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Exposure to aircraft noise exacerbates cardiovascular and oxidative damage in three mouse models of diabetes. 暴露于飞机噪音会加剧三种糖尿病小鼠模型的心血管和氧化损伤。
IF 8.4 2区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-10-01 DOI: 10.1093/eurjpc/zwae320
Dominika Mihalikova, Paul Stamm, Miroslava Kvandova, Chinmayi Pednekar, Lea Strohm, Henning Ubbens, Matthias Oelze, Marin Kuntic, Claudius Witzler, Maria Teresa Bayo Jimenez, Sanela Rajlic, Katie Frenis, Qi Tang, Yue Ruan, Susanne Karbach, Hartmut Kleinert, Omar Hahad, Alex von Kriegsheim, Ning Xia, Tilman Grune, Huige Li, Swenja Kröller-Schön, Adrian Gericke, Wolfram Ruf, Philipp S Wild, Philipp Lurz, Thomas Münzel, Andreas Daiber, Thomas Jansen

Background: Epidemiology links noise to increased risk of metabolic diseases like diabetes and obesity. Translational studies in humans and experimental animals showed that noise causes reactive oxygen species (ROS)-mediated cardiovascular damage. The interaction between noise and diabetes, specifically potential additive adverse effects, remains to be determined.

Methods and results: C57BL/6 mice were treated with streptozotocin (i.p. injections, 50 mg/kg/d for 5d) to induce type-1 diabetes, with S961 (subcutaneous osmotic minipumps, 0.57 mg/kg/d for 7d) or fed a high-fat diet (HFD, 20 weeks) to induce type-2 diabetes. Control and diabetic mice were exposed to aircraft noise to an average sound pressure level of 72 dB(A) for 4d. While body weight was unaffected, noise reduced insulin production in all diabetes models. The oral glucose tolerance test showed only an additive aggravation by noise in the HFD model. Noise increased blood pressure and aggravated diabetes-induced aortic, mesenteric, and cerebral arterioles endothelial dysfunction. ROS formation in cerebral arterioles, the aorta, the heart, and isolated mitochondria was consistently increased by noise in all models of diabetes. Mitochondrial respiration was impaired by diabetes and noise, however without additive effects. Noise increased ROS and caused inflammation in adipose tissue in the HFD model. RNA sequencing data and alteration of gene pathway clusters also supported additive damage by noise in the setting of diabetes.

Conclusion: In all three models of diabetes, aircraft noise exacerbates oxidative stress, inflammation, and endothelial dysfunction in mice with pre-existing diabetes. Thus, noise may potentiate the already increased cardiovascular risk in diabetic patients.

背景:流行病学将噪声与糖尿病和肥胖症等代谢性疾病的风险增加联系起来。对人类和实验动物进行的转化研究表明,噪音会导致活性氧(ROS)介导的心血管损伤。噪声与糖尿病之间的相互作用,特别是潜在的叠加不利影响,仍有待确定:用链脲佐菌素(静脉注射,50 毫克/千克/天,持续 5 天)诱导 C57BL/6 小鼠患 1 型糖尿病,用 S961(皮下渗透微型泵,0.57 毫克/千克/天,持续 7 天)或喂食高脂饮食(HFD,20 周)诱导 2 型糖尿病。对照组和糖尿病小鼠暴露于平均声压级为 72 dB(A) 的飞机噪音中 4 天。虽然体重未受影响,但噪音减少了所有糖尿病模型的胰岛素分泌。在高频分解模型中,口服葡萄糖耐量试验仅显示噪音会加重病情。噪音会升高血压,加重糖尿病引起的主动脉、肠系膜和脑动脉内皮功能障碍。在所有糖尿病模型中,脑动脉血管、主动脉、心脏和离体线粒体中的 ROS 形成都因噪音而持续增加。线粒体呼吸受到糖尿病和噪音的影响,但没有叠加效应。在高密度脂蛋白胆固醇模型中,噪声增加了 ROS 并导致脂肪组织炎症。RNA测序数据和基因通路集群的改变也证实了噪声对糖尿病患者造成的叠加损害:结论:在所有三种糖尿病模型中,飞机噪声都会加剧原有糖尿病小鼠的氧化应激、炎症和内皮功能障碍。因此,噪声可能会加剧糖尿病患者已经增加的心血管风险。
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引用次数: 0
Correction to: Lipoprotein(a): Don't forget about secondary prevention. 更正为脂蛋白(a):不要忘记二级预防。
IF 8.4 2区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-09-30 DOI: 10.1093/eurjpc/zwae311
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引用次数: 0
Fontan hemodynamics in adults with obesity compared to overweight and normal body mass index: a retrospective invasive exercise study. 肥胖成人与超重和体重指数正常成人的丰塔血液动力学比较:一项回顾性有创运动研究。
IF 8.4 2区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-09-28 DOI: 10.1093/eurjpc/zwae314
Derek N Opp, C Charles Jain, Alexander C Egbe, Barry A Borlaug, Yogesh V Reddy, Heidi M Connolly, Kyla M Lara-Breitinger, Rachael Cordina, William R Miranda

Aims: The effects of obesity on Fontan hemodynamics are poorly understood. Accordingly, we assessed its impact on exercise invasive hemodynamics and exercise capacity.

Methods: Seventy-seven adults post-Fontan undergoing exercise cardiac catheterization (supine cycle protocol) were retrospectively identified using an institutional database and categorized according to the presence of obesity (body mass index [BMI] >30 kg/m2) and overweight/normal BMI (BMI≤30 kg/m2).

Results: There were 18 individuals with obesity (BMI 36.4±3 kg/m2) and 59 (BMI 24.1±3.6 kg/m2) with overweight/normal BMI. Peak oxygen consumption (VO2) on noninvasive cardiopulmonary exercise testing was lower in patients with obesity (15.6±3.5 vs 19.6±5.8 ml/kg/min, p=0.04). At rest, systemic flow (Qs) (7.0 [4.8; 8.3] vs 4.8 [3.9; 5.8] l/min, p=0.001), pulmonary artery (PA) pressure (16.3±3.5 vs 13.1±3.5 mmHg, p=0.002), and PA wedge pressure (PAWP) (11.7±4.4 vs 8.9±3.1 mmHg, p=0.01) were higher, while arterial O2 saturation was lower (89.5% [86.5; 92.3] vs 93% [90; 95]) in obesity compared to overweight/normal BMI. Similarly, patients with obesity had higher exercise PA pressure (29.7±6.5 vs 24.7±6.8 mmHg, p=0.01) and PAWP (23.0±6.5 vs 19.8±7.3 mmHg, p=0.047), but lower arterial O2 saturation (82.4±7.0% vs 89% [85; 92], p=0.003).

Conclusion: Adults post-Fontan with obesity have worse aerobic capacity, increased Qs, higher filling pressures, and decreased arterial O2 saturation compared to those with overweight/normal BMI, both at rest and during exercise, mirroring the findings observed in the obesity phenotype of heart failure with preserved ejection fraction. Whether treating obesity and its cardiometabolic sequelae in Fontan patients will improve hemodynamics and outcomes requires further study.

目的:人们对肥胖对丰坦血流动力学的影响知之甚少。因此,我们评估了肥胖对运动创伤性血液动力学和运动能力的影响:方法:我们利用机构数据库对 77 名接受运动心导管检查(仰卧循环方案)的丰坦术后成人进行了回顾性鉴定,并根据是否存在肥胖(体重指数[BMI] >30 kg/m2)和超重/正常体重指数(BMI≤30 kg/m2)进行了分类:结果:18 人肥胖(体重指数为 36.4±3 kg/m2),59 人超重/体重指数正常(体重指数为 24.1±3.6 kg/m2)。肥胖症患者在无创心肺运动测试中的峰值耗氧量(VO2)较低(15.6±3.5 vs 19.6±5.8ml/kg/min,P=0.04)。静息时,全身血流(Qs)(7.0 [4.8; 8.3] vs 4.8 [3.9; 5.8] l/min,p=0.001)、肺动脉(PA)压(16.3±3.5 vs 13.1±3.5mmHg,p=0.002)和肺动脉楔压(PAWP)(11.7±4.4 vs 8.9±3.1 mmHg,p=0.01)更高,而动脉血氧饱和度则更低(89.5% [86.5; 92.3] vs 93% [90; 95])。同样,肥胖患者的运动 PA 压力(29.7±6.5 vs 24.7±6.8 mmHg,p=0.01)和 PAWP(23.0±6.5 vs 19.8±7.3 mmHg,p=0.047)较高,但动脉血氧饱和度较低(82.4±7.0% vs 89% [85;92],p=0.003):结论:与超重/体重指数正常的人相比,肥胖的方坦术后成人在静息和运动时的有氧能力更差、Qs增加、充盈压升高、动脉血氧饱和度降低,这与射血分数保留型心力衰竭的肥胖表型中观察到的结果一致。治疗丰坦患者的肥胖及其心脏代谢后遗症是否能改善血液动力学和预后还需要进一步研究。
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引用次数: 0
Lipid Lowering Therapy After Myocardial Infarction: Strike Early, Strong and equally in women and men. 心肌梗死后的降脂治疗:早出击、强出击,男女平等。
IF 8.4 2区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-09-28 DOI: 10.1093/eurjpc/zwae319
Gal Tsaban, Barbara Vitola
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引用次数: 0
Every activity and intensity count in cardiovascular prevention in individuals with cardiovascular disease. 在心血管疾病患者的心血管预防中,每项活动和强度都很重要。
IF 8.4 2区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-09-27 DOI: 10.1093/eurjpc/zwae299
Esmée A Bakker, Henner Hanssen
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引用次数: 0
Can incidental physical activity offset the deleterious associations of sedentary behaviour with major adverse cardiovascular events? 偶然的体育锻炼能否抵消久坐行为与主要不良心血管事件之间的有害联系?
IF 8.4 2区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-09-26 DOI: 10.1093/eurjpc/zwae316
Nicholas A Koemel, Matthew N Ahmadi, Raaj Kishore Biswas, Annemarie Koster, Andrew J Atkin, Angelo Sabag, Emmanuel Stamatakis

Aims: Incidental physical activity as part of daily living may offer feasibility advantages over traditional exercise. We examined the joint associations of incidental physical activity and sedentary behaviour with major adverse cardiovascular events (MACE) risk.

Methods: Analyses included 22,368 non-exercising adults from the UK Biobank accelerometry sub-study (Median age [IQR]: 62.9 [11.6] years; 41.8% male). Physical activity and sedentary behaviour exposures were derived using a machine learning-based intensity and posture classification schema. We assessed the tertile-based joint associations of sedentary behaviour and: a) incidental vigorous (VPA), b) incidental moderate to vigorous (MVPA), c) vigorous intermittent lifestyle physical activity (VILPA; bouts lasting up to 1 minute), and d) moderate to vigorous intermittent lifestyle physical activity (MV-ILPA; bouts lasting up to 3 minutes) with MACE risk.

Results: Over an 8.0-year median follow-up, 819 MACE events occurred. Compared to the highest physical activity and lowest sedentary time, high sedentary behaviour (>11.4 hours/day) with low incidental VPA (<2.1 minutes/day) had an HR of 1.34 (95% CI: 0.98, 1.84) and low incidental MVPA (<21.8 minutes/day) had a 1.89 HR (95% CI: 1.42, 2.52) for MACE. Sedentary behaviour was not associated with MACE at medium and high levels of VPA or VILPA. Completing 4.1 minutes/day of VPA or VILPA may offset the MACE risk associated with high sedentary behaviour. Conversely, 31-65 minutes of incidental MVPA or 26-52 minutes of MV-ILPA per day largely attenuated the associations with MACE.

Conclusion: Brief intermittent bursts of vigorous incidental physical activity may offset cardiovascular risks from high sedentary behaviour.

目的:与传统运动相比,作为日常生活一部分的偶然体育锻炼可能具有可行性优势。我们研究了偶然体育锻炼和久坐行为与主要不良心血管事件(MACE)风险之间的关系:分析对象包括英国生物库加速度子研究中的 22,368 名非运动成年人(中位年龄 [IQR]:62.9 [11.6] 岁;41.8% 为男性)。体育活动和久坐行为暴露是通过基于机器学习的强度和姿势分类模式得出的。我们评估了久坐行为与下列因素的三等分联合关系:a)偶然剧烈(VPA);b)偶然中度至剧烈(MVPA);c)剧烈间歇性生活方式体力活动(VILPA;持续时间不超过 1 分钟);d)中度至剧烈间歇性生活方式体力活动(MV-ILPA;持续时间不超过 3 分钟):在8.0年的中位随访期间,共发生了819起MACE事件。与体力活动量最大、久坐时间最少的人群相比,久坐时间较长(>11.4小时/天)、偶发性VPA较少的人群(结论:短暂的间歇性剧烈运动可抵消久坐导致的心血管风险。
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引用次数: 0
Heart rate response and recovery in cycle exercise testing - normal values and association with mortality. 循环运动测试中的心率反应和恢复--正常值及与死亡率的关系。
IF 8.4 2区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-09-26 DOI: 10.1093/eurjpc/zwae308
Jordi Jou, Xingwu Zhou, Thomas Lindow, Lars Brudin, Kristofer Hedman, Magnus Ekström, Andrei Malinovschi

Aim: Chronotropic incompetence and impaired heart rate (HR) recovery are related to mortality. Guidelines lack specific reference values for HR recovery. We defined normal values and studied blunted HR response and recovery, and mortality risk.

Methods: We included 9,917 subjects (45% females) aged 18-85 years who performed a cycle exercise test. We defined normal values for peak HR, HR reserve, and HR recovery at 1 and 2 minutes (HRR1 and HRR2) based on individuals apparently healthy (N=2,242). Associations between blunted HR indices (<5th percentile) and mortality over a median follow-up of 8.6 years were analysed using Cox regression and competing risk analysis.

Results: All HR indices were age-dependent and independent predictors of all-cause and CV mortality. The 5th percentiles of HR reserve, HRR1, and HRR2 correlated weakly with existing reference values. HR recovery variables were the strongest predictors of all-cause mortality (HRR1, hazard ratio 1.70 [95% confidence interval, 1.49-1.94] and HRR2, 1.57 [1.37-1.79]), including in subjects with normal exercise capacity (HRR1, 1.96 [1.61-2.39] and HRR2, 1.76 [1.46-2.12]). Combining HR indices appeared to increase the risk of all-cause (HRR1 and HRR2, 1.96 [1.68-2.29] and peak HR and HRR1, 1.87 [1.56-2.23]) and CV mortality, although no specific combination was superior for predicting CV mortality.

Conclusions: All HR variables were age-dependent and associated with all-cause and CV mortality. Blunted HR recovery variables were the strongest predictors of all-cause mortality, even in subjects with normal exercise capacity. Combined blunted HR indices appeared to add prognostic value.

目的:嗜铬细胞功能不全和心率(HR)恢复受损与死亡率有关。指南缺乏心率恢复的具体参考值。我们定义了正常值,并研究了心率反应和恢复能力减弱以及死亡风险:我们纳入了 9,917 名年龄在 18-85 岁之间、进行过自行车运动测试的受试者(45% 为女性)。我们根据明显健康的个体(2242 人)定义了峰值心率、心率储备以及 1 分钟和 2 分钟心率恢复(HRR1 和 HRR2)的正常值。心率指数钝化之间的关联(结果:所有心率指数都与年龄有关,是全因死亡率和冠心病死亡率的独立预测因素。心率储备、HRR1 和 HRR2 的第 5 百分位数与现有参考值的相关性较弱。心率恢复变量是全因死亡率的最强预测因子(HRR1,危险比 1.70 [95%置信区间,1.49-1.94];HRR2,1.57 [1.37-1.79]),包括运动能力正常的受试者(HRR1,1.96 [1.61-2.39];HRR2,1.76 [1.46-2.12])。结合心率指数似乎会增加全因(HRR1 和 HRR2,1.96 [1.68-2.29];峰值心率和 HRR1,1.87 [1.56-2.23])和心血管死亡的风险,尽管没有特定的组合在预测心血管死亡方面更有优势:所有心率变量都与年龄有关,并与全因死亡率和心血管死亡率相关。心率恢复钝化变量是全因死亡率的最强预测因素,即使是运动能力正常的受试者也是如此。综合的心率钝化指数似乎增加了预后价值。
{"title":"Heart rate response and recovery in cycle exercise testing - normal values and association with mortality.","authors":"Jordi Jou, Xingwu Zhou, Thomas Lindow, Lars Brudin, Kristofer Hedman, Magnus Ekström, Andrei Malinovschi","doi":"10.1093/eurjpc/zwae308","DOIUrl":"https://doi.org/10.1093/eurjpc/zwae308","url":null,"abstract":"<p><strong>Aim: </strong>Chronotropic incompetence and impaired heart rate (HR) recovery are related to mortality. Guidelines lack specific reference values for HR recovery. We defined normal values and studied blunted HR response and recovery, and mortality risk.</p><p><strong>Methods: </strong>We included 9,917 subjects (45% females) aged 18-85 years who performed a cycle exercise test. We defined normal values for peak HR, HR reserve, and HR recovery at 1 and 2 minutes (HRR1 and HRR2) based on individuals apparently healthy (N=2,242). Associations between blunted HR indices (<5th percentile) and mortality over a median follow-up of 8.6 years were analysed using Cox regression and competing risk analysis.</p><p><strong>Results: </strong>All HR indices were age-dependent and independent predictors of all-cause and CV mortality. The 5th percentiles of HR reserve, HRR1, and HRR2 correlated weakly with existing reference values. HR recovery variables were the strongest predictors of all-cause mortality (HRR1, hazard ratio 1.70 [95% confidence interval, 1.49-1.94] and HRR2, 1.57 [1.37-1.79]), including in subjects with normal exercise capacity (HRR1, 1.96 [1.61-2.39] and HRR2, 1.76 [1.46-2.12]). Combining HR indices appeared to increase the risk of all-cause (HRR1 and HRR2, 1.96 [1.68-2.29] and peak HR and HRR1, 1.87 [1.56-2.23]) and CV mortality, although no specific combination was superior for predicting CV mortality.</p><p><strong>Conclusions: </strong>All HR variables were age-dependent and associated with all-cause and CV mortality. Blunted HR recovery variables were the strongest predictors of all-cause mortality, even in subjects with normal exercise capacity. Combined blunted HR indices appeared to add prognostic value.</p>","PeriodicalId":12051,"journal":{"name":"European journal of preventive cardiology","volume":null,"pages":null},"PeriodicalIF":8.4,"publicationDate":"2024-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142344263","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Circadian heart rate fluctuations predict cardiovascular and all-cause mortality in type 2 and type 1 diabetes: a 21-year retrospective longitudinal study. 昼夜节律心率波动可预测 2 型和 1 型糖尿病患者的心血管疾病和全因死亡率:一项为期 21 年的回顾性纵向研究。
IF 8.4 2区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-09-26 DOI: 10.1093/eurjpc/zwae305
Lorenzo Nesti, Martina Chiriacò, Luca Sacchetta, Diego Moriconi, Lorenza Santoni, Nicola Riccardo Pugliese, Simone Gallo, Noemi Cimbalo, Giovanna Forotti, Giuliano Chiriacò, Simone Leonetti, Andrea Natali, Anna Solini, Domenico Tricò

Background: Circadian heart rate (HR) fluctuations are associated with cardiovascular health. We examined their relationship with microvascular disease and long-term survival in patients with diabetes.

Methods: In this secondary analysis from the CHAMP1ON cohort of 497 adults with metabolic disease, 349 participants who had type 1 or type 2 diabetes, baseline 24h ambulatory blood pressure and HR monitoring (ABPM), and survival data over a 21-year observational follow-up were included. Clinical features, microvascular complications, and mortality rates were examined in participants with low circadian HR fluctuations (24h-HR SD below the median of 30.4) and blunted nocturnal HR dip (<10%).

Results: Low 24h-HR SD and blunted nocturnal HR dip were associated with an adverse cardiometabolic risk profile and 12-23% higher prevalence of cardiac autonomic neuropathy and nephropathy. After 6,251 person-years follow-up (21.0 [14.0-21.0] years), a total of 136 (39%) deaths occurred, of which 100 (68%) of cardiovascular cause. The low 24h-HR SD group had a higher risk for both cardiovascular (adjusted hazard ratio [aHR] 2.00, 95%CI 1.30-3.08, p=0.002) and all-cause mortality (aHR 1.61, 95%CI 1.13-2.29, p=0.009), compared with high 24h-HR SD. Similarly, patients with blunted nocturnal HR dip had a higher risk for cardiovascular (aHR 1.63, 95%CI 1.08-2.46, p=0.019) and all-cause mortality (aHR 1.69, 95%CI 1.20-2.38, p=0.003), compared with those with preserved nocturnal HR dip.

Conclusions: Impaired circadian HR fluctuations are associated with microvascular disease and long-term cardiovascular and all-cause mortality in diabetes. ABPM-derived HR measures may provide a widely available and inexpensive risk stratification tool in this high-risk population.

背景:昼夜节律心率(HR)波动与心血管健康有关:昼夜节律心率(HR)波动与心血管健康有关。我们研究了它们与糖尿病患者微血管疾病和长期生存的关系:在这项由 497 名患有代谢性疾病的成年人组成的 CHAMP1ON 队列的二次分析中,纳入了 349 名 1 型或 2 型糖尿病患者、基线 24 小时动态血压和心率监测 (ABPM) 以及 21 年观察随访期间的生存数据。研究人员对昼夜节律心率波动较小(24小时心率标异值低于中位数30.4)和夜间心率骤降较弱的参与者的临床特征、微血管并发症和死亡率进行了分析(结果:24小时心率标异值较小和夜间心率骤降较弱的参与者的临床特征、微血管并发症和死亡率均低于中位数30.4):24h-HR SD 值低和夜间心率骤降迟钝与不良的心脏代谢风险状况有关,且心脏自主神经病变和肾病的发病率高出 12-23%。经过6251人年的随访(21.0 [14.0-21.0] 年),共有136人(39%)死亡,其中100人(68%)死于心血管疾病。与高 24h-HR SD 组相比,低 24h-HR SD 组的心血管(调整后危险比 [aHR] 2.00,95%CI 1.30-3.08,p=0.002)和全因死亡(aHR 1.61,95%CI 1.13-2.29,p=0.009)风险更高。同样,与夜间心率下降保持不变的患者相比,夜间心率下降减弱的患者心血管(aHR 1.63,95%CI 1.08-2.46,p=0.019)和全因死亡(aHR 1.69,95%CI 1.20-2.38,p=0.003)风险更高:结论:昼夜心率波动受损与糖尿病患者的微血管疾病及长期心血管和全因死亡率有关。ABPM 导出的心率测量可为这一高风险人群提供一种广泛可用且成本低廉的风险分层工具。
{"title":"Circadian heart rate fluctuations predict cardiovascular and all-cause mortality in type 2 and type 1 diabetes: a 21-year retrospective longitudinal study.","authors":"Lorenzo Nesti, Martina Chiriacò, Luca Sacchetta, Diego Moriconi, Lorenza Santoni, Nicola Riccardo Pugliese, Simone Gallo, Noemi Cimbalo, Giovanna Forotti, Giuliano Chiriacò, Simone Leonetti, Andrea Natali, Anna Solini, Domenico Tricò","doi":"10.1093/eurjpc/zwae305","DOIUrl":"https://doi.org/10.1093/eurjpc/zwae305","url":null,"abstract":"<p><strong>Background: </strong>Circadian heart rate (HR) fluctuations are associated with cardiovascular health. We examined their relationship with microvascular disease and long-term survival in patients with diabetes.</p><p><strong>Methods: </strong>In this secondary analysis from the CHAMP1ON cohort of 497 adults with metabolic disease, 349 participants who had type 1 or type 2 diabetes, baseline 24h ambulatory blood pressure and HR monitoring (ABPM), and survival data over a 21-year observational follow-up were included. Clinical features, microvascular complications, and mortality rates were examined in participants with low circadian HR fluctuations (24h-HR SD below the median of 30.4) and blunted nocturnal HR dip (<10%).</p><p><strong>Results: </strong>Low 24h-HR SD and blunted nocturnal HR dip were associated with an adverse cardiometabolic risk profile and 12-23% higher prevalence of cardiac autonomic neuropathy and nephropathy. After 6,251 person-years follow-up (21.0 [14.0-21.0] years), a total of 136 (39%) deaths occurred, of which 100 (68%) of cardiovascular cause. The low 24h-HR SD group had a higher risk for both cardiovascular (adjusted hazard ratio [aHR] 2.00, 95%CI 1.30-3.08, p=0.002) and all-cause mortality (aHR 1.61, 95%CI 1.13-2.29, p=0.009), compared with high 24h-HR SD. Similarly, patients with blunted nocturnal HR dip had a higher risk for cardiovascular (aHR 1.63, 95%CI 1.08-2.46, p=0.019) and all-cause mortality (aHR 1.69, 95%CI 1.20-2.38, p=0.003), compared with those with preserved nocturnal HR dip.</p><p><strong>Conclusions: </strong>Impaired circadian HR fluctuations are associated with microvascular disease and long-term cardiovascular and all-cause mortality in diabetes. ABPM-derived HR measures may provide a widely available and inexpensive risk stratification tool in this high-risk population.</p>","PeriodicalId":12051,"journal":{"name":"European journal of preventive cardiology","volume":null,"pages":null},"PeriodicalIF":8.4,"publicationDate":"2024-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142344258","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Phenotypic characterisation of people at risk of atrial fibrillation: Protocol for the FIND-AF longitudinal cohort study. 心房颤动高危人群的表型特征:FIND-AF 纵向队列研究协议。
IF 8.4 2区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-09-25 DOI: 10.1093/eurjpc/zwae303
Ali Wahab, Ramesh Nadarajah, Catherine Reynolds, Sheena Bennett, Edisemi Ambakederemo, Mohammad Harris, Tanina Younsi, Tobin Joesph, Keerthenan Raveendera, Adam Smith, Asad Bhatty, Gregory Y H Lip, Peter P Swoboda, Jianhua Wu, Chris P Gale

Aims: The Future Innovations in Novel Detection of Atrial Fibrillation (FIND-AF) longitudinal cohort study is a multi-centre prospective cohort study of patients identified at risk of atrial fibrillation (AF). The aim of the FIND-AF longitudinal cohort study is to provide multi-modal phenotypic characterisation of these patients.

Methods and results: 1955 participants identified as at risk of AF by the FIND-AF algorithm from primary care electronic health (EHR) data, aged 30 years and above and eligible for oral anticoagulation, will be be recruited between October 2023 and November 2024 to receive home-based intermittent ECG monitoring. About 500 participants without diagnosed AF will then undergo cross-sectional phenotypic characterisation including physical examination, symptoms assessment, serum blood biomarkers and echocardiography, and non-stress cardiac magnetic resonance imaging. Longitudinal information about cardio-renal-metabolic-pulmonary outcomes will be ascertained from linkages to EHR data. The study is funded by the British Heart Foundation (CC/22/250026). The study has ethical approval (North West - Greater Manchester South Research Ethics Committee reference 23/NW/0180). Findings will be announced at relevant conferences and published in peer-reviewed journals in line with the Funder's open access policy.

Conclusions: The FIND-AF multi-centre prospective longitudinal cohort study aims to (i) provide evidence for the impact of comorbidities on AF genesis (ii) uncover actionable targets to prevent AF, and (iii) act as a platform for cohort randomised clinical trials that investigate enhanced detection and prevention of AF.

目的:心房颤动新型检测的未来创新(FIND-AF)纵向队列研究是一项多中心前瞻性队列研究,研究对象是已发现有心房颤动(AF)风险的患者。FIND-AF 纵向队列研究的目的是为这些患者提供多模式的表型特征:将在 2023 年 10 月至 2024 年 11 月间招募 1955 名通过 FIND-AF 算法从初级保健电子健康(EHR)数据中识别出有房颤风险、年龄在 30 岁及以上且符合口服抗凝治疗条件的参与者,他们将接受基于家庭的间歇性心电图监测。随后,约 500 名未确诊房颤的参与者将接受横断面表型特征描述,包括体格检查、症状评估、血清血液生物标志物、超声心动图和非应激心脏磁共振成像。通过与电子病历数据的连接,将确定心肾代谢肺功能结果的纵向信息。该研究由英国心脏基金会(CC/22/250026)资助。该研究已获得伦理批准(西北-大曼彻斯特南部研究伦理委员会编号 23/NW/0180)。研究结果将在相关会议上公布,并根据资助方的开放获取政策在同行评审期刊上发表:FIND-AF 多中心前瞻性纵向队列研究旨在:(i) 为合并症对房颤发生的影响提供证据;(ii) 发现预防房颤的可行目标;(iii) 作为队列随机临床试验的平台,研究如何加强房颤的检测和预防。
{"title":"Phenotypic characterisation of people at risk of atrial fibrillation: Protocol for the FIND-AF longitudinal cohort study.","authors":"Ali Wahab, Ramesh Nadarajah, Catherine Reynolds, Sheena Bennett, Edisemi Ambakederemo, Mohammad Harris, Tanina Younsi, Tobin Joesph, Keerthenan Raveendera, Adam Smith, Asad Bhatty, Gregory Y H Lip, Peter P Swoboda, Jianhua Wu, Chris P Gale","doi":"10.1093/eurjpc/zwae303","DOIUrl":"https://doi.org/10.1093/eurjpc/zwae303","url":null,"abstract":"<p><strong>Aims: </strong>The Future Innovations in Novel Detection of Atrial Fibrillation (FIND-AF) longitudinal cohort study is a multi-centre prospective cohort study of patients identified at risk of atrial fibrillation (AF). The aim of the FIND-AF longitudinal cohort study is to provide multi-modal phenotypic characterisation of these patients.</p><p><strong>Methods and results: </strong>1955 participants identified as at risk of AF by the FIND-AF algorithm from primary care electronic health (EHR) data, aged 30 years and above and eligible for oral anticoagulation, will be be recruited between October 2023 and November 2024 to receive home-based intermittent ECG monitoring. About 500 participants without diagnosed AF will then undergo cross-sectional phenotypic characterisation including physical examination, symptoms assessment, serum blood biomarkers and echocardiography, and non-stress cardiac magnetic resonance imaging. Longitudinal information about cardio-renal-metabolic-pulmonary outcomes will be ascertained from linkages to EHR data. The study is funded by the British Heart Foundation (CC/22/250026). The study has ethical approval (North West - Greater Manchester South Research Ethics Committee reference 23/NW/0180). Findings will be announced at relevant conferences and published in peer-reviewed journals in line with the Funder's open access policy.</p><p><strong>Conclusions: </strong>The FIND-AF multi-centre prospective longitudinal cohort study aims to (i) provide evidence for the impact of comorbidities on AF genesis (ii) uncover actionable targets to prevent AF, and (iii) act as a platform for cohort randomised clinical trials that investigate enhanced detection and prevention of AF.</p>","PeriodicalId":12051,"journal":{"name":"European journal of preventive cardiology","volume":null,"pages":null},"PeriodicalIF":8.4,"publicationDate":"2024-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142344265","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
A randomised controlled implementation study integrating patient self-screening with a remote central monitoring system to screen community-dwellers aged 75 years and older for atrial fibrillation. 一项随机对照实施研究,将患者自我筛查与远程中央监控系统相结合,对 75 岁及以上的社区居民进行心房颤动筛查。
IF 8.4 2区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-09-25 DOI: 10.1093/eurjpc/zwae312
Kam Cheong Wong, Tu N Nguyen, Simone Marschner, Samual Turnbull, Anupama Balasuriya Indrawansa, Rose White, Mason Jenner Burns, Vishal Gopal, Haeri Min, Desi Quintans, Amy von Huben, Steven A Trankle, Tim Usherwood, Richard I Lindley, Saurabh Kumar, Clara K Chow

Aims: Diagnosis of atrial fibrillation (AF) provides opportunities to reduce stroke risk. This study aimed to compare AF diagnosis rates, participant satisfaction and feasibility of an electrocardiogram (ECG) self-screening virtual care system with usual care.

Methods: This randomised controlled implementation study involving community-dwelling people aged ≥75 years was conducted from May 2021 to June 2023. Participants were given a handheld single-lead ECG device and trained to self-record ECGs once daily on weekdays for 12 months. The control group received usual care with their general practitioners in the first 6 months and participated in the subsequent 6 months. AF diagnosis and participant satisfaction were assessed at 6 months.

Results: 200 participants (mean age 79.0±3.4 years; 54.0% female; 72.5% urban). AF was diagnosed in 10/97 (10.3%) intervention participants and 2/100 (2.0%) in the control group (Odds Ratio 5.6, 95% CI 1.4-37.3, p=0.03). In the intervention, 80% of AF cases were diagnosed within 3 months. 91/93 (97.9%) intervention participants and 55/93 (59.1%) control-waitlisted participants (p<0.001) were satisfied with AF screening. Of the expected 20 days per month, the overall monthly median number of days participants self-recorded ECGs was 20 (interquartile range 17-22). Participants were confident using the device (93%), reported it was easy to use (98%) and found screening efficient (96%).

Conclusions: Patient-led AF self-screening using single-lead ECG devices with a remote central monitoring system was feasible, acceptable, and effective in diagnosing AF among older people. This screening model could be adapted for implementation, interfacing with integrated care models within existing health systems.

目的:心房颤动(AF)诊断为降低中风风险提供了机会。本研究旨在比较心房颤动诊断率、参与者满意度以及心电图自我筛查虚拟护理系统与常规护理的可行性:这项随机对照实施研究于 2021 年 5 月至 2023 年 6 月进行,涉及年龄≥75 岁的社区居民。参与者将获得一个手持式单导联心电图仪,并接受为期12个月的培训,在工作日每天进行一次自我心电图记录。对照组在前 6 个月接受全科医生的常规护理,并在随后的 6 个月参加培训。结果:200 名参与者(平均年龄为 79.0±3.4 岁;54.0% 为女性;72.5% 为城市居民)。10/97(10.3%)名干预组参与者被确诊为房颤,2/100(2.0%)名对照组参与者被确诊为房颤(Odds Ratio 5.6,95% CI 1.4-37.3,P=0.03)。在干预组中,80% 的房颤病例在 3 个月内确诊。91/93(97.9%)名干预组参与者和55/93(59.1%)名对照组等待组参与者(p结论:使用单导联心电图设备和远程中央监测系统进行患者主导的房颤自我筛查在诊断老年人房颤方面是可行的、可接受的和有效的。这种筛查模式可与现有医疗系统中的综合护理模式相衔接并加以调整实施。
{"title":"A randomised controlled implementation study integrating patient self-screening with a remote central monitoring system to screen community-dwellers aged 75 years and older for atrial fibrillation.","authors":"Kam Cheong Wong, Tu N Nguyen, Simone Marschner, Samual Turnbull, Anupama Balasuriya Indrawansa, Rose White, Mason Jenner Burns, Vishal Gopal, Haeri Min, Desi Quintans, Amy von Huben, Steven A Trankle, Tim Usherwood, Richard I Lindley, Saurabh Kumar, Clara K Chow","doi":"10.1093/eurjpc/zwae312","DOIUrl":"10.1093/eurjpc/zwae312","url":null,"abstract":"<p><strong>Aims: </strong>Diagnosis of atrial fibrillation (AF) provides opportunities to reduce stroke risk. This study aimed to compare AF diagnosis rates, participant satisfaction and feasibility of an electrocardiogram (ECG) self-screening virtual care system with usual care.</p><p><strong>Methods: </strong>This randomised controlled implementation study involving community-dwelling people aged ≥75 years was conducted from May 2021 to June 2023. Participants were given a handheld single-lead ECG device and trained to self-record ECGs once daily on weekdays for 12 months. The control group received usual care with their general practitioners in the first 6 months and participated in the subsequent 6 months. AF diagnosis and participant satisfaction were assessed at 6 months.</p><p><strong>Results: </strong>200 participants (mean age 79.0±3.4 years; 54.0% female; 72.5% urban). AF was diagnosed in 10/97 (10.3%) intervention participants and 2/100 (2.0%) in the control group (Odds Ratio 5.6, 95% CI 1.4-37.3, p=0.03). In the intervention, 80% of AF cases were diagnosed within 3 months. 91/93 (97.9%) intervention participants and 55/93 (59.1%) control-waitlisted participants (p<0.001) were satisfied with AF screening. Of the expected 20 days per month, the overall monthly median number of days participants self-recorded ECGs was 20 (interquartile range 17-22). Participants were confident using the device (93%), reported it was easy to use (98%) and found screening efficient (96%).</p><p><strong>Conclusions: </strong>Patient-led AF self-screening using single-lead ECG devices with a remote central monitoring system was feasible, acceptable, and effective in diagnosing AF among older people. This screening model could be adapted for implementation, interfacing with integrated care models within existing health systems.</p>","PeriodicalId":12051,"journal":{"name":"European journal of preventive cardiology","volume":null,"pages":null},"PeriodicalIF":8.4,"publicationDate":"2024-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142344256","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
期刊
European journal of preventive cardiology
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