Mohamed Magdi, Sarath Lal Mannumbeth Renjithal, Mahmood Mubasher, Mostafa Reda Mostafa, Yashdeep Lathwal, Pradeeksha Mukuntharaj, Sarah Mohamed, Richard Alweis, Bryan E-Xin Tan, Bipul Baibhav
Background: Ischemic stroke is a devastating complication of atrial fibrillation (Afib). Anticoagulation is the gold standard to prevent stroke and systemic embolization. However, many patients have a contraindication to oral anticoagulation. The WATCHMAN device, which closes the left atrial appendage, is non-inferior to warfarin to prevent embolic events in clinical trials. Post-procedural anticoagulation is needed to avoid device-related thrombosis. The use of anticoagulants after WATCHMAN implantation in patients with high bleeding risks has been a source of debate.
Objective: This article summarizes the current evidence on anticoagulation following the implantation of the WATCHMAN device, focusing on patients who have an absolute contraindication to oral anticoagulation.
Observation: The WATCHMAN device is efficacious and safe in preventing stroke and systemic embolization. Warfarin and aspirin are given for 45 days after implantation. If TEE at 45 days shows minimal residual peri-device flow (≤ 5mm) and no device-related thrombus, warfarin is stopped. This is followed by aspirin and clopidogrel for six months, then aspirin indefinitely. Antithrombotic therapy with aspirin and clopidogrel for six months followed by daily aspirin indefinitely may be feasible for patients with an absolute contraindication to OAC. DOACs are more convenient to use than warfarin, and limited evidence suggests that they are not inferior following implantation of the device.
Conclusion: Following the WATCHMAN implantation, the most often utilized regimen is warfarin followed by antiplatelet treatment. In cases where there is a high risk of bleeding, antiplatelets alone may be sufficient. More research is needed to tailor the existing antithrombotic regimen to the needs of patients.
{"title":"The WATCHMAN device and post-implantation anticoagulation management. A review of key studies and the risk of device-related thrombosis.","authors":"Mohamed Magdi, Sarath Lal Mannumbeth Renjithal, Mahmood Mubasher, Mostafa Reda Mostafa, Yashdeep Lathwal, Pradeeksha Mukuntharaj, Sarah Mohamed, Richard Alweis, Bryan E-Xin Tan, Bipul Baibhav","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Ischemic stroke is a devastating complication of atrial fibrillation (Afib). Anticoagulation is the gold standard to prevent stroke and systemic embolization. However, many patients have a contraindication to oral anticoagulation. The WATCHMAN device, which closes the left atrial appendage, is non-inferior to warfarin to prevent embolic events in clinical trials. Post-procedural anticoagulation is needed to avoid device-related thrombosis. The use of anticoagulants after WATCHMAN implantation in patients with high bleeding risks has been a source of debate.</p><p><strong>Objective: </strong>This article summarizes the current evidence on anticoagulation following the implantation of the WATCHMAN device, focusing on patients who have an absolute contraindication to oral anticoagulation.</p><p><strong>Observation: </strong>The WATCHMAN device is efficacious and safe in preventing stroke and systemic embolization. Warfarin and aspirin are given for 45 days after implantation. If TEE at 45 days shows minimal residual peri-device flow (≤ 5mm) and no device-related thrombus, warfarin is stopped. This is followed by aspirin and clopidogrel for six months, then aspirin indefinitely. Antithrombotic therapy with aspirin and clopidogrel for six months followed by daily aspirin indefinitely may be feasible for patients with an absolute contraindication to OAC. DOACs are more convenient to use than warfarin, and limited evidence suggests that they are not inferior following implantation of the device.</p><p><strong>Conclusion: </strong>Following the WATCHMAN implantation, the most often utilized regimen is warfarin followed by antiplatelet treatment. In cases where there is a high risk of bleeding, antiplatelets alone may be sufficient. More research is needed to tailor the existing antithrombotic regimen to the needs of patients.</p>","PeriodicalId":7427,"journal":{"name":"American journal of cardiovascular disease","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2021-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8784674/pdf/ajcd0011-0714.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39885986","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}
Dinaldo C Oliveira, Carolina G C Oliveira, Edivaldo B Mendes, Maria M Silveira, João V Cabral, Esmeralci Ferreira
Introduction: Interleukin 17 (IL-17) is produced by Th17 and other cells. It is debatable whether IL-17 is atherogenic or atheroprotective. The role of this interleukin in the development and progression of coronary artery disease is unknown. Our aim was to evaluate if there were differences in serum IL-17A levels according to to clinical presentation of coronary artery disease.
Methods: This cross-sectional study enrolled 101 patients with acute coronary syndrome (ACS), 100 patients with chronic coronary syndrome (CCS), and 70 healthy volunteers. Blood samples were collected from patients and controls (within 48 h) to analyze IL-17A levels. Clinical characteristics were recorded using questionnaires. This study was approved by the Ethics Committee.
Results: Comparisons of the clinical characteristics between patients with ACS and CCS revealed the following: mean age (62 ± 12.4 years vs. 63.3 ± 9.8 years, P = 0.4), male (63.4% vs. 58%, P = 0.4), hypertension (85.1% vs. 79%, P = 0.1), dyslipidemia (48% vs. 31%, P = 0.01), diabetes mellitus (47.5% vs. 41%, P = 0.3), previous myocardial infarction (57.4% vs. 40%, P = 0.01), and smoking (29.7% vs. 38%, P = 1). The peripheral concentrations of IL-17A in ACS, CCS and controls were 5.36 ± 8.83, 6.69 ± 17.92, and 6.26 ± 11.13, respectively, with P = 0.6. In addition, the comparison between ACS and CCS showed: 5.36 ± 8.83 vs. 6.69 ± 17.92%, P = 0.3.
Conclusion: The main finding of this study was that circulating IL-17 levels were similar in patients with ACS, CCS, and healthy volunteers. In addition, there was no difference between patients with ACS and those with CCS. Therefore, in patients with ACS and CCS, circulating IL-17A concentrations are low and there were no differences between patients with coronary artery disease and healthy individuals.
{"title":"Circulating interleukin-17A in patients with acute and chronic coronary syndromes.","authors":"Dinaldo C Oliveira, Carolina G C Oliveira, Edivaldo B Mendes, Maria M Silveira, João V Cabral, Esmeralci Ferreira","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Introduction: </strong>Interleukin 17 (IL-17) is produced by Th17 and other cells. It is debatable whether IL-17 is atherogenic or atheroprotective. The role of this interleukin in the development and progression of coronary artery disease is unknown. Our aim was to evaluate if there were differences in serum IL-17A levels according to to clinical presentation of coronary artery disease.</p><p><strong>Methods: </strong>This cross-sectional study enrolled 101 patients with acute coronary syndrome (ACS), 100 patients with chronic coronary syndrome (CCS), and 70 healthy volunteers. Blood samples were collected from patients and controls (within 48 h) to analyze IL-17A levels. Clinical characteristics were recorded using questionnaires. This study was approved by the Ethics Committee.</p><p><strong>Results: </strong>Comparisons of the clinical characteristics between patients with ACS and CCS revealed the following: mean age (62 ± 12.4 years vs. 63.3 ± 9.8 years, P = 0.4), male (63.4% vs. 58%, P = 0.4), hypertension (85.1% vs. 79%, P = 0.1), dyslipidemia (48% vs. 31%, P = 0.01), diabetes mellitus (47.5% vs. 41%, P = 0.3), previous myocardial infarction (57.4% vs. 40%, P = 0.01), and smoking (29.7% vs. 38%, P = 1). The peripheral concentrations of IL-17A in ACS, CCS and controls were 5.36 ± 8.83, 6.69 ± 17.92, and 6.26 ± 11.13, respectively, with P = 0.6. In addition, the comparison between ACS and CCS showed: 5.36 ± 8.83 vs. 6.69 ± 17.92%, P = 0.3.</p><p><strong>Conclusion: </strong>The main finding of this study was that circulating IL-17 levels were similar in patients with ACS, CCS, and healthy volunteers. In addition, there was no difference between patients with ACS and those with CCS. Therefore, in patients with ACS and CCS, circulating IL-17A concentrations are low and there were no differences between patients with coronary artery disease and healthy individuals.</p>","PeriodicalId":7427,"journal":{"name":"American journal of cardiovascular disease","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2021-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8784676/pdf/ajcd0011-0704.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39885984","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}
Objectives: To evaluate the safety and efficacy of sacubitril/valsartan versus ramipril in patients with STEMI and cardiogenic shock.
Methods: Patients who received primary percutaneous coronary intervention (PPCI) for STEMI complicated with cardiogenic shock were randomized 1:1 to sacubitril/valsartan versus ramipril after clinical stabilization. The primary outcome was major adverse cardiac events (MACE) at 30 days and 6 months. Secondary in-hospital clinical outcomes included recurrent shock, new or re-initiation of vasoactive medications, and acute kidney injury (AKI). All-cause death, cardiac death, hospitalization due to heart failure (HF), myocardial infarction (MI), and stroke were examined at 30 days and 6 months. Study ID 016-01-2018.
Results: 100 patients with STEMI and cardiogenic shock were included (mean age 54.7±10.3 years, 87% men). Initiation of sacubitril/valsartan and ramipril occurred at 38.18±18.44 versus 39.0±21.03 hours after stabilization, respectively. The primary outcome was similar between both groups at 30 days and 6 months. No difference in in-hospital or 30-day clinical outcomes was observed. However, at 6 months, patients in the sacubitril/valsartan arm suffered less hospitalization with HF (18% vs 38%, P=0.044) compared with patients in the ramipril arm. Other clinical outcomes at 6 months were similar between both groups.
Conclusions: Sacubitril/valsartan in patients with STEMI and cardiogenic shock may be associated with improved clinical outcome at 6 months compared with ramipril. Larger randomized controlled trials with longer follow-up are recommended.
目的:评价苏比里尔/缬沙坦与雷米普利在STEMI合并心源性休克患者中的安全性和有效性。方法:STEMI合并心源性休克接受原发性经皮冠状动脉介入治疗(PPCI)的患者在临床稳定后,按1:1的比例随机分为苏比里尔/缬沙坦和雷米普利。主要终点是30天和6个月的主要不良心脏事件(MACE)。次要住院临床结果包括复发性休克、新的或重新开始使用血管活性药物和急性肾损伤(AKI)。在30天和6个月时分别检查全因死亡、心源性死亡、心力衰竭(HF)、心肌梗死(MI)和中风住院情况。研究编号016-01-2018。结果:纳入STEMI合并心源性休克患者100例(平均年龄54.7±10.3岁,男性87%)。sacubitril/缬沙坦和雷米普利分别在稳定后38.18±18.44和39.0±21.03小时开始使用。两组在30天和6个月时的主要结局相似。住院和30天临床结果均无差异。然而,在6个月时,与雷米普利组相比,苏比里尔/缬沙坦组患者因HF住院的次数较少(18% vs 38%, P=0.044)。6个月时两组的其他临床结果相似。结论:与雷米普利相比,Sacubitril/缬沙坦治疗STEMI和心源性休克患者6个月时的临床结果可能有所改善。建议进行更大规模的随机对照试验,随访时间更长。
{"title":"SAcubitril/valsartan versus ramipril in patients with ST-segment Elevation Myocardial Infarction and cardiogenic SHOCK (SAVE-SHOCK): a pilot randomized controlled trial.","authors":"Ahmed Rezq, Marwan Saad, Mostafa El Nozahi","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Objectives: </strong>To evaluate the safety and efficacy of sacubitril/valsartan versus ramipril in patients with STEMI and cardiogenic shock.</p><p><strong>Methods: </strong>Patients who received primary percutaneous coronary intervention (PPCI) for STEMI complicated with cardiogenic shock were randomized 1:1 to sacubitril/valsartan versus ramipril after clinical stabilization. The primary outcome was major adverse cardiac events (MACE) at 30 days and 6 months. Secondary in-hospital clinical outcomes included recurrent shock, new or re-initiation of vasoactive medications, and acute kidney injury (AKI). All-cause death, cardiac death, hospitalization due to heart failure (HF), myocardial infarction (MI), and stroke were examined at 30 days and 6 months. Study ID 016-01-2018.</p><p><strong>Results: </strong>100 patients with STEMI and cardiogenic shock were included (mean age 54.7±10.3 years, 87% men). Initiation of sacubitril/valsartan and ramipril occurred at 38.18±18.44 versus 39.0±21.03 hours after stabilization, respectively. The primary outcome was similar between both groups at 30 days and 6 months. No difference in in-hospital or 30-day clinical outcomes was observed. However, at 6 months, patients in the sacubitril/valsartan arm suffered less hospitalization with HF (18% vs 38%, P=0.044) compared with patients in the ramipril arm. Other clinical outcomes at 6 months were similar between both groups.</p><p><strong>Conclusions: </strong>Sacubitril/valsartan in patients with STEMI and cardiogenic shock may be associated with improved clinical outcome at 6 months compared with ramipril. Larger randomized controlled trials with longer follow-up are recommended.</p>","PeriodicalId":7427,"journal":{"name":"American journal of cardiovascular disease","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2021-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8784671/pdf/ajcd0011-0734.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39885987","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 : 2021-12-01DOI: 10.1093/eurheartj/suab139.058
L. Amore, Fabio Alghisi, E. Pancaldi, G. Pascariello, A. Cersosimo, G. Cimino, Nicola Bernardi, E. Calvi, C. Lombardi, E. Sciatti, E. Vizzardi, M. Metra
BACKGROUND The multiple beneficial effects of sacubitril/valsartan in the treatment of heart failure with reduced ejection fraction are vastly known, but still no or few mentions have been made regarding its effects on endothelial dysfunction and arterial stiffness. PATIENTS AND METHODS To understand more deeply if sacubitril/valsartan may have a role on endothelial function and arterial stiffness, 15 patients with dilated cardiomyopathy with reduced left ventricular ejection fraction (LVEF) were evaluated through transthoracic echocardiography, peripheral arterial tonometry (EndoPAT®) and applanation tonometry (SphygmoCor® Px system). These noninvasive exams were performed at the beginning of the study and after 6 months of sacubitril/valsartan treatment. RESULTS Aortic stiffness parameters didn't differ after 6 months of treatment. Augmentation pressure (P=0.889), augmentation index (P=0.906) and sphygmic wave velocity (P=0.263) increased slightly, but they weren't found to be statistically significant. Systolic, diastolic, and differential central arterial pressure didn't differ at the beginning and at the end of the study. RHI (reactive hyperemia index) increased significantly after 6 months (P=0.001) as well as augmentation index corrected for 75 bpm. Ejection fraction (32.21% ± 5.7 to 38.43% ± 8.4; P=0.010) and diastolic dysfunction degree (P=0.021) improved. There was an improvement in mitral regurgitation that wasn't statistically significant (P=0.116). TAPSE didn't change while pulmonary systolic arterial pressure increased, although not significantly (22.83 mmHg ± 4 to 27.33 mmHg ± 6; P=0.068) and within the normal range values. CONCLUSIONS Even though in a study with a limited number of patients, sacubitril/valsartan improved endothelial function, left ventricular function, MR, and diastolic function significantly in patients with dilated cardiomyopathy and reduced LVEF. It showed no effects on vascular stiffness.
{"title":"Study of endothelial function and vascular stiffness in patients affected by dilated cardiomyopathy on treatment with sacubitril/valsartan.","authors":"L. Amore, Fabio Alghisi, E. Pancaldi, G. Pascariello, A. Cersosimo, G. Cimino, Nicola Bernardi, E. Calvi, C. Lombardi, E. Sciatti, E. Vizzardi, M. Metra","doi":"10.1093/eurheartj/suab139.058","DOIUrl":"https://doi.org/10.1093/eurheartj/suab139.058","url":null,"abstract":"BACKGROUND\u0000The multiple beneficial effects of sacubitril/valsartan in the treatment of heart failure with reduced ejection fraction are vastly known, but still no or few mentions have been made regarding its effects on endothelial dysfunction and arterial stiffness.\u0000\u0000\u0000PATIENTS AND METHODS\u0000To understand more deeply if sacubitril/valsartan may have a role on endothelial function and arterial stiffness, 15 patients with dilated cardiomyopathy with reduced left ventricular ejection fraction (LVEF) were evaluated through transthoracic echocardiography, peripheral arterial tonometry (EndoPAT®) and applanation tonometry (SphygmoCor® Px system). These noninvasive exams were performed at the beginning of the study and after 6 months of sacubitril/valsartan treatment.\u0000\u0000\u0000RESULTS\u0000Aortic stiffness parameters didn't differ after 6 months of treatment. Augmentation pressure (P=0.889), augmentation index (P=0.906) and sphygmic wave velocity (P=0.263) increased slightly, but they weren't found to be statistically significant. Systolic, diastolic, and differential central arterial pressure didn't differ at the beginning and at the end of the study. RHI (reactive hyperemia index) increased significantly after 6 months (P=0.001) as well as augmentation index corrected for 75 bpm. Ejection fraction (32.21% ± 5.7 to 38.43% ± 8.4; P=0.010) and diastolic dysfunction degree (P=0.021) improved. There was an improvement in mitral regurgitation that wasn't statistically significant (P=0.116). TAPSE didn't change while pulmonary systolic arterial pressure increased, although not significantly (22.83 mmHg ± 4 to 27.33 mmHg ± 6; P=0.068) and within the normal range values.\u0000\u0000\u0000CONCLUSIONS\u0000Even though in a study with a limited number of patients, sacubitril/valsartan improved endothelial function, left ventricular function, MR, and diastolic function significantly in patients with dilated cardiomyopathy and reduced LVEF. It showed no effects on vascular stiffness.","PeriodicalId":7427,"journal":{"name":"American journal of cardiovascular disease","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2021-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82132422","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Massimo Slavich, Giulio Falasconi, Alberto Guarnaccia, Luigi Pannone, Lorenzo Rampa, Gabriele Fragasso, Andrea Granata, Stefano Savonitto, Roberto Spoladore
Profuse sweating is a symptom often reported by cardiological patients and could be also an early phenomenon of adaptation or rather cardiac maladaptation in the context of incipient heart failure (HF). By definition, in HF patients the low cardiac output causing reduced renal blood supply and reduced pressure in the arterial baroreceptors activate compensatory mechanisms such as the RAAS and the adrenergic autonomic nervous system. The retention of fluids caused by the decompensation of heart-kidney system could generate a reactive hyperhidrosis and even anticipate an incipient decompensation and might prevent manifest volume overload. Moreover, in HF patients the overactive sympathetic nervous system generates an increase in the reabsorption of fluids in the kidney, on the other hand it generates a signaling to the sweat glands to induce a dispersion of fluids, with loss of sodium and chlorine at the glandular ductal level. Finally sweat gland production physiology during physical activity is also altered in HF patients. This review is focused on sweating and its pathophysiological role in heart failure. Although all the mechanisms underlying this phenomenon are not fully understood, there are interesting connections that might explain this fluid elimination as a wise and sophisticated way to prevent incipient heart failure crisis. Future research could be focused on studying new drugs that selectively would be able to promote fluid elimination by this specific way in patients suffering from heart failure.
{"title":"Hyperhidrosis: the neglected sign in heart failure patients.","authors":"Massimo Slavich, Giulio Falasconi, Alberto Guarnaccia, Luigi Pannone, Lorenzo Rampa, Gabriele Fragasso, Andrea Granata, Stefano Savonitto, Roberto Spoladore","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Profuse sweating is a symptom often reported by cardiological patients and could be also an early phenomenon of adaptation or rather cardiac maladaptation in the context of incipient heart failure (HF). By definition, in HF patients the low cardiac output causing reduced renal blood supply and reduced pressure in the arterial baroreceptors activate compensatory mechanisms such as the RAAS and the adrenergic autonomic nervous system. The retention of fluids caused by the decompensation of heart-kidney system could generate a reactive hyperhidrosis and even anticipate an incipient decompensation and might prevent manifest volume overload. Moreover, in HF patients the overactive sympathetic nervous system generates an increase in the reabsorption of fluids in the kidney, on the other hand it generates a signaling to the sweat glands to induce a dispersion of fluids, with loss of sodium and chlorine at the glandular ductal level. Finally sweat gland production physiology during physical activity is also altered in HF patients. This review is focused on sweating and its pathophysiological role in heart failure. Although all the mechanisms underlying this phenomenon are not fully understood, there are interesting connections that might explain this fluid elimination as a wise and sophisticated way to prevent incipient heart failure crisis. Future research could be focused on studying new drugs that selectively would be able to promote fluid elimination by this specific way in patients suffering from heart failure.</p>","PeriodicalId":7427,"journal":{"name":"American journal of cardiovascular disease","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2021-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8611272/pdf/ajcd0011-0635.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39679889","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}
Sri Harsha Patlolla, Lina Ya'Qoub, Narut Prasitlumkum, Pranathi R Sundaragiri, Wisit Cheungpasitporn, Rajkumar P Doshi, Syed Tanveer Rab, Saraschandra Vallabhajosyula
The influence of weight on in-hospital events of acute myocardial infarction complicated with cardiac arrest (AMI-CA) is understudied. To address this, we utilized the National Inpatient Sample database (2008-2017) to identify adult AMI-CA admissions and categorized them by BMI into underweight, normal weight, and overweight/obese groups. The outcomes of interest included differences in in-hospital mortality, use of invasive therapies, hospitalization costs, and hospital length of stay across the three weight categories. Of the 314,609 AMI-CA admissions during the study period, 268,764 (85.4%) were normal weight, 1,791 (0.6%) were underweight, and 44,053 (14.0%) were overweight/obese. Compared to 2008, in 2017, adjusted temporal trends revealed significant increase in prevalence of AMI-CA in underweight (adjusted OR {aOR} 3.88 [95% CI 3.04-4.94], P<0.001) category, and overweight/obese AMI-CA admissions (aOR 2.67 [95% CI 2.53-2.81], P<0.001). AMI-CA admissions that were underweight were older, more often female, with greater comorbidity burden, and presented more often with non-ST-segment-elevation AMI, non-shockable rhythm, and in-hospital arrest. Overweight/obesity was associated with higher use of angiography, PCI, and greater need for mechanical circulatory support whereas underweight status had the lowest use of these procedures. Compared to normal weight AMI-CA admissions, underweight admissions had comparable adjusted in-hospital mortality (adjusted OR 0.97 [95% CI 0.87-1.09], P=0.64) whereas overweight/obese admissions had lower in-hospital mortality (adjusted OR 0.92 [95% CI 0.90-0.95], P<0.001). In conclusion, underweight AMI-CA admissions were associated with lower use of cardiac procedures and had in-hospital mortality comparable to normal weight admissions. Overweight/obese status was associated with higher rates of cardiac procedures and lower in-hospital mortality.
体重对急性心肌梗死合并心脏骤停(AMI-CA)住院事件的影响尚未得到充分研究。为了解决这个问题,我们利用国家住院患者样本数据库(2008-2017)来确定成人AMI-CA入院,并根据BMI将他们分为体重不足、正常体重和超重/肥胖组。研究的结果包括三种体重类别的住院死亡率、侵入性治疗的使用、住院费用和住院时间的差异。在研究期间入院的314609例AMI-CA患者中,体重正常的有268764例(85.4%),体重不足的有1791例(0.6%),超重/肥胖的有44053例(14.0%)。与2008年相比,2017年,调整后的时间趋势显示,体重不足人群AMI-CA患病率显著增加(调整后的OR {aOR} 3.88 [95% CI 3.04-4.94], P
{"title":"Trends and differences in management and outcomes of cardiac arrest in underweight and obese acute myocardial infarction hospitalizations.","authors":"Sri Harsha Patlolla, Lina Ya'Qoub, Narut Prasitlumkum, Pranathi R Sundaragiri, Wisit Cheungpasitporn, Rajkumar P Doshi, Syed Tanveer Rab, Saraschandra Vallabhajosyula","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>The influence of weight on in-hospital events of acute myocardial infarction complicated with cardiac arrest (AMI-CA) is understudied. To address this, we utilized the National Inpatient Sample database (2008-2017) to identify adult AMI-CA admissions and categorized them by BMI into underweight, normal weight, and overweight/obese groups. The outcomes of interest included differences in in-hospital mortality, use of invasive therapies, hospitalization costs, and hospital length of stay across the three weight categories. Of the 314,609 AMI-CA admissions during the study period, 268,764 (85.4%) were normal weight, 1,791 (0.6%) were underweight, and 44,053 (14.0%) were overweight/obese. Compared to 2008, in 2017, adjusted temporal trends revealed significant increase in prevalence of AMI-CA in underweight (adjusted OR {aOR} 3.88 [95% CI 3.04-4.94], P<0.001) category, and overweight/obese AMI-CA admissions (aOR 2.67 [95% CI 2.53-2.81], P<0.001). AMI-CA admissions that were underweight were older, more often female, with greater comorbidity burden, and presented more often with non-ST-segment-elevation AMI, non-shockable rhythm, and in-hospital arrest. Overweight/obesity was associated with higher use of angiography, PCI, and greater need for mechanical circulatory support whereas underweight status had the lowest use of these procedures. Compared to normal weight AMI-CA admissions, underweight admissions had comparable adjusted in-hospital mortality (adjusted OR 0.97 [95% CI 0.87-1.09], P=0.64) whereas overweight/obese admissions had lower in-hospital mortality (adjusted OR 0.92 [95% CI 0.90-0.95], P<0.001). In conclusion, underweight AMI-CA admissions were associated with lower use of cardiac procedures and had in-hospital mortality comparable to normal weight admissions. Overweight/obese status was associated with higher rates of cardiac procedures and lower in-hospital mortality.</p>","PeriodicalId":7427,"journal":{"name":"American journal of cardiovascular disease","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2021-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8611264/pdf/ajcd0011-0576.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39947946","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}
Fatih Yalçin, Hulya Yalçin, Maria Roselle Abraham, Theodore P Abraham
Early recognition of hypertensive heart disease is needed to prevent macrovascular and microvascular damage. Hypertension (HTN) is a risk factor for coronary artery disease, and plays a prominent role in the development of adverse left ventricular (LV) remodeling and heart failure. Here, we review new knowledge on effects of HTN on cardiac geometry and function, obtained from multimodality cardiac imaging, including echocardiography, positron emission tomography and magnetic resonance imaging. Early recognition of changes in LV geometry and function induced by HTN could identify patients at risk for end-organ damage, who could be targeted for close monitoring and intensive therapy. Basal septal hypertrophy as the early imaging biomarker at the adaptive phase may be a specific aspect not only in hypertensive heart but stress-related conditions and called stressed heart morphology.
{"title":"Ultimate phases of hypertensive heart disease and stressed heart morphology by conventional and novel cardiac imaging.","authors":"Fatih Yalçin, Hulya Yalçin, Maria Roselle Abraham, Theodore P Abraham","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Early recognition of hypertensive heart disease is needed to prevent macrovascular and microvascular damage. Hypertension (HTN) is a risk factor for coronary artery disease, and plays a prominent role in the development of adverse left ventricular (LV) remodeling and heart failure. Here, we review new knowledge on effects of HTN on cardiac geometry and function, obtained from multimodality cardiac imaging, including echocardiography, positron emission tomography and magnetic resonance imaging. Early recognition of changes in LV geometry and function induced by HTN could identify patients at risk for end-organ damage, who could be targeted for close monitoring and intensive therapy. Basal septal hypertrophy as the early imaging biomarker at the adaptive phase may be a specific aspect not only in hypertensive heart but stress-related conditions and called stressed heart morphology.</p>","PeriodicalId":7427,"journal":{"name":"American journal of cardiovascular disease","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2021-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8611267/pdf/ajcd0011-0628.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39947952","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}
Background: Hypertension is most common prevailing cardiovascular disease worldwide. In this condition the effectiveness and safety of already available and many time-tested medications should be regularly reviewed.
Methodology: Ethical approval of study was obtained from human research ethics committee of the hospital. 180 patients were enrolled with three groups of antihypertensive medication groups as calcium channel blocker (amlodipine), beta blocker (metoprolol) and angiotensin receptor blocker (telmisartan) over a span of eight months. The data was obtained from week zero to twelve (SBP: Systolic Blood Pressure and DBP: Diastolic Blood Pressure). Safety of Beta blocker, calcium channel blocker and angiotensin receptor blocker were investigated.
Results: Comparison of efficacy between the beta blocker, calcium channel blocker and angiotensin blocker receptor blocker were shown to be non-significant. It indicated that all drug therapies have the same successful reduction of SBP (P-0.4819). No significant adverse reactions were observed in either class of the medicines.
Conclusion: The study showed the efficacy of Calcium Channel Blocker, Beta Blocker and Angiotensin Receptor Blocker in reduction of SBP & DBP was same, while Calcium Channel Blockers were superior to other two medications.
{"title":"Effectiveness and safety assessment of beta-blockers, calcium channel blockers, and angiotensin receptor blockers in hypertensive patients: a prospective study.","authors":"Nilay Solanki, Dhruvi Pandit, Shubha Desai","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Hypertension is most common prevailing cardiovascular disease worldwide. In this condition the effectiveness and safety of already available and many time-tested medications should be regularly reviewed.</p><p><strong>Methodology: </strong>Ethical approval of study was obtained from human research ethics committee of the hospital. 180 patients were enrolled with three groups of antihypertensive medication groups as calcium channel blocker (amlodipine), beta blocker (metoprolol) and angiotensin receptor blocker (telmisartan) over a span of eight months. The data was obtained from week zero to twelve (SBP: Systolic Blood Pressure and DBP: Diastolic Blood Pressure). Safety of Beta blocker, calcium channel blocker and angiotensin receptor blocker were investigated.</p><p><strong>Results: </strong>Comparison of efficacy between the beta blocker, calcium channel blocker and angiotensin blocker receptor blocker were shown to be non-significant. It indicated that all drug therapies have the same successful reduction of SBP (P-0.4819). No significant adverse reactions were observed in either class of the medicines.</p><p><strong>Conclusion: </strong>The study showed the efficacy of Calcium Channel Blocker, Beta Blocker and Angiotensin Receptor Blocker in reduction of SBP & DBP was same, while Calcium Channel Blockers were superior to other two medications.</p>","PeriodicalId":7427,"journal":{"name":"American journal of cardiovascular disease","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2021-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8611269/pdf/ajcd0011-0601.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39947948","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}
Efrén Martínez-Quintana, Michelle María Sánchez-Matos, Fayna Rodríguez-González, Antonio Tugores
In isolated populations rare genetic diseases are important and relatively frequent. The objective of this study is to determine the geographical aggregates of maternal and paternal ancestors of patients with congenital heart disease (CHD) to determine whether there is an association between the different areas and types of cardiac defects. Descriptive, observational, and cross-sectional study of patients with CHD obtained consecutively in a single adult CHD unit between January 2018 and December 2019 in Gran Canaria (Canary Islands, Spain). To be included in the study, at least one of the grandparents (maternal or paternal) should be born in Gran Canaria. 258 out of 353 CHD patients met the inclusion criteria. 58% of CHD patients were male and the median age was of 28 (21-40) years old. The most frequent types of CHD were cardiac septal defects (76 patients), right side cardiac outflow tract anomalies (74 patients) and left side cardiac outflow tract anomalies (58 patients). 13% of the patients had a family history of CHD, 11% showed consanguinity and 7% had an associated polymalformative syndrome. 20% of the four ancestors were born in the same municipality and a significant association was seen between two areas of Gran Canaria, orographically related, and right-side cardiac outflow tract anomalies (P<0.001). In conclusion in patients with tetralogy of Fallot and/or pulmonary valve stenosis/atresia an ancestry's geographic aggregation was seen.
{"title":"Genealogy of patients with congenital heart disease in isolated populations.","authors":"Efrén Martínez-Quintana, Michelle María Sánchez-Matos, Fayna Rodríguez-González, Antonio Tugores","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>In isolated populations rare genetic diseases are important and relatively frequent. The objective of this study is to determine the geographical aggregates of maternal and paternal ancestors of patients with congenital heart disease (CHD) to determine whether there is an association between the different areas and types of cardiac defects. Descriptive, observational, and cross-sectional study of patients with CHD obtained consecutively in a single adult CHD unit between January 2018 and December 2019 in Gran Canaria (Canary Islands, Spain). To be included in the study, at least one of the grandparents (maternal or paternal) should be born in Gran Canaria. 258 out of 353 CHD patients met the inclusion criteria. 58% of CHD patients were male and the median age was of 28 (21-40) years old. The most frequent types of CHD were cardiac septal defects (76 patients), right side cardiac outflow tract anomalies (74 patients) and left side cardiac outflow tract anomalies (58 patients). 13% of the patients had a family history of CHD, 11% showed consanguinity and 7% had an associated polymalformative syndrome. 20% of the four ancestors were born in the same municipality and a significant association was seen between two areas of Gran Canaria, orographically related, and right-side cardiac outflow tract anomalies (P<0.001). In conclusion in patients with tetralogy of Fallot and/or pulmonary valve stenosis/atresia an ancestry's geographic aggregation was seen.</p>","PeriodicalId":7427,"journal":{"name":"American journal of cardiovascular disease","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2021-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8611265/pdf/ajcd0011-0688.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39679894","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}
Introduction: The objective of our study was to evaluate the severity of diastolic dysfunction in patients with heart failure with preserved ejection fraction (HFpEF), atrial fibrillation (AF) and type 2 diabetes mellitus (T2DM) compared to those with HFpEF and AF without DM.
Material and methods: This is an observational, prospective, case-control study. We selected 720 patients with heart failure consecutively admitted between March 2019-December 2020, of whom 253 patients with AF. After applying the inclusion/exclusion criteria, 105 subjects remained in the study. The patients were divided into two groups, according to the presence of T2DM: group A (39 patients with T2DM, 37.14%), group B (66 patients without T2DM, 62.85%). 2D transthoracic echocardiography was performed in all patients. The study was approved by the Ethics Committee of the hospital. Statistical analysis was performed using R software, version 4.0.2.
Results: Patients with HFpEF, AF, and T2DM had higher LV filling pressures compared to those without DM (OR = 5.00, 95% CI: 1.77-15.19). Moreover, patients with insulin-requiring T2DM (OR = 6.25, 95% CI: 1.50-25.98) had higher LV filling pressures than those treated with oral antidiabetic drugs (OR = 4.44, 95% CI: 1.37-15.17). We demonstrated that patients with T2DM had higher E/e' ratio (difference -2.78, P 0.0003, 95% CI: -4.24 to -1.31) and lower deceleration time (DT) (difference 23.04, P 0.0002, 95% CI: 11.10-34.97) than those without T2DM.
Conclusions: Patients with HFpEF, AF and T2DM have higher LV filling pressures than those without T2DM, suggesting that the presence of T2DM leads to a more severe diastolic dysfunction.
{"title":"Diastolic function in patients with heart failure with preserved ejection fraction and atrial fibrillation: impact of diabetes.","authors":"Ruxandra-Nicoleta Horodinschi, Camelia Cristina Diaconu","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Introduction: </strong>The objective of our study was to evaluate the severity of diastolic dysfunction in patients with heart failure with preserved ejection fraction (HFpEF), atrial fibrillation (AF) and type 2 diabetes mellitus (T2DM) compared to those with HFpEF and AF without DM.</p><p><strong>Material and methods: </strong>This is an observational, prospective, case-control study. We selected 720 patients with heart failure consecutively admitted between March 2019-December 2020, of whom 253 patients with AF. After applying the inclusion/exclusion criteria, 105 subjects remained in the study. The patients were divided into two groups, according to the presence of T2DM: group A (39 patients with T2DM, 37.14%), group B (66 patients without T2DM, 62.85%). 2D transthoracic echocardiography was performed in all patients. The study was approved by the Ethics Committee of the hospital. Statistical analysis was performed using R software, version 4.0.2.</p><p><strong>Results: </strong>Patients with HFpEF, AF, and T2DM had higher LV filling pressures compared to those without DM (OR = 5.00, 95% CI: 1.77-15.19). Moreover, patients with insulin-requiring T2DM (OR = 6.25, 95% CI: 1.50-25.98) had higher LV filling pressures than those treated with oral antidiabetic drugs (OR = 4.44, 95% CI: 1.37-15.17). We demonstrated that patients with T2DM had higher E/e' ratio (difference -2.78, P 0.0003, 95% CI: -4.24 to -1.31) and lower deceleration time (DT) (difference 23.04, P 0.0002, 95% CI: 11.10-34.97) than those without T2DM.</p><p><strong>Conclusions: </strong>Patients with HFpEF, AF and T2DM have higher LV filling pressures than those without T2DM, suggesting that the presence of T2DM leads to a more severe diastolic dysfunction.</p>","PeriodicalId":7427,"journal":{"name":"American journal of cardiovascular disease","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2021-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8611268/pdf/ajcd0011-0564.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39947945","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}