Pub Date : 2024-06-25eCollection Date: 2024-06-01DOI: 10.31083/j.rcm2506230
Chen Wang, Gaoshuang Fu, Xinnan Wang, Ning Li
Heart failure (HF) is a complex, life-threatening condition characterized by high mortality, morbidity, and poor quality of life. Despite studies of epidemiology, pathogenesis, and therapies, the rate of HF hospitalization is still increasing due to the growing and aging population and an increase in obesity in relatively younger individuals. It remains a predominant issue in the public health and the global economic burden. Current research has focused on how HF affects the entire range of left ventricular ejection fraction (LVEF), especially the three HF subgroups. This review provides a latest overview of pharmacological and non-pharmacological strategies of these three subgroups (HF with preserved ejection fraction, HF with reduced ejection fraction, and HF with mildly reduced ejection fraction). We summarize conventional therapies, investigate novel strategies, and explore the new technologies such as aortic thoracic stimulation and interatrial shunting devices.
{"title":"Pharmacological and Non-Pharmacological Advancements in Heart Failure Treatment.","authors":"Chen Wang, Gaoshuang Fu, Xinnan Wang, Ning Li","doi":"10.31083/j.rcm2506230","DOIUrl":"10.31083/j.rcm2506230","url":null,"abstract":"<p><p>Heart failure (HF) is a complex, life-threatening condition characterized by high mortality, morbidity, and poor quality of life. Despite studies of epidemiology, pathogenesis, and therapies, the rate of HF hospitalization is still increasing due to the growing and aging population and an increase in obesity in relatively younger individuals. It remains a predominant issue in the public health and the global economic burden. Current research has focused on how HF affects the entire range of left ventricular ejection fraction (LVEF), especially the three HF subgroups. This review provides a latest overview of pharmacological and non-pharmacological strategies of these three subgroups (HF with preserved ejection fraction, HF with reduced ejection fraction, and HF with mildly reduced ejection fraction). We summarize conventional therapies, investigate novel strategies, and explore the new technologies such as aortic thoracic stimulation and interatrial shunting devices.</p>","PeriodicalId":20989,"journal":{"name":"Reviews in cardiovascular medicine","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11270106/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141793346","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-25eCollection Date: 2024-06-01DOI: 10.31083/j.rcm2506231
María M Adeva-Andany, Alberto Domínguez-Montero, Elvira Castro-Quintela, Raquel Funcasta-Calderón, Carlos Fernández-Fernández
Patients with obstructive sleep apnea (OSA) experience insulin resistance and its clinical consequences, including hypertriglyceridemia, reduced high density lipoprotein-associated cholesterol (HDL-c), visceral adiposity, hepatic steatosis, increased epicardial fat thickness, essential hypertension, glucose intolerance, increased risk for type 2 diabetes, chronic kidney disease, subclinical vascular damage, and increased risk for cardiovascular events. Obesity is a major contributor to OSA. The prevalence of OSA is almost universal among patients with severe obesity undergoing bariatric surgery. However, insulin resistance and its clinical complications occur in OSA patients irrespective of general obesity (body mass index). In OSA patients, apnea episodes during sleep induce oxyhemoglobin desaturation and tissue hypoxia. Insulin resistance is an adaptive response to tissue hypoxia and develops in conditions with limited tissue oxygen supply, including healthy subjects exposed to hypobaric hypoxia (high altitude) and OSA patients. Indicators of oxyhemoglobin desaturation have been robustly and independently linked to insulin resistance and its clinical manifestations in patients with OSA. Insulin resistance mediates the elevated rate of type 2 diabetes, chronic kidney disease, and cardiovascular disease unexplained with traditional cardiovascular risk factors present in OSA patients. Pathophysiological processes underlying hypoxia-induced insulin resistance involve hypoxia inducible factor-1 upregulation and peroxisome proliferator-activated receptor-gamma (PPAR- ) downregulation. In human adipose tissue, PPAR- activity promotes glucose transport into adipocytes, lipid droplet biogenesis, and whole-body insulin sensitivity. Silencing of PPAR- in the adipose tissue reduces glucose uptake and fat accumulation into adipocytes and promotes insulin resistance. In conclusion, tissue hypoxia drives insulin resistance and its clinical consequences in patients with OSA, regardless of body mass index.
阻塞性睡眠呼吸暂停(OSA)患者会出现胰岛素抵抗及其临床后果,包括高甘油三酯血症、高密度脂蛋白相关胆固醇(HDL-c)降低、内脏脂肪过多、肝脂肪变性、心外膜脂肪厚度增加、原发性高血压、葡萄糖不耐受、2 型糖尿病风险增加、慢性肾病、亚临床血管损伤以及心血管事件风险增加。肥胖是导致 OSA 的主要因素。在接受减肥手术的重度肥胖患者中,OSA 的发病率几乎是普遍的。然而,无论肥胖程度(体重指数)如何,OSA 患者都会出现胰岛素抵抗及其临床并发症。在 OSA 患者中,睡眠过程中的呼吸暂停会导致氧合血红蛋白不饱和和组织缺氧。胰岛素抵抗是对组织缺氧的一种适应性反应,会在组织供氧有限的条件下产生,包括暴露于低压缺氧(高海拔)环境中的健康人和 OSA 患者。氧合血红蛋白不饱和指标与胰岛素抵抗及其在 OSA 患者中的临床表现密切相关。胰岛素抵抗介导了 2 型糖尿病、慢性肾病和心血管疾病发病率的升高,而 OSA 患者身上存在的传统心血管风险因素无法解释其原因。缺氧诱导的胰岛素抵抗的病理生理过程包括缺氧诱导因子-1 的上调和过氧化物酶体增殖激活受体-γ(PPAR- γ)的下调。在人体脂肪组织中,PPAR- γ 的活性可促进葡萄糖转运到脂肪细胞、脂滴生物生成和全身胰岛素敏感性。沉默脂肪组织中的 PPAR- γ 可减少葡萄糖摄取和脂肪细胞中的脂肪积累,并促进胰岛素抵抗。总之,无论体重指数如何,组织缺氧都会导致 OSA 患者的胰岛素抵抗及其临床后果。
{"title":"Hypoxia-Induced Insulin Resistance Mediates the Elevated Cardiovascular Risk in Patients with Obstructive Sleep Apnea: A Comprehensive Review.","authors":"María M Adeva-Andany, Alberto Domínguez-Montero, Elvira Castro-Quintela, Raquel Funcasta-Calderón, Carlos Fernández-Fernández","doi":"10.31083/j.rcm2506231","DOIUrl":"10.31083/j.rcm2506231","url":null,"abstract":"<p><p>Patients with obstructive sleep apnea (OSA) experience insulin resistance and its clinical consequences, including hypertriglyceridemia, reduced high density lipoprotein-associated cholesterol (HDL-c), visceral adiposity, hepatic steatosis, increased epicardial fat thickness, essential hypertension, glucose intolerance, increased risk for type 2 diabetes, chronic kidney disease, subclinical vascular damage, and increased risk for cardiovascular events. Obesity is a major contributor to OSA. The prevalence of OSA is almost universal among patients with severe obesity undergoing bariatric surgery. However, insulin resistance and its clinical complications occur in OSA patients irrespective of general obesity (body mass index). In OSA patients, apnea episodes during sleep induce oxyhemoglobin desaturation and tissue hypoxia. Insulin resistance is an adaptive response to tissue hypoxia and develops in conditions with limited tissue oxygen supply, including healthy subjects exposed to hypobaric hypoxia (high altitude) and OSA patients. Indicators of oxyhemoglobin desaturation have been robustly and independently linked to insulin resistance and its clinical manifestations in patients with OSA. Insulin resistance mediates the elevated rate of type 2 diabetes, chronic kidney disease, and cardiovascular disease unexplained with traditional cardiovascular risk factors present in OSA patients. Pathophysiological processes underlying hypoxia-induced insulin resistance involve hypoxia inducible factor-1 upregulation and peroxisome proliferator-activated receptor-gamma (PPAR- <math><mi>γ</mi></math> ) downregulation. In human adipose tissue, PPAR- <math><mi>γ</mi></math> activity promotes glucose transport into adipocytes, lipid droplet biogenesis, and whole-body insulin sensitivity. Silencing of PPAR- <math><mi>γ</mi></math> in the adipose tissue reduces glucose uptake and fat accumulation into adipocytes and promotes insulin resistance. In conclusion, tissue hypoxia drives insulin resistance and its clinical consequences in patients with OSA, regardless of body mass index.</p>","PeriodicalId":20989,"journal":{"name":"Reviews in cardiovascular medicine","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11270082/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141793339","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-24eCollection Date: 2024-06-01DOI: 10.31083/j.rcm2506228
Sheng Su, Likun Zhou, Le Li, Zhuxin Zhang, Yulong Xiong, Zhenhao Zhang, Zhao Hu, Yan Yao
Backgrounds: Hematocrit is found an independent risk factor for acute kidney injury (AKI) in certain patients, but this effect in patients with acute myocardial infarction (AMI) is unclear. We aim to identify the relationship between hematocrit and AKI in patients with AMI.
Methods: The patient data for the discovery and validation cohorts were extracted from the electronic Intensive Care Unit database and the Medical Information Mart for Intensive Care III database, respectively, to identify the relationship between hematocrit and AKI. With normal hematocrit as the reference, patients were divided into five groups based on the initial hematocrit value. The primary outcome was AKI during hospitalization. A multivariable logistic regression and a marginal effect analysis were used to evaluate the relationship between hematocrit and AKI.
Results: In this study, a total of 9692 patients diagnosed with AMI were included, with 7712 patients in the discovery cohort and 1980 patients in the validation cohort. In the discovery cohort, hematocrit in 30-33%, 27-30% or 27% were independent risk factors for AKI in the multivariate logistic analysis, with odds ratio (OR) of 1.774 (95% confidence interval [CI]: 1.203-2.617, p = 0.004), 1.834 (95% CI: 1.136-2.961, p = 0.013) and 2.577 (95% CI: 1.510-4.397, p 0.001), respectively. Additionally, in the validation cohort, low hematocrit levels independently contributed to an increased risk of AKI among patients with AMI. During the analysis of marginal effects, a significant negative linear relationship between hematocrit levels and AKI was observed.
Conclusions: Decreased hematocrit was an independent risk factor for AKI in patients with AMI. The relationship between hematocrit and AKI was negative linear.
背景:血细胞比容是某些患者急性肾损伤(AKI)的独立危险因素,但在急性心肌梗死(AMI)患者中的影响尚不明确。我们旨在确定急性心肌梗死患者血细胞比容与急性肾损伤之间的关系:方法:分别从电子重症监护室数据库和重症监护医学信息市场 III 数据库中提取发现队列和验证队列的患者数据,以确定血细胞比容与 AKI 之间的关系。以正常血细胞比容为参照,根据初始血细胞比容值将患者分为五组。主要结果为住院期间的 AKI。采用多变量逻辑回归和边际效应分析来评估血细胞比容与 AKI 之间的关系:本研究共纳入 9692 例确诊为急性心肌梗死的患者,其中 7712 例患者为发现队列,1980 例患者为验证队列。在发现队列中,血细胞比容在 30-33%、27-30% 或 27% 是多变量逻辑分析中 AKI 的独立风险因素,其几率比(OR)分别为 1.774(95% 置信区间 [CI]:1.203-2.617,P = 0.004)、1.834(95% CI:1.136-2.961,P = 0.013)和 2.577(95% CI:1.510-4.397,P 0.001)。此外,在验证队列中,低血细胞比容水平是导致急性胰腺炎患者发生 AKI 风险增加的独立原因。在边际效应分析中,观察到血细胞比容水平与 AKI 之间存在显著的负线性关系:结论:血细胞比容降低是急性胰腺炎患者发生 AKI 的一个独立风险因素。结论:血细胞比容降低是急性心肌梗死患者发生 AKI 的独立风险因素,血细胞比容与 AKI 之间呈负线性关系。
{"title":"Association between Hematocrit and Acute Kidney Injury in Patients with Acute Myocardial Infarction.","authors":"Sheng Su, Likun Zhou, Le Li, Zhuxin Zhang, Yulong Xiong, Zhenhao Zhang, Zhao Hu, Yan Yao","doi":"10.31083/j.rcm2506228","DOIUrl":"10.31083/j.rcm2506228","url":null,"abstract":"<p><strong>Backgrounds: </strong>Hematocrit is found an independent risk factor for acute kidney injury (AKI) in certain patients, but this effect in patients with acute myocardial infarction (AMI) is unclear. We aim to identify the relationship between hematocrit and AKI in patients with AMI.</p><p><strong>Methods: </strong>The patient data for the discovery and validation cohorts were extracted from the electronic Intensive Care Unit database and the Medical Information Mart for Intensive Care III database, respectively, to identify the relationship between hematocrit and AKI. With normal hematocrit as the reference, patients were divided into five groups based on the initial hematocrit value. The primary outcome was AKI during hospitalization. A multivariable logistic regression and a marginal effect analysis were used to evaluate the relationship between hematocrit and AKI.</p><p><strong>Results: </strong>In this study, a total of 9692 patients diagnosed with AMI were included, with 7712 patients in the discovery cohort and 1980 patients in the validation cohort. In the discovery cohort, hematocrit in 30-33%, 27-30% or <math><mo><</mo></math> 27% were independent risk factors for AKI in the multivariate logistic analysis, with odds ratio (OR) of 1.774 (95% confidence interval [CI]: 1.203-2.617, <i>p</i> = 0.004), 1.834 (95% CI: 1.136-2.961, <i>p</i> = 0.013) and 2.577 (95% CI: 1.510-4.397, <i>p</i> <math><mo><</mo></math> 0.001), respectively. Additionally, in the validation cohort, low hematocrit levels independently contributed to an increased risk of AKI among patients with AMI. During the analysis of marginal effects, a significant negative linear relationship between hematocrit levels and AKI was observed.</p><p><strong>Conclusions: </strong>Decreased hematocrit was an independent risk factor for AKI in patients with AMI. The relationship between hematocrit and AKI was negative linear.</p>","PeriodicalId":20989,"journal":{"name":"Reviews in cardiovascular medicine","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11270070/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141793335","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Peripheral artery disease (PAD) is recognized as a significant contributor to the public health burden in the cardiovascular field and has a significant rate of morbidity and mortality. In the intermediate stages, exercise therapy is recommended by the guidelines, although supervised programs are scarcely available. This single-center observational study aimed to evaluate the long-term outcomes of patients with PAD and claudication receiving optimal medical care and follow-up or revascularization procedures or structured home-based exercise.
Methods: The records of 1590 PAD patients with claudication were assessed at the Vascular Surgery Unit between 2008 and 2017. Based on the findings of the recruitment visit, patients were assigned to one of the three following groups according to the available guidelines: Revascularization (Rev), structured exercise therapy (Ex), or control (Co). The exercise program was prescribed at the hospital and executed at home with two daily 10-minute interval walking sessions at a pain-free speed. The number and date of deaths, all-cause hospitalizations, and peripheral revascularizations for 5 years were collected from the Emilia-Romagna regional database.
Results: At entry, 137 patients underwent revascularization; 1087 patients were included in the Ex group, and 366 were included in the Co group. At baseline, patients in the Rev group were significantly younger and had fewer comorbidities (p 0.001). A propensity score matching analysis was performed, and three balanced subgroups of 119 patients were each created. The mortality rate was significantly (p 0.001) greater in the Co (45%) group than in the Rev (11%) and Ex (11%) groups, as was the incidence of all-cause hospitalizations (Co: 95%; Rev 56%; Ex 60%; p 0.001). There were no differences in peripheral revascularizations (Co: 19%; Rev: 17%; Ex 11%).
Conclusions: In PAD patients with claudication, both revascularization procedures and structured home-based exercise sessions are associated with better long-term clinical outcomes than walking advice and follow-up only.
背景:外周动脉疾病(PAD)被认为是心血管领域公共卫生负担的一个重要因素,其发病率和死亡率都很高。在疾病的中期阶段,指南推荐进行运动疗法,但目前很少有指导性计划。这项单中心观察性研究旨在评估PAD和跛行患者接受最佳医疗护理和随访、血管重建手术或有组织的家庭锻炼后的长期疗效:2008年至2017年间,血管外科对1590名伴有跛行的PAD患者的病历进行了评估。根据招募访问的结果,按照现有指南将患者分配到以下三组中的一组:血管重建组(Rev)、结构化运动疗法组(Ex)或对照组(Co)。患者在医院接受运动治疗,并在家中以无痛的速度进行每天两次、每次 10 分钟的间歇性步行。研究人员从艾米利亚-罗马涅地区数据库中收集了5年内死亡、全因住院和外周血管再造的人数和日期:入组时,137 名患者接受了血管再通手术;1087 名患者被纳入 Ex 组,366 名患者被纳入 Co 组。基线时,Rev 组患者明显更年轻,合并症更少(P 0.001)。进行倾向评分匹配分析后,创建了三个平衡亚组,每组 119 名患者。Co组的死亡率(45%)明显高于Rev组(11%)和Ex组(11%)(P 0.001),全因住院率也是如此(Co:95%;Rev:56%;Ex:60%;P 0.001)。外周血管再通率没有差异(Co:19%;Rev:17%;Ex:11%):结论:对于有跛行的 PAD 患者,血管再通手术和有组织的家庭锻炼课程与仅步行建议和随访相比,具有更好的长期临床疗效。
{"title":"To Treat or not to Treat? The Fate of Patients with Intermittent Claudication Following Different Therapeutic Options.","authors":"Elpiniki Tsolaki, Luca Traina, Caterina Savriè, Franco Guerzoni, Nicola Napoli, Roberto Manfredini, Maria Cristina Taddia, Fabio Manfredini, Nicola Lamberti","doi":"10.31083/j.rcm2506229","DOIUrl":"10.31083/j.rcm2506229","url":null,"abstract":"<p><strong>Background: </strong>Peripheral artery disease (PAD) is recognized as a significant contributor to the public health burden in the cardiovascular field and has a significant rate of morbidity and mortality. In the intermediate stages, exercise therapy is recommended by the guidelines, although supervised programs are scarcely available. This single-center observational study aimed to evaluate the long-term outcomes of patients with PAD and claudication receiving optimal medical care and follow-up or revascularization procedures or structured home-based exercise.</p><p><strong>Methods: </strong>The records of 1590 PAD patients with claudication were assessed at the Vascular Surgery Unit between 2008 and 2017. Based on the findings of the recruitment visit, patients were assigned to one of the three following groups according to the available guidelines: Revascularization (Rev), structured exercise therapy (Ex), or control (Co). The exercise program was prescribed at the hospital and executed at home with two daily 10-minute interval walking sessions at a pain-free speed. The number and date of deaths, all-cause hospitalizations, and peripheral revascularizations for 5 years were collected from the Emilia-Romagna regional database.</p><p><strong>Results: </strong>At entry, 137 patients underwent revascularization; 1087 patients were included in the Ex group, and 366 were included in the Co group. At baseline, patients in the Rev group were significantly younger and had fewer comorbidities (<i>p</i> <math><mo><</mo></math> 0.001). A propensity score matching analysis was performed, and three balanced subgroups of 119 patients were each created. The mortality rate was significantly (<i>p</i> <math><mo><</mo></math> 0.001) greater in the Co (45%) group than in the Rev (11%) and Ex (11%) groups, as was the incidence of all-cause hospitalizations (Co: 95%; Rev 56%; Ex 60%; <i>p</i> <math><mo><</mo></math> 0.001). There were no differences in peripheral revascularizations (Co: 19%; Rev: 17%; Ex 11%).</p><p><strong>Conclusions: </strong>In PAD patients with claudication, both revascularization procedures and structured home-based exercise sessions are associated with better long-term clinical outcomes than walking advice and follow-up only.</p>","PeriodicalId":20989,"journal":{"name":"Reviews in cardiovascular medicine","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11270107/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141793353","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-24eCollection Date: 2024-06-01DOI: 10.31083/j.rcm2506227
Chu Fan, Hangyu Yan, Kehang Lei, Xuepeng Li, Dan Li, Shutong Dong, Yue Zhang, Yutong Cheng, Zhao Li, Nan Li, Zhizhong Li, Ji Huang
Background: Tai Chi is an increasingly utilized aerobic rehabilitation exercise in the field of cardiovascular disease (CVD). However, there remains debate regarding its effects on physiological function and mental health in patients with coronary heart disease (CHD). This study aims to investigate the impact of Tai Chi-based rehabilitation exercises on physical and psychological health outcomes for CHD patients.
Methods: By collecting data from 12 databases up to December 2022, we conducted a meta-analysis of randomized controlled trials (RCTs) to evaluate the effects of Tai Chi on the physical function and psychological health among CHD patients.
Results: We analyzed twenty qualified studies involving 2095 patients. Meta-analyses revealed that compared with conventional therapy groups, those who participated in Tai Chi-based interventions demonstrated significant improvements in physical function as measured by six-minute walk test (6MWT) [mean difference (MD) = 56.40, 95% confidence interval (CI) (38.50, 74.29), p 0.01], maximal oxygen consumption ( max) [standardized mean difference (SMD) = 0. 57, 95% CI (0.12, 1.03), p = 0.01], New York Heart Association (NYHA) class [relative risk (RR) = 1.34, 95% CI (1.18, 1.53), p 0.01] and physical health components (PHC) [SMD = 1.23, 95% CI (0.76, 1.69), p 0.01]. Additionally, Tai Chi participants showed greater improvement than control groups across various psychological parameters including anxiety scales [SMD = -0.80, 95% CI (-1.33, -0.28), p = 0.003], depression scales [SMD = -0.77, 95% CI (-1.32, -0.23), p = 0.005] and mental health components (MHC) [SMD = 1.27, 95% CI (0.76, -1.78), p 0.01]. The GRADEpro (Grade Guideline Development Tool) indicated evidence levels ranging from very low to moderate.
Conclusions: The present meta-analysis demonstrates that mind-body rehabilitation exercises based on Tai Chi can improve both physical and psychological health outcomes for CHD patients. These findings suggest that this exercise pattern may be a potential option for cardiovascular rehabilitation.
Prospero registration: The protocol for this systematic review and meta-analysis has been registered with PROSPERO International Prospective Systematic Reviews (No: CRD42022370021, http://www.crd.york.ac.uk/PROSPERO).
{"title":"Effect of Tai Chi-Based Psychosomatic Rehabilitation Exercise on Physiological Function and Mental Health of Patients with Coronary Heart Disease: A Meta-Analysis.","authors":"Chu Fan, Hangyu Yan, Kehang Lei, Xuepeng Li, Dan Li, Shutong Dong, Yue Zhang, Yutong Cheng, Zhao Li, Nan Li, Zhizhong Li, Ji Huang","doi":"10.31083/j.rcm2506227","DOIUrl":"10.31083/j.rcm2506227","url":null,"abstract":"<p><strong>Background: </strong>Tai Chi is an increasingly utilized aerobic rehabilitation exercise in the field of cardiovascular disease (CVD). However, there remains debate regarding its effects on physiological function and mental health in patients with coronary heart disease (CHD). This study aims to investigate the impact of Tai Chi-based rehabilitation exercises on physical and psychological health outcomes for CHD patients.</p><p><strong>Methods: </strong>By collecting data from 12 databases up to December 2022, we conducted a meta-analysis of randomized controlled trials (RCTs) to evaluate the effects of Tai Chi on the physical function and psychological health among CHD patients.</p><p><strong>Results: </strong>We analyzed twenty qualified studies involving 2095 patients. Meta-analyses revealed that compared with conventional therapy groups, those who participated in Tai Chi-based interventions demonstrated significant improvements in physical function as measured by six-minute walk test (6MWT) [mean difference (MD) = 56.40, 95% confidence interval (CI) (38.50, 74.29), <i>p</i> <math><mo><</mo></math> 0.01], maximal oxygen consumption ( <math><msub><mi>VO</mi> <mn>2</mn></msub> </math> max) [standardized mean difference (SMD) = 0. 57, 95% CI (0.12, 1.03), <i>p</i> = 0.01], New York Heart Association (NYHA) class [relative risk (RR) = 1.34, 95% CI (1.18, 1.53), <i>p</i> <math><mo><</mo></math> 0.01] and physical health components (PHC) [SMD = 1.23, 95% CI (0.76, 1.69), <i>p</i> <math><mo><</mo></math> 0.01]. Additionally, Tai Chi participants showed greater improvement than control groups across various psychological parameters including anxiety scales [SMD = -0.80, 95% CI (-1.33, -0.28), <i>p</i> = 0.003], depression scales [SMD = -0.77, 95% CI (-1.32, -0.23), <i>p</i> = 0.005] and mental health components (MHC) [SMD = 1.27, 95% CI (0.76, -1.78), <i>p</i> <math><mo><</mo></math> 0.01]. The GRADEpro (Grade Guideline Development Tool) indicated evidence levels ranging from very low to moderate.</p><p><strong>Conclusions: </strong>The present meta-analysis demonstrates that mind-body rehabilitation exercises based on Tai Chi can improve both physical and psychological health outcomes for CHD patients. These findings suggest that this exercise pattern may be a potential option for cardiovascular rehabilitation.</p><p><strong>Prospero registration: </strong>The protocol for this systematic review and meta-analysis has been registered with PROSPERO International Prospective Systematic Reviews (No: CRD42022370021, http://www.crd.york.ac.uk/PROSPERO).</p>","PeriodicalId":20989,"journal":{"name":"Reviews in cardiovascular medicine","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11270087/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141793320","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-21eCollection Date: 2024-06-01DOI: 10.31083/j.rcm2506226
Meng Yuan, Lei Zhong, Jie Min, Jianhong Lu, Lili Ye, Qikai Shen, Beiping Hu, Haiying Sheng
Background: Cardiogenic shock (CS) is a critical illness with a high mortality rate in clinical practice. Although some biomarkers have been found to be associated with mortality in patients suffering from CS in previous studies. The albumin-corrected anion gap (ACAG) has not been studied in depth. Our study aimed to explore the relationship between ACAG and mortality in patients with CS.
Methods: All baseline data was extracted from Medical Information Mart for Intensive Care-IV version: 2.0 (MIMIC-IV). According to the prognosis at 30 days of follow-up, they were divided into survivors and non-survivors groups. The survival curves between the two groups were drawn using the Kaplan-Meier method and the log-rank test. Valid factors were selected using the least absolute shrinkage and selection operator (LASSO) logistic analysis model. Analysis was performed to investigate the relationship between mortality and all enrolled patients using restricted cubic spline (RCS) and Cox proportional hazards models. Receiver operating characteristic (ROC) curves were used to assess the predictive ability of ACAG. Evaluation of final result stability using sensitivity analysis.
Results: 839 cases were selected to meet the inclusion criteria and categorized into survivors and non-survivors groups in the final analysis. The ACAG value measured for the first time at the time of admission was selected as the research object. Kaplan-Meier (K-M) survival curves showed that cumulative 30- and 90-day survival decreased progressively with elevated ACAG (p 0.001), and multifactorial Cox regression analyses showed ACAG to be an independent risk factor for increased 30- and 90-day mortality in patients suffering from CS (p 0.05). RCS curves revealed that all-cause mortality in this group of patients increased with increasing ACAG ( 2 = 5.830, p = 0.120). The ROC curve showed that the best cutoff value for ACAG for predicting 30-day mortality in patients with CS was 22.625, with a sensitivity of 44.0% and a specificity of 74.7%. The relationship between ACAG and CS short-term mortality remained stable in all sensitivity analyses (All p 0.05).
Conclusions: The ACAG is an independent risk factor for 30- and 90-day mortality in CS patients and predicts poor clinical outcomes in CS patients. According to our study, elevated ACAG at admission, especially when ACAG 20 mmol/L, was an independent predictor of all-cause mortality in CS.
{"title":"Association between Albumin-Corrected Anion Gap and Mortality in Patients with Cardiogenic Shock.","authors":"Meng Yuan, Lei Zhong, Jie Min, Jianhong Lu, Lili Ye, Qikai Shen, Beiping Hu, Haiying Sheng","doi":"10.31083/j.rcm2506226","DOIUrl":"10.31083/j.rcm2506226","url":null,"abstract":"<p><strong>Background: </strong>Cardiogenic shock (CS) is a critical illness with a high mortality rate in clinical practice. Although some biomarkers have been found to be associated with mortality in patients suffering from CS in previous studies. The albumin-corrected anion gap (ACAG) has not been studied in depth. Our study aimed to explore the relationship between ACAG and mortality in patients with CS.</p><p><strong>Methods: </strong>All baseline data was extracted from Medical Information Mart for Intensive Care-IV version: 2.0 (MIMIC-IV). According to the prognosis at 30 days of follow-up, they were divided into survivors and non-survivors groups. The survival curves between the two groups were drawn using the Kaplan-Meier method and the log-rank test. Valid factors were selected using the least absolute shrinkage and selection operator (LASSO) logistic analysis model. Analysis was performed to investigate the relationship between mortality and all enrolled patients using restricted cubic spline (RCS) and Cox proportional hazards models. Receiver operating characteristic (ROC) curves were used to assess the predictive ability of ACAG. Evaluation of final result stability using sensitivity analysis.</p><p><strong>Results: </strong>839 cases were selected to meet the inclusion criteria and categorized into survivors and non-survivors groups in the final analysis. The ACAG value measured for the first time at the time of admission was selected as the research object. Kaplan-Meier (K-M) survival curves showed that cumulative 30- and 90-day survival decreased progressively with elevated ACAG (<i>p</i> <math><mo><</mo></math> 0.001), and multifactorial Cox regression analyses showed ACAG to be an independent risk factor for increased 30- and 90-day mortality in patients suffering from CS (<i>p</i> <math><mo><</mo></math> 0.05). RCS curves revealed that all-cause mortality in this group of patients increased with increasing ACAG ( <math><mi>χ</mi></math> <sup>2</sup> = 5.830, <i>p</i> = 0.120). The ROC curve showed that the best cutoff value for ACAG for predicting 30-day mortality in patients with CS was 22.625, with a sensitivity of 44.0% and a specificity of 74.7%. The relationship between ACAG and CS short-term mortality remained stable in all sensitivity analyses (All <i>p</i> <math><mo><</mo></math> 0.05).</p><p><strong>Conclusions: </strong>The ACAG is an independent risk factor for 30- and 90-day mortality in CS patients and predicts poor clinical outcomes in CS patients. According to our study, elevated ACAG at admission, especially when ACAG <math><mo>></mo></math> 20 mmol/L, was an independent predictor of all-cause mortality in CS.</p>","PeriodicalId":20989,"journal":{"name":"Reviews in cardiovascular medicine","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-06-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11270101/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141793333","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-20eCollection Date: 2024-06-01DOI: 10.31083/j.rcm2506224
Bahadır Aytekin, Serkan Mola, Gökay Deniz, Sinan Özçelik, Hakkı Zafer İşcan
Background: The funnel technique, the hybrid assembly of a thoracic and abdominal aortic endograft, is advantageous for frail patients where efficient oversizing is not possible for infrarenal wide aortic necks over 34 mm. We sought to determine the advantages and disadvantages of the Funnel-endovascular aneurysm repair (EVAR) technique using 60 mm length thoracic endograft.
Methods: This retrospective study included 22 patients, all frail with high comorbidities, who were operated on with the Funnel technique using the 60 mm Lifetech Ankura thoracic endograft, in 7 urgent and 15 elective cases from January 2018. There were no exclusion criteria except having an age 60 years. Primary endpoints were the technical success and early mortality and morbidity; secondary endpoints were late outcomes such as endoleak, migration, late open surgical conversion, successful sac shrinkage, and enlargement at the infrarenal aortic neck diameter.
Results: The patients' mean age was 72.6 7.3 years (62-86 years), with a mean aneurysm diameter of 83.2 16.8 mm and mean infrarenal aortic diameter of 38.7 2.4 mm. There was no early mortality. Technical success was 100%. 21 standard bifurcated and one aorto-uni-iliac abdominal endograft were deployed. The mean fluoroscopy time was 14.3 5.2 minutes. Mean follow-up was 32.8 19.6 months, with no endovascular complications. There was no Type-1a or Type-3 endoleak, migration, infrarenal aortic neck diameter enlargement, or aneurysm sac enlargement. During the follow-up, three patients died, but there was no aneurysm-related mortality.
Conclusions: Funnel-EVAR is effective and safe for patients with a wide infrarenal aortic neck diameter when assessing midterm outcomes. Therefore, it should be part of the armamentarium of a vascular surgeon in patients with wide aortic necks 34 mm.
{"title":"Midterm Outcomes for Funnel-EVAR.","authors":"Bahadır Aytekin, Serkan Mola, Gökay Deniz, Sinan Özçelik, Hakkı Zafer İşcan","doi":"10.31083/j.rcm2506224","DOIUrl":"10.31083/j.rcm2506224","url":null,"abstract":"<p><strong>Background: </strong>The funnel technique, the hybrid assembly of a thoracic and abdominal aortic endograft, is advantageous for frail patients where efficient oversizing is not possible for infrarenal wide aortic necks over 34 mm. We sought to determine the advantages and disadvantages of the Funnel-endovascular aneurysm repair (EVAR) technique using 60 mm length thoracic endograft.</p><p><strong>Methods: </strong>This retrospective study included 22 patients, all frail with high comorbidities, who were operated on with the Funnel technique using the 60 mm Lifetech Ankura thoracic endograft, in 7 urgent and 15 elective cases from January 2018. There were no exclusion criteria except having an age <math><mo><</mo></math> 60 years. Primary endpoints were the technical success and early mortality and morbidity; secondary endpoints were late outcomes such as endoleak, migration, late open surgical conversion, successful sac shrinkage, and enlargement at the infrarenal aortic neck diameter.</p><p><strong>Results: </strong>The patients' mean age was 72.6 <math><mo>±</mo></math> 7.3 years (62-86 years), with a mean aneurysm diameter of 83.2 <math><mo>±</mo></math> 16.8 mm and mean infrarenal aortic diameter of 38.7 <math><mo>±</mo></math> 2.4 mm. There was no early mortality. Technical success was 100%. 21 standard bifurcated and one aorto-uni-iliac abdominal endograft were deployed. The mean fluoroscopy time was 14.3 <math><mo>±</mo></math> 5.2 minutes. Mean follow-up was 32.8 <math><mo>±</mo></math> 19.6 months, with no endovascular complications. There was no Type-1a or Type-3 endoleak, migration, infrarenal aortic neck diameter enlargement, or aneurysm sac enlargement. During the follow-up, three patients died, but there was no aneurysm-related mortality.</p><p><strong>Conclusions: </strong>Funnel-EVAR is effective and safe for patients with a wide infrarenal aortic neck diameter when assessing midterm outcomes. Therefore, it should be part of the armamentarium of a vascular surgeon in patients with wide aortic necks <math><mo>></mo></math> 34 mm.</p>","PeriodicalId":20989,"journal":{"name":"Reviews in cardiovascular medicine","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11270054/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141793343","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-20eCollection Date: 2024-06-01DOI: 10.31083/j.rcm2506225
Ali Amr, Elham Kayvanpour, Christoph Reich, Jan Koelemen, Shamily Asokan, Norbert Frey, Benjamin Meder, Farbod Sedaghat-Hamedani
Background: Cardiac myosin inhibitors (CMIs), including Mavacamten and Aficamten, have emerged as a groundbreaking treatment for hypertrophic cardiomyopathy (HCM). The results from phase 2 and 3 randomized clinical trials for both drugs have showed promising outcomes. However, the highly selective patient recruitment for these trials raises questions about the generalizability of the observed positive effects across broader patient populations suffering from HCM.
Methods: A retrospective cohort study at University Hospital Heidelberg included 404 HCM patients. Baseline assessments included family history, electrocardiograms (ECGs), and advanced cardiac imaging, to ensure the exclusion of secondary causes of left ventricular hypertrophy.
Results: Among the HCM patients evaluated, only a small percentage met the inclusion criteria for recent CMI trials: 10.4% for EXPLORER-HCM and 4.7% for SEQUOIA-HCM. The predominant exclusion factor was the stringent left ventricular outflow tract (LVOT) gradient requirement.
Conclusions: This study highlights a significant discrepancy between patient demographics in clinical trials and those encountered in routine HCM clinical practice. Despite promising results from the initial randomized clinical trials that led to the approval of Mavacamten, the selected patient population only represents a small part of the HCM patient cohort seen in routine clinics. This study advocates for further expanded randomized clinical trials with broader inclusion criteria to represent diverse primary HCM patient populations.
{"title":"Assessing the Applicability of Cardiac Myosin Inhibitors for Hypertrophic Cardiomyopathy Management in a Large Single Center Cohort.","authors":"Ali Amr, Elham Kayvanpour, Christoph Reich, Jan Koelemen, Shamily Asokan, Norbert Frey, Benjamin Meder, Farbod Sedaghat-Hamedani","doi":"10.31083/j.rcm2506225","DOIUrl":"10.31083/j.rcm2506225","url":null,"abstract":"<p><strong>Background: </strong>Cardiac myosin inhibitors (CMIs), including Mavacamten and Aficamten, have emerged as a groundbreaking treatment for hypertrophic cardiomyopathy (HCM). The results from phase 2 and 3 randomized clinical trials for both drugs have showed promising outcomes. However, the highly selective patient recruitment for these trials raises questions about the generalizability of the observed positive effects across broader patient populations suffering from HCM.</p><p><strong>Methods: </strong>A retrospective cohort study at University Hospital Heidelberg included 404 HCM patients. Baseline assessments included family history, electrocardiograms (ECGs), and advanced cardiac imaging, to ensure the exclusion of secondary causes of left ventricular hypertrophy.</p><p><strong>Results: </strong>Among the HCM patients evaluated, only a small percentage met the inclusion criteria for recent CMI trials: 10.4% for EXPLORER-HCM and 4.7% for SEQUOIA-HCM. The predominant exclusion factor was the stringent left ventricular outflow tract (LVOT) gradient requirement.</p><p><strong>Conclusions: </strong>This study highlights a significant discrepancy between patient demographics in clinical trials and those encountered in routine HCM clinical practice. Despite promising results from the initial randomized clinical trials that led to the approval of Mavacamten, the selected patient population only represents a small part of the HCM patient cohort seen in routine clinics. This study advocates for further expanded randomized clinical trials with broader inclusion criteria to represent diverse primary HCM patient populations.</p>","PeriodicalId":20989,"journal":{"name":"Reviews in cardiovascular medicine","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11270100/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141793332","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-20eCollection Date: 2024-06-01DOI: 10.31083/j.rcm2506223
Andrea Messori, Sabrina Trippoli, Maria Rita Romeo, Valeria Fadda, Melania Rivano, Lorenzo Di Spazio
Background: The reconstruction of individual patient data from published Kaplan-Meier survival curves is a new technique (often denoted as the IPDfromKM method) for studying efficacy in cases where multiple trials are available, and the endpoint is long-term mortality. In patients with tricuspid regurgitation, both valve repair and valve replacement have been proposed to improve prognosis; 6 controlled clinical trials (CTs) have been conducted to compare the two therapeutic options mentioned above. The objective of our analysis was to study these six trials through the application of the IPDfromKM method.
Methods: In the present report, we applied the IPDfromKM method to carry out a pooled analysis of these 6 CTs to investigate the effectiveness of valve repair vs valve replacement and to assess the between-study heterogeneity from this clinical material. After reconstructing individual patient data from these 6 trials, patients treated with valve repair were pooled together and their Kaplan-Meier curve was generated. Likewise, patients treated with valve replacement were pooled together and their Kaplan-Meier curve was generated. Finally, these two curves were compared by standard survival statistics. The hazard ratio (HR) was determined; death from any cause was the endpoint.
Results: These 6 CTs included a total of 552 patients; in each of these CTs, the patient group treated with valve repair was compared with another group treated with valve replacement. Our statistical results showed a significantly better survival for valve repair compared with valve replacement (HR, 0.6098; 95% confidence intervals (CI), 0.445 to 0.835; p = 0.002). Heterogeneity was found to be significant in the 6 patient arms undergoing replacement, but not in those undergoing valve repair. In valve replacement, the classification of patients in class III or IV of New York Heart Association (NYHA) was the main negative prognostic factor.
Conclusions: Our analysis confirmed the methodological advantages of the IPDfromKM method in the indirect comparative analysis of multiple trials. These advantages include appropriate analysis of censored patients, original assessment of heterogeneity, and graphical presentation of the results, wherein individual patients retain an important role.
{"title":"Studying the Outcomes in Patients with Tricuspid Regurgitation Treated with Valve Repair or Valve Replacement: Interpreting the Survival Pattern on The Long Term by Application of Artificial Intelligence Methods.","authors":"Andrea Messori, Sabrina Trippoli, Maria Rita Romeo, Valeria Fadda, Melania Rivano, Lorenzo Di Spazio","doi":"10.31083/j.rcm2506223","DOIUrl":"10.31083/j.rcm2506223","url":null,"abstract":"<p><strong>Background: </strong>The reconstruction of individual patient data from published Kaplan-Meier survival curves is a new technique (often denoted as the IPDfromKM method) for studying efficacy in cases where multiple trials are available, and the endpoint is long-term mortality. In patients with tricuspid regurgitation, both valve repair and valve replacement have been proposed to improve prognosis; 6 controlled clinical trials (CTs) have been conducted to compare the two therapeutic options mentioned above. The objective of our analysis was to study these six trials through the application of the IPDfromKM method.</p><p><strong>Methods: </strong>In the present report, we applied the IPDfromKM method to carry out a pooled analysis of these 6 CTs to investigate the effectiveness of valve repair vs valve replacement and to assess the between-study heterogeneity from this clinical material. After reconstructing individual patient data from these 6 trials, patients treated with valve repair were pooled together and their Kaplan-Meier curve was generated. Likewise, patients treated with valve replacement were pooled together and their Kaplan-Meier curve was generated. Finally, these two curves were compared by standard survival statistics. The hazard ratio (HR) was determined; death from any cause was the endpoint.</p><p><strong>Results: </strong>These 6 CTs included a total of 552 patients; in each of these CTs, the patient group treated with valve repair was compared with another group treated with valve replacement. Our statistical results showed a significantly better survival for valve repair compared with valve replacement (HR, 0.6098; 95% confidence intervals (CI), 0.445 to 0.835; <i>p</i> = 0.002). Heterogeneity was found to be significant in the 6 patient arms undergoing replacement, but not in those undergoing valve repair. In valve replacement, the classification of patients in class III or IV of New York Heart Association (NYHA) was the main negative prognostic factor.</p><p><strong>Conclusions: </strong>Our analysis confirmed the methodological advantages of the IPDfromKM method in the indirect comparative analysis of multiple trials. These advantages include appropriate analysis of censored patients, original assessment of heterogeneity, and graphical presentation of the results, wherein individual patients retain an important role.</p>","PeriodicalId":20989,"journal":{"name":"Reviews in cardiovascular medicine","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11270104/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141793351","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-19eCollection Date: 2024-06-01DOI: 10.31083/j.rcm2506220
Reinaldo B Bestetti, Marcelo José Ferreira Soares, Rosemary Furlan-Daniel, Augusto Cardinalli-Neto, Marcelo A Nakazone
Pulmonary thromboembolism (PE) is a potential major complication in patients with chronic Chagas heart disease (CChD). The source of PE is the right-sided chambers instead of deep vein thrombosis. Little is known regarding risk factors, clinical picture, and the clinical course of patients with PE secondary to CChD. The aim of this review was to try to provide doctors with such data. We searched for papers related to PE in CChD patients in the PUBMED from 1955 to 2020. Twenty-six manuscripts were retrieved, of which 12 fulfilled entry criteria and were included in the study. Right-sided cardiac thrombosis or PE was confirmed on morphological or imaging studies. A total of 431 patients with PE were reported. Age varied from 30 to 85 years. About 332 patients were reported to have chronic heart failure (CHF), whereas 41 (9%) sudden cardiac death (SCD) at autopsy. Clinical manifestations reported were sudden onset dyspnea was found in 1 patient, haemoptysis in 2, worsening CHF in 2, and chest pain in 1. An X-ray chest was reported for 6 patients: abnormalities consistent with PE were found in 3. The resting electrocardiogram (ECG) was reported for 5 patients: it was abnormal in all. One study reported a mean left ventricular ejection fraction of 42.1 18.7%. The prevalence of right-sided cardiac thrombosis varied from 66% to 85% patients. PE was the cause of death in 17% of patients. The clinical diagnosis of PE in patients with Chagas cardiomyopathy (ChCM) is very difficult in the absence of a prediction score that performs well. However, in the presence of haemoptysis or worsening heart failure (HF), abnormal ECG, or chest X-ray, the diagnosis of PE should be raised, and patients promptly referred to detailed Doppler Tissue Echocardiography and computed tomography angiography, and treated in a timely manner.
肺血栓栓塞症(PE)是慢性恰加斯心脏病(CChD)患者潜在的主要并发症。肺血栓栓塞症的来源是右侧心腔,而不是深静脉血栓形成。人们对继发于南美锥虫病的 PE 患者的危险因素、临床表现和临床过程知之甚少。本综述旨在为医生提供此类数据。我们在 PUBMED 上搜索了 1955 年至 2020 年间与 CChD 患者 PE 相关的论文。共检索到 26 篇手稿,其中 12 篇符合入选标准,被纳入本研究。右侧心脏血栓或 PE 经形态学或影像学研究证实。共报告了 431 例 PE 患者。年龄从 30 岁到 85 岁不等。据报告,约 332 名患者患有慢性心力衰竭 (CHF),而 41 名患者(9%)在尸检时出现心脏性猝死 (SCD)。据报告,临床表现为 1 名患者突然出现呼吸困难,2 名患者咯血,2 名患者慢性心力衰竭恶化,1 名患者胸痛。据报告,6 名患者接受了胸部 X 光检查:其中 3 名患者出现与 PE 一致的异常。一项研究报告的平均左心室射血分数为 42.1 ± 18.7%。右侧心脏血栓形成的发生率从 66% 到 85% 不等。17%的患者死于 PE。恰加斯病心肌病(ChCM)患者的 PE 临床诊断非常困难,因为没有一个性能良好的预测评分。然而,如果出现咯血或心力衰竭(HF)恶化、心电图或胸部 X 光片异常,则应提高 PE 诊断率,并及时转诊至详细的多普勒组织超声心动图和计算机断层扫描血管造影,以及时治疗。
{"title":"Right-Sided Cardiac Thrombosis and Pulmonary Thromboembolism in Chronic Chagas Disease: A Review of Clinical Features and Post-Mortem Examination.","authors":"Reinaldo B Bestetti, Marcelo José Ferreira Soares, Rosemary Furlan-Daniel, Augusto Cardinalli-Neto, Marcelo A Nakazone","doi":"10.31083/j.rcm2506220","DOIUrl":"10.31083/j.rcm2506220","url":null,"abstract":"<p><p>Pulmonary thromboembolism (PE) is a potential major complication in patients with chronic Chagas heart disease (CChD). The source of PE is the right-sided chambers instead of deep vein thrombosis. Little is known regarding risk factors, clinical picture, and the clinical course of patients with PE secondary to CChD. The aim of this review was to try to provide doctors with such data. We searched for papers related to PE in CChD patients in the PUBMED from 1955 to 2020. Twenty-six manuscripts were retrieved, of which 12 fulfilled entry criteria and were included in the study. Right-sided cardiac thrombosis or PE was confirmed on morphological or imaging studies. A total of 431 patients with PE were reported. Age varied from 30 to 85 years. About 332 patients were reported to have chronic heart failure (CHF), whereas 41 (9%) sudden cardiac death (SCD) at autopsy. Clinical manifestations reported were sudden onset dyspnea was found in 1 patient, haemoptysis in 2, worsening CHF in 2, and chest pain in 1. An X-ray chest was reported for 6 patients: abnormalities consistent with PE were found in 3. The resting electrocardiogram (ECG) was reported for 5 patients: it was abnormal in all. One study reported a mean left ventricular ejection fraction of 42.1 <math><mo>±</mo></math> 18.7%. The prevalence of right-sided cardiac thrombosis varied from 66% to 85% patients. PE was the cause of death in 17% of patients. The clinical diagnosis of PE in patients with Chagas cardiomyopathy (ChCM) is very difficult in the absence of a prediction score that performs well. However, in the presence of haemoptysis or worsening heart failure (HF), abnormal ECG, or chest X-ray, the diagnosis of PE should be raised, and patients promptly referred to detailed Doppler Tissue Echocardiography and computed tomography angiography, and treated in a timely manner.</p>","PeriodicalId":20989,"journal":{"name":"Reviews in cardiovascular medicine","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11270065/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141793347","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}