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Martins D, Silva C, Ferreira AC, Dourado S, Albuquerque A, Saraiva F, Batista AB, Castro P, Leite-Moreira A, Barros AS, Miranda IM. Unravelling the Gut Microbiome Role in Cardiovascular Disease: A Systematic Review and a Meta-Analysis. Biomolecules 2024; 14:731. [PMID: 38927134 PMCID: PMC11201797 DOI: 10.3390/biom14060731] [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: 04/26/2024] [Revised: 06/04/2024] [Accepted: 06/17/2024] [Indexed: 06/28/2024] Open
Abstract
A notable shift in understanding the human microbiome's influence on cardiovascular disease (CVD) is underway, although the causal association remains elusive. A systematic review and meta-analysis were conducted to synthesise current knowledge on microbial taxonomy and metabolite variations between healthy controls (HCs) and those with CVD. An extensive search encompassing three databases identified 67 relevant studies (2012-2023) covering CVD pathologies from 4707 reports. Metagenomic and metabolomic data, both qualitative and quantitative, were obtained. Analysis revealed substantial variability in microbial alpha and beta diversities. Moreover, specific changes in bacterial populations were shown, including increased Streptococcus and Proteobacteria and decreased Faecalibacterium in patients with CVD compared with HC. Additionally, elevated trimethylamine N-oxide levels were reported in CVD cases. Biochemical parameter analysis indicated increased fasting glucose and triglycerides and decreased total cholesterol and low- and high-density lipoprotein cholesterol levels in diseased individuals. This study revealed a significant relationship between certain bacterial species and CVD. Additionally, it has become clear that there are substantial inconsistencies in the methodologies employed and the reporting standards adhered to in various studies. Undoubtedly, standardising research methodologies and developing extensive guidelines for microbiome studies are crucial for advancing the field.
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Affiliation(s)
- Diana Martins
- Cardiovascular R&D Centre—UnIC@RISE, Department of Surgery and Physiology, Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal
| | - Cláudia Silva
- Cardiovascular R&D Centre—UnIC@RISE, Department of Surgery and Physiology, Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal
| | - António Carlos Ferreira
- Cardiovascular R&D Centre—UnIC@RISE, Department of Surgery and Physiology, Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal
| | - Sara Dourado
- Cardiovascular R&D Centre—UnIC@RISE, Department of Surgery and Physiology, Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal
| | - Ana Albuquerque
- Cardiovascular R&D Centre—UnIC@RISE, Department of Surgery and Physiology, Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal
| | - Francisca Saraiva
- Cardiovascular R&D Centre—UnIC@RISE, Department of Surgery and Physiology, Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal
| | - Ana Beatriz Batista
- Cardiovascular R&D Centre—UnIC@RISE, Department of Surgery and Physiology, Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal
| | - Pedro Castro
- Cardiovascular R&D Centre—UnIC@RISE, Department of Surgery and Physiology, Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal
- Department of Neurology, São João Hospital Center, Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal
| | - Adelino Leite-Moreira
- Cardiovascular R&D Centre—UnIC@RISE, Department of Surgery and Physiology, Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal
| | - António S. Barros
- Cardiovascular R&D Centre—UnIC@RISE, Department of Surgery and Physiology, Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal
| | - Isabel M. Miranda
- Cardiovascular R&D Centre—UnIC@RISE, Department of Surgery and Physiology, Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal
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2
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Lopez KN, Allen KY, Baker-Smith CM, Bravo-Jaimes K, Burns J, Cherestal B, Deen JF, Hills BK, Huang JH, Lizano Santamaria RW, Lodeiro CA, Melo V, Moreno JS, Nuñez Gallegos F, Onugha H, Pastor TA, Wallace MC, Ansah DA. Health Equity and Policy Considerations for Pediatric and Adult Congenital Heart Disease Care among Minoritized Populations in the United States. J Cardiovasc Dev Dis 2024; 11:36. [PMID: 38392250 PMCID: PMC10888593 DOI: 10.3390/jcdd11020036] [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: 12/29/2023] [Revised: 01/16/2024] [Accepted: 01/19/2024] [Indexed: 02/24/2024] Open
Abstract
Achieving health equity in populations with congenital heart disease (CHD) requires recognizing existing disparities throughout the lifespan that negatively and disproportionately impact specific groups of individuals. These disparities occur at individual, institutional, or system levels and often result in increased morbidity and mortality for marginalized or racially minoritized populations (population subgroups (e.g., ethnic, racial, social, religious) with differential power compared to those deemed to hold the majority power in the population). Creating actionable strategies and solutions to address these health disparities in patients with CHD requires critically examining multilevel factors and health policies that continue to drive health inequities, including varying social determinants of health (SDOH), systemic inequities, and structural racism. In this comprehensive review article, we focus on health equity solutions and health policy considerations for minoritized and marginalized populations with CHD throughout their lifespan in the United States. We review unique challenges that these populations may face and strategies for mitigating disparities in lifelong CHD care. We assess ways to deliver culturally competent CHD care and to help lower-health-literacy populations navigate CHD care. Finally, we review system-level health policies that impact reimbursement and research funding, as well as institutional policies that impact leadership diversity and representation in the workforce.
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Affiliation(s)
- Keila N Lopez
- Texas Children's Hospital, Department of Pediatrics, Division of Pediatric Cardiology, Baylor College of Medicine, Houston, TX 77030, USA
| | - Kiona Y Allen
- Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
| | - Carissa M Baker-Smith
- Center for Cardiovascular Research and Innovation, Nemours Cardiac Center, Nemours Children's Health, Wilmington, DE 19803, USA
| | - Katia Bravo-Jaimes
- Department of Cardiovascular Medicine, Mayo Clinic Florida, Jacksonville, FL 32224, USA
| | - Joseph Burns
- Texas Children's Hospital, Department of Pediatrics, Division of Pediatric Cardiology, Baylor College of Medicine, Houston, TX 77030, USA
| | - Bianca Cherestal
- Ward Family Heart Center, Children's Mercy Kansas City, Kansas City, MO 64108, USA
| | - Jason F Deen
- Department of Pediatrics and Medicine, University of Washington, Seattle, WA 98105, USA
| | - Brittany K Hills
- Division of Pediatric Cardiology, UT Southwestern, Children's Health, Dallas, TX 75390, USA
| | - Jennifer H Huang
- Doernbecher Children's Hospital, Oregon Health and Science University, Portland, OR 97239, USA
| | | | - Carlos A Lodeiro
- Texas Children's Hospital, Department of Pediatrics, Division of Pediatric Cardiology, Baylor College of Medicine, Houston, TX 77030, USA
| | - Valentina Melo
- Texas Children's Hospital, Department of Pediatrics, Baylor College of Medicine, Houston, TX 77030, USA
| | - Jasmine S Moreno
- Texas Children's Hospital, Department of Pediatrics, Division of Pediatric Cardiology, Baylor College of Medicine, Houston, TX 77030, USA
| | - Flora Nuñez Gallegos
- Department of Pediatrics, University of California San Francisco Benioff Children's Hospital, San Francisco, CA 94158, USA
| | - Harris Onugha
- Texas Children's Hospital, Department of Pediatrics, Baylor College of Medicine, Houston, TX 77030, USA
| | - Tony A Pastor
- Division of Pediatric Cardiology, Yale School of Medicine, Yale New Haven Hospital, New Haven, CT 06510, USA
| | - Michelle C Wallace
- Department of Pediatrics, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, GA 30322, USA
| | - Deidra A Ansah
- Texas Children's Hospital, Department of Pediatrics, Division of Pediatric Cardiology, Baylor College of Medicine, Houston, TX 77030, USA
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3
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Masson W, Barbagelata L, Lobo M, Corral P, Nogueira JP, Lucas L. Dyslipidemia in adults with congenital heart disease: A systematic review and meta-analysis. Nutr Metab Cardiovasc Dis 2024; 34:19-32. [PMID: 37949709 DOI: 10.1016/j.numecd.2023.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 08/18/2023] [Accepted: 09/12/2023] [Indexed: 11/12/2023]
Abstract
AIMS Several particular characteristics of patients with congenital heart disease could affect lipid levels. The objectives of this study were: a) to analyze the prevalence of dyslipidemia in congenital heart disease patients; 2) to compare lipid levels between congenital heart disease patients and a control group. DATA SYNTHESIS This systematic review and meta-analysis was performed according to PRISMA guidelines (PROSPERO CRD42023432041). A literature search was performed to detect studies that have reported lipid levels or the prevalence of dyslipidemia in congenital heart disease patients. We performed a qualitative analysis (studies that reported dyslipidemia prevalence) and quantitative analysis (studies that compared lipid values between congenital heart disease patients and controls). In total, 29 observational studies involving 22,914 patients with congenital heart disease and 641,086 controls were eligible for this review. The reported presence of "hyperlipidemia" or "dyslipidemia" ranged from 14.3% to 69.9%. When studies analyzed lipid variables dichotomously between congenital heart disease patients and controls, the results were conflicting. The quantitative analysis showed that patients with congenital heart disease have lower levels of total cholesterol (MD: -18.9 [95% CI: -22.2 to -15.7]; I2 = 93%), LDL-C (MD: -10.7 [95% CI: -13.1 to -8.3]; I2 = 90%) and HDL-C (MD: -6.3 [95% CI: -7.7 to -4.9]; I2 = 95%) compared to controls. CONCLUSIONS The qualitative analysis showed some concerns, but the quantitative analysis indicates that congenital heart disease patients showed lower levels of total cholesterol, LDL-C, and HDL-C compared to controls. New research should be developed to clarify this relevant topic.
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Affiliation(s)
- Walter Masson
- Cardiology Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
| | - Leandro Barbagelata
- Cardiology Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Martín Lobo
- Cardiology Department, Hospital Militar Campo de Mayo, Buenos Aires, Argentina
| | - Pablo Corral
- Facultad de Medicina, Universidad FASTA. Mar del Plata, Argentina
| | - Juan P Nogueira
- Universidad Internacional de las Américas, San José, Costa Rica; Centro de Investigación en Endocrinología, Nutrición y Metabolismo (CIENM), Facultad de Ciencias de la Salud, Universidad Nacional de Formosa, Argentina
| | - Luciano Lucas
- Cardiology Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
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4
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Abdelrehim AA, Dearani JA, Holst KA, Miranda WR, Connolly HM, Todd AL, Burchill LJ, Schaff HV, Pochettino A, Stephens EH. Risk factors and early outcomes of repeat sternotomy in 1960 adults with congenital heart disease: A 30-year, single-center study. J Thorac Cardiovasc Surg 2023:S0022-5223(23)01090-5. [PMID: 37981102 DOI: 10.1016/j.jtcvs.2023.11.014] [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: 06/20/2023] [Revised: 10/06/2023] [Accepted: 11/05/2023] [Indexed: 11/21/2023]
Abstract
OBJECTIVE Patients with congenital heart disease (CHD) increasingly live into adulthood, often requiring cardiac reoperation. We aimed to assess the outcomes of adults with CHD (ACHD) undergoing repeat sternotomy at our institution. METHODS Review of our institution's cardiac surgery database identified 1960 ACHD patients undergoing repeat median sternotomy from 1993 to 2023. The primary outcome was early mortality, and the secondary outcome was a composite end point of mortality and significant morbidity. Univariable and multivariable logistic regression models were used to determine factors independently associated with outcomes. RESULTS Of the 1960 ACHDs patient undergoing repeat sternotomy, 1183 (60.3%) underwent a second, third (n = 506, 25.8%), fourth (n = 168, 8.5%), fifth (n = 70, 3.5%), and sixth sternotomy or greater (n = 33, 1.6%). CHD diagnoses were minor complexity (n = 145, 7.4%), moderate complexity (n = 1380, 70.4%), and major complexity (n = 435, 22.1%). Distribution of procedures included valve (n = 549, 28%), congenital (n = 625, 32%), aortic (n = 104, 5.3%), and major procedural combinations (n = 682, 34.7%). Overall early mortality was 3.1%. Factors independently associated with early mortality were older age at surgery, CHD of major complexity, preoperative renal failure, preoperative ejection fraction, urgent operation, and postoperative blood transfusion. In addition, sternotomy number and bypass time were independently associated with the composite outcome. CONCLUSIONS Despite the increase in early mortality with sternotomy number, sternotomy number was not independently associated with early mortality but with increased morbidity. Improvement strategies should target factors leading to urgent operations, early referral, along with operative efficiency including bypass time and blood conservation.
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Affiliation(s)
| | - Joseph A Dearani
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minn.
| | - Kimberly A Holst
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minn
| | | | - Heidi M Connolly
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minn
| | - Austin L Todd
- Department of Clinical Trials and Biostatistics, Mayo Clinic, Rochester, Minn
| | - Luke J Burchill
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minn
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5
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Gafranek JT, D'Aniello E, Ravisankar P, Thakkar K, Vagnozzi RJ, Lim HW, Salomonis N, Waxman JS. Sinus venosus adaptation models prolonged cardiovascular disease and reveals insights into evolutionary transitions of the vertebrate heart. Nat Commun 2023; 14:5509. [PMID: 37679366 PMCID: PMC10485058 DOI: 10.1038/s41467-023-41184-y] [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: 04/26/2022] [Accepted: 08/24/2023] [Indexed: 09/09/2023] Open
Abstract
How two-chambered hearts in basal vertebrates have evolved from single-chamber hearts found in ancestral chordates remains unclear. Here, we show that the teleost sinus venosus (SV) is a chamber-like vessel comprised of an outer layer of smooth muscle cells. We find that in adult zebrafish nr2f1a mutants, which lack atria, the SV comes to physically resemble the thicker bulbus arteriosus (BA) at the arterial pole of the heart through an adaptive, hypertensive response involving smooth muscle proliferation due to aberrant hemodynamic flow. Single cell transcriptomics show that smooth muscle and endothelial cell populations within the adapting SV also take on arterial signatures. Bulk transcriptomics of the blood sinuses flanking the tunicate heart reinforce a model of greater equivalency in ancestral chordate BA and SV precursors. Our data simultaneously reveal that secondary complications from congenital heart defects can develop in adult zebrafish similar to those in humans and that the foundation of equivalency between flanking auxiliary vessels may remain latent within basal vertebrate hearts.
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Affiliation(s)
- Jacob T Gafranek
- Molecular and Developmental Biology Graduate Program, University of Cincinnati College of Medicine, Cincinnati, OH, 45267, USA
- Division of Molecular Cardiovascular Biology and Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, 45229, USA
| | - Enrico D'Aniello
- Department of Biology and Evolution of Marine Organisms, Stazione Zoologica Anton Dohrn, 80121, Napoli, Italy
| | - Padmapriyadarshini Ravisankar
- Division of Molecular Cardiovascular Biology and Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, 45229, USA
| | - Kairavee Thakkar
- Division of Biomedical Informatics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, 45229, USA
- Department of Pharmacology and Systems Physiology, University of Cincinnati, College of Medicine, Cincinnati, OH, 45267, USA
| | - Ronald J Vagnozzi
- Division of Cardiology, Gates Center for Regenerative Medicine, Consortium for Fibrosis Research and Translation (CFReT), University of Colorado Anschutz Medical Campus, Aurora, CO, 80045, USA
| | - Hee-Woong Lim
- Division of Biomedical Informatics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, 45229, USA
- Department of Pediatrics, University of Cincinnati, College of Medicine, Cincinnati, OH, 45267, USA
| | - Nathan Salomonis
- Division of Biomedical Informatics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, 45229, USA
- Department of Pediatrics, University of Cincinnati, College of Medicine, Cincinnati, OH, 45267, USA
| | - Joshua S Waxman
- Division of Molecular Cardiovascular Biology and Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, 45229, USA.
- Department of Pediatrics, University of Cincinnati, College of Medicine, Cincinnati, OH, 45267, USA.
- Division of Developmental Biology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, 45229, USA.
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6
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Honicky M, Cardoso SM, de Lima LRA, Silva DAS, de Lima TR, Back IDC, Moreno YMF. Clusters of lifestyle behaviors associated with atherosclerosis risk factors in children and adolescents with congenital heart disease: Floripa CHild Study. Appl Physiol Nutr Metab 2023; 48:231-240. [PMID: 36459689 DOI: 10.1139/apnm-2022-0091] [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: 12/05/2022]
Abstract
Secondary cardiovascular disease is the main cause of mortality in congenital heart disease (CHD) patients. The cardiovascular risk could be widely prevented with adherence to a healthy lifestyle; however, clusters of lifestyle behaviors related to atherosclerosis risk factors in children and adolescents with CHD remain unclear. We aimed to describe the clusters of lifestyle behaviors of children and adolescents with CHD and to evaluate their association with atherosclerosis risk factors. We conducted a cross-sectional study on 227 children and adolescents with CHD (median age:10.02 [IQR:7.08-13.02] years). Dietary intake, physical activity (PA), and sedentary behavior (SB) were evaluated. Clusters of lifestyle behaviors were determined using a two-step cluster analysis. Atherosclerosis risk factors evaluated include body fat mass, central obesity, blood pressure, lipid parameters, glucose, C-reactive protein, and carotid intima-media thickness (cIMT). Multiple logistic regressions were used. The "unhealthy: high SB + low PA" cluster was associated with elevated body fat mass, central obesity, and elevated cIMT. Furthermore, the "unhealthy: low PA + unhealthy eating habits" cluster was associated with elevated body fat mass, central obesity, and elevated glucose. The unhealthier lifestyle behavior clusters were associated with atherosclerosis risk factors in children and adolescents with CHD. Multidisciplinary strategies to promote healthy behaviors are needed to prevent cardiovascular disease in later life.
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Affiliation(s)
- Michele Honicky
- Post Graduate Program in Nutrition, Federal University of Santa Catarina, Health Science Centre, Florianopolis, Santa Catarina, Brazil
| | - Silvia M Cardoso
- Polydoro Ernani São Tiago University Hospital, Federal University of Santa Catarina, Florianopolis, Santa Catarina, Brazil
| | - Luiz R A de Lima
- Institute of Physical Education and Sport, Federal University of Alagoas, Maceió, Alagoas, Brazil
| | - Diego A S Silva
- Research Center in Kinanthropometry and Human Performance, Federal University of Santa Catarina, Florianopolis, Santa Catarina, Brazil
| | - Tiago R de Lima
- Research Center in Kinanthropometry and Human Performance, Federal University of Santa Catarina, Florianopolis, Santa Catarina, Brazil
| | - Isabela de C Back
- Federal University of Santa Catarina, Health Science Centre, Florianopolis, Santa Catarina, Brazil
| | - Yara M F Moreno
- Post Graduate Program in Nutrition, Federal University of Santa Catarina, Health Science Centre, Florianopolis, Santa Catarina, Brazil
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7
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Anagnostopoulou A. Τhe Burden of Obesity on Adult Survivors of Congenital Heart Disease, Past, and Future Directions. Curr Probl Cardiol 2023; 48:101610. [PMID: 36682391 DOI: 10.1016/j.cpcardiol.2023.101610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 01/17/2023] [Indexed: 01/21/2023]
Abstract
The ongoing obesity epidemic has started to ebb. However, as most children with congenital heart disease survive until adulthood, the burgeoning trend has started to spill over in the adult congenital heart disease population as well. This review aims to decipher the prevalence, outcomes, and future directions of obesity in adult survivors of congenital heart disease.
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8
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Shi Y, Zhang W. Acute Myocardial Infarction in a 13-Year-Old Boy after Bone Marrow Transplantation. J Emerg Med 2022; 63:787-790. [PMID: 36369122 DOI: 10.1016/j.jemermed.2022.09.021] [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: 05/10/2022] [Revised: 06/23/2022] [Accepted: 09/04/2022] [Indexed: 11/11/2022]
Abstract
BACKGROUND Advances in bone marrow transplantation (BMT) present a unique opportunity for treating leukemia in children. It has also increased the risk of long-term complications in the lungs, genitourinary tract, and nervous system. Coronary artery disease is the most common type of heart disease in older adults, but is not generally acknowledged as a complication of BMT, especially in young patients. CASE REPORT We report the occurrence of acute myocardial infarction in a 13-year-old boy, approximately 5 years after he received a half-matched related bone marrow transplant from his father for T-cell lymphoblastic leukemia. Acute myocarditis was suspected early in the clinical course on the basis of his age and clinical presentations, such as atypical chest pain and dyspnea. Follow-up coronary angiography revealed a total occlusion of the right coronary artery, as well as diffused lesions of the left main, anterior descending, and circumflex branch. Fortunately, he was discharged from the hospital in satisfactory general condition after complex treatment. Why Should An Emergency Physician Be Aware of This? In this case, its rarity and poor clinical recognition were the main reasons for delayed diagnosis, which led to a delay to coronary angiography. Given the high mortality in cardiovascular complications among BMT recipients, the correct diagnostic assessment in such cases becomes particularly relevant.
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Affiliation(s)
- Ying Shi
- Northern Jiangsu People's Hospital, Yangzhou, Jiangsu, China
| | - Wenjuan Zhang
- Northern Jiangsu People's Hospital, Yangzhou, Jiangsu, China
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9
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Moustafa A, Popat H, Ayer J, Haghighi M, Skilton M, Carmo KB. Infants With Congenital Heart Disease at Risk of Early Atherosclerotic Disease. J Am Heart Assoc 2022; 11:e025772. [DOI: 10.1161/jaha.122.025772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Background
Aortic intima‐media thickness (aIMT) measurement is an established indicator of preclinical atherosclerosis. We aimed to describe the aIMT in infants with congenital heart disease undergoing cardiac surgery over the first year of life and explore its association with cardiopulmonary bypass, growth velocity, and a diagnosis of left heart obstruction.
Methods and Results
A prospective cohort study measuring mean and maximum aIMT preoperatively, at 3 months, and 1 year of age in neonates with congenital heart disease undergoing cardiac surgery. Twenty‐four infants with a median gestation of 39 weeks and a median birth weight of 3184 g were included. Sixteen (67%) infants had left outflow tract obstruction. Gestation correlated inversely with baseline mean aIMT (β=−0.027,
P
=0.018) and positively with the percentage of increase in mean and maximum aIMT between baseline and 3 months (β=17%,
P
=0.027 and β=15%,
P
=0.023). The presence of left outflow obstruction was significantly associated with increasing mean and maximum aIMT between baseline and 1 year (mean aIMT change: β=34%,
P
=0.017 and maximum aIMT change β=43%,
P
=0.001). Both subgroups of left heart obstruction and non‐left heart obstruction significantly changed over time (
P
=0.001 and
P
<0.001) but trends were not statistically different between both subgroups (
P
=0.21). Growth velocity and cardiopulmonary bypass were not associated with baseline or change in aIMT over the first year of life.
Conclusions
AIMT significantly increased over the first 3 months in our cohort of infants with repaired congenital heart disease. Increasing gestation was associated with decreasing aIMT at 3 months. Growth velocity and cardiopulmonary bypass were not associated with aIMT changes over the first year. Left heart obstruction was associated with a trend toward increased aIMT.
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Affiliation(s)
- Ahmed Moustafa
- Grace Centre for Newborn Intensive Care The Children’s Hospital at Westmead Sydney New South Wales Australia
- Faculty of Medicine and Health The University of Sydney New South Wales Sydney Australia
| | - Himanshu Popat
- Grace Centre for Newborn Intensive Care The Children’s Hospital at Westmead Sydney New South Wales Australia
- Faculty of Medicine and Health The University of Sydney New South Wales Sydney Australia
| | - Julian Ayer
- Faculty of Medicine and Health The University of Sydney New South Wales Sydney Australia
- The Heart Centre for Children The Children’s Hospital at Westmead Sydney New South Wales Australia
| | - Marjan Haghighi
- Faculty of Medicine and Health The University of Sydney New South Wales Sydney Australia
- The Heart Centre for Children The Children’s Hospital at Westmead Sydney New South Wales Australia
| | - Michael Skilton
- Faculty of Medicine and Health The University of Sydney New South Wales Sydney Australia
| | - Kathryn Browning Carmo
- Grace Centre for Newborn Intensive Care The Children’s Hospital at Westmead Sydney New South Wales Australia
- Faculty of Medicine and Health The University of Sydney New South Wales Sydney Australia
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10
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Levene J, Cambron C, McGrath L, Garcia IC, Broberg C, Ramsey K, Khan A. Prevalence of traditional and non-traditional cardiovascular risk factors in adults with congenital heart disease. INTERNATIONAL JOURNAL OF CARDIOLOGY CONGENITAL HEART DISEASE 2022. [DOI: 10.1016/j.ijcchd.2022.100424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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11
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Schipper HS, de Ferranti S. Atherosclerotic Cardiovascular Risk as an Emerging Priority in Pediatrics. Pediatrics 2022; 150:189711. [PMID: 36217888 DOI: 10.1542/peds.2022-057956] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/29/2022] [Indexed: 12/05/2022] Open
Abstract
Over the last decades, childhood and adolescence have emerged as an important window of opportunity to prevent atherosclerotic cardiovascular disease (ASCVD) later in life. Here, we discuss the underlying advances in the field. First, atherosclerosis development starts as early as childhood. Atherogenesis initiates in the iliac arteries and abdominal aorta and subsequently develops in higher regions of the arterial tree, as has been demonstrated in nonhuman primate studies and human autopsy studies. Obesity, hypertension, hyperlipidemia, and hyperglycemia at a young age can accelerate atherogenesis. Children and adolescents with obesity have a relative risk of ∼ 2.5 for ASCVD mortality later in life, compared to peers with a normal weight. Conversely, early prevention improves long-term cardiovascular outcomes. Second, we review disease-associated factors that add to the traditional risk factors. Various pediatric disorders carry similar or even higher risks of ASCVD than obesity, including chronic inflammatory disorders, organ transplant recipients, familial hypercholesterolemia, endocrine disorders, childhood cancer survivors, chronic kidney diseases, congenital heart diseases, and premature birth, especially after fetal growth restriction. The involved disease-associated factors that fuel atherogenesis are diverse and include inflammation, vascular, and endothelial factors. The diverse and growing list of pediatric groups at risk underscores that cardiovascular risk management has solidly entered the realm of general pediatrics. In a second review in this series, we will, therefore, focus on recent advances in cardiovascular risk assessment and management and their implications for pediatric practice.
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Affiliation(s)
- Henk S Schipper
- Department of Pediatric Cardiology.,Center for Translational Immunology, Wilhelmina Children's Hospital and University Medical Center Utrecht, Utrecht, The Netherlands
| | - Sarah de Ferranti
- Department of Cardiology, Boston Children's Hospital and Harvard University Medical School, Boston, Massachusetts
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12
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Zoller T, Prioli MA, Clemente M, Pilati M, Sandrini C, Luciani GB, Deganello Saccomani M, Ficial B, Gaffuri M, Piacentini G, Calciano L, Pietrobelli A. Congenital Heart Disease: Growth Evaluation and Sport Activity in a Paediatric Population. CHILDREN 2022; 9:children9060884. [PMID: 35740821 PMCID: PMC9221605 DOI: 10.3390/children9060884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Revised: 06/02/2022] [Accepted: 06/08/2022] [Indexed: 11/17/2022]
Abstract
(1) Objective: To evaluate: (i) the associations of age and disease severity with anthropometric indices and weight status, (ii) the difference in the frequency of sports activity among different levels of disease severity in paediatric patients with congenital heart disease (CHD). (2) Methods: Clinical data of Caucasian children (aged 2–18 years) diagnosed with CHD (2005–2018) were retrospectively collected from the electronic register of outpatient visits. Of the 475 children with CHD, 368 children and their 1690 complete anthropometric measurements were eligible for inclusion in our analysis. (3) Results: Significant increase with age was observed for weight z-score [beta (95%CI): 0.03 (0.02, 0.05) for one-unit of age] and BMI z-score [0.06 (0.03, 0.08)] but not for height z-score. The probability of being underweight and overweight/obese increased and decreased with disease severity, respectively. The obesity probability of patients with mild CHD (0.06 [95%CI: 0.03, 0.08]) was not statistically distinguishable from that of patients with moderate CHD (0.03 [95%CI: 0.02, 0.05]), whereas it was lower in patients with severe CHD (0.004 [95%CI: 0.0, 0.009]). No obese patients with a univentricular heart defect were observed. Days spent in sport activities were equal to 1.9 [95%CI: 1.6, 2.2] days/week, 1.9 [1.5, 2.2], 1.4 [1.1, 1.7] and 0.7 [0.1, 1.3] in patients with mild, moderate, severe and univentricular CHD, respectively. (4) Conclusions: The risk of being overweight and obese should not be underestimated in paediatric patients diagnosed with CHD, especially in children with mild or moderate heart defects. It could be prevented or reduced by promoting a healthy lifestyle.
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Affiliation(s)
- Thomas Zoller
- Paediatric Clinic, Department of Surgery, Dentistry, Paediatrics and Gynaecology, University of Verona, 37126 Verona, Italy; (T.Z.); (M.D.S.); (B.F.); (M.G.); (G.P.)
| | - Maria Antonia Prioli
- Division of Cardiac Surgery, Department of Surgery, Dentistry, Paediatrics and Gynaecology, University of Verona, 37126 Verona, Italy; (M.A.P.); (M.P.); (C.S.); (G.B.L.)
| | - Maria Clemente
- Paediatric Clinic, Department of Surgery, Dentistry, Paediatrics and Gynaecology, University of Verona, 37126 Verona, Italy; (T.Z.); (M.D.S.); (B.F.); (M.G.); (G.P.)
- Correspondence:
| | - Mara Pilati
- Division of Cardiac Surgery, Department of Surgery, Dentistry, Paediatrics and Gynaecology, University of Verona, 37126 Verona, Italy; (M.A.P.); (M.P.); (C.S.); (G.B.L.)
| | - Camilla Sandrini
- Division of Cardiac Surgery, Department of Surgery, Dentistry, Paediatrics and Gynaecology, University of Verona, 37126 Verona, Italy; (M.A.P.); (M.P.); (C.S.); (G.B.L.)
| | - Giovanni Battista Luciani
- Division of Cardiac Surgery, Department of Surgery, Dentistry, Paediatrics and Gynaecology, University of Verona, 37126 Verona, Italy; (M.A.P.); (M.P.); (C.S.); (G.B.L.)
| | - Marco Deganello Saccomani
- Paediatric Clinic, Department of Surgery, Dentistry, Paediatrics and Gynaecology, University of Verona, 37126 Verona, Italy; (T.Z.); (M.D.S.); (B.F.); (M.G.); (G.P.)
| | - Benjamim Ficial
- Paediatric Clinic, Department of Surgery, Dentistry, Paediatrics and Gynaecology, University of Verona, 37126 Verona, Italy; (T.Z.); (M.D.S.); (B.F.); (M.G.); (G.P.)
| | - Marcella Gaffuri
- Paediatric Clinic, Department of Surgery, Dentistry, Paediatrics and Gynaecology, University of Verona, 37126 Verona, Italy; (T.Z.); (M.D.S.); (B.F.); (M.G.); (G.P.)
| | - Giorgio Piacentini
- Paediatric Clinic, Department of Surgery, Dentistry, Paediatrics and Gynaecology, University of Verona, 37126 Verona, Italy; (T.Z.); (M.D.S.); (B.F.); (M.G.); (G.P.)
| | - Lucia Calciano
- Unit of Epidemiology and Medical Statistics, Department of Diagnostics and Public Health, University of Verona, 37126 Verona, Italy;
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Bhatt AB, Lantin-Hermoso MR, Daniels CJ, Jaquiss R, Landis BJ, Marino BS, Rathod RH, Vincent RN, Keller BB, Villafane J. Isolated Coarctation of the Aorta: Current Concepts and Perspectives. Front Cardiovasc Med 2022; 9:817866. [PMID: 35694677 PMCID: PMC9174545 DOI: 10.3389/fcvm.2022.817866] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 03/21/2022] [Indexed: 12/02/2022] Open
Abstract
Current management of isolated CoA, localized narrowing of the aortic arch in the absence of other congenital heart disease, is a success story with improved prenatal diagnosis, high survival and improved understanding of long-term complication. Isolated CoA has heterogenous presentations, complex etiologic mechanisms, and progressive pathophysiologic changes that influence outcome. End-to-end or extended end-to-end anastomosis are the favored surgical approaches for isolated CoA in infants and transcatheter intervention is favored for children and adults. Primary stent placement is the procedure of choice in larger children and adults. Most adults with treated isolated CoA thrive, have normal daily activities, and undergo successful childbirth. Fetal echocardiography is the cornerstone of prenatal counseling and genetic testing is recommended. Advanced 3D imaging identifies aortic complications and myocardial dysfunction and guides individualized therapies including re-intervention. Adult CHD program enrollment is recommended. Longer follow-up data are needed to determine the frequency and severity of aneurysm formation, myocardial dysfunction, and whether childhood lifestyle modifications reduce late-onset complications.
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Affiliation(s)
- Ami B. Bhatt
- Departments of Internal Medicine and Pediatrics and Division of Cardiology, Harvard Medical School, Boston, MA, United States
| | - Maria R. Lantin-Hermoso
- Section of Cardiology, Department of Pediatrics, Baylor College of Medicine, Houston, TX, United States
| | - Curt J. Daniels
- Departments of Pediatrics and Internal Medicine, The Ohio State University Medical Center, Columbus, OH, United States
| | - Robert Jaquiss
- Department of Cardiovascular and Thoracic Surgery and Department of Pediatrics, UT Southwestern Medical Center, Dallas, TX, United States
| | - Benjamin John Landis
- Department of Pediatrics and Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Bradley S. Marino
- Department of Pediatric Cardiology, Cleveland Clinic Children's, Cleveland, OH, United States
| | - Rahul H. Rathod
- Department of Pediatrics, Harvard Medical School, Boston, MA, United States
| | - Robert N. Vincent
- Department of Pediatrics, New York Medical College, Valhalla, NY, United States
| | - Bradley B. Keller
- Cincinnati Children's Heart Institute and the Department of Pediatrics, University of Cincinnati, Cincinnati, OH, United States
- *Correspondence: Bradley B. Keller
| | - Juan Villafane
- Cincinnati Children's Heart Institute and the Department of Pediatrics, University of Cincinnati, Cincinnati, OH, United States
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14
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Odom TL, Zheng Y, Kattan G, Tumin D, Strickland DM, Steed RD, Sarno LA. Recognition of congenital heart disease in subsequent hospital visits among children with a prenatal diagnosis. PROGRESS IN PEDIATRIC CARDIOLOGY 2022. [DOI: 10.1016/j.ppedcard.2022.101490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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15
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Garcia-Canadilla P, Isabel-Roquero A, Aurensanz-Clemente E, Valls-Esteve A, Miguel FA, Ormazabal D, Llanos F, Sanchez-de-Toledo J. Machine Learning-Based Systems for the Anticipation of Adverse Events After Pediatric Cardiac Surgery. Front Pediatr 2022; 10:930913. [PMID: 35832588 PMCID: PMC9271800 DOI: 10.3389/fped.2022.930913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 06/06/2022] [Indexed: 11/18/2022] Open
Abstract
Pediatric congenital heart disease (CHD) patients are at higher risk of postoperative complications and clinical deterioration either due to their underlying pathology or due to the cardiac surgery, contributing significantly to mortality, morbidity, hospital and family costs, and poor quality of life. In current clinical practice, clinical deterioration is detected, in most of the cases, when it has already occurred. Several early warning scores (EWS) have been proposed to assess children at risk of clinical deterioration using vital signs and risk indicators, in order to intervene in a timely manner to reduce the impact of deterioration and risk of death among children. However, EWS are based on measurements performed at a single time point without incorporating trends nor providing information about patient's risk trajectory. Moreover, some of these measurements rely on subjective assessment making them susceptible to different interpretations. All these limitations could explain why the implementation of EWS in high-resource settings failed to show a significant decrease in hospital mortality. By means of machine learning (ML) based algorithms we could integrate heterogeneous and complex data to predict patient's risk of deterioration. In this perspective article, we provide a brief overview of the potential of ML technologies to improve the identification of pediatric CHD patients at high-risk for clinical deterioration after cardiac surgery, and present the CORTEX traffic light, a ML-based predictive system that Sant Joan de Déu Barcelona Children's Hospital is implementing, as an illustration of the application of an ML-based risk stratification system in a relevant hospital setting.
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Affiliation(s)
- Patricia Garcia-Canadilla
- BCNatal-Barcelona Center for Maternal-Fetal and Neonatal Medicine, Hospital Sant Joan de Déu and Hospital Clínic, University of Barcelona, Barcelona, Spain.,Cardiovascular Diseases and Child Development, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain
| | - Alba Isabel-Roquero
- Department of Pediatric Cardiology, Hospital Sant Joan de Déu Barcelona, Esplugues de Llobregat, Spain.,BCNMedTech, Universitat Pompeu Fabra, Barcelona, Spain
| | - Esther Aurensanz-Clemente
- Cardiovascular Diseases and Child Development, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain.,Department of Pediatric Cardiology, Hospital Sant Joan de Déu Barcelona, Esplugues de Llobregat, Spain
| | - Arnau Valls-Esteve
- Innovation in Health Technologies, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain
| | - Francesca Aina Miguel
- Department of Engineering, Hospital Sant Joan de Déu Barcelona, Esplugues de Llobregat, Spain
| | - Daniel Ormazabal
- Department of Informatics, Hospital Sant Joan de Déu Barcelona, Esplugues de Llobregat, Spain
| | - Floren Llanos
- Department of Informatics, Hospital Sant Joan de Déu Barcelona, Esplugues de Llobregat, Spain
| | - Joan Sanchez-de-Toledo
- Cardiovascular Diseases and Child Development, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain.,Department of Pediatric Cardiology, Hospital Sant Joan de Déu Barcelona, Esplugues de Llobregat, Spain.,Department of Critical Care Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA, United States
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16
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Krishnamurthy Y, Pagliaro JA, Grady CB, Katz N, Bunn D, Bhatt AB. Patient evaluation of a virtual visit program for adults with congenital heart disease. Am Heart J 2021; 242:138-145. [PMID: 34400141 DOI: 10.1016/j.ahj.2021.08.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 08/07/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND Improved longevity for adults with congenital heart disease (ACHD) necessitates regular, longitudinal care for this population. Telemedicine has emerged as a strategy to increase access to subspecialty care. We evaluated patient experience with a virtual visit program in the pre-COVID era to identify patient-centered benefits and limitations. METHODS We enrolled patients for 30-minute synchronous videoconferencing virtual visits at our institution between October 2013 and March 2019. All patients were Massachusetts residents. Patients were surveyed and their characteristics were abstracted from electronic medical records. RESULTS A total of 264 virtual visits were conducted among 174 patients with a median age of 40 years. Patients traveled a median of 70 miles for in-person visits. Many visits were to review patient data (47%), and most individuals had moderate complexity CHD (45%). Patients reported very high satisfaction with a median visit rating of 10. Patients mostly preferred virtual visits when considering convenience and cost. No difference in preference to in-person visits was reported when considering sharing private information, confidence that concerns would be addressed, and overall visit quality. In-person visits were still preferred for personal connections and showing a physical problem. CONCLUSION We find that patients are highly satisfied with virtual visits. ACHD programs should consider blended virtual and in-person care. Long-term regulatory provisions will further improve care through the expansion of telemedicine in the post-COVID era.
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Affiliation(s)
| | - Jaclyn A Pagliaro
- Department of Medicine, Division of Cardiology , Massachusetts General Hospital, Boston, Massachusetts
| | - Connor B Grady
- Department of Medicine, Division of Cardiology , Massachusetts General Hospital, Boston, Massachusetts; Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut
| | - Nava Katz
- Department of Medicine, Division of Cardiology , Massachusetts General Hospital, Boston, Massachusetts
| | - David Bunn
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Ami B Bhatt
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts; Department of Medicine, Division of Cardiology , Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts; Department of Public Health, University of Maryland, College Park, Maryland.
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17
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Overweight and Obesity in Patients with Congenital Heart Disease: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18189931. [PMID: 34574853 PMCID: PMC8466650 DOI: 10.3390/ijerph18189931] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 09/17/2021] [Accepted: 09/18/2021] [Indexed: 11/17/2022]
Abstract
Background: Overweight and obesity have become a major public health concern in recent decades, particularly in patients with chronic health conditions like congenital heart disease (CHD). This systematic review elaborates on the prevalence and the longitudinal development of overweight and obesity in children and adults with CHD. Methods: A systematic literature search was conducted in PubMed, Cochrane, and Scopus from January 2010 to December 2020 on overweight and obesity prevalence in children and adults with CHD. Results: Of 30 included studies, 15 studies evaluated 5680 pediatric patients with CHD, 9 studies evaluated 6657 adults with CHD (ACHD) and 6 studies examined 9273 both pediatric patients and ACHD. Fifteen studies received the quality rating “good”, nine studies “fair”, and six studies “poor”. In children with CHD, overweight prevalence was between 9.5–31.5%, and obesity prevalence was between 9.5–26%; in ACHD, overweight prevalence was between 22–53%, and obesity was between 7–26%. The prevalence of overweight and obesity was thereby similar to the general population. Overweight and obesity have been shown to increase with age. Conclusion: The prevalence of overweight and obesity in children and adults with CHD is similar to the general population, demonstrating that the growing obesity pandemic is also affecting the CHD population.
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18
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Abstract
Introduction: Advancements in surgery and management have resulted in a growing population of aging adults with tetralogy of Fallot (TOF). As a result, there has been a parallel growth in late complications associated with the sequelae from the underlying cardiac anomalies as well as the surgical and other interventional treatments.Areas covered: Here, we review challenges related to an aging population of patients with TOF, particularly late complications, and highlight advances in management and key areas for future research. Pulmonary regurgitation, heart failure, arrhythmias, and aortic complications are some of these late complications. There is also a growing incidence of acquired cardiovascular disease, obesity, and diabetes associated with aging. Management of these late complications and acquired comorbidities continues to evolve as research provides insights into long-term outcomes from medical therapies and surgical interventions.Expert opinion: The management of an aging TOF population will continue to transform with advances in imaging technologies to identify subclinical disease and valve replacement technologies that will prevent and mitigate disease progression. In the coming years, we speculate that there will be more data to support the use of novel heart failure therapies in TOF and consensus guidelines on the management of refractory arrhythmias and aortic complications.
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Affiliation(s)
- Jennifer P Woo
- Department of Medicine, Division of Cardiovascular Medicine, Stanford University School of Medicine, California, USA
| | - Doff B McElhinney
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, California, USA
| | - George K Lui
- Department of Medicine, Division of Cardiovascular Medicine, Stanford University School of Medicine, California, USA
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19
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Wasmer K, Eckardt L, Baumgartner H, Köbe J. Therapy of supraventricular and ventricular arrhythmias in adults with congenital heart disease-narrative review. Cardiovasc Diagn Ther 2021; 11:550-562. [PMID: 33968633 DOI: 10.21037/cdt-20-634] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Arrhythmias are among the most common late complications in adults with congenital heart disease (ACHD) and a frequent reason for hospital admission. Both, supraventricular and ventricular arrhythmias, not only cause debilitating symptoms, but may be life-threatening by increasing risk of stroke, causing or worsening heart failure and being associated with sudden death. Substrate and risk for arrhythmia differs widely between congenital defects with specific arrhythmias being much more common in some patients than others. Atrial macroreentrant arrhythmias are particularly frequent in patients with atrial septal defects and repair that involves atrial incisions including patients with transposition of the great arteries (TGA) and atrial switch. Accessory pathways and related arrhythmias are often associated with Ebstein's anomaly and congenitally corrected TGA. Monomorphic ventricular arrhythmias occur in patients with ventricular incisions, namely patients with Tetralogy of Fallot. Changes in surgical repair techniques influence arrhythmia prevalence and substrate as well as anatomical access for catheter ablation procedures. In addition, epidemiologic changes associated with improved long-term survival will further increase the prevalence of atrial fibrillation in ACHD. This article summarizes current understanding of prevalence of specific arrhythmias, underlying mechanisms, medical and interventional treatment options and their outcome in ACHD.
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Affiliation(s)
- Kristina Wasmer
- Department of Cardiology II - Electrophysiology, University Hospital Muenster, Cardiology, Muenster, Germany
| | - Lars Eckardt
- Department of Cardiology II - Electrophysiology, University Hospital Muenster, Cardiology, Muenster, Germany
| | - Helmut Baumgartner
- Department of Cardiology III, Division of Adult Congenital and Valvular Heart Disease, University Hospital Muenster, Cardiology, Muenster, Germany
| | - Julia Köbe
- Department of Cardiology II - Electrophysiology, University Hospital Muenster, Cardiology, Muenster, Germany
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20
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Niwa K. Metabolic syndrome and coronary artery disease in adults with congenital heart disease. Cardiovasc Diagn Ther 2021; 11:563-576. [PMID: 33968634 DOI: 10.21037/cdt-20-781] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
In adults with congenital heart disease (ACHD), conditions acquired with aging, such as metabolic syndrome, hypertension, diabetes mellitus, and obesity, can negatively influence the original cardiovascular disease. Metabolic syndrome has a higher prevalence in ACHD than in the general population. In contrast, coronary artery disease shows a similar prevalence in adults with acyanotic CHD and the general population, while adults with cyanotic CHD, even after repair, have an even lower incidence of coronary artery disease than the general population/adults with acyanotic CHD. However, even in those with cyanotic CHD, coronary artery disease can develop when they have risk factors such as obesity, dyslipidemia, hypertension, diabetes mellitus, smoking habit, or limited exercise. The prevalence of risk factors for cardiovascular disease is similar between ACHD and the general population, but an increased risk of coronary atherosclerosis has been observed for congenital coronary artery anomalies, dextro-transposition of the great arteries after arterial switch operation, Ross procedure, and coarctation of the aorta. Aortopathy may be an additional risk factor for cardiovascular disease. As ACHD have other abnormalities that may make the heart more vulnerable to both the development of atherosclerosis and adverse cardiovascular sequelae, regular evaluation of their cardiovascular disease risk status is recommended. Metabolic syndrome is more common among ACHD than in the general population, and may therefore increase the future incidence of atherosclerotic coronary artery disease even in ACHD. Thus, ACHD should be screened for metabolic syndrome to eliminate risk factors for atherosclerotic coronary artery disease.
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Affiliation(s)
- Koichiro Niwa
- Department of Cardiology, Cardiovascular Center, St Luke's International Hospital, Tokyo 104-8560, Japan
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21
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Abstract
The number of rTOF patients who survive into adulthood is steadily rising, with currently more than 90% reaching the third decade of life. However, rTOF patients are not cured, but rather have a lifelong increased risk for cardiac and non-cardiac complications. Heart failure is recognized as a significant complication. Its occurrence is strongly associated with adverse outcome. Unfortunately, conventional concepts of heart failure may not be directly applicable in this patient group. This article presents a review of the current knowledge on HF in rTOF patients, including incidence and prevalence, the most common mechanisms of heart failure, i.e., valvular pathologies, shunt lesions, left atrial hypertension, primary left heart and right heart failure, arrhythmias, and coronary artery disease. In addition, we will review information regarding extracardiac complications, risk factors for the development of heart failure, clinical impact and prognosis, and assessment possibilities, particularly of the right ventricle, as well as management strategies. We explore potential future concepts that may stimulate further research into this field.
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22
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Potential regulatory role of epigenetic RNA methylation in cardiovascular diseases. Biomed Pharmacother 2021; 137:111376. [PMID: 33588266 DOI: 10.1016/j.biopha.2021.111376] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 02/05/2021] [Accepted: 02/08/2021] [Indexed: 12/17/2022] Open
Abstract
Cardiovascular diseases (CVDs) are the leading cause of morbidity and mortality worldwide, especially in developing countries. To date, several approaches have been proposed for the prevention and treatment of CVDs. However, the increased risk of developing cardiovascular events that result in hospitalization has become a growing public health concern. The pathogenesis of CVDs has been analyzed from various perspectives. Recent data suggest that regulatory RNAs play a multidimensional role in the development of CVDs. Studies have identified several mRNA modifications that have contributed to the functional characterization of various cardiac diseases. RNA methylation, such as N6-methyladenosine, N1-methyladenosine, 5-methylcytosine, N7-methylguanosine, N4-acetylcytidine, and 2'-O-methylation are novel epigenetic modifications that affect the regulation of cell growth, immunity, DNA damage, calcium signaling, apoptosis, and aging in cardiomyocytes. In this review, we summarize the role of RNA methylation in the pathophysiology of CVDs and the potential of using epigenetics to treat such disorders.
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23
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Fedchenko M, Mandalenakis Z, Hultsberg-Olsson G, Dellborg H, Eriksson P, Dellborg M. Validation of myocardial infarction diagnosis in patients with congenital heart disease in Sweden. BMC Cardiovasc Disord 2020; 20:460. [PMID: 33096985 PMCID: PMC7584083 DOI: 10.1186/s12872-020-01737-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 10/11/2020] [Indexed: 12/28/2022] Open
Abstract
Background The population of adults with congenital heart disease (CHD) is growing, and increasingly more patients with CHD reach older ages. Patients with CHD are at an increased risk of myocardial infarction (MI) with increased age. Diagnosing MI in patients with CHD can be challenging in clinical practice owing to a high prevalence of aberrant electrocardiograms, ventricular hypertrophy, and heart failure, among other factors. The National Swedish Patient Register (NPR) is widely used in epidemiological studies; however, MI diagnoses specifically in patients with CHD have never been validated in the NPR. Methods We contacted hospitals and medical archive services to request medical records for 249 patients, born during 1970–2012, with both CHD and MI diagnoses and who were randomly selected from the NPR by the Swedish National Board of Health and Welfare. Follow-up was until 2015. We performed a medical chart review to validate the MI diagnoses; we also validated CHD diagnoses to ensure that only patients with confirmed CHD diagnoses were included in the MI validation process. Results We received medical records for 96.4% (n = 238/249) of patients for validation of CHD diagnoses. In total, 74.8% (n = 178/238) had a confirmed CHD diagnosis; of these, 70.2% (n = 167) had a fully correct CHD diagnosis in the NPR; a further 4.6% (n = 11) had a CHD diagnosis, but it was misclassified. MI diagnoses were validated in 167 (93.8%) patients with confirmed CHD. Of the patients with confirmed CHD, 88.0% (n = 147/167) had correct MI diagnoses. Patients with non-complex CHD diagnoses had more correct MI diagnoses than patients with complex CHD (91.0%, n = 131 compared with 69.6%, n = 16). The main cause for incorrect MI diagnoses was typographical error, contributing to 50.0% of the incorrect diagnoses. Conclusions The validity of MI diagnoses in patients with confirmed CHD in the NPR is high, with nearly 9 of 10 MI diagnoses being correct (88.0%). MI in patients with CHD can safely be studied using the NPR.
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Affiliation(s)
- Maria Fedchenko
- Institute of Medicine, Department of Molecular and Clinical Medicine/Cardiology, Sahlgrenska University Hospital/Östra, Diagnosvägen 11, 416 50, Gothenburg, Sweden.
| | - Zacharias Mandalenakis
- Institute of Medicine, Department of Molecular and Clinical Medicine/Cardiology, Sahlgrenska University Hospital/Östra, Diagnosvägen 11, 416 50, Gothenburg, Sweden
| | - Görel Hultsberg-Olsson
- Institute of Medicine, Department of Molecular and Clinical Medicine/Cardiology, Sahlgrenska University Hospital/Östra, Diagnosvägen 11, 416 50, Gothenburg, Sweden
| | - Helena Dellborg
- Institute of Medicine, Department of Molecular and Clinical Medicine/Cardiology, Sahlgrenska University Hospital/Östra, Diagnosvägen 11, 416 50, Gothenburg, Sweden
| | - Peter Eriksson
- Institute of Medicine, Department of Molecular and Clinical Medicine/Cardiology, Sahlgrenska University Hospital/Östra, Diagnosvägen 11, 416 50, Gothenburg, Sweden
| | - Mikael Dellborg
- Institute of Medicine, Department of Molecular and Clinical Medicine/Cardiology, Sahlgrenska University Hospital/Östra, Diagnosvägen 11, 416 50, Gothenburg, Sweden
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24
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Honicky M, Cardoso SM, de Lima LRA, Ozcariz SGI, Vieira FGK, de Carlos Back I, Moreno YMF. Added sugar and trans fatty acid intake and sedentary behavior were associated with excess total-body and central adiposity in children and adolescents with congenital heart disease. Pediatr Obes 2020; 15:e12623. [PMID: 32050058 DOI: 10.1111/ijpo.12623] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2019] [Revised: 12/07/2019] [Accepted: 01/10/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Over the past three decades, the prevalence rate of overweight and obesity has increased in survivors with congenital heart disease, and little is known about the body composition and its association with clinical characteristics and lifestyle factors. OBJECTIVES To evaluate excess total-body adiposity and central adiposity and, to describe associated factors. METHODS Cross-sectional study with children and adolescents who underwent procedure to treat congenital heart disease, from January to July 2017. Sociodemographic and clinical characteristics, and lifestyle factors (dietary intake, physical activity, and sedentary behavior) were assessed. Adiposity was assessed using air-displacement plethysmography and waist circumference. Factors associated with excess total-body adiposity and central adiposity were analyzed using logistic regression models. RESULTS Of 232 patients, 22.4% were identified with excess total-body adiposity and 24.6% with central adiposity. Significant factors positively associated with excess total-body adiposity were intake of added sugar and trans fatty acids, adjusted for confounding factors. Similarly, lifestyle factors were positively associated with central adiposity: intake of added sugar and trans fatty acids, sedentary behavior, and family history of obesity. CONCLUSIONS Lifestyle factors were associated with excess total-body adiposity and central adiposity. Assessment of body composition and healthy-lifestyle counseling into outpatient care may be the key point to prevent obesity in children and adolescents with congenital heart disease.
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Affiliation(s)
- M Honicky
- Postgraduate Program in Nutrition, Federal University of Santa Catarina, Health Sciences Center, University Campus, Florianopolis, South Carolina, Brazil
| | - S M Cardoso
- Postgraduate Program in Public Health, Federal University of Santa Catarina, Health Sciences Center, University Campus, Florianopolis, South Carolina, Brazil
| | - L R A de Lima
- Department of Physical Education, University of State Santa Catarina, Laguna, South Carolina, Brazil
| | - S G I Ozcariz
- Postgraduate Program in Nutrition, Federal University of Santa Catarina, Health Sciences Center, University Campus, Florianopolis, South Carolina, Brazil
| | - F G K Vieira
- Postgraduate Program in Nutrition, Federal University of Santa Catarina, Health Sciences Center, University Campus, Florianopolis, South Carolina, Brazil
| | - I de Carlos Back
- Postgraduate Program in Public Health, Federal University of Santa Catarina, Health Sciences Center, University Campus, Florianopolis, South Carolina, Brazil
| | - Y M F Moreno
- Postgraduate Program in Nutrition, Federal University of Santa Catarina, Health Sciences Center, University Campus, Florianopolis, South Carolina, Brazil
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Kaplinski M, Griffis H, Liu F, Tinker C, Laney NC, Mendoza M, Cohen MS, Meyers K, Natarajan SS. Clinical Innovation: A Multidisciplinary Program for the Diagnosis and Treatment of Systemic Hypertension in Children and Adolescents. Clin Pediatr (Phila) 2020; 59:228-235. [PMID: 31893928 DOI: 10.1177/0009922819898180] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Pediatric systemic hypertension (HTN) is underdiagnosed and undertreated. The Divisions of Cardiology and Nephrology at our institution developed a comprehensive outpatient HTN program to (1) screen children at risk for HTN, (2) assess cardiovascular health, and (3) optimize medical management. We report our findings during all initial visits (n = 304) from December 2011 to September 2018. Of the cohort, 38% were obese and 36% reported little to no exercise. More than half of patients ≥11 years old did not have recommended lipid screening. When evaluating ambulatory blood pressure monitoring results, clinic blood pressure did not accurately diagnose patients with or without HTN and many patients on antihypertensive medications were inadequately treated. Visit recommendations included addition of or changes to antihypertensive medication in 35% of patients. A multidisciplinary program dedicated to pediatric HTN helps screen patients who are at risk. Ambulatory blood pressure monitoring identifies HTN in patients with normal clinic blood pressure and those on antihypertensive medication.
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Affiliation(s)
- Michelle Kaplinski
- Lucile Packard Children's Hospital, Stanford University, Palo Alto, CA, USA
| | - Heather Griffis
- Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, USA
| | - Fang Liu
- Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, USA
| | - Craig Tinker
- Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, USA
| | - Nina C Laney
- Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, USA
| | - Melodee Mendoza
- Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, USA
| | - Meryl S Cohen
- Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, USA
| | - Kevin Meyers
- Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, USA
| | - Shobha S Natarajan
- Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, USA
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26
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Saha P, Potiny P, Rigdon J, Morello M, Tcheandjieu C, Romfh A, Fernandes SM, McElhinney DB, Bernstein D, Lui GK, Shaw GM, Ingelsson E, Priest JR. Substantial Cardiovascular Morbidity in Adults With Lower-Complexity Congenital Heart Disease. Circulation 2020; 139:1889-1899. [PMID: 30813762 DOI: 10.1161/circulationaha.118.037064] [Citation(s) in RCA: 61] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Although lower-complexity cardiac malformations constitute the majority of adult congenital heart disease (ACHD), the long-term risks of adverse cardiovascular events and relationship with conventional risk factors in this population are poorly understood. We aimed to quantify the risk of adverse cardiovascular events associated with lower-complexity ACHD that is unmeasured by conventional risk factors. METHODS A multitiered classification algorithm was used to select individuals with lower-complexity ACHD and individuals without ACHD for comparison among >500 000 British adults in the UK Biobank. ACHD diagnoses were subclassified as isolated aortic valve and noncomplex defects. Time-to-event analyses were conducted for the primary end points of fatal or nonfatal acute coronary syndrome, ischemic stroke, heart failure, and atrial fibrillation and a secondary combined end point for major adverse cardiovascular events. Maximum follow-up time for the study period was 22 years with retrospectively and prospectively collected data from the UK Biobank. RESULTS We identified 2006 individuals with lower-complexity ACHD and 497 983 unexposed individuals in the UK Biobank (median age at enrollment, 58 [interquartile range, 51-63] years). Of the ACHD-exposed group, 59% were male, 51% were current or former smokers, 30% were obese, and 69%, 41%, and 7% were diagnosed or treated for hypertension, hyperlipidemia, and diabetes mellitus, respectively. After adjustment for 12 measured cardiovascular risk factors, ACHD remained strongly associated with the primary end points, with hazard ratios ranging from 2.0 (95% CI, 1.5-2.8; P<0.001) for acute coronary syndrome to 13.0 (95% CI, 9.4-18.1; P<0.001) for heart failure. ACHD-exposed individuals with ≤2 cardiovascular risk factors had a 29% age-adjusted incidence rate of major adverse cardiovascular events, in contrast to 13% in individuals without ACHD with ≥5 risk factors. CONCLUSIONS Individuals with lower-complexity ACHD had a higher burden of adverse cardiovascular events relative to the general population that was unaccounted for by conventional cardiovascular risk factors. These findings highlight the need for closer surveillance of patients with mild to moderate ACHD and further investigation into management and mechanisms of cardiovascular risk unique to this growing population of high-risk adults.
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Affiliation(s)
- Priyanka Saha
- Division of Cardiology, Department of Pediatrics (P.S., P.P., M.M., C.T., A.R., S.M.F., D.B.M., D.B., G.K.L., J.R.P.), Stanford University School of Medicine, CA.,Stanford Cardiovascular Institute (P.S., C.T., D.B.M., D.B., E.I., J.R.P.), Stanford University School of Medicine, CA.,Harvard Medical School, Boston, MA (P.S.)
| | - Praneetha Potiny
- Division of Cardiology, Department of Pediatrics (P.S., P.P., M.M., C.T., A.R., S.M.F., D.B.M., D.B., G.K.L., J.R.P.), Stanford University School of Medicine, CA
| | - Joseph Rigdon
- Quantitative Sciences Unit (J.R.), Stanford University School of Medicine, CA
| | - Melissa Morello
- Division of Cardiology, Department of Pediatrics (P.S., P.P., M.M., C.T., A.R., S.M.F., D.B.M., D.B., G.K.L., J.R.P.), Stanford University School of Medicine, CA.,Department of Medicine, Division of Cardiovascular Medicine (M.M., C.T., A.R., S.M.F., G.K.L., E.I.), Stanford University School of Medicine, CA
| | - Catherine Tcheandjieu
- Division of Cardiology, Department of Pediatrics (P.S., P.P., M.M., C.T., A.R., S.M.F., D.B.M., D.B., G.K.L., J.R.P.), Stanford University School of Medicine, CA.,Stanford Cardiovascular Institute (P.S., C.T., D.B.M., D.B., E.I., J.R.P.), Stanford University School of Medicine, CA.,Department of Medicine, Division of Cardiovascular Medicine (M.M., C.T., A.R., S.M.F., G.K.L., E.I.), Stanford University School of Medicine, CA
| | - Anitra Romfh
- Division of Cardiology, Department of Pediatrics (P.S., P.P., M.M., C.T., A.R., S.M.F., D.B.M., D.B., G.K.L., J.R.P.), Stanford University School of Medicine, CA.,Department of Medicine, Division of Cardiovascular Medicine (M.M., C.T., A.R., S.M.F., G.K.L., E.I.), Stanford University School of Medicine, CA
| | - Susan M Fernandes
- Division of Cardiology, Department of Pediatrics (P.S., P.P., M.M., C.T., A.R., S.M.F., D.B.M., D.B., G.K.L., J.R.P.), Stanford University School of Medicine, CA.,Department of Medicine, Division of Cardiovascular Medicine (M.M., C.T., A.R., S.M.F., G.K.L., E.I.), Stanford University School of Medicine, CA
| | - Doff B McElhinney
- Division of Cardiology, Department of Pediatrics (P.S., P.P., M.M., C.T., A.R., S.M.F., D.B.M., D.B., G.K.L., J.R.P.), Stanford University School of Medicine, CA.,Stanford Cardiovascular Institute (P.S., C.T., D.B.M., D.B., E.I., J.R.P.), Stanford University School of Medicine, CA.,Department of Cardiothoracic Surgery (D.B.M.), Stanford University School of Medicine, CA
| | - Daniel Bernstein
- Division of Cardiology, Department of Pediatrics (P.S., P.P., M.M., C.T., A.R., S.M.F., D.B.M., D.B., G.K.L., J.R.P.), Stanford University School of Medicine, CA.,Stanford Cardiovascular Institute (P.S., C.T., D.B.M., D.B., E.I., J.R.P.), Stanford University School of Medicine, CA
| | - George K Lui
- Division of Cardiology, Department of Pediatrics (P.S., P.P., M.M., C.T., A.R., S.M.F., D.B.M., D.B., G.K.L., J.R.P.), Stanford University School of Medicine, CA.,Department of Medicine, Division of Cardiovascular Medicine (M.M., C.T., A.R., S.M.F., G.K.L., E.I.), Stanford University School of Medicine, CA
| | - Gary M Shaw
- Department of Pediatrics (G.M.S.), Stanford University School of Medicine, CA
| | - Erik Ingelsson
- Stanford Cardiovascular Institute (P.S., C.T., D.B.M., D.B., E.I., J.R.P.), Stanford University School of Medicine, CA.,Department of Medicine, Division of Cardiovascular Medicine (M.M., C.T., A.R., S.M.F., G.K.L., E.I.), Stanford University School of Medicine, CA.,Stanford Diabetes Research Center, Stanford University, CA (E.I., J.R.P.)
| | - James R Priest
- Division of Cardiology, Department of Pediatrics (P.S., P.P., M.M., C.T., A.R., S.M.F., D.B.M., D.B., G.K.L., J.R.P.), Stanford University School of Medicine, CA.,Stanford Cardiovascular Institute (P.S., C.T., D.B.M., D.B., E.I., J.R.P.), Stanford University School of Medicine, CA.,Stanford Diabetes Research Center, Stanford University, CA (E.I., J.R.P.).,Chan-Zuckerberg BioHub, San Francisco, CA (J.R.P.)
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de Ferranti SD, Steinberger J, Ameduri R, Baker A, Gooding H, Kelly AS, Mietus-Snyder M, Mitsnefes MM, Peterson AL, St-Pierre J, Urbina EM, Zachariah JP, Zaidi AN. Cardiovascular Risk Reduction in High-Risk Pediatric Patients: A Scientific Statement From the American Heart Association. Circulation 2019; 139:e603-e634. [PMID: 30798614 DOI: 10.1161/cir.0000000000000618] [Citation(s) in RCA: 210] [Impact Index Per Article: 42.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
This scientific statement presents considerations for clinical management regarding the assessment and risk reduction of select pediatric populations at high risk for premature cardiovascular disease, including acquired arteriosclerosis or atherosclerosis. For each topic, the evidence for accelerated acquired coronary artery disease and stroke in childhood and adolescence and the evidence for benefit of interventions in youth will be reviewed. Children and adolescents may be at higher risk for cardiovascular disease because of significant atherosclerotic or arteriosclerotic risk factors, high-risk conditions that promote atherosclerosis, or coronary artery or other cardiac or vascular abnormalities that make the individual more vulnerable to the adverse effects of traditional cardiovascular risk factors. Existing scientific statements and guidelines will be referenced when applicable, and suggestions for risk identification and reduction specific to each setting will be described. This statement is directed toward pediatric cardiologists, primary care providers, and subspecialists who provide clinical care for these young patients. The focus will be on management and justification for management, minimizing information on pathophysiology and epidemiology.
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Kuijpers JM, Vaartjes I, Bokma JP, van Melle JP, Sieswerda GT, Konings TC, Bakker-de Boo M, van der Bilt I, Voogel B, Zwinderman AH, Mulder BJM, Bouma BJ. Risk of coronary artery disease in adults with congenital heart disease: A comparison with the general population. Int J Cardiol 2019; 304:39-42. [PMID: 31767384 DOI: 10.1016/j.ijcard.2019.11.114] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 09/28/2019] [Accepted: 11/15/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND Coronary artery disease (CAD) will increasingly determine outcome in the aging adult congenital heart disease (CHD) population. We aimed to determine sex-specific incidence of CAD in adult CHD patients throughout adulthood, compared to the general population. METHODS AND RESULTS We followed 11,723 adult CHD patients (median age 33 years; 49% male; 57% mild, 34% moderate, 9% severe CHD) from the Dutch CONCOR registry, and two age-sex-matched persons per patient from the general population for first CAD event in national registers (period 2002-2012). Incidence rates were estimated using smoothed hazard functions. CAD risk during follow-up, stratified by CHD severity, was compared using proportional subdistribution hazards regression. In ACHD patients, 103 CAD events (43 women) occurred over 60,456 person-years. Rates per 1000person-years increased from 0.3(95% confidence interval: 0.1-0.6) at age 20 to 5.8(3.7-8.9) at 70 years in female, and from 0.5(0.3-1.0) to 7.8(5.1-11.8) in male patients. Compared to the general population, relative risk was 12.0(2.5-56.3) in women and 4.6(1.7-12.1) in men aged 20 years. Relative risk declined with age, remaining significant up to age ~65 years in women and ~50 years in men. In patients with mild, moderate and severe CHD, CAD risk was 1.3(0.9-1.9), 1.6(1.0-2.5) and 2.9(1.3-6.9) times increased compared to the general population, respectively. CONCLUSIONS We found increased CAD risk in adult CHD patients, with greater relative risk at younger age, in women and those with more severe CHD. These results underline the importance of screening for and treatment of CAD risk factors in these patients.
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Affiliation(s)
- Joey M Kuijpers
- Department of Cardiology, Academic Medical Center, Amsterdam, the Netherlands; Netherlands Heart Institute, Utrecht, the Netherlands
| | - Ilonca Vaartjes
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Jouke P Bokma
- Department of Cardiology, Academic Medical Center, Amsterdam, the Netherlands; Netherlands Heart Institute, Utrecht, the Netherlands
| | - Joost P van Melle
- Department of Cardiology, University Medical Center Groningen, Groningen, the Netherlands
| | - Gertjan Tj Sieswerda
- Department of Cardiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Thelma C Konings
- Department of Cardiology, VU University Medical Center, Amsterdam, the Netherlands
| | | | - Ivo van der Bilt
- Department of Cardiology, HagaZiekenhuis, Den Haag, the Netherlands
| | - Bart Voogel
- Department of Cardiology, Spaarne Gasthuis, Haarlem/Hoofddorp, the Netherlands
| | - Aeilko H Zwinderman
- Department of Clinical Epidemiology and Biostatistics, Academic Medical Center, Amsterdam, the Netherlands
| | - Barbara J M Mulder
- Department of Cardiology, Academic Medical Center, Amsterdam, the Netherlands; Netherlands Heart Institute, Utrecht, the Netherlands
| | - Berto J Bouma
- Department of Cardiology, Academic Medical Center, Amsterdam, the Netherlands.
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Shustak RJ, Cohen MS. What influences outcomes in pediatric and congenital cardiovascular disease?: A healthy lifestyle; obesity and overweight. PROGRESS IN PEDIATRIC CARDIOLOGY 2019. [DOI: 10.1016/j.ppedcard.2019.101141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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30
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Martínez-Quintana E, Rodríguez-Hernández JL, Rodríguez-González F, Riaño-Ruiz M, Fraguela-Medina C, Girolimetti A, Jiménez-Rodríguez S. Cardiovascular risk factors and arterial thrombotic events in congenital heart disease patients. Int J Clin Pract 2019; 73:1-8. [PMID: 31141298 DOI: 10.1111/ijcp.13378] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 10/26/2018] [Accepted: 05/25/2019] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION As congenital patients get older, it can be hypothesised that cardiovascular risk factors increase. METHODS Retrospective study of congenital heart disease (CHD) patients attended between January 2008 and September 2018. Cardiovascular risk factors, myocardial infarction, stroke, peripheral vascular disease, and analytical data such as serum glucose and lipid profile were determined. RESULTS Eight hundred and eighteen CHD patients and 1955 control patients matched for age and sex were studied. CHD patients were distributed in simple (462 patients), moderate (228 patients) and great (128 patients) complexity. Median age in CHD patients was 33 (25-41) years old and 56% were male. CHD patients were significantly more hypertensive and diabetic but less dyslipidemic and smokers than patients in the control group. Twenty-seven (3.3%) CHD patients had an arterial thrombotic event: 3 coronary, 22 neurological and 2 peripheral vascular disease. No significant differences were seen in the incidence of myocardial infarction between the control and the CHD groups. However CHD patients had a significant higher incidence of arterial thrombotic events (coronary, neurological and peripheral vascular events) at the expense of strokes and transient ischaemic attacks (22 vs 2 events in CHD and control patients, respectively). Also, no significant differences were seen in age, sex, BMI, arterial hypertension, diabetes mellitus, dyslipidemia, smoking habit, serum glucose, total and LDL cholesterol, statin treatment, myocardial infarction and arterial thrombotic events according to CHD complexity. Being older and having arterial hypertension, diabetes mellitus, dyslipidemia and smoking habit were more frequent among CHD patients with arterial thrombosis. CONCLUSIONS Congenital heart diseases are more hypertensive and diabetic but less dyslipemic and smokers than patients in the control group. CHD patients have a higher incidence of neurological events but not of myocardial infarction in relation to the control population.
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Affiliation(s)
- Efrén Martínez-Quintana
- Cardiology Service, Complejo Hospitalario Universitario Insular-Materno Infantil, Las Palmas de Gran Canaria, Spain
- Medical and Surgical Sciences Department, Faculty of Health Sciences, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | | | - Fayna Rodríguez-González
- Ophthalmology Service, Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, Spain
| | - Marta Riaño-Ruiz
- Department of Biochemistry and Clinical Analyses, Complejo Hospitalario Universitario Insular-Materno Infantil, Las Palmas de Gran Canaria, Spain
| | - Carla Fraguela-Medina
- Medical and Surgical Sciences Department, Faculty of Health Sciences, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Angela Girolimetti
- Medical and Surgical Sciences Department, Faculty of Health Sciences, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Sara Jiménez-Rodríguez
- Medical and Surgical Sciences Department, Faculty of Health Sciences, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
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Wong TW, Kan CD, Chiu WT, Fok KL, Ruan YC, Jiang X, Chen J, Kao CC, Chen IY, Lin HC, Chou CH, Lin CW, Yu CK, Tsao S, Lee YP, Chan HC, Wang JN. Progenitor Cells Derived from Drain Waste Product of Open-Heart Surgery in Children. J Clin Med 2019; 8:jcm8071028. [PMID: 31336927 PMCID: PMC6678880 DOI: 10.3390/jcm8071028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 06/25/2019] [Accepted: 07/10/2019] [Indexed: 11/23/2022] Open
Abstract
Human cardiac progenitor cells isolated from the same host may have advantages over other sources of stem cells. The aim of this study is to establish a new source of human progenitor cells collected from a waste product, pericardiac effusion fluid, after open-heart surgery in children with congenital heart diseases. The fluid was collected every 24 h for 2 days after surgery in 37 children. Mononuclear cells were isolated and expanded in vitro. These pericardial effusion-derived progenitor cells (PEPCs) exhibiting cardiogenic lineage markers, were highly proliferative and enhanced angiogenesis in vitro. Three weeks after stem cell transplantation into the ischemic heart in mice, cardiac ejection fraction was improved significantly without detectable progenitor cells. Gene expression profiles of the repaired hearts revealed activation of several known repair mechanisms including paracrine effects, cell migration, and angiogenesis. These progenitor cells may have the potential for heart regeneration.
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Affiliation(s)
- Tak-Wah Wong
- Department of Dermatology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan
- Department of Biochemistry and Molecular Biology, College of Medicine, National Cheng Kung University, Tainan 701, Taiwan
- Center of Applied Nanomedicine, National Cheng Kung University, Tainan 701, Taiwan
| | - Chung-Dann Kan
- Department of Surgery, Institute of Cardiovascular Research Center, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan
| | - Wen-Tai Chiu
- Department of Biomedical Engineering, National Cheng Kung University, Tainan 701, Taiwan
| | - Kin Lam Fok
- Epithelial Cell Biology Research Center, School of Biomedical Sciences, Faculty of Medicine, the Chinese University of Hong Kong, Shatin, Hong Kong
| | - Ye Chun Ruan
- Epithelial Cell Biology Research Center, School of Biomedical Sciences, Faculty of Medicine, the Chinese University of Hong Kong, Shatin, Hong Kong
| | - Xiaohua Jiang
- Epithelial Cell Biology Research Center, School of Biomedical Sciences, Faculty of Medicine, the Chinese University of Hong Kong, Shatin, Hong Kong
- Key Laboratory for Regenerative Medicine, Ministry of Education of the People's Republic of China, Shatin, HongKong
| | - Junjiang Chen
- Epithelial Cell Biology Research Center, School of Biomedical Sciences, Faculty of Medicine, the Chinese University of Hong Kong, Shatin, Hong Kong
| | - Chiu-Ching Kao
- Department of Dermatology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan
| | - I-Yu Chen
- Department of Dermatology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan
| | - Hui-Chun Lin
- Department of Dermatology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan
| | - Chia-Hsuan Chou
- Department of Dermatology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan
- Institute of Basic Medical Sciences, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan
| | - Chou-Wen Lin
- Biomedical Technology and Device Research Laboratories, Industrial Technology Research Institute, Liuo-Jia, Tainan 734, Taiwan
| | - Chun-Keung Yu
- Institute of Basic Medical Sciences, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan
- Department of Microbiology and Immunology, Center of Infectious Disease and Signaling Research, College of Medicine, National Cheng Kung University, Tainan 701, Taiwan
- National Laboratory Animal Center, National Applied Research Laboratories, Taipei 11529, Taiwan
| | - Stephanie Tsao
- Department of Dermatology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan
| | - Yi-Ping Lee
- Institute of Basic Medical Sciences, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan
| | - Hsiao Chang Chan
- Epithelial Cell Biology Research Center, School of Biomedical Sciences, Faculty of Medicine, the Chinese University of Hong Kong, Shatin, Hong Kong
- Key Laboratory for Regenerative Medicine, Ministry of Education of the People's Republic of China, Shatin, HongKong
| | - Jieh-Neng Wang
- Department of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan.
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Niwa K. Metabolic Syndrome in Adult Congenital Heart Disease. Korean Circ J 2019; 49:691-708. [PMID: 31347322 PMCID: PMC6675699 DOI: 10.4070/kcj.2019.0187] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 06/24/2019] [Indexed: 12/18/2022] Open
Abstract
In adult congenital heart disease (ACHD), residua and sequellae after initial repair develop late complications such as cardiac failure, arrhythmias, thrombosis, aortopathy, pulmonary hypertension and others. Acquired lesions with aging such as hypertension, diabetes mellitus, obesity can be negative influence on original cardiovascular disease (CVD). Also, atherosclerosis may pose an additional health problem to ACHD when they grow older and reach the age at which atherosclerosis becomes clinically relevant. In spite of the theoretical risk of atherosclerosis in ACHD due to above mentioned factors, cyanotic ACHDs even after repair are noted to have minimal incidence of coronary artery disease (CAD). Acyanotic ACHD has similar prevalence of CAD as the general population. However, even in cyanotic ACHD, CAD can develop when they have several risk factors for CAD. The prevalence of risk factor is similar between ACHD and the general population. Risk of premature atherosclerotic CVD in ACHD is based, 3 principal mechanisms: lesions with coronary artery abnormalities, obstructive lesions of left ventricle and aorta such as coarctation of the aorta and aortopathy. Coronary artery abnormalities are directly affected or altered surgically, such as arterial switch in transposition patients, may confer greater risk for premature atherosclerotic CAD. Metabolic syndrome is more common among ACHD than in the general population, and possibly increases the incidence of atherosclerotic CAD even in ACHD in future. Thus, ACHD should be screened for metabolic syndrome and eliminating risk factors for atherosclerotic CAD.
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Affiliation(s)
- Koichiro Niwa
- Cardiovascular Center, Department of Cardiology, St. Luke's International Hospital, Tokyo, Japan.
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Abstract
BACKGROUND Although sleep apnea is an important disorder associated with cardiac events, data regarding its prevalence and risk factors in adult patients with congenital heart disease are limited. METHODS In this study, patients underwent a sleep study in the hospital. Indications for admission were classified as heart failure, diagnostic catheterisation, interventional catheterisation, or arrhythmia. The prevalence, characteristics, and risk factors of sleep apnea using a type-3 portable overnight polygraph in adult patients with congenital heart disease were evaluated. RESULTS There were 104 patients [median age: 36 (interquartile range: 28-48) years] who were admitted for heart failure 34% (n = 36), diagnostic catheterisation 26% (n = 27), interventional catheterisation 18% (n = 19), or arrhythmia 22% (n = 23). The prevalence of sleep apnea, defined as a respiratory disturbance index ≥5, was 63% (n = 63), with a distribution of 37%, 16%, and 10% for mild (5≤ respiratory disturbance index <15), moderate (15≤ respiratory disturbance index <30), and severe (respiratory disturbance index ≥30) sleep apnea, respectively. A large majority of the sleep apnea cases were categorised as obstructive sleep apnea (92%, n = 58). The respiratory disturbance index ≥15 group had a significantly higher proportion of male patients and higher body mass index, noradrenaline level, and aortic blood pressure than the group without sleep apnea (respiratory disturbance index <5). Multivariable analysis showed that New York Heart Association class ≥II (OR, 4.36; 95% CI, 1.09-20.87) and body mass index ≥25 (OR, 4.29; 95% CI, 1.32-15.23) were independent risk factors for a respiratory disturbance index ≥15. CONCLUSION Our results showed a high prevalence of sleep apnea in adult patients with congenital heart disease. Its unique haemodynamics may be associated with a high prevalence of sleep apnea. Congestive heart failure and being overweight are important risk factors for sleep apnea. Management of heart failure and general lifestyle improvements will be important for controlling sleep apnea symptoms in these patients.
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Smith JMC, Andrade JG, Human D, Field TS. Adults With Complex Congenital Heart Disease: Cerebrovascular Considerations for the Neurologist. Front Neurol 2019; 10:329. [PMID: 31019488 PMCID: PMC6458261 DOI: 10.3389/fneur.2019.00329] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Accepted: 03/18/2019] [Indexed: 01/15/2023] Open
Abstract
As infant and childhood mortality has decreased in congenital heart disease, this population is increasingly reaching adulthood. Adults with congenital heart disease (ACHD) represent a group with increased risk of stroke, silent brain infarcts, and vascular cognitive impairment. Cyanotic and other complex cardiac lesions confer the greatest risk of these cerebrovascular insults. ACHD patients, in addition to having an increased risk of stroke from structural cardiac issues and associated physiological changes, may have an accelerated burden of conventional vascular risk factors, including hypertension and impaired glucose metabolism. Adult neurologists should be aware of the risks of clinically evident and subclinical cerebrovascular disease in this population. We review the existing evidence on primary and secondary stroke prevention in individuals with complex congenital heart disease, and identify knowledge gaps in need of further research, including treatment of acute stroke in this population. Multisystemic genetic syndromes are outside the scope of this review.
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Affiliation(s)
- Jonathan M C Smith
- M.D. Senior Pediatric Neurology Resident, University of British Columbia, Vancouver, BC, Canada
| | - Jason G Andrade
- FRCPC Clinical Associate Professor of Cardiology, University of British Columbia, Vancouver, BC, Canada
| | - Derek Human
- FRCPC, Clinical Professor of Pediatric Cardiology, BC Children's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Thalia S Field
- M.D. Senior Pediatric Neurology Resident, University of British Columbia, Vancouver, BC, Canada.,FRCPC Clinical Associate Professor of Cardiology, University of British Columbia, Vancouver, BC, Canada.,FRCPC, Clinical Professor of Pediatric Cardiology, BC Children's Hospital, University of British Columbia, Vancouver, BC, Canada
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Malavazos AE, Capitanio G, Chessa M, Matelloni IA, Milani V, Stella E, Al Kassem LF, Sironi F, Boveri S, Giamberti A, Masocco M, Ranucci M, Menicanti L, Morricone L. Body mass index stratification in hospitalized Italian adults with congenital heart disease in relation to complexity, diagnosis, sex and age. Nutr Metab Cardiovasc Dis 2019; 29:367-377. [PMID: 30795994 DOI: 10.1016/j.numecd.2019.01.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 01/18/2019] [Accepted: 01/20/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND AND AIMS Adults with congenital heart disease (ACHD) are at risk of overweight and obesity, two major health problems, though underweight can be a negative prognostic factor too. Awareness of the body mass index (BMI) in ACHD is very limited. The present study describes the use and prevalence of BMI in Italian symptomatic hospitalized ACHD patients in relation to complexity by Bethesda system classification, diagnosis, sex and age. METHODS AND RESULTS We classified 1388 ACHD patients, aged 18-69 years, on the basis of their BMI, and compared them to the Italian reference population. In our total ACHD population we found a significantly higher prevalence of underweight compared to the Italian reference population (6.34% vs 3.20%). ACHD women were more underweight than men. Underweight decreased with age. Overweight was significantly less frequent in the total ACHD population (26.73% compared to 31.70%) in the Italian reference population. Men were more likely to be overweight than women. In statistical terms obesity was similar in the Italian reference population (10.50%) and our ACHD population (9.58%). Both overweight and obesity increased with age. Results were comparable using a diagnostic anatomical-functional classification and the Bethesda system classification. CONCLUSIONS In our cohort of ACHD the prevalence of underweight was double that of the Italian reference population. The prevalence of overweight was lower, while obesity was similar. Since BMI does not account for differences in body fat distribution, a future aim will be to quantify the visceral component of the adipose tissue in ACHD patients and examine their body composition in order to reflect their risk of acquired cardiovascular disease better, and either to maintain or achieve an adequate visceral component.
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Affiliation(s)
- A E Malavazos
- Clinical Nutrition and Cardiovascular Prevention Unit and High Speciality Center for Dietetics, Nutritional Education and Cardiometabolic Prevention, I.R.C.C.S.Policlinico San Donato, San Donato Milanese, Italy.
| | - G Capitanio
- Clinical Nutrition and Cardiovascular Prevention Unit and High Speciality Center for Dietetics, Nutritional Education and Cardiometabolic Prevention, I.R.C.C.S.Policlinico San Donato, San Donato Milanese, Italy
| | - M Chessa
- Pediatric and Adult Congenital Heart Centre, I.R.C.C.S. Policlinico San Donato, San Donato Milanese, Italy
| | - I A Matelloni
- Clinical Nutrition and Cardiovascular Prevention Unit and High Speciality Center for Dietetics, Nutritional Education and Cardiometabolic Prevention, I.R.C.C.S.Policlinico San Donato, San Donato Milanese, Italy
| | - V Milani
- Scientific Directorate, I.R.C.C.S. Policlinico San Donato, San Donato Milanese, Italy
| | - E Stella
- Clinical Nutrition and Cardiovascular Prevention Unit and High Speciality Center for Dietetics, Nutritional Education and Cardiometabolic Prevention, I.R.C.C.S.Policlinico San Donato, San Donato Milanese, Italy
| | - L F Al Kassem
- Clinical Nutrition and Cardiovascular Prevention Unit and High Speciality Center for Dietetics, Nutritional Education and Cardiometabolic Prevention, I.R.C.C.S.Policlinico San Donato, San Donato Milanese, Italy
| | - F Sironi
- Clinical Nutrition and Cardiovascular Prevention Unit and High Speciality Center for Dietetics, Nutritional Education and Cardiometabolic Prevention, I.R.C.C.S.Policlinico San Donato, San Donato Milanese, Italy
| | - S Boveri
- Scientific Directorate, I.R.C.C.S. Policlinico San Donato, San Donato Milanese, Italy
| | - A Giamberti
- Pediatric and Adult Congenital Heart Centre, I.R.C.C.S. Policlinico San Donato, San Donato Milanese, Italy
| | - M Masocco
- Italian National Health Institute, Rome, Italy
| | - M Ranucci
- Department of Cardiothoracic, Vascular Anesthesia and Intensive Care, I.R.C.C.S. Policlinico San Donato, San Donato Milanese, Italy
| | - L Menicanti
- Department of Cardiac Surgery, I.R.C.C.S. Policlinico San Donato, San Donato Milanese, Italy
| | - L Morricone
- Clinical Nutrition and Cardiovascular Prevention Unit and High Speciality Center for Dietetics, Nutritional Education and Cardiometabolic Prevention, I.R.C.C.S.Policlinico San Donato, San Donato Milanese, Italy
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36
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Predicting acquired cardiovascular disease in adults with congenital heart disease is risky business. Int J Cardiol 2019; 277:106-107. [DOI: 10.1016/j.ijcard.2018.10.061] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Accepted: 10/17/2018] [Indexed: 11/22/2022]
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Abstract
BACKGROUND Although sleep apnoea is an important disorder associated with cardiac events, data regarding its prevalence and risk factors in adult patients with CHD are limited. METHODS In this study, patients underwent a sleep study in the hospital. Indications for admission were classified as heart failure, diagnostic catheterisation, interventional catheterisation, or arrhythmia. The prevalence, characteristics, and risk factors of sleep apnoea using a type 3 portable overnight polygraph in adult patients with CHD were evaluated. RESULTS This study comprised 104 patients of median age 36 years with interquartile range of 28-48 years, admitted for heart failure 34% (n = 36), diagnostic catheterisation 26% (n = 27), interventional catheterisation 18% (n = 19), or arrhythmia 22% (n = 23). The prevalence of sleep apnoea, defined as a respiratory disturbance index ≥5, was 63% (n = 63), with a distribution of 37, 16, and 10% for mild (5≤ respiratory disturbance index <15), moderate (15⩽ respiratory disturbance index <30), and severe (respiratory disturbance index ≥30) sleep apnoea, respectively. A large majority of the sleep apnoea cases were categorised as obstructive sleep apnoea (92%, n = 58). The respiratory disturbance index ≥15 group had a significantly higher proportion of male patients and higher body mass index, noradrenaline level, and aortic blood pressure than the group without sleep apnoea (respiratory disturbance index <5). Multi-variable analysis showed that NYHA class ≥II, whose odds ratio 4.36, 95% confidence interval 1.09-20.87, and body mass index ≥25, whose odds ratio 4.29, 95% confidence interval 1.32-15.23, were independent risk factors for a respiratory disturbance index ≥15. CONCLUSION Our results showed a high prevalence of sleep apnoea in adult patients with CHD. Its unique haemodynamics may be associated with a high prevalence of sleep apnoea. Congestive heart failure and being overweight are important risk factors for sleep apnoea. Management of heart failure and general lifestyle improvements are important for controlling sleep apnoea symptoms in these patients.
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Lyle T, Hartman M. Adult congenital heart disease physical activity recommendation form: a feasibility study. JOURNAL OF CONGENITAL CARDIOLOGY 2018. [DOI: 10.1186/s40949-018-0021-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Abstract
PURPOSE OF REVIEW This review paper describes the management of patients with dextro-transposition of the great arteries (D-TGA) with a focus on the complications seen and the appropriate care required to identify and prevent adverse events. RECENT FINDINGS D-TGA is a form of cyanotic congenital heart disease (CHD) representing ~ 3% of all CHD and almost 20% of all cyanotic CHD. Since the late 1980s, standard of care is to repair these patients with an arterial switch operation (ASO) as opposed to a Mustard/Senning operation. The long-term survival and complication rates are superior in the ASO. Long-term follow-up is recommended for all D-TGA patients and includes management with adult congenital heart disease specialists and the use of echocardiography and advanced imaging with CT or MRI. The most common complications seen are pulmonary stenosis, coronary artery stenosis, and neo-aortic regurgitation. Careful evaluation of new symptoms or declining function is essential in preventing and treating these long-term sequelae.
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Affiliation(s)
- Jared Kirzner
- Cornell Center for Adult Congenital Heart Disease, Departments of Medicine and Pediatrics, Division of Cardiology, New York Presbyterian Hospital, Weill Cornell Medicine, 520 East 70th Street, Starr 425, New York, NY, 10021, USA
| | - Altaf Pirmohamed
- Cornell Center for Adult Congenital Heart Disease, Departments of Medicine and Pediatrics, Division of Cardiology, New York Presbyterian Hospital, Weill Cornell Medicine, 520 East 70th Street, Starr 425, New York, NY, 10021, USA
| | - Jonathan Ginns
- Cornell Center for Adult Congenital Heart Disease, Departments of Medicine and Pediatrics, Division of Cardiology, New York Presbyterian Hospital, Weill Cornell Medicine, 520 East 70th Street, Starr 425, New York, NY, 10021, USA
| | - Harsimran S Singh
- Cornell Center for Adult Congenital Heart Disease, Departments of Medicine and Pediatrics, Division of Cardiology, New York Presbyterian Hospital, Weill Cornell Medicine, 520 East 70th Street, Starr 425, New York, NY, 10021, USA.
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40
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Harris KC, Voss C, Rankin K, Aminzadah B, Gardner R, Mackie AS. Modifiable cardiovascular risk factors in adolescents and adults with congenital heart disease. CONGENIT HEART DIS 2018; 13:563-570. [DOI: 10.1111/chd.12612] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Revised: 04/19/2018] [Accepted: 04/22/2018] [Indexed: 11/26/2022]
Affiliation(s)
- Kevin C. Harris
- Division of Cardiology, Children's Heart Centre, BC Children's Hospital; University of British Columbia; Vancouver British Columbia Canada
| | - Christine Voss
- Division of Cardiology, Children's Heart Centre, BC Children's Hospital; University of British Columbia; Vancouver British Columbia Canada
| | - Kathryn Rankin
- Division of Cardiology, Stollery Children's Hospital; University of Alberta; Edmonton Alberta Canada
| | - Basmina Aminzadah
- Division of Cardiology, Stollery Children's Hospital; University of Alberta; Edmonton Alberta Canada
| | - Ross Gardner
- Division of Cardiology, Children's Heart Centre, BC Children's Hospital; University of British Columbia; Vancouver British Columbia Canada
| | - Andrew S. Mackie
- Division of Cardiology, Stollery Children's Hospital; University of Alberta; Edmonton Alberta Canada
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Steiner JM, Kovacs AH. Adults with congenital heart disease – Facing morbidities and uncertain early mortality. PROGRESS IN PEDIATRIC CARDIOLOGY 2018. [DOI: 10.1016/j.ppedcard.2018.01.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Ware AL, Young PC, Weng C, Presson AP, Minich LL, Menon SC. Prevalence of Coronary Artery Disease Risk Factors and Metabolic Syndrome in Children with Heart Disease. Pediatr Cardiol 2018; 39:261-267. [PMID: 29058030 DOI: 10.1007/s00246-017-1750-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Accepted: 10/07/2017] [Indexed: 12/19/2022]
Abstract
Children with acquired and congenital heart disease (CHD) are increasingly surviving to adulthood. Our aim was to determine the prevalence of coronary artery disease (CAD) risk factors in children at known risk for early CAD or with severe CHD. We recruited children (8-19 years) at risk for early CAD-Kawasaki disease (KD, N = 36) and coarctation (69) or severe CHD: > 1 cardiopulmonary bypass surgery (60), single ventricle (15), prosthetic valves (13). Anthropometric measurements, blood pressure, and fasting lipid data were compared with summaries from National Health and Nutrition Examination Survey (NHANES) publications (1999-2012). Relative risk (RR) ratios were calculated based on age classification and pooled to obtain overall RR. Of 174 subjects, 106 were male (61%) and 138 (79%) had CHD. Compared to NHANES data, hypertension and low HDL were higher in the study cohort [RR 11.7 (CI 6.34-21.6), p < 0.001; and 1.79 (CI 1.36-2.35). p < 0.001] and obesity and elevated total cholesterol were lower [RR 0.59 (CI 0.37-0.96), p = 0.03; and 0.42 (CI 0.19-0.95), p = 0.04]. Elevated non-HDL was similar between groups. Age category had similar RR for all CAD risk factors. Eight subjects had metabolic syndrome. Risk factors were similar between KD versus CHD subgroups. Both coarctation and non-coarctation subjects had increased RR for hypertension. Hypertension is the most common risk factor for children at risk of early CAD and severe CHD. Metabolic syndrome is rare. These patients should be screened and treated for hypertension and current recommendations for universal lipid screening are adequate for follow-up.
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Affiliation(s)
- Adam L Ware
- Division of Pediatric Cardiology, Department of Pediatrics, University of Utah, Salt Lake City, UT, USA.
| | - Paul C Young
- Department of Pediatrics, University of Utah, Salt Lake City, UT, USA
| | - Cindy Weng
- Study Design and Biostatistics Center, University of Utah, Salt Lake City, UT, USA
| | - Angela P Presson
- Study Design and Biostatistics Center, University of Utah, Salt Lake City, UT, USA
| | - L LuAnn Minich
- Division of Pediatric Cardiology, Department of Pediatrics, University of Utah, Salt Lake City, UT, USA
| | - Shaji C Menon
- Division of Pediatric Cardiology, Department of Pediatrics, University of Utah, Salt Lake City, UT, USA
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Diagnosis and Management of Noncardiac Complications in Adults With Congenital Heart Disease: A Scientific Statement From the American Heart Association. Circulation 2017; 136:e348-e392. [DOI: 10.1161/cir.0000000000000535] [Citation(s) in RCA: 106] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Life expectancy and quality of life for those born with congenital heart disease (CHD) have greatly improved over the past 3 decades. While representing a great advance for these patients, who have been able to move from childhood to successful adult lives in increasing numbers, this development has resulted in an epidemiological shift and a generation of patients who are at risk of developing chronic multisystem disease in adulthood. Noncardiac complications significantly contribute to the morbidity and mortality of adults with CHD. Reduced survival has been documented in patients with CHD with renal dysfunction, restrictive lung disease, anemia, and cirrhosis. Furthermore, as this population ages, atherosclerotic cardiovascular disease and its risk factors are becoming increasingly prevalent. Disorders of psychosocial and cognitive development are key factors affecting the quality of life of these individuals. It is incumbent on physicians who care for patients with CHD to be mindful of the effects that disease of organs other than the heart may have on the well-being of adults with CHD. Further research is needed to understand how these noncardiac complications may affect the long-term outcome in these patients and what modifiable factors can be targeted for preventive intervention.
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Opotowsky AR, Loukas B, Ellervik C, Moko LE, Singh MN, Landzberg EI, Rimm EB, Landzberg MJ. Design and Implementation of a Prospective Adult Congenital Heart Disease Biobank. World J Pediatr Congenit Heart Surg 2017; 7:734-743. [PMID: 27834768 DOI: 10.1177/2150135116672648] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Accepted: 09/12/2016] [Indexed: 01/05/2023]
Abstract
BACKGROUND Adults with congenital heart disease (ACHD) comprise a growing, increasingly complex population. The Boston Adult Congenital Heart Disease Biobank is a program for the collection and storage of biospecimens to provide a sustainable resource for scientific biomarker investigation in ACHD. METHODS We describe a protocol to collect, process, and store biospecimens for ACHD or associated diagnoses developed based on existing literature and consultation with cardiovascular biomarker epidemiologists. The protocol involves collecting urine and ∼48.5 mL of blood. A subset of the blood and urine undergoes immediate clinically relevant testing. The remaining biospecimens are processed soon after collection and stored at -80°C as aliquots of ethylenediaminetetraacetic acid (EDTA) and lithium heparin plasma, serum, red cell and buffy coat pellet, and urine supernatant. Including tubes with diverse anticoagulant and clot accelerator contents will enable flexible downstream use. Demographic and clinical data are entered into a database; data on biospecimen collection, processing, and storage are managed by an enterprise laboratory information management system. RESULTS Since implementation in 2012, we have enrolled more than 650 unique participants (aged 18-80 years, 53.3% women); the Biobank contains over 11,000 biospecimen aliquots. The most common primary CHD diagnoses are single ventricle status-post Fontan procedure (18.8%), repaired tetralogy of Fallot with pulmonary stenosis or atresia (17.6%), and left-sided obstructive lesions (17.5%). CONCLUSIONS We describe the design and implementation of biospecimen collection, handling, and storage protocols with multiple levels of quality assurance. These protocols are feasible and reflect the size and goals of the Boston ACHD Biobank.
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Affiliation(s)
- Alexander R Opotowsky
- Department of Cardiology, Boston Children's Hospital, Boston, MA, USA .,Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Brittani Loukas
- Department of Cardiology, Boston Children's Hospital, Boston, MA, USA
| | - Christina Ellervik
- Department of Laboratory Medicine, Boston Children's Hospital, Boston, MA, USA
| | - Lilamarie E Moko
- Department of Cardiology, Boston Children's Hospital, Boston, MA, USA
| | - Michael N Singh
- Department of Cardiology, Boston Children's Hospital, Boston, MA, USA.,Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | | | - Eric B Rimm
- Departments of Nutrition and Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Michael J Landzberg
- Department of Cardiology, Boston Children's Hospital, Boston, MA, USA.,Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
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Saito C, Fukushima N, Fukushima K, Matsumura G, Ashihara K, Hagiwara N. Factors associated with aortic root dilatation after surgically repaired ventricular septal defect. Echocardiography 2017; 34:1203-1209. [PMID: 28681451 DOI: 10.1111/echo.13622] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Aortic root dilatation (ARD) in congenital heart disease is related to aortic aneurysm, rupture, and dissection. This study aimed to investigate the factors associated with ARD in patients with surgically repaired ventricular septal defect (VSD). METHODS This cross-sectional study included 152 patients with surgically repaired VSD. Two definitions of ARD were used: (1) observed Valsalva diameter to body surface area (BSA) ratio >2.1 cm/m2 and (2) absolute value of Valsalva diameter ≥4.0 cm. Odds ratios (ORs) and 95% confidence intervals (CIs) of ARD presence were calculated using multivariate logistic regressions. RESULTS The prevalence of ARD ranged between 8.6% and 32.9%. Using the definition of observed aortic root diameter/BSA >2.1 cm/m2 , patients with nonsubarterial VSD type were more likely to have ARD (OR 5.65, 95% CI; 1.83-17.44, P=.003) than those with subarterial type, and patients with preoperative right- or noncoronary cusp prolapse (R/NCCP) were more likely to have ARD (OR 3.68, 95% CI; 1.20-11.23, P=.022) than patients without preoperative R/NCCP after adjustment for sex, age at repair (ie, shunt duration), VSD size, and postoperative follow-up period. Using the definition of absolute Valsalva diameter ≥4 cm, nonsubarterial VSD type and presence of R/NCCP were also significantly associated with ARD after adjustment for the same covariates. CONCLUSIONS Anatomical and morphological features (nonsubarterial type and presence of preoperative R/NCCP) are independently correlated with ARD in patients with VSD regardless of the different definitions of ARD. Patients with surgically repaired VSD may need careful monitoring for potential ARD development.
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Affiliation(s)
- Chihiro Saito
- Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan
| | - Noritoshi Fukushima
- Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan.,Department of Preventive Medicine and Public Health, Tokyo Medical University, Tokyo, Japan
| | - Keiko Fukushima
- Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan
| | - Goki Matsumura
- Department of Cardiovascular Surgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Kyomi Ashihara
- Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan
| | - Nobuhisa Hagiwara
- Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan
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Everitt IK, Gerardin JF, Rodriguez FH, Book WM. Improving the quality of transition and transfer of care in young adults with congenital heart disease. CONGENIT HEART DIS 2017; 12:242-250. [DOI: 10.1111/chd.12463] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2016] [Revised: 02/15/2017] [Accepted: 03/05/2017] [Indexed: 12/23/2022]
Affiliation(s)
- Ian K. Everitt
- Emory University School of Medicine; Atlanta Georgia, USA
| | - Jennifer F. Gerardin
- Division of Cardiology, Department of Medicine, Emory University School of Medicine and Department of Medicine; Emory University School of Medicine; Atlanta Georgia, USA
| | - Fred H. Rodriguez
- Division of Cardiology, Department of Medicine, Emory University School of Medicine and Department of Medicine; Emory University School of Medicine; Atlanta Georgia, USA
- Sibley Heart Center Cardiology, Emory University School of Medicine; Atlanta Georgia, USA
| | - Wendy M. Book
- Division of Cardiology, Department of Medicine, Emory University School of Medicine and Department of Medicine; Emory University School of Medicine; Atlanta Georgia, USA
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47
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Hinton RB, Ware SM. Heart Failure in Pediatric Patients With Congenital Heart Disease. Circ Res 2017; 120:978-994. [PMID: 28302743 DOI: 10.1161/circresaha.116.308996] [Citation(s) in RCA: 98] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Revised: 12/27/2016] [Accepted: 12/28/2016] [Indexed: 12/14/2022]
Abstract
Heart failure (HF) is a complex clinical syndrome resulting from diverse primary and secondary causes and shared pathways of disease progression, correlating with substantial mortality, morbidity, and cost. HF in children is most commonly attributable to coexistent congenital heart disease, with different risks depending on the specific type of malformation. Current management and therapy for HF in children are extrapolated from treatment approaches in adults. This review discusses the causes, epidemiology, and manifestations of HF in children with congenital heart disease and presents the clinical, genetic, and molecular characteristics that are similar or distinct from adult HF. The objective of this review is to provide a framework for understanding rapidly increasing genetic and molecular information in the challenging context of detailed phenotyping. We review clinical and translational research studies of HF in congenital heart disease including at the genome, transcriptome, and epigenetic levels. Unresolved issues and directions for future study are presented.
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Affiliation(s)
- Robert B Hinton
- From the Department of Pediatrics and Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis
| | - Stephanie M Ware
- From the Department of Pediatrics and Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis.
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48
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Robbins JM, Onukwube J, Goudie A, Collins RT. How often is congenital heart disease recognized as a significant comorbidity among hospitalized adults with congenital heart disease? Int J Cardiol 2017; 235:42-48. [PMID: 28279500 DOI: 10.1016/j.ijcard.2017.02.100] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Revised: 01/23/2017] [Accepted: 02/20/2017] [Indexed: 10/20/2022]
Abstract
BACKGROUND Despite frequent life-long hemodynamic and electrophysiologic abnormalities, adults with congenital heart defects (CHDs) are often lost to medical follow-up. Using a cohort of adults with CHD receiving hospital care in Arkansas, we sought to determine how often a CHD is recognized and coded during hospital admissions. METHODS Data for this study come from the Agency for Healthcare Research and Quality's Arkansas State Inpatient Database (SID) for years 2004 to 2012. Using unique identifiers that link patients across hospitalizations, we created a cohort of 3973 patients≥18years old with an ICD-9 code for a CHD diagnosis noted at discharge during any hospitalization. RESULTS These 3973 patients had 19,638 hospitalizations. A CHD was listed as the principal diagnosis in 3% of hospitalizations, a secondary diagnosis in 22%, and no CHD was listed in 75% of hospitalizations. Among patients with a critical CHD, no critical CHD was noted in 69% of hospitalizations. Cardiovascular events (heart failure, arrhythmias, cerebrovascular accidents, embolic event, or death) occurred in 60% of hospitalizations of critical CHD patients wherein no critical CHD was recorded. CONCLUSIONS CHDs are rarely acknowledged during hospitalizations of adults with a known CHD even when cardiovascular events occur. Improved awareness, disclosure and attention to comorbid CHDs among patients and providers may improve hospital management and outcomes of cardiovascular events.
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Affiliation(s)
- James M Robbins
- Department of Pediatrics, University of Arkansas for Medical Sciences, United States.
| | - Jennifer Onukwube
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, United States
| | - Anthony Goudie
- Department of Pediatrics, University of Arkansas for Medical Sciences, United States
| | - R Thomas Collins
- Department of Pediatrics, University of Arkansas for Medical Sciences, United States; Department of Internal Medicine, University of Arkansas for Medical Sciences, United States
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Lui GK, Rogers IS, Ding VY, Hedlin HK, MacMillen K, Maron DJ, Sillman C, Romfh A, Dade TC, Haeffele C, Grady SR, McElhinney DB, Murphy DJ, Fernandes SM. Risk Estimates for Atherosclerotic Cardiovascular Disease in Adults With Congenital Heart Disease. Am J Cardiol 2017; 119:112-118. [PMID: 28247847 DOI: 10.1016/j.amjcard.2016.09.023] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Revised: 09/13/2016] [Accepted: 09/13/2016] [Indexed: 12/31/2022]
Abstract
The adult with congenital heart disease (CHD) is at risk of developing atherosclerotic cardiovascular disease (ASCVD). We performed a cross-sectional study to describe established ASCVD risk factors and estimate 10-year and lifetime risk of ASCVD in adults over age 18 with CHD of moderate or great complexity using 3 validated risk assessment tools-the Framingham Study Cardiovascular Disease Risk Assessment, the Reynolds Risk Score, and the ASCVD Risk Estimator. We obtained extensive clinical and survey data on 178 enrolled patients, with average age 37.1 ± 12.6 years, 51% men. At least 1 modifiable ASCVD risk factor was present in 70%; the 2 most common were overweight/obesity (53%) and systemic hypertension (24%). Laboratory data were available in 103 of the 178 patients. Abnormal levels of glycated hemoglobin, high-sensitivity C-reactive protein, and high-density lipoprotein were each found in around 30% of patients. The 10-year ASCVD predicted risk using all 3 tools was relatively low (i.e., at least 90% of patients <10% risk), yet the median estimated lifetime risk was 36%. In conclusion, ASCVD risk factors are prevalent in adults with CHD. The risk estimation tools suggest that this population is particularly vulnerable to ASCVD with aging and should undergo guideline-based screening and management of modifiable risk factors.
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