Pub Date : 2025-01-01DOI: 10.1016/j.ahjo.2024.100488
Bhavesh Katbamna , Lingling Wu , Mario Rodriguez , Phillip King , Joel Schilling , Jamal Mahar , Ajith P. Nair , Hani Jneid , Elizabeth S. Klings , Gerald L. Weinhouse , Sula Mazimba , Marc A. Simon , Markus Strauss , Chayakrit Krittanawong
The right heart catheterization (RHC) remains an important diagnostic tool for a spectrum of cardiovascular disease processes including pulmonary hypertension (PH), shock, valvular heart disease, and unexplained dyspnea. While it gained widespread utilization after its introduction, the role of the RHC has evolved to provide valuable information for the management of advanced therapies in heart failure (HF) and cardiogenic shock (CS) to name a few. In this review, we provide a comprehensive overview on the indications, utilization, complications, interpretation, and calculations associated with RHC.
{"title":"The uses of right heart catheterization in cardio-pulmonary disease: State-of-the-art","authors":"Bhavesh Katbamna , Lingling Wu , Mario Rodriguez , Phillip King , Joel Schilling , Jamal Mahar , Ajith P. Nair , Hani Jneid , Elizabeth S. Klings , Gerald L. Weinhouse , Sula Mazimba , Marc A. Simon , Markus Strauss , Chayakrit Krittanawong","doi":"10.1016/j.ahjo.2024.100488","DOIUrl":"10.1016/j.ahjo.2024.100488","url":null,"abstract":"<div><div>The right heart catheterization (RHC) remains an important diagnostic tool for a spectrum of cardiovascular disease processes including pulmonary hypertension (PH), shock, valvular heart disease, and unexplained dyspnea. While it gained widespread utilization after its introduction, the role of the RHC has evolved to provide valuable information for the management of advanced therapies in heart failure (HF) and cardiogenic shock (CS) to name a few. In this review, we provide a comprehensive overview on the indications, utilization, complications, interpretation, and calculations associated with RHC.</div></div>","PeriodicalId":72158,"journal":{"name":"American heart journal plus : cardiology research and practice","volume":"49 ","pages":"Article 100488"},"PeriodicalIF":1.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11699050/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142933847","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 : 2024-12-01DOI: 10.1016/j.ahjo.2024.100485
Geoffrey A. Strange , Michael P. Feneley , David Prior , David Muller , Prasanna Venkataraman , Yiling Situ , Simon Stewart , David Playford
Many severe aortic stenosis (AS) cases are undetected and/or not considered for potentially life-saving treatment, with a persistent male-bias reported among those undergoing aortic valve replacement (AVR). We evaluated the clinical value of a validated artificial intelligence automated alert system (AI-AAS) that detects severe AS from routine echocardiographic measurements. In a retrospective, clinical cohort of 21,749 adults investigated with transthoracic echocardiography at two tertiary-referral centres, we identified 4057 women (aged 61.6 ± 18.1 years) and 5132 men (60.8 ± 17.5 years) with native aortic valves. We firstly applied the AI-AAS to the cardiologists' reported echo measurements, to detect all AS cases, including guideline-defined severe AS. Two expert clinicians then independently reviewed the original clinical diagnosis/management based on the initial report. Initially, 218/9189 (2.4 %, 95%CI 2.1–2.7 %) severe AS cases were diagnosed. The AI-AAS subsequently increased this number by 158 (52 % women) to 376 cases (4.1 %, 95%CI 3.7–4.5 %) of severe guideline-defined AS. Overall, more women were under-diagnosed (92/169 [54.4 %] versus 80/207 [38.6 %] men – adjusted odds ratio [aOR] 0.21, 95%CI 0.10–0.45). Even when accounting for potential contraindications to valvular intervention, women were persistently less likely to be considered for valvular intervention (aOR 0.54, 95%CI 0.31–0.95) and/or underwent AVR (aOR 0.29, 95%CI 0.09–0.74). Our study suggests an AI-AAS application that is agnostic to gender, haemodynamic bias, symptoms, or clinical factors, provides an objective alert to severe forms of AS (including guideline-defined severe AS) following a routine echocardiogram, and has the potential to increase the number of people (especially women) directed towards more definitive treatment/specialist care.
{"title":"Detection of severe aortic stenosis by clinicians versus artificial intelligence: A retrospective clinical cohort study","authors":"Geoffrey A. Strange , Michael P. Feneley , David Prior , David Muller , Prasanna Venkataraman , Yiling Situ , Simon Stewart , David Playford","doi":"10.1016/j.ahjo.2024.100485","DOIUrl":"10.1016/j.ahjo.2024.100485","url":null,"abstract":"<div><div>Many severe aortic stenosis (AS) cases are undetected and/or not considered for potentially life-saving treatment, with a persistent male-bias reported among those undergoing aortic valve replacement (AVR). We evaluated the clinical value of a validated artificial intelligence automated alert system (AI-AAS) that detects severe AS from routine echocardiographic measurements. In a retrospective, clinical cohort of 21,749 adults investigated with transthoracic echocardiography at two tertiary-referral centres, we identified 4057 women (aged 61.6 ± 18.1 years) and 5132 men (60.8 ± 17.5 years) with native aortic valves. We firstly applied the AI-AAS to the cardiologists' reported echo measurements, to detect all AS cases, including guideline-defined severe AS. Two expert clinicians then independently reviewed the original clinical diagnosis/management based on the initial report. Initially, 218/9189 (2.4 %, 95%CI 2.1–2.7 %) severe AS cases were diagnosed. The AI-AAS subsequently increased this number by 158 (52 % women) to 376 cases (4.1 %, 95%CI 3.7–4.5 %) of severe guideline-defined AS. Overall, more women were under-diagnosed (92/169 [54.4 %] versus 80/207 [38.6 %] men – adjusted odds ratio [aOR] 0.21, 95%CI 0.10–0.45). Even when accounting for potential contraindications to valvular intervention, women were persistently less likely to be considered for valvular intervention (aOR 0.54, 95%CI 0.31–0.95) and/or underwent AVR (aOR 0.29, 95%CI 0.09–0.74). Our study suggests an AI-AAS application that is agnostic to gender, haemodynamic bias, symptoms, or clinical factors, provides an objective alert to severe forms of AS (including guideline-defined severe AS) following a routine echocardiogram, and has the potential to increase the number of people (especially women) directed towards more definitive treatment/specialist care.</div></div>","PeriodicalId":72158,"journal":{"name":"American heart journal plus : cardiology research and practice","volume":"48 ","pages":"Article 100485"},"PeriodicalIF":1.3,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142744368","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 : 2024-12-01DOI: 10.1016/j.ahjo.2024.100486
Diego Araiza-Garaygordobil , Oscar-Ulises Preciado-Gutierrez , Jorge Daniel Sierra-Lara Martinez , Hector Gonzalez-Pacheco , Rodrigo Gopar-Nieto , Ximena Latapi-Ruiz Esparza , Sarai Hernandez-Pastrana , Braiana-Angeles Diaz-Herrera , Amada Alvarez-Sangabriel , Antonio Jordan-Rios , Alexandra Arias-Mendoza
Background and aims
Heart failure with preserved ejection fraction (HFpEF) is an increasingly common clinical syndrome, estimated to constitute approximately 50 % of all heart failure (HF) cases. Nonetheless, registries from specific geographic areas, as Latin America, are lacking. The present study aims to report the underlying causes, comorbidities, treatment patterns and outcomes of patients with HFpEF in a large cardiovascular center in Mexico City.
Methods
The present is a prospective, longitudinal, observational study, including female and male patients over 18 years of age, who presented to the emergency department, coronary care unit or outpatient department of the National Institute of Cardiology Ignacio Chavez in Mexico City with HFpEF. Patients were classified according to different phenotypes and current literature. The primary outcome was the composite total HFpEF hospitalization and all-cause mortality.
Results
Within a median follow-up of 472 (IQR 425–518) days, total mortality was 14.56 %, with 10.68 % attributed to cardiovascular causes. HF hospitalization was 7.77 %. Atrial fibrillation showed a notable association with outcomes (adjusted HR 2.87, P = 0.028). Beta-blocker showed a non-significant trend towards benefit, while mineralocorticoid receptor antagonists (MRA) significantly influenced outcomes (adjusted HR 3.30, P = 0.018). The primary composite endpoint occurred in 19.42 % of patients, with no significant difference among phenotypes (P = 0.536).
Conclusions
We observed a substantial comorbidity burden impacting quality of life, as indicated by KCCQ scores. There was a high incidence of hard endpoints, including cardiovascular death and hospitalizations, alongside significant variability in treatment utilization. Future research should focus on elucidating individual healthcare trajectories in HFpEF patients and promoting wider adoption of evidence-based therapies.
{"title":"Prospective registry of heart failure with preserved ejection fraction in México: EDIFICE-Mx","authors":"Diego Araiza-Garaygordobil , Oscar-Ulises Preciado-Gutierrez , Jorge Daniel Sierra-Lara Martinez , Hector Gonzalez-Pacheco , Rodrigo Gopar-Nieto , Ximena Latapi-Ruiz Esparza , Sarai Hernandez-Pastrana , Braiana-Angeles Diaz-Herrera , Amada Alvarez-Sangabriel , Antonio Jordan-Rios , Alexandra Arias-Mendoza","doi":"10.1016/j.ahjo.2024.100486","DOIUrl":"10.1016/j.ahjo.2024.100486","url":null,"abstract":"<div><h3>Background and aims</h3><div>Heart failure with preserved ejection fraction (HFpEF) is an increasingly common clinical syndrome, estimated to constitute approximately 50 % of all heart failure (HF) cases. Nonetheless, registries from specific geographic areas, as Latin America, are lacking. The present study aims to report the underlying causes, comorbidities, treatment patterns and outcomes of patients with HFpEF in a large cardiovascular center in Mexico City.</div></div><div><h3>Methods</h3><div>The present is a prospective, longitudinal, observational study, including female and male patients over 18 years of age, who presented to the emergency department, coronary care unit or outpatient department of the National Institute of Cardiology Ignacio Chavez in Mexico City with HFpEF. Patients were classified according to different phenotypes and current literature. The primary outcome was the composite total HFpEF hospitalization and all-cause mortality.</div></div><div><h3>Results</h3><div>Within a median follow-up of 472 (IQR 425–518) days, total mortality was 14.56 %, with 10.68 % attributed to cardiovascular causes. HF hospitalization was 7.77 %. Atrial fibrillation showed a notable association with outcomes (adjusted HR 2.87, P = 0.028). Beta-blocker showed a non-significant trend towards benefit, while mineralocorticoid receptor antagonists (MRA) significantly influenced outcomes (adjusted HR 3.30, P = 0.018). The primary composite endpoint occurred in 19.42 % of patients, with no significant difference among phenotypes (P = 0.536).</div></div><div><h3>Conclusions</h3><div>We observed a substantial comorbidity burden impacting quality of life, as indicated by KCCQ scores. There was a high incidence of hard endpoints, including cardiovascular death and hospitalizations, alongside significant variability in treatment utilization. Future research should focus on elucidating individual healthcare trajectories in HFpEF patients and promoting wider adoption of evidence-based therapies.</div></div>","PeriodicalId":72158,"journal":{"name":"American heart journal plus : cardiology research and practice","volume":"48 ","pages":"Article 100486"},"PeriodicalIF":1.3,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142758843","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 : 2024-11-09DOI: 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.
{"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}
Pub Date : 2024-11-01DOI: 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.
{"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}
Pub Date : 2024-11-01DOI: 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.
{"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}
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}
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}
Pub Date : 2024-10-31DOI: 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.
{"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}
Pub Date : 2024-10-24DOI: 10.1016/j.ahjo.2024.100478
Michele Golino , Alexa Coe , Anas Aljabi , Azita H. Talasaz , Benjamin Van Tassell , Antonio Abbate , Roshanak Markley
{"title":"Effect of colchicine on 90-day outcomes in patients with acute myocarditis: a real-world analysis","authors":"Michele Golino , Alexa Coe , Anas Aljabi , Azita H. Talasaz , Benjamin Van Tassell , Antonio Abbate , Roshanak Markley","doi":"10.1016/j.ahjo.2024.100478","DOIUrl":"10.1016/j.ahjo.2024.100478","url":null,"abstract":"","PeriodicalId":72158,"journal":{"name":"American heart journal plus : cardiology research and practice","volume":"47 ","pages":"Article 100478"},"PeriodicalIF":1.3,"publicationDate":"2024-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142532321","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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