Pub Date : 2024-11-23DOI: 10.1016/j.ijcha.2024.101566
Yijing Xin , Siqi Lyu , Yanmin Yang
Background
The aim of this study was to evaluate the association between baseline creatine kinase-myocardial band (CK-MB) and the risk of in-hospital all-cause mortality in acute type A and type B aortic dissection (AD) patients, and to explore the predictive value of CK-MB.
Methods
A single-center retrospective analysis was performed on 552 acute AD (type A 329 patients, type B 223 patients). Outcomes were the incidence of in-hospital all-cause mortality. Kaplan-Meier curve was used to compare the all-cause death risk in two groups (normal CK-MB group and elevated CK-MB group). The Cox regression model and restricted cubic splines (RCS) were conducted to assess the relationship between CK-MB and outcomes. Stratified analysis was performed based on gender, age (<50 years or ≥ 50 years), and surgery or endovascular therapy.
Results
The Kaplan-Meier curves showed statistically significant differences in outcomes among the different CK-MB level groups for both acute type A and type B AD patients. Cox regression analysis revealed that the in-hospital mortality risk was significantly high in the elevated CK-MB groups for both acute type A and type B AD patients. The RCS curve revealed that CK-MB was non-linearly and J-shaped correlated with in-hospital all-cause mortality for acute type A AD patients, and linearly correlated with in-hospital all-cause mortality for acute type B AD patients.
Conclusion
Baseline CK-MB elevations were associated with an increased risk of in-hospital all-cause mortality in acute type A and type B AD patients, and it was independently associated with poor prognosis in type A patients.
背景本研究旨在评估急性A型和B型主动脉夹层（AD）患者基线肌酸激酶-心肌带（CK-MB）与院内全因死亡风险之间的关系，并探讨CK-MB的预测价值。方法对552例急性AD患者（A型329例，B型223例）进行了单中心回顾性分析。结果为院内全因死亡率。采用 Kaplan-Meier 曲线比较两组患者（CK-MB 正常组和 CK-MB 升高组）的全因死亡风险。采用 Cox 回归模型和限制性立方样条曲线（RCS）评估 CK-MB 与预后之间的关系。结果Kaplan-Meier曲线显示，急性A型和B型AD患者不同CK-MB水平组的预后差异有统计学意义。Cox 回归分析显示，CK-MB 升高组的急性 A 型和 B 型 AD 患者院内死亡风险明显较高。RCS曲线显示，CK-MB与急性A型AD患者的院内全因死亡率呈非线性和J型相关，而与急性B型AD患者的院内全因死亡率呈线性相关。
{"title":"Creatine kinase-MB elevation in patients with acute aortic dissection predict worse in-hospital outcomes","authors":"Yijing Xin , Siqi Lyu , Yanmin Yang","doi":"10.1016/j.ijcha.2024.101566","DOIUrl":"10.1016/j.ijcha.2024.101566","url":null,"abstract":"<div><h3>Background</h3><div>The aim of this study was to evaluate the association between baseline creatine kinase-myocardial band (CK-MB) and the risk of in-hospital all-cause mortality in acute type A and type B aortic dissection (AD) patients, and to explore the predictive value of CK-MB.</div></div><div><h3>Methods</h3><div>A single-center retrospective analysis was performed on 552 acute AD (type A 329 patients, type B 223 patients). Outcomes were the incidence of in-hospital all-cause mortality. Kaplan-Meier curve was used to compare the all-cause death risk in two groups (normal CK-MB group and elevated CK-MB group). The Cox regression model and restricted cubic splines (RCS) were conducted to assess the relationship between CK-MB and outcomes. Stratified analysis was performed based on gender, age (<50 years or ≥ 50 years), and surgery or endovascular therapy.</div></div><div><h3>Results</h3><div>The Kaplan-Meier curves showed statistically significant differences in outcomes among the different CK-MB level groups for both acute type A and type B AD patients. Cox regression analysis revealed that the in-hospital mortality risk was significantly high in the elevated CK-MB groups for both acute type A and type B AD patients. The RCS curve revealed that CK-MB was non-linearly and J-shaped correlated with in-hospital all-cause mortality for acute type A AD patients, and linearly correlated with in-hospital all-cause mortality for acute type B AD patients.</div></div><div><h3>Conclusion</h3><div>Baseline CK-MB elevations were associated with an increased risk of in-hospital all-cause mortality in acute type A and type B AD patients, and it was independently associated with poor prognosis in type A patients.</div></div>","PeriodicalId":38026,"journal":{"name":"IJC Heart and Vasculature","volume":"56 ","pages":"Article 101566"},"PeriodicalIF":2.5,"publicationDate":"2024-11-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142698031","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}
The correlation between coronary artery calcification (CAC) detected via electrocardiogram-gated computed tomography (ECG-gated CT) and future cardiovascular events has been well-established. Non-ECG-gated CT is simple and widely used, making it suitable for screening. However, the correlation between CAC observed via non-ECG-gated CT and cardiovascular and non-cardiovascular events remains unclear. Therefore, we examined the association between coronary calcification detected via non-ECG-gated CT and prognosis.
Methods
This non-randomized, retrospective cohort study included 353 consecutive patients with cardiovascular diseases (male/female 229/124; mean age, 68.6 ± 12.7 years) who underwent non-ECG-gated CT between October 1, 2017 and May 31, 2021. Correlations between the Agatston score and cardiovascular and non-cardiovascular events were evaluated. The Agatston scores were divided into three tertiles (low, intermediate, and high) and compared. The primary endpoint was composite cardiovascular events, including cardiac death, myocardial infarction, hospitalization for congestive heart failure, stroke, and unplanned cardiac surgery. The secondary endpoint was composite non-cardiovascular events, including non-cardiovascular death, cancer development, and hospitalization for a non-cardiovascular worsening event.
Results
During the median follow-up period of 16.9 (interquartile range, 2.2–38.6) months, 83 patients reached the primary endpoint, while 81 patients reached the secondary endpoint. Kaplan–Meier analysis indicated that patients with high Agatston scores had a significantly higher incidence of cardiovascular and non-cardiovascular events than those with low Agatston scores (p < 0.001).
Conclusions
In this study, the Agatston score obtained using non-ECG-gated CT predicted cardiovascular and non-cardiovascular events. Non-ECG-gated CT can be easily performed, aiding early detection in patients with high event rates.
{"title":"Prognostic value of coronary calcification detected via non-electrocardiogram-gated computed tomography in patients with cardiovascular disease: A retrospective cohort study","authors":"Tomitaka Wakaki, Yusuke Takagi, Yuto Ono, Ryosuke Kato, Ken Abe, Hiroyuki Watanabe","doi":"10.1016/j.ijcha.2024.101560","DOIUrl":"10.1016/j.ijcha.2024.101560","url":null,"abstract":"<div><h3>Background</h3><div>The correlation between coronary artery calcification (CAC) detected via electrocardiogram-gated computed tomography (ECG-gated CT) and future cardiovascular events has been well-established. Non-ECG-gated CT is simple and widely used, making it suitable for screening. However, the correlation between CAC observed via non-ECG-gated CT and cardiovascular and non-cardiovascular events remains unclear. Therefore, we examined the association between coronary calcification detected via non-ECG-gated CT and prognosis.</div></div><div><h3>Methods</h3><div>This non-randomized, retrospective cohort study included 353 consecutive patients with cardiovascular diseases (male/female 229/124; mean age, 68.6 ± 12.7 years) who underwent non-ECG-gated CT between October 1, 2017 and May 31, 2021. Correlations between the Agatston score and cardiovascular and non-cardiovascular events were evaluated. The Agatston scores were divided into three tertiles (low, intermediate, and high) and compared. The primary endpoint was composite cardiovascular events, including cardiac death, myocardial infarction, hospitalization for congestive heart failure, stroke, and unplanned cardiac surgery. The secondary endpoint was composite non-cardiovascular events, including non-cardiovascular death, cancer development, and hospitalization for a non-cardiovascular worsening event.</div></div><div><h3>Results</h3><div>During the median follow-up period of 16.9 (interquartile range, 2.2–38.6) months, 83 patients reached the primary endpoint, while 81 patients reached the secondary endpoint. Kaplan–Meier analysis indicated that patients with high Agatston scores had a significantly higher incidence of cardiovascular and non-cardiovascular events than those with low Agatston scores (<em>p</em> < 0.001).</div></div><div><h3>Conclusions</h3><div>In this study, the Agatston score obtained using non-ECG-gated CT predicted cardiovascular and non-cardiovascular events. Non-ECG-gated CT can be easily performed, aiding early detection in patients with high event rates.</div></div>","PeriodicalId":38026,"journal":{"name":"IJC Heart and Vasculature","volume":"56 ","pages":"Article 101560"},"PeriodicalIF":2.5,"publicationDate":"2024-11-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142698030","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 : 2024-11-22DOI: 10.1016/j.ijcha.2024.101562
Niya Mileva , Panayot Panayotov , Irina Hristova , Greta Koleva , Despina Georgieva , Raya Ivanova , Dobrin Vassilev
Background
Aortic stiffening is a well-known cardiovascular risk factor. Computed tomography (CT) has proven to be a valuable tool in the assessment of aortic elastic properties. Drugs that inhibit the renin-angiotensin system (RAS) play a central role in cardioprotective therapy. We aimed to evaluate the relationship between aortic elastic properties and RAS-targeted therapy in hypertensive patients.
Methods
This is an observational prospective study of hypertensive patients with nonobstructive coronary artery disease who underwent coronary CT angiography (CCTA). Aortic compliance and distensibility were calculated from the ECG-gated CCTA image. Patients were divided into two groups − those with RAS-targeted therapy − RAS(+) and those with non-RAS-targeted therapy − RAS(−). The elastic properties of the aorta were compared between the two groups.
Results
A total of 142 patients were included in the final analysis. 53.5 % of the population were in the RAS(+) group and 46.5 % in the RAS(−) group. Elastic properties of ascending and descending aorta were significantly higher in the RAS(+) group compared to the RAS(−) group: AA compliance 1.42 ± 0.75 mm2/mmHg in the RAS(+) vs 1.03 ± 0.91 mm2/mmHg in the RAS(−), p = 0.024; AA distensibility 2.86 ± 1.11 x10-3mm3 in the RAS(+) vs 1.82 ± 0.97 x10-3mm3 in RAS(−), p < 0.001; DA compliance 1.45 ± 1.10 mm2/mmHg in the RAS(+) vs 1.11 ± 0.91 mm2/mmHg in the RAS(−), p 0.031; DA distensibility 2.35 ± 0.84 x10-3mm3 in the RAS(+) vs 1.73 ± 1.21 x10-3mm3 in RAS(−), p < 0.001. There was an excellent correlation between RAS therapy and ascending aorta compliance and distensibility (r = 0.901, p < 0.001 and r = 0.875, p < 0.001, respectively).
Conclusion
Patients receiving RAS-blocking treatment revealed significantly higher compliance and distensibility of ascending and descending aorta. In addition, aortic elastic properties were significantly correlated with the RAS-targeted therapy.
{"title":"Impact of renin-angiotensin system targeted therapy on aortic elastic properties assessed by computed tomography","authors":"Niya Mileva , Panayot Panayotov , Irina Hristova , Greta Koleva , Despina Georgieva , Raya Ivanova , Dobrin Vassilev","doi":"10.1016/j.ijcha.2024.101562","DOIUrl":"10.1016/j.ijcha.2024.101562","url":null,"abstract":"<div><h3>Background</h3><div>Aortic stiffening is a well-known cardiovascular risk factor. Computed tomography (CT) has proven to be a valuable tool in the assessment of aortic elastic properties. Drugs that inhibit the renin-angiotensin system (RAS) play a central role in cardioprotective therapy. We aimed to evaluate the relationship between aortic elastic properties and RAS-targeted therapy in hypertensive patients.</div></div><div><h3>Methods</h3><div>This is an observational prospective study of hypertensive patients with nonobstructive coronary artery disease who underwent coronary CT angiography (CCTA). Aortic compliance and distensibility were calculated from the ECG-gated CCTA image. Patients were divided into two groups − those with RAS-targeted therapy − RAS(+) and those with non-RAS-targeted therapy − RAS(−). The elastic properties of the aorta were compared between the two groups.</div></div><div><h3>Results</h3><div>A total of 142 patients were included in the final analysis. 53.5 % of the population were in the RAS(+) group and 46.5 % in the RAS(−) group. Elastic properties of ascending and descending aorta were significantly higher in the RAS(+) group compared to the RAS(−) group: AA compliance 1.42 ± 0.75 mm<sup>2</sup>/mmHg in the RAS(+) vs 1.03 ± 0.91 mm<sup>2</sup>/mmHg in the RAS(−), p = 0.024; AA distensibility 2.86 ± 1.11 x10<sup>-3</sup>mm<sup>3</sup> in the RAS(+) vs 1.82 ± 0.97 x10<sup>-3</sup>mm<sup>3</sup> in RAS(−), p < 0.001; DA compliance 1.45 ± 1.10 mm<sup>2</sup>/mmHg in the RAS(+) vs 1.11 ± 0.91 mm<sup>2</sup>/mmHg in the RAS(−), p 0.031; DA distensibility 2.35 ± 0.84 x10<sup>-3</sup>mm<sup>3</sup> in the RAS(+) vs 1.73 ± 1.21 x10<sup>-3</sup>mm<sup>3</sup> in RAS(−), p < 0.001. There was an excellent correlation between RAS therapy and ascending aorta compliance and distensibility (r = 0.901, p < 0.001 and<!--> <!-->r = 0.875, p < 0.001, respectively).</div></div><div><h3>Conclusion</h3><div>Patients receiving RAS-blocking treatment revealed significantly higher compliance and distensibility of ascending and descending aorta. In addition, aortic elastic properties were significantly correlated with the RAS-targeted therapy.</div></div>","PeriodicalId":38026,"journal":{"name":"IJC Heart and Vasculature","volume":"55 ","pages":"Article 101562"},"PeriodicalIF":2.5,"publicationDate":"2024-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142698517","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 : 2024-11-22DOI: 10.1016/j.ijcha.2024.101563
T. Roovers , M. Habibovic , P. Lodder , J.W. Widdershoven , W.J. Kop
Background
Cardiovascular disease (CVD) risk is associated with health behaviors such as physical inactivity, dietary habits, and smoking. The autonomic nervous system plays a key role in this association. The present longitudinal study examines whether ECG-based indices of autonomic nervous system activity change during an eHealth-based behavior intervention program and assesses whether improvements in health behaviors are associated with increases in parasympathetic autonomic nervous system activity.
Methods
Data from the DoCHANGE-2 (https://clinicaltrials.gov/study/NCT03178305) eHealth-based behavior intervention study in patients with CVD were analyzed for participants with valid ECG recordings (N = 58, mean age = 58.9 [SD = 12.7] years, 21 % women). Heart rate variability (indexed as RMSSD) was calculated from home-recorded (40 s) ECGs over 5-day periods at baseline, 3, and 6 months. Health behaviors, clinical, and psychosocial information was obtained from questionnaires and medical records. Data were analyzed using linear mixed models and general linear models.
Results
Over the 6-month period, RMSSD decreased significantly, with the lowest values at six months (B = -19.336 [95 %CI −36.291; 2.381], p = 0.026). Health behaviors improved significantly during the active (0–3 months) intervention period (B = 13.360 [95 %CI 6.931 19.789], p < 0.001). Higher BMI (B = −0.369 [−0.739; 0.000]; p = 0.05) and older age (B = −0.404 [95 % CI −0.597; − 0.211]; p < 0.001) were associated with lower RMSSD across the three timepoints. No consistent associations were found between changes in health behaviors and changes in RMSSD.
Conclusion
This study shows that changes in HRV during an eHealth-based behavioral intervention were not associated with the observed improvements in health behaviors. These findings require replication in larger well-controlled investigations.
{"title":"Changes in heart rate variability during an eHealth behavior change intervention program in patients with cardiovascular disease","authors":"T. Roovers , M. Habibovic , P. Lodder , J.W. Widdershoven , W.J. Kop","doi":"10.1016/j.ijcha.2024.101563","DOIUrl":"10.1016/j.ijcha.2024.101563","url":null,"abstract":"<div><h3>Background</h3><div>Cardiovascular disease (CVD) risk is associated with health behaviors such as physical inactivity, dietary habits, and smoking. The autonomic nervous system plays a key role in this association. The present longitudinal study examines whether ECG-based indices of autonomic nervous system activity change during an eHealth-based behavior intervention program and assesses whether improvements in health behaviors are associated with increases in parasympathetic autonomic nervous system activity.</div></div><div><h3>Methods</h3><div>Data from the DoCHANGE-2 (<span><span>https://clinicaltrials.gov/study/NCT03178305</span><svg><path></path></svg></span>) eHealth-based behavior intervention study in patients with CVD were analyzed for participants with valid ECG recordings (N = 58, mean age = 58.9 [SD = 12.7] years, 21 % women). Heart rate variability (indexed as RMSSD) was calculated from home-recorded (40 s) ECGs over 5-day periods at baseline, 3, and 6 months. Health behaviors, clinical, and psychosocial information was obtained from questionnaires and medical records. Data were analyzed using linear mixed models and general linear models.</div></div><div><h3>Results</h3><div>Over the 6-month period, RMSSD decreased significantly, with the lowest values at six months (B = -19.336 [95 %CI −36.291; 2.381], p = 0.026). Health behaviors improved significantly during the active (0–3 months) intervention period (B = 13.360 [95 %CI 6.931 19.789], p < 0.001). Higher BMI (B = −0.369 [−0.739; 0.000]; p = 0.05) and older age (B = −0.404 [95 % CI −0.597; − 0.211]; p < 0.001) were associated with lower RMSSD across the three timepoints. No consistent associations were found between changes in health behaviors and changes in RMSSD.</div></div><div><h3>Conclusion</h3><div>This study shows that changes in HRV during an eHealth-based behavioral intervention were not associated with the observed improvements in health behaviors. These findings require replication in larger well-controlled investigations.</div></div>","PeriodicalId":38026,"journal":{"name":"IJC Heart and Vasculature","volume":"55 ","pages":"Article 101563"},"PeriodicalIF":2.5,"publicationDate":"2024-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142697426","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 : 2024-11-22DOI: 10.1016/j.ijcha.2024.101564
E.C.I. Woelders , B. Yosofi , D.A.M. Peeters , L.S.F. Konijnenberg , C. von Birgelen , J.B. van Rees , S.C.H. van den Oord , A.A.C.M. Heestermans , B.E.P.M. Claessen , N. van Royen , R.J.M. van Geuns , R. Nijveldt , P. Damman
Background
Ticagrelor monotherapy after 1–3 months of dual antiplatelet therapy (DAPT) has shown to be effective and safe after percutaneous coronary intervention (PCI), including in patients with an ST elevation myocardial infarction (STEMI). Direct omission of aspirin could further reduce bleeding complications and may reduce the incidence and expansion of intramyocardial haemorrhage (IMH), a frequent complication after revascularisation for a STEMI.
Methods
This multicentre open label pilot study randomises 200 STEMI patients within 24 hours after primary PCI and before the first subsequent dose of aspirin to ticagrelor monotherapy or ticagrelor plus aspirin for twelve months. As IMH is more frequently observed after an anterior STEMI, IMH and infarct size will be determined with cardiac magnetic resonance (CMR) imaging in 60 anterior STEMI patients. In this subgroup, blood samples will be analysed for biochemical outcomes.
Results
The primary safety endpoint consists of major adverse cardiac and cerebral events, and the primary efficacy endpoint is infarct size on CMR. Secondary efficacy endpoints consist of the incidence and extent of IMH determined by CMR, and of clinical bleeding events. Other endpoints include all-cause mortality and biochemical outcomes.
Conclusion
The STOP-IMH pilot study compares ticagrelor monotherapy with ticagrelor plus aspirin directly after primary PCI in 200 STEMI patients. We aim to provide a signal of safety regarding ischemic events for the direct omission of aspirin after primary PCI, and to compare the infarct size by CMR between the two treatment strategies in the first week after primary PCI.
{"title":"Rationale and design of the STOP-IMH randomised trial: Safety of ticagrelor monotherapy after primary percutaneous coronary intervention for ST-elevation myocardial infarction and the effect on intramyocardial haemorrhage","authors":"E.C.I. Woelders , B. Yosofi , D.A.M. Peeters , L.S.F. Konijnenberg , C. von Birgelen , J.B. van Rees , S.C.H. van den Oord , A.A.C.M. Heestermans , B.E.P.M. Claessen , N. van Royen , R.J.M. van Geuns , R. Nijveldt , P. Damman","doi":"10.1016/j.ijcha.2024.101564","DOIUrl":"10.1016/j.ijcha.2024.101564","url":null,"abstract":"<div><h3>Background</h3><div>Ticagrelor monotherapy after 1–3 months of dual antiplatelet therapy (DAPT) has shown to be effective and safe after percutaneous coronary intervention (PCI), including in patients with an ST elevation myocardial infarction (STEMI). Direct omission of aspirin could further reduce bleeding complications and may reduce the incidence and expansion of intramyocardial haemorrhage (IMH), a frequent complication after revascularisation for a STEMI.</div></div><div><h3>Methods</h3><div>This multicentre open label pilot study randomises 200 STEMI patients within 24 hours after primary PCI and before the first subsequent dose of aspirin to ticagrelor monotherapy or ticagrelor plus aspirin for twelve months. As IMH is more frequently observed after an anterior STEMI, IMH and infarct size will be determined with cardiac magnetic resonance (CMR) imaging in 60 anterior STEMI patients. In this subgroup, blood samples will be analysed for biochemical outcomes.</div></div><div><h3>Results</h3><div>The primary safety endpoint consists of major adverse cardiac and cerebral events, and the primary efficacy endpoint is infarct size on CMR. Secondary efficacy endpoints consist of the incidence and extent of IMH determined by CMR, and of clinical bleeding events. Other endpoints include all-cause mortality and biochemical outcomes.</div></div><div><h3>Conclusion</h3><div>The STOP-IMH pilot study compares ticagrelor monotherapy with ticagrelor plus aspirin directly after primary PCI in 200 STEMI patients. We aim to provide a signal of safety regarding ischemic events for the direct omission of aspirin after primary PCI, and to compare the infarct size by CMR between the two treatment strategies in the first week after primary PCI.</div></div>","PeriodicalId":38026,"journal":{"name":"IJC Heart and Vasculature","volume":"56 ","pages":"Article 101564"},"PeriodicalIF":2.5,"publicationDate":"2024-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142698029","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 : 2024-11-21DOI: 10.1016/j.ijcha.2024.101561
Jennifer Zhou , Shane Nanayakkara , Rozanne Johnston , Ellen Gardner , Nay Min Htun , Sonny Palmer , Samer Noaman , Liam Guiney , David M. Kaye , Antony S. Walton , Dion Stub
Background
Socioeconomic status (SES) is an important determinant of healthcare outcomes in many settings, but few studies have evaluated the impact of SES among patients with aortic stenosis (AS). We sought to explore the association between SES and clinical characteristics, care quality and outcomes among patients undergoing transcatheter aortic valve implantation (TAVI) for severe AS.
Methods
Consecutive patients undergoing TAVI for severe AS at three hospitals between August 2008 and February 2023 were prospectively enrolled in a multicentre registry. Patients were stratified into SES quintiles using a census-derived index. Demographic, procedural, and outcomes data were retrospectively analysed.
Results
A total of 2,462 patients underwent TAVI during the study period. Lower SES patients were younger than those of higher SES, had more comorbidities, and were less likely to have private health insurance or receive care in private hospitals. Compared to higher SES groups, lower SES patients presented with more advanced disease markers (lower aortic valve area, lower dimensionless index, increased pulmonary hypertension) and were more likely to undergo urgent TAVI, but faced longer wait times for elective TAVI. Despite these pre-procedural differences, mortality and complication rates were similar across SES groups. In multivariable analyses, SES was not an independent predictor of mortality or major adverse cardiovascular events (MACE) at 30 days or 12 months.
Conclusions
SES did not independently predict mortality or MACE in patients undergoing TAVI for severe AS. However, disparities in pre-procedural characteristics and access barriers were identified, highlighting the need to address SES-related inequities in healthcare delivery.
{"title":"Association of socioeconomic status with clinical characteristics, care quality and outcomes in patients undergoing transcatheter aortic valve implantation","authors":"Jennifer Zhou , Shane Nanayakkara , Rozanne Johnston , Ellen Gardner , Nay Min Htun , Sonny Palmer , Samer Noaman , Liam Guiney , David M. Kaye , Antony S. Walton , Dion Stub","doi":"10.1016/j.ijcha.2024.101561","DOIUrl":"10.1016/j.ijcha.2024.101561","url":null,"abstract":"<div><h3>Background</h3><div>Socioeconomic status (SES) is an important determinant of healthcare outcomes in many settings, but few studies have evaluated the impact of SES among patients with aortic stenosis (AS). We sought to explore the association between SES and clinical characteristics, care quality and outcomes among patients undergoing transcatheter aortic valve implantation (TAVI) for severe AS.</div></div><div><h3>Methods</h3><div>Consecutive patients undergoing TAVI for severe AS at three hospitals between August 2008 and February 2023 were prospectively enrolled in a multicentre registry. Patients were stratified into SES quintiles using a census-derived index. Demographic, procedural, and outcomes data were retrospectively analysed.</div></div><div><h3>Results</h3><div>A total of 2,462 patients underwent TAVI during the study period. Lower SES patients were younger than those of higher SES, had more comorbidities, and were less likely to have private health insurance or receive care in private hospitals. Compared to higher SES groups, lower SES patients presented with more advanced disease markers (lower aortic valve area, lower dimensionless index, increased pulmonary hypertension) and were more likely to undergo urgent TAVI, but faced longer wait times for elective TAVI. Despite these pre-procedural differences, mortality and complication rates were similar across SES groups. In multivariable analyses, SES was not an independent predictor of mortality or major adverse cardiovascular events (MACE) at 30 days or 12 months.</div></div><div><h3>Conclusions</h3><div>SES did not independently predict mortality or MACE in patients undergoing TAVI for severe AS. However, disparities in pre-procedural characteristics and access barriers were identified, highlighting the need to address SES-related inequities in healthcare delivery.</div></div>","PeriodicalId":38026,"journal":{"name":"IJC Heart and Vasculature","volume":"55 ","pages":"Article 101561"},"PeriodicalIF":2.5,"publicationDate":"2024-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142698518","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 : 2024-11-21DOI: 10.1016/j.ijcha.2024.101558
Stefano Fumagalli , Giulia Ricciardi , Claudia Di Serio , Elisa Berni , Giancarlo La Marca , Giuseppe Pieraccini , Riccardo Romoli , Emanuele Santamaria , Giulia Spanalatte , Camilla Cagnoni , Arianna Tariello , Giada Alla Viligiardi , Agostino Virdis , Igor Diemberger , Andrea Ungar , Niccolò Marchionni
Background
Atrial fibrillation (AF) is the most common arrhythmia diagnosed at an older age. AF is associated with frailty, a condition possibly justifying the higher rate of complications and mortality in aged individuals. This study was aimed at describing the characteristics correlated to frailty in older AF subjects.
Methods
After having excluded a < 3 months major surgery procedure, cancer or other conditions associated with activation of inflammation, and a life expectancy < 12 months, we consecutively enrolled patients ≥ 65 years with persistent AF. They underwent a Comprehensive Geriatric Assessment evaluation. In particular, Mini-Mental State Examination, 15-item Geriatric Depression Scale and Short-Physical Performance Battery (SPPB) described, respectively, cognitive profile, depressive symptoms and physical performance. A venous blood sample was collected to measure interleukin-6 (IL-6; marker of low-grade inflammation) and acylcarnitines, expression of mitochondrial dysfunction and abnormal energy production.
Results
Overall, 49 patients (mean age: 76 ± 6 years; women 30.6 %) were studied. Cluster analysis described two different patterns; the second (N = 18, 36.7 %), when compared to the first one (N = 31, 63.3 %), was characterized by a worse phenotype, identified by the simultaneous presence of lower body mass index, higher CHA2DS2-VASc score (index of clinical complexity), worse SPPB functional performance, and high IL-6 levels. Second cluster patients had a higher concentration of 13 of the 35 acylcarnitines evaluated and increased 5-year mortality. All these features can outline a frail condition.
Conclusions
Body size, clinical complexity, physical performance and low-grade inflammation seem to rapidly and adequately describe frailty.
{"title":"From geriatric assessment to inflammation. A pilot, observational, study about frailty components in older patients with persistent atrial fibrillation","authors":"Stefano Fumagalli , Giulia Ricciardi , Claudia Di Serio , Elisa Berni , Giancarlo La Marca , Giuseppe Pieraccini , Riccardo Romoli , Emanuele Santamaria , Giulia Spanalatte , Camilla Cagnoni , Arianna Tariello , Giada Alla Viligiardi , Agostino Virdis , Igor Diemberger , Andrea Ungar , Niccolò Marchionni","doi":"10.1016/j.ijcha.2024.101558","DOIUrl":"10.1016/j.ijcha.2024.101558","url":null,"abstract":"<div><h3>Background</h3><div>Atrial fibrillation (AF) is the most common arrhythmia diagnosed at an older age. AF is associated with frailty, a condition possibly justifying the higher rate of complications and mortality in aged individuals. This study was aimed at describing the characteristics correlated to frailty in older AF subjects.</div></div><div><h3>Methods</h3><div>After having excluded a < 3 months major surgery procedure, cancer or other conditions associated with activation of inflammation, and a life expectancy < 12 months, we consecutively enrolled patients ≥ 65 years with persistent AF. They underwent a Comprehensive Geriatric Assessment evaluation. In particular, Mini-Mental State Examination, 15-item Geriatric Depression Scale and Short-Physical Performance Battery (SPPB) described, respectively, cognitive profile, depressive symptoms and physical performance. A venous blood sample was collected to measure interleukin-6 (IL-6; marker of low-grade inflammation) and acylcarnitines, expression of mitochondrial dysfunction and abnormal energy production.</div></div><div><h3>Results</h3><div>Overall, 49 patients (mean age: 76 ± 6 years; women 30.6 %) were studied. Cluster analysis described two different patterns; the second (N = 18, 36.7 %), when compared to the first one (N = 31, 63.3 %), was characterized by a worse phenotype, identified by the simultaneous presence of lower body mass index, higher CHA<sub>2</sub>DS<sub>2</sub>-VASc score (index of clinical complexity), worse SPPB functional performance, and high IL-6 levels. Second cluster patients had a higher concentration of 13 of the 35 acylcarnitines evaluated and increased 5-year mortality. All these features can outline a frail condition.</div></div><div><h3>Conclusions</h3><div>Body size, clinical complexity, physical performance and low-grade inflammation seem to rapidly and adequately describe frailty.</div></div>","PeriodicalId":38026,"journal":{"name":"IJC Heart and Vasculature","volume":"55 ","pages":"Article 101558"},"PeriodicalIF":2.5,"publicationDate":"2024-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142698516","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 : 2024-11-18DOI: 10.1016/j.ijcha.2024.101556
Yanwei Li , Zhulu Chen , Rui Lan , Tao Ran , Jingyi He , Jialian Li , Qiuyue Shi , Min Mao , Zhong Zuo
Background
Atherosclerotic renal artery stenosis (ARAS) is commonly associated with cardiovascular diseases(CVD). Patients with ARAS typically present with cardiac structural and functional abnormalities, and the differences in cardiac structure and function compared to hypertensive patients without ARAS remain to be explored.
Methods
A total of 499 hypertensive patients were included, of whom 134 had ARAS and 365 had no renal artery stenosis (RAS). Parameters about cardiac function and structure detected by echocardiography and other clinical data are collected. Univariate and multivariate binary logistic regression and mediation analysis were performed on the collected data.
Results
Compared to hypertensive patients without ARAS, those with ARAS had significantly increased left ventricular (LV) internal diameter (LVIDd), posterior wall thickness (PWTd), LV geometric abnormalities, diastolic dysfunction, and a higher prevalence of LV hypertrophy (LVH). After adjustment, ARAS was significantly associated with LV diastolic dysfunction (LVDF) (OR = 1.12, 95 %CI = 1.03–1.3), LVIDd (OR = 1.07, 95 %CI = 1.02–1.13), LV geometry (OR = 1.24, 95 %CI = 1.12–1.36), PWTd (OR = 1.2, 95 %CI = 1.09–1.31), and LV mass index (OR = 1.31, 95 %CI = 1.18–1.47). Mediation analysis identified hypersensitive C-reactive protein (Hs-CRP) and serum creatinine (Scr) as significant mediators, accounting for 10.80 % to 59.54 % of the ARAS impact on LV abnormalities.
Conclusion
ARAS appears to be an independent risk factor for abnormalities in cardiac function and structure, potentially mediated by Hs-CRP and Scr. Hypertensive patients with ARAS demonstrate a higher prevalence of left ventricular hypertrophy (LVH) and diastolic dysfunction, underscoring the importance of vigilant monitoring in this population.
{"title":"Atherosclerotic renal artery stenosis, mediating biomarkers, and risk of cardiac among individuals with hypertension: A real-world study","authors":"Yanwei Li , Zhulu Chen , Rui Lan , Tao Ran , Jingyi He , Jialian Li , Qiuyue Shi , Min Mao , Zhong Zuo","doi":"10.1016/j.ijcha.2024.101556","DOIUrl":"10.1016/j.ijcha.2024.101556","url":null,"abstract":"<div><h3>Background</h3><div>Atherosclerotic renal artery stenosis (ARAS) is commonly associated with cardiovascular diseases(CVD). Patients with ARAS typically present with cardiac structural and functional abnormalities, and the differences in cardiac structure and function compared to hypertensive patients without ARAS remain to be explored.</div></div><div><h3>Methods</h3><div>A total of 499 hypertensive patients were included, of whom 134 had ARAS and 365 had no renal artery stenosis (RAS). Parameters about cardiac function and structure detected by echocardiography and other clinical data are collected. Univariate and multivariate binary logistic regression and mediation analysis were performed on the collected data.</div></div><div><h3>Results</h3><div>Compared to hypertensive patients without ARAS, those with ARAS had significantly increased left ventricular (LV) internal diameter (LVIDd), posterior wall thickness (PWTd), LV geometric abnormalities, diastolic dysfunction, and a higher prevalence of LV hypertrophy (LVH). After adjustment, ARAS was significantly associated with LV diastolic dysfunction (LVDF) (OR = 1.12, 95 %CI = 1.03–1.3), LVIDd (OR = 1.07, 95 %CI = 1.02–1.13), LV geometry (OR = 1.24, 95 %CI = 1.12–1.36), PWTd (OR = 1.2, 95 %CI = 1.09–1.31), and LV mass index (OR = 1.31, 95 %CI = 1.18–1.47). Mediation analysis identified hypersensitive C-reactive protein (Hs-CRP) and serum creatinine (Scr) as significant mediators, accounting for 10.80 % to 59.54 % of the ARAS impact on LV abnormalities.</div></div><div><h3>Conclusion</h3><div>ARAS appears to be an independent risk factor for abnormalities in cardiac function and structure, potentially mediated by Hs-CRP and Scr. Hypertensive patients with ARAS demonstrate a higher prevalence of left ventricular hypertrophy (LVH) and diastolic dysfunction, underscoring the importance of vigilant monitoring in this population.</div></div>","PeriodicalId":38026,"journal":{"name":"IJC Heart and Vasculature","volume":"55 ","pages":"Article 101556"},"PeriodicalIF":2.5,"publicationDate":"2024-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142698587","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 : 2024-11-16DOI: 10.1016/j.ijcha.2024.101554
Jiaqi Pan , Enrui Zhang , Jie Han , Haiyu Zou , Liangrong Zheng
Background
Despite receiving pacemaker therapy, patients with heart failure with reduced ejection fraction (HFrEF) due to dilated cardiomyopathy (DCM) remain at an increased risk of adverse cardiovascular events. The high-sensitivity C-reactive protein (hs-CRP)-to-albumin ratio (CAR) is a novel indicator. This study aimed to assess the prognostic value of preoperative CAR in this population.
Methods
Patients with DCM who underwent cardiac resynchronization therapy (CRT) or implantable cardiac defibrillator (ICD) implantation for HFrEF between 2018 and 2023 were involved. The primary endpoint was major adverse cardiac events (MACE). Cox regression models were used to investigate predictors for MACE. Receiver operating characteristic (ROC) curve analysis was utilized to evaluate the diagnostic efficacy and identify the optimal cutoff point.
Results
We enrolled 250 patients, of whom 78 experienced MACE. Patients who experienced MACE had a significantly higher CAR than those without MACE (p < 0.001). Multivariate Cox regression analysis indicated CAR as an independent predictor for MACE (hazard ratio = 4.301, 95 % confidence interval [CI] 1.833–10.091, p < 0.001). ROC curve analysis demonstrated the discriminatory ability of CAR in predicting MACE (area under the curve [AUC] = 0.732, 95 % CI 0.666–0.792, p < 0.001), with an optimal threshold of 0.08. Furthermore, the incidence of MACE was significantly higher in the high-CAR (> 0.08) group compared to the low-CAR (≤ 0.08) group (48.8 % vs. 13.6 %, p < 0.001).
Conclusion
Among patients with DCM and HFrEF treated with CRT or ICD, CAR can serve as an independent risk predictor, with higher levels associated with poorer outcomes.
{"title":"Prognostic value of preoperative high-sensitivity C-reactive protein to albumin ratio in patients with dilated cardiomyopathy receiving pacemaker therapy: A retrospective two-center study in China","authors":"Jiaqi Pan , Enrui Zhang , Jie Han , Haiyu Zou , Liangrong Zheng","doi":"10.1016/j.ijcha.2024.101554","DOIUrl":"10.1016/j.ijcha.2024.101554","url":null,"abstract":"<div><h3>Background</h3><div>Despite receiving pacemaker therapy, patients with heart failure with reduced ejection fraction (HFrEF) due to dilated cardiomyopathy (DCM) remain at an increased risk of adverse cardiovascular events. The high-sensitivity C-reactive protein (hs-CRP)-to-albumin ratio (CAR) is a novel indicator. This study aimed to assess the prognostic value of preoperative CAR in this population.</div></div><div><h3>Methods</h3><div>Patients with DCM who underwent cardiac resynchronization therapy (CRT) or implantable cardiac defibrillator (ICD) implantation for HFrEF between 2018 and 2023 were involved. The primary endpoint was major adverse cardiac events (MACE). Cox regression models were used to investigate predictors for MACE. Receiver operating characteristic (ROC) curve analysis was utilized to evaluate the diagnostic efficacy and identify the optimal cutoff point.</div></div><div><h3>Results</h3><div>We enrolled 250 patients, of whom 78 experienced MACE. Patients who experienced MACE had a significantly higher CAR than those without MACE (<em>p</em> < 0.001). Multivariate Cox regression analysis indicated CAR as an independent predictor for MACE (hazard ratio = 4.301, 95 % confidence interval [CI] 1.833–10.091, <em>p</em> < 0.001). ROC curve analysis demonstrated the discriminatory ability of CAR in predicting MACE (area under the curve [AUC] = 0.732, 95 % CI 0.666–0.792, <em>p</em> < 0.001), with an optimal threshold of 0.08. Furthermore, the incidence of MACE was significantly higher in the high-CAR (> 0.08) group compared to the low-CAR (≤ 0.08) group (48.8 % vs. 13.6 %, <em>p</em> < 0.001).</div></div><div><h3>Conclusion</h3><div>Among patients with DCM and HFrEF treated with CRT or ICD, CAR can serve as an independent risk predictor, with higher levels associated with poorer outcomes.</div></div>","PeriodicalId":38026,"journal":{"name":"IJC Heart and Vasculature","volume":"55 ","pages":"Article 101554"},"PeriodicalIF":2.5,"publicationDate":"2024-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142659348","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 : 2024-11-16DOI: 10.1016/j.ijcha.2024.101557
Shreya Banerjee , Pranav S. Garimella , Kimberly N. Hong , Alexander L. Bullen , Lori B. Daniels , Nicholas Wettersten
Proenkephalin (PENK) is a novel biomarker of kidney function associated with cardiovascular risk in patients with cardiovascular disease. Its association with cardiovascular outcomes in ambulatory individuals is less described. In an observational study of 199 ambulatory Veterans enrolled from April to September 2010, we assessed PENK’s association with major adverse cardiac events (MACE − cardiovascular death, heart failure [HF] hospitalization, myocardial infarction [MI], or stroke) and individual outcomes of all-cause mortality, incident HF, and cardiovascular death using Cox regression. We also assessed the association of PENK with left ventricular ejection fraction (LVEF), left ventricular end-diastolic diameter (LVEDd), and left ventricular mass index (LVMi) with linear regression. The mean age was 66 ± 12 years, 99 % were men, and 76 % were White, with median follow-up of 12.7 years. Each two-fold higher PENK was associated with a 73 % higher risk of MACE in unadjusted analysis (HR 1.73; 95 % CI 1.00, 2.99; p = 0.043), though this association lost significance after adjusting for confounders (HR 1.69; 95 % CI 0.90–3.15; p = 0.098). PENK was not associated with all-cause mortality, incident HF or cardiovascular death, although risk estimates were elevated with wide confidence intervals for incident HF and cardiovascular death. PENK was not associated with LVMi or LVEDd but had a non-linear relationship with LVEF with low and high PENK associated with lower LVEF. In conclusion, PENK may be associated with a higher risk of MACE in ambulatory Veterans with diverse health statuses; however, further studies are needed.
Abbreviations: PENK: Proenkephalin A; MACE: Major Adverse Cardiac Events.
{"title":"Association between Proenkephalin A and cardiovascular outcomes in ambulatory Veterans","authors":"Shreya Banerjee , Pranav S. Garimella , Kimberly N. Hong , Alexander L. Bullen , Lori B. Daniels , Nicholas Wettersten","doi":"10.1016/j.ijcha.2024.101557","DOIUrl":"10.1016/j.ijcha.2024.101557","url":null,"abstract":"<div><div>Proenkephalin (PENK) is a novel biomarker of kidney function associated with cardiovascular risk in patients with cardiovascular disease. Its association with cardiovascular outcomes in ambulatory individuals is less described. In an observational study of 199 ambulatory Veterans enrolled from April to September 2010, we assessed PENK’s association with major adverse cardiac events (MACE − cardiovascular death, heart failure [HF] hospitalization, myocardial infarction [MI], or stroke) and individual outcomes of all-cause mortality, incident HF, and cardiovascular death using Cox regression. We also assessed the association of PENK with left ventricular ejection fraction (LVEF), left ventricular end-diastolic diameter (LVEDd), and left ventricular mass index (LVMi) with linear regression. The mean age was 66 ± 12 years, 99 % were men, and 76 % were White, with median follow-up of 12.7 years. Each two-fold higher PENK was associated with a 73 % higher risk of MACE in unadjusted analysis (HR 1.73; 95 % CI 1.00, 2.99; p = 0.043), though this association lost significance after adjusting for confounders (HR 1.69; 95 % CI 0.90–3.15; p = 0.098). PENK was not associated with all-cause mortality, incident HF or cardiovascular death, although risk estimates were elevated with wide confidence intervals for incident HF and cardiovascular death. PENK was not associated with LVMi or LVEDd but had a non-linear relationship with LVEF with low and high PENK associated with lower LVEF. In conclusion, PENK may be associated with a higher risk of MACE in ambulatory Veterans with diverse health statuses; however, further studies are needed.</div><div>Abbreviations: PENK: Proenkephalin A; MACE: Major Adverse Cardiac Events.</div></div>","PeriodicalId":38026,"journal":{"name":"IJC Heart and Vasculature","volume":"55 ","pages":"Article 101557"},"PeriodicalIF":2.5,"publicationDate":"2024-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142659349","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}
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