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Lee JS, Choi J, Shin HJ, Jung JM, Seo WK. Incidence and risk of stroke in Korean patients with congenital heart disease. J Stroke Cerebrovasc Dis 2023; 32:107408. [PMID: 37980821 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107408] [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: 03/21/2023] [Revised: 09/26/2023] [Accepted: 10/03/2023] [Indexed: 11/21/2023] Open
Abstract
OBJECTIVES The incidence and risk of ischemic stroke (IS) and hemorrhagic stroke (HS) in Korean patients with CHD have not been reported, therefore, we aimed to investigate this. MATERIALS AND METHODS Participants were selected from the Korean National Health Insurance Service benefit records from 2006-2017. Cases were extracted using diagnosis codes related to CHD. Controls without CHD were selected through age- and sex-matched random sampling at a 1:10 ratio. RESULTS The case and control groups included 232,203 and 3,024,633 participants, respectively. The median (interquartile range) follow-up period was 7.28 (3.59-8.73) years. The incidence rates of IS and HS per 100,000 person-years were much higher in cases than in controls (IS: 135 vs. 47; HS: 41.7 vs. 24.9). After adjusting for confounders, CHD was a risk factor for IS and HS (subdistribution HR; 1.96 and 1.71, respectively). In patients with CHD, the following risk factors were identified: diabetes, heart failure, and atrial fibrillation for any stroke; hypertension, atrial septal defects, and use of antiplatelet agents for IS only; and coronary artery bypass graft surgery for HS only. CONCLUSIONS Korean patients with CHD have a high risk of stroke. A personalized preventive approach is needed to reduce the incidence of stroke in this population.
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Affiliation(s)
- Jue Seong Lee
- Department of Pediatrics, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Jongun Choi
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hong Ju Shin
- Department of Thoracic and Cardiovascular Surgery, Myoungju Hospital, Yongin, Korea
| | - Jin-Man Jung
- Department of Neurology, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea; Korea University Zebrafish Translational Medical Research Center, Ansan, Korea.
| | - Woo-Keun Seo
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Brida M, De Rosa S, Legendre A, Ladouceur M, Dos Subira L, Scognamiglio G, Di Mario C, Roos-Hesselink J, Goossens E, Diller G, Gatzoulis MA. Acquired cardiovascular disease in adults with congenital heart disease. Eur Heart J 2023; 44:4533-4548. [PMID: 37758198 DOI: 10.1093/eurheartj/ehad570] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/03/2023] Open
Abstract
Rates of successful surgical repair and life expectancy for patients with congenital heart disease have increased dramatically in recent decades. Thanks to advances in diagnosis, treatment, and follow-up care, an ever-increasing number of individuals with congenital heart disease are reaching advanced age. The exposure to cardiovascular risk factors during their lifetime is modifying the outlook and late clinical trajectory of adult congenital heart disease (ACHD). Their disease burden is shifting from congenital to acquired, primarily atherosclerotic cardiovascular disease (ASCVD) with worrisome consequences. In addition, the complex background of ACHD often curbs appropriate preventive strategies by general practitioners or adult cardiologists. Comprehensive guidance for the prevention and management of acquired heart disease in ACHD patients is currently not available, as this topic has not been covered by the European Society of Cardiology (ESC) guidelines on cardiovascular disease prevention or the ESC guidelines for the management of ACHD. In this document, a state-of-the-art overview of acquired heart disease in ACHD patients and guidance on ASCVD prevention for both ACHD specialists and non-ACHD cardiologists are provided. The aim is to provide a clinical consensus statement to foster the development of a sustainable strategy for the prevention of ASCVD in a practical and simple-to-follow way in this ever-growing cardiovascular cohort, thus reducing their cardiovascular burden.
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Affiliation(s)
- Margarita Brida
- Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, Royal Brompton & Harefield Hospitals, Guys & St Thomas's NHS Trust and National Heart and Lung Institute, Imperial College, Sydney Street, London SW3 6NP, UK
- Department of Medical Rehabilitation, Medical Faculty, University of Rijeka, Croatia
| | - Salvatore De Rosa
- Department of Medical and Surgical Sciences, 'Magna Graecia' University, Catanzaro, Italy
| | - Antoine Legendre
- Congenital and Pediatric Cardiology, Adult Congenital Heart Disease Unit, Hôpital Européen Georges Pompidou, Paris, France
- Adult Congenital Heart Disease Unit, Hôpital Européen Georges Pompidou, Assistance Publique des Hôpitaux de Paris, Paris Cité University, Paris, France
| | - Magalie Ladouceur
- Adult Congenital Heart Disease Unit, Hôpital Européen Georges Pompidou, Assistance Publique des Hôpitaux de Paris, Paris Cité University, Paris, France
| | - Laura Dos Subira
- Unitat de Cardiopaties Congènites de l'Adolescent i de l'Adult (UCCAA); CIBERCV, European Reference Network for rare, low-prevalence, or complex diseases of the heart (ERN GUARD-Heart), Vall d'Hebron Hospital, Barcelona, Spain
| | | | - Carlo Di Mario
- Structural Interventional Cardiology, Department of Clinical & Experimental Medicine, Careggi University Hospital, Florence, Italy
| | | | - Eva Goossens
- Centre for Research and Innovation in Care, Faculty of Nursing, University of Antwerp, Antwerp, Belgium
| | - Gerhard Diller
- Department of Cardiology III-Adult Congenital and Valvular Heart Disease, University Hospital Muenster, Muenster, Germany
| | - Michael A Gatzoulis
- Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, Royal Brompton & Harefield Hospitals, Guys & St Thomas's NHS Trust and National Heart and Lung Institute, Imperial College, Sydney Street, London SW3 6NP, UK
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3
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Chi C, Knight WE, Riching AS, Zhang Z, Tatavosian R, Zhuang Y, Moldovan R, Rachubinski AL, Gao D, Xu H, Espinosa JM, Song K. Interferon hyperactivity impairs cardiogenesis in Down syndrome via downregulation of canonical Wnt signaling. iScience 2023; 26:107012. [PMID: 37360690 PMCID: PMC10285545 DOI: 10.1016/j.isci.2023.107012] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 05/03/2023] [Accepted: 05/28/2023] [Indexed: 06/28/2023] Open
Abstract
Congenital heart defects (CHDs) are frequent in children with Down syndrome (DS), caused by trisomy of chromosome 21. However, the underlying mechanisms are poorly understood. Here, using a human-induced pluripotent stem cell (iPSC)-based model and the Dp(16)1Yey/+ (Dp16) mouse model of DS, we identified downregulation of canonical Wnt signaling downstream of increased dosage of interferon (IFN) receptors (IFNRs) genes on chromosome 21 as a causative factor of cardiogenic dysregulation in DS. We differentiated human iPSCs derived from individuals with DS and CHDs, and healthy euploid controls into cardiac cells. We observed that T21 upregulates IFN signaling, downregulates the canonical WNT pathway, and impairs cardiac differentiation. Furthermore, genetic and pharmacological normalization of IFN signaling restored canonical WNT signaling and rescued defects in cardiogenesis in DS in vitro and in vivo. Our findings provide insights into mechanisms underlying abnormal cardiogenesis in DS, ultimately aiding the development of therapeutic strategies.
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Affiliation(s)
- Congwu Chi
- Division of Cardiology, Department of Medicine, University of Colorado Anschutz Medical Campus; Aurora, CO 80045, USA
- Linda Crnic Institute for Down Syndrome, University of Colorado Anschutz Medical Campus; Aurora, CO 80045, USA
- Gates Center for Regenerative Medicine and Stem Cell Biology, University of Colorado Anschutz Medical Campus; Aurora, CO 80045, USA
| | - Walter E. Knight
- Division of Cardiology, Department of Medicine, University of Colorado Anschutz Medical Campus; Aurora, CO 80045, USA
- Consortium for Fibrosis Research & Translation, University of Colorado Anschutz Medical Campus; Aurora, CO 80045, USA
| | - Andrew S. Riching
- Division of Cardiology, Department of Medicine, University of Colorado Anschutz Medical Campus; Aurora, CO 80045, USA
- Consortium for Fibrosis Research & Translation, University of Colorado Anschutz Medical Campus; Aurora, CO 80045, USA
| | - Zhen Zhang
- Division of Cardiology, Department of Medicine, University of Colorado Anschutz Medical Campus; Aurora, CO 80045, USA
| | - Roubina Tatavosian
- Linda Crnic Institute for Down Syndrome, University of Colorado Anschutz Medical Campus; Aurora, CO 80045, USA
- Department of Pharmacology, University of Colorado Anschutz Medical Campus; Aurora, CO 80045, USA
| | - Yonghua Zhuang
- Department of Pediatrics, University of Colorado Anschutz Medical Campus; Aurora, CO 80045, USA
| | - Radu Moldovan
- Department of Pharmacology, University of Colorado Anschutz Medical Campus; Aurora, CO 80045, USA
| | - Angela L. Rachubinski
- Linda Crnic Institute for Down Syndrome, University of Colorado Anschutz Medical Campus; Aurora, CO 80045, USA
- Department of Pediatrics, University of Colorado Anschutz Medical Campus; Aurora, CO 80045, USA
| | - Dexiang Gao
- Department of Pediatrics, University of Colorado Anschutz Medical Campus; Aurora, CO 80045, USA
| | - Hongyan Xu
- Department of Population Health Sciences, Medical College of Georgia, Augusta University; Augusta, GA 30912, USA
| | - Joaquin M. Espinosa
- Linda Crnic Institute for Down Syndrome, University of Colorado Anschutz Medical Campus; Aurora, CO 80045, USA
- Department of Pharmacology, University of Colorado Anschutz Medical Campus; Aurora, CO 80045, USA
| | - Kunhua Song
- Division of Cardiology, Department of Medicine, University of Colorado Anschutz Medical Campus; Aurora, CO 80045, USA
- Linda Crnic Institute for Down Syndrome, University of Colorado Anschutz Medical Campus; Aurora, CO 80045, USA
- Gates Center for Regenerative Medicine and Stem Cell Biology, University of Colorado Anschutz Medical Campus; Aurora, CO 80045, USA
- Consortium for Fibrosis Research & Translation, University of Colorado Anschutz Medical Campus; Aurora, CO 80045, USA
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4
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Yu M, Aguirre M, Jia M, Gjoni K, Cordova-Palomera A, Munger C, Amgalan D, Ma XR, Pereira A, Tcheandjieu C, Seidman C, Seidman J, Tristani-Firouzi M, Chung W, Goldmuntz E, Srivastava D, Loos RJ, Chami N, Cordell H, Dreßen M, Mueller-Myhsok B, Lahm H, Krane M, Pollard KS, Engreitz JM, Gagliano Taliun SA, Gelb BD, Priest JR. Oligogenic Architecture of Rare Noncoding Variants Distinguishes 4 Congenital Heart Disease Phenotypes. CIRCULATION. GENOMIC AND PRECISION MEDICINE 2023; 16:258-266. [PMID: 37026454 PMCID: PMC10330096 DOI: 10.1161/circgen.122.003968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 01/29/2023] [Indexed: 05/10/2023]
Abstract
BACKGROUND Congenital heart disease (CHD) is highly heritable, but the power to identify inherited risk has been limited to analyses of common variants in small cohorts. METHODS We performed reimputation of 4 CHD cohorts (n=55 342) to the TOPMed reference panel (freeze 5), permitting meta-analysis of 14 784 017 variants including 6 035 962 rare variants of high imputation quality as validated by whole genome sequencing. RESULTS Meta-analysis identified 16 novel loci, including 12 rare variants, which displayed moderate or large effect sizes (median odds ratio, 3.02) for 4 separate CHD categories. Analyses of chromatin structure link 13 of the genome-wide significant loci to key genes in cardiac development; rs373447426 (minor allele frequency, 0.003 [odds ratio, 3.37 for Conotruncal heart disease]; P=1.49×10-8) is predicted to disrupt chromatin structure for 2 nearby genes BDH1 and DLG1 involved in Conotruncal development. A lead variant rs189203952 (minor allele frequency, 0.01 [odds ratio, 2.4 for left ventricular outflow tract obstruction]; P=1.46×10-8) is predicted to disrupt the binding sites of 4 transcription factors known to participate in cardiac development in the promoter of SPAG9. A tissue-specific model of chromatin conformation suggests that common variant rs78256848 (minor allele frequency, 0.11 [odds ratio, 1.4 for Conotruncal heart disease]; P=2.6×10-8) physically interacts with NCAM1 (PFDR=1.86×10-27), a neural adhesion molecule acting in cardiac development. Importantly, while each individual malformation displayed substantial heritability (observed h2 ranging from 0.26 for complex malformations to 0.37 for left ventricular outflow tract obstructive disease) the risk for different CHD malformations appeared to be separate, without genetic correlation measured by linkage disequilibrium score regression or regional colocalization. CONCLUSIONS We describe a set of rare noncoding variants conferring significant risk for individual heart malformations which are linked to genes governing cardiac development. These results illustrate that the oligogenic basis of CHD and significant heritability may be linked to rare variants outside protein-coding regions conferring substantial risk for individual categories of cardiac malformation.
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Affiliation(s)
- Mengyao Yu
- Dept of Pediatrics, Stanford Univ School of Medicine
| | - Matthew Aguirre
- Dept of Pediatrics, Stanford Univ School of Medicine
- Dept of Biomedical Data Science, Stanford Univ, Stanford CA
| | - Meiwen Jia
- Dept of Translational Research in Psychiatry, Max Planck Institute of Psychiatry Munich, Munich, Germany
| | - Ketrin Gjoni
- Gladstone Institutes; Univ of California San Francisco, San Francisco CA
| | | | - Chad Munger
- Dept of Genetics, Stanford Univ School of Medicine
| | | | - X Rosa Ma
- Dept of Genetics, Stanford Univ School of Medicine
| | | | - Catherine Tcheandjieu
- Dept of Pediatrics, Stanford Univ School of Medicine
- Gladstone Institutes; Univ of California San Francisco, San Francisco CA
| | | | | | | | - Wendy Chung
- Dept of Pediatrics, Columbia Univ, New York, NY
| | | | - Deepak Srivastava
- Gladstone Institutes; Univ of California San Francisco, San Francisco CA
| | | | | | - Heather Cordell
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle Univ, International Centre for Life, Central Parkway, Newcastle upon Tyne, United Kingdom
| | - Martina Dreßen
- Dept of Cardiovascular Surgery, Division of Experimental Surgery, Institute Insure (Institute for Translational Cardiac Surgery), German Heart Center Munich & Technical Univ of Munich, School of Medicine & Health, Munich, Germany
| | - Bertram Mueller-Myhsok
- Dept of Translational Research in Psychiatry, Max Planck Institute of Psychiatry Munich, Munich, Germany
| | - Harald Lahm
- Dept of Cardiovascular Surgery, Division of Experimental Surgery, Institute Insure (Institute for Translational Cardiac Surgery), German Heart Center Munich & Technical Univ of Munich, School of Medicine & Health, Munich, Germany
| | - Markus Krane
- Dept of Cardiovascular Surgery, Division of Experimental Surgery, Institute Insure (Institute for Translational Cardiac Surgery), German Heart Center Munich & Technical Univ of Munich, School of Medicine & Health, Munich, Germany
- Dept of Cardiac Surgery, Yale School of Medicine, New Haven, CT
| | - Katherine S. Pollard
- Gladstone Institutes; Univ of California San Francisco, San Francisco CA
- Chan Zuckerberg Biohub, San Francisco
| | - Jesse M. Engreitz
- Dept of Genetics, Stanford Univ School of Medicine
- Basic Sciences and Engineering (BASE) Initiative, Betty Irene Moore Children’s Heart Center, Lucile Packard Children’s Hospital, Stanford, CA
| | - Sarah A. Gagliano Taliun
- Dept of Medicine & Dept of Neurosciences, Faculty of Medicine, Université de Montréal
- Montreal Heart Institute, Montreal, Quebec, Canada
| | - Bruce D. Gelb
- The Mindich Child Health & Development Institute at the Hess Center for Science & Medicine at Mount Sinai, New York, NY
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Lawless L, Xie L, Zhang K. The inter- and multi- generational epigenetic alterations induced by maternal cadmium exposure. Front Cell Dev Biol 2023; 11:1148906. [PMID: 37152287 PMCID: PMC10157395 DOI: 10.3389/fcell.2023.1148906] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 04/12/2023] [Indexed: 05/09/2023] Open
Abstract
Exposure to cadmium during pregnancy, from environmental or lifestyle factors, has been shown to have detrimental fetal and placental developmental effects, along with negatively impacting maternal health during gestation. Additionally, prenatal cadmium exposure places the offspring at risk for developing diseases in infancy, adolescence, and adulthood. Although given much attention, the underlying mechanisms of cadmium-induced teratogenicity and disease development remain largely unknown. Epigenetic changes in DNA, RNA and protein modifications have been observed during cadmium exposure, which implies a scientific premise as a conceivable mode of cadmium toxicity for developmental origins of health and disease (DOHaD). This review aims to examine the literature and provide a comprehensive overview of epigenetic alterations induced by prenatal cadmium exposure, within the developing fetus and placenta, and the continued effects observed in childhood and across generations.
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Affiliation(s)
- Lauren Lawless
- Institute of Bioscience and Technology, Texas A&M University, Houston, TX, United States
- Department of Nutrition, Texas A&M University, College Station, TX, United States
| | - Linglin Xie
- Department of Nutrition, Texas A&M University, College Station, TX, United States
| | - Ke Zhang
- Institute of Bioscience and Technology, Texas A&M University, Houston, TX, United States
- Department of Nutrition, Texas A&M University, College Station, TX, United States
- *Correspondence: Ke Zhang,
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Fox KR, Vannatta K, Jackson JL. Difficulties With Executive Function Are Associated With Risky Health Behaviors Among Young Adult Congenital Heart Defect Survivors. J Cardiovasc Nurs 2023; 38:60-69. [PMID: 36037294 PMCID: PMC9771948 DOI: 10.1097/jcn.0000000000000941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Adults with congenital heart defects (CHDs) have an increased risk for cardiovascular complications, but few are in optimal cardiovascular health. Executive function deficits, which are elevated among CHD survivors, may contribute to engagement in behaviors that increase cardiovascular risk. OBJECTIVE The aim of this study was to identify the association between executive function and the health risk behaviors of tobacco use, saturated fat intake, and insufficient physical activity among young adults with CHDs. METHODS Young adults with CHDs completed the Behavior Rating Inventory of Executive Function-Adult Version, which yields composite and 9 individual domain scores (eg, inhibition, working memory). Participants also completed self-report measures of tobacco use, saturated fat intake, and physical activity. Linear and logistic regression models determined the association between executive function and risky health behaviors, adjusting for demographic factors, disease status, and emotional distress. RESULTS One in 10 young adults with CHDs reported clinically significant difficulties with global executive function. Difficulties with global executive function were associated with increased tobacco use ( P = .018) and greater saturated fat intake ( P = .015) but not insufficient physical activity ( P = .902). Difficulties with inhibition were specifically associated with increased tobacco use ( P = .003) and greater saturated fat intake ( P = .007), and problems with self-monitoring were associated with increased tobacco use ( P = .017). CONCLUSIONS Executive function difficulties are associated with self-reported engagement in health risk behaviors among young adults with CHDs. Health behavior interventions for adult CHD survivors may require additional modifications that consider executive function problems, particularly difficulties with inhibition.
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El-Chouli M, Meddis A, Christensen DM, Gerds TA, Sehested T, Malmborg M, Phelps M, Bang CN, Ahlehoff O, Torp-Pedersen C, Sindet-Pedersen C, Raunsø J, Idorn L, Gislason G. Lifetime risk of comorbidity in patients with simple congenital heart disease: a Danish nationwide study. Eur Heart J 2022; 44:741-748. [PMID: 36477305 PMCID: PMC9976987 DOI: 10.1093/eurheartj/ehac727] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 10/25/2022] [Accepted: 11/23/2022] [Indexed: 12/12/2022] Open
Abstract
AIMS In a continuously ageing population of patients with congenital heart disease (CHD), understanding the long-term risk of morbidity is crucial. The aim of this study was to compare the lifetime risks of developing comorbidities in patients with simple CHD and matched controls. METHODS AND RESULTS Using the Danish nationwide registers spanning from 1977 to 2018, simple CHD cases were defined as isolated atrial septal defect (ASD), ventricular septal defect (VSD), pulmonary stenosis, or patent ductus arteriosus in patients surviving until at least 5 years of age. There were 10 controls identified per case. Reported were absolute lifetime risks and lifetime risk differences (between patients with simple CHD and controls) of incident comorbidities stratified by groups and specific cardiovascular comorbidities. Of the included 17 157 individuals with simple CHD, the largest subgroups were ASD (37.7%) and VSD (33.9%), and 52% were females. The median follow-up time for patients with CHD was 21.2 years (interquartile range: 9.4-39.0) and for controls, 19.8 years (9.0-37.0). The lifetime risks for the investigated comorbidities were higher and appeared overall at younger ages for simple CHD compared with controls, except for neoplasms and chronic kidney disease. The lifetime risk difference among the comorbidity groups was highest for neurological disease (male: 15.2%, female: 11.3%), pulmonary disease (male: 9.1%, female: 11.7%), and among the specific comorbidities for stroke (male: 18.9%, female: 11.4%). The overall risk of stroke in patients with simple CHD was mainly driven by ASD (male: 28.9%, female: 17.5%), while the risks of myocardial infarction and heart failure were driven by VSD. The associated lifetime risks of stroke, myocardial infarction, and heart failure in both sexes were smaller in invasively treated patients compared with untreated patients with simple CHD. CONCLUSION Patients with simple CHD had increased lifetime risks of all comorbidities compared with matched controls, except for neoplasms and chronic kidney disease. These findings highlight the need for increased attention towards early management of comorbidity risk factors.
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Affiliation(s)
| | - Alessandra Meddis
- Section of Biostatistics, University of Copenhagen, Copenhagen, Denmark
| | | | - Thomas A Gerds
- Danish Heart Foundation, Vognmagergade 7, 1120 Copenhagen, Denmark,Section of Biostatistics, University of Copenhagen, Copenhagen, Denmark
| | - Thomas Sehested
- Danish Heart Foundation, Vognmagergade 7, 1120 Copenhagen, Denmark,Department of Cardiology, Roskilde University Hospital, Zealand, Denmark
| | - Morten Malmborg
- Danish Heart Foundation, Vognmagergade 7, 1120 Copenhagen, Denmark
| | - Matthew Phelps
- Danish Heart Foundation, Vognmagergade 7, 1120 Copenhagen, Denmark
| | - Casper N Bang
- Department of Cardiology, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Ole Ahlehoff
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Christian Torp-Pedersen
- Departments of Clinical Investigation and Cardiology, North Zealand University Hospital, Hillerød, Denmark
| | | | - Jakob Raunsø
- Department of Cardiology, Copenhagen University Hospital, Herlev and Gentofte, Herlev, Denmark
| | - Lars Idorn
- Department of Pediatric Cardiology, Rigshospitalet, Copenhagen, Denmark
| | - Gunnar Gislason
- Danish Heart Foundation, Vognmagergade 7, 1120 Copenhagen, Denmark,Department of Cardiology, Copenhagen University Hospital, Herlev and Gentofte, Hellerup, Denmark,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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8
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Lee JS, Jung JM, Choi J, Seo WK, Shin HJ. Major Adverse Cardiovascular Events in Korean Congenital Heart Disease Patients: A Nationwide Age- and Sex-Matched Case-Control Study. Yonsei Med J 2022; 63:1069-1077. [PMID: 36444542 PMCID: PMC9760894 DOI: 10.3349/ymj.2022.0111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 09/30/2022] [Accepted: 10/11/2022] [Indexed: 11/12/2022] Open
Abstract
PURPOSE Congenital heart disease (CHD) is a known risk factor for acquired cardiovascular and cerebrovascular diseases. However, available evidence on CHD is limited mostly to Western populations. This study aimed to evaluate the prevalence of vascular events and all-cause mortality in Korean patients with CHD and to further corroborate CHD as a predictor of vascular events and all-cause mortality. MATERIALS AND METHODS The claims data of the Korean National Health Insurance Service (NHIS) were retrospectively reviewed. Information regarding diagnostic codes, comorbidities, medical services, income level, and residential area was also collected. Outcomes of interest included stroke, myocardial infarction (MI), all-cause mortality, and major adverse cardiovascular events (MACE). RESULTS We included 232203 patients with CHD and 3024633 individuals without CHD as a control group through age- and sex-matched 1:10 random sampling. The prevalences of hypertension, congestive heart failure, ischemic heart disease, hyperlipidemia, and atrial fibrillation were significantly higher in the CHD group, which had a more than two-fold higher incidence of vascular events and all-cause mortality, than in the group without CHD. Multivariable models demonstrated that CHD was a significant risk factor for stroke, MI, all-cause mortality, and MACE. CONCLUSION In conclusion, this nationwide study demonstrates that Korean patients with CHD have a high incidence of comorbidities, vascular events, and mortality. CHD has been established as an important predictor of cardiovascular events. Further studies are warranted to identify high-risk patients with CHD and related factors to prevent vascular events.
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Affiliation(s)
- Jue Seong Lee
- Department of Pediatrics, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Jin-Man Jung
- Department of Neurology, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
- \nKorea University Zebrafish Translational Medical Research Center, Ansan, Korea
| | - Jongun Choi
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Woo-Keun Seo
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
| | - Hong Ju Shin
- Department of Thoracic and Cardiovascular Surgery, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea.
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Graham G, Dearani JA, Abdelrehim AA, Miranda WR, Schaff H, Stulak JM, Todd AL, Stephens EH. Early and Mid-Term Outcomes of Coronary Artery Bypass Grafting in Adults With Congenital Heart Disease. Semin Thorac Cardiovasc Surg 2022; 36:82-90. [PMID: 36334861 DOI: 10.1053/j.semtcvs.2022.10.007] [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: 10/12/2022] [Accepted: 10/24/2022] [Indexed: 11/06/2022]
Abstract
Atherosclerotic coronary artery disease (CAD) is well-studied in acquired cardiac diseases; however, little data exist regarding outcomes of adult congenital heart disease (ACHD) with CAD. This study examined patients who underwent coronary artery bypass grafting (CABG) during repair of ACHD. This was a retrospective study of patients who underwent CABG for CAD concomitant with ACHD repair 1972-2021. Demographic information, ACHD diagnosis, surgical history, operative details, and outcomes were analyzed. Data are presented as median (interquartile range [IQR]). 157 patients were identified with a median age of 63 (IQR 17) years. Left anterior descending (LAD) was the predominant diseased artery (109 patients [69%]); of those 83 (76%) were treated with mammary artery. 90 (57.3%) patients had 1 bypass, 42 (26.7%) 2, 19 (12%) 3, and 6 (3.8%) had 4. There has been no early mortality since 1988. There was no long-term survival difference between the patients with LAD disease treated with mammary compared to vein (P = 0.68), but early mortality was higher in those treated with vein (10.3% vs 0%, P = 0.018). Late recurrent angina was found in 18 patients (12%) and recurrent CAD found in 17 patients (11%), with 16 patients (10%) requiring CAD reintervention. At most recent follow-up (7.2 [IQR 11.4] years), 101 (64.3%) patients were deceased at 10 (IQR 13.1) years after surgery. Surgical revascularization for CAD may be necessary during the treatment of ACHD, most commonly for LAD disease. Early mortality was low in recent decades. Continued surveillance for recurrent CAD is required.
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Affiliation(s)
- Gabriel Graham
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota
| | - Joseph A Dearani
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota
| | | | - William R Miranda
- Department of Cardiovascular Diseases, Division of Clinical Trials and Biostatistics, Mayo Clinic, Rochester, Minnesota
| | - Hartzell Schaff
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota
| | - John M Stulak
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota
| | - Ausitn L Todd
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota
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10
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The Link between Stroke Risk and Orodental Status-A Comprehensive Review. J Clin Med 2022; 11:jcm11195854. [PMID: 36233721 PMCID: PMC9572898 DOI: 10.3390/jcm11195854] [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: 09/01/2022] [Revised: 09/21/2022] [Accepted: 09/29/2022] [Indexed: 11/17/2022] Open
Abstract
One of the primary causes of disability and mortality in the adult population worldwide is stroke. A person's general health is significantly impacted by their oral and dental health. People who have poor oral health are more susceptible to conditions such as stroke. Stroke risk has long been linked to oral and dental conditions. The risk of stroke and its cost impact on the healthcare systems appear to be significantly reduced as a result of the decline in the incidence and prevalence of oral and dental illnesses. Hypothetically, better management of oral hygiene and dental health lead to reduced stroke risk. To the authors' best knowledge, for the first time, the potential link between dental health and stroke were cross-examined. The most typical stroke symptoms, oral and dental illnesses linked to stroke, and the role of oral healthcare professionals in stroke prevention are revealed. The potential mediating processes and subsequent long-term cognitive and functional neurological outcomes are based on the available literature. It must be noted that periodontal diseases and tooth loss are two common oral health measures. Lack of knowledge on the effects of poor oral health on systemic health together with limited access to primary medical or dental care are considered to be partially responsible for the elevated risk of stroke. Concrete evidence confirming the associations between oral inflammatory conditions and stroke in large cohort prospective studies, stratifying association between oral disease severity and stroke risk and disease effects on stroke survival will be desirable. In terms of clinical pathology, a predictive model of stroke as a function of oral health status, and biomarkers of systemic inflammation could be useful for both cardiologists and dentists.
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11
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Diaz P, Coughlin W, Lam W, Ermis P, Aguilar D, Ganduglia Cazaban CM, Agopian AJ. Describing characteristics of adults with and without congenital heart defects hospitalized with COVID-19. Birth Defects Res 2022; 114:652-661. [PMID: 35689527 PMCID: PMC9349963 DOI: 10.1002/bdr2.2052] [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: 03/11/2022] [Revised: 05/19/2022] [Accepted: 05/20/2022] [Indexed: 12/05/2022]
Abstract
Background We sought to describe patient characteristics in adults with and without congenital heart defects (CHDs) during hospitalization for COVID‐19. Methods We analyzed data collected by Optum®, a nationally representative database of electronic medical records, for 369 adults with CHDs and 41,578 without CHDs hospitalized for COVID‐19 between January 1, 2020, and December 10, 2020. We used Poisson regression to describe and compare epidemiologic characteristics, heart‐related conditions, and severe outcomes between these two groups. Results The distributions of many epidemiologic characteristics were similar between the two groups, but patients with CHDs were significantly more likely to be current or former smokers compared to patients without CHDs (risk ratio [RR]: 1.5, 95% confidence interval [CI]: 1.2, 1.8). Patients with CHDs were also significantly more likely to have heart failure, stroke, acute arrhythmia, myocardial injury, acute pulmonary hypertension, venous thromboembolism, and obesity documented at the time of the COVID‐19 hospitalization (RR range: 1.5–4.7) but not respiratory failure. Patients with CHDs (7 days) had a significantly longer median length of stay than those without CHDs (5 days; p < .001) and were significantly more likely to have an intensive care unit (ICU) admission (RR: 1.6, 95 CI: 1.2–1.9). Conclusions Our description of patients among a large population improves our understanding of the clinical course of COVID‐19 among adults with CHDs. Adults with CHD appear to be at greater risk for more severe CHD, including greater risk of ICU admission and longer length of hospital stays.
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Affiliation(s)
- Perla Diaz
- Department of Epidemiology, Human Genetics and Environmental Sciences, UTHealth School of Public Health, Houston, Texas, USA
| | - Will Coughlin
- Management, Policy and Community Health, The University of Texas Health Science Centre at Houston
| | - Wilson Lam
- Section of Cardiology, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA
| | - Peter Ermis
- Section of Cardiology, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA
| | - David Aguilar
- Department of Epidemiology, Human Genetics and Environmental Sciences, UTHealth School of Public Health, Houston, Texas, USA.,Division of Cardiology, University of Texas McGovern Medical School, Houston, Texas, USA
| | | | - A J Agopian
- Department of Epidemiology, Human Genetics and Environmental Sciences, UTHealth School of Public Health, Houston, Texas, USA
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12
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Sadeq A, Baraka MA, Hamrouni A, Elnour AA. Retrospective cohort study on risk factors for developing ischemic stroke. Pharm Pract (Granada) 2022; 20:2682. [PMID: 36733525 PMCID: PMC9851832 DOI: 10.18549/pharmpract.2022.3.2682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 06/20/2022] [Indexed: 02/05/2023] Open
Abstract
Background There is a paucity of studies describing the risk factors for developing ischemic stroke in our region. Objective The objective of the current study was to delineate the potential risk factors for the development of ischemic stroke. Methods We have conducted a retrospective cohort hospitalbased study that has enrolled 231 subjects. The subjects have had presented to the emergency department in a tertiary hospital in the United Arab Emirates. Subjects were diagnosed with ischemic stroke within 24 hours of presentation. Outcome measure The main outcome measure was the development of ischemic stroke during an indexed hospital visit. Results The mean age was 47.5 ±3.2 with a higher preponderance of males over females (60.9%) and 48.1% were ≥ 65 years. The final logistic regression model for the development of ischemic stroke contains seven variables. In descending order, the seven predictive risk factors for the development of ischemic stroke were: hypertension (OR 6.1, CI 2.4-9.5; P = 0.029), coronary artery disease (OR 4.2, 3.7-9.1; P = 0.038), low physical activity (OR 4.2, CI 2.1-9.1; P = 0.035), history of previous stroke (OR 4.1, 1.4-3.4; P = 0.033), atrial fibrillation (OR 3.2, CI 2.6-8.2; P = 0.017), family history of stroke (OR 3.1, 1.3-6.9; P = 0.042) and diabetes mellitus (OR 2.7, CI 1.25-6.1; P = 0.035). The specificity of the model was 58.1%; the sensitivity was 86.1%, and the overall accuracy was 75.7%. Conclusion It is prudent to control modifiable risk factors for the development of strokes such as hypertension, diabetes, atrial fibrillation, coronary artery disease, and low physical activity.
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Affiliation(s)
- Adel Sadeq
- PhD, MSc. Assistant Professor, Program of Clinical Pharmacy, College of Pharmacy, Al Ain University, Al Ain-UAE, United Arab Emirates.
| | - Mohamed A Baraka
- PhD, MSc. Assistant professor, Clinical Pharmacy department, College of Pharmacy, Al Ain University, Al Ain campus, United Arab Emirates, Assistant professor, Clinical Pharmacy department, College of Pharmacy, Al-Azhar University, Cairo, Egypt. mohamed. ,
| | - Amar Hamrouni
- PhD, MSc. Assistant Professor, Program of Clinical Pharmacy, College of Pharmacy, Al Ain University, Al Ain-UAE, United Arab Emirates.
| | - Asim Ahmed Elnour
- PhD, MSc. Program of Clinical Pharmacy, College of Pharmacy, AAU Health and Biomedical Research Center, Al Ain University, Abu Dhabi, United Arab
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13
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Zarouni SA, Mheiri NMA, Blooshi KA, Serkal YA, Preman N, Naqvi SA, Khan Y. Impact of an electronic medical record-based automated screening program for critical congenital heart disease: Emirates Health Services, United Arab Emirates. BMC Med Inform Decis Mak 2022; 22:165. [PMID: 35729549 PMCID: PMC9214992 DOI: 10.1186/s12911-022-01900-y] [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: 11/29/2021] [Accepted: 06/02/2022] [Indexed: 11/30/2022] Open
Abstract
Background Almost eight children per 1000 live births are expected to have a congenital heart defect globally. The seven most critical congenital heart conditions that cause severe compromise on the patient’s quality and duration of life are collectively referred to as the Critical Congenital Heart Diseases (CCHD). CCHD is a critical condition that requires prompt detection and intervention as a life-saving measure. Pulse oximetry is a non-invasive, highly specific, and moderately sensitive method that can be used for screening new-borns for CCHD. The Emirates Health Services (EHS), UAE, adopted a strategy of developing a stringent program for newborn screening of Critical Congenital Heart disease, which would help in the early diagnosis and treatment of CCHD patients. An automated EMR (Wareed) driven solution was introduced to enhance this program as part of the routine workflow for the nurse care providers.
Methods Our study is a retrospective observational study that aims to understand: the prevalence of CCHD in our target population and to study the impact of an automated program on screening compliance and its implications for early diagnosis of CCHD.
Results We found that an EMR-driven automated screening program was highly effective in achieving high compliance (98.9%). It created a (statistically significant) improvement in the disease identification for CCHD in live births at EHS facilities.
Conclusion We conclude that implementing an automated protocol through the EMR can effectively improve new-born screening coverage. It reduces the days to CCHD diagnosis, which would improve health outcomes in neonates.
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Affiliation(s)
| | | | | | | | | | | | - Yasir Khan
- Cerner Middle East, Dubai, United Arab Emirates
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14
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Thangappan K, Haney LC, Riggs K, Chen S, Mehegan M, VanderPluym C, Woods R, LaPar D, Lorts A, Zafar F, Morales DLS. Children who stroke on VAD support: when is it safe to transplant and what are their outcomes? Artif Organs 2022; 46:1389-1398. [PMID: 35132634 DOI: 10.1111/aor.14194] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 11/04/2021] [Accepted: 11/29/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Ventricular assist devices (VADs) increase waitlist survival, yet the risk of stroke remains notable. The purpose of this study was to analyze how strokes on VAD support impact post-transplant (post-Tx) outcomes in children. METHODS 520 pediatric (<18 yo) heart transplant candidates listed from January 2011 to April 2018 with a VAD implant date were matched between the United Network of Organ Sharing and Pediatric Health Information System databases. Patients were divided into pre-Tx Stroke and No Stroke cohorts. RESULTS 81% of the 520 patients were transplanted. 28% (n=146) had a pre-Tx Stroke. 59% (n=89) of the Stroke patients were transplanted at a median of 57 (IQR 17-102) days from stroke. Significantly more No Stroke cohort (90%) were transplanted (p<0.001). There was no difference in post-Tx survival between the Stroke and No Stroke cohorts (p=0.440). Time between stroke and transplant for patients who died within one year of transplant was 32.0 days (median) compared to 60.5 days for those alive > 1year (p=0.18). Regarding patients in whom time from stroke to transplant was more than 60 days, one-year survival of Stroke vs. No Stroke patients was 96% vs. 95% (p=0.811), respectively. CONCLUSION Patients with stroke during VAD support, once transplanted, enjoy similar survival compared to No Stroke patients. We hypothesize that allowing Stroke patients more time to recover could improve post-Tx outcomes. Unfortunately, the ideal duration of time between stroke and safe transplantation could not be determined and will require more detailed and larger studies in the future.
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Affiliation(s)
- Karthik Thangappan
- Department of Cardiothoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Li Cai Haney
- Department of Cardiothoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Kyle Riggs
- Division of Cardiothoracic Surgery, Cohen Children's Medical Center, New Hyde Park, NY, USA
| | - Sharon Chen
- Division of Pediatric Cardiology, Lucile Packard Children's Hospital Stanford, Palo Alto, CA, USA
| | - Mary Mehegan
- Division of Cardiothoracic Surgery, St. Louis Children's Hospital, Saint Louis, MO, USA
| | | | - Ronald Woods
- Division of Congenital Heart Surgery, Children's Hospital of Wisconsin, Milwaukee, WI, USA
| | - Damien LaPar
- Department of Pediatric Cardiac Surgery, Columbia University Irving Medical Center, New York, NY, USA
| | - Angela Lorts
- Department of Cardiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Farhan Zafar
- Department of Cardiothoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - David L S Morales
- Department of Cardiothoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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15
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Pinson MR, Chung DD, Adams AM, Scopice C, Payne EA, Sivakumar M, Miranda RC. Extracellular Vesicles in Premature Aging and Diseases in Adulthood Due to Developmental Exposures. Aging Dis 2021; 12:1516-1535. [PMID: 34527425 PMCID: PMC8407878 DOI: 10.14336/ad.2021.0322] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 03/22/2021] [Indexed: 12/12/2022] Open
Abstract
The developmental origins of health and disease (DOHaD) is a paradigm that links prenatal and early life exposures that occur during crucial periods of development to health outcome and risk of disease later in life. Maternal exposures to stress, some psychoactive drugs and alcohol, and environmental chemicals, among others, may result in functional changes in developing fetal tissues, creating a predisposition for disease in the individual as they age. Extracellular vesicles (EVs) may be mediators of both the immediate effects of exposure during development and early childhood as well as the long-term consequences of exposure that lead to increased risk and disease severity later in life. Given the prevalence of diseases with developmental origins, such as cardiovascular disease, neurodegenerative disorders, osteoporosis, metabolic dysfunction, and cancer, it is important to identify persistent mediators of disease risk. In this review, we take this approach, viewing diseases typically associated with aging in light of early life exposures and discuss the potential role of EVs as mediators of lasting consequences.
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Affiliation(s)
- Marisa R Pinson
- Department of Neuroscience and Experimental Therapeutics, Texas A&M University Health Science Center, Bryan, TX 77807, USA
| | - Dae D Chung
- Department of Neuroscience and Experimental Therapeutics, Texas A&M University Health Science Center, Bryan, TX 77807, USA
| | - Amy M Adams
- Department of Neuroscience and Experimental Therapeutics, Texas A&M University Health Science Center, Bryan, TX 77807, USA
| | - Chiara Scopice
- Department of Neuroscience and Experimental Therapeutics, Texas A&M University Health Science Center, Bryan, TX 77807, USA
| | - Elizabeth A Payne
- Department of Neuroscience and Experimental Therapeutics, Texas A&M University Health Science Center, Bryan, TX 77807, USA
| | - Monisha Sivakumar
- Department of Neuroscience and Experimental Therapeutics, Texas A&M University Health Science Center, Bryan, TX 77807, USA
| | - Rajesh C Miranda
- Department of Neuroscience and Experimental Therapeutics, Texas A&M University Health Science Center, Bryan, TX 77807, USA
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16
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Chung DD, Pinson MR, Bhenderu LS, Lai MS, Patel RA, Miranda RC. Toxic and Teratogenic Effects of Prenatal Alcohol Exposure on Fetal Development, Adolescence, and Adulthood. Int J Mol Sci 2021; 22:ijms22168785. [PMID: 34445488 PMCID: PMC8395909 DOI: 10.3390/ijms22168785] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 08/08/2021] [Accepted: 08/11/2021] [Indexed: 12/12/2022] Open
Abstract
Prenatal alcohol exposure (PAE) can have immediate and long-lasting toxic and teratogenic effects on an individual’s development and health. As a toxicant, alcohol can lead to a variety of physical and neurological anomalies in the fetus that can lead to behavioral and other impairments which may last a lifetime. Recent studies have focused on identifying mechanisms that mediate the immediate teratogenic effects of alcohol on fetal development and mechanisms that facilitate the persistent toxic effects of alcohol on health and predisposition to disease later in life. This review focuses on the contribution of epigenetic modifications and intercellular transporters like extracellular vesicles to the toxicity of PAE and to immediate and long-term consequences on an individual’s health and risk of disease.
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17
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Fedchenko M, Mandalenakis Z, Giang KW, Rosengren A, Eriksson P, Dellborg M. Long-term outcomes after myocardial infarction in middle-aged and older patients with congenital heart disease-a nationwide study. Eur Heart J 2021; 42:2577-2586. [PMID: 33219678 PMCID: PMC8266664 DOI: 10.1093/eurheartj/ehaa874] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 07/28/2020] [Accepted: 10/07/2020] [Indexed: 11/16/2022] Open
Abstract
Aims We aimed to describe the risk of myocardial infarction (MI) in middle-aged and older patients with congenital heart disease (ACHD) and to evaluate the long-term outcomes after index MI in patients with ACHD compared with controls. Methods and results A search of the Swedish National Patient Register identified 17 189 patients with ACHD (52.2% male) and 180 131 age- and sex-matched controls randomly selected from the general population who were born from 1930 to 1970 and were alive at 40 years of age; all followed up until December 2017 (mean follow-up 23.2 ± 11.0 years). Patients with ACHD had a 1.6-fold higher risk of MI compared with controls [hazard ratio (HR) 1.6, 95% confidence interval (CI) 1.5–1.7, P < 0.001] and the cumulative incidence of MI by 65 years of age was 7.4% in patients with ACHD vs. 4.4% in controls. Patients with ACHD had a 1.4-fold increased risk of experiencing a composite event after the index MI compared with controls (HR 1.4, 95% CI 1.3–1.6, P < 0.001), driven largely by the occurrence of new-onset heart failure in 42.2% (n = 537) of patients with ACHD vs. 29.5% (n = 2526) of controls. Conclusion Patients with ACHD had an increased risk of developing MI and of recurrent MI, new-onset heart failure, or death after the index MI, compared with controls, mainly because of a higher incidence of newly diagnosed heart failure in patients with ACHD. Recognizing and managing the modifiable cardiovascular risk factors should be of importance to reduce morbidity and mortality in patients with ACHD.
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Affiliation(s)
- Maria Fedchenko
- Institute of Medicine, Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Diagnosvägen 11, 416 50 Gothenburg, Sweden
| | - Zacharias Mandalenakis
- Institute of Medicine, Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Diagnosvägen 11, 416 50 Gothenburg, Sweden.,ACHD Unit, Department of Medicine, Sahlgrenska University Hospital/Östra Hospital, Diagnosvägen 11, 416 50 Gothenburg, Sweden
| | - Kok Wai Giang
- Institute of Medicine, Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Diagnosvägen 11, 416 50 Gothenburg, Sweden
| | - Annika Rosengren
- Institute of Medicine, Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Diagnosvägen 11, 416 50 Gothenburg, Sweden
| | - Peter Eriksson
- Institute of Medicine, Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Diagnosvägen 11, 416 50 Gothenburg, Sweden.,ACHD Unit, Department of Medicine, Sahlgrenska University Hospital/Östra Hospital, Diagnosvägen 11, 416 50 Gothenburg, Sweden
| | - Mikael Dellborg
- Institute of Medicine, Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Diagnosvägen 11, 416 50 Gothenburg, Sweden.,ACHD Unit, Department of Medicine, Sahlgrenska University Hospital/Östra Hospital, Diagnosvägen 11, 416 50 Gothenburg, Sweden
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18
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Smoking among adult congenital heart disease survivors in the United States: Prevalence and relationship with illness perceptions. J Behav Med 2021; 44:772-783. [PMID: 34185220 DOI: 10.1007/s10865-021-00239-5] [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: 10/23/2020] [Accepted: 06/12/2021] [Indexed: 10/21/2022]
Abstract
The relationship between smoking and illness perceptions among congenital heart disease (CHD) survivors is unknown. The primary aims of the present study were to compare the smoking prevalence among CHD survivors to a nationally representative U.S. sample and examine the relationship between smoking and illness perceptions. CHD survivors (N = 744) from six U.S. sites participated in the study. The smoking prevalence among CHD survivors (9.3%) was lower than the general population (15.3%). However, 23.3% of CHD survivors with severe functional limitations smoked. Smoking prevalence differed by U.S. region, with a greater proportion of those attending CHD care in the Midwest reporting smoking (11.8%). The illness perception dimensions of Concern and Emotional Response were independently associated with smoking. Differences in illness perceptions enhance our understanding of smoking among CHD survivors and may guide interventions promoting positive health behaviors. The protocol for the study from which the present analyses were conducted was recorded at ClinicalTrials.gov: NCT02150603.
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19
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Niwa K. Metabolic syndrome and coronary artery disease in adults with congenital heart disease. Cardiovasc Diagn Ther 2021; 11:563-576. [PMID: 33968634 DOI: 10.21037/cdt-20-781] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
In adults with congenital heart disease (ACHD), conditions acquired with aging, such as metabolic syndrome, hypertension, diabetes mellitus, and obesity, can negatively influence the original cardiovascular disease. Metabolic syndrome has a higher prevalence in ACHD than in the general population. In contrast, coronary artery disease shows a similar prevalence in adults with acyanotic CHD and the general population, while adults with cyanotic CHD, even after repair, have an even lower incidence of coronary artery disease than the general population/adults with acyanotic CHD. However, even in those with cyanotic CHD, coronary artery disease can develop when they have risk factors such as obesity, dyslipidemia, hypertension, diabetes mellitus, smoking habit, or limited exercise. The prevalence of risk factors for cardiovascular disease is similar between ACHD and the general population, but an increased risk of coronary atherosclerosis has been observed for congenital coronary artery anomalies, dextro-transposition of the great arteries after arterial switch operation, Ross procedure, and coarctation of the aorta. Aortopathy may be an additional risk factor for cardiovascular disease. As ACHD have other abnormalities that may make the heart more vulnerable to both the development of atherosclerosis and adverse cardiovascular sequelae, regular evaluation of their cardiovascular disease risk status is recommended. Metabolic syndrome is more common among ACHD than in the general population, and may therefore increase the future incidence of atherosclerotic coronary artery disease even in ACHD. Thus, ACHD should be screened for metabolic syndrome to eliminate risk factors for atherosclerotic coronary artery disease.
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Affiliation(s)
- Koichiro Niwa
- Department of Cardiology, Cardiovascular Center, St Luke's International Hospital, Tokyo 104-8560, Japan
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20
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de Miguel IM, Ávila P. Atrial Fibrillation in Congenital Heart Disease. Eur Cardiol 2021; 16:e06. [PMID: 33737960 PMCID: PMC7967824 DOI: 10.15420/ecr.2020.41] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 12/08/2020] [Indexed: 01/25/2023] Open
Abstract
The increasing prevalence of AF in a growing population of adults with congenital heart disease (CHD) poses new challenges to clinicians involved in the management of these patients. Distinctive underlying anatomies, unique physiological aspects, a high diversity of corrective surgeries and associated comorbidities can complicate clinical decision-making. In this review, the authors provide an overview of the current knowledge on epidemiology and pathophysiology, with a special focus on the differences to the non-CHD population and the clinical impact of AF in adults with CHD. Acute and long-term management strategies are summarised, including the use of antiarrhythmic drugs, catheter or surgical ablation and prophylaxis of thromboembolism. Finally, gaps of knowledge and potential areas of future research are highlighted.
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Affiliation(s)
- Irene Martín de Miguel
- Cardiology Department, Hospital General Universitario Gregorio Marañón Madrid, Spain.,Instituto de Investigación Sanitaria Gregorio Marañón Madrid, Spain.,Faculty of Medicine, Universidad Complutense and CIBERCV Madrid, Spain
| | - Pablo Ávila
- Cardiology Department, Hospital General Universitario Gregorio Marañón Madrid, Spain.,Instituto de Investigación Sanitaria Gregorio Marañón Madrid, Spain.,Faculty of Medicine, Universidad Complutense and CIBERCV Madrid, Spain
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21
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Goldstein SA, Goldstein LB. Neurologic complications of congenital heart disease in adults. HANDBOOK OF CLINICAL NEUROLOGY 2021; 177:15-22. [PMID: 33632433 DOI: 10.1016/b978-0-12-819814-8.00011-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Congenital heart disease (CHD) is a heterogeneous group of structural abnormalities of the cardiovascular system that are present at birth. Advances in childhood medical and surgical treatment have led to increasing numbers of adults with CHD. Neurological complications of CHD in adults are varied and can include an increased risk of stroke not only related to the underlying congenital defect and its surgical management but also due to atherosclerotic disease associated with advancing age. In addition to cerebrovascular events, CHD in adults is also associated with an increased risk of neurodevelopmental disorders, cognitive impairment, psychiatric disease, and epilepsy. Collaborative multidisciplinary care with contributions from neurologists and cardiologists with expertise in adult CHD is necessary to provide optimal long-term care for this complex and rapidly evolving population.
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Affiliation(s)
- Sarah A Goldstein
- Department of Medicine, Division of Cardiology, Duke University, Durham, NC, United States
| | - Larry B Goldstein
- Department of Neurology, Kentucky Neuroscience Institute, University of Kentucky, Lexington, KY, United States.
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22
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Jang SY, Huh J, Kim EK, Chang SA, Song J, Kang IS, Park SW. Impact of Atrial Fibrillation on Survival in Adults with Congenital Heart Disease: a Retrospective Population-based Study. J Korean Med Sci 2021; 36:e43. [PMID: 33527785 PMCID: PMC7850860 DOI: 10.3346/jkms.2021.36.e43] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 12/02/2020] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND The number of adults with congenital heart disease (ACHD) with atrial fibrillation (AF) is expected to increase. We sought to assess the impact of AF on survival in Korean ACHD. METHODS Records of AF in ACHD were extracted from the records of the Korea National Health Insurance Service from 2006 through 2015. Multiple Cox proportional hazards analyses were carried out after adjustment for age, sex, income level, AF, and comorbidities. Survival rates (SRs) with and without AF were compared. The death records from 2006 through 2016 were included. RESULTS A total of 3,999 ACHD had AF (51.4% were male) and 62,691 ACHD did not have AF (43.5% were male); the proportion of ACHD who were 60 years and older was 53.0% and 27.0% in those with and without AF, respectively (P < 0.001). The age-standardized incidence rate for AF was 1,842.0 persons per 100,000 people in the Korean general population from 2006 through 2015. For AF in ACHD, it was 5,996.4 persons per 100,000 ACHD during the same period, which was higher than that in the general population (P < 0.001). Significantly higher proportion of death (20.9%) occurred in ACHD with AF than without AF (8.3%) (P < 0.001). The adjusted hazard ratio for AF of death in ACHD was 1.39 (95% confidence interval, 1.29-1.50). The ten-year SR of ACHD with AF was 69.7% whereas it was 87.5% in non-AF (P < 0.001). CONCLUSION In ACHD, AF occurs more frequently and has a worse prognosis than seen in the non-valvular general population in Korea. AF is associated with increased death in ACHD, especially with aging.
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Affiliation(s)
- Shin Yi Jang
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - June Huh
- Department of Pediatrics, Adult Congenital Heart Clinic, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
| | - Eun Kyoung Kim
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sung A Chang
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jinyoung Song
- Department of Pediatrics, Adult Congenital Heart Clinic, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - I Seok Kang
- Department of Pediatrics, Adult Congenital Heart Clinic, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seung Woo Park
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
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23
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Reich K, Moledina A, Kwan E, Keir M. Congenital Heart Disease (CHD) in Seniors: a Retrospective Study Defining a Brand New Cohort. Can Geriatr J 2020; 23:270-276. [PMID: 33282046 PMCID: PMC7704070 DOI: 10.5770/cgj.23.435] [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] [Indexed: 11/22/2022] Open
Abstract
Background With improved surgical techniques and medical therapy, patients with congenital heart disease (CHD) are now expected to achieve normal life expectancies. As a result, a new cohort of senior patients with adult congenital heart disease (ACHD) is emerging which has not been well characterized. Methods This study is a retrospective chart review of patients with moderate to complex CHD over the age of 60 years in Southern Alberta. We examined the number, length, and reasons for hospitalizations, and identified common adult comorbidities. Results A total of 84 patients with CHD who were 60 years or older were identified. The average age was 67.9 ± 6.6 years, with the majority of patients having moderate CHD. The most common cardiac comorbidities were arrhythmia, hypertension, and heart failure, which were also the most common reasons for hospital admission. There were 1.85 admissions per 10 patient-years, with a median length of stay of 6.0 (3.8-10.5) days. Conclusions With advanced age, the ACHD population is at risk of developing significant medical burden from acquired cardiac comorbidities, resulting in hospitalization. This analysis provides insight into disease characteristics of seniors with CHD. Further studies are needed to better understand this population and the association with geriatric syndromes.
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Affiliation(s)
- Krista Reich
- Department of Medicine, University of Calgary, Calgary
| | | | - Emily Kwan
- Department of Geriatric Medicine, University of Calgary, Calgary
| | - Michelle Keir
- Southern Alberta Adult Congenital Heart Clinic, Libin Cardiovascular Institute, University of Calgary, Calgary, AB, Canada
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24
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Jiang WF, Xu YJ, Zhao CM, Wang XH, Qiu XB, Liu X, Wu SH, Yang YQ. A novel TBX5 mutation predisposes to familial cardiac septal defects and atrial fibrillation as well as bicuspid aortic valve. Genet Mol Biol 2020; 43:e20200142. [PMID: 33306779 PMCID: PMC7783509 DOI: 10.1590/1678-4685-gmb-2020-0142] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 09/19/2020] [Indexed: 02/06/2023] Open
Abstract
TBX5 has been linked to Holt-Oram syndrome, with congenital heart defect (CHD) and atrial fibrillation (AF) being two major cardiac phenotypes. However, the prevalence of a TBX5 variation in patients with CHD and AF remains obscure. In this research, by sequencing analysis of TBX5 in 178 index patients with both CHD and AF, a novel heterozygous variation, NM_000192.3: c.577G>T; p.(Gly193*), was identified in one index patient with CHD and AF as well as bicuspid aortic valve (BAV), with an allele frequency of approximately 0.28%. Genetic analysis of the proband's pedigree showed that the variation co-segregated with the diseases. The pathogenic variation was not detected in 292 unrelated healthy subjects. Functional analysis by using a dual-luciferase reporter assay system showed that the Gly193*-mutant TBX5 protein failed to transcriptionally activate its target genes MYH6 and NPPA. Moreover, the mutation nullified the synergistic transactivation between TBX5 and GATA4 as well as NKX2-5. Additionally, whole-exome sequencing analysis showed no other genes contributing to the diseases. This investigation firstly links a pathogenic variant in the TBX5 gene to familial CHD and AF as well as BAV, suggesting that CHD and AF as well as BAV share a common developmental basis in a subset of patients.
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Affiliation(s)
- Wei-Feng Jiang
- Shanghai Jiao Tong University, Department of Cardiology, Shanghai Chest Hospital, Shanghai, China
| | - Ying-Jia Xu
- Fudan University, Department of Cardiology, Shanghai Fifth People's Hospital, Shanghai, China
| | - Cui-Mei Zhao
- Tongji University School of Medicine, Department of Cardiology, Tongji Hospital, Shanghai, China
| | - Xin-Hua Wang
- Shanghai Jiao Tong University School of Medicine, Department of Cardiology, Renji Hospital, Shanghai, China
| | - Xing-Biao Qiu
- Shanghai Jiao Tong University, Department of Cardiology, Shanghai Chest Hospital, Shanghai, China
| | - Xu Liu
- Shanghai Jiao Tong University, Department of Cardiology, Shanghai Chest Hospital, Shanghai, China
| | - Shao-Hui Wu
- Shanghai Jiao Tong University, Department of Cardiology, Shanghai Chest Hospital, Shanghai, China
| | - Yi-Qing Yang
- Fudan University, Department of Cardiology, Shanghai Fifth People's Hospital, Shanghai, China.,Fudan University, Cardiovascular Research Laboratory, Shanghai Fifth People's Hospital, Shanghai, China.,Fudan University, Central Laboratory, Shanghai Fifth People's Hospital, Shanghai, China
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25
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Bay A, Lämås K, Berghammer M, Sandberg C, Johansson B. Enablers and barriers for being physically active: experiences from adults with congenital heart disease. Eur J Cardiovasc Nurs 2020; 20:276–284. [PMID: 33611356 DOI: 10.1177/1474515120963314] [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: 08/30/2019] [Accepted: 08/27/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND In general, adults with congenital heart disease have reduced exercise capacity and many do not reach the recommended level of physical activity. A physically active lifestyle is essential to maintain health and to counteract acquired cardiovascular disease, therefore enablers and barriers for being physically active are important to identify. AIM To describe what adults with complex congenital heart diseases consider as physical activity, and what they experience as enablers and barriers for being physically active. METHODS A qualitative study using semi-structured interviews in which 14 adults with complex congenital heart disease (seven women) participated. The interviews were analysed using qualitative content analysis. RESULTS The analysis revealed four categories considered enablers and barriers - encouragement, energy level, approach and environment. The following is exemplified by the category encouragement as an enabler: if one had experienced support and encouragement to be physically active as a child, they were more positive to be physically active as an adult. In contrast, as a barrier, if the child lacked support and encouragement from others, they had never had the opportunity to learn to be physically active. CONCLUSION It is important for adults with congenital heart disease to have the opportunity to identify barriers and enablers for being physically active. They need knowledge about their own exercise capacity and need to feel safe that physical activity is not harmful. This knowledge can be used by healthcare professionals to promote, support and eliminate misconceptions about physical activity. Barriers can potentially be transformed into enablers through increased knowledge about attitudes and prerequisites.
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Affiliation(s)
- Annika Bay
- Department of Public Health and Clinical Medicine, Umeå University, Sweden.,Department of Nursing, Umeå University, Sweden
| | | | - Malin Berghammer
- Department of Health Science, University West, Sweden.,Department of Paediatrics, The Queen Silvia Children's Hospital, Sweden
| | - Camilla Sandberg
- Department of Public Health and Clinical Medicine, Umeå University, Sweden.,Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Sweden
| | - Bengt Johansson
- Department of Public Health and Clinical Medicine, Umeå University, Sweden
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26
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Fedchenko M, Mandalenakis Z, Hultsberg-Olsson G, Dellborg H, Eriksson P, Dellborg M. Validation of myocardial infarction diagnosis in patients with congenital heart disease in Sweden. BMC Cardiovasc Disord 2020; 20:460. [PMID: 33096985 PMCID: PMC7584083 DOI: 10.1186/s12872-020-01737-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 10/11/2020] [Indexed: 12/28/2022] Open
Abstract
Background The population of adults with congenital heart disease (CHD) is growing, and increasingly more patients with CHD reach older ages. Patients with CHD are at an increased risk of myocardial infarction (MI) with increased age. Diagnosing MI in patients with CHD can be challenging in clinical practice owing to a high prevalence of aberrant electrocardiograms, ventricular hypertrophy, and heart failure, among other factors. The National Swedish Patient Register (NPR) is widely used in epidemiological studies; however, MI diagnoses specifically in patients with CHD have never been validated in the NPR. Methods We contacted hospitals and medical archive services to request medical records for 249 patients, born during 1970–2012, with both CHD and MI diagnoses and who were randomly selected from the NPR by the Swedish National Board of Health and Welfare. Follow-up was until 2015. We performed a medical chart review to validate the MI diagnoses; we also validated CHD diagnoses to ensure that only patients with confirmed CHD diagnoses were included in the MI validation process. Results We received medical records for 96.4% (n = 238/249) of patients for validation of CHD diagnoses. In total, 74.8% (n = 178/238) had a confirmed CHD diagnosis; of these, 70.2% (n = 167) had a fully correct CHD diagnosis in the NPR; a further 4.6% (n = 11) had a CHD diagnosis, but it was misclassified. MI diagnoses were validated in 167 (93.8%) patients with confirmed CHD. Of the patients with confirmed CHD, 88.0% (n = 147/167) had correct MI diagnoses. Patients with non-complex CHD diagnoses had more correct MI diagnoses than patients with complex CHD (91.0%, n = 131 compared with 69.6%, n = 16). The main cause for incorrect MI diagnoses was typographical error, contributing to 50.0% of the incorrect diagnoses. Conclusions The validity of MI diagnoses in patients with confirmed CHD in the NPR is high, with nearly 9 of 10 MI diagnoses being correct (88.0%). MI in patients with CHD can safely be studied using the NPR.
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Affiliation(s)
- Maria Fedchenko
- Institute of Medicine, Department of Molecular and Clinical Medicine/Cardiology, Sahlgrenska University Hospital/Östra, Diagnosvägen 11, 416 50, Gothenburg, Sweden.
| | - Zacharias Mandalenakis
- Institute of Medicine, Department of Molecular and Clinical Medicine/Cardiology, Sahlgrenska University Hospital/Östra, Diagnosvägen 11, 416 50, Gothenburg, Sweden
| | - Görel Hultsberg-Olsson
- Institute of Medicine, Department of Molecular and Clinical Medicine/Cardiology, Sahlgrenska University Hospital/Östra, Diagnosvägen 11, 416 50, Gothenburg, Sweden
| | - Helena Dellborg
- Institute of Medicine, Department of Molecular and Clinical Medicine/Cardiology, Sahlgrenska University Hospital/Östra, Diagnosvägen 11, 416 50, Gothenburg, Sweden
| | - Peter Eriksson
- Institute of Medicine, Department of Molecular and Clinical Medicine/Cardiology, Sahlgrenska University Hospital/Östra, Diagnosvägen 11, 416 50, Gothenburg, Sweden
| | - Mikael Dellborg
- Institute of Medicine, Department of Molecular and Clinical Medicine/Cardiology, Sahlgrenska University Hospital/Östra, Diagnosvägen 11, 416 50, Gothenburg, Sweden
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27
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Jokinen E. Coronary artery disease in patients with congenital heart defects. J Intern Med 2020; 288:383-389. [PMID: 32391638 DOI: 10.1111/joim.13080] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 03/23/2020] [Accepted: 04/06/2020] [Indexed: 11/30/2022]
Abstract
The prognosis of patients with congenital heart defects has improved significantly: more and more patients reach adulthood and old age. At the same time, the possibility of cardiovascular morbidity increases. The conventional risk factors for coronary artery disease are at least as high or even higher in patients than in the general population. Obesity and sedentary life style are more common in adults with congenital heart defect (ACHD) than in general population. In some patients, for example those with coarctation of the aorta or patients with operated coronary arteries in the infancy, the incidence of coronary artery disease (CAD) is clearly increased. In some patients with cyanotic heart defects (e.g. Fontan), the incidence of CAD might be lower, but it usually returns to the average level or higher after correction of the defect. Coronary artery disease is one of the most important reasons for mortality also in ACHD patients, and the consequences of a coronary event might be more fateful in a patient with a corrected congenital heart defect than in her/his peer. There should be a paradigm shift from operative mortality and short-term outcome to long-term morbidity and prevention of cardiovascular disease - a task that often has been forgotten during follow-up visits.
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Affiliation(s)
- E Jokinen
- Pediatric Cardiology, Pediatric Research Center, New Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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28
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Wang T, Chen L, Yang T, Huang P, Wang L, Zhao L, Zhang S, Ye Z, Chen L, Zheng Z, Qin J. Congenital Heart Disease and Risk of Cardiovascular Disease: A Meta-Analysis of Cohort Studies. J Am Heart Assoc 2020; 8:e012030. [PMID: 31070503 PMCID: PMC6585327 DOI: 10.1161/jaha.119.012030] [Citation(s) in RCA: 70] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Background Despite remarkable success in the surgical and medical management of congenital heart disease ( CHD ), some survivors still experience cardiovascular complications over the long term. The goal of this study was to evaluate the association between CHD and risk of cardiovascular disease ( CVD ) by conducting a meta-analysis of cohort studies. Methods and Results A systematic literature search of several databases was conducted through April 2018 to identify studies reporting the risk of CVD , stroke, heart failure, and coronary artery heart disease in CHD survivors. The quality of individual studies was assessed using the Newcastle-Ottawa scale. The overall risk estimates were pooled using fixed-effects meta-analysis. Subgroup analyses were performed to explore possible sources of heterogeneity. Nine cohort studies comprising 684 200 participants were included. The overall combined relative risks for people with CHD compared with the controls were 3.12 (95% CI, 3.01-3.24) for CVD , 2.46 (95% CI, 2.30-2.63) for stroke, 5.89 (95% CI, 5.58-6.21) for heart failure, and 1.50 (95% CI, 1.40-1.61) for coronary artery heart disease. Significant heterogeneity was detected across studies regarding these risk estimates. Heterogeneity in the risk estimate of CVD was explained by geographic region, type of study design, sample source, age composition, and controlled confounders. Conclusions This meta-analysis of cohort studies of CHD found an association of increased risk of CVD in later life, although we cannot determine whether this association is confounded by a risk factor profile of CVD among CHD survivors or whether CHD is an independent risk factor.
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Affiliation(s)
- Tingting Wang
- 1 Department of Epidemiology and Health Statistics Xiangya School of Public Health Central South University Changsha China
| | - Lizhang Chen
- 1 Department of Epidemiology and Health Statistics Xiangya School of Public Health Central South University Changsha China
| | - Tubao Yang
- 1 Department of Epidemiology and Health Statistics Xiangya School of Public Health Central South University Changsha China
| | - Peng Huang
- 2 Department of Cardio-Thoracic Surgery Hunan Children's Hospital Changsha China
| | - Lesan Wang
- 1 Department of Epidemiology and Health Statistics Xiangya School of Public Health Central South University Changsha China
| | - Lijuan Zhao
- 1 Department of Epidemiology and Health Statistics Xiangya School of Public Health Central South University Changsha China
| | - Senmao Zhang
- 1 Department of Epidemiology and Health Statistics Xiangya School of Public Health Central South University Changsha China
| | - Ziwei Ye
- 1 Department of Epidemiology and Health Statistics Xiangya School of Public Health Central South University Changsha China
| | - Letao Chen
- 1 Department of Epidemiology and Health Statistics Xiangya School of Public Health Central South University Changsha China
| | - Zan Zheng
- 1 Department of Epidemiology and Health Statistics Xiangya School of Public Health Central South University Changsha China
| | - Jiabi Qin
- 1 Department of Epidemiology and Health Statistics Xiangya School of Public Health Central South University Changsha China
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29
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Zhang Y, Sun YM, Xu YJ, Zhao CM, Yuan F, Guo XJ, Guo YH, Yang CX, Gu JN, Qiao Q, Wang J, Yang YQ. A New TBX5 Loss-of-Function Mutation Contributes to Congenital Heart Defect and Atrioventricular Block. Int Heart J 2020; 61:761-768. [DOI: 10.1536/ihj.19-650] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Yan Zhang
- Department of Cardiology, Shanghai Jing'an District Central Hospital, Fudan University
| | - Yu-Min Sun
- Department of Cardiology, Shanghai Jing'an District Central Hospital, Fudan University
| | - Ying-Jia Xu
- Department of Cardiology, Shanghai Fifth People's Hospital, Fudan University
- Center for Complex Cardiac Arrhythmias of Minhang District, Shanghai Fifth People's Hospital, Fudan University
- Cardiovascular Research Laboratory, Shanghai Fifth People's Hospital, Fudan University
| | - Cui-Mei Zhao
- Department of Cardiology, Tongji Hospital, Tongji University School of Medicine
| | - Fang Yuan
- Department of Cardiology, Shanghai Tongren Hospital, Shanghai Jiao Tong University School of Medicine
| | - Xiao-Juan Guo
- Department of Cardiology, Shanghai Fifth People's Hospital, Fudan University
- Center for Complex Cardiac Arrhythmias of Minhang District, Shanghai Fifth People's Hospital, Fudan University
- Cardiovascular Research Laboratory, Shanghai Fifth People's Hospital, Fudan University
| | - Yu-Han Guo
- Department of Cardiology, Shanghai Fifth People's Hospital, Fudan University
- Center for Complex Cardiac Arrhythmias of Minhang District, Shanghai Fifth People's Hospital, Fudan University
- Cardiovascular Research Laboratory, Shanghai Fifth People's Hospital, Fudan University
| | - Chen-Xi Yang
- Department of Cardiology, Shanghai Fifth People's Hospital, Fudan University
- Center for Complex Cardiac Arrhythmias of Minhang District, Shanghai Fifth People's Hospital, Fudan University
- Cardiovascular Research Laboratory, Shanghai Fifth People's Hospital, Fudan University
| | - Jia-Ning Gu
- Department of Cardiology, Shanghai Fifth People's Hospital, Fudan University
- Center for Complex Cardiac Arrhythmias of Minhang District, Shanghai Fifth People's Hospital, Fudan University
- Cardiovascular Research Laboratory, Shanghai Fifth People's Hospital, Fudan University
| | - Qi Qiao
- Department of Cardiology, Shanghai Fifth People's Hospital, Fudan University
- Center for Complex Cardiac Arrhythmias of Minhang District, Shanghai Fifth People's Hospital, Fudan University
- Cardiovascular Research Laboratory, Shanghai Fifth People's Hospital, Fudan University
| | - Jun Wang
- Department of Cardiology, Shanghai Jing'an District Central Hospital, Fudan University
| | - Yi-Qing Yang
- Department of Cardiology, Shanghai Fifth People's Hospital, Fudan University
- Center for Complex Cardiac Arrhythmias of Minhang District, Shanghai Fifth People's Hospital, Fudan University
- Cardiovascular Research Laboratory, Shanghai Fifth People's Hospital, Fudan University
- Central Laboratory, Shanghai Fifth People's Hospital, Fudan University
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30
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Farr SL, Klewer SE, Nembhard WN, Alter C, Downing KF, Andrews JG, Collins RT, Glidewell J, Benavides A, Goudie A, Riehle-Colarusso T, Overman L, Riser AP, Oster ME. Rationale and design of CH STRONG: Congenital Heart Survey To Recognize Outcomes, Needs, and well-beinG. Am Heart J 2020; 221:106-113. [PMID: 31986287 DOI: 10.1016/j.ahj.2019.12.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2019] [Accepted: 12/27/2019] [Indexed: 10/25/2022]
Abstract
Studies of outcomes among adults with congenital heart defects (CHDs) have focused on those receiving cardiac care, limiting generalizability. The Congenital Heart Survey To Recognize Outcomes, Needs, and well-beinG (CH STRONG) will assess comorbidities, health care utilization, quality of life, and social and educational outcomes from a US population-based sample of young adults living with CHD. METHODS Individuals with CHD born between 1980 and 1997 were identified using active, population-based birth defects surveillance systems from 3 US locations (Arkansas [AR]; Arizona [AZ]; and Atlanta, Georgia [GA]) linked to death records. Individuals with current contact information responded to mailed survey materials during 2016 to 2019. Respondents and nonrespondents were compared using χ2 tests. RESULTS Sites obtained contact information for 74.6% of the 9,312 eligible individuals alive at recruitment. Of those, 1,656 returned surveys, either online (18.1%) or via paper (81.9%), for a response rate of 23.9% (AR: 18.3%; AZ: 30.7%; Atlanta, GA: 28.0%; P value < .01). For 20.0% of respondents, a proxy completed the survey, with 63.9% reporting that the individual with CHD was mentally unable. Among respondents and nonrespondents, respectively, sex (female: 54.0% and 47.3%), maternal race/ethnicity (non-Hispanic white: 74.3% and 63.0%), CHD severity (severe: 33.8% and 27.9%), and noncardiac congenital anomalies (34.8% and 38.9%) differed significantly (P value < .01); birth year (1991-1997: 56.0% and 57.5%) and presence of Down syndrome (9.2% and 8.9%) did not differ. CONCLUSIONS CH STRONG will provide the first multisite, population-based findings on long-term outcomes among the growing population of US adults with CHD.
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31
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Saha P, Potiny P, Rigdon J, Morello M, Tcheandjieu C, Romfh A, Fernandes SM, McElhinney DB, Bernstein D, Lui GK, Shaw GM, Ingelsson E, Priest JR. Substantial Cardiovascular Morbidity in Adults With Lower-Complexity Congenital Heart Disease. Circulation 2020; 139:1889-1899. [PMID: 30813762 DOI: 10.1161/circulationaha.118.037064] [Citation(s) in RCA: 61] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Although lower-complexity cardiac malformations constitute the majority of adult congenital heart disease (ACHD), the long-term risks of adverse cardiovascular events and relationship with conventional risk factors in this population are poorly understood. We aimed to quantify the risk of adverse cardiovascular events associated with lower-complexity ACHD that is unmeasured by conventional risk factors. METHODS A multitiered classification algorithm was used to select individuals with lower-complexity ACHD and individuals without ACHD for comparison among >500 000 British adults in the UK Biobank. ACHD diagnoses were subclassified as isolated aortic valve and noncomplex defects. Time-to-event analyses were conducted for the primary end points of fatal or nonfatal acute coronary syndrome, ischemic stroke, heart failure, and atrial fibrillation and a secondary combined end point for major adverse cardiovascular events. Maximum follow-up time for the study period was 22 years with retrospectively and prospectively collected data from the UK Biobank. RESULTS We identified 2006 individuals with lower-complexity ACHD and 497 983 unexposed individuals in the UK Biobank (median age at enrollment, 58 [interquartile range, 51-63] years). Of the ACHD-exposed group, 59% were male, 51% were current or former smokers, 30% were obese, and 69%, 41%, and 7% were diagnosed or treated for hypertension, hyperlipidemia, and diabetes mellitus, respectively. After adjustment for 12 measured cardiovascular risk factors, ACHD remained strongly associated with the primary end points, with hazard ratios ranging from 2.0 (95% CI, 1.5-2.8; P<0.001) for acute coronary syndrome to 13.0 (95% CI, 9.4-18.1; P<0.001) for heart failure. ACHD-exposed individuals with ≤2 cardiovascular risk factors had a 29% age-adjusted incidence rate of major adverse cardiovascular events, in contrast to 13% in individuals without ACHD with ≥5 risk factors. CONCLUSIONS Individuals with lower-complexity ACHD had a higher burden of adverse cardiovascular events relative to the general population that was unaccounted for by conventional cardiovascular risk factors. These findings highlight the need for closer surveillance of patients with mild to moderate ACHD and further investigation into management and mechanisms of cardiovascular risk unique to this growing population of high-risk adults.
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Affiliation(s)
- Priyanka Saha
- Division of Cardiology, Department of Pediatrics (P.S., P.P., M.M., C.T., A.R., S.M.F., D.B.M., D.B., G.K.L., J.R.P.), Stanford University School of Medicine, CA.,Stanford Cardiovascular Institute (P.S., C.T., D.B.M., D.B., E.I., J.R.P.), Stanford University School of Medicine, CA.,Harvard Medical School, Boston, MA (P.S.)
| | - Praneetha Potiny
- Division of Cardiology, Department of Pediatrics (P.S., P.P., M.M., C.T., A.R., S.M.F., D.B.M., D.B., G.K.L., J.R.P.), Stanford University School of Medicine, CA
| | - Joseph Rigdon
- Quantitative Sciences Unit (J.R.), Stanford University School of Medicine, CA
| | - Melissa Morello
- Division of Cardiology, Department of Pediatrics (P.S., P.P., M.M., C.T., A.R., S.M.F., D.B.M., D.B., G.K.L., J.R.P.), Stanford University School of Medicine, CA.,Department of Medicine, Division of Cardiovascular Medicine (M.M., C.T., A.R., S.M.F., G.K.L., E.I.), Stanford University School of Medicine, CA
| | - Catherine Tcheandjieu
- Division of Cardiology, Department of Pediatrics (P.S., P.P., M.M., C.T., A.R., S.M.F., D.B.M., D.B., G.K.L., J.R.P.), Stanford University School of Medicine, CA.,Stanford Cardiovascular Institute (P.S., C.T., D.B.M., D.B., E.I., J.R.P.), Stanford University School of Medicine, CA.,Department of Medicine, Division of Cardiovascular Medicine (M.M., C.T., A.R., S.M.F., G.K.L., E.I.), Stanford University School of Medicine, CA
| | - Anitra Romfh
- Division of Cardiology, Department of Pediatrics (P.S., P.P., M.M., C.T., A.R., S.M.F., D.B.M., D.B., G.K.L., J.R.P.), Stanford University School of Medicine, CA.,Department of Medicine, Division of Cardiovascular Medicine (M.M., C.T., A.R., S.M.F., G.K.L., E.I.), Stanford University School of Medicine, CA
| | - Susan M Fernandes
- Division of Cardiology, Department of Pediatrics (P.S., P.P., M.M., C.T., A.R., S.M.F., D.B.M., D.B., G.K.L., J.R.P.), Stanford University School of Medicine, CA.,Department of Medicine, Division of Cardiovascular Medicine (M.M., C.T., A.R., S.M.F., G.K.L., E.I.), Stanford University School of Medicine, CA
| | - Doff B McElhinney
- Division of Cardiology, Department of Pediatrics (P.S., P.P., M.M., C.T., A.R., S.M.F., D.B.M., D.B., G.K.L., J.R.P.), Stanford University School of Medicine, CA.,Stanford Cardiovascular Institute (P.S., C.T., D.B.M., D.B., E.I., J.R.P.), Stanford University School of Medicine, CA.,Department of Cardiothoracic Surgery (D.B.M.), Stanford University School of Medicine, CA
| | - Daniel Bernstein
- Division of Cardiology, Department of Pediatrics (P.S., P.P., M.M., C.T., A.R., S.M.F., D.B.M., D.B., G.K.L., J.R.P.), Stanford University School of Medicine, CA.,Stanford Cardiovascular Institute (P.S., C.T., D.B.M., D.B., E.I., J.R.P.), Stanford University School of Medicine, CA
| | - George K Lui
- Division of Cardiology, Department of Pediatrics (P.S., P.P., M.M., C.T., A.R., S.M.F., D.B.M., D.B., G.K.L., J.R.P.), Stanford University School of Medicine, CA.,Department of Medicine, Division of Cardiovascular Medicine (M.M., C.T., A.R., S.M.F., G.K.L., E.I.), Stanford University School of Medicine, CA
| | - Gary M Shaw
- Department of Pediatrics (G.M.S.), Stanford University School of Medicine, CA
| | - Erik Ingelsson
- Stanford Cardiovascular Institute (P.S., C.T., D.B.M., D.B., E.I., J.R.P.), Stanford University School of Medicine, CA.,Department of Medicine, Division of Cardiovascular Medicine (M.M., C.T., A.R., S.M.F., G.K.L., E.I.), Stanford University School of Medicine, CA.,Stanford Diabetes Research Center, Stanford University, CA (E.I., J.R.P.)
| | - James R Priest
- Division of Cardiology, Department of Pediatrics (P.S., P.P., M.M., C.T., A.R., S.M.F., D.B.M., D.B., G.K.L., J.R.P.), Stanford University School of Medicine, CA.,Stanford Cardiovascular Institute (P.S., C.T., D.B.M., D.B., E.I., J.R.P.), Stanford University School of Medicine, CA.,Stanford Diabetes Research Center, Stanford University, CA (E.I., J.R.P.).,Chan-Zuckerberg BioHub, San Francisco, CA (J.R.P.)
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32
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Hansson L, Lind T, Öhlund I, Wiklund U, Rydberg A. Increased abdominal fat mass and high fat consumption in young school children with congenital heart disease: results from a case‐control study. J Hum Nutr Diet 2020; 33:566-573. [DOI: 10.1111/jhn.12739] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- L. Hansson
- Department of Clinical Sciences, Paediatrics Umeå University Umeå Sweden
| | - T. Lind
- Department of Clinical Sciences, Paediatrics Umeå University Umeå Sweden
| | - I. Öhlund
- Department of Clinical Sciences, Paediatrics Umeå University Umeå Sweden
| | - U. Wiklund
- Department of Radiation Sciences Biomedical Engineering Umeå University Umeå Sweden
| | - A. Rydberg
- Department of Clinical Sciences, Paediatrics Umeå University Umeå Sweden
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33
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Moons P, Luyckx K, Kovacs AH, Holbein CE, Thomet C, Budts W, Enomoto J, Sluman MA, Yang HL, Jackson JL, Khairy P, Cook SC, Chidambarathanu S, Alday L, Eriksen K, Dellborg M, Berghammer M, Johansson B, Mackie AS, Menahem S, Caruana M, Veldtman G, Soufi A, Fernandes SM, White K, Callus E, Kutty S, Apers S. Prevalence and Effects of Cigarette Smoking, Cannabis Consumption, and Co-use in Adults From 15 Countries With Congenital Heart Disease. Can J Cardiol 2019; 35:1842-1850. [DOI: 10.1016/j.cjca.2019.07.635] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 07/02/2019] [Accepted: 07/16/2019] [Indexed: 12/31/2022] Open
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34
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Neurocognition in Adult Congenital Heart Disease: How to Monitor and Prevent Progressive Decline. Can J Cardiol 2019; 35:1675-1685. [DOI: 10.1016/j.cjca.2019.06.020] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 06/18/2019] [Accepted: 06/18/2019] [Indexed: 12/31/2022] Open
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35
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Qiu H, Chen Z, Lv L, Tang W, Hu R. Associations Between microRNA Polymorphisms and Development of Coronary Artery Disease: A Case-Control Study. DNA Cell Biol 2019; 39:25-36. [PMID: 31692368 DOI: 10.1089/dna.2019.4963] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Coronary artery disease (CAD), a common cardiovascular disease, has become a vital cause of mortality worldwide. Genetic microRNA (miR) polymorphisms might contribute to CAD susceptibility. In this study, we selected miR-146a, miR-196a2, and miR-499 single nucleotide polymorphisms and conducted a case-control study. In total, 505 CAD cases and 1109 controls were recruited. We used SNPscan™ genotyping assay to obtain genotyping of miR rs2910164, rs11614913, and rs3746444 variants. We found that miR-196a2 rs11614913 T > C decreased the susceptibility of myocardial infarction (MI) (TC vs. TT: adjusted p = 0.007 and CC/TC vs. TT: adjusted p = 0.012). In female subgroup, our results indicated that miR-196a2 rs11614913 T > C variants might also decrease the susceptibility of CAD (TC vs. TT: adjusted p = 0.017 and TC/CC vs. TT: adjusted p = 0.015). In summary, these results suggest that miR-196a2 rs11614913 T > C locus decreases the susceptibility of CAD in female and MI subgroups. However, further studies are needed to validate the potential associations of miR-196a2 rs11614913 locus with CAD.
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Affiliation(s)
- Hao Qiu
- Department of Immunology, School of Medicine, Jiangsu University, Zhenjiang, China
| | - Zheng Chen
- Department of Anesthesiology, Zhenjiang No. 1 People's Hospital, Zhenjiang, China
| | - Lu Lv
- Department of Cardiothoracic Surgery, Zhenjiang No. 1 People's Hospital, Zhenjiang, China
| | - Weifeng Tang
- Department of Cardiothoracic Surgery, Zhenjiang No. 1 People's Hospital, Zhenjiang, China
| | - Rong Hu
- Department of Cardiology, Fujian Medical University Union Hospital, Fuzhou, China
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36
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Agarwal A, Thombley R, Broberg CS, Harris IS, Foster E, Mahadevan VS, John A, Vittinghoff E, Marcus GM, Dudley RA. Age- and Lesion-Related Comorbidity Burden Among US Adults With Congenital Heart Disease: A Population-Based Study. J Am Heart Assoc 2019; 8:e013450. [PMID: 31575318 PMCID: PMC6818026 DOI: 10.1161/jaha.119.013450] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Background As patients with congenital heart disease (CHD) are living longer, understanding the comorbidities they develop as they age is increasingly important. However, there are no published population-based estimates of the comorbidity burden among the US adult patients with CHD. Methods and Results Using the IBM MarketScan commercial claims database from 2010 to 2016, we identified adults aged ≥18 years with CHD and 2 full years of continuous enrollment. These were frequency matched with adults without CHD within categories jointly defined by age, sex, and dates of enrollment in the database. A total of 40 127 patients with CHD met the inclusion criteria (mean [SD] age, 36.8 [14.6] years; and 48.2% were women). Adults with CHD were nearly twice as likely to have any comorbidity than those without CHD (P<0.001). After adjusting for covariates, patients with CHD had a higher prevalence risk ratio for "previously recognized to be common in CHD" (risk ratio, 9.41; 95% CI, 7.99-11.1), "other cardiovascular" (risk ratio, 1.73; 95% CI, 1.66-1.80), and "noncardiovascular" (risk ratio, 1.47; 95% CI, 1.41-1.52) comorbidities. After adjusting for covariates and considering interaction with age, patients with severe CHD had higher risks of previously recognized to be common in CHD and lower risks of other cardiovascular comorbidities than age-stratified patients with nonsevere CHD. For noncardiovascular comorbidities, the risk was higher among patients with severe than nonsevere CHD before, but not after, the age of 40 years. Conclusions Our data underscore the unique clinical needs of adults with CHD compared with their peers. Clinicians caring for CHD may want to use a multidisciplinary approach, including building close collaborations with internists and specialists, to help provide appropriate care for the highly prevalent noncardiovascular comorbidities.
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Affiliation(s)
- Anushree Agarwal
- Division of Cardiology Department of Medicine University of California, San Francisco San Francisco CA
| | - Robert Thombley
- Department of Medicine Philip R. Lee Institute for Health Policy Studies School of Medicine, and Center for Healthcare Value University of California, San Francisco San Francisco CA
| | - Craig S Broberg
- Adult Congenital Heart Disease Program Knight Cardiovascular Institute Oregon Health and Science University Portland OR
| | - Ian S Harris
- Division of Cardiology Department of Medicine University of California, San Francisco San Francisco CA
| | - Elyse Foster
- Division of Cardiology Department of Medicine University of California, San Francisco San Francisco CA
| | - Vaikom S Mahadevan
- Division of Cardiology Department of Medicine University of California, San Francisco San Francisco CA
| | - Anitha John
- Division of Cardiology Children's National Health System Washington DC
| | - Eric Vittinghoff
- Division of Cardiology Department of Medicine University of California, San Francisco San Francisco CA
| | - Greg M Marcus
- Division of Cardiology Department of Medicine University of California, San Francisco San Francisco CA
| | - R Adams Dudley
- Department of Medicine Philip R. Lee Institute for Health Policy Studies School of Medicine, and Center for Healthcare Value University of California, San Francisco San Francisco CA
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37
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Wang Z, Song HM, Wang F, Zhao CM, Huang RT, Xue S, Li RG, Qiu XB, Xu YJ, Liu XY, Yang YQ. A New ISL1 Loss-of-Function Mutation Predisposes to Congenital Double Outlet Right Ventricle. Int Heart J 2019; 60:1113-1122. [DOI: 10.1536/ihj.18-685] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Zhi Wang
- Department of Pediatrics, Tongji Hospital, Tongji University School of Medicine
| | - Hao-Ming Song
- Department of Cardiology, Tongji Hospital, Tongji University School of Medicine
| | - Fei Wang
- Department of Neurosurgery, Tongji Hospital, Tongji University School of Medicine
| | - Cui-Mei Zhao
- Department of Cardiology, Tongji Hospital, Tongji University School of Medicine
| | - Ri-Tai Huang
- Department of Cardiovascular Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University
| | - Song Xue
- Department of Cardiovascular Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University
| | - Ruo-Gu Li
- Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiao Tong University
| | - Xing-Biao Qiu
- Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiao Tong University
| | - Ying-Jia Xu
- Department of Cardiology, The Fifth People's Hospital of Shanghai, Fudan University
| | - Xing-Yuan Liu
- Department of Pediatrics, Tongji Hospital, Tongji University School of Medicine
| | - Yi-Qing Yang
- Department of Cardiology, The Fifth People's Hospital of Shanghai, Fudan University
- Department of Cardiovascular Research Laboratory, The Fifth People's Hospital of Shanghai, Fudan University
- Department of Central Laboratory, The Fifth People's Hospital of Shanghai, Fudan University
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38
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Johnson B, Buelow M, Earing M, Cohen S, Bartz P, Ginde S. Coronary artery disease screening in adults with congenital heart disease prior to cardiac surgery. CONGENIT HEART DIS 2019; 14:895-900. [PMID: 31489771 DOI: 10.1111/chd.12839] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 07/26/2019] [Accepted: 08/20/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVE As adults with congenital heart disease (CHD) grow older, preoperative screening for coronary artery disease (CAD) may be indicated prior to CHD surgery. Data regarding the indications for preoperative CAD screening in this population are limited. Current practice is to follow guidelines for patients with valvular heart disease; however, the risk for CAD in certain congenital heart diagnoses may be higher than the general population. This study aimed to assess the results of preoperative CAD screening in patients prior to CHD surgery. DESIGN Retrospective study. SETTING Single tertiary center. PATIENTS Patients ≥35 years that had CHD surgery from 1/1/2007 to 5/1/2017. OUTCOME MEASURES Data regarding CAD risk factors and preoperative CAD screening results were obtained. Prevalence and risk factors for CAD were analyzed, along with their relationship to perioperative outcomes. RESULTS A total of 73 patients underwent CAD screening with either cardiac catheterization (56%) or computed tomography angiography (34%) prior to CHD surgery. Overall 16 (22%) patients were found to have CAD. Only two patients had severe coronary stenosis and underwent coronary bypass grafting at time of CHD surgery. Patients with CAD were more likely to be older and have history of hypertension, dyslipidemia, and tobacco smoking. CHD diagnosis was not significantly associated with presence of CAD. CONCLUSION CAD is common in asymptomatic older patients referred for screening prior to CHD surgery; however, severe CAD requiring concomitant coronary intervention is uncommon. Preoperative CAD screening should be based on age and traditional CAD risk factors, rather than underlying CHD.
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Affiliation(s)
- Bradley Johnson
- Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin.,Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Matthew Buelow
- Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin.,Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Michael Earing
- Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin.,Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Scott Cohen
- Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin.,Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Peter Bartz
- Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin.,Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Salil Ginde
- Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin.,Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin
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39
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Fedchenko M, Mandalenakis Z, Dellborg H, Hultsberg-Olsson G, Björk A, Eriksson P, Dellborg M. Cardiovascular risk factors in adults with coarctation of the aorta. CONGENIT HEART DIS 2019; 14:549-558. [PMID: 31099471 DOI: 10.1111/chd.12785] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 02/18/2019] [Accepted: 04/21/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND The aging patient with adult congenital heart disease (ACHD) faces the risk of developing atherosclerotic disease. Patients with coarctation of the aorta (CoA) are especially vulnerable because of an inherent high risk of developing hypertension. However, data on the prevalence of other cardiovascular risk factors are scarce. Therefore, this study aimed to describe the prevalence of traditional cardiovascular risk factors (diabetes, hypertension, hyperlipidemia, smoking, obesity, and sedentary lifestyle) in adult patients with CoA. METHODS Patients with CoA who were registered at the ACHD clinic in Gothenburg were asked to participate in a comprehensive cardiovascular risk assessment. This assessment included a glucose tolerance test, cholesterol profile, ambulatory blood pressure measurements, and a lifestyle questionnaire. RESULTS A total of 72 patients participated. The median age was 43.5 years and 58.3% were men. Sixty-six (91.7%) patients had ≥one cardiovascular risk factor and 40.3% had ≥three risk factors. Three (4.2%) patients were newly diagnosed with diabetes or impaired glucose tolerance. More than half of the patients had hyperlipidemia (n = 42, 58.3%) and 35 patients (48.6%) were overweight or obese. Only three (4.2%) patients smoked regularly. Of the 60 patients who underwent 24-hour ambulatory blood pressure measurement, 33 (55.0%) were hypertensive. Of the 30 patients with known hypertension only 9 (30.0%) had well-controlled blood pressure on ambulatory blood pressure measurement. CONCLUSIONS Cardiovascular risk factors among patients with CoA are prevalent. This may indicate a need for more aggressive screening strategies of traditional risk factors to minimize the risk of these patients also developing atherosclerotic disease.
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Affiliation(s)
- Maria Fedchenko
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska University Hospital/Östra, Gothenburg, Sweden
| | - Zacharias Mandalenakis
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska University Hospital/Östra, Gothenburg, Sweden
| | - Helena Dellborg
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska University Hospital/Östra, Gothenburg, Sweden
| | - Görel Hultsberg-Olsson
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska University Hospital/Östra, Gothenburg, Sweden
| | - Anna Björk
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska University Hospital/Östra, Gothenburg, Sweden
| | - Peter Eriksson
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska University Hospital/Östra, Gothenburg, Sweden
| | - Mikael Dellborg
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska University Hospital/Östra, Gothenburg, Sweden
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40
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Egbe AC, Ananthaneni S, Jadav R, Kothapalli S, Rihal CS, Masood M, Angirekula M, Najam M, Bajwa N, Tarek K, Matthew J, Connolly HM. Coronary artery disease in adults with tetralogy of Fallot. CONGENIT HEART DIS 2019; 14:491-497. [DOI: 10.1111/chd.12782] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 04/06/2019] [Accepted: 04/22/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Alexander C. Egbe
- Department of Cardiovascular Medicine Mayo Clinic Rochester Minnesota
| | | | - Raja Jadav
- Department of Cardiovascular Medicine Mayo Clinic Rochester Minnesota
| | | | | | - Muhammad Masood
- Department of Cardiovascular Medicine Mayo Clinic Rochester Minnesota
| | | | - Maria Najam
- Department of Cardiovascular Medicine Mayo Clinic Rochester Minnesota
| | - Numra Bajwa
- Department of Cardiovascular Medicine Mayo Clinic Rochester Minnesota
| | - Karim Tarek
- Department of Cardiovascular Medicine Mayo Clinic Rochester Minnesota
| | - Jessey Matthew
- Department of Cardiovascular Medicine Mayo Clinic Rochester Minnesota
| | - Heidi M. Connolly
- Department of Cardiovascular Medicine Mayo Clinic Rochester Minnesota
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41
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Konagai N, Fukui S, Kitano M, Asaumi Y, Nakanishi M, Ogo T, Fujita T, Ohnishi Y, Kobayashi J, Yasuda S. Successful Transcatheter Atrial Septal Defect Closure Prior to Coronary Artery Bypass Grafting Using Anti-Congestive Therapies and Intraaortic Balloon Pumping in a Patient with Severe Ischemic Cardiomyopathy and Triple-Vessel Coronary Artery Disease. Int Heart J 2018; 59:1480-1484. [DOI: 10.1536/ihj.17-563] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Nao Konagai
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
- Department of Advanced Cardiovascular Medicine, Kumamoto University Graduate School of Medical Sciences
| | - Shigefumi Fukui
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Masataka Kitano
- Department of Pediatric Cardiology, National Cerebral and Cardiovascular Center
| | - Yasuhide Asaumi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Michio Nakanishi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Takeshi Ogo
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Tomoyuki Fujita
- Department of Cardiac Surgery, National Cerebral and Cardiovascular Center
| | - Yoshihiko Ohnishi
- Department of Anesthesiology, National Cerebral and Cardiovascular Center
| | - Junjiro Kobayashi
- Department of Cardiac Surgery, National Cerebral and Cardiovascular Center
| | - Satoshi Yasuda
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
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42
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Bay A, Lämås K, Berghammer M, Sandberg C, Johansson B. It’s like balancing on a slackline-A description of how adults with congenital heart disease describe themselves in relation to physical activity. J Clin Nurs 2018; 27:3131-3138. [DOI: 10.1111/jocn.14507] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/01/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Annika Bay
- Department of Public Health and Clinical Medicine; Umeå University; Umeå Sweden
- Department of Nursing; Umeå University; Umeå Sweden
| | | | - Malin Berghammer
- Department of Health Science; University West; Trollhättan Sweden
- Department of Pediatrics; The Queen Silvia Children's Hospital; Gothenburg Sweden
| | - Camilla Sandberg
- Department of Public Health and Clinical Medicine; Umeå University; Umeå Sweden
- Department of Community Medicine and Rehabilitation, Physiotherapy; Umeå University; Umeå Sweden
| | - Bengt Johansson
- Department of Public Health and Clinical Medicine; Umeå University; Umeå Sweden
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43
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44
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Ing RJ, Twite MD. Noteworthy Literature published in 2017 for Congenital Cardiac Anesthesiologists. Semin Cardiothorac Vasc Anesth 2018; 22:35-48. [DOI: 10.1177/1089253217753398] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
This review focuses on the literature published during the 13 months from December 2016 to December 2017 that is of interest to anesthesiologists taking care of children and adults with congenital heart disease. Five themes are addressed during this time period and 100 peer-reviewed articles are discussed.
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Affiliation(s)
- Richard J. Ing
- Children’s Hospital Colorado, Anschutz Medical Campus, Aurora, CO, USA
- University of Colorado, Aurora, CO, USA
| | - Mark D. Twite
- Children’s Hospital Colorado, Anschutz Medical Campus, Aurora, CO, USA
- University of Colorado, Aurora, CO, USA
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45
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Giannakoulas G, Ntiloudi D. Acquired cardiovascular disease in adult patients with congenital heart disease. Heart 2017; 104:546-547. [DOI: 10.1136/heartjnl-2017-311997] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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