Pub Date : 2022-06-02DOI: 10.1080/14017431.2022.2079714
R. M. Andreassen, J. Kronborg, H. Schirmer, E. Mathiesen, T. Melsom, B. Eriksen, T. Jenssen, M. Solbu
Abstract Objectives. Urinary albumin excretion is a risk marker for cardiovascular disease (CVD). Studies suggest that urinary orosomucoid may be a more sensitive marker of general endothelial dysfunction than albuminuria. The aim of this population-based cross-sectional study was to examine the associations between urinary orosomucoid to creatinine ratio (UOCR), urinary albumin to creatinine ratio (UACR) and subclinical CVD. Design. From the Tromsø Study (2007/2008), we included all men and women who had measurements of urinary orosomucoid (n = 7181). Among these, 6963 were examined with ultrasound of the right carotid artery and 2245 with echocardiography. We assessed the associations between urinary markers and subclinical CVD measured as intima media thickness of the carotid artery, presence and area of carotid plaque and diastolic dysfunction (DD). UOCR and UACR were dichotomized as upper quartile versus the three lowest. Results. High UOCR, adjusted for UACR, age, cardiovascular risk factors and kidney function, was associated with presence of DD in men (OR: 3.18, 95% CI [1.27, 7.95], p = .013), and presence of plaque (OR: 1.20, 95% CI [1.01, 1.44], p = .038) and intima media thickness in women (OR: 1.34, 95% CI [1.09, 1.65], p = .005). Analyses showed no significant interaction between sex and UOCR for any endpoints. UACR was not significantly associated with DD, but the associations with intima media thickness and plaque were of magnitudes comparable to those observed for UOCR. Conclusions. UOCR was positively associated with subclinical CVD. We need prospective studies to confirm whether UOCR is a clinically useful biomarker and to study possible sex differences.
{"title":"Urinary orosomucoid is associated with diastolic dysfunction and carotid arteriopathy in the general population. Cross-sectional data from the Tromsø study","authors":"R. M. Andreassen, J. Kronborg, H. Schirmer, E. Mathiesen, T. Melsom, B. Eriksen, T. Jenssen, M. Solbu","doi":"10.1080/14017431.2022.2079714","DOIUrl":"https://doi.org/10.1080/14017431.2022.2079714","url":null,"abstract":"Abstract Objectives. Urinary albumin excretion is a risk marker for cardiovascular disease (CVD). Studies suggest that urinary orosomucoid may be a more sensitive marker of general endothelial dysfunction than albuminuria. The aim of this population-based cross-sectional study was to examine the associations between urinary orosomucoid to creatinine ratio (UOCR), urinary albumin to creatinine ratio (UACR) and subclinical CVD. Design. From the Tromsø Study (2007/2008), we included all men and women who had measurements of urinary orosomucoid (n = 7181). Among these, 6963 were examined with ultrasound of the right carotid artery and 2245 with echocardiography. We assessed the associations between urinary markers and subclinical CVD measured as intima media thickness of the carotid artery, presence and area of carotid plaque and diastolic dysfunction (DD). UOCR and UACR were dichotomized as upper quartile versus the three lowest. Results. High UOCR, adjusted for UACR, age, cardiovascular risk factors and kidney function, was associated with presence of DD in men (OR: 3.18, 95% CI [1.27, 7.95], p = .013), and presence of plaque (OR: 1.20, 95% CI [1.01, 1.44], p = .038) and intima media thickness in women (OR: 1.34, 95% CI [1.09, 1.65], p = .005). Analyses showed no significant interaction between sex and UOCR for any endpoints. UACR was not significantly associated with DD, but the associations with intima media thickness and plaque were of magnitudes comparable to those observed for UOCR. Conclusions. UOCR was positively associated with subclinical CVD. We need prospective studies to confirm whether UOCR is a clinically useful biomarker and to study possible sex differences.","PeriodicalId":21383,"journal":{"name":"Scandinavian Cardiovascular Journal","volume":"56 1","pages":"148 - 156"},"PeriodicalIF":2.2,"publicationDate":"2022-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49240189","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-05-31DOI: 10.1080/14017431.2022.2075561
H. Gardarsdottir, M. Sigurdsson, K. Andersen, I. Gudmundsdottir
Abstract Objective. To evaluate the impact of sex on treatment and survival after acute myocardial infarction (AMI) in Iceland. Methods. A retrospective, nationwide cohort study of patients with STEMI (2008–2018) and NSTEMI (2013–2018) and obstructive coronary artery disease. Patient and procedural information were obtained from a registry and electronic health records. Survival was estimated with Kaplan–Meier method and Cox regression analysis used to identify risk factors for long-term mortality. Excess mortality from the AMI episode was estimated by comparing the survival with age- and sex-matched population in Iceland at 30-day interval. Results. A total of 1345 STEMI-patients (24% women) and 1249 NSTEMI-patients (24% women) were evaluated. Women with STEMI (mean age: 71 ± 11 vs. 67 ± 12) and NSTEMI (mean age: 69 ± 13 vs. 62 ± 12) were older and less likely to have previous cardiovascular disease. There was neither sex difference in the extent of coronary artery disease nor treatment. Although crude one-year post-STEMI survival was lower for women (88.7% vs. 93.4%, p = .006), female sex was not an independent risk factor after adjusting for age and co-morbidities after STEMI and was protective for NSTEMI (HR 0.67, 95% CI: 0.46–0.97). There was excess 30-day mortality in both STEMI and NSTEMI for women compared with sex-, age- and inclusion year-matched Icelandic population, but thereafter the mortality rate was similar. Conclusion. Women and men with AMI in Iceland receive comparable treatment including revascularization and long-term survival appears similar. Prognosis after NSTEMI is better in women, whereas higher early mortality after STEMI may be caused by delays in presentation and diagnosis.
摘要目的。评估性别对冰岛急性心肌梗死(AMI)后治疗和生存的影响。方法。STEMI(2008-2018)和NSTEMI(2013-2018)合并阻塞性冠状动脉疾病患者的回顾性全国队列研究从登记处和电子健康记录中获得患者和程序信息。生存率采用Kaplan-Meier法估计，Cox回归分析用于确定长期死亡率的危险因素。通过比较冰岛年龄和性别匹配人群30天的生存率，估计AMI发作的超额死亡率。结果。共评估了1345例stemi患者(24%女性)和1249例nstemi患者(24%女性)。STEMI患者(平均年龄:71±11 vs. 67±12)和NSTEMI患者(平均年龄:69±13 vs. 62±12)年龄较大，既往心血管疾病的可能性较小。冠状动脉疾病的范围和治疗没有性别差异。尽管女性STEMI术后1年的粗生存率较低(88.7% vs. 93.4%， p = 0.006)，但在调整年龄和STEMI术后合病后，女性性别不是独立的危险因素，而对非STEMI具有保护作用(HR 0.67, 95% CI: 0.46-0.97)。与性别、年龄和纳入年份匹配的冰岛人口相比，STEMI和NSTEMI中女性的30天死亡率都偏高，但此后死亡率相似。结论。在冰岛，患有AMI的女性和男性接受了类似的治疗，包括血运重建术和长期生存率似乎相似。女性非STEMI后的预后较好，而STEMI后较高的早期死亡率可能是由于表现和诊断的延迟造成的。
{"title":"Long-term survival of Icelandic women following acute myocardial infarction","authors":"H. Gardarsdottir, M. Sigurdsson, K. Andersen, I. Gudmundsdottir","doi":"10.1080/14017431.2022.2075561","DOIUrl":"https://doi.org/10.1080/14017431.2022.2075561","url":null,"abstract":"Abstract Objective. To evaluate the impact of sex on treatment and survival after acute myocardial infarction (AMI) in Iceland. Methods. A retrospective, nationwide cohort study of patients with STEMI (2008–2018) and NSTEMI (2013–2018) and obstructive coronary artery disease. Patient and procedural information were obtained from a registry and electronic health records. Survival was estimated with Kaplan–Meier method and Cox regression analysis used to identify risk factors for long-term mortality. Excess mortality from the AMI episode was estimated by comparing the survival with age- and sex-matched population in Iceland at 30-day interval. Results. A total of 1345 STEMI-patients (24% women) and 1249 NSTEMI-patients (24% women) were evaluated. Women with STEMI (mean age: 71 ± 11 vs. 67 ± 12) and NSTEMI (mean age: 69 ± 13 vs. 62 ± 12) were older and less likely to have previous cardiovascular disease. There was neither sex difference in the extent of coronary artery disease nor treatment. Although crude one-year post-STEMI survival was lower for women (88.7% vs. 93.4%, p = .006), female sex was not an independent risk factor after adjusting for age and co-morbidities after STEMI and was protective for NSTEMI (HR 0.67, 95% CI: 0.46–0.97). There was excess 30-day mortality in both STEMI and NSTEMI for women compared with sex-, age- and inclusion year-matched Icelandic population, but thereafter the mortality rate was similar. Conclusion. Women and men with AMI in Iceland receive comparable treatment including revascularization and long-term survival appears similar. Prognosis after NSTEMI is better in women, whereas higher early mortality after STEMI may be caused by delays in presentation and diagnosis.","PeriodicalId":21383,"journal":{"name":"Scandinavian Cardiovascular Journal","volume":"56 1","pages":"114 - 120"},"PeriodicalIF":2.2,"publicationDate":"2022-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46007329","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-05-19DOI: 10.1080/14017431.2022.2060526
Päivi Pietilä-Effati, Mathias Höglund, A. Käräjämäki, Filip Höglund, Anne-Maria Nabb, Eija Matila, M. Koistinen
Abstract Cardiac resynchronization therapy (CRT) reduces the morbidity and mortality in advanced heart failure (HF) in about two-thirds of the patients. Approximately one-third of the patients do not respond to CRT. The overactivity of sympathetic nervous system is associated with advanced HF and deteriorates the hemodynamic state. We tested the hypothesis that controlling sympathetic overactivity by renal denervation (RDN) could be beneficial in nonresponders for CRT. In our HeartF-RDN study (ClinalTrials.gov. NCT02638324), RDN could not reverse the progression of HF in subjects with New York Heart Association Classification (NYHA) III-IV stage symptoms.
{"title":"Renal denervation in patients who do not respond to cardiac resynchronization therapy","authors":"Päivi Pietilä-Effati, Mathias Höglund, A. Käräjämäki, Filip Höglund, Anne-Maria Nabb, Eija Matila, M. Koistinen","doi":"10.1080/14017431.2022.2060526","DOIUrl":"https://doi.org/10.1080/14017431.2022.2060526","url":null,"abstract":"Abstract Cardiac resynchronization therapy (CRT) reduces the morbidity and mortality in advanced heart failure (HF) in about two-thirds of the patients. Approximately one-third of the patients do not respond to CRT. The overactivity of sympathetic nervous system is associated with advanced HF and deteriorates the hemodynamic state. We tested the hypothesis that controlling sympathetic overactivity by renal denervation (RDN) could be beneficial in nonresponders for CRT. In our HeartF-RDN study (ClinalTrials.gov. NCT02638324), RDN could not reverse the progression of HF in subjects with New York Heart Association Classification (NYHA) III-IV stage symptoms.","PeriodicalId":21383,"journal":{"name":"Scandinavian Cardiovascular Journal","volume":"56 1","pages":"103 - 106"},"PeriodicalIF":2.2,"publicationDate":"2022-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46553539","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-05-13DOI: 10.1080/14017431.2022.2074094
M. Wykrętowicz, Łukasz Gąsiorowski, Anna Kłusek-Zielińska, K. Katulska
Abstract CHA2DS2-VASc score system aids in clinical decision-making in subjects with atrial fibrillation (AF). Little is known on the association between CHA2DS2-VASc scores and brain structure in patients without cardiac arrhythmia. Detailed brain architecture analysis was performed. Assessment of bivariate correlation between the volume of segmented brain structures and Z-scores of CHA2DS2-VASc showed that higher risk scores correlated negatively and significantly with various brain framework. Our study confirms that a cluster of risk factors incorporated in a well-established risk score correlated with brain tissue volume independently of the presence of an arrhythmia.
CHA2DS2-VASc评分系统有助于房颤(AF)患者的临床决策。对于无心律失常患者CHA2DS2-VASc评分与脑结构之间的关系知之甚少。进行了详细的脑结构分析。对分节脑结构体积与CHA2DS2-VASc z -评分的双变量相关性评估显示，较高的风险评分与不同脑结构呈显著负相关。我们的研究证实，一组风险因素纳入了一个完善的风险评分，与脑组织体积相关，独立于心律失常的存在。
{"title":"Brain structure and stroke risk score in subjects without a history of atrial fibrillation","authors":"M. Wykrętowicz, Łukasz Gąsiorowski, Anna Kłusek-Zielińska, K. Katulska","doi":"10.1080/14017431.2022.2074094","DOIUrl":"https://doi.org/10.1080/14017431.2022.2074094","url":null,"abstract":"Abstract CHA2DS2-VASc score system aids in clinical decision-making in subjects with atrial fibrillation (AF). Little is known on the association between CHA2DS2-VASc scores and brain structure in patients without cardiac arrhythmia. Detailed brain architecture analysis was performed. Assessment of bivariate correlation between the volume of segmented brain structures and Z-scores of CHA2DS2-VASc showed that higher risk scores correlated negatively and significantly with various brain framework. Our study confirms that a cluster of risk factors incorporated in a well-established risk score correlated with brain tissue volume independently of the presence of an arrhythmia.","PeriodicalId":21383,"journal":{"name":"Scandinavian Cardiovascular Journal","volume":"56 1","pages":"100 - 102"},"PeriodicalIF":2.2,"publicationDate":"2022-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42621884","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-05-12DOI: 10.1080/14017431.2022.2074095
J. Sule, C. Chua, Caven Teo, A. Choong, F. Sazzad, T. Kofidis, V. Sorokin
Abstract Objectives. Composite frozen elephant trunk is an increasingly popular solution for complex aortic pathologies. This review aims to compare outcomes of zone 0 type II hybrid (hybrid II) with the composite frozen elephant trunk (FET) technique in managing acute Stanford type A aortic dissections. Methods. PubMed and Embase were systematically searched using PRISMA protocol. 11 relevant studies describing the outcomes of hybrid II arch repair and FET techniques in patients with type A aortic dissection were included in the meta-analysis. The study focused on early post-operative 30-day outcomes analysing mortality, stroke, spinal cord injury, renal impairment requiring dialysis, bleeding and lung infection. Results. 1305 patients were included in the analysis – 343 receiving hybrid II repair and 962 treated with the FET. Meta-analysis of proportions showed Hybrid II was associated with less early mortality [5.0 (CI 3.1–7.8) vs 8.1 (CI 6.5–10.0) %], stroke [2.3 (CI 1.1–4.6) vs 7.0 (CI 5.5–8.8) %], spinal cord injury [2.0 (CI 0.9–4.3) vs 3.8 (CI 2.8–5.3) %], renal impairment requiring dialysis [7.9 (CI 5.5–11.2) vs 11.8 (CI 9.8–14.0) %], reoperation for bleeding [3.9 (CI 1.8–8.4) vs 10.6 (CI 8.1–13.8) %] and lung infection [14.8 (CI 10.8–20.0) vs 20.7 (CI 16.9–25.1) %]. Conclusion. Hybrid II should be considered in favour of FET technique in acute Stanford type A dissection patients who are at higher risk due to age and comorbidities.
{"title":"Hybrid type II and frozen elephant trunk in acute Stanford type A aortic dissections","authors":"J. Sule, C. Chua, Caven Teo, A. Choong, F. Sazzad, T. Kofidis, V. Sorokin","doi":"10.1080/14017431.2022.2074095","DOIUrl":"https://doi.org/10.1080/14017431.2022.2074095","url":null,"abstract":"Abstract Objectives. Composite frozen elephant trunk is an increasingly popular solution for complex aortic pathologies. This review aims to compare outcomes of zone 0 type II hybrid (hybrid II) with the composite frozen elephant trunk (FET) technique in managing acute Stanford type A aortic dissections. Methods. PubMed and Embase were systematically searched using PRISMA protocol. 11 relevant studies describing the outcomes of hybrid II arch repair and FET techniques in patients with type A aortic dissection were included in the meta-analysis. The study focused on early post-operative 30-day outcomes analysing mortality, stroke, spinal cord injury, renal impairment requiring dialysis, bleeding and lung infection. Results. 1305 patients were included in the analysis – 343 receiving hybrid II repair and 962 treated with the FET. Meta-analysis of proportions showed Hybrid II was associated with less early mortality [5.0 (CI 3.1–7.8) vs 8.1 (CI 6.5–10.0) %], stroke [2.3 (CI 1.1–4.6) vs 7.0 (CI 5.5–8.8) %], spinal cord injury [2.0 (CI 0.9–4.3) vs 3.8 (CI 2.8–5.3) %], renal impairment requiring dialysis [7.9 (CI 5.5–11.2) vs 11.8 (CI 9.8–14.0) %], reoperation for bleeding [3.9 (CI 1.8–8.4) vs 10.6 (CI 8.1–13.8) %] and lung infection [14.8 (CI 10.8–20.0) vs 20.7 (CI 16.9–25.1) %]. Conclusion. Hybrid II should be considered in favour of FET technique in acute Stanford type A dissection patients who are at higher risk due to age and comorbidities.","PeriodicalId":21383,"journal":{"name":"Scandinavian Cardiovascular Journal","volume":"56 1","pages":"91 - 99"},"PeriodicalIF":2.2,"publicationDate":"2022-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44648568","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-05-12DOI: 10.1080/14017431.2022.2074093
Anne Toftgaard Pedersen, J. Kjaergaard, C. Hassager, M. Frydland, J. Hartvig Thomsen, Anika Klein, H. Schmidt, J. Møller, S. Wiberg
Abstract Objectives Prognostication after out-of-hospital cardiac arrest (OHCA) remains challenging. The inflammatory response after OHCA has been associated with increased mortality. This study investigates the associations and predictive value between inflammatory markers and outcome in resuscitated OHCA patients. Design The study is based on post hoc analyses of a double-blind controlled trial, where resuscitated OHCA patients were randomized to receive either exenatide or placebo. Blood was analyzed for levels of inflammatory markers the day following admission. Primary endpoint was time to death for up to 180 days. Secondary endpoints included 180-day mortality and poor neurological outcome after 180 days, defined as a cerebral performance category (CPC) of 3 to 5. Results Among 110 included patients we found significant associations between higher leucocyte quartile and increasing mortality in univariable analysis (OR 2.6 (95%CI 1.6–4.2), p < .001), as well as in multivariable analysis (OR 2.1 (95%CI 1.1–4.0), p = .02). A significant association was found between higher neutrophil quartile and increasing mortality in univariable analysis (OR 3.0 (95%CI 1.8–5.0), p < .001) as well as multivariable analysis (OR 2.4 (95%CI 1.2–4.6), p = .01). Leucocyte and neutrophil levels were predictive of poor outcome after 180 days with area under the receiver operating characteristics curves of 0.79 and 0.81, respectively. We found no associations between CRP and lymphocyte levels versus outcome. Conclusions Total leucocyte count and neutrophil levels measured the first day following OHCA were significantly associated with 180-day all-cause mortality and may potentially act as early predictors of outcome. Clinical trial registration www.clinicaltrials.gov, unique identifier: NCT02442791
{"title":"Association between inflammatory markers and survival in comatose, resuscitated out-of-hospital cardiac arrest patients","authors":"Anne Toftgaard Pedersen, J. Kjaergaard, C. Hassager, M. Frydland, J. Hartvig Thomsen, Anika Klein, H. Schmidt, J. Møller, S. Wiberg","doi":"10.1080/14017431.2022.2074093","DOIUrl":"https://doi.org/10.1080/14017431.2022.2074093","url":null,"abstract":"Abstract Objectives Prognostication after out-of-hospital cardiac arrest (OHCA) remains challenging. The inflammatory response after OHCA has been associated with increased mortality. This study investigates the associations and predictive value between inflammatory markers and outcome in resuscitated OHCA patients. Design The study is based on post hoc analyses of a double-blind controlled trial, where resuscitated OHCA patients were randomized to receive either exenatide or placebo. Blood was analyzed for levels of inflammatory markers the day following admission. Primary endpoint was time to death for up to 180 days. Secondary endpoints included 180-day mortality and poor neurological outcome after 180 days, defined as a cerebral performance category (CPC) of 3 to 5. Results Among 110 included patients we found significant associations between higher leucocyte quartile and increasing mortality in univariable analysis (OR 2.6 (95%CI 1.6–4.2), p < .001), as well as in multivariable analysis (OR 2.1 (95%CI 1.1–4.0), p = .02). A significant association was found between higher neutrophil quartile and increasing mortality in univariable analysis (OR 3.0 (95%CI 1.8–5.0), p < .001) as well as multivariable analysis (OR 2.4 (95%CI 1.2–4.6), p = .01). Leucocyte and neutrophil levels were predictive of poor outcome after 180 days with area under the receiver operating characteristics curves of 0.79 and 0.81, respectively. We found no associations between CRP and lymphocyte levels versus outcome. Conclusions Total leucocyte count and neutrophil levels measured the first day following OHCA were significantly associated with 180-day all-cause mortality and may potentially act as early predictors of outcome. Clinical trial registration www.clinicaltrials.gov, unique identifier: NCT02442791","PeriodicalId":21383,"journal":{"name":"Scandinavian Cardiovascular Journal","volume":"56 1","pages":"85 - 90"},"PeriodicalIF":2.2,"publicationDate":"2022-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42966246","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-05-10DOI: 10.1080/14017431.2022.2071460
A. Agnino, Ascanio Graniero, P. Gerometta, L. Giroletti, G. Albano, C. Roscitano, A. Anselmi
Abstract Objectives. The safety and effectiveness of the Trifecta GT bioprosthesis (introduced in 2016) in less invasive aortic valve replacement are scarcely investigated. Our aim was to evaluate the immediate and initial follow-up results of this device in the context of less invasive surgery. We discuss patient-specific strategies for the selection of the surgical approach. Methods. A retrospective review of 133 patients undergoing AVR with the Trifecta GT through three less invasive accesses (UMS, Upper ministernotomy; RMS, Reversed ministernotomy; RAMT, Right anterior minithoracotomy) was performed. In-hospital, follow-up and hemodynamic performance (PPM, Patient-prosthesis mismatch) data were collected. Results. Among patients, 79% received UMS, 11% RMS and 10% RAMT. Selection of approach was based on preoperative anatomical analysis (CT-scan) and planned concomitant procedures. There was no operative mortality, no valve-related adverse events. There were 36 concomitant procedures. No significant intergroup differences occurred in cardiopulmonary bypass, aortic clamp, mechanical ventilation time, ICU stay and average bleeding. There were two cases of moderate PPM (1.5%) and no instances of severe PPM; there were no significant (≥2/4) perivalvular leaks. Average mean gradient at discharge was 8 ± 3 mmHg. At follow-up (average: 2.5 ± 0.9 years, 100% complete, 315 patient years) there was no mortality and no valve-related adverse event. Hemodynamic performance was maintained at follow-up. Conclusions. The optimal device for less invasive AVR needs to be individualized, as well as the selection of the surgical approach. The use of the Trifecta GT bioprosthesis appears to be reproductible whatever less invasive approach is employed, with confirmed excellent hemodynamic performance.
{"title":"Less invasive aortic valve replacement using the trifecta bioprosthesis","authors":"A. Agnino, Ascanio Graniero, P. Gerometta, L. Giroletti, G. Albano, C. Roscitano, A. Anselmi","doi":"10.1080/14017431.2022.2071460","DOIUrl":"https://doi.org/10.1080/14017431.2022.2071460","url":null,"abstract":"Abstract Objectives. The safety and effectiveness of the Trifecta GT bioprosthesis (introduced in 2016) in less invasive aortic valve replacement are scarcely investigated. Our aim was to evaluate the immediate and initial follow-up results of this device in the context of less invasive surgery. We discuss patient-specific strategies for the selection of the surgical approach. Methods. A retrospective review of 133 patients undergoing AVR with the Trifecta GT through three less invasive accesses (UMS, Upper ministernotomy; RMS, Reversed ministernotomy; RAMT, Right anterior minithoracotomy) was performed. In-hospital, follow-up and hemodynamic performance (PPM, Patient-prosthesis mismatch) data were collected. Results. Among patients, 79% received UMS, 11% RMS and 10% RAMT. Selection of approach was based on preoperative anatomical analysis (CT-scan) and planned concomitant procedures. There was no operative mortality, no valve-related adverse events. There were 36 concomitant procedures. No significant intergroup differences occurred in cardiopulmonary bypass, aortic clamp, mechanical ventilation time, ICU stay and average bleeding. There were two cases of moderate PPM (1.5%) and no instances of severe PPM; there were no significant (≥2/4) perivalvular leaks. Average mean gradient at discharge was 8 ± 3 mmHg. At follow-up (average: 2.5 ± 0.9 years, 100% complete, 315 patient years) there was no mortality and no valve-related adverse event. Hemodynamic performance was maintained at follow-up. Conclusions. The optimal device for less invasive AVR needs to be individualized, as well as the selection of the surgical approach. The use of the Trifecta GT bioprosthesis appears to be reproductible whatever less invasive approach is employed, with confirmed excellent hemodynamic performance.","PeriodicalId":21383,"journal":{"name":"Scandinavian Cardiovascular Journal","volume":"56 1","pages":"79 - 84"},"PeriodicalIF":2.2,"publicationDate":"2022-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48877140","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-05-02DOI: 10.1080/14017431.2022.2069855
Fatima Zebari, Vishal Amlani, M. Langenskiöld, J. Nordanstig
Abstract Objective. Lower extremity atherosclerotic disease (LEAD) diagnosis is largely based on ankle-brachial index (ABI) recordings. Equipment that could automatically determine ABI may facilitate LEAD identification within a broad range of health services. We aimed to test the measurement properties of an automated oscillometric ABI measurement device (MESI ABPI MD®) as compared to manual reference ABI measurements in patients with and without LEAD. Design. A total of 153 patients with and without LEAD visiting a vascular surgery clinic underwent manual and automated ABI measurements. In total, 306 limbs were investigated. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated to assess the automated ABI device overall validity, with the manual method as reference. Correlation analysis (Spearman) was used to assess patterns of correlation between measurement methods while Bland–Altman plots were used to quantify measurement agreement. Results. Sensitivity and specificity for the automated ABI device were 75 and 67% whereas PPV and NPV were 72 and 71%, respectively. The correlation coefficient (automated versus manual measurements) was r = 0.552, p < .01. Bland-Altman plots revealed proportional bias and a tendency by the automated device to overestimate lower ABI values and underestimate higher ABI values. The best agreement between automated and manual ABI recordings was observed within the normal ABI range. Conclusions. The ABPI MD® device performance was unfavorable. The automated device tended to overestimate lower ABI values while underestimating higher values, which may lead to underdiagnosis of LEAD. Our data do not support the use of this automated ABI measurement device in clinical practice.
{"title":"Validation of an automated measurement method for determination of the ankle-brachial index","authors":"Fatima Zebari, Vishal Amlani, M. Langenskiöld, J. Nordanstig","doi":"10.1080/14017431.2022.2069855","DOIUrl":"https://doi.org/10.1080/14017431.2022.2069855","url":null,"abstract":"Abstract Objective. Lower extremity atherosclerotic disease (LEAD) diagnosis is largely based on ankle-brachial index (ABI) recordings. Equipment that could automatically determine ABI may facilitate LEAD identification within a broad range of health services. We aimed to test the measurement properties of an automated oscillometric ABI measurement device (MESI ABPI MD®) as compared to manual reference ABI measurements in patients with and without LEAD. Design. A total of 153 patients with and without LEAD visiting a vascular surgery clinic underwent manual and automated ABI measurements. In total, 306 limbs were investigated. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated to assess the automated ABI device overall validity, with the manual method as reference. Correlation analysis (Spearman) was used to assess patterns of correlation between measurement methods while Bland–Altman plots were used to quantify measurement agreement. Results. Sensitivity and specificity for the automated ABI device were 75 and 67% whereas PPV and NPV were 72 and 71%, respectively. The correlation coefficient (automated versus manual measurements) was r = 0.552, p < .01. Bland-Altman plots revealed proportional bias and a tendency by the automated device to overestimate lower ABI values and underestimate higher ABI values. The best agreement between automated and manual ABI recordings was observed within the normal ABI range. Conclusions. The ABPI MD® device performance was unfavorable. The automated device tended to overestimate lower ABI values while underestimating higher values, which may lead to underdiagnosis of LEAD. Our data do not support the use of this automated ABI measurement device in clinical practice.","PeriodicalId":21383,"journal":{"name":"Scandinavian Cardiovascular Journal","volume":"56 1","pages":"73 - 78"},"PeriodicalIF":2.2,"publicationDate":"2022-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49626235","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-04-08DOI: 10.1080/14017431.2022.2060525
V. Abromaitiene, J. Greisen, H. Kimose, Zidryne Karaliunaite, C. Jakobsen
Abstract Objectives. The goal of this study was to examine whether the use of free arterial grafts could reduce the need for repeated revascularization and all-cause mortality in patients undergoing coronary artery grafting. Design. The cohort study included 17,354 consecutive adults with isolated coronary artery grafting from 2000 to 2016 in three cardiac surgery centers. Data were obtained from the Western Denmark Heart Registry. Propensity matching with 24 factors was used to establish comparable groups of patients receiving either vein grafts (n = 1019) or free arterial grafts (n = 1019) for outcome analysis. Results. The need for repeated revascularization and all-cause mortality was similar in both graft groups at 10 years of follow-up. Creatine-Kinase MB Isoenzyme >100 μg/L increased the risk of repeated revascularization rate after 1, 5 and 10 years. Conclusions. Long-term outcomes in revascularization and survival are comparable after free arterial or saphenous vein grafting.
{"title":"Comparison of free arterial and saphenous vein grafting in outcomes after coronary bypass surgery","authors":"V. Abromaitiene, J. Greisen, H. Kimose, Zidryne Karaliunaite, C. Jakobsen","doi":"10.1080/14017431.2022.2060525","DOIUrl":"https://doi.org/10.1080/14017431.2022.2060525","url":null,"abstract":"Abstract Objectives. The goal of this study was to examine whether the use of free arterial grafts could reduce the need for repeated revascularization and all-cause mortality in patients undergoing coronary artery grafting. Design. The cohort study included 17,354 consecutive adults with isolated coronary artery grafting from 2000 to 2016 in three cardiac surgery centers. Data were obtained from the Western Denmark Heart Registry. Propensity matching with 24 factors was used to establish comparable groups of patients receiving either vein grafts (n = 1019) or free arterial grafts (n = 1019) for outcome analysis. Results. The need for repeated revascularization and all-cause mortality was similar in both graft groups at 10 years of follow-up. Creatine-Kinase MB Isoenzyme >100 μg/L increased the risk of repeated revascularization rate after 1, 5 and 10 years. Conclusions. Long-term outcomes in revascularization and survival are comparable after free arterial or saphenous vein grafting.","PeriodicalId":21383,"journal":{"name":"Scandinavian Cardiovascular Journal","volume":"56 1","pages":"42 - 47"},"PeriodicalIF":2.2,"publicationDate":"2022-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42838839","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-04-07DOI: 10.1080/14017431.2022.2060527
P. Scicchitano, M. Ciccone, M. Iacoviello, P. Guida, M. De Palo, A. Potenza, M. Basile, P. Sasanelli, Francesco Trotta, M. Sanasi, P. Caldarola, F. Massari
Abstract Background. The assessment of long-term mortality in acute decompensated heart failure (ADHF) is challenging. Respiratory failure and congestion play a fundamental role in risk stratification of ADHF patients. The aim of this study was to investigate the impact of arterial blood gases (ABG) and congestion on long-term mortality in patients with ADHF. Methods and results. We enrolled 252 patients with ADHF. Brain natriuretic peptide (BNP), blood urea nitrogen (BUN), phase angle as assessed by means of bioimpedance vector analysis, and ABG analysis were collected at admission. The endpoint was all-cause mortality. At a median follow-up of 447 d (interquartile range [IQR]: 248–667), 72 patients died 1–840 d (median 106, IQR: 29–233) after discharge. Respiratory failure types I and II were observed in 78 (19%) and 53 (20%) patients, respectively. The ROC analyses revealed that the cut-off points for predicting death were: BNP > 441 pg/mL, BUN > 1.67 mmol/L, partial pressure in oxygen (PaO2) ≤69.7 mmHg, and phase angle ≤4.9°. Taken together, these four variables proved to be good predictors for long-term mortality in ADHF (area under the curve [AUC] 0.78, 95% CI 0.72–0.78), thus explaining 60% of all deaths. A multiparametric score based on these variables was determined: each single-unit increase promoted a 2.2-fold augmentation of the risk for death (hazard ratio [HR] 2.2, 95% CI 1.8–2.8, p< .0001). Conclusions. A multiparametric approach based on measurements of BNP, BUN, PaO2, and phase angle is a reliable approach for long-term prediction of mortality risk in patients with ADHF.
抽象的背景。急性失代偿性心力衰竭(ADHF)的长期死亡率评估具有挑战性。呼吸衰竭和充血是ADHF患者风险分层的基础。本研究的目的是探讨动脉血气(ABG)和充血对ADHF患者长期死亡率的影响。方法与结果。我们招募了252例ADHF患者。入院时采集脑钠肽(BNP)、血尿素氮(BUN)、生物阻抗矢量分析测定的相位角、ABG分析。终点是全因死亡率。中位随访447 d(四分位数间距[IQR]: 248-667)， 72例患者出院后1-840 d死亡(中位106例，IQR: 29-233)。I型和II型呼吸衰竭分别为78例(19%)和53例(20%)。ROC分析显示，预测死亡的截止点为:BNP > 441 pg/mL, BUN > 1.67 mmol/L, PaO2≤69.7 mmHg，相位角≤4.9°。总之，这四个变量被证明是ADHF长期死亡率的良好预测因子(曲线下面积[AUC] 0.78, 95% CI 0.72-0.78)，因此可以解释60%的死亡。基于这些变量确定了多参数评分:每增加一个单位，死亡风险增加2.2倍(风险比[HR] 2.2, 95% CI 1.8-2.8, p< 0.0001)。结论。基于BNP、BUN、PaO2和相位角测量的多参数方法是预测ADHF患者死亡风险的可靠方法。
{"title":"Respiratory failure and bioelectrical phase angle are independent predictors for long-term survival in acute heart failure","authors":"P. Scicchitano, M. Ciccone, M. Iacoviello, P. Guida, M. De Palo, A. Potenza, M. Basile, P. Sasanelli, Francesco Trotta, M. Sanasi, P. Caldarola, F. Massari","doi":"10.1080/14017431.2022.2060527","DOIUrl":"https://doi.org/10.1080/14017431.2022.2060527","url":null,"abstract":"Abstract Background. The assessment of long-term mortality in acute decompensated heart failure (ADHF) is challenging. Respiratory failure and congestion play a fundamental role in risk stratification of ADHF patients. The aim of this study was to investigate the impact of arterial blood gases (ABG) and congestion on long-term mortality in patients with ADHF. Methods and results. We enrolled 252 patients with ADHF. Brain natriuretic peptide (BNP), blood urea nitrogen (BUN), phase angle as assessed by means of bioimpedance vector analysis, and ABG analysis were collected at admission. The endpoint was all-cause mortality. At a median follow-up of 447 d (interquartile range [IQR]: 248–667), 72 patients died 1–840 d (median 106, IQR: 29–233) after discharge. Respiratory failure types I and II were observed in 78 (19%) and 53 (20%) patients, respectively. The ROC analyses revealed that the cut-off points for predicting death were: BNP > 441 pg/mL, BUN > 1.67 mmol/L, partial pressure in oxygen (PaO2) ≤69.7 mmHg, and phase angle ≤4.9°. Taken together, these four variables proved to be good predictors for long-term mortality in ADHF (area under the curve [AUC] 0.78, 95% CI 0.72–0.78), thus explaining 60% of all deaths. A multiparametric score based on these variables was determined: each single-unit increase promoted a 2.2-fold augmentation of the risk for death (hazard ratio [HR] 2.2, 95% CI 1.8–2.8, p< .0001). Conclusions. A multiparametric approach based on measurements of BNP, BUN, PaO2, and phase angle is a reliable approach for long-term prediction of mortality risk in patients with ADHF.","PeriodicalId":21383,"journal":{"name":"Scandinavian Cardiovascular Journal","volume":"56 1","pages":"28 - 34"},"PeriodicalIF":2.2,"publicationDate":"2022-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48962719","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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