INTRODUCTION Heart failure (HF) is a major global public health concern. The application of machine learning (ML) to identify individuals at high risk and enable early intervention is a promising approach for improving HF prognosis. We aim to systematically evaluate the performance and value of ML models for predicting HF prognosis. METHODS PubMed, Web of Science, Scopus, and Embase online databases were searched up to April 30, 2023, to identify studies on the use of ML models to predict HF prognosis. HF prognosis primarily encompasses readmission and mortality. The meta-analysis was conducted by MedCalc software. Subgroup analyses include grouping based on types of ML models, time interval, sample sizes, the number of predictive variables, validation methods, whether to conduct hyperparameter optimization and calibration, data set partitioning methods. RESULTS A total of 31 studies were included. The most common ML models were random forest, boosting, support vector machine, neural network. The area under the receiver operating characteristic curve (AUC) for predicting HF readmission was 0.675 (95% CI 0.651-0.699, P<0.001), and the AUC for predicting HF mortality was 0.790 (95% CI 0.765-0.816, P<0.001). Subgroup analyses revealed that models with the prediction time interval of 1 year, sample sizes =10,000, the number of predictive variables =100, external validation, hyperparameter tuning, calibration adjustment, and data set partitioning using 10-fold cross-validation exhibited favorable performance within their respective subgroups. CONCLUSION The performance of ML models in predicting HF readmission is relatively poor, while its performance in predicting HF mortality is moderate. The quality of the relevant studies is generally low, it is essential to enhance the predictive capabilities of ML models through targeted improvements in practical applications.
导言心力衰竭（HF）是全球关注的主要公共卫生问题。应用机器学习（ML）识别高危人群并进行早期干预是改善心力衰竭预后的有效方法。我们旨在系统评估 ML 模型预测 HF 预后的性能和价值。方法检索了截至 2023 年 4 月 30 日的 Web of Science、Scopus 和 Embase 在线数据库，以确定使用 ML 模型预测 HF 预后的研究。心房颤动预后主要包括再入院率和死亡率。荟萃分析由 MedCalc 软件进行。分组分析包括基于 ML 模型类型、时间间隔、样本大小、预测变量数量、验证方法、是否进行超参数优化和校准、数据集划分方法的分组。最常见的 ML 模型是随机森林、提升、支持向量机和神经网络。预测高频再入院的接收者操作特征曲线下面积（AUC）为 0.675（95% CI 0.651-0.699，P<0.001），预测高频死亡率的接收者操作特征曲线下面积（AUC）为 0.790（95% CI 0.765-0.816，P<0.001）。亚组分析显示，预测时间间隔为 1 年、样本量=10,000、预测变量数=100、外部验证、超参数调整、校准调整和使用 10 倍交叉验证进行数据集划分的模型在各自亚组中表现出良好的性能。相关研究的质量普遍较低，因此在实际应用中必须通过有针对性的改进来提高 ML 模型的预测能力。
{"title":"The Efficacy of Machine Learning Models for Predicting the Prognosis of Heart Failure: A Systematic Review and Meta-Analysis.","authors":"Zhaohui Xu, Yinqin Hu, Xinyi Shao, Tianyun Shi, Jiahui Yang, Qiqi Wan, Yongming Liu","doi":"10.1159/000538639","DOIUrl":"https://doi.org/10.1159/000538639","url":null,"abstract":"INTRODUCTION\u0000Heart failure (HF) is a major global public health concern. The application of machine learning (ML) to identify individuals at high risk and enable early intervention is a promising approach for improving HF prognosis. We aim to systematically evaluate the performance and value of ML models for predicting HF prognosis.\u0000\u0000\u0000METHODS\u0000PubMed, Web of Science, Scopus, and Embase online databases were searched up to April 30, 2023, to identify studies on the use of ML models to predict HF prognosis. HF prognosis primarily encompasses readmission and mortality. The meta-analysis was conducted by MedCalc software. Subgroup analyses include grouping based on types of ML models, time interval, sample sizes, the number of predictive variables, validation methods, whether to conduct hyperparameter optimization and calibration, data set partitioning methods.\u0000\u0000\u0000RESULTS\u0000A total of 31 studies were included. The most common ML models were random forest, boosting, support vector machine, neural network. The area under the receiver operating characteristic curve (AUC) for predicting HF readmission was 0.675 (95% CI 0.651-0.699, P<0.001), and the AUC for predicting HF mortality was 0.790 (95% CI 0.765-0.816, P<0.001). Subgroup analyses revealed that models with the prediction time interval of 1 year, sample sizes =10,000, the number of predictive variables =100, external validation, hyperparameter tuning, calibration adjustment, and data set partitioning using 10-fold cross-validation exhibited favorable performance within their respective subgroups.\u0000\u0000\u0000CONCLUSION\u0000The performance of ML models in predicting HF readmission is relatively poor, while its performance in predicting HF mortality is moderate. The quality of the relevant studies is generally low, it is essential to enhance the predictive capabilities of ML models through targeted improvements in practical applications.","PeriodicalId":9391,"journal":{"name":"Cardiology","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140676970","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Shilin Wang, Hao Liu, Peiwen Yang, Zhiwen Wang, Shu Chen
BACKGROUND Ventricular septal rupture (VSR) is a mechanical issue that can occur following an acute myocardial infarction (AMI) and has a high mortality rate. It requires a comprehensive, team-based approach for prompt diagnosis and maintaining stable blood flow. While the occurrence of VSR has lessened over the past hundred years and advancements have been made in treatment techniques, the mortality rate within 30 days can still surpass 40 percent. Surgery is the primary treatment method. For patients with stable blood flow, it's generally considered safer to perform surgery 4-6 weeks after the AMI to repair the VSR. However, the timing of surgery for patients with early instability in their blood flow is still a topic of debate. SUMMARY There's a lack of set criteria and standards to determine the best time for surgery in patients with VSR following an infarction who have unstable blood flow, especially when considering the use of blood circulation support devices and other techniques for maintaining blood flow that are used in clinical settings. KEY MESSAGES This review outlines the features of different mechanical circulatory support devices utilized in treating VSR, along with the current scoring system designed to direct the treatment approach for VSR patients.
{"title":"Current Understanding of Timing of Surgical Repair for Ventricular Septal Rupture following Acute Myocardial Infarction.","authors":"Shilin Wang, Hao Liu, Peiwen Yang, Zhiwen Wang, Shu Chen","doi":"10.1159/000538967","DOIUrl":"https://doi.org/10.1159/000538967","url":null,"abstract":"BACKGROUND\u0000Ventricular septal rupture (VSR) is a mechanical issue that can occur following an acute myocardial infarction (AMI) and has a high mortality rate. It requires a comprehensive, team-based approach for prompt diagnosis and maintaining stable blood flow. While the occurrence of VSR has lessened over the past hundred years and advancements have been made in treatment techniques, the mortality rate within 30 days can still surpass 40 percent. Surgery is the primary treatment method. For patients with stable blood flow, it's generally considered safer to perform surgery 4-6 weeks after the AMI to repair the VSR. However, the timing of surgery for patients with early instability in their blood flow is still a topic of debate.\u0000\u0000\u0000SUMMARY\u0000There's a lack of set criteria and standards to determine the best time for surgery in patients with VSR following an infarction who have unstable blood flow, especially when considering the use of blood circulation support devices and other techniques for maintaining blood flow that are used in clinical settings.\u0000\u0000\u0000KEY MESSAGES\u0000This review outlines the features of different mechanical circulatory support devices utilized in treating VSR, along with the current scoring system designed to direct the treatment approach for VSR patients.","PeriodicalId":9391,"journal":{"name":"Cardiology","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140680079","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background Cardiac Implantable Electronic Devices (CIEDs), including pacemakers, defibrillators, and resynchronization devices, significantly enhance patient outcomes, reduce sudden cardiac death, and improve health-related quality of life. CIED implantation is associated to persistent shoulder dysfunction in a considerable number of patients one-year post-implantation. This may result in disability, diminished quality of life, work absenteeism, and negative psychological effects. Restoring upper extremity function after CIED implantation should be a standard of cardiovascular care. Our systematic scoping review aimed to summarize available evidence, addressing vital questions about safety, effectiveness, exercise type, and time of exercise initiation immediately after CIED implantation. Methods We conducted a comprehensive literature search in five electronic databases for original research in English, and a manual search on the references of included studies. We used Rayyan web application for study selection, and PRISMA-ScR to conduct and report the review. We assessed methodological quality using Cochrane Risk of Bias Assessment Tool and Joanna Briggs Institute critical appraisal checklists. Results This review included six studies that used upper extremity pendular, range of motion, stretching and strengthening exercises. Initiation time varied from first post-operative day to second post-operative week. All studies showed significant association between active upper extremity exercise and reduced dysfunction and disability after CIED implantation. There were no significant differences in complication rates between control and experimental groups. Conclusions A limited number of low-to-average quality studies suggest active upper extremity exercise immediately after CIED implantation is safe, effective at reducing dysfunction, and improves quality of life. Higher-quality studies are needed to validate these findings.
{"title":"Optimizing Recovery: A Systematic Scoping Review of Upper Extremity Exercise Immediately After Cardiac Implantable Electronic Device Implantation.","authors":"Praveen Jayaprabha Surendran, Prasobh Jacob, Javier Loureiro Diaz, Dinesh Kumar Selvamani, Gigi Mathew, Narasimman Swaminathan","doi":"10.1159/000538793","DOIUrl":"https://doi.org/10.1159/000538793","url":null,"abstract":"Background Cardiac Implantable Electronic Devices (CIEDs), including pacemakers, defibrillators, and resynchronization devices, significantly enhance patient outcomes, reduce sudden cardiac death, and improve health-related quality of life. CIED implantation is associated to persistent shoulder dysfunction in a considerable number of patients one-year post-implantation. This may result in disability, diminished quality of life, work absenteeism, and negative psychological effects. Restoring upper extremity function after CIED implantation should be a standard of cardiovascular care. Our systematic scoping review aimed to summarize available evidence, addressing vital questions about safety, effectiveness, exercise type, and time of exercise initiation immediately after CIED implantation. Methods We conducted a comprehensive literature search in five electronic databases for original research in English, and a manual search on the references of included studies. We used Rayyan web application for study selection, and PRISMA-ScR to conduct and report the review. We assessed methodological quality using Cochrane Risk of Bias Assessment Tool and Joanna Briggs Institute critical appraisal checklists. Results This review included six studies that used upper extremity pendular, range of motion, stretching and strengthening exercises. Initiation time varied from first post-operative day to second post-operative week. All studies showed significant association between active upper extremity exercise and reduced dysfunction and disability after CIED implantation. There were no significant differences in complication rates between control and experimental groups. Conclusions A limited number of low-to-average quality studies suggest active upper extremity exercise immediately after CIED implantation is safe, effective at reducing dysfunction, and improves quality of life. Higher-quality studies are needed to validate these findings.","PeriodicalId":9391,"journal":{"name":"Cardiology","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140680471","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Mingfei Li, Dawei Lin, Jianing Fan, Feng Zhang, Wenzhi Pan, Daxin Zhou, J. Ge
【Abstract】 Aim: To investigate the safety of interventional therapy in patients with secondary atrial septal defect (atrial septal defect, ASD) with complete aortic rim deficiency and explore the predictors of right atrial non-reverse remodeling. METHODS 1011 patients with ASD who underwent transcatheter closure in the Department of Cardiology, Zhongshan Hospital affiliated to Fudan University from June 2017 to June 2022 were enrolled in the study. They were divided into a complete aortic rim deficiency group and without absent aortic rim group. Furthermore, patients who had an enlarged right atrial in the absent aortic rim group were divided into two sub-groups according to whether their right atrial reversed remodeling post-procedure. Multivariate logistic regression was used to determine the predictors of right atrial reversed remodeling. RESULTS During the 1-year follow-up, no major operative complications occurred in all patients with the absence of an aortic rim and a normal edge. After the operation, the right heart remodeling was significantly reversed, multivariate logistic regression analysis was performed and found that preoperative without coronary heart disease, lower plasma creatinine level, and larger RA and RV dimension were predictive factors for the reverse of right atrial remodeling after treatment. CONCLUSION Transcatheter closure of ASD with complete aortic rim deficiency is safe and feasible. The patients without coronary heart disease, the lower the creatinine value and the less tricuspid regurgitation before an operation, the more improvement of right atrial remodeling after the operation.
{"title":"Transcatheter closure of atrial septal defects with absent aortic rim and the predictors of right atrial reverse remodelingTranscatheter closure of atrial septal defects with absent aortic rim and the predictors of right atrial reverse remodeling: 5 years experience in China.","authors":"Mingfei Li, Dawei Lin, Jianing Fan, Feng Zhang, Wenzhi Pan, Daxin Zhou, J. Ge","doi":"10.1159/000538772","DOIUrl":"https://doi.org/10.1159/000538772","url":null,"abstract":"【Abstract】 Aim: To investigate the safety of interventional therapy in patients with secondary atrial septal defect (atrial septal defect, ASD) with complete aortic rim deficiency and explore the predictors of right atrial non-reverse remodeling.\u0000\u0000\u0000METHODS\u00001011 patients with ASD who underwent transcatheter closure in the Department of Cardiology, Zhongshan Hospital affiliated to Fudan University from June 2017 to June 2022 were enrolled in the study. They were divided into a complete aortic rim deficiency group and without absent aortic rim group. Furthermore, patients who had an enlarged right atrial in the absent aortic rim group were divided into two sub-groups according to whether their right atrial reversed remodeling post-procedure. Multivariate logistic regression was used to determine the predictors of right atrial reversed remodeling.\u0000\u0000\u0000RESULTS\u0000During the 1-year follow-up, no major operative complications occurred in all patients with the absence of an aortic rim and a normal edge. After the operation, the right heart remodeling was significantly reversed, multivariate logistic regression analysis was performed and found that preoperative without coronary heart disease, lower plasma creatinine level, and larger RA and RV dimension were predictive factors for the reverse of right atrial remodeling after treatment.\u0000\u0000\u0000CONCLUSION\u0000Transcatheter closure of ASD with complete aortic rim deficiency is safe and feasible. The patients without coronary heart disease, the lower the creatinine value and the less tricuspid regurgitation before an operation, the more improvement of right atrial remodeling after the operation.","PeriodicalId":9391,"journal":{"name":"Cardiology","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140698336","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Jia Zhao, Bo Wang, Shengjun Ta, Xiaonan Lu, Xueli Zhao, Jiao Liu, Jiarui Yuan, Jing Wang, Liwen Liu
INTRODUCTION Calcium channel gene variations have been reported to be associated with hypertrophic cardiomyopathy (HCM) in family, but the relationship between calcium channel gene variations and HCM remains undefined in population. METHODS A total of 719 HCM unrelated patients were initially enrolled. Finally, 371 patients were identified based on inclusion and exclusion criteria, including 145 patients with gene negative, 28 patients with a single rare calcium channel gene variation (calcium gene variation), 162 patients with a single pathogenic/likely pathogenic sarcomere gene variation (sarcomere gene variation) and 36 patients with a single pathogenic/likely pathogenic sarcomere gene variation and a single rare calcium channel gene variation (double gene variations). Then the demographic, electrocardiographic, echocardiographic and follow-up data were collected. RESULTS Patients with double gene variations were at an earlier age and had more percent of family history of HCM, and had thicker walls, higher left ventricular outflow tract pressure gradient, more pathological Q waves, and more bundle branch block as compared with those with single sarcomere gene variation. During the follow-up period, patients with double gene variations had more primary endpoints than other three groups (p=0.0013). Multivariate analysis showed that double gene variations was the independent predictor of for primary endpoint events in patients (HR 4.82, 95% CI 1.77 to 13.2; p=0.002). CONCLUSION We found that patients with double gene variations had more severe HCM phenotype and prognosis. The pathogenesis effects of sarcomere gene variation and calcium channel gene variation may be cumulative in HCM populations.
{"title":"Association between hypertrophic cardiomyopathy and variations in sarcomere gene and calcium channel gene in adults.","authors":"Jia Zhao, Bo Wang, Shengjun Ta, Xiaonan Lu, Xueli Zhao, Jiao Liu, Jiarui Yuan, Jing Wang, Liwen Liu","doi":"10.1159/000538747","DOIUrl":"https://doi.org/10.1159/000538747","url":null,"abstract":"INTRODUCTION\u0000Calcium channel gene variations have been reported to be associated with hypertrophic cardiomyopathy (HCM) in family, but the relationship between calcium channel gene variations and HCM remains undefined in population.\u0000\u0000\u0000METHODS\u0000A total of 719 HCM unrelated patients were initially enrolled. Finally, 371 patients were identified based on inclusion and exclusion criteria, including 145 patients with gene negative, 28 patients with a single rare calcium channel gene variation (calcium gene variation), 162 patients with a single pathogenic/likely pathogenic sarcomere gene variation (sarcomere gene variation) and 36 patients with a single pathogenic/likely pathogenic sarcomere gene variation and a single rare calcium channel gene variation (double gene variations). Then the demographic, electrocardiographic, echocardiographic and follow-up data were collected.\u0000\u0000\u0000RESULTS\u0000Patients with double gene variations were at an earlier age and had more percent of family history of HCM, and had thicker walls, higher left ventricular outflow tract pressure gradient, more pathological Q waves, and more bundle branch block as compared with those with single sarcomere gene variation. During the follow-up period, patients with double gene variations had more primary endpoints than other three groups (p=0.0013). Multivariate analysis showed that double gene variations was the independent predictor of for primary endpoint events in patients (HR 4.82, 95% CI 1.77 to 13.2; p=0.002).\u0000\u0000\u0000CONCLUSION\u0000We found that patients with double gene variations had more severe HCM phenotype and prognosis. The pathogenesis effects of sarcomere gene variation and calcium channel gene variation may be cumulative in HCM populations.","PeriodicalId":9391,"journal":{"name":"Cardiology","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-04-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140709878","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Chariclia Paradissis, Neil Cottrell, Ian D. Coombes, William Y.S. Wang, Michael A. Barras
Introduction The contribution of medication harm to rehospitalisation and adverse patient outcomes after an acute myocardial infarction (AMI) needs exploration. Rehospitalisation is costly to both patients and the healthcare facility. Following an AMI, patients are at risk of medication harm as they are often older, have multiple comorbidities and polypharmacy. This study aimed to quantify and evaluate medication harm causing unplanned rehospitalisation after an AMI. Methods This was a retrospective cohort study of patients discharged from a quaternary hospital post-AMI. All rehospitalisations within 18 months were identified using medical record review and coding data. The primary outcome measure was medication harm rehospitalisation. Preventability, causality and severity assessments of medication harm were conducted. Results A total of 1564 patients experienced an AMI and 415 (26.5%) were rehospitalised. Eighty-nine patients (5.7% of total population; 6.0% of those discharged) experienced a total of 101 medication harm events. Those with medication harm were older (p=0.007) and had higher rates of heart failure (p=0.005), chronic kidney disease (CKD) (p=0.046), chronic obstructive pulmonary disease (COPD) (p=0.037) and a prior history of ischaemic heart disease (p=0.005). Gastrointestinal (GI) bleeding, acute kidney injury (AKI) and hypotension were the most common medication harm events. Forty percent of events were avoidable and 84% were classed as 'serious'. Furosemide, antiplatelets and angiotensin-converting enzyme inhibitors (ACEi) were the most commonly implicated medications. The median time to medication harm rehospitalisation was 79 days (interquartile range [IQR]: 16-200 days). Conclusion Medication harm causes unplanned rehospitalisation in 5.7% of all AMI patients (1 in 17 patients; 6.0% of those discharged). The majority of harm was serious and occurred within the first 200 days of discharge. This study highlights that measures to attenuate the risk of medication harm rehospitalisation are essential, including post-discharge medication management.
{"title":"Unplanned rehospitalisation due to medication harm following an Acute Myocardial Infarction.","authors":"Chariclia Paradissis, Neil Cottrell, Ian D. Coombes, William Y.S. Wang, Michael A. Barras","doi":"10.1159/000538773","DOIUrl":"https://doi.org/10.1159/000538773","url":null,"abstract":"Introduction The contribution of medication harm to rehospitalisation and adverse patient outcomes after an acute myocardial infarction (AMI) needs exploration. Rehospitalisation is costly to both patients and the healthcare facility. Following an AMI, patients are at risk of medication harm as they are often older, have multiple comorbidities and polypharmacy. This study aimed to quantify and evaluate medication harm causing unplanned rehospitalisation after an AMI. Methods This was a retrospective cohort study of patients discharged from a quaternary hospital post-AMI. All rehospitalisations within 18 months were identified using medical record review and coding data. The primary outcome measure was medication harm rehospitalisation. Preventability, causality and severity assessments of medication harm were conducted. Results A total of 1564 patients experienced an AMI and 415 (26.5%) were rehospitalised. Eighty-nine patients (5.7% of total population; 6.0% of those discharged) experienced a total of 101 medication harm events. Those with medication harm were older (p=0.007) and had higher rates of heart failure (p=0.005), chronic kidney disease (CKD) (p=0.046), chronic obstructive pulmonary disease (COPD) (p=0.037) and a prior history of ischaemic heart disease (p=0.005). Gastrointestinal (GI) bleeding, acute kidney injury (AKI) and hypotension were the most common medication harm events. Forty percent of events were avoidable and 84% were classed as 'serious'. Furosemide, antiplatelets and angiotensin-converting enzyme inhibitors (ACEi) were the most commonly implicated medications. The median time to medication harm rehospitalisation was 79 days (interquartile range [IQR]: 16-200 days). Conclusion Medication harm causes unplanned rehospitalisation in 5.7% of all AMI patients (1 in 17 patients; 6.0% of those discharged). The majority of harm was serious and occurred within the first 200 days of discharge. This study highlights that measures to attenuate the risk of medication harm rehospitalisation are essential, including post-discharge medication management.","PeriodicalId":9391,"journal":{"name":"Cardiology","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-04-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140711291","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
INTRODUCTION The use of angiotensin II receptor blockers (ARBs) in the treatment of hypertrophic cardiomyopathy (HCM) remains a subject of controversy. METHODS We conducted a comprehensive search of the Cochrane Library, PubMed, EMBASE, ClinicalTrials.gov, and Web of Science databases until October 2023 to identify articles investigating the effects of ARBs in patients diagnosed with HCM. Predefined criteria were utilized for selecting data on study characteristics and results. RESULTS The study included a total of 387 patients from 6 randomized controlled trials, which were reported in 7 articles. The results of the meta-analysis revealed that the utilization of ARBs did not yield a reduction in left ventricular (LV) mass (p = 0.07) and maximum LV wall thickness (p = 0.25), nor did it demonstrate any improvement in LV fibrosis (p = 0.39). Furthermore, there was no significant impact observed on early diastolic mitral annular velocity (p = 0.19) and LV ejection fraction (p = 0.44). CONCLUSIONS The administration of ARBs does not appear to yield improvements in cardiac structure, function, and myocardial fibrosis in patients with HCM.
{"title":"The Role of Angiotensin II Receptor Blockers in the Management of Hypertrophic Cardiomyopathy: An Updated Meta-Analysis of Randomized Controlled Trials.","authors":"Yong Wan, Shuai He, Tingli Xu, Shuwei Wang, Minfang Qi, Pengcheng Gan","doi":"10.1159/000538638","DOIUrl":"https://doi.org/10.1159/000538638","url":null,"abstract":"INTRODUCTION\u0000The use of angiotensin II receptor blockers (ARBs) in the treatment of hypertrophic cardiomyopathy (HCM) remains a subject of controversy.\u0000\u0000\u0000METHODS\u0000We conducted a comprehensive search of the Cochrane Library, PubMed, EMBASE, ClinicalTrials.gov, and Web of Science databases until October 2023 to identify articles investigating the effects of ARBs in patients diagnosed with HCM. Predefined criteria were utilized for selecting data on study characteristics and results.\u0000\u0000\u0000RESULTS\u0000The study included a total of 387 patients from 6 randomized controlled trials, which were reported in 7 articles. The results of the meta-analysis revealed that the utilization of ARBs did not yield a reduction in left ventricular (LV) mass (p = 0.07) and maximum LV wall thickness (p = 0.25), nor did it demonstrate any improvement in LV fibrosis (p = 0.39). Furthermore, there was no significant impact observed on early diastolic mitral annular velocity (p = 0.19) and LV ejection fraction (p = 0.44).\u0000\u0000\u0000CONCLUSIONS\u0000The administration of ARBs does not appear to yield improvements in cardiac structure, function, and myocardial fibrosis in patients with HCM.","PeriodicalId":9391,"journal":{"name":"Cardiology","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140720244","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
T. Nilsson, A. Mokhtari, Jenny Sandgren, Jakob Lundager Forberg, Pontus Olsson de Capretz, Ulf Ekelund
INTRODUCTION With the implementation of early reperfusion therapy, the number of complications in patients with acute coronary syndrome (ACS) has diminished significantly. However, ACS patients are still routinely admitted to units with high-level monitoring such as the coronary or intensive care unit (CCU/ICU). The cost of these admissions is high and there is often a shortage of beds. The aim of this study was to analyze the complications in contemporary ED patients with ACS and to map patient management. METHODS This observational study was a secondary analysis of data collected in the ESC-TROP trial (NCT03421873) that included 26545 consecutive chest pain patients ≥ 18 years at five Swedish emergency departments (ED). Complications were defined as the following within 30 days: Death, cardiac arrest, cardiogenic shock, pulmonary edema, severe ventricular arrhythmia, high-degree AV-block that required a pacemaker, and mechanical complications such as papillary muscle rupture, cardiac tamponade, or ventricular septum defects (VSD). Complications were identified via diagnosis and/or intervention codes in the database, and manual chart review was performed in cases with complications. RESULTS Of all 26545 patients, 2463 (9.3%) were diagnosed with ACS, and 151 of these (6.1%) suffered any complication within 30 days. Mean age was higher in patients with (79.2 years) than without (69.4 years) complications, and more were female (39.7% vs. 33.0%). Eighty-four (3.4% of all ACS patients) patients died, 33 (1.3%) had cardiac arrest, 22 (0.9%) respiratory failure, 13 (0.5%) high-degree AV block, 10 (0.4%) cardiogenic shock, 12 (0.5%) severe ventricular arrhythmia, and 2 each (<0.1%) had VSD or cardiac tamponade. Almost 30% of the complications were present already at the ED, and 40% of patients with complications were not admitted to the CCU/ICU. Only 80 (53%) of the patients with complications underwent coronary angiography and 62 (41%) were revascularized with PCI or CABG. CONCLUSION With current care, serious complications occurred in only 6 out of 100 ACS patients, and 2 of these complications were present already at the ED. Four out of ten ACS patients with complications were not admitted to the CCU/ICU and about half did not undergo coronary angiography. Further research is needed to improve risk assessment in ED ACS patients, which may allow more effective use of cardiac monitoring and hospital resources.
{"title":"Complications in emergency department patients with acute coronary syndrome with contemporary care.","authors":"T. Nilsson, A. Mokhtari, Jenny Sandgren, Jakob Lundager Forberg, Pontus Olsson de Capretz, Ulf Ekelund","doi":"10.1159/000538637","DOIUrl":"https://doi.org/10.1159/000538637","url":null,"abstract":"INTRODUCTION\u0000With the implementation of early reperfusion therapy, the number of complications in patients with acute coronary syndrome (ACS) has diminished significantly. However, ACS patients are still routinely admitted to units with high-level monitoring such as the coronary or intensive care unit (CCU/ICU). The cost of these admissions is high and there is often a shortage of beds. The aim of this study was to analyze the complications in contemporary ED patients with ACS and to map patient management.\u0000\u0000\u0000METHODS\u0000This observational study was a secondary analysis of data collected in the ESC-TROP trial (NCT03421873) that included 26545 consecutive chest pain patients ≥ 18 years at five Swedish emergency departments (ED). Complications were defined as the following within 30 days: Death, cardiac arrest, cardiogenic shock, pulmonary edema, severe ventricular arrhythmia, high-degree AV-block that required a pacemaker, and mechanical complications such as papillary muscle rupture, cardiac tamponade, or ventricular septum defects (VSD). Complications were identified via diagnosis and/or intervention codes in the database, and manual chart review was performed in cases with complications.\u0000\u0000\u0000RESULTS\u0000Of all 26545 patients, 2463 (9.3%) were diagnosed with ACS, and 151 of these (6.1%) suffered any complication within 30 days. Mean age was higher in patients with (79.2 years) than without (69.4 years) complications, and more were female (39.7% vs. 33.0%). Eighty-four (3.4% of all ACS patients) patients died, 33 (1.3%) had cardiac arrest, 22 (0.9%) respiratory failure, 13 (0.5%) high-degree AV block, 10 (0.4%) cardiogenic shock, 12 (0.5%) severe ventricular arrhythmia, and 2 each (<0.1%) had VSD or cardiac tamponade. Almost 30% of the complications were present already at the ED, and 40% of patients with complications were not admitted to the CCU/ICU. Only 80 (53%) of the patients with complications underwent coronary angiography and 62 (41%) were revascularized with PCI or CABG.\u0000\u0000\u0000CONCLUSION\u0000With current care, serious complications occurred in only 6 out of 100 ACS patients, and 2 of these complications were present already at the ED. Four out of ten ACS patients with complications were not admitted to the CCU/ICU and about half did not undergo coronary angiography. Further research is needed to improve risk assessment in ED ACS patients, which may allow more effective use of cardiac monitoring and hospital resources.","PeriodicalId":9391,"journal":{"name":"Cardiology","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140719093","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Andrea Caccia, Giacomo Ruzzenenti, Valentina Bellantonio, Raffaele Falco, Alexios S. Kotinas, A. Preda, Patrizio Mazzone
{"title":"Challenging Silent Cerebral Embolism during Left Atrial Appendage Occlusion: A Lesson from Recent Studies.","authors":"Andrea Caccia, Giacomo Ruzzenenti, Valentina Bellantonio, Raffaele Falco, Alexios S. Kotinas, A. Preda, Patrizio Mazzone","doi":"10.1159/000538337","DOIUrl":"https://doi.org/10.1159/000538337","url":null,"abstract":"","PeriodicalId":9391,"journal":{"name":"Cardiology","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140732500","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
INTRODUCTION Atrial fibrillation (AF) often occurs in patients with rheumatic mitral stenosis (RMS) and is associated with adverse clinical outcomes. Mitral valve mean pressure gradient (MVMPG) is utilized as an indicator to assess the severity of mitral stenosis and its hemodynamic implications. This study aims to investigate the association between MVMPG and AF in individuals with RMS. METHODS We conducted a retrospective analysis of medical records from 360 consecutive patients diagnosed with RMS at the First Affiliated Hospital of Wenzhou Medical University between January 2018 and January 2023. Using both univariate and multivariate logistic regression models, the relationship between MVMPG and AF was evaluated. Restricted cubic splines were employed to test for linearity, and stratified and interaction analyses were performed to evaluate the stability of this relationship among different subgroups. RESULTS Based on the MVMPG levels, 360 RMS patients in total were categorized into three groups for the analysis: Q1 (<5mmHg), Q2 (5-10 mmHg), and Q3 (>10 mmHg). The average age was 60.6 years (Q1: 66.1, Q2: 61.9, Q3: 55.8), and 70.8% were female. The prevalence of AF was 39.6%, 56.5%, and 63.2% in Q1, Q2, and Q3, respectively. After adjusting for potential confounders, a significant association between MVMPG and AF was observed. In Q2, there was a 119% increase in AF (OR 2.19, 95% CI: 1.01-4.75), while in Q3, there was a 238% increase (OR 3.38, 95% CI: 1.39-8.19), compared to Q1. The relationship between MVMPG and AF was linear (p = 0.503). These results remained consistent in each subgroup analysis. CONCLUSION Our study reveals a significant positive association between MVMPG and AF in patients with RMS, which holds important clinical implications. It is necessary to conduct further research.
{"title":"Association between Mitral Valve Mean Pressure Gradient and Atrial Fibrillation in Patients with Rheumatic Mitral Stenosis: A Cross-sectional Study.","authors":"Changcai Wu","doi":"10.1159/000538739","DOIUrl":"https://doi.org/10.1159/000538739","url":null,"abstract":"INTRODUCTION\u0000Atrial fibrillation (AF) often occurs in patients with rheumatic mitral stenosis (RMS) and is associated with adverse clinical outcomes. Mitral valve mean pressure gradient (MVMPG) is utilized as an indicator to assess the severity of mitral stenosis and its hemodynamic implications. This study aims to investigate the association between MVMPG and AF in individuals with RMS.\u0000\u0000\u0000METHODS\u0000We conducted a retrospective analysis of medical records from 360 consecutive patients diagnosed with RMS at the First Affiliated Hospital of Wenzhou Medical University between January 2018 and January 2023. Using both univariate and multivariate logistic regression models, the relationship between MVMPG and AF was evaluated. Restricted cubic splines were employed to test for linearity, and stratified and interaction analyses were performed to evaluate the stability of this relationship among different subgroups.\u0000\u0000\u0000RESULTS\u0000Based on the MVMPG levels, 360 RMS patients in total were categorized into three groups for the analysis: Q1 (<5mmHg), Q2 (5-10 mmHg), and Q3 (>10 mmHg). The average age was 60.6 years (Q1: 66.1, Q2: 61.9, Q3: 55.8), and 70.8% were female. The prevalence of AF was 39.6%, 56.5%, and 63.2% in Q1, Q2, and Q3, respectively. After adjusting for potential confounders, a significant association between MVMPG and AF was observed. In Q2, there was a 119% increase in AF (OR 2.19, 95% CI: 1.01-4.75), while in Q3, there was a 238% increase (OR 3.38, 95% CI: 1.39-8.19), compared to Q1. The relationship between MVMPG and AF was linear (p = 0.503). These results remained consistent in each subgroup analysis.\u0000\u0000\u0000CONCLUSION\u0000Our study reveals a significant positive association between MVMPG and AF in patients with RMS, which holds important clinical implications. It is necessary to conduct further research.","PeriodicalId":9391,"journal":{"name":"Cardiology","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-04-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140735142","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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