Pub Date : 2024-09-09DOI: 10.3389/fcvm.2024.1384972
Yulan Luo, Dou Yuan
Right atrial appendage aneurysm is an extremely rare cardiac anomaly. With unclear etiology, there is still no standard treatment method. Clinical symptoms and complications are important indicators for surgical resection. A 2-year-old boy without obvious cardiac symptoms was diagnosed with a giant right atrial outpouching arising from the right atrial appendage by computed tomography. The right atrial outpouching measured approximately 95 × 43 mm. Due to its large size and potential impact on function of right atrium and ventricle, the aneurysm was resected in surgery. During the surgery a 105 × 55 mm noncontractile cystic structure was found locating on the right anterior side of the right atrium. No other abnormalities like intracavity thrombus were detected. The patient was discharged five days after surgery. Postoperative recovery was uneventful.
{"title":"Case Report: A giant right atrial appendage aneurysm in a child","authors":"Yulan Luo, Dou Yuan","doi":"10.3389/fcvm.2024.1384972","DOIUrl":"https://doi.org/10.3389/fcvm.2024.1384972","url":null,"abstract":"Right atrial appendage aneurysm is an extremely rare cardiac anomaly. With unclear etiology, there is still no standard treatment method. Clinical symptoms and complications are important indicators for surgical resection. A 2-year-old boy without obvious cardiac symptoms was diagnosed with a giant right atrial outpouching arising from the right atrial appendage by computed tomography. The right atrial outpouching measured approximately 95 × 43 mm. Due to its large size and potential impact on function of right atrium and ventricle, the aneurysm was resected in surgery. During the surgery a 105 × 55 mm noncontractile cystic structure was found locating on the right anterior side of the right atrium. No other abnormalities like intracavity thrombus were detected. The patient was discharged five days after surgery. Postoperative recovery was uneventful.","PeriodicalId":12414,"journal":{"name":"Frontiers in Cardiovascular Medicine","volume":null,"pages":null},"PeriodicalIF":3.6,"publicationDate":"2024-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142221758","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-09DOI: 10.3389/fcvm.2024.1423153
Fuzheng Guo, Simeng Zhang, Zhe Du, Jing Tai, Fengbo Pei, Yi Shi
Anomalous origin of one pulmonary artery (AOPA) is a rare congenital heart disease whose symptoms often occur in infancy, and patients have little chance of surviving into adulthood without timely treatments. AOPA is more frequent in infants and toddlers rather than in adults, and it accounts for only 0.12% of all congenital heart disease cases. In all AOPA cases, the right pulmonary artery from the ascending aorta remains common. This study reported a case with anomalous origin of the left pulmonary artery (AOLPA) from the descending aorta in a teenager who underwent double-incision surgery of median sternotomy and left lateral thoracotomies with favorable outcomes.
{"title":"Surgical treatment of anomalous origin of the left pulmonary artery from the descending aorta in a teenager: a case report","authors":"Fuzheng Guo, Simeng Zhang, Zhe Du, Jing Tai, Fengbo Pei, Yi Shi","doi":"10.3389/fcvm.2024.1423153","DOIUrl":"https://doi.org/10.3389/fcvm.2024.1423153","url":null,"abstract":"Anomalous origin of one pulmonary artery (AOPA) is a rare congenital heart disease whose symptoms often occur in infancy, and patients have little chance of surviving into adulthood without timely treatments. AOPA is more frequent in infants and toddlers rather than in adults, and it accounts for only 0.12% of all congenital heart disease cases. In all AOPA cases, the right pulmonary artery from the ascending aorta remains common. This study reported a case with anomalous origin of the left pulmonary artery (AOLPA) from the descending aorta in a teenager who underwent double-incision surgery of median sternotomy and left lateral thoracotomies with favorable outcomes.","PeriodicalId":12414,"journal":{"name":"Frontiers in Cardiovascular Medicine","volume":null,"pages":null},"PeriodicalIF":3.6,"publicationDate":"2024-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142221783","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-06DOI: 10.3389/fcvm.2024.1439696
Domingo Pascual-Figal, Antoni Bayes-Genis
The main goals of the pharmacological treatment of Heart failure with reduced ejection fraction (HFrEF) are the reduction of mortality and the prevention of hospitalizations. However, other outcomes such as improvements in cardiac remodeling and clinical status, functional capacity and quality of life, should be taken into account. Also, given the significant inter-individual and intra-individual variability of HF, and the fact that patients usually present with comorbidities, an appropriate treatment for HFrEF should exert a clinical benefit in most patient profiles irrespective of their characteristics or the presence of comorbidities, while providing organ protection beyond the cardiovascular system. The aim of this narrative review is to determine which are the proven effects of the guideline-directed treatments for HFrEF on five key clinical outcomes: cardiovascular mortality and hospitalization due to HF, sudden death, reverse cardiac remodeling, renal protection and evidence in hospitalized patients. Publications that fulfilled the pre-established selection criteria were selected and reviewed. Renin-angiotensin system (RAS) inhibitors, namely angiotensin-converting enzyme inhibitors (ACE-I) and angiotensin II receptor blockers (ARBs) or angiotensin receptor-neprilysin inhibitors (ARNI), beta-blockers (BB), mineralocorticoid receptor antagonists (MRA), sodium-glucose co-transporter 2 inhibitors (SGLT2i) show a benefit in terms of mortality and hospitalization rates. ARNI, BB, and MRA have demonstrated a significant positive effect on the incidence of sudden death. ARB, ARNI, BB and SGLT2i have been associated with clear benefits in reverse cardiac remodeling. Additionally, there is consistent evidence of renal protection from ARB, ARNI, and SGLT2i in renal protection and of benefits for hospitalized patients from ARNI and SGLT2i. In conclusion, the combination of drugs that gather most beneficial effects in HFrEF, beyond cardiovascular mortality and hospitalization, would be ideally pursued.
{"title":"Looking for the ideal medication for heart failure with reduced ejection fraction: a narrative review","authors":"Domingo Pascual-Figal, Antoni Bayes-Genis","doi":"10.3389/fcvm.2024.1439696","DOIUrl":"https://doi.org/10.3389/fcvm.2024.1439696","url":null,"abstract":"The main goals of the pharmacological treatment of Heart failure with reduced ejection fraction (HFrEF) are the reduction of mortality and the prevention of hospitalizations. However, other outcomes such as improvements in cardiac remodeling and clinical status, functional capacity and quality of life, should be taken into account. Also, given the significant inter-individual and intra-individual variability of HF, and the fact that patients usually present with comorbidities, an appropriate treatment for HFrEF should exert a clinical benefit in most patient profiles irrespective of their characteristics or the presence of comorbidities, while providing organ protection beyond the cardiovascular system. The aim of this narrative review is to determine which are the proven effects of the guideline-directed treatments for HFrEF on five key clinical outcomes: cardiovascular mortality and hospitalization due to HF, sudden death, reverse cardiac remodeling, renal protection and evidence in hospitalized patients. Publications that fulfilled the pre-established selection criteria were selected and reviewed. Renin-angiotensin system (RAS) inhibitors, namely angiotensin-converting enzyme inhibitors (ACE-I) and angiotensin II receptor blockers (ARBs) or angiotensin receptor-neprilysin inhibitors (ARNI), beta-blockers (BB), mineralocorticoid receptor antagonists (MRA), sodium-glucose co-transporter 2 inhibitors (SGLT2i) show a benefit in terms of mortality and hospitalization rates. ARNI, BB, and MRA have demonstrated a significant positive effect on the incidence of sudden death. ARB, ARNI, BB and SGLT2i have been associated with clear benefits in reverse cardiac remodeling. Additionally, there is consistent evidence of renal protection from ARB, ARNI, and SGLT2i in renal protection and of benefits for hospitalized patients from ARNI and SGLT2i. In conclusion, the combination of drugs that gather most beneficial effects in HFrEF, beyond cardiovascular mortality and hospitalization, would be ideally pursued.","PeriodicalId":12414,"journal":{"name":"Frontiers in Cardiovascular Medicine","volume":null,"pages":null},"PeriodicalIF":3.6,"publicationDate":"2024-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142221761","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Chronic Thromboembolic Pulmonary Hypertension (CTEPH) presents a significant diagnostic challenge due to its complex and often nonspecific clinical manifestations. This review outlines a comprehensive approach to the diagnostic assessment of CTEPH, emphasizing the importance of a high index of suspicion in patients with unexplained dyspnea or persistent symptoms post-acute pulmonary embolism. We discuss the pivotal role of multimodal imaging, including echocardiography, ventilation/perfusion scans, CT pulmonary angiography, and magnetic resonance imaging, in the identification and confirmation of CTEPH. Furthermore, the review highlights the essential function of right heart catheterization in validating the hemodynamic parameters indicative of CTEPH, establishing its definitive diagnosis. Advances in diagnostic technologies and the integration of a multidisciplinary approach are critical for the timely and accurate diagnosis of CTEPH, facilitating early therapeutic intervention and improving patient outcomes. This manuscript aims to equip clinicians with the knowledge and tools necessary for the efficient diagnostic workflow of CTEPH, promoting awareness and understanding of this potentially treatable cause of pulmonary hypertension.
{"title":"Chronic thromboembolic pulmonary hypertension: the diagnostic assessment","authors":"Beatrice Simeone, Enrico Maggio, Leonardo Schirone, Erica Rocco, Gianmarco Sarto, Luigi Spadafora, Marco Bernardi, Luca D’ Ambrosio, Maurizio Forte, Daniele Vecchio, Valentina Valenti, Sebastiano Sciarretta, Carmine Dario Vizza","doi":"10.3389/fcvm.2024.1439402","DOIUrl":"https://doi.org/10.3389/fcvm.2024.1439402","url":null,"abstract":"Chronic Thromboembolic Pulmonary Hypertension (CTEPH) presents a significant diagnostic challenge due to its complex and often nonspecific clinical manifestations. This review outlines a comprehensive approach to the diagnostic assessment of CTEPH, emphasizing the importance of a high index of suspicion in patients with unexplained dyspnea or persistent symptoms post-acute pulmonary embolism. We discuss the pivotal role of multimodal imaging, including echocardiography, ventilation/perfusion scans, CT pulmonary angiography, and magnetic resonance imaging, in the identification and confirmation of CTEPH. Furthermore, the review highlights the essential function of right heart catheterization in validating the hemodynamic parameters indicative of CTEPH, establishing its definitive diagnosis. Advances in diagnostic technologies and the integration of a multidisciplinary approach are critical for the timely and accurate diagnosis of CTEPH, facilitating early therapeutic intervention and improving patient outcomes. This manuscript aims to equip clinicians with the knowledge and tools necessary for the efficient diagnostic workflow of CTEPH, promoting awareness and understanding of this potentially treatable cause of pulmonary hypertension.","PeriodicalId":12414,"journal":{"name":"Frontiers in Cardiovascular Medicine","volume":null,"pages":null},"PeriodicalIF":3.6,"publicationDate":"2024-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142221782","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-06DOI: 10.3389/fcvm.2024.1465912
Mingxuan Che, Fuhai Li, Yaning Jia, Qingzheng Liu, Jian Hu, Jidong Zhang, Shiguo Liu
Barth syndrome (BTHS) is a rare X-linked recessive genetic disorder characterized by a broad spectrum of clinical features including cardiomyopathy, skeletal myopathy, neutropenia, growth delay, and 3-methylglutaconic aciduria. This disease is caused by loss-of-function mutations in the TAFAZZIN gene located on chromosome Xq28, resulting in cardiolipin deficiency. Most patients are diagnosed in childhood, and the mortality rate is highest in the early years. We report a case of acute, life-threatening metabolic decompensation occurring one day after birth. A novel TAFAZZIN splice site mutation was identified in the patient, marking the first reported case of such a mutation in BTHS identified in China. The report aims to expand our understanding of the spectrum of TAFAZZIN mutations in BTHS.
{"title":"Case Report: A Chinese child with Barth syndrome caused by a novel TAFAZZIN mutation","authors":"Mingxuan Che, Fuhai Li, Yaning Jia, Qingzheng Liu, Jian Hu, Jidong Zhang, Shiguo Liu","doi":"10.3389/fcvm.2024.1465912","DOIUrl":"https://doi.org/10.3389/fcvm.2024.1465912","url":null,"abstract":"Barth syndrome (BTHS) is a rare X-linked recessive genetic disorder characterized by a broad spectrum of clinical features including cardiomyopathy, skeletal myopathy, neutropenia, growth delay, and 3-methylglutaconic aciduria. This disease is caused by loss-of-function mutations in the <jats:italic>TAFAZZIN</jats:italic> gene located on chromosome Xq28, resulting in cardiolipin deficiency. Most patients are diagnosed in childhood, and the mortality rate is highest in the early years. We report a case of acute, life-threatening metabolic decompensation occurring one day after birth. A novel <jats:italic>TAFAZZIN</jats:italic> splice site mutation was identified in the patient, marking the first reported case of such a mutation in BTHS identified in China. The report aims to expand our understanding of the spectrum of <jats:italic>TAFAZZIN</jats:italic> mutations in BTHS.","PeriodicalId":12414,"journal":{"name":"Frontiers in Cardiovascular Medicine","volume":null,"pages":null},"PeriodicalIF":3.6,"publicationDate":"2024-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142221762","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-06DOI: 10.3389/fcvm.2024.1459833
Natalie Montarello, Gabriel Bioh, Calum Byrne, Imtiaz Hassan, Vitaliy Androshchuk, Camelia Demetrescu, Sze Mun Mak, Ronak Rajani
Infective Endocarditis (IE) remains a significant health challenge. Despite an increasing awareness, mortality is high and has remained largely unchanged over recent decades. Early diagnosis of IE is imperative and to assist clinicians several diagnostic criteria have been proposed. The best known are the Duke criteria. Originally published in 1994, these criteria have undergone significant modifications. This manuscript provides a timeline of the successive changes that have been made over the last 30 years. Changes which to a large degree have reflected both the evolving epidemiology of IE and the proliferation and increasing availability of advanced multi-modality imaging. Importantly, many of these changes now form part of societal guidelines for the diagnosis of IE. To provide validation for the incorporation of cardiac computed tomography (CT) in current guidelines, the manuscript demonstrates a spectrum of pictorial case studies that re-enforce the utility and growing importance of early cardiac CT in the diagnosis and treatment of suspected IE.
{"title":"Cardiac computed tomography in infective endocarditis: “bridging the detection gap”","authors":"Natalie Montarello, Gabriel Bioh, Calum Byrne, Imtiaz Hassan, Vitaliy Androshchuk, Camelia Demetrescu, Sze Mun Mak, Ronak Rajani","doi":"10.3389/fcvm.2024.1459833","DOIUrl":"https://doi.org/10.3389/fcvm.2024.1459833","url":null,"abstract":"Infective Endocarditis (IE) remains a significant health challenge. Despite an increasing awareness, mortality is high and has remained largely unchanged over recent decades. Early diagnosis of IE is imperative and to assist clinicians several diagnostic criteria have been proposed. The best known are the Duke criteria. Originally published in 1994, these criteria have undergone significant modifications. This manuscript provides a timeline of the successive changes that have been made over the last 30 years. Changes which to a large degree have reflected both the evolving epidemiology of IE and the proliferation and increasing availability of advanced multi-modality imaging. Importantly, many of these changes now form part of societal guidelines for the diagnosis of IE. To provide validation for the incorporation of cardiac computed tomography (CT) in current guidelines, the manuscript demonstrates a spectrum of pictorial case studies that re-enforce the utility and growing importance of early cardiac CT in the diagnosis and treatment of suspected IE.","PeriodicalId":12414,"journal":{"name":"Frontiers in Cardiovascular Medicine","volume":null,"pages":null},"PeriodicalIF":3.6,"publicationDate":"2024-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142221781","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
IntroductionIntra-aortic balloon pump (IABP) is sometimes coupled with Venoarterial extracorporeal membrane oxygenation (VA-ECMO) to treat patients with cardiogenic shock. In this study, we attempted to evaluate the association of the IABP approach on survival and vascular complication rates in adults with cardiogenic shock undergoing VA-ECMO.MethodsWe performed a systematic search of original studies on VA-ECMO with and without IABP in PubMed, EMBASE, and the Cochrane Library.ResultsA total of 42 studies with 8,759 patients were included. The pooled in-hospital deaths of patients on VA-ECMO with and without IABP were 2,962/4,807 (61.61%) versus 2,666/3,952 (67.45%). VA-ECMO with IABP presents lower in-hospital mortality (risk ratio, 0.88; 95% CI, 0.86-0.91; P < 0.00001). In addition, IABP was associated with lower in-hospital mortality of patients with postcardiotomy cardiogenic shock and ischaemic heart disease. (risk ratio, 0.93; 95% CI, 0.87–0.98; P = 0.01; risk ratio, 0.85; 95% CI, 0.82–0.89; P < 0.00001). There was no significant difference in in-hospital morbidity in neurological, gastrointestinal, limb-related, bleeding, and infection complications between patients on VA-ECMO with and without IABP.DiscussionIn these observational studies, concomitant use of IABP and VA-ECMO in adult patients with cardiogenic shock was associated with reduced in-hospital mortality.Systematic Review RegistrationPROSPERO [CRD42017069259].
{"title":"Efficacy of venoarterial extracorporeal membrane oxygenation with and without intra-aortic balloon pump in adult cardiogenic shock","authors":"Haiwang Wang, Chuanlong Li, Duo Li, Yuansen Chen, Wenli Li, Yanqing Liu, Yongnan Li, Haojun Fan, Shike Hou","doi":"10.3389/fcvm.2024.1431875","DOIUrl":"https://doi.org/10.3389/fcvm.2024.1431875","url":null,"abstract":"IntroductionIntra-aortic balloon pump (IABP) is sometimes coupled with Venoarterial extracorporeal membrane oxygenation (VA-ECMO) to treat patients with cardiogenic shock. In this study, we attempted to evaluate the association of the IABP approach on survival and vascular complication rates in adults with cardiogenic shock undergoing VA-ECMO.MethodsWe performed a systematic search of original studies on VA-ECMO with and without IABP in PubMed, EMBASE, and the Cochrane Library.ResultsA total of 42 studies with 8,759 patients were included. The pooled in-hospital deaths of patients on VA-ECMO with and without IABP were 2,962/4,807 (61.61%) versus 2,666/3,952 (67.45%). VA-ECMO with IABP presents lower in-hospital mortality (risk ratio, 0.88; 95% CI, 0.86-0.91; <jats:italic>P</jats:italic> &lt; 0.00001). In addition, IABP was associated with lower in-hospital mortality of patients with postcardiotomy cardiogenic shock and ischaemic heart disease. (risk ratio, 0.93; 95% CI, 0.87–0.98; <jats:italic>P</jats:italic> = 0.01; risk ratio, 0.85; 95% CI, 0.82–0.89; <jats:italic>P</jats:italic> &lt; 0.00001). There was no significant difference in in-hospital morbidity in neurological, gastrointestinal, limb-related, bleeding, and infection complications between patients on VA-ECMO with and without IABP.DiscussionIn these observational studies, concomitant use of IABP and VA-ECMO in adult patients with cardiogenic shock was associated with reduced in-hospital mortality.Systematic Review RegistrationPROSPERO [CRD42017069259].","PeriodicalId":12414,"journal":{"name":"Frontiers in Cardiovascular Medicine","volume":null,"pages":null},"PeriodicalIF":3.6,"publicationDate":"2024-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142221784","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-05DOI: 10.3389/fcvm.2024.1399899
Rani Khatib, Abigail Barrowcliff, Franki Wilson, Sidra Awan, Mutiba Khan, Stephen Wheatcroft, Alistair S. Hall
PurposeExtended dual antiplatelet therapy (DAPT) with ticagrelor and aspirin is recommended in selected cases after myocardial infarction (MI) but not widely deployed in practice. This study assessed an innovative, cardiology pharmacist-led virtual service for determining eligibility for extended DAPT among patients completing 12 months of initial DAPT in primary care following MI.MethodsWithin this model, potentially eligible individuals are reviewed virtually by a cardiology pharmacist for suitability for extended DAPT with reduced-dose ticagrelor [60 mg twice daily (BD)] for up to 3 years. Eligibility is guided by the PEGASUS-TIMI 54 trial criteria (aged ≥50 years and having ≥1 high-risk feature for further ischaemic events). This is balanced against potential ineligibility driven primarily by bleeding risk, assessed using PRECISE-DAPT score. The final recommendation is sent to primary care to action. The present work is a retrospective evaluation of patients referred to the service between July 2018 and December 2021.ResultsA total of 200 patients were included [n = 131 (65.5%) male; mean age: 69.4 ± 9.5 years]. Of these, 79 (39.5%) were recommended for extended DAPT based on the balance of risks for further ischaemic events vs. bleeding. Sixty-three patients on high-dose DAPT (ticagrelor 90 mg BD)—which is inappropriate beyond 12 months—were reassigned to reduced-dose DAPT or aspirin monotherapy.ConclusionsThis virtual clinic played a key role in medicines optimisation, enabling appropriate patients to benefit from extended DAPT while offsetting bleeding risk. The model could be adapted locally for use elsewhere.
{"title":"Supporting appropriate use of extended dual antiplatelet therapy post-myocardial infarction based on an innovative 12-month ticagrelor virtual service","authors":"Rani Khatib, Abigail Barrowcliff, Franki Wilson, Sidra Awan, Mutiba Khan, Stephen Wheatcroft, Alistair S. Hall","doi":"10.3389/fcvm.2024.1399899","DOIUrl":"https://doi.org/10.3389/fcvm.2024.1399899","url":null,"abstract":"PurposeExtended dual antiplatelet therapy (DAPT) with ticagrelor and aspirin is recommended in selected cases after myocardial infarction (MI) but not widely deployed in practice. This study assessed an innovative, cardiology pharmacist-led virtual service for determining eligibility for extended DAPT among patients completing 12 months of initial DAPT in primary care following MI.MethodsWithin this model, potentially eligible individuals are reviewed virtually by a cardiology pharmacist for suitability for extended DAPT with reduced-dose ticagrelor [60 mg twice daily (BD)] for up to 3 years. Eligibility is guided by the PEGASUS-TIMI 54 trial criteria (aged ≥50 years and having ≥1 high-risk feature for further ischaemic events). This is balanced against potential ineligibility driven primarily by bleeding risk, assessed using PRECISE-DAPT score. The final recommendation is sent to primary care to action. The present work is a retrospective evaluation of patients referred to the service between July 2018 and December 2021.ResultsA total of 200 patients were included [<jats:italic>n</jats:italic> = 131 (65.5%) male; mean age: 69.4 ± 9.5 years]. Of these, 79 (39.5%) were recommended for extended DAPT based on the balance of risks for further ischaemic events vs. bleeding. Sixty-three patients on high-dose DAPT (ticagrelor 90 mg BD)—which is inappropriate beyond 12 months—were reassigned to reduced-dose DAPT or aspirin monotherapy.ConclusionsThis virtual clinic played a key role in medicines optimisation, enabling appropriate patients to benefit from extended DAPT while offsetting bleeding risk. The model could be adapted locally for use elsewhere.","PeriodicalId":12414,"journal":{"name":"Frontiers in Cardiovascular Medicine","volume":null,"pages":null},"PeriodicalIF":3.6,"publicationDate":"2024-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142221789","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-05DOI: 10.3389/fcvm.2024.1374765
Jennifer S. Williams, Elise Wiley, Jem L. Cheng, Jenna C. Stone, William Bostad, Joshua M. Cherubini, Martin J. Gibala, Ada Tang, Maureen J. MacDonald
BackgroundSex differences exist in cardiovascular disease risk factors including elevated blood pressure and arterial stiffness, and decreased endothelial function in males compared to females. Feminine gender expression may be associated with elevated risk of acute coronary syndrome. However, no study has investigated the associations between sex, gender identity, and gender expression and cardiovascular disease risk factors in young adults.MethodsOne hundred and thirty participants (22 ± 3 years) underwent assessments of hemodynamics, arterial stiffness [pulse wave velocity (PWV)], and brachial artery endothelial function (flow-mediated dilation; %FMD). Participants completed a questionnaire capturing sex category (50 male/80 female), gender identity category (49 men/79 women/2 non-binary), and aspects of gender expression assessed by the Bem Sex Role Inventory-30 (39 androgynous/33 feminine/29 masculine/29 undifferentiated). Sex/gender identity category groups were compared using unpaired t-tests and gender expression groups compared using one-way ANOVAs.ResultsResting systolic and mean arterial pressure (p < 0.01) were elevated in males vs. females. Central PWV was elevated in males [median (interquartile range): 6.4 (1.8) vs. 5.8 (2.2) m/s, p = 0.02]; however, leg and arm PWV were not different between sexes. %FMD was elevated in males vs. females, after accounting for a larger baseline artery diameter in males (8.8 ± 3.3% vs. 7.2 ± 3.1%, p = 0.02); since the majority of participants were cisgender, the same results were found examining gender identity (men vs. women). There were no differences across gender expression groups (p > 0.05).ConclusionsSex/gender identity category, but not gender expression, influence cardiovascular risk factors (blood pressure, arterial stiffness, endothelial function) in cisgender adults; further research is needed in gender-diverse populations.
背景与女性相比，男性在心血管疾病风险因素方面存在性别差异，包括血压升高、动脉僵化以及内皮功能下降。女性的性别表达可能与急性冠状动脉综合征的风险升高有关。方法 130 名参与者（22 ± 3 岁）接受了血液动力学、动脉僵化[脉搏波速度（PWV）]和肱动脉内皮功能（血流介导的扩张；%FMD）评估。参与者填写了一份调查问卷，其中包括性别类别（50 名男性/80 名女性）、性别认同类别（49 名男性/79 名女性/2 名非二元），以及由 Bem Sex Role Inventory-30 评估的性别表达方面（39 名雌雄同体者/33 名女性/29 名男性/29 名未分化者）。性别/性别认同类别组之间的比较采用非配对 t 检验，性别表达组之间的比较采用单因素方差分析。男性的中心脉搏波速度升高[中位数（四分位间范围）：6.4 (1.8) vs. 5.8 (2.2) m/s，p = 0.02]；然而，腿部和手臂的脉搏波速度在性别之间没有差异。在考虑到男性基线动脉直径更大（8.8 ± 3.3% vs. 7.2 ± 3.1%，p = 0.02）的情况下，男性的 FMD 百分比高于女性；由于大多数参与者都是顺性性别，因此对性别认同（男性 vs. 女性）的研究结果相同。结论性别/性别认同类别（而非性别表达）对顺性别成年人的心血管风险因素（血压、动脉僵化、内皮功能）有影响；需要在性别多样化人群中开展进一步研究。
{"title":"Differences in cardiovascular risk factors associated with sex and gender identity, but not gender expression, in young, healthy cisgender adults","authors":"Jennifer S. Williams, Elise Wiley, Jem L. Cheng, Jenna C. Stone, William Bostad, Joshua M. Cherubini, Martin J. Gibala, Ada Tang, Maureen J. MacDonald","doi":"10.3389/fcvm.2024.1374765","DOIUrl":"https://doi.org/10.3389/fcvm.2024.1374765","url":null,"abstract":"BackgroundSex differences exist in cardiovascular disease risk factors including elevated blood pressure and arterial stiffness, and decreased endothelial function in males compared to females. Feminine gender expression may be associated with elevated risk of acute coronary syndrome. However, no study has investigated the associations between sex, gender identity, and gender expression and cardiovascular disease risk factors in young adults.MethodsOne hundred and thirty participants (22 ± 3 years) underwent assessments of hemodynamics, arterial stiffness [pulse wave velocity (PWV)], and brachial artery endothelial function (flow-mediated dilation; %FMD). Participants completed a questionnaire capturing sex category (50 male/80 female), gender identity category (49 men/79 women/2 non-binary), and aspects of gender expression assessed by the Bem Sex Role Inventory-30 (39 androgynous/33 feminine/29 masculine/29 undifferentiated). Sex/gender identity category groups were compared using unpaired <jats:italic>t</jats:italic>-tests and gender expression groups compared using one-way ANOVAs.ResultsResting systolic and mean arterial pressure (<jats:italic>p</jats:italic> &lt; 0.01) were elevated in males vs. females. Central PWV was elevated in males [median (interquartile range): 6.4 (1.8) vs. 5.8 (2.2) m/s, <jats:italic>p</jats:italic> = 0.02]; however, leg and arm PWV were not different between sexes. %FMD was elevated in males vs. females, after accounting for a larger baseline artery diameter in males (8.8 ± 3.3% vs. 7.2 ± 3.1%, <jats:italic>p</jats:italic> = 0.02); since the majority of participants were cisgender, the same results were found examining gender identity (men vs. women). There were no differences across gender expression groups (<jats:italic>p</jats:italic> &gt; 0.05).ConclusionsSex/gender identity category, but not gender expression, influence cardiovascular risk factors (blood pressure, arterial stiffness, endothelial function) in cisgender adults; further research is needed in gender-diverse populations.","PeriodicalId":12414,"journal":{"name":"Frontiers in Cardiovascular Medicine","volume":null,"pages":null},"PeriodicalIF":3.6,"publicationDate":"2024-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142221785","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
BackgroundLipoprotein(a) [Lp(a)] is an independent risk factor for atherosclerotic cardiovascular disease (ASCVD). However, the association between Lp(a) and adverse outcomes in patients with ischemic heart failure (IHF) remains unclear. This study aimed to investigate the relationship between serum Lp(a) levels and the incidence of major adverse cardiovascular events (MACE) in IHF patients.MethodsIn this single-center, retrospective cohort study, 1,168 IHF patients who underwent elective percutaneous coronary intervention (PCI) were enrolled. Patients were divided into four groups based on Lp(a) quartiles. The primary endpoint was MACE, defined as a composite of all-cause mortality, non-fatal myocardial infarction (MI), and any revascularization. Cox proportional hazards models were used to evaluate the association between Lp(a) quartiles and adverse outcomes. Restricted cubic spline (RCS) curve were constructed to explore the nonlinear relationship between Lp(a) levels and MACE risk. Subgroup analyses were performed to investigate the association in different subgroups.ResultsThe incidence of MACE increased significantly across Lp(a) quartiles (Quartile 4 vs. Quartile 1: 46.4% vs. 22.9%, P < 0.001). After adjusting for confounding factors, the highest Lp(a) group remained independently associated with an increased risk of MACE (HR, 95% CI: 2.28, 1.69–3.07, P < 0.001, P for trend <0.001), all-cause mortality (HR, 95% CI: 2.33, 1.54–3.54, P < 0.001, P for trend = 0.01), and any revascularization (HR, 95% CI: 2.18, 1.35–3.53, P = 0.002, P for trend = 0.001). The RCS model demonstrated a nonlinear positive relationship between Lp(a) levels and MACE risk. Subgroup analysis revealed a significant interaction with body mass index (BMI), with a more pronounced association observed in patients with higher BMI (P for interaction <0.001).ConclusionElevated Lp(a) levels were independently associated with an increased risk of MACE, mortality, and revascularization in IHF patients, with a stronger effect in obese individuals.
背景脂蛋白（a）[Lp（a）]是动脉粥样硬化性心血管疾病（ASCVD）的独立危险因素。然而，脂蛋白（a）与缺血性心力衰竭（IHF）患者不良预后之间的关系仍不清楚。本研究旨在探讨 IHF 患者血清脂蛋白（a）水平与主要不良心血管事件（MACE）发生率之间的关系。方法在这项单中心回顾性队列研究中，共纳入了 1,168 名接受择期经皮冠状动脉介入治疗（PCI）的 IHF 患者。根据脂蛋白（a）四分位数将患者分为四组。主要终点是MACE，定义为全因死亡率、非致死性心肌梗死（MI）和任何血运重建的综合。Cox比例危险模型用于评估脂蛋白（a）四分位数与不良结局之间的关系。构建了限制性立方样条曲线（RCS），以探讨脂蛋白（a）水平与MACE风险之间的非线性关系。结果 Lp（a）四分位数的MACE发生率显著增加（四分位数4 vs. 四分位数1：46.4% vs. 22.9%，P < 0.001）。在对混杂因素进行调整后，Lp（a）最高的组别仍与MACE风险增加独立相关（HR，95% CI：2.28，1.69-3.07，P < 0.001，趋势P <0.001）、全因死亡率（HR，95% CI：2.33，1.54-3.54，P <0.001，P for trend = 0.01）和任何血运重建（HR，95% CI：2.18，1.35-3.53，P = 0.002，P for trend = 0.001）。RCS模型显示，脂蛋白（a）水平与MACE风险之间存在非线性正相关关系。亚组分析显示，Lp（a）水平与体重指数（BMI）存在显著的交互作用，体重指数越高的患者相关性越明显（交互作用的 P 值为 0.001）。
{"title":"Lipoprotein(a) as a novel biomarker for predicting adverse outcomes in ischemic heart failure","authors":"Biyang Zhang, Yinxiao Xu, Xin Huang, Tienan Sun, Meishi Ma, Zheng Chen, Yujie Zhou","doi":"10.3389/fcvm.2024.1466146","DOIUrl":"https://doi.org/10.3389/fcvm.2024.1466146","url":null,"abstract":"BackgroundLipoprotein(a) [Lp(a)] is an independent risk factor for atherosclerotic cardiovascular disease (ASCVD). However, the association between Lp(a) and adverse outcomes in patients with ischemic heart failure (IHF) remains unclear. This study aimed to investigate the relationship between serum Lp(a) levels and the incidence of major adverse cardiovascular events (MACE) in IHF patients.MethodsIn this single-center, retrospective cohort study, 1,168 IHF patients who underwent elective percutaneous coronary intervention (PCI) were enrolled. Patients were divided into four groups based on Lp(a) quartiles. The primary endpoint was MACE, defined as a composite of all-cause mortality, non-fatal myocardial infarction (MI), and any revascularization. Cox proportional hazards models were used to evaluate the association between Lp(a) quartiles and adverse outcomes. Restricted cubic spline (RCS) curve were constructed to explore the nonlinear relationship between Lp(a) levels and MACE risk. Subgroup analyses were performed to investigate the association in different subgroups.ResultsThe incidence of MACE increased significantly across Lp(a) quartiles (Quartile 4 vs. Quartile 1: 46.4% vs. 22.9%, <jats:italic>P</jats:italic> &lt; 0.001). After adjusting for confounding factors, the highest Lp(a) group remained independently associated with an increased risk of MACE (HR, 95% CI: 2.28, 1.69–3.07, <jats:italic>P</jats:italic> &lt; 0.001, P for trend &lt;0.001), all-cause mortality (HR, 95% CI: 2.33, 1.54–3.54, <jats:italic>P</jats:italic> &lt; 0.001, P for trend = 0.01), and any revascularization (HR, 95% CI: 2.18, 1.35–3.53, <jats:italic>P</jats:italic> = 0.002, P for trend = 0.001). The RCS model demonstrated a nonlinear positive relationship between Lp(a) levels and MACE risk. Subgroup analysis revealed a significant interaction with body mass index (BMI), with a more pronounced association observed in patients with higher BMI (P for interaction &lt;0.001).ConclusionElevated Lp(a) levels were independently associated with an increased risk of MACE, mortality, and revascularization in IHF patients, with a stronger effect in obese individuals.","PeriodicalId":12414,"journal":{"name":"Frontiers in Cardiovascular Medicine","volume":null,"pages":null},"PeriodicalIF":3.6,"publicationDate":"2024-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142221787","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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