Pub Date : 2024-11-05DOI: 10.1007/s00059-024-05278-7
Thomas Münzel, Marin Kuntic, Paul Stamm, Andreas Daiber
Smoking is one of the leading causes of chronic non-communicable diseases and a significant risk factor for cardiovascular and respiratory diseases. While global tobacco consumption has decreased over the past two decades, the use of e‑cigarettes and water pipes (shisha) has surged at an alarming rate, particularly among younger individuals. E‑cigarettes do not offer a completely risk-free alternative to traditional cigarettes, as the vast array of flavors and ease of use contribute to a growing number of dependent users. Furthermore, they are not necessarily effective in overcoming nicotine addiction. This contribution provides an overview of the cardiovascular health impacts associated with shisha smoking and e‑cigarette vaping, with a particular emphasis on the detrimental effects on endothelial function. The harmful biological effects of the toxic substances in these products, especially oxidative stress and inflammatory responses, are also discussed. Finally, the current state of recommendations, legal regulations, and commercial advertising are summarized.
{"title":"E-cigarettes and vaping, new spotlight on smoking as an old cardiovascular risk factor?","authors":"Thomas Münzel, Marin Kuntic, Paul Stamm, Andreas Daiber","doi":"10.1007/s00059-024-05278-7","DOIUrl":"https://doi.org/10.1007/s00059-024-05278-7","url":null,"abstract":"<p><p>Smoking is one of the leading causes of chronic non-communicable diseases and a significant risk factor for cardiovascular and respiratory diseases. While global tobacco consumption has decreased over the past two decades, the use of e‑cigarettes and water pipes (shisha) has surged at an alarming rate, particularly among younger individuals. E‑cigarettes do not offer a completely risk-free alternative to traditional cigarettes, as the vast array of flavors and ease of use contribute to a growing number of dependent users. Furthermore, they are not necessarily effective in overcoming nicotine addiction. This contribution provides an overview of the cardiovascular health impacts associated with shisha smoking and e‑cigarette vaping, with a particular emphasis on the detrimental effects on endothelial function. The harmful biological effects of the toxic substances in these products, especially oxidative stress and inflammatory responses, are also discussed. Finally, the current state of recommendations, legal regulations, and commercial advertising are summarized.</p>","PeriodicalId":12863,"journal":{"name":"Herz","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2024-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142582494","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-04DOI: 10.1007/s00059-024-05280-z
Bernhard Maisch
Alcohol is socially accepted and widely consumed as a recreational beverage. Furthermore, it is used as a disinfectant for medicinal purposes and as a cultural asset it is also part of religious rituals. However, it is also an intoxicant and an addictive substance. The deleterious side of alcohol is reflected in the fact that around 3 million people worldwide die every year as a direct or indirect result of alcohol consumption. For several decades, epidemiological studies suggested that drinking alcohol in moderate quantities was beneficial. This was referred to as the "French paradox," which described differences in mortality between France and Finland mainly, but also other countries, that were found in epidemiological studies. The difference in the levels of alcohol consumption was found to explain the differences in mortality in view of the otherwise similar risk factors. When alcoholic drinks per day were plotted against all-cause mortality this led to a J-shaped curve. This finding represented a window of benefit for moderate alcohol consumption. However, the recent publication by Zhao et al. in 2023 revisited the relationship between the quantity of alcohol consumed and mortality risk and led to a paradigm change, which has influenced not only the recommendations of Canada's Guidance on Alcohol and Health but also the recommendations and guidelines of major health organizations: "No alcohol is better than a little." The J‑shaped curve as an explanation of the French paradox became a linear relationship between the amount of alcohol consumption and the increasing mortality from tumors and cardiovascular diseases. The renewed review of several control groups in previous epidemiological studies revealed a recruitment error due to the inclusion of abstinent ex-drinkers. Taking this bias into account, the alcohol-friendly view of small amounts of alcohol being cardioprotective had to be revised. The combined misuse of alcohol and other risk factors for carcinogenesis and heart diseases still needs further attention. The misuse of both alcohol and cocaine led to the conclusion that when the two risky substances are consumed together, it is even more detrimental than the mere sum of the two.
{"title":"Alcohol consumption-none is better than a little.","authors":"Bernhard Maisch","doi":"10.1007/s00059-024-05280-z","DOIUrl":"https://doi.org/10.1007/s00059-024-05280-z","url":null,"abstract":"<p><p>Alcohol is socially accepted and widely consumed as a recreational beverage. Furthermore, it is used as a disinfectant for medicinal purposes and as a cultural asset it is also part of religious rituals. However, it is also an intoxicant and an addictive substance. The deleterious side of alcohol is reflected in the fact that around 3 million people worldwide die every year as a direct or indirect result of alcohol consumption. For several decades, epidemiological studies suggested that drinking alcohol in moderate quantities was beneficial. This was referred to as the \"French paradox,\" which described differences in mortality between France and Finland mainly, but also other countries, that were found in epidemiological studies. The difference in the levels of alcohol consumption was found to explain the differences in mortality in view of the otherwise similar risk factors. When alcoholic drinks per day were plotted against all-cause mortality this led to a J-shaped curve. This finding represented a window of benefit for moderate alcohol consumption. However, the recent publication by Zhao et al. in 2023 revisited the relationship between the quantity of alcohol consumed and mortality risk and led to a paradigm change, which has influenced not only the recommendations of Canada's Guidance on Alcohol and Health but also the recommendations and guidelines of major health organizations: \"No alcohol is better than a little.\" The J‑shaped curve as an explanation of the French paradox became a linear relationship between the amount of alcohol consumption and the increasing mortality from tumors and cardiovascular diseases. The renewed review of several control groups in previous epidemiological studies revealed a recruitment error due to the inclusion of abstinent ex-drinkers. Taking this bias into account, the alcohol-friendly view of small amounts of alcohol being cardioprotective had to be revised. The combined misuse of alcohol and other risk factors for carcinogenesis and heart diseases still needs further attention. The misuse of both alcohol and cocaine led to the conclusion that when the two risky substances are consumed together, it is even more detrimental than the mere sum of the two.</p>","PeriodicalId":12863,"journal":{"name":"Herz","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142567754","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-04DOI: 10.1007/s00059-024-05282-x
Julia Sharkova, Tanja Nickolaus, Jürgen R Schaefer
Cannabis and the marijuana derived from it, which mainly contains the psychoactive ingredient tetrahydrocannabinol (THC), is increasingly being used both for medicinal purposes and as a narcotic. While many emphasize the positive aspects and uses of cannabis, it is equally important to examine the potential negative effects on health. Here, we pay special attention to undesired cardiovascular effects, as the cardiovascular system is known to react strongly to psychoactive substances. This article highlights the current scientific findings on the effects of cannabis and marijuana on the heart and cardiovascular system. Since many patients conceal their marijuana consumption, we expect a high number of unreported cases. Therefore, the need to disclose any drug consumption is crucial for further therapeutic decisions when taking the medical history.
{"title":"Effects of cannabis use on the heart.","authors":"Julia Sharkova, Tanja Nickolaus, Jürgen R Schaefer","doi":"10.1007/s00059-024-05282-x","DOIUrl":"https://doi.org/10.1007/s00059-024-05282-x","url":null,"abstract":"<p><p>Cannabis and the marijuana derived from it, which mainly contains the psychoactive ingredient tetrahydrocannabinol (THC), is increasingly being used both for medicinal purposes and as a narcotic. While many emphasize the positive aspects and uses of cannabis, it is equally important to examine the potential negative effects on health. Here, we pay special attention to undesired cardiovascular effects, as the cardiovascular system is known to react strongly to psychoactive substances. This article highlights the current scientific findings on the effects of cannabis and marijuana on the heart and cardiovascular system. Since many patients conceal their marijuana consumption, we expect a high number of unreported cases. Therefore, the need to disclose any drug consumption is crucial for further therapeutic decisions when taking the medical history.</p>","PeriodicalId":12863,"journal":{"name":"Herz","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142575910","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-29DOI: 10.1007/s00059-024-05283-w
Fernando Baía Bezerra, Luis Eduardo Rodrigues Sobreira, Vitor Kendi Tsuchiya Sano, Artur de Oliveira Macena Lôbo, Jorge Henrique Cavalcanti Orestes Cardoso, Francinny Alves Kelly, Francisco Cezar Aquino de Moraes, Fernanda Marciano Consolim-Colombo
{"title":"Erratum to: Efficacy of sacubitril-valsartan vs. angiotensin-converting enzyme inhibitors or angiotensin receptor blockers in preventing atrial fibrillation recurrence after catheter ablation: a systematic review and meta-analysis.","authors":"Fernando Baía Bezerra, Luis Eduardo Rodrigues Sobreira, Vitor Kendi Tsuchiya Sano, Artur de Oliveira Macena Lôbo, Jorge Henrique Cavalcanti Orestes Cardoso, Francinny Alves Kelly, Francisco Cezar Aquino de Moraes, Fernanda Marciano Consolim-Colombo","doi":"10.1007/s00059-024-05283-w","DOIUrl":"https://doi.org/10.1007/s00059-024-05283-w","url":null,"abstract":"","PeriodicalId":12863,"journal":{"name":"Herz","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2024-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142545123","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-25DOI: 10.1007/s00059-024-05279-6
Kristin Annawald, Katrin Streckfuss-Bömeke, Thomas Meyer
Crystalline methamphetamine hydrochloride is an illegal drug with a high addictive potential, better known by its colloquial name "ice" or "crystal meth". The abuse of this drug has led to significant health problems worldwide. Like other amphetamine-type stimulants, chronic consumption of methamphetamine leads to direct toxic effects on the central nervous system, causing cognitive impairment, depressive behavior, and other severe neurological or psychiatric symptoms. Besides its neurotoxicity, the drug exhibits numerous deleterious effects on the cardiovascular system, including hypertension, accelerated atherosclerosis, vasospasm-induced acute coronary syndromes, sudden cardiac death, and dilated cardiomyopathy with congestive heart failure and left ventricular dysfunction. The excessive release of catecholamines upon methamphetamine exposure causes vasoconstriction and vasospasm, which ultimately lead to hypertension, tachycardia, endothelial dysfunction, and cardiotoxicity. While numerous studies have focused on transcription factors expressed in the brain that cause the neurotoxic effects of the drug, much less is known about transcription factors involved in the development of methamphetamine-induced heart failure. In this article, we provide an overview of the Janus kinase-signal transducer and activator of transcription 3 (JAK-STAT3) pathway involved in ischemia/reperfusion injury in the myocardium, which may be activated by the vasospasm-inducing action of the drug. However, much more work is needed to decipher the precise role of STAT protein family members, including the potentially cardioprotective STAT3, in the pathogenesis of methamphetamine-induced cardiotoxicity.
盐酸甲基苯丙胺晶体是一种极易上瘾的非法药物,俗称 "冰毒 "或 "冰毒"。这种药物的滥用在全球范围内导致了严重的健康问题。与其他苯丙胺类兴奋剂一样,长期吸食甲基苯丙胺会对中枢神经系统产生直接毒性作用,导致认知障碍、抑郁行为和其他严重的神经或精神症状。除神经毒性外,该药物还对心血管系统产生多种有害影响,包括高血压、加速动脉粥样硬化、血管痉挛引起的急性冠状动脉综合征、心脏性猝死、充血性心力衰竭和左心室功能障碍的扩张型心肌病。接触甲基苯丙胺后,儿茶酚胺的过度释放会引起血管收缩和血管痉挛,最终导致高血压、心动过速、内皮功能障碍和心脏毒性。虽然许多研究都集中在大脑中表达的转录因子上,这些因子会导致药物的神经毒性效应,但对甲基苯丙胺诱发心力衰竭的转录因子却知之甚少。在这篇文章中,我们概述了参与心肌缺血/再灌注损伤的 Janus 激酶-信号转导和转录激活因子 3(JAK-STAT3)通路,该通路可能被药物的血管痉挛诱导作用激活。然而,还需要做更多的工作,才能揭示 STAT 蛋白家族成员(包括可能具有心脏保护作用的 STAT3)在甲基苯丙胺诱发心脏毒性的发病机制中的确切作用。
{"title":"Methamphetamine-induced cardiotoxicity: in search of protective transcriptional mechanisms.","authors":"Kristin Annawald, Katrin Streckfuss-Bömeke, Thomas Meyer","doi":"10.1007/s00059-024-05279-6","DOIUrl":"https://doi.org/10.1007/s00059-024-05279-6","url":null,"abstract":"<p><p>Crystalline methamphetamine hydrochloride is an illegal drug with a high addictive potential, better known by its colloquial name \"ice\" or \"crystal meth\". The abuse of this drug has led to significant health problems worldwide. Like other amphetamine-type stimulants, chronic consumption of methamphetamine leads to direct toxic effects on the central nervous system, causing cognitive impairment, depressive behavior, and other severe neurological or psychiatric symptoms. Besides its neurotoxicity, the drug exhibits numerous deleterious effects on the cardiovascular system, including hypertension, accelerated atherosclerosis, vasospasm-induced acute coronary syndromes, sudden cardiac death, and dilated cardiomyopathy with congestive heart failure and left ventricular dysfunction. The excessive release of catecholamines upon methamphetamine exposure causes vasoconstriction and vasospasm, which ultimately lead to hypertension, tachycardia, endothelial dysfunction, and cardiotoxicity. While numerous studies have focused on transcription factors expressed in the brain that cause the neurotoxic effects of the drug, much less is known about transcription factors involved in the development of methamphetamine-induced heart failure. In this article, we provide an overview of the Janus kinase-signal transducer and activator of transcription 3 (JAK-STAT3) pathway involved in ischemia/reperfusion injury in the myocardium, which may be activated by the vasospasm-inducing action of the drug. However, much more work is needed to decipher the precise role of STAT protein family members, including the potentially cardioprotective STAT3, in the pathogenesis of methamphetamine-induced cardiotoxicity.</p>","PeriodicalId":12863,"journal":{"name":"Herz","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142499099","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-21DOI: 10.1007/s00059-024-05274-x
Stephan H Schirmer
The risk assessment of patients with cardiovascular diseases before noncardiac surgery (NCS) is particularly relevant in cardiology because of the frequency and the involvement of different disciplines. The risk is determined by the operation itself and the disease or risk profile, including the patient's age. Specialist preoperative consultation can therefore remain limited if the surgery-related risk is low. The subjective symptoms (exercise tolerance) and also the determination of the cardiac biomarkers N‑terminal pro-brain natriuretic peptide (NT-proBNP) and troponin are particularly relevant for assessing the indications for an instrumental or specialist examination. Cardiovascular drug treatment should predominantly be continued perioperatively but not initiated just for the operation. There are practical guidelines for pausing oral anticoagulation, whereby a general heparin bridging is no longer recommended.
{"title":"[Cardiovascular management of patients undergoing noncardiac surgery].","authors":"Stephan H Schirmer","doi":"10.1007/s00059-024-05274-x","DOIUrl":"https://doi.org/10.1007/s00059-024-05274-x","url":null,"abstract":"<p><p>The risk assessment of patients with cardiovascular diseases before noncardiac surgery (NCS) is particularly relevant in cardiology because of the frequency and the involvement of different disciplines. The risk is determined by the operation itself and the disease or risk profile, including the patient's age. Specialist preoperative consultation can therefore remain limited if the surgery-related risk is low. The subjective symptoms (exercise tolerance) and also the determination of the cardiac biomarkers N‑terminal pro-brain natriuretic peptide (NT-proBNP) and troponin are particularly relevant for assessing the indications for an instrumental or specialist examination. Cardiovascular drug treatment should predominantly be continued perioperatively but not initiated just for the operation. There are practical guidelines for pausing oral anticoagulation, whereby a general heparin bridging is no longer recommended.</p>","PeriodicalId":12863,"journal":{"name":"Herz","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2024-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142463339","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-16DOI: 10.1007/s00059-024-05277-8
Akbulut Muge, Tan Kürklü Seda, Gulyigit Halil, Ozerdem Emre, Kozluca Volkan, Esenboga Kerim, Baskovski Emir, Demirtola Ayse Irem, Tekin Cemre, Dincer Irem
Background: The left atrial appendage (LAA) is the primary site of embolism in individuals with atrial fibrillation (AF). We aimed to evaluate the morphological features of the LAA orifice in patients with sinus rhythm, paroxysmal AF, and persistent AF using three-dimensional (3D) transesophageal echocardiography (TOE). We also intended to identify morphometric parameters of the LAA orifice that may be potentially associated with an increased risk of ischemic stroke.
Methods: We prospectively enrolled 106 patients undergoing TOE. Patients were divided into three groups: group 1 (sinus rhythm), group 2 (persistent AF), and group 3 (paroxysmal AF). All patients underwent a comprehensive evaluation through transthoracic echocardiography (TTE) and TOE. Off-line analyses were performed of the recorded images.
Results: The LAA minor orifice area and minimal orifice diameter were greater in patients with persistent AF compared with individuals in sinus rhythm. Patients with persistent AF also had deeper LAAs compared with those in sinus rhythm. None of the LAA orifice morphometric measures were related to ischemic stroke risk. The only independent predictors of ischemic stroke were heart rhythm and the CHA2DS2VASc score.
Conclusion: Persistent AF is associated with LAA dilation, increased depth, and larger orifice size. To our knowledge, this is the first study to demonstrate LAA orifice structural remodeling in patients with AF using 3D TOE.
背景:左心房阑尾(LAA)是心房颤动(AF)患者栓塞的主要部位。我们旨在使用三维(3D)经食道超声心动图(TOE)评估窦性心律、阵发性房颤和持续性房颤患者 LAA 孔口的形态特征。我们还打算确定可能与缺血性中风风险增加有关的 LAA 口形态参数:我们前瞻性地招募了 106 名接受 TOE 检查的患者。患者分为三组:第一组(窦性心律)、第二组(持续性房颤)和第三组(阵发性房颤)。所有患者都接受了经胸超声心动图 (TTE) 和 TOE 的全面评估。对记录的图像进行离线分析:结果:与窦性心律患者相比,持续性房颤患者的 LAA 小口面积和最小口直径更大。与窦性心律患者相比,持续性房颤患者的 LAA 也更深。LAA 孔口形态计量指标均与缺血性卒中风险无关。缺血性中风的唯一独立预测因素是心律和 CHA2DS2VASc 评分:结论:持续性房颤与 LAA 扩张、深度增加和孔径增大有关。据我们所知,这是第一项使用三维 TOE 显示房颤患者 LAA 腔口结构重塑的研究。
{"title":"Left atrial appendage orifice morphology in sickness and in health.","authors":"Akbulut Muge, Tan Kürklü Seda, Gulyigit Halil, Ozerdem Emre, Kozluca Volkan, Esenboga Kerim, Baskovski Emir, Demirtola Ayse Irem, Tekin Cemre, Dincer Irem","doi":"10.1007/s00059-024-05277-8","DOIUrl":"https://doi.org/10.1007/s00059-024-05277-8","url":null,"abstract":"<p><strong>Background: </strong>The left atrial appendage (LAA) is the primary site of embolism in individuals with atrial fibrillation (AF). We aimed to evaluate the morphological features of the LAA orifice in patients with sinus rhythm, paroxysmal AF, and persistent AF using three-dimensional (3D) transesophageal echocardiography (TOE). We also intended to identify morphometric parameters of the LAA orifice that may be potentially associated with an increased risk of ischemic stroke.</p><p><strong>Methods: </strong>We prospectively enrolled 106 patients undergoing TOE. Patients were divided into three groups: group 1 (sinus rhythm), group 2 (persistent AF), and group 3 (paroxysmal AF). All patients underwent a comprehensive evaluation through transthoracic echocardiography (TTE) and TOE. Off-line analyses were performed of the recorded images.</p><p><strong>Results: </strong>The LAA minor orifice area and minimal orifice diameter were greater in patients with persistent AF compared with individuals in sinus rhythm. Patients with persistent AF also had deeper LAAs compared with those in sinus rhythm. None of the LAA orifice morphometric measures were related to ischemic stroke risk. The only independent predictors of ischemic stroke were heart rhythm and the CHA<sub>2</sub>DS<sub>2</sub>VASc score.</p><p><strong>Conclusion: </strong>Persistent AF is associated with LAA dilation, increased depth, and larger orifice size. To our knowledge, this is the first study to demonstrate LAA orifice structural remodeling in patients with AF using 3D TOE.</p>","PeriodicalId":12863,"journal":{"name":"Herz","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142463340","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-14DOI: 10.1007/s00059-024-05276-9
Selin Cilli Hayıroğlu, Mehmet Uzun
Background: The objective of this study was to assess the accuracy of VO2 measurements in predicting long-term major adverse cardiac events (MACEs) in patients with high cardiovascular risk.
Methods: Based on a 10-year atherosclerotic cardiovascular disease risk score, 333 patients with high cardiovascular risk were included in this retrospective analysis. The study endpoint was MACEs, comprising all-cause mortality, cardiovascular mortality, non-fatal myocardial infarction or stroke, and coronary revascularization. The study cohort was divided into two groups according to the frequency of MACE occurrence. Measurements of VO2 were assessed for the prediction of MACEs.
Results: The best predictive accuracy for 1‑year MACEs was determined to be a VO2 max value of ≥ 20.3 mL/kg/min, with 60% specificity and 60% sensitivity (area under the curve [AUC]: 0.61; 95% confidence interval [CI]: 0.51-0.71; p < 0.001), and for 5‑year MACEs it was ≥ 19.9 mL/kg/min, with 69% specificity and 64% sensitivity (AUC: 0.69; 95% CI: 0.62-0.76; p < 0.001). Multivariable Cox regression analysis, after adjusting for univariable factors, showed that VO2 max was independently associated with both short- and long-term MACEs in patients at high cardiovascular risk (hazard ratio [HR]: 0.900, 95% CI: 0.858-0.943, p < 0.001).
Conclusion: According to the results of this pilot study, VO2 max can predict both short- and long-term MACEs in patients at high cardiovascular risk.
{"title":"Predictive role of peak VO<sub>2</sub> for short- and long-term major adverse cardiac events in patients with high cardiovascular risk.","authors":"Selin Cilli Hayıroğlu, Mehmet Uzun","doi":"10.1007/s00059-024-05276-9","DOIUrl":"https://doi.org/10.1007/s00059-024-05276-9","url":null,"abstract":"<p><strong>Background: </strong>The objective of this study was to assess the accuracy of VO<sub>2</sub> measurements in predicting long-term major adverse cardiac events (MACEs) in patients with high cardiovascular risk.</p><p><strong>Methods: </strong>Based on a 10-year atherosclerotic cardiovascular disease risk score, 333 patients with high cardiovascular risk were included in this retrospective analysis. The study endpoint was MACEs, comprising all-cause mortality, cardiovascular mortality, non-fatal myocardial infarction or stroke, and coronary revascularization. The study cohort was divided into two groups according to the frequency of MACE occurrence. Measurements of VO<sub>2</sub> were assessed for the prediction of MACEs.</p><p><strong>Results: </strong>The best predictive accuracy for 1‑year MACEs was determined to be a VO<sub>2</sub> max value of ≥ 20.3 mL/kg/min, with 60% specificity and 60% sensitivity (area under the curve [AUC]: 0.61; 95% confidence interval [CI]: 0.51-0.71; p < 0.001), and for 5‑year MACEs it was ≥ 19.9 mL/kg/min, with 69% specificity and 64% sensitivity (AUC: 0.69; 95% CI: 0.62-0.76; p < 0.001). Multivariable Cox regression analysis, after adjusting for univariable factors, showed that VO<sub>2</sub> max was independently associated with both short- and long-term MACEs in patients at high cardiovascular risk (hazard ratio [HR]: 0.900, 95% CI: 0.858-0.943, p < 0.001).</p><p><strong>Conclusion: </strong>According to the results of this pilot study, VO<sub>2</sub> max can predict both short- and long-term MACEs in patients at high cardiovascular risk.</p>","PeriodicalId":12863,"journal":{"name":"Herz","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2024-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142463341","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-01Epub Date: 2024-09-25DOI: 10.1007/s00059-024-05270-1
Peter W Radke
{"title":"[eCardiology].","authors":"Peter W Radke","doi":"10.1007/s00059-024-05270-1","DOIUrl":"https://doi.org/10.1007/s00059-024-05270-1","url":null,"abstract":"","PeriodicalId":12863,"journal":{"name":"Herz","volume":"49 5","pages":"319-320"},"PeriodicalIF":1.1,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142345180","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-01Epub Date: 2024-08-27DOI: 10.1007/s00059-024-05260-3
Nora Kähler, Gerhard Hindricks, Nikolaos Dagres, Verena Tscholl
The 2018 guidelines of the European Society of Cardiology (ESC) provide improved algorithms for the diagnostics and treatment of syncope. New guidelines on ventricular tachycardia, on the prevention of sudden cardiac death and on cardiomyopathies and pacemakers have refined the recommendations. The detailed medical history and examination are crucial for differentiating between cardiac and noncardiac causes and determining the appropriate treatment. High-risk patients need urgent and comprehensive diagnostics. The basic diagnostics include medical history, physical examination and a 12-lead electrocardiography (ECG). Further tests, such as long-term ECG monitoring, implantable loop recorders and electrophysiological investigations are helpful in unclear cases. The treatment depends on the cause, with pacemaker implantation and implantable cardioverter defibrillators (ICD) being important for cardiac causes, while behavioral measures and medication management have priority for noncardiac syncope.
{"title":"[Diagnostics and treatment of syncope].","authors":"Nora Kähler, Gerhard Hindricks, Nikolaos Dagres, Verena Tscholl","doi":"10.1007/s00059-024-05260-3","DOIUrl":"10.1007/s00059-024-05260-3","url":null,"abstract":"<p><p>The 2018 guidelines of the European Society of Cardiology (ESC) provide improved algorithms for the diagnostics and treatment of syncope. New guidelines on ventricular tachycardia, on the prevention of sudden cardiac death and on cardiomyopathies and pacemakers have refined the recommendations. The detailed medical history and examination are crucial for differentiating between cardiac and noncardiac causes and determining the appropriate treatment. High-risk patients need urgent and comprehensive diagnostics. The basic diagnostics include medical history, physical examination and a 12-lead electrocardiography (ECG). Further tests, such as long-term ECG monitoring, implantable loop recorders and electrophysiological investigations are helpful in unclear cases. The treatment depends on the cause, with pacemaker implantation and implantable cardioverter defibrillators (ICD) being important for cardiac causes, while behavioral measures and medication management have priority for noncardiac syncope.</p>","PeriodicalId":12863,"journal":{"name":"Herz","volume":" ","pages":"394-403"},"PeriodicalIF":1.1,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142072610","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}