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Xie J, Lin H, Zuo A, Shao J, Sun W, Wang S, Song J, Yao W, Luo Y, Sun J, Wang M. The JMJD family of histone demethylase and their intimate links to cardiovascular disease. Cell Signal 2024; 116:111046. [PMID: 38242266 DOI: 10.1016/j.cellsig.2024.111046] [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: 02/23/2023] [Revised: 01/05/2024] [Accepted: 01/11/2024] [Indexed: 01/21/2024]
Abstract
The incidence rate and mortality rate of cardiovascular disease rank first in the world. It is associated with various high-risk factors, and there is no single cause. Epigenetic modifications, such as DNA methylation or histone modification, actively participate in the initiation and development of cardiovascular diseases. Histone lysine methylation is a type of histone post-translational modification. The human Jumonji C domain (JMJD) protein family consists of more than 30 members. JMJD proteins participate in many key nuclear processes and play a key role in the specific regulation of gene expression, DNA damage and repair, and DNA replication. Importantly, increasing evidence shows that JMJD proteins are abnormally expressed in cardiovascular diseases, which may be a potential mechanism for the occurrence and development of these diseases. Here, we discuss the key roles of JMJD proteins in various common cardiovascular diseases. This includes histone lysine demethylase, which has been studied in depth, and less-studied JMJD members. Furthermore, we focus on the epigenetic changes induced by each JMJD member, summarize recent research progress, and evaluate their relationship with cardiovascular diseases and therapeutic potential.
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Affiliation(s)
- Jiarun Xie
- Department of Traditional Chinese Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou 510280, China; School of Traditional Chinese Medicine, Southern Medical University, Guangzhou 510515, China
| | - Haoyu Lin
- Department of Traditional Chinese Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou 510280, China; School of Traditional Chinese Medicine, Southern Medical University, Guangzhou 510515, China
| | - Anna Zuo
- Department of Traditional Chinese Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou 510280, China; School of Traditional Chinese Medicine, Southern Medical University, Guangzhou 510515, China
| | - Junqiao Shao
- Department of Traditional Chinese Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou 510280, China; School of Traditional Chinese Medicine, Southern Medical University, Guangzhou 510515, China
| | - Wei Sun
- Department of Traditional Chinese Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou 510280, China; School of Traditional Chinese Medicine, Southern Medical University, Guangzhou 510515, China
| | - Shaoting Wang
- Department of Traditional Chinese Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou 510280, China; School of Traditional Chinese Medicine, Southern Medical University, Guangzhou 510515, China
| | - Jianda Song
- Department of Traditional Chinese Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou 510280, China; School of Traditional Chinese Medicine, Southern Medical University, Guangzhou 510515, China
| | - Wang Yao
- Department of Traditional Chinese Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou 510280, China; School of Traditional Chinese Medicine, Southern Medical University, Guangzhou 510515, China
| | - Yanyu Luo
- Department of Traditional Chinese Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou 510280, China; School of Traditional Chinese Medicine, Southern Medical University, Guangzhou 510515, China
| | - Jia Sun
- Department of Traditional Chinese Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou 510280, China.
| | - Ming Wang
- Department of Traditional Chinese Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou 510280, China; School of Traditional Chinese Medicine, Southern Medical University, Guangzhou 510515, China.
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Pittman TW, Zhang X, Punyadeera C, Henry CS. Electrochemical Immunosensor for the Quantification of Galectin-3 in Saliva. SENSORS AND ACTUATORS. B, CHEMICAL 2024; 400:134811. [PMID: 38046365 PMCID: PMC10688601 DOI: 10.1016/j.snb.2023.134811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/05/2023]
Abstract
Heart failure (HF) is an emerging epidemic and remains a major clinical and public health problem. Advances in the healthcare management of HF may lead to lower morbidity and mortality rates but require diagnostics to guide the process. Current diagnostics/prognostics approaches rely on expensive equipment, centralized facilities and trained personnel, marginalizing healthcare access in developing countries and rural communities. These issues have led researchers to focus on developing portable and affordable diagnostics that can be deployed at the point-of-care (POC). Typically, HF biomarkers are measured in blood not saliva. Recently, our team correlated concentrations of salivary Galectin-3 (Gal-3) to outcomes in patients with HF. We have developed an analytical device which consists of an immunoassay based on a screen-printed carbon electrode (SPCE) to quantify Gal-3 levels in saliva samples. Using 10 μL of saliva, the proposed electrochemical immunoassay achieved a concentration dependent signal response in the clinically relevant range with a limit of detection of 9.66 ng/mL. In addition, the storage stability of the modified electrode was investigated, and only a 10.9% loss in current response over a 35-day period. The results of the immunoassay on the modified SPCEs suggest validity as a POC biosensor system for the management of HF.
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Affiliation(s)
- Trey W. Pittman
- Department of Chemistry, Colorado State University, Fort Collins, Colorado 80523, USA
| | - Xi Zhang
- Griffith Institute for Drug Discover, Griffith University, Nathan, Australia
| | - Chamindie Punyadeera
- Griffith Institute for Drug Discover, Griffith University, Nathan, Australia
- Menzies Health Institute, Griffith University, Gold Coast, Australia
- Translational Research Institute, Woolloongabba, Australia
| | - Charles S. Henry
- Department of Chemistry, Colorado State University, Fort Collins, Colorado 80523, USA
- Metallurgy and Materials Science Research Institute, Chulalongkorn University, Soi Chula 12, Phayathai Rd., Pathumwan, Bangkok 10330, Thailand
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Li N, Khan SB, Chen S, Aiyiti W, Zhou J, Lu B. Promising New Horizons in Medicine: Medical Advancements with Nanocomposite Manufacturing via 3D Printing. Polymers (Basel) 2023; 15:4122. [PMID: 37896366 PMCID: PMC10610836 DOI: 10.3390/polym15204122] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 10/11/2023] [Accepted: 10/12/2023] [Indexed: 10/29/2023] Open
Abstract
Three-dimensional printing technology has fundamentally revolutionized the product development processes in several industries. Three-dimensional printing enables the creation of tailored prostheses and other medical equipment, anatomical models for surgical planning and training, and even innovative means of directly giving drugs to patients. Polymers and their composites have found broad usage in the healthcare business due to their many beneficial properties. As a result, the application of 3D printing technology in the medical area has transformed the design and manufacturing of medical devices and prosthetics. Polymers and their composites have become attractive materials in this industry because of their unique mechanical, thermal, electrical, and optical qualities. This review article presents a comprehensive analysis of the current state-of-the-art applications of polymer and its composites in the medical field using 3D printing technology. It covers the latest research developments in the design and manufacturing of patient-specific medical devices, prostheses, and anatomical models for surgical planning and training. The article also discusses the use of 3D printing technology for drug delivery systems (DDS) and tissue engineering. Various 3D printing techniques, such as stereolithography, fused deposition modeling (FDM), and selective laser sintering (SLS), are reviewed, along with their benefits and drawbacks. Legal and regulatory issues related to the use of 3D printing technology in the medical field are also addressed. The article concludes with an outlook on the future potential of polymer and its composites in 3D printing technology for the medical field. The research findings indicate that 3D printing technology has enormous potential to revolutionize the development and manufacture of medical devices, leading to improved patient outcomes and better healthcare services.
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Affiliation(s)
- Nan Li
- School of Mechanical Engineering, Xinjiang University, Urumqi 830017, China
- School of Manufacturing Science and Engineering, Key Laboratory of Testing Technology for Manufacturing Process, Ministry of Education, Southwest University of Science and Technology, Mianyang 621010, China
- School of Education (Normal School), Dongguan University of Technology, Dongguan 523808, China
| | - Sadaf Bashir Khan
- School of Manufacturing Science and Engineering, Key Laboratory of Testing Technology for Manufacturing Process, Ministry of Education, Southwest University of Science and Technology, Mianyang 621010, China
| | - Shenggui Chen
- School of Art and Design, Guangzhou Panyu Polytechnic, Guangzhou 511483, China
| | - Wurikaixi Aiyiti
- School of Mechanical Engineering, Xinjiang University, Urumqi 830017, China
| | - Jianping Zhou
- School of Mechanical Engineering, Xinjiang University, Urumqi 830017, China
| | - Bingheng Lu
- School of Mechanical Engineering, Xinjiang University, Urumqi 830017, China
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Nordström J, Kvernby S, Kero T, Sörensen J, Harms HJ, Lubberink M. Left-ventricular volumes and ejection fraction from cardiac ECG-gated 15O-water positron emission tomography compared to cardiac magnetic resonance imaging using simultaneous hybrid PET/MR. J Nucl Cardiol 2023; 30:1352-1362. [PMID: 36482239 PMCID: PMC10372106 DOI: 10.1007/s12350-022-03154-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 11/01/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND 15O-water PET is the gold standard for noninvasive quantification of myocardial blood flow. In addition to evaluation of ischemia, the assessment of cardiac function and remodeling is important in all cardiac diseases. However, since 15O-water is freely diffusible and standard uptake images show little contrast between the myocardium and blood pool, the assessment of left-ventricular (LV) volumes and ejection fraction (EF) is challenging. Therefore, the aim of the present study was to investigate the feasibility of calculating LV volumes and EF from first-pass analysis of 15O-water PET, by comparison with cardiac magnetic resonance imaging (CMR) using a hybrid PET/MR scanner. METHODS Twenty-four patients with known or suspected CAD underwent a simultaneous ECG-gated cardiac PET/MR scan. The 15O-water first-pass images (0-50 seconds) were analyzed using the CarPET software and the CMR images were analyzed using the software Segment, for LV volumes and EF calculations. The LV volumes and EF were compared using correlation and Bland-Altman analysis. In addition, inter- and intra-observer variability of LV volumes and EF were assessed for both modalities. RESULTS The correlation between PET and CMR was strong for volumes (r > 0.84) and moderate for EF (r = 0.52), where the moderate correlation for EF was partly due to the small range of EF values. Agreement was high for all parameters, with a slight overestimation of PET values for end-diastolic volume but with no significant mean bias for other parameters. Inter- and intra-observer agreement of volumes was high and comparable between PET and CMR. For EF, inter-observer agreement was higher for PET and intra-observer agreement was higher for CMR. CONCLUSION LV volumes and EF can be calculated by first-pass analysis of a 15O-water PET scan with high accuracy and comparable precision as with CMR.
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Affiliation(s)
- Jonny Nordström
- Department of Surgical Sciences/Nuclear Medicine & PET, Uppsala University, Uppsala, Sweden.
- Centre for Research and Development, Uppsala/Gävleborg County, Gävle, Sweden.
| | - Sofia Kvernby
- Department of Surgical Sciences/Nuclear Medicine & PET, Uppsala University, Uppsala, Sweden
- Medical Physics, Uppsala University Hospital, Uppsala, Sweden
| | - Tanja Kero
- Department of Surgical Sciences/Nuclear Medicine & PET, Uppsala University, Uppsala, Sweden
- Medical Imaging Centre, Uppsala University Hospital, Uppsala, Sweden
| | - Jens Sörensen
- Department of Surgical Sciences/Nuclear Medicine & PET, Uppsala University, Uppsala, Sweden
- Medical Imaging Centre, Uppsala University Hospital, Uppsala, Sweden
| | - Hendrik J Harms
- Department of Surgical Sciences/Nuclear Medicine & PET, Uppsala University, Uppsala, Sweden
| | - Mark Lubberink
- Department of Surgical Sciences/Nuclear Medicine & PET, Uppsala University, Uppsala, Sweden
- Medical Physics, Uppsala University Hospital, Uppsala, Sweden
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Buege MJ, Drill E, Horwitz SM, LeVoir A, Pak T, Peterson TJ, Dao PH, Matasar MJ. Low incidence of cardiotoxicity in patients with non-Hodgkin lymphoma receiving EPOCH after prior anthracycline exposure. Eur J Haematol 2023; 111:96-102. [PMID: 36971022 PMCID: PMC10634315 DOI: 10.1111/ejh.13971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 02/21/2023] [Accepted: 02/22/2023] [Indexed: 03/29/2023]
Abstract
OBJECTIVE To describe the incidence of cardiotoxicity in patients with anthracycline exposure who subsequently receive EPOCH for non-Hodgkin lymphoma (NHL). METHODS We conducted a retrospective cohort study of adults with anthracycline exposure who subsequently received EPOCH for NHL at Memorial Sloan Kettering Cancer Center. The primary outcome was cumulative incidence of arrhythmia, heart failure (HF), left ventricular (LV) dysfunction, or cardiac death. RESULTS Among 140 patients, most had diffuse large B-cell lymphoma. Inclusive of EPOCH, median cumulative doxorubicin-equivalent dose was 364 mg/m2 ; exposure was 400 mg/m2 or higher in 41%. With median 36-month follow-up, 23 cardiac events were noted in 20 patients. Cumulative incidence of cardiac events at 60 months was 15% (95% confidence interval [CI]: 9%-21%). When limited to LV dysfunction/HF, cumulative incidence at 60 months was 7% (95% CI: 3%-13%), with most events occurring after the first year. Univariate analysis indicated only history of cardiac disease and dyslipidemia to be associated with cardiotoxicity; no other risk factors, including cumulative anthracycline dose, were identified. CONCLUSIONS In this retrospective cohort, representing the largest experience in this setting with extended follow-up, cumulative incidence of cardiac events was low. Rates of LV dysfunction or HF were particularly low, suggesting infusional administration may mitigate risk despite prior exposure.
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Affiliation(s)
- Michael J. Buege
- Department of Pharmacy, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10018, USA
| | - Esther Drill
- Department of Epidemiology & Biostatistics, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10018, USA
| | - Steven M. Horwitz
- Department of Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10018, USA
| | - Andréa LeVoir
- Department of Pharmacy, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10018, USA
| | - Terry Pak
- Department of Pharmacy, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10018, USA
| | - Tim J. Peterson
- Department of Pharmacy, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10018, USA
| | - Phuong H. Dao
- Department of Pharmacy, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10018, USA
| | - Matthew J. Matasar
- Department of Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10018, USA
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Olivotto I, Udelson JE, Pieroni M, Rapezzi C. Genetic causes of heart failure with preserved ejection fraction: emerging pharmacological treatments. Eur Heart J 2023; 44:656-667. [PMID: 36582184 DOI: 10.1093/eurheartj/ehac764] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 11/13/2022] [Accepted: 11/26/2022] [Indexed: 12/31/2022] Open
Abstract
Heart failure with preserved ejection fraction (HFpEF) is a major driver of cardiac morbidity and mortality in developed countries, due to ageing populations and the increasing prevalence of comorbidities. While heart failure with reduced ejection fraction is dominated by left ventricular impairment, HFpEF results from a complex interplay of cardiac remodelling, peripheral circulation, and concomitant features including age, hypertension, obesity, and diabetes. In an important subset, however, HFpEF is subtended by specific diseases of the myocardium that are genetically determined, have distinct pathophysiology, and are increasingly amenable to targeted, innovative treatments. While each of these conditions is rare, they collectively represent a relevant subset within HFpEF cohorts, and their prompt recognition has major consequences for clinical practice, as access to dedicated, disease-specific treatments may radically change the quality of life and outcome. Furthermore, response to standard heart failure treatment will generally be modest for these individuals, whose inclusion in registries and trials may dilute the perceived efficacy of treatments targeting mainstream HFpEF. Finally, a better understanding of the molecular underpinnings of monogenic myocardial disease may help identify therapeutic targets and develop innovative treatments for selected HFpEF phenotypes of broader epidemiological relevance. The field of genetic cardiomyopathies is undergoing rapid transformation due to recent, groundbreaking advances in drug development, and deserves greater awareness within the heart failure community. The present review addressed existing and developing therapies for genetic causes of HFpEF, including hypertrophic cardiomyopathy, cardiac amyloidosis, and storage diseases, discussing their potential impact on management and their broader implications for our understanding of HFpEF at large.
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Affiliation(s)
- Iacopo Olivotto
- Department of Experimental and Clinical Medicine, University of Florence, Meyer University Children Hospital and Careggi University Hospital, Viale Pieraccini 24, 50139 Florence, Italy
| | - James E Udelson
- Division of Cardiology and The CardioVascular Center, Tufts Medical Center, and the Tufts University School of Medicine, 800 Washington St, Boston, MA 02111, USA
| | - Maurizio Pieroni
- Cardiology Department, Hospital San Donato, Via Pietro Nenni, 20 - 52100 Arezzo, Italy
| | - Claudio Rapezzi
- Cardiology Centre, University of Ferrara, Via Fossato di Mortara, 64/B - 44121 Ferrara, Italy.,Maria Cecilia Hospital, GVM Care & Research, Via Corriera, 1, 48033 Cotignola, Emilia-Romagna, Italy
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Optimization of pharmacotherapies for ambulatory patients with heart failure and reduced ejection fraction is associated with improved outcomes. Int J Cardiol 2023; 370:300-308. [PMID: 36174819 DOI: 10.1016/j.ijcard.2022.09.058] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 09/20/2022] [Accepted: 09/21/2022] [Indexed: 01/02/2023]
Abstract
BACKGROUND In heart failure, specific target doses for each drug are recommended, but some patients receive suboptimal dosing, others are undertreated or remain chronically in a titration phase, despite having no apparent contraindication or intolerance. We assessed the association of different levels of adherence to guidelines with outcomes in patients with heart failure and reduced ejection fraction (HFrEF). METHODS Medical records of patients with HFrEF followed at our heart failure (HF) clinic for at least 6 months (n = 511) were reviewed and patients categorized as: 1) optimized (25.4%); 2) in-titration (29.0%); 3) undertreated (32.7%); and 4) intolerant/contraindicated (12.9%). Risk of mortality or HF events (hospitalization, emergency visit or ambulatory administration of intravenous diuretics) within one year was assessed using Cox regression models and Kaplan-Meier curves. RESULTS Compared to optimized patients, those intolerant (HR: 4.60 [95%CI: 2.23-9.48]; p < 0.0001) had the highest risk of outcomes, followed by those undertreated (3.45 [1.78-6.67]; p = 0.0002) and in-titration (1.99 [0.97-4.06]; p = 0.0588). Overall predictors of outcomes included loop diuretics' use (4.54 [2.39-8.60]), undertreatment (2.38 [1.22-4.67]), intolerance/ contraindication to triple therapy (3.08 [1.47-6.42]), peripheral vascular disease (2.13 [1.29-3.50]) and NYHA class III-IV (1.89 [1.25-2.85]); all p < 0.05. CONCLUSION Level of adherence to guidelines is associated with outcomes, with intolerant/contraindicated patients having the worst prognosis and those undertreated and in-titration at intermediate risk compared to those optimized. Up-titration of therapy should be attempted whenever possible, considering patients' limitations, to potentially improve outcomes.
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D'Onofrio A, Fiocco A, Nadali M, Gerosa G. Transapical mitral valve repair procedures: Primetime for microinvasive mitral valve surgery. J Card Surg 2022; 37:4053-4061. [PMID: 34550618 PMCID: PMC10078712 DOI: 10.1111/jocs.16011] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 06/29/2021] [Accepted: 07/27/2021] [Indexed: 01/06/2023]
Abstract
INTRODUCTION Nowadays micro-invasive-procedures (off-pump, beating-heart) for mitral valve repair (MVRe) are abruptly expanding with the potential to be adopted as a valuable alternative to surgery. In the present manuscript, the authors review the available technologies intended to treat mitral regurgitation (MR) through transapical approach, including annuloplasty and chordal-repair options. ANNULOPLASTY To date, Valcare Amend is the only transapical MV ring to have been implanted in patients. The device allows for stabilization of the annulus through a complete semirigid d-shaped ring. The first-in-human successful procedure was performed in 2016 by our Group and subsequent clinical experience included a total of 14 implanted patients. Currently, the technology is under clinical trial evaluation to validate the efficacy and safety profile of the device. CHORDAL REPAIR Beating-heart chordal implantation via transapical approach is a current feasible, safe and reproducible option. Neochord DS1000 is the most widely used technology in the field, with a solid procedural experience and good results in well-selected patients. Its clinical use has been validated in Europe since 2012, while it is still under clinical investigation in the United States. Harpoon MVRe system is a novel technology, recently CE-mark approved for clinical use. DISCUSSION AND CONCLUSIONS Transapical micro-invasive technologies are current viable therapies to treat MR in selected patients. Although there are still several limitations that preclude an extensive use of such procedures, their results are promising in well-selected patients. Embracing transcatheter MVRe therapies should guide the cardiac surgeon through the new revolution of micro-invasive MV tailored repair.
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Affiliation(s)
- Augusto D'Onofrio
- Division of Cardiac Surgery, Department of Cardiac, Thoracic Vascular Sciences and Public Health, University of Padova, Veneto, Padova, Italy
| | - Alessandro Fiocco
- Division of Cardiac Surgery, Department of Cardiac, Thoracic Vascular Sciences and Public Health, University of Padova, Veneto, Padova, Italy
| | - Matteo Nadali
- Division of Cardiac Surgery, Department of Cardiac, Thoracic Vascular Sciences and Public Health, University of Padova, Veneto, Padova, Italy
| | - Gino Gerosa
- Division of Cardiac Surgery, Department of Cardiac, Thoracic Vascular Sciences and Public Health, University of Padova, Veneto, Padova, Italy
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Villalba-Orero M, Garcia-Pavia P, Lara-Pezzi E. Non-invasive assessment of HFpEF in mouse models: current gaps and future directions. BMC Med 2022; 20:349. [PMID: 36229816 PMCID: PMC9563110 DOI: 10.1186/s12916-022-02546-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 09/01/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Heart failure (HF) with preserved ejection fraction (HFpEF) prevalence is increasing, and large clinical trials have failed to reduce mortality. A major reason for this outcome is the failure to translate results from basic research to the clinics. Evaluation of HFpEF in mouse models requires assessing three major key features defining this complex syndrome: the presence of a preserved left ventricular ejection fraction (LVEF), diastolic dysfunction, and the development of HF. In addition, HFpEF is associated with multiple comorbidities such as systemic arterial hypertension, chronic obstructive pulmonary disease, sleep apnea, diabetes, and obesity; thus, non-cardiac disorders assessment is crucial for a complete phenotype characterization. Non-invasive procedures present unquestionable advantages to maintain animal welfare and enable longitudinal analyses. However, unequivocally determining the presence of HFpEF using these methods remains challenging. MAIN TEXT Transthoracic echocardiography (TTE) represents an invaluable tool in HFpEF diagnosis, allowing evaluation of LVEF, diastolic dysfunction, and lung congestion in mice. Since conventional parameters used to evaluate an abnormal diastole like E/A ratio, isovolumic relaxation time, and E/e' may pose limitations in mice, including advanced TTE techniques to characterize cardiac motion, including an assessment under stress, will improve diagnosis. Patients with HFpEF also show electrical cardiac remodelling and therefore electrocardiography may add valuable information in mouse models to assess chronotropic incompetence and sinoatrial node dysfunction, which are major contributors to exercise intolerance. To complete the non-invasive diagnosis of HF, low aerobic exercise capacity and fatigue using exercise tests, impaired oxygen exchange using metabolic cages, and determination of blood biomarkers can be determined. Finally, since HFpEF patients commonly present non-cardiac pathological conditions, acquisition of systemic and pulmonary arterial pressures, blood glucose levels, and performing glucose tolerance and insulin resistance tests are required for a complete phenotyping. CONCLUSION Identification of reliable models of HFpEF in mice by using proper diagnosis tools is necessary to translate basic research results to the clinics. Determining the presence of several HFpEF indicators and a higher number of abnormal parameters will lead to more reliable evidence of HFpEF.
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Affiliation(s)
- María Villalba-Orero
- Departamento de Medicina y Cirugía Animal, Facultad de Veterinaria, Universidad Complutense de Madrid, Av. Puerta de Hierro, s/n, 28040, Madrid, Spain. .,Myocardial Pathophysiology Area, Centro Nacional de Investigaciones Cardiovasculares Carlos III, Melchor Fernández Almagro, 3, 28029, Madrid, Spain. .,Centro de investigación Biomédica en Red Cardiovascular (CIBERCV), Madrid, Spain.
| | - Pablo Garcia-Pavia
- Myocardial Pathophysiology Area, Centro Nacional de Investigaciones Cardiovasculares Carlos III, Melchor Fernández Almagro, 3, 28029, Madrid, Spain.,Centro de investigación Biomédica en Red Cardiovascular (CIBERCV), Madrid, Spain.,Heart Failure and Inherited Cardiac Diseases Unit, Department of Cardiology, Hospital Universitario Puerta de Hierro Majadahonda, IDIPHISA, Madrid, Spain.,Universidad Francisco de Vitoria, Madrid, Spain
| | - Enrique Lara-Pezzi
- Myocardial Pathophysiology Area, Centro Nacional de Investigaciones Cardiovasculares Carlos III, Melchor Fernández Almagro, 3, 28029, Madrid, Spain. .,Centro de investigación Biomédica en Red Cardiovascular (CIBERCV), Madrid, Spain.
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Sörensen J, Nordström J, Baron T, Mörner S, Granstam SO, Lubberink M, Tolbod L, van den Berg J, Flachskampf FA, Kero T, Magnusson P, Harms HJ. Diagnosis of left ventricular hypertrophy using non-ECG-gated 15O-water PET. J Nucl Cardiol 2022; 29:2361-2373. [PMID: 34286452 PMCID: PMC9553817 DOI: 10.1007/s12350-021-02734-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 06/17/2021] [Indexed: 11/30/2022]
Abstract
AIM To develop a method for diagnosing left ventricular (LV) hypertrophy from cardiac perfusion 15O-water positron emission tomography (PET). METHODS We retrospectively pooled data from 139 subjects in four research cohorts. LV remodeling patterns ranged from normal to severe eccentric and concentric hypertrophy. 15O-water PET scans (n = 197) were performed with three different PET devices. A low-end scanner (66 scans) was used for method development, and remaining scans with newer devices for a blinded evaluation. Dynamic data were converted into parametric images of perfusable tissue fraction for semi-automatic delineation of the LV wall and calculation of LV mass (LVM) and septal wall thickness (WT). LVM and WT from PET were compared to cardiac magnetic resonance (CMR, n = 47) and WT to 2D-echocardiography (2DE, n = 36). PET accuracy was tested using linear regression, Bland-Altman plots, and ROC curves. Observer reproducibility were evaluated using intraclass correlation coefficients. RESULTS High correlations were found in the blinded analyses (r ≥ 0.87, P < 0.0001 for all). AUC for detecting increased LVM and WT (> 12 mm and > 15 mm) was ≥ 0.95 (P < 0.0001 for all). Reproducibility was excellent (ICC ≥ 0.93, P < 0.0001). CONCLUSION 15O-water PET might detect LV hypertrophy with high accuracy and precision.
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Affiliation(s)
- Jens Sörensen
- Department of Surgical Sciences, Radiology & Nuclear Medicine, Uppsala University, Uppsala, Sweden.
- PET Center, Entrance 86, Uppsala University Hospital, 751 85, Uppsala, Sweden.
| | - Jonny Nordström
- Department of Surgical Sciences, Radiology & Nuclear Medicine, Uppsala University, Uppsala, Sweden
- Centre for Research and Development, Region Gävleborg/Uppsala University, Gävle, Sweden
| | - Tomasz Baron
- Department of Medical Sciences, Clinical Physiology and Cardiology, Uppsala University, Uppsala, Sweden
| | - Stellan Mörner
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Sven-Olof Granstam
- Department of Medical Sciences, Clinical Physiology and Cardiology, Uppsala University, Uppsala, Sweden
| | - Mark Lubberink
- Department of Surgical Sciences, Radiology & Nuclear Medicine, Uppsala University, Uppsala, Sweden
| | - Lars Tolbod
- Nuclear Medicine and PET, Institute of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Jeffrey van den Berg
- Department of Surgical Sciences, Radiology & Nuclear Medicine, Uppsala University, Uppsala, Sweden
| | - Frank A Flachskampf
- Department of Medical Sciences, Clinical Physiology and Cardiology, Uppsala University, Uppsala, Sweden
| | - Tanja Kero
- Department of Surgical Sciences, Radiology & Nuclear Medicine, Uppsala University, Uppsala, Sweden
| | - Peter Magnusson
- Centre for Research and Development, Region Gävleborg/Uppsala University, Gävle, Sweden
- Cardiology Research Unit, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Hendrik J Harms
- Department of Surgical Sciences, Radiology & Nuclear Medicine, Uppsala University, Uppsala, Sweden
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11
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Pop-Busui R, Januzzi JL, Bruemmer D, Butalia S, Green JB, Horton WB, Knight C, Levi M, Rasouli N, Richardson CR. Heart Failure: An Underappreciated Complication of Diabetes. A Consensus Report of the American Diabetes Association. Diabetes Care 2022; 45:1670-1690. [PMID: 35796765 PMCID: PMC9726978 DOI: 10.2337/dci22-0014] [Citation(s) in RCA: 116] [Impact Index Per Article: 58.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 03/29/2022] [Indexed: 02/03/2023]
Abstract
Heart failure (HF) has been recognized as a common complication of diabetes, with a prevalence of up to 22% in individuals with diabetes and increasing incidence rates. Data also suggest that HF may develop in individuals with diabetes even in the absence of hypertension, coronary heart disease, or valvular heart disease and, as such, represents a major cardiovascular complication in this vulnerable population; HF may also be the first presentation of cardiovascular disease in many individuals with diabetes. Given that during the past decade, the prevalence of diabetes (particularly type 2 diabetes) has risen by 30% globally (with prevalence expected to increase further), the burden of HF on the health care system will continue to rise. The scope of this American Diabetes Association consensus report with designated representation from the American College of Cardiology is to provide clear guidance to practitioners on the best approaches for screening and diagnosing HF in individuals with diabetes or prediabetes, with the goal to ensure access to optimal, evidence-based management for all and to mitigate the risks of serious complications, leveraging prior policy statements by the American College of Cardiology and American Heart Association.
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Affiliation(s)
- Rodica Pop-Busui
- Division of Metabolism, Endocrinology and Diabetes, Department of Internal Medicine, University of Michigan, Ann Arbor, MI
| | - James L. Januzzi
- Cardiology Division, Massachusetts General Hospital, and Cardiometabolic Trials, Baim Institute for Clinical Research, Boston, MA
| | - Dennis Bruemmer
- Center for Cardiometabolic Health, Section of Preventive Cardiology and Rehabilitation, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, OH
| | - Sonia Butalia
- Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Jennifer B. Green
- Division of Endocrinology and Duke Clinical Research Institute, Department of Medicine, Duke University Medical Center, Durham, NC
| | - William B. Horton
- Division of Endocrinology and Metabolism, Department of Medicine, University of Virginia, Charlottesville, VA
| | - Colette Knight
- Inserra Family Diabetes Institute, Hackensack University Medical Center, Hackensack Meridian School of Medicine, Hackensack, NJ
| | - Moshe Levi
- Department of Biochemistry and Molecular & Cellular Biology, Georgetown University, Washington, DC
| | - Neda Rasouli
- Division of Endocrinology, Metabolism and Diabetes, Department of Medicine, University of Colorado School of Medicine, Aurora, CO
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12
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Shen NN, Wang JL, Fu YP. The microRNA Expression Profiling in Heart Failure: A Systematic Review and Meta-Analysis. Front Cardiovasc Med 2022; 9:856358. [PMID: 35783849 PMCID: PMC9240229 DOI: 10.3389/fcvm.2022.856358] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 05/27/2022] [Indexed: 12/16/2022] Open
Abstract
Background Heart failure (HF) is a main consequence of cardiovascular diseases worldwide. Abnormal expression levels of microRNAs (miRNAs) in HF are observed in current studies. Novel biomarkers miRNAs may play an important role in the development of HF. Nevertheless, the inconsistency of miRNA expression limits the clinical application. We thus perform this systematic review of the miRNAs expression profiling to identify potential HF biomarkers. Methods The electronic databases of Embase, Medline, and Cochrane Library were systematically searched to identify the miRNA expression profiles between HF subjects and non-HF controls before May 26th, 2021. The pooled results were shown as log10 odds ratios (logORs) with 95% confidence intervals (CI) using random-effect models. Subgroup analyses were conducted according to species, region, and sample source. The quality assessment of included studies was independently conducted based on Diagnostic Accuracy Study 2 (QUADAS-2). The sensitivity analysis was conducted based on sample size. Results A total of 55 miRNA expression articles reporting 276 miRNAs of HF were included. 47 consistently up-regulated and 10 down-regulated miRNAs were identified in the overall analysis, with the most up-regulated miR-21 (logOR 8.02; 95% CI: 6.76–9.27, P < 0.001) and the most down-regulated miR-30c (logOR 6.62; 95% CI: 3.04–10.20, P < 0.001). The subgroup analysis of sample source identified 35 up-regulated and 10 down-regulated miRNAs in blood sample, the most up-regulated and down-regulated miRNAs were miR-210-3p and miR-30c, respectively. In the region sub-groups, let-7i-5p and miR-129 were most up-regulated and down-regulated in Asian countries, while in non-Asian countries, let-7e-5p and miR-30c were the most dysregulated. It’s worth noting that miR-622 was consistently up-regulated in both Asian and non-Asian countries. Sensitivity analysis showed that 46 out of 58 (79.31%) miRNAs were dysregulated. Conclusion A total of 57 consistently dysregulated miRNAs related to HF were confirmed in this study. Seven dysregulated miRNAs (miR-21, miR-30c, miR-210-3p, let-7i-5p, miR-129, let-7e-5p, and miR-622) may be considered as potential non-invasive biomarkers for HF. However, further validation in larger-scale studies are needed to verify our conclusions.
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Affiliation(s)
- Nan-Nan Shen
- Department of Pharmacy, Affiliated Hospital of Shaoxing University, Shaoxing, China
| | - Jia-Liang Wang
- Department of Pharmacy, Affiliated Hospital of Shaoxing University, Shaoxing, China
- *Correspondence: Jia-Liang Wang,
| | - Yong-ping Fu
- Department of Cardiology, Affiliated Hospital of Shaoxing University, Shaoxing, China
- Yong-ping Fu,
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13
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Ni L, Lin B, Hu L, Zhang R, Fu F, Shen M, Yang J, Shi D. Pyruvate Kinase M2 Protects Heart from Pressure Overload-Induced Heart Failure by Phosphorylating RAC1. J Am Heart Assoc 2022; 11:e024854. [PMID: 35656980 PMCID: PMC9238738 DOI: 10.1161/jaha.121.024854] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Background Heart failure, caused by sustained pressure overload, remains a major public health problem. PKM (pyruvate kinase M) acts as a rate‐limiting enzyme of glycolysis. PKM2 (pyruvate kinase M2), an alternative splicing product of PKM, plays complex roles in various biological processes and diseases. However, the role of PKM2 in the development of heart failure remains unknown. Methods and Results Cardiomyocyte‐specific Pkm2 knockout mice were generated by crossing the floxed Pkm2 mice with α‐MHC (myosin heavy chain)‐Cre transgenic mice, and cardiac specific Pkm2 overexpression mice were established by injecting adeno‐associated virus serotype 9 system. The results showed that cardiomyocyte‐specific Pkm2 deletion resulted in significant deterioration of cardiac functions under pressure overload, whereas Pkm2 overexpression mitigated transverse aortic constriction‐induced cardiac hypertrophy and improved heart functions. Mechanistically, we demonstrated that PKM2 acted as a protein kinase rather than a pyruvate kinase, which inhibited the activation of RAC1 (rho family, small GTP binding protein)‐MAPK (mitogen‐activated protein kinase) signaling pathway by phosphorylating RAC1 in the progress of heart failure. In addition, blockade of RAC1 through NSC23766, a specific RAC1 inhibitor, attenuated pathological cardiac remodeling in Pkm2 deficiency mice subjected to transverse aortic constriction. Conclusions This study revealed that PKM2 attenuated overload‐induced pathological cardiac hypertrophy and heart failure, which provides an attractive target for the prevention and treatment of cardiomyopathies.
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Affiliation(s)
- Le Ni
- Department of Cardiology Shanghai East HospitalTongji University School of Medicine Shanghai China.,Key Laboratory of Arrhythmias of the Ministry of Education of China Shanghai East HospitalTongji University School of Medicine Shanghai China
| | - Bowen Lin
- Department of Cardiology Shanghai East HospitalTongji University School of Medicine Shanghai China.,Key Laboratory of Arrhythmias of the Ministry of Education of China Shanghai East HospitalTongji University School of Medicine Shanghai China
| | - Lingjie Hu
- Department of Cardiology Shanghai East HospitalTongji University School of Medicine Shanghai China.,Key Laboratory of Arrhythmias of the Ministry of Education of China Shanghai East HospitalTongji University School of Medicine Shanghai China
| | | | - Fengmei Fu
- Jinzhou Medical University Liaoning China
| | - Meiting Shen
- Department of Cardiology Shanghai East HospitalTongji University School of Medicine Shanghai China.,Key Laboratory of Arrhythmias of the Ministry of Education of China Shanghai East HospitalTongji University School of Medicine Shanghai China
| | - Jian Yang
- Department of Cardiology Shanghai East HospitalTongji University School of Medicine Shanghai China.,Key Laboratory of Arrhythmias of the Ministry of Education of China Shanghai East HospitalTongji University School of Medicine Shanghai China.,Department of Cell Biology Tongji University School of Medicine Shanghai China.,Institute of Medical Genetics Tongji University Shanghai China
| | - Dan Shi
- Department of Cardiology Shanghai East HospitalTongji University School of Medicine Shanghai China.,Key Laboratory of Arrhythmias of the Ministry of Education of China Shanghai East HospitalTongji University School of Medicine Shanghai China
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14
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Gerosa G, Thourani VH, Borger M, D'Onofrio A. Microinvasive cardiac surgery: when less is more-'render to Caesar the things that are Caesar's; and to the surgeon the things that are the surgeons''. Eur J Cardiothorac Surg 2022; 62:6528408. [PMID: 35157037 DOI: 10.1093/ejcts/ezac084] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 01/06/2022] [Accepted: 02/11/2022] [Indexed: 12/27/2022] Open
Affiliation(s)
- Gino Gerosa
- Cardiac Surgery Unit, Cardio-Thoracic-Vascular Sciences and Public Health Department, Padova University Hospital, Padova, Italy
| | - Vinod H Thourani
- Department of Cardiovascular Surgery, Marcus Valve Center, Piedmont Heart Institute, Atlanta, GA, USA
| | - Michael Borger
- University Clinic for Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany
| | - Augusto D'Onofrio
- Cardiac Surgery Unit, Cardio-Thoracic-Vascular Sciences and Public Health Department, Padova University Hospital, Padova, Italy
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15
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Beattie JM, Higginson IJ, McDonagh TA, Gao W. Implementation of the Mental Capacity Act: a national observational study comparing resultant trends in place of death for older heart failure decedents with or without comorbid dementia. BMC Med 2022; 20:30. [PMID: 35057803 PMCID: PMC9901524 DOI: 10.1186/s12916-021-02210-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 12/07/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Heart failure (HF) is increasingly prevalent in the growing elderly population and commonly associated with cognitive impairment. We compared trends in place of death (PoD) of HF patients with/without comorbid dementia around the implementation period of the Mental Capacity Act (MCA) in October 2007, this legislation supporting patient-centred decision making for those with reduced agency. METHODS Analyses of death certification data for England between January 2001 and December 2018, describing the PoD and sociodemographic characteristics of all people ≥ 65 years registered with HF as the underlying cause of death, with/without a mention of comorbid dementia. We used modified Poisson regression with robust error variance to determine the prevalence ratio (PR) of the outcome in dying at home, in care homes or hospices compared to dying in hospital. Covariates included year of death, age, gender, marital status, comorbidity burden, index of multiple deprivation and urban/rural settings. RESULTS One hundred twenty thousand sixty-eight HF-related death records were included of which 8199 mentioned dementia as a contributory cause. The overall prevalence proportion of dementia was 6.8%, the trend significantly increasing from 5.6 to 8.0% pre- and post-MCA (Cochran-Armitage trend test p < 0.0001). Dementia was coded as unspecified (78.2%), Alzheimer's disease (13.5%) and vascular (8.3%). Demented decedents were commonly older, female, and with more comorbidities. Pre-MCA, PoD for non-demented HF patients was hospital 68.2%, care homes 20.2% and 10.7% dying at home. Corresponding figures for those with comorbid dementia were 47.6%, 48.0% and 4.2%, respectively. Following MCA enforcement, PoD for those without dementia shifted from hospital to home, 62.5% and 17.2%, respectively; PR: 1.026 [95%CI: 1.024-1.029]. While home deaths also rose to 10.0% for those with dementia, with hospital deaths increasing to 50.4%, this trend was insignificant, PR: 1.001 [0.988-1.015]. Care home deaths reduced for all, with/without dementia, PR: 0.959 [0.949-0.969] and PR: 0.996 [0.993-0.998], respectively. Hospice as PoD was rare for both groups with no appreciable change over the study period. CONCLUSIONS Our analyses suggest the MCA did not materially affect the PoD of HF decedents with comorbid dementia, likely reflecting difficulties implementing this legislation in real-life clinical practice.
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Affiliation(s)
- James M Beattie
- Cicely Saunders Institute of Palliative Care and Rehabilitation, King's College London, London, UK.,School of Cardiovascular Medicine and Sciences, King's College London, London, UK
| | - Irene J Higginson
- Cicely Saunders Institute of Palliative Care and Rehabilitation, King's College London, London, UK
| | - Theresa A McDonagh
- School of Cardiovascular Medicine and Sciences, King's College London, London, UK
| | - Wei Gao
- Cicely Saunders Institute of Palliative Care and Rehabilitation, King's College London, London, UK.
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16
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Zhang L, Liu W, Sun W, Wang X, Tian M, Pei LL, Liu K, Liang J, Zhou L, Lu J, Ning M, Buonanno FS, Xu Y, Song B. Heart Failure and Ischemic Stroke: A Bidirectional and Multivariable Mendelian Randomization Study. Front Genet 2021; 12:771044. [PMID: 34912375 PMCID: PMC8666512 DOI: 10.3389/fgene.2021.771044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 11/08/2021] [Indexed: 12/17/2022] Open
Abstract
Background: Heart failure (HF) is a potential cause of ischemic stroke (IS), and previous studies have reported an association between HF and IS. This study aimed to analyze the causal link between HF and IS using bidirectional and multivariable Mendelian randomization (MR) studies. Methods: Genetic variants significantly associated with HF and IS were selected in the MR analysis from two large genome-wide association studies. Bidirectional and multivariable MR analyses were performed to evaluate the effect of HF on IS or the effect of IS on HF. Results: Two-sample MR analysis showed causal effects of HF on IS of all causes [odds ratio (OR) = 1.555, 95% confidence interval (CI): 1.343–1.799, p = 3.35 × 10−9] and large artery atherosclerosis stroke (LAS) (OR = 1.678, 95% CI: 1.044–2.696, p = 3.03 × 10−5), while there was a suggestive effect of HF on cardioembolic stroke (CES) (OR = 3.355, 95% CI: 1.031–10.919, p = 0.044). Genetically predicted HF was not associated with small artery occlusion stroke. Bidirectional MR analysis showed causal effects of IS of all causes (OR = 1.211, 95% CI: 1.040–1.410, p = 0.014) and CES (OR = 1.277, 95% CI: 1.213–1.344, p = 6.73 × 10−21) on HF, while there were no causal effects of LAS on HF. Conclusion: This MR analysis provided evidence of the causal links between genetically predicted HF and IS. Subgroup analysis highlighted the causal or suggestive relationship between genetically predicted HF and LAS or CES. The potential causal links need further investigation with genetic information about other ancestries or etiologies of HF.
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Affiliation(s)
- Luyang Zhang
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Henan Key Laboratory of Cerebrovascular Diseases, Zhengzhou, China
| | - Weishi Liu
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Henan Key Laboratory of Cerebrovascular Diseases, Zhengzhou, China.,Clinical Systems Biology Laboratories, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Wenxian Sun
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Henan Key Laboratory of Cerebrovascular Diseases, Zhengzhou, China
| | - Xin Wang
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Henan Key Laboratory of Cerebrovascular Diseases, Zhengzhou, China
| | - Mengke Tian
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Henan Key Laboratory of Cerebrovascular Diseases, Zhengzhou, China
| | - Lu-Lu Pei
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Henan Key Laboratory of Cerebrovascular Diseases, Zhengzhou, China
| | - Kai Liu
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Henan Key Laboratory of Cerebrovascular Diseases, Zhengzhou, China
| | - Jing Liang
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Henan Key Laboratory of Cerebrovascular Diseases, Zhengzhou, China
| | - Lue Zhou
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Henan Key Laboratory of Cerebrovascular Diseases, Zhengzhou, China
| | - Jie Lu
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Mingming Ning
- Clinical Proteomics Research Center and Cardio-Neurology Division, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Ferdinando S Buonanno
- Clinical Proteomics Research Center and Cardio-Neurology Division, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Yuming Xu
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Henan Key Laboratory of Cerebrovascular Diseases, Zhengzhou, China
| | - Bo Song
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Henan Key Laboratory of Cerebrovascular Diseases, Zhengzhou, China
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17
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Guariento A, Fiocco A, Vida V. Commentary: A transcatheter challenge: Can you deploy a valve into a Big Mac? JTCVS Tech 2021; 10:262-263. [PMID: 34977732 PMCID: PMC8691775 DOI: 10.1016/j.xjtc.2021.08.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 08/13/2021] [Accepted: 08/26/2021] [Indexed: 12/05/2022] Open
Affiliation(s)
- Alvise Guariento
- Pediatric and Congenital Cardiac Surgery Unit, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | - Alessandro Fiocco
- Pediatric and Congenital Cardiac Surgery Unit, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | - Vladimiro Vida
- Pediatric and Congenital Cardiac Surgery Unit, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
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18
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Tini G, Cannatà A, Canepa M, Masci PG, Pardini M, Giacca M, Sinagra G, Marchionni N, Del Monte F, Udelson JE, Olivotto I. Is heart failure with preserved ejection fraction a 'dementia' of the heart? Heart Fail Rev 2021; 27:587-594. [PMID: 33907929 DOI: 10.1007/s10741-021-10114-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/19/2021] [Indexed: 01/09/2023]
Abstract
Heart failure with preserved ejection fraction (HFpEF) remains an elusive entity, due to its heterogeneous clinical profile and an arbitrarily defined nosology. Several pathophysiological mechanisms recognized as central for the development of HFpEF appear to be in common with the process of physiological aging of the heart. Both conditions are characterized by progressive impairment in cardiac function, accompanied by left ventricular hypertrophy, diastolic dysfunction, sarcomeric, and metabolic abnormalities. The neurological paradigm of dementia-intended as a progressive, multifactorial organ damage with decline of functional reserve, eventually leading to irreversible dysfunction-is well suited to represent HFpEF. In such perspective, certain phenotypes of HFpEF may be viewed as a maladaptive response to environmental modifiers, causing premature and pathological aging of the heart. We here propose that the 'HFpEF syndrome' may reflect the interplay of adverse structural remodelling and erosion of functional reserve, mirroring the processes leading to dementia in the brain. The resulting conceptual framework may help advance our understanding of HFpEF and unravel potential therapeutical targets.
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Affiliation(s)
- Giacomo Tini
- Cardiovascular Disease Unit, IRCCS Ospedale Policlinico San Martino, University of Genova, Genova, Italy. .,Cardiomyopathy Unit, Careggi University Hospital, Florence, Italy.
| | - Antonio Cannatà
- Cardiothoracic Department, Azienda Sanitaria Universitaria Integrata Di Trieste, University of Trieste, Trieste, Italy
| | - Marco Canepa
- Cardiovascular Disease Unit, IRCCS Ospedale Policlinico San Martino, University of Genova, Genova, Italy
| | - Pier Giorgio Masci
- Department of Cardiovascular Imaging, School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Matteo Pardini
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Genova, Italy.,IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Mauro Giacca
- School of Cardiovascular Medicine & Sciences, King's College London British Heart Foundation Centre, London, UK
| | - Gianfranco Sinagra
- Cardiothoracic Department, Azienda Sanitaria Universitaria Integrata Di Trieste, University of Trieste, Trieste, Italy
| | - Niccolò Marchionni
- Cardiothoracovascular Department, Careggi University Hospital, Florence, Italy
| | - Federica Del Monte
- Department of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - James E Udelson
- Division of Cardiology, Tufts Medical Center, Boston, MA, USA
| | - Iacopo Olivotto
- Cardiomyopathy Unit, Careggi University Hospital, Florence, Italy.,Cardiothoracovascular Department, Careggi University Hospital, Florence, Italy
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19
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Liu L, Zhao Q, Lin L, Yang G, Yu L, Zhuo L, Yang Y, Xu Y. Myeloid MKL1 Disseminates Cues to Promote Cardiac Hypertrophy in Mice. Front Cell Dev Biol 2021; 9:583492. [PMID: 33898415 PMCID: PMC8063155 DOI: 10.3389/fcell.2021.583492] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 01/04/2021] [Indexed: 12/11/2022] Open
Abstract
Cardiac hypertrophy is a key pathophysiological process in the heart in response to stress cues. Although taking place in cardiomyocytes, the hypertrophic response is influenced by other cell types, both within the heart and derived from circulation. In the present study we investigated the myeloid-specific role of megakaryocytic leukemia 1 (MKL1) in cardiac hypertrophy. Following transverse aortic constriction (TAC), myeloid MKL1 conditional knockout (MFCKO) mice exhibit an attenuated phenotype of cardiac hypertrophy compared to the WT mice. In accordance, the MFCKO mice were protected from excessive cardiac inflammation and fibrosis as opposed to the WT mice. Conditioned media collected from macrophages enhanced the pro-hypertrophic response in cardiomyocytes exposed to endothelin in an MKL1-dependent manner. Of interest, expression levels of macrophage derived miR-155, known to promote cardiac hypertrophy, were down-regulated in the MFCKO mice compared to the WT mice. MKL1 depletion or inhibition repressed miR-155 expression in macrophages. Mechanistically, MKL1 interacted with NF-κB to activate miR-155 transcription in macrophages. In conclusion, our data suggest that MKL1 may contribute to pathological hypertrophy via regulating macrophage-derived miR-155 transcription.
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Affiliation(s)
- Li Liu
- Jiangsu Key Laboratory for Molecular and Medical Biotechnology, College of Life Sciences, Nanjing Normal University, Nanjing, China.,Key Laboratory of Targeted Intervention of Cardiovascular Disease and Collaborative Innovation Center for Cardiovascular Translational Medicine, Department of Pathophysiology, Nanjing Medical University, Nanjing, China
| | - Qianwen Zhao
- Key Laboratory of Targeted Intervention of Cardiovascular Disease and Collaborative Innovation Center for Cardiovascular Translational Medicine, Department of Pathophysiology, Nanjing Medical University, Nanjing, China
| | - Lin Lin
- Jiangsu Key Laboratory for Molecular and Medical Biotechnology, College of Life Sciences, Nanjing Normal University, Nanjing, China
| | - Guang Yang
- Department of Pathology, Suzhou Municipal Hospital Affiliated with Nanjing Medical University, Suzhou, China
| | - Liming Yu
- Key Laboratory of Targeted Intervention of Cardiovascular Disease and Collaborative Innovation Center for Cardiovascular Translational Medicine, Department of Pathophysiology, Nanjing Medical University, Nanjing, China
| | - Lili Zhuo
- Department of Geriatrics, The Second Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Yuyu Yang
- Jiangsu Key Laboratory for Molecular and Medical Biotechnology, College of Life Sciences, Nanjing Normal University, Nanjing, China.,Institute of Biomedical Research, Liaocheng University, Liaocheng, China
| | - Yong Xu
- Key Laboratory of Targeted Intervention of Cardiovascular Disease and Collaborative Innovation Center for Cardiovascular Translational Medicine, Department of Pathophysiology, Nanjing Medical University, Nanjing, China.,Institute of Biomedical Research, Liaocheng University, Liaocheng, China
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20
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The Heart Failure with Preserved Ejection Fraction Conundrum-Redefining the Problem and Finding Common Ground? Curr Heart Fail Rep 2021; 17:34-42. [PMID: 32112345 DOI: 10.1007/s11897-020-00454-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
PURPOSE OF REVIEW Heart failure with preserved ejection fraction (HFpEF) or diastolic heart failure (DHF) makes up more than half of all congestive heart failure presentations (CHF). With an ageing population, the case load and the financial burden is projected to increase, even to epidemic proportions. CHF hospitalizations add too much of the financial and infrastructure strain. Unlike systolic heart failure (SHF), much is still either uncertain or unknown. Specifically, in epidemiology, the disease burden is established; however, risk factors and pathophysiological associations are less clear; diagnostic tools are based on rigid parameters without the ability to accurately monitor treatments effects and disease progression; finally, therapeutics are similar to SHF but without prognostic data for efficacy. RECENT FINDINGS The last several years have seen guidelines changing to account for greater epidemiological observations. Most of these remain general observation of shortness of breath symptom matched to static echocardiographic parameters. The introduction of exercise diastolic stress test has been welcome and warrants greater focus. HFpEF is likely to see new thinking in the coming decades. This review provides some of perspective on this topic.
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21
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Dapagliflozin in Patients with Chronic Heart Failure: A Systematic Review and Meta-Analysis. Cardiol Res Pract 2021; 2021:6657380. [PMID: 33859839 PMCID: PMC8026320 DOI: 10.1155/2021/6657380] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 03/03/2021] [Accepted: 03/14/2021] [Indexed: 12/21/2022] Open
Abstract
Sodium-glucose cotransporter-2 (SGLT2) inhibitors represent newly developed oral antidiabetic drugs that are practiced for type 2 diabetes mellitus management and may decrease the risk of the first hospitalization in heart failure. The activity of SGLT2 inhibitors is not related to glucose, and the effectiveness and safety of SGLT2 inhibitors in individuals with chronic heart failure (CHF) remain unclear. We systematically retrieved PubMed, Cochrane Library, Embase, NCKI, VIP, Wanfang Data, and ClinicalTrials.gov records to identify eligible trials. The primary endpoints were cardiovascular death/hospitalization for heart failure (CV death/HHF), cardiovascular death, and hospitalization for heart failure. Secondary endpoints included hypoglycemia, volume depletion, urinary tract infection, left ventricular ejection fraction (LVEF), and NT-proBNP. Nine randomized controlled clinical trials were included. Dapagliflozin was reported to significantly decrease CV death/HHF (relative risk (RR): 0.75; 95% confidence interval (CI): 0.68-0.84), CV death (RR: 0.80; 95% CI: 0.68-0.93), and HHF (RR: 0.72; 95% CI: 0.63-0.83). There was no effect on hypoglycemia (RR: 0.69; 95% CI: 0.34-1.40), volume depletion (RR: 1.17; 95% CI: 0.97-1.41), urinary tract infection (RR: 0.82; 95% CI: 0.43-1.57), LVEF (WMD: 0.53; 95% CI: -4.04-5.09), or NT-proBNP (SMD: -0.66; 95% CI: -1.42-0.10). The risk of CV death/HHF, CV death, and HHF was lower among patients receiving dapagliflozin than patients receiving placebo.
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Liu L, Zhao Q, Kong M, Mao L, Yang Y, Xu Y. Myocardin-related transcription factor A (MRTF-A) regulates integrin beta 2 transcription to promote macrophage infiltration and cardiac hypertrophy in mice. Cardiovasc Res 2021; 118:844-858. [PMID: 33752236 DOI: 10.1093/cvr/cvab110] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 03/19/2021] [Indexed: 01/01/2023] Open
Abstract
AIMS Macrophage-mediated inflammatory response represents a key pathophysiological process in a host of cardiovascular diseases including heart failure. Regardless of etiology, heart failure is invariably preceded by cardiac hypertrophy. In the present study we investigated the effect of macrophage-specific deletion of myocardin-related transcription factor A (MRTF-A) on cardiac hypertrophy and the underlying mechanism. METHODS AND RESULTS We report that when subjected to transverse aortic constriction (TAC), macrophage MRTF-A conditional knockout (CKO) mice developed a less severe phenotype of cardiac hypertrophy compared to wild type (WT) littermates and were partially protected from the loss of heart function. In addition, there was less extensive cardiac fibrosis in the CKO mice than WT mice following the TAC procedure. Further analysis revealed that cardiac inflammation, as assessed by levels of pro-inflammatory cytokines and chemokines, was dampened in CKO mice paralleling reduced infiltration of macrophages in the heart. Mechanistically, MRTF-A deficiency attenuated the expression of integrin beta 2 (ITGB2/CD18) in macrophage thereby disrupting adhesion of macrophages to vascular endothelial cells. MRTF-A was recruited by Sp1 to the ITGB2 promoter and cooperated with Sp1 to activate ITGB2 transcription in macrophages. Administration of a CD18 blocking antibody attenuated TAC induced cardiac hypertrophy in mice. Interaction between MRTF-A and the histone demethylase KDM3A likely contributed to IGTB2 transcription and consequently adhesion of macrophages to endothelial cells. CONCLUSIONS Our data suggest that MRTF-A may regulate macrophage trafficking and contribute to the pathogenesis of cardiac hypertrophy by activating ITGB2 transcription.
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Affiliation(s)
- Li Liu
- Jiangsu Key Laboratory of Medical Biotechnology, College of Life Sciences, Nanjing Normal University, Nanjing, China
| | - Qianwen Zhao
- Key Laboratory of Targeted Intervention of Cardiovascular Disease and Collaborative Innovation Center for Cardiovascular Translational Medicine, Department of Pathophysiology, Nanjing Medical University, Nanjing, China
| | - Ming Kong
- Key Laboratory of Targeted Intervention of Cardiovascular Disease and Collaborative Innovation Center for Cardiovascular Translational Medicine, Department of Pathophysiology, Nanjing Medical University, Nanjing, China
| | - Lei Mao
- Key Laboratory of Targeted Intervention of Cardiovascular Disease and Collaborative Innovation Center for Cardiovascular Translational Medicine, Department of Pathophysiology, Nanjing Medical University, Nanjing, China
| | - Yuyu Yang
- Jiangsu Key Laboratory of Medical Biotechnology, College of Life Sciences, Nanjing Normal University, Nanjing, China.,Institute of Biomedical Research, Liaocheng University, Liaocheng, China
| | - Yong Xu
- Key Laboratory of Targeted Intervention of Cardiovascular Disease and Collaborative Innovation Center for Cardiovascular Translational Medicine, Department of Pathophysiology, Nanjing Medical University, Nanjing, China.,Institute of Biomedical Research, Liaocheng University, Liaocheng, China
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Lampropoulos IC, Raptis DG, Daniil Z, Tasoulis SK, Plagianakos VP, Malli F, Gourgoulianis KI. Temporal trends in pulmonary embolism prevalence in Greece during 2013-2017. BMC Public Health 2021; 21:559. [PMID: 33743643 PMCID: PMC7981863 DOI: 10.1186/s12889-021-10621-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 03/14/2021] [Indexed: 11/10/2022] Open
Abstract
Background Pulmonary embolism (PE) epidemiological data about the disease prevalence in the general population are unclear. The present study aims to investigate the prevalence of PE in Greece and the associated temporal trends for the years 2013–2017. Methods Data on medical prescriptions for PE in the years 2013–2017 were provided by the Greek National Health Service Organization (EOPYY). Data on age, gender, specialty of the prescribing physician and prescription unit were provided as well. Results The total number of medical prescriptions for PE for the study period was 101,426. Of the total prescriptions, 51% were issued by the Public Sector and 48% by the Private Sector. In 2013 the prevalence of PE was 5.43 cases per 100,000 citizens and increased constantly until 2017 with 23.79 cases per 100,000 population. Prevalence was higher in all years studied in the age group of 70–80 years. For the year 2017, we observed 69.35 cases per 100,000 population for subjects 70–80 years, followed by the ages 80–90 (60.58/100,000) and 60–70 years (56.47 /100,000). Females displayed higher PE prevalence than males and higher increasing trend. Conclusion PE prevalence has an increasing trend throughout the years 2013–2017 while prevalence in females is higher than males and displays a higher increasing trend. Our results may be used to appropriately organize nationwide health care campaigns aiming at the diagnosis, treatment and prevention of PE. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-10621-2.
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Affiliation(s)
- Ioannis C Lampropoulos
- Respiratory Medicine Department, University of Thessaly, School of Medicine, Biopolis (Mezourlo), 41110, Larissa, Greece
| | - Dimitrios G Raptis
- Respiratory Medicine Department, University of Thessaly, School of Medicine, Biopolis (Mezourlo), 41110, Larissa, Greece
| | - Zoe Daniil
- Respiratory Medicine Department, University of Thessaly, School of Medicine, Biopolis (Mezourlo), 41110, Larissa, Greece
| | - Sotirios K Tasoulis
- Department of Computer Science and Biomedical Informatics, University of Thessaly, Lamia, Greece
| | - Vassilis P Plagianakos
- Department of Computer Science and Biomedical Informatics, University of Thessaly, Lamia, Greece.,Greek National Health Service Organization (EOPYY), Athens, Greece
| | - Foteini Malli
- Respiratory Medicine Department, University of Thessaly, School of Medicine, Biopolis (Mezourlo), 41110, Larissa, Greece. .,Respiratory Disorders Lab, Faculty of Nursing, University of Thessaly, Larissa, Greece.
| | - Konstantinos I Gourgoulianis
- Respiratory Medicine Department, University of Thessaly, School of Medicine, Biopolis (Mezourlo), 41110, Larissa, Greece
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Purwowiyoto SL, Prawara AS. Metabolic syndrome and heart failure: mechanism and management. Med Pharm Rep 2021; 94:15-21. [PMID: 33629043 PMCID: PMC7880077 DOI: 10.15386/mpr-1884] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 10/15/2020] [Accepted: 11/06/2020] [Indexed: 12/14/2022] Open
Abstract
Heart failure (HF) and metabolic syndrome (MetS) are syndromes that affect a large proportion of the world population. MetS is known to be one of the risk factors of HF, and it can also act as comorbidity in HF. This review aims to further discuss the mechanism of MetS in causing HF, the management of MetS in order to prevent HF, and the management of MetS in HF patients. Visceral adiposity is the primary trigger of MetS which is followed by chronic inflammation, insulin resistance, and neurohormonal activation. All the mechanisms causing MetS play also an important role in the progression of HF. The MetS approach can be achieved by managing its components according to the current guidelines and careful management of MetS should be done in patients with HF. MetS is closely related to the progression of HF so that comprehensive management which involves a multidisciplinary team is necessary for managing patients with metabolic syndrome and heart failure.
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Affiliation(s)
- Sidhi Laksono Purwowiyoto
- Cardiac Catheterization Laboratory, Department of Cardiology and Vascular Medicine, RSUD Pasar Rebo, East Jakarta, Indonesia.,Faculty of Medicine, Universitas Muhammadiyah Prof. DR. Hamka, Tangerang, Indonesia
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25
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Precision medicine in human heart modeling : Perspectives, challenges, and opportunities. Biomech Model Mechanobiol 2021; 20:803-831. [PMID: 33580313 PMCID: PMC8154814 DOI: 10.1007/s10237-021-01421-z] [Citation(s) in RCA: 62] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 01/07/2021] [Indexed: 01/05/2023]
Abstract
Precision medicine is a new frontier in healthcare that uses scientific methods to customize medical treatment to the individual genes, anatomy, physiology, and lifestyle of each person. In cardiovascular health, precision medicine has emerged as a promising paradigm to enable cost-effective solutions that improve quality of life and reduce mortality rates. However, the exact role in precision medicine for human heart modeling has not yet been fully explored. Here, we discuss the challenges and opportunities for personalized human heart simulations, from diagnosis to device design, treatment planning, and prognosis. With a view toward personalization, we map out the history of anatomic, physical, and constitutive human heart models throughout the past three decades. We illustrate recent human heart modeling in electrophysiology, cardiac mechanics, and fluid dynamics and highlight clinically relevant applications of these models for drug development, pacing lead failure, heart failure, ventricular assist devices, edge-to-edge repair, and annuloplasty. With a view toward translational medicine, we provide a clinical perspective on virtual imaging trials and a regulatory perspective on medical device innovation. We show that precision medicine in human heart modeling does not necessarily require a fully personalized, high-resolution whole heart model with an entire personalized medical history. Instead, we advocate for creating personalized models out of population-based libraries with geometric, biological, physical, and clinical information by morphing between clinical data and medical histories from cohorts of patients using machine learning. We anticipate that this perspective will shape the path toward introducing human heart simulations into precision medicine with the ultimate goals to facilitate clinical decision making, guide treatment planning, and accelerate device design.
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26
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Chan MY, Efthymios M, Tan SH, Pickering JW, Troughton R, Pemberton C, Ho HH, Prabath JF, Drum CL, Ling LH, Soo WM, Chai SC, Fong A, Oon YY, Loh JP, Lee CH, Foo RSY, Ackers-Johnson MA, Pilbrow A, Richards AM. Prioritizing Candidates of Post-Myocardial Infarction Heart Failure Using Plasma Proteomics and Single-Cell Transcriptomics. Circulation 2020; 142:1408-1421. [PMID: 32885678 PMCID: PMC7547904 DOI: 10.1161/circulationaha.119.045158] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Supplemental Digital Content is available in the text. Background: Heart failure (HF) is the most common long-term complication of acute myocardial infarction (MI). Understanding plasma proteins associated with post-MI HF and their gene expression may identify new candidates for biomarker and drug target discovery. Methods: We used aptamer-based affinity-capture plasma proteomics to measure 1305 plasma proteins at 1 month post-MI in a New Zealand cohort (CDCS [Coronary Disease Cohort Study]) including 181 patients post-MI who were subsequently hospitalized for HF in comparison with 250 patients post-MI who remained event free over a median follow-up of 4.9 years. We then correlated plasma proteins with left ventricular ejection fraction measured at 4 months post-MI and identified proteins potentially coregulated in post-MI HF using weighted gene co-expression network analysis. A Singapore cohort (IMMACULATE [Improving Outcomes in Myocardial Infarction through Reversal of Cardiac Remodelling]) of 223 patients post-MI, of which 33 patients were hospitalized for HF (median follow-up, 2.0 years), was used for further candidate enrichment of plasma proteins by using Fisher meta-analysis, resampling-based statistical testing, and machine learning. We then cross-referenced differentially expressed proteins with their differentially expressed genes from single-cell transcriptomes of nonmyocyte cardiac cells isolated from a murine MI model, and single-cell and single-nucleus transcriptomes of cardiac myocytes from murine HF models and human patients with HF. Results: In the CDCS cohort, 212 differentially expressed plasma proteins were significantly associated with subsequent HF events. Of these, 96 correlated with left ventricular ejection fraction measured at 4 months post-MI. Weighted gene co-expression network analysis prioritized 63 of the 212 proteins that demonstrated significantly higher correlations among patients who developed post-MI HF in comparison with event-free controls (data set 1). Cross-cohort meta-analysis of the IMMACULATE cohort identified 36 plasma proteins associated with post-MI HF (data set 2), whereas single-cell transcriptomes identified 15 gene-protein candidates (data set 3). The majority of prioritized proteins were of matricellular origin. The 6 most highly enriched proteins that were common to all 3 data sets included well-established biomarkers of post-MI HF: N-terminal B-type natriuretic peptide and troponin T, and newly emergent biomarkers, angiopoietin-2, thrombospondin-2, latent transforming growth factor-β binding protein-4, and follistatin-related protein-3, as well. Conclusions: Large-scale human plasma proteomics, cross-referenced to unbiased cardiac transcriptomics at single-cell resolution, prioritized protein candidates associated with post-MI HF for further mechanistic and clinical validation.
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Affiliation(s)
- Mark Y Chan
- Department of Medicine, Yong Loo-Lin School of Medicine, National University of Singapore (M.Y.C., M.E., S.H.T., C.L.D., L.H.L., W.-M.S., J.P.L., C.-H.L., R.S.Y.F., M.A.A.-J., A.M.R.).,National University Heart Centre, National University Health System, Singapore (M.Y.C., C.L.D., L.H.L., W.-M.S., J.P.L., C.-H.L., R.S.Y.F., A.M.R.)
| | - Motakis Efthymios
- Department of Medicine, Yong Loo-Lin School of Medicine, National University of Singapore (M.Y.C., M.E., S.H.T., C.L.D., L.H.L., W.-M.S., J.P.L., C.-H.L., R.S.Y.F., M.A.A.-J., A.M.R.).,Genome Institute of Singapore, Agency for Science, Technology, and Research, Singapore (M.E., R.S.Y.F., M.A.A.-J.)
| | - Sock Hwee Tan
- Department of Medicine, Yong Loo-Lin School of Medicine, National University of Singapore (M.Y.C., M.E., S.H.T., C.L.D., L.H.L., W.-M.S., J.P.L., C.-H.L., R.S.Y.F., M.A.A.-J., A.M.R.)
| | - John W Pickering
- Christchurch Heart Institute, Department of Medicine, University of Otago, New Zealand (J.W.P., R.T., C.P., A.P., A.M.R.)
| | - Richard Troughton
- Christchurch Heart Institute, Department of Medicine, University of Otago, New Zealand (J.W.P., R.T., C.P., A.P., A.M.R.)
| | - Christopher Pemberton
- Christchurch Heart Institute, Department of Medicine, University of Otago, New Zealand (J.W.P., R.T., C.P., A.P., A.M.R.)
| | - Hee-Hwa Ho
- Tan Tock Seng Hospital, Singapore (H.-H.H., J.-F.P.)
| | | | - Chester L Drum
- Department of Medicine, Yong Loo-Lin School of Medicine, National University of Singapore (M.Y.C., M.E., S.H.T., C.L.D., L.H.L., W.-M.S., J.P.L., C.-H.L., R.S.Y.F., M.A.A.-J., A.M.R.).,National University Heart Centre, National University Health System, Singapore (M.Y.C., C.L.D., L.H.L., W.-M.S., J.P.L., C.-H.L., R.S.Y.F., A.M.R.)
| | - Lieng Hsi Ling
- Department of Medicine, Yong Loo-Lin School of Medicine, National University of Singapore (M.Y.C., M.E., S.H.T., C.L.D., L.H.L., W.-M.S., J.P.L., C.-H.L., R.S.Y.F., M.A.A.-J., A.M.R.).,National University Heart Centre, National University Health System, Singapore (M.Y.C., C.L.D., L.H.L., W.-M.S., J.P.L., C.-H.L., R.S.Y.F., A.M.R.)
| | - Wern-Miin Soo
- Department of Medicine, Yong Loo-Lin School of Medicine, National University of Singapore (M.Y.C., M.E., S.H.T., C.L.D., L.H.L., W.-M.S., J.P.L., C.-H.L., R.S.Y.F., M.A.A.-J., A.M.R.).,National University Heart Centre, National University Health System, Singapore (M.Y.C., C.L.D., L.H.L., W.-M.S., J.P.L., C.-H.L., R.S.Y.F., A.M.R.)
| | | | - Alan Fong
- Sarawak Heart Institute, Kuching, Malaysia (A.F., Y.-Y.O.)
| | - Yen-Yee Oon
- Sarawak Heart Institute, Kuching, Malaysia (A.F., Y.-Y.O.)
| | - Joshua P Loh
- Department of Medicine, Yong Loo-Lin School of Medicine, National University of Singapore (M.Y.C., M.E., S.H.T., C.L.D., L.H.L., W.-M.S., J.P.L., C.-H.L., R.S.Y.F., M.A.A.-J., A.M.R.).,National University Heart Centre, National University Health System, Singapore (M.Y.C., C.L.D., L.H.L., W.-M.S., J.P.L., C.-H.L., R.S.Y.F., A.M.R.)
| | - Chi-Hang Lee
- Department of Medicine, Yong Loo-Lin School of Medicine, National University of Singapore (M.Y.C., M.E., S.H.T., C.L.D., L.H.L., W.-M.S., J.P.L., C.-H.L., R.S.Y.F., M.A.A.-J., A.M.R.).,National University Heart Centre, National University Health System, Singapore (M.Y.C., C.L.D., L.H.L., W.-M.S., J.P.L., C.-H.L., R.S.Y.F., A.M.R.)
| | - Roger S Y Foo
- Department of Medicine, Yong Loo-Lin School of Medicine, National University of Singapore (M.Y.C., M.E., S.H.T., C.L.D., L.H.L., W.-M.S., J.P.L., C.-H.L., R.S.Y.F., M.A.A.-J., A.M.R.).,National University Heart Centre, National University Health System, Singapore (M.Y.C., C.L.D., L.H.L., W.-M.S., J.P.L., C.-H.L., R.S.Y.F., A.M.R.).,Genome Institute of Singapore, Agency for Science, Technology, and Research, Singapore (M.E., R.S.Y.F., M.A.A.-J.)
| | - Matthew Andrew Ackers-Johnson
- Department of Medicine, Yong Loo-Lin School of Medicine, National University of Singapore (M.Y.C., M.E., S.H.T., C.L.D., L.H.L., W.-M.S., J.P.L., C.-H.L., R.S.Y.F., M.A.A.-J., A.M.R.).,Genome Institute of Singapore, Agency for Science, Technology, and Research, Singapore (M.E., R.S.Y.F., M.A.A.-J.)
| | - Anna Pilbrow
- Christchurch Heart Institute, Department of Medicine, University of Otago, New Zealand (J.W.P., R.T., C.P., A.P., A.M.R.)
| | - A Mark Richards
- Department of Medicine, Yong Loo-Lin School of Medicine, National University of Singapore (M.Y.C., M.E., S.H.T., C.L.D., L.H.L., W.-M.S., J.P.L., C.-H.L., R.S.Y.F., M.A.A.-J., A.M.R.).,National University Heart Centre, National University Health System, Singapore (M.Y.C., C.L.D., L.H.L., W.-M.S., J.P.L., C.-H.L., R.S.Y.F., A.M.R.).,Changi General Hospital, Singapore (S.-C.C.)
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Murata D, Arai K, Nakayama K. Scaffold-Free Bio-3D Printing Using Spheroids as "Bio-Inks" for Tissue (Re-)Construction and Drug Response Tests. Adv Healthc Mater 2020; 9:e1901831. [PMID: 32378363 DOI: 10.1002/adhm.201901831] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 02/21/2020] [Accepted: 03/04/2020] [Indexed: 02/06/2023]
Abstract
In recent years, scaffold-free bio-3D printing using cell aggregates (spheroids) as "bio-inks" has attracted increasing attention as a method for 3D cell construction. Bio-3D printing uses a technique called the Kenzan method, wherein spheroids are placed one-by-one in a microneedle array (the "Kenzan") using a bio-3D printer. The bio-3D printer is a machine that was developed to perform bio-3D printing automatically. Recently, it has been reported that cell constructs can be produced by a bio-3D printer using spheroids composed of many types of cells and that this can contribute to tissue (re-)construction. This progress report summarizes the production and effectiveness of various cell constructs prepared using bio-3D printers. It also considers the future issues and prospects of various cell constructs obtained by using this method for further development of scaffold-free 3D cell constructions.
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Affiliation(s)
- Daiki Murata
- Center for Regenerative Medicine ResearchFaculty of MedicineSaga University Honjo‐machi Saga 840‐8502 Japan
| | - Kenichi Arai
- Center for Regenerative Medicine ResearchFaculty of MedicineSaga University Honjo‐machi Saga 840‐8502 Japan
| | - Koichi Nakayama
- Center for Regenerative Medicine ResearchFaculty of MedicineSaga University Honjo‐machi Saga 840‐8502 Japan
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28
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(Expert consensus statement of the Czech Heart Failure Association of the Czech Society of Cardiology on the managing of heart failure clinics). COR ET VASA 2020. [DOI: 10.33678/cor.2020.046] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Vicent L, Cinca J, Vazquez-García R, Gonzalez-Juanatey JR, Rivera M, Segovia J, Pascual-Figal D, Bover R, Worner F, Delgado-Jiménez J, Fernández-Avilés F, Martínez-Sellés M. Discharge treatment with angiotensin-converting enzyme inhibitor/angiotensin receptor blocker after a heart failure hospitalisation is associated with a better prognosis irrespective of left ventricular ejection fraction. Intern Med J 2020; 49:1505-1513. [PMID: 30887642 DOI: 10.1111/imj.14289] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 02/18/2019] [Accepted: 03/05/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND Medical therapy could improve the prognosis of real-life patients discharged after a heart failure (HF) hospitalisation. AIM To determine the impact of discharge HF treatment on mortality and readmissions in different left ventricular ejection fraction (LVEF) groups. METHODS Multicentre prospective registry in 20 Spanish hospitals. Patients were enrolled after a HF hospitalisation. RESULTS A total of 1831 patients was included (583 (31.8%) HF with reduced ejection fraction (HFrEF); 227 (12.4%) HF with midrange ejection fraction (HFmrEF); 610 (33.3%) HF with preserved ejection fraction (HFpEF), and 411 (22.4%) with unknown LVEF). Angiotensin-converting enzyme (ACE) inhibitors/angiotensin II receptor blockers (ARB) at discharge were independently associated with a reduction in: (i) all-cause mortality: hazard ratio (HR) 0.55, 95% confidence interval (CI) 0.41-0.74, P < 0.001, with a similar effect in the four groups; (ii) mortality due to refractory HF HR 0.45, 95% CI 0.29-0.64, P < 0.001, with a similar effect in the three groups with known LVEF; (iii) mortality/HF admissions (HR 0.61; 95% CI: 0.50-0.74), more evident in HFrEF (HR 0.54; 95% CI: 0.38-0.78) compared with HRmEF (HR 0.64; 95% CI 0.40-1.02), or HFpEF (HR 0.70; 95% CI 0.53-0.92). In patients with HFrEF triple therapy (ACE inhibitor/ARB + beta blocker + mineralocorticoid receptor antagonist) was associated with the lowest mortality risk (HR 0.21; 95% CI: 0.08-0.57, P = 0.002) compared with patients that received none of these drugs. CONCLUSIONS Discharge treatment with ACE inhibitor/ARB after a HF hospitalisation is associated with a reduction in all-cause and refractory HF mortality, irrespective of LVEF.
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Affiliation(s)
- Lourdes Vicent
- Cardiology Department, Hospital General Universitario Gregorio Marañón, CIBERCV, Madrid, Spain
| | - Juan Cinca
- Cardiology Department, Hospital de la Santa Creu i Sant Pau, CIBERCV, Barcelona, Spain
| | | | | | - Miguel Rivera
- Cardiology Department, University Hospital La Fe, Spain
| | - Javier Segovia
- Cardiology Department, Hospital Universitario Puerta de Hierro Majadahonda, CIBERCV, Madrid, Spain
| | - Domingo Pascual-Figal
- Cardiology Department, Hospital Clínico Universitario Virgen de la Arrixaca, El Palmar, Spain
| | - Ramón Bover
- Cardiology Department, Hospital Clinico San Carlos, Madrid, Spain
| | - Fernando Worner
- Cardiology Department, Hospital Universitari Arnau de Vilanova, Lleida, IRBLLEIDA, Spain
| | | | - Francisco Fernández-Avilés
- Cardiology Department, Hospital General Universitario Gregorio Marañón, CIBERCV, Madrid, Spain.,Cardiology Department, Universidad Complutense, Madrid, Spain
| | - Manuel Martínez-Sellés
- Cardiology Department, Hospital General Universitario Gregorio Marañón, CIBERCV, Madrid, Spain.,Cardiology Department, Universidad Complutense, Madrid, Spain.,Universidad Europea, Madrid, Spain
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Jain CC, Borlaug BA. Hemodynamic assessment in heart failure. Catheter Cardiovasc Interv 2020; 95:420-428. [PMID: 31507065 DOI: 10.1002/ccd.28490] [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: 08/23/2019] [Accepted: 08/25/2019] [Indexed: 12/28/2022]
Abstract
Hemodynamics play a central role in the pathophysiology of heart failure (HF), yet their proper assessment and optimization remains challenging. Heart failure is defined as the inability of the heart to deliver adequate perfusion (cardiac output) to the body at rest or exercise, or to require an elevation in cardiac filling pressures in order to do this. This bedrock definition is important because it relies on measurable quantities (filling pressures and output) that are readily assessed in the cardiac catheterization laboratory. Here we present three cases to illustrate how better understanding of the determinants of cardiac output and stroke volume: preload, afterload, contractility, and lusitropy, as well as the determinants of congestion (high filling pressures) may be used to guide optimization of hemodynamic status. The goal is that the readers will be able to think more critically when evaluating the hemodynamics of their patient in HF and recognize the complex interplay that determines the complex balance between cardiac ejection and filling capabilities, and how this alters symptoms and outcomes for patients with HF. KEY POINTS: Careful assessment of hemodynamics in the catheterization laboratory allows for actionable insight to a patient's volume status, cardiac function and can help prognosticate outcomes. Exercise hemodynamics in heart failure is a powerful tool to better understand the cause of symptoms and predict outcomes. Clinicians should aim to decrease biventricular filling pressures to normal values to improve morbidity and reduce risk for readmission. In patients with heart failure and reduced ejection fraction, clinicians should aim to decrease afterload as much as can be tolerated by the renal function and patient's symptoms. Low cardiac output can often be improved by optimizing preload and afterload rather than initiating inotropes, which should be reserved until needed. In advanced heart failure, the right heart function becomes a key determinant of symptoms and outcomes.
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Affiliation(s)
| | - Barry A Borlaug
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
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Mangieri A, Laricchia A, Giannini F, Gallo F, Kargoli F, Ladanyi A, Testa L, Colombo A, Latib A. Emerging Technologies for Percutaneous Mitral Valve Repair. Front Cardiovasc Med 2019; 6:161. [PMID: 31781576 PMCID: PMC6851532 DOI: 10.3389/fcvm.2019.00161] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Accepted: 10/21/2019] [Indexed: 12/19/2022] Open
Abstract
Mitral regurgitation (MR) is a common disease affecting more than 4 million people in the United States and the European Union. A significant number of percutaneous valves have been developed recently, specifically designed for the mitral anatomy, and with a promising evidence of good procedural and echocardiographic outcomes. However, even if transcatheter mitral valve replacement (TMVR) will have a role in the future of percutaneous treatment of both functional and degenerative mitral regurgitation, percutaneous mitral valve repair will always play a vital role in the treatment of MR because of the favorable safety profile and the fact that it respects the native anatomy. In this review, we will discuss the new emerging technologies under development to treat mitral regurgitation focusing on different devices that aim to target different components of the mitral anatomy.
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Affiliation(s)
| | | | | | - Francesco Gallo
- GVM Care and Research, Maria Cecilia Hospital, Ravenna, Italy
| | - Faraj Kargoli
- Division of Cardiology, Department of Medicine, Montefiore Medical Center, Bronx, NY, United States
| | - Annamaria Ladanyi
- Division of Cardiology, Department of Medicine, Montefiore Medical Center, Bronx, NY, United States.,San Raffaele University Hospital, Milan, Italy
| | - Luca Testa
- Department of Clinical and Interventional Cardiology, IRCCS Policlinico San Donato, Milan, Italy
| | - Antonio Colombo
- GVM Care and Research, Maria Cecilia Hospital, Ravenna, Italy
| | - Azeem Latib
- Division of Cardiology, Department of Medicine, Montefiore Medical Center, Bronx, NY, United States.,Division of Cardiology, Department of Medicine, University of Cape Town, Cape Town, South Africa
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Li T, Zhang Z, Zhang X, Chen Z, Cheng HJ, Ahmad S, Ferrario CM, Cheng CP. Reversal of angiotensin-(1-12)-caused positive modulation on left ventricular contractile performance in heart failure: Assessment by pressure-volume analysis. Int J Cardiol 2019; 301:135-141. [PMID: 31521437 DOI: 10.1016/j.ijcard.2019.09.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 08/19/2019] [Accepted: 09/04/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Angiotensin-(1-12) [Ang-(1-12)] is a renin-independent precursor for direct angiotensin-II production by chymase. Substantial evidence suggests that heart failure (HF) may alter cardiac Ang-(1-12) expression and activity; this novel Ang-(1-12)/chymase axis may be the main source for angiotensin-II deleterious actions in HF. We hypothesized that HF alters cardiac response to Ang-(1-12). Its stimulation may produce cardiac negative modulation and exacerbate left ventricle (LV) systolic and diastolic dysfunction. METHODS AND RESULTS We assessed the effects of Ang-(1-12) (2 nmol/kg/min, iv, 10 min) on LV contractility, LV diastolic filling, and LV-arterial coupling (AVC) in 16 SD male rats with HF-induced by isoproterenol (3 mo after 170 mg/kg sq. for 2 consecutive days) and 10 age-matched male controls. In normal controls, versus baseline, Ang-(1-12) increased LV end-systolic pressure, without altering heart rate, arterial elastance (EA), LV end-diastolic pressure (PED), the time constant of LV relaxation (τ) and ejection fraction (EF). Ang-(1-12) significantly increased the slopes (EES) of LV end-systolic pressure (P)-volume (V) relations and the slopes (MSW) of LV stroke wok-end-diastolic V relations, indicating increased LV contractility. AVC (quantified as EES/EA) improved. In contrast, in HF, versus HF baseline, Ang-(1-12) produced a similar increase in PES, but significantly increased τ, EA, and PED. The early diastolic portion of LV PV loop was shifted upward with reduced in EF. Moreover, Ang-(1-12) significantly decreased EES and MSW, demonstrating decreased LV contractility. AVC was decreased by 43%. CONCLUSIONS In both normal and HF rats, Ang-(1-12) causes similar vasoconstriction. In normal, Ang-(1-12) increases LV contractile function. In HF, Ang-(1-12) has adverse effects and depresses LV systolic and diastolic functional performance.
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Affiliation(s)
- Tiankai Li
- Department of Cardiology, the First Affiliated Hospital of Harbin Medical University, Harbin, China; Department of Internal Medicine, Section on Cardiovascular Medicine, Wake Forest School of Medicine, Winston Salem, NC, United States of America
| | - Zhi Zhang
- Department of Internal Medicine, Section on Cardiovascular Medicine, Wake Forest School of Medicine, Winston Salem, NC, United States of America; Department of cardiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine (originally named "Shanghai First People's Hospital"), Shanghai, China
| | - Xiaowei Zhang
- Department of Internal Medicine, Section on Cardiovascular Medicine, Wake Forest School of Medicine, Winston Salem, NC, United States of America; Department of Cardiology, The Second Hospital of Shandong University, Jinan, Shandong, China
| | - Zhe Chen
- Department of Internal Medicine, Section on Cardiovascular Medicine, Wake Forest School of Medicine, Winston Salem, NC, United States of America; Department of Endocrinology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Heng-Jie Cheng
- Department of Cardiology, the First Affiliated Hospital of Harbin Medical University, Harbin, China; Department of Internal Medicine, Section on Cardiovascular Medicine, Wake Forest School of Medicine, Winston Salem, NC, United States of America
| | - Sarfaraz Ahmad
- Department of Surgery, Wake Forest School of Medicine, Winston-Salem, North Carolina, United States of America; Department of Physiology and Pharmacology, Wake Forest School of Medicine, Winston-Salem, NC, United States of America
| | - Carlos M Ferrario
- Department of Surgery, Wake Forest School of Medicine, Winston-Salem, North Carolina, United States of America; Department of Physiology and Pharmacology, Wake Forest School of Medicine, Winston-Salem, NC, United States of America
| | - Che Ping Cheng
- Department of Cardiology, the First Affiliated Hospital of Harbin Medical University, Harbin, China; Department of Internal Medicine, Section on Cardiovascular Medicine, Wake Forest School of Medicine, Winston Salem, NC, United States of America.
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Kinugawa K, Sato N, Inomata T, Yasuda M, Shimakawa T, Fukuta Y. A Prospective, Multicenter, Post-Marketing Surveillance Study to Evaluate the Safety and Effectiveness of Tolvaptan in Patients with Reduced, Preserved, and Mid-Range Ejection Fraction Heart Failure. Int Heart J 2019; 60:1123-1130. [PMID: 31484861 DOI: 10.1536/ihj.18-671] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Tolvaptan, a vasopressin V2 receptor antagonist, is approved in Japan for the treatment of fluid retention in patients with heart failure (HF), and in the United States for hyponatremia. The efficacy and safety of tolvaptan in patients with HF with reduced ejection fraction (HFrEF) have been demonstrated previously. However, its efficacy in patients with HF having preserved (HFpEF) and mid-range (HFmrEF) ejection fraction (EF) remains uncertain. The present subgroup analysis from the post-marketing surveillance SMILE Study aims to explore the efficacy and safety of tolvaptan across the HF subgroups (HFrEF, HFpEF, and HFmrEF).Patients with HF accompanied by fluid retention who received tolvaptan were enrolled. Primary endpoints were: change in body weight, 24-hour urine volume, congestive symptoms, and safety over 14-day treatment. Of the 3,349 patients enrolled, left ventricular EF data were available for 1,741 patients; 45.7% had HFpEF. Tolvaptan treatment resulted in body weight reduction and increases in 24-hour urine volume across the 3 subgroups. Congestive symptoms significantly improved over the 14-day treatment in all subgroups. The frequency of adverse events (AEs) was comparable across the subgroups; thirst was the most common AE.Tolvaptan provides a safe and effective option for treating fluid retention in patients with HFpEF, as well as HFmrEF and HFrEF.
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Affiliation(s)
| | - Naoki Sato
- Department of Cardiovascular Medicine, Kawaguchi Cardiovascular and Respiratory Hospital
| | - Takayuki Inomata
- Department of Cardiology, Kitasato University Kitasato Institute Hospital
| | | | | | - Yasuhiko Fukuta
- Department of Pharmacovigilance, Otsuka Pharmaceutical Co., Ltd
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Yan J, Pan Y, Xiao J, Ma W, Li L, Zhong M, Long H, Kong F, Shao W. High Level of Lipoprotein(a) as Predictor for Recurrent Heart Failure in Patients with Chronic Heart Failure: a Cohort Study. Arq Bras Cardiol 2019; 113:197-204. [PMID: 31340235 PMCID: PMC6777886 DOI: 10.5935/abc.20190120] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Accepted: 11/14/2018] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Elevated plasma levels of Lipoprotein(a) [Lp(a)] are recognized as a significant risk factor for atherosclerotic vascular disease. However, there are limited data regarding association between Lp(a) and recurrent heart failure (HF) in patients with chronic HF caused by coronary heart disease (CHD). OBJECTIVE Elevated levels of Lp(a) might have a prognostic impact on recurrent HF in patients with chronic HF caused by CHD. METHODS A total of 309 patients with chronic HF caused by CHD were consecutively enrolled in this study. The patients were divided into 2 groups according to whether Lp(a) levels were above or below the median level for the entire cohort (20.6 mg/dL): the high Lp(a) group (n = 155) and the low Lp(a) group (n = 154). A 2-sided p < 0.05 was statistically considered significant. RESULTS During the median follow-up period of 186 days, 31 cases out of a total of 309 patients (10.03%) could not be reached during follow-up. A Kaplan-Meier analysis demonstrated that patients with higher Lp(a) levels had a higher incidence of recurrent HF than those with lower Lp(a) levels (log-rank < 0.0001). A multivariate Cox regression analysis revealed that Lp(a) levels were independently correlated with the incidence of recurrent HF after adjustment of potential confounders (hazard ratio: 2.720, 95 % confidence interval: 1.730-4.277, p < 0.0001). CONCLUSIONS In Chinese patients with chronic HF caused by CHD, elevated levels of Lp(a) are independently associated with recurrent HF.
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Affiliation(s)
- Jianlong Yan
- Huadu District People's Hospital, Southern Medical University - Cardiology, Guangzhou - China
| | - Yanbin Pan
- Huadu District People's Hospital, Southern Medical University - Intensive Care Unit., Guangzhou - China
| | - Junhui Xiao
- Huadu District People's Hospital, Southern Medical University - Cardiology, Guangzhou - China
| | - Wenxue Ma
- Huadu District People's Hospital, Southern Medical University - Cardiology, Guangzhou - China
| | - Li Li
- Huadu District People's Hospital, Southern Medical University - Cardiology, Guangzhou - China
| | - Mingjiang Zhong
- Huadu District People's Hospital, Southern Medical University - Cardiology, Guangzhou - China
| | - Haiquan Long
- Huadu District People's Hospital, Southern Medical University - Cardiology, Guangzhou - China
| | - Fanliang Kong
- Huadu District People's Hospital, Southern Medical University - Cardiology, Guangzhou - China
| | - Wenming Shao
- The First Affiliated Hospital of Jinan University - Emergency, Guangzhou - China
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Age-Stratified National Trends in Pulmonary Embolism Admissions. Chest 2019; 156:733-742. [PMID: 31233745 DOI: 10.1016/j.chest.2019.05.021] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2018] [Revised: 05/14/2019] [Accepted: 05/27/2019] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Pulmonary embolism (PE) is one of the leading causes of death in hospitalized patients. Treatment patterns and patient demographics for PE are changing; therefore, we sought to evaluate national trends in admission rate, discharge disposition, and length of stay (LOS) in patients hospitalized with PE. METHODS The National Inpatient Sample database was used to collect data for hospitalizations of patients ≥ 20 years old with primary diagnosis of PE between January 2000 and September 2015. Patient demographics and hospital characteristics, stratified by patient age, were reported. Trends in rates of hospitalizations for PE, LOS, discharge disposition, and hospital charges were assessed across age groups. RESULTS There were an estimated 2,159,568 hospitalizations with primary diagnosis of PE. The rate of PE per 100,000 persons increased by > 100%, and was highest among elderly patients. Increased age and comorbidity burden were independently associated with poor outcomes. Inpatient mortality and LOS decreased across all age groups, but was highest in the elderly. Home health utilization increased in patients ≥ 55 years old. Average hospital charges increased across all age groups, despite shorter length of stay, with patients ≥ 85 experiencing $13,000 average increase. CONCLUSIONS Between 2000 and 2015, the rate of hospitalization for PE increased across all age groups. Despite improvements in average LOS and inpatient mortality, hospitalizations became more expensive, and patients required more resources (ie, home health) on discharge. This increased resource utilization was most apparent in elderly patients. This suggests that targeted clinical trials designed to improve outcomes in all age brackets are needed.
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Udelson JE. Is Heart Failure Etiology Destiny?: Outcome and Therapeutic Implications. JACC. HEART FAILURE 2019; 7:466-468. [PMID: 31078474 DOI: 10.1016/j.jchf.2019.03.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Accepted: 03/24/2019] [Indexed: 06/09/2023]
Affiliation(s)
- James E Udelson
- Division of Cardiology and the CardioVascular Center, Tufts Medical Center, Boston, Massachusetts.
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Guo J, Li S, Li Y, Yan C, Wan Q, Wang Z. HSP90 inhibitor 17-AAG prevents apoptosis of cardiomyocytes via miR-93-dependent mitigation of endoplasmic reticulum stress. J Cell Biochem 2019; 120:7888-7896. [PMID: 30556167 DOI: 10.1002/jcb.28064] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Accepted: 10/22/2018] [Indexed: 01/24/2023]
Abstract
Heart failure accounts for substantial morbidity and mortality worldwide. Accumulating evidence suggests that aberrant cardiac cell death caused by endoplasmic reticulum stress (ERS) is often associated with structural or functional cardiac abnormalities that lead to insufficient cardiac output. The detailed molecular mechanism underlying the pathological death of cardiomyocytes still remains poorly understood. We found that 17-AAG (tanespimycin), an HSP90 (heat shock protein 90) inhibitor often used to kill cancer cells, could potently inhibit tunicamycin-induced ERS and the downstream nuclear factor kappa B activity in neonatal rat cardiomyocytes, leading to diminished apoptotic signaling and thus enhanced cell survival. Interestingly, the antiapoptotic effect of 17-AAG on cardiomyocytes required normal expression of miR-93, an oncogenic microRNA known to promote cell survival and growth. Our study implicated a new pharmacological role of 17-AAG in supporting the miR-93-associated oncogenic signaling to prevent the pathological death of cardiomyocytes. The results opened opportunities for exploring new strategies in the development of therapeutic agents.
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Affiliation(s)
- Jingjing Guo
- Department of Cardiology, Huaihe Hospital, Henan University, Kaifeng City, Henan, China
| | - Shengnan Li
- Department of Cardiology, Huaihe Hospital, Henan University, Kaifeng City, Henan, China
| | - Yanming Li
- Department of Cardiology, Huaihe Hospital, Henan University, Kaifeng City, Henan, China
| | - Chenyun Yan
- Department of Cardiology, Huaihe Hospital, Henan University, Kaifeng City, Henan, China
| | - Qilin Wan
- Department of Cardiology, Huaihe Hospital, Henan University, Kaifeng City, Henan, China
| | - Zhizhong Wang
- Department of Cardiology, Huaihe Hospital, Henan University, Kaifeng City, Henan, China
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Li R, He H, Fang S, Hua Y, Yang X, Yuan Y, Liang S, Liu P, Tian Y, Xu F, Zhang Z, Huang Y. Time Series Characteristics of Serum Branched-Chain Amino Acids for Early Diagnosis of Chronic Heart Failure. J Proteome Res 2019; 18:2121-2128. [PMID: 30895791 DOI: 10.1021/acs.jproteome.9b00002] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Chronic heart failure (CHF) is an ongoing clinical syndrome with cardiac dysfunction that can be traced to alterations in cardiac metabolism. The identification of metabolic biomarkers in easily accessible fluids to improve the early diagnosis of CHF has been elusive to date. In this study, we took multidimensional analytical techniques to discover potentially new diagnostic biomarkers by focusing on the dynamic changes of metabolites in serum during the progression of CHF. Using mass-spectrometry-based untargeted metabolomics, we identified 23 cardiac metabolites that were altered in a rat model of myocardial infarction induced CHF. Among these differential metabolites, branched-chain amino acids (BCAAs) in serum, especially leucine and valine, showed a high capability to differentiate between CHF and sham-operated rats, of which area under the receiver operating characteristic curve was greater than 0.75. Combining with targeted analysis of the amino acids and related proteins and genes, we confirmed that BCAA metabolic pathway was significantly inhibited in rat failing hearts. On the basis of the time series data of serum samples, we characterized the fluctuation pattern of circulating BCAAs by the disease progression model. Finally, the time-resolved diagnostic potential of serum BCAAs was evaluated by the machine-learning-based classifier, and high diagnostic accuracy of 93.75% was achieved within 3 weeks after surgery. These findings provide a promising metabolic signature that can be further exploited for CHF early diagnostic development.
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Affiliation(s)
- Ruiting Li
- Key Laboratory of Drug Quality Control and Pharmacovigilance , China Pharmaceutical University, Ministry of Education , Nanjing 210009 , China.,Key Laboratory of Myocardial Ischemia , Harbin Medical University, Ministry of Education , Harbin , China
| | - Hua He
- Center of Drug Metabolism and Pharmacokinetics, College of Pharmacy , China Pharmaceutical University, Ministry of Education , Nanjing 210009 , China
| | - Shaohong Fang
- Key Laboratory of Myocardial Ischemia , Harbin Medical University, Ministry of Education , Harbin , China
| | - Yunfei Hua
- Key Laboratory of Drug Quality Control and Pharmacovigilance , China Pharmaceutical University, Ministry of Education , Nanjing 210009 , China
| | - Xuping Yang
- Key Laboratory of Drug Quality Control and Pharmacovigilance , China Pharmaceutical University, Ministry of Education , Nanjing 210009 , China
| | - Yi Yuan
- Center of Drug Metabolism and Pharmacokinetics, College of Pharmacy , China Pharmaceutical University, Ministry of Education , Nanjing 210009 , China
| | - Shuang Liang
- Center of Drug Metabolism and Pharmacokinetics, College of Pharmacy , China Pharmaceutical University, Ministry of Education , Nanjing 210009 , China
| | - Peifang Liu
- Key Laboratory of Myocardial Ischemia , Harbin Medical University, Ministry of Education , Harbin , China.,Department of Neurology, The Second Affiliated Hospital , Harbin Medical University , Harbin , China
| | - Yuan Tian
- Key Laboratory of Drug Quality Control and Pharmacovigilance , China Pharmaceutical University, Ministry of Education , Nanjing 210009 , China
| | - Fengguo Xu
- Key Laboratory of Drug Quality Control and Pharmacovigilance , China Pharmaceutical University, Ministry of Education , Nanjing 210009 , China
| | - Zunjian Zhang
- Key Laboratory of Drug Quality Control and Pharmacovigilance , China Pharmaceutical University, Ministry of Education , Nanjing 210009 , China
| | - Yin Huang
- Key Laboratory of Drug Quality Control and Pharmacovigilance , China Pharmaceutical University, Ministry of Education , Nanjing 210009 , China.,Key Laboratory of Myocardial Ischemia , Harbin Medical University, Ministry of Education , Harbin , China
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Marrero-Rivera GE, Vargas P, López-Candales A. Heart failure readmissions: a losing battle or an opportunity for improvement? Postgrad Med 2019; 131:182-184. [PMID: 30843457 DOI: 10.1080/00325481.2019.1589154] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Despite great strides in diagnosis and management of heart failure (HF), this chronic illness continues to be a worldwide epidemic with approximately 23 million people afflicted across the globe. In the US, over 6.5 million carry a HF diagnosis with almost 90% of all HF deaths occurring in patients over the age of 70. Since one in five Americans are expected to be older than 65 years by 2050, almost 1,000,000 new HF cases are expected to be diagnosed every year. The staggering nature of these numbers only pales in comparison to current dismal HF survival statistics. The unavoidable natural history of HF continues to be characterized by the occurrence of repetitive hospital admissions. Not only are hospital readmissions demarcated as one of the most important risk factors associated with mortality; but also, a well-recognized trigger for additional hospital readmissions. Even when HF treatment guidelines have been recently updated; the mere fact that four HF societies have issued individual recommendations without reaching a common unifying consensus statement adds to the complexity of HF patient management. The purpose of this Editorial not only to fuel more interest on this topic but also to spark the notion that we have a potential catastrophe in our hands and is the responsibility of all health-care professionals to attend to this vital issue.
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Affiliation(s)
| | - Pedro Vargas
- b Cardiovascular Medicine Division of the University of Puerto Rico School of Medicine , San Juan , Puerto Rico
| | - Angel López-Candales
- b Cardiovascular Medicine Division of the University of Puerto Rico School of Medicine , San Juan , Puerto Rico
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Cainzos-Achirica M, Enjuanes C, Greenland P, McEvoy JW, Cushman M, Dardari Z, Nasir K, Budoff MJ, Al-Mallah MH, Yeboah J, Miedema MD, Blumenthal RS, Comin-Colet J, Blaha MJ. The prognostic value of interleukin 6 in multiple chronic diseases and all-cause death: The Multi-Ethnic Study of Atherosclerosis (MESA). Atherosclerosis 2018; 278:217-225. [PMID: 30312930 DOI: 10.1016/j.atherosclerosis.2018.09.034] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 09/12/2018] [Accepted: 09/25/2018] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND AIMS We aimed to evaluate the associations and prognostic value of interleukin-6 (IL6) for the prediction of atherosclerotic cardiovascular disease (ASCVD) events, heart failure (HF), and other chronic diseases in a large, multi-ethnic, contemporary population. METHODS We included 6617 participants from the Multi-Ethnic Study of Atherosclerosis (5640 non-users, 977 users of statins at baseline). Main outcomes were hard ASCVD events and HF; secondary outcomes included all-cause death, atrial fibrillation, venous thromboembolism and cancer. RESULTS Median follow-up was 13.2 years. Strong associations were observed in Cox regression analyses between higher IL6 levels and ASCVD events, HF, and mortality, particularly among statins users. In the latter, associations remained strong after adjusting for traditional risk factors and other inflammation biomarkers (e.g., risk factor, hsCRP-adjusted hazard ratio for incident HF comparing 3rd vs. 1st IL6 tertiles: 3.55, 95% CI 1.23-10.27). Although IL6 did not improve CHD prediction beyond traditional risk factors, among statin users it improved the prediction of stroke (improvement in the C statistic +0.018), incident HF (+0.028, the largest C statistic increase across all study outcomes), and all-cause death (+0.017). CONCLUSIONS IL6 is strongly and independently associated with ASCVD events, HF, and all-cause mortality, particularly among statin users. Although the prognostic value of IL6 is limited for the prediction of CHD events, it may have a role for the prediction of stroke, HF and all-cause death in asymptomatic statin users. Larger studies are needed to replicate these findings.
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Affiliation(s)
- Miguel Cainzos-Achirica
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Department of Cardiology, Johns Hopkins Medical Institutions, Baltimore, MD, USA; Bellvitge University Hospital and Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain; Universitat de Barcelona, Barcelona, Spain; RTI Health Solutions, Pharmacoepidemiology and Risk Management, Barcelona, Spain.
| | - Cristina Enjuanes
- Bellvitge University Hospital and Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Philip Greenland
- Departments of Medicine and Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - John W McEvoy
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Department of Cardiology, Johns Hopkins Medical Institutions, Baltimore, MD, USA; Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Mary Cushman
- Departments of Medicine and Pathology and Laboratory Medicine, Larner College of Medicine at the University of Vermont, Burlington, VT, USA
| | - Zeina Dardari
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Department of Cardiology, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Khurram Nasir
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Department of Cardiology, Johns Hopkins Medical Institutions, Baltimore, MD, USA; Center for Healthcare Advancement and Outcomes, Miami Cardiac and Vascular Institute, Baptist Heath South Florida, Miami, FL, USA
| | - Matthew J Budoff
- Los Angeles Biomedical Research Institute at Harbor-UCLA, Torrance, CA, USA
| | - Mouaz H Al-Mallah
- King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, King Abdulaziz Cardiac Center, Ministry of National Guard, Health Affairs, Saudi Arabia
| | | | - Michael D Miedema
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, MN, USA
| | - Roger S Blumenthal
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Department of Cardiology, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Josep Comin-Colet
- Bellvitge University Hospital and Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain; Department of Clinical Sciences, University of Barcelona, Barcelona, Spain
| | - Michael J Blaha
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Department of Cardiology, Johns Hopkins Medical Institutions, Baltimore, MD, USA; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Levinsson A, Dubé M, Tardif J, de Denus S. Sex, drugs, and heart failure: a sex-sensitive review of the evidence base behind current heart failure clinical guidelines. ESC Heart Fail 2018; 5:745-754. [PMID: 29916560 PMCID: PMC6165928 DOI: 10.1002/ehf2.12307] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Revised: 03/26/2018] [Accepted: 04/30/2018] [Indexed: 12/11/2022] Open
Abstract
Heart failure (HF) is a complex disease, almost as common in women as in men. Nonetheless, HF clinical presentation, prognosis, and aetiology vary by sex. This review summarizes the current state of sex-sensitive issues related to HF drugs included in treatment guidelines and suggests future directions for improved care. Heart failure presentation differs between female and male patients: females more often show with hypertensive aetiology and the preserved ejection fraction phenotype, while men more often show ischaemic aetiology and the reduced ejection fraction phenotype. Yet the HF clinical guidelines in Europe, the United States, and Canada do not reflect the sexual dimorphism. Further, in randomized clinical trials of HF medication, women are largely underrepresented, typically consisting of ≥70% men. Given the knowledge that some adverse drug reactions, such as torsade de pointes and angiotensin-converting enzyme inhibitor-induced cough, occur more frequently in women, we emphasize the need to test medications thoroughly in both sexes and explore sexual dimorphisms. To better represent all of the targeted patient population and provide better care for all, two kinds of change must come about: recruitment methods to randomized clinical trial samples need to evolve and the participation needs to seem more attractive to women.
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Affiliation(s)
- Anna Levinsson
- Beaulieu‐Saucier Université de Montréal Pharmacogenomics CentreMontrealQuebecCanada
- Montreal Heart InstituteMontrealQuebecCanada
- Faculty of MedicineUniversité de MontréalMontrealQuebecCanada
| | - Marie‐Pierre Dubé
- Beaulieu‐Saucier Université de Montréal Pharmacogenomics CentreMontrealQuebecCanada
- Montreal Heart InstituteMontrealQuebecCanada
- Faculty of MedicineUniversité de MontréalMontrealQuebecCanada
| | - Jean‐Claude Tardif
- Beaulieu‐Saucier Université de Montréal Pharmacogenomics CentreMontrealQuebecCanada
- Montreal Heart InstituteMontrealQuebecCanada
- Faculty of MedicineUniversité de MontréalMontrealQuebecCanada
| | - Simon de Denus
- Beaulieu‐Saucier Université de Montréal Pharmacogenomics CentreMontrealQuebecCanada
- Montreal Heart InstituteMontrealQuebecCanada
- Faculty of PharmacyUniversité de MontréalMontrealQuebecCanada
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Affiliation(s)
- Lynne Warner Stevenson
- From the Advanced Heart Disease Section, Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (L.W.S.); and Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Boston, MA (R.B.D.).
| | - Roger B Davis
- From the Advanced Heart Disease Section, Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (L.W.S.); and Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Boston, MA (R.B.D.)
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Cainzos-Achirica M, Rebordosa C, Vela E, Cleries M, Matsushita K, Plana E, Rivero-Ferrer E, Enjuanes C, Jimenez-Marrero S, Garcia-Rodriguez LA, Comin-Colet J, Perez-Gutthann S. Challenges of evaluating chronic heart failure and acute heart failure events in research studies using large health care databases. Am Heart J 2018; 202:76-83. [PMID: 29902694 DOI: 10.1016/j.ahj.2018.05.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Accepted: 05/14/2018] [Indexed: 01/06/2023]
Abstract
Epidemiological studies on heart failure (HF) using large health care databases are becoming increasingly frequent, as they represent an invaluable opportunity to characterize the importance and risk factors of HF from a population perspective. Nevertheless, because of its complex diagnosis and natural history, the heterogeneous use of the relevant terminology in routine clinical practice, and the limitations of some disease coding systems, HF can be a challenging condition to assess using large health care databases as the main source of information. In this narrative review, we discuss some of the challenges that researchers may face, with a special focus on the identification and validation of chronic HF cases and acute HF decompensations. For each of these challenges, we present some potential solutions inspired by the literature and/or based on our research experience, aimed at increasing the internal validity of research and at informing its interpretation. We also discuss future directions on the field, presenting constructive recommendations aimed at facilitating the conduct of valid epidemiological studies on HF in the coming years.
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Affiliation(s)
- Miguel Cainzos-Achirica
- RTI Health Solutions, Pharmacoepidemiology and Risk Management, Barcelona, Spain; Community Heart Failure Program, Department of Cardiology, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain; Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona,; Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Department of Cardiology, Johns Hopkins Medical Institutions, Baltimore, MD.
| | - Cristina Rebordosa
- RTI Health Solutions, Pharmacoepidemiology and Risk Management, Barcelona, Spain
| | - Emili Vela
- Healthcare Information and Knowledge Unit, Catalan Health Service, Barcelona, Spain
| | - Montse Cleries
- Healthcare Information and Knowledge Unit, Catalan Health Service, Barcelona, Spain
| | - Kunihiro Matsushita
- Johns Hopkins Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, MD; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Estel Plana
- RTI Health Solutions, Pharmacoepidemiology and Risk Management, Barcelona, Spain
| | - Elena Rivero-Ferrer
- RTI Health Solutions, Pharmacoepidemiology and Risk Management, Barcelona, Spain
| | - Cristina Enjuanes
- Community Heart Failure Program, Department of Cardiology, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain; Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona
| | - Santiago Jimenez-Marrero
- Community Heart Failure Program, Department of Cardiology, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain; Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona
| | | | - Josep Comin-Colet
- Community Heart Failure Program, Department of Cardiology, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain; Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona,; Department of Clinical Sciences, University of Barcelona, Barcelona, Spain
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Isovolumic loading of the failing heart by intraventricular placement of a spring expander attenuates cardiac atrophy after heterotopic heart transplantation. Biosci Rep 2018; 38:BSR20180371. [PMID: 29743195 PMCID: PMC6019382 DOI: 10.1042/bsr20180371] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 04/20/2018] [Accepted: 04/30/2018] [Indexed: 12/21/2022] Open
Abstract
Cardiac atrophy is the most common complication of prolonged application of the left ventricle (LV) assist device (LVAD) in patients with advanced heart failure (HF). Our aim was to evaluate the course of unloading-induced cardiac atrophy in rats with failing hearts, and to examine if increased isovolumic loading obtained by intraventricular implantation of an especially designed spring expander would attenuate this process. Heterotopic abdominal heart transplantation (HTx) was used as a rat model of heart unloading. HF was induced by volume overload achieved by creation of the aorto-caval fistula (ACF). The degree of cardiac atrophy was assessed as the weight ratio of the heterotopically transplanted heart (HW) to the control heart. Isovolumic loading was increased by intraventricular implantation of a stainless steel three-branch spring expander. The course of cardiac atrophy was evaluated on days 7, 14, 21, and 28 after HTx Seven days unloading by HTx in failing hearts sufficed to substantially decrease the HW (-59 ± 3%), the decrease progressed when measured on days 14, 21, and 28 after HTx Implantation of the spring expander significantly reduced the decreases in whole HW at all the time points (-39 ± 3 compared with -59 ± 3, -52 ± 2 compared with -69 ± 3, -51 ± 2 compared with -71 ± 2, and -44 ± 2 compared with -71 ± 3%, respectively; P<0.05 in each case). We conclude that the enhanced isovolumic heart loading obtained by implantation of the spring expander attenuates the development of unloading-induced cardiac atrophy in the failing rat heart.
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López-Candales A, Hernández Burgos PM, Vargas PE. New heart failure reclassification: are we left with more questions than answers? Postgrad Med 2018; 130:449-451. [PMID: 29846126 DOI: 10.1080/00325481.2018.1481715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Affiliation(s)
- Angel López-Candales
- a Cardiovascular Medicine Division at the University of Puerto Rico School of Medicine , Medical Sciences Campus , San Juan , Puerto Rico
| | | | - Pedro E Vargas
- a Cardiovascular Medicine Division at the University of Puerto Rico School of Medicine , Medical Sciences Campus , San Juan , Puerto Rico
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Franco J, Formiga F, Cepeda J, Llacer P, Arévalo-Lorido J, Cerqueiro J, González-Franco A, Epelde F, Manzano L, Montero Pérez-Barquero M. Influencia de la fibrilación auricular en la mortalidad de los pacientes con insuficiencia cardiaca con fracción de eyección preservada. Med Clin (Barc) 2018; 150:376-382. [DOI: 10.1016/j.medcli.2017.06.065] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2017] [Revised: 06/16/2017] [Accepted: 06/22/2017] [Indexed: 10/18/2022]
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Medina F, Franco J, Huerta J, Charte A. Fibrilación auricular en la insuficiencia cardiaca aguda: características clínicas y pronóstico. Semergen 2018; 44:e98-e100. [DOI: 10.1016/j.semerg.2018.01.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2018] [Accepted: 01/11/2018] [Indexed: 01/18/2023]
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Zhou K, Yue P, Ma F, Yan H, Zhang Y, Wang C, Qiu D, Hua Y, Li Y. Interpreting the various associations of MiRNA polymorphisms with susceptibilities of cardiovascular diseases: Current evidence based on a systematic review and meta-analysis. Medicine (Baltimore) 2018; 97:e10712. [PMID: 29794746 PMCID: PMC6393131 DOI: 10.1097/md.0000000000010712] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND To interpret the various associations between miRNA polymorphisms and cardiovascular diseases (CVD). METHODS Literature search has identified relevant studies up to June 2016. A meta-analysis was performed followed the guidelines from the Cochrane review group and the PRISMA statement. Studies were identified by searching the Cochrane Library, EMBASE, PUBMED and WHO clinical trials registry center. A meta-analysis has been done with a fixed/random-effect model using STATA 14.0, which also has been used to estimate the publication bias and meta-regression. RESULTS The results from 11 case-control studies were included. The miR-146a G/C makes a contribution to the causing of CVD as recessive genetic model. And the miR-499 G/A raised the risks of cardiomyopathy, however it could still accelerate the procedure of CVD combined with myocardial infraction. At this point, we consider that it could deepen the adverse of outcomes from coronary artery disease (CAD), but it's hard to draw an association between miR-499 G/A and CAD. At last the miR-196a2 T/C demonstrated a contrary role between development problem and metabolic issues, which protects the development procedure and impairs the metabolism to cause different disease phenotypes. CONCLUSION Despite inter-study variability, the polymorphisms from miR-146a, miR-499 and miR-196a2 have impacts on cardiovascular disease. Each type of miRNA has individual role in either cardiac development or the origins of CVD.
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Affiliation(s)
- Kaiyu Zhou
- Department of Pediatrics, West China Second University Hospital, Sichuan University
- Ministry of Education Key Laboratory of Women and Children's Diseases and Birth Defects, West China Second University Hospital, Sichuan University
- Program for Changjiang Scholars and Innovative Research Team in University, West China Second University Hospital, Sichuan University
| | - Peng Yue
- Department of Pediatrics, West China Second University Hospital, Sichuan University
- Ministry of Education Key Laboratory of Women and Children's Diseases and Birth Defects, West China Second University Hospital, Sichuan University
- West China Medical School, Sichuan University, Chengdu, Sichuan, China
| | - Fan Ma
- Department of Pediatrics, West China Second University Hospital, Sichuan University
- Ministry of Education Key Laboratory of Women and Children's Diseases and Birth Defects, West China Second University Hospital, Sichuan University
- West China Medical School, Sichuan University, Chengdu, Sichuan, China
| | - Hualin Yan
- Department of Pediatrics, West China Second University Hospital, Sichuan University
- Ministry of Education Key Laboratory of Women and Children's Diseases and Birth Defects, West China Second University Hospital, Sichuan University
- West China Medical School, Sichuan University, Chengdu, Sichuan, China
| | - Yi Zhang
- Department of Pediatrics, West China Second University Hospital, Sichuan University
- Ministry of Education Key Laboratory of Women and Children's Diseases and Birth Defects, West China Second University Hospital, Sichuan University
| | - Chuan Wang
- Department of Pediatrics, West China Second University Hospital, Sichuan University
- Ministry of Education Key Laboratory of Women and Children's Diseases and Birth Defects, West China Second University Hospital, Sichuan University
| | - Dajian Qiu
- Department of Pediatrics, West China Second University Hospital, Sichuan University
- Ministry of Education Key Laboratory of Women and Children's Diseases and Birth Defects, West China Second University Hospital, Sichuan University
| | - Yimin Hua
- Department of Pediatrics, West China Second University Hospital, Sichuan University
- Ministry of Education Key Laboratory of Women and Children's Diseases and Birth Defects, West China Second University Hospital, Sichuan University
- Program for Changjiang Scholars and Innovative Research Team in University, West China Second University Hospital, Sichuan University
| | - Yifei Li
- Department of Pediatrics, West China Second University Hospital, Sichuan University
- Ministry of Education Key Laboratory of Women and Children's Diseases and Birth Defects, West China Second University Hospital, Sichuan University
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Stevenson LW, Schneiweiss S, Gilstrap L. Propensity to match or mismatch patients and therapies? Eur J Heart Fail 2017; 20:355-358. [DOI: 10.1002/ejhf.983] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Revised: 08/02/2017] [Accepted: 08/04/2017] [Indexed: 11/11/2022] Open
Affiliation(s)
| | | | - Lauren Gilstrap
- Cardiovascular Division; Brigham and Women's Hospital; Boston MA USA
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