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Bai B, Li D, Xu M, Liao Y, Zhou H, Liu F, Li W, Ma H. Clinical implication of sarcopenia in patients with acute decompensated heart failure: Design and rationale. ESC Heart Fail 2024. [PMID: 39225327 DOI: 10.1002/ehf2.15044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2024] [Revised: 07/20/2024] [Accepted: 08/19/2024] [Indexed: 09/04/2024] Open
Abstract
BACKGROUND Sarcopenia is widely recognized as an age-related syndrome that involves a progressive loss of skeletal muscle mass and muscle strength. Many studies have shown that sarcopenia is associated with disease severity and exercise intolerance, as well as an independent predictor of mortality in patients with chronic heart failure. However, there is little research on the impact of sarcopenia on patients hospitalized with acute decompensated heart failure (ADHF). METHODS This is a prospective, multicentre, observational cohort study. Enrolment of at least 500 participants adults aged over 18 years hospitalized for ADHF is planned, with a minimum of 195 cases each for patients with and without sarcopenia. Each patient is followed up for 6 months, 1 year, 2 years or until the occurrence of endpoint. The primary clinical outcome is all-cause mortality at 6 months. Other clinical outcomes of interest include cardiovascular mortality, all-cause hospitalization, heart failure hospitalization and survival time from enrolment to event occurrence. The sympathetic nervous activity, psychosocial factors, quality of life, physical function, and physical activity will be assessed and recorded at baseline. This study will examine the correlation between sarcopenia and prognosis in different subgroups of patients, and explore the additive effect of different comorbidities and sarcopenia on prognosis in patients with ADHF. CONCLUSIONS This study will provide important information and evidence on the clinical aspects of sarcopenia in patients with ADHF, potentially contributing to accurate risk stratification and optimal clinical management for patients with ADHF. REGISTRATION (URL: https://www. CLINICALTRIALS gov); Unique identifier: NCT06298825.
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Affiliation(s)
- Bingqing Bai
- Department of Cardiac Rehabilitation, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
- South China University of Technology, Guangzhou, China
| | - Dujuan Li
- Department of Rehabilitation Medicine, The Second Affiliated Hospital of Wannan Medical College, Wuhu, China
| | - Mingyu Xu
- Department of Cardiac Rehabilitation, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
- South China University of Technology, Guangzhou, China
| | - Yingxue Liao
- Department of Cardiac Rehabilitation, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Haofeng Zhou
- Department of Cardiac Rehabilitation, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Fengyao Liu
- Department of Cardiac Rehabilitation, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
- South China University of Technology, Guangzhou, China
| | - Wen Li
- Department of Rehabilitation Medicine, The Second Affiliated Hospital of Wannan Medical College, Wuhu, China
| | - Huan Ma
- Department of Cardiac Rehabilitation, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
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Newman E, Kamanu C, Gibson G, Brailovsky Y. How to Optimize Goal-Directed Medical Therapy (GDMT) in Patients with Heart Failure. Curr Cardiol Rep 2024; 26:995-1003. [PMID: 39093374 PMCID: PMC11379751 DOI: 10.1007/s11886-024-02101-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/11/2024] [Indexed: 08/04/2024]
Abstract
PURPOSE OF REVIEW Heart failure is a clinical syndrome with signs and symptoms from underlying cardiac abnormality and evidence of pulmonary or systemic congestion on laboratory testing or other objective findings (Bozkurt et al. in Eur J Heart Fail 23:352-380, 2021). Heart failure with reduced ejection fraction (HFrEF), when heart failure is due to underlying reduction in ejection fraction to ≤ 40. The goal of this review is to briefly describe the mechanisms and benefits of the various pharmacological interventions described in the 2022 AHA/ACC/HFSA Guidelines focusing on Stage C: Symptomatic Heart Failure HFrEF, while providing basic guidance on safe use of these medications. RECENT FINDINGS Use of medications from each class as recommended in the 2022 Guidelines can provide significant morbidity and mortality benefits for our patients. Despite advances in therapeutics for patients with HFrEF, patients are frequently under treated and more research is needed to help optimize management of these complicated patients.
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Affiliation(s)
- Emily Newman
- Division of Cardiology, Thomas Jefferson University Hospital, 833 Chestnut Street, Suite 630, Philadelphia, PA, 19107, USA
| | - Chukwuemezie Kamanu
- Department of Medicine, Thomas Jefferson University Hospital, 833 Chestnut Street, Suite 630, Philadelphia, PA, 19107, USA
| | - Gregory Gibson
- Division of Cardiology, Thomas Jefferson University Hospital, 833 Chestnut Street, Suite 630, Philadelphia, PA, 19107, USA
| | - Yevgeniy Brailovsky
- Division of Cardiology, Thomas Jefferson University Hospital, 833 Chestnut Street, Suite 630, Philadelphia, PA, 19107, USA.
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3
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Zhang Z, Subramaniam DS, Howard SW, Johnston KJ, Frick WH, Enard K, Hinyard L. Use of Palliative Care Among Adults With Newly Diagnosed Heart Failure: Insights From a US National Insured Patient Sample. J Am Heart Assoc 2024; 13:e035459. [PMID: 39206718 DOI: 10.1161/jaha.124.035459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Accepted: 07/26/2024] [Indexed: 09/04/2024]
Abstract
BACKGROUND Despite the known benefits for individuals with heart failure (HF), incomplete data suggest a low use of palliative care (PC) for HF in the United States. We aimed to investigate the national PC use for adults with HF by determining when they received their first PC consultation (PCC) and the associations with clinical factors following diagnosis of HF. METHODS AND RESULTS We conducted a retrospective cohort study in a national all-payer electronic health record database to identify adults (aged ≥18 years) with newly diagnosed HF between 2011 and 2018. The proportion of those who received PCC within 5 years following a diagnosis of HF, and associations of time to first PCC with patient characteristics and HF-specific clinical markers were determined. We followed 127 712 patients for a median of 792 days, of whom 18.3% received PCC in 5 years. Shorter time to receive PCC was associated with diagnoses of HF in 2016 to 2018 (compared with 2010-2015: adjusted hazard ratio [aHR], 1.421 [95% CI, 1.370-1.475]), advanced HF (aHR, 2.065 [95% CI, 1.940-2.198]), cardiogenic shock (aHR, 2.587 [95% CI, 2.414-2.773]), implantable cardioverter-defibrillator (aHR, 5.718 [95% CI, 5.327-6.138]), and visits at academic medical centers (aHR, 1.439 [95% CI, 1.381-1.500]). CONCLUSIONS Despite an expanded definition of PC and recommendations by professional societies, PC for HF remains low in the United States. Racial and geographic variations in access and use of PC exist for patients with HF. Future studies should interrogate the mechanisms of PC underusage, especially before advanced stages, and address barriers to PC services across the health care system.
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Affiliation(s)
- Zidong Zhang
- Advanced HEAlth Data (AHEAD) Institute, Saint Louis University School of Medicine St. Louis MO USA
| | - Divya S Subramaniam
- Advanced HEAlth Data (AHEAD) Institute, Saint Louis University School of Medicine St. Louis MO USA
- Department of Health & Clinical Outcomes Research Saint Louis University School of Medicine St. Louis MO USA
| | | | | | - William H Frick
- Division of Cardiology, Department of Internal Medicine Saint Louis University School of Medicine St. Louis MO USA
| | - Kimberly Enard
- Department of Health Management and Policy, College for Public Health and Social Justice Saint Louis University St. Louis MO USA
| | - Leslie Hinyard
- Advanced HEAlth Data (AHEAD) Institute, Saint Louis University School of Medicine St. Louis MO USA
- Department of Health & Clinical Outcomes Research Saint Louis University School of Medicine St. Louis MO USA
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Iancu DG, Varga A, Cristescu L, Dumbrava RA, Stoica F, Moldovan DA, Suteu RA, Tilea I. Kidney Dysfunction, Hepatic Impairment, and Lipid Metabolism Abnormalities in Patients with Precapillary Pulmonary Hypertension. Diagnostics (Basel) 2024; 14:1824. [PMID: 39202312 PMCID: PMC11353558 DOI: 10.3390/diagnostics14161824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2024] [Revised: 08/16/2024] [Accepted: 08/20/2024] [Indexed: 09/03/2024] Open
Abstract
BACKGROUND Pulmonary hypertension (PH) is a global health issue that has profound medical and research implications. METHODS This retrospective study examined changes in renal and liver function, as well as lipid metabolism, over a 12-month period in 49 adult patients with pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH). All cases were admitted, managed, and followed up with in the PH Center, County Emergency Clinical Hospital of Targu Mures, Romania. RESULTS Kidney dysfunction was observed in 12.24% of cases at baseline, decreasing to 8.16% at 12 months, and CTEPH patients were more affected. In particular, CTEPH patients exhibited an improvement in renal function, confirmed by an increase in their glomerular filtration rates. Hepatic impairment was present in 57.14% of subjects at baseline, declining to 42.86% at 12 months, with significant improvements noted in the PAH group. Lipid metabolic dysregulations were experienced by 22.45% of all patients at baseline, decreasing to 16.33% at 6 months, with a slow elevation to 24.49% at 12 months, but with no statistically significant differences. Pharmacological regimens were adjusted in accordance with the PH groups, a patient's functional and clinical response, and laboratory tests. CONCLUSIONS Our results demonstrate the multi-organ damage in PH and the importance of individualized treatment approaches.
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Affiliation(s)
- Dragos Gabriel Iancu
- Doctoral School, G.E. Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540142 Targu Mures, Romania; (D.G.I.); (L.C.); (R.A.D.); (F.S.); (D.A.M.)
- Department of Internal Medicine II, Emergency Clinical County Hospital, 540042 Targu Mures, Romania
- Faculty of Medicine, G.E. Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540142 Targu Mures, Romania;
| | - Andreea Varga
- Faculty of Medicine, G.E. Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540142 Targu Mures, Romania;
- Department of Cardiology II, Emergency Clinical County Hospital, 540042 Targu Mures, Romania
| | - Liviu Cristescu
- Doctoral School, G.E. Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540142 Targu Mures, Romania; (D.G.I.); (L.C.); (R.A.D.); (F.S.); (D.A.M.)
- Faculty of Medicine, G.E. Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540142 Targu Mures, Romania;
| | - Robert Adrian Dumbrava
- Doctoral School, G.E. Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540142 Targu Mures, Romania; (D.G.I.); (L.C.); (R.A.D.); (F.S.); (D.A.M.)
- Department of Internal Medicine II, Emergency Clinical County Hospital, 540042 Targu Mures, Romania
| | - Florin Stoica
- Doctoral School, G.E. Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540142 Targu Mures, Romania; (D.G.I.); (L.C.); (R.A.D.); (F.S.); (D.A.M.)
- Department of Internal Medicine II, Emergency Clinical County Hospital, 540042 Targu Mures, Romania
| | - Diana Andreea Moldovan
- Doctoral School, G.E. Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540142 Targu Mures, Romania; (D.G.I.); (L.C.); (R.A.D.); (F.S.); (D.A.M.)
- Faculty of Medicine, G.E. Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540142 Targu Mures, Romania;
- Department of Cardiology I, The Emergency Institute for Cardiovascular Diseases and Transplantation, 540136 Targu Mures, Romania;
| | - Radu Adrian Suteu
- Department of Cardiology I, The Emergency Institute for Cardiovascular Diseases and Transplantation, 540136 Targu Mures, Romania;
| | - Ioan Tilea
- Faculty of Medicine, G.E. Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540142 Targu Mures, Romania;
- Department of Cardiology II, Emergency Clinical County Hospital, 540042 Targu Mures, Romania
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Wang X, Zhang Y, Xia J, Xu H, Zhang L, Feng N, An X. Impact of β-blockers on in-hospital mortality in patients with heart failure: a retrospective propensity-score matched analysis based on MIMIC-IV database. Front Pharmacol 2024; 15:1448015. [PMID: 39193346 PMCID: PMC11347275 DOI: 10.3389/fphar.2024.1448015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2024] [Accepted: 08/02/2024] [Indexed: 08/29/2024] Open
Abstract
Introduction This study assessed the relationship between β-blockers treatment and in-hospital mortality among individuals diagnosed with heart failure (HF). Methods A retrospective cohort study was carried out on 9,968 HF patients sourced from the Medical Information Mart for Intensive Care (MIMIC)-IV database. Propensity score matching (PSM) was employed to balance the baseline differences. A multivariate regression analysis was utilized to evaluate the impact of β-blockers therapy on in-hospital mortality. Results Among the 9,968 patients, 6,439 (64.6%) were β-blockers users. Before matching, the overall in-hospital mortality rate was 12.2% (1,217/9,968). Following PSM, a total of 3,212 patient pairs were successfully matched. The analysis revealed a correlation between β-blockers therapy and decreased in-hospital mortality (odds ratio 0.51 [0.43-0.60], P < 0.001), as well as shorter Los (length of stay) hospital (β -1.43 [-1.96∼-0.09], P < 0.001). Notably, long-acting β-blockers treatment was linked to a decreased risk of in-hospital mortality (odds ratio 0.55 [0.46-0.65], P < 0.001) and a shorter Los hospital (β -1.21 [-1.80∼-0.63], P < 0.001). Conversely, the research results did not show a notable decrease in-hospital mortality (odds ratio 0.66 [0.44-1.01], P = 0.051) or Los hospital (β -1.01 [-2.2∼-0.25], P = 0.117) associated with short-acting β-blocker therapy. Discussion β-blockers therapy in the intensive care unit demonstrates potential benefits in lowering the risk of in-hospital mortality and reducing the duration of hospitalization among patients with HF. Specifically, long-acting β-blockers exhibit a protective effect by significantly decreasing both in-hospital mortality and Los hospital. Conversely, the study did not observe a substantial impact on in-hospital mortality or Los hospital duration in this cohort of patients following the administration of short-acting β-blockers.
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Affiliation(s)
- Xin Wang
- Department of Interventional Vascular, Zibo 148 Hospital, China RongTong Medical Healthcare Group Co., Ltd., Zibo, Shandong, China
| | - Yuzhu Zhang
- Department of Anesthesiology, Zibo Central Hospital, Zibo, Shandong, China
| | - Jiangling Xia
- Department of Anesthesiology, Zibo Central Hospital, Zibo, Shandong, China
| | - Hongyu Xu
- Department of Anesthesiology, Zibo Central Hospital, Zibo, Shandong, China
| | - Lu Zhang
- Department of Anesthesiology, Zibo Central Hospital, Zibo, Shandong, China
| | - Nianhai Feng
- Department of Anesthesiology, Zibo Central Hospital, Zibo, Shandong, China
| | - Xiaona An
- Department of Anesthesiology, Zibo Central Hospital, Zibo, Shandong, China
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Chen J, Cui Y, Wu P, Dassanayake R, Yu P, Fu K, Sun Z, Liu Y, Zhou Y. Nitroxyl donating and visualization with a coumarin-based fluorescence probe. SPECTROCHIMICA ACTA. PART A, MOLECULAR AND BIOMOLECULAR SPECTROSCOPY 2024; 316:124317. [PMID: 38692102 DOI: 10.1016/j.saa.2024.124317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Revised: 03/27/2024] [Accepted: 04/18/2024] [Indexed: 05/03/2024]
Abstract
Nitroxyl (HNO), the single-electron reduction product of nitric oxide (NO), has attracted great interest in the treatment of congestive heart failure in clinical trials. In this paper, we describe the first coumarin-based compound N-hydroxy-2-oxo-2H-chromene-6-sulfonamide (CD1) as a dualfunctional HNO donor, which can release both an HNO signaling molecule and a fluorescent reporter. Under physiological conditions (pH 7.4 and 37 °C), the CD1 HNO donor can readily decompose with a half-life of ∼90 min. The corresponding stoichiometry HNO from the CD1 donor was confirmed using both Vitamin B12 and phosphine compound traps. In addition to HNO releasing, specifically, the degradation product 2-oxo-2H-chromene-6-sulfinate (CS1) was generated as a fluorescent marker during the decomposition. Therefore, the HNO amount released in situ can be accurately monitored through fluorescence generation. As compared to the CD1 donor, the fluorescence intensity increased by about 4.9-fold. The concentration limit of detection of HNO releasing was determined to be ∼0.13 μM according to the fluorescence generation of CS1 at physiological conditions. Moreover, the bioimaging of the CD1 donor was demonstrated in the cell culture of HeLa cells, where the intracellular fluorescence signals were observed, inferring the site of HNO release. Finally, we anticipate that this novel coumarin-based CD1 donor opens a new platform for exploring the biology of HNO.
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Affiliation(s)
- Jiajun Chen
- Key Laboratory of Advanced Materials of Tropical Island Resources of Ministry of Education and School of Chemical Engineering and Technology, Hainan University, Haikou, Hainan 570228, China
| | - Yunxi Cui
- College of Life Sciences, Nankai University, Tianjin 300071, China
| | - Peixuan Wu
- Key Laboratory of Advanced Materials of Tropical Island Resources of Ministry of Education and School of Chemical Engineering and Technology, Hainan University, Haikou, Hainan 570228, China
| | - Rohan Dassanayake
- Department of Biosystems Technology, Faculty of Technology, University of Sri Jayewardenepura, Pitipana, Homagama 10200, Sri Lanka
| | - Peng Yu
- Department of Joint Surgery, The First Affiliated Hospital of Hainan Medical University, Haikou 570102, China
| | - Kun Fu
- Department of Joint Surgery, The First Affiliated Hospital of Hainan Medical University, Haikou 570102, China
| | - Zhicheng Sun
- Beijing Engineering Research Center of Printed Electronics, Beijing Institute of Graphic Communication, Beijing 102600, China
| | - Yuanyuan Liu
- Key Laboratory of Advanced Materials of Tropical Island Resources of Ministry of Education and School of Chemical Engineering and Technology, Hainan University, Haikou, Hainan 570228, China
| | - Yang Zhou
- Key Laboratory of Advanced Materials of Tropical Island Resources of Ministry of Education and School of Chemical Engineering and Technology, Hainan University, Haikou, Hainan 570228, China.
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Sadiq E, Woodiwiss A, Norton G, Modi G. Cardioembolic stroke in an HIV endemic region: underdiagnosed and severe. BMJ Neurol Open 2024; 6:e000592. [PMID: 39104634 PMCID: PMC11298736 DOI: 10.1136/bmjno-2023-000592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 07/11/2024] [Indexed: 08/07/2024] Open
Abstract
Background and objectives Cardioembolic stroke (CES) appears to be a rare cause of stroke (4%-9%) in people living with HIV (PLWH) in sub-Saharan Africa (SSA). However, due to limited access to diagnostic resources, this may be an underestimate. It is also unclear which cardiac pathologies are the major contributors to CES in this region. We sought to determine the prevalence and aetiology of CES in PLWH and to determine whether there are any differences compared with HIV negative stroke patients. Methods This cross-sectional study recruited PLWH with new-onset stroke at a quaternary-level hospital in Johannesburg, South Africa, from 2014 to 2017, and compared them to age-matched and sex-matched HIV negative stroke patients. Comprehensive investigations were performed to determine the underlying stroke aetiology, including electrocardiography, echocardiography, CT angiography and cerebrospinal fluid examination. Results 85 PLWH with ischaemic stroke were recruited and compared with 109 HIV negative controls. CES was identified in 17/85 (20.0%) of PLWH. These patients had more severe strokes than PLWH with non-CES (National Institutes of Health Stroke Scale score 14.9±6.7 vs 11.7±5.4, p=0.04). Cardiomyopathy was the predominant cardiac pathology in PLWH (76.4% vs 45.5% in HIV negative, p=0.04) while valvulopathy was more common in HIV negative patients (42.4% vs 11.8% in PLWH, p=0.03). Arrhythmia (n=1) and ischaemic heart disease (n=1) were uncommon in PLWH. Conclusion CES is underdiagnosed in SSA and is more severe than non-CES. The identification of cardiomyopathy as the predominant underlying cardiac pathology may assist to target resources towards its detection using accessible cost-effective biomarkers.
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Affiliation(s)
- Eitzaz Sadiq
- Division of Neurology, Department of Neurosciences, University of the Witwatersrand Johannesburg Faculty of Health Sciences, Johannesburg, South Africa
| | - Angela Woodiwiss
- Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, University of the Witwatersrand Johannesburg Faculty of Health Sciences, Johannesburg, South Africa
| | - Gavin Norton
- Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, University of the Witwatersrand Johannesburg Faculty of Health Sciences, Johannesburg, South Africa
| | - Girish Modi
- Division of Neurology, Department of Neurosciences, University of the Witwatersrand Johannesburg Faculty of Health Sciences, Johannesburg, South Africa
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Meehan CP, White E, CVitan A, Jiang L, Wu WC, Wice M, Stafford J, Rudolph JL. Factors Associated With Early Palliative Care Among Patients With Heart Failure. J Palliat Med 2024; 27:1001-1008. [PMID: 38608234 DOI: 10.1089/jpm.2023.0539] [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] [Indexed: 04/14/2024] Open
Abstract
Background: Heart failure (HF) is a progressive, life-limiting illness for which palliative care (PC) is considered standard of care. Among patients that do receive PC, consultation tends to occur late in the illness course. Objective: Our primary aim was to examine patient factors associated with receiving PC in HF. Secondarily, we sought to determine factors associated with early PC encounters. Design: This was a retrospective cohort study of U.S. Veterans with prior hospitalization who died between January 1, 2011 and December 31, 2020. Setting/Subjects: Subjects were Veterans with HF who died with a prior admission to a Veterans Affairs hospital in the United States. Measurements: We calculated the time from PC encounter to death. We characterized HF patients who died without PC, with late PC (≤90 days before death), and with early PC (>90 days before death). Results: We identified 232,079 Veterans with a mean age of (76.5 ± 10.7) years. Within the cohort, 56.5% (n = 131,122) of Veterans died with no PC, 22.5% (n = 52,114) had PC <90 days before death, and 21.0% (n = 48,843) had PC >90 days before death. Veterans who died without PC tended to be younger with fewer comorbidities. Conclusions: While more than 20% of HF patients in our cohort had PC well in advance of death, more than half died without PC. PC involvement seemed to be driven by comorbidities rather than HF. Effective collaboration with Cardiology is needed to identify patients who would benefit from earlier PC involvement.
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Affiliation(s)
- Caroline P Meehan
- Department of Medicine, Rhode Island Hospital and Lifespan Health System, Providence, Rhode Island, USA
| | - Emily White
- Department of Medicine, Rhode Island Hospital and Lifespan Health System, Providence, Rhode Island, USA
| | - Alexander CVitan
- Department of Medicine, Rhode Island Hospital and Lifespan Health System, Providence, Rhode Island, USA
| | - Lan Jiang
- Center of Innovation in Long-Term Services and Supports, Providence VA Medical Center, Providence, Rhode Island, USA
| | - Wen-Chih Wu
- Department of Medicine, Rhode Island Hospital and Lifespan Health System, Providence, Rhode Island, USA
- Center of Innovation in Long-Term Services and Supports, Providence VA Medical Center, Providence, Rhode Island, USA
- Department of Medicine, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Mitchell Wice
- Center of Innovation in Long-Term Services and Supports, Providence VA Medical Center, Providence, Rhode Island, USA
- Department of Medicine, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
- Geriatrics and Extended Care, Providence VA Healthcare System, Providence, Rhode Island, USA
| | - Jensy Stafford
- Center of Innovation in Long-Term Services and Supports, Providence VA Medical Center, Providence, Rhode Island, USA
- Department of Medicine, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - James L Rudolph
- Center of Innovation in Long-Term Services and Supports, Providence VA Medical Center, Providence, Rhode Island, USA
- Department of Medicine, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
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Kobayashi T, Iwasaki T, Kurata H, Nikaido A, Hata Y. The 30-second chair stand test (CS30) as a predictor of exercise tolerance in elderly individuals (≥75 years) with stage A/B heart failure. IJC HEART & VASCULATURE 2024; 53:101442. [PMID: 39228972 PMCID: PMC11368597 DOI: 10.1016/j.ijcha.2024.101442] [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: 11/17/2023] [Revised: 05/10/2024] [Accepted: 06/02/2024] [Indexed: 09/05/2024]
Abstract
Background In Japan, the number of very elderly individuals with heart failure (HF) is on the rise. One indicator of HF stage progression is a decrease in exercise tolerance (ET). While peak oxygen uptake (peak VO₂) determined by cardiopulmonary exercise testing (CPX) is the gold standard for ET assessment, the wide-scale applicability of CPX is constrained owing to expensive equipment and challenges in this population. The 30-second chair stand test (CS30), a simple and quick alternative, is widely used among community-dwelling elderly individuals. The objective of this study was to investigate whether CS30 is a predictor of ET in elderly individuals with stage A/B HF. Methods Of 748 outpatients aged 75 years and over who visited our center between March 2021 and December 2022, 493 patients (296 males and 197 females) were included in this study. CS30 was measured using a seat height of 40 cm, and peak VO₂ was assessed using CPX. Results The findings showed a statistically significant positive association between CS30 and peak VO₂ for both males and females (males: β = 0.255, 95 % CI = 0.102-0.407; females: β = 0.282, 95 % CI = 0.043-0.521). Receiver operating characteristic (ROC) analyses showed moderate accuracy of CS30 in predicting low ET in both sexes (males AUC = 0.740, 95 % CI = 0.640-0.841, p < 0.001; females AUC = 0.725, 95 % CI = 0.644-0.807, p < 0.001). The cut-off values of CS30 were established as 18 times for males and 16 times for females. Conclusions CS30 is a potentially convenient method for estimating current ET in older adults, providing a feasible alternative to CPX.
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Affiliation(s)
- Taku Kobayashi
- Department of Rehabilitation, Minamino Cardiovascular Hospital, Japan
- Hachioji Minamino Cardiac Rehabilitation Clinic, Japan
| | - Takatoshi Iwasaki
- Department of Rehabilitation, Minamino Cardiovascular Hospital, Japan
- Hachioji Minamino Cardiac Rehabilitation Clinic, Japan
| | - Hiroko Kurata
- Department of Rehabilitation, Minamino Cardiovascular Hospital, Japan
- Hachioji Minamino Cardiac Rehabilitation Clinic, Japan
| | - Akira Nikaido
- Hachioji Minamino Cardiac Rehabilitation Clinic, Japan
- Department of Cardiology, Minamino Cardiovascular Hospital, Japan
| | - Yoshiki Hata
- Department of Cardiology, Minamino Cardiovascular Hospital, Japan
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10
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Gou D, Min C, Peng X, Wu H, Zhang L, Chen Y, Tao M. Associating factors of cognitive frailty among older people with chronic heart failure: Based on LASSO-logistic regression. J Adv Nurs 2024. [PMID: 39078209 DOI: 10.1111/jan.16352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 06/10/2024] [Accepted: 07/08/2024] [Indexed: 07/31/2024]
Abstract
AIM To analyse factors associated with cognitive frailty among older chronic heart failure patients in China. DESIGN A cross-sectional design. METHODS Between August 2021 and November 2022, a total of 421 chronic heart failure patients (age ≥60 years) were randomly selected from the cardiology department of the affiliated hospital of Zunyi Medical University. The FRAIL scale, Mini-Mental State Examination, 15-item Geriatric Depression Scale, Social Support Rating Scale, Short-form Mini Nutritional Assessment and Pittsburgh Sleep Quality Index were utilized for measurement and evaluation. The demographic and clinical characteristics of patients were collected. To select initial variables, the Least Absolute Shrinkage Selection Operator was applied, and then logistic regression analysis was used to confirm associating factors. RESULTS Among 421 elderly people with chronic heart failure, 83 cases (19.7%) showed cognitive frailty. Of 31 variables, seven were selected by Least Absolute Shrinkage Selection Operator regression. Finally, multivariate logistic regression revealed that the age, monthly salary, drinking, NYHA classification, length of hospital stay, depression and malnutrition risk/malnutrition were independently associated with cognitive frailty. CONCLUSION The high proportion of cognitive frailty in older people with chronic heart failure should be concerned. Additionally, in the setting of cognitive frailty, efforts to diagnose it and develop interventions to prevent or reverse cognitive frailty status among older chronic heart failure patients are necessary. IMPACT The findings of our study highlight the necessity to evaluate cognitive frailty in older people with chronic heart failure and provide a new perspective and scientific basis for medical staff to develop individualized and specific interventions to prevent or reverse cognitive frailty status. REPORTING METHOD This study has been reported in compliance with STROBE reporting guidelines for cross-sectional studies. PATIENT OR PUBLIC CONTRIBUTION No Patient or Public Contribution.
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Affiliation(s)
- Dengqun Gou
- Department of Nursing, Affiliated Hospital of Zunyi Medical University, Zunyi, P. R. China
| | - Changhang Min
- Department of Laboratory Medicine, Affiliated Hospital of Zunyi Medical University, Zunyi, P. R. China
| | - Xiaofeng Peng
- Department of Nursing, Affiliated Hospital of Zunyi Medical University, Zunyi, P. R. China
| | - Hemei Wu
- Department of Nursing, Affiliated Hospital of Zunyi Medical University, Zunyi, P. R. China
| | - Lu Zhang
- Department of Nursing, Affiliated Hospital of Zunyi Medical University, Zunyi, P. R. China
| | - Yu Chen
- Department of Nursing, Affiliated Hospital of Zunyi Medical University, Zunyi, P. R. China
| | - Ming Tao
- Department of Nursing, Affiliated Hospital of Zunyi Medical University, Zunyi, P. R. China
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11
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Malinow I, Fong DC, Miyamoto M, Badran S, Hong CC. Pediatric dilated cardiomyopathy: a review of current clinical approaches and pathogenesis. Front Pediatr 2024; 12:1404942. [PMID: 38966492 PMCID: PMC11223501 DOI: 10.3389/fped.2024.1404942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Accepted: 06/05/2024] [Indexed: 07/06/2024] Open
Abstract
Pediatric dilated cardiomyopathy (DCM) is a rare, yet life-threatening cardiovascular condition characterized by systolic dysfunction with biventricular dilatation and reduced myocardial contractility. Therapeutic options are limited with nearly 40% of children undergoing heart transplant or death within 2 years of diagnosis. Pediatric patients are currently diagnosed based on correlating the clinical picture with echocardiographic findings. Patient age, etiology of disease, and parameters of cardiac function significantly impact prognosis. Treatments for pediatric DCM aim to ameliorate symptoms, reduce progression of disease, and prevent life-threatening arrhythmias. Many therapeutic agents with known efficacy in adults lack the same evidence in children. Unlike adult DCM, the pathogenesis of pediatric DCM is not well understood as approximately two thirds of cases are classified as idiopathic disease. Children experience unique gene expression changes and molecular pathway activation in response to DCM. Studies have pointed to a significant genetic component in pediatric DCM, with variants in genes related to sarcomere and cytoskeleton structure implicated. In this regard, pediatric DCM can be considered pediatric manifestations of inherited cardiomyopathy syndromes. Yet exciting recent studies in infantile DCM suggest that this subset has a distinct etiology involving defective postnatal cardiac maturation, such as the failure of programmed centrosome breakdown in cardiomyocytes. Improved knowledge of pathogenesis is central to developing child-specific treatment approaches. This review aims to discuss the established biological pathogenesis of pediatric DCM, current clinical guidelines, and promising therapeutic avenues, highlighting differences from adult disease. The overarching goal is to unravel the complexities surrounding this condition to facilitate the advancement of novel therapeutic interventions and improve prognosis and overall quality of life for pediatric patients affected by DCM.
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Affiliation(s)
- Ian Malinow
- Division of Cardiovascular Medicine, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Daniel C. Fong
- Division of Cardiovascular Medicine, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Matthew Miyamoto
- Division of Cardiovascular Medicine, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Sarah Badran
- Department of Pediatric Cardiology, Michigan State University College of Human Medicine Helen Devos Children’s Hospital, Grand Rapids, MI, United States
| | - Charles C. Hong
- Department of Medicine, Division of Cardiology, Michigan State University College of Human Medicine, East Lansing, MI, United States
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12
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Yang C, Liu W, Tong Z, Lei F, Lin L, Huang X, Zhang X, Sun T, Wu G, Shan H, Chen S, Li H. The Relationship Between Insulin Resistance Indicated by Triglyceride and Glucose Index and Left Ventricular Hypertrophy and Decreased Left Ventricular Diastolic Function with Preserved Ejection Fraction. Diabetes Metab Syndr Obes 2024; 17:2259-2272. [PMID: 38868630 PMCID: PMC11166847 DOI: 10.2147/dmso.s454876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 05/13/2024] [Indexed: 06/14/2024] Open
Abstract
Aim The evidence on the association between insulin resistance (IR) and the prevalence or incidence of cardiac dysfunction has been controversial, and the relationship between pre-diabetic IR and cardiac function is lacking. Large sample studies in the Chinese general population are urgently needed to explore the association between IR and the risk of left ventricular hypertrophy (LVH) and decreased left ventricular diastolic function with preserved ejection fraction (LVDFpEF). Methods Based on a National Health Check-up database in China, we conducted a multicenter cross-sectional retrospective study in 344,420 individuals. Furthermore, at a single center, we performed two retrospective longitudinal studies encompassing 8270 and 5827 individuals to investigate the association between IR and the development of new-onset LVH and LVDFpEF, respectively. The median follow-up duration exceeded 2.5 years. The triglyceride and glucose (TyG) index, known for its high sensitivity in detecting IR, serves as a reliable alternative marker of IR. The logistic and cox proportional hazard regression models were used to determine the relationships. Results In the cross-sectional study, IR showed a positive association with the prevalence of LVH and decreased LVDFpEF after adjusting for confounders. In the longitudinal cohort, IR was also correlated with the new onset of LVH and decreased LVDFpEF, with hazard ratios (HR) of 1.986 (95% CI: 1.307, 3.017) and 1.386 (95% CI: 1.167, 1.647) in the fourth quartile of TyG levels compared to the lowest quartile, respectively, after adjusting for confounders. The subgroup analysis in non-hypertensive or non-diabetic people and the sensitivity analysis in the population with homeostasis model assessment of insulin resistance (HOMA-IR) further verified the above-mentioned results. Conclusion IR was associated with LVH and decreased LVDFpEF. Effective management of IR may prevent or delay the development of adverse LVH and decreased LVDFpEF.
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Affiliation(s)
- Chengzhang Yang
- Department of Cardiology, Huanggang Central Hospital, Huanggang, People’s Republic of China
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, People’s Republic of China
| | - Weifang Liu
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, People’s Republic of China
- Institute of Model Animal, Wuhan University, Wuhan, People’s Republic of China
| | - Zijia Tong
- Department of Cardiology, Huanggang Central Hospital, Huanggang, People’s Republic of China
| | - Fang Lei
- Institute of Model Animal, Wuhan University, Wuhan, People’s Republic of China
- Medical Science Research Center, Zhongnan Hospital of Wuhan University, Wuhan, People’s Republic of China
| | - Lijin Lin
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, People’s Republic of China
- Institute of Model Animal, Wuhan University, Wuhan, People’s Republic of China
| | - Xuewei Huang
- Institute of Model Animal, Wuhan University, Wuhan, People’s Republic of China
- Department of Cardiology, The Third Xiangya Hospital, Central South University, Changsha, People’s Republic of China
| | - Xingyuan Zhang
- Institute of Model Animal, Wuhan University, Wuhan, People’s Republic of China
- School of Basic Medical Science, Wuhan University, Wuhan, People’s Republic of China
| | - Tao Sun
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, People’s Republic of China
- Institute of Model Animal, Wuhan University, Wuhan, People’s Republic of China
| | - Gang Wu
- Department of Cardiology, Huanggang Central Hospital, Huanggang, People’s Republic of China
| | - Huajing Shan
- Department of Cardiology, Huanggang Central Hospital, Huanggang, People’s Republic of China
| | - Shaoze Chen
- Department of Cardiology, Huanggang Central Hospital, Huanggang, People’s Republic of China
| | - Hongliang Li
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, People’s Republic of China
- Institute of Model Animal, Wuhan University, Wuhan, People’s Republic of China
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13
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Ommen SR, Ho CY, Asif IM, Balaji S, Burke MA, Day SM, Dearani JA, Epps KC, Evanovich L, Ferrari VA, Joglar JA, Khan SS, Kim JJ, Kittleson MM, Krittanawong C, Martinez MW, Mital S, Naidu SS, Saberi S, Semsarian C, Times S, Waldman CB. 2024 AHA/ACC/AMSSM/HRS/PACES/SCMR Guideline for the Management of Hypertrophic Cardiomyopathy: A Report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines. Circulation 2024; 149:e1239-e1311. [PMID: 38718139 DOI: 10.1161/cir.0000000000001250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/05/2024]
Abstract
AIM The "2024 AHA/ACC/AMSSM/HRS/PACES/SCMR Guideline for the Management of Hypertrophic Cardiomyopathy" provides recommendations to guide clinicians in the management of patients with hypertrophic cardiomyopathy. METHODS A comprehensive literature search was conducted from September 14, 2022, to November 22, 2022, encompassing studies, reviews, and other evidence on human subjects that were published in English from PubMed, EMBASE, the Cochrane Library, the Agency for Healthcare Research and Quality, and other selected databases relevant to this guideline. Additional relevant studies, published through May 23, 2023, during the guideline writing process, were also considered by the writing committee and added to the evidence tables, where appropriate. STRUCTURE Hypertrophic cardiomyopathy remains a common genetic heart disease reported in populations globally. Recommendations from the "2020 AHA/ACC Guideline for the Diagnosis and Treatment of Patients With Hypertrophic Cardiomyopathy" have been updated with new evidence to guide clinicians.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Victor A Ferrari
- AHA/ACC Joint Committee on Clinical Practice Guidelines liaison
- SCMR representative
| | | | - Sadiya S Khan
- ACC/AHA Joint Committee on Performance Measures representative
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14
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Ogilvie LM, Coyle-Asbil B, Brunt KR, Petrik J, Simpson JA. Therapy-naïve malignancy causes cardiovascular disease: a state-of-the-art cardio-oncology perspective. Am J Physiol Heart Circ Physiol 2024; 326:H1515-H1537. [PMID: 38639740 DOI: 10.1152/ajpheart.00795.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 04/15/2024] [Accepted: 04/15/2024] [Indexed: 04/20/2024]
Abstract
Cardiovascular disease (CVD) and cancer are the leading causes of mortality worldwide. Although generally thought of as distinct diseases, the intersectional overlap between CVD and cancer is increasingly evident in both causal and mechanistic relationships. The field of cardio-oncology is largely focused on the cardiotoxic effects of cancer therapies (e.g., chemotherapy, radiation). Furthermore, the cumulative effects of cardiotoxic therapy exposure and the prevalence of CVD risk factors in patients with cancer lead to long-term morbidity and poor quality of life in this patient population, even when patients are cancer-free. Evidence from patients with cancer and animal models demonstrates that the presence of malignancy itself, independent of cardiotoxic therapy exposure or CVD risk factors, negatively impacts cardiac structure and function. As such, the primary focus of this review is the cardiac pathophysiological and molecular features of therapy-naïve cancer. We also summarize the strengths and limitations of preclinical cancer models for cardio-oncology research and discuss therapeutic strategies that have been tested experimentally for the treatment of cancer-induced cardiac atrophy and dysfunction. Finally, we explore an adjacent area of interest, called "reverse cardio-oncology," where the sequelae of heart failure augment cancer progression. Here, we emphasize the cross-disease communication between malignancy and the injured heart and discuss the importance of chronic low-grade inflammation and endocrine factors in the progression of both diseases.
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Affiliation(s)
- Leslie M Ogilvie
- Department of Human Health and Nutritional Sciences, University of Guelph, Guelph, Ontario, Canada
| | - Bridget Coyle-Asbil
- Department of Human Health and Nutritional Sciences, University of Guelph, Guelph, Ontario, Canada
| | - Keith R Brunt
- Department of Pharmacology, Dalhousie Medicine New Brunswick, Saint John, New Brunswick, Canada
- IMPART Investigator Team Canada, Saint John, New Brunswick, Canada
| | - Jim Petrik
- Department of Biomedical Sciences, University of Guelph, Guelph, Ontario, Canada
| | - Jeremy A Simpson
- Department of Human Health and Nutritional Sciences, University of Guelph, Guelph, Ontario, Canada
- IMPART Investigator Team Canada, Saint John, New Brunswick, Canada
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15
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Miao F, Tian A, Wang B, Li J. Cognitive impairment in young and middle-aged patients with acute heart failure. ESC Heart Fail 2024. [PMID: 38816208 DOI: 10.1002/ehf2.14885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 04/15/2024] [Accepted: 05/11/2024] [Indexed: 06/01/2024] Open
Abstract
AIMS This study aimed to investigate the prevalence, risk factors and prognostic implications of cognitive impairment in young and middle-aged patients with acute heart failure (HF). METHODS In a prospective cohort of patients with acute HF, we assessed cognitive function by the Mini-Cog, predictors of the cognitive impairment and its associations with 30 day and 1 year cardiovascular death or HF rehospitalization among young and middle-aged patients (<65 years old). RESULTS Among 1958 young and middle-aged patients, the prevalence of cognitive impairment was 19.6%. Predictors of cognitive impairment included older age, females, lower education levels and prior strokes. Compared with patients having normal cognitive function, cognitive impairment was associated with a higher risk of 30 day cardiovascular death or HF rehospitalization [hazard ratio (HR), 1.52, 95% confidence interval (CI), 1.07-2.17, P = 0.02], but not for 1 year cardiovascular death or HF rehospitalization (HR, 1.06, 95% CI, 0.87-1.30, P = 0.55). CONCLUSIONS Cognitive impairment is present in a notable proportion of young and middle-aged patients with acute HF and is associated with an increased risk of short-term adverse outcomes. Strategies for screening and intervention for cognitive impairment at a younger age are necessary, particularly for those at high risk.
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Affiliation(s)
- Fengyu Miao
- National Clinical Research Center for Cardiovascular Diseases, NHC Key Laboratory of Clinical Research for Cardiovascular Medications, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, Beijing, People's Republic of China
- Fuwai Hospital, Chinese Academy of Medical Sciences, Shenzhen, People's Republic of China
- Beijing Municipal Health Big Data and Policy Research Center, Beijing Institute of Hospital Management, Beijing, People's Republic of China
| | - Aoxi Tian
- National Clinical Research Center for Cardiovascular Diseases, NHC Key Laboratory of Clinical Research for Cardiovascular Medications, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, Beijing, People's Republic of China
- Fuwai Hospital, Chinese Academy of Medical Sciences, Shenzhen, People's Republic of China
| | - Bin Wang
- National Clinical Research Center for Cardiovascular Diseases, NHC Key Laboratory of Clinical Research for Cardiovascular Medications, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, Beijing, People's Republic of China
- Fuwai Hospital, Chinese Academy of Medical Sciences, Shenzhen, People's Republic of China
| | - Jing Li
- National Clinical Research Center for Cardiovascular Diseases, NHC Key Laboratory of Clinical Research for Cardiovascular Medications, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, Beijing, People's Republic of China
- Fuwai Hospital, Chinese Academy of Medical Sciences, Shenzhen, People's Republic of China
- Central-China Branch of National Center for Cardiovascular Diseases, Central-China Hospital, Zhengzhou, People's Republic of China
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16
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Zheng Y, Chen Q, Xia C, Liu H. Thirst symptoms in patients with heart failure: An integrative review. J Adv Nurs 2024. [PMID: 38771082 DOI: 10.1111/jan.16250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 03/29/2024] [Accepted: 05/10/2024] [Indexed: 05/22/2024]
Abstract
AIM To identify the risk and protective factors affecting thirst symptoms in patients with heart failure (HF) and intervention strategies to alleviate thirst symptoms. DESIGN An integrative review. METHODS A total of 61 articles were retrieved. Screening yielded a total of 21 articles which were appraised for quality. The quality of studies was assessed using the Mixed Methods Appraisal Tool. DATA SOURCES Ten electronic databases were searched in October 2023, including Embase, Pubmed, CINAHL, Cochrane, Web of Science, Wiley, CNKI, VIP, CBM and WanFang. In addition, we searched grey databases and manually searched reference lists of included and relevant reviews. RESULTS In total, 1644 articles were retrieved, of which 21 were included. Eight studies addressed the factors. Six themes emerged as risk factors, including demographics, severity of disease, psycho-environmental, medication, fluid restriction and homeostasis. Conversely, an increase in fluid intake, a high score of sodium restriction diet attitude and using ARB were identified as protective factors. Thirteen studies focus on intervention strategies. Five unique intervention strategies were identified, including Traditional Chinese Medicine, mint-related interventions, sour-flavour interventions, improved water restriction and cluster nursing strategy. CONCLUSION This finding identified the factors associated with thirst symptoms in patients with HF, especially concerning the elaboration of risk factors, which suggests that healthcare professionals should focus on the risk factors for thirst in patients with HF and consciously avoid the occurrence of these risk factors. Additionally, there are considerable cultural differences in interventions, therefore, to increase adherence during symptom management, careful selection of appropriate intervention strategies based on the requirements and preferences of patients is required. While there are some therapies, there aren't enough high-quality empirical investigations. Thus, multi-centre, large-sample studies are also required in subsequent research to demonstrate the interventions' effectiveness. IMPLICATIONS FOR THE PROFESSION The nurse must notice the symptoms of thirst in HF to slow down the disease's progression and improve the patient's physical and emotional well-being. REPORTING METHOD The review complies with the PRISMA guidelines for reporting systematic reviews. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution.
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Affiliation(s)
- Yingjun Zheng
- Shantou University Medical College, Shantou, Guangdong Province, China
- The Second Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong Province, China
| | - Qiongshan Chen
- Shantou University Medical College, Shantou, Guangdong Province, China
- The Second Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong Province, China
| | - Chengyu Xia
- Shantou University Medical College, Shantou, Guangdong Province, China
- The Second Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong Province, China
| | - Hui Liu
- The Second Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong Province, China
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17
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Zhao H, Jiang J, Zhong G, Peng Y, Wen Y, Liang Y, Shan Z. Prognostic Value of Depressive Symptoms for Cardiovascular Events in Female Patients With Heart Failure With Reduced Ejection Fraction and Heart Failure With Preserved Ejection Fraction. J Am Heart Assoc 2024; 13:e032961. [PMID: 38686893 PMCID: PMC11179909 DOI: 10.1161/jaha.123.032961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 03/27/2024] [Indexed: 05/02/2024]
Abstract
BACKGROUND Among those with heart failure (HF), women are more likely to develop depression than men. Few studies have focused on the outcomes of female patients with HF with depressive symptoms. METHODS AND RESULTS A total of 506 female patients with HF with preserved ejection fraction were included in this secondary analysis from the TOPCAT (Treatment of Preserved Cardiac Function Heart Failure With an Aldosterone Antagonist) cohort, and 439 female patients with HF with reduced ejection fraction were included from the HF-ACTION (Heart Failure: A Controlled Trial Investigating Outcomes of Exercise Training) cohort. Depressive symptoms were measured using the Patient Health Questionnaire-9 and Beck Depression Inventory-II. The depression class was categorized by severity, and the change in clinical depression class was defined as aggravated (1-grade increase) or improved (1-grade decrease). The prognostic value of depressive symptoms was determined by using multivariable Cox proportional hazards models. Female patients with improved depressive symptoms had worse depressive status at baseline and lower baseline Kansas City Cardiomyopathy Questionnaire scores. Depression class at the 12-month visit and depression class change were the dominant prognostic factors for cardiovascular death in female patients with HF with preserved ejection fraction (hazard ratio [HR], 1.43 [95% CI, 1.02-2.01], P=0.036; HR, 1.71 [95% CI, 1.14-2.55], P=0.009). Among the patients with HF with reduced ejection fraction, both the depression class at baseline and depression class change had significant prognostic effects on cardiovascular death (HR, 3.30 [95% CI, 1.70-6.39], P<0.001; HR, 2.21 [95% CI, 1.28-3.80], P=0.004). However, the prognostic value of depressive assessments for hospitalization in patients with HF is unclear. CONCLUSIONS In female patients with HF with reduced ejection fraction, the depression class at baseline was most strongly associated with cardiovascular death, whereas in female patients with HF with preserved ejection fraction, the change in depression class exhibited a more significant prognostic trend.
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Affiliation(s)
- Hengli Zhao
- Guangdong Provincial Key Laboratory of Clinical PharmacologyMedical Research Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Southern Medical UniversityGuangzhouChina
| | - Jiaxue Jiang
- School of MedicineSouth China University of TechnologyGuangzhouChina
| | - Guoheng Zhong
- Department of Cardiology, State Key Laboratory of Organ Failure ResearchNanfang Hospital, Southern Medical UniversityGuangzhouChina
| | - You Peng
- Division of Obstetrics and GynecologyNanfang Hospital, Southern Medical UniversityGuangzhouChina
| | - Yihong Wen
- School of MedicineSouth China University of TechnologyGuangzhouChina
| | - Yu Liang
- Guangdong Provincial Key Laboratory of Clinical PharmacologyMedical Research Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Southern Medical UniversityGuangzhouChina
| | - Zhixin Shan
- Guangdong Provincial Key Laboratory of Clinical PharmacologyMedical Research Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Southern Medical UniversityGuangzhouChina
- The Innovation Centre of Ministry of Education for Development and Diseases, School of MedicineSouth China University of TechnologyGuangzhouChina
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Liu R, Yao J, Chen K, Peng W. Association between biomarkers of zinc and copper status and heart failure: a meta-analysis. ESC Heart Fail 2024. [PMID: 38690587 DOI: 10.1002/ehf2.14837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 03/23/2024] [Accepted: 04/10/2024] [Indexed: 05/02/2024] Open
Abstract
AIMS Previous studies have investigated the relationship between heart failure (HF) and levels of zinc and copper, but conflicting results have been reported. This meta-analysis aims to clarify the role of zinc and copper in HF progression by examining the associations between HF and concentrations of these minerals. METHODS AND RESULTS We utilized STATA 12.0 software to calculate the standard mean difference (SMD) and 95% confidence interval (CI) for serum zinc and copper levels in patients with HF compared with healthy controls (HCs). The meta-analysis indicated a lower serum zinc level in patients with HF compared with HCs, using a random effects model (SMD = -0.77; 95% CI: -1.01, -0.54; I2 = 61.9%, the P-value for Q test = 0.002). Additionally, the meta-analysis showed an increased serum copper level in patients with HF compared with HCs, using a random effects model (SMD = 0.66; 95% CI: 0.09, 1.23; I2 = 93.8%, the P-value for Q test < 0.001). Meta-regression analysis indicated that publication year, age, and gender were not responsible for heterogeneity across studies. CONCLUSIONS This meta-analysis demonstrates that patients with HF have lower serum zinc and higher copper concentrations compared with healthy subjects. However, the potential of zinc supplementation as a therapy for HF should be approached with caution. The heterogeneity among the included studies was found to be high. It is recommended that further well-designed large sample studies be conducted to validate these findings.
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Affiliation(s)
- Ruixin Liu
- Intensive Care Unit, Jinhua Municipal Central Hospital Medical Group, Jinhua, China
| | - Jiali Yao
- Intensive Care Unit, Jinhua Municipal Central Hospital Medical Group, Jinhua, China
| | - Kexian Chen
- Intensive Care Unit, Jinhua Municipal Central Hospital Medical Group, Jinhua, China
| | - Wei Peng
- Intensive Care Unit, Jinhua Municipal Central Hospital Medical Group, Jinhua, China
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Kokkinos P, Faselis C, Pittaras A, Samuel IBH, Lavie CJ, Vargas JD, Lamonte M, Franklin B, Assimes TL, Murphy R, Zhang J, Sui X, Myers J. Cardiorespiratory fitness and risk of heart failure with preserved ejection fraction. Eur J Heart Fail 2024; 26:1163-1171. [PMID: 38152843 DOI: 10.1002/ejhf.3117] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 11/01/2023] [Accepted: 12/19/2023] [Indexed: 12/29/2023] Open
Abstract
AIMS Preventive strategies for heart failure with preserved ejection fraction (HFpEF) include pharmacotherapies and lifestyle modifications. However, the association between cardiorespiratory fitness (CRF) assessed objectively by a standardized exercise treadmill test (ETT) and the risk of HFpEF has not been evaluated. Thus, we evaluated the association between CRF and HFpEF incidence. METHODS AND RESULTS We assessed CRF in US Veterans (624 551 men; mean age 61.2 ± 9.7 years and 43 179 women; mean age 55.0 ± 8.9 years) by a standardized ETT performed between 1999 and 2020 across US Veterans Affairs Medical Centers. All had no evidence of heart failure or myocardial infarction prior to completion of the ETT. We assigned participants to one of five age- and gender-specific CRF categories (quintiles) based on peak metabolic equivalents (METs) achieved during the ETT and four categories based on CRF changes in those with two ETT evaluations (n = 139 434) ≥1.0 year apart. During a median follow-up of 10.1 years (interquartile range 6.0-14.3 years), providing 6 879 229 person-years, there were 16 493 HFpEF events with an average annual rate of 2.4 events per 1000 person-years. The adjusted risk of HFpEF decreased across CRF categories as CRF increased, independent of comorbidities. For fit individuals (≥10.5 METs) the hazard ratio (HR) was 0.48 (95% confidence interval [CI] 0.46-0.51) compared with least fit (≤4.9 METs; referent). Being unfit carried the highest risk (HR 2.88, 95% CI 2.67-3.11) of any other comorbidity. The risk of unfit individuals who became fit was 37% lower (HR 0.63, 95% CI 0.57-0.71), compared to those who remained unfit. CONCLUSIONS Higher CRF levels are independently associated with lower HFpEF in a dose-response manner. Changes in CRF reflected proportional changes in HFpEF risk, suggesting that the HFpEF risk was modulated by CRF.
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Affiliation(s)
- Peter Kokkinos
- Cardiology Division, DC Veterans Affairs Medical Center, Washington, DC, USA
- Department of Kinesiology and Health, School of Arts and Sciences, Rutgers University, New Brunswick, NJ, USA
- Department of Clinical Research and Leadership, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Charles Faselis
- DC Veterans Affairs Medical Center, Washington, DC, USA
- Department of Medicine, George Washington University School of Medicine, and Health Sciences, Washington, DC, USA
| | - Andreas Pittaras
- Cardiology Division, DC Veterans Affairs Medical Center, Washington, DC, USA
- Department of Medicine, George Washington University School of Medicine, and Health Sciences, Washington, DC, USA
| | - Immanuel Babu Henry Samuel
- War Related Illness and Injury Study Center, DC Veterans Affairs Medical Center, Washington, DC, USA
- The Henry Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
| | - Carl J Lavie
- John Ochsner Heart and Vascular Institute, Ochsner Clinical School, The University of Queensland School of Medicine, New Orleans, LA, USA
| | - Jose D Vargas
- Cardiology Division, DC Veterans Affairs Medical Center, Washington, DC, USA
| | - Michael Lamonte
- Department of Social and Preventive Medicine, University of Buffalo, Buffalo, NY, USA
| | - Barry Franklin
- Preventive Cardiology, William Beaumont Hospital, Royal Oak, MI, USA
| | | | - Rayelynn Murphy
- Cardiology Division, DC Veterans Affairs Medical Center, Washington, DC, USA
| | - Jiajia Zhang
- Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, SC, USA
| | - Xuemei Sui
- Department of Exercise Science, University of South Carolina System, Columbia, SC, USA
| | - Jonathan Myers
- Cardiology, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
- Department of Cardiology, Stanford University, Stanford, CA, USA
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20
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Takeda Y. Predicting Low Global Longitudinal Strain in Patients With Preclinical Heart Failure. Circ J 2024; 88:711-712. [PMID: 38538310 DOI: 10.1253/circj.cj-24-0159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Affiliation(s)
- Yasuharu Takeda
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
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21
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Haddadin R, Aboujaoude C, Trad G. Congestive Hepatopathy: A Review of the Literature. Cureus 2024; 16:e58766. [PMID: 38779242 PMCID: PMC11110487 DOI: 10.7759/cureus.58766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/21/2024] [Indexed: 05/25/2024] Open
Abstract
Congestive hepatopathy (CH), stemming from compromised hepatic venous flow or heightened intrahepatic pressure, represents a significant consequence of cardiovascular conditions like congestive heart failure (CHF). This review of literature encapsulates the core aspects of this condition, characterized by hepatic congestion, cellular injury, and impaired liver function. Diagnostic challenges arise due to symptoms mirroring primary liver diseases. Management revolves around addressing the underlying cause and mitigating fluid retention. This review of literature provides a snapshot of CH's complexity, emphasizing its clinical implications and the need for comprehensive understanding in clinical practice.
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Affiliation(s)
| | | | - George Trad
- Internal Medicine, MountainView Hospital, Las Vegas, USA
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22
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Fu Q, Wang Y, Yan C, Xiang YK. Phosphodiesterase in heart and vessels: from physiology to diseases. Physiol Rev 2024; 104:765-834. [PMID: 37971403 PMCID: PMC11281825 DOI: 10.1152/physrev.00015.2023] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 10/17/2023] [Accepted: 11/08/2023] [Indexed: 11/19/2023] Open
Abstract
Phosphodiesterases (PDEs) are a superfamily of enzymes that hydrolyze cyclic nucleotides, including cyclic adenosine monophosphate (cAMP) and cyclic guanosine monophosphate (cGMP). Both cyclic nucleotides are critical secondary messengers in the neurohormonal regulation in the cardiovascular system. PDEs precisely control spatiotemporal subcellular distribution of cyclic nucleotides in a cell- and tissue-specific manner, playing critical roles in physiological responses to hormone stimulation in the heart and vessels. Dysregulation of PDEs has been linked to the development of several cardiovascular diseases, such as hypertension, aneurysm, atherosclerosis, arrhythmia, and heart failure. Targeting these enzymes has been proven effective in treating cardiovascular diseases and is an attractive and promising strategy for the development of new drugs. In this review, we discuss the current understanding of the complex regulation of PDE isoforms in cardiovascular function, highlighting the divergent and even opposing roles of PDE isoforms in different pathogenesis.
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Affiliation(s)
- Qin Fu
- Department of Pharmacology, School of Basic Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- The Key Laboratory for Drug Target Research and Pharmacodynamic Evaluation of Hubei Province, Wuhan, China
| | - Ying Wang
- Department of Pharmacology, School of Medicine, Southern University of Science and Technology, Shenzhen, China
| | - Chen Yan
- Aab Cardiovascular Research Institute, University of Rochester Medical Center, Rochester, New York, United States
| | - Yang K Xiang
- Department of Pharmacology, University of California at Davis, Davis, California, United States
- Department of Veterans Affairs Northern California Healthcare System, Mather, California, United States
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23
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Bryl R, Kulus M, Bryja A, Domagała D, Mozdziak P, Antosik P, Bukowska D, Zabel M, Dzięgiel P, Kempisty B. Cardiac progenitor cell therapy: mechanisms of action. Cell Biosci 2024; 14:30. [PMID: 38444042 PMCID: PMC10913616 DOI: 10.1186/s13578-024-01211-x] [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: 07/01/2023] [Accepted: 02/17/2024] [Indexed: 03/07/2024] Open
Abstract
Heart failure (HF) is an end-stage of many cardiac diseases and one of the main causes of death worldwide. The current management of this disease remains suboptimal. The adult mammalian heart was considered a post-mitotic organ. However, several reports suggest that it may possess modest regenerative potential. Adult cardiac progenitor cells (CPCs), the main players in the cardiac regeneration, constitute, as it may seem, a heterogenous group of cells, which remain quiescent in physiological conditions and become activated after an injury, contributing to cardiomyocytes renewal. They can mediate their beneficial effects through direct differentiation into cardiac cells and activation of resident stem cells but majorly do so through paracrine release of factors. CPCs can secrete cytokines, chemokines, and growth factors as well as exosomes, rich in proteins, lipids and non-coding RNAs, such as miRNAs and YRNAs, which contribute to reparation of myocardium by promoting angiogenesis, cardioprotection, cardiomyogenesis, anti-fibrotic activity, and by immune modulation. Preclinical studies assessing cardiac progenitor cells and cardiac progenitor cells-derived exosomes on damaged myocardium show that administration of cardiac progenitor cells-derived exosomes can mimic effects of cell transplantation. Exosomes may become new promising therapeutic strategy for heart regeneration nevertheless there are still several limitations as to their use in the clinic. Key questions regarding their dosage, safety, specificity, pharmacokinetics, pharmacodynamics and route of administration remain outstanding. There are still gaps in the knowledge on basic biology of exosomes and filling them will bring as closer to translation into clinic.
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Affiliation(s)
- Rut Bryl
- Section of Regenerative Medicine and Cancer Research, Natural Sciences Club, Faculty of Biology, Adam Mickiewicz University, Poznań, Poznan, 61-614, Poland
| | - Magdalena Kulus
- Department of Veterinary Surgery, Institute of Veterinary Medicine, Nicolaus Copernicus University, Torun, 87-100, Poland
| | - Artur Bryja
- Department of Human Morphology and Embryology, Division of Anatomy, Wroclaw Medical University, Wroclaw, 50-367, Poland
| | - Dominika Domagała
- Department of Human Morphology and Embryology, Division of Anatomy, Wroclaw Medical University, Wroclaw, 50-367, Poland
| | - Paul Mozdziak
- Prestage Department of Poultry Science, North Carolina State University, Raleigh, NC, 27695, USA
- Physiology Graduate Faculty, North Carolina State University, Raleigh, NC, 27695, USA
| | - Paweł Antosik
- Department of Veterinary Surgery, Institute of Veterinary Medicine, Nicolaus Copernicus University, Torun, 87-100, Poland
| | - Dorota Bukowska
- Department of Diagnostics and Clinical Sciences, Institute of Veterinary Medicine, Nicolaus Copernicus University in Torun, Torun, 87-100, Poland
| | - Maciej Zabel
- Division of Anatomy and Histology, University of Zielona Góra, Zielona Góra, 65-046, Poland
- Department of Human Morphology and Embryology, Division of Histology and Embryology, Wroclaw Medical University, Wroclaw, 50-368, Poland
| | - Piotr Dzięgiel
- Department of Human Morphology and Embryology, Division of Histology and Embryology, Wroclaw Medical University, Wroclaw, 50-368, Poland
| | - Bartosz Kempisty
- Department of Veterinary Surgery, Institute of Veterinary Medicine, Nicolaus Copernicus University, Torun, 87-100, Poland.
- Department of Human Morphology and Embryology, Division of Anatomy, Wroclaw Medical University, Wroclaw, 50-367, Poland.
- Physiology Graduate Faculty, North Carolina State University, Raleigh, NC, 27695, USA.
- Department of Obstetrics and Gynaecology, University Hospital and Masaryk University, Brno, 62500, Czech Republic.
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24
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Tajeu GS, Ruiz-Negrón N, Moran AE, Zhang Z, Kolm P, Weintraub WS, Bress AP, Bellows BK. Cost of Cardiovascular Disease Event and Cardiovascular Disease Treatment-Related Complication Hospitalizations in the United States. Circ Cardiovasc Qual Outcomes 2024; 17:e009999. [PMID: 38328916 PMCID: PMC11099996 DOI: 10.1161/circoutcomes.123.009999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 11/17/2023] [Indexed: 02/09/2024]
Abstract
BACKGROUND Cardiovascular disease (CVD) is among the costliest conditions in the United States, and cost-effectiveness analyses can be used to assess economic impact and prioritize CVD treatments. We aimed to develop standardized, nationally representative CVD events and selected possible CVD treatment-related complication hospitalization costs for use in cost-effectiveness analyses. METHODS Nationally representative costs were derived using publicly available inpatient hospital discharge data from the 2012-2018 National Inpatient Sample. Events were identified using the principal International Classification of Diseases, Ninth Revision and International Classification of Diseases, Tenth Revision codes. Facility charges were converted to costs using charge-to-cost ratios, and total costs were estimated by applying a published professional fee ratio. All costs are reported in 2021 US dollars. Mean costs were estimated for events overall and stratified by age, sex, and survival status at discharge. Annual costs to the US health care system were estimated by multiplying the mean annual number of events by the mean total cost per discharge. RESULTS The annual mean number of hospital discharges among CVD events was the highest for heart failure (1 087 000 per year) and cerebrovascular disease (800 600 per year). The mean cost per hospital discharge was the highest for peripheral vascular disease ($33 700 [95% CI, $33 300-$34 000]) and ventricular tachycardia/ventricular fibrillation ($32 500 [95% CI, $32 100-$32 900]). Hospitalizations contributing the most to annual US health care costs were heart failure ($19 500 [95% CI, $19 300-$19 800] million) and acute myocardial infarction ($18 300, [95% CI, $18 200-$18 500] million). Acute kidney injury was the most frequent possible treatment complication (515 000 per year), and bradycardia had the highest mean hospitalization costs ($17 400 [95% CI, $17 200-$17 500]). CONCLUSIONS The hospitalization cost estimates and statistical code reported in the current study have the potential to increase transparency and comparability of cost-effectiveness analyses for CVD in the United States.
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Affiliation(s)
- Gabriel S. Tajeu
- Department of Health Services Administration and Policy, Temple University, Philadelphia, PA
| | | | - Andrew E. Moran
- Division of General Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | | | - Paul Kolm
- MedStar Health Research Institute and Department of Medicine, Georgetown University, Washington, DC
| | - William S. Weintraub
- MedStar Health Research Institute and Department of Medicine, Georgetown University, Washington, DC
| | - Adam P. Bress
- Department of Population Health Sciences, University of Utah, Salt Lake City, UT
| | - Brandon K. Bellows
- Division of General Medicine, Columbia University Irving Medical Center, New York, NY, USA
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25
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Santoro F, Vitale E, Ragnatela I, Cetera R, Leopzzi A, Mallardi A, Matera A, Mele M, Correale M, Brunetti ND. Multidisciplinary approach in cardiomyopathies: From genetics to advanced imaging. Heart Fail Rev 2024; 29:445-462. [PMID: 38041702 DOI: 10.1007/s10741-023-10373-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/23/2023] [Indexed: 12/03/2023]
Abstract
Cardiomyopathies are myocardial diseases characterized by mechanical and electrical dysfunction of the heart muscle which could lead to heart failure and life-threatening arrhythmias. Certainly, an accurate anamnesis, a meticulous physical examination, and an ECG are cornerstones in raising the diagnostic suspicion. However, cardiovascular imaging techniques are indispensable to diagnose a specific cardiomyopathy, to stratify the risk related to the disease and even to track the response to the therapy. Echocardiography is often the first exam that the patient undergoes, because of its non-invasiveness, wide availability, and cost-effectiveness. Cardiac magnetic resonance imaging allows to integrate and implement the information obtained with the echography. Furthermore, cardiomyopathies' genetic basis has been investigated over the years and the list of genetic mutations deemed potentially pathogenic is expected to grow further. The aim of this review is to show echocardiographic, cardiac magnetic resonance imaging, and genetic features of several cardiomyopathies: dilated cardiomyopathy (DMC), hypertrophic cardiomyopathy (HCM), arrhythmogenic cardiomyopathy (ACM), left ventricular noncompaction cardiomyopathy (LVNC), myocarditis, and takotsubo cardiomyopathy.
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Affiliation(s)
- Francesco Santoro
- Department of Medical and Surgical Sciences, Cardiology Unit, Policlinico "Riuniti", University of Foggia, Viale Pinto n.1, 71122, Foggia, Italy.
| | - Enrica Vitale
- Department of Medical and Surgical Sciences, Cardiology Unit, Policlinico "Riuniti", University of Foggia, Viale Pinto n.1, 71122, Foggia, Italy
| | - Ilaria Ragnatela
- Department of Medical and Surgical Sciences, Cardiology Unit, Policlinico "Riuniti", University of Foggia, Viale Pinto n.1, 71122, Foggia, Italy
| | - Rosa Cetera
- Department of Medical and Surgical Sciences, Cardiology Unit, Policlinico "Riuniti", University of Foggia, Viale Pinto n.1, 71122, Foggia, Italy
| | | | | | - Annalisa Matera
- Department of Medical and Surgical Sciences, Cardiology Unit, Policlinico "Riuniti", University of Foggia, Viale Pinto n.1, 71122, Foggia, Italy
| | - Marco Mele
- Department of Medical and Surgical Sciences, Cardiology Unit, Policlinico "Riuniti", University of Foggia, Viale Pinto n.1, 71122, Foggia, Italy
| | - Michele Correale
- Department of Medical and Surgical Sciences, Cardiology Unit, Policlinico "Riuniti", University of Foggia, Viale Pinto n.1, 71122, Foggia, Italy
| | - Natale Daniele Brunetti
- Department of Medical and Surgical Sciences, Cardiology Unit, Policlinico "Riuniti", University of Foggia, Viale Pinto n.1, 71122, Foggia, Italy
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26
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Doi SN, Thune JJ, Nielsen JC, Haarbo J, Videbæk L, Yafasova A, Bruun NE, Gustafsson F, Eiskjær H, Hassager C, Svendsen JH, Høfsten DE, Torp‐Pedersen C, Pehrson S, Køber L, Butt JH. Estimated Glomerular Filtration Rate and Implantable Cardioverter-Defibrillator in Nonischemic Systolic Heart Failure: Extended Follow-Up of DANISH. J Am Heart Assoc 2024; 13:e031977. [PMID: 38293926 PMCID: PMC11056118 DOI: 10.1161/jaha.123.031977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 12/29/2023] [Indexed: 02/01/2024]
Abstract
BACKGROUND Patients with heart failure and chronic kidney disease (CKD) may have an increased risk of death from causes competing with arrhythmic death, which could have implications for the efficacy of implantable cardioverter-defibrillators (ICDs). We examined the long-term effects of primary prophylactic ICD implantation, compared with usual care, according to baseline CKD status in an extended follow-up study of DANISH (Danish Study to Assess the Efficacy of ICDs in Patients With Nonischemic Systolic Heart Failure on Mortality). METHODS AND RESULTS In the DANISH trial, 1116 patients with nonischemic heart failure with reduced ejection fraction were randomized to receive an ICD (N=556) or usual care (N=550). Outcomes were analyzed according to CKD status (estimated glomerular filtration rate ≥/<60 mL/min per 1.73 m2) at baseline. In total, 1113 patients had an available estimated glomerular filtration rate measurement at baseline (median estimated glomerular filtration rate 73 mL/min per 1.73 m2), and 316 (28%) had CKD. During a median follow-up of 9.5 years, ICD implantation, compared with usual care, did not reduce the rate of all-cause mortality (no CKD, HR, 0.82 [95% CI, 0.64-1.04]; CKD, HR, 1.02 [95% CI, 0.75-1.38]; Pinteraction=0.31) or cardiovascular death (no CKD, HR, 0.77 [95% CI, 0.58-1.03]; CKD, HR, 1.05 [95% CI, 0.73-1.51]; Pinteraction=0.20), irrespective of baseline CKD status. Similarly, baseline CKD status did not modify the beneficial effects of ICD implantation on sudden cardiovascular death (no CKD, HR, 0.57 [95% CI, 0.32-1.00]; CKD, HR, 0.65 [95% CI, 0.34-1.24]; Pinteraction=0.70). CONCLUSIONS ICD implantation, compared with usual care, did not reduce the overall mortality rate, but it did reduce the rate of sudden cardiovascular death, regardless of baseline kidney function in patients with nonischemic heart failure with reduced ejection fraction. REGISTRATION URL: https://www.clinicaltrials.gov; Unique identifier: NCT00542945.
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MESH Headings
- Humans
- Defibrillators, Implantable/adverse effects
- Heart Failure, Systolic/complications
- Heart Failure, Systolic/therapy
- Follow-Up Studies
- Risk Factors
- Glomerular Filtration Rate
- Death, Sudden, Cardiac/epidemiology
- Death, Sudden, Cardiac/etiology
- Death, Sudden, Cardiac/prevention & control
- Heart Failure/diagnosis
- Heart Failure/therapy
- Heart Failure/complications
- Renal Insufficiency, Chronic/complications
- Renal Insufficiency, Chronic/diagnosis
- Renal Insufficiency, Chronic/therapy
- Ventricular Dysfunction, Left
- Denmark/epidemiology
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Affiliation(s)
- Seiko N. Doi
- Department of CardiologyCopenhagen University Hospital—RigshospitaletCopenhagenDenmark
| | - Jens Jakob Thune
- Department of Clinical MedicineUniversity of CopenhagenCopenhagenDenmark
- Department of CardiologyCopenhagen University Hospital—Bispebjerg and FrederiksbergCopenhagenDenmark
| | - Jens C. Nielsen
- Department of CardiologyAarhus University HospitalAarhusDenmark
- Department of Clinical MedicineAarhus UniversityAarhusDenmark
| | - Jens Haarbo
- Department of CardiologyCopenhagen University Hospital—Herlev and GentofteHellerupDenmark
| | - Lars Videbæk
- Department of CardiologyOdense University HospitalSvendborgDenmark
| | - Adelina Yafasova
- Department of CardiologyCopenhagen University Hospital—RigshospitaletCopenhagenDenmark
| | - Niels E. Bruun
- Department of Clinical MedicineUniversity of CopenhagenCopenhagenDenmark
- Department of CardiologyAalborg University HospitalAalborgDenmark
- Department of CardiologyZealand University HospitalRoskildeDenmark
| | - Finn Gustafsson
- Department of CardiologyCopenhagen University Hospital—RigshospitaletCopenhagenDenmark
- Department of Clinical MedicineUniversity of CopenhagenCopenhagenDenmark
| | - Hans Eiskjær
- Department of CardiologyAarhus University HospitalAarhusDenmark
| | - Christian Hassager
- Department of CardiologyCopenhagen University Hospital—RigshospitaletCopenhagenDenmark
- Department of Clinical MedicineUniversity of CopenhagenCopenhagenDenmark
| | - Jesper H. Svendsen
- Department of CardiologyCopenhagen University Hospital—RigshospitaletCopenhagenDenmark
- Department of Clinical MedicineUniversity of CopenhagenCopenhagenDenmark
| | - Dan E. Høfsten
- Department of CardiologyCopenhagen University Hospital—RigshospitaletCopenhagenDenmark
- Department of Clinical MedicineUniversity of CopenhagenCopenhagenDenmark
| | - Christian Torp‐Pedersen
- Department of CardiologyNordsjællands HospitalHillerødDenmark
- Department of Public HealthUniversity of CopenhagenCopenhagenDenmark
| | - Steen Pehrson
- Department of CardiologyCopenhagen University Hospital—RigshospitaletCopenhagenDenmark
| | - Lars Køber
- Department of CardiologyCopenhagen University Hospital—RigshospitaletCopenhagenDenmark
- Department of Clinical MedicineUniversity of CopenhagenCopenhagenDenmark
| | - Jawad H. Butt
- Department of CardiologyCopenhagen University Hospital—RigshospitaletCopenhagenDenmark
- Department of CardiologyZealand University HospitalRoskildeDenmark
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27
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Jo W, Won T, Daoud A, Čiháková D. Immune checkpoint inhibitors associated cardiovascular immune-related adverse events. Front Immunol 2024; 15:1340373. [PMID: 38375475 PMCID: PMC10875074 DOI: 10.3389/fimmu.2024.1340373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 01/19/2024] [Indexed: 02/21/2024] Open
Abstract
Immune checkpoint inhibitors (ICIs) are specialized monoclonal antibodies (mAbs) that target immune checkpoints and their ligands, counteracting cancer cell-induced T-cell suppression. Approved ICIs like cytotoxic T-lymphocyte antigen-4 (CTLA-4), programmed death-1 (PD-1), its ligand PD-L1, and lymphocyte activation gene-3 (LAG-3) have improved cancer patient outcomes by enhancing anti-tumor responses. However, some patients are unresponsive, and others experience immune-related adverse events (irAEs), affecting organs like the lung, liver, intestine, skin and now the cardiovascular system. These cardiac irAEs include conditions like myocarditis, atherosclerosis, pericarditis, arrhythmias, and cardiomyopathy. Ongoing clinical trials investigate promising alternative co-inhibitory receptor targets, including T cell immunoglobulin and mucin domain-containing protein 3 (Tim-3) and T cell immunoreceptor with immunoglobulin and ITIM domain (TIGIT). This review delves into the mechanisms of approved ICIs (CTLA-4, PD-1, PD-L1, and LAG-3) and upcoming options like Tim-3 and TIGIT. It explores the use of ICIs in cancer treatment, supported by both preclinical and clinical data. Additionally, it examines the mechanisms behind cardiac toxic irAEs, focusing on ICI-associated myocarditis and atherosclerosis. These insights are vital as ICIs continue to revolutionize cancer therapy, offering hope to patients, while also necessitating careful monitoring and management of potential side effects, including emerging cardiac complications.
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Affiliation(s)
- Wonyoung Jo
- Department of Biomedical Engineering, Johns Hopkins University, Whiting School of Engineering, Baltimore, MD, United States
| | - Taejoon Won
- Department of Pathobiology, University of Illinois Urbana-Champaign, College of Veterinary Medicine, Urbana, IL, United States
| | - Abdel Daoud
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins University, Bloomberg School of Public Health, Baltimore, MD, United States
| | - Daniela Čiháková
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins University, Bloomberg School of Public Health, Baltimore, MD, United States
- Department of Pathology, Johns Hopkins University, School of Medicine, Baltimore, MD, United States
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28
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Kayani M, Fatima N, Yarra PC, Almansouri NE, K D, Balasubramanian A, Parvathaneni N, Mowo-Wale AG, Valdez JA, Nazir Z. Novel Biomarkers in Early Detection of Heart Failure: A Narrative Review. Cureus 2024; 16:e53445. [PMID: 38435138 PMCID: PMC10909379 DOI: 10.7759/cureus.53445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/02/2024] [Indexed: 03/05/2024] Open
Abstract
Heart failure (HF) represents a significant global health challenge, characterized by a variety of symptoms resulting from cardiac dysfunction. This dysfunction often leads to systemic and pulmonary congestion. The pathophysiology of HF is complex, involving stimulation of the sympathetic nervous system, which is insufficiently balanced by the release of natriuretic peptide. This imbalance leads to progressive hypertrophy and dilatation of the heart's chambers, impairing its pumping efficiency and increasing the risk of arrhythmias and conduction disorders. The prevalence of HF is exceptionally high in industrialized nations and is expected to increase owing to an aging population and advancements in diagnostic methods. This study emphasizes the critical role of early diagnosis in reducing morbidity and mortality associated with HF, focusing specifically on the evolving importance of biomarkers in managing this condition. Biomarkers have played a key role in transforming the diagnosis and treatment of HF. Traditional biomarkers such as b-type natriuretic peptide and N-terminal pro-b-type natriuretic peptide have been widely adopted for their cost-effectiveness and ease of access. However, the rise of novel biomarkers such as growth differentiation factor 15 and adrenomedullin has shown promising results, offering superior sensitivity and specificity. These new biomarkers enhance diagnostic accuracy, risk stratification, and prognostic evaluation in HF patients. Despite these advancements, challenges remain, such as limited availability, high costs, and the need for further validation in diverse patient populations. Through a comprehensive literature review across databases such as PubMed, Google Scholar, and the Cochrane Library, this study compiles and analyzes data from 18 relevant studies, offering a detailed understanding of the current state of HF biomarkers. The study examines both traditional and emerging biomarkers such as galectin-3 and soluble suppression of tumorigenicity 2 in HF, exploring their clinical roles and impact on patient outcomes.
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Affiliation(s)
- Maryam Kayani
- Cardiology, Shifa Tameer-e-Millat University Shifa College of Medicine, Islamabad, PAK
| | - Neha Fatima
- Internal Medicine, Lisie Hospital, Kochi, IND
| | | | - Naiela E Almansouri
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
- Internal Medicine, University of Tripoli, Tripoli, LBY
| | - Deepshikha K
- Cardiology, Pondicherry Institute of Medical Sciences, Pondicherry, IND
| | | | | | | | - Josue A Valdez
- General Practice, Universidad Autónoma de Durango, Los Mochis, MEX
| | - Zahra Nazir
- Internal Medicine, Combined Military Hospital, Quetta, PAK
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29
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Alamro Y, Arshad K, Latif R, Al Akeel M, Mozaffari MA. From Collapse to Recovery: Thiamine Intervention in Cardiac Beriberi. Cureus 2024; 16:e54179. [PMID: 38496114 PMCID: PMC10940958 DOI: 10.7759/cureus.54179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/14/2024] [Indexed: 03/19/2024] Open
Abstract
This case report details the challenging presentation of a 68-year-old patient of cardio-circulatory collapse with pericardial effusion and recurrent pleural effusions. Hypotension did not respond to conventional intensive care measures. Despite comprehensive investigations, the underlying cause remained unidentified until intravenous thiamine replacement therapy was administered, restoring normotension and preventing pericardial or pleural effusion recurrence. The case underscores the importance of early recognition of thiamine deficiency in patients with pericardial and pleural effusions or critical illness, emphasizing the need to expand vigilance for thiamine deficiency and consider replacement therapy without a definitive diagnosis.
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Affiliation(s)
- Yazan Alamro
- Internal Medicine, Corewell Health Dearborn Hospital, Dearborn, USA
| | - Khurram Arshad
- Internal Medicine, Corewell Health Dearborn Hospital, Dearborn, USA
| | - Rabia Latif
- Internal Medicine, McLaren Flint Hospital, Flint, USA
| | - Mohannad Al Akeel
- Internal Medicine, East Tennessee State University Quillen College of Medicine, Johnson City, USA
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30
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Hamatani Y, Iguchi M, Moriuchi K, Anchi Y, Inuzuka Y, Nishikawa R, Shimamura K, Kondo H, Mima H, Yamashita Y, Takabayashi K, Takenaka K, Korai K, Kawase Y, Murai R, Yaku H, Nagao K, Kitano M, Aono Y, Kitai T, Sato Y, Kimura T, Akao M. Effectiveness and safety of morphine administration for refractory dyspnoea among hospitalised patients with advanced heart failure: the Morphine-HF study. BMJ Support Palliat Care 2024; 13:e1300-e1307. [PMID: 37169517 DOI: 10.1136/spcare-2023-004247] [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: 03/01/2023] [Accepted: 04/12/2023] [Indexed: 05/13/2023]
Abstract
OBJECTIVES Morphine is effective in alleviating dyspnoea in patients with cancer. We aimed to investigate the effectiveness and safety of morphine administration for refractory dyspnoea in patients with advanced heart failure (HF). METHODS We conducted a multicentre, prospective, observational study of hospitalised patients with advanced HF in whom morphine was administered for refractory dyspnoea. Morphine effectiveness was evaluated by dyspnoea intensity changes, assessed regularly by both a quantitative subjective scale (Visual Analogue Scale (VAS; graded from 0 to 100 mm)) and an objective scale (Support Team Assessment Schedule-Japanese (STAS-J; graded from 0 to 4 points)). Safety was assessed by vital sign changes and new-onset severe adverse events, including nausea, vomiting, constipation and delirium based on the Common Terminology Criteria for Adverse Events. RESULTS From 15 Japanese institutions between September 2020 and August 2022, we included 28 hospitalised patients with advanced HF in whom morphine was administered (mean age: 83.8±8.7 years, male: 15 (54%), New York Heart Association class IV: 26 (93%) and mean left ventricular ejection fraction: 38%±19%). Both VAS and STAS-J significantly improved from baseline to day 1 (VAS: 67±26 to 50±31 mm; p=0.02 and STAS-J: 3.3±0.8 to 2.6±1.1 points; p=0.006, respectively), and thereafter the improvements sustained through to day 7. After morphine administration, vital signs including blood pressure, pulse rate and oxygen saturation did not change, and no new-onset severe adverse events occurred through to day 7. CONCLUSIONS This study suggested acceptable effectiveness and safety for morphine administration in treating refractory dyspnoea in hospitalised patients with advanced HF.
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Affiliation(s)
- Yasuhiro Hamatani
- Cardiology, National Hospital Organisation Kyoto Medical Center, Kyoto, Japan
| | - Moritake Iguchi
- Cardiology, National Hospital Organisation Kyoto Medical Center, Kyoto, Japan
| | - Kenji Moriuchi
- Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Yuta Anchi
- Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Yasutaka Inuzuka
- Cardiovascular Medicine, Shiga Medical Center for Adults, Moriyama, Japan
| | - Ryusuke Nishikawa
- Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | | | | | - Hibiki Mima
- Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Yugo Yamashita
- Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | | | | | - Kengo Korai
- Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Yuichi Kawase
- Cardiovascular Medicine, Kurashiki Central Hospital, Kurashiki, Japan
| | - Ryosuke Murai
- Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
| | | | - Kazuya Nagao
- Cardiology, Osaka Red Cross Hospital, Osaka, Japan
| | - Mariko Kitano
- Cardiovascular Center, Kitano Hospital, Osaka, Japan
| | - Yuya Aono
- Cardiology, Kansai Electric Power Hospital, Osaka, Japan
| | - Takeshi Kitai
- Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Yukihito Sato
- Cardiology, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Japan
| | | | - Masaharu Akao
- Cardiology, National Hospital Organisation Kyoto Medical Center, Kyoto, Japan
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Shimizu T, Kanai C, Asakawa Y. Relationship between independence in activities of daily living at discharge and physical activity at admission of older postoperative hip fracture rehabilitation inpatients: A retrospective case-control study. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2024; 29:e2070. [PMID: 38284469 DOI: 10.1002/pri.2070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 12/21/2023] [Accepted: 01/02/2024] [Indexed: 01/30/2024]
Abstract
BACKGROUND AND PURPOSE Hip fractures are associated with a reduction in activities of daily living (ADL) and require long-term care. The physical activity of patients with hip fractures is temporarily impaired immediately after surgery, causing difficulty in the measurement of physical activities at the time of rehabilitation admission. This study examined the relationship between ADL at discharge and light- and moderate-intensity physical activity at the time of rehabilitation admission by determining a cut-off value predicting ADL independence. METHODS This retrospective case control study analyzed 43 postoperative hip fracture patients aged ≥65 years admitting into inpatient rehabilitation. ADL at discharge was assessed using the Functional Independent Measure motor items (FIM-m). The duration of physical activity at the time of rehabilitation admission was measured using an activity tracker equipped with an accelerometer. Prehospital frailty was evaluated using Clinical Frailty Scale. The relationship between these variables was examined using Spearman's product-moment correlation coefficient. Differences in physical activity between patients requiring and not requiring assistance with ADLs were examined using the analysis of covariance. A receiver operating characteristic curve of the need for ADL assistance at discharge was constructed from the duration of physical activity. RESULTS The duration of physical activity at the time of rehabilitation admission was related to FIM-m at discharge. The cut-off value of the duration of physical activity for predicting the need for ADL assistance at discharge was 135 s, with a sensitivity of 83.3% and specificity of 68.4% (area under the curve: 0.76). DISCUSSION The duration of physical activity at the time of rehabilitation admission may be a factor that can quantitatively predict the risk of requiring assistance with ADLs at discharge in older hip fracture patients. The duration of light-and-moderate intensity physical activity may be a component of multidisciplinary inpatient rehabilitation to improve patients' ADL.
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Affiliation(s)
- Tomoko Shimizu
- Department of Rehabilitation, Anti-Tuberculosis Association, Shin-Yamanote Hospital, Tokyo, Japan
- Department of Physical Therapy, Graduate School of Human Health Science, Tokyo Metropolitan University, Tokyo, Japan
| | - Chiaki Kanai
- Department of Rehabilitation, Anti-Tuberculosis Association, Shin-Yamanote Hospital, Tokyo, Japan
- Department of Physical Therapy, Graduate School of Human Health Science, Tokyo Metropolitan University, Tokyo, Japan
| | - Yasuyoshi Asakawa
- Department of Physical Therapy, Graduate School of Human Health Science, Tokyo Metropolitan University, Tokyo, Japan
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Nguadi J, Faraj R, Mouhib Z, Lakhal Z, Bouzelmat H. Tako-Tsubo Syndrome Triggered by a Fibroscopy: Case Report. Cureus 2024; 16:e52420. [PMID: 38371085 PMCID: PMC10870091 DOI: 10.7759/cureus.52420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/17/2024] [Indexed: 02/20/2024] Open
Abstract
Tako-Tsubo cardiomyopathy, also called stress cardiopathy, is a rare syndrome characterized by transient regional systolic dysfunction. It can mimic myocardial infarction but the absence of coronary obstruction allows to redress the diagnosis. Its pathogenesis is not well understood. However, the role of physical or emotional stress has often been associated with this pathology. Here we report, a rare case of a 63-year-old female, with no cardiac risk factors, who presented Tako-Tsubo syndrome after a fibroscopy. This case aims to show that Tako-Tsubo syndrome should be suspected in patients, especially women, with no cardiac risk factors, who present acute chest pain in the context of physical or emotional stress, after excluding differential diagnoses.
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Affiliation(s)
- Jaouad Nguadi
- Cardiology, Mohammed V Military Hospital, Mohamed V University, Rabat, MAR
| | - Raid Faraj
- Cardiology, Ibn Sina Hospital University, Mohammed V University, Rabat, MAR
| | - Zaynab Mouhib
- Cardiology, Mohammed V Military Hospital, Mohamed V University, Rabat, MAR
| | - Zouhair Lakhal
- Cardiology, Mohammed V Military Hospital, Mohamed V University, Rabat, MAR
| | - Hicham Bouzelmat
- Cardiology, Mohammed V Military Hospital, Mohamed V University, Rabat, MAR
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Zhang X, Wan Y, Karunathilaka N, Chan W, Kostner K, Hartel G, Coats AJS, Atherton JJ, Punyadeera C. Prognostic utility of serum NT-proBNP (fragments 1-76aa and 13-71aa) and galectin-3 in predicting death and re-hospitalisation due to cardiovascular events in patients with heart failure. Heart Vessels 2024; 39:86-94. [PMID: 37537380 PMCID: PMC10764512 DOI: 10.1007/s00380-023-02296-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 07/20/2023] [Indexed: 08/05/2023]
Abstract
Patients with heart failure (HF) are at a higher risk of rehospitalisation. In this study, we investigated the prognostic utility of galectin-3 (Gal-3) and NT-proBNP fragments (1-76aa and 13-71aa) as biomarkers to predict outcomes for patients with HF. We collected blood samples from patients with HF (n = 101). Gal-3 and NT-proBNP fragments (1-76aa and 13-71aa) concentrations were measured by immunoassay. Survival analysis and Cox proportional regression models were used to determine the prognostic utility of Gal-3 and NT-proBNP fragments. In patients with increased baseline levels of NT-proBNP1-76 the time to primary endpoint (cardiovascular death or re-hospitalisation) was significantly shorter (p = 0.0058), but not in patient with increased baseline levels of Gal-3 or NTproBNP13-71. Patients with increased levels of NT-proBNP13-71aa at 1 month showed reduced time to the primary endpoint (p = 0.0123). Our findings demonstrated that Gal-3 and NT-proBNP can be used as prognostic biomarkers to stratify patients with HF.
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Affiliation(s)
- Xi Zhang
- Saliva and Liquid Biopsy Translational Laboratory, Griffith Institute for Drug Discovery, Griffith University, 46, Don Young Rd, Nathan, QLD, 4111, Australia
- Menzies Health Institute Queensland (MHIQ), Griffith University, Gold Coast, QLD, Australia
| | - Yunxia Wan
- Saliva and Liquid Biopsy Translational Laboratory, The School of Biomedical Sciences, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, QLD, Australia
| | - Nuwan Karunathilaka
- Saliva and Liquid Biopsy Translational Laboratory, Griffith Institute for Drug Discovery, Griffith University, 46, Don Young Rd, Nathan, QLD, 4111, Australia
- Menzies Health Institute Queensland (MHIQ), Griffith University, Gold Coast, QLD, Australia
| | - Wandy Chan
- The Prince Charles Hospital, Brisbane, QLD, Australia
- School of Medicine, University of Queensland, Brisbane, Australia
| | - Karam Kostner
- Department of Cardiology, Mater Adult Hospital, Brisbane, QLD, Australia
| | - Gunter Hartel
- Statistics Unit, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | - Andrew J S Coats
- Faculty of Medicine, Monash University, Melbourne, VIC, Australia
- University of Warwick, Coventry, UK
- Monash University, Clayton, Australia
| | - John J Atherton
- Cardiology Department, Faculty of Medicine, Royal Brisbane and Women's Hospital and University of Queensland, Brisbane, QLD, Australia
| | - Chamindie Punyadeera
- Saliva and Liquid Biopsy Translational Laboratory, Griffith Institute for Drug Discovery, Griffith University, 46, Don Young Rd, Nathan, QLD, 4111, Australia.
- Saliva and Liquid Biopsy Translational Laboratory, The School of Biomedical Sciences, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, QLD, Australia.
- Translational Research Institute, Woolloongabba, Australia.
- Menzies Health Institute Queensland (MHIQ), Griffith University, Gold Coast, QLD, Australia.
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Kronk NN, Kronk BK, Robbie AT. A Case Report: Lithium-Induced Neurotoxicity, a Differential to Always Consider. Cureus 2023; 15:e50225. [PMID: 38192942 PMCID: PMC10773538 DOI: 10.7759/cureus.50225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/09/2023] [Indexed: 01/10/2024] Open
Abstract
Lithium, a mood stabilizer commonly prescribed for bipolar disorder, has a narrow therapeutic index that increases the risk of toxicity for patients who are prescribed this medication. Patients presenting with lithium toxicity could have a wide array of symptoms triggered by several factors that mimic other neurological conditions. In this paper, we discuss the case of an 81-year-old male who presented to the emergency department with worsening tremors and visual hallucinations, ataxia, and cognitive decline. He was initially thought to have Parkinson's disease with dementia in the outpatient setting and was later found to have lithium toxicity. Swift identification and management, involving fluid diuresis, led to the complete resolution of the patient's neurological symptoms by the fourth day of hospitalization. This case calls attention to the challenges of diagnosing lithium toxicity due to the variability in presentation as well as precipitating factors that clinicians must be cognizant of when working up patients who are prescribed lithium.
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Affiliation(s)
- Noah N Kronk
- Emergency Medicine, University of Missouri School of Medicine, Columbia, USA
| | - Brooke K Kronk
- Neurology, University of Missouri School of Medicine, Columbia, USA
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Morris K, Takegami M, Teramoto K, Murata S, Nakatsuka K, Ogata S, Nishimura K. Cognitive transitions based on functional status in older adults with heart failure: a population-based study. ESC Heart Fail 2023; 10:3454-3462. [PMID: 37706364 PMCID: PMC10682903 DOI: 10.1002/ehf2.14512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 07/21/2023] [Accepted: 08/18/2023] [Indexed: 09/15/2023] Open
Abstract
AIMS Cognitive impairment and functional status are both important determinants of poor outcomes in heart failure (HF). However, little is known about how functional status impacts the changes in cognitive status during the disease course. This study aimed to describe the cognitive transitions in patients with HF and assess the relationship of these transitions to functional status, which was assessed by the dependency of activities of daily living (ADL). METHODS AND RESULTS This retrospective cohort study included 1764 patients with an International Classification of Diseases-10 code of HF (≥65 years, mean age 82.3 ± 7.9 years, 39% male) from a long-term care and medical insurance database from Nobeoka city, a rural city of south-western Japan. Cognitive status at baseline and 6, 12, 18, and 24 month time points was collected, and participants were stratified based on ADL status at baseline. Generalized estimating equations and multi-state modelling were used to examine associations between ADL dependency and cognitive changes/mortality. Transition probabilities were estimated using multi-state modelling. At baseline, there were 1279 (73%) and 485 (27%) patients with independent and dependent ADL, respectively. In overall patients, 1656 (93.9%) patients had normal/mild cognitive status and 108 (6%) patients had a moderate/severe cognitive status at baseline. The majority [104 (96%) patients] of patients with moderate/severe cognitive status at baseline had dependent ADL. In patients with moderate/severe cognitive status, the number of patients with dependent ADL always outnumbered that of the independent ADL throughout the follow-up. Multi-state modelling estimated that patients with dependent ADL and normal/mild cognitive status at baseline had 47% probability of maintaining the same cognitive status at 24 months, while the probability of maintaining the same cognitive status was 86% for those with independent ADL. Patients with normal/mild cognitive status in the dependent ADL group at baseline had a higher risk of experiencing a transition to moderate/severe cognitive status at any time point during 24 months compared with those with independent ADL [hazard ratio 5.24 (95% confidence interval 3.47-7.90)]. CONCLUSIONS In older patients with HF, the prevalence of cognitive impairment was always higher for those with reduced functional status. Despite having a normal/mild cognitive status at baseline, patients with dependent ADL are at high risk of experiencing cognitive decline over 24 months with substantially less chance of maintaining their cognitive status. ADL dependency was an important risk factor of cognitive decline in patients with HF.
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Affiliation(s)
- Kensuke Morris
- Department of Preventive Medicine and EpidemiologyNational Cerebral and Cardiovascular CenterSuitaJapan
| | - Misa Takegami
- Department of Preventive Medicine and EpidemiologyNational Cerebral and Cardiovascular CenterSuitaJapan
- Department of Public Health and Health Policy, Graduate School of MedicineThe University of TokyoTokyoJapan
| | - Kanako Teramoto
- Department of BiostatisticsNational Cerebral and Cardiovascular CenterSuitaJapan
| | - Shunsuke Murata
- Department of Preventive Medicine and EpidemiologyNational Cerebral and Cardiovascular CenterSuitaJapan
- Department of Public Health, Graduate School of Health SciencesKobe UniversityKobeJapan
- Japan Society for the Promotion of ScienceTokyoJapan
| | - Kiyomasa Nakatsuka
- Department of Preventive Medicine and EpidemiologyNational Cerebral and Cardiovascular CenterSuitaJapan
- Department of Public Health, Graduate School of Health SciencesKobe UniversityKobeJapan
| | - Soshiro Ogata
- Department of Preventive Medicine and EpidemiologyNational Cerebral and Cardiovascular CenterSuitaJapan
| | - Kunihiro Nishimura
- Department of Preventive Medicine and EpidemiologyNational Cerebral and Cardiovascular CenterSuitaJapan
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Xu Y, Wan W, Zeng H, Xiang Z, Li M, Yao Y, Li Y, Bortolanza M, Wu J. Exosomes and their derivatives as biomarkers and therapeutic delivery agents for cardiovascular diseases: Situations and challenges. J Transl Int Med 2023; 11:341-354. [PMID: 38130647 PMCID: PMC10732499 DOI: 10.2478/jtim-2023-0124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023] Open
Abstract
Microvesicles known as exosomes have a diameter of 40 to 160 nm and are derived from small endosomal membranes. Exosomes have attracted increasing attention over the past ten years in part because they are functional vehicles that can deliver a variety of lipids, proteins, and nucleic acids to the target cells they encounter. Because of this function, exosomes may be used for the diagnosis, prognosis and treatment of many diseases. All throughout the world, cardiovascular diseases (CVDs) continue to be a significant cause of death. Because exosomes are mediators of communication between cells, which contribute to many physiological and pathological aspects, they may aid in improving CVD therapies as biomarkers for diagnosing and predicting CVDs. Many studies demonstrated that exosomes are associated with CVDs, such as coronary artery disease, heart failure, cardiomyopathy and atrial fibrillation. Exosomes participate in the progression or inhibition of these diseases mainly through the contents they deliver. However, the application of exosomes in diferent CVDs is not very mature. So further research is needed in this field.
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Affiliation(s)
- Yunyang Xu
- Zhejiang University School of Medicine, Hangzhou 310009, Zhejiang Province, China
| | - Weimin Wan
- Department of Clinical Laboratory, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Gusu School, Nanjing Medical University, Suzhou215008, Jiangsu Province, China
| | - Huixuan Zeng
- Zhejiang University School of Medicine, Hangzhou 310009, Zhejiang Province, China
| | - Ze Xiang
- Zhejiang University School of Medicine, Hangzhou 310009, Zhejiang Province, China
| | - Mo Li
- Department of Clinical Laboratory, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Gusu School, Nanjing Medical University, Suzhou215008, Jiangsu Province, China
| | - Yiwen Yao
- Department of Internal Medicine V-Pulmonology, Allergology, Respiratory Intensive Care Medicine, Saarland University Hospital, 66424Homburg, Germany
| | - Yuan Li
- Department of Cardiology, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Gusu School, Nanjing Medical University, Suzhou215008, Jiangsu Province, China
| | - Mariza Bortolanza
- Department of Internal Medicine V-Pulmonology, Allergology, Respiratory Intensive Care Medicine, Saarland University Hospital, 66424Homburg, Germany
| | - Jian Wu
- Department of Clinical Laboratory, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Gusu School, Nanjing Medical University, Suzhou215008, Jiangsu Province, China
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Chiba T, Yokota J, Takahashi R, Sasaki K, Suzuki H. Prealbumin level is a predictor of activities of daily living at discharge in older patients with heart failure who became ADL-independent after hospitalization: - Acute and early recovery cardiac rehabilitation trials. JAPANESE JOURNAL OF COMPREHENSIVE REHABILITATION SCIENCE 2023; 14:69-77. [PMID: 38021254 PMCID: PMC10654348 DOI: 10.11336/jjcrs.14.69] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/06/2023] [Indexed: 12/01/2023]
Abstract
Chiba T, Yokota J, Takahashi R, Sasaki K, Suzuki H. Prealbumin level is a predictor of activities of daily living at discharge in older patients with heart failure who became ADL-independent after hospitalization - Acute and early recovery cardiac rehabilitation trials. Jpn J Compr Rehabil Sci 2023; 14: 69-77. Objective To determine the relationship between prealbumin level and activities of daily living (ADL) at discharge in patients with heart failure (HF) and assess the usefulness of prealbumin measurement in predicting discharge Barthel Index (BI) in older patients with HF who become non-independent in ADL after hospital admission. Methods Patients with HF, aged ≥75 years, who were admitted to an acute hospital and underwent acute and early recovery cardiac rehabilitation (CR) were studied retrospectively. The exclusion criteria were non-independent ADL before admission (BI < 85 points) and independent ADL at the start of CR (BI ≥ 85 points). The usefulness of prealbumin level in predicting discharge BI was compared between four models. Albumin and Controlling Nutritional Status (CONUT) were used as comparison variables. The models and independent variables were model 1 (covariates only), model 2 (prealbumin + covariates), model 3 (albumin + covariates), and model 4 (CONUT score + covariates). Adjusted R2, a measure of model fit, was used to compare predictive ability. Results A total of 152 patients were included in the analysis. Prealbumin level was a significant variable for BI at discharge but not albumin or CONUT. The adjusted R2 was higher in model 2 with the addition of prealbumin than that in model 1 (0.362 vs. 0.347). Conclusion Prealbumin levels are useful in predicting discharge BI in older patients with HF who become non-independent in ADL after hospitalization.
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Affiliation(s)
- Takaaki Chiba
- Department of Rehabilitation, National Hospital Organization Sendai Medical Center, Sendai, Miyagi, Japan
| | - Junichi Yokota
- Division of Comprehensive Rehabilitation Sciences, Hirosaki University Graduate School of Health Sciences, Hirosaki, Aomori, Japan
| | - Ren Takahashi
- Department of Rehabilitation, National Hospital Organization Sendai Medical Center, Sendai, Miyagi, Japan
| | - Kosuke Sasaki
- Department of Rehabilitation, National Hospital Organization Sendai Medical Center, Sendai, Miyagi, Japan
| | - Hiroto Suzuki
- Department of Rehabilitation, Faculty of Medical Science and Welfare, Tohoku Bunka Gakuen University, Miyagi, Japan
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Shropshire SJ, Fabbri M, Manemann SM, Roger VL, Killian JM, Weston SA, Chamberlain AM. Patient Awareness of Heart Failure Diagnosis: A Community Study. J Am Heart Assoc 2023; 12:e029284. [PMID: 37929749 PMCID: PMC10727375 DOI: 10.1161/jaha.122.029284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 08/22/2023] [Indexed: 11/07/2023]
Abstract
Background Heart failure (HF) is a complex disease that contributes to a high number of hospitalizations, deaths, and economic health care costs each year. However, among patients with HF, there is a lack of awareness of their HF diagnosis that has not been fully examined. Methods and Results Residents from 3 counties of southeast Minnesota with a first-ever International Classification of Diseases, Ninth Revision (ICD-9) code 428 or Tenth Revision (ICD-10) code I50 between January 1, 2013 and March 31, 2016 (N=2461) were prospectively surveyed to measure HF self-awareness. A total of 1114 patients returned the survey (response rate, 45%), and 787 had validated HF upon medical record review. Among these 787 patients with HF (mean age, 76 years; 53% men), 37% (n=293) were aware of their HF diagnosis. After adjustment, being a woman (odds ratio [OR], 1.56 [95% CI, 1.10-2.22]), having HF with reduced ejection fraction (OR, 1.58 [95% CI, 1.13-2.22]), attending the HF clinic (OR, 4.07 [95% CI, 2.25-7.36]), and having coronary artery disease (OR, 1.65 [95% CI, 1.16-2.37]) were all associated with increased awareness of an HF diagnosis. Conversely, having diabetes was associated with decreased awareness of an HF diagnosis (adjusted OR, 0.69 [95% CI, 0.50-0.95]). Conclusions Awareness of an HF diagnosis is low in a community population of patients with HF. Strategies to improve patient awareness of their diagnosis should be implemented to improve self-care behaviors and outcomes in patients with HF.
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Affiliation(s)
| | - Matteo Fabbri
- Department of Cardiovascular DiseaseInova Fairfax Medical CenterFalls ChurchVAUSA
| | | | - Véronique L. Roger
- Department of Quantitative Health SciencesMayo ClinicRochesterMNUSA
- Division of Intramural ResearchNational Heart Lung and Blood Institute, National Institutes of HealthBethesdaMDUSA
| | - Jill M. Killian
- Department of Quantitative Health SciencesMayo ClinicRochesterMNUSA
| | - Susan A. Weston
- Department of Quantitative Health SciencesMayo ClinicRochesterMNUSA
| | - Alanna M. Chamberlain
- Department of Cardiovascular MedicineMayo ClinicRochesterMNUSA
- Department of Quantitative Health SciencesMayo ClinicRochesterMNUSA
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Tepavcevic S, Romic S, Zec M, Culafic T, Stojiljkovic M, Ivkovic T, Pantelic M, Kostic M, Stanisic J, Koricanac G. Effects of Walnut-Rich Diet on Cation-Handling Proteins in the Heart of Healthy and Metabolically Compromised Male Rats. J Med Food 2023; 26:849-857. [PMID: 37889606 DOI: 10.1089/jmf.2022.0157] [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] [Indexed: 10/29/2023] Open
Abstract
The transport of cations in the cardiomyocytes, crucial for the functioning of the heart, can be affected by walnut diet due to the high content of polyunsaturated fatty acids. Healthy and metabolically compromised rats (drinking 10% fructose solution) were subjected to a diet supplemented with 2.4 g of walnuts for 6 weeks to investigate the effect on proteins involved in cation transport in the heart cells. Fructose increased the level of the α1 subunit of Na+/K+-ATPase and the phosphorylation of extracellular signal-regulated kinase 1/2 in the heart of control and walnut-eating rats, while elevated L-type calcium channel α (LTCCα), sodium-calcium exchanger 1 (NCX1), and Maxi Kα level were observed only in rats that did not consume walnuts. However, walnuts significantly increased the cardiac content of LTCC, NCX1, and Maxi Kα, as well as Kir6.1 and SUR2B subunits of KATP channel, but only in fructose-naive rats. In animals that drank fructose, a significant increasing effect of walnuts was observed only in Akt kinase phosphorylation, which may be a part of the antiarrhythmic mechanism of decreasing cation currents in cardiomyocytes. The walnut diet-induced increase in LTCC and NCX1 expression in healthy rats may indicate intense cardiac calcium turnover, whereas the effect on Kir6.1 and SUR2B subunits suggests stimulation of KATP channel transport in the cardiac vasculature. The effects of walnuts on the cation-handling proteins in the heart, mostly limited to healthy animals, suggest the possible use of a walnut-supplemented diet in the prevention rather than the treatment of cardiological channelopathies.
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Affiliation(s)
- Snezana Tepavcevic
- Laboratory for Molecular Biology and Endocrinology, Vinča Institute of Nuclear Sciences, National Institute of the Republic of Serbia, University of Belgrade, Belgrade, Serbia
| | - Snjezana Romic
- Laboratory for Molecular Biology and Endocrinology, Vinča Institute of Nuclear Sciences, National Institute of the Republic of Serbia, University of Belgrade, Belgrade, Serbia
| | - Manja Zec
- Colorado Program for Musculoskeletal Research, Department of Orthopedics, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Tijana Culafic
- Laboratory for Molecular Biology and Endocrinology, Vinča Institute of Nuclear Sciences, National Institute of the Republic of Serbia, University of Belgrade, Belgrade, Serbia
| | - Mojca Stojiljkovic
- Laboratory for Molecular Biology and Endocrinology, Vinča Institute of Nuclear Sciences, National Institute of the Republic of Serbia, University of Belgrade, Belgrade, Serbia
| | - Tamara Ivkovic
- Laboratory for Molecular Biology and Endocrinology, Vinča Institute of Nuclear Sciences, National Institute of the Republic of Serbia, University of Belgrade, Belgrade, Serbia
| | - Marija Pantelic
- Laboratory for Molecular Biology and Endocrinology, Vinča Institute of Nuclear Sciences, National Institute of the Republic of Serbia, University of Belgrade, Belgrade, Serbia
| | - Milan Kostic
- Laboratory for Molecular Biology and Endocrinology, Vinča Institute of Nuclear Sciences, National Institute of the Republic of Serbia, University of Belgrade, Belgrade, Serbia
| | - Jelena Stanisic
- Laboratory for Molecular Biology and Endocrinology, Vinča Institute of Nuclear Sciences, National Institute of the Republic of Serbia, University of Belgrade, Belgrade, Serbia
| | - Goran Koricanac
- Laboratory for Molecular Biology and Endocrinology, Vinča Institute of Nuclear Sciences, National Institute of the Republic of Serbia, University of Belgrade, Belgrade, Serbia
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Bhattacharjee P, Khan Z. Sacubitril/Valsartan in the Treatment of Heart Failure With Reduced Ejection Fraction Focusing on the Impact on the Quality of Life: A Systematic Review and Meta-Analysis of Randomized Clinical Trials. Cureus 2023; 15:e48674. [PMID: 38090453 PMCID: PMC10714125 DOI: 10.7759/cureus.48674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/11/2023] [Indexed: 04/10/2024] Open
Abstract
There exists a paucity of research data reported by analyses performed on randomized clinical trials (RCTs) that encompass quality of life (QOL) and the aftermath for patients suffering from heart failure with reduced ejection fraction (HFrEF). This systematic review and meta-analysis of randomized clinical trials (RCTs) have been done to evaluate the drug sacubitril/valsartan in the treatment of heart failure (HF) with reduced ejection fraction (HFrEF) with a clear focus on the effect it bestows on measures of physical exercise tolerance and quality of life. A thorough systematic search was done in databases including Cochrane Central Register of Controlled Trials (CENTRAL), ClinicalTrials.gov, Embase, and PubMed from 1 January 2010 to 1 January 2023. The search only included published RCTs on adult patients aged 18 and above, with heart failure with reduced ejection fraction (HFrEF). Data analysis was performed by using the software RevMan 5.4 (Cochrane Collaboration, London, United Kingdom). The included studies' bias risk was assessed using the Cochrane Collaboration's Risk of Bias tool. The quality of evidence for the primary outcome was done using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) framework. This systematic review and meta-analysis of RCTs yielded 458 studies, of which eight randomized clinical trials were included and analyzed. The meta-analysis of the included trials shows that the I2 value is 61% (i.e., I2 > 50%), demonstrating a substantial heterogeneity within the studies. The left ventricular ejection fraction (LVEF) expressed in percentage was reported in the five studies, and thereby, a subgroup analysis that yielded a confidence interval (CI) of 95% had the standard mean difference of 0.02 (-0.02, 0.07). The trials had disparity between the reporting of effect on peak oxygen consumption (VO2), measured through cardiopulmonary exercise testing (CPET) methods, six-minute walking test (6MWT), overall physical activity, and exercise capacity. Sacubitril/valsartan did not exponentially improve peak VO2 or 6MWT in these trials; however, the patient-reported data suggested that the quality of life was modestly influenced by the drug. A subgroup analysis was performed using the pooled effect value by the random effects model. The findings showed that the sacubitril/valsartan group significantly was better than the control group in improving HFrEF-associated health-related quality of life (HRQoL). This study is a systematic review and meta-analysis of randomized clinical trials that evaluated the drug sacubitril/valsartan in treating heart failure with reduced ejection fraction (HFrEF) and focused on its tangible effect on the measures of physical exercise tolerance and quality of life. It depicts that the statistical scrutiny due to the lack of significant data and parity across studies did not impart significant improvement of either LVEF, peak VO2, or 6MWT with the use of sacubitril/valsartan; however, the reported exercise tolerance, including daytime physical activity, had a modest impact with the said drug. The pooled values demonstrated that the sacubitril/valsartan group significantly outperformed the control group in improving HFrEF HRQoL.
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Affiliation(s)
| | - Zahid Khan
- Acute Medicine, Mid and South Essex NHS Foundation Trust, Southend-on-Sea, GBR
- Cardiology, Barts Heart Centre, London, GBR
- Cardiology and General Medicine, Barking, Havering and Redbridge University Hospitals NHS Trust, London, GBR
- Cardiology, Royal Free Hospital, London, GBR
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41
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Luviano A, Pandya A. Evolution of Value in American College of Cardiology/American Heart Association Clinical Practice Guidelines. Circ Cardiovasc Qual Outcomes 2023; 16:e010086. [PMID: 37920978 PMCID: PMC10842500 DOI: 10.1161/circoutcomes.123.010086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 09/22/2023] [Indexed: 11/04/2023]
Abstract
BACKGROUND In January 2014, the American College of Cardiology/American Heart Association released a policy statement arguing for the inclusion of cost-effectiveness analysis (CEA) and value assessments in clinical practice guidelines. It is unclear whether subsequent guidelines changed how they incorporated such concepts. METHODS We analyzed guidelines of cardiovascular disease subconditions with a guideline released before and after 2014. We counted the words (total and per page) for 8 selected value- or CEA-related terms and compared counts and rates of terms per page in the guidelines before and after 2014. We counted the number of recommendations with at least 1 reference to a CEA or a CEA-related article to compare the ratios of such recommendations to all recommendations before and after 2014. We looked for the inclusion of the value assessment system recommended by the writing committee of the American College of Cardiology/American Heart Association policy statement of 2014. RESULTS We analyzed 20 guidelines of 10 different cardiovascular disease subconditions. Seven of the 10 cardiovascular disease subconditions had guidelines with a greater term per page rate after 2014 than before 2014. Across all 20 guidelines, the proportion of recommendations with at least 1 reference to a CEA changed from 0.44% to 1.99% (P<0.01). The proportion of recommendations with at least 1 reference to a CEA-related article changed from 1.02% to 3.34% (P<0.01). Only 3 guidelines used a value assessment system. CONCLUSIONS The proportion of recommendations with at least 1 reference to a CEA or CEA-related article was low before and after 2014 for most of the subconditions, however, with substantial variation in this finding across the guidelines included in our analysis. There is a need to organize existing CEA information better and produce more policy-relevant CEAs so guideline writers can more easily make recommendations that incentivize high-value care and caution against using low-value care.
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Affiliation(s)
- Andrea Luviano
- Harvard University, Ph.D. Program in Health Policy, Cambridge, MA, USA
| | - Ankur Pandya
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA. USA
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42
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Andreescu M. Recent Advances in Serum Biomarkers for Cardiological Risk Stratification and Insight into the Cardiac Management of the Patients With Hematological Malignancies Treated With Targeted Therapy. Cureus 2023; 15:e49696. [PMID: 38033434 PMCID: PMC10688222 DOI: 10.7759/cureus.49696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/30/2023] [Indexed: 12/02/2023] Open
Abstract
Cardiovascular diseases (CVD) have emerged as a common and serious complication of cancer treatment, particularly in patients undergoing cardiotoxic therapies. Over the last few years, the medical community has become increasingly aware of the potential for cardiotoxicity resulting from cancer treatments involving chemotherapy, targeted therapies, and radiation therapy. This recognition is due to the significant risk of morbidity and mortality in cancer patients and survivors resulting from such treatment-induced cardiovascular damage. While the cardiotoxic effects of chemotherapy and targeted therapy have been discussed in medical literature, only a limited number of studies have explored the role of serum biomarkers in cardiological risk stratification. In recent years, serum biomarkers have emerged as a valuable tool for assessing and managing cardiotoxicity in patients with hematological malignancies. This review article provides a summary of the current state of knowledge on the usefulness of biomarkers in managing cardiotoxicity resulting from different targeted therapies throughout the cancer care continuum. Although cardiac biomarkers have demonstrated potential in identifying subclinical cardiotoxicity and tracking the response to cardioprotective treatments, further research is necessary to determine optimal biomarkers and surveillance strategies. The incorporation of cardiac biomarkers into clinical practice in patients undergoing targeted therapies could potentially lead to improved long-term cardiovascular outcomes in cancer patients and survivors.
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Affiliation(s)
- Mihaela Andreescu
- Department of Hematology, Colentina Clinical Hospital, Bucharest, ROU
- Department of Clinical Sciences, Hematology, Faculty of Medicine, Titu Maiorescu University of Bucharest, Bucharest, ROU
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43
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Chen S, Wang H, Ning B. Efficacy and safety of early ultrafiltration in patients with acute decompensated heart failure: a meta-analysis. Front Cardiovasc Med 2023; 10:1234092. [PMID: 37920175 PMCID: PMC10619751 DOI: 10.3389/fcvm.2023.1234092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Accepted: 09/19/2023] [Indexed: 11/04/2023] Open
Abstract
Objective The objective of this study is to investigate the efficacy and safety of early ultrafiltration in patients with acute decompensated heart failure. Methods A systematic search was conducted on PubMed, Cochrane Library, and EMbase databases from inception to April 2023 to identify randomized controlled trials that compared the efficacy and safety of early ultrafiltration and conventional diuretics in patients with acute decompensated heart failure. Two investigators independently screened all eligible studies and extracted relevant data. The primary outcomes of interest were changes in body weight and creatinine levels, as well as the rate of readmission and mortality within 30 days. Meta-analysis was conducted using RevMan 5.4 software. Results This meta-analysis included eight studies and found that early ultrafiltration was effective in reducing body weight in patients with acute decompensated heart failure (RR = 1.45, 95% CI: 0.54-2.35, P = 0.002), but it also increased serum creatinine (RR = 0.1, 95% CI: 0.03-0.17, P = 0.003). However, it did not reduce the 30-day rehospitalization rate or mortality rate (30-day rehospitalization rate: RR = 0.84, 95% CI: 0.62-1.14, P = 0.28; Mortality: RR = 0.90, 95% CI: 0.57-1.44, P = 0.67). Conclusion Although early ultrafiltration is more effective in reducing body weight in patients with acute decompensated heart failure, it is associated with an increase in serum creatinine levels and does not reduce the rate of readmission or mortality within 30 days. Systematic Review Registration identifier: CRD42023416152.
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Affiliation(s)
- Shuai Chen
- Department of Cardiovascular Medicine, Fuyang People's Hospital Affiliated to Anhui Medical University, Fuyang, China
| | - Hongqi Wang
- Department of Cardiovascular Medicine, Fuyang People's Hospital Affiliated to Anhui Medical University, Fuyang, China
| | - Bin Ning
- Department of Cardiovascular Medicine, Fuyang People's Hospital Affiliated to Anhui Medical University, Fuyang, China
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44
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Shimizu T, Kanai C, Ueda K, Asakawa Y. Physical Activity and Activities of Daily Living in Older Adult Patients With Heart Failure Admitted for Subacute Musculoskeletal Disease. Ann Rehabil Med 2023; 47:426-437. [PMID: 37907233 PMCID: PMC10620488 DOI: 10.5535/arm.23031] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 08/21/2023] [Accepted: 08/22/2023] [Indexed: 11/02/2023] Open
Abstract
OBJECTIVE : To examine activities of daily living (ADL) and physical activity in older adults with heart failure admitted to a rehabilitation ward for subacute musculoskeletal disease. METHODS : This study included patients with musculoskeletal disease (aged ≥75 years) who were admitted to the rehabilitation ward. Data on age, ADL, and time for physical activity (metabolic equivalents [METs]) were collected. Patients were divided into groups with or without heart failure, and the differences were compared using Mann-Whitney U-test. RESULTS : This study included 84 musculoskeletal patients, including 25 with heart failure. The heart-failure group had similar levels of ADL independence compared to the without-heart-failure group (p=0.28) but had shorter duration of continuous and sustained physical activities and less total time (p<0.01) of light-intensity physical activity or higher. CONCLUSION : Older adults with subacute musculoskeletal disease with heart failure do not necessarily require a large amount of physical activity to maintain ADL at the time of discharge. But very low physical activity may increase the risk for developing hospitalization-associated disability. Physical activity in older adults with subacute musculoskeletal disease with heart failure should be monitored separately from ADL.
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Affiliation(s)
- Tomoko Shimizu
- Department of Rehabilitation, The Anti-Tuberculosis Association, Shin-Yamanote Hospital, Tokyo, Japan
- Department of Physical Therapy, Graduate School of Human Health Science, Tokyo Metropolitan University, Tokyo, Japan
| | - Chiaki Kanai
- Department of Rehabilitation, The Anti-Tuberculosis Association, Shin-Yamanote Hospital, Tokyo, Japan
- Department of Physical Therapy, Graduate School of Human Health Science, Tokyo Metropolitan University, Tokyo, Japan
| | - Keisuke Ueda
- Department of Rehabilitation, The Anti-Tuberculosis Association, Shin-Yamanote Hospital, Tokyo, Japan
| | - Yasuyoshi Asakawa
- Department of Physical Therapy, Graduate School of Human Health Science, Tokyo Metropolitan University, Tokyo, Japan
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45
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Chung MK, Patton KK, Lau CP, Dal Forno ARJ, Al-Khatib SM, Arora V, Birgersdotter-Green UM, Cha YM, Chung EH, Cronin EM, Curtis AB, Cygankiewicz I, Dandamudi G, Dubin AM, Ensch DP, Glotzer TV, Gold MR, Goldberger ZD, Gopinathannair R, Gorodeski EZ, Gutierrez A, Guzman JC, Huang W, Imrey PB, Indik JH, Karim S, Karpawich PP, Khaykin Y, Kiehl EL, Kron J, Kutyifa V, Link MS, Marine JE, Mullens W, Park SJ, Parkash R, Patete MF, Pathak RK, Perona CA, Rickard J, Schoenfeld MH, Seow SC, Shen WK, Shoda M, Singh JP, Slotwiner DJ, Sridhar ARM, Srivatsa UN, Stecker EC, Tanawuttiwat T, Tang WHW, Tapias CA, Tracy CM, Upadhyay GA, Varma N, Vernooy K, Vijayaraman P, Worsnick SA, Zareba W, Zeitler EP, Lopez-Cabanillas N, Ellenbogen KA, Hua W, Ikeda T, Mackall JA, Mason PK, McLeod CJ, Mela T, Moore JP, Racenet LK. 2023 HRS/APHRS/LAHRS guideline on cardiac physiologic pacing for the avoidance and mitigation of heart failure. J Arrhythm 2023; 39:681-756. [PMID: 37799799 PMCID: PMC10549836 DOI: 10.1002/joa3.12872] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/07/2023] Open
Abstract
Cardiac physiologic pacing (CPP), encompassing cardiac resynchronization therapy (CRT) and conduction system pacing (CSP), has emerged as a pacing therapy strategy that may mitigate or prevent the development of heart failure (HF) in patients with ventricular dyssynchrony or pacing-induced cardiomyopathy. This clinical practice guideline is intended to provide guidance on indications for CRT for HF therapy and CPP in patients with pacemaker indications or HF, patient selection, pre-procedure evaluation and preparation, implant procedure management, follow-up evaluation and optimization of CPP response, and use in pediatric populations. Gaps in knowledge, pointing to new directions for future research, are also identified.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Eugene H Chung
- University of Michigan Medical School Ann Arbor Michigan USA
| | | | | | | | | | - Anne M Dubin
- Stanford University, Pediatric Cardiology Palo Alto California USA
| | - Douglas P Ensch
- Cleveland Clinic Cleveland Ohio USA
- University of Washington Seattle Washington USA
- University of Hong Kong Hong Kong China
- Hospital SOS Cárdio Florianópolis Brazil
- Duke University Medical Center Durham North Carolina USA
- Indraprastha Apollo Hospital New Delhi India
- University of California San Diego Health La Jolla California USA
- Mayo Clinic, Rochester Rochester Minnesota USA
- University of Michigan Medical School Ann Arbor Michigan USA
- Temple University Philadelphia Pennsylvania USA
- University at Buffalo Buffalo New York USA
- Medical University of Łódź, Łódź Poland
- Virginia Mason Franciscan Health Tacoma Washington USA
- Stanford University, Pediatric Cardiology Palo Alto California USA
- Hackensack Meridian School of Medicine Hackensack New Jersey USA
- Medical University of South Carolina Charleston South Carolina USA
- University of Wisconsin School of Medicine and Public Health Madison Wisconsin USA
- Kansas City Heart Rhythm Institute Overland Park Kansas USA
- University Hospitals and Case Western Reserve University School of Medicine Cleveland Ohio USA
- University of Minnesota Minneapolis Minnesota USA
- McMaster University Hamilton Ontario Canada
- First Affiliated Hospital of Wenzhou Medical University Wenzhou China
- Case Western Reserve University Cleveland Ohio USA
- University of Arizona, Sarver Heart Center Tucson Arizona USA
- MetroHealth Medical Center Case Western Reserve University Cleveland Ohio USA
- The Children's Hospital of Michigan Central Michigan University Detroit Michigan USA
- Southlake Regional Health Center Newmarket Ontario Canada
- Sentara Norfolk Virginia USA
- Virginia Commonwealth University Richmond Virginia USA
- University of Rochester Medical Center Rochester New York USA
- University of Texas Southwestern Medical Center Dallas Texas USA
- Johns Hopkins University School of Medicine Baltimore Maryland USA
- Ziekenhuis Oost-Limburg Genk Belgium and Hasselt University Hasselt Belgium
- Sungkyunkwan University School of Medicine, Samsung Medical Center Seoul Republic of Korea
- QEII Health Sciences Center Halifax Nova Scotia Canada
- Clinica Corazones Unidos Santo Domingo Dominican Republic
- Australian National University, Canberra Hospital Garran Australian Capital Territory Australia
- Santojanni Hospital Buenos Aires Argentina
- Yale University School of Medicine New Haven Connecticut USA
- National University Hospital Singapore Singapore
- Mayo Clinic Phoenix Arizona USA
- Tokyo Women's Medical University Tokyo Japan
- Massachusetts General Hospital, Harvard Medical School Boston Massachusetts USA
- Weill Cornell Medicine Population Health Sciences New York New York USA
- University of California Davis Sacramento California USA
- Oregon Health & Science University Portland Oregon USA
- Indiana University Indianapolis Indiana USA
- Fundación Cardioinfantil Instituto de Cardiologia Bogotá Colombia
- George Washington University Washington District of Columbia USA
- University of Chicago Medicine Chicago Illinois USA
- Cardiovascular Research Institute Maastricht, Maastricht University Medical Center Maastricht The Netherlands
- Geisinger Health System Wilkes-Barre Pennsylvania USA
- Dartmouth Hitchcock Medical Center New Hampshire Lebanon
| | - Taya V Glotzer
- Hackensack Meridian School of Medicine Hackensack New Jersey USA
| | - Michael R Gold
- Medical University of South Carolina Charleston South Carolina USA
| | - Zachary D Goldberger
- University of Wisconsin School of Medicine and Public Health Madison Wisconsin USA
| | | | - Eiran Z Gorodeski
- University Hospitals and Case Western Reserve University School of Medicine Cleveland Ohio USA
| | | | | | - Weijian Huang
- First Affiliated Hospital of Wenzhou Medical University Wenzhou China
| | - Peter B Imrey
- Cleveland Clinic Cleveland Ohio USA
- Case Western Reserve University Cleveland Ohio USA
| | - Julia H Indik
- University of Arizona, Sarver Heart Center Tucson Arizona USA
| | - Saima Karim
- MetroHealth Medical Center Case Western Reserve University Cleveland Ohio USA
| | - Peter P Karpawich
- The Children's Hospital of Michigan Central Michigan University Detroit Michigan USA
| | - Yaariv Khaykin
- Southlake Regional Health Center Newmarket Ontario Canada
| | | | - Jordana Kron
- Virginia Commonwealth University Richmond Virginia USA
| | | | - Mark S Link
- University of Texas Southwestern Medical Center Dallas Texas USA
| | - Joseph E Marine
- Johns Hopkins University School of Medicine Baltimore Maryland USA
| | - Wilfried Mullens
- Ziekenhuis Oost-Limburg Genk Belgium and Hasselt University Hasselt Belgium
| | - Seung-Jung Park
- Sungkyunkwan University School of Medicine, Samsung Medical Center Seoul Republic of Korea
| | | | | | - Rajeev Kumar Pathak
- Australian National University, Canberra Hospital Garran Australian Capital Territory Australia
| | | | | | | | | | | | - Morio Shoda
- Tokyo Women's Medical University Tokyo Japan
| | - Jagmeet P Singh
- Massachusetts General Hospital, Harvard Medical School Boston Massachusetts USA
| | - David J Slotwiner
- Weill Cornell Medicine Population Health Sciences New York New York USA
| | | | - Uma N Srivatsa
- University of California Davis Sacramento California USA
| | | | | | | | | | - Cynthia M Tracy
- George Washington University Washington District of Columbia USA
| | | | | | - Kevin Vernooy
- Cardiovascular Research Institute Maastricht, Maastricht University Medical Center Maastricht The Netherlands
| | | | | | - Wojciech Zareba
- University of Rochester Medical Center Rochester New York USA
| | | | - Nestor Lopez-Cabanillas
- Cleveland Clinic Cleveland Ohio USA
- University of Washington Seattle Washington USA
- University of Hong Kong Hong Kong China
- Hospital SOS Cárdio Florianópolis Brazil
- Duke University Medical Center Durham North Carolina USA
- Indraprastha Apollo Hospital New Delhi India
- University of California San Diego Health La Jolla California USA
- Mayo Clinic, Rochester Rochester Minnesota USA
- University of Michigan Medical School Ann Arbor Michigan USA
- Temple University Philadelphia Pennsylvania USA
- University at Buffalo Buffalo New York USA
- Medical University of Łódź, Łódź Poland
- Virginia Mason Franciscan Health Tacoma Washington USA
- Stanford University, Pediatric Cardiology Palo Alto California USA
- Hackensack Meridian School of Medicine Hackensack New Jersey USA
- Medical University of South Carolina Charleston South Carolina USA
- University of Wisconsin School of Medicine and Public Health Madison Wisconsin USA
- Kansas City Heart Rhythm Institute Overland Park Kansas USA
- University Hospitals and Case Western Reserve University School of Medicine Cleveland Ohio USA
- University of Minnesota Minneapolis Minnesota USA
- McMaster University Hamilton Ontario Canada
- First Affiliated Hospital of Wenzhou Medical University Wenzhou China
- Case Western Reserve University Cleveland Ohio USA
- University of Arizona, Sarver Heart Center Tucson Arizona USA
- MetroHealth Medical Center Case Western Reserve University Cleveland Ohio USA
- The Children's Hospital of Michigan Central Michigan University Detroit Michigan USA
- Southlake Regional Health Center Newmarket Ontario Canada
- Sentara Norfolk Virginia USA
- Virginia Commonwealth University Richmond Virginia USA
- University of Rochester Medical Center Rochester New York USA
- University of Texas Southwestern Medical Center Dallas Texas USA
- Johns Hopkins University School of Medicine Baltimore Maryland USA
- Ziekenhuis Oost-Limburg Genk Belgium and Hasselt University Hasselt Belgium
- Sungkyunkwan University School of Medicine, Samsung Medical Center Seoul Republic of Korea
- QEII Health Sciences Center Halifax Nova Scotia Canada
- Clinica Corazones Unidos Santo Domingo Dominican Republic
- Australian National University, Canberra Hospital Garran Australian Capital Territory Australia
- Santojanni Hospital Buenos Aires Argentina
- Yale University School of Medicine New Haven Connecticut USA
- National University Hospital Singapore Singapore
- Mayo Clinic Phoenix Arizona USA
- Tokyo Women's Medical University Tokyo Japan
- Massachusetts General Hospital, Harvard Medical School Boston Massachusetts USA
- Weill Cornell Medicine Population Health Sciences New York New York USA
- University of California Davis Sacramento California USA
- Oregon Health & Science University Portland Oregon USA
- Indiana University Indianapolis Indiana USA
- Fundación Cardioinfantil Instituto de Cardiologia Bogotá Colombia
- George Washington University Washington District of Columbia USA
- University of Chicago Medicine Chicago Illinois USA
- Cardiovascular Research Institute Maastricht, Maastricht University Medical Center Maastricht The Netherlands
- Geisinger Health System Wilkes-Barre Pennsylvania USA
- Dartmouth Hitchcock Medical Center New Hampshire Lebanon
| | - Kenneth A Ellenbogen
- Cleveland Clinic Cleveland Ohio USA
- University of Washington Seattle Washington USA
- University of Hong Kong Hong Kong China
- Hospital SOS Cárdio Florianópolis Brazil
- Duke University Medical Center Durham North Carolina USA
- Indraprastha Apollo Hospital New Delhi India
- University of California San Diego Health La Jolla California USA
- Mayo Clinic, Rochester Rochester Minnesota USA
- University of Michigan Medical School Ann Arbor Michigan USA
- Temple University Philadelphia Pennsylvania USA
- University at Buffalo Buffalo New York USA
- Medical University of Łódź, Łódź Poland
- Virginia Mason Franciscan Health Tacoma Washington USA
- Stanford University, Pediatric Cardiology Palo Alto California USA
- Hackensack Meridian School of Medicine Hackensack New Jersey USA
- Medical University of South Carolina Charleston South Carolina USA
- University of Wisconsin School of Medicine and Public Health Madison Wisconsin USA
- Kansas City Heart Rhythm Institute Overland Park Kansas USA
- University Hospitals and Case Western Reserve University School of Medicine Cleveland Ohio USA
- University of Minnesota Minneapolis Minnesota USA
- McMaster University Hamilton Ontario Canada
- First Affiliated Hospital of Wenzhou Medical University Wenzhou China
- Case Western Reserve University Cleveland Ohio USA
- University of Arizona, Sarver Heart Center Tucson Arizona USA
- MetroHealth Medical Center Case Western Reserve University Cleveland Ohio USA
- The Children's Hospital of Michigan Central Michigan University Detroit Michigan USA
- Southlake Regional Health Center Newmarket Ontario Canada
- Sentara Norfolk Virginia USA
- Virginia Commonwealth University Richmond Virginia USA
- University of Rochester Medical Center Rochester New York USA
- University of Texas Southwestern Medical Center Dallas Texas USA
- Johns Hopkins University School of Medicine Baltimore Maryland USA
- Ziekenhuis Oost-Limburg Genk Belgium and Hasselt University Hasselt Belgium
- Sungkyunkwan University School of Medicine, Samsung Medical Center Seoul Republic of Korea
- QEII Health Sciences Center Halifax Nova Scotia Canada
- Clinica Corazones Unidos Santo Domingo Dominican Republic
- Australian National University, Canberra Hospital Garran Australian Capital Territory Australia
- Santojanni Hospital Buenos Aires Argentina
- Yale University School of Medicine New Haven Connecticut USA
- National University Hospital Singapore Singapore
- Mayo Clinic Phoenix Arizona USA
- Tokyo Women's Medical University Tokyo Japan
- Massachusetts General Hospital, Harvard Medical School Boston Massachusetts USA
- Weill Cornell Medicine Population Health Sciences New York New York USA
- University of California Davis Sacramento California USA
- Oregon Health & Science University Portland Oregon USA
- Indiana University Indianapolis Indiana USA
- Fundación Cardioinfantil Instituto de Cardiologia Bogotá Colombia
- George Washington University Washington District of Columbia USA
- University of Chicago Medicine Chicago Illinois USA
- Cardiovascular Research Institute Maastricht, Maastricht University Medical Center Maastricht The Netherlands
- Geisinger Health System Wilkes-Barre Pennsylvania USA
- Dartmouth Hitchcock Medical Center New Hampshire Lebanon
| | - Wei Hua
- Cleveland Clinic Cleveland Ohio USA
- University of Washington Seattle Washington USA
- University of Hong Kong Hong Kong China
- Hospital SOS Cárdio Florianópolis Brazil
- Duke University Medical Center Durham North Carolina USA
- Indraprastha Apollo Hospital New Delhi India
- University of California San Diego Health La Jolla California USA
- Mayo Clinic, Rochester Rochester Minnesota USA
- University of Michigan Medical School Ann Arbor Michigan USA
- Temple University Philadelphia Pennsylvania USA
- University at Buffalo Buffalo New York USA
- Medical University of Łódź, Łódź Poland
- Virginia Mason Franciscan Health Tacoma Washington USA
- Stanford University, Pediatric Cardiology Palo Alto California USA
- Hackensack Meridian School of Medicine Hackensack New Jersey USA
- Medical University of South Carolina Charleston South Carolina USA
- University of Wisconsin School of Medicine and Public Health Madison Wisconsin USA
- Kansas City Heart Rhythm Institute Overland Park Kansas USA
- University Hospitals and Case Western Reserve University School of Medicine Cleveland Ohio USA
- University of Minnesota Minneapolis Minnesota USA
- McMaster University Hamilton Ontario Canada
- First Affiliated Hospital of Wenzhou Medical University Wenzhou China
- Case Western Reserve University Cleveland Ohio USA
- University of Arizona, Sarver Heart Center Tucson Arizona USA
- MetroHealth Medical Center Case Western Reserve University Cleveland Ohio USA
- The Children's Hospital of Michigan Central Michigan University Detroit Michigan USA
- Southlake Regional Health Center Newmarket Ontario Canada
- Sentara Norfolk Virginia USA
- Virginia Commonwealth University Richmond Virginia USA
- University of Rochester Medical Center Rochester New York USA
- University of Texas Southwestern Medical Center Dallas Texas USA
- Johns Hopkins University School of Medicine Baltimore Maryland USA
- Ziekenhuis Oost-Limburg Genk Belgium and Hasselt University Hasselt Belgium
- Sungkyunkwan University School of Medicine, Samsung Medical Center Seoul Republic of Korea
- QEII Health Sciences Center Halifax Nova Scotia Canada
- Clinica Corazones Unidos Santo Domingo Dominican Republic
- Australian National University, Canberra Hospital Garran Australian Capital Territory Australia
- Santojanni Hospital Buenos Aires Argentina
- Yale University School of Medicine New Haven Connecticut USA
- National University Hospital Singapore Singapore
- Mayo Clinic Phoenix Arizona USA
- Tokyo Women's Medical University Tokyo Japan
- Massachusetts General Hospital, Harvard Medical School Boston Massachusetts USA
- Weill Cornell Medicine Population Health Sciences New York New York USA
- University of California Davis Sacramento California USA
- Oregon Health & Science University Portland Oregon USA
- Indiana University Indianapolis Indiana USA
- Fundación Cardioinfantil Instituto de Cardiologia Bogotá Colombia
- George Washington University Washington District of Columbia USA
- University of Chicago Medicine Chicago Illinois USA
- Cardiovascular Research Institute Maastricht, Maastricht University Medical Center Maastricht The Netherlands
- Geisinger Health System Wilkes-Barre Pennsylvania USA
- Dartmouth Hitchcock Medical Center New Hampshire Lebanon
| | - Takanori Ikeda
- Cleveland Clinic Cleveland Ohio USA
- University of Washington Seattle Washington USA
- University of Hong Kong Hong Kong China
- Hospital SOS Cárdio Florianópolis Brazil
- Duke University Medical Center Durham North Carolina USA
- Indraprastha Apollo Hospital New Delhi India
- University of California San Diego Health La Jolla California USA
- Mayo Clinic, Rochester Rochester Minnesota USA
- University of Michigan Medical School Ann Arbor Michigan USA
- Temple University Philadelphia Pennsylvania USA
- University at Buffalo Buffalo New York USA
- Medical University of Łódź, Łódź Poland
- Virginia Mason Franciscan Health Tacoma Washington USA
- Stanford University, Pediatric Cardiology Palo Alto California USA
- Hackensack Meridian School of Medicine Hackensack New Jersey USA
- Medical University of South Carolina Charleston South Carolina USA
- University of Wisconsin School of Medicine and Public Health Madison Wisconsin USA
- Kansas City Heart Rhythm Institute Overland Park Kansas USA
- University Hospitals and Case Western Reserve University School of Medicine Cleveland Ohio USA
- University of Minnesota Minneapolis Minnesota USA
- McMaster University Hamilton Ontario Canada
- First Affiliated Hospital of Wenzhou Medical University Wenzhou China
- Case Western Reserve University Cleveland Ohio USA
- University of Arizona, Sarver Heart Center Tucson Arizona USA
- MetroHealth Medical Center Case Western Reserve University Cleveland Ohio USA
- The Children's Hospital of Michigan Central Michigan University Detroit Michigan USA
- Southlake Regional Health Center Newmarket Ontario Canada
- Sentara Norfolk Virginia USA
- Virginia Commonwealth University Richmond Virginia USA
- University of Rochester Medical Center Rochester New York USA
- University of Texas Southwestern Medical Center Dallas Texas USA
- Johns Hopkins University School of Medicine Baltimore Maryland USA
- Ziekenhuis Oost-Limburg Genk Belgium and Hasselt University Hasselt Belgium
- Sungkyunkwan University School of Medicine, Samsung Medical Center Seoul Republic of Korea
- QEII Health Sciences Center Halifax Nova Scotia Canada
- Clinica Corazones Unidos Santo Domingo Dominican Republic
- Australian National University, Canberra Hospital Garran Australian Capital Territory Australia
- Santojanni Hospital Buenos Aires Argentina
- Yale University School of Medicine New Haven Connecticut USA
- National University Hospital Singapore Singapore
- Mayo Clinic Phoenix Arizona USA
- Tokyo Women's Medical University Tokyo Japan
- Massachusetts General Hospital, Harvard Medical School Boston Massachusetts USA
- Weill Cornell Medicine Population Health Sciences New York New York USA
- University of California Davis Sacramento California USA
- Oregon Health & Science University Portland Oregon USA
- Indiana University Indianapolis Indiana USA
- Fundación Cardioinfantil Instituto de Cardiologia Bogotá Colombia
- George Washington University Washington District of Columbia USA
- University of Chicago Medicine Chicago Illinois USA
- Cardiovascular Research Institute Maastricht, Maastricht University Medical Center Maastricht The Netherlands
- Geisinger Health System Wilkes-Barre Pennsylvania USA
- Dartmouth Hitchcock Medical Center New Hampshire Lebanon
| | - Judith A Mackall
- Cleveland Clinic Cleveland Ohio USA
- University of Washington Seattle Washington USA
- University of Hong Kong Hong Kong China
- Hospital SOS Cárdio Florianópolis Brazil
- Duke University Medical Center Durham North Carolina USA
- Indraprastha Apollo Hospital New Delhi India
- University of California San Diego Health La Jolla California USA
- Mayo Clinic, Rochester Rochester Minnesota USA
- University of Michigan Medical School Ann Arbor Michigan USA
- Temple University Philadelphia Pennsylvania USA
- University at Buffalo Buffalo New York USA
- Medical University of Łódź, Łódź Poland
- Virginia Mason Franciscan Health Tacoma Washington USA
- Stanford University, Pediatric Cardiology Palo Alto California USA
- Hackensack Meridian School of Medicine Hackensack New Jersey USA
- Medical University of South Carolina Charleston South Carolina USA
- University of Wisconsin School of Medicine and Public Health Madison Wisconsin USA
- Kansas City Heart Rhythm Institute Overland Park Kansas USA
- University Hospitals and Case Western Reserve University School of Medicine Cleveland Ohio USA
- University of Minnesota Minneapolis Minnesota USA
- McMaster University Hamilton Ontario Canada
- First Affiliated Hospital of Wenzhou Medical University Wenzhou China
- Case Western Reserve University Cleveland Ohio USA
- University of Arizona, Sarver Heart Center Tucson Arizona USA
- MetroHealth Medical Center Case Western Reserve University Cleveland Ohio USA
- The Children's Hospital of Michigan Central Michigan University Detroit Michigan USA
- Southlake Regional Health Center Newmarket Ontario Canada
- Sentara Norfolk Virginia USA
- Virginia Commonwealth University Richmond Virginia USA
- University of Rochester Medical Center Rochester New York USA
- University of Texas Southwestern Medical Center Dallas Texas USA
- Johns Hopkins University School of Medicine Baltimore Maryland USA
- Ziekenhuis Oost-Limburg Genk Belgium and Hasselt University Hasselt Belgium
- Sungkyunkwan University School of Medicine, Samsung Medical Center Seoul Republic of Korea
- QEII Health Sciences Center Halifax Nova Scotia Canada
- Clinica Corazones Unidos Santo Domingo Dominican Republic
- Australian National University, Canberra Hospital Garran Australian Capital Territory Australia
- Santojanni Hospital Buenos Aires Argentina
- Yale University School of Medicine New Haven Connecticut USA
- National University Hospital Singapore Singapore
- Mayo Clinic Phoenix Arizona USA
- Tokyo Women's Medical University Tokyo Japan
- Massachusetts General Hospital, Harvard Medical School Boston Massachusetts USA
- Weill Cornell Medicine Population Health Sciences New York New York USA
- University of California Davis Sacramento California USA
- Oregon Health & Science University Portland Oregon USA
- Indiana University Indianapolis Indiana USA
- Fundación Cardioinfantil Instituto de Cardiologia Bogotá Colombia
- George Washington University Washington District of Columbia USA
- University of Chicago Medicine Chicago Illinois USA
- Cardiovascular Research Institute Maastricht, Maastricht University Medical Center Maastricht The Netherlands
- Geisinger Health System Wilkes-Barre Pennsylvania USA
- Dartmouth Hitchcock Medical Center New Hampshire Lebanon
| | - Pamela K Mason
- Cleveland Clinic Cleveland Ohio USA
- University of Washington Seattle Washington USA
- University of Hong Kong Hong Kong China
- Hospital SOS Cárdio Florianópolis Brazil
- Duke University Medical Center Durham North Carolina USA
- Indraprastha Apollo Hospital New Delhi India
- University of California San Diego Health La Jolla California USA
- Mayo Clinic, Rochester Rochester Minnesota USA
- University of Michigan Medical School Ann Arbor Michigan USA
- Temple University Philadelphia Pennsylvania USA
- University at Buffalo Buffalo New York USA
- Medical University of Łódź, Łódź Poland
- Virginia Mason Franciscan Health Tacoma Washington USA
- Stanford University, Pediatric Cardiology Palo Alto California USA
- Hackensack Meridian School of Medicine Hackensack New Jersey USA
- Medical University of South Carolina Charleston South Carolina USA
- University of Wisconsin School of Medicine and Public Health Madison Wisconsin USA
- Kansas City Heart Rhythm Institute Overland Park Kansas USA
- University Hospitals and Case Western Reserve University School of Medicine Cleveland Ohio USA
- University of Minnesota Minneapolis Minnesota USA
- McMaster University Hamilton Ontario Canada
- First Affiliated Hospital of Wenzhou Medical University Wenzhou China
- Case Western Reserve University Cleveland Ohio USA
- University of Arizona, Sarver Heart Center Tucson Arizona USA
- MetroHealth Medical Center Case Western Reserve University Cleveland Ohio USA
- The Children's Hospital of Michigan Central Michigan University Detroit Michigan USA
- Southlake Regional Health Center Newmarket Ontario Canada
- Sentara Norfolk Virginia USA
- Virginia Commonwealth University Richmond Virginia USA
- University of Rochester Medical Center Rochester New York USA
- University of Texas Southwestern Medical Center Dallas Texas USA
- Johns Hopkins University School of Medicine Baltimore Maryland USA
- Ziekenhuis Oost-Limburg Genk Belgium and Hasselt University Hasselt Belgium
- Sungkyunkwan University School of Medicine, Samsung Medical Center Seoul Republic of Korea
- QEII Health Sciences Center Halifax Nova Scotia Canada
- Clinica Corazones Unidos Santo Domingo Dominican Republic
- Australian National University, Canberra Hospital Garran Australian Capital Territory Australia
- Santojanni Hospital Buenos Aires Argentina
- Yale University School of Medicine New Haven Connecticut USA
- National University Hospital Singapore Singapore
- Mayo Clinic Phoenix Arizona USA
- Tokyo Women's Medical University Tokyo Japan
- Massachusetts General Hospital, Harvard Medical School Boston Massachusetts USA
- Weill Cornell Medicine Population Health Sciences New York New York USA
- University of California Davis Sacramento California USA
- Oregon Health & Science University Portland Oregon USA
- Indiana University Indianapolis Indiana USA
- Fundación Cardioinfantil Instituto de Cardiologia Bogotá Colombia
- George Washington University Washington District of Columbia USA
- University of Chicago Medicine Chicago Illinois USA
- Cardiovascular Research Institute Maastricht, Maastricht University Medical Center Maastricht The Netherlands
- Geisinger Health System Wilkes-Barre Pennsylvania USA
- Dartmouth Hitchcock Medical Center New Hampshire Lebanon
| | - Christopher J McLeod
- Cleveland Clinic Cleveland Ohio USA
- University of Washington Seattle Washington USA
- University of Hong Kong Hong Kong China
- Hospital SOS Cárdio Florianópolis Brazil
- Duke University Medical Center Durham North Carolina USA
- Indraprastha Apollo Hospital New Delhi India
- University of California San Diego Health La Jolla California USA
- Mayo Clinic, Rochester Rochester Minnesota USA
- University of Michigan Medical School Ann Arbor Michigan USA
- Temple University Philadelphia Pennsylvania USA
- University at Buffalo Buffalo New York USA
- Medical University of Łódź, Łódź Poland
- Virginia Mason Franciscan Health Tacoma Washington USA
- Stanford University, Pediatric Cardiology Palo Alto California USA
- Hackensack Meridian School of Medicine Hackensack New Jersey USA
- Medical University of South Carolina Charleston South Carolina USA
- University of Wisconsin School of Medicine and Public Health Madison Wisconsin USA
- Kansas City Heart Rhythm Institute Overland Park Kansas USA
- University Hospitals and Case Western Reserve University School of Medicine Cleveland Ohio USA
- University of Minnesota Minneapolis Minnesota USA
- McMaster University Hamilton Ontario Canada
- First Affiliated Hospital of Wenzhou Medical University Wenzhou China
- Case Western Reserve University Cleveland Ohio USA
- University of Arizona, Sarver Heart Center Tucson Arizona USA
- MetroHealth Medical Center Case Western Reserve University Cleveland Ohio USA
- The Children's Hospital of Michigan Central Michigan University Detroit Michigan USA
- Southlake Regional Health Center Newmarket Ontario Canada
- Sentara Norfolk Virginia USA
- Virginia Commonwealth University Richmond Virginia USA
- University of Rochester Medical Center Rochester New York USA
- University of Texas Southwestern Medical Center Dallas Texas USA
- Johns Hopkins University School of Medicine Baltimore Maryland USA
- Ziekenhuis Oost-Limburg Genk Belgium and Hasselt University Hasselt Belgium
- Sungkyunkwan University School of Medicine, Samsung Medical Center Seoul Republic of Korea
- QEII Health Sciences Center Halifax Nova Scotia Canada
- Clinica Corazones Unidos Santo Domingo Dominican Republic
- Australian National University, Canberra Hospital Garran Australian Capital Territory Australia
- Santojanni Hospital Buenos Aires Argentina
- Yale University School of Medicine New Haven Connecticut USA
- National University Hospital Singapore Singapore
- Mayo Clinic Phoenix Arizona USA
- Tokyo Women's Medical University Tokyo Japan
- Massachusetts General Hospital, Harvard Medical School Boston Massachusetts USA
- Weill Cornell Medicine Population Health Sciences New York New York USA
- University of California Davis Sacramento California USA
- Oregon Health & Science University Portland Oregon USA
- Indiana University Indianapolis Indiana USA
- Fundación Cardioinfantil Instituto de Cardiologia Bogotá Colombia
- George Washington University Washington District of Columbia USA
- University of Chicago Medicine Chicago Illinois USA
- Cardiovascular Research Institute Maastricht, Maastricht University Medical Center Maastricht The Netherlands
- Geisinger Health System Wilkes-Barre Pennsylvania USA
- Dartmouth Hitchcock Medical Center New Hampshire Lebanon
| | - Theofanie Mela
- Cleveland Clinic Cleveland Ohio USA
- University of Washington Seattle Washington USA
- University of Hong Kong Hong Kong China
- Hospital SOS Cárdio Florianópolis Brazil
- Duke University Medical Center Durham North Carolina USA
- Indraprastha Apollo Hospital New Delhi India
- University of California San Diego Health La Jolla California USA
- Mayo Clinic, Rochester Rochester Minnesota USA
- University of Michigan Medical School Ann Arbor Michigan USA
- Temple University Philadelphia Pennsylvania USA
- University at Buffalo Buffalo New York USA
- Medical University of Łódź, Łódź Poland
- Virginia Mason Franciscan Health Tacoma Washington USA
- Stanford University, Pediatric Cardiology Palo Alto California USA
- Hackensack Meridian School of Medicine Hackensack New Jersey USA
- Medical University of South Carolina Charleston South Carolina USA
- University of Wisconsin School of Medicine and Public Health Madison Wisconsin USA
- Kansas City Heart Rhythm Institute Overland Park Kansas USA
- University Hospitals and Case Western Reserve University School of Medicine Cleveland Ohio USA
- University of Minnesota Minneapolis Minnesota USA
- McMaster University Hamilton Ontario Canada
- First Affiliated Hospital of Wenzhou Medical University Wenzhou China
- Case Western Reserve University Cleveland Ohio USA
- University of Arizona, Sarver Heart Center Tucson Arizona USA
- MetroHealth Medical Center Case Western Reserve University Cleveland Ohio USA
- The Children's Hospital of Michigan Central Michigan University Detroit Michigan USA
- Southlake Regional Health Center Newmarket Ontario Canada
- Sentara Norfolk Virginia USA
- Virginia Commonwealth University Richmond Virginia USA
- University of Rochester Medical Center Rochester New York USA
- University of Texas Southwestern Medical Center Dallas Texas USA
- Johns Hopkins University School of Medicine Baltimore Maryland USA
- Ziekenhuis Oost-Limburg Genk Belgium and Hasselt University Hasselt Belgium
- Sungkyunkwan University School of Medicine, Samsung Medical Center Seoul Republic of Korea
- QEII Health Sciences Center Halifax Nova Scotia Canada
- Clinica Corazones Unidos Santo Domingo Dominican Republic
- Australian National University, Canberra Hospital Garran Australian Capital Territory Australia
- Santojanni Hospital Buenos Aires Argentina
- Yale University School of Medicine New Haven Connecticut USA
- National University Hospital Singapore Singapore
- Mayo Clinic Phoenix Arizona USA
- Tokyo Women's Medical University Tokyo Japan
- Massachusetts General Hospital, Harvard Medical School Boston Massachusetts USA
- Weill Cornell Medicine Population Health Sciences New York New York USA
- University of California Davis Sacramento California USA
- Oregon Health & Science University Portland Oregon USA
- Indiana University Indianapolis Indiana USA
- Fundación Cardioinfantil Instituto de Cardiologia Bogotá Colombia
- George Washington University Washington District of Columbia USA
- University of Chicago Medicine Chicago Illinois USA
- Cardiovascular Research Institute Maastricht, Maastricht University Medical Center Maastricht The Netherlands
- Geisinger Health System Wilkes-Barre Pennsylvania USA
- Dartmouth Hitchcock Medical Center New Hampshire Lebanon
| | - Jeremy P Moore
- Cleveland Clinic Cleveland Ohio USA
- University of Washington Seattle Washington USA
- University of Hong Kong Hong Kong China
- Hospital SOS Cárdio Florianópolis Brazil
- Duke University Medical Center Durham North Carolina USA
- Indraprastha Apollo Hospital New Delhi India
- University of California San Diego Health La Jolla California USA
- Mayo Clinic, Rochester Rochester Minnesota USA
- University of Michigan Medical School Ann Arbor Michigan USA
- Temple University Philadelphia Pennsylvania USA
- University at Buffalo Buffalo New York USA
- Medical University of Łódź, Łódź Poland
- Virginia Mason Franciscan Health Tacoma Washington USA
- Stanford University, Pediatric Cardiology Palo Alto California USA
- Hackensack Meridian School of Medicine Hackensack New Jersey USA
- Medical University of South Carolina Charleston South Carolina USA
- University of Wisconsin School of Medicine and Public Health Madison Wisconsin USA
- Kansas City Heart Rhythm Institute Overland Park Kansas USA
- University Hospitals and Case Western Reserve University School of Medicine Cleveland Ohio USA
- University of Minnesota Minneapolis Minnesota USA
- McMaster University Hamilton Ontario Canada
- First Affiliated Hospital of Wenzhou Medical University Wenzhou China
- Case Western Reserve University Cleveland Ohio USA
- University of Arizona, Sarver Heart Center Tucson Arizona USA
- MetroHealth Medical Center Case Western Reserve University Cleveland Ohio USA
- The Children's Hospital of Michigan Central Michigan University Detroit Michigan USA
- Southlake Regional Health Center Newmarket Ontario Canada
- Sentara Norfolk Virginia USA
- Virginia Commonwealth University Richmond Virginia USA
- University of Rochester Medical Center Rochester New York USA
- University of Texas Southwestern Medical Center Dallas Texas USA
- Johns Hopkins University School of Medicine Baltimore Maryland USA
- Ziekenhuis Oost-Limburg Genk Belgium and Hasselt University Hasselt Belgium
- Sungkyunkwan University School of Medicine, Samsung Medical Center Seoul Republic of Korea
- QEII Health Sciences Center Halifax Nova Scotia Canada
- Clinica Corazones Unidos Santo Domingo Dominican Republic
- Australian National University, Canberra Hospital Garran Australian Capital Territory Australia
- Santojanni Hospital Buenos Aires Argentina
- Yale University School of Medicine New Haven Connecticut USA
- National University Hospital Singapore Singapore
- Mayo Clinic Phoenix Arizona USA
- Tokyo Women's Medical University Tokyo Japan
- Massachusetts General Hospital, Harvard Medical School Boston Massachusetts USA
- Weill Cornell Medicine Population Health Sciences New York New York USA
- University of California Davis Sacramento California USA
- Oregon Health & Science University Portland Oregon USA
- Indiana University Indianapolis Indiana USA
- Fundación Cardioinfantil Instituto de Cardiologia Bogotá Colombia
- George Washington University Washington District of Columbia USA
- University of Chicago Medicine Chicago Illinois USA
- Cardiovascular Research Institute Maastricht, Maastricht University Medical Center Maastricht The Netherlands
- Geisinger Health System Wilkes-Barre Pennsylvania USA
- Dartmouth Hitchcock Medical Center New Hampshire Lebanon
| | - Laurel Kay Racenet
- Cleveland Clinic Cleveland Ohio USA
- University of Washington Seattle Washington USA
- University of Hong Kong Hong Kong China
- Hospital SOS Cárdio Florianópolis Brazil
- Duke University Medical Center Durham North Carolina USA
- Indraprastha Apollo Hospital New Delhi India
- University of California San Diego Health La Jolla California USA
- Mayo Clinic, Rochester Rochester Minnesota USA
- University of Michigan Medical School Ann Arbor Michigan USA
- Temple University Philadelphia Pennsylvania USA
- University at Buffalo Buffalo New York USA
- Medical University of Łódź, Łódź Poland
- Virginia Mason Franciscan Health Tacoma Washington USA
- Stanford University, Pediatric Cardiology Palo Alto California USA
- Hackensack Meridian School of Medicine Hackensack New Jersey USA
- Medical University of South Carolina Charleston South Carolina USA
- University of Wisconsin School of Medicine and Public Health Madison Wisconsin USA
- Kansas City Heart Rhythm Institute Overland Park Kansas USA
- University Hospitals and Case Western Reserve University School of Medicine Cleveland Ohio USA
- University of Minnesota Minneapolis Minnesota USA
- McMaster University Hamilton Ontario Canada
- First Affiliated Hospital of Wenzhou Medical University Wenzhou China
- Case Western Reserve University Cleveland Ohio USA
- University of Arizona, Sarver Heart Center Tucson Arizona USA
- MetroHealth Medical Center Case Western Reserve University Cleveland Ohio USA
- The Children's Hospital of Michigan Central Michigan University Detroit Michigan USA
- Southlake Regional Health Center Newmarket Ontario Canada
- Sentara Norfolk Virginia USA
- Virginia Commonwealth University Richmond Virginia USA
- University of Rochester Medical Center Rochester New York USA
- University of Texas Southwestern Medical Center Dallas Texas USA
- Johns Hopkins University School of Medicine Baltimore Maryland USA
- Ziekenhuis Oost-Limburg Genk Belgium and Hasselt University Hasselt Belgium
- Sungkyunkwan University School of Medicine, Samsung Medical Center Seoul Republic of Korea
- QEII Health Sciences Center Halifax Nova Scotia Canada
- Clinica Corazones Unidos Santo Domingo Dominican Republic
- Australian National University, Canberra Hospital Garran Australian Capital Territory Australia
- Santojanni Hospital Buenos Aires Argentina
- Yale University School of Medicine New Haven Connecticut USA
- National University Hospital Singapore Singapore
- Mayo Clinic Phoenix Arizona USA
- Tokyo Women's Medical University Tokyo Japan
- Massachusetts General Hospital, Harvard Medical School Boston Massachusetts USA
- Weill Cornell Medicine Population Health Sciences New York New York USA
- University of California Davis Sacramento California USA
- Oregon Health & Science University Portland Oregon USA
- Indiana University Indianapolis Indiana USA
- Fundación Cardioinfantil Instituto de Cardiologia Bogotá Colombia
- George Washington University Washington District of Columbia USA
- University of Chicago Medicine Chicago Illinois USA
- Cardiovascular Research Institute Maastricht, Maastricht University Medical Center Maastricht The Netherlands
- Geisinger Health System Wilkes-Barre Pennsylvania USA
- Dartmouth Hitchcock Medical Center New Hampshire Lebanon
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46
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Rana K, Jay J, Patel S, Sueta C, Deyo Z. A Retrospective Cohort Evaluation of a Pharmacist-Led Approach for Transitioning Patients to an Angiotensin Receptor-Neprilysin Inhibitor. J Pharm Pract 2023; 36:1061-1067. [PMID: 35392695 DOI: 10.1177/08971900221087087] [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] [Indexed: 11/16/2022]
Abstract
Background: Heart failure guidelines recommend replacing an angiotensin-converting enzyme inhibitor (ACEI) or angiotensin receptor blocker (ARB) with an angiotensin receptor neprilysin inhibitor (ARNI) to reduce morbidity and mortality in NYHA Class II-III patients with reduced ejection fraction (HFrEF). Objective: This study aims to determine if a pharmacist-led outpatient ARNI replacement and titration program led to more patients achieving target doses of ARNI compared to usual care. Methods: A single health system, retrospective electronic medical record review identified 791 patients with active ARNI prescriptions and at least two outpatient cardiology visits with a pharmacist or usual care provider between January 2015 through September 2018. The primary outcome was the percentage of patients who achieved a target ARNI dose of 97/103 mg twice daily. The secondary outcomes were the median dose achieved, number of visits required to achieve target dose, hospitalizations, and all-cause death. Results: ARNI was initiated and continued by a pharmacist in 64 patients and 727 by usual care. More patients in the pharmacist group, 60.9% (n = 39), achieved target dose vs. 18.0% (n = 131) of patients managed by usual care (95% CI, 0.31-0.55, p < 0.0001). The pharmacist group also had higher median total daily dose of ARNI (200 mg (IQR = 300) vs 100 mg (IQR = 100), p < 0.0001) and more likely to achieve a higher total daily dose in fewer visits. Conclusions: An advanced practice provider pharmacist-led outpatient ARNI replacement and titration program was more effective in achieving target doses of ARNI in HFrEF patients as compared to usual care.
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Affiliation(s)
- Krishna Rana
- Department of Pharmacy, Durham Veterans Affairs Medical Center, Durham, NC, USA
| | - Jessica Jay
- Virginia Commonwealth University, Richmond, VA, USA
| | - Sonalie Patel
- Department of Pharmacy, Northwestern Memorial Hospital, Chicago, IL, USA
| | - Carla Sueta
- Division of Cardiology, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Zack Deyo
- Department of Pharmacy, University of North Carolina Hospitals, Chapel Hill, NC, USA
- Division of Practice Advancement and Clinical Education, UNC Eshelman School of Pharmacy, Chapel Hill, NC, USA
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47
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Tah S, Valderrama M, Afzal M, Iqbal J, Farooq A, Lak MA, Gostomczyk K, Jami E, Kumar M, Sundaram A, Sharifa M, Arain M. Heart Failure With Preserved Ejection Fraction: An Evolving Understanding. Cureus 2023; 15:e46152. [PMID: 37900404 PMCID: PMC10613100 DOI: 10.7759/cureus.46152] [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: 08/23/2023] [Accepted: 09/28/2023] [Indexed: 10/31/2023] Open
Abstract
Heart failure (HF) with preserved ejection fraction (HFpEF) is a clinical syndrome in which patients have signs and symptoms of HF due to high left ventricular (LV) filling pressure despite normal or near normal LV ejection fraction. It is more common than HF with reduced ejection fraction (HFrEF), and its diagnosis and treatment are more challenging than HFrEF. Although hypertension is the primary risk factor, coronary artery disease and other comorbidities, such as atrial fibrillation (AF), diabetes, chronic kidney disease (CKD), and obesity, also play an essential role in its formation. This review summarizes current knowledge about HFpEF, its pathophysiology, clinical presentation, diagnostic challenges, current treatments, and promising novel treatments. It is essential to continue to be updated on the latest treatments for HFpEF so that patients always receive the most therapeutic treatments. The use of GnRH agonists in the management of HFpEF, infusion of Apo a-I nanoparticle, low-level transcutaneous vagal stimulation (LLTS), and estrogen only in post-menopausal women are promising strategies to prevent diastolic dysfunction and HFpEF; however, there is still no proven curative treatment for HFpEF yet.
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Affiliation(s)
- Sunanda Tah
- Surgery, Beckley Appalachian Regional Healthcare (ARH) Hospital, Beckley, USA
- Surgery, Saint James School of Medicine, Arnos Vale, VCT
| | | | - Maham Afzal
- Medicine, Fatima Jinnah Medical University, Lahore, PAK
| | | | - Aisha Farooq
- Internal Medicine, Dr. Ruth Pfau Hospital, Karachi, PAK
| | | | - Karol Gostomczyk
- Medicine, Collegium Medicum Nicolaus Copernicus University, Bydgoszcz, POL
| | - Elhama Jami
- Internal Medicine, Herat Regional Hospital, Herat, AFG
| | | | | | | | - Mustafa Arain
- Internal Medicine, Civil Hospital Karachi, Karachi, PAK
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48
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Abdeen HA, Helmy ZM, Elnaggar MI, Aldhahi MI, Taha MM, Marques-Sule E, Amin DI, Ibrahim BS, Abdel Aziz A, Castiglione V, Atef H. Different Continuous Training Intensities Improve Echocardiographic Parameters, Quality of Life, and Functional Capacity in Heart Failure Patients with Reduced Ejection Fraction. Int J Gen Med 2023; 16:3933-3945. [PMID: 37670928 PMCID: PMC10475351 DOI: 10.2147/ijgm.s420933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 08/10/2023] [Indexed: 09/07/2023] Open
Abstract
Background Multiple comorbidities and physiological changes play a role in a range of heart failure conditions and influence the most effective approach to exercise-based rehabilitation. This research aimed to examine and compare the outcomes of continuous training at three different intensities, focusing on left ventricular (LV) remodeling, functional capacity, and quality of life among patients with heart failure with reduced ejection fraction (HFrEF). Methods In this randomized control trial, a total of 60 male patients (average age: 54.33 ±2.35 years) with HFrEF were randomly allocated into three groups: 1) High-intensity continuous training group (HICT), 2) Moderate-intensity continuous training group (MICT), and 3) Low-intensity continuous training group (LICT). All the training was performed on a bicycle ergometer 3 times/week for 12 weeks. Echocardiographic parameters (left ventricular ejection fraction, left ventricular end-diastolic dimension, left ventricular end-systolic dimension, N-terminal pro-B-type natriuretic peptide (NT-proBNP), quality of life (Minnesota Living with Heart Failure Questionnaire), and functional capacity (6-minute walking test) were assessed before and the end of the study. Results The HICT group demonstrated the greatest improvements in all measured variables when compared to the other two groups (P < 0.05). These findings were consistent across all measured outcomes. Conclusion It was determined that HICT appears to yield the most favorable outcomes in enhancing echocardiographic measures, NT-proBNP levels, quality of life, and functional capacity among HFrEF patients.
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Affiliation(s)
- Heba A Abdeen
- Department of Physical Therapy for Cardiovascular/Respiratory Disorder and Geriatrics, Faculty of Physical Therapy, Cairo University, Giza, 11432, Egypt
| | - Zeinab M Helmy
- Department of Physical Therapy for Cardiovascular/Respiratory Disorder and Geriatrics, Faculty of Physical Therapy, Cairo University, Giza, 11432, Egypt
| | - Moustafa I Elnaggar
- Faculty of Physical Therapy, Heliopolis University for Sustainable Development, Giza, Egypt
| | - Monira I Aldhahi
- Department of Rehabilitation Sciences, College of Health and Rehabilitation Sciences, Princess Nourah bint Abdulrahman University, Riyadh, 11671, Saudi Arabia
| | - Mona Mohamed Taha
- Department of Rehabilitation Sciences, College of Health and Rehabilitation Sciences, Princess Nourah bint Abdulrahman University, Riyadh, 11671, Saudi Arabia
| | - Elena Marques-Sule
- Physiotherapy in Motion, Multispeciality Research Group (PTinMOTION), Department of Physiotherapy, University of Valencia, Valencia, Spain
| | - Doaa I Amin
- Basic Science Department, Faculty of Physical Therapy, Cairo University, Cairo, Egypt
| | | | | | - Vincenzo Castiglione
- Fondazione Toscana Gabriele Monasterio; “Health Science” Interdisciplinary Research Center, Scuola Superiore Sant’Anna, Pisa, Italy
| | - Hady Atef
- Department of Physical Therapy for Cardiovascular/Respiratory Disorder and Geriatrics, Faculty of Physical Therapy, Cairo University, Giza, 11432, Egypt
- School of Allied Health Professions (SAHP), Keele University, Staffordshire, UK
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49
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Virani SS, Newby LK, Arnold SV, Bittner V, Brewer LC, Demeter SH, Dixon DL, Fearon WF, Hess B, Johnson HM, Kazi DS, Kolte D, Kumbhani DJ, LoFaso J, Mahtta D, Mark DB, Minissian M, Navar AM, Patel AR, Piano MR, Rodriguez F, Talbot AW, Taqueti VR, Thomas RJ, van Diepen S, Wiggins B, Williams MS. 2023 AHA/ACC/ACCP/ASPC/NLA/PCNA Guideline for the Management of Patients With Chronic Coronary Disease: A Report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines. Circulation 2023; 148:e9-e119. [PMID: 37471501 DOI: 10.1161/cir.0000000000001168] [Citation(s) in RCA: 182] [Impact Index Per Article: 182.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/22/2023]
Abstract
AIM The "2023 AHA/ACC/ACCP/ASPC/NLA/PCNA Guideline for the Management of Patients With Chronic Coronary Disease" provides an update to and consolidates new evidence since the "2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease" and the corresponding "2014 ACC/AHA/AATS/PCNA/SCAI/STS Focused Update of the Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease." METHODS A comprehensive literature search was conducted from September 2021 to May 2022. Clinical studies, systematic reviews and meta-analyses, and other evidence conducted on human participants were identified that were published in English from MEDLINE (through PubMed), EMBASE, the Cochrane Library, Agency for Healthcare Research and Quality, and other selected databases relevant to this guideline. STRUCTURE This guideline provides an evidenced-based and patient-centered approach to management of patients with chronic coronary disease, considering social determinants of health and incorporating the principles of shared decision-making and team-based care. Relevant topics include general approaches to treatment decisions, guideline-directed management and therapy to reduce symptoms and future cardiovascular events, decision-making pertaining to revascularization in patients with chronic coronary disease, recommendations for management in special populations, patient follow-up and monitoring, evidence gaps, and areas in need of future research. Where applicable, and based on availability of cost-effectiveness data, cost-value recommendations are also provided for clinicians. Many recommendations from previously published guidelines have been updated with new evidence, and new recommendations have been created when supported by published data.
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Affiliation(s)
| | | | | | | | | | | | - Dave L Dixon
- Former Joint Committee on Clinical Practice Guideline member; current member during the writing effort
| | - William F Fearon
- Society for Cardiovascular Angiography and Interventions representative
| | | | | | | | - Dhaval Kolte
- AHA/ACC Joint Committee on Clinical Data Standards
| | | | | | | | - Daniel B Mark
- Former Joint Committee on Clinical Practice Guideline member; current member during the writing effort
| | | | | | | | - Mariann R Piano
- Former Joint Committee on Clinical Practice Guideline member; current member during the writing effort
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50
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Liu XL, Wang GZ, Rui MP, Fan D, Zhang J, Zhu ZH, Perez R, Wang T, Yang LC, Lyu L, Zheng J, Wang G. Imaging characterization of myocardial function, fibrosis, and perfusion in a nonhuman primate model with heart failure-like features. Front Cardiovasc Med 2023; 10:1214249. [PMID: 37663419 PMCID: PMC10471131 DOI: 10.3389/fcvm.2023.1214249] [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: 04/29/2023] [Accepted: 07/25/2023] [Indexed: 09/05/2023] Open
Abstract
Introduction The availability of a human-like chronic heart failure (HF) animal model was critical for affiliating development of novel therapeutic drug treatments. With the close physiology relatedness to humans, the non-human primate (NHP) HF model would be valuable to better understand the pathophysiology and pharmacology of HF. The purpose of this work was to present preliminary cardiac image findings using echocardiography and cardiovascular magnetic resonance (CMR) in a HF-like cynomolgus macaque model. Methods The NHP diet-induced model developed cardiac phenotypes that exhibited diastolic dysfunction with reduced left ventricular ejection fraction (LVEF) or preserved LVEF. Twenty cynomolgus monkeys with cardiac dysfunction were selected by echocardiography and subsequently separated into two groups, LVEF < 65% (termed as HFrEF, n = 10) and LVEF ≥ 65% with diastolic dysfunction (termed as HFpEF, n = 10). Another group of ten healthy monkeys was used as the healthy control. All monkeys underwent a CMR study to measure global longitudinal strain (GLS), myocardial extracellular volume (ECV), and late gadolinium enhancement (LGE). In healthy controls and HFpEF group, quantitative perfusion imaging scans at rest and under dobutamine stress were performed and myocardial perfusion reserve (MPR) was subsequently obtained. Results No LGE was observed in any monkey. Monkeys with HF-like features were significantly older, compared to the healthy control group. There were significant differences among the three groups in ECV (20.79 ± 3.65% in healthy controls; 27.06 ± 3.37% in HFpEF group, and 31.11 ± 4.50% in HFrEFgroup, p < 0.001), as well as for stress perfusion (2.40 ± 0.34 ml/min/g in healthy controls vs. 1.28 ± 0.24 ml/min/g in HFpEF group, p < 0.01) and corresponding MPR (1.83 ± 0.3 vs. 1.35 ± 0.29, p < 0.01). After adjusting for age, ECV (p = 0.01) and MPR (p = 0.048) still showed significant differences among the three groups. Conclusion Our preliminary imaging findings demonstrated cardiac dysfunction, elevated ECV, and/or reduced MPR in this HF-like NHP model. This pilot study laid the foundation for further mechanistic research and the development of a drug testing platform for distinct HF pathophysiology.
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Affiliation(s)
- Xing-Li Liu
- Department of Radiology, The First People’s Hospital of Yunnan Province, Kunming, China
- Department of Radiology, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, China
| | - Guan-Zhong Wang
- Department of Pharmocolgy, Kunming Biomed International of TriApex Group, Kunming, China
| | - Mao-Ping Rui
- Department of Radiology, The First People’s Hospital of Yunnan Province, Kunming, China
- Department of Radiology, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, China
| | - Dong Fan
- Department of Radiology, The First People’s Hospital of Yunnan Province, Kunming, China
- Department of Radiology, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, China
| | - Jie Zhang
- Department of Pharmocolgy, Kunming Biomed International of TriApex Group, Kunming, China
| | - Zheng-Hua Zhu
- Department of Pharmocolgy, Kunming Biomed International of TriApex Group, Kunming, China
| | - Rosario Perez
- Department of Pharmocolgy, Kunming Biomed International of TriApex Group, Kunming, China
| | - Tony Wang
- Department of Pharmocolgy, Kunming Biomed International of TriApex Group, Kunming, China
| | - Li-Chuan Yang
- Department of Pharmocolgy, Kunming Biomed International of TriApex Group, Kunming, China
| | - Liang Lyu
- Department of Radiology, The First People’s Hospital of Yunnan Province, Kunming, China
- Department of Radiology, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, China
| | - Jie Zheng
- Mallinckrodt Institute of Radiology, Washington University in Saint Louis, St. Louis, MO, United States
| | - Gang Wang
- Department of Radiology, The First People’s Hospital of Yunnan Province, Kunming, China
- Department of Radiology, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, China
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