction patients comorbidity with hypertension and hyperhomocysteinemia. Sci Rep 2021; 11:22936. [PMID: 34824345 PMCID: PMC8617252 DOI: 10.1038/s41598-021-02340-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 11/09/2021] [Indexed: 11/30/2022] Open
Abstract
This study investigated the outcomes and major adverse cardiovascular events (MACEs) incurred by acute myocardial infarction (AMI) patients comorbiding with hypertension and hyperhomocysteinemia (HHcy) during hospitalization and 1-year follow-up. 648 consecutive AMI patients were divided into four categories: (1) hypertension with Hcy ≥ 15 µmol/L; (2) hypertension with Hcy < 15 µmol/L; (3) no-hypertension with Hcy ≥ 15 µmol/L; (4) no-hypertension with Hcy < 15 µmol/L. Information taken from these case files included gender, past medical history, vital signs, laboratory examination, electrocardiogram, coronary angiography, cardiac ultrasound, and medicine treatment. The primary endpoints were duration of coronary care units (CCU) stay, duration of in-hospital stay, and MACEs during follow-up. Our data show that hypertension and HHcy have a synergistic effect in AMI patients, AMI comorbiding with hypertension and HHcy patients had more severe multi-coronary artery disease and more frequent non-culprit coronary lesions complete clogging, had a higher prevalence of pro-brain natriuretic peptide, and significant decreases in the left ventricular ejection fraction. These patients had significant increases in the duration of CCU stay and in-hospital stay, had significant increase in the rate of MACEs, had significant decreases in the survival rate during follow-up.
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Palmer BR, Paterson MA, Frampton CM, Pilbrow AP, Skelton L, Pemberton CJ, Doughty RN, Ellis CJ, Troughton RW, Richards AM, Cameron VA. Vascular endothelial growth factor-A promoter polymorphisms, circulating VEGF-A and survival in acute coronary syndromes. PLoS One 2021; 16:e0254206. [PMID: 34260629 PMCID: PMC8279389 DOI: 10.1371/journal.pone.0254206] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 06/22/2021] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Development of a competent collateral circulation in established coronary artery disease is cardio-protective. The vascular endothelial growth factor (VEGF) system plays a key role in this process. We investigated the prognostic performance of circulating VEGF-A and three genetic variants in the VEGFA gene in a clinical coronary cohort. METHODS AND RESULTS The Coronary Disease Cohort Study (CDCS) recruited 2,140 patients, with a diagnosis of acute coronary syndrome (ACS), after admission to Christchurch or Auckland City Hospitals between July 2002 and January 2009. We present data for 1927 patients from the cohort genotyped for three SNPs in the VEGF-A gene, rs699947 (C-2578A), rs2010963 (C405G) and rs3025039 (C936T). Plasma VEGF-A concentrations were assayed in a subgroup (n = 550) of CDCS patients (geometric mean 36.6 [34.7-38.5] pg/ml). VEGF-A levels correlated with patient heart rate at baseline (p = 0.034). None of rs699947, rs3025039, nor rs2010963 genotypes were significantly associated with VEGF-A levels, but rs3025039 genotype was positively associated with collateral vessels perfusion according to the Rentrop classification (p = 0.01) and baseline natriuretic peptide levels (p<0.05). Survival in the CDCS cohort was independently associated with baseline VEGF-A levels and (in males) with rs699947 genotype. CONCLUSIONS This study is strongly suggestive that VEGF-A levels have value as a prognostic biomarker in coronary heart disease patients and SNPs in VEGF-A deserve further investigation as prognostic markers and indicators of angiogenic potential influencing the formation of collateral circulation.
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Affiliation(s)
- Barry R. Palmer
- Department of Medicine, Christchurch Heart Institute, University of Otago Christchurch, Christchurch, New Zealand
- School of Health Sciences, College of Health, Massey University, Wellington, New Zealand
- * E-mail:
| | - Melinda A. Paterson
- Department of Medicine, Christchurch Heart Institute, University of Otago Christchurch, Christchurch, New Zealand
| | - Chris. M. Frampton
- Department of Medicine, Christchurch Heart Institute, University of Otago Christchurch, Christchurch, New Zealand
| | - Anna P. Pilbrow
- Department of Medicine, Christchurch Heart Institute, University of Otago Christchurch, Christchurch, New Zealand
| | - Lorraine Skelton
- Department of Medicine, Christchurch Heart Institute, University of Otago Christchurch, Christchurch, New Zealand
| | - Chris J. Pemberton
- Department of Medicine, Christchurch Heart Institute, University of Otago Christchurch, Christchurch, New Zealand
| | - Robert N. Doughty
- Faculty of Medicine and Health Sciences, Department of Medicine, University of Auckland, Auckland, New Zealand
| | - Chris J. Ellis
- Faculty of Medicine and Health Sciences, Department of Medicine, University of Auckland, Auckland, New Zealand
| | - Richard W. Troughton
- Department of Medicine, Christchurch Heart Institute, University of Otago Christchurch, Christchurch, New Zealand
| | - A. Mark Richards
- Department of Medicine, Christchurch Heart Institute, University of Otago Christchurch, Christchurch, New Zealand
- Cardiovascular Research Institute, National University of Singapore, Singapore, Singapore
| | - Vicky A. Cameron
- Department of Medicine, Christchurch Heart Institute, University of Otago Christchurch, Christchurch, New Zealand
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Jenča D, Melenovský V, Stehlik J, Staněk V, Kettner J, Kautzner J, Adámková V, Wohlfahrt P. Heart failure after myocardial infarction: incidence and predictors. ESC Heart Fail 2020; 8:222-237. [PMID: 33319509 PMCID: PMC7835562 DOI: 10.1002/ehf2.13144] [Citation(s) in RCA: 231] [Impact Index Per Article: 57.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 10/14/2020] [Accepted: 11/15/2020] [Indexed: 12/11/2022] Open
Abstract
Aims The aim of the present paper was to provide an up‐to‐date view on epidemiology and risk factors of heart failure (HF) development after myocardial infarction. Methods and results Based on literature review, several clinical risk factors and biochemical, genetic, and imaging biomarkers were identified to predict the risk of HF development after myocardial infarction. Conclusions Heart failure is still a frequent complication of myocardial infarction. Timely identification of subjects at risk for HF development using a multimodality approach, and early initiation of guideline‐directed HF therapy in these patients, can decrease the HF burden.
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Affiliation(s)
- Dominik Jenča
- Department of Cardiology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic.,Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Vojtěch Melenovský
- Department of Cardiology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Josef Stehlik
- Division of Cardiovascular Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Vladimír Staněk
- Department of Cardiology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Jiří Kettner
- Department of Cardiology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Josef Kautzner
- Department of Cardiology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic.,Faculty of Medicine, Dentistry of the Palacký University, Olomouc, Czech Republic
| | - Věra Adámková
- Department of Preventive Cardiology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Peter Wohlfahrt
- Third Faculty of Medicine, Charles University, Prague, Czech Republic.,Division of Cardiovascular Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA.,Department of Preventive Cardiology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic.,Centre for Cardiovascular Prevention, First Faculty of Medicine and Thomayer Hospital, Charles University, Videnska 800, Prague 4, 140 59, Czech Republic
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9
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Abstract
Background Hypertension is a leading cause of cardiovascular disease, stroke, and death. It affects a substantial proportion of the population worldwide, and remains underdiagnosed and undertreated. Body Long-standing high blood pressure leads to left ventricular hypertrophy and diastolic dysfunction that cause an increase in myocardial rigidity, which renders the myocardium less compliant to changes in the preload, afterload, and sympathetic tone. Adequate blood pressure control must be achieved in patients with hypertension to prevent progression to overt heart failure. Controlling blood pressure is also important in patients with established heart failure, especially among those with preserved ejection fractions. However, aggressive blood pressure lowering can cause adverse outcomes, because a reverse J-curve association may exist between the blood pressure and the outcomes of patients with heart failure. Little robust evidence exists regarding the optimal blood pressure target for patients with heart failure, but a value near 130/80 mmHg seems to be adequate according to the current guidelines. Conclusion Prospective studies are required to further investigate the optimal blood pressure target for patients with heart failure.
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Affiliation(s)
- Gyu Chul Oh
- Cardiovascular Center & Department of Internal Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, South Korea
| | - Hyun-Jai Cho
- Cardiovascular Center & Department of Internal Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, South Korea
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10
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Obata JE, Horikoshi T, Nakamura T, Kugiyama K. Sustained endothelial dysfunction in the infarct-related coronary artery is associated with left ventricular adverse remodeling in survivors of ST-segment elevation myocardial infarction. J Cardiol 2019; 75:261-269. [PMID: 31447080 DOI: 10.1016/j.jjcc.2019.08.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 07/30/2019] [Accepted: 08/02/2019] [Indexed: 01/27/2023]
Abstract
BACKGROUND Ischemia-reperfusion causes endothelial injury and dysfunction in the infarct-related coronary artery (IRA). Using serial assessment of coronary endothelial vasomotor function and left ventriculography (LVG), this study prospectively investigated the clinical impact of endothelial vasomotor dysfunction in the patent IRA on left ventricular (LV) remodeling in survivors of ST-elevation myocardial infarction (STEMI). METHODS This study included 78 patients with STEMI due to occlusion of the left anterior descending coronary artery (LAD) and successful reperfusion therapy with percutaneous coronary intervention. All of them had LV ejection fraction (LVEF) <55%. LVG and the vasomotor responses to acetylcholine (ACh) in the LAD were examined within 2 weeks (1st test) and 6 months (2nd test) after MI. Cut-off values for coronary vasomotor dysfunction in response to ACh were based on the lower 10% of the distribution of coronary vasomotor responses to ACh in 20 control subjects. RESULTS LV adverse remodeling, defined as a >10% increase in either LV end-diastolic volume index (LVEDVI) and/or end-systolic volume index (LVESVI) from the 1st to the 2nd test, occurred in 21 (70%) of 30 patients with sustained impairment of the coronary flow response to ACh at both the 1st and 2nd tests and 14 (29%) of 48 in the other coronary flow response group (p < 0.01). In multivariate logistic regression analysis, a >10% increase in LVEDVI and LVESVI was respectively associated with sustained impairment of the coronary diameter and flow responses to ACh (OR 4.9 and 3.5, 95% CI 1.7-14.1 and 1.1-10.9, p < 0.01 and p = 0.03, respectively), that was independent of hypertension, peak creatine phosphokinase, and the baseline coronary flow response to ACh at the 1st test. CONCLUSIONS Sustained endothelial vasomotor dysfunction in the IRA was associated with LV adverse remodeling in STEMI survivors with successful reperfusion therapy.
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Affiliation(s)
- Jun-Ei Obata
- Department of Internal Medicine II, University of Yamanashi, Faculty of Medicine, Chuo, Yamanashi, Japan
| | - Takeo Horikoshi
- Department of Internal Medicine II, University of Yamanashi, Faculty of Medicine, Chuo, Yamanashi, Japan
| | - Takamitsu Nakamura
- Department of Internal Medicine II, University of Yamanashi, Faculty of Medicine, Chuo, Yamanashi, Japan
| | - Kiyotaka Kugiyama
- Department of Internal Medicine II, University of Yamanashi, Faculty of Medicine, Chuo, Yamanashi, Japan.
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11
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Weinheimer CJ, Kovacs A, Evans S, Matkovich SJ, Barger PM, Mann DL. Load-Dependent Changes in Left Ventricular Structure and Function in a Pathophysiologically Relevant Murine Model of Reversible Heart Failure. Circ Heart Fail 2019; 11:e004351. [PMID: 29716898 DOI: 10.1161/circheartfailure.117.004351] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Accepted: 03/22/2018] [Indexed: 01/19/2023]
Abstract
BACKGROUND To better understand reverse left ventricular (LV) remodeling, we developed a murine model wherein mice develop LV remodeling after transverse aortic constriction (TAC) and a small apical myocardial infarct (MI) and undergo reverse LV remodeling after removal of the aortic band. METHODS AND RESULTS Mice studied were subjected to sham (n=6) surgery or TAC+MI (n=12). Two weeks post-TAC+MI, 1 group underwent debanding (referred to as heart failure debanding [HF-DB] mice; n=6), whereas the aortic band remained in a second group (heart failure [HF] group; n=6). LV remodeling was evaluated by 2D echocardiography at 1 day, 2 weeks and 6 weeks post-TAC+MI. The hearts were analyzed by transcriptional profiling at 4 and 6 weeks and histologically at 6 weeks. Debanding normalized LV volumes, LV mass, and cardiac myocyte hypertrophy at 6 weeks in HF-DB mice, with no difference in myofibrillar collagen in the HF and HF-DB mice. LV ejection fraction and radial strain improved after debanding; however, both remained decreased in the HF-DB mice relative to sham and were not different from HF mice at 6 weeks. Hemodynamic unloading in the HF-DB mice was accompanied by a 35% normalization of the HF genes at 2 weeks and 80% of the HF genes at 4 weeks. CONCLUSIONS Hemodynamic unloading of a pathophysiologically relevant mouse model of HF results in normalization of LV structure, incomplete recovery of LV function, and incomplete reversal of the HF transcriptional program. The HF-DB mouse model may provide novel insights into mechanisms of reverse LV remodeling.
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Affiliation(s)
- Carla J Weinheimer
- Center for Cardiovascular Research, Cardiovascular Division, Washington University School of Medicine, St. Louis, MO
| | - Attila Kovacs
- Center for Cardiovascular Research, Cardiovascular Division, Washington University School of Medicine, St. Louis, MO
| | - Sarah Evans
- Center for Cardiovascular Research, Cardiovascular Division, Washington University School of Medicine, St. Louis, MO
| | - Scot J Matkovich
- Center for Cardiovascular Research, Cardiovascular Division, Washington University School of Medicine, St. Louis, MO
| | - Philip M Barger
- Center for Cardiovascular Research, Cardiovascular Division, Washington University School of Medicine, St. Louis, MO
| | - Douglas L Mann
- Center for Cardiovascular Research, Cardiovascular Division, Washington University School of Medicine, St. Louis, MO.
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12
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Carrick D, Haig C, Maznyczka AM, Carberry J, Mangion K, Ahmed N, Yue May VT, McEntegart M, Petrie MC, Eteiba H, Lindsay M, Hood S, Watkins S, Davie A, Mahrous A, Mordi I, Ford I, Radjenovic A, Welsh P, Sattar N, Wetherall K, Oldroyd KG, Berry C. Hypertension, Microvascular Pathology, and Prognosis After an Acute Myocardial Infarction. Hypertension 2019; 72:720-730. [PMID: 30012869 PMCID: PMC6080885 DOI: 10.1161/hypertensionaha.117.10786] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The rationale for our study was to investigate the pathophysiology of microvascular injury in patients with acute ST-segment-elevation myocardial infarction in relation to a history of hypertension. We undertook a cohort study using invasive and noninvasive measures of microvascular injury, cardiac magnetic resonance imaging at 2 days and 6 months, and assessed health outcomes in the longer term. Three hundred twenty-four patients with acute myocardial infarction (mean age, 59 [12] years; blood pressure, 135 [25] / 79 [14] mm Hg; 237 [73%] male, 105 [32%] with antecedent hypertension) were prospectively enrolled during emergency percutaneous coronary intervention. Compared with patients without antecedent hypertension, patients with hypertension were older (63 [12] years versus 57 [11] years; P<0.001) and a lower proportion were cigarette smokers (52 [50%] versus 144 [66%]; P=0.007). Coronary blood flow, microvascular resistance within the culprit artery, infarct pathologies, inflammation (C-reactive protein and interleukin-6) were not associated with hypertension. Compared with patients without antecedent hypertension, patients with hypertension had less improvement in left ventricular ejection fraction at 6 months from baseline (5.3 [8.2]% versus 7.4 [7.6]%; P=0.040). Antecedent hypertension was a multivariable associate of incident myocardial hemorrhage 2-day post-MI (1.81 [0.98-3.34]; P=0.059) and all-cause death or heart failure (n=47 events, n=24 with hypertension; 2.53 [1.28-4.98]; P=0.007) postdischarge (median follow-up 4 years). Severe progressive microvascular injury is implicated in the pathophysiology and prognosis of patients with a history of hypertension and acute myocardial infarction. Clinical Trial Registration- URL: http://www.clinicaltrials.gov . Unique identifier: NCT02072850.
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Affiliation(s)
- David Carrick
- From the British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom (D.C., A.M.M., J.C., K.M., N.A., V.T.Y.M., M.M., M.C.P., I.M., A.R., P.W., N.S., K.G.O., C.B.).,West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, United Kingdom (D.C., A.M.M., J.C., K.M., N.A., V.T.Y.M., M.M., M.C.P., H.E., M.L., S.H., S.W., A.D., A.M., I.M., K.G.O., C.B.)
| | - Caroline Haig
- Robertson Centre for Biostatistics, University of Glasgow, United Kingdom (C.H., I.F., K.W.)
| | - Annette M Maznyczka
- From the British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom (D.C., A.M.M., J.C., K.M., N.A., V.T.Y.M., M.M., M.C.P., I.M., A.R., P.W., N.S., K.G.O., C.B.).,West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, United Kingdom (D.C., A.M.M., J.C., K.M., N.A., V.T.Y.M., M.M., M.C.P., H.E., M.L., S.H., S.W., A.D., A.M., I.M., K.G.O., C.B.)
| | - Jaclyn Carberry
- From the British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom (D.C., A.M.M., J.C., K.M., N.A., V.T.Y.M., M.M., M.C.P., I.M., A.R., P.W., N.S., K.G.O., C.B.).,West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, United Kingdom (D.C., A.M.M., J.C., K.M., N.A., V.T.Y.M., M.M., M.C.P., H.E., M.L., S.H., S.W., A.D., A.M., I.M., K.G.O., C.B.)
| | - Kenneth Mangion
- From the British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom (D.C., A.M.M., J.C., K.M., N.A., V.T.Y.M., M.M., M.C.P., I.M., A.R., P.W., N.S., K.G.O., C.B.).,West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, United Kingdom (D.C., A.M.M., J.C., K.M., N.A., V.T.Y.M., M.M., M.C.P., H.E., M.L., S.H., S.W., A.D., A.M., I.M., K.G.O., C.B.)
| | - Nadeem Ahmed
- From the British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom (D.C., A.M.M., J.C., K.M., N.A., V.T.Y.M., M.M., M.C.P., I.M., A.R., P.W., N.S., K.G.O., C.B.).,West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, United Kingdom (D.C., A.M.M., J.C., K.M., N.A., V.T.Y.M., M.M., M.C.P., H.E., M.L., S.H., S.W., A.D., A.M., I.M., K.G.O., C.B.)
| | - Vannesa Teng Yue May
- From the British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom (D.C., A.M.M., J.C., K.M., N.A., V.T.Y.M., M.M., M.C.P., I.M., A.R., P.W., N.S., K.G.O., C.B.).,West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, United Kingdom (D.C., A.M.M., J.C., K.M., N.A., V.T.Y.M., M.M., M.C.P., H.E., M.L., S.H., S.W., A.D., A.M., I.M., K.G.O., C.B.)
| | - Margaret McEntegart
- From the British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom (D.C., A.M.M., J.C., K.M., N.A., V.T.Y.M., M.M., M.C.P., I.M., A.R., P.W., N.S., K.G.O., C.B.).,West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, United Kingdom (D.C., A.M.M., J.C., K.M., N.A., V.T.Y.M., M.M., M.C.P., H.E., M.L., S.H., S.W., A.D., A.M., I.M., K.G.O., C.B.)
| | - Mark C Petrie
- From the British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom (D.C., A.M.M., J.C., K.M., N.A., V.T.Y.M., M.M., M.C.P., I.M., A.R., P.W., N.S., K.G.O., C.B.).,West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, United Kingdom (D.C., A.M.M., J.C., K.M., N.A., V.T.Y.M., M.M., M.C.P., H.E., M.L., S.H., S.W., A.D., A.M., I.M., K.G.O., C.B.)
| | - Hany Eteiba
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, United Kingdom (D.C., A.M.M., J.C., K.M., N.A., V.T.Y.M., M.M., M.C.P., H.E., M.L., S.H., S.W., A.D., A.M., I.M., K.G.O., C.B.)
| | - Mitchell Lindsay
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, United Kingdom (D.C., A.M.M., J.C., K.M., N.A., V.T.Y.M., M.M., M.C.P., H.E., M.L., S.H., S.W., A.D., A.M., I.M., K.G.O., C.B.)
| | - Stuart Hood
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, United Kingdom (D.C., A.M.M., J.C., K.M., N.A., V.T.Y.M., M.M., M.C.P., H.E., M.L., S.H., S.W., A.D., A.M., I.M., K.G.O., C.B.)
| | - Stuart Watkins
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, United Kingdom (D.C., A.M.M., J.C., K.M., N.A., V.T.Y.M., M.M., M.C.P., H.E., M.L., S.H., S.W., A.D., A.M., I.M., K.G.O., C.B.)
| | - Andrew Davie
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, United Kingdom (D.C., A.M.M., J.C., K.M., N.A., V.T.Y.M., M.M., M.C.P., H.E., M.L., S.H., S.W., A.D., A.M., I.M., K.G.O., C.B.)
| | - Ahmed Mahrous
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, United Kingdom (D.C., A.M.M., J.C., K.M., N.A., V.T.Y.M., M.M., M.C.P., H.E., M.L., S.H., S.W., A.D., A.M., I.M., K.G.O., C.B.)
| | - Ify Mordi
- From the British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom (D.C., A.M.M., J.C., K.M., N.A., V.T.Y.M., M.M., M.C.P., I.M., A.R., P.W., N.S., K.G.O., C.B.).,West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, United Kingdom (D.C., A.M.M., J.C., K.M., N.A., V.T.Y.M., M.M., M.C.P., H.E., M.L., S.H., S.W., A.D., A.M., I.M., K.G.O., C.B.)
| | - Ian Ford
- Robertson Centre for Biostatistics, University of Glasgow, United Kingdom (C.H., I.F., K.W.)
| | - Aleksandra Radjenovic
- From the British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom (D.C., A.M.M., J.C., K.M., N.A., V.T.Y.M., M.M., M.C.P., I.M., A.R., P.W., N.S., K.G.O., C.B.)
| | - Paul Welsh
- From the British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom (D.C., A.M.M., J.C., K.M., N.A., V.T.Y.M., M.M., M.C.P., I.M., A.R., P.W., N.S., K.G.O., C.B.)
| | - Naveed Sattar
- From the British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom (D.C., A.M.M., J.C., K.M., N.A., V.T.Y.M., M.M., M.C.P., I.M., A.R., P.W., N.S., K.G.O., C.B.)
| | - Kirsty Wetherall
- Robertson Centre for Biostatistics, University of Glasgow, United Kingdom (C.H., I.F., K.W.)
| | - Keith G Oldroyd
- From the British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom (D.C., A.M.M., J.C., K.M., N.A., V.T.Y.M., M.M., M.C.P., I.M., A.R., P.W., N.S., K.G.O., C.B.).,West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, United Kingdom (D.C., A.M.M., J.C., K.M., N.A., V.T.Y.M., M.M., M.C.P., H.E., M.L., S.H., S.W., A.D., A.M., I.M., K.G.O., C.B.)
| | - Colin Berry
- From the British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom (D.C., A.M.M., J.C., K.M., N.A., V.T.Y.M., M.M., M.C.P., I.M., A.R., P.W., N.S., K.G.O., C.B.).,West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, United Kingdom (D.C., A.M.M., J.C., K.M., N.A., V.T.Y.M., M.M., M.C.P., H.E., M.L., S.H., S.W., A.D., A.M., I.M., K.G.O., C.B.)
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13
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First Hospitalization for Heart Failure in Outpatients With Stable Coronary Artery Disease: Determinants, Role of Incident Myocardial Infarction, and Prognosis. J Card Fail 2018; 24:815-822. [DOI: 10.1016/j.cardfail.2018.09.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Revised: 09/03/2018] [Accepted: 09/27/2018] [Indexed: 11/27/2022]
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Efficacy and Safety of Zofenopril Versus Ramipril in the Treatment of Myocardial Infarction and Heart Failure: A Review of the Published and Unpublished Data of the Randomized Double-Blind SMILE-4 Study. Adv Ther 2018; 35:604-618. [PMID: 29667144 PMCID: PMC5960496 DOI: 10.1007/s12325-018-0697-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Indexed: 12/18/2022]
Abstract
Zofenopril is a lipophilic, sulfhydryl group-containing angiotensin-converting enzyme (ACE)-inhibitor, characterized by wide tissue distribution, long duration of action, and pleiotropic effects on endothelial dysfunction. Its clinical efficacy and safety have been described in the four randomized controlled trials of the SMILE program, which globally enrolled more than 3600 patients in post-acute myocardial infarction (AMI) setting. The SMILE-4 study specifically selected patients with left ventricular dysfunction at admission, and compared the effects of zofenopril or ramipril in combination with acetylsalicylic acid (ASA). Zofenopril demonstrated its superiority over ramipril in reducing the combined occurrence of death or hospitalization for cardiovascular causes both in the overall population included in the original study and in subgroups of patients at highest risk, namely hypertensive and diabetic subjects. The effects of the early treatment with zofenopril were sustained over time, and, after 5 years of follow-up, zofenopril increased the survival likelihood and reduced the hospitalization rate. Compared to ramipril, zofenopril was cost-effective with a number to treat of 13 and an incremental cost-effectiveness ratio (ICER) of 2125.45 euros for any additional event prevented. Furthermore, in real-world settings, zofenopril decreased the risk of death in patients with heart failure, particularly in men, and in subjects older than 76 years or with ejection fraction lower than 54%. These results support the early use of zofenopril immediately after AMI, even in the presence of comorbidities, and its maintenance over time to reduce the risk of heart failure. FUNDING Menarini International Operations Luxembourg S.A.
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15
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Long-term outcome and risk assessment in premature acute myocardial infarction: A 10-year follow-up study. Int J Cardiol 2017; 240:37-42. [DOI: 10.1016/j.ijcard.2017.03.146] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Revised: 03/22/2017] [Accepted: 03/31/2017] [Indexed: 11/23/2022]
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Borghi C, Omboni S, Reggiardo G, Bacchelli S, Degli Esposti D, Ambrosioni E. Cardioprotective role of zofenopril in hypertensive patients with acute myocardial infarction: a pooled individual data analysis of the SMILE studies. Blood Press 2017; 26:211-219. [PMID: 28155333 DOI: 10.1080/08037051.2017.1281712] [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: 10/20/2022]
Abstract
PURPOSE The four SMILE studies demonstrated that early administration of zofenopril following acute myocardial infarction is prognostically beneficial compared to placebo or other angiotensin-converting enzyme (ACE) inhibitors. In the present retrospective pooled analysis of individual SMILE studies, we evaluated the efficacy of zofenopril on cardiovascular (CV) outcomes in 1880 hypertensive and 1662 normotensive patients. MATERIALS AND METHODS Four hundred and forty-nine hypertensives and 486 normotensives were treated with placebo, 980 and 786 with zofenopril 30-60 mg daily, 252 and 259 with lisinopril 5-10 mg daily, 199 and 131 with ramipril 10 mg daily, for 6 to 48 weeks. RESULTS The 1-year risk of death or hospitalization for CV causes was significantly reduced with zofenopril and lisinopril vs. placebo in both hypertensive (HR: 0.65; 95%CI: 0.48-0.86; p = .003 and .60, .36-.99; p = .049, respectively) and normotensive patients (0.56, 0.42-0.75; p = .0001 and .51, .28-.90; p = .020), whereas this was not the case for ramipril (hypertensives: 1.02, 0.69-1.52; p = .918; normotensives: 0.91, 0.59-1.41; p = .670). Zofenopril significantly reduced the risk of CV outcomes vs. the other two ACE-inhibitors pooled together in hypertensive (0.76; 0.58-0.99; p = .045), but not in normotensive patients (0.77; 0.55-1.10; p = .150). CONCLUSIONS In cardiac patients of the SMILE studies with arterial hypertension treatment with the ACE-inhibitor zofenopril was beneficial in reducing the 1-year risk of CV events as compared to placebo and ramipril. An efficacy similar to that of zofenopril was observed with lisinopril.
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Affiliation(s)
- Claudio Borghi
- a Unit of Internal Medicine, Policlinico S. Orsola , University of Bologna , Bologna , Italy
| | - Stefano Omboni
- b Clinical Research Unit , Italian Institute of Telemedicine , Varese , Italy
| | | | - Stefano Bacchelli
- a Unit of Internal Medicine, Policlinico S. Orsola , University of Bologna , Bologna , Italy
| | - Daniela Degli Esposti
- a Unit of Internal Medicine, Policlinico S. Orsola , University of Bologna , Bologna , Italy
| | - Ettore Ambrosioni
- a Unit of Internal Medicine, Policlinico S. Orsola , University of Bologna , Bologna , Italy
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Tsai IT, Wang CP, Lu YC, Hung WC, Wu CC, Lu LF, Chung FM, Hsu CC, Lee YJ, Yu TH. The burden of major adverse cardiac events in patients with coronary artery disease. BMC Cardiovasc Disord 2017; 17:1. [PMID: 28052754 PMCID: PMC5210314 DOI: 10.1186/s12872-016-0436-7] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Accepted: 12/07/2016] [Indexed: 12/30/2022] Open
Abstract
Background Patients with a history of cardiovascular disease are at high risk of developing secondary major adverse cardiac events (MACE). This study aimed to identify independent predictors of MACE after hospital admission which could be used to identify of high-risk patients who may benefit from preventive strategies. Methods This study included 1,520 consecutive patients with coronary artery disease (CAD) (654 with acute coronary syndrome (ACS) and 866 with elective percutaneous coronary intervention (PCI) patients) who received PCI and/or stenting. MACE was defined as all-cause mortality or rehospitalization for a cardiovascular- related illness. Cardiovascular-related illnesses included heart failure, reinfarction (nonfatal), recurrence of angina pectoris and repeat PCI or coronary artery bypass graft. Results During a mean follow-up period of 32 months, 558 of the 1,520 patients developed at least one MACE. Cox regression analysis showed that the baseline clinical and biochemical variables which associated with MACE were age, being illiterate, a widow or widower, and/or economically dependent, having triple vessel disease, stent implantation, anemia, and/or diabetes mellitus, waist to hip ratio (WHR), diastolic blood pressure, fasting glucose, total cholesterol, high-density lipoprotein cholesterol (HDL-C), creatinine, estimated glomerular filtration rate (eGFR), red blood cell count, hemoglobin, hematocrit, and mean corpuscular-hemoglobin concentration (MCHC) in ACS patients, and age, malnourished, and/or economically dependent, taking hypoglycemic medication, having triple vessel disease, stent implantation, anemia, diabetes mellitus, and/or hypertension, WHR, fasting glucose, HDL-C, uric acid, creatinine, eGFR, high-sensitivity C-reactive protein, mean corpuscular volume, and MCHC in elective PCI patients. Using multivariate Cox regression analysis, we found the MACE’s independent factors are triple vessel disease, stent implantation, hypertension, and eGFR in ACS patients, and having triple vessel disease, stent implantation, hypertension, and uric acid in elective PCI patients. Conclusions Having triple vessel disease, stent implantation, hypertension, and eGFR or uric acid independently predicted MACE in patients with CAD after long-term follow-up. Fortunately, these factors are modifiable and should be identified and monitored early.
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Affiliation(s)
- I-Ting Tsai
- Department of Emergency, E-Da Hospital, I-Shou University, Kaohsiung, 82445, Taiwan.,Department of Nursing, I-Shou University, Kaohsiung, 82445, Taiwan
| | - Chao-Ping Wang
- Division of Cardiology, E-Da Hospital, I-Shou University, No. 1, Yi-Da Rd, Jiau-Shu Village, Yan-Chao District, Kaohsiung, 82445, Taiwan.,School of Medicine for International Students, E-Da Hospital, I-Shou University, Kaohsiung, 82445, Taiwan
| | - Yung-Chuan Lu
- Division of Endocrinology and Metabolism, E-Da Hospital, I-Shou University, Kaohsiung, 82445, Taiwan.,School of Medicine for International Students, E-Da Hospital, I-Shou University, Kaohsiung, 82445, Taiwan
| | - Wei-Chin Hung
- Division of Cardiology, E-Da Hospital, I-Shou University, No. 1, Yi-Da Rd, Jiau-Shu Village, Yan-Chao District, Kaohsiung, 82445, Taiwan
| | - Cheng-Ching Wu
- Division of Cardiology, E-Da Hospital, I-Shou University, No. 1, Yi-Da Rd, Jiau-Shu Village, Yan-Chao District, Kaohsiung, 82445, Taiwan.,Department of Biomedical Engineering, National Cheng Kung University, Tainan, 70101, Taiwan
| | - Li-Fen Lu
- Division of Cardiac Surgery, Department of Surgery, E-Da Hospital, I-Shou University, Kaohsiung, 82445, Taiwan
| | - Fu-Mei Chung
- Division of Cardiology, E-Da Hospital, I-Shou University, No. 1, Yi-Da Rd, Jiau-Shu Village, Yan-Chao District, Kaohsiung, 82445, Taiwan
| | - Chia-Chang Hsu
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, E-Da Hospital, I-Shou University, Kaohsiung, 82445, Taiwan
| | | | - Teng-Hung Yu
- Division of Cardiology, E-Da Hospital, I-Shou University, No. 1, Yi-Da Rd, Jiau-Shu Village, Yan-Chao District, Kaohsiung, 82445, Taiwan.
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Reinstadler SJ, Stiermaier T, Eitel C, Saad M, Metzler B, de Waha S, Fuernau G, Desch S, Thiele H, Eitel I. Antecedent hypertension and myocardial injury in patients with reperfused ST-elevation myocardial infarction. J Cardiovasc Magn Reson 2016; 18:80. [PMID: 27832796 PMCID: PMC5105316 DOI: 10.1186/s12968-016-0299-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Accepted: 10/27/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Antecedent hypertension is associated with poor outcome in patients with ST-elevation myocardial infarction (STEMI). Whether differences in myocardial salvage, infarct size and microvascular injury contribute to the adverse outcome is unknown. We investigated the association between antecedent hypertension and cardiovascular magnetic resonance (CMR) parameters of myocardial salvage and damage in a multicenter CMR substudy of the AIDA-STEMI trial (Abciximab Intracoronary versus intravenously Drug Application in ST-elevation myocardial infarction). METHODS We analyzed 792 consecutive STEMI patients reperfused within 12 h after symptom onset. Patients underwent CMR imaging for assessment of myocardial salvage, infarct size and microvascular obstruction within 10 days after infarction. Major adverse cardiac events (MACE) were recorded at 12-month follow-up. RESULTS Antecedent hypertension was present in 540 patients (68 %) and was associated with a significantly increased baseline risk profile (advanced age, higher body mass index, higher incidence of diabetes, hypercholesterolemia, previous angioplasty and multivessel disease, p < 0.001 for all). MACE were more frequent in patients with hypertension as compared to patients without hypertension (45 [8 %] vs. 8 [3 %], p < 0.01). Antecedent hypertension remained an independent predictor of MACE after multivariate adjustment (hazard ratio 3.42 [confidence interval 1.45-8.08], p < 0.01). There was, however, no significant difference in the area at risk, infarct size, myocardial salvage index, extent of microvascular obstruction, and left ventricular ejection fraction between the groups (all p > 0.05). CONCLUSION Despite a higher rate of MACE in contemporary reperfused STEMI patients with antecedent hypertension, there was no difference in reperfusion efficacy, infarct size and reperfusion injury as visualized by CMR. TRIAL REGISTRATION NCT00712101 .
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Affiliation(s)
- Sebastian J. Reinstadler
- University Heart Center Lübeck, Medical Clinic II, Department of Cardiology, Angiology and Intensive Care Medicine, University of Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstraße 35, A-6020 Innsbruck, Austria
| | - Thomas Stiermaier
- University Heart Center Lübeck, Medical Clinic II, Department of Cardiology, Angiology and Intensive Care Medicine, University of Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany
| | - Charlotte Eitel
- University Heart Center Lübeck, Medical Clinic II, Department of Cardiology, Angiology and Intensive Care Medicine, University of Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany
| | - Mohammed Saad
- University Heart Center Lübeck, Medical Clinic II, Department of Cardiology, Angiology and Intensive Care Medicine, University of Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany
| | - Bernhard Metzler
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstraße 35, A-6020 Innsbruck, Austria
| | - Suzanne de Waha
- University Heart Center Lübeck, Medical Clinic II, Department of Cardiology, Angiology and Intensive Care Medicine, University of Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany
| | - Georg Fuernau
- University Heart Center Lübeck, Medical Clinic II, Department of Cardiology, Angiology and Intensive Care Medicine, University of Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany
| | - Steffen Desch
- University Heart Center Lübeck, Medical Clinic II, Department of Cardiology, Angiology and Intensive Care Medicine, University of Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany
| | - Holger Thiele
- University Heart Center Lübeck, Medical Clinic II, Department of Cardiology, Angiology and Intensive Care Medicine, University of Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany
| | - Ingo Eitel
- University Heart Center Lübeck, Medical Clinic II, Department of Cardiology, Angiology and Intensive Care Medicine, University of Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany
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Meredith PA, Ostergren J. Review: From Hypertension to Heart Failure — Are There Better Primary Prevention Strategies? J Renin Angiotensin Aldosterone Syst 2016; 7:64-73. [PMID: 17083060 DOI: 10.3317/jraas.2006.012] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Although in the developed world the incidence of and mortality from coronary heart disease (CHD) and stroke have been declining over the last 15 years, heart failure is increasing in incidence, prevalence and overall mortality, despite advances in the diagnosis and management of the condition. Hypertension, alone or in combination with CHD, precedes the development of heart failure in the majority of both men and women. Whilst there have been improvements in the overall management of hypertension, as reflected in rates of diagnosis, awareness, treatment and control of blood pressure (BP), there are still many patients with hypertension who remain undiagnosed or untreated and of those who do receive treatment many fail to achieve current targets for BP control. Placebo controlled trials in hypertension, largely based on diuretic and beta-blocker-based regimens, have unequivocally demonstrated that the treatment of hypertension can significantly reduce the incidence of heart failure. Newer treatment strategies offer theoretical and proven practical advantages over established antihypertensive therapy. In particular, AT1-receptor blockers appear to provide benefits beyond BP control and are effective in the treatment of both hypertension and heart failure. Thus, the primary prevention of heart failure in hypertensive patients should be based upon strategies that provide tight and sustained BP control necessitating the use of multiple drugs. However, there is now compelling evidence to suggest that this therapy should include an antihypertensive agent that inhibits the reninangiotensin-aldosterone system (RAAS).
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Affiliation(s)
- Peter A Meredith
- Department of Medicine and Therapeutics, University of Glasgow, Glasgow, Scotland, UK.
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Bozbay M, Uyarel H, Cicek G, Oz A, Keskin M, Murat A, Yildirim E, Karaca G, Ergelen M, Eren M. CHA2DS2-VASc Score Predicts In-Hospital and Long-Term Clinical Outcomes in Patients With ST-Segment Elevation Myocardial Infarction Who Were Undergoing Primary Percutaneous Coronary Intervention. Clin Appl Thromb Hemost 2016; 23:132-138. [DOI: 10.1177/1076029616646874] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
CHA2DS2-VASc score includes similar risk factors for coronary artery disease. We hypothesized that admission CHA2DS2-VASc score might be predictive of adverse clinical outcomes for patients with ST-segment elevation myocardial infarction (STEMI) who were undergoing primary percutaneous coronary intervention. A total of 647 patients with STEMI enrolled in this study. The study population was divided into 2 groups according to their admission CHA2DS2-VASc score. The low group (n = 521) was defined as CHA2DS2-VASc score ≤2, and the high group (n = 126) was defined as CHA2DS2-VASc score >2. Patients in the high group had significantly higher incidence of in-hospital cardiovascular mortality (8.7% vs 1.9%; P < .001). Long-term mortality was significantly frequent in the high group (13.4% vs 3.6%, P < .001). Hypertension, admission CHA2DS2-VASc score, and Killip class >1 were independent predictors of long-term mortality. Admission CHA2DS2-VASc score >2 was identified as an effective cutoff point for long-term mortality (area under curve = 0.821; 95% confidence interval: 0.76-0.89; P < .001). CHA2DS2-VASc score is a simple, very useful, easily remembered bedside score for predicting in-hospital and long-term adverse clinical outcomes in STEMI.
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Affiliation(s)
- Mehmet Bozbay
- Department of Cardiology, Dr Siyami Ersek Cardiovascular and Thoracic Surgery Research and Training Hospital, Istanbul, Turkey
| | - Huseyin Uyarel
- Department of Cardiology, School of Medicine, Bezmi Alem Vakif University, Istanbul, Turkey
| | - Gokhan Cicek
- Department of Cardiology, Ankara Numune Hospital, Ankara, Turkey
| | - Ahmet Oz
- Department of Cardiology, Dr Siyami Ersek Cardiovascular and Thoracic Surgery Research and Training Hospital, Istanbul, Turkey
| | - Muhammed Keskin
- Department of Cardiology, Dr Siyami Ersek Cardiovascular and Thoracic Surgery Research and Training Hospital, Istanbul, Turkey
| | - Ahmet Murat
- Department of Cardiology, Dr Siyami Ersek Cardiovascular and Thoracic Surgery Research and Training Hospital, Istanbul, Turkey
| | - Ersin Yildirim
- Department of Cardiology, Elazıg Research and Training Hospital, Elazıg, Turkey
| | - Gurkan Karaca
- Department of Cardiology, Amasya Sabuncu Serafeddin Research and Training Hospital, Amasya, Turkey
| | - Mehmet Ergelen
- Department of Cardiology, School of Medicine, Bezmi Alem Vakif University, Istanbul, Turkey
| | - Mehmet Eren
- Department of Cardiology, Dr Siyami Ersek Cardiovascular and Thoracic Surgery Research and Training Hospital, Istanbul, Turkey
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Miranda B, Barrabés JA, Figueras J, Pineda V, Rodríguez-Palomares J, Lidón RM, Sambola A, Bañeras J, Otaegui I, García-Dorado D. Plasma bilirubin values on admission and ventricular remodeling after a first anterior ST-segment elevation acute myocardial infarction. Ann Med 2016; 48:1-9. [PMID: 26631587 DOI: 10.3109/07853890.2015.1112027] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Bilirubin may elicit cardiovascular protection and heme oxygenase-1 overexpression attenuated post-infarction ventricular remodeling in experimental animals, but the association between bilirubin levels and post-infarction remodeling is unknown. MATERIALS AND METHODS In 145 patients with a first anterior ST-segment elevation acute myocardial infarction (STEMI), we assessed whether plasma bilirubin on admission predicted adverse remodeling (left ventricular end-diastolic volume [LVEDV] increase ≥20% between discharge and 6 months, estimated by magnetic resonance imaging). RESULTS Patients' baseline characteristics and management were comparable among bilirubin tertiles. LVEDV increased at 6 months (P < 0.001) with respect to the initial exam, but the magnitude of this increase was similar across increasing bilirubin tertiles (10.8 [30.2], 10.1 [22.9], and 12.7 [24.3]%, P = 0.500). Median (25-75 percentile) bilirubin values in patients with and without adverse remodeling were 0.75 (0.60-0.93) and 0.73 (0.60-0.92) mg/dL (P = 0.693). Absence of final TIMI flow grade 3 (odds ratio 3.92, 95% CI 1.12-13.66) and a history of hypertension (2.04, 0.93-4.50), but not admission bilirubin, were independently associated with adverse remodeling. Bilirubin also did not predict the increase in ejection fraction at 6 months. CONCLUSIONS Admission bilirubin values are not related to LVEDV or ejection fraction progression after a first anterior STEMI and do not predict adverse ventricular remodeling. Key messages Bilirubin levels are inversely related to cardiovascular disease, and overexpression of heme oxygenase-1 (the enzyme that determines bilirubin production) has prevented post-infarction ventricular remodeling in experimental animals, but the association between bilirubin levels and the progression of ventricular volumes and function in patients with acute myocardial infarction remained unexplored. In this cohort of patients with a first acute anterior ST-segment elevation myocardial infarction receiving contemporary management, bilirubin levels on admission were not predictive of the changes in left ventricular volumes or ejection fraction at 6 months measured by serial cardiac magnetic resonance imaging. The data are contrary to a significant protective effect of bilirubin against post-infarction ventricular remodeling.
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Affiliation(s)
- Berta Miranda
- a Servicio de Cardiología, Hospital Universitari Vall d'Hebron, VHIR, Universitat Autònoma de Barcelona , Barcelona , Spain
| | - José A Barrabés
- a Servicio de Cardiología, Hospital Universitari Vall d'Hebron, VHIR, Universitat Autònoma de Barcelona , Barcelona , Spain
| | - Jaume Figueras
- a Servicio de Cardiología, Hospital Universitari Vall d'Hebron, VHIR, Universitat Autònoma de Barcelona , Barcelona , Spain
| | - Victor Pineda
- b Servicio de Radiología, Hospital Universitari Vall d'Hebron, VHIR, Universitat Autònoma de Barcelona , Barcelona , Spain
| | - José Rodríguez-Palomares
- a Servicio de Cardiología, Hospital Universitari Vall d'Hebron, VHIR, Universitat Autònoma de Barcelona , Barcelona , Spain
| | - Rosa-Maria Lidón
- a Servicio de Cardiología, Hospital Universitari Vall d'Hebron, VHIR, Universitat Autònoma de Barcelona , Barcelona , Spain
| | - Antonia Sambola
- a Servicio de Cardiología, Hospital Universitari Vall d'Hebron, VHIR, Universitat Autònoma de Barcelona , Barcelona , Spain
| | - Jordi Bañeras
- a Servicio de Cardiología, Hospital Universitari Vall d'Hebron, VHIR, Universitat Autònoma de Barcelona , Barcelona , Spain
| | - Imanol Otaegui
- a Servicio de Cardiología, Hospital Universitari Vall d'Hebron, VHIR, Universitat Autònoma de Barcelona , Barcelona , Spain
| | - David García-Dorado
- a Servicio de Cardiología, Hospital Universitari Vall d'Hebron, VHIR, Universitat Autònoma de Barcelona , Barcelona , Spain
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Ma W, Liang Y, Zhu J, Yang Y, Tan H, Yu L, Gao X, Feng G, Li J. Impact of Admission Systolic Blood Pressure and Antecedent Hypertension on Short-Term Outcomes After ST-Segment Elevation Myocardial Infarction: Strobe-Compliant Article. Medicine (Baltimore) 2015; 94:e1446. [PMID: 26313807 PMCID: PMC4602932 DOI: 10.1097/md.0000000000001446] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
We evaluated the combined effect of admission systolic blood pressure (SBP) and antecedent hypertension on short-term outcomes in patients with ST-segment elevation myocardial infarction (STEMI). Data were derived from a multicenter survey of 7303 consecutive patients with STEMI. Patients were divided into 4 groups according to different blood pressure status: high SBP without hypertension, high SBP with hypertension, low SBP without hypertension, and low SBP with hypertension. The primary endpoints were 7 and 30-day all-cause mortality. The prevalence of hypertension was 40.7%, and the best cutoff of admission SBP for predicting 30-day mortality was 108 mmHg by receiver-operating characteristic curve. Patients with hypertension were older, more often female, also had longer onset-to-admission time, more comorbidities, and higher Killip class. Patients with both low SBP (≤108 mmHg) and hypertension group had significantly higher 7 and 30-day mortality than those in other groups (all P < 0.001). After multivariate adjustment, low SBP with hypertension group was still an independent risk factor for predicting 7-day mortality (hazard ratios [HR] 1.86, 95% confidence interval [CI] 1.41-2.46; P < 0.001) and 30-day mortality (HR 1.88, 95% CI 1.46-2.43; P < 0.001). In patients with SBP > 108 mmHg, a history of hypertension could increase the risk of 30-day mortality by 27% (HR 1.00 vs 1.27, P = 0.012), while in patients with SBP ≤ 108 mmHg, this increased risk reached to 37% (HR 1.51 vs 1.88, P < 0.001). In conclusion, low admission SBP was the relatively dominant contributor for predicting 7 and 30-day all-cause mortality, and a concurrent antecedent hypertension increased the corresponding risk of mortality.
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Affiliation(s)
- Wenfang Ma
- From the State Key Laboratory of Cardiovascular Disease, Emergency and Critical Care Center, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
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23
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Vaicekavičius E, Vasiliauskas D, Navickas R, Milvidaitė I, Unikas R, Venclovienė J, Kubilius R. Impact of hypertension on postreperfusion left ventricular recovery in patients with ST-segment elevation myocardial infarction and multivessel coronary artery disease. MEDICINA-LITHUANIA 2015; 51:38-45. [PMID: 25744774 DOI: 10.1016/j.medici.2015.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2013] [Accepted: 01/16/2015] [Indexed: 10/24/2022]
Abstract
OBJECTIVE The aim of this study was to investigate the impact of admission systolic blood pressure (ASBP) and left ventricular (LV) mass on the postreperfusion LV recovery in patients with ST-segment elevation myocardial infarction (STEMI) and concomitant coronary multivessel disease (MVD). MATERIALS AND METHODS A retrospective analysis of 12-month postreperfusion LV recovery was performed in 104 patients after primary percutaneous coronary intervention (PPCI). Patients with elevated ASBP (>140mmHg) were assigned to the first group (n=58); with normal ASBP (<140mmHg), to the second group (n=46); with increased myocardial mass index (MMI) (>100g/m(2)), to the third group (n=70); and with normal MMI (<100g/m(2)), to the fourth group (n=34). Severity of MVD was evaluated by the Syntax score. The LV recovery was assessed by evolution of quantitative characteristics of electrocardiography (QRS score, ST score, ECG STEMI stage) and echocardiography (LV ejection fraction, volume and mass indices) registered before and after PPCI, at discharge, and after 1, 6, and 12 months. RESULTS There were no significant differences in the baseline QRS and ST scores, ECG STEMI stage, LVEF, MMI, and Syntax score comparing all the patients' groups. The serial ECG criteria showed only a very small impact of ASBP on postreperfusion LV recovery. Only ECG STEMI stage progression was slower in the patients with elevated ASBP. In patients with different MMI, the QRS and ST scores were higher and ECG STEMI stage was lower in patients with increased MMI. LVEF after 1 year was significantly lower in the third group as compared to the fourth group (42.58%±8.25% vs. 46.8%±7.13%, P=0.018). CONCLUSION Postreperfusion LV recovery was more related not to ASBP but to the increased LV mass assessed by echocardiography in patients with STEMI and MVD.
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Affiliation(s)
- Edvardas Vaicekavičius
- Institute of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania.
| | - Donatas Vasiliauskas
- Institute of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Ramūnas Navickas
- Institute of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Irena Milvidaitė
- Institute of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Ramūnas Unikas
- Department of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Jonė Venclovienė
- Institute of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Raimondas Kubilius
- Department of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
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Abstract
Hypertension is an important risk factor implicated in the development of multiple common cardiac conditions, including coronary atherosclerosis, heart failure, and atrial fibrillation. Epidemiologic studies have provided insights into the shared pathogenesis of hypertension and subclinical as well as clinically evident cardiac diseases. The mechanistic common ground between chronic blood pressure elevation and cardiac disease likely begins early in life. Understanding these connections will aid ongoing efforts to identify individuals at risk, develop targeted therapeutics, and improve overall outcomes for individuals with elevated blood pressure in the population at large.
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Impact of hypertension on infarct size in ST elevation myocardial infarction patients undergoing primary angioplasty. J Hypertens 2014; 31:2433-7. [PMID: 24220592 DOI: 10.1097/hjh.0b013e328364cbee] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Hypertension is a well known risk factor for atherosclerosis. However, data on the impact of hypertension in patients with ST-segment elevation myocardial infarction (STEMI) are inconsistent, and mainly related to studies performed in the thrombolytic era, with very few data on patients undergoing primary angioplasty. The aim of the current study was to evaluate the impact of hypertension on scintigraphic infarct size in STEMI patients undergoing primary percutaneous coronary intervention (PCI). METHOD Our population is represented by 830 STEMI patients undergoing primary PCI. Infarct size was evaluated at 30 days by technetium-99m-sestamibi. RESULTS Hypertension was associated with more advanced age (P<0.001), a larger prevalence of diabetes (P=0.001), female sex (P<0.001), but lower prevalence of smoking (P<0.001) and anterior infarction (P=0.042). No difference was observed in ischemia time, cardiogenic shock at presentation, in preprocedural thrombolysis in myocardial infarction (TIMI) flow, and collateral circulation. Hypertension did not affect the rate of postprocedural TIMI 3 flow. Hypertension did not affect infarct size [12.5% (4.1-23.8%) vs. 12.8% (4.3-24.7%), P=0.38]. Similar results were observed in subanalyses in major high-risk subgroups. No impact of hypertension on infarct size was confirmed when the analysis was conducted according to the percentage of patients with infarct size above the median [adjusted odds ratio (95% CI)=0.97 (0.72-1.33), P=0.92]. CONCLUSION This study shows that among STEMI patients, undergoing primary PCI hypertension does not affect scintigraphic infarct size.
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De Luca G, Dirksen MT, Spaulding C, Kelbæk H, Schalij M, Thuesen L, van der Hoeven B, Vink MA, Kaiser C, Musto C, Chechi T, Spaziani G, Diaz de la Llera LS, Pasceri V, Di Lorenzo E, Violini R, Suryapranata H, Stone GW. Impact of hypertension on clinical outcome in STEMI patients undergoing primary angioplasty with BMS or DES: insights from the DESERT cooperation. Int J Cardiol 2014; 175:50-4. [PMID: 24852835 DOI: 10.1016/j.ijcard.2014.04.180] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2013] [Revised: 03/30/2014] [Accepted: 04/17/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND Hypertension is a well known risk factor for atherosclerosis. However, data on the prognostic impact of hypertension in patients with ST elevation myocardial infarction (STEMI) are inconsistent and mainly related to studies performed in the thrombolytic era, with very few data in patients undergoing primary angioplasty. Therefore, the aim of the current study was to evaluate the impact hypertension on clinical outcome in STEMI patients undergoing primary PCI with BMS or DES. METHODS Our population is represented by 6298 STEMI patients undergoing primary angioplasty included in the DESERT database from 11 randomized trials comparing DES vs BMS for STEMI. RESULTS Hypertension was observed in 2764 patients (43.9%), and associated with ageing (p<0.0001), female gender (p<0.001), diabetes (p<0.0001), hypercholesterolemia (p<0.0001), previous MI (p=0.002), previous revascularization (p=0.002), longer time-to-treatment (p<0.001), preprocedural TIMI 3 flow, and with a lower prevalence of smoking (41% vs 53.9%, p<0.001) and anterior MI (42% vs 45.9%, p=0.002). Hypertension was associated with impaired postprocedural TIMI 0-2 flow (Adjusted OR [95% CI]=1.22 [1.01-1.47], p=0.034). At a follow-up of 1,201 ± 440 days, hypertension was associated with higher mortality (adjusted HR [95% CI]=1.24 [1.01-1.54], p=0.048), reinfarction (adjusted HR [95% CI]=1.31 [1.03-1.66], p=0.027), stent thrombosis (adjusted HR [95% CI]=1.29 [0.98-1.71], p=0.068) and TVR (adjusted HR [95% CI]=1.22 [1.04-1.44], p=0.013). CONCLUSIONS This study showed that among STEMI patients undergoing primary angioplasty with DES or BMS, hypertension is independently associated with impaired epicardial reperfusion, mortality, reinfarction and TVR, and a trend in higher ST.
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Affiliation(s)
- Giuseppe De Luca
- Division of Cardiology, Ospedale "Maggiore della Carità", Eastern Piedmont University, Novara, Italy; Centro di Biotecnologie per la Ricerca Medica Applicata (BRMA), Eastern Piedmont University, Novara, Italy.
| | - Maurits T Dirksen
- Department of Interventional Cardiology, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
| | - Christian Spaulding
- Assistance Publique-Hopitaux de Paris Cochin Hospital, Paris 5 Medical School Rene Descartes University and INSERM Unite 780 Avenir, Paris, France
| | | | - Martin Schalij
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Leif Thuesen
- Cardiac Department, Skejby Hospital, Skejby, Denmark
| | - Bas van der Hoeven
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Marteen A Vink
- Department of Interventional Cardiology, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
| | - Christoph Kaiser
- Department of Cardiology, University Hospital Basel, Switzerland
| | - Carmine Musto
- Division of Cardiology, San Camillo Hospital, Rome, Italy
| | - Tania Chechi
- Ospedale Santa Maria Annunziata, Bagno a Ripoli, Florence, Italy
| | - Gaia Spaziani
- Ospedale Santa Maria Annunziata, Bagno a Ripoli, Florence, Italy
| | | | - Vincenzo Pasceri
- Interventional Cardiology Unit, San Filippo Neri Hospital, Rome, Italy
| | | | | | | | - Gregg W Stone
- Columbia University Medical Center, New York City, NY, USA; Cardiovascular Research Foundation, New York City, NY, USA
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Palmer BR, Slow S, Ellis KL, Pilbrow AP, Skelton L, Frampton CM, Palmer SC, Troughton RW, Yandle TG, Doughty RN, Whalley GA, Lever M, George PM, Chambers ST, Ellis C, Richards AM, Cameron VA. Genetic polymorphism rs6922269 in the MTHFD1L gene is associated with survival and baseline active vitamin B12 levels in post-acute coronary syndromes patients. PLoS One 2014; 9:e89029. [PMID: 24618918 PMCID: PMC3949666 DOI: 10.1371/journal.pone.0089029] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2013] [Accepted: 01/19/2014] [Indexed: 11/23/2022] Open
Abstract
Background and Aims The methylene-tetrahydrofolate dehydrogenase (NADP+ dependent) 1-like (MTHFD1L) gene is involved in mitochondrial tetrahydrofolate metabolism. Polymorphisms in MTHFD1L, including rs6922269, have been implicated in risk for coronary artery disease (CAD). We investigated the association between rs6922269 and known metabolic risk factors and survival in two independent cohorts of coronary heart disease patients. Methods and Results DNA and plasma from 1940 patients with acute coronary syndromes were collected a median of 32 days after index hospital admission (Coronary Disease Cohort Study, CDCS). Samples from a validation cohort of 842 patients post-myocardial infarction (PMI) were taken 24–96 hours after hospitalization. DNA samples were genotyped for rs6922269, using a TaqMan assay. Homocysteine and active vitamin B12 were measured by immunoassay in baseline CDCS plasma samples, but not PMI plasma. All cause mortality was documented over follow-up of 4.1 (CDCS) and 8.8 (PMI) years, respectively. rs6922269 genotype frequencies were AA n = 135, 7.0%; GA n = 785, 40.5% and GG n = 1020, 52.5% in the CDCS and similar in the PMI cohort. CDCS patients with AA genotype for rs6922269 had lower levels of co-variate adjusted baseline plasma active vitamin B12 (p = 0.017) and poorer survival than patients with GG or GA genotype (mortality: AA 19.6%, GA 12.0%, GG 11.6%; p = 0.007). In multivariate analysis, rs6922269 genotype predicted survival, independent of established covariate predictors (p = 0.03). However the association between genotype and survival was not validated in the PMI cohort. Conclusion MTHFD1L rs6922269 genotype is associated with active vitamin B12 levels at baseline and may be a marker of prognostic risk in patients with established coronary heart disease.
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Affiliation(s)
- Barry R. Palmer
- Christchurch Heart Institute, Department of Medicine, University of Otago, Christchurch, New Zealand
- Genetics Otago, University of Otago, Christchurch, New Zealand
- Institute of Food, Nutrition & Human Health, Massey University, Wellington, New Zealand
- * E-mail:
| | - Sandy Slow
- Pathology Department, University of Otago, Christchurch, New Zealand
- Clinical Biochemistry Unit, Canterbury Health Laboratories, Christchurch, New Zealand
| | - Katrina L. Ellis
- Christchurch Heart Institute, Department of Medicine, University of Otago, Christchurch, New Zealand
| | - Anna P. Pilbrow
- Christchurch Heart Institute, Department of Medicine, University of Otago, Christchurch, New Zealand
| | - Lorraine Skelton
- Christchurch Heart Institute, Department of Medicine, University of Otago, Christchurch, New Zealand
| | - Chris M. Frampton
- Christchurch Heart Institute, Department of Medicine, University of Otago, Christchurch, New Zealand
| | - Suetonia C. Palmer
- Christchurch Heart Institute, Department of Medicine, University of Otago, Christchurch, New Zealand
| | - Richard W. Troughton
- Christchurch Heart Institute, Department of Medicine, University of Otago, Christchurch, New Zealand
| | - Tim G. Yandle
- Christchurch Heart Institute, Department of Medicine, University of Otago, Christchurch, New Zealand
| | - Rob N. Doughty
- Department of Medicine, Faculty of Medicine & Health Sciences, University of Auckland, Auckland, New Zealand
| | - Gillian A. Whalley
- Department of Medicine, Faculty of Medicine & Health Sciences, University of Auckland, Auckland, New Zealand
- Department of Medical Imaging, Unitec Institute of Technology, Auckland, New Zealand
| | - Michael Lever
- Pathology Department, University of Otago, Christchurch, New Zealand
- Clinical Biochemistry Unit, Canterbury Health Laboratories, Christchurch, New Zealand
| | - Peter M. George
- Pathology Department, University of Otago, Christchurch, New Zealand
- Clinical Biochemistry Unit, Canterbury Health Laboratories, Christchurch, New Zealand
| | - Stephen T. Chambers
- Clinical Biochemistry Unit, Canterbury Health Laboratories, Christchurch, New Zealand
| | - Chris Ellis
- Department of Medicine, Faculty of Medicine & Health Sciences, University of Auckland, Auckland, New Zealand
| | - A. Mark Richards
- Christchurch Heart Institute, Department of Medicine, University of Otago, Christchurch, New Zealand
| | - Vicky A. Cameron
- Christchurch Heart Institute, Department of Medicine, University of Otago, Christchurch, New Zealand
- Genetics Otago, University of Otago, Christchurch, New Zealand
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Zofenopril and ramipril and acetylsalicylic acid in postmyocardial infarction patients with left ventricular systolic dysfunction: a retrospective analysis in hypertensive patients of the SMILE-4 study. J Hypertens 2014; 31:1256-64. [PMID: 23552127 DOI: 10.1097/hjh.0b013e3283605cd8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Antecedent hypertension represents a risk factor for adverse outcomes in survivors of acute myocardial infarction (AMI). Prognosis of such patients might be greatly improved by drugs enhancing blood pressure control. In the present retrospective analysis of the randomized, double-blind, parallel-group, SMILE-4 study we compared the efficacy of zofenopril 60 mg and acetylsalicylic acid (ASA) 100 mg versus ramipril 10 mg and ASA in patients with AMI complicated by left ventricular dysfunction, classified according to a history of hypertension. METHODS The primary study end-point was 1-year combined occurrence of death or hospitalization for cardiovascular causes. Hypertension was defined according to medical history and current blood pressure values at entry and could be determined in 682 of 716 patients of the intention-to-treat analysis. RESULTS One hundred and fifty-seven patients (23%) were normotensives and 525 (77%) hypertensives. In the normotensive population the primary end-point occurred in 19 of 76 zofenopril-treated patients (25%) and in 23 of 81 ramipril-treated patients (28%) [odds ratio (95% confidence interval): 0.84 (0.41-1.71), P = 0.631]. In the hypertensive population, major cardiovascular outcomes were reported in 84 of 273 zofenopril-treated patients (31%) and in 99 of 252 ramipril-treated patients (39%), with a 31% significantly (P = 0.041) lower risk with zofenopril [0.69 (0.48-0.99)]. The superiority of zofenopril versus ramipril was particularly evident in patients with isolated systolic hypertension [n = 131, 0.48 (0.23-0.99), P = 0.045]. CONCLUSION This retrospective analysis of the SMILE-4 study confirmed the good efficacy of zofenopril and ASA in the prevention of long-term cardiovascular outcomes also in the subgroup of patients with hypertension.
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Impact of Hypertension History on Short and Long-Term Prognosis in Patients with Acute Myocardial Infarction Treated with Percutaneous Angioplasty: Comparison Between STEMI and NSTEMI. High Blood Press Cardiovasc Prev 2013; 21:37-43. [DOI: 10.1007/s40292-013-0032-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2013] [Accepted: 10/22/2013] [Indexed: 10/26/2022] Open
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Zaliaduonyte-Peksiene D, Simonyte S, Lesauskaite V, Vaskelyte J, Gustiene O, Mizariene V, Jurkevicius R, Jariene G, Tamosiunas A, Zaliunas R. Left ventricular remodelling after acute myocardial infarction: Impact of clinical, echocardiographic parameters and polymorphism of angiotensinogen gene. J Renin Angiotensin Aldosterone Syst 2013; 15:286-93. [DOI: 10.1177/1470320312471228] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
| | - Sandrita Simonyte
- Institute of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Lithuania
| | - Vaiva Lesauskaite
- Institute of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Lithuania
| | - Jolanta Vaskelyte
- Department of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Lithuania
- Institute of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Lithuania
| | - Olivija Gustiene
- Department of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Lithuania
| | - Vaida Mizariene
- Department of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Lithuania
| | - Renaldas Jurkevicius
- Department of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Lithuania
| | - Giedre Jariene
- Institute of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Lithuania
| | - Abdonas Tamosiunas
- Institute of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Lithuania
| | - Remigijus Zaliunas
- Department of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Lithuania
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Lee MG, Jeong MH, Lee KH, Park KH, Sim DS, Yoon HJ, Yoon NS, Kim KH, Park HW, Hong YJ, Kim JH, Ahn Y, Cho JG, Park JC, Kang JC. Prognostic impact of diabetes mellitus and hypertension for mid-term outcome of patients with acute myocardial infarction who underwent percutaneous coronary intervention. J Cardiol 2012; 60:257-63. [DOI: 10.1016/j.jjcc.2012.06.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2012] [Revised: 05/19/2012] [Accepted: 06/06/2012] [Indexed: 12/20/2022]
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Pedrinelli R, Ballo P, Fiorentini C, Denti S, Galderisi M, Ganau A, Germanò G, Innelli P, Paini A, Perlini S, Salvetti M, Zacà V. Hypertension and acute myocardial infarction: an overview. J Cardiovasc Med (Hagerstown) 2012; 13:194-202. [PMID: 22317927 DOI: 10.2459/jcm.0b013e3283511ee2] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
History of hypertension is a frequent finding in patients with acute myocardial infarction (AMI) and its recurring association with female sex, diabetes, older age, less frequent smoking and more frequent vascular comorbidities composes a risk profile quite distinctive from the normotensive ischemic counterpart.Antecedent hypertension associates with higher rates of death and morbid events both during the early and long-term course of AMI, particularly if complicated by left ventricular dysfunction and/or congestive heart failure. Renin-angiotensin-aldosterone system blockade, through either angiotensin-converting enzyme inhibition, angiotensin II receptor blockade or aldosterone antagonism, exerts particular benefits in that high-risk hypertensive subgroup.In contrast to the negative implications carried by antecedent hypertension, higher systolic pressure at the onset of chest pain associates with lower mortality within 1 year from coronary occlusion, whereas increased blood pressure recorded after hemodynamic stabilization from the acute ischemic event bears inconsistent relationships with recurring coronary events in the long-term follow-up.Whether antihypertensive treatment in post-AMI hypertensive patients prevents ischemic relapses is uncertain. As a matter of fact, excessive diastolic pressure drops may jeopardize coronary perfusion and predispose to new acute coronary events, although the precise cause-effect mechanisms underlying this phenomenon need further evaluation.
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Affiliation(s)
- Roberto Pedrinelli
- Dipartimento Cardio Toracico e Vascolare, Universita' Di Pisa, 56100 Pisa, Italy.
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Yoon NS, Jeong MH, Ahn Y, Kim JH, Chae SC, Kim YJ, Hur SH, Seong IW, Hong TJ, Choi D, Cho MC, Kim CJ, Seung KB, Chung WS, Jang YS, Cho JG, Park SJ. Impact of high-normal blood pressure measured in emergency room on adverse cardiac events in acute myocardial infarction. Korean Circ J 2012; 42:304-10. [PMID: 22701132 PMCID: PMC3369961 DOI: 10.4070/kcj.2012.42.5.304] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2011] [Revised: 09/01/2011] [Accepted: 11/07/2011] [Indexed: 11/13/2022] Open
Abstract
Background and Objectives Prehypertension according to JNC7 is common and is associated with increased vascular mortality. The importance of management in high-normal blood pressure (BP) is underemphasized. Subjects and Methods We analyzed major adverse cardiac events (MACEs) in the Korea Acute Myocardial Infarction Registry in normal BP (group I) and high-normal BP (group II) patients. Results Among 14871 patients, 159 (61±12.3 years, 122 males) satisfied the study indication. Six-month and one-year clinical follow-up rate was 88.9% and 85.8%, respectively. Group I had 78 patients (60.9±12.4 years). Group II had 81 patients (61.6±12.5 years). Demographics of patients were not different between groups. Treatment strategy was not different. Initial Thrombolysis in Myocardial Infarction flow grade 0 was less frequent in group II (n=32, 47.1%) than in group I (n=16, 21.9%) (p=0.001). Successful intervention rate was not different between group II (93.8%) and group I (97.1%) (p=0.590). Six-month MACE occurred in 3 patients in group I (4.4%) and 10 in group II (15.6%) (p=0.031). Compared with normal BP, the odds ratio for patients with high-normal BP was 1.147 (p=0.045, 95% confidence interval 1.011-1.402) for 6-month MACE. Conclusion Even though high-normal BP patients had a better baseline clinical status, the prognosis was poorer than patients with normal BP. Therapeutic BP target goal for the patients with acute myocardial infarction should be <140/90 mm Hg, which is recommended in JNC7.
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Affiliation(s)
- Nam Sik Yoon
- The Heart Center of Chonnam National University Hospital, Gwangju, Korea
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Ayhan E, Uyarel H, Cicek G, Ergelen M, Işık T, Eren M. Clinical outcomes of primary angioplasty in ST elevation myocardial infarction patients with antecedent hypertension during hospital stay and follow-up. Clin Exp Hypertens 2012; 34:357-62. [PMID: 22468933 DOI: 10.3109/10641963.2011.649934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Hypertension is a known risk factor for coronary artery disease. However, the number of studies focusing on the events following ST elevation myocardial infarction (STEMI) in patients with an antecedent hypertension is limited. Our aim is to evaluate the clinical outcomes of primary angioplasty in STEMI patients with antecedent hypertension during hospital stay and follow-up. A total of 373 patients (177 of whom had antecedent hypertension) who were treated by primary angioplasty because of STEMI were included in this study. All parameters were compared between the groups with and without hypertension. Hypertensive patients who received primary angioplasty were older (59.9 ± 12.6 vs. 52 ± 12.3, P < .001) and had higher rates of in-hospital mortality and major adverse cardiac events than patients without hypertension. Among STEMI patients, only history of hypertension for more than 10 years was a predictor of in-hospital mortality (odds ratio: 4.374, 95% CI 1.017-18.822, P = .04). Patients with an antecedent hypertension have higher initial risk profiles and show more negative outcomes during a 6-month follow-up period.
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Affiliation(s)
- Erkan Ayhan
- Department of Cardiology, Balıkesir University School of Medicine, Balikesir, Turkey.
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Kranjcec D, Altabas V. Metabolic syndrome influencing infarct size and heart failure in patients with acute coronary syndrome: does gender matter? Endocr J 2012; 59:1065-76. [PMID: 22971940 DOI: 10.1507/endocrj.ej12-0131] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Metabolic syndrome (MetS) is the occurrence of diabetes mellitus/glucose intolerance, arterial hypertension, central obesity, dyslipidemia, and microalbuminuria in the same patient (definition by WHO). Presence of metabolic syndrome is associated with larger myocardial infarction size and complications following acute myocardial infarction. Two hundred and thirty patients with acute coronary syndromes were analyzed. Those with MetS (n=141) included patients with diabetes mellitus/glucose intolerance and at least two of the following criteria: hypertension, hypertriglyceridemia/low HDL cholesterol, android obesity/body mass index (BMI) ≥ 30, or microalbuminuria. Control group did not meet criteria for MetS. Presence of heart failure was assigned according to Killip classification. The MetS group had larger myocardial infarction size determined by peak creatine-kinase (CK) (1484±1354 vs. 981±890, p = 0.003) and CK MB (141±117 vs. 95±78, p = 0.002). While in non-MetS group males had larger myocardial infarction than females, in MetS group females had larger myocardial infarction than males. Cardiac failure occurred more in MetS group of patients, again was more prominent in females. Occurrence of metabolic syndrome in acute coronary syndrome patients predisposes to larger myocardial infarction size, more on the account of female patients having MetS. MetS, again particularly in females, predisposes to higher chance of having heart failure during acute coronary syndrome. Recognizing the female group with MetS as of higher risk for large myocardial infarction and heart failure leads us to pay special attention on this patient population.
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Affiliation(s)
- Darko Kranjcec
- Department of Cardiology, Division of Internal Medicine, Zabok General Hospital, Zabok, Croatia
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Zaliaduonyte-Peksiene D, Vaskelyte JJ, Mizariene V, Jurkevicius R, Zaliunas R. Does Longitudinal Strain Predict Left Ventricular Remodeling after Myocardial Infarction? Echocardiography 2011; 29:419-27. [DOI: 10.1111/j.1540-8175.2011.01597.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
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Palmer BR, Frampton CM, Skelton L, Yandle TG, Doughty RN, Whalley GA, Ellis CJ, Troughton RW, Richards AM, Cameron VA. KCNE5 polymorphism rs697829 is associated with QT interval and survival in acute coronary syndromes patients. J Cardiovasc Electrophysiol 2011; 23:319-24. [PMID: 21985337 DOI: 10.1111/j.1540-8167.2011.02192.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION The KCNE family is a group of small transmembrane channel proteins involved in potassium ion (K(+)) conductance. The X-linked KCNE5 gene encodes a regulator of the K(+) current mediated by the potassium channel KCNQ1. Polymorphisms in KCNE5 have been associated with altered cardiac electrophysiological properties in human studies. We investigated associations of the common rs697829 polymorphism from KCNE5 with baseline characteristics, baseline electrocardiographic (ECG) measurements, and patient survival in a cohort of post-acute coronary syndromes (ACS) patients (the Coronary Disease Cohort Study cohort). METHODS AND RESULTS DNA samples (n = 1,740) were genotyped for rs697829 using a TaqMan assay. Baseline ECG data revealed corrected QT (QTc) interval was associated with rs697829 in male, but not female, patients, being extended in the G genotype group (A 416 ± 1.71; G 431 ± 4.25 ms, P = 0.002). Covariate-adjusted survival was poorest in G genotype patients in Cox proportional hazard modeling of mortality data of males (P(overall) = 0.020). Male patients with G genotype had a hazard ratio of 1.44 (1.11-2.33) for death when compared to the A genotype male patients (P = 0.048) after adjustment for age, baseline log-transformed N-terminal pro-B-type natriuretic peptide (NTproBNP), β-blocker and insulin treatment, QTc interval, history of myocardial infarction, and physical activity score. CONCLUSION This study suggests an association between rs697829, a common single nucleotide polymorphism (SNP) from KCNE5, and ECG measurements and survival in postacute ACS patients. Prolonged subclinical QT interval may be a marker of adverse outcome in this group of patients.
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Affiliation(s)
- Barry R Palmer
- Christchurch Cardioendocrine Research Group, Department of Medicine, University of Otago, Christchurch, New Zealand.
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Picariello C, Lazzeri C, Attanà P, Chiostri M, Gensini GF, Valente S. The impact of hypertension on patients with acute coronary syndromes. Int J Hypertens 2011; 2011:563657. [PMID: 21747979 PMCID: PMC3124673 DOI: 10.4061/2011/563657] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2011] [Revised: 04/15/2011] [Accepted: 04/19/2011] [Indexed: 01/12/2023] Open
Abstract
Arterial chronic hypertension (HTN) is a well-known cardiovascular risk factor for development of atherosclerosis. In order to explain the relation between HTN and acute coronary syndromes the following factors should be considered: (1) risk factors are shared by the diseases, such as genetic risk, insulin resistance, sympathetic hyperactivity, and vasoactive substances (i.e., angiotensin II); (2) hypertension is associated with the development of atherosclerosis (which in turn contributes to progression of myocardial infarction). From all the registries and the data available up to now, hypertensive patients with ACS are more likely to be older, female, of nonwhite ethnicity, and having a higher prevalence of comorbidities. Data on the prognostic role of a preexisting hypertensive state in ACS patients are so far contrasting. The aim of the present paper is to focus on hypertensive patients with ACS, in order to better elucidate whether these patients are at higher risk and deserve a tailored approach for management and followup.
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Affiliation(s)
- Claudio Picariello
- Intensive Cardiac Care Unit, Careggi Hospital, Viale Morgagni 85, 50184 Florence, Italy
| | - Chiara Lazzeri
- Intensive Cardiac Care Unit, Careggi Hospital, Viale Morgagni 85, 50184 Florence, Italy
| | - Paola Attanà
- Intensive Cardiac Care Unit, Careggi Hospital, Viale Morgagni 85, 50184 Florence, Italy
| | - Marco Chiostri
- Intensive Cardiac Care Unit, Careggi Hospital, Viale Morgagni 85, 50184 Florence, Italy
| | - Gian Franco Gensini
- Intensive Cardiac Care Unit, Careggi Hospital, Viale Morgagni 85, 50184 Florence, Italy
| | - Serafina Valente
- Intensive Cardiac Care Unit, Careggi Hospital, Viale Morgagni 85, 50184 Florence, Italy
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Ali WM, Zubaid M, El-Menyar A, Al Mahmeed W, Al-Lawati J, Singh R, Ridha M, Al-Hamdan R, Alhabib K, Al Suwaidi J. The prevalence and outcome of hypertension in patients with acute coronary syndrome in six Middle-Eastern countries. Blood Press 2010; 20:20-6. [PMID: 20843191 DOI: 10.3109/08037051.2010.518673] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
AIMS The aim was to report the prevalence and significance of hypertension (HTN) in patients with acute coronary syndrome (ACS). METHODS AND MAJOR FINDINGS Over a 6-month period in 2007, 8171 consecutive patients (49.4% hypertensive and 50.6% non-hypertensive) presenting with ACS were enrolled in a prospective, multicenter study from six Middle Eastern adjacent countries. Patients with HTN were older (59.2 vs 53.1 years, p<0.001), and more likely to be female (34% vs 14.4%, p<0.001) when compared with patients without HTN. Patients with HTN were also more likely to have diabetes mellitus, hyperlipidemia, cerebrovascular disease, prior history of coronary artery disease, peripheral artery disease but less likely to be cigarette smokers. At admission, HTN patients had higher Killip class, heart rate and GRACE risk scoring. In-hospital mortality was higher in hypertensive patients with ST-elevation myocardial infarction (STEMI) but not in patients with non-STEMI or unstable angina. The incidence of heart failure complications was significantly higher among patients with HTN in overall ACS type (OR = 1.2, 95% CI 1.001-1.338, p= 0.04). MAIN CONCLUSION In this large cohort of patients with ACS, HTN was an independent predictor of heart failure and was associated with an increased rate of in-hospital mortality in STEMI only.
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Affiliation(s)
- Waleed M Ali
- Department of Cardiology, Hamad Medical Corporation (HMC), Qatar and Weill Cornell Medical College, Doha, Qatar
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Abstract
Flash pulmonary edema (FPE) is a general clinical term used to describe a particularly dramatic form of acute decompensated heart failure. Well-established risk factors for heart failure such as hypertension, coronary ischemia, valvular heart disease, and diastolic dysfunction are associated with acute decompensated heart failure as well as with FPE. However, endothelial dysfunction possibly secondary to an excessive activity of renin-angiotensin-aldosterone system, impaired nitric oxide synthesis, increased endothelin levels, and/or excessive circulating catecholamines may cause excessive pulmonary capillary permeability and facilitate FPE formation. Renal artery stenosis particularly when bilateral has been identified has a common cause of FPE. Lack of diurnal variation in blood pressure and a widened pulse pressure have been identified as risk factors for FPE. This review is an attempt to delineate clinical and pathophysiological mechanisms responsible for FPE and to distinguish pathophysiologic, clinical, and therapeutic aspects of FPE from those of acute decompensated heart failure.
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Affiliation(s)
- Stefano F Rimoldi
- Swiss Cardiovascular Center Bern, University Hospital, Bern, Switzerland.
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Relation of circulating markers of fibrosis and progression of left and right ventricular dysfunction in hypertensive patients with heart failure. J Hypertens 2009; 27:2483-91. [DOI: 10.1097/hjh.0b013e3283316c4d] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Britton KA, Gaziano JM, Djoussé L. Normal systolic blood pressure and risk of heart failure in US male physicians. Eur J Heart Fail 2009; 11:1129-34. [PMID: 19861382 DOI: 10.1093/eurjhf/hfp141] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
AIMS Heart failure (HF) is a major public health issue and hypertension is a major predictor of HF. Observational studies have demonstrated a continuous and graded relationship between 'normal' systolic blood pressure (SBP) and cardiovascular disease. However, limited data are available on the relationship between normotensive SBP and the risk of HF. METHODS AND RESULTS To test the hypothesis that there is a graded relation between SBP and HF risk among subjects with normal SBP, we used data on 18 876 participants who were healthy and were free of HF at baseline. Incident HF cases were ascertained by annual follow-up questionnaires and validated through a review of medical records. Cox proportional hazard model was used to compute multivariable-adjusted hazard ratios with corresponding 95% confidence intervals. Between 1982 and 2008, 1098 cases of HF occurred. There was a 35% increased risk of HF among subjects with SBP 130-139 mmHg compared with people with optimal SBP (<120 mmHg). In addition, there was a linear trend in HF risk across the normal range of SBP. CONCLUSION Our findings suggest a linear relationship between normotensive SBP and HF risk. Strategies to prevent HF, such as lifestyle modification, should be emphasized across all blood pressure ranges.
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Affiliation(s)
- Kathryn A Britton
- Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02115, USA.
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Kang DG, Jeong MH, Ahn Y, Chae SC, Hur SH, Hong TJ, Kim YJ, Seong IW, Chae JK, Rhew JY, Chae IH, Cho MC, Bae JH, Rha SW, Kim CJ, Jang YS, Yoon J, Seung KB, Park SJ. Clinical effects of hypertension on the mortality of patients with acute myocardial infarction. J Korean Med Sci 2009; 24:800-6. [PMID: 19794974 PMCID: PMC2752759 DOI: 10.3346/jkms.2009.24.5.800] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2008] [Accepted: 11/22/2008] [Indexed: 11/20/2022] Open
Abstract
The incidence of ischemic heart disease has been increased rapidly in Korea. However, the clinical effects of antecedent hypertension on acute myocardial infarction have not been identified. We assessed the relationship between antecedent hypertension and clinical outcomes in 7,784 patients with acute myocardial infarction in the Korea Acute Myocardial Infarction Registry during one-year follow-up. Diabetes mellitus, hyperlipidemia, cerebrovascular disease, heart failure, and peripheral artery disease were more prevalent in hypertensives (n=3,775) than nonhypertensives (n=4,009). During hospitalization, hypertensive patients suffered from acute renal failure, shock, and cerebrovascular event more frequently than in nonhypertensives. During follow-up of one-year, the incidence of major adverse cardiac events was higher in hypertensives. In multi-variate adjustment, old age, Killip class > or =III, left ventricular ejection fraction <45%, systolic blood pressure <90 mmHg on admission, post procedural TIMI flow grade < or =2, female sex, and history of hypertension were independent predictors for in-hospital mortality. However antecedent hypertension was not significantly associated with one-year mortality. Hypertension at the time of acute myocardial infarction is associated with an increased rate of in-hospital mortality.
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Affiliation(s)
| | | | | | | | - Seung Ho Hur
- Keimyung University Dongsan Medical Center, Daegu, Korea
| | | | | | - In Whan Seong
- Chungnam National University Hospital, Daejeon, Korea
| | | | | | - In Ho Chae
- Seoul National University Bundang Hospital, Seongam, Korea
| | | | | | | | | | | | | | - Ki Bae Seung
- Catholic University of Seoul St. Mary's Hospital, Seoul, Korea
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Chen G, Hemmelgarn B, Alhaider S, Quan H, Campbell N, Rabi D. Meta-analysis of adverse cardiovascular outcomes associated with antecedent hypertension after myocardial infarction. Am J Cardiol 2009; 104:141-7. [PMID: 19576336 DOI: 10.1016/j.amjcard.2009.02.048] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2008] [Revised: 02/23/2009] [Accepted: 02/23/2009] [Indexed: 10/20/2022]
Abstract
The aim of this study was to investigate the association of antecedent hypertension with adverse cardiovascular outcomes after myocardial infarction. A search of Medline and EMBASE was supplemented by manual searches of the bibliographies of key retrieved reports. The studies were included if they reported antecedent hypertension as a risk factor for adverse outcomes (death, stroke, congestive heart failure, recurrent myocardial infarction) in survivors of myocardial infarctions. Relative risks (RRs) were pooled using a random-effects model, and the robustness of the pooled RRs was evaluated in sensitivity analyses. Cumulative meta-analysis, by chronologic year of study beginning, was also performed. The search yielded 17 studies (n = 56,748 participants) that reported antecedent hypertension with adverse outcomes for survivors of myocardial infarctions. Randomized clinical trials (n = 8) were pooled separately from cohort studies (n = 9). For randomized clinical trials, the pooled RRs were 1.19 (95% confidence interval [CI] 1.13 to 1.26) for all-cause mortality and 1.29 (95% CI 1.09 to 1.53) for cardiovascular disease mortality. For cohort studies, the pooled RRs were 1.46 (95% CI 1.34 to 1.61) for all-cause mortality and 1.54 (95% CI 1.22 to 1.93) for cardiovascular disease mortality. Antecedent hypertension was also consistently associated with an increased risk for stroke, congestive heart failure, and recurrent myocardial infarction. Pooled estimates were robust in sensitivity analysis. In conclusion, antecedent hypertension was associated with adverse outcomes for survivors of myocardial infarctions, the association of antecedent hypertension with all-cause mortality outcomes decreased over time, and this decreased association reflects improved treatment and management of hypertension in more recent years.
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Betti I, Castelli G, Barchielli A, Beligni C, Boscherini V, De Luca L, Messeri G, Gheorghiade M, Maisel A, Zuppiroli A. The Role of N-terminal PRO-Brain Natriuretic Peptide and Echocardiography for Screening Asymptomatic Left Ventricular Dysfunction in a Population at High Risk for Heart Failure. The PROBE-HF Study. J Card Fail 2009; 15:377-84. [DOI: 10.1016/j.cardfail.2008.12.002] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2007] [Revised: 11/16/2008] [Accepted: 12/03/2008] [Indexed: 02/06/2023]
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Gaddam KK, Verma A, Thompson M, Amin R, Ventura H. Hypertension and cardiac failure in its various forms. Med Clin North Am 2009; 93:665-80. [PMID: 19427498 DOI: 10.1016/j.mcna.2009.02.005] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Hypertension clearly increases the risk of systolic or diastolic heart failure. With aging population and advancements in treatment of cardiovascular diseases, the prevalence of heart failure is ever-increasing and is a principal cause of cardiovascular morbidity and mortality. Treating hypertension has been shown to decrease the risk of development of heart failure and hence underscores the early recognition and treatment of hypertension and hypertensive heart disease. Antihypertensive treatment with drugs from all classes except direct vasodilators is effective in reversing LVH and preventing heart failure. Also, all of the major classes of antihypertensive drugs, particularly beta-blockers and RAS antagonists, with the exception of calcium antagonists, have been shown to improve survival in patients who have LV systolic dysfunction. However, phenotyping and identifying the pathophysiology and appropriate treatments for patients who have diastolic dysfunction and heart failure with preserved ejection fraction has been a daunting task. At this time, treatment of these patients is largely empiric, focusing on BP control, and treating or avoiding intravascular volume overload.
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Affiliation(s)
- Krishna K Gaddam
- Department of Medicine, Division of Cardiovascular Diseases, Ochsner Clinic Foundation, New Orleans, LA 70121, USA
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Kosmala W, Plaksej R, Strotmann JM, Weigel C, Herrmann S, Niemann M, Mende H, Störk S, Angermann CE, Wagner JA, Weidemann F. Progression of left ventricular functional abnormalities in hypertensive patients with heart failure: an ultrasonic two-dimensional speckle tracking study. J Am Soc Echocardiogr 2009; 21:1309-17. [PMID: 19041574 DOI: 10.1016/j.echo.2008.10.006] [Citation(s) in RCA: 88] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2008] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Two-dimensional (2-D) strain imaging is a novel echocardiographic technique for myocardial function evaluation. We sought to investigate left ventricular (LV) systolic function in patients with heart failure caused by hypertension using a 2-D strain approach and to validate this method against Doppler strain measurements. METHODS The study population comprised 81 patients (66.4 +/- 7.4 years) with hypertension in New York Heart Association (NYHA) class I to IV and 20 healthy controls. RESULTS Decreased longitudinal strain was demonstrated in the basal septal segment in NYHA I, in the basal and mid septal and basal lateral segments in NYHA II, and in all segments in NYHA III and IV. Radial and circumferential strain were reduced in patients with NYHA III and IV. Independent predictors of strain were duration of HT, LV mass index, LV end-diastolic volume index, and systolic blood pressure. The agreement between 2-D and Doppler strain remained within acceptable ranges (mean difference +/- 1 standard deviation: 0.61%-1.92% +/- 2.38%-2.92% for longitudinal strain in particular segments and 4.98% +/- 5.26% for radial strain). CONCLUSION In hypertensive patients, (1) LV longitudinal systolic function progressively deteriorates from NYHA I to IV and abnormalities commence in the basal septum, (2) LV radial and circumferential systolic impairment appears in NYHA III and IV, and (3) 2-D strain measurement provides a feasible tool for the quantitation of LV systolic performance.
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Affiliation(s)
- Wojciech Kosmala
- Department of Cardiology, Wroclaw Medical University, Wroclaw, Poland.
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Flaherty JD, Udelson JE, Gheorghiade M, Wu E, Davidson CJ. Assessment and key targets for therapy in the post-myocardial infarction patient with left ventricular dysfunction. Am J Cardiol 2008; 102:5G-12G. [PMID: 18722186 DOI: 10.1016/j.amjcard.2008.06.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
In the post-myocardial infarction (MI) patient with coronary artery disease (CAD) and left ventricular dysfunction (LVD), ischemia and adverse remodeling hinder myocardial performance and increase electrical instability. Collectively, the coronary arteries, myocardium, and conduction system represent the principal pathophysiologic targets in MI complicated by LVD. Consequently, an accurate assessment of disease severity in these targets is essential for the design of an effective therapeutic program. This review describes the current modalities for assessing the key pathophysiologic targets in post-MI patients with LVD and the effects of systemic factors on cardiac disease severity.
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Affiliation(s)
- James D Flaherty
- Division of Cardiology, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois 60611, USA.
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Cerisano G, Parodi G, Dovellini EV, Migliorini A, Tommasi M, Raspanti S, Buonamici P, Taddeucci E, Valenti R, Antoniucci D. Time course of serum collagen types I and III metabolism products after reperfused acute myocardial infarction in patients with and without systemic hypertension. J Hum Hypertens 2008; 23:40-7. [DOI: 10.1038/jhh.2008.98] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Pitt B, Ahmed A, Love TE, Krum H, Nicolau J, Cardoso JS, Parkhomenko A, Aschermann M, Corbalán R, Solomon H, Shi H, Zannad F. History of hypertension and eplerenone in patients with acute myocardial infarction complicated by heart failure. Hypertension 2008; 52:271-8. [PMID: 18559720 DOI: 10.1161/hypertensionaha.107.109314] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
In the Eplerenone Post-Acute Myocardial Infarction Heart Failure Efficacy and Survival Study (n=6632), eplerenone-associated reduction in all-cause mortality was significantly greater in those with a history of hypertension (Hx-HTN). There were 4007 patients with Hx-HTN (eplerenone: n=1983) and 2625 patients without Hx-HTN (eplerenone: n=1336). Propensity scores for eplerenone use, separately calculated for patients with and without Hx-HTN, were used to assemble matched cohorts of 1838 and 1176 pairs of patients. In patients with Hx-HTN, all-cause mortality occurred in 18% of patients treated with placebo (rate, 1430/10 000 person-years) and 14% of patients treated with eplerenone (rate, 1058/10 000 person-years) during 2350 and 2457 years of follow-up, respectively (hazard ratio [HR]: 0.71; 95% CI: 0.59 to 0.85; P<0.0001). Composite end point of cardiovascular hospitalization or cardiovascular mortality occurred in 33% of placebo-treated patients (3029/10 000 person-years) and 28% of eplerenone-treated patients (2438/10 000 person-years) with Hx-HTN (HR: 0.82; 95% CI: 0.72 to 0.94; P=0.003). In patients without Hx-HTN, eplerenone reduced heart failure hospitalization (HR: 73; 95% CI: 0.55 to 0.97; P=0.028) but had no effect on mortality (HR: 0.91; 95% CI: 0.72 to 1.15; P=0.435) or on the composite end point (HR: 0.91; 95% CI: 0.76 to 1.10; P=0.331). Eplerenone should, therefore, be prescribed to all of the post-acute myocardial infarction patients with reduced left ventricular ejection fraction and heart failure regardless of Hx-HTN.
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Affiliation(s)
- Bertram Pitt
- University of Michigan, 1500 E Medical Center Dr, 3910 Taubman Center, Ann Arbor, MI 48109-0366, USA.
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