Yuling Yan, Yue Han, Bin Liu, J. Du, Jing Wang, X. Jing, Ya-jie Liu, Songbai Deng, Jianlin Du, Yingrui Li, Q. She
Objective: This study evaluated the optimal systolic blood pressure (SBP) target for older patients with hypertension. Method: A Bayesian network meta-analysis was conducted. The risk of bias of the included studies was assessed by using a modified version of the Cochrane risk of bias. The trial outcomes comprised the following clinical events: major adverse cardiovascular events (MACE), cardiovascular mortality, all-cause mortality, myocardial infarction, heart failure and stroke. Results: A total of six trials were included. We reclassified all treatment therapies into three conditions according to the final achieved SBP after intervention (<130 mmHg, 130–139 mmHg and ≥140 mmHg). Our results demonstrated that anti-hypertensive treatment with an SBP target <130 mmHg, compared with treatment with an SBP target ≥140 mmHg, significantly decreased the incidence of MACE (OR 0.43, 95%CI 0.19–0.76), but no statistical difference was found in other comparisons. Although the results showed a trend toward more intensive anti-hypertension therapy having better effects on preventing cardiovascular mortality, all-cause mortality, myocardial infarction, heart failure, and stroke, no significant differences were found among groups. Conclusions: Our meta-analysis suggested that SBP <130 mmHg might be the optimal BP control target for patients ≥60 years of age; however, further evidence is required to support our findings.
{"title":"Optimal Blood Pressure Control Target for Older Patients with Hypertension: A Systematic Review and Meta-Analysis","authors":"Yuling Yan, Yue Han, Bin Liu, J. Du, Jing Wang, X. Jing, Ya-jie Liu, Songbai Deng, Jianlin Du, Yingrui Li, Q. She","doi":"10.15212/cvia.2023.0008","DOIUrl":"https://doi.org/10.15212/cvia.2023.0008","url":null,"abstract":"\u0000Objective: This study evaluated the optimal systolic blood pressure (SBP) target for older patients with hypertension.\u0000\u0000Method: A Bayesian network meta-analysis was conducted. The risk of bias of the included studies was assessed by using a modified version of the Cochrane risk of bias. The trial outcomes comprised the following clinical events: major adverse cardiovascular events (MACE), cardiovascular mortality, all-cause mortality, myocardial infarction, heart failure and stroke.\u0000\u0000Results: A total of six trials were included. We reclassified all treatment therapies into three conditions according to the final achieved SBP after intervention (<130 mmHg, 130–139 mmHg and ≥140 mmHg). Our results demonstrated that anti-hypertensive treatment with an SBP target <130 mmHg, compared with treatment with an SBP target ≥140 mmHg, significantly decreased the incidence of MACE (OR 0.43, 95%CI 0.19–0.76), but no statistical difference was found in other comparisons. Although the results showed a trend toward more intensive anti-hypertension therapy having better effects on preventing cardiovascular mortality, all-cause mortality, myocardial infarction, heart failure, and stroke, no significant differences were found among groups.\u0000\u0000Conclusions: Our meta-analysis suggested that SBP <130 mmHg might be the optimal BP control target for patients ≥60 years of age; however, further evidence is required to support our findings.","PeriodicalId":41559,"journal":{"name":"Cardiovascular Innovations and Applications","volume":null,"pages":null},"PeriodicalIF":0.5,"publicationDate":"2023-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42120801","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Patients with persistent atrial fibrillation (PsAF) have a high risk of recurrence after catheter radiofrequency ablation. Nevertheless, no effective prognostic tools have been developed to identify these high-risk patients to date. This study sought to develop and validate a simple linear predictive model for predicting postoperative recurrence in patients with PsAF. Methods: From June 2013 to June 2021, patients with PsAF admitted to our hospital were enrolled in this single-center, retrospective, observational study. The characteristics substantially associated with recurrence in patients with PsAF were screened through univariate and multivariate logistic regression analysis. The receiver operating characteristic curve was used to assess the predictive significance of the nomogram model after nomogram development. Furthermore, to assess the clinical value of the nomogram, we performed calibration curve and decision curve analyses. Results: A total of 209 patients were included in the study, 42 (20.10%) of whom were monitored up to 1 year for recurrent AF. The duration of AF episodes, left atrial diameter, BMI, CKMB, and alcohol consumption were found to be independent risk factors (P<0.05) and were integrated into the nomogram model development. The area under the curve was 0.895, the sensitivity was 93.3%, and the specificity was 71.4%, thus indicating the model’s excellent predictive ability. The C-index of the predictive nomogram model was 0.906. Calibration curve and decision curve analyses further revealed that the model had robust prediction and strong discrimination ability. Conclusion: This simple, practical, and innovative nomogram can help clinicians in evaluation of the risk of PsAF recurrence after catheter ablation, thus facilitating preoperative evaluation, postoperative monitoring and ultimately the construction of more personalized therapeutic protocols.
{"title":"Development and Validation of a Postoperative Prognostic Nomogram to Predict Recurrence in Patients with Persistent Atrial Fibrillation: A Retrospective Cohort Study","authors":"Cong-Ying Deng, Ailin Zou, Ling Sun, Yuan Ji","doi":"10.15212/cvia.2023.0001","DOIUrl":"https://doi.org/10.15212/cvia.2023.0001","url":null,"abstract":"\u0000Background: Patients with persistent atrial fibrillation (PsAF) have a high risk of recurrence after catheter radiofrequency ablation. Nevertheless, no effective prognostic tools have been developed to identify these high-risk patients to date. This study sought to develop and validate a simple linear predictive model for predicting postoperative recurrence in patients with PsAF.\u0000\u0000Methods: From June 2013 to June 2021, patients with PsAF admitted to our hospital were enrolled in this single-center, retrospective, observational study. The characteristics substantially associated with recurrence in patients with PsAF were screened through univariate and multivariate logistic regression analysis. The receiver operating characteristic curve was used to assess the predictive significance of the nomogram model after nomogram development. Furthermore, to assess the clinical value of the nomogram, we performed calibration curve and decision curve analyses.\u0000\u0000Results: A total of 209 patients were included in the study, 42 (20.10%) of whom were monitored up to 1 year for recurrent AF. The duration of AF episodes, left atrial diameter, BMI, CKMB, and alcohol consumption were found to be independent risk factors (P<0.05) and were integrated into the nomogram model development. The area under the curve was 0.895, the sensitivity was 93.3%, and the specificity was 71.4%, thus indicating the model’s excellent predictive ability. The C-index of the predictive nomogram model was 0.906. Calibration curve and decision curve analyses further revealed that the model had robust prediction and strong discrimination ability.\u0000\u0000Conclusion: This simple, practical, and innovative nomogram can help clinicians in evaluation of the risk of PsAF recurrence after catheter ablation, thus facilitating preoperative evaluation, postoperative monitoring and ultimately the construction of more personalized therapeutic protocols.","PeriodicalId":41559,"journal":{"name":"Cardiovascular Innovations and Applications","volume":null,"pages":null},"PeriodicalIF":0.5,"publicationDate":"2023-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42709799","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Jong Kun Park, I. Vavilin, Jacob Zaemes, Araba Ofosu-Somuah, Raghav Gattani, C. Sahebi, A. Truesdell
Background: Spontaneous heparin-induced thrombocytopenia is a pro-thrombotic syndrome in which anti-heparin antibodies develop without heparin exposure. Case presentation: A 78-year-old man who underwent a successful lumbar laminectomy presented to the hospital 5 days after discharge for stroke-like symptoms and was found to have acute infarcts of the bilateral frontal lobes. The patient was found to be severely thrombocytopenic and was incidentally found to have an inferior wall myocardial infarction. Further investigation led to the diagnosis of bilateral lower extremity deep vein thromboses. His overall clinical presentation prompted a detailed hematologic workup that indicated positivity for heparin-induced thrombocytopenia despite no previous exposure to heparin products. Conclusions: This case illustrates a patient with no prior lifetime heparin exposure who underwent laminectomy with subsequent development of acute infarcts of the bilateral frontal lobes, an inferior wall myocardial infarction, and bilateral lower extremity deep vein thromboses, with concern for sequelae of spontaneous heparin-induced thrombocytopenia.
{"title":"Spontaneous Heparin-Induced Thrombocytopenia Presenting as Concomitant Bilateral Cerebrovascular Infarction and Acute Coronary Syndrome","authors":"Jong Kun Park, I. Vavilin, Jacob Zaemes, Araba Ofosu-Somuah, Raghav Gattani, C. Sahebi, A. Truesdell","doi":"10.15212/cvia.2023.0007","DOIUrl":"https://doi.org/10.15212/cvia.2023.0007","url":null,"abstract":"\u0000Background: Spontaneous heparin-induced thrombocytopenia is a pro-thrombotic syndrome in which anti-heparin antibodies develop without heparin exposure.\u0000\u0000Case presentation: A 78-year-old man who underwent a successful lumbar laminectomy presented to the hospital 5 days after discharge for stroke-like symptoms and was found to have acute infarcts of the bilateral frontal lobes. The patient was found to be severely thrombocytopenic and was incidentally found to have an inferior wall myocardial infarction. Further investigation led to the diagnosis of bilateral lower extremity deep vein thromboses. His overall clinical presentation prompted a detailed hematologic workup that indicated positivity for heparin-induced thrombocytopenia despite no previous exposure to heparin products.\u0000\u0000Conclusions: This case illustrates a patient with no prior lifetime heparin exposure who underwent laminectomy with subsequent development of acute infarcts of the bilateral frontal lobes, an inferior wall myocardial infarction, and bilateral lower extremity deep vein thromboses, with concern for sequelae of spontaneous heparin-induced thrombocytopenia.","PeriodicalId":41559,"journal":{"name":"Cardiovascular Innovations and Applications","volume":null,"pages":null},"PeriodicalIF":0.5,"publicationDate":"2023-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49169168","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Cardiac surgery-associated acute kidney injury (CSA-AKI) is a major complication that increases morbidity and mortality after cardiac surgery. Most established predictive models are limited to the analysis of nonlinear relationships and do not adequately consider intraoperative variables and early postoperative variables. Nonextracorporeal circulation coronary artery bypass grafting (off-pump CABG) remains the procedure of choice for most coronary surgeries, and refined CSA-AKI predictive models for off-pump CABG are notably lacking. Therefore, this study used an artificial intelligence-based machine learning approach to predict CSA-AKI from comprehensive perioperative data. Methods: In total, 293 variables were analysed in the clinical data of patients undergoing off-pump CABG in the Department of Cardiac Surgery at the First Affiliated Hospital of Guangxi Medical University between 2012 and 2021. According to the KDIGO criteria, postoperative AKI was defined by an elevation of at least 50% within 7 days, or 0.3 mg/dL within 48 hours, with respect to the reference serum creatinine level. Five machine learning algorithms—a simple decision tree, random forest, support vector machine, extreme gradient boosting and gradient boosting decision tree (GBDT)—were used to construct the CSA-AKI predictive model. The performance of these models was evaluated with the area under the receiver operating characteristic curve (AUC). Shapley additive explanation (SHAP) values were used to explain the predictive model. Results: The three most influential features in the importance matrix plot were 1-day postoperative serum potassium concentration, 1-day postoperative serum magnesium ion concentration, and 1-day postoperative serum creatine phosphokinase concentration. Conclusion: GBDT exhibited the largest AUC (0.87) and can be used to predict the risk of AKI development after surgery, thus enabling clinicians to optimise treatment strategies and minimise postoperative complications.
{"title":"Machine Learning for Predicting the Development of Postoperative Acute Kidney Injury After Coronary Artery Bypass Grafting Without Extracorporeal Circulation","authors":"Sai Zheng, Yugui Li, Cheng Luo, Fang Chen, Guoxing Ling, Baoshi Zheng","doi":"10.15212/cvia.2023.0006","DOIUrl":"https://doi.org/10.15212/cvia.2023.0006","url":null,"abstract":"\u0000Background: Cardiac surgery-associated acute kidney injury (CSA-AKI) is a major complication that increases morbidity and mortality after cardiac surgery. Most established predictive models are limited to the analysis of nonlinear relationships and do not adequately consider intraoperative variables and early postoperative variables. Nonextracorporeal circulation coronary artery bypass grafting (off-pump CABG) remains the procedure of choice for most coronary surgeries, and refined CSA-AKI predictive models for off-pump CABG are notably lacking. Therefore, this study used an artificial intelligence-based machine learning approach to predict CSA-AKI from comprehensive perioperative data.\u0000\u0000Methods: In total, 293 variables were analysed in the clinical data of patients undergoing off-pump CABG in the Department of Cardiac Surgery at the First Affiliated Hospital of Guangxi Medical University between 2012 and 2021. According to the KDIGO criteria, postoperative AKI was defined by an elevation of at least 50% within 7 days, or 0.3 mg/dL within 48 hours, with respect to the reference serum creatinine level. Five machine learning algorithms—a simple decision tree, random forest, support vector machine, extreme gradient boosting and gradient boosting decision tree (GBDT)—were used to construct the CSA-AKI predictive model. The performance of these models was evaluated with the area under the receiver operating characteristic curve (AUC). Shapley additive explanation (SHAP) values were used to explain the predictive model.\u0000\u0000Results: The three most influential features in the importance matrix plot were 1-day postoperative serum potassium concentration, 1-day postoperative serum magnesium ion concentration, and 1-day postoperative serum creatine phosphokinase concentration.\u0000\u0000Conclusion: GBDT exhibited the largest AUC (0.87) and can be used to predict the risk of AKI development after surgery, thus enabling clinicians to optimise treatment strategies and minimise postoperative complications.","PeriodicalId":41559,"journal":{"name":"Cardiovascular Innovations and Applications","volume":null,"pages":null},"PeriodicalIF":0.5,"publicationDate":"2023-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47538277","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Bo Jia, Cheng Luo, Chengnan Li, Y. Ge, Yongliang Zhong, Z. Qiao, Haiou Hu, Suwei Chen, Junming Zhu
Introduction: Acute type A aortic dissection (ATAAD) is a catastrophic disease with fatal outcomes. Malperfusion syndrome (MPS) is a serious complication of ATAAD, with an incidence of 20–40%. Many studies have shown that MPS is the main risk factor for poor ATAAD prognosis. However, a risk scoring system for ATAAD based on MPS is lacking. Here, we designed a risk scoring system for ATAAD to assess mortality through quantitative assessment of relevant organ malperfusion and subsequently develop rational treatment strategies. Methods and analysis: This was a prospective observational study. Patients’ perioperative clinical data were collected to establish a database of ATAAD (N≥3000) and determine whether these patients had malperfusion complications. The Anzhen risk scoring system was established on the basis of organ malperfusion by using a random forest survival model and a logistics model. The better method was then chosen to establish a revised risk scoring system. Ethics and dissemination: This study received ethical approval from the Ethics Committees of Beijing Anzhen Hospital, Capital Medical University (KS2019034-1). Patient consent was waived because biological samples were not collected, and no patient rights were violated. Findings will be disseminated at scientific conferences and in peer-reviewed publications.
{"title":"The Anzhen Risk Scoring System for Acute Type A Aortic Dissection: A Prospective Observational Study Protocol","authors":"Bo Jia, Cheng Luo, Chengnan Li, Y. Ge, Yongliang Zhong, Z. Qiao, Haiou Hu, Suwei Chen, Junming Zhu","doi":"10.15212/cvia.2023.0002","DOIUrl":"https://doi.org/10.15212/cvia.2023.0002","url":null,"abstract":"\u0000Introduction: Acute type A aortic dissection (ATAAD) is a catastrophic disease with fatal outcomes. Malperfusion syndrome (MPS) is a serious complication of ATAAD, with an incidence of 20–40%. Many studies have shown that MPS is the main risk factor for poor ATAAD prognosis. However, a risk scoring system for ATAAD based on MPS is lacking. Here, we designed a risk scoring system for ATAAD to assess mortality through quantitative assessment of relevant organ malperfusion and subsequently develop rational treatment strategies.\u0000\u0000Methods and analysis: This was a prospective observational study. Patients’ perioperative clinical data were collected to establish a database of ATAAD (N≥3000) and determine whether these patients had malperfusion complications. The Anzhen risk scoring system was established on the basis of organ malperfusion by using a random forest survival model and a logistics model. The better method was then chosen to establish a revised risk scoring system.\u0000\u0000Ethics and dissemination: This study received ethical approval from the Ethics Committees of Beijing Anzhen Hospital, Capital Medical University (KS2019034-1). Patient consent was waived because biological samples were not collected, and no patient rights were violated. Findings will be disseminated at scientific conferences and in peer-reviewed publications.","PeriodicalId":41559,"journal":{"name":"Cardiovascular Innovations and Applications","volume":null,"pages":null},"PeriodicalIF":0.5,"publicationDate":"2023-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47776710","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Jiaqi Wang, Feifei Zhang, Man Gao, Yudan Wang, Xuelian Song, Yingxiao Li, Y. Dang, X. Qi
Purpose: Coronary no-reflow phenomenon (NRP), a common adverse complication in patients with ST-segment elevation myocardial infarction (STEMI) treated by percutaneous coronary intervention (PCI), is associated with poor patient prognosis. In this study, the correlation between the systemic immune-inflammation index (SII) and NRP in older patients with STEMI was studied, to provide a basis for early identification of high-risk patients and improve their prognosis. Materials and methods: Between January 2017 and June 2020, 578 older patients with acute STEMI admitted to the Department of Cardiology of Hebei General Hospital for direct PCI treatment were selected for this retrospective study. Patients were divided into an NRP group and normal-flow group according to whether NRP occurred during the operation. Clinical data and the examination indexes of the two groups were collected. Logistic regression was used to analyze the independent predictors of NRP, and the receiver operating characteristic curve was used to further analyze the ability of SII to predict NRP in older patients with STEMI. Results: Multivariate logistic analysis indicated that hypertension (OR=2.048, 95% CI:1.252–3.352, P=0.004), lymphocyte count (OR=0.571, 95% CI:0.368–0.885, P=0.012), platelet count (OR=1.009, 95% CI:1.005–1.013, P<0.001), hemoglobin (OR=1.015, 95% CI:1.003–1.028, P=0.018), multivessel disease (OR=2.237, 95% CI:1.407–3.558, P=0.001), and SII≥1814 (OR=3.799, 95% CI:2.190–6.593, P<0.001) were independent predictors of NRP after primary PCI in older patients with STEMI. Receiver operating characteristic curve analysis demonstrated that SII had a high predictive value for NRP (AUC=0.738; 95% CI:0.686–0.790), with the best cut-off value of 1814, a sensitivity of 52.85% and a specificity of 85.71%. Conclusion: For older patients with STEMI undergoing primary PCI, SII is a valid predictor of NRP.
{"title":"The Systemic Immune Inflammatory Index Predicts No-Reflow Phenomenon after Primary Percutaneous Coronary Intervention in Older Patients with STEMI","authors":"Jiaqi Wang, Feifei Zhang, Man Gao, Yudan Wang, Xuelian Song, Yingxiao Li, Y. Dang, X. Qi","doi":"10.15212/cvia.2023.0005","DOIUrl":"https://doi.org/10.15212/cvia.2023.0005","url":null,"abstract":"\u0000Purpose: Coronary no-reflow phenomenon (NRP), a common adverse complication in patients with ST-segment elevation myocardial infarction (STEMI) treated by percutaneous coronary intervention (PCI), is associated with poor patient prognosis. In this study, the correlation between the systemic immune-inflammation index (SII) and NRP in older patients with STEMI was studied, to provide a basis for early identification of high-risk patients and improve their prognosis.\u0000\u0000Materials and methods: Between January 2017 and June 2020, 578 older patients with acute STEMI admitted to the Department of Cardiology of Hebei General Hospital for direct PCI treatment were selected for this retrospective study. Patients were divided into an NRP group and normal-flow group according to whether NRP occurred during the operation. Clinical data and the examination indexes of the two groups were collected. Logistic regression was used to analyze the independent predictors of NRP, and the receiver operating characteristic curve was used to further analyze the ability of SII to predict NRP in older patients with STEMI.\u0000\u0000Results: Multivariate logistic analysis indicated that hypertension (OR=2.048, 95% CI:1.252–3.352, P=0.004), lymphocyte count (OR=0.571, 95% CI:0.368–0.885, P=0.012), platelet count (OR=1.009, 95% CI:1.005–1.013, P<0.001), hemoglobin (OR=1.015, 95% CI:1.003–1.028, P=0.018), multivessel disease (OR=2.237, 95% CI:1.407–3.558, P=0.001), and SII≥1814 (OR=3.799, 95% CI:2.190–6.593, P<0.001) were independent predictors of NRP after primary PCI in older patients with STEMI. Receiver operating characteristic curve analysis demonstrated that SII had a high predictive value for NRP (AUC=0.738; 95% CI:0.686–0.790), with the best cut-off value of 1814, a sensitivity of 52.85% and a specificity of 85.71%.\u0000\u0000Conclusion: For older patients with STEMI undergoing primary PCI, SII is a valid predictor of NRP.","PeriodicalId":41559,"journal":{"name":"Cardiovascular Innovations and Applications","volume":null,"pages":null},"PeriodicalIF":0.5,"publicationDate":"2023-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45142607","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Objectives: According to the findings of randomized controlled trials, blood lipid levels in patients with coronary heart disease (CHD) can be significantly decreased through a combination of pitavastatin and ezetimibe; however, the effects and clinical applications of this treatment remain controversial. This meta-analysis was aimed at objectively assessing the efficacy and safety of pitavastatin and ezetimibe in lowering blood lipid levels. Design: Relevant studies were retrieved from electronic databases, including PubMed, Cochrane Library, Embase, China National Knowledge Infrastructure, VIP, and WanFang Data, from database inception to June 8, 2022. The levels of low-density lipoprotein cholesterol, total cholesterol, triglycerides, and high-density lipoprotein cholesterol in patients’ serum after treatment were the primary endpoint. Results: Nine randomized controlled trials (2586 patients) met the inclusion criteria. The meta-analysis indicated that pitavastatin plus ezetimibe resulted in significantly lower levels of LDL-C [standardized mean difference (SMD)=−0.86, 95% confidence interval (CI) (−1.15 to −0.58), P<0.01], TC [SMD=−0.84, 95% CI (−1.10 to −0.59), P<0.01], and TG [SMD=−0.59, 95% CI (−0.89 to −0.28), P<0.01] than pitavastatin alone. Conclusions: Pitavastatin plus ezetimibe significantly decreased serum LDL-C, TC, and TG levels in patients with CHD.
{"title":"Lowering of Blood Lipid Levels with a Combination of Pitavastatin and Ezetimibe in Patients with Coronary Heart Disease: A Meta-Analysis","authors":"Ru-Ping Cai, Chen Chang, Xingjie Zhong, Q. Su","doi":"10.15212/cvia.2023.0004","DOIUrl":"https://doi.org/10.15212/cvia.2023.0004","url":null,"abstract":"\u0000Objectives: According to the findings of randomized controlled trials, blood lipid levels in patients with coronary heart disease (CHD) can be significantly decreased through a combination of pitavastatin and ezetimibe; however, the effects and clinical applications of this treatment remain controversial. This meta-analysis was aimed at objectively assessing the efficacy and safety of pitavastatin and ezetimibe in lowering blood lipid levels.\u0000\u0000Design: Relevant studies were retrieved from electronic databases, including PubMed, Cochrane Library, Embase, China National Knowledge Infrastructure, VIP, and WanFang Data, from database inception to June 8, 2022. The levels of low-density lipoprotein cholesterol, total cholesterol, triglycerides, and high-density lipoprotein cholesterol in patients’ serum after treatment were the primary endpoint.\u0000\u0000Results: Nine randomized controlled trials (2586 patients) met the inclusion criteria. The meta-analysis indicated that pitavastatin plus ezetimibe resulted in significantly lower levels of LDL-C [standardized mean difference (SMD)=−0.86, 95% confidence interval (CI) (−1.15 to −0.58), P<0.01], TC [SMD=−0.84, 95% CI (−1.10 to −0.59), P<0.01], and TG [SMD=−0.59, 95% CI (−0.89 to −0.28), P<0.01] than pitavastatin alone.\u0000\u0000Conclusions: Pitavastatin plus ezetimibe significantly decreased serum LDL-C, TC, and TG levels in patients with CHD.","PeriodicalId":41559,"journal":{"name":"Cardiovascular Innovations and Applications","volume":null,"pages":null},"PeriodicalIF":0.5,"publicationDate":"2023-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45256415","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pan-Guo Zhao, Yi-Xiong Huang, Li-Ping Xiao, Jing Cui, Dong-Tao Li, Yi Cao, Jiang-chun He, Yong Xu, Jun Guo, Hao Xue, Yu Chen, Tian-Chang Li
Aim: Intracoronary murmur results from turbulent flow due to coronary artery narrowing. This study evaluated the diagnostic performance of a method for acoustic analysis of turbulent murmur caused by coronary artery stenosis in coronary artery disease (CAD) in Chinese populations. Method: Patients admitted to the cardiovascular department of the Sixth Medical Center of the Chinese People’s Liberation Army General Hospital between September 2021 and June 2022 for elective coronary angiography were prospectively enrolled. A digital electronic stethoscope was used to record heart sounds before angiography. Quantitative coronary angiography (QCA) served as the “gold standard” for CAD diagnosis to evaluate the diagnostic performance of the acoustic analysis method for CAD. Results: A total of 452 patients had complete QCA and heart sound data. The final interpretation results of the acoustic analysis method indicated 310 disease cases and 142 normal results. Increasing the cut-off values of coronary artery diameter stenosis from 30% to 50%, 70%, and 90% increased the sensitivity and NPV of the acoustic analysis method; the sensitivity was 75.6%, 81.9%, 83.3%, and 85.7%, respectively; the NPV was 33.1%, 57.0%, 69.7%, and 88.0%, respectively; the specificity and PPV decreased (specificity of 75.8%, 70.4%, 51.0%, and 37.5%, respectively; PPV of 95.2%, 89.0%, 69.4%, and 32.9%, respectively); and the AUC values were 0.757, 0.762, 0.672, and 0.616, respectively. The sensitivity of the acoustic analysis method for one-vessel disease was 86.6% when the cut-off value was 50%. The sensitivity for identifying left anterior descending coronary artery lesions was best, at 90.7%. The sensitivity for identifying isolated coronary artery branch lesions was 66.7%, whereas the sensitivity for identifying three-vessel disease in multi-vessel coronary artery lesions was better, at 82.9%. Conclusion: Acoustic analysis of turbulent murmur caused by coronary artery stenosis for diagnosis of CAD may have favorable performance in the Chinese population. This method has good performance in CAD diagnosis with a cut-off coronary artery diameter for stenosis of 50%.
{"title":"Diagnosis of Coronary Artery Disease by Acoustic Analysis of Turbulent Murmur Caused by Coronary Artery Stenosis: A Single Center Study from China","authors":"Pan-Guo Zhao, Yi-Xiong Huang, Li-Ping Xiao, Jing Cui, Dong-Tao Li, Yi Cao, Jiang-chun He, Yong Xu, Jun Guo, Hao Xue, Yu Chen, Tian-Chang Li","doi":"10.15212/cvia.2022.0023","DOIUrl":"https://doi.org/10.15212/cvia.2022.0023","url":null,"abstract":"\u0000Aim: Intracoronary murmur results from turbulent flow due to coronary artery narrowing. This study evaluated the diagnostic performance of a method for acoustic analysis of turbulent murmur caused by coronary artery stenosis in coronary artery disease (CAD) in Chinese populations.\u0000\u0000Method: Patients admitted to the cardiovascular department of the Sixth Medical Center of the Chinese People’s Liberation Army General Hospital between September 2021 and June 2022 for elective coronary angiography were prospectively enrolled. A digital electronic stethoscope was used to record heart sounds before angiography. Quantitative coronary angiography (QCA) served as the “gold standard” for CAD diagnosis to evaluate the diagnostic performance of the acoustic analysis method for CAD.\u0000\u0000Results: A total of 452 patients had complete QCA and heart sound data. The final interpretation results of the acoustic analysis method indicated 310 disease cases and 142 normal results. Increasing the cut-off values of coronary artery diameter stenosis from 30% to 50%, 70%, and 90% increased the sensitivity and NPV of the acoustic analysis method; the sensitivity was 75.6%, 81.9%, 83.3%, and 85.7%, respectively; the NPV was 33.1%, 57.0%, 69.7%, and 88.0%, respectively; the specificity and PPV decreased (specificity of 75.8%, 70.4%, 51.0%, and 37.5%, respectively; PPV of 95.2%, 89.0%, 69.4%, and 32.9%, respectively); and the AUC values were 0.757, 0.762, 0.672, and 0.616, respectively. The sensitivity of the acoustic analysis method for one-vessel disease was 86.6% when the cut-off value was 50%. The sensitivity for identifying left anterior descending coronary artery lesions was best, at 90.7%. The sensitivity for identifying isolated coronary artery branch lesions was 66.7%, whereas the sensitivity for identifying three-vessel disease in multi-vessel coronary artery lesions was better, at 82.9%.\u0000\u0000Conclusion: Acoustic analysis of turbulent murmur caused by coronary artery stenosis for diagnosis of CAD may have favorable performance in the Chinese population. This method has good performance in CAD diagnosis with a cut-off coronary artery diameter for stenosis of 50%.","PeriodicalId":41559,"journal":{"name":"Cardiovascular Innovations and Applications","volume":null,"pages":null},"PeriodicalIF":0.5,"publicationDate":"2023-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47031255","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sai Ma, Lili He, Qingjuan Zuo, Guo-rui Zhang, Yifang Guo
Aims: Sodium-glucose cotransporter-2 (SGLT2) inhibitors have been found to ameliorate major adverse cardiovascular events in patients with heart failure with preserved ejection fraction (HFpEF), but the exact mechanism is unknown. Ferroptosis is a form of programmed necrosis. Herein, we verified that canagliflozin (CANA) ameliorates heart function in HFpEF rats, partly by regulating ferroptosis, which may be activated by AMPK/PGC-1α/Nrf2 signaling. Methods: An HFpEF model was established and subjected to CANA treatment. Blood pressure was monitored, and echocardiography was performed at the 12th week. Pathological examination was performed, and expression of ferroptosis-associated proteins and AMPK/PGC-1α/Nrf2 signaling related proteins was detected. Results: CANA had an antihypertensive effect and increased E/A ratios in HFpEF rats. Myocardial pathology was ameliorated, on the basis of decreased cross-sectional area and intercellular fibrosis. Acyl-CoA synthetase long-chain family member 4 (ACSL4) expression increased, whereas ferritin heavy chain 1 (FTH1) expression decreased in HFpEF rats, which showed iron overload. CANA reversed changes in ACSL4 and FTH1, and decreased iron accumulation, but did not alter glutathione peroxidase 4 (GPX4) expression. The expression of AMPK/PGC-1α/Nrf2 signaling related proteins and heme oxygenase 1 (HO-1) in the HFpEF group decreased but was reverted after CANA treatment. Conclusions: CANA regulates ferroptosis, potentially via activating AMPK/PGC-1α/Nrf2 signaling in HFpEF rats.
{"title":"Canagliflozin Regulates Ferroptosis, Potentially via Activating AMPK/PGC-1α/Nrf2 Signaling in HFpEF Rats","authors":"Sai Ma, Lili He, Qingjuan Zuo, Guo-rui Zhang, Yifang Guo","doi":"10.15212/cvia.2022.0024","DOIUrl":"https://doi.org/10.15212/cvia.2022.0024","url":null,"abstract":"\u0000Aims: Sodium-glucose cotransporter-2 (SGLT2) inhibitors have been found to ameliorate major adverse cardiovascular events in patients with heart failure with preserved ejection fraction (HFpEF), but the exact mechanism is unknown. Ferroptosis is a form of programmed necrosis. Herein, we verified that canagliflozin (CANA) ameliorates heart function in HFpEF rats, partly by regulating ferroptosis, which may be activated by AMPK/PGC-1α/Nrf2 signaling.\u0000\u0000Methods: An HFpEF model was established and subjected to CANA treatment. Blood pressure was monitored, and echocardiography was performed at the 12th week. Pathological examination was performed, and expression of ferroptosis-associated proteins and AMPK/PGC-1α/Nrf2 signaling related proteins was detected.\u0000\u0000Results: CANA had an antihypertensive effect and increased E/A ratios in HFpEF rats. Myocardial pathology was ameliorated, on the basis of decreased cross-sectional area and intercellular fibrosis. Acyl-CoA synthetase long-chain family member 4 (ACSL4) expression increased, whereas ferritin heavy chain 1 (FTH1) expression decreased in HFpEF rats, which showed iron overload. CANA reversed changes in ACSL4 and FTH1, and decreased iron accumulation, but did not alter glutathione peroxidase 4 (GPX4) expression. The expression of AMPK/PGC-1α/Nrf2 signaling related proteins and heme oxygenase 1 (HO-1) in the HFpEF group decreased but was reverted after CANA treatment.\u0000\u0000Conclusions: CANA regulates ferroptosis, potentially via activating AMPK/PGC-1α/Nrf2 signaling in HFpEF rats.","PeriodicalId":41559,"journal":{"name":"Cardiovascular Innovations and Applications","volume":null,"pages":null},"PeriodicalIF":0.5,"publicationDate":"2023-01-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44549712","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Atrial fibrillation (AF), the most common sustained cardiac arrhythmia, is increasing in incidence and prevalence worldwide. AF significantly increases the risk of intracardiac thrombus formation and, if left untreated, ischemic stroke. In patients with nonvalvular AF (NVAF), the left atrial appendage (LAA) has been determined to be the source of thrombus development in 91% to 99% of cases. In this regard, oral anticoagulants (OACs) have become the standard treatment for stroke prevention in most patients with AF; however, OACs are associated with a risk of bleeding complications, and their efficacy depends on optimal patient compliance. Among alternative approaches to embolic stroke prevention, surgical LAA excision for stroke prevention for valvular AF was attempted as early as the late 1940s. LAA excision remains recommended in surgical guidelines for patients with NVAF requiring open-heart coronary bypass or valvular replacement/repair surgeries. However, owing to the traumatic/invasive nature and suboptimal outcomes of conventional surgical LAA intervention, clinical application of this approach is limited in current cardiology practice. Percutaneous LAA occlusion (LAAO) is increasingly being performed as an alternative to OAC for stroke prevention, particularly in patients with elevated bleeding risk. Substantial progress has been made in percutaneous LAAO therapy since its inception approximately 20 years ago. This article systematically reviews the literature leading to the development of LAAO and the evidence-based clinical experience supporting the application of this treatment strategy for NVAF, with a focus on recently published critical evaluations of US FDA and CE mark approved LAAO devices. Future perspectives regarding knowledge and technology gaps are also discussed, recognizing the many ongoing clinical trials that are likely to be transformative and the critical unanswered questions regarding LAAO therapy.
{"title":"Percutaneous Left Atrial Appendage Occlusion Therapy: Past, Present, and Future","authors":"Xinqiang Han, Jianzeng Dong, D. Benditt","doi":"10.15212/cvia.2023.0026","DOIUrl":"https://doi.org/10.15212/cvia.2023.0026","url":null,"abstract":"Atrial fibrillation (AF), the most common sustained cardiac arrhythmia, is increasing in incidence and prevalence worldwide. AF significantly increases the risk of intracardiac thrombus formation and, if left untreated, ischemic stroke. In patients with nonvalvular AF (NVAF), the left atrial appendage (LAA) has been determined to be the source of thrombus development in 91% to 99% of cases. In this regard, oral anticoagulants (OACs) have become the standard treatment for stroke prevention in most patients with AF; however, OACs are associated with a risk of bleeding complications, and their efficacy depends on optimal patient compliance. Among alternative approaches to embolic stroke prevention, surgical LAA excision for stroke prevention for valvular AF was attempted as early as the late 1940s. LAA excision remains recommended in surgical guidelines for patients with NVAF requiring open-heart coronary bypass or valvular replacement/repair surgeries. However, owing to the traumatic/invasive nature and suboptimal outcomes of conventional surgical LAA intervention, clinical application of this approach is limited in current cardiology practice. Percutaneous LAA occlusion (LAAO) is increasingly being performed as an alternative to OAC for stroke prevention, particularly in patients with elevated bleeding risk. Substantial progress has been made in percutaneous LAAO therapy since its inception approximately 20 years ago. This article systematically reviews the literature leading to the development of LAAO and the evidence-based clinical experience supporting the application of this treatment strategy for NVAF, with a focus on recently published critical evaluations of US FDA and CE mark approved LAAO devices. Future perspectives regarding knowledge and technology gaps are also discussed, recognizing the many ongoing clinical trials that are likely to be transformative and the critical unanswered questions regarding LAAO therapy.","PeriodicalId":41559,"journal":{"name":"Cardiovascular Innovations and Applications","volume":null,"pages":null},"PeriodicalIF":0.5,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67306357","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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