We aimed to assess the diagnostic performance of Cardiac Magnetic Resonance (CMR) strain parameters in ACM patients to evaluate their diagnostic role. We systematically searched MEDLINE, EMBASE, Scopus, and Web of Science. Of the 146 records, 16 were included. All Right Ventricle (RV) global strains were significantly reduced in ACM patients compared to controls (Standardized Mean Difference (SMD)[95 % Confidence Interval (CI)]: Longitudinal 1.31[0.79,1.83]; Circumferential 0.88[0.34,1.42]; Radial −1.14[−1.78,−0.51]). Similarly, all Left Ventricle (LV) global strains were significantly impaired in ACM compared to healthy controls (SDM [95 %CI]: Longitudinal 0.88[0.48,12.28], Circumferential 0.97[0.72,1.22], Radial −1.24[−1.49,−1.00]). Regarding regional RV strains, longitudinal and circumferential strains were significantly reduced in basal and mid-wall regions, while they were comparable to controls in the apical regions. The RV radial strain was reduced only within the basal region in the ACM group compared to controls. ACM patients exhibited significant impairment of regional LV strains in all regions–basal, mid-wall, and apical–compared to control subjects. Ultimately, despite the limitations of CMR-FT in terms of reproducibility, it is superior to qualitative assessment in detecting wall motion abnormalities. Thus, integrating CMR-FT with ACM diagnostic criteria seems to enhance its diagnostic yield.
{"title":"Value of cardiac magnetic resonance feature-tracking in Arrhythmogenic Cardiomyopathy (ACM): A systematic review and meta-analysis","authors":"MohammadHossein MozafaryBazargany , Alireza Salmanipour , Amir Ghaffari Jolfayi , Amir Azimi , Hooman Bakhshandeh , Behnaz Mahmoodieh , Saeed Tofighi , Niloofar Gholami , Jafar Golzarian , Marzieh Motevalli","doi":"10.1016/j.ijcha.2024.101455","DOIUrl":"https://doi.org/10.1016/j.ijcha.2024.101455","url":null,"abstract":"<div><p>We aimed to assess the diagnostic performance of Cardiac Magnetic Resonance (CMR) strain parameters in ACM patients to evaluate their diagnostic role. We systematically searched MEDLINE, EMBASE, Scopus, and Web of Science. Of the 146 records, 16 were included. All Right Ventricle (RV) global strains were significantly reduced in ACM patients compared to controls (Standardized Mean Difference (SMD)[95 % Confidence Interval (CI)]: Longitudinal 1.31[0.79,1.83]; Circumferential 0.88[0.34,1.42]; Radial −1.14[−1.78,−0.51]). Similarly, all Left Ventricle (LV) global strains were significantly impaired in ACM compared to healthy controls (SDM [95 %CI]: Longitudinal 0.88[0.48,12.28], Circumferential 0.97[0.72,1.22], Radial −1.24[−1.49,−1.00]). Regarding regional RV strains, longitudinal and circumferential strains were significantly reduced in basal and mid-wall regions, while they were comparable to controls in the apical regions. The RV radial strain was reduced only within the basal region in the ACM group compared to controls. ACM patients exhibited significant impairment of regional LV strains in all regions–basal, mid-wall, and apical–compared to control subjects. Ultimately, despite the limitations of CMR-FT in terms of reproducibility, it is superior to qualitative assessment in detecting wall motion abnormalities. Thus, integrating CMR-FT with ACM diagnostic criteria seems to enhance its diagnostic yield.</p></div>","PeriodicalId":38026,"journal":{"name":"IJC Heart and Vasculature","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2352906724001210/pdfft?md5=56da2a9fea6408e9b786df570fea7a3f&pid=1-s2.0-S2352906724001210-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141541819","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}
There are currently no established non-invasive indices of echocardiography for elevated left atrial pressure (LAP) especially in patients with atrial fibrillation (AF). Remote dielectric sensing (ReDS) is a novel non-invasive electromagnetic energy-based technology that quantifies total lung fluid, enabling the monitoring of volume status in patients with heart failure. The utility of ReDS for estimating LAP in patients with AF remains unknown.
Methods
We prospectively investigated patients with AF in whom LAP was directly measured during catheter ablation for AF, and ReDS measurements were conducted the day before ablation. Elevated LAP was defined as LAP ≥ 15 mmHg.
Results
A total of 61 patients were included (median age 66 years, 38 % female). Among them, 26 patients had elevated LAP. There was a positive correlation between ReDS and LAP (r = 0.363, P = 0.004). Receiver operating characteristic curve analysis for the prediction of elevated LAP demonstrated that the best cut-off value of ReDS was 30 %, with a sensitivity of 65 %, specificity of 69 %, and an area under the curve of 0.703 (95 % confidence interval 0.568–0.837). Multivariate logistic regression analysis revealed that ReDS was an independent predictor of elevated LAP, among covariates including left ventricular ejection fraction, the ratio of early transmitral flow velocity to septal mitral annular early diastolic velocity, and left atrial volume index.
Conclusions
Our results suggest ReDS could be a valuable marker of elevated LAP even in patients with AF. Further studies are needed to elucidate the effectiveness of a ReDS-guided decongestive strategy in patients with heart failure.
背景目前还没有针对左心房压力(LAP)升高,尤其是心房颤动(AF)患者的无创超声心动图指标。远程介电传感(ReDS)是一种基于电磁能的新型无创技术,可量化肺液总量,从而监测心衰患者的肺容量状态。我们对房颤患者进行了前瞻性调查,在房颤导管消融过程中直接测量了患者的 LAP,并在消融前一天进行了 ReDS 测量。结果 共纳入 61 名患者(中位年龄 66 岁,38% 为女性)。其中,26 名患者的 LAP 升高。ReDS 与 LAP 呈正相关(r = 0.363,P = 0.004)。预测 LAP 升高的接收者操作特征曲线分析表明,ReDS 的最佳临界值为 30%,灵敏度为 65%,特异度为 69%,曲线下面积为 0.703(95% 置信区间为 0.568-0.837)。多变量逻辑回归分析表明,在包括左室射血分数、二尖瓣环早期舒张期血流速度与室间隔二尖瓣环早期舒张期血流速度之比以及左房容积指数在内的协变量中,ReDS 是 LAP 升高的独立预测因子。还需要进一步研究来阐明 ReDS 指导下的减充血策略在心衰患者中的有效性。
{"title":"Remote dielectric sensing predicts elevated left atrial pressure in patients with atrial fibrillation","authors":"Shunsuke Tamaki, Katsuji Inoue, Hiroshi Kawakami, Tomoki Fujisawa, Ryo Miyabe, Yasuhisa Nakao, Shigehiro Miyazaki, Yusuke Akazawa, Toru Miyoshi, Akinori Higaki, Fumiyasu Seike, Haruhiko Higashi, Kazuhisa Nishimura, Shuntaro Ikeda, Osamu Yamaguchi","doi":"10.1016/j.ijcha.2024.101459","DOIUrl":"https://doi.org/10.1016/j.ijcha.2024.101459","url":null,"abstract":"<div><h3>Background</h3><p>There are currently no established non-invasive indices of echocardiography for elevated left atrial pressure (LAP) especially in patients with atrial fibrillation (AF). Remote dielectric sensing (ReDS) is a novel non-invasive electromagnetic energy-based technology that quantifies total lung fluid, enabling the monitoring of volume status in patients with heart failure. The utility of ReDS for estimating LAP in patients with AF remains unknown.</p></div><div><h3>Methods</h3><p>We prospectively investigated patients with AF in whom LAP was directly measured during catheter ablation for AF, and ReDS measurements were conducted the day before ablation. Elevated LAP was defined as LAP ≥ 15 mmHg.</p></div><div><h3>Results</h3><p>A total of 61 patients were included (median age 66 years, 38 % female). Among them, 26 patients had elevated LAP. There was a positive correlation between ReDS and LAP (<em>r</em> = 0.363, <em>P</em> = 0.004). Receiver operating characteristic curve analysis for the prediction of elevated LAP demonstrated that the best cut-off value of ReDS was 30 %, with a sensitivity of 65 %, specificity of 69 %, and an area under the curve of 0.703 (95 % confidence interval 0.568–0.837). Multivariate logistic regression analysis revealed that ReDS was an independent predictor of elevated LAP, among covariates including left ventricular ejection fraction, the ratio of early transmitral flow velocity to septal mitral annular early diastolic velocity, and left atrial volume index.</p></div><div><h3>Conclusions</h3><p>Our results suggest ReDS could be a valuable marker of elevated LAP even in patients with AF. Further studies are needed to elucidate the effectiveness of a ReDS-guided decongestive strategy in patients with heart failure.</p></div>","PeriodicalId":38026,"journal":{"name":"IJC Heart and Vasculature","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2352906724001258/pdfft?md5=6231e65f84c2bf89214a5399af4bd1bb&pid=1-s2.0-S2352906724001258-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141593849","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 : 2024-07-05DOI: 10.1016/j.ijcha.2024.101457
Runlu Sun , Qi Guo , Hongwei Li , Xiao Liu , Yuan Jiang , Jingfeng Wang , Yuling Zhang
Background
Data regarding risk factors for premature coronary artery disease (PCAD) is scarce given that few research focus on it. This study aimed to develop and validate a clinical nomogram for PCAD patients in Guangzhou.
Methods
We recruited 108 PCAD patients (female ≤65 years old and male ≤55 years old) and 96 healthy controls from Sun Yat-sen Memorial Hospital of Sun Yat-sen University between 01/01/2021 and 31/12/2022. Twenty potentially relevant indicators of PCAD were extracted. Next, the least absolute shrinkage and selection operator (LASSO) regression analysis was used to optimize variable selection. The nomogram was developed based on the selected variables visually.
Results
Independent risk factors, including body mass index (BMI), history of PCAD, glucose, Apolipoprotein A1(ApoA1), high density lipoprotein 2-cholesterol (HDL2-C), total cholesterol and triglyceride, were identified by LASSO and logistic regression analysis. The nomogram showed accurate discrimination (area under the receiver operator characteristic curve, ROC, 87.45 %, 95 % CI: 82.58 %-92.32 %). Decision curve analysis (DCA) suggested that the nomogram was clinical beneficial. HDL2, one risk factor, was isolated by a two-step discontinuous density-gradient ultracentrifugation method. And HDL2 from PCAD patients exhibited less 3H-cholesterol efflux (22.17 % vs 26.64 %, P < 0.05) and less delivery of NBD-cholesterol detecting by confocal microscope compared with healthy controls.
Conclusions
In conclusion, the seven-factor nomogram can achieve a reasonable relationship with PCAD, and a large cohort were needed to enhance the credibility and effectiveness of our model in future.
{"title":"Development and validation of a nomogram for premature coronary artery disease patients in Guangzhou","authors":"Runlu Sun , Qi Guo , Hongwei Li , Xiao Liu , Yuan Jiang , Jingfeng Wang , Yuling Zhang","doi":"10.1016/j.ijcha.2024.101457","DOIUrl":"https://doi.org/10.1016/j.ijcha.2024.101457","url":null,"abstract":"<div><h3>Background</h3><p>Data regarding risk factors for premature coronary artery disease (PCAD) is scarce given that few research focus on it. This study aimed to develop and validate a clinical nomogram for PCAD patients in Guangzhou.</p></div><div><h3>Methods</h3><p>We recruited 108 PCAD patients (female ≤65 years old and male ≤55 years old) and 96 healthy controls from Sun Yat-sen Memorial Hospital of Sun Yat-sen University between 01/01/2021 and 31/12/2022. Twenty potentially relevant indicators of PCAD were extracted. Next, the least absolute shrinkage and selection operator (LASSO) regression analysis was used to optimize variable selection. The nomogram was developed based on the selected variables visually.</p></div><div><h3>Results</h3><p>Independent risk factors, including body mass index (BMI), history of PCAD, glucose, Apolipoprotein A1(ApoA1), high density lipoprotein 2-cholesterol (HDL2-C), total cholesterol and triglyceride, were identified by LASSO and logistic regression analysis. The nomogram showed accurate discrimination (area under the receiver operator characteristic curve, ROC, 87.45 %, 95 % CI: 82.58 %-92.32 %). Decision curve analysis (DCA) suggested that the nomogram was clinical beneficial. HDL2, one risk factor, was isolated by a two-step discontinuous density-gradient ultracentrifugation method. And HDL2 from PCAD patients exhibited less <sup>3</sup>H-cholesterol efflux (22.17 % vs 26.64 %, <em>P</em> < 0.05) and less delivery of NBD-cholesterol detecting by confocal microscope compared with healthy controls.</p></div><div><h3>Conclusions</h3><p>In conclusion, the seven-factor nomogram can achieve a reasonable relationship with PCAD, and a large cohort were needed to enhance the credibility and effectiveness of our model in future.</p></div>","PeriodicalId":38026,"journal":{"name":"IJC Heart and Vasculature","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2352906724001234/pdfft?md5=48ebb8e9052e1892ed9289879e42fdfd&pid=1-s2.0-S2352906724001234-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141543576","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 : 2024-07-04DOI: 10.1016/j.ijcha.2024.101437
Bruna Punzo , Liberatore Tramontano , Alberto Clemente , Sara Seitun , Erica Maffei , Luca Saba , Carlo Nicola De Cecco , Eduardo Bossone , Jagat Narula , Carlo Cavaliere , Filippo Cademartiri
Background and aims
Cardiac ParaGangliomas (PGLs) are rare extra-adrenal tumours that arise from chromaffin cells of the sympathetic ganglia. PGL are often diagnosed incidentally, with no symptoms or symptoms related to cardiovascular dysfunction.
Methods
Cardiac Computed Tomography (CCT) and Cardiac Magnetic Resonance (CMR) can detect the correct morphology and position of the lesion and provide proper tissue characterization.
Nuclear medicine imaging, with Positron Emission Tomography (PET) or Single Photon Emission Computed Tomography (SPECT) with specific radiotracers, can evaluate the functionality of the PGL and to distinguish a secreting from a non-secreting tumour.
Results
In association with biochemical parameters, a multimodal imaging approach, not yet standardized, can be useful both in the diagnosis, in the monitoring and in the treatment planning.
Conclusions
In this systematic review, we aim to investigate the role of diagnostic imaging, in particular CCT, CMR, PET and SPECT in diagnosis, characterization and monitoring of cardiac PGLs.
{"title":"Advanced imaging of cardiac Paraganglioma: A systematic review","authors":"Bruna Punzo , Liberatore Tramontano , Alberto Clemente , Sara Seitun , Erica Maffei , Luca Saba , Carlo Nicola De Cecco , Eduardo Bossone , Jagat Narula , Carlo Cavaliere , Filippo Cademartiri","doi":"10.1016/j.ijcha.2024.101437","DOIUrl":"https://doi.org/10.1016/j.ijcha.2024.101437","url":null,"abstract":"<div><h3>Background and aims</h3><p>Cardiac ParaGangliomas (PGLs) are rare extra-adrenal tumours that arise from chromaffin cells of the sympathetic ganglia. PGL are often diagnosed incidentally, with no symptoms or symptoms related to cardiovascular dysfunction.</p></div><div><h3>Methods</h3><p>Cardiac Computed Tomography (CCT) and Cardiac Magnetic Resonance (CMR) can detect the correct morphology and position of the lesion and provide proper tissue characterization.</p><p>Nuclear medicine imaging, with Positron Emission Tomography (PET) or Single Photon Emission Computed Tomography (SPECT) with specific radiotracers, can evaluate the functionality of the PGL and to distinguish a secreting from a non-secreting tumour.</p></div><div><h3>Results</h3><p>In association with biochemical parameters, a multimodal imaging approach, not yet standardized, can be useful both in the diagnosis, in the monitoring and in the treatment planning.</p></div><div><h3>Conclusions</h3><p>In this systematic review, we aim to investigate the role of diagnostic imaging, in particular CCT, CMR, PET and SPECT in diagnosis, characterization and monitoring of cardiac PGLs.</p></div>","PeriodicalId":38026,"journal":{"name":"IJC Heart and Vasculature","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2352906724001039/pdfft?md5=36e4c6afd2081f6464637843cb9a01c2&pid=1-s2.0-S2352906724001039-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141541818","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 : 2024-06-29DOI: 10.1016/j.ijcha.2024.101453
Background
Observational studies have established an association between serum uric acid and cardiovascular disease (CVD). However, these studies are susceptible to uncontrolled confounders and reverse causality bias. To overcome these challenges, we employed a two-sample Mendelian randomization (MR) approach to investigate the causal link between serum uric acid and CVD.
Methods
We utilized Genome-wide association study (GWAS) data for serum uric acid and six CVD: coronary artery disease (CAD), hypertension, myocardial infarction (MI), heart failure (HF), angina, and coronary heart disease (CHD). MR analyses employed inverse variance weighting (IVW), MR-Egger, weighted median, and weighted model. Sensitivity analyses were conducted to assess result reliability, including Cochrane’s Q test, MR-Egger intercept, MR-PRESSO, and the leave-one-out approach.
Results
IVW analysis revealed that a genetic predisposition to elevated serum uric acid levels significantly increases the risk of CVD, with higher odds ratios (ORs) observed for CAD (OR: 1.227; 95 % CI: 1.107–1.360, P = 0.0002), hypertension (OR: 1.318, 95 %CI: 1.184–1.466, P = 2.13E-06), MI (OR: 1.184, 95 %CI: 1.108–1.266, P = 2.13E-06), HF (OR: 1.158, 95 %CI: 1.066–1.258, P = 2.13E-06), angina (OR: 1.150, 95 %CI: 1.074–1.231, P = 0.0002) and CHD (OR: 1.170, 95 %CI: 1.072–1.276, P = 0.0005). Sensitivity analysis research results have robustness.
Conclusion
This MR study robustly demonstrates a significant causal relationship between genetically elevated serum uric acid and various cardiovascular diseases, suggesting that higher levels may enhance the risk of cardiovascular events. Consequently, patients with elevated uric acid levels warrant early and aggressive interventions to mitigate cardiovascular risks.
{"title":"Causal relationship between serum uric acid and cardiovascular disease: A Mendelian randomization study","authors":"","doi":"10.1016/j.ijcha.2024.101453","DOIUrl":"10.1016/j.ijcha.2024.101453","url":null,"abstract":"<div><h3>Background</h3><p>Observational studies have established an association between serum uric acid and cardiovascular disease (CVD). However, these studies are susceptible to uncontrolled confounders and reverse causality bias. To overcome these challenges, we employed a two-sample Mendelian randomization (MR) approach to investigate the causal link between serum uric acid and CVD.</p></div><div><h3>Methods</h3><p>We utilized Genome-wide association study (GWAS) data for serum uric acid and six CVD: coronary artery disease (CAD), hypertension, myocardial infarction (MI), heart failure (HF), angina, and coronary heart disease (CHD). MR analyses employed inverse variance weighting (IVW), MR-Egger, weighted median, and weighted model. Sensitivity analyses were conducted to assess result reliability, including Cochrane’s Q test, MR-Egger intercept, MR-PRESSO, and the leave-one-out approach.</p></div><div><h3>Results</h3><p>IVW analysis revealed that a genetic predisposition to elevated serum uric acid levels significantly increases the risk of CVD, with higher odds ratios (ORs) observed for CAD (OR: 1.227; 95 % CI: 1.107–1.360, <em>P</em> = 0.0002), hypertension (OR: 1.318, 95 %CI: 1.184–1.466, <em>P</em> = 2.13E-06), MI (OR: 1.184, 95 %CI: 1.108–1.266, <em>P</em> = 2.13E-06), HF (OR: 1.158, 95 %CI: 1.066–1.258, <em>P</em> = 2.13E-06), angina (OR: 1.150, 95 %CI: 1.074–1.231, <em>P</em> = 0.0002) and CHD (OR: 1.170, 95 %CI: 1.072–1.276, <em>P</em> = 0.0005). Sensitivity analysis research results have robustness.</p></div><div><h3>Conclusion</h3><p>This MR study robustly demonstrates a significant causal relationship between genetically elevated serum uric acid and various cardiovascular diseases, suggesting that higher levels may enhance the risk of cardiovascular events. Consequently, patients with elevated uric acid levels warrant early and aggressive interventions to mitigate cardiovascular risks.</p></div>","PeriodicalId":38026,"journal":{"name":"IJC Heart and Vasculature","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2352906724001192/pdfft?md5=f8201d6eed4f04381b26d3207f628d0f&pid=1-s2.0-S2352906724001192-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142241912","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 : 2024-06-28DOI: 10.1016/j.ijcha.2024.101452
Anke C. Fender, Dobromir Dobrev
{"title":"Recent highlights from the International Journal of Cardiology Heart & Vasculature: Basic and translational research","authors":"Anke C. Fender, Dobromir Dobrev","doi":"10.1016/j.ijcha.2024.101452","DOIUrl":"https://doi.org/10.1016/j.ijcha.2024.101452","url":null,"abstract":"","PeriodicalId":38026,"journal":{"name":"IJC Heart and Vasculature","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2352906724001180/pdfft?md5=669b7efffa1542ba3e12e41169abf0f3&pid=1-s2.0-S2352906724001180-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141486086","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 : 2024-06-27DOI: 10.1016/j.ijcha.2024.101451
Andrea De Lorenzo, Marcos Fernandes, Eduardo Tibirica
In clinical practice, there is vast knowledge regarding the evaluation of macrocirculatory parameters, such as systemic blood pressure and cardiac output, for the hemodynamic monitoring of patients. However, assessment of the microcirculation has not yet been incorporated into the bedside armamentarium. Hand-held intravital video microscopy enables the direct, noninvasive, evaluation of the sublingual microcirculation at the bedside, offering insights into the status of the systemic microcirculation. It is easily performed and may be employed in several clinical settings, providing immediate results that may help guide patient management. Therefore, the incorporation of hand-held intravital video microscopy into clinical practice may lead to tremendous improvements in the quality of care of critical, unstable patients or offer new data in the evaluation of patients with chronic diseases, especially those with microcirculatory involvement, such as occurs in diabetes.
{"title":"From bench to bedside: A review of the application and potential of microcirculatory assessment by hand-held videomicroscopy","authors":"Andrea De Lorenzo, Marcos Fernandes, Eduardo Tibirica","doi":"10.1016/j.ijcha.2024.101451","DOIUrl":"https://doi.org/10.1016/j.ijcha.2024.101451","url":null,"abstract":"<div><p>In clinical practice, there is vast knowledge regarding the evaluation of macrocirculatory parameters, such as systemic blood pressure and cardiac output, for the hemodynamic monitoring of patients. However, assessment of the microcirculation has not yet been incorporated into the bedside armamentarium. Hand-held intravital video microscopy enables the direct, noninvasive, evaluation of the sublingual microcirculation at the bedside, offering insights into the status of the systemic microcirculation. It is easily performed and may be employed in several clinical settings, providing immediate results that may help guide patient management. Therefore, the incorporation of hand-held intravital video microscopy into clinical practice may lead to tremendous improvements in the quality of care of critical, unstable patients or offer new data in the evaluation of patients with chronic diseases, especially those with microcirculatory involvement, such as occurs in diabetes.</p></div>","PeriodicalId":38026,"journal":{"name":"IJC Heart and Vasculature","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2352906724001179/pdfft?md5=633974b35003a85b89d9d764428fcd26&pid=1-s2.0-S2352906724001179-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141486083","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 : 2024-06-26DOI: 10.1016/j.ijcha.2024.101443
K. Giskes , N. Lowres , J. Orchard , K. Hyun , C. Hespe , B. Freedman
Background
Atrial fibrillation (AF) is associated with stroke. Major changes to AF management recommendations in 2016–2018 advised that: 1. Stroke risk be estimated using the CHA2DS2-VA score; 2. Antiplatelet agents (APAs) do not effectively mitigate stroke risk; 3. Anticoagulation is prioritised above bleeding risk among high-risk patients; and 4. Non-vitamin K oral anticoagulants (NOACs) are used as first-line anticoagulants.
Aim
To examine trends in stroke risk management among high-risk patients with non-valvular AF in Australia between 2011–2019.
Method
De-identified data of patients were obtained from 164 separate general practices. Data included information on patient demographics, diagnoses, health risk factors and recent prescriptions. Patients with a diagnosis of non-valvular AF were identified and stroke risk was calculated by CHA2DS2-VA score. High risk patients (i.e. CHA2DS2-VA ≥ 2) were categorised as being managed by oral anticoagulants (OACs, i.e., warfarin or NOACs), APAs only, or neither (i.e., no OACs or APAs) and time trends in prescribing were examined. Multivariate analyses examined the characteristics of patients receiving the guideline recommended OAC management.
Results
Data were available for 337,964 patients; 8696 (2.6 %) had AF. Most patients with AF (85.8 %, n = 7116) had high stroke risk. The proportion of high-risk patients managed on OACs increased from 56.7 % in 2011 to 73.7 % in 2019, while the proportion prescribed APAs declined from 31.1 % to 14.0 %. Those receiving neither treatment remained steady (around 12 %). Overall, 26.3 % of patients were inadequately anticoagulated at the end of the study period. There were no age or gender differences in receiving the guideline-recommended therapy, and patients with comorbidities associated with increased stroke risk were more likely to receive OAC therapy.
Conclusions
Stroke risk management among patients with AF has improved between 2011–2019, however there is still scope for further gains as many high-risk patients remain inadequately anticoagulated. Better stroke risk assessment by clinicians coupled with addressing practitioner concerns about bleeding risk may improve management of high-risk patients.
{"title":"Time trends in stroke risk management among high-risk patients with non-valvular atrial fibrillation in Australia between 2011–2019","authors":"K. Giskes , N. Lowres , J. Orchard , K. Hyun , C. Hespe , B. Freedman","doi":"10.1016/j.ijcha.2024.101443","DOIUrl":"https://doi.org/10.1016/j.ijcha.2024.101443","url":null,"abstract":"<div><h3>Background</h3><p>Atrial fibrillation (AF) is associated with stroke. Major changes to AF management recommendations in 2016–2018 advised that: 1. Stroke risk be estimated using the CHA<sub>2</sub>DS<sub>2</sub>-VA score; 2. Antiplatelet agents (APAs) do not effectively mitigate stroke risk; 3. Anticoagulation is prioritised above bleeding risk among high-risk patients; and 4. Non-vitamin K oral anticoagulants (NOACs) are used as first-line anticoagulants.</p></div><div><h3>Aim</h3><p>To examine trends in stroke risk management among high-risk patients with non-valvular AF in Australia between 2011–2019.</p></div><div><h3>Method</h3><p>De-identified data of patients were obtained from 164 separate general practices. Data included information on patient demographics, diagnoses, health risk factors and recent prescriptions. Patients with a diagnosis of non-valvular AF were identified and stroke risk was calculated by CHA<sub>2</sub>DS<sub>2</sub>-VA score. High risk patients (i.e. CHA<sub>2</sub>D<sub>S</sub>2-VA ≥ 2) were categorised as being managed by oral anticoagulants (OACs, i.e., warfarin or NOACs), APAs only, or neither (i.e., no OACs or APAs) and time trends in prescribing were examined. Multivariate analyses examined the characteristics of patients receiving the guideline recommended OAC management.</p></div><div><h3>Results</h3><p>Data were available for 337,964 patients; 8696 (2.6 %) had AF. Most patients with AF (85.8 %, n = 7116) had high stroke risk. The proportion of high-risk patients managed on OACs increased from 56.7 % in 2011 to 73.7 % in 2019, while the proportion prescribed APAs declined from 31.1 % to 14.0 %. Those receiving neither treatment remained steady (around 12 %). Overall, 26.3 % of patients were inadequately anticoagulated at the end of the study period. There were no age or gender differences in receiving the guideline-recommended therapy, and patients with comorbidities associated with increased stroke risk were more likely to receive OAC therapy.</p></div><div><h3>Conclusions</h3><p>Stroke risk management among patients with AF has improved between 2011–2019, however there is still scope for further gains as many high-risk patients remain inadequately anticoagulated. Better stroke risk assessment by clinicians coupled with addressing practitioner concerns about bleeding risk may improve management of high-risk patients.</p></div>","PeriodicalId":38026,"journal":{"name":"IJC Heart and Vasculature","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S235290672400109X/pdfft?md5=1090db0ea14b2e2f9d47cca59b8dd294&pid=1-s2.0-S235290672400109X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141486087","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 : 2024-06-25DOI: 10.1016/j.ijcha.2024.101450
Michael C. Hill , Noah Kim , William Galanter , Ben S. Gerber , Colin C. Hubbard , Dawood Darbar , Mark D. McCauley
Background
Obesity increases risk of atrial fibrillation (AF) at least in part due to pro-inflammatory effects, but has been paradoxically associated with improved mortality. Although statins have pleiotropic anti-inflammatory properties, their interaction with obesity and clinical outcomes in AF is unknown. We explored the relationship between BMI, statin use, and all-cause mortality and AF/congestive heart failure (CHF)-related encounters, hypothesizing that statin exposure may be differentially associated with improved outcomes in overweight/obesity.
Methods
This was a single center retrospective cohort study of adults with AF diagnosed between 2011–2018. Patients were grouped by body mass index (BMI) and statin use at time of AF diagnosis. Outcomes included all-cause mortality and ED or inpatient encounters for AF or CHF.
Results and Conclusions
A total of 2503 subjects were included (median age 66 years, 43.4 % female, median BMI 29.8 kg/m2, 54.6 % on baseline statin therapy). Increasing BMI was associated with decreased mortality hazard but not associated with AF/CHF encounter risk. Adjusting for statin-BMI interaction, demographics, and cardiovascular comorbidities, overweight non-statin users experienced improved mortality (adjusted hazard ratio [aHR] 0.55, 95 % CI 0.35–0.84) compared to statin users (aHR 0.98, 95 % CI 0.69–1.40; interaction P-value = 0.013). Mortality hazard was consistently lower in obese non-statin users than in statin users, however interaction was insignificant. No significant BMI-statin interactions were observed in AF/CHF encounter risk. In summary, statin use was not differentially associated with improved mortality or hospitalization risk in overweight/obese groups. These findings do not support statins for secondary prevention of adverse outcomes based on overweight/obesity status alone.
背景肥胖会增加心房颤动(房颤)的风险,至少部分原因是由于促炎作用,但与此同时,肥胖却与死亡率的改善有着矛盾的联系。虽然他汀类药物具有多重抗炎特性,但其与肥胖和心房颤动临床结局之间的相互作用尚不清楚。我们探讨了体重指数、他汀类药物的使用与全因死亡率和房颤/充血性心力衰竭(CHF)相关病例之间的关系,假设他汀类药物的暴露可能与超重/肥胖患者的预后改善有不同程度的关联。根据体重指数(BMI)和确诊房颤时他汀类药物的使用情况对患者进行分组。结果包括全因死亡率和因房颤或慢性心房颤动而就诊的急诊室或住院患者人数。结果和结论共纳入 2503 名受试者(中位年龄 66 岁,43.4% 为女性,中位体重指数 29.8 kg/m2,54.6% 接受过他汀类药物治疗)。体重指数的增加与死亡率的降低有关,但与房颤/慢性阻塞性肺病的发病风险无关。调整他汀与体重指数的交互作用、人口统计学和心血管合并症后,与他汀使用者相比,超重非他汀使用者的死亡率有所提高(调整后危险比 [aHR] 0.55,95 % CI 0.35-0.84)(aHR 0.98,95 % CI 0.69-1.40;交互作用 P 值 = 0.013)。肥胖的非他汀类药物使用者的死亡率一直低于他汀类药物使用者,但交互作用不显著。在房颤/慢性阻塞性肺病发病风险方面,未观察到明显的体重指数-他汀相互作用。总之,在超重/肥胖人群中,他汀类药物的使用与死亡率或住院风险的改善并无差异。这些发现并不支持仅根据超重/肥胖状况将他汀类药物用于不良后果的二级预防。
{"title":"Association between obesity and statin use on mortality and hospital encounters in atrial fibrillation","authors":"Michael C. Hill , Noah Kim , William Galanter , Ben S. Gerber , Colin C. Hubbard , Dawood Darbar , Mark D. McCauley","doi":"10.1016/j.ijcha.2024.101450","DOIUrl":"https://doi.org/10.1016/j.ijcha.2024.101450","url":null,"abstract":"<div><h3>Background</h3><p>Obesity increases risk of atrial fibrillation (AF) at least in part due to pro-inflammatory effects, but has been paradoxically associated with improved mortality. Although statins have pleiotropic anti-inflammatory properties, their interaction with obesity and clinical outcomes in AF is unknown. We explored the relationship between BMI, statin use, and all-cause mortality and AF/congestive heart failure (CHF)-related encounters, hypothesizing that statin exposure may be differentially associated with improved outcomes in overweight/obesity.</p></div><div><h3>Methods</h3><p>This was a single center retrospective cohort study of adults with AF diagnosed between 2011–2018. Patients were grouped by body mass index (BMI) and statin use at time of AF diagnosis. Outcomes included all-cause mortality and ED or inpatient encounters for AF or CHF.</p></div><div><h3>Results and Conclusions</h3><p>A total of 2503 subjects were included (median age 66 years, 43.4 % female, median BMI 29.8 kg/m<sup>2</sup>, 54.6 % on baseline statin therapy). Increasing BMI was associated with decreased mortality hazard but not associated with AF/CHF encounter risk. Adjusting for statin-BMI interaction, demographics, and cardiovascular comorbidities, overweight non-statin users experienced improved mortality (adjusted hazard ratio [aHR] 0.55, 95 % CI 0.35–0.84) compared to statin users (aHR 0.98, 95 % CI 0.69–1.40; interaction P-value = 0.013). Mortality hazard was consistently lower in obese non-statin users than in statin users, however interaction was insignificant. No significant BMI-statin interactions were observed in AF/CHF encounter risk. In summary, statin use was not differentially associated with improved mortality or hospitalization risk in overweight/obese groups. These findings do not support statins for secondary prevention of adverse outcomes based on overweight/obesity status alone.</p></div>","PeriodicalId":38026,"journal":{"name":"IJC Heart and Vasculature","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2352906724001167/pdfft?md5=1823ff5ce7c92fea12f1a9e42b4434d5&pid=1-s2.0-S2352906724001167-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141486085","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 : 2024-06-22DOI: 10.1016/j.ijcha.2024.101448
Juan Esteban Gómez-Mesa , Clara Saldarriaga , Alex Arnulfo Rivera-Toquica , Silfredo Arrieta-González , Alfonso Muñoz-Velásquez , Eduardo José Echeverry-Navarrete , Julián Rodrigo Lugo-Peña , Juan Alberto Cerón , Oscar Sveins Rincón-Peña , Luis Eduardo Silva-Diazgranados , Hugo Ernesto Osorio-Carmona , Alejandro Posada-Bastidas , Juan Camilo García , Alejandro David Ochoa-Morón , Luis Eduardo Echeverría , RECOLFACA Investigators
Background
The value of Sodium-glucose cotransporter-2 inhibitors (SGLT-2 inhibitor) therapy in individuals with heart failure with preserved EF (HFpEF) was unknown until the EMPEROR-Preserved trial. We aimed to assess the proportion of patients with HFpEF that are eligible for empagliflozin therapy within the Colombian Heart Failure Registry (RECOLFACA).
Methods
RECOLFACA enrolled adult patients with a HF diagnosis during 2017–2019 from 60 medical centers in Colombia. Criteria of the EMPEROR-Preserved Trial were used to recruit participants. The main outcome was individual eligibility with N-terminal pro-B-type natriuretic peptide (NT-proBNP) criteria, while the secondary outcome was eligibility without NT-proBNP data.
Results
RECOLFACA had 799 patients with HFpEF (mean age70.7 ± 13.5; 50.7 % males). According to the major selection criteria of the EMPEROR Preserved Trial, 73.7 % patients would be eligible for empagliflozin therapy initiation when considering the NT-proBNP threshold. The NT-proBNP threshold represented the main determinant of ineligibility in patients with this biomarker measure (13.6 %; n = 16). In patients without NT-proBNP data, the main reasons for exclusion were the diagnosis of symptomatic hypotension or a systolic blood pressure below 100 mmHg (7.5 %), having an eGFR < 20 ml/min/1.73 m2 (4.3 %), and haemoglobin < 9 g/dl (3.1 %). Excluding NT-proBNP criteria increased empagliflozin eligibility to 80.6 %.
Conclusion
Most patients with HFpEF from RECOLFACA are potential candidates for empagliflozin therapy initiation according to the EMPEROR-Preserved trial criteria. These findings favor the utilization of SGLT-2 inhibitor medications in daily medical practice, which may further decrease morbidity and mortality in HF patients, regardless of their EF classification.
{"title":"Eligibility of sodium-glucose cotransporter-2 inhibitors in heart failure with preserved ejection fraction: Insights from the Colombian heart failure registry (RECOLFACA)","authors":"Juan Esteban Gómez-Mesa , Clara Saldarriaga , Alex Arnulfo Rivera-Toquica , Silfredo Arrieta-González , Alfonso Muñoz-Velásquez , Eduardo José Echeverry-Navarrete , Julián Rodrigo Lugo-Peña , Juan Alberto Cerón , Oscar Sveins Rincón-Peña , Luis Eduardo Silva-Diazgranados , Hugo Ernesto Osorio-Carmona , Alejandro Posada-Bastidas , Juan Camilo García , Alejandro David Ochoa-Morón , Luis Eduardo Echeverría , RECOLFACA Investigators","doi":"10.1016/j.ijcha.2024.101448","DOIUrl":"https://doi.org/10.1016/j.ijcha.2024.101448","url":null,"abstract":"<div><h3>Background</h3><p>The value of Sodium-glucose cotransporter-2 inhibitors (SGLT-2 inhibitor) therapy in individuals with heart failure with preserved EF (HFpEF) was unknown until the EMPEROR-Preserved trial. We aimed to assess the proportion of patients with HFpEF that are eligible for empagliflozin therapy within the Colombian Heart Failure Registry (RECOLFACA).</p></div><div><h3>Methods</h3><p>RECOLFACA enrolled adult patients with a HF diagnosis during 2017–2019 from 60 medical centers in Colombia. Criteria of the EMPEROR-Preserved Trial were used to recruit participants. The main outcome was individual eligibility with N-terminal pro-B-type natriuretic peptide (NT-proBNP) criteria, while the secondary outcome was eligibility without NT-proBNP data.</p></div><div><h3>Results</h3><p>RECOLFACA had 799 patients with HFpEF (mean age70.7 ± 13.5; 50.7 % males). According to the major selection criteria of the EMPEROR Preserved Trial, 73.7 % patients would be eligible for empagliflozin therapy initiation when considering the NT-proBNP threshold. The NT-proBNP threshold represented the main determinant of ineligibility in patients with this biomarker measure (13.6 %; n = 16). In patients without NT-proBNP data, the main reasons for exclusion were the diagnosis of symptomatic hypotension or a systolic blood pressure below 100 mmHg (7.5 %), having an eGFR < 20 ml/min/1.73 m<sup>2</sup> (4.3 %), and haemoglobin < 9 g/dl (3.1 %). Excluding NT-proBNP criteria increased empagliflozin eligibility to 80.6 %.</p></div><div><h3>Conclusion</h3><p>Most patients with HFpEF from RECOLFACA are potential candidates for empagliflozin therapy initiation according to the EMPEROR-Preserved trial criteria. These findings favor the utilization of SGLT-2 inhibitor medications in daily medical practice, which may further decrease morbidity and mortality in HF patients, regardless of their EF classification.</p></div>","PeriodicalId":38026,"journal":{"name":"IJC Heart and Vasculature","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2352906724001143/pdfft?md5=91fed5ab34cf66160efe9559de31dc95&pid=1-s2.0-S2352906724001143-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141444338","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}