Sissel J Godtfredsen, K. Kragholm, A. M. Kristensen, T. Bekfani, R. Sørensen, Maurizio Sessa, Christian Torp-Pedersen, Deepak L Bhatt, Manan Pareek
The efficacy and safety of ticagrelor or prasugrel versus clopidogrel in patients with atrial fibrillation (AF) on oral anticoagulation (OAC) undergoing percutaneous coronary intervention (PCI) for myocardial infarction have not been established. Nationwide cohort study of patients on OAC for AF who underwent PCI for myocardial infarction from 2011 through 2019 and were prescribed a P2Y12 inhibitor at discharge. The primary efficacy outcome was major adverse cardiovascular events (MACE), defined as a composite of death from any cause, stroke, recurrent myocardial infarction, or repeat revascularization. The primary safety outcome was cerebral, gastrointestinal, or urogenital bleeding requiring hospitalization. Absolute and relative risks for outcomes at 1 year were calculated through multivariable logistic regression with average treatment effect modeling. Outcomes were standardized for the individual components of CHA2DS2-VASc and HAS-BLED scores as well as type of OAC, aspirin, and proton pump inhibitor use. We included 2259 patients of whom 1918 (84.9%) were prescribed clopidogrel and 341 (15.1%) ticagrelor or prasugrel. The standardized risk of MACE was significantly lower in the ticagrelor or prasugrel group compared with the clopidogrel group (standardized absolute risk, 16.4% vs. 19.4%; relative risk, 0.84, 95% confidence interval, 0.70-0.98; P=0.02), while the risk of bleeding did not differ (standardized absolute risk, 5.5% vs. 5.1%; relative risk, 1.07, 95% confidence interval, 0.73-1.41; P=0.69). In patients with AF on OAC who underwent PCI for myocardial infarction, treatment with ticagrelor or prasugrel versus clopidogrel was associated with reduced ischemic risk, without a concomitantly increased bleeding risk.
{"title":"Ticagrelor or prasugrel versus clopidogrel in patients with atrial fibrillation undergoing percutaneous coronary intervention for myocardial infarction","authors":"Sissel J Godtfredsen, K. Kragholm, A. M. Kristensen, T. Bekfani, R. Sørensen, Maurizio Sessa, Christian Torp-Pedersen, Deepak L Bhatt, Manan Pareek","doi":"10.1093/ehjopen/oead134","DOIUrl":"https://doi.org/10.1093/ehjopen/oead134","url":null,"abstract":"\u0000 \u0000 \u0000 The efficacy and safety of ticagrelor or prasugrel versus clopidogrel in patients with atrial fibrillation (AF) on oral anticoagulation (OAC) undergoing percutaneous coronary intervention (PCI) for myocardial infarction have not been established.\u0000 \u0000 \u0000 \u0000 Nationwide cohort study of patients on OAC for AF who underwent PCI for myocardial infarction from 2011 through 2019 and were prescribed a P2Y12 inhibitor at discharge. The primary efficacy outcome was major adverse cardiovascular events (MACE), defined as a composite of death from any cause, stroke, recurrent myocardial infarction, or repeat revascularization. The primary safety outcome was cerebral, gastrointestinal, or urogenital bleeding requiring hospitalization. Absolute and relative risks for outcomes at 1 year were calculated through multivariable logistic regression with average treatment effect modeling. Outcomes were standardized for the individual components of CHA2DS2-VASc and HAS-BLED scores as well as type of OAC, aspirin, and proton pump inhibitor use.\u0000 \u0000 \u0000 \u0000 We included 2259 patients of whom 1918 (84.9%) were prescribed clopidogrel and 341 (15.1%) ticagrelor or prasugrel. The standardized risk of MACE was significantly lower in the ticagrelor or prasugrel group compared with the clopidogrel group (standardized absolute risk, 16.4% vs. 19.4%; relative risk, 0.84, 95% confidence interval, 0.70-0.98; P=0.02), while the risk of bleeding did not differ (standardized absolute risk, 5.5% vs. 5.1%; relative risk, 1.07, 95% confidence interval, 0.73-1.41; P=0.69).\u0000 \u0000 \u0000 \u0000 In patients with AF on OAC who underwent PCI for myocardial infarction, treatment with ticagrelor or prasugrel versus clopidogrel was associated with reduced ischemic risk, without a concomitantly increased bleeding risk.\u0000","PeriodicalId":93995,"journal":{"name":"European heart journal open","volume":"16 8","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138971914","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}
Pub Date : 2023-12-14eCollection Date: 2024-01-01DOI: 10.1093/ehjopen/oead133
Morgane Pierre-Jean, Benjamin Marut, Elizabeth Curtis, Elena Galli, Marc Cuggia, Guillaume Bouzillé, Erwan Donal
Aims: Patients presenting symptoms of heart failure with preserved ejection fraction (HFpEF) are not a homogenous population. Different phenotypes can differ in prognosis and optimal management strategies. We sought to identify phenotypes of HFpEF by using the medical information database from a large university hospital centre using machine learning.
Methods and results: We explored the use of clinical variables from electronic health records in addition to echocardiography to identify different phenotypes of patients with HFpEF. The proposed methodology identifies four phenotypic clusters based on both clinical and echocardiographic characteristics, which have differing prognoses (death and cardiovascular hospitalization).
Conclusion: This work demonstrated that artificial intelligence-derived phenotypes could be used as a tool for physicians to assess risk and to target therapies that may improve outcomes.
{"title":"Phenotyping of heart failure with preserved ejection faction using electronic health records and echocardiography.","authors":"Morgane Pierre-Jean, Benjamin Marut, Elizabeth Curtis, Elena Galli, Marc Cuggia, Guillaume Bouzillé, Erwan Donal","doi":"10.1093/ehjopen/oead133","DOIUrl":"10.1093/ehjopen/oead133","url":null,"abstract":"<p><strong>Aims: </strong>Patients presenting symptoms of heart failure with preserved ejection fraction (HFpEF) are not a homogenous population. Different phenotypes can differ in prognosis and optimal management strategies. We sought to identify phenotypes of HFpEF by using the medical information database from a large university hospital centre using machine learning.</p><p><strong>Methods and results: </strong>We explored the use of clinical variables from electronic health records in addition to echocardiography to identify different phenotypes of patients with HFpEF. The proposed methodology identifies four phenotypic clusters based on both clinical and echocardiographic characteristics, which have differing prognoses (death and cardiovascular hospitalization).</p><p><strong>Conclusion: </strong>This work demonstrated that artificial intelligence-derived phenotypes could be used as a tool for physicians to assess risk and to target therapies that may improve outcomes.</p>","PeriodicalId":93995,"journal":{"name":"European heart journal open","volume":"4 1","pages":"oead133"},"PeriodicalIF":0.0,"publicationDate":"2023-12-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10775683/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139405708","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}
S. Simmonds, Mandy OJ Grootaert, I. Cuijpers, P. Carai, Nadéche Geuens, M. Herwig, Pieter Baatsen, Nazha Hamdani, A. Luttun, Stephane Heymans, E. A. Jones
Microvascular dysfunction has been proposed to drive heart failure with preserved ejection fraction (HFpEF), but the initiating molecular and cellular events are largely unknown. Our objective was to determine when microvascular alterations in HFpEF begin, how they contribute to disease progression, and how pericyte dysfunction plays a role herein. Microvascular dysfunction, characterised by inflammatory activation, loss of junctional barrier function and altered pericyte-endothelial crosstalk, was assessed with respect to the development of cardiac dysfunction, in the Zucker fatty and spontaneously hypertensive (ZSF1) obese rat model of HFpEF at three time points: 6, 14, and 21 weeks of age. Pericyte loss was the earliest and strongest microvascular change, occurring before prominent echocardiographic signs of diastolic dysfunction were present. Pericytes were shown to be less proliferative and had a disrupted morphology at 14 weeks in the obese ZSF1 animals, who also exhibited an increased capillary luminal diameter and disrupted endothelial junctions. Microvascular dysfunction was also studied in a mouse model of chronic reduction in capillary pericyte coverage (PDGF-Bret/ret), which spontaneously developed many aspects of diastolic dysfunction. Pericytes exposed to oxidative stress in vitro showed downregulation of cell cycle associated pathways, and induced a pro-inflammatory state in endothelial cells upon co-culture. We propose pericytes are important for maintaining endothelial cell function, where loss of pericytes enhances the reactivity of endothelial cells to inflammatory signals and promotes microvascular dysfunction, thereby accelerating the development of HFpEF.
{"title":"Pericyte loss initiates microvascular dysfunction in the development of diastolic dysfunction","authors":"S. Simmonds, Mandy OJ Grootaert, I. Cuijpers, P. Carai, Nadéche Geuens, M. Herwig, Pieter Baatsen, Nazha Hamdani, A. Luttun, Stephane Heymans, E. A. Jones","doi":"10.1093/ehjopen/oead129","DOIUrl":"https://doi.org/10.1093/ehjopen/oead129","url":null,"abstract":"\u0000 \u0000 \u0000 Microvascular dysfunction has been proposed to drive heart failure with preserved ejection fraction (HFpEF), but the initiating molecular and cellular events are largely unknown. Our objective was to determine when microvascular alterations in HFpEF begin, how they contribute to disease progression, and how pericyte dysfunction plays a role herein.\u0000 \u0000 \u0000 \u0000 Microvascular dysfunction, characterised by inflammatory activation, loss of junctional barrier function and altered pericyte-endothelial crosstalk, was assessed with respect to the development of cardiac dysfunction, in the Zucker fatty and spontaneously hypertensive (ZSF1) obese rat model of HFpEF at three time points: 6, 14, and 21 weeks of age. Pericyte loss was the earliest and strongest microvascular change, occurring before prominent echocardiographic signs of diastolic dysfunction were present. Pericytes were shown to be less proliferative and had a disrupted morphology at 14 weeks in the obese ZSF1 animals, who also exhibited an increased capillary luminal diameter and disrupted endothelial junctions. Microvascular dysfunction was also studied in a mouse model of chronic reduction in capillary pericyte coverage (PDGF-Bret/ret), which spontaneously developed many aspects of diastolic dysfunction. Pericytes exposed to oxidative stress in vitro showed downregulation of cell cycle associated pathways, and induced a pro-inflammatory state in endothelial cells upon co-culture.\u0000 \u0000 \u0000 \u0000 We propose pericytes are important for maintaining endothelial cell function, where loss of pericytes enhances the reactivity of endothelial cells to inflammatory signals and promotes microvascular dysfunction, thereby accelerating the development of HFpEF.\u0000","PeriodicalId":93995,"journal":{"name":"European heart journal open","volume":"1 9","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138586065","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}
A. Hazim, Lara F Nhola, Vidur Kailash, Song Zhang, Nicole P. Sandhu, Amir Lerman, C. Loprinzi, K. Ruddy, H. Villarraga, Bradley Lewis, Joerg Herrmann
The objective of this study was to assess the effect of HER2-directed therapy (HER2-Tx) on peripheral vasoreactivity and its correlation with cardiac function changes and the additive effects of anthracycline/cyclophosphamide (AC) therapy and baseline cardiovascular risk. Single-center, prospective cohort study of women with newly diagnosed stage 1-3 HER2-positive breast cancer undergoing HER2-Tx +/- AC. All participants underwent baseline and three-monthly evaluations with Endo-Peripheral Arterial Tonometry (Endo-PAT), vascular biomarkers (C-type natriuretic peptide (CNP) and neuregulin-1 beta (NRG-1β)), and echocardiography. Cardiotoxicity was defined as a decrease in the left ventricular ejection fraction (LVEF) of >10% to a value <53%. Of the 47 patients enrolled, 20 (43%) received AC in addition to HER2-Tx. Deterioration of reactive hyperemia index (RHI) on Endo-PAT by ≥20% was more common in patients receiving HER-Tx plus AC than HER2-Tx alone (65% vs 22%; p=0.003). A decrease in CNP and log NRG-1β levels by 1 standard deviation did not differ significantly between the AC and non-AC groups (CNP: 20.0% vs 7.4%; p=0.20 and NRG-1β: 15% vs 11%; p=0.69) nor did GLS (35% vs 37%; p=0.89). Patients treated with AC had a significantly lower 3D GE LVEF than non-AC recipients as early as 3 months after exposure (mean 59.3 % (SD 3) vs. 63.8 (SD 4); p=0.02). RHI and GLS were the only parameters correlating with LVEF change. Combination therapy with AC, but not HER2-Tx alone, leads to a decline in peripheral vascular and cardiac function. Larger studies will need to define more precisely the causal correlation between vascular and cardiac function changes in cancer patients.
本研究的目的是评估her2定向治疗(HER2-Tx)对外周血管反应性的影响及其与心功能变化的相关性，以及蒽环类药物/环磷酰胺(AC)治疗的叠加效应和基线心血管风险。新诊断为1-3期her2阳性乳腺癌的女性接受HER2-Tx +/- AC的单中心前瞻性队列研究。所有参与者接受基线和3个月的外周动脉压测仪(endodo - pat)、血管生物标志物(c型利钠肽(CNP)和神经调节蛋白-1β (NRG-1β)和超声心动图评估。心脏毒性定义为左心室射血分数(LVEF)下降>10%至<53%。在纳入的47例患者中，20例(43%)在接受HER2-Tx治疗的同时接受了AC治疗。在接受HER-Tx联合AC治疗的患者中，Endo-PAT反应性充血指数(RHI)恶化≥20%的情况比单独接受HER2-Tx治疗的患者更常见(65% vs 22%;p = 0.003)。CNP和log NRG-1β水平降低1个标准差在AC组和非AC组之间无显著差异(CNP: 20.0% vs 7.4%;p=0.20, NRG-1β: 15% vs 11%;p=0.69)， GLS也没有(35% vs 37%;p = 0.89)。早在接触AC后3个月，接受AC治疗的患者的3D GE LVEF就显著低于未接受AC治疗的患者(平均59.3% (SD 3) vs. 63.8 (SD 4);p = 0.02)。RHI和GLS是唯一与LVEF变化相关的参数。与AC联合治疗，而不是单独使用HER2-Tx，会导致周围血管和心脏功能下降。更大规模的研究需要更精确地定义癌症患者血管和心脏功能变化之间的因果关系。
{"title":"Changes in Vascular Function and Correlation with Cardiotoxicity in Women with Newly Diagnosed Breast Cancer","authors":"A. Hazim, Lara F Nhola, Vidur Kailash, Song Zhang, Nicole P. Sandhu, Amir Lerman, C. Loprinzi, K. Ruddy, H. Villarraga, Bradley Lewis, Joerg Herrmann","doi":"10.1093/ehjopen/oead130","DOIUrl":"https://doi.org/10.1093/ehjopen/oead130","url":null,"abstract":"\u0000 \u0000 \u0000 The objective of this study was to assess the effect of HER2-directed therapy (HER2-Tx) on peripheral vasoreactivity and its correlation with cardiac function changes and the additive effects of anthracycline/cyclophosphamide (AC) therapy and baseline cardiovascular risk.\u0000 \u0000 \u0000 \u0000 Single-center, prospective cohort study of women with newly diagnosed stage 1-3 HER2-positive breast cancer undergoing HER2-Tx +/- AC. All participants underwent baseline and three-monthly evaluations with Endo-Peripheral Arterial Tonometry (Endo-PAT), vascular biomarkers (C-type natriuretic peptide (CNP) and neuregulin-1 beta (NRG-1β)), and echocardiography. Cardiotoxicity was defined as a decrease in the left ventricular ejection fraction (LVEF) of >10% to a value <53%. Of the 47 patients enrolled, 20 (43%) received AC in addition to HER2-Tx. Deterioration of reactive hyperemia index (RHI) on Endo-PAT by ≥20% was more common in patients receiving HER-Tx plus AC than HER2-Tx alone (65% vs 22%; p=0.003). A decrease in CNP and log NRG-1β levels by 1 standard deviation did not differ significantly between the AC and non-AC groups (CNP: 20.0% vs 7.4%; p=0.20 and NRG-1β: 15% vs 11%; p=0.69) nor did GLS (35% vs 37%; p=0.89). Patients treated with AC had a significantly lower 3D GE LVEF than non-AC recipients as early as 3 months after exposure (mean 59.3 % (SD 3) vs. 63.8 (SD 4); p=0.02). RHI and GLS were the only parameters correlating with LVEF change.\u0000 \u0000 \u0000 \u0000 Combination therapy with AC, but not HER2-Tx alone, leads to a decline in peripheral vascular and cardiac function. Larger studies will need to define more precisely the causal correlation between vascular and cardiac function changes in cancer patients.\u0000","PeriodicalId":93995,"journal":{"name":"European heart journal open","volume":"19 5","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138589693","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}
R. Lazar, T. Myers, T. Gropen, M. Leesar, James Davies, A. Gerstenecker, Amani M. Norling, M. Pavol, R. Marshall, S. Kodali
Aortic valve stenosis (AS) results in higher systolic pressure to overcome resistance from the stenotic valve, leading to heart failure and decline in cardiac output. There has been no assessment of cerebral blood flow (CBF) association with neurocognition in AS, or the effects of valve replacement. The goal was to determine if AS is associated with altered cerebral hemodynamics and impaired neurocognition, and whether transcatheter aortic valve replacement (TAVR) improves hemodynamics and cognition. In 42 patients with planned TAVR, transcranial Doppler (TCD) assessed bilateral MCA mean flow velocity (MFV); abnormality was < 34.45 cm/sec. The neurocognitive battery assessed memory, language, attention, visual-spatial skills, and executive function, yielding a composite Z-score. Impairment was <1.5 SDs below the normative mean. The mean age was 78 years, 59%M, and the mean valve gradient was 46.87mm/Hg. Mean follow-up was 36 days post-TAVR (range 27 - 55). Pre-TAVR, the mean MFV was 42.36 cm/sec (SD=10.17), and the mean cognitive Z-score was -0.22 SD’s (range -1.99 to 1.08) below the normative mean. Among the 34 patients who returned after TAVR, the MFV was 41.59 cm/sec (SD=10.42), not different from baseline (p=0.66, 2.28-3.67). Post-TAVR average Zscores were 0.05 SDs above the normative mean, not meeting the pre-specified threshold for a clinically significant 0.5 SD change. Among patients with severe AS, there was little impairment of MFV on TCD and no correlation with cognition. TAVR did not affect MFV or cognition. Assumptions about diminished CBF and improvement after TAVR were not supported.
{"title":"Cerebral blood flow and neurocognition in patients undergoing TAVR for severe aortic stenosis","authors":"R. Lazar, T. Myers, T. Gropen, M. Leesar, James Davies, A. Gerstenecker, Amani M. Norling, M. Pavol, R. Marshall, S. Kodali","doi":"10.1093/ehjopen/oead124","DOIUrl":"https://doi.org/10.1093/ehjopen/oead124","url":null,"abstract":"\u0000 \u0000 \u0000 Aortic valve stenosis (AS) results in higher systolic pressure to overcome resistance from the stenotic valve, leading to heart failure and decline in cardiac output. There has been no assessment of cerebral blood flow (CBF) association with neurocognition in AS, or the effects of valve replacement. The goal was to determine if AS is associated with altered cerebral hemodynamics and impaired neurocognition, and whether transcatheter aortic valve replacement (TAVR) improves hemodynamics and cognition.\u0000 \u0000 \u0000 \u0000 In 42 patients with planned TAVR, transcranial Doppler (TCD) assessed bilateral MCA mean flow velocity (MFV); abnormality was < 34.45 cm/sec. The neurocognitive battery assessed memory, language, attention, visual-spatial skills, and executive function, yielding a composite Z-score. Impairment was <1.5 SDs below the normative mean.\u0000 \u0000 \u0000 \u0000 The mean age was 78 years, 59%M, and the mean valve gradient was 46.87mm/Hg. Mean follow-up was 36 days post-TAVR (range 27 - 55). Pre-TAVR, the mean MFV was 42.36 cm/sec (SD=10.17), and the mean cognitive Z-score was -0.22 SD’s (range -1.99 to 1.08) below the normative mean. Among the 34 patients who returned after TAVR, the MFV was 41.59 cm/sec (SD=10.42), not different from baseline (p=0.66, 2.28-3.67). Post-TAVR average Zscores were 0.05 SDs above the normative mean, not meeting the pre-specified threshold for a clinically significant 0.5 SD change.\u0000 \u0000 \u0000 \u0000 Among patients with severe AS, there was little impairment of MFV on TCD and no correlation with cognition. TAVR did not affect MFV or cognition. Assumptions about diminished CBF and improvement after TAVR were not supported.\u0000","PeriodicalId":93995,"journal":{"name":"European heart journal open","volume":"51 14","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138593259","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}
Mofei Wang, Justin A. Ching-Johnson, Hao Yin, C. O’Neil, Alex X. Li, Michael W. A. Chu, Robert Bartha, J. G. Pickering
Thoracic aortic aneurysms (TAAs) carry a risk of catastrophic dissection. Current strategies to evaluate this risk entail measuring aortic diameter but do not image medial degeneration, the cause of TAAs. We sought to determine if the advanced magnetic resonance imaging acquisition strategy, diffusion tensor imaging (DTI), could delineate medial degeneration in the ascending thoracic aorta. Porcine ascending aortas were subjected to enzyme microinjection which yielded local aortic medial degeneration. These lesions were detected by DTI, using a 9.4T MRI scanner, based on tensor disorientation, disrupted diffusion tracts, and altered DTI metrics. High-resolution spatial analysis revealed that fractional anisotropy positively correlated, and mean and radial diffusivity inversely correlated, with SMC and elastin content (P<0.001 for all). Ten operatively harvested human ascending aorta samples (mean subject age 61.6±13.3 years, diameter range 29-64 mm) showed medial pathology that was more diffuse and more complex. Nonetheless, DTI metrics within an aorta spatially correlated with SMC, elastin and, especially, glycosaminoglycan (GAG) content. Moreover, there were inter-individual differences in slice-averaged DTI metrics. GAG accumulation and elastin degradation were captured by reduced fractional anisotropy (R2=0.47, P=0.043; R2=0.76, P=0.002), with GAG accumulation also captured by increased mean diffusivity (R2=0.46, P=0.045) and increased radial diffusivity (R2=0.60, P=0.015). Ex vivo high-field DTI can detect ascending aorta medial degeneration and can differentiate TAAs in accordance with their histopathology, especially elastin and GAG changes. This non-destructive window into aortic medial microstructure raises prospects for probing the risks of TAAs beyond lumen dimensions.
{"title":"Mapping microarchitectural degeneration in the dilated ascending aorta with ex vivo diffusion tensor imaging","authors":"Mofei Wang, Justin A. Ching-Johnson, Hao Yin, C. O’Neil, Alex X. Li, Michael W. A. Chu, Robert Bartha, J. G. Pickering","doi":"10.1093/ehjopen/oead128","DOIUrl":"https://doi.org/10.1093/ehjopen/oead128","url":null,"abstract":"\u0000 \u0000 \u0000 Thoracic aortic aneurysms (TAAs) carry a risk of catastrophic dissection. Current strategies to evaluate this risk entail measuring aortic diameter but do not image medial degeneration, the cause of TAAs. We sought to determine if the advanced magnetic resonance imaging acquisition strategy, diffusion tensor imaging (DTI), could delineate medial degeneration in the ascending thoracic aorta.\u0000 \u0000 \u0000 \u0000 Porcine ascending aortas were subjected to enzyme microinjection which yielded local aortic medial degeneration. These lesions were detected by DTI, using a 9.4T MRI scanner, based on tensor disorientation, disrupted diffusion tracts, and altered DTI metrics. High-resolution spatial analysis revealed that fractional anisotropy positively correlated, and mean and radial diffusivity inversely correlated, with SMC and elastin content (P<0.001 for all). Ten operatively harvested human ascending aorta samples (mean subject age 61.6±13.3 years, diameter range 29-64 mm) showed medial pathology that was more diffuse and more complex. Nonetheless, DTI metrics within an aorta spatially correlated with SMC, elastin and, especially, glycosaminoglycan (GAG) content. Moreover, there were inter-individual differences in slice-averaged DTI metrics. GAG accumulation and elastin degradation were captured by reduced fractional anisotropy (R2=0.47, P=0.043; R2=0.76, P=0.002), with GAG accumulation also captured by increased mean diffusivity (R2=0.46, P=0.045) and increased radial diffusivity (R2=0.60, P=0.015).\u0000 \u0000 \u0000 \u0000 Ex vivo high-field DTI can detect ascending aorta medial degeneration and can differentiate TAAs in accordance with their histopathology, especially elastin and GAG changes. This non-destructive window into aortic medial microstructure raises prospects for probing the risks of TAAs beyond lumen dimensions.\u0000","PeriodicalId":93995,"journal":{"name":"European heart journal open","volume":"70 10","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138598368","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}
G. Peretto, Simone Sala, E. Carturan, Stefania Rizzo, A. Villatore, G. de Luca, C. Campochiaro, A. Palmisano, D. Vignale, M. De Gaspari, L. Dagna, Antonio Esposito, Cristina Basso, P. Camici, P. Della Bella
Clinical features and risk stratification of patients with viral myocarditis (VM) complicated by ventricular arrhythmias (VA) are incompletely understood. We aim to describe arrhythmia patterns and outcomes in patients with VM and early-onset VA. We present a single center study, enrolling patients with VM proven by endomyocardial biopsy, and evidence of VA within 24 hours of hospitalization. The incidence of major adverse events (MAE), including all-cause death, severe heart failure, advanced atrioventricular blocks, or major VA, was evaluated during a 24-month follow-up (FU), and compared with a matched group of virus-negative myocarditis. Of patients with VM (n=74, mean age 47±16 years, 66% males, LVEF 51±13%), 20 (27%) presented with major VA (VT/VF), and 32 (44%) had polymorphic VA. Patients with polymorphic VA more commonly had evidence of ongoing systemic infection (24/32 vs. 10/42, p=0.004) and experienced greater occurrence of MAE at discharge (15/32 vs. 2/42, p<0.001). However, the incidence of MAE during FU was higher in patients with monomorphic VA compared to those with polymorphic VA (17/42 vs. 2/28, p=0.002). Patients with monomorphic VA displayed frequently signs of chronic cardiomyopathy, and had outcomes comparable with virus-negative myocarditis (Log rank p=0.929). Presentation with VT/VF was independently associated with MAE (at discharge: HR 4.7, 95%CI 1.6-14.0, p=0.005; during FU: HR 6.3, 95%CI 2.3-17.6, p<0.001). In patients with VM, polymorphic VA point to ongoing systemic infection and early adverse outcomes, whereas monomorphic VA suggest chronic cardiomyopathy and greater incidence of MAE during FU. Presentation with VT/VF is independently associated with MAE.
{"title":"Clinical profiling and Outcomes of Viral Myocarditis manifesting with Ventricular Arrhythmias","authors":"G. Peretto, Simone Sala, E. Carturan, Stefania Rizzo, A. Villatore, G. de Luca, C. Campochiaro, A. Palmisano, D. Vignale, M. De Gaspari, L. Dagna, Antonio Esposito, Cristina Basso, P. Camici, P. Della Bella","doi":"10.1093/ehjopen/oead132","DOIUrl":"https://doi.org/10.1093/ehjopen/oead132","url":null,"abstract":"\u0000 \u0000 \u0000 Clinical features and risk stratification of patients with viral myocarditis (VM) complicated by ventricular arrhythmias (VA) are incompletely understood. We aim to describe arrhythmia patterns and outcomes in patients with VM and early-onset VA.\u0000 \u0000 \u0000 \u0000 We present a single center study, enrolling patients with VM proven by endomyocardial biopsy, and evidence of VA within 24 hours of hospitalization. The incidence of major adverse events (MAE), including all-cause death, severe heart failure, advanced atrioventricular blocks, or major VA, was evaluated during a 24-month follow-up (FU), and compared with a matched group of virus-negative myocarditis.\u0000 \u0000 \u0000 \u0000 Of patients with VM (n=74, mean age 47±16 years, 66% males, LVEF 51±13%), 20 (27%) presented with major VA (VT/VF), and 32 (44%) had polymorphic VA. Patients with polymorphic VA more commonly had evidence of ongoing systemic infection (24/32 vs. 10/42, p=0.004) and experienced greater occurrence of MAE at discharge (15/32 vs. 2/42, p<0.001). However, the incidence of MAE during FU was higher in patients with monomorphic VA compared to those with polymorphic VA (17/42 vs. 2/28, p=0.002). Patients with monomorphic VA displayed frequently signs of chronic cardiomyopathy, and had outcomes comparable with virus-negative myocarditis (Log rank p=0.929). Presentation with VT/VF was independently associated with MAE (at discharge: HR 4.7, 95%CI 1.6-14.0, p=0.005; during FU: HR 6.3, 95%CI 2.3-17.6, p<0.001).\u0000 \u0000 \u0000 \u0000 In patients with VM, polymorphic VA point to ongoing systemic infection and early adverse outcomes, whereas monomorphic VA suggest chronic cardiomyopathy and greater incidence of MAE during FU. Presentation with VT/VF is independently associated with MAE.\u0000","PeriodicalId":93995,"journal":{"name":"European heart journal open","volume":"72 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138598485","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}
Hamid Y Hassen, Steven Abrams, G. Musinguzi, Imogen Rogers, Alfred Dusabimana, P. Mphekgwana, H. Bastiaens, H. Bastiaens, Hamid Y Hassen, N. Aerts, S. Anthierens, Kathleen Van Royen, Caroline Masquillier, Jean Yves Le Reste, D. Le Goff, G. Perraud, Harm van Marwijk, Elisabeth Ford, Tom Grice-Jackson, Imogen Rogers, P. Nahar, Linda Gibson, M. Bowyer, Almighty Nkengateh, G. Musinguzi, R. Ndejjo, Fred Nuwaha, T. Sodi, P. Mphekgwana, Nancy Malema, Nancy Kgatla, T. Mothiba
Accurate prediction of a person’s risk of cardiovascular disease (CVD) is vital to initiate appropriate intervention. The non-laboratory INTERHEART risk score (NL-IHRS) is among the tools to estimate future risk of CVD. However, measurement disparities of the tool across contexts are not well documented. Thus, we investigated variation in NL-IHRS and components in selected sub-Saharan African and European countries. We used data from a multi-country study involving 9309 participants, i.e., 4941 in Europe, 3371 in South Africa and 997 in Uganda. Disparities in total NL-IHRS score, specific subcomponents, subcategories, and their contribution to the total score was investigated. The variation in the adjusted total and component scores were compared across contexts using analysis of variance. The adjusted mean NL-IHRS was higher in South Africa (10.2) and Europe (10.0) compared to Uganda (8.2) and the difference was statistically significant (p<0.001). The prevalence and percent contribution of diabetes mellitus and high blood pressure were lowest in Uganda. Score contribution of non-modifiable factors was lower in Uganda and South Africa, entailing 11.5% and 8.0% of the total score respectively. Contribution of behavioral factors to the total score was highest in both sub-Saharan African countries. In particular, adjusted scores related to unhealthy dietary patterns were highest in South Africa (3.21) compared to Uganda (1.66) and Europe (1.09). Whereas contribution of metabolic factors was highest in Europe (30.6%) compared with Uganda (20.8%) and South Africa (22.6%). The total risk score, subcomponents, categories, and their contribution to total score greatly varies across contexts, which could be due to disparities in risk burden and/or self-reporting bias in resource limited settings. Therefore, primary preventive initiatives should identify risk factor burden across contexts and intervention activities need to be customized accordingly. Furthermore, contextualizing the risk assessment tool and evaluating its usefulness in different settings is recommended.
{"title":"Disparities in the non-laboratory INTERHEART risk score and its components in selected countries of Europe and sub-Saharan Africa: Analysis from the SPICES multi-country project","authors":"Hamid Y Hassen, Steven Abrams, G. Musinguzi, Imogen Rogers, Alfred Dusabimana, P. Mphekgwana, H. Bastiaens, H. Bastiaens, Hamid Y Hassen, N. Aerts, S. Anthierens, Kathleen Van Royen, Caroline Masquillier, Jean Yves Le Reste, D. Le Goff, G. Perraud, Harm van Marwijk, Elisabeth Ford, Tom Grice-Jackson, Imogen Rogers, P. Nahar, Linda Gibson, M. Bowyer, Almighty Nkengateh, G. Musinguzi, R. Ndejjo, Fred Nuwaha, T. Sodi, P. Mphekgwana, Nancy Malema, Nancy Kgatla, T. Mothiba","doi":"10.1093/ehjopen/oead131","DOIUrl":"https://doi.org/10.1093/ehjopen/oead131","url":null,"abstract":"\u0000 \u0000 \u0000 Accurate prediction of a person’s risk of cardiovascular disease (CVD) is vital to initiate appropriate intervention. The non-laboratory INTERHEART risk score (NL-IHRS) is among the tools to estimate future risk of CVD. However, measurement disparities of the tool across contexts are not well documented. Thus, we investigated variation in NL-IHRS and components in selected sub-Saharan African and European countries.\u0000 \u0000 \u0000 \u0000 We used data from a multi-country study involving 9309 participants, i.e., 4941 in Europe, 3371 in South Africa and 997 in Uganda. Disparities in total NL-IHRS score, specific subcomponents, subcategories, and their contribution to the total score was investigated. The variation in the adjusted total and component scores were compared across contexts using analysis of variance.\u0000 \u0000 \u0000 \u0000 The adjusted mean NL-IHRS was higher in South Africa (10.2) and Europe (10.0) compared to Uganda (8.2) and the difference was statistically significant (p<0.001). The prevalence and percent contribution of diabetes mellitus and high blood pressure were lowest in Uganda. Score contribution of non-modifiable factors was lower in Uganda and South Africa, entailing 11.5% and 8.0% of the total score respectively. Contribution of behavioral factors to the total score was highest in both sub-Saharan African countries. In particular, adjusted scores related to unhealthy dietary patterns were highest in South Africa (3.21) compared to Uganda (1.66) and Europe (1.09). Whereas contribution of metabolic factors was highest in Europe (30.6%) compared with Uganda (20.8%) and South Africa (22.6%).\u0000 \u0000 \u0000 \u0000 The total risk score, subcomponents, categories, and their contribution to total score greatly varies across contexts, which could be due to disparities in risk burden and/or self-reporting bias in resource limited settings. Therefore, primary preventive initiatives should identify risk factor burden across contexts and intervention activities need to be customized accordingly. Furthermore, contextualizing the risk assessment tool and evaluating its usefulness in different settings is recommended.\u0000","PeriodicalId":93995,"journal":{"name":"European heart journal open","volume":"119 52","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138599551","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}
I. Dykun, A. A. Mahabadi, Stefanie Jehn, Ankur Kalra, T. Isogai, O. Wazni, Mohamad Kanj, A. Krishnaswamy, G. Reed, James J Yun, Matthias Totzeck, R. Jánosi, Alexander Y Lind, Samir R Kapadia, T. Rassaf, R. Puri
Conduction abnormalities necessitating permanent pacemaker (PPM) implantation remains the most frequent complication post-TAVI, yet reliance on PPM function varies. We evaluated the association of right-ventricular (RV)-stimulation rate post-TAVI with 1-year MACE (all-cause mortality and heart failure hospitalization). This retrospective cohort study of patients undergoing TAVI in 2 high-volume centers included patients with existing PPM pre-TAVI or new PPM post-TAVI. There was a bimodal distribution of RV-stimulation rates stratifying patients into 2 groups of either low [≤10%: 1.0 (0.0, 3.6)] or high [>10%: 96.0 (54.0, 99.9)] RV-stimulation rate post-TAVI. Hazard ratios (HR) and 95% confidence intervals (CI) were calculated comparing MACE in patients with high vs. low RV-stimulation rates post-TAVI. From 4659 patients, 408 patients (8.6%) had an existing PPM pre-TAVI and 361 patients (7.7%) underwent PPM implantation post-TAVI. Mean age was 82.3 ± 8.1 years, 39% were women. A high RV-stimulation rate (>10%) development post-TAVI associated with a 2-fold increased risk for MACE [1.97 (1.20, 3.25), p = 0.008]. Valve implantation depth was an independent predictor of high RV-stimulation rate [odds ratio (95% CI): 1.58 (1.21, 2.06), p=<0.001] and itself associated with MACE [1.27 (1.00, 1.59), p = 0.047]. Greater RV-stimulation rates post-TAVI correlates with increased 1-year MACE in patients with new PPM post-TAVI or in those with existing PPM but low RV-stimulation rates pre-TAVI. A shallower valve implantation depth reduces the risk of greater RV-stimulation rates post-TAVI, correlating with improved patient outcomes. These data highlight the importance of a meticulous implant technique even in TAVI recipients with pre-existing PPMs.
{"title":"The Degree of Permanent Pacemaker Dependence and Clinical Outcomes Following TAVI: Implications for Procedural Technique","authors":"I. Dykun, A. A. Mahabadi, Stefanie Jehn, Ankur Kalra, T. Isogai, O. Wazni, Mohamad Kanj, A. Krishnaswamy, G. Reed, James J Yun, Matthias Totzeck, R. Jánosi, Alexander Y Lind, Samir R Kapadia, T. Rassaf, R. Puri","doi":"10.1093/ehjopen/oead127","DOIUrl":"https://doi.org/10.1093/ehjopen/oead127","url":null,"abstract":"\u0000 \u0000 \u0000 Conduction abnormalities necessitating permanent pacemaker (PPM) implantation remains the most frequent complication post-TAVI, yet reliance on PPM function varies. We evaluated the association of right-ventricular (RV)-stimulation rate post-TAVI with 1-year MACE (all-cause mortality and heart failure hospitalization).\u0000 \u0000 \u0000 \u0000 This retrospective cohort study of patients undergoing TAVI in 2 high-volume centers included patients with existing PPM pre-TAVI or new PPM post-TAVI. There was a bimodal distribution of RV-stimulation rates stratifying patients into 2 groups of either low [≤10%: 1.0 (0.0, 3.6)] or high [>10%: 96.0 (54.0, 99.9)] RV-stimulation rate post-TAVI. Hazard ratios (HR) and 95% confidence intervals (CI) were calculated comparing MACE in patients with high vs. low RV-stimulation rates post-TAVI.\u0000 \u0000 \u0000 \u0000 From 4659 patients, 408 patients (8.6%) had an existing PPM pre-TAVI and 361 patients (7.7%) underwent PPM implantation post-TAVI. Mean age was 82.3 ± 8.1 years, 39% were women. A high RV-stimulation rate (>10%) development post-TAVI associated with a 2-fold increased risk for MACE [1.97 (1.20, 3.25), p = 0.008]. Valve implantation depth was an independent predictor of high RV-stimulation rate [odds ratio (95% CI): 1.58 (1.21, 2.06), p=<0.001] and itself associated with MACE [1.27 (1.00, 1.59), p = 0.047].\u0000 \u0000 \u0000 \u0000 Greater RV-stimulation rates post-TAVI correlates with increased 1-year MACE in patients with new PPM post-TAVI or in those with existing PPM but low RV-stimulation rates pre-TAVI. A shallower valve implantation depth reduces the risk of greater RV-stimulation rates post-TAVI, correlating with improved patient outcomes. These data highlight the importance of a meticulous implant technique even in TAVI recipients with pre-existing PPMs.\u0000","PeriodicalId":93995,"journal":{"name":"European heart journal open","volume":"23 10","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138603910","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}
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