Lukas Tomas, Pernilla Katra, Wiaam Badn, Linda Andersson, Jan Nilsson, Alexandru Schiopu, Daniel Engelbertsen, Isabel Gonçalves, Eva Bengtsson, Harry Björkbacka
Abstract Aims Invariant natural killer T (iNKT) cells, a T cell subset that is CD1d-restricted and expresses a semi-invariant T cell receptor, have been proposed to contribute to dyslipidaemia-driven cardiovascular disease due to their ability to specifically recognize lipid antigens. Studies in mice have attributed pro-atherogenic properties to iNKT cells, but studies in humans investigating associations of iNKT cells with incident coronary events (CE) are lacking. Methods and results Here, we used flow cytometry to enumerate circulating iNKT cells (CD3+ CD1d-PBS57-Tetramer+) in a case-control cohort nested within the prospective population-based Malmö Diet and Cancer Study (n = 416) to explore associations with incident first-time CE during a median follow-up of 14 years. We found a significant inverse association between CD4− and CD8− double negative (DN) iNKT cells and incident CE, with an odds ratio of 0.62 [95% confidence interval (CI) 0.38–0.99; P = 0.046] comparing the highest vs. the lowest tertile of DN iNKT cells. The association remained significant after adjustment for cardiovascular risk factors with an odds ratio of 0.57 (95% CI 0.33–0.99; P = 0.046). In contrast, total iNKT cells were not significantly associated with incident CE after adjustment, with an odds ratio of 0.74 (95% CI 0.43–1.27; P = 0.276). Conclusion Our findings indicate that animal studies suggesting an atherosclerosis-promoting role for iNKT cells may not translate to human cardiovascular disease as our data show an association between high circulating numbers of DN iNKT cells and decreased risk of incident CE.
{"title":"Invariant natural killer T cells and incidence of first-time coronary events: a nested case-control study","authors":"Lukas Tomas, Pernilla Katra, Wiaam Badn, Linda Andersson, Jan Nilsson, Alexandru Schiopu, Daniel Engelbertsen, Isabel Gonçalves, Eva Bengtsson, Harry Björkbacka","doi":"10.1093/ehjopen/oead094","DOIUrl":"https://doi.org/10.1093/ehjopen/oead094","url":null,"abstract":"Abstract Aims Invariant natural killer T (iNKT) cells, a T cell subset that is CD1d-restricted and expresses a semi-invariant T cell receptor, have been proposed to contribute to dyslipidaemia-driven cardiovascular disease due to their ability to specifically recognize lipid antigens. Studies in mice have attributed pro-atherogenic properties to iNKT cells, but studies in humans investigating associations of iNKT cells with incident coronary events (CE) are lacking. Methods and results Here, we used flow cytometry to enumerate circulating iNKT cells (CD3+ CD1d-PBS57-Tetramer+) in a case-control cohort nested within the prospective population-based Malmö Diet and Cancer Study (n = 416) to explore associations with incident first-time CE during a median follow-up of 14 years. We found a significant inverse association between CD4− and CD8− double negative (DN) iNKT cells and incident CE, with an odds ratio of 0.62 [95% confidence interval (CI) 0.38–0.99; P = 0.046] comparing the highest vs. the lowest tertile of DN iNKT cells. The association remained significant after adjustment for cardiovascular risk factors with an odds ratio of 0.57 (95% CI 0.33–0.99; P = 0.046). In contrast, total iNKT cells were not significantly associated with incident CE after adjustment, with an odds ratio of 0.74 (95% CI 0.43–1.27; P = 0.276). Conclusion Our findings indicate that animal studies suggesting an atherosclerosis-promoting role for iNKT cells may not translate to human cardiovascular disease as our data show an association between high circulating numbers of DN iNKT cells and decreased risk of incident CE.","PeriodicalId":93995,"journal":{"name":"European heart journal open","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135385528","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}
Hannah M la Roi-Teeuw, Maarten van Smeden, Geert-Jan Geersing, Olaf H Klungel, Frans H Rutten, Patrick C Souverein, Sander van Doorn
Abstract Background and Aims Previous studies suggest relatively increased cardiovascular risk after Covid-19 infection. This study assessed incidence and explored individual risk and timing of cardiovascular disease occurring post-Covid-19 in a large primary care database. Methods Data were extracted from the United Kingdom’s Clinical Practice Research Datalink. Incidence rates within 180 days post-infection were estimated for arterial or venous events, inflammatory heart disease, and new-onset atrial fibrillation or heart failure. Next, multivariable logistic regression models were developed on 220,751 adults with Covid-19 infection before December 1st 2020 using age, sex and traditional cardiovascular risk factors. All models were externally validated in (1) 138,034 vaccinated and (2) 503,404 unvaccinated adults with a first Covid-19 infection after December 1st 2020. Discriminative performance and calibration were evaluated with internal and external validation. Results Increased incidence rates were observed up to 60 days after Covid-19 infection for venous and arterial cardiovascular events, and new-onset atrial fibrillation, but not for inflammatory heart disease or heart failure, with the highest rate for venous events (13 per 1000 person-years). The best prediction models had c-statistics of 0.90 or higher. However, less than 5% of adults had a predicted 180-day outcome-specific risk larger than 1%. These rare outcomes complicated calibration. Conclusions Risks of arterial and venous cardiovascular events, and new-onset atrial fibrillation are increased within the first 60 days after Covid-19 infection in the general population. Models’ c-statistics suggest high discrimination, but because of the very low absolute risks they are insufficient to inform individual risk management.
{"title":"Incidence and individual risk prediction of post-Covid-19 cardiovascular disease in the general population: a multivariable prediction model development and validation study","authors":"Hannah M la Roi-Teeuw, Maarten van Smeden, Geert-Jan Geersing, Olaf H Klungel, Frans H Rutten, Patrick C Souverein, Sander van Doorn","doi":"10.1093/ehjopen/oead101","DOIUrl":"https://doi.org/10.1093/ehjopen/oead101","url":null,"abstract":"Abstract Background and Aims Previous studies suggest relatively increased cardiovascular risk after Covid-19 infection. This study assessed incidence and explored individual risk and timing of cardiovascular disease occurring post-Covid-19 in a large primary care database. Methods Data were extracted from the United Kingdom’s Clinical Practice Research Datalink. Incidence rates within 180 days post-infection were estimated for arterial or venous events, inflammatory heart disease, and new-onset atrial fibrillation or heart failure. Next, multivariable logistic regression models were developed on 220,751 adults with Covid-19 infection before December 1st 2020 using age, sex and traditional cardiovascular risk factors. All models were externally validated in (1) 138,034 vaccinated and (2) 503,404 unvaccinated adults with a first Covid-19 infection after December 1st 2020. Discriminative performance and calibration were evaluated with internal and external validation. Results Increased incidence rates were observed up to 60 days after Covid-19 infection for venous and arterial cardiovascular events, and new-onset atrial fibrillation, but not for inflammatory heart disease or heart failure, with the highest rate for venous events (13 per 1000 person-years). The best prediction models had c-statistics of 0.90 or higher. However, less than 5% of adults had a predicted 180-day outcome-specific risk larger than 1%. These rare outcomes complicated calibration. Conclusions Risks of arterial and venous cardiovascular events, and new-onset atrial fibrillation are increased within the first 60 days after Covid-19 infection in the general population. Models’ c-statistics suggest high discrimination, but because of the very low absolute risks they are insufficient to inform individual risk management.","PeriodicalId":93995,"journal":{"name":"European heart journal open","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135425450","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}
Aims: The prognostic value of the presence of atrial fibrillation (AF) in patients at the time of cardiac sarcoidosis (CS) diagnosis is unknown. This study aimed to investigate the association between AF at the time of CS diagnosis and patient prognosis.
Methods and results: This study is a post-hoc analysis of Illustration of the Management and Prognosis of Japanese Patients with CS, a multicentre, retrospective observational study that evaluated the clinical characteristics and prognosis of patients with CS. The primary endpoint was the combined endpoint of all-cause death and hospitalization due to heart failure. After excluding patients with missing data about AF status, 445 patients (62 ± 11 years, 36% males) diagnosed with CS according to the Japanese current diagnostic guideline were analysed. Compared to patients without AF, patients with AF (n = 46, 10%) had higher levels of brain natriuretic peptide and a higher prevalence of heart failure hospitalizations. During a median follow-up period of 3.2 years (interquartile range, 1.7-5.8 years), 80 primary endpoints were observed. Kaplan-Meier curve analysis indicated that concomitant AF at the time of diagnosis was significantly associated with a high incidence of primary endpoints (log-rank P = 0.002). This association was retained after adjusting for known risk factors including log-transformed brain natriuretic peptide levels and left ventricular ejection fractions [hazard ratio, 1.96 (95% confidence interval, 1.05-3.65); P = 0.035].
Conclusion: The presence of AF at the time of CS diagnosis is associated with higher incidence of all-cause death and heart failure hospitalization.
{"title":"Prevalence and prognostic value of atrial fibrillation in patients with cardiac sarcoidosis.","authors":"Yudai Fujimoto, Yuya Matsue, Daichi Maeda, Taishi Dotare, Tsutomu Sunayama, Takashi Iso, Yutaka Nakamura, Yu Suresvar Singh, Yuka Akama, Kenji Yoshioka, Takeshi Kitai, Yoshihisa Naruse, Tatsunori Taniguchi, Hidekazu Tanaka, Takahiro Okumura, Yuichi Baba, Takeru Nabeta, Tohru Minamino","doi":"10.1093/ehjopen/oead100","DOIUrl":"10.1093/ehjopen/oead100","url":null,"abstract":"<p><strong>Aims: </strong>The prognostic value of the presence of atrial fibrillation (AF) in patients at the time of cardiac sarcoidosis (CS) diagnosis is unknown. This study aimed to investigate the association between AF at the time of CS diagnosis and patient prognosis.</p><p><strong>Methods and results: </strong>This study is a post-hoc analysis of Illustration of the Management and Prognosis of Japanese Patients with CS, a multicentre, retrospective observational study that evaluated the clinical characteristics and prognosis of patients with CS. The primary endpoint was the combined endpoint of all-cause death and hospitalization due to heart failure. After excluding patients with missing data about AF status, 445 patients (62 ± 11 years, 36% males) diagnosed with CS according to the Japanese current diagnostic guideline were analysed. Compared to patients without AF, patients with AF (<i>n</i> = 46, 10%) had higher levels of brain natriuretic peptide and a higher prevalence of heart failure hospitalizations. During a median follow-up period of 3.2 years (interquartile range, 1.7-5.8 years), 80 primary endpoints were observed. Kaplan-Meier curve analysis indicated that concomitant AF at the time of diagnosis was significantly associated with a high incidence of primary endpoints (log-rank <i>P</i> = 0.002). This association was retained after adjusting for known risk factors including log-transformed brain natriuretic peptide levels and left ventricular ejection fractions [hazard ratio, 1.96 (95% confidence interval, 1.05-3.65); <i>P</i> = 0.035].</p><p><strong>Conclusion: </strong>The presence of AF at the time of CS diagnosis is associated with higher incidence of all-cause death and heart failure hospitalization.</p>","PeriodicalId":93995,"journal":{"name":"European heart journal open","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/ab/ae/oead100.PMC10578462.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41242580","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 : 2023-09-22eCollection Date: 2023-09-01DOI: 10.1093/ehjopen/oead092
Paolo Boretto, Neal Hitesh Patel, Keval Patel, Mannat Rana, Andrea Saglietto, Manas Soni, Mahmood Ahmad, Jamie Sin Ying Ho, Ovidio De Filippo, Rui Andre Providencia, Jonathan James Hyett Bray, Fabrizio D'Ascenzo
Cardiac involvement is the foremost determinant of the clinical progression of amyloidosis. The diagnostic role of cardiac magnetic resonance (CMR) imaging in cardiac amyloidosis has been established, but the prognostic role of various right and left CMR tissue characterization and functional parameters, including global longitudinal strain (GLS), late gadolinium enhancement (LGE), and parametric mapping, is yet to be delineated. We searched EMBASE, PubMed, and MEDLINE for studies analysing the prognostic use of CMR imaging in patients with light chain amyloidosis or transthyretin amyloidosis cardiac amyloidosis. The primary endpoint was all-cause mortality. A random effects model was used to calculate a pooled odds ratio using inverse-variance weighting. Nineteen studies with 2199 patients [66% males, median age 59.7 years, interquartile range (IQR) 58-67] were included. Median follow-up was 24 months (IQR 20-32), during which 40.8% of patients died. Both tissue characterization left heart parameters such as elevated extracellular volume [hazard ratio (HR) 3.95, 95% confidence interval (CI) 3.01-5.17], extension of left ventricular (LV) LGE (HR 2.69, 95% CI 2.07-3.49) elevated native T1 (HR 2.19, 95% CI 1.12-4.28), and functional parameters such as reduced LV GLS (HR 1.91, 95% CI 1.52-2.41) and reduced LV ejection fraction (EF; HR 1.20, 95% CI 1.17-1.23) were associated with increased all-cause mortality. Unlike the presence of right ventricular (RV) LGE (HR 3.40, 95% CI 0.51-22.54), parameters such as RV GLS (HR 2.08, 95% CI 1.6-2.69), RVEF (HR 1.13, 95% CI 1.05-1.22), and tricuspid annular systolic excursion (TAPSE) (HR 1.11, 95% CI 1.02-1.21) were also associated with mortality. In this large meta-analysis of patients with cardiac amyloidosis, CMR parameters assessing RV and LV function and tissue characterization were associated with an increased risk of mortality.
{"title":"Prognosis prediction in cardiac amyloidosis by cardiac magnetic resonance imaging: a systematic review with meta-analysis.","authors":"Paolo Boretto, Neal Hitesh Patel, Keval Patel, Mannat Rana, Andrea Saglietto, Manas Soni, Mahmood Ahmad, Jamie Sin Ying Ho, Ovidio De Filippo, Rui Andre Providencia, Jonathan James Hyett Bray, Fabrizio D'Ascenzo","doi":"10.1093/ehjopen/oead092","DOIUrl":"10.1093/ehjopen/oead092","url":null,"abstract":"<p><p>Cardiac involvement is the foremost determinant of the clinical progression of amyloidosis. The diagnostic role of cardiac magnetic resonance (CMR) imaging in cardiac amyloidosis has been established, but the prognostic role of various right and left CMR tissue characterization and functional parameters, including global longitudinal strain (GLS), late gadolinium enhancement (LGE), and parametric mapping, is yet to be delineated. We searched EMBASE, PubMed, and MEDLINE for studies analysing the prognostic use of CMR imaging in patients with light chain amyloidosis or transthyretin amyloidosis cardiac amyloidosis. The primary endpoint was all-cause mortality. A random effects model was used to calculate a pooled odds ratio using inverse-variance weighting. Nineteen studies with 2199 patients [66% males, median age 59.7 years, interquartile range (IQR) 58-67] were included. Median follow-up was 24 months (IQR 20-32), during which 40.8% of patients died. Both tissue characterization left heart parameters such as elevated extracellular volume [hazard ratio (HR) 3.95, 95% confidence interval (CI) 3.01-5.17], extension of left ventricular (LV) LGE (HR 2.69, 95% CI 2.07-3.49) elevated native T1 (HR 2.19, 95% CI 1.12-4.28), and functional parameters such as reduced LV GLS (HR 1.91, 95% CI 1.52-2.41) and reduced LV ejection fraction (EF; HR 1.20, 95% CI 1.17-1.23) were associated with increased all-cause mortality. Unlike the presence of right ventricular (RV) LGE (HR 3.40, 95% CI 0.51-22.54), parameters such as RV GLS (HR 2.08, 95% CI 1.6-2.69), RVEF (HR 1.13, 95% CI 1.05-1.22), and tricuspid annular systolic excursion (TAPSE) (HR 1.11, 95% CI 1.02-1.21) were also associated with mortality. In this large meta-analysis of patients with cardiac amyloidosis, CMR parameters assessing RV and LV function and tissue characterization were associated with an increased risk of mortality.</p>","PeriodicalId":93995,"journal":{"name":"European heart journal open","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/3f/fc/oead092.PMC10575621.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41242581","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 : 2023-09-22eCollection Date: 2023-09-01DOI: 10.1093/ehjopen/oead091
Daniele Ronco, Albert Ariza-Solé, Mariusz Kowalewski, Matteo Matteucci, Michele Di Mauro, Esteban López-de-Sá, Marco Ranucci, Alessandro Sionis, Nikolaos Bonaros, Michele De Bonis, Claudio Francesco Russo, Aitor Uribarri, Santiago Montero, Theodor Fischlein, Adam Kowalówka, Shiho Naito, Jean-François Obadia, Roberto Martín-Asenjo, Jaime Aboal, Matthias Thielmann, Caterina Simon, Rut Andrea-Riba, Carolina Parra, Thierry Folliguet, Manuel Martínez-Sellés, Marcelo Sanmartín Fernández, Nawwar Al-Attar, Ana Viana Tejedor, Giuseppe Filiberto Serraino, Virginia Burgos Palacios, Udo Boeken, Sergio Raposeiras Roubin, Miguel Antonio Solla Buceta, Pedro Luis Sánchez Fernández, Roberto Scrofani, Gemma Pastor Báez, Pablo Jorge Pérez, Guglielmo Actis Dato, Juan Carlos Garcia-Rubira, Jose H de Gea Garcia, Giulio Massimi, Andrea Musazzi, Roberto Lorusso
Aims: Many historical and recent reports showed that post-infarction ventricular septal rupture (VSR) represents a life-threatening condition and the strategy to optimally manage it remains undefined. Therefore, disparate treatment policies among different centres with variable results are often described. We analysed data from European centres to capture the current clinical practice in VSR management.
Methods and results: Thirty-nine centres belonging to eight European countries participated in a survey, filling a digital form of 38 questions from April to October 2022, to collect information about all the aspects of VSR treatment. Most centres encounter 1-5 VSR cases/year. Surgery remains the treatment of choice over percutaneous closure (71.8% vs. 28.2%). A delayed repair represents the preferred approach (87.2%). Haemodynamic conditions influence the management in almost all centres, although some try to achieve patients stabilization and delayed surgery even in cardiogenic shock. Although 33.3% of centres do not perform coronarography in unstable patients, revascularization approaches are widely variable. Most centres adopt mechanical circulatory support (MCS), mostly extracorporeal membrane oxygenation, especially pre-operatively to stabilize patients and achieve delayed repair. Post-operatively, such MCS are more often adopted in patients with ventricular dysfunction.
Conclusion: In real-life, delayed surgery, regardless of the haemodynamic conditions, is the preferred strategy for VSR management in Europe. Extracorporeal membrane oxygenation is becoming the most frequently adopted MCS as bridge-to-operation. This survey provides a useful background to develop dedicated, prospective studies to strengthen the current evidence on VSR treatment and to help improving its currently unsatisfactory outcomes.
{"title":"The current clinical practice for management of post-infarction ventricular septal rupture: a European survey.","authors":"Daniele Ronco, Albert Ariza-Solé, Mariusz Kowalewski, Matteo Matteucci, Michele Di Mauro, Esteban López-de-Sá, Marco Ranucci, Alessandro Sionis, Nikolaos Bonaros, Michele De Bonis, Claudio Francesco Russo, Aitor Uribarri, Santiago Montero, Theodor Fischlein, Adam Kowalówka, Shiho Naito, Jean-François Obadia, Roberto Martín-Asenjo, Jaime Aboal, Matthias Thielmann, Caterina Simon, Rut Andrea-Riba, Carolina Parra, Thierry Folliguet, Manuel Martínez-Sellés, Marcelo Sanmartín Fernández, Nawwar Al-Attar, Ana Viana Tejedor, Giuseppe Filiberto Serraino, Virginia Burgos Palacios, Udo Boeken, Sergio Raposeiras Roubin, Miguel Antonio Solla Buceta, Pedro Luis Sánchez Fernández, Roberto Scrofani, Gemma Pastor Báez, Pablo Jorge Pérez, Guglielmo Actis Dato, Juan Carlos Garcia-Rubira, Jose H de Gea Garcia, Giulio Massimi, Andrea Musazzi, Roberto Lorusso","doi":"10.1093/ehjopen/oead091","DOIUrl":"10.1093/ehjopen/oead091","url":null,"abstract":"<p><strong>Aims: </strong>Many historical and recent reports showed that post-infarction ventricular septal rupture (VSR) represents a life-threatening condition and the strategy to optimally manage it remains undefined. Therefore, disparate treatment policies among different centres with variable results are often described. We analysed data from European centres to capture the current clinical practice in VSR management.</p><p><strong>Methods and results: </strong>Thirty-nine centres belonging to eight European countries participated in a survey, filling a digital form of 38 questions from April to October 2022, to collect information about all the aspects of VSR treatment. Most centres encounter 1-5 VSR cases/year. Surgery remains the treatment of choice over percutaneous closure (71.8% vs. 28.2%). A delayed repair represents the preferred approach (87.2%). Haemodynamic conditions influence the management in almost all centres, although some try to achieve patients stabilization and delayed surgery even in cardiogenic shock. Although 33.3% of centres do not perform coronarography in unstable patients, revascularization approaches are widely variable. Most centres adopt mechanical circulatory support (MCS), mostly extracorporeal membrane oxygenation, especially pre-operatively to stabilize patients and achieve delayed repair. Post-operatively, such MCS are more often adopted in patients with ventricular dysfunction.</p><p><strong>Conclusion: </strong>In real-life, delayed surgery, regardless of the haemodynamic conditions, is the preferred strategy for VSR management in Europe. Extracorporeal membrane oxygenation is becoming the most frequently adopted MCS as bridge-to-operation. This survey provides a useful background to develop dedicated, prospective studies to strengthen the current evidence on VSR treatment and to help improving its currently unsatisfactory outcomes.</p>","PeriodicalId":93995,"journal":{"name":"European heart journal open","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/4e/aa/oead091.PMC10568658.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41242582","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 : 2023-09-22eCollection Date: 2023-11-01DOI: 10.1093/ehjopen/oead093
Jonas Wuopio, Marju Orho-Melander, Gunnar Engström, Johan Ärnlöv
{"title":"'No research without perfect methods': a problematic approach in epidemiology.","authors":"Jonas Wuopio, Marju Orho-Melander, Gunnar Engström, Johan Ärnlöv","doi":"10.1093/ehjopen/oead093","DOIUrl":"10.1093/ehjopen/oead093","url":null,"abstract":"","PeriodicalId":93995,"journal":{"name":"European heart journal open","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10634624/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89721667","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 : 2023-09-20eCollection Date: 2023-09-01DOI: 10.1093/ehjopen/oead089
Lisa Seekircher, Lena Tschiderer, Lars Lind, Maya S Safarova, Maryam Kavousi, M Arfan Ikram, Eva Lonn, Salim Yusuf, Diederick E Grobbee, John J P Kastelein, Frank L J Visseren, Matthew Walters, Jesse Dawson, Peter Higgins, Stefan Agewall, Alberico Catapano, Eric de Groot, Mark A Espeland, Gerhard Klingenschmid, Dianna Magliano, Michael H Olsen, David Preiss, Dirk Sander, Michael Skilton, Dorota A Zozulińska-Ziółkiewicz, Muriel P C Grooteman, Peter J Blankestijn, Kazuo Kitagawa, Shuhei Okazaki, Maria V Manzi, Costantino Mancusi, Raffaele Izzo, Moise Desvarieux, Tatjana Rundek, Hertzel C Gerstein, Michiel L Bots, Michael J Sweeting, Matthias W Lorenz, Peter Willeit
Aims: Current guidelines recommend measuring carotid intima-media thickness (IMT) at the far wall of the common carotid artery (CCA). We aimed to precisely quantify associations of near vs. far wall CCA-IMT with the risk for atherosclerotic cardiovascular disease (CVD, defined as coronary heart disease or stroke) and their added predictive values.
Methods and results: We analysed individual records of 41 941 participants from 16 prospective studies in the Proof-ATHERO consortium {mean age 61 years [standard deviation (SD) = 11]; 53% female; 16% prior CVD}. Mean baseline values of near and far wall CCA-IMT were 0.83 (SD = 0.28) and 0.82 (SD = 0.27) mm, differed by a mean of 0.02 mm (95% limits of agreement: -0.40 to 0.43), and were moderately correlated [r = 0.44; 95% confidence interval (CI): 0.39-0.49). Over a median follow-up of 9.3 years, we recorded 10 423 CVD events. We pooled study-specific hazard ratios for CVD using random-effects meta-analysis. Near and far wall CCA-IMT values were approximately linearly associated with CVD risk. The respective hazard ratios per SD higher value were 1.18 (95% CI: 1.14-1.22; I² = 30.7%) and 1.20 (1.18-1.23; I² = 5.3%) when adjusted for age, sex, and prior CVD and 1.09 (1.07-1.12; I² = 8.4%) and 1.14 (1.12-1.16; I²=1.3%) upon multivariable adjustment (all P < 0.001). Assessing CCA-IMT at both walls provided a greater C-index improvement than assessing CCA-IMT at one wall only [+0.0046 vs. +0.0023 for near (P < 0.001), +0.0037 for far wall (P = 0.006)].
Conclusions: The associations of near and far wall CCA-IMT with incident CVD were positive, approximately linear, and similarly strong. Improvement in risk discrimination was highest when CCA-IMT was measured at both walls.
{"title":"Intima-media thickness at the near or far wall of the common carotid artery in cardiovascular risk assessment.","authors":"Lisa Seekircher, Lena Tschiderer, Lars Lind, Maya S Safarova, Maryam Kavousi, M Arfan Ikram, Eva Lonn, Salim Yusuf, Diederick E Grobbee, John J P Kastelein, Frank L J Visseren, Matthew Walters, Jesse Dawson, Peter Higgins, Stefan Agewall, Alberico Catapano, Eric de Groot, Mark A Espeland, Gerhard Klingenschmid, Dianna Magliano, Michael H Olsen, David Preiss, Dirk Sander, Michael Skilton, Dorota A Zozulińska-Ziółkiewicz, Muriel P C Grooteman, Peter J Blankestijn, Kazuo Kitagawa, Shuhei Okazaki, Maria V Manzi, Costantino Mancusi, Raffaele Izzo, Moise Desvarieux, Tatjana Rundek, Hertzel C Gerstein, Michiel L Bots, Michael J Sweeting, Matthias W Lorenz, Peter Willeit","doi":"10.1093/ehjopen/oead089","DOIUrl":"10.1093/ehjopen/oead089","url":null,"abstract":"<p><strong>Aims: </strong>Current guidelines recommend measuring carotid intima-media thickness (IMT) at the far wall of the common carotid artery (CCA). We aimed to precisely quantify associations of near vs. far wall CCA-IMT with the risk for atherosclerotic cardiovascular disease (CVD, defined as coronary heart disease or stroke) and their added predictive values.</p><p><strong>Methods and results: </strong>We analysed individual records of 41 941 participants from 16 prospective studies in the Proof-ATHERO consortium {mean age 61 years [standard deviation (SD) = 11]; 53% female; 16% prior CVD}. Mean baseline values of near and far wall CCA-IMT were 0.83 (SD = 0.28) and 0.82 (SD = 0.27) mm, differed by a mean of 0.02 mm (95% limits of agreement: -0.40 to 0.43), and were moderately correlated [<i>r</i> = 0.44; 95% confidence interval (CI): 0.39-0.49). Over a median follow-up of 9.3 years, we recorded 10 423 CVD events. We pooled study-specific hazard ratios for CVD using random-effects meta-analysis. Near and far wall CCA-IMT values were approximately linearly associated with CVD risk. The respective hazard ratios per SD higher value were 1.18 (95% CI: 1.14-1.22; <i>I</i>² = 30.7%) and 1.20 (1.18-1.23; <i>I</i>² = 5.3%) when adjusted for age, sex, and prior CVD and 1.09 (1.07-1.12; <i>I</i>² = 8.4%) and 1.14 (1.12-1.16; <i>I</i>²=1.3%) upon multivariable adjustment (all <i>P</i> < 0.001). Assessing CCA-IMT at both walls provided a greater C-index improvement than assessing CCA-IMT at one wall only [+0.0046 vs. +0.0023 for near (<i>P</i> < 0.001), +0.0037 for far wall (<i>P</i> = 0.006)].</p><p><strong>Conclusions: </strong>The associations of near and far wall CCA-IMT with incident CVD were positive, approximately linear, and similarly strong. Improvement in risk discrimination was highest when CCA-IMT was measured at both walls.</p>","PeriodicalId":93995,"journal":{"name":"European heart journal open","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/03/c1/oead089.PMC10575622.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41242579","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 : 2023-09-07eCollection Date: 2023-09-01DOI: 10.1093/ehjopen/oead088
Carl G Glessgen, Marianthi Boulougouri, Jean-Paul Vallée, Stéphane Noble, Alexandra Platon, Pierre-Alexandre Poletti, Jean-François Paul, Jean-François Deux
Aims: To evaluate a deep-learning model (DLM) for detecting coronary stenoses in emergency room patients with acute chest pain (ACP) explored with electrocardiogram-gated aortic computed tomography angiography (CTA) to rule out aortic dissection.
Methods and results: This retrospective study included 217 emergency room patients (41% female, mean age 67.2 years) presenting with ACP and evaluated by aortic CTA at our institution. Computed tomography angiography was assessed by two readers, who rated the coronary arteries as 1 (no stenosis), 2 (<50% stenosis), or 3 (≥50% stenosis). Computed tomography angiography was categorized as high quality (HQ), if all three main coronary arteries were analysable and low quality (LQ) otherwise. Curvilinear coronary images were rated by a DLM using the same system. Per-patient and per-vessel analyses were conducted. One hundred and twenty-one patients had HQ and 96 LQ CTA. Sensitivity, specificity, positive predictive value, negative predictive value (NPV), and accuracy of the DLM in patients with high-quality image for detecting ≥50% stenoses were 100, 62, 59, 100, and 75% at the patient level and 98, 79, 57, 99, and 84% at the vessel level, respectively. Sensitivity was lower (79%) for detecting ≥50% stenoses at the vessel level in patients with low-quality image. Diagnostic accuracy was 84% in both groups. All 12 patients with acute coronary syndrome (ACS) and stenoses by invasive coronary angiography (ICA) were rated 3 by the DLM.
Conclusion: A DLM demonstrated high NPV for significant coronary artery stenosis in patients with ACP. All patients with ACS and stenoses by ICA were identified by the DLM.
{"title":"Artificial intelligence-based opportunistic detection of coronary artery stenosis on aortic computed tomography angiography in emergency department patients with acute chest pain.","authors":"Carl G Glessgen, Marianthi Boulougouri, Jean-Paul Vallée, Stéphane Noble, Alexandra Platon, Pierre-Alexandre Poletti, Jean-François Paul, Jean-François Deux","doi":"10.1093/ehjopen/oead088","DOIUrl":"https://doi.org/10.1093/ehjopen/oead088","url":null,"abstract":"<p><strong>Aims: </strong>To evaluate a deep-learning model (DLM) for detecting coronary stenoses in emergency room patients with acute chest pain (ACP) explored with electrocardiogram-gated aortic computed tomography angiography (CTA) to rule out aortic dissection.</p><p><strong>Methods and results: </strong>This retrospective study included 217 emergency room patients (41% female, mean age 67.2 years) presenting with ACP and evaluated by aortic CTA at our institution. Computed tomography angiography was assessed by two readers, who rated the coronary arteries as 1 (no stenosis), 2 (<50% stenosis), or 3 (≥50% stenosis). Computed tomography angiography was categorized as high quality (HQ), if all three main coronary arteries were analysable and low quality (LQ) otherwise. Curvilinear coronary images were rated by a DLM using the same system. Per-patient and per-vessel analyses were conducted. One hundred and twenty-one patients had HQ and 96 LQ CTA. Sensitivity, specificity, positive predictive value, negative predictive value (NPV), and accuracy of the DLM in patients with high-quality image for detecting ≥50% stenoses were 100, 62, 59, 100, and 75% at the patient level and 98, 79, 57, 99, and 84% at the vessel level, respectively. Sensitivity was lower (79%) for detecting ≥50% stenoses at the vessel level in patients with low-quality image. Diagnostic accuracy was 84% in both groups. All 12 patients with acute coronary syndrome (ACS) and stenoses by invasive coronary angiography (ICA) were rated 3 by the DLM.</p><p><strong>Conclusion: </strong>A DLM demonstrated high NPV for significant coronary artery stenosis in patients with ACP. All patients with ACS and stenoses by ICA were identified by the DLM.</p>","PeriodicalId":93995,"journal":{"name":"European heart journal open","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/a9/d0/oead088.PMC10516619.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41167483","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}
Vikash Jaiswal, Song Peng Ang, Vibhor Agrawal, Vamsikalyan Borra, Dhrubajyoti Bandyopadhyay, Aayusha Dhakal, Teresa DeMarco, Gregg C Fonarow
Department of Cardiovascular Research, Larkin Community Hospital, South Miami, FL, USA; Department of Internal Medicine, Rutgers Health/Community Medical Center, Toms River, NJ, USA; Department of Medicine, King George’s Medical University, Lucknow, India; Department of Internal Medicine, University of Texas Rio Grande Valley, Weslaco, TX, USA; Department of Cardiology, New York Medical College at Westchester Medical Center, Valhalla, NY, USA; Kathmandu University School of Medical Sciences, Dhulikhel, Nepal; Division of Cardiology, University of California, San Francisco, CA, USA; and Ahmanson-UCLA Cardiomyopathy Center, Ronald Reagan UCLA Medical Center, Los Angeles, CA, USA
{"title":"Sotatercept for the treatment of pulmonary arterial hypertension: a meta-analysis of randomized controlled trials.","authors":"Vikash Jaiswal, Song Peng Ang, Vibhor Agrawal, Vamsikalyan Borra, Dhrubajyoti Bandyopadhyay, Aayusha Dhakal, Teresa DeMarco, Gregg C Fonarow","doi":"10.1093/ehjopen/oead086","DOIUrl":"https://doi.org/10.1093/ehjopen/oead086","url":null,"abstract":"Department of Cardiovascular Research, Larkin Community Hospital, South Miami, FL, USA; Department of Internal Medicine, Rutgers Health/Community Medical Center, Toms River, NJ, USA; Department of Medicine, King George’s Medical University, Lucknow, India; Department of Internal Medicine, University of Texas Rio Grande Valley, Weslaco, TX, USA; Department of Cardiology, New York Medical College at Westchester Medical Center, Valhalla, NY, USA; Kathmandu University School of Medical Sciences, Dhulikhel, Nepal; Division of Cardiology, University of California, San Francisco, CA, USA; and Ahmanson-UCLA Cardiomyopathy Center, Ronald Reagan UCLA Medical Center, Los Angeles, CA, USA","PeriodicalId":93995,"journal":{"name":"European heart journal open","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/5e/b4/oead086.PMC10521901.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41169252","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}