Aino-Maija Vuorinen, J. Lehtonen, S. Pakarinen, M. Holmström, S. Kivistö, T. Kaasalainen
Background Some myocardial diseases, such as cardiac sarcoidosis, predispose to complete atrioventricular block. The European Society of Cardiology Guidelines on cardiac pacing in 2021 recommend myocardial disease screening in patients with conduction disorder requiring pacemaker with multimodality imaging, including cardiac magnetic resonance (CMR) imaging. The ability of CMR imaging to detect myocardial disease in patients with a temporary pacing wire is not well documented. Methods and Results Our myocardial disease screening protocol is based on using an active fixation pacing lead connected to a reusable extracorporeal pacing generator (temporary permanent pacemaker) as a bridge to a permanent pacemaker. From 2011 to 2019, we identified 17 patients from our CMR database who underwent CMR imaging with a temporary permanent pacemaker for atrioventricular block. We analyzed their clinical presentations, CMR data, and pacemaker therapy. All CMRs were performed without adverse events. Pacing leads induced minor artifacts to the septal myocardial segments. The extent of late gadolinium enhancement in CMR imaging was used to screen patients for the presence of myocardial disease. Patients with evidence of late gadolinium enhancement underwent endomyocardial biopsy. If considered clinically indicated, also 18‐F‐fluorodeoxyglucose positron emission tomography and extracardiac tissue biopsy were performed if sarcoidosis was suspected. Eventually, 8 of 17 patients (47.1%) were diagnosed with histologically confirmed granulomatous inflammatory cardiac disease. Importantly, only 1 had a previously diagnosed extracardiac sarcoidosis at the time of presentation with high‐degree atrioventricular block. Conclusions CMR imaging with temporary permanent pacemaker protocol is an effective and safe early screening tool for myocardial disease in patients presenting with atrioventricular block requiring immediate, continuous pacing for bradycardia.
{"title":"Cardiac Magnetic Resonance Imaging–Based Screening for Cardiac Sarcoidosis in Patients With Atrioventricular Block Requiring Temporary Pacing","authors":"Aino-Maija Vuorinen, J. Lehtonen, S. Pakarinen, M. Holmström, S. Kivistö, T. Kaasalainen","doi":"10.1161/JAHA.121.024257","DOIUrl":"https://doi.org/10.1161/JAHA.121.024257","url":null,"abstract":"Background Some myocardial diseases, such as cardiac sarcoidosis, predispose to complete atrioventricular block. The European Society of Cardiology Guidelines on cardiac pacing in 2021 recommend myocardial disease screening in patients with conduction disorder requiring pacemaker with multimodality imaging, including cardiac magnetic resonance (CMR) imaging. The ability of CMR imaging to detect myocardial disease in patients with a temporary pacing wire is not well documented. Methods and Results Our myocardial disease screening protocol is based on using an active fixation pacing lead connected to a reusable extracorporeal pacing generator (temporary permanent pacemaker) as a bridge to a permanent pacemaker. From 2011 to 2019, we identified 17 patients from our CMR database who underwent CMR imaging with a temporary permanent pacemaker for atrioventricular block. We analyzed their clinical presentations, CMR data, and pacemaker therapy. All CMRs were performed without adverse events. Pacing leads induced minor artifacts to the septal myocardial segments. The extent of late gadolinium enhancement in CMR imaging was used to screen patients for the presence of myocardial disease. Patients with evidence of late gadolinium enhancement underwent endomyocardial biopsy. If considered clinically indicated, also 18‐F‐fluorodeoxyglucose positron emission tomography and extracardiac tissue biopsy were performed if sarcoidosis was suspected. Eventually, 8 of 17 patients (47.1%) were diagnosed with histologically confirmed granulomatous inflammatory cardiac disease. Importantly, only 1 had a previously diagnosed extracardiac sarcoidosis at the time of presentation with high‐degree atrioventricular block. Conclusions CMR imaging with temporary permanent pacemaker protocol is an effective and safe early screening tool for myocardial disease in patients presenting with atrioventricular block requiring immediate, continuous pacing for bradycardia.","PeriodicalId":17189,"journal":{"name":"Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease","volume":"28 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91370540","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
nlike conduction disease in elderly patients, advanced atrioventricular block in young and middle-aged patients is predominantly attributable to causes other than degenerative conduction disease and coronary artery disease. 1 Frequent causes of advanced atrioventricular block in young people include cardiac sarcoidosis, 2– 4 giant cell myocarditis, 2 genetic cardiomyopathies 5 caused by mutations in LMNA , 6 SCN5A , 7 and EMD , 8 and Lyme carditis in places where Lyme disease is endemic. 9 tachyarrhythmia, follow-
{"title":"Managing Patients With Advanced Atrioventricular Block: The Essential Role of Cardiovascular Magnetic Resonance Imaging for Timely and Accurate Diagnosis","authors":"L. von Wald, C. Shenoy","doi":"10.1161/JAHA.122.026199","DOIUrl":"https://doi.org/10.1161/JAHA.122.026199","url":null,"abstract":"nlike conduction disease in elderly patients, advanced atrioventricular block in young and middle-aged patients is predominantly attributable to causes other than degenerative conduction disease and coronary artery disease. 1 Frequent causes of advanced atrioventricular block in young people include cardiac sarcoidosis, 2– 4 giant cell myocarditis, 2 genetic cardiomyopathies 5 caused by mutations in LMNA , 6 SCN5A , 7 and EMD , 8 and Lyme carditis in places where Lyme disease is endemic. 9 tachyarrhythmia, follow-","PeriodicalId":17189,"journal":{"name":"Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease","volume":"106 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85544397","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The synthetic opioid methadone has long been recognized to cause not only QT prolongation on ECG but also a predilection for torsade de pointes.1,2 Despite the limited distribution of the drug in comparison to other opioids, methadone use has been inordinately implicated in sudden death from ventricular arrhythmia.3 However, the full mechanistic scope of why this drug is arrhythmogenic has been unresolved.
{"title":"Arrhythmogenesis and Prolonged Repolarization From Synthetic Opioids: Finally Sorted?","authors":"L. Eckhardt","doi":"10.1161/JAHA.122.025778","DOIUrl":"https://doi.org/10.1161/JAHA.122.025778","url":null,"abstract":"The synthetic opioid methadone has long been recognized to cause not only QT prolongation on ECG but also a predilection for torsade de pointes.1,2 Despite the limited distribution of the drug in comparison to other opioids, methadone use has been inordinately implicated in sudden death from ventricular arrhythmia.3 However, the full mechanistic scope of why this drug is arrhythmogenic has been unresolved.","PeriodicalId":17189,"journal":{"name":"Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease","volume":"30 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88308538","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Victor J. Del Brutto, Hans-Christoph Diener, J. Easton, C. Granger, Lisa Cronin, E. Kleine, Claudia Grauer, M. Brueckmann, K. Toyoda, P. Schellinger, P. Lyrer, C. Molina, A. Chutinet, C. Bladin, C. Estol, R. Sacco
Background We sought to determine recurrent stroke predictors among patients with embolic strokes of undetermined source (ESUS). Methods and Results We applied Cox proportional hazards models to identify clinical features associated with recurrent stroke among participants enrolled in RE‐SPECT ESUS (Randomized, Double‐Blind, Evaluation in Secondary Stroke Prevention Comparing the Efficacy and Safety of the Oral Thrombin Inhibitor Dabigatran Etexilate Versus Acetylsalicylic Acid in Patients With Embolic Stroke of Undetermined Source) trial, an international clinical trial evaluating dabigatran versus aspirin for patients with ESUS. During a median follow‐up of 19 months, 384 of 5390 participants had recurrent stroke (annual rate, 4.5%). Multivariable models revealed that stroke or transient ischemic attack before the index event (hazard ratio [HR], 2.27 [95% CI, 1.83–2.82]), creatinine clearance <50 mL/min (HR, 1.69 [95% CI, 1.23–2.32]), male sex (HR, 1.60 [95% CI, 1.27–2.02]), and CHA2DS2‐VASc ≥4 (HR, 1.55 [95% CI, 1.15–2.08] and HR, 1.66 [95% CI, 1.21–2.26] for scores of 4 and ≥5, respectively) versus CHA2DS2‐VASc of 2 to 3, were independent predictors for recurrent stroke. Conclusions In RE‐SPECT ESUS trial, expected risk factors previously linked to other common stroke causes were associated with stroke recurrence. These data help define high‐risk groups for subsequent stroke that may be useful for clinicians and for researchers designing trials among patients with ESUS. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT02239120.
{"title":"Predictors of Recurrent Stroke After Embolic Stroke of Undetermined Source in the RE‐SPECT ESUS Trial","authors":"Victor J. Del Brutto, Hans-Christoph Diener, J. Easton, C. Granger, Lisa Cronin, E. Kleine, Claudia Grauer, M. Brueckmann, K. Toyoda, P. Schellinger, P. Lyrer, C. Molina, A. Chutinet, C. Bladin, C. Estol, R. Sacco","doi":"10.1161/JAHA.121.023545","DOIUrl":"https://doi.org/10.1161/JAHA.121.023545","url":null,"abstract":"Background We sought to determine recurrent stroke predictors among patients with embolic strokes of undetermined source (ESUS). Methods and Results We applied Cox proportional hazards models to identify clinical features associated with recurrent stroke among participants enrolled in RE‐SPECT ESUS (Randomized, Double‐Blind, Evaluation in Secondary Stroke Prevention Comparing the Efficacy and Safety of the Oral Thrombin Inhibitor Dabigatran Etexilate Versus Acetylsalicylic Acid in Patients With Embolic Stroke of Undetermined Source) trial, an international clinical trial evaluating dabigatran versus aspirin for patients with ESUS. During a median follow‐up of 19 months, 384 of 5390 participants had recurrent stroke (annual rate, 4.5%). Multivariable models revealed that stroke or transient ischemic attack before the index event (hazard ratio [HR], 2.27 [95% CI, 1.83–2.82]), creatinine clearance <50 mL/min (HR, 1.69 [95% CI, 1.23–2.32]), male sex (HR, 1.60 [95% CI, 1.27–2.02]), and CHA2DS2‐VASc ≥4 (HR, 1.55 [95% CI, 1.15–2.08] and HR, 1.66 [95% CI, 1.21–2.26] for scores of 4 and ≥5, respectively) versus CHA2DS2‐VASc of 2 to 3, were independent predictors for recurrent stroke. Conclusions In RE‐SPECT ESUS trial, expected risk factors previously linked to other common stroke causes were associated with stroke recurrence. These data help define high‐risk groups for subsequent stroke that may be useful for clinicians and for researchers designing trials among patients with ESUS. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT02239120.","PeriodicalId":17189,"journal":{"name":"Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease","volume":"17 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72699682","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
C. Park, Hyungwoo Kim, Y. S. Joo, J. Park, T. Chang, T. Yoo, S. Park, D. Chae, W. Chung, Yong‐Soo Kim, K. Oh, Shin-Wook Kang, S. Han
Background Whether visit‐to‐visit systolic blood pressure (SBP) variability can predict major adverse cardiovascular events (MACE) in patients with chronic kidney disease is unclear. Methods and Results We investigated the relationship between SDs of visit‐to‐visit SBP variability during the first year of enrollment and MACE among 1575 participants from KNOW‐CKD (Korean Cohort Study for Outcome in Patients With Chronic Kidney Disease). Participants were categorized into 3 groups according to tertiles of visit‐to‐visit SBP variability (SD). The study end point was MACE, defined as a composite of nonfatal myocardial infarction, unstable angina, revascularization, nonfatal stroke, hospitalization for heart failure, or cardiac death. During 6748 patient‐years of follow‐up (median, 4.2 years), MACE occurred in 64 participants (4.1%). Compared with the lowest tertile of visit‐to‐visit SBP variability (SD), the hazard ratios (HRs) for the middle and the highest tertile were 1.64 (95% CI, 0.80–3.36) and 2.23 (95% CI, 1.12–4.44), respectively, in a multivariable cause‐specific hazard model. In addition, the HR associated with each 5‐mm Hg increase in visit‐to‐visit SBP variability (SD) was 1.21 (95% CI, 1.01–1.45). This association was consistent in sensitivity analyses with 2 additional definitions of SBP variability determined by the coefficient of variation and variation independent of the mean. The corresponding HRs for the middle and highest tertiles were 2.11 (95% CI, 1.03–4.35) and 2.28 (95% CI, 1.12–4.63), respectively, in the analysis with the coefficient of variation and 1.76 (95% CI, 0.87–3.57) and 2.04 (95% CI, 1.03–4.03), respectively, with the variation independent of the mean. Conclusions Higher visit‐to‐visit SBP variability is associated with an increased risk of MACE in patients with chronic kidney disease. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT01630486.
{"title":"Association Between Systolic Blood Pressure Variability and Major Adverse Cardiovascular Events in Korean Patients With Chronic Kidney Disease: Findings From KNOW‐CKD","authors":"C. Park, Hyungwoo Kim, Y. S. Joo, J. Park, T. Chang, T. Yoo, S. Park, D. Chae, W. Chung, Yong‐Soo Kim, K. Oh, Shin-Wook Kang, S. Han","doi":"10.1161/JAHA.122.025513","DOIUrl":"https://doi.org/10.1161/JAHA.122.025513","url":null,"abstract":"Background Whether visit‐to‐visit systolic blood pressure (SBP) variability can predict major adverse cardiovascular events (MACE) in patients with chronic kidney disease is unclear. Methods and Results We investigated the relationship between SDs of visit‐to‐visit SBP variability during the first year of enrollment and MACE among 1575 participants from KNOW‐CKD (Korean Cohort Study for Outcome in Patients With Chronic Kidney Disease). Participants were categorized into 3 groups according to tertiles of visit‐to‐visit SBP variability (SD). The study end point was MACE, defined as a composite of nonfatal myocardial infarction, unstable angina, revascularization, nonfatal stroke, hospitalization for heart failure, or cardiac death. During 6748 patient‐years of follow‐up (median, 4.2 years), MACE occurred in 64 participants (4.1%). Compared with the lowest tertile of visit‐to‐visit SBP variability (SD), the hazard ratios (HRs) for the middle and the highest tertile were 1.64 (95% CI, 0.80–3.36) and 2.23 (95% CI, 1.12–4.44), respectively, in a multivariable cause‐specific hazard model. In addition, the HR associated with each 5‐mm Hg increase in visit‐to‐visit SBP variability (SD) was 1.21 (95% CI, 1.01–1.45). This association was consistent in sensitivity analyses with 2 additional definitions of SBP variability determined by the coefficient of variation and variation independent of the mean. The corresponding HRs for the middle and highest tertiles were 2.11 (95% CI, 1.03–4.35) and 2.28 (95% CI, 1.12–4.63), respectively, in the analysis with the coefficient of variation and 1.76 (95% CI, 0.87–3.57) and 2.04 (95% CI, 1.03–4.03), respectively, with the variation independent of the mean. Conclusions Higher visit‐to‐visit SBP variability is associated with an increased risk of MACE in patients with chronic kidney disease. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT01630486.","PeriodicalId":17189,"journal":{"name":"Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease","volume":"11 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90564404","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
N. Dai, S. Yuan, K. Dou, Rui Zhang, Nan Hu, Jining He, C. Guan, Tongqiang Zou, Z. Qiao, S. Duan, Lihua Xie, Yongfu Yu, Yingmei Zhang, Bo Xu, Junbo Ge
Background Coronary diffuse disease associates with poor outcomes, but little is known about its role after percutaneous coronary intervention (PCI). We aimed to investigate the prognostic implication of pre‐PCI focal or diffuse disease patterns combined with post‐PCI quantitative flow ratio (QFR). Methods and Results Pre‐PCI QFR derived pullback pressure gradient (PPG) (QFR‐PPG) was measured to assess physiological disease patterns for 1685 included vessels; the vessels were classified according to dichotomous pre‐PCI QFR‐PPG and post‐PCI QFR. Vessel‐oriented composite outcome, a composite of vessel‐related ischemia‐driven revascularization, vessel‐related myocardial infarction, or cardiac death at 2 years was compared among these groups. Vessels with low pre‐PCI PPG (3.9% versus 2.0%, hazard ratio [HR], 1.93; 95% CI, 1.08–3.44; P=0.02) or low post‐PCI QFR (9.8% versus 2.7%, HR, 3.78; 95% CI, 1.61–8.87; P=0.001) demonstrated higher vessel‐oriented composite outcome risk after stent implantation. Of note, despite high post‐PCI QFR achieved, vessels with low pre‐PCI QFR‐PPG presented higher risk of vessel‐oriented composite outcome than those with high pre‐PCI QFR‐PPG (3.7% versus 1.8%, HR, 2.03; 95% CI, 1.09–3.76; P=0.03) and pre‐PCI QFR‐PPG demonstrated direct prognostic effect not mediated by post‐PCI QFR. Integration of groups classified by pre‐PCI QFR‐PPG and post‐PCI QFR showed significantly higher discriminant and reclassification abilities than clinical factors (C‐index 0.77 versus 0.72, P=0.03; integrated discrimination improvement 0.93%, P=0.04; net reclassification index 0.33, P=0.02). Conclusions Prognostic value of pre‐PCI focal or diffuse disease patterns assessed by QFR‐PPG index was retained even after successful PCI, which is mostly explained by its direct effect that was not mediated by post‐PCI QFR. Integration of both pre‐PCI and post‐PCI physiological information can provide better risk stratification in vessels with stent implantation. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT05104580.
{"title":"Prognostic Implications of Prestent Pullback Pressure Gradient and Poststent Quantitative Flow Ratio in Patients Undergoing Percutaneous Coronary Intervention","authors":"N. Dai, S. Yuan, K. Dou, Rui Zhang, Nan Hu, Jining He, C. Guan, Tongqiang Zou, Z. Qiao, S. Duan, Lihua Xie, Yongfu Yu, Yingmei Zhang, Bo Xu, Junbo Ge","doi":"10.1161/JAHA.121.024903","DOIUrl":"https://doi.org/10.1161/JAHA.121.024903","url":null,"abstract":"Background Coronary diffuse disease associates with poor outcomes, but little is known about its role after percutaneous coronary intervention (PCI). We aimed to investigate the prognostic implication of pre‐PCI focal or diffuse disease patterns combined with post‐PCI quantitative flow ratio (QFR). Methods and Results Pre‐PCI QFR derived pullback pressure gradient (PPG) (QFR‐PPG) was measured to assess physiological disease patterns for 1685 included vessels; the vessels were classified according to dichotomous pre‐PCI QFR‐PPG and post‐PCI QFR. Vessel‐oriented composite outcome, a composite of vessel‐related ischemia‐driven revascularization, vessel‐related myocardial infarction, or cardiac death at 2 years was compared among these groups. Vessels with low pre‐PCI PPG (3.9% versus 2.0%, hazard ratio [HR], 1.93; 95% CI, 1.08–3.44; P=0.02) or low post‐PCI QFR (9.8% versus 2.7%, HR, 3.78; 95% CI, 1.61–8.87; P=0.001) demonstrated higher vessel‐oriented composite outcome risk after stent implantation. Of note, despite high post‐PCI QFR achieved, vessels with low pre‐PCI QFR‐PPG presented higher risk of vessel‐oriented composite outcome than those with high pre‐PCI QFR‐PPG (3.7% versus 1.8%, HR, 2.03; 95% CI, 1.09–3.76; P=0.03) and pre‐PCI QFR‐PPG demonstrated direct prognostic effect not mediated by post‐PCI QFR. Integration of groups classified by pre‐PCI QFR‐PPG and post‐PCI QFR showed significantly higher discriminant and reclassification abilities than clinical factors (C‐index 0.77 versus 0.72, P=0.03; integrated discrimination improvement 0.93%, P=0.04; net reclassification index 0.33, P=0.02). Conclusions Prognostic value of pre‐PCI focal or diffuse disease patterns assessed by QFR‐PPG index was retained even after successful PCI, which is mostly explained by its direct effect that was not mediated by post‐PCI QFR. Integration of both pre‐PCI and post‐PCI physiological information can provide better risk stratification in vessels with stent implantation. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT05104580.","PeriodicalId":17189,"journal":{"name":"Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease","volume":"2 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82515475","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
B. Weber, Dana Weisenfeld, Thany Seyok, Sicong Huang, E. Massarotti, Leanne Barrett, C. Bibbo, D. H. Solomon, J. Plutzky, M. Bolster, M. D. Di Carli, K. Liao
will be prevalent in patients with RA who have low estimated ASCVD risk and that CMD will be associated with higher levels of IL- 6. We analyzed baseline data from the LIIRA (Lipids, Inflammation and Cardiovascular Risk in RA) study, NCT02714881. The data that support the findings of this study are available from the corresponding author upon reasonable request. LIIRA included individuals with RA, age>35 years with active RA, not on a statin or biologic therapy. All subjects underwent assessment of cardiovascular risk factors, as well as the validated RA Disease Activity Score- 28- C- reactive protein (CRP3), which includes tender, swollen joints, and hsCRP (high-sensitivity CRP); a stress myocardial perfusion positron emission tomography scan was performed to quantify CFR. Standard positron emission tomography imaging protocols were performed as previously described. 3 CFR was calculated as the ratio of myocardial blood flow (mL/min per g) at peak stress over that at rest; CMD was defined as CFR<2.5. Attenuation correction computed tomography scans were reviewed for semi-quantitative assessment of coronary artery calcium. HsCRP and IL- 6 levels were measured in the clinical laboratory. A Wilcoxon rank- sum test was performed
{"title":"Relationship Between Risk of Atherosclerotic Cardiovascular Disease, Inflammation, and Coronary Microvascular Dysfunction in Rheumatoid Arthritis","authors":"B. Weber, Dana Weisenfeld, Thany Seyok, Sicong Huang, E. Massarotti, Leanne Barrett, C. Bibbo, D. H. Solomon, J. Plutzky, M. Bolster, M. D. Di Carli, K. Liao","doi":"10.1161/JAHA.121.025467","DOIUrl":"https://doi.org/10.1161/JAHA.121.025467","url":null,"abstract":"will be prevalent in patients with RA who have low estimated ASCVD risk and that CMD will be associated with higher levels of IL- 6. We analyzed baseline data from the LIIRA (Lipids, Inflammation and Cardiovascular Risk in RA) study, NCT02714881. The data that support the findings of this study are available from the corresponding author upon reasonable request. LIIRA included individuals with RA, age>35 years with active RA, not on a statin or biologic therapy. All subjects underwent assessment of cardiovascular risk factors, as well as the validated RA Disease Activity Score- 28- C- reactive protein (CRP3), which includes tender, swollen joints, and hsCRP (high-sensitivity CRP); a stress myocardial perfusion positron emission tomography scan was performed to quantify CFR. Standard positron emission tomography imaging protocols were performed as previously described. 3 CFR was calculated as the ratio of myocardial blood flow (mL/min per g) at peak stress over that at rest; CMD was defined as CFR<2.5. Attenuation correction computed tomography scans were reviewed for semi-quantitative assessment of coronary artery calcium. HsCRP and IL- 6 levels were measured in the clinical laboratory. A Wilcoxon rank- sum test was performed","PeriodicalId":17189,"journal":{"name":"Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease","volume":"84 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72867921","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
R. Gopinathannair, N. Pothineni, J. Trivedi, H. Roukoz, J. Cowger, Mustafa M. Ahmed, A. Bhan, Ashwin K Ravichandran, G. Bhat, Amin Al Ahmad, A. Natale, L. Di Biase, M. Slaughter, D. Lakkireddy
Background Atrial and ventricular arrhythmias are commonly encountered in patients with advanced heart failure, with amiodarone being the most commonly used antiarrhythmic drug in continuous‐flow left ventricular assist device (CF‐LVAD) recipients. The purpose of this study was to assess the impact of amiodarone use on long‐term all‐cause mortality in ptients with a CF‐LVAD. Methods and Results A retrospective multicenter study of CF‐LVAD was conducted at 5 centers including all CF‐LVAD implants from 2007 to 2015. Patients were stratified based on pre–CF‐LVAD implant amiodarone use. Additional use of amiodarone after CF‐LVAD implantation was also evaluated. Primary outcome was all‐cause mortality during long‐term follow‐up. Kaplan‐Meier curves were used to assess survival outcomes. Multivariable Cox regression was used to identify predictors of outcomes. Propensity matching was done to address baseline differences. A total of 480 patients with a CF‐LVAD (aged 58±13 years, 81% men) were included. Of these, 170 (35.4%) were on chronic amiodarone therapy at the time of CF‐LVAD implant, and 310 (64.6%) were not on amiodarone. Rate of all‐cause mortality over the follow‐up period was 32.9% in the amiodarone group compared with 29.6% in those not on amiodarone (P=0.008). Similar results were noted in the propensity‐matched group (log‐rank, P=0.04). On multivariable Cox regression analysis, amiodarone use at baseline was independently associated with all‐cause mortality (hazard ratio, 1.68 [95% CI, 1.1–2.5]; P=0.01). Conclusions Amiodarone use was associated with significantly increased rates of all‐cause mortality in CF‐LVAD recipients. Earlier interventions for arrhythmias to avoid long‐term amiodarone exposure may improve long‐term outcomes in CF‐LVAD recipients and needs further study.
{"title":"Amiodarone Use and All‐Cause Mortality in Patients With a Continuous‐Flow Left Ventricular Assist Device","authors":"R. Gopinathannair, N. Pothineni, J. Trivedi, H. Roukoz, J. Cowger, Mustafa M. Ahmed, A. Bhan, Ashwin K Ravichandran, G. Bhat, Amin Al Ahmad, A. Natale, L. Di Biase, M. Slaughter, D. Lakkireddy","doi":"10.1161/JAHA.121.023762","DOIUrl":"https://doi.org/10.1161/JAHA.121.023762","url":null,"abstract":"Background Atrial and ventricular arrhythmias are commonly encountered in patients with advanced heart failure, with amiodarone being the most commonly used antiarrhythmic drug in continuous‐flow left ventricular assist device (CF‐LVAD) recipients. The purpose of this study was to assess the impact of amiodarone use on long‐term all‐cause mortality in ptients with a CF‐LVAD. Methods and Results A retrospective multicenter study of CF‐LVAD was conducted at 5 centers including all CF‐LVAD implants from 2007 to 2015. Patients were stratified based on pre–CF‐LVAD implant amiodarone use. Additional use of amiodarone after CF‐LVAD implantation was also evaluated. Primary outcome was all‐cause mortality during long‐term follow‐up. Kaplan‐Meier curves were used to assess survival outcomes. Multivariable Cox regression was used to identify predictors of outcomes. Propensity matching was done to address baseline differences. A total of 480 patients with a CF‐LVAD (aged 58±13 years, 81% men) were included. Of these, 170 (35.4%) were on chronic amiodarone therapy at the time of CF‐LVAD implant, and 310 (64.6%) were not on amiodarone. Rate of all‐cause mortality over the follow‐up period was 32.9% in the amiodarone group compared with 29.6% in those not on amiodarone (P=0.008). Similar results were noted in the propensity‐matched group (log‐rank, P=0.04). On multivariable Cox regression analysis, amiodarone use at baseline was independently associated with all‐cause mortality (hazard ratio, 1.68 [95% CI, 1.1–2.5]; P=0.01). Conclusions Amiodarone use was associated with significantly increased rates of all‐cause mortality in CF‐LVAD recipients. Earlier interventions for arrhythmias to avoid long‐term amiodarone exposure may improve long‐term outcomes in CF‐LVAD recipients and needs further study.","PeriodicalId":17189,"journal":{"name":"Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease","volume":"48 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85302557","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Le Ni, Bowen Lin, Lingjie Hu, Ruoyu Zhang, Fengmei Fu, Meiting Shen, Jian Yang, Dan Shi
Background Heart failure, caused by sustained pressure overload, remains a major public health problem. PKM (pyruvate kinase M) acts as a rate‐limiting enzyme of glycolysis. PKM2 (pyruvate kinase M2), an alternative splicing product of PKM, plays complex roles in various biological processes and diseases. However, the role of PKM2 in the development of heart failure remains unknown. Methods and Results Cardiomyocyte‐specific Pkm2 knockout mice were generated by crossing the floxed Pkm2 mice with α‐MHC (myosin heavy chain)‐Cre transgenic mice, and cardiac specific Pkm2 overexpression mice were established by injecting adeno‐associated virus serotype 9 system. The results showed that cardiomyocyte‐specific Pkm2 deletion resulted in significant deterioration of cardiac functions under pressure overload, whereas Pkm2 overexpression mitigated transverse aortic constriction‐induced cardiac hypertrophy and improved heart functions. Mechanistically, we demonstrated that PKM2 acted as a protein kinase rather than a pyruvate kinase, which inhibited the activation of RAC1 (rho family, small GTP binding protein)‐MAPK (mitogen‐activated protein kinase) signaling pathway by phosphorylating RAC1 in the progress of heart failure. In addition, blockade of RAC1 through NSC23766, a specific RAC1 inhibitor, attenuated pathological cardiac remodeling in Pkm2 deficiency mice subjected to transverse aortic constriction. Conclusions This study revealed that PKM2 attenuated overload‐induced pathological cardiac hypertrophy and heart failure, which provides an attractive target for the prevention and treatment of cardiomyopathies.
{"title":"Pyruvate Kinase M2 Protects Heart from Pressure Overload‐Induced Heart Failure by Phosphorylating RAC1","authors":"Le Ni, Bowen Lin, Lingjie Hu, Ruoyu Zhang, Fengmei Fu, Meiting Shen, Jian Yang, Dan Shi","doi":"10.1161/JAHA.121.024854","DOIUrl":"https://doi.org/10.1161/JAHA.121.024854","url":null,"abstract":"Background Heart failure, caused by sustained pressure overload, remains a major public health problem. PKM (pyruvate kinase M) acts as a rate‐limiting enzyme of glycolysis. PKM2 (pyruvate kinase M2), an alternative splicing product of PKM, plays complex roles in various biological processes and diseases. However, the role of PKM2 in the development of heart failure remains unknown. Methods and Results Cardiomyocyte‐specific Pkm2 knockout mice were generated by crossing the floxed Pkm2 mice with α‐MHC (myosin heavy chain)‐Cre transgenic mice, and cardiac specific Pkm2 overexpression mice were established by injecting adeno‐associated virus serotype 9 system. The results showed that cardiomyocyte‐specific Pkm2 deletion resulted in significant deterioration of cardiac functions under pressure overload, whereas Pkm2 overexpression mitigated transverse aortic constriction‐induced cardiac hypertrophy and improved heart functions. Mechanistically, we demonstrated that PKM2 acted as a protein kinase rather than a pyruvate kinase, which inhibited the activation of RAC1 (rho family, small GTP binding protein)‐MAPK (mitogen‐activated protein kinase) signaling pathway by phosphorylating RAC1 in the progress of heart failure. In addition, blockade of RAC1 through NSC23766, a specific RAC1 inhibitor, attenuated pathological cardiac remodeling in Pkm2 deficiency mice subjected to transverse aortic constriction. Conclusions This study revealed that PKM2 attenuated overload‐induced pathological cardiac hypertrophy and heart failure, which provides an attractive target for the prevention and treatment of cardiomyopathies.","PeriodicalId":17189,"journal":{"name":"Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease","volume":"112 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90887197","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Lucas Hollanda Oliveira, M. Viana, C. Luize, Ricardo Sobral de Carvalho, C. Cirenza, Cristiano de Oliveira Dietrich, L. C. Correia, Cláudio Marcelo Bittencourt das Virgens, Juliana Medeiros Filgueiras, M. Barreto, E. Porto, E. Coutinho, Â. de Paola
Background Catheter ablation (CA) is a safe, effective, cost‐effective technique and may be considered a first‐line strategy for the treatment of symptomatic supraventricular tachycardias (SVT). Despite the high prospect of cure and the recommendations of international guidelines in considering CA as a first‐line treatment strategy, the average time between diagnosis and the procedure may be long. The present study aims to evaluate predictors related to non‐referral for CA as first‐line treatment in patients with SVT. Methods and Results The model was derived from a retrospective cohort of patients with SVT or ventricular pre‐excitation referred for CA in a tertiary center. Clinical and demographical features were used as independent variables and non‐referral for CA as first‐line treatment the dependent variable in a stepwise logistic regression analysis. Among 20 clinical‐demographic variables from 350 patients, 10 were included in initial logistic regression analysis: age, women, presence of pre‐excitation on ECG, palpitation, dyspnea and chest discomfort, number of antiarrhythmic drugs before ablation, number of concomitant symptoms, symptoms’ duration and evaluations in the emergency room due to SVT. After multivariable adjusted analysis, age (odds ratio [OR], 1.2; 95% CI 1.01–1.32; P=0.04), chest discomfort during supraventricular tachycardia (OR, 2.7; CI 1.6–4.7; P<0.001) and number of antiarrhythmic drugs before ablation (OR, 1.8; CI 1.4–2.3; P<0.001) showed a positive independent association for non‐referral for CA as SVT first‐line treatment. Conclusions The independent predictors of non‐referral for CA as first‐line treatment in our logistic regression analysis indicate the existence of biases in the decision‐making process in the referral process of patients who would benefit the most from catheter ablation. They very likely suggest a skewed medical decision‐making process leading to catheter ablation underuse.
导管消融(CA)是一种安全、有效、经济的技术，可能被认为是治疗症状性室上性心动过速(SVT)的一线策略。尽管有很高的治愈前景，并且国际指南建议将CA作为一线治疗策略，但从诊断到手术的平均时间可能很长。本研究旨在评估与非转诊CA作为SVT患者一线治疗相关的预测因素。方法和结果该模型来源于一个三级中心的室性心动过速或心室预兴奋患者的回顾性队列。在逐步logistic回归分析中，临床和人口统计学特征作为自变量，非转诊CA作为一线治疗的因变量。在来自350例患者的20个临床人口学变量中，有10个变量被纳入了初始logistic回归分析:年龄、女性、ECG上的预兴奋、心悸、呼吸困难和胸部不适、消融前抗心律失常药物的数量、伴随症状的数量、症状持续时间和因SVT在急诊室的评估。经多变量调整分析，年龄(优势比[OR]， 1.2;95% ci 1.01-1.32;P=0.04)，室上性心动过速时胸部不适(OR, 2.7;可信区间1.6 - -4.7;P<0.001)和消融前抗心律失常药物的数量(OR, 1.8;可信区间1.4 - -2.3;P<0.001)显示非转诊CA作为SVT一线治疗的独立正相关。结论:在我们的logistic回归分析中，不转诊CA作为一线治疗的独立预测因素表明，在转诊过程中，哪些患者将从导管消融中获益最多，在决策过程中存在偏差。它们很可能表明，一个扭曲的医疗决策过程导致导管消融使用不足。
{"title":"Underuse of Catheter Ablation as First‐Line Therapy for Supraventricular Tachycardia","authors":"Lucas Hollanda Oliveira, M. Viana, C. Luize, Ricardo Sobral de Carvalho, C. Cirenza, Cristiano de Oliveira Dietrich, L. C. Correia, Cláudio Marcelo Bittencourt das Virgens, Juliana Medeiros Filgueiras, M. Barreto, E. Porto, E. Coutinho, Â. de Paola","doi":"10.1161/JAHA.121.022648","DOIUrl":"https://doi.org/10.1161/JAHA.121.022648","url":null,"abstract":"Background Catheter ablation (CA) is a safe, effective, cost‐effective technique and may be considered a first‐line strategy for the treatment of symptomatic supraventricular tachycardias (SVT). Despite the high prospect of cure and the recommendations of international guidelines in considering CA as a first‐line treatment strategy, the average time between diagnosis and the procedure may be long. The present study aims to evaluate predictors related to non‐referral for CA as first‐line treatment in patients with SVT. Methods and Results The model was derived from a retrospective cohort of patients with SVT or ventricular pre‐excitation referred for CA in a tertiary center. Clinical and demographical features were used as independent variables and non‐referral for CA as first‐line treatment the dependent variable in a stepwise logistic regression analysis. Among 20 clinical‐demographic variables from 350 patients, 10 were included in initial logistic regression analysis: age, women, presence of pre‐excitation on ECG, palpitation, dyspnea and chest discomfort, number of antiarrhythmic drugs before ablation, number of concomitant symptoms, symptoms’ duration and evaluations in the emergency room due to SVT. After multivariable adjusted analysis, age (odds ratio [OR], 1.2; 95% CI 1.01–1.32; P=0.04), chest discomfort during supraventricular tachycardia (OR, 2.7; CI 1.6–4.7; P<0.001) and number of antiarrhythmic drugs before ablation (OR, 1.8; CI 1.4–2.3; P<0.001) showed a positive independent association for non‐referral for CA as SVT first‐line treatment. Conclusions The independent predictors of non‐referral for CA as first‐line treatment in our logistic regression analysis indicate the existence of biases in the decision‐making process in the referral process of patients who would benefit the most from catheter ablation. They very likely suggest a skewed medical decision‐making process leading to catheter ablation underuse.","PeriodicalId":17189,"journal":{"name":"Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease","volume":"159 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86731696","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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