Pub Date : 2025-03-01DOI: 10.1016/j.ahjo.2025.100518
Celestine Odigwe, Rajasekhar Mulyala, Haijra Malik, Brent Ruiz, Mariam Riad, Mohammad As Sayiadeh, Sanchitha Honganur, Alexis Parks, Mustafeez Ur Rahman, Nasser Lakkis
Semaglutide, a GLP-1 receptor agonist, has emerged as a promising agent in cardiovascular disease management, particularly for patients with obesity and diabetes. Recent studies have demonstrated significant benefits of Semaglutide beyond glycemic control, including reduced major adverse cardiovascular events (MACE), improvements in heart failure symptoms, and weight reduction. Notably, the STEP-HFpEF trial highlighted improved exercise capacity and a reduction in NT-proBNP levels, offering a novel therapeutic pathway for heart failure management. Additionally, Semaglutide has shown anti-inflammatory effects, reducing C-reactive protein (CRP) and tumor necrosis factor-alpha (TNF-α), thereby mitigating atherosclerotic risks. Moreover, the SELECT trial demonstrated Semaglutide's cardiovascular benefits in non-diabetic, obese patients, suggesting that its effects extend beyond weight loss. These findings represent a potential paradigm shift in cardiovascular risk management, although access and affordability remain key challenges.
{"title":"Emerging role of GLP-1 agonists in cardio-metabolic therapy - Focus on Semaglutide","authors":"Celestine Odigwe, Rajasekhar Mulyala, Haijra Malik, Brent Ruiz, Mariam Riad, Mohammad As Sayiadeh, Sanchitha Honganur, Alexis Parks, Mustafeez Ur Rahman, Nasser Lakkis","doi":"10.1016/j.ahjo.2025.100518","DOIUrl":"10.1016/j.ahjo.2025.100518","url":null,"abstract":"<div><div>Semaglutide, a GLP-1 receptor agonist, has emerged as a promising agent in cardiovascular disease management, particularly for patients with obesity and diabetes. Recent studies have demonstrated significant benefits of Semaglutide beyond glycemic control, including reduced major adverse cardiovascular events (MACE), improvements in heart failure symptoms, and weight reduction. Notably, the STEP-HFpEF trial highlighted improved exercise capacity and a reduction in NT-proBNP levels, offering a novel therapeutic pathway for heart failure management. Additionally, Semaglutide has shown anti-inflammatory effects, reducing C-reactive protein (CRP) and tumor necrosis factor-alpha (TNF-α), thereby mitigating atherosclerotic risks. Moreover, the SELECT trial demonstrated Semaglutide's cardiovascular benefits in non-diabetic, obese patients, suggesting that its effects extend beyond weight loss. These findings represent a potential paradigm shift in cardiovascular risk management, although access and affordability remain key challenges.</div></div>","PeriodicalId":72158,"journal":{"name":"American heart journal plus : cardiology research and practice","volume":"52 ","pages":"Article 100518"},"PeriodicalIF":1.3,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143529173","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 : 2025-02-28DOI: 10.1016/j.ahjo.2025.100517
Stephanie Jou , Laura P. Gelfman , Karen P. Alexander , R. Sean Morrison , Deepak L. Bhatt , Alan Moskowitz , Emilia Bagiella , Annetine Gelijns , Gregg W. Stone , David J. Cohen , Leslee J. Shaw , Krishna K. Patel
Background
When patients with suspected or known coronary artery disease (CAD) present with new or worsening ischemic symptoms, initial referral to imaging or optimization of guideline directed medical therapy (GDMT) with deferral of testing are both acceptable management approaches.
Methods
In this 12-center study, a 19-item survey exploring preferred management strategy for symptomatic older adults (≥75 years) with or without known CAD, and major patient and clinical factors driving this decision making was administered to clinicians.
Results
There were 96 respondents (70.8 % cardiologists, 20.9 % primary care physicians/geriatricians). Among patients without known CAD, 59 (61.4 %) respondents favored early referral to testing, 6 (6.3 %) opted for initial GDMT and 23 (24.0 %) preferred both. For patients with known CAD, 27 (28.1 %) prioritized initial GDMT optimization, 37 (38.6 %) would refer for early testing and 19.8 % both. Key factors influencing initial preference for GDMT optimization were unoptimized anti-anginal medications, patient preference, increased complication risk, frailty, cognitive impairment and comorbidities. Key factors influencing preference for initial imaging were increasing symptom severity, already optimized GDMT, and electrocardiogram changes. When imaging revealed ischemia, clinicians reported weighing symptom severity, ischemic burden, current medications, comorbidities, frailty, and procedural risks before referring for invasive cardiac angiography.
Conclusion
Both initial GDMT optimization and referral for imaging are frequently used approaches for the symptomatic older patient with suspected or known CAD. The survey highlighted the importance of patient characteristics such as frailty, cognitive impairment, multimorbidity and the gap in clinical guidance on how to optimally manage symptomatic older adults with CAD.
{"title":"Clinical practice patterns among older multimorbid adults presenting with suspected ischemic symptoms: A multi-center survey","authors":"Stephanie Jou , Laura P. Gelfman , Karen P. Alexander , R. Sean Morrison , Deepak L. Bhatt , Alan Moskowitz , Emilia Bagiella , Annetine Gelijns , Gregg W. Stone , David J. Cohen , Leslee J. Shaw , Krishna K. Patel","doi":"10.1016/j.ahjo.2025.100517","DOIUrl":"10.1016/j.ahjo.2025.100517","url":null,"abstract":"<div><h3>Background</h3><div>When patients with suspected or known coronary artery disease (CAD) present with new or worsening ischemic symptoms, initial referral to imaging or optimization of guideline directed medical therapy (GDMT) with deferral of testing are both acceptable management approaches.</div></div><div><h3>Methods</h3><div>In this 12-center study, a 19-item survey exploring preferred management strategy for symptomatic older adults (≥75 years) with or without known CAD, and major patient and clinical factors driving this decision making was administered to clinicians.</div></div><div><h3>Results</h3><div>There were 96 respondents (70.8 % cardiologists, 20.9 % primary care physicians/geriatricians). Among patients without known CAD, 59 (61.4 %) respondents favored early referral to testing, 6 (6.3 %) opted for initial GDMT and 23 (24.0 %) preferred both. For patients with known CAD, 27 (28.1 %) prioritized initial GDMT optimization, 37 (38.6 %) would refer for early testing and 19.8 % both. Key factors influencing initial preference for GDMT optimization were unoptimized anti-anginal medications, patient preference, increased complication risk, frailty, cognitive impairment and comorbidities. Key factors influencing preference for initial imaging were increasing symptom severity, already optimized GDMT, and electrocardiogram changes. When imaging revealed ischemia, clinicians reported weighing symptom severity, ischemic burden, current medications, comorbidities, frailty, and procedural risks before referring for invasive cardiac angiography.</div></div><div><h3>Conclusion</h3><div>Both initial GDMT optimization and referral for imaging are frequently used approaches for the symptomatic older patient with suspected or known CAD. The survey highlighted the importance of patient characteristics such as frailty, cognitive impairment, multimorbidity and the gap in clinical guidance on how to optimally manage symptomatic older adults with CAD.</div></div>","PeriodicalId":72158,"journal":{"name":"American heart journal plus : cardiology research and practice","volume":"52 ","pages":"Article 100517"},"PeriodicalIF":1.3,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143551163","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 : 2025-02-23DOI: 10.1016/j.ahjo.2025.100514
Riccardo Fenici , Marco Picerni , Peter Fenici , Donatella Brisinda
Decades of experimental and clinical studies, along with the most recent clinical trials, have demonstrated the diagnostic potential of magnetocardiography, particularly for the non-invasive early diagnosis of myocardial ischemia. It has also proven to be a valuable clinical tool for monitoring fetal well-being, normal growth, prenatal arrhythmias, and risk markers for sudden death. Such applications have recently received official recognition from Health Canada and the American Heart Association. This unquestionable success, and the additional evidence of magnetocardiography's high sensitivity in diagnosing infiltrative and inflammatory cardiomyopathies, has sparked renewed interest among clinicians.
However, while these aforementioned applications are likely to significantly influence the broader clinical adoption of magnetocardiography, the general focus on these areas has shifted attention away from what we have always regarded as the fundamental strength of contactless cardiac magnetic field mapping: its unique ability to bridge the gap between experimental electrophysiology at the cellular level and non-invasive clinical assessments of human electrophysiology.
This review aims to engage readers by sharing our vision, experience, and several key research milestones, emphasizing the lesser-explored yet significant potential of magnetocardiography. Specifically, it highlights its unique capability to detect electrically silent phenomena that may be critical for the timely and accurate identification of arrhythmogenic focal electrotonic and vortex currents, which can trigger or sustain life-threatening arrhythmias.
{"title":"An advanced vision of magnetocardiography as an unrivalled method for a more comprehensive non-invasive clinical electrophysiological assessment","authors":"Riccardo Fenici , Marco Picerni , Peter Fenici , Donatella Brisinda","doi":"10.1016/j.ahjo.2025.100514","DOIUrl":"10.1016/j.ahjo.2025.100514","url":null,"abstract":"<div><div>Decades of experimental and clinical studies, along with the most recent clinical trials, have demonstrated the diagnostic potential of magnetocardiography, particularly for the non-invasive early diagnosis of myocardial ischemia. It has also proven to be a valuable clinical tool for monitoring fetal well-being, normal growth, prenatal arrhythmias, and risk markers for sudden death. Such applications have recently received official recognition from Health Canada and the American Heart Association. This unquestionable success, and the additional evidence of magnetocardiography's high sensitivity in diagnosing infiltrative and inflammatory cardiomyopathies, has sparked renewed interest among clinicians.</div><div>However, while these aforementioned applications are likely to significantly influence the broader clinical adoption of magnetocardiography, the general focus on these areas has shifted attention away from what we have always regarded as the fundamental strength of contactless cardiac magnetic field mapping: its unique ability to bridge the gap between experimental electrophysiology at the cellular level and non-invasive clinical assessments of human electrophysiology.</div><div>This review aims to engage readers by sharing our vision, experience, and several key research milestones, emphasizing the lesser-explored yet significant potential of magnetocardiography. Specifically, it highlights its unique capability to detect electrically silent phenomena that may be critical for the timely and accurate identification of arrhythmogenic focal electrotonic and vortex currents, which can trigger or sustain life-threatening arrhythmias.</div></div>","PeriodicalId":72158,"journal":{"name":"American heart journal plus : cardiology research and practice","volume":"52 ","pages":"Article 100514"},"PeriodicalIF":1.3,"publicationDate":"2025-02-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143488207","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 : 2025-02-21DOI: 10.1016/j.ahjo.2025.100513
Katherine E. Hampilos , Anum Asif , Puja K. Mehta , Daniel S. Berman , Galen Cook-Wiens , Michael D. Nelson , Carl J. Pepine , C. Noel Bairey Merz , Janet Wei
Introduction
Patients with coronary microvascular dysfunction (CMD) are at increased risk of developing heart failure with preserved ejection fraction (HFpEF). We hypothesized that higher myocardial biomarkers (ultra-high sensitivity cardiac troponin I [u-hs-TnI]) and ventricular dysfunction (N-terminal pro-BNP [NT-proBNP]) would be related to greater ischemia improvement on the late sodium channel inhibitor ranolazine.
Methods
We analyzed CMD participants with baseline myocardial biomarkers randomized to ranolazine or placebo (RWISE trial: NCT01342029). Ischemia response was change in global myocardial perfusion reserve index (∆MPRI) or Seattle Angina Questionnaire (∆SAQ).
Results
Among 64 randomized participants with u-hs-TnI and 40 with NT-proBNP, higher u-hs-TnI related to improved ∆MPRI (r = 0.26, p = 0.04), but not ∆SAQ (r = 0.03, p = 0.80) on ranolazine. There was no relation with NT-proBNP.
Conclusions
These findings suggest that higher u-hs-TnI signals greater ischemia improvement on ranolazine. Further studies evaluating ischemia therapies in CMD are needed to develop potential HFpEF prevention targets.
{"title":"Myocardial biomarkers in coronary microvascular dysfunction: Response to ranolazine","authors":"Katherine E. Hampilos , Anum Asif , Puja K. Mehta , Daniel S. Berman , Galen Cook-Wiens , Michael D. Nelson , Carl J. Pepine , C. Noel Bairey Merz , Janet Wei","doi":"10.1016/j.ahjo.2025.100513","DOIUrl":"10.1016/j.ahjo.2025.100513","url":null,"abstract":"<div><h3>Introduction</h3><div>Patients with coronary microvascular dysfunction (CMD) are at increased risk of developing heart failure with preserved ejection fraction (HFpEF). We hypothesized that higher myocardial biomarkers (ultra-high sensitivity cardiac troponin I [u-hs-TnI]) and ventricular dysfunction (N-terminal pro-BNP [NT-proBNP]) would be related to greater ischemia improvement on the late sodium channel inhibitor ranolazine.</div></div><div><h3>Methods</h3><div>We analyzed CMD participants with baseline myocardial biomarkers randomized to ranolazine or placebo (RWISE trial: <span><span>NCT01342029</span><svg><path></path></svg></span>). Ischemia response was change in global myocardial perfusion reserve index (∆MPRI) or Seattle Angina Questionnaire (∆SAQ).</div></div><div><h3>Results</h3><div>Among 64 randomized participants with u-hs-TnI and 40 with NT-proBNP, higher u-hs-TnI related to improved ∆MPRI (<em>r</em> = 0.26, <em>p</em> = 0.04), but not ∆SAQ (<em>r</em> = 0.03, <em>p</em> = 0.80) on ranolazine. There was no relation with NT-proBNP.</div></div><div><h3>Conclusions</h3><div>These findings suggest that higher u-hs-TnI signals greater ischemia improvement on ranolazine. Further studies evaluating ischemia therapies in CMD are needed to develop potential HFpEF prevention targets.</div></div>","PeriodicalId":72158,"journal":{"name":"American heart journal plus : cardiology research and practice","volume":"52 ","pages":"Article 100513"},"PeriodicalIF":1.3,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143508928","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 : 2025-02-21DOI: 10.1016/j.ahjo.2025.100511
César Del Castillo , Alicia Tapia , Arnulfo Begazo , Miguel Oyonarte
Background
Infective endocarditis (IE) is still a complex disease despite advances in modern medicine, with diverse epidemiology and clinical manifestation, and poor prognosis. Several recommendations have recently been published but it is uncertain if they can be extrapolated to every country.
Objectives
To describe our national clinical and epidemiological profile on IE.
Methodology
A systematic search through PubMed, Scielo, and abstracts book of Chilean Congress since 2012. Studies assessing adult patients with IE from Chile reporting information related to epidemiology, clinical manifestation, treatment, and complications have also been consulted.
Results
Ten registries were included. The mean age was 53.9-year-old, and most cases were male (64 %) with arterial hypertension (42 %). Most cases were from the central and southern zones of Chile. The most frequent clinical symptoms were fever and heart failure, with acute presentation (63.5 %), aortic valve (72.2 %), and native valve involvement (83.7 %). Predominantly, it was medical treatment over surgical treatment (57.7 versus 42.3 %), with main surgical indications due to local cardiac complications (66 %) and heart failure related (65.9 %). Complications included mechanical valve damage in 24.7 %, and embolism in 27.7 %. Staphylococcus sp. (28 %) was the predominant microorganism, particularly Staphylococcus aureus, and negative microbiological studies were seen in 34 %. In-hospital mortality was 24.8 %, whereas global mortality was 33.3 %.
Conclusion
This systematic review highlights epidemiological and clinical aspects of IE across Chile, such as acute presentation, predominance of aortic valve involvement, and S. aureus infection. However, there is a lack of prospective registries, therefore reflecting the need to collect richer information.
{"title":"Clinical and epidemiological profile of infective endocarditis in Chile - A systematic review of descriptive analysis","authors":"César Del Castillo , Alicia Tapia , Arnulfo Begazo , Miguel Oyonarte","doi":"10.1016/j.ahjo.2025.100511","DOIUrl":"10.1016/j.ahjo.2025.100511","url":null,"abstract":"<div><h3>Background</h3><div>Infective endocarditis (IE) is still a complex disease despite advances in modern medicine, with diverse epidemiology and clinical manifestation, and poor prognosis. Several recommendations have recently been published but it is uncertain if they can be extrapolated to every country.</div></div><div><h3>Objectives</h3><div>To describe our national clinical and epidemiological profile on IE.</div></div><div><h3>Methodology</h3><div>A systematic search through PubMed, Scielo, and abstracts book of Chilean Congress since 2012. Studies assessing adult patients with IE from Chile reporting information related to epidemiology, clinical manifestation, treatment, and complications have also been consulted.</div></div><div><h3>Results</h3><div>Ten registries were included. The mean age was 53.9-year-old, and most cases were male (64 %) with arterial hypertension (42 %). Most cases were from the central and southern zones of Chile. The most frequent clinical symptoms were fever and heart failure, with acute presentation (63.5 %), aortic valve (72.2 %), and native valve involvement (83.7 %). Predominantly, it was medical treatment over surgical treatment (57.7 versus 42.3 %), with main surgical indications due to local cardiac complications (66 %) and heart failure related (65.9 %). Complications included mechanical valve damage in 24.7 %, and embolism in 27.7 %. Staphylococcus sp. (28 %) was the predominant microorganism, particularly <em>Staphylococcus aureus</em>, and negative microbiological studies were seen in 34 %. In-hospital mortality was 24.8 %, whereas global mortality was 33.3 %.</div></div><div><h3>Conclusion</h3><div>This systematic review highlights epidemiological and clinical aspects of IE across Chile, such as acute presentation, predominance of aortic valve involvement, and <em>S. aureus</em> infection. However, there is a lack of prospective registries, therefore reflecting the need to collect richer information.</div></div>","PeriodicalId":72158,"journal":{"name":"American heart journal plus : cardiology research and practice","volume":"52 ","pages":"Article 100511"},"PeriodicalIF":1.3,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143551164","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 : 2025-02-21DOI: 10.1016/j.ahjo.2025.100512
Wojciech E. Krzyzanowski, Pawel Radecki, Marta K. Szczerbińska, Kamil Dawidczyk, Mikołaj Kosek, Krzysztof Romanik, Wojciech Suchcicki, Dariusz Karwowski, Paweł R. Natkowski
Background
This study evaluated the effectiveness of the Radiaction system in providing comprehensive protection to medical personnel during fluoroscopy-guided procedures in an Interventional Cardiology (IC) laboratory. The system confines the imaging beam and blocks scatter radiation at its source, enhancing safety for the Cath lab staff.
Methods
A prospective, non-randomized, controlled study compared real-time procedures with and without Radiaction. Sensors were placed around the room and on the main physician to measure radiation exposure during 82 diagnostic and 24 interventional cases without the Radiaction system and 65 diagnostic and 39 interventional cases with Radiaction.
Results
Results demonstrated a significant reduction in radiation exposure with the Radiaction system. Across all cases, the overall reduction in radiation was 74.7 % for all sensor locations and 82.9 % for the main physician. Diagnostic procedures exhibited a reduction of 73 % with the Radiaction system and Interventional procedures demonstrated a 79 % reduction across all sensors with the Radiaction system. Calculations were conducted to estimate the reduction during the time that the system was deployed, revealing an 85.7 % reduction across all sensors and 95.1 % for the main physician, reflecting the full potential of the system when used during 100 % of the X-ray time. Users expressed high satisfaction with the system, citing its user-friendly nature, and seamless integration into clinical workflow.
Conclusions
The Radiaction system significantly reduced radiation exposure in all cases compared to cases conducted without Radiaction. These findings support the potential of the Radiaction system to offer full-body protection from scattered radiation to all medical personnel in the IC suite, emphasizing its value in enhancing occupational safety in medical environments.
{"title":"Evaluation of a first of a kind robotic radiation protection technology to reduce scatter exposure during diagnostic procedures and percutaneous coronary interventions","authors":"Wojciech E. Krzyzanowski, Pawel Radecki, Marta K. Szczerbińska, Kamil Dawidczyk, Mikołaj Kosek, Krzysztof Romanik, Wojciech Suchcicki, Dariusz Karwowski, Paweł R. Natkowski","doi":"10.1016/j.ahjo.2025.100512","DOIUrl":"10.1016/j.ahjo.2025.100512","url":null,"abstract":"<div><h3>Background</h3><div>This study evaluated the effectiveness of the Radiaction system in providing comprehensive protection to medical personnel during fluoroscopy-guided procedures in an Interventional Cardiology (IC) laboratory. The system confines the imaging beam and blocks scatter radiation at its source, enhancing safety for the Cath lab staff.</div></div><div><h3>Methods</h3><div>A prospective, non-randomized, controlled study compared real-time procedures with and without Radiaction. Sensors were placed around the room and on the main physician to measure radiation exposure during 82 diagnostic and 24 interventional cases without the Radiaction system and 65 diagnostic and 39 interventional cases with Radiaction.</div></div><div><h3>Results</h3><div>Results demonstrated a significant reduction in radiation exposure with the Radiaction system. Across all cases, the overall reduction in radiation was 74.7 % for all sensor locations and 82.9 % for the main physician. Diagnostic procedures exhibited a reduction of 73 % with the Radiaction system and Interventional procedures demonstrated a 79 % reduction across all sensors with the Radiaction system. Calculations were conducted to estimate the reduction during the time that the system was deployed, revealing an 85.7 % reduction across all sensors and 95.1 % for the main physician, reflecting the full potential of the system when used during 100 % of the X-ray time. Users expressed high satisfaction with the system, citing its user-friendly nature, and seamless integration into clinical workflow.</div></div><div><h3>Conclusions</h3><div>The Radiaction system significantly reduced radiation exposure in all cases compared to cases conducted without Radiaction. These findings support the potential of the Radiaction system to offer full-body protection from scattered radiation to all medical personnel in the IC suite, emphasizing its value in enhancing occupational safety in medical environments.</div></div>","PeriodicalId":72158,"journal":{"name":"American heart journal plus : cardiology research and practice","volume":"52 ","pages":"Article 100512"},"PeriodicalIF":1.3,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143478864","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 : 2025-02-18DOI: 10.1016/j.ahjo.2025.100509
Jamal Mughal , Venkat R. Katkoori , Stefan Mark Nidorf , Megan Manu , George S. Abela
Cholesterol crystals (CCs) released into the coronary circulation during plaque rupture have multiple adverse impacts on both the arterial conduit as well as the myocardium. CCs form within the atheromatous plaque by the saturation of free cholesterol deposition via facilitated LDL-c entry because of a dysfunctional endothelium. Once formed, CCs are viewed as a foreign body and activate inflammation via the innate immune system. Eventually, an inflamed atheromatous plaque ruptures by virtue of the growth and expansion of CCs that begin to occupy a greater volume than the liquid phase cholesterol. In some instances, the sharp edges of CCs can puncture and tear the plaque's fibrous cap causing rupture leading to thrombosis and myocardial infarction. In these circumstances, CCs are released from the ruptured plaque and travel down the coronary artery where they can scrape the endothelial lining which enhances vasospastic activity, further worsening ischemia. Moreover, when CCs lodge in the distal arteriolar and capillary beds, they not only obstruct blood flow to further aggravate ischemia but also activate an inflammatory response in the myocardium that leads to further tissue injury. Treatment of CCs has thus far been limited but studies using statins, aspirin and colchicine have demonstrated them to be effective in dissolving CCs that may provide additional benefits for both prevention and potentially for acute cardiovascular events.
斑块破裂时释放到冠状动脉循环中的胆固醇结晶（CC）会对动脉导管和心肌产生多种不利影响。由于内皮功能失调，游离胆固醇沉积饱和，促进低密度脂蛋白-c 进入动脉粥样斑块，从而形成 CC。一旦形成，CC 就会被视为异物，并通过先天性免疫系统激活炎症。最终，发炎的动脉粥样斑块会因开始占据比液相胆固醇更大体积的 CC 的生长和扩张而破裂。在某些情况下，CCs 的锋利边缘会刺穿并撕裂斑块的纤维帽，导致斑块破裂，从而引发血栓形成和心肌梗死。在这种情况下，CCs 会从破裂的斑块中释放出来，并沿着冠状动脉向下移动，在那里它们会刮伤血管内皮，从而增强血管痉挛活动，使缺血进一步恶化。此外，当CCs停留在远端动脉和毛细血管床时，它们不仅会阻碍血流，进一步加重缺血，还会激活心肌的炎症反应，导致组织进一步损伤。迄今为止，CCs 的治疗方法还很有限，但使用他汀类药物、阿司匹林和秋水仙碱进行的研究表明，它们能有效溶解 CCs，从而为预防和潜在治疗急性心血管事件提供额外的益处。
{"title":"The formation of cholesterol crystals and embolization during myocardial infarction","authors":"Jamal Mughal , Venkat R. Katkoori , Stefan Mark Nidorf , Megan Manu , George S. Abela","doi":"10.1016/j.ahjo.2025.100509","DOIUrl":"10.1016/j.ahjo.2025.100509","url":null,"abstract":"<div><div>Cholesterol crystals (CCs) released into the coronary circulation during plaque rupture have multiple adverse impacts on both the arterial conduit as well as the myocardium. CCs form within the atheromatous plaque by the saturation of free cholesterol deposition via facilitated LDL-c entry because of a dysfunctional endothelium. Once formed, CCs are viewed as a foreign body and activate inflammation via the innate immune system. Eventually, an inflamed atheromatous plaque ruptures by virtue of the growth and expansion of CCs that begin to occupy a greater volume than the liquid phase cholesterol. In some instances, the sharp edges of CCs can puncture and tear the plaque's fibrous cap causing rupture leading to thrombosis and myocardial infarction. In these circumstances, CCs are released from the ruptured plaque and travel down the coronary artery where they can scrape the endothelial lining which enhances vasospastic activity, further worsening ischemia. Moreover, when CCs lodge in the distal arteriolar and capillary beds, they not only obstruct blood flow to further aggravate ischemia but also activate an inflammatory response in the myocardium that leads to further tissue injury. Treatment of CCs has thus far been limited but studies using statins, aspirin and colchicine have demonstrated them to be effective in dissolving CCs that may provide additional benefits for both prevention and potentially for acute cardiovascular events.</div></div>","PeriodicalId":72158,"journal":{"name":"American heart journal plus : cardiology research and practice","volume":"51 ","pages":"Article 100509"},"PeriodicalIF":1.3,"publicationDate":"2025-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143454606","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 : 2025-02-03DOI: 10.1016/j.ahjo.2025.100503
Bindee Kuriya , Lihi Eder , Sahil Koppikar , Jessica Widdifield , Anna Chu , Jiming Fang , Irene Jeong , Douglas Lee , Jacob Udell
Background
Individuals with inflammatory arthritis (IA) face an elevated risk of heart failure (HF). However, whether the quality of HF care in IA patients differs from other high-risk groups, such as those with diabetes mellitus (DM), remains unclear.
Methods
This population-based cohort study in Ontario, Canada, included patients who experienced their first HF hospitalization and survived to discharge. Patients were categorized into four groups: IA alone, DM alone, IA + DM, and a general population comparator. We assessed quality care measures within 30 days of hospitalization (echocardiogram, electrocardiogram, chest x-ray) and physician follow-up within 7 days. Guideline-directed medical therapy (GDMT) adherence was evaluated within 90 days and classified as perfect, moderate, or poor. Logistic regression was used to determine whether IA was independently associated with lower HF care quality.
Results
Among 101,645 eligible hospitalizations, 1987 had IA + DM, 3849 had IA alone, 33,553 had DM alone, and 62,256 were general comparators. While all groups showed high adherence to testing, IA patients (with or without DM) had significantly lower GDMT use compared to DM patients (p < 0.001). IA was independently linked to lower odds of moderate or perfect GDMT adherence.
Conclusion
Although adherence to HF testing quality measures was high, IA patients were less likely to receive GDMT than those with DM. Further research is needed to understand the reasons for lower GDMT use in IA and its impact on HF outcomes such as re-hospitalization and mortality.
{"title":"Evaluating the quality of care for heart failure hospitalizations in inflammatory arthritis – A population-based cohort study","authors":"Bindee Kuriya , Lihi Eder , Sahil Koppikar , Jessica Widdifield , Anna Chu , Jiming Fang , Irene Jeong , Douglas Lee , Jacob Udell","doi":"10.1016/j.ahjo.2025.100503","DOIUrl":"10.1016/j.ahjo.2025.100503","url":null,"abstract":"<div><h3>Background</h3><div>Individuals with inflammatory arthritis (IA) face an elevated risk of heart failure (HF). However, whether the quality of HF care in IA patients differs from other high-risk groups, such as those with diabetes mellitus (DM), remains unclear.</div></div><div><h3>Methods</h3><div>This population-based cohort study in Ontario, Canada, included patients who experienced their first HF hospitalization and survived to discharge. Patients were categorized into four groups: IA alone, DM alone, IA + DM, and a general population comparator. We assessed quality care measures within 30 days of hospitalization (echocardiogram, electrocardiogram, chest x-ray) and physician follow-up within 7 days. Guideline-directed medical therapy (GDMT) adherence was evaluated within 90 days and classified as perfect, moderate, or poor. Logistic regression was used to determine whether IA was independently associated with lower HF care quality.</div></div><div><h3>Results</h3><div>Among 101,645 eligible hospitalizations, 1987 had IA + DM, 3849 had IA alone, 33,553 had DM alone, and 62,256 were general comparators. While all groups showed high adherence to testing, IA patients (with or without DM) had significantly lower GDMT use compared to DM patients (<em>p</em> < 0.001). IA was independently linked to lower odds of moderate or perfect GDMT adherence.</div></div><div><h3>Conclusion</h3><div>Although adherence to HF testing quality measures was high, IA patients were less likely to receive GDMT than those with DM. Further research is needed to understand the reasons for lower GDMT use in IA and its impact on HF outcomes such as re-hospitalization and mortality.</div></div>","PeriodicalId":72158,"journal":{"name":"American heart journal plus : cardiology research and practice","volume":"51 ","pages":"Article 100503"},"PeriodicalIF":1.3,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143160060","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}
Acute myocardial infarction (AMI) complicated by cardiogenic shock has a high mortality rate. Mechanical circulatory support (MCS) has been increasingly used; however, the optimal timing for MCS insertion remains uncertain. This study aimed to evaluate outcomes of pre-percutaneous coronary intervention (PCI) vs post-PCI MCS insertion in AMI patients with cardiogenic shock.
Methods
A systematic search using 4 databases, including PubMed, Embase, Web of Science, and Cochrane CENTRAL, was conducted from inception to October 25, 2024. Studies comparing outcomes of MCS insertion pre-PCI vs post-PCI in this setting were included.
Results
There were 36 studies with a total of 6218 participants were included in this meta-analysis, using a random-effects model. Most of the included studies were non-randomized and retrospective. Early MCS insertion (prior to PCI) was associated with a lower risk of in-hospital mortality compared to late insertion (post-PCI), with an odds ratio (OR) of 0.46 (95%CI 0.36 to 0.57), p < 0.01. Subgroup analysis by MCS type (IABP, Impella, and ECMO) demonstrated that early insertion prior to PCI significantly reduced in-hospital mortality, regardless of the MCS type. Early MCS insertion prior to PCI was also associated with lower 30-day mortality (OR 0.62, (95%CI 0.43 to 0.89), p = 0.01) and 6-month mortality (OR 0.53, (95%CI 0.34 to 0.83), p = 0.01) compared to late insertion. There was no difference in 1-year mortality or in MCS-related complications.
Conclusions
Early MCS insertion prior to PCI is potentially associated with reduced in-hospital, 30-day, and 6-month mortality compared to post-PCI insertion in AMI patients with cardiogenic shock.
{"title":"Timing of mechanical circulatory support in acute myocardial infarction complicated by cardiogenic shock: A systematic review and meta-analysis","authors":"Tanawat Attachaipanich , Suthinee Attachaipanich , Kotchakorn Kaewboot","doi":"10.1016/j.ahjo.2025.100506","DOIUrl":"10.1016/j.ahjo.2025.100506","url":null,"abstract":"<div><h3>Background</h3><div>Acute myocardial infarction (AMI) complicated by cardiogenic shock has a high mortality rate. Mechanical circulatory support (MCS) has been increasingly used; however, the optimal timing for MCS insertion remains uncertain. This study aimed to evaluate outcomes of pre-percutaneous coronary intervention (PCI) vs post-PCI MCS insertion in AMI patients with cardiogenic shock.</div></div><div><h3>Methods</h3><div>A systematic search using 4 databases, including PubMed, Embase, Web of Science, and Cochrane CENTRAL, was conducted from inception to October 25, 2024. Studies comparing outcomes of MCS insertion pre-PCI vs post-PCI in this setting were included.</div></div><div><h3>Results</h3><div>There were 36 studies with a total of 6218 participants were included in this meta-analysis, using a random-effects model. Most of the included studies were non-randomized and retrospective. Early MCS insertion (prior to PCI) was associated with a lower risk of in-hospital mortality compared to late insertion (post-PCI), with an odds ratio (OR) of 0.46 (95%CI 0.36 to 0.57), <em>p</em> < 0.01. Subgroup analysis by MCS type (IABP, Impella, and ECMO) demonstrated that early insertion prior to PCI significantly reduced in-hospital mortality, regardless of the MCS type. Early MCS insertion prior to PCI was also associated with lower 30-day mortality (OR 0.62, (95%CI 0.43 to 0.89), <em>p</em> = 0.01) and 6-month mortality (OR 0.53, (95%CI 0.34 to 0.83), p = 0.01) compared to late insertion. There was no difference in 1-year mortality or in MCS-related complications.</div></div><div><h3>Conclusions</h3><div>Early MCS insertion prior to PCI is potentially associated with reduced in-hospital, 30-day, and 6-month mortality compared to post-PCI insertion in AMI patients with cardiogenic shock.</div></div>","PeriodicalId":72158,"journal":{"name":"American heart journal plus : cardiology research and practice","volume":"50 ","pages":"Article 100506"},"PeriodicalIF":1.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143172947","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}
Herein, we identified compound heterozygous PROC missense variants in a protein C deficient patient with recurrent thrombotic events, including intestinal necrosis, extrahepatic portal vein obstruction, and lower limb venous thrombosis. The patient's protein C activity and antigen levels were extremely low (<10 % and 5 %, respectively). Exome sequencing analysis revealed two rare missense variants (c.76G>A:p.Val26Met in exon 3 and c.1000G>A:p.Gly334Ser in exon 9), both confirmed to be associated with protein C deficiency and one synonymous variant (c.423G>T:p.Ser141Ser in exon 6) in PROC. PCR amplification of genomic DNA spanning these exons followed by Sanger sequencing analysis revealed that the c.76G>A and the synonymous c.423G>T variants were in the same allele, whereas the c.1000G>A variant was on the opposite allele, indicating compound heterozygosity. Western blot analysis of Huh-7 and HEK293T cells transfected with expression vectors encoding PROC with or without these variants demonstrated that Gly334Ser-PROC expression levels were significantly decreased in culture media collected from HEK293T cells, while the expression levels of protein C with these variants were not significantly altered in cell lysates. This suggests that these variants may affect both protein activity and the secretory process of protein C.
{"title":"Protein C deficiency with recurrent systemic thrombosis associated with compound heterozygous PROC missense variants","authors":"Mikio Shiba , Shuichiro Higo , Yu Morishita , Yasuhiro Ichibori , Yoshihiro Kin , Yasushi Sakata , Yoshiharu Higuchi","doi":"10.1016/j.ahjo.2024.100496","DOIUrl":"10.1016/j.ahjo.2024.100496","url":null,"abstract":"<div><div>Herein, we identified compound heterozygous <em>PROC</em> missense variants in a protein C deficient patient with recurrent thrombotic events, including intestinal necrosis, extrahepatic portal vein obstruction, and lower limb venous thrombosis. The patient's protein C activity and antigen levels were extremely low (<10 % and 5 %, respectively). Exome sequencing analysis revealed two rare missense variants (c.76G>A:p.Val26Met in exon 3 and c.1000G>A:p.Gly334Ser in exon 9), both confirmed to be associated with protein C deficiency and one synonymous variant (c.423G>T:p.Ser141Ser in exon 6) in <em>PROC</em>. PCR amplification of genomic DNA spanning these exons followed by Sanger sequencing analysis revealed that the c.76G>A and the synonymous c.423G>T variants were in the same allele, whereas the c.1000G>A variant was on the opposite allele, indicating compound heterozygosity. Western blot analysis of Huh-7 and HEK293T cells transfected with expression vectors encoding <em>PROC</em> with or without these variants demonstrated that Gly334Ser-PROC expression levels were significantly decreased in culture media collected from HEK293T cells, while the expression levels of protein C with these variants were not significantly altered in cell lysates. This suggests that these variants may affect both protein activity and the secretory process of protein C.</div></div>","PeriodicalId":72158,"journal":{"name":"American heart journal plus : cardiology research and practice","volume":"50 ","pages":"Article 100496"},"PeriodicalIF":1.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143172987","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}
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