J. Sabatino, I. Leo, A. Strangio, Sabrina La Bella, Rosalba De Sarro, Vincenzo Montemurro, G. Pedrizzetti, Fabio Troilo, Marco Maglione, Daniele Torella, Giovanni Di Salvo, Salvatore De Rosa
Assessment of intracardiac flow dynamics has recently acquired significance due to the development of new measurement methods based on echocardiography. Recent studies have demonstrated that cardiac abnormalities are associated with changes in intracardiac vortical flows. Yet, no previous study assessed the impact of aortic stenosis (AS) on intracardiac vortices. to explore the clinical potential of additional information provided by quantifying intracardiac flow dynamics in patients with AS. One hundred twenty patients with severe AS, sixty patients with concentric remodelling (VR) and hundred controls (CTRL) were prospectively included and underwent non-invasive evaluation of intracardiac flow dynamics. In addition to standard echocardiography, fluid dynamics were assessed by means of HyperDoppler. Vortex depth (p<0.001), vortex length (p=0.003), vortex intensity (p<0.001) and vortex area (p=0.049) were significantly increased in AS compared to CTRL. In addition, mean energy dissipation was significantly higher in AS compared to CTRL (p<0.001) and VR (p=0.002). At ROC analysis, vortex depth showed the best discrimination capacity for AS (p<0.001). Changes in fluid dynamics-based HyperDoppler indices can be reliably assessed in patients with AS. Significant changes in vortex depth and intensity can selectively differentiate AS from both concentric remodelling and healthy controls, suggesting that the assessment of intracardiac flow dynamics may provide complementary information to standard echocardiography to better characterize patients’ subsets.
{"title":"Changes of intracardiac flow dynamics measured by HyperDoppler in patients with aortic stenosis","authors":"J. Sabatino, I. Leo, A. Strangio, Sabrina La Bella, Rosalba De Sarro, Vincenzo Montemurro, G. Pedrizzetti, Fabio Troilo, Marco Maglione, Daniele Torella, Giovanni Di Salvo, Salvatore De Rosa","doi":"10.1093/ehjopen/oeae069","DOIUrl":"https://doi.org/10.1093/ehjopen/oeae069","url":null,"abstract":"\u0000 \u0000 \u0000 Assessment of intracardiac flow dynamics has recently acquired significance due to the development of new measurement methods based on echocardiography. Recent studies have demonstrated that cardiac abnormalities are associated with changes in intracardiac vortical flows. Yet, no previous study assessed the impact of aortic stenosis (AS) on intracardiac vortices.\u0000 \u0000 \u0000 \u0000 to explore the clinical potential of additional information provided by quantifying intracardiac flow dynamics in patients with AS.\u0000 \u0000 \u0000 \u0000 One hundred twenty patients with severe AS, sixty patients with concentric remodelling (VR) and hundred controls (CTRL) were prospectively included and underwent non-invasive evaluation of intracardiac flow dynamics. In addition to standard echocardiography, fluid dynamics were assessed by means of HyperDoppler.\u0000 \u0000 \u0000 \u0000 Vortex depth (p<0.001), vortex length (p=0.003), vortex intensity (p<0.001) and vortex area (p=0.049) were significantly increased in AS compared to CTRL. In addition, mean energy dissipation was significantly higher in AS compared to CTRL (p<0.001) and VR (p=0.002). At ROC analysis, vortex depth showed the best discrimination capacity for AS (p<0.001).\u0000 \u0000 \u0000 \u0000 Changes in fluid dynamics-based HyperDoppler indices can be reliably assessed in patients with AS. Significant changes in vortex depth and intensity can selectively differentiate AS from both concentric remodelling and healthy controls, suggesting that the assessment of intracardiac flow dynamics may provide complementary information to standard echocardiography to better characterize patients’ subsets.\u0000","PeriodicalId":11973,"journal":{"name":"European Heart Journal Open","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141927019","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
E. Zulfaj, Amirali Nejat, A. Espinosa, Shafaat Hussain, A. Haamid, Ahmed Elmahdy, Yalda Kakei, Abhishek Jha, Björn Redfors, E. Omerovic
Adequate animal models are necessary to understand human conditions such as Takotsubo syndrome (TS), characterized by the heart's transient regional wall motion abnormalities. This study aims to develop a reproducible, low-mortality TS model that closely mimics the human condition and addresses the limitations of existing models. We conducted six experiments using 309 Sprague Dawley rats, each approximately 300 grams and aged 7-8 weeks. Initially, we replicated an established model using intraperitoneal isoprenaline injections. Subsequent experiments varied the doses and infusion durations of intravenous isoprenaline and assessed the effects of sex, strain, and breeder on the development of reversible akinetic segments. High-resolution echocardiography monitored regional wall motion over 30 days to correlate with histological changes. Increasing isoprenaline dose and infusion time significantly enhanced akinesia (p < 0.01), resulting in pronounced apical ballooning observed in 3D imaging. Akinesia peaked at 6 hours post-infusion, with recovery observed at 24 hours; most rats recovered from akinetic segments within 48-72 hours. Optimizing the mode of administration, dose, and duration achieved a TS-like phenotype in 90% of cases with a 16.7% mortality rate. Histological examinations confirmed myocardial injury occurred independently of apical ballooning. This study presents a refined TS model that reliably replicates the syndrome's key features, including morphological and electrocardiographic changes, demonstrating its transient nature with high fidelity and reduced mortality. The model’s reproducibility, evidenced by consistent results across trials, suggests its potential for broader application pending further validation.
{"title":"Development of a Small Animal Model Replicating Core Characteristics of Takotsubo Syndrome in Humans","authors":"E. Zulfaj, Amirali Nejat, A. Espinosa, Shafaat Hussain, A. Haamid, Ahmed Elmahdy, Yalda Kakei, Abhishek Jha, Björn Redfors, E. Omerovic","doi":"10.1093/ehjopen/oeae048","DOIUrl":"https://doi.org/10.1093/ehjopen/oeae048","url":null,"abstract":"\u0000 \u0000 \u0000 Adequate animal models are necessary to understand human conditions such as Takotsubo syndrome (TS), characterized by the heart's transient regional wall motion abnormalities. This study aims to develop a reproducible, low-mortality TS model that closely mimics the human condition and addresses the limitations of existing models.\u0000 \u0000 \u0000 \u0000 We conducted six experiments using 309 Sprague Dawley rats, each approximately 300 grams and aged 7-8 weeks. Initially, we replicated an established model using intraperitoneal isoprenaline injections. Subsequent experiments varied the doses and infusion durations of intravenous isoprenaline and assessed the effects of sex, strain, and breeder on the development of reversible akinetic segments. High-resolution echocardiography monitored regional wall motion over 30 days to correlate with histological changes.\u0000 \u0000 \u0000 \u0000 Increasing isoprenaline dose and infusion time significantly enhanced akinesia (p < 0.01), resulting in pronounced apical ballooning observed in 3D imaging. Akinesia peaked at 6 hours post-infusion, with recovery observed at 24 hours; most rats recovered from akinetic segments within 48-72 hours. Optimizing the mode of administration, dose, and duration achieved a TS-like phenotype in 90% of cases with a 16.7% mortality rate. Histological examinations confirmed myocardial injury occurred independently of apical ballooning.\u0000 \u0000 \u0000 \u0000 This study presents a refined TS model that reliably replicates the syndrome's key features, including morphological and electrocardiographic changes, demonstrating its transient nature with high fidelity and reduced mortality. The model’s reproducibility, evidenced by consistent results across trials, suggests its potential for broader application pending further validation.\u0000","PeriodicalId":11973,"journal":{"name":"European Heart Journal Open","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141347745","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Tanja Knopp, Rebecca Jung, J. Wild, Magdalena L. Bochenek, P. Efentakis, Annika Lehmann, Tabea Bieler, V. Garlapati, Cindy Richter, M. Molitor, Katharina Perius, S. Finger, J. Lagrange, Iman Ghasemi, Konstantinos Zifkos, K. Kommoss, Joumana Masri, S. Reissig, V. Randriamboavonjy, T. Wunderlich, Nadine Hövelmeyer, Alexander N R Weber, I. Mufazalov, M. Bosmann, Ingo Bechmann, I. Fleming, M. Oelze, A. Daiber, T. Münzel, Katrin Schäfer, P. Wenzel, Ari Waisman, S. Karbach
The cytokine interleukin-6 (IL-6) plays a central role in the inflammation cascade as well as in cardiovascular disease progression. Since myeloid cells are a primary source of IL-6 formation, we aimed to generate a mouse model to study the role of myeloid cell-derived IL-6 in vascular disease. IL-6 overexpressing (IL-6OE) mice were generated and crossed with LysM-Cre mice, to generate mice (LysM-IL-6OE mice) overexpressing the cytokine in myeloid cells. Eight to 12 week old LysM-IL-6OE mice spontaneously developed inflammatory colitis, significantly impaired endothelium dependent aortic relaxation, increased aortic reactive oxygen species (ROS) formation and vascular dysfunction in resistance vessels. The latter phenotype was associated with decreased survival. Vascular dysfunction was accompanied by a significant accumulation of neutrophils, monocytes and macrophages in the aorta, increased myeloid cell reactivity (elevated ROS production), and vascular fibrosis associated with phenotypic changes of vascular smooth muscle cells. In addition to elevated Mcp1 and Cxcl1 mRNA levels, aortae from LysM-IL-6OE mice expressed higher levels of iNOS and endothelin-1, thus partially accounting for vascular dysfunction whereas systemic blood pressure alterations were not observed. Bone marrow transplantation experiments revealed that vascular dysfunction and ROS formation were driven by bone marrow cell-derived IL-6 in a dose-dependent manner. Mice with conditional overexpression of IL-6 in myeloid cells show systemic and vascular inflammation as well as endothelial dysfunction. Decrease of circulating IL-6 levels by replacing IL-6 producing myeloid cells in the bone marrow improved vascular dysfunction in this model, underpinning the relevant role of IL-6 in vascular disease.
{"title":"Myeloid cell derived Interleukin-6 induces vascular dysfunction and vascular and systemic inflammation","authors":"Tanja Knopp, Rebecca Jung, J. Wild, Magdalena L. Bochenek, P. Efentakis, Annika Lehmann, Tabea Bieler, V. Garlapati, Cindy Richter, M. Molitor, Katharina Perius, S. Finger, J. Lagrange, Iman Ghasemi, Konstantinos Zifkos, K. Kommoss, Joumana Masri, S. Reissig, V. Randriamboavonjy, T. Wunderlich, Nadine Hövelmeyer, Alexander N R Weber, I. Mufazalov, M. Bosmann, Ingo Bechmann, I. Fleming, M. Oelze, A. Daiber, T. Münzel, Katrin Schäfer, P. Wenzel, Ari Waisman, S. Karbach","doi":"10.1093/ehjopen/oeae046","DOIUrl":"https://doi.org/10.1093/ehjopen/oeae046","url":null,"abstract":"\u0000 \u0000 \u0000 The cytokine interleukin-6 (IL-6) plays a central role in the inflammation cascade as well as in cardiovascular disease progression. Since myeloid cells are a primary source of IL-6 formation, we aimed to generate a mouse model to study the role of myeloid cell-derived IL-6 in vascular disease.\u0000 \u0000 \u0000 \u0000 IL-6 overexpressing (IL-6OE) mice were generated and crossed with LysM-Cre mice, to generate mice (LysM-IL-6OE mice) overexpressing the cytokine in myeloid cells. Eight to 12 week old LysM-IL-6OE mice spontaneously developed inflammatory colitis, significantly impaired endothelium dependent aortic relaxation, increased aortic reactive oxygen species (ROS) formation and vascular dysfunction in resistance vessels. The latter phenotype was associated with decreased survival. Vascular dysfunction was accompanied by a significant accumulation of neutrophils, monocytes and macrophages in the aorta, increased myeloid cell reactivity (elevated ROS production), and vascular fibrosis associated with phenotypic changes of vascular smooth muscle cells. In addition to elevated Mcp1 and Cxcl1 mRNA levels, aortae from LysM-IL-6OE mice expressed higher levels of iNOS and endothelin-1, thus partially accounting for vascular dysfunction whereas systemic blood pressure alterations were not observed. Bone marrow transplantation experiments revealed that vascular dysfunction and ROS formation were driven by bone marrow cell-derived IL-6 in a dose-dependent manner.\u0000 \u0000 \u0000 \u0000 Mice with conditional overexpression of IL-6 in myeloid cells show systemic and vascular inflammation as well as endothelial dysfunction. Decrease of circulating IL-6 levels by replacing IL-6 producing myeloid cells in the bone marrow improved vascular dysfunction in this model, underpinning the relevant role of IL-6 in vascular disease.\u0000","PeriodicalId":11973,"journal":{"name":"European Heart Journal Open","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141353830","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Myeloid-specific interleukin-6 response: from vascular effects to the potential for novel personalized medicines","authors":"Daniel FJ Ketelhuth, Magnus Bäck","doi":"10.1093/ehjopen/oeae047","DOIUrl":"https://doi.org/10.1093/ehjopen/oeae047","url":null,"abstract":"","PeriodicalId":11973,"journal":{"name":"European Heart Journal Open","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141351241","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Johan O. Wedin, Sergey Rodin, Frank A Flachskampf, Oscar E Simonson, Johan Pallin, Jonathan Hörsne Malmborg, Stefan K James, Elisabeth Ståhle, K. Grinnemo
To investigate (i) the association between preoperative left atrial (LA) reservoir strain and postoperative atrial fibrillation (AF), and (ii) the incidence of postoperative ischemic stroke events separately in bicuspid (BAV) and tricuspid aortic valve (TAV) patients after surgical aortic valve replacement for isolated severe aortic stenosis (AS). We prospectively enrolled 227 patients (n = 133 BAV and n = 94 TAV) with isolated severe AS scheduled for aortic valve replacement. A comprehensive intra- and interobserver validated preoperative echocardiogram with analysis of LA reservoir strain was performed. Postoperative AF was defined as a sustained (>30 s) episode of atrial fibrillation or atrial flutter. Timing of neurological events were defined in accordance with the Valve Academic Research Consortium (VARC)-3 criteria for stroke. Postoperative AF occurred in 114 of 227 patients (50.2%), with no difference between BAV and TAV patients (48.1% vs. 53.1%, P = 0.452). Persisting postoperative AF at discharge was more frequent in BAV patients (29.7% vs. 8.0%, P = 0.005). Preoperative LA reservoir strain was independently associated with postoperative AF (odds ratio [OR] = 1.064, 95% CI 1.032–1.095, P < 0.001), with a significant interaction between LA reservoir strain and aortic valve morphology (Pinteraction = 0.002). The cumulative TIA/stroke incidence during follow-up was significantly higher in BAV patients (19.1% vs. 5.8% at five years). Preoperative LA function was associated with postoperative AF after aortic valve replacement in BAV AS patients, while postoperative AF in TAV AS patients likely depends on transient postoperative alterations and traditional cardiovascular risk factors. TIA/stroke during follow-up was more common in BAV AS patients.
目的：研究(i)术前左心房（LA）贮器应变与术后心房颤动（AF）之间的关系，以及(ii)手术主动脉瓣置换治疗孤立性重度主动脉瓣狭窄（AS）后，双尖瓣（BAV）和三尖瓣主动脉瓣（TAV）患者术后缺血性卒中事件的发生率。 我们前瞻性地招募了227名计划接受主动脉瓣置换术的孤立性重度主动脉瓣狭窄患者（BAV患者133人，TAV患者94人）。我们对患者进行了全面的术前超声心动图检查，并分析了 LA 储腔应变。术后房颤定义为持续（>30 秒）发作的心房颤动或心房扑动。神经系统事件的发生时间根据瓣膜学术研究联盟（VARC）-3 脑卒中标准进行定义。227 例患者中有 114 例（50.2%）发生术后房颤，BAV 和 TAV 患者之间无差异（48.1% vs. 53.1%，P = 0.452）。BAV患者出院时术后持续房颤的发生率更高（29.7% vs. 8.0%，P = 0.005）。术前 LA 储腔应变与术后房颤独立相关（几率比 [OR] = 1.064，95% CI 1.032-1.095，P <0.001），LA 储腔应变与主动脉瓣形态之间存在显著的交互作用（Pinteraction = 0.002）。BAV患者在随访期间的累积TIA/卒中发生率明显更高（五年时为19.1%对5.8%）。 BAV AS患者术前LA功能与主动脉瓣置换术后房颤有关，而TAV AS患者术后房颤可能取决于术后短暂的改变和传统的心血管风险因素。BAV AS患者在随访期间发生TIA/中风的几率更高。
{"title":"Left atrial dysfunction in bicuspid aortic valve patients with severe aortic stenosis is associated with postoperative atrial fibrillation following aortic valve replacement","authors":"Johan O. Wedin, Sergey Rodin, Frank A Flachskampf, Oscar E Simonson, Johan Pallin, Jonathan Hörsne Malmborg, Stefan K James, Elisabeth Ståhle, K. Grinnemo","doi":"10.1093/ehjopen/oeae020","DOIUrl":"https://doi.org/10.1093/ehjopen/oeae020","url":null,"abstract":"\u0000 \u0000 \u0000 To investigate (i) the association between preoperative left atrial (LA) reservoir strain and postoperative atrial fibrillation (AF), and (ii) the incidence of postoperative ischemic stroke events separately in bicuspid (BAV) and tricuspid aortic valve (TAV) patients after surgical aortic valve replacement for isolated severe aortic stenosis (AS).\u0000 \u0000 \u0000 \u0000 We prospectively enrolled 227 patients (n = 133 BAV and n = 94 TAV) with isolated severe AS scheduled for aortic valve replacement. A comprehensive intra- and interobserver validated preoperative echocardiogram with analysis of LA reservoir strain was performed. Postoperative AF was defined as a sustained (>30 s) episode of atrial fibrillation or atrial flutter. Timing of neurological events were defined in accordance with the Valve Academic Research Consortium (VARC)-3 criteria for stroke. Postoperative AF occurred in 114 of 227 patients (50.2%), with no difference between BAV and TAV patients (48.1% vs. 53.1%, P = 0.452). Persisting postoperative AF at discharge was more frequent in BAV patients (29.7% vs. 8.0%, P = 0.005). Preoperative LA reservoir strain was independently associated with postoperative AF (odds ratio [OR] = 1.064, 95% CI 1.032–1.095, P < 0.001), with a significant interaction between LA reservoir strain and aortic valve morphology (Pinteraction = 0.002). The cumulative TIA/stroke incidence during follow-up was significantly higher in BAV patients (19.1% vs. 5.8% at five years).\u0000 \u0000 \u0000 \u0000 Preoperative LA function was associated with postoperative AF after aortic valve replacement in BAV AS patients, while postoperative AF in TAV AS patients likely depends on transient postoperative alterations and traditional cardiovascular risk factors. TIA/stroke during follow-up was more common in BAV AS patients.\u0000","PeriodicalId":11973,"journal":{"name":"European Heart Journal Open","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140373106","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Jie Jun Wong, Laureen Yi-Ting Wang, K. Hasegawa, Kay Woon Ho, Zijuan Huang, L. Teo, Jack Wei Chieh Tan, Kazuyuki Kasahara, R. Tan, Junbo Ge, A. Koh
Aging-related cardiovascular disease and frailty burdens are anticipated to rise with global aging. In response to directions from major cardiovascular societies, we investigated frailty knowledge, awareness, and practices among cardiologists as key stakeholders in this emerging paradigm a year after the European Frailty in Cardiology consensus document was published. We launched a prospective multinational web-based survey via social networks to broad cardiology communities representing multiple World Health Organization regions, including Western Pacific and Southeast Asia regions. Overall, 578 respondents [38.2% female; ages 35-49 years (55.2%), 50-64 years (34.4%)] across subspecialties, including interventionists (43.3%), general cardiologists (30.6%), and heart failure specialists (HFs) (10.9%), were surveyed. Nearly half had read the consensus document (38.9%). Non-interventionists had better perceived knowledge of frailty assessment instruments (fully or vaguely aware, 57.2% vs 45%, adj. p=0.0002), exercise programs (well aware, 12.9% vs 6.0%, adj. p=0.001), and engaged more in multidisciplinary team care (frequently or occasionally 52.6% vs 41%, adj. p=0.002) than interventionists. HFs more often addressed preprocedural frailty (frequently or occasionally, 43.5% vs 28.2%, p=0.004) and polypharmacy (frequently or occasionally, 85.5% vs 71%, adj. p=0.014), and had consistently better composite knowledge (39.3% vs 21.6%, adj. p=0.001) and practice responses (21% vs 11.1%, adj. p=0.018) than non-HFs. Respondents with better knowledge responses also had better frailty practices (40.3% vs 3.6%, adj. p<0.001). Distinct response differences suggest that future strategies strengthening frailty principles should address practices peculiar to subspecialties, such as preprocedural frailty strategies for interventionists and rehabilitation interventions for heart failure specialists.
随着全球老龄化的加剧，预计与老龄化相关的心血管疾病和虚弱负担将不断增加。为了响应主要心血管协会的指示，我们在《欧洲心脏病学中的虚弱》共识文件发表一年后，调查了作为这一新兴模式主要利益相关者的心脏病学家对虚弱的了解、认识和实践。 我们通过社交网络向代表世界卫生组织多个地区（包括西太平洋和东南亚地区）的广大心脏病学社区发起了一项前瞻性跨国网络调查。 总共有 578 名受访者[38.2% 为女性；年龄在 35-49 岁（55.2%）和 50-64 岁（34.4%）之间]接受了调查，他们来自各个亚专科，包括介入专家（43.3%）、普通心脏病专家（30.6%）和心力衰竭专家（10.9%）。近一半的人阅读过共识文件（38.9%）。与干预者相比，非干预者对虚弱评估工具（完全了解或模糊了解，57.2% 对 45%，修正后 p=0.0002）、运动计划（非常了解，12.9% 对 6.0%，修正后 p=0.001）和多学科团队护理（经常或偶尔了解，52.6% 对 41%，修正后 p=0.002）的认知度更高。与非高血压患者相比，高血压患者更经常处理术前虚弱问题（经常或偶尔，43.5% vs 28.2%，adj. p=0.004）和多药治疗问题（经常或偶尔，85.5% vs 71%，adj. p=0.014），其综合知识（39.3% vs 21.6%，adj. p=0.001）和实践反应（21% vs 11.1%，adj. p=0.018）也一直更好。知识回答较好的受访者也有较好的虚弱实践（40.3% vs 3.6%，adj. p<0.001）。 不同的回答差异表明，未来加强虚弱原则的策略应针对亚专科的特殊实践，如介入专家的术前虚弱策略和心衰专家的康复干预。
{"title":"Current Frailty Knowledge, Awareness, and Practices Among Physicians following the 2022 European Consensus Document on Frailty in Cardiology","authors":"Jie Jun Wong, Laureen Yi-Ting Wang, K. Hasegawa, Kay Woon Ho, Zijuan Huang, L. Teo, Jack Wei Chieh Tan, Kazuyuki Kasahara, R. Tan, Junbo Ge, A. Koh","doi":"10.1093/ehjopen/oeae025","DOIUrl":"https://doi.org/10.1093/ehjopen/oeae025","url":null,"abstract":"\u0000 \u0000 \u0000 Aging-related cardiovascular disease and frailty burdens are anticipated to rise with global aging. In response to directions from major cardiovascular societies, we investigated frailty knowledge, awareness, and practices among cardiologists as key stakeholders in this emerging paradigm a year after the European Frailty in Cardiology consensus document was published.\u0000 \u0000 \u0000 \u0000 We launched a prospective multinational web-based survey via social networks to broad cardiology communities representing multiple World Health Organization regions, including Western Pacific and Southeast Asia regions.\u0000 \u0000 \u0000 \u0000 Overall, 578 respondents [38.2% female; ages 35-49 years (55.2%), 50-64 years (34.4%)] across subspecialties, including interventionists (43.3%), general cardiologists (30.6%), and heart failure specialists (HFs) (10.9%), were surveyed. Nearly half had read the consensus document (38.9%). Non-interventionists had better perceived knowledge of frailty assessment instruments (fully or vaguely aware, 57.2% vs 45%, adj. p=0.0002), exercise programs (well aware, 12.9% vs 6.0%, adj. p=0.001), and engaged more in multidisciplinary team care (frequently or occasionally 52.6% vs 41%, adj. p=0.002) than interventionists. HFs more often addressed preprocedural frailty (frequently or occasionally, 43.5% vs 28.2%, p=0.004) and polypharmacy (frequently or occasionally, 85.5% vs 71%, adj. p=0.014), and had consistently better composite knowledge (39.3% vs 21.6%, adj. p=0.001) and practice responses (21% vs 11.1%, adj. p=0.018) than non-HFs. Respondents with better knowledge responses also had better frailty practices (40.3% vs 3.6%, adj. p<0.001).\u0000 \u0000 \u0000 \u0000 Distinct response differences suggest that future strategies strengthening frailty principles should address practices peculiar to subspecialties, such as preprocedural frailty strategies for interventionists and rehabilitation interventions for heart failure specialists.\u0000","PeriodicalId":11973,"journal":{"name":"European Heart Journal Open","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140376908","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Daisuke Miyahara, M. Izumo, Yukio Sato, Tatsuro Shoji, Risako Murata, Ryutaro Oda, T. Okuno, S. Kuwata, Yoshihiro J. Akashi
Current evidence on the prognostic value of exercise stress echocardiography (ESE) in asymptomatic patients with low-gradient severe AS is limited. Therefore, this study aimed to elucidate its prognostic implications for patients with low-gradient severe AS and determine the added value of ESE in risk stratification for this population. This retrospective observational study included 122 consecutive asymptomatic patients with either moderate (mean pressure gradient [MPG] <40 mmHg and aortic valve area [AVA] 1.0–1.5 cm2) or low-gradient severe (MPG <40 mmHg and AVA <1.0 cm2) AS and preserved left ventricular ejection fraction (≥50%) who underwent ESE. All patients were followed up for AS-related events. Of 143 patients, 21 who met any exclusion criteria, including early interventions, were excluded, and 122 conservatively managed patients (76.5 [71.0–80.3] years; 48.3% male) were included in this study. During a median follow-up period of 989 (578–1571) days, 64 patients experienced AS-related events. Patients with low-gradient severe AS had significantly lower event-free survival rates than those with moderate AS (log-rank test, p<0.001). Multivariable Cox regression analysis showed that the mitral E/e’ ratio during exercise was independently associated with AS-related events (hazard ratio=1.075, p<0.001) in patients with low-gradient severe AS. This study suggests that asymptomatic patients with low-gradient severe AS have worse prognoses than those with moderate AS. Additionally, the mitral E/e’ ratio during exercise is a useful parameter for risk stratification in patients with low-gradient severe AS.
目前有关运动负荷超声心动图（ESE）对低梯度重度强直性脊柱炎无症状患者预后价值的证据有限。因此，本研究旨在阐明运动负荷超声心动图对低梯度重度 AS 患者预后的影响，并确定 ESE 在该人群风险分层中的附加价值。 这项回顾性观察研究纳入了 122 例连续接受 ESE 的无症状中度（平均压力梯度 [MPG] <40 mmHg，主动脉瓣面积 [AVA] 1.0-1.5 cm2）或低梯度重度（平均压力梯度 <40 mmHg，主动脉瓣面积 <1.0 cm2）AS 患者，这些患者的左室射血分数保留（≥50%）。所有患者均接受了 AS 相关事件的随访。在 143 例患者中，21 例符合任何排除标准（包括早期干预）的患者被排除在外，122 例保守治疗的患者（76.5 [71.0-80.3] 岁；48.3% 为男性）被纳入本研究。在989（578-1571）天的中位随访期间，64名患者发生了与强直性脊柱炎相关的事件。低梯度重度强直性脊柱炎患者的无事件生存率明显低于中度强直性脊柱炎患者（log-rank检验，P<0.001）。多变量考克斯回归分析显示，运动时二尖瓣E/e'比值与低梯度重度AS患者的AS相关事件独立相关（危险比=1.075，P<0.001）。 这项研究表明，无症状的低梯度重度强直性脊柱炎患者的预后比中度强直性脊柱炎患者差。此外，运动时的二尖瓣E/e'比值是对低梯度重度AS患者进行风险分层的有用参数。
{"title":"Prediction of symptoms development and aortic valve replacement in patients with low gradient severe aortic stenosis","authors":"Daisuke Miyahara, M. Izumo, Yukio Sato, Tatsuro Shoji, Risako Murata, Ryutaro Oda, T. Okuno, S. Kuwata, Yoshihiro J. Akashi","doi":"10.1093/ehjopen/oeae018","DOIUrl":"https://doi.org/10.1093/ehjopen/oeae018","url":null,"abstract":"\u0000 \u0000 \u0000 Current evidence on the prognostic value of exercise stress echocardiography (ESE) in asymptomatic patients with low-gradient severe AS is limited. Therefore, this study aimed to elucidate its prognostic implications for patients with low-gradient severe AS and determine the added value of ESE in risk stratification for this population.\u0000 \u0000 \u0000 \u0000 This retrospective observational study included 122 consecutive asymptomatic patients with either moderate (mean pressure gradient [MPG] <40 mmHg and aortic valve area [AVA] 1.0–1.5 cm2) or low-gradient severe (MPG <40 mmHg and AVA <1.0 cm2) AS and preserved left ventricular ejection fraction (≥50%) who underwent ESE. All patients were followed up for AS-related events. Of 143 patients, 21 who met any exclusion criteria, including early interventions, were excluded, and 122 conservatively managed patients (76.5 [71.0–80.3] years; 48.3% male) were included in this study. During a median follow-up period of 989 (578–1571) days, 64 patients experienced AS-related events. Patients with low-gradient severe AS had significantly lower event-free survival rates than those with moderate AS (log-rank test, p<0.001). Multivariable Cox regression analysis showed that the mitral E/e’ ratio during exercise was independently associated with AS-related events (hazard ratio=1.075, p<0.001) in patients with low-gradient severe AS.\u0000 \u0000 \u0000 \u0000 This study suggests that asymptomatic patients with low-gradient severe AS have worse prognoses than those with moderate AS. Additionally, the mitral E/e’ ratio during exercise is a useful parameter for risk stratification in patients with low-gradient severe AS.\u0000","PeriodicalId":11973,"journal":{"name":"European Heart Journal Open","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140078245","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Y. Hamatani, M. Iguchi, Keita Okamoto, Y. Nakanishi, K. Minami, K. Ishigami, S. Ikeda, K. Doi, T. Yoshizawa, Y. Ide, A. Fujino, M. Ishii, N. Masunaga, M. Esato, H. Tsuji, H. Wada, K. Hasegawa, M. Abe, M. Akao
Atrial fibrillation (AF) increases the risk of heart failure (HF); however, little is known regarding the risk stratification for incident HF in AF patients, especially with preserved left ventricular ejection fraction (LVEF). The Fushimi AF Registry is a community-based prospective survey of AF patients. From the registry, 3,002 non-valvular AF patients with preserved LVEF and with the data of antero-posterior left atrial diameter (LAD) at enrollment were investigated. Patients were stratified by LAD (<40 mm, 40-44 mm, 45-49 mm, and ≥50 mm) with backgrounds and HF hospitalization incidences compared between groups. Of 3,002 patients (mean age: 73.5 ± 10.7 years, women: 1,226 [41%], paroxysmal AF: 1,579 [53%], and mean CHA2DS2-VASc score: 3.3 ± 1.7), the mean LAD was 43 ± 8 mm. Patients with larger LAD were older and less often paroxysmal AF, with a higher CHA2DS2-VASc score (all P < 0.001). HF hospitalization occurred in 412 patients during the median follow-up period of 6.0 years. Larger LAD was independently associated with a higher HF hospitalization risk (LAD ≥50 mm; hazard ratio [HR]: 2.36, 95% confidence interval [CI]: 1.75-3.18, LAD 45-49 mm; HR: 1.84, 95%CI: 1.37-2.46 and LAD 40-44 mm: HR: 1.34, 95%CI: 1.01-1.78, compared with LAD <40 mm) after adjustment by age, sex, AF type, and CHA2DS2-VASc score. These results were also consistent across major subgroups, showing no significant interaction. LAD is significantly associated with the risk of incident HF in AF patients with preserved LVEF, suggesting the utility of LAD regarding HF risk stratification for these patients.
{"title":"Association of left atrial enlargement with heart failure events in non-valvular atrial fibrillation patients with preserved left ventricular ejection fraction","authors":"Y. Hamatani, M. Iguchi, Keita Okamoto, Y. Nakanishi, K. Minami, K. Ishigami, S. Ikeda, K. Doi, T. Yoshizawa, Y. Ide, A. Fujino, M. Ishii, N. Masunaga, M. Esato, H. Tsuji, H. Wada, K. Hasegawa, M. Abe, M. Akao","doi":"10.1093/ehjopen/oeae015","DOIUrl":"https://doi.org/10.1093/ehjopen/oeae015","url":null,"abstract":"\u0000 \u0000 \u0000 Atrial fibrillation (AF) increases the risk of heart failure (HF); however, little is known regarding the risk stratification for incident HF in AF patients, especially with preserved left ventricular ejection fraction (LVEF).\u0000 \u0000 \u0000 \u0000 The Fushimi AF Registry is a community-based prospective survey of AF patients. From the registry, 3,002 non-valvular AF patients with preserved LVEF and with the data of antero-posterior left atrial diameter (LAD) at enrollment were investigated. Patients were stratified by LAD (<40 mm, 40-44 mm, 45-49 mm, and ≥50 mm) with backgrounds and HF hospitalization incidences compared between groups. Of 3,002 patients (mean age: 73.5 ± 10.7 years, women: 1,226 [41%], paroxysmal AF: 1,579 [53%], and mean CHA2DS2-VASc score: 3.3 ± 1.7), the mean LAD was 43 ± 8 mm. Patients with larger LAD were older and less often paroxysmal AF, with a higher CHA2DS2-VASc score (all P < 0.001). HF hospitalization occurred in 412 patients during the median follow-up period of 6.0 years. Larger LAD was independently associated with a higher HF hospitalization risk (LAD ≥50 mm; hazard ratio [HR]: 2.36, 95% confidence interval [CI]: 1.75-3.18, LAD 45-49 mm; HR: 1.84, 95%CI: 1.37-2.46 and LAD 40-44 mm: HR: 1.34, 95%CI: 1.01-1.78, compared with LAD <40 mm) after adjustment by age, sex, AF type, and CHA2DS2-VASc score. These results were also consistent across major subgroups, showing no significant interaction.\u0000 \u0000 \u0000 \u0000 LAD is significantly associated with the risk of incident HF in AF patients with preserved LVEF, suggesting the utility of LAD regarding HF risk stratification for these patients.\u0000","PeriodicalId":11973,"journal":{"name":"European Heart Journal Open","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140089042","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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