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Wu J, Biswas D, Ryan M, Bernstein BS, Rizvi M, Fairhurst N, Kaye G, Baral R, Searle T, Melikian N, Sado D, Lüscher TF, Grocott-Mason R, Carr-White G, Teo J, Dobson R, Bromage DI, McDonagh TA, Shah AM, O'Gallagher K. Artificial intelligence methods for improved detection of undiagnosed heart failure with preserved ejection fraction. Eur J Heart Fail 2024; 26:302-310. [PMID: 38152863 DOI: 10.1002/ejhf.3115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 10/20/2023] [Accepted: 12/07/2023] [Indexed: 12/29/2023] Open
Abstract
AIM Heart failure with preserved ejection fraction (HFpEF) remains under-diagnosed in clinical practice despite accounting for nearly half of all heart failure (HF) cases. Accurate and timely diagnosis of HFpEF is crucial for proper patient management and treatment. In this study, we explored the potential of natural language processing (NLP) to improve the detection and diagnosis of HFpEF according to the European Society of Cardiology (ESC) diagnostic criteria. METHODS AND RESULTS In a retrospective cohort study, we used an NLP pipeline applied to the electronic health record (EHR) to identify patients with a clinical diagnosis of HF between 2010 and 2022. We collected demographic, clinical, echocardiographic and outcome data from the EHR. Patients were categorized according to the left ventricular ejection fraction (LVEF). Those with LVEF ≥50% were further categorized based on whether they had a clinician-assigned diagnosis of HFpEF and if not, whether they met the ESC diagnostic criteria. Results were validated in a second, independent centre. We identified 8606 patients with HF. Of 3727 consecutive patients with HF and LVEF ≥50% on echocardiogram, only 8.3% had a clinician-assigned diagnosis of HFpEF, while 75.4% met ESC criteria but did not have a formal diagnosis of HFpEF. Patients with confirmed HFpEF were hospitalized more frequently; however the ESC criteria group had a higher 5-year mortality, despite being less comorbid and experiencing fewer acute cardiovascular events. CONCLUSIONS This study demonstrates that patients with undiagnosed HFpEF are an at-risk group with high mortality. It is possible to use NLP methods to identify likely HFpEF patients from EHR data who would likely then benefit from expert clinical review and complement the use of diagnostic algorithms.
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Affiliation(s)
- Jack Wu
- School of Cardiovascular and Metabolic Medicine & Sciences, British Heart Foundation Centre of Research Excellence, King's College London, London, UK
| | - Dhruva Biswas
- School of Cardiovascular and Metabolic Medicine & Sciences, British Heart Foundation Centre of Research Excellence, King's College London, London, UK
- King's College Hospital NHS Foundation Trust, London, UK
| | - Matthew Ryan
- School of Cardiovascular and Metabolic Medicine & Sciences, British Heart Foundation Centre of Research Excellence, King's College London, London, UK
- King's College Hospital NHS Foundation Trust, London, UK
| | - Brett S Bernstein
- School of Cardiovascular and Metabolic Medicine & Sciences, British Heart Foundation Centre of Research Excellence, King's College London, London, UK
- King's College Hospital NHS Foundation Trust, London, UK
| | - Maleeha Rizvi
- School of Cardiovascular and Metabolic Medicine & Sciences, British Heart Foundation Centre of Research Excellence, King's College London, London, UK
- Guy's and St Thomas' Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | | | - George Kaye
- King's College Hospital NHS Foundation Trust, London, UK
| | - Ranu Baral
- King's College Hospital NHS Foundation Trust, London, UK
| | - Tom Searle
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Narbeh Melikian
- School of Cardiovascular and Metabolic Medicine & Sciences, British Heart Foundation Centre of Research Excellence, King's College London, London, UK
- King's College Hospital NHS Foundation Trust, London, UK
| | - Daniel Sado
- School of Cardiovascular and Metabolic Medicine & Sciences, British Heart Foundation Centre of Research Excellence, King's College London, London, UK
- King's College Hospital NHS Foundation Trust, London, UK
| | - Thomas F Lüscher
- Royal Brompton and Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Richard Grocott-Mason
- Royal Brompton and Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Gerald Carr-White
- Guy's and St Thomas' Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - James Teo
- King's College Hospital NHS Foundation Trust, London, UK
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Richard Dobson
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Daniel I Bromage
- School of Cardiovascular and Metabolic Medicine & Sciences, British Heart Foundation Centre of Research Excellence, King's College London, London, UK
- King's College Hospital NHS Foundation Trust, London, UK
| | - Theresa A McDonagh
- School of Cardiovascular and Metabolic Medicine & Sciences, British Heart Foundation Centre of Research Excellence, King's College London, London, UK
- King's College Hospital NHS Foundation Trust, London, UK
| | - Ajay M Shah
- School of Cardiovascular and Metabolic Medicine & Sciences, British Heart Foundation Centre of Research Excellence, King's College London, London, UK
- King's College Hospital NHS Foundation Trust, London, UK
| | - Kevin O'Gallagher
- School of Cardiovascular and Metabolic Medicine & Sciences, British Heart Foundation Centre of Research Excellence, King's College London, London, UK
- King's College Hospital NHS Foundation Trust, London, UK
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2
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Cannata A, Bromage DI, McDonagh TA. When observation meets randomization: 'Don't let a crisis go to waste'. Eur J Heart Fail 2023; 25:2189-2190. [PMID: 37953719 DOI: 10.1002/ejhf.3089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 11/08/2023] [Indexed: 11/14/2023] Open
Affiliation(s)
- Antonio Cannata
- School of Cardiovascular Medicine & Sciences, King's College London British Heart Foundation Centre of Excellence, London, UK
- Department of Cardiology, King's College Hospital NHS Foundation Trust, London, UK
| | - Daniel I Bromage
- School of Cardiovascular Medicine & Sciences, King's College London British Heart Foundation Centre of Excellence, London, UK
- Department of Cardiology, King's College Hospital NHS Foundation Trust, London, UK
| | - Theresa A McDonagh
- School of Cardiovascular Medicine & Sciences, King's College London British Heart Foundation Centre of Excellence, London, UK
- Department of Cardiology, King's College Hospital NHS Foundation Trust, London, UK
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Crisci G, Bobbio E, Gentile P, Bromage DI, Bollano E, Ferone E, Israr MZ, Heaney LM, Polte CL, Cannatà A, Salzano A. Biomarkers in Acute Myocarditis and Chronic Inflammatory Cardiomyopathy: An Updated Review of the Literature. J Clin Med 2023; 12:7214. [PMID: 38068265 PMCID: PMC10706911 DOI: 10.3390/jcm12237214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Revised: 11/10/2023] [Accepted: 11/17/2023] [Indexed: 02/15/2024] Open
Abstract
Myocarditis is a disease caused by cardiac inflammation that can progress to dilated cardiomyopathy, heart failure, and eventually death. Several etiologies, including autoimmune, drug-induced, and infectious, lead to inflammation, which causes damage to the myocardium, followed by remodeling and fibrosis. Although there has been an increasing understanding of pathophysiology, early and accurate diagnosis, and effective treatment remain challenging due to the high heterogeneity. As a result, many patients have poor prognosis, with those surviving at risk of long-term sequelae. Current diagnostic methods, including imaging and endomyocardial biopsy, are, at times, expensive, invasive, and not always performed early enough to affect disease progression. Therefore, the identification of accurate, cost-effective, and prognostically informative biomarkers is critical for screening and treatment. The review then focuses on the biomarkers currently associated with these conditions, which have been extensively studied via blood tests and imaging techniques. The information within this review was retrieved through extensive literature research conducted on major publicly accessible databases and has been collated and revised by an international panel of experts. The biomarkers discussed in the article have shown great promise in clinical research studies and provide clinicians with essential tools for early diagnosis and improved outcomes.
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Affiliation(s)
- Giulia Crisci
- Department of Translational Medical Sciences, Federico II University, 80131 Naples, Italy;
- Italian Clinical Outcome Research and Reporting Program (I-CORRP), 80131 Naples, Italy
| | - Emanuele Bobbio
- Department of Cardiology, Sahlgrenska University Hospital, 41345 Gothenburg, Sweden; (E.B.); (E.B.)
- Institute of Medicine, The Sahlgrenska Academy at the University of Gothenburg, 41390 Gothenburg, Sweden;
| | - Piero Gentile
- De Gasperis Cardio Center, Niguarda Hospital, 20162 Milan, Italy;
| | - Daniel I. Bromage
- Department of Cardiology, King’s College Hospital NHS Foundation Trust, Denmark Hill, London SE5 9RS, UK; (D.I.B.); (E.F.)
- Department of Cardiovascular Sciences, Faculty of Life Sciences & Medicine, King’s College London, London SE5 8AF, UK
| | - Entela Bollano
- Department of Cardiology, Sahlgrenska University Hospital, 41345 Gothenburg, Sweden; (E.B.); (E.B.)
- Institute of Medicine, The Sahlgrenska Academy at the University of Gothenburg, 41390 Gothenburg, Sweden;
| | - Emma Ferone
- Department of Cardiology, King’s College Hospital NHS Foundation Trust, Denmark Hill, London SE5 9RS, UK; (D.I.B.); (E.F.)
- Department of Cardiovascular Sciences, Faculty of Life Sciences & Medicine, King’s College London, London SE5 8AF, UK
| | - Muhammad Zubair Israr
- Department of Cardiovascular Sciences, University of Leicester and NIHR Leicester Biomedical Research Centre, Groby Road, Leicester LE3 9QP, UK;
| | - Liam M. Heaney
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough LE11 3TU, UK;
| | - Christian L. Polte
- Institute of Medicine, The Sahlgrenska Academy at the University of Gothenburg, 41390 Gothenburg, Sweden;
- Department of Clinical Physiology, Sahlgrenska University Hospital, 41345 Gothenburg, Sweden
| | - Antonio Cannatà
- Department of Cardiology, King’s College Hospital NHS Foundation Trust, Denmark Hill, London SE5 9RS, UK; (D.I.B.); (E.F.)
- Department of Cardiovascular Sciences, Faculty of Life Sciences & Medicine, King’s College London, London SE5 8AF, UK
| | - Andrea Salzano
- Department of Cardiovascular Sciences, University of Leicester and NIHR Leicester Biomedical Research Centre, Groby Road, Leicester LE3 9QP, UK;
- Cardiology Unit, AORN A Cardarelli, 80131 Naples, Italy
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Roy R, Cannata A, Al-Agil M, Ferone E, Jordan A, To-Dang B, Sadler M, Shamsi A, Albarjas M, Piper S, Giacca M, Shah AM, McDonagh T, Bromage DI, Scott PA. Diagnostic accuracy, clinical characteristics, and prognostic differences of patients with acute myocarditis according to inclusion criteria. European Heart Journal - Quality of Care and Clinical Outcomes 2023:qcad061. [PMID: 37930743 DOI: 10.1093/ehjqcco/qcad061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2023]
Abstract
INTRODUCTION The diagnosis of acute myocarditis (AM) is complex due to its heterogeneity and typically is defined by either Electronic Healthcare Records (EHRs) or advanced imaging and endomyocardial biopsy, but there is no consensus. We aimed to investigate the diagnostic accuracy of these approaches for AM. METHODS Data on ICD 10th Revision(ICD-10) codes corresponding to AM were collected from two hospitals and compared to CMR-confirmed or clinically suspected(CS) AM cases with respect to diagnostic accuracy, clinical characteristics, and all-cause mortality. Next, we performed a review of published AM studies according to inclusion criteria. RESULTS We identified 291 unique admissions with ICD-10 codes corresponding to AM in the first three diagnostic positions. The positive predictive value(PPV) of ICD-10 codes for CMR-confirmed or CS-AM was 36%, and patients with CMR-confirmed or CS AM had a lower all-cause mortality than those with a refuted diagnosis (P = 0.019). Using an unstructured approach, patients with CMR-confirmed and CS AM had similar demographics, comorbidity profiles and survival over a median follow-up of 52 months (P = 0.72). Our review of the literature confirmed our findings. Outcomes for patients included in studies using CMR-confirmed criteria were favourable compared to studies with EMB-confirmed AM cases. CONCLUSION ICD-10 codes have poor accuracy in identification of AM cases and should be used with caution in clinical research. There are important differences in management and outcomes of patients according to the selection criteria used to diagnose AM. Potential selection biases must be considered when interpreting AM cohorts and requires standardisation of inclusion criteria for AM studies.
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Affiliation(s)
- Roman Roy
- King's College London British Heart Foundation Centre of Excellence, School of Cardiovascular Medicine & Sciences, London, UK
- King's College Hospital NHS Foundation Trust, London, UK
| | - Antonio Cannata
- King's College London British Heart Foundation Centre of Excellence, School of Cardiovascular Medicine & Sciences, London, UK
- King's College Hospital NHS Foundation Trust, London, UK
| | | | - Emma Ferone
- King's College London British Heart Foundation Centre of Excellence, School of Cardiovascular Medicine & Sciences, London, UK
| | - Antonio Jordan
- King's College Hospital NHS Foundation Trust, London, UK
| | - Brian To-Dang
- King's College Hospital NHS Foundation Trust, London, UK
| | - Matthew Sadler
- King's College London British Heart Foundation Centre of Excellence, School of Cardiovascular Medicine & Sciences, London, UK
- King's College Hospital NHS Foundation Trust, London, UK
| | - Aamir Shamsi
- King's College Hospital NHS Foundation Trust, London, UK
| | | | - Susan Piper
- King's College Hospital NHS Foundation Trust, London, UK
| | - Mauro Giacca
- King's College London British Heart Foundation Centre of Excellence, School of Cardiovascular Medicine & Sciences, London, UK
| | - Ajay M Shah
- King's College London British Heart Foundation Centre of Excellence, School of Cardiovascular Medicine & Sciences, London, UK
| | | | - Daniel I Bromage
- King's College London British Heart Foundation Centre of Excellence, School of Cardiovascular Medicine & Sciences, London, UK
- King's College Hospital NHS Foundation Trust, London, UK
| | - Paul A Scott
- King's College Hospital NHS Foundation Trust, London, UK
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5
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Cannata A, Badawy L, Anyu AT, Samways J, Sweeney M, Jordan‐Rios A, Zakeri R, Scott PA, Piper S, Plymen CM, McDonagh TA, Bromage DI. The prognostic impact of specialist cardiology input in patients admitted for heart failure and normal ejection fraction. ESC Heart Fail 2023; 10:2648-2655. [PMID: 37357540 PMCID: PMC10375143 DOI: 10.1002/ehf2.14440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 05/06/2023] [Accepted: 05/23/2023] [Indexed: 06/27/2023] Open
Abstract
AIMS Specialist cardiology care is associated with a prognostic benefit in patients with heart failure (HF) with reduced ejection fraction (HFrEF) admitted with decompensated HF. However, up to one third of patients admitted with HF and normal ejection fraction (HFnEF) do not receive specialist cardiology input. Whether this has prognostic implications is unknown. METHODS AND RESULTS Data on patients hospitalized with HFnEF from two tertiary centres were analysed. The primary outcome measure was all-cause mortality during follow-up. The secondary outcome was in-hospital mortality. A total of 1413 patients were included in the study. Of these, 23% (n = 322) did not receive in-hospital specialist cardiology input. Patients seen by a cardiologist were less likely to have hypertension (73% vs. 79%, P = 0.03) and respiratory co-morbidities (25% vs. 31%, P = 0.02) compared with those who did not receive specialist input. Similarly, clinical presentation was more severe for those who received specialist input (New York Heart Association III/IV 83% vs. 75% respectively, P = 0.003; moderate-to-severe peripheral oedema 65% vs. 54%, P < 0.001). Medical management was similar, except for a higher use of diuretics (90% vs. 86%, P = 0.04) and a longer length of stay for patients who received specialist input (9 vs. 4 days, P < 0.001). Long-term outcomes were comparable between patients who received specialist input and those who did not. However, specialist input was independently associated with lower in-hospital mortality (hazard ratio 0.19, confidence interval 0.09-0.43, P < 0.001). CONCLUSIONS In-hospital cardiology specialist input has no long-term prognostic advantage in patients with HFnEF but is independently associated with reduced in-hospital mortality.
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Affiliation(s)
- Antonio Cannata
- Department of CardiologyKing's College Hospital LondonLondonUK
- School of Cardiovascular Medicine and SciencesKing's College London British Heart Foundation Centre of ExcellenceLondonUK
| | - Layla Badawy
- Department of CardiologyKing's College Hospital LondonLondonUK
| | | | - Jack Samways
- Department of Cardiology, Hammersmith HospitalImperial College Healthcare NHS TrustLondonUK
| | - Mark Sweeney
- Department of Cardiology, Hammersmith HospitalImperial College Healthcare NHS TrustLondonUK
| | | | - Rosita Zakeri
- Department of CardiologyKing's College Hospital LondonLondonUK
- School of Cardiovascular Medicine and SciencesKing's College London British Heart Foundation Centre of ExcellenceLondonUK
| | - Paul A. Scott
- Department of CardiologyKing's College Hospital LondonLondonUK
| | - Susan Piper
- Department of CardiologyKing's College Hospital LondonLondonUK
| | - Carla M. Plymen
- Department of Cardiology, Hammersmith HospitalImperial College Healthcare NHS TrustLondonUK
| | - Theresa A. McDonagh
- Department of CardiologyKing's College Hospital LondonLondonUK
- School of Cardiovascular Medicine and SciencesKing's College London British Heart Foundation Centre of ExcellenceLondonUK
| | - Daniel I. Bromage
- Department of CardiologyKing's College Hospital LondonLondonUK
- School of Cardiovascular Medicine and SciencesKing's College London British Heart Foundation Centre of ExcellenceLondonUK
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Abstract
PURPOSE OF REVIEW Heart failure (HF) is commonly associated with iron deficiency (ID), defined as insufficient levels of iron to meet physiological demands. ID's association with anaemia is well understood but it is increasingly recognised as an important comorbidity in HF, even in the absence of anaemia. This review summarises contemporary evidence for the measurement and treatment of ID, in both HFrEF and HFpEF, and specific HF aetiologies, and highlights important gaps in the evidence-base. RECENT FINDINGS ID is common among patients with HF and associated with increased morbidity and mortality. Correcting ID in patients with HF can impact upon functional status, exercise tolerance, symptoms, and overall quality of life, irrespective of anaemia status. ID is a modifiable comorbidity in HF. Therefore, recognising and treating ID has emerging therapeutic potential and is important for all clinicians who care for patients with HF to understand the rationale and approach to treatment.
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Affiliation(s)
- Aamir Shamsi
- Department of Cardiology, King's College Hospital London, Denmark Hill, Brixton, London, SE5 9RS, UK
| | - Antonio Cannata
- Department of Cardiology, King's College Hospital London, Denmark Hill, Brixton, London, SE5 9RS, UK
- School of Cardiovascular Medicine and Sciences, King's College London British Heart Foundation Centre of Excellence, James Black Centre, 125 Coldharbour Lane, London, SE5 9NU, UK
| | - Susan Piper
- Department of Cardiology, King's College Hospital London, Denmark Hill, Brixton, London, SE5 9RS, UK
| | - Daniel I Bromage
- Department of Cardiology, King's College Hospital London, Denmark Hill, Brixton, London, SE5 9RS, UK
- School of Cardiovascular Medicine and Sciences, King's College London British Heart Foundation Centre of Excellence, James Black Centre, 125 Coldharbour Lane, London, SE5 9NU, UK
| | - Theresa A McDonagh
- Department of Cardiology, King's College Hospital London, Denmark Hill, Brixton, London, SE5 9RS, UK.
- School of Cardiovascular Medicine and Sciences, King's College London British Heart Foundation Centre of Excellence, James Black Centre, 125 Coldharbour Lane, London, SE5 9NU, UK.
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Khan P, Selvarajah K, Gohel S, Sidhu BS, Cannatà A, Bromage DI, McDonagh T, Murgatroyd F, Scott PA. Syncope in ICD recipients: a single centre experience. Europace 2023; 25:940-947. [PMID: 36638366 PMCID: PMC10062314 DOI: 10.1093/europace/euac281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 12/22/2022] [Indexed: 01/15/2023] Open
Abstract
AIMS There is little evidence of the impact of syncope in implantable cardioverter-defibrillator (ICD) patients in routine community hospital care. This single-centre retrospective study sought to evaluate the incidence and prognostic significance of syncope in consecutive ICD patients. METHODS AND RESULTS Data were collected on consecutive patients undergoing first ICD implantation between January 2009 and December 2019. The primary endpoints were the first occurrence of all-cause syncope, all-cause mortality, and all-cause hospitalization. Multivariate Cox proportional hazard models were used to identify risk factors associated with syncope and to analyse the subsequent risk of mortality and hospitalization. 1003 patients (58% primary prevention) were included in the final analysis. During a mean follow-up of 1519 ± 1055 days, 106 (10.6%) experienced syncope, 304 died (30.3%), and 477 (47.5%) were hospitalized for any cause. In an analysis adjusted for baseline variables, the first occurrence of syncope was associated with a significantly increased risk of mortality (HR 2.82, P < 0.001) and the first occurrence of hospitalization (HR 2.46, P = 0.002). CONCLUSION Syncope in ICD recipients is common and associated with a poor prognosis irrespective of baseline variables and ICD programming. The occurrence of syncope is associated with a significant increase in the risk of mortality and hospitalization.
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Affiliation(s)
- Parisha Khan
- Department of Cardiology, King's College Hospital NHS Foundation Trust, Denmark Hill, London SE5 9RS, UK
| | - Karshana Selvarajah
- Department of Cardiology, King's College Hospital NHS Foundation Trust, Denmark Hill, London SE5 9RS, UK
| | - Sheena Gohel
- Department of Cardiology, King's College Hospital NHS Foundation Trust, Denmark Hill, London SE5 9RS, UK
| | - Baldeep S Sidhu
- Department of Cardiology, King's College Hospital NHS Foundation Trust, Denmark Hill, London SE5 9RS, UK
| | - Antonio Cannatà
- Department of Cardiology, King's College Hospital NHS Foundation Trust, Denmark Hill, London SE5 9RS, UK
- School of Cardiovascular Medicine and Sciences, King’s College London, James Black Centre, London SE5 9NU, UK
| | - Daniel I Bromage
- Department of Cardiology, King's College Hospital NHS Foundation Trust, Denmark Hill, London SE5 9RS, UK
- School of Cardiovascular Medicine and Sciences, King’s College London, James Black Centre, London SE5 9NU, UK
| | - Theresa McDonagh
- Department of Cardiology, King's College Hospital NHS Foundation Trust, Denmark Hill, London SE5 9RS, UK
- School of Cardiovascular Medicine and Sciences, King’s College London, James Black Centre, London SE5 9NU, UK
| | - Francis Murgatroyd
- Department of Cardiology, King's College Hospital NHS Foundation Trust, Denmark Hill, London SE5 9RS, UK
| | - Paul A Scott
- Department of Cardiology, King's College Hospital NHS Foundation Trust, Denmark Hill, London SE5 9RS, UK
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Jordan-Rios A, Nuzzi V, Bromage DI, McDonagh T, Sinagra G, Cannata A. Reshaping care in the aftermath of the pandemic. Implications for cardiology health systems. Eur J Intern Med 2023; 109:4-11. [PMID: 36462964 PMCID: PMC9709614 DOI: 10.1016/j.ejim.2022.11.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 10/12/2022] [Accepted: 11/23/2022] [Indexed: 12/02/2022]
Abstract
In the last two years, the COVID-19 pandemic has undeniably changed everyday life and significantly reshaped the healthcare systems. Besides the direct effect on daily care leading to significant excess mortality, several collateral damages have been observed during the pandemic. The impact of the pandemic led to staff shortages, disrupted education, worse healthcare professional well-being, and a lack of proper clinical training and research. In this review we highlight the results of these important changes and how can the healthcare systems can adapt to prevent unprecedented events in case of future catastrophes.
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Affiliation(s)
- Antonio Jordan-Rios
- Department of Cardiovascular Science, Faculty of Life Science and Medicine, King's College London, 125 Coldharbour lane, London SE5 9RS, UK
| | - Vincenzo Nuzzi
- Cardiothoracovascular Department, Azienda Sanitaria Universitaria Integrata Giuliano Isontina (ASUGI), University of Trieste, Trieste, Italy
| | - Daniel I Bromage
- Department of Cardiovascular Science, Faculty of Life Science and Medicine, King's College London, 125 Coldharbour lane, London SE5 9RS, UK
| | - Theresa McDonagh
- Department of Cardiovascular Science, Faculty of Life Science and Medicine, King's College London, 125 Coldharbour lane, London SE5 9RS, UK
| | - Gianfranco Sinagra
- Cardiothoracovascular Department, Azienda Sanitaria Universitaria Integrata Giuliano Isontina (ASUGI), University of Trieste, Trieste, Italy
| | - Antonio Cannata
- Department of Cardiovascular Science, Faculty of Life Science and Medicine, King's College London, 125 Coldharbour lane, London SE5 9RS, UK; Cardiothoracovascular Department, Azienda Sanitaria Universitaria Integrata Giuliano Isontina (ASUGI), University of Trieste, Trieste, Italy.
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McDonagh TA, Bromage DI, Cannata A. Intravenous iron passes another endurance test in heart failure. Lancet 2022; 400:2158-2159. [PMID: 36347266 DOI: 10.1016/s0140-6736(22)02180-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 11/01/2022] [Indexed: 11/06/2022]
Affiliation(s)
- Theresa A McDonagh
- King's College Hospital and School of Cardiovascular Sciences, King's College London, London WC2R 2LS, UK.
| | - Daniel I Bromage
- King's College Hospital and School of Cardiovascular Sciences, King's College London, London WC2R 2LS, UK
| | - Antonio Cannata
- King's College Hospital and School of Cardiovascular Sciences, King's College London, London WC2R 2LS, UK
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Nuzzi V, Cannatà A, Pellicori P, Manca P, Stolfo D, Gregorio C, Barbati G, Bromage DI, Mcdonagh T, Cleland JG, Merlo M, Sinagra G. 115 DIURETIC DOSE TRAJECTORIES IN DILATED CARDIOMYOPATHY: PROGNOSTIC IMPLICATIONS. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartjsupp/suac121.639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Abstract
Background
For patients with heart failure, prescription of loop diuretics (LD) and higher doses are associated with adverse prognosis. We investigated LD dose trajectories and their associations with outcomes in patients with dilated cardiomyopathy (DCM).
Methods
Associations between outcomes and both furosemide equivalent dose (FED) at enrolment and change in FED in the subsequent 24 months were evaluated. According to FED trajectory, patients were divided in i) dose↑ (FED increase by ≥50% or newly initiated); ii) dose↓ (FED decrease by ≥50%); iii) stable dose (change in FED by <50%); iv) never-users. Primary outcome was all-cause-death/heart transplantation/ventricular-assist-device/heart failure hospitalization. Secondary outcome was all-cause-death/heart transplantation/ventricular-assist-device.
Results
Of 1,131 patients enrolled, 738 (65%) were prescribed LD at baseline. Baseline FED was independently associated with outcome (HR per 20mg increase: 1.12 [95% CI 1.04-1.22, p=0.003]. Of the 908 with information on FED within 24 months from enrolment, 31% were never-users; 29% dose↓; 26% stable dose and 14% dose↑. In adjusted models, compared to never-users, stable dose had a higher risk of primary outcome (HR 2.42 [95% CI: 1.19-4.93], p=0.015), while dose↑ had the worst prognosis (HR 2.76 [95% C.I. 1.27-6.03], p=0.011). The results were consistent for the secondary outcome. Compared to patients who remained on LD, discontinuation of LD (143, 24%) was associated with improved outcome (HR 0.43 [95% C.I. 0.28-0.65], p<0.001).
Conclusions
In a large cohort of patients with DCM, LD use and increasing FED are powerful markers of adverse outcomes. Patients who never require LD have an excellent prognosis.
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Affiliation(s)
- Vincenzo Nuzzi
- Azienda Sanitaria Giuliano-Isontina, Dipartimento Cardiotoracovascolare, Università Di Trieste
| | - Antonio Cannatà
- Azienda Sanitaria Giuliano-Isontina, Dipartimento Cardiotoracovascolare, Università Di Trieste
| | | | - Paolo Manca
- Azienda Sanitaria Giuliano-Isontina, Dipartimento Cardiotoracovascolare, Università Di Trieste
| | - Davide Stolfo
- Azienda Sanitaria Giuliano-Isontina, Dipartimento Cardiotoracovascolare, Università Di Trieste
| | - Caterina Gregorio
- Azienda Sanitaria Giuliano-Isontina, Dipartimento Cardiotoracovascolare, Università Di Trieste
| | - Giulia Barbati
- Azienda Sanitaria Giuliano-Isontina, Dipartimento Cardiotoracovascolare, Università Di Trieste
| | | | | | | | - Marco Merlo
- Azienda Sanitaria Giuliano-Isontina, Dipartimento Cardiotoracovascolare, Università Di Trieste
| | - Gianfranco Sinagra
- Azienda Sanitaria Giuliano-Isontina, Dipartimento Cardiotoracovascolare, Università Di Trieste
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11
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Cannata A, Bhatti P, Roy R, Al-Agil M, Daniel A, Ferone E, Jordan A, Cassimon B, Bradwell S, Khawaja A, Sadler M, Shamsi A, Huntington J, Birkinshaw A, Rind I, Rosmini S, Piper S, Sado D, Giacca M, Shah AM, McDonagh T, Scott PA, Bromage DI. Prognostic relevance of demographic factors in cardiac magnetic resonance-proven acute myocarditis: A cohort study. Front Cardiovasc Med 2022; 9:1037837. [PMID: 36312271 PMCID: PMC9606774 DOI: 10.3389/fcvm.2022.1037837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 09/28/2022] [Indexed: 11/15/2022] Open
Abstract
Aim Acute myocarditis (AM) is a heterogeneous condition with variable estimates of survival. Contemporary criteria for the diagnosis of clinically suspected AM enable non-invasive assessment, resulting in greater sensitivity and more representative cohorts. We aimed to describe the demographic characteristics and long-term outcomes of patients with AM diagnosed using non-invasive criteria. Methods and results A total of 199 patients with cardiac magnetic resonance (CMR)-confirmed AM were included. The majority (n = 130, 65%) were male, and the average age was 39 ± 16 years. Half of the patients were White (n = 99, 52%), with the remainder from Black and Minority Ethnic (BAME) groups. The most common clinical presentation was chest pain (n = 156, 78%), with smaller numbers presenting with breathlessness (n = 25, 13%) and arrhythmias (n = 18, 9%). Patients admitted with breathlessness were sicker and more often required inotropes, steroids, and renal replacement therapy (p < 0.001, p < 0.001, and p = 0.01, respectively). Over a median follow-up of 53 (IQR 34-76) months, 11 patients (6%) experienced an adverse outcome, defined as a composite of all-cause mortality, resuscitated cardiac arrest, and appropriate implantable cardioverter defibrillator (ICD) therapy. Patients in the arrhythmia group had a worse prognosis, with a nearly sevenfold risk of adverse events [hazard ratio (HR) 6.97; 95% confidence interval (CI) 1.87-26.00, p = 0.004]. Sex and ethnicity were not significantly associated with the outcome. Conclusion AM is highly heterogeneous with an overall favourable prognosis. Three-quarters of patients with AM present with chest pain, which is associated with a benign prognosis. AM presenting with life-threatening arrhythmias is associated with a higher risk of adverse events.
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Affiliation(s)
- Antonio Cannata
- British Heart Foundation Centre of Research Excellence, School of Cardiovascular Medicine and Sciences, King’s College London, London, United Kingdom
- King’s College Hospital NHS Foundation Trust, London, United Kingdom
| | - Prashan Bhatti
- King’s College Hospital NHS Foundation Trust, London, United Kingdom
| | - Roman Roy
- British Heart Foundation Centre of Research Excellence, School of Cardiovascular Medicine and Sciences, King’s College London, London, United Kingdom
- King’s College Hospital NHS Foundation Trust, London, United Kingdom
| | - Mohammad Al-Agil
- King’s College Hospital NHS Foundation Trust, London, United Kingdom
| | - Allen Daniel
- King’s College Hospital NHS Foundation Trust, London, United Kingdom
| | - Emma Ferone
- British Heart Foundation Centre of Research Excellence, School of Cardiovascular Medicine and Sciences, King’s College London, London, United Kingdom
| | - Antonio Jordan
- King’s College Hospital NHS Foundation Trust, London, United Kingdom
| | - Barbara Cassimon
- King’s College Hospital NHS Foundation Trust, London, United Kingdom
| | - Susie Bradwell
- King’s College Hospital NHS Foundation Trust, London, United Kingdom
| | - Abdullah Khawaja
- King’s College Hospital NHS Foundation Trust, London, United Kingdom
| | - Matthew Sadler
- King’s College Hospital NHS Foundation Trust, London, United Kingdom
| | - Aamir Shamsi
- King’s College Hospital NHS Foundation Trust, London, United Kingdom
| | - Josef Huntington
- British Heart Foundation Centre of Research Excellence, School of Cardiovascular Medicine and Sciences, King’s College London, London, United Kingdom
| | | | - Irfan Rind
- King’s College Hospital NHS Foundation Trust, London, United Kingdom
| | - Stefania Rosmini
- King’s College Hospital NHS Foundation Trust, London, United Kingdom
| | - Susan Piper
- King’s College Hospital NHS Foundation Trust, London, United Kingdom
| | - Daniel Sado
- King’s College Hospital NHS Foundation Trust, London, United Kingdom
| | - Mauro Giacca
- British Heart Foundation Centre of Research Excellence, School of Cardiovascular Medicine and Sciences, King’s College London, London, United Kingdom
| | - Ajay M. Shah
- British Heart Foundation Centre of Research Excellence, School of Cardiovascular Medicine and Sciences, King’s College London, London, United Kingdom
| | - Theresa McDonagh
- King’s College Hospital NHS Foundation Trust, London, United Kingdom
| | - Paul A. Scott
- King’s College Hospital NHS Foundation Trust, London, United Kingdom
| | - Daniel I. Bromage
- British Heart Foundation Centre of Research Excellence, School of Cardiovascular Medicine and Sciences, King’s College London, London, United Kingdom
- King’s College Hospital NHS Foundation Trust, London, United Kingdom
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12
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Porcari A, Merlo M, Baggio C, Gagno G, Cittar M, Barbati G, Paldino A, Castrichini M, Vitrella G, Pagnan L, Cannatà A, Andreis A, Cecere A, Cipriani A, Raafs A, Bromage DI, Rosmini S, Scott P, Sado D, Di Bella G, Nucifora G, Marra MP, Heymans S, Imazio M, Sinagra G. Global longitudinal strain by CMR improves prognostic stratification in acute myocarditis presenting with normal LVEF. Eur J Clin Invest 2022; 52:e13815. [PMID: 35598175 DOI: 10.1111/eci.13815] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 04/21/2022] [Accepted: 05/07/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Prognostic stratification of acute myocarditis (AM) presenting with normal left ventricular ejection fraction (LVEF) relies mostly on late gadolinium enhancement (LGE) characterization. Left ventricular peak global longitudinal strain (LV-GLS) measured by feature tracking analysis might improve prognostication of AM presenting with normal LVEF. METHODS Data of patients undergoing cardiac magnetic resonance (CMR) for clinically suspected AM in seven European Centres (2013-2020) were retrospectively analysed. Patients with AM confirmed by CMR and LVEF ≥50% were included. LGE was visually characterized: localized versus. non-localized, subepicardial versus midwall. LV-GLS was measured by dedicated software. The primary outcome was the first occurrence of an adverse cardiovascular event (ACE) including cardiac death, life-threatening arrhythmias, development of heart failure or of LVEF <50%. RESULTS Of 389 screened patients, 256 (66%) fulfilled inclusion criteria: median age 36 years, 71% males, median LVEF 60%, median LV-GLS -17.3%. CMR was performed at 4 days from hospitalization. At 27 months, 24 (9%) patients experienced ≥1 ACE (71% developed LVEF <50%). Compared to the others, they had lower median LV-GLS values (-13.9% vs. -17.5%, p = .001). At Kaplan-Meier analysis, impaired LV-GLS (both considered as > -20% or quartiles), non-localized and midwall LGE were associated with ACEs. Patients with LV-GLS ≤-20% did not experience ACEs. LV-GLS remained associated with ACEs after adjustment for non-localized and midwall LGE. CONCLUSION In AM presenting with LVEF ≥50%, LV-GLS provides independent prognostic value over LGE characterization, improving risk stratification and representing a rationale for further studies of therapy in this cohort.
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Affiliation(s)
- Aldostefano Porcari
- Centre for Diagnosis and Treatment of Cardiomyopathies, Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI) and University of Trieste, Trieste, Italy
| | - Marco Merlo
- Centre for Diagnosis and Treatment of Cardiomyopathies, Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI) and University of Trieste, Trieste, Italy
| | - Chiara Baggio
- Centre for Diagnosis and Treatment of Cardiomyopathies, Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI) and University of Trieste, Trieste, Italy
| | - Giulia Gagno
- Centre for Diagnosis and Treatment of Cardiomyopathies, Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI) and University of Trieste, Trieste, Italy
| | - Marco Cittar
- Centre for Diagnosis and Treatment of Cardiomyopathies, Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI) and University of Trieste, Trieste, Italy
| | - Giulia Barbati
- Department of Medical Sciences, Biostatistics Unit, University of Trieste, Trieste, Italy
| | - Alessia Paldino
- Centre for Diagnosis and Treatment of Cardiomyopathies, Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI) and University of Trieste, Trieste, Italy
| | - Matteo Castrichini
- Centre for Diagnosis and Treatment of Cardiomyopathies, Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI) and University of Trieste, Trieste, Italy
| | - Giancarlo Vitrella
- Centre for Diagnosis and Treatment of Cardiomyopathies, Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI) and University of Trieste, Trieste, Italy
| | - Lorenzo Pagnan
- Department of Radiology, Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI), Trieste, Italy
| | - Antonio Cannatà
- Centre for Diagnosis and Treatment of Cardiomyopathies, Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI) and University of Trieste, Trieste, Italy.,Department of Cardiovascular Sciences - Faculty of Life Sciences & Medicine, King's College London, London, UK.,Department of Cardiology, King's College Hospital NHS Foundation Trust, London, UK
| | - Alessandro Andreis
- University Cardiology A.O.U., Città della Salute e della Scienza di Torino, Turin, Italy
| | - Annagrazia Cecere
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Alberto Cipriani
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Anne Raafs
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Daniel I Bromage
- Department of Cardiovascular Sciences - Faculty of Life Sciences & Medicine, King's College London, London, UK.,Department of Cardiology, King's College Hospital NHS Foundation Trust, London, UK
| | - Stefania Rosmini
- Department of Cardiology, King's College Hospital NHS Foundation Trust, London, UK
| | - Paul Scott
- Department of Cardiovascular Sciences - Faculty of Life Sciences & Medicine, King's College London, London, UK
| | - Daniel Sado
- Department of Cardiovascular Sciences - Faculty of Life Sciences & Medicine, King's College London, London, UK
| | | | - Gaetano Nucifora
- NorthWest Cardiac Imaging Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Martina Perazzolo Marra
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Stephane Heymans
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Massimo Imazio
- Cardiology, Cardiothoracic Department, University Hospital "Santa Maria della Misericordia", ASUFC, Udine, Italy
| | - Gianfranco Sinagra
- Centre for Diagnosis and Treatment of Cardiomyopathies, Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI) and University of Trieste, Trieste, Italy
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13
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Nuzzi V, Del Mestre E, Degrassi A, Bromage DI, Manca P, Piper S, Artico J, Gentile P, Scott PA, Chiatto M, Merlo M, Pareek N, Giacca M, Sinagra G, McDonagh TA, Cannata A. Cardiovascular Damage in COVID-19: What We Know Two Years Later. Curr Cardiol Rep 2022; 24:1085-1091. [PMID: 35751835 PMCID: PMC9244358 DOI: 10.1007/s11886-022-01730-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/06/2022] [Indexed: 12/15/2022]
Abstract
PURPOSE OF THE REVIEW The Coronavirus disease 2019 (COVID-19) pandemic has profoundly influenced cardiological clinical and basic research in the past two years. In the present review, we summarize the current knowledge on myocardial involvement in COVID-19, providing an overview on the incidence, the pathogenetic mechanisms, and the clinical implications of cardiac injury in this setting. RECENT FINDINGS The possibility of heart involvement in patients with COVID-19 has received great attention since the beginning of the pandemic. After more than two years, several steps have been taken in understanding the mechanisms and the incidence of cardiac injury during COVID-19 infection. Similarly, studies globally have clarified the implications of co-existing heart disease and COVID-19. Severe COVID-19 infection may be complicated by myocardial injury. To date, a direct damage from the virus has not been demonstrated. The presence of myocardial injury should be systematically assessed for a prognostication purpose and for possible therapeutic implications.
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Affiliation(s)
- Vincenzo Nuzzi
- Cardiothoracovascular Department, Azienda Sanitaria Universitaria Integrata Giuliano Isontina (ASUGI), University of Trieste, Trieste, Italy
| | - Eva Del Mestre
- Cardiothoracovascular Department, Azienda Sanitaria Universitaria Integrata Giuliano Isontina (ASUGI), University of Trieste, Trieste, Italy
| | - Alessia Degrassi
- Department of Emergency Medicine, Azienda Sanitaria Universitaria Integrata Giuliano Isontina (ASUGI), Friuli-Venezia Giulia, Trieste, Italy
| | - Daniel I Bromage
- Department of Cardiovascular Science, Faculty of Life Science and Medicine, King's College London, London, UK
| | - Paolo Manca
- Cardiothoracovascular Department, Azienda Sanitaria Universitaria Integrata Giuliano Isontina (ASUGI), University of Trieste, Trieste, Italy
| | - Susan Piper
- Department of Cardiovascular Science, Faculty of Life Science and Medicine, King's College London, London, UK
| | - Jessica Artico
- Institute of Cardiovascular Science, Barts Heart Centre, Barts Health NHS Trust, University College London, West Smithfield, London, UK
| | - Piero Gentile
- De Gasperis Cardio Center, Niguarda Hospital, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Paul A Scott
- Department of Cardiovascular Science, Faculty of Life Science and Medicine, King's College London, London, UK
| | - Mario Chiatto
- UOC di Cardiologia UTIC, Ospedale Civile dell'Annunziata, Cosenza, Italy
| | - Marco Merlo
- Cardiothoracovascular Department, Azienda Sanitaria Universitaria Integrata Giuliano Isontina (ASUGI), University of Trieste, Trieste, Italy
| | - Nilesh Pareek
- Department of Cardiovascular Science, Faculty of Life Science and Medicine, King's College London, London, UK
| | - Mauro Giacca
- Department of Cardiovascular Science, Faculty of Life Science and Medicine, King's College London, London, UK
| | - Gianfranco Sinagra
- Cardiothoracovascular Department, Azienda Sanitaria Universitaria Integrata Giuliano Isontina (ASUGI), University of Trieste, Trieste, Italy
| | - Theresa A McDonagh
- Department of Cardiovascular Science, Faculty of Life Science and Medicine, King's College London, London, UK
| | - Antonio Cannata
- Cardiothoracovascular Department, Azienda Sanitaria Universitaria Integrata Giuliano Isontina (ASUGI), University of Trieste, Trieste, Italy.
- Department of Cardiovascular Science, Faculty of Life Science and Medicine, King's College London, London, UK.
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14
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Bromage DI, Cannata A, McDonagh TA. Combination diuretic therapy for acute heart failure: "Alone we can do so little; together we can do so much". Eur J Heart Fail 2022; 24:1611-1613. [PMID: 35867843 DOI: 10.1002/ejhf.2634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 07/14/2022] [Indexed: 11/06/2022] Open
Affiliation(s)
- Daniel I Bromage
- School of Cardiovascular Medicine & Sciences, King's College London British Heart Foundation Centre of Excellence, 125 Coldharbour Lane, London, SE5 9NU, UK.,Department of Cardiology, King's College Hospital NHS Foundation Trust, London, SE5 9RS, UK
| | - Antonio Cannata
- School of Cardiovascular Medicine & Sciences, King's College London British Heart Foundation Centre of Excellence, 125 Coldharbour Lane, London, SE5 9NU, UK.,Department of Cardiology, King's College Hospital NHS Foundation Trust, London, SE5 9RS, UK
| | - Theresa A McDonagh
- School of Cardiovascular Medicine & Sciences, King's College London British Heart Foundation Centre of Excellence, 125 Coldharbour Lane, London, SE5 9NU, UK.,Department of Cardiology, King's College Hospital NHS Foundation Trust, London, SE5 9RS, UK
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15
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Lalario A, Del Mestre E, Lo Casto M, Nuzzi V, Manca P, Bromage DI, Barbati G, Merlo M, Sinagra G, Cannatà A. Clinical characterization and natural history of chemotherapy-induced dilated cardiomyopathy. ESC Heart Fail 2022; 9:3052-3059. [PMID: 35735911 DOI: 10.1002/ehf2.14045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Revised: 05/11/2022] [Accepted: 06/03/2022] [Indexed: 11/10/2022] Open
Abstract
AIMS Chemotherapy-induced dilated cardiomyopathy (CI-DCM) is a well-recognized phenotype of non-ischemic dilated cardiomyopathy (DCM), characterized by poor outcomes. However, a detailed comparison between idiopathic DCM (iDCM) and CI-DCM is still lacking. METHODS AND RESULTS All consecutive DCM patients enrolled in the Trieste Muscle Heart Disease Registry were analysed. CI-DCM and iDCM were defined according to current recommendations. The primary study outcome measure was all-mortality death and secondary outcomes were a) a composite of cardiovascular death/heart-transplantation/ventricular-assist-device implantation, and b) major ventricular arrhythmias. The study included 551 patients (499 iDCM and 52 CI-DCM). At enrolment, compared with iDCM, CI-DCM patients were older (51 ± 14 years vs. 58 ± 3 years, respectively, P < 0.001) and had a higher left ventricular ejection fraction (32% ± 9 vs. 35% ± 10, respectively, P = 0.03). Over a median follow-up of 90 months (IQR 54-140 months), CI-DCM patients had a higher incidence of all-cause mortality compared with iDCM (36.5% vs. 8.4% in CI-DCM and iDCM respectively, P < 0.001), while the incidence of major ventricular arrhythmias was higher in the iDCM group compared with CI-DCM (4% vs. 0%, in CI-DCM and iDCM respectively, P = 0.03). The risk of the composite outcome was comparable between the two groups (P = 0.91). At Cox multivariable analysis, the diagnosis of CI-DCM emerged as independently associated to primary outcome (HR 6.42, 95% C.I. 2.52-16.31, P < 0.001). CONCLUSIONS In a well-selected DCM cohort, patients with a chemotherapy-induced aetiology had a higher incidence of all-cause mortality compared with iDCM. Conversely, the incidence of life-threatening ventricular arrhythmic events was higher among patients with iDCM.
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Affiliation(s)
- Andrea Lalario
- Department of Cardiology, Azienda Sanitaria Universitaria Integrata Giuliano Isontina (ASUGI), University of Trieste, Trieste, Italy
| | - Eva Del Mestre
- Department of Cardiology, Azienda Sanitaria Universitaria Integrata Giuliano Isontina (ASUGI), University of Trieste, Trieste, Italy
| | - Michele Lo Casto
- Department of Cardiology, Azienda Sanitaria Universitaria Integrata Giuliano Isontina (ASUGI), University of Trieste, Trieste, Italy
| | - Vincenzo Nuzzi
- Department of Cardiology, Azienda Sanitaria Universitaria Integrata Giuliano Isontina (ASUGI), University of Trieste, Trieste, Italy
| | - Paolo Manca
- Department of Cardiology, Azienda Sanitaria Universitaria Integrata Giuliano Isontina (ASUGI), University of Trieste, Trieste, Italy
| | - Daniel I Bromage
- Department of Cardiovascular Science, Faculty of Life Science and Medicine, King's College London, London, UK
| | - Giulia Barbati
- Biostatistic Unit, University of Trieste, Trieste, Italy
| | - Marco Merlo
- Department of Cardiology, Azienda Sanitaria Universitaria Integrata Giuliano Isontina (ASUGI), University of Trieste, Trieste, Italy
| | - Gianfranco Sinagra
- Department of Cardiology, Azienda Sanitaria Universitaria Integrata Giuliano Isontina (ASUGI), University of Trieste, Trieste, Italy
| | - Antonio Cannatà
- Department of Cardiology, Azienda Sanitaria Universitaria Integrata Giuliano Isontina (ASUGI), University of Trieste, Trieste, Italy.,Department of Cardiovascular Science, Faculty of Life Science and Medicine, King's College London, London, UK
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16
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Cannatà A, Bromage DI, McDonagh TA. COVID-19 and heart failure: the dark side of the moon. Eur J Heart Fail 2022; 24:1129-1131. [PMID: 35481841 PMCID: PMC9087422 DOI: 10.1002/ejhf.2518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 04/22/2022] [Indexed: 11/28/2022] Open
Affiliation(s)
- Antonio Cannatà
- School of Cardiovascular Medicine & SciencesKing's College London British Heart Foundation Centre of ExcellenceLondonUK
- Department of CardiologyKing's College Hospital NHS Foundation TrustLondonUK
| | - Daniel I. Bromage
- School of Cardiovascular Medicine & SciencesKing's College London British Heart Foundation Centre of ExcellenceLondonUK
- Department of CardiologyKing's College Hospital NHS Foundation TrustLondonUK
| | - Theresa A. McDonagh
- School of Cardiovascular Medicine & SciencesKing's College London British Heart Foundation Centre of ExcellenceLondonUK
- Department of CardiologyKing's College Hospital NHS Foundation TrustLondonUK
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17
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Godec TR, Bromage DI, Pujades‐Rodriguez M, Cannatà A, Gonzalez‐Izquierdo A, Denaxas S, Hemingway H, Shah AM, Yellon DM, McDonagh TA. Cardiovascular outcomes associated with treatment of type 2 diabetes in patients with ischaemic heart failure. ESC Heart Fail 2022; 9:1608-1615. [PMID: 35322592 PMCID: PMC9065866 DOI: 10.1002/ehf2.13910] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Revised: 01/31/2022] [Accepted: 03/11/2022] [Indexed: 12/31/2022] Open
Abstract
AIM The optimal strategy for diabetes control in patients with heart failure (HF) following myocardial infarction (MI) remains unknown. Metformin, a guideline-recommended therapy for patients with chronic HF and type 2 diabetes mellitus (T2DM), is associated with reduced mortality and HF hospitalizations. However, worse outcomes have been reported when used at the time of MI. We compared outcomes of patients with T2DM and HF of ischaemic aetiology according to antidiabetic treatment. METHODS AND RESULTS This study used linked data from primary care, hospital admissions, and death registries for 4.7 million inhabitants in England, as part of the CALIBER resource. The primary endpoint was a composite of cardiovascular mortality and HF hospitalization. The secondary endpoints were the individual components of the primary endpoint and all-cause mortality. To evaluate the effect of temporal changes in diabetes treatment, antidiabetic medication was included as time-dependent covariates in survival analyses. The study included 1172 patients with T2DM and prior MI and incident HF between 3 January 1998 and 26 February 2010. Five hundred and ninety-six patients had the primary outcome over median follow-up of 2.53 (IQR: 0.98-4.92) years. Adjusted analyses showed a reduced hazard of the composite endpoint for exposure to all antidiabetic medication with hazard ratios (HRs) of 0.50 [95% confidence interval (CI): 0.42-0.59], 0.66 (95% CI: 0.55-0.80), and 0.53 (95% CI: 0.43-0.65), respectively. A similar effect was seen for all-cause mortality [HRs of 0.43 (95% CI: 0.35-0.52), 0.57 (95% CI: 0.46-0.70), and 0.34 (95% CI: 0.27-0.43), respectively]. CONCLUSIONS When considering changes in antidiabetic treatment over time, all drug classes were associated with reduced risk of cardiovascular mortality and HF hospitalization.
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Affiliation(s)
- Thomas R. Godec
- Department of Medical Statistics, Faculty of Epidemiology and Population HealthThe London School of Hygiene & Tropical MedicineLondonUK
| | - Daniel I. Bromage
- School of Cardiovascular Medicine and SciencesKing's College London British Heart Foundation Centre of Excellence, James Black Centre125 Coldharbour LaneLondonSE5 9NUUK
| | | | - Antonio Cannatà
- School of Cardiovascular Medicine and SciencesKing's College London British Heart Foundation Centre of Excellence, James Black Centre125 Coldharbour LaneLondonSE5 9NUUK
| | - Arturo Gonzalez‐Izquierdo
- Institute of Health InformaticsUniversity College LondonLondonUK
- Health Data Research UK LondonUniversity College LondonLondonUK
- The National Institute for Health Research University College London Hospitals Biomedical Research CentreUniversity College LondonLondonUK
| | - Spiros Denaxas
- Institute of Health InformaticsUniversity College LondonLondonUK
- Health Data Research UK LondonUniversity College LondonLondonUK
- The National Institute for Health Research University College London Hospitals Biomedical Research CentreUniversity College LondonLondonUK
| | - Harry Hemingway
- Institute of Health InformaticsUniversity College LondonLondonUK
- Health Data Research UK LondonUniversity College LondonLondonUK
- The National Institute for Health Research University College London Hospitals Biomedical Research CentreUniversity College LondonLondonUK
| | - Ajay M. Shah
- School of Cardiovascular Medicine and SciencesKing's College London British Heart Foundation Centre of Excellence, James Black Centre125 Coldharbour LaneLondonSE5 9NUUK
| | - Derek M. Yellon
- The Hatter Cardiovascular InstituteUniversity College LondonLondonUK
| | - Theresa A. McDonagh
- School of Cardiovascular Medicine and SciencesKing's College London British Heart Foundation Centre of Excellence, James Black Centre125 Coldharbour LaneLondonSE5 9NUUK
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18
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Affiliation(s)
- Daniel I Bromage
- Department of Cardiology, King's College Hospital London, Denmark Hill, Brixton, London, United Kingdom
- School of Cardiovascular Medicine and Sciences, King's College London British Heart Foundation Centre of Excellence, James Black Centre, London, United Kingdom
| | - Nilesh Pareek
- Department of Cardiology, King's College Hospital London, Denmark Hill, Brixton, London, United Kingdom
- School of Cardiovascular Medicine and Sciences, King's College London British Heart Foundation Centre of Excellence, James Black Centre, London, United Kingdom
| | - Antonio Cannata
- Department of Cardiology, King's College Hospital London, Denmark Hill, Brixton, London, United Kingdom
- School of Cardiovascular Medicine and Sciences, King's College London British Heart Foundation Centre of Excellence, James Black Centre, London, United Kingdom
| | - Pietro Ameri
- IRCCS Ospedale Policlinico San Martino, IRCCS Italian Cardiovascular Network, Genova, Italy; and
- Department of Internal Medicine, University of Genova, Genova, Italy
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19
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Bromage DI, Trevelin SC, Huntington J, Yang VX, Muthukumar A, Mackie SJ, Sawyer G, Zhang X, Santos CXC, Safinia N, Smyrnias I, Giacca M, Ivetic A, Shah AM. Nrf2 attenuates the innate immune response after experimental myocardial infarction. Biochem Biophys Res Commun 2022; 606:10-16. [PMID: 35338853 DOI: 10.1016/j.bbrc.2022.03.043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 03/03/2022] [Accepted: 03/08/2022] [Indexed: 11/02/2022]
Abstract
BACKGROUND There is compelling evidence implicating dysregulated inflammation in the mechanism of ventricular remodeling and heart failure (HF) after MI. The transcription factor nuclear factor erythroid-derived 2-like 2 (Nrf2, encoded by Nfe2l2) is a promising target in this context since it impedes transcriptional upregulation of pro-inflammatory cytokines and is anti-inflammatory in various murine models. OBJECTIVES We aimed to investigate the contribution of Nrf2 to the inflammatory response after experimental myocardial infarction (MI). METHODS We subjected Nrf2-/- mice and wild type (WT) controls to permanent left coronary artery (LCA) ligation. The inflammatory response was investigated with fluorescence-activated cell sorting (FACS) analysis of peripheral blood and heart cell suspensions, together with qRT-PCR of infarcted tissue for chemokines and their receptors. To investigate whether Nrf2-mediated transcription is a dedicated function of leukocytes, we interrogated publicly available RNA-sequencing (RNA-seq) data from mouse hearts after permanent LCA ligation for Nrf2-regulated gene (NRG) expression. RESULTS FACS analysis demonstrated a profoundly inflamed phenotype in the hearts of global Nrf2-/- mice as compared to WT mice after MI. Moreover, infarcted tissue from Nrf2-/- mice displayed higher expression of mRNA coding for inflammatory cytokines, chemokines, and their receptors, including IL-6, Ccl2, and Cxcr4. RNA-seq analysis showed upregulated NRG expression in WT mice after MI compared to naive mice, which was significantly higher in bioinformatically isolated CCR2+ cells. CONCLUSIONS Taken together, the results suggest that Nrf2 signalling in leukocytes, and possibly CCR2+ monocytes and monocyte-derived cardiac resident macrophages, may be potential targets to prevent post-MI ventricular remodeling.
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Affiliation(s)
- Daniel I Bromage
- School of Cardiovascular Medicine and Sciences, King's College London British Heart Foundation Centre of Excellence, James Black Centre, 125 Coldharbour Lane, London, SE5 9NU, UK.
| | - Silvia C Trevelin
- School of Cardiovascular Medicine and Sciences, King's College London British Heart Foundation Centre of Excellence, James Black Centre, 125 Coldharbour Lane, London, SE5 9NU, UK
| | - Josef Huntington
- School of Cardiovascular Medicine and Sciences, King's College London British Heart Foundation Centre of Excellence, James Black Centre, 125 Coldharbour Lane, London, SE5 9NU, UK
| | - Victoria X Yang
- School of Cardiovascular Medicine and Sciences, King's College London British Heart Foundation Centre of Excellence, James Black Centre, 125 Coldharbour Lane, London, SE5 9NU, UK
| | - Ananya Muthukumar
- School of Cardiovascular Medicine and Sciences, King's College London British Heart Foundation Centre of Excellence, James Black Centre, 125 Coldharbour Lane, London, SE5 9NU, UK
| | - Sarah J Mackie
- School of Cancer and Pharmaceutical Sciences, SGDP Centre, King's College London, Memory Lane, London, SE5 8AF, UK
| | - Greta Sawyer
- School of Cardiovascular Medicine and Sciences, King's College London British Heart Foundation Centre of Excellence, James Black Centre, 125 Coldharbour Lane, London, SE5 9NU, UK
| | - Xiaohong Zhang
- School of Cardiovascular Medicine and Sciences, King's College London British Heart Foundation Centre of Excellence, James Black Centre, 125 Coldharbour Lane, London, SE5 9NU, UK
| | - Celio X C Santos
- School of Cardiovascular Medicine and Sciences, King's College London British Heart Foundation Centre of Excellence, James Black Centre, 125 Coldharbour Lane, London, SE5 9NU, UK
| | - Niloufar Safinia
- MRC Centre for Transplantation, Division of Transplantation Immunology and Mucosal Biology, King's College London, James Black Centre, 125 Coldharbour Lane, London, SE5 9NU, UK
| | - Ioannis Smyrnias
- School of Cardiovascular Medicine and Sciences, King's College London British Heart Foundation Centre of Excellence, James Black Centre, 125 Coldharbour Lane, London, SE5 9NU, UK; School of Veterinary Medicine, Faculty of Health and Medical Sciences, University of Surrey, Surrey, GU2 7AL, UK
| | - Mauro Giacca
- School of Cardiovascular Medicine and Sciences, King's College London British Heart Foundation Centre of Excellence, James Black Centre, 125 Coldharbour Lane, London, SE5 9NU, UK
| | - Aleksandar Ivetic
- School of Cardiovascular Medicine and Sciences, King's College London British Heart Foundation Centre of Excellence, James Black Centre, 125 Coldharbour Lane, London, SE5 9NU, UK
| | - Ajay M Shah
- School of Cardiovascular Medicine and Sciences, King's College London British Heart Foundation Centre of Excellence, James Black Centre, 125 Coldharbour Lane, London, SE5 9NU, UK
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20
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Ammirati E, Lupi L, Palazzini M, Hendren NS, Grodin JL, Cannistraci CV, Schmidt M, Hekimian G, Peretto G, Bochaton T, Hayek A, Piriou N, Leonardi S, Guida S, Turco A, Sala S, Uribarri A, Van de Heyning CM, Mapelli M, Campodonico J, Pedrotti P, Barrionuevo Sánchez MI, Ariza Sole A, Marini M, Matassini MV, Vourc'h M, Cannatà A, Bromage DI, Briguglia D, Salamanca J, Diez-Villanueva P, Lehtonen J, Huang F, Russel S, Soriano F, Turrini F, Cipriani M, Bramerio M, Di Pasquale M, Grosu A, Senni M, Farina D, Agostoni P, Rizzo S, De Gaspari M, Marzo F, Duran JM, Adler ED, Giannattasio C, Basso C, McDonagh T, Kerneis M, Combes A, Camici PG, de Lemos JA, Metra M. Prevalence, Characteristics, and Outcomes of COVID-19-Associated Acute Myocarditis. Circulation 2022; 145:1123-1139. [PMID: 35404682 PMCID: PMC8989611 DOI: 10.1161/circulationaha.121.056817] [Citation(s) in RCA: 97] [Impact Index Per Article: 48.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Background: Acute myocarditis (AM) is thought to be a rare cardiovascular complication of COVID-19, although minimal data are available beyond case reports. We aim to report the prevalence, baseline characteristics, in-hospital management, and outcomes for patients with COVID-19–associated AM on the basis of a retrospective cohort from 23 hospitals in the United States and Europe. Methods: A total of 112 patients with suspected AM from 56 963 hospitalized patients with COVID-19 were evaluated between February 1, 2020, and April 30, 2021. Inclusion criteria were hospitalization for COVID-19 and a diagnosis of AM on the basis of endomyocardial biopsy or increased troponin level plus typical signs of AM on cardiac magnetic resonance imaging. We identified 97 patients with possible AM, and among them, 54 patients with definite/probable AM supported by endomyocardial biopsy in 17 (31.5%) patients or magnetic resonance imaging in 50 (92.6%). We analyzed patient characteristics, treatments, and outcomes among all COVID-19–associated AM. Results: AM prevalence among hospitalized patients with COVID-19 was 2.4 per 1000 hospitalizations considering definite/probable and 4.1 per 1000 considering also possible AM. The median age of definite/probable cases was 38 years, and 38.9% were female. On admission, chest pain and dyspnea were the most frequent symptoms (55.5% and 53.7%, respectively). Thirty-one cases (57.4%) occurred in the absence of COVID-19–associated pneumonia. Twenty-one (38.9%) had a fulminant presentation requiring inotropic support or temporary mechanical circulatory support. The composite of in-hospital mortality or temporary mechanical circulatory support occurred in 20.4%. At 120 days, estimated mortality was 6.6%, 15.1% in patients with associated pneumonia versus 0% in patients without pneumonia (P=0.044). During hospitalization, left ventricular ejection fraction, assessed by echocardiography, improved from a median of 40% on admission to 55% at discharge (n=47; P<0.0001) similarly in patients with or without pneumonia. Corticosteroids were frequently administered (55.5%). Conclusions: AM occurrence is estimated between 2.4 and 4.1 out of 1000 patients hospitalized for COVID-19. The majority of AM occurs in the absence of pneumonia and is often complicated by hemodynamic instability. AM is a rare complication in patients hospitalized for COVID-19, with an outcome that differs on the basis of the presence of concomitant pneumonia.
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Affiliation(s)
- Enrico Ammirati
- De Gasperis Cardio Center and Transplant Center, Niguarda Hospital, Milano, Italy (E.A., M.P., P.P. F.S., M.C., C.G.)
| | - Laura Lupi
- Institute of Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Italy (L.L., M.D.P., M. Metra)
| | - Matteo Palazzini
- De Gasperis Cardio Center and Transplant Center, Niguarda Hospital, Milano, Italy (E.A., M.P., P.P. F.S., M.C., C.G.)
| | - Nicholas S Hendren
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas (N.S.H., J.L.G., J.A.d.L.)
| | - Justin L Grodin
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas (N.S.H., J.L.G., J.A.d.L.)
| | - Carlo V Cannistraci
- Center for Complex Network Intelligence, Tsinghua Laboratory of Brain and Intelligence, Department of Computer Science, Department of Biomedical Engineering, Tsinghua University, Beijing, China (C.V.C.).,Center for Systems Biology Dresden, Germany (C.V.C.)
| | - Matthieu Schmidt
- Sorbonne Université, UMRS 1166, Institute of Cardiometabolism and Nutrition, Service de Médecine Intensive-Réanimation, Institut de Cardiologie, Assistance Publique-Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, France (M. Schmidt, G.H., A. Combes)
| | - Guillaume Hekimian
- Sorbonne Université, UMRS 1166, Institute of Cardiometabolism and Nutrition, Service de Médecine Intensive-Réanimation, Institut de Cardiologie, Assistance Publique-Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, France (M. Schmidt, G.H., A. Combes)
| | - Giovanni Peretto
- San Raffaele Hospital and Vita Salute University, Milano, Italy (G.P., S.S., P.G.C.)
| | - Thomas Bochaton
- Urgences et Soins Critiques Cardiologiques, Hôpital Cardiologique, Hospices Civils de Lyon, Bron, France (T.B., A.H.)
| | - Ahmad Hayek
- Urgences et Soins Critiques Cardiologiques, Hôpital Cardiologique, Hospices Civils de Lyon, Bron, France (T.B., A.H.)
| | - Nicolas Piriou
- Université Nantes, CHU Nantes, Centre National de la Recherche Scientifique, Institut National de la Santé et de la Recherche Médicale, l'Institut du Thorax, France (N.P.)
| | - Sergio Leonardi
- University of Pavia and Fondazione Istituto di Ricovero e Cura a Carattere Scientificio Policlinico S. Matteo, Italy (S.L., S.G., A.T.)
| | - Stefania Guida
- University of Pavia and Fondazione Istituto di Ricovero e Cura a Carattere Scientificio Policlinico S. Matteo, Italy (S.L., S.G., A.T.)
| | - Annalisa Turco
- University of Pavia and Fondazione Istituto di Ricovero e Cura a Carattere Scientificio Policlinico S. Matteo, Italy (S.L., S.G., A.T.)
| | - Simone Sala
- San Raffaele Hospital and Vita Salute University, Milano, Italy (G.P., S.S., P.G.C.)
| | - Aitor Uribarri
- Departamento de Cardiología, Hospital Clínico Universitario, Valladolid, Spain (A.U.).,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, Instituto de Salud Carlos III, Madrid, Spain (A.U.)
| | - Caroline M Van de Heyning
- Department of Cardiology, Antwerp University Hospital, and Genetics, Pharmacology and Physiopathology of Heart, Blood Vessels and Skeleton Research Group, Antwerp University, Belgium (C.M.V.d.H.)
| | - Massimo Mapelli
- Centro Cardiologico Monzino Istituto di Ricovero e Cura a Carattere Scientificio, Milano, Italy (M. Mapelli, J.C., P.A.).,Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milano, Italy (M. Mapelli, J.C., P.A.)
| | - Jeness Campodonico
- Centro Cardiologico Monzino Istituto di Ricovero e Cura a Carattere Scientificio, Milano, Italy (M. Mapelli, J.C., P.A.).,Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milano, Italy (M. Mapelli, J.C., P.A.)
| | - Patrizia Pedrotti
- De Gasperis Cardio Center and Transplant Center, Niguarda Hospital, Milano, Italy (E.A., M.P., P.P. F.S., M.C., C.G.)
| | - Maria Isabel Barrionuevo Sánchez
- Cardiology Department, Bellvitge University Hospital, Bioheart, Grup de Malalties Cardiovasculars, Institut d'Investigació Biomèdica de Bellvitge, Institut d'Investigació Biomèdica de Bellvitge, L'Hospotalet del Llobregat, Barcelona, Spain (M.I.B.S., A.A.S.)
| | - Albert Ariza Sole
- Cardiology Department, Bellvitge University Hospital, Bioheart, Grup de Malalties Cardiovasculars, Institut d'Investigació Biomèdica de Bellvitge, Institut d'Investigació Biomèdica de Bellvitge, L'Hospotalet del Llobregat, Barcelona, Spain (M.I.B.S., A.A.S.)
| | - Marco Marini
- Cardiology Division, Cardiovascular Department, Azienda Ospedaliero Universitaria Ospedali Riuniti di Ancona Umberto I-GM Lancisi-G Salesi, Ancona, Italy (M. Marini, M.V.M.)
| | - Maria Vittoria Matassini
- Cardiology Division, Cardiovascular Department, Azienda Ospedaliero Universitaria Ospedali Riuniti di Ancona Umberto I-GM Lancisi-G Salesi, Ancona, Italy (M. Marini, M.V.M.)
| | - Mickael Vourc'h
- Department of Anesthesiology and Surgical Intensive Care, Hôpital Laennec, University Hospital of Nantes, France (M.V.).,School of Medicine, UPRES EA 3826, Thérapeutiques Cliniques et Expérimentales des Infections, IRS2 Nantes Biotech, France (M.V.)
| | - Antonio Cannatà
- School of Cardiovascular Medicine and Sciences, King's College London British Heart Foundation Centre of Excellence, James Black Centre, United Kingdom (A. Cannatà, D.I.B., T.M.).,Department of Cardiology, King's College Hospital London, United Kingdom (A. Cannatà, D.I.B., T.M.)
| | - Daniel I Bromage
- School of Cardiovascular Medicine and Sciences, King's College London British Heart Foundation Centre of Excellence, James Black Centre, United Kingdom (A. Cannatà, D.I.B., T.M.).,Department of Cardiology, King's College Hospital London, United Kingdom (A. Cannatà, D.I.B., T.M.)
| | | | - Jorge Salamanca
- Cardiology Department, Hospital Universitario De La Princesa, Madrid, Spain (J.S., P.D.-V.)
| | - Pablo Diez-Villanueva
- Cardiology Department, Hospital Universitario De La Princesa, Madrid, Spain (J.S., P.D.-V.)
| | - Jukka Lehtonen
- Heart and Lung Center, Department of Cardiology, Helsinki University Hospital, Finland (J.L.)
| | - Florent Huang
- Service de Cardiologie, Hôpital Foch, Suresnes, France (F.H., S. Russel)
| | - Stéphanie Russel
- Service de Cardiologie, Hôpital Foch, Suresnes, France (F.H., S. Russel)
| | - Francesco Soriano
- De Gasperis Cardio Center and Transplant Center, Niguarda Hospital, Milano, Italy (E.A., M.P., P.P. F.S., M.C., C.G.)
| | | | - Manlio Cipriani
- De Gasperis Cardio Center and Transplant Center, Niguarda Hospital, Milano, Italy (E.A., M.P., P.P. F.S., M.C., C.G.)
| | - Manuela Bramerio
- Department of Histopathology, Niguarda Hospital, Milano, Italy (M.B.)
| | - Mattia Di Pasquale
- Institute of Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Italy (L.L., M.D.P., M. Metra)
| | - Aurelia Grosu
- Cardiovascular Department, ASST Papa Giovanni XXIII, Bergamo, Italy (A.G., M. Senni)
| | - Michele Senni
- Cardiovascular Department, ASST Papa Giovanni XXIII, Bergamo, Italy (A.G., M. Senni)
| | - Davide Farina
- Institute of Radiology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Italy (D.F.)
| | - Piergiuseppe Agostoni
- Centro Cardiologico Monzino Istituto di Ricovero e Cura a Carattere Scientificio, Milano, Italy (M. Mapelli, J.C., P.A.).,Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milano, Italy (M. Mapelli, J.C., P.A.)
| | - Stefania Rizzo
- Cardiovascular Pathology Unit, Azienda Ospedaliera, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Italy (S. Rizzo, M.D.G., C.B.)
| | - Monica De Gaspari
- Cardiovascular Pathology Unit, Azienda Ospedaliera, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Italy (S. Rizzo, M.D.G., C.B.)
| | - Francesca Marzo
- Department of Cardiology, Infermi Hospital, Rimini, Italy (F.M.)
| | - Jason M Duran
- Division of Cardiology, Department of Medicine, University of California San Diego (J.M.D., E.D.A.)
| | - Eric D Adler
- Division of Cardiology, Department of Medicine, University of California San Diego (J.M.D., E.D.A.)
| | - Cristina Giannattasio
- De Gasperis Cardio Center and Transplant Center, Niguarda Hospital, Milano, Italy (E.A., M.P., P.P. F.S., M.C., C.G.).,Department of Health Sciences, University of Milano-Bicocca, Monza, Italy (C.G.)
| | - Cristina Basso
- Cardiovascular Pathology Unit, Azienda Ospedaliera, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Italy (S. Rizzo, M.D.G., C.B.)
| | - Theresa McDonagh
- School of Cardiovascular Medicine and Sciences, King's College London British Heart Foundation Centre of Excellence, James Black Centre, United Kingdom (A. Cannatà, D.I.B., T.M.).,Department of Cardiology, King's College Hospital London, United Kingdom (A. Cannatà, D.I.B., T.M.)
| | - Mathieu Kerneis
- Sorbonne Université, ACTION Study Group, Institut National de la Santé et de la Recherche Médicale UMRS1166, Institute of CardioMetabolism and Nutrition, Institut de Cardiologie, Hôpital Pitié-Salpêtrière (AP-HP), Paris, France (M.K.)
| | - Alain Combes
- Sorbonne Université, UMRS 1166, Institute of Cardiometabolism and Nutrition, Service de Médecine Intensive-Réanimation, Institut de Cardiologie, Assistance Publique-Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, France (M. Schmidt, G.H., A. Combes)
| | - Paolo G Camici
- San Raffaele Hospital and Vita Salute University, Milano, Italy (G.P., S.S., P.G.C.)
| | - James A de Lemos
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas (N.S.H., J.L.G., J.A.d.L.)
| | - Marco Metra
- Institute of Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Italy (L.L., M.D.P., M. Metra)
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21
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Cannatà A, Merlo M, Dal Ferro M, Barbati G, Manca P, Paldino A, Graw S, Gigli M, Stolfo D, Johnson R, Roy D, Tharratt K, Bromage DI, Jirikowic J, Abbate A, Goodwin A, Rao K, Marawan A, Carr-White G, Robert L, Parikh V, Ashley E, McDonagh T, Lakdawala NK, Fatkin D, Taylor MRG, Mestroni L, Sinagra G. Association of Titin Variations With Late-Onset Dilated Cardiomyopathy. JAMA Cardiol 2022; 7:371-377. [PMID: 35138330 PMCID: PMC8829739 DOI: 10.1001/jamacardio.2021.5890] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 12/09/2021] [Indexed: 12/21/2022]
Abstract
IMPORTANCE Dilated cardiomyopathy (DCM) is frequently caused by genetic factors. Studies identifying deleterious rare variants have predominantly focused on early-onset cases, and little is known about the genetic underpinnings of the growing numbers of patients with DCM who are diagnosed when they are older than 60 years (ie, late-onset DCM). OBJECTIVE To investigate the prevalence, type, and prognostic impact of disease-associated rare variants in patients with late-onset DCM. DESIGN, SETTING, AND PARTICIPANTS A population of patients with late-onset DCM who had undergone genetic testing in 7 international tertiary referral centers worldwide were enrolled from March 1990 to August 2020. A positive genotype was defined as the presence of pathogenic or likely pathogenic (P/LP) variants. MAIN OUTCOMES AND MEASURES The study outcome was all-cause mortality. RESULTS A total of 184 patients older than 60 years (103 female [56%]; mean [SD] age, 67 [6] years; mean [SD] left ventricular ejection fraction, 32% [10%]) were studied. Sixty-six patients (36%) were carriers of a P/LP variant. Titin-truncating variants were the most prevalent (present in 46 [25%] of the total population and accounting for 46 [69%] of all genotype-positive patients). During a median (interquartile range) follow-up of 42 (10-115) months, 23 patients (13%) died; 17 (25%) of these were carriers of P/LP variants, while 6 patients (5.1%) were genotype-negative. CONCLUSIONS AND RELEVANCE Late-onset DCM might represent a distinct subgroup characterized by and a high genetic variation burden, largely due to titin-truncating variants. Patients with a positive genetic test had higher mortality than genotype-negative patients. These findings support the extended use of genetic testing also in older patients.
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Affiliation(s)
- Antonio Cannatà
- Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), University of Trieste, Trieste, Italy
- Department of Cardiovascular Sciences, Faculty of Life Sciences & Medicine, King’s College London, London, United Kingdom
- Department of Cardiology, King’s College Hospital, London, United Kingdom
| | - Marco Merlo
- Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), University of Trieste, Trieste, Italy
| | - Matteo Dal Ferro
- Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), University of Trieste, Trieste, Italy
| | - Giulia Barbati
- Biostatistics Unit, University of Trieste, Trieste, Italy
| | - Paolo Manca
- Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), University of Trieste, Trieste, Italy
| | - Alessia Paldino
- Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), University of Trieste, Trieste, Italy
| | - Sharon Graw
- Cardiovascular Institute and Adult Medical Genetics Program, University of Colorado Anschutz Medical Campus, Aurora
| | - Marta Gigli
- Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), University of Trieste, Trieste, Italy
| | - Davide Stolfo
- Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), University of Trieste, Trieste, Italy
| | - Renee Johnson
- Molecular Cardiology Division, Victor Chang Cardiac Research Institute, Darlinghurst, New South Wales, Australia
- Faculty of Medicine, UNSW Sydney, Kensington, New South Wales, Australia
- Cardiology Department, St Vincent’s Hospital, Darlinghurst, New South Wales, Australia
| | - Darius Roy
- Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Kevin Tharratt
- Center for Inherited Heart Disease, Stanford University, Stanford, California
| | - Daniel I. Bromage
- Department of Cardiovascular Sciences, Faculty of Life Sciences & Medicine, King’s College London, London, United Kingdom
- Department of Cardiology, King’s College Hospital, London, United Kingdom
| | - Jean Jirikowic
- Cardiovascular Institute and Adult Medical Genetics Program, University of Colorado Anschutz Medical Campus, Aurora
| | - Antonio Abbate
- VCU Pauley Heart Center, Virginia Commonwealth University, Richmond
| | - Allison Goodwin
- VCU Medical Center, Clinical Genetics Services, Richmond, Virginia
| | - Krishnasree Rao
- VCU Pauley Heart Center, Virginia Commonwealth University, Richmond
| | - Amr Marawan
- VCU Pauley Heart Center, Virginia Commonwealth University, Richmond
| | - Gerry Carr-White
- Department of Cardiology, Guys and St Thomas’ NHS Trust, London, United Kingdom
| | - Leema Robert
- Department of Clinical Genetics, Guys and St Thomas' NHS Trust, London, United Kingdom
| | - Victoria Parikh
- Center for Inherited Heart Disease, Stanford University, Stanford, California
| | - Euan Ashley
- Center for Inherited Heart Disease, Stanford University, Stanford, California
| | - Theresa McDonagh
- Department of Cardiovascular Sciences, Faculty of Life Sciences & Medicine, King’s College London, London, United Kingdom
- Department of Cardiology, King’s College Hospital, London, United Kingdom
| | - Neal K. Lakdawala
- Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Diane Fatkin
- Molecular Cardiology Division, Victor Chang Cardiac Research Institute, Darlinghurst, New South Wales, Australia
- Faculty of Medicine, UNSW Sydney, Kensington, New South Wales, Australia
- Cardiology Department, St Vincent’s Hospital, Darlinghurst, New South Wales, Australia
| | - Matthew R. G. Taylor
- Cardiovascular Institute and Adult Medical Genetics Program, University of Colorado Anschutz Medical Campus, Aurora
| | - Luisa Mestroni
- Cardiovascular Institute and Adult Medical Genetics Program, University of Colorado Anschutz Medical Campus, Aurora
| | - Gianfranco Sinagra
- Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), University of Trieste, Trieste, Italy
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22
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Manca P, Nuzzi V, Cannatà A, Castrichini M, Bromage DI, De Luca A, Stolfo D, Schulz U, Merlo M, Sinagra G. The right ventricular involvement in dilated cardiomyopathy: prevalence and prognostic implications of the often-neglected child. Heart Fail Rev 2022; 27:1795-1805. [PMID: 35315505 PMCID: PMC9388461 DOI: 10.1007/s10741-022-10229-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/15/2022] [Indexed: 12/02/2022]
Abstract
Dilated cardiomyopathy (DCM) is a primary heart muscle disease characterized by left or biventricular systolic impairment. Historically, most of the clinical attention has been devoted to the evaluation of left ventricular function and morphology, while right ventricle (RV) has been for many years the forgotten chamber. Recently, progresses in cardiac imaging gave clinicians precious tools for the evaluation of RV, raising the awareness of the importance of biventricular assessment in DCM. Indeed, RV involvement is far from being uncommon in DCM, and the presence of right ventricular dysfunction (RVD) is one of the major negative prognostic determinants in DCM patients. However, some aspects such as the possible role of specific genetic mutations in determining the biventricular phenotype in DCM, or the lack of specific treatments able to primarily counteract RVD, still need research. In this review, we summarized the current knowledge on RV involvement in DCM, giving an overview on the epidemiology and pathogenetic mechanisms implicated in determining RVD. Furthermore, we discussed the imaging techniques to evaluate RV function and the role of RV failure in advanced heart failure.
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Affiliation(s)
- Paolo Manca
- Division of Cardiology, Cardiovascular Department, Azienda Sanitaria Universitaria Integrata Giuliana Isontina (ASUGI), University of Trieste, Via Valdoni 7, 34149, Trieste, Italy
| | - Vincenzo Nuzzi
- Division of Cardiology, Cardiovascular Department, Azienda Sanitaria Universitaria Integrata Giuliana Isontina (ASUGI), University of Trieste, Via Valdoni 7, 34149, Trieste, Italy
| | - Antonio Cannatà
- Division of Cardiology, Cardiovascular Department, Azienda Sanitaria Universitaria Integrata Giuliana Isontina (ASUGI), University of Trieste, Via Valdoni 7, 34149, Trieste, Italy.,Department of Cardiovascular Science, Faculty of Life Science and Medicine, King's College London, London, UK
| | - Matteo Castrichini
- Division of Cardiology, Cardiovascular Department, Azienda Sanitaria Universitaria Integrata Giuliana Isontina (ASUGI), University of Trieste, Via Valdoni 7, 34149, Trieste, Italy
| | - Daniel I Bromage
- Department of Cardiovascular Science, Faculty of Life Science and Medicine, King's College London, London, UK
| | - Antonio De Luca
- Division of Cardiology, Cardiovascular Department, Azienda Sanitaria Universitaria Integrata Giuliana Isontina (ASUGI), University of Trieste, Via Valdoni 7, 34149, Trieste, Italy
| | - Davide Stolfo
- Division of Cardiology, Cardiovascular Department, Azienda Sanitaria Universitaria Integrata Giuliana Isontina (ASUGI), University of Trieste, Via Valdoni 7, 34149, Trieste, Italy.,Division of Cardiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Uwe Schulz
- Department of Cardiac Surgery, Heart Center, University of Leipzig, Leipzig, Germany
| | - Marco Merlo
- Division of Cardiology, Cardiovascular Department, Azienda Sanitaria Universitaria Integrata Giuliana Isontina (ASUGI), University of Trieste, Via Valdoni 7, 34149, Trieste, Italy.
| | - Gianfranco Sinagra
- Division of Cardiology, Cardiovascular Department, Azienda Sanitaria Universitaria Integrata Giuliana Isontina (ASUGI), University of Trieste, Via Valdoni 7, 34149, Trieste, Italy
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23
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Rind IA, Cannata A, McDonaugh B, Cassimon B, Bannister C, Scott PA, Piper S, Bromage DI, McDonagh TA. Patients hospitalised with heart failure across different waves of the COVID-19 pandemic show consistent clinical characteristics and outcomes. Int J Cardiol 2022; 350:125-129. [PMID: 34971665 PMCID: PMC8714242 DOI: 10.1016/j.ijcard.2021.12.042] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 12/17/2021] [Accepted: 12/23/2021] [Indexed: 12/22/2022]
Abstract
BACKGROUND During the first wave of the COVID-19 pandemic, admissions for cardiovascular disease, including Heart Failure (HF), were reduced. Patients hospitalised for HF were sicker and with increased in-hospital mortality. So far, whether following waves had a different impact on HF patients is unknown. METHODS All consecutive patients hospitalised for acute heart failure during three different COVID-19 related national lockdowns were analysed. The lockdown periods were defined according to Government guidelines as 23/3/2020 to 4/7/2020 (First Lockdown), 4/11/2020 to 2/12/2020 (Second Lockdown) and 5/1/2021 to 28/2/2021 (Third Lockdown). RESULTS Overall, 184 patients hospitalised for HF were included in the study, 95 during the 1st lockdown, 30 during the 2nd lockdown and 59 during the 3rd lockdown. Across the three groups had comparable clinical characteristics, comorbidities and cardiovascular risk factors. Specialist in-hospital care was uninterrupted during the pandemic showing comparable mortality rates (p = 0.10). Although medical therapy for HF was comparable between the three lockdowns, a significantly higher proportion of patients received Angiotensin Receptor-Neprilysin Inhibitors (ARNI) in the second and third lockdowns (p < 0.001). CONCLUSIONS Although public health approaches changed throughout the pandemic, the clinical characteristics and outcomes of HF patients were consistent across different waves. For patients hospitalised in the subsequent waves, a more rapid optimization of medical therapy was observed during hospitalization. Particular attention should be devoted to prevent collateral cardiovascular damage during public health emergencies.
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Affiliation(s)
- Irfan A Rind
- Department of Cardiology, King's College Hospital London, Denmark Hill, Brixton, London SE5 9RS, UK
| | - Antonio Cannata
- Department of Cardiology, King's College Hospital London, Denmark Hill, Brixton, London SE5 9RS, UK; School of Cardiovascular Medicine and Sciences, King's College London British Heart Foundation Centre of Excellence, James Black Centre, 125 Coldharbour Lane, London SE5 9NU, UK
| | - Benedict McDonaugh
- Department of Cardiology, King's College Hospital London, Denmark Hill, Brixton, London SE5 9RS, UK
| | - Barbara Cassimon
- Department of Cardiology, King's College Hospital London, Denmark Hill, Brixton, London SE5 9RS, UK
| | - Clare Bannister
- Department of Cardiology, King's College Hospital London, Denmark Hill, Brixton, London SE5 9RS, UK
| | - Paul A Scott
- Department of Cardiology, King's College Hospital London, Denmark Hill, Brixton, London SE5 9RS, UK
| | - Susan Piper
- Department of Cardiology, King's College Hospital London, Denmark Hill, Brixton, London SE5 9RS, UK
| | - Daniel I Bromage
- Department of Cardiology, King's College Hospital London, Denmark Hill, Brixton, London SE5 9RS, UK; School of Cardiovascular Medicine and Sciences, King's College London British Heart Foundation Centre of Excellence, James Black Centre, 125 Coldharbour Lane, London SE5 9NU, UK
| | - Theresa A McDonagh
- Department of Cardiology, King's College Hospital London, Denmark Hill, Brixton, London SE5 9RS, UK; School of Cardiovascular Medicine and Sciences, King's College London British Heart Foundation Centre of Excellence, James Black Centre, 125 Coldharbour Lane, London SE5 9NU, UK.
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24
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Khan P, Gopinath B, Jahagirdar N, Laybourn M, Cannatà A, Bromage DI, Murgatroyd F, Scott PA. Improving Adoption of Evidence-Based Implantable Cardioverter Defibrillator Programming – A single centre experience. Heart Rhythm 2022; 19:1011-1012. [DOI: 10.1016/j.hrthm.2022.01.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 01/20/2022] [Accepted: 01/24/2022] [Indexed: 11/04/2022]
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25
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Holm N, Bromage DI, Cannata A, DeCourcey J, Bhatti P, Huang M, McDonagh TA. Association between ethnicity and degree of improvement in cardiac function following initiation of sacubitril/valsartan. J Cardiovasc Med (Hagerstown) 2022; 23:37-41. [PMID: 34632983 DOI: 10.2459/jcm.0000000000001268] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
AIMS The aim of this study was to determine the degree of short-term improvement in left ventricular ejection fraction (LVEF), haemodynamics, NT-proBNP and quality of life following initiation of sacubitril/valsartan in black patients when compared with white patients. METHODS This was a retrospective, observational, single-centre, hypothesis-generating study of patients with symptomatic heart failure and reduced ejection fraction (HFrEF) treated with guideline recommended therapy, who were transitioned from an ACE inhibitor (ACE-I) or angiotensin receptor blocker (ARB) to sacubitril/valsartan. RESULTS Our analysis included 83 patients (mean age 57 years) with echocardiography performed before and after transition from ACE-I/ARB to sacubitril/valsartan, after excluding patients with concomitant Cardiac resynchronization therapy implantation. Overall, sacubitril/valsartan was associated with LVEF improvement from 28.8% ± 0.7 to 32.0% ± 1.1% (P = 0.0002), but no reverse remodelling was observed. The association with LVEF improvement was only observed in white patients (n = 46, P = 0.0006), but not in black patients (n = 37, P = 0.1728), and appeared to be associated with reduced blood pressure (baseline vs. 2-week blood pressure 116.5 ± 13.9 vs. 109.4 ± 14.3 mmHg, respectively, in white patients, P = 0.0449). Fifteen patients (18.1%) became ineligible for primary prevention Implantable cardioverter defibrillator implantation. CONCLUSION Sacubitril/valsartan was associated with improved LVEF, NT-proBNP concentrations and quality of life in patients with symptomatic HFrEF on guideline recommended therapy. However, in our cohort, improvement of LVEF and quality of life might be attenuated in black patients, which warrants further investigation.
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Affiliation(s)
| | - Daniel I Bromage
- Department of Cardiology, King's College Hospital London
- School of Cardiovascular Medicine and Sciences, King's College London British Heart Foundation Centre of Excellence, James Black Centre, London, UK
| | - Antonio Cannata
- Department of Cardiology, King's College Hospital London
- School of Cardiovascular Medicine and Sciences, King's College London British Heart Foundation Centre of Excellence, James Black Centre, London, UK
| | | | - Prashan Bhatti
- Department of Cardiology, King's College Hospital London
| | - Marilou Huang
- Department of Cardiology, King's College Hospital London
| | - Theresa A McDonagh
- Department of Cardiology, King's College Hospital London
- School of Cardiovascular Medicine and Sciences, King's College London British Heart Foundation Centre of Excellence, James Black Centre, London, UK
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26
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Porcari A, Merlo M, Baggio C, Gagno G, Cittar M, Barbati G, Paldino A, Castrichini M, Vitrella G, Pagnan L, Cannata A, Andreis A, Cecere A, Cipriani A, Raafs A, Bromage DI, Rosmini S, Scott P, Sado D, Di Bella G, Nucifora G, Marra MP, Heymans S, Imazio M, Sinagra G. 100 Global longitudinal strain by CMR improves prognostic stratification in acute myocarditis presenting with normal LVEF. Eur Heart J Suppl 2021. [DOI: 10.1093/eurheartj/suab132.046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Aims
Prognostic stratification of acute myocarditis (AM) presenting with normal left ventricular (LV) ejection fraction (EF) relies mostly on late gadolinium enhancement (LGE) at cardiac magnetic resonance (CMR) imaging. In this specific AM population, LV peak global longitudinal strain (LV-GLS) measured by feature tracking (FT) analysis might provide further prognostic information.
Methods and results
Data of patients undergoing CMR for clinically suspected AM in seven European Centres, between January 2013 and August 2020, were retrospectively analysed. Those patients fulfilling CMR Lake Louise Criteria (LLC) for the diagnosis of AM and presenting with normal LVEF (≥50%) were included. Patients presenting with heart failure (HF) or significant arrhythmic events, LVEF <50% or haemodynamic instability were excluded. CMR-LGE extent (localized vs. diffuse), localization (subepicardial vs. mid-wall), and distribution (anteroseptal vs. inferolateral) were visually assessed. LV-GLS was measured by dedicated software. The primary outcome was the first occurrence of an adverse cardiovascular event (ACE) including a composite of cardiac death, development of heart failure, life-threatening arrhythmias, or development of LVEF <50%. In patients experiencing more than one event, the first one was considered for the outcome analysis. Of 389 patients with clinically suspected AM, 256 (66%) had confirmed AM with LVEF ≥50% and were included. Median age was 36 years, 71% were males, median LVEF was 60%, and median LV-GLS −17.3%. CMR was performed at a median time of 4 (IQR: 2–12) days from hospital admission. At a median follow-up of 27 months, 24 (9%) patients experienced at least one ACE with development of LVEF <50% accounting for 17 [71%]. Compared to the others, patients experiencing ACEs had lower median LV-GLS values at baseline (−13.9% vs. −17.5%, P = 0.001). At Kaplan–Meier analysis, impaired LV-GLS (both considered as >-20% or quartiles), diffuse and mid-wall LGE were associated with a significantly higher rate of ACEs. LV-GLS remained independently associated with ACEs after adjustment for diffuse or mid-wall LGE as covariate at bivariable analysis.
Conclusions
In AM with LVEF ≥50%, LV-GLS provides independent prognostic value over LGE, improving risk stratification and providing a rationale for further studies of therapy in this cohort.
100 Figure
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Affiliation(s)
- Aldostefano Porcari
- Center for Diagnosis and Treatment of Cardiomyopathies, Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano-Isontina and University of Trieste, Trieste, Italy
| | - Marco Merlo
- Center for Diagnosis and Treatment of Cardiomyopathies, Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano-Isontina and University of Trieste, Trieste, Italy
| | - Chiara Baggio
- Center for Diagnosis and Treatment of Cardiomyopathies, Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano-Isontina and University of Trieste, Trieste, Italy
| | - Giulia Gagno
- Center for Diagnosis and Treatment of Cardiomyopathies, Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano-Isontina and University of Trieste, Trieste, Italy
| | - Marco Cittar
- Center for Diagnosis and Treatment of Cardiomyopathies, Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano-Isontina and University of Trieste, Trieste, Italy
| | - Giulia Barbati
- Biosatistics Unit, Department of Medical Sciences, University of Trieste, Trieste, Italy
| | - Alessia Paldino
- Center for Diagnosis and Treatment of Cardiomyopathies, Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano-Isontina and University of Trieste, Trieste, Italy
| | - Matteo Castrichini
- Center for Diagnosis and Treatment of Cardiomyopathies, Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano-Isontina and University of Trieste, Trieste, Italy
| | - Giancarlo Vitrella
- Center for Diagnosis and Treatment of Cardiomyopathies, Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano-Isontina and University of Trieste, Trieste, Italy
| | - Lorenzo Pagnan
- Department of Radiology, Azienda Sanitaria Universitaria Giuliano-Isontina, Trieste, Italy
| | - Antonio Cannata
- Center for Diagnosis and Treatment of Cardiomyopathies, Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano-Isontina and University of Trieste, Trieste, Italy
- Department of Cardiovascular Sciences, Faculty of Life Sciences and Medicine, King’s College, London, UK
- Department of Cardiology, King’s College Hospital NHS Foundation Trust, London, UK
| | - Alessandro Andreis
- University Cardiology, A.O.U. Città della Salute e Della Scienza di Torino, Turin, Italy
| | - Annagrazia Cecere
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Alberto Cipriani
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Anne Raafs
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, The Netherlands
| | - Daniel I Bromage
- Department of Cardiovascular Sciences, Faculty of Life Sciences and Medicine, King’s College, London, UK
- Department of Cardiology, King’s College Hospital NHS Foundation Trust, London, UK
| | - Stefania Rosmini
- Department of Cardiology, King’s College Hospital NHS Foundation Trust, London, UK
| | - Paul Scott
- Department of Cardiovascular Sciences, Faculty of Life Sciences and Medicine, King’s College, London, UK
| | - Daniel Sado
- Department of Cardiovascular Sciences, Faculty of Life Sciences and Medicine, King’s College, London, UK
| | | | - Gaetano Nucifora
- Northwest Cardiac Imaging Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Martina Perazzolo Marra
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Stephane Heymans
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, The Netherlands
| | - Massimo Imazio
- University Cardiology, A.O.U. Città della Salute e Della Scienza di Torino, Turin, Italy
| | - Gianfranco Sinagra
- Center for Diagnosis and Treatment of Cardiomyopathies, Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano-Isontina and University of Trieste, Trieste, Italy
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27
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Khan P, Jahagirdar N, Laybourn M, Harding I, Cannatà A, Bromage DI, Shabeeh H, Kabunga P, Petzer E, Murgatroyd F, Scott PA. Generic ICD programming and outcomes. Pacing Clin Electrophysiol 2021; 44:1995-2004. [PMID: 34672370 DOI: 10.1111/pace.14386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 10/02/2021] [Accepted: 10/17/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Generic ICD programming, where shock-reduction programming is extrapolated from trials of one manufacturer to another, may reduce non-essential ICD therapies beyond that seen in randomized trials. However, the benefits and risks are unknown. The purpose of this retrospective cohort study was to evaluate the impact of a standardized programming protocol, based on generic programming, across manufacturers. METHODS We included all new ICDs in a single center (2009-2019). In 2013 a standardized programming protocol based on generic programming was introduced, incorporating high detection rates (200 bpm for primary prevention) and long detection (30/40 or equivalent in VF zone) for all patients. Patients were classified into three groups based on implant programming: pre-guideline (PS), post-guideline and guideline compliant (GC) and post-guideline but not guideline compliant (NGC). The end-points were the first occurrence of any device therapy (ATP or shock), ICD shock, syncope and all-cause mortality. Survival analysis was used to evaluate outcomes. RESULTS 1003 patients were included (mean follow-up 1519 ± 1005 days). In primary prevention patients (n = 583) freedom from ICD therapy (91.5% vs. 73.6%, p < .001) or shock (94.7% vs 84.8%, p = .02) were significantly higher in GC compared to PS patients, without significant increase in syncope or mortality. In secondary prevention patients (n = 420) freedom from any ICD therapy or any shock were non-significantly higher in GC compared to PS patients, without an increase in syncope or mortality. CONCLUSIONS In primary prevention patients a standardized programming protocol, incorporating generic programming, reduced the burden of ICD therapy without an increase in adverse outcomes.
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Affiliation(s)
- Parisha Khan
- Department of Cardiology, King's College Hospital NHS Foundation Trust, London, UK
| | - Nishat Jahagirdar
- Department of Cardiology, King's College Hospital NHS Foundation Trust, London, UK
| | - Micaela Laybourn
- Department of Cardiology, King's College Hospital NHS Foundation Trust, London, UK
| | - Idris Harding
- Department of Cardiology, King's College Hospital NHS Foundation Trust, London, UK
| | - Antonio Cannatà
- Department of Cardiology, King's College Hospital NHS Foundation Trust, London, UK.,School of Cardiovascular Medicine and Sciences, King's College London, London, UK
| | - Daniel I Bromage
- Department of Cardiology, King's College Hospital NHS Foundation Trust, London, UK.,School of Cardiovascular Medicine and Sciences, King's College London, London, UK
| | - Husain Shabeeh
- Department of Cardiology, King's College Hospital NHS Foundation Trust, London, UK
| | - Peter Kabunga
- Department of Cardiology, King's College Hospital NHS Foundation Trust, London, UK
| | - Edward Petzer
- Department of Cardiology, King's College Hospital NHS Foundation Trust, London, UK
| | - Francis Murgatroyd
- Department of Cardiology, King's College Hospital NHS Foundation Trust, London, UK
| | - Paul A Scott
- Department of Cardiology, King's College Hospital NHS Foundation Trust, London, UK
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28
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Ta Anyu A, Badawy L, Cannata A, Bromage DI, Rind IA, Albarjas M, Piper S, Shah AM, McDonagh TA. Long-term outcomes after heart failure hospitalization during the COVID-19 pandemic: a multisite report from heart failure referral centers in London. ESC Heart Fail 2021; 8:4701-4704. [PMID: 34477319 PMCID: PMC8653039 DOI: 10.1002/ehf2.13579] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 07/24/2021] [Accepted: 08/11/2021] [Indexed: 12/16/2022] Open
Abstract
AIMS Patients hospitalized for heart failure (HF) had worse in-hospital outcomes during the first wave of the COVID-19 pandemic. However, their long-term outcomes are unknown. We describe long-term outcomes among patients who survived to hospital discharge compared with patients hospitalized in 2019 from two referral centers in London during the COVID-19 pandemic. METHODS AND RESULTS In total, 512 patients who survived their hospitalization for acute HF in two South London referral centers between 7 January and 14 June 2020 were included in the study and compared with 725 patients from the corresponding period in 2019. The primary outcome was all-cause mortality. The demographic characteristics of patients admitted in 2020 were similar to the 2019 cohort. Median (IQR) follow-up was 622 (348-691) days. All-cause mortality after discharge remained significantly higher for patients admitted in 2020 compared with the equivalent period in 2019 (P < 0.01), which may relate to observed differences in place of care with fewer patients being managed on specialist cardiology wards during the COVID-19 pandemic. CONCLUSION Hospitalization for HF during the first wave of the COVID-19 pandemic was associated with higher all-cause mortality among patients who survived to discharge. Further studies are necessary to identify predictors of these adverse outcomes to improve outpatient management during a critical period in the management of acute HF.
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Affiliation(s)
- Anawinla Ta Anyu
- Department of Cardiology, King's College Hospital London, Denmark Hill, Brixton, London, SE5 9RS, UK
| | - Layla Badawy
- Department of Cardiology, King's College Hospital London, Denmark Hill, Brixton, London, SE5 9RS, UK
| | - Antonio Cannata
- Department of Cardiology, King's College Hospital London, Denmark Hill, Brixton, London, SE5 9RS, UK.,School of Cardiovascular Medicine and Sciences, King's College London British Heart Foundation Centre of Excellence, London, UK
| | - Daniel I Bromage
- Department of Cardiology, King's College Hospital London, Denmark Hill, Brixton, London, SE5 9RS, UK.,School of Cardiovascular Medicine and Sciences, King's College London British Heart Foundation Centre of Excellence, London, UK
| | - Irfan A Rind
- School of Cardiovascular Medicine and Sciences, King's College London British Heart Foundation Centre of Excellence, London, UK
| | - Mohammad Albarjas
- Department of Cardiology, Princess Royal University Hospital, Kent, UK
| | - Susan Piper
- School of Cardiovascular Medicine and Sciences, King's College London British Heart Foundation Centre of Excellence, London, UK
| | - Ajay M Shah
- Department of Cardiology, King's College Hospital London, Denmark Hill, Brixton, London, SE5 9RS, UK.,School of Cardiovascular Medicine and Sciences, King's College London British Heart Foundation Centre of Excellence, London, UK
| | - Theresa A McDonagh
- Department of Cardiology, King's College Hospital London, Denmark Hill, Brixton, London, SE5 9RS, UK.,School of Cardiovascular Medicine and Sciences, King's College London British Heart Foundation Centre of Excellence, London, UK
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29
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Cannata A, Watson SA, Daniel A, Giacca M, Shah AM, McDonagh TA, Scott PA, Bromage DI. Impact of the COVID-19 pandemic on in-hospital mortality in cardiovascular disease: a meta-analysis. Eur J Prev Cardiol 2021; 29:1266-1274. [PMID: 34297822 PMCID: PMC8344916 DOI: 10.1093/eurjpc/zwab119] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 05/25/2021] [Accepted: 06/23/2021] [Indexed: 02/07/2023]
Abstract
Aims The COVID-19 pandemic has resulted in excess mortality due to both COVID-19 directly and other conditions, including cardiovascular (CV) disease. We aimed to explore the excess in-hospital mortality, unrelated to COVID-19 infection, across a range of CV diseases. Methods and results A systematic search was performed for studies investigating in-hospital mortality among patients admitted with CV disease without SARS-CoV-2 infection compared with a period outside the COVID-19 pandemic. Fifteen studies on 27 421 patients with CV disease were included in the analysis. The average in-hospital mortality rate was 10.4% (n = 974) in the COVID-19 group and 5.7% (n = 1026) in the comparator group. Compared with periods outside the COVID-19 pandemic, the pooled risk ratio (RR) demonstrated increased in-hospital mortality by 62% during COVID-19 [95% confidence interval (CI) 1.20–2.20, P = 0.002]. Studies with a decline in admission rate >50% during the COVID-19 pandemic observed the greatest increase in mortality compared with those with <50% reduction [RR 2.74 (95% CI 2.43–3.10) vs. 1.21 (95% CI 1.07–1.37), P < 0.001]. The observed increased mortality was consistent across different CV conditions (P = 0.74 for interaction). Conclusions In-hospital mortality among patients admitted with CV diseases was increased relative to periods outside the pandemic, independent of co-infection with COVID-19. This effect was larger in studies with the biggest decline in admission rates, suggesting a sicker cohort of patients in this period. However, studies were generally poorly conducted, and there is a need for further well-designed studies to establish the full extent of mortality not directly related to COVID-19 infection.
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Affiliation(s)
- Antonio Cannata
- School of Cardiovascular Medicine & Sciences, King's College London British Heart Foundation Centre of Excellence, 125 Coldharbour Lane, London SE5 9NU, UK.,Department of Cardiology, King's College Hospital NHS Foundation Trust, London, SE5 9RS, UK
| | - Samuel A Watson
- School of Cardiovascular Medicine & Sciences, King's College London British Heart Foundation Centre of Excellence, 125 Coldharbour Lane, London SE5 9NU, UK.,Department of Cardiology, King's College Hospital NHS Foundation Trust, London, SE5 9RS, UK
| | - Allen Daniel
- Department of Cardiology, King's College Hospital NHS Foundation Trust, London, SE5 9RS, UK
| | - Mauro Giacca
- School of Cardiovascular Medicine & Sciences, King's College London British Heart Foundation Centre of Excellence, 125 Coldharbour Lane, London SE5 9NU, UK
| | - Ajay M Shah
- School of Cardiovascular Medicine & Sciences, King's College London British Heart Foundation Centre of Excellence, 125 Coldharbour Lane, London SE5 9NU, UK
| | - Theresa A McDonagh
- Department of Cardiology, King's College Hospital NHS Foundation Trust, London, SE5 9RS, UK
| | - Paul A Scott
- Department of Cardiology, King's College Hospital NHS Foundation Trust, London, SE5 9RS, UK
| | - Daniel I Bromage
- School of Cardiovascular Medicine & Sciences, King's College London British Heart Foundation Centre of Excellence, 125 Coldharbour Lane, London SE5 9NU, UK.,Department of Cardiology, King's College Hospital NHS Foundation Trust, London, SE5 9RS, UK
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30
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Affiliation(s)
- Antonio Cannatà
- School of Cardiovascular Medicine and Sciences, King's College London British Heart Foundation Centre of Excellence, James Black Centre, London, UK.,Department of Cardiology, King's College Hospital London, London, UK
| | - Daniel I Bromage
- School of Cardiovascular Medicine and Sciences, King's College London British Heart Foundation Centre of Excellence, James Black Centre, London, UK.,Department of Cardiology, King's College Hospital London, London, UK
| | - Theresa A McDonagh
- School of Cardiovascular Medicine and Sciences, King's College London British Heart Foundation Centre of Excellence, James Black Centre, London, UK.,Department of Cardiology, King's College Hospital London, London, UK
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31
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Abstract
Acute myocarditis is an inflammatory condition of the heart characterised by cellular injury and the influx of leucocytes, including neutrophils, monocytes, macrophages and lymphocytes. While this response is vital for tissue repair, excessive scar deposition and maladaptive ventricular remodelling can result in a legacy of heart failure. It is increasingly recognised as a clinical phenomenon due, in part, to increased availability of cardiac magnetic resonance imaging in patients presenting with chest pain in the absence of significant coronary artery disease. Emerging epidemiological evidence has associated myocarditis with poor outcomes in the context of left ventricular impairment, and even when the left ventricle is preserved outcomes are less benign than once thought. Despite this, our understanding of the contribution of the inflammatory response to the pathophysiology of acute myocarditis lags behind that of acute myocardial infarction, which is the vanguard cardiovascular condition for inflammation research. We recently reviewed monocyte and macrophage phenotype and function in acute myocardial infarction, concluding that their plasticity and heterogeneity might account for conflicting evidence from attempts to target specific leucocyte subpopulations. Here, we revise our understanding of myocardial inflammation, which is predominantly derived from myocardial infarction research, review experimental evidence for the immune response in acute myocarditis, focusing on innate immunity, and discuss potential future directions for immunotherapy research in acute myocarditis.
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Affiliation(s)
- Abdullah Khawaja
- School of Cardiovascular Medicine and Sciences, King's College London British Heart Foundation Centre of Excellence, James Black Centre, 125 Coldharbour Lane, London, SE5 9NU, UK
| | - Daniel I Bromage
- School of Cardiovascular Medicine and Sciences, King's College London British Heart Foundation Centre of Excellence, James Black Centre, 125 Coldharbour Lane, London, SE5 9NU, UK.
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Peet C, Ivetic A, Bromage DI, Shah AM. Cardiac monocytes and macrophages after myocardial infarction. Cardiovasc Res 2021; 116:1101-1112. [PMID: 31841135 PMCID: PMC7177720 DOI: 10.1093/cvr/cvz336] [Citation(s) in RCA: 236] [Impact Index Per Article: 78.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 11/03/2019] [Accepted: 12/12/2019] [Indexed: 12/17/2022] Open
Abstract
Improvements in early interventions after acute myocardial infarction (AMI), notably, the increased use of timely reperfusion therapy, have increased survival dramatically in recent decades. Despite this, maladaptive ventricular remodelling and subsequent heart failure (HF) following AMI remain a significant clinical challenge, particularly because several pre-clinical strategies to attenuate remodelling have failed to translate into clinical practice. Monocytes and macrophages, pleiotropic cells of the innate immune system, are integral in both the initial inflammatory response to injury and subsequent wound healing in many tissues, including the heart. However, maladaptive immune cell behaviour contributes to ventricular remodelling in mouse models, prompting experimental efforts to modulate the immune response to prevent the development of HF. Seminal work in macrophage biology defined macrophages as monocyte-derived cells that are comprised of two populations, pro-inflammatory M1 macrophages and reparative M2 macrophages, and initial investigations into cardiac macrophage populations following AMI suggested they aligned well to this model. However, more recent data, in the heart and other tissues, demonstrate remarkable heterogeneity and plasticity in macrophage development, phenotype, and function. These recent insights into macrophage biology may explain the failure of non-specific immunosuppressive strategies and offer novel opportunities for therapeutic targeting to prevent HF following AMI. Here, we summarize the traditional monocyte-macrophage paradigm, experimental evidence for the significance of these cells in HF after AMI, and the potential relevance of emerging evidence that refutes canonical models of monocyte and macrophage biology.
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Affiliation(s)
- Claire Peet
- School of Cardiovascular Medicine and Sciences, James Black Centre, King's College London BHF Centre of Excellence, 125 Coldharbour Lane, London SE5 9NU, UK
| | - Aleksandar Ivetic
- School of Cardiovascular Medicine and Sciences, James Black Centre, King's College London BHF Centre of Excellence, 125 Coldharbour Lane, London SE5 9NU, UK
| | - Daniel I Bromage
- School of Cardiovascular Medicine and Sciences, James Black Centre, King's College London BHF Centre of Excellence, 125 Coldharbour Lane, London SE5 9NU, UK
| | - Ajay M Shah
- School of Cardiovascular Medicine and Sciences, James Black Centre, King's College London BHF Centre of Excellence, 125 Coldharbour Lane, London SE5 9NU, UK
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Cannatà A, Bromage DI, Rind IA, Gregorio C, Bannister C, Albarjas M, Piper S, Shah AM, McDonagh TA. Temporal trends in decompensated heart failure and outcomes during COVID-19: a multisite report from heart failure referral centres in London. Eur J Heart Fail 2020; 22:2219-2224. [PMID: 32809274 PMCID: PMC7461082 DOI: 10.1002/ejhf.1986] [Citation(s) in RCA: 91] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 08/06/2020] [Accepted: 08/09/2020] [Indexed: 12/21/2022] Open
Abstract
AIMS Admission rates for acute decompensated heart failure (HF) declined during the COVID-19 pandemic. However, the impact of this reduction on hospital mortality is unknown. We describe temporal trends in the presentation of patients with acute HF and their in-hospital outcomes at two referral centres in London during the COVID-19 pandemic. METHODS AND RESULTS A total of 1372 patients hospitalized for HF in two referral centres in South London between 7 January and 14 June 2020 were included in the study and their outcomes compared with those of equivalent patients of the same time period in 2019. The primary outcome was all-cause in-hospital mortality. The number of HF hospitalizations was significantly reduced during the COVID-19 pandemic, compared with 2019 (P < 0.001). Specifically, we observed a temporary reduction in hospitalizations during the COVID-19 peak, followed by a return to 2019 levels. Patients admitted during the COVID-19 pandemic had demographic characteristics similar to those admitted during the equivalent period in 2019. However, in-hospital mortality was significantly higher in 2020 than in 2019 (P = 0.015). Hospitalization in 2020 was independently associated with worse in-hospital mortality (hazard ratio 2.23, 95% confidence interval 1.34-3.72; P = 0.002). CONCLUSIONS During the COVID-19 pandemic there was a reduction in HF hospitalization and a higher rate of in-hospital mortality. Hospitalization for HF in 2020 is independently associated with more adverse outcomes. Further studies are required to investigate the predictors of these adverse outcomes to help inform potential changes to the management of HF patients while some constraints to usual care remain.
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Affiliation(s)
- Antonio Cannatà
- School of Cardiovascular Medicine and Sciences, King's College London British Heart Foundation Centre of Excellence, London, UK.,Department of Cardiology, King's College Hospital London, London, UK
| | - Daniel I Bromage
- School of Cardiovascular Medicine and Sciences, King's College London British Heart Foundation Centre of Excellence, London, UK.,Department of Cardiology, King's College Hospital London, London, UK
| | - Irfan A Rind
- Department of Cardiology, King's College Hospital London, London, UK
| | | | - Clare Bannister
- School of Cardiovascular Medicine and Sciences, King's College London British Heart Foundation Centre of Excellence, London, UK.,Department of Cardiology, King's College Hospital London, London, UK
| | - Mohammed Albarjas
- Department of Cardiology, Princess Royal University Hospital, Farnborough, UK
| | - Susan Piper
- Department of Cardiology, King's College Hospital London, London, UK
| | - Ajay M Shah
- School of Cardiovascular Medicine and Sciences, King's College London British Heart Foundation Centre of Excellence, London, UK.,Department of Cardiology, King's College Hospital London, London, UK
| | - Theresa A McDonagh
- School of Cardiovascular Medicine and Sciences, King's College London British Heart Foundation Centre of Excellence, London, UK.,Department of Cardiology, King's College Hospital London, London, UK
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Affiliation(s)
- Antonio Cannata
- King's College Hospital NHS Foundation Trust, London, UK.,School of Cardiovascular Medicine and Sciences, James Black Centre, King's College London BHF Centre of Excellence, 125 Coldharbour Lane, London SE5 9NU, UK
| | - Daniel I Bromage
- King's College Hospital NHS Foundation Trust, London, UK.,School of Cardiovascular Medicine and Sciences, James Black Centre, King's College London BHF Centre of Excellence, 125 Coldharbour Lane, London SE5 9NU, UK
| | - Theresa McDonagh
- King's College Hospital NHS Foundation Trust, London, UK.,School of Cardiovascular Medicine and Sciences, James Black Centre, King's College London BHF Centre of Excellence, 125 Coldharbour Lane, London SE5 9NU, UK
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Bromage DI, Cannatà A, Rind IA, Gregorio C, Piper S, Shah AM, McDonagh TA. The impact of COVID-19 on heart failure hospitalization and management: report from a Heart Failure Unit in London during the peak of the pandemic. Eur J Heart Fail 2020; 22:978-984. [PMID: 32478951 PMCID: PMC7300902 DOI: 10.1002/ejhf.1925] [Citation(s) in RCA: 139] [Impact Index Per Article: 34.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 05/22/2020] [Accepted: 05/27/2020] [Indexed: 01/08/2023] Open
Abstract
AIMS To examine the impact of COVID-19 on acute heart failure (AHF) hospitalization rates, clinical characteristics and management of patients admitted to a tertiary Heart Failure Unit in London during the peak of the pandemic. METHODS AND RESULTS Data from King's College Hospital, London, reported to the National Heart Failure Audit for England and Wales, between 2 March-19 April 2020 were compared both to a pre-COVID cohort and the corresponding time periods in 2017 to 2019 with respect to absolute hospitalization rates. Furthermore, we performed detailed comparison of patients hospitalized during the COVID-19 pandemic and patients presenting in the same period in 2019 with respect to clinical characteristics and management during the index admission. A significantly lower admission rate for AHF was observed during the study period compared to all other included time periods. Patients admitted during the COVID-19 pandemic had higher rates of New York Heart Association III or IV symptoms (96% vs. 77%, P = 0.03) and severe peripheral oedema (39% vs. 14%, P = 0.01). We did not observe any differences in inpatient management, including place of care and pharmacological management of heart failure with reduced ejection fraction. CONCLUSION Incident AHF hospitalization significantly declined in our centre during the COVID-19 pandemic, but hospitalized patients had more severe symptoms at admission. Further studies are needed to investigate whether the incidence of AHF declined or patients did not present to hospital while the national lockdown and social distancing restrictions were in place. From a public health perspective, it is imperative to ascertain whether this will be associated with worse long-term outcomes.
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Affiliation(s)
- Daniel I Bromage
- School of Cardiovascular Medicine and Sciences, King's College London British Heart Foundation Centre of Excellence, James Black Centre, London, UK.,Department of Cardiology, King's College Hospital London, London, UK
| | - Antonio Cannatà
- School of Cardiovascular Medicine and Sciences, King's College London British Heart Foundation Centre of Excellence, James Black Centre, London, UK.,Department of Cardiology, King's College Hospital London, London, UK
| | - Irfan A Rind
- Department of Cardiology, King's College Hospital London, London, UK
| | | | - Susan Piper
- Department of Cardiology, King's College Hospital London, London, UK
| | - Ajay M Shah
- School of Cardiovascular Medicine and Sciences, King's College London British Heart Foundation Centre of Excellence, James Black Centre, London, UK.,Department of Cardiology, King's College Hospital London, London, UK
| | - Theresa A McDonagh
- School of Cardiovascular Medicine and Sciences, King's College London British Heart Foundation Centre of Excellence, James Black Centre, London, UK.,Department of Cardiology, King's College Hospital London, London, UK.,NICOR National Heart Failure Audit Clinical Lead, London, UK
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Ziff OJ, Samra M, Howard JP, Bromage DI, Ruschitzka F, Francis DP, Kotecha D. Beta-blocker efficacy across different cardiovascular indications: an umbrella review and meta-analytic assessment. BMC Med 2020; 18:103. [PMID: 32366251 PMCID: PMC7199339 DOI: 10.1186/s12916-020-01564-3] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Accepted: 03/17/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Beta-blockers are widely used for many cardiovascular conditions; however, their efficacy in contemporary clinical practice remains uncertain. METHODS We performed a prospectively designed, umbrella review of meta-analyses of randomised controlled trials (RCTs) investigating the evidence of beta-blockers in the contemporary management of coronary artery disease (CAD), heart failure (HF), patients undergoing surgery or hypertension (registration: PROSPERO CRD42016038375). We searched MEDLINE, EMBASE and the Cochrane Library from inception until December 2018. Outcomes were analysed as beta-blockers versus control for all-cause mortality, myocardial infarction (MI), incident HF or stroke. Two independent investigators abstracted the data, assessed the quality of the evidence and rated the certainty of evidence. RESULTS We identified 98 meta-analyses, including 284 unique RCTs and 1,617,523 patient-years of follow-up. In CAD, 12 meta-analyses (93 RCTs, 103,481 patients) showed that beta-blockers reduced mortality in analyses before routine reperfusion, but there was a lack of benefit in contemporary studies where ≥ 50% of patients received thrombolytics or intervention. Beta-blockers reduced incident MI at the expense of increased HF. In HF with reduced ejection fraction, 34 meta-analyses (66 RCTs, 35,383 patients) demonstrated a reduction in mortality and HF hospitalisation with beta-blockers in sinus rhythm, but not in atrial fibrillation. In patients undergoing surgery, 23 meta-analyses (89 RCTs, 19,211 patients) showed no effect of beta-blockers on mortality for cardiac surgery, but increased mortality in non-cardiac surgery. In non-cardiac surgery, beta-blockers reduced MI after surgery but increased the risk of stroke. In hypertension, 27 meta-analyses (36 RCTs, 260,549 patients) identified no benefit versus placebo, but beta-blockers were inferior to other agents for preventing mortality and stroke. CONCLUSIONS Beta-blockers substantially reduce mortality in HF patients in sinus rhythm, but for other conditions, clinicians need to weigh up both benefit and potential risk.
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Affiliation(s)
- Oliver J Ziff
- University of Birmingham Institute of Cardiovascular Sciences, Medical School, Birmingham, B15 2TT, UK.,University College London, London, WC1E 6BT, UK
| | | | | | - Daniel I Bromage
- University College London, London, WC1E 6BT, UK.,Kings College London, London, WC2R 2LS, UK
| | | | | | - Dipak Kotecha
- University of Birmingham Institute of Cardiovascular Sciences, Medical School, Birmingham, B15 2TT, UK. .,Monash Centre of Cardiovascular Research & Education in Therapeutics, Monash University, Melbourne, Victoria, 3004, Australia. .,University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital, Institute of Translational Medicine, Birmingham, B15 2GW, UK.
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Bromage DI, Godec TR, Pujades-Rodriguez M, Gonzalez-Izquierdo A, Denaxas S, Hemingway H, Yellon DM. Metformin use and cardiovascular outcomes after acute myocardial infarction in patients with type 2 diabetes: a cohort study. Cardiovasc Diabetol 2019; 18:168. [PMID: 31815634 PMCID: PMC6900858 DOI: 10.1186/s12933-019-0972-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Accepted: 11/29/2019] [Indexed: 12/21/2022] Open
Abstract
Background The use of metformin after acute myocardial infarction (AMI) has been associated with reduced mortality in people with type 2 diabetes mellitus (T2DM). However, it is not known if it is acutely cardioprotective in patients taking metformin at the time of AMI. We compared patient outcomes according to metformin status at the time of admission for fatal and non-fatal AMI in a large cohort of patients in England. Methods This study used linked data from primary care, hospital admissions and death registry from 4.7 million inhabitants in England, as part of the CALIBER resource. The primary endpoint was a composite of acute myocardial infarction requiring hospitalisation, stroke and cardiovascular death. The secondary endpoints were heart failure (HF) hospitalisation and all-cause mortality. Results 4,030 patients with T2DM and incident AMI recorded between January 1998 and October 2010 were included. At AMI admission, 63.9% of patients were receiving metformin and 36.1% another oral hypoglycaemic drug. Median follow-up was 343 (IQR: 1–1436) days. Adjusted analyses showed an increased hazard of the composite endpoint in metformin users compared to non-users (HR 1.09 [1.01–1.19]), but not of the secondary endpoints. The higher risk of the composite endpoint in metformin users was only observed in people taking metformin at AMI admission, whereas metformin use post-AMI was associated with a reduction in risk of all-cause mortality (0.76 [0.62–0.93], P = 0.009). Conclusions Our study suggests that metformin use at the time of first AMI is associated with increased risk of cardiovascular disease and death in patients with T2DM, while its use post-AMI might be beneficial. Further investigation in well-designed randomised controlled trials is indicated, especially in view of emerging evidence of cardioprotection from sodium-glucose co-transporter-2 (SGLT2) inhibitors.
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Affiliation(s)
- Daniel I Bromage
- The Hatter Cardiovascular Institute, University College London, 67 Chenies Mews, London, WC1E 6HX, UK.,School of Cardiovascular Medicine and Sciences, King's College London British Heart Foundation Centre of Excellence, James Black Centre, 125 Coldharbour Lane, London, SE5 9NU, UK
| | - Tom R Godec
- The London School of Hygiene & Tropical Medicine, Keppel St, London, WC1E 7HT, UK
| | - Mar Pujades-Rodriguez
- Leeds Institute of Health Sciences, University of Leeds, Clarendon Way, Leeds, LS2 9JL, UK
| | - Arturo Gonzalez-Izquierdo
- Institute of Health Informatics, University College London, 222 Euston Road, London, NW1 2DA, UK.,Health Data Research UK London, University College London, 222 Euston Road, London, NW1 2DA, UK.,The National Institute for Health Research University College London Hospitals Biomedical Research Centre, University College London, 222 Euston Road, London, NW1 2DA, UK
| | - S Denaxas
- Institute of Health Informatics, University College London, 222 Euston Road, London, NW1 2DA, UK.,Health Data Research UK London, University College London, 222 Euston Road, London, NW1 2DA, UK.,The National Institute for Health Research University College London Hospitals Biomedical Research Centre, University College London, 222 Euston Road, London, NW1 2DA, UK
| | - Harry Hemingway
- Institute of Health Informatics, University College London, 222 Euston Road, London, NW1 2DA, UK.,Health Data Research UK London, University College London, 222 Euston Road, London, NW1 2DA, UK.,The National Institute for Health Research University College London Hospitals Biomedical Research Centre, University College London, 222 Euston Road, London, NW1 2DA, UK
| | - Derek M Yellon
- The Hatter Cardiovascular Institute, University College London, 67 Chenies Mews, London, WC1E 6HX, UK.
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Ziff OJ, Bromage DI, Yellon DM, Davidson SM. Therapeutic strategies utilizing SDF-1α in ischaemic cardiomyopathy. Cardiovasc Res 2019; 114:358-367. [PMID: 29040423 PMCID: PMC6005112 DOI: 10.1093/cvr/cvx203] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2017] [Accepted: 10/12/2017] [Indexed: 01/07/2023] Open
Abstract
Heart failure is rapidly increasing in prevalence and will redraw the global landscape for cardiovascular health. Alleviating and repairing cardiac injury associated with myocardial infarction (MI) is key to improving this burden. Homing signals mobilize and recruit stem cells to the ischaemic myocardium where they exert beneficial paracrine effects. The chemoattractant cytokine SDF-1α and its associated receptor CXCR4 are upregulated after MI and appear to be important in this context. Activation of CXCR4 promotes both cardiomyocyte survival and stem cell migration towards the infarcted myocardium. These effects have beneficial effects on infarct size, and left ventricular remodelling and function. However, the timing of endogenous SDF-1α release and CXCR4 upregulation may not be optimal. Furthermore, current ELISA-based assays cannot distinguish between active SDF-1α, and SDF-1α inactivated by dipeptidyl peptidase 4 (DPP4). Current therapeutic approaches aim to recruit the SDF-1α-CXCR4 pathway or prolong SDF-1α life-time by preventing its cleavage by DPP4. This review assesses the evidence supporting these approaches and proposes SDF-1α as an important confounder in recent studies of DPP4 inhibitors.
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Affiliation(s)
- Oliver J Ziff
- The Hatter Cardiovascular Institute, Institute of Cardiovascular Science, University College London, 67 Chenies Mews, London WC1E 6HX, UK
| | - Daniel I Bromage
- The Hatter Cardiovascular Institute, Institute of Cardiovascular Science, University College London, 67 Chenies Mews, London WC1E 6HX, UK
| | - Derek M Yellon
- The Hatter Cardiovascular Institute, Institute of Cardiovascular Science, University College London, 67 Chenies Mews, London WC1E 6HX, UK
| | - Sean M Davidson
- The Hatter Cardiovascular Institute, Institute of Cardiovascular Science, University College London, 67 Chenies Mews, London WC1E 6HX, UK
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Bromage DI, Taferner S, He Z, Ziff OJ, Yellon DM, Davidson SM. Stromal cell-derived factor-1α signals via the endothelium to protect the heart against ischaemia-reperfusion injury. J Mol Cell Cardiol 2019; 128:187-197. [PMID: 30738798 PMCID: PMC6408335 DOI: 10.1016/j.yjmcc.2019.02.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 01/18/2019] [Accepted: 02/06/2019] [Indexed: 12/31/2022]
Abstract
AIMS The chemokine stromal derived factor-1α (SDF-1α) is known to protect the heart acutely from ischaemia-reperfusion injury via its cognate receptor, CXCR4. However, the timing and cellular location of this effect, remains controversial. METHODS AND RESULTS Wild type male and female mice were subjected to 40 min LAD territory ischaemia in vivo and injected with either saline (control) or SDF-1α prior to 2 h reperfusion. Infarct size as a proportion of area at risk was assessed histologically using Evans blue and triphenyltetrazolium chloride. Our results confirm the cardioprotective effect of exogenous SDF-1α in mouse ischaemia-reperfusion injury and, for the first time, show protection when SDF-1α is delivered just prior to reperfusion, which has important therapeutic implications. The role of cell type was examined using the same in vivo ischaemia-reperfusion protocol in cardiomyocyte- and endothelial-specific CXCR4-null mice, and by Western blot analysis of endothelial cells treated in vitro. These experiments demonstrated that the acute infarct-sparing effect is mediated by endothelial cells, possibly via the signalling kinases Erk1/2 and PI3K/Akt. Unexpectedly, cardiomyocyte-specific deletion of CXCR4 was found to be cardioprotective per se. RNAseq analysis indicated altered expression of the mitochondrial protein co-enzyme Q10b in these mice. CONCLUSIONS Administration of SDF-1α is cardioprotective when administered prior to reperfusion and may, therefore, have clinical utility. SDF-1α-CXCR4-mediated cardioprotection from ischaemia-reperfusion injury is contingent on the cellular location of CXCR4 activation. Specifically, cardioprotection is mediated by endothelial signalling, while cardiomyocyte-specific deletion of CXCR4 has an infarct-sparing effect per se.
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Affiliation(s)
- Daniel I Bromage
- The Hatter Cardiovascular Institute, University College London, 67 Chenies Mews, London WC1E 6HX, UK
| | - Stasa Taferner
- The Hatter Cardiovascular Institute, University College London, 67 Chenies Mews, London WC1E 6HX, UK
| | - Zhenhe He
- The Hatter Cardiovascular Institute, University College London, 67 Chenies Mews, London WC1E 6HX, UK
| | - Oliver J Ziff
- The Hatter Cardiovascular Institute, University College London, 67 Chenies Mews, London WC1E 6HX, UK
| | - Derek M Yellon
- The Hatter Cardiovascular Institute, University College London, 67 Chenies Mews, London WC1E 6HX, UK.
| | - Sean M Davidson
- The Hatter Cardiovascular Institute, University College London, 67 Chenies Mews, London WC1E 6HX, UK
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Bromage DI, Santos CX, Shah AM. Developing potential biomarkers through bedside-to-bench translation. J Mol Cell Cardiol 2018; 133:209-210. [PMID: 30472252 DOI: 10.1016/j.yjmcc.2018.07.254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2018] [Accepted: 07/25/2018] [Indexed: 10/27/2022]
Affiliation(s)
- D I Bromage
- King's College London British Heart Foundation Centre of Excellence, London, UK
| | - C X Santos
- King's College London British Heart Foundation Centre of Excellence, London, UK
| | - A M Shah
- King's College London British Heart Foundation Centre of Excellence, London, UK.
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Davidson SM, Arjun S, Basalay MV, Bell RM, Bromage DI, Bøtker HE, Carr RD, Cunningham J, Ghosh AK, Heusch G, Ibanez B, Kleinbongard P, Lecour S, Maddock H, Ovize M, Walker M, Wiart M, Yellon DM. The 10th Biennial Hatter Cardiovascular Institute workshop: cellular protection-evaluating new directions in the setting of myocardial infarction, ischaemic stroke, and cardio-oncology. Basic Res Cardiol 2018; 113:43. [PMID: 30310998 PMCID: PMC6182684 DOI: 10.1007/s00395-018-0704-z] [Citation(s) in RCA: 64] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 10/04/2018] [Indexed: 12/13/2022]
Abstract
Due to its poor capacity for regeneration, the heart is particularly sensitive to the loss of contractile cardiomyocytes. The onslaught of damage caused by ischaemia and reperfusion, occurring during an acute myocardial infarction and the subsequent reperfusion therapy, can wipe out upwards of a billion cardiomyocytes. A similar program of cell death can cause the irreversible loss of neurons in ischaemic stroke. Similar pathways of lethal cell injury can contribute to other pathologies such as left ventricular dysfunction and heart failure caused by cancer therapy. Consequently, strategies designed to protect the heart from lethal cell injury have the potential to be applicable across all three pathologies. The investigators meeting at the 10th Hatter Cardiovascular Institute workshop examined the parallels between ST-segment elevation myocardial infarction (STEMI), ischaemic stroke, and other pathologies that cause the loss of cardiomyocytes including cancer therapeutic cardiotoxicity. They examined the prospects for protection by remote ischaemic conditioning (RIC) in each scenario, and evaluated impasses and novel opportunities for cellular protection, with the future landscape for RIC in the clinical setting to be determined by the outcome of the large ERIC-PPCI/CONDI2 study. It was agreed that the way forward must include measures to improve experimental methodologies, such that they better reflect the clinical scenario and to judiciously select combinations of therapies targeting specific pathways of cellular death and injury.
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Affiliation(s)
- Sean M Davidson
- The Hatter Cardiovascular Institute, Institute of Cardiovascular Science, University College London, 67 Chenies Mews, London, WC1E 6HX, UK
| | - Sapna Arjun
- The Hatter Cardiovascular Institute, Institute of Cardiovascular Science, University College London, 67 Chenies Mews, London, WC1E 6HX, UK
| | - Maryna V Basalay
- The Hatter Cardiovascular Institute, Institute of Cardiovascular Science, University College London, 67 Chenies Mews, London, WC1E 6HX, UK
| | - Robert M Bell
- The Hatter Cardiovascular Institute, Institute of Cardiovascular Science, University College London, 67 Chenies Mews, London, WC1E 6HX, UK
| | - Daniel I Bromage
- School of Cardiovascular Medicine and Sciences, King's College London British Heart Foundation Centre of Excellence, James Black Centre, 125 Coldharbour Lane, London, SE5 9NU, UK
| | - Hans Erik Bøtker
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
| | - Richard D Carr
- The Hatter Cardiovascular Institute, Institute of Cardiovascular Science, University College London, 67 Chenies Mews, London, WC1E 6HX, UK
- MSD A/S, Copenhagen, Denmark
| | - John Cunningham
- Centre for Nephrology, UCL Medical School, Royal Free Campus, Rowland Hill Street, London, NW3 2PF, UK
| | - Arjun K Ghosh
- The Hatter Cardiovascular Institute, Institute of Cardiovascular Science, University College London, 67 Chenies Mews, London, WC1E 6HX, UK
| | - Gerd Heusch
- West German Heart and Vascular Center, Institute for Pathophysiology, University of Essen Medical School, Essen, Germany
| | - Borja Ibanez
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
- CIBER de Enfermedades CardioVasculares, Madrid, Spain
- IIS-Fundación Jiménez Díaz University Hospital, Madrid, Spain
| | - Petra Kleinbongard
- West German Heart and Vascular Center, Institute for Pathophysiology, University of Essen Medical School, Essen, Germany
| | - Sandrine Lecour
- Cardioprotection Group, Hatter Institute for Cardiovascular Research in Africa, University of Cape Town, Cape Town, South Africa
| | - Helen Maddock
- Centre for Sport, Exercise and Life Sciences, Faculty of Health and Life Sciences, Coventry University, Priory Street, Coventry, CV1 5FB, UK
| | - Michel Ovize
- INSERM U1060, CarMeN Laboratory, Université de Lyon and Service d'explorations Fonctionnelles Cardiovasculaires Groupement Hospitalier Est, 59 Boulevard Pinel, 69500, Bron, France
| | - Malcolm Walker
- The Hatter Cardiovascular Institute, Institute of Cardiovascular Science, University College London, 67 Chenies Mews, London, WC1E 6HX, UK
| | - Marlene Wiart
- INSERM U1060, CarMeN Laboratory, Université de Lyon and Service d'explorations Fonctionnelles Cardiovasculaires Groupement Hospitalier Est, 59 Boulevard Pinel, 69500, Bron, France
- CNRS, Lyon, France
| | - Derek M Yellon
- The Hatter Cardiovascular Institute, Institute of Cardiovascular Science, University College London, 67 Chenies Mews, London, WC1E 6HX, UK.
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Bromage DI, Pickard JMJ, Rossello X, Ziff OJ, Burke N, Yellon DM, Davidson SM. Remote ischaemic conditioning reduces infarct size in animal in vivo models of ischaemia-reperfusion injury: a systematic review and meta-analysis. Cardiovasc Res 2017; 113:288-297. [PMID: 28028069 PMCID: PMC5408955 DOI: 10.1093/cvr/cvw219] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Accepted: 09/22/2016] [Indexed: 12/15/2022] Open
Abstract
Aims The potential of remote ischaemic conditioning (RIC) to ameliorate myocardial ischaemia-reperfusion injury (IRI) remains controversial. We aimed to analyse the pre-clinical evidence base to ascertain the overall effect and variability of RIC in animal in vivo models of myocardial IRI. Furthermore, we aimed to investigate the impact of different study protocols on the protective utility of RIC in animal models and identify gaps in our understanding of this promising therapeutic strategy. Methods and results Our primary outcome measure was the difference in mean infarct size between RIC and control groups in in vivo models of myocardial IRI. A systematic review returned 31 reports, from which we made 22 controlled comparisons of remote ischaemic preconditioning (RIPreC) and 21 of remote ischaemic perconditioning and postconditioning (RIPerC/RIPostC) in a pooled random-effects meta-analysis. In total, our analysis includes data from 280 control animals and 373 animals subject to RIC. Overall, RIPreC reduced infarct size as a percentage of area at risk by 22.8% (95% CI 18.8–26.9%), when compared with untreated controls (P < 0.001). Similarly, RIPerC/RIPostC reduced infarct size by 22.2% (95% CI 17.1–25.3%; P < 0.001). Interestingly, we observed significant heterogeneity in effect size (T2 = 92.9% and I2 = 99.4%; P < 0.001) that could not be explained by any of the experimental variables analysed by meta-regression. However, few reports have systematically characterized RIC protocols, and few of the included in vivo studies satisfactorily met study quality requirements, particularly with respect to blinding and randomization. Conclusions RIC significantly reduces infarct size in in vivo models of myocardial IRI. Heterogeneity between studies could not be explained by the experimental variables tested, but studies are limited in number and lack consistency in quality and study design. There is therefore a clear need for more well-performed in vivo studies with particular emphasis on detailed characterization of RIC protocols and investigating the potential impact of gender. Finally, more studies investigating the potential benefit of RIC in larger species are required before translation to humans.
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Affiliation(s)
| | | | | | | | | | - Derek M. Yellon
- Corresponding author. Tel: +44 203 447 9591; fax: +44 203 447 9818, E-mail:
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Dyson A, Dal-Pizzol F, Sabbatini G, Lach AB, Galfo F, dos Santos Cardoso J, Pescador Mendonça B, Hargreaves I, Bollen Pinto B, Bromage DI, Martin JF, Moore KP, Feelisch M, Singer M. Ammonium tetrathiomolybdate following ischemia/reperfusion injury: Chemistry, pharmacology, and impact of a new class of sulfide donor in preclinical injury models. PLoS Med 2017; 14:e1002310. [PMID: 28678794 PMCID: PMC5497958 DOI: 10.1371/journal.pmed.1002310] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Accepted: 04/26/2017] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Early revascularization of ischemic organs is key to improving outcomes, yet consequent reperfusion injury may be harmful. Reperfusion injury is largely attributed to excess mitochondrial production of reactive oxygen species (ROS). Sulfide inhibits mitochondria and reduces ROS production. Ammonium tetrathiomolybdate (ATTM), a copper chelator, releases sulfide in a controlled and novel manner, and may offer potential therapeutic utility. METHODS AND FINDINGS In vitro, ATTM releases sulfide in a time-, pH-, temperature-, and thiol-dependent manner. Controlled sulfide release from ATTM reduces metabolism (measured as oxygen consumption) both in vivo in awake rats and ex vivo in skeletal muscle tissue, with a superior safety profile compared to standard sulfide generators. Given intravenously at reperfusion/resuscitation to rats, ATTM significantly reduced infarct size following either myocardial or cerebral ischemia, and conferred survival benefit following severe hemorrhage. Mechanistic studies (in vitro anoxia/reoxygenation) demonstrated a mitochondrial site of action (decreased MitoSOX fluorescence), where the majority of damaging ROS is produced. CONCLUSIONS The inorganic thiometallate ATTM represents a new class of sulfide-releasing drugs. Our findings provide impetus for further investigation of this compound as a novel adjunct therapy for reperfusion injury.
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Affiliation(s)
- Alex Dyson
- Bloomsbury Institute for Intensive Care Medicine, Division of Medicine, University College London, London, United Kingdom
- Magnus Oxygen, London, United Kingdom
| | - Felipe Dal-Pizzol
- Bloomsbury Institute for Intensive Care Medicine, Division of Medicine, University College London, London, United Kingdom
- Laboratory of Experimental Pathophysiology, University of Southern Santa Catarina, Criciúma, Brazil
| | - Giovanni Sabbatini
- Bloomsbury Institute for Intensive Care Medicine, Division of Medicine, University College London, London, United Kingdom
| | - Anna B. Lach
- Bloomsbury Institute for Intensive Care Medicine, Division of Medicine, University College London, London, United Kingdom
- Magnus Oxygen, London, United Kingdom
| | - Federica Galfo
- Bloomsbury Institute for Intensive Care Medicine, Division of Medicine, University College London, London, United Kingdom
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | | | - Bruna Pescador Mendonça
- Laboratory of Experimental Pathophysiology, University of Southern Santa Catarina, Criciúma, Brazil
| | - Iain Hargreaves
- Department of Molecular Neuroscience, Institute of Neurology, University College London, London, United Kingdom
| | - Bernardo Bollen Pinto
- Bloomsbury Institute for Intensive Care Medicine, Division of Medicine, University College London, London, United Kingdom
| | - Daniel I. Bromage
- Hatter Cardiovascular Institute, University College London, London, United Kingdom
| | - John F. Martin
- Bloomsbury Institute for Intensive Care Medicine, Division of Medicine, University College London, London, United Kingdom
- Magnus Oxygen, London, United Kingdom
| | - Kevin P. Moore
- Institute for Liver and Digestive Health, University College London, London, United Kingdom
| | - Martin Feelisch
- Clinical and Experimental Sciences, Faculty of Medicine, Southampton General Hospital and Institute for Life Sciences, University of Southampton, Southampton, United Kingdom
| | - Mervyn Singer
- Bloomsbury Institute for Intensive Care Medicine, Division of Medicine, University College London, London, United Kingdom
- Magnus Oxygen, London, United Kingdom
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Bromage DI, Taferner S, Pillai M, Yellon DM, Davidson SM. A novel recombinant antibody specific to full-length stromal derived factor-1 for potential application in biomarker studies. PLoS One 2017; 12:e0174447. [PMID: 28379992 PMCID: PMC5381782 DOI: 10.1371/journal.pone.0174447] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Accepted: 03/09/2017] [Indexed: 11/21/2022] Open
Abstract
Background Stromal derived factor-1α (SDF-1α/CXCL12) is a chemokine that is up-regulated in diseases characterised by tissue hypoxia, including myocardial infarction, ischaemic cardiomyopathy and remote ischaemic conditioning (RIC), a technique of cyclical, non-injurious ischaemia applied remote from the heart that protects the heat from lethal ischaemia-reperfusion injury. Accordingly, there is considerable interest in SDF-1α as a potential biomarker of such conditions. However, SDF-1α is rapidly degraded and inactivated by dipeptidyl peptidase 4 and other peptidases, and the kinetics of intact SDF-1α remain unknown. Methods & results To facilitate investigation of full-length SDF-1α we established an ELISA using a novel recombinant human antibody we developed called HCI.SDF1. HCI.SDF1 is specific to the N-terminal sequence of all isoforms of SDF-1 and has a comparable KD to commercially available antibodies. Together with a detection antibody specific to the α-isoform, HCI.SDF1 was used to specifically quantify full-length SDF-1α in blood for the first time. Using RIC applied to the hind limb of Sprague-Dawley rats or the arms of healthy human volunteers, we demonstrate an increase in SDF-1α using a commercially available antibody, as previously reported, but an unexpected decrease in full-length SDF-1α after RIC in both species. Conclusions We report for the first time the development of a novel recombinant antibody specific to full-length SDF-1. Applied to RIC, we demonstrate a significant decrease in SDF-1α that is at odds with the literature and suggests a need to investigate the kinetics of full-length SDF-1α in conditions characterised by tissue hypoxia.
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Affiliation(s)
- Daniel I. Bromage
- The Hatter Cardiovascular Institute, University College London, London, United Kingdom
| | - Stasa Taferner
- The Hatter Cardiovascular Institute, University College London, London, United Kingdom
| | - Mahesh Pillai
- The Hatter Cardiovascular Institute, University College London, London, United Kingdom
| | - Derek M. Yellon
- The Hatter Cardiovascular Institute, University College London, London, United Kingdom
| | - Sean M. Davidson
- The Hatter Cardiovascular Institute, University College London, London, United Kingdom
- * E-mail:
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Davidson SM, He Z, Dyson A, Bromage DI, Yellon DM. Ventilation strategy has a major influence on remote ischaemic preconditioning in mice. J Cell Mol Med 2017; 21:2426-2431. [PMID: 28374972 PMCID: PMC5618711 DOI: 10.1111/jcmm.13164] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Accepted: 02/16/2017] [Indexed: 12/03/2022] Open
Abstract
Whether oxygen should be administered acutely during ST‐segment elevation myocardial infarction is debated. Despite this controversy, the possible influence of supplementary oxygen on animal models of ischaemia–reperfusion injury or cardioprotection is rarely considered. We used an in vivo mouse model of ischaemia and reperfusion to investigate the effect of ventilation with room air versus 100% oxygen. The coronary artery of anaesthetized mice was occluded for 40 min. followed by 2‐hrs reperfusion. Infarct size was measured by tetrazolium staining and expressed as a percentage of area at risk, determined using Evan's blue. Unexpectedly, infarct size in mice ventilated with 100% oxygen was significantly smaller than in those ventilated with room air (33 ± 5% versus 46 ± 3%; n = 6; P < 0.01). We tested a standard protocol of 3 × 5 min. cycles of remote ischaemic preconditioning (RIPC) and found this was unable to protect mice ventilated with 100% oxygen. RIPC protocols using 2.5‐ or 10‐min. occlusion were similarly ineffective in mice ventilated with oxygen. Similar disparate results were obtained with direct cardiac ischaemic preconditioning. In contrast, pharmacological protection using bradykinin administered at reperfusion was effective even in mice ventilated with 100% oxygen, reducing infarct size from 33 ± 5% to 21 ± 3% (n = 4–6; P < 0.01). Laser speckle contrast imaging of blood flow and direct pO2 measurements were made in the hindlimb, but these measurements did not correlate with protection. In conclusion, ventilation protocol can have a major influence on infarct size and ischaemic preconditioning protocols in mice.
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Affiliation(s)
- Sean M Davidson
- The Hatter Cardiovascular Institute, University College London, London, UK
| | - Zhenhe He
- The Hatter Cardiovascular Institute, University College London, London, UK
| | - Alex Dyson
- Magnus Sciences, University College London, London, UK
| | - Daniel I Bromage
- The Hatter Cardiovascular Institute, University College London, London, UK
| | - Derek M Yellon
- The Hatter Cardiovascular Institute, University College London, London, UK
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Andre E, Yaniz-Galende E, Hamilton C, Dusting GJ, Hellen N, Poulet CE, Diez Cunado M, Smits AM, Lowe V, Eckardt D, Du Pre B, Sanz Ruiz R, Moerkamp AT, Tribulova N, Smani T, Liskova YV, Greco S, Guzzolino E, Franco D, Lozano-Velasco E, Knorr M, Pavoine C, Bukowska A, Van Linthout S, Miteva K, Sulzgruber P, Latet SC, Portnychenko A, Cannavo A, Kamilova U, Sagach VF, Santin Y, Octavia Y, Haller PM, Octavia Y, Rubies C, Dei Zotti F, Wong KHK, Gonzalez Miqueo A, Kruithof BPT, Kadur Nagaraju C, Shaposhnikova Y, Songia P, Lindner D, Wilson C, Benzoni P, Fabbri A, Campostrini G, Jorge E, Casini S, Mengarelli I, Nikolov A, Bublikov DS, Kheloufi M, Rubies C, Walker RE, Van Dijk RA, Posthuma JJ, Dumitriu IE, Karshovska E, Sakic A, Alexandru N, Martin-Lorenzo M, Molica F, Taylor RF, Mcarthur L, Crocini C, Matsuyama TA, Mazzoni L, Lin WK, Owen TJ, Scigliano M, Sheehan A, Bezerra Gurgel AR, Bromage DI, Kiss A, Ikeda G, Pickard JMJ, Wirth G, Casos K, Khudiakov A, Nistal JF, Ferrantini C, Park SJ, Di Maggio S, Gentile F, Dini L, Buyandelger B, Larrasa-Alonso J, Schirmer I, Chin SH, Cimiotti D, Martini H, Hohensinner PJ, Garabito M, Zeni F, Licholai S, De Bortoli M, Sivitskaya L, Viczenczova C, Rainer PP, Smith LE, Suna G, Gambardella J, Cozma A, De Gonzalo Calvo D, Scoditti E, Clark BJ, Mansfield C, Eckardt D, Gomez L, Llucia-Valldeperas A, De Pauw A, Porporato P, Bouzin C, Draoui N, Sonveaux P, Balligand JL, Mougenot N, Formicola L, Nadaud S, Dierick F, Hajjar RJ, Marazzi G, Sassoon D, Hulot JS, Zamora VR, Burton FL, Macquaide N, Smith GL, Hernandez D, Sivakumaran P, Millard R, Wong RCB, Pebay A, Shepherd RK, Lim SY, Owen T, Jabbour RJ, Kloc M, Kodagoda T, Denning C, Harding SE, Ramos S, Terracciano C, Gorelik J, Wei K, Bushway P, Ruiz-Lozano P, Mercola M, Moerkamp AT, Vegh AMD, Dronkers E, Lodder K, Van Herwaarden T, Goumans MJ, Pellet-Many C, Zachary I, Noack K, Bosio A, Feyen DAM, Demkes EJ, Dierickx PJ, Doevendans PA, Vos MA, Van Veen AAB, Van Laake LW, Fernandez Santos ME, Suarez Sancho S, Fuentes Arroyo L, Plasencia Martin V, Velasco Sevillano P, Casado Plasencia A, Climent AM, Guillem M, Atienza Fernandez F, Fernandez-Aviles F, Dingenouts CKE, Lodder K, Kruithof BPT, Van Herwaarden T, Vegh AMD, Goumans MJ, Smits AM, Knezl V, Szeiffova Bacova B, Egan Benova T, Viczenczova C, Goncalvesova E, Slezak J, Calderon-Sanchez E, Diaz I, Ordonez A, Salikova SP, Zaccagnini G, Voellenkle C, Sadeghi I, Maimone B, Castelvecchio S, Gaetano C, Menicanti L, Martelli F, Hatcher C, D'aurizio R, Groth M, Baugmart M, Mercatanti A, Russo F, Mariani L, Magliaro C, Pitto L, Lozano-Velasco E, Jodar-Garcia A, Galiano-Torres J, Lopez-Navarrete I, Aranega A, Wagensteen R, Quesada A, Aranega A, Franco D, Finger S, Karbach S, Kossmann S, Muenzel T, Wenzel P, Keck M, Mougenot N, Favier S, Fuand A, Atassi F, Barbier C, Lompre AM, Hulot JS, Nikonova Y, Pluteanu F, Kockskaemper J, Chilukoti RK, Wolke C, Lendeckel U, Gardemann A, Goette A, Miteva K, Pappritz K, Mueller I, El-Shafeey M, Ringe J, Tschoepe C, Pappritz K, El-Shafeey M, Ringe J, Tschoepe C, Van Linthout S, Koller L, Richter B, Blum S, Koprak M, Huelsmann M, Pacher R, Goliasch G, Wojta J, Niessner A, Van Herck PL, Claeys MJ, Haine SE, Lenders GD, Miljoen HP, Segers VF, Vandendriescche TR, Hoymans VY, Vrints CJ, Lapikova-Bryhinska T, Gurianova V, Portnichenko H, Vasylenko M, Zapara Y, Portnichenko V, Liccardo D, Lymperopoulos A, Santangelo M, Leosco D, Koch WJ, Ferrara N, Rengo G, Alieva T, Rasulova Z, Masharipova D, Dorofeyeva NA, Drachuk KO, Sicard P, Yucel Y, Dutaur M, Vindis C, Parini A, Mialet-Perez J, Van Deel ED, De Boer M, De Waard MC, Duncker DJ, Nagel F, Inci M, Santer D, Hallstroem S, Podesser BK, Kararigas G, De Boer M, Kietadisorn R, Swinnen M, Duimel H, Verheyen F, Chrifi I, Brandt MM, Cheng C, Janssens S, Moens AL, Duncker DJ, Batlle M, Dantas AP, Sanz M, Sitges M, Mont L, Guasch E, Lobysheva I, Beauloye C, Balligand JL, Vanhoutte PM, Tang EHC, Beaumont J, Lopez B, Ravassa S, Hermida N, Valencia F, Gomez-Doblas JJ, San Jose G, De Teresa E, Diez J, Van De Merbel AF, Kruithof-De Julio M, Goumans MJ, Claus P, Dries E, Angelo Singh A, Vermeulen K, Roderick HL, Sipido KR, Driesen RB, Ilchenko I, Bobronnikova L, Myasoedova V, Alamanni F, Tremoli E, Poggio P, Becher PM, Gotzhein F, Klingel K, Blankenberg S, Westermann D, Zi M, Cartwright E, Campostrini G, Bonzanni M, Milanesi R, Bucchi A, Baruscotti M, Difrancesco D, Barbuti A, Fantini M, Wilders R, Severi S, Benzoni P, Dell' Era P, Serzanti M, Olesen MS, Muneretto C, Bisleri G, Difrancesco D, Baruscotti M, Bucchi A, Barbuti A, Amoros-Figueras G, Raga S, Campos B, Alonso-Martin C, Rodriguez-Font E, Vinolas X, Cinca J, Guerra JM, Mengarelli I, Schumacher CA, Veldkamp MW, Verkerk AO, Remme CA, Veerman C, Guan K, Stauske M, Tan H, Barc J, Wilde A, Verkerk A, Bezzina C, Tsinlikov I, Tsinlikova I, Nicoloff G, Blazhev A, Garev A, Andrienko AV, Lychev VG, Vorobova EN, Anchugina DA, Vion AC, Hammoutene A, Poisson J, Dupont N, Souyri M, Tedgui A, Codogno P, Boulanger CM, Rautou PE, Dantas AP, Batlle M, Guasch E, Torres M, Montserrat JM, Almendros I, Mont L, Austin CA, Holt CM, Rijs K, Wezel A, Hamming JF, Kolodgie FD, Virmani R, Schaapherder AF, Lindeman JHN, Posma JJN, Van Oerle R, Spronk HMH, Ten Cate H, Dinkla S, Kaski JC, Schober A, Chaabane C, Ambartsumian N, Grigorian M, Bochaton-Piallat ML, Dragan E, Andrei E, Niculescu L, Georgescu A, Gonzalez-Calero L, Maroto AS, Martinez PJ, Heredero A, Aldamiz-Echevarria G, Vivanco F, Alvarez-Llamas G, Meens MJ, Pelli G, Foglia B, Scemes E, Kwak BR, Caldwell JL, Eisner DA, Dibb KM, Trafford AW, Chilton L, Smith GL, Nicklin SA, Coppini R, Ferrantini C, Yan P, Loew LM, Poggesi C, Cerbai E, Pavone FS, Sacconi L, Tanaka H, Ishibashi-Ueda H, Takamatsu T, Coppini R, Ferrantini C, Gentile F, Pioner JM, Santini L, Sartiani L, Bargelli V, Poggesi C, Mugelli A, Cerbai E, Maciejewska M, Bolton EL, Wang Y, O'brien F, Ruas M, Lei M, Sitsapesan R, Galione A, Terrar DA, Smith JG, Garcia D, Barriales-Villa R, Monserrat L, Harding SE, Denning C, Marston SB, Watson S, Tkach S, Faggian G, Terracciano CM, Perbellini F, Eiros Zamora J, Papadaki M, Messer A, Marston S, Gould I, Johnston A, Dunne M, Smith G, Kemi OJ, Pillai M, Davidson SM, Yellon DM, Tratsiakovich Y, Jang J, Gonon AT, Pernow J, Matoba T, Koga J, Egashira K, Burke N, Davidson SM, Yellon DM, Korpisalo P, Hakkarainen H, Laidinen S, Yla-Herttuala S, Ferrer-Curriu G, Perez M, Permanyer E, Blasco-Lucas A, Gracia JM, Castro MA, Barquinero J, Galinanes M, Kostina D, Kostareva A, Malashicheva A, Merino D, Ruiz L, Gomez J, Juarez C, Gil A, Garcia R, Hurle MA, Coppini R, Pioner JM, Gentile F, Mazzoni L, Rossi A, Tesi C, Belardinelli L, Olivotto I, Cerbai E, Mugelli A, Poggesi C, Eun-Ji EJ, Lim BK, Choi DJ, Milano G, Bertolotti M, De Marchis F, Zollo F, Sommariva E, Capogrossi MC, Pompilio G, Bianchi ME, Raucci A, Pioner JM, Coppini R, Scellini B, Tardiff J, Tesi C, Poggesi C, Ferrantini C, Mazzoni L, Sartiani L, Coppini R, Diolaiuti L, Ferrari P, Cerbai E, Mugelli A, Mansfield C, Luther P, Knoell R, Villalba M, Sanchez-Cabo F, Lopez-Olaneta MM, Ortiz-Sanchez P, Garcia-Pavia P, Lara-Pezzi E, Klauke B, Gerdes D, Schulz U, Gummert J, Milting H, Wake E, Kocsis-Fodor G, Brack KE, Ng GA, Kostareva A, Smolina N, Majchrzak M, Moehner D, Wies A, Milting H, Stehle R, Pfitzer G, Muegge A, Jaquet K, Maggiorani D, Lefevre L, Dutaur M, Mialet-Perez J, Parini A, Cussac D, Douin-Echinard V, Ebenbauer B, Kaun C, Prager M, Wojta J, Rega-Kaun G, Costa G, Onetti Y, Jimenez-Altayo F, Vila E, Dantas AP, Milano G, Bertolotti M, Scopece A, Piacentini L, Bianchi ME, Capogrossi MC, Pompilio G, Colombo G, Raucci A, Blaz M, Kapelak B, Sanak M, Bauce B, Calore C, Lorenzon A, Calore M, Poloni G, Mazzotti E, Rigato I, Daliento L, Basso C, Thiene G, Melacini P, Corrado D, Rampazzo A, Danilenko NG, Vaikhanskaya TG, Davydenko OG, Szeiffova Bacova B, Kura B, Egan Benova T, Yin CH, Kukreja R, Slezak J, Tribulova N, Lee DI, Sorge M, Glabe C, Paolocci N, Guarnieri C, Tomaselli GF, Kass DA, Van Eyk JE, Agnetti G, Cordwell SJ, White MY, Wojakowski W, Lynch M, Barallobre-Barreiro J, Yin X, Mayr U, White S, Jahingiri M, Hill J, Mayr M, Sorriento D, Ciccarelli M, Fiordelisi A, Campiglia P, Trimarco B, Iaccarino G, Sitar Taut AV, Schiau S, Orasan O, Halloumi W, Negrean V, Zdrenghea D, Pop D, Van Der Meer RW, Rijzewijk LJ, Smit JWA, Revuelta-Lopez E, Nasarre L, Escola-Gil JC, Lamb HJ, Llorente-Cortes V, Pellegrino M, Massaro M, Carluccio MA, Calabriso N, Wabitsch M, Storelli C, De Caterina R, Church SJ, Callagy S, Begley P, Kureishy N, Mcharg S, Bishop PN, Unwin RD, Cooper GJS, Mawad D, Perbellini F, Tonkin J, Bello SO, Simonotto JD, Lyon AR, Stevens MM, Terracciano CM, Harding SE, Kernbach M, Czichowski V, Bosio A, Fuentes L, Hernandez-Redondo I, Guillem MS, Fernandez ME, Sanz R, Atienza F, Climent AM, Fernandez-Aviles F, Soler-Botija C, Prat-Vidal C, Galvez-Monton C, Roura S, Perea-Gil I, Bragos R, Bayes-Genis A. Poster session 1Cell growth, differentiation and stem cells - Heart72Understanding the metabolism of cardiac progenitor cells: a first step towards controlling their proliferation and differentiation?73Expression of pw1/peg3 identifies a new cardiac adult stem cell population involved in post-myocardial infarction remodeling74Long-term stimulation of iPS-derived cardiomyocytes using optogenetic techniques to promote phenotypic changes in E-C coupling75Benefits of electrical stimulation on differentiation and maturation of cardiomyocytes from human induced pluripotent stem cells76Constitutive beta-adrenoceptor-mediated cAMP production controls spontaneous automaticity of human induced pluripotent stem cell-derived cardiomyocytes77Formation and stability of T-tubules in cardiomyocytes78Identification of miRNAs promoting human cardiomyocyte proliferation by regulating Hippo pathway79A direct comparison of foetal to adult epicardial cell activation reveals distinct differences relevant for the post-injury response80Role of neuropilins in zebrafish heart regeneration81Highly efficient immunomagnetic purification of cardiomyocytes derived from human pluripotent stem cells82Cardiac progenitor cells posses a molecular circadian clock and display large 24-hour oscillations in proliferation and stress tolerance83Influence of sirolimus and everolimus on bone marrow-derived mesenchymal stem cell biology84Endoglin is important for epicardial behaviour following cardiac injuryCell death and apoptosis - Heart87Ultrastructural alterations reflecting Ca2+ handling and cell-to-cell coupling disorders precede occurrence of severe arrhythmias in intact animal heart88Urocortin-1 promotes cardioprotection through ERK1/2 and EPAC pathways: role in apoptosis and necrosis89Expression p38 MAPK and Cas-3 in myocardium LV of rats with experimental heart failure at melatonin and enalapril introductionTranscriptional control and RNA species - Heart92Accumulation of beta-amyloid 1-40 in HF patients: the role of lncRNA BACE1-AS93Role of miR-182 in zebrafish and mouse models of Holt-Oram syndrome94Mir-27 distinctly regulates muscle-enriched transcription factors and growth factors in cardiac and skeletal muscle cells95AF risk factors impair PITX2 expression leading to Wnt-microRNA-ion channel remodelingCytokines and cellular inflammation - Heart98Post-infarct survival depends on the interplay of monocytes, neutrophils and interferon gamma in a mouse model of myocardial Infarction99Inflammatory cd11b/c cells play a protective role in compensated cardiac hypertrophy by promoting an orai3-related pro-survival signal100Anti-inflammatory effects of endothelin receptor blockade in the atrial tissue of spontaneously hypertensive rats101Mesenchymal stromal cells reduce NLRP3 inflammasome activity in Coxsackievirus B3-induced myocarditis102Mesenchymal stromal cells modulate monocytes trafficking in Coxsackievirus B3-induced myocarditis103The impact of regulatory T lymphocytes on long-term mortality in patients with chronic heart failure104Temporal dynamics of dendritic cells after ST-elevation myocardial infarction relate with improvement of myocardial functionGrowth factors and neurohormones - Heart107Preconditioning of hypertrophied heart: miR-1 and IGF-1 crosstalk108Modulation of catecholamine secretion from human adrenal chromaffin cells by manipulation of G protein-coupled receptor kinase-2 activity109Evaluation of cyclic adenosin-3,5- monophosphate and neurohormones in patients with chronic heart failureNitric oxide and reactive oxygen species - Heart112Hydrogen sulfide donor inhibits oxidative and nitrosative stress, cardiohemodynamics disturbances and restores cNOS coupling in old rats113Role and mechanisms of action of aldehydes produced by monoamine oxidase A in cardiomyocyte death and heart failure114Exercise training has contrasting effects in myocardial infarction and pressure-overload due to different endothelial nitric oxide synthase regulation115S-Nitroso Human Serum Albumin dose-dependently leads to vasodilation and alters reactive hyperaemia in coronary arteries of an isolated mouse heart model116Modulating endothelial nitric oxide synthase with folic acid attenuates doxorubicin-induced cardiomyopathy119Effects of long-term very high intensity exercise on aortic structure and function in an animal model120Electron paramagnetic resonance spectroscopy quantification of nitrosylated hemoglobin (HbNO) as an index of vascular nitric oxide bioavailability in vivo121Deletion of repressor activator protein 1 impairs acetylcholine-induced relaxation due to production of reactive oxygen speciesExtracellular matrix and fibrosis - Heart124MicroRNA-19b is associated with myocardial collagen cross-linking in patients with severe aortic stenosis. Potential usefulness as a circulating biomarker125A new ex vivo model to study cardiac fibrosis126Heterogeneity of fibrosis and fibroblast differentiation in the left ventricle after myocardial infarction127Effect of carbohydrate metabolism degree compensation to the level of galectin-3 changes in hypertensive patients with chronic heart failure and type 2 diabetes mellitus128Statin paradox in association with calcification of bicuspid aortic valve interstitial cells129Cardiac function remains impaired despite reversible cardiac fibrosis after healed experimental viral myocarditisIon channels, ion exchangers and cellular electrophysiology - Heart132Identifying a novel role for PMCA1 (Atp2b1) in heart rhythm instability133Mutations of the caveolin-3 gene as a predisposing factor for cardiac arrhythmias134The human sinoatrial node action potential: time for a computational model135iPSC-derived cardiomyocytes as a model to dissect ion current alterations of genetic atrial fibrillation136Postextrasystolic potentiation in healthy and diseased hearts: effects of the site of origin and coupling interval of the preceding extrasystole137Absence of Nav1.8-based (late) sodium current in rabbit cardiomyocytes and human iPSC-CMs138hiPSC-derived cardiomyocytes from Brugada Syndrome patients without identified mutations do not exhibit cellular electrophysiological abnormalitiesMicrocirculation141Atherogenic indices, collagen type IV turnover and the development of microvascular complications- study in diabetics with arterial hypertension142Changes in the microvasculature and blood viscosity in women with rheumatoid arthritis, hypercholesterolemia and hypertensionAtherosclerosis145Shear stress regulates endothelial autophagy: consequences on endothelial senescence and atherogenesis146Obstructive sleep apnea causes aortic remodeling in a chronic murine model147Aortic perivascular adipose tissue displays an aged phenotype in early and late atherosclerosis in ApoE-/- mice148A systematic evaluation of the cellular innate immune response during the process of human atherosclerosis149Inhibition of Coagulation factor Xa increases plaque stability and attenuates the onset and progression of atherosclerotic plaque in apolipoprotein e-deficient mice150Regulatory CD4+ T cells from patients with atherosclerosis display pro-inflammatory skewing and enhanced suppression function151Hypoxia-inducible factor (HIF)-1alpha regulates macrophage energy metabolism by mediating miRNAs152Extracellular S100A4 is a key player of smooth muscle cell phenotypic transition: implications in atherosclerosis153Microparticles of healthy origins improve atherosclerosis-associated endothelial progenitor cell dysfunction via microRNA transfer154Arterial remodeling and metabolism impairment in early atherosclerosis155Role of pannexin1 in atherosclerotic plaque formationCalcium fluxes and excitation-contraction coupling158Amphiphysin II induces tubule formation in cardiac cells159Interleukin 1 beta regulation of connexin 43 in cardiac fibroblasts and the effects of adult cardiac myocyte:fibroblast co-culture on myocyte contraction160T-tubular electrical defects contribute to blunted beta-adrenergic response in heart failure161Beat-to-beat variability of intracellular Ca2+ dynamics of Purkinje cells in the infarct border zone of the mouse heart revealed by rapid-scanning confocal microscopy162The efficacy of late sodium current blockers in hypertrophic cardiomyopathy is dependent on genotype: a study on transgenic mouse models with different mutations163Synthesis of cADPR and NAADP by intracellular CD38 in heart: role in inotropic and arrhythmogenic effects of beta-adrenoceptor signalingContractile apparatus166Towards an engineered heart tissue model of HCM using hiPSC expressing the ACTC E99K mutation167Diastolic mechanical load delays structural and functional deterioration of ultrathin adult heart slices in culture168Structural investigation of the cardiac troponin complex by molecular dynamics169Exercise training restores myocardial and oxidative skeletal muscle function from myocardial infarction heart failure ratsOxygen sensing, ischaemia and reperfusion172A novel antibody specific to full-length stromal derived factor-1 alpha reveals that remote conditioning induces its cleavage by endothelial dipeptidyl peptidase 4173Attenuation of myocardial and vascular arginase activity by vagal nerve stimulation via a mechanism involving alpha-7 nicotinic receptor during cardiac ischemia and reperfusion174Novel nanoparticle-mediated medicine for myocardial ischemia-reperfusion injury simultaneously targeting mitochondrial injury and myocardial inflammation175Acetylcholine plays a key role in myocardial ischaemic preconditioning via recruitment of intrinsic cardiac ganglia176The role of nitric oxide and VEGFR-2 signaling in post ischemic revascularization and muscle recovery in aged hypercholesterolemic mice177Efficacy of ischemic preconditioning to protect the human myocardium: the role of clinical conditions and treatmentsCardiomyopathies and fibrosis180Plakophilin-2 haploinsufficiency leads to impaired canonical Wnt signaling in ARVC patient181Improved technique for customized, easier, safer and more reliable transverse aortic arch banding and debanding in mice as a model of pressure overload hypertrophy182Late sodium current inhibitors for the treatment of inducible obstruction and diastolic dysfunction in hypertrophic cardiomyopathy: a study on human myocardium183Angiotensin II receptor antagonist fimasartan has protective role of left ventricular fibrosis and remodeling in the rat ischemic heart184Role of High-Mobility Group Box 1 (HMGB1) redox state on cardiac fibroblasts activities and heart function after myocardial infarction185Atrial remodeling in hypertrophic cardiomyopathy: insights from mouse models carrying different mutations in cTnT186Electrophysiological abnormalities in ventricular cardiomyocytes from a Maine Coon cat with hypertrophic cardiomyopathy: effects of ranolazine187ZBTB17 is a novel cardiomyopathy candidate gene and regulates autophagy in the heart188Inhibition of SRSF4 in cardiomyocytes induces left ventricular hypertrophy189Molecular characterization of a novel cardiomyopathy related desmin frame shift mutation190Autonomic characterisation of electro-mechanical remodeling in an in-vitro leporine model of heart failure191Modulation of Ca2+-regulatory function by three novel mutations in TNNI3 associated with severe infant restrictive cardiomyopathyAging194The aging impact on cardiac mesenchymal like stromal cells (S+P+)195Reversal of premature aging markers after bariatric surgery196Sex-associated differences in vascular remodeling during aging: role of renin-angiotensin system197Role of the receptor for advanced glycation end-products (RAGE) in age dependent left ventricle dysfunctionsGenetics and epigenetics200hsa-miR-21-5p as a key factor in aortic remodeling during aneurysm formation201Co-inheritance of mutations associated with arrhythmogenic and hypertrophic cardiomyopathy in two Italian families202Lamin a/c hot spot codon 190: form various amino acid substitutions to clinical effects203Treatment with aspirin and atorvastatin attenuate cardiac injury induced by rat chest irradiation: Implication of myocardial miR-1, miR-21, connexin-43 and PKCGenomics, proteomics, metabolomics, lipidomics and glycomics206Differential phosphorylation of desmin at serines 27 and 31 drives the accumulation of preamyloid oligomers in heart failure207Potential role of kinase Akt2 in the reduced recovery of type 2 diabetic hearts subjected to ischemia / reperfusion injury208A proteomics comparison of extracellular matrix remodelling in porcine coronary arteries upon stent implantationMetabolism, diabetes mellitus and obesity211Targeting grk2 as therapeutic strategy for cancer associated to diabetes212Effects of salbutamol on large arterial stiffness in patients with metabolic syndrome213Circulating microRNA-1 and microRNA-133a: potential biomarkers of myocardial steatosis in type 2 diabetes mellitus214Anti-inflammatory nutrigenomic effects of hydroxytyrosol in human adipocytes - protective mechanisms of mediterranean diets in obesity-related inflammation215Alterations in the metal content of different cardiac regions within a rat model of diabetic cardiomyopathyTissue engineering218A novel conductive patch for application in cardiac tissue engineering219Establishment of a simplified and improved workflow from neonatal heart dissociation to cardiomyocyte purification and characterization220Effects of flexible substrate on cardiomyocytes cell culture221Mechanical stretching on cardiac adipose progenitors upregulates sarcomere-related genes. Cardiovasc Res 2016. [DOI: 10.1093/cvr/cvw135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Bromage DI, Jones DA, Rathod KS, Grout C, Iqbal MB, Lim P, Jain A, Kalra SS, Crake T, Astroulakis Z, Ozkor M, Rakhit RD, Knight CJ, Dalby MC, Malik IS, Mathur A, Redwood S, MacCarthy PA, Wragg A. Outcome of 1051 Octogenarian Patients With ST-Segment Elevation Myocardial Infarction Treated With Primary Percutaneous Coronary Intervention: Observational Cohort From the London Heart Attack Group. J Am Heart Assoc 2016; 5:JAHA.115.003027. [PMID: 27353606 PMCID: PMC4937253 DOI: 10.1161/jaha.115.003027] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Background ST‐segment elevation myocardial infarction is increasingly common in octogenarians, and optimal management in this cohort is uncertain. This study aimed to describe the outcomes of octogenarians with ST‐segment elevation myocardial infarction treated by primary percutaneous coronary intervention. Methods and Results We analyzed 10 249 consecutive patients with ST‐segment elevation myocardial infarction treated with primary percutaneous coronary intervention between 2005 and 2011 at 8 tertiary cardiac centers across London, United Kingdom. The primary end point was all‐cause mortality at a median follow‐up of 3 years. In total, 1051 patients (10.3%) were octogenarians, with an average age of 84.2 years, and the proportion increased over the study period (P=0.04). In‐hospital mortality (7.7% vs 2.4%, P<0.0001) and long‐term mortality (51.6% vs 12.8%, P<0.0001) were increased in octogenarians compared with patients aged <80 years, and age was an independent predictor of mortality in a fully adjusted model (hazard ratio 1.07, 95% CI 1.07–1.09, P<0.0001). Time‐stratified analysis revealed an increasingly elderly and more complex cohort over time. Nonetheless, long‐term mortality rates among octogenarians remained static over time, and this may be attributable to improved percutaneous coronary intervention techniques, including significantly higher rates of radial access and lower bleeding complications. Variables associated with bleeding complications were similar between octogenarian and younger cohorts. Conclusions In this large registry, octogenarians undergoing primary percutaneous coronary intervention had a higher rate of complications and mortality compared with a younger population. Over time, octogenarians undergoing primary percutaneous coronary intervention increased in number, age, and complexity. Nevertheless, in‐hospital outcomes were reasonable, and long‐term mortality rates were static.
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Affiliation(s)
- Daniel I Bromage
- The Hatter Cardiovascular Institute, University College London, London, UK
| | - Daniel A Jones
- Barts Health NHS Trust, St Bartholomew's Hospital, London, UK
| | | | - Claire Grout
- Barts Health NHS Trust, St Bartholomew's Hospital, London, UK
| | - M Bilal Iqbal
- Royal Brompton & Harefield NHS Foundation Trust, Harefield Hospital, Middlesex, UK
| | - Pitt Lim
- St. George's Healthcare NHS Foundation Trust, St. George's Hospital, London, UK
| | - Ajay Jain
- Barts Health NHS Trust, St Bartholomew's Hospital, London, UK
| | - Sundeep S Kalra
- Kings College Hospital, King's College Hospital NHS Foundation Trust, London, UK
| | - Tom Crake
- UCL Hospitals NHS Foundation Trust, Heart Hospital, London, UK
| | - Zoe Astroulakis
- St. George's Healthcare NHS Foundation Trust, St. George's Hospital, London, UK
| | - Mick Ozkor
- UCL Hospitals NHS Foundation Trust, Heart Hospital, London, UK
| | | | | | - Miles C Dalby
- Royal Brompton & Harefield NHS Foundation Trust, Harefield Hospital, Middlesex, UK
| | - Iqbal S Malik
- Imperial College Healthcare NHS Foundation Trust, Hammersmith Hospital, London, UK
| | - Anthony Mathur
- Barts Health NHS Trust, St Bartholomew's Hospital, London, UK
| | - Simon Redwood
- BHF Centre of Excellence, King's College London, St. Thomas Hospital, London, UK
| | - Philip A MacCarthy
- Kings College Hospital, King's College Hospital NHS Foundation Trust, London, UK
| | - Andrew Wragg
- Barts Health NHS Trust, St Bartholomew's Hospital, London, UK
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Rathod KS, Jones DA, Bromage DI, Gallagher SM, Rathod VS, Kennon S, Knight C, Rothman MT, Mathur A, Smith E, Jain AK, Archbold RA, Wragg A. Radial primary percutaneous coronary intervention is independently associated with decreased long-term mortality in high-risk ST-elevation myocardial infarction patients. J Cardiovasc Med (Hagerstown) 2016; 16:170-7. [PMID: 25634086 DOI: 10.2459/jcm.0000000000000230] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIM To compare long-term clinical outcomes in patients with ST-elevation myocardial infarction (STEMI) treated by primary percutaneous coronary intervention (PPCI) using radial and femoral arterial access. METHODS AND RESULTS The present study was an observational cohort study of patients with STEMI treated consecutively with PPCI between 2004 and 2011 at a single centre. The primary end point was all-cause mortality at a median follow-up of 3 years.Among 2727 patients, 1600 (58.7%) underwent PPCI via the femoral route. The femoral group was older (64.7 vs. 61.7 years; P < 0.0001), and had higher rates of diabetes (18.6% vs. 16.0%; P < 0.0001), previous PCI (11.2 vs. 7.8%; P = 0.004), previous myocardial infarction (15.3 vs. 8.3%; P < 0.0001) and cardiogenic shock (9.8 vs. 1.3%; P < 0.0001). Bleeding complications were more frequent in the femoral group (4.7 vs. 1.2%; P < 0.0001). The 5-year death rate was significantly higher in the femoral group than in the radial group (10.4 vs. 3.0%; P < 0.0001). After adjustment for confounding variables, bleeding complications [heart rate 2.07 (95% confidence interval 1.05-4.08)] and femoral access [heart rate 1.60 (95% confidence interval 1.02-2.53)] were independent predictors of all-cause mortality. After stratification using the propensity score, excess long-term mortality in patients treated via the femoral approach was predominantly in patients with a high baseline risk of death. CONCLUSION Patients undergoing PPCI via the femoral route are at a higher risk of adverse short-term and long-term outcomes than patients undergoing PPCI via the radial route. Patients with a high baseline risk may benefit most from radial access, and future outcome studies should focus on the most at-risk patients.
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Affiliation(s)
- Krishnaraj S Rathod
- aDepartment of Cardiology, London Chest Hospital bDepartment of Clinical Pharmacology, William Harvey Research Institute, Queen Mary University cNIHR Cardiovascular Biomedical Research Unit, London Chest Hospital, London, UK
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Bromage DI, Pillai M, Davidson SM, Yellon DM. 28 Remote ischaemic conditioning involves signalling via CXCR4 but does not increase circulating levels of its known ligands. Heart 2015. [DOI: 10.1136/heartjnl-2015-308734.28] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Malik A, Bromage DI, He Z, Candilio L, Hamarneh A, Taferner S, Davidson SM, Yellon DM. Exogenous SDF-1α Protects Human Myocardium from Hypoxia-Reoxygenation Injury via CXCR4. Cardiovasc Drugs Ther 2015; 29:589-592. [PMID: 26482377 PMCID: PMC4674527 DOI: 10.1007/s10557-015-6622-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- A Malik
- The Hatter Cardiovascular Institute, University College London, 67 Chenies Mews, London, WC1E 6HX, UK
| | - D I Bromage
- The Hatter Cardiovascular Institute, University College London, 67 Chenies Mews, London, WC1E 6HX, UK
| | - Z He
- The Hatter Cardiovascular Institute, University College London, 67 Chenies Mews, London, WC1E 6HX, UK
| | - L Candilio
- The Hatter Cardiovascular Institute, University College London, 67 Chenies Mews, London, WC1E 6HX, UK
| | - A Hamarneh
- The Hatter Cardiovascular Institute, University College London, 67 Chenies Mews, London, WC1E 6HX, UK
| | - S Taferner
- The Hatter Cardiovascular Institute, University College London, 67 Chenies Mews, London, WC1E 6HX, UK
| | - S M Davidson
- The Hatter Cardiovascular Institute, University College London, 67 Chenies Mews, London, WC1E 6HX, UK
| | - D M Yellon
- The Hatter Cardiovascular Institute, University College London, 67 Chenies Mews, London, WC1E 6HX, UK.
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