Qiao Guo, Weilong Hong, Jie Chen, Xiwen Zhu, Guangyou Duan, He Huang, Chenyang Duan
Objective: Patients receiving intensive care often have diabetes mellitus (DM) together with chronic heart failure (CHF). In these patients, the use of metformin in intensive care is controversial. This study was aimed at assessing the mortality rates of patients with DM and CHF treated with metformin. Methods: The Medical Information Mart for Intensive Care database was used to identify patients with type 2 diabetes mellitus (T2DM) and CHF. A 90-day mortality comparison was conducted between patients who were and were not administered metformin. Propensity score matching analysis and multivariable Cox proportional hazard regression were used to ensure the robustness of our results. Results: A total of 2153 patients (180 receiving metformin and 1973 not receiving metformin) with T2DM and CHF were included in the study. The 90-day mortality rates were 30.5% (601/1971) and 5.5% (10/182) in the non-metformin and metformin groups, respectively. In the propensity score matching analyses, metformin use was associated with a 71% lower 90-day mortality (hazard ratio, 0.29; 95% confidence interval, 0.14–0.59; P < 0.001). The results were insensitive to change when sensitivity analyses were performed. Conclusion: Metformin treatment may decrease the mortality risk in critically ill patients with T2DM and CHF in the intensive care unit.
{"title":"Metformin Treatment is Associated with Mortality in Patients with Type 2 Diabetes and Chronic Heart Failure in the Intensive Care Unit: A Retrospective Cohort Study","authors":"Qiao Guo, Weilong Hong, Jie Chen, Xiwen Zhu, Guangyou Duan, He Huang, Chenyang Duan","doi":"10.15212/cvia.2023.0042","DOIUrl":"https://doi.org/10.15212/cvia.2023.0042","url":null,"abstract":"Objective: Patients receiving intensive care often have diabetes mellitus (DM) together with chronic heart failure (CHF). In these patients, the use of metformin in intensive care is controversial. This study was aimed at assessing the mortality rates of patients with DM and CHF treated with metformin. Methods: The Medical Information Mart for Intensive Care database was used to identify patients with type 2 diabetes mellitus (T2DM) and CHF. A 90-day mortality comparison was conducted between patients who were and were not administered metformin. Propensity score matching analysis and multivariable Cox proportional hazard regression were used to ensure the robustness of our results. Results: A total of 2153 patients (180 receiving metformin and 1973 not receiving metformin) with T2DM and CHF were included in the study. The 90-day mortality rates were 30.5% (601/1971) and 5.5% (10/182) in the non-metformin and metformin groups, respectively. In the propensity score matching analyses, metformin use was associated with a 71% lower 90-day mortality (hazard ratio, 0.29; 95% confidence interval, 0.14–0.59; P < 0.001). The results were insensitive to change when sensitivity analyses were performed. Conclusion: Metformin treatment may decrease the mortality risk in critically ill patients with T2DM and CHF in the intensive care unit.","PeriodicalId":41559,"journal":{"name":"Cardiovascular Innovations and Applications","volume":"1 1","pages":""},"PeriodicalIF":0.5,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67306926","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}
The Chinese Heart Journal published the “Chinese Expert Guidelines for the Prevention of Stroke Associated with Patent Foramen Ovale” (hereafter referred to as “the Guidelines”) in 2021. The Guidelines were initiated by Professor Yushun Zhang of the No.1 Affiliated Hospital of Xi’an Jiaotong University, and 55 domestic experts participated in their discussion and formulation. The Guidelines focus on eight key issues in the prevention of stroke associated with patent foramen ovale (PFO), including definition and epidemiology, anatomical features, ultrasound diagnosis, clinical screening, and prevention and treatment of PFO-associated stroke. The prevention and treatment of PFO-associated stroke include pharmacological prevention, prevention of PFO with transcatheter occlusion and transcatheter occlusion of PFO. Patients with PFO are at elevated risk of perioperative stroke. In China, lung cancer ranks first in incidence among malignant tumors. The number of lung cancer surgeries is increasing each year, and the incidence of PFO in the population is approximately 25%. Although perioperative stroke in patients with lung cancer due to the presence of PFO has rarely been reported, given the high disability rate of stroke, incidence of PFO, and incidence of lung cancer, herein, we consider the Guidelines for the management of perioperative stroke in lung cancer. Our aim is to provide further perspectives in decreasing the risk of perioperative stroke in patients with lung cancer and PFO, to improve their quality of life and increase the safety of surgery.
{"title":"Re-conceptualization of the “Chinese Expert Guidelines for the Prevention of Stroke Associated with Patent Foramen Ovale” for the Management of Perioperative Stroke in Patients with Lung Cancer","authors":"Zhen Chen, Ying Liu, Qibin Song, H. Zou","doi":"10.15212/cvia.2023.0035","DOIUrl":"https://doi.org/10.15212/cvia.2023.0035","url":null,"abstract":"The Chinese Heart Journal published the “Chinese Expert Guidelines for the Prevention of Stroke Associated with Patent Foramen Ovale” (hereafter referred to as “the Guidelines”) in 2021. The Guidelines were initiated by Professor Yushun Zhang of the No.1 Affiliated Hospital of Xi’an Jiaotong University, and 55 domestic experts participated in their discussion and formulation. The Guidelines focus on eight key issues in the prevention of stroke associated with patent foramen ovale (PFO), including definition and epidemiology, anatomical features, ultrasound diagnosis, clinical screening, and prevention and treatment of PFO-associated stroke. The prevention and treatment of PFO-associated stroke include pharmacological prevention, prevention of PFO with transcatheter occlusion and transcatheter occlusion of PFO. Patients with PFO are at elevated risk of perioperative stroke. In China, lung cancer ranks first in incidence among malignant tumors. The number of lung cancer surgeries is increasing each year, and the incidence of PFO in the population is approximately 25%. Although perioperative stroke in patients with lung cancer due to the presence of PFO has rarely been reported, given the high disability rate of stroke, incidence of PFO, and incidence of lung cancer, herein, we consider the Guidelines for the management of perioperative stroke in lung cancer. Our aim is to provide further perspectives in decreasing the risk of perioperative stroke in patients with lung cancer and PFO, to improve their quality of life and increase the safety of surgery.","PeriodicalId":41559,"journal":{"name":"Cardiovascular Innovations and Applications","volume":"1 1","pages":""},"PeriodicalIF":0.5,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67306642","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: Heart failure (HF) is generally associated with poor quality of life (QoL). Limited data are available characterizing health-related QoL (HRQL) in Chinese patients with HF. Methods: We used the Minnesota Living with Heart Failure Questionnaire (MLHFQ) to record QoL in 4082 patients with HF from China who were followed up over 12 months in the Heart Failure Registry of Patient Outcomes (HERO) study. Baseline HRQL and differences in QoL between women and men with heart failure were compared. We used multivariable Cox regression with adjustment for variables to assess the association between MLHFQ summary scores and a composite of all-cause mortality and HF hospitalization. Result: At baseline, the mean MLHFQ in the overall population was 42.9 ± 19.57; the scores for physical and emotional domains were 22.0 ± 8.69 and 8.66 ± 6.08, respectively. Women had a higher (poorer) MLHFQ summary score (44.27 ± 19.13) than men (41.63 ± 19.90) (P<0.001). Female patients also had higher MLHFQ physical and emotional scores than male patients (P<0.001). The specific scores of the questionnaire were higher in women than men. NYHA class was the strongest independent predictor of MLHFQ score (β=6.12 unit increment; P<0.001). Sex was not independently associated with higher MLHFQ scores after multivariable adjustments. The 12-month mortality in the overall cohort was 19.6%, the hospitalization rate was 24.4%, and the composite endpoint was 40.15%. A 10-point increase in MLHFQ score was associated with higher risk of mortality (female and male HRs=1.19 [95% CI 1.12–1.26]; P<0.001 and 1.18 [95% CI 1.12–1.24]; P<0.001, respectively) and composite outcomes (HRs=1.08 [95% CI 1.04–1.13]; P<0.001 and 1.11 [95% CI 1.07–1.14]; P<0.001, respectively). Females did not show a significant association between HRQL and hospitalization (HR=1.04 [95% CI 0.99–1.09]; P=0.107). Conclusion: Quality of life was largely poorer in women than men, but was similar between sexes in terms of physical burden and emotional limitation. HRQL is an independent predictor of all-cause death and HF hospitalization in patients with HF.
背景:心力衰竭(HF)通常与较差的生活质量(QoL)相关。有关中国心衰患者健康相关生活质量(HRQL)的资料有限。方法:我们使用明尼苏达州心力衰竭患者生活问卷(MLHFQ)记录4082名中国心力衰竭患者的生活质量，这些患者在心力衰竭患者结局登记(HERO)研究中随访超过12个月。比较女性和男性心力衰竭患者的基线HRQL和生活质量差异。我们使用多变量Cox回归对变量进行校正，以评估MLHFQ综合评分与全因死亡率和心衰住院率之间的关系。结果:基线时，总体人群MLHFQ均值为42.9±19.57;生理和情绪领域得分分别为22.0±8.69分和8.66±6.08分。女性MLHFQ综合评分(44.27±19.13)高于男性(41.63±19.90)(P<0.001)。女性患者的MLHFQ生理和情绪评分也高于男性患者(P<0.001)。女性的问卷具体得分高于男性。NYHA分级是MLHFQ评分的最强独立预测因子(β=6.12单位增量;P < 0.001)。在多变量调整后，性别与更高的MLHFQ分数没有独立的关联。整个队列的12个月死亡率为19.6%，住院率为24.4%，综合终点为40.15%。MLHFQ评分每增加10分，死亡风险就会增加(女性和男性hr =1.19 [95% CI 1.12-1.26];P<0.001和1.18 [95% CI 1.12-1.24];P<0.001)和综合结果(hr =1.08 [95% CI 1.04-1.13];P<0.001和1.11 [95% CI 1.07-1.14];分别为P < 0.001)。女性患者HRQL与住院治疗无显著相关性(HR=1.04 [95% CI 0.99-1.09];P = 0.107)。结论:女性的生活质量明显低于男性，但在身体负担和情感限制方面，性别差异不大。HRQL是心衰患者全因死亡和心衰住院的独立预测因子。
{"title":"Sex Differences in Quality of Life and Clinical Outcomes in Patients with Heart Failure","authors":"Jingxuan Liu, Zhou Lu, Wan Xuesi, Jianzeng Dong","doi":"10.15212/cvia.2023.0046","DOIUrl":"https://doi.org/10.15212/cvia.2023.0046","url":null,"abstract":"Background: Heart failure (HF) is generally associated with poor quality of life (QoL). Limited data are available characterizing health-related QoL (HRQL) in Chinese patients with HF. Methods: We used the Minnesota Living with Heart Failure Questionnaire (MLHFQ) to record QoL in 4082 patients with HF from China who were followed up over 12 months in the Heart Failure Registry of Patient Outcomes (HERO) study. Baseline HRQL and differences in QoL between women and men with heart failure were compared. We used multivariable Cox regression with adjustment for variables to assess the association between MLHFQ summary scores and a composite of all-cause mortality and HF hospitalization. Result: At baseline, the mean MLHFQ in the overall population was 42.9 ± 19.57; the scores for physical and emotional domains were 22.0 ± 8.69 and 8.66 ± 6.08, respectively. Women had a higher (poorer) MLHFQ summary score (44.27 ± 19.13) than men (41.63 ± 19.90) (P<0.001). Female patients also had higher MLHFQ physical and emotional scores than male patients (P<0.001). The specific scores of the questionnaire were higher in women than men. NYHA class was the strongest independent predictor of MLHFQ score (β=6.12 unit increment; P<0.001). Sex was not independently associated with higher MLHFQ scores after multivariable adjustments. The 12-month mortality in the overall cohort was 19.6%, the hospitalization rate was 24.4%, and the composite endpoint was 40.15%. A 10-point increase in MLHFQ score was associated with higher risk of mortality (female and male HRs=1.19 [95% CI 1.12–1.26]; P<0.001 and 1.18 [95% CI 1.12–1.24]; P<0.001, respectively) and composite outcomes (HRs=1.08 [95% CI 1.04–1.13]; P<0.001 and 1.11 [95% CI 1.07–1.14]; P<0.001, respectively). Females did not show a significant association between HRQL and hospitalization (HR=1.04 [95% CI 0.99–1.09]; P=0.107). Conclusion: Quality of life was largely poorer in women than men, but was similar between sexes in terms of physical burden and emotional limitation. HRQL is an independent predictor of all-cause death and HF hospitalization in patients with HF.","PeriodicalId":41559,"journal":{"name":"Cardiovascular Innovations and Applications","volume":"1 1","pages":""},"PeriodicalIF":0.5,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67307326","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: Human neutrophil peptide-1 (HNP-1) is a commonly investigated therapeutic agent. However, its role in hypertensive left ventricular hypertrophy (HLVH) remains unclear. Methods: We measured HNP-1 levels in patients with hypertension and treated HLVH rat and H9c2 cell hypertrophy models with HNP-1. Cardiomyocyte hypertrophy indexes (i.e., single-cell surface area, left ventricular fibrosis area, BNP levels, and β-MHC levels) were measured with hematoxylin-eosin and Masson’s trichrome staining and WB. NF-кB signaling factors (i.e., IKKβ, p-IKKβ, IкBα, p-IкBα, p65, and p-p65) were measured with WB and qPCR. Finally, inflammatory factors (i.e., IL-6, IL-1α, and TNF-α) were measured with ELISA. Results: HNP-1 levels were lower in the exposure than the control groups (M (95% CI), 48.83 (45.64–52.26) vs. 59.03 (55.62–62.54), P = 0.000). Diminished HNP-1 was associated with HLVH occurrence in patients. HLVH rat and H9c2 cell hypertrophy models revealed elevated cardiomyocyte hypertrophy indexes and NF-кB signaling and inflammatory factors. However, each HNP-1 treatment group showed lower levels of the aforementioned indices than were observed in the model groups. Conclusion: Diminished HNP-1 is a risk factor for HLVH. HNP-1 treatment may reverse HLVH by inhibiting NF-кB signaling pathways.
{"title":"HNP-1 Reverses Hypertensive Left Ventricular Hypertrophy by Inhibiting the NF-кB Signaling Pathway","authors":"Xiaorong Duan, Zhenqiu Yu","doi":"10.15212/cvia.2023.0057","DOIUrl":"https://doi.org/10.15212/cvia.2023.0057","url":null,"abstract":"Background: Human neutrophil peptide-1 (HNP-1) is a commonly investigated therapeutic agent. However, its role in hypertensive left ventricular hypertrophy (HLVH) remains unclear. Methods: We measured HNP-1 levels in patients with hypertension and treated HLVH rat and H9c2 cell hypertrophy models with HNP-1. Cardiomyocyte hypertrophy indexes (i.e., single-cell surface area, left ventricular fibrosis area, BNP levels, and β-MHC levels) were measured with hematoxylin-eosin and Masson’s trichrome staining and WB. NF-кB signaling factors (i.e., IKKβ, p-IKKβ, IкBα, p-IкBα, p65, and p-p65) were measured with WB and qPCR. Finally, inflammatory factors (i.e., IL-6, IL-1α, and TNF-α) were measured with ELISA. Results: HNP-1 levels were lower in the exposure than the control groups (M (95% CI), 48.83 (45.64–52.26) vs. 59.03 (55.62–62.54), P = 0.000). Diminished HNP-1 was associated with HLVH occurrence in patients. HLVH rat and H9c2 cell hypertrophy models revealed elevated cardiomyocyte hypertrophy indexes and NF-кB signaling and inflammatory factors. However, each HNP-1 treatment group showed lower levels of the aforementioned indices than were observed in the model groups. Conclusion: Diminished HNP-1 is a risk factor for HLVH. HNP-1 treatment may reverse HLVH by inhibiting NF-кB signaling pathways.","PeriodicalId":41559,"journal":{"name":"Cardiovascular Innovations and Applications","volume":"12 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135441332","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}
Objective: Few studies have been conducted to establish animal models of left bundle branch block by using three-dimensional mapping systems. This research was aimed at creating a canine left bundle branch block model by using a three-dimensional mapping system. Materials and Methods: We used a three-dimensional mapping system to map and ablate the left bundle branch in beagles. Results: Ten canines underwent radiofrequency ablation, among which left bundle branch block was successfully established in eight, one experienced ventricular fibrillation, and one developed third-degree atrioventricular block. The maximum HV interval measured within the left ventricle was 29.00 ± 2.93 ms, and the LBP-V interval at the ablation site was 20.63 ± 2.77 ms. The LBP-V interval at the ablation target was 71.08% of the maximum HV interval. Conclusion: This three-dimensional mapping system is a reliable and effective guide for ablation of the left bundle branch in dogs.
{"title":"Left Bundle Branch Ablation Guided by a Three-Dimensional Mapping System: A Novel Method for Establishing a Heart Failure Animal Model","authors":"Pengkang He, Han Jin, Yiran Hu, Sixian Weng, Sijing Cheng, Hao Huang","doi":"10.15212/cvia.2023.0066","DOIUrl":"https://doi.org/10.15212/cvia.2023.0066","url":null,"abstract":"Objective: Few studies have been conducted to establish animal models of left bundle branch block by using three-dimensional mapping systems. This research was aimed at creating a canine left bundle branch block model by using a three-dimensional mapping system. Materials and Methods: We used a three-dimensional mapping system to map and ablate the left bundle branch in beagles. Results: Ten canines underwent radiofrequency ablation, among which left bundle branch block was successfully established in eight, one experienced ventricular fibrillation, and one developed third-degree atrioventricular block. The maximum HV interval measured within the left ventricle was 29.00 ± 2.93 ms, and the LBP-V interval at the ablation site was 20.63 ± 2.77 ms. The LBP-V interval at the ablation target was 71.08% of the maximum HV interval. Conclusion: This three-dimensional mapping system is a reliable and effective guide for ablation of the left bundle branch in dogs.","PeriodicalId":41559,"journal":{"name":"Cardiovascular Innovations and Applications","volume":"14 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135444954","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}
Purpose: This study was aimed at evaluating the safety and efficacy of warfarin versus rivaroxaban in patients with atrial fibrillation (AF) and different CHA2DS2-VASc score subgroups in northern China. Methods: A retrospective cohort study was conducted to evaluate 387 patients with AF who received treatment at our institution between September 2018 and August 2019. The patients were divided into two groups receiving either warfarin (n=194) or rivaroxaban (n=193). Follow-up data were collected, including adherence, bleeding and ischemic stroke events. Results: The group receiving rivaroxaban showed better adherence than the group receiving warfarin. In the warfarin-treated group, bleeding incidents declined with increasing scores. In the warfarin-treated group, patients with scores of 2–3 had greater adherence and fewer stroke occurrences. The events of bleeding and stroke did not significantly differ in patients in the rivaroxaban-treated group with different scores. Conclusions: Compared with patients in the warfarin group with different CHA2DS2-VASc scores, those in the rivaroxaban group had greater compliance, and fewer bleeding and stroke events. Regardless of economic considerations, rivaroxaban is preferable for anticoagulative AF treatment in northern Chinese patients.
{"title":"Comparison of the Safety and Efficacy of Warfarin Versus Rivaroxaban in Northern Chinese Patients with Different CHA2DS2-VASc Scores: A Retrospective Cohort Study","authors":"Shiwei Xu, Qi Zhao, Haiyu Zhang, Xianghui Li, Jing Lu, Hongyan Wang, Yuanyuan Guo, Z. Dong","doi":"10.15212/cvia.2023.0030","DOIUrl":"https://doi.org/10.15212/cvia.2023.0030","url":null,"abstract":"Purpose: This study was aimed at evaluating the safety and efficacy of warfarin versus rivaroxaban in patients with atrial fibrillation (AF) and different CHA2DS2-VASc score subgroups in northern China. Methods: A retrospective cohort study was conducted to evaluate 387 patients with AF who received treatment at our institution between September 2018 and August 2019. The patients were divided into two groups receiving either warfarin (n=194) or rivaroxaban (n=193). Follow-up data were collected, including adherence, bleeding and ischemic stroke events. Results: The group receiving rivaroxaban showed better adherence than the group receiving warfarin. In the warfarin-treated group, bleeding incidents declined with increasing scores. In the warfarin-treated group, patients with scores of 2–3 had greater adherence and fewer stroke occurrences. The events of bleeding and stroke did not significantly differ in patients in the rivaroxaban-treated group with different scores. Conclusions: Compared with patients in the warfarin group with different CHA2DS2-VASc scores, those in the rivaroxaban group had greater compliance, and fewer bleeding and stroke events. Regardless of economic considerations, rivaroxaban is preferable for anticoagulative AF treatment in northern Chinese patients.","PeriodicalId":41559,"journal":{"name":"Cardiovascular Innovations and Applications","volume":"1 1","pages":""},"PeriodicalIF":0.5,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67306014","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}
Objective: Neuro-endocrine tumors (NET) resulting in syndromes of serotonin excess can lead to cardiac involvement, and substantial mortality and morbidity. This article is aimed at reviewing the pathophysiology, diagnosis and management of carcinoid heart disease (CHD). Results: The pathophysiology of CHD stems from chronic exposure to circulating vasoactive compounds. Frequent clinical evaluations, monitoring of biomarker levels and cardiac imaging play critical roles in screening and early recognition. The complexity of the disease necessitates a multidisciplinary approach, medical management and timely surgical intervention. Conclusion: Outcomes of CHD have improved, owing to advances in medical management and increased surgical expertise. Surgical valvular intervention is the only definitive therapy for the treatment of symptomatic CHD.
{"title":"Carcinoid Heart Disease – A Review of Pathophysiology, Clinical Manifestations, Diagnosis and Management","authors":"S. Ghanta, S. Vallurupalli","doi":"10.15212/cvia.2023.0041","DOIUrl":"https://doi.org/10.15212/cvia.2023.0041","url":null,"abstract":"Objective: Neuro-endocrine tumors (NET) resulting in syndromes of serotonin excess can lead to cardiac involvement, and substantial mortality and morbidity. This article is aimed at reviewing the pathophysiology, diagnosis and management of carcinoid heart disease (CHD). Results: The pathophysiology of CHD stems from chronic exposure to circulating vasoactive compounds. Frequent clinical evaluations, monitoring of biomarker levels and cardiac imaging play critical roles in screening and early recognition. The complexity of the disease necessitates a multidisciplinary approach, medical management and timely surgical intervention. Conclusion: Outcomes of CHD have improved, owing to advances in medical management and increased surgical expertise. Surgical valvular intervention is the only definitive therapy for the treatment of symptomatic CHD.","PeriodicalId":41559,"journal":{"name":"Cardiovascular Innovations and Applications","volume":"1 1","pages":""},"PeriodicalIF":0.5,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67306862","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}
{"title":"It’s Time to Consider Ablation as First-Line Therapy for Atrial Fibrillation","authors":"S. Ross, W. Miles","doi":"10.15212/cvia.2023.0052","DOIUrl":"https://doi.org/10.15212/cvia.2023.0052","url":null,"abstract":"","PeriodicalId":41559,"journal":{"name":"Cardiovascular Innovations and Applications","volume":"1 1","pages":""},"PeriodicalIF":0.5,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67307342","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}
Balloon rupture during transcatheter aortic valve replacement (TAVR) is a rare but serious complication. Here, we present two cases of balloon rupture in patients with severe aortic stenosis and type 0 bicuspid aortic valves. Three-dimensional models based on pre-procedure cardiac CT angiography were used to investigate these cases post hoc. The models revealed asymmetrical distribution of calcifications with sharply spiked features in the bicuspid aortic valves. The narrow calcified orifices resulted in uneven force distribution on the expanded balloon, thus leading to balloon rupture. We additionally review the classification and causes of balloon rupture, summarize methods for avoiding complications, and describe treatment options. Accurate pre-procedural anatomy evaluation and computer modeling are crucial for planning and managing TAVR procedures. Further investigation through computer simulation is necessary to determine the appropriate balloon size and inflation locations, to provide a reference for pre-procedural preparation.
{"title":"Balloon Rupture during Pre-Dilation for Transcatheter Aortic Valve Replacement in Patients with a Bicuspid Aortic Valve: Classification, Treatment Strategies, and Prevention","authors":"Xinlei Wu, Tianbo Wu, Rutao Wang, Ahmed Elkoumy, Daozhu Wu, Osama Soliman, Xinmin Zhang, Lianpin Wu","doi":"10.15212/cvia.2023.0063","DOIUrl":"https://doi.org/10.15212/cvia.2023.0063","url":null,"abstract":"Balloon rupture during transcatheter aortic valve replacement (TAVR) is a rare but serious complication. Here, we present two cases of balloon rupture in patients with severe aortic stenosis and type 0 bicuspid aortic valves. Three-dimensional models based on pre-procedure cardiac CT angiography were used to investigate these cases post hoc. The models revealed asymmetrical distribution of calcifications with sharply spiked features in the bicuspid aortic valves. The narrow calcified orifices resulted in uneven force distribution on the expanded balloon, thus leading to balloon rupture. We additionally review the classification and causes of balloon rupture, summarize methods for avoiding complications, and describe treatment options. Accurate pre-procedural anatomy evaluation and computer modeling are crucial for planning and managing TAVR procedures. Further investigation through computer simulation is necessary to determine the appropriate balloon size and inflation locations, to provide a reference for pre-procedural preparation.","PeriodicalId":41559,"journal":{"name":"Cardiovascular Innovations and Applications","volume":"58 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135159322","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}
Aim: The aim of this observational study was to perform in-depth analysis of autonomic nervous system function in patients older than 60 years of age with coronary artery disease, and normotension or hypertension. Method: A total of 104 patients older than 60 years with coronary heart disease (CHD) were divided into a normotension group and hypertension (HT) group, and 24-hour Holter monitoring was performed to assess autonomic function. Result: Among the 104 patients with CHD analyzed, 52 had normotension, and 52 had hypertension. The 24-hour Holter results based on time-domain methods indicated that the values of the time-domain parameters of heart rate variability were significantly lower in the CHD+HT group than the CHD group. Furthermore, during both the daytime and nighttime, the time-domain parameters were significantly lower in the CHD+HT group than the CHD group. No difference was observed in autonomic function during the daytime and nighttime in each group. Values of frequency-domain parameters of heart rate variability were also significantly lower in the CHD+HT group than the CHD group. More patients in the CHD+HT group than the CHD group received percutaneous coronary intervention (57.69% vs. 50% χ2=0.619, P=0.55). In 12 months of follow-up, we found no significant differences in rehospitalization for unstable angina and target lesion revascularization between patients with CHD with normotension versus hypertension. Conclusion: The heart autonomic nervous system dysfunction in patients older than 60 years with CHD with hypertension was more severe than that in patients with CHD with normotension, and therefore, should receive greater clinical attention.
{"title":"Changes in Autonomic Nervous System Function in Patients >60 Years of Age with Coronary Heart Disease, and Normotension or Hypertension: An Observational Study","authors":"Jing-Xiu Li, Jing Wang, Bei-Bei Ding, Mingchen Gao","doi":"10.15212/cvia.2023.0038","DOIUrl":"https://doi.org/10.15212/cvia.2023.0038","url":null,"abstract":"Aim: The aim of this observational study was to perform in-depth analysis of autonomic nervous system function in patients older than 60 years of age with coronary artery disease, and normotension or hypertension. Method: A total of 104 patients older than 60 years with coronary heart disease (CHD) were divided into a normotension group and hypertension (HT) group, and 24-hour Holter monitoring was performed to assess autonomic function. Result: Among the 104 patients with CHD analyzed, 52 had normotension, and 52 had hypertension. The 24-hour Holter results based on time-domain methods indicated that the values of the time-domain parameters of heart rate variability were significantly lower in the CHD+HT group than the CHD group. Furthermore, during both the daytime and nighttime, the time-domain parameters were significantly lower in the CHD+HT group than the CHD group. No difference was observed in autonomic function during the daytime and nighttime in each group. Values of frequency-domain parameters of heart rate variability were also significantly lower in the CHD+HT group than the CHD group. More patients in the CHD+HT group than the CHD group received percutaneous coronary intervention (57.69% vs. 50% χ2=0.619, P=0.55). In 12 months of follow-up, we found no significant differences in rehospitalization for unstable angina and target lesion revascularization between patients with CHD with normotension versus hypertension. Conclusion: The heart autonomic nervous system dysfunction in patients older than 60 years with CHD with hypertension was more severe than that in patients with CHD with normotension, and therefore, should receive greater clinical attention.","PeriodicalId":41559,"journal":{"name":"Cardiovascular Innovations and Applications","volume":"1 1","pages":""},"PeriodicalIF":0.5,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67306464","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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