Pub Date : 2024-10-01DOI: 10.1016/j.ahjo.2024.100463
Kelsey Gardiner , Kate Hanneman , Rebecca Kozor
The healthcare sector is a major contributor to the universal climate footprint, of this a significant proportion is attributable to medical imaging and further to dedicated cardiac imaging. The increasing availability and utility of cardiac imaging techniques for prognosis, diagnosis and management raises concerns for the impact of these investigations on the environment.
Our objective was to review the published literature assessing the environmental impact of non-invasive imaging modalities within cardiology, subsequently helping guide physicians toward a more sustainable approach to cardiac imaging and improved awareness of the environmental impact of healthcare within this field.
We conducted a systematic review of studies measuring the environmental impact of non-invasive cardiac imaging. A total of 8 studies were included in the final analysis.
Cardiac imaging has a significant environmental impact, which varies by modality: lowest for echocardiography and highest for MRI. As a whole this field represents a significant contributor to climate-related threats to human health, which we should strive toward harm minimisation. This may be mitigated through the conscious utilisation of energy consumption and contrast media, as well as healthcare worker education and quality improvement to guide imaging choice based on environmental impact alongside conventional determinants such as patient characteristics, clinical guidelines and cost (visual abstract).
{"title":"The environmental effects of non-invasive cardiac imaging","authors":"Kelsey Gardiner , Kate Hanneman , Rebecca Kozor","doi":"10.1016/j.ahjo.2024.100463","DOIUrl":"10.1016/j.ahjo.2024.100463","url":null,"abstract":"<div><div>The healthcare sector is a major contributor to the universal climate footprint, of this a significant proportion is attributable to medical imaging and further to dedicated cardiac imaging. The increasing availability and utility of cardiac imaging techniques for prognosis, diagnosis and management raises concerns for the impact of these investigations on the environment.</div><div>Our objective was to review the published literature assessing the environmental impact of non-invasive imaging modalities within cardiology, subsequently helping guide physicians toward a more sustainable approach to cardiac imaging and improved awareness of the environmental impact of healthcare within this field.</div><div>We conducted a systematic review of studies measuring the environmental impact of non-invasive cardiac imaging. A total of 8 studies were included in the final analysis.</div><div>Cardiac imaging has a significant environmental impact, which varies by modality: lowest for echocardiography and highest for MRI. As a whole this field represents a significant contributor to climate-related threats to human health, which we should strive toward harm minimisation. This may be mitigated through the conscious utilisation of energy consumption and contrast media, as well as healthcare worker education and quality improvement to guide imaging choice based on environmental impact alongside conventional determinants such as patient characteristics, clinical guidelines and cost (visual abstract).</div></div>","PeriodicalId":72158,"journal":{"name":"American heart journal plus : cardiology research and practice","volume":"46 ","pages":"Article 100463"},"PeriodicalIF":1.3,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142359118","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 : 2024-10-01DOI: 10.1016/j.ahjo.2024.100466
Noha Rami Ismail , Hamdy A. Makhlouf , Atef Hassan , Ahmed Elshahat , Mohamed Abdelfatah Abdellatif , Abdelmoemen Esam Rezk , Abdelrahman Mady , Rashad G. Mohamed , Hanady Mohammad Elfeky , Ahmed Abdelaziz
Background
Chronic thromboembolic pulmonary hypertension (CTEPH) is a major risk for pulmonary hypertension with poor prognosis. Limited data is available on the optimal treatment of choice. We aimed to comprehensively assess the efficacy and safety of CTEPH targeted therapies and update the evidence.
Methods
We searched PubMed, Scopus, and the Cochrane library up to December 2023 to include randomized controlled trials comparing different therapies in patients with CTEPH. Primary outcomes were 6-minute walk distance (6 MWD), pulmonary vascular resistance (PVR), and mean pulmonary artery pressure (mPAP). While secondary outcomes were the mean right atrial pressure (mRAP), Borg dyspnea score, cardiac output (CO), cardiac index, adverse events, and all-cause mortality.
Results
Fourteen RCTs comprising 1047 patients were included in this network meta-analysis. Regarding 6 MWD, PADN (MD=113.59, 95% CI: 53.80; 173.39), BPA (MD=48.84, 95% CI: 27.99; 69.69), riociguat (MD=42.59, 95% CI: 22.01; 63.18), treprostinil (MD=41.60, 95% CI: 17.07; 66.13), and macitentan (MD=34.00, 95% CI: 3.50; 64.50) were favored compared to placebo. In terms of PVR, BPA (MD=-392.19, 95% CI: -571.77; -212.62), treprostinil (MD=-287.20, 95% CI: -475.63; -98.77), PADN (MD=-280.61, 95% CI: -506.69; -54.52), bosentan (MD=-176.00, 95% CI: -340.91; -11.09), and riociguat (MD=-171.61, 95% CI: -298.40; -44.81) displayed statistically significant results.
Conclusion
Current therapeutic modalities are effective in terms of improving exercise capacity, pulmonary hemodynamics, and reducing adverse events and all-cause mortality. Overall, BPA and PADN were superior to all other targeted medications in the studied outcomes.
{"title":"An in-depth evaluation of the efficacy and safety of various treatment modalities for chronic thromboembolic pulmonary hypertension: A systematic review and network meta-analysis","authors":"Noha Rami Ismail , Hamdy A. Makhlouf , Atef Hassan , Ahmed Elshahat , Mohamed Abdelfatah Abdellatif , Abdelmoemen Esam Rezk , Abdelrahman Mady , Rashad G. Mohamed , Hanady Mohammad Elfeky , Ahmed Abdelaziz","doi":"10.1016/j.ahjo.2024.100466","DOIUrl":"10.1016/j.ahjo.2024.100466","url":null,"abstract":"<div><h3>Background</h3><div>Chronic thromboembolic pulmonary hypertension (CTEPH) is a major risk for pulmonary hypertension with poor prognosis. Limited data is available on the optimal treatment of choice. We aimed to comprehensively assess the efficacy and safety of CTEPH targeted therapies and update the evidence.</div></div><div><h3>Methods</h3><div>We searched PubMed, Scopus, and the Cochrane library up to December 2023 to include randomized controlled trials comparing different therapies in patients with CTEPH. Primary outcomes were 6-minute walk distance (6 MWD), pulmonary vascular resistance (PVR), and mean pulmonary artery pressure (mPAP). While secondary outcomes were the mean right atrial pressure (mRAP), Borg dyspnea score, cardiac output (CO), cardiac index, adverse events, and all-cause mortality.</div></div><div><h3>Results</h3><div>Fourteen RCTs comprising 1047 patients were included in this network meta-analysis. Regarding 6 MWD, PADN (MD=113.59, 95% CI: 53.80; 173.39), BPA (MD=48.84, 95% CI: 27.99; 69.69), riociguat (MD=42.59, 95% CI: 22.01; 63.18), treprostinil (MD=41.60, 95% CI: 17.07; 66.13), and macitentan (MD=34.00, 95% CI: 3.50; 64.50) were favored compared to placebo. In terms of PVR, BPA (MD=-392.19, 95% CI: -571.77; -212.62), treprostinil (MD=-287.20, 95% CI: -475.63; -98.77), PADN (MD=-280.61, 95% CI: -506.69; -54.52), bosentan (MD=-176.00, 95% CI: -340.91; -11.09), and riociguat (MD=-171.61, 95% CI: -298.40; -44.81) displayed statistically significant results.</div></div><div><h3>Conclusion</h3><div>Current therapeutic modalities are effective in terms of improving exercise capacity, pulmonary hemodynamics, and reducing adverse events and all-cause mortality. Overall, BPA and PADN were superior to all other targeted medications in the studied outcomes.</div></div>","PeriodicalId":72158,"journal":{"name":"American heart journal plus : cardiology research and practice","volume":"46 ","pages":"Article 100466"},"PeriodicalIF":1.3,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142359119","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 : 2024-09-21DOI: 10.1016/j.ahjo.2024.100464
Keith C. Ferdinand, Asaad Nakhle
{"title":"OCEANIC-AF and the inferior efficacy of asundexian compared to apixaban in patients at high risk with atrial fibrillation: Have we come to the end of the road for factor XIa inhibitors?","authors":"Keith C. Ferdinand, Asaad Nakhle","doi":"10.1016/j.ahjo.2024.100464","DOIUrl":"10.1016/j.ahjo.2024.100464","url":null,"abstract":"","PeriodicalId":72158,"journal":{"name":"American heart journal plus : cardiology research and practice","volume":"46 ","pages":"Article 100464"},"PeriodicalIF":1.3,"publicationDate":"2024-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666602224001071/pdfft?md5=dcef97a58d558630a5736f14bf7ddda6&pid=1-s2.0-S2666602224001071-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142310615","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 : 2024-09-21DOI: 10.1016/j.ahjo.2024.100462
Nismat Javed , Preeti Jadhav , Sridhar Chilimuri , Johanna Contreras , Jacqueline Tamis-Holland , Jonathan N. Bella
Background
Current knowledge about non-acute myocardial infarction-associated cardiogenic shock (nAMI-CS) by ethnicity is limited. This study compares clinical features and outcomes of nAMI-CS in Hispanic versus non-Hispanic patients in the U.S.
Methods
Hospitalizations with nAMI-CS from 2018 to 2020 were identified using the National Inpatient Sample (NIS) database. Patients were classified by ethnicity (Hispanic vs. non-Hispanic). Statistical analysis, including Chi-square and t-tests, was conducted using STATA version 18.
Results
Out of 8607 nAMI-CS hospitalizations, 832 (9.6 %) were Hispanic. Hispanic patients were younger (62.3 ± 15.2 vs. 66.2 ± 15.3 years) and had higher incidences of smoking (2.4 % vs. 2.1 %), coronary artery disease (45.4 % vs. 44.1 %), myocardial infarction (2.9 % vs. 1.9 %), heart failure (10.1 % vs. 9.2 %), and diabetes mellitus (18.9 % vs. 18.1 %). They had lower incidences of hypertension (32.9 % vs. 34.3 %), valve disease (1.9 % vs. 2.1 %), and cerebrovascular disease (6.5 % vs. 8.5 %, all p < 0.005). Hispanic patients had slightly higher in-hospital mortality rates (18.6 % vs. 17 %, p < 0.001), with an adjusted odds ratio (aOR) of 1.20 (95 % CI: 1.01–1.50, p = 0.01). Their hospital stays were longer (17.7 ± 1.87 vs. 13.2 ± 0.31 days, p = 0.03) and costlier ($409,280 ± 591,582 vs. $291,298 ± 461,920, p = 0.03).
Conclusion
Hispanic nAMI-CS patients are younger, have more co-morbid conditions, longer hospital stays, higher costs, and higher in-hospital mortality rates than non-Hispanic patients. Further research is needed to understand the mechanisms behind these disparities.
背景目前关于不同种族非急性心肌梗死相关性心源性休克（nAMI-CS）的知识有限。本研究比较了美国西班牙裔与非西班牙裔患者的 nAMI-CS 临床特征和预后。方法使用全国住院患者抽样（NIS）数据库确定了 2018 年至 2020 年住院的 nAMI-CS 患者。患者按种族（西班牙裔与非西班牙裔）分类。使用 STATA 18 版进行了统计分析，包括卡方检验和 t 检验。结果在 8607 例 nAMI-CS 住院患者中，有 832 例（9.6%）为西班牙裔。西班牙裔患者更年轻（62.3 ± 15.2 岁 vs. 66.2 ± 15.3 岁），吸烟（2.4% vs. 2.1%）、冠状动脉疾病（45.4% vs. 44.1%）、心肌梗塞（2.9% vs. 1.9%）、心力衰竭（10.1% vs. 9.2%）和糖尿病（18.9% vs. 18.1%）的发病率更高。他们的高血压（32.9% 对 34.3%）、瓣膜病（1.9% 对 2.1%）和脑血管病（6.5% 对 8.5%，均为 0.005%）发病率较低。西班牙裔患者的院内死亡率略高（18.6% 对 17%，p < 0.001），调整后的几率比（aOR）为 1.20（95 % CI：1.01-1.50，p = 0.01）。他们的住院时间更长（17.7 ± 1.87 天 vs. 13.2 ± 0.31 天，p = 0.03），费用更高（409,280 美元 ± 591,582 美元 vs. 291,298 美元 ± 461,920 美元，p = 0.03）。要了解这些差异背后的机制，还需要进一步的研究。
{"title":"Non-acute myocardial infarction-associated cardiogenic shock in Hispanic patients: An analysis from the National Inpatient Sample Database","authors":"Nismat Javed , Preeti Jadhav , Sridhar Chilimuri , Johanna Contreras , Jacqueline Tamis-Holland , Jonathan N. Bella","doi":"10.1016/j.ahjo.2024.100462","DOIUrl":"10.1016/j.ahjo.2024.100462","url":null,"abstract":"<div><h3>Background</h3><p>Current knowledge about non-acute myocardial infarction-associated cardiogenic shock (nAMI-CS) by ethnicity is limited. This study compares clinical features and outcomes of nAMI-CS in Hispanic versus non-Hispanic patients in the U.S.</p></div><div><h3>Methods</h3><p>Hospitalizations with nAMI-CS from 2018 to 2020 were identified using the National Inpatient Sample (NIS) database. Patients were classified by ethnicity (Hispanic vs. non-Hispanic). Statistical analysis, including Chi-square and <em>t</em>-tests, was conducted using STATA version 18.</p></div><div><h3>Results</h3><p>Out of 8607 nAMI-CS hospitalizations, 832 (9.6 %) were Hispanic. Hispanic patients were younger (62.3 ± 15.2 vs. 66.2 ± 15.3 years) and had higher incidences of smoking (2.4 % vs. 2.1 %), coronary artery disease (45.4 % vs. 44.1 %), myocardial infarction (2.9 % vs. 1.9 %), heart failure (10.1 % vs. 9.2 %), and diabetes mellitus (18.9 % vs. 18.1 %). They had lower incidences of hypertension (32.9 % vs. 34.3 %), valve disease (1.9 % vs. 2.1 %), and cerebrovascular disease (6.5 % vs. 8.5 %, all <em>p</em> < 0.005). Hispanic patients had slightly higher in-hospital mortality rates (18.6 % vs. 17 %, <em>p</em> < 0.001), with an adjusted odds ratio (aOR) of 1.20 (95 % CI: 1.01–1.50, <em>p</em> = 0.01). Their hospital stays were longer (17.7 ± 1.87 vs. 13.2 ± 0.31 days, <em>p</em> = 0.03) and costlier ($409,280 ± 591,582 vs. $291,298 ± 461,920, <em>p</em> = 0.03).</p></div><div><h3>Conclusion</h3><p>Hispanic nAMI-CS patients are younger, have more co-morbid conditions, longer hospital stays, higher costs, and higher in-hospital mortality rates than non-Hispanic patients. Further research is needed to understand the mechanisms behind these disparities.</p></div>","PeriodicalId":72158,"journal":{"name":"American heart journal plus : cardiology research and practice","volume":"46 ","pages":"Article 100462"},"PeriodicalIF":1.3,"publicationDate":"2024-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666602224001058/pdfft?md5=607be9c43a6fd5a30ff2714fb09c0e1e&pid=1-s2.0-S2666602224001058-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142272894","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 : 2024-09-13DOI: 10.1016/j.ahjo.2024.100460
Dahlene Fusco , Sharon Liu , Marc Theberge , Anuhya S. Pulapaka , William Rittmeyer , Yitian Zha , Marlowe Maylin , W. Ben Rothwell , Prateek Adhikari , Peter Reynaud , Keith Ferdinand , Arnaud Drouin
{"title":"Understanding the link between COVID-19, blood pressure and obesity: Perspectives from the New Orleans experience","authors":"Dahlene Fusco , Sharon Liu , Marc Theberge , Anuhya S. Pulapaka , William Rittmeyer , Yitian Zha , Marlowe Maylin , W. Ben Rothwell , Prateek Adhikari , Peter Reynaud , Keith Ferdinand , Arnaud Drouin","doi":"10.1016/j.ahjo.2024.100460","DOIUrl":"10.1016/j.ahjo.2024.100460","url":null,"abstract":"","PeriodicalId":72158,"journal":{"name":"American heart journal plus : cardiology research and practice","volume":"46 ","pages":"Article 100460"},"PeriodicalIF":1.3,"publicationDate":"2024-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666602224001034/pdfft?md5=555a12aefd5d4a3e3290c4b07352ac95&pid=1-s2.0-S2666602224001034-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142240226","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 : 2024-09-11DOI: 10.1016/j.ahjo.2024.100456
Peter Rasmussen , Yong-Fang Kuo , Biai Dominique Elmir Digbeu , Wissam Harmouch , Steven Mai , Mukaila Raji
Congestive heart failure (CHF) and opioid use disorder (OUD) commonly coexist and are major contributors to high healthcare utilization in the United States. Medication assisted treatment (MAT; e.g., buprenorphine and methadone) reduces opioid-related mortality by about 50 %; yet little is known about how OUD treatment impacts CHF outcomes in patients with both CHF and OUD. We examined the impact of MAT (buprenorphine, methadone, and naltrexone) on CHF outcomes in patients diagnosed with OUD and CHF, and which MAT (buprenorphine or methadone) medication is associated with the fewest CHF outcomes. A retrospective cohort study of patients 18 years or older diagnosed with both CHF and OUD was conducted using Optum's de-identified Clinformatics® Data Mart Database. Multivariate logistic regression modeling was used to compared patients who were prescribed MAT to those who were not. The primary outcomes were CHF hospitalizations and CHF emergency department visits. No significant differences in the primary outcomes between the MAT and non-MAT cohorts were observed. In conclusion, the lack of association of MAT with negative CHF outcomes suggest that life-saving MAT can be safely used for OUD treatment in the CHF setting.
在美国，充血性心力衰竭（CHF）和阿片类药物使用障碍（OUD）通常同时存在，并且是造成医疗保健利用率高的主要原因。药物辅助治疗（MAT，如丁丙诺啡和美沙酮）可将阿片类药物相关死亡率降低约 50%；然而，人们对 OUD 治疗如何影响同时患有慢性心力衰竭和 OUD 患者的慢性心力衰竭预后知之甚少。我们研究了 MAT（丁丙诺啡、美沙酮和纳曲酮）对确诊为 OUD 和 CHF 患者的 CHF 结局的影响，以及哪种 MAT（丁丙诺啡或美沙酮）药物与最少的 CHF 结局相关。我们使用 Optum 的去身份化 Clinformatics® Data Mart 数据库，对 18 岁或 18 岁以上同时诊断为 CHF 和 OUD 的患者进行了一项回顾性队列研究。该研究使用多变量逻辑回归模型对开具 MAT 的患者与未开具 MAT 的患者进行了比较。主要结果为慢性阻塞性肺病住院率和慢性阻塞性肺病急诊就诊率。MAT 和非 MAT 组群之间的主要结果无明显差异。总之，MAT 与慢性阻塞性肺病的不良后果没有关联，这表明在慢性阻塞性肺病环境中，可以安全地使用 MAT 治疗 OUD，从而挽救生命。
{"title":"The impact of medication-assisted treatment for opioid use disorder on congestive heart failure outcomes","authors":"Peter Rasmussen , Yong-Fang Kuo , Biai Dominique Elmir Digbeu , Wissam Harmouch , Steven Mai , Mukaila Raji","doi":"10.1016/j.ahjo.2024.100456","DOIUrl":"10.1016/j.ahjo.2024.100456","url":null,"abstract":"<div><p>Congestive heart failure (CHF) and opioid use disorder (OUD) commonly coexist and are major contributors to high healthcare utilization in the United States. Medication assisted treatment (MAT; e.g., buprenorphine and methadone) reduces opioid-related mortality by about 50 %; yet little is known about how OUD treatment impacts CHF outcomes in patients with both CHF and OUD. We examined the impact of MAT (buprenorphine, methadone, and naltrexone) on CHF outcomes in patients diagnosed with OUD and CHF, and which MAT (buprenorphine or methadone) medication is associated with the fewest CHF outcomes. A retrospective cohort study of patients 18 years or older diagnosed with both CHF and OUD was conducted using Optum's de-identified Clinformatics® Data Mart Database. Multivariate logistic regression modeling was used to compared patients who were prescribed MAT to those who were not. The primary outcomes were CHF hospitalizations and CHF emergency department visits. No significant differences in the primary outcomes between the MAT and non-MAT cohorts were observed. In conclusion, the lack of association of MAT with negative CHF outcomes suggest that life-saving MAT can be safely used for OUD treatment in the CHF setting.</p></div>","PeriodicalId":72158,"journal":{"name":"American heart journal plus : cardiology research and practice","volume":"46 ","pages":"Article 100456"},"PeriodicalIF":1.3,"publicationDate":"2024-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666602224000995/pdfft?md5=0e5f1ef19187891c6ab32b259b28d155&pid=1-s2.0-S2666602224000995-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142272893","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 : 2024-09-10DOI: 10.1016/j.ahjo.2024.100455
Tina K. Reddy , Chloé D. Villavaso , Anuhya V. Pulapaka , Keith C. Ferdinand
The role of incretin-based therapies, including glucagon-like peptide-1 receptor agonists (GLP1RAs) and dual GLP-1/glucose-dependent insulinotropic polypeptide (GIP) receptor agonists, in the management of type 2 diabetes mellitus (T2DM) and obesity has been increasingly recognized, along with significant cardiovascular (CV) benefits. Despite the clinical efficacy of incretin-based therapies, high costs, suboptimal access, limited insurance coverage, and therapeutic inertia present substantial barriers to widespread adoption. Overcoming these obstacles is essential for the equitable initiation, access, and utilization of incretin-based therapies. Clinicians must make targeted efforts to ensure health equity in the use of these and other advanced therapies.
{"title":"Achieving equitable access to incretin-based therapies in cardiovascular care","authors":"Tina K. Reddy , Chloé D. Villavaso , Anuhya V. Pulapaka , Keith C. Ferdinand","doi":"10.1016/j.ahjo.2024.100455","DOIUrl":"10.1016/j.ahjo.2024.100455","url":null,"abstract":"<div><p>The role of incretin-based therapies, including glucagon-like peptide-1 receptor agonists (GLP1RAs) and dual GLP-1/glucose-dependent insulinotropic polypeptide (GIP) receptor agonists, in the management of type 2 diabetes mellitus (T2DM) and obesity has been increasingly recognized, along with significant cardiovascular (CV) benefits. Despite the clinical efficacy of incretin-based therapies, high costs, suboptimal access, limited insurance coverage, and therapeutic inertia present substantial barriers to widespread adoption. Overcoming these obstacles is essential for the equitable initiation, access, and utilization of incretin-based therapies. Clinicians must make targeted efforts to ensure health equity in the use of these and other advanced therapies.</p></div>","PeriodicalId":72158,"journal":{"name":"American heart journal plus : cardiology research and practice","volume":"46 ","pages":"Article 100455"},"PeriodicalIF":1.3,"publicationDate":"2024-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666602224000983/pdfft?md5=494094e1cf7ab22754c230b4cc73d32d&pid=1-s2.0-S2666602224000983-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142229350","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 : 2024-09-07DOI: 10.1016/j.ahjo.2024.100461
Sha Liu , Yuangang Qiu , Chuqun Lv
Background
Nicorandil and verapamil can improve coronary blood flow and coronary microcirculation during percutaneous coronary intervention. However, the effects of intracoronary (IC) administration of nicorandil and verapamil on hemodynamics remain unclear.
Aims
To clarify the safety and effects of IC administration of nicorandil and verapamil on blood pressure (BP) and heart rate (HR) to provide evidence-based basis for clinical intervention.
Methods
The study cohort included 70 patients with coronary artery stenosis recruited from Zhejiang Provincial Hospital of Traditional Chinese Medicine. The patients were randomly assigned to the intervention group (IC administration of 2 mg/2 ml of nicorandil and 200 μg/2 ml of verapamil) or the control group (IC administration of 2 ml of saline). BP and HR were compared before medication, after medication, and when stabilized.
Results
IC administration of verapamil at 200 μg significantly reduced systolic BP as compared to the control group (113.72 ± 3.40 vs. 123.63 ± 3.33 mmHg, respectively, p < 0.05) for a short period of time, and returned to baseline within 2 min, but had no effect on diastolic BP and HR. IC administration injection of nicorandil at 2 mg had no effect on BP or HR. There were no instances of major cardiovascular events.
Conclusion
IC administration of nicorandil at 2 mg is safe as an adjunctive medication during interventional angiography. Verapamil can also be used as an IC adjuvant, although BP and HR must be monitored for patients with low basal BP, especially systolic BP.
{"title":"Effects of intracoronary administration of small doses of nicorandil and verapamil on blood pressure and heart rate","authors":"Sha Liu , Yuangang Qiu , Chuqun Lv","doi":"10.1016/j.ahjo.2024.100461","DOIUrl":"10.1016/j.ahjo.2024.100461","url":null,"abstract":"<div><h3>Background</h3><p>Nicorandil and verapamil can improve coronary blood flow and coronary microcirculation during percutaneous coronary intervention. However, the effects of intracoronary (IC) administration of nicorandil and verapamil on hemodynamics remain unclear.</p></div><div><h3>Aims</h3><p>To clarify the safety and effects of IC administration of nicorandil and verapamil on blood pressure (BP) and heart rate (HR) to provide evidence-based basis for clinical intervention.</p></div><div><h3>Methods</h3><p>The study cohort included 70 patients with coronary artery stenosis recruited from Zhejiang Provincial Hospital of Traditional Chinese Medicine. The patients were randomly assigned to the intervention group (IC administration of 2 mg/2 ml of nicorandil and 200 μg/2 ml of verapamil) or the control group (IC administration of 2 ml of saline). BP and HR were compared before medication, after medication, and when stabilized.</p></div><div><h3>Results</h3><p>IC administration of verapamil at 200 μg significantly reduced systolic BP as compared to the control group (113.72 ± 3.40 vs. 123.63 ± 3.33 mmHg, respectively, <em>p</em> < 0.05) for a short period of time, and returned to baseline within 2 min, but had no effect on diastolic BP and HR. IC administration injection of nicorandil at 2 mg had no effect on BP or HR. There were no instances of major cardiovascular events.</p></div><div><h3>Conclusion</h3><p>IC administration of nicorandil at 2 mg is safe as an adjunctive medication during interventional angiography. Verapamil can also be used as an IC adjuvant, although BP and HR must be monitored for patients with low basal BP, especially systolic BP.</p></div>","PeriodicalId":72158,"journal":{"name":"American heart journal plus : cardiology research and practice","volume":"46 ","pages":"Article 100461"},"PeriodicalIF":1.3,"publicationDate":"2024-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666602224001046/pdfft?md5=f74d767fe74078552676d87b0a4bbf95&pid=1-s2.0-S2666602224001046-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142151784","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 : 2024-09-07DOI: 10.1016/j.ahjo.2024.100458
Daniela Di Lisi , Cristina Madaudo , Maria Gabriella Carmina , Francesco Clemenza , Domenico Scelfo , Eluisa La Franca , Michela Pieri , Giuseppe Vitale , Alfredo Ruggero Galassi , Giuseppina Novo
Background/aims
Myocarditis is an inflammatory disease with diverse clinical presentations. It is known that low-risk patients have a good prognosis compared to high-risk patients. There are few data regarding the prognosis of intermediate-risk patients. This study aimed to analyze the long-term outcomes of patients with acute myocarditis with different risk profiles at presentation, focusing on the intermediate risk one.
Methods
A retrospective multicenter study was conducted, enrolling patients who met the diagnostic criteria for clinically suspected myocarditis with acute presentation. Patients were stratified into high, intermediate and low risk, according to the classification proposed by Sinagra and his team. Cardiovascular adverse events (AEs) were assessed after a median follow-up of 19 months. Echocardiographic and cardiac magnetic resonance (CMR) parameters predictive of adverse events have been reported.
Results
We enrolled 127 patients (mean age 30 ± 13 years; 103 men, 24 women). High-risk patients had a higher frequency of adverse events (80 %) compared to other groups (16 %–16 %, p < 0.0001). An association was observed between the number of segments with late gadolinium enhancement (LGE) at baseline CMR and the occurrence of adverse events (p < 0.0037). The sum of segments with LGE was statistically correlated with lower left ventricular GLS (p < 0.009). The number of segments with LGE that most accurately identified the occurrence of adverse events was 2.5 [AUC 0.5; p = 0.24].
Conclusions
Our study confirms the higher incidence of AE in the high group; the prognosis of patients at intermediate risk is not very different from those at low risk. It can be hypothesized that the extent of LGE at baseline is the main predictor of adverse events in patients at intermediate risk.
{"title":"Prognosis of myocarditis stratified by initial clinical presentation: Does “intermediate” risk still play a role?","authors":"Daniela Di Lisi , Cristina Madaudo , Maria Gabriella Carmina , Francesco Clemenza , Domenico Scelfo , Eluisa La Franca , Michela Pieri , Giuseppe Vitale , Alfredo Ruggero Galassi , Giuseppina Novo","doi":"10.1016/j.ahjo.2024.100458","DOIUrl":"10.1016/j.ahjo.2024.100458","url":null,"abstract":"<div><h3>Background/aims</h3><p>Myocarditis is an inflammatory disease with diverse clinical presentations. It is known that low-risk patients have a good prognosis compared to high-risk patients. There are few data regarding the prognosis of intermediate-risk patients. This study aimed to analyze the long-term outcomes of patients with acute myocarditis with different risk profiles at presentation, focusing on the intermediate risk one.</p></div><div><h3>Methods</h3><p>A retrospective multicenter study was conducted, enrolling patients who met the diagnostic criteria for clinically suspected myocarditis with acute presentation. Patients were stratified into high, intermediate and low risk, according to the classification proposed by Sinagra and his team. Cardiovascular adverse events (AEs) were assessed after a median follow-up of 19 months. Echocardiographic and cardiac magnetic resonance (CMR) parameters predictive of adverse events have been reported.</p></div><div><h3>Results</h3><p>We enrolled 127 patients (mean age 30 ± 13 years; 103 men, 24 women). High-risk patients had a higher frequency of adverse events (80 %) compared to other groups (16 %–16 %, p < 0.0001). An association was observed between the number of segments with late gadolinium enhancement (LGE) at baseline CMR and the occurrence of adverse events (p < 0.0037). The sum of segments with LGE was statistically correlated with lower left ventricular GLS (p < 0.009). The number of segments with LGE that most accurately identified the occurrence of adverse events was 2.5 [AUC 0.5; p = 0.24].</p></div><div><h3>Conclusions</h3><p>Our study confirms the higher incidence of AE in the high group; the prognosis of patients at intermediate risk is not very different from those at low risk. It can be hypothesized that the extent of LGE at baseline is the main predictor of adverse events in patients at intermediate risk.</p></div>","PeriodicalId":72158,"journal":{"name":"American heart journal plus : cardiology research and practice","volume":"46 ","pages":"Article 100458"},"PeriodicalIF":1.3,"publicationDate":"2024-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666602224001010/pdfft?md5=c00958d0c2879f8beba18375433d81d4&pid=1-s2.0-S2666602224001010-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142167175","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 : 2024-09-06DOI: 10.1016/j.ahjo.2024.100457
Matthew Bang, Wenjun Fan, Nathan D. Wong
Study objective
Liver fibrosis is associated with increased cardiovascular disease (CVD) risk and mortality. However, it is unknown how these risks compare in those with pre-diabetes (pre-DM) or diabetes (DM). We examined the association of FIB-4 levels, an indicator of liver fibrosis, with CVD risk and mortality according to DM status.
Design and setting
Prospective, longitudinal cohort study.
Participants
We examined 13,326 U.S. adults (6.7 % with DM) with FIB-4 measures classified as low (<1.30), intermediate (1.30- < 2.67), high (2.67- < 3.25), and very high (≥3.25). National Death Index linkage provided mortality status for CVD, liver-related, and all causes over 17.5 years.
Main outcomes
We calculated 10-year ASCVD risk in persons without known ASCVD. Cox regression examined the relation of FIB-4 with mortality by DM status.
Results
High/very high FIB-4 levels were greater in those with (2.2 %) vs. without (0.4 %) DM (p < 0.0001). Higher FIB-4 scores and DM were associated with greater estimated ASCVD risks (p < 0.0001); 44.5 % of those at high /very high FIB-4 levels had ≥20 % estimated ASCVD risk. CVD mortality hazard ratios (HRs) (95 % CI) associated with high/very high FIB-4 in those with pre-DM and DM were 8.76 (3.66–20.95), and 0.89 (0.22–3.53), respectively, and for total mortality were 5.46 (3.16–9.43), and 2.07 (0.90–4.74), respectively, which were attenuated after adjustment.
Conclusions
Our findings indicate the need for increased efforts to identify those at risk of liver fibrosis in adults with pre-DM or DM to prevent CVD and total mortality.
{"title":"Liver fibrosis according to diabetes status and relation to cardiovascular risk and mortality in US adults","authors":"Matthew Bang, Wenjun Fan, Nathan D. Wong","doi":"10.1016/j.ahjo.2024.100457","DOIUrl":"10.1016/j.ahjo.2024.100457","url":null,"abstract":"<div><h3>Study objective</h3><div>Liver fibrosis is associated with increased cardiovascular disease (CVD) risk and mortality. However, it is unknown how these risks compare in those with pre-diabetes (pre-DM) or diabetes (DM). We examined the association of FIB-4 levels, an indicator of liver fibrosis, with CVD risk and mortality according to DM status.</div></div><div><h3>Design and setting</h3><div>Prospective, longitudinal cohort study.</div></div><div><h3>Participants</h3><div>We examined 13,326 U.S. adults (6.7 % with DM) with FIB-4 measures classified as low (<1.30), intermediate (1.30- < 2.67), high (2.67- < 3.25), and very high (≥3.25). National Death Index linkage provided mortality status for CVD, liver-related, and all causes over 17.5 years.</div></div><div><h3>Main outcomes</h3><div>We calculated 10-year ASCVD risk in persons without known ASCVD. Cox regression examined the relation of FIB-4 with mortality by DM status.</div></div><div><h3>Results</h3><div>High/very high FIB-4 levels were greater in those with (2.2 %) vs. without (0.4 %) DM (<em>p</em> < 0.0001). Higher FIB-4 scores and DM were associated with greater estimated ASCVD risks (<em>p</em> < 0.0001); 44.5 % of those at high /very high FIB-4 levels had ≥20 % estimated ASCVD risk. CVD mortality hazard ratios (HRs) (95 % CI) associated with high/very high FIB-4 in those with pre-DM and DM were 8.76 (3.66–20.95), and 0.89 (0.22–3.53), respectively, and for total mortality were 5.46 (3.16–9.43), and 2.07 (0.90–4.74), respectively, which were attenuated after adjustment.</div></div><div><h3>Conclusions</h3><div>Our findings indicate the need for increased efforts to identify those at risk of liver fibrosis in adults with pre-DM or DM to prevent CVD and total mortality.</div></div>","PeriodicalId":72158,"journal":{"name":"American heart journal plus : cardiology research and practice","volume":"46 ","pages":"Article 100457"},"PeriodicalIF":1.3,"publicationDate":"2024-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666602224001009/pdfft?md5=9b19babe0ac07725c55affcad4a3fdd1&pid=1-s2.0-S2666602224001009-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142310614","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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