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Masterson Creber R, Dimagli A, Niño de Rivera S, Russell D, Gerry S, Lees B, Guazzelli A, Flather M, Taggart DP, Gray A, Gaudino M. Minimal clinically important differences in patient-reported outcomes after coronary artery bypass surgery in the arterial revascularization trial. Eur J Cardiothorac Surg 2024; 66:ezae208. [PMID: 38845077 DOI: 10.1093/ejcts/ezae208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 04/19/2024] [Indexed: 07/03/2024] Open
Abstract
OBJECTIVES This article identifies minimal clinically important differences (MCIDs) in quality of life (QoL) measures among patients who had coronary artery bypass grafting (CABG) and were enrolled in the arterial revascularization trial (ART). METHODS AND RESULTS The European Quality of Life-5 Dimensions (EQ-5D) and the Short Form Health Survey 36-Item (SF-36) physical component (PC) and mental component (MC) scores were recorded at baseline, 5 years and 10 years in ART. The MCIDs were calculated as changes in QoL scores anchored to 1-class improvement in the New York Heart Association functional class and Canadian Cardiovascular Society scale at 5 years. Cox proportional hazard models were used to evaluate associations between MCIDs and mortality. Patient cohorts were examined for the SF-36 PC (N = 2671), SF-36 MC (N = 2815) and EQ-5D (N = 2943) measures, respectively. All QoL scores significantly improved after CABG compared to baseline. When anchored to the New York Heart Association, the MCID at 5 years was 17 (95% confidence interval: 17-20) for SF-36 PC, 14 (14-17) for the SF-36 MC and 0.12 (0.12-0.15) for EQ-5D. Using the Canadian Cardiovascular Society scale as an anchor, the MCID at 5 years was 15 (15-17) for the SF-36 PC, 12 (13-15) for the SF-36 MC and 0.12 (0.11-0.14) for the EQ-5D. The MCIDs for SF-36 PC and EQ-5D at 5 years were associated with a lower risk of mortality at the 10-year follow-up point after surgery. CONCLUSIONS MCIDs for CABG patients have been identified. These thresholds may have direct clinical applications in monitoring patients during follow-up and in designing new trials that include QoL as a primary study outcome. CLINICAL TRIAL REGISTRATION NUMBER ISRCTN46552265.
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Affiliation(s)
| | - Arnaldo Dimagli
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY, USA
| | | | - David Russell
- Department of Sociology, Appalachian State University, Boone, NC, USA
| | - Stephen Gerry
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology & Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Belinda Lees
- Nuffield Department of Surgical Sciences, University of Oxford, John Radcliffe Hospital, Oxford, UK
| | - Alice Guazzelli
- Nuffield Department of Surgical Sciences, University of Oxford, John Radcliffe Hospital, Oxford, UK
| | - Marcus Flather
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - David P Taggart
- Nuffield Department of Surgical Sciences, University of Oxford, John Radcliffe Hospital, Oxford, UK
| | - Alastair Gray
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Mario Gaudino
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY, USA
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2
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Kang W. Exploring the retrospective and prospective associations between the big five personality traits and clinical diagnosis of angina in middle-aged and older adults. J Psychosom Res 2024; 182:111803. [PMID: 38795399 DOI: 10.1016/j.jpsychores.2024.111803] [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: 12/27/2023] [Revised: 05/12/2024] [Accepted: 05/19/2024] [Indexed: 05/27/2024]
Abstract
OBJECTIVE The goal of the present research was to test the retrospective and prospective associations between the Big Five personality traits and clinical diagnosis of angina while controlling for demographic characteristics. METHODS Data from middle-aged and older adults from a cohort study Understanding Society: the UK Household Longitudinal Study (UKHLS) were extracted and analyzed using binary logistic regressions (N = 10,124 for the retrospective study and N = 5485 for the prospective study). Personality was measured using a self-report 15-item version of the Big Five inventory between 2011 and 2012. Angina was measured by a self-report clinical diagnosis history question in each wave from until 2019. Covariates in our models included age, sex, income (monthly), education, and marital status. RESULTS Neuroticism was positively related to the likelihood of clinical angina diagnosis in both the retrospective (OR = 1.22, 95% C.I. [1.11, 1.34]) and the prospective (OR = 1.52, 95% C.I. [1.19, 1.94]) study whereas Extraversion had a positive association with odds of angina (OR = 1.52, 95% C.I. [1.17, 1.97]) in the prospective study only. The negative association between Openness and clinical angina diagnosis in the cross-sectional analysis is borderline significant (OR = 0.91, p = 0.048, 95% C.I. [0.83, 1.00]). CONCLUSION Our research indicated that personality traits are associated with the risk of angina. These findings emphasize the importance of considering personality traits in understanding the etiology of angina and potentially informing personalized prevention and intervention strategies.
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Affiliation(s)
- Weixi Kang
- School of Arts and Humanities, Tung Wah College, Hong Kong, China.
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3
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Akkus O, Huzmeli I, Seker T, Bekler O, Sen F, Kaypakli O, Yildiz Ozer A, Yalcin F. Effectiveness of Device-Guided Breathing in Chronic Coronary Syndrome: A Randomized Controlled Study. ACTA CARDIOLOGICA SINICA 2023; 39:720-732. [PMID: 37720408 PMCID: PMC10499964 DOI: 10.6515/acs.202309_39(5).20230306e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 03/06/2023] [Indexed: 09/19/2023]
Abstract
Background Chronic coronary syndrome (CCS) is one of the most life-restricting coronary artery diseases, and symptom relief is the main goal in CCS patients who suffer from angina. Objectives To assess the potential benefits of device-guided breathing in CCS patients with angina in this randomized, controlled, single-blinded study. Methods Fifty-one patients with CCS received device-guided breathing for 7 days/8 weeks. Exercise capacity [exercise stress test], cardiac function [transthoracic echocardiography], and angina severity [Canadian Cardiovascular Society Classification] were evaluated initially and after the training. Device-guided breathing was performed at the lowest resistance of the device (POWERbreathe® Classic LR) for the control group (n = 17). The low load training group (LLTG; n = 18) and high load training group (HLTG; n = 16) were trained at 30% and 50% of maximal inspiratory pressure. Baseline characteristics were compared using one-way ANOVA and Kruskal-Wallis test. Categorical data were compared using the chi-square test. ANCOVA was performed to compare changes between three groups. A p value < 0.05 was considered statistically significant. Results Metabolic equivalent values were significantly improved in both HLTG and LLTG groups (p < 0.001, p = 0.003). The Duke treadmill score significantly improved and shifted to low-risk both in the HLTG (p < 0.001) and LLTG (p < 0.001) groups. Angina severity significantly alleviated after the training in both HLTG and LLTG groups (p < 0.001, p = 0.002). Conclusions An 8-week long program of short-term respiratory muscle training provided positive gains in exercise capacity and angina severity in CCS patients with angina. The effects of long-term training programs on CCS patients should be investigated clinically because of the possibility of helping to decrease the need for invasive treatments.
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Affiliation(s)
- Oguz Akkus
- Department of Cardiology, Tayfur Ata Sokmen Faculty of Medicine
| | - Irem Huzmeli
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Hatay Mustafa Kemal University, Hatay
| | - Taner Seker
- Department of Cardiology, Adana Health Practice and Research Center, University of Health Sciences, Adana
| | - Ozkan Bekler
- Department of Cardiology, Tayfur Ata Sokmen Faculty of Medicine
| | - Fatih Sen
- Department of Cardiology, Tayfur Ata Sokmen Faculty of Medicine
| | - Onur Kaypakli
- Department of Cardiology, Tayfur Ata Sokmen Faculty of Medicine
| | - Aysel Yildiz Ozer
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Marmara University, Istanbul, Turkey
| | - Fatih Yalcin
- Department of Cardiology, Tayfur Ata Sokmen Faculty of Medicine
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4
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Kaur G, Chand S, Rai D, Baibhav B, Blankstein R, Mukherjee D, Levy P, Gulati M. Contemporary Risk Stratification of Acute Coronary Syndrome. US CARDIOLOGY REVIEW 2022. [DOI: 10.15420/usc.2022.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Chest pain is one of the most common presenting concerns of patients seeking care in the emergency department, and the underlying etiology can range from acute coronary syndrome to various other non-cardiac causes. Initial evaluation should focus on characterizing symptoms and identifying risk factors, but further risk stratification using clinical decision pathways and biomarkers (cardiac troponin) is essential. The 2021 American Heart Association/American College of Cardiology guidelines for the evaluation and diagnosis of chest pain represent the first ever guidelines for the evaluation of patients with acute chest pain. The contemporary risk stratification methods described in these guidelines allow for the identification of patient subgroups: patients who do not require further testing, patients who should proceed directly to the cath lab, and patients who will benefit from further anatomic or functional testing. In this review, we describe contemporary risk stratification methods for acute coronary syndrome and summarize the recommendations put forth by the guidelines.
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Affiliation(s)
- Gurleen Kaur
- Department of Internal Medicine, Brigham and Women’s Hospital, Boston, MA
| | - Swati Chand
- Department of Internal Medicine, Rochester General Hospital, Rochester, NY
| | - Devesh Rai
- Department of Cardiology, Sands-Constellation Heart Institute, Rochester Regional Health, Rochester, NY
| | - Bipul Baibhav
- Department of Cardiology, Sands-Constellation Heart Institute, Rochester Regional Health, Rochester, NY
| | - Ron Blankstein
- Cardiovascular Division, Brigham and Women’s Hospital, Boston, MA
| | - Debabrata Mukherjee
- Division of Cardiovascular Diseases, Texas Tech University Health Sciences Center at El Paso, El Paso, TX
| | - Phillip Levy
- Department of Emergency Medicine, Wayne State University, Detroit, MI
| | - Martha Gulati
- Department of Cardiology, Barbra Streisand Women’s Heart Center, Cedars-Sinai Smidt Heart Institute, Los Angeles, CA
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5
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Katsuragawa S, Goto A, Tsurutani Y, Fukuma S, Inoue K. No Healthcare Utilization and Death. J Gen Intern Med 2022; 37:1648-1657. [PMID: 34590212 PMCID: PMC9130427 DOI: 10.1007/s11606-021-07138-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 09/03/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND An inappropriately low frequency of healthcare utilization has been reported to be associated with poor control of chronic diseases, accelerating healthcare disparities. However, the evidence is limited regarding the association between no healthcare utilization and mortality. OBJECTIVES To examine whether individuals without healthcare utilization have the increased risks of mortality among the US general population. DESIGN Prospective cohort study PARTICIPANTS: Adults aged ≥ 20 years (n = 39,067) in the National Health and Nutrition Examination Survey (NHANES)1999-2014 linked to national mortality data through December 2015. MAIN MEASURES The exposure was the number of visits to healthcare providers during the past year (healthcare utilization): none, 1-3 times (referent), 4-9 times, or ≥ 10 times. Cox hazard regression models were employed to estimate the adjusted hazard ratios (aHR) of all-cause, cardiovascular, and cancer mortality adjusting for socio-demographic characteristics and comorbidities. KEY RESULTS During a median follow-up of 7.4 years, participants without visit over the past year showed higher risks of all-cause mortality (aHR [95% CI] = 1.16 [1.04-1.30]) and cardiovascular mortality (aHR [95% CI] = 1.62 [1.28-2.05]) than those who visited the office 1-3 times. We found no evidence of the association between no visit and cancer mortality. The association between no providers' office visit and all-cause mortality was stronger among males (aHR [95% CI] = 1.22 [1.06-1.40]) than females (aHR [95% CI] = 0.97 [0.79-1.19]; p-for-interaction = 0.01) and among uninsured individuals (aHR [95% CI] = 1.22 [0.98-1.51]) than insured individuals (aHR [95% CI] = 1.09 [0.95-1.25]; p-for-interaction = 0.04). CONCLUSION No providers' office visit over a year was associated with increased risks of all-cause and cardiovascular mortality. Further investigations are warranted to identify the underlying reasons for the elevated mortality risks due to no healthcare utilization.
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Affiliation(s)
- Sho Katsuragawa
- Endocrinology and Diabetes Center, Yokohama Rosai Hospital, Yokohama, Japan
- Department of Health Data Science, Graduate School of Data Science, Yokohama City University, Yokohama, Japan
| | - Atsushi Goto
- Department of Health Data Science, Graduate School of Data Science, Yokohama City University, Yokohama, Japan
| | - Yuya Tsurutani
- Endocrinology and Diabetes Center, Yokohama Rosai Hospital, Yokohama, Japan
| | - Shingo Fukuma
- Human Health Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Kosuke Inoue
- Department of Epidemiology, UCLA Fielding School of Public Health, 650 Charles E. Young Dr. South, Los Angeles, CA, 90095, USA.
- Department of Social Epidemiology, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
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6
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Kotajärvi J, Tolppanen AM, Hartikainen J, Miettinen H, Viljakainen M, Martikainen J, Roine RP, Lavikainen P. Correlation of the disease-specific Canadian Cardiovascular Society (CCS) classification and health-related quality of life (15D) in coronary artery disease patients. PLoS One 2022; 17:e0266101. [PMID: 35363816 PMCID: PMC8975144 DOI: 10.1371/journal.pone.0266101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 03/15/2022] [Indexed: 11/29/2022] Open
Abstract
Background Generic health-related quality of life (HRQoL) and disease-specific instruments measure HRQoL from different aspects, although generic instruments often contain dimensions that reflect common symptoms. We evaluated how the change in 15D HRQoL and Canadian Cardiovascular Society (CCS) grading of angina severity correlate among coronary artery disease patients during 12-month follow-up. Methods Altogether 1 271 patients scheduled for coronary angiography between June 2015 and February 2017 returned the 15D HRQoL and CCS questionnaires before angiography and after one-year follow-up as a part of routine clinical practice. Spearman correlations between one-year changes in the CCS and the 15D and its dimensions were evaluated. Changes in 15D were classified into 5 categories based on the reported minimal important difference (MID) for the instrument. Results Change in the CCS grade correlated moderately with the MID-based change in the 15D (r = 0.33, 95% confidence interval 0.27–0.39). Correlations between these instruments were similar in different age groups, between sexes and treatment modalities. Of the individual 15D dimensions, changes in breathing (r = 0.40) and vitality (r = 0.30) had the strongest correlations with CCS change. Conclusion The symptom-based evaluation of the change in the CCS grade may not catch the full benefit or harm of the treatment and vice versa, a generic instrument, such as 15D, likely does not fully capture change in disease-specific symptoms. Thus, generic and disease-specific instruments are complementary and should be used in conjunction.
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Affiliation(s)
- Jarno Kotajärvi
- Department of Health and Social Management, University of Eastern Finland, Kuopio, Finland
| | - Anna-Maija Tolppanen
- Kuopio Research Centre of Geriatric Care, University of Eastern Finland, Kuopio, Finland
- School of Pharmacy, University of Eastern Finland, Kuopio, Finland
| | - Juha Hartikainen
- Heart Center, Kuopio University Hospital, Kuopio, Finland
- School of Medicine, University of Eastern Finland, Kuopio, Finland
| | | | | | | | - Risto P. Roine
- Department of Health and Social Management, University of Eastern Finland, Kuopio, Finland
- Kuopio University Hospital, Kuopio, Finland
| | - Piia Lavikainen
- School of Pharmacy, University of Eastern Finland, Kuopio, Finland
- Heart Center, Kuopio University Hospital, Kuopio, Finland
- * E-mail:
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7
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Nakano S, Kohsaka S, Chikamori T, Fukushima K, Kobayashi Y, Kozuma K, Manabe S, Matsuo H, Nakamura M, Ohno T, Sawano M, Toda K, Ueda Y, Yokoi H, Gatate Y, Kasai T, Kawase Y, Matsumoto N, Mori H, Nakazato R, Niimi N, Saito Y, Shintani A, Watanabe I, Watanabe Y, Ikari Y, Jinzaki M, Kosuge M, Nakajima K, Kimura T. JCS 2022 Guideline Focused Update on Diagnosis and Treatment in Patients With Stable Coronary Artery Disease. Circ J 2022; 86:882-915. [DOI: 10.1253/circj.cj-21-1041] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Shintaro Nakano
- Cardiology, Saitama Medical University International Medical Center
| | | | | | - Kenji Fukushima
- Department of Radiology and Nuclear Medicine, Fukushima Medical University
| | | | - Ken Kozuma
- Cardiology, Teikyo University School of Medicine
| | - Susumu Manabe
- Cardiac Surgery, International University of Health and Welfare Mita Hospital
| | | | - Masato Nakamura
- Cardiovascular Medicine, Toho University Ohashi Medical Center
| | | | | | - Koichi Toda
- Cardiovascular Surgery, Osaka University Graduate School of Medicine
| | - Yasunori Ueda
- Cardiovascular Division, National Hospital Organization Osaka National Hospital
| | - Hiroyoshi Yokoi
- Cardiovascular Center, International University of Health and Welfare Fukuoka Sanno Hospital
| | - Yodo Gatate
- Cardiology, Self-Defense Forces Central Hospital
| | | | | | | | - Hitoshi Mori
- Cardiology, Saitama Medical University International Medical Center
| | | | | | - Yuichi Saito
- Cardiovascular Medicine, Chiba University School of Medicine
| | - Ayumi Shintani
- Medical Statistics, Osaka City University Graduate School of Medicine
| | - Ippei Watanabe
- Cardiovascular Medicine, Toho University School of Medicine
| | | | - Yuji Ikari
- Cardiology, Tokai University School of Medicine
| | | | | | - Kenichi Nakajima
- Functional Imaging and Artificial Intelligence, Kanazawa University
| | - Takeshi Kimura
- Cardiovascular Medicine, Kyoto University Graduate School of Medicine
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8
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Chen Q, Thompson J, Hu Y, Lesnefsky EJ. Reversing mitochondrial defects in aged hearts: role of mitochondrial calpain activation. Am J Physiol Cell Physiol 2022; 322:C296-C310. [PMID: 35044856 PMCID: PMC8836732 DOI: 10.1152/ajpcell.00279.2021] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 01/10/2022] [Accepted: 01/10/2022] [Indexed: 02/03/2023]
Abstract
Aging chronically increases endoplasmic reticulum (ER) stress that contributes to mitochondrial dysfunction. Activation of calpain 1 (CPN1) impairs mitochondrial function during acute ER stress. We proposed that aging-induced ER stress led to mitochondrial dysfunction by activating CPN1. We posit that attenuation of the ER stress or direct inhibition of CPN1 in aged hearts can decrease cardiac injury during ischemia-reperfusion by improving mitochondrial function. Male young (3 mo) and aged mice (24 mo) were used in the present study, and 4-phenylbutyrate (4-PBA) was used to decrease the ER stress in aged mice. Subsarcolemmal (SSM) and interfibrillar mitochondria (IFM) were isolated. Chronic 4-PBA treatment for 2 wk decreased CPN1 activation as shown by the decreased cleavage of spectrin in cytosol and apoptosis inducing factor (AIF) and the α1 subunit of pyruvate dehydrogenase (PDH) in mitochondria. Treatment improved oxidative phosphorylation in 24-mo-old SSM and IFM at baseline compared with vehicle. When 4-PBA-treated 24-mo-old hearts were subjected to ischemia-reperfusion, infarct size was decreased. These results support that attenuation of the ER stress decreased cardiac injury in aged hearts by improving mitochondrial function before ischemia. To challenge the role of CPN1 as an effector of the ER stress, aged mice were treated with MDL-28170 (MDL, an inhibitor of calpain 1). MDL treatment improved mitochondrial function in aged SSM and IFM. MDL-treated 24-mo-old hearts sustained less cardiac injury following ischemia-reperfusion. These results support that age-induced ER stress augments cardiac injury during ischemia-reperfusion by impairing mitochondrial function through activation of CPN1.
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Affiliation(s)
- Qun Chen
- Division of Cardiology, Department of Medicine, Virginia Commonwealth University, Richmond, Virginia
| | - Jeremy Thompson
- Division of Cardiology, Department of Medicine, Virginia Commonwealth University, Richmond, Virginia
| | - Ying Hu
- Division of Cardiology, Department of Medicine, Virginia Commonwealth University, Richmond, Virginia
| | - Edward J Lesnefsky
- Division of Cardiology, Department of Medicine, Virginia Commonwealth University, Richmond, Virginia
- Department of Biochemistry and Molecular Biology, Virginia Commonwealth University, Richmond, Virginia
- Department of Physiology and Biophysics, Virginia Commonwealth University, Richmond, Virginia
- McGuire Department of Veterans Affairs Medical Center, Richmond, Virginia
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9
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Hochstadt A, Itach T, Merdler I, Ghantous E, Ziv-Baran T, Leshno M, Banai S, Konigstein M. The Effectiveness of CS Reducer for the treatment of Refractory Angina - a Meta-Analysis. Can J Cardiol 2021; 38:376-383. [PMID: 34968714 DOI: 10.1016/j.cjca.2021.12.009] [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] [Received: 09/14/2021] [Revised: 11/25/2021] [Accepted: 12/19/2021] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Refractory angina is a debilitating condition that affects quality of life of patients worldwide, that after exhausting standard available therapies are regarded as "no option" patients. Recently, coronary sinus (CS) Reducer implantation became available and is gaining popularity in the treatment of refractory angina. The effectiveness of this therapy was demonstrated in one randomized sham-control trial and numerous uncontrolled prospective studies entailing altogether several hundred patients. We performed a meta-analysis to incorporate the data and elucidate its efficacy and safety. METHODS A meta-analysis of prospective studies assessing the effects of CS narrowing published in English until June 2021 was performed. The primary outcome was the proportion of patients improving ≥1 class in the Canadian Cardiovascular Society (CSS) angina score. Other endpoints included proportion of patients improving ≥2 CCS classes, procedural success, periprocedural complications, changes in Seattle Angina Questionnaire (SAQ) scores, and six-minute walk test (6MWT). RESULTS Data from 9 studies, including 846 patients was included. An improvement of ≥1 CSS class occurred in 76% [95% CI 73%- 80%] of patients. Improvement of ≥2 CSS classes was observed in 40% of patients (95% CI of 35-46%). Procedure success was 98%, with no major and 3% of non-major periprocedural complications. Post procedural SAQ scores and 6MWT distance were significantly improved. CONCLUSIONS In patients suffering from angina refractory to medical and interventional therapies, CS narrowing implantation improves symptoms and quality of life, with a low complication rate. These results are consistent in one randomized trial and in multiple prospective, uncontrolled studies.
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10
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Reading Turchioe M, Volodarskiy A, Pathak J, Wright DN, Tcheng JE, Slotwiner D. Systematic review of current natural language processing methods and applications in cardiology. Heart 2021; 108:909-916. [PMID: 34711662 DOI: 10.1136/heartjnl-2021-319769] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 09/29/2021] [Indexed: 01/16/2023] Open
Abstract
Natural language processing (NLP) is a set of automated methods to organise and evaluate the information contained in unstructured clinical notes, which are a rich source of real-world data from clinical care that may be used to improve outcomes and understanding of disease in cardiology. The purpose of this systematic review is to provide an understanding of NLP, review how it has been used to date within cardiology and illustrate the opportunities that this approach provides for both research and clinical care. We systematically searched six scholarly databases (ACM Digital Library, Arxiv, Embase, IEEE Explore, PubMed and Scopus) for studies published in 2015-2020 describing the development or application of NLP methods for clinical text focused on cardiac disease. Studies not published in English, lacking a description of NLP methods, non-cardiac focused and duplicates were excluded. Two independent reviewers extracted general study information, clinical details and NLP details and appraised quality using a checklist of quality indicators for NLP studies. We identified 37 studies developing and applying NLP in heart failure, imaging, coronary artery disease, electrophysiology, general cardiology and valvular heart disease. Most studies used NLP to identify patients with a specific diagnosis and extract disease severity using rule-based NLP methods. Some used NLP algorithms to predict clinical outcomes. A major limitation is the inability to aggregate findings across studies due to vastly different NLP methods, evaluation and reporting. This review reveals numerous opportunities for future NLP work in cardiology with more diverse patient samples, cardiac diseases, datasets, methods and applications.
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Affiliation(s)
- Meghan Reading Turchioe
- Department of Population Health Sciences, Division of Health Informatics, Weill Cornell Medicine, New York, New York, USA
| | - Alexander Volodarskiy
- Department of Medicine, Division of Cardiology, NewYork-Presbyterian Hospital, New York, New York, USA
| | - Jyotishman Pathak
- Department of Population Health Sciences, Division of Health Informatics, Weill Cornell Medicine, New York, New York, USA
| | - Drew N Wright
- Samuel J. Wood Library & C.V. Starr Biomedical Information Center, Weill Cornell Medical College, New York, New York, USA
| | - James Enlou Tcheng
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - David Slotwiner
- Department of Population Health Sciences, Division of Health Informatics, Weill Cornell Medicine, New York, New York, USA.,Department of Medicine, Division of Cardiology, NewYork-Presbyterian Hospital, New York, New York, USA
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11
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Huzmeli I, Ozer AY, Akkus O, Katayıfcı N, Sen F, Yurdalan SU, Polat MG. Comparison of functional exercise capacity, quality of life and respiratory and peripheral muscle strength between patients with stable angina and healthy controls. J Int Med Res 2021; 48:300060520979211. [PMID: 33334226 PMCID: PMC7750767 DOI: 10.1177/0300060520979211] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Objective We aimed to compare functional exercise capacity, respiratory and peripheral
muscle strength, pulmonary function and quality of life between patients
with stable angina and healthy controls. Methods We compared 33 patients with stable angina (55.21 ± 6.12 years old, Canada
Class II–III, left ventricular ejection fraction: 61.92 ± 7.55) and 30
healthy controls (52.70 ± 4.22 years old). Functional capacity (6-minute
walk test (6-MWT)), respiratory muscle strength (mouth pressure device),
peripheral muscle strength (dynamometer), pulmonary function (spirometer)
and quality of life (Short Form 36 (SF-36)) were evaluated. Results 6-MWT distance (499.20 ± 51.91 m versus 633.05 ± 57.62 m), maximal
inspiratory pressure (85.42 ± 20.52 cmH2O versus
110.44 ± 32.95 cmH2O), maximal expiratory pressure
(83.33 ± 19.05 cmH2O versus 147.96 ± 54.80 cmH2O)
and peripheral muscle strength, pulmonary function and SF-36 sub-scores were
lower in the angina group versus the healthy controls, respectively. Conclusion Impaired peripheral and respiratory muscle strength, reduction in exercise
capacity and quality of life are obvious in patients with stable angina.
Therefore, these parameters should be considered in stable angina
physiotherapy programmes to improve impairments.
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Affiliation(s)
- Irem Huzmeli
- Department Of Physiotherapy And Rehabilitation, Faculty of Health Sciences, Hatay Mustafa Kemal University, Hatay, Turkey
| | - Aysel-Yildiz Ozer
- Department Of Physiotherapy And Rehabilitation, Faculty of Health Sciences, Marmara University, Istanbul, Turkey
| | - Oguz Akkus
- Department Of Cardiology, Tayfur Ata Sokmen Faculty of Medicine, Hatay Mustafa Kemal University, Hatay, Turkey
| | - Nihan Katayıfcı
- Department Of Physiotherapy And Rehabilitation, Faculty of Health Sciences, Hatay Mustafa Kemal University, Hatay, Turkey
| | - Fatih Sen
- Department Of Cardiology, Tayfur Ata Sokmen Faculty of Medicine, Hatay Mustafa Kemal University, Hatay, Turkey
| | - Saadet Ufuk Yurdalan
- Department Of Physiotherapy And Rehabilitation, Faculty of Health Sciences, Marmara University, Istanbul, Turkey
| | - Mine Gulden Polat
- Department Of Physiotherapy And Rehabilitation, Faculty of Health Sciences, Marmara University, Istanbul, Turkey
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12
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Chronic metformin treatment decreases cardiac injury during ischemia-reperfusion by attenuating endoplasmic reticulum stress with improved mitochondrial function. Aging (Albany NY) 2021; 13:7828-7845. [PMID: 33746115 PMCID: PMC8034968 DOI: 10.18632/aging.202858] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 02/11/2021] [Indexed: 11/25/2022]
Abstract
Aging impairs mitochondrial function that leads to greater cardiac injury during ischemia and reperfusion. Cardiac endoplasm reticulum (ER) stress increases with age and contributes to mitochondrial dysfunction. Metformin is an anti-diabetic drug that protects cardiac mitochondria during acute ER stress. We hypothesized that metformin treatment would improve preexisting mitochondrial dysfunction in aged hearts by attenuating ER stress, followed by a decrease in cardiac injury during subsequent ischemia and reperfusion. Male young (3 mo.) and aged mice (24 mo.) received metformin (300 mg/kg/day) dissolved in drinking water with sucrose (0.2 g/100 ml) as sweetener for two weeks versus sucrose vehicle alone. Cytosol, subsarcolemmal (SSM), and interfibrillar mitochondria (IFM) were isolated. In separate groups, cardioprotection was evaluated using ex vivo isolated heart perfusion with 25 min. global ischemia and 60 min. reperfusion. Infarct size was measured. The contents of CHOP and cleaved ATF6 were decreased in metformin-treated 24 mo. mice compared to vehicle, supporting a decrease in ER stress. Metformin treatment improved OXPHOS in IFM in 24 mo. using a complex I substrate. Metformin treatment decreased infarct size following ischemia-reperfusion. Thus, metformin feeding decreased cardiac injury in aged mice during ischemia-reperfusion by improving pre-ischemic mitochondrial function via inhibition of ER stress.
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13
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Li X, Guo D, Zhou H, Hu Y, Fang X, Chen Y. Pro-inflammatory Mediators and Oxidative Stress: Therapeutic Markers for Recurrent Angina Pectoris after Coronary Artery Stenting in Elderly Patients. Curr Vasc Pharmacol 2021; 19:643-654. [PMID: 33511935 DOI: 10.2174/1570161119666210129142707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 11/19/2020] [Accepted: 01/01/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Pro-inflammatory mediators and oxidative stress are related to severity of angina pectoris in patients with coronary heart disease. OBJECTIVE We evaluated the effects of pro-inflammatory mediators and oxidative stress on recurrent angina pectoris after coronary artery stenting in elderly patients. METHODS We determined the expression levels of malondialdehyde (MDA), acrolein (ACR), tumour necrosis factor-α (TNF-α), toll-like receptor 4 (TLR4), superoxide dismutase 3 (SOD3), paraoxonase-1 (PON-1), stromal cell-derived factor-1α (SDF-1α) and endothelial progenitor cells (EPCs) in elderly patients with recurrent angina pectoris after coronary artery stenting. RESULTS Levels of MDA, ACR, TNF-α and TLR4 were significantly increased (p<0.001), and levels of SOD3, PON-1, SDF-1α and EPCs were significantly decreased (p<0.001) in the elderly patients with recurrent angina pectoris after coronary artery stenting. MDA, ACR, TNF-α and TLR4 as markers of oxidative stress and pro-inflammatory mediators may have suppressed SOD3, PON-1, SDF-1α and EPCs as markers of anti-oxidative stress/anti-inflammatory responses. Oxidative stress and pro-inflammatory mediators were important factors involved in recurrent angina pectoris of elderly patients after coronary artery stenting. CONCLUSION Oxidative stress and pro-inflammatory mediators could be considered as potential non-invasive prognostic, predictive and therapeutic biomarkers for stable recurrent angina and recurrent unstable angina in the elderly patients after coronary artery stenting.
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Affiliation(s)
- Xia Li
- Department of Geriatrics, The Affiliated Huaian Hospital of Xuzhou Medical University, Huaian 223002. China
| | - Dianxuan Guo
- Department of Geriatrics, The Affiliated Huaian Hospital of Xuzhou Medical University, Huaian 223002. China
| | - Hualan Zhou
- Department of Geriatrics, The Affiliated Huaian Hospital of Xuzhou Medical University, Huaian 223002. China
| | - Youdong Hu
- Department of Geriatrics, The Affiliated Huaian Hospital of Xuzhou Medical University, Huaian 223002. China
| | - Xiang Fang
- Department of Geriatrics, The Affiliated Huaian Hospital of Xuzhou Medical University, Huaian 223002. China
| | - Ying Chen
- Department of Geriatrics, The Affiliated Huaian Hospital of Xuzhou Medical University, Huaian 223002. China
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14
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Alaarag A, Amin O. Blood pressure variability in patients with angina and non-obstructive coronary artery disease. J Hum Hypertens 2021; 35:1074-1080. [PMID: 33414504 DOI: 10.1038/s41371-020-00475-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 11/11/2020] [Accepted: 12/09/2020] [Indexed: 11/09/2022]
Abstract
There is a real challenge in the management of ischemia with non-obstructive coronary artery disease. So, we need to study the mechanisms of persistent angina and non-obstructive coronary artery (ANOCA) patients. One of those possible mechanisms is blood pressure variability (BPV). We aimed to study the relation between BPV and angina in patients with non-obstructive coronary artery disease. Our study included 150 patients with chest pain and positive non-invasive stress test suggestive of myocardial ischemia and normal coronary angiography or non-obstructive coronary artery disease. We used an ambulatory blood pressure monitoring device. We found a positive correlation between BPV as measured by average real variability (ARV) as well as standard deviation (SD) parameters and the severity of anginal symptoms with P values for all parameters was 0.001 except day systolic SD P-value was 0.021. We performed a regression analysis for all statistically significant parameters. We found that 24H diastolic ARV, day diastolic ARV, night diastolic ARV, 24H diastolic SD, day diastolic SD, and night diastolic SD were independent predictors of the severity of angina with P-values (0.015, 0.007, 0.011, 0.037, 0.014, and 0.029), respectively. We concluded that short-term BPV represented by ARV and SD had a consistent association with angina in patients with non-obstructive coronary artery disease. The diastolic parameters of ARV and SD were independent predictors of the severity of angina with non-obstructive coronary artery disease.
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Affiliation(s)
- Ahmed Alaarag
- Department of Cardiology, Tanta University, Tanta, Egypt.
| | - Osama Amin
- Department of Cardiology, Beni-Suef University, Beni Suef, Egypt
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15
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Bradley SM. Deafening Silence: The Lack of Structured Patient Symptoms in Clinical Documentation of Angina. J Am Heart Assoc 2019; 8:e013664. [PMID: 31364491 PMCID: PMC6761635 DOI: 10.1161/jaha.119.013664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
See Article Owlia et al
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Affiliation(s)
- Steven M. Bradley
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation Minneapolis MN
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16
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Owlia M, Dodson JA, King JB, Derington CG, Herrick JS, Sedlis SP, Crook J, DuVall SL, LaFleur J, Nelson R, Patterson OV, Shah RU, Bress AP. Angina Severity, Mortality, and Healthcare Utilization Among Veterans With Stable Angina. J Am Heart Assoc 2019; 8:e012811. [PMID: 31362569 PMCID: PMC6761668 DOI: 10.1161/jaha.119.012811] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Background Canadian Cardiovascular Society (CCS) angina severity classification is associated with mortality, myocardial infarction, and coronary revascularization in clinical trial and registry data. The objective of this study was to determine associations between CCS class and all‐cause mortality and healthcare utilization, using natural language processing to extract CCS classifications from clinical notes. Methods and Results In this retrospective cohort study of veterans in the United States with stable angina from January 1, 2006, to December 31, 2013, natural language processing extracted CCS classifications. Veterans with a prior diagnosis of coronary artery disease were excluded. Outcomes included all‐cause mortality (primary), all‐cause and cardiovascular‐specific hospitalizations, coronary revascularization, and 1‐year healthcare costs. Of 299 577 veterans identified, 14 216 (4.7%) had ≥1 CCS classification extracted by natural language processing. The mean age was 66.6±9.8 years, 99% of participants were male, and 81% were white. During a median follow‐up of 3.4 years, all‐cause mortality rates were 4.58, 4.60, 6.22, and 6.83 per 100 person‐years for CCS classes I, II, III, and IV, respectively. Multivariable adjusted hazard ratios for all‐cause mortality comparing CCS II, III, and IV with those in class I were 1.05 (95% CI, 0.95–1.15), 1.33 (95% CI, 1.20–1.47), and 1.48 (95% CI, 1.25–1.76), respectively. The multivariable hazard ratio comparing CCS IV with CCS I was 1.20 (95% CI, 1.09–1.33) for all‐cause hospitalization, 1.25 (95% CI, 0.96–1.64) for acute coronary syndrome hospitalizations, 1.00 (95% CI, 0.80–1.26) for heart failure hospitalizations, 1.05 (95% CI, 0.88–1.25) for atrial fibrillation hospitalizations, 1.92 (95% CI, 1.40–2.64) for percutaneous coronary intervention, and 2.51 (95% CI, 1.99–3.16) for coronary artery bypass grafting surgery. Conclusions Natural language processing–extracted CCS classification was positively associated with all‐cause mortality and healthcare utilization, demonstrating the prognostic importance of anginal symptom assessment and documentation. See Editorial Mehta and Bradley
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Affiliation(s)
- Mina Owlia
- Leon H. Charney Division of Cardiology Department of Medicine New York University School of Medicine New York NY
| | - John A Dodson
- Leon H. Charney Division of Cardiology Department of Medicine New York University School of Medicine New York NY.,Department of Population Health New York University School of Medicine New York NY
| | - Jordan B King
- Department of Population Health Sciences University of Utah Salt Lake City UT.,Department of Pharmacy Kaiser Permanente Colorado Aurora CO.,George E. Wahlen Department of Veterans Affairs Medical Center Salt Lake City UT
| | - Catherine G Derington
- Department of Pharmacy Kaiser Permanente Colorado Aurora CO.,Department of Clinical Pharmacy University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences Aurora CO
| | - Jennifer S Herrick
- Department of Population Health Sciences University of Utah Salt Lake City UT
| | - Steven P Sedlis
- Leon H. Charney Division of Cardiology Department of Medicine New York University School of Medicine New York NY.,Cardiology Section Veterans Affairs Medical Center Manhattan NY
| | - Jacob Crook
- Department of Internal Medicine University of Utah Salt Lake City UT.,George E. Wahlen Department of Veterans Affairs Medical Center Salt Lake City UT
| | - Scott L DuVall
- Department of Internal Medicine University of Utah Salt Lake City UT.,George E. Wahlen Department of Veterans Affairs Medical Center Salt Lake City UT
| | - Joanne LaFleur
- Department of Pharmacotherapy University of Utah Salt Lake City UT.,George E. Wahlen Department of Veterans Affairs Medical Center Salt Lake City UT
| | - Richard Nelson
- Department of Internal Medicine University of Utah Salt Lake City UT.,George E. Wahlen Department of Veterans Affairs Medical Center Salt Lake City UT
| | - Olga V Patterson
- Department of Internal Medicine University of Utah Salt Lake City UT.,George E. Wahlen Department of Veterans Affairs Medical Center Salt Lake City UT
| | - Rashmee U Shah
- Department of Internal Medicine University of Utah Salt Lake City UT
| | - Adam P Bress
- Department of Population Health Sciences University of Utah Salt Lake City UT.,Department of Internal Medicine University of Utah Salt Lake City UT.,George E. Wahlen Department of Veterans Affairs Medical Center Salt Lake City UT
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