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Afshani MR, Torfi E, Akiash N, Jahanshahi A, Mohamadi A, Sherafat O. Effect of empagliflozin on left ventricular volumes in type 2 diabetes or prediabetes heart failure patients with reduced ejection fraction. Acta Cardiol 2024; 79:419-425. [PMID: 38511517 DOI: 10.1080/00015385.2023.2240130] [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: 04/03/2023] [Accepted: 07/19/2023] [Indexed: 03/22/2024]
Abstract
OBJECTIVE Sodium-glucose cotransporter 2 (SGLT2) inhibitors, such as empagliflozin are antidiabetic drugs that have recently been reported to have cardio-protective action; however, their effect on cardiac structure and function in heart failure with reduced ejection fraction (HFrEF) has not yet been determined. This study evaluates the efficacy of empagliflozin on left ventricular (LV) volumes in type 2 diabetes or prediabetes patients with HFrEF. METHODS This randomised, double-blind, trial study was conducted on 104 patients with type 2 diabetes or prediabetes with HFrEF referred to Imam Khomeini and Golestan hospitals in Ahvaz, Iran. The patients were randomised to receive empagliflozin (10 mg once daily) in addition to standard treatments of HFrEF or receive only standard treatments (control group) for six months. During the six months of follow-up, changes in LV volumes, LVEF, hospitalisation for heart failure (HF) were evaluated. RESULTS Empagliflozin reduced LVEDVI and LVESVI by 10.0 and 8.0 mL/m2 (p < 0.0001). Furthermore, a significant increase in LVEF was observed in the empagliflozin group (p < 0.0001) without any significant change in the control group (p = 0.389). The hospitalisation rate was lower in the empagliflozin group than the control group (3.8% vs. 23.1%; p = 0.008). CONCLUSIONS Empagliflozin is effective in reducing LV volumes and hospitalisation rate in patients with type 2 diabetes and prediabetes and HFrEF. Therefore, treatment with empagliflozin for six months was associated with a significant reduction in adverse cardiovascular outcomes in these patients.
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Affiliation(s)
- Mohammad Reza Afshani
- Internal Cardiology, Atherosclerosis Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Ekhlas Torfi
- Internal Cardiology, Atherosclerosis Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Nehzat Akiash
- Echocardiography, Atherosclerosis Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Alireza Jahanshahi
- Endocrinology and Metabolism, Diabetes Research Center, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Asghar Mohamadi
- Instructor of Nursing, Cardiovascular Research Center, Shahid Rahimi Hospital, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Omid Sherafat
- Department of Cardiology, Resident of Cardiology, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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Sabe SA, Sabe MA, Kennedy KF, Sellke FW, Ehsan A. Risk Factors for Heart Failure Readmission After Cardiac Surgery. JACC. ADVANCES 2023; 2:100599. [PMID: 38938350 PMCID: PMC11198058 DOI: 10.1016/j.jacadv.2023.100599] [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: 04/19/2023] [Revised: 06/05/2023] [Accepted: 06/23/2023] [Indexed: 06/29/2024]
Abstract
Background Heart failure (HF) is a leading cause of readmission after cardiac surgery, yet risk factors for HF readmission after cardiac surgery remain poorly characterized. Objectives This study aimed to identify risk factors associated with 30-day HF-specific readmissions after cardiac surgery using a national database. Methods We queried the 2016 to 2018 National Readmissions Database to identify U.S. patients who underwent coronary artery bypass grafting (CABG), mitral valve repair/replacement, and/or aortic valve repair/replacement. Exclusion criteria included history of ventricular assist device or heart transplant, dialysis-dependent renal insufficiency, and death during index admission. Clinical variables were defined using International Classification of Diseases-10th Revision codes. The primary outcome was a 30-day readmission for HF following discharge. Multivariable logistic regression was used to account for relevant clinical and demographic covariates and identify independent risk factors for HF readmissions following cardiac surgery. Results Our study included 394,050 patients who underwent cardiac surgery (mean age 66 ± 12 years, 63% isolated CABG, 27% isolated valve, 11% CABG + valve). Of these patients, 7,318 were readmitted within 30 days of discharge for a principal diagnosis of HF. Independent risk factors of HF-specific readmission included older age, female sex, prolonged length of stay, comorbid congestive HF, nondialysis dependent chronic kidney disease, chronic obstructive pulmonary disease, chronic liver disease, obesity, atrial fibrillation, and acute kidney injury. Prior CABG was marginally protective for HF-specific readmission. Conclusions Using a national registry, we identified risk factors associated with HF readmission after cardiac surgery. Further analysis of these risk factors and their association with HF readmission is warranted.
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Affiliation(s)
- Sharif A. Sabe
- Division of Cardiothoracic Surgery, Department of Surgery, Rhode Island Hospital, Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Marwa A. Sabe
- Division of Cardiovascular Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Kevin F. Kennedy
- Independent consultant for Lifespan, Providence, Rhode Island, USA
| | - Frank W. Sellke
- Division of Cardiothoracic Surgery, Department of Surgery, Rhode Island Hospital, Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Afshin Ehsan
- Division of Cardiothoracic Surgery, Department of Surgery, Rhode Island Hospital, Alpert Medical School of Brown University, Providence, Rhode Island, USA
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Vesnina ZV, Grakova EV. Diagnostic radiology methods for assessing coronary artery bypass graft viability. BULLETIN OF SIBERIAN MEDICINE 2022. [DOI: 10.20538/1682-0363-2022-3-140-153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The review describes available modern radiological methods which are currently applied for a detailed and comprehensive anatomical and functional assessment of the viability of various coronary artery bypass grafts. In addition, it presents some aspects of the implementation of these methods and clinical interpretation of the results.
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Affiliation(s)
- Zh. V. Vesnina
- Cardiology Research Institute, Tomsk National Research Medical Center (NRMC), Russian Academy of Sciences
| | - E. V. Grakova
- Cardiology Research Institute, Tomsk National Research Medical Center (NRMC), Russian Academy of Sciences
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Risk of Heart Failure in Patients with ST-Elevation Myocardial Infarction Receiving Drug-Eluting Stent Implantation and Undefined Duration of Antiplatelets. J Pers Med 2022; 12:jpm12030369. [PMID: 35330369 PMCID: PMC8950168 DOI: 10.3390/jpm12030369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 02/16/2022] [Accepted: 02/25/2022] [Indexed: 11/16/2022] Open
Abstract
It remains unknown as to whether the use of new-generation drug-eluting stent (NG-DES) in patients with ST-elevation myocardial infarction (STEMI) who receive an undefined duration of dual antiplatelet therapy (DAPT) reduces the risk of hospitalization for heart failure (HHF). In this population-based retrospective cohort study, we applied propensity score matching to select 6831 pairs of patients with STEMI who had similar baseline characteristics and received either NG-DES or bare-metal stent (BMS) implantation between 1 January 2007 and 31 December 2016. The risk of stent-associated HHF was evaluated, wherein death was considered a competing risk. Rates of cumulative incidence competing risk for HHF at the 1, 2, 3, 4, and 5 year follow-up were lower in the NG-DES group (3.79%, 5.21%, 6.15%, 7.01%, and 8.29%, respectively) than in the BMS group (4.51%, 6.21%, 7.32%, 8.33%, and 9.83%, respectively). NG-DES implantation was associated with a lower risk of HHF than BMS implantation after 5 years, with an adjusted subdistribution hazard ratio of 0.82 (95% confidence interval 0.72−0.92, p = 0.001). These results accord with those of patients who received DAPT for >6 months. Our findings highlight that NG-DESs may reduce HHF risk in patients with STEMI receiving an undefined duration of DAPT.
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de Waard D, Fagan A, Minnaar C, Horne D. Prise en charge des patients après un pontage aortocoronarien: guide pour les professionnels en soins primaires. CMAJ 2021; 193:E1107-E1113. [PMID: 34281973 PMCID: PMC8315203 DOI: 10.1503/cmaj.191108-f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Affiliation(s)
- Dominique de Waard
- Faculté de médecine (de Waard, Fagan, Horne), Université Dalhousie; Division de la chirurgie cardiaque (de Waard, Fagan, Horne), Hôpital Queen Elizabeth II, Halifax, N.-É.; Hôpital Bethesda (Minnaar), Steinbach, Man
| | - Andrew Fagan
- Faculté de médecine (de Waard, Fagan, Horne), Université Dalhousie; Division de la chirurgie cardiaque (de Waard, Fagan, Horne), Hôpital Queen Elizabeth II, Halifax, N.-É.; Hôpital Bethesda (Minnaar), Steinbach, Man
| | - Christo Minnaar
- Faculté de médecine (de Waard, Fagan, Horne), Université Dalhousie; Division de la chirurgie cardiaque (de Waard, Fagan, Horne), Hôpital Queen Elizabeth II, Halifax, N.-É.; Hôpital Bethesda (Minnaar), Steinbach, Man
| | - David Horne
- Faculté de médecine (de Waard, Fagan, Horne), Université Dalhousie; Division de la chirurgie cardiaque (de Waard, Fagan, Horne), Hôpital Queen Elizabeth II, Halifax, N.-É.; Hôpital Bethesda (Minnaar), Steinbach, Man.
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6
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Teo YH, Tam WW, Koo CY, Aung AT, Sia CH, Wong RCC, Kong W, Poh KK, Kofidis T, Kojodjojo P, Lee CH. Sleep apnea and recurrent heart failure hospitalizations after coronary artery bypass grafting. J Clin Sleep Med 2021; 17:2399-2407. [PMID: 34216202 DOI: 10.5664/jcsm.9442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Sleep apnea is prevalent in patients undergoing coronary artery bypass grafting (CABG). We investigated the relationship between sleep apnea and recurrent heart failure hospitalizations in patient undergoing non-urgent CABG. METHODS Between November 2013 and December 2018, 1007 patients completed a sleep study prior to CABG and were followed up until April 2020. Recurrent heart failure hospitalizations were analyzed by Poisson, negative binomial, Andersen-Gill, and joint frailty models, with partial and full adjustment for covariates. RESULTS At an average follow-up of 3.3 years, the number of patients with 0, 1, or ≥2 heart failure hospitalizations were 908 (90.2%), 62 (6.2%), and 37 (3.7%), respectively. The total number of heart failure hospitalizations was 179, comprising 62 (35%) first and 117 (65%) repeat events. The numbers of heart failure hospitalizations for the sleep apnea (n = 513, 50.9%) and non-sleep apnea groups were 127 and 52, respectively. Negative binomial regression demonstrated that sleep apnea was associated with recurrent heart failure hospitalizations (fully adjusted rate ratio, 1.71; 95% confidence interval [CI], 1.12-2.62; p = 0.013). Similar results were found in Poisson (1.63; 95%CI, 1.15-2.31; p = 0.006), Andersen-Gill (1.66; 95% CI, 1.01-2.75; p = 0.047), and joint frailty models (1.72; 95% CI, 1.00-3.01; p = 0.056). CONCLUSIONS In patients after CABG, repeat events accounted for two-thirds of heart failure hospitalizations. Sleep apnea was independently associated with recurrent heart failure hospitalizations.
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Affiliation(s)
- Yao Hao Teo
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Wilson W Tam
- Alice Lee Centre for Nursing Studies, National University of Singapore, Singapore
| | - Chieh-Yang Koo
- Department of Cardiology, National University Heart Centre Singapore, Singapore
| | - Aye-Thandar Aung
- Department of Cardiology, National University Heart Centre Singapore, Singapore
| | - Ching-Hui Sia
- Department of Cardiology, National University Heart Centre Singapore, Singapore
| | - Raymond C C Wong
- Department of Cardiology, National University Heart Centre Singapore, Singapore
| | - William Kong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Department of Cardiology, National University Heart Centre Singapore, Singapore
| | - Kian-Keong Poh
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Department of Cardiology, National University Heart Centre Singapore, Singapore
| | - Theodoros Kofidis
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Department of Cardiac, Thoracic and Vascular Surgery, National University Heart Centre, Singapore.,Cardiovascular Research Institute, National University of Singapore, Singapore
| | - Pipin Kojodjojo
- Alice Lee Centre for Nursing Studies, National University of Singapore, Singapore.,Division of Cardiology, Department of Medicine, Ng Teng Fong General Hospital, Singapore
| | - Chi-Hang Lee
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Alice Lee Centre for Nursing Studies, National University of Singapore, Singapore.,Cardiovascular Research Institute, National University of Singapore, Singapore
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7
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de Waard D, Fagan A, Minnaar C, Horne D. Management of patients after coronary artery bypass grafting surgery: a guide for primary care practitioners. CMAJ 2021; 193:E689-E694. [PMID: 33972222 PMCID: PMC8157999 DOI: 10.1503/cmaj.191108] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Affiliation(s)
- Dominique de Waard
- Faculty of Medicine (de Waard, Fagan, Horne), Dalhousie University; Division of Cardiac Surgery (de Waard, Fagan, Horne), QEII Hospital, Halifax, NS; Bethesda Hospital (Minnaar), Steinbach, Man
| | - Andrew Fagan
- Faculty of Medicine (de Waard, Fagan, Horne), Dalhousie University; Division of Cardiac Surgery (de Waard, Fagan, Horne), QEII Hospital, Halifax, NS; Bethesda Hospital (Minnaar), Steinbach, Man
| | - Christo Minnaar
- Faculty of Medicine (de Waard, Fagan, Horne), Dalhousie University; Division of Cardiac Surgery (de Waard, Fagan, Horne), QEII Hospital, Halifax, NS; Bethesda Hospital (Minnaar), Steinbach, Man
| | - David Horne
- Faculty of Medicine (de Waard, Fagan, Horne), Dalhousie University; Division of Cardiac Surgery (de Waard, Fagan, Horne), QEII Hospital, Halifax, NS; Bethesda Hospital (Minnaar), Steinbach, Man.
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8
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Ortiz F, Mbai M, Adabag S, Garcia S, Nguyen J, Goldman S, Ward HB, Kelly RF, Carlson S, Holman WL, McFalls EO. Utility of nuclear stress imaging in predicting long-term outcomes one-year post CABG Surgery. J Nucl Cardiol 2020; 27:1970-1978. [PMID: 30397864 DOI: 10.1007/s12350-018-01469-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Accepted: 09/09/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND Early MPI after CABG is currently considered rarely appropriate in asymptomatic patients. This study aimed to identify prognostic value of nuclear stress-imaging post-CABG. METHODS This was a single center prospective study looking at long-term outcomes post-CABG. Per protocol participants underwent SPECT-MPI stress testing and coronary angiogram on the same day, 1-year following CABG. Defect size was semi-quantified. The primary outcomes were the composite of death and congestive heart failure. RESULTS Eighty-four participants underwent nuclear stress-imaging and angiography, with a median follow-up of 11.1 years. Three separate stress findings predicted the primary outcome: inability to reach stage 3 of a Bruce protocol (OR 7.3, CI 2.4-22.1, P < 0.001), LVEF < 45% (OR 4.0, CI 1.1-15.3, P = 0.041) and a moderate-large stress defect size (HR 2.31, CI 1.1-1.5, P = 0.04). These findings appear to be additive and strongest among patients who underwent exercise stress testing (HR 10.6, CI 3.6-30.6, P < 0.001). Graft disease was identified in 39 (46%) patients and compared to those individuals with no graft disease, did not predict long-term adverse outcomes (P = 0.29). CONCLUSION In clinically stable patients early after revascularization with CABG, SPECT-MPI can identify patients at higher risk of heart failure and death.
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Affiliation(s)
| | - Mackenzi Mbai
- VA Medical Center Minneapolis, University of Minnesota, Minneapolis, MN, USA
| | - Selcuk Adabag
- VA Medical Center Minneapolis, University of Minnesota, Minneapolis, MN, USA
| | - Santiago Garcia
- VA Medical Center Minneapolis, University of Minnesota, Minneapolis, MN, USA
| | | | - Steven Goldman
- Southern Arizona VA Health Systems, University of Arizona, Tucson, AZ, USA
| | - Herbert B Ward
- VA Medical Center Minneapolis, University of Minnesota, Minneapolis, MN, USA
| | - Rosemary F Kelly
- VA Medical Center Minneapolis, University of Minnesota, Minneapolis, MN, USA
| | | | - William L Holman
- Birmingham VA Medical Center, University of Alabama Birmingham, Birmingham, AL, USA
| | - Edward O McFalls
- VA Medical Center Minneapolis, University of Minnesota, Minneapolis, MN, USA
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9
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Lin CF, Chang YH, Yu FC, Tsai CT, Chen CC, Liu HY, Chien LN. Risk of heart failure following drug-eluting stent implantation in patients with non-ST-elevation myocardial infarction. Atherosclerosis 2020; 316:84-89. [PMID: 33109336 DOI: 10.1016/j.atherosclerosis.2020.10.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 09/17/2020] [Accepted: 10/07/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND AIMS The association between implanted stent types and heart failure in patients with non-ST-elevation myocardial infarction (NSTEMI) remains unknown. The current study aimed to investigate whether the implantation of a newer-generation drug-eluting stent (NG-DES) compared with that of a bare-metal stent (BMS) in patients with NSTEMI who receive an undefined duration of dual antiplatelet therapy (DAPT) reduces the risk of hospitalization for heart failure (HHF). METHODS In this nationwide, population-based retrospective cohort study, propensity score matching was used on the Taiwan's National Health Insurance Research Database to select 8,644 pairs of patients with NSTEMI and similar baseline characteristics receiving NG-DES or BMS implantation between January 1, 2007 and December 31, 2016. A competing risk model was constructed to evaluate the risk of HHF in the NG-DES and BMS groups. Death was considered a competing risk. RESULTS Rates of cumulative incidence competing risk for HHF at 1, 2, 3, 4, and 5-year follow-ups were lower in the NG-DES group (4.11%, 5.63%, 6.72%, 7.65%, and 8.89%, respectively) than in the BMS group (5.89%, 7.81%, 9.25%, 10.8%, and 11.9%, respectively). After adjustment for all clinical variables, NG-DES implantation was associated with a lower risk of HHF than BMS implantation after 5 years, with an adjusted subdistribution hazard ratio of 0.71 (95% CI = 0.64-0.79, p < 0.001). These results are in agreement with those of patients who received DAPT for >6 months. CONCLUSIONS NG-DESs may reduce HHF risk in patients with NSTEMI who receive an undefined duration of DAPT.
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Affiliation(s)
- Chao-Feng Lin
- Department of Medicine, MacKay Medical College, New Taipei City, Taiwan; Ph.D. Program for Cancer Molecular Biology and Drug Discovery, College of Medical Science and Technology, Taipei Medical University and Academia Sinica, Taiwan; Division of Cardiology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan
| | - Ya-Hui Chang
- Department of Pharmacy, MacKay Memorial Hospital, Taipei, Taiwan
| | - Fa-Chang Yu
- Division of Cardiology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan
| | - Chen-Ting Tsai
- Division of Cardiology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan
| | - Chun-Chao Chen
- Division of Cardiology, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Hung-Yi Liu
- Health and Clinical Research Data Center, Office of Data Center, Taipei Medical University, Taipei, Taiwan
| | - Li-Nien Chien
- Health and Clinical Research Data Center, Office of Data Center, Taipei Medical University, Taipei, Taiwan; School of Health Care Administration, College of Management, Taipei Medical University, Taipei, Taiwan.
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10
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Liu H, Wu DD, Zheng SQ, Zeng ZH, Ding T, Liu ZG, Liu XC. Loop isolation-based uploading preconditioning to protect heart from damage: a proof-of-concept study. Herz 2019; 45:745-751. [PMID: 31410516 DOI: 10.1007/s00059-019-04845-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Revised: 06/15/2019] [Accepted: 07/20/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Little is known on the role of indirect clamp releasing in coronary artery bypass grafting (CABG). Loop isolation-based uploading preconditioning (LiuPhD) was modified to protect the heart from damage and the question of whether this can attenuate reperfusion injury after global myocardial ischemia was examined. METHODS A post-hoc comparative analysis was conducted of a prospective single-arm trial on the use of the LiuPhD strategy for 60 multivessel-disease patients undergoing isolated first-time elective on-pump CABG versus 1:1 propensity score-matched patients from the historical database of the same center. RESULTS A total of 120 matched patients had a median age of 62.0 (interquartile range [IQR] 55.8-69.0) years, 27 (22.5%) women, 35 (29.2%) with left main disease, and median follow-up of 18.5 (10.9-35.4) months. The LiuPhD group had shorter post-bypass times than conventional controls (10 [6-13] vs 14 [10-19] mins; p = 0.003). The LiuPhD group had similar needs in terms of composite cardiac-specific interventions (38/60 vs 44/60; p = 0.29). At follow-up of safety, the risk for composite major adverse cardiac and cerebrovascular events was similar between groups (event-free survival: 82.3% vs 73.8%; hazard ratio 1.00 [0.39, 2.54], p log-rank test = 0.99). CONCLUSION The LiuPhD strategy is associated with short post-bypass times, comparable risk of myocardial injury, and similar safety compared with conventional direct clamp releasing.
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Affiliation(s)
- Hong Liu
- Department of Cardiovascular Surgery, TEDA International Cardiovascular Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, 300457, Tianjin, China
| | - Dong-Dong Wu
- Department of Cardiovascular Surgery, TEDA International Cardiovascular Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, 300457, Tianjin, China
| | - Si-Qiang Zheng
- Department of Cardiovascular Surgery, TEDA International Cardiovascular Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, 300457, Tianjin, China
| | - Zhi-Hua Zeng
- Department of Cardiovascular Surgery, TEDA International Cardiovascular Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, 300457, Tianjin, China
| | - Tong Ding
- Department of Cardiovascular Surgery, TEDA International Cardiovascular Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, 300457, Tianjin, China
| | - Zhi-Gang Liu
- Department of Cardiovascular Surgery, TEDA International Cardiovascular Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, 300457, Tianjin, China
| | - Xiao-Cheng Liu
- Department of Cardiovascular Surgery, TEDA International Cardiovascular Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, 300457, Tianjin, China.
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11
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Cooper S, Teoh H, Campeau MA, Verma S, Leask RL. Empagliflozin restores the integrity of the endothelial glycocalyx in vitro. Mol Cell Biochem 2019; 459:121-130. [PMID: 31127491 DOI: 10.1007/s11010-019-03555-2] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Accepted: 05/14/2019] [Indexed: 12/22/2022]
Abstract
The antihyperglycemic agent empagliflozin not only improves glycemic control but has also been associated with clinically meaningful reductions in cardiovascular events. Studies have shown that empagliflozin significantly reduces cardiovascular death and heart failure-associated hospitalizations. Given that endothelial dysfunction is closely linked with the pathogenesis of atherosclerotic cardiovascular disease, we hypothesized that the cardiovascular benefits observed with empagliflozin may be a result of its positive impact on the health of the endothelial glycocalyx (GCX), a critical component for the endothelium homeostasis. Human abdominal aortic endothelial cells (HAAECs) were either statically cultured or subjected to a steady wall shear stress of 10 dyne/cm2. Empagliflozin (50 µM, 24 h) restored heparinase III-mediated GCX disruption and the normal mechanotransduction responses in GCX-compromised HAAECs while reducing the attachment of all-trans retinoic acid-transformed NB4 cells to HAAECs. The current body of work suggests that the cardioprotective properties previously reported for empagliflozin may in part be due to the ability of empagliflozin to preserve and restore the structural integrity of the GCX, which in turn helps to maintain vascular health by promoting an anti-inflammatory endothelium, in the presence of a pro-inflammatory environment. Further studies are needed to fully understand the mechanisms underlying the cardiovascular benefits of empagliflozin.
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Affiliation(s)
- Scott Cooper
- Department of Chemical Engineering, McGill University, 3610 University Street, Montréal, QC, H3A 2B2, Canada
| | - Hwee Teoh
- Division of Endocrinology and Metabolism, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, ON, Canada.,Division of Cardiac Surgery, Keenan Research Centre for Biomedical Science of St. Michael's Hospital, Toronto, ON, Canada
| | - Marc Antoine Campeau
- Department of Chemical Engineering, McGill University, 3610 University Street, Montréal, QC, H3A 2B2, Canada
| | - Subodh Verma
- Division of Cardiac Surgery, Keenan Research Centre for Biomedical Science of St. Michael's Hospital, Toronto, ON, Canada.,Departments of Surgery, and Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada
| | - Richard L Leask
- Department of Chemical Engineering, McGill University, 3610 University Street, Montréal, QC, H3A 2B2, Canada. .,Montreal Heart Institute, Montréal, QC, Canada.
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12
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Verma S, Mazer CD, Fitchett D, Inzucchi SE, Pfarr E, George JT, Zinman B. Empagliflozin reduces cardiovascular events, mortality and renal events in participants with type 2 diabetes after coronary artery bypass graft surgery: subanalysis of the EMPA-REG OUTCOME® randomised trial. Diabetologia 2018; 61:1712-1723. [PMID: 29777264 PMCID: PMC6061159 DOI: 10.1007/s00125-018-4644-9] [Citation(s) in RCA: 72] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Accepted: 04/27/2018] [Indexed: 01/13/2023]
Abstract
AIMS/HYPOTHESIS After coronary artery bypass graft (CABG) surgery in individuals with type 2 diabetes, there remains a considerable residual cardiovascular risk. In the EMPA-REG OUTCOME® trial in participants with type 2 diabetes and established cardiovascular disease, empagliflozin reduced the risk of cardiovascular death by 38%, all-cause mortality by 32%, hospitalisation for heart failure by 35% and incident or worsening nephropathy by 39% vs placebo when given in addition to standard of care. The aim of this post hoc analysis of the EMPA-REG OUTCOME® trial was to determine the effects of the sodium glucose cotransporter 2 inhibitor empagliflozin on cardiovascular events and mortality in participants with type 2 diabetes and a self-reported history of CABG surgery. METHODS The EMPA-REG OUTCOME® trial was a randomised, double-blind, placebo-controlled trial. Participants with type 2 diabetes and established cardiovascular disease were randomised 1:1:1 to receive placebo, empagliflozin 10 mg or empagliflozin 25 mg, once daily, in addition to standard of care. In subgroups by self-reported history of CABG (yes/no) at baseline, we assessed: cardiovascular death; all-cause mortality; hospitalisation for heart failure; and incident or worsening nephropathy (progression to macroalbuminuria, doubling of serum creatinine, initiation of renal replacement therapy or death due to renal disease). Differences in risk between empagliflozin and placebo were assessed using a Cox proportional hazards model. RESULTS At baseline, 25% (1175/4687) of participants who received empagliflozin and 24% (563/2333) of participants who received placebo had a history of CABG surgery. In participants with a history of CABG surgery, HRs (95% CI) with empagliflozin vs placebo were 0.52 (0.32, 0.84) for cardiovascular mortality, 0.57 (0.39, 0.83) for all-cause mortality, 0.50 (0.32, 0.77) for hospitalisation for heart failure and 0.65 (0.50, 0.84) for incident or worsening nephropathy. Results were consistent between participants with and without a history of CABG surgery (p > 0.05 for treatment by subgroup interactions). CONCLUSIONS/INTERPRETATION In participants with type 2 diabetes and a self-reported history of CABG surgery, treatment with empagliflozin was associated with profound reductions in cardiovascular and all-cause mortality, hospitalisation for heart failure, and incident or worsening nephropathy. These data have important implications for the secondary prevention of cardiovascular events after CABG in individuals with type 2 diabetes. TRIAL REGISTRATION ClinicalTrials.gov NCT01131676.
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Affiliation(s)
- Subodh Verma
- Division of Cardiac Surgery, St Michael's Hospital, University of Toronto, 30 Bond St, Toronto, ON, M5B 1W8, Canada.
| | - C David Mazer
- Department of Anesthesia, St Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - David Fitchett
- Division of Cardiology, St Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - Silvio E Inzucchi
- Section of Endocrinology, Yale University School of Medicine, New Haven, CT, USA
| | - Egon Pfarr
- Boehringer Ingelheim Pharma GmbH & Co. KG, Ingelheim, Germany
| | | | - Bernard Zinman
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, University of Toronto, Toronto, Canada
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Quality of medical therapy in heart failure patients undergoing elective revascularisation: A protective effect of disease modifying therapy at discharge. Sci Rep 2017; 7:14909. [PMID: 29097746 PMCID: PMC5668379 DOI: 10.1038/s41598-017-15004-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Accepted: 10/20/2017] [Indexed: 12/28/2022] Open
Abstract
The STICH(-ES) trial showed that coronary artery bypass grafting was superior to medical therapy alone in treating ischemic heart failure. However, dosages of disease modifying drugs were not reported. We included 128 (84% male, mean age 66 ± 11 years) consecutive patients with ischemic heart failure and an ejection fraction ≤35% undergoing isolated elective coronary artery bypass grafting. We defined optimal medical therapy (OMT) as prescription of ≥50% dosages of guideline recommended medications (i.e. beta-blocker (BB) and renin angiotensin system (RAS) antagonist) plus prescription of a mineralocorticoid receptor antagonist (MRA). The mean logistic EuroSCORE was 12.3 ± 13.8%. The five year survival was 74%. At discharge, 111 patients (87%) were on a BB and 106 (83%) were on a RAS antagonist. Forty-nine patients (38%) received an MRA. Only 8 patients (6%) received OMT. A Cox regression analysis revealed EuroSCORE (p < 0.001) and the use of MRA (p = 0.003) and BB (p = 0.037) at discharge as significant predictors of 5 year survival. Prescription rates of heart failure medication are comparable to those reported in the STICH trial, but rates of OMT are very low at admission and discharge. Prescription of BB and MRA was associated with improved survival, highlighting the need for disease management programs and rigorous discharge management.
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14
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Falkenham A, Saraswat MK, Wong C, Gawdat K, Myers T, Begum J, Buth KJ, Haidl I, Marshall J, Légaré JF. Recovery free of heart failure after acute coronary syndrome and coronary revascularization. ESC Heart Fail 2017; 5:107-114. [PMID: 28737273 PMCID: PMC5793972 DOI: 10.1002/ehf2.12197] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Revised: 04/14/2017] [Accepted: 06/20/2017] [Indexed: 12/12/2022] Open
Abstract
Aims Previous studies have examined risk factors for the development of heart failure (HF) subsequent to acute coronary syndrome (ACS). Our study seeks to clarify the clinical variables that best characterize patients who remain free from HF after coronary artery bypass grafting (CABG) surgery for ACS to determine novel biological factors favouring freedom from HF in prospective translational studies. Methods and results Nova Scotia residents (1995–2012) undergoing CABG within 3 weeks of ACS were included. The primary outcome was freedom from readmission to hospital due to HF. Descriptive statistics were generated, and a Cox proportional hazards model assessed outcome with adjustment for clinical characteristics. Of 11 936 Nova Scotians who underwent isolated CABG, 3264 (27%) had a recent ACS and were included. Deaths occurred in 210 (6%) of subjects prior to discharge. A total of 3054 patients were included in the long‐term analysis. During follow‐up, HF necessitating readmission occurred in 688 (21%) subjects with a hazard ratio of 12% at 2 years. The adjusted Cox model demonstrated significantly better freedom from HF for younger, male subjects without metabolic syndrome and no history of chronic obstructive pulmonary disease, renal insufficiency, atrial fibrillation, or HF. Conclusions Our findings have outlined important clinical variables that predict freedom from HF. Furthermore, we have shown that 12% of patients undergoing CABG after ACS develop HF (2 years). Our findings support our next phase in which we plan to prospectively collect blood and tissue specimens from ACS patients undergoing CABG in order to determine novel biological mechanism(s) that favour resolution of post‐ACS inflammation.
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Affiliation(s)
- Alec Falkenham
- Department of Pathology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Manoj K Saraswat
- Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Chloe Wong
- Department of Pathology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Kareem Gawdat
- Department of Pathology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Tanya Myers
- Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Jahanara Begum
- Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Karen J Buth
- Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Ian Haidl
- Department of Microbiology and Immunology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Jean Marshall
- Department of Microbiology and Immunology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Jean-Francois Légaré
- Department of Pathology, Dalhousie University, Halifax, Nova Scotia, Canada.,Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada.,Department of Microbiology and Immunology, Dalhousie University, Halifax, Nova Scotia, Canada
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Barnason S, White-Williams C, Rossi LP, Centeno M, Crabbe DL, Lee KS, McCabe N, Nauser J, Schulz P, Stamp K, Wood K. Evidence for Therapeutic Patient Education Interventions to Promote Cardiovascular Patient Self-Management: A Scientific Statement for Healthcare Professionals From the American Heart Association. Circ Cardiovasc Qual Outcomes 2017. [DOI: 10.1161/hcq.0000000000000025] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Hobbs R, Korutla V, Suzuki Y, Acker M, Vallabhajosyula P. Mechanical Circulatory Support as a Bridge to Definitive Surgical Repair After Post-Myocardial Infarct Ventricular Septal Defect. J Card Surg 2015; 30:535-40. [DOI: 10.1111/jocs.12561] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Revised: 03/26/2015] [Accepted: 04/03/2015] [Indexed: 12/01/2022]
Affiliation(s)
- Reilly Hobbs
- Division of Cardiovascular Surgery; Department of Surgery; Hospital of the University of Pennsylvania; Philadelphia Pennsylvania
| | - Varun Korutla
- Division of Cardiovascular Surgery; Department of Surgery; Hospital of the University of Pennsylvania; Philadelphia Pennsylvania
| | - Yoshikazu Suzuki
- Division of Cardiovascular Surgery; Department of Surgery; Hospital of the University of Pennsylvania; Philadelphia Pennsylvania
| | - Michael Acker
- Division of Cardiovascular Surgery; Department of Surgery; Hospital of the University of Pennsylvania; Philadelphia Pennsylvania
| | - Prashanth Vallabhajosyula
- Division of Cardiovascular Surgery; Department of Surgery; Hospital of the University of Pennsylvania; Philadelphia Pennsylvania
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Bansal B, Mithal A, Carvalho P, Mehta Y, Trehan N. Feasibility, efficacy, and safety of a simple insulin infusion protocol in a large volume cardiac surgery unit in India. Indian J Endocrinol Metab 2015; 19:47-51. [PMID: 25593825 PMCID: PMC4287778 DOI: 10.4103/2230-8210.146864] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
AIM Inpatient hyperglycemia management is essential, but difficult to achieve especially in a large volume cardiac surgery setup, thus necessitating use of nurse-led insulin protocols. A rapid flux of nurses dealing with a huge workload has been a cause for traditionally not using nurse-led protocols in most Indian institutes. The challenges we faced were to have a simple protocol for the nurses to accept it without compromising on glycemic control. Therefore, this observational study was planned to measure the efficacy and safety of the insulin infusion protocol in cardiac surgery patients. MATERIALS AND METHODS Insulin protocol was implemented, using seven fixed columns of infusion with the nurse making decisions to initiate and titrate doses based on simple rules. Blood glucose (BG) data captured from blood gas analyzers (glucometrics) in the intervention group (i.e., after protocol implementation) were compared to control group (i.e., before the protocol implementation). RESULTS The mean BG for the first 48 h was lower in the intervention group as compared to control group, without an increase in the episodes of hypoglycemia. The nurses found the protocol easy to understand, less time-consuming and there was no protocol deviation over 8 months after implementation. CONCLUSION A small change in the process, allowing nurses to titrate insulin doses based on some rules and having seven fixed columns of insulin infusion rates, improved glycemic control and efficiency.
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Affiliation(s)
- Beena Bansal
- Division of Endocrinology and Diabetes, Medanta - The Medicity, Gurgaon, Haryana, India
| | - Ambrish Mithal
- Division of Endocrinology and Diabetes, Medanta - The Medicity, Gurgaon, Haryana, India
| | | | - Yatin Mehta
- Institute of Critical Care and Anesthesiology, Medanta - The Medicity, Gurgaon, Haryana, India
| | - Naresh Trehan
- Heart Institute-Division of Cardiothoracic and Vascular Surgery, Medanta - The Medicity, Gurgaon, Haryana, India
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