Pub Date : 2024-10-10DOI: 10.1016/j.cpcardiol.2024.102867
Aristóteles Comte de Alencar Neto MD, PhD , Natália de Melo Pereira MD , Cristhian Espinoza Romero MD, MSc , Caio Rebouças Fonseca Cafezeiro MD, PhD , Bruno Vaz Kerges Bueno MD , Joao Henrique Rissato MD , Fernando Linhares Pereira MD , Maria Cristina Chammas MD, PhD , Félix José Alvarez Ramires MD, PhD , Charles Mady MD, PhD , Wilson Mathias Junior MD, PhD , Roberto Kalil Filho MD, PhD , Fabio Fernandes MD, PhD
Introduction
Amyloidosis is a group of diseases characterized by the deposition of misfolded protein fragments, forming insoluble fibrils in organs and tissues. Transthyretin (ATTR) amyloidosis, particularly cardiac amyloidosis (CA), leads to myocardial stiffness and heart failure. Right ventricular (RV) involvement is common in CA, but assessing RV stiffness noninvasively is challenging. This study aimed to evaluate RV stiffness using shear wave elastography (SWE) and correlate the findings with clinical, laboratory, and echocardiographic parameters.
Materials and Methods
In this prospective, single-center, cross-sectional study, 60 patients were divided into three groups: 20 with cardiac ATTR amyloidosis (ATTR-CM), 20 with non-cardiac ATTR amyloidosis (ATTR non-CM), and 20 healthy controls. Myocardial stiffness was measured using SWE in the free wall of the RV. Pearson's and Spearman's correlation coefficients were used for statistical analysis, with significance set at p < 0.05.
Results
RV SWE values showed a strong positive correlation with functional class and a moderate correlation with BNP and troponin I levels. A significant negative correlation was found between RV SWE values and the 6-minute walk test distance. SWE also correlated with echocardiographic variables like interventricular septum thickness and RV basal diameter. An SWE cutoff of ≥ 4.6. kPa was associated with cardiac involvement, showing 65 % sensitivity and 76 % specificity.
Conclusions
SWE is a valuable noninvasive technique for assessing RV stiffness in CA patients, correlating well with clinical and echocardiographic parameters. An RV SWE value of ≥ 4.6 kPa could aid in early detection of cardiac involvement in ATTR amyloidosis, improving diagnosis and management.
简介淀粉样变性是一组以错误折叠的蛋白质片段沉积在器官和组织中形成不溶性纤维为特征的疾病。转甲状腺素（ATTR）淀粉样变性，尤其是心脏淀粉样变性（CA），会导致心肌僵硬和心力衰竭。右心室（RV）受累在 CA 中很常见，但用无创方法评估右心室僵硬度具有挑战性。本研究旨在使用剪切波弹性成像（SWE）评估右心室僵硬度，并将评估结果与临床、实验室和超声心动图参数相关联：在这项前瞻性、单中心、横断面研究中，60 名患者被分为三组：20 名心源性 ATTR 淀粉样变性（ATTR-CM）患者、20 名非心源性 ATTR 淀粉样变性（ATTR 非 CM）患者和 20 名健康对照组。心肌僵硬度采用心室游离壁的 SWE 测量。采用皮尔逊和斯皮尔曼相关系数进行统计分析，显著性以 p < 0.05 为限：RV SWE 值与功能分级呈强正相关，与 BNP 和肌钙蛋白 I 水平呈中度相关。发现左心室 SWE 值与 6 分钟步行测试距离呈明显负相关。SWE 还与超声心动图变量（如室间隔厚度和 RV 基底直径）相关。SWE 临界值≥ 4.6 kPa 与心脏受累相关，显示出 65% 的敏感性和 76% 的特异性：SWE是评估CA患者RV僵硬度的一种有价值的无创技术，与临床和超声心动图参数有很好的相关性。RV SWE值≥4.6 kPa有助于早期发现ATTR淀粉样变性的心脏受累情况，从而改善诊断和治疗。
{"title":"Assessment of right ventricular myocardial stiffness by cardiac elastography in patients with transthyretin amyloidosis","authors":"Aristóteles Comte de Alencar Neto MD, PhD , Natália de Melo Pereira MD , Cristhian Espinoza Romero MD, MSc , Caio Rebouças Fonseca Cafezeiro MD, PhD , Bruno Vaz Kerges Bueno MD , Joao Henrique Rissato MD , Fernando Linhares Pereira MD , Maria Cristina Chammas MD, PhD , Félix José Alvarez Ramires MD, PhD , Charles Mady MD, PhD , Wilson Mathias Junior MD, PhD , Roberto Kalil Filho MD, PhD , Fabio Fernandes MD, PhD","doi":"10.1016/j.cpcardiol.2024.102867","DOIUrl":"10.1016/j.cpcardiol.2024.102867","url":null,"abstract":"<div><h3>Introduction</h3><div>Amyloidosis is a group of diseases characterized by the deposition of misfolded protein fragments, forming insoluble fibrils in organs and tissues. Transthyretin (ATTR) amyloidosis, particularly cardiac amyloidosis (CA), leads to myocardial stiffness and heart failure. Right ventricular (RV) involvement is common in CA, but assessing RV stiffness noninvasively is challenging. This study aimed to evaluate RV stiffness using shear wave elastography (SWE) and correlate the findings with clinical, laboratory, and echocardiographic parameters.</div></div><div><h3>Materials and Methods</h3><div>In this prospective, single-center, cross-sectional study, 60 patients were divided into three groups: 20 with cardiac ATTR amyloidosis (ATTR-CM), 20 with non-cardiac ATTR amyloidosis (ATTR non-CM), and 20 healthy controls. Myocardial stiffness was measured using SWE in the free wall of the RV. Pearson's and Spearman's correlation coefficients were used for statistical analysis, with significance set at p < 0.05.</div></div><div><h3>Results</h3><div>RV SWE values showed a strong positive correlation with functional class and a moderate correlation with BNP and troponin I levels. A significant negative correlation was found between RV SWE values and the 6-minute walk test distance. SWE also correlated with echocardiographic variables like interventricular septum thickness and RV basal diameter. An SWE cutoff of ≥ 4.6. kPa was associated with cardiac involvement, showing 65 % sensitivity and 76 % specificity.</div></div><div><h3>Conclusions</h3><div>SWE is a valuable noninvasive technique for assessing RV stiffness in CA patients, correlating well with clinical and echocardiographic parameters. An RV SWE value of ≥ 4.6 kPa could aid in early detection of cardiac involvement in ATTR amyloidosis, improving diagnosis and management.</div></div>","PeriodicalId":51006,"journal":{"name":"Current Problems in Cardiology","volume":"50 1","pages":"Article 102867"},"PeriodicalIF":3.0,"publicationDate":"2024-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142407189","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-10DOI: 10.1016/j.cpcardiol.2024.102880
Julia M. Fernandes , Rafael P.S. Pinheiro , Frans Serpa M.D. , Naieli M. de Andrade , Vinicius Pereira , Ângelo E.E. Sbardelotto , Wilton F. Gomes M.D.
Background
Direct Oral Anticoagulants (DOACs) are the first line anticoagulation for patients with non-valvular atrial fibrillation (NVAF). Percutaneous Left Atrial Appendage Occlusion (LAAO) has emerged as a new therapy and its safety and effectiveness compared with DOACs are still controversial.
Methods
A systematic review of randomized controlled trials and observational studies was conducted, focusing on patients with NVAF. Outcomes analyzed included: (1) all-cause mortality; (2) cardiovascular (CV) mortality; (3) thromboembolic events; (4) stroke or transient ischemic attack (TIA); (5) bleeding events; and a (6) composite of death, hemorrhagic, and thromboembolic events. We performed a subgroup analysis of major bleeding according to different definitions: (1) Bleeding Academic Research Consortium (BARC); (2) International Society on Thrombosis and Haemostasis (ISTH); and (3) other definitions.
Results
Ten studies involving 18,507 patients were included, with 42.35 % undergoing LAAO. In pooled analysis, LAAO was associated with lower rates of all-cause mortality (HR 0.63; 95 % CI 0.50-0.80), cardiovascular mortality (HR 0.56; 95 % CI 0.45-0.70), and of the composite outcome (HR 0.73; 95 % CI 0.58-0.92). A trend towards lower stroke/TIA events was observed but not statistically significant. Overall bleeding events did not significantly differ between groups; using the ISTH definition, LAAO showed significantly lower incidence of bleeding events (HR 0.63; 95 % CI 0.43-0.91). No difference was found in thromboembolic events.
Conclusion
LAAO was associated with a significantly lower all-cause mortality and cardiovascular mortality, as well as the composite of death, hemorrhagic or thromboembolic events, as compared with DOACs.
背景：直接口服抗凝药（DOACs）是非瓣膜性心房颤动（NVAF）患者的一线抗凝药物。经皮左心房阑尾封堵术（LAAO）已成为一种新疗法，与 DOACs 相比，其安全性和有效性仍存在争议：方法：对随机对照试验和观察性研究进行了系统回顾，重点关注 NVAF 患者。分析的结果包括(1)全因死亡率；(2)心血管（CV）死亡率；(3)血栓栓塞事件；(4)中风或短暂性脑缺血发作（TIA）；(5)出血事件；(6)死亡、出血和血栓栓塞事件的复合。我们根据（1）出血学术研究联盟（BARC）；（2）国际血栓与止血学会（ISTH）；（3）其他定义的不同定义对大出血进行了亚组分析：共纳入 10 项研究，涉及 18,507 名患者，其中 42.35% 的患者接受了 LAAO。在汇总分析中，LAAO 与较低的全因死亡率（HR 0.63；95% CI 0.50-0.80）、心血管死亡率（HR 0.56；95% CI 0.45-0.70）和综合结果（HR 0.73；95% CI 0.58-0.92）相关。中风/TIA事件呈下降趋势，但无统计学意义。采用ISTH定义，LAAO组的出血事件发生率明显降低（HR 0.63；95% CI 0.43-0.91）。在血栓栓塞事件方面没有发现明显差异：与 DOACs 相比，LAAO 可显著降低全因死亡率和心血管死亡率，以及死亡、出血或血栓栓塞事件的复合死亡率。
{"title":"Left atrial appendage occlusion devices vs direct oral anticoagulants for atrial fibrillation: An updated systematic review and meta-analysis","authors":"Julia M. Fernandes , Rafael P.S. Pinheiro , Frans Serpa M.D. , Naieli M. de Andrade , Vinicius Pereira , Ângelo E.E. Sbardelotto , Wilton F. Gomes M.D.","doi":"10.1016/j.cpcardiol.2024.102880","DOIUrl":"10.1016/j.cpcardiol.2024.102880","url":null,"abstract":"<div><h3>Background</h3><div>Direct Oral Anticoagulants (DOACs) are the first line anticoagulation for patients with non-valvular atrial fibrillation (NVAF). Percutaneous Left Atrial Appendage Occlusion (LAAO) has emerged as a new therapy and its safety and effectiveness compared with DOACs are still controversial.</div></div><div><h3>Methods</h3><div>A systematic review of randomized controlled trials and observational studies was conducted, focusing on patients with NVAF. Outcomes analyzed included: (1) all-cause mortality; (2) cardiovascular (CV) mortality; (3) thromboembolic events; (4) stroke or transient ischemic attack (TIA); (5) bleeding events; and a (6) composite of death, hemorrhagic, and thromboembolic events. We performed a subgroup analysis of major bleeding according to different definitions: (1) Bleeding Academic Research Consortium (BARC); (2) International Society on Thrombosis and Haemostasis (ISTH); and (3) other definitions.</div></div><div><h3>Results</h3><div>Ten studies involving 18,507 patients were included, with 42.35 % undergoing LAAO. In pooled analysis, LAAO was associated with lower rates of all-cause mortality (HR 0.63; 95 % CI 0.50-0.80), cardiovascular mortality (HR 0.56; 95 % CI 0.45-0.70), and of the composite outcome (HR 0.73; 95 % CI 0.58-0.92). A trend towards lower stroke/TIA events was observed but not statistically significant. Overall bleeding events did not significantly differ between groups; using the ISTH definition, LAAO showed significantly lower incidence of bleeding events (HR 0.63; 95 % CI 0.43-0.91). No difference was found in thromboembolic events.</div></div><div><h3>Conclusion</h3><div>LAAO was associated with a significantly lower all-cause mortality and cardiovascular mortality, as well as the composite of death, hemorrhagic or thromboembolic events, as compared with DOACs.</div></div>","PeriodicalId":51006,"journal":{"name":"Current Problems in Cardiology","volume":"50 1","pages":"Article 102880"},"PeriodicalIF":3.0,"publicationDate":"2024-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142480091","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-10DOI: 10.1016/j.cpcardiol.2024.102881
Fengrui Shi , Jie Yu , Hong Wang , Chuanzhong Wu
Objective
This study aims to compare the relative effects of different mind-body exercises on cardiorespiratory function and quality of life in Heart failure (HF) patients, providing valuable insights for their rehabilitation.
Methods
We conducted a search across seven Chinese and English databases, including China National Knowledge Infrastructure (CNKI) and Web of Science. A network meta-analysis was performed using STATA 14.0 within a frequentist framework.
Results
A total of 38 studies were included, encompassing eight types of mind-body exercises. Ten studies reported peak VO2, indicating that dancing outperformed Tai Chi (MD:3.52, 95 % CI:6.74, -0.30) and Baduanjin (MD:2.34, 95 % CI:4.32, -0.36). Additionally, Pilates demonstrated greater effectiveness than Yijinjing, aside from Tai Chi (MD:5.10, 95 % CI:8.71, -1.49) and Baduanjin (MD:3.92, 95 % CI:6.50, -1.34). Twenty-one studies reported the six-minute walk test (6MTW), with only Tai Chi significantly improving 6MTW scores compared to the control group (MD: 50.77, 95 % CI: 8.12, 93.42). Twenty-three studies assessed left ventricular ejection fraction (LVEF), finding that Tai Chi (MD: 3.83, 95 % CI: 2.07, 5.59), Baduanjin (MD: 2.90, 95 % CI: 1.04, 4.76), and yoga (MD: 3.32, 95 % CI: 0.37, 6.27) significantly increased LVEF in HF patients. Nineteen studies evaluated quality of life, with the Liuzijue possibly being the most effective intervention (SUCRA: 98.9).
Conclusion
Different mind-body exercises have their own advantages in improving the heart function and quality of life of HF patients. In the future, higher-quality studies with larger samples are needed to further verify the validity of the results.
{"title":"The impact of various mind-body exercises on cardiorespiratory function and quality of life in heart failure patients: A network meta-analysis","authors":"Fengrui Shi , Jie Yu , Hong Wang , Chuanzhong Wu","doi":"10.1016/j.cpcardiol.2024.102881","DOIUrl":"10.1016/j.cpcardiol.2024.102881","url":null,"abstract":"<div><h3>Objective</h3><div>This study aims to compare the relative effects of different mind-body exercises on cardiorespiratory function and quality of life in Heart failure (HF) patients, providing valuable insights for their rehabilitation.</div></div><div><h3>Methods</h3><div>We conducted a search across seven Chinese and English databases, including China National Knowledge Infrastructure (CNKI) and Web of Science. A network meta-analysis was performed using STATA 14.0 within a frequentist framework.</div></div><div><h3>Results</h3><div>A total of 38 studies were included, encompassing eight types of mind-body exercises. Ten studies reported peak VO<sub>2</sub>, indicating that dancing outperformed Tai Chi (MD:3.52, 95 % CI:6.74, -0.30) and Baduanjin (MD:2.34, 95 % CI:4.32, -0.36). Additionally, Pilates demonstrated greater effectiveness than Yijinjing, aside from Tai Chi (MD:5.10, 95 % CI:8.71, -1.49) and Baduanjin (MD:3.92, 95 % CI:6.50, -1.34). Twenty-one studies reported the six-minute walk test (6MTW), with only Tai Chi significantly improving 6MTW scores compared to the control group (MD: 50.77, 95 % CI: 8.12, 93.42). Twenty-three studies assessed left ventricular ejection fraction (LVEF), finding that Tai Chi (MD: 3.83, 95 % CI: 2.07, 5.59), Baduanjin (MD: 2.90, 95 % CI: 1.04, 4.76), and yoga (MD: 3.32, 95 % CI: 0.37, 6.27) significantly increased LVEF in HF patients. Nineteen studies evaluated quality of life, with the Liuzijue possibly being the most effective intervention (SUCRA: 98.9).</div></div><div><h3>Conclusion</h3><div>Different mind-body exercises have their own advantages in improving the heart function and quality of life of HF patients. In the future, higher-quality studies with larger samples are needed to further verify the validity of the results.</div></div>","PeriodicalId":51006,"journal":{"name":"Current Problems in Cardiology","volume":"49 12","pages":"Article 102881"},"PeriodicalIF":3.0,"publicationDate":"2024-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142407192","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-10DOI: 10.1016/j.cpcardiol.2024.102877
Muhannad A. Abbasi MD , Elias Akiki MD , Edward A. El-Am MD, Jeffrey B. Geske MD, J. Martijn Bos MD, PhD, Michael J. Ackerman MD, PhD, Zachi I. Attia PhD, Paul A. Friedman MD, Konstantinos C. Siontis MD, Darrell B. Newman MD
{"title":"Artificial intelligence electrocardiography for the evaluation of cardiac involvement in Fabry disease","authors":"Muhannad A. Abbasi MD , Elias Akiki MD , Edward A. El-Am MD, Jeffrey B. Geske MD, J. Martijn Bos MD, PhD, Michael J. Ackerman MD, PhD, Zachi I. Attia PhD, Paul A. Friedman MD, Konstantinos C. Siontis MD, Darrell B. Newman MD","doi":"10.1016/j.cpcardiol.2024.102877","DOIUrl":"10.1016/j.cpcardiol.2024.102877","url":null,"abstract":"","PeriodicalId":51006,"journal":{"name":"Current Problems in Cardiology","volume":"50 1","pages":"Article 102877"},"PeriodicalIF":3.0,"publicationDate":"2024-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142407179","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-10DOI: 10.1016/j.cpcardiol.2024.102879
Joshua Pillai , Kathryn Pillai
Given the rapid development of large language models (LLMs), such as ChatGPT, in its ability to understand and generate human-like texts, these technologies inspired efforts to explore their capabilities in natural language processing tasks, especially those in healthcare contexts. The performance of these tools have been evaluated thoroughly across medicine in diverse tasks, including standardized medical examinations, medical-decision making, and many others. In this journal, Anaya et al. published a study comparing the readability metrics of medical education resources formulated by ChatGPT with those of major U.S. institutions (AHA, ACC, HFSA) about heart failure. In this work, we provide a critical review of this article and further describe approaches to help mitigate challenges in reproducibility of studies evaluating LLMs in cardiology. Additionally, we provide suggestions to optimize sampling of responses provided by LLMs for future studies. Overall, while the study by Anaya et al. provides a meaningful contribution to literature of LLMs in cardiology, further comprehensive studies are necessary to address current limitations and further strengthen our understanding of these novel tools.
{"title":"ChatGPT as a medical education resource in cardiology: Mitigating replicability challenges and optimizing model performance","authors":"Joshua Pillai , Kathryn Pillai","doi":"10.1016/j.cpcardiol.2024.102879","DOIUrl":"10.1016/j.cpcardiol.2024.102879","url":null,"abstract":"<div><div>Given the rapid development of large language models (LLMs), such as ChatGPT, in its ability to understand and generate human-like texts, these technologies inspired efforts to explore their capabilities in natural language processing tasks, especially those in healthcare contexts. The performance of these tools have been evaluated thoroughly across medicine in diverse tasks, including standardized medical examinations, medical-decision making, and many others. In this journal, Anaya et al. published a study comparing the readability metrics of medical education resources formulated by ChatGPT with those of major U.S. institutions (AHA, ACC, HFSA) about heart failure. In this work, we provide a critical review of this article and further describe approaches to help mitigate challenges in reproducibility of studies evaluating LLMs in cardiology. Additionally, we provide suggestions to optimize sampling of responses provided by LLMs for future studies. Overall, while the study by Anaya et al. provides a meaningful contribution to literature of LLMs in cardiology, further comprehensive studies are necessary to address current limitations and further strengthen our understanding of these novel tools.</div></div>","PeriodicalId":51006,"journal":{"name":"Current Problems in Cardiology","volume":"49 12","pages":"Article 102879"},"PeriodicalIF":3.0,"publicationDate":"2024-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142407190","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-09DOI: 10.1016/j.cpcardiol.2024.102875
Rida Siddiqui MBBS , Hadia Nadeem MBBS , Muttia Abdul Sattar MBBS , Manahil Rehan MBBS , Daniya Naveed Sheikh MBBS , Sara Jawed MBBS , Abdullah Akram MBBS
Hypertension is a prevalent condition that significantly contributes to cardiovascular morbidity and mortality worldwide. Aldosterone, a key hormone in the regulation of blood pressure, has been implicated in the pathophysiology of hypertension, leading to increased interest in aldosterone synthase inhibitors (ASIs) as a therapeutic option. This meta-analysis aims to systematically evaluate the efficacy and safety of ASIs in reducing blood pressure and associated adverse events in older adults with hypertension, providing a comprehensive overview of current evidence to inform clinical practice.
A comprehensive electronic search was conducted using PubMed, Google Scholar, Cochrane Central, and Clinicaltrials.gov were extensively searched till 31 December,2023. Out of 729 articles identified through our search strategy, 6 randomized controlled trials met the eligibility criteria and were included in the meta-analysis. The studies varied in sample size, duration, and specific ASIs evaluated, focusing on older adults with hypertension. Baseline characteristics and outcomes were extracted using an online Excel sheet, summarising parameters such as age, sex, race, BMI, and duration of hypertension. The Cochrane risk of bias tool was utilised to assess the quality of included trials across five domains: selection, reporting, performance, detection, and attrition bias. Statistical analyses were performed using RevMan version 5.4, applying random effects models for forest plots with a significance level set at p<0.05.
The meta-analysis found that aldosterone synthase inhibitors (ASIs) significantly reduced systolic blood pressure (SBP) with ASIs compared to placebo, with a mean difference of Mean Difference (MD) -5.44, 95% Confidence Interval (CI) -7.02 to -3.86; p-value <0.00001, I^2 = 26%], indicating effective blood pressure management in older adults with hypertension. Additionally, the analysis showed a significant reduction in plasma aldosterone levels favouring the intervention group (MD=-1.89, 95% CI, P=0.00001, I²=0%). However, there was no statistically significant difference in the incidence of serious adverse events between ASIs and placebo (RR=0.98, 95% CI, P=0.86, I²=0%), suggesting that ASIs are generally safe for use in this population.
ASIs are generally well-tolerated among the studied population. Overall, the findings support the efficacy of ASIs in managing hypertension without a significant increase in adverse events. However, future large scale trials are required to confirm our results and determine the long term benefits and risks of ASI in treatment of hypertension.
高血压是一种普遍存在的疾病，在很大程度上导致了全球心血管疾病的发病率和死亡率。醛固酮是调节血压的一种关键激素，与高血压的病理生理学有关联，因此人们越来越关注醛固酮合成酶抑制剂（ASI）作为一种治疗选择。本荟萃分析旨在系统评估醛固酮合成酶抑制剂在降低老年高血压患者血压及相关不良事件方面的疗效和安全性，为临床实践提供全面的现有证据。截至 2023 年 12 月 31 日，我们使用 PubMed、Google Scholar、Cochrane Central 和 Clinicaltrials.gov 进行了全面的电子检索。在通过搜索策略确定的 729 篇文章中，有 6 项随机对照试验符合资格标准并被纳入荟萃分析。这些研究的样本量、持续时间和评估的具体 ASI 各不相同，主要针对患有高血压的老年人。使用在线 Excel 表提取基线特征和结果，总结年龄、性别、种族、体重指数和高血压持续时间等参数。科克伦偏倚风险工具用于评估纳入试验在五个方面的质量：选择偏倚、报告偏倚、绩效偏倚、检测偏倚和自然减员偏倚。统计分析使用 RevMan 5.4 版进行，采用随机效应模型绘制森林图，显著性水平设定为 p
{"title":"Efficacy and safety of aldosterone synthase inhibitors in hypertension: A systematic review and meta- analysis","authors":"Rida Siddiqui MBBS , Hadia Nadeem MBBS , Muttia Abdul Sattar MBBS , Manahil Rehan MBBS , Daniya Naveed Sheikh MBBS , Sara Jawed MBBS , Abdullah Akram MBBS","doi":"10.1016/j.cpcardiol.2024.102875","DOIUrl":"10.1016/j.cpcardiol.2024.102875","url":null,"abstract":"<div><div>Hypertension is a prevalent condition that significantly contributes to cardiovascular morbidity and mortality worldwide. Aldosterone, a key hormone in the regulation of blood pressure, has been implicated in the pathophysiology of hypertension, leading to increased interest in aldosterone synthase inhibitors (ASIs) as a therapeutic option. This meta-analysis aims to systematically evaluate the efficacy and safety of ASIs in reducing blood pressure and associated adverse events in older adults with hypertension, providing a comprehensive overview of current evidence to inform clinical practice.</div><div>A comprehensive electronic search was conducted using PubMed, Google Scholar, Cochrane Central, and Clinicaltrials.gov were extensively searched till 31 December,2023. Out of 729 articles identified through our search strategy, 6 randomized controlled trials met the eligibility criteria and were included in the meta-analysis. The studies varied in sample size, duration, and specific ASIs evaluated, focusing on older adults with hypertension. Baseline characteristics and outcomes were extracted using an online Excel sheet, summarising parameters such as age, sex, race, BMI, and duration of hypertension. The Cochrane risk of bias tool was utilised to assess the quality of included trials across five domains: selection, reporting, performance, detection, and attrition bias. Statistical analyses were performed using RevMan version 5.4, applying random effects models for forest plots with a significance level set at p<0.05.</div><div>The meta-analysis found that aldosterone synthase inhibitors (ASIs) significantly reduced systolic blood pressure (SBP) with ASIs compared to placebo, with a mean difference of Mean Difference (MD) -5.44, 95% Confidence Interval (CI) -7.02 to -3.86; p-value <0.00001, I^2 = 26%], indicating effective blood pressure management in older adults with hypertension. Additionally, the analysis showed a significant reduction in plasma aldosterone levels favouring the intervention group (MD=-1.89, 95% CI, P=0.00001, I²=0%). However, there was no statistically significant difference in the incidence of serious adverse events between ASIs and placebo (RR=0.98, 95% CI, P=0.86, I²=0%), suggesting that ASIs are generally safe for use in this population.</div><div>ASIs are generally well-tolerated among the studied population. Overall, the findings support the efficacy of ASIs in managing hypertension without a significant increase in adverse events. However, future large scale trials are required to confirm our results and determine the long term benefits and risks of ASI in treatment of hypertension.</div></div>","PeriodicalId":51006,"journal":{"name":"Current Problems in Cardiology","volume":"49 12","pages":"Article 102875"},"PeriodicalIF":3.0,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142394964","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-05DOI: 10.1016/j.cpcardiol.2024.102874
Abdulghafoor Alsomali , Gregory Y.H. Lip , Riaz Akhtar , Mark Field , Andrea Grillo , Nicola Tidbury , Donato Leo , Riccardo Proietti
Central blood pressure (CBP) measurements, compared to brachial blood pressure (bBP), offer a superior predictive accuracy for aortovascular disease outcomes. This emphasises the distinctiveness of central hemodynamic metrics such as CBP, measuring the pressure directly exerted from the cardiac muscle to the major arteries, and provides a more direct assessment of cardiovascular workload than bBP, which measures the pressure against peripheral artery walls. This review synthesises findings evaluating the correlation between CBP and key aortovascular disease markers. Thoracic aortic aneurysm (TAA) growth is a crucial aspect of aortovascular assessment. CBP more accurately correlates with arterial stiffness (AS), the growth of TAA, and cardiovascular diseases, offering a more dependable prediction of aortovascular diseases, adverse cardiovascular events (CVE) and organ damage compared to bBP. The incorporation of CBP into routine clinical practice could enhance aortovascular assessments and therapeutic strategies when compared to bBP, particularly through a deeper understanding of aortic wave dynamics, which could fundamentally alter aortovascular diagnostics and treatment. In conclusion, integrating CBP into aortovascular and cardiovascular risk management is encouraged. Further research is necessary to substantiate these aspects and explore the operative implications of CBP in clinical settings.
{"title":"Associations between central and brachial blood pressure in patients with hypertension and aortovascular disease: Implications for clinical practice","authors":"Abdulghafoor Alsomali , Gregory Y.H. Lip , Riaz Akhtar , Mark Field , Andrea Grillo , Nicola Tidbury , Donato Leo , Riccardo Proietti","doi":"10.1016/j.cpcardiol.2024.102874","DOIUrl":"10.1016/j.cpcardiol.2024.102874","url":null,"abstract":"<div><div>Central blood pressure (CBP) measurements, compared to brachial blood pressure (bBP), offer a superior predictive accuracy for aortovascular disease outcomes. This emphasises the distinctiveness of central hemodynamic metrics such as CBP, measuring the pressure directly exerted from the cardiac muscle to the major arteries, and provides a more direct assessment of cardiovascular workload than bBP, which measures the pressure against peripheral artery walls. This review synthesises findings evaluating the correlation between CBP and key aortovascular disease markers. Thoracic aortic aneurysm (TAA) growth is a crucial aspect of aortovascular assessment. CBP more accurately correlates with arterial stiffness (AS), the growth of TAA, and cardiovascular diseases, offering a more dependable prediction of aortovascular diseases, adverse cardiovascular events (CVE) and organ damage compared to bBP. The incorporation of CBP into routine clinical practice could enhance aortovascular assessments and therapeutic strategies when compared to bBP, particularly through a deeper understanding of aortic wave dynamics, which could fundamentally alter aortovascular diagnostics and treatment. In conclusion, integrating CBP into aortovascular and cardiovascular risk management is encouraged. Further research is necessary to substantiate these aspects and explore the operative implications of CBP in clinical settings.</div></div>","PeriodicalId":51006,"journal":{"name":"Current Problems in Cardiology","volume":"50 1","pages":"Article 102874"},"PeriodicalIF":3.0,"publicationDate":"2024-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142382306","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-05DOI: 10.1016/j.cpcardiol.2024.102872
Lin Wang, Xinchu Zhou, Danfeng Tang, Chao Zhang, Chunguang Pan, Fei Dai
Objective
Coronary heart disease (CHD) poses a significant threat to patients' health, with stable angina pectoris (SAP) being prevalent among individuals with CHD. This study aims to evaluate the effects of Traditional Chinese Exercise (TCE) on the physical and mental well-being, as well as the quality of life, of patients suffering from SAP.
Methods
We searched databases including China National Knowledge Infrastructure (CNKI), Wanfang, China Science and Technology Journal Database, PubMed, Web of Science, Cochrane and Embase for randomised controlled trials evaluating the effects of TCE on patients with SAP. Effect sizes and heterogeneity were calculated using RevMan 5.3 software.
Results
A total of 14 studies involving 1,288 participants were included in the analysis. Most studies were assessed to have a moderate risk of bias. The pooled results indicated that TCE significantly improved the 6-Minute Walk Test scores of patients with SAP (MD = 35.48, 95 % CI: 23.66–47.29, P < 0.001), enhanced scores across various dimensions of the Seattle Angina Questionnaire (P < 0.05), and reduced levels of depression (MD = -6.32, 95 % CI: -9.13 to -3.51, P < 0.001) and anxiety (MD = -6.41, 95 % CI: -9.18 to -3.64, P < 0.001) among SAP patients. Additionally, the Egger's test revealed no significant publication bias across the outcomes (P > 0.05).
Conclusion
TCE significantly enhances the physical and mental health of SAP patients, leading to improved quality of life. Future studies with larger sample sizes and high methodological quality are needed to further evaluate the clinical efficacy of TCE.
{"title":"Effects of traditional Chinese exercise on physical and mental health and quality of survival in patients with stable angina pectoris: A meta-analysis","authors":"Lin Wang, Xinchu Zhou, Danfeng Tang, Chao Zhang, Chunguang Pan, Fei Dai","doi":"10.1016/j.cpcardiol.2024.102872","DOIUrl":"10.1016/j.cpcardiol.2024.102872","url":null,"abstract":"<div><h3>Objective</h3><div>Coronary heart disease (CHD) poses a significant threat to patients' health, with stable angina pectoris (SAP) being prevalent among individuals with CHD. This study aims to evaluate the effects of Traditional Chinese Exercise (TCE) on the physical and mental well-being, as well as the quality of life, of patients suffering from SAP.</div></div><div><h3>Methods</h3><div>We searched databases including China National Knowledge Infrastructure (CNKI), Wanfang, China Science and Technology Journal Database, PubMed, Web of Science, Cochrane and Embase for randomised controlled trials evaluating the effects of TCE on patients with SAP. Effect sizes and heterogeneity were calculated using RevMan 5.3 software.</div></div><div><h3>Results</h3><div>A total of 14 studies involving 1,288 participants were included in the analysis. Most studies were assessed to have a moderate risk of bias. The pooled results indicated that TCE significantly improved the 6-Minute Walk Test scores of patients with SAP (MD = 35.48, 95 % CI: 23.66–47.29, <em>P</em> < 0.001), enhanced scores across various dimensions of the Seattle Angina Questionnaire (<em>P</em> < 0.05), and reduced levels of depression (MD = -6.32, 95 % CI: -9.13 to -3.51, <em>P</em> < 0.001) and anxiety (MD = -6.41, 95 % CI: -9.18 to -3.64, <em>P</em> < 0.001) among SAP patients. Additionally, the Egger's test revealed no significant publication bias across the outcomes (<em>P</em> > 0.05).</div></div><div><h3>Conclusion</h3><div>TCE significantly enhances the physical and mental health of SAP patients, leading to improved quality of life. Future studies with larger sample sizes and high methodological quality are needed to further evaluate the clinical efficacy of TCE.</div></div>","PeriodicalId":51006,"journal":{"name":"Current Problems in Cardiology","volume":"49 12","pages":"Article 102872"},"PeriodicalIF":3.0,"publicationDate":"2024-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142394965","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-05DOI: 10.1016/j.cpcardiol.2024.102871
Mohammed Mhanna MD, MPH , Mohammed Ayyad MD , Ibrahim Mortada MD , Ahmad Al-Abdouh MD , Ahmad Jabri MD , Abdulmajeed Al-Harbi MD , Mahmoud Barbarawi MD , Azizullah Beran MD , Ernesto Ruiz Duque MD , Shareef Mansour MBBS
Introduction
The management of anticoagulation in patients with durable left ventricular assist devices (LVADs) is challenging. Traditionally, warfarin has been used, but its limitations have prompted interest in direct oral anticoagulants (DOACs). This meta-analysis aims to evaluate the safety and efficacy of DOACs compared to warfarin in LVAD patients.
Methods
We searched databases for studies comparing DOACs and warfarin in LVAD patients. Primary outcomes were thromboembolic events and major bleeding events. Secondary outcomes were the individual components of the thromboembolic events, minor bleeding events, and all-cause mortality. Random-effects model was used to calculate log risk-ratios (RR) with 95 % confidence intervals (CI).
Results
Nine studies with a total of 316 LVAD patients (153 on DOACs, 163 on warfarin) were included. Thromboembolic events were similar between the groups (Log RR -0.42, 95 % CI:1.29 to 0.45, P = 0.34). Major bleeding events were significantly fewer in the DOAC group (Log RR -1.05, 95 % CI:1.73 to -0.36, P < 0.01). Minor bleeding events were also less common with DOACs (Log RR -0.77, 95 % CI:1.46 to -0.07, P = 0.03). No significant differences were observed in pump thrombosis, ischemic cerebrovascular accident events, or all-cause mortality.
Conclusion
DOACs appear to be a safe and effective alternative to warfarin for anticoagulation in LVAD patients, associated with fewer major and minor bleeding events. These findings support the consideration of DOACs in this patient population, though further research is needed to confirm these results and guide clinical practice.
{"title":"Direct oral anticoagulants versus warfarin in adults with durable left ventricular assist devices: A systematic review and meta-analysis","authors":"Mohammed Mhanna MD, MPH , Mohammed Ayyad MD , Ibrahim Mortada MD , Ahmad Al-Abdouh MD , Ahmad Jabri MD , Abdulmajeed Al-Harbi MD , Mahmoud Barbarawi MD , Azizullah Beran MD , Ernesto Ruiz Duque MD , Shareef Mansour MBBS","doi":"10.1016/j.cpcardiol.2024.102871","DOIUrl":"10.1016/j.cpcardiol.2024.102871","url":null,"abstract":"<div><h3>Introduction</h3><div>The management of anticoagulation in patients with durable left ventricular assist devices (LVADs) is challenging. Traditionally, warfarin has been used, but its limitations have prompted interest in direct oral anticoagulants (DOACs). This meta-analysis aims to evaluate the safety and efficacy of DOACs compared to warfarin in LVAD patients.</div></div><div><h3>Methods</h3><div>We searched databases for studies comparing DOACs and warfarin in LVAD patients. Primary outcomes were thromboembolic events and major bleeding events. Secondary outcomes were the individual components of the thromboembolic events, minor bleeding events, and all-cause mortality. Random-effects model was used to calculate log risk-ratios (RR) with 95 % confidence intervals (CI).</div></div><div><h3>Results</h3><div>Nine studies with a total of 316 LVAD patients (153 on DOACs, 163 on warfarin) were included. Thromboembolic events were similar between the groups (Log RR -0.42, 95 % CI:1.29 to 0.45, <em>P</em> = 0.34). Major bleeding events were significantly fewer in the DOAC group (Log RR -1.05, 95 % CI:1.73 to -0.36, <em>P <</em> 0.01). Minor bleeding events were also less common with DOACs (Log RR -0.77, 95 % CI:1.46 to -0.07, <em>P</em> = 0.03). No significant differences were observed in pump thrombosis, ischemic cerebrovascular accident events, or all-cause mortality.</div></div><div><h3>Conclusion</h3><div>DOACs appear to be a safe and effective alternative to warfarin for anticoagulation in LVAD patients, associated with fewer major and minor bleeding events. These findings support the consideration of DOACs in this patient population, though further research is needed to confirm these results and guide clinical practice.</div></div>","PeriodicalId":51006,"journal":{"name":"Current Problems in Cardiology","volume":"49 12","pages":"Article 102871"},"PeriodicalIF":3.0,"publicationDate":"2024-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142382307","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Stroke is a leading cause of death and disability worldwide. While caregivers play a vital role in recovery, their long-term support can affect their mental well-being. This study aims to estimate the pooled prevalence of depression and associated factors among caregivers of stroke survivors in developing countries.
Method
A comprehensive literature search using the preferred reporting items for systematic review and meta-analysis (PRISMA) statement was conducted on Scopus, PsycINFO, EMBASE, Google Scholar, Psychiatry Online, and PubMed/MEDLINE. Data were extracted via a Microsoft Excel spreadsheet and analyzed via STATA version 11.0. Egger regression tests and funnel plot analysis were used to check for publication bias, and the I2 statistic was used to evaluate statistical heterogeneity. Sensitivity and subgroup analyses were also conducted to identify potential causes of heterogeneity.
Results
Seventeen articles from 12 different countries were analyzed. The pooled prevalence of depression among caregivers of stroke survivors was 48.75% (95% confidence interval (CI): 38.64– 58.86). However, the prevalence of depression ranged widely from 17.2%–76%, which may be due to the variation in the depression assessment tools used, types of caregivers, and continent. A long duration of caregiving was the only significant factor associated with depression among caregivers of stroke survivors.
Conclusion
The current systematic review and meta-analysis revealed a high prevalence of depression among caregivers of stroke survivors in developing countries. However, there was significant heterogeneity between studies, which could be explained by differences in the depression assessment tools used, types of caregivers, and continents. Factors such as long caregiving times were significantly associated with depression among caregivers of stroke survivors. The study suggests that the depression assessment tool utilized itself could have modified the prevalence of depression among caregivers of stroke survivors. Therefore, a single depression assessment tool needs to be authorized.
{"title":"Prevalence of depression and associated factors among caregivers of stroke survivors in developing countries: A systematic review and meta-analysis","authors":"Tekletsadik Tekleslassie Alemayehu , Yilkal Abebaw Wassie , Gebresilassie Tadesse , Setegn Fentahun , Abebaw Setegn Yazie , Berhihun Agegn Mengistie , Mnichil Chanie Worku , Aschalew Mulatu , Abaynesh Fentahun Bekalu , Eskedar Dires Gebremeskel , Rahel Belete Abebe , Leila Kenzu Kemal , Zemenu Wubie , Gebremariam Wulie Geremew","doi":"10.1016/j.cpcardiol.2024.102876","DOIUrl":"10.1016/j.cpcardiol.2024.102876","url":null,"abstract":"<div><h3>Background</h3><div>Stroke is a leading cause of death and disability worldwide. While caregivers play a vital role in recovery, their long-term support can affect their mental well-being. This study aims to estimate the pooled prevalence of depression and associated factors among caregivers of stroke survivors in developing countries.</div></div><div><h3>Method</h3><div>A comprehensive literature search using the preferred reporting items for systematic review and meta-analysis (PRISMA) statement was conducted on Scopus, PsycINFO, EMBASE, Google Scholar, Psychiatry Online, and PubMed/MEDLINE. Data were extracted via a Microsoft Excel spreadsheet and analyzed via STATA version 11.0. Egger regression tests and funnel plot analysis were used to check for publication bias, and the I<sup>2</sup> statistic was used to evaluate statistical heterogeneity. Sensitivity and subgroup analyses were also conducted to identify potential causes of heterogeneity.</div></div><div><h3>Results</h3><div>Seventeen articles from 12 different countries were analyzed. The pooled prevalence of depression among caregivers of stroke survivors was 48.75% (95% confidence interval (CI): 38.64– 58.86). However, the prevalence of depression ranged widely from 17.2%–76%, which may be due to the variation in the depression assessment tools used, types of caregivers, and continent. A long duration of caregiving was the only significant factor associated with depression among caregivers of stroke survivors.</div></div><div><h3>Conclusion</h3><div>The current systematic review and meta-analysis revealed a high prevalence of depression among caregivers of stroke survivors in developing countries. However, there was significant heterogeneity between studies, which could be explained by differences in the depression assessment tools used, types of caregivers, and continents. Factors such as long caregiving times were significantly associated with depression among caregivers of stroke survivors. The study suggests that the depression assessment tool utilized itself could have modified the prevalence of depression among caregivers of stroke survivors. Therefore, a single depression assessment tool needs to be authorized.</div></div>","PeriodicalId":51006,"journal":{"name":"Current Problems in Cardiology","volume":"49 12","pages":"Article 102876"},"PeriodicalIF":3.0,"publicationDate":"2024-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142382308","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"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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