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Autonomic reactivity to mental stress is associated with cardiovascular mortality. 自律神经对精神压力的反应与心血管死亡率有关。
Pub Date : 2024-10-15 eCollection Date: 2024-11-01 DOI: 10.1093/ehjopen/oeae086
Anish S Shah, Viola Vaccarino, Kasra Moazzami, Zakaria Almuwaqqat, Mariana Garcia, Laura Ward, Lisa Elon, Yi-An Ko, Yan V Sun, Brad D Pearce, Paolo Raggi, J Douglas Bremner, Rachel Lampert, Arshed A Quyyumi, Amit J Shah

Aims: The mechanisms linking acute psychological stress to cardiovascular disease (CVD) mortality are incompletely understood. We studied the relationship of electrocardiographic measures of autonomic dysfunction during acute mental stress provocation and CVD death.

Methods and results: In a pooled cohort of 765 participants with stable CVD from two related studies, we collected Holter data during standardized laboratory-based mental stress testing with a speech task and followed them for events. We assessed autonomic function using low-frequency (LF) heart rate variability (HRV) in 5-min intervals before, during, and after stress induction, and specifically examined changes from rest to stress. We employed cause-specific survival models to examine its association with CVD and all-cause mortality, controlling for demographic and CVD risk factors. The mean (SD) age was 58 (10) years, 35% were women, and 44% self-identified as Black. After a median follow-up of 5.6 years, 37 (5%) died from CVD causes. A stress-induced LF HRV decrease (67% of sample), vs. increase, was associated with a hazard ratio (HR) of 3.48 (95% confidence interval-3.25, 3.73) for CVD mortality. Low rest LF HRV (bottom quartile) was also independently associated with CVD mortality, HR = 1.75 (1.58, 1.94), vs. normal rest LF HRV (upper three quartiles). The combination of stress-induced LF HRV decrease and low rest LF HRV was associated with HR = 5.73 (5.33, 6.15) vs. the normal stress/rest LF HRV reference. We found similar results with HF HRV.

Conclusion: Stress-induced LF HRV decrease and low rest LF HRV are both independently and additively associated with a higher CVD mortality risk. Additional research is needed to assess whether targeting autonomic dysfunction may improve CVD outcomes.

目的:急性心理应激与心血管疾病(CVD)死亡率之间的关联机制尚不完全清楚。我们研究了在急性心理应激诱发过程中自主神经功能紊乱的心电图测量与心血管疾病死亡之间的关系:我们在两项相关研究的 765 名稳定型心血管疾病患者的集合队列中,收集了在标准化实验室精神压力测试中进行言语任务的 Holter 数据,并对他们进行了事件跟踪。我们在应激诱导前、应激诱导中和应激诱导后的 5 分钟间隔内使用低频(LF)心率变异性(HRV)评估自律神经功能,并特别考察了从静息到应激的变化。在控制人口统计学和心血管疾病风险因素的前提下,我们采用了特定原因生存模型来研究其与心血管疾病和全因死亡率的关系。平均(标清)年龄为 58(10)岁,35% 为女性,44% 自认为是黑人。中位随访 5.6 年后,37 人(5%)死于心血管疾病。压力引起的低频心率变异下降(67% 的样本)与心血管疾病死亡率的危险比(HR)为 3.48(95% 置信区间-3.25,3.73),而压力引起的低频心率变异上升与心血管疾病死亡率的危险比(HR)为 3.48(95% 置信区间-3.25,3.73)。低静息低频心率变异(下四分位数)与正常静息低频心率变异(上三个四分位数)相比,也与心血管疾病死亡率独立相关,HR = 1.75 (1.58, 1.94)。与正常应激/静息低频心率变异参考值相比,应激诱导的低频心率变异下降和低静息低频心率变异的组合与心率=5.73(5.33,6.15)相关。我们在高频心率变异方面也发现了类似的结果:结论:应激诱导的低频心率变异下降和低静息低频心率变异与较高的心血管疾病死亡风险有独立的叠加关系。需要进行更多的研究来评估针对自律神经功能紊乱的治疗是否能改善心血管疾病的预后。
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引用次数: 0
Call to action for acute myocardial infarction in women: international multi-disciplinary practical roadmap. 女性急性心肌梗死行动呼吁:国际多学科实用路线图。
Pub Date : 2024-10-12 eCollection Date: 2024-11-01 DOI: 10.1093/ehjopen/oeae087
Stephane Manzo-Silberman, Michal Hawranek, Shrilla Banerjee, Marta Kaluzna-Oleksy, Mirvat Alasnag, Valeria Paradies, Biljana Parapid, Pierre Sabouret, Agnieszka Wolczenko, Vijay Kunadian, Izabella Uchmanowicz, Jacky Nizard, Martine Gilard, Roxana Mehran, Alaide Chieffo

Cardiovascular diseases are the leading cause of death among women, and the incidence among younger women has shown the greatest increase over the last decades, in particular for acute myocardial infarction (AMI). Moreover, the prognosis of women post-AMI is poor when compared with men of similar ages. Since the 1990s, an abundant literature has highlighted the existing differences between sexes with regard to presentation, burden, and impact of traditional risk factors and of risk factors pertaining predominantly to women, the perception of risk by women and men, and the pathophysiological causations, their treatment, and prognosis. These data that have been accumulated over recent years highlight several targets for improvement. The objective of this collaborative work is to define the actions required to reverse the growing incidence of AMI in women and improve the patient pathway and care, as well as the prognosis. We aim to provide practical toolkits for different health professionals involved in the care of women, so that each step, from cardiovascular risk assessment to symptom recognition, to the AMI pathway and rehabilitation, thus facilitating that from prevention to intervention of AMI, can be optimized.

心血管疾病是女性死亡的主要原因,在过去几十年中,年轻女性的发病率增幅最大,尤其是急性心肌梗死(AMI)。此外,与年龄相仿的男性相比,急性心肌梗死后女性的预后较差。自 20 世纪 90 年代以来,大量文献强调了两性在传统风险因素和主要与女性有关的风险因素的表现、负担和影响、男女对风险的认识、病理生理学原因、治疗和预后方面存在的差异。近年来积累的这些数据强调了几个需要改进的目标。这项合作工作的目的是确定需要采取哪些行动来扭转女性急性心肌梗死发病率不断上升的趋势,并改善患者的就医途径和护理以及预后。我们的目标是为参与女性护理的不同医疗专业人员提供实用的工具包,以便优化从心血管风险评估到症状识别,再到急性心肌梗死路径和康复的每一个步骤,从而促进急性心肌梗死从预防到干预的整个过程。
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引用次数: 0
Risk of venous thromboembolism in patients with congenital heart disease: a nationwide, register-based, case-control study. 先天性心脏病患者的静脉血栓栓塞风险:一项基于登记的全国性病例对照研究。
Pub Date : 2024-10-10 eCollection Date: 2024-11-01 DOI: 10.1093/ehjopen/oeae089
Dagmara Cuszynska-Kruk, Maria Fedchenko, Kok Wai Giang, Mikael Dellborg, Peter Eriksson, Per-Olof Hansson, Zacharias Mandalenakis

Aims: Patients with congenital heart disease (CHD) have an increased risk of developing acquired cardiovascular diseases. However, the risk of venous thromboembolism (VTE) in patients with CHD is unknown. We aimed to investigate the incidence and risk of VTE in patients with CHD compared with matched controls without CHD.

Methods and results: Data from Swedish health registers were used to identify all patients with CHD between 1970 and 2017 in Sweden. Each patient with CHD was matched with 10 controls from the Swedish Total Population Register. The primary outcome of the study was an event of VTE. Follow-up was from birth until VTE, death, or the end of the study (2017). Cox proportional hazard models were used to investigate the risk of VTE in patients with CHD and controls. A total of 67 814 patients with CHD and 583 709 matched controls were identified and included in the study. During a mean follow-up of 15.9 (SD ± 12.5) years, 554 (0.8%) patients with CHD and 1571 (0.3%) controls developed VTE. The risk of VTE was 3.3 [95% confidence interval [CI] 2.6-3.4) times higher in patients with CHD than in controls. Patients with conotruncal defects had the highest risk of VTE (hazard ratio 7.06, 95% CI 5.52-9.03).

Conclusion: In our nationwide study, we found that the risk of VTE in patients with CHD was more than three times higher than in matched controls. The highest risk of VTE was in patients with the most complex lesions. Further research is crucial to clarify the underlying risk factors and prevent VTE in patients with CHD.

目的:先天性心脏病(CHD)患者罹患后天性心血管疾病的风险增加。然而,先天性心脏病患者发生静脉血栓栓塞症(VTE)的风险尚不清楚。我们的目的是调查先天性心脏病患者与非先天性心脏病的匹配对照组相比,静脉血栓栓塞症的发病率和风险:我们利用瑞典健康登记册中的数据,确定了 1970 年至 2017 年期间瑞典所有患有先天性心脏病的患者。每名冠心病患者都与瑞典总人口登记册中的 10 名对照者进行了配对。研究的主要结果是VTE事件。随访时间为出生至 VTE、死亡或研究结束(2017 年)。研究采用 Cox 比例危险模型来调查冠心病患者和对照组的 VTE 风险。研究共确定并纳入了 67 814 名冠心病患者和 583 709 名匹配对照。在平均 15.9(SD ± 12.5)年的随访期间,554 名(0.8%)冠心病患者和 1571 名(0.3%)对照组患者发生了 VTE。冠心病患者发生 VTE 的风险是对照组的 3.3 [95% 置信区间 [CI] 2.6-3.4] 倍。患有冠状动脉缺陷的患者发生 VTE 的风险最高(危险比 7.06,95% CI 5.52-9.03):在这项全国性研究中,我们发现冠心病患者发生 VTE 的风险是匹配对照组的三倍多。病变最复杂的患者发生 VTE 的风险最高。进一步的研究对于明确潜在风险因素和预防冠心病患者 VTE 至关重要。
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引用次数: 0
Revisiting secondary mitral regurgitation threshold severity: insights and lessons from the RESHAPE-HF2 trial. 重新审视继发性二尖瓣反流阈值的严重程度:RESHAPE-HF2 试验的启示和教训。
Pub Date : 2024-10-01 eCollection Date: 2024-09-01 DOI: 10.1093/ehjopen/oeae084
Patrizio Lancellotti, Tadafumi Sugimoto, Magnus Bäck

Aims: This article revisits the severity threshold for secondary mitral regurgitation (MR), focusing on insights and lessons from the RESHAPE-HF2 trial. It aims to challenge the traditional effective regurgitant orifice area (EROA) threshold of ≥0.40 cm2 used for intervention, suggesting that earlier intervention may benefit patients with lower EROA. It also explores how transcatheter edge-to-edge repair (TEER) improves outcomes in patients with secondary MR and assesses the impact of left ventricular (LV) remodeling on treatment success.

Methods and results: The RESHAPE-HF2 trial evaluated the use of TEER in patients with moderate-to-severe secondary MR, comparing outcomes in those with an EROA ≥0.2 cm2 and no extensive LV remodeling. TEER significantly reduced heart failure hospitalizations and improved quality of life in these patients. This supports the notion that patients with less severe MR, who still show symptoms despite optimal medical therapy, may benefit from earlier intervention. Comparisons with COAPT and MITRA-FR trials underscored the importance of selecting patients based on MR severity relative to LV dilatation.

Conclusions: The RESHAPE-HF2 trial highlights the need to reconsider the current EROA threshold for secondary MR intervention. TEER has shown to be beneficial even in patients with lower MR severity, suggesting that earlier intervention could improve outcomes. A more dynamic and integrated approach, considering both MR severity and LV remodeling, is essential for optimizing patient selection and treatment success.

目的:本文重新审视了继发性二尖瓣反流(MR)的严重程度阈值,重点探讨了 RESHAPE-HF2 试验的启示和经验。文章旨在挑战用于干预的有效反流孔面积(EROA)≥0.40 平方厘米的传统阈值,指出早期干预可使EROA较低的患者受益。研究还探讨了经导管边缘到边缘修补术(TEER)如何改善继发性MR患者的预后,并评估了左心室(LV)重塑对治疗成功的影响:RESHAPE-HF2试验评估了TEER在中重度继发性MR患者中的应用,比较了EROA≥0.2 cm2且左心室无广泛重塑的患者的治疗效果。TEER 大大降低了这些患者的心衰住院率,并改善了他们的生活质量。这支持了一种观点,即尽管接受了最佳的药物治疗,但仍有症状的不太严重的 MR 患者可能会从早期干预中获益。与COAPT和MITRA-FR试验的比较强调了根据MR严重程度和左心室扩张程度选择患者的重要性:RESHAPE-HF2试验强调,有必要重新考虑目前二级MR干预的EROA阈值。TEER即使对MR严重程度较低的患者也有益处,这表明早期干预可改善预后。同时考虑 MR 严重程度和左心室重塑的更动态、更综合的方法对于优化患者选择和治疗成功至关重要。
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引用次数: 0
Health-related quality of life with rivaroxaban plus aspirin vs. aspirin alone in chronic stable cardiovascular disease: Cardiovascular Outcomes for People Using Anticoagulation Strategies (COMPASS) trial. 慢性稳定型心血管疾病患者服用利伐沙班加阿司匹林与单用阿司匹林的健康相关生活质量对比:使用抗凝策略者的心血管效果(COMPASS)试验。
Pub Date : 2024-09-27 eCollection Date: 2024-09-01 DOI: 10.1093/ehjopen/oeae083
Feng Xie, Jiajun Yan, John Eikelboom, Sonia Anand, Eva Muehlhofer, Eleanor Pullenayegum, Yang Wang, Alvaro Avezum, Deepak L Bhatt, Salim Yusuf, Jackie Bosch

Aims: This study aimed to compare the effects of the combination of rivaroxaban and aspirin with aspirin alone on health-related quality of life in the Cardiovascular Outcomes for People Using Anticoagulation Strategies (COMPASS) trial.

Methods and results: Health-related quality of life assessed using the EQ-5D-3L. The treatment effects on health utility and EQ visual analogue scale (EQ VAS) scores were compared between rivaroxaban plus aspirin and aspirin alone in terms of adjusted mean difference in change from baseline and odds ratio of having deterioration events. Nine thousand forty-nine (98.9%) and 6916 (75.5%) completed the EQ-5D-3L at baseline and at final visit, respectively. Nine thousand twenty-eight (98.9%) and 6887 (76.3%) completed the EQ-5D-3L at baseline and final visit, respectively. Mean (standard deviation) health utility and EQ VAS scores at baseline were 0.871 (0.141) and 76.0 (15.3), respectively, for the rivaroxaban plus aspirin group, compared with 0.873 (0.139) and 75.8 (15.1) for the aspirin group. Adjusted mean difference in change from baseline utility was -0.002 [95% confidence interval (CI), -0.006, 0.002, P = 0.30] between the combination therapy group and the aspirin group. The odds ratio (95% CI) of experiencing deterioration in health utility was 1.01 (95% CI, 0.93, 1.10, P = 0.81) between the two groups. Adjusted mean difference in change from baseline EQ VAS was 0.02 (95% CI, -0.43, 0.47, P = 0.93) between the two groups.

Conclusion: This analysis of the COMPASS trial demonstrated that the quality of life of patients was similar between the rivaroxaban plus aspirin group and the aspirin alone group.

Registration: Trial registration number: ClinicalTrials.gov number (NCT01776424). Trial protocol and statistical analysis plan: https://www.nejm.org/doi/full/10.1056/NEJMoa1709118#APPNEJMoa1709118PRO.

目的:本研究旨在比较利伐沙班和阿司匹林联合用药与阿司匹林单独用药对使用抗凝策略者心血管结局(COMPASS)试验中健康相关生活质量的影响:使用 EQ-5D-3L 评估健康相关生活质量。比较了利伐沙班加阿司匹林和单用阿司匹林对健康效用和EQ视觉模拟量表(EQ VAS)评分的治疗效果,即与基线相比的调整后平均变化差异和发生恶化事件的几率比率。分别有949人(98.9%)和6916人(75.5%)在基线和最终访问时完成了EQ-5D-3L。九千二百八十八人(98.9%)和六千八百八十七人(76.3%)分别在基线和最终就诊时完成了 EQ-5D-3L。利伐沙班加阿司匹林组基线健康效用和EQ VAS评分的平均值(标准差)分别为0.871(0.141)和76.0(15.3),而阿司匹林组分别为0.873(0.139)和75.8(15.1)。联合疗法组与阿司匹林组之间的基线效用变化调整后平均差异为-0.002 [95% 置信区间 (CI),-0.006,0.002,P = 0.30]。两组间健康效用恶化的几率比(95% CI)为 1.01(95% CI,0.93,1.10,P = 0.81)。两组间 EQ VAS 与基线相比的调整后平均变化差异为 0.02(95% CI,-0.43,0.47,P = 0.93):COMPASS试验的这项分析表明,利伐沙班联合阿司匹林组与单用阿司匹林组患者的生活质量相似:注册:试验注册号:试验注册号:ClinicalTrials.gov 编号(NCT01776424)。试验方案和统计分析计划:https://www.nejm.org/doi/full/10.1056/NEJMoa1709118#APPNEJMoa1709118PRO。
{"title":"Health-related quality of life with rivaroxaban plus aspirin vs. aspirin alone in chronic stable cardiovascular disease: Cardiovascular Outcomes for People Using Anticoagulation Strategies (COMPASS) trial.","authors":"Feng Xie, Jiajun Yan, John Eikelboom, Sonia Anand, Eva Muehlhofer, Eleanor Pullenayegum, Yang Wang, Alvaro Avezum, Deepak L Bhatt, Salim Yusuf, Jackie Bosch","doi":"10.1093/ehjopen/oeae083","DOIUrl":"https://doi.org/10.1093/ehjopen/oeae083","url":null,"abstract":"<p><strong>Aims: </strong>This study aimed to compare the effects of the combination of rivaroxaban and aspirin with aspirin alone on health-related quality of life in the Cardiovascular Outcomes for People Using Anticoagulation Strategies (COMPASS) trial.</p><p><strong>Methods and results: </strong>Health-related quality of life assessed using the EQ-5D-3L. The treatment effects on health utility and EQ visual analogue scale (EQ VAS) scores were compared between rivaroxaban plus aspirin and aspirin alone in terms of adjusted mean difference in change from baseline and odds ratio of having deterioration events. Nine thousand forty-nine (98.9%) and 6916 (75.5%) completed the EQ-5D-3L at baseline and at final visit, respectively. Nine thousand twenty-eight (98.9%) and 6887 (76.3%) completed the EQ-5D-3L at baseline and final visit, respectively. Mean (standard deviation) health utility and EQ VAS scores at baseline were 0.871 (0.141) and 76.0 (15.3), respectively, for the rivaroxaban plus aspirin group, compared with 0.873 (0.139) and 75.8 (15.1) for the aspirin group. Adjusted mean difference in change from baseline utility was -0.002 [95% confidence interval (CI), -0.006, 0.002, <i>P</i> = 0.30] between the combination therapy group and the aspirin group. The odds ratio (95% CI) of experiencing deterioration in health utility was 1.01 (95% CI, 0.93, 1.10, <i>P</i> = 0.81) between the two groups. Adjusted mean difference in change from baseline EQ VAS was 0.02 (95% CI, -0.43, 0.47, <i>P</i> = 0.93) between the two groups.</p><p><strong>Conclusion: </strong>This analysis of the COMPASS trial demonstrated that the quality of life of patients was similar between the rivaroxaban plus aspirin group and the aspirin alone group.</p><p><strong>Registration: </strong>Trial registration number: ClinicalTrials.gov number (NCT01776424). Trial protocol and statistical analysis plan: https://www.nejm.org/doi/full/10.1056/NEJMoa1709118#APPNEJMoa1709118PRO.</p>","PeriodicalId":93995,"journal":{"name":"European heart journal open","volume":"4 5","pages":"oeae083"},"PeriodicalIF":0.0,"publicationDate":"2024-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11495100/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142515234","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}
引用次数: 0
Impact of whole-body and skeletal muscle composition on peak oxygen uptake in heart failure: a systematic review and meta-analysis. 全身和骨骼肌成分对心力衰竭患者峰值摄氧量的影响:系统回顾和荟萃分析。
Pub Date : 2024-09-26 eCollection Date: 2024-09-01 DOI: 10.1093/ehjopen/oeae082
Veronika Schmid, Stephen J Foulkes, Devyn Walesiak, Jing Wang, Corey R Tomczak, Wesley J Tucker, Siddhartha S Angadi, Martin Halle, Mark J Haykowsky

Aims: Heart failure (HF) has a major impact on exercise tolerance that may (in part) be due to abnormalities in body and skeletal muscle composition. This systematic review and meta-analysis aims to assess how differences in whole-body and skeletal muscle composition between patients with HF and non-HF controls (CON) contribute to reduced peak oxygen uptake (VO2peak).

Methods and results: The PubMed database was searched from 1975 to May 2024 for eligible studies. Cross-sectional studies with measures of VO2peak, body composition, or muscle biopsies in HF and CON were considered. Out of 709 articles, 27 studies were included in this analysis. Compared with CON, VO2peak [weighted mean difference (WMD): -9.96 mL/kg/min, 95% confidence interval (CI): -11.71 to -8.21), total body lean mass (WMD: -1.63 kg, 95% CI: -3.05 to -0.21), leg lean mass (WMD: -1.38 kg, 95% CI: -2.18 to -0.59), thigh skeletal muscle area (WMD: -10.88 cm2 , 95% CI: -21.40 to -0.37), Type I fibres (WMD: -7.76%, 95% CI: -14.81 to -0.71), and capillary-to-fibre ratio (WMD: -0.27, 95% CI: -0.50 to -0.03) were significantly lower in HF. Total body fat mass (WMD: 3.34 kg, 95% CI: 0.35-6.34), leg fat mass (WMD: 1.37 kg, 95% CI: 0.37-2.37), and Type IIx fibres (WMD: 7.72%, 95% CI: 1.52-13.91) were significantly higher in HF compared with CON. Absolute VO2peak was significantly associated with total body and leg lean mass, thigh skeletal muscle area, and capillary-to-fibre ratio.

Conclusion: Individuals with HF display abnormalities in body and skeletal muscle composition including reduced lean mass, oxidative Type I fibres, and capillary-to-fibre ratio that negatively impact VO2peak.

目的:心力衰竭(HF)对运动耐量有很大影响,这可能(部分)是由于身体和骨骼肌成分异常造成的。本系统综述和荟萃分析旨在评估心力衰竭患者和非心力衰竭对照组(CON)之间全身和骨骼肌组成的差异如何导致峰值摄氧量(VO2peak)降低:在PubMed数据库中搜索了1975年至2024年5月期间符合条件的研究。研究考虑了对高频和低频患者的VO2peak、身体成分或肌肉活检进行测量的横断面研究。在 709 篇文章中,有 27 项研究被纳入本次分析。与 CON 相比,VO2peak(加权平均差(WMD):-9.96 mL/kg/min,95% 置信区间(CI):-11.71 至 -8.21)、全身瘦体重(WMD:-1.63 kg,95% CI:-3.05 至 -0.21)、腿部瘦体重(WMD:-1.38 kg,95% CI:-2.18至-0.59)、大腿骨骼肌面积(WMD:-10.88平方厘米,95% CI:-21.40至-0.37)、I型纤维(WMD:-7.76%,95% CI:-14.81至-0.71)和毛细血管与纤维比率(WMD:-0.27,95% CI:-0.50至-0.03)均显著低于高血脂患者。与 CON 相比,HF 患者的全身脂肪量(WMD:3.34 千克,95% CI:0.35-6.34)、腿部脂肪量(WMD:1.37 千克,95% CI:0.37-2.37)和 IIx 型纤维(WMD:7.72%,95% CI:1.52-13.91)明显较高。绝对 VO2 峰值与全身和腿部瘦体重、大腿骨骼肌面积以及毛细血管与纤维比率有明显相关性:结论:心房颤动患者的身体和骨骼肌组成存在异常,包括瘦体重、氧化性 I 型纤维和毛细血管与纤维比率减少,这对 VO2 峰产生了负面影响。
{"title":"Impact of whole-body and skeletal muscle composition on peak oxygen uptake in heart failure: a systematic review and meta-analysis.","authors":"Veronika Schmid, Stephen J Foulkes, Devyn Walesiak, Jing Wang, Corey R Tomczak, Wesley J Tucker, Siddhartha S Angadi, Martin Halle, Mark J Haykowsky","doi":"10.1093/ehjopen/oeae082","DOIUrl":"10.1093/ehjopen/oeae082","url":null,"abstract":"<p><strong>Aims: </strong>Heart failure (HF) has a major impact on exercise tolerance that may (in part) be due to abnormalities in body and skeletal muscle composition. This systematic review and meta-analysis aims to assess how differences in whole-body and skeletal muscle composition between patients with HF and non-HF controls (CON) contribute to reduced peak oxygen uptake (VO<sub>2</sub>peak).</p><p><strong>Methods and results: </strong>The PubMed database was searched from 1975 to May 2024 for eligible studies. Cross-sectional studies with measures of VO<sub>2</sub>peak, body composition, or muscle biopsies in HF and CON were considered. Out of 709 articles, 27 studies were included in this analysis. Compared with CON, VO<sub>2</sub>peak [weighted mean difference (WMD): -9.96 mL/kg/min, 95% confidence interval (CI): -11.71 to -8.21), total body lean mass (WMD: -1.63 kg, 95% CI: -3.05 to -0.21), leg lean mass (WMD: -1.38 kg, 95% CI: -2.18 to -0.59), thigh skeletal muscle area (WMD: -10.88 cm<sup>2</sup> , 95% CI: -21.40 to -0.37), Type I fibres (WMD: -7.76%, 95% CI: -14.81 to -0.71), and capillary-to-fibre ratio (WMD: -0.27, 95% CI: -0.50 to -0.03) were significantly lower in HF. Total body fat mass (WMD: 3.34 kg, 95% CI: 0.35-6.34), leg fat mass (WMD: 1.37 kg, 95% CI: 0.37-2.37), and Type IIx fibres (WMD: 7.72%, 95% CI: 1.52-13.91) were significantly higher in HF compared with CON. Absolute VO<sub>2</sub>peak was significantly associated with total body and leg lean mass, thigh skeletal muscle area, and capillary-to-fibre ratio.</p><p><strong>Conclusion: </strong>Individuals with HF display abnormalities in body and skeletal muscle composition including reduced lean mass, oxidative Type I fibres, and capillary-to-fibre ratio that negatively impact VO<sub>2</sub>peak.</p>","PeriodicalId":93995,"journal":{"name":"European heart journal open","volume":"4 5","pages":"oeae082"},"PeriodicalIF":0.0,"publicationDate":"2024-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11505452/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142515235","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}
引用次数: 0
Anticoagulant-related bleeding as a sign of underlying tumoural lesions in patients with atrial fibrillation: a nationwide cohort study. 抗凝剂相关出血是心房颤动患者潜在肿瘤病变的征兆:一项全国性队列研究。
Pub Date : 2024-09-24 eCollection Date: 2024-09-01 DOI: 10.1093/ehjopen/oeae081
Kristiaan Proesmans, Maxim Grymonprez, Sylvie Rottey, Lies Lahousse

Aims: Bleeding events are a well-known complication of oral anticoagulant (OAC) use in patients with atrial fibrillation (AF). While these are undesirable, bleedings could have a warning potential for underlying tumoural lesions. Therefore, we aimed to investigate the association between anticoagulant-related bleeding and newly diagnosed tumoural lesions in a nationwide cohort study.

Methods and results: Using Belgian nationwide data, AF patients without any tumoural lesions were included when initiating OACs between 2013 and 2019. The absolute and relative risks of newly diagnosed tumoural lesions were investigated in OAC users with vs. without an OAC-related bleeding event. Analyses were additionally stratified by tumoural lesion, location-specific bleeding, and OAC type. A total of 230 386 OAC users were included, among whom 35 192 persons were diagnosed with a tumoural lesion during follow-up. Persons with a clinically relevant bleeding during OAC use had a tumoural lesion incidence of 15.33 per 100 person-years compared to an incidence of 5.22 per 100 person-years in persons without bleeding. Site-specific gastrointestinal, urogenital, respiratory, and intracranial bleeding events were respectively associated with a significantly increased risk of incident gastrointestinal [adjusted hazard ratio (aHR) 8.13 (95% confidence interval (CI): 7.08-9.34)], urological [aHR 12.73 (95% CI: 10.56-15.35)], respiratory [aHR 4.91 (95% CI: 3.24-7.44)], and intracranial tumoural lesions [aHR 27.89 (95% CI: 16.53-47.04)].

Conclusion: Bleeding events in AF patients initiated on OAC were associated with an increased risk of tumoural lesions. Therefore, OAC-related bleeding events could unmask an underlying tumoural lesion.

目的:众所周知,心房颤动(房颤)患者使用口服抗凝剂(OAC)会出现出血并发症。虽然这些并发症并不可取,但出血可能对潜在的肿瘤病变具有警示作用。因此,我们旨在通过一项全国性队列研究,调查抗凝剂相关出血与新诊断肿瘤病变之间的关联:利用比利时全国范围内的数据,纳入了在 2013 年至 2019 年期间开始使用 OAC 的无任何肿瘤病变的房颤患者。研究调查了有与无 OAC 相关出血事件的 OAC 使用者新诊断出肿瘤病变的绝对风险和相对风险。此外,还根据肿瘤病变、特定部位出血和 OAC 类型进行了分层分析。共纳入了 230 386 名 OAC 使用者,其中 35 192 人在随访期间确诊为肿瘤病变。在使用 OAC 期间发生临床相关出血的患者,肿瘤病变发生率为每 100 人年 15.33 例,而未发生出血的患者肿瘤病变发生率为每 100 人年 5.22 例。特异性胃肠道、泌尿生殖系统、呼吸系统和颅内出血事件分别与胃肠道事件风险显著增加有关[调整后危险比(aHR)8.13(95% 置信区间(CI):7.08-9.34)]、泌尿系统[aHR 12.73(95% CI:10.56-15.35)]、呼吸系统[aHR 4.91(95% CI:3.24-7.44)]和颅内肿瘤病变[aHR 27.89(95% CI:16.53-47.04)]:结论:开始使用 OAC 的房颤患者发生出血事件与肿瘤病变风险增加有关。因此,与 OAC 相关的出血事件可能会掩盖潜在的肿瘤病变。
{"title":"Anticoagulant-related bleeding as a sign of underlying tumoural lesions in patients with atrial fibrillation: a nationwide cohort study.","authors":"Kristiaan Proesmans, Maxim Grymonprez, Sylvie Rottey, Lies Lahousse","doi":"10.1093/ehjopen/oeae081","DOIUrl":"https://doi.org/10.1093/ehjopen/oeae081","url":null,"abstract":"<p><strong>Aims: </strong>Bleeding events are a well-known complication of oral anticoagulant (OAC) use in patients with atrial fibrillation (AF). While these are undesirable, bleedings could have a warning potential for underlying tumoural lesions. Therefore, we aimed to investigate the association between anticoagulant-related bleeding and newly diagnosed tumoural lesions in a nationwide cohort study.</p><p><strong>Methods and results: </strong>Using Belgian nationwide data, AF patients without any tumoural lesions were included when initiating OACs between 2013 and 2019. The absolute and relative risks of newly diagnosed tumoural lesions were investigated in OAC users with vs. without an OAC-related bleeding event. Analyses were additionally stratified by tumoural lesion, location-specific bleeding, and OAC type. A total of 230 386 OAC users were included, among whom 35 192 persons were diagnosed with a tumoural lesion during follow-up. Persons with a clinically relevant bleeding during OAC use had a tumoural lesion incidence of 15.33 per 100 person-years compared to an incidence of 5.22 per 100 person-years in persons without bleeding. Site-specific gastrointestinal, urogenital, respiratory, and intracranial bleeding events were respectively associated with a significantly increased risk of incident gastrointestinal [adjusted hazard ratio (aHR) 8.13 (95% confidence interval (CI): 7.08-9.34)], urological [aHR 12.73 (95% CI: 10.56-15.35)], respiratory [aHR 4.91 (95% CI: 3.24-7.44)], and intracranial tumoural lesions [aHR 27.89 (95% CI: 16.53-47.04)].</p><p><strong>Conclusion: </strong>Bleeding events in AF patients initiated on OAC were associated with an increased risk of tumoural lesions. Therefore, OAC-related bleeding events could unmask an underlying tumoural lesion.</p>","PeriodicalId":93995,"journal":{"name":"European heart journal open","volume":"4 5","pages":"oeae081"},"PeriodicalIF":0.0,"publicationDate":"2024-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11467691/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142484034","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}
引用次数: 0
Short-term impact of cardiovascular screening by traditional risk assessment or coronary artery calcium score on health-related quality of life: the ROBINSCA trial. 通过传统风险评估或冠状动脉钙化评分进行心血管筛查对健康相关生活质量的短期影响:ROBINSCA 试验。
Pub Date : 2024-09-23 eCollection Date: 2024-09-01 DOI: 10.1093/ehjopen/oeae080
Dana Moldovanu, Harry J de Koning, Marleen Vonder, Jan Willem C Gratama, Henk J Adriaansen, Jeanine E Roeters van Lennep, Rozemarijn Vliegenthart, Pim van der Harst, Richard L Braam, Paul R M van Dijkman, Matthijs Oudkerk, Carlijn M van der Aalst

Aims: Evidence on the impact of screening for cardiovascular diseases (CVDs) on health-related quality of life (HRQoL) is important for policy decisions about screening implementation and to uncover teachable moments to motivate healthy lifestyle choices. It is unknown whether screening by cardiac computed tomography (CT) scan has a stronger impact on HRQoL than screening by traditional risk prediction models. The study aims to investigate differences in HRQoL across the screening process between participants who were randomized to CVD risk estimation by coronary artery calcium score or Systematic COronary Risk Evaluation.

Methods and results: A subset of 2687 ROBINSCA participants filled in questionnaires at (T0) randomization, (T1) invitation, (T2) 1-3 days before screening, (T3) 1-3 days after, and (T4) screening result. Generic HRQoL (SF-12; EQ-5D) and anxiety (STAI-6) were measured. We investigated the differences in changes in HRQoL across the screening process with linear mixed models. We found comparable levels of HRQoL at all screening moments for the two intervention groups. Mental health scores were worse at invitation and randomization than at the later time points, irrespective of screening group (all P < 0.001). A result indicating a heightened CVD risk was associated with increased anxiety in the CT screening group.

Conclusion: Computed tomography screening for CVD risk has no detrimental impact on HRQoL and anxiety levels compared to screening by traditional risk assessment. Receiving an invitation to screenning or a result implying increased CVD risk could function as teachable moments for high-risk individuals.

Registration: ROBINSCA trial registration number: NTR6471 in Dutch Trial Register (NTR).

目的:有关心血管疾病(CVD)筛查对健康相关生活质量(HRQoL)影响的证据对于筛查实施的政策决策以及发现激励人们选择健康生活方式的教学时机非常重要。目前尚不清楚心脏计算机断层扫描(CT)筛查是否比传统风险预测模型筛查对 HRQoL 有更大的影响。本研究旨在调查通过冠状动脉钙化评分或系统性冠状动脉风险评估进行心血管疾病风险评估的随机参与者在整个筛查过程中的 HRQoL 差异:2687名ROBINSCA参与者在随机化(T0)、邀请(T1)、筛查前1-3天(T2)、筛查后1-3天(T3)和筛查结果(T4)时填写了问卷。对一般 HRQoL(SF-12;EQ-5D)和焦虑(STAI-6)进行了测量。我们使用线性混合模型研究了整个筛查过程中 HRQoL 变化的差异。我们发现,两个干预组在所有筛查时刻的 HRQoL 水平相当。无论筛查组别如何,受邀和随机时的心理健康评分都比之后的时间点要差(所有 P <0.001)。CT筛查组的结果表明心血管疾病风险增加与焦虑增加有关:结论:与传统的风险评估筛查相比,计算机断层扫描心血管疾病风险筛查不会对患者的心身健康质量和焦虑水平产生不利影响。收到筛查邀请或筛查结果意味着心血管疾病风险增加,这对高危人群来说是一个可教的时刻:ROBINSCA试验注册号:NTR6471注册:ROBINSCA 试验注册号:NTR6471,荷兰试验注册(NTR)。
{"title":"Short-term impact of cardiovascular screening by traditional risk assessment or coronary artery calcium score on health-related quality of life: the ROBINSCA trial.","authors":"Dana Moldovanu, Harry J de Koning, Marleen Vonder, Jan Willem C Gratama, Henk J Adriaansen, Jeanine E Roeters van Lennep, Rozemarijn Vliegenthart, Pim van der Harst, Richard L Braam, Paul R M van Dijkman, Matthijs Oudkerk, Carlijn M van der Aalst","doi":"10.1093/ehjopen/oeae080","DOIUrl":"https://doi.org/10.1093/ehjopen/oeae080","url":null,"abstract":"<p><strong>Aims: </strong>Evidence on the impact of screening for cardiovascular diseases (CVDs) on health-related quality of life (HRQoL) is important for policy decisions about screening implementation and to uncover teachable moments to motivate healthy lifestyle choices. It is unknown whether screening by cardiac computed tomography (CT) scan has a stronger impact on HRQoL than screening by traditional risk prediction models. The study aims to investigate differences in HRQoL across the screening process between participants who were randomized to CVD risk estimation by coronary artery calcium score or Systematic COronary Risk Evaluation.</p><p><strong>Methods and results: </strong>A subset of 2687 ROBINSCA participants filled in questionnaires at (T0) randomization, (T1) invitation, (T2) 1-3 days before screening, (T3) 1-3 days after, and (T4) screening result. Generic HRQoL (SF-12; EQ-5D) and anxiety (STAI-6) were measured. We investigated the differences in changes in HRQoL across the screening process with linear mixed models. We found comparable levels of HRQoL at all screening moments for the two intervention groups. Mental health scores were worse at invitation and randomization than at the later time points, irrespective of screening group (all <i>P</i> < 0.001). A result indicating a heightened CVD risk was associated with increased anxiety in the CT screening group.</p><p><strong>Conclusion: </strong>Computed tomography screening for CVD risk has no detrimental impact on HRQoL and anxiety levels compared to screening by traditional risk assessment. Receiving an invitation to screenning or a result implying increased CVD risk could function as teachable moments for high-risk individuals.</p><p><strong>Registration: </strong>ROBINSCA trial registration number: NTR6471 in Dutch Trial Register (NTR).</p>","PeriodicalId":93995,"journal":{"name":"European heart journal open","volume":"4 5","pages":"oeae080"},"PeriodicalIF":0.0,"publicationDate":"2024-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11483572/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142484036","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}
引用次数: 0
Performance of D-dimer, cardiac troponin T, C-reactive protein, and NT-proBNP in prediction of long-term mortality in patients with suspected pulmonary embolism. D-二聚体、心肌肌钙蛋白 T、C 反应蛋白和 NT-proBNP在预测疑似肺栓塞患者长期死亡率方面的表现。
Pub Date : 2024-09-20 eCollection Date: 2024-09-01 DOI: 10.1093/ehjopen/oeae079
Juha Kauppi, K E Juhani Airaksinen, Joonas Lehto, Jussi-Pekka Pouru, Juuso Saha, Petra Purola, Samuli Jaakkola, Jarmo Lehtonen, Tuija Vasankari, Markus Juonala, Tuomas Kiviniemi

Aims: Pulmonary embolism (PE) is a common and potentially life-threatening condition requiring emergent diagnostic work-up. Despite wide use of biomarkers, little is known how they predict long-term prognosis of patients evaluated for suspected PE.

Methods and results: We sought to assess the predictive performance of N-terminal pro-brain natriuretic peptide (NT-proBNP), C-reactive protein, fibrin D-dimer (FIDD), and cardiac troponin T (cTnT) in patients who underwent computed tomography pulmonary angiography (CTPA) for clinical suspicion of PE. The analysis involved 1001 patients, with 222 (22.2%) receiving a PE diagnosis at index imaging. Mean ages of patients with and without PE were 65.0 ± 17.1 and 64.5 ± 17.7 years, respectively. Median follow-up time was 3.9 years (interquartile range 2.9-4.9). Mortality was relatively high among both patients with and without documented PE (24.8% vs. 31.7%, P = 0.047). In patients with PE, only elevated NT-proBNP > 1000 ng/L and C-reactive protein > 50 mg/L levels at hospital admission were associated with higher mortality in an adjusted Cox regression model, but receiver operating characteristic (ROC) analysis showed no improved prediction compared to clinical variables. Among patients without PE, elevated NT-proBNP > 1000 ng/L, C-reactive protein > 10 mg/L, cTnT > 50 ng/L, and FIDD > 1.0 mg/L all predicted mortality. In an ROC analysis among patients without PE, models including NT-proBNP, cTnT, or C-reactive protein provided improved predictive performance.

Conclusion: Patients evaluated for clinical suspicion of PE have high long-term mortality. Commonly used biomarkers provide long-term prognostic value in patients without PE. Given the relatively young age, it is vital to identify these high-risk patients and perform differential diagnosis work-up for alternative life-threatening conditions, and manage them as appropriate.

目的:肺栓塞(PE)是一种常见且可能危及生命的疾病,需要进行紧急诊断。尽管生物标志物被广泛使用,但人们对其如何预测疑似肺栓塞患者的长期预后知之甚少:我们试图评估 N 端前脑钠肽 (NT-proBNP)、C 反应蛋白、纤维蛋白 D-二聚体 (FIDD) 和心肌肌钙蛋白 T (cTnT) 对因临床怀疑 PE 而接受计算机断层扫描肺血管造影术 (CTPA) 患者的预测能力。该分析涉及 1001 名患者,其中 222 人(22.2%)在指数成像时得到 PE 诊断。有 PE 和无 PE 患者的平均年龄分别为 65.0 ± 17.1 岁和 64.5 ± 17.7 岁。中位随访时间为 3.9 年(四分位间范围为 2.9-4.9)。有记录和无记录 PE 患者的死亡率都相对较高(24.8% vs. 31.7%,P = 0.047)。在 PE 患者中,在调整后的 Cox 回归模型中,只有入院时升高的 NT-proBNP > 1000 ng/L 和 C 反应蛋白 > 50 mg/L 水平与较高的死亡率相关,但接受者操作特征(ROC)分析显示,与临床变量相比,预测效果并无改善。在无 PE 的患者中,NT-proBNP 升高 > 1000 ng/L、C 反应蛋白 > 10 mg/L、cTnT > 50 ng/L 和 FIDD > 1.0 mg/L 均可预测死亡率。在对无 PE 患者进行的 ROC 分析中,包括 NT-proBNP、cTnT 或 C 反应蛋白在内的模型可提高预测性能:结论:因临床怀疑 PE 而接受评估的患者长期死亡率很高。结论:因临床怀疑 PE 而接受评估的患者的长期死亡率很高。常用的生物标志物对无 PE 的患者具有长期预后价值。鉴于这些患者年龄相对较小,因此必须识别这些高危患者,对其他危及生命的疾病进行鉴别诊断,并酌情处理。
{"title":"Performance of D-dimer, cardiac troponin T, C-reactive protein, and NT-proBNP in prediction of long-term mortality in patients with suspected pulmonary embolism.","authors":"Juha Kauppi, K E Juhani Airaksinen, Joonas Lehto, Jussi-Pekka Pouru, Juuso Saha, Petra Purola, Samuli Jaakkola, Jarmo Lehtonen, Tuija Vasankari, Markus Juonala, Tuomas Kiviniemi","doi":"10.1093/ehjopen/oeae079","DOIUrl":"https://doi.org/10.1093/ehjopen/oeae079","url":null,"abstract":"<p><strong>Aims: </strong>Pulmonary embolism (PE) is a common and potentially life-threatening condition requiring emergent diagnostic work-up. Despite wide use of biomarkers, little is known how they predict long-term prognosis of patients evaluated for suspected PE.</p><p><strong>Methods and results: </strong>We sought to assess the predictive performance of N-terminal pro-brain natriuretic peptide (NT-proBNP), C-reactive protein, fibrin D-dimer (FIDD), and cardiac troponin T (cTnT) in patients who underwent computed tomography pulmonary angiography (CTPA) for clinical suspicion of PE. The analysis involved 1001 patients, with 222 (22.2%) receiving a PE diagnosis at index imaging. Mean ages of patients with and without PE were 65.0 ± 17.1 and 64.5 ± 17.7 years, respectively. Median follow-up time was 3.9 years (interquartile range 2.9-4.9). Mortality was relatively high among both patients with and without documented PE (24.8% vs. 31.7%, <i>P</i> = 0.047). In patients with PE, only elevated NT-proBNP > 1000 ng/L and C-reactive protein > 50 mg/L levels at hospital admission were associated with higher mortality in an adjusted Cox regression model, but receiver operating characteristic (ROC) analysis showed no improved prediction compared to clinical variables. Among patients without PE, elevated NT-proBNP > 1000 ng/L, C-reactive protein > 10 mg/L, cTnT > 50 ng/L, and FIDD > 1.0 mg/L all predicted mortality. In an ROC analysis among patients without PE, models including NT-proBNP, cTnT, or C-reactive protein provided improved predictive performance.</p><p><strong>Conclusion: </strong>Patients evaluated for clinical suspicion of PE have high long-term mortality. Commonly used biomarkers provide long-term prognostic value in patients without PE. Given the relatively young age, it is vital to identify these high-risk patients and perform differential diagnosis work-up for alternative life-threatening conditions, and manage them as appropriate.</p>","PeriodicalId":93995,"journal":{"name":"European heart journal open","volume":"4 5","pages":"oeae079"},"PeriodicalIF":0.0,"publicationDate":"2024-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11467688/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142484035","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}
引用次数: 0
Epicardial adipose tissue and muscle distribution affect outcomes in very old patients after transcatheter aortic valve replacement. 心外膜脂肪组织和肌肉分布影响经导管主动脉瓣置换术后高龄患者的预后。
Pub Date : 2024-09-20 eCollection Date: 2024-09-01 DOI: 10.1093/ehjopen/oeae073
Susanne Rohrbach, Oezge Uluocak, Marieke Junge, Fabienne Knapp, Rainer Schulz, Andreas Böning, Holger M Nef, Gabriele A Krombach, Bernd Niemann

Aims: To analyse the relevance of body composition and blood markers for long-term outcomes in very old patients after transcatheter aortic valve replacement (TAVR).

Methods and results: A total of 403 very old patients were characterized with regard to subcutaneous, visceral, and epicardial fat, psoas muscle area, plasma growth differentiation factor 15 (GDF-15), and leptin. Cohorts grouped by body mass index (BMI) were analysed for long-term outcomes. Patients underwent transapical and transfemoral TAVR (similar 30-day/1-year survival). Body mass index >35 kg/m2 showed increased 2- and 3-year mortality compared with BMI 25-34.9 kg/m2 but not compared with BMI <25 kg/m2. Fat areas correlated positively to BMI (epicardial: R 2 = 0.05, P < 0.01; visceral: R 2 = 0.20, P < 0.001; subcutaneous: R 2 = 0.13, P < 0.001). Increased epicardial or visceral but not subcutaneous fat area resulted in higher long-term mortality. Patients with high BMI (1781.3 mm2 ± 75.8, P < 0.05) and lean patients (1729.4 ± 52.8, P < 0.01) showed lower psoas muscle area compared with those with mildly elevated BMI (2055.2 ± 91.7). Reduced psoas muscle area and increased visceral fat and epicardial fat areas were independent predictors of long-term mortality. The levels of serum GDF-15 were the highest in BMI >40 kg/m2 (2793.5 pg/mL ± 123.2) vs. BMI <25 kg/m2 (2017.6 pg/mL ±130.8), BMI 25-30 kg/m2 (1881.8 pg/mL ±127.4), or BMI 30-35 kg/m2 (2054.2 pg/mL ±124.1, all P < 0.05). Increased GDF-15 level predicted mortality (2587 pg/mL, area under the receiver operating characteristic curve 0.94). Serum leptin level increased with BMI without predictive value for long-term mortality.

Conclusion: Morbidly visceral and epicardial fat accumulation, reduction in muscle area, and GDF-15 increase are strong predictors of adverse outcomes in very old patients post-TAVR.

目的:分析经导管主动脉瓣置换术(TAVR)后高龄患者的身体成分和血液指标与长期预后的相关性:共对 403 名高龄患者的皮下脂肪、内脏脂肪和心外膜脂肪、腰肌面积、血浆生长分化因子 15 (GDF-15) 和瘦素进行了特征描述。对按体重指数(BMI)分组的组群进行了长期结果分析。患者接受了经心尖和经股动脉 TAVR(30 天/1 年存活率相似)。与体重指数为 25-34.9 kg/m2 的患者相比,体重指数大于 35 kg/m2 的患者 2 年和 3 年死亡率增加,但与体重指数为 2 的患者相比则没有增加:R 2 = 0.05,P < 0.01;内脏:内脏:R 2 = 0.20,P < 0.001;皮下:R 2 = 0.13,P < 0.001:R 2 = 0.13,P < 0.001)。心外膜或内脏脂肪面积增加会导致长期死亡率升高,而皮下脂肪面积增加则不会。与体重指数轻度升高的患者(2055.2 ± 91.7)相比,体重指数高的患者(1781.3 mm2 ± 75.8,P < 0.05)和瘦弱的患者(1729.4 ± 52.8,P < 0.01)腰肌面积较小。腰肌面积减少、内脏脂肪和心外膜脂肪面积增加是长期死亡率的独立预测因素。BMI >40 kg/m2(2793.5 pg/mL ± 123.2)与 BMI 2(2017.6 pg/mL ± 130.8)、BMI 25-30 kg/m2(1881.8 pg/mL ± 127.4)或 BMI 30-35 kg/m2(2054.2 pg/mL ± 124.1,所有 P <0.05)相比,血清 GDF-15 水平最高。GDF-15 水平升高可预测死亡率(2587 pg/mL,接收器操作特征曲线下面积为 0.94)。血清瘦素水平随体重指数升高而升高,但对长期死亡率无预测价值:结论:病态的内脏和心外膜脂肪堆积、肌肉面积减少以及GDF-15的增加是TAVR术后高龄患者不良预后的有力预测因素。
{"title":"Epicardial adipose tissue and muscle distribution affect outcomes in very old patients after transcatheter aortic valve replacement.","authors":"Susanne Rohrbach, Oezge Uluocak, Marieke Junge, Fabienne Knapp, Rainer Schulz, Andreas Böning, Holger M Nef, Gabriele A Krombach, Bernd Niemann","doi":"10.1093/ehjopen/oeae073","DOIUrl":"10.1093/ehjopen/oeae073","url":null,"abstract":"<p><strong>Aims: </strong>To analyse the relevance of body composition and blood markers for long-term outcomes in very old patients after transcatheter aortic valve replacement (TAVR).</p><p><strong>Methods and results: </strong>A total of 403 very old patients were characterized with regard to subcutaneous, visceral, and epicardial fat, psoas muscle area, plasma growth differentiation factor 15 (GDF-15), and leptin. Cohorts grouped by body mass index (BMI) were analysed for long-term outcomes. Patients underwent transapical and transfemoral TAVR (similar 30-day/1-year survival). Body mass index >35 kg/m<sup>2</sup> showed increased 2- and 3-year mortality compared with BMI 25-34.9 kg/m<sup>2</sup> but not compared with BMI <25 kg/m<sup>2</sup>. Fat areas correlated positively to BMI (epicardial: <i>R</i> <sup>2</sup> = 0.05, <i>P</i> < 0.01; visceral: <i>R</i> <sup>2</sup> = 0.20, <i>P</i> < 0.001; subcutaneous: <i>R</i> <sup>2</sup> = 0.13, <i>P</i> < 0.001). Increased epicardial or visceral but not subcutaneous fat area resulted in higher long-term mortality. Patients with high BMI (1781.3 mm<sup>2</sup> ± 75.8, <i>P</i> < 0.05) and lean patients (1729.4 ± 52.8, <i>P</i> < 0.01) showed lower psoas muscle area compared with those with mildly elevated BMI (2055.2 ± 91.7). Reduced psoas muscle area and increased visceral fat and epicardial fat areas were independent predictors of long-term mortality. The levels of serum GDF-15 were the highest in BMI >40 kg/m<sup>2</sup> (2793.5 pg/mL ± 123.2) vs. BMI <25 kg/m<sup>2</sup> (2017.6 pg/mL ±130.8), BMI 25-30 kg/m<sup>2</sup> (1881.8 pg/mL ±127.4), or BMI 30-35 kg/m<sup>2</sup> (2054.2 pg/mL ±124.1, all <i>P</i> < 0.05). Increased GDF-15 level predicted mortality (2587 pg/mL, area under the receiver operating characteristic curve 0.94). Serum leptin level increased with BMI without predictive value for long-term mortality.</p><p><strong>Conclusion: </strong>Morbidly visceral and epicardial fat accumulation, reduction in muscle area, and GDF-15 increase are strong predictors of adverse outcomes in very old patients post-TAVR.</p>","PeriodicalId":93995,"journal":{"name":"European heart journal open","volume":"4 5","pages":"oeae073"},"PeriodicalIF":0.0,"publicationDate":"2024-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11414403/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142304542","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}
引用次数: 0
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European heart journal open
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