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Forssten MP, Mohammad Ismail A, Ioannidis I, Ribeiro MAF, Cao Y, Sarani B, Mohseni S. Prioritizing patients for hip fracture surgery: the role of frailty and cardiac risk. Front Surg 2024; 11:1367457. [PMID: 38525320 PMCID: PMC10957751 DOI: 10.3389/fsurg.2024.1367457] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 02/19/2024] [Indexed: 03/26/2024] Open
Abstract
Introduction The number of patients with hip fractures continues to rise as the average age of the population increases. Optimizing outcomes in this cohort is predicated on timely operative repair. The aim of this study was to determine if patients with hip fractures who are frail or have a higher cardiac risk suffer from an increased risk of in-hospital mortality when surgery is postponed >24 h. Methods All patients registered in the 2013-2021 TQIP dataset who were ≥65 years old and underwent surgical fixation of an isolated hip fracture caused by a ground-level fall were included. Adjustment for confounding was performed using inverse probability weighting (IPW) while stratifying for frailty with the Orthopedic Frailty Score (OFS) and cardiac risk using the Revised Cardiac Risk Index (RCRI). The outcome was presented as the absolute risk difference in in-hospital mortality. Results A total of 254,400 patients were included. After IPW, all confounders were balanced. A delay in surgery was associated with an increased risk of in-hospital mortality across all strata, and, as the degree of frailty and cardiac risk increased, so too did the risk of mortality. In patients with OFS ≥4, delaying surgery >24 h was associated with a 2.33 percentage point increase in the absolute mortality rate (95% CI: 0.57-4.09, p = 0.010), resulting in a number needed to harm (NNH) of 43. Furthermore, the absolute risk of mortality increased by 4.65 percentage points in patients with RCRI ≥4 who had their surgery delayed >24 h (95% CI: 0.90-8.40, p = 0.015), resulting in a NNH of 22. For patients with OFS 0 and RCRI 0, the corresponding NNHs when delaying surgery >24 h were 345 and 333, respectively. Conclusion Delaying surgery beyond 24 h from admission increases the risk of mortality for all geriatric hip fracture patients. The magnitude of the negative impact increases with the patient's level of cardiac risk and frailty. Operative intervention should not be delayed based on frailty or cardiac risk.
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Affiliation(s)
- Maximilian Peter Forssten
- Department of Orthopedic Surgery, Faculty of Medicine and Health, Orebro University, Orebro, Sweden
- School of Medical Sciences, Orebro University, Orebro, Sweden
| | - Ahmad Mohammad Ismail
- Department of Orthopedic Surgery, Faculty of Medicine and Health, Orebro University, Orebro, Sweden
- School of Medical Sciences, Orebro University, Orebro, Sweden
| | - Ioannis Ioannidis
- Department of Orthopedic Surgery, Faculty of Medicine and Health, Orebro University, Orebro, Sweden
- School of Medical Sciences, Orebro University, Orebro, Sweden
| | - Marcelo A. F. Ribeiro
- Pontifical Catholic University of São Paulo, São Paulo, Brazil
- Khalifa University and Gulf Medical University, Abu Dhabi, United Arab Emirates
- Department of Surgery, Sheikh Shakhbout Medical City, Abu Dhabi, United Arab Emirates
| | - Yang Cao
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Faculty of Medicine and Health, Orebro University, Orebro, Sweden
| | - Babak Sarani
- Division of Trauma and Acute Care Surgery, George Washington University School of Medicine & Health Sciences, Washington, DC, United States
| | - Shahin Mohseni
- School of Medical Sciences, Orebro University, Orebro, Sweden
- Department of Surgery, Sheikh Shakhbout Medical City, Abu Dhabi, United Arab Emirates
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Perez-Gutierrez A, McGill RL, Juengel B, Bachul PJ, Danz DN, Josephson M, Chung BB, Nguyen A, Fung JJ, Barth RN, Becker YT. The Seattle Heart Failure Model in Kidney Transplant Recipients. J Clin Med 2023; 12:7614. [PMID: 38137683 PMCID: PMC10743453 DOI: 10.3390/jcm12247614] [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: 10/15/2023] [Revised: 12/01/2023] [Accepted: 12/06/2023] [Indexed: 12/24/2023] Open
Abstract
Cardiovascular disease is the leading cause of mortality following kidney transplantation. Heart failure affects 17-21% of patients with chronic kidney disease and increases along with time receiving dialysis. The Seattle Heart Failure Model (SHFM) is a validated mortality risk model for heart failure patients that incorporates clinical, therapeutic, and laboratory parameters but does not include measures of kidney function. We applied the SHFM to patients with end-stage renal disease (ESRD) who were being evaluated for kidney transplantation to determine if the model was associated with post-transplant mortality. This retrospective single-center study analyzed survival among 360 adult deceased-donor kidney transplant recipients. Cox regression was used to model post-transplant patient survival. Our findings indicated that a 1.0-point increase in the adapted SHFM score was significantly associated with post-transplant mortality (HR 1.76, 95% CI = 1.10-2.83, p = 0.02), independently of the Kidney Donor Profile Index and Estimated Post-Transplant Survival. Individual covariates of the SHFM were evaluated in univariate analyses, and age, sodium, cholesterol, and lymphocyte count were significantly related to mortality. This study provides preliminary evidence that an adapted SHFM score could be a useful tool in evaluating mortality risk post-transplant in patients with ESRD.
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Affiliation(s)
| | - Rita L. McGill
- Section of Nephrology, Department of Medicine, University of Chicago, Chicago, IL 60637, USA
| | - Braden Juengel
- Department of Surgery, Transplant Institute, University of Chicago, Chicago, IL 60637, USA
| | - Piotr J. Bachul
- Department of Surgery, Transplant Institute, University of Chicago, Chicago, IL 60637, USA
| | - David N. Danz
- Department of Economics, University of Pittsburgh, Pittsburgh, PA 15260, USA
| | - Michelle Josephson
- Section of Nephrology, Department of Medicine, University of Chicago, Chicago, IL 60637, USA
| | - Ben B. Chung
- Section of Cardiology, Department of Medicine, University of Chicago, Chicago, IL 60637, USA
| | - Ann Nguyen
- Section of Cardiology, Department of Medicine, University of Chicago, Chicago, IL 60637, USA
| | - John J. Fung
- Department of Surgery, Transplant Institute, University of Chicago, Chicago, IL 60637, USA
| | - Rolf N. Barth
- Department of Surgery, Transplant Institute, University of Chicago, Chicago, IL 60637, USA
| | - Yolanda T. Becker
- Department of Surgery, Transplant Institute, University of Chicago, Chicago, IL 60637, USA
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Djokic I, Milicic B, Matic P, Ilijevski N, Milojevic M, Jovic M. Enhancing predictive accuracy of the cardiac risk score in open abdominal aortic surgery: the role of left ventricular wall motion abnormalities. Front Cardiovasc Med 2023; 10:1239153. [PMID: 38107265 PMCID: PMC10722257 DOI: 10.3389/fcvm.2023.1239153] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 11/20/2023] [Indexed: 12/19/2023] Open
Abstract
Background Open abdominal aortic surgery carries many potential complications, with cardiac adverse events being the most significant concern. The Vascular Study Group Cardiac Risk Index (VSG-CRI) is a commonly used tool for predicting severe cardiac complications and guiding clinical decision-making. However, despite the potential prognostic significance of left ventricular wall motion abnormalities (LVWMAs) and reduced LV ejection fraction (LVEF) for adverse outcomes, the VSG-CRI model has not accounted for them. Hence, the main objective of this study was to analyze the added value of LV wall motion on the discriminatory power of the modified VSG-CRI in predicting major postoperative cardiac complications. Methods A prospective study was conducted involving 271 patients who underwent elective abdominal aortic surgery between 2019 and 2021. VSG-CRI scores were calculated, and preoperative transthoracic echocardiography was conducted for all patients. Subsequently, a modified version of the VSG-CRI, accounting for reduced LVEF and LVWMAs, was developed and incorporated into the dataset. The postoperative incidence of the composite endpoint of major adverse cardiac events (MACEs), including myocardial infarction, clinically relevant arrhythmias treated with medicaments or by cardioversion, or congestive heart failure, was assessed at discharge from the index hospitalization, with adjudicators blinded to events. The predictive accuracy of both the original and modified VSG-CRI was assessed using C-Statistics. Results In total, 61 patients (22.5%) experienced MACEs. Among these patients, a significantly higher proportion had preoperative LVWMAs compared to those without (62.3% vs. 32.9%, p < 0.001). Multivariable regression analysis revealed the VSG-CRI [odds ratio (OR) 1.46, 95% confidence interval (CI) 1.21-1.77; p < 0.001] and LVWMA (OR 2.76; 95% CI 1.46-5.23; p = 0.002) as independent predictors of MACEs. Additionally, the modified VSG-CRI model demonstrated superior predictability compared to the baseline VSG-CRI model, suggesting an improved predictive performance for anticipating MACEs following abdominal aortic surgery [area under the curve (AUC) 0.74; 95% CI 0.68-0.81 vs. AUC 0.70; 95% CI 0.63-0.77; respectively]. Conclusion The findings of this study suggest that incorporating preoperative echocardiography can enhance the predictive accuracy of the VSG-CRI for predicting MACEs after open abdominal aortic surgery. Before its implementation in clinical settings, external validation is necessary to confirm the generalizability of this newly developed predictive model across different populations.
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Affiliation(s)
- Ivana Djokic
- Clinic for Anesthesia and Intensive Care, Dedinje Cardiovascular Institute, Belgrade, Serbia
| | - Biljana Milicic
- Department of Medical Statistics and Informatics, Faculty of Dental Medicine, University of Belgrade, Belgrade, Serbia
| | - Predrag Matic
- Clinic for Vascular Surgery, Dedinje Cardiovascular Institute, Belgrade, Serbia
- School of Medicine, Belgrade University, Belgrade, Serbia
| | - Nenad Ilijevski
- Clinic for Vascular Surgery, Dedinje Cardiovascular Institute, Belgrade, Serbia
- School of Medicine, Belgrade University, Belgrade, Serbia
| | - Milan Milojevic
- Department of Cardiovascular Research, Dedinje Cardiovascular Institute, Belgrade, Serbia
| | - Miomir Jovic
- Clinic for Anesthesia and Intensive Care, Dedinje Cardiovascular Institute, Belgrade, Serbia
- School of Medicine, Belgrade University, Belgrade, Serbia
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Bailly M, Courtehoux M, Metrard G, Angoulvant D, Ribeiro MJ. Dynamic CZT-SPECT: Characterizing the Lower Values of Myocardial Blood Flow and Reserve. Clin Nucl Med 2023; 48:969-970. [PMID: 37756437 PMCID: PMC10581433 DOI: 10.1097/rlu.0000000000004849] [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: 04/12/2023] [Revised: 07/14/2023] [Indexed: 09/29/2023]
Abstract
ABSTRACT CZT-SPECT myocardial perfusion enables quantification of myocardial blood flow (MBF). Normal values and thresholds have been accurately defined in PET but remain unclear in SPECT. The aim of this study was to report normal MBF and myocardial flow reserve values in very low-risk patients referred for coronary artery disease screening with dynamic SPECT, in comparison with patients experiencing coronary artery disease. Eighty-four patients (31 male) were analyzed. The mean 10 years risk of fatal cardiovascular events score was 2.7% ± 1.4%. The mean global stress MBF and myocardial flow reserve were 1.6 ± 0.6 mL/min/g and 2.7 ± 0.7.
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Affiliation(s)
- Matthieu Bailly
- From the Nuclear Medicine Department, CHR Orleans
- UPR 4301, CBM, CNRS Orleans, Orleans
| | | | - Gilles Metrard
- From the Nuclear Medicine Department, CHR Orleans
- UPR 4301, CBM, CNRS Orleans, Orleans
| | | | - Maria Joao Ribeiro
- Nuclear Medicine Department
- UMR 1253, iBrain, Université de Tours, Inserm, Tours, France
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Trivedi V, Ladha KS, Jivraj NK, Saskin R, Thorpe KE, Wijeysundera DN, Cuthbertson BH. Association between preoperative cardiac risk assessment and health care costs in major noncardiac surgery: a multicentre health economic analysis. Can J Anaesth 2023; 70:1340-1349. [PMID: 37430180 DOI: 10.1007/s12630-023-02519-x] [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: 12/08/2022] [Revised: 02/08/2023] [Accepted: 02/09/2023] [Indexed: 07/12/2023] Open
Abstract
PURPOSE Patients with impaired functional capacity who undergo major surgery are at increased risk of postoperative morbidity including complications and increased length of stay. These outcomes have been associated with increased hospital and health system costs. We aimed to assess whether common preoperative risk indices are associated with postoperative cost. METHODS We conducted a health economic analysis focused on the subset of Measurement of Exercise Tolerance before Surgery (METS) study participants in Ontario, Canada. Participants were scheduled for major elective noncardiac surgery and underwent several preoperative assessments of cardiac risk, including physicians' subjective assessment, Duke Activity Status Index (DASI) questionnaire, peak oxygen consumption, and N-terminal pro-B-type natriuretic peptide concentration. Using linked health administrative data, postoperative costs were calculated for both one year and in-hospital. Using multiple regression models, we tested for association between the preoperative measures of cardiac risk and postoperative costs. RESULTS Our study included 487 patients (mean [standard deviation] age 68 [11] yr and 47.0% female) who underwent noncardiac surgery between 13 June 2013 and 8 March 2016. Overall, the median [interquartile range] cost incurred within one year postoperatively was CAD 27,587 [13,902-32,590], of which CAD 12,928 [10,253-12,810] were incurred in-hospital and CAD 14,497 [10,917-15,017] were incurred by 30 days. None of the four preoperative measures of cardiac risk assessment were associated with costs incurred in hospital or at one year postoperatively. This lack of strong association persisted in sensitivity analyses considering type of surgical procedure, burden of preoperative cost, and when costs were categorized as quantiles. CONCLUSION In patients undergoing major noncardiac surgery, common measures of functional capacity are not consistently associated with total postoperative cost. Until further data exist that differ from this analysis, clinicians and health care funders should not assume that preoperative measures of cardiac risk are associated with annual health care or hospital costs for such surgeries.
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Affiliation(s)
- Vatsal Trivedi
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada
- Institute for Better Health, Trillium Health Partners, Mississauga, ON, Canada
| | - Karim S Ladha
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada
- Department of Anesthesia, St Michael's Hospital, Toronto, ON, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada
| | - Naheed K Jivraj
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada
| | - Refik Saskin
- Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
| | - Kevin E Thorpe
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Duminda N Wijeysundera
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada
- Department of Anesthesia, St Michael's Hospital, Toronto, ON, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada
| | - Brian H Cuthbertson
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada.
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada.
- Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, 2075 Bayview Ave., Toronto, ON, M4N 3M5, Canada.
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Nandate H, Takasaki Y, Nakata Y, Hamada T, Konishi A, Abe N, Kitamura S, Nishihara T, Yorozuya T. Incidence and characteristics of early elevation of cardiac troponin I after intrathoracic surgery: A single-center retrospective observational study. Medicine (Baltimore) 2023; 102:e33361. [PMID: 37000092 PMCID: PMC10063319 DOI: 10.1097/md.0000000000033361] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Revised: 02/14/2023] [Accepted: 03/03/2023] [Indexed: 04/01/2023] Open
Abstract
The early elevation of cardiac troponins within 24 hours after noncardiac surgery is reportedly associated with increased postoperative morbidities. Several predisposing factors, including the frequent occurrence of hypoxia and increased pulmonary arterial pressure, may likely contribute to this elevation, especially after intrathoracic surgery. Therefore, this retrospective study aimed to elucidate the incidence and characteristics of the early elevation of cardiac troponin I after intrathoracic surgery. This study included 320 patients who underwent intrathoracic surgery between January 1, 2018, and June 30, 2021. Specific perioperative variables were retrospectively collected from their electrical clinical records. The serum concentration of high-sensitivity cardiac troponin I (hs cTnI) was measured twice immediately after the intensive care unit arrival and on the following day. We grouped these patients into two: the early elevation of hs cTnI (EECT) group (hs cTnI value > 26.2 ng/L by at least 1 measurement) and the non-early elevation (non-EECT) group. Patient characteristics were then compared between these groups. The hs cTnI level elevated within 24 hours postoperatively in 103 patients (32.2%). In univariate analysis, intraoperative variables, including the duration of unilateral ventilation (199.2 minutes, P = .0025) and surgery (210.6 minutes, P = .0012), estimated blood loss volume (406.7 mL, P = .0022), percentage of stored red blood cell (RBC) transfusion (10.7%, P = .0059), and percentage of lobectomy or combination of other lung resection types (88.3%, P = .00188), were significantly higher in the EECT group than in the non-EECT group. In the log-rank test, prolonged hospitalization was more prevalent in the EECT group (P = .0485). Furthermore, multivariate analysis revealed 3 independent risk factors for the early elevation of hs cTnI: coexisting chronic renal failure (odds ratio [OR], 3.25), lobectomy or combined resections (OR, 2.65), and stored RBC transfusion (OR, 3.41). The early elevation of hs cTnI commonly occurs after intrathoracic surgery, with an incidence of 32.2%. Its 3 independent risk factors are coexisting chronic renal failure, lung resection type, and stored RBC transfusion.
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Affiliation(s)
- Hideyuki Nandate
- Department of Anesthesia and Perioperative Medicine, Ehime University Graduate School of Medicine, Toon, Japan
- Division of Intensive Care, Ehime University Hospital, Toon, Japan
| | - Yasushi Takasaki
- Department of Anesthesia and Perioperative Medicine, Ehime University Graduate School of Medicine, Toon, Japan
- Division of Intensive Care, Ehime University Hospital, Toon, Japan
| | - Yukihiro Nakata
- Department of Anesthesia and Perioperative Medicine, Ehime University Graduate School of Medicine, Toon, Japan
- Division of Intensive Care, Ehime University Hospital, Toon, Japan
| | - Taisuke Hamada
- Department of Anesthesia and Perioperative Medicine, Ehime University Graduate School of Medicine, Toon, Japan
| | - Amane Konishi
- Department of Anesthesia and Perioperative Medicine, Ehime University Graduate School of Medicine, Toon, Japan
| | - Naoki Abe
- Department of Anesthesia and Perioperative Medicine, Ehime University Graduate School of Medicine, Toon, Japan
| | - Sakiko Kitamura
- Department of Anesthesia and Perioperative Medicine, Ehime University Graduate School of Medicine, Toon, Japan
| | - Tasuku Nishihara
- Department of Anesthesia and Perioperative Medicine, Ehime University Graduate School of Medicine, Toon, Japan
| | - Toshihiro Yorozuya
- Department of Anesthesia and Perioperative Medicine, Ehime University Graduate School of Medicine, Toon, Japan
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Klein GJ, Gula LJ. A Sensible Decision: Evidence Should Guide Management Decisions for Asymptomatic WPW Pattern in Any Patient. JACC Case Rep 2023; 9:101605. [PMID: 36909275 PMCID: PMC9998717 DOI: 10.1016/j.jaccas.2022.08.021] [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] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Hernández-Ruiz P, Amezcua-Guerra LM, López-Vidal Y, González-Pacheco H, Pinto-Cardoso S, Amedei A, Aguirre-García MM. Comparative characterization of inflammatory profile and oral microbiome according to an inflammation-based risk score in ST-segment elevation myocardial infarction. Front Cell Infect Microbiol 2023; 13:1095380. [PMID: 36860987 PMCID: PMC9968971 DOI: 10.3389/fcimb.2023.1095380] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 01/31/2023] [Indexed: 02/15/2023] Open
Abstract
Ischemic heart disease considers the myocardial infarction (MI), either non-ST-segment elevation (non-STEMI) or ST-segment elevation myocardial infarction (STEMI); this represents the main cause of mortality in Mexican population. Regarding to the inflammatory state, this is reported to be a major prognostic factor of mortality for patients with MI. One of the conditions capable of producing systemic inflammation is periodontal disease. It has been proposed that the oral microbiota is translocated through the bloodstream to the liver and intestine, generating intestinal dysbiosis. The aim of this protocol is to assess oral microbiota diversity and circulating inflammatory profile in STEMI patients stratified according to an inflammation-based risk scoring system. We found that Bacteriodetes phylum was the most abundant in STEMI patients, and Prevotella was the most abundant genus, with a higher proportion in periodontitis patients. In fact, Prevotella genus was found to correlate positively and significantly with elevated IL-6 concentration. Our study defined a non-causal association inferred between the cardiovascular risk of STEMI patients, determined by changes in the oral microbiota that influence the development of periodontal disease and its relationship with the exacerbation of the systemic inflammatory response.
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Affiliation(s)
- Paulina Hernández-Ruiz
- Unidad de Investigación UNAM-INC, División de Investigación, Facultad de Medicina, Universidad Nacional Autónoma de México. Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de Mexico, Mexico
| | - Luis M. Amezcua-Guerra
- Departamento de Inmunología, Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de Mexico, Mexico
| | - Yolanda López-Vidal
- Programa de Inmunología Molecular Microbiana, Departamento de Microbiología y Parasitología, División de Investigación, Facultad de Medicina, Universidad Nacional Autónoma de México, Ciudad de Mexico, Mexico
| | - Héctor González-Pacheco
- Unidad de Cuidados Coronarios, Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de Mexico, Mexico
| | - Sandra Pinto-Cardoso
- Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Centro de Investigación en Enfermedades Infecciosas, Ciudad de Mexico, Mexico
| | - Amedeo Amedei
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy,Interdisciplinary Internal Medicine Unit, Careggi University Hospital, Florence, Italy
| | - María Magdalena Aguirre-García
- Unidad de Investigación UNAM-INC, División de Investigación, Facultad de Medicina, Universidad Nacional Autónoma de México. Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de Mexico, Mexico,*Correspondence: María Magdalena Aguirre-García,
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Acar O, Sarac GA, Rota DD, Aksoy H. Evaluation of pro-atherogenic lipid profile and high atherohenic indexes in patients with Behçet's disease: A case-control study. J Cosmet Dermatol 2023; 22:1887-1892. [PMID: 36762412 DOI: 10.1111/jocd.15647] [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: 09/05/2022] [Revised: 12/18/2022] [Accepted: 01/10/2023] [Indexed: 02/11/2023]
Abstract
BACKGROUND Behçet's disease is a systemic auto-immune and auto-inflammatory chronic disease in which genetic and environmental factors play a role. Patients with Behçet's are at significant risk for developing many comorbidities, including cardiovascular diseases. AIMS It was aimed to investigate the relationship between serum lipid parameters and atherogenic indexes to evaluate the cardiovascular risk status in patients with Behçet's disease. PATIENTS/METHODS This study was designed as a single-center, retrospective case-control study. The study was conducted with 212 patients over 18 years of age, 106 in the case group and 106 in the control group. RESULTS There was a significant difference in lipid values between the patients with Behçet's disease and the control group. While the serum triglyceride, total cholesterol, low-density lipoprotein cholesterol (LDL-C), and non-high-density lipoprotein cholesterol (NHC) levels were significantly higher, the high-density lipoprotein cholesterol (HDL-C) level was low in patients with Behçet's disease. From atherogenic indexes, Atherogenic Index of Plasma (AIP) (0.03 ± 0.27 vs. -0.07 ± 0.23, p = 0.003), Castelli Risk Index I (CRI-I) (4.24 ± 1.07 vs. 3.02 ± 0.96, p < 0.001), Castelli Risk Index II (CRI-II) (2.65 ± 0.81 vs. 1.84 ± 0.59, p < 0.001) and Atherogenic Coefficient (AC) (3.24 ± 1.07 vs. 2.02 ± 0.96, p < 0.001) levels were significantly higher in patients with Behçet's disease. CONCLUSION Our study shows that patients with Behçet's have a higher pro-atherogenic lipid profile and atherogenic indexes at high risk. Patients with Behçet's have an increased risk of cardiovascular diseases associated with atherosclerosis.
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Affiliation(s)
- Onur Acar
- Ağrı Provincial Health Directorate, Republic of Turkey, Ministry of Health, Ağrı, Turkey
| | - Gulhan Aksoy Sarac
- Ufuk University Faculty of Medicine Department of Dermatology, Ankara, Turkey
| | - Didem Dinçer Rota
- Ufuk University Faculty of Medicine Department of Dermatology, Ankara, Turkey
| | - Hakan Aksoy
- Department of Cardiology, Memorial Ankara Hospital, Ankara, Turkey
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Čukić M, Savić D, Sidorova J. When Heart Beats Differently in Depression: Review of Nonlinear Heart Rate Variability Measures. JMIR Ment Health 2023; 10:e40342. [PMID: 36649063 PMCID: PMC9890355 DOI: 10.2196/40342] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 11/28/2022] [Accepted: 12/06/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Disturbed heart dynamics in depression seriously increases mortality risk. Heart rate variability (HRV) is a rich source of information for studying this dynamics. This paper is a meta-analytic review with methodological commentary of the application of nonlinear analysis of HRV and its possibility to address cardiovascular diseases in depression. OBJECTIVE This paper aimed to appeal for the introduction of cardiological screening to patients with depression, because it is still far from established practice. The other (main) objective of the paper was to show that nonlinear methods in HRV analysis give better results than standard ones. METHODS We systematically searched on the web for papers on nonlinear analyses of HRV in depression, in line with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 framework recommendations. We scrutinized the chosen publications and performed random-effects meta-analysis, using the esci module in jamovi software where standardized effect sizes (ESs) are corrected to yield the proof of the practical utility of their results. RESULTS In all, 26 publications on the connection of nonlinear HRV measures and depression meeting our inclusion criteria were selected, examining a total of 1537 patients diagnosed with depression and 1041 healthy controls (N=2578). The overall ES (unbiased) was 1.03 (95% CI 0.703-1.35; diamond ratio 3.60). We performed 3 more meta-analytic comparisons, demonstrating the overall effectiveness of 3 groups of nonlinear analysis: detrended fluctuation analysis (overall ES 0.364, 95% CI 0.237-0.491), entropy-based measures (overall ES 1.05, 95% CI 0.572-1.52), and all other nonlinear measures (overall ES 0.702, 95% CI 0.422-0.982). The effectiveness of the applied methods of electrocardiogram analysis was compared and discussed in the light of detection and prevention of depression-related cardiovascular risk. CONCLUSIONS We compared the ESs of nonlinear and conventional time and spectral methods (found in the literature) and demonstrated that those of the former are larger, which recommends their use for the early screening of cardiovascular abnormalities in patients with depression to prevent possible deleterious events.
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Affiliation(s)
- Milena Čukić
- Empa Materials Science and Technology, Empa Swiss Federal Institute, St Gallen, Switzerland
| | - Danka Savić
- Vinča Institute for Nuclear Physics, Laboratory of Theoretical and Condensed Matter Physics 020/2, Vinca Institute, University of Belgrade, Belgrade, Serbia
| | - Julia Sidorova
- Bioinformatics Platform, Hospital Clínic, Barcelona, Spain
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11
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Ghelani R, Chow JJ, Varnava A. The Athletic ECG: A Line of Defense Against Misinterpretation. JACC Case Rep 2022; 4:1509-1514. [PMID: 36444192 PMCID: PMC9700076 DOI: 10.1016/j.jaccas.2022.08.024] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Revised: 08/08/2022] [Accepted: 08/17/2022] [Indexed: 06/16/2023]
Abstract
A 17-year-old competitive athlete was found to have a minor electrocardiogram abnormality on routine screening. Cardiac magnetic resonance revealed evidence of marked myocarditis, allowing a subsequent safe abstinence from exercise. The case highlights the importance of careful electrocardiogram interpretation, especially in athletes, where physiologic adaptive changes can pose a diagnostic challenge. (Level of Difficulty: Intermediate.).
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Affiliation(s)
- Rahul Ghelani
- Chelsea and Westminster National Health Service Foundation Trust, London, United Kingdom
| | - Ji-Jian Chow
- Cardiology Department, Imperial College Healthcare Trust, London, United Kingdom
| | - Amanda Varnava
- Cardiology Department, Imperial College Healthcare Trust, London, United Kingdom
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12
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Vivekanandam V, Männikkö R, Skorupinska I, Germain L, Gray B, Wedderburn S, Kozyra D, Sud R, James N, Holmes S, Savvatis K, Fialho D, Merve A, Pattni J, Farrugia M, Behr ER, Marini-Bettolo C, Hanna MG, Matthews E. Andersen-Tawil syndrome: deep phenotyping reveals significant cardiac and neuromuscular morbidity. Brain 2022; 145:2108-2120. [PMID: 34919635 DOI: 10.1093/brain/awab445] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 05/08/2021] [Revised: 09/21/2021] [Accepted: 12/13/2021] [Indexed: 11/14/2022] Open
Abstract
Andersen-Tawil syndrome is a neurological channelopathy caused by mutations in the KCNJ2 gene that encodes the ubiquitously expressed Kir2.1 potassium channel. The syndrome is characterized by episodic weakness, cardiac arrythmias and dysmorphic features. However, the full extent of the multisystem phenotype is not well described. In-depth, multisystem phenotyping is required to inform diagnosis and guide management. We report our findings following deep multimodal phenotyping across all systems in a large case series of 69 total patients, with comprehensive data for 52. As a national referral centre, we assessed point prevalence and showed it is higher than previously reported, at 0.105 per 100 000 population in England. While the classical phenotype of episodic weakness is recognized, we found that a quarter of our cohort have fixed myopathy and 13.5% required a wheelchair or gait aid. We identified frequent fat accumulation on MRI and tubular aggregates on muscle biopsy, emphasizing the active myopathic process underpinning the potential for severe neuromuscular disability. Long exercise testing was not reliable in predicting neuromuscular symptoms. A normal long exercise test was seen in five patients, of whom four had episodic weakness. Sixty-seven per cent of patients treated with acetazolamide reported a good neuromuscular response. Thirteen per cent of the cohort required cardiac defibrillator or pacemaker insertion. An additional 23% reported syncope. Baseline electrocardiograms were not helpful in stratifying cardiac risk, but Holter monitoring was. A subset of patients had no cardiac symptoms, but had abnormal Holter monitor recordings which prompted medication treatment. We describe the utility of loop recorders to guide management in two such asymptomatic patients. Micrognathia was the most commonly reported skeletal feature; however, 8% of patients did not have dysmorphic features and one-third of patients had only mild dysmorphic features. We describe novel phenotypic features including abnormal echocardiogram in nine patients, prominent pain, fatigue and fasciculations. Five patients exhibited executive dysfunction and slowed processing which may be linked to central expression of KCNJ2. We report eight new KCNJ2 variants with in vitro functional data. Our series illustrates that Andersen-Tawil syndrome is not benign. We report marked neuromuscular morbidity and cardiac risk with multisystem involvement. Our key recommendations include proactive genetic screening of all family members of a proband. This is required, given the risk of cardiac arrhythmias among asymptomatic individuals, and a significant subset of Andersen-Tawil syndrome patients have no (or few) dysmorphic features or negative long exercise test. We discuss recommendations for increased cardiac surveillance and neuropsychometry testing.
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Affiliation(s)
- Vinojini Vivekanandam
- Centre for Neuromuscular Diseases, UCL Queen Square Institute of Neurology, London, UK
| | - Roope Männikkö
- Centre for Neuromuscular Diseases, UCL Queen Square Institute of Neurology, London, UK
| | - Iwona Skorupinska
- Centre for Neuromuscular Diseases, UCL Queen Square Institute of Neurology, London, UK
| | - Louise Germain
- Centre for Neuromuscular Diseases, UCL Queen Square Institute of Neurology, London, UK
| | - Belinda Gray
- Cardiovascular Clinical Academic Group, St. George's, University of London and St. George's University Hospitals NHS Foundation Trust, London, UK
| | - Sarah Wedderburn
- West of Scotland Regional Genetics Service, Queen Elizabeth University Hospital, Glasgow, UK
| | - Damian Kozyra
- Centre for Neuromuscular Diseases, UCL Queen Square Institute of Neurology, London, UK
| | - Richa Sud
- Centre for Neuromuscular Diseases, UCL Queen Square Institute of Neurology, London, UK
| | - Natalie James
- Centre for Neuromuscular Diseases, UCL Queen Square Institute of Neurology, London, UK
| | - Sarah Holmes
- Centre for Neuromuscular Diseases, UCL Queen Square Institute of Neurology, London, UK
| | | | - Doreen Fialho
- Centre for Neuromuscular Diseases, UCL Queen Square Institute of Neurology, London, UK
| | - Ashirwad Merve
- Department of Neuropathology, National Hospital for Neurology and Neurosurgery, London, UK
| | - Jatin Pattni
- Neuropsychology, National Hospital for Neurology and Neurosurgery, London, UK
| | - Maria Farrugia
- West of Scotland Regional Genetics Service, Queen Elizabeth University Hospital, Glasgow, UK
| | - Elijah R Behr
- Cardiovascular Clinical Academic Group, St. George's, University of London and St. George's University Hospitals NHS Foundation Trust, London, UK
| | - Chiara Marini-Bettolo
- John Walton Muscular Dystrophy Research Centre, Newcastle University and Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Michael G Hanna
- Centre for Neuromuscular Diseases, UCL Queen Square Institute of Neurology, London, UK
| | - Emma Matthews
- Centre for Neuromuscular Diseases, UCL Queen Square Institute of Neurology, London, UK
- Atkinson-Morley Neuromuscular Centre, Department of Neurology, St George's University Hospitals NHS Foundation Trust, London, UK
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13
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Hahn M, Stamer UM, Luedi MM, Book M, Rieder HU, Stüber F. ASA Status, NPPA/NPPB Haplotype and Coronary Artery Disease Have an Impact on BNP/NT-proBNP Plasma Levels. Cells 2022; 11:766. [PMID: 35269388 DOI: 10.3390/cells11050766] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 02/04/2022] [Accepted: 02/18/2022] [Indexed: 12/31/2022] Open
Abstract
Plasma concentrations of natriuretic peptides (NP) contribute to risk stratification and management of patients undergoing non-cardiac surgery. However, genetically determined variability in the levels of these biomarkers has been described previously. In the perioperative setting, genetic contribution to NP plasma level variability has not yet been determined. A cohort of 427 patients presenting for non-cardiac surgery was genotyped for single-nucleotide polymorphisms (SNPs) from the NPPA/NPPB locus. Haplotype population frequencies were estimated and adjusted haplotype trait associations for brain natriuretic peptide (BNP) and amino-terminal pro natriuretic peptide (NT-proBNP) were calculated. Five SNPs were included in the analysis. Compared to the reference haplotype TATAT (rs198358, rs5068, rs632793, rs198389, rs6676300), haplotype CACGC, with an estimated frequency of 4%, showed elevated BNP and NT-proBNP plasma concentrations by 44% and 94%, respectively. Haplotype CGCGC, with an estimated frequency of 9%, lowered NT-proBNP concentrations by 28%. ASA classification status III and IV, as well as coronary artery disease, were the strongest predictors of increased NP plasma levels. Inclusion of genetic information might improve perioperative risk stratification of patients based on adjusted thresholds of NP plasma levels.
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14
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Obuobi S, Belardo D, Gulati M. The Precision of Cardiovascular Disease Prevention Begins With a Zip Code. JACC Case Rep 2021; 3:982-4. [PMID: 34317668 DOI: 10.1016/j.jaccas.2021.02.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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15
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Pelliccia A. The Case of an Asymptomatic Athlete With Short-Coupled Premature Ventricular Contractions: A Missed Opportunity. JACC Case Rep 2021; 3:502-503. [PMID: 34317567 PMCID: PMC8311048 DOI: 10.1016/j.jaccas.2021.01.019] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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16
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Brathwaite BM, Howell RS, Petrone P, Brathwaite CEM. Safety of Bariatric Surgery in Patients With Congestive Heart Failure: Results of an 11-Year Retrospective Study. Am Surg 2021; 88:1195-1200. [PMID: 33522255 DOI: 10.1177/0003134821991975] [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] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Congestive heart failure (CHF) is a known risk factor for increased postoperative morbidity. However, the safety in patients with CHF has not been well established. The objective of this study was to assess the safety of surgery in patients with a history of CHF undergoing bariatric surgical procedures. METHODS Retrospective review of a prospectively maintained Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) Center of Excellence database. Patients with known CHF undergoing bariatric procedures over an 11-year period were reviewed. RESULTS Over the 11-year period, 4470 total bariatric surgeries were performed, of which 41 (.92%) patients had known CHF. Twenty-one patients were men (51.2%) with a mean age of 55.8 years and mean body mass index (BMI) of 51.9. Comorbidities included hypertension (87.8%), obstructive sleep apnea (80.5%), osteoarthritis (63.4%), gastroesophageal reflux disease (56%), and diabetes (53.7%). Surgical procedures included 16 sleeve gastrectomies (SGs) (39%), 11 Roux-en-Y gastric bypasses (RYGBs) (26.8%), 10 laparoscopic adjustable gastric bands (LAGBs) (24.4%), 1 removal of a gastric band and conversion to SG (2.4%), 1 removal of a gastric band to RYGB (2.4%), 1 gastric band over RYGB pouch (2.4%), and 1 gastric band replacement (2.4%). All cases were performed minimally invasively (73.2% laparoscopic and 26.8% robotic). Mean LOS was 2.53 days. Thirty-day complications included 2 readmissions (4.9% [1 small bowel obstruction and 1 pulmonary edema]), 1 reoperation (2.4% [small bowel obstruction]), and 1 mortality (2.4%) on postoperative day 30 unrelated to the surgery. CONCLUSIONS Bariatric surgery can be performed safely in patients with CHF.
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Affiliation(s)
- Barbara M Brathwaite
- 16038Stony Brook School of Nursing, Stony Brook University, Stony Brook, NY, USA.,Department of Surgery, 24998NYU Langone Hospital-Long Island, NYU Long Island School of Medicine, Mineola, New York, USA
| | - Raelina S Howell
- Department of Surgery, 24998NYU Langone Hospital-Long Island, NYU Long Island School of Medicine, Mineola, New York, USA
| | - Patrizio Petrone
- Department of Surgery, 24998NYU Langone Hospital-Long Island, NYU Long Island School of Medicine, Mineola, New York, USA
| | - Collin E M Brathwaite
- Department of Surgery, 24998NYU Langone Hospital-Long Island, NYU Long Island School of Medicine, Mineola, New York, USA
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17
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Motiani P, Chhabra V, Ahmad Z, Sharma PK, Gupta A. Risk Recognition and Multidisciplinary Approach for Non-Cardiac Surgeries in Paediatric Cardiac Patients: A Retrospective Observational Study. Cureus 2020; 12:e12030. [PMID: 33376661 PMCID: PMC7755101 DOI: 10.7759/cureus.12030] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Congenital heart disease (CHD), a structural and functional heart disease, is the commonest birth defect with an incidence of one in 125 live births worldwide with ventricular septal defect (VSD), atrial septal defect (ASD) and tetralogy of Fallot (TOF) constituting the majority. Surgery for associated extra-cardiac anomalies (airway, skeletal, genitourinary, and gastrointestinal) may be required in 30% of these patients. Delivery of uneventful anaesthesia in these children requires an understanding of not only paediatric anaesthesia but also of the pathophysiology of the cardiac lesion and its associated risks. Aims The purpose of this retrospective review was to highlight the approach to the anaesthetic management and outcomes of patients with significant cardiac lesions presenting for non-cardiac surgeries. Material and methods A retrospective chart review of all children with congenital heart disease (CHD) (repaired or unrepaired) who were posted for a non-cardiac surgery in this tertiary care Paediatric super-specialty hospital from January 1, 2018 to December 31, 2019 was carried out. Data on demographics, peri-operative management, and clinical course was retrieved. Inclusion criteria were paediatric patients (0-18 years) of either gender with a diagnosis of a CHD (repaired or unrepaired) undergoing any non-cardiac surgeries (NCS) under anaesthesia/Monitored Anaesthesia Care (MAC). Exclusion criteria were procedures only under local anaesthesia (LA) or a minor procedure done solely under sedation not involving an anaesthesiologist. Results During the study period, we found five eligible cases who underwent a total of six procedures. Five procedures were elective and one was an emergency. Preoperative optimization was conducted by a multidisciplinary team including paediatric surgeons, anaesthesiologists, physicians, and cardio-thoracic surgeons. Anaesthesia was conducted by at least a consultant paediatric anaesthesiologist. Overall all patients tolerated anaesthesia well without any adverse events or complications. All six anaesthetic encounters were safe and uneventful.
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Affiliation(s)
- Poonam Motiani
- Paediatric Anaesthesia, Super Speciality Paediatric Hospital & Post Graduate Teaching Institute, Noida, IND
| | - Vibha Chhabra
- Paediatric Anaesthesia, Super Speciality Paediatric Hospital & Post Graduate Teaching Institute, Noida, IND
| | - Zainab Ahmad
- Anesthesiology and Critical Care, All India Institute of Medical Sciences, Bhopal, IND
| | - Pramod K Sharma
- Paediatric Surgery, All India Institute of Medical Sciences, Bhopal, IND
| | - Anju Gupta
- Anesthesiology and Critical Care, All India Institute of Medical Sciences, New Delhi, IND
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18
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Benlloch M, Cuerda-Ballester M, Drehmer E, Platero JL, Carrera-Juliá S, López-Rodríguez MM, Ceron JJ, Tvarijonaviciute A, Navarro MÁ, Moreno ML, de la Rubia Ortí JE. Possible Reduction of Cardiac Risk after Supplementation with Epigallocatechin Gallate and Increase of Ketone Bodies in the Blood in Patients with Multiple Sclerosis. A Pilot Study. Nutrients 2020; 12:nu12123792. [PMID: 33322022 PMCID: PMC7763038 DOI: 10.3390/nu12123792] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 12/04/2020] [Accepted: 12/07/2020] [Indexed: 02/07/2023] Open
Abstract
Multiple sclerosis (MS) is a neurodegenerative disease that causes anthropometric changes characterised by functional disability, increase in fat mass, and decrease in lean mass. All these variables are related to a greater cardiac risk. The polyphenol epigallocatechin gallate (EGCG) and an increase in ketone bodies in the blood have been shown to have beneficial effects on anthropometric and biochemical variables related to cardiovascular activity. The aim of this study was to analyse the impact of the intervention with EGCG and ketone bodies on cardiac risk in MS patients. A population of 51 MS patients were randomly assigned to a control group and an intervention group (daily dose of 800 mg of EGCG and 60 mL of coconut oil). Both groups followed an isocaloric diet for 4 months. Levels of beta-hydroxybutyrate (BHB), albumin, paraoxonase 1 (PON1) and C-reactive protein (CRP) were measured in serum before and after the intervention, as well as determining functional ability, waist circumference, waist-to-hip ratio (WHR), waist-to-height ratio (WHtR), fat percentage and muscle percentage. After 4 months, in the intervention group there was a significant increase in BHB, PON1 and albumin, while CRP did not vary; a significant decrease in cardiac risk associated with a significant decline in WHR; as well as a significant increase in muscle percentage. By contrast, these changes were not observed in the control group. Finally, results from analysis of variance (ANOVA) revealed a significant time–condition interaction effect, observing that WHtR and fat mass decreased in the intervention group, while they increased in the control group.
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Affiliation(s)
- María Benlloch
- Department of Nursing, Catholic University of Valencia San Vicente Mártir, C/Espartero, 7, 46007 Valencia, Spain;
| | - María Cuerda-Ballester
- Doctoral Degree School, Catholic University of Valencia San Vicente Mártir, C/Quevedo, 2, 46001 Valencia, Spain; (M.C.-B.); (J.L.P.)
| | - Eraci Drehmer
- Department of Basic Sciences, Catholic University of Valencia San Vicente Mártir, C/Ramiro de Maeztu, 14, 46900 Torrente, Valencia, Spain; (E.D.); (M.Á.N.)
| | - Jose Luis Platero
- Doctoral Degree School, Catholic University of Valencia San Vicente Mártir, C/Quevedo, 2, 46001 Valencia, Spain; (M.C.-B.); (J.L.P.)
| | - Sandra Carrera-Juliá
- Department of Nutrition and Dietetics, Catholic University of Valencia San Vicente Mártir, C/Quevedo, 2, 46001 Valencia, Spain;
| | - María Mar López-Rodríguez
- Department of Nursing, Physiotherapy and Medicine, University of Almería, Carretera Sacramento, C/San Urbano, s/n, La Cañada, 04120 Almería, Spain;
| | - Jose Joaquin Ceron
- Interdisciplinary Laboratory of Clinical Analysis, Campus of Excellence Mare Nostrum, University of Murcia, 30100 Murcia, Spain; (J.J.C.); (A.T.)
| | - Asta Tvarijonaviciute
- Interdisciplinary Laboratory of Clinical Analysis, Campus of Excellence Mare Nostrum, University of Murcia, 30100 Murcia, Spain; (J.J.C.); (A.T.)
| | - Marí Ángeles Navarro
- Department of Basic Sciences, Catholic University of Valencia San Vicente Mártir, C/Ramiro de Maeztu, 14, 46900 Torrente, Valencia, Spain; (E.D.); (M.Á.N.)
| | - Mari Luz Moreno
- Department of Basic Sciences, Catholic University of Valencia San Vicente Mártir, C/Ramiro de Maeztu, 14, 46900 Torrente, Valencia, Spain; (E.D.); (M.Á.N.)
- Correspondence: (M.L.M.); (J.E.d.l.R.O.); Tel.: +34-96-363-74-12 (ext. 5538) (M.L.M.); +34-96-363-74-12 (ext. 44014) (J.E.d.l.R.O.)
| | - Jose Enrique de la Rubia Ortí
- Department of Nursing, Catholic University of Valencia San Vicente Mártir, C/Espartero, 7, 46007 Valencia, Spain;
- Correspondence: (M.L.M.); (J.E.d.l.R.O.); Tel.: +34-96-363-74-12 (ext. 5538) (M.L.M.); +34-96-363-74-12 (ext. 44014) (J.E.d.l.R.O.)
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19
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Ribeiro F, Takahashi C, Vanzella LM, Laurino MJL, Lima IM, Silva VEDS, Silva JPLN, Valente HB, da Silva AKF, Christofaro DGD, Vanderlei LCM. An investigation into whether cardiac risk stratification protocols actually predict complications in cardiac rehabilitation programs? Clin Rehabil 2020; 35:775-784. [PMID: 33292000 DOI: 10.1177/0269215520978499] [Citation(s) in RCA: 2] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES This study evaluated the capacity of cardiac risk stratification protocols on simple complications that occur during activities of a cardiovascular rehabilitation program. DESIGN Observational longitudinal cohort study. SETTING Outpatient clinic of cardiovascular rehabilitation. SUBJECT Patients diagnosed with cardiovascular disease and/or risk factors. INTERVENTIONS Not applicable. MAIN MEASURES The relationship between the cardiac risk classes of seven risk stratification protocols and the occurrence of simple complications (such angina, abnormal changes in blood pressure, arrhythmias, fatigue, muscle pain, pallor) was assessed using the chi-square test, and when statistical significance was observed, sensitivity, specificity and accuracy were determined. RESULTS About 76 patients were analyzed. The American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR) protocol showed a statistically significant relationship between simple complications and cardiac risk classes (P-value = 0.046), however the results of sensitivity (0.53), specificity (0.52), and accuracy (0.53) were not significant. The other protocols analyzed were not significant: American College of Sports Medicine (P-value = 0.801), Brazilian Society of Cardiology (P-value = 0.734), American Heart Association (P-value = 0.957), Pashkow (P-value = 0.790), Society French Cardiology (P-value = 0.314), and Spanish Society of Cardiology (P-value = 0.078). CONCLUSION The AACVPR protocol showed a significant relationship between the risk classes and the occurrence of simple complications, however, the low values obtained for sensitivity, specificity and accuracy show that it is not useful for this purpose. CLINICAL TRIALS REGISTRATION NCT03446742.
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Affiliation(s)
- Felipe Ribeiro
- Physiotherapy Department, School of Sciences and Technologies, São Paulo State University - UNESP, Presidente Prudente, São Paulo, Brazil
| | - Carolina Takahashi
- Physiotherapy Department, School of Sciences and Technologies, São Paulo State University - UNESP, Presidente Prudente, São Paulo, Brazil
| | - Lais Manata Vanzella
- Physiotherapy Department, School of Sciences and Technologies, São Paulo State University - UNESP, Presidente Prudente, São Paulo, Brazil
| | - Maria Julia Lopez Laurino
- Physiotherapy Department, School of Sciences and Technologies, São Paulo State University - UNESP, Presidente Prudente, São Paulo, Brazil
| | - Isabelle Maina Lima
- Physiotherapy Department, School of Sciences and Technologies, São Paulo State University - UNESP, Presidente Prudente, São Paulo, Brazil
| | - Vitor Eduardo Dos Santos Silva
- Physiotherapy Department, School of Sciences and Technologies, São Paulo State University - UNESP, Presidente Prudente, São Paulo, Brazil
| | - João Pedro Lucas Neves Silva
- Physiotherapy Department, School of Sciences and Technologies, São Paulo State University - UNESP, Presidente Prudente, São Paulo, Brazil
| | - Heloisa Balotari Valente
- Physiotherapy Department, School of Sciences and Technologies, São Paulo State University - UNESP, Presidente Prudente, São Paulo, Brazil
| | - Anne Kastelianne França da Silva
- Physiotherapy Department, School of Sciences and Technologies, São Paulo State University - UNESP, Presidente Prudente, São Paulo, Brazil
| | - Diego Giulliano Destro Christofaro
- Department of Physical Education, School of Sciences and Technologies, São Paulo State University - UNESP, Presidente Prudente, São Paulo, Brazil
| | - Luiz Carlos Marques Vanderlei
- Physiotherapy Department, School of Sciences and Technologies, São Paulo State University - UNESP, Presidente Prudente, São Paulo, Brazil
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20
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Dawson KL, Vincent LL, Krieger EV, Stout KK, Buber J. Acute Increase in Deaths Among Patients With Adult Congenital Heart Disease During COVID-19: Single-Center Experience. JACC Case Rep 2020; 2:1275-8. [PMID: 32835269 DOI: 10.1016/j.jaccas.2020.06.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 06/03/2020] [Accepted: 06/05/2020] [Indexed: 12/23/2022]
Abstract
Fear of acquiring severe acute respiratory syndrome coronavirus-2 infection is a major contributor to underutilization of the health care system during the current pandemic. In this report, we describe 4 cases of unexpected deaths that occurred within a short time period in patients with adult congenital heart disease without warning symptoms. (Level of Difficulty: Intermediate.)
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21
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Fabozzo A, Rossi E, Facci G, Bottio T, Gerosa G. Mitral Valve Repair and Anomalous Origin of Circumflex Artery: To Ring or Not to Ring. JACC Case Rep 2019; 1:503-507. [PMID: 34316865 PMCID: PMC8289087 DOI: 10.1016/j.jaccas.2019.08.030] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 07/11/2019] [Accepted: 08/15/2019] [Indexed: 11/25/2022]
Abstract
We describe a case of an adult patient with mitral valve regurgitation and the anomalous origin and course of the left circumflex coronary artery. Use of a ringless procedure or a microinvasive approach, such as transapical neochordae implantation, would have possibly avoided a life-threatening post-operative complication. (Level of Difficulty: Advanced.).
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Affiliation(s)
- Assunta Fabozzo
- Department of Cardio-Thoracic-Vascular Science and Public Health, Cardiac Surgery Unit, Hospital of Padova, Padova, Italy
| | - Elena Rossi
- Department of Cardio-Thoracic-Vascular Science and Public Health, Cardiac Surgery Unit, Hospital of Padova, Padova, Italy
| | - Gabriele Facci
- Department of Cardio-Thoracic-Vascular Science and Public Health, Cardiac Surgery Unit, Hospital of Padova, Padova, Italy
| | - Tomaso Bottio
- Department of Cardio-Thoracic-Vascular Science and Public Health, Cardiac Surgery Unit, Hospital of Padova, Padova, Italy
| | - Gino Gerosa
- Department of Cardio-Thoracic-Vascular Science and Public Health, Cardiac Surgery Unit, Hospital of Padova, Padova, Italy
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22
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Bhattacharya PT, Golamari RR, Vunnam S, Moparthi S, Venkatappa N, Dollard DJ, Missri J, Yang W, Kimmel SE. Predictive risk stratification using HEART (history, electrocardiogram, age, risk factors, and initial troponin) and TIMI (thrombolysis in myocardial infarction) scores in non-high risk chest pain patients: An African American urban community based hospital study. Medicine (Baltimore) 2019; 98:e16370. [PMID: 31393346 PMCID: PMC6708799 DOI: 10.1097/md.0000000000016370] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Validated risk scoring systems in African American (AA) population are under studied. We utilized history, electrocardiogram, age, risk factors, and initial troponin (HEART) and thrombolysis in myocardial infarction (TIMI) scores to predict major adverse cardiovascular events (MACE) in non-high cardiovascular (CV) risk predominantly AA patient population.A retrospective emergency department (ED) charts review of 1266 chest pain patients where HEART and TIMI scores were calculated for each patient. Logistic regression model was computed to predict 6-week and 1-year MACE and 90-day cardiac readmission. Decision curve analysis (DCA) was constructed to differentiate between clinical strategies in non-high CV risk patients.Of the 817 patients included, 500 patients had low HEART score vs. 317 patients who had moderate HEART score. Six hundred sixty-three patients had low TIMI score vs. 154 patients had high TIMI score. The univariate logistic regression model shows odds ratio of predicting 6-week MACE using HEART score was 3.11 (95% confidence interval [CI] 1.43-6.76, P = .004) with increase in risk category from low to moderate vs. 2.07 (95% CI 1.18-3.63, P = .011) using TIMI score with increase in risk category from low to high and c-statistic of 0.86 vs. 0.79, respectively. DCA showed net benefit of using HEART score is equally predictive of 6-week MACE when compared to TIMI.In non-high CV risk AA patients, HEART score is better predictive tool for 6-week MACE when compared to TIMI score. Furthermore, patients presenting to ED with chest pain, the optimal strategy for a 2% to 4% miss rate threshold probability should be to discharge these patients from the ED.
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Affiliation(s)
- Priyanka T. Bhattacharya
- Department of General Internal Medicine, Perelman School of Medicine, University of Pennsylvania
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania
| | - Reshma R. Golamari
- Department of Internal Medicine, Mercy Catholic Medical Center, Drexel University College of Medicine
| | - Sandhya Vunnam
- Department of Internal Medicine, Mercy Catholic Medical Center, Drexel University College of Medicine
| | - Smitha Moparthi
- Department of Internal Medicine, Mercy Catholic Medical Center, Drexel University College of Medicine
| | - Neethi Venkatappa
- Department of Internal Medicine, Mercy Catholic Medical Center, Drexel University College of Medicine
| | - Denis J. Dollard
- Department of Internal Medicine, Mercy Catholic Medical Center, Drexel University College of Medicine
| | - Jose Missri
- Department of Medicine, Division of Cardiology, Drexel University College of Medicine, Philadelphia, PA
| | - Wei Yang
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania
| | - Stephen E. Kimmel
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania
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Ackland GL, Abbott TEF, Cain D, Edwards MR, Sultan P, Karmali SN, Fowler AJ, Whittle JR, MacDonald NJ, Reyes A, Paredes LG, Stephens RCM, Del Arroyo AG, Woldman S, Archbold RA, Wragg A, Kam E, Ahmad T, Khan AW, Niebrzegowska E, Pearse RM. Preoperative systemic inflammation and perioperative myocardial injury: prospective observational multicentre cohort study of patients undergoing non-cardiac surgery. Br J Anaesth 2019; 122:180-7. [PMID: 30686303 DOI: 10.1016/j.bja.2018.09.002] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Revised: 08/26/2018] [Accepted: 09/03/2018] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Systemic inflammation is pivotal in the pathogenesis of cardiovascular disease. As inflammation can directly cause cardiomyocyte injury, we hypothesised that established systemic inflammation, as reflected by elevated preoperative neutrophil-lymphocyte ratio (NLR) >4, predisposes patients to perioperative myocardial injury. METHODS We prospectively recruited 1652 patients aged ≥45 yr who underwent non-cardiac surgery in two UK centres. Serum high sensitivity troponin T (hsTnT) concentrations were measured on the first three postoperative days. Clinicians and investigators were blinded to the troponin results. The primary outcome was perioperative myocardial injury, defined as hsTnT≥14 ng L-1 within 3 days after surgery. We assessed whether myocardial injury was associated with preoperative NLR>4, activated reactive oxygen species (ROS) generation in circulating monocytes, or both. Multivariable logistic regression analysis explored associations between age, sex, NLR, Revised Cardiac Risk Index, individual leukocyte subsets, and myocardial injury. Flow cytometric quantification of ROS was done in 21 patients. Data are presented as n (%) or odds ratio (OR) with 95% confidence intervals. RESULTS Preoperative NLR>4 was present in 239/1652 (14.5%) patients. Myocardial injury occurred in 405/1652 (24.5%) patients and was more common in patients with preoperative NLR>4 [OR: 2.56 (1.92-3.41); P<0.0001]. Myocardial injury was independently associated with lower absolute preoperative lymphocyte count [OR 1.80 (1.50-2.17); P<0.0001] and higher absolute preoperative monocyte count [OR 1.93 (1.12-3.30); P=0.017]. Monocyte ROS generation correlated with NLR (r=0.47; P=0.03). CONCLUSIONS Preoperative NLR>4 is associated with perioperative myocardial injury, independent of conventional risk factors. Systemic inflammation may contribute to the development of perioperative myocardial injury. CLINICAL TRIAL REGISTRATION NCT01842568.
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24
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Abstract
Background: Prior to spine surgery (SS), we ask whether and when to stop low-dose aspirin (LD-ASA), particularly in patients with significant cardiovascular disease (CAD). Although platelets typically regenerate in 10 days, it can take longer in older patients. Methods: Here we reviewed several studies regarding the perioperative risks/complications [e.g. hemorrhagic complications, estimated blood loss (EBL), continued postoperative drainage] for continuing vs. stopping LD-ASA at various intervals prior to lumbar SS. Results: Multiple studies confirmed the increased perioperative risks for continuing LD-ASA throughout SS, or when stopping it for just 3–7 preoperative days; however, there were no increased risks if stopped between 7 to 10 days postoperatively. Other studies documented no increased perioperative risk for continuing LD-ASA throughout SS, although some indicated increased morbidity (e.g., one patient developed a postoperative hematoma resulting in irreversible paralysis). Conclusions: Several studies demonstrated more hemorrhagic complications if LD-ASA was continued throughout or stopped just 3 to up to 7 days prior to SS. However, there were no adverse bleeding events if stopped from 7–10 days preoperatively. As a spine surgeon who wishes to avoid a postoperative epidural hematoma/paralysis, I would recommend stopping LD-ASA 10 days or longer prior to SS. Nevertheless, each spine surgeon must determine what is in the “best interest” of their individual patient. Certainly, we need future randomized controlled trials to better answer: when and if to stop LD-ASA before spine surgery.
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Affiliation(s)
- Nancy E Epstein
- Professor of Clinical Neurosurgery, School of Medicine, State University of N.Y. at Stony Brook, New York, USA.,Chief of Neurosurgical Spine and Education, NYU Winthrop Hospital, NYU Winthrop Neuro Science, Mineola, New York, USA
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25
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Viteri OA, Sallman MA, Berens PM, Berens PD, Amro FH, Hutchinson MS, Ramin SM, Blackwell SC, Refuerzo JS, Smith JA. Potential of Metformin to Improve Cardiac Risk in Postpartum Women with Gestational Diabetes. Front Med (Lausanne) 2017; 4:180. [PMID: 29164116 PMCID: PMC5670110 DOI: 10.3389/fmed.2017.00180] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [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: 06/06/2017] [Accepted: 10/06/2017] [Indexed: 12/21/2022] Open
Abstract
Objective Pregnancy is associated with an increase in total cholesterol, high density lipoproteins (HDL), and low-density lipoproteins (LDL). Postpartum, HDL and LDL decrease over the first 12 weeks postpartum. Oxidized LDL (ox-LDL) is a marker of oxidative stress-related inflammation, which is associated with obesity and also with development of cardiovascular disease. Cardiovascular protection and weight loss are benefits from metformin, especially in women with diabetes. The objective of this study was to compare changes in lipid profiles and biomarkers for obesity during the initial 6 weeks postpartum between women with gestational diabetes mellitus (GDM) treated with metformin versus placebo. Methods This was a planned ancillary study of a randomized controlled trial compares metformin versus placebo in women with GDM for postpartum weight loss. Two 3 mL blood samples were collected within 24 h of delivery and 6 weeks postpartum immediately processed after collection then stored at −20°C until completion of clinical trial prior to analysis. Change in the median plasma concentrations of total cholesterol, HDL, ox-LDL, glucose, insulin, leptin, and unacylated ghrelin were compared between study groups. Results Of the 77 postpartum women were included, 35 received metformin and 42 received placebo. There was less of a reduction in HDL in the metformin group compared to placebo (−2.3 versus −7.5 mg/dL, p = 0.019). In addition, there was a greater reduction in ox-LDL in those receiving metformin (−12.2 versus −3.8 mg/dL, p = 0.038). No other differences were observed in the selected biomarkers evaluated. Conclusion Biomarker levels of HDL and ox-LDL were positively affected during the initial 6 weeks postpartum in GDM women treated with metformin. Additional studies with a longer duration of metformin treatment in the postpartum period are warranted to evaluate long-term potential benefits.
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Affiliation(s)
- Oscar A Viteri
- Department of Obstetrics, Gynecology and Reproductive Sciences, UTHealth McGovern Medical School, Houston, TX, United States
| | - Mary Alice Sallman
- Department of Obstetrics, Gynecology and Reproductive Sciences, UTHealth McGovern Medical School, Houston, TX, United States
| | - Pauline M Berens
- Department of Obstetrics, Gynecology and Reproductive Sciences, UTHealth McGovern Medical School, Houston, TX, United States
| | - Pamela D Berens
- Department of Obstetrics, Gynecology and Reproductive Sciences, UTHealth McGovern Medical School, Houston, TX, United States
| | - Farah H Amro
- Department of Obstetrics, Gynecology and Reproductive Sciences, UTHealth McGovern Medical School, Houston, TX, United States
| | - Maria S Hutchinson
- Department of Obstetrics, Gynecology and Reproductive Sciences, UTHealth McGovern Medical School, Houston, TX, United States
| | - Susan M Ramin
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX, United States
| | - Sean C Blackwell
- Department of Obstetrics, Gynecology and Reproductive Sciences, UTHealth McGovern Medical School, Houston, TX, United States
| | - Jerrie S Refuerzo
- Department of Obstetrics, Gynecology and Reproductive Sciences, UTHealth McGovern Medical School, Houston, TX, United States
| | - Judith A Smith
- Department of Obstetrics, Gynecology and Reproductive Sciences, UTHealth McGovern Medical School, Houston, TX, United States
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Castrodeza J, Amat-Santos IJ, Blanco M, Cortes C, Tobar J, Martin-Morquecho I, López J, Di Stefano S, Rojas P, Varela-Falcon LH, Gomez I, San Roman JA. Propensity score matched comparison of transcatheter aortic valve implantation versus conventional surgery in intermediate and low risk aortic stenosis patients: A hint of real-world. Cardiol J 2016; 23:541-551. [PMID: 27439368 DOI: 10.5603/cj.a2016.0051] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [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: 01/27/2016] [Revised: 07/20/2016] [Accepted: 06/09/2016] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Recently, the use of transcatheter aortic valve implantation (TAVI) in inter-mediate-low risk patients has been evaluated in the PARTNER II randomized trial. However, in the last years, this therapy has been employed in this scenario with underreported results, as compared to surgical aortic valve replacement (SAVR). METHODS We enrolled 362 consecutive patients with severe symptomatic aortic stenosis and intermediate-low surgical risk (logEuroSCORE < 20%), treated in our center with TAVI (103 patients) or single SAVR (259 patients) between 2009 and 2014. Patients were matched according to age, gender, logEuroSCORE, and use of bioprosthesis. RESULTS Mean age of the patients was 73 ± 10.4 years, and 40.3% were women. LogEuroSCORE and Society Thoracic Surgeons score were 7.0 ± 4.4% and 4.2 ± 2.5%, respectively, with mean left ventricular ejection fraction of 52 ± 9%. There were no differences regarding other comorbidities. The length-of-hospitalization was 11 ± 5 days after TAVI vs. 17 ± 9 days after SAVR (p = 0.003). After matched comparison, no differences in terms of in-hospital mortality (5.7% after TAVI vs. 2.9% after SAVR, p = 0.687) and 1-year mortality (11.4% vs. 7.1%, p = 0.381) were found. The combined endpoint of stroke and mortality at 1-year was also similar between both groups (15.7% in TAVI patients vs. 14.4% after SAVR, p = 0.136). Multivariate analysis determined that aortic regurgitation (AR) was an independent predictor of mortality (OR = 3.623, 95% CI: 1.267-10.358, p = 0.016). Although the rate of AR was higher after TAVI, none of the patients treated with the newest generation devices (10.7%) presented more than a mild degree of AR. CONCLUSIONS TAVI is feasible and shows comparable results to surgery in terms of early, 1-year mortality, as well as cerebrovascular events in patients with severe aortic stenosis and intermediate-low operative risk. Better transvalvular gradients, yet higher rates of AR were found, however, newer devices presented comparable rate of AR.
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Affiliation(s)
| | - Ignacio J Amat-Santos
- Cardiology Department, Hospital Clínico Universitario de Valladolid, Valladolid, Spain.
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Abstract
This review provides an outline of the association between major depressive disorder (MDD) and coronary heart disease (CHD). Much is known about the two individual clinical conditions; however, it is not until recently, biological mechanisms have been uncovered that link both MDD and CHD. The activation of stress pathways have been implicated as a neurochemical mechanism that links MDD and CHD. Depression is known to be associated with poorer outcomes of CHD. Psychological factors, such as major depression and stress, are now known as risk factors for developing CHD, which is as important and is independent of classic risk factors, such as hypertension, diabetes mellitus, and cigarette smoking. Both conditions have great socioeconomic importance given that depression and CHD are likely to be two of the three leading causes of global burden of disease. Better understanding of the common causal pathways will help us delineate more appropriate treatments.
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Affiliation(s)
- Arup K Dhar
- Human Neurotransmitters Laboratory, Baker IDI Heart and Diabetes Institute, Melbourne, VIC, Australia; Alfred Psychiatry, Alfred Health, Melbourne, VIC, Australia; Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
| | - David A Barton
- Human Neurotransmitters Laboratory, Baker IDI Heart and Diabetes Institute, Melbourne, VIC, Australia; Alfred Psychiatry, Alfred Health, Melbourne, VIC, Australia; Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
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28
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Walker A, Keene T, Argus C, Driller M, Guy JH, Rattray B. Immune and inflammatory responses of Australian firefighters after repeated exposures to the heat. Ergonomics 2015; 58:2032-2039. [PMID: 26082313 DOI: 10.1080/00140139.2015.1051596] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
When firefighters work in hot conditions, altered immune and inflammatory responses may increase the risk of a cardiac event. The present study aimed to establish the time course of such responses. Forty-two urban firefighters completed a repeat work protocol in a heat chamber (100 ± 5°C). Changes to leukocytes, platelets, TNFα, IL-6, IL-10, LPS and CRP were evaluated immediately post-work and also after 1 and 24 h of rest. Increases in core temperatures were associated with significant increases in leukocytes, platelets and TNFα directly following work. Further, platelets continued to increase at 1 h (+31.2 ± 31.3 × 10(9) l, p < 0.01) and remained elevated at 24 h (+15.9 ± 19.6 × 10(9) l, p < 0.01). Sustained increases in leukocytes and platelets may increase the risk of cardiac events in firefighters when performing repeat work tasks in the heat. This is particularly relevant during multi-day deployments following natural disasters. Practitioner Summary: Firefighters regularly re-enter fire affected buildings or are redeployed to further operational tasks. Should work in the heat lead to sustained immune and inflammatory changes following extended rest periods, incident controllers should plan appropriate work/rest cycles to minimise these changes and any subsequent risks of cardiac events.
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Affiliation(s)
- Anthony Walker
- a UC Research Institute for Sport and Exercise, University of Canberra , Canberra , Australia
- b ACT Fire & Rescue Service , Canberra , Australia
- c Discipline of Sport and Exercise Science, Faculty of Health, University of Canberra, Bruce , ACT 2601, Canberra , Australia
| | - Toby Keene
- d ACT Ambulance Service , Canberra , Australia
| | - Christos Argus
- a UC Research Institute for Sport and Exercise, University of Canberra , Canberra , Australia
- e ACT Brumbies Super Rugby , Canberra , Australia
| | - Matthew Driller
- f Department of Sport and Leisure Studies , University of Waikato , Hamilton , New Zealand
| | - Joshua H Guy
- g Department of Sport and Exercise Science , James Cook University , Cairns , Australia
| | - Ben Rattray
- a UC Research Institute for Sport and Exercise, University of Canberra , Canberra , Australia
- c Discipline of Sport and Exercise Science, Faculty of Health, University of Canberra, Bruce , ACT 2601, Canberra , Australia
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Romo ML, McCrillis AM, Brite J, Reales D, Dowd JB, Schooling CM. Pharmacologic androgen deprivation and cardiovascular disease risk factors: a systematic review. Eur J Clin Invest 2015; 45:475-84. [PMID: 25753698 DOI: 10.1111/eci.12431] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [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: 07/14/2014] [Accepted: 03/04/2015] [Indexed: 12/19/2022]
Abstract
BACKGROUND Pharmacologic androgen deprivation therapy (ADT) is widely used to treat prostate cancer. Observational studies suggest ADT is associated with cardiovascular disease and its risk factors; however, such studies may be subject to bias. Our objective was to evaluate the effect of ADT on cardiovascular disease risk factors using data from randomized controlled trials (RCTs). MATERIALS AND METHODS We conducted a systematic review using MEDLINE and MEDLINE In-Process (1950-June 2013), EMBASE (1974-June 2013) and Web of Science (1900-June 2013) for all RCTs in men with prostate cancer that compared pharmacologic ADT (i.e. use of gonadotropin-releasing hormone agonist or antagonist) with a group that did not receive ADT and reported data on cardiovascular disease risk factors including blood pressure, cholesterol, triglycerides, fibrinogen, biomarkers of insulin sensitivity, adiposity and C-reactive protein. We also searched for ongoing or unpublished trials. This study was registered at the PROSPERO International Prospective Register of Systematic Reviews (CRD42013005035). RESULTS Of the 3272 unique publications identified in our systematic review, we did not identify a single RCT that reported data on any cardiovascular disease risk factor. We were unable to locate unreported data from corresponding authors or study sponsors. CONCLUSIONS There is a lack of published, reliable evidence describing the effects of ADT on cardiovascular disease risk factors. RCTs have likely collected data on these risk factors as part of routine study monitoring; however, these data have not been published. To understand the effect of ADT on cardiovascular morbidity, these data must be made available to the scientific community.
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Affiliation(s)
- Matthew L Romo
- Epidemiology and Biostatistics, CUNY School of Public Health, Hunter College, New York, NY, USA
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Roache JD, Kahn R, Newton TF, Wallace CL, Murff WL, De La Garza R 2nd, Rivera O, Anderson A, Mojsiak J, Elkashef A. A double-blind, placebo-controlled assessment of the safety of potential interactions between intravenous cocaine, ethanol, and oral disulfiram. Drug Alcohol Depend 2011; 119:37-45. [PMID: 21696894 DOI: 10.1016/j.drugalcdep.2011.05.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2010] [Revised: 05/10/2011] [Accepted: 05/11/2011] [Indexed: 11/24/2022]
Abstract
BACKGROUND A majority of cocaine addicts have a comorbid alcohol use disorder. Previous studies demonstrated efficacy of disulfiram in the treatment of cocaine dependence among patients with comorbid alcohol use disorder or opioid dependence. However, the cardiac risks of a disulfiram-ethanol reaction (DER) in individuals who drink, when coupled with the cardiac effects of cocaine, could result in significant toxicity or lethality due to the 3-way drug interaction. AIMS This study examined the safety of combining cocaine (30 mg i.v.) and ethanol (0.4 g/kg i.v.) in disulfiram-treated (0, 250, and 500 mg/d, p.o.) cocaine-dependent research volunteers. RESULTS The results showed that disulfiram did not enhance the cardiovascular effects of cocaine and may have reduced the subjective high from cocaine. In contrast, ethanol produced adverse ECG changes including QTc prolongation and a DER consisting of hypotension, tachycardia, nausea, and flushing in disulfiram-treated subjects. The severity of the DER was related to disulfiram dose and the trial with 500 mg/d was stopped prematurely due to safety concerns. The DER-related hypotension and tachycardia seen with ethanol infusion alone in disulfiram-treated subjects, was not exacerbated when combined with cocaine. In fact, cocaine tended to counteract the ethanol-related hypotension though it did exacerbate the tachycardia in two of seven subjects. CONCLUSIONS Though conclusions are limited by the moderate doses of cocaine, ethanol, and disulfiram tested, the data do suggest that the risks of the moderate use of cocaine and ethanol in individuals treated with moderate doses of disulfiram (≤ 250 mg/d) may not be as problematic as some may assume.
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Abstract
Conventional cardiac risk factors do not fully explain the incidence of coronary artery disease and coronary events. Risk stratification and therapy based solely on these conventional risk factors may exclude a population who would otherwise benefit from lifestyle and risk factor modification. Recent efforts to improve our ability to recognize individuals and populations at increased risk of coronary events have focused on the noninvasive imaging of atherosclerosis, both in coronary and extracoronary arterial beds, or the identification of "non-traditional" serum markers. We review the complimentary role of these newer methods of risk stratification in the context of conventional risk factor evaluation.
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Affiliation(s)
- R M Benitez
- Department of Medicine, University of Maryland School of Medicine, Baltimore 21201, USA.
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Abstract
OBJECTIVE To establish rates of and risk factors for cardiac complications after noncardiac surgery in veterans. DESIGN Prospective cohort study. SETTING A large urban veterans affairs hospital. PARTICIPANTS One thousand patients with known or suspected cardiac problems undergoing 1,121 noncardiac procedures. MEASUREMENTS Patients were assessed preoperatively for important clinical variables. Postoperative evaluation was done by an assessor blinded to preoperative status with a daily physical examination, electrocardiogram, and creatine kinase with MB fraction until postoperative day 6, day of discharge, death, or reoperation (whichever occurred earliest). Serial electrocardiograms, enzymes, and chest radiographs were obtained as indicated. Severe cardiac complications included cardiac death, cardiac arrest, myocardial infarction, ventricular tachycardia, and fibrillation and pulmonary edema. Serious cardiac complications included the above, heart failure, and unstable angina. MAIN RESULTS Severe and serious complications were seen in 24% and 32% of aortic, 8.3% and 10% of carotid, 11.8% and 14.7% of peripheral vascular, 9.0% and 13.1% of intraabdominal/intrathoracic, 2.9% and 3.3% of intermediate-risk (head and neck and major orthopedic procedures), and 0.27% and 1.1% of low-risk procedures respectively. The five associated patient-specific risk factors identified by logistic regression are: myocardial infarction < 6 months (odds ratio [OR], 4.5; 95% confidence interval [CI], 1.9 to 12.9), emergency surgery (OR, 2.6; 95% CI, 1.2 to 5.6), myocardial infarction > 6 months (OR, 2.2; 95% CI, 1.4 to 3.5), heart failure ever (OR, 1.9; 95% CI, 1.2 to 3.0), and rhythm other than sinus (OR, 1.7; 95% CI, 0.9 to 3.2). Inclusion of the planned operative procedure significantly improves the predictive ability of our risk model. CONCLUSIONS Five patient-specific risk factors are associated with high risk for cardiac complications in the perioperative period of noncardiac surgery in veterans. Inclusion of the operative procedure significantly improves the predictive ability of the risk model. Overall cardiac complication rates (pretest probabilities) are established for these patients. A simple nomogram is presented for calculation of post-test probabilities by incorporating the operative procedure.
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Affiliation(s)
- R Kumar
- Received from the Section of General Internal Medicine, Department of Internal Medicine, Veterans Affairs Medical Center, U.T. Southwestern Medical School, Dallas, TX, USA.
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