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

Background

Acute heart failure necessitates intensive care, and arterial catheterization is a commonly performed invasive procedure in the intensive care unit (ICU). We aimed to investigate the association between arterial catheterization and outcomes in acute heart failure patients without shock.

Methods

We utilized MIMIC-IV database records for acute heart failure patients at Beth Israel Deaconess Medical Center from 2008 to 2019. Employing doubly robust estimation, we examined the relationship between arterial catheterization and outcomes, including 28-day, 90-day, in-hospital mortality, and ICU-free days within 28 days.

Results

Of 6936 patients identified, 2078 met inclusion criteria; 347 underwent arterial catheterization during their ICU stay. We observed no significant difference in 28-day mortality (odds ratio [OR]: 0.61, 95 % confidence interval [CI]: 0.31–1.21, P = 0.155), though catheterization was associated with reduced in-hospital mortality (OR: 0.41, 95 % CI: 0.14–0.65, P = 0.02). No significant effects were observed on 90-day mortality or ICU-free days within 28 days.

Conclusion

Our findings suggest that arterial catheterization is not associated with 28- and 90-day mortality rates in acute heart failure patients without shock but is linked to lower in-hospital mortality. Additional research and consensus are required to determine the appropriate utilization of arterial catheterization in patients.

Background

Cancer survivors face an elevated risk of cardiovascular disease (CVD) and cardiovascular disease mortality (CVDm) compared to the general population. Allostatic load (AL), a composite score reflecting cardiovascular, metabolic, and immune markers, assesses the cumulative impact of chronic stress and life events. Increased AL in cancer patients is linked to up to a 30 % higher CVD risk. We hypothesized that cancer diagnosis and therapy contribute to increased AL, mediating the association between cancer survivorship and CVDm.

Methods

This retrospective cohort study analyzed National Health and Nutrition Examination Survey (NHANES) data linked with the National Death Index (NDI) from 1988 to 2019. Cancer survivorship (yes vs. no), AL, and CVDm were the exposure, mediator, and outcome variables, respectively. Mediation analyses adapted to survival outcomes were performed.

Results

Among 14,416 participants, cancer survivors <65 years-old exhibited a 41 % higher associated CVDm risk. High AL mediated 5.4 %, 8.9 %, and 3.6 % of the effect for all adults, 18–64 years, and ≥65 years, respectively. Black patients <65 years-old had an 84 % higher associated CVDm risk, with AL mediating 9.2 %, 5.8 %, and 12.6 % for all adults, 18–64 years, and ≥65 years, respectively. White patients showed a 20 % higher associated CVDm risk, with AL mediating 4.4 %, 2.8 %, and 5.7 % for all adults, 18–64 years, and ≥65 years, respectively.

Conclusions

Increased CVDm risk among cancer survivors, particularly in Black individuals, is associated with higher AL mediation. These disparities may stem from social determinants of health.

Cardiac allografts suffer diastolic dysfunction early post-heart transplantation (HTx) due to ischemic injury, however the natural course of diastology recovery post HTx remains unknown (Tallaj et al., 2007 [1]). We retrospectively reviewed 60 adult HTx patients between 2015 and 2021 at a single site. Invasive hemodynamics and echocardiograms were obtained at 2 weeks and 1, 3, 6, and 12 months post-HTx. RA strain by 2D feature tracking was compared to intracardiac pressure measurements. In all patients, we observed normalization of RV and RA filling pressures by post-operative week 12 and recovery of diastolic dysfunction by month 6. There was an inverse correlation between RV end-diastolic pressure and RA contractile (r = −0.192, p < 0.05) and reservoir (r = −0.128, p < 0.05) functions in the allograft. As the post-transplant care paradigm shifts away from invasive procedures, right atrial indices should be included in imaging-based allograft surveillance studies.

Background

Climate change has been associated with adverse cardiovascular health, prompting interest in climate mitigation strategies while improving access for cardiovascular patients. We estimated greenhouse gas and air pollution savings from telehealth use in cardiology.

Methods

Using cardiology telehealth visits at a large academic medical center from July 2020 to March 2024, carbon dioxide (CO₂), nitrogen oxides (NO_x), carbon monoxide (CO), and particulate matter (PM_2.5) emissions saved were calculated using U.S. Environmental Protection Agency modeling software. Savings were converted into real-world comparators and differences were assessed by cardiology subspecialty and patient insurance status.

Results

Over 45 months, 14,828 telehealth visits among 9942 patients resulted in savings of 484,152 kg of CO₂, 5225 kg of CO, 243,491 g of NO_x, and 9091 g of PM_2.5 with the total carbon saved equivalent to planting 9070 tree saplings over ten years. CO₂ emissions saved per visit (kg) differed significantly by payor (Self-pay 24.99, Medicare 19.67, Medicaid 19.54, Private 17.85, Other 17.37, p = 0.004) and by subspecialty (Interventional 23.79, General 19.08, Heart Failure 18.86, Electrophysiology 17.81, Adult Congenital 16.59, p < 0.001).

Conclusions

Carbon emission and air pollution savings from telehealth in cardiology were substantial, with an estimated 19.06 kg of CO₂ saved per visit and total savings over 45 months equivalent to planting over nine thousand trees.

Background

Left ventricular assist devices (LVADs) may induce electromagnetic interference (EMI) affecting implanted cardiac devices, including more novel subcutaneous implantable cardiac defibrillators (S-ICDs).

Methods

In this case series, the authors retrospectively reviewed courses of 6 patients with S-ICDs who underwent LVAD implantation at a single center.

Results

Of the 6 patients reviewed, 4 experienced inappropriate ICD shocks, of which 3 resulted from EMI. Five of the 6 patients ultimately had S-ICD therapies disabled.

Conclusions

Due to EMI resulting in inappropriate shocks and improved tolerability of malignant arrhythmias, deactivation or removal of S-ICDs should be considered in patients undergoing LVAD implantation.

Study objective

There is inadequate awareness of the effect of food on the bioavailability of dronedarone. We report results from two phase 1 studies assessing the effect of food on dronedarone's bioavailability.

Design, setting and participants

Study 1; single-center, open-label, randomized study in healthy adults (males and females). Study 2; single-center, open-label, randomized study in healthy males.

Interventions

Study 1; a single 400-mg oral dose of dronedarone (marketed formulation) in fed (high-fat [47.4 g] meal) and fasted states. Study 2; a single 800-mg oral dose of dronedarone (two 400-mg tablets) after fat-rich (37.3 g) and low-fat (5.3 g) meals, and after fasting.

Main outcome measures

Pharmacokinetic parameters including maximum plasma concentration (C_max) and area under the curve from time 0 to last measurable time (AUC_last) were assessed for dronedarone and its active N-debutyl metabolite.

Results

Twenty-six participants were included in Study 1 and nine in Study 2. In Study 1, administration of 400 mg dronedarone with a high-fat meal vs. fasted state resulted in 2.8-fold and 2.0-fold increases in C_max and AUC_last, respectively. In Study 2, administration of 800 mg dronedarone with a fat-rich or low-fat meal vs. fasted state resulted in 4.6-fold and 3.2-fold increases in C_max, respectively, and 3.1-fold and 2.3-fold increases, respectively, in AUC_last. Results for the N-debutyl metabolite were similar to dronedarone. No adverse events were considered related to dronedarone.

Conclusion

With food, the bioavailability of dronedarone is markedly increased. In clinical practice, dronedarone should be administered with a complete meal to maximize drug absorption.

Background

In patients with angina and non-obstructive coronary artery disease (ANOCA), diagnosis of coronary microvascular dysfunction (CMD) remains an unmet need. Magnetocardiography (MCG), is a rest-based, non-invasive scan that can detect weak electrophysiological changes that occur at the early phase of ischemia.

Objective

This study assessed the ability of MCG to detect CMD in ANOCA patients as compared to reference standard, invasive coronary flow reserve (CFR).

Methods

Patients with ANOCA and invasive coronary physiologic assessment using intracoronary flow measurements with Doppler and thermodilution methods were enrolled. CMD was defined dichotomously as an invasive CFR < 2.0 by Doppler or thermodilution assessment. Noninvasive 36-channel 90-s MCG scan was performed and quantitative assessment of four distinct MCG features was completed. We evaluated the diagnostic performance of 2 or more abnormal MCG features to detect CMD in the overall cohort and performed a subgroup analysis in the subset of patients with Doppler CFR assessment.

Results

Among 79 ANOCA patients, 25 were CMD positive and 54 patients were CMD negative by CFR. Using invasive CFR as reference, MCG had an ROC AUC of 0.66 with a sensitivity of 68 % and specificity of 65 % for the detection of CMD. In the subgroup with Doppler CFR assessment, MCG had an ROC AUC of 0.76 with a sensitivity of 75 % and specificity of 77 %.

Conclusions

In ANOCA patients, MCG demonstrates the ability to detect CMD using a 90-second non-invasive scan without the need for an intravenous stressor or ionizing radiation. Further investigations are needed to validate an MCG-based diagnostic pathway for CMD.

Introduction

Since the beginning of the COronaVIrus Disease 2019 (COVID-19) pandemic, poor attention has been paid to the indirect effects of the pandemia on cardiovascular health system, in particular in patients with Acute Coronary Syndrome (ACS). The aims of this study is to compare possible epidemiological, clinical and management differences between the four epidemic waves in groups of patients hospitalized for ACS with a view to highlighting the burden of the pandemic on the management of this syndrome.

Materials and methods

In this retrospective observational study we included 98 patients admitted to Coronary Intensive Care Unit (CICU) for ACS between March 2020 and March 2022, who underwent revascularization procedure using percutaneous coronary angioplasty (PCI). The patients examined were divided into four groups representative of the four epidemic waves that affected our country.

Results

The rate of hospitalization for ACS increased progressively to a 178 % increase in the third wave compared to the first (p = 0.003), with an increase of 900 % if we consider only Non-ST-Elevation Myocardial Infarction (NSTEMI) (representing 54 % of the ACS diagnoses of the third group against 14.3 % in the first). Longer door-to-balloon times were recorded in the third wave for the increased presence of NSTEMI. The average hospital stay was lower in the third wave with 5 ± 2 days (p = 0.007) as well as mortality (5.1 % in the third wave; the highest in the fourth wave with 9.5 %).

Conclusions

The study show that the management of ACS suffered most from the indirect effects of the pandemic during the first wave, both because of the unpreparedness of hospital facilities and because of the fear of infection that has dissuaded people from asking for help.

Study objective

Transgender persons face increased risk in developing cardiovascular diseases due to administration of hormonal therapy used for gender expression, or due to the presence of other risk factors, such as minority stress and difficulty to have full access to health care. Even though the need for gender diversity in research has been identified, the number of clinical trials including transgender persons remains low. The aim of this study was to highlight gaps in inclusion of transgender individuals in cardiovascular clinical research.

Design, setting

A search in the pubmed.com database, as well as in the clinicaltrials.gov repository, was performed with search terms regarding transgender persons and cardiovascular diseases.

Main outcome measure(s)

The inclusion of transgender persons in cardiovascular clinical trials was evaluated.

Results and conclusions

This study revealed that there is only a small number of cardiovascular clinical trials including or studying transgender persons. This finding demonstrates the overall lack of clinical trials regarding cardiovascular health in transgender individuals and is indicative of their under-representation in clinical research.