The thyroid gland is responsible for metabolism, as well as cardiac function and the peripheral vascular system. Thyroid dysfunctions are associated with an increase in the risk of cardiovascular diseases, including heart failure and coronary heart disease atrial fibrillation, by impairing heart contractility, stroke volume, heart rate, peripheral vascular resistance, and electrical activity. Thyroid dysfunctions also alter several cardiovascular risk factors, such as atherosclerosis, hypertension, and dyslipidemia, as well as causing stroke, which is associated with atrial fibrillation. An antiarrhythmic drug, amiodarone, may also induce both thyrotoxicosis and hypothyroidism, so its use requires serial thyroid function testing. Every CVD patient is recommended to be screened and treated for any possible thyroid dysfunction to reduce the patient’s mortality and morbidity.
{"title":"The impact of thyroid disorder on cardiovascular disease: Unraveling the connection and implications for patient care","authors":"Nanny Natalia Mulyani Soetedjo , Dessy Agustini , Hikmat Permana","doi":"10.1016/j.ijcha.2024.101536","DOIUrl":"10.1016/j.ijcha.2024.101536","url":null,"abstract":"<div><div>The thyroid gland is responsible for metabolism, as well as cardiac function and the peripheral vascular system. Thyroid dysfunctions are associated with an increase in the risk of cardiovascular diseases, including heart failure and coronary heart disease atrial fibrillation, by impairing heart contractility, stroke volume, heart rate, peripheral vascular resistance, and electrical activity. Thyroid dysfunctions also alter several cardiovascular risk factors, such as atherosclerosis, hypertension, and dyslipidemia, as well as causing stroke, which is associated with atrial fibrillation. An antiarrhythmic drug, amiodarone, may also induce both thyrotoxicosis and hypothyroidism, so its use requires serial thyroid function testing. Every CVD patient is recommended to be screened and treated for any possible thyroid dysfunction to reduce the patient’s mortality and morbidity.</div></div>","PeriodicalId":38026,"journal":{"name":"IJC Heart and Vasculature","volume":"55 ","pages":"Article 101536"},"PeriodicalIF":2.5,"publicationDate":"2024-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142529506","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 : 2024-10-23DOI: 10.1016/j.ijcha.2024.101541
Antti Lappalainen , Juha E.K. Hartikainen , Konsta Teppo , Olli Halminen , Aapo L. Aro , Rasmus Siponen , Janne Virrankorpi , Annukka Marjamaa , Birgitta Salmela , Jukka Putaala , Pirjo Mustonen , Miika Linna , Jari Haukka , K.E. Juhani Airaksinen , Mika Lehto
Background
Catheter ablation is a well-established treatment to prevent atrial fibrillation (AF) and atrial flutter (AFL) recurrences and to relieve symptoms, whereas pacemaker implantation and atrioventricular node (AVN) ablation is used for rate control when medical therapy fails.
Aims
We investigated temporal trends and patient characteristics in catheter ablation procedures for AF, AFL and AVN in Finland between 2012–2018.
Methods
Finnish AntiCoagulation in Atrial Fibrillation (FinACAF) is a registry-based study including all patients with AF or AFL in Finland between 2012–2018.
Results
The number of patients with AF or AFL diagnosis in Finland increased from 185 057 to 243 802 between 2012–2018 and a total of 8954 first-time catheter ablation procedures were performed. Of them, 4909 (54.8 %) were AF ablations, 2731 (30.5 %) AFL ablations and 1314 (14.7 %) AVN ablations. The procedural numbers increased from 457/year to 934/year for AF, from 223/year to 553/year for AFL and from 114/year to 238/year for AVN. Altogether, 0.65% of all patients with diagnosed AF or AFL underwent AF, AFL or AVN ablation in 2018. The mean age of the patients increased in all ablation groups. Patients undergoing AF and AFL ablations were predominantly men (69.7 % and 74.6 % respectively) whereas patients undergoing AVN ablation were more often women (56.9%).
Conclusions
The use of catheter ablation more than doubled during 2012–2018 and the increase was particularly seen in the elderly patients. Nevertheless, only a minority of AF and AFL patients were treated with catheter ablations.
{"title":"Temporal trends of catheter ablation procedures in patients with atrial fibrillation and atrial flutter: A nationwide cohort study","authors":"Antti Lappalainen , Juha E.K. Hartikainen , Konsta Teppo , Olli Halminen , Aapo L. Aro , Rasmus Siponen , Janne Virrankorpi , Annukka Marjamaa , Birgitta Salmela , Jukka Putaala , Pirjo Mustonen , Miika Linna , Jari Haukka , K.E. Juhani Airaksinen , Mika Lehto","doi":"10.1016/j.ijcha.2024.101541","DOIUrl":"10.1016/j.ijcha.2024.101541","url":null,"abstract":"<div><h3>Background</h3><div>Catheter ablation is a well-established treatment to prevent atrial fibrillation (AF) and atrial flutter (AFL) recurrences and to relieve symptoms, whereas pacemaker implantation and atrioventricular node (AVN) ablation is used for rate control when medical therapy fails.</div></div><div><h3>Aims</h3><div>We investigated temporal trends and patient characteristics in catheter ablation procedures for AF, AFL and AVN in Finland between 2012–2018.</div></div><div><h3>Methods</h3><div>Finnish AntiCoagulation in Atrial Fibrillation (FinACAF) is a registry-based study including all patients with AF or AFL in Finland between 2012–2018.</div></div><div><h3>Results</h3><div>The number of patients with AF or AFL diagnosis in Finland increased from 185<!--> <!-->057 to 243<!--> <!-->802 between 2012–2018 and a total of 8954 first-time catheter ablation procedures were performed. Of them, 4909 (54.8 %) were AF ablations, 2731 (30.5 %) AFL ablations and 1314 (14.7 %) AVN ablations. The procedural numbers increased from 457/year to 934/year for AF, from 223/year to 553/year for AFL and from 114/year to 238/year for AVN. Altogether, 0.65% of all patients with diagnosed AF or AFL underwent AF, AFL or AVN ablation in 2018. The mean age of the patients increased in all ablation groups. Patients undergoing AF and AFL ablations were predominantly men (69.7 % and 74.6 % respectively) whereas patients undergoing AVN ablation were more often women (56.9%).</div></div><div><h3>Conclusions</h3><div>The use of catheter ablation more than doubled during 2012–2018 and the increase was particularly seen in the elderly patients. Nevertheless, only a minority of AF and AFL patients were treated with catheter ablations.</div></div>","PeriodicalId":38026,"journal":{"name":"IJC Heart and Vasculature","volume":"55 ","pages":"Article 101541"},"PeriodicalIF":2.5,"publicationDate":"2024-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142529504","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 : 2024-10-22DOI: 10.1016/j.ijcha.2024.101534
Markku Pentikäinen , Piia Simonen , Pauliina Leskelä , Terttu Harju , Pertti Jääskeläinen , Christina Wennerström , Nikolaj Bødker , Eija Heikkilä , Mari Lahelma , Riikka-Leena Leskelä , Airi Puhakka , on behalf of the FINPAH study group
Objectives
Given that pulmonary arterial hypertension (PAH) and chronic thromboembolic hypertension (CTEPH) are rare yet severe subtypes of pulmonary hypertension significantly impacting patients’ lives, this study analyzed the total societal costs of these conditions in Finland.
Methods
PAH (n = 247) and CTEPH (n = 177) patients diagnosed between 2008 and 2019 were analyzed for primary and specialty outpatient visits, emergency visits, hospitalizations, home and institutional care, sick leaves, disability pensions, and drug costs for 5 years before and after diagnosis.
Results
In PAH and CTEPH, annual specialty care number of outpatient visits increased from 3.8 and 3.3 (5 years before diagnosis) to 13.8 and 9.5 one-year post-diagnosis, then decreased to 9.2 and 4.0 at 5 years post-diagnosis. Annual inpatient days rose from 2.8 and 2.7 to 16.1 and 19.7 pre-diagnosis, then fell to 10.2 and 3.5 post-diagnosis, respectively. Within 5 years post-diagnosis, in working-age 70 % PAH and 42 % CTEPH patients received disability pensions. Drug therapy accounted for most costs (67 % in PAH and 60 % in CTEPH), followed by inpatient care, disability pensions, and outpatient care. Total costs were significantly lower for CTEPH, especially after pulmonary endarterectomy. Among PAH subtypes, the highest costs were in patients with PAH associated with connective tissue diseases.
Conclusions
PAH and CTEPH cause a significant economic burden on patients and society with considerable differences depending on the PAH subtype and whether the patient has undergone PEA operation or not.
{"title":"Economic burden of pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH) in Finland","authors":"Markku Pentikäinen , Piia Simonen , Pauliina Leskelä , Terttu Harju , Pertti Jääskeläinen , Christina Wennerström , Nikolaj Bødker , Eija Heikkilä , Mari Lahelma , Riikka-Leena Leskelä , Airi Puhakka , on behalf of the FINPAH study group","doi":"10.1016/j.ijcha.2024.101534","DOIUrl":"10.1016/j.ijcha.2024.101534","url":null,"abstract":"<div><h3>Objectives</h3><div>Given that pulmonary arterial hypertension (PAH) and chronic thromboembolic hypertension (CTEPH) are rare yet severe subtypes of pulmonary hypertension significantly impacting patients’ lives, this study analyzed the total societal costs of these conditions in Finland.</div></div><div><h3>Methods</h3><div>PAH (n = 247) and CTEPH (n = 177) patients diagnosed between 2008 and 2019 were analyzed for primary and specialty outpatient visits, emergency visits, hospitalizations, home and institutional care, sick leaves, disability pensions, and drug costs for 5 years before and after diagnosis.</div></div><div><h3>Results</h3><div>In PAH and CTEPH, annual specialty care number of outpatient visits increased from 3.8 and 3.3 (5 years before diagnosis) to 13.8 and 9.5 one-year post-diagnosis, then decreased to 9.2 and 4.0 at 5 years post-diagnosis. Annual inpatient days rose from 2.8 and 2.7 to 16.1 and 19.7 pre-diagnosis, then fell to 10.2 and 3.5 post-diagnosis, respectively. Within 5 years post-diagnosis, in working-age 70 % PAH and 42 % CTEPH patients received disability pensions. Drug therapy accounted for most costs (67 % in PAH and 60 % in CTEPH), followed by inpatient care, disability pensions, and outpatient care. Total costs were significantly lower for CTEPH, especially after pulmonary endarterectomy. Among PAH subtypes, the highest costs were in patients with PAH associated with connective tissue diseases.</div></div><div><h3>Conclusions</h3><div>PAH and CTEPH cause a significant economic burden on patients and society with considerable differences depending on the PAH subtype and whether the patient has undergone PEA operation or not.</div></div>","PeriodicalId":38026,"journal":{"name":"IJC Heart and Vasculature","volume":"55 ","pages":"Article 101534"},"PeriodicalIF":2.5,"publicationDate":"2024-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142530202","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}
Inadequate representation of women and racial minorities in heart failure (HF) clinical trials continues to limit the generalizability of the results. This could create a disparity in treatment for future heart failure therapies and devices. The study aims to assess the representation of women and racial minorities in recent heart failure studies involving sodium-glucose cotransporter-2 (SGLT-2) inhibitors.
Methods
PubMed was used to search randomized controlled trials (RCTs) looking at SGLT-2 inhibitors and heart failure, which were published from inception to August 2024.
Results
A total of 43 RCTs with 27,703 participants were identified. The studies were published between 2018 and 2024. Seven studies (41 %) were multi-country, with 45 countries represented. The overall proportion of women enrolled in the studies was 35.6 %. The proportion of women was 24.06 % in studies that recruited only patients with HFrEF, 44.33 % in those that recruited only patients with HFpEF, and 41.4 % in those that recruited both HFrEF and HFpEF. Data on race was partially reported in 25 studies (58 %). 76 % of the pharmaceutical industry-funded studies reported race data. However, only 33.3 % of the unfunded or non-industry-funded studies reported race data. In the studies that reported race data, 72.91 % were Caucasians, 15.48 % were Asians, 5.62 % were African-American and 4.1 % were mixed race or others.
In the bivariate analysis, race was more likely to be reported in studies done in the US (p < 0.001), multi-country studies (p = 0.013), and studies sponsored by pharmaceutical companies. More than a third of the study participants were more likely to be women in more recently published studies than older studies (p < 0.001). Additionally, more than a third of the study participants were more likely to be women in studies done in the US (p = 0.055). The multivariate analysis showed an increased odds of having more than a third of the study participants being women in more recently published studies (OR 1.83, 95 % CI 1.06–3.17, p = 0.031) and in studies done in the US (OR 7.69, 95 % CI 1.53–38.59, p = 0.013).
Conclusion
Our study found that women and racial minority individuals have remained underrepresented in recent heart failure studies. Although some progress has been made over the years, more work is needed to improve data reporting and address barriers to enrollment for women and racial minority individuals in clinical trials.
{"title":"Representation of women and racial minorities in SGLT2 inhibitors and heart failure clinical trials","authors":"Rahul Gupta , Chukwuemeka Umeh , Tamanna Mohta , Ajay Vaidya , Aaron Wolfson , Jonathan Nattiv , Harpreet Bhatia , Gagan Kaur , Raghav Dhawan , Puja Darji , Benson Eghreriniovo , Eseosa Sanwo , Priya Hotwani , Payaam Mahdavian , Sabina Kumar , Bhoodev Tiwari","doi":"10.1016/j.ijcha.2024.101539","DOIUrl":"10.1016/j.ijcha.2024.101539","url":null,"abstract":"<div><h3>Background</h3><div>Inadequate representation of women and racial minorities in heart failure (HF) clinical trials continues to limit the generalizability of the results. This could create a disparity in treatment for future heart failure therapies and devices. The study aims to assess the representation of women and racial minorities in recent heart failure studies involving sodium-glucose cotransporter-2 (SGLT-2) inhibitors.</div></div><div><h3>Methods</h3><div>PubMed was used to search randomized controlled trials (RCTs) looking at SGLT-2 inhibitors and heart failure, which were published from inception to August 2024.</div></div><div><h3>Results</h3><div>A total of 43 RCTs with 27,703 participants were identified. The studies were published between 2018 and 2024. Seven studies (41 %) were multi-country, with 45 countries represented. The overall proportion of women enrolled in the studies was 35.6 %. The proportion of women was 24.06 % in studies that recruited only patients with HFrEF, 44.33 % in those that recruited only patients with HFpEF, and 41.4 % in those that recruited both HFrEF and HFpEF. Data on race was partially reported in 25 studies (58 %). 76 % of the pharmaceutical industry-funded studies reported race data. However, only 33.3 % of the unfunded or non-industry-funded studies reported race data. In the studies that reported race data, 72.91 % were Caucasians, 15.48 % were Asians, 5.62 % were African-American and 4.1 % were mixed race or others.</div><div>In the bivariate analysis, race was more likely to be reported in studies done in the US (p < 0.001), multi-country studies (p = 0.013), and studies sponsored by pharmaceutical companies. More than a third of the study participants were more likely to be women in more recently published studies than older studies (p < 0.001). Additionally, more than a third of the study participants were more likely to be women in studies done in the US (p = 0.055). The multivariate analysis showed an increased odds of having more than a third of the study participants being women in more recently published studies (OR 1.83, 95 % CI 1.06–3.17, p = 0.031) and in studies done in the US (OR 7.69, 95 % CI 1.53–38.59, p = 0.013).</div></div><div><h3>Conclusion</h3><div>Our study found that women and racial minority individuals have remained underrepresented in recent heart failure studies. Although some progress has been made over the years, more work is needed to improve data reporting and address barriers to enrollment for women and racial minority individuals in clinical trials.</div></div>","PeriodicalId":38026,"journal":{"name":"IJC Heart and Vasculature","volume":"55 ","pages":"Article 101539"},"PeriodicalIF":2.5,"publicationDate":"2024-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142529503","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 : 2024-10-20DOI: 10.1016/j.ijcha.2024.101526
Balbir Singh , D. Prabhakar , Jay Shah , Keshava R , Nakul Sinha , Prafulla Kerkar , Prasant Kumar Sahoo , Rajendra Kumar Premchand Jain , Subhash Chandra , Shuvanan Ray , Shital Sarda
Atherosclerotic plaque formation is a leading cause of arterial thrombosis that significantly impacts global health by instigating major adverse cardiovascular events (MACE) like myocardial infarction (MI) and stroke. Platelets are central to this process, leading to the development of antiplatelet therapies, to mitigate MACE risks. The combination of aspirin with a potent P2Y12 inhibitor known as dual antiplatelet therapy (DAPT) is the standard for post-percutaneous coronary intervention (PCI) aimed at reducing ischemic events. However, DAPT’s associated bleeding risks, particularly in high bleeding risk (HBR) patients, require a balanced approach to optimize therapeutic outcomes. Recent advancements have led to the exploration of ticagrelor monotherapy as a promising strategy after short-term DAPT to reduce bleeding risks while preserving ischemic protection. This review manuscript focuses on ticagrelor monotherapy for HBR patients with discussion on optimal timing, patient selection, and treatment duration. It highlights ticagrelor’s broad efficacy in diverse patient sub-groups and outlines its superiority over aspirin (ASA) and clopidogrel monotherapies. Trials such as TICO, TWILIGHT, GLOBAL LEADERS, and ULTIMATE-DAPT as well as literature meta-analyses validate ticagrelor monotherapy’s role in lowering mortality and clinical adverse events versus conventional DAPT. The review endorses a personalized treatment regimen, beginning with DAPT before moving to ticagrelor monotherapy, as a balanced method for managing both bleeding and ischemic risks in post-PCI acute coronary syndrome (ACS) patients, especially those facing higher bleeding threats.
{"title":"Breaking boundaries: Ticagrelor monotherapy in high-risk patients","authors":"Balbir Singh , D. Prabhakar , Jay Shah , Keshava R , Nakul Sinha , Prafulla Kerkar , Prasant Kumar Sahoo , Rajendra Kumar Premchand Jain , Subhash Chandra , Shuvanan Ray , Shital Sarda","doi":"10.1016/j.ijcha.2024.101526","DOIUrl":"10.1016/j.ijcha.2024.101526","url":null,"abstract":"<div><div>Atherosclerotic plaque formation is a leading cause of arterial thrombosis that significantly impacts global health by instigating major adverse cardiovascular events (MACE) like myocardial infarction (MI) and stroke. Platelets are central to this process, leading to the development of antiplatelet therapies, to mitigate MACE risks. The combination of aspirin with a potent P2Y<sub>12</sub> inhibitor known as dual antiplatelet therapy (DAPT) is the standard for post-percutaneous coronary intervention (PCI) aimed at reducing ischemic events. However, DAPT’s associated bleeding risks, particularly in high bleeding risk (HBR) patients, require a balanced approach to optimize therapeutic outcomes. Recent advancements have led to the exploration of ticagrelor monotherapy as a promising strategy after short-term DAPT to reduce bleeding risks while preserving ischemic protection. This review manuscript focuses on ticagrelor monotherapy for HBR patients with discussion on optimal timing, patient selection, and treatment duration. It highlights ticagrelor’s broad efficacy in diverse patient sub-groups and outlines its superiority over aspirin (ASA) and clopidogrel monotherapies. Trials such as TICO, TWILIGHT, GLOBAL LEADERS, and ULTIMATE-DAPT as well as literature <em>meta</em>-analyses validate ticagrelor monotherapy’s role in lowering mortality and clinical adverse events versus conventional DAPT. The review endorses a personalized treatment regimen, beginning with DAPT before moving to ticagrelor monotherapy, as a balanced method for managing both bleeding and ischemic risks in post-PCI acute coronary syndrome (ACS) patients, especially those facing higher bleeding threats.</div></div>","PeriodicalId":38026,"journal":{"name":"IJC Heart and Vasculature","volume":"55 ","pages":"Article 101526"},"PeriodicalIF":2.5,"publicationDate":"2024-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142529505","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 : 2024-10-19DOI: 10.1016/j.ijcha.2024.101527
Juan Liu , Hui He , Hong Su , Jun Hou , Yan Luo , Qiang Chen , Qiao Feng , Xiufen Peng , Maoling Jiang , Long Xia , Hanxiong Liu , Zhen Zhang , Shiqiang Xiong , Lin Cai
Background
The Academic Research Consortium for High Bleeding Risk (ARC-HBR) criteria were proposed for predicting bleeding risk in patients undergoing percutaneous coronary intervention (PCI). However, there is a lack of research evaluating the risk of in-hospital bleeding following PCI for acute coronary syndrome (ACS) utilizing the ARC-HBR criteria.
Methods and results
This study involved 1013 ACS patients who underwent PCI and dual antiplatelet therapy. There were 63 cases of in-hospital bleeding events (6.22 %). According to the ARC-HBR criteria, patients classified as HBR had a significantly greater bleeding rate than non-HBR patients (15.81 % vs. 1.99 %, p < 0.001). As the CRUSADE score category increased, the risk of bleeding also increased. The area under the receiver operating characteristic curve (AUC) of the ARC-HBR criteria was significantly greater than that of the CRUSADE score for bleeding (0.751 vs. 0.696, p < 0.0001). Subgroup analysis revealed that the ARC-HBR criteria exhibited better predictive ability for ST-segment elevation myocardial infarction (STEMI, AUC 0.767 vs. 0.694, p = 0.020) but comparable predictive ability in patients with unstable angina (AUC 0.756 vs. 0.644, p = 0.213), non-ST-segment elevation myocardial infarction (AUC 0.713 vs. 0.683, p = 0.644), and non-ST-segment elevation ACS (AUC 0.739 vs. 0.687, p = 0.330).
Conclusion
Compared with the CRUSADE score, the ARC-HBR criteria demonstrate superior predictive ability for in-hospital bleeding events during PCI in ACS patients. Routine assessment of the ARC-HBR score might be helpful for identifying high-risk individuals in this specific population.
{"title":"The predictive value of the ARC-HBR criteria for in-hospital bleeding risk following percutaneous coronary intervention in patients with acute coronary syndrome","authors":"Juan Liu , Hui He , Hong Su , Jun Hou , Yan Luo , Qiang Chen , Qiao Feng , Xiufen Peng , Maoling Jiang , Long Xia , Hanxiong Liu , Zhen Zhang , Shiqiang Xiong , Lin Cai","doi":"10.1016/j.ijcha.2024.101527","DOIUrl":"10.1016/j.ijcha.2024.101527","url":null,"abstract":"<div><h3>Background</h3><div>The Academic Research Consortium for High Bleeding Risk (ARC-HBR) criteria were proposed for predicting bleeding risk in patients undergoing percutaneous coronary intervention (PCI). However, there is a lack of research evaluating the risk of in-hospital bleeding following PCI for acute coronary syndrome (ACS) utilizing the ARC-HBR criteria.</div></div><div><h3>Methods and results</h3><div>This study involved 1013 ACS patients who underwent PCI and dual antiplatelet therapy. There were 63 cases of in-hospital bleeding events (6.22 %). According to the ARC-HBR criteria, patients classified as HBR had a significantly greater bleeding rate than non-HBR patients (15.81 % vs. 1.99 %, p < 0.001). As the CRUSADE score category increased, the risk of bleeding also increased. The area under the receiver operating characteristic curve (AUC) of the ARC-HBR criteria was significantly greater than that of the CRUSADE score for bleeding (0.751 vs. 0.696, p < 0.0001). Subgroup analysis revealed that the ARC-HBR criteria exhibited better predictive ability for ST-segment elevation myocardial infarction (STEMI, AUC 0.767 vs. 0.694, p = 0.020) but comparable predictive ability in patients with unstable angina (AUC 0.756 vs. 0.644, p = 0.213), non-ST-segment elevation myocardial infarction (AUC 0.713 vs. 0.683, p = 0.644), and non-ST-segment elevation ACS (AUC 0.739 vs. 0.687, p = 0.330).</div></div><div><h3>Conclusion</h3><div>Compared with the CRUSADE score, the ARC-HBR criteria demonstrate superior predictive ability for in-hospital bleeding events during PCI in ACS patients. Routine assessment of the ARC-HBR score might be helpful for identifying high-risk individuals in this specific population.</div></div>","PeriodicalId":38026,"journal":{"name":"IJC Heart and Vasculature","volume":"55 ","pages":"Article 101527"},"PeriodicalIF":2.5,"publicationDate":"2024-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142529502","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 : 2024-10-17DOI: 10.1016/j.ijcha.2024.101522
Michael Cronin , Dina Neiroukh , Aoife Lowery , William Wijns , Michael Kerin , Maccon Keane , Silvie Blazkova , Osama Soliman
Cardiac biomarkers are a vital component within the first edition of the European Society of Cardiology guidelines in Cardio-Oncology. Specifically, they are mentioned in the definition of mild asymptomatic cancer therapy-related cardiac dysfunction, where left ventricular systolic function is ≥50 % with two outcomes; either a new decrease in global longitudinal strain >15 % from baseline and/or a new rise in cardiac biomarkers above the defined 99th percentile cut off values. Cardiac troponin is one such biomarker.
Many of the treatments for breast cancer have published data on cardiac dysfunction and/or cardiovascular toxicity, and such may lead to an elevation in cardiac troponin. However, there is conflicting and incomplete data regarding how to approach an elevated cardiac troponin during anti-cancer treatment, which has confounded patient care in the clinical trial setting.
We propose a novel framework to guide physicians in treatment-related elevation of cardiac troponin in the breast cancer population. Secondly, the additive role which the recommendation that cardiac troponin carries within mild asymptomatic definitions of CTRCD is the subject of great debate. We suggest a reflection on the role of biomarkers, specifically in reference to cardiac troponin.
{"title":"Proposed framework regarding management of patients with breast cancer and anti-cancer treatment-related elevation in cardiac troponin","authors":"Michael Cronin , Dina Neiroukh , Aoife Lowery , William Wijns , Michael Kerin , Maccon Keane , Silvie Blazkova , Osama Soliman","doi":"10.1016/j.ijcha.2024.101522","DOIUrl":"10.1016/j.ijcha.2024.101522","url":null,"abstract":"<div><div>Cardiac biomarkers are a vital component within the first edition of the European Society of Cardiology guidelines in Cardio-Oncology. Specifically, they are mentioned in the definition of mild asymptomatic cancer therapy-related cardiac dysfunction, where left ventricular systolic function is ≥50 % with two outcomes; either a new decrease in global longitudinal strain >15 % from baseline and/or a new rise in cardiac biomarkers above the defined 99th percentile cut off values. Cardiac troponin is one such biomarker.</div><div>Many of the treatments for breast cancer have published data on cardiac dysfunction and/or cardiovascular toxicity, and such may lead to an elevation in cardiac troponin. However, there is conflicting and incomplete data regarding how to approach an elevated cardiac troponin during anti-cancer treatment, which has confounded patient care in the clinical trial setting.</div><div>We propose a novel framework to guide physicians in treatment-related elevation of cardiac troponin in the breast cancer population. Secondly, the additive role which the recommendation that cardiac troponin carries within mild asymptomatic definitions of CTRCD is the subject of great debate. We suggest a reflection on the role of biomarkers, specifically in reference to cardiac troponin.</div></div>","PeriodicalId":38026,"journal":{"name":"IJC Heart and Vasculature","volume":"55 ","pages":"Article 101522"},"PeriodicalIF":2.5,"publicationDate":"2024-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142445409","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}
Myocardial infarction (MI), a major global cause of mortality and morbidity, continues to pose a significant burden on public health. Despite advances in understanding its pathogenesis, there remains a need to elucidate the intricate molecular mechanisms underlying MI progression. Long non-coding RNAs (lncRNAs) have emerged as key regulators in diverse biological processes, yet their specific roles in MI pathophysiology remain elusive. Conducting a thorough review of literature using PubMed and Google Scholar databases, we investigated the involvement of lncRNAs in MI, focusing on their regulatory functions and downstream signaling pathways. Our analysis revealed extensive dysregulation of lncRNAs in MI, impacting various biological processes through diverse mechanisms. Notably, lncRNAs act as crucial modulators of gene expression and signaling cascades, functioning as decoys, regulators, and scaffolds. Furthermore, studies identified the multifaceted roles of lncRNAs in modulating inflammation, apoptosis, autophagy, necrosis, fibrosis, remodeling, and ischemia–reperfusion injury during MI progression. Recent research highlights the pivotal contribution of lncRNAs to MI pathogenesis, offering novel insights into potential therapeutic interventions. Moreover, the identification of circulating lncRNA signatures holds promise for the development of non-invasive diagnostic biomarkers. In summary, findings underscore the significance of lncRNAs in MI pathophysiology, emphasizing their potential as therapeutic targets and diagnostic tools for improved patient management and outcomes.
心肌梗死（MI）是导致全球死亡和发病的主要原因之一，继续给公共卫生带来沉重负担。尽管人们对心肌梗死发病机理的认识取得了进展，但仍然需要阐明心肌梗死进展背后错综复杂的分子机制。长非编码 RNA（lncRNA）已成为多种生物过程中的关键调控因子，但它们在 MI 病理生理学中的具体作用仍然难以捉摸。我们利用 PubMed 和 Google Scholar 数据库对文献进行了全面回顾，研究了 lncRNA 在 MI 中的参与情况，重点关注其调控功能和下游信号通路。我们的分析表明，lncRNAs 在 MI 中广泛失调，通过不同的机制影响着各种生物过程。值得注意的是，lncRNAs 是基因表达和信号级联的关键调节因子，具有诱饵、调节因子和支架的功能。此外，研究还发现了 lncRNA 在 MI 进展过程中调节炎症、细胞凋亡、自噬、坏死、纤维化、重塑和缺血再灌注损伤的多方面作用。最近的研究强调了 lncRNA 在心肌梗死发病机制中的关键作用，为潜在的治疗干预提供了新的见解。此外，循环 lncRNA 标志的鉴定为开发非侵入性诊断生物标志物带来了希望。总之，研究结果强调了 lncRNAs 在 MI 病理生理学中的重要性，强调了它们作为治疗靶点和诊断工具的潜力，以改善患者管理和预后。
{"title":"Importance of long non-coding RNAs in the pathogenesis, diagnosis, and treatment of myocardial infarction","authors":"Maryam Zolfaghari Dehkharghani , Safa Mousavi , Nazanin Kianifard , Amin Fazlzadeh , Hamid Parsa , Ali Tavakoli Pirzaman , Andarz Fazlollahpour-Naghibi","doi":"10.1016/j.ijcha.2024.101529","DOIUrl":"10.1016/j.ijcha.2024.101529","url":null,"abstract":"<div><div>Myocardial infarction (MI), a major global cause of mortality and morbidity, continues to pose a significant burden on public health. Despite advances in understanding its pathogenesis, there remains a need to elucidate the intricate molecular mechanisms underlying MI progression. Long non-coding RNAs (lncRNAs) have emerged as key regulators in diverse biological processes, yet their specific roles in MI pathophysiology remain elusive. Conducting a thorough review of literature using PubMed and Google Scholar databases, we investigated the involvement of lncRNAs in MI, focusing on their regulatory functions and downstream signaling pathways. Our analysis revealed extensive dysregulation of lncRNAs in MI, impacting various biological processes through diverse mechanisms. Notably, lncRNAs act as crucial modulators of gene expression and signaling cascades, functioning as decoys, regulators, and scaffolds. Furthermore, studies identified the multifaceted roles of lncRNAs in modulating inflammation, apoptosis, autophagy, necrosis, fibrosis, remodeling, and ischemia–reperfusion injury during MI progression. Recent research highlights the pivotal contribution of lncRNAs to MI pathogenesis, offering novel insights into potential therapeutic interventions. Moreover, the identification of circulating lncRNA signatures holds promise for the development of non-invasive diagnostic biomarkers. In summary, findings underscore the significance of lncRNAs in MI pathophysiology, emphasizing their potential as therapeutic targets and diagnostic tools for improved patient management and outcomes.</div></div>","PeriodicalId":38026,"journal":{"name":"IJC Heart and Vasculature","volume":"55 ","pages":"Article 101529"},"PeriodicalIF":2.5,"publicationDate":"2024-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142445408","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 : 2024-10-15DOI: 10.1016/j.ijcha.2024.101535
Michael C. Hill , Kaitlyn Legg , Amer Ardati , Vicki Groo
Background
The role of medical therapy for heart failure with reduced ejection fraction (HFrEF) in subjects with end-stage renal disease receiving renal transplantation (RT) is understudied. Here, we describe post-RT HFrEF medical management practices at a single urban, academic tertiary care center.
Methods
RT recipients between January 1, 2015 and November 30, 2020 with history of ejection fraction (EF) <40 % prior to RT were included. Medications, renal function, blood pressure, cardiology follow-up, and echocardiograms ≥90d post-RT were retrospectively collected for 2 years post-RT.
Results and conclusions
47/750 (6.3 %) of RT recipients had prior HFrEF diagnosis, of whom 26 experienced improvement in EF prior to RT. Pre-RT medical therapy included beta blocker (BB) in 43 (92 %) of subjects and renin-angiotensin-aldosterone inhibitors (RAASi) in 23 (49 %). By 24 months post-RT, BB were used in 34 (76 %) and RAASi were used in 12 (27 %) of subjects. Rates of post-RT cardiology follow-up (51 %) and echocardiogram (38 %) were lower than expected in this cohort. Of 29 subjects potentially eligible for RAASi based on preserved renal function and no hyperkalemia or hypotension episodes during follow-up, only 6 (21 %) received RAASi. Of 6 subjects with post-RT EF <50 %, 4 were eligible but did not receive RAASi. Multidisciplinary collaboration between cardiology and transplant teams may help improve care for this high-risk patient population.
{"title":"Heart failure medication use and follow-up patterns in renal transplant recipients with reduced ejection fraction: A single-center experience","authors":"Michael C. Hill , Kaitlyn Legg , Amer Ardati , Vicki Groo","doi":"10.1016/j.ijcha.2024.101535","DOIUrl":"10.1016/j.ijcha.2024.101535","url":null,"abstract":"<div><h3>Background</h3><div>The role of medical therapy for heart failure with reduced ejection fraction (HFrEF) in subjects with end-stage renal disease receiving renal transplantation (RT) is understudied. Here, we describe post-RT HFrEF medical management practices at a single urban, academic tertiary care center.</div></div><div><h3>Methods</h3><div>RT recipients between January 1, 2015 and November 30, 2020 with history of ejection fraction (EF) <40 % prior to RT were included. Medications, renal function, blood pressure, cardiology follow-up, and echocardiograms ≥90d post-RT were retrospectively collected for 2 years post-RT.</div></div><div><h3>Results and conclusions</h3><div>47/750 (6.3 %) of RT recipients had prior HFrEF diagnosis, of whom 26 experienced improvement in EF prior to RT. Pre-RT medical therapy included beta blocker (BB) in 43 (92 %) of subjects and renin-angiotensin-aldosterone inhibitors (RAASi) in 23 (49 %). By 24 months post-RT, BB were used in 34 (76 %) and RAASi were used in 12 (27 %) of subjects. Rates of post-RT cardiology follow-up (51 %) and echocardiogram (38 %) were lower than expected in this cohort. Of 29 subjects potentially eligible for RAASi based on preserved renal function and no hyperkalemia or hypotension episodes during follow-up, only 6 (21 %) received RAASi. Of 6 subjects with post-RT EF <50 %, 4 were eligible but did not receive RAASi. Multidisciplinary collaboration between cardiology and transplant teams may help improve care for this high-risk patient population.</div></div>","PeriodicalId":38026,"journal":{"name":"IJC Heart and Vasculature","volume":"55 ","pages":"Article 101535"},"PeriodicalIF":2.5,"publicationDate":"2024-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142433411","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 : 2024-10-15DOI: 10.1016/j.ijcha.2024.101530
Ao Li , ZiAn Feng , ShiHao Fu , ZhenXiao Ma , HaiYang Zhang , ZhiWei Zhao
<div><h3>Background</h3><div>There exists a robust correlation between the infiltration of immune cells and the pathogenesis of aortic dissection (AD). Moreover, blood metabolites serve as immunomodulatory agents within the organism, influencing the immune system’s response and potentially playing a role in the development of AD. Nevertheless, the intricate genetic causal nexus between specific immune cells, blood metabolites, and AD remains partially elucidated.</div></div><div><h3>Objectives</h3><div>This study aims to elucidate the causal relationships between specific immune cell types and the risk of developing AD, mediated by blood metabolites, using Mendelian Randomization (MR) methods.</div></div><div><h3>Methods</h3><div>We undertook a comprehensive investigation of 731 immune cell types through the analysis of published genome-wide association studies (GWAS). Our methodology hinged on the application of two-sample Mendelian randomization (MR) and mediator MR analyses, prioritizing blood metabolites as potential intermediary factors and AD as the principal outcome of interest. The primary statistical method employed was inverse variance-weighted estimation, complemented by a variety of sensitivity analyses to reinforce our conclusions. The entirety of our statistical analyses was executed on the R software platform.</div></div><div><h3>Results</h3><div>Our analyses elucidated that three immune cell types exhibited a positive correlation with the incidence of AD, whereas two immune cell types were inversely associated with AD risk. Significantly, our mediation Mendelian randomization (MR) findings identified Benzoate as a pivotal mediator in the influence of CD19 on IgD − CD38br cells on AD, with a mediation proportion of 5.38 %. Additionally, N-acetylproline was determined to mediate the effect of CD24 on IgD- CD38- cells on AD, accounting for a mediation proportion of 13.70 %. Furthermore, Carnitine C5:1 was found to mediate the effect of CD28 on secreting T regulatory (Treg) cells on AD, with a mediation proportion of 17.80 %.</div></div><div><h3>Conclusions</h3><div>These findings offer a nuanced understanding of the pathophysiological mechanisms underlying AD, thereby advancing the precision medicine paradigm in the clinical management of AD.</div><div>Abbreviations: AD: aortic dissection; AA: aortic aneurysm; GWAS: genome-wide association study; MR: Mendelian randomization; TSMR: two-step Mendelian randomization; Treg: secreting T regulatory cell; VSMC: vascular smooth muscle cell; MMP: matrix metalloproteinase; ROS: reactive oxygen species; IV: instrumental variable; SNP: single-nucleotide polymorphism; IVW: inverse variance weighted; LDSC: linkage disequilibrium score regression; OR: odds ratio; CI: confidence interval; LD: linkage disequilibrium; AC: absolute cell; MFI: median fluorescence intensity; MP: morphological parameter; RC: relative cell; CLSA: Canadian Longitudinal Study of Aging; Lp(a): Lipoprotein a; OxPL: oxidised ph
背景免疫细胞的浸润与主动脉夹层（AD）的发病机制之间存在着密切的联系。此外，血液中的代谢物可作为机体内的免疫调节剂，影响免疫系统的反应，并可能在主动脉夹层的发病中发挥作用。本研究旨在利用孟德尔随机化（Mendelian Randomization，MR）方法，阐明血液代谢物介导的特定免疫细胞类型与AD发病风险之间的因果关系。方法我们通过分析已发表的全基因组关联研究（GWAS），对731种免疫细胞类型进行了全面调查。我们的方法主要是应用双样本孟德尔随机化（MR）和中介MR分析，将血液代谢物作为潜在的中介因素，将AD作为主要的研究结果。我们采用的主要统计方法是反方差加权估计法，并辅以各种敏感性分析来强化我们的结论。我们的所有统计分析都是在 R 软件平台上进行的。结果我们的分析表明，三种免疫细胞类型与 AD 发病率呈正相关，而两种免疫细胞类型与 AD 风险呈反相关。值得注意的是，我们的调解孟德尔随机化（MR）研究结果发现，苯甲酸盐是影响 IgD - CD38br 细胞的 CD19 对 AD 影响的关键调解因子，调解比例为 5.38%。此外，N-乙酰脯氨酸被确定为CD24对IgD- CD38-细胞对AD影响的中介因子，其中介比例为13.70%。此外，还发现肉碱 C5:1 能介导 CD28 对分泌 T 调节（Treg）细胞对 AD 的影响，介导比例为 17.80%。结论这些研究结果让人们对 AD 的病理生理机制有了细致入微的了解，从而推进了 AD 临床治疗中的精准医学范式：缩写：AD：主动脉夹层；AA：主动脉瘤；GWAS：全基因组关联研究；MR：孟德尔随机化；TSMR：两步孟德尔随机化；Treg：分泌型 T 调节细胞；VSMC：血管平滑肌细胞；MMP：基质金属蛋白酶；ROS：活性氧；IV：工具变量；SNP：单核苷酸多态性；IVW：反方差加权；LDSC：连锁不平衡得分回归；OR：几率比；CI：置信区间；LD：连锁不平衡；AC：绝对细胞；MFI：中位荧光强度；MP：形态参数；RC：相对细胞；CLSA：加拿大老龄化纵向研究；Lp（a）：Lp（a）：脂蛋白 a；OxPL：氧化磷脂；NMDAR：N-甲基-d-天冬氨酸谷氨酸受体；STROBE-MR：利用孟德尔随机化加强流行病学中观察性研究的报告。
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