Pub Date : 2024-09-04DOI: 10.1016/j.ijcha.2024.101506
Han Zhang , Tianlong Wang , Jing Wang, Gang Liu, Shujie Yan, Yuan Teng, Jian Wang, Bingyang Ji
Background
Left ventricular (LV) overload is a frequent complication during VA-ECMO associated with poor outcomes. Many strategies of LV unloading have been documented but lack of evidence shows which is better. We conducted a network meta-analysis to compare different LV unloading strategies.
Methods
We searched databases for all published studies on LV unloading strategies during VA-ECMO. The pre-defined primary outcome was all-cause mortality.
Results
45 observational studies (34235 patients) were included. The Surface Under the Cumulative Ranking values (SUCRA) demonstrated that compared to no unloading strategy (15.4 %), IABP (73.8 %), pLVAD (60.8 %), atrial septostomy (51.2 %), catheter venting (48.8 %) were all associated with decreased all-cause mortality, in which IABP and pLVAD existed statistical significance. For secondary outcomes, no unloading group had the shortest VA-ECMO duration, ICU and hospital length of stay, and the lower risk of complications compared with unloading strategies. IABP was associated with reducing VA-ECMO duration, ICU and hospital length of stay, and the risk of complications (except for hemolysis as the second best) compared with other unloading strategies.
Conclusions
LV unloading strategies during VA-ECMO were associated with improved survival compared to no unloading, but the tendency to increase the risk of various complications deserves more consideration.
背景左心室(LV)负荷过重是 VA-ECMO 期间经常出现的并发症,与不良预后有关。目前已有多种左心室减压策略,但没有证据表明哪种策略更好。我们进行了一项网络荟萃分析,以比较不同的左心室减压策略。方法我们在数据库中搜索了所有已发表的关于VA-ECMO期间左心室减压策略的研究。结果共纳入45项观察性研究(34235例患者)。累积排名表面值(Surface Under the Cumulative Ranking values,SUCRA)显示,与无减压策略(15.4%)相比,IABP(73.8%)、pLVAD(60.8%)、心房间隔造口术(51.2%)和导管通气(48.8%)均与全因死亡率下降相关,其中IABP和pLVAD具有统计学意义。在次要结果方面,与减压策略相比,无减压组的VA-ECMO持续时间、重症监护室和住院时间最短,并发症风险较低。与其他卸载策略相比,IABP可缩短VA-ECMO持续时间、缩短ICU和住院时间、降低并发症风险(溶血风险次之)。
{"title":"Different strategies in left ventricle unloading during venoarterial extracorporeal membrane oxygenation: A network meta-analysis","authors":"Han Zhang , Tianlong Wang , Jing Wang, Gang Liu, Shujie Yan, Yuan Teng, Jian Wang, Bingyang Ji","doi":"10.1016/j.ijcha.2024.101506","DOIUrl":"10.1016/j.ijcha.2024.101506","url":null,"abstract":"<div><h3>Background</h3><p>Left ventricular (LV) overload is a frequent complication during VA-ECMO associated with poor outcomes. Many strategies of LV unloading have been documented but lack of evidence shows which is better. We conducted a network meta-analysis to compare different LV unloading strategies.</p></div><div><h3>Methods</h3><p>We searched databases for all published studies on LV unloading strategies during VA-ECMO. The pre-defined primary outcome was all-cause mortality.</p></div><div><h3>Results</h3><p>45 observational studies (34235 patients) were included. The Surface Under the Cumulative Ranking values (SUCRA) demonstrated that compared to no unloading strategy (15.4 %), IABP (73.8 %), pLVAD (60.8 %), atrial septostomy (51.2 %), catheter venting (48.8 %) were all associated with decreased all-cause mortality, in which IABP and pLVAD existed statistical significance. For secondary outcomes, no unloading group had the shortest VA-ECMO duration, ICU and hospital length of stay, and the lower risk of complications compared with unloading strategies. IABP was associated with reducing VA-ECMO duration, ICU and hospital length of stay, and the risk of complications (except for hemolysis as the second best) compared with other unloading strategies.</p></div><div><h3>Conclusions</h3><p>LV unloading strategies during VA-ECMO were associated with improved survival compared to no unloading, but the tendency to increase the risk of various complications deserves more consideration.</p></div>","PeriodicalId":38026,"journal":{"name":"IJC Heart and Vasculature","volume":"54 ","pages":"Article 101506"},"PeriodicalIF":2.5,"publicationDate":"2024-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2352906724001726/pdfft?md5=f224f4f6e7a6e59bb2546b444075ccc4&pid=1-s2.0-S2352906724001726-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142129569","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 : 2024-09-04DOI: 10.1016/j.ijcha.2024.101401
Chenyang Zhang , JiaQi Zhang , Xuan Zhao , Dongyang Jiang , Xiaoqian Liu , Ying Liang
Objects
To evaluate the association of direct oral anticoagulants (DOACs) and warfarin with dementia incidence in atrial fibrillation (AF) patients.
Methods
Relevant studies were retrieved in databases including Embase, PubMed, Cochrane, Web of Knowledge, and ClinicalTrials.gov. Meta-analysis was then conducted using Stata 12.0 software.
Results
A total of 9 studies involving 447,644 AF patients were included. The results indicated that AF patients treated with DOACs had a lower incidence of dementia compared to those treated with warfarin (RR: 0.692, 95 % CI: 0.603–0.793, P = 0.000), This trend was observed in both age groups, <75 years old (RR: 0.770, 95 % CI: 0.639–0.929, P = 0.006) and ≥75 years old (RR: 0.858, 95 % CI: 0.756–0.973, P = 0.017), particularly in cases of Alzheimer's disease (RR: 0.798, 95 % CI: 0.684–0.932, P = 0.004) rather than vascular dementia (RR: 0.841, 95 % CI: 0.61–0.143, P = 0.269). Furthermore, patients taking rivaroxaban (RR: 0.680, 95 % CI: 0.624–0.741, P = 0.000) and apixaban (RR: 0.598, 95 % CI: 0.528–0.676, P = 0.000) instead of dabigatran (RR: 0.941, 95 % CI: 0.862–1.027, p = 0.17) exhibited a lower incidence of dementia than those took warfarin. Notably, AF patients taking rivaroxaban (RR: 0.75, 95 % CI: 0.67–0.84, P = 0.000) and apixaban (RR: 0.758, 95 % CI: 0.647–0.889, P = 0.001) had a lower incidence of dementia than those taking dabigatran, although the difference between trivaroxaban and apixaban was not statistically significant (RR:1.161, 95 % CI: 0.934–1.443, P = 0.018).
Conclusions
AF patients treated with DOACs, particularly rivaroxaban and apixaban, showed a lower incidence of dementia compared to those treated with warfarin, with a notable disparity observed when compared to dabigatran.
{"title":"Association of direct oral anticoagulants and warfarin with incidence of dementia in atrial fibrillation patients: A systematic review and meta-analysis","authors":"Chenyang Zhang , JiaQi Zhang , Xuan Zhao , Dongyang Jiang , Xiaoqian Liu , Ying Liang","doi":"10.1016/j.ijcha.2024.101401","DOIUrl":"10.1016/j.ijcha.2024.101401","url":null,"abstract":"<div><h3>Objects</h3><p>To evaluate the association of direct oral anticoagulants (DOACs) and warfarin with dementia incidence in atrial fibrillation (AF) patients.</p></div><div><h3>Methods</h3><p>Relevant studies were retrieved in databases including Embase, PubMed, Cochrane, Web of Knowledge, and <span><span>ClinicalTrials.gov</span><svg><path></path></svg></span>. Meta-analysis was then conducted using Stata 12.0 software.</p></div><div><h3>Results</h3><p>A total of 9 studies involving 447,644 AF patients were included. The results indicated that AF patients treated with DOACs had a lower incidence of dementia compared to those treated with warfarin (RR: 0.692, 95 % CI: 0.603–0.793, P = 0.000), This trend was observed in both age groups, <75 years old (RR: 0.770, 95 % CI: 0.639–0.929, P = 0.006) and ≥75 years old (RR: 0.858, 95 % CI: 0.756–0.973, P = 0.017), particularly in cases of Alzheimer's disease (RR: 0.798, 95 % CI: 0.684–0.932, P = 0.004) rather than vascular dementia (RR: 0.841, 95 % CI: 0.61–0.143, P = 0.269). Furthermore, patients taking rivaroxaban (RR: 0.680, 95 % CI: 0.624–0.741, P = 0.000) and apixaban (RR: 0.598, 95 % CI: 0.528–0.676, P = 0.000) instead of dabigatran (RR: 0.941, 95 % CI: 0.862–1.027, p = 0.17) exhibited a lower incidence of dementia than those took warfarin. Notably, AF patients taking rivaroxaban (RR: 0.75, 95 % CI: 0.67–0.84, P = 0.000) and apixaban (RR: 0.758, 95 % CI: 0.647–0.889, P = 0.001) had a lower incidence of dementia than those taking dabigatran, although the difference between trivaroxaban and apixaban was not statistically significant (RR:1.161, 95 % CI: 0.934–1.443, P = 0.018).</p></div><div><h3>Conclusions</h3><p>AF patients treated with DOACs, particularly rivaroxaban and apixaban, showed a lower incidence of dementia compared to those treated with warfarin, with a notable disparity observed when compared to dabigatran.</p></div>","PeriodicalId":38026,"journal":{"name":"IJC Heart and Vasculature","volume":"54 ","pages":"Article 101401"},"PeriodicalIF":2.5,"publicationDate":"2024-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2352906724000678/pdfft?md5=f2635a67ca2597df1d45bd4e4727e043&pid=1-s2.0-S2352906724000678-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142137136","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 : 2024-08-31DOI: 10.1016/j.ijcha.2024.101502
Caterina Delcea , Catalin Adrian Buzea , Dobromir Dobrev , Gheorghe Andrei Dan
Background
Heart failure (HF) and inflammation have a bidirectional relation leading to activation and adaptation of multiple cellular lines, including leucocyte subtypes and platelets. We aimed to assess and compare the predictive value of the neutrophil–lymphocyte (NLR), monocyte-lymphocyte (MLR) and platelet-lymphocyte (PLR) ratios for all-cause long-term mortality in HF.
Methods
This is an observational retrospective cohort study that included patients from the HI-HF cohort that survived the initial hospitalization. Vital status and survival time were assessed in June 2020.
Results
We analyzed 1018 HF patients with a mean age of 72.32 ± 10.29 years and 53.54 % women. All-cause long-term mortality was 38.21 % after a median follow-up time of 68 [38 – 82] months. NLR (AUC 0.667, 95 %CI 0.637 – 0.697), MLR (AUC 0.670, 95 %CI 0.640 – 0.700) and PLR (AUC 0.606, 95 %CI 0.574 – 0.636) were predictors of all-cause mortality. In multivariable Cox proportional hazards analysis, NLR≥3.56 was the only hematological index independent predictor of fatality (HR 1.36, 95 %CI 1.05 – 1.76).
Conclusions
Of the three hematological indices, NLR was the only independent predictor of all-cause long-term mortality of HF patients. We suggest NLR≥3.56 as an auxiliary prognostic biomarker for the evaluation of HF patients.
{"title":"Prognostic roles of neutrophil–lymphocyte, monocyte-lymphocyte and platelet-lymphocyte ratios for long-term all-cause mortality in heart failure","authors":"Caterina Delcea , Catalin Adrian Buzea , Dobromir Dobrev , Gheorghe Andrei Dan","doi":"10.1016/j.ijcha.2024.101502","DOIUrl":"10.1016/j.ijcha.2024.101502","url":null,"abstract":"<div><h3>Background</h3><p>Heart failure (HF) and inflammation have a bidirectional relation leading to activation and adaptation of multiple cellular lines, including leucocyte subtypes and platelets. We aimed to assess and compare the predictive value of the neutrophil–lymphocyte (NLR), monocyte-lymphocyte (MLR) and platelet-lymphocyte (PLR) ratios for all-cause long-term mortality in HF.</p></div><div><h3>Methods</h3><p>This is an observational retrospective cohort study that included patients from the HI-HF cohort that survived the initial hospitalization. Vital status and survival time were assessed in June 2020.</p></div><div><h3>Results</h3><p>We analyzed 1018 HF patients with a mean age of 72.32 ± 10.29 years and 53.54 % women. All-cause long-term mortality was 38.21 % after a median follow-up time of 68 [38 – 82] months. NLR (AUC 0.667, 95 %CI 0.637 – 0.697), MLR (AUC 0.670, 95 %CI 0.640 – 0.700) and PLR (AUC 0.606, 95 %CI 0.574 – 0.636) were predictors of all-cause mortality. In multivariable Cox proportional hazards analysis, NLR≥3.56 was the only hematological index independent predictor of fatality (HR 1.36, 95 %CI 1.05 – 1.76).</p></div><div><h3>Conclusions</h3><p>Of the three hematological indices, NLR was the only independent predictor of all-cause long-term mortality of HF patients. We suggest NLR≥3.56 as an auxiliary prognostic biomarker for the evaluation of HF patients.</p></div>","PeriodicalId":38026,"journal":{"name":"IJC Heart and Vasculature","volume":"54 ","pages":"Article 101502"},"PeriodicalIF":2.5,"publicationDate":"2024-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2352906724001684/pdfft?md5=f4239ce5d28d3757c3dd163c9a89cdec&pid=1-s2.0-S2352906724001684-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142099162","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 : 2024-08-29DOI: 10.1016/j.ijcha.2024.101500
Zhaohai Su , Weiling Lu , Jun Cao , Zheng Xie , Pei Zhao
Abdominal aortic aneurysms (AAAs) are characterized by permanent dilatation of the abdominal aorta, which is accompanied by inflammation, degradation of the extracellular matrix (ECM) and disruption of vascular smooth muscle cell (VSMC) homeostasis. Endoplasmic reticulum (ER) stress is involved in the regulation of inflammation, oxidative stress and VSMC apoptosis, all of which are critical factors in AAA development. Although several studies have revealed the occurrence of ER stress in AAA development, the specific biological functions of ER stress in AAA development remain largely unknown. Given that targeting ER stress is a promising strategy for treating AAAs, further investigation of the physiological and pathological roles of ER stress in AAA development is warranted.
腹主动脉瘤(AAA)的特征是腹主动脉永久性扩张,同时伴有炎症、细胞外基质(ECM)降解和血管平滑肌细胞(VSMC)平衡的破坏。内质网(ER)应激参与了炎症、氧化应激和血管平滑肌细胞凋亡的调控,所有这些都是 AAA 发生的关键因素。尽管多项研究揭示了ER应激在AAA发生发展过程中的存在,但ER应激在AAA发生发展过程中的具体生物学功能在很大程度上仍然未知。鉴于靶向 ER 应激是治疗 AAA 的一种有前景的策略,有必要进一步研究 ER 应激在 AAA 发生过程中的生理和病理作用。
{"title":"Endoplasmic reticulum stress in abdominal aortic aneurysm","authors":"Zhaohai Su , Weiling Lu , Jun Cao , Zheng Xie , Pei Zhao","doi":"10.1016/j.ijcha.2024.101500","DOIUrl":"10.1016/j.ijcha.2024.101500","url":null,"abstract":"<div><p>Abdominal aortic aneurysms (AAAs) are characterized by permanent dilatation of the abdominal aorta, which is accompanied by inflammation, degradation of the extracellular matrix (ECM) and disruption of vascular smooth muscle cell (VSMC) homeostasis. Endoplasmic reticulum (ER) stress is involved in the regulation of inflammation, oxidative stress and VSMC apoptosis, all of which are critical factors in AAA development. Although several studies have revealed the occurrence of ER stress in AAA development, the specific biological functions of ER stress in AAA development remain largely unknown. Given that targeting ER stress is a promising strategy for treating AAAs, further investigation of the physiological and pathological roles of ER stress in AAA development is warranted.</p></div>","PeriodicalId":38026,"journal":{"name":"IJC Heart and Vasculature","volume":"54 ","pages":"Article 101500"},"PeriodicalIF":2.5,"publicationDate":"2024-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2352906724001660/pdfft?md5=622126c5340e63a3e781c5e4589168c7&pid=1-s2.0-S2352906724001660-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142099161","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 : 2024-08-27DOI: 10.1016/j.ijcha.2024.101481
Rui Li , Jian Zhang , Lingling Ke , Xiaohui Zhang , Jiawei Wu , Jinsong Han
Backgrounds
It is well known that epicardial adipose tissue (EAT) is associated with the development of atrial fibrillation (AF). The aim of this study was to investigate whether EAT density (EAT-d) is associated with the development of new-onset atrial fibrillation (POAF) after aortic valve replacement (AVR).
Methods
We retrospectively studied 143 patients who underwent simple AVR at Department of Cardiovascular Surgery of the General Hospital of Northern Theater Command between June 2020 to August 2023. All patients received cardiac coronary artery computed tomography (CT) before surgery. EAT-d, EAT volume and EAT volume index (EATVI) were quantitatively measured and analysed using EAT analysis software (TIMESlicePro). POAF was detected by 7-day Holter monitoring.
Results
Of 143 patients undergoing AVR, 55 patients (38.46 %) developed POAF after surgery. Male patients and patients who had elder age or smoking history were more likely to develop POAF. On univariable analysis, patients developed POAF had significantly more EAT-d (−79.19(−83.91, −74.69) vs. −81.54(−87.16, −76.76); P = 0.043) and EATVI (4.14(3.32,5.03) vs. 3.90(2.70,4.51); P = 0.043) than patients without POAF. On multivariable analysis, EAT-d and age were independent risk factors for POAF (odds ratio (OR): 1.186, 95 % confidence interval (CI): 1.062–1.324, P = 0.002; OR: 1.119, 95 %CI: 1.055–1.187, P < 0.001). Furthermore, EAT-d was significantly associated with age. Furthermore, EAT-d was associated with cardiac structure changes, such as cardiac left ventricular end-diastolic, left ventricular end-systolic volumes and NT-proBNP before surgery.
Conclusion
EAT-d and age are independent predictors of POAF after simple AVR. EAT-d was related with age.
{"title":"Association of epicardial adipose tissue density with postoperative atrial fibrillation after isolated aortic valve replacement","authors":"Rui Li , Jian Zhang , Lingling Ke , Xiaohui Zhang , Jiawei Wu , Jinsong Han","doi":"10.1016/j.ijcha.2024.101481","DOIUrl":"10.1016/j.ijcha.2024.101481","url":null,"abstract":"<div><h3>Backgrounds</h3><p>It is well known that epicardial adipose tissue (EAT) is associated with the development of atrial fibrillation (AF). The aim of this study was to investigate whether EAT density (EAT-d) is associated with the development of new-onset atrial fibrillation (POAF) after aortic valve replacement (AVR).</p></div><div><h3>Methods</h3><p>We retrospectively studied 143 patients who underwent simple AVR at Department of Cardiovascular Surgery of the General Hospital of Northern Theater Command between June 2020 to August 2023. All patients received cardiac coronary artery computed tomography (CT) before surgery. EAT-d, EAT volume and EAT volume index (EATVI) were quantitatively measured and analysed using EAT analysis software (TIMESlicePro). POAF was detected by 7-day Holter monitoring.</p></div><div><h3>Results</h3><p>Of 143 patients undergoing AVR, 55 patients (38.46 %) developed POAF after surgery. Male patients and patients who had elder age or smoking history were more likely to develop POAF. On univariable analysis, patients developed POAF had significantly more EAT-d (−79.19(−83.91, −74.69) vs. −81.54(−87.16, −76.76); P = 0.043) and EATVI (4.14(3.32,5.03) vs. 3.90(2.70,4.51); P = 0.043) than patients without POAF. On multivariable analysis, EAT-d and age were independent risk factors for POAF (odds ratio (OR): 1.186, 95 % confidence interval (CI): 1.062–1.324, P = 0.002; OR: 1.119, 95 %CI: 1.055–1.187, P < 0.001). Furthermore, EAT-d was significantly associated with age. Furthermore, EAT-d was associated with cardiac structure changes, such as cardiac left ventricular end-diastolic, left ventricular end-systolic volumes and NT-proBNP before surgery.</p></div><div><h3>Conclusion</h3><p>EAT-d and age are independent predictors of POAF after simple AVR. EAT-d was related with age.</p></div>","PeriodicalId":38026,"journal":{"name":"IJC Heart and Vasculature","volume":"54 ","pages":"Article 101481"},"PeriodicalIF":2.5,"publicationDate":"2024-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2352906724001477/pdfft?md5=f95b178af551fcb4ee9233fa5dd34677&pid=1-s2.0-S2352906724001477-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142083642","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 : 2024-08-27DOI: 10.1016/j.ijcha.2024.101499
Eduardo B. Schaustz , José Carlos P. Secco , Julia M. Barroso , Juliana R. Ferreira , Mariana B. Tortelly , Adriana L. Pimentel , Ana Cristina B.S. Figueiredo , Denilson C. Albuquerque , Allan R. Kluser Sales , Paulo H. Rosado de-Castro , Martha V.T. Pinheiro , Olga F. Souza , Emiliano Medei , Ronir R. Luiz , Andréa Silvestre-Sousa , Gabriel C. Camargo , Renata Moll-Bernardes
Background
Concerns have been raised about cardiac inflammation in patients with long COVID-19, particularly those with myocardial injury during the acute phase of the disease. This study was conducted to examine myopericardial involvement, detected by cardiac magnetic resonance (CMR) imaging in patients hospitalized for COVID-19.
Methods
Adult patients hospitalized with COVID-19 who presented myocardial injury or increased D-dimers were enrolled in this prospective study. All patients were invited to undergo CMR imaging examination after discharge. During follow-up, patients with nonischemic myocardial or pericardial involvement detected on the first CMR imaging examination underwent second examinations. CMR imaging findings were compared with those of a control group of healthy patients with no comorbidity.
Results
Of 180 included patients, 53 underwent CMR imaging examination. The mean age was 58.4 ± 18.3 years, and 73.6 % were male. Myocardial and pericardial LGE was reported in 43.4 % and 35.8 % of patients, respectively. Nonischemic myocardial or pericardial involvement was reported in 26 (49.1 %) patients. The prevalence of pericardial LGE was associated inversely with the interval between hospital discharge and CMR. COVID-19 survivors had higher end-systolic volume indices (ESVis) and lower left-ventricular ejection fractions than did healthy controls. Seventeen patients underwent follow-up CMR imaging; the end-diastolic volume index, ESVi, and prevalence of pericardial LGE, but not that of nonischemic LGE, were reduced.
Conclusion
Among COVID-19 survivors with myocardial injury during the acute phase of the disease, the incidences of nonischemic myocardial and pericardial LGE and CMR imaging–detected signs of cardiac remodeling, partially reversed during follow-up, were high.
{"title":"Cardiac remodeling and inflammation detected by magnetic resonance imaging in COVID-19 survivors","authors":"Eduardo B. Schaustz , José Carlos P. Secco , Julia M. Barroso , Juliana R. Ferreira , Mariana B. Tortelly , Adriana L. Pimentel , Ana Cristina B.S. Figueiredo , Denilson C. Albuquerque , Allan R. Kluser Sales , Paulo H. Rosado de-Castro , Martha V.T. Pinheiro , Olga F. Souza , Emiliano Medei , Ronir R. Luiz , Andréa Silvestre-Sousa , Gabriel C. Camargo , Renata Moll-Bernardes","doi":"10.1016/j.ijcha.2024.101499","DOIUrl":"10.1016/j.ijcha.2024.101499","url":null,"abstract":"<div><h3>Background</h3><p>Concerns have been raised about cardiac inflammation in patients with long COVID-19, particularly those with myocardial injury during the acute phase of the disease. This study was conducted to examine myopericardial involvement, detected by cardiac magnetic resonance (CMR) imaging in patients hospitalized for COVID-19.</p></div><div><h3>Methods</h3><p>Adult patients hospitalized with COVID-19 who presented myocardial injury or increased D-dimers were enrolled in this prospective study. All patients were invited to undergo CMR imaging examination after discharge. During follow-up, patients with nonischemic myocardial or pericardial involvement detected on the first CMR imaging examination underwent second examinations. CMR imaging findings were compared with those of a control group of healthy patients with no comorbidity.</p></div><div><h3>Results</h3><p>Of 180 included patients, 53 underwent CMR imaging examination. The mean age was 58.4 ± 18.3 years, and 73.6 % were male. Myocardial and pericardial LGE was reported in 43.4 % and 35.8 % of patients, respectively. Nonischemic myocardial or pericardial involvement was reported in 26 (49.1 %) patients. The prevalence of pericardial LGE was associated inversely with the interval between hospital discharge and CMR. COVID-19 survivors had higher end-systolic volume indices (ESVis) and lower left-ventricular ejection fractions than did healthy controls. Seventeen patients underwent follow-up CMR imaging; the end-diastolic volume index, ESVi, and prevalence of pericardial LGE, but not that of nonischemic LGE, were reduced.</p></div><div><h3>Conclusion</h3><p>Among COVID-19 survivors with myocardial injury during the acute phase of the disease, the incidences of nonischemic myocardial and pericardial LGE and CMR imaging–detected signs of cardiac remodeling, partially reversed during follow-up, were high.</p></div>","PeriodicalId":38026,"journal":{"name":"IJC Heart and Vasculature","volume":"54 ","pages":"Article 101499"},"PeriodicalIF":2.5,"publicationDate":"2024-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2352906724001659/pdfft?md5=b4c289219c9b250d73830f5ce40db98e&pid=1-s2.0-S2352906724001659-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142086921","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}
Data on treatment of spontaneous coronary artery dissection (SCAD) has evolved with guidance from national societies beginning around 2018. Given emerging guidance and relatively uncommon presentation of SCAD, we hypothesized that a specialized SCAD clinic would improve guidance-based care.
Methods
We utilized a system-wide electronic medical record search to identify individuals with SCAD diagnosis from 2018 to 2023. All diagnostic angiograms were reviewed to verify diagnosis. We analyzed frequency of guidance-based care since 2018 system-wide. We also compared guidance-based care for individuals with index visits to the SCAD outpatient clinic as compared to non-SCAD clinic providers from initiation of specialty clinic in 2021.
Results
Differences were observed in pregnancy and contraception discussions (88 % vs 0 %, p < 0.001) among pre-menopausal individuals in SCAD clinic compared to non-SCAD clinics. Safety of hormone replacement therapy (HRT) in menopausal women was addressed more by SCAD clinic providers (85 % vs 7 %, p < 0.001). There was more fibromuscular dysplasia (FMD) screening in SCAD clinic (100 % vs 30 %, p < 0.001). Among individuals with migraines, there was more discussion of triggering medications (triptans) in SCAD clinic (80 % vs 14 %, p = 0.008). In individuals prescribed statins not by primary prevention guidelines and without atherosclerosis, there was a trend toward more discussion of statin use in SCAD clinic follow up vs non-SCAD clinic providers (63 % vs 17 %, p = 0.06).
Conclusions
Individuals with follow up in SCAD clinic compared to non-SCAD clinics were more likely to have future pregnancy and contraception counseling, discussion of HRT safety, and FMD screening following index outpatient visit. Future quality improvement initiatives will target these aspects of guidance-based care among non-SCAD clinic providers with integration into cardiology fellow training.
{"title":"Guidance Directed Care of Spontaneous Coronary Artery Dissection: A Healthcare System-Based Experience","authors":"Eleanor Christenson , Deeksha Acharya , Kathryn Berlacher, Agnes Koczo","doi":"10.1016/j.ijcha.2024.101498","DOIUrl":"10.1016/j.ijcha.2024.101498","url":null,"abstract":"<div><h3>Introduction</h3><p>Data on treatment of spontaneous coronary artery dissection (SCAD) has evolved with guidance from national societies beginning around 2018. Given emerging guidance and relatively uncommon presentation of SCAD, we hypothesized that a specialized SCAD clinic would improve guidance-based care.</p></div><div><h3>Methods</h3><p>We utilized a system-wide electronic medical record search to identify individuals with SCAD diagnosis from 2018 to 2023. All diagnostic angiograms were reviewed to verify diagnosis. We analyzed frequency of guidance-based care since 2018 system-wide. We also compared guidance-based care for individuals with index visits to the SCAD outpatient clinic as compared to non-SCAD clinic providers from initiation of specialty clinic in 2021.</p></div><div><h3>Results</h3><p>Differences were observed in pregnancy and contraception discussions (88 % vs 0 %, p < 0.001) among pre-menopausal individuals in SCAD clinic compared to non-SCAD clinics. Safety of hormone replacement therapy (HRT) in menopausal women was addressed more by SCAD clinic providers (85 % vs 7 %, p < 0.001). There was more fibromuscular dysplasia (FMD) screening in SCAD clinic (100 % vs 30 %, p < 0.001). Among individuals with migraines, there was more discussion of triggering medications (triptans) in SCAD clinic (80 % vs 14 %, p = 0.008). In individuals prescribed statins not by primary prevention guidelines and without atherosclerosis, there was a trend toward more discussion of statin use in SCAD clinic follow up vs non-SCAD clinic providers (63 % vs 17 %, p = 0.06).</p></div><div><h3>Conclusions</h3><p>Individuals with follow up in SCAD clinic compared to non-SCAD clinics were more likely to have future pregnancy and contraception counseling, discussion of HRT safety, and FMD screening following index outpatient visit. Future quality improvement initiatives will target these aspects of guidance-based care among non-SCAD clinic providers with integration into cardiology fellow training.</p></div>","PeriodicalId":38026,"journal":{"name":"IJC Heart and Vasculature","volume":"54 ","pages":"Article 101498"},"PeriodicalIF":2.5,"publicationDate":"2024-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2352906724001647/pdfft?md5=1a5e079813addd8a512b9c2bd309b41d&pid=1-s2.0-S2352906724001647-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142076625","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 : 2024-08-22DOI: 10.1016/j.ijcha.2024.101487
Augusto D’Onofrio , Giorgia Cibin , Chiara Tessari , Giulia Lorenzoni , Giampaolo Luzi , Erica Manzan , Dario Gregori , Gino Gerosa , the INTU-ITA And RES-ITA Investigators
Background
Conventional stented, rapid deployment and new-generation stented valves are now available for surgical aortic valve replacement (SAVR). New-generation devices feature advanced tissue treatment for theoretical prolonged durability and a new stent design able to expand in case of future transcatheter Valve-in-Valve. Aim of this retrospective, multicenter, propensity-weighted study was to compare early clinical and hemodynamic outcomes of these three different bioprostheses.
Methods
We analyzed data of 2589 patients from two national multicenter registries and one Institutional database. Study devices were Magna Ease, Intuity/Intuity Elite and Inspiris Resilia (Edwards Lifesciences, Irvine, CA, USA) and were implanted in 296 (11.4 %), 1688 (65.2 %) and 605 (23.4 %) patients, respectively. A propensity score weighting approach was employed.
Results
In isolated SAVR, aortic cross clamp (ACC) time was shorter for Intuity (Magna Ease: 87, Intuity: 55, Inspiris: 70 min; Magna Ease vs. Intuity: p < 0.001; Inspiris vs. Intuity: p < 0.001). Overall mortality was 2 %, 1.7 % and 0.5 % in Magna Ease, Intuity and Inspiris groups, respectively (Magna Ease vs. Intuity: p = 0.476; Inspiris vs. Intuity: p = 0.395); permanent pace-maker implantation rate was lower for Inspiris (Magna Ease: 6 %, Intuity: 6 %, Inspiris: 2 %; Magna Ease vs. Intuity: p = 0.679; Inspiris vs. Intuity: p < 0.001). Median mean gradients were 13, 10 and 10 mmHg for Magna Ease, Intuity and Inspiris, respectively (Magna Ease vs. Intuity: p < 0.001; Inspiris vs. Intuity: p = 0.13).
Conclusions
All study devices provide excellent early clinical and hemodynamic outcomes. Inspiris shows low rates of permanent pace-maker implantation and its transaortic gradients are similar to rapid-deployment valves and lower than Magna Ease.
背景传统支架、快速部署和新一代支架瓣膜现已可用于外科主动脉瓣置换术(SAVR)。新一代设备采用先进的组织处理技术,理论上可延长耐用性,而且新型支架设计可在未来经导管瓣中瓣的情况下进行扩张。这项回顾性、多中心、倾向加权研究的目的是比较这三种不同生物前体的早期临床和血流动力学结果。方法我们分析了来自两个国家多中心登记处和一个机构数据库的 2589 名患者的数据。研究设备为 Magna Ease、Intuity/Intuity Elite 和 Inspiris Resilia(Edwards Lifesciences,Irvine,CA,USA),分别植入 296 例(11.4%)、1688 例(65.2%)和 605 例(23.4%)患者体内。结果在孤立SAVR中,Intuity的主动脉交叉钳夹(ACC)时间更短(Magna Ease:87分钟,Intuity:55分钟,Inspiris:70分钟;Magna Ease vs. Intuity:p < 0.001;Inspiris vs. Intuity:p < 0.001)。Magna Ease 组、Intuity 组和 Inspiris 组的总死亡率分别为 2%、1.7% 和 0.5%(Magna Ease vs. Intuity:p = 0.476;Inspiris vs. Intuity:p = 0.395);Inspiris的永久起搏器植入率较低(Magna Ease:6%,Intuity:6%,Inspiris:2%;Magna Ease vs. Intuity:p = 0.679;Inspiris vs. Intuity:p <0.001)。Magna Ease、Intuity 和 Inspiris 的中位平均梯度分别为 13、10 和 10 mmHg(Magna Ease vs. Intuity:p = 0.001;Inspiris vs. Intuity:p = 0.13)。Inspiris显示出较低的永久起搏器植入率,其经主动脉梯度与快速部署瓣膜相似,低于Magna Ease。
{"title":"Multicenter, propensity-weighted comparison of stented, rapid-deployment and new-generation aortic valves","authors":"Augusto D’Onofrio , Giorgia Cibin , Chiara Tessari , Giulia Lorenzoni , Giampaolo Luzi , Erica Manzan , Dario Gregori , Gino Gerosa , the INTU-ITA And RES-ITA Investigators","doi":"10.1016/j.ijcha.2024.101487","DOIUrl":"10.1016/j.ijcha.2024.101487","url":null,"abstract":"<div><h3>Background</h3><p>Conventional stented, rapid deployment and new-generation stented valves are now available for surgical aortic valve replacement (SAVR). New-generation devices feature advanced tissue treatment for theoretical prolonged durability and a new stent design able to expand in case of future transcatheter Valve-in-Valve. Aim of this retrospective, multicenter, propensity-weighted study was to compare early clinical and hemodynamic outcomes of these three different bioprostheses.</p></div><div><h3>Methods</h3><p>We analyzed data of 2589 patients from two national multicenter registries and one Institutional database. Study devices were Magna Ease, Intuity/Intuity Elite and Inspiris Resilia (Edwards Lifesciences, Irvine, CA, USA) and were implanted in 296 (11.4 %), 1688 (65.2 %) and 605 (23.4 %) patients, respectively. A propensity score weighting approach was employed.</p></div><div><h3>Results</h3><p>In isolated SAVR, aortic cross clamp (ACC) time was shorter for Intuity (Magna Ease: 87, Intuity: 55, Inspiris: 70 min; Magna Ease vs. Intuity: p < 0.001; Inspiris vs. Intuity: p < 0.001). Overall mortality was 2 %, 1.7 % and 0.5 % in Magna Ease, Intuity and Inspiris groups, respectively (Magna Ease vs. Intuity: p = 0.476; Inspiris vs. Intuity: p = 0.395); permanent pace-maker implantation rate was lower for Inspiris (Magna Ease: 6 %, Intuity: 6 %, Inspiris: 2 %; Magna Ease vs. Intuity: p = 0.679; Inspiris vs. Intuity: p < 0.001). Median mean gradients were 13, 10 and 10 mmHg for Magna Ease, Intuity and Inspiris, respectively (Magna Ease vs. Intuity: p < 0.001; Inspiris vs. Intuity: p = 0.13).</p></div><div><h3>Conclusions</h3><p>All study devices provide excellent early clinical and hemodynamic outcomes. Inspiris shows low rates of permanent pace-maker implantation and its transaortic gradients are similar to rapid-deployment valves and lower than Magna Ease.</p></div>","PeriodicalId":38026,"journal":{"name":"IJC Heart and Vasculature","volume":"54 ","pages":"Article 101487"},"PeriodicalIF":2.5,"publicationDate":"2024-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2352906724001532/pdfft?md5=aaf57a7591a1bc8db585e9a4529dba64&pid=1-s2.0-S2352906724001532-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142040818","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}