Pub Date : 2024-11-01DOI: 10.1016/j.pcad.2024.10.006
Marta Belmonte , Alberto Foà , Pasquale Paolisso , Luca Bergamaschi , Emanuele Gallinoro , Alberto Polimeni , Roberto Scarsini , Saverio Muscoli , Sara Amicone , Antonio De Vita , Angelo Villano , Francesco Angeli , Matteo Armillotta , Vincenzo Sucato , Saverio Tremamunno , Doralisa Morrone , Ciro Indolfi , Pasquale Perrone Filardi , Flavio Ribichini , Gaetano Antonio Lanza , Carmine Pizzi
The prevalence of coronary microvascular dysfunction (CMD) beyond the spectrum of chronic coronary syndromes (CCS) is non-negligible, pertaining to pathophysiological and therapeutical implications. Thanks to the availability of accurate and safe non-invasive technique, CMD can be identified as a key player in heart failure, cardiomyopathies, Takotsubo syndrome, aortic stenosis. While CMD is widely recognized as a cause of myocardial ischemia leading to a worse prognosis even in the absence of obstructive coronary artery disease, the characterization of CMD patterns beyond CCS might provide valuable insights on the underlying disease progression, being potentially a “red flag” of adverse cardiac remodeling and a major determinant of response to therapy and outcomes. In this review, we aimed to provide an overview of the latest evidence on the prevalence, mechanistic and prognostic implications of CMD beyond the spectrum of CCS (i.e. heart failure, cardiomyopathies, Takotsubo syndrome, aortic stenosis).
{"title":"Coronary microvascular dysfunction beyond the spectrum of chronic coronary syndromes","authors":"Marta Belmonte , Alberto Foà , Pasquale Paolisso , Luca Bergamaschi , Emanuele Gallinoro , Alberto Polimeni , Roberto Scarsini , Saverio Muscoli , Sara Amicone , Antonio De Vita , Angelo Villano , Francesco Angeli , Matteo Armillotta , Vincenzo Sucato , Saverio Tremamunno , Doralisa Morrone , Ciro Indolfi , Pasquale Perrone Filardi , Flavio Ribichini , Gaetano Antonio Lanza , Carmine Pizzi","doi":"10.1016/j.pcad.2024.10.006","DOIUrl":"10.1016/j.pcad.2024.10.006","url":null,"abstract":"<div><div>The prevalence of coronary microvascular dysfunction (CMD) beyond the spectrum of chronic coronary syndromes (CCS) is non-negligible, pertaining to pathophysiological and therapeutical implications. Thanks to the availability of accurate and safe non-invasive technique, CMD can be identified as a key player in heart failure, cardiomyopathies, Takotsubo syndrome, aortic stenosis. While CMD is widely recognized as a cause of myocardial ischemia leading to a worse prognosis even in the absence of obstructive coronary artery disease, the characterization of CMD patterns beyond CCS might provide valuable insights on the underlying disease progression, being potentially a “red flag” of adverse cardiac remodeling and a major determinant of response to therapy and outcomes. In this review, we aimed to provide an overview of the latest evidence on the prevalence, mechanistic and prognostic implications of CMD beyond the spectrum of CCS (i.e. heart failure, cardiomyopathies, Takotsubo syndrome, aortic stenosis).</div></div>","PeriodicalId":21156,"journal":{"name":"Progress in cardiovascular diseases","volume":"87 ","pages":"Pages 73-82"},"PeriodicalIF":5.6,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142515600","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}
The American Heart Association recently defined the complex interactions among the cardiovascular, renal, and metabolic systems as CKM syndrome. To promote better patient outcomes, having a more profound understanding of CKM pathophysiology and pursuing holistic preventative and therapy strategies is critical. Despite many gaps in understanding CKM syndrome, this study attempts to elucidate two of these gaps: the new emerging biomarkers for screening and the role of inflammation in its pathophysiology. For this review, an extensive search for specific terms was conducted in the following databases: PubMed, Scopus, Web of Science, and Google Scholar. Studies were first assessed by title, abstract, keywords, and selected for portfolio according to eligibility criteria, which led to 38 studies. They provided background information about CKM syndrome; data suggested that serum uric acid, leptin, aldosterone, bilirubin, soluble neprilysin, lipocalin-type-prostaglandin-D-synthase, and endocan could be valuable biomarkers for CKM screening; and finally, the inflammation role in CKM.
美国心脏协会最近将心血管、肾脏和代谢系统之间复杂的相互作用定义为 CKM 综合征。为了改善患者的预后，更深入地了解 CKM 病理生理学并采取全面的预防和治疗策略至关重要。尽管对 CKM 综合征的认识还存在许多空白，但本研究试图阐明其中的两个空白：用于筛查的新兴生物标志物以及炎症在其病理生理学中的作用。为了撰写这篇综述，我们在以下数据库中对特定术语进行了广泛搜索：PubMed、Scopus、Web of Science 和 Google Scholar。首先根据标题、摘要和关键词对研究进行评估，然后根据资格标准筛选出 38 篇研究。这些研究提供了有关 CKM 综合征的背景信息；数据表明，血清尿酸、瘦素、醛固酮、胆红素、可溶性肾酶、脂钙素型-前列腺素-D-合成酶和内切酶可能是筛查 CKM 的有价值的生物标志物；最后，研究了炎症在 CKM 中的作用。
{"title":"Cardiovascular-kidney-metabolic syndrome – An integrative review","authors":"Katiana Simões Kittelson , Arquimedes Gasparotto Junior , Natasha Fillmore , Roberto da Silva Gomes","doi":"10.1016/j.pcad.2024.10.012","DOIUrl":"10.1016/j.pcad.2024.10.012","url":null,"abstract":"<div><div>The American Heart Association recently defined the complex interactions among the cardiovascular, renal, and metabolic systems as CKM syndrome. To promote better patient outcomes, having a more profound understanding of CKM pathophysiology and pursuing holistic preventative and therapy strategies is critical. Despite many gaps in understanding CKM syndrome, this study attempts to elucidate two of these gaps: the new emerging biomarkers for screening and the role of inflammation in its pathophysiology. For this review, an extensive search for specific terms was conducted in the following databases: PubMed, Scopus, Web of Science, and Google Scholar. Studies were first assessed by title, abstract, keywords, and selected for portfolio according to eligibility criteria, which led to 38 studies. They provided background information about CKM syndrome; data suggested that serum uric acid, leptin, aldosterone, bilirubin, soluble neprilysin, lipocalin-type-prostaglandin-D-synthase, and endocan could be valuable biomarkers for CKM screening; and finally, the inflammation role in CKM.</div></div>","PeriodicalId":21156,"journal":{"name":"Progress in cardiovascular diseases","volume":"87 ","pages":"Pages 26-36"},"PeriodicalIF":5.6,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142564836","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 : 2024-11-01DOI: 10.1016/j.pcad.2024.10.003
Andy Smith , Ross Arena , Simon L. Bacon , Mark A. Faghy , Giovanni Grazzi , Andrea Raisi , Amber L. Vermeesch , Martin Ong'wen , Dejana Popovic , Nicolaas P. Pronk
The purpose of this perspective is to provide recommendations on the use of Artificial Intelligence (AI) in health promotion. To arrive at these recommendations, we followed a 6-step process. The first step was to recruit an international authorship team from the Healthy Living for Pandemic Event Protection (HL- PIVOT) network. This enabled us to achieve an international perspective with insights from Canada, Great Britain, Kenya, Italy, and the US. A philosophical inquiry was conducted addressing 5 questions. What should the relationship be between humans and AI in health promotion? How can the public and professionals trust AI? How can we ensure AI is aligned with our values? How can we ensure the ethical use of data by AI? How can we control AI? 4 hypothetical scenarios were also developed to provide perspectives on: i) Artificial ‘Versus’ Human Intelligence; ii) AI Empowerment in Self-Care; iii) Could AI Improve Patient Provider Relationship; and iii) The Kenyan Cancer Patient at the Height of a Pandemic. Based on the philosophical inquiry and the scenarios 11 recommendations are made by the HL-PIVOT on the use of AI in health promotion. The golden thread running through these recommendations is a human centric approach. The recommendations begin by suggesting that workforce planning should take account of AI. They conclude with the statement that any serious incidents involving an AI in Health Promotion should be reported to the relevant regulatory authority.
{"title":"Recommendations on the use of artificial intelligence in health promotion","authors":"Andy Smith , Ross Arena , Simon L. Bacon , Mark A. Faghy , Giovanni Grazzi , Andrea Raisi , Amber L. Vermeesch , Martin Ong'wen , Dejana Popovic , Nicolaas P. Pronk","doi":"10.1016/j.pcad.2024.10.003","DOIUrl":"10.1016/j.pcad.2024.10.003","url":null,"abstract":"<div><div>The purpose of this perspective is to provide recommendations on the use of Artificial Intelligence (AI) in health promotion. To arrive at these recommendations, we followed a 6-step process. The first step was to recruit an international authorship team from the Healthy Living for Pandemic Event Protection (HL- PIVOT) network. This enabled us to achieve an international perspective with insights from Canada, Great Britain, Kenya, Italy, and the US. A philosophical inquiry was conducted addressing 5 questions. What should the relationship be between humans and AI in health promotion? How can the public and professionals trust AI? How can we ensure AI is aligned with our values? How can we ensure the ethical use of data by AI? How can we control AI? 4 hypothetical scenarios were also developed to provide perspectives on: i) Artificial ‘Versus’ Human Intelligence; ii) AI Empowerment in Self-Care; iii) Could AI Improve Patient Provider Relationship; and iii) The Kenyan Cancer Patient at the Height of a Pandemic. Based on the philosophical inquiry and the scenarios 11 recommendations are made by the HL-PIVOT on the use of AI in health promotion. The golden thread running through these recommendations is a human centric approach. The recommendations begin by suggesting that workforce planning should take account of AI. They conclude with the statement that any serious incidents involving an AI in Health Promotion should be reported to the relevant regulatory authority.</div></div>","PeriodicalId":21156,"journal":{"name":"Progress in cardiovascular diseases","volume":"87 ","pages":"Pages 37-43"},"PeriodicalIF":5.6,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142402519","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-01DOI: 10.1016/j.pcad.2024.10.010
T. Elizabeth Workman , Ali Ahmed , Helen M. Sheriff , Venkatesh K. Raman , Sijian Zhang , Yijun Shao , Charles Faselis , Gregg C. Fonarow , Qing Zeng-Treitler
Background
Natural language processing (NLP) can facilitate research utilizing data from electronic health records (EHRs). Large language models can potentially improve NLP applications leveraging EHR notes. The objective of this study was to assess the performance of zero-shot learning using Chat Generative Pre-trained Transformer 4 (ChatGPT-4) for extraction of symptoms and signs, and compare its performance to baseline machine learning and rule-based methods developed using annotated data.
Methods and results
From unstructured clinical notes of the national EHR data of the Veterans healthcare system, we extracted 1999 text snippets containing relevant keywords for heart failure symptoms and signs, which were then annotated by two clinicians. We also created 102 synthetic snippets that were semantically similar to snippets randomly selected from the original 1999 snippets. The authors applied zero-shot learning, using two different forms of prompt engineering in a symptom and sign extraction task with ChatGPT-4, utilizing the synthetic snippets. For comparison, baseline models using machine learning and rule-based methods were trained using the original 1999 annotated text snippets, and then used to classify the 102 synthetic snippets.
The best zero-shot learning application achieved 90.6 % precision, 100 % recall, and 95 % F1 score, outperforming the best baseline method, which achieved 54.9 % precision, 82.4 % recall, and 65.5 % F1 score. Prompt style and temperature settings influenced zero-shot learning performance.
Conclusions
Zero-shot learning utilizing ChatGPT-4 significantly outperformed traditional machine learning and rule-based NLP. Prompt type and temperature settings affected zero-shot learning performance. These findings suggest a more efficient means of symptoms and signs extraction than traditional machine learning and rule-based methods.
{"title":"ChatGPT-4 extraction of heart failure symptoms and signs from electronic health records","authors":"T. Elizabeth Workman , Ali Ahmed , Helen M. Sheriff , Venkatesh K. Raman , Sijian Zhang , Yijun Shao , Charles Faselis , Gregg C. Fonarow , Qing Zeng-Treitler","doi":"10.1016/j.pcad.2024.10.010","DOIUrl":"10.1016/j.pcad.2024.10.010","url":null,"abstract":"<div><h3>Background</h3><div>Natural language processing (NLP) can facilitate research utilizing data from electronic health records (EHRs). Large language models can potentially improve NLP applications leveraging EHR notes. The objective of this study was to assess the performance of zero-shot learning using Chat Generative Pre-trained Transformer 4 (ChatGPT-4) for extraction of symptoms and signs, and compare its performance to baseline machine learning and rule-based methods developed using annotated data.</div></div><div><h3>Methods and results</h3><div>From unstructured clinical notes of the national EHR data of the Veterans healthcare system, we extracted 1999 text snippets containing relevant keywords for heart failure symptoms and signs, which were then annotated by two clinicians. We also created 102 synthetic snippets that were semantically similar to snippets randomly selected from the original 1999 snippets. The authors applied zero-shot learning, using two different forms of prompt engineering in a symptom and sign extraction task with ChatGPT-4, utilizing the synthetic snippets. For comparison, baseline models using machine learning and rule-based methods were trained using the original 1999 annotated text snippets, and then used to classify the 102 synthetic snippets.</div><div>The best zero-shot learning application achieved 90.6 % precision, 100 % recall, and 95 % F1 score, outperforming the best baseline method, which achieved 54.9 % precision, 82.4 % recall, and 65.5 % F1 score. Prompt style and temperature settings influenced zero-shot learning performance.</div></div><div><h3>Conclusions</h3><div>Zero-shot learning utilizing ChatGPT-4 significantly outperformed traditional machine learning and rule-based NLP. Prompt type and temperature settings affected zero-shot learning performance. These findings suggest a more efficient means of symptoms and signs extraction than traditional machine learning and rule-based methods.</div></div>","PeriodicalId":21156,"journal":{"name":"Progress in cardiovascular diseases","volume":"87 ","pages":"Pages 44-49"},"PeriodicalIF":5.6,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142515599","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 : 2024-11-01DOI: 10.1016/j.pcad.2024.10.014
Ahmed Abdelaziz , Karim Atta , Ahmed Farid Gadelmawla , Mohamed Abdelaziz , Muhammad Desouky , Yasmin Negida , Ahmed A. Ibrahim , Dua Abdelraouf Eldosoky , Ahmed Helmi , Shrouk Ramadan , Emad Singer , Jose Tafur-Soto
{"title":"Safety outcomes of oral anticoagulants in patients with an indication of anti-coagulants after TAVR: A meta-analysis","authors":"Ahmed Abdelaziz , Karim Atta , Ahmed Farid Gadelmawla , Mohamed Abdelaziz , Muhammad Desouky , Yasmin Negida , Ahmed A. Ibrahim , Dua Abdelraouf Eldosoky , Ahmed Helmi , Shrouk Ramadan , Emad Singer , Jose Tafur-Soto","doi":"10.1016/j.pcad.2024.10.014","DOIUrl":"10.1016/j.pcad.2024.10.014","url":null,"abstract":"","PeriodicalId":21156,"journal":{"name":"Progress in cardiovascular diseases","volume":"87 ","pages":"Pages 97-99"},"PeriodicalIF":5.6,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142564933","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 : 2024-11-01DOI: 10.1016/j.pcad.2024.11.001
Carl J. Lavie
{"title":"Assorted topics III 2024","authors":"Carl J. Lavie","doi":"10.1016/j.pcad.2024.11.001","DOIUrl":"10.1016/j.pcad.2024.11.001","url":null,"abstract":"","PeriodicalId":21156,"journal":{"name":"Progress in cardiovascular diseases","volume":"87 ","pages":"Page 1"},"PeriodicalIF":5.6,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142640470","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 : 2024-11-01DOI: 10.1016/j.pcad.2024.10.001
Afshin Heidari , Mohammad Ghorbani , Sara Hassanzadeh , Elham Rahmanipour
Background
Takotsubo Cardiomyopathy (TCM) is a transient heart condition often precipitated by stress and characterized by atypical ventricular ballooning. The interplay between TCM and Adrenal Insufficiency (AI), particularly the influence of catecholamine excess and glucocorticoid deficiency on TCM's pathogenesis in individuals with AI, warrants comprehensive exploration for a better understanding of TCM pathophysiology and establishment of potential therapeutic strategies.
Methods
We conducted an extensive literature search via PubMed and Google Scholar, targeting reports on AI, heart failure, and cardiomyopathy, supplemented by forward and backward citation tracing. We analyzed 46 cases from 45 reports, assessing the clinical presentation and outcomes in the context of AI categorization.
Results
In patients with AI, a glucocorticoid deficit appears to exacerbate the myocardial vulnerability to catecholamine toxicity, precipitating TCM. Most conditions were reversible; however, three pre-1990 cases resulted in irreversible outcomes.
Conclusions
The investigation into the AI and TCM intersection highlights the pathogenic significance of catecholamines in the absence of glucocorticoids. The data consolidates the hypothesis that glucocorticoid scarcity exacerbates the cardiac susceptibility to catecholaminergic toxicity, potentially triggering TCM. The study affirms glucocorticoids' cardioprotective roles and elucidates how catecholamine surges contribute to TCM pathogenesis, suggesting strategic clinical management adjustments for AI patients to reduce TCM incidence.
背景：塔克氏心肌病（Takotsubo Cardiomyopathy，TCM）是一种一过性心脏疾病，通常由应激诱发，以非典型心室气囊扩张为特征。中药与肾上腺功能不全（AI）之间的相互作用，尤其是儿茶酚胺过多和糖皮质激素缺乏对中药在 AI 患者中发病机制的影响，值得进行全面探讨，以更好地了解中药的病理生理学并制定潜在的治疗策略：我们通过 PubMed 和 Google Scholar 进行了广泛的文献检索，主要针对有关人工智能、心力衰竭和心肌病的报道，并辅以正向和反向引文追踪。我们分析了 45 篇报道中的 46 个病例，并根据 AI 分类评估了临床表现和预后：结果：在 AI 患者中，糖皮质激素的缺乏似乎加剧了心肌对儿茶酚胺毒性的脆弱性，从而诱发了中药。大多数情况是可逆的，但有三例 1990 年以前的病例导致了不可逆转的结果：对 AI 和中药交叉的调查强调了儿茶酚胺在糖皮质激素缺失时的致病意义。这些数据巩固了糖皮质激素缺乏会加剧心脏对儿茶酚胺能毒性的易感性，从而可能引发中医的假说。该研究肯定了糖皮质激素的心脏保护作用，并阐明了儿茶酚胺激增是如何导致中医发病的，建议对人工流产患者进行战略性临床管理调整，以降低中医发病率。
{"title":"A review of the interplay between Takotsubo cardiomyopathy and adrenal insufficiency: Catecholamine surge and glucocorticoid deficiency","authors":"Afshin Heidari , Mohammad Ghorbani , Sara Hassanzadeh , Elham Rahmanipour","doi":"10.1016/j.pcad.2024.10.001","DOIUrl":"10.1016/j.pcad.2024.10.001","url":null,"abstract":"<div><h3>Background</h3><div>Takotsubo Cardiomyopathy (TCM) is a transient heart condition often precipitated by stress and characterized by atypical ventricular ballooning. The interplay between TCM and Adrenal Insufficiency (AI), particularly the influence of catecholamine excess and glucocorticoid deficiency on TCM's pathogenesis in individuals with AI, warrants comprehensive exploration for a better understanding of TCM pathophysiology and establishment of potential therapeutic strategies.</div></div><div><h3>Methods</h3><div>We conducted an extensive literature search via PubMed and Google Scholar, targeting reports on AI, heart failure, and cardiomyopathy, supplemented by forward and backward citation tracing. We analyzed 46 cases from 45 reports, assessing the clinical presentation and outcomes in the context of AI categorization.</div></div><div><h3>Results</h3><div>In patients with AI, a glucocorticoid deficit appears to exacerbate the myocardial vulnerability to catecholamine toxicity, precipitating TCM. Most conditions were reversible; however, three pre-1990 cases resulted in irreversible outcomes.</div></div><div><h3>Conclusions</h3><div>The investigation into the AI and TCM intersection highlights the pathogenic significance of catecholamines in the absence of glucocorticoids. The data consolidates the hypothesis that glucocorticoid scarcity exacerbates the cardiac susceptibility to catecholaminergic toxicity, potentially triggering TCM. The study affirms glucocorticoids' cardioprotective roles and elucidates how catecholamine surges contribute to TCM pathogenesis, suggesting strategic clinical management adjustments for AI patients to reduce TCM incidence.</div></div>","PeriodicalId":21156,"journal":{"name":"Progress in cardiovascular diseases","volume":"87 ","pages":"Pages 18-25"},"PeriodicalIF":5.6,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142402517","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 : 2024-11-01DOI: 10.1016/j.pcad.2024.10.005
Stefan Seman , Milorad Tesic , Marija Babic , Lidija Mikic , Lazar Velicki , Nduka C Okwose , Sarah J Charman , Maria Tafelmeier , Iacopo Olivotto , Nenad Filipovic , Arsen Ristic , Ross Arena , Marco Guazzi , Djordje Jakovljevic , Thomas G Allison , Dejana Popovic , on behalf of SILICOFCM study investigators
Aim
We sought the cardiopulmonary exercise testing (CPET) parameter that most accurately reflected therapeutic efficacy in patients with hypertrophic cardiomyopathy (HCM).
Methods
Well-being questionnaire, N-terminal brain natriuretic peptide measurements, echocardiography, and CPET were performed in patients with symptomatic non-obstructive HCM during phase II, randomized, open-label multicentre study, before and after 16 weeks of traditional or sacubitril/valsartan treatment. Patients were followed 36 months after the initial CPET. Primary endpoints were changes in: 1) peak oxygen consumption (VO2); 2) VO2 at anaerobic threshold (AT); 3) oxygen pulse; 4) minute ventilation (VE)/carbon-dioxide (CO2) production slope; 5) VE/VCO2 at AT (VE/VCO2_AT); 6) VE/VCO2 nadir; 7) VE/VCO2 intercept; and 8) partial end-tidal pressure of carbon-dioxide (PETCO2) change during CPET.
Results
Of 115 screened patients, 61 (52 ± 14 years, 43 % women) were included. Within subject therapy effects were detected only by the VE/VCO2 intercept and PETCO2 change, whereas the differences between medical regimens were detected by differences in VE/VCO2 nadir and VE/VCO2_AT changes after the treatment. The best predictors of the change in well-being were left ventricular outflow tract maximal gradient and VE/VCO2 intercept (B = 0.41,0.36; SE = 0.16,0.30; CI = 0.14–0.79, 0.15–1.14; p = 0.006,0.016, respectively). Adverse cardiac events were best predicted by the initial VE/VCO2 nadir.
Conclusion
Ventilatory efficiency parameters outperform peak VO2 in gauging therapy effects in patients with HCM.
{"title":"The ventilatory efficiency parameters outperform peak oxygen consumption in monitoring the therapy effects in patients with hypertrophic cardiomyopathy","authors":"Stefan Seman , Milorad Tesic , Marija Babic , Lidija Mikic , Lazar Velicki , Nduka C Okwose , Sarah J Charman , Maria Tafelmeier , Iacopo Olivotto , Nenad Filipovic , Arsen Ristic , Ross Arena , Marco Guazzi , Djordje Jakovljevic , Thomas G Allison , Dejana Popovic , on behalf of SILICOFCM study investigators","doi":"10.1016/j.pcad.2024.10.005","DOIUrl":"10.1016/j.pcad.2024.10.005","url":null,"abstract":"<div><h3>Aim</h3><div>We sought the cardiopulmonary exercise testing (CPET) parameter that most accurately reflected therapeutic efficacy in patients with hypertrophic cardiomyopathy (HCM).</div></div><div><h3>Methods</h3><div>Well-being questionnaire, N-terminal brain natriuretic peptide measurements, echocardiography, and CPET were performed in patients with symptomatic non-obstructive HCM during phase II, randomized, open-label multicentre study, before and after 16 weeks of traditional or sacubitril/valsartan treatment. Patients were followed 36 months after the initial CPET. Primary endpoints were changes in: 1) peak oxygen consumption (VO<sub>2</sub>); 2) VO<sub>2</sub> at anaerobic threshold (AT); 3) oxygen pulse; 4) minute ventilation (VE)/carbon-dioxide (CO<sub>2</sub>) production slope; 5) VE/VCO<sub>2</sub> at AT (VE/VCO<sub>2</sub>_AT); 6) VE/VCO<sub>2</sub> nadir; 7) VE/VCO<sub>2</sub> intercept; and 8) partial end-tidal pressure of carbon-dioxide (P<sub>ET</sub>CO<sub>2</sub>) change during CPET.</div></div><div><h3>Results</h3><div>Of 115 screened patients, 61 (52 ± 14 years, 43 % women) were included. Within subject therapy effects were detected only by the VE/VCO<sub>2</sub> intercept and P<sub>ET</sub>CO<sub>2</sub> change, whereas the differences between medical regimens were detected by differences in VE/VCO<sub>2</sub> nadir and VE/VCO<sub>2</sub>_AT changes after the treatment. The best predictors of the change in well-being were left ventricular outflow tract maximal gradient and VE/VCO<sub>2</sub> intercept (B = 0.41,0.36; SE = 0.16,0.30; CI = 0.14–0.79, 0.15–1.14; <em>p</em> = 0.006,0.016, respectively). Adverse cardiac events were best predicted by the initial VE/VCO<sub>2</sub> nadir.</div></div><div><h3>Conclusion</h3><div>Ventilatory efficiency parameters outperform peak VO<sub>2</sub> in gauging therapy effects in patients with HCM.</div></div>","PeriodicalId":21156,"journal":{"name":"Progress in cardiovascular diseases","volume":"87 ","pages":"Pages 90-96"},"PeriodicalIF":5.6,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142484625","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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