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Wang Y, Song N, Zhang J, Li J, Li R, Wang L. Systematic evaluation of vertebral bone quality score as an opportunistic screening method for BMD in spine surgery patients. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2024; 33:3261-3267. [PMID: 38671248 DOI: 10.1007/s00586-024-08284-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 04/09/2024] [Accepted: 04/18/2024] [Indexed: 04/28/2024]
Abstract
PURPOSE This study aimed to evaluate and compare the predictive value of vertebral bone quality (VBQ) score for low BMD and osteoporosis. Furthermore, we sought to enhance diagnostic effectiveness by integrating VBQ with easily accessible patient-specific factors. METHODS We retrospectively analyzed data from 180 patients. VBQ was obtained by preoperative MRI. Low BMD was classified as meeting the standards for either osteopenia or osteoporosis. The receiver operating characteristic curve analysis and multivariate logistic regression were used to detect the ability of variables to assess BMD. The z-test was used to compare the area under the curves of different variables. RESULTS VBQ was more effective in identifying low BMD than osteoporosis (AUC, 0.768 vs. 0.613, p = 0.02). Elevated VBQ (OR 6.912, 95% CI 2.72-17.6) and low BMI (0.858, 0.76-0.97) were risk factors for low BMD, while the risk factor for osteoporosis was age (1.067, 1.02-1.12), not VBQ. ROC analysis showed that AUCs were 0.613 for VBQ and 0.665 for age when screening for osteoporosis. The combined variable of VBQ, sex, age, and BMI obtained by logistic regression significantly improved the efficacy of BMD screening, with an AUC of 0.824 for low BMD and 0.733 for osteoporosis. CONCLUSION VBQ is better at detecting low BMD than identifying osteoporosis. The ability of VBQ to predict osteoporosis is limited, and a similar diagnostic efficacy can be achieved with age. Incorporating VBQ alongside demographic data enhances the efficiency of BMD assessment. With the development of artificial intelligence in medicine, this simple method is promising.
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Affiliation(s)
- Yunsheng Wang
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Qiaoxi District, 139 Ziqiang Road, Shijiazhuang, 050051, China
- Key Laboratory of Orthopedic Biomechanics of Hebei Province, Shijiazhuang, Hebei, China
| | - Ning Song
- Key Laboratory of Orthopedic Biomechanics of Hebei Province, Shijiazhuang, Hebei, China
- Department of Operating Room, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Jiali Zhang
- Department of Pharmacology, Hebei Medical University, Shijiazhuang, Hebei, China
| | - Jia Li
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Qiaoxi District, 139 Ziqiang Road, Shijiazhuang, 050051, China
- Key Laboratory of Orthopedic Biomechanics of Hebei Province, Shijiazhuang, Hebei, China
| | - Ruoyu Li
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Qiaoxi District, 139 Ziqiang Road, Shijiazhuang, 050051, China
- Key Laboratory of Orthopedic Biomechanics of Hebei Province, Shijiazhuang, Hebei, China
| | - Linfeng Wang
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Qiaoxi District, 139 Ziqiang Road, Shijiazhuang, 050051, China.
- Key Laboratory of Orthopedic Biomechanics of Hebei Province, Shijiazhuang, Hebei, China.
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Scrutinio D, Guida P, Passantino A. Functional limitation predicts mortality in heart failure with preserved ejection fraction. Eur J Intern Med 2024:S0953-6205(24)00331-5. [PMID: 39084953 DOI: 10.1016/j.ejim.2024.07.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Revised: 07/12/2024] [Accepted: 07/25/2024] [Indexed: 08/02/2024]
Abstract
BACKGROUND While the prognostic value of six-minute walking test (6MWT) in patients with heart failure (HF) and reduced ejection fraction has been firmly established, there are few or no data correlating the distance walked during 6MWT (6MWD) with mortality in patients with HF with preserved ejection fraction (HFpEF) METHODS: We studied 482 patients with HFpEF who had been admitted to inpatients cardiac rehabilitation. The primary outcome was 3-year all-cause mortality. The association between 6MWD and the primary outcome was assessed using multivariable models. Established risk markers were incorporated into the models. RESULTS 174 patients died during the 3-year follow-up. Taking the highest tertile of 6MWD (≥360 m) as reference, the adjusted hazard ratio (HR) of the primary outcome was 2.23 (95 % CI 1.31-3.78; p = .003) for the patients in the intermediate tertile (241-359 m) and 4.94 (95 % CI 2.90-8.39; p < .001) for those in the lowest tertile (≤240 m). The annual mortality rate was 25.0 % in the lowest tertile, 10.9 % in the intermediate tertile, and 5.3 % in the highest tertile. When the distance walked was normalized for age, sex, and body mass index and expressed as percent-of-predicted walking distance, the adjusted HR was 1.30 (95 % CI 0.76-2.22; p = .331) for the patients in the intermediate tertile (58.2 % to 77.6 %) and 3.52 (95 % CI 2.12-5.85; p < .001) for those in the lowest tertile (≤58.1 %). CONCLUSIONS Our findings suggest that measuring functional capacity by evaluating the distance that a patient can walk over a period of 6 min provides important prognostic information in HFpEF.
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Affiliation(s)
- Domenico Scrutinio
- Istituti Clinici Scientifici Maugeri SpA SB, IRCCS, Institute of Bari, Via Generale Nicola Bellomo 73/75, Bari, Italy.
| | - Pietro Guida
- Regional General Hospital "F. Miulli", Acquaviva delle Fonti, Bari, Italy
| | - Andrea Passantino
- Istituti Clinici Scientifici Maugeri SpA SB, IRCCS, Institute of Bari, Via Generale Nicola Bellomo 73/75, Bari, Italy
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Costenbader KH, Cook NR, Lee IM, Hahn J, Walter J, Bubes V, Kotler G, Yang N, Friedman S, Alexander EK, Manson JE. Vitamin D and Marine n-3 Fatty Acids for Autoimmune Disease Prevention: Outcomes Two Years After Completion of a Double-Blind, Placebo-Controlled Trial. Arthritis Rheumatol 2024; 76:973-983. [PMID: 38272846 DOI: 10.1002/art.42811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 01/02/2024] [Accepted: 01/22/2024] [Indexed: 01/27/2024]
Abstract
OBJECTIVE In the 5.3-year randomized, 2 × 2 factorial, double-blind, placebo-controlled Vitamin D and Omega-3 Trial (VITAL), vitamin D supplementation reduced autoimmune disease (AD) incidence (hazard ratio [HR] 0.78, 95% confidence interval [CI] 0.61-0.99). Omega-3 (n-3) fatty acid supplementation showed a statistically nonsignificant reduction (HR 0.85, 95% CI 0.67-1.08). We aimed to confirm further AD cases arising during and after randomization and assess sustained effects with two years of postintervention observation. METHODS Of the 12,786 men aged ≥50 and 13,085 women aged ≥55 initially randomized, we observed surviving and willing participants for two more years. We continued to confirm annual participant-reported new AD by medical record review. Cox models calculated HRs for all confirmed incident AD, (and secondary endpoints, including probable cases, and individual ADs), during the observational and randomized periods. RESULTS A total of 21,592 participants (83.5%) were observed for two more years; 514 participants developed incident confirmed AD (236 since prior report), of whom 255 had been randomized to vitamin D versus 259 to vitamin D placebo (HR 0.98 [95% CI 0.83-1.17] at 7 years). AD was confirmed in 234 participants initially randomized to n-3 fatty acids versus 280 randomized to its placebo (HR 0.83 [95% CI 0.70-0.99] at 7 years). Of newly confirmed cases, 65 had onset during randomization; their inclusion changed randomized results as follows: HR 0.85 (95% CI 0.70-1.04) for vitamin D and HR 0.87 (95% CI 0.71-1.06) for n-3 fatty acids. CONCLUSION Two years after trial termination, the protective effects of 2000 IU/day of vitamin D dissipated, but 1,000 mg/day of n-3 fatty acids had a sustained effect in reducing AD incidence.
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Affiliation(s)
| | - Nancy R Cook
- Brigham and Women's Hospital and Harvard University, Boston, Massachusetts
| | - I-Min Lee
- Brigham and Women's Hospital and Harvard University, Boston, Massachusetts
| | - Jill Hahn
- Harvard University, Boston, Massachusetts
| | | | - Vadim Bubes
- Brigham and Women's Hospital, Boston, Massachusetts
| | | | - Nicole Yang
- Brigham and Women's Hospital and Harvard University, Boston, Massachusetts
| | - Sonia Friedman
- Brigham and Women's Hospital and Harvard University, Boston, Massachusetts
| | - Erik K Alexander
- Brigham and Women's Hospital and Harvard University, Boston, Massachusetts
| | - JoAnn E Manson
- Brigham and Women's Hospital and Harvard University, Boston, Massachusetts
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Fernando SM, Qureshi D, Talarico R, Vigod SN, McIsaac DI, Sterling LH, van Diepen S, Price S, Di Santo P, Kyeremanteng K, Fan E, Needham DM, Brodie D, Bienvenu OJ, Combes A, Slutsky AS, Scales DC, Herridge MS, Thiele H, Hibbert B, Tanuseputro P, Mathew R. Mental health sequelae in survivors of cardiogenic shock complicating myocardial infarction. A population-based cohort study. Intensive Care Med 2024; 50:901-912. [PMID: 38695924 DOI: 10.1007/s00134-024-07399-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 03/21/2024] [Indexed: 06/11/2024]
Abstract
PURPOSE Cardiogenic shock secondary to acute myocardial infarction (AMI-CS) is associated with substantial short- and long-term morbidity and mortality. However, there are limited data on mental health sequelae that survivors experience following discharge. METHODS We conducted a retrospective, population-based cohort study in Ontario, Canada of critically ill adult (≥ 18 years) survivors of AMI-CS, admitted to hospital between April 1, 2009 and March 31, 2019. We compared these patients to AMI survivors without shock. We captured outcome data using linked health administrative databases. The primary outcome was a new mental health diagnosis (a composite of mood, anxiety, or related disorders; schizophrenia/psychotic disorders; and other mental health disorders) following hospital discharge. We secondarily evaluated incidence of deliberate self-harm and death by suicide. We compared patients using overlap propensity score-weighted, cause-specific proportional hazard models. RESULTS We included 7812 consecutive survivors of AMI-CS, from 135 centers. Mean age was 68.4 (standard deviation (SD) 12.2) years, and 70.3% were male. Median follow-up time was 767 days (interquartile range (IQR) 225-1682). Incidence of new mental health diagnosis among AMI-CS survivors was 109.6 per 1,000 person-years (95% confidence interval (CI) 105.4-113.9), compared with 103.8 per 1000 person-years (95% CI 102.5-105.2) among AMI survivors without shock. After propensity score adjustment, there was no difference in the risk of new mental health diagnoses following discharge [hazard ratio (HR) 0.99 (95% CI 0.94-1.03)]. Factors associated with new mental health diagnoses following AMI-CS included female sex, pre-existing mental health diagnoses, and discharge to a long-term hospital or rehabilitation institute. CONCLUSION Survivors of AMI-CS experience substantial mental health morbidity following discharge. Risk of new mental health diagnoses was comparable between survivors of AMI with and without shock. Future research on interventions to mitigate psychiatric sequelae after AMI-CS is warranted.
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Affiliation(s)
- Shannon M Fernando
- Division of Critical Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada.
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada.
- Department of Critical Care, Lakeridge Health Corporation, Oshawa, ON, Canada.
| | - Danial Qureshi
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
- ICES, Toronto, ON, Canada
- Bruyère Research Institute, Ottawa, ON, Canada
| | - Robert Talarico
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- ICES, Toronto, ON, Canada
| | - Simone N Vigod
- ICES, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Women's College Hospital and Research Institute, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Daniel I McIsaac
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- ICES, Toronto, ON, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
- Department of Anesthesiology and Pain Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Lee H Sterling
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Sean van Diepen
- Department of Critical Care Medicine, University of Alberta, Edmonton, AB, Canada
- Division of Cardiology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
- VIGOUR Centre, University of Alberta, Edmonton, AB, Canada
| | - Susanna Price
- Royal, Brompton & Harefield Hospitals, London, UK
- National Heart and Lung Institute, Imperial College, London, UK
| | - Pietro Di Santo
- Division of Critical Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Kwadwo Kyeremanteng
- Division of Critical Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Eddy Fan
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
| | - Dale M Needham
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Daniel Brodie
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Oscar Joseph Bienvenu
- Department of Psychiatry and Behavioural Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Alain Combes
- Institute of Cardiometabolism and Nutrition, Sorbonne University, Paris, France
- Service de Médeceine Intensive-Réanimation, Hôpitaux Universitaires Pitié Salpêtrière, Assistance Publique-Hôpitaux de Paris, Institut de Cardiologie, Paris, France
| | - Arthur S Slutsky
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
| | - Damon C Scales
- ICES, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
| | - Margaret S Herridge
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
| | - Holger Thiele
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at the University of Leipzig and Leipzig Heart Institute, Leipzig, Germany
| | - Benjamin Hibbert
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Peter Tanuseputro
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- ICES, Toronto, ON, Canada
- Bruyère Research Institute, Ottawa, ON, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
- Division of Palliative Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Rebecca Mathew
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, ON, Canada
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Reed KS, Frescoln AM, Keleher Q, Brellenthin AG, Kohut ML, Lefferts WK. Effects of aerobic exercise training on cerebral pulsatile hemodynamics in middle-aged adults with elevated blood pressure/stage 1 hypertension. J Appl Physiol (1985) 2024; 136:1376-1387. [PMID: 38601998 DOI: 10.1152/japplphysiol.00689.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 03/13/2024] [Accepted: 03/29/2024] [Indexed: 04/12/2024] Open
Abstract
Mechanisms behind the protective effects of aerobic exercise on brain health remain elusive but may be vascular in origin and relate to cerebral pulsatility. This pilot study investigated the effects of 12-wk aerobic exercise training on cerebral pulsatility and its vascular contributors (large artery stiffness, characteristic impedance) in at-risk middle-aged adults. Twenty-eight inactive middle-aged adults with elevated blood pressure or stage 1 hypertension were assigned to either moderate/vigorous aerobic exercise training (AET) for 3 days/wk or no-exercise control (CON) group. Middle cerebral artery (MCA) pulsatility index (PI), large artery (i.e., aorta, carotid) stiffness, and characteristic impedance were assessed via Doppler and tonometry at baseline, 6, and 12 wk, whereas cardiorespiratory fitness (V̇o2peak) was assessed via incremental exercise test and cognitive function via computerized battery at baseline and 12 wk. V̇o2peak increased 6% in AET and decreased 4% in CON (P < 0.05). Proximal aortic compliance increased (P = 0.04, partial η2 = 0.14) and aortic characteristic impedance decreased (P = 0.02, partial η2 = 0.17) with AET but not CON. Cerebral pulsatility showed a medium-to-large effect size increase with AET, although not statistically significant (P = 0.07, partial η2 = 0.11) compared with CON. Working memory reaction time improved with AET but not CON (P = 0.02, partial η2 = 0.20). Our data suggest 12-wk AET elicited improvements in central vascular hemodynamics (e.g., proximal aortic compliance and characteristic impedance) along with apparent, paradoxical increases in cerebral pulsatile hemodynamics.NEW & NOTEWORTHY We identify differential central versus cerebrovascular responses to 12 wk of aerobic exercise training in middle-aged adults. Although proximal aortic compliance and characteristic impedance improved after 12 wk of exercise, cerebral pulsatility tended to unexpectedly increase. These data suggest short-term aerobic exercise training may lead to more immediate benefits in the central vasculature, whereas longer duration exercise training may be required for beneficial changes in pulsatility within the cerebrovasculature.
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Affiliation(s)
- Krista S Reed
- Department of Kinesiology, Iowa State University, Ames, Iowa, United States
| | - Abby M Frescoln
- Department of Kinesiology, Iowa State University, Ames, Iowa, United States
| | - Quinn Keleher
- Department of Kinesiology, Iowa State University, Ames, Iowa, United States
| | | | - Marian L Kohut
- Department of Kinesiology, Iowa State University, Ames, Iowa, United States
| | - Wesley K Lefferts
- Department of Kinesiology, Iowa State University, Ames, Iowa, United States
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Montellano FA, Rücker V, Ungethüm K, Penalba A, Hotter B, Giralt M, Wiedmann S, Mackenrodt D, Morbach C, Frantz S, Störk S, Whiteley WN, Kleinschnitz C, Meisel A, Montaner J, Haeusler KG, Heuschmann PU. Biomarkers to improve functional outcome prediction after ischemic stroke: Results from the SICFAIL, STRAWINSKI, and PREDICT studies. Eur Stroke J 2024:23969873241250272. [PMID: 38711254 DOI: 10.1177/23969873241250272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/08/2024] Open
Abstract
BACKGROUND AND AIMS Acute ischemic stroke (AIS) outcome prognostication remains challenging despite available prognostic models. We investigated whether a biomarker panel improves the predictive performance of established prognostic scores. METHODS We investigated the improvement in discrimination, calibration, and overall performance by adding five biomarkers (procalcitonin, copeptin, cortisol, mid-regional pro-atrial natriuretic peptide (MR-proANP), and N-terminal pro-B-type natriuretic peptide (NT-proBNP)) to the Acute Stroke Registry and Analysis of Lausanne (ASTRAL) and age/NIHSS scores using data from two prospective cohort studies (SICFAIL, PREDICT) and one clinical trial (STRAWINSKI). Poor outcome was defined as mRS > 2 at 12 (SICFAIL, derivation dataset) or 3 months (PREDICT/STRAWINSKI, pooled external validation dataset). RESULTS Among 412 SICFAIL participants (median age 70 years, quartiles 59-78; 63% male; median NIHSS score 3, quartiles 1-5), 29% had a poor outcome. Area under the curve of the ASTRAL and age/NIHSS were 0.76 (95% CI 0.71-0.81) and 0.77 (95% CI 0.73-0.82), respectively. Copeptin (0.79, 95% CI 0.74-0.84), NT-proBNP (0.80, 95% CI 0.76-0.84), and MR-proANP (0.79, 95% CI 0.75-0.84) significantly improved ASTRAL score's discrimination, calibration, and overall performance. Copeptin improved age/NIHSS model's discrimination, copeptin, MR-proANP, and NT-proBNP improved its calibration and overall performance. In the validation dataset (450 patients, median age 73 years, quartiles 66-81; 54% men; median NIHSS score 8, quartiles 3-14), copeptin was independently associated with various definitions of poor outcome and also mortality. Copeptin did not increase model's discrimination but it did improve calibration and overall model performance. DISCUSSION Copeptin, NT-proBNP, and MR-proANP improved modest but consistently the predictive performance of established prognostic scores in patients with mild AIS. Copeptin was most consistently associated with poor outcome in patients with moderate to severe AIS, although its added prognostic value was less obvious.
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Affiliation(s)
- Felipe A Montellano
- Institute of Clinical Epidemiology and Biometry, Julius-Maximilians-Universität (JMU) Würzburg, Würzburg, Germany
- Department of Neurology, University Hospital Würzburg, Würzburg, Germany
- Interdisciplinary Center for Clinical Research, University Hospital Würzburg, Würzburg, Germany
| | - Viktoria Rücker
- Institute of Clinical Epidemiology and Biometry, Julius-Maximilians-Universität (JMU) Würzburg, Würzburg, Germany
| | - Kathrin Ungethüm
- Institute of Clinical Epidemiology and Biometry, Julius-Maximilians-Universität (JMU) Würzburg, Würzburg, Germany
- Institute of Medical Data Science, University Hospital Würzburg, Würzburg, Germany
| | - Anna Penalba
- Neurovascular Research Laboratory, Vall d'Hebron Institute of Research, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Benjamin Hotter
- Department of Neurology and Experimental Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Center for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany
- NeuroCure Clinical Research Center, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Marina Giralt
- Department of Biochemistry, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Silke Wiedmann
- Institute of Clinical Epidemiology and Biometry, Julius-Maximilians-Universität (JMU) Würzburg, Würzburg, Germany
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
| | - Daniel Mackenrodt
- Institute of Clinical Epidemiology and Biometry, Julius-Maximilians-Universität (JMU) Würzburg, Würzburg, Germany
- Department of Neurology, University Hospital Würzburg, Würzburg, Germany
| | - Caroline Morbach
- Department Clinical Research & Epidemiology, Comprehensive Heart Failure Center, University Hospital Würzburg, Würzburg, Germany
- Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany
| | - Stefan Frantz
- Department Clinical Research & Epidemiology, Comprehensive Heart Failure Center, University Hospital Würzburg, Würzburg, Germany
| | - Stefan Störk
- Department Clinical Research & Epidemiology, Comprehensive Heart Failure Center, University Hospital Würzburg, Würzburg, Germany
- Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany
| | - William N Whiteley
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Christoph Kleinschnitz
- Department of Neurology and Center for Translational Neuroscience and Behavioural Science (C-TNBS), University Hospital Essen, Essen, Germany
| | - Andreas Meisel
- Department of Neurology and Experimental Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Center for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany
- NeuroCure Clinical Research Center, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Joan Montaner
- Neurovascular Research Laboratory, Vall d'Hebron Institute of Research, Universitat Autònoma de Barcelona, Barcelona, Spain
- Stroke Research Program, Instituto de Biomedicina de Sevilla/Hospital Universitario Virgen del Rocío/Consejo Superior de Investigaciones Científicas/University of Seville, Seville, Spain
- Department of Neurology, Hospital Universitario Virgen Macarena, Seville, Spain
| | | | - Peter U Heuschmann
- Institute of Clinical Epidemiology and Biometry, Julius-Maximilians-Universität (JMU) Würzburg, Würzburg, Germany
- Institute of Medical Data Science, University Hospital Würzburg, Würzburg, Germany
- Clinical Trial Center Würzburg, University Hospital Würzburg, Würzburg, Germany
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Zhou L, Tian Y, Su Z, Sun JY, Sun W. Risk factors and prediction model for new-onset hypertensive disorders of pregnancy: a retrospective cohort study. Front Cardiovasc Med 2024; 11:1272779. [PMID: 38751664 PMCID: PMC11094209 DOI: 10.3389/fcvm.2024.1272779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 04/17/2024] [Indexed: 05/18/2024] Open
Abstract
Background and aims Hypertensive disorders of pregnancy (HDP) is a significant cause of maternal and neonatal mortality. This study aims to identify risk factors for new-onset HDP and to develop a prediction model for assessing the risk of new-onset hypertension during pregnancy. Methods We included 446 pregnant women without baseline hypertension from Liyang People's Hospital at the first inspection, and they were followed up until delivery. We collected maternal clinical parameters and biomarkers between 16th and 20th weeks of gestation. Logistic regression was used to determine the effect of the risk factors on HDP. For model development, a backward selection algorithm was applied to choose pertinent biomarkers, and predictive models were created based on multiple machine learning methods (generalised linear model, multivariate adaptive regression splines, random forest, and k-nearest neighbours). Model performance was evaluated using the area under the curve. Results Out of the 446 participants, 153 developed new-onset HDP. The HDP group exhibited significantly higher baseline body mass index (BMI), weight change, baseline systolic/diastolic blood pressure, and platelet counts than the control group. The increase in baseline BMI, weight change, and baseline systolic and diastolic blood pressure significantly elevated the risk of HDP, with odds ratios and 95% confidence intervals of 1.10 (1.03-1.17), 1.10 (1.05-1.16), 1.04 (1.01-1.08), and 1.10 (1.05-1.14) respectively. Restricted cubic spline showed a linear dose-dependent association of baseline BMI and weight change with the risk of HDP. The random forest-based prediction model showed robust performance with the area under the curve of 0.85 in the training set. Conclusion This study establishes a prediction model to evaluate the risk of new-onset HDP, which might facilitate the early diagnosis and management of HDP.
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Affiliation(s)
- Ling Zhou
- Department of Obstetrics and Gynecology, Liyang People's Hospital, Liyang, Jiangsu, China
| | - Yunfan Tian
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Zhenyang Su
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Jin-Yu Sun
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Wei Sun
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
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Schulte PJ, Goldberg JD, Oster RA, Ambrosius WT, Bonner LB, Cabral H, Carter RE, Chen Y, Desai M, Li D, Lindsell CJ, Pomann GM, Slade E, Tosteson TD, Yu F, Spratt H. Peer review of clinical and translational research manuscripts: Perspectives from statistical collaborators. J Clin Transl Sci 2024; 8:e20. [PMID: 38384899 PMCID: PMC10879991 DOI: 10.1017/cts.2023.707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 11/29/2023] [Accepted: 12/19/2023] [Indexed: 02/23/2024] Open
Abstract
Research articles in the clinical and translational science literature commonly use quantitative data to inform evaluation of interventions, learn about the etiology of disease, or develop methods for diagnostic testing or risk prediction of future events. The peer review process must evaluate the methodology used therein, including use of quantitative statistical methods. In this manuscript, we provide guidance for peer reviewers tasked with assessing quantitative methodology, intended to complement guidelines and recommendations that exist for manuscript authors. We describe components of clinical and translational science research manuscripts that require assessment including study design and hypothesis evaluation, sampling and data acquisition, interventions (for studies that include an intervention), measurement of data, statistical analysis methods, presentation of the study results, and interpretation of the study results. For each component, we describe what reviewers should look for and assess; how reviewers should provide helpful comments for fixable errors or omissions; and how reviewers should communicate uncorrectable and irreparable errors. We then discuss the critical concepts of transparency and acceptance/revision guidelines when communicating with responsible journal editors.
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Affiliation(s)
- Phillip J. Schulte
- Division of Clinical Trials and Biostatistics, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Judith D. Goldberg
- Division of Biostatistics, Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Robert A. Oster
- Department of Medicine, Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Walter T. Ambrosius
- Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Lauren Balmert Bonner
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Howard Cabral
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Rickey E. Carter
- Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, FL, USA
| | - Ye Chen
- Biostatistics, Epidemiology and Research Design (BERD), Tufts Clinical and Translational Science Institute (CTSI), Boston, MA, USA
| | - Manisha Desai
- Quantitative Sciences Unit, Departments of Medicine, Biomedical Data Science, and Epidemiology and Population Health, Stanford University, Stanford, CA, USA
| | - Dongmei Li
- Department of Clinical and Translational Research, Obstetrics and Gynecology and Public Health Sciences, University of Rochester Medical Center, Rochester, NY, USA
| | | | - Gina-Maria Pomann
- Department of Biostatistics and Bioinformatics, Duke University, Durham, NC, USA
| | - Emily Slade
- Department of Biostatistics, University of Kentucky, Lexington, KY, USA
| | - Tor D. Tosteson
- Department of Biomedical Data Science, Geisel School of Medicine, Dartmouth College, Hanover, NH, USA
| | - Fang Yu
- Department of Biostatistics, University of Nebraska Medical Center, Omaha, NE, USA
| | - Heidi Spratt
- Department of Biostatistics and Data Science, School of Public and Population Health, University of Texas Medical Branch, Galveston, TX, USA
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Clavero-Adell M, Ayerza-Casas A, Palanca-Arias D, López-Ramón M, Jiménez-Montañés L, Olmos S. Early assessment of cardiomyopathy in Duchenne patients by means of longitudinal strain echocardiography. Cardiol Young 2024; 34:151-156. [PMID: 37272541 DOI: 10.1017/s104795112300149x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
INTRODUCTION The diagnosis of Duchenne-linked cardiomyopathy may be challenging. Conventional echocardiographic measurements typically show deterioration beyond the second decade. Global longitudinal strain has been proposed as an earlier marker than left ventricular ejection fraction. MATERIAL AND METHODS A prospective, observational, cross-sectional, case-control study was carried out. Both Duchenne patients and control subjects underwent transthoracic echocardiogram in order to assess left ventricle function. Bayesian linear regression was the main tool for inference. Age effects were parameterised by means of a spline function because of its simplicity to characterise continuous variables and smooth contributions. The posterior distribution of the marginal age effects was used to assess the earliest age of deterioration of each marker. RESULTS Sixteen Duchenne patients and twenty-two healthy male subjects were enrolled. On overage, cardiac function measures were found for ejection fraction and longitudinal strain among different groups. Age effects on global longitudinal strain are more reliably found at ages of 6 and above, while ejection fraction starts to deteriorate at an older age. Progressive left ventricular dysfunction in Duchenne patients is one of the key issues and starts at an early age with subtle symptoms. CONCLUSION This cross-sectional study provides supporting evidence that global longitudinal strain is an earlier marker of disease progression than ejection fraction in Duchenne patients.
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Affiliation(s)
- Marcos Clavero-Adell
- Pediatric Cardiology Unit, University Hospital Miguel Servet, Zaragoza, Spain
- Dislipemias Primarias, IIS Aragón, Zaragoza, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBER-CV), Instituto de Salud Carlos III, Madrid, Spain
- Faculty of Medicine, Universidad de Zaragoza, Spain
| | - Ariadna Ayerza-Casas
- Pediatric Cardiology Unit, University Hospital Miguel Servet, Zaragoza, Spain
- Faculty of Medicine, Universidad de Zaragoza, Spain
| | - Daniel Palanca-Arias
- Pediatric Cardiology Unit, University Hospital Miguel Servet, Zaragoza, Spain
- Faculty of Medicine, Universidad de Zaragoza, Spain
| | - Marta López-Ramón
- Pediatric Cardiology Unit, University Hospital Miguel Servet, Zaragoza, Spain
| | | | - Salvador Olmos
- Dislipemias Primarias, IIS Aragón, Zaragoza, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBER-CV), Instituto de Salud Carlos III, Madrid, Spain
- Aragon Institute of Engineering Research (I3A), Universidad de Zaragoza, Spain
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10
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Mendiola EA, Neelakantan S, Xiang Q, Xia S, Zhang J, Serpooshan V, Vanderslice P, Avazmohammadi R. An image-driven micromechanical approach to characterize multiscale remodeling in infarcted myocardium. Acta Biomater 2024; 173:109-122. [PMID: 37925122 PMCID: PMC10924194 DOI: 10.1016/j.actbio.2023.10.027] [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: 05/11/2023] [Revised: 10/19/2023] [Accepted: 10/24/2023] [Indexed: 11/06/2023]
Abstract
Myocardial infarction (MI) is accompanied by the formation of a fibrotic scar in the left ventricle (LV) and initiates significant alterations in the architecture and constituents of the LV free wall (LVFW). Previous studies have shown that LV adaptation is highly individual, indicating that the identification of remodeling mechanisms post-MI demands a fully subject-specific approach that can integrate a host of structural alterations at the fiber-level to changes in bulk biomechanical adaptation at the tissue-level. We present an image-driven micromechanical approach to characterize remodeling, assimilating new biaxial mechanical data, histological studies, and digital image correlation data within an in-silico framework to elucidate the fiber-level remodeling mechanisms that drive tissue-level adaptation for each subject. We found that a progressively diffused collagen fiber structure combined with similarly disorganized myofiber architecture in the healthy region leads to the loss of LVFW anisotropy post-MI, offering an important tissue-level hallmark for LV maladaptation. In contrast, our results suggest that reductions in collagen undulation are an adaptive mechanism competing against LVFW thinning. Additionally, we show that the inclusion of subject-specific geometry when modeling myocardial tissue is essential for accurate prediction of tissue kinematics. Our approach serves as an essential step toward identifying fiber-level remodeling indices that govern the transition of MI to systolic heart failure. These indices complement the traditional, organ-level measures of LV anatomy and function that often fall short of early prognostication of heart failure in MI. In addition, our approach offers an integrated methodology to advance the design of personalized interventions, such as hydrogel injection, to reinforce and suppress native adaptive and maladaptive mechanisms, respectively, to prevent the transition of MI to heart failure. STATEMENT OF SIGNIFICANCE: Biomechanical and architectural adaptation of the LVFW remains a central, yet overlooked, remodeling process post-MI. Our study indicates the biomechanical adaptation of the LVFW post-MI is highly individual and driven by altered fiber network architecture and collective changes in collagen fiber content, undulation, and stiffness. Our findings demonstrate the possibility of using cardiac strains to infer such fiber-level remodeling events through in-silico modeling, paving the way for in-vivo characterization of multiscale biomechanical indices in humans. Such indices will complement the traditional, organ-level measures of LV anatomy and function that often fall short of early prognostication of heart failure in MI.
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Affiliation(s)
- Emilio A Mendiola
- Department of Biomedical Engineering, Texas A&M University, College Station, TX, USA
| | - Sunder Neelakantan
- Department of Biomedical Engineering, Texas A&M University, College Station, TX, USA
| | - Qian Xiang
- Department of Molecular Cardiology, Texas Heart Institute, Houston, Texas, USA
| | - Shuda Xia
- Oden Institute for Computational Engineering and Sciences, Department of Biomedical Engineering, The University of Texas at Austin, Austin, TX, USA
| | - Jianyi Zhang
- Department of Biomedical Engineering, The University of Alabama at Birmingham, Birmingham, AL, United States
| | - Vahid Serpooshan
- Wallace H. Coulter Department of Biomedical Engineering, Emory University School of Medicine and Georgia Institute of Technology, Atlanta, GA, United States; Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, United States; Children's Healthcare of Atlanta, Atlanta, GA, United States
| | - Peter Vanderslice
- Department of Molecular Cardiology, Texas Heart Institute, Houston, Texas, USA.
| | - Reza Avazmohammadi
- Department of Biomedical Engineering, Texas A&M University, College Station, TX, USA; J. Mike Walker '66 Department of Mechanical Engineering, Texas A&M University, College Station, TX, USA; Department of Cardiovascular Sciences, Houston Methodist Academic Institute, Houston, TX, USA.
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11
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Fernando SM, MacLaren G, Barbaro RP, Mathew R, Munshi L, Madahar P, Fried JA, Ramanathan K, Lorusso R, Brodie D, McIsaac DI. Age and associated outcomes among patients receiving venoarterial extracorporeal membrane oxygenation-analysis of the Extracorporeal Life Support Organization registry. Intensive Care Med 2023; 49:1456-1466. [PMID: 37792052 DOI: 10.1007/s00134-023-07199-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 08/08/2023] [Indexed: 10/05/2023]
Abstract
PURPOSE Venoarterial extracorporeal membrane oxygenation (V-A ECMO) can be used to support severely ill patients with cardiogenic shock. While age is commonly used in patient selection, little is known regarding its association with outcomes in this population. We sought to evaluate the association between increasing age and outcomes following V-A ECMO. METHODS We used individual-level patient data from 440 centers in the international Extracorporeal Life Support Organization registry. We included all adult patients receiving V-A ECMO from 2017 to 2019. The primary outcome was hospital mortality. Secondary outcomes included a composite of complications following initiation of V-A ECMO. We conducted Bayesian analyses of the relationship between increasing age and outcomes of interest. RESULTS We included 15,172 patients receiving V-A ECMO. Of these, 8172 (53.9%) died in hospital. For the analysis conducted using weakly informed priors, and as compared to the reference category of age 18-29, the age bracket of 30-39 (odds ratio [OR] 0.94, 95% credible interval [CrI] 0.79-1.10) was not associated with hospital mortality, but age brackets 40-49 (odds ratio [OR] 1.26, 95% CrI: 1.08-1.47), 50-59 (OR 1.78, 95% CrI: 1.55-2.06), 60-69 (OR 2.24, 95% CrI: 1.94-2.59), 70-79 (OR 2.90, 95% CrI: 2.49-3.39) and ≥ 80 (OR 4.02, 95% CrI: 3.13-5.20) were independently associated with increasing hospital mortality. Similar results were found in the analysis conducted with an informative prior, as well as between increasing age and post-ECMO complications. CONCLUSIONS Among patients receiving V-A ECMO for cardiogenic shock, increasing age is strongly associated with increasing odds of death and complications, and this association emerges as early as 40 years of age.
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Affiliation(s)
- Shannon M Fernando
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada.
- Department of Critical Care, Lakeridge Health Corporation, Oshawa, ON, Canada.
| | - Graeme MacLaren
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Cardiothoracic Intensive Care Unit, National University Heart Centre, National University Hospital, Singapore, Singapore
| | - Ryan P Barbaro
- Division of Pediatric Critical Care Medicine, University of Michigan, Ann Arbor, MI, USA
- Child Health Evaluation and Research Center, University of Michigan, Ann Arbor, MI, USA
| | - Rebecca Mathew
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Laveena Munshi
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Purnema Madahar
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, USA
- Center for Acute Respiratory Failure, New York-Presbyterian Hospital, New York, NY, USA
| | - Justin A Fried
- Division of Cardiology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Kollengode Ramanathan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Cardiothoracic Intensive Care Unit, National University Heart Centre, National University Hospital, Singapore, Singapore
| | - Roberto Lorusso
- Department of Cardio Thoracic Surgery, Maastricht University Medical Centre, Maastricht University, Maastricht, The Netherlands
- Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands
| | - Daniel Brodie
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Daniel I McIsaac
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Department of Anesthesiology and Pain Medicine, University of Ottawa, Ottawa, ON, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
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12
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Oranchuk DJ, Hopkins WG, Cronin JB, Storey AG, Nelson AR. The effects of regional quadriceps architecture on angle-specific rapid force expression. Appl Physiol Nutr Metab 2023; 48:829-840. [PMID: 37390497 DOI: 10.1139/apnm-2023-0074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/02/2023]
Abstract
Evaluating anatomical contributions to performance can increase understanding of muscle mechanics and guide physical preparation. While the impact of anatomy on muscular performance is well studied, the effects of regional quadriceps architecture on rapid torque or force expression are less clear. Regional (proximal, middle, and distal) quadriceps (vastus lateralis, rectus femoris, and vastus intermedius) thickness (MT), pennation angle (PA), and fascicle length (FL) of 24 males (48 limbs) were assessed via ultrasonography. Participants performed maximal isometric knee extensions at 40°, 70°, and 100° of knee flexion to evaluate rate of force development from 0 to 200 ms (RFD0-200). Measurements were repeated on three occasions with the greatest RFD0-200 and mean muscle architecture measures used for analysis. Linear regression models predicting angle-specific RFD0-200 from regional anatomy provided adjusted correlations (√adjR2) with bootstrapped compatibility limits. Mid-rectus femoris MT (√adjR2 = 0.41-0.51) and proximal vastus lateralis FL (√adjR2 = 0.42-0.48) were the best single predictors of RFD0-200, and the only measures to reach precision with 99% compatibility limits. Small simple correlations were found across all regions and joint angles between RFD0-200 and vastus lateralis MT (√adjR2 = 0.28 ± 0.13; mean ± SD), vastus lateralis FL (√adjR2 = 0.33 ± 0.10), rectus femoris MT (√adjR2 = 0.38 ± 0.10), and lateral vastus intermedius MT (√adjR2 = 0.24 ± 0.10). Between-correlation comparisons are reported within the article. Researchers should measure mid-region rectus femoris MT and vastus lateralis FL to efficiently and robustly evaluate potential anatomical contributions to rapid knee extension force changes, with distal and proximal measurements providing little additional value. However, correlations were generally small to moderate, suggesting that neurological factors may be critical in rapid force expression.
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Affiliation(s)
- Dustin J Oranchuk
- Sports Performance Research Institute New Zealand, Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
- Institute for Health and Sport, Victoria University, Melbourne, Australia
- Muscle Morphology, Mechanics, and Performance Laboratory, Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, CO, US
| | - William G Hopkins
- Institute for Health and Sport, Victoria University, Melbourne, Australia
| | - John B Cronin
- Sports Performance Research Institute New Zealand, Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Adam G Storey
- Sports Performance Research Institute New Zealand, Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
| | - André R Nelson
- Institute for Health and Sport, Victoria University, Melbourne, Australia
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13
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Godoy LC, Ko DT, Farkouh ME, Shah BR, Austin PC. Dealing With Nonproportional Hazards in Coronary Revascularisation Studies. Can J Cardiol 2023; 39:1651-1660. [PMID: 37468120 DOI: 10.1016/j.cjca.2023.07.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 07/12/2023] [Accepted: 07/13/2023] [Indexed: 07/21/2023] Open
Abstract
The Cox proportional hazards model is one of the most popular statistical tools to model time to event outcomes without the need for specifying the hazards or survival time distributions. The Cox model requires that the ratio of the hazards of the occurrence of the outcome for any 2 individuals remains constant during the entire follow-up. Studies comparing coronary revascularisation strategies, however, might be prone to violations of proportionality by the crossing of the hazard functions over time. Early increases in the risk of cardiovascular outcomes are commonly observed when comparing coronary artery bypass grafting vs percutaneous coronary intervention, whereas decreased risk might be observed later during the follow-up. The same is valid for comparisons between invasive vs conservative coronary revascularisation strategies. In these situations, the statistical power of the Cox model is reduced, and hazard ratios might not be an informative summary measure of treatment effect. In this article, we discuss methods to identify and account for nonproportionality. We illustrate the use of these methods in a case study based on reconstructed data from a coronary revascularisation clinical trial. And finally, we review the cardiovascular literature to estimate how the proportionality assumption has been reported in coronary revascularisation studies recently.
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Affiliation(s)
- Lucas C Godoy
- Peter Munk Cardiac Centre, University of Toronto, Toronto, Ontario, Canada; ICES, Toronto, Ontario, Canada; Institute of Health Policy Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Dennis T Ko
- ICES, Toronto, Ontario, Canada; Institute of Health Policy Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada; Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Michael E Farkouh
- Peter Munk Cardiac Centre, University of Toronto, Toronto, Ontario, Canada; Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Baiju R Shah
- ICES, Toronto, Ontario, Canada; Institute of Health Policy Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada; Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Peter C Austin
- ICES, Toronto, Ontario, Canada; Institute of Health Policy Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada.
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14
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Ghadimi K, Cappiello JL, Wright MC, Levy JH, Bryner BS, DeVore AD, Schroder JN, Patel CB, Rajagopal S, Shah SH, Milano CA. Inhaled Epoprostenol Compared With Nitric Oxide for Right Ventricular Support After Major Cardiac Surgery. Circulation 2023; 148:1316-1329. [PMID: 37401479 PMCID: PMC10615678 DOI: 10.1161/circulationaha.122.062464] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Accepted: 06/06/2023] [Indexed: 07/05/2023]
Abstract
BACKGROUND Right ventricular failure (RVF) is a leading driver of morbidity and death after major cardiac surgery for advanced heart failure, including orthotopic heart transplantation and left ventricular assist device implantation. Inhaled pulmonary-selective vasodilators, such as inhaled epoprostenol (iEPO) and nitric oxide (iNO), are essential therapeutics for the prevention and medical management of postoperative RVF. However, there is limited evidence from clinical trials to guide agent selection despite the significant cost considerations of iNO therapy. METHODS In this double-blind trial, participants were stratified by assigned surgery and key preoperative prognostic features, then randomized to continuously receive either iEPO or iNO beginning at the time of separation from cardiopulmonary bypass with the continuation of treatment into the intensive care unit stay. The primary outcome was the composite RVF rate after both operations, defined after transplantation by the initiation of mechanical circulatory support for isolated RVF, and defined after left ventricular assist device implantation by moderate or severe right heart failure according to criteria from the Interagency Registry for Mechanically Assisted Circulatory Support. An equivalence margin of 15 percentage points was prespecified for between-group RVF risk difference. Secondary postoperative outcomes were assessed for treatment differences and included: mechanical ventilation duration; hospital and intensive care unit length of stay during the index hospitalization; acute kidney injury development including renal replacement therapy initiation; and death at 30 days, 90 days, and 1 year after surgery. RESULTS Of 231 randomized participants who met eligibility at the time of surgery, 120 received iEPO, and 111 received iNO. Primary outcome occurred in 30 participants (25.0%) in the iEPO group and 25 participants (22.5%) in the iNO group, for a risk difference of 2.5 percentage points (two one-sided test 90% CI, -6.6% to 11.6%) in support of equivalence. There were no significant between-group differences for any of the measured postoperative secondary outcomes. CONCLUSIONS Among patients undergoing major cardiac surgery for advanced heart failure, inhaled pulmonary-selective vasodilator treatment using iEPO was associated with similar risks for RVF development and development of other postoperative secondary outcomes compared with treatment using iNO. REGISTRATION URL: https://www. CLINICALTRIALS gov; Unique identifier: NCT03081052.
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Affiliation(s)
- Kamrouz Ghadimi
- Department of Anesthesiology, Divisions of Cardiothoracic Anesthesiology and Critical Care Medicine, and the Clinical Research Unit (K.G., M.C.W., J.H.L.), Duke University School of Medicine, Durham, NC
| | | | - Mary Cooter Wright
- Department of Anesthesiology, Divisions of Cardiothoracic Anesthesiology and Critical Care Medicine, and the Clinical Research Unit (K.G., M.C.W., J.H.L.), Duke University School of Medicine, Durham, NC
| | - Jerrold H Levy
- Department of Anesthesiology, Divisions of Cardiothoracic Anesthesiology and Critical Care Medicine, and the Clinical Research Unit (K.G., M.C.W., J.H.L.), Duke University School of Medicine, Durham, NC
- Department of Surgery, Adult Cardiac Surgery Section (J.H.L., B.S.B., J.N.S., C.A.M.), Duke University School of Medicine, Durham, NC
| | - Benjamin S Bryner
- Department of Surgery, Adult Cardiac Surgery Section (J.H.L., B.S.B., J.N.S., C.A.M.), Duke University School of Medicine, Durham, NC
| | - Adam D DeVore
- Department of Medicine, Division of Cardiology (A.D.D., C.B.P., S.R., S.H.S.), Duke University School of Medicine, Durham, NC
| | - Jacob N Schroder
- Department of Surgery, Adult Cardiac Surgery Section (J.H.L., B.S.B., J.N.S., C.A.M.), Duke University School of Medicine, Durham, NC
| | - Chetan B Patel
- Department of Medicine, Division of Cardiology (A.D.D., C.B.P., S.R., S.H.S.), Duke University School of Medicine, Durham, NC
| | - Sudarshan Rajagopal
- Department of Medicine, Division of Cardiology (A.D.D., C.B.P., S.R., S.H.S.), Duke University School of Medicine, Durham, NC
| | - Svati H Shah
- Department of Medicine, Division of Cardiology (A.D.D., C.B.P., S.R., S.H.S.), Duke University School of Medicine, Durham, NC
| | - Carmelo A Milano
- Department of Surgery, Adult Cardiac Surgery Section (J.H.L., B.S.B., J.N.S., C.A.M.), Duke University School of Medicine, Durham, NC
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15
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Müller AM, Bertram J, Bradaric C, Koppara T, Cassese S, Xhepa E, Heilmeier B, Ott I, Kastrati A, Laugwitz KL, Ibrahim T, Dirschinger RJ. Frequency of subclavian artery stenosis in patients with mammarian artery coronary bypass and suspected coronary artery disease progression. Clin Res Cardiol 2023; 112:1204-1211. [PMID: 36239814 PMCID: PMC10449982 DOI: 10.1007/s00392-022-02113-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 10/04/2022] [Indexed: 12/24/2022]
Abstract
We retrospectively analyzed patient records of all patients with a history of internal mammarian artery (IMA) coronary bypass undergoing coronary angiography at two cardiovascular centers between January 1st 1999 and December 31st 2019. A total of 11,929 coronary angiographies with or without percutaneous coronary intervention were carried out in 3921 patients. Our analysis revealed 82 (2%) patients with documented subclavian artery stenosis. Of these, 8 (10%) patients were classified as having mild, 18 (22%) moderate, and 56 (68%) severe subclavian artery stenosis. In 7 (9%) patients with subclavian artery stenosis, angiography revealed occlusion of the IMA graft. 26 (32%) patients with severe subclavian artery stenosis underwent endovascular or surgical revasculararization of the subclavian artery. In this retrospective multicenter study, subclavian artery stenosis was a relevant finding in patients with an internal mammarian artery coronary bypass graft undergoing coronary angiography. The development of dedicated algorithms for screening and ischemia evaluation in affected individuals may improve treatment of this potentially underdiagnosed and undertreated condition.
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Affiliation(s)
- Arne M Müller
- Klinik Und Poliklinik Für Innere Medizin I., Klinikum Rechts Der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany.
| | - Justus Bertram
- Klinik Und Poliklinik Für Innere Medizin I., Klinikum Rechts Der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany
| | - Christian Bradaric
- Klinik Und Poliklinik Für Innere Medizin I., Klinikum Rechts Der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany
| | - Tobias Koppara
- Klinik Und Poliklinik Für Innere Medizin I., Klinikum Rechts Der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany
| | - Salvatore Cassese
- Deutsches Herzzentrum München, Abteilung Für Herz- Und Kreislauferkrankungen, Technische Universität München, Lazarettstr. 36, 80636, Munich, Germany
| | - Erion Xhepa
- Deutsches Herzzentrum München, Abteilung Für Herz- Und Kreislauferkrankungen, Technische Universität München, Lazarettstr. 36, 80636, Munich, Germany
| | | | - Ilka Ott
- Helios Klinikum Pforzheim, Abteilung für Kardiologie, Angiologie und Intensivmedizin, Kanzlerstr. 2-6, 75175, Pforzheim, Germany
| | - Adnan Kastrati
- Deutsches Herzzentrum München, Abteilung Für Herz- Und Kreislauferkrankungen, Technische Universität München, Lazarettstr. 36, 80636, Munich, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Biedersteiner Str. 29, 80331, Munich, Germany
| | - Karl-Ludwig Laugwitz
- Klinik Und Poliklinik Für Innere Medizin I., Klinikum Rechts Der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Biedersteiner Str. 29, 80331, Munich, Germany
| | - Tareq Ibrahim
- Klinik Und Poliklinik Für Innere Medizin I., Klinikum Rechts Der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany
| | - Ralf J Dirschinger
- Klinik Und Poliklinik Für Innere Medizin I., Klinikum Rechts Der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany.
- Gefäßpraxis im Tal, Tal 13, 80331, Munich, Germany.
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Adda-Rezig I, Cossu J, Falvo N, Ecarnot F, Desmettre T, Meneveau N, Piazza G, Chopard R. Home treatment versus early discharge for the outpatient management of acute pulmonary embolism: A non-interventional, post-hoc cohort analysis. Thromb Res 2023; 227:25-33. [PMID: 37209588 DOI: 10.1016/j.thromres.2023.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 03/06/2023] [Accepted: 05/08/2023] [Indexed: 05/22/2023]
Abstract
INTRODUCTION We prospectively investigated whether home treatment of pulmonary embolism (PE), is as effective and safe as the recommended early discharge management in terms of outcomes at 3 months. METHODS We performed a post hoc analysis of prospectively and consecutively recorded data in acute PE patients from a tertiary care facility between January 2012 and November 2021. Home treatment was defined as discharge to home directly from the emergency department (ED) after <24 h stay. Early discharge was defined as in-hospital stay of ≥24 h and ≤48 h. Primary efficacy and safety outcomes were a composite of PE-related death or recurrent venous thrombo-embolism, and major bleeding, respectively. Outcomes between groups were compared using penalized multivariable models. RESULTS In total, 181 patients (30.6 %) were included in the home treatment group and 463 (69.4 %) patients in the early discharge group. Median duration of ED stay was 8.1 h (IQR, 3.6-10.2 h) in the home treatment group, and median length of hospital stay was 36.4 h (IQR, 28.7-40.2) in the early discharge group. The adjusted rate of the primary efficacy outcome was 1.90 % (95 % CI, 0.16-15.2) vs 2.05 % (95 % CI, 0.24-10.1) for home treatment vs early discharge (hazard ratio (HR) 0.86 (95 % CI, 0.27-2.74). The adjusted rates of the primary safety outcome did not differ between groups at 3 months. CONCLUSIONS In a non-randomized cohort of selected acute PE patients, home treatment provided comparable rates of adverse VTE and bleeding events to the recommended early discharge management, and appears to have similar clinical outcomes at 3 months.
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Affiliation(s)
| | - Johann Cossu
- Emergency Department, University Hospital Jean Minjoz, Besançon, France
| | - Nicolas Falvo
- Department of Internal Medicine, University Hospital Dijon-Bourgogne, Dijon, France
| | - Fiona Ecarnot
- Department of Cardiology, University Hospital Jean Minjoz, Besançon, France; EA3920, University of Franche-Comté, Besançon, France
| | - Thibaut Desmettre
- Emergency Department, University Hospital Jean Minjoz, Besançon, France
| | - Nicolas Meneveau
- Department of Cardiology, University Hospital Jean Minjoz, Besançon, France; EA3920, University of Franche-Comté, Besançon, France; F-CRIN, INNOVTE Network, France
| | - Gregory Piazza
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Romain Chopard
- Department of Cardiology, University Hospital Jean Minjoz, Besançon, France; EA3920, University of Franche-Comté, Besançon, France; F-CRIN, INNOVTE Network, France.
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17
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Neelakantan S, Kumar M, Mendiola EA, Phelan H, Serpooshan V, Sadayappan S, Avazmohammadi R. Multiscale characterization of left ventricle active behavior in the mouse. Acta Biomater 2023; 162:240-253. [PMID: 36963596 PMCID: PMC10416730 DOI: 10.1016/j.actbio.2023.03.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 03/07/2023] [Accepted: 03/15/2023] [Indexed: 03/26/2023]
Abstract
The myocardium possesses an intricately designed microarchitecture to produce an optimal cardiac contraction. The contractile behavior of the heart is generated at the sarcomere level and travels across several length scales to manifest as the systolic function at the organ level. While passive myocardial behavior has been studied extensively, the translation of active tension produced at the fiber level to the organ-level function is not well understood. Alterations in cardiac systolic function are often key sequelae in structural heart diseases, such as myocardial infarction and systolic heart failure; thus, characterization of the contractile behavior of the heart across multiple length scales is essential to improve our understanding of mechanisms collectively leading to depressed systolic function. In this study, we present a methodology to characterize the active behavior of left ventricle free wall (LVFW) myocardial tissues in mice. Combined with active tests in papillary muscle fibers and conventional in vivo contractility measurement at the organ level in an animal-specific manner, we establish a multiscale active characterization of the heart from fiber to organ. In addition, we quantified myocardial architecture from histology to shed light on the directionality of the contractility at the tissue level. The LVFW tissue activation-relaxation behavior under isometric conditions was qualitatively similar to that of the papillary muscle fiber bundle. However, the maximum stress developed in the LVFW tissue was an order of magnitude lower than that developed by a fiber bundle, and the time taken for active forces to plateau was 2-3 orders of magnitude longer. Although the LVFW tissue exhibited a slightly stiffer passive response in the circumferential direction, the tissues produced significantly larger active stresses in the longitudinal direction during active testing. Also, contrary to passive viscoelastic stress relaxation, active stresses relaxed faster in the direction with larger peak stresses. The multiscale experimental pipeline presented in this work is expected to provide crucial insight into the contractile adaptation mechanisms of the heart with impaired systolic function. STATEMENT OF SIGNIFICANCE: Heart failure cause significant alterations to the contractile-relaxation behavior of the yocardium. Multiscale characterization of the contractile behavior of the myocardium is essential to advance our understanding of how contractility translates from fiber to organ and to identify the multiscale mechanisms leading to impaired cardiac function. While passive myocardial behavior has been studied extensively, the investigation of tissue-level contractile behavior remains critically scarce in the literature. To the best of our knowledge, our study here is the first to investigate the contractile behavior of the left ventricle at multiple length scales in small animals. Our results indicate that the active myocardial wall is a function of transmural depth and relaxes faster in the direction with larger peak stresses.
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Affiliation(s)
- Sunder Neelakantan
- Department of Biomedical Engineering, Texas A&M University, College Station, TX, USA
| | - Mohit Kumar
- Department of Internal Medicine, Division of Cardiovascular Health and Disease, University of Cincinnati College of Medicine, Cincinnati, OH 45267, USA
| | - Emilio A Mendiola
- Department of Biomedical Engineering, Texas A&M University, College Station, TX, USA
| | - Haley Phelan
- Department of Biomedical Engineering, Texas A&M University, College Station, TX, USA
| | - Vahid Serpooshan
- Department of Biomedical Engineering, Emory University School of Medicine and Georgia Institute of Technology, Atlanta, GA 30322, USA; Department of Pediatrics, Emory University School of Medicine, Atlanta, GA 30322, USA; Children's Healthcare of Atlanta, Atlanta, GA 30322, USA
| | - Sakthivel Sadayappan
- Department of Internal Medicine, Division of Cardiovascular Health and Disease, University of Cincinnati College of Medicine, Cincinnati, OH 45267, USA.
| | - Reza Avazmohammadi
- Department of Biomedical Engineering, Texas A&M University, College Station, TX, USA; J. Mike Walker '66 Department of Mechanical Engineering, Texas A&M University, College Station, TX, USA; Department of Cardiovascular Sciences, Houston Methodist Academic Institute, Houston, TX, USA.
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18
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Sánchez-Iglesias I, Martín-Aguilar C. Significant Differences and Experimental Designs Do Not Necessarily Imply Clinical Relevance: Effect Sizes and Causality Claims in Antidepressant Treatments. J Clin Med 2023; 12:jcm12093181. [PMID: 37176620 PMCID: PMC10179584 DOI: 10.3390/jcm12093181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Revised: 04/20/2023] [Accepted: 04/27/2023] [Indexed: 05/15/2023] Open
Abstract
Clinical trials are the backbone of medical scientific research. However, this experimental strategy has some drawbacks. We focused on two issues: (a) The internal validity ensured by clinical trial procedures does not necessarily allow for generalization of efficacy results to causal claims about effectiveness in the population. (b) Statistical significance does not imply clinical or practical significance; p-values should be supplemented with effect size (ES) estimators and an interpretation of the magnitude of the effects found. We conducted a systematic review (from 2000 to 2020) on Scopus, PubMed, and four ProQuest databases, including PsycINFO. We searched for experimental studies with significant effects of pharmacological treatments on depressive symptoms, measured with a specific scale for depression. We assessed the claims of effectiveness, and reporting and interpreting of effect sizes in a small, unbiased sample of clinical trials (n = 10). Only 30% of the studies acknowledged that efficacy does not necessarily translate to effectiveness. Only 20% reported ES indices, and only 40% interpreted the magnitude of their findings. We encourage reflection on the applicability of results derived from clinical trials about the efficacy of antidepressant treatments, which often influence daily clinical decision-making. Comparing experimental results of antidepressants with supplementary observational studies can provide clinicians with greater flexibility in prescribing medication based on patient characteristics. Furthermore, the ES of a treatment should be considered, as treatments with a small effect may be worthwhile in certain circumstances, while treatments with a large effect may be justified despite additional costs or complications. Therefore, researchers are encouraged to report and interpret ES and explicitly discuss the suitability of their sample for the clinical population to which the antidepressant treatment will be applied.
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Affiliation(s)
- Iván Sánchez-Iglesias
- Department of Psychobiology & Behavioral Sciences Methods, Complutense University of Madrid, 28223 Madrid, Spain
| | - Celia Martín-Aguilar
- Centro Universitario San Rafael-Nebrija, Universidad Nebrija, 28036 Madrid, Spain
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19
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Gao R, Qu Q, Guo Q, Sun J, Liao S, Zhu Q, Zhu X, Cheang I, Yao W, Zhang H, Li X, Zhou Y. Construction of a web-based dynamic nomogram for predicting the prognosis in acute heart failure. ESC Heart Fail 2023. [PMID: 37076115 PMCID: PMC10375097 DOI: 10.1002/ehf2.14371] [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: 10/06/2022] [Revised: 03/17/2023] [Accepted: 03/23/2023] [Indexed: 04/21/2023] Open
Abstract
AIMS The early identification and appropriate management may provide clinically meaningful and substained benefits in patients with acute heart failure (AHF). This study aimed to develop an integrative nomogram with myocardial perfusion imaging (MPI) for predicting the risk of all-cause mortality in AHF patients. METHODS AND RESULTS Prospective study of 147 patients with AHF who received gated MPI (59.0 [47.5, 68.0] years; 78.2% males) were enrolled and followed for the primary endpoint of all-cause mortality. We analysed the demographic information, laboratory tests, electrocardiogram, and transthoracic echocardiogram by the least absolute shrinkage and selection operator (LASSO) regression for selection of key features. A multivariate stepwise Cox analysis was performed to identify independent risk factors and construct a nomogram. The predictive values of the constructed model were compared by Kaplan-Meier curve, area under the curves (AUCs), calibration plots, continuous net reclassification improvement, integrated discrimination improvement, and decision curve analysis. The 1, 3, and 5 year cumulative rates of death were 10%, 22%, and 29%, respectively. Diastolic blood pressure [hazard ratio (HR) 0.96, 95% confidence interval (CI) 0.93-0.99; P = 0.017], valvular heart disease (HR 3.05, 95% CI 1.36-6.83; P = 0.007), cardiac resynchronization therapy (HR 0.37, 95% CI 0.17-0.82; P = 0.014), N-terminal pro-B-type natriuretic peptide (per 100 pg/mL; HR 1.02, 95% CI 1.01-1.03; P < 0.001), and rest scar burden (HR 1.03, 95% CI 1.01-1.06; P = 0.008) were independent risk factors for patients with AHF. The cross-validated AUCs (95% CI) of nomogram constructed by diastolic blood pressure, valvular heart disease, cardiac resynchronization therapy, N-terminal pro-B-type natriuretic peptide, and rest scar burden were 0.88 (0.73-1.00), 0.83 (0.70-0.97), and 0.79 (0.62-0.95) at 1, 3, and 5 years, respectively. Continuous net reclassification improvement and integrated discrimination improvement were also observed, and the decision curve analysis identified the greater net benefit of the nomogram across a wide range of threshold probabilities (0-100% at 1 and 3 years; 0-61% and 62-100% at 5 years) compared with dismissing the included factors or using either factor alone. CONCLUSIONS A predictive nomogram for the risk of all-cause mortality in patients with AHF was developed and validated in this study. The nomogram incorporated the rest scar burden by MPI is highly predictive, and may help to better stratify clinical risk and guide treatment decisions in patients with AHF.
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Affiliation(s)
- Rongrong Gao
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China
| | - Qiang Qu
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China
| | - Qixin Guo
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China
| | - Jinyu Sun
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China
| | - Shengen Liao
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China
| | - Qingqing Zhu
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China
| | - Xu Zhu
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China
| | - Iokfai Cheang
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China
| | - Wenming Yao
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China
| | - Haifeng Zhang
- Department of Cardiology, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Gusu School, Nanjing Medical University, 26 Daoqian Street, Suzhou, 215002, China
- Department of Cardiology, Jiangsu Province Hospital, 300 Guangzhou Road, Nanjing, 210029, China
| | - Xinli Li
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China
| | - Yanli Zhou
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China
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20
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Pewowaruk RJ, Korcarz C, Stein JH, Bluemke D, Tedla Y, Gepner AD. Methods of arterial stiffness calculation and cardiovascular disease events: the multiethnic study of atherosclerosis. J Hypertens 2023; 41:486-493. [PMID: 36728257 PMCID: PMC10038853 DOI: 10.1097/hjh.0000000000003365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND A wide variety of different formulae have been used to calculate local arterial stiffness with little external validation in relationship to cardiovascular events. We compared the associations of several arterial stiffness calculations in a large, multiethnic cohort. METHODS The multi-ethnic study of atherosclerosis (MESA) is a longitudinal study of 6814 adults without clinical cardiovascular disease (CVD) at enrollment. MESA participants with CVD surveillance through year 2018 and carotid ultrasound ( n = 5873) or aorta MRI ( n = 3175) at the baseline exam (2000-2002) were included. We analyzed 21 different calculations of local arterial stiffness. Cross-sectional and longitudinal statistical analyses were performed in addition to Cox hazard modeling for associations with CVD events (myocardial infarction, resuscitated cardiac arrest, stroke, adjudicated angina, and cardiovascular death). RESULTS Carotid artery stiffness calculations had variable correlations with each other ( r = 0.56-0.99); aortic stiffness measures were similar ( r = 0.66-0.99). Nevertheless, for CVD events, the hazard ratio (HR) per standard deviation change were similar for all carotid stiffness calculations with HRs in the range of 1.00-1.10 (equivalence P < 0.001). For the aorta, aortic distensibility coefficient had a stronger association with CVD events (HR 1.18 [1.02-1.37]) compared to aorta Peterson's elastic modulus (HR 0.98 [0.89-1.07]) and aorta pulse wave velocity (HR 1.00 [0.90-1.11]). HRs between all other aortic stiffness calculations were equivalent ( P < 0.01). CONCLUSION Different methods of calculating local arterial stiffness largely gave equivalent results, indicating that the variety of different arterial stiffness calculations in use do not cause inconsistent findings.
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Affiliation(s)
- Ryan J Pewowaruk
- University of Wisconsin School of Medicine and Public Health
- William S. Middleton Memorial Veteran's Hospital, Madison, Wisconsin
| | - Claudia Korcarz
- University of Wisconsin School of Medicine and Public Health
| | - James H Stein
- University of Wisconsin School of Medicine and Public Health
| | - David Bluemke
- University of Wisconsin School of Medicine and Public Health
| | - Yacob Tedla
- Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Adam D Gepner
- University of Wisconsin School of Medicine and Public Health
- William S. Middleton Memorial Veteran's Hospital, Madison, Wisconsin
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21
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Sommersten CH, Gjerde ES, Laupsa-Borge J, Andersen AI, Lawrence-Archer L, McCann A, Hansson P, Raza GS, Herzig KH, Lied GA, Martins C, Mellgren G, Dierkes J, Dankel SN. Relationship between Ketones, Ghrelin, and, Appetite on Isocaloric Diets with Varying Carbohydrate Quality and Amount: Results from a Randomized Controlled Trial in People with Obesity (CARBFUNC). J Nutr 2023; 153:459-469. [PMID: 36894239 PMCID: PMC10127526 DOI: 10.1016/j.tjnut.2022.12.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 12/23/2022] [Accepted: 12/28/2022] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Low-carbohydrate high-fat (LCHF) diets may suppress the increase in appetite otherwise seen after diet-induced fat loss. However, studies of diets without severe energy restriction are lacking, and the effects of carbohydrate quality relative to quantity have not been directly compared. OBJECTIVES To evaluated short- (3 mo) and long-term (12 mo) changes in fasting plasma concentrations of total ghrelin, β-hydroxybutyrate (βHB), and subjective feelings of appetite on 3 isocaloric eating patterns within a moderate caloric range (2000-2500 kcal/d) and with varying carbohydrate quality or quantity. METHODS We performed a randomized controlled trial of 193 adults with obesity, comparing eating patterns based on "acellular" carbohydrate sources (e.g., flour-based whole-grain products; comparator arm), "cellular" carbohydrate sources (minimally processed foods with intact cellular structures), or LCHF principles. Outcomes were compared by an intention-to-treat analysis using constrained linear mixed modeling. This trial was registered at clinicaltrials.gov as NCT03401970. RESULTS Of the 193 adults, 118 (61%) and 57 (30%) completed 3 and 12 mo of follow-up. Throughout the intervention, intakes of protein and energy were similar with all 3 eating patterns, with comparable reductions in body weight (5%-7%) and visceral fat volume (12%-17%) after 12 mo. After 3 mo, ghrelin increased significantly with the acellular (mean: 46 pg/mL; 95% CI: 11, 81) and cellular (mean: 54 pg/mL; 95% CI: 21, 88) diets but not with the LCHF diet (mean: 11 pg/mL; 95% CI: -16, 38). Although βHB increased significantly more with the LCHF diet than with the acellular diet after 3 m (mean: 0.16 mmol/L; 95% CI: 0.09, 0.24), this did not correspond to a significant group difference in ghrelin (unless the 2 high-carbohydrate groups were combined [mean: -39.6 pg/mL; 95% CI: -76, -3.3]). No significant between-group differences were seen in feelings of hunger. CONCLUSIONS Modestly energy-restricted isocaloric diets differing in carbohydrate cellularity and amount showed no significant differences in fasting total ghrelin or subjective hunger feelings. An increase in ketones with the LCHF diet to 0.3-0.4 mmol/L was insufficient to substantially curb increases in fasting ghrelin during fat loss.
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Affiliation(s)
- Cathrine Horn Sommersten
- Mohn Nutrition Research Laboratory, Centre for Nutrition, Department of Clinical Science, University of Bergen, Bergen, Norway; Mohn Nutrition Research Laboratory, Centre for Nutrition, Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Eirin Semb Gjerde
- Mohn Nutrition Research Laboratory, Centre for Nutrition, Department of Clinical Science, University of Bergen, Bergen, Norway; Mohn Nutrition Research Laboratory, Centre for Nutrition, Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Johnny Laupsa-Borge
- Mohn Nutrition Research Laboratory, Centre for Nutrition, Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Amanda Io Andersen
- Mohn Nutrition Research Laboratory, Centre for Nutrition, Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Laurence Lawrence-Archer
- Hormone Laboratory, Department of Medical Biochemistry and Pharmacology, Haukeland University Hospital, Bergen, Norway
| | | | - Patrik Hansson
- Department of Clinical Medicine, Faculty of Health Sciences, the Arctic University of Norway, Tromsø, Norway
| | - Ghulam S Raza
- Research Unit of Biomedicine, Faculty of Medicine, University of Oulu, Oulu, Finland
| | - Karl Heinz Herzig
- Research Unit of Biomedicine, Faculty of Medicine, University of Oulu, Oulu, Finland
| | - Gülen Arslan Lied
- Mohn Nutrition Research Laboratory, Centre for Nutrition, Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Catia Martins
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Sciences and Technology, Trondheim, Norway; Centre for Obesity and Innovation, Clinic of Surgery, St. Olav University Hospital, Trondheim, Norway
| | - Gunnar Mellgren
- Mohn Nutrition Research Laboratory, Centre for Nutrition, Department of Clinical Science, University of Bergen, Bergen, Norway; Hormone Laboratory, Department of Medical Biochemistry and Pharmacology, Haukeland University Hospital, Bergen, Norway
| | - Jutta Dierkes
- Mohn Nutrition Research Laboratory, Centre for Nutrition, Department of Clinical Medicine, University of Bergen, Bergen, Norway; Hormone Laboratory, Department of Medical Biochemistry and Pharmacology, Haukeland University Hospital, Bergen, Norway
| | - Simon N Dankel
- Mohn Nutrition Research Laboratory, Centre for Nutrition, Department of Clinical Science, University of Bergen, Bergen, Norway; Hormone Laboratory, Department of Medical Biochemistry and Pharmacology, Haukeland University Hospital, Bergen, Norway.
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22
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Cai Q, Zhao X, Dong L, Zhang X, Wang C, Wang S, Zhou Y, Zhou X, Li Y, Wang S, Liu L, Hu A. Keeping obesity status is a risk factor of hypertension onset: evidence from a community-based longitudinal cohort study in North China. Front Public Health 2023; 11:1170334. [PMID: 37181695 PMCID: PMC10173577 DOI: 10.3389/fpubh.2023.1170334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 03/28/2023] [Indexed: 05/16/2023] Open
Abstract
Objective The purpose of our study was to investigate the association of obesity status change with hypertension onset based on a community-based longitudinal cohort study in North China. Methods This longitudinal study included 3,581 individuals free of hypertension at baseline in the first survey (2011-2012). All participants were followed up (2018-2019). According to the criteria, a total of 2,618 individuals were collected for analysis. We used adjusted Cox regression models and Kaplan-Meier survival analysis to estimate the association between obesity status change and hypertension onset. Additionally, we applied the forest plot to visualize the subgroup analysis including age, gender, and the differences in some variables between baseline and follow-up. Finally, we conducted a sensitivity analysis to examine the stability of our results. Results Over nearly 7 years of follow-up, a total of 811 (31%) developed hypertension. The new hypertension incidence was mostly observed in those who were obese all the time (P for trend < 0.01). In the fully adjusted Cox regression model, being obese all the time increased the risk of hypertension by 30.10% [HR 4.01 (95% CI 2.20-7.32)]. The Kaplan-Meier survival analysis revealed the change in obesity status as an important feature to predict the occurrence of hypertension. Sensitivity analysis shows a consistent trend between the change in obesity status and hypertension onset in all populations. Subgroup analysis showed that age above 60 years was an important risk factor for hypertension onset, that men were more likely than women to develop hypertension, and that weight control was beneficial in avoiding future hypertension in women. There were statistically significant differences in ΔBMI, ΔSBP, ΔDBP, and ΔbaPWV between the four groups, and all variables, except baPWV changes, increased the risk of future hypertension. Conclusion Our study shows that obese status was notably associated with a significant risk of hypertension onset among the Chinese community-based cohort.
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Affiliation(s)
- Qiujing Cai
- Center for Non-communicable Disease Management, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Xiaolei Zhao
- Center for Non-communicable Disease Management, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Liguang Dong
- Center for Health Care Management, Peking University Shougang Hospital, Beijing, China
- Beijing Hypertension League, Beijing, China
| | - Xinmin Zhang
- Center for Non-communicable Disease Management, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Chenglong Wang
- Center for Non-communicable Disease Management, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Shu Wang
- Beijing Hypertension League, Beijing, China
| | - Yi Zhou
- Department of Cardiology, Fuwai Hospital, Beijing, China
| | - Xianliang Zhou
- Department of Cardiology, Fuwai Hospital, Beijing, China
| | - Yanqi Li
- Beijing Hypertension League, Beijing, China
| | - Shuyu Wang
- Beijing Hypertension League, Beijing, China
| | | | - Aihua Hu
- Center for Non-communicable Disease Management, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
- *Correspondence: Aihua Hu
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23
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Zhang HZ, Wang YH, Ge YL, Wang SY, Sun JY, Chen LL, Su S, Sun Y. Obesity, malnutrition, and the prevalence and outcome of hypertension: Evidence from the National Health and Nutrition Examination Survey. Front Cardiovasc Med 2023; 10:1043491. [PMID: 36937935 PMCID: PMC10018144 DOI: 10.3389/fcvm.2023.1043491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 02/13/2023] [Indexed: 03/06/2023] Open
Abstract
Background Nutritionally unhealthy obesity is a newly introduced phenotype characterized by a combined condition of malnutrition and obesity. This study aims to explore the combined influence of obesity and nutritional status on the prevalence and outcome of hypertension. Methods Participants collected from the National Health and Nutrition Examination Survey (NHANES) database were divided into four subgroups according to their obesity and nutritional conditions, as defined by waist circumference and serum albumin concentration. The lean-well-nourished was set as the reference group. Logistic regression models were applied to evaluate the hypertension risk. Kaplan-Meier analysis and Cox proportional hazard regression models were used to assess the survival curve and outcome risk of participants with hypertension. Results A total of 28,554 participants with 10,625 hypertension patients were included in the analysis. The lean-malnourished group showed a lower hypertension risk (odds ratio [OR] 0.85, 95% confidence interval [CI]: 0.77-0.94), while the obese-well-nourished condition elevated the risk (OR 1.47, 95% CI: 1.3-1.67). Two malnourished groups had higher mortality risks (HR 1.42, 95% CI: 1.12-1.80 and HR 1.31, 95% CI: 1.03-1.69 for the lean and obese, respectively) than the reference group. The outcome risk of the obese-well-nourished group (HR 1.02, 95% CI: 0.76-1.36) was similar to the lean-well-nourished. Conclusion Malnutrition was associated with a lower risk of developing hypertension in both lean and obese participants, but it was associated with a worse outcome once the hypertension is present. The lean-malnourished hypertension patients had the highest all-cause mortality risk followed by the obese-malnourished. The obese-well-nourished hypertension patients showed a similar mortality risk to the lean-well-nourished hypertension patients.
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Affiliation(s)
- Heng-Zhi Zhang
- Department of Burn and Plastic Surgery, Children’s Hospital of Nanjing Medical University, Nanjing, China
- The First Clinical Medicine College, Nanjing Medical University, Nanjing, China
- *Correspondence: Ying Sun, ; Shuang Su, ; Heng-Zhi Zhang,
| | - Yi-Han Wang
- Department of Burn and Plastic Surgery, Children’s Hospital of Nanjing Medical University, Nanjing, China
- The First Clinical Medicine College, Nanjing Medical University, Nanjing, China
| | - Ying-Lin Ge
- Department of Biomedical Engineering, College of Medicine, Tianjin University, Tianjin, China
| | - Shu-Yu Wang
- The First Clinical Medicine College, Nanjing Medical University, Nanjing, China
| | - Jin-Yu Sun
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Lu-Lu Chen
- Department of Anatomy, Histology, and Embryology, Nanjing Medical University, Nanjing, China
| | - Shuang Su
- Nanjing Pukou Central Hospital, Pukou Branch Hospital of Jiangsu Province Hospital, Nanjing, China
- *Correspondence: Ying Sun, ; Shuang Su, ; Heng-Zhi Zhang,
| | - Ying Sun
- Department of Burn and Plastic Surgery, Children’s Hospital of Nanjing Medical University, Nanjing, China
- *Correspondence: Ying Sun, ; Shuang Su, ; Heng-Zhi Zhang,
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O’Gallagher K, Rosentreter RE, Elaine Soriano J, Roomi A, Saleem S, Lam T, Roy R, Gordon GR, Raj SR, Chowienczyk PJ, Shah AM, Phillips AA. The Effect of a Neuronal Nitric Oxide Synthase Inhibitor on Neurovascular Regulation in Humans. Circ Res 2022; 131:952-961. [PMID: 36349758 PMCID: PMC9770134 DOI: 10.1161/circresaha.122.321631] [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] [Indexed: 11/10/2022]
Abstract
BACKGROUND Neurovascular coupling (NVC) is a key process in cerebral blood flow regulation. NVC ensures adequate brain perfusion to changes in local metabolic demands. Neuronal nitric oxide synthase (nNOS) is suspected to be involved in NVC; however, this has not been tested in humans. Our objective was to investigate the effects of nNOS inhibition on NVC in humans. METHODS We performed a 3-visit partially randomized, double-blinded, placebo-controlled, crossover study in 12 healthy subjects. On each visit, subjects received an intravenous infusion of either S-methyl-L-thiocitrulline (a selective nNOS-inhibitor), 0.9% saline (placebo control), or phenylephrine (pressor control). The NVC assessment involved eliciting posterior circulation hyperemia through visual stimulation while measuring posterior and middle cerebral arteries blood velocity. RESULTS nNOS inhibition blunted the rapidity of the NVC response versus pressor control, evidenced by a reduced initial rise in mean posterior cerebral artery velocity (-3.3% [-6.5, -0.01], P=0.049), and a reduced rate of increase (ie, acceleration) in posterior cerebral artery velocity (slope reduced -4.3% [-8.5, -0.1], P=0.045). The overall magnitude of posterior cerebral artery response relative to placebo control or pressor control was not affected. Changes in BP parameters were well-matched between the S-methyl-L-thiocitrulline and pressor control arms. CONCLUSIONS Neuronal NOS plays a role in dynamic cerebral blood flow control in healthy adults, particularly the rapidity of the NVC response to visual stimulation. This work opens the way to further investigation of the role of nNOS in conditions of impaired NVC, potentially revealing a therapeutic target.
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Affiliation(s)
- Kevin O’Gallagher
- School of Cardiovascular and Metabolic Medicine & Sciences, King’s College London British Heart Foundation Centre of Research Excellence, London, UK (K.O., A.R., R.R., P.J.C., A.M.S.).,NIHR Biomedical Research Centre, Clinical Research Facility, Guy’s and St Thomas NHS Foundation Trust, London, UK (K.O., A.R., P.J.C., A.M.S.)
| | - Ryan E. Rosentreter
- Departments of Physiology and Pharmacology, Clinical Neurosciences, Cardiac Sciences, Hotchkiss Brain Institute, Libin Cardiovascular Institute of Alberta, Cumming School of Medicine, University of Calgary, Alberta, Canada (R.E.R, J.E.S., T.L., G.R.G., S.R.R., A.A.P.)
| | - Jan Elaine Soriano
- Departments of Physiology and Pharmacology, Clinical Neurosciences, Cardiac Sciences, Hotchkiss Brain Institute, Libin Cardiovascular Institute of Alberta, Cumming School of Medicine, University of Calgary, Alberta, Canada (R.E.R, J.E.S., T.L., G.R.G., S.R.R., A.A.P.)
| | - Ali Roomi
- School of Cardiovascular and Metabolic Medicine & Sciences, King’s College London British Heart Foundation Centre of Research Excellence, London, UK (K.O., A.R., R.R., P.J.C., A.M.S.).,NIHR Biomedical Research Centre, Clinical Research Facility, Guy’s and St Thomas NHS Foundation Trust, London, UK (K.O., A.R., P.J.C., A.M.S.)
| | - Saqib Saleem
- Department of Electrical and Computer Engineering, COMSATS University, Sahiwal, Pakistan (S.S.)
| | - Tyler Lam
- Departments of Physiology and Pharmacology, Clinical Neurosciences, Cardiac Sciences, Hotchkiss Brain Institute, Libin Cardiovascular Institute of Alberta, Cumming School of Medicine, University of Calgary, Alberta, Canada (R.E.R, J.E.S., T.L., G.R.G., S.R.R., A.A.P.)
| | - Roman Roy
- School of Cardiovascular and Metabolic Medicine & Sciences, King’s College London British Heart Foundation Centre of Research Excellence, London, UK (K.O., A.R., R.R., P.J.C., A.M.S.)
| | - Grant R. Gordon
- Departments of Physiology and Pharmacology, Clinical Neurosciences, Cardiac Sciences, Hotchkiss Brain Institute, Libin Cardiovascular Institute of Alberta, Cumming School of Medicine, University of Calgary, Alberta, Canada (R.E.R, J.E.S., T.L., G.R.G., S.R.R., A.A.P.)
| | - Satish R. Raj
- Departments of Physiology and Pharmacology, Clinical Neurosciences, Cardiac Sciences, Hotchkiss Brain Institute, Libin Cardiovascular Institute of Alberta, Cumming School of Medicine, University of Calgary, Alberta, Canada (R.E.R, J.E.S., T.L., G.R.G., S.R.R., A.A.P.)
| | - Philip J. Chowienczyk
- School of Cardiovascular and Metabolic Medicine & Sciences, King’s College London British Heart Foundation Centre of Research Excellence, London, UK (K.O., A.R., R.R., P.J.C., A.M.S.).,NIHR Biomedical Research Centre, Clinical Research Facility, Guy’s and St Thomas NHS Foundation Trust, London, UK (K.O., A.R., P.J.C., A.M.S.)
| | - Ajay M. Shah
- School of Cardiovascular and Metabolic Medicine & Sciences, King’s College London British Heart Foundation Centre of Research Excellence, London, UK (K.O., A.R., R.R., P.J.C., A.M.S.).,NIHR Biomedical Research Centre, Clinical Research Facility, Guy’s and St Thomas NHS Foundation Trust, London, UK (K.O., A.R., P.J.C., A.M.S.)
| | - Aaron A. Phillips
- Departments of Physiology and Pharmacology, Clinical Neurosciences, Cardiac Sciences, Hotchkiss Brain Institute, Libin Cardiovascular Institute of Alberta, Cumming School of Medicine, University of Calgary, Alberta, Canada (R.E.R, J.E.S., T.L., G.R.G., S.R.R., A.A.P.)
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25
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Jung RG, Di Santo P, Mathew R, Simard T, Parlow S, Weng W, Abdel-Razek O, Malhotra N, Cheung M, Hutson JH, Marbach JA, Motazedian P, Thibert MJ, Fernando SM, Nery PB, Nair GM, Russo JJ, Hibbert B, Ramirez FD. Arrhythmic events and mortality in patients with cardiogenic shock on inotropic support: results of the DOREMI randomized trial. Can J Cardiol 2022; 39:394-402. [PMID: 36150583 DOI: 10.1016/j.cjca.2022.09.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 09/14/2022] [Accepted: 09/15/2022] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND Inotropic support is widely used in the management of cardiogenic shock (CS). Existing data on the incidence and significance of arrhythmic events in patients with CS on inotropic support is at high risk of bias. METHODS The DObutamine compaREd to MIlrinone (DOREMI) trial randomized patients to receive dobutamine or milrinone in a double-blind fashion. Patients with and without arrhythmic events (defined as arrhythmias requiring intervention or sustained ventricular arrhythmias) were compared to (1) identify factors associated with their occurrence and (2) examine their association with in-hospital mortality and secondary outcomes. RESULTS Ninety-two patients (47.9%) had arrhythmic events, occurring equally with dobutamine and milrinone (P=0.563). The need for vasopressor support at inotrope initiation and a history of atrial fibrillation were positively associated with arrhythmic events whereas predominant right ventricular dysfunction, previous myocardial infarction, and increasing left ventricular ejection fraction were negatively associated with them. Supraventricular arrhythmic events were not associated with mortality (RR 0.97, 95% CI 0.68-1.40, P=0.879) but were positively associated with resuscitated cardiac arrests and hospital length of stay. Ventricular arrhythmic events were positively associated with mortality (RR 1.66, 95% CI 1.13-2.43; P=0.026) and resuscitated cardiac arrests. Arrhythmic events were most often treated with amiodarone (97%) and electrical cardioversion (27%), which were not associated with mortality. CONCLUSIONS Clinically relevant arrhythmic events occur in approximately half of patients with CS treated with dobutamine or milrinone and are associated with adverse clinical outcomes. Five factors may help identify patients most at risk of arrhythmic events.
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Affiliation(s)
- Richard G Jung
- CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, Ontario Canada
| | - Pietro Di Santo
- CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Rebecca Mathew
- CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Trevor Simard
- CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; Division of Cardiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Simon Parlow
- CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Willy Weng
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Omar Abdel-Razek
- CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Nikita Malhotra
- CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Matthew Cheung
- CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Jordan H Hutson
- CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; Division of Critical Care, University of Ottawa, Ottawa, Ontario, Canada
| | - Jeffrey A Marbach
- CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; Division of Cardiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Pouya Motazedian
- CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Michael J Thibert
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Shannon M Fernando
- Division of Critical Care, University of Ottawa, Ottawa, Ontario, Canada
| | - Pablo B Nery
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Girish M Nair
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Juan J Russo
- CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Benjamin Hibbert
- CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, Ontario Canada
| | - F Daniel Ramirez
- CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada.
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Trends in management and outcomes of pulmonary embolism with a multidisciplinary response team. J Thromb Thrombolysis 2022; 54:449-460. [PMID: 36057054 DOI: 10.1007/s11239-022-02697-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/14/2022] [Indexed: 10/14/2022]
Abstract
Multidisciplinary pulmonary embolism (PE) response teams have garnered widespread adoption given the complexities of managing acute PE and provide a platform for assessment of trends in therapy and outcomes. We describe temporal trends in PE management and outcomes following the deployment of such a team. All consecutive patients managed by our multidisciplinary PE response team activated by the Emergency Department were included over a 5-year calendar period. We examined temporal trends in management and rates of a composite primary endpoint (all-cause-death, major bleeding, recurrent venous thromboembolism, and readmission) at 30 days and 6 months. We assessed 425 patients between 2015 and 2019. We observed an increase in PE acuity and use of systemic thrombolysis. The primary endpoint at 30 days decreased from 16.3% in 2015 to 7.1% in 2019 (adjusted rate ratio per period, 0.63; 95%CI, 0.47-0.84), driven by a decrease in the adjusted rate of major bleeding. Among 406 patients with complete follow-up, the adjusted rate ratio per year for the primary outcome at 6 months was 0.37 (95%CI, 0.19-0.71), driven by a decrease in all-cause mortality. We observed evidence of temporal changes in clinical presentation, therapeutic strategies, and outcomes for acute PE, in parallel to, but not necessarily because of, the implementation of a multidisciplinary response team. Over time, major bleeding, mortality and readmission rates decreased, despite an increase in PE risk category.
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27
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Reversing Cardiac Hypertrophy at the Source Using a Cardiac Targeting Peptide Linked to miRNA106a: Targeting Genes That Cause Cardiac Hypertrophy. Pharmaceuticals (Basel) 2022; 15:ph15070871. [PMID: 35890169 PMCID: PMC9317130 DOI: 10.3390/ph15070871] [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] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 07/06/2022] [Accepted: 07/09/2022] [Indexed: 02/04/2023] Open
Abstract
Causes and treatments for heart failure (HF) have been investigated for over a century culminating in data that have led to numerous pharmacological and surgical therapies. Unfortunately, to date, even with the most current treatments, HF remains a progressive disease with no therapies targeting the cardiomyocytes directly. Technological advances within the past two to three years have brought about new paradigms for treating many diseases that previously had been extremely difficult to resolve. One of these new paradigms has been a shift from pharmacological agents to antisense technology (e.g., microRNAs) to target the molecular underpinnings of pathological processes leading to disease onset. Although this paradigm shift may have been postulated over a decade ago, only within the past few years has it become feasible. Here, we show that miRNA106a targets genes that, when misregulated, have been shown to cause hypertrophy and eventual HF. The addition of miRNA106a suppresses misexpressed HF genes and reverses hypertrophy. Most importantly, using a cardiac targeting peptide reversibly linked to miRNA106a, we show delivery is specific to cardiomyocytes.
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28
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Cheng C, Sun JY, Zhou Y, Xie QY, Wang LY, Kong XQ, Sun W. High waist circumference is a risk factor for hypertension in normal-weight or overweight individuals with normal metabolic profiles. J Clin Hypertens (Greenwich) 2022; 24:908-917. [PMID: 35739356 PMCID: PMC9278579 DOI: 10.1111/jch.14528] [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] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Revised: 05/25/2022] [Accepted: 06/03/2022] [Indexed: 01/22/2023]
Abstract
This study aims to investigate the relationship between waist circumference and hypertension risk in normal‐weight/overweight individuals with normal cardiometabolic profiles. The authors included 7217 normal‐weight and overweight individuals with normal cardiometabolic profiles from the 2001 to 2014 US National Health and Nutrition Examination Survey. The authors summarized demographic characteristics, cardiometabolic profiles, and behavioral factors across waist circumference quartiles. Then, in the logistic regression analysis, the authors observed a positive and significant association between waist circumference (as a continuous variable) and the prevalence of hypertension in all three models (nonadjusted, minimally adjusted, and fully adjusted), with odds ratios (95% confidence intervals) of 1.76 (1.65–1.86), 1.29 (1.20–1.39), and 1.24 (1.09–1.40), respectively. When analyzed as a categorical variable, individuals in the highest waist circumference group had a 1.48‐fold increased risk of hypertension than the lowest group in the fully adjusted model. Moreover, the Cox regression analysis revealed a positive and significant association between waist circumference and all‐cause mortality in individuals with hypertension in the nonadjusted model (HR, 1.27; 95% CI, 1.10–1.47) and the fully adjusted model (HR, 1.59; 95% CI, 1.22–2.06). In conclusions, our results showed that, even in those with normal metabolic profiles, high waist circumference was significantly associated with the increased prevalence of hypertension. And once hypertension has been established, patients with high waist circumference showed elevated all‐cause mortality. Therefore, waist circumference should be routinely measured and controlled regardless of metabolic profiles.
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Affiliation(s)
- Chen Cheng
- Cardiovascular Research Center, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Gusu School, Nanjing Medical University, Suzhou, Jiangsu, China.,Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Jin-Yu Sun
- Cardiovascular Research Center, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Gusu School, Nanjing Medical University, Suzhou, Jiangsu, China.,Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Ying Zhou
- Cardiovascular Research Center, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Gusu School, Nanjing Medical University, Suzhou, Jiangsu, China.,Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Qi-Yang Xie
- Cardiovascular Research Center, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Gusu School, Nanjing Medical University, Suzhou, Jiangsu, China.,Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Li-Yuan Wang
- Cardiovascular Research Center, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Gusu School, Nanjing Medical University, Suzhou, Jiangsu, China.,Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Xiang-Qing Kong
- Cardiovascular Research Center, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Gusu School, Nanjing Medical University, Suzhou, Jiangsu, China.,Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing Medical University, Nanjing, Jiangsu, China.,Key Laboratory of Targeted Intervention of Cardiovascular Disease, Collaborative Innovation Center for Cardiovascular Disease Translational Medicine, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Wei Sun
- Cardiovascular Research Center, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Gusu School, Nanjing Medical University, Suzhou, Jiangsu, China.,Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing Medical University, Nanjing, Jiangsu, China.,Key Laboratory of Targeted Intervention of Cardiovascular Disease, Collaborative Innovation Center for Cardiovascular Disease Translational Medicine, Nanjing Medical University, Nanjing, Jiangsu, China
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Chopard R, Albertsen IE, Ecarnot F, Guth S, Besutti M, Falvo N, Piazza G, Meneveau N. Extended Anticoagulation After Pulmonary Embolism: A Multicenter Observational Cohort Analysis. J Am Heart Assoc 2022; 11:e024425. [PMID: 35730608 PMCID: PMC9333394 DOI: 10.1161/jaha.121.024425] [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: 12/13/2022]
Abstract
Background Pulmonary embolism (PE) has a long‐term risk of adverse events, which can be prevented by extended anticoagulation. We compared clinical characteristics and outcomes between patients treated with 2‐year extended anticoagulation and those who were not, in a population who had completed an initial phase of 3 to 6 months of anticoagulant therapy after acute PE. Methods and Results Observational cohort analysis of patients with PE who survived an initial phase of 3 to 6 months anticoagulation. Primary efficacy outcome was all‐cause death or recurrent venous thromboembolism. Primary safety outcome was major bleeding. In total, 858 (71.5%) patients were treated with and 341 (28.5%) were treated without extended anticoagulant therapy during the active study period. Age <65 years, intermediate‐high or high‐risk index PE, normal platelet count, and the absence of concomitant antiplatelet treatment were independently associated with the prescription of extended anticoagulation. The mean duration of the active phase was 2.1±0.3 years. The adjusted rate of the primary efficacy outcome was 2.1% in the extended group and 7.7% in the nonextended group (P<0.001) for patients treated with extended anticoagulant therapy. Rate of bleeding were similar between the extended anticoagulant group and the nonextended group. Conclusions Extended oral anticoagulation over 2 and a half years after index PE seems to provide a net clinical benefit compared with no anticoagulation in patients with PE selected to receive extended anticoagulation. Randomized clinical trials are warranted to explore the potential benefit of extended anticoagulation in patients with PE, especially those with transient provoking factors but residual risk.
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Affiliation(s)
- Romain Chopard
- Department of Cardiology University Hospital Jean Minjoz Besançon France.,EA3920 University of Burgundy Franche-Comté Besançon France.,F-CRIN INNOVTE Network Saint-Etienne France
| | | | - Fiona Ecarnot
- Department of Cardiology University Hospital Jean Minjoz Besançon France.,EA3920 University of Burgundy Franche-Comté Besançon France
| | - Sebastien Guth
- Department of Cardiology University Hospital Jean Minjoz Besançon France
| | - Matthieu Besutti
- Department of Cardiology University Hospital Jean Minjoz Besançon France
| | - Nicolas Falvo
- Department of Internal Medicine University Hospital Dijon-Bourgogne Dijon France
| | - Gregory Piazza
- Division of Cardiovascular Medicine Department of Medicine Brigham and Women's HospitalHarvard Medical School Boston MA
| | - Nicolas Meneveau
- Department of Cardiology University Hospital Jean Minjoz Besançon France.,EA3920 University of Burgundy Franche-Comté Besançon France.,F-CRIN INNOVTE Network Saint-Etienne France
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30
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Dwivedi AK. How to write statistical analysis section in medical research. J Investig Med 2022; 70:1759-1770. [PMID: 35710142 DOI: 10.1136/jim-2022-002479] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/01/2022] [Indexed: 12/15/2022]
Abstract
Reporting of statistical analysis is essential in any clinical and translational research study. However, medical research studies sometimes report statistical analysis that is either inappropriate or insufficient to attest to the accuracy and validity of findings and conclusions. Published works involving inaccurate statistical analyses and insufficient reporting influence the conduct of future scientific studies, including meta-analyses and medical decisions. Although the biostatistical practice has been improved over the years due to the involvement of statistical reviewers and collaborators in research studies, there remain areas of improvement for transparent reporting of the statistical analysis section in a study. Evidence-based biostatistics practice throughout the research is useful for generating reliable data and translating meaningful data to meaningful interpretation and decisions in medical research. Most existing research reporting guidelines do not provide guidance for reporting methods in the statistical analysis section that helps in evaluating the quality of findings and data interpretation. In this report, we highlight the global and critical steps to be reported in the statistical analysis of grants and research articles. We provide clarity and the importance of understanding study objective types, data generation process, effect size use, evidence-based biostatistical methods use, and development of statistical models through several thematic frameworks. We also provide published examples of adherence or non-adherence to methodological standards related to each step in the statistical analysis and their implications. We believe the suggestions provided in this report can have far-reaching implications for education and strengthening the quality of statistical reporting and biostatistical practice in medical research.
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Affiliation(s)
- Alok Kumar Dwivedi
- Department of Molecular and Translational Medicine, Division of Biostatistics and Epidemiology, Texas Tech University Health Sciences Center El Paso, El Paso, Texas, USA
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31
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Feng G, Qin G, Zhang T, Chen Z, Zhao Y. Common Statistical Methods and Reporting of Results in Medical Research. CARDIOVASCULAR INNOVATIONS AND APPLICATIONS 2022. [DOI: 10.15212/cvia.2022.0001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Statistical analysis is critical in medical research. The objective of this article is to summarize the appropriate use and reporting of commonly used statistical methods in medical research, on the basis of existing statistical guidelines and the authors’ experience in reviewing
manuscripts, to provide recommendations for statistical applications and reporting.
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Affiliation(s)
- Guoshuang Feng
- Big Data Center, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, 100045, China
| | - Guoyou Qin
- Department of Biostatistics, School of Public Health, Fudan University, Shanghai, 200032, China
| | - Tao Zhang
- Department of Biostatistics, School of Public Health, Shandong University, Jinan, 250012, China
| | - Zheng Chen
- Department of Biostatistics, School of Public Health, Southern Medical University, Guangzhou, 510515, China
| | - Yang Zhao
- Department of Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, 211166, China
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32
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Scrutinio D, Guida P, Ruggieri R, Passantino A. Prognostic value of functional capacity after transitional rehabilitation in older patients hospitalized for heart failure. J Am Geriatr Soc 2022; 70:1774-1784. [PMID: 35266550 PMCID: PMC9311803 DOI: 10.1111/jgs.17736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 02/15/2022] [Accepted: 02/18/2022] [Indexed: 11/29/2022]
Abstract
Background Poor functional status is highly prevalent among older patients hospitalized for HF and marks a downward inflection point in functional and prognostic trajectories. We assessed the prognostic value of 6‐min walk test after transitional cardiac rehabilitation in older patients hospitalized for heart failure (HF). Methods We studied 759 patients aged ≥60 years who had been transferred to six inpatient rehabilitation facilities (IRF) from acute care hospitals after a hospitalization for acute HF. The primary outcome was 3‐year all‐cause mortality. We used multivariable Cox analysis to determine the association between 6‐min walk distance (6MWD) at discharge from the IRFs and the primary outcome, adjusting for established predictors of death. The optimal cutoff for 6MWD was considered as the one that maximized the chi‐square statistic. Results Mean age was 75 ± 8 years. 6MWD significantly increased from admission to discharge (145 to 210 m; p < 0.001). The optimal cutoff for 6MWD was 198 m. After full adjustment, the hazard ratio for each 50 m‐increase in discharge 6MWD was 0.90 (0.87–0.94; p < 0.001) and that for discharge 6MWD dichotomized at the optimal cutoff 0.48 (0.38–0.60; p < 0.001). The incidence rate of death/100 person‐years for the patients who walked >198 m was 13.0 (10.0–15.5) compared with 30.8 (26.9–35.4) for those who walked <198 m. A statistically significant interaction of discharge 6MWD with left ventricular ejection fraction (EF) on the risk of death was observed (p value for interaction 0.047). Conclusions A rehabilitation intervention provided in the critical hospital‐to‐home transition period to older patients hospitalized for HF resulted in improved functional capacity. Increasing levels of functional capacity following rehabilitation were closely associated with decreasing risk of death; this association was significantly stronger for the subgroup with preserved EF.
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Affiliation(s)
- Domenico Scrutinio
- Department of Cardiac Rehabilitation, Istituti Clinici Scientifici Maugeri SpA SB, IRCCS, Institute of Bari, Bari, Italy
| | - Pietro Guida
- Department of Cardiac Rehabilitation, Istituti Clinici Scientifici Maugeri SpA SB, IRCCS, Institute of Bari, Bari, Italy
| | - Roberta Ruggieri
- Department of Cardiac Rehabilitation, Istituti Clinici Scientifici Maugeri SpA SB, IRCCS, Institute of Bari, Bari, Italy
| | - Andrea Passantino
- Department of Cardiac Rehabilitation, Istituti Clinici Scientifici Maugeri SpA SB, IRCCS, Institute of Bari, Bari, Italy
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Lu HS, Daugherty A. Key Factors for Improving Rigor and Reproducibility: Guidelines, Peer Reviews, and Journal Technical Reviews. Front Cardiovasc Med 2022; 9:856102. [PMID: 35369348 PMCID: PMC8965503 DOI: 10.3389/fcvm.2022.856102] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 02/02/2022] [Indexed: 11/13/2022] Open
Abstract
To respond to the NIH's policy for rigor and reproducibility in preclinical research, many journals have implemented guidelines and checklists to guide authors in improving the rigor and reproducibility of their research. Transparency in developing detailed prospective experimental designs and providing raw data are essential premises of rigor and reproducibility. Standard peer reviews and journal-specific technical and statistical reviews are critical factors for enhancing rigor and reproducibility. This brief review also shares some experience from Arteriosclerosis, Thrombosis, and Vascular Biology, an American Heart Association journal, that has implemented several mechanisms to enhance rigor and reproducibility for preclinical research.
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Affiliation(s)
- Hong S. Lu
- Saha Cardiovascular Research Center, University of Kentucky, Lexington, KY, United States
- Saha Aortic Center, University of Kentucky, Lexington, KY, United States
- Department of Physiology, University of Kentucky, Lexington, KY, United States
- *Correspondence: Hong S. Lu
| | - Alan Daugherty
- Saha Cardiovascular Research Center, University of Kentucky, Lexington, KY, United States
- Saha Aortic Center, University of Kentucky, Lexington, KY, United States
- Department of Physiology, University of Kentucky, Lexington, KY, United States
- Alan Daugherty
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Sun J, Ma Y, Liu H, Qu Q, Cheng C, Kong X, Huang W, Sun W. High waist circumference is a risk factor of new‐onset hypertension: Evidence from the China Health and Retirement Longitudinal Study. J Clin Hypertens (Greenwich) 2022; 24:320-328. [PMID: 35188335 PMCID: PMC8924994 DOI: 10.1111/jch.14446] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 01/27/2022] [Accepted: 02/04/2022] [Indexed: 01/15/2023]
Affiliation(s)
- Jin‐Yu Sun
- The Affiliated Jiangsu Shengze Hospital of Nanjing Medical University Suzhou China
- Department of Cardiology The First Affiliated Hospital of Nanjing Medical University Nanjing China
| | - Yong‐Xiang Ma
- The Affiliated Jiangsu Shengze Hospital of Nanjing Medical University Suzhou China
| | - Heng‐Li Liu
- Department of Cardiology Geriatric Hospital of Nanjing Medical University Nanjing China
| | - Qiang Qu
- Department of Cardiology The First Affiliated Hospital of Nanjing Medical University Nanjing China
| | - Chen Cheng
- Department of Cardiology The First Affiliated Hospital of Nanjing Medical University Nanjing China
| | - Xiang‐Qing Kong
- Department of Cardiology The First Affiliated Hospital of Nanjing Medical University Nanjing China
| | - Wen‐Jun Huang
- The Affiliated Jiangsu Shengze Hospital of Nanjing Medical University Suzhou China
| | - Wei Sun
- Department of Cardiology The First Affiliated Hospital of Nanjing Medical University Nanjing China
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Hahn J, Cook NR, Alexander EK, Friedman S, Walter J, Bubes V, Kotler G, Lee IM, Manson JE, Costenbader KH. Vitamin D and marine omega 3 fatty acid supplementation and incident autoimmune disease: VITAL randomized controlled trial. BMJ 2022; 376:e066452. [PMID: 35082139 PMCID: PMC8791065 DOI: 10.1136/bmj-2021-066452] [Citation(s) in RCA: 155] [Impact Index Per Article: 77.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/01/2021] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To investigate whether vitamin D and marine derived long chain omega 3 fatty acids reduce autoimmune disease risk. DESIGN Vitamin D and omega 3 trial (VITAL), a nationwide, randomized, double blind, placebo controlled trial with a two-by-two factorial design. SETTING Nationwide in the United States. PARTICIPANTS 25 871 participants, consisting of 12 786 men ≥50 years and 13 085 women ≥55 years at enrollment. INTERVENTIONS Vitamin D (2000 IU/day) or matched placebo, and omega 3 fatty acids (1000 mg/day) or matched placebo. Participants self-reported all incident autoimmune diseases from baseline to a median of 5.3 years of follow-up; these diseases were confirmed by extensive medical record review. Cox proportional hazard models were used to test the effects of vitamin D and omega 3 fatty acids on autoimmune disease incidence. MAIN OUTCOME MEASURES The primary endpoint was all incident autoimmune diseases confirmed by medical record review: rheumatoid arthritis, polymyalgia rheumatica, autoimmune thyroid disease, psoriasis, and all others. RESULTS 25 871 participants were enrolled and followed for a median of 5.3 years. 18 046 self-identified as non-Hispanic white, 5106 as black, and 2152 as other racial and ethnic groups. The mean age was 67.1 years. For the vitamin D arm, 123 participants in the treatment group and 155 in the placebo group had a confirmed autoimmune disease (hazard ratio 0.78, 95% confidence interval 0.61 to 0.99, P=0.05). In the omega 3 fatty acids arm, 130 participants in the treatment group and 148 in the placebo group had a confirmed autoimmune disease (0.85, 0.67 to 1.08, P=0.19). Compared with the reference arm (vitamin D placebo and omega 3 fatty acid placebo; 88 with confirmed autoimmune disease), 63 participants who received vitamin D and omega 3 fatty acids (0.69, 0.49 to 0.96), 60 who received only vitamin D (0.68, 0.48 to 0.94), and 67 who received only omega 3 fatty acids (0.74, 0.54 to 1.03) had confirmed autoimmune disease. CONCLUSIONS Vitamin D supplementation for five years, with or without omega 3 fatty acids, reduced autoimmune disease by 22%, while omega 3 fatty acid supplementation with or without vitamin D reduced the autoimmune disease rate by 15% (not statistically significant). Both treatment arms showed larger effects than the reference arm (vitamin D placebo and omega 3 fatty acid placebo). STUDY REGISTRATION ClinicalTrials.gov NCT01351805 and NCT01169259.
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Affiliation(s)
- Jill Hahn
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Division of Rheumatology, Inflammation and Immunity, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Nancy R Cook
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Erik K Alexander
- Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Sonia Friedman
- Center for Crohn's and Colitis, Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Boston, MA, USA
| | - Joseph Walter
- Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Vadim Bubes
- Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Gregory Kotler
- Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - I-Min Lee
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - JoAnn E Manson
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Karen H Costenbader
- Division of Rheumatology, Inflammation and Immunity, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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Kang SL, Ramroop R, Manojlovich L, Runeckles K, Fan S, Chaturvedi RR, Lee KJ, Benson LN. Is there a role for endovascular stent implantation in the management of postoperative right ventricular outflow tract obstruction in the era of transcatheter valve implantation? Catheter Cardiovasc Interv 2021; 99:1138-1148. [PMID: 34967102 DOI: 10.1002/ccd.30043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Revised: 11/18/2021] [Accepted: 11/25/2021] [Indexed: 11/12/2022]
Abstract
BACKGROUND The optimal management pathway for the dysfunctional right ventricular outflow tract (RVOT) is uncertain. We evaluated the long-term outcomes and clinical impact of stent implantation for obstructed RVOTs in an era of rapidly progressing transcatheter pulmonary valve technology. METHODS Retrospective review of 151 children with a biventricular repair who underwent stenting of obstructed RVOT between 1991 and 2017. RESULTS RVOT stenting resulted in significant changes in peak right ventricle (RV)-to-pulmonary artery (PA) gradient (39.4 ± 17.1-14.9 ± 8.3; p < 0.001) and RV-to-aortic pressure ratio (0.78 ± 0.22-0.49 ± 0.13; p < 0.001). Subsequent percutaneous reinterventions in 51 children to palliate recurrent stenosis were similarly effective. Ninety-nine (66%) children reached the primary outcome of subsequent pulmonary valve replacement (PVR). Freedom from PVR from the time of stent implantation was 91%, 51%, and 23% at 1, 5, and 10 years, respectively. Small balloon diameters for stent deployment were associated with shorter freedom from PVR. When additional children without stent palliation (with RV-to-PA conduits) were added to the stent cohort (total 506 children), the multistate analysis showed the longest freedom from PVR in those with stent palliation and subsequent catheter reintervention. Pulmonary regurgitation was well-tolerated clinically. Indexed RV dimensions and function estimated by echocardiography remained stable at last follow up or before primary outcome. CONCLUSION Prolongation of conduit longevity with stent implant remains an important strategy to allow for somatic growth to optimize the risk-benefit profile for subsequent surgical or transcatheter pulmonary valve replacement performed at an older age.
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Affiliation(s)
- Sok-Leng Kang
- Department of Pediatric Cardiology, Alder Hey Children's Hospital, Liverpool, UK
| | - Ronand Ramroop
- Department of Paediatric Medicine, Wendy Fitzwilliam's Childrens' Hospital, Eric Williams Medical Sciences Complex, Trinidad and Tobago, West Indies
| | - Larissa Manojlovich
- The Department of Pediatrics, Division of Cardiology, The Labatt Family Heart Center, The Hospital for Sick Children, University of Toronto School of Medicine, Toronto, Ontario, Canada
| | - Kyle Runeckles
- Ted Rogers Computational Program, Cardiovascular Data Management Centre, Ted Rogers Centre for Heart Research, The Hospital for Sick Children, Toronto, Canada
| | - Steve Fan
- Ted Rogers Computational Program, Cardiovascular Data Management Centre, Ted Rogers Centre for Heart Research, The Hospital for Sick Children, Toronto, Canada
| | - Rajiv R Chaturvedi
- Ted Rogers Computational Program, Cardiovascular Data Management Centre, Ted Rogers Centre for Heart Research, The Hospital for Sick Children, Toronto, Canada
| | - Kyong-Jin Lee
- Division of Cardiology, Lucile Packard Children's Hospital Stanford, Palo Alto, California, USA
| | - Lee N Benson
- The Department of Pediatrics, Division of Cardiology, The Labatt Family Heart Center, The Hospital for Sick Children, University of Toronto School of Medicine, Toronto, Ontario, Canada
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Reeves MJ, Gall SL, Raval AP. Hello Authors! We Are the Technical Reviewers and Are Here to Help You! Stroke 2021; 53:307-310. [PMID: 34963301 DOI: 10.1161/strokeaha.121.035647] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Mathew J Reeves
- Department of Epidemiology and Biostatistics, College of Human Medicine, Michigan State University, East Lansing (M.J.R.)
| | - Seana L Gall
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia (S.L.G.)
| | - Ami P Raval
- Peritz Scheinberg Cerebral Vascular Disease Research Laboratory, Department of Neurology, Leonard M. Miller School of Medicine, University of Miami, FL (A.P.R.)
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Analyses of repeatedly measured continuous outcomes in randomized controlled trials needed substantial improvements. J Clin Epidemiol 2021; 143:105-117. [PMID: 34896232 DOI: 10.1016/j.jclinepi.2021.12.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 11/19/2021] [Accepted: 12/02/2021] [Indexed: 02/05/2023]
Abstract
OBJECTIVES Systematic understanding is lacking regarding how current trials handle repeated measure data and the extent to which appropriate statistical methods are used for such data set. This study investigated the current practice of analyzing the repeated measure data among randomized controlled trials (RCTs). STUDY DESIGN AND SETTING We searched the Core Clinical Journals indexed in PubMed for RCTs published in 2019 and included a continuous primary outcome with repeated measures. We randomly sampled RCTs from the eligible trials. Team of methods trained investigators screened studies for eligibility and collected data using the pilot-tested, standardized questionnaires. We thoroughly documented statistical analyses of the continuous primary outcome with repeated measures and particularly recorded how statistically advanced methods were used to handle these repeated measures. RESULTS In total, 200 trials were included. Of these trials, the mean number of repeated measures for the continuous primary outcome was 5.46 (SD = 3.4); 58 (29.0%) trials did not specify the time point of primary outcome in the method; 113 (56.5%) trials did not use statistically advanced methods for handling repeated measure data in the primary analyses. Among187 trials included the baseline values, 88 (47.1%) trials did not adjust for outcome value at baseline. Among 87 trials using statistically advanced methods, 49 (56.3%) did not specify correlation structure for model. CONCLUSIONS The statistical analyses of repeatedly measured continuous outcomes in RCTs need substantial improvements. Careful planning of the primary outcome and the use of statistically advanced methods for analyzing data are warranted.
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Highland HM, Gamazon ER, Below JE. Revisiting Some Useful Statistical Guidelines in Circulation Research in Response to a Changing Landscape. Circ Res 2021; 128:1724-1727. [PMID: 34032508 DOI: 10.1161/circresaha.120.317360] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Heather M Highland
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC (H.H.)
| | - Eric R Gamazon
- Vanderbilt Genetics Institute, Vanderbilt University Medical Center, Nashville, TN (E.G.).,MRC Epidemiology Unit, University of Cambridge, Cambridge, UK (E.G.)
| | - Jennifer E Below
- Vanderbilt Genetics Institute, Vanderbilt University Medical Center, Nashville, TN (J.B.)
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