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Role of optical coherence tomography in clinical management of myocardial infarction with nonobstructive coronary arteries.
IF 1.8 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-12-28 DOI: 10.26599/1671-5411.2024.12.007
Kenichi Tani, Osamu Kurihara, Akihiro Shirakabe, Nobuaki Kobayashi, Masamichi Takano, Kuniya Asai

Myocardial infarction without angiographic moderate to severe stenosis (> 50%) and any other related diagnosis on clinical presentation is defined as myocardial infarction with nonobstructive coronary arteries (MINOCA). Common causes of MINOCA working diagnosis includes plaque disruption, spontaneous coronary artery dissection, coronary artery spasm, coronary thromboembolism, Takotsubo cardiomyopathy, and myocarditis. Clinical history, assay of myocardial enzymes, electrocardiogram, echocardiography, coronary angiography, and left ventriculography facilitate the initial diagnosis of MINOCA and reveal the underlying causes, while cardiovascular magnetic resonance and optical coherence tomography (OCT) are used to confirm the diagnosis. Although cardiovascular magnetic resonance is the gold standard noninvasive diagnostic tool for MINOCA, its ability to diagnose the cause and mechanism underlying this condition in the coronary arteries is limited because of its image resolution. Observational studies have demonstrated that OCT can be used to determine the underlying cause of MINOCA by investigating the characteristics of the culprit lesions and to predict the prognosis of the patients. In this article, we review the current diagnostic approach for MINOCA focusing on each imaging tool. Furthermore, we reevaluate the role of OCT in the clinical management of MINOCA. Identifying the cause of MINOCA through OCT might help select optimal and effective drug treatments and improve prognosis.

{"title":"Role of optical coherence tomography in clinical management of myocardial infarction with nonobstructive coronary arteries.","authors":"Kenichi Tani, Osamu Kurihara, Akihiro Shirakabe, Nobuaki Kobayashi, Masamichi Takano, Kuniya Asai","doi":"10.26599/1671-5411.2024.12.007","DOIUrl":"10.26599/1671-5411.2024.12.007","url":null,"abstract":"<p><p>Myocardial infarction without angiographic moderate to severe stenosis (> 50%) and any other related diagnosis on clinical presentation is defined as myocardial infarction with nonobstructive coronary arteries (MINOCA). Common causes of MINOCA working diagnosis includes plaque disruption, spontaneous coronary artery dissection, coronary artery spasm, coronary thromboembolism, Takotsubo cardiomyopathy, and myocarditis. Clinical history, assay of myocardial enzymes, electrocardiogram, echocardiography, coronary angiography, and left ventriculography facilitate the initial diagnosis of MINOCA and reveal the underlying causes, while cardiovascular magnetic resonance and optical coherence tomography (OCT) are used to confirm the diagnosis. Although cardiovascular magnetic resonance is the gold standard noninvasive diagnostic tool for MINOCA, its ability to diagnose the cause and mechanism underlying this condition in the coronary arteries is limited because of its image resolution. Observational studies have demonstrated that OCT can be used to determine the underlying cause of MINOCA by investigating the characteristics of the culprit lesions and to predict the prognosis of the patients. In this article, we review the current diagnostic approach for MINOCA focusing on each imaging tool. Furthermore, we reevaluate the role of OCT in the clinical management of MINOCA. Identifying the cause of MINOCA through OCT might help select optimal and effective drug treatments and improve prognosis.</p>","PeriodicalId":51294,"journal":{"name":"Journal of Geriatric Cardiology","volume":"21 12","pages":"1133-1140"},"PeriodicalIF":1.8,"publicationDate":"2024-12-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11808491/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143400384","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Transcervical occlusion of atrial septal defect complicating with absence of hepatic segment of inferior vena cava in a patient with dextrocardia.
IF 1.8 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-12-28 DOI: 10.26599/1671-5411.2024.12.006
Jia-Wang Xiao, Zhong-Chao Wang, Jing-Song Geng, Jian-Ming Wang, Qi-Guang Wang
{"title":"Transcervical occlusion of atrial septal defect complicating with absence of hepatic segment of inferior vena cava in a patient with dextrocardia.","authors":"Jia-Wang Xiao, Zhong-Chao Wang, Jing-Song Geng, Jian-Ming Wang, Qi-Guang Wang","doi":"10.26599/1671-5411.2024.12.006","DOIUrl":"10.26599/1671-5411.2024.12.006","url":null,"abstract":"","PeriodicalId":51294,"journal":{"name":"Journal of Geriatric Cardiology","volume":"21 12","pages":"1149-1152"},"PeriodicalIF":1.8,"publicationDate":"2024-12-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11808487/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143400461","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
In the early diagnosis of cardiac amyloidosis by point-of-care ultrasound (POCUS) in older patients with heart failure: towards a new standard of care?
IF 1.8 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-12-28 DOI: 10.26599/1671-5411.2024.12.003
Laura Samaniego-Vega, Ana Ayesta-Lopez, Elena Valle-Calonge, Jesus M De La Hera-Galarza, Jose Gutierrez-Rodriguez, Pablo Solla-Suarez
{"title":"In the early diagnosis of cardiac amyloidosis by point-of-care ultrasound (POCUS) in older patients with heart failure: towards a new standard of care?","authors":"Laura Samaniego-Vega, Ana Ayesta-Lopez, Elena Valle-Calonge, Jesus M De La Hera-Galarza, Jose Gutierrez-Rodriguez, Pablo Solla-Suarez","doi":"10.26599/1671-5411.2024.12.003","DOIUrl":"10.26599/1671-5411.2024.12.003","url":null,"abstract":"","PeriodicalId":51294,"journal":{"name":"Journal of Geriatric Cardiology","volume":"21 12","pages":"1147-1148"},"PeriodicalIF":1.8,"publicationDate":"2024-12-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11808490/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143400886","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
The effects of hypothalamic microglial activation on ventricular arrhythmias in stress cardiomyopathy.
IF 1.8 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-12-28 DOI: 10.26599/1671-5411.2024.12.002
Peng-Qi Lin, Quan-Wei Pei, Bin Li, Jie-Mei Yang, Li-Na Zou, De-Zhan Su, Jun-Pei Zhang, Hong-Peng Yin, Mbabazi Nadine, Jun-Jie Yang, Nevzorova Vera A, Khan Musawir Abbas, Zhao-Lei Jiang, Jing-Jie Li, De-Chun Yin

Background: Stress cardiomyopathy (SCM) currently has a high incidence in older adults, and the theories regarding its causes include "catecholamine myocardial toxicity" and "sympathetic hyperactivation". However, the role of the central nervous system in the pathogenesis of SCM remains unknown. We investigated the role of microglia activation in the paraventricular hypothalamic nucleus (PVN) in the development of SCM.

Methods: An SCM model was created using male Sprague-Dawley (SD) rats, immobilized for 6 h every day for a week. Electrocardiogram, cardiac electrophysiology, and echocardiography examinations were performed to verify the changes in cardiac structure and function in rats with SCM. RNA sequencing was used to explore the changes in the hypothalamus during SCM. In addition, brain and heart tissues were collected to detect microglial activation and sympathetic activity.

Results: The main findings were as follows: (1) immobilization stress successfully induced SCM in SD rats; (2) microglia were significantly activated in the hypothalamus, as evidenced by cytosol thickening, increases in the number of microglial branches, and microglia enriched in the PVN; (3) in SCM, the microglia in the PVN exhibited increased central and peripheral cardiac sympathetic activity and increased the expression of neuroinflammatory factors; and (4) it is possible that inhibiting microglial activation could suppress the sympathetic activity of the central nervous system and heart and increase cardiac electrical stability in SCM rats.

Conclusions: SCM was induced in SD rats by immobilization stress, acting through the activation of the hypothalamic microglia. The activated microglia were specifically enriched in the PVN, increasing the activity of the central and peripheral sympathetic nervous systems by regulating the expression of neuro-inflammatory factors, mediating dysfunction of the left ventricle, and increasing the susceptibility to ventricular arrhythmias.

{"title":"The effects of hypothalamic microglial activation on ventricular arrhythmias in stress cardiomyopathy.","authors":"Peng-Qi Lin, Quan-Wei Pei, Bin Li, Jie-Mei Yang, Li-Na Zou, De-Zhan Su, Jun-Pei Zhang, Hong-Peng Yin, Mbabazi Nadine, Jun-Jie Yang, Nevzorova Vera A, Khan Musawir Abbas, Zhao-Lei Jiang, Jing-Jie Li, De-Chun Yin","doi":"10.26599/1671-5411.2024.12.002","DOIUrl":"10.26599/1671-5411.2024.12.002","url":null,"abstract":"<p><strong>Background: </strong>Stress cardiomyopathy (SCM) currently has a high incidence in older adults, and the theories regarding its causes include \"catecholamine myocardial toxicity\" and \"sympathetic hyperactivation\". However, the role of the central nervous system in the pathogenesis of SCM remains unknown. We investigated the role of microglia activation in the paraventricular hypothalamic nucleus (PVN) in the development of SCM.</p><p><strong>Methods: </strong>An SCM model was created using male Sprague-Dawley (SD) rats, immobilized for 6 h every day for a week. Electrocardiogram, cardiac electrophysiology, and echocardiography examinations were performed to verify the changes in cardiac structure and function in rats with SCM. RNA sequencing was used to explore the changes in the hypothalamus during SCM. In addition, brain and heart tissues were collected to detect microglial activation and sympathetic activity.</p><p><strong>Results: </strong>The main findings were as follows: (1) immobilization stress successfully induced SCM in SD rats; (2) microglia were significantly activated in the hypothalamus, as evidenced by cytosol thickening, increases in the number of microglial branches, and microglia enriched in the PVN; (3) in SCM, the microglia in the PVN exhibited increased central and peripheral cardiac sympathetic activity and increased the expression of neuroinflammatory factors; and (4) it is possible that inhibiting microglial activation could suppress the sympathetic activity of the central nervous system and heart and increase cardiac electrical stability in SCM rats.</p><p><strong>Conclusions: </strong>SCM was induced in SD rats by immobilization stress, acting through the activation of the hypothalamic microglia. The activated microglia were specifically enriched in the PVN, increasing the activity of the central and peripheral sympathetic nervous systems by regulating the expression of neuro-inflammatory factors, mediating dysfunction of the left ventricle, and increasing the susceptibility to ventricular arrhythmias.</p>","PeriodicalId":51294,"journal":{"name":"Journal of Geriatric Cardiology","volume":"21 12","pages":"1119-1132"},"PeriodicalIF":1.8,"publicationDate":"2024-12-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11808488/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143400458","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Arrhythmogenic left ventricular cardiomyopathy mimicking acute myocardial infarction. 模仿急性心肌梗死的致心律失常性左心室心肌病。
IF 1.8 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-12-28 DOI: 10.26599/1671-5411.2024.12.004
Cen-Cen Wu, Le-Qun Zhou, Xin-Yu Wang, Ling-Yun Zu, Wei-Xian Xu
{"title":"Arrhythmogenic left ventricular cardiomyopathy mimicking acute myocardial infarction.","authors":"Cen-Cen Wu, Le-Qun Zhou, Xin-Yu Wang, Ling-Yun Zu, Wei-Xian Xu","doi":"10.26599/1671-5411.2024.12.004","DOIUrl":"10.26599/1671-5411.2024.12.004","url":null,"abstract":"","PeriodicalId":51294,"journal":{"name":"Journal of Geriatric Cardiology","volume":"21 12","pages":"1141-1146"},"PeriodicalIF":1.8,"publicationDate":"2024-12-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11808489/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143400885","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Perioperative adverse cardiac events predict post-discharge mortality after fragility hip fracture in elderly patients without cardiovascular disease.
IF 1.8 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-12-28 DOI: 10.26599/1671-5411.2024.12.001
Seung-Chan Kim, Sook-Jung Kim, Jeong-Eun Yi

Background: Perioperative adverse cardiac events (PACEs) in elderly patients with hip fractures are associated with perioperative mortality. We investigated the relationship of PACE with post-discharge mortality and further explored whether it differs between patients with and without cardiovascular disease (CVD).

Methods: We retrospectively analyzed data from patients aged ≥ 65 years who underwent fragility hip fracture surgery from September 2016 to December 2021. PACE was defined as a composite of congestive heart failure, cardiogenic shock, myocardial injury after non-cardiac surgery, arrhythmic event, ischemic stroke, or acute pulmonary thromboembolism during hospitalization or within the 30-day postoperative period. Patients with 30-day mortality were excluded. The primary endpoint was all-cause mortality after hospital discharge.

Results: Of the 446 patients (133 patients in the CVD group and 313 patients in the non-CVD group), 14.8% experienced PACE, and overall mortality during a median of 15.9 months (interquartile range: 6.6-27.0 months) was 20.9% [CVD (26.3%) vs. non-CVD (18.5%), P = 0.064]. Patients with PACE demonstrated a significantly worse survival rate than those without PACE in both groups (all log-rank P < 0.05). After adjustment for confounders, PACE was an independent predictor of mortality in the overall population [hazard ratio (HR) = 3.01, 95% CI: 1.69-5.35, P < 0.001]. Its prognostic impact was significant in patients without CVD (HR = 2.69, 95% CI: 1.35-5.38, P = 0.005) but not in those with CVD (HR = 1.20, 95% CI: 0.41-3.50, P = 0.735).

Conclusions: PACE was associated with increased post-discharge mortality after fragility hip fracture, especially in elderly patients without CVD.

{"title":"Perioperative adverse cardiac events predict post-discharge mortality after fragility hip fracture in elderly patients without cardiovascular disease.","authors":"Seung-Chan Kim, Sook-Jung Kim, Jeong-Eun Yi","doi":"10.26599/1671-5411.2024.12.001","DOIUrl":"10.26599/1671-5411.2024.12.001","url":null,"abstract":"<p><strong>Background: </strong>Perioperative adverse cardiac events (PACEs) in elderly patients with hip fractures are associated with perioperative mortality. We investigated the relationship of PACE with post-discharge mortality and further explored whether it differs between patients with and without cardiovascular disease (CVD).</p><p><strong>Methods: </strong>We retrospectively analyzed data from patients aged ≥ 65 years who underwent fragility hip fracture surgery from September 2016 to December 2021. PACE was defined as a composite of congestive heart failure, cardiogenic shock, myocardial injury after non-cardiac surgery, arrhythmic event, ischemic stroke, or acute pulmonary thromboembolism during hospitalization or within the 30-day postoperative period. Patients with 30-day mortality were excluded. The primary endpoint was all-cause mortality after hospital discharge.</p><p><strong>Results: </strong>Of the 446 patients (133 patients in the CVD group and 313 patients in the non-CVD group), 14.8% experienced PACE, and overall mortality during a median of 15.9 months (interquartile range: 6.6-27.0 months) was 20.9% [CVD (26.3%) <i>vs.</i> non-CVD (18.5%), <i>P</i> = 0.064]. Patients with PACE demonstrated a significantly worse survival rate than those without PACE in both groups (all log-rank <i>P</i> < 0.05). After adjustment for confounders, PACE was an independent predictor of mortality in the overall population [hazard ratio (HR) = 3.01, 95% CI: 1.69-5.35, <i>P</i> < 0.001]. Its prognostic impact was significant in patients without CVD (HR = 2.69, 95% CI: 1.35-5.38, <i>P</i> = 0.005) but not in those with CVD (HR = 1.20, 95% CI: 0.41-3.50, <i>P</i> = 0.735).</p><p><strong>Conclusions: </strong>PACE was associated with increased post-discharge mortality after fragility hip fracture, especially in elderly patients without CVD.</p>","PeriodicalId":51294,"journal":{"name":"Journal of Geriatric Cardiology","volume":"21 12","pages":"1099-1108"},"PeriodicalIF":1.8,"publicationDate":"2024-12-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11808486/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143400887","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Radiomics of baseline epicardial adipose tissue predicts left ventricular mass regression after transcatheter aortic valve replacement.
IF 1.8 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-12-28 DOI: 10.26599/1671-5411.2024.12.005
Yi Zhang, Hao-Ran Yang, Xing-Yu Ji, Tian-Yuan Xiong, Mao Chen

Background: Epicardial adipose tissue (EAT) radiomics derived from cardiac computed tomography (CT) images may provide insights into EAT characteristics, which can further predict regression of left ventricular mass index (LVMI) after transcatheter aortic valve replacement (TAVR). This study aimed to develop and validate a radiomics nomogram based on pre-procedural EAT CT to predict inadequate LVMI regression following TAVR.

Methods: Inadequate LVMI regression was defined as ΔLVMI% < 15% at one-year post TAVR. Radiomics features from pre-procedural CT images were selected mainly by least absolute shrinkage and selection operator algorithm. The patients were randomly divided into the training and validation cohorts to establish and evaluate three feature classifier models based on the selected features, using which the Radiomics scores (Radscores) were then calculated. A radiomics nomogram was constructed using independent risk factors and further assessed using area under the curve, calibration curve, and decision curve analysis.

Results: A total of 144 consecutive TAVR patients (42 patients with inadequate and 102 patients with adequate LVMI regression) were randomly assigned to the training and validation cohorts (116 patients and 28 patients, respectively). A total of 1130 radiomics features from each patient yielded 6 features for the Radscore construction after selection, with logistic regression and support vector machine models favored. Subsequently, a nomogram based solely on the Radscore was constructed, with an area under the curve of 0.743 in the validation cohort, along with favorable decision curve analysis and calibration curves.

Conclusions: The developed radiomics nomogram, serving as a non-invasive tool, achieved satisfactory preoperative prediction of inadequate LVMI regression in TAVR patients, thereby facilitating clinical management.

{"title":"Radiomics of baseline epicardial adipose tissue predicts left ventricular mass regression after transcatheter aortic valve replacement.","authors":"Yi Zhang, Hao-Ran Yang, Xing-Yu Ji, Tian-Yuan Xiong, Mao Chen","doi":"10.26599/1671-5411.2024.12.005","DOIUrl":"10.26599/1671-5411.2024.12.005","url":null,"abstract":"<p><strong>Background: </strong>Epicardial adipose tissue (EAT) radiomics derived from cardiac computed tomography (CT) images may provide insights into EAT characteristics, which can further predict regression of left ventricular mass index (LVMI) after transcatheter aortic valve replacement (TAVR). This study aimed to develop and validate a radiomics nomogram based on pre-procedural EAT CT to predict inadequate LVMI regression following TAVR.</p><p><strong>Methods: </strong>Inadequate LVMI regression was defined as ΔLVMI% < 15% at one-year post TAVR. Radiomics features from pre-procedural CT images were selected mainly by least absolute shrinkage and selection operator algorithm. The patients were randomly divided into the training and validation cohorts to establish and evaluate three feature classifier models based on the selected features, using which the Radiomics scores (Radscores) were then calculated. A radiomics nomogram was constructed using independent risk factors and further assessed using area under the curve, calibration curve, and decision curve analysis.</p><p><strong>Results: </strong>A total of 144 consecutive TAVR patients (42 patients with inadequate and 102 patients with adequate LVMI regression) were randomly assigned to the training and validation cohorts (116 patients and 28 patients, respectively). A total of 1130 radiomics features from each patient yielded 6 features for the Radscore construction after selection, with logistic regression and support vector machine models favored. Subsequently, a nomogram based solely on the Radscore was constructed, with an area under the curve of 0.743 in the validation cohort, along with favorable decision curve analysis and calibration curves.</p><p><strong>Conclusions: </strong>The developed radiomics nomogram, serving as a non-invasive tool, achieved satisfactory preoperative prediction of inadequate LVMI regression in TAVR patients, thereby facilitating clinical management.</p>","PeriodicalId":51294,"journal":{"name":"Journal of Geriatric Cardiology","volume":"21 12","pages":"1109-1118"},"PeriodicalIF":1.8,"publicationDate":"2024-12-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11808492/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143399876","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
The role of acetazolamide in critical care and emergency medicine. 乙酰唑胺在重症监护和急诊医学中的作用。
IF 1.8 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-11-28 DOI: 10.26599/1671-5411.2024.11.005
Jacopo Davide Giamello, Gabriele Savioli, Yaroslava Longhitano, Fiorenza Ferrari, Salvatore D'Agnano, Ciro Esposito, Manfredi Tesauro, Christian Zanza

Acetazolamide is the commonly prescribed oral and intravenous carbonic anhydrase inhibitor; over the years, its use in clinical practice has decreased in favor of more recent drugs. However, it is a rather handy drug, which can be useful in several clinical settings when managing critically ill patients. The objective of this review is the evaluation of the most recent evidence on the use of acetazolamide in emergency medicine and critical care medicine. Furthermore, the safety profile of this drug has been evaluated. This is a narrative review on the use of acetazolamide in the main contexts in which this drug can be useful in emergency situations for patients with potential critical issues. For the timeline 1999-2024, a search was conducted on the main scientific platforms; resources of greatest relevance for the use of acetazolamide in critical care and emergency medicine were selected. The most common emergency situations in which a critically ill patient could benefit from acetazolamide therapy are acute heart failure, acute mountain sickness, post hypercapnic metabolic alkalosis, idiopathic intracranial hypertension and acute angle-closure glaucoma. In a few cases, however, randomized controlled clinical trials have been conducted. There are also other less solid indications based mostly on experience or retrospective data. Acetazolamide seems to be an overall safe drug; serious side effects are rare and can be avoided by carefully selecting the patients to be treated. Acetazolamide represents a precious resource for emergency physicians and intensivists; critical patients with different conditions can in fact benefit from it; furthermore, acetazolamide is a safe drug if administered to correctly selected patients.

乙酰唑胺是常用的口服和静脉注射碳酸酐酶抑制剂;多年来,它在临床实践中的使用已经减少,更青睐于最近的药物。然而,它是一种相当方便的药物,在治疗危重病人的几个临床环境中都很有用。本综述的目的是评价乙酰唑胺在急诊医学和重症监护医学中使用的最新证据。此外,该药物的安全性已被评估。这是一篇关于乙酰唑胺在主要情况下使用的叙述性综述,在这种情况下,这种药物可以在紧急情况下对有潜在严重问题的患者有用。对于1999-2024年的时间线,在主要的科学平台上进行了搜索;选择了与在重症监护和急诊医学中使用乙酰唑胺最相关的资源。急性心力衰竭、急性高原病、高碳酸血症后代谢性碱中毒、特发性颅内高压和急性闭角型青光眼是危重患者受益于乙酰唑胺治疗的最常见紧急情况。然而,在少数情况下,进行了随机对照临床试验。也有其他不太可靠的迹象,主要基于经验或回顾性数据。乙酰唑胺似乎是一种整体安全的药物;严重的副作用是罕见的,可以通过仔细选择要治疗的患者来避免。乙酰唑胺是急诊医师和重症医师的宝贵资源;事实上,不同病情的危重患者都能从中受益;此外,乙酰唑胺是一种安全的药物,如果给予正确选择的病人。
{"title":"The role of acetazolamide in critical care and emergency medicine.","authors":"Jacopo Davide Giamello, Gabriele Savioli, Yaroslava Longhitano, Fiorenza Ferrari, Salvatore D'Agnano, Ciro Esposito, Manfredi Tesauro, Christian Zanza","doi":"10.26599/1671-5411.2024.11.005","DOIUrl":"10.26599/1671-5411.2024.11.005","url":null,"abstract":"<p><p>Acetazolamide is the commonly prescribed oral and intravenous carbonic anhydrase inhibitor; over the years, its use in clinical practice has decreased in favor of more recent drugs. However, it is a rather handy drug, which can be useful in several clinical settings when managing critically ill patients. The objective of this review is the evaluation of the most recent evidence on the use of acetazolamide in emergency medicine and critical care medicine. Furthermore, the safety profile of this drug has been evaluated. This is a narrative review on the use of acetazolamide in the main contexts in which this drug can be useful in emergency situations for patients with potential critical issues. For the timeline 1999-2024, a search was conducted on the main scientific platforms; resources of greatest relevance for the use of acetazolamide in critical care and emergency medicine were selected. The most common emergency situations in which a critically ill patient could benefit from acetazolamide therapy are acute heart failure, acute mountain sickness, post hypercapnic metabolic alkalosis, idiopathic intracranial hypertension and acute angle-closure glaucoma. In a few cases, however, randomized controlled clinical trials have been conducted. There are also other less solid indications based mostly on experience or retrospective data. Acetazolamide seems to be an overall safe drug; serious side effects are rare and can be avoided by carefully selecting the patients to be treated. Acetazolamide represents a precious resource for emergency physicians and intensivists; critical patients with different conditions can in fact benefit from it; furthermore, acetazolamide is a safe drug if administered to correctly selected patients.</p>","PeriodicalId":51294,"journal":{"name":"Journal of Geriatric Cardiology","volume":"21 11","pages":"1085-1095"},"PeriodicalIF":1.8,"publicationDate":"2024-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11672352/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142903926","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Survival after surgery for acute type A aortic dissection in octogenarians. 八旬老人急性 A 型主动脉夹层手术后的存活率。
IF 1.8 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-11-28 DOI: 10.26599/1671-5411.2024.11.009
Antonio Fiore, Javier Rodriguez Lega, Joscha Buech, Giovanni Mariscalco, Andrea Perrotti, Konrad Wisniewski, Angel G Pinto, Till Demal, Jan Rocek, Petr Kacer, Giuseppe Gatti, Igor Vendramin, Mauro Rinaldi, Eduard Quintana, Dario Di Perna, Francesco Nappi, Mark Field, Amer Harky, Matteo Pettinari, Angelo M Dell'Aquila, Francesco Onorati, Mikko Jormalainen, Tatu Juvonen, Timo Mäkikallio, Caroline Radner, Sven Peterss, Vito D'Andrea, Fausto Biancari

Objective: To evaluate the benefits of surgical repair acute type A aortic dissection (ATAAD) on survival of octogenarians.

Methods: Patients who underwent surgery for acute ATAAD from the multicenter European Registry of Type A Aortic Dissection (ERTAAD) were the subjects of the present analysis.

Results: 326 (8.4%) patients were aged ≥ 80 years. Among 280 propensity score matched pairs, in-hospital mortality was 30.0% in patients aged ≥ 80 years and 20.0% in younger patients (P = 0.006), while 10-year mortality were 93.2% and 48.0%, respectively (P < 0.001). The hazard of mortality was higher among octogenarians up to two years after surgery, but it became comparable to that of younger patients up to 5 years. Among patients who survived 3 months after surgery, 10-year relative survival was 0.77 in patients aged < 80 years, and 0.46 in patients aged ≥ 80 years. Relative survival of octogenarians decreased markedly 5 years after surgery. Age ≥ 85 years, glomerular filtration rate, preoperative invasive ventilation, preoperative mesenteric mal-perfusion and aortic root replacement were independent predictors of in-hospital mortality among octogenarians (AUC = 0.792; E:O ratio = 0.991; CITL = 0.016; slope = 1.096). An additive score was developed. A risk score ≤ 1 was observed in 68.4% of patients, and their in-hospital mortality was 20.9%.

Conclusions: Provided a thoughtful patient selection, surgery may provide a survival benefit in patients aged ≥ 80 years with ATAAD that, when compared to younger patients and the general population, may last up to 5 years after the procedure. These findings have significant epidemiologic and clinical relevance because of the increasing longevity of the population of the Western countries.

目的:评估手术修复急性 A 型主动脉夹层(ATAAD)对八旬老人生存的益处:评估手术修复急性A型主动脉夹层(ATAAD)对八旬老人存活率的益处:本分析以欧洲主动脉夹层多中心登记处(ERTAAD)中因急性A型主动脉夹层接受手术治疗的患者为对象:326名(8.4%)患者的年龄≥80岁。在 280 对倾向评分匹配的患者中,年龄≥ 80 岁的患者院内死亡率为 30.0%,年龄较小的患者为 20.0%(P = 0.006),10 年死亡率分别为 93.2% 和 48.0%(P < 0.001)。八旬老人术后两年内的死亡率较高,但术后五年内的死亡率与年轻患者相当。在术后 3 个月存活的患者中,年龄小于 80 岁的患者 10 年相对存活率为 0.77,而年龄大于 80 岁的患者 10 年相对存活率为 0.46。八旬老人术后 5 年的相对存活率明显下降。年龄≥85岁、肾小球滤过率、术前有创通气、术前肠系膜灌注不良和主动脉根部置换是八旬老人院内死亡率的独立预测因素(AUC = 0.792;E:O 比 = 0.991;CITL = 0.016;斜率 = 1.096)。得出了一个附加分值。68.4%的患者风险评分≤1,院内死亡率为20.9%:结论:只要对患者进行周到的选择,手术可为年龄≥80岁的ATAAD患者带来生存益处,与年轻患者和普通人群相比,这种益处在术后可持续5年之久。由于西方国家人口的寿命越来越长,这些发现具有重要的流行病学和临床意义。
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引用次数: 0
Association of handgrip strength with aortic stenosis among adults aged 60 years and older: evidence from the 157097 UK Biobank participants. 在60岁及以上的成年人中,握力与主动脉狭窄的关系:来自157097名英国生物银行参与者的证据
IF 1.8 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-11-28 DOI: 10.26599/1671-5411.2024.11.003
Cheng-Xiang Song, Qing Li, Cong-Ying Xia, Lu Long, Xiao-Xi Zeng, Jun-Li Li, Mao Chen

Objective: To examine the association of handgrip strength with aortic stenosis incidence among adults aged 60 years and older.

Methods: We conducted a cohort study using the UK Biobank data to assess the relationship between handgrip strength and incident aortic stenosis in individuals aged 60 years and older. Handgrip strength was measured using a Jamar J00105 hydraulic hand dynamometer. Adjusted Cox proportional hazards regression models were conducted to assess the association between handgrip strength and incident aortic stenosis.

Results: We included 157,097 UK Biobank participants (78,151 women and 78,946 men) in our study, with mean age of 64 ± 2.9 years. During a median follow-up of 8.1 (7.4-8.8) years, 1543 (1.0%) participants developed incident aortic stenosis. Compared with those with the lowest handgrip strength (tertile 1), the adjusted hazard ratios (95% confidence interval) of incident aortic stenosis in the middle (tertile 2) and the highest (tertile 3) were 0.86 (0.77-0.97) and 0.76 (0.67-0.87), respectively.

Conclusions: Higher handgrip strength was associated with lower risk of developing aortic stenosis in older adults. Future studies warrant preventive strategies for older adults with lower handgrip strength.

目的:探讨握力与60岁及以上成人主动脉瓣狭窄发生率的关系。方法:我们使用UK Biobank数据进行了一项队列研究,以评估60岁及以上个体的握力与主动脉狭窄发生率之间的关系。用Jamar J00105液压手测力仪测量握力。采用校正Cox比例风险回归模型评估握力与主动脉狭窄发生率之间的关系。结果:我们的研究纳入了157,097名英国生物银行参与者(78,151名女性和78,946名男性),平均年龄为64±2.9岁。在中位随访8.1年(7.4-8.8年)期间,1543名(1.0%)参与者发生了突发主动脉狭窄。与最低握力组(tertile 1)相比,中位(tertile 2)和最高位(tertile 3)发生主动脉狭窄的校正风险比(95%可信区间)分别为0.86(0.77 ~ 0.97)和0.76(0.67 ~ 0.87)。结论:老年人握力越大,发生主动脉狭窄的风险越低。未来的研究需要对握力较低的老年人采取预防策略。
{"title":"Association of handgrip strength with aortic stenosis among adults aged 60 years and older: evidence from the 157097 UK Biobank participants.","authors":"Cheng-Xiang Song, Qing Li, Cong-Ying Xia, Lu Long, Xiao-Xi Zeng, Jun-Li Li, Mao Chen","doi":"10.26599/1671-5411.2024.11.003","DOIUrl":"10.26599/1671-5411.2024.11.003","url":null,"abstract":"<p><strong>Objective: </strong>To examine the association of handgrip strength with aortic stenosis incidence among adults aged 60 years and older.</p><p><strong>Methods: </strong>We conducted a cohort study using the UK Biobank data to assess the relationship between handgrip strength and incident aortic stenosis in individuals aged 60 years and older. Handgrip strength was measured using a Jamar J00105 hydraulic hand dynamometer. Adjusted Cox proportional hazards regression models were conducted to assess the association between handgrip strength and incident aortic stenosis.</p><p><strong>Results: </strong>We included 157,097 UK Biobank participants (78,151 women and 78,946 men) in our study, with mean age of 64 ± 2.9 years. During a median follow-up of 8.1 (7.4-8.8) years, 1543 (1.0%) participants developed incident aortic stenosis. Compared with those with the lowest handgrip strength (tertile 1), the adjusted hazard ratios (95% confidence interval) of incident aortic stenosis in the middle (tertile 2) and the highest (tertile 3) were 0.86 (0.77-0.97) and 0.76 (0.67-0.87), respectively.</p><p><strong>Conclusions: </strong>Higher handgrip strength was associated with lower risk of developing aortic stenosis in older adults. Future studies warrant preventive strategies for older adults with lower handgrip strength.</p>","PeriodicalId":51294,"journal":{"name":"Journal of Geriatric Cardiology","volume":"21 11","pages":"1026-1033"},"PeriodicalIF":1.8,"publicationDate":"2024-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11672353/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142902868","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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Journal of Geriatric Cardiology
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