Pub Date : 2025-02-01DOI: 10.1016/j.mayocp.2024.11.001
Rick A. Nishimura MD, Steve R. Ommen MD, Joseph A. Dearani MD, Hartzell V. Schaff MD
Valvular heart disease is one of the most common cardiovascular diseases today and may result in severe limiting symptoms, a shortened lifespan, and, in some cases, sudden death. It is important to identify significant valve disease because intervention can restore quality of life and in many instances increase longevity. In most patients, the diagnosis of significant valvular heart disease can be made on the basis of a physical examination, yet nearly half of the patients who could benefit from interventions are not being recognized or referred. There have been major improvements in both the diagnosis and treatment of patients with valvular heart disease, with noninvasive echocardiography available to confirm the presence and severity of valve disease, better and more durable surgical procedures, and the advent of catheter-based therapies. There are now national guidelines to aid clinicians in the optimal timing of the intervention, which are presented. However, it is now recognized that the long-standing volume or pressure overload from valve disease can result in incipient ventricular dysfunction even before the onset of symptoms or a drop in ejection fraction; therefore, there is an impetus to recognize and to treat these patients earlier and earlier in the disease natural history. A shared decision-making process should play a key role in the final decision for therapy, outlining the goals and risks of possible intervention coupled with the patient’s own needs and expectations.
{"title":"Valvular Heart Disease—A New Evolving Paradigm","authors":"Rick A. Nishimura MD, Steve R. Ommen MD, Joseph A. Dearani MD, Hartzell V. Schaff MD","doi":"10.1016/j.mayocp.2024.11.001","DOIUrl":"10.1016/j.mayocp.2024.11.001","url":null,"abstract":"<div><div>Valvular heart disease is one of the most common cardiovascular diseases today and may result in severe limiting symptoms, a shortened lifespan, and, in some cases, sudden death. It is important to identify significant valve disease because intervention can restore quality of life and in many instances increase longevity. In most patients, the diagnosis of significant valvular heart disease can be made on the basis of a physical examination, yet nearly half of the patients who could benefit from interventions are not being recognized or referred. There have been major improvements in both the diagnosis and treatment of patients with valvular heart disease, with noninvasive echocardiography available to confirm the presence and severity of valve disease, better and more durable surgical procedures, and the advent of catheter-based therapies. There are now national guidelines to aid clinicians in the optimal timing of the intervention, which are presented. However, it is now recognized that the long-standing volume or pressure overload from valve disease can result in incipient ventricular dysfunction even before the onset of symptoms or a drop in ejection fraction; therefore, there is an impetus to recognize and to treat these patients earlier and earlier in the disease natural history. A shared decision-making process should play a key role in the final decision for therapy, outlining the goals and risks of possible intervention coupled with the patient’s own needs and expectations.</div></div>","PeriodicalId":18334,"journal":{"name":"Mayo Clinic proceedings","volume":"100 2","pages":"Pages 358-379"},"PeriodicalIF":6.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143149565","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.mayocp.2024.07.006
Rene Rivera Gutierrez MD , Elif Tama MD , Dima Bechenati MD , Regina Castañeda Hernandez MD , Pamela K. Bennett APRN, DNP , Allyson W. McNally APRN, DNP , Sima Fansa MD , Diego Anazco MD , Andres Acosta MD, PhD , Maria D. Hurtado Andrade MD, PhD
Objective
To determine the effect of tirzepatide on weight, diabetes control, and insulin requirements, and its safety profile in adults with type 1 diabetes (T1D) and overweight or obesity.
Patients and Methods
This is a retrospective study of adults with T1D using tirzepatide for overweight/obesity treatment between June 1, 2022, and October 31, 2023, at Mayo Clinic. Fifty-one patients fulfilled inclusion and exclusion criteria (adults with established T1D diagnosis and a body mass index ≥27 kg/m2 using tirzepatide for 3 months or longer and without a history of bariatric surgery or active malignancy). Data were collected from the electronic medical record and reported as median (Q1-Q3).
Results
Most individuals were female (30, 58.8%), White (49, 96.1%), and with obesity class III (21, 41.2%). During a median follow-up time of 8.0 (Q1-Q3: 4.0-10.0) months, the total body weight loss was 8.5% (Q1-Q3: 5.3%-13.8%) (P<.01). At 12 months, total body weight loss was 12.2% (Q1-Q3: 7.3%-19.8%) (n=26). By the last follow-up, hemoglobin A1c decreased by 0.9% (Q1-Q3: 0.3%-1.1%) (P<.0001) and daily insulin requirements by 31.6% (Q1-Q3: –48.0% to –10.9% (P<.01). Basal and bolus insulin doses decreased proportionally, with a more precipitous decline during the first 6 months of tirzepatide therapy. The use of tirzepatide was associated with an improvement of cardiometabolic parameters. There was no increased incidence of hypoglycemia. The most common side effect was nausea (7, 13.7%).
Conclusion
Tirzepatide for the treatment of overweight and obesity in adults with T1D leads to substantial weight loss, improved diabetes control, and decreased insulin requirements, without worsening hypoglycemia. Future studies are needed to ascertain the long-term effect of tirzepatide in this population, ideally focusing on cardiovascular outcomes.
{"title":"Effect of Tirzepatide on Body Weight and Diabetes Control in Adults With Type 1 Diabetes and Overweight or Obesity","authors":"Rene Rivera Gutierrez MD , Elif Tama MD , Dima Bechenati MD , Regina Castañeda Hernandez MD , Pamela K. Bennett APRN, DNP , Allyson W. McNally APRN, DNP , Sima Fansa MD , Diego Anazco MD , Andres Acosta MD, PhD , Maria D. Hurtado Andrade MD, PhD","doi":"10.1016/j.mayocp.2024.07.006","DOIUrl":"10.1016/j.mayocp.2024.07.006","url":null,"abstract":"<div><h3>Objective</h3><div>To determine the effect of tirzepatide on weight, diabetes control, and insulin requirements, and its safety profile in adults with type 1 diabetes (T1D) and overweight or obesity.</div></div><div><h3>Patients and Methods</h3><div>This is a retrospective study of adults with T1D using tirzepatide for overweight/obesity treatment between June 1, 2022, and October 31, 2023<strong>,</strong> at Mayo Clinic. Fifty-one patients fulfilled inclusion and exclusion criteria (adults with established T1D diagnosis and a body mass index ≥27 kg/m<sup>2</sup> using tirzepatide for 3 months or longer and without a history of bariatric surgery or active malignancy). Data were collected from the electronic medical record and reported as median (Q1-Q3).</div></div><div><h3>Results</h3><div>Most individuals were female (30, 58.8%), White (49, 96.1%), and with obesity class III (21, 41.2%). During a median follow-up time of 8.0 (Q1-Q3: 4.0-10.0) months, the total body weight loss was 8.5% (Q1-Q3: 5.3%-13.8%) (<em>P</em><.01). At 12 months, total body weight loss was 12.2% (Q1-Q3: 7.3%-19.8%) (n=26). By the last follow-up, hemoglobin A<sub>1c</sub> decreased by 0.9% (Q1-Q3: 0.3%-1.1%) (<em>P</em><.0001) and daily insulin requirements by 31.6% (Q1-Q3: –48.0% to –10.9% (<em>P</em><.01). Basal and bolus insulin doses decreased proportionally, with a more precipitous decline during the first 6 months of tirzepatide therapy. The use of tirzepatide was associated with an improvement of cardiometabolic parameters. There was no increased incidence of hypoglycemia. The most common side effect was nausea (7, 13.7%).</div></div><div><h3>Conclusion</h3><div>Tirzepatide for the treatment of overweight and obesity in adults with T1D leads to substantial weight loss, improved diabetes control, and decreased insulin requirements, without worsening hypoglycemia. Future studies are needed to ascertain the long-term effect of tirzepatide in this population, ideally focusing on cardiovascular outcomes.</div></div>","PeriodicalId":18334,"journal":{"name":"Mayo Clinic proceedings","volume":"100 2","pages":"Pages 265-275"},"PeriodicalIF":6.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142730124","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.mayocp.2024.08.028
Chi-Yu Chen MD , Shao-Sung Huang MD , Shuo-Ming Ou MD, PhD , Yang Ho MD , Tz-Heng Chen MD , Kuo-Hua Lee MD , Yuan-Chia Chu PhD , Yao-Pin Lin MD, PhD , Wei-Cheng Tseng MD, PhD , Der-Cherng Tarng MD, PhD
Objective
To investigate how estimated glomerular filtration rate (eGFR) decline following sodium-glucose cotransporter-2 inhibitors (SGLT2i) initiation predicts long-term cardiorenal outcomes.
Methods
From 2016 to 2020, a longitudinal cohort of 4942 diabetic patients treated with SGLT2i were enrolled and followed until December 2021. Patients were categorized into mild (≤30%), moderate (>30%∼≤40%) and severe (>40%) decline groups by the maximal eGFR change between 2 to 12 weeks after SGLT2i treatment. Cox regression was used to explore the association between eGFR decline and risks of a composite outcome of all-cause mortality, major adverse cardiovascular events (MACE), and major adverse renal events (MARE) after comprehensively adjusting for clinical and laboratory confounders.
Results
After a median follow-up of 2.57 years, 125 deaths, 192 MACE, and 247 MARE occurred. Severe and moderate eGFR decline groups showed higher risks of composite outcome (severe adjusted hazard ratio [aHR], 4.56; 95% CI, 2.70 to 7.70; moderate aHR, 1.94; 95% CI, 1.17 to 3.24) and death (severe aHR, 3.54; 95% CI, 1.16 to 10.83; moderate aHR, 3.63; 95% CI, 1.22 to 10.77) vs mild decline group. The severe decline group also had higher MACE (aHR, 3.65; 95% CI, 1.76 to 7.59) and MARE (aHR, 4.94; 95% CI 2.71 to 9.01) risks, whereas the moderate decline group only demonstrated higher MARE risk (aHR, 2.25; 95% CI, 1.22 to 4.14). The results were consistent in restricted cubic spline and sensitivity analyses.
Conclusion
An excessive eGFR decline greater than 30% after SGLT2i initiation was progressively associated with higher hazards of major adverse cardiorenal events. Careful and vigilant surveillance with timely treatment in such patients are suggested.
{"title":"Excessive Initial Renal Function Decline Following Sodium-Glucose Cotransporter-2 Inhibitor Treatment Predicts Major Adverse Cardiorenal Outcomes","authors":"Chi-Yu Chen MD , Shao-Sung Huang MD , Shuo-Ming Ou MD, PhD , Yang Ho MD , Tz-Heng Chen MD , Kuo-Hua Lee MD , Yuan-Chia Chu PhD , Yao-Pin Lin MD, PhD , Wei-Cheng Tseng MD, PhD , Der-Cherng Tarng MD, PhD","doi":"10.1016/j.mayocp.2024.08.028","DOIUrl":"10.1016/j.mayocp.2024.08.028","url":null,"abstract":"<div><h3>Objective</h3><div>To investigate how estimated glomerular filtration rate (eGFR) decline following sodium-glucose cotransporter-2 inhibitors (SGLT2i) initiation predicts long-term cardiorenal outcomes.</div></div><div><h3>Methods</h3><div>From 2016 to 2020, a longitudinal cohort of 4942 diabetic patients treated with SGLT2i were enrolled and followed until December 2021. Patients were categorized into mild (≤30%), moderate (>30%∼≤40%) and severe (>40%) decline groups by the maximal eGFR change between 2 to 12 weeks after SGLT2i treatment. Cox regression was used to explore the association between eGFR decline and risks of a composite outcome of all-cause mortality, major adverse cardiovascular events (MACE), and major adverse renal events (MARE) after comprehensively adjusting for clinical and laboratory confounders.</div></div><div><h3>Results</h3><div>After a median follow-up of 2.57 years, 125 deaths, 192 MACE, and 247 MARE occurred. Severe and moderate eGFR decline groups showed higher risks of composite outcome (severe adjusted hazard ratio [aHR], 4.56; 95% CI, 2.70 to 7.70; moderate aHR, 1.94; 95% CI, 1.17 to 3.24) and death (severe aHR, 3.54; 95% CI, 1.16 to 10.83; moderate aHR, 3.63; 95% CI, 1.22 to 10.77) vs mild decline group. The severe decline group also had higher MACE (aHR, 3.65; 95% CI, 1.76 to 7.59) and MARE (aHR, 4.94; 95% CI 2.71 to 9.01) risks, whereas the moderate decline group only demonstrated higher MARE risk (aHR, 2.25; 95% CI, 1.22 to 4.14). The results were consistent in restricted cubic spline and sensitivity analyses.</div></div><div><h3>Conclusion</h3><div>An excessive eGFR decline greater than 30% after SGLT2i initiation was progressively associated with higher hazards of major adverse cardiorenal events. Careful and vigilant surveillance with timely treatment in such patients are suggested.</div></div>","PeriodicalId":18334,"journal":{"name":"Mayo Clinic proceedings","volume":"100 2","pages":"Pages 204-219"},"PeriodicalIF":6.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142965311","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.mayocp.2024.08.027
Thirusivapragasam Subramaniam MBBS , Joseph A. Dearani MD , John M. Stulak MD , Brian Lahr MS , Alex Lee BS , Jordan D. Miller PhD
Objective
To study the effectiveness of virtual reality (VR) in reducing anxiety levels in patients undergoing first-time sternotomy for cardiac surgery.
Patients and Methods
A total of 100 adult patients scheduled for cardiac surgery at Mayo Clinic in Rochester, Minnesota, USA, was recruited from April 19, 2022, to October 12, 2022. Before surgery, patients wore a physiological monitor to record vital signs. On the day of surgery, patients completed the State-Trait Anxiety Inventory (STAI) and were randomized into two groups: one receiving a tablet-based intervention (control) and the other an immersive VR experience in the preoperative holding area. After the interventions, patients repeated the state anxiety component of the STAI.
Results
The results showed that overall state anxiety scores decreased an average of 2.0 points with tablet treatment, but this change failed to reach statistical significance. However, 6 of 20 specific state anxiety features significantly improved with tablet treatment whereas 1 feature significantly worsened. With the VR experience, overall state anxiety scores were significantly reduced by an average of 2.9 points, with improvement in seven state anxiety features (three of which did not overlap with the tablet intervention). Despite a greater reduction in the STAI score with the VR experience, there were no significant differences in the anxiolytic responses between groups. Physiologically, both tablet and VR treatments slightly but significantly reduced pulse rate, with no difference between the groups.
Conclusion
Overall, the findings suggest that treatment of older adults with an immersive VR experience before cardiac surgery can significantly reduce overall anxiety. Further investigation determining how such interventions can be optimally implemented in surgical practices and whether such interventions reduce the need for anxiolytic medications and improve the overall patient experience is needed.
{"title":"A Randomized, Controlled Trial of In-Hospital Use of Virtual Reality to Reduce Preoperative Anxiety Prior to Cardiac Surgery","authors":"Thirusivapragasam Subramaniam MBBS , Joseph A. Dearani MD , John M. Stulak MD , Brian Lahr MS , Alex Lee BS , Jordan D. Miller PhD","doi":"10.1016/j.mayocp.2024.08.027","DOIUrl":"10.1016/j.mayocp.2024.08.027","url":null,"abstract":"<div><h3>Objective</h3><div>To study the effectiveness of virtual reality (VR) in reducing anxiety levels in patients undergoing first-time sternotomy for cardiac surgery.</div></div><div><h3>Patients and Methods</h3><div>A total of 100 adult patients scheduled for cardiac surgery at Mayo Clinic in Rochester, Minnesota, USA, was recruited from April 19, 2022, to October 12, 2022. Before surgery, patients wore a physiological monitor to record vital signs. On the day of surgery, patients completed the State-Trait Anxiety Inventory (STAI) and were randomized into two groups: one receiving a tablet-based intervention (control) and the other an immersive VR experience in the preoperative holding area. After the interventions, patients repeated the state anxiety component of the STAI.</div></div><div><h3>Results</h3><div>The results showed that overall state anxiety scores decreased an average of 2.0 points with tablet treatment, but this change failed to reach statistical significance. However, 6 of 20 specific state anxiety features significantly improved with tablet treatment whereas 1 feature significantly worsened. With the VR experience, overall state anxiety scores were significantly reduced by an average of 2.9 points, with improvement in seven state anxiety features (three of which did not overlap with the tablet intervention). Despite a greater reduction in the STAI score with the VR experience, there were no significant differences in the anxiolytic responses between groups. Physiologically, both tablet and VR treatments slightly but significantly reduced pulse rate, with no difference between the groups.</div></div><div><h3>Conclusion</h3><div>Overall, the findings suggest that treatment of older adults with an immersive VR experience before cardiac surgery can significantly reduce overall anxiety. Further investigation determining how such interventions can be optimally implemented in surgical practices and whether such interventions reduce the need for anxiolytic medications and improve the overall patient experience is needed.</div></div>","PeriodicalId":18334,"journal":{"name":"Mayo Clinic proceedings","volume":"100 2","pages":"Pages 220-234"},"PeriodicalIF":6.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142932295","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.mayocp.2024.11.020
Pannathat Soontrapa MD, Sarah E. Berini MD, Wilson I. Gonsalves MD, Ellen D. McPhail MD, JaNean K. Engelstad, Surendra Dasari PhD, Kathyrn L. Eschbacher MD, Christopher J. Klein MD, Peter J. Dyck MD, P. James B. Dyck MD
{"title":"A Distinctive Pattern of Pathologic Abnormality in Amyloid-like Monoclonal IgM Deposition Neuropathy","authors":"Pannathat Soontrapa MD, Sarah E. Berini MD, Wilson I. Gonsalves MD, Ellen D. McPhail MD, JaNean K. Engelstad, Surendra Dasari PhD, Kathyrn L. Eschbacher MD, Christopher J. Klein MD, Peter J. Dyck MD, P. James B. Dyck MD","doi":"10.1016/j.mayocp.2024.11.020","DOIUrl":"10.1016/j.mayocp.2024.11.020","url":null,"abstract":"","PeriodicalId":18334,"journal":{"name":"Mayo Clinic proceedings","volume":"100 2","pages":"Pages 390-393"},"PeriodicalIF":6.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143149129","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.mayocp.2024.10.004
Alexander R. Zheutlin MD, MS , Eric L. Stulberg MD, MPH , Alexander Chaitoff MD, MPH , Benjamin R.E. Harris MD
{"title":"County-Level Social Determinants of Health and Coronary Heart Disease: An Ecological Analysis of US Adults","authors":"Alexander R. Zheutlin MD, MS , Eric L. Stulberg MD, MPH , Alexander Chaitoff MD, MPH , Benjamin R.E. Harris MD","doi":"10.1016/j.mayocp.2024.10.004","DOIUrl":"10.1016/j.mayocp.2024.10.004","url":null,"abstract":"","PeriodicalId":18334,"journal":{"name":"Mayo Clinic proceedings","volume":"100 2","pages":"Pages 381-383"},"PeriodicalIF":6.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142979049","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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