Pub Date : 2019-01-01DOI: 10.1177/1753944719840192
Frank Tillman, Jennifer Kim, Tanya Makhlouf, Leah Osae
Background: Our aim was to review the published literature evaluating treatment approaches for chronic heart failure (HF), notably as it relates to African American patients.
Method: We undertook a comprehensive database search (1986-2017) of PubMed, EMBASE, and Ovid/MEDLINE utilizing terms 'African American', 'black', 'chronic heart failure', 'heart failure', 'medication', 'chronic therapy', and 'clinical trials'. Additional notable studies were obtained from ClinicalTrials.gov . Studies published in English that examine treatment modalities of chronic HF in African American and non-African American patients were included.
Results: Examples of current gaps worthy of investigation include whether to maximize thiazides and calcium-channel blockers prior to adding renin-angiotensin system (RAS) inhibitors or beta blockers in HF with preserved ejection fraction; whether hydralazine/isosorbide dinitrate (ISDN) should be initiated during earlier HF stages; whether to prioritize hydralazine/ISDN over other agents such as RAS inhibitors; varying response of African Americans to different agents within drug classes; and the role of mineralocorticoid receptor antagonists.
Conclusion: Further studies are needed in order for consensus guidelines to clarify how best to treat this population.
{"title":"A comprehensive review of chronic heart failure pharmacotherapy treatment approaches in African Americans.","authors":"Frank Tillman, Jennifer Kim, Tanya Makhlouf, Leah Osae","doi":"10.1177/1753944719840192","DOIUrl":"10.1177/1753944719840192","url":null,"abstract":"<p><strong>Background: </strong>Our aim was to review the published literature evaluating treatment approaches for chronic heart failure (HF), notably as it relates to African American patients.</p><p><strong>Method: </strong>We undertook a comprehensive database search (1986-2017) of PubMed, EMBASE, and Ovid/MEDLINE utilizing terms 'African American', 'black', 'chronic heart failure', 'heart failure', 'medication', 'chronic therapy', and 'clinical trials'. Additional notable studies were obtained from ClinicalTrials.gov . Studies published in English that examine treatment modalities of chronic HF in African American and non-African American patients were included.</p><p><strong>Results: </strong>Examples of current gaps worthy of investigation include whether to maximize thiazides and calcium-channel blockers prior to adding renin-angiotensin system (RAS) inhibitors or beta blockers in HF with preserved ejection fraction; whether hydralazine/isosorbide dinitrate (ISDN) should be initiated during earlier HF stages; whether to prioritize hydralazine/ISDN over other agents such as RAS inhibitors; varying response of African Americans to different agents within drug classes; and the role of mineralocorticoid receptor antagonists.</p><p><strong>Conclusion: </strong>Further studies are needed in order for consensus guidelines to clarify how best to treat this population.</p>","PeriodicalId":23035,"journal":{"name":"Therapeutic Advances in Cardiovascular Disease","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1753944719840192","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37406539","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-01-01DOI: 10.1177/1753944719826420
Kenan Yalta, Orkide Palabiyik, Muhammet Gurdogan, Yekta Gurlertop
Over recent decades, the prevalence of aortic valve stenosis (AVS) has been constantly increasing possibly owing to the aging of general population. Severe AVS as determined by an aortic valve area (AVA) of <1 cm2 has been regarded as a serious clinical condition potentially associated with a variety of adverse outcomes, including sudden cardiac death (SCD). However, patients with severe AVS (in the absence of overt high-risk features) are usually evaluated and managed exclusively based on symptomatology or imperfect prognostic tools including exercise testing and biomarkers, with a potential risk of mismanagement, suggesting the need for further objective risk stratifiers in this setting. Within this context, copeptin (C-terminal pro-vasopressin), a novel neurohormone widely considered as the surrogate marker of the arginine-vasopressin (AVP) system, may potentially serve as a reliable prognostic and therapeutic guide (e.g. timing of aortic valvular intervention) in patients with severe AVS largely based on its hemodynamic, fibrogenic as well as autonomic implications in these patients. Accordingly, the present paper aims to discuss clinical and pathophysiological implications of copeptin in the setting of AVS along with a summary of biomarkers and other prognostic tools used in this setting.
{"title":"Serum copeptin might improve risk stratification and management of aortic valve stenosis: a review of pathophysiological insights and practical implications.","authors":"Kenan Yalta, Orkide Palabiyik, Muhammet Gurdogan, Yekta Gurlertop","doi":"10.1177/1753944719826420","DOIUrl":"https://doi.org/10.1177/1753944719826420","url":null,"abstract":"<p><p>Over recent decades, the prevalence of aortic valve stenosis (AVS) has been constantly increasing possibly owing to the aging of general population. Severe AVS as determined by an aortic valve area (AVA) of <1 cm<sup>2</sup> has been regarded as a serious clinical condition potentially associated with a variety of adverse outcomes, including sudden cardiac death (SCD). However, patients with severe AVS (in the absence of overt high-risk features) are usually evaluated and managed exclusively based on symptomatology or imperfect prognostic tools including exercise testing and biomarkers, with a potential risk of mismanagement, suggesting the need for further objective risk stratifiers in this setting. Within this context, copeptin (C-terminal pro-vasopressin), a novel neurohormone widely considered as the surrogate marker of the arginine-vasopressin (AVP) system, may potentially serve as a reliable prognostic and therapeutic guide (e.g. timing of aortic valvular intervention) in patients with severe AVS largely based on its hemodynamic, fibrogenic as well as autonomic implications in these patients. Accordingly, the present paper aims to discuss clinical and pathophysiological implications of copeptin in the setting of AVS along with a summary of biomarkers and other prognostic tools used in this setting.</p>","PeriodicalId":23035,"journal":{"name":"Therapeutic Advances in Cardiovascular Disease","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1753944719826420","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36998155","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-12-01Epub Date: 2018-10-08DOI: 10.1177/1753944718801568
Julia Merkle, Anton Sabashnikov, Antje-Christin Deppe, Mohamed Zeriouh, Johanna Maier, Carolyn Weber, Kaveh Eghbalzadeh, Georg Schlachtenberger, Olga Shostak, Ilija Djordjevic, Elmar Kuhn, Parwis B Rahmanian, Navid Madershahian, Christian Rustenbach, Oliver Liakopoulos, Yeong-Hoon Choi, Ferdinand Kuhn-Régnier, Thorsten Wahlers
Background:: Stanford A acute aortic dissection (AAD) is a life-threatening emergency associated with major morbidity and mortality. The aim of this study was to compare outcomes of three different surgical approaches in patients with Stanford A AAD.
Methods:: From January 2006 to March 2015 a total of 240 consecutive patients with diagnosed Stanford A AAD underwent elective, isolated surgical aortic repair in our centre. Patients were divided into three groups according to the extent of surgical repair: isolated replacement of the ascending aorta, hemiarch replacement and total arch replacement. Patients were followed up for up to 9 years. After univariate analysis multinomial logistic regression was performed for subgroup analysis. Baseline characteristics and endpoints as well as long-term survival were analysed.
Results:: There were no statistically significant differences among the three groups in terms of demographics and preoperative baseline and clinical characteristics. Incidence of in-hospital stroke ( p = 0.034), need for reopening due to bleeding ( p = 0.031) and in-hospital mortality ( p = 0.017) increased significantly with the extent of the surgical approach. There was no statistical difference in terms of long-term survival ( p = 0.166) among the three groups. Applying multinomial logistic regression for subgroup analysis significantly higher odds for stroke ( p = 0.023), reopening for bleeding ( p = 0.010) and in-hospital mortality ( p = 0.009) for the arch surgery group in comparison to the ascending aorta surgery group as well as significantly higher odds for stroke ( p = 0.029) for the total arch surgery group in comparison to the hemiarch surgery group were identified.
Conclusions:: With Stanford A AAD the incidence of perioperative complications increased significantly with the extent of the surgical approach. Subgroup analysis and long-term follow up in patients undergoing isolated ascending or hemiarch surgery showed a lower incidence of cerebrovascular events compared with surgery for total arch replacement.
背景:急性主动脉夹层(AAD)是一种危及生命的紧急情况,与主要发病率和死亡率相关。本研究的目的是比较三种不同手术入路治疗Stanford A - AAD患者的结果。方法:2006年1月至2015年3月,连续240例确诊为Stanford a AAD的患者在本中心接受了选择性、孤立性手术主动脉修复。根据手术修复程度将患者分为孤立升主动脉置换术组、血弓置换术组和全弓置换术组。患者随访时间长达9年。单因素分析后,采用多项逻辑回归进行亚组分析。分析基线特征和终点以及长期生存。结果:三组患者在人口统计学、术前基线及临床特征方面均无统计学差异。住院卒中发生率(p = 0.034)、因出血而重开手术的需要(p = 0.031)和住院死亡率(p = 0.017)随着手术入路的扩大而显著增加。三组患者的长期生存率比较,差异无统计学意义(p = 0.166)。应用多项logistic回归对亚组分析发现,与升主动脉手术组相比,足弓手术组卒中(p = 0.023)、因出血重新开业(p = 0.010)和住院死亡率(p = 0.009)的几率显著较高,而全足弓手术组卒中的几率显著高于足弓手术组(p = 0.029)。结论:Stanford A AAD围手术期并发症的发生率随手术入路的扩大而明显增加。亚组分析和长期随访显示,与全弓置换术相比,接受孤立升弓或血弓手术的患者脑血管事件发生率较低。
{"title":"Impact of ascending aortic, hemiarch and arch repair on early and long-term outcomes in patients with Stanford A acute aortic dissection.","authors":"Julia Merkle, Anton Sabashnikov, Antje-Christin Deppe, Mohamed Zeriouh, Johanna Maier, Carolyn Weber, Kaveh Eghbalzadeh, Georg Schlachtenberger, Olga Shostak, Ilija Djordjevic, Elmar Kuhn, Parwis B Rahmanian, Navid Madershahian, Christian Rustenbach, Oliver Liakopoulos, Yeong-Hoon Choi, Ferdinand Kuhn-Régnier, Thorsten Wahlers","doi":"10.1177/1753944718801568","DOIUrl":"https://doi.org/10.1177/1753944718801568","url":null,"abstract":"<p><strong>Background:: </strong>Stanford A acute aortic dissection (AAD) is a life-threatening emergency associated with major morbidity and mortality. The aim of this study was to compare outcomes of three different surgical approaches in patients with Stanford A AAD.</p><p><strong>Methods:: </strong>From January 2006 to March 2015 a total of 240 consecutive patients with diagnosed Stanford A AAD underwent elective, isolated surgical aortic repair in our centre. Patients were divided into three groups according to the extent of surgical repair: isolated replacement of the ascending aorta, hemiarch replacement and total arch replacement. Patients were followed up for up to 9 years. After univariate analysis multinomial logistic regression was performed for subgroup analysis. Baseline characteristics and endpoints as well as long-term survival were analysed.</p><p><strong>Results:: </strong>There were no statistically significant differences among the three groups in terms of demographics and preoperative baseline and clinical characteristics. Incidence of in-hospital stroke ( p = 0.034), need for reopening due to bleeding ( p = 0.031) and in-hospital mortality ( p = 0.017) increased significantly with the extent of the surgical approach. There was no statistical difference in terms of long-term survival ( p = 0.166) among the three groups. Applying multinomial logistic regression for subgroup analysis significantly higher odds for stroke ( p = 0.023), reopening for bleeding ( p = 0.010) and in-hospital mortality ( p = 0.009) for the arch surgery group in comparison to the ascending aorta surgery group as well as significantly higher odds for stroke ( p = 0.029) for the total arch surgery group in comparison to the hemiarch surgery group were identified.</p><p><strong>Conclusions:: </strong>With Stanford A AAD the incidence of perioperative complications increased significantly with the extent of the surgical approach. Subgroup analysis and long-term follow up in patients undergoing isolated ascending or hemiarch surgery showed a lower incidence of cerebrovascular events compared with surgery for total arch replacement.</p>","PeriodicalId":23035,"journal":{"name":"Therapeutic Advances in Cardiovascular Disease","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2018-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1753944718801568","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36564896","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-12-01Epub Date: 2018-10-08DOI: 10.1177/1753944718803309
Rafael Inácio Brandão, Ricardo Zanetti Gomes, Luana Lopes, Filipe Silva Linhares, José Carlos Rebuglio Vellosa, Katia Sabrina Paludo
Background:: The aim of this study was to evaluate the effects of the antioxidant allopurinol and ischemic post-conditioning on the deleterious effects of ischemia followed by reperfusion (I/R) in a standardized model of ischemia involving infra-renal aortic occlusion in rats.
Methods:: The animals were randomly divided into five groups: (A) animals not subjected to ischemia; (B) animals subjected to 2 h of ischemia and reperfusion only once; (C) animals given an allopurinol dose by gavage, then subjected to 2 h of ischemia and reperfusion only once; (D) animals subjected to 2 h of ischemia and post-conditioning and (E) animals that received allopurinol, then subjected to 2 h of ischemia and post-conditioning. The blood samples and small intestine segments were harvested for analysis after 3 days.
Results:: The protective effects of the use of allopurinol and ischemic post-conditioning were observed by measuring aspartate aminotransferase, alanine aminotransferase and lactate levels. The benefits of post-conditioning were evident from the total antioxidant capacity and creatinine levels, but these could not ascertain any positive effects of allopurinol. The histological analysis of mesentery revealed that both methods were effective in minimizing the harmful effects of the ischemia and reperfusion process.
Conclusion:: Individual protocols significantly reduced I/R systemic injuries, but no additional protection was observed when the two strategies were combined.
{"title":"Remote post-conditioning and allopurinol reduce ischemia-reperfusion injury in an infra-renal ischemia model.","authors":"Rafael Inácio Brandão, Ricardo Zanetti Gomes, Luana Lopes, Filipe Silva Linhares, José Carlos Rebuglio Vellosa, Katia Sabrina Paludo","doi":"10.1177/1753944718803309","DOIUrl":"https://doi.org/10.1177/1753944718803309","url":null,"abstract":"<p><strong>Background:: </strong>The aim of this study was to evaluate the effects of the antioxidant allopurinol and ischemic post-conditioning on the deleterious effects of ischemia followed by reperfusion (I/R) in a standardized model of ischemia involving infra-renal aortic occlusion in rats.</p><p><strong>Methods:: </strong>The animals were randomly divided into five groups: (A) animals not subjected to ischemia; (B) animals subjected to 2 h of ischemia and reperfusion only once; (C) animals given an allopurinol dose by gavage, then subjected to 2 h of ischemia and reperfusion only once; (D) animals subjected to 2 h of ischemia and post-conditioning and (E) animals that received allopurinol, then subjected to 2 h of ischemia and post-conditioning. The blood samples and small intestine segments were harvested for analysis after 3 days.</p><p><strong>Results:: </strong>The protective effects of the use of allopurinol and ischemic post-conditioning were observed by measuring aspartate aminotransferase, alanine aminotransferase and lactate levels. The benefits of post-conditioning were evident from the total antioxidant capacity and creatinine levels, but these could not ascertain any positive effects of allopurinol. The histological analysis of mesentery revealed that both methods were effective in minimizing the harmful effects of the ischemia and reperfusion process.</p><p><strong>Conclusion:: </strong>Individual protocols significantly reduced I/R systemic injuries, but no additional protection was observed when the two strategies were combined.</p>","PeriodicalId":23035,"journal":{"name":"Therapeutic Advances in Cardiovascular Disease","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2018-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1753944718803309","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36565598","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-12-01Epub Date: 2018-09-30DOI: 10.1177/1753944718801554
Arthur Bracey, Wassim Shatila, James Wilson
In optimizing anticoagulation therapy, it is essential to balance treatment efficacy with the major adverse effect of anticoagulant treatment, bleeding risk. This narrative review examines the efficacy and safety of the non-vitamin K antagonist oral anticoagulants (NOACs) dabigatran, rivaroxaban, apixaban, and edoxaban compared with standard anticoagulation or placebo. NOAC therapies provide equivalent to superior protection versus standard therapy, with similar or superior safety, and potential benefits in convenience. We will review the phase III evidence for each of the available NOACs in different antithrombotic indications, including atrial fibrillation (in the absence of significant mitral stenosis or mechanical heart valves); prophylaxis of venous thromboembolism (VTE) in patients undergoing orthopedic surgery; and acute and long-term treatment of VTE. Further, we will illustrate scenarios in which the evidence is stronger for a particular agent in the context of the overall positive safety and efficacy profile of NOACs in general. Limitations of the factor Xa inhibitors include the lack of a specific antidote in case of a bleeding emergency (an approved agent is available for reversing the effect of the direct thrombin inhibitor). We discuss the options for mitigating bleeding and describe the ongoing developments towards specific reversal agents. In conclusion, the available data for efficacy and safety, together with reliable pharmacokinetics obviating the need for regular monitoring, indicate that NOACs may offer substantial benefits for patients with nonvalvular atrial fibrillation or VTE.
{"title":"Bleeding in patients receiving non-vitamin K oral anticoagulants: clinical trial evidence.","authors":"Arthur Bracey, Wassim Shatila, James Wilson","doi":"10.1177/1753944718801554","DOIUrl":"https://doi.org/10.1177/1753944718801554","url":null,"abstract":"<p><p>In optimizing anticoagulation therapy, it is essential to balance treatment efficacy with the major adverse effect of anticoagulant treatment, bleeding risk. This narrative review examines the efficacy and safety of the non-vitamin K antagonist oral anticoagulants (NOACs) dabigatran, rivaroxaban, apixaban, and edoxaban compared with standard anticoagulation or placebo. NOAC therapies provide equivalent to superior protection versus standard therapy, with similar or superior safety, and potential benefits in convenience. We will review the phase III evidence for each of the available NOACs in different antithrombotic indications, including atrial fibrillation (in the absence of significant mitral stenosis or mechanical heart valves); prophylaxis of venous thromboembolism (VTE) in patients undergoing orthopedic surgery; and acute and long-term treatment of VTE. Further, we will illustrate scenarios in which the evidence is stronger for a particular agent in the context of the overall positive safety and efficacy profile of NOACs in general. Limitations of the factor Xa inhibitors include the lack of a specific antidote in case of a bleeding emergency (an approved agent is available for reversing the effect of the direct thrombin inhibitor). We discuss the options for mitigating bleeding and describe the ongoing developments towards specific reversal agents. In conclusion, the available data for efficacy and safety, together with reliable pharmacokinetics obviating the need for regular monitoring, indicate that NOACs may offer substantial benefits for patients with nonvalvular atrial fibrillation or VTE.</p>","PeriodicalId":23035,"journal":{"name":"Therapeutic Advances in Cardiovascular Disease","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2018-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1753944718801554","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36538434","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-12-01Epub Date: 2018-11-15DOI: 10.1177/1753944718809266
Talal Alzahrani, John Tiu, Gurusher Panjrath, Allen Solomon
Background:: There have been significant advances in the treatment of patients with cardiomyopathy with reduced ejection fraction (EF < 40%). However, there is a dearth of information in the treatment of patients with cardiomyopathy and midrange EF (40-50%). Current guidelines state to treat these patients similarly to patients with cardiomyopathy and preserved EF. Data from the Prevention of Events with Angiotensin-Converting Enzyme Inhibition (PEACE) trial were used to elucidate whether angiotensin-converting enzyme (ACE) inhibitors improve clinical outcomes in patients with ischemic cardiomyopathy and midrange EF.
Methods:: A post hoc subgroup analysis of the PEACE trial was conducted to evaluate the effect of ACE inhibitors in a subgroup of patients with ischemic cardiomyopathy and midrange EF (40-50%). A Chi-square test and a Student's t-test were used to examine and compare the binary and continuous variables of baseline characteristics and outcomes between experimental and comparison groups.
Results:: We studied a subgroup of patients from the PEACE trial with ischemic cardiomyopathy and midrange EF ( n = 2512 of 8290 total patients). Patients were assigned to either the interventional group ( n = 1247) or the placebo group ( n = 1265). There were no significant differences in baseline demographic and health characteristics between the two groups. During a total of 7 years (mean 4.7 years) of follow up, the risk of composite outcomes [all-cause mortality, nonfatal myocardial infarction, and stroke; relative risk (RR) 0.79, 95% confidence interval (CI) 0.63-0.98; p = 0.03] and all-cause mortality (RR 0.85, 95% CI 0.73-0.99; p = 0.03) was reduced in patients treated with trandolapril.
Conclusion:: This study revealed the benefit of ACE inhibitors among patients with ischemic cardiomyopathy and midrange EF.
{"title":"The effect of angiotensin-converting enzyme inhibitors on clinical outcomes in patients with ischemic cardiomyopathy and midrange ejection fraction: a post hoc subgroup analysis from the PEACE trial.","authors":"Talal Alzahrani, John Tiu, Gurusher Panjrath, Allen Solomon","doi":"10.1177/1753944718809266","DOIUrl":"https://doi.org/10.1177/1753944718809266","url":null,"abstract":"<p><strong>Background:: </strong>There have been significant advances in the treatment of patients with cardiomyopathy with reduced ejection fraction (EF < 40%). However, there is a dearth of information in the treatment of patients with cardiomyopathy and midrange EF (40-50%). Current guidelines state to treat these patients similarly to patients with cardiomyopathy and preserved EF. Data from the Prevention of Events with Angiotensin-Converting Enzyme Inhibition (PEACE) trial were used to elucidate whether angiotensin-converting enzyme (ACE) inhibitors improve clinical outcomes in patients with ischemic cardiomyopathy and midrange EF.</p><p><strong>Methods:: </strong>A post hoc subgroup analysis of the PEACE trial was conducted to evaluate the effect of ACE inhibitors in a subgroup of patients with ischemic cardiomyopathy and midrange EF (40-50%). A Chi-square test and a Student's t-test were used to examine and compare the binary and continuous variables of baseline characteristics and outcomes between experimental and comparison groups.</p><p><strong>Results:: </strong>We studied a subgroup of patients from the PEACE trial with ischemic cardiomyopathy and midrange EF ( n = 2512 of 8290 total patients). Patients were assigned to either the interventional group ( n = 1247) or the placebo group ( n = 1265). There were no significant differences in baseline demographic and health characteristics between the two groups. During a total of 7 years (mean 4.7 years) of follow up, the risk of composite outcomes [all-cause mortality, nonfatal myocardial infarction, and stroke; relative risk (RR) 0.79, 95% confidence interval (CI) 0.63-0.98; p = 0.03] and all-cause mortality (RR 0.85, 95% CI 0.73-0.99; p = 0.03) was reduced in patients treated with trandolapril.</p><p><strong>Conclusion:: </strong>This study revealed the benefit of ACE inhibitors among patients with ischemic cardiomyopathy and midrange EF.</p>","PeriodicalId":23035,"journal":{"name":"Therapeutic Advances in Cardiovascular Disease","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2018-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1753944718809266","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36673205","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-12-01Epub Date: 2018-09-23DOI: 10.1177/1753944718801559
Payman Majd, Navid Madershahian, Anton Sabashnikov, Carolyn Weber, Wael Ahmad, Alexander Weymann, Stephanie Heinen, Julia Merkle, Kaveh Eghbalzadeh, Jens Wippermann, Jan Brunkwall, Thorsten Wahlers
Background:: There is still much controversy about whether meteorological conditions influence the occurrence of acute aortic dissection (AAD). The aim of the present study was to investigate the possible correlation between atmospheric pressure, temperature, lunar cycle and the event of aortic dissection in our patient population.
Methods:: The clinical data for 348 patients with AAD (73% type Stanford A) were confronted with the meteorological data provided by the Cologne weather station over the same period.
Results:: There were no statistically significant differences between meteorological parameters on days of AAD events compared with control days. A logistic regression model showed that air pressure (odds ratio [OR] 1.004, 95% confidence interval [CI] 0.991-1.017, p = 0.542), air temperature (OR 0.978, 95% CI 0.949-1.008, p = 0.145), season ( p = 0.918) and month of the event ( p = 0.175) as well as presence of full moon (OR 1.579, 95% CI 0.763-3.270, p = 0.219) were not able to predict AAD events. Also, no predictive power of meteorological data and season was found on analysing their impact on different types of AAD events.
Conclusions:: Our study did not reveal any dependence of atmospheric pressure, air temperature or the presence of full moon on the incidence of different types of AAD.
背景:关于气象条件是否影响急性主动脉夹层(AAD)的发生,目前仍有很多争议。本研究的目的是探讨大气压、温度、月亮周期与我们患者中主动脉夹层事件之间可能的相关性。方法:将348例AAD患者(73%为Stanford A型)的临床资料与科隆气象站同期提供的气象资料进行比对。结果:与对照日相比,AAD事件发生日气象参数间差异无统计学意义。logistic回归模型显示气压(比值比[OR] 1.004, 95%可信区间[CI] 0.991-1.017, p = 0.542)、气温(比值比[OR] 0.978, 95% CI 0.949-1.008, p = 0.145)、季节(p = 0.918)和事件发生的月份(p = 0.175)以及满月(比值比[OR] 1.579, 95% CI 0.763-3.270, p = 0.219)不能预测AAD事件。此外,在分析气象资料和季节对不同类型AAD事件的影响时,没有发现气象资料和季节的预测能力。结论:我们的研究没有发现气压、气温或满月的存在与不同类型AAD的发病率有任何关系。
{"title":"Impact of meteorological conditions on the incidence of acute aortic dissection.","authors":"Payman Majd, Navid Madershahian, Anton Sabashnikov, Carolyn Weber, Wael Ahmad, Alexander Weymann, Stephanie Heinen, Julia Merkle, Kaveh Eghbalzadeh, Jens Wippermann, Jan Brunkwall, Thorsten Wahlers","doi":"10.1177/1753944718801559","DOIUrl":"https://doi.org/10.1177/1753944718801559","url":null,"abstract":"<p><strong>Background:: </strong>There is still much controversy about whether meteorological conditions influence the occurrence of acute aortic dissection (AAD). The aim of the present study was to investigate the possible correlation between atmospheric pressure, temperature, lunar cycle and the event of aortic dissection in our patient population.</p><p><strong>Methods:: </strong>The clinical data for 348 patients with AAD (73% type Stanford A) were confronted with the meteorological data provided by the Cologne weather station over the same period.</p><p><strong>Results:: </strong>There were no statistically significant differences between meteorological parameters on days of AAD events compared with control days. A logistic regression model showed that air pressure (odds ratio [OR] 1.004, 95% confidence interval [CI] 0.991-1.017, p = 0.542), air temperature (OR 0.978, 95% CI 0.949-1.008, p = 0.145), season ( p = 0.918) and month of the event ( p = 0.175) as well as presence of full moon (OR 1.579, 95% CI 0.763-3.270, p = 0.219) were not able to predict AAD events. Also, no predictive power of meteorological data and season was found on analysing their impact on different types of AAD events.</p><p><strong>Conclusions:: </strong>Our study did not reveal any dependence of atmospheric pressure, air temperature or the presence of full moon on the incidence of different types of AAD.</p>","PeriodicalId":23035,"journal":{"name":"Therapeutic Advances in Cardiovascular Disease","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2018-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1753944718801559","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36514420","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-12-01Epub Date: 2018-09-20DOI: 10.1177/1753944718792420
Bart Hiemstra, Remco Bergman, Anthony R Absalom, Joukje van der Naalt, Pim van der Harst, Ronald de Vos, Wybe Nieuwland, Maarten W Nijsten, Iwan C C van der Horst
Background:: Over the past decade, prehospital and in-hospital treatment for out-of-hospital cardiac arrest (OHCA) has improved considerably. There are sparse data on the long-term outcome, especially in elderly patients. We studied whether elderly patients benefit to the same extent compared with younger patients and at long-term follow up as compared with the general population.
Methods:: Between 2001 and 2010, data from all patients presented to our hospital after OHCA were recorded. Elderly patients (⩾75 years) were compared with younger patients. Neurological outcome was classified as cerebral performance category (CPC) at hospital discharge and long-term survival was compared with younger patients and predicted survival rates of the general population.
Results:: Of the 810 patients admitted after OHCA, a total of 551 patients (68%) achieved return of spontaneous circulation, including 125 (23%) elderly patients with a mean age of 81 ± 5 years. In-hospital survival was lower in elderly patients compared with younger patients with rates of 33% versus 57% ( p < 0.001). A CPC of 1 was present in 73% of the elderly patients versus 86% of the younger patients ( p = 0.031). In 7.3% of the elderly patients, a CPC >2 was observed versus 2.5% of their younger counterparts ( p = 0.103). Elderly patients had a median survival of 6.5 [95% confidence interval (CI) 2.0-7.9] years compared with 7.7 (95% CI 7.5-7.9) years of the general population ( p = 0.019).
Conclusions:: The survival rate after OHCA in elderly patients is approximately half that of younger patients. Elderly patients who survive to discharge frequently have favorable neurological outcomes and a long-term survival that approximates that of the general population.
{"title":"Long-term outcome of elderly out-of-hospital cardiac arrest survivors as compared with their younger counterparts and the general population.","authors":"Bart Hiemstra, Remco Bergman, Anthony R Absalom, Joukje van der Naalt, Pim van der Harst, Ronald de Vos, Wybe Nieuwland, Maarten W Nijsten, Iwan C C van der Horst","doi":"10.1177/1753944718792420","DOIUrl":"10.1177/1753944718792420","url":null,"abstract":"<p><strong>Background:: </strong>Over the past decade, prehospital and in-hospital treatment for out-of-hospital cardiac arrest (OHCA) has improved considerably. There are sparse data on the long-term outcome, especially in elderly patients. We studied whether elderly patients benefit to the same extent compared with younger patients and at long-term follow up as compared with the general population.</p><p><strong>Methods:: </strong>Between 2001 and 2010, data from all patients presented to our hospital after OHCA were recorded. Elderly patients (⩾75 years) were compared with younger patients. Neurological outcome was classified as cerebral performance category (CPC) at hospital discharge and long-term survival was compared with younger patients and predicted survival rates of the general population.</p><p><strong>Results:: </strong>Of the 810 patients admitted after OHCA, a total of 551 patients (68%) achieved return of spontaneous circulation, including 125 (23%) elderly patients with a mean age of 81 ± 5 years. In-hospital survival was lower in elderly patients compared with younger patients with rates of 33% versus 57% ( p < 0.001). A CPC of 1 was present in 73% of the elderly patients versus 86% of the younger patients ( p = 0.031). In 7.3% of the elderly patients, a CPC >2 was observed versus 2.5% of their younger counterparts ( p = 0.103). Elderly patients had a median survival of 6.5 [95% confidence interval (CI) 2.0-7.9] years compared with 7.7 (95% CI 7.5-7.9) years of the general population ( p = 0.019).</p><p><strong>Conclusions:: </strong>The survival rate after OHCA in elderly patients is approximately half that of younger patients. Elderly patients who survive to discharge frequently have favorable neurological outcomes and a long-term survival that approximates that of the general population.</p>","PeriodicalId":23035,"journal":{"name":"Therapeutic Advances in Cardiovascular Disease","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2018-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/17/e6/10.1177_1753944718792420.PMC6266245.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36501724","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-11-01Epub Date: 2018-09-19DOI: 10.1177/1753944718798345
Kaveh Eghbalzadeh, Anton Sabashnikov, Carolyn Weber, Mohamed Zeriouh, Ilija Djordjevic, Julia Merkle, Olga Shostak, Sergey Saenko, Payman Majd, Oliver Liakopoulos, Parwis B Rahmanian, Navid Madershahian, Yeong-Hoon Choi, Ferdinand Kuhn-Régnier, Jens Wippermann, Thorsten Wahlers
Background: The aim of the present study was to determine whether raised preoperative serum creatinine affected the long-term outcome in patients undergoing surgical aortic repair for Stanford A acute aortic dissection (AAD).
Methods: A total of 240 patients diagnosed with Stanford A AAD underwent surgical repair from January 2006 to April 2015. A propensity score matching was applied, resulting in 73 pairs consisting of one group with normal and one group with preoperative elevated creatinine levels. The cohorts were well balanced for baseline and preoperative clinical characteristics. Both groups were compared regarding their early postoperative variables, as well as estimated survival with up to 9-year follow up. Also, the impact of acute postoperative kidney injury and its severity on long-term survival was analyzed.
Results: The proportion of patients suffering Stanford A AAD with raised creatinine levels was 31.3% ( n = 75). After propensity matching, there were no statistically significant differences regarding demographics, comorbidities, preoperative baseline and clinical characteristics. Postoperatively matched patients with elevated creatinine had longer intensive care unit ( p < 0.001) and total hospital stay ( p = 0.002), prolonged intubation times ( p = 0.014), higher need for hemofiltration ( p < 0.001), higher incidence of temporary neurological disorders ( p = 0.16), infection ( p = 0.005), and trend toward higher incidence of sepsis ( p = 0.097). However, there were no significant differences regarding 30-day mortality (20.5% versus 20.5%, p = 1.000) and long-term overall survival. Further, neither the incidence nor the different stages of acute kidney injury according to the Acute Kidney Injury Network showed any statistically significant differences in terms of long-term survival for both groups [log rank p = 0.636, Breslow (generalized Wilcoxon) p = 0.470, Tarone-Ware p = 0.558].
Conclusions: Patients with elevated creatinine levels undergoing surgical repair for Stanford A AAD demonstrate higher rate of early postoperative complications. However, 30-day mortality and long-term survival in this patient cohort is not significantly impaired.
背景:本研究的目的是确定术前血清肌酐升高是否影响Stanford A急性主动脉夹层(AAD)手术主动脉修复患者的长期预后。方法:2006年1月至2015年4月,240例确诊为Stanford A AAD的患者行手术修复。采用倾向评分匹配,得到73对,包括一组正常和一组术前肌酐水平升高。这些队列在基线和术前临床特征上都得到了很好的平衡。比较两组患者的术后早期变量,以及长达9年随访的估计生存率。分析术后急性肾损伤及其严重程度对长期生存的影响。结果:Stanford A AAD患者肌酐水平升高的比例为31.3% (n = 75)。倾向匹配后,两组在人口统计学、合并症、术前基线和临床特征方面无统计学差异。术后肌酐升高的匹配患者重症监护时间(p < 0.001)和总住院时间(p = 0.002)更长,插管时间延长(p = 0.014),血液滤过需求增加(p < 0.001),暂时性神经功能障碍发生率增加(p = 0.16),感染发生率增加(p = 0.005),脓毒症发生率增加(p = 0.097)。然而,30天死亡率(20.5%对20.5%,p = 1.000)和长期总生存率没有显著差异。此外,根据急性肾损伤网络,两组急性肾损伤的发生率和不同阶段在长期生存方面均无统计学差异[log rank p = 0.636, Breslow (generalized Wilcoxon) p = 0.470, Tarone-Ware p = 0.558]。结论:肌酐水平升高的Stanford A AAD手术修复患者术后早期并发症发生率较高。然而,该患者队列的30天死亡率和长期生存率没有明显受损。
{"title":"Impact of preoperative elevated serum creatinine on long-term outcome of patients undergoing aortic repair with Stanford A dissection: a retrospective matched pair analysis.","authors":"Kaveh Eghbalzadeh, Anton Sabashnikov, Carolyn Weber, Mohamed Zeriouh, Ilija Djordjevic, Julia Merkle, Olga Shostak, Sergey Saenko, Payman Majd, Oliver Liakopoulos, Parwis B Rahmanian, Navid Madershahian, Yeong-Hoon Choi, Ferdinand Kuhn-Régnier, Jens Wippermann, Thorsten Wahlers","doi":"10.1177/1753944718798345","DOIUrl":"https://doi.org/10.1177/1753944718798345","url":null,"abstract":"<p><strong>Background: </strong>The aim of the present study was to determine whether raised preoperative serum creatinine affected the long-term outcome in patients undergoing surgical aortic repair for Stanford A acute aortic dissection (AAD).</p><p><strong>Methods: </strong>A total of 240 patients diagnosed with Stanford A AAD underwent surgical repair from January 2006 to April 2015. A propensity score matching was applied, resulting in 73 pairs consisting of one group with normal and one group with preoperative elevated creatinine levels. The cohorts were well balanced for baseline and preoperative clinical characteristics. Both groups were compared regarding their early postoperative variables, as well as estimated survival with up to 9-year follow up. Also, the impact of acute postoperative kidney injury and its severity on long-term survival was analyzed.</p><p><strong>Results: </strong>The proportion of patients suffering Stanford A AAD with raised creatinine levels was 31.3% ( n = 75). After propensity matching, there were no statistically significant differences regarding demographics, comorbidities, preoperative baseline and clinical characteristics. Postoperatively matched patients with elevated creatinine had longer intensive care unit ( p < 0.001) and total hospital stay ( p = 0.002), prolonged intubation times ( p = 0.014), higher need for hemofiltration ( p < 0.001), higher incidence of temporary neurological disorders ( p = 0.16), infection ( p = 0.005), and trend toward higher incidence of sepsis ( p = 0.097). However, there were no significant differences regarding 30-day mortality (20.5% versus 20.5%, p = 1.000) and long-term overall survival. Further, neither the incidence nor the different stages of acute kidney injury according to the Acute Kidney Injury Network showed any statistically significant differences in terms of long-term survival for both groups [log rank p = 0.636, Breslow (generalized Wilcoxon) p = 0.470, Tarone-Ware p = 0.558].</p><p><strong>Conclusions: </strong>Patients with elevated creatinine levels undergoing surgical repair for Stanford A AAD demonstrate higher rate of early postoperative complications. However, 30-day mortality and long-term survival in this patient cohort is not significantly impaired.</p>","PeriodicalId":23035,"journal":{"name":"Therapeutic Advances in Cardiovascular Disease","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2018-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1753944718798345","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36503044","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-11-01Epub Date: 2018-08-15DOI: 10.1177/1753944718792413
Eduardo M Vilela, Catarina Ruivo, Claudio E Guerreiro, Marisa P Silva, Ricardo Ladeiras-Lopes, Daniel Caeiro, Gustavo P Morais, João Primo, Pedro Braga, Nuno Ferreira, José Pedro L Nunes, Vasco Gama Ribeiro
Background: Pericardial effusion (PE) can develop in several pathological scenarios, and is often initially evaluated by means of echocardiography. Computed tomography (CT) has been used as an aid in the management of patients presenting with PE, in selected cases. The role of CT-guided pericardiocentesis in contemporary practice, however, remains not fully ascertained. We aimed at presenting a systematic review concerning the state-of-the-art of this technique. Methods: A systematic review of published data on the use of CT for guiding pericardiocentesis was carried out (search performed on PubMed, ISI Web of Knowledge and Scopus databases). Results: From title and abstract analysis, 14 articles were included that met the prespecified criteria. After full-text analysis, six articles were excluded. The eight articles under analysis included a total of 635 procedures performed in 571 patients. CT guidance was mostly used in a postoperative setting (364 procedures). Most procedures were done mainly for therapeutic purposes (528 procedures). Success rates ranged from 94% to 100%. Complications ranged from 0% to 7.8%. Conclusion: CT-guided pericardiocentesis is a useful technique in the approach to PE, in several clinical scenarios. Its use can be especially relevant in the postoperative period, as well as in individuals with suboptimal image quality (as assessed by echocardiography, for the moment the first choice in the approach to most cases of PE).
背景:心包积液(PE)可在多种病理情况下发生,通常通过超声心动图进行初步评估。计算机断层扫描(CT)已被用作辅助管理的病人提出PE,在选定的情况下。然而,ct引导下的心包穿刺术在当代实践中的作用仍未完全确定。我们的目的是对这项技术的最新进展进行系统的综述。方法:对已发表的使用CT指导心包穿刺术的数据进行系统回顾(在PubMed、ISI Web of Knowledge和Scopus数据库中进行检索)。结果:通过题目和摘要分析,纳入符合预定标准的文献14篇。经过全文分析,排除了6篇文章。所分析的8篇文章包括571例患者的635例手术。CT引导主要用于术后设置(364例)。大多数手术主要是为了治疗目的(528例)。成功率从94%到100%不等。并发症从0%到7.8%不等。结论:在一些临床情况下,ct引导下心包穿刺是一种有用的PE入路技术。它的使用尤其适用于术后,以及图像质量不佳的个体(通过超声心动图评估,目前是大多数PE病例的首选方法)。
{"title":"Computed tomography-guided pericardiocentesis: a systematic review concerning contemporary evidence and future perspectives.","authors":"Eduardo M Vilela, Catarina Ruivo, Claudio E Guerreiro, Marisa P Silva, Ricardo Ladeiras-Lopes, Daniel Caeiro, Gustavo P Morais, João Primo, Pedro Braga, Nuno Ferreira, José Pedro L Nunes, Vasco Gama Ribeiro","doi":"10.1177/1753944718792413","DOIUrl":"https://doi.org/10.1177/1753944718792413","url":null,"abstract":"Background: Pericardial effusion (PE) can develop in several pathological scenarios, and is often initially evaluated by means of echocardiography. Computed tomography (CT) has been used as an aid in the management of patients presenting with PE, in selected cases. The role of CT-guided pericardiocentesis in contemporary practice, however, remains not fully ascertained. We aimed at presenting a systematic review concerning the state-of-the-art of this technique. Methods: A systematic review of published data on the use of CT for guiding pericardiocentesis was carried out (search performed on PubMed, ISI Web of Knowledge and Scopus databases). Results: From title and abstract analysis, 14 articles were included that met the prespecified criteria. After full-text analysis, six articles were excluded. The eight articles under analysis included a total of 635 procedures performed in 571 patients. CT guidance was mostly used in a postoperative setting (364 procedures). Most procedures were done mainly for therapeutic purposes (528 procedures). Success rates ranged from 94% to 100%. Complications ranged from 0% to 7.8%. Conclusion: CT-guided pericardiocentesis is a useful technique in the approach to PE, in several clinical scenarios. Its use can be especially relevant in the postoperative period, as well as in individuals with suboptimal image quality (as assessed by echocardiography, for the moment the first choice in the approach to most cases of PE).","PeriodicalId":23035,"journal":{"name":"Therapeutic Advances in Cardiovascular Disease","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2018-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1753944718792413","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36400822","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}