Current Problems in Cardiology最新文献_第7页

Cardiovascular disease prevalence and associated factors in a low-resource setting: A multilevel analysis from Somalia's first demographic health survey 低资源环境中的心血管疾病流行率及相关因素：索马里首次人口健康调查的多层次分析

IF 3 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Current Problems in Cardiology

Pub Date : 2024-09-22 DOI: 10.1016/j.cpcardiol.2024.102861

Abdirashid M. Yousuf , Hodo Abdikarim , Mohamed A. Hussein , Abdikadir N. Abdi , Harun I. Warsame , Abdisalam Hassan Muse

Background

Cardiovascular diseases (CVDs) are a leading cause of death globally, with low- and middle-income countries disproportionately affected. Somalia, a nation grappling with persistent humanitarian crises and a rising burden of non-communicable diseases, has limited data on CVD prevalence and its risk factors. This study, the first of its kind in Somalia, leverages data from the inaugural nationally representative demographic health survey to examine the prevalence and associated factors of CVD among Somali adults.

Methods

A cross-sectional analysis was conducted using data from the 2020 Somali Demographic Health Survey, encompassing 5062 participants aged 35 years and older. Multilevel logistic regression was utilized to explore associations between individual-level and community-level factors and CVD prevalence. Individual-level factors included age, sex, marital status, education, wealth, smoking, and khat chewing. Community-level factors encompassed region and type of residence.

Results

The prevalence of CVD in Somalia was found to be 7.1%. Community-level factors were significantly associated with CVD prevalence. Residents of Sool region exhibited higher odds of CVD, while those in Banadir region had lower odds. Nomadic communities demonstrated lower CVD risk compared to urban areas. School attendance was marginally associated with CVD risk. After controlling for other factors, sex of the household head remained significant, with females having slightly lower odds of CVD.

Conclusion

This study underscores the critical influence of community-level factors, particularly region and type of residence, on CVD prevalence in Somalia. The findings highlight the need for targeted interventions that address geographic disparities and promote healthy lifestyles within communities. Future research should delve deeper into the underlying mechanisms of these associations and explore the impact of individual-level factors like school attendance and sex on CVD risk.

背景心血管疾病（CVD）是全球死亡的主要原因之一，中低收入国家受到的影响尤为严重。索马里正努力应对持续的人道主义危机和不断增加的非传染性疾病负担，但有关心血管疾病发病率及其风险因素的数据却十分有限。本研究是索马里的首项此类研究，利用首次全国代表性人口健康调查的数据，研究了索马里成年人心血管疾病的患病率和相关因素。方法利用 2020 年索马里人口健康调查的数据进行了横断面分析，共有 5062 名 35 岁及以上的参与者。利用多层次逻辑回归探讨了个人层面和社区层面因素与心血管疾病患病率之间的关联。个人因素包括年龄、性别、婚姻状况、教育程度、财富、吸烟和咀嚼阿拉伯茶叶。结果发现，索马里的心血管疾病患病率为 7.1%。社区因素与心血管疾病的发病率有很大关系。苏勒地区的居民患心血管疾病的几率较高，而巴纳迪尔地区的居民患心血管疾病的几率较低。与城市地区相比，游牧社区的心血管疾病风险较低。入学率与心血管疾病风险的关系不大。在对其他因素进行控制后，户主的性别仍具有重要意义，女性患心血管疾病的几率略低。研究结果突出表明，有必要在社区内采取有针对性的干预措施，以解决地域差异并促进健康的生活方式。未来的研究应深入探讨这些关联的内在机制，并探讨就学率和性别等个人层面因素对心血管疾病风险的影响。

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引用次数: 0

Mindfulness training for cardiovascular health in type 2 diabetes: A critical review 针对 2 型糖尿病患者心血管健康的正念训练：批判性评论。

IF 3 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Current Problems in Cardiology

Pub Date : 2024-09-21 DOI: 10.1016/j.cpcardiol.2024.102833

Arnav Gandhi , Rhenita Rajkumar , Sanjay Nehru Dakka , Jeba Sania , Fatima Khurram , Jorge Cabrera , Swathi N․L․

Mindfulness training has gained increasing attention as a potential intervention to improve cardiovascular health, particularly in populations with chronic conditions, such as type 2 diabetes. Given the heightened cardiovascular risk associated with type 2 diabetes, identifying effective non-pharmacological strategies to mitigate these risks is crucial. This critical review assessed the current evidence on the impact of mindfulness training on cardiovascular health in individuals with type 2 diabetes. A comprehensive literature search was conducted using the PubMed database, and studies were selected based on stringent inclusion and exclusion criteria. The search strategy was meticulously designed to filter out high-quality articles and ensure that only the most relevant and rigorous studies were included in the analysis. The findings from this review suggest that while mindfulness training has the potential to improve cardiovascular health in individuals with type 2 diabetes, evidence remains mixed. Some studies have reported significant improvements in cardiovascular markers, such as blood pressure and inflammation, while others have shown limited or no effects. This variability highlights the need for further research to better understand the mechanisms underlying these outcomes and identify the most effective mindfulness interventions for this population. In conclusion, mindfulness training appears to be a promising approach for enhancing cardiovascular health in Type 2 diabetes patients, yet the current evidence is inconclusive. Future research should focus on standardizing mindfulness interventions, conducting larger clinical trials, and exploring the long-term benefits of these interventions on cardiovascular outcomes in high-risk populations.

正念训练作为一种改善心血管健康的潜在干预措施，受到了越来越多的关注，尤其是在 2 型糖尿病等慢性病患者中。鉴于 2 型糖尿病会增加心血管风险，因此确定有效的非药物策略来降低这些风险至关重要。这篇重要综述评估了正念训练对 2 型糖尿病患者心血管健康影响的现有证据。我们使用 PubMed 数据库进行了全面的文献检索，并根据严格的纳入和排除标准对研究进行了筛选。搜索策略经过精心设计，以筛选出高质量的文章，并确保只有最相关、最严谨的研究才被纳入分析。本综述的研究结果表明，虽然正念训练有可能改善 2 型糖尿病患者的心血管健康，但证据仍然参差不齐。一些研究报告显示，心血管指标（如血压和炎症）有明显改善，而另一些研究则显示效果有限或没有效果。这种差异凸显了进一步研究的必要性，以便更好地了解这些结果的内在机制，并确定对这一人群最有效的正念干预措施。总之，正念训练似乎是增强 2 型糖尿病患者心血管健康的一种很有前景的方法，但目前的证据尚不确定。未来的研究应重点关注正念干预措施的标准化、开展更大规模的临床试验以及探索这些干预措施对高危人群心血管预后的长期益处。

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引用次数: 0

From molecules to heart regeneration: Understanding the complex and profound role of non-coding RNAs in stimulating cardiomyocyte proliferation for cardiac repair 从分子到心脏再生：了解非编码 RNA 在刺激心肌细胞增殖以促进心脏修复方面的复杂而深远的作用。

IF 3 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Current Problems in Cardiology

Pub Date : 2024-09-19 DOI: 10.1016/j.cpcardiol.2024.102857

Mohammed Alissa , Mohammed Aldurayhim , Osama Abdulaziz , Ohud Alsalmi , Alsamghan Awad , Uthman Balgith Algopishi , Sarah Alharbi , Awaji Y. Safhi , Khadijah Hassan Khan , Christin Uffar

Recent studies of noncoding genomes have shown important implications for regulating gene expression and genetic programs during development and their association with health, including cardiovascular disease. There are nearly 2,500 microRNAs (miRNAs), 12,000 long-chain non-coding RNAs (lncRNA), and nearly 4,000 circular RNAs (circles). Even though they do not code for proteins, they make up nearly 99% of the human genome. Non-coding RNA families (ncRNAs) have recently been discovered and established as novel and necessary controllers of cardiovascular risk factors and cellular processes and, therefore, have the potential to improve the diagnosis and prediction of cardiovascular disease. The increase in the prevalence of cardiovascular disease can be explained by the shortcomings of existing therapies, which focus only on the non-coding RNAs that protein codes for. On the other hand, recent studies point to the possibility of using ncRNAs in the early detection and intervention of CVD. These findings suggest that developing diagnostic tools and therapies based on miRNAs, lncRNAs, and circRNAs will potentially enhance the clinical management of patients with cardiovascular disease. Cardiovascular diseases include CH, HF, RHD, ACS, MI, AS, MF, ARR, and PAH, of which CH is the most common cardiovascular disease, followed by HF and RHD. This paper aims to elucidate the biological and clinical significance of miRNAs, increase, and circles, as well as their expression profiles and the possibility of regulating non-coding transcripts in cardiovascular diseases to improve the application of ncRNAs in diagnosis and treatment.

最近对非编码基因组的研究表明，非编码基因组对调节发育过程中的基因表达和遗传程序具有重要意义，而且与健康（包括心血管疾病）有关。目前有近 2,500 种微小核糖核酸（miRNA）、12,000 种长链非编码核糖核酸（lncRNA）和近 4,000 种环状核糖核酸（circular RNA）。尽管它们不编码蛋白质，但却占人类基因组的近 99%。非编码 RNA 家族（ncRNAs）最近被发现并确定为心血管风险因素和细胞过程的新型必要控制者，因此有可能改善心血管疾病的诊断和预测。心血管疾病发病率的增加可以解释为现有疗法的缺陷，这些疗法只关注蛋白质编码的非编码 RNA。另一方面，最近的研究指出了利用 ncRNA 早期检测和干预心血管疾病的可能性。这些研究结果表明，开发基于 miRNA、lncRNA 和 circRNA 的诊断工具和疗法将有可能提高心血管疾病患者的临床治疗水平。心血管疾病包括心肌梗死、心房颤动、急性心肌梗死、心肌梗死、急性心肌梗死、心肌梗死、ARR 和 PAH，其中心肌梗死是最常见的心血管疾病，其次是心房颤动和急性心肌梗死。本文旨在阐明 miRNAs 的生物学和临床意义，以及它们在心血管疾病中的表达谱和调控非编码转录本的可能性，以提高 ncRNAs 在诊断和治疗中的应用。

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引用次数: 0

Imaging modalities in cardiac amyloidosis 心脏淀粉样变性的成像模式。

IF 3 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Current Problems in Cardiology

Pub Date : 2024-09-19 DOI: 10.1016/j.cpcardiol.2024.102858

Zubair Bashir MD , Mahnoor Musharraf MBBS , Rabia Azam MBBS , Syed Bukhari MD

Cardiac amyloidosis (CA) is an infiltrative restrictive cardiomyopathy caused by the deposition of amyloid fibrils in the myocardium, presenting primarily as transthyretin cardiac amyloidosis (ATTR) and immunoglobulin light chain cardiac amyloidosis (AL). ATTR is further classified into wild-type (ATTRwt) and hereditary (ATTRv) based on transthyretin gene mutation. The disease is increasingly recognized as a significant cause of heart failure. Advances in diagnostic modalities, including electrocardiography, echocardiography, cardiac magnetic resonance imaging, and technetium pyrophosphate scintigraphy, have revolutionized the non-invasive diagnosis of CA. While ATTR can often be diagnosed with scintigraphy, AL typically requires histological confirmation. This review explores these diagnostic tools, emphasizing their role in early detection and quantification of disease burden, which are crucial for timely treatment and prognostication. This comprehensive overview aims to aid clinicians in efficiently diagnosing CA, ultimately improving patient outcomes.

心脏淀粉样变性（CA）是由淀粉样纤维沉积在心肌中引起的浸润性局限性心肌病，主要表现为转甲状腺素心脏淀粉样变性（ATTR）和免疫球蛋白轻链心脏淀粉样变性（AL）。根据转甲状腺素基因突变，ATTR 又可分为野生型（ATTRwt）和遗传型（ATTRv）。越来越多的人认识到这种疾病是导致心力衰竭的重要原因。包括心电图、超声心动图、心脏磁共振成像和焦磷酸锝闪烁成像在内的诊断方法的进步彻底改变了 CA 的无创诊断。ATTR 通常可通过闪烁成像诊断，而 AL 通常需要组织学证实。本综述探讨了这些诊断工具，强调了它们在早期检测和量化疾病负担方面的作用，这对及时治疗和预后至关重要。本综述旨在帮助临床医生有效诊断 CA，最终改善患者的预后。

引用次数: 0

Artificial intelligence-enhanced electrocardiogram for the diagnosis of cardiac amyloidosis: A systemic review and meta-analysis 人工智能增强心电图诊断心脏淀粉样变性：系统综述与元分析》。

IF 3 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Current Problems in Cardiology

Pub Date : 2024-09-19 DOI: 10.1016/j.cpcardiol.2024.102860

Laibah Arshad Khan MBBS , Fahad Hassan Shaikh MBBS , Muhammad Sami Khan MBBS , Bayan Zafar MBBS , Maheera Farooqi MBBS , Bayarbaatar Bold MD , Hafiza Madiha Aslam MBBS , Nabeeha Essam MBBS , Isma Noor MBBS , Amber Siddique MBBS , Saad Shakil MBBS , Mahnoor Asghar Keen MBBS

Background

Diagnosis of cardiac amyloidosis (CA) is often delayed due to variability in clinical presentation. The electrocardiogram (ECG) is one of the most common and widely available tools for assessing cardiovascular diseases. Artificial intelligence (AI) models analyzing ECG have recently been developed to detect CA, but their pooled accuracy is yet to be evaluated.

Methods

We searched the Scopus, MEDLINE, and Cochrane CENTRAL databases until April 2024 for studies assessing AI-enhanced ECG diagnosis of CA. Studies reporting findings from derivation and validation cohorts were included. Studies combining other diagnostic modalities, such as echocardiography, were excluded. The outcome of interest was the area under the receiver operating characteristic curve (AUC) for overall CA and subtypes transthyretin amyloidosis (ATTR) and light chain amyloidosis (AL). Analysis was done using RevMan 5.4.1 general inverse variance random effects model, pooling data for AUC and 95 % confidence intervals (CI).

Results

Five studies comprising seven cohorts met the eligibility criteria. The total derivation and validation cohorts were 8,639 and 3,843, respectively, although one study did not describe this data. The AUC was 0.89 (95 % CI, 0.86-0.91) for cardiac amyloidosis, 0.90 (95 % CI, 0.86-0.95) for ATTR amyloidosis, and 0.80 (95 % CI, 0.80-0.93) for AL amyloidosis.

Conclusion

AI-enhanced ECG models effectively detect CA and may provide a valuable tool for the early detection and intervention of this disease.

背景：由于临床表现的多变性，心脏淀粉样变性（CA）的诊断常常被延迟。心电图（ECG）是评估心血管疾病最常见、最广泛使用的工具之一。分析心电图的人工智能（AI）模型最近已被开发出来用于检测CA，但其综合准确性还有待评估：我们在 Scopus、MEDLINE 和 Cochrane CENTRAL 数据库中检索了截至 2024 年 4 月的评估 AI 增强心电图诊断 CA 的研究。纳入了报告衍生队列和验证队列结果的研究。排除了结合其他诊断方式（如超声心动图）的研究。研究结果是总体CA和亚型转甲状腺素淀粉样变性（ATTR）和轻链淀粉样变性（AL）的接收者操作特征曲线下面积（AUC）。分析采用RevMan 5.4.1一般反方差随机效应模型，对AUC和95%置信区间（CI）数据进行汇总：共有五项研究、七个队列符合资格标准。推导队列和验证队列的总人数分别为 8,639 人和 3,843 人，但有一项研究未说明该数据。心脏淀粉样变性的AUC为0.89（95% CI，0.86-0.91），ATTR淀粉样变性为0.90（95% CI，0.86-0.95），AL淀粉样变性为0.80（95% CI，0.80-0.93）：结论：人工智能增强心电图模型可有效检测CA，是早期检测和干预该疾病的重要工具。

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引用次数: 0

Cost-effectiveness of lowering systolic blood pressure in reducing cardiovascular disease burden in Australia 降低收缩压对减轻澳大利亚心血管疾病负担的成本效益。

IF 3 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Current Problems in Cardiology

Pub Date : 2024-09-19 DOI: 10.1016/j.cpcardiol.2024.102859

Haeri Cho , Jinkyeong Lee , Alison Cao , Grant Choo Way Leong , Kathryn Chenh , Dina Abushanab , Clara Marquina , Zanfina Ademi (Professor)

Aim

Cardiovascular diseases (CVD) remain a leading global cause of death. This research examines the impact of lowering systolic blood pressure (SBP) on reducing CVD prevalence. It also assesses the cost-effectiveness of such interventions from a healthcare perspective.

Methods

A synthesis matrix was created to analyse CVD risk factors (SBP, smoking, diabetes, and cholesterol), identifying SBP as the most impactful modifiable risk factor. We utilised validated health economic model which incorporates pooled cohort risk equations to predict the 10-year risk of the first CVD event, factoring in participants' gender, age, SBP, cholesterol levels, diabetes, and smoking status. The primary outcome was the incremental cost-effectiveness ratio (ICER), measured in costs per quality-adjusted life years (QALYs) and years of life lived. In a hypothetical scenario, we reduced SBP by 20 % in participants with levels ≥140 mmHg, based on the 2016 Hypertension Management Guide (National Heart Foundation of Australia). A 5 % discount rate was applied to all costs and outcomes.

Results

After reducing SBP by 20 % in participants with levels ≥140 mmHg, we observed a decrease in CVD deaths by 4756 cases (1.21 %) and non-fatal CVD events by 7877 cases (0.77 %). Post-intervention, there was an increase in years of life lived and QALYs experienced by 26,252 years (0.03 %) and 23,928 years (0.03 %), respectively. Acute and chronic costs also decreased, with acute event costs reduced by AUD 24,437,625 (0.28 %) and chronic costs by AUD 18,544,776 (0.71 %). Hypothetical scenario was found to be dominant (cost-saving).

Conclusions

Our results demonstrate that reducing SBP at the population level is cost-saving and has a significant positive impact on cardiovascular outcomes and related costs for those at risk of CVD.

目的：心血管疾病（CVD）仍然是全球主要死因。本研究探讨了降低收缩压 (SBP) 对减少心血管疾病发病率的影响，并从医疗保健角度评估了此类干预措施的成本效益。研究还从医疗保健的角度评估了此类干预措施的成本效益：我们创建了一个综合矩阵来分析心血管疾病的风险因素（收缩压、吸烟、糖尿病和胆固醇），确定收缩压是影响最大的可改变风险因素。我们采用了经过验证的健康经济模型，该模型结合了集合队列风险方程来预测首次心血管疾病事件的 10 年风险，并考虑了参与者的性别、年龄、血压、胆固醇水平、糖尿病和吸烟状况。主要结果是增量成本效益比 (ICER)，以每质量调整生命年 (QALY) 的成本和寿命来衡量。在假设情况下，根据《2016 年高血压管理指南》（澳大利亚国家心脏基金会），我们将血压水平≥ 140 mmHg 的参与者的 SBP 降低了 20%。所有成本和结果均采用 5% 的贴现率：将SBP水平≥140 mmHg的参与者的SBP降低20%后，我们观察到心血管疾病死亡人数减少了4756例（1.21%），非致命心血管疾病事件减少了7877例（0.77%）。干预后，寿命和 QALY 分别增加了 26,252 年（0.03%）和 23,928 年（0.03%）。急性和慢性成本也有所降低，急性事件成本降低了 24,437,625 澳元（0.28%），慢性成本降低了 18,544,776 澳元（0.71%）。假设情况占主导地位（节省成本）：我们的研究结果表明，在人群水平上降低 SBP 可以节约成本，并对心血管疾病的预后和心血管疾病高危人群的相关成本产生显著的积极影响。

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引用次数: 0

Decoding the ECG patterns of apical hypertrophic cardiomyopathy: Unraveling differential diagnoses 解码心尖肥厚型心肌病的心电图模式：解读鉴别诊断

IF 3 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Current Problems in Cardiology

Pub Date : 2024-09-17 DOI: 10.1016/j.cpcardiol.2024.102856

Shyla Gupta , Connie Xie , Juan Farina , Hasan Alturki , Sebastian Garcia-Zamora , Amer Johri , Arshdeep Raul , Adrian Baranchuk

引用次数: 0

Cardiomyopathies in Pregnancy: Trends and Clinical Outcomes in Delivery Hospitalizations in the United States (2005-2020) 妊娠期心肌病：美国分娩住院趋势和临床结果（2005-2020 年）

IF 3 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Current Problems in Cardiology

Pub Date : 2024-09-17 DOI: 10.1016/j.cpcardiol.2024.102855

Danish Iltaf Satti MBBS , Eunjung Choi MD , Harsh P. Patel MD , Mohammed Faisaluddin MD , Adhya Mehta MD , Bhavin Patel MD , Chigolum Pamela Oyeka MD, MPH , Shruti Hegde MD , Yaa Adoma Kwapong MD, MPH , Jeffrey Shi Kai Chan MBChB, MPH , Shannon Anderson MD , Nasrien E. Ibrahim MD , Shashank S. Sinha MD, MSc , Sourbha S. Dani MD, MSc , Garima Sharma MD

Background

Cardiomyopathy (CDM) in pregnancy is associated with maternal morbidity and mortality.

Objectives

To explore trends and clinical outcomes in CDM subtypes during delivery hospitalizations.

Methods

We used the National Inpatient Sample database to identify delivery hospitalizations between 2005-2020 by CDM subtypes: peripartum (PPCM), dilated (DCM), hypertrophic (HCM), and restrictive (RCM). Maternal and fetal outcomes were identified using International Classification of Diseases, 9th and 10th Revision, Clinical Modification codes. Baseline characteristics and temporal trends of CDM subtypes were analyzed. Maternal cardiovascular, pregnancy, and fetal outcomes were evaluated by CDM subtype using univariate logistic regression. The primary outcome was in-hospital mortality.

Results

During 2005-2020, 37,125 out of 61,811,842 delivery hospitalizations were complicated by CDM. Among CDM-related delivery hospitalizations, the most prevalent were DCM (46%), followed by PPCM (45.6%), HCM (4.6%), and RCM (3.9%). The rates of in-hospital mortality (1.7%), adverse cardiovascular events such as acute heart failure (17%), cardiogenic shock (3.4%), and cardiac arrest (3.1%), and adverse pregnancy outcomes such as preeclampsia (14.2%) and preterm labor (11%), were highest among PPCM (all p < 0.0001). The prevalence of PPCM (49.1% to 38.5%) decreased while the prevalence of HCM (2.7% to 8.8%) and DCM (48% to 52.2%) increased over time.

Conclusions

Over a 15-year period, PPCM had higher rates of in-hospital mortality, cardiovascular events, and adverse pregnancy outcomes compared to other CDM subtypes. While the prevalence of PPCM decreased over time, the prevalence of HCM and DCM increased. Hence, further research on cardiomyopathies during pregnancy and prospective studies on this vulnerable patient cohort are urgently needed.

背景妊娠期心肌病（CDM）与孕产妇发病率和死亡率相关。方法我们使用全国住院病人抽样数据库，按 CDM 亚型（围产期（PPCM）、扩张型（DCM）、肥厚型（HCM）和限制型（RCM））识别 2005-2020 年间的住院分娩病例。孕产妇和胎儿的结果是通过《国际疾病分类》第 9 版和第 10 版临床修正版代码确定的。分析了 CDM 亚型的基线特征和时间趋势。采用单变量逻辑回归对 CDM 亚型的产妇心血管、妊娠和胎儿结局进行了评估。结果2005-2020年间，61,811,842例住院分娩中有37,125例因CDM而并发症。在 CDM 相关的住院分娩中，最常见的是 DCM（46%），其次是 PPCM（45.6%）、HCM（4.6%）和 RCM（3.9%）。PPCM 的院内死亡率（1.7%）、急性心力衰竭（17%）、心源性休克（3.4%）和心脏骤停（3.1%）等不良心血管事件以及子痫前期（14.2%）和早产（11%）等不良妊娠结局的发生率最高（所有 p 均为 0.0001）。结论15 年间，与其他 CDM 亚型相比，PPCM 的院内死亡率、心血管事件发生率和不良妊娠结局发生率更高。随着时间的推移，PPCM 的患病率有所下降，而 HCM 和 DCM 的患病率则有所上升。因此，迫切需要对孕期心肌病进行进一步研究，并对这一脆弱的患者群体进行前瞻性研究。

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引用次数: 0

Antegrade approach versus retrograde approach percutaneous coronary intervention for chronic total occlusion: An updated meta-analysis 经皮冠状动脉介入治疗慢性全闭塞的逆行途径与顺行途径：最新的 Meta 分析。

IF 3 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Current Problems in Cardiology

Pub Date : 2024-09-17 DOI: 10.1016/j.cpcardiol.2024.102832

Ahmed Abdelaziz MD , Abdelrahman Hafez MD , Karim Atta M.B.B.S , Hanaa Elsayed MD , Ahmed Elaraby MD , Ahmed A. Ibrahim MD , Ahmed Farid Gadelmawla MD , Ahmed Helmi MD , Basel Abdelazeem MD , Carl J. Lavie MD , Jose Tafur-Soto MD

Background

Retrograde approach has notably improved success rates of chronic total occlusion (CTO) percutaneous coronary intervention (PCI). However, longer procedural time, increase use of fluoroscopy and contrast dye have been reported in retrograde techniques in CTO PCI. We aimed to study in-hospital and long-term outcomes of retrograde approach versus antegrade approach in CTO PCI.

Methods

We searched PubMed, Scopus, WOS, and Cochrane Central until June 2023 to include all relevant studies that compared retrograde approach versus antegrade approach in patients with CTO PCI. We synthesized the outcome data using a random-effects model, expressing the effect estimates as odds ratios (OR) or mean difference (MD) with corresponding 95 % confidence intervals (CI).

Results

A total of 18 studies comprising 21,276 patients were included in the analysis. Regarding in-hospital outcomes, antegrade approach was associated with lower odds of MACE (OR= 0.34, 95 % CI: 0.23 to 0.51), all-cause mortality (OR= 0.35, 95 % CI: 0.19 to 0.64), MI (OR= 0.36, 95 % CI: 0.25 to 0.53), urgent pericardiocentesis (OR= 0.27, 95 % CI: 0.16 to 0.46), CIN (OR= 0.46, 95 % CI: 0.33 to 0.65), procedural complications (OR= 0.52, 95 % CI: 0.33 to 0.83), target vessel perforation (OR= 0.45, 95 % CI: 0.32 to 0.64). while antegrade was associated with higher success rates (OR= 1.16, 95 % CI: 1.1 to 1.22).

Conclusion

Compared to antegrade technique, retrograde was associated with higher risk for in-hospital and long-term adverse events, and preferably should be performed in more complex CTO lesions.

背景：逆行方法显著提高了慢性全闭塞（CTO）经皮冠状动脉介入治疗（PCI）的成功率。然而，有报道称逆行技术在 CTO PCI 中的手术时间更长，透视和造影剂的使用增加。我们的目的是研究逆行法与顺行法在 CTO PCI 中的院内和长期疗效：我们检索了 PubMed、Scopus、WOS 和 Cochrane Central，截至 2023 年 6 月，纳入了所有比较 CTO PCI 患者逆行入路与顺行入路的相关研究。我们采用随机效应模型对结果数据进行了综合分析，将效应估计值表示为几率比（OR）或平均差（MD），以及相应的95%置信区间（CI）：共有18项研究、18830名患者参与了分析。在院内结局方面，逆行入路与较低的 MACE（OR= 0.34，95% CI：0.23 至 0.51）、全因死亡率（OR= 0.35，95% CI：0.19 至 0.64）、MI（OR= 0.36，95% CI：0.25 至 0.53）、紧急心包穿刺术（OR= 0.27，95% CI：0.CIN（OR= 0.46，95% CI：0.33~0.65）、手术并发症（OR= 0.52，95% CI：0.33~0.83）、靶血管穿孔（OR= 0.45，95% CI：0.32~0.64）：结论：与逆行技术相比，逆行技术与较高的院内和长期不良事件风险相关，最好在较复杂的CTO病变中实施逆行技术。

{"title":"Antegrade approach versus retrograde approach percutaneous coronary intervention for chronic total occlusion: An updated meta-analysis","authors":"Ahmed Abdelaziz MD , Abdelrahman Hafez MD , Karim Atta M.B.B.S , Hanaa Elsayed MD , Ahmed Elaraby MD , Ahmed A. Ibrahim MD , Ahmed Farid Gadelmawla MD , Ahmed Helmi MD , Basel Abdelazeem MD , Carl J. Lavie MD , Jose Tafur-Soto MD","doi":"10.1016/j.cpcardiol.2024.102832","DOIUrl":"10.1016/j.cpcardiol.2024.102832","url":null,"abstract":"<div><h3>Background</h3><div>Retrograde approach has notably improved success rates of chronic total occlusion (CTO) percutaneous coronary intervention (PCI). However, longer procedural time, increase use of fluoroscopy and contrast dye have been reported in retrograde techniques in CTO PCI. We aimed to study in-hospital and long-term outcomes of retrograde approach versus antegrade approach in CTO PCI.</div></div><div><h3>Methods</h3><div>We searched PubMed, Scopus, WOS, and Cochrane Central until June 2023 to include all relevant studies that compared retrograde approach versus antegrade approach in patients with CTO PCI. We synthesized the outcome data using a random-effects model, expressing the effect estimates as odds ratios (OR) or mean difference (MD) with corresponding 95 % confidence intervals (CI).</div></div><div><h3>Results</h3><div>A total of 18 studies comprising 21,276 patients were included in the analysis. Regarding in-hospital outcomes, antegrade approach was associated with lower odds of MACE (OR= 0.34, 95 % CI: 0.23 to 0.51), all-cause mortality (OR= 0.35, 95 % CI: 0.19 to 0.64), MI (OR= 0.36, 95 % CI: 0.25 to 0.53), urgent pericardiocentesis (OR= 0.27, 95 % CI: 0.16 to 0.46), CIN (OR= 0.46, 95 % CI: 0.33 to 0.65), procedural complications (OR= 0.52, 95 % CI: 0.33 to 0.83), target vessel perforation (OR= 0.45, 95 % CI: 0.32 to 0.64). while antegrade was associated with higher success rates (OR= 1.16, 95 % CI: 1.1 to 1.22).</div></div><div><h3>Conclusion</h3><div>Compared to antegrade technique, retrograde was associated with higher risk for in-hospital and long-term adverse events, and preferably should be performed in more complex CTO lesions.</div></div>","PeriodicalId":51006,"journal":{"name":"Current Problems in Cardiology","volume":"49 12","pages":"Article 102832"},"PeriodicalIF":3.0,"publicationDate":"2024-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142300238","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}

引用次数: 0

The hidden epidemic: Hypertension-related mortality surges amongst younger adults in the United States 隐性流行病：美国年轻成年人中与高血压相关的死亡率激增

IF 3 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Current Problems in Cardiology

Pub Date : 2024-09-12 DOI: 10.1016/j.cpcardiol.2024.102842

Ahmed Kamal Siddiqi MBBS , Kumail Mustafa Ali MBBS , Muhammad Talha Maniya MBBS , Ahmed Mustafa Rashid MBBS , Shahzeb Arif Khatri MBBS , Mariana Garcia MD , Raymundo A. Quintana MD , Muhammad Naeem MD

Background

The prevalence of hypertension (HTN) has significantly increased among younger adults (15-45 yrs) in the U.S. Despite this, there is limited data on trends of HTN-related mortality within this population.

Methods

Data from the CDC WONDER multiple-cause of death database was analyzed from 1999 to 2021, focusing on HTN-related mortality in young adults aged 15 to 45 years. Age-adjusted mortality rates (AAMRs) per 100,000 persons and annual percent changes (APCs) were calculated and stratified by year, sex, race/ethnicity, urbanization status, and census region.

Results

Between 1999 and 2021, there were 201,860 HTN-related deaths among young adults in the U.S. The AAMR increased from 2.8 in 1999 to 5.0 in 2001 (APC 35.3; 95 % CI 20.6 to 44.5) and then to 9.4 in 2019 (APC 3.1; 95 % CI 2.7 to 3.5) before sharply rising to 13.9 in 2021 (APC 22.3; 95 % CI 15.1 to 26.4). Men consistently exhibited higher AAMRs than women from 1999 (AAMR men: 3.6 vs women: 1.9) to 2021 (AAMR men: 18.9 vs women: 8.8). In 2020, the highest AAMR was observed among non-Hispanic (NH) Black or African American young adults (30.2), followed by NH American Indian/Alaska Natives (29.6), NH White (9.9), Hispanics or Latino (9.3) and NH Asian or Pacific Islander (5.0). The Southern region had the highest AAMR (9.3), followed by the Midwest (6.4), West (5.8), and Northeast (5.4). Nonmetropolitan areas consistently had higher AAMR (8.5) than metropolitan areas (7.0). States in the top 90 th percentile for AAMRs included Mississippi, the District of Columbia, Oklahoma, West Virginia, and Arkansas, with these states exhibiting approximately five times the AAMRs of those in the lower 10th percentile.

Conclusion

HTN-related mortality among young adults in the U.S. increased steadily until 2019, followed by a sharp rise in 2020 and 2021. The highest AAMRs were observed among men, NH Black young adults, and individuals residing in the Southern and non-metropolitan areas of the U.S. These findings underscore the need for targeted interventions to reduce the burden and address disparities in HTN-related mortality among young adults in the U.S.

背景美国年轻成年人（15-45 岁）的高血压（HTN）患病率显著增加。尽管如此，有关这一人群中与高血压相关的死亡率趋势的数据却很有限。方法分析了美国疾病预防控制中心 WONDER 多死因数据库中 1999 年至 2021 年的数据，重点关注 15-45 岁年轻成年人中与高血压相关的死亡率。计算了每 10 万人的年龄调整死亡率（AAMRs）和年百分比变化率（APCs），并按年份、性别、种族/民族、城市化状况和人口普查地区进行了分层。AAMR从1999年的2.8升至2001年的5.0（APC 35.3; 95 % CI 20.6至44.5），然后升至2019年的9.4（APC 3.1; 95 % CI 2.7至3.5），之后急剧升至2021年的13.9（APC 22.3; 95 % CI 15.1至26.4）。从 1999 年（男性急性呼吸道感染率：3.6 vs 女性：1.9）到 2021 年（男性急性呼吸道感染率：18.9 vs 女性：8.8），男性的急性呼吸道感染率一直高于女性。2020 年，非西班牙裔（NH）黑人或非裔美国人青壮年的年平均死亡率最高（30.2），其次是 NH 美国印第安人/阿拉斯加原住民（29.6）、NH 白人（9.9）、西班牙裔或拉丁裔（9.3）以及 NH 亚洲人或太平洋岛民（5.0）。南部地区的 AAMR 最高（9.3），其次是中西部（6.4）、西部（5.8）和东北部（5.4）。非大都市地区的 AAMR（8.5）一直高于大都市地区（7.0）。AAMR排名前90%的州包括密西西比州、哥伦比亚特区、俄克拉荷马州、西弗吉尼亚州和阿肯色州，这些州的AAMR约为排名后10%的州的5倍。男性、新罕布什尔州黑人青壮年以及居住在美国南部和非大都会地区的人的急性心肌梗死死亡率最高。这些发现强调了有必要采取有针对性的干预措施，以减轻美国青壮年中与高血压相关的死亡率的负担并解决这方面的差异。

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引用次数: 0