Pub Date : 2021-10-01Epub Date: 2021-12-30DOI: 10.4103/2470-7511.334404
Jun Ren
{"title":"Cardiovascular medicine in the era of COVID-19 pandemics.","authors":"Jun Ren","doi":"10.4103/2470-7511.334404","DOIUrl":"10.4103/2470-7511.334404","url":null,"abstract":"","PeriodicalId":52908,"journal":{"name":"Cardiology Plus","volume":"6 1","pages":"199-201"},"PeriodicalIF":0.0,"publicationDate":"2021-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8951666/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46144437","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-10-01DOI: 10.4103/2470-7511.334400
C. Tam, C. Siu, H. Tse
The coronavirus disease-2019 (COVID-19) pandemic has brought unprecedented changes to our world and health-care system. Its high virulence and infectiousness directly infect people's respiratory system and indirectly disrupt our health-care infrastructure. In particular, ST elevation myocardial infarction (STEMI) is a clinical emergency emphasizes on the establishment of care system to minimize delay to reperfusion. As such, the impact of COVID-19 on STEMI care, ranging from disease severity, patient delay, diagnostic difficulty, triage to selection of reperfusion strategy and postoperative care, is immense. Importantly, not only we have to save our patients, but we must also need to protect all health-care workers and prevent environmental contamination. Otherwise, in-hospital transmission can quickly evolve into nosocomial outbreak with staff infection and quarantine which lead to health-care system collapse. In this article, we will discuss the challenges in various aspects of STEMI management during COVID-19, as well as the mitigation measures we can take to optimize outcome and our future.
{"title":"Challenges in management of ST elevation myocardial infarction during COVID-19 pandemic","authors":"C. Tam, C. Siu, H. Tse","doi":"10.4103/2470-7511.334400","DOIUrl":"https://doi.org/10.4103/2470-7511.334400","url":null,"abstract":"The coronavirus disease-2019 (COVID-19) pandemic has brought unprecedented changes to our world and health-care system. Its high virulence and infectiousness directly infect people's respiratory system and indirectly disrupt our health-care infrastructure. In particular, ST elevation myocardial infarction (STEMI) is a clinical emergency emphasizes on the establishment of care system to minimize delay to reperfusion. As such, the impact of COVID-19 on STEMI care, ranging from disease severity, patient delay, diagnostic difficulty, triage to selection of reperfusion strategy and postoperative care, is immense. Importantly, not only we have to save our patients, but we must also need to protect all health-care workers and prevent environmental contamination. Otherwise, in-hospital transmission can quickly evolve into nosocomial outbreak with staff infection and quarantine which lead to health-care system collapse. In this article, we will discuss the challenges in various aspects of STEMI management during COVID-19, as well as the mitigation measures we can take to optimize outcome and our future.","PeriodicalId":52908,"journal":{"name":"Cardiology Plus","volume":"6 1","pages":"218 - 230"},"PeriodicalIF":0.0,"publicationDate":"2021-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47272021","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-10-01DOI: 10.4103/2470-7511.334397
Jia Guang-Hong, J. Sowers
The global coronavirus disease-19 (COVID-19) pandemic, caused by severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2), has created an unprecedented, global public health crisis. Epidemiological studies showed that hypertension is a frequent comorbidity, as well as an independent prognostic risk factor in patients with COVID-19. Angiotensin-converting enzyme-2 (ACE-2) is a receptor for SARS-CoV-2, and thus essential for viral entry into human cells. This review summarizes the recent findings of epidemiology of hypertension in COVID-19 patients and highlights the critical role of ACE2. We also review the impact of endothelial dysfunction, inflammation, and arterial stiffness in promoting hypertension and cardiovascular disease in COVID-19 patients. This review also discusses therapeutic strategies for managing hypertension in patients with COVID-19, with particular emphasis on ACE inhibitors, angiotensin receptor blockers, and calcium channel blockers.
{"title":"Management of hypertension in patients with COVID-19: Implication of angiotensin-converting enzyme 2","authors":"Jia Guang-Hong, J. Sowers","doi":"10.4103/2470-7511.334397","DOIUrl":"https://doi.org/10.4103/2470-7511.334397","url":null,"abstract":"The global coronavirus disease-19 (COVID-19) pandemic, caused by severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2), has created an unprecedented, global public health crisis. Epidemiological studies showed that hypertension is a frequent comorbidity, as well as an independent prognostic risk factor in patients with COVID-19. Angiotensin-converting enzyme-2 (ACE-2) is a receptor for SARS-CoV-2, and thus essential for viral entry into human cells. This review summarizes the recent findings of epidemiology of hypertension in COVID-19 patients and highlights the critical role of ACE2. We also review the impact of endothelial dysfunction, inflammation, and arterial stiffness in promoting hypertension and cardiovascular disease in COVID-19 patients. This review also discusses therapeutic strategies for managing hypertension in patients with COVID-19, with particular emphasis on ACE inhibitors, angiotensin receptor blockers, and calcium channel blockers.","PeriodicalId":52908,"journal":{"name":"Cardiology Plus","volume":"6 1","pages":"210 - 217"},"PeriodicalIF":0.0,"publicationDate":"2021-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49137076","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-07-01DOI: 10.4103/2470-7511.327241
Lifan Yang, W. Pan, L. Guan, Xiao-chun Zhang, Lei Zhang, Shasha Chen, Daxin Zhou, J. Ge
Objectives: Patients undergoing trans-carotid transcatheter aortic valve replacement (TC-TAVR) are more likely to suffer from a stroke because of cerebral blood hypoperfusion and blood occlusion caused by the introducer sheath compared with the trans-femoral (TF) approach. The present study aimed to compare the incidence of stroke between the TC and TF approaches and explore the causes of stroke after TAVR. Methods: We retrospectively reviewed the medical records of 414 consecutive patients with severe aortic valve stenosis who underwent TC- or TF-TAVR at our center from October 2010 to November 2019; these patients were included in this observational study. The clinical data, such as the incidence of stroke, were compared between TC- and TF-TAVR patients. The correlation between carotid artery blood block interval (CABBI) and neurological events was also analyzed. The study was approved by the Ethics Committee of Zhongshan Hospital of Fudan University (approval No. YL2014-32). Results: Patients undergoing TC-TAVR had a significantly higher incidence of stroke than those undergoing TF-TAVR (12.5% vs. 0, P < 0.001), whereas the baseline data and the incidence of other complications did not differ significantly between the patients undergoing TC- and TF-TAVR (P > 0.05). Moreover, in TC-TAVR patients, the average CABBI of stroke was significantly longer than that of nonstroke patients (61.7 ± 20.7 min vs. 25.1 ± 1.6 min, P = 0.001). The number of patients with CABBI >30 min in the stroke group was greater than that in the nonstroke group (P < 0.001). Conclusions: In the absence of the cerebral and carotid artery evaluation before TAVR, surgeons should take into consideration the time of CABBI <30 min to avoid the possibility of stroke.
目的:与经股动脉(TF)入路相比，经颈动脉经导管主动脉瓣置换术(TC-TAVR)患者更容易发生脑卒中，因为引入器鞘引起的脑血灌注不足和血液闭塞。本研究旨在比较TAVR入路与TF入路的卒中发生率，并探讨TAVR后卒中的原因。方法:回顾性分析2010年10月至2019年11月在本中心连续接受TC或TF-TAVR治疗的414例严重主动脉瓣狭窄患者的病历;这些患者被纳入这项观察性研究。比较TC- tavr和TF-TAVR患者的临床资料，如卒中发生率。分析颈动脉血阻断间隔(CABBI)与神经事件的相关性。本研究已获复旦大学中山医院伦理委员会批准(批准号:YL2014-32)。结果:TC- tavr患者卒中发生率明显高于TF-TAVR患者(12.5% vs. 0, P < 0.001)，而TC- tavr和TF-TAVR患者的基线数据和其他并发症发生率无显著差异(P < 0.05)。此外，TC-TAVR患者卒中的平均CABBI明显长于非卒中患者(61.7±20.7 min vs. 25.1±1.6 min, P = 0.001)。卒中组bbb30 min发生CABBI的患者数大于非卒中组(P < 0.001)。结论:在TAVR术前未进行脑动脉和颈动脉评估的情况下，外科医生应考虑CABBI时间< 30min，以避免发生脑卒中的可能性。
{"title":"Association between stroke and carotid artery blood block interval in trans-carotid transcatheter aortic valve replacement: A retrospective observational study","authors":"Lifan Yang, W. Pan, L. Guan, Xiao-chun Zhang, Lei Zhang, Shasha Chen, Daxin Zhou, J. Ge","doi":"10.4103/2470-7511.327241","DOIUrl":"https://doi.org/10.4103/2470-7511.327241","url":null,"abstract":"Objectives: Patients undergoing trans-carotid transcatheter aortic valve replacement (TC-TAVR) are more likely to suffer from a stroke because of cerebral blood hypoperfusion and blood occlusion caused by the introducer sheath compared with the trans-femoral (TF) approach. The present study aimed to compare the incidence of stroke between the TC and TF approaches and explore the causes of stroke after TAVR. Methods: We retrospectively reviewed the medical records of 414 consecutive patients with severe aortic valve stenosis who underwent TC- or TF-TAVR at our center from October 2010 to November 2019; these patients were included in this observational study. The clinical data, such as the incidence of stroke, were compared between TC- and TF-TAVR patients. The correlation between carotid artery blood block interval (CABBI) and neurological events was also analyzed. The study was approved by the Ethics Committee of Zhongshan Hospital of Fudan University (approval No. YL2014-32). Results: Patients undergoing TC-TAVR had a significantly higher incidence of stroke than those undergoing TF-TAVR (12.5% vs. 0, P < 0.001), whereas the baseline data and the incidence of other complications did not differ significantly between the patients undergoing TC- and TF-TAVR (P > 0.05). Moreover, in TC-TAVR patients, the average CABBI of stroke was significantly longer than that of nonstroke patients (61.7 ± 20.7 min vs. 25.1 ± 1.6 min, P = 0.001). The number of patients with CABBI >30 min in the stroke group was greater than that in the nonstroke group (P < 0.001). Conclusions: In the absence of the cerebral and carotid artery evaluation before TAVR, surgeons should take into consideration the time of CABBI <30 min to avoid the possibility of stroke.","PeriodicalId":52908,"journal":{"name":"Cardiology Plus","volume":"6 1","pages":"181 - 186"},"PeriodicalIF":0.0,"publicationDate":"2021-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45770779","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-07-01DOI: 10.4103/2470-7511.327240
Hui-Wen Zhang, Yuan-Lin Guo, Cheng-gang Zhu, N. Wu, Ying Gao, Q. Dong, Jing Sun, Jian‐Jun Li
Background and Objectives: Patients with nonobstructive coronary artery disease (NOCAD) have an increased risk of cardiovascular events (CVEs) compared to that in individuals with normal or near-normal coronary arteries (NNCAs) and even a similar risk to that in individuals with obstructive coronary artery disease (OCAD). However, the predictors for a worse outcome in patients with NOCAD are not fully determined. This study aimed to investigate the association of high-sensitive C-reactive protein (hs-CRP) and CVEs in patients with NOCAD. Materials and Methods: In total, 4662 patients with coronary artery angiography were enrolled and followed up for CVE. Patients were classified as having NNCA (<20% stenosis, n = 698, 15.0%), NOCAD (20%–49% stenosis, n = 639, 14.3%), and OCAD (≥50% stenosis, n = 3325, 70.7%) and then further subdivided into three groups based on their baseline hs-CRP level (<1, 1–3, and >3 mg/L). Proportional hazards models were used to assess the risk of CVEs. Results: Over an average 13403 person-year follow-up, 338 patients experienced CVEs. Patients with NOCAD and OCAD had a higher rate of CVE than those with NNCA (P < 0.05). The CVE risk was significantly higher in NOCAD (hazard ratio [HR]: 2.31, 95% confidence interval [CI]: 1.30–4.01, P = 0.004) and OCAD (HR: 3.09, 95% CI: 1.88–5.07, P < 0.001) patients than in NNCA patients. Moreover, elevated hs-CRP levels were associated with an incremental rate of CVE (P < 0.05). Conclusions: Patients with NOCAD had worse outcomes and elevated hs-CRP levels were positively associated with CVEs, which potentially helps assess risk in NOCAD patients.
{"title":"The relationship between c-reactive protein and cardiovascular events in patients with obstructive and nonobstructive coronary artery disease","authors":"Hui-Wen Zhang, Yuan-Lin Guo, Cheng-gang Zhu, N. Wu, Ying Gao, Q. Dong, Jing Sun, Jian‐Jun Li","doi":"10.4103/2470-7511.327240","DOIUrl":"https://doi.org/10.4103/2470-7511.327240","url":null,"abstract":"Background and Objectives: Patients with nonobstructive coronary artery disease (NOCAD) have an increased risk of cardiovascular events (CVEs) compared to that in individuals with normal or near-normal coronary arteries (NNCAs) and even a similar risk to that in individuals with obstructive coronary artery disease (OCAD). However, the predictors for a worse outcome in patients with NOCAD are not fully determined. This study aimed to investigate the association of high-sensitive C-reactive protein (hs-CRP) and CVEs in patients with NOCAD. Materials and Methods: In total, 4662 patients with coronary artery angiography were enrolled and followed up for CVE. Patients were classified as having NNCA (<20% stenosis, n = 698, 15.0%), NOCAD (20%–49% stenosis, n = 639, 14.3%), and OCAD (≥50% stenosis, n = 3325, 70.7%) and then further subdivided into three groups based on their baseline hs-CRP level (<1, 1–3, and >3 mg/L). Proportional hazards models were used to assess the risk of CVEs. Results: Over an average 13403 person-year follow-up, 338 patients experienced CVEs. Patients with NOCAD and OCAD had a higher rate of CVE than those with NNCA (P < 0.05). The CVE risk was significantly higher in NOCAD (hazard ratio [HR]: 2.31, 95% confidence interval [CI]: 1.30–4.01, P = 0.004) and OCAD (HR: 3.09, 95% CI: 1.88–5.07, P < 0.001) patients than in NNCA patients. Moreover, elevated hs-CRP levels were associated with an incremental rate of CVE (P < 0.05). Conclusions: Patients with NOCAD had worse outcomes and elevated hs-CRP levels were positively associated with CVEs, which potentially helps assess risk in NOCAD patients.","PeriodicalId":52908,"journal":{"name":"Cardiology Plus","volume":"6 1","pages":"166 - 173"},"PeriodicalIF":0.0,"publicationDate":"2021-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46761473","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background and Objectives: Sodium-glucose co-transporter 2 inhibitors (SGLT2is) significantly reduce the risk of cardiovascular events in patients with type 2 diabetes mellitus (T2DM). However, the effectiveness of SGLT2is in heart failure (HF) treatment has not yet been established. The aim of this meta-analysis was to assess the efficacy and safety of SGLT2is in HF treatment by focusing on cardiovascular death (CVD), hospitalization for HF (HHF), and a composite of CVD and HHF. Methods: We searched literature sources in PubMed, EMBASE, and Cochrane Library up until December 20, 2020. Only randomized controlled trials were included in this meta-analysis. We compared the treatment and placebo groups in terms of their associated risks of CVD and HHF and their safety endpoints. The Cochrane tool for assessing risk of bias in randomized trials was applied. Results: The 10 selected studies included 17,043 HF patients and dapagliflozin, empagliflozin, canagliflozin, ertugliflozin, and sotagliflozin as experimental arms. At least 4 included studies were with high quality. For CVD, HHF, and their composite, the pooled risk ratio estimates were 0.87 (95% confidence interval [CI], 0.78–0.96; P = 0.004), 0.70 (95% CI, 0.65–0.76; P < 0.001), and 0.76 (95% CI, 0.71–0.81; P < 0.001), respectively. The incidence of volume depletion, hypoglycemia events, fractures, acute renal injury, and urogenital tract infection was not significantly higher in the SGLT2i group than in the placebo group. Stratified analyses showed similar efficacy and safety results for HF patients with T2DM, those without T2DM, and those being treated with different types of SGLT2is. Conclusions: This meta-analysis demonstrated that various SGLT2is significantly decreased the risks of CVD and HHF in HF patients with and without T2DM. It also showed that clinical administration of SGLT2is was relatively safe in terms of the aforementioned risk factors. SGLT2is might embrace broader clinical application in future HF treatment.
{"title":"Efficacy and safety of sodium-glucose co-transporter 2 inhibitors in heart failure patients: A systematic review and meta-analysis of randomized controlled trials","authors":"Yucheng Wang, Ming-hui Li, Ying Yu, Hui Shi, Ruizhen Chen","doi":"10.4103/2470-7511.327238","DOIUrl":"https://doi.org/10.4103/2470-7511.327238","url":null,"abstract":"Background and Objectives: Sodium-glucose co-transporter 2 inhibitors (SGLT2is) significantly reduce the risk of cardiovascular events in patients with type 2 diabetes mellitus (T2DM). However, the effectiveness of SGLT2is in heart failure (HF) treatment has not yet been established. The aim of this meta-analysis was to assess the efficacy and safety of SGLT2is in HF treatment by focusing on cardiovascular death (CVD), hospitalization for HF (HHF), and a composite of CVD and HHF. Methods: We searched literature sources in PubMed, EMBASE, and Cochrane Library up until December 20, 2020. Only randomized controlled trials were included in this meta-analysis. We compared the treatment and placebo groups in terms of their associated risks of CVD and HHF and their safety endpoints. The Cochrane tool for assessing risk of bias in randomized trials was applied. Results: The 10 selected studies included 17,043 HF patients and dapagliflozin, empagliflozin, canagliflozin, ertugliflozin, and sotagliflozin as experimental arms. At least 4 included studies were with high quality. For CVD, HHF, and their composite, the pooled risk ratio estimates were 0.87 (95% confidence interval [CI], 0.78–0.96; P = 0.004), 0.70 (95% CI, 0.65–0.76; P < 0.001), and 0.76 (95% CI, 0.71–0.81; P < 0.001), respectively. The incidence of volume depletion, hypoglycemia events, fractures, acute renal injury, and urogenital tract infection was not significantly higher in the SGLT2i group than in the placebo group. Stratified analyses showed similar efficacy and safety results for HF patients with T2DM, those without T2DM, and those being treated with different types of SGLT2is. Conclusions: This meta-analysis demonstrated that various SGLT2is significantly decreased the risks of CVD and HHF in HF patients with and without T2DM. It also showed that clinical administration of SGLT2is was relatively safe in terms of the aforementioned risk factors. SGLT2is might embrace broader clinical application in future HF treatment.","PeriodicalId":52908,"journal":{"name":"Cardiology Plus","volume":"6 1","pages":"156 - 165"},"PeriodicalIF":0.0,"publicationDate":"2021-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43848324","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-07-01DOI: 10.4103/2470-7511.327242
Yi Zhang, Qiuyue Li, Tianqing Li
Background and Objectives: Cardiovascular diseases (CVDs) are associated with a heavy health burden globally. Although there are several studies and reviews with a focus on the effects of ambient particulate matter on CVDs, presently, review of the association between particulate matter components and cardiovascular biomarkers has not been reported. Therefore, in this study, we reviewed the effects of particulate matter exposure on the levels of cardiovascular biomarkers. Methods: PubMed, Embase, and Web of Science databases were searched for related studies published between January 1, 2010, and May 30, 2021, using keywords, including particle, particulate, constituent, component, composition, cardiovascular biomarker, inflammation, oxidative stress, coagulation vasoactivity, and lipid metabolism. Results: Ten studies, which met the inclusion criteria, highlighted the existence of significant associations between particulate matter components and the levels of cardiovascular biomarkers, including lipid, inflammation and coagulation biomarkers, etc. However, multicenter studies evidence regarding the effects of long-term exposure to particulate matter components on cardiovascular biomarkers is still lacking. Further, studies with a focus on proteomics, and metabolomics of cardiovascular biomarkers owing to particulate matter exposure are also scarce. Conclusions: Exposure to particulate matter components was found to be significantly associated with cardiovascular biomarkers. However, in future, it would be necessary to conduct multicenter studies on the effects of long-term exposure to particulate components on the levels of cardiovascular biomarkers.
背景和目的:心血管疾病(cvd)在全球范围内与沉重的健康负担相关。虽然有一些研究和综述关注环境颗粒物对心血管疾病的影响，但目前，关于颗粒物成分与心血管生物标志物之间关系的综述尚未见报道。因此，在本研究中，我们回顾了颗粒物暴露对心血管生物标志物水平的影响。方法:检索PubMed、Embase和Web of Science数据库，检索2010年1月1日至2021年5月30日期间发表的相关研究，检索关键词包括颗粒、颗粒、成分、成分、组成、心血管生物标志物、炎症、氧化应激、凝血血管活性和脂质代谢。结果:符合纳入标准的10项研究强调了颗粒物组分与心血管生物标志物水平之间存在显著相关性，包括脂质、炎症和凝血生物标志物等。然而，关于长期暴露于颗粒物组分对心血管生物标志物的影响的多中心研究证据仍然缺乏。此外，由于颗粒物暴露，关注心血管生物标志物的蛋白质组学和代谢组学的研究也很少。结论:暴露于颗粒物成分与心血管生物标志物显著相关。然而，在未来，有必要开展多中心研究，研究长期暴露于颗粒成分对心血管生物标志物水平的影响。
{"title":"Epidemiological evidence in the effects of ambient particulate matter components on cardiovascular biomarkers: A systematic review","authors":"Yi Zhang, Qiuyue Li, Tianqing Li","doi":"10.4103/2470-7511.327242","DOIUrl":"https://doi.org/10.4103/2470-7511.327242","url":null,"abstract":"Background and Objectives: Cardiovascular diseases (CVDs) are associated with a heavy health burden globally. Although there are several studies and reviews with a focus on the effects of ambient particulate matter on CVDs, presently, review of the association between particulate matter components and cardiovascular biomarkers has not been reported. Therefore, in this study, we reviewed the effects of particulate matter exposure on the levels of cardiovascular biomarkers. Methods: PubMed, Embase, and Web of Science databases were searched for related studies published between January 1, 2010, and May 30, 2021, using keywords, including particle, particulate, constituent, component, composition, cardiovascular biomarker, inflammation, oxidative stress, coagulation vasoactivity, and lipid metabolism. Results: Ten studies, which met the inclusion criteria, highlighted the existence of significant associations between particulate matter components and the levels of cardiovascular biomarkers, including lipid, inflammation and coagulation biomarkers, etc. However, multicenter studies evidence regarding the effects of long-term exposure to particulate matter components on cardiovascular biomarkers is still lacking. Further, studies with a focus on proteomics, and metabolomics of cardiovascular biomarkers owing to particulate matter exposure are also scarce. Conclusions: Exposure to particulate matter components was found to be significantly associated with cardiovascular biomarkers. However, in future, it would be necessary to conduct multicenter studies on the effects of long-term exposure to particulate components on the levels of cardiovascular biomarkers.","PeriodicalId":52908,"journal":{"name":"Cardiology Plus","volume":"6 1","pages":"149 - 155"},"PeriodicalIF":0.0,"publicationDate":"2021-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41753264","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-07-01DOI: 10.4103/2470-7511.327239
Ding-cheng Xiang, Yinghui Jin, W. Fang, X. Su, Bo Yu, Yan Wang, Wei-min Wang, Lefeng Wang, Hong-Bing Yan, Xianghua Fu, Zhijie Zheng, K. Labresh, Y. Huo, J. Ge
Background: The National Chest Pain Centers Program (NCPCP) is the largest nationwide, hospital-based, multifaceted, continuous quality improvement initiative, which aims to monitor and improve the quality of care for patients with acute chest pain. The accreditation of the standardized chest pain center is central to the project. The purpose of establishing chest pain centers is to develop a mechanism for “sending acute chest pain patients to a hospital with capabilities for the best treatment in the shortest time possible.” Objectives: This study aims to evaluate the effectiveness and implementation of the chest pain center accreditation and to identify factors that may influence its implementation in local settings. Study Design and Methods: Hospitals that have been accredited between January 2016 and September 2020 will be recruited in this study. We will conduct a self-controlled retrospective cohort study by comparing the care performance before, during, and after the accreditation. Measures for care performance will be selected based on the American College of Cardiology/American Heart Association clinical practice guidelines, which will be divided into prehospital processes, in-hospital processes, and in-hospital outcomes. For the implementation of the chest pain center accreditation, we will use a modified reach, effectiveness, adoption, implementation, maintenance (RE-AIM) framework to investigate the implementation process, and the consolidated framework for implementation research will be used to identify factors that emerge within the local context and influence the implementation fidelity and feasibility. Progress to Date: As of September 2020, there were 4,621 hospitals that registered the NCPCP, of which 1,507 hospitals were accredited. A total of 5,228,973 patients with a primary diagnosis on admission were enrolled from the registered hospitals, among which 34.6% were acute coronary syndromes. Conclusions: In this study, we proposed recommendations for improving the implementation of chest pain center accreditation, which will improve the quality of care for patients with acute chest pain and promote the sustainable development of chest pain center.
{"title":"The national chest pain centers program: Monitoring and improving quality of care for patients with acute chest pain in China","authors":"Ding-cheng Xiang, Yinghui Jin, W. Fang, X. Su, Bo Yu, Yan Wang, Wei-min Wang, Lefeng Wang, Hong-Bing Yan, Xianghua Fu, Zhijie Zheng, K. Labresh, Y. Huo, J. Ge","doi":"10.4103/2470-7511.327239","DOIUrl":"https://doi.org/10.4103/2470-7511.327239","url":null,"abstract":"Background: The National Chest Pain Centers Program (NCPCP) is the largest nationwide, hospital-based, multifaceted, continuous quality improvement initiative, which aims to monitor and improve the quality of care for patients with acute chest pain. The accreditation of the standardized chest pain center is central to the project. The purpose of establishing chest pain centers is to develop a mechanism for “sending acute chest pain patients to a hospital with capabilities for the best treatment in the shortest time possible.” Objectives: This study aims to evaluate the effectiveness and implementation of the chest pain center accreditation and to identify factors that may influence its implementation in local settings. Study Design and Methods: Hospitals that have been accredited between January 2016 and September 2020 will be recruited in this study. We will conduct a self-controlled retrospective cohort study by comparing the care performance before, during, and after the accreditation. Measures for care performance will be selected based on the American College of Cardiology/American Heart Association clinical practice guidelines, which will be divided into prehospital processes, in-hospital processes, and in-hospital outcomes. For the implementation of the chest pain center accreditation, we will use a modified reach, effectiveness, adoption, implementation, maintenance (RE-AIM) framework to investigate the implementation process, and the consolidated framework for implementation research will be used to identify factors that emerge within the local context and influence the implementation fidelity and feasibility. Progress to Date: As of September 2020, there were 4,621 hospitals that registered the NCPCP, of which 1,507 hospitals were accredited. A total of 5,228,973 patients with a primary diagnosis on admission were enrolled from the registered hospitals, among which 34.6% were acute coronary syndromes. Conclusions: In this study, we proposed recommendations for improving the implementation of chest pain center accreditation, which will improve the quality of care for patients with acute chest pain and promote the sustainable development of chest pain center.","PeriodicalId":52908,"journal":{"name":"Cardiology Plus","volume":"6 1","pages":"187 - 197"},"PeriodicalIF":0.0,"publicationDate":"2021-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48836232","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-07-01DOI: 10.4103/2470-7511.327243
S. Liao, Rongrong Gao, I. Cheang, Xinyi Lu, Yan-li Zhou, Hai-Feng Zhang, W. Yao, Xinli Li
Background and Objective: Clinical studies have suggested that low tri-iodothyronine (T3) syndrome negatively affects the clinical outcomes of patients with acute heart failure (AHF). The aim of this prospective cohort study was to evaluate the effect of low T3 syndrome in terms of prognosis and risk-predictive potential in AHF. Methods: A prospective observational cohort study was conducted from April 2012 to August 2016 in Nanjing, China. All clinical baseline characteristics were retrieved from electronic medical records. Low T3 syndrome was defined by a low free T3 level (<3.1 pM) accompanied by a normal thyroid-stimulating hormone level. The association between the free T3 level and mortality and the incremental risk prediction were estimated in Cox regression adjusted models. Results: In total, 312 patients with AHF for whom detailed thyroid hormone profiles were available were prospectively enrolled. Seventy-two patients exhibited low T3 syndrome. Over a median follow-up period of 35 months, 121 cumulative deaths occurred. Cardiovascular death was observed in 94 patients. After extensive adjustment for confounders, the low T3 syndrome-associated hazard ratios (95% confidence intervals) were 1.74 (1.16–2.61, P = 0.007) for all-cause mortality and 1.90 (1.21–2.98, P = 0.005) for cardiovascular mortality. The restricted cubic splines suggested a negative linear relationship between the free T3 level and mortality risk. Considering reclassification, adding low T3 syndrome to the fully adjusted model improved the risk prediction for all-cause mortality (integrated discrimination improvement [IDI]: 2.0%, P = 0.030; net reclassification improvement [NRI]: 8.9%, P = 0.232) and cardiovascular mortality (IDI: 2.5%, P = 0.030; NRI: 21.3%, P = 0.013). Conclusions: Low T3 syndrome reclassified risk prediction for mortality beyond traditional risk factors for patients with AHF.
{"title":"Low tri-iodothyronine syndrome improves the risk prediction for mortality in patients with acute heart failure: A prospective observational cohort study","authors":"S. Liao, Rongrong Gao, I. Cheang, Xinyi Lu, Yan-li Zhou, Hai-Feng Zhang, W. Yao, Xinli Li","doi":"10.4103/2470-7511.327243","DOIUrl":"https://doi.org/10.4103/2470-7511.327243","url":null,"abstract":"Background and Objective: Clinical studies have suggested that low tri-iodothyronine (T3) syndrome negatively affects the clinical outcomes of patients with acute heart failure (AHF). The aim of this prospective cohort study was to evaluate the effect of low T3 syndrome in terms of prognosis and risk-predictive potential in AHF. Methods: A prospective observational cohort study was conducted from April 2012 to August 2016 in Nanjing, China. All clinical baseline characteristics were retrieved from electronic medical records. Low T3 syndrome was defined by a low free T3 level (<3.1 pM) accompanied by a normal thyroid-stimulating hormone level. The association between the free T3 level and mortality and the incremental risk prediction were estimated in Cox regression adjusted models. Results: In total, 312 patients with AHF for whom detailed thyroid hormone profiles were available were prospectively enrolled. Seventy-two patients exhibited low T3 syndrome. Over a median follow-up period of 35 months, 121 cumulative deaths occurred. Cardiovascular death was observed in 94 patients. After extensive adjustment for confounders, the low T3 syndrome-associated hazard ratios (95% confidence intervals) were 1.74 (1.16–2.61, P = 0.007) for all-cause mortality and 1.90 (1.21–2.98, P = 0.005) for cardiovascular mortality. The restricted cubic splines suggested a negative linear relationship between the free T3 level and mortality risk. Considering reclassification, adding low T3 syndrome to the fully adjusted model improved the risk prediction for all-cause mortality (integrated discrimination improvement [IDI]: 2.0%, P = 0.030; net reclassification improvement [NRI]: 8.9%, P = 0.232) and cardiovascular mortality (IDI: 2.5%, P = 0.030; NRI: 21.3%, P = 0.013). Conclusions: Low T3 syndrome reclassified risk prediction for mortality beyond traditional risk factors for patients with AHF.","PeriodicalId":52908,"journal":{"name":"Cardiology Plus","volume":"6 1","pages":"174 - 180"},"PeriodicalIF":0.0,"publicationDate":"2021-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46501155","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-04-01DOI: 10.4103/2470-7511.320321
Yan-xiang Zang, Wei-min Li, Qi Lou, H. Wang, Yu Duan
At present, guideline-directed medical therapy of heart failure (HF) has achieved certain results, but the evidence mostly focuses on HF with reduced ejection fraction, and there are some problems in the research on HF with preserved ejection fraction (HFpEF), such as inconsistent inclusion criteria and unconvincing results. Therefore, it may be more individualized and targeted to perform classification, typing, and treatment of HF from aspects such as pathogenesis, etiology, or pathophysiology, but not ejection fraction, especially HFpEF with strong heterogeneity. Ge's phenotyping of HFpEF is based on etiology and pathology, aiming at improving the outcome of HFpEF and exploring new approaches for the prognosis of HF.
{"title":"Viewing the future research directions of heart failure from ge's phenotyping of heart failure with preserved ejection fraction","authors":"Yan-xiang Zang, Wei-min Li, Qi Lou, H. Wang, Yu Duan","doi":"10.4103/2470-7511.320321","DOIUrl":"https://doi.org/10.4103/2470-7511.320321","url":null,"abstract":"At present, guideline-directed medical therapy of heart failure (HF) has achieved certain results, but the evidence mostly focuses on HF with reduced ejection fraction, and there are some problems in the research on HF with preserved ejection fraction (HFpEF), such as inconsistent inclusion criteria and unconvincing results. Therefore, it may be more individualized and targeted to perform classification, typing, and treatment of HF from aspects such as pathogenesis, etiology, or pathophysiology, but not ejection fraction, especially HFpEF with strong heterogeneity. Ge's phenotyping of HFpEF is based on etiology and pathology, aiming at improving the outcome of HFpEF and exploring new approaches for the prognosis of HF.","PeriodicalId":52908,"journal":{"name":"Cardiology Plus","volume":"6 1","pages":"88 - 91"},"PeriodicalIF":0.0,"publicationDate":"2021-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43173526","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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