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Huang N, Lu H. Association between instantaneous heart rate sequence during the awake period and cardiovascular events: a study based on Sleep Heart Health Study. Minerva Cardiol Angiol 2024; 72:465-476. [PMID: 39254955 DOI: 10.23736/s2724-5683.24.06466-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/11/2024]
Abstract
BACKGROUND Heart rate variability (HRV) has been reported to be associated with cardiovascular diseases (CVD), while few studies focused on the instantaneous heart rate (IHR). This study aimed to establish models to predict the occurrence of cardiovascular events based on the IHR sequence. METHODS A total of 2977 participants with useful electrocardiogram (ECG) data and free of CVD events at baseline from the Sleep Heart Health Study (SHHS) database were included in this retrospective cohort study. All IHR indicators were measured during the awake period before sleep. The logistic regression, random forest, and XGBoost methods were used to develop the predictive models. The model performance was quantified by calculating the area under the curve (AUC). RESULTS Of theses 2977 participants, 1460 (49.04%) participants had CVD events during the 15-year follow-up. Higher standard deviation of IHR (SDHR) (OR=0.906; 95% CI, 0.832-0.986), coefficient of variation of IHR (CVHR) (OR=0.910; 95% CI, 0.835-0.990), power in low frequency (LF) (OR=0.896; 95% CI, 0.822-0.975), power in high frequency (HF) (OR=0.872; 95% CI, 0.796-0.955), and total power (TP) (OR=0.887; 95% CI, 0.813-0.967) were associated with the lower risk of CVD events, while ratio of semi-minor axis and semi-major axis in Poincare plot (SDratio) (OR=1.105; 95% CI, 1.012-1.206) was related to the higher risk of CVD events. The AUCs of the logistic regression, random forest, and the XGBoost models were 0.734 (95% CI, 0.701-0.767), 0.794 (95% CI, 0.764-0.823) and 0.828 (95% CI, 0.801-0.855) in the testing set, respectively. CONCLUSIONS IHR sequences were important predictors of cardiovascular events. The IHR indicators should be paid more attention to in future clinical researches on CVD.
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Affiliation(s)
- Nan Huang
- Department of Cardiovascular Medicine, Liuzhou People's Hospital, Liuzhou, Guangxi, China -
| | - Haiou Lu
- Department of General Practice, Liuzhou People's Hospital, Liuzhou, Guangxi, China
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Røsand Ø, Wang J, Scrimgeour N, Marwarha G, Høydal MA. Exosomal Preconditioning of Human iPSC-Derived Cardiomyocytes Beneficially Alters Cardiac Electrophysiology and Micro RNA Expression. Int J Mol Sci 2024; 25:8460. [PMID: 39126028 PMCID: PMC11313350 DOI: 10.3390/ijms25158460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2024] [Revised: 07/27/2024] [Accepted: 07/29/2024] [Indexed: 08/12/2024] Open
Abstract
Experimental evidence, both in vitro and in vivo, has indicated cardioprotective effects of extracellular vesicles (EVs) derived from various cell types, including induced pluripotent stem cell-derived cardiomyocytes. The biological effects of EV secretion, particularly in the context of ischemia and cardiac electrophysiology, remain to be fully explored. Therefore, the goal of this study was to unveil the effects of exosome (EXO)-mediated cell-cell signaling during hypoxia by employing a simulated preconditioning approach on human-induced pluripotent stem cell-derived cardiomyocytes (hIPSC-CMs). Electrophysiological activity of hIPSC-CMs was measured using a multielectrode array (MEA) system. A total of 16 h of hypoxic stress drastically increased the beat period. Moreover, hIPSC-CMs preconditioned with EXOs displayed significantly longer beat periods compared with non-treated cells after 16 h of hypoxia (+15.7%, p < 0.05). Furthermore, preconditioning with hypoxic EXOs resulted in faster excitation-contraction (EC) coupling compared with non-treated hIPSC-CMs after 16 h of hypoxia (-25.3%, p < 0.05). Additionally, microRNA (miR) sequencing and gene target prediction analysis of the non-treated and pre-conditioned hIPSC-CMs identified 10 differentially regulated miRs and 44 gene targets. These results shed light on the intricate involvement of miRs, emphasizing gene targets associated with cell survival, contraction, apoptosis, reactive oxygen species (ROS) regulation, and ion channel modulation. Overall, this study demonstrates that EXOs secreted by hIPSC-CM during hypoxia beneficially alter electrophysiological properties in recipient cells exposed to hypoxic stress, which could play a crucial role in the development of targeted interventions to improve outcomes in ischemic heart conditions.
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Affiliation(s)
| | | | | | | | - Morten Andre Høydal
- Group of Molecular and Cellular Cardiology, Department of Circulation and Medical Imaging, Faculty of Medicine and Health, Norwegian University of Science and Technology (NTNU), 7030 Trondheim, Norway; (Ø.R.); (J.W.); (N.S.); (G.M.)
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Kobayashi S, Sakakura K, Jinnouchi H, Taniguchi Y, Tsukui T, Hatori M, Watanabe Y, Yamamoto K, Seguchi M, Wada H, Fujita H. Impact of controlled blood pressure and pulse rate at discharge on clinical outcomes in patients with ST-segment elevation myocardial infarction. J Cardiol 2024; 83:394-400. [PMID: 37802203 DOI: 10.1016/j.jjcc.2023.09.013] [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: 06/12/2023] [Revised: 09/05/2023] [Accepted: 09/18/2023] [Indexed: 10/08/2023]
Abstract
BACKGROUND Although major guidelines recommend the routine introduction of angiotensin-converting enzyme (ACE) inhibitors/angiotensin receptor blockers (ARBs) and beta-blockers for patients with ST-segment elevation myocardial infarction (STEMI), evidence regarding the target blood pressure (BP) or pulse rate (PR) at hospital discharge is sparse. This retrospective study aimed to compare the clinical outcomes in patients with STEMI between those with good BP and PR control and those with poor BP or PR control. METHODS We included 748 patients with STEMI who received both ACE inhibitors/ARBs and beta-blockers at hospital discharge, and divided them into a good control group (systolic BP ≤140 mmHg and PR ≤80 bpm, n = 564) and a poor control group (systolic BP >140 mmHg or PR >80 bpm, n = 184). The primary endpoint was major cardiovascular events (MACE) defined as the composite of all-cause death, non-fatal myocardial infarction, and re-admission for heart failure. RESULTS During the median follow-up duration of 568 days, a total of 119 MACE were observed. The Kaplan-Meier curves showed that MACE were more frequently observed in the poor control group (p = 0.009). In the multivariate Cox hazard analysis, the good control group was inversely associated with MACE (HR 0.656, 95 % CI: 0.444-0.968, p = 0.034) after controlling for multiple confounding factors. CONCLUSIONS The good control of systolic BP and PR at discharge was inversely associated with long-term adverse events in STEMI patients treated with both ACE inhibitors/ARBs and beta blockers. This study suggests the importance of titration of ACE inhibitors/ARBs and beta-blockers for better clinical outcomes in patients with STEMI.
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Affiliation(s)
- Satomi Kobayashi
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Saitama City, Japan
| | - Kenichi Sakakura
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Saitama City, Japan.
| | - Hiroyuki Jinnouchi
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Saitama City, Japan
| | - Yousuke Taniguchi
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Saitama City, Japan
| | - Takunori Tsukui
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Saitama City, Japan
| | - Masashi Hatori
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Saitama City, Japan
| | - Yusuke Watanabe
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Saitama City, Japan
| | - Kei Yamamoto
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Saitama City, Japan
| | - Masaru Seguchi
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Saitama City, Japan
| | - Hiroshi Wada
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Saitama City, Japan
| | - Hideo Fujita
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Saitama City, Japan
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Chen K, Chen L, Shan Z, Wang G, Qu S, Qin G, Yu X, Xin W, Hsieh TH, Mu Y. Beinaglutide for weight management in Chinese individuals with overweight or obesity: A phase 3 randomized controlled clinical study. Diabetes Obes Metab 2024; 26:690-698. [PMID: 37945546 DOI: 10.1111/dom.15360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Revised: 10/11/2023] [Accepted: 10/20/2023] [Indexed: 11/12/2023]
Abstract
AIM To investigate the efficacy and safety of beinaglutide as an adjunct to lifestyle intervention among non-diabetic Chinese individuals with overweight or obesity. METHODS This multicentre, randomized, double-blind, placebo-controlled trial (ChiCTR1900023428) included 427 Chinese adults with a body mass index of 28 kg/m2 or higher (obesity) or 24-27.9 kg/m2 (overweight) with weight-related complications. Patients were randomized in a 2:1 ratio to receive 0.2 mg of beinaglutide (subcutaneous) thrice daily or placebo for 16 weeks. Co-primary endpoints were body weight change and the proportion of patients with a weight reduction of 5% or more. RESULTS Mean body weight change from baseline to week 16 was -6.0% and -2.4% in the beinaglutide (n = 282) and placebo (n = 138) groups, respectively; the mixed model repeated measures difference was -3.6% (95% confidence interval: -4.6% to -2.6%; P < .0001). At week 16, more beinaglutide-treated patients achieved a weight reduction of 5% or more (58.2% vs. 25.4% [placebo], odds ratio: 4.4; P < .0001) and of 10% or more (21.3% vs. 5.1% [placebo], odds ratio: 5.5; P < .0001). Beinaglutide also resulted in greater waist circumference reduction (difference: -1.81 cm; P < .01). The weight regain rate 12 weeks after beinaglutide treatment was 0.78%. Nausea (transient and mild-to-moderate) was the most common adverse event in the beinaglutide group (49.3% vs. 7.1% [placebo]). More patients receiving beinaglutide discontinued treatment because of adverse events (5.9% vs. 0.7% [placebo]). Pancreatitis or an increased resting heart rate was not observed in the beinaglutide group. CONCLUSION Beinaglutide combined with lifestyle intervention resulted in significant and clinically meaningful weight reduction with good tolerance in non-diabetic Chinese individuals with overweight or obesity.
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Affiliation(s)
- Kang Chen
- The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Li Chen
- Qilu Hospital of Shandong University, Jinan, China
| | - Zhongyan Shan
- The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Guixia Wang
- The First Hospital of Jilin University, Jilin, China
| | - Shen Qu
- Shanghai Tenth People's Hospital, Shanghai, China
| | - Guijun Qin
- The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xuefeng Yu
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Weiquan Xin
- Shanghai Benemae Pharmaceutical Corporation, Shanghai, China
| | - Tsung-Han Hsieh
- Shanghai Benemae Pharmaceutical Corporation, Shanghai, China
| | - Yiming Mu
- The First Medical Center of Chinese PLA General Hospital, Beijing, China
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Qi T, Zhang J, Zhang K, Zhang W, Song Y, Lian K, Kan C, Han F, Hou N, Sun X. Unraveling the role of the FHL family in cardiac diseases: Mechanisms, implications, and future directions. Biochem Biophys Res Commun 2024; 694:149468. [PMID: 38183876 DOI: 10.1016/j.bbrc.2024.149468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 12/23/2023] [Accepted: 01/02/2024] [Indexed: 01/08/2024]
Abstract
Heart diseases are a major cause of morbidity and mortality worldwide. Understanding the molecular mechanisms underlying these diseases is essential for the development of effective diagnostic and therapeutic strategies. The FHL family consists of five members: FHL1, FHL2, FHL3, FHL4, and FHL5/Act. These members exhibit different expression patterns in various tissues including the heart. FHL family proteins are implicated in cardiac remodeling, regulation of metabolic enzymes, and cardiac biomechanical stress perception. A large number of studies have explored the link between FHL family proteins and cardiac disease, skeletal muscle disease, and ovarian metabolism, but a comprehensive and in-depth understanding of the specific molecular mechanisms targeting FHL on cardiac disease is lacking. The aim of this review is to explore the structure and function of FHL family members, to comprehensively elucidate the mechanisms by which they regulate the heart, and to explore in depth the changes in FHL family members observed in different cardiac disorders, as well as the effects of mutations in FHL proteins on heart health.
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Affiliation(s)
- Tongbing Qi
- Department of Endocrinology and Metabolism, Affiliated Hospital of Weifang Medical University, Weifang, 261031, China; Clinical Research Center, Affiliated Hospital of Weifang Medical University, Weifang, 261031, China
| | - Jingwen Zhang
- Department of Endocrinology and Metabolism, Affiliated Hospital of Weifang Medical University, Weifang, 261031, China; Clinical Research Center, Affiliated Hospital of Weifang Medical University, Weifang, 261031, China
| | - Kexin Zhang
- Department of Endocrinology and Metabolism, Affiliated Hospital of Weifang Medical University, Weifang, 261031, China; Clinical Research Center, Affiliated Hospital of Weifang Medical University, Weifang, 261031, China
| | - Wenqiang Zhang
- Department of Endocrinology and Metabolism, Affiliated Hospital of Weifang Medical University, Weifang, 261031, China; Clinical Research Center, Affiliated Hospital of Weifang Medical University, Weifang, 261031, China; Department of Pathology, Affiliated Hospital of Weifang Medical University, Weifang, 261031, China
| | - Yixin Song
- Department of Endocrinology and Metabolism, Affiliated Hospital of Weifang Medical University, Weifang, 261031, China; Clinical Research Center, Affiliated Hospital of Weifang Medical University, Weifang, 261031, China
| | - Kexin Lian
- Department of Nephrology, Affiliated Hospital of Weifang Medical University, Weifang, 261031, China
| | - Chengxia Kan
- Department of Endocrinology and Metabolism, Affiliated Hospital of Weifang Medical University, Weifang, 261031, China; Clinical Research Center, Affiliated Hospital of Weifang Medical University, Weifang, 261031, China
| | - Fang Han
- Department of Endocrinology and Metabolism, Affiliated Hospital of Weifang Medical University, Weifang, 261031, China; Clinical Research Center, Affiliated Hospital of Weifang Medical University, Weifang, 261031, China; Department of Pathology, Affiliated Hospital of Weifang Medical University, Weifang, 261031, China
| | - Ningning Hou
- Department of Endocrinology and Metabolism, Affiliated Hospital of Weifang Medical University, Weifang, 261031, China.
| | - Xiaodong Sun
- Department of Endocrinology and Metabolism, Affiliated Hospital of Weifang Medical University, Weifang, 261031, China; Clinical Research Center, Affiliated Hospital of Weifang Medical University, Weifang, 261031, China.
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Hou J, Lu K, Chen P, Wang P, Li J, Yang J, Liu Q, Xue Q, Tang Z, Pei H. Comprehensive viewpoints on heart rate variability at high altitude. Clin Exp Hypertens 2023; 45:2238923. [PMID: 37552638 DOI: 10.1080/10641963.2023.2238923] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 07/11/2023] [Accepted: 07/14/2023] [Indexed: 08/10/2023]
Abstract
OBJECTIVES Hypoxia is a physiological state characterized by reduced oxygen levels in organs and tissues. It is a common clinicopathological process and a major cause of health problems in highland areas. Heart rate variability (HRV) is a measure of the balance in autonomic innervation to the heart. It provides valuable information on the regulation of the cardiovascular system by neurohumoral factors, and changes in HRV reflect the complex interactions between multiple systems. In this review, we provide a comprehensive overview of the relationship between high-altitude hypoxia and HRV. We summarize the different mechanisms of diseases caused by hypoxia and explore the changes in HRV across various systems. Additionally, we discuss relevant pharmaceutical interventions. Overall, this review aims to provide research ideas and assistance for in-depth studies on HRV. By understanding the intricate relationship between high-altitude hypoxia and HRV, we can gain insights into the underlying mechanisms and potential therapeutic approaches to mitigate the effects of hypoxia on cardiovascular and other systems. METHODS The relevant literature was collected systematically from scientific database, including PubMed, Web of Science, China National Knowledge Infrastructure (CNKI), Baidu Scholar, as well as other literature sources, such as classic books of hypoxia. RESULTS There is a close relationship between heart rate variability and high-altitude hypoxia. Heart rate variability is an indicator that evaluates the impact of hypoxia on the cardiovascular system and other related systems. By improving the observation of HRV, we can estimate the progress of cardiovascular diseases and predict the impact on other systems related to cardiovascular health. At the same time, changes in heart rate variability can be used to observe the efficacy of preventive drugs for altitude related diseases. CONCLUSIONS HRV can be used to assess autonomic nervous function under various systemic conditions, and can be used to predict and monitor diseases caused by hypoxia at high altitude. Investigating the correlation between high altitude hypoxia and heart rate variability can help make HRV more rapid, accurate, and effective for the diagnosis of plateau-related diseases.
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Affiliation(s)
- Jun Hou
- Department of Cardiology, Chengdu Third People's Hospital, Affiliated Hospital of Southwest Jiao Tong University, Cardiovascular Disease Research Institute of Chengdu, Chengdu, China
| | - Keji Lu
- School of Medical and Life Sciences, Chengdu University of TCM, Chengdu, China
| | - Peiwen Chen
- School of Medical and Life Sciences, Chengdu University of TCM, Chengdu, China
| | - Peng Wang
- Department of Cardiology, The General Hospital of Western Theater Command, Chengdu, China
| | - Jing Li
- Department of Cardiology, The General Hospital of Western Theater Command, Chengdu, China
| | - Jiali Yang
- Department of Cardiology, Chengdu Third People's Hospital, Affiliated Hospital of Southwest Jiao Tong University, Cardiovascular Disease Research Institute of Chengdu, Chengdu, China
| | - Qing Liu
- Department of Medical Engineering, The 950th Hospital of PLA, Yecheng, Xinjiang, China
| | - Qiang Xue
- Department of Cardiology Xijing Hospital, Air Force Medical University, Xi'an, China
| | - Zhaobing Tang
- Department of Rehabilitation Medicine, The General Hospital of Western Theater Command, Chengdu, China
| | - Haifeng Pei
- Department of Cardiology, The General Hospital of Western Theater Command, Chengdu, China
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Chen S, Pan X, Mo J, Wang B. Establishment and validation of a prediction nomogram for heart failure risk in patients with acute myocardial infarction during hospitalization. BMC Cardiovasc Disord 2023; 23:619. [PMID: 38110880 PMCID: PMC10726532 DOI: 10.1186/s12872-023-03665-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Accepted: 12/08/2023] [Indexed: 12/20/2023] Open
Abstract
BACKGROUND Acute myocardial infarction (AMI) with consequent heart failure is one of the leading causes of death in humans. The aim of this study was to develop a prediction model to identify heart failure risk in patients with AMI during hospitalization. METHODS The data on hospitalized patients with AMI were retrospectively collected and divided randomly into modeling and validation groups at a ratio of 7:3. In the modeling group, the independent risk factors for heart failure during hospitalization were obtained to establish a logistic prediction model, and a nomogram was constructed. The receiver operating characteristic (ROC) curve, calibration curve, and decision curve analysis (DCA) were used to evaluate the predictive performance and clinical value. Machine learning models with stacking method were also constructed and compared to logistic model. RESULTS A total of 1875 patients with AMI were enrolled in this study, with a heart failure rate of 5.1% during hospitalization. The independent risk factors for heart failure were age, heart rate, systolic blood pressure, troponin T, left ventricular ejection fraction and pro-brain natriuretic peptide levels. The area under the curve (AUC) of the model in modeling group and validation group were 0.829 and 0.846, respectively. The calibration curve showed high prediction accuracy and the DCA curve showed good clinical value. The AUC value of the ensemble model by the stacking method in the validation group were 0.821, comparable to logistic prediction model. CONCLUSIONS This model, combining laboratory and clinical factors, has good efficacy in predicting heart failure during hospitalization in AMI patients.
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Affiliation(s)
- Shengyue Chen
- Author affiliations Dalian Medical University, Dalian, Liaoning, China
| | - Xinling Pan
- Author affiliations Department of Biomedical Sciences Laboratory, Wenzhou Medical University Affiliated Dongyang Hospital, Dongyang, Zhejiang, China
| | - Jiahang Mo
- Author affiliations Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China
| | - Bin Wang
- Author affiliations Department of Hepatobiliary Surgery, Wenzhou Medical University Affiliated Dongyang Hospital, Dongyang, Zhejiang, China.
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Kobalava Z, Kvasnikov B, Burtsev Y. Effectiveness and Tolerability of Bisoprolol/Perindopril Single-Pill Combination in Patients with Arterial Hypertension and a History of Myocardial Infarction: The PRIDE Observational Study. Adv Ther 2023; 40:2725-2740. [PMID: 37029871 PMCID: PMC10220120 DOI: 10.1007/s12325-023-02462-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 02/13/2023] [Indexed: 04/09/2023]
Abstract
INTRODUCTION This study assessed the real-life effectiveness of a single-pill combination (SPC) of bisoprolol/perindopril for controlling blood pressure (BP) and symptoms of angina in patients with hypertension and a history of myocardial infarction (MI). METHODS Eligible patients with arterial hypertension and a history of MI were aged 18-79 years and had initiated bisoprolol/perindopril SPC within 3 months of study enrollment as part of routine Russian clinical practice. The primary endpoint was mean change in systolic and diastolic BP (SBP/DBP) at week 12 compared with baseline (data collected retrospectively). Secondary endpoints were assessed at weeks 4 and 12 and included mean change in resting heart rate (HR), proportion of patients reaching target level of resting HR, antianginal effectiveness of the SPC, and proportion of patients reaching target BP levels. RESULTS A total of 504 patients were enrolled, of whom 481 comprised the full analysis set (mean age 61.4 ± 8.9 years, 68% men). Mean baseline SBP/DBP and HR values were 148.9 ± 16.8/87.7 ± 11.0 mmHg and 77.4 ± 10.5 bpm, respectively. Mean durations of hypertension and CAD were 12.8 ± 8.4 and 6.1 ± 6.3 years, respectively, and time since MI was 3.8 ± 5.3 years. At week 12, SBP/DBP had decreased by 24.9/12.2 mmHg (P < 0.001 vs baseline). Target BP (< 140/90 mmHg) was achieved by 69.8% and 95.9% of patients at weeks 4 and 12, respectively, and target HR (55-60 bpm) by 17.3% and 34.5% at weeks 4 and 12 versus 3.1% at baseline (P < 0.001). Reductions in angina attacks, nitrate consumption, and improvements in HR were statistically significant. Treatment was well tolerated. CONCLUSION Treatment of symptomatic patients with CAD, hypertension, and a history of MI with a bisoprolol/perindopril SPC was associated with significant decreases in SBP/DBP and a high proportion of patients achieving BP treatment goals. This was accompanied by improvements in angina symptoms and reductions in HR in a broad patient population representative of those seen in everyday clinical practice. TRIAL REGISTRATION ClinicalTrials.gov Identifier NCT04656847.
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Affiliation(s)
| | - Boris Kvasnikov
- Department of Medical Affairs, Servier Russia, Moscow, Russia
| | - Yuriy Burtsev
- Department of Medical Affairs, Servier Russia, Moscow, Russia
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Chen Z, Pan W, Cao J, Dai X, Lin W, Chen H, Yi K, Yu M. Admission Heart Rate and Mortality in Critically Ill Patients with Acute Aortic Dissection. Int Heart J 2023; 64:44-52. [PMID: 36725077 DOI: 10.1536/ihj.22-346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
The association between admission heart rate (HR) and the mortality of critically ill patients with acute aortic dissection (AAD) remains unclear.The data were extracted from the Medical Information Mart for Intensive Care (MIMIC-III) database. Cox regression models and Kaplan-Meier (KM) survival curve were used to explore the association between admission HR and 90-day, 1-year, and 3-year mortality in patients with AAD. Sensitivity analyses were conducted to assess potential bias.A total of 374 eligible AAD patients were included and divided in 4 groups according to admission HR (HR ≤ 70, 71-80, 81-90, and > 90 beats per minute (bpm) ). The patients with AAD in the group with HR > 90 bpm had higher 90-day, 1-year, and 3-year mortality than those in the groups with HR ≤ 70, 71-80, and 81-90 bpm. After adjusting for age, sex, BMI, systolic blood pressure, diastolic blood pressure, SOFA score, SAPSII score, Stanford type, hypertension, coronary artery disease, liver disease, atrial fibrillation, valvular disease, intensive care unit mechanical ventilation, aortic surgery, and thoracic endovascular aortic repair, patients with admission HR > 90 bpm had a higher risk of 90-day, 1-year, and 3-year mortality [adjusted hazard ratio, 95% confidence interval, 5.14 (2.22-11.91) P < 0.001; 4.31 (2.10-8.84) P < 0.001; 3.01 (1.66-5.46) P < 0.001] than those with HR 81-90 bpm. The 90-day, 1-year, and 3-year mortality were similar among the groups with HR ≤ 70, 71-80, and 81-90 bpm.Admission HR > 90 bpm was independently associated with all-cause mortality in critically ill AAD patients, either type A or B aortic dissection.
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Affiliation(s)
- Zeliang Chen
- Department of Cardiology, The First Affiliated Hospital, Shantou University Medical College
- Department of Cardiology, Jieyang People's Hospital
| | - Wei Pan
- Department of Cardiology, Jieyang People's Hospital
- Department of Gynecologic Oncology, The Cancer Hospital of Shantou University Medical College
| | - Jing Cao
- Department of Cardiology, The First Affiliated Hospital, Shantou University Medical College
| | - Xiaoqing Dai
- Department of Cardiology, The First Affiliated Hospital, Shantou University Medical College
| | - Wan Lin
- Department of Cardiology, The First Affiliated Hospital, Shantou University Medical College
| | - Hongjuan Chen
- Department of Cardiology, The First Affiliated Hospital of Henan University of Science and Technology
| | - Kaihong Yi
- Department of Cardiology, The First Affiliated Hospital, Shantou University Medical College
| | - Min Yu
- Department of Cardiology, The First Affiliated Hospital, Shantou University Medical College
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Khan MS, Shahid I, Greene SJ, Mentz RJ, DeVore AD, Butler J. Mechanisms of current therapeutic strategies for heart failure: more questions than answers? Cardiovasc Res 2023; 118:3467-3481. [PMID: 36536991 DOI: 10.1093/cvr/cvac187] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 10/19/2022] [Accepted: 10/21/2022] [Indexed: 12/24/2022] Open
Abstract
Heart failure (HF) is a complex, multifactorial and heterogeneous syndrome with substantial mortality and morbidity. Over the last few decades, numerous attempts have been made to develop targeted therapies that may attenuate the known pathophysiological pathways responsible for causing the progression of HF. However, therapies developed with this objective have sometimes failed to show benefit. The pathophysiological construct of HF with numerous aetiologies suggests that interventions with broad mechanisms of action which simultaneously target more than one pathway maybe more effective in improving the outcomes of patients with HF. Indeed, current therapeutics with clinical benefits in HF have targeted a wider range of intermediate phenotypes. Despite extensive scientific breakthroughs in HF research recently, questions persist regarding the ideal therapeutic targets which may help achieve maximum benefit. In this review, we evaluate the mechanism of action of current therapeutic strategies, the pathophysiological pathways they target and highlight remaining knowledge gaps regarding the mode of action of these interventions.
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Affiliation(s)
- Muhammad Shahzeb Khan
- From the Division of Cardiology, Duke University School of Medicine, Durham, NC, USA
| | - Izza Shahid
- Division of Cardiovascular Prevention, Houston Methodist Academic Institute, Houston, TX, USA
| | - Stephen J Greene
- From the Division of Cardiology, Duke University School of Medicine, Durham, NC, USA.,Duke Clinical Research Institute, Durham, NC, USA
| | - Robert J Mentz
- From the Division of Cardiology, Duke University School of Medicine, Durham, NC, USA.,Duke Clinical Research Institute, Durham, NC, USA
| | - Adam D DeVore
- From the Division of Cardiology, Duke University School of Medicine, Durham, NC, USA.,Duke Clinical Research Institute, Durham, NC, USA
| | - Javed Butler
- Baylor Scott and White Research Institute, Baylor University Medical Center, 3434 Live Oak St Ste 501, Dallas 75204, TX, USA
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11
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Chen D, Sandler DP, Keil AP, Heiss G, Whitsel EA, Pratt GC, Stewart PA, Stenzel MR, Groth CP, Banerjee S, Huynh TB, Edwards JK, Jackson WB, Engeda J, Kwok RK, Werder EJ, Lawrence KG, Engel LS. Fine particulate matter and incident coronary heart disease events up to 10 years of follow-up among Deepwater Horizon oil spill workers. ENVIRONMENTAL RESEARCH 2023; 217:114841. [PMID: 36403648 PMCID: PMC9825646 DOI: 10.1016/j.envres.2022.114841] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 11/05/2022] [Accepted: 11/15/2022] [Indexed: 05/31/2023]
Abstract
BACKGROUND During the 2010 Deepwater Horizon (DWH) disaster, in-situ burning and flaring were conducted to remove oil from the water. Workers near combustion sites were potentially exposed to burning-related fine particulate matter (PM2.5). Exposure to PM2.5 has been linked to increased risk of coronary heart disease (CHD), but no study has examined the relationship among oil spill workers. OBJECTIVES To investigate the association between estimated PM2.5 from burning/flaring of oil/gas and CHD risk among the DWH oil spill workers. METHODS We included workers who participated in response and cleanup activities on the water during the DWH disaster (N = 9091). PM2.5 exposures were estimated using a job-exposure matrix that linked modelled PM2.5 concentrations to detailed DWH spill work histories provided by participants. We ascertained CHD events as the first self-reported physician-diagnosed CHD or a fatal CHD event that occurred after each worker's last day of burning exposure. We estimated hazard ratios (HR) and 95% confidence intervals (95%CI) for the associations between categories of average or cumulative daily maximum PM2.5 exposure (versus a referent category of water workers not near controlled burning) and subsequent CHD. We assessed exposure-response trends by examining continuous exposure parameters in models. RESULTS We observed increased CHD hazard among workers with higher levels of average daily maximum exposure (low vs. referent: HR = 1.26, 95% CI: 0.93, 1.70; high vs. referent: HR = 2.11, 95% CI: 1.08, 4.12; per 10 μg/m3 increase: HR = 1.10, 95% CI: 1.02, 1.19). We also observed suggestively elevated HRs among workers with higher cumulative daily maximum exposure (low vs. referent: HR = 1.19, 95% CI: 0.68, 2.08; medium vs. referent: HR = 1.38, 95% CI: 0.88, 2.16; high vs. referent: HR = 1.44, 95% CI: 0.96, 2.14; per 100 μg/m3-d increase: HR = 1.03, 95% CI: 1.00, 1.05). CONCLUSIONS Among oil spill workers, exposure to PM2.5 from flaring/burning of oil/gas was associated with increased risk of CHD.
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Affiliation(s)
- Dazhe Chen
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA.
| | - Dale P Sandler
- Epidemiology Branch, National Institute of Environmental Health Sciences, Research Triangle Park, NC, USA
| | - Alexander P Keil
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Gerardo Heiss
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Eric A Whitsel
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA; Department of Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Gregory C Pratt
- Division of Environmental Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | | | - Mark R Stenzel
- Exposure Assessment Applications, LLC, Arlington, VA, USA
| | - Caroline P Groth
- Department of Epidemiology and Biostatistics, School of Public Health, West Virginia University, Morgantown, WV, USA
| | - Sudipto Banerjee
- Department of Biostatistics, Fielding School of Public Health, University of California - Los Angeles, Los Angeles, CA, USA
| | - Tran B Huynh
- Department of Environmental and Occupational Health, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Jessie K Edwards
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - W Braxton Jackson
- Social & Scientific Systems, Inc, a DLH Holdings Company, Durham, NC, USA
| | - Joseph Engeda
- Social & Scientific Systems, Inc, a DLH Holdings Company, Durham, NC, USA
| | - Richard K Kwok
- Epidemiology Branch, National Institute of Environmental Health Sciences, Research Triangle Park, NC, USA; Office of the Director, National Institute of Environmental Health Sciences, Bethesda, MD, USA
| | - Emily J Werder
- Epidemiology Branch, National Institute of Environmental Health Sciences, Research Triangle Park, NC, USA
| | - Kaitlyn G Lawrence
- Epidemiology Branch, National Institute of Environmental Health Sciences, Research Triangle Park, NC, USA
| | - Lawrence S Engel
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA; Epidemiology Branch, National Institute of Environmental Health Sciences, Research Triangle Park, NC, USA.
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12
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Mohan JC, Sathyamurthy I, Panja M, Agarwala R, Ponde CK, Kumar AS, Mahala BK, Kolapkar V, Kumar RVL, Patel K. Expert Consensus on Ivabradine-based Therapy for Heart Rate Management in Chronic Coronary Syndrome and Heart Failure with Reduced Ejection Fraction in India. Curr Cardiol Rev 2023; 19:97-106. [PMID: 36941812 PMCID: PMC10518888 DOI: 10.2174/1573403x19666230320105623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 01/10/2023] [Accepted: 01/10/2023] [Indexed: 03/23/2023] Open
Abstract
Heart rate is an important indicator of health and disease and the modulation of heart rate can help to improve cardiovascular outcomes. Besides β-blockers, Ivabradine is a wellestablished heart rate modulating drug that reduces heart rate without any hemodynamic effects. This consensus document was developed with the help of expert opinions from cardiologists across India on effective heart rate management in routine clinical practice and choosing an appropriate Ivabradine-based therapy considering the available scientific data and guideline recommendations. Based on the discussion during the meetings, increased heart rate was recognized as a significant predictor of adverse cardiovascular outcomes among patients with chronic coronary syndromes and heart failure with reduced ejection fraction making heart rate modulation important in these subsets. Ivabradine is indicated in the management of chronic coronary syndromes and heart failure with reduced ejection fraction for patients in whom heart rate targets cannot be achieved despite guideline-directed β-blocker dosing or having contraindication/intolerance to β-blockers. A prolonged release once-daily dosage of Ivabradine can be considered in patients already stabilized on Ivabradine twice-daily. Ivabradine/β-blocker fixed-dose combination can also be considered to reduce pill burden. Two consensus algorithms have been developed for further guidance on the appropriate usage of Ivabradine-based therapies. Ivabradine and β-blockers can provide more pronounced clinical improvement in most chronic coronary syndromes and heart failure with reduced ejection fraction patients with a fixed-dose combination providing an opportunity to improve adherence.
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Affiliation(s)
- J C Mohan
- Head of Department & Senior Consultant Cardiology, Jaipur Golden Hospital, Delhi, India
| | - I Sathyamurthy
- Senior Interventional Cardiologist, Apollo Hospitals, Chennai, India
| | - Monotosh Panja
- Senior Interventional Cardiologist, AMRI Hospitals, Kolkata, India
| | - Rajeev Agarwala
- Head of Department and Consultant Cardiologist, Jaswant Rai Speciality Hospital, Meerut, India
| | - C K Ponde
- Head of Department and Consultant Cardiologist, P. D. Hinduja National Hospital & Medical Research Centre, Mumbai, India
| | - A Sreenivas Kumar
- Director Cardiology & Clinical Research, Apollo Health City, Hyderabad, India; Apollo Hospitals, Hyderabad, India
| | - Bijay Kumar Mahala
- Senior Consultant Cardiology, Narayana Institute of Cardiac Sciences, Bangalore, India
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Sebastian S, Weinstein LS, Ludwig A, Munroe P, Tinker A. Slowing Heart Rate Protects Against Pathological Cardiac Hypertrophy. FUNCTION 2022; 4:zqac055. [PMID: 36540889 PMCID: PMC9761894 DOI: 10.1093/function/zqac055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 10/27/2022] [Indexed: 12/23/2022] Open
Abstract
We aimed to determine the pathophysiological impact of heart rate (HR) slowing on cardiac function. We have recently developed a murine model in which it is possible to conditionally delete the stimulatory heterotrimeric G-protein (Gαs) in the sinoatrial (SA) node after the addition of tamoxifen using cre-loxP technology. The addition of tamoxifen leads to bradycardia. We used this approach to examine the physiological and pathophysiological effects of HR slowing. We first looked at the impact on exercise performance by running the mice on a treadmill. After the addition of tamoxifen, mice with conditional deletion of Gαs in the SA node ran a shorter distance at a slower speed. Littermate controls preserved their exercise capacity after tamoxifen. Results consistent with impaired cardiac capacity in the mutants were also obtained with a dobutamine echocardiographic stress test. We then examined if HR reduction influenced pathological cardiac hypertrophy using two models: ligation of the left anterior descending coronary artery for myocardial infarction and abdominal aortic banding for hypertensive heart disease. In littermate controls, both procedures resulted in cardiac hypertrophy. However, induction of HR reduction prior to surgical intervention significantly ameliorated the hypertrophy. In order to assess potential protein kinase pathways that may be activated in the left ventricle by relative bradycardia, we used a phospho-antibody array and this revealed selective activation of phosphoinositide-3 kinase. In conclusion, HR reduction protects against pathological cardiac hypertrophy but limits physiological exercise capacity.
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Affiliation(s)
- Sonia Sebastian
- William Harvey Heart Centre, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK
| | - Lee S Weinstein
- Metabolic Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases/National Institutes of Health, Building 10, Room 8C101, Bethesda, MD 20892-1752, USA
| | - Andreas Ludwig
- Institut fuer Experimentelle und Klinische Pharmakologie und Toxikologie, Universitaet Erlangen-Nuernberg, Fahrstr. 17, 91054 Erlangen, Germany
| | - Patricia Munroe
- William Harvey Heart Centre, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK
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Nedoshivin A, Petrova PTS, Karpov Y. Efficacy and Safety of Ivabradine in Combination with Beta-Blockers in Patients with Stable Angina Pectoris: A Systematic Review and Meta-analysis. Adv Ther 2022; 39:4189-4204. [PMID: 35842897 PMCID: PMC9402524 DOI: 10.1007/s12325-022-02222-1] [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] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 06/13/2022] [Indexed: 01/09/2023]
Abstract
INTRODUCTION Beta-blockers are recommended by the European Society of Cardiology as first-line antianginal therapy for reducing heart rate (HR) and symptoms in patients with chronic coronary syndrome, despite a lack of data showing superiority to other antianginal agents. Most patients with angina pectoris require combination therapy to manage symptoms, with a second-line agent chosen to manage the predominant cardiovascular problem. Ivabradine, a selective sinus node If channel inhibitor shown to reduce HR and protect against anginal symptoms, has previously demonstrated noninferior anti-ischaemic and antianginal efficacy to beta-blockers. METHODS This systematic review and meta-analysis assessed the efficacy and safety of ivabradine in patients with stable angina pectoris who remained symptomatic despite receiving beta-blockers. Keyword searches of PubMed, The Cochrane Central Library Register, ClinicalTrials.gov, The World Health Organization International Clinical Trials Registry Platform (ICTRP) and Google Scholar identified studies comparing ivabradine plus beta-blockers with placebo or other first- or second-line antianginal agents in patients with stable angina pectoris. No date limits or language restrictions were applied. Outcomes were evaluated after 1 and 4 months of treatment, including changes in HR, angina attacks, use of short-acting nitrates, quality of life and safety. Risk of bias was evaluated on the basis of recommendations of the Cochrane Handbook for Systematic Reviews of Interventions. RESULTS Seven relevant studies were identified (N = 6821). Ivabradine plus a beta-blocker consistently reduced HR, anginal symptoms and short-acting nitrate consumption within 1 month of initiating therapy, with continued reductions for up to 4 months. Furthermore, ivabradine plus beta-blocker therapy was well tolerated, with bradycardia rarely reported (0.1% of patients overall). This study is limited by the inclusion of only two randomised studies, which may lead to result interpretation bias. CONCLUSIONS Ivabradine may be valuable for tailoring early antianginal treatment when used in combination with beta-blockers for chronic stable angina inadequately controlled by beta-blockers.
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Affiliation(s)
- Alexander Nedoshivin
- Chair of Internal Medicine, Almazov National Medical Research Centre, Akkuratova Str., 2, St Petersburg, Russian Federation.
| | | | - Yuri Karpov
- Angiology Department, National Medical Research Centre of Cardiology, Moscow, Russian Federation
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15
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Li J, Tian Z, Qi S, Zhang J, Li L, Pan J. Cardiovascular Response of Aged Outpatients With Systemic Diseases During Tooth Extraction: A Single-Center Retrospective Observational Study. Front Public Health 2022; 10:938609. [PMID: 35928496 PMCID: PMC9344048 DOI: 10.3389/fpubh.2022.938609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Accepted: 06/20/2022] [Indexed: 11/20/2022] Open
Abstract
Background Aged people are maintaining many natural teeth due to improved oral health. However, compromised general health and poor oral hygiene habits at earlier ages resulted in poor status of preserved teeth. Therefore, tooth extraction is required in many aged people. More knowledge is needed because there are many risk factors during the surgery in frail aged adults. The aim of this study was to evaluate the cardiovascular response of such a population during tooth extraction and analyze risk factors to provide clinical guidance. Methods A retrospective study was performed on aged patients with systemic diseases who underwent tooth extraction. Data regarding demographic profiles and cardiovascular parameters of heart rate and blood pressure were collected preoperative, when local anesthesia was administered, at the beginning of tooth extraction, 5 min after tooth extraction, and postoperative. The effects of risk factors, including age, sex, and systemic diseases on these parameters were analyzed with a multilevel model. Results Heart rate (HR), systolic blood pressure (SBP), and diastolic blood pressure (DBP) of aged patients increased significantly when performing local anesthesia and tooth extraction. During the operation, the older patients (β = 2.011, P = 0.005) and the diabetics (β = 3.902, P < 0.0001) were associated with higher SBP, while those with more tooth extractions exhibited higher HR (β = 0.893, P = 0.007). Women patients showed both significantly elevated HR (β = 1.687, P < 0.0001) and SBP (β = 2.268, P < 0.0001). However, for coronary artery disease patients, HR (β = −2.747, P < 0.0001) and blood pressure [SBP (β = −4.094, P < 0.0001) and DBP (β = −0.87, P = 0.016)] were markedly lower than those of patients without a diagnosis of coronary artery disease. Conclusion Cardiovascular response of aged outpatients with systemic diseases during tooth extraction is quite significant. Age, sex, systemic diseases, and the number of tooth extraction could be risk factors closely associated with cardiovascular response. The findings might provide safety guidance for dentists on tooth extraction in this population.
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Affiliation(s)
- Jinjin Li
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, China
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, Department of Head and Neck Oncology, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Zhiyan Tian
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Shuqun Qi
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Jiankang Zhang
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Longjiang Li
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, Department of Head and Neck Oncology, West China Hospital of Stomatology, Sichuan University, Chengdu, China
- *Correspondence: Longjiang Li
| | - Jian Pan
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, China
- Jian Pan
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16
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Yang Z, Liu P, Luo F, Liu Y, Lai J, Cheng C, Liu Q. Risk Factors and Heart Rate Variability Associated with Left Ventricular Enlargement in Patients with Frequent Premature Ventricular Contractions. Cardiology 2022; 147:421-435. [PMID: 35551378 DOI: 10.1159/000524985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 05/07/2022] [Indexed: 12/29/2022]
Abstract
INTRODUCTION Premature ventricular contractions (PVCs) were now well recognized to carry the risk of inducing left ventricular (LV) enlargement and were closely related to the cardiac autonomic nervous activity quantified by heart rate variability (HRV) analysis. However, the relationship between LV enlargement and HRV in patients with frequent PVCs is still unclear. This study aimed to investigate the risk factors and HRV for LV enlargement in patients with frequent PVCs. METHODS Patients with frequent PVCs (n = 571), whose PVC burden counts >10,000/24 h or PVC burden >10%, were recruited. Patients were divided into LV enlargement group (n = 161), defined as female left ventricular end-diastolic diameter (LVEDD) >49.8 mm or male LVEDD >54.2 mm, and LV normal group (n = 410). Two groups were compared on their clinical, electrocardiographic, and HRV parameters. Logistic regression analysis was used to predict the risk factors of LV enlargement in patients with frequent PVCs. The parameters of echocardiography, Holter monitoring, and HRV were collected after ablation. RESULTS There were significant differences between the patients with left enlargement and with normal LV structure, in terms of sex, left ventricular ejection fraction (LVEF), level of N-terminal pro-brain natriuretic peptide (NT-proBNP), 24-h PVC burden, with nonsustained ventricular tachycardia, multifocal PVCs, QRS duration of PVC, and values of very low-frequency power of HRV parameter (all p < 0.05). Multivariate analysis showed that female gender (odds ratio [OR] = 2.753, p < 0.001), increased NT-proBNP (OR = 1.011, p = 0.022), increased LVEF (OR = 0.292, p < 0.001), increased 24-h PVC burden (OR = 1.594, p < 0.001), increased standard deviation of all NN intervals (SDNN) (OR = 1.100, p = 0.003), increased the proportion of consecutive NN intervals that differ by more than 50 ms (pNN50) (OR = 0.844, p = 0.026) were predictors for LV enlargement in patients with frequent PVCs. 84.4% (54/64) of patients with LV enlargement at baseline had normalized their LV structure after ablation. The values of SDNN, standard deviation of the averages of NN intervals in all 5-min segments, the square root of the mean of the sum of the squares of differences between adjacent NN intervals, pNN50, low-frequency power (LF), LF/high-frequency power ratio of patients were significantly decreased after ablation (all p < 0.05). CONCLUSION Female gender, increased level of NT-proBNP, lower LVEF, higher PVC burden, increased sympathetic parameters SDNN, and reduced parasympathetic parameters pNN50 were the independent risk factors of LV enlargement in patients with frequent PVCs. LV enlargement induced by PVCs can be reversible after PVC elimination by ablation. The activities of sympathetic and parasympathetic were reduced after ablation.
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Affiliation(s)
- Zhenyu Yang
- Department of Cardiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ping Liu
- Department of Cardiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Feifei Luo
- Department of Cardiology, Wuhan Fourth Hospital, Puai Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yiwen Liu
- Department of Cardiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jinsheng Lai
- Department of Cardiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Chongsheng Cheng
- Department of Pulmonary and Critical Care Medicine, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Qigong Liu
- Department of Cardiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Moyehodie YA, Muluneh MW, Belay AT, Fenta SM. Time to Death and Its Determinant Factors Among Patients With Chronic Heart Failure in Northwest Ethiopia: A Retrospective Study at Selected Referral Hospitals. Front Cardiovasc Med 2022; 9:817074. [PMID: 35600464 PMCID: PMC9120604 DOI: 10.3389/fcvm.2022.817074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 03/21/2022] [Indexed: 11/25/2022] Open
Abstract
Background Heart failure (HF) is a major health problem that affects patients and healthcare systems worldwide. It is the leading cause of morbidity and death and negatively impacts the quality of life, healthcare costs, and longevity. However, the causes of death were not well defined. This study aimed to identify the determinants of death among patients with HF in the Amhara Region, Northwest Ethiopia. Methods A multicenter retrospective cohort study was conducted on 285 patients in the age group 15 years or older under follow-up from 1 January 2015 to 31 December 2019. Descriptive analyses were summarized using the Kaplan–Meier survival curve and the log-rank test. Then, the Cox-proportional hazard regression model was employed to estimate the hazard of death up to 5 years after they were admitted to the HF department to follow up on their treatment. Results Out of 285 patients with HF, 93(32.6%) of the respondents were dying within 5 years of follow-up. Anemia was the common comorbid disease (30.5%), and valvular heart disease was the most common etiology (33.7%) of chronic heart failure in this study. This study showed a significant mortality difference between hospitals. HF patients with hypertension [adjusted hazard ratio (AHR): 3.5076, 95% confidence interval (CI): 1.43, 8.60], anemia (AHR: 2.85, 95% 1.61, 5.03), pneumonia (AHR: 2.02, 95% 1.20, 3.39), chronic kidney disease (2.23, CI: 1.31, 3.77), and diabetes mellitus (AHR: 2.42, 95% CI: 1.43, 4.09) were at a higher risk of death. Moreover, patients with symptoms listed in the New York Heart Association Class (III and IV), Ischemic Heart Disease and unknown etiologies, men (AHR: 2.76, 95%:1.59, 4.78), and those with a high pulse rate (AHR: 1.02, 95%:1.00, 1.04) were at a higher risk of death. Conclusion There was a mortality difference between hospitals. This study has revealed that HF patients with anemia, diabetes mellitus, pneumonia, hypertension, chronic kidney disease, HF etiologies, severe New York Heart Association Class (III and IV), men, and high pulse rate were the main factors associated with death. Health professionals could give more attention to patients whose pulse rate is high, men, and a patient who had comorbidities in the ward.
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Li J, Yang Y, Wang H, Ma D, Wang H, Chu L, Zhang Y, Gao Y. Baicalein Ameliorates Myocardial Ischemia Through Reduction of Oxidative Stress, Inflammation and Apoptosis via TLR4/MyD88/MAPK S/NF-κB Pathway and Regulation of Ca 2+ Homeostasis by L-type Ca 2+ Channels. Front Pharmacol 2022; 13:842723. [PMID: 35370644 PMCID: PMC8967179 DOI: 10.3389/fphar.2022.842723] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Accepted: 01/31/2022] [Indexed: 12/12/2022] Open
Abstract
Background: Baicalein (Bai) is the principal ingredient of Scutellaria baicalensis Georgi. Reports concerning the therapeutic advantages in treating cardiovascular diseases have been published. However, its protective mechanism towards myocardial ischemia (MI) is undefined. Objective: The aim of this study was to investigate the protective mechanisms of Bai on mouse and rat models of MI. Methods: Mice were pre-treated with Bai (30 and 60 mg/kg/day) for 7 days followed by subcutaneous injections of isoproterenol (ISO, 85 mg/kg/day) for 2 days to establish the MI model. Electrocardiograms were recorded and serum was used to detect creatine kinase (CK), lactate dehydrogenase (LDH), superoxide dismutase (SOD), catalase (CAT), glutathione (GSH) and malondialdehyde (MDA). Cardiac tissues were used to detect Ca2+ concentration, morphological pathologies, reactive oxygen species (ROS), interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α). In addition, the expression levels of Bcl-2-associated X (Bax), B cell lymphoma-2 (Bcl-2), Caspase-3, Toll-like receptor-4 (TLR4), myeloid differentiation protein 88 (MyD88), nuclear factor-kappa B (NF-κB), p-p38, p-extracellular signal-regulated kinase1/2 (p-ERK1/2) and c-Jun N-terminal kinase (p-JNK) were assessed by western blots in myocardial tissues. The effects of Bai on L-type Ca2+ currents (ICa-L), contractility and Ca2+ transients in rat isolated cardiomyocytes were monitored by using patch clamp technique and IonOptix system. Moreover, ISO-induced H9c2 myocardial injury was used to detect levels of inflammation and apoptosis. Results: Bai caused an improvement in heart rate, ST-segment and heart coefficients. Moreover, Bai led to a reduction in CK, LDH and Ca2+ concentrations and improved morphological pathologies. Bai inhibited ROS generation and reinstated SOD, CAT and GSH activities in addition to inhibition of replenishing MDA content. Also, expressions of IL-6 and TNF-α in addition to Bax and Caspase-3 were suppressed, while Bcl-2 expression was upregulated. Bai inhibited protein expressions of TLR4/MyD88/MAPKS/NF-κB and significantly inhibited ICa-L, myocyte contraction and Ca2+ transients. Furthermore, Bai caused a reduction in inflammation and apoptosis in H9c2 cells. Conclusions: Bai demonstrated ameliorative actions towards MI, which might have been related to attenuation of oxidative stress, inflammation and apoptosis via suppression of TLR4/MyD88/MAPKS/NF-κB pathway and adjustment of Ca2+ homeostasis via L-type Ca2+ channels.
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Affiliation(s)
- Jinghan Li
- School of Basic Medicine, Hebei University of Chinese Medicine, Shijiazhuang, China
| | - Yakun Yang
- School of Pharmacy, Hebei University of Chinese Medicine, Shijiazhuang, China
| | - Hua Wang
- School of Basic Medicine, Hebei University of Chinese Medicine, Shijiazhuang, China
| | - Donglai Ma
- School of Pharmacy, Hebei University of Chinese Medicine, Shijiazhuang, China
| | - Hongfang Wang
- School of Pharmacy, Hebei University of Chinese Medicine, Shijiazhuang, China
| | - Li Chu
- School of Pharmacy, Hebei University of Chinese Medicine, Shijiazhuang, China.,Hebei Key Laboratory of Integrative Medicine on Liver-Kidney Patterns, Hebei University of Chinese Medicine, Shijiazhuang, China
| | - Yuanyuan Zhang
- School of Pharmacy, Hebei University of Chinese Medicine, Shijiazhuang, China
| | - Yonggang Gao
- School of Basic Medicine, Hebei University of Chinese Medicine, Shijiazhuang, China
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Chacón-Diaz M, Hernández-Vásquez A, Custodio-Sánchez P. [One-year survival among patients with ST-elevation myocardial infarction in Peru]. ARCHIVOS PERUANOS DE CARDIOLOGIA Y CIRUGIA CARDIOVASCULAR 2022; 3:53-59. [PMID: 37351306 PMCID: PMC10284578 DOI: 10.47487/apcyccv.v3i2.218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 06/30/2022] [Indexed: 06/24/2023]
Abstract
Objectives To determine one-year survival and factors associated with mortality in patients with ST-segment elevation myocardial infarction in Peru. Methods An analysis was made of the cohort of patients included in the PERSTEMI-II registry during the year 2020, in whom survival at one year after the event and its risk factors were evaluated using Kaplan-Meier survival analysis and Cox regression. Results Of 374 patients in the PERSTEMI-II study, 366 (97.9%) completed follow-up up to one year after the event with a survival rate of 85%. Successful reperfusion was related to better survival at 1 year (hazard ratio [HR]=0.30, 95% CI: 0.14-0.62, p=0.001). Age (HR=1.04, 95% CI: 1.01-1.07, p=0.003), chronic kidney disease (HR=2.15, 95% CI: 1.04-4.39, p=0.037) and cardiogenic shock (HR=6.67, 95% CI: 3.72-11.97, p<0.001) were factors of higher mortality at 1-year follow-up. Conclusion The PERSTEMI-II registry is the first Peruvian registry that provides data on survival after ST-segment elevation myocardial infarction, which is 85% at one year. Successful reperfusion improves survival at one-year post infarction.
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Affiliation(s)
- Manuel Chacón-Diaz
- Universidad Científica del Sur. Lima, Perú.Universidad Científica del SurUniversidad Científica del SurLimaPeru
- Instituto Nacional Cardiovascular INCOR. Lima, Perú.Instituto Nacional Cardiovascular INCORLimaPerú
| | - Akram Hernández-Vásquez
- Centro de Excelencia en Investigaciones Económicas y Sociales en Salud, Vicerrectorado de Investigación, Universidad San Ignacio de Loyola. Lima, Perú.Universidad San Ignacio de LoyolaCentro de Excelencia en Investigaciones Económicas y Sociales en SaludVicerrectorado de InvestigaciónUniversidad San Ignacio de LoyolaLimaPeru
| | - Piero Custodio-Sánchez
- Hospital Nacional Almanzor Aguinaga Asenjo, Essalud. Chiclayo, Perú.Hospital Nacional Almanzor Aguinaga Asenjo, EssaludChiclayoPerú
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20
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Ma R, Gao J, Mao S, Wang Z. Association between heart rate and cardiovascular death in patients with coronary heart disease: A NHANES-based cohort study. Clin Cardiol 2022; 45:574-582. [PMID: 35352385 PMCID: PMC9045079 DOI: 10.1002/clc.23818] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 03/08/2022] [Accepted: 03/11/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Due to the lack of research, this study aimed to assess the association between the specific range of heart rate and cardiovascular (CV) death in coronary heart disease (CHD) patients. HYPOTHESIS Heart rate of 70-79 bpm may be associated with reduced risk of CV death in CHD patients. METHODS This retrospective cohort study collected the data of CHD patients from the eight cycles of the Health and Nutrition Examination Survey (NHANES). The included patients were divided into four groups: <60, 60-69, 70-79, and ≥80 bpm. The start of follow-up date was the mobile examination center date, the last follow-up date was December 31, 2015. The average follow-up time was 81.70 months, and the longest follow-up time was 200 months. Competing risk models were developed to evaluate the association between heart rate and CV death, with hazard ratios (HRs) and 95% confidence intervals (CIs) calculated. RESULTS A total of 1648 patients with CHD were included in this study. CHD patients at heart rate of <60 (HR, 1.35; 95% CI, 1.34-1.36), 60-69 (HR, 1.05; 95% CI, 1.04-1.06) or ≥80 (HR, 1.39; 95% CI, 1.38-1.41) bpm had a higher risk of CV death than those at heart rate of 70-79 bpm. CONCLUSIONS Heart rate of <70 or ≥80 bpm was associated with an elevated risk of CV death among CHD patients. Continuous monitoring of heart rate may help to screen for health risks and offer early interventions to corresponding patients.
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Affiliation(s)
- Ruicong Ma
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Jianbo Gao
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Shiyuan Mao
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Zhirong Wang
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
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21
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Tan J, Yang M, Wang H, Shen C, Wu M, Xu H, Wu Y, Li Y, Li X, Huang T, Deng S, Yang Z, Gao S, Li H, Zhou J, Chen H, Cao N, Cai W. Moderate heart rate reduction promotes cardiac regeneration through stimulation of the metabolic pattern switch. Cell Rep 2022; 38:110468. [PMID: 35263588 DOI: 10.1016/j.celrep.2022.110468] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 12/19/2021] [Accepted: 02/10/2022] [Indexed: 01/07/2023] Open
Abstract
As a biological pump, the heart needs to consume a substantial amount of energy to maintain sustained beating. Myocardial energy metabolism was recently reported to be related to the loss of proliferative capacity in cardiomyocytes (CMs). However, the intrinsic relationship between beating rate and proliferation in CMs and whether energy metabolism can regulate this relationship remains unclear. In this study, we find that moderate heart rate reduction (HRR) induces CM proliferation under physiological conditions and promotes cardiac regenerative repair after myocardial injury. Mechanistically, moderate HRR induces G1/S transition and increases the expression of glycolytic enzymes in CMs. Furthermore, moderate HRR induces a metabolic pattern switch, activating glucose metabolism and increasing the relative proportion of ATP production by the glycolytic pathway for biosynthesis of substrates needed for proliferative CMs. These results highlight the potential therapeutic role of HRR in not only acute myocardial protection but also long-term CM restoration.
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Affiliation(s)
- Jing Tan
- Laboratory Animal Center and Department of Biochemistry, Institute of Guangdong Engineering and Technology Research Center for Disease-Model Animals, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou 510080, China
| | - Ming Yang
- Laboratory Animal Center and Department of Biochemistry, Institute of Guangdong Engineering and Technology Research Center for Disease-Model Animals, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou 510080, China
| | - Haiping Wang
- Laboratory Animal Center and Department of Biochemistry, Institute of Guangdong Engineering and Technology Research Center for Disease-Model Animals, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou 510080, China
| | - Conghui Shen
- Laboratory Animal Center and Department of Biochemistry, Institute of Guangdong Engineering and Technology Research Center for Disease-Model Animals, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou 510080, China
| | - Maoxiong Wu
- Department of Cardiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China
| | - He Xu
- Program of Stem Cells and Regenerative Medicine, Zhongshan School of Medicine, Sun Yat-Sen University, Guangdong 510080, China
| | - Yandi Wu
- Laboratory Animal Center and Department of Biochemistry, Institute of Guangdong Engineering and Technology Research Center for Disease-Model Animals, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou 510080, China
| | - Yuanlong Li
- Laboratory Animal Center and Department of Biochemistry, Institute of Guangdong Engineering and Technology Research Center for Disease-Model Animals, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou 510080, China
| | - Xinghui Li
- Laboratory Animal Center and Department of Biochemistry, Institute of Guangdong Engineering and Technology Research Center for Disease-Model Animals, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou 510080, China
| | - Tongsheng Huang
- Laboratory Animal Center and Department of Biochemistry, Institute of Guangdong Engineering and Technology Research Center for Disease-Model Animals, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou 510080, China
| | - Shijie Deng
- Laboratory Animal Center and Department of Biochemistry, Institute of Guangdong Engineering and Technology Research Center for Disease-Model Animals, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou 510080, China
| | - Zhenyu Yang
- Laboratory Animal Center and Department of Biochemistry, Institute of Guangdong Engineering and Technology Research Center for Disease-Model Animals, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou 510080, China
| | - Saifei Gao
- Laboratory Animal Center and Department of Biochemistry, Institute of Guangdong Engineering and Technology Research Center for Disease-Model Animals, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou 510080, China
| | - Hui Li
- Laboratory Animal Center and Department of Biochemistry, Institute of Guangdong Engineering and Technology Research Center for Disease-Model Animals, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou 510080, China
| | - Jiaguo Zhou
- Department of Pharmacology, Cardiac and Cerebrovascular Research Center, Zhongshan School of Medicine, Sun Yat-sen University, Guangdong 510080, China
| | - Hui Chen
- Department of Obstetrics and Gynecology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China.
| | - Nan Cao
- Program of Stem Cells and Regenerative Medicine, Zhongshan School of Medicine, Sun Yat-Sen University, Guangdong 510080, China.
| | - Weibin Cai
- Laboratory Animal Center and Department of Biochemistry, Institute of Guangdong Engineering and Technology Research Center for Disease-Model Animals, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou 510080, China.
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22
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Rimmele DL, Borof K, Jensen M, Behrendt CA, Cheng B, Debus ES, Gerloff C, Thomalla G. Association Between Carotid Atherosclerosis and Atrial Fibrillation, Cardiac, and Renal Function. Eur J Vasc Endovasc Surg 2022; 63:641-647. [DOI: 10.1016/j.ejvs.2022.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 12/20/2021] [Accepted: 01/16/2022] [Indexed: 11/03/2022]
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23
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Ke B, Tan X, Ren L, Fan Y, Zhang Y, Li F, Sun Q, Liu T, Jia L, Wang Y, Du J. Aldosterone dysregulation predicts the risk of mortality and rehospitalization in heart failure with a preserved ejection fraction. SCIENCE CHINA. LIFE SCIENCES 2022; 65:631-642. [PMID: 34258711 DOI: 10.1007/s11427-021-1945-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 05/14/2021] [Indexed: 10/20/2022]
Abstract
Serum aldosterone is associated with cardiac remodeling, which contributes to morbidity and mortality in heart failure (HF); however, the prognostic value of aldosterone in HF with a preserved ejection fraction (HFpEF) is unclear. We used liquid chromatography-tandem mass spectrometry to quantify serum aldosterone in 873 patients with HFpEF in a Registry Study of Biomarkers for HF. The retrospective study was conducted at Beijing Anzhen Hospital from May 2017 to October 2019. The primary endpoint was a composite of all-cause mortality and rehospitalization for HF. Aldosterone concentrations in patients with and without events were 124.22 pmol L-1 (interquartile range (IQR): 48.62-256.20) and 96.33 pmol L-1 (IQR: 37.33-215.76), respectively (P=0.023). Aldosterone independently predicted all-cause mortality (adjusted hazard ratio (aHR), 1.55; 95% confidence interval (95%CI), 1.06-2.27; P=0.024) and the primary endpoint (aHR, 1.43; 95%CI, 1.11-1.85; P=0.006). Patients with high aldosterone concentrations were at higher risk of concentric remodeling (adjusted odds ratio (aOR), 1.45; 95% CI, 1.03-2.04; P=0.034). Patients with high aldosterone and B-type natriuretic peptide concentrations were at a higher risk of the primary endpoint (hazard ratio (HR), 1.85; 95%CI, 1.29-2.66; P=0.001). We conclude that elevated aldosterone is associated with a risk of rehospitalization with HF and all-cause mortality in patients with HFpEF.
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Affiliation(s)
- Bingbing Ke
- Beijing Collaborative Innovation Centre for Cardiovascular Disorders, the Key Laboratory of Remodeling-Related Cardiovascular Disease, Ministry of Education, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, China.,Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, 100029, China
| | - Xin Tan
- Beijing Collaborative Innovation Centre for Cardiovascular Disorders, the Key Laboratory of Remodeling-Related Cardiovascular Disease, Ministry of Education, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, China.,Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, 100029, China
| | - Lu Ren
- Beijing Collaborative Innovation Centre for Cardiovascular Disorders, the Key Laboratory of Remodeling-Related Cardiovascular Disease, Ministry of Education, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, China.,Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, 100029, China
| | - Yangkai Fan
- Beijing Collaborative Innovation Centre for Cardiovascular Disorders, the Key Laboratory of Remodeling-Related Cardiovascular Disease, Ministry of Education, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, China.,Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, 100029, China
| | - Yixin Zhang
- Beijing Collaborative Innovation Centre for Cardiovascular Disorders, the Key Laboratory of Remodeling-Related Cardiovascular Disease, Ministry of Education, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, China.,Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, 100029, China
| | - Fengjuan Li
- Beijing Collaborative Innovation Centre for Cardiovascular Disorders, the Key Laboratory of Remodeling-Related Cardiovascular Disease, Ministry of Education, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, China.,Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, 100029, China
| | - Qiqi Sun
- Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, 100029, China
| | - Tong Liu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, China
| | - Lixin Jia
- Beijing Collaborative Innovation Centre for Cardiovascular Disorders, the Key Laboratory of Remodeling-Related Cardiovascular Disease, Ministry of Education, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, China.,Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, 100029, China.,Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, China
| | - Yuan Wang
- Beijing Collaborative Innovation Centre for Cardiovascular Disorders, the Key Laboratory of Remodeling-Related Cardiovascular Disease, Ministry of Education, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, China. .,Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, 100029, China.
| | - Jie Du
- Beijing Collaborative Innovation Centre for Cardiovascular Disorders, the Key Laboratory of Remodeling-Related Cardiovascular Disease, Ministry of Education, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, China. .,Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, 100029, China.
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24
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Sun N, Chen Y, Xi Y, Wang H, Wang L. Association Between Heart Rate and Major Adverse Cardiovascular Events Among 9,991 Hypertentive Patients: A Multicenter Retrospective Follow-Up Study. Front Cardiovasc Med 2021; 8:741784. [PMID: 34926603 PMCID: PMC8678089 DOI: 10.3389/fcvm.2021.741784] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 11/09/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: To assess the effect of heart rate at baseline on major adverse cardiovascular events (MACEs) among hypertensive patients in China. Methods: A multicenter retrospective study was conducted with a 24 month follow-up period. A total of 10,031 hypertensive patients treated with standard antihypertensive drugs were grouped according to their heart rate before treatment: <65 beats per min (bpm), 65-69 bpm, 70-74 bpm, 75-79 bpm, and ≥80 bpm. The occurrence of any of MACEs was as the endpoint event during the 24 month follow-up period. The effect of heart rate at baseline on MACEs was analyzed using univate and multivariable Cox proportional regression analyses, with hazard ratios (HRs) and 95% confidence intervals (CIs). The restricted cubic spline (RCS) model was used to fit the Cox proportional harzard model with 5 knots at the 5th, 25th, 50th, 75th, and 95th percentiles of heart rate. Results: Totally 9,991 patients were finally enrolled with the mean systolic pressure (SBP)/diastolic pressure (DBP) of 130.59 ± 7.13/77.66 ± 5.99 mmHg at 24 month follow-up. The incidence of MACEs was 4.80% (n = 480). After adjustment for age, gender, baseline blood pressure, alcohol drinking, smoking, hyperlipidemia, diabetes, coronary heart disease, cerebrovascular disease and antihypertensive drug use, patients with heart rate <65 bpm (HR = 1.450, 95% CI: 1.098-1.915) and ≥80 bpm (HR = 1.391, 95% CI: 1.056-11.832) showed 0.45 fold and 0.391 fold increases of MACE risks, compared with patients with heart rate of 70-74 bpm. Furthermore, MACE risks were increased by 86.0% and 65.4% in men, and 59.3% and 69.0% in elderly patients aged ≥65 years at heart rate <65 bpm or ≥80 bpm, respectively. We also found a non-liner U-shaped correlation between heart rate and the occurrence of MACEs. Conclusions: Heart rate might be an independent risk factor for MACEs in hypertensive patients. An appropriate range of heart rate control may offer guidance to hypertension treatment.
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Affiliation(s)
- Ningling Sun
- Department of Hypertension, Heart Center, Peking University People's Hospital, Beijing, China
| | - Yuanyuan Chen
- Department of Hypertension, Heart Center, Peking University People's Hospital, Beijing, China
| | - Yang Xi
- Department of Hypertension, Heart Center, Peking University People's Hospital, Beijing, China
| | - Hongyi Wang
- Department of Hypertension, Heart Center, Peking University People's Hospital, Beijing, China
| | - Luyan Wang
- Department of Hypertension, Heart Center, Peking University People's Hospital, Beijing, China
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25
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Effect of High-Intensity Interval Training on Physical Health in Coronary Artery Disease Patients: A Meta-Analysis of Randomized Controlled Trials. J Cardiovasc Dev Dis 2021; 8:jcdd8110158. [PMID: 34821711 PMCID: PMC8622669 DOI: 10.3390/jcdd8110158] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Revised: 11/10/2021] [Accepted: 11/15/2021] [Indexed: 01/02/2023] Open
Abstract
The effects of exercise-based cardiac rehabilitation (CR) on physical health in coronary artery disease (CAD) patients has long been established, while the optimal exercise mode remains to be determined. This meta-analysis compared the efficacy of high-intensity interval training (HIIT) versus moderate-intensity continuous training (MICT) in CAD patients. Databases were searched up to December 2020. Twenty-five studies with 1272 participants were analyzed. The results showed that both HIIT and MICT induced significant VO2peak improvement with a 4.52 mL/kg/min (p < 0.01) and 2.36 mL/kg/min (p < 0.01), respectively. Additionally, a larger improvement of VO2peak (1.92 mL/kg/min, p < 0.01) was observed in HIIT over MICT. HIIT with medium and long intervals, higher work/rest ratio induced larger VO2peak improvement than the compared subgroup. Interestingly, non-isocaloric exercise protocols induced larger VO2peak improvement compared with isocaloric protocols. In addition, both HIIT and MICT significantly increased anaerobic threshold and peak power with HIIT superior to MICT. No significant different changes were observed in blood pressure after HIIT or MICT intervention, however when HIIT was compared with MICT, MICT seems superior to HIIT in reducing systolic blood pressure (−3.61 mmHg, p < 0.01) and diastolic blood pressure (−2.37 mmHg, p < 0.01). Although, HIIT and MICT induced significant improvement of most other parameters, like HRrest, HRpeak, left ventricular ejection fraction (LVEF), quality of life (QoL), no significant differences were noted between groups. This meta-analysis suggested that HIIT is superior to MICT in increasing VO2peak, anaerobic threshold, peak power in CAD patients. Additionally, the efficacy of HIIT over MICT in improving VO2peaks was influenced by HIIT intervals, work/rest ratio and total caloric consumption. Both HIIT and MICT did not significantly influence resting BP, however, MICT seemed to be more effective in reducing BP than HIIT. HIIT and MICT equally significantly influenced HRrest, HRpeak, HRR1min, OUES, LVEF%, QoL.
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26
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Li W, Li Y, Zhi W, Liu C, Fan W, Miao Q, Gu X. Diagnostic value of using exosome-derived cysteine-rich protein 61 as biomarkers for acute coronary syndrome. Exp Ther Med 2021; 22:1437. [PMID: 34721679 PMCID: PMC8549088 DOI: 10.3892/etm.2021.10872] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 08/05/2021] [Indexed: 12/15/2022] Open
Abstract
Acute coronary syndrome (ACS) is the main manifestation of cardiovascular disease and the primary cause of adult hospitalization in China. There is an urgent demand for novel biomarkers for the diagnosis of ACS. Although plasma cysteine-rich protein 61 (Cyr61) has been previously reported to be accurate for ACS diagnosis, the accuracy of exosomal Cyr61 in ACS diagnosis remains unknown. In the present study, the aim was to assess the potential of applying exosomal Cyr61 in ACS diagnosis and to explore the role of Cyr61 in vascular remodeling in vitro. The abundance of Cyr61 in plasma-derived exosomes from patients with unstable angina pectoris (UAP), acute myocardial infarction (AMI) patients in addition to those isolated from healthy individuals were detected using an ELISA kit. The association between exosomal Cyr61 levels and clinical characteristics of ACS patients was analyzed through χ2 test, Fisher's exact test and Student's t-test. Receiver operating characteristic (ROC) curve analysis was used to determine the accuracy of using exosomal Cyr61 as a biomarker of ACS diagnosis. Furthermore, independent predictors of the existence of ACS were investigated through a multivariate analysis. Subsequently, the role of Cyr61 on vascular remodeling was evaluated in vascular smooth muscle cells (VSMCs) upon oxidized low-density lipoprotein (ox-LDL) treatment by performing Cyr61 knockdown, Cell Counting Kit-8, flow cytometry and Transwell assays. Exosomal Cyr61 expression was found to be significantly elevated in patients with ACS compared with that in healthy individuals. In addition, exosomal Cyr61 levels were associated with sex, family history of ACS and glucose levels. ROC curve analyzes revealed that exosomal Cyr61 expression could be used to differentiate patients with UAP, AMI and ACS from healthy individuals. Furthermore, exosomal Cyr61 levels were independently correlated with the existence of ACS. In vitro, Cyr61 expression was demonstrated to be significantly increased in VSMCs after ox-LDL exposure in a concentration- and time-dependent manner. Functionally, the elevated cell viability and migration of VSMCs induced by ox-LDL were partially but significantly inhibited by Cyr61 knockdown. By contrast, knocking down Cyr61 expression significantly elevated the apoptosis rate of VSMCs compared with that in the ox-LDL-treated group. In conclusion, data from the present study suggest that Cyr61 serve a regulatory role in vascular remodeling in vitro, where exosomal Cyr61 levels may represent a promising biomarker for ACS diagnosis.
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Affiliation(s)
- Wei Li
- Department of Cardiovascular Medicine, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei 050000, P.R. China
| | - Yi Li
- Department of Cardiovascular Medicine, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei 050000, P.R. China
| | - Wei Zhi
- Department of Cardiovascular Medicine, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei 050000, P.R. China
| | - Chen Liu
- Department of Cardiovascular Medicine, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei 050000, P.R. China
| | - Weize Fan
- Department of Cardiovascular Medicine, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei 050000, P.R. China
| | - Qing Miao
- Department of Cardiovascular Medicine, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei 050000, P.R. China
| | - Xinshun Gu
- Department of Cardiovascular Medicine, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei 050000, P.R. China
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Qin S, Huang L, Zhou J, Wang H, Li Q, Wu H, Wu J. Prevalence and Related Risk Factors Associated with Coronary Heart Disease (CHD) Among Middle-Aged and Elderly Patients with Vision Impairment (VI). Int J Gen Med 2021; 14:6125-6133. [PMID: 34611427 PMCID: PMC8485921 DOI: 10.2147/ijgm.s330726] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 09/15/2021] [Indexed: 11/30/2022] Open
Abstract
Purpose To investigate the prevalence and related risk factors associated with coronary heart disease (CHD) among middle-aged and elderly patients with vision impairment (VI). Patients and Methods The study was conducted with 1355 visually impaired adults over 45 years old, recruited from a Rehabilitation Hospital in China. Visual impairment is diagnosed by a doctor according to guidelines. Data were analyzed using multiple correspondence and logistic regression analysis. This research represents an important step towards the development of empirically based practical suggestions for decision-makers and health professionals that support visually impaired middle-aged and elderly people to participate in physical exercise and weight management when needed. Results Of the 1335 middle-aged and elderly adults (mean age ± SD, 63.56 ± 7.74 years; 45.6% male) with VI, a total of 154 (11.5%) developed CHD. In all people with VI, age (OR 1.47; 95% CI 1.16–2.02), hypertension (OR 2.14; 95% CI 1.46–3.14), diabetes (OR 3.79; 95% CI 2.29–6.27), blindness (OR 1.68; 95% CI 1.16–2.43), moderate activity (OR 0.86; 95% CI 0.69–0.98), and HR <60 beats/min (OR 1.43; 95% CI 1.08–2.48) are significantly related to CHD. Statistical analysis based on age grouping indicated that fasting plasma glucose, hypertension, diabetes, blindness, heart rate (<60 beats/min), and moderate activity were shown to have a strong association with development of CHD in age group <65 years (p < 0.05). Conclusion Compared with historical data, poorer vision degree, resting heart rate below 60 beats a minute and low physical activity level are emerging as new and increasing threats to CHD in middle-aged and elderly VI population. Interventions to enhance physical functioning and risk screening may be effective in the prevention of CHD in VI population.
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Affiliation(s)
- Shengmei Qin
- School of Nursing, Shanghai University of Traditional Chinese Medicine, Shanghai, People's Republic of China
| | - Lan Huang
- School of Nursing, Shanghai University of Traditional Chinese Medicine, Shanghai, People's Republic of China
| | - Jie Zhou
- School of Nursing, Shanghai University of Traditional Chinese Medicine, Shanghai, People's Republic of China
| | - Hao Wang
- School of Nursing, Shanghai University of Traditional Chinese Medicine, Shanghai, People's Republic of China
| | - Qi Li
- School of Nursing, Shanghai University of Traditional Chinese Medicine, Shanghai, People's Republic of China
| | - Hengjing Wu
- Clinical Center for Intelligent Rehabilitation Research, Shanghai YangZhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), School of Medicine, Tongji University, Shanghai, People's Republic of China
| | - Jing Wu
- School of Nursing, Shanghai University of Traditional Chinese Medicine, Shanghai, People's Republic of China
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28
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Suciadi LP, Wibawa K, Jessica G, Henrina J, Cahyadi I, Santi BT, Hariadi TK, Tedjasukmana F, Kristanti NM, Pakpahan EF, Manullang RA, Sutandar A. Tachycardia and Pre-existing Chronic Kidney Disease Are Predictors of the Worse Clinical Outcomes in Patients Recently Hospitalized With Acute Heart Failure. Cureus 2021; 13:e15802. [PMID: 34306870 PMCID: PMC8294205 DOI: 10.7759/cureus.15802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/21/2021] [Indexed: 11/12/2022] Open
Abstract
Background: This study aimed to assess the factors contributing to the outcomes of recently hospitalized patients with heart failure (HF). Methods: A prospective data of 76 adults who were admitted due to acute HF between October 1, 2019 and June 30, 2020 at our center were analyzed. Endpoints included survival and rehospitalization within six months after discharge. Results: The mean age was 64.9 ± 13.8 years, with a male preponderance (68.4%). Approximately 60.5% of patients had the left ventricular ejection fraction (LVEF) <40%, whereas 26.3% of patients had LVEF ≥50%. Coronary artery disease (75%), arterial hypertension (72.4%), chronic kidney disease (46.1%), and diabetes mellitus (46.1%) were the most frequent comorbidities. Poor compliance (40.8%) and non-cardiac infection (21.1%) were the common precipitating factors for hospitalization. The majority of subjects had severe symptoms, indicated by the frequent need of intensive care unit (43%), high N-terminal prohormone brain natriuretic peptide levels [NT-proBNP; median, 4765 (1539.7-11782.2) pg/mL], and presence of either atrial fibrillation, severe mitral regurgitation, or significant pulmonary hypertension in approximately one-third of cases. Even though in-hospital mortality was relatively low (2.6%), the all-cause mortality and rehospitalization rates in the next six months after discharge were still high, reaching 22.54% and 19.72%, respectively. Further survival analysis showed that tachycardia on admission and pre-existing chronic kidney disease (CKD) resulted in low six-month survival rates among these patients. Conclusion: After hospital discharge, patients with HF were still exposed to higher risks of death and readmission albeit with the medication addressed. Tachycardia on admission and pre-existing CKD might predict worse outcomes.
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Affiliation(s)
- Leonardo P Suciadi
- Cardiology, Siloam Heart Institute/Siloam Hospitals Kebon Jeruk, Jakarta, IDN
| | | | | | | | | | - Bryany T Santi
- Epidemiology, School of Medicine and Health Sciences Atma Jaya Catholic University of Indonesia, Jakarta, IDN
| | - Titus K Hariadi
- Cardiology, Siloam Heart Institute/Siloam Hospitals Kebon Jeruk, Jakarta, IDN
| | - Firman Tedjasukmana
- Cardiology, Siloam Heart Institute/Siloam Hospitals Kebon Jeruk, Jakarta, IDN
| | | | - Elisa F Pakpahan
- Cardiology, Siloam Heart Institute/Siloam Hospitals Kebon Jeruk, Jakarta, IDN
| | - Reynold A Manullang
- Cardiology, Siloam Heart Institute/Siloam Hospitals Kebon Jeruk, Jakarta, IDN
| | - Antono Sutandar
- Cardiology, Siloam Heart Institute/Siloam Hospitals Kebon Jeruk, Jakarta, IDN
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Patcheva S, Merzel EK, Milanovicc A, Bozicc M, Jug B. Prognostic impact of resting heart rate in patients with peripheral artery disease. Vascular 2021; 30:441-447. [PMID: 34024216 DOI: 10.1177/17085381211013971] [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: 12/24/2022]
Abstract
OBJECTIVES Resting heart rate has been increasingly identified as a marker of cardiovascular risk and has been extensively studied as a predictor of coronary artery disease progression. In peripheral artery disease, the prognostic impact of resting heart rate remains elusive. METHODS Consecutive patients undergoing invasive peripheral procedures were included. Data included resting heart rate determination by averaging manual radial pulse palpation measurements taken 24 h before and after an invasive peripheral procedure. RESULTS A total of 1720 patients were included (mean age 70±11 years, 38% were female, 39% had critical limb ischemia). During a median follow-up of 729 days, 364 (21.2%) patients died. Resting heart rate emerged as an independent predictor of mortality, even after adjusting for clinical characteristics, peripheral artery disease manifestation and anatomic extent, traditional risk factors, co-morbidities, and disease-modifying therapies: hazard ratio for heart rate >75 bpm was 1.010 (95% confidence interval 1.001-1.109), with each bpm increase in resting heart rate conferring a 1.1% increase in the risk of all-cause mortality (95% confidence interval 0.1-10.9%, adjusted p = 0.030). CONCLUSIONS Resting heart rate is an independent predictor of mortality in patients with peripheral artery disease; our findings extend heart rate as a possible marker of prognosis to non-coronary atherosclerotic vascular disease.
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Affiliation(s)
- Simona Patcheva
- Medical Faculty, University of Ljubljana, Ljubljana, Slovenia
| | - Eva K Merzel
- Medical Faculty, University of Ljubljana, Ljubljana, Slovenia
| | | | - Mojca Bozicc
- Medical Faculty, University of Ljubljana, Ljubljana, Slovenia.,Department of Vascular Diseases, University Medical Center Ljubljana, Ljubljana, Slovenia
| | - Borut Jug
- Medical Faculty, University of Ljubljana, Ljubljana, Slovenia.,Department of Vascular Diseases, University Medical Center Ljubljana, Ljubljana, Slovenia
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30
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Izumida T, Imamura T, Ueno Y, Tanaka S, Kataoka N, Nakamura M, Kinugawa K. Impact of optimal heart rate on left ventricular reverse remodeling and functional improvement in patients with systolic heart failure. Heart Vessels 2021; 36:1688-1693. [PMID: 33956182 DOI: 10.1007/s00380-021-01864-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 04/30/2021] [Indexed: 11/25/2022]
Abstract
Heart rate modulation therapy using ivabradine reduces mortality and morbidity in patients with systolic heart failure, whereas too reduced heart rate seems to worsen the clinical outcome. The optimal heart rate during heart rate modulation therapy remains unknown. Consecutive patients with left ventricular ejection fraction < 50% who received echocardiographic assessments and simultaneous heart rate measurements were retrospectively investigated. Theoretically ideal heart rate was calculated using a previously proposed formula: 93 - 0.13 × (deceleration time [msec]). Impacts of heart rate on the 1-year echocardiographic left ventricular reverse remodeling were compared among the three groups stratified by the heart rate status: optimal heart rate group (within 10 bpm of ideal heart rate), below-optimal heart rate group (< 10 bpm of ideal heart rate), and above-optimal heart rate group (> 10 bpm of ideal heart rate). A total of 75 patients (70 years old, 60 men) were included. There were no significant differences in the baseline characteristics among the three groups, except for the higher prevalence of tolvaptan use and higher plasma B-type natriuretic peptide level in the below-optimal heart rate group. Left ventricular end-diastolic diameter (from 55 to 54) and left ventricular ejection fraction (from 39 to 46) improved significantly only in the optimal heart rate group at 1-year follow-up (p < 0.05 for both). Optimal heart rate, which was calculated using a formula consisting of deceleration time, was associated with cardiac reverse remodeling in patients with systolic heart failure. Prospective study to investigate the implication of deceleration time-guided aggressive heart rate optimization is the next concern.
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Affiliation(s)
- Toshihide Izumida
- Second Department of Internal Medicine, University of Toyama, 2630 Sugitani Toyama, Toyama, 930-0194, Japan
| | - Teruhiko Imamura
- Second Department of Internal Medicine, University of Toyama, 2630 Sugitani Toyama, Toyama, 930-0194, Japan.
| | - Yohei Ueno
- Second Department of Internal Medicine, University of Toyama, 2630 Sugitani Toyama, Toyama, 930-0194, Japan
| | - Shuhei Tanaka
- Second Department of Internal Medicine, University of Toyama, 2630 Sugitani Toyama, Toyama, 930-0194, Japan
| | - Naoya Kataoka
- Second Department of Internal Medicine, University of Toyama, 2630 Sugitani Toyama, Toyama, 930-0194, Japan
| | - Makiko Nakamura
- Second Department of Internal Medicine, University of Toyama, 2630 Sugitani Toyama, Toyama, 930-0194, Japan
| | - Koichiro Kinugawa
- Second Department of Internal Medicine, University of Toyama, 2630 Sugitani Toyama, Toyama, 930-0194, Japan
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31
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Wang J, Zhou L, Zhang Y, Zhang H, Xie Y, Chen Z, Huang B, Zeng K, Lei J, Mai J, Pan Y, Chen Y, Wang J, Guo Q. Minimum heart rate and mortality in critically ill myocardial infarction patients: an analysis of the MIMIC-III database. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:496. [PMID: 33850893 PMCID: PMC8039698 DOI: 10.21037/atm-21-992] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Low minimum heart rate (MHR) is common in critically ill myocardial infarction (MI) patients. However, the association between MHR and the mortality of critically ill MI patients remains unclear. Methods In this retrospective cohort study, a total of 2,031 critically ill MI patients were enrolled from the Medical Information Mart for Intensive Care (MIMIC)-III database. Patients were divided into a low MHR group [MHR <60 beats per minute (bpm)] and a high MHR group (MHR ≥60 bpm). A Cox proportional hazard model was used to elucidate the association between these two groups and the mortality of MI patients. The association between mortality and MHR as a continuous variable was analyzed non-parametrically using restricted cubic splines. Sensitivity analyses were conducted to determine the impact of different admission heart rate, hypertension, atrial fibrillation, and vasopressor use on our results. Results MI patients in the low MHR group had higher 30-day and 1-year mortality than those in the high MHR group (20.59% vs. 10.91%, P<0.001 and 29.76% vs. 19.31%, P<0.001, respectively). After adjustment, the low MHR group was significantly correlated with 30-day mortality [hazard ratio, 1.779, 95% confidence interval (CI), 1.400-2.261, P<0.001] and 1-year mortality (hazard ratio, 1.537, 95% CI, 1.272-1.859, P<0.001). This correlation remained remarkable in patients with low or high admission heart rate, with or without hypertension, and with or without atrial fibrillation. An apparent L-curve relationship was observed between the 30-day mortality or 1-year mortality and MHR as a continuous variable. Conclusions MHR under 60 bpm may be associated with a higher risk for both 30-day and 1-year mortality in critically ill MI patients. These findings highlight the possibility of MHR as an early risk indicator and potential therapeutic target for mortality in critically ill MI patients, which warrants further investigation.
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Affiliation(s)
- Junjie Wang
- Department of Cardiology, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Arrhythmia and Electrophysiology, Guangzhou, China
| | - Lingqu Zhou
- Department of Cardiology, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Arrhythmia and Electrophysiology, Guangzhou, China
| | - Yinyin Zhang
- Department of Cardiology, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Arrhythmia and Electrophysiology, Guangzhou, China
| | - Haifeng Zhang
- Department of Cardiology, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Arrhythmia and Electrophysiology, Guangzhou, China
| | - Yong Xie
- Department of Cardiology, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Arrhythmia and Electrophysiology, Guangzhou, China
| | - Zhiteng Chen
- Department of Cardiology, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Arrhythmia and Electrophysiology, Guangzhou, China
| | - Boshui Huang
- Department of Cardiology, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Arrhythmia and Electrophysiology, Guangzhou, China
| | - Kuan Zeng
- Department of Cardiac Surgery, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, China
| | - Juan Lei
- Department of Cardiology, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Arrhythmia and Electrophysiology, Guangzhou, China
| | - Jingting Mai
- Department of Cardiology, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Arrhythmia and Electrophysiology, Guangzhou, China
| | - Yue Pan
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Medical Research Center, Sun Yat-Sen Memorial Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yangxin Chen
- Department of Cardiology, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Arrhythmia and Electrophysiology, Guangzhou, China
| | - Jingfeng Wang
- Department of Cardiology, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Arrhythmia and Electrophysiology, Guangzhou, China
| | - Qi Guo
- Department of Cardiology, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Arrhythmia and Electrophysiology, Guangzhou, China
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Kumar VRS, Choudhary SK, Radhakrishnan PK, Bharath RS, Chandrasekaran N, Sankar V, Sukumaran A, Oommen C. Lopsided Blood-Thinning Drug Increases the Risk of Internal Flow Choking Leading to Shock Wave Generation Causing Asymptomatic Cardiovascular Disease. GLOBAL CHALLENGES (HOBOKEN, NJ) 2021; 5:2000076. [PMID: 33728053 PMCID: PMC7933821 DOI: 10.1002/gch2.202000076] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 11/13/2020] [Indexed: 05/04/2023]
Abstract
The discovery of Sanal flow choking in the cardiovascular-system calls for multidisciplinary and global action to develop innovative treatments and to develop new drugs to negate the risk of asymptomatic-cardiovascular-diseases. Herein, it is shown that when blood-pressure-ratio (BPR) reaches the lower-critical-hemorrhage-index (LCHI) internal-flow-choking and shock wave generation can occur in the cardiovascular-system, with sudden expansion/divergence/vasospasm or bifurcation regions, without prejudice to the percutaneous-coronary-intervention (PCI). Analytical findings reveal that the relatively high and the low blood-viscosity are cardiovascular-risk factors. In vitro studies have shown that nitrogen, oxygen, and carbon dioxide gases are dominant in fresh blood samples of humans/guinea pigs at a temperature range of 98.6-104 F. An in silico study demonstrated the Sanal flow choking phenomenon leading to shock-wave generation and pressure-overshoot in the cardiovascular-system. It has been established that disproportionate blood-thinning treatment increases the risk of the internal-flow-choking due to the enhanced boundary-layer-blockage-factor, resulting from an increase in flow-turbulence level in the cardiovascular-system, caused by an increase in Reynolds number as a consequence of low blood-viscosity. The cardiovascular-risk can be diminished by concurrently lessening the viscosity of biofluid/blood and flow-turbulence by raising the thermal-tolerance-level in terms of blood-heat-capacity-ratio (BHCR) and/or by decreasing the systolic-to-diastolic blood-pressure-ratio.
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Affiliation(s)
- Valsalayam Raghavapanicker Sanal Kumar
- Vikram Sarabhai Space Centre (SC CA No.6301/2013)Indian Space Research OrganisationThiruvananthapuramKerala695022India
- National Centre for Combustion Research and DevelopmentIndian Institute of ScienceBangaloreKarnataka560012India
- Department of Aeronautical EngineeringKumaraguru College of TechnologyCoimbatoreTamil Nadu641049India
| | - Shiv Kumar Choudhary
- Department of Cardiothoracic and Vascular SurgeryAll India Institute of Medical SciencesNew Delhi110029India
| | | | | | - Nichith Chandrasekaran
- National Centre for Combustion Research and DevelopmentIndian Institute of ScienceBangaloreKarnataka560012India
- Department of Aeronautical EngineeringKumaraguru College of TechnologyCoimbatoreTamil Nadu641049India
| | - Vigneshwaran Sankar
- Department of Aeronautical EngineeringKumaraguru College of TechnologyCoimbatoreTamil Nadu641049India
- Department of Aerospace EngineeringIndian Institute of TechnologyKanpurUttar Pradesh208016India
| | - Ajith Sukumaran
- Department of Aeronautical EngineeringKumaraguru College of TechnologyCoimbatoreTamil Nadu641049India
| | - Charlie Oommen
- National Centre for Combustion Research and DevelopmentIndian Institute of ScienceBangaloreKarnataka560012India
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33
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Cong L, Ma W. Early neurological deterioration in cardiogenic cerebral embolism due to nonvalvular atrial fibrillation: Predisposing factors and clinical implications. Brain Behav 2021; 11:e01985. [PMID: 33277821 PMCID: PMC7882173 DOI: 10.1002/brb3.1985] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 11/16/2020] [Accepted: 11/20/2020] [Indexed: 12/15/2022] Open
Abstract
PURPOSE The aim of the study was to investigate factors which may predispose patients to early neurological deterioration (END) and explore peripheral biomarkers for the prediction of END in cardiogenic cerebral embolism (CCE) patients. METHODS Patients diagnosed with CCE within 24 hr of onset between January 2017 and January 2019 were included in this study. END was defined as an increase of ≥2 on the National Institutes of Health Stroke Scale (NIHSS) or the emergence of new neurological symptoms within 3 days of admission. Binary logistic regression was used to investigate the factors associated with END. Receiver operating characteristic (ROC) curves were then generated to determine the predictive value of the potential biomarkers and the optimal cutoff values. RESULTS Of the 129 (male, 55.81%; mean age 71.85 ± 11.99 years) CCE patients, 55 patients with END were identified. Hemorrhage transformation (HT), coronary heart disease (CHD), diastolic blood pressure, cystatin C levels, NIHSS score, and platelet-to-lymphocyte ratio (PLR) at admission were independently associated with END. A peripheral cystatin C level ≥ 1.41 mg/L and a PLR ≥ 132.97 were predictive factors for END in CCE patients. The lymphocyte-to-monocyte ratio (LMR) was negatively independently associated with HT, and LMR < 2.31 may predict the occurrence of HT in patients with CCE. CONCLUSIONS Of the potential predisposing factors considered, increased cystatin C and PLR were associated with END within 3 days of CCE, and a decreased LMR may have predictive value for HT in CCE patients.
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Affiliation(s)
- Lin Cong
- Department of Neurology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Weining Ma
- Department of Neurosurgery, Shengjing Hospital of China Medical University, Shenyang, China
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34
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Ferrari R, Pavasini R, Campo G. Beta-blockers and COPD: how can harmony be restored in a marriage in crisis? Eur Heart J 2020; 41:4423-4424. [PMID: 33316038 DOI: 10.1093/eurheartj/ehaa873] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 10/09/2020] [Indexed: 02/04/2023] Open
Affiliation(s)
- Roberto Ferrari
- Centro Cardiologico Universitario di Ferrara, University of Ferrara, Italy.,Maria Cecilia Hospital, GVM Care & Research, Cotignola (RA), Italy
| | - Rita Pavasini
- Centro Cardiologico Universitario di Ferrara, University of Ferrara, Italy
| | - Gianluca Campo
- Centro Cardiologico Universitario di Ferrara, University of Ferrara, Italy.,Maria Cecilia Hospital, GVM Care & Research, Cotignola (RA), Italy
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Abstract
Heart failure is a complex clinical syndrome and represents the final path of numerous heart diseases. Coronary artery disease is recognized as the primary risk factor for heart failure development, being the main etiological factor in more than 50% of heart failure patients in North America and Europe. Regardless of overt coronary artery disease, myocardial ischemia is a common finding in failing hearts, likely due to structural or functional coronary circulation alterations. Ischemia is a self-propagating process which irreversibly impairs the cardiac function and negatively impacts prognosis. Thus, a better and thorough understanding of myocardial ischemia pathophysiology in heart failure would likely lead to significantly improved outcomes in these patients. This review aims to describe the mechanisms of myocardial ischemia and coronary artery disease in heart failure, focusing on coronary circulation dysfunctions due to increased parietal stress or non-obstructive coronary disease, and discussing the association and management of coronary artery disease in patients with heart failure.
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Affiliation(s)
- Beniamino R Pagliaro
- Cardio Center, Humanitas Clinical and Research Center - IRCCS, Rozzano, Milan, Italy
| | - Francesco Cannata
- Cardio Center, Humanitas Clinical and Research Center - IRCCS, Rozzano, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090 Pieve Emanuele, Milan, Italy
| | - Giulio G Stefanini
- Cardio Center, Humanitas Clinical and Research Center - IRCCS, Rozzano, Milan, Italy. .,Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090 Pieve Emanuele, Milan, Italy.
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36
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Simonyan MA, Posnenkova OM, Kiselev AR. Capabilities of photoplethysmography as a method for screening of cardiovascular system pathology. CARDIO-IT 2020. [DOI: 10.15275/cardioit.2020.0102] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Currently, vegetative dysfunction considered to be one of principal mechanisms in the pathogenesis of cardiovascular pathology, which causes a cascade of events leading to changes in the properties and a structure of vascular wall. This review article contains literature from various databases (Russian science citation index, PubMed, Google Shcolar, Scopus). It presents the methods for assessing vegetative imbalance. In particular, the method of photoplethysmography (PPGV) is considered for recording periodic fluctuations at various frequencies in the distal vascular bed which characterize physiological processes (cardiac activity, respiratory influences, neurogenic, myogenic and endothelial activity). In addition, other diagnostic capabilities of PPGV such as heart rate (HR) assessment, determining the properties of vascular wall and the level of blood saturation are elucidated. This paper demonstrates a wide range of PPGV applications. The simplicity of PPGV reproduction and its cost-effectiveness make it feasible both in routine clinical practice for the purposes of screening for cardiovascular pathology, and for individual health monitoring incorporated in smart devices.
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The impact of time-updated resting heart rate on cause-specific mortality in a random middle-aged male population: a lifetime follow-up. Clin Res Cardiol 2020; 110:822-830. [PMID: 32696079 PMCID: PMC8166682 DOI: 10.1007/s00392-020-01714-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Accepted: 07/13/2020] [Indexed: 12/04/2022]
Abstract
Background A high resting heart rate (RHR) is associated with an increase in adverse events. However, the long-term prognostic value in a general population is unclear. We aimed to investigate the impact of RHR, based on both baseline and time-updated values, on mortality in a middle-aged male cohort. Methods A random population sample of 852 men, all born in 1913, was followed from age 50 until age 98, with repeated examinations including RHR over a period of 48 years. The impact of baseline and time-updated RHR on cause-specific mortality was assessed using Cox proportional hazard models and cubic spline models. Results A baseline RHR of ≥ 90 beats per minute (bpm) was associated with higher all-cause mortality, as compared with an RHR of 60–70 bpm (hazard ratio [HR] 1.60, 95% confidence interval [CI] 1.17–2.19, P = 0.003), but not with cardiovascular (CV) mortality. A time-updated RHR of < 60 bpm (HR 1.41, 95% CI 1.07–1.85, P = 0.014) and a time-updated RHR of 70–80 bpm (HR 1.34, 95% CI 1.02–1.75, P = 0.036) were both associated with higher CV mortality as compared with an RHR of 60–70 bpm after multivariable adjustment. Analyses using cubic spline models confirmed that the association of time-updated RHR with all-cause and CV mortality complied with a U-shaped curve with 60 bpm as a reference. Conclusion In this middle-aged male cohort, a time-updated RHR of 60–70 bpm was associated with the lowest CV mortality, suggesting that a time-updated RHR could be a useful long-term prognostic index in the general population. Graphic abstract ![]()
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38
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Abstract
Compared with the general population, myocardial infarction (MI) survivors have a higher risk of mortality in the first year after the index event.The aim of this study was to determine the associations between variables obtained during the index admission and 1-year all-cause mortality on follow-up.A cohort of 296 patients was enrolled in the study, with a median age of 63.8 ± 12.68 years. All patients received a coronary angiography and stent implantation by percutaneous coronary intervention. Each variable was tested for association with all-cause mortality, using chi-square tests for categorical and binary variables and t tests for continuous variables. The relative prognostic power of each significant variable was further evaluated by logistic regression before and after adjustment for differences in baseline characteristics.Patients who were deceased after 1-year of MI had significantly higher mean age, increased prevalence of diabetes, and elevated heart rate as compared to those who were surviving. Univariate analysis indicated that patient mortality within 1-year of MI was strongly correlated with higher rates of pump failure on admission (P < .0001), bleeding complications (P = .02), the severity of coronary artery disease measured by Gensini score (P = .04), and decreased left ventricular ejection fraction (LVEF) (P < .0001). After adjustment of baseline variables, only pump failure (P = .006) and reduced LVEF (P < .0001) were independently associated with 1-year mortality.Our study shows that LVEF dysfunction and pump failure are independent predictors of 1-year all-cause post-MI mortality, while the severity of coronary artery disease and bleeding did not qualify as independent predictors. Also, age, history of diabetes, and elevated heart rate may be used as markers for increased mortality rates.
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39
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Wu Q, Liu L, Jiang X, Hu YY, Liang QS, He ZS, Xue Y, Zhu W, Tang ZX, Hou YY, Zhao Q, Wang XH. Effect of voluntary breathing exercises on stable coronary artery disease in heart rate variability and rate-pressure product: a study protocol for a single-blind, prospective, randomized controlled trial. Trials 2020; 21:602. [PMID: 32611442 PMCID: PMC7330950 DOI: 10.1186/s13063-020-04402-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 05/11/2020] [Indexed: 12/04/2022] Open
Abstract
Background At present, China has more than 11 million patients with stable coronary heart disease and this is becoming a major public health problem. The pathological changes of coronary heart disease can lead to dysfunction of the cardiac autonomic nervous system, which increases the risk of complications such as malignant arrhythmia (ventricular flutter, ventricular fibrillation, etc.), heart rate, systolic blood pressure, and rate-pressure product (RPP), which is highly correlated with myocardial oxygen consumption and indirectly reflects myocardial blood supply and oxygen consumption. Although the guidelines recommend that such patients take drugs to reduce heart rate and myocardial oxygen consumption, the clinical control of heart rate is still not ideal. Thus, in this trial, we will use voluntary breathing exercises as the strategy of exercise rehabilitation for patients with stable coronary artery disease (SCAD), in order to increase the vagus nerve activity and/or reduce the sympathetic nervous activity, help maintain or rebuild the balance of plant nerve system, improve the time-domain index of heart rate variability, reduce the burden on the heart, and relieve patients’ anxiety and other negative emotions. Methods This is a 6-month single-blind, randomized controlled clinical trial that will be conducted in the First Affiliated Hospital of Soochow University. A total of 140 patients who fill out the Informed Consent Form are registered and randomized 1:1 into the Voluntary Breathing Exercises (VBE)-based clinical trial monitoring group (n = 70) or the Routine follow-up group (n = 70). The VBE-based clinical trial monitoring group is given VBE training on the basis of conventional treatment and health education, while the control group received conventional health education and follow-up. The primary outcomes will be measured heart rate variability and RPP. Secondary outcomes will include changes in Self-rating Anxiety Scale, total cholesterol, triglyceride, high-density lipoprotein, low-density lipoprotein, weight, and body mass index. Discussion This trial will carry out scientific respiratory exercise for patients with SCAD, which belongs to the category of active secondary prevention for patients, and changes from remedial to pre-protective. VBE is easy to operate and is not limited by time and place. It is important and meaningful to carry out VBE for patients with SCAD. This study will provide considerable evidence for further large-scale trials and alternative strategies for the rehabilitation nursing of patients with SCAD. Trial registration Chinese Clinical Trials Registry, 1900024043. Registered on 23 June 2019.
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Affiliation(s)
- Qing Wu
- Department of Cardiology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Lin Liu
- Department of Cardiology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Xin Jiang
- Nursing Department, Wuxi People's Hospital, Wuxi, China
| | - Yao-Yao Hu
- School of nursing, Soochow University, Suzhou, China
| | - Qiu-Shi Liang
- School of nursing, Soochow University, Suzhou, China
| | - Zhi-Song He
- Department of Cardiology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Yuan Xue
- School of nursing, Soochow University, Suzhou, China
| | - Wei Zhu
- Electrocardiographic room, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Zai-Xiang Tang
- School of Public Health, Soochow University, Suzhou, China
| | - Yun-Ying Hou
- Department of Cardiology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Qi Zhao
- Department of Radiotherapy, The First Affiliated Hospital of Soochow University, Suzhou, China.
| | - Xiao-Hua Wang
- Department of Cardiology, The First Affiliated Hospital of Soochow University, Suzhou, China.
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40
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Resting Heart Rate and Type 2 Diabetes: A Complex Relationship in Need of Greater Understanding. J Am Coll Cardiol 2020; 74:2175-2177. [PMID: 31648710 DOI: 10.1016/j.jacc.2019.08.1030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 08/26/2019] [Indexed: 11/20/2022]
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Severino P, D’Amato A, Pucci M, Infusino F, Birtolo LI, Mariani MV, Lavalle C, Maestrini V, Mancone M, Fedele F. Ischemic Heart Disease and Heart Failure: Role of Coronary Ion Channels. Int J Mol Sci 2020; 21:E3167. [PMID: 32365863 PMCID: PMC7246492 DOI: 10.3390/ijms21093167] [Citation(s) in RCA: 75] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 04/28/2020] [Accepted: 04/28/2020] [Indexed: 01/09/2023] Open
Abstract
Heart failure is a complex syndrome responsible for high rates of death and hospitalization. Ischemic heart disease is one of the most frequent causes of heart failure and it is normally attributed to coronary artery disease, defined by the presence of one or more obstructive plaques, which determine a reduced coronary blood flow, causing myocardial ischemia and consequent heart failure. However, coronary obstruction is only an element of a complex pathophysiological process that leads to myocardial ischemia. In the literature, attention paid to the role of microcirculation, in the pathophysiology of ischemic heart disease and heart failure, is growing. Coronary microvascular dysfunction determines an inability of coronary circulation to satisfy myocardial metabolic demands, due to the imbalance of coronary blood flow regulatory mechanisms, including ion channels, leading to the development of hypoxia, fibrosis and tissue death, which may determine a loss of myocardial function, even beyond the presence of atherosclerotic epicardial plaques. For this reason, ion channels may represent the link among coronary microvascular dysfunction, ischemic heart disease and consequent heart failure.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Francesco Fedele
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico, 155-00161 Rome, Italy; (P.S.); (A.D.); (M.P.); (F.I.); (L.I.B.); (M.V.M.); (C.L.); (V.M.); (M.M.)
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42
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Md Lazin Md Lazim MR, Aminuddin A, Chellappan K, Ugusman A, Hamid AA, Wan Ahmad WAN, Mohamad MSF. Is Heart Rate a Confounding Factor for Photoplethysmography Markers? A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17072591. [PMID: 32290168 PMCID: PMC7177218 DOI: 10.3390/ijerph17072591] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 01/30/2020] [Accepted: 02/02/2020] [Indexed: 11/18/2022]
Abstract
Finger photoplethysmography (PPG) waveform is blood volume change of finger microcirculation that reflects vascular function. Reflection index (RI), stiffness index (SI) and second derivative of photoplethysmogram (SDPPG) are derived from PPG waveforms proposed as cardiovascular disease (CVD) markers. Heart rate (HR) is a known factor that affects vascular function. Individual resting HR variation may affect RI, SI and SDPPG. This review aims to identify studies about the relationship between HR with RI, SI and SDPPG among humans. A literature search was conducted in Medline via the Ebscohost and Scopus databases to find relevant articles published within 11 years. The main inclusion criteria were articles in the English language that discuss the relationship between HR with RI, SI and SDPPG using PPG among humans. The search found 1960 relevant articles but only six articles that met the inclusion criteria. SI and RI showed an association with HR. SDPPG (SDPPG-b/SDPPG-a ratio, SDPPG-d/SDPPG-a ratio, aging index (AGI) and revised aging index (RAGI)) also had an association with HR. Only RI had a considerable association with HR, the association between SI and HR was non-considerable and the association between HR and SDPPG was inconclusive. Further interventional studies should be conducted to investigate this issue, as a variation in resting HR may challenge the validity of PPG-based CVD markers.
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Affiliation(s)
- Md Rizman Md Lazin Md Lazim
- Department of Physiology, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia;
- Department of Physiology, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Center, Jalan Yaacob Latif, Bandar Tun Razak, Cheras 56000, Kuala Lumpur, Malaysia; (A.A.); (A.U.); (A.A.H.)
| | - Amilia Aminuddin
- Department of Physiology, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Center, Jalan Yaacob Latif, Bandar Tun Razak, Cheras 56000, Kuala Lumpur, Malaysia; (A.A.); (A.U.); (A.A.H.)
| | - Kalaivani Chellappan
- Centre of Advance Electronic & Communication Engineering (PAKET), Universiti Kebangsaan Malaysia, Bangi 43600, Selangor, Malaysia
- Correspondence: ; Tel.: +603-8911-8374
| | - Azizah Ugusman
- Department of Physiology, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Center, Jalan Yaacob Latif, Bandar Tun Razak, Cheras 56000, Kuala Lumpur, Malaysia; (A.A.); (A.U.); (A.A.H.)
| | - Adila A Hamid
- Department of Physiology, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Center, Jalan Yaacob Latif, Bandar Tun Razak, Cheras 56000, Kuala Lumpur, Malaysia; (A.A.); (A.U.); (A.A.H.)
| | - Wan Amir Nizam Wan Ahmad
- Biomedicine Programme, School of Health Sciences, Health Campus, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia;
| | - Mohd Shawal Faizal Mohamad
- Department of Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Center, Jalan Yaacob Latif, Bandar Tun Razak, Cheras 56000, Kuala Lumpur, Malaysia;
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43
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Ferrari R, Pavasini R, Censi S, Squeri A, Rosano G. The New ESC Guidelines for the Diagnosis and Management of Chronic Coronary Syndromes: the Good and the Not So Good. Curr Probl Cardiol 2020; 46:100554. [PMID: 32173068 DOI: 10.1016/j.cpcardiol.2020.100554] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Accepted: 12/13/2019] [Indexed: 12/17/2022]
Abstract
During the annual meeting in Paris, the European Society of Cardiology released the new guidelines for the diagnosis and management of chronic coronary syndromes that will replace the 2013 guidelines on stable coronary artery disease. We intend to provide a brief commentary on what, in our opinion, is good and what is not as good. Our careful analysis shows that the 2019 guidelines contain a number of positive innovations, including a new definition, a central role of non-invasive testing for myocardial ischaemia, the most contemporary prevalence of the disease, the fact that medical therapy remains paramount despite the important advances in revascularisation and many other good issues as well as some limitations. The section on medical therapy of chronic coronary syndromes patients shows some inconsistency between text and the suggested scheme as well as contradictions with recommendations of regulatory agencies. It is not immediate to appreciate what is good and what is not so good in guidelines, which are often read in a hurry. We have provided a short commentary for the readers who usually concentrate more on the figures and flowcharts rather than on the text.
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Tian J, Yuan Y, Shen M, Zhang X, He M, Guo H, Yang H, Wu T. Association of resting heart rate and its change with incident cardiovascular events in the middle-aged and older Chinese. Sci Rep 2019; 9:6556. [PMID: 31024039 PMCID: PMC6484081 DOI: 10.1038/s41598-019-43045-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Accepted: 04/02/2019] [Indexed: 01/15/2023] Open
Abstract
Whether heart rate change is associated with cardiovascular disease (CVD) in the general population is unclear. We conducted a prospective cohort study to assess the association of resting heart rate and its change with incident CVD in the middle-aged and older Chinese. Resting heart rate was measured during the baseline survey (September 2008 to June 2010) and the resurvey (2013). Incident CVD was followed up until December 31, 2016. Finally, a total of 20,828 participants were included in the analyses of baseline heart rate and 9132 participants were included in the analyses of heart rate change. The associations of baseline heart rate and heart rate change with incident CVD were assessed with multivariable Cox proportional hazards models. Compared with moderate baseline heart rate (65 to 80 bpm), low baseline heart rate (<65 bpm) was associated with higher risk of CVD (HR, 1.19; 95% CI, 1.07–1.32). Compared with stable heart rate (−5 to 15 bpm) in the moderate baseline heart rate group (65 to 80 bpm), an increase of heart rate (>15 bpm) in high baseline heart rate group (>80 bpm) (HR, 1.67; 95% CI, 1.02–2.71) or a decrease of heart rate (<−5 bpm) in low baseline heart rate group (<65 bpm) (HR, 2.48; 95% CI, 1.27–4.82) was associated with higher risk of CVD. In conclusion, low resting heart rate is associated with higher risk of CVD. Both continuous increase in high baseline heart rate and decrease in low baseline heart rate are associated with higher risk of CVD.
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Affiliation(s)
- Jing Tian
- Key Laboratory of Environment and Health, Ministry of Education and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Yu Yuan
- Key Laboratory of Environment and Health, Ministry of Education and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Miaoyan Shen
- Key Laboratory of Environment and Health, Ministry of Education and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Xiaomin Zhang
- Key Laboratory of Environment and Health, Ministry of Education and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Meian He
- Key Laboratory of Environment and Health, Ministry of Education and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Huan Guo
- Key Laboratory of Environment and Health, Ministry of Education and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Handong Yang
- Dongfeng Central Hospital, Dongfeng Motor Corporation and Hubei University of Medicine, Shiyan, Hubei, China
| | - Tangchun Wu
- Key Laboratory of Environment and Health, Ministry of Education and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.
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45
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Affiliation(s)
- Roberto Ferrari
- Centro Cardiologico Universitario and LTTA Centre, University Hospital of Ferrara, Ferrara, Italy.,Maria Cecilia Hospital, GVM Care & Research, E.S. Health Science Foundation, Cotignola, Italy
| | - Rita Pavasini
- Centro Cardiologico Universitario and LTTA Centre, University Hospital of Ferrara, Ferrara, Italy.,Maria Cecilia Hospital, GVM Care & Research, E.S. Health Science Foundation, Cotignola, Italy
| | - Cristina Balla
- Centro Cardiologico Universitario and LTTA Centre, University Hospital of Ferrara, Ferrara, Italy.,Maria Cecilia Hospital, GVM Care & Research, E.S. Health Science Foundation, Cotignola, Italy
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46
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Alapati V, Tang F, Charlap E, Chan PS, Heidenreich PA, Jones PG, Spertus JA, Srinivas V, Kizer JR. Discharge Heart Rate After Hospitalization for Myocardial Infarction and Long-Term Mortality in 2 US Registries. J Am Heart Assoc 2019; 8:e010855. [PMID: 30691334 PMCID: PMC6405572 DOI: 10.1161/jaha.118.010855] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Accepted: 01/03/2019] [Indexed: 12/22/2022]
Abstract
Background Although admission heart rate predicts higher mortality after acute myocardial infarction ( AMI ), less is known about discharge heart rate. We tested the hypothesis that higher discharge heart rate after AMI is related to increased long-term mortality independent of admission heart rate, and assessed whether β blockers modify this relationship. Methods and Results In 2 prospective US multicenter registries of AMI , we evaluated the associations of discharge and admission heart rate with 3-year mortality using Cox models. Among 6576 patients with AMI , discharge heart rate was modestly associated with initial heart rate ( r=0.28), comorbidities, and infarct severity. In this cohort, 10.7% did not receive β blockers at discharge. After full adjustment for demographic, psychosocial, and clinical covariates, discharge heart rate (hazard ratio [HR]=1.14 per 10 beats per minute [bpm]; 95% CI =1.07-1.21 per 10 bpm) was more strongly associated with risk of death than admission heart rate (HR=1.05 per 10 bpm; 95% CI=1.02-1.09 per 10 bpm) when both were entered in the same model ( P=0.043 for comparison). There was a significant interaction between discharge heart rate and β-blocker use ( P=0.004) on mortality, wherein risk of death was markedly higher among those with high discharge heart rate and not on β blockers (HR=1.35 per 10 bpm; 95% CI=1.19-1.53 per 10 bpm) versus those with a high discharge heart rate and on β blockers at discharge (HR=1.10 per 10 bpm; 95% CI=1.03-1.17 per 10 bpm). Conclusions Higher discharge heart rate after AMI was more strongly associated with 3-year mortality than admission heart rate, and the risk associated with higher discharge heart rate was modified by β blockers at discharge. These findings highlight opportunities for risk stratification and intervention that will require further investigation.
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Affiliation(s)
| | - Fengming Tang
- Saint Luke's Mid America Heart InstituteKansas CityMO
| | | | - Paul S. Chan
- Saint Luke's Mid America Heart InstituteKansas CityMO
| | - Paul A. Heidenreich
- Palo Alto Veterans Affairs Health Care System and Stanford School of MedicinePalo AltoCA
| | | | | | | | - Jorge R. Kizer
- San Francisco Veterans Affairs Health Care System and University of California San FranciscoSan FranciscoCA
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Possible Ameliorative Effect of Ivabradine on the Autonomic and Left Ventricular Dysfunction Induced by Doxorubicin in Male Rats. J Cardiovasc Pharmacol 2018; 72:22-31. [DOI: 10.1097/fjc.0000000000000586] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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48
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Ferrari R, Camici PG, Crea F, Danchin N, Fox K, Maggioni AP, Manolis AJ, Marzilli M, Rosano GMC, Lopez-Sendon JL. A 'diamond' approach to personalized treatment of angina. Nat Rev Cardiol 2017; 15:120-132. [DOI: 10.1038/nrcardio.2017.131] [Citation(s) in RCA: 73] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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49
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Chen H, Ding S, Zhou M, Wu X, Liu X, Liu J, Wu Y, Liu D. PON1 L55M and Q192R gene polymorphisms and CAD risks in patients with hyperlipidemia. Herz 2017; 43:642-648. [DOI: 10.1007/s00059-017-4611-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2017] [Revised: 07/11/2017] [Accepted: 08/02/2017] [Indexed: 01/01/2023]
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50
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Nikolovska Vukadinović A, Vukadinović D, Borer J, Cowie M, Komajda M, Lainscak M, Swedberg K, Böhm M. Heart rate and its reduction in chronic heart failure and beyond. Eur J Heart Fail 2017. [DOI: 10.1002/ejhf.902] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Affiliation(s)
| | - Davor Vukadinović
- Klinik für Innere Medizin III; der Universität des Saarlandes; Homburg/Saar Germany
| | - Jeffrey Borer
- Division of Cardiovascular Medicine and the Howard Gilman Institute for Heart Valve Disease and the Schiavone Institute for Cardiovascular Translational Research; State University of New York Downstate Medical Center; New York NY USA
| | | | | | - Mitja Lainscak
- Department of Cardiology, Department of Research and Education; Celje Slovenia
| | - Karl Swedberg
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy; University of Gothenburg; Göteborg Sweden
| | - Michael Böhm
- Klinik für Innere Medizin III; der Universität des Saarlandes; Homburg/Saar Germany
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