Pub Date : 2022-01-28DOI: 10.11909/j.issn.1671-5411.2022.01.005
Xiao-fei Ye, Wei Zhang, Yi Chen, Chao-Ying Miao, Qi-Fang Huang, C. Sheng, Shuai Shao, Dian Wang, Shao-kun Xu, Lei Lei, Di Zhang, Yi-lin Chen, Lei-Xiao Hu, Jia-Hui Xia, Yi-Bang Cheng, Ying Wang, Q. Guo, Yan Li, N. Lowres, B. Freedman, Ji-Guang Wang
BACKGROUND Alcohol consumption is a known modifiable risk factor for atrial fibrillation. The association, however, might differ according to gender. We investigated gender-specific associations between alcohol consumption and incident atrial fibrillation in an elderly Chinese population. METHODS Our study participants were elderly residents (≥ 65 years) recruited from five community health centers in the urban area of Shanghai (n = 6,618). Alcohol intake was classified as never drinkers and current light-to-moderate (< 40 g/day) and heavy drinkers (≥ 40 g/day). Atrial fibrillation was detected by a 30-s single-lead electrocardiography (ECG, AliveCor® Heart Monitor) and further evaluated with a regular 12-lead ECG. RESULTS During a median of 2.1 years (interquartile range: 2.0−2.2) follow-up, the incidence rate of atrial fibrillation was 1.10% in all study participants. It was slightly but non-significantly higher in men (n = 2849) than women (n = 3769, 1.30% vs. 0.96%, P = 0.19) and in current drinkers (n = 793) than never drinkers (n = 5825, 1.64% vs. 1.03%,P = 0.12). In both unadjusted and adjusted analyses, there was interaction between sex and current alcohol intake in relation to the incidence of atrial fibrillation (P < 0.0001). After adjustment for confounding factors, current drinkers had a significantly higher incidence rate of atrial fibrillation than never drinkers in women (12.96% [7/54] vs. 0.78% [29/3715], adjusted odds ratio [OR] = 10.25, 95% confidence interval [CI]: 3.54−29.67,P < 0.0001), but not in men (0.81% [6/739] vs. 1.47% [31/2110], OR = 0.62, 95% CI: 0.25−1.51,P = 0.29). CONCLUSIONS Our study showed a significant association between alcohol intake and the incidence of atrial fibrillation in elderly Chinese women, but not men.
{"title":"Alcohol consumption in relation to the incidence of atrial fibrillation in an elderly Chinese population","authors":"Xiao-fei Ye, Wei Zhang, Yi Chen, Chao-Ying Miao, Qi-Fang Huang, C. Sheng, Shuai Shao, Dian Wang, Shao-kun Xu, Lei Lei, Di Zhang, Yi-lin Chen, Lei-Xiao Hu, Jia-Hui Xia, Yi-Bang Cheng, Ying Wang, Q. Guo, Yan Li, N. Lowres, B. Freedman, Ji-Guang Wang","doi":"10.11909/j.issn.1671-5411.2022.01.005","DOIUrl":"https://doi.org/10.11909/j.issn.1671-5411.2022.01.005","url":null,"abstract":"BACKGROUND Alcohol consumption is a known modifiable risk factor for atrial fibrillation. The association, however, might differ according to gender. We investigated gender-specific associations between alcohol consumption and incident atrial fibrillation in an elderly Chinese population. METHODS Our study participants were elderly residents (≥ 65 years) recruited from five community health centers in the urban area of Shanghai (n = 6,618). Alcohol intake was classified as never drinkers and current light-to-moderate (< 40 g/day) and heavy drinkers (≥ 40 g/day). Atrial fibrillation was detected by a 30-s single-lead electrocardiography (ECG, AliveCor® Heart Monitor) and further evaluated with a regular 12-lead ECG. RESULTS During a median of 2.1 years (interquartile range: 2.0−2.2) follow-up, the incidence rate of atrial fibrillation was 1.10% in all study participants. It was slightly but non-significantly higher in men (n = 2849) than women (n = 3769, 1.30% vs. 0.96%, P = 0.19) and in current drinkers (n = 793) than never drinkers (n = 5825, 1.64% vs. 1.03%,P = 0.12). In both unadjusted and adjusted analyses, there was interaction between sex and current alcohol intake in relation to the incidence of atrial fibrillation (P < 0.0001). After adjustment for confounding factors, current drinkers had a significantly higher incidence rate of atrial fibrillation than never drinkers in women (12.96% [7/54] vs. 0.78% [29/3715], adjusted odds ratio [OR] = 10.25, 95% confidence interval [CI]: 3.54−29.67,P < 0.0001), but not in men (0.81% [6/739] vs. 1.47% [31/2110], OR = 0.62, 95% CI: 0.25−1.51,P = 0.29). CONCLUSIONS Our study showed a significant association between alcohol intake and the incidence of atrial fibrillation in elderly Chinese women, but not men.","PeriodicalId":285674,"journal":{"name":"Journal of geriatric cardiology : JGC","volume":"19 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122329242","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 : 2022-01-28DOI: 10.11909/j.issn.1671-5411.2022.01.008
Koji Takahashi, Mina Yamashita, Tomoki Sakaue, Daijiro Enomoto, Shigeki Uemura, T. Okura, S. Ikeda, T. Senba, Akira Saijo, Nobuhisa Yamamura, S. Kitazawa
1. Department of Community Emergency Medicine, Ehime University Graduate School of Medicine, Ehime, Japan; 2. Department of Cardiology, Yawatahama City General Hospital, Ehime, Japan; 3. Department of Hematology, Yawatahama City General Hospital, Ehime, Japan; 4. Department of Clinical Pathology, Yawatahama City General Hospital, Ehime, Japan; 5. Department of Molecular Pathology, Ehime University Graduate School of Medicine, Ehime, Japan ✉ Correspondence to: michitokitatsumasa@gmail.com https://doi.org/10.11909/j.issn.1671-5411.2022.01.008
{"title":"Light chain cardiac amyloidosis in a nonagenarian","authors":"Koji Takahashi, Mina Yamashita, Tomoki Sakaue, Daijiro Enomoto, Shigeki Uemura, T. Okura, S. Ikeda, T. Senba, Akira Saijo, Nobuhisa Yamamura, S. Kitazawa","doi":"10.11909/j.issn.1671-5411.2022.01.008","DOIUrl":"https://doi.org/10.11909/j.issn.1671-5411.2022.01.008","url":null,"abstract":"1. Department of Community Emergency Medicine, Ehime University Graduate School of Medicine, Ehime, Japan; 2. Department of Cardiology, Yawatahama City General Hospital, Ehime, Japan; 3. Department of Hematology, Yawatahama City General Hospital, Ehime, Japan; 4. Department of Clinical Pathology, Yawatahama City General Hospital, Ehime, Japan; 5. Department of Molecular Pathology, Ehime University Graduate School of Medicine, Ehime, Japan ✉ Correspondence to: michitokitatsumasa@gmail.com https://doi.org/10.11909/j.issn.1671-5411.2022.01.008","PeriodicalId":285674,"journal":{"name":"Journal of geriatric cardiology : JGC","volume":"3 9-10 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133578424","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 : 2022-01-28DOI: 10.11909/j.issn.1671-5411.2022.01.009
Rubén KA Tapia-Orihuela, S. M. Gharacholou, S. Asirvatham, F. D. Munoz
Cardiac resynchronization therapy (CRT) has emerged as an important intervention for patients with heart failure (HF) with reduced ejection fraction and delayed ventricular activation. In these patients, CRT has demonstrated to improve quality of life, promote reverse left ventricular (LV) remodeling, reduce HF hospitalizations, and extend survival. However, despite advancements in our understanding of CRT, a significant number of patients do not respond to this therapy. Several invasive and non-invasive parameters have been assessed to predict response to CRT, but the electrocardiogram (ECG) has remained as the prevailing screening method albeit with limitations. Ideally, an accurate, simple, and reproducible ECG marker or set of markers would dramatically overcome the current limitations. We describe the clinical utility of an old ECG parameter that can estimate ventricular activation delay: the onset to intrinsicoid deflection (ID). Based on the concept of direct measurement of ventricular activation time (intrinsic deflection onset), time to ID onset measures on the surface ECG the time that the electrical activation time takes to reach the area subtended by the corresponding surface ECG lead. Based on this principle, the time to ID on the lateral leads can estimate the delay activation to the lateral LV wall and can be used as a predictor for CRT response, particularly in patients with non-specific intraventricular conduction delay or in patients with left bundle branch block and QRS < 150 ms. The aim of this review is to present the current evidence and potential use of this ECG parameter to estimate LV activation and predict CRT response.
{"title":"Electrocardiographic markers of cardiac resynchronization therapy response: delayed time to intrinsicoid deflection onset in lateral leads","authors":"Rubén KA Tapia-Orihuela, S. M. Gharacholou, S. Asirvatham, F. D. Munoz","doi":"10.11909/j.issn.1671-5411.2022.01.009","DOIUrl":"https://doi.org/10.11909/j.issn.1671-5411.2022.01.009","url":null,"abstract":"Cardiac resynchronization therapy (CRT) has emerged as an important intervention for patients with heart failure (HF) with reduced ejection fraction and delayed ventricular activation. In these patients, CRT has demonstrated to improve quality of life, promote reverse left ventricular (LV) remodeling, reduce HF hospitalizations, and extend survival. However, despite advancements in our understanding of CRT, a significant number of patients do not respond to this therapy. Several invasive and non-invasive parameters have been assessed to predict response to CRT, but the electrocardiogram (ECG) has remained as the prevailing screening method albeit with limitations. Ideally, an accurate, simple, and reproducible ECG marker or set of markers would dramatically overcome the current limitations. We describe the clinical utility of an old ECG parameter that can estimate ventricular activation delay: the onset to intrinsicoid deflection (ID). Based on the concept of direct measurement of ventricular activation time (intrinsic deflection onset), time to ID onset measures on the surface ECG the time that the electrical activation time takes to reach the area subtended by the corresponding surface ECG lead. Based on this principle, the time to ID on the lateral leads can estimate the delay activation to the lateral LV wall and can be used as a predictor for CRT response, particularly in patients with non-specific intraventricular conduction delay or in patients with left bundle branch block and QRS < 150 ms. The aim of this review is to present the current evidence and potential use of this ECG parameter to estimate LV activation and predict CRT response.","PeriodicalId":285674,"journal":{"name":"Journal of geriatric cardiology : JGC","volume":"13 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126169194","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 : 2022-01-28DOI: 10.11909/j.issn.1671-5411.2022.01.003
M. Ghossein, A. V. van Stipdonk, F. Prinzen, K. Vernooy
Cardiac resynchronization therapy (CRT) is a good treatment for heart failure accompanied by ventricular conduction abnormalities. Current ECG criteria in international guidelines seem to be suboptimal to select heart failure patients for CRT. The criteria QRS duration and left bundle branch block (LBBB) QRS morphology insufficiently detect left ventricular activation delay, which is required for benefit from CRT. Additionally, there are various definitions for LBBB, in which each one has a different association with CRT benefit and is prone to subjective interpretation. Recent studies have shown that the objectively measured vectorcardiographic QRS area identifies left ventricular activation delay with higher accuracy than any of the current ECG criteria. Indeed, various studies have consistently shown that a high QRS area prior to CRT predicts both echocardiographic and clinical improvement after CRT. The beneficial relation of QRS area with CRT-outcome was largely independent from QRS morphology, QRS duration, and patient characteristics known to affect CRT-outcome including ischemic etiology and sex. On top of QRS area prior to CRT, the reduction in QRS area after CRT further improves benefit. QRS area is easily obtainable from a standard 12-lead ECG though it currently requires off-line analysis. Clinical applicability will be significantly improved when QRS area is automatically determined by ECG equipment.
{"title":"Vectorcardiographic QRS area as a predictor of response to cardiac resynchronization therapy","authors":"M. Ghossein, A. V. van Stipdonk, F. Prinzen, K. Vernooy","doi":"10.11909/j.issn.1671-5411.2022.01.003","DOIUrl":"https://doi.org/10.11909/j.issn.1671-5411.2022.01.003","url":null,"abstract":"Cardiac resynchronization therapy (CRT) is a good treatment for heart failure accompanied by ventricular conduction abnormalities. Current ECG criteria in international guidelines seem to be suboptimal to select heart failure patients for CRT. The criteria QRS duration and left bundle branch block (LBBB) QRS morphology insufficiently detect left ventricular activation delay, which is required for benefit from CRT. Additionally, there are various definitions for LBBB, in which each one has a different association with CRT benefit and is prone to subjective interpretation. Recent studies have shown that the objectively measured vectorcardiographic QRS area identifies left ventricular activation delay with higher accuracy than any of the current ECG criteria. Indeed, various studies have consistently shown that a high QRS area prior to CRT predicts both echocardiographic and clinical improvement after CRT. The beneficial relation of QRS area with CRT-outcome was largely independent from QRS morphology, QRS duration, and patient characteristics known to affect CRT-outcome including ischemic etiology and sex. On top of QRS area prior to CRT, the reduction in QRS area after CRT further improves benefit. QRS area is easily obtainable from a standard 12-lead ECG though it currently requires off-line analysis. Clinical applicability will be significantly improved when QRS area is automatically determined by ECG equipment.","PeriodicalId":285674,"journal":{"name":"Journal of geriatric cardiology : JGC","volume":"36 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132457847","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 : 2022-01-28DOI: 10.11909/j.issn.1671-5411.2022.01.004
Jing-jia Wang, Zhenhuang Zhuang, Canqing Yu, Wen-yao Wang, Wenxiu Wang, Kuo Zhang, X. Meng, Jun Gao, Jian Tian, Ji-lin Zheng, Jie Yang, Tao Huang, Chunli Shao, Yifang Tang
BACKGROUND Growing evidence have demonstrated that thyroid hormones have been involved in the processes of cardiovascular metabolism. However, the causal relationship of thyroid function and cardiometabolic health remains partly unknown. METHODS The Mendelian randomization (MR) was used to test genetic, potentially causal relationships between instrumental variables and cardiometabolic traits. Genetic variants of free thyroxine (FT4) and thyrotropin (TSH) levels within the reference range were used as instrumental variables. Data for genetic associations with cardiometabolic diseases were acquired from the genome-wide association studies of the FinnGen, CARDIoGRAM and CARDIoGRAMplusC4D, CHARGE, and MEGASTROKE. This study was conducted using summary statistic data from large, previously described cohorts. Association between thyroid function and essential hypertension (EHTN), secondary hypertension (SHTN), hyperlipidemia (HPL), type 2 diabetes mellitus (T2DM), ischemic heart disease (IHD), myocardial infarction (MI), heart failure (HF), pulmonary heart disease (PHD), stroke, and non-rheumatic valve disease (NRVD) were examined. RESULTS Genetically predicted FT4 levels were associated with SHTN (odds ratio = 0.48; 95% CI = 0.04−0.82,P = 0.027), HPL (odds ratio = 0.67; 95% CI = 0.18−0.88,P = 0.023), T2DM (odds ratio = 0.80; 95% CI = 0.42−0.86,P = 0.005), IHD (odds ratio = 0.85; 95% CI = 0.49−0.98,P = 0.039), NRVD (odds ratio = 0.75; 95% CI = 0.27−0.97,P = 0.039). Additionally, genetically predicted TSH levels were associated with HF (odds ratio = 0.82; 95% CI = 0.68−0.99,P = 0.042), PHD (odds ratio = 0.75; 95% CI = 0.32−0.82,P = 0.006), stroke (odds ratio = 0.95; 95% CI = 0.81−0.97,P = 0.007). However, genetically predicted thyroid function traits were not associated with EHTN and MI. CONCLUSIONS Our study suggests FT4 and TSH are associated with cardiometabolic diseases, underscoring the importance of the pituitary-thyroid-cardiac axis in cardiometabolic health susceptibility.
背景越来越多的证据表明，甲状腺激素参与了心血管代谢的过程。然而，甲状腺功能与心脏代谢健康的因果关系仍部分未知。方法采用孟德尔随机化(MR)来检验工具变量与心脏代谢性状之间的遗传关系和潜在因果关系。参考范围内游离甲状腺素(FT4)和促甲状腺素(TSH)水平的遗传变异作为工具变量。与心脏代谢疾病的遗传关联数据来自FinnGen、CARDIoGRAM和CARDIoGRAMplusC4D、CHARGE和MEGASTROKE的全基因组关联研究。本研究是利用先前描述的大型队列的汇总统计数据进行的。观察甲状腺功能与原发性高血压(EHTN)、继发性高血压(SHTN)、高脂血症(HPL)、2型糖尿病(T2DM)、缺血性心脏病(IHD)、心肌梗死(MI)、心力衰竭(HF)、肺心病(PHD)、脑卒中、非风湿性瓣膜病(NRVD)的关系。结果基因预测的FT4水平与SHTN相关(优势比= 0.48;95% CI = 0.04 ~ 0.82,P = 0.027)， HPL(优势比= 0.67;95% CI = 0.18−0.88,P = 0.023)， T2DM(优势比= 0.80;95% CI = 0.42 ~ 0.86,P = 0.005)， IHD(优势比= 0.85;95% CI = 0.49 ~ 0.98,P = 0.039)， NRVD(优势比= 0.75;95% ci = 0.27 ~ 0.97, p = 0.039)。此外，基因预测的TSH水平与HF相关(优势比= 0.82;95% CI = 0.68 ~ 0.99,P = 0.042)， PHD(优势比= 0.75;95% CI = 0.32 ~ 0.82,P = 0.006)，卒中(优势比= 0.95;95% ci = 0.81−0.97,p = 0.007)。然而，遗传预测的甲状腺功能特征与EHTN和MI无关。结论我们的研究表明FT4和TSH与心脏代谢疾病相关，强调了垂体-甲状腺-心脏轴在心脏代谢健康易感性中的重要性。
{"title":"Assessment of causal direction between thyroid function and cardiometabolic health: a Mendelian randomization study","authors":"Jing-jia Wang, Zhenhuang Zhuang, Canqing Yu, Wen-yao Wang, Wenxiu Wang, Kuo Zhang, X. Meng, Jun Gao, Jian Tian, Ji-lin Zheng, Jie Yang, Tao Huang, Chunli Shao, Yifang Tang","doi":"10.11909/j.issn.1671-5411.2022.01.004","DOIUrl":"https://doi.org/10.11909/j.issn.1671-5411.2022.01.004","url":null,"abstract":"BACKGROUND Growing evidence have demonstrated that thyroid hormones have been involved in the processes of cardiovascular metabolism. However, the causal relationship of thyroid function and cardiometabolic health remains partly unknown. METHODS The Mendelian randomization (MR) was used to test genetic, potentially causal relationships between instrumental variables and cardiometabolic traits. Genetic variants of free thyroxine (FT4) and thyrotropin (TSH) levels within the reference range were used as instrumental variables. Data for genetic associations with cardiometabolic diseases were acquired from the genome-wide association studies of the FinnGen, CARDIoGRAM and CARDIoGRAMplusC4D, CHARGE, and MEGASTROKE. This study was conducted using summary statistic data from large, previously described cohorts. Association between thyroid function and essential hypertension (EHTN), secondary hypertension (SHTN), hyperlipidemia (HPL), type 2 diabetes mellitus (T2DM), ischemic heart disease (IHD), myocardial infarction (MI), heart failure (HF), pulmonary heart disease (PHD), stroke, and non-rheumatic valve disease (NRVD) were examined. RESULTS Genetically predicted FT4 levels were associated with SHTN (odds ratio = 0.48; 95% CI = 0.04−0.82,P = 0.027), HPL (odds ratio = 0.67; 95% CI = 0.18−0.88,P = 0.023), T2DM (odds ratio = 0.80; 95% CI = 0.42−0.86,P = 0.005), IHD (odds ratio = 0.85; 95% CI = 0.49−0.98,P = 0.039), NRVD (odds ratio = 0.75; 95% CI = 0.27−0.97,P = 0.039). Additionally, genetically predicted TSH levels were associated with HF (odds ratio = 0.82; 95% CI = 0.68−0.99,P = 0.042), PHD (odds ratio = 0.75; 95% CI = 0.32−0.82,P = 0.006), stroke (odds ratio = 0.95; 95% CI = 0.81−0.97,P = 0.007). However, genetically predicted thyroid function traits were not associated with EHTN and MI. CONCLUSIONS Our study suggests FT4 and TSH are associated with cardiometabolic diseases, underscoring the importance of the pituitary-thyroid-cardiac axis in cardiometabolic health susceptibility.","PeriodicalId":285674,"journal":{"name":"Journal of geriatric cardiology : JGC","volume":"103 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116046979","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 : 2022-01-28DOI: 10.11909/j.issn.1671-5411.2022.01.001
Manish Kumar, N. Lopetegui-Lia, C. Malouf, Mansour Almnajam, P. Coll, Agnes S. Kim
Cancer and atrial fibrillation (AF) are common co-morbid conditions in older adults. Both cancer and cancer treatment increase the risk of developing new AF which increases morbidity and mortality. Heart rate and rhythm control along with anticoagulation therapy remain the mainstay of treatment of AF in older adults with both cancer and AF. Adjustments to the treatment may be necessary because of drug interactions with concurrent chemotherapy. Cancer and old age increase the risk of both, thromboembolism and bleeding. The risk of these complications is further enhanced by concomitant cancer therapy, frailty, poor nutrition status and, coexisting geriatric syndromes. Therefore, careful attention needs to be given to the risks and benefits of using anticoagulant medications. This review focuses on the management of AF in older patients with cancer, including at the end-of-life care.
{"title":"Atrial fibrillation in older adults with cancer","authors":"Manish Kumar, N. Lopetegui-Lia, C. Malouf, Mansour Almnajam, P. Coll, Agnes S. Kim","doi":"10.11909/j.issn.1671-5411.2022.01.001","DOIUrl":"https://doi.org/10.11909/j.issn.1671-5411.2022.01.001","url":null,"abstract":"Cancer and atrial fibrillation (AF) are common co-morbid conditions in older adults. Both cancer and cancer treatment increase the risk of developing new AF which increases morbidity and mortality. Heart rate and rhythm control along with anticoagulation therapy remain the mainstay of treatment of AF in older adults with both cancer and AF. Adjustments to the treatment may be necessary because of drug interactions with concurrent chemotherapy. Cancer and old age increase the risk of both, thromboembolism and bleeding. The risk of these complications is further enhanced by concomitant cancer therapy, frailty, poor nutrition status and, coexisting geriatric syndromes. Therefore, careful attention needs to be given to the risks and benefits of using anticoagulant medications. This review focuses on the management of AF in older patients with cancer, including at the end-of-life care.","PeriodicalId":285674,"journal":{"name":"Journal of geriatric cardiology : JGC","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128490038","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 : 2022-01-28DOI: 10.11909/j.issn.1671-5411.2022.01.010
P. Satish, B. Narasimhan, A. Hagendorff, B. Tayal
The role of electromechanical dyssynchrony in heart failure gained prominence in literature with the results of trials of cardiac resynchronization therapy (CRT). CRT has shown to significantly decrease heart failure hospitalization and mortality in heart failure patients with dyssynchrony. Current guidelines recommend the use of electrical dyssynchrony based on a QRS > 150 ms and a left bundle branch block pattern on surface electrocardiogram to identify dyssynchrony in patients who will benefit from CRT implantation. However, predicting response to CRT remains a challenge with nearly one-third of patients gaining no benefit from the device. Multiple echocardiographic measures of mechanical dyssynchrony have been studied over the past two decade. However, trials where mechanical dyssynchrony used as an additional or lone criteria for CRT failed to show any benefit in the response to CRT. This shows that a deeper understanding of cardiac mechanics should be applied in the assessment of dyssynchrony. This review discusses the evolving role of imaging techniques in assessing cardiac dyssynchrony and their application in patients considered for device therapy.
{"title":"Evolving concept of dyssynchrony and its utility","authors":"P. Satish, B. Narasimhan, A. Hagendorff, B. Tayal","doi":"10.11909/j.issn.1671-5411.2022.01.010","DOIUrl":"https://doi.org/10.11909/j.issn.1671-5411.2022.01.010","url":null,"abstract":"The role of electromechanical dyssynchrony in heart failure gained prominence in literature with the results of trials of cardiac resynchronization therapy (CRT). CRT has shown to significantly decrease heart failure hospitalization and mortality in heart failure patients with dyssynchrony. Current guidelines recommend the use of electrical dyssynchrony based on a QRS > 150 ms and a left bundle branch block pattern on surface electrocardiogram to identify dyssynchrony in patients who will benefit from CRT implantation. However, predicting response to CRT remains a challenge with nearly one-third of patients gaining no benefit from the device. Multiple echocardiographic measures of mechanical dyssynchrony have been studied over the past two decade. However, trials where mechanical dyssynchrony used as an additional or lone criteria for CRT failed to show any benefit in the response to CRT. This shows that a deeper understanding of cardiac mechanics should be applied in the assessment of dyssynchrony. This review discusses the evolving role of imaging techniques in assessing cardiac dyssynchrony and their application in patients considered for device therapy.","PeriodicalId":285674,"journal":{"name":"Journal of geriatric cardiology : JGC","volume":"15 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"117054815","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 : 2022-01-01DOI: 10.1016/j.acvdsp.2021.09.200
Delphine Thiolliere, B. Harbaoui, C. Falandry, M. Bonnefoy, J. Lega, P. Lantelme, P. Courand
{"title":"Screening for hypertension-mediated organ damage and aetiology: still of value after 65 years of age?","authors":"Delphine Thiolliere, B. Harbaoui, C. Falandry, M. Bonnefoy, J. Lega, P. Lantelme, P. Courand","doi":"10.1016/j.acvdsp.2021.09.200","DOIUrl":"https://doi.org/10.1016/j.acvdsp.2021.09.200","url":null,"abstract":"","PeriodicalId":285674,"journal":{"name":"Journal of geriatric cardiology : JGC","volume":"50 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116762526","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 : 2021-11-21DOI: 10.1101/2021.11.20.21266625
D. Satti, Y. H. A. Lee, K. Leung, J. Hui, T. Kot, Arslan Babar, A. Wai, Tong Liu, L. Roever, G. Tse, J. Chan
Aim: To assess the effect of vasopressin, steroid and epinephrine (VSE) combination therapy on return of spontaneous circulation (ROSC) after in-hospital cardiac arrest (IHCA), and test the conclusiveness of evidence using trial sequential analysis (TSA). Methods: The systematic search included PubMed, EMBASE, Scopus, and Cochrane Central Register of Controlled Trials. Randomized controlled trials that included adult patients with in-hospital cardiac arrest, with at least one group receiving combined vasopressin, epinephrine and steroid therapy were selected. Data was extracted independently by two reviewers. The main outcome of interest was ROSC. Other outcomes included survival to hospital discharge with good neurological outcomes and survival to 30 and 90 days with good neurological outcomes. Results: We included a total of three randomized controlled trials (n=869 patients). Results showed that Vasopressin, steroid and epinephrine combination therapy increased return of spontaneous circulation (risk ratio, 1.32; 95% CI, 1.18-1.47) as compared to placebo. Trial sequential analysis demonstrated that the existing evidence is conclusive. This was also validated by the alpha-spending adjusted relative risk (1.32 [1.16, 1.49], p<0.0001). Other outcomes could not be meta-analysed due to differences in timeframe in the included studies. Conclusions: VSE combination therapy administered in cardiopulmonary resuscitation led to improved rates of return of spontaneous circulation. Future trials of vasopressin, steroid and epinephrine combination therapy should evaluate survival to hospital discharge, neurological function and long-term survival. Keywords: cardiac arrest; cardiopulmonary resuscitation; meta-analysis; vasopressin; steroid; epinephrine
目的:评价抗利尿激素、类固醇和肾上腺素(VSE)联合治疗对院内心脏骤停(IHCA)后自发循环恢复(ROSC)的影响，并采用试验序贯分析(TSA)检验证据的结结性。方法:系统检索PubMed、EMBASE、Scopus、Cochrane Central Register of Controlled Trials。随机对照试验包括住院心脏骤停的成年患者，至少有一组接受抗利尿激素、肾上腺素和类固醇联合治疗。数据由两位审稿人独立提取。我们感兴趣的主要结果是ROSC。其他结果包括存活至出院且神经系统预后良好，存活至30天和90天且神经系统预后良好。结果:我们共纳入3项随机对照试验(n=869例患者)。结果显示，抗利尿激素、类固醇和肾上腺素联合治疗可增加自发性循环的恢复(风险比，1.32;95% CI, 1.18-1.47)。试验序列分析表明，现有证据是确凿的。α支出调整后的相对风险也证实了这一点(1.32 [1.16,1.49]，p<0.0001)。由于纳入研究的时间范围不同，其他结果无法进行meta分析。结论:在心肺复苏中给予VSE联合治疗可提高自发循环的恢复率。未来的抗利尿激素、类固醇和肾上腺素联合治疗的试验应评估患者的生存至出院、神经功能和长期生存。关键词:心脏骤停;心肺复苏;荟萃分析;后叶加压素;类固醇;肾上腺素
{"title":"Efficacy of vasopressin, steroid, and epinephrine protocol for in-hospital cardiac arrest resuscitation: A systematic review and meta-analysis of randomized controlled trials with trial sequential analysis","authors":"D. Satti, Y. H. A. Lee, K. Leung, J. Hui, T. Kot, Arslan Babar, A. Wai, Tong Liu, L. Roever, G. Tse, J. Chan","doi":"10.1101/2021.11.20.21266625","DOIUrl":"https://doi.org/10.1101/2021.11.20.21266625","url":null,"abstract":"Aim: To assess the effect of vasopressin, steroid and epinephrine (VSE) combination therapy on return of spontaneous circulation (ROSC) after in-hospital cardiac arrest (IHCA), and test the conclusiveness of evidence using trial sequential analysis (TSA). Methods: The systematic search included PubMed, EMBASE, Scopus, and Cochrane Central Register of Controlled Trials. Randomized controlled trials that included adult patients with in-hospital cardiac arrest, with at least one group receiving combined vasopressin, epinephrine and steroid therapy were selected. Data was extracted independently by two reviewers. The main outcome of interest was ROSC. Other outcomes included survival to hospital discharge with good neurological outcomes and survival to 30 and 90 days with good neurological outcomes. Results: We included a total of three randomized controlled trials (n=869 patients). Results showed that Vasopressin, steroid and epinephrine combination therapy increased return of spontaneous circulation (risk ratio, 1.32; 95% CI, 1.18-1.47) as compared to placebo. Trial sequential analysis demonstrated that the existing evidence is conclusive. This was also validated by the alpha-spending adjusted relative risk (1.32 [1.16, 1.49], p<0.0001). Other outcomes could not be meta-analysed due to differences in timeframe in the included studies. Conclusions: VSE combination therapy administered in cardiopulmonary resuscitation led to improved rates of return of spontaneous circulation. Future trials of vasopressin, steroid and epinephrine combination therapy should evaluate survival to hospital discharge, neurological function and long-term survival. Keywords: cardiac arrest; cardiopulmonary resuscitation; meta-analysis; vasopressin; steroid; epinephrine","PeriodicalId":285674,"journal":{"name":"Journal of geriatric cardiology : JGC","volume":"11 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115392773","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 : 2021-03-13DOI: 10.11909/j.issn.1671-5411.2022.03.002
Bao-tao Huang, L. Yang, Bosen Yang, Fangyang Huang, Q. Xiao, Xiao-bo Pu, Yong Peng, Mao Chen
BACKGROUND Left ventricular hypertrophy (LVH) is prevalent in obese individuals. Besides, both of LVH and obesity is associated with subclinical LV dysfunction. The study aims to investigate the interplay between body fat and LVH in relation to all-cause death in patients with coronary artery disease (CAD). METHODS In this retrospective cohort study, a total of 2243 patients with angiographically proven CAD were included. Body fat and LV mass were calculated using established formulas. Patients were grouped according to body fat percentage and presence or absence of LVH. Cox-proportional hazard models were used to observe the interaction effect of body fat and LVH on all-cause death. RESULTS Of 2243 patients enrolled, 560 (25%) had a higher body fat percentage, and 1045 (46.6%) had LVH. After a median follow-up of 2.2 years, the cumulative mortality rate was 8.2% in the group with higher body fat and LVH, 2.5% in those with lower body fat and no LVH, 5.4% in those with higher body fat and no LVH, and 7.8% in those with lower body fat and LVH (log-rank P < 0.001). There was a statistically significant interaction between body fat percentage and LVH ( P interaction was 0.003). After correcting for confounding factors, patients with higher body fat and LVH had the highest risk of all-cause death (HR = 3.49, 95% CI: 1.40–8.69, P = 0.007) compared with those with lower body fat and no LVH; in contrast, patients with higher body fat and no LVH had no statistically significant difference in risk of death compared with those with lower body fat and no LVH (HR = 2.03, 95% CI: 0.70–5.92, P = 0.195). CONCLUSION A higher body fat percentage was associated with a different risk of all-cause death in patients with CAD, stratified by coexistence of LVH or not. Higher body fat was significantly associated with a greater risk of mortality among patients with LVH but not among those without LVH.
背景:左心室肥厚(LVH)在肥胖人群中普遍存在。此外，LVH和肥胖均与亚临床左室功能障碍有关。本研究旨在探讨体脂和LVH与冠心病(CAD)患者全因死亡之间的相互作用。方法:在这项回顾性队列研究中，共纳入2243例经血管造影证实的冠心病患者。用已建立的公式计算体脂和左室质量。根据体脂率和LVH有无进行分组。采用Cox-proportional hazard models观察体脂与LVH对全因死亡的交互作用。结果在2243例入组患者中，560例(25%)体脂率较高，1045例(46.6%)LVH。中位随访时间为2.2年，体脂高且LVH组的累积死亡率为8.2%，体脂低且无LVH组为2.5%，体脂高且无LVH组为5.4%，体脂低且LVH组为7.8% (log-rank P < 0.001)。体脂率与LVH交互作用有统计学意义(P交互作用为0.003)。校正混杂因素后，体脂高且LVH患者与体脂低且无LVH患者相比，全因死亡风险最高(HR = 3.49, 95% CI: 1.40-8.69, P = 0.007);体脂高且无LVH的患者与体脂低且无LVH的患者相比，死亡风险差异无统计学意义(HR = 2.03, 95% CI: 0.70 ~ 5.92, P = 0.195)。结论较高的体脂率与冠心病患者全因死亡的不同风险相关，并根据是否存在LVH进行分层。高体脂与LVH患者较高的死亡风险显著相关，但与无LVH患者无关。
{"title":"Relationship of body fat and left ventricular hypertrophy with the risk of all-cause death in patients with coronary artery disease","authors":"Bao-tao Huang, L. Yang, Bosen Yang, Fangyang Huang, Q. Xiao, Xiao-bo Pu, Yong Peng, Mao Chen","doi":"10.11909/j.issn.1671-5411.2022.03.002","DOIUrl":"https://doi.org/10.11909/j.issn.1671-5411.2022.03.002","url":null,"abstract":"BACKGROUND Left ventricular hypertrophy (LVH) is prevalent in obese individuals. Besides, both of LVH and obesity is associated with subclinical LV dysfunction. The study aims to investigate the interplay between body fat and LVH in relation to all-cause death in patients with coronary artery disease (CAD). METHODS In this retrospective cohort study, a total of 2243 patients with angiographically proven CAD were included. Body fat and LV mass were calculated using established formulas. Patients were grouped according to body fat percentage and presence or absence of LVH. Cox-proportional hazard models were used to observe the interaction effect of body fat and LVH on all-cause death. RESULTS Of 2243 patients enrolled, 560 (25%) had a higher body fat percentage, and 1045 (46.6%) had LVH. After a median follow-up of 2.2 years, the cumulative mortality rate was 8.2% in the group with higher body fat and LVH, 2.5% in those with lower body fat and no LVH, 5.4% in those with higher body fat and no LVH, and 7.8% in those with lower body fat and LVH (log-rank P < 0.001). There was a statistically significant interaction between body fat percentage and LVH ( P interaction was 0.003). After correcting for confounding factors, patients with higher body fat and LVH had the highest risk of all-cause death (HR = 3.49, 95% CI: 1.40–8.69, P = 0.007) compared with those with lower body fat and no LVH; in contrast, patients with higher body fat and no LVH had no statistically significant difference in risk of death compared with those with lower body fat and no LVH (HR = 2.03, 95% CI: 0.70–5.92, P = 0.195). CONCLUSION A higher body fat percentage was associated with a different risk of all-cause death in patients with CAD, stratified by coexistence of LVH or not. Higher body fat was significantly associated with a greater risk of mortality among patients with LVH but not among those without LVH.","PeriodicalId":285674,"journal":{"name":"Journal of geriatric cardiology : JGC","volume":"134 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115534807","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}
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