American heart journal plus : cardiology research and practice最新文献

CMR and adverse clinical outcomes in peripartum cardiomyopathy CMR 与围产期心肌病的不良临床结果

IF 1.3 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

American heart journal plus : cardiology research and practice

Pub Date : 2024-11-09 DOI: 10.1016/j.ahjo.2024.100484

Agnes Koczo , Deeksha Acharya , Benay Ozbay , Rami Alharethi , Michael M. Givertz , Uri Elkayam , Erik B. Schelbert , Dennis M. McNamara , Timothy C. Wong

Background

Peripartum cardiomyopathy (PPCM) is associated with significant morbidity and mortality. Recent studies show recovery of left ventricular ejection fraction (LVEF) can still be associated with longitudinal adverse clinical outcomes. Cardiac MRI (CMR) may yield additional prognostic parameters of serious adverse outcomes (SAE) beyond LVEF.

Methods

Individuals with PPCM and CMR within 3 months of diagnosis were analyzed from the Investigations in Pregnancy Associated Cardiomyopathy (IPAC) trial and our institution from 2010-present. Indexed left ventricular (LV) mass, ventricular volumes, cardiac output, global longitudinal strain (GLS), extracellular cellular volume (ECV) as well as epicardial fat volume (EFV) were analyzed. SAEs included left ventricular assist device (LVAD), heart transplant and death. CMR parameters were compared between SAE and no SAEs groups by non-parametric techniques.

Results

Among 51 individuals with mean age of 31 years at diagnosis, 6/51 (12 %) experienced 11 adverse outcomes. EF at time of CMR (15.0 vs 37.3 %, p < 0.001), peak LV GLS (−4.1 % vs −10.0, p = 0.002) ECV (43.6 vs 28.2, p = 0.02) and stroke volume differed significantly among groups. In univariate regression analysis, worse LVEF, lower peak GLS and greater LVESVi were predictive of adverse outcomes.

Conclusion

Prior studies found baseline LVEF by echo is a predictor of serious adverse outcomes. CMR identified significantly different baseline LVESVi peak LV GLS and ECV among PPCM with SAEs vs no SAEs. If confirmed in larger studies, diffuse myocardial fibrosis may represent a therapeutic target in PPCM.

背景围产期心肌病（PPCM）与严重的发病率和死亡率相关。最近的研究表明，左心室射血分数（LVEF）的恢复仍与纵向不良临床结局有关。除了 LVEF 外，心脏核磁共振成像（CMR）可能会产生更多严重不良预后（SAE）的预后参数。方法分析了 2010 年至今妊娠相关心肌病研究（IPAC）试验和本机构的 PPCM 患者，并在确诊后 3 个月内进行了 CMR 检查。对指数左心室（LV）质量、心室容积、心输出量、整体纵向应变（GLS）、细胞外体积（ECV）以及心外膜脂肪体积（EFV）进行了分析。SAE 包括左心室辅助装置（LVAD）、心脏移植和死亡。采用非参数技术比较了出现 SAE 组和未出现 SAE 组的 CMR 参数。结果在 51 名诊断时平均年龄为 31 岁的患者中，6/51（12%）人出现了 11 种不良后果。CMR检查时的EF（15.0 vs 37.3 %，p <0.001）、左心室GLS峰值（-4.1 % vs -10.0，p = 0.002）、ECV（43.6 vs 28.2，p = 0.02）和卒中容量在各组间存在显著差异。在单变量回归分析中，更差的 LVEF、更低的峰值 GLS 和更大的 LVESVi 可预测不良预后。CMR发现，有SAE的PPCM与无SAE的PPCM的基线LVESVi峰值LV GLS和ECV存在明显差异。如果在更大规模的研究中得到证实，弥漫性心肌纤维化可能是 PPCM 的治疗目标。

{"title":"CMR and adverse clinical outcomes in peripartum cardiomyopathy","authors":"Agnes Koczo , Deeksha Acharya , Benay Ozbay , Rami Alharethi , Michael M. Givertz , Uri Elkayam , Erik B. Schelbert , Dennis M. McNamara , Timothy C. Wong","doi":"10.1016/j.ahjo.2024.100484","DOIUrl":"10.1016/j.ahjo.2024.100484","url":null,"abstract":"<div><h3>Background</h3><div>Peripartum cardiomyopathy (PPCM) is associated with significant morbidity and mortality. Recent studies show recovery of left ventricular ejection fraction (LVEF) can still be associated with longitudinal adverse clinical outcomes. Cardiac MRI (CMR) may yield additional prognostic parameters of serious adverse outcomes (SAE) beyond LVEF.</div></div><div><h3>Methods</h3><div>Individuals with PPCM and CMR within 3 months of diagnosis were analyzed from the Investigations in Pregnancy Associated Cardiomyopathy (IPAC) trial and our institution from 2010-present. Indexed left ventricular (LV) mass, ventricular volumes, cardiac output, global longitudinal strain (GLS), extracellular cellular volume (ECV) as well as epicardial fat volume (EFV) were analyzed. SAEs included left ventricular assist device (LVAD), heart transplant and death. CMR parameters were compared between SAE and no SAEs groups by non-parametric techniques.</div></div><div><h3>Results</h3><div>Among 51 individuals with mean age of 31 years at diagnosis, 6/51 (12 %) experienced 11 adverse outcomes. EF at time of CMR (15.0 vs 37.3 %, <em>p</em> < 0.001), peak LV GLS (−4.1 % vs −10.0, <em>p</em> = 0.002) ECV (43.6 vs 28.2, <em>p</em> = 0.02) and stroke volume differed significantly among groups. In univariate regression analysis, worse LVEF, lower peak GLS and greater LVESVi were predictive of adverse outcomes.</div></div><div><h3>Conclusion</h3><div>Prior studies found baseline LVEF by echo is a predictor of serious adverse outcomes. CMR identified significantly different baseline LVESVi peak LV GLS and ECV among PPCM with SAEs vs no SAEs. If confirmed in larger studies, diffuse myocardial fibrosis may represent a therapeutic target in PPCM.</div></div>","PeriodicalId":72158,"journal":{"name":"American heart journal plus : cardiology research and practice","volume":"48 ","pages":"Article 100484"},"PeriodicalIF":1.3,"publicationDate":"2024-11-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142651794","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}

引用次数: 0

Prevalence and risk factors associated with decompensated heart failure after successful elective cardioversion for atrial fibrillation and atrial flutter 成功进行心房颤动和心房扑动选择性心脏复律术后出现失代偿性心力衰竭的患病率和相关风险因素

IF 1.3 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

American heart journal plus : cardiology research and practice

Pub Date : 2024-11-01 DOI: 10.1016/j.ahjo.2024.100480

Christina Healy, Palwinder Sodhi, Annabelle Barnett, Timothy Hess, Jennifer M. Wright

Study objective

To determine the incidence of and risk factors for HF after successful electrical and ablative cardioversion (CV) of atrial fibrillation (AF) and atrial flutter (AFL).

Design

Retrospective cohort study.

Setting

Single center academic institution.

Participants

Seven hundred fifty-five patients underwent successful elective CV from July 1, 2018 to May 20, 2019. Patients presenting in arrhythmias other than AF or AFL, those who developed HF due to alternative etiologies, and those who developed arrhythmia recurrence within 30 days were excluded. Medical records of the remaining 451 patients were reviewed before and after CV.

Main outcomes measured

Development of heart failure despite sinus rhythm following CV and the risk factors associated with this outcome.

Results

Thirty-three (7.3 %) of 451 patients who met inclusion criteria for our study developed new or worsening HF symptoms while maintaining sinus rhythm (SR) after successful CV. Symptoms were reported an average of 5.1 days following CV (range 0–17 days, SD 4.71). Following a multivariate stepwise logistic regression model, prior HF hospitalization (OR 3.91, 95 % CI 1.82–8.39), BMI (OR 1.06, 95 % CI 1.02–1.11), and valve disease (OR 2.51, 95 % CI 1.12–5.60) remained significant risk factors, and anti-arrhythmic drug (AAD) use was marginally significant (OR 2.02, 95 % CI 0.95–4.31).

Conclusion

Despite maintenance of SR, 7.3 % of patients developed decompensated HF in the 30 days following successful CV of AF or AFL, indicating this complication may be more frequent than previously believed. Predictors of HF post-CV included elevated BMI, valve disease, previous HF hospitalization, and prior AAD use.

研究目的确定房颤（AF）和心房扑动（AFL）成功电复律和消融心脏复律（CV）后高血压的发生率和风险因素.设计回顾性队列研究.设置单中心学术机构.参与者2018年7月1日至2019年5月20日期间，755名患者成功接受了选择性CV。排除了出现房颤或AFL以外的心律失常的患者、因其他病因导致HF的患者以及30天内心律失常复发的患者。对其余 451 名患者进行了心电图检查前后的病历回顾。主要测量结果心电图检查后虽有窦性心律，但仍出现心力衰竭，以及与这一结果相关的风险因素。出现症状的时间平均为 CV 后 5.1 天（范围为 0-17 天，SD 为 4.71）。在多变量逐步逻辑回归模型中，之前的高血压住院治疗（OR 3.91，95 % CI 1.82-8.39）、体重指数（OR 1.06，95 % CI 1.02-1.11）和瓣膜疾病（OR 2.51，95 % CI 1.12-5.60）仍然是重要的风险因素，而使用抗心律失常药物（AAD）则略有意义（OR 2.结论尽管维持了 SR，但仍有 7.3% 的患者在房颤或 AFL 成功 CV 后的 30 天内出现失代偿性 HF，这表明这种并发症可能比之前认为的更为常见。心房颤动后出现心房颤动的预测因素包括体重指数升高、瓣膜疾病、既往心房颤动住院和既往使用过 AAD。

{"title":"Prevalence and risk factors associated with decompensated heart failure after successful elective cardioversion for atrial fibrillation and atrial flutter","authors":"Christina Healy, Palwinder Sodhi, Annabelle Barnett, Timothy Hess, Jennifer M. Wright","doi":"10.1016/j.ahjo.2024.100480","DOIUrl":"10.1016/j.ahjo.2024.100480","url":null,"abstract":"<div><h3>Study objective</h3><div>To determine the incidence of and risk factors for HF after successful electrical and ablative cardioversion (CV) of atrial fibrillation (AF) and atrial flutter (AFL).</div></div><div><h3>Design</h3><div>Retrospective cohort study.</div></div><div><h3>Setting</h3><div>Single center academic institution.</div></div><div><h3>Participants</h3><div>Seven hundred fifty-five patients underwent successful elective CV from July 1, 2018 to May 20, 2019. Patients presenting in arrhythmias other than AF or AFL, those who developed HF due to alternative etiologies, and those who developed arrhythmia recurrence within 30 days were excluded. Medical records of the remaining 451 patients were reviewed before and after CV.</div></div><div><h3>Main outcomes measured</h3><div>Development of heart failure despite sinus rhythm following CV and the risk factors associated with this outcome.</div></div><div><h3>Results</h3><div>Thirty-three (7.3 %) of 451 patients who met inclusion criteria for our study developed new or worsening HF symptoms while maintaining sinus rhythm (SR) after successful CV. Symptoms were reported an average of 5.1 days following CV (range 0–17 days, SD 4.71). Following a multivariate stepwise logistic regression model, prior HF hospitalization (OR 3.91, 95 % CI 1.82–8.39), BMI (OR 1.06, 95 % CI 1.02–1.11), and valve disease (OR 2.51, 95 % CI 1.12–5.60) remained significant risk factors, and anti-arrhythmic drug (AAD) use was marginally significant (OR 2.02, 95 % CI 0.95–4.31).</div></div><div><h3>Conclusion</h3><div>Despite maintenance of SR, 7.3 % of patients developed decompensated HF in the 30 days following successful CV of AF or AFL, indicating this complication may be more frequent than previously believed. Predictors of HF post-CV included elevated BMI, valve disease, previous HF hospitalization, and prior AAD use.</div></div>","PeriodicalId":72158,"journal":{"name":"American heart journal plus : cardiology research and practice","volume":"47 ","pages":"Article 100480"},"PeriodicalIF":1.3,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142571947","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}

引用次数: 0

The evaluation of combined fractional flow reserve and dynamic SPECT in chronic total occlusion 在慢性全闭塞中联合使用分数血流储备和动态 SPECT 进行评估

IF 1.3 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

American heart journal plus : cardiology research and practice

Pub Date : 2024-11-01 DOI: 10.1016/j.ahjo.2024.100477

Shufu Chang , Rende Xu , Hao Lu , Yuxiang Dai , Chenguang Li , Jie Zhang , Gang Zhao , Juying Qian , Jianying Ma , Junbo Ge

Background

Chronic total occlusion (CTO) is the most challenging subset in percutaneous coronary intervention (PCI), but the optimal selection of patients and indication for such procedures remain a subject of debate. We sought to investigate the role of physiological function in treatment decisions of CTO PCI by measuring fractional flow reserve (FFR) and Dynamic SPECT imaging in this study.

Methods

All the FFR of CTO vessel were measured before and immediately after CTO revascularization, and Dynamic SPECT imaging were detected before PCI in patients with an identified CTO.

Results

A total of 53 patients with single-vessel CTO lesions were included in this cohort study. The mean FFR value was 0.34 ± 0.09 at baseline. Immediately after successful CTO PCI, the FFR value significantly increased to 0.79 ± 0.11. The regional coronary flow reserve (CFR) of CTO vessels was 1.62 ± 0.64, which was significantly and positively correlated with the baseline FFR value (r = 0.607, p = 0.005). The area under the ROC curve of the baseline FFR for the detection of ischemia was 0.923 (p < 0.001). The diagnostic performance in terms of sensitivity and specificity was 83.3 % and 85.7 % for baseline FFR with a ROC-optimized cutoff value of 0.35.

Conclusions

A significant correlation was found between the CFR derived from dynamic SPECT and baseline FFR. An FFR of <0.35 before CTO PCI can be taken as the cutoff for the presence of inducible ischemia, which was a useful index for therapy options.

背景慢性全闭塞（CTO）是经皮冠状动脉介入治疗（PCI）中最具挑战性的亚组，但患者的最佳选择和此类手术的适应症仍存在争议。我们试图通过测量分数血流储备（FFR）和动态 SPECT 成像来研究生理功能在 CTO PCI 治疗决策中的作用。方法在 CTO 血管再通前和紧随其后测量所有 CTO 血管的 FFR，并在确定有 CTO 的患者 PCI 前检测动态 SPECT 成像。基线时的平均 FFR 值为 0.34 ± 0.09。成功进行 CTO PCI 术后，FFR 值立即大幅上升至 0.79 ± 0.11。CTO 血管的区域冠状动脉血流储备（CFR）为 1.62 ± 0.64，与基线 FFR 值呈显著正相关（r = 0.607，p = 0.005）。基线 FFR 检测缺血的 ROC 曲线下面积为 0.923（p < 0.001）。基线 FFR 的灵敏度和特异度分别为 83.3% 和 85.7%，ROC 优化临界值为 0.35。CTO PCI 前的 FFR 值为 0.35，可作为存在诱发性缺血的临界值，这对治疗方案的选择是一个有用的指标。

{"title":"The evaluation of combined fractional flow reserve and dynamic SPECT in chronic total occlusion","authors":"Shufu Chang , Rende Xu , Hao Lu , Yuxiang Dai , Chenguang Li , Jie Zhang , Gang Zhao , Juying Qian , Jianying Ma , Junbo Ge","doi":"10.1016/j.ahjo.2024.100477","DOIUrl":"10.1016/j.ahjo.2024.100477","url":null,"abstract":"<div><h3>Background</h3><div>Chronic total occlusion (CTO) is the most challenging subset in percutaneous coronary intervention (PCI), but the optimal selection of patients and indication for such procedures remain a subject of debate. We sought to investigate the role of physiological function in treatment decisions of CTO PCI by measuring fractional flow reserve (FFR) and Dynamic SPECT imaging in this study.</div></div><div><h3>Methods</h3><div>All the FFR of CTO vessel were measured before and immediately after CTO revascularization, and Dynamic SPECT imaging were detected before PCI in patients with an identified CTO.</div></div><div><h3>Results</h3><div>A total of 53 patients with single-vessel CTO lesions were included in this cohort study. The mean FFR value was 0.34 ± 0.09 at baseline. Immediately after successful CTO PCI, the FFR value significantly increased to 0.79 ± 0.11. The regional coronary flow reserve (CFR) of CTO vessels was 1.62 ± 0.64, which was significantly and positively correlated with the baseline FFR value (<em>r</em> = 0.607, <em>p</em> = 0.005). The area under the ROC curve of the baseline FFR for the detection of ischemia was 0.923 (<em>p</em> < 0.001). The diagnostic performance in terms of sensitivity and specificity was 83.3 % and 85.7 % for baseline FFR with a ROC-optimized cutoff value of 0.35.</div></div><div><h3>Conclusions</h3><div>A significant correlation was found between the CFR derived from dynamic SPECT and baseline FFR. An FFR of <0.35 before CTO PCI can be taken as the cutoff for the presence of inducible ischemia, which was a useful index for therapy options.</div></div>","PeriodicalId":72158,"journal":{"name":"American heart journal plus : cardiology research and practice","volume":"47 ","pages":"Article 100477"},"PeriodicalIF":1.3,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142553749","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}

引用次数: 0

Causal associations of Sjögren's syndrome with cardiovascular disease: A two-sample Mendelian randomization study 斯约格伦综合征与心血管疾病的因果关系：双样本孟德尔随机研究

IF 1.3 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

American heart journal plus : cardiology research and practice

Pub Date : 2024-11-01 DOI: 10.1016/j.ahjo.2024.100482

Chen Su , Xiaobo Zhu , Qiang Wang, Feng Jiang, Junjie Zhang

Study objectives

Observational and cohort studies have associated Sjögren's syndrome (SS) with various types of cardiovascular disease (CVD), yet causal relationships have not been established. We employed Mendelian randomization (MR) to investigate potential causal links between SS and CVD in the general population.

Methods

We conducted a two-sample MR analysis using data from four distinct sources for 11 genome-wide significant single nucleotide polymorphisms (SNPs) associated with SS and data for 13 types of CVD sourced from FinnGen, IEU OpenGWAS, and GWAS catalog. The inverse variance weighted method was selected as the primary analytical approach, complemented by various sensitivity analyses.

Results

MR analyses provide evidence of a significantly increased risk of ischemic stroke associated with genetically predicted SS (odds ratio [OR], 1.0237; 95 % CI, 1.0096 to 1.0379; p = 0.0009), as well as suggestive evidence of a potential causal relationship between SS and an increased risk of chronic heart failure (OR, 1.0302; 95 % CI, 1.0020 to 1.0592; p = 0.0355). Sensitivity analyses reinforced these associations, demonstrating robustness and consistency across multiple statistical methods. The secondary analysis, conducted after outlier correction using MR-PRESSO and RadialMR methods, reaffirmed these associations and also indicated a suggestive causal link between SS and non-rheumatic valvular heart disease (OR, 1.0251; 95 % CI, 1.0021 to 1.0486; p = 0.0323).

Conclusions

This study demonstrates that genetically predicted SS is a potential causative risk factor for ischemic stroke, chronic heart failure, and non-rheumatic valvular heart disease on a large-scale population. However, further research incorporating ancestral diversity is required to confirm a causal relationship between SS and CVD.

研究目的观察性研究和队列研究发现，斯约格伦综合征（SS）与各种类型的心血管疾病（CVD）有关，但因果关系尚未确定。我们采用孟德尔随机化（Mendelian randomization，MR）方法调查了普通人群中SS与心血管疾病之间的潜在因果关系。我们利用来自四个不同来源的数据进行了双样本MR分析，其中包括与SS相关的11个全基因组重要单核苷酸多态性（SNPs），以及来自FinnGen、IEU OpenGWAS和GWAS目录的13种心血管疾病数据。结果MR 分析证明，缺血性中风的风险显著增加与遗传预测的 SS 有关（几率比 [OR]，1.0237; 95 % CI, 1.0096 to 1.0379; p = 0.0009），以及 SS 与慢性心力衰竭风险增加之间潜在因果关系的提示性证据（OR, 1.0302; 95 % CI, 1.0020 to 1.0592; p = 0.0355）。敏感性分析加强了这些关联，证明了多种统计方法的稳健性和一致性。使用 MR-PRESSO 和 RadialMR 方法对离群值进行校正后进行的二次分析再次证实了这些关联，并表明 SS 与非风湿性瓣膜性心脏病之间存在提示性因果关系（OR，1.0251；95 % CI，1.0021 至 1.0486；p = 0.0323）。然而，要确认 SS 与心血管疾病之间的因果关系，还需要结合祖先多样性开展进一步研究。

{"title":"Causal associations of Sjögren's syndrome with cardiovascular disease: A two-sample Mendelian randomization study","authors":"Chen Su , Xiaobo Zhu , Qiang Wang, Feng Jiang, Junjie Zhang","doi":"10.1016/j.ahjo.2024.100482","DOIUrl":"10.1016/j.ahjo.2024.100482","url":null,"abstract":"<div><h3>Study objectives</h3><div>Observational and cohort studies have associated Sjögren's syndrome (SS) with various types of cardiovascular disease (CVD), yet causal relationships have not been established. We employed Mendelian randomization (MR) to investigate potential causal links between SS and CVD in the general population.</div></div><div><h3>Methods</h3><div>We conducted a two-sample MR analysis using data from four distinct sources for 11 genome-wide significant single nucleotide polymorphisms (SNPs) associated with SS and data for 13 types of CVD sourced from FinnGen, IEU OpenGWAS, and GWAS catalog. The inverse variance weighted method was selected as the primary analytical approach, complemented by various sensitivity analyses.</div></div><div><h3>Results</h3><div>MR analyses provide evidence of a significantly increased risk of ischemic stroke associated with genetically predicted SS (odds ratio [OR], 1.0237; 95 % CI, 1.0096 to 1.0379; <em>p</em> = 0.0009), as well as suggestive evidence of a potential causal relationship between SS and an increased risk of chronic heart failure (OR, 1.0302; 95 % CI, 1.0020 to 1.0592; <em>p</em> = 0.0355). Sensitivity analyses reinforced these associations, demonstrating robustness and consistency across multiple statistical methods. The secondary analysis, conducted after outlier correction using MR-PRESSO and RadialMR methods, reaffirmed these associations and also indicated a suggestive causal link between SS and non-rheumatic valvular heart disease (OR, 1.0251; 95 % CI, 1.0021 to 1.0486; <em>p</em> = 0.0323).</div></div><div><h3>Conclusions</h3><div>This study demonstrates that genetically predicted SS is a potential causative risk factor for ischemic stroke, chronic heart failure, and non-rheumatic valvular heart disease on a large-scale population. However, further research incorporating ancestral diversity is required to confirm a causal relationship between SS and CVD.</div></div>","PeriodicalId":72158,"journal":{"name":"American heart journal plus : cardiology research and practice","volume":"47 ","pages":"Article 100482"},"PeriodicalIF":1.3,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142571948","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}

引用次数: 0

Baseline inflammatory status affects the prognostic impact of statins in patients with peripheral arterial disease 基线炎症状态会影响他汀类药物对外周动脉疾病患者预后的影响

IF 1.3 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

American heart journal plus : cardiology research and practice

Pub Date : 2024-11-01 DOI: 10.1016/j.ahjo.2024.100481

Kentaro Jujo , Daisuke Ueshima , Takuro Abe , Kensuke Shimazaki , Yo Fujimoto , Tomofumi Tanaka , Teppei Murata , Toru Miyazaki , Michiaki Matsumoto , Hideo Tokuyama , Tsukasa Shimura , Ryuichi Funada , Naotaka Murata , Michiaki Higashitani , Toma-Code Registry Investigators

Background

Statins bring favourable effects on the clinical prognosis of patients with atherosclerotic disease partly through their anti-inflammatory properties. However, this effect has not been fully verified in patients with peripheral arterial disease (PAD). We aimed to test whether statins exert different prognostic effects depending on the degrees of inflammation in patients with PAD.

Methods

This study was a sub-analysis of a multicenter prospective cohort of 2321 consecutive patients with PAD who received endovascular therapy (EVT). After excluding patients without information on C-reactive protein (CRP) levels at the time of index EVT, 1974 patients (1021 statin users and 953 non-users) were classified into four groups depending on CRP levels: low CRP (<0.1 mg/dL), intermediate-low CRP (0.1–0.3 mg/dL), intermediate-high CRP (0.3–1.0 mg/dL), and high CRP (>1.0 mg/dL). A composite of death, stroke, myocardial infarction, and major amputation as the primary endpoint was compared between statin users and non-users in each CRP category.

Results

During the median observation period of 316 days, the primary composite endpoint occurred in 112 (11.0 %) statin users and 178 (18.7 %) non-users (log-rank test, p < 0.001). However, statin therapy was associated with significantly lower event rates only in the intermediate-high- and high-CRP categories (p = 0.02 and p = 0.008, respectively). Multivariable Cox regression analysis revealed that statin use was independently associated with the primary endpoint only in the high-CRP category (adjusted hazard ratio: 0.64 [95 % confidence interval: 0.41–0.98]).

Conclusion

Statins may exert favourable prognostic effects in patients with PAD and highly elevated CRP levels.

背景胰岛素对动脉粥样硬化疾病患者的临床预后具有有利影响，部分原因是胰岛素具有抗炎特性。然而，这种作用在外周动脉疾病（PAD）患者中尚未得到充分验证。我们的目的是检验他汀类药物是否会因 PAD 患者炎症程度的不同而对预后产生不同的影响。这项研究是对 2321 名连续接受血管内治疗（EVT）的 PAD 患者进行的多中心前瞻性队列的子分析。在排除了指数EVT时没有C反应蛋白（CRP）水平信息的患者后，根据CRP水平将1974名患者（1021名他汀类药物使用者和953名非使用者）分为四组：低CRP（<0.1 mg/dL）、中低CRP（0.1-0.3 mg/dL）、中高CRP（0.3-1.0 mg/dL）和高CRP（>1.0 mg/dL）。结果在316天的中位观察期内，他汀类药物使用者中有112人（11.0%）出现了主要复合终点，而非使用者中有178人（18.7%）出现了主要复合终点（对数秩检验，p <0.001）。然而，他汀类药物治疗仅与中高和高CRP类别的事件发生率显著降低有关（p = 0.02 和 p = 0.008）。多变量 Cox 回归分析显示，只有在高 CRP 类别中，他汀类药物的使用才与主要终点独立相关（调整后危险比：0.64 [95 % 置信区间：0.41-0.98]）。

{"title":"Baseline inflammatory status affects the prognostic impact of statins in patients with peripheral arterial disease","authors":"Kentaro Jujo , Daisuke Ueshima , Takuro Abe , Kensuke Shimazaki , Yo Fujimoto , Tomofumi Tanaka , Teppei Murata , Toru Miyazaki , Michiaki Matsumoto , Hideo Tokuyama , Tsukasa Shimura , Ryuichi Funada , Naotaka Murata , Michiaki Higashitani , Toma-Code Registry Investigators","doi":"10.1016/j.ahjo.2024.100481","DOIUrl":"10.1016/j.ahjo.2024.100481","url":null,"abstract":"<div><h3>Background</h3><div>Statins bring favourable effects on the clinical prognosis of patients with atherosclerotic disease partly through their anti-inflammatory properties. However, this effect has not been fully verified in patients with peripheral arterial disease (PAD). We aimed to test whether statins exert different prognostic effects depending on the degrees of inflammation in patients with PAD.</div></div><div><h3>Methods</h3><div>This study was a sub-analysis of a multicenter prospective cohort of 2321 consecutive patients with PAD who received endovascular therapy (EVT). After excluding patients without information on C-reactive protein (CRP) levels at the time of index EVT, 1974 patients (1021 statin users and 953 non-users) were classified into four groups depending on CRP levels: low CRP (<0.1 mg/dL), intermediate-low CRP (0.1–0.3 mg/dL), intermediate-high CRP (0.3–1.0 mg/dL), and high CRP (>1.0 mg/dL). A composite of death, stroke, myocardial infarction, and major amputation as the primary endpoint was compared between statin users and non-users in each CRP category.</div></div><div><h3>Results</h3><div>During the median observation period of 316 days, the primary composite endpoint occurred in 112 (11.0 %) statin users and 178 (18.7 %) non-users (log-rank test, <em>p</em> < 0.001). However, statin therapy was associated with significantly lower event rates only in the intermediate-high- and high-CRP categories (<em>p</em> = 0.02 and <em>p</em> = 0.008, respectively). Multivariable Cox regression analysis revealed that statin use was independently associated with the primary endpoint only in the high-CRP category (adjusted hazard ratio: 0.64 [95 % confidence interval: 0.41–0.98]).</div></div><div><h3>Conclusion</h3><div>Statins may exert favourable prognostic effects in patients with PAD and highly elevated CRP levels.</div></div>","PeriodicalId":72158,"journal":{"name":"American heart journal plus : cardiology research and practice","volume":"47 ","pages":"Article 100481"},"PeriodicalIF":1.3,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142586065","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}

引用次数: 0

Artificial intelligence: Applications in cardio-oncology and potential impact on racial disparities 人工智能：心脏病肿瘤学的应用及对种族差异的潜在影响

IF 1.3 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

American heart journal plus : cardiology research and practice

Pub Date : 2024-10-31 DOI: 10.1016/j.ahjo.2024.100479

Gift Echefu , Rushabh Shah , Zanele Sanchez , John Rickards , Sherry-Ann Brown

Numerous cancer therapies have detrimental cardiovascular effects on cancer survivors. Cardiovascular toxicity can span the course of cancer treatment and is influenced by several factors. To mitigate these risks, cardio-oncology has evolved, with an emphasis on prevention and treatment of cardiovascular complications resulting from the presence of cancer and cancer therapy. Artificial intelligence (AI) holds multifaceted potential to enhance cardio-oncologic outcomes. AI algorithms are currently utilizing clinical data input to identify patients at risk for cardiac complications. Additional application opportunities for AI in cardio-oncology involve multimodal cardiovascular imaging, where algorithms can also utilize imaging input to generate predictive risk profiles for cancer patients. The impact of AI extends to digital health tools, playing a pivotal role in the development of digital platforms and wearable technologies. Multidisciplinary teams have been formed to implement and evaluate the efficacy of these technologies, assessing AI-driven clinical decision support tools. Other avenues similarly support practical application of AI in clinical practice, such as incorporation into electronic health records (EHRs) to detect patients at risk for cardiovascular diseases. While these AI applications may help improve preventive measures and facilitate tailored treatment to patients, they are also capable of perpetuating and exacerbating healthcare disparities, if trained on limited, homogenous datasets. However, if trained and operated appropriately, AI holds substantial promise in positively influencing clinical practice in cardio-oncology. In this review, we explore the impact of AI on cardio-oncology care, particularly regarding predicting cardiotoxicity from cancer treatments, while addressing racial and ethnic biases in algorithmic implementation.

许多癌症疗法都会对癌症幸存者的心血管产生不利影响。心血管毒性可贯穿整个癌症治疗过程，并受多种因素影响。为了降低这些风险，心血管肿瘤学得到了发展，重点是预防和治疗因癌症和癌症治疗而引起的心血管并发症。人工智能（AI）在提高心血管肿瘤治疗效果方面具有多方面的潜力。目前，人工智能算法正在利用临床数据输入来识别有心脏并发症风险的患者。人工智能在心脏肿瘤学中的其他应用机会还包括多模态心血管成像，算法还可以利用成像输入为癌症患者生成预测性风险档案。人工智能的影响延伸到数字健康工具，在数字平台和可穿戴技术的开发中发挥着关键作用。多学科团队已经成立，以实施和评估这些技术的功效，评估人工智能驱动的临床决策支持工具。其他途径也同样支持人工智能在临床实践中的实际应用，例如将其纳入电子健康记录（EHR）以检测心血管疾病高危患者。虽然这些人工智能应用可能有助于改善预防措施并促进为患者提供量身定制的治疗，但如果在有限的同质数据集上进行训练，它们也有可能延续和加剧医疗差距。不过，如果训练和操作得当，人工智能有望对心脏病肿瘤学的临床实践产生积极影响。在这篇综述中，我们将探讨人工智能对肿瘤心脏病学治疗的影响，尤其是在预测癌症治疗的心脏毒性方面，同时解决算法实施过程中的种族和民族偏见。

{"title":"Artificial intelligence: Applications in cardio-oncology and potential impact on racial disparities","authors":"Gift Echefu , Rushabh Shah , Zanele Sanchez , John Rickards , Sherry-Ann Brown","doi":"10.1016/j.ahjo.2024.100479","DOIUrl":"10.1016/j.ahjo.2024.100479","url":null,"abstract":"<div><div>Numerous cancer therapies have detrimental cardiovascular effects on cancer survivors. Cardiovascular toxicity can span the course of cancer treatment and is influenced by several factors. To mitigate these risks, cardio-oncology has evolved, with an emphasis on prevention and treatment of cardiovascular complications resulting from the presence of cancer and cancer therapy. Artificial intelligence (AI) holds multifaceted potential to enhance cardio-oncologic outcomes. AI algorithms are currently utilizing clinical data input to identify patients at risk for cardiac complications. Additional application opportunities for AI in cardio-oncology involve multimodal cardiovascular imaging, where algorithms can also utilize imaging input to generate predictive risk profiles for cancer patients. The impact of AI extends to digital health tools, playing a pivotal role in the development of digital platforms and wearable technologies. Multidisciplinary teams have been formed to implement and evaluate the efficacy of these technologies, assessing AI-driven clinical decision support tools. Other avenues similarly support practical application of AI in clinical practice, such as incorporation into electronic health records (EHRs) to detect patients at risk for cardiovascular diseases. While these AI applications may help improve preventive measures and facilitate tailored treatment to patients, they are also capable of perpetuating and exacerbating healthcare disparities, if trained on limited, homogenous datasets. However, if trained and operated appropriately, AI holds substantial promise in positively influencing clinical practice in cardio-oncology. In this review, we explore the impact of AI on cardio-oncology care, particularly regarding predicting cardiotoxicity from cancer treatments, while addressing racial and ethnic biases in algorithmic implementation.</div></div>","PeriodicalId":72158,"journal":{"name":"American heart journal plus : cardiology research and practice","volume":"48 ","pages":"Article 100479"},"PeriodicalIF":1.3,"publicationDate":"2024-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142651793","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}

引用次数: 0

Effect of colchicine on 90-day outcomes in patients with acute myocarditis: a real-world analysis 秋水仙碱对急性心肌炎患者 90 天疗效的影响：真实世界分析

IF 1.3 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

American heart journal plus : cardiology research and practice

Pub Date : 2024-10-24 DOI: 10.1016/j.ahjo.2024.100478

Michele Golino , Alexa Coe , Anas Aljabi , Azita H. Talasaz , Benjamin Van Tassell , Antonio Abbate , Roshanak Markley

引用次数: 0

Medication optimization clinic decreases hospitalizations and mortality for patients with heart failure with reduced ejection fraction 优化用药诊所降低了射血分数降低型心力衰竭患者的住院率和死亡率

IF 1.3 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

American heart journal plus : cardiology research and practice

Pub Date : 2024-10-16 DOI: 10.1016/j.ahjo.2024.100470

James C. Coons , Jennifer Kliner , Michael A. Mathier , Suresh Mulukutla , Floyd Thoma , Ahmet Sezer , Mary Keebler

Study objective

To evaluate the impact of a medication optimization clinic (MOC) on GDMT and outcomes for patients with HFrEF versus usual care.

Design

Retrospective evaluation of a multi-site MOC was conducted.

Setting

Large health system with academic and community hospitals.

Participants

Patients with HFrEF referred to MOC by their cardiologist versus usual care.

Interventions

GDMT use managed by an advanced practice provider or clinical pharmacist through weekly telemedicine visits.

Main outcome measures

The primary outcome was HF hospitalization. Cardiovascular hospitalization and all-cause mortality were also assessed. Kaplan−Meier Curve, Cumulative Incidence Function, and competing risk analysis with regression models were conducted.

Results

1419 patients in MOC group were compared to 5116 control patients. GDMT use was significantly higher in MOC: quadruple therapy (49 % vs. 19 %; p < 0.0001), angiotensin-receptor neprilysin inhibitor (62 % vs. 45 %; p < 0.0001), beta blocker (92 % vs. 88 %; p < 0.0001), mineralocorticoid receptor antagonist (69 % vs. 45 %; p < 0.0001), and sodium glucose cotransporter-2 inhibitor (68 % vs. 35 %; p < 0.0001). Competing risk analyses showed that HF and CV hospitalizations were significantly lower at all times points (3, 6, and 12 months) for MOC vs. control (p < 0.001). All-cause mortality was significantly lower at 6 months (p = 0.006) and 12 months (p < 0.001), but did not differ at 3 months (p = 0.35), for MOC vs. control.

Conclusions

MOC was associated with improved GDMT and lower risks of hospitalizations due to HF and any cardiovascular cause, and all-cause mortality in patients with HFrEF.

研究目的评估药物优化门诊（MOC）与常规护理对高频低氧血症（HFrEF）患者GDMT和预后的影响.设计对一个多站点MOC进行了回顾性评估.设置由学术医院和社区医院组成的大型医疗系统.参与者由心脏病专家转诊至MOC的高频低氧血症（HFrEF）患者与常规护理.干预由高级医疗服务提供者或临床药剂师通过每周的远程医疗访问管理GDMT的使用.主要结果测量主要结果是高频住院。还评估了心血管疾病住院率和全因死亡率。结果1419名MOC组患者与5116名对照组患者进行了比较。在 MOC 组中，GDMT 的使用率明显更高：四联疗法（49 % vs. 19 %；p <；0.0001）、血管紧张素受体肾素抑制剂（62 % vs. 45 %；p <；0.0001）、β-受体阻滞剂（92 % vs. 88 %；p <；0.0001）。88%；p <；0.0001）、矿物质皮质激素受体拮抗剂（69% 对 45%；p <；0.0001）和钠葡萄糖共转运体-2 抑制剂（68% 对 35%；p <；0.0001）。竞争风险分析表明，在所有时间点（3、6 和 12 个月），MOC 与对照组相比，心房颤动和冠心病住院率均显著降低（p <0.001）。MOC与对照组相比，全因死亡率在6个月（p = 0.006）和12个月（p < 0.001）时明显降低，但在3个月（p = 0.35）时并无差异。

{"title":"Medication optimization clinic decreases hospitalizations and mortality for patients with heart failure with reduced ejection fraction","authors":"James C. Coons , Jennifer Kliner , Michael A. Mathier , Suresh Mulukutla , Floyd Thoma , Ahmet Sezer , Mary Keebler","doi":"10.1016/j.ahjo.2024.100470","DOIUrl":"10.1016/j.ahjo.2024.100470","url":null,"abstract":"<div><h3>Study objective</h3><div>To evaluate the impact of a medication optimization clinic (MOC) on GDMT and outcomes for patients with HFrEF versus usual care.</div></div><div><h3>Design</h3><div>Retrospective evaluation of a multi-site MOC was conducted.</div></div><div><h3>Setting</h3><div>Large health system with academic and community hospitals.</div></div><div><h3>Participants</h3><div>Patients with HFrEF referred to MOC by their cardiologist versus usual care.</div></div><div><h3>Interventions</h3><div>GDMT use managed by an advanced practice provider or clinical pharmacist through weekly telemedicine visits.</div></div><div><h3>Main outcome measures</h3><div>The primary outcome was HF hospitalization. Cardiovascular hospitalization and all-cause mortality were also assessed. Kaplan−Meier Curve, Cumulative Incidence Function, and competing risk analysis with regression models were conducted.</div></div><div><h3>Results</h3><div>1419 patients in MOC group were compared to 5116 control patients. GDMT use was significantly higher in MOC: quadruple therapy (49 % vs. 19 %; p < 0.0001), angiotensin-receptor neprilysin inhibitor (62 % vs. 45 %; p < 0.0001), beta blocker (92 % vs. 88 %; p < 0.0001), mineralocorticoid receptor antagonist (69 % vs. 45 %; p < 0.0001), and sodium glucose cotransporter-2 inhibitor (68 % vs. 35 %; p < 0.0001). Competing risk analyses showed that HF and CV hospitalizations were significantly lower at all times points (3, 6, and 12 months) for MOC vs. control (p < 0.001). All-cause mortality was significantly lower at 6 months (p = 0.006) and 12 months (p < 0.001), but did not differ at 3 months (p = 0.35), for MOC vs. control.</div></div><div><h3>Conclusions</h3><div>MOC was associated with improved GDMT and lower risks of hospitalizations due to HF and any cardiovascular cause, and all-cause mortality in patients with HFrEF.</div></div>","PeriodicalId":72158,"journal":{"name":"American heart journal plus : cardiology research and practice","volume":"47 ","pages":"Article 100470"},"PeriodicalIF":1.3,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142532385","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}

引用次数: 0

The impact of door to extracorporeal cardiopulmonary resuscitation time on mortality and neurological outcomes among out-of-hospital cardiac arrest acute myocardial infarction patients treated by primary percutaneous coronary intervention 院外心脏骤停急性心肌梗死患者接受初诊经皮冠状动脉介入治疗后，体外心肺复苏门时间对死亡率和神经系统预后的影响

IF 1.3 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

American heart journal plus : cardiology research and practice

Pub Date : 2024-10-14 DOI: 10.1016/j.ahjo.2024.100473

Taro Takeuchi , Yasunori Ueda , Shumpei Kosugi , Kuniyasu Ikeoka , Haruya Yamane , Takuya Ohashi , Takashi Iehara , Kazuho Ukai , Kazuki Oozato , Satoshi Oosaki , Masayuki Nakamura , Tatsuhisa Ozaki , Tsuyoshi Mishima , Haruhiko Abe , Koichi Inoue , Yasushi Matsumura

Background

Few previous studies evaluated the impact of time from the hospital arrival to the implementation of extracorporeal cardiopulmonary resuscitation (ECPR) (door to ECPR time) on outcomes among out-of-hospital cardiac arrest (OHCA) acute myocardial infarction (MI) patients.

Methods

50 patients with OHCA who received both ECPR and percutaneous coronary intervention (PCI) at Cardiovascular Division, NHO Osaka National Hospital were analyzed. Patients were divided into 2 groups according to the median of door to ECPR time. The primary outcome was all-cause death. Survival analyses were conducted to compare all-cause mortality at 90 days between 2 groups. Neurological outcome at 30 days was also compared between 2 groups using the Cerebral Performance Category (CPC).

Results

The multivariable Cox proportional-hazards model showed that all-cause mortality at 90 days was significantly higher among patients with door to ECPR time ≥ 25 min compared with those with door to ECPR time < 25 min (adjusted hazard ratio [HR]: 3.14; 95 % confidence interval [CI]: 1.21–8.18). The proportion of patients with CPC at 30 days ≤ 2 was significantly higher among patients with shorter door to ECPR time (P = 0.048).

Conclusion

Among patients with OHCA due to acute MI who received ECPR and PCI, the shorter door to ECPR time was associated with the lower mortality and favorable neurological outcomes.

背景以前很少有研究评估从到达医院到实施体外心肺复苏（ECPR）的时间（从入院到实施 ECPR 的时间）对院外心脏骤停（OHCA）急性心肌梗死（MI）患者预后的影响。方法分析了 50 名在 NHO 大阪国立医院心血管科接受 ECPR 和经皮冠状动脉介入治疗（PCI）的 OHCA 患者。根据从入院到 ECPR 时间的中位数将患者分为两组。主要结果为全因死亡。对两组患者 90 天的全因死亡率进行了生存分析比较。结果多变量 Cox 比例危险模型显示，与门到 ECPR 时间 < 25 分钟的患者相比，门到 ECPR 时间≥ 25 分钟的患者在 90 天内的全因死亡率明显更高（调整后危险比 [HR]：3.14；95 % 置信区间 [CI]：1.21-8.18）。结论在急性心肌梗死导致的 OHCA 患者中，接受 ECPR 和 PCI 的患者中，门到 ECPR 时间越短，死亡率越低，神经系统预后越好。

{"title":"The impact of door to extracorporeal cardiopulmonary resuscitation time on mortality and neurological outcomes among out-of-hospital cardiac arrest acute myocardial infarction patients treated by primary percutaneous coronary intervention","authors":"Taro Takeuchi , Yasunori Ueda , Shumpei Kosugi , Kuniyasu Ikeoka , Haruya Yamane , Takuya Ohashi , Takashi Iehara , Kazuho Ukai , Kazuki Oozato , Satoshi Oosaki , Masayuki Nakamura , Tatsuhisa Ozaki , Tsuyoshi Mishima , Haruhiko Abe , Koichi Inoue , Yasushi Matsumura","doi":"10.1016/j.ahjo.2024.100473","DOIUrl":"10.1016/j.ahjo.2024.100473","url":null,"abstract":"<div><h3>Background</h3><div>Few previous studies evaluated the impact of time from the hospital arrival to the implementation of extracorporeal cardiopulmonary resuscitation (ECPR) (door to ECPR time) on outcomes among out-of-hospital cardiac arrest (OHCA) acute myocardial infarction (MI) patients.</div></div><div><h3>Methods</h3><div>50 patients with OHCA who received both ECPR and percutaneous coronary intervention (PCI) at Cardiovascular Division, NHO Osaka National Hospital were analyzed. Patients were divided into 2 groups according to the median of door to ECPR time. The primary outcome was all-cause death. Survival analyses were conducted to compare all-cause mortality at 90 days between 2 groups. Neurological outcome at 30 days was also compared between 2 groups using the Cerebral Performance Category (CPC).</div></div><div><h3>Results</h3><div>The multivariable Cox proportional-hazards model showed that all-cause mortality at 90 days was significantly higher among patients with door to ECPR time ≥ 25 min compared with those with door to ECPR time < 25 min (adjusted hazard ratio [HR]: 3.14; 95 % confidence interval [CI]: 1.21–8.18). The proportion of patients with CPC at 30 days ≤ 2 was significantly higher among patients with shorter door to ECPR time (<em>P</em> = 0.048).</div></div><div><h3>Conclusion</h3><div>Among patients with OHCA due to acute MI who received ECPR and PCI, the shorter door to ECPR time was associated with the lower mortality and favorable neurological outcomes.</div></div>","PeriodicalId":72158,"journal":{"name":"American heart journal plus : cardiology research and practice","volume":"47 ","pages":"Article 100473"},"PeriodicalIF":1.3,"publicationDate":"2024-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142532384","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}

引用次数: 0

The interplay of climate change and physical activity: Implications for cardiovascular health 气候变化与体育锻炼的相互作用：对心血管健康的影响

IF 1.3 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

American heart journal plus : cardiology research and practice

Pub Date : 2024-10-14 DOI: 10.1016/j.ahjo.2024.100474

Eloise J. Thompson , Sarah E. Alexander , Kegan Moneghetti, Erin J. Howden

Cardiovascular disease (CVD) is one of the top contributors to global disease burden. Meeting the physical activity guidelines can effectively control and prevent several CVD risk factors, including obesity, hypertension and diabetes mellitus. The effects of climate change are multifactorial and have direct impacts on cardiovascular health. Increasing ambient temperatures, worsening air and water quality and urbanisation and loss of greenspace will also have indirect effects of cardiovascular health by impacting the ability and opportunity to participate in physical activity. A changing climate also has implications for large scale sporting events and policies regarding risk mitigation during exercise in hot climates. This review will discuss the impact of a changing climate on cardiovascular health and physical activity and the implications for the future of organised sport.

心血管疾病（CVD）是造成全球疾病负担的首要因素之一。符合体育锻炼指南可以有效控制和预防多种心血管疾病风险因素，包括肥胖、高血压和糖尿病。气候变化的影响是多因素的，对心血管健康有直接影响。环境温度的升高、空气和水质的恶化以及城市化和绿地的减少也会影响人们参加体育活动的能力和机会，从而对心血管健康产生间接影响。不断变化的气候也会对大型体育赛事以及在炎热气候条件下降低运动风险的政策产生影响。本综述将讨论不断变化的气候对心血管健康和体育活动的影响，以及对未来有组织体育运动的影响。

引用次数: 0