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Chobufo MD, Ali S, Taha A, Duhan S, Patel N, Gonuguntla K, Ludhwani D, Thyagaturu H, Keisham B, Shaik A, Alharbi A, Sattar Y, Mamas MA, Kohli U, Balla S. Temporal Trends of Infant Mortality Secondary to Congenital Heart Disease: National CDC Cohort Analysis (1999-2020). Birth Defects Res 2024; 116:e2398. [PMID: 39219403 DOI: 10.1002/bdr2.2398] [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: 02/22/2024] [Revised: 07/20/2024] [Accepted: 08/13/2024] [Indexed: 09/04/2024]
Abstract
BACKGROUND Infant mortality continues to be a significant problem for patients with congenital heart disease (CHD). Limited data exist on the recent trends of mortality in infants with CHD. METHODS The CDC WONDER (Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research) was queried to identify deaths occurring within the United States with CHD listed as one of the causes of death between 1999 and 2020. Subsequently, trends were calculated using the Joinpoint regression program (version 4.9.1.0; National Cancer Institute). RESULTS A total of 47,015 deaths occurred in infants due to CHD at the national level from the year 1999 to 2020. The overall proportional infant mortality (compared to all deaths) declined (47.3% to 37.1%, average annual percent change [AAPC]: -1.1 [95% CI -1.6 to -0.6, p < 0.001]). There was a significant decline in proportional mortality in both Black (45.3% to 34.3%, AAPC: -0.5 [-0.8 to -0.2, p = 0.002]) and White patients (55.6% to 48.6%, AAPC: -1.2 [-1.7 to -0.7, p = 0.001]), with a steeper decline among White than Black patients. A statistically significant decline in the proportional infant mortality in both non-Hispanic (43.3% to 33.0%, AAPC: -1.3% [95% CI -1.9 to -0.7, p < 0.001]) and Hispanic (67.6% to 57.7%, AAPC: -0.7 [95% CI -0.9 to -0.4, p < 0.001]) patients was observed, with a steeper decline among non-Hispanic infant population. The proportional infant mortality decreased in males (47.5% to 53.1%, AAPC: -1.4% [-1.9 to -0.9, p < 0.001]) and females (47.1% to 39.6%, AAPC: -0.9 [-1.9 to 0.0, p = 0.05]). A steady decline in for both females and males was noted. CONCLUSION Our study showed a significant decrease in CHD-related mortality rate in infants and age-adjusted mortality rate (AAMR) between 1999 and 2020. However, sex-based, racial/ethnic disparities were noted, with female, Black, and Hispanic patients showing a lesser decline than male, White, and non-Hispanic patients.
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Affiliation(s)
- Muchi Ditah Chobufo
- Department of Cardiology, West Virginia University, Morgantown, West Virginia, USA
| | - Shafaqat Ali
- Department of Medicine, Louisiana State University, Shreveport, Louisiana, USA
| | - Amro Taha
- Department of Medicine, Weiss Memorial Hospital, Chicago, Illinois, USA
| | - Sanchit Duhan
- Department of Cardiology, Carle Foundation Hospital, Urbana, Illinois, USA
| | - Neel Patel
- Department of Internal Medicine, Landmark Medical Center, Woonsocket, Rhode Island, USA
| | - Karthik Gonuguntla
- Department of Cardiology, West Virginia University, Morgantown, West Virginia, USA
| | - Dipesh Ludhwani
- Department of Cardiology, West Virginia University, Morgantown, West Virginia, USA
| | - Harshith Thyagaturu
- Department of Cardiology, West Virginia University, Morgantown, West Virginia, USA
| | - Bijeta Keisham
- Department of Medicine, Shandong Second Medical University, Weifang, Shandong, China
| | - Ayesha Shaik
- Department of Cardiology, Hartford Hospital, Hartford, Connecticut, USA
| | - Anas Alharbi
- Department of Cardiology, West Virginia University, Morgantown, West Virginia, USA
| | - Yasar Sattar
- Department of Cardiology, West Virginia University, Morgantown, West Virginia, USA
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, Keele University, Stoke-on-Trent, UK
| | - Utkarsh Kohli
- Department of Paediatric Cardiology, West Virginia University, Morgantown, West Virginia, USA
| | - Sudarshan Balla
- Department of Cardiology, West Virginia University, Morgantown, West Virginia, USA
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Egbe AC, Miranda WR, Jain CC, Burchill LJ, Young KA, Rose CH, Karnakoti S, Ahmed MH, Connolly HM. Cardiac remodelling during pregnancy in women with congenital heart disease and systemic left ventricle. Eur Heart J Cardiovasc Imaging 2024:jeae173. [PMID: 39073413 DOI: 10.1093/ehjci/jeae173] [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: 03/26/2024] [Revised: 05/22/2024] [Accepted: 05/27/2024] [Indexed: 07/30/2024] Open
Abstract
AIMS Women with congenital heart disease (CHD) are at risk of pregnancy-related adverse outcomes (PRAO). The purpose of this study was to assess temporal changes in cardiac structure and function (cardiac remodelling) during pregnancy, and the association with PRAO in women with CHD. METHODS AND RESULTS Retrospective study of pregnant women with CHD and serial echocardiograms (2003-2021). Cardiac structure and function were assessed at pre-specified time points: prepregnancy, early pregnancy, late pregnancy, and postnatal period. PRAO was defined as the composite of maternal cardiovascular, obstetric, and neonatal complications. The study comprised 81 women with CHD (age, 29 ± 5 years). Compared to the baseline echocardiogram, there was a relative increase in right ventricular systolic pressure (RVSP) (relative change 13 ± 5%, P < 0.001, in early pregnancy; and 18 ± 5%, P < 0.001, in late pregnancy). There was a relative decrease in right ventricle free wall strain (RVFWS) (relative change -11 ± 3%, P < 0.001, in late pregnancy; and -11 ± 4%, P = 0.003, in postnatal period), and a relative decrease in RVFWS/RVSP (relative change, -10 ± 5%, P = 0.02 in early pregnancy, -26 ± 7%, P < 0.001, in late pregnancy, and -14 ± 5%, P < 0.001, in postnatal period). Baseline right ventricular to pulmonary arterial (RV-PA) coupling, and temporal change in RV-PA coupling were associated with PRAO, after adjustment for maternal age and severity of cardiovascular disease. CONCLUSION Women with CHD had a temporal decrease in RV systolic function and RV-PA coupling, and these changes were associated with PRAO. Further studies are required to delineate the aetiology of deterioration in RV-PA coupling during pregnancy, and the long-term implications of right heart dysfunction observed in the postnatal period.
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Affiliation(s)
- Alexander C Egbe
- Department of Cardiovascular Medicine, Mayo Clinic Rochester, Mayo Clinic and Foundation, 200 First Street SW, Rochester, MN 55905, USA
| | - William R Miranda
- Department of Cardiovascular Medicine, Mayo Clinic Rochester, Mayo Clinic and Foundation, 200 First Street SW, Rochester, MN 55905, USA
| | - C Charles Jain
- Department of Cardiovascular Medicine, Mayo Clinic Rochester, Mayo Clinic and Foundation, 200 First Street SW, Rochester, MN 55905, USA
| | - Luke J Burchill
- Department of Cardiovascular Medicine, Mayo Clinic Rochester, Mayo Clinic and Foundation, 200 First Street SW, Rochester, MN 55905, USA
| | - Kathleen A Young
- Department of Cardiovascular Medicine, Mayo Clinic Rochester, Mayo Clinic and Foundation, 200 First Street SW, Rochester, MN 55905, USA
| | - Carl H Rose
- Department of Obstetrics and Gynaecology, Mayo Clinic Rochester, Rochester, MN 55905, USA
| | - Snigdha Karnakoti
- Department of Cardiovascular Medicine, Mayo Clinic Rochester, Mayo Clinic and Foundation, 200 First Street SW, Rochester, MN 55905, USA
| | - Marwan H Ahmed
- Department of Cardiovascular Medicine, Mayo Clinic Rochester, Mayo Clinic and Foundation, 200 First Street SW, Rochester, MN 55905, USA
| | - Heidi M Connolly
- Department of Cardiovascular Medicine, Mayo Clinic Rochester, Mayo Clinic and Foundation, 200 First Street SW, Rochester, MN 55905, USA
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Landstrom AP, Spears T, D'Ottavio A, Chiswell K, Sommerhalter K, Soim A, Farr SL, Crume T, Book WM, Whitehead K, Botto LD, Li JS, Hsu DT. Cardiovascular disease risk factors in congenital heart disease survivors are associated with heart failure. Pediatr Res 2024:10.1038/s41390-024-03352-8. [PMID: 38969815 DOI: 10.1038/s41390-024-03352-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 03/07/2024] [Accepted: 05/16/2024] [Indexed: 07/07/2024]
Abstract
BACKGROUND Despite advances in treatment and survival, individuals with congenital heart defects (CHD) have a higher risk of heart failure (HF) compared to the general population. OBJECTIVE To evaluate comorbidities associated with HF in patients with CHD with a goal of identifying potentially modifiable risk factors that may reduce HF-associated morbidity and mortality. METHODS Five surveillance sites in the United States linked population-based healthcare data and vital records. Individuals with an ICD-9-CM code for CHD aged 11-64 years were included and were stratified by presence of HF diagnosis code. Prevalence of death and cardiovascular risk factors based on diagnosis codes were compared by HF status using log-linear regression. RESULTS A total of 25,343 individuals met inclusion/exclusion criteria. HF was documented for 2.2% of adolescents and 12.9% of adults with CHD. Adolescents and adults with HF had a higher mortality than those without HF. In both age groups, HF was positively associated with coronary artery disease, hypertension, obesity, diabetes, and increased healthcare utilization compared to those without HF. CONCLUSIONS Within this population-based cohort, over 1 in 50 adolescents and 1 in 8 adults with CHD had HF, which was associated with increased mortality. Modifiable cardiovascular comorbidities were associated with HF. IMPACT Five sites in the United States linked population-based healthcare data and vital records to establish surveillance network for identifying the factors which influence congenital heart disease (CHD) outcomes. Survivors of CHD frequently develop heart failure across the lifespan. Over 1 in 50 adolescent and 1 in 8 adult survivors of CHD have heart failure which is associated with increased mortality compared to CHD survivors without heart failure. Heart failure development is associated with potentially modifiable cardiovascular risk factors such as hypertension, coronary artery disease, and diabetes. Controlling modifiable cardiovascular risk factors may serve to lower the risk of heart failure and mortality in survivors of congenital heart disease of all ages.
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Affiliation(s)
- Andrew P Landstrom
- Duke Department of Pediatrics, Division of Cardiology, Duke University School of Medicine, Durham, NC, USA.
| | - Tracy Spears
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
| | - Alfred D'Ottavio
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
| | - Karen Chiswell
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
| | - Kristin Sommerhalter
- Bureau of Environmental and Occupational Epidemiology, New York State Department of Health, Albany, NY, USA
| | - Aida Soim
- Bureau of Environmental and Occupational Epidemiology, New York State Department of Health, Albany, NY, USA
| | - Sherry L Farr
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Tessa Crume
- Department of Epidemiology, Colorado School of Public Health, University of Colorado, Aurora, CO, USA
| | - Wendy M Book
- Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Kevin Whitehead
- Department of Pediatrics, University of Utah, Salt Lake City, UT, USA
- Department of Medicine, University of Utah, Salt Lake City, UT, USA
| | - Lorenzo D Botto
- Department of Pediatrics, University of Utah, Salt Lake City, UT, USA
| | - Jennifer S Li
- Duke Department of Pediatrics, Division of Cardiology, Duke University School of Medicine, Durham, NC, USA
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
| | - Daphne T Hsu
- Pediatric Heart Center, Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, NY, USA
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Rivera E, Trivedi K, Cao G. Septal Defects: Unveiling Sex-Based Disparities and Screening Challenges for Timely Intervention Through a Case Report and Systematic Literature Review. Cureus 2024; 16:e65752. [PMID: 39144879 PMCID: PMC11324003 DOI: 10.7759/cureus.65752] [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: 07/30/2024] [Indexed: 08/16/2024] Open
Abstract
Atrial septal defects (ASDs), comprising a significant portion of congenital cardiac anomalies, encompass a rarer and more diagnostically challenging subset known as sinus venosus ASDs (SVASDs). ASDs are more prevalent in females, and the prognosis for patients under 40 years of age is generally favorable with advancements in surgical and transcatheter interventions. However, undiagnosed ASDs in adults above 40 years old, especially females, often lead to severe complications, including pulmonary hypertension, atrial fibrillation, Eisenmenger syndrome, and a mortality rate exceeding 50%. Our detailed case study focuses on an obese 42-year-old Hispanic migrant female with chronic respiratory failure misattributed to pulmonary hypertension, resulting in the progression of complications from undiagnosed SVASD. Further investigation using contrast-enhanced transesophageal echocardiography (TEE) elucidated the correct diagnosis four years after her initial presentation. This report explores the potential factors contributing to the patient's delayed diagnosis and development of advanced cardiac complications of pulmonary hypertension leading to Eisenmenger syndrome that precluded her from procedural intervention. Furthermore, this report pioneers the first thorough review of case reports in adults newly diagnosed with SVASD, revealing sex-based differences in complications.
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Affiliation(s)
- Elsy Rivera
- Internal Medicine, Methodist Health System, Dallas, USA
| | - Kathan Trivedi
- Internal Medicine, Methodist Dallas Medical Center, Dallas, USA
| | - George Cao
- Internal Medicine, Methodist Health System, Dallas, USA
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Mahdi NA, Guerma L, Desrosiers-Gagnon C, Dore A, Mongeon FP, Mondésert B, Ibrahim R, Poirier N, Guertin MC, Leduc L, Codsi E, Khairy P, Chaix MA. Sex-Related Differences and Influence of Pregnancy in Transposition of Great Arteries With Systemic Right Ventricle. JACC. ADVANCES 2024; 3:101015. [PMID: 39130012 PMCID: PMC11312776 DOI: 10.1016/j.jacadv.2024.101015] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 03/19/2024] [Accepted: 03/29/2024] [Indexed: 08/13/2024]
Abstract
Background There is a paucity of data regarding sex-related differences on cardiac outcomes in the context of transposition of the great arteries (TGA) with a systemic right ventricle and biventricular physiology (sRV-biV). Moreover, the long-term impact of pregnancy on cardiac outcomes remains unknown. Objectives The purpose of this study was to identify sex-related differences and the influence of pregnancy on cardiac outcomes in TGA sRV-biV population. Methods A retrospective cohort study was conducted on 213 adults with TGA sRV-biV, 82 (38.4%) women, age 42.6 ± 12.8 years, with a median follow-up of 16 years. Cardiac events, interventions, last follow-up sRV-biV dysfunction, and heart failure (HF) medications were compared between men vs women, and women with vs without pregnancies resulting in live births. Results Women had a lower incidence of nonsustained ventricular tachycardia (HR: 1.80; 95% CI: 1.04-3.09, P = 0.035) and nonsignificantly fewer HF-related hospitalizations than men (HR: 2.10; 95% CI: 0.95-4.67, P = 0.069) in univariable analysis. At the last follow-up, women had a lower prevalence of moderate to severe sRV-biV dysfunction than men (P < 0.001) and were less frequently prescribed HF therapy. Women had fewer implantable cardioverter-defibrillators for primary prevention than men (P = 0.016), with no difference for secondary prevention. Women who had pregnancies resulting in live births (N = 47), had a high prevalence of cardiac events in the 15 (IQR: 9-28) years following pregnancy with no significant differences with those without (N = 32) pregnancies. Conclusions Women with a sRV-biV have fewer adverse cardiovascular events than men. Due to sRV-biV, pregnancy remains with high maternal risk but is not associated with worse long-term cardiac outcomes under rigorous multidisciplinary cardio-obstetrical care.
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Affiliation(s)
- Naïma-Ayane Mahdi
- Adult Congenital Heart Center, Montreal Heart Institute, Department of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - Léa Guerma
- Adult Congenital Heart Center, Montreal Heart Institute, Department of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - Charles Desrosiers-Gagnon
- Adult Congenital Heart Center, Montreal Heart Institute, Department of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - Annie Dore
- Adult Congenital Heart Center, Montreal Heart Institute, Department of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - François-Pierre Mongeon
- Adult Congenital Heart Center, Montreal Heart Institute, Department of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - Blandine Mondésert
- Adult Congenital Heart Center, Montreal Heart Institute, Department of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - Réda Ibrahim
- Adult Congenital Heart Center, Montreal Heart Institute, Department of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - Nancy Poirier
- Adult Congenital Heart Center, Montreal Heart Institute, Department of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - Marie-Claude Guertin
- Montreal Health Innovation Coordinating Center (MHICC), Montreal, Quebec, Canada
| | - Line Leduc
- Centre de médecine fœto-maternelle, CHU Sainte-Justine, Université de Montréal, Montréal, Québec, Canada
| | - Elisabeth Codsi
- Centre de médecine fœto-maternelle, CHU Sainte-Justine, Université de Montréal, Montréal, Québec, Canada
| | - Paul Khairy
- Adult Congenital Heart Center, Montreal Heart Institute, Department of Medicine, Université de Montréal, Montreal, Quebec, Canada
- Montreal Health Innovation Coordinating Center (MHICC), Montreal, Quebec, Canada
| | - Marie-A Chaix
- Adult Congenital Heart Center, Montreal Heart Institute, Department of Medicine, Université de Montréal, Montreal, Quebec, Canada
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Egbe AC, Miranda WR, Jain CC, Burchill LJ, Abozied O, Ahmed MH, Jokhadar M, Karnakoti S, Connolly HM. Sex Differences in Outcomes of Adults With Isolated Coarctation of the Aorta. CJC Open 2024; 6:759-767. [PMID: 38846445 PMCID: PMC11150945 DOI: 10.1016/j.cjco.2024.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Accepted: 01/25/2024] [Indexed: 06/09/2024] Open
Abstract
Background Data are limited about the effect (or lack thereof) of sex on clinical outcomes in adults with coarctation of the aorta (COA). The purpose of this study was to compare atherosclerotic cardiovascular disease (ASCVD) risk profile, blood pressure (BP) data, echocardiographic indices, and mortality between men and women with COA. Methods Retrospective study of adults with COA, and no associated left-sided obstructive lesions, who received care at Mayo Clinic (2003-2022). ASCVD risk profile was assessed as the prevalence of hypertension, hyperlipidemia, type 2 diabetes, obesity, smoking history, and coronary artery disease. A 24-hour BP monitor was used to assess daytime and nighttime BP and calculate nocturnal dipping. Results Of 621 patients with isolated COA, 375 (60%) were men, and 246 (40%) were women. Women had similar ASCVD risk profile and daytime BP as men. However, women had less nocturnal dipping (7 ± 5 mm Hg vs 16 ± 7 mm Hg, P < 0.001), higher pulmonary artery mean pressure (23 mm Hg [interquartile range: 16-31] vs 20 mm Hg [interquartile range: 15-28], P = 0.04), and higher pulmonary vascular resistance index (3.41 ± 1.14 WU · m2 vs 3.02 ± 0.76 WU · m2, P = 0.006). Female sex was associated with all-cause mortality (adjusted hazard ratio 1.26, 95% confidence interval 1.04-1.94) and cardiovascular mortality (adjusted hazard ratio 1.38, 95% confidence interval 1.09-2.18). Conclusions Women had a higher risk of both cardiovascular mortality and all-cause mortality compared to the risks in men. This difference may be related to the higher-than-expected ASCVD risk factors, abnormal nocturnal blood pressure, and pulmonary hypertension observed in women in this cohort. Further studies are required to identify optimal measures to address these risk factors.
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Affiliation(s)
- Alexander C. Egbe
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - William R. Miranda
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - C. Charles Jain
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Luke J. Burchill
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Omar Abozied
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Marwan H. Ahmed
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Maan Jokhadar
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Snigdha Karnakoti
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Heidi M. Connolly
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
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Richter S, Bechmann N. Patient Sex and Origin Influence Distribution of Driver Genes and Clinical Presentation of Paraganglioma. J Endocr Soc 2024; 8:bvae038. [PMID: 38481600 PMCID: PMC10928507 DOI: 10.1210/jendso/bvae038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Indexed: 04/07/2024] Open
Abstract
Context Sexual and ancestral differences in driver gene prevalence have been described in many cancers but have not yet been investigated in pheochromocytoma and paraganglioma (PPGL). Objective This study aims to assess whether sex and ancestry influence prevalence of PPGL driver genes and clinical presentation. Methods We conducted a retrospective analysis of patients with PPGL considering studies from 2010 onwards that included minimal data of type of disease, sex, mutated gene, and country of origin. Additional features were recorded when available (age, tumor location, bilateral or multifocal, somatic or germline, and metastatic disease). Results We included 2162 patients: 877 in Europe and 757 in Asia. Males presented more often with germline pathogenic variants (PVs) in genes activating hypoxia pathways (P = .0006) and had more often sympathetic paragangliomas (P = .0005) and metastasis (P = .0039). On the other hand, females with PPGLs due to MAX PVs were diagnosed later than males (P = .0378) and more often developed metastasis (P = .0497). European but not Asian females presented more often with PPGLs due to PVs in genes related to kinase signaling (P = .0052), particularly RET and TMEM127. Contrary to experiences from Europe, Asian patients with PPGL due to PVs in kinase signaling genes NF1, HRAS, and FGFR1 showed a high proportion of sympathetic tumors, while European patients almost exclusively had adrenal tumors (P < .005). Conclusion Personalized management of patients with PPGL might benefit from considering sexual and ancestral differences. Further studies with better clinically aligned cohorts from various origins are required to better dissect ancestral influences on PPGL development.
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Affiliation(s)
- Susan Richter
- Institute for Clinical Chemistry and Laboratory Medicine, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, 01307 Dresden, Germany
| | - Nicole Bechmann
- Institute for Clinical Chemistry and Laboratory Medicine, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, 01307 Dresden, Germany
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8
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Wiens EJ, Kawa K, Kass M, Shah AH. Impact of biological sex on valvular heart disease, interventions, and outcomes. Can J Physiol Pharmacol 2024. [PMID: 38427984 DOI: 10.1139/cjpp-2023-0390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2024]
Abstract
Valvular heart disease (VHD) is common, affecting >14% of individuals aged >75, and is associated with morbidity, including heart failure and arrhythmia, and risk of early mortality. Increasingly, important sex differences are being found between males and females with VHD. These sex differences can involve the epidemiology, pathophysiology, presentation, diagnosis, and outcomes of the disease. Females are often disadvantaged, and female sex has been shown to be associated with delayed diagnosis and inferior outcomes in various forms of VHD. In addition, the unique pathophysiologic state of pregnancy is associated with increased risk for maternal and fetal morbidity and mortality in many forms of VHD. Therefore, understanding and recognizing these sex differences, and familiarity with the attendant risks of pregnancy and management of pregnant females with VHD, is of great importance for any primary care or cardiovascular medicine practitioner caring for the female patient. This review will outline sex differences in aortic, mitral, pulmonic, and tricuspid VHD, with particular focus on differences in pathophysiology, clinical presentation, and outcomes. In addition, the pathophysiology and management implications of pregnancy will be discussed.
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Affiliation(s)
- Evan J Wiens
- Department of Critical Care Medicine, University of Alberta, Edmonton, AB, Canada
| | - Kristal Kawa
- College of Nursing, University of Manitoba, Winnipeg, MB, Canada
| | - Malek Kass
- Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
- Section of Cardiology, Department of Internal Medicine, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Ashish H Shah
- Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
- Section of Cardiology, Department of Internal Medicine, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
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Kaemmerer H, Diller GP, Dähnert I, Eichstaedt CA, Eicken A, Freiberger A, Freilinger S, Geiger R, Gorenflo M, Grünig E, Hager A, Herberg U, Huntgeburth M, Kaemmerer AS, Kozlik-Feldmann R, Lammers A, Nagdyman N, Michel S, Schmidt KH, Uebing A, von Scheidt F, Apitz C. [Pulmonary arterial hypertension in congenital heart disease - Part I]. Pneumologie 2023; 77:956-961. [PMID: 37963485 DOI: 10.1055/a-2146-7434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2023]
Abstract
The number of adults with congenital heart disease (CHD) is steadily rising and amounts to approximately 360,000 in Germany. CHD is often associated with pulmonary arterial hypertension (PAH), which may develop early in untreated CHD. Despite timely treatment of CHD, PAH often persists or recurs in older age and is associated with significant morbidity and mortality.The revised European Society of Cardiology/European Respiratory Society 2022 guidelines for the diagnosis and treatment of PH represent a significant contribution to the optimized care of those affected. However, the topic of "adults with congenital heart defects" is addressed only relatively superficially in these guidelines. Therefore, this article addresses the perspective of congenital cardiology in greater depth.
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Affiliation(s)
- Harald Kaemmerer
- Internationales Zentrum für Erwachsene mit angeborenem Herzfehler, Klinik für angeborene Herzfehler und Kinderkardiologie, Deutsches Herzzentrum München, München, Deutschland
| | - Gerhard Paul Diller
- Klinik für Kardiologie III: Angeborene Herzfehler (EMAH) und Klappenerkrankungen, Universitätsklinikum Münster, Münster, Deutschland
| | - Ingo Dähnert
- Universitätsklinik für Kinderkardiologie, Herzzentrum Leipzig, Leipzig, Deutschland
| | - Christina A Eichstaedt
- Zentrum für Pulmonale Hypertonie, Thoraxklinik Heidelberg am Universitätsklinikum Heidelberg, Heidelberg, Deutschland
- Institut für Humangenetik, Universität Heidelberg, INF 366, Heidelberg, Deutschland
| | - Andreas Eicken
- Internationales Zentrum für Erwachsene mit angeborenem Herzfehler, Klinik für angeborene Herzfehler und Kinderkardiologie, Deutsches Herzzentrum München, München, Deutschland
| | - Annika Freiberger
- Internationales Zentrum für Erwachsene mit angeborenem Herzfehler, Klinik für angeborene Herzfehler und Kinderkardiologie, Deutsches Herzzentrum München, München, Deutschland
| | - Sebastian Freilinger
- Internationales Zentrum für Erwachsene mit angeborenem Herzfehler, Klinik für angeborene Herzfehler und Kinderkardiologie, Deutsches Herzzentrum München, München, Deutschland
| | - Ralf Geiger
- Univ.-Klinik für Pädiatrie III, Kardiologie, Pneumologie, Allergologie, Cystische Fibrose, Innsbruck, Österreich
| | - Matthias Gorenflo
- Klinik für Kinderkardiologie und angeborene Herzfehler, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - Ekkehard Grünig
- Zentrum für Pulmonale Hypertonie, Thoraxklinik Heidelberg am Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - Alfred Hager
- Internationales Zentrum für Erwachsene mit angeborenem Herzfehler, Klinik für angeborene Herzfehler und Kinderkardiologie, Deutsches Herzzentrum München, München, Deutschland
| | - Ulrike Herberg
- Klinik für Kinderkardiologie und Angeborene Herzfehler, Universitätsklinikum Aachen, Aachen, Deutschland
| | - Michael Huntgeburth
- Internationales Zentrum für Erwachsene mit angeborenem Herzfehler, Klinik für angeborene Herzfehler und Kinderkardiologie, Deutsches Herzzentrum München, München, Deutschland
| | | | - Rainer Kozlik-Feldmann
- Klinik und Poliklinik für Kinderkardiologie, Universitäres Herz- und Gefäßzentrum Hamburg, Klinik und Poliklinik für Kinderherzmedizin und Erwachsene mit angeborenen Herzfehlern, Hamburg, Deutschland
| | - Astrid Lammers
- Klinik für Pädiatrische Kardiologie, Universitätsklinikum Münster, Münster, Deutschland
| | - Nicole Nagdyman
- Internationales Zentrum für Erwachsene mit angeborenem Herzfehler, Klinik für angeborene Herzfehler und Kinderkardiologie, Deutsches Herzzentrum München, München, Deutschland
| | - Sebastian Michel
- LMU Klinikum, Herzchirurgische Klinik und Poliklinik, Sektion für Chirurgie angeborener Herzfehler und Kinderherzchirurgie, Campus Großhadern, München
| | - Kai Helge Schmidt
- Universitätsmedizin Mainz, Zentrum für Kardiologie - Kardiologie I, Johannes Gutenberg-Universität Mainz, Mainz, Deutschland
| | - Anselm Uebing
- Universitätsklinikum Schleswig-Holstein, Klinik für angeborene Herzfehler und Kinderkardiologie, Kiel, Deutschland
| | - Fabian von Scheidt
- Internationales Zentrum für Erwachsene mit angeborenem Herzfehler, Klinik für angeborene Herzfehler und Kinderkardiologie, Deutsches Herzzentrum München, München, Deutschland
| | - Christian Apitz
- Universitätsklinik für Kinder- und Jugendmedizin Ulm, Ulm, Deutschland
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Farjat‐Pasos JI, Guedeney P, Houde C, Alperi A, Robichaud M, Côté M, Montalescot G, Rodés‐Cabau J. Sex Differences in Patients With Cryptogenic Cerebrovascular Events Undergoing Transcatheter Closure of Patent Foramen Ovale. J Am Heart Assoc 2023; 12:e030359. [PMID: 37776218 PMCID: PMC10727268 DOI: 10.1161/jaha.123.030359] [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: 05/16/2023] [Accepted: 07/18/2023] [Indexed: 10/02/2023]
Abstract
Background Scarce data exist on sex differences in patients with cryptogenic cerebrovascular events undergoing patent foramen ovale (PFO) closure. This study aimed to determine the sex differences in clinical profile, procedural characteristics, and long-term outcomes of patients with cryptogenic cerebrovascular events undergoing PFO closure. Methods and Results A retrospective cohort was used, including 1076 consecutive patients undergoing PFO closure because of a cryptogenic cerebrovascular event. Patients were divided into 2 groups: 469 (43.6%) women and 607 (56.4%) men. The median follow-up was 3 years (interquartile range, 2-8 years). Women were younger (46±13 versus 50±12 years; P<0.01) and had a higher risk of paradoxical embolism score (6.9±1.7 versus 6.6±1.6; P<0.01). Procedural characteristics and postprocedural antithrombotic therapy were similar. At follow-up, there were no differences in atrial fibrillation (women versus men: 0.47 versus 0.97 per 100 patient-years; incidence rate ratio [IRR], 0.55 [95% CI, 0.27-1.11]; P=0.095; adjusted P=0.901), stroke (0.17 versus 0.07 per 100 patient-years; IRR, 2.58 [95% CI, 0.47-14.1]; P=0.274; adjusted P=0.201), or transient ischemic attack (0.43 versus 0.18 per 100 patient-years; IRR, 2.58 [95% CI, 0.88-7.54]; P=0.084; adjusted P=0.121); nevertheless, women exhibited a higher incidence of combined ischemic cerebrovascular events (0.61 versus 0.26 per 100 patient-years; IRR, 2.58 [95% CI, 1.04-6.39]; P=0.041; adjusted P=0.028) and bleeding events (1.04 versus 0.45 per 100 patient-years; IRR, 2.82 [95% CI, 1.41-5.65]; P=0.003; adjusted P=0.004). Conclusions Compared with men, women with cryptogenic cerebrovascular events undergoing PFO closure were younger and had a higher risk of paradoxical embolism score. After a median follow-up of 3 years, there were no differences in stroke events, but women exhibited a higher rate of combined (stroke and transient ischemic attack) cerebrovascular events and bleeding complications. Additional studies are warranted to clarify sex-related outcomes after PFO closure further.
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Affiliation(s)
| | - Paul Guedeney
- Sorbonne Université, ACTION Study Group, INSERM UMRS_1166 Institut de Cardiologie (AP‐HP)ParisFrance
| | - Christine Houde
- Centre Hospitalier Universitaire de QuebecLaval UniversityQuebec CityQuebecCanada
| | - Alberto Alperi
- Quebec Heart and Lung Institute, Laval UniversityQuebec CityQuebecCanada
| | - Mathieu Robichaud
- Quebec Heart and Lung Institute, Laval UniversityQuebec CityQuebecCanada
| | - Mélanie Côté
- Quebec Heart and Lung Institute, Laval UniversityQuebec CityQuebecCanada
| | - Gilles Montalescot
- Sorbonne Université, ACTION Study Group, INSERM UMRS_1166 Institut de Cardiologie (AP‐HP)ParisFrance
| | - Josep Rodés‐Cabau
- Quebec Heart and Lung Institute, Laval UniversityQuebec CityQuebecCanada
- Centre Hospitalier Universitaire de QuebecLaval UniversityQuebec CityQuebecCanada
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11
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Raj K, Vyas V, Yeruva K, Gangu K, Majeed H, Desai A, Pillai KJ, Kumar P, Aedma SK, Watts A, Gahona CCT, Chandna S, Varadarajan P, Pai RG. Mortality and Complications of COVID-19 Among Adult Congenital Heart Disease Patients: A Retrospective Cohort Study Using the National Inpatient Sample Database. Curr Probl Cardiol 2023; 48:101644. [PMID: 36773953 PMCID: PMC9911147 DOI: 10.1016/j.cpcardiol.2023.101644] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 02/04/2023] [Indexed: 02/11/2023]
Abstract
This study examines in-hospital mortality and complicated COVID-19 infection among adult congenital heart disease (ACHD) patients admitted with COVID-19, using the National Inpatient Sample (NIS). A total of 4219 COVID-19 patients with ACHD were included. We demonstrated that COVID-19 patients with ACHD were more likely to experience in-hospital mortality (OR 1.04, 95% CI 1.04-1.04, P < 0.01) and complicated COVID-19 infection (OR: 1.30, 95% CI: 1.11-1.53, P < 0.01). In our sub-group analysis, COVID-19 patients with tetralogy of Fallot (TOF) had higher mortality and COVID-19 patients with atrial septal defects (ASD) had a higher incidence of complicated infection when compared to COVID-19 patients with all other ACHDs. Risk factors for mortality among COVID-19 patients with ACHD include advanced age, lower income, unrepaired ACHD, malnutrition, and chronic liver disease. Accordingly, we recommend aggressive preventive care with vaccination and non-pharmacologic measures in order to improve survival for ACHD patients.
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Affiliation(s)
- Kavin Raj
- Division of Cardiology, Department of Medicine, University of California Riverside School of Medicine, Riverside, CA.
| | - Vrinda Vyas
- Division of Cardiology, Department of Medicine, University of California Riverside School of Medicine, Riverside, CA
| | - Karthik Yeruva
- Department of Internal Medicine, Merit Health River Region Hospital, Vicksburg, MS
| | - Karthik Gangu
- Department of Internal Medicine, University of Kansas Medical Center, Kansas City, KS
| | - Harris Majeed
- Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM
| | - Aditya Desai
- Division of Cardiology, Department of Medicine, University of California Riverside School of Medicine, Riverside, CA
| | - Keerthana J Pillai
- Department of Medicine, Kilpauk Medical College, Chennai, Tamil Nadu, India
| | - Preetham Kumar
- Division of Cardiology, Department of Medicine, University of California Riverside School of Medicine, Riverside, CA
| | - Surya K Aedma
- Division of Cardiology, Department of Medicine, University of California Riverside School of Medicine, Riverside, CA
| | - Abi Watts
- Division of Cardiology, Department of Medicine, University of Texas Health Sciences Center at Houston, Houston, TX
| | - Christian C T Gahona
- Division of Cardiology, Department of Medicine, Kansas University Medical Center, Kansas City, KS
| | - Sanya Chandna
- Department of Hospital Medicine, Cleveland Clinic Foundation, Cleveland, OH
| | - Padmini Varadarajan
- Division of Cardiology, Department of Medicine, University of California Riverside School of Medicine, Riverside, CA
| | - Ramdas G Pai
- Division of Cardiology, Department of Medicine, University of California Riverside School of Medicine, Riverside, CA
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Sharma V, Goessling LS, Brar AK, Eghtesady P. Multiple subtypes of coxsackievirus group B can cause congenital heart disease. Birth Defects Res 2023; 115:171-178. [PMID: 36094067 DOI: 10.1002/bdr2.2086] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 08/11/2022] [Accepted: 08/24/2022] [Indexed: 01/27/2023]
Abstract
BACKGROUND Different serotypes of coxsackievirus B (CVB), which is the most common cause of viral myocarditis, target cardiomyocytes through Coxsackie and Adenovirus Receptor and Decay-Accelerating Factor. Both receptors are expressed in the fetal heart. We hypothesized that infection with different serotypes of CVB during early pregnancy plays a role in pathogenesis of congenital heart defect (CHD). METHODS In this study, we use a murine model to infect with CVB1, CVB4, and combination of CVB3 + CVB4 during a critical period in gestation. We examined offspring of pregnant mice for fetal death and heart defects following viral infection. RESULT Fetuses from uninfected control dams showed normal heart development, while maternal CVB infection precipitates CHD: majorly ventricular septal defects (VSD) and non-compaction of ventricular myocardium (NC), with some infrequent cases of double outlet right ventricle, left ventricle wall rupture, right ventricle hypertrophy, and thickened/dysplastic semilunar valves. Infection of pregnant dams with CVB1 leads to 44% VSD and 41.2% NC cases, while with CVB4 leads to 31.7% VSD and 13.3% NC cases. Co-infection with CVB3 + CVB4 increases fetal pathology to 51.3% VSD and 41% NC cases. Infection can also result in fetal death, with higher incidences with CVB3 + CVB4 with 46.2% cases, compared to 33.3% by CVB1 and 21.7% by CVB4. Male fetuses were more susceptible to all phenotypes. CONCLUSION Our report shows that prenatal CVB infections can lead to pathogenesis of certain heart defects in mouse model, particularly exacerbated with co-infections. This data confirms a link between prenatal CVB infection and CHD development and highlights it is not unique to just one serotype of CVB.
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Affiliation(s)
- Vipul Sharma
- Division of Pediatric Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Lisa S Goessling
- Division of Pediatric Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Anoop K Brar
- Division of Pediatric Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Pirooz Eghtesady
- Division of Pediatric Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
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13
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Asghar A, Stefanescu Schmidt AC, Sahakyan Y, Horlick EM, Abrahamyan L. Sex differences in baseline profiles and short-term outcomes in patients undergoing closure of patent foramen ovale. AMERICAN HEART JOURNAL PLUS : CARDIOLOGY RESEARCH AND PRACTICE 2022; 21:100199. [PMID: 38559747 PMCID: PMC10978392 DOI: 10.1016/j.ahjo.2022.100199] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 08/24/2022] [Indexed: 04/04/2024]
Abstract
Objectives Although sex differences have been emphasized in stroke and congenital heart disease, there has been limited investigation into their role in patent foramen ovale (PFO) closure for secondary prevention of stroke. We aimed to explore differences by sex in baseline profiles, procedural characteristics, and short-term outcomes of patients undergoing transcatheter PFO closure. Methods Data of adult patients undergoing transcatheter PFO closure at the Toronto General Hospital from 1997 to 2017 was retrospectively analyzed. Baseline information included demographic characteristics, medical history, diagnostic, and procedural information, and periprocedural complications. Post-closure outcomes were captured at index hospitalization and during the first follow-up. Results From 1031 patients in the cohort sample, 80.7 % underwent closure for cryptogenic stroke and 44.7 % (n = 461) were females. We observed significant sex-related differences in baseline characteristics; females were younger, less likely to have a history of smoking, and less likely to have several cardiovascular risk factors at baseline (p < 0.05). The median time to first follow-up was 89 days for both groups. Recurrent stroke was observed in 0.1 % and TIA observed in 0.4 % of in the 'cryptogenic stroke/TIA' group; in the 'other indications' group, 1.4 % stroke and no TIA were reported. No significant differences were present between sexes. Conclusions There were no differences in procedural and short-term outcomes between males and females undergoing transcatheter PFO closure, but significant baseline differences in risk factors were identified. There is a critical need for long-term, systematic studies to understand sex and gender differences in the PFO population.
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Affiliation(s)
- Areeba Asghar
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Ada C. Stefanescu Schmidt
- Toronto Congenital Cardiac Centre for Adults, Peter Munk Cardiac Centre, UHN, Toronto, Ontario, Canada
| | - Yeva Sahakyan
- Toronto Health Economics and Technology Assessment (THETA) Collaborative, Toronto General Hospital Research Institute, University Health Network (UHN), Toronto, Ontario, Canada
| | - Eric M. Horlick
- Toronto Congenital Cardiac Centre for Adults, Peter Munk Cardiac Centre, UHN, Toronto, Ontario, Canada
| | - Lusine Abrahamyan
- Toronto Health Economics and Technology Assessment (THETA) Collaborative, Toronto General Hospital Research Institute, University Health Network (UHN), Toronto, Ontario, Canada
- Toronto General Hospital Research Institute, UHN, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
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Bhimani SA, Hsich E, Boyle G, Liu W, Worley S, Bostdorff H, Nasman C, Saarel E, Amdani S. Sex disparities in the current era of pediatric heart transplantation in the United States. J Heart Lung Transplant 2021; 41:391-399. [PMID: 34933797 DOI: 10.1016/j.healun.2021.10.021] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 10/21/2021] [Accepted: 10/31/2021] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND While sex-related differences in transplant outcomes have been well characterized amongst adults, there are no sex-specific pediatric heart transplant studies over the last decade and none evaluating waitlist outcomes. In a contemporary cohort of children undergoing heart transplantation in the United States, this analysis was performed to determine if there were sex disparities in waitlist and/or post-transplant outcomes. METHODS Retrospective review of Scientific Registry of Transplant Recipients database from December 16, 2011 to February 28, 2019 to compare male and female children after listing and after transplant. Demographic, clinical characteristics and outcomes were compared unadjusted and after 1:1 propensity matching for selected covariates. RESULTS Of 4089 patients, 2299 (56%) were males. At listing, males were more likely to be older, have congenital heart disease (58% vs 48%), renal dysfunction (49% vs 44%) and implantable cardioverter defibrillator (9% vs 7%). At transplant, males were more likely to have renal (42 % vs 35%) and liver dysfunction (13% vs 10%), PRA >10% (29% vs 22%) and ischemic time >3.5 hours (p < 0.05 for all). There were no significant sex differences found in unadjusted rates of transplant or mortality. After propensity matching, females had increased waitlist mortality (HR 1.3, 95%CI 1.04-1.5; p =0.019) compared to males. There were no significant differences in post-transplant morbidity or mortality (HR 1.2, 95% CI 0.93-1.5; p = 0.18) between groups. CONCLUSION In a contemporary pediatric cohort, females have inferior heart transplant waitlist survival compared to propensity-matched males despite lower acuity of illness at listing and similar rates of transplantation. There were no sex-disparities noted in post-transplant outcomes.
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Affiliation(s)
- Salima A Bhimani
- Department of Pediatric Cardiology, Cleveland Clinic Children's Hospital, Cleveland, Ohio
| | - Eileen Hsich
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Gerard Boyle
- Department of Pediatric Cardiology, Cleveland Clinic Children's Hospital, Cleveland, Ohio
| | - Wei Liu
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio
| | - Sarah Worley
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio
| | - Hannah Bostdorff
- Department of Pediatric Cardiology, Cleveland Clinic Children's Hospital, Cleveland, Ohio
| | - Colleen Nasman
- Department of Pediatric Cardiology, Cleveland Clinic Children's Hospital, Cleveland, Ohio
| | | | - Shahnawaz Amdani
- Department of Pediatric Cardiology, Cleveland Clinic Children's Hospital, Cleveland, Ohio.
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Sex differences in cardiac function and clinical outcome in patients with a Fontan circulation. INTERNATIONAL JOURNAL OF CARDIOLOGY CONGENITAL HEART DISEASE 2021. [DOI: 10.1016/j.ijcchd.2021.100197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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16
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Freilinger S, Andonian C, Beckmann J, Ewert P, Kaemmerer H, Lang N, Nagdyman N, Oberhoffer-Fritz R, Pieper L, Schelling J, von Scheidt F, Neidenbach R. Differences in the experiences and perceptions of men and women with congenital heart defects: A call for gender-sensitive, specialized, and integrative care. INTERNATIONAL JOURNAL OF CARDIOLOGY CONGENITAL HEART DISEASE 2021. [DOI: 10.1016/j.ijcchd.2021.100185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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17
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Snygg-Martin U, Giang KW, Dellborg M, Robertson J, Mandalenakis Z. Cumulative incidence of infective endocarditis in patients with congenital heart disease: a nationwide, case-control study over nine decades. Clin Infect Dis 2021; 73:1469-1475. [PMID: 34036324 PMCID: PMC8528398 DOI: 10.1093/cid/ciab478] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Congenital heart disease (CHD) is a lifelong predisposing condition for infective endocarditis (IE). As a consequence of advances in pediatric care, the number of adults with CHD is now exceeding the number of children. The goal of the present study was to determine the cumulative incidence of IE in patients with CHD and detect temporal changes compared with controls. METHODS Nationwide registry-based case-control study of patients with CHD born 1930-2017 matched with 10 random controls. Infective endocarditis episodes were linked using the Swedish 10-digit personal identification number. RESULTS In total, 89,541 patients with CHD and 890,470 matched controls were included. In patients with CHD, 1477 IE episodes were registered and 447 episodes in controls. Patients with CHD had 8.5% cumulative incidence of IE at age 87 years, compared with 0.7% in matched controls. Incidence rate of IE per 100,000 person-years was 65.5 (95% confidence interval [CI] 62.2-68.9) and 1.8 (95% CI 1.7-2.0) in CHD patients and controls, respectively. By age 18 years, patients with CHD had an IE incidence similar to that of 81-year-old controls. Incidence of IE differed by age but not by birth year. Bacterial etiology was registered from 1997 in half of the IE episodes; among CHD IE cases, 43.3% were caused by streptococci, 29.8% by Staphylococcus aureus. CONCLUSIONS Infective endocarditis remains an important complication in patients with CHD. Incidence correlate with age and the number of IE episodes are expected to increase as the CHD population grow older.
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Affiliation(s)
- Ulrika Snygg-Martin
- Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Sweden; and Department of Infectious Diseases, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden
| | - Kok Wai Giang
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden; and Department of Medicine, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden
| | - Mikael Dellborg
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden; and Department of Medicine, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden; and Adult Congenital Heart Unit, Department of Medicine, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden
| | - Josefina Robertson
- Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Sweden; and Department of Infectious Diseases, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden
| | - Zacharias Mandalenakis
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden; and Department of Medicine, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden; and Adult Congenital Heart Unit, Department of Medicine, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden
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18
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Landsem LM, Ross FJ, Joffe DC, Latham GJ. The Year in Review: Anesthesia for Congenital Heart Disease 2020. Semin Cardiothorac Vasc Anesth 2021; 25:107-119. [PMID: 33999739 DOI: 10.1177/10892532211011325] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
This review focuses on the literature published during the calendar year 2020 that is of interest to anesthesiologists taking care of children and adults with congenital heart disease. Five major themes are discussed, including COVID-19 in children with heart disease, race and outcome disparities in congenital heart disease, Norwood procedure and outcomes, Fontan procedure and outcomes, and neurotoxicity/neurologic outcomes. A total of 59 peer-reviewed articles are discussed.
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Affiliation(s)
- Leah M Landsem
- Seattle Children's Hospital, Seattle, WA, USA.,University of Washington, Seattle, WA, USA
| | - Faith J Ross
- Seattle Children's Hospital, Seattle, WA, USA.,University of Washington, Seattle, WA, USA
| | - Denise C Joffe
- Seattle Children's Hospital, Seattle, WA, USA.,University of Washington, Seattle, WA, USA
| | - Gregory J Latham
- Seattle Children's Hospital, Seattle, WA, USA.,University of Washington, Seattle, WA, USA
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Kim YY, Geisinger MT, Bhamare T, Wasserman M, Min J, Goldmuntz E. Natural history of the aortic root in Tetralogy of Fallot after repair. INTERNATIONAL JOURNAL OF CARDIOLOGY CONGENITAL HEART DISEASE 2021. [DOI: 10.1016/j.ijcchd.2021.100092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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20
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Baumgartner H, De Backer J, Babu-Narayan SV, Budts W, Chessa M, Diller GP, Iung B, Kluin J, Lang IM, Meijboom F, Moons P, Mulder BJ, Oechslin E, Roos-Hesselink JW, Schwerzmann M, Sondergaard L, Zeppenfeld K, Ernst S, Ladouceur M, Aboyans V, Alexander D, Christodorescu R, Corrado D, D’Alto M, de Groot N, Delgado V, Di Salvo G, Dos Subira L, Eicken A, Fitzsimons D, Frogoudaki AA, Gatzoulis M, Heymans S, Hörer J, Houyel L, Jondeau G, Katus HA, Landmesser U, Lewis BS, Lyon A, Mueller CE, Mylotte D, Petersen SE, Petronio AS, Roffi M, Rosenhek R, Shlyakhto E, Simpson IA, Sousa-Uva M, Torp-Pedersen CT, Touyz RM, Van De Bruaene A. Guía ESC 2020 para el tratamiento de las cardiopatías congénitas del adulto. Rev Esp Cardiol 2021. [DOI: 10.1016/j.recesp.2020.10.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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21
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Windsor J, Mukundan C, Stopak J, Ramakrishna H. Analysis of the 2020 European Society of Cardiology (ESC) Guidelines for the Management of Adults With Congenital Heart Disease (ACHD). J Cardiothorac Vasc Anesth 2021; 36:2738-2757. [PMID: 33985885 DOI: 10.1053/j.jvca.2021.04.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Accepted: 04/04/2021] [Indexed: 01/02/2023]
Abstract
Adult congenital heart disease (ACHD) continues to rapidly increase worldwide. With an estimated 1.5 million adults with ACHD in the USA alone, there is a growing need for better education in the management of these complex patients and multiple knowledge gaps exist. This manuscript comprehensively reviewed the recent (2020) updated European Society of Cardiology Guidelines for the management of ACHD created by the Task Force for the management of adult congenital heart disease of the European Society of Cardiology, with perioperative implications for the adult cardiac anesthesiologist and intensivist who may be called upon to manage these complex patients.
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Affiliation(s)
- Jimmy Windsor
- Clinical Associate Professor of Anesthesia, University of Iowa Carver College of Medicine Department of Anesthesia, Division of Pediatric Anesthesia, 200 Hawkins Drive, Iowa City, Iowa, 52242
| | - Chaitra Mukundan
- Clinical Assistant Professor of Anesthesia, University of Iowa Carver College of Medicine Department of Anesthesia, Division of Pediatric Anesthesia, 200 Hawkins Drive, Iowa City, Iowa, 52242
| | - Joshua Stopak
- Clinical Assistant Professor of Anesthesia, University of Iowa Carver College of Medicine Department of Anesthesia, Division of Pediatric Anesthesia, 200 Hawkins Drive, Iowa City, Iowa, 52242
| | - Harish Ramakrishna
- Professor of Anesthesiology, Mayo Clinic School of Medicine, Department of Anesthesiology and Perioperative Medicine, Division of Cardiovascular and Thoracic Anesthesiology, 200 First Street SW, Rochester, MN 55905.
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22
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Baumgartner H, De Backer J, Babu-Narayan SV, Budts W, Chessa M, Diller GP, Lung B, Kluin J, Lang IM, Meijboom F, Moons P, Mulder BJM, Oechslin E, Roos-Hesselink JW, Schwerzmann M, Sondergaard L, Zeppenfeld K. 2020 ESC Guidelines for the management of adult congenital heart disease. Eur Heart J 2021; 42:563-645. [PMID: 32860028 DOI: 10.1093/eurheartj/ehaa554] [Citation(s) in RCA: 890] [Impact Index Per Article: 296.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
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Sharma V, Goessling LS, Brar AK, Joshi CS, Mysorekar IU, Eghtesady P. Coxsackievirus B3 Infection Early in Pregnancy Induces Congenital Heart Defects Through Suppression of Fetal Cardiomyocyte Proliferation. J Am Heart Assoc 2021; 10:e017995. [PMID: 33440998 PMCID: PMC7955305 DOI: 10.1161/jaha.120.017995] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 12/04/2020] [Indexed: 12/13/2022]
Abstract
Background Coxsackievirus B (CVB) is the most common cause of viral myocarditis. It targets cardiomyocytes through coxsackie and adenovirus receptor, which is highly expressed in the fetal heart. We hypothesized CVB3 can precipitate congenital heart defects when fetal infection occurs during critical window of gestation. Methods and Results We infected C57Bl/6 pregnant mice with CVB3 during time points in early gestation (embryonic day [E] 5, E7, E9, and E11). We used different viral titers to examine possible dose-response relationship and assessed viral loads in various fetal organs. Provided viral exposure occurred between E7 and E9, we observed characteristic features of ventricular septal defect (33.6%), abnormal myocardial architecture resembling noncompaction (23.5%), and double-outlet right ventricle (4.4%) among 209 viable fetuses examined. We observed a direct relationship between viral titers and severity of congenital heart defects, with apparent predominance among female fetuses. Infected dams remained healthy; we did not observe any maternal heart or placental injury suggestive of direct viral effects on developing heart as likely cause of congenital heart defects. We examined signaling pathways in CVB3-exposed hearts using RNA sequencing, Kyoto Encyclopedia of Genes and Genomes enrichment analysis, and immunohistochemistry. Signaling proteins of the Hippo, tight junction, transforming growth factor-β1, and extracellular matrix proteins were the most highly enriched in CVB3-infected fetuses with ventricular septal defects. Moreover, cardiomyocyte proliferation was 50% lower in fetuses with ventricular septal defects compared with uninfected controls. Conclusions We conclude prenatal CVB3 infection induces congenital heart defects. Alterations in myocardial proliferate capacity and consequent changes in cardiac architecture and trabeculation appear to account for most of observed phenotypes.
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Affiliation(s)
- Vipul Sharma
- Division of Pediatric Cardiothoracic SurgeryDepartment of SurgeryWashington University School of MedicineSt. LouisMO
| | - Lisa S. Goessling
- Division of Pediatric Cardiothoracic SurgeryDepartment of SurgeryWashington University School of MedicineSt. LouisMO
| | - Anoop K. Brar
- Division of Pediatric Cardiothoracic SurgeryDepartment of SurgeryWashington University School of MedicineSt. LouisMO
| | - Chetanchandra S. Joshi
- Department of Obstetrics and GynecologyWashington University School of MedicineSt. LouisMO
- Department of Pathology and ImmunologyWashington University School of MedicineSt. LouisMO
| | - Indira U. Mysorekar
- Department of Obstetrics and GynecologyWashington University School of MedicineSt. LouisMO
- Department of Pathology and ImmunologyWashington University School of MedicineSt. LouisMO
| | - Pirooz Eghtesady
- Division of Pediatric Cardiothoracic SurgeryDepartment of SurgeryWashington University School of MedicineSt. LouisMO
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24
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Baker DW, Dennis MR, Zannino D, Schilling C, Moreno PD, Bullock A, Disney P, Radford DJ, Hornung T, Grigg L, d'Udekem Y, Ayer J, Celermajer DS, Cordina R. Path ahead for 'low risk' adolescents living with a Fontan circulation. Heart 2020; 107:heartjnl-2020-317619. [PMID: 33229361 DOI: 10.1136/heartjnl-2020-317619] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 10/07/2020] [Accepted: 10/14/2020] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE A high risk of morbidity and mortality is well documented in adults with a Fontan circulation. The difference in outcomes between those with and without significant morbidity at the time of transition to adult care has not been well characterised. METHODS We analysed clinical outcomes in patients enrolled in the Australian and New Zealand Fontan Registry ≥16 years of age. Low risk (LR) Fontan patients were defined as those without history of sustained arrhythmia, thromboembolic event, transplantation, Fontan conversion, protein-losing enteropathy, plastic bronchitis, New York Heart Association class III/IV and/or moderate/severe atrioventricular valve regurgitation or ventricular dysfunction. Increased risk (IR) patients had one or more risk factor. RESULTS Inclusion criteria were met in 822 patients; mean age 26±8 years, median follow-up from age 16 was 9 years, 203 had atriopulmonary connection (APC) and 619 had total cavopulmonary connection (TCPC). Survival at 30 years was higher in the LR versus IR; 94% versus 82% (p=0.005), 89% versus 77% (p=0.07) for APC and 96% versus 89% (p=0.05) for TCPC. LR patients experienced less Fontan failure (HR 0.34, 95% CI 0.23 to 0.49, p<0.001) and ventricular dysfunction (HR 0.46, 95% CI 0.29 to 0.71, p=0.001) compared with IR patients. For LR TCPC patients, modelled survival projections at 60 years were 49%-67%. CONCLUSIONS Clinical outcomes for adolescents LR at transition to adult care are markedly superior to those who have established risk factors for Fontan failure, which is an important consideration when formulating individualised long-term risk estimates and counselling patients.
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Affiliation(s)
- David W Baker
- Department of Cardiology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Mark R Dennis
- Department of Cardiology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
- The University of Sydney Sydney Medical School, Sydney, New South Wales, Australia
| | - Diana Zannino
- Murdoch Childrens Research Institute, Melbourne, Victoria, Australia
| | - Chris Schilling
- Department of Surgery, St Vincent's Hospital Melbourne Pty Ltd, Melbourne, Victoria, Australia
| | - Patricia D Moreno
- Murdoch Childrens Research Institute, Melbourne, Victoria, Australia
| | - Andrew Bullock
- Department of Cardiology, Perth Children's Hospital, Perth, Western Australia, Australia
| | - Patrick Disney
- Department of Cardiology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Dorothy J Radford
- Adult Congenital Heart Unit, The Prince Charles Hospital, Brisbane, Brisbane, Queensland, Australia
| | - Tim Hornung
- Green Lane Paediatric and Congenital Cardiac Service, Starship Hospital, Auckland, New Zealand
| | - Leeanne Grigg
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Yves d'Udekem
- Murdoch Childrens Research Institute, Melbourne, Victoria, Australia
- Department of Cardiac Surgery and Department of Cardiology, Royal Childrens Hospital Melbourne, Melbourne, Victoria, Australia
| | - Julian Ayer
- The University of Sydney Sydney Medical School, Sydney, New South Wales, Australia
- Department of Cardiology, Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - David S Celermajer
- Department of Cardiology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
- The University of Sydney Sydney Medical School, Sydney, New South Wales, Australia
| | - Rachael Cordina
- Department of Cardiology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
- The University of Sydney Sydney Medical School, Sydney, New South Wales, Australia
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25
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Sim HT, Kim JW, Kim SH, Park SJ, Jang SI, Lee CH. Correlation Between Total Repair Timing and Late Aortic Root Dilatation in Repaired Tetralogy of Fallot. Pediatr Cardiol 2020; 41:1501-1508. [PMID: 32642799 DOI: 10.1007/s00246-020-02394-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 06/11/2020] [Indexed: 11/30/2022]
Abstract
Aortic root dilatation is frequently encountered in adults with repaired Tetralogy of Fallot (TOF). The timing of total repair is known to have a significant correlation with late aortic root dilatation, but it is not well established. The objective of this study was to investigate the risk factors and correlation with timing of total repair for aortic root dilatation in adults with repaired TOF. An observational retrospective cohort study was conducted in 314 adults (≥ 18 years) with repaired TOF. Aortic root dilatation was defined when the absolute diameter of Sinus of Valsalva (SoV) was over 40 mm. SoV was measured by echocardiography in 110 patients, computed tomography angiography in 168 patients, and magnetic resonance image in 36 patients. Aortic root dilatation was observed in 65 patients (20.7%). Among them, 3 patients underwent Bentall operation due to acute aortic dissection or aortic root aneurysm. On multivariate logistic regression analysis, age at total repair was a significant risk factor for late aortic root dilatation (OR = 3.14; 95% CI 1.62-6.08; p = 0.001) and the cutoff value of age was 1.9 years. However, late aortic root dilatation was also observed in 10% of patients (10/91) who operated before 1 year of age. Late total repair was a significant risk factor for late aortic root dilatation in repaired TOF. However, early total repair did not always prevent late aortic root dilatation. These results suggest that congenital aortic pathology may also be a possible cause of aortic root dilatation along with longstanding hemodynamic stress.
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Affiliation(s)
- Hyung Tae Sim
- Department of Thoracic and Cardiovascular Surgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Republic of Korea
| | - Jeong-Won Kim
- Department of Thoracic and Cardiovascular Surgery, Sejong General Hospital, Sejong Heart Institute, 28, Hohyeon-ro 489 Beon-gil, Sosa-gu, Bucheon, Gyeonggi-do, 422-711, Republic of Korea
| | - Seong Ho Kim
- Department of Pediatric Cardiology, Sejong General Hospital, Bucheon, Republic of Korea
| | - Su-Jin Park
- Department of Pediatric Cardiology, Sejong General Hospital, Bucheon, Republic of Korea
| | - So-Ick Jang
- Department of Pediatric Cardiology, Sejong General Hospital, Bucheon, Republic of Korea
| | - Chang-Ha Lee
- Department of Thoracic and Cardiovascular Surgery, Sejong General Hospital, Sejong Heart Institute, 28, Hohyeon-ro 489 Beon-gil, Sosa-gu, Bucheon, Gyeonggi-do, 422-711, Republic of Korea.
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26
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Lifetime Burden of Adult Congenital Heart Disease in the USA Using a Microsimulation Model. Pediatr Cardiol 2020; 41:1515-1525. [PMID: 32651615 DOI: 10.1007/s00246-020-02409-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 07/03/2020] [Indexed: 12/16/2022]
Abstract
Congenital heart defects (CHD) represent a growing burden of illness among adults. We estimated the lifetime health, education, labor, and social outcomes of adults with CHD in the USA using the Future Adult Model, a dynamic microsimulation model that has been used to study the lifetime impacts of a variety of chronic diseases. We simulated a cohort of adult heads of households > 25 years old derived from the Panel Survey of Income Dynamics who reported a childhood heart problem as a proxy for CHD and calculated life expectancy, disability-free and quality-adjusted life years, lifetime earnings, education attainment, employment, development of chronic disease, medical spending, and disability insurance claiming status. Total burden of disease was estimated by comparing to a healthy cohort with no childhood heart problem. Eighty-seven individuals reporting a childhood heart problem were identified from the PSID and were used to generate the synthetic cohort simulated in the model. Life expectancy, disability-free, quality-adjusted, and discounted quality-adjusted life years were an average 4.6, 6.7, 5.3, and 1.4 years lower than in healthy adults. Lung disease, cancer, and severe mental distress were more common compared to healthy individuals. The CHD cohort earned $237,800 less in lifetime earnings and incurred higher average total medical spend by $66,600 compared to healthy individuals. Compared to healthy adults, the total burden of CHD is over $500K per adult. Despite being among the healthiest adults with CHD, there are significant decrements in life expectancy, employment, and lifetime earnings, with concomitant increases in medical spend.
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27
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Hagdorn QAJ, Beurskens NEG, Gorter TM, Eshuis G, Hillege HL, Lui GK, Ceresnak SR, Chan FP, van Melle JP, Berger RMF, Willems TP. Sex differences in patients with repaired tetralogy of Fallot support a tailored approach for males and females: a cardiac magnetic resonance study. Int J Cardiovasc Imaging 2020; 36:1997-2005. [PMID: 32472300 PMCID: PMC7497497 DOI: 10.1007/s10554-020-01900-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 05/25/2020] [Indexed: 12/27/2022]
Abstract
Purpose Substantial differences between sexes exist with respect to cardiovascular diseases, including congenital heart disease. Nevertheless, clinical decisions in the long-term follow-up of patients with repaired tetralogy of Fallot (rTOF) are currently based on unisex thresholds for cardiac magnetic resonance (CMR) measurements. This study aimed to assess whether sex differences exist in cardiac adaptation to hemodynamic loading conditions in patients with rTOF. Methods and Results This cross-sectional, two-center, combined pediatric and adult cohort included 320 rTOF patients (163 males, 51%) who underwent routine CMR. Despite similar age (median and interquartile range [m + IQR] 23.4 [15.2-34.4] years), surgical history, and hemodynamic loading, males with rTOF demonstrated higher biventricular CMR-derived volumes and masses, indexed for body surface area, compared to females (e.g. m + IQR right ventricular (RV) end-diastolic volume: males 123 [100-151] mL/m2, females 114 [94-131] mL/m2, P = 0.007). Sex-specific Z-scores of biventricular volumes and masses were similar for males and females. RV volumes and masses correlated with hemodynamic loading, but these relations did not differ between sexes. Biventricular ejection fraction (EF) appeared to be lower in male patients, compared to female patients (e.g. m + IQR RVEF: males 48 [43-54]%, females 52 [46-57]%, P < 0.001). Conclusion Indexed ventricular volumes and masses are higher in males with rTOF, compared to females, similar to the healthy population. RV hypertrophy and dilatation correlated to loading conditions similarly for both sexes. However, under comparable loading conditions, males demonstrated more severe functional impairment. These results indicate that sex-differences should no longer be ignored in treatment strategies, including timing of pulmonary valve replacement.
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Affiliation(s)
- Quint A J Hagdorn
- Center for Congenital Heart Diseases, Department of Pediatric Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
| | - Niek E G Beurskens
- Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam UMC, University of Amsterdam, Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Thomas M Gorter
- Center for Congenital Heart Diseases, Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Graziëlla Eshuis
- Center for Congenital Heart Diseases, Department of Pediatric Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Hans L Hillege
- Center for Congenital Heart Diseases, Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - George K Lui
- Departments of Medicine and Pediatrics, Divisions of Cardiovascular Medicine and Pediatric Cardiology, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Scott R Ceresnak
- Division of Pediatric Cardiology, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Frandics P Chan
- Department of Radiology, Stanford University Medical Center, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Joost P van Melle
- Center for Congenital Heart Diseases, Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Rolf M F Berger
- Center for Congenital Heart Diseases, Department of Pediatric Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Tineke P Willems
- Department of Radiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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28
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Lopez KN, Morris SA, Sexson Tejtel SK, Espaillat A, Salemi JL. US Mortality Attributable to Congenital Heart Disease Across the Lifespan From 1999 Through 2017 Exposes Persistent Racial/Ethnic Disparities. Circulation 2020; 142:1132-1147. [PMID: 32795094 DOI: 10.1161/circulationaha.120.046822] [Citation(s) in RCA: 104] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Congenital heart disease (CHD) accounts for ≈40% of deaths in US children with birth defects. Previous US data from 1999 to 2006 demonstrated an overall decrease in CHD mortality. Our study aimed to assess current trends in US mortality related to CHD from infancy to adulthood over the past 19 years and determine differences by sex and race/ethnicity. METHODS We conducted an analysis of death certificates from 1999 to 2017 to calculate annual CHD mortality by age at death, race/ethnicity, and sex. Population estimates used as denominators in mortality rate calculations for infants were based on National Center for Health Statistics live birth data. Mortality rates in individuals ≥1 year of age used US Census Bureau bridged-race population estimates as denominators. We used joinpoint regression to characterize temporal trends in all-cause mortality, mortality resulting directly attributable to and related to CHD by age, race/ethnicity, and sex. RESULTS There were 47.7 million deaths with 1 in 814 deaths attributable to CHD (n=58 599). Although all-cause mortality decreased 16.4% across all ages, mortality resulting from CHD declined 39.4% overall. The mean annual decrease in CHD mortality was 2.6%, with the largest decrease for those >65 years of age. The age-adjusted mortality rate decreased from 1.37 to 0.83 per 100 000. Males had higher mortality attributable to CHD than females throughout the study, although both sexes declined at a similar rate (≈40% overall), with a 3% to 4% annual decrease between 1999 and 2009, followed by a slower annual decrease of 1.4% through 2017. Mortality resulting from CHD significantly declined among all races/ethnicities studied, although disparities in mortality persisted for non-Hispanic Blacks versus non-Hispanic Whites (mean annual decrease 2.3% versus 2.6%, respectively; age-adjusted mortality rate 1.67 to 1.05 versus 1.35 to 0.80 per 100 000, respectively). CONCLUSIONS Although overall US mortality attributable to CHD has decreased over the past 19 years, disparities in mortality persist for males in comparison with females and for non-Hispanic Blacks in comparison with non-Hispanic Whites. Determining factors that contribute to these disparities such as access to quality care, timely diagnosis, and maintenance of insurance will be important moving into the next decade.
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Affiliation(s)
- Keila N Lopez
- Division of Pediatric Cardiology, Department of Pediatrics, Texas Children's Hospital and Baylor College of Medicine, Houston (K.N.L., S.A.M., S.K.S.T.)
| | - Shaine A Morris
- Division of Pediatric Cardiology, Department of Pediatrics, Texas Children's Hospital and Baylor College of Medicine, Houston (K.N.L., S.A.M., S.K.S.T.)
| | - S Kristen Sexson Tejtel
- Division of Pediatric Cardiology, Department of Pediatrics, Texas Children's Hospital and Baylor College of Medicine, Houston (K.N.L., S.A.M., S.K.S.T.)
| | - Andre Espaillat
- Department of Pediatrics, Texas Children's Hospital, Houston (A.E.)
| | - Jason L Salemi
- College of Public Health (J.L.S.), University of South Florida, Tampa.,Department of Obstetrics and Gynecology, Morsani College of Medicine (J.L.S.), University of South Florida, Tampa
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29
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Kaemmerer H, Gorenflo M, Huscher D, Pittrow D, Apitz C, Baumgartner H, Berger F, Bruch L, Brunnemer E, Budts W, Claussen M, Coghlan G, Dähnert I, D’Alto M, Delcroix M, Distler O, Dittrich S, Dumitrescu D, Ewert R, Faehling M, Germund I, Ghofrani HA, Grohé C, Grossekreymborg K, Halank M, Hansmann G, Harzheim D, Nemes A, Havasi K, Held M, M. Hoeper M, Hofbeck M, Hohenfrost-Schmidt W, Jurevičienė E, Gumbienè L, Kabitz HJ, Klose H, Köhler T, Konstantinides S, Köestenberger M, Kozlik-Feldmann R, Kramer HH, Kropf-Sanchen C, Lammers A, Lange T, Meyn P, Miera O, Milger-Kneidinger K, Neidenbach R, Neurohr C, Opitz C, Perings C, Remppis BA, Riemekasten G, Scelsi L, Scholtz W, Simkova I, Skowasch D, Skride A, Stähler G, Stiller B, Tsangaris I, Vizza CD, Vonk Noordegraaf A, Wilkens H, Wirtz H, Diller GP, Grünig E, Rosenkranz S. Pulmonary Hypertension in Adults with Congenital Heart Disease: Real-World Data from the International COMPERA-CHD Registry. J Clin Med 2020; 9:jcm9051456. [PMID: 32414075 PMCID: PMC7290703 DOI: 10.3390/jcm9051456] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 05/05/2020] [Accepted: 05/08/2020] [Indexed: 12/19/2022] Open
Abstract
INTRODUCTION Pulmonary hypertension (PH) is a common complication in patients with congenital heart disease (CHD), aggravating the natural, post-operative, or post-interventional course of the underlying anomaly. The various CHDs differ substantially in characteristics, functionality, and clinical outcomes among each other and compared with other diseases with pulmonary hypertension. OBJECTIVE To describe current management strategies and outcomes for adults with PH in relation to different types of CHD based on real-world data. METHODS AND RESULTS COMPERA (Comparative, Prospective Registry of Newly Initiated Therapies for Pulmonary Hypertension) is a prospective, international PH registry comprising, at the time of data analysis, >8200 patients with various forms of PH. Here, we analyzed a subgroup of 680 patients with PH due to CHD, who were included between 2007 and 2018 in 49 specialized centers for PH and/or CHD located in 11 European countries. At enrollment, the patients´ median age was 44 years (67% female), and patients had either pre-tricuspid shunts, post-tricuspid shunts, complex CHD, congenital left heart or aortic disease, or miscellaneous other types of CHD. Upon inclusion, targeted therapies for pulmonary arterial hypertension (PAH) included endothelin receptor antagonists, PDE-5 inhibitors, prostacyclin analogues, and soluble guanylate cyclase stimulators. Eighty patients with Eisenmenger syndrome were treatment-naïve. While at inclusion the primary PAH treatment for the cohort was monotherapy (70% of patients), with 30% of the patients on combination therapy, after a median observation time of 45.3 months, the number of patients on combination therapy had increased significantly, to 50%. The use of oral anticoagulants or antiplatelets was dependent on the underlying diagnosis or comorbidities. In the entire COMPERA-CHD cohort, after follow-up and receiving targeted PAH therapy (n = 511), 91 patients died over the course of a 5-year follow up. The 5-year Kaplan-Meier survival estimate for CHD associated PH was significantly better than that for idiopathic PAH (76% vs. 54%; p < 0.001). Within the CHD associated PH group, survival estimates differed particularly depending on the underlying diagnosis and treatment status. CONCLUSIONS In COMPERA-CHD, the overall survival of patients with CHD associated PH was dependent on the underlying diagnosis and treatment status, but was significantly better as than that for idiopathic PAH. Nevertheless, overall survival of patients with PAH due to CHD was still markedly reduced compared with survival of patients with other types of CHD, despite an increasing number of patients on PAH-targeted combination therapy.
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Affiliation(s)
- Harald Kaemmerer
- Deutsches Herzzentrum München, Klinik für Angeborene Herzfehler und Kinderkardiologie, München, Technische Universität München, 80636 Munich, Germany;
- Correspondence: (H.K.); (M.G.); Tel.: +49-89-1218-3011(H.K.); Fax: +49-89-1218-3013 (H.K.)
| | - Matthias Gorenflo
- Universitätsklinikum Heidelberg, Zentrum für Kinder- und Jugendmedizin, Angelika-Lautenschläger-Klinik, 69120 Heidelberg, Germany
- Correspondence: (H.K.); (M.G.); Tel.: +49-89-1218-3011(H.K.); Fax: +49-89-1218-3013 (H.K.)
| | - Dörte Huscher
- Institute of Biometry and Clinical Epidemiology, and Berlin Institute of Health, Charité Universitätsmedizin, 10117 Berlin, Germany;
| | - David Pittrow
- Medical Faculty, Institute for Clinical Pharmacology, Technical University, 01307 Dresden, Germany;
- GWT-TUD GmbH, Pharmacoepidemiology, 01307 Dresden, Germany
| | - Christian Apitz
- Universitätsklinik für Kinder- und Jugendmedizin, Sektion Pädiatrische Kardiologie, 89075 Ulm, Germany;
| | - Helmut Baumgartner
- Universitätsklinik Münster, Klinik für Angeborene (EMAH) und Erworbene Herzfehler, 48149 Münster, Germany; (H.B.); (G.-P.D.)
| | - Felix Berger
- Deutsches Herzzentrum Berlin, Klinik für Angeborene Herzfehler/Kinderkardiologie, 13353 Berlin, Germany; (F.B.); (O.M.)
| | - Leonhard Bruch
- Unfallkrankenhaus Berlin, Klinik für Innere Medizin, 12683 Berlin, Germany;
| | - Eva Brunnemer
- Medizinische Universitätsklinik (Krehl-Klinik), Klinik für Kardiologie, Angiologie und Pneumologie (Innere Medizin III), 69120 Heidelberg, Germany;
| | - Werner Budts
- UZ Leuven, Congenital and Structural Cardiology, Campus Gasthuisberg, 3000 Leuven, Belgium;
| | - Martin Claussen
- LungenClinic Grosshansdorf, Fachabteilung Pneumologie, 22927 Großhansdorf, Germany;
| | - Gerry Coghlan
- Royal Free Hospital, Cardiology, London NW3 2QG, UK;
| | - Ingo Dähnert
- Herzzentrum Leipzig GmbH, Klinik für Kinderkardiologie, 04289 Leipzig, Germany;
| | | | - Marion Delcroix
- Department of Respiratory Diseases, University Hospitals of Leuven, 3000 Leuven, Belgium;
| | - Oliver Distler
- Universitätsspital Zürich, Klinik für Rheumatologie, 8091 Zürich, Switzerland;
| | - Sven Dittrich
- Universitätsklinikum Erlangen, Kinderkardiologie, 91054 Erlangen, Germany;
| | - Daniel Dumitrescu
- HDZ NRW, Klinik für Thorax- und Kardiovaskularchirurgie, 32545 Bad Oeynhausen, Germany;
| | - Ralf Ewert
- Universitätsmedizin Greifswald, Zentrum für Innere Medizin, Klinik und Poliklinik für Innere Medizin B, 17475 Greifswald, Germany;
| | - Martin Faehling
- Klinikum Esslingen GmbH, Klinik für Kardiologie, Angiologie und Pneumologie, 73730 Esslingen a.N., Germany;
| | - Ingo Germund
- Uniklinik Köln—Herzzentrum, Klinik und Poliklinik für Kinderkardiologie, 50937 Köln, Germany;
| | | | - Christian Grohé
- Evangelische Lungenklinik Berlin, Klinik für Pneumologie, 13125 Berlin, Germany;
| | - Karsten Grossekreymborg
- Kinderherzzentrum und Zentrum für Angeborene Herzfehler, Justus-Liebig Universität, Zentrum für Kinderheilkunde, Abteilung Kinderkardiologie, 35390 Giessen, Germany;
| | - Michael Halank
- Universitätsklinikum Carl Gustav Carus der Technischen Universität Dresden, Medizinische Klinik und Poliklinik I, 01307 Dresden, Germany;
| | - Georg Hansmann
- Medizinische Hochschule Hannover, Zentrum für Pulmonale Hypertonie im Kindesalter/Klinik für pädiatrische Kardiologie und Intensivmedizin, 30625 Hannover, Germany;
| | - Dominik Harzheim
- Waldburg Zeil Kliniken Gmbh & Co. KG, Fachkliniken Wangen, Lungenzentrum Süd-West, Klinik für Pneumologie, Beatmungsmedizin und Allergologie, 88239 Wangen im Allgäu, Germany; (D.H.); (P.M.)
| | - Attila Nemes
- 2nd Dep. of Internal Medicine and Cardiology Center Hungary, Faculty of Medicine, Szent-Györgyi Albert Clinical Center, University of Szeged, 6725 Szeged, Hungary; (A.N.); (K.H.)
| | - Kalman Havasi
- 2nd Dep. of Internal Medicine and Cardiology Center Hungary, Faculty of Medicine, Szent-Györgyi Albert Clinical Center, University of Szeged, 6725 Szeged, Hungary; (A.N.); (K.H.)
| | - Matthias Held
- Missionsärztliche Klinik gGmbH, Abteilung für Innere Medizin, 97074 Würzburg, Germany;
| | - Marius M. Hoeper
- Medizinische Hochschule Hannover, Abt. Pneumologie, 30625 Hannover, Germany;
| | - Michael Hofbeck
- Universitätsklinik für Kinder- und Jugendmedizin Tübingen, Kinderkardiologie, Pulmologie, Intensivmedizin, 72076 Tübingen, Germany;
| | | | - Elena Jurevičienė
- Faculty of Medicine of Vilnius University; Referal Centre of Pulmonary Hypertension, Vilnius University Hospital Santaros klinikos, 08661 Vilnius, Lithuania; (E.J.); (L.G.)
| | - Lina Gumbienè
- Faculty of Medicine of Vilnius University; Referal Centre of Pulmonary Hypertension, Vilnius University Hospital Santaros klinikos, 08661 Vilnius, Lithuania; (E.J.); (L.G.)
| | - Hans-Joachim Kabitz
- Gemeinnützige Krankenhausbetriebsgesellschaft Konstanz mbH, Medizinische Klinik II, 78464 Konstanz, Germany;
| | - Hans Klose
- Universitätsklinikum Hamburg Eppendorf, Studienzentrale Pneumologie, 20251 Hamburg, Germany;
| | - Thomas Köhler
- Universitätsklinikum Freiburg, Medizinische Klinik, Abteilung Pneumologie, 79106 Freiburg, Germany;
| | | | - Martin Köestenberger
- LKH - Univ. Klinikum Graz, Universitätsklinik für Kinder- und Jugendheilkunde, Abteilung für Pädiatrische Kardiologie, 8036 Graz, Austria;
| | - Rainer Kozlik-Feldmann
- Universitäres Herzzentrum Hamburg, Klinik und Poliklinik für Kinderkardiologie, 20251 Hamburg, Germany;
| | - Hans-Heiner Kramer
- Universitätsklinikum Schleswig-Holstein, Klinik für angeborene Herzfehler & Kinderkardiologie (Haus 9), 24105 Kiel, Germany;
| | | | - Astrid Lammers
- Westfälische Wilhelms-Universität Münster, Klinik für Kinder- und Jugendmedizin - Pädiatrische Kardiologie, 48149 Münster, Germany;
| | - Tobias Lange
- Universitätsklinikum Regensburg, Medizinische Klinik und Poliklinik II, 93053 Regensburg, Germany;
| | - Philipp Meyn
- Waldburg Zeil Kliniken Gmbh & Co. KG, Fachkliniken Wangen, Lungenzentrum Süd-West, Klinik für Pneumologie, Beatmungsmedizin und Allergologie, 88239 Wangen im Allgäu, Germany; (D.H.); (P.M.)
| | - Oliver Miera
- Deutsches Herzzentrum Berlin, Klinik für Angeborene Herzfehler/Kinderkardiologie, 13353 Berlin, Germany; (F.B.); (O.M.)
| | | | - Rhoia Neidenbach
- Deutsches Herzzentrum München, Klinik für Angeborene Herzfehler und Kinderkardiologie, München, Technische Universität München, 80636 Munich, Germany;
| | - Claus Neurohr
- Klinik Schillerhöhe, Abteilung für Pneumologie und Beatmungsmedizin, 70839 Gerlingen, Germany;
| | - Christian Opitz
- DRK Kliniken Berlin Westend, Klinik für Innere Medizin, Schwerpunkt Kardiologie, 14050 Berlin, Germany;
| | | | | | - Gabriele Riemekasten
- Clinic of Rheumatology and Clinical Immunology, University of Lübeck, University Clinic Schleswig Holstein, 23562 Lübeck, Germany;
| | - Laura Scelsi
- Fondazione IRCCS Policlinico San Matteo University of Pavia, 27100 Pavia- PV Italy, Germany;
| | - Werner Scholtz
- Clinic for General and Interventional Cardiology/Angiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, 32545 Bad Oeynhausen, Germany;
| | - Iveta Simkova
- Dept. Cardiology and Angiology, Faculty of Medicine, Slovak Medical University and National Institute of Cardiovascular Diseases, 83348 Bratislava, Slovakia;
| | - Dirk Skowasch
- Universitätsklinikum Bonn, Medizinische Klinik und Poliklinik II, Innere Medizin-Kardiologie/Pneumologie, 53127 Bonn, Germany;
| | - Andris Skride
- Pauls Stradins Clinical University Hospital, 1002 Riga, Latvia;
| | - Gerd Stähler
- Klinik Löwenstein, Medizinische Klinik I, 74245 Löwenstein, Germany;
| | - Brigitte Stiller
- Universitäts-Herzzentrum Freiburg - Bad Krozingen, Klinik für Angeborene Herzfehler und Pädiatrische Kardiologie, 79189 Freiburg, Germany;
| | - Iraklis Tsangaris
- 2nd Critical Care Department, Attikon University Hospital, National and Kapodistrian University of Athens, 12462 Athens, Greece;
| | - Carmine Dario Vizza
- Pulmonary Hypertension Center, Dept. Clnical, Anestesiologic and Cardiovascular Sciences, University of Rome La Sapienza, 00185 Rome, Italy;
| | | | - Heinrike Wilkens
- Universitätsklinikum des Saarlandes, Innere Medizin V, 66421 Homburg, Germany;
| | - Hubert Wirtz
- Universitätsklinikum Leipzig, Medizinische Klinik und Poliklinik I, Abteilung für Pneumologie, 04103 Leipzig, Germany;
| | - Gerhard-Paul Diller
- Universitätsklinik Münster, Klinik für Angeborene (EMAH) und Erworbene Herzfehler, 48149 Münster, Germany; (H.B.); (G.-P.D.)
| | - Ekkehard Grünig
- Thoraxklinik Heidelberg gGmbH, Zentrum für Pulmonale Hypertonie, 69126 Heidelberg, Germany;
| | - Stephan Rosenkranz
- Universitätsklinik Köln- Herzzentrum, Klinik III für Innere Medizin, 50937 Köln, Germany;
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Cardiovascular complications in patients with total cavopulmonary connection: A nationwide cohort study. Int J Cardiol 2020; 305:120-126. [PMID: 32001036 DOI: 10.1016/j.ijcard.2019.12.062] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Revised: 12/16/2019] [Accepted: 12/29/2019] [Indexed: 11/24/2022]
Abstract
BACKGROUND Long-term outcomes are not well established at the population level after completion of the total cavopulmonary connection (TCPC) among patients with functional univentricular hearts. PURPOSE To evaluate the incidence of cardiovascular events after TCPC completion. METHODS From a validated population-based cohort, we identified 178 patients with TCPC circulation completed after January 1, 1995. We established a comparison cohort by frequency-matching patients 1:200 on sex, and month and year of birth to the general Danish population (n = 35,600 population controls). We started follow-up at date of TCPC completion for cases and, for controls, at the index date of their matched case. The risks of cardiovascular events were assessed using cumulative incidence rates and Poisson regression models adjusted for age, sex, and calendar year. RESULTS The median age at TCPC completion was 3.3 years (interquartile range 2.6 to 5.3 years). Over a median follow-up of 12.5 years, 10 (5.6%) TCPC patients died and 7 (4.5%) had a heart transplantation compared with a 0.2% mortality in the matched population. In TCPC patients, 15.7% had an arrhythmia (11.8% supraventricular tachycardia), 3.4% had a stroke (all ischemic), and 21.4% of TCPC patients initiated a combination of a diuretic and a renin-angiotensin system (RAS)-inhibitor. These rates were >50-fold higher than in the comparison cohort: 0.2% arrhythmia, 0.06% stroke, and 0.04% starting a diuretic and a RAS-inhibitor. CONCLUSIONS Patients with TCPC circulation face a high risk of cardiovascular events during intermediate term follow-up.
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Gales J, Krasuski RA, Awerbach JD. Emergency department evaluation of chest pain among adult congenital heart disease patients. Am Heart J 2020; 222:191-198. [PMID: 32105985 DOI: 10.1016/j.ahj.2020.02.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Accepted: 02/01/2020] [Indexed: 06/10/2023]
Abstract
BACKGROUND Data regarding emergency department (ED) assessment of acute chest pain (CP) and incidence of myocardial infarction (MI) among adult congenital heart disease (ACHD) patients, relative to the non-congenital population, is lacking. OBJECTIVES To describe MI risk in ACHD patients presenting to the ED with chest pain and to compare clinical characteristics, diagnostic testing patterns, and outcomes to controls. METHODS We retrospectively identified a cohort of ACHD patients presenting with acute CP and matched them with non-ACHD controls at a large tertiary-level ED during the period 1998-2018. RESULTS The congenital and control cohorts comprised 297 patients respectively. While MI was less common among ACHD patients (5.2%) than controls (19.7%), P = .01, arrhythmia (14% vs 6%, P < .001) and acute heart failure (3% vs 0.3%, P = .02) were more often the cause of symptoms. Despite more often presenting with non-anginal CP (81% vs 66%, P < .001) and having fewer CAD risk factors (P = .03), ACHD patients underwent more frequent stress testing (22% vs 14%, P < .001) and underwent invasive coronary angiography with equal frequency (7% vs 8%, P = .99). The trend of greater diagnostic scrutiny for acute coronary disease, in the absence of increased risk, strongly correlated with degree of congenital complexity. Both CP character and HEART Score reliably predicted MI for ACHD patients and controls (both P < .001). CONCLUSION MI is an uncommon cause of CP among ACHD patients presenting to the ED and occurs less frequently than seen in the general population. Established MI predictors, CP character and HEART Score, can reliably identify MI in ACHD patients.
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Affiliation(s)
- Jordan Gales
- Department of Internal Medicine, Duke University Hospital, Durham, NC
| | - Richard A Krasuski
- Division of Cardiovascular Medicine, Duke University Hospital, Durham, NC.
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Profile of Endothelin-1, Nitric Oxide, and Prostacyclin Levels in Pulmonary Arterial Hypertension Related to Uncorrected Atrial Septal Defect: Results from a Single Center Study in Indonesia. Cardiol Res Pract 2020; 2020:7526508. [PMID: 32377429 PMCID: PMC7199565 DOI: 10.1155/2020/7526508] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2019] [Revised: 10/14/2019] [Accepted: 11/06/2019] [Indexed: 11/30/2022] Open
Abstract
Methods The study design was cross-sectional. The subjects were adult uncorrected secundum ASD with PAH. Pulmonary artery pressure was measured with right heart catheterization. Pulmonary venous blood was obtained during catheterization for measuring endothelin-1, prostacyclin, and nitric oxide. Correlation tests were performed to determine any association between biomarkers and mean pulmonary artery pressure (mPAP). The levels of biomarkers were compared based on the severity of PAH. Statistical significance was determined at p < 0.05. Results Forty-four subjects were enrolled in this study. Endothelin-1 level and mPAP had significant moderate positive correlation (r = 0.423 and p value = 0.004). However, no significant correlation was observed between prostacyclin, nitric oxide levels, and mPAP. The pattern of endothelin-1, prostacyclin, and nitric oxide was distinctive. Levels of endothelin-1 were incrementally increased from mild, moderate, to severe PAH. The levels of prostacyclin and nitric oxide had similar pattern in association with the severity of PAH, which was increased in mild-to-moderate PAH but decreased in severe PAH. Conclusions There was a distinctive pattern of endothelin-1, prostacyclin, and nitric oxide based on severity of PAH in adult uncorrected ASD. Significant correlations existed between endothelin-1 and the severity of PAH and mPAP.
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Dennis M, Zannino D, du Plessis K, Bullock A, Disney PJS, Radford DJ, Hornung T, Grigg L, Cordina R, d'Udekem Y, Celermajer DS. Clinical Outcomes in Adolescents and Adults After the Fontan Procedure. J Am Coll Cardiol 2019; 71:1009-1017. [PMID: 29495980 DOI: 10.1016/j.jacc.2017.12.054] [Citation(s) in RCA: 127] [Impact Index Per Article: 25.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 11/27/2017] [Accepted: 12/19/2017] [Indexed: 12/23/2022]
Abstract
BACKGROUND Long-term outcomes of Fontan patients who survive to age ≥16 years have not been well characterized. The Australian and New Zealand Fontan Registry (ANZFR) provides a unique opportunity to understand survival and complication rates in Fontan patients who transition to adult congenital heart disease centers. OBJECTIVES This study sought to describe the survival and complications of adult patients who have had a Fontan procedure. METHODS The study analyzed outcomes in patients ≥16 years of age who were prospectively enrolled in the ANZFR. RESULTS Data from all 683 adult survivors from the ANZFR were analyzed. Mortality status was confirmed from the National Death Index. There were 201 atriopulmonary (AP) connections and 482 total cavopulmonary connections (249 lateral tunnels and 233 extracardiac conduits). For these subjects, the survival rate at age 30 years was 90% (95% CI: 87% to 93%), and it was 80% (95% CI: 75% to 87%) at 40 years of age. Survival at age 30 years was significantly worse for the patients with AP connections (p = 0.03). At latest follow-up, only 53% of patients were in New York Heart Association functional class I. After the age of 16 years, 136 (20%) had experienced at least 1 new arrhythmia, 42 (6%) required a permanent pacemaker, 45 (7%) had a thromboembolic event, and 135 (21%) required a surgical reintervention. Only 41% (95% CI: 33% to 51%) of Fontan patients were free of serious adverse events at 40 years of age. CONCLUSIONS This comprehensively followed cohort showed that a variety of morbid complications is common in Fontan adults, and that there is a substantial incidence of premature death, particularly in patients with AP connections.
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Affiliation(s)
- Mark Dennis
- Sydney Medical School, University of Sydney, Camperdown, Sydney, Australia; Department of Cardiology, Royal Prince Alfred Hospital, Missenden Road, Sydney, Australia
| | - Diana Zannino
- Murdoch Children's Research Institute, Melbourne, Australia
| | | | - Andrew Bullock
- Children's Cardiac Centre, Princess Margaret Hospital for Children, Perth, Australia
| | - Patrick J S Disney
- Department of Cardiovascular Services, Royal Adelaide Hospital, Adelaide, Australia
| | - Dorothy J Radford
- Adult Congenital Heart Unit, The Prince Charles Hospital, Brisbane, Australia
| | - Tim Hornung
- Green Lane Paediatric and Congenital Cardiac Service, Starship Children's Hospital Auckland, Auckland, New Zealand
| | - Leeanne Grigg
- Department of Cardiology, The Royal Melbourne Hospital, Melbourne, Australia
| | - Rachael Cordina
- Sydney Medical School, University of Sydney, Camperdown, Sydney, Australia; Department of Cardiology, Royal Prince Alfred Hospital, Missenden Road, Sydney, Australia
| | - Yves d'Udekem
- Murdoch Children's Research Institute, Melbourne, Australia; Departments of Cardiac Surgery and Cardiology, Royal Children's Hospital, Melbourne, Australia
| | - David S Celermajer
- Sydney Medical School, University of Sydney, Camperdown, Sydney, Australia; Department of Cardiology, Royal Prince Alfred Hospital, Missenden Road, Sydney, Australia.
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D'Alto M, Budts W, Diller GP, Mulder B, Egidy Assenza G, Oreto L, Ciliberti P, Bassareo PP, Gatzoulis MA, Dimopoulos K. Does gender affect the prognosis and risk of complications in patients with congenital heart disease in the modern era? Int J Cardiol 2019; 290:156-161. [PMID: 31085083 DOI: 10.1016/j.ijcard.2019.05.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 03/26/2019] [Accepted: 05/03/2019] [Indexed: 11/17/2022]
Abstract
Gender differences in the outcome of acquired cardiovascular disease are well known, but available literature on the influence of gender in congenital heart disease (CHD) is limited. Registries have provided valuable, albeit at times conflicting data. Higher mortality rates have been reported in older males with CHD, while sudden cardiac death is more prevalent in young males. However, mortality around surgery for CHD is higher in girls compared to boys, likely due to smaller body size. Women are at higher risk of developing pulmonary arterial hypertension, but at lower risk of adverse aortic outcomes, even though they are less likely to receive aortic surgery. Finally, women have a lower risk of presenting with infective endocarditis compared to men. The underlying reasons for gender differences in CHD can be attributed to genetic, hormonal, behavioural and other causes. The aim of the present paper is to provide an overview of available evidence on gender differences in CHD and their impact on outcome.
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Affiliation(s)
- Michele D'Alto
- Department of Cardiology, Second University of Naples - Monaldi Hospital, Naples, Italy.
| | - Werner Budts
- Division of Cardiovascular Diseases, University Hospitals Leuven - Department of Cardiovascular Sciences, Catholic University of Leuven, Leuven, Belgium
| | - Gerhard P Diller
- Department of Cardiology and Angiology, Adult Congenital and Valvular Heart Disease Center, University of Münster, Münster, Germany
| | - Barbara Mulder
- Department of Cardiology, Academic Medical Center, Amsterdam, the Netherlands
| | - Gabriele Egidy Assenza
- Pediatric Cardiology Unit, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Lilia Oreto
- Department of Paediatrics, University of Messina, Messina, Italy
| | - Paolo Ciliberti
- Pediatric Cardiology and Cardiac Surgery, Bambino Gesù Children's Hospital, Rome, Italy
| | - Pier Paolo Bassareo
- University College of Dublin, Mater Misericordiae University Teaching Hospital, Dublin, Ireland
| | - Michael A Gatzoulis
- Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, Royal Brompton Hospital, London, UK
| | - Konstantinos Dimopoulos
- Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, Royal Brompton Hospital, London, UK
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Real-world healthcare utilization in adult congenital heart disease: a systematic review of trends and ratios. Cardiol Young 2019; 29:553-563. [PMID: 31046858 DOI: 10.1017/s1047951119000441] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND As a result of medical advances, the adult congenital heart disease population is rapidly expanding. Nonetheless, most patients remain prone to increased morbidity and mortality. Therefore, long-term medical resource use is required. This systematic review aims to present the trends over the past decades of medical resource utilization in adult congenital heart disease as well as its current status, with a focus on hospitalizations, emergency department visits, outpatient cardiology visits, and visits to other healthcare professionals. METHODS MEDLINE (Pubmed), Embase, and Web of Science were searched for retrospective database research publications. The ISPOR checklist for retrospective database research was used for quality appraisal. Trends over time are explored. RESULTS Twenty-one articles met the inclusion criteria. All but one of the studies was conducted in Western Europe and North America. The absolute number of hospitalizations has been increasing over the last several decades. This increase is highest in patients with mild lesions, although these numbers are largely driven by hospitalizations of patients with an atrial septal defect or a patent foramen ovale. Meanwhile, outpatient cardiology visits are increasing at an even higher pace, and occur most often in geriatric patients and patients with severe lesions. Conversely, the number of hospitalizations per 100 patients is decreasing over time. Literature is scarce on other types of healthcare use. CONCLUSION A strong rise in healthcare utilization is noticed, despite the mitigating effect of improved efficiency levels. As the population continues to grow, innovative medical management strategies will be required to accommodate its increasing healthcare utilization.
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Kwag EM, Lee JS, Kim SH. The incidentally diagnosed adult congenital heart disease during routine medical health checkups in 27,897 Koreans at a single center over seven years. BMC Cardiovasc Disord 2018; 18:223. [PMID: 30518327 PMCID: PMC6280454 DOI: 10.1186/s12872-018-0968-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Accepted: 11/27/2018] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The rate of incidentally diagnosed congenital heart disease (CHD) in adulthood has not been reported. The aim of this study was to investigate the detection rate of CHD in adults by routine, general health checkups. METHODS Data was acquired from 222,401 patients older than 19 years who participated in general health checkups from January 2010 to December 2016. We excluded persons who did not undergo echocardiography during the general health checkups, who underwent echocardiography prior to the health checkups, and who were previously diagnosed with CHD. RESULTS Among the 27,897 patients, who were included in the final analysis, 293 cases were newly diagnosed as CHD, and the overall detection rate was 1.05%. The mean age of patients with CHD was 48.7 ± 21.5 years, and most of them were female (n = 187, 63.8%). More than two-thirds were between the third and fifth decade of life, and only six patients (2.04%) were older than 70 years. The most common type was bicuspid aortic valve (n = 155). Interestingly, Ebstein's anomaly that required surgical repair was detected in five persons. CONCLUSIONS During general health checkup, there were cases of severe CHD that required cardiac surgery upon diagnosis.
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Affiliation(s)
- Eun Min Kwag
- Department of Pediatrics, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, 158, Paryong-ro, Masanhoewon-gu, Changwon, Gyeongsangnam-do, 51353, Republic of Korea
| | - Ju Suk Lee
- Department of Pediatrics, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, 158, Paryong-ro, Masanhoewon-gu, Changwon, Gyeongsangnam-do, 51353, Republic of Korea
| | - Sung Hoon Kim
- Department of Pediatrics, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, 158, Paryong-ro, Masanhoewon-gu, Changwon, Gyeongsangnam-do, 51353, Republic of Korea.
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Abstract
Heart failure remains the most common cause of morbidity and mortality in adults with congenital heart disease (CHD). Although gender-specific outcomes are not robust, it seems that women with CHD may be more affected by late heart failure (HF) than men. A specialized and experienced adult CHD team is required to care for these women as they age, including assessment for reversible causes of HF and in the management of pregnancy, labor, and delivery.
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Phenotype, management and predictors of outcome in a large cohort of adult congenital heart disease patients with heart failure. Int J Cardiol 2018; 252:80-87. [DOI: 10.1016/j.ijcard.2017.10.086] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Revised: 10/13/2017] [Accepted: 10/23/2017] [Indexed: 11/18/2022]
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Yoo BW. Epidemiology of Congenital Heart Disease with Emphasis on Sex-Related Aspects. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2018; 1065:49-59. [DOI: 10.1007/978-3-319-77932-4_3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Gender-specific care for adults with congenital heart disease: A look in the future? Int J Cardiol 2017; 245:141-142. [DOI: 10.1016/j.ijcard.2017.07.072] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2017] [Accepted: 07/18/2017] [Indexed: 11/19/2022]
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Adult congenital heart disease in Greece: Preliminary data from the CHALLENGE registry. Int J Cardiol 2017; 245:109-113. [PMID: 28743482 DOI: 10.1016/j.ijcard.2017.07.024] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2017] [Revised: 07/01/2017] [Accepted: 07/10/2017] [Indexed: 11/20/2022]
Abstract
BACKGROUND The majority of patients with congenital heart disease (CHD), nowadays, survives into adulthood and is faced with long-term complications. We aimed to study the basic demographic and clinical characteristics of adult patients with congenital heart disease (ACHD) in Greece. METHODS A registry named CHALLENGE (Adult Congenital Heart Disease Registry. A registry from Hellenic Cardiology Society) was initiated in January 2012. Patients with structural CHD older than 16years old were enrolled by 16 specialized centers nationwide. RESULTS Out of a population of 2115 patients with ACHD, who have been registered, (mean age 38years (SD 16), 52% women), 47% were classified as suffering from mild, 37% from moderate and 15% from severe ACHD. Atrial septal defect (ASD) was the most prevalent diagnosis (33%). The vast majority of ACHD patients (92%) was asymptomatic or mildly symptomatic (NYHA class I/II). The most symptomatic patients were suffering from an ASD, most often the elderly or those under targeted therapy for pulmonary arterial hypertension. Elderly patients (>60years old) accounted for 12% of the ACHD population. Half of patients had undergone at least one open-heart surgery, while 39% were under cardiac medications (15% under antiarrhythmic drugs, 16% under anticoagulants, 16% under medications for heart failure and 4% under targeted therapy for pulmonary arterial hypertension). CONCLUSIONS ACHD patients are an emerging patient population and national prospective registries such as CHALLENGE are of unique importance in order to identify the ongoing needs of these patients and match them with the appropriate resource allocation.
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Schmidt S, Ramseier-Hadorn M, Thomet C, Wustmann K, Schwerzmann M. Gender-related differences in self-reported dental care in adults with congenital heart disease at increased risk of infective endocarditis. Open Heart 2017; 4:e000575. [PMID: 28674625 PMCID: PMC5471876 DOI: 10.1136/openhrt-2016-000575] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Revised: 01/13/2017] [Accepted: 01/31/2017] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE Adults with congenital heart disease (CHD) are at increased risk of infective endocarditis (IE). Women with CHD have a lower IE risk, potentially due to gender-related differences in dental care. We aimed to assess self-reported dental hygiene measures in adults with CHD, and to identify factors associated with good oral hygiene. METHODS AND RESULTS Descriptive study includes 187 adults with CHD at increased risk of IE. The patients' IE knowledge was assessed using an adapted version of the Leuven Knowledge Questionnaire for CHD. Their mean age was 34.9±14.9 years, 73 of them (39%) were women, 91 (49%) were at high risk for IE, including 66 (35%) with a prosthetic valve, 14 (7%) with a history of IE and 11 (6%) with cyanotic CHD or residual shunts/valvular regurgitation in the proximity of prosthetic material. The self-defined IE knowledge score did not differ between men and women (21.6±10.0 vs 23.4±10.0; p=0.225). 126 patients (67%) reported to have a good oral hygiene. Female gender (OR 2.4, 95% CI 1.1 to 4.4), and a higher IE knowledge score (OR 1.2, 95% CI 1.1 to 1.5, per 5 points) were the variables independently associated with good oral hygiene. CONCLUSIONS In adults with CHD, patients with a higher IE knowledge score and women are more likely to practise dental care as recommended. Gender differences in oral hygiene practise may explain the observed lower female IE incidence rate. Efforts to improve patients' knowledge on IE are encouraged.
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Affiliation(s)
- Susann Schmidt
- Center for Congenital Heart Disease, University Hospital Inselspital, University of Bern, Bern, Switzerland
| | - Marlies Ramseier-Hadorn
- Center for Congenital Heart Disease, University Hospital Inselspital, University of Bern, Bern, Switzerland
| | - Corina Thomet
- Center for Congenital Heart Disease, University Hospital Inselspital, University of Bern, Bern, Switzerland
| | - Kerstin Wustmann
- Center for Congenital Heart Disease, University Hospital Inselspital, University of Bern, Bern, Switzerland
| | - Markus Schwerzmann
- Center for Congenital Heart Disease, University Hospital Inselspital, University of Bern, Bern, Switzerland
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Verheugt CL, Uiterwaal CS, Vaartjes I, van der Velde ET, Zomer AC, Meijboom FJ, Pieper PG, Post MC, Vliegen HW, Hazekamp MG, Grobbee DE, Mulder BJ. Chance of surgery in adult congenital heart disease. Eur J Prev Cardiol 2017; 24:1319-1327. [PMID: 28541122 DOI: 10.1177/2047487317710355] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Young patients with congenital heart disease reaching adulthood face mandatory transition to adult cardiology. Their new cardiologist needs to assess the chances of major future events such as surgery. Using a large national registry, we assessed if patient characteristics at the age of 18 years could predict the chance of congenital heart surgery in adulthood. Design and methods Of 10,300 patients from the CONCOR national registry, we used general patient characteristics at age 18 years, underlying congenital heart defect, history of complications, and interventions in childhood as potential predictors of congenital heart surgery occurring from age 18 years up to age 40 and 60 years. Cox regression was used to calculate hazard ratios with 95% confidence intervals. Analyses were performed separately for all congenital heart surgery and for valvular surgery alone. Results Altogether 2427 patients underwent congenital heart surgery after age 18 years, 1389 of whom underwent valvular surgery. Underlying heart defect, male sex, multiple defects, childhood endocarditis, supraventricular arrhythmia, aortic complications and paediatric cardiovascular surgery, independently predicted adult congenital heart surgery. The mean chance of congenital heart surgery was 22% up to age 40 and 43% up to age 60 years; individual chances spanned from 9-68% up to age 40 and from 19-93% up to age 60 years. Conclusion At the time of transition from paediatric to adult cardiology, an easily obtainable set of characteristics of patients with congenital heart disease can meaningfully inform cardiologists about the patient's individual chance of surgery in adulthood. Our findings warrant validation in other cohorts.
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Affiliation(s)
- Carianne L Verheugt
- 1 Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, the Netherlands.,2 Department of Cardiology, Academic Medical Center, the Netherlands.,3 Netherlands Heart Institute, the Netherlands
| | - Cuno Spm Uiterwaal
- 1 Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, the Netherlands
| | - Ilonca Vaartjes
- 1 Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, the Netherlands
| | | | - A C Zomer
- 2 Department of Cardiology, Academic Medical Center, the Netherlands.,3 Netherlands Heart Institute, the Netherlands
| | - Folkert J Meijboom
- 5 Department of Cardiology, University Medical Center Utrecht, the Netherlands
| | - Petronella G Pieper
- 6 Department of Cardiology, University Medical Center Groningen, the Netherlands
| | - Marco C Post
- 7 Department of Cardiology, St Antonius Hospital, the Netherlands
| | - Hubert W Vliegen
- 4 Department of Cardiology, Leiden University Medical Center, the Netherlands
| | - Mark G Hazekamp
- 8 Department of Cardiothoracic Surgery, Leiden University Medical Center, the Netherlands.,9 Department of Cardiothoracic Surgery, Academic Medical Center, the Netherlands
| | - Diederick E Grobbee
- 1 Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, the Netherlands
| | - Barbara Jm Mulder
- 2 Department of Cardiology, Academic Medical Center, the Netherlands.,3 Netherlands Heart Institute, the Netherlands
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Mbaye A, Bodian M, Ngaïdé AA, Abdourafiq H, Leye MCBO, Savodogo S, Aw F, Ndiaye M, Kouamé I, Babaka K, Dioum M, Gaye ND, Sarr SA, Ndiaye MB, Kane AD, Kane A. [Congenital heart disease in adolescents and adults: Management in a general cardiology department in Senegal]. Ann Cardiol Angeiol (Paris) 2017; 66:217-222. [PMID: 28506578 DOI: 10.1016/j.ancard.2017.02.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2016] [Accepted: 02/26/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND Congenital heart diseases in adults include malformations treated in childhood that decompensate secondarily and those asymptomatic at birth, appear later. This study aims to identify congenital heart diseases in adults in general cardiology department of Senegal and to assess clinical presentations, treatment and outcomes. METHODS We conducted a cross-sectional and descriptive study based on the records of patients aged at least 16 years and followed for congenital heart disease in the cardiology department of the General Hospital of Grand-Yoff in Dakar between May 2003 and March 2015. Diagnosis of heart disease was based on echocardiography. RESULTS We have registered 50 dossiers of patients equivalent to a prevalence of 0.75%, with a female predominance (64%). The average age of patients was 36.2±18.4 years (16-79 years), and mean age of diagnosis was 29.76±22.58 years. Dyspnea was the main sign (60%). Main malformations were the atrial septal defect (38%), pulmonary stenosis (14%), the ventricular septal defect (12%) and patent ductus arteriosus (10%). According to the classification of Bethesda, heart disease was simple complexity (42%), intermediate (58%) or severe (10%). The treatment was medical in 43 patients and 7 patients had surgical repair. Main complications were infective endocarditis (10%), atrial fibrillation (12%), heart failure (24%) and pulmonary arterial hypertension (50%). CONCLUSION Congenital heart diseases in adults seem underestimated in our countries. Surgical repair is rare. It is necessary to ensure a good management of the transition between pediatric and adult age.
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Affiliation(s)
- A Mbaye
- Service de cardiologie, hôpital général de Grand-Yoff, BP 3270, Dakar, Sénégal.
| | - M Bodian
- Service de cardiologie, centre hospitalo-universitaire Aristide-Le-Dantec, BP 6003, Dakar-Étoile, Sénégal
| | - A A Ngaïdé
- Service de cardiologie, hôpital général de Grand-Yoff, BP 3270, Dakar, Sénégal
| | - H Abdourafiq
- Service de cardiologie, hôpital général de Grand-Yoff, BP 3270, Dakar, Sénégal
| | - M C B O Leye
- Service de cardiologie, centre hospitalier national de Fann, BP 3053, Dakar-Fann, Sénégal
| | - S Savodogo
- Service de cardiologie, hôpital général de Grand-Yoff, BP 3270, Dakar, Sénégal
| | - F Aw
- Service de cardiologie, centre hospitalo-universitaire Aristide-Le-Dantec, BP 6003, Dakar-Étoile, Sénégal
| | - M Ndiaye
- Service de cardiologie, hôpital général de Grand-Yoff, BP 3270, Dakar, Sénégal
| | - I Kouamé
- Service de cardiologie, hôpital général de Grand-Yoff, BP 3270, Dakar, Sénégal
| | - K Babaka
- Service de cardiologie, hôpital général de Grand-Yoff, BP 3270, Dakar, Sénégal
| | - M Dioum
- Service de cardiologie, centre hospitalier national de Fann, BP 3053, Dakar-Fann, Sénégal
| | - N D Gaye
- Service de cardiologie, hôpital général de Grand-Yoff, BP 3270, Dakar, Sénégal
| | - S A Sarr
- Service de cardiologie, centre hospitalo-universitaire Aristide-Le-Dantec, BP 6003, Dakar-Étoile, Sénégal
| | - M B Ndiaye
- Service de cardiologie, centre hospitalo-universitaire Aristide-Le-Dantec, BP 6003, Dakar-Étoile, Sénégal
| | - A D Kane
- Service de cardiologie, centre hospitalo-universitaire Aristide-Le-Dantec, BP 6003, Dakar-Étoile, Sénégal
| | - A Kane
- Service de cardiologie, hôpital général de Grand-Yoff, BP 3270, Dakar, Sénégal
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46
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Affiliation(s)
- Anne Marie Valente
- From the Department of Cardiology, Boston Children’s Hospital, MA (A.M.V., T.G.); Department of Pediatrics, Harvard Medical School, Boston, MA (A.M.V., T.G.); and Department of Medicine, Division of Cardiology, Brigham and Women’s Hospital, Boston, MA (A.M.V.)
| | - Tal Geva
- From the Department of Cardiology, Boston Children’s Hospital, MA (A.M.V., T.G.); Department of Pediatrics, Harvard Medical School, Boston, MA (A.M.V., T.G.); and Department of Medicine, Division of Cardiology, Brigham and Women’s Hospital, Boston, MA (A.M.V.)
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47
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Bouma BJ, Mulder BJ. Changing Landscape of Congenital Heart Disease. Circ Res 2017; 120:908-922. [DOI: 10.1161/circresaha.116.309302] [Citation(s) in RCA: 129] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Revised: 01/13/2017] [Accepted: 01/13/2017] [Indexed: 01/23/2023]
Abstract
Congenital heart disease is the most frequently occurring congenital disorder affecting ≈0.8% of live births. Thanks to great efforts and technical improvements, including the development of cardiopulmonary bypass in the 1950s, large-scale repair in these patients became possible, with subsequent dramatic reduction in morbidity and mortality. The ongoing search for progress and the growing understanding of the cardiovascular system and its pathophysiology refined all aspects of care for these patients. As a consequence, survival further increased over the past decades, and a new group of patients, those who survived congenital heart disease into adulthood, emerged. However, a large range of complications raised at the horizon as arrhythmias, endocarditis, pulmonary hypertension, and heart failure, and the need for additional treatment became clear. Technical solutions were sought in perfection and creation of new surgical techniques by developing catheter-based interventions, with elimination of open heart surgery and new electronic devices enabling, for example, multisite pacing and implantation of internal cardiac defibrillators to prevent sudden death. Over time, many pharmaceutical studies were conducted, changing clinical treatment slowly toward evidence-based care, although results were often limited by low numbers and clinical heterogeneity. More attention has been given to secondary issues like sports participation, pregnancy, work, and social-related difficulties. The relevance of these issues was already recognized in the 1970s when the need for specialized centers with multidisciplinary teams was proclaimed. Finally, research has become incorporated in care. Results of intervention studies and registries increased the knowledge on epidemiology of adults with congenital heart disease and their complications during life, and at the end, several guidelines became easily accessible, guiding physicians to deliver care appropriately. Over the past decades, the landscape of adult congenital heart disease has changed dramatically, which has to be continued in the future.
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Affiliation(s)
- Berto J. Bouma
- From the Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands
| | - Barbara J.M. Mulder
- From the Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands
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48
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Zuin M, Rigatelli G. Systematic long-term follow-up programs in patients with simple congenital heart diseases: how long is long? J Thorac Dis 2017; 8:E1605-E1607. [PMID: 28149592 DOI: 10.21037/jtd.2016.11.109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Marco Zuin
- Department of Cardiology, Rovigo General Hospital, Rovigo, Italy; ; Section of Internal and Cardiopulmonary Medicine, Department of Medical Science, University of Ferrara, Ferrara, Italy
| | - Gianluca Rigatelli
- Department of Cardiovascular Diagnosis and Endoluminal Interventions, Rovigo General Hospital, Rovigo, Italy
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49
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Ilardi D, Ono KE, McCartney R, Book W, Stringer AY. Neurocognitive functioning in adults with congenital heart disease. CONGENIT HEART DIS 2016; 12:166-173. [DOI: 10.1111/chd.12434] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Revised: 08/12/2016] [Accepted: 09/16/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Dawn Ilardi
- Department of Neuropsychology, Children's Healthcare of Atlanta; Atlanta Georgia USA
- Department of Rehabilitation Medicine, Emory University; Atlanta Georgia USA
| | - Kim E. Ono
- Department of Neuropsychology, Children's Healthcare of Atlanta; Atlanta Georgia USA
- Department of Rehabilitation Medicine, Emory University; Atlanta Georgia USA
| | - Rebecca McCartney
- Behavioral Health, Southeast Permanente Medical Group; Tucker Georgia USA
| | - Wendy Book
- Department of Internal Medicine, Division of Cardiology, Emory University; Atlanta Georgia USA
| | - Anthony Y. Stringer
- Department of Rehabilitation Medicine, Emory University; Atlanta Georgia USA
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50
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Sturla F, Vismara R, Jaworek M, Votta E, Romitelli P, Pappalardo OA, Lucherini F, Antona C, Fiore GB, Redaelli A. In vitro and in silico approaches to quantify the effects of the Mitraclip ® system on mitral valve function. J Biomech 2016; 50:83-92. [PMID: 27863743 DOI: 10.1016/j.jbiomech.2016.11.013] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Accepted: 11/02/2016] [Indexed: 12/01/2022]
Abstract
Mitraclip® implantation is widely used as a valid alternative to conventional open-chest surgery in high-risk patients with severe mitral valve (MV) regurgitation. Although effective in reducing mitral regurgitation (MR) in the majority of cases, the clip implantation produces a double-orifice area that can result in altered MV biomechanics, particularly in term of hemodynamics and mechanical stress distribution on the leaflets. In this scenario, we combined the consistency of in vitro experimental platforms with the versatility of numerical simulations to investigate clip impact on MV functioning. The fluid dynamic determinants of the procedure were experimentally investigated under different working conditions (from 40bpm to 100bpm of simulated heart rate) on six swine hearts; subsequently, fluid dynamic data served as realistic boundary conditions in a computational framework able to quantitatively assess the post-procedural MV biomechanics. The finite element model of a human mitral valve featuring an isolated posterior leaflet prolapse was reconstructed from cardiac magnetic resonance. A complete as well as a marginal, sub-optimal grasping of the leaflets were finally simulated. The clipping procedure resulted in a properly coapting valve from the geometrical perspective in all the simulated configurations. Symmetrical complete grasping resulted in symmetrical distribution of the mechanical stress, while uncomplete asymmetrical grasping resulted in higher stress distribution, particularly on the prolapsing leaflet. This work pinpointed that the mechanical stress distribution following the clipping procedure is dependent on the cardiac hemodynamics and has a correlation with the proper execution of the grasping procedure, requiring accurate evaluation prior to clip delivery.
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Affiliation(s)
- Francesco Sturla
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milano, Italy.
| | - Riccardo Vismara
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milano, Italy
| | - Michal Jaworek
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milano, Italy
| | - Emiliano Votta
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milano, Italy
| | | | - Omar A Pappalardo
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milano, Italy; Division of cardiovascular Surgery, Università degli Studi di Verona, Verona, Italy
| | - Federico Lucherini
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milano, Italy
| | - Carlo Antona
- Forcardiolab, Fondazione per la ricerca in Cardiochirurgia ONLUS, Milan, Italy; Cardiovascular Surgery Department, "Luigi Sacco" University general Hospital, Milan, Italy; Università degli Studi di Milano, Milan, Italy
| | - Gianfranco B Fiore
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milano, Italy
| | - Alberto Redaelli
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milano, Italy
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