Michael Khorsandi MD, Roger S. Blumenthal MD, Michael J. Blaha MD, MPH, Payal Kohli MD
Background
The 2023 Multisociety Guideline for the Management of Chronic Coronary Disease (CCD) updates recommendations for CCD, formerly known as “stable ischemic heart disease.” This condition encompasses a spectrum of coronary vascular pathologies from subclinical to clinical ischemic heart disease.
Hypothesis
The new “ABC” mnemonic offers clinicians a streamlined framework for applying Class One Recommendations (COR1) and integrating recent updates into CCD management.
Methods
A critical analysis of the 2023 CCD guidelines was conducted, with this review highlighting key elements.
Results
The review outlines crucial changes, including novel recommendations supported by current clinical evidence. The focus is on these developments, clarifying their importance for day-to-day clinical practice.
Conclusions
The review encourages a synergistic approach between primary healthcare providers and cardiologists to develop comprehensive strategies for lifestyle modification and medication therapy in CCD care. Furthermore, it suggests that utilizing comprehensive risk assessment tools can refine medical decision-making, ultimately enhancing patient care and clinical outcomes.
{"title":"The ABCs of the 2023 AHA/ACC/ACCP/ASPC/NLA/PCNA guideline for the management of patients with chronic coronary disease","authors":"Michael Khorsandi MD, Roger S. Blumenthal MD, Michael J. Blaha MD, MPH, Payal Kohli MD","doi":"10.1002/clc.24284","DOIUrl":"10.1002/clc.24284","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The 2023 Multisociety Guideline for the Management of Chronic Coronary Disease (CCD) updates recommendations for CCD, formerly known as “stable ischemic heart disease.” This condition encompasses a spectrum of coronary vascular pathologies from subclinical to clinical ischemic heart disease.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Hypothesis</h3>\u0000 \u0000 <p>The new “ABC” mnemonic offers clinicians a streamlined framework for applying Class One Recommendations (COR1) and integrating recent updates into CCD management.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A critical analysis of the 2023 CCD guidelines was conducted, with this review highlighting key elements.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The review outlines crucial changes, including novel recommendations supported by current clinical evidence. The focus is on these developments, clarifying their importance for day-to-day clinical practice.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The review encourages a synergistic approach between primary healthcare providers and cardiologists to develop comprehensive strategies for lifestyle modification and medication therapy in CCD care. Furthermore, it suggests that utilizing comprehensive risk assessment tools can refine medical decision-making, ultimately enhancing patient care and clinical outcomes.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2024-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.24284","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141064421","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Olanzapine, an atypical antipsychotic medication, has gained prominence in the treatment of schizophrenia and related psychotic disorders due to its effectiveness and perceived safety profile. However, emerging evidence suggests a potential link between olanzapine use and adverse cardiovascular effects, including cardiomyopathy. This narrative review explores the mechanisms, clinical implications, and management strategies associated with olanzapine-induced cardiomyopathy. A comprehensive review of the literature was conducted to investigate the relationship between olanzapine and cardiomyopathy. The search included epidemiological studies, clinical case reports, and mechanistic research focusing on the pathophysiology of olanzapine-induced cardiomyopathy. The review also examined treatment strategies for managing this potential complication. Olanzapine-induced cardiomyopathy is hypothesized to be associated with metabolic disturbances and receptor antagonism. The metabolic effects of olanzapine, such as weight gain, insulin resistance, and dyslipidemia, share similarities with obesity-related cardiomyopathy. Additionally, olanzapine's antagonism of certain receptors may contribute to cardiovascular stress. The review highlighted that patients with new-onset heart failure and significant weight gain while on olanzapine should be closely monitored for signs of cardiomyopathy. Early detection and prompt withdrawal of olanzapine, along with initiation of goal-directed medical therapy, are crucial for mitigating this potentially life-threatening condition. The relationship between olanzapine and cardiomyopathy is complex and not yet fully understood. However, the potential for significant cardiovascular risk necessitates vigilance among healthcare providers. Early identification and management of olanzapine-induced cardiomyopathy can improve patient outcomes. Further research is needed to elucidate the precise mechanisms behind this adverse effect and to develop optimized treatment strategies for patients requiring antipsychotic therapy.
{"title":"Olanzapine-induced cardiomyopathy: A mimicker of obesity cardiomyopathy?","authors":"Oluwaremilekun Zeth Tolu-Akinnawo MD, MPH, Toluwalase Awoyemi MD, PhD, Rocio Barriga Guzman MD, Akhtar Naveed MD","doi":"10.1002/clc.24278","DOIUrl":"10.1002/clc.24278","url":null,"abstract":"<p>Olanzapine, an atypical antipsychotic medication, has gained prominence in the treatment of schizophrenia and related psychotic disorders due to its effectiveness and perceived safety profile. However, emerging evidence suggests a potential link between olanzapine use and adverse cardiovascular effects, including cardiomyopathy. This narrative review explores the mechanisms, clinical implications, and management strategies associated with olanzapine-induced cardiomyopathy. A comprehensive review of the literature was conducted to investigate the relationship between olanzapine and cardiomyopathy. The search included epidemiological studies, clinical case reports, and mechanistic research focusing on the pathophysiology of olanzapine-induced cardiomyopathy. The review also examined treatment strategies for managing this potential complication. Olanzapine-induced cardiomyopathy is hypothesized to be associated with metabolic disturbances and receptor antagonism. The metabolic effects of olanzapine, such as weight gain, insulin resistance, and dyslipidemia, share similarities with obesity-related cardiomyopathy. Additionally, olanzapine's antagonism of certain receptors may contribute to cardiovascular stress. The review highlighted that patients with new-onset heart failure and significant weight gain while on olanzapine should be closely monitored for signs of cardiomyopathy. Early detection and prompt withdrawal of olanzapine, along with initiation of goal-directed medical therapy, are crucial for mitigating this potentially life-threatening condition. The relationship between olanzapine and cardiomyopathy is complex and not yet fully understood. However, the potential for significant cardiovascular risk necessitates vigilance among healthcare providers. Early identification and management of olanzapine-induced cardiomyopathy can improve patient outcomes. Further research is needed to elucidate the precise mechanisms behind this adverse effect and to develop optimized treatment strategies for patients requiring antipsychotic therapy.</p>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2024-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.24278","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141064399","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ayesha Rehman MBBS, Shahab Saidullah MBBS, Muhammad Asad MBBS, Umer R. Gondal MBBS, Amna Ashraf MBBS, Muhammad F. Khan MBBS, Waheed Akhtar MBBS, Amin Mehmoodi MBBS, Jahanzeb Malik MBBS
Background
Semaglutide, a once-weekly glucagon-like peptide-1 receptor agonist, has shown promise in weight management and cardiovascular outcomes in other populations. This study aimed to evaluate the efficacy of semaglutide in heart failure with preserved ejection fraction (HFpEF) patients with obesity.
Methods
A retrospective study analyzed 318 patients with HFpEF, of which 104 received semaglutide and 214 received placebo. Primary endpoints included evaluating changes in exercise capacity and weight management.
Results
Semaglutide treatment led to significant improvements in the primary endpoints. Patients in the semaglutide group demonstrated substantial enhancements in exercise capacity, as measured by the 6-min walk distance, compared to the placebo group (mean difference 15.1 meters, 95% CI 5.8 to 24.4, p = 0.002). Additionally, semaglutide resulted in substantial weight loss compared to placebo (mean difference −2.9%, 95% CI −4.1–−1.7, p = 0.001). Several secondary endpoints, including reductions in C-reactive protein levels and improvements in other clinical parameters, further supported the efficacy of semaglutide. Adverse events were generally well-tolerated, with no unexpected safety concerns.
Conclusion
Semaglutide demonstrated significant clinical benefits in HFpEF patients with obesity, as evidenced by improved symptoms, physical function, and weight reduction.
背景塞马鲁肽是一种每周一次的胰高血糖素样肽-1受体激动剂，已在其他人群中显示出控制体重和改善心血管预后的前景。本研究旨在评估塞马鲁肽对肥胖型射血分数保留型心力衰竭（HFpEF）患者的疗效：一项回顾性研究分析了318名射血分数保留型心力衰竭患者，其中104人接受了semaglutide治疗，214人接受了安慰剂治疗。主要终点包括评估运动能力和体重管理的变化：结果：塞马鲁肽治疗显著改善了主要终点。与安慰剂组相比，以6分钟步行距离为衡量标准，塞马鲁肽组患者的运动能力大幅提高（平均差异为15.1米，95% CI为5.8至24.4，P = 0.002）。此外，与安慰剂组相比，塞马鲁肽还能显著减轻体重（平均差异-2.9%，95% CI -4.1--1.7，p = 0.001）。几个次要终点，包括C反应蛋白水平的降低和其他临床参数的改善，进一步证实了塞马鲁肽的疗效。患者对不良反应的耐受性普遍良好，没有出现意外的安全问题：结论：塞马鲁肽对肥胖型高频血友病患者有显著的临床疗效，表现为症状改善、身体功能改善和体重减轻。
{"title":"Efficacy and safety of semaglutide in patients with heart failure with preserved ejection fraction and obesity","authors":"Ayesha Rehman MBBS, Shahab Saidullah MBBS, Muhammad Asad MBBS, Umer R. Gondal MBBS, Amna Ashraf MBBS, Muhammad F. Khan MBBS, Waheed Akhtar MBBS, Amin Mehmoodi MBBS, Jahanzeb Malik MBBS","doi":"10.1002/clc.24283","DOIUrl":"10.1002/clc.24283","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Semaglutide, a once-weekly glucagon-like peptide-1 receptor agonist, has shown promise in weight management and cardiovascular outcomes in other populations. This study aimed to evaluate the efficacy of semaglutide in heart failure with preserved ejection fraction (HFpEF) patients with obesity.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A retrospective study analyzed 318 patients with HFpEF, of which 104 received semaglutide and 214 received placebo. Primary endpoints included evaluating changes in exercise capacity and weight management.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Semaglutide treatment led to significant improvements in the primary endpoints. Patients in the semaglutide group demonstrated substantial enhancements in exercise capacity, as measured by the 6-min walk distance, compared to the placebo group (mean difference 15.1 meters, 95% CI 5.8 to 24.4, <i>p</i> = 0.002). Additionally, semaglutide resulted in substantial weight loss compared to placebo (mean difference −2.9%, 95% CI −4.1–−1.7, <i>p</i> = 0.001). Several secondary endpoints, including reductions in C-reactive protein levels and improvements in other clinical parameters, further supported the efficacy of semaglutide. Adverse events were generally well-tolerated, with no unexpected safety concerns.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Semaglutide demonstrated significant clinical benefits in HFpEF patients with obesity, as evidenced by improved symptoms, physical function, and weight reduction.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2024-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.24283","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141064394","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Paravalvular leak (PVL) is an uncommon complication of prosthetic valve implantation, which can lead to infective endocarditis, heart failure, and hemolytic anemia. Surgical reintervention of PVLs is associated with high mortality rates. Transcatheter PVL closure (TPVLc) has emerged as an alternative to surgical reoperation. This method provides a high success rate with a low rate of complications. This article reviews the pathogenesis, clinical manifestation, diagnosis, and management of PVL and complications following TPVLc. Besides, we presented a case of a patient with severe PVL following mitral valve replacement, who experienced complete heart block (CHB) during TPVLc. The first TPVLc procedure failed in our patient due to possible AV-node insult during catheterization. After 1 week of persistent CHB, a permanent pacemaker was implanted. The defect was successfully passed using the previous attempt. Considering the advantages of TPVLc, procedure failure should be regarded as a concern. TPVLc should be performed by experienced medical teams in carefully selected patients.
{"title":"Complications of transcatheter paravalvular leak device closure of mitral valve: An updated review of the literature and a rare case presentation","authors":"Yaser Jenab MD, Saeed Nourian, Negin Sadat Hosseini Mohammadi, Reza Mohseni-Badalabadi MD, Kaveh Hosseini MD, Sarina Zakavi MD, Ismail Ates MD","doi":"10.1002/clc.24272","DOIUrl":"https://doi.org/10.1002/clc.24272","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 <p>Paravalvular leak (PVL) is an uncommon complication of prosthetic valve implantation, which can lead to infective endocarditis, heart failure, and hemolytic anemia. Surgical reintervention of PVLs is associated with high mortality rates. Transcatheter PVL closure (TPVLc) has emerged as an alternative to surgical reoperation. This method provides a high success rate with a low rate of complications. This article reviews the pathogenesis, clinical manifestation, diagnosis, and management of PVL and complications following TPVLc. Besides, we presented a case of a patient with severe PVL following mitral valve replacement, who experienced complete heart block (CHB) during TPVLc. The first TPVLc procedure failed in our patient due to possible AV-node insult during catheterization. After 1 week of persistent CHB, a permanent pacemaker was implanted. The defect was successfully passed using the previous attempt. Considering the advantages of TPVLc, procedure failure should be regarded as a concern. TPVLc should be performed by experienced medical teams in carefully selected patients.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2024-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.24272","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140919314","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Dong et al. investigated the relationship between interdialytic home blood pressure variability (BPV) and mortality in individuals with end-stage kidney disease (ESKD) undergoing hemodialysis.1 Their study revealed a notable correlation between increasing home BPV and a stepwise escalation in the risk of all-cause mortality among this population. In the discussion, the authors attributed this association to comorbid cardiovascular diseases, diabetes, systemic inflammation, and higher vascular stiffness. We believe that a more comprehensive characterization of vascular integrity impairment is needed to explain this BPV-outcome association.
Our team previously introduced the concept of vascular frailty, which elucidates vascular structural and functional degeneration leading to physical frailty or the coexistence of both phenotypes.2 Vascular tissues are exquisitely susceptible to adverse consequences related to tissue senescence from chronological aging and metabotoxic stimuli, particularly uremic toxins. Vascular frailty manifests through structural degenerations such as vascular calcification and atherosclerosis, as well as functional perturbations like increased stiffness and vasomotor dysfunction. Uremic toxins predispose individuals with chronic kidney disease to developing physical frailty3 and contribute to the pathogenesis of vascular frailty by inducing vascular calcification and increasing vascular stiffness,4 thereby leading to higher BPV. It is widely acknowledged that ESKD patients are prone to developing vascular calcification over time. Moreover, individuals with ESKD exhibit accelerated aging and heightened tissue wear, culminating in physical frailty that significantly elevates mortality risk. Our previous findings demonstrated that ESKD patients with frailty faced a significantly higher risk of mortality compared with those without.5
From this perspective, we recommend that the authors consider incorporating additional features of vascular frailty, such as measurements of vascular calcification severity and evidence of autonomic dysfunction, in their assessments of these patients. Doing so will facilitate a more thorough understanding of the mechanisms underlying the BPV-outcome association.
Szu-Ying Lee and Chia-Ter Chao are responsible for drafting of this manuscript.
{"title":"Exploring the role of vascular frailty in understanding blood pressure variability and mortality risk among end-stage kidney disease patients undergoing hemodialysis","authors":"Szu-Ying Lee MD, Chia-Ter Chao MD, PhD","doi":"10.1002/clc.24281","DOIUrl":"10.1002/clc.24281","url":null,"abstract":"<p>Dong et al. investigated the relationship between interdialytic home blood pressure variability (BPV) and mortality in individuals with end-stage kidney disease (ESKD) undergoing hemodialysis.<span><sup>1</sup></span> Their study revealed a notable correlation between increasing home BPV and a stepwise escalation in the risk of all-cause mortality among this population. In the discussion, the authors attributed this association to comorbid cardiovascular diseases, diabetes, systemic inflammation, and higher vascular stiffness. We believe that a more comprehensive characterization of vascular integrity impairment is needed to explain this BPV-outcome association.</p><p>Our team previously introduced the concept of vascular frailty, which elucidates vascular structural and functional degeneration leading to physical frailty or the coexistence of both phenotypes.<span><sup>2</sup></span> Vascular tissues are exquisitely susceptible to adverse consequences related to tissue senescence from chronological aging and metabotoxic stimuli, particularly uremic toxins. Vascular frailty manifests through structural degenerations such as vascular calcification and atherosclerosis, as well as functional perturbations like increased stiffness and vasomotor dysfunction. Uremic toxins predispose individuals with chronic kidney disease to developing physical frailty<span><sup>3</sup></span> and contribute to the pathogenesis of vascular frailty by inducing vascular calcification and increasing vascular stiffness,<span><sup>4</sup></span> thereby leading to higher BPV. It is widely acknowledged that ESKD patients are prone to developing vascular calcification over time. Moreover, individuals with ESKD exhibit accelerated aging and heightened tissue wear, culminating in physical frailty that significantly elevates mortality risk. Our previous findings demonstrated that ESKD patients with frailty faced a significantly higher risk of mortality compared with those without.<span><sup>5</sup></span></p><p>From this perspective, we recommend that the authors consider incorporating additional features of vascular frailty, such as measurements of vascular calcification severity and evidence of autonomic dysfunction, in their assessments of these patients. Doing so will facilitate a more thorough understanding of the mechanisms underlying the BPV-outcome association.</p><p>Szu-Ying Lee and Chia-Ter Chao are responsible for drafting of this manuscript.</p><p>The authors declare no conflict of interest.</p>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2024-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.24281","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140911283","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Carlos Diaz-Arocutipa MD, Guillermo Moreno PhD, Lourdes Vicent MD
Background
Observational studies suggest that valvular surgery can reduce mortality in selected patients with infective endocarditis (IE). However, the benefit of this intervention according to frailty levels remains unclear. Our study aims to assess the effect of valvular surgery according to frailty status in this population.
Methods
We performed a retrospective study using the 2016−2019 National Inpatient Sample database. Adult patients with a primary diagnosis of IE were included. Frailty was assessed using the Hospital Frailty Risk Score. Inverse probability of treatment weighting (IPTW) was used to balance baseline differences between groups.
Results
A total of 53,275 patients with IE were included, with 18.3% underwent valvular surgery. The median age was 52 (34−68) years, with 41% females. Overall, 42.7% had low risk of frailty, 53.1% intermediate risk, and 4.2% high risk. After IPTW adjustment, in-hospital mortality was similar both for the entire cohort between valvular and non-valvular surgery groups (3.7% vs. 4.1%, p = .483), and low (1% vs. 0.9%, p = .952) or moderate (5.4% vs. 6%, p = .548) risk of frailty. However, patients at high risk of frailty had significantly lower in-hospital mortality in the valvular surgery group (4.6% vs. 13.9%, p = .016). Renal replacement therapy was similar between groups across frailty status. In contrast, surgery was associated with increased use of mechanical circulatory support and pacemaker implantation.
Conclusions
Our findings suggest that there was no difference in survival between valve surgery and medical management in patients at low/intermediate frailty risk, but not for high-risk individuals.
背景：观察性研究表明，瓣膜手术可降低特定感染性心内膜炎（IE）患者的死亡率。然而，根据虚弱程度进行干预的益处仍不明确。我们的研究旨在根据该人群的虚弱状况评估瓣膜手术的效果：我们利用 2016-2019 年全国住院患者抽样数据库进行了一项回顾性研究。研究纳入了主要诊断为 IE 的成人患者。采用医院虚弱风险评分对患者的虚弱程度进行评估。采用逆概率治疗加权法（IPTW）平衡各组间的基线差异：共纳入了 53275 名 IE 患者，其中 18.3% 接受了瓣膜手术。中位年龄为 52（34-68）岁，女性占 41%。总体而言，42.7%的患者体弱风险较低，53.1%为中度风险，4.2%为高度风险。经过IPTW调整后，整个队列中瓣膜手术组和非瓣膜手术组的院内死亡率相似（3.7% vs. 4.1%，p = .483），虚弱风险为低度（1% vs. 0.9%，p = .952）或中度（5.4% vs. 6%，p = .548）。然而，在瓣膜手术组中，虚弱高风险患者的院内死亡率明显较低（4.6% vs. 13.9%，p = .016）。肾脏替代治疗在不同体弱状况的组别中效果相似。相比之下，手术与机械循环支持和起搏器植入的使用增加有关：我们的研究结果表明，瓣膜手术和内科治疗在低/中度虚弱风险患者的生存率上没有差异，但在高风险患者中则没有差异。
{"title":"Impact of valvular surgery according to frailty risk in patients with infective endocarditis","authors":"Carlos Diaz-Arocutipa MD, Guillermo Moreno PhD, Lourdes Vicent MD","doi":"10.1002/clc.24268","DOIUrl":"10.1002/clc.24268","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Observational studies suggest that valvular surgery can reduce mortality in selected patients with infective endocarditis (IE). However, the benefit of this intervention according to frailty levels remains unclear. Our study aims to assess the effect of valvular surgery according to frailty status in this population.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We performed a retrospective study using the 2016−2019 National Inpatient Sample database. Adult patients with a primary diagnosis of IE were included. Frailty was assessed using the Hospital Frailty Risk Score. Inverse probability of treatment weighting (IPTW) was used to balance baseline differences between groups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 53,275 patients with IE were included, with 18.3% underwent valvular surgery. The median age was 52 (34−68) years, with 41% females. Overall, 42.7% had low risk of frailty, 53.1% intermediate risk, and 4.2% high risk. After IPTW adjustment, in-hospital mortality was similar both for the entire cohort between valvular and non-valvular surgery groups (3.7% vs. 4.1%, <i>p</i> = .483), and low (1% vs. 0.9%, <i>p</i> = .952) or moderate (5.4% vs. 6%, <i>p</i> = .548) risk of frailty. However, patients at high risk of frailty had significantly lower in-hospital mortality in the valvular surgery group (4.6% vs. 13.9%, <i>p</i> = .016). Renal replacement therapy was similar between groups across frailty status. In contrast, surgery was associated with increased use of mechanical circulatory support and pacemaker implantation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Our findings suggest that there was no difference in survival between valve surgery and medical management in patients at low/intermediate frailty risk, but not for high-risk individuals.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2024-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.24268","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140916240","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Badar ud Din Shah MBBS, Rohan Raj MBBS, Parvinder Kaur MBBS, Ali Karim MBBS, Raveena Bai Bansari MBBS, Amin Mehmoodi, Jahanzeb Malik MBBS
This comprehensive article delves into the intricate and multifaceted issue of noise pollution, shedding light on its diverse sources, profound health implications, and the economic burden it imposes on societies. Noise pollution is an increasingly prevalent environmental challenge, impacting millions of people worldwide, often without their full awareness of its adverse effects. Drawing from a wealth of scientific research, the article underscores the well-established links between noise pollution and a spectrum of health issues, including cardiovascular diseases, sleep disturbances, and psychological stress. While exploring the sources and consequences of noise pollution, the article highlights the urgent need for a holistic and collaborative approach to mitigate its impact. This entails a combination of regulatory measures, technological innovations, urban planning strategies, and public education campaigns. It is increasingly evident that the detrimental effects of noise pollution extend beyond physical health, encompassing mental and social well-being. The article also addresses the synergistic relationship between noise pollution and other environmental stressors, emphasizing the importance of considering noise in conjunction with factors like air pollution and access to green spaces. It examines the potential of green spaces to mitigate the effects of noise pollution and enhance overall health.
{"title":"Association of transportation noise with cardiovascular diseases","authors":"Badar ud Din Shah MBBS, Rohan Raj MBBS, Parvinder Kaur MBBS, Ali Karim MBBS, Raveena Bai Bansari MBBS, Amin Mehmoodi, Jahanzeb Malik MBBS","doi":"10.1002/clc.24275","DOIUrl":"https://doi.org/10.1002/clc.24275","url":null,"abstract":"<p>This comprehensive article delves into the intricate and multifaceted issue of noise pollution, shedding light on its diverse sources, profound health implications, and the economic burden it imposes on societies. Noise pollution is an increasingly prevalent environmental challenge, impacting millions of people worldwide, often without their full awareness of its adverse effects. Drawing from a wealth of scientific research, the article underscores the well-established links between noise pollution and a spectrum of health issues, including cardiovascular diseases, sleep disturbances, and psychological stress. While exploring the sources and consequences of noise pollution, the article highlights the urgent need for a holistic and collaborative approach to mitigate its impact. This entails a combination of regulatory measures, technological innovations, urban planning strategies, and public education campaigns. It is increasingly evident that the detrimental effects of noise pollution extend beyond physical health, encompassing mental and social well-being. The article also addresses the synergistic relationship between noise pollution and other environmental stressors, emphasizing the importance of considering noise in conjunction with factors like air pollution and access to green spaces. It examines the potential of green spaces to mitigate the effects of noise pollution and enhance overall health.</p>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2024-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.24275","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140844950","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sasa Rajsic MD, PhD, Robert Breitkopf MD, MBA, Benedikt Treml MD, MBA, Dragana Jadzic MD, PhD, Nicole Innerhofer MD, Christine Eckhardt MD, PhD, Christoph Oberleitner MD, Zoran Bukumiric MD
Background
The use of extracorporeal membrane oxygenation (ECMO) is associated with complex hemostatic changes. Systemic anticoagulation is initiated to prevent clotting in the ECMO system, but this comes with an increased risk of bleeding. Evidence on the use of anti-Xa-guided monitoring to prevent bleeding during ECMO support is limited. Therefore, we aimed to analyze the association between anti-factor Xa-guided anticoagulation and hemorrhage during ECMO.
Methods
A systematic review and meta-analysis was performed (up to August 2023). PROSPERO: CRD42023448888.
Results
Twenty-six studies comprising 2293 patients were included in the analysis, with six works being part of the meta-analysis. The mean anti-Xa values did not show a significant difference between patients with and without hemorrhage (standardized mean difference −0.05; 95% confidence interval [CI]: −0.19; 0.28, p = .69). We found a positive correlation between anti-Xa levels and unfractionated heparin dose (UFH; pooled estimate of correlation coefficients 0.44; 95% CI: 0.33; 0.55, p < .001). The most frequent complications were any type of hemorrhage (pooled 36%) and thrombosis (33%). Nearly half of the critically ill patients did not survive to hospital discharge (47%).
Conclusions
The most appropriate tool for anticoagulation monitoring in ECMO patients is uncertain. Our analysis did not reveal a significant difference in anti-Xa levels in patients with and without hemorrhagic events. However, we found a moderate correlation between anti-Xa and the UFH dose, supporting its utilization in monitoring UFH anticoagulation. Given the limitations of time-guided monitoring methods, the role of anti-Xa is promising and further research is warranted.
背景 使用体外膜肺氧合（ECMO）与复杂的止血变化有关。为了防止 ECMO 系统中的凝血，需要进行全身抗凝治疗，但这也增加了出血的风险。在 ECMO 支持期间使用抗 Xa 指导监测以预防出血的证据有限。因此，我们旨在分析抗 Xa 因子指导的抗凝与 ECMO 期间出血之间的关系。 方法 我们进行了系统回顾和荟萃分析（截至 2023 年 8 月）。prospero：CRD42023448888。 结果 共有 26 项研究，2293 名患者参与了分析，其中 6 项研究参与了荟萃分析。有出血和无出血患者的抗 Xa 平均值没有明显差异（标准化平均差异-0.05；95% 置信区间 [CI]：-0.19; 0.28, p = .69).我们发现抗 Xa 水平与非丝裂肝素剂量（UFH；相关系数的集合估计值为 0.44；95% CI：0.33；0.55，P = .001）呈正相关。最常见的并发症是各种类型的出血（合计 36%）和血栓形成（33%）。近一半的危重病人没有活到出院（47%）。 结论 ECMO 患者抗凝监测的最合适工具尚不确定。我们的分析并未发现有出血事件和无出血事件患者的抗 Xa 水平有明显差异。然而，我们发现抗 Xa 与 UFH 剂量之间存在适度相关性，这支持了在监测 UFH 抗凝时使用抗 Xa。鉴于时间引导监测方法的局限性，抗 Xa 的作用很有前景，值得进一步研究。
{"title":"Association of anti-factor Xa-guided anticoagulation with hemorrhage during ECMO support: A systematic review and meta-analysis","authors":"Sasa Rajsic MD, PhD, Robert Breitkopf MD, MBA, Benedikt Treml MD, MBA, Dragana Jadzic MD, PhD, Nicole Innerhofer MD, Christine Eckhardt MD, PhD, Christoph Oberleitner MD, Zoran Bukumiric MD","doi":"10.1002/clc.24273","DOIUrl":"https://doi.org/10.1002/clc.24273","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The use of extracorporeal membrane oxygenation (ECMO) is associated with complex hemostatic changes. Systemic anticoagulation is initiated to prevent clotting in the ECMO system, but this comes with an increased risk of bleeding. Evidence on the use of anti-Xa-guided monitoring to prevent bleeding during ECMO support is limited. Therefore, we aimed to analyze the association between anti-factor Xa-guided anticoagulation and hemorrhage during ECMO.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A systematic review and meta-analysis was performed (up to August 2023). PROSPERO: CRD42023448888.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Twenty-six studies comprising 2293 patients were included in the analysis, with six works being part of the meta-analysis. The mean anti-Xa values did not show a significant difference between patients with and without hemorrhage (standardized mean difference −0.05; 95% confidence interval [CI]: −0.19; 0.28, <i>p</i> = .69). We found a positive correlation between anti-Xa levels and unfractionated heparin dose (UFH; pooled estimate of correlation coefficients 0.44; 95% CI: 0.33; 0.55, <i>p</i> < .001). The most frequent complications were any type of hemorrhage (pooled 36%) and thrombosis (33%). Nearly half of the critically ill patients did not survive to hospital discharge (47%).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The most appropriate tool for anticoagulation monitoring in ECMO patients is uncertain. Our analysis did not reveal a significant difference in anti-Xa levels in patients with and without hemorrhagic events. However, we found a moderate correlation between anti-Xa and the UFH dose, supporting its utilization in monitoring UFH anticoagulation. Given the limitations of time-guided monitoring methods, the role of anti-Xa is promising and further research is warranted.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2024-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.24273","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140818971","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Xueli Tian MM, Xiaozeng Li MM, Qingqing Zhang, Xiangling Qiao, Xin Li MM, Zijian Zhang
Objective
The current study delves into the impact of heart failure education intervention on improving therapeutic outcomes for heart failure (HF) patients with reduced nonvalvular ejection fraction.
Methods
There involved a total of 60 HF patients with non-valvular ejection fraction reduction who met the inclusion requirements. Patients enrolled were randomly distributed into an observation group and a control group. The observation group received heart failure education intervention, while the control group received conventional intervention. The therapeutic effect, changes in physical indicators, cardiac function indicators, coagulation function, self-management scale scores, and the incidence of adverse cardiovascular events were meticulously evaluated.
Results
The total effective proportion in the observation group was 96.67%, which was significantly higher than the control group's proportion of 76.67% (p < .05). After treatment, several parameters in the observation group showed significant improvements compared to the control group: hs-CRP, IL-6, LVEDV value, LVESV value, PT value, APTT value, and TT value were all evidently lower in the observation group. Additionally, the cardiac index, LVEF value, and heart failure self-management scale fraction were significantly higher in the observation group compared to the control group (p < .05). Furthermore, the incidence of adverse cardiovascular events in the observation group was only 6.67%, which was significantly lower than the control group's incidence of 20.00% (p < .05).
Conclusion
Heart failure education intervention demonstrates effectiveness in improving the therapeutic outcomes for HF patients and reduced nonvalvular ejection fraction. Additionally, it enhances patients' self-management abilities. Given these positive results, it is highly recommended to promote and implement HF education intervention in clinical practice.
{"title":"Improving therapeutic outcomes in heart failure with reduced nonvalvular ejection fraction: A clinical study of heart failure education intervention","authors":"Xueli Tian MM, Xiaozeng Li MM, Qingqing Zhang, Xiangling Qiao, Xin Li MM, Zijian Zhang","doi":"10.1002/clc.24265","DOIUrl":"https://doi.org/10.1002/clc.24265","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>The current study delves into the impact of heart failure education intervention on improving therapeutic outcomes for heart failure (HF) patients with reduced nonvalvular ejection fraction.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>There involved a total of 60 HF patients with non-valvular ejection fraction reduction who met the inclusion requirements. Patients enrolled were randomly distributed into an observation group and a control group. The observation group received heart failure education intervention, while the control group received conventional intervention. The therapeutic effect, changes in physical indicators, cardiac function indicators, coagulation function, self-management scale scores, and the incidence of adverse cardiovascular events were meticulously evaluated.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The total effective proportion in the observation group was 96.67%, which was significantly higher than the control group's proportion of 76.67% (<i>p</i> < .05). After treatment, several parameters in the observation group showed significant improvements compared to the control group: hs-CRP, IL-6, LVEDV value, LVESV value, PT value, APTT value, and TT value were all evidently lower in the observation group. Additionally, the cardiac index, LVEF value, and heart failure self-management scale fraction were significantly higher in the observation group compared to the control group (<i>p</i> < .05). Furthermore, the incidence of adverse cardiovascular events in the observation group was only 6.67%, which was significantly lower than the control group's incidence of 20.00% (<i>p</i> < .05).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Heart failure education intervention demonstrates effectiveness in improving the therapeutic outcomes for HF patients and reduced nonvalvular ejection fraction. Additionally, it enhances patients' self-management abilities. Given these positive results, it is highly recommended to promote and implement HF education intervention in clinical practice.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2024-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.24265","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140808077","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Hui Li PhD, Xue Liu MD, Xinhui Wang MD, Qingqing Yang PhD
Background
Previous study has demonstrated a link between TFQI, indicating the central sensitivity of thyroid hormones, and conditions like obesity, diabetes, and metabolic syndrome.
Hypothesis
Nevertheless, the potential relationship between TFQI and cardiovascular disease (CVD) in individuals with normal thyroid function has yet to be established.
Methods
The present research is a retrospective cohort investigation that included a total of 6297 individuals who had normal function of the thyroid and no history of thyroid disorders. These participants were selected from National Health and Nutrition Examination Survey data set, covering the years 2007–2012. The calculation of TFQI was performed depending on FT4 and TSH. Given the complex survey design and sample weights, we used multivariate linear regression models and stratified analysis to evaluate TFQI's correlation with CVD.
Results
Subjects with CVD had greater levels of TFQI than those with no CVD. After adjusting for other covariates, TFQI exhibited a positive association with CVD risk, and the OR was 1.706 (p = .005). In subgroup analyses that were stratified by sex and BMI, it was shown that female individuals who had CVD had greater levels of TFQI in comparison to female participants without CVD (p = .002). Furthermore, elevated levels of TFQI were consistently connected to a raised incidence of CVD in the BMI (>28 kg/m2) group after regulating for different covariates. Furthermore, correlation analysis showed an association between TFQI and metabolic biomarkers.
Conclusions
The levels of TFQI are strongly connected to the prevalence of CVD, indicating that energy metabolism may be related to the occurrence of CVD.
{"title":"Relationship between Thyroid Feedback Quantile-based Index and cardiovascular diseases in a population with normal thyroid function: Evidence from the National Health and Nutrition Examination Survey 2007–2012","authors":"Hui Li PhD, Xue Liu MD, Xinhui Wang MD, Qingqing Yang PhD","doi":"10.1002/clc.24271","DOIUrl":"https://doi.org/10.1002/clc.24271","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Previous study has demonstrated a link between TFQI, indicating the central sensitivity of thyroid hormones, and conditions like obesity, diabetes, and metabolic syndrome.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Hypothesis</h3>\u0000 \u0000 <p>Nevertheless, the potential relationship between TFQI and cardiovascular disease (CVD) in individuals with normal thyroid function has yet to be established.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The present research is a retrospective cohort investigation that included a total of 6297 individuals who had normal function of the thyroid and no history of thyroid disorders. These participants were selected from National Health and Nutrition Examination Survey data set, covering the years 2007–2012. The calculation of TFQI was performed depending on FT4 and TSH. Given the complex survey design and sample weights, we used multivariate linear regression models and stratified analysis to evaluate TFQI's correlation with CVD.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Subjects with CVD had greater levels of TFQI than those with no CVD. After adjusting for other covariates, TFQI exhibited a positive association with CVD risk, and the OR was 1.706 (<i>p</i> = .005). In subgroup analyses that were stratified by sex and BMI, it was shown that female individuals who had CVD had greater levels of TFQI in comparison to female participants without CVD (<i>p</i> = .002). Furthermore, elevated levels of TFQI were consistently connected to a raised incidence of CVD in the BMI (>28 kg/m<sup>2</sup>) group after regulating for different covariates. Furthermore, correlation analysis showed an association between TFQI and metabolic biomarkers.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The levels of TFQI are strongly connected to the prevalence of CVD, indicating that energy metabolism may be related to the occurrence of CVD.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2024-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.24271","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140808141","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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