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Diagnostic value of left ventricular layer strain and specific regional strain patterns in cardiac amyloidosis and Fabry disease 左心室层应变和特定区域应变模式在心脏淀粉样变性病和法布里病中的诊断价值
Pub Date : 2024-05-22 DOI: 10.1093/ehjopen/oeae041
Tilman Steudel, Gina Barzen, D. Frumkin, Elena Romero-Dorta, Sebastian Spethmann, Gerhard Hindricks, Karl Stangl, Fabian Knebel, Bettina Heidecker, Sima Canaan-Kühl, Helena Franziska Pernice, K. Hahn, I. Mattig, Anna Brand
Layer-specific left ventricular (LV) strain alterations have been suggested as a specific finding in Fabry Disease (FD). Our study aimed to assess the diagnostic value of layer specific radial strain (RS) indices compared to the established LV regional strain pattern in Cardiac Amyloidosis (CA) and FD, i.e. apical sparing, and posterolateral strain deficiency. We retrospectively analyzed the global, subendocardial, subepicardial LV radial strain, the corresponding strain gradient, as well as the regional and global longitudinal strain. The diagnostic accuracy of the diverse LV strain analyses was comparatively assessed using receiver operating curve (ROC) and multivariable regression analyses. In 40 FD and 76 CA patients, CA featured more reduced layer strain values [Global RS -12.3 (-15.6 to -9.6) in CA vs. -16.7 (-20.0 to-13.6) in FD; p < 0.001; subendocardial RS -22.3 (-27.4 to -15.9) vs. -28.3 (-31.8 to -23.6), p < 0.001; subepicardial RS -6.6 (-8.6 to -4.7) in CA vs. -8.9 (-11.7 to- 6.5 in FD; p < 0.001]. Global radial and longitudinal strain held an AUC of 0.75 (0.66 to 0.84) and AUC 0.73 (0.63 to 0.83). While the apical sparing and PLSD strain pattern showed the highest accuracy as single parameters [AUC 0.87 (0.79 to 0.95) and 0.81 (0.72 to 0.89), p < 0.001], the combination of subendocardial RS and the apical sparing pattern featured the highest diagnostic accuracy [AUC 0.92 (0.87 to 0.97)]. Combining radial strain derived parameters to the established strain pattern apical sparing and PLSD improve the diagnostic accuracy in the echocardiographic assessment in suspected storage disease.
法布里病(Fabry Disease,FD)的特异性左心室(LV)应变改变被认为是一种特异性发现。我们的研究旨在评估各层特异性径向应变(RS)指数与心脏淀粉样变性(CA)和法布里病已确立的左心室区域应变模式(即心尖稀疏和后外侧应变缺乏)相比的诊断价值。 我们回顾性分析了整体、心内膜下、心外膜下左心室径向应变、相应的应变梯度以及区域和整体纵向应变。利用接收器操作曲线(ROC)和多变量回归分析比较评估了各种左心室应变分析的诊断准确性。在40例FD和76例CA患者中,CA患者的层应变值更低[CA患者的全层RS为-12.3(-15.6至-9.6),而FD患者为-16.7(-20.0至-13.6);P < 0.001; 心内膜下 RS -22.3 (-27.4 to -15.9) vs. -28.3 (-31.8 to -23.6), p < 0.001; 心外膜下 RS -6.6 (-8.6 to -4.7) in CA vs. -8.9 (-11.7 to -6.5 in FD; p < 0.001]。全球径向和纵向应变的 AUC 分别为 0.75(0.66 至 0.84)和 0.73(0.63 至 0.83)。心尖疏松和 PLSD 应变模式作为单一参数显示出最高的准确性[AUC 0.87(0.79 至 0.95)和 0.81(0.72 至 0.89),p < 0.001],而心内膜下 RS 和心尖疏松模式的组合则显示出最高的诊断准确性[AUC 0.92(0.87 至 0.97)]。 将径向应变衍生参数与已建立的应变模式心尖疏松和 PLSD 相结合,可提高疑似储层疾病超声心动图评估的诊断准确性。
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引用次数: 0
Assessing Pressure Wave Components for Aortic Stiffness Monitoring through Spectral Regression Learning 通过频谱回归学习评估主动脉僵硬度监测的压力波成分
Pub Date : 2024-05-21 DOI: 10.1093/ehjopen/oeae040
Arian Aghilinejad, Morteza Gharib
The aging process notably induces structural changes in the arterial system, primarily manifesting as increased aortic stiffness, a precursor to cardiovascular events. While wave separation analysis is a robust tool for decomposing the components of blood pressure waveform, its relationship with cardiovascular events, such as aortic stiffening, is incompletely understood. Furthermore, its applicability has been limited due to the need for concurrent measurements of pressure and flow. Our aim in this study addresses this gap by introducing a spectral regression learning method for pressure-only wave separation analysis. Leveraging data from the Framingham Heart Study (2,640 individuals, 55% women), we evaluate the accuracy of pressure-only estimates, their interchangeability with reference method based on ultrasound-derived flow waves, and their association with Carotid-femoral pulse wave velocity. Method-derived estimates are strongly correlated with the reference ones for forward wave amplitude (R2=0.91), backward wave amplitude (R2=0.88), reflection index (R2=0.87), and moderately correlated with time delay between forward and backward waves (R2=0.38). The proposed pressure-only method shows interchangeability with reference method through covariate analysis. Adjusting for age, sex, body size, mean blood pressure, and heart rate, results suggest that both pressure-only and pressure-flow evaluations of wave separation parameters yield similar model performance for predicting Carotid-femoral pulse wave velocity with forward wave amplitude as the only significant factor (p < 0.001; 95% confidence interval, 0.056-0.097). We propose an interchangeable pressure-only wave separation analysis method and demonstrate its clinical applicability in capturing aortic stiffening. The proposed method provides valuable non-invasive tool for assessing cardiovascular health.
衰老过程会明显诱发动脉系统的结构变化,主要表现为主动脉僵化,这是心血管事件的前兆。虽然波形分离分析是分解血压波形成分的有力工具,但其与心血管事件(如主动脉僵化)之间的关系尚未完全明了。此外,由于需要同时测量血压和血流,其适用性也受到了限制。我们在这项研究中引入了光谱回归学习方法,用于纯压力波分离分析,从而弥补了这一不足。 利用弗雷明汉心脏研究(2,640 人,55% 为女性)的数据,我们评估了纯压力估计值的准确性、其与基于超声波衍生流动波的参考方法的互换性,以及其与颈动脉-股动脉脉搏波速度的关联性。在前向波振幅(R2=0.91)、后向波振幅(R2=0.88)和反射指数(R2=0.87)方面,该方法得出的估计值与参考值有很强的相关性,而与前向波和后向波之间的时间延迟(R2=0.38)有中度相关性。通过协变量分析,拟议的纯压力方法与参考方法具有互换性。调整年龄、性别、体型、平均血压和心率后,结果表明,在预测颈动脉-股动脉脉搏波速度时,纯压力和压力-流量评估波分离参数的模型性能相似,前向波振幅是唯一显著的因素(p < 0.001;95% 置信区间,0.056-0.097)。 我们提出了一种可互换的纯压力波分离分析方法,并证明了它在捕捉主动脉僵化方面的临床适用性。所提出的方法为评估心血管健康提供了有价值的无创工具。
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引用次数: 0
Sex-specific cardiac magnetic resonance pulmonary capillary wedge pressure. 心脏磁共振肺毛细血管楔压的性别特异性。
Pub Date : 2024-05-15 eCollection Date: 2024-05-01 DOI: 10.1093/ehjopen/oeae038
Pankaj Garg, Ciaran Grafton-Clarke, Gareth Matthews, Peter Swoboda, Liang Zhong, Nay Aung, Ross Thomson, Samer Alabed, Ahmet Demirkiran, Vassilios S Vassiliou, Andrew J Swift

Aims: Heart failure (HF) with preserved ejection fraction disproportionately affects women. There are no validated sex-specific tools for HF diagnosis despite widely reported differences in cardiac structure. This study investigates whether sex, as assigned at birth, influences cardiac magnetic resonance (CMR) assessment of left ventricular filling pressure (LVFP), a hallmark of HF agnostic to ejection fraction.

Methods and results: A derivation cohort of patients with suspected pulmonary hypertension and HF from the Sheffield centre underwent invasive right heart catheterization and CMR within 24 h of each other. A sex-specific CMR model to estimate LVFP, measured as pulmonary capillary wedge pressure (PCWP), was developed using multivariable regression. A validation cohort of patients with confirmed HF from the Leeds centre was used to evaluate for the primary endpoints of HF hospitalization and major adverse cardiovascular events (MACEs). Comparison between generic and sex-specific CMR-derived PCWP was undertaken. A total of 835 (60% female) and 454 (36% female) patients were recruited into the derivation and validation cohorts respectively. A sex-specific model incorporating left atrial volume and left ventricular mass was created. The generic CMR PCWP showed significant differences between males and females (14.7 ± 4 vs. 13 ± 3.0 mmHg, P > 0.001), not present with the sex-specific CMR PCWP (14.1 ± 3 vs. 13.8 mmHg, P = 0.3). The sex-specific, but not the generic, CMR PCWP was associated with HF hospitalization (hazard ratio 3.9, P = 0.0002) and MACE (hazard ratio 2.5, P = 0.001) over a mean follow-up period of 2.4 ± 1.2 years.

Conclusion: Accounting for sex improves precision and prognostic performance of CMR biomarkers for HF.

目的:射血分数保留型心力衰竭(HF)对女性的影响尤为严重。尽管广泛报道了心脏结构的差异,但目前还没有有效的性别特异性工具来诊断心力衰竭。本研究调查了出生时的性别是否会影响心脏磁共振(CMR)对左心室充盈压(LVFP)的评估,左心室充盈压是与射血分数无关的心力衰竭的标志:谢菲尔德中心的疑似肺动脉高压和心房颤动患者衍生队列在 24 小时内分别接受了有创右心导管检查和 CMR 检查。使用多变量回归法建立了一个性别特异性 CMR 模型来估算 LVFP(以肺毛细血管楔压(PCWP)测量)。利兹中心的确诊心房颤动患者组成的验证队列用于评估心房颤动住院和主要不良心血管事件(MACE)的主要终点。比较了通用和性别特异性 CMR 派生 PCWP。推导组和验证组分别共招募了 835 名(60% 为女性)和 454 名(36% 为女性)患者。建立了一个包含左心房容积和左心室质量的性别特异性模型。通用 CMR PCWP 显示男性和女性之间存在显著差异(14.7 ± 4 vs. 13 ± 3.0 mmHg,P > 0.001),而性别特异性 CMR PCWP 则不存在这种差异(14.1 ± 3 vs. 13.8 mmHg,P = 0.3)。在平均2.4 ± 1.2年的随访期间,性别特异性CMR PCWP与HF住院(危险比为3.9,P = 0.0002)和MACE(危险比为2.5,P = 0.001)相关,而一般CMR PCWP与HF住院(危险比为3.9,P = 0.0002)和MACE(危险比为2.5,P = 0.001)无关:结论:考虑性别因素可提高心房颤动CMR生物标志物的精确度和预后性能。
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引用次数: 0
Medical treatment of heart failure with RAS inhibitors and beta blockers in aortic stenosis – association to long-term outcome after aortic valve replacement 主动脉瓣狭窄患者使用 RAS 抑制剂和β受体阻滞剂治疗心力衰竭--与主动脉瓣置换术后的长期预后有关
Pub Date : 2024-05-09 DOI: 10.1093/ehjopen/oeae039
Johan Hopfgarten, Stefan James, L. Lindhagen, T. Baron, Elisabeth Ståhle, C. Christersson
There is a lack of robust data on optimal medical treatment of heart failure in patients with severe aortic stenosis, with no randomized controlled trials guiding treatment. To study the association between exposure to renin-angiotensin-aldosterone system (RAS) inhibitors or beta-blockers and outcome after aortic valve replacement in patients with aortic stenosis and heart failure. The study included all patients with heart failure undergoing aortic valve replacement for aortic stenosis in Sweden between 2008-2016 (n = 4668 patients). Exposure to treatment was assessed by continuous tracking of drug dispensations and outcome events were all-cause mortality and hospitalization for heart failure collected from national patient registries. After adjustment for age, sex, atrial fibrillation, hypertension, diabetes mellitus and prior myocardial infarction Cox regression analysis showed that RAS inhibition was associated with a lower risk of all-cause mortality in patients with reduced LV-EF (HR 0.58, 95% CI 0.51 - 0.65) and preserved LV-EF (HR 0.69, 95% CI 0.56 - 0.85). Beta-blockade was associated with a lower risk of all-cause mortality in patients with reduced LV-EF (HR 0.81, 95% CI 0.71–0.92), but not in preserved LV-EF (HR 0.87, 95% CI 0.69 - 1.10). There was no association between RAS inhibition or beta-blockade and the risk of hospitalization for heart failure. RAS inhibition was associated with lower all-cause mortality after valve replacement in patients with both reduced and preserved LV-EF. Beta-blockade was associated with lower all-cause mortality only in patients with reduced LV-EF.
目前缺乏关于重度主动脉瓣狭窄患者心力衰竭最佳治疗方法的可靠数据,也没有指导治疗的随机对照试验。 研究主动脉瓣狭窄和心力衰竭患者主动脉瓣置换术后肾素-血管紧张素-醛固酮系统(RAS)抑制剂或β-受体阻滞剂的暴露与预后之间的关系。 该研究纳入了2008-2016年间在瑞典因主动脉瓣狭窄而接受主动脉瓣置换术的所有心衰患者(n = 4668名患者)。通过对配药情况的连续跟踪评估治疗暴露情况,结果事件为全因死亡率和因心力衰竭住院,这些数据均来自全国患者登记处。在对年龄、性别、心房颤动、高血压、糖尿病和既往心肌梗死进行调整后,考克斯回归分析表明,RAS 抑制与 LV-EF 降低(HR 0.58,95% CI 0.51 - 0.65)和 LV-EF 保持(HR 0.69,95% CI 0.56 - 0.85)患者的全因死亡风险降低相关。在 LV-EF 降低的患者中,β-受体阻滞与较低的全因死亡风险相关(HR 0.81,95% CI 0.71-0.92),但在 LV-EF 保持的患者中,β-受体阻滞与较低的全因死亡风险无关(HR 0.87,95% CI 0.69 - 1.10)。RAS抑制或β-受体阻滞与心衰住院风险之间没有关联。 RAS抑制与LV-EF降低或保留的患者瓣膜置换术后全因死亡率降低有关。只有 LV-EF 降低的患者服用β-受体阻滞剂才会降低全因死亡率。
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引用次数: 0
Gene Expression and Ultrastructural Evidence for Metabolic Derangement in the Primary Mitral Regurgitation Heart 原发性二尖瓣反流心脏代谢紊乱的基因表达和超微结构证据
Pub Date : 2024-05-01 DOI: 10.1093/ehjopen/oeae034
Mariame Selma Kane, J. X. M. Juncos, S. Manzoor, Maximiliano Grenett, Joo-Yeun Oh, Betty Pat, Mustafa I Ahmed, Clifton Lewis, James E Davies, Thomas S. Denney, Jonathan McConathy, Louis J. Dell'Italia
Chronic neurohormonal activation and hemodynamic load cause derangement in myocardial substrate utilization. We test the hypothesis that the primary mitral regurgitation heart (PMR) heart shows altered metabolic gene profile and cardiac ultrastructure consistent with decreased fatty acid and glucose metabolism despite LVEF > 60%. Metabolic gene expression in right atrial (RA), left atrial (LA), and left ventricular (LV) biopsies from donor hearts (n = 10) and from patients with moderate to severe PMR (n = 11) at surgery showed decreased mRNA glucose transporter type 4 (GLUT-4), GLUT-1 and insulin receptor substrate 2 and increased mRNA hexokinase 2, O-linked N-acetylglucosamine transferase and O-GlcNAcase, rate-limiting steps in the hexosamine biosynthetic pathway. Pericardial fluid levels of Neuropeptide Y were 4-fold higher than simultaneous plasma indicative of increased sympathetic drive. Quantitative TEM shows glycogen accumulation, glycophagy, increased lipid droplets, and mitochondrial cristae lysis. These findings are associated with increased mRNA for glycogen synthase kinase 3β, decreased carnitine palmitoyl transferase 2, and fatty acid synthase in PMR vs. normals. Cardiac magnetic resonance/positron emission tomography for 2-deoxy-2-[18F]fluoro-D-glucose ([18F]FDG) uptake showed decreased LV [18F]FDG uptake and increased plasma HbA1c, free fatty acids, mtDAMPs in a separate cohort of stable moderate PMR patients with LVEF > 60% (n = 8) vs. normal controls (n = 8). The PMR heart has a global ultrastructural and metabolic gene expression pattern of decreased glucose uptake along with increased glycogen and lipid droplets. Further studies must determine whether this presentation is an adaptation or maladaptation in the PMR heart in the clinical evaluation of PMR.
慢性神经激素激活和血流动力学负荷会导致心肌底物利用失调。我们验证了一个假设,即原发性二尖瓣反流心脏(PMR)尽管 LVEF > 60%,但其代谢基因谱和心脏超微结构会发生改变,与脂肪酸和葡萄糖代谢下降相一致。 手术时,供体心脏(10 例)和中重度 PMR 患者(11 例)的右心房(RA)、左心房(LA)和左心室(LV)活检组织中的代谢基因表达显示,mRNA 葡萄糖转运体 4 型(GLUT-4)减少、葡萄糖转运体 4 型(GLUT-4)、GLUT-1 和胰岛素受体底物 2 的 mRNA 减少,而六氨肽生物合成途径中的限速步骤--己糖激酶 2、O-连接的 N-乙酰葡糖胺转移酶和 O-GlcNA 酶的 mRNA 增加。心包液中神经肽 Y 的水平比同时血浆中的水平高出 4 倍,表明交感神经驱动力增强。定量 TEM 显示糖原累积、糖吞噬、脂滴增加和线粒体嵴裂解。与正常人相比,这些发现与PMR中糖原合酶激酶3β的mRNA增加、肉碱棕榈酰转移酶2和脂肪酸合酶减少有关。心脏磁共振/正电子发射断层扫描检测2-脱氧-2-[18F]氟-D-葡萄糖([18F]FDG)摄取量显示,在一组LVEF大于60%的稳定中度PMR患者(n = 8)与正常对照组(n = 8)中,左心室[18F]FDG摄取量减少,血浆HbA1c、游离脂肪酸、mtDAMPs增加。 PMR 心脏的整体超微结构和代谢基因表达模式为葡萄糖摄取减少,糖原和脂滴增加。在对 PMR 进行临床评估时,必须进一步研究确定这种表现是 PMR 心脏的适应性还是适应性不良。
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引用次数: 0
Drug-target Mendelian randomization analysis supports lowering plasma ANGPTL3, ANGPTL4, and APOC3 levels as strategies for reducing cardiovascular disease risk. 药物靶点孟德尔随机分析支持将降低血浆 ANGPTL3、ANGPTL4 和 APOC3 水平作为降低心血管疾病风险的策略。
Pub Date : 2024-04-30 eCollection Date: 2024-05-01 DOI: 10.1093/ehjopen/oeae035
Fredrik Landfors, Peter Henneman, Elin Chorell, Stefan K Nilsson, Sander Kersten

Aims: APOC3, ANGPTL3, and ANGPTL4 are circulating proteins that are actively pursued as pharmacological targets to treat dyslipidaemia and reduce the risk of atherosclerotic cardiovascular disease. Here, we used human genetic data to compare the predicted therapeutic and adverse effects of APOC3, ANGPTL3, and ANGPTL4 inactivation.

Methods and results: We conducted drug-target Mendelian randomization analyses using variants in proximity to the genes associated with circulating protein levels to compare APOC3, ANGPTL3, and ANGPTL4 as drug targets. We obtained exposure and outcome data from large-scale genome-wide association studies and used generalized least squares to correct for linkage disequilibrium-related correlation. We evaluated five primary cardiometabolic endpoints and screened for potential side effects across 694 disease-related endpoints, 43 clinical laboratory tests, and 11 internal organ MRI measurements. Genetically lowering circulating ANGPTL4 levels reduced the odds of coronary artery disease (CAD) [odds ratio, 0.57 per s.d. protein (95% CI 0.47-0.70)] and Type 2 diabetes (T2D) [odds ratio, 0.73 per s.d. protein (95% CI 0.57-0.94)]. Genetically lowering circulating APOC3 levels also reduced the odds of CAD [odds ratio, 0.90 per s.d. protein (95% CI 0.82-0.99)]. Genetically lowered ANGPTL3 levels via common variants were not associated with CAD. However, meta-analysis of protein-truncating variants revealed that ANGPTL3 inactivation protected against CAD (odds ratio, 0.71 per allele [95%CI, 0.58-0.85]). Analysis of lowered ANGPTL3, ANGPTL4, and APOC3 levels did not identify important safety concerns.

Conclusion: Human genetic evidence suggests that therapies aimed at reducing circulating levels of ANGPTL3, ANGPTL4, and APOC3 reduce the risk of CAD. ANGPTL4 lowering may also reduce the risk of T2D.

目的:APOC3、ANGPTL3 和 ANGPTL4 是循环蛋白,作为治疗血脂异常和降低动脉粥样硬化性心血管疾病风险的药物靶点,它们正受到积极的关注。在此,我们利用人类基因数据比较了 APOC3、ANGPTL3 和 ANGPTL4 失活的预期治疗效果和不良反应:我们利用与循环蛋白水平相关的基因附近的变异进行了药物靶点孟德尔随机分析,以比较作为药物靶点的APOC3、ANGPTL3和ANGPTL4。我们从大规模全基因组关联研究中获得了暴露和结果数据,并使用广义最小二乘法校正了与连锁不平衡相关的相关性。我们评估了五个主要心脏代谢终点,并筛查了 694 个疾病相关终点、43 个临床实验室测试和 11 个内部器官核磁共振成像测量的潜在副作用。通过基因降低循环ANGPTL4水平可降低冠状动脉疾病(CAD)[几率比,每s.d.蛋白0.57(95% CI 0.47-0.70)]和2型糖尿病(T2D)[几率比,每s.d.蛋白0.73(95% CI 0.57-0.94)]。通过基因降低循环中 APOC3 的水平也会降低患 CAD 的几率[几率比,每 s.d. 蛋白 0.90(95% CI 0.82-0.99)]。通过常见变异基因降低 ANGPTL3 水平与 CAD 无关。然而,对蛋白截断变异的荟萃分析表明,ANGPTL3 失活可预防 CAD(每个等位基因的几率为 0.71 [95%CI,0.58-0.85])。对ANGPTL3、ANGPTL4和APOC3水平降低的分析没有发现重要的安全性问题:人类遗传学证据表明,旨在降低ANGPTL3、ANGPTL4和APOC3循环水平的疗法可降低CAD风险。降低 ANGPTL4 还可降低 T2D 风险。
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引用次数: 0
Clinical characteristics of patients with high extracellular volume fraction evaluated by cardiac computed tomography for coronary artery evaluation. 通过心脏计算机断层扫描评估冠状动脉的高细胞外容积分数患者的临床特征。
Pub Date : 2024-04-27 eCollection Date: 2024-05-01 DOI: 10.1093/ehjopen/oeae036
Tetsuya Oguni, Seiji Takashio, Naoto Kuyama, Kyoko Hirakawa, Shinsuke Hanatani, Fumi Oike, Hiroki Usuku, Yasushi Matsuzawa, Masafumi Kidoh, Seitaro Oda, Eiichiro Yamamoto, Mitsuharu Ueda, Toshinori Hirai, Kenichi Tsujita

Aims: This study aims to evaluate the distribution of extracellular volume fraction detected via computed tomography, clinical characteristics of high extracellular volume fraction detected via computed tomography, and the rate of incidental detection of cardiac amyloidosis in patients undergoing cardiac computed tomography for coronary artery evaluation.

Methods and results: This study included 874 consecutive patients (mean age, 74.4 ± 7.1 years; men, 65%), comprising men aged ≥60 years and women aged ≥70 years, who had undergone cardiac computed tomography between January 2020 and September 2022. The mean extracellular volume fraction detected via computed tomography was 29.7 ± 5.2%, and 108 patients (12.4%) had an extracellular volume fraction detected via computed tomography of ≥35%. Older age (75.9 ± 8.2 years vs. 74.2 ± 6.9 years; P = 0.042), male sex (75.9% vs. 63.0%; P = 0.007), impaired left ventricular ejection fraction, increased high-sensitivity cardiac troponin T and B-type natriuretic peptide levels, and increased left ventricular thickness showed significant associations with an extracellular volume fraction detected via computed tomography of ≥35%. Cardiac amyloidosis was diagnosed incidentally in 15 patients based on an increase in extracellular volume fraction detected via computed tomography. The prevalence of cardiac amyloidosis was 1.7% (15/874) and 14.3% (15/105) in the entire study population and in patients with an extracellular volume fraction detected via computed tomography of ≥35%, respectively. An increase in the extracellular volume fraction detected via computed tomography was suggestive of cardiac amyloidosis.

Conclusion: Elevated extracellular volume fraction detected via computed tomography, associated with elevated cardiac biomarker levels and myocardial structural changes, may lead to the incidental diagnosis of cardiac amyloidosis.

目的:本研究旨在评估接受心脏计算机断层扫描冠状动脉评估的患者中,通过计算机断层扫描检测到的细胞外体积分数的分布情况、通过计算机断层扫描检测到的高细胞外体积分数的临床特征以及偶然发现心脏淀粉样变性的比率:这项研究纳入了 874 名连续患者(平均年龄为 74.4 ± 7.1 岁;男性占 65%),其中包括年龄≥60 岁的男性和年龄≥70 岁的女性,他们在 2020 年 1 月至 2022 年 9 月期间接受了心脏计算机断层扫描。通过计算机断层扫描检测到的平均细胞外体积分数为 29.7 ± 5.2%,108 名患者(12.4%)通过计算机断层扫描检测到的细胞外体积分数≥35%。年龄较大(75.9 ± 8.2 岁 vs. 74.2 ± 6.9 岁;P = 0.042)、性别为男性(75.9% vs. 63.0%;P = 0.007)、左室射血分数受损、高敏心肌肌钙蛋白 T 和 B 型钠尿肽水平升高以及左室厚度增加与通过计算机断层扫描检测到的细胞外容积分数≥35%有显著关联。根据计算机断层扫描检测到的细胞外容积分数的增加,15 名患者被偶然诊断为心脏淀粉样变性。在整个研究人群和通过计算机断层扫描检测到细胞外体积分数≥35%的患者中,心脏淀粉样变性的发病率分别为1.7%(15/874)和14.3%(15/105)。通过计算机断层扫描检测到的细胞外体积分数增加提示心脏淀粉样变性:结论:通过计算机断层扫描检测到的细胞外体积分数升高,与心脏生物标志物水平升高和心肌结构变化相关联,可能导致心脏淀粉样变性的偶然诊断。
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引用次数: 0
Association between lipoprotein(a) and premature atherosclerotic cardiovascular disease: a systematic review and meta-analysis. 脂蛋白(a)与过早发生动脉粥样硬化性心血管疾病之间的关系:系统回顾和荟萃分析。
Pub Date : 2024-04-26 eCollection Date: 2024-05-01 DOI: 10.1093/ehjopen/oeae031
Xu Tian, Nan Zhang, Gary Tse, Guangping Li, Yihong Sun, Tong Liu

Aims: High lipoprotein(a) [Lp(a)] level has been demonstrated as an important risk factor for atherosclerotic cardiovascular diseases (ASCVD) amongst the older populations, whereas its effects in the younger population remain unclear. This study evaluated the associations between Lp(a) and the risk of premature ASCVD.

Method and results: PubMed and Embase were searched for related studies until 12 November 2023. Fifty-one studies including 100 540 participants were included. Mean age of patients ranged from 35.3 to 62.3 years. The proportion of male participants ranged from 0% to 100%. The mean follow-up was provided in five studies ranging from 1 year to 40 years. The definition of elevated Lp(a) varied among studies, such as >30 mg/dL, >50 mg/dL, the top tertiles, the top quartiles, the top quintiles, and so on. Higher Lp(a) was significantly associated with the composite ASCVD [odds ratio (OR): 2.15, 95% confidence interval (95% CI): 1.53-3.02, P < 0.001], especially for coronary artery disease (OR: 2.44, 95% CI: 2.06-2.90, P < 0.001) and peripheral arterial disease (OR: 2.56, 95% CI: 1.56-4.21, P < 0.001). This association remained significant in familial hypercholesterolaemia (FH) (OR: 3.11, 95% CI: 1.63-5.96, P < 0.001) and type 2 diabetes mellitus (T2DM) patients (OR: 2.23; 95% CI: 1.54-3.23, P < 0.001).Significant results were observed in South Asians (OR: 3.71, 95% CI: 2.31-5.96, P < 0.001), Caucasians (OR: 3.17, 95% CI: 2.22-4.52, P < 0.001), and patients with baseline low-density lipoprotein cholesterol (LDL-c) level ≥ 2.6 mmol/L.

Conclusion: Elevated Lp(a) predicts the risk of the composite or individual ASCVD in young, regardless of study design, gender, population characteristics (community or hospitalized), different premature definitions, and various Lp(a) measurement approaches. This association was important in South Asians, Caucasians, FH patients, T2DM patients, and patients with baseline LDL-c level ≥ 2.6 mmol/L.

目的:在老年人群中,高脂蛋白(a)[Lp(a)]水平已被证明是动脉粥样硬化性心血管疾病(ASCVD)的一个重要风险因素,而其对年轻人群的影响仍不清楚。本研究评估了脂蛋白(a)与过早发生 ASCVD 风险之间的关系:搜索了 PubMed 和 Embase 上的相关研究,截止日期为 2023 年 11 月 12 日。共纳入 51 项研究,包括 100 540 名参与者。患者的平均年龄从 35.3 岁到 62.3 岁不等。男性参与者的比例从 0% 到 100% 不等。五项研究提供的平均随访时间从 1 年到 40 年不等。不同研究对脂蛋白(a)升高的定义各不相同,如>30 毫克/分升、>50 毫克/分升、最高三分位数、最高四分位数、最高五分位数等。较高的脂蛋白(a)与综合 ASCVD 显著相关[几率比(OR):2.15,95% 置信区间(95% CI):1.53-3.02,P<0.001],尤其是冠状动脉疾病(OR:2.44,95% CI:2.06-2.90,P<0.001)和外周动脉疾病(OR:2.56,95% CI:1.56-4.21,P<0.001)。在家族性高胆固醇血症(FH)(OR:3.11,95% CI:1.63-5.96,P<0.001)和 2 型糖尿病(T2DM)患者(OR:2.23;95% CI:1.54-3.23,P<0.001)中,这种关联仍然显著。在南亚人(OR:3.71,95% CI:2.31-5.96,P<0.001)、白种人(OR:3.17,95% CI:2.22-4.52,P<0.001)和基线低密度脂蛋白胆固醇(LDL-c)水平≥2.6 mmol/L的患者中观察到显著结果:无论研究设计、性别、人群特征(社区或住院)、不同的过早定义以及不同的脂蛋白(a)测量方法如何,脂蛋白(a)升高都能预测年轻人发生综合或单项 ASCVD 的风险。这种关联在南亚人、白种人、FH 患者、T2DM 患者和基线 LDL-c 水平≥ 2.6 mmol/L 的患者中非常重要。
{"title":"Association between lipoprotein(a) and premature atherosclerotic cardiovascular disease: a systematic review and meta-analysis.","authors":"Xu Tian, Nan Zhang, Gary Tse, Guangping Li, Yihong Sun, Tong Liu","doi":"10.1093/ehjopen/oeae031","DOIUrl":"10.1093/ehjopen/oeae031","url":null,"abstract":"<p><strong>Aims: </strong>High lipoprotein(a) [Lp(a)] level has been demonstrated as an important risk factor for atherosclerotic cardiovascular diseases (ASCVD) amongst the older populations, whereas its effects in the younger population remain unclear. This study evaluated the associations between Lp(a) and the risk of premature ASCVD.</p><p><strong>Method and results: </strong>PubMed and Embase were searched for related studies until 12 November 2023. Fifty-one studies including 100 540 participants were included. Mean age of patients ranged from 35.3 to 62.3 years. The proportion of male participants ranged from 0% to 100%. The mean follow-up was provided in five studies ranging from 1 year to 40 years. The definition of elevated Lp(a) varied among studies, such as >30 mg/dL, >50 mg/dL, the top tertiles, the top quartiles, the top quintiles, and so on. Higher Lp(a) was significantly associated with the composite ASCVD [odds ratio (OR): 2.15, 95% confidence interval (95% CI): 1.53-3.02, <i>P</i> < 0.001], especially for coronary artery disease (OR: 2.44, 95% CI: 2.06-2.90, <i>P</i> < 0.001) and peripheral arterial disease (OR: 2.56, 95% CI: 1.56-4.21, <i>P</i> < 0.001). This association remained significant in familial hypercholesterolaemia (FH) (OR: 3.11, 95% CI: 1.63-5.96, <i>P</i> < 0.001) and type 2 diabetes mellitus (T2DM) patients (OR: 2.23; 95% CI: 1.54-3.23, <i>P</i> < 0.001).Significant results were observed in South Asians (OR: 3.71, 95% CI: 2.31-5.96, <i>P</i> < 0.001), Caucasians (OR: 3.17, 95% CI: 2.22-4.52, <i>P</i> < 0.001), and patients with baseline low-density lipoprotein cholesterol (LDL-c) level ≥ 2.6 mmol/L.</p><p><strong>Conclusion: </strong>Elevated Lp(a) predicts the risk of the composite or individual ASCVD in young, regardless of study design, gender, population characteristics (community or hospitalized), different premature definitions, and various Lp(a) measurement approaches. This association was important in South Asians, Caucasians, FH patients, T2DM patients, and patients with baseline LDL-c level ≥ 2.6 mmol/L.</p>","PeriodicalId":93995,"journal":{"name":"European heart journal open","volume":"4 3","pages":"oeae031"},"PeriodicalIF":0.0,"publicationDate":"2024-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11086656/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140913598","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
A multi-component intervention increased access to smoking cessation treatment after hospitalization for atherosclerotic cardiovascular disease: a randomized trial. 多成分干预增加了因动脉粥样硬化性心血管疾病住院后接受戒烟治疗的机会:随机试验。
Pub Date : 2024-04-08 eCollection Date: 2024-03-01 DOI: 10.1093/ehjopen/oeae028
Karin Pleym, Toril Dammen, Harald Wedon-Fekjaer, Einar Husebye, Elise Sverre, Serena Tonstad, John Munkhaugen

Aims: To evaluate the effects of a multi-component intervention for smokers hospitalized for atherosclerotic cardiovascular disease (ASCVD) on the participation rate in community-based cessation programmes and the use of cessation drugs. Additionally, to explore the impact on the cessation rates at 6 months.

Methods and results: A randomized parallel-group study was conducted at a Norwegian secondary care hospital in 2021. The intervention group was: (i) counselled using motivational interviewing techniques during hospitalization; (ii) given an information leaflet, detailing the cessation programme; and (iii) referred to the community-based smoking cessation treatment including a post-discharge pro-active telephone invitation. The control group received usual care and the same information leaflet containing clear contact details for initiating participation. Data were collected at baseline, 1, 3, and 6 months. Among 99 smokers hospitalized with ASCVD, 40 were excluded. Of 59 randomized patients, 4 were lost to follow-up and 55 completed the study. The mean age was 65.1 (standard deviation 9.3) years, 35% were female, and 88% had smoked >20 years. Co-morbidity was prevalent (mean Charlson score 4.8). The intervention group was more likely to participate in the smoking cessation treatment {48 vs. 7%, difference: 41% [95% confidence interval (CI): 14%, 63%]} and used cessation drugs more frequently [59 vs. 21%, difference: 38% (95% CI: 17%, 59%)]. At the 6 months point prevalence, we observed notable between-group differences in self-reported cessation rate (48 vs. 25%).

Conclusion: The intervention significantly increased the participation rate at community-based smoking cessation programmes and the use of cessation drugs among multi-morbid smokers hospitalized for ASCVD.

目的:评估针对因动脉粥样硬化性心血管疾病(ASCVD)住院的吸烟者采取的多成分干预措施对社区戒烟计划参与率和戒烟药物使用率的影响。此外,还探讨了对6个月戒烟率的影响:2021年,挪威一家二级医院开展了一项随机平行分组研究。干预组:(i) 在住院期间使用动机访谈技术进行咨询;(ii) 发放信息宣传单,详细介绍戒烟计划;(iii) 转介到社区戒烟治疗,包括出院后主动电话邀请。对照组接受常规护理和同样的信息宣传单,其中包含明确的联系方式,以便开始参与。在基线、1个月、3个月和6个月时收集数据。在因患 ASCVD 而住院的 99 名吸烟者中,有 40 人被排除在外。在 59 名随机患者中,4 人失去了随访机会,55 人完成了研究。患者平均年龄为 65.1 岁(标准差为 9.3),35% 为女性,88% 吸烟超过 20 年。共病现象普遍(平均 Charlson 评分 4.8)。干预组更有可能参加戒烟治疗{48%对7%,差异:41%[95%置信区间(95% 置信区间)]:41%[95%置信区间(CI):14%,63%]},并且更经常使用戒烟药物[59%对21%,差异:38%(95%CI:17%,59%)]。在 6 个月的点流行率中,我们观察到组间自我报告戒烟率的显著差异(48% 对 25%):干预措施大大提高了社区戒烟计划的参与率以及因患慢性心血管疾病住院的多病吸烟者的戒烟药物使用率。
{"title":"A multi-component intervention increased access to smoking cessation treatment after hospitalization for atherosclerotic cardiovascular disease: a randomized trial.","authors":"Karin Pleym, Toril Dammen, Harald Wedon-Fekjaer, Einar Husebye, Elise Sverre, Serena Tonstad, John Munkhaugen","doi":"10.1093/ehjopen/oeae028","DOIUrl":"https://doi.org/10.1093/ehjopen/oeae028","url":null,"abstract":"<p><strong>Aims: </strong>To evaluate the effects of a multi-component intervention for smokers hospitalized for atherosclerotic cardiovascular disease (ASCVD) on the participation rate in community-based cessation programmes and the use of cessation drugs. Additionally, to explore the impact on the cessation rates at 6 months.</p><p><strong>Methods and results: </strong>A randomized parallel-group study was conducted at a Norwegian secondary care hospital in 2021. The intervention group was: (i) counselled using motivational interviewing techniques during hospitalization; (ii) given an information leaflet, detailing the cessation programme; and (iii) referred to the community-based smoking cessation treatment including a post-discharge pro-active telephone invitation. The control group received usual care and the same information leaflet containing clear contact details for initiating participation. Data were collected at baseline, 1, 3, and 6 months. Among 99 smokers hospitalized with ASCVD, 40 were excluded. Of 59 randomized patients, 4 were lost to follow-up and 55 completed the study. The mean age was 65.1 (standard deviation 9.3) years, 35% were female, and 88% had smoked >20 years. Co-morbidity was prevalent (mean Charlson score 4.8). The intervention group was more likely to participate in the smoking cessation treatment {48 vs. 7%, difference: 41% [95% confidence interval (CI): 14%, 63%]} and used cessation drugs more frequently [59 vs. 21%, difference: 38% (95% CI: 17%, 59%)]. At the 6 months point prevalence, we observed notable between-group differences in self-reported cessation rate (48 vs. 25%).</p><p><strong>Conclusion: </strong>The intervention significantly increased the participation rate at community-based smoking cessation programmes and the use of cessation drugs among multi-morbid smokers hospitalized for ASCVD.</p>","PeriodicalId":93995,"journal":{"name":"European heart journal open","volume":"4 2","pages":"oeae028"},"PeriodicalIF":0.0,"publicationDate":"2024-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11044967/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140861397","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
Ceramides: a potential cardiovascular biomarker in young adult childhood cancer survivors? 神经酰胺:年轻的成年儿童癌症幸存者的潜在心血管生物标志物?
Pub Date : 2024-04-04 eCollection Date: 2024-03-01 DOI: 10.1093/ehjopen/oeae026
Olof Broberg, Constance G Weismann, Ingrid Øra, Thomas Wiebe, Reijo Laaksonen, Petru Liuba

Aims: The aim of this study was to investigate circulating ceramides involved in cardiovascular disease (CVD) in young adult childhood cancer survivors (CCS) and their correlations to previously reported adverse cardiovascular changes in this cohort.

Methods and results: Fifty-seven CCS and 53 healthy controls (age 20-30 years) were studied. Plasma long-chain ceramides, known to be cardiotoxic (C16:0, C18:0, C24:0, and C24:1), were analysed by mass spectrometry. The coronary event risk test 2 (CERT2) score was calculated from the ceramide data. Cardiac and carotid artery ultrasound data and lipid data available from previous studies of this cohort were used to study partial correlations with ceramide and CERT2 score data. All four analysed ceramides were elevated in CCS compared with controls (P ≤ 0.012). The greatest difference was noted for C18:0, which was 33% higher in CCS compared with controls adjusted for sex, age, and body mass index (BMI) (P < 0.001). The CERT2 score was higher in CCS compared with controls (P < 0.001). In the CCS group, 35% had a high to very high CERT2 score (7-12) when compared with 9% in the control group (P < 0.001). The CCS subgroup with a CERT2 score ≥ 7 had higher heart rate, systolic blood pressure, and higher levels of apolipoprotein B compared with CCS with a CERT2 score < 6 (P ≤ 0.011). When adjusted for age, sex, and BMI, CERT2 score was significantly correlated with arterial stiffness, growth hormone, and cranial radiotherapy (P < 0.044).

Conclusion: Ceramides could be important biomarkers in understanding the pathophysiology of CVD and in predicting CVD disease risk in young adult CCS.

目的:本研究旨在调查年轻的成年儿童癌症幸存者(CCS)中与心血管疾病(CVD)有关的循环神经酰胺及其与之前报道的该人群心血管不良变化的相关性:对 57 名儿童癌症幸存者和 53 名健康对照者(20-30 岁)进行了研究。通过质谱分析了血浆中已知具有心脏毒性的长链神经酰胺(C16:0、C18:0、C24:0 和 C24:1)。根据神经酰胺数据计算出冠状动脉事件风险测试 2 (CERT2) 分数。心脏和颈动脉超声波数据以及该队列先前研究中的血脂数据被用来研究神经酰胺和CERT2评分数据的部分相关性。与对照组相比,CCS 中所有四种被分析的神经酰胺都升高了(P ≤ 0.012)。C18:0的差异最大,与对照组相比,经性别、年龄和体重指数(BMI)调整后,CCS的C18:0高出33%(P < 0.001)。与对照组相比,CCS 的 CERT2 得分更高(P < 0.001)。与对照组的 9% 相比,CCS 组中有 35% 的人的 CERT2 得分为高到非常高(7-12)(P < 0.001)。与 CERT2 得分小于 6 的 CCS 相比,CERT2 得分≥ 7 的 CCS 亚组具有更高的心率、收缩压和脂蛋白 B 水平(P ≤ 0.011)。在对年龄、性别和体重指数进行调整后,CERT2评分与动脉僵化、生长激素和头颅放疗有显著相关性(P < 0.044):神经酰胺可能是了解心血管疾病的病理生理学和预测年轻成人心血管疾病风险的重要生物标志物。
{"title":"Ceramides: a potential cardiovascular biomarker in young adult childhood cancer survivors?","authors":"Olof Broberg, Constance G Weismann, Ingrid Øra, Thomas Wiebe, Reijo Laaksonen, Petru Liuba","doi":"10.1093/ehjopen/oeae026","DOIUrl":"https://doi.org/10.1093/ehjopen/oeae026","url":null,"abstract":"<p><strong>Aims: </strong>The aim of this study was to investigate circulating ceramides involved in cardiovascular disease (CVD) in young adult childhood cancer survivors (CCS) and their correlations to previously reported adverse cardiovascular changes in this cohort.</p><p><strong>Methods and results: </strong>Fifty-seven CCS and 53 healthy controls (age 20-30 years) were studied. Plasma long-chain ceramides, known to be cardiotoxic (C16:0, C18:0, C24:0, and C24:1), were analysed by mass spectrometry. The coronary event risk test 2 (CERT2) score was calculated from the ceramide data. Cardiac and carotid artery ultrasound data and lipid data available from previous studies of this cohort were used to study partial correlations with ceramide and CERT2 score data. All four analysed ceramides were elevated in CCS compared with controls (<i>P</i> ≤ 0.012). The greatest difference was noted for C18:0, which was 33% higher in CCS compared with controls adjusted for sex, age, and body mass index (BMI) (<i>P</i> < 0.001). The CERT2 score was higher in CCS compared with controls (<i>P</i> < 0.001). In the CCS group, 35% had a high to very high CERT2 score (7-12) when compared with 9% in the control group (<i>P</i> < 0.001). The CCS subgroup with a CERT2 score ≥ 7 had higher heart rate, systolic blood pressure, and higher levels of apolipoprotein B compared with CCS with a CERT2 score < 6 (<i>P</i> ≤ 0.011). When adjusted for age, sex, and BMI, CERT2 score was significantly correlated with arterial stiffness, growth hormone, and cranial radiotherapy (<i>P</i> < 0.044).</p><p><strong>Conclusion: </strong>Ceramides could be important biomarkers in understanding the pathophysiology of CVD and in predicting CVD disease risk in young adult CCS.</p>","PeriodicalId":93995,"journal":{"name":"European heart journal open","volume":"4 2","pages":"oeae026"},"PeriodicalIF":0.0,"publicationDate":"2024-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11042783/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140862054","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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