Pub Date : 2020-01-01DOI: 10.1177/1753944720912071
Javier Mariani, Andrés Rosende, Maximiliano De Abreu, Gabriel Gonzalez Villa Monte, Heraldo D'Imperio, Laura Antonietti, Gabriela Lemonnier, Alejandra de Bonis, Carlos Tajer
Background: Adherence to treatment after a myocardial infarction (MI) is poor, even in the early postinfarction period. Combining evidence-based drugs into a multicap could improve adherence in this population. No previous randomized trial assessing fixed-dose combination therapy has included patients early after a MI. We aimed to assess if a multicap containing four secondary prevention drugs increases adherence to treatment at 6 months after MI hospitalization. The study was designed as a randomized, parallel, open-label, controlled trial.
Methods: Patients were randomized within 7 days of a MI to either multicap or control group. The multicap group received a capsule containing aspirin, atenolol, ramipril, and simvastatin. The control group received each drug in separate pills. The primary outcome was adherence at 6 months. We also measured blood pressure, heart rate, serum cholesterol levels, C-reactive protein, and platelet aggregation.
Results: The study was stopped prematurely when 100 patients were included for futility. At 6 months, 92 (95.8%) patients were adherent to medical treatment: 98.0% in the multicap group and 93.5% in the control group [relative risk (RR) 1.05; 95% confidence interval (CI) 0.96-1.14; p = 0.347]. There were no differences between groups in systolic blood pressure (p = 0.662), diastolic blood pressure (p = 0.784), heart rate (p = 0.533), total cholesterol (p = 0.760), LDL-c (p = 0.979), C-reactive protein (p = 0.399), or in the proportion of patients with adequate platelet aggregation inhibition (p = 0.600).
Conclusions: The study did not find any improvement in the adherence at 6 months after a MI with a multicap-based strategy (Multicap for Increase Adherence After Acute Myocardial Infarction; [ ClinicalTrials.gov identifier: NCT02271178]).
{"title":"Multicap to improve adherence after acute coronary syndromes: results of a randomized controlled clinical trial.","authors":"Javier Mariani, Andrés Rosende, Maximiliano De Abreu, Gabriel Gonzalez Villa Monte, Heraldo D'Imperio, Laura Antonietti, Gabriela Lemonnier, Alejandra de Bonis, Carlos Tajer","doi":"10.1177/1753944720912071","DOIUrl":"10.1177/1753944720912071","url":null,"abstract":"<p><strong>Background: </strong>Adherence to treatment after a myocardial infarction (MI) is poor, even in the early postinfarction period. Combining evidence-based drugs into a multicap could improve adherence in this population. No previous randomized trial assessing fixed-dose combination therapy has included patients early after a MI. We aimed to assess if a multicap containing four secondary prevention drugs increases adherence to treatment at 6 months after MI hospitalization. The study was designed as a randomized, parallel, open-label, controlled trial.</p><p><strong>Methods: </strong>Patients were randomized within 7 days of a MI to either multicap or control group. The multicap group received a capsule containing aspirin, atenolol, ramipril, and simvastatin. The control group received each drug in separate pills. The primary outcome was adherence at 6 months. We also measured blood pressure, heart rate, serum cholesterol levels, C-reactive protein, and platelet aggregation.</p><p><strong>Results: </strong>The study was stopped prematurely when 100 patients were included for futility. At 6 months, 92 (95.8%) patients were adherent to medical treatment: 98.0% in the multicap group and 93.5% in the control group [relative risk (RR) 1.05; 95% confidence interval (CI) 0.96-1.14; <i>p</i> = 0.347]. There were no differences between groups in systolic blood pressure (<i>p</i> = 0.662), diastolic blood pressure (<i>p</i> = 0.784), heart rate (<i>p</i> = 0.533), total cholesterol (<i>p</i> = 0.760), LDL-c (<i>p</i> = 0.979), C-reactive protein (<i>p</i> = 0.399), or in the proportion of patients with adequate platelet aggregation inhibition (<i>p</i> = 0.600).</p><p><strong>Conclusions: </strong>The study did not find any improvement in the adherence at 6 months after a MI with a multicap-based strategy (Multicap for Increase Adherence After Acute Myocardial Infarction; [ ClinicalTrials.gov identifier: NCT02271178]).</p>","PeriodicalId":23035,"journal":{"name":"Therapeutic Advances in Cardiovascular Disease","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/11/52/10.1177_1753944720912071.PMC7081461.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37748631","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 : 2020-01-01DOI: 10.1177/1753944720926824
Mikayla Muzzey, Katie B Tellor, Karthik Ramaswamy, Martin Schwarze, Anastasia L Armbruster
Introduction: Current atrial fibrillation (AF) guidelines recommend flecainide as a first-line rhythm control option in patients without structural heart disease. While there is proven efficacy in clinical trials and guideline support, it is hypothesized that flecainide may be underutilized due to negative outcomes in the CAST trial and that adverse effects are less common than previously perceived.
Methods: This retrospective chart review evaluated patients ⩾18 years initiated on flecainide for AF from August 2011 to October 2016 by a cardiology provider at the study site. Exclusion criteria included: <5 days of flecainide therapy, AF due to a reversible cause, and inadequate documentation. The primary outcome was efficacy of flecainide at maintaining symptomatic control at 6 and 12 months. Secondary outcomes included characterization of alterations in rhythm control strategies and documented normal sinus rhythm per electrocardiogram at 6 and 12 months.
Results: Of the 326 patients identified, 144 patients were included. After 6 and 12 months, 102 patients (70.8%) and 89 patients (61.8%) of the 144 were symptomatically controlled. Atenolol use (p = 0.024), female sex (p = 0.006), hypertension (p = 0.040), and dronedarone failure (p = 0.012) were associated with flecainide discontinuation at 6 months. At 12 months, only previous propafenone failure (p = 0.032) was significant. Of the 144 patients, 16 (11.1%) reported adverse effects with dizziness, hot flashes, bradycardia, and headache (1.4% each) being the most common.
Conclusion: Flecainide is a well-tolerated medication, even at 12 months, with very minor adverse effects. These results support the utility of flecainide in guideline recommended patient populations.
{"title":"Flecainide is well-tolerated and effective in patient with atrial fibrillation at 12 months: a retrospective study.","authors":"Mikayla Muzzey, Katie B Tellor, Karthik Ramaswamy, Martin Schwarze, Anastasia L Armbruster","doi":"10.1177/1753944720926824","DOIUrl":"https://doi.org/10.1177/1753944720926824","url":null,"abstract":"<p><strong>Introduction: </strong>Current atrial fibrillation (AF) guidelines recommend flecainide as a first-line rhythm control option in patients without structural heart disease. While there is proven efficacy in clinical trials and guideline support, it is hypothesized that flecainide may be underutilized due to negative outcomes in the CAST trial and that adverse effects are less common than previously perceived.</p><p><strong>Methods: </strong>This retrospective chart review evaluated patients ⩾18 years initiated on flecainide for AF from August 2011 to October 2016 by a cardiology provider at the study site. Exclusion criteria included: <5 days of flecainide therapy, AF due to a reversible cause, and inadequate documentation. The primary outcome was efficacy of flecainide at maintaining symptomatic control at 6 and 12 months. Secondary outcomes included characterization of alterations in rhythm control strategies and documented normal sinus rhythm per electrocardiogram at 6 and 12 months.</p><p><strong>Results: </strong>Of the 326 patients identified, 144 patients were included. After 6 and 12 months, 102 patients (70.8%) and 89 patients (61.8%) of the 144 were symptomatically controlled. Atenolol use (<i>p</i> = 0.024), female sex (<i>p</i> = 0.006), hypertension (<i>p</i> = 0.040), and dronedarone failure (<i>p</i> = 0.012) were associated with flecainide discontinuation at 6 months. At 12 months, only previous propafenone failure (<i>p</i> = 0.032) was significant. Of the 144 patients, 16 (11.1%) reported adverse effects with dizziness, hot flashes, bradycardia, and headache (1.4% each) being the most common.</p><p><strong>Conclusion: </strong>Flecainide is a well-tolerated medication, even at 12 months, with very minor adverse effects. These results support the utility of flecainide in guideline recommended patient populations.</p>","PeriodicalId":23035,"journal":{"name":"Therapeutic Advances in Cardiovascular Disease","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1753944720926824","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38126223","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 : 2019-12-01DOI: 10.1177/1753944719891691
Phoebe M. Tran, Lam Tran
Background: Myocardial infarctions (MIs) are the leading cause of death in the United States (US). Differences in MI mortality rates exist between rural and urban areas in the US. Early recognition of MI symptoms can lead to receiving prompt lifesaving treatment. In this study, we identified the influence of living in a rural area, rurality, on disparities in MI symptom awareness across the US. Methods: We examined 2007 and 2009 Behavioral Risk Factor Surveillances System survey data using logistic regressions to model the impact of rurality on MI symptom awareness while controlling for sociodemographic and MI clinical factors. From the results of these models, we created a type of marginal probability, known as average adjusted predictions (AAPs) and the difference in AAPs, called average marginal effects (AMEs), to determine patterns of awareness for each MI symptom between rural, suburban, and urban areas. Results: We found that there were similar odds and probabilities of being aware of all five MI symptoms between rural, suburban, and urban areas, although rural residents consistently had a slightly higher odds and probability of being aware of all five MI symptoms compared with suburban and urban residents. Rural, suburban, and urban residents had the highest probability of being aware of chest pain/discomfort (95.5–96.1%) and the lowest probability of being aware of jaw/back/neck pain (68.6–72.0%). After adjustment, more than 25% of rural, suburban, and urban residents were found to be unaware that jaw/back/neck pain and feeling weak/light-headed/faint were symptoms of MI. AMEs were greatest for all areas for jaw/back/neck pain (−3.5% to −3.2%) and smallest for chest pain/discomfort (−0.6% to −0.2%). Conclusions: The study’s results highlight the need to increase awareness of the MI symptoms of jaw/back/neck pain and feeling weak/light-headed/faint to shorten hospital delay and time to treatment, especially for rural areas where cardiovascular disease mortality is high.
{"title":"Influence of rurality on the awareness of myocardial infarction symptoms in the US","authors":"Phoebe M. Tran, Lam Tran","doi":"10.1177/1753944719891691","DOIUrl":"https://doi.org/10.1177/1753944719891691","url":null,"abstract":"Background: Myocardial infarctions (MIs) are the leading cause of death in the United States (US). Differences in MI mortality rates exist between rural and urban areas in the US. Early recognition of MI symptoms can lead to receiving prompt lifesaving treatment. In this study, we identified the influence of living in a rural area, rurality, on disparities in MI symptom awareness across the US. Methods: We examined 2007 and 2009 Behavioral Risk Factor Surveillances System survey data using logistic regressions to model the impact of rurality on MI symptom awareness while controlling for sociodemographic and MI clinical factors. From the results of these models, we created a type of marginal probability, known as average adjusted predictions (AAPs) and the difference in AAPs, called average marginal effects (AMEs), to determine patterns of awareness for each MI symptom between rural, suburban, and urban areas. Results: We found that there were similar odds and probabilities of being aware of all five MI symptoms between rural, suburban, and urban areas, although rural residents consistently had a slightly higher odds and probability of being aware of all five MI symptoms compared with suburban and urban residents. Rural, suburban, and urban residents had the highest probability of being aware of chest pain/discomfort (95.5–96.1%) and the lowest probability of being aware of jaw/back/neck pain (68.6–72.0%). After adjustment, more than 25% of rural, suburban, and urban residents were found to be unaware that jaw/back/neck pain and feeling weak/light-headed/faint were symptoms of MI. AMEs were greatest for all areas for jaw/back/neck pain (−3.5% to −3.2%) and smallest for chest pain/discomfort (−0.6% to −0.2%). Conclusions: The study’s results highlight the need to increase awareness of the MI symptoms of jaw/back/neck pain and feeling weak/light-headed/faint to shorten hospital delay and time to treatment, especially for rural areas where cardiovascular disease mortality is high.","PeriodicalId":23035,"journal":{"name":"Therapeutic Advances in Cardiovascular Disease","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2019-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1753944719891691","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45434938","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-09-01DOI: 10.1177/1753944719876517
Bruno Silva Lopes, N. Craveiro, J. Firmino-Machado, P. Ribeiro, M. Castelo-Branco
Background: Impedance cardiography is a reliable, well-tolerated, and non-invasive method used to obtain hemodynamic measurements and could potentially be useful in heart failure (HF) diagnosis, hemodynamic monitoring of critically ill patients, and help in the choice of antihypertensive therapy. The objective of this study was to determine the differences between hemodynamic parameters in a study population of hypertensive patients with and without HF, using impedance cardiography. Methods: A case-control study was designed and named the TARGET study. Participants were enrolled in two study groups: control group C, hypertensive patients without HF and the HF group, hypertensive patients with HF. A descriptive analysis was carried out to characterize the sample and differences in continuous variables were tested for statistical significance by independent sample t test. Results: The study included 102 hypertensive outpatients. The control group consisted of 77 individuals (58.4% males; mean age 63.9 ± 12.5 years old) and the HF group consisted of 25 individuals (44.0% males; mean age 74.2 ± 8.7 years old). The mean Cardiac Index (CI) was 2.70 ± 1.02 L.min.m−2 (2.89 ± 1.04 versus 2.12 ± 0.70; p < 0.001), mean Stroke Index (SI) was 35.5 ± 14.7 mL.m−2 (37.7 ± 15.2 versus 28.5 ± 10.8; p = 0.006), mean Ejection Phase Contractility Index (EPCI) was 33.7 ± 12.7 1000 s−2 (35.8 ± 13.1 versus 27.2 ± 9.2; p = 0.003), mean Inotropic State Index (ISI) was 74.3 ± 28.2 100 s−2 (78.8 ± 28.9 versus 60.6 ± 20.7; p = 0.005), and mean Left Stroke Work Index (LSWI) was 51.3 ± 23.1 g.min.m−2 (55.4 ± 23.5 versus 38.9 ± 16.6; p = 0.002). Conclusions: In this study, hypertensive patients with HF had significantly lower values of blood flow parameters, contractility, and left work indices compared with hypertensive patients without HF. These differences reflected the incorrect hemodynamic pattern (mostly hypodynamic) of these patients. Impedance cardiography (ICG) seems to be an adequate method to reflect these differences.
{"title":"Hemodynamic differences among hypertensive patients with and without heart failure using impedance cardiography","authors":"Bruno Silva Lopes, N. Craveiro, J. Firmino-Machado, P. Ribeiro, M. Castelo-Branco","doi":"10.1177/1753944719876517","DOIUrl":"https://doi.org/10.1177/1753944719876517","url":null,"abstract":"Background: Impedance cardiography is a reliable, well-tolerated, and non-invasive method used to obtain hemodynamic measurements and could potentially be useful in heart failure (HF) diagnosis, hemodynamic monitoring of critically ill patients, and help in the choice of antihypertensive therapy. The objective of this study was to determine the differences between hemodynamic parameters in a study population of hypertensive patients with and without HF, using impedance cardiography. Methods: A case-control study was designed and named the TARGET study. Participants were enrolled in two study groups: control group C, hypertensive patients without HF and the HF group, hypertensive patients with HF. A descriptive analysis was carried out to characterize the sample and differences in continuous variables were tested for statistical significance by independent sample t test. Results: The study included 102 hypertensive outpatients. The control group consisted of 77 individuals (58.4% males; mean age 63.9 ± 12.5 years old) and the HF group consisted of 25 individuals (44.0% males; mean age 74.2 ± 8.7 years old). The mean Cardiac Index (CI) was 2.70 ± 1.02 L.min.m−2 (2.89 ± 1.04 versus 2.12 ± 0.70; p < 0.001), mean Stroke Index (SI) was 35.5 ± 14.7 mL.m−2 (37.7 ± 15.2 versus 28.5 ± 10.8; p = 0.006), mean Ejection Phase Contractility Index (EPCI) was 33.7 ± 12.7 1000 s−2 (35.8 ± 13.1 versus 27.2 ± 9.2; p = 0.003), mean Inotropic State Index (ISI) was 74.3 ± 28.2 100 s−2 (78.8 ± 28.9 versus 60.6 ± 20.7; p = 0.005), and mean Left Stroke Work Index (LSWI) was 51.3 ± 23.1 g.min.m−2 (55.4 ± 23.5 versus 38.9 ± 16.6; p = 0.002). Conclusions: In this study, hypertensive patients with HF had significantly lower values of blood flow parameters, contractility, and left work indices compared with hypertensive patients without HF. These differences reflected the incorrect hemodynamic pattern (mostly hypodynamic) of these patients. Impedance cardiography (ICG) seems to be an adequate method to reflect these differences.","PeriodicalId":23035,"journal":{"name":"Therapeutic Advances in Cardiovascular Disease","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2019-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1753944719876517","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44924766","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-08-01DOI: 10.1177/1753944719870084
S. Giannitsi, M. Bougiakli, A. Bechlioulis, A. Kotsia, L. Michalis, K. Naka
Reduced functional ability and exercise tolerance in patients with heart failure (HF) are associated with poor quality of life and a worse prognosis. The 6-minute walking test (6MWT) is a widely available and well-tolerated test for the assessment of the functional capacity of patients with HF. Although the cardiopulmonary exercise test (a maximal exercise test) remains the gold standard for the evaluation of exercise capacity in patients with HF, the 6MWT (submaximal exercise test) may provide reliable information about the patient’s daily activity. The current review summarizes the value of 6MWT in patients with HF and identifies its usefulness and limitations in everyday clinical practice in populations of HF. We aimed to investigate potential associations of 6MWD with other measures of functional status and determinants of 6MWD in patients with HF as well as to review its prognostic role and changes to various interventions in these patients.
{"title":"6-minute walking test: a useful tool in the management of heart failure patients","authors":"S. Giannitsi, M. Bougiakli, A. Bechlioulis, A. Kotsia, L. Michalis, K. Naka","doi":"10.1177/1753944719870084","DOIUrl":"https://doi.org/10.1177/1753944719870084","url":null,"abstract":"Reduced functional ability and exercise tolerance in patients with heart failure (HF) are associated with poor quality of life and a worse prognosis. The 6-minute walking test (6MWT) is a widely available and well-tolerated test for the assessment of the functional capacity of patients with HF. Although the cardiopulmonary exercise test (a maximal exercise test) remains the gold standard for the evaluation of exercise capacity in patients with HF, the 6MWT (submaximal exercise test) may provide reliable information about the patient’s daily activity. The current review summarizes the value of 6MWT in patients with HF and identifies its usefulness and limitations in everyday clinical practice in populations of HF. We aimed to investigate potential associations of 6MWD with other measures of functional status and determinants of 6MWD in patients with HF as well as to review its prognostic role and changes to various interventions in these patients.","PeriodicalId":23035,"journal":{"name":"Therapeutic Advances in Cardiovascular Disease","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2019-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1753944719870084","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42380923","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background:: Although tolvaptan, an electrolyte-free water diuretic for congestive heart failure (HF), is reported to have no effect on long-term mortality or HF-related morbidity, there may exist some subgroups of patients who may receive beneficial effect of tolvaptan. The purpose of this study was to identify clinical factors associated with mid-term effect of tolvaptan on clinical outcomes of patients who discharged after acute HF.
Methods:: We retrospectively analyzed 140 patients (88 male; mean age, 77.1 ± 11.0 years) with acute HF who received tolvaptan (initial dose 8.6 ± 3.6 mg/day) during their hospitalization. They were divided into two groups according to how the tolvaptan was used at discharge; 77 in the tolvaptan-continued group and 63 in the discontinued group.
Results:: The Cox proportional hazards model revealed that eGFR was the only independent predictor for the occurrence of mid-term cardiac events (composite of re-hospitalization due to HF and all-cause death; aHR = 0.9870, p = 0.02597). The Kaplan-Meier survival curves of the two groups demonstrated no difference in cumulative event-free rates. In the subgroup with preserved renal function at admission (eGFR ⩾ 30 ml/min/1.73 m2), the continuous use of tolvaptan increased composite events (aHR = 2.130, p = 0.02549).
Conclusions:: The continuous use of tolvaptan after discharge did not affect mid-term cardiac events of HF overall but may be associated with increased cardiac events in the subgroup with preserved renal function. These findings suggest that the tolvaptan administration might need to be limited to treatment of in-hospital acute HF.
背景:虽然托伐普坦是一种无电解质水利尿剂,用于治疗充血性心力衰竭(HF),据报道对长期死亡率或HF相关发病率没有影响,但可能存在一些亚组的患者可能受益于托伐普坦。本研究的目的是确定与托伐普坦对急性心衰出院患者临床结局中期影响相关的临床因素。方法回顾性分析140例患者的临床资料,其中男性88例;平均年龄77.1±11.0岁),住院期间接受托伐普坦(初始剂量8.6±3.6 mg/天)治疗的急性HF患者。根据他们出院时使用托伐普坦的方式分为两组;托伐普坦继续组77例,停药组63例。结果:Cox比例风险模型显示,eGFR是中期心脏事件发生的唯一独立预测因子(合并HF再住院和全因死亡;aHR = 0.9870, p = 0.02597)。Kaplan-Meier生存曲线显示两组的累积无事件发生率无差异。在入院时肾功能保留的亚组(eGFR大于或等于30 ml/min/1.73 m2)中,持续使用托伐普坦增加了复合事件(aHR = 2.130, p = 0.02549)。结论:出院后继续使用托伐普坦对HF中期心脏事件总体上没有影响,但可能与肾功能保留亚组心脏事件增加有关。这些发现表明,托伐普坦可能需要限制在治疗院内急性心衰。
{"title":"Impact of renal function on mid-term outcomes in heart failure patients treated with tolvaptan.","authors":"Kensuke Fujioka, Sumio Mizuno, Taro Ichise, Takao Matsui, Hiroaki Hirase, Masato Yamaguchi, Takahiko Aoyama, Masakazu Yamagishi, Noboru Fujino, Masa-Aki Kawashiri, Kenshi Hayashi","doi":"10.1177/1753944718819064","DOIUrl":"https://doi.org/10.1177/1753944718819064","url":null,"abstract":"<p><strong>Background:: </strong>Although tolvaptan, an electrolyte-free water diuretic for congestive heart failure (HF), is reported to have no effect on long-term mortality or HF-related morbidity, there may exist some subgroups of patients who may receive beneficial effect of tolvaptan. The purpose of this study was to identify clinical factors associated with mid-term effect of tolvaptan on clinical outcomes of patients who discharged after acute HF.</p><p><strong>Methods:: </strong>We retrospectively analyzed 140 patients (88 male; mean age, 77.1 ± 11.0 years) with acute HF who received tolvaptan (initial dose 8.6 ± 3.6 mg/day) during their hospitalization. They were divided into two groups according to how the tolvaptan was used at discharge; 77 in the tolvaptan-continued group and 63 in the discontinued group.</p><p><strong>Results:: </strong>The Cox proportional hazards model revealed that eGFR was the only independent predictor for the occurrence of mid-term cardiac events (composite of re-hospitalization due to HF and all-cause death; aHR = 0.9870, p = 0.02597). The Kaplan-Meier survival curves of the two groups demonstrated no difference in cumulative event-free rates. In the subgroup with preserved renal function at admission (eGFR ⩾ 30 ml/min/1.73 m<sup>2</sup>), the continuous use of tolvaptan increased composite events (aHR = 2.130, p = 0.02549).</p><p><strong>Conclusions:: </strong>The continuous use of tolvaptan after discharge did not affect mid-term cardiac events of HF overall but may be associated with increased cardiac events in the subgroup with preserved renal function. These findings suggest that the tolvaptan administration might need to be limited to treatment of in-hospital acute HF.</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/10.1177/1753944718819064","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37172533","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: 10.1177/1753944719880448
H. Duman, A. G. Özyıldız, I. Bahceci, H. Duman, A. Uslu, E. Ergül
Background: Visfatin is an adipokine that plays a role in the inflammatory process of atherosclerosis. This study aimed to investigate whether adipokine is associated with the extent of stable coronary artery disease (CAD). Methods: The study population included 110 patients who underwent elective coronary angiography (CAG) due to stable angina pectoris. The severity of CAD was assessed by the ‘Synergy Between Percutaneous Coronary Intervention With TAXUS and Cardiac Surgery (SYNTAX)’ score. We evaluated patients in two groups: group 1 with a SYNTAX score <22 (low) and group 2 with a SYNTAX score ⩾22 (intermediate to high). Results: Serum visfatin (8.6 ± 4.2 ng/ml versus 13.4 ± 5.2 ng/ml, p < 0.001) and serum C-reactive protein (CRP) levels [0.46 (0.25–0.77) mg/dl versus 0.71 (0.32–1.10) mg/dl, p < 0.001] were lower in group 1. A positive significant correlation was found between serum visfatin level and SYNTAX score (r = 0.559, p < 0.001). In a multivariate logistic regression analysis, visfatin [odds ratio (OR) 1.22, 95% confidence interval (CI) 1.10–1.36; p < 0.001], CRP (OR 6.22, 95% CI 1.70–22.7; p = 0.006), and diabetes mellitus (OR 3.83, 95% CI 1.10–13.2; p = 0.034) were found to be independent predictors of SYNTAX score. Conclusions: Serum visfatin level was positively correlated with CAD severity in patients with high SYNTAX score. Serum visfatin level can be a useful biomarker for predicting high SYNTAX scores in patients with angina pectoris undergoing CAG.
背景:Visfatin是一种脂肪因子,在动脉粥样硬化的炎症过程中发挥作用。本研究旨在探讨脂肪因子是否与稳定性冠状动脉疾病(CAD)的程度相关。方法:研究人群包括110例因稳定性心绞痛而行选择性冠状动脉造影(CAG)的患者。CAD的严重程度通过“经皮冠状动脉介入治疗与心脏手术(SYNTAX)之间的协同作用”评分来评估。我们评估了两组患者:SYNTAX评分<22(低)的第1组和SYNTAX评分大于或小于22(中高)的第2组。结果:1组血清visfatin(8.6±4.2 ng/ml vs 13.4±5.2 ng/ml, p < 0.001)、c反应蛋白(CRP)水平[0.46 (0.25 ~ 0.77)mg/dl vs 0.71 (0.32 ~ 1.10) mg/dl, p < 0.001]降低。血清visfatin水平与SYNTAX评分呈正相关(r = 0.559, p < 0.001)。在多变量logistic回归分析中,visfatin[比值比(OR) 1.22, 95%可信区间(CI) 1.10-1.36;p < 0.001], CRP (OR 6.22, 95% CI 1.70-22.7;p = 0.006),糖尿病(OR 3.83, 95% CI 1.10-13.2;p = 0.034)是句法评分的独立预测因子。结论:SYNTAX评分高的患者血清visfatin水平与冠心病严重程度呈正相关。血清内脂素水平可作为预测心绞痛CAG患者SYNTAX评分高的有用生物标志物。
{"title":"Serum visfatin level is associated with complexity of coronary artery disease in patients with stable angina pectoris","authors":"H. Duman, A. G. Özyıldız, I. Bahceci, H. Duman, A. Uslu, E. Ergül","doi":"10.1177/1753944719880448","DOIUrl":"https://doi.org/10.1177/1753944719880448","url":null,"abstract":"Background: Visfatin is an adipokine that plays a role in the inflammatory process of atherosclerosis. This study aimed to investigate whether adipokine is associated with the extent of stable coronary artery disease (CAD). Methods: The study population included 110 patients who underwent elective coronary angiography (CAG) due to stable angina pectoris. The severity of CAD was assessed by the ‘Synergy Between Percutaneous Coronary Intervention With TAXUS and Cardiac Surgery (SYNTAX)’ score. We evaluated patients in two groups: group 1 with a SYNTAX score <22 (low) and group 2 with a SYNTAX score ⩾22 (intermediate to high). Results: Serum visfatin (8.6 ± 4.2 ng/ml versus 13.4 ± 5.2 ng/ml, p < 0.001) and serum C-reactive protein (CRP) levels [0.46 (0.25–0.77) mg/dl versus 0.71 (0.32–1.10) mg/dl, p < 0.001] were lower in group 1. A positive significant correlation was found between serum visfatin level and SYNTAX score (r = 0.559, p < 0.001). In a multivariate logistic regression analysis, visfatin [odds ratio (OR) 1.22, 95% confidence interval (CI) 1.10–1.36; p < 0.001], CRP (OR 6.22, 95% CI 1.70–22.7; p = 0.006), and diabetes mellitus (OR 3.83, 95% CI 1.10–13.2; p = 0.034) were found to be independent predictors of SYNTAX score. Conclusions: Serum visfatin level was positively correlated with CAD severity in patients with high SYNTAX score. Serum visfatin level can be a useful biomarker for predicting high SYNTAX scores in patients with angina pectoris undergoing CAG.","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/10.1177/1753944719880448","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47966812","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-01-01DOI: 10.1177/1753944719860676
Alejandra Gutierrez, R. Patell, L. Rybicki, A. Khorana
Background: The role of cancer-specific factors for ischemic stroke and mortality in patients with cancer and atrial fibrillation (AF) is unknown. We evaluated the utility of a previously validated risk tool for venous thromboembolism (VTE) in cancer outpatients [Khorana score (KS)] in predicting stroke and mortality in cancer patients with AF. Methods: We conducted a retrospective cohort study of patients with cancer and AF at the Cleveland Clinic from 2008 to 2014. Outcomes, CHADS2, CHA2DS2-VASc, and KS scores were calculated from date of cancer diagnosis. Prognostic factors were identified with Fine and Gray regression (for stroke) or Cox proportional hazards analysis (for mortality). Results: The study population comprised 1181 patients. Genitourinary (19%), lung (18%), and gastrointestinal (13%) were the most frequent cancers. Overall, 67% had CHADS2 ⩾ 2, 57% had an intermediate KS (1–2), and 7% high KS (⩾3). Median follow up was 26.5 months (range 0.03–76). At a median of 8.2 months (range 0–61), 45 patients (3.8%) developed a stroke and 418 (35%) died. In multivariable analysis a high KS (HR 4.5, 95% CI 3.2–6.3, p < 0.001) was associated with a quadruple risk of death and every point increase in CHADS2 score had a 20% increased risk of death (HR 1.19, 95% CI 1.1–1.2, p < 0.001). The addition of KS did not improve risk stratification for ischemic stroke to CHADS2. Conclusion: In patients with cancer and AF, CHADS2 and CHA2DS2-VASc but not KS were predictive of ischemic stroke. A high KS represented a unique predictor of mortality beyond traditional risk scores.
背景:癌症特异性因素在癌症合并心房颤动(AF)患者缺血性卒中和死亡率中的作用尚不清楚。我们评估了先前验证的癌症门诊患者静脉血栓栓塞(VTE)风险工具[Khorana评分(KS)]在预测癌症合并房颤患者卒中和死亡率方面的效用。方法:我们对2008年至2014年克利夫兰诊所的癌症合并房颤患者进行了回顾性队列研究。结果,CHADS2、CHA2DS2-VASc和KS评分从癌症诊断之日起计算。预后因素通过Fine和Gray回归(用于中风)或Cox比例风险分析(用于死亡率)确定。结果:研究人群包括1181例患者。泌尿生殖系统(19%)、肺部(18%)和胃肠道(13%)是最常见的癌症。总体而言,67%的CHADS2大于或等于2,57%的中间KS(1-2)和7%的高KS(大于或等于3)。中位随访时间为26.5个月(范围0.03-76)。在中位8.2个月(范围0-61)时,45名患者(3.8%)发生中风,418名患者(35%)死亡。在多变量分析中,高KS (HR 4.5, 95% CI 3.2-6.3, p < 0.001)与4倍的死亡风险相关,CHADS2评分每增加1分,死亡风险增加20% (HR 1.19, 95% CI 1.1-1.2, p < 0.001)。添加KS并没有改善缺血性卒中对CHADS2的风险分层。结论:在癌症合并房颤患者中,CHADS2和CHA2DS2-VASc是缺血性卒中的预测指标,而KS不是。高KS代表了传统风险评分之外的独特的死亡率预测因子。
{"title":"Predicting outcomes in patients with cancer and atrial fibrillation","authors":"Alejandra Gutierrez, R. Patell, L. Rybicki, A. Khorana","doi":"10.1177/1753944719860676","DOIUrl":"https://doi.org/10.1177/1753944719860676","url":null,"abstract":"Background: The role of cancer-specific factors for ischemic stroke and mortality in patients with cancer and atrial fibrillation (AF) is unknown. We evaluated the utility of a previously validated risk tool for venous thromboembolism (VTE) in cancer outpatients [Khorana score (KS)] in predicting stroke and mortality in cancer patients with AF. Methods: We conducted a retrospective cohort study of patients with cancer and AF at the Cleveland Clinic from 2008 to 2014. Outcomes, CHADS2, CHA2DS2-VASc, and KS scores were calculated from date of cancer diagnosis. Prognostic factors were identified with Fine and Gray regression (for stroke) or Cox proportional hazards analysis (for mortality). Results: The study population comprised 1181 patients. Genitourinary (19%), lung (18%), and gastrointestinal (13%) were the most frequent cancers. Overall, 67% had CHADS2 ⩾ 2, 57% had an intermediate KS (1–2), and 7% high KS (⩾3). Median follow up was 26.5 months (range 0.03–76). At a median of 8.2 months (range 0–61), 45 patients (3.8%) developed a stroke and 418 (35%) died. In multivariable analysis a high KS (HR 4.5, 95% CI 3.2–6.3, p < 0.001) was associated with a quadruple risk of death and every point increase in CHADS2 score had a 20% increased risk of death (HR 1.19, 95% CI 1.1–1.2, p < 0.001). The addition of KS did not improve risk stratification for ischemic stroke to CHADS2. Conclusion: In patients with cancer and AF, CHADS2 and CHA2DS2-VASc but not KS were predictive of ischemic stroke. A high KS represented a unique predictor of mortality beyond traditional risk scores.","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/10.1177/1753944719860676","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46356523","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A sizable proportion of coronary artery disease (CAD) patients undergoing percutaneous coronary intervention (PCI) with stent implantation have an indication for treatment with oral anticoagulant therapy (OAC). The coexistence of atrial fibrillation (AF) and the need for PCI expose patients to a higher risk of developing thrombotic complications, and a multitargeted antithrombotic treatment strategy, addressing both platelet- and coagulation-mediated triggering mechanisms of thrombosis, is necessary for ensuring full protection from ischemic hazards. The increased bleeding risk identified with triple antithrombotic therapy has driven the search for alternative treatment modalities and pharmacological combination strategies aimed at achieving an optimal balance between safety and efficacy in this complex clinical scenario. Over a short time period, the paradigms surrounding the management of patients undergoing PCI who require OAC have substantially evolved. In this review, we summarize and critically evaluate the results of recent randomized clinical trials investigating the pharmacological management of patients who, in addition to antiplatelet therapy, have an indication for OAC treatment before or at the time of a PCI procedure.
{"title":"Evolving paradigms in antithrombotic therapy for anticoagulated patients undergoing coronary stenting.","authors":"Sergio Buccheri, Dominick J Angiolillo, Davide Capodanno","doi":"10.1177/1753944719891688","DOIUrl":"10.1177/1753944719891688","url":null,"abstract":"<p><p>A sizable proportion of coronary artery disease (CAD) patients undergoing percutaneous coronary intervention (PCI) with stent implantation have an indication for treatment with oral anticoagulant therapy (OAC). The coexistence of atrial fibrillation (AF) and the need for PCI expose patients to a higher risk of developing thrombotic complications, and a multitargeted antithrombotic treatment strategy, addressing both platelet- and coagulation-mediated triggering mechanisms of thrombosis, is necessary for ensuring full protection from ischemic hazards. The increased bleeding risk identified with triple antithrombotic therapy has driven the search for alternative treatment modalities and pharmacological combination strategies aimed at achieving an optimal balance between safety and efficacy in this complex clinical scenario. Over a short time period, the paradigms surrounding the management of patients undergoing PCI who require OAC have substantially evolved. In this review, we summarize and critically evaluate the results of recent randomized clinical trials investigating the pharmacological management of patients who, in addition to antiplatelet therapy, have an indication for OAC treatment before or at the time of a PCI procedure.</p>","PeriodicalId":23035,"journal":{"name":"Therapeutic Advances in Cardiovascular Disease","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6902384/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45485006","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: 10.1177/1753944719841795
Mohamed Zeriouh, Anton Sabashnikov, Arne Tenbrock, Klaus Neef, Julia Merkle, Kaveh Eghbalzadeh, Carolyn Weber, Oliver J Liakopoulos, Antje-Christin Deppe, Christof Stamm, Douglas B Cowan, Thorsten Wahlers, Yeong-Hoon Choi
Background: Pressure-overload left-ventricular hypertrophy (LVH) is an increasingly prevalent pathological condition of the myocardial muscle and an independent risk factor for a variety of cardiac diseases. We investigated changes in expression levels of proangiogeneic genes in a small animal model of LVH.
Methods: Myocardial hypertrophy was induced by transaortic constriction (TAC) in C57BL/6 mice and compared with sham-operated controls. The myocardial expression levels of vascular endothelial growth factor (VEGF), its receptors (KDR and FLT-1), stromal-cell-derived factor 1 (SDF1) and the transcription factors hypoxia-inducible factor-1 and 2 (HIF1 and HIF2) were analyzed by quantitative polymerase chain reaction over the course of 25 weeks. Histological sections were stained for caveolin-1 to visualize endothelial cells and determine the capillary density. The left-ventricular morphology and function were assessed weekly by electrocardiogram-gated magnetic resonance imaging.
Results: The heart weight of TAC animals increased significantly from week 4 to 25 ( p = 0.005) compared with sham-treated animals. At 1 day after TAC, the expression of VEGF and SDF1 also increased, but was downregulated again after 1 week. The expression of HIF2 was significantly downregulated after 1 week and remained at a lower level in the subsequent weeks. The expression level of FLT-1 was also significantly decreased 1 week after TAC. HIF-1 and KDR showed similar changes compared with sham-operated animals. However, the expression levels of HIF1 after 4 and 8 weeks were significantly decreased compared with day 1. KDR changes were significantly decreased after 1, 2, 4, 8 and 25 weeks compared with week 3. After 4 weeks post-TAC, the size of the capillary vessels increased ( p = 0.005) while the capillary density itself decreased (TAC: 2143 ± 293 /mm2 versus sham: 2531 ± 321 /mm2; p = 0.021). Starting from week 4, the left-ventricular ejection fraction decreased compared with controls ( p = 0.049).
Conclusions: The decrease in capillary density in the hypertrophic myocardium appears to be linked to the dysregulation in the expression of proangiogeneic factors. The results suggest that overcoming this dysregulation may lead to reconstitution of capillary density in the hypertrophic heart, and thus be beneficial for cardiac function and survival.
{"title":"Dysregulation of proangiogeneic factors in pressure-overload left-ventricular hypertrophy results in inadequate capillary growth.","authors":"Mohamed Zeriouh, Anton Sabashnikov, Arne Tenbrock, Klaus Neef, Julia Merkle, Kaveh Eghbalzadeh, Carolyn Weber, Oliver J Liakopoulos, Antje-Christin Deppe, Christof Stamm, Douglas B Cowan, Thorsten Wahlers, Yeong-Hoon Choi","doi":"10.1177/1753944719841795","DOIUrl":"https://doi.org/10.1177/1753944719841795","url":null,"abstract":"<p><strong>Background: </strong>Pressure-overload left-ventricular hypertrophy (LVH) is an increasingly prevalent pathological condition of the myocardial muscle and an independent risk factor for a variety of cardiac diseases. We investigated changes in expression levels of proangiogeneic genes in a small animal model of LVH.</p><p><strong>Methods: </strong>Myocardial hypertrophy was induced by transaortic constriction (TAC) in C57BL/6 mice and compared with sham-operated controls. The myocardial expression levels of vascular endothelial growth factor (VEGF), its receptors (KDR and FLT-1), stromal-cell-derived factor 1 (SDF1) and the transcription factors hypoxia-inducible factor-1 and 2 (HIF1 and HIF2) were analyzed by quantitative polymerase chain reaction over the course of 25 weeks. Histological sections were stained for caveolin-1 to visualize endothelial cells and determine the capillary density. The left-ventricular morphology and function were assessed weekly by electrocardiogram-gated magnetic resonance imaging.</p><p><strong>Results: </strong>The heart weight of TAC animals increased significantly from week 4 to 25 ( p = 0.005) compared with sham-treated animals. At 1 day after TAC, the expression of VEGF and SDF1 also increased, but was downregulated again after 1 week. The expression of HIF2 was significantly downregulated after 1 week and remained at a lower level in the subsequent weeks. The expression level of FLT-1 was also significantly decreased 1 week after TAC. HIF-1 and KDR showed similar changes compared with sham-operated animals. However, the expression levels of HIF1 after 4 and 8 weeks were significantly decreased compared with day 1. KDR changes were significantly decreased after 1, 2, 4, 8 and 25 weeks compared with week 3. After 4 weeks post-TAC, the size of the capillary vessels increased ( p = 0.005) while the capillary density itself decreased (TAC: 2143 ± 293 /mm<sup>2</sup> versus sham: 2531 ± 321 /mm<sup>2</sup>; p = 0.021). Starting from week 4, the left-ventricular ejection fraction decreased compared with controls ( p = 0.049).</p><p><strong>Conclusions: </strong>The decrease in capillary density in the hypertrophic myocardium appears to be linked to the dysregulation in the expression of proangiogeneic factors. The results suggest that overcoming this dysregulation may lead to reconstitution of capillary density in the hypertrophic heart, and thus be beneficial for cardiac function and survival.</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/10.1177/1753944719841795","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37242053","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}