Pub Date : 2024-08-31Epub Date: 2024-07-31DOI: 10.21037/cdt-24-27
Chang-Yeon Kim, Jae Yong Lee, Hae Won Jung
Background: Previous studies revealed a linear relationship between body mass index (BMI) and repeat coronary revascularization rate in patients who underwent percutaneous coronary intervention (PCI). However, this relationship has not been demonstrated in Korean patients who meet old and new target low-density lipoprotein cholesterol (LDL-C) levels of Korean dyslipidemia guidelines. Therefore, we conducted this study to find out the effect of BMI on repeat coronary revascularization rate in patients with LDL-C <55 mg/dL and patients with LDL-C <70 mg/dL.
Methods: This cohort study was followed for 42 months in Daegu Catholic Medical Center, Korea. We included 429 patients with LDL-C <70 mg/dL 1 year after PCI. We compared repeat revascularization rates using Kaplan-Meier survival curves between the normal weight group (18.5 kg/m2 ≤ BMI < 23 kg/m2) and the pre-obesity and obesity group (23 kg/m2 ≤ BMI) in patients with LDL-C <55 mg/dL and patients with LDL-C <70 mg/dL.
Results: During a follow-up period, there was no significant difference in repeat coronary revascularization-free survival between a group with LDL-C <55 mg/dL and a group with LDL-C <70 mg/dL (79.6% vs. 76.2%, P=0.32). In normal weight patients, LDL-C <55 mg/dL group showed higher repeat coronary revascularization-free survival than LDL-C <70 mg/dL group (89.3% vs. 77.1%, P=0.05). There was no significant difference in repeat revascularization-free survival between the normal weight group and the pre-obesity and obesity group in patients with LDL-C <70 mg/dL (77.1% vs. 75.7%, P=0.67). However, the normal weight group showed significantly higher repeat revascularization-free survival compared to the pre-obesity and obesity group in patients with LDL-C <55 mg/dL (89.3% vs. 74.3%, P=0.03). Normal body weight and LDL-C <55 mg/dL [hazard ratio (HR): 0.421, 95% confidence interval (CI): 0.193-0.916, P=0.02] was the only independent predictor for repeat revascularization.
Conclusions: In Korean PCI patients with normal body weight whose LDL-C level is less than 70 mg/dL, but more than 55 mg/dL, should be treated with more intensive therapy to lower LDL-C to less than 55 mg/dL. For obese patients who have succeeded in reducing LDL-C below 55 mg/dL, it seems that weight loss should be attempted to a normal body weight level.
{"title":"Impact of body mass index on repeat coronary revascularization rates in patients with LDL-C below 55 mg/dL and LDL-C below 70 mg/dL: a 42-month cohort study in Korea.","authors":"Chang-Yeon Kim, Jae Yong Lee, Hae Won Jung","doi":"10.21037/cdt-24-27","DOIUrl":"https://doi.org/10.21037/cdt-24-27","url":null,"abstract":"<p><strong>Background: </strong>Previous studies revealed a linear relationship between body mass index (BMI) and repeat coronary revascularization rate in patients who underwent percutaneous coronary intervention (PCI). However, this relationship has not been demonstrated in Korean patients who meet old and new target low-density lipoprotein cholesterol (LDL-C) levels of Korean dyslipidemia guidelines. Therefore, we conducted this study to find out the effect of BMI on repeat coronary revascularization rate in patients with LDL-C <55 mg/dL and patients with LDL-C <70 mg/dL.</p><p><strong>Methods: </strong>This cohort study was followed for 42 months in Daegu Catholic Medical Center, Korea. We included 429 patients with LDL-C <70 mg/dL 1 year after PCI. We compared repeat revascularization rates using Kaplan-Meier survival curves between the normal weight group (18.5 kg/m<sup>2</sup> ≤ BMI < 23 kg/m<sup>2</sup>) and the pre-obesity and obesity group (23 kg/m<sup>2</sup> ≤ BMI) in patients with LDL-C <55 mg/dL and patients with LDL-C <70 mg/dL.</p><p><strong>Results: </strong>During a follow-up period, there was no significant difference in repeat coronary revascularization-free survival between a group with LDL-C <55 mg/dL and a group with LDL-C <70 mg/dL (79.6% <i>vs.</i> 76.2%, P=0.32). In normal weight patients, LDL-C <55 mg/dL group showed higher repeat coronary revascularization-free survival than LDL-C <70 mg/dL group (89.3% <i>vs.</i> 77.1%, P=0.05). There was no significant difference in repeat revascularization-free survival between the normal weight group and the pre-obesity and obesity group in patients with LDL-C <70 mg/dL (77.1% <i>vs.</i> 75.7%, P=0.67). However, the normal weight group showed significantly higher repeat revascularization-free survival compared to the pre-obesity and obesity group in patients with LDL-C <55 mg/dL (89.3% <i>vs.</i> 74.3%, P=0.03). Normal body weight and LDL-C <55 mg/dL [hazard ratio (HR): 0.421, 95% confidence interval (CI): 0.193-0.916, P=0.02] was the only independent predictor for repeat revascularization.</p><p><strong>Conclusions: </strong>In Korean PCI patients with normal body weight whose LDL-C level is less than 70 mg/dL, but more than 55 mg/dL, should be treated with more intensive therapy to lower LDL-C to less than 55 mg/dL. For obese patients who have succeeded in reducing LDL-C below 55 mg/dL, it seems that weight loss should be attempted to a normal body weight level.</p>","PeriodicalId":9592,"journal":{"name":"Cardiovascular diagnosis and therapy","volume":"14 4","pages":"642-654"},"PeriodicalIF":2.1,"publicationDate":"2024-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11384448/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142280650","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-31Epub Date: 2024-08-06DOI: 10.21037/cdt-23-466
Monisha Ghosh Srabanti, Julio Garcia
<p><strong>Background: </strong>Chronic primary mitral regurgitation (MR) is caused by the defect in >1 component of the mitral valve, potentially leading to left ventricular hypertrophy (LVH). The relationship between LVH subtypes and the insufficiency grading of chronic MR remains unclear. Thus, we aimed to investigate this association and explore the impact of unhealthy habits on LVH development in patients with chronic primary MR through a cross-sectional study.</p><p><strong>Methods: </strong>Cardiac magnetic resonance (CMR) data was retrospectively collected from 3T magnetic resonance imaging (MRI) scanners in 71 patients with chronic primary MR (range, 20-84 years, 52% men). Considered patients (with mild-to-severe MR) were enrolled between March 2015 and September 2022 from the Cardiovascular Imaging Registry of Calgary (CIROC) database. Left ventricle (LV) function was assessed using cvi42 v5.11.5. Patients were categorized into 'mild-to-severe' MR using regurgitation fraction (RF), according to the current imaging guidelines. LVH subtypes were determined using mass-to-volume (M/V) calculations. IBM SPSS was used to run all the statistical analyses. This study employed normality checks by using the Shapiro-Wilk test; one-way analysis of variance (ANOVA) and Kruskal-Wallis tests with post-hoc pairwise comparisons; Chi-squared tests, Fisher's Exact test, crosstabulation analysis, and multinomial logistic regression to examine relationships between MR severity, LVH types, and impact of lifestyle factors, significance at P<0.05.</p><p><strong>Results: </strong>Eccentric LVH was significantly associated with increased severity of MR, while concentric remodeling (CR) was linked to decreased MR severity (χ<sup>2</sup>=13.276, P=0.03, stratified by sex χ<sup>2</sup>=7.729, P=0.005). Sex differences emerged in the overall study population. Eccentric LVH was dominantly higher than CR in both males and females (females: 57.7% <i>vs.</i> 42.3%, P=0.05, males: 82.8% <i>vs.</i> 17.2%, P=0.26). No differences were observed between age groups ('Young-Middle' = under 60 years, and 'Middle-Old' = over 60 years). Still, there were notable differences in LVH prevalence within the 'Young-Middle' age group for mild-moderate (P=0.01) and moderate-severe MR (P=0.02). Eccentric LVH was associated with higher body mass index (BMI), smoking, and frequent alcohol consumption [odds ratio (OR) 1.02, 95% confidence interval (CI): 0.56-1.26; OR 1.65, 95% CI: 1.31-6.52; OR 1.15, 95% CI: 0.26-1.34], while CR was solely associated with increased BMI (smokers OR =1.84, 95% CI: 1.25-3.91 and alcohol consumers OR =1.32, 95% CI: 0.86-2.48). Nicotine and caffeine consumption did not appear to be a risk factor for LVH (nicotine: eccentric, OR =0.99, 95% CI: 0.65-1.86; CR, OR =0.97, 95% CI: 0.69-2.39 and caffeine: eccentric, OR =0.69, 95% CI: 0.48-1.61; CR, OR =0.97, 95% CI: 0.78-4.01).</p><p><strong>Conclusions: </strong>This study reveals sex-based associations between LVH sub
{"title":"Quadratic stratification of left ventricular hypertrophy and association with mitral insufficiency grading: a retrospective study using cardiac magnetic resonance.","authors":"Monisha Ghosh Srabanti, Julio Garcia","doi":"10.21037/cdt-23-466","DOIUrl":"https://doi.org/10.21037/cdt-23-466","url":null,"abstract":"<p><strong>Background: </strong>Chronic primary mitral regurgitation (MR) is caused by the defect in >1 component of the mitral valve, potentially leading to left ventricular hypertrophy (LVH). The relationship between LVH subtypes and the insufficiency grading of chronic MR remains unclear. Thus, we aimed to investigate this association and explore the impact of unhealthy habits on LVH development in patients with chronic primary MR through a cross-sectional study.</p><p><strong>Methods: </strong>Cardiac magnetic resonance (CMR) data was retrospectively collected from 3T magnetic resonance imaging (MRI) scanners in 71 patients with chronic primary MR (range, 20-84 years, 52% men). Considered patients (with mild-to-severe MR) were enrolled between March 2015 and September 2022 from the Cardiovascular Imaging Registry of Calgary (CIROC) database. Left ventricle (LV) function was assessed using cvi42 v5.11.5. Patients were categorized into 'mild-to-severe' MR using regurgitation fraction (RF), according to the current imaging guidelines. LVH subtypes were determined using mass-to-volume (M/V) calculations. IBM SPSS was used to run all the statistical analyses. This study employed normality checks by using the Shapiro-Wilk test; one-way analysis of variance (ANOVA) and Kruskal-Wallis tests with post-hoc pairwise comparisons; Chi-squared tests, Fisher's Exact test, crosstabulation analysis, and multinomial logistic regression to examine relationships between MR severity, LVH types, and impact of lifestyle factors, significance at P<0.05.</p><p><strong>Results: </strong>Eccentric LVH was significantly associated with increased severity of MR, while concentric remodeling (CR) was linked to decreased MR severity (χ<sup>2</sup>=13.276, P=0.03, stratified by sex χ<sup>2</sup>=7.729, P=0.005). Sex differences emerged in the overall study population. Eccentric LVH was dominantly higher than CR in both males and females (females: 57.7% <i>vs.</i> 42.3%, P=0.05, males: 82.8% <i>vs.</i> 17.2%, P=0.26). No differences were observed between age groups ('Young-Middle' = under 60 years, and 'Middle-Old' = over 60 years). Still, there were notable differences in LVH prevalence within the 'Young-Middle' age group for mild-moderate (P=0.01) and moderate-severe MR (P=0.02). Eccentric LVH was associated with higher body mass index (BMI), smoking, and frequent alcohol consumption [odds ratio (OR) 1.02, 95% confidence interval (CI): 0.56-1.26; OR 1.65, 95% CI: 1.31-6.52; OR 1.15, 95% CI: 0.26-1.34], while CR was solely associated with increased BMI (smokers OR =1.84, 95% CI: 1.25-3.91 and alcohol consumers OR =1.32, 95% CI: 0.86-2.48). Nicotine and caffeine consumption did not appear to be a risk factor for LVH (nicotine: eccentric, OR =0.99, 95% CI: 0.65-1.86; CR, OR =0.97, 95% CI: 0.69-2.39 and caffeine: eccentric, OR =0.69, 95% CI: 0.48-1.61; CR, OR =0.97, 95% CI: 0.78-4.01).</p><p><strong>Conclusions: </strong>This study reveals sex-based associations between LVH sub","PeriodicalId":9592,"journal":{"name":"Cardiovascular diagnosis and therapy","volume":"14 4","pages":"589-608"},"PeriodicalIF":2.1,"publicationDate":"2024-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11384468/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142280657","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-30Epub Date: 2024-06-17DOI: 10.21037/cdt-24-25
Jiesuck Park, Jaeik Jeon, Yeonyee E Yoon, Yeonggul Jang, Jiyeon Kim, Dawun Jeong, Jina Lee, Youngtaek Hong, Seongmin Ha, Arsanjani Reza, Hyung-Bok Park, Seung-Ah Lee, Hyejung Choi, Hong-Mi Choi, In-Chang Hwang, Goo-Yeong Cho, Hyuk-Jae Chang
<p><strong>Background: </strong>Evaluating left ventricular diastolic function (LVDF) is crucial in echocardiography; however, the complexity and time demands of current guidelines challenge clinical use. This study aimed to develop an artificial intelligence (AI)-based framework for automatic LVDF assessment to reduce subjectivity and improve accuracy and outcome prediction.</p><p><strong>Methods: </strong>We developed an AI-based LVDF assessment framework using a nationwide echocardiographic dataset from five tertiary hospitals. This framework automatically identifies views, calculates diastolic parameters, including mitral inflow and annular velocities (E/A ratio, e' velocity, and E/e' ratio), maximal tricuspid regurgitation velocity, left atrial (LA) volume index, and left atrial reservoir strain (LARS). Subsequently, it grades LVDF according to guidelines. The AI-framework was validated on an external dataset composed of randomly screened 173 outpatients who underwent transthoracic echocardiography with suspicion for diastolic dysfunction and 33 individuals from medical check-ups with normal echocardiograms at Seoul National University Bundang Hospital, tertiary medical center in Korea, between May 2012 and June 2022. Additionally, we assessed the predictive value of AI-derived diastolic parameters and LVDF grades for a clinical endpoint, defined as a composite of all-cause death and hospitalization for heart failure, using Cox-regression risk modelling.</p><p><strong>Results: </strong>In an evaluation with 200 echocardiographic examinations (167 suspected diastolic dysfunction patients, 33 controls), it achieves an overall accuracy of 99.1% in identifying necessary views. Strong correlations (Pearson coefficient 0.901-0.959) were observed between AI-derived and manually-derived measurements of diastolic parameters, including LARS as well as conventional parameters. When following the guidelines, whether utilizing AI-derived or manually-derived parameters, the evaluation of LVDF consistently showed high concordance rates (94%). However, both methods exhibited lower concordance rates with the clinician's prior assessments (77.5% and 78.5%, respectively). Importantly, both AI-derived and manually-derived LVDF grades independently demonstrated significant prognostic value [adjusted hazard ratio (HR) =3.03; P=0.03 and adjusted HR =2.75; P=0.04, respectively] for predicting clinical outcome. In contrast, the clinician's prior grading lost its significance as a prognostic indicator after adjusting for clinical risk factors (adjusted HR =1.63; P=0.36). AI-derived LARS values significantly decreased with worsening LVDF (P for trend <0.001), and low LARS (<17%) was associated with increased risk for the clinical outcome (Log-rank P=0.04) relative to that for preserved LARS (≥17%).</p><p><strong>Conclusions: </strong>Our AI-based approach for automatic LVDF assessment on echocardiography is feasible, potentially enhancing clinical diagnosis and outcom
{"title":"Artificial intelligence-enhanced automation of left ventricular diastolic assessment: a pilot study for feasibility, diagnostic validation, and outcome prediction.","authors":"Jiesuck Park, Jaeik Jeon, Yeonyee E Yoon, Yeonggul Jang, Jiyeon Kim, Dawun Jeong, Jina Lee, Youngtaek Hong, Seongmin Ha, Arsanjani Reza, Hyung-Bok Park, Seung-Ah Lee, Hyejung Choi, Hong-Mi Choi, In-Chang Hwang, Goo-Yeong Cho, Hyuk-Jae Chang","doi":"10.21037/cdt-24-25","DOIUrl":"10.21037/cdt-24-25","url":null,"abstract":"<p><strong>Background: </strong>Evaluating left ventricular diastolic function (LVDF) is crucial in echocardiography; however, the complexity and time demands of current guidelines challenge clinical use. This study aimed to develop an artificial intelligence (AI)-based framework for automatic LVDF assessment to reduce subjectivity and improve accuracy and outcome prediction.</p><p><strong>Methods: </strong>We developed an AI-based LVDF assessment framework using a nationwide echocardiographic dataset from five tertiary hospitals. This framework automatically identifies views, calculates diastolic parameters, including mitral inflow and annular velocities (E/A ratio, e' velocity, and E/e' ratio), maximal tricuspid regurgitation velocity, left atrial (LA) volume index, and left atrial reservoir strain (LARS). Subsequently, it grades LVDF according to guidelines. The AI-framework was validated on an external dataset composed of randomly screened 173 outpatients who underwent transthoracic echocardiography with suspicion for diastolic dysfunction and 33 individuals from medical check-ups with normal echocardiograms at Seoul National University Bundang Hospital, tertiary medical center in Korea, between May 2012 and June 2022. Additionally, we assessed the predictive value of AI-derived diastolic parameters and LVDF grades for a clinical endpoint, defined as a composite of all-cause death and hospitalization for heart failure, using Cox-regression risk modelling.</p><p><strong>Results: </strong>In an evaluation with 200 echocardiographic examinations (167 suspected diastolic dysfunction patients, 33 controls), it achieves an overall accuracy of 99.1% in identifying necessary views. Strong correlations (Pearson coefficient 0.901-0.959) were observed between AI-derived and manually-derived measurements of diastolic parameters, including LARS as well as conventional parameters. When following the guidelines, whether utilizing AI-derived or manually-derived parameters, the evaluation of LVDF consistently showed high concordance rates (94%). However, both methods exhibited lower concordance rates with the clinician's prior assessments (77.5% and 78.5%, respectively). Importantly, both AI-derived and manually-derived LVDF grades independently demonstrated significant prognostic value [adjusted hazard ratio (HR) =3.03; P=0.03 and adjusted HR =2.75; P=0.04, respectively] for predicting clinical outcome. In contrast, the clinician's prior grading lost its significance as a prognostic indicator after adjusting for clinical risk factors (adjusted HR =1.63; P=0.36). AI-derived LARS values significantly decreased with worsening LVDF (P for trend <0.001), and low LARS (<17%) was associated with increased risk for the clinical outcome (Log-rank P=0.04) relative to that for preserved LARS (≥17%).</p><p><strong>Conclusions: </strong>Our AI-based approach for automatic LVDF assessment on echocardiography is feasible, potentially enhancing clinical diagnosis and outcom","PeriodicalId":9592,"journal":{"name":"Cardiovascular diagnosis and therapy","volume":"14 3","pages":"352-366"},"PeriodicalIF":2.1,"publicationDate":"2024-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11223940/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141554147","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-30Epub Date: 2024-06-27DOI: 10.21037/cdt-23-418
Amin Daoulah, Ahmed Elmahrouk, Amr A Arafat, Badr Alzahrani, Mohammed Alshehri, Wael Qenawi, Abdelmaksoud Elganady, Wael Almahmeed, Ahmed Jamjoom, Youssef Elmahrouk, Mohammed A Qutub, Ziad Dahdouh, Nooraldaem Yousif, Omar Kanbr, Taher Hassan, Tarique Shahzad Chachar, Abdulwali Abohasan, Abdulrahman M Alqahtani, Alaa Aldossari, Mohamed Ajaz Ghani, Wael Refaat, Mohammed Balghith, Hameedullah M Kazim, Ibrahim A M Abdulhabeeb, Jairam Aithal, Issam Altnji, Ehab Selim, Shahrukh Hashmani, Ahmed M Ibrahim, Reda Abuelatta, Ahmed A Ghonim, Abeer M Shawky, Osama Ahmad, Abdulaziz Alkaluf, Adnan Fathey Hussien, Mohamed N Alama, Seraj Abualnaja, Rasha Taha Baqais, Abdulkarim Alhassoun, Ehab Elghaysha, Salem Owaid Al Wabisi, Adel N Algublan, Naveen Nasim, Amir Lotfi
Background: Preoperative intra-aortic balloon pump (IABP) before coronary artery bypass grafting (CABG) could improve operative outcomes by augmenting the diastolic coronary blood flow. Data on preoperative IABP use in patients with left-main coronary artery (LMCA) disease are limited. This study aimed to characterize patients who received preoperative IABP before CABG for LMCA and evaluate its effect on postoperative outcomes.
Methods: This multicenter retrospective cohort study that included consecutive 914 patients who underwent CABG for unprotected LMCA disease from January 2015 to December 2019 in 14 tertiary referral centers. Patients were grouped according to the preoperative IABP insertion into patients with IABP (n=101) and without IABP (n=813). Propensity score matching adjusting for preoperative variables, with 1:1 match and a caliber of 0.03 identified 80 matched pairs. The primary outcomes used in propensity score matching were cardiac mortality and major adverse cardiac and cerebrovascular events (MACCE).
Results: IABP was commonly inserted in patients with previous myocardial infarction (MI), chronic kidney disease, peripheral arterial disease, and congestive heart failure. IABP patients had higher EuroSCORE [ES >8%: 95 (11.86%) vs. 40 (39.60%), P<0.001] and SYNTAX {29 [interquartile range (IQR) 25-35] vs. 33 (IQR 26-36); P=0.02} scores. Preoperative cardiogenic shock and arrhythmia were more prevalent in patients with IABP, while acute coronary syndrome was more prevalent in patients without IABP. After matching, there was no difference in vasoactive inotropic score between groups [3.5 (IQR 1-7.5) vs. 6 (IQR 1-13.5), P=0.06], and lactate levels were nonsignificantly higher in patients with IABP [2.4 (IQR 1.4-4.5) vs. 3.1 (IQR 1.05-7.75), P=0.05]. There were no differences between groups in acute kidney injury [20 (25%) vs. 26 (32.5%), P=0.34], cerebrovascular accidents [3 (3.75%) vs. 4 (5%), P>0.99], heart failure [5 (6.25%) vs. 7 (8.75%), P=0.75], MI [7 (8.75%) vs. 8 (10%), P>0.99], major adverse cardiac and cerebrovascular events [10 (12.5%) vs. 17 (21.25%), P=0.21], and cardiac mortality [6 (7.50%) vs. 14 (17.50%), P=0.09]. Patients who received IABP had longer ventilation times [8.5 (IQR 6-23) vs. 15.5 (IQR 5-50.5) h, P=0.03] and intensive care unit (ICU) stays [3 (IQR 2-5) vs. 4 (IQR 2-7.5) days, P=0.01].
Conclusions: Preoperative IABP in patients with LMCA might not be associated with reduced cardiac mortality or hospital complications. IABP could increase the duration of mechanical ventilation and ICU stay, and its use should be individualized for each patient.
背景：冠状动脉旁路移植术（CABG）术前使用主动脉内球囊反搏泵（IABP）可增强冠状动脉舒张期血流量，从而改善手术效果。有关冠状动脉左主干（LMCA）疾病患者术前使用 IABP 的数据很有限。本研究旨在了解因 LMCA 而接受 CABG 手术前使用 IABP 的患者的特征，并评估其对术后效果的影响：这项多中心回顾性队列研究纳入了 2015 年 1 月至 2019 年 12 月期间在 14 家三级转诊中心因未受保护的 LMCA 疾病而接受 CABG 的连续 914 例患者。根据术前植入 IABP 的情况将患者分为植入 IABP 的患者（n=101）和未植入 IABP 的患者（n=813）。根据术前变量进行倾向评分匹配，匹配比例为 1:1，匹配口径为 0.03，确定了 80 对匹配患者。倾向评分匹配的主要结果是心脏死亡率和主要不良心脑血管事件（MACCE）：结果：曾发生心肌梗死（MI）、慢性肾病、外周动脉疾病和充血性心力衰竭的患者通常会植入 IABP。IABP患者的EuroSCORE[ES>8%]更高：95 (11.86%) vs. 40 (39.60%)，Pvs. 33 (IQR 26-36)；P=0.02}。使用 IABP 的患者术前发生心源性休克和心律失常的比例更高，而未使用 IABP 的患者发生急性冠脉综合征的比例更高。配对后，各组间血管活性肌力评分无差异[3.5 (IQR 1-7.5) vs. 6 (IQR 1-13.5)，P=0.06]，使用 IABP 的患者乳酸水平明显更高[2.4 (IQR 1.4-4.5) vs. 3.1 (IQR 1.05-7.75)，P=0.05]。急性肾损伤[20（25%） vs. 26（32.5%），P=0.34]、脑血管意外[3（3.75%） vs. 4（5%），P>0.99]、心力衰竭[5（6.25%） vs. 7（8.75%），P=0.75]、心肌梗死[7（8.75%） vs. 8（10%），P>0.99]、主要不良心脑血管事件[10（12.5%） vs. 17（21.25%），P=0.21]和心脏病死亡率[6（7.50%） vs. 14（17.50%），P=0.09]。接受IABP的患者通气时间[8.5（IQR 6-23）小时 vs 15.5（IQR 5-50.5）小时，P=0.03]和重症监护室（ICU）停留时间[3（IQR 2-5）天 vs 4（IQR 2-7.5）天，P=0.01]更长：LMCA患者术前使用IABP可能与降低心脏死亡率或住院并发症无关。IABP 可能会延长机械通气和重症监护病房的住院时间，因此应根据每位患者的具体情况使用。
{"title":"Impact of preoperative intra-aortic balloon pump on outcomes in coronary artery bypass grafting for unprotected left-main coronary artery disease.","authors":"Amin Daoulah, Ahmed Elmahrouk, Amr A Arafat, Badr Alzahrani, Mohammed Alshehri, Wael Qenawi, Abdelmaksoud Elganady, Wael Almahmeed, Ahmed Jamjoom, Youssef Elmahrouk, Mohammed A Qutub, Ziad Dahdouh, Nooraldaem Yousif, Omar Kanbr, Taher Hassan, Tarique Shahzad Chachar, Abdulwali Abohasan, Abdulrahman M Alqahtani, Alaa Aldossari, Mohamed Ajaz Ghani, Wael Refaat, Mohammed Balghith, Hameedullah M Kazim, Ibrahim A M Abdulhabeeb, Jairam Aithal, Issam Altnji, Ehab Selim, Shahrukh Hashmani, Ahmed M Ibrahim, Reda Abuelatta, Ahmed A Ghonim, Abeer M Shawky, Osama Ahmad, Abdulaziz Alkaluf, Adnan Fathey Hussien, Mohamed N Alama, Seraj Abualnaja, Rasha Taha Baqais, Abdulkarim Alhassoun, Ehab Elghaysha, Salem Owaid Al Wabisi, Adel N Algublan, Naveen Nasim, Amir Lotfi","doi":"10.21037/cdt-23-418","DOIUrl":"10.21037/cdt-23-418","url":null,"abstract":"<p><strong>Background: </strong>Preoperative intra-aortic balloon pump (IABP) before coronary artery bypass grafting (CABG) could improve operative outcomes by augmenting the diastolic coronary blood flow. Data on preoperative IABP use in patients with left-main coronary artery (LMCA) disease are limited. This study aimed to characterize patients who received preoperative IABP before CABG for LMCA and evaluate its effect on postoperative outcomes.</p><p><strong>Methods: </strong>This multicenter retrospective cohort study that included consecutive 914 patients who underwent CABG for unprotected LMCA disease from January 2015 to December 2019 in 14 tertiary referral centers. Patients were grouped according to the preoperative IABP insertion into patients with IABP (n=101) and without IABP (n=813). Propensity score matching adjusting for preoperative variables, with 1:1 match and a caliber of 0.03 identified 80 matched pairs. The primary outcomes used in propensity score matching were cardiac mortality and major adverse cardiac and cerebrovascular events (MACCE).</p><p><strong>Results: </strong>IABP was commonly inserted in patients with previous myocardial infarction (MI), chronic kidney disease, peripheral arterial disease, and congestive heart failure. IABP patients had higher EuroSCORE [ES >8%: 95 (11.86%) <i>vs.</i> 40 (39.60%), P<0.001] and SYNTAX {29 [interquartile range (IQR) 25-35] <i>vs.</i> 33 (IQR 26-36); P=0.02} scores. Preoperative cardiogenic shock and arrhythmia were more prevalent in patients with IABP, while acute coronary syndrome was more prevalent in patients without IABP. After matching, there was no difference in vasoactive inotropic score between groups [3.5 (IQR 1-7.5) <i>vs.</i> 6 (IQR 1-13.5), P=0.06], and lactate levels were nonsignificantly higher in patients with IABP [2.4 (IQR 1.4-4.5) <i>vs.</i> 3.1 (IQR 1.05-7.75), P=0.05]. There were no differences between groups in acute kidney injury [20 (25%) <i>vs.</i> 26 (32.5%), P=0.34], cerebrovascular accidents [3 (3.75%) <i>vs.</i> 4 (5%), P>0.99], heart failure [5 (6.25%) <i>vs.</i> 7 (8.75%), P=0.75], MI [7 (8.75%) <i>vs.</i> 8 (10%), P>0.99], major adverse cardiac and cerebrovascular events [10 (12.5%) <i>vs.</i> 17 (21.25%), P=0.21], and cardiac mortality [6 (7.50%) <i>vs.</i> 14 (17.50%), P=0.09]. Patients who received IABP had longer ventilation times [8.5 (IQR 6-23) <i>vs.</i> 15.5 (IQR 5-50.5) h, P=0.03] and intensive care unit (ICU) stays [3 (IQR 2-5) <i>vs.</i> 4 (IQR 2-7.5) days, P=0.01].</p><p><strong>Conclusions: </strong>Preoperative IABP in patients with LMCA might not be associated with reduced cardiac mortality or hospital complications. IABP could increase the duration of mechanical ventilation and ICU stay, and its use should be individualized for each patient.</p>","PeriodicalId":9592,"journal":{"name":"Cardiovascular diagnosis and therapy","volume":"14 3","pages":"340-351"},"PeriodicalIF":2.1,"publicationDate":"2024-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11223939/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141554192","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-30Epub Date: 2024-06-18DOI: 10.21037/cdt-23-398
Yangyang Zhao, Yini Fang, Hang Zhao, Ai-Ling Wang, Jiecheng Peng
Background: Previous studies have suggested that adequate myocardial reperfusion after percutaneous coronary intervention (PCI) can improve the inhomogeneity of myocardial repolarization. However, it remains unclear whether no-reflow (NR) following emergency PCI involves disadvantages related to ventricular repolarization indices. The present study aimed to determine the effect of NR on QT dispersion (QTd) in patients with ST-segment elevation myocardial infarction (STEMI) and to evaluate the prognostic value of the relative reduction of QTd on ventricular arrhythmia events (VAEs).
Methods: A prospective case-control study was conducted. According to the inclusion criteria, 275 patients with STEMI who underwent primary PCI treatment at the First People's Hospital of Anqing affiliated to Anhui Medical University from January 2020 to May 2023 were enrolled. According to whether NR occurred during PCI, these patients were divided into two groups: an NR group and a non-NR group. Subsequently, the QT intervals were measured before and at 12 hours after PCI. Afterward, the QTd, corrected QTd (QTcd), and the relative reduction of QTd and QTcd 12 hours pre- and postprocedure (ΔQTd-R and ΔQTcd-R, respectively) were calculated. Finally, multivariable logistic regression analysis was performed to predict the risk of VAE occurrence.
Results: In the non-NR group, there was a significant decrease from baseline in postprocedure QTd (48±17 vs. 73±22 ms; P=0.009) and QTcd (54±19 vs. 80±23 ms; P=0.01); in contrast, the NR group showed no significant difference in QTd (64±20 vs. 75±23 ms; P=0.58) or QTd (70±22 vs. 82±26 ms; P=0.45). Furthermore, the ΔQTd-R and ΔQTcd-R were both lower in the NR group than in the non-NR group (P<0.05); however, the rate of VAEs was higher in the NR group than in the non-NR group (15.2% vs. 6.2%; P=0.02). The multivariable logistic regression analysis results revealed that each increase of 12% in ΔQTcd-R was an independent predictor of VAEs (odds ratio: 0.547; 95% confidence interval: 0.228-0.976).
Conclusions: The NR phenomenon following primary PCI in patients with STEMI leads to the defective recovery of QTd and QTcd. Furthermore, ΔQTcd-R can be viewed as an effective indicator for evaluating the myocardial repolarization inhomogeneity, and short-term clinical outcomes.
背景：以往的研究表明，经皮冠状动脉介入治疗（PCI）后充分的心肌再灌注可改善心肌再极化的不均匀性。然而，目前仍不清楚急诊 PCI 后无再灌注（NR）是否会对心室再极化指数造成不利影响。本研究旨在确定 NR 对 ST 段抬高型心肌梗死（STEMI）患者 QT 离散度（QTd）的影响，并评估 QTd 相对降低对室性心律失常事件（VAEs）的预后价值：方法：进行了一项前瞻性病例对照研究。根据纳入标准，纳入了2020年1月至2023年5月在安徽医科大学附属安庆市第一人民医院接受初级PCI治疗的275例STEMI患者。根据PCI过程中是否发生NR，这些患者被分为两组：NR组和非NR组。随后，在 PCI 前和 PCI 后 12 小时测量 QT 间期。之后，计算 QTd、校正 QTd (QTcd)，以及术前和术后 12 小时 QTd 和 QTcd 的相对缩短率（分别为 ΔQTd-R 和 ΔQTcd-R）。最后，进行多变量逻辑回归分析以预测发生 VAE 的风险：结果：在非 NR 组中，术后 QTd（48±17 vs. 73±22 ms；P=0.009）和 QTcd（54±19 vs. 80±23 ms；P=0.01）较基线显著下降；相比之下，NR 组的 QTd（64±20 vs. 75±23 ms；P=0.58）或 QTd（70±22 vs. 82±26 ms；P=0.45）无显著差异。此外，NR 组的ΔQTd-R 和 ΔQTcd-R均低于非 NR 组（Pvs.6.2%；P=0.02）。多变量逻辑回归分析结果显示，ΔQTcd-R每增加12%是VAEs的独立预测因子（几率比：0.547；95%置信区间：0.228-0.976）：结论：STEMI 患者进行初级 PCI 后的 NR 现象会导致 QTd 和 QTcd 的恢复缺陷。此外，ΔQTcd-R 可被视为评估心肌复极化不均匀性和短期临床预后的有效指标。
{"title":"Defective recovery of QT dispersion due to no-reflow following acute interventional therapy in patients with ST-segment elevation myocardial infarction.","authors":"Yangyang Zhao, Yini Fang, Hang Zhao, Ai-Ling Wang, Jiecheng Peng","doi":"10.21037/cdt-23-398","DOIUrl":"10.21037/cdt-23-398","url":null,"abstract":"<p><strong>Background: </strong>Previous studies have suggested that adequate myocardial reperfusion after percutaneous coronary intervention (PCI) can improve the inhomogeneity of myocardial repolarization. However, it remains unclear whether no-reflow (NR) following emergency PCI involves disadvantages related to ventricular repolarization indices. The present study aimed to determine the effect of NR on QT dispersion (QTd) in patients with ST-segment elevation myocardial infarction (STEMI) and to evaluate the prognostic value of the relative reduction of QTd on ventricular arrhythmia events (VAEs).</p><p><strong>Methods: </strong>A prospective case-control study was conducted. According to the inclusion criteria, 275 patients with STEMI who underwent primary PCI treatment at the First People's Hospital of Anqing affiliated to Anhui Medical University from January 2020 to May 2023 were enrolled. According to whether NR occurred during PCI, these patients were divided into two groups: an NR group and a non-NR group. Subsequently, the QT intervals were measured before and at 12 hours after PCI. Afterward, the QTd, corrected QTd (QTcd), and the relative reduction of QTd and QTcd 12 hours pre- and postprocedure (ΔQTd-R and ΔQTcd-R, respectively) were calculated. Finally, multivariable logistic regression analysis was performed to predict the risk of VAE occurrence.</p><p><strong>Results: </strong>In the non-NR group, there was a significant decrease from baseline in postprocedure QTd (48±17 <i>vs.</i> 73±22 ms; P=0.009) and QTcd (54±19 <i>vs.</i> 80±23 ms; P=0.01); in contrast, the NR group showed no significant difference in QTd (64±20 <i>vs.</i> 75±23 ms; P=0.58) or QTd (70±22 <i>vs.</i> 82±26 ms; P=0.45). Furthermore, the ΔQTd-R and ΔQTcd-R were both lower in the NR group than in the non-NR group (P<0.05); however, the rate of VAEs was higher in the NR group than in the non-NR group (15.2% <i>vs.</i> 6.2%; P=0.02). The multivariable logistic regression analysis results revealed that each increase of 12% in ΔQTcd-R was an independent predictor of VAEs (odds ratio: 0.547; 95% confidence interval: 0.228-0.976).</p><p><strong>Conclusions: </strong>The NR phenomenon following primary PCI in patients with STEMI leads to the defective recovery of QTd and QTcd. Furthermore, ΔQTcd-R can be viewed as an effective indicator for evaluating the myocardial repolarization inhomogeneity, and short-term clinical outcomes.</p>","PeriodicalId":9592,"journal":{"name":"Cardiovascular diagnosis and therapy","volume":"14 3","pages":"388-401"},"PeriodicalIF":2.1,"publicationDate":"2024-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11223942/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141554189","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-30Epub Date: 2024-06-27DOI: 10.21037/cdt-24-146
Yini Fang, Haoran Wu, Xue Liang, Tianxing Li, Ruiting Jia, Yang Dong, Yanfei Zheng, Qi Wang, Lingru Li
Background: The overall prevalence of dyslipidemia continues to increase, which poses a significant risk for coronary artery disease. Some patients with dyslipidemia do not respond to or benefit from conventional lipid-lowering therapy, which warrants the need for alternative and complementary therapies. Chinese patent medicine (CPM) has shown great potential in the treatment of dyslipidemia, but its clinical value needs to be further explored. This study aims to systematically evaluate the efficacy and safety of CPM in treating dyslipidemia.
Methods: This study was registered in INPLASY as INPLASY202330090. The randomized controlled trials included in this study were published in January 2013 to March 2023 and retrieved from the Web of Science, PubMed, Embase, Cochrane Library, SinoMed, China National Knowledge Internet, WanFang, and VIP. The bias risk in the study was independently evaluated by two reviewers using the Cochrane Randomized Trial Bias Risk Tool (RoB 2) Review Manager 5.4 software was used for the overall effect analysis and subgroup analysis of four blood lipids, and the trial sequential analysis (TSA) was conducted to check the results.
Results: A total of 69 studies were included, involving 6,993 participants. The methodological quality was in the middle level. Meta-analysis showed that CPM markedly improved the levels of total cholesterol (TC) [mean difference (MD) =-0.54 mmol/L; 95% confidence interval (CI): -0.71 to -0.37; P<0.001], triglyceride (TG) (MD =-0.43 mmol/L; 95% CI: -0.53 to -0.33; P<0.001), low-density lipoprotein cholesterol (LDL-C) (MD =-0.40 mmol/L; 95% CI: -0.50 to -0.30; P<0.001) and increased levels of high-density lipoprotein cholesterol (HDL-C) (MD =0.23 mmol/L; 95% CI: 0.18 to 0.27; P<0.001), in patients with dyslipidemia. Though CPM did not differ significantly from statins when used alone, it could improve lipid profile better in all cases when used in combination with statins and with drugs used for comorbidities or co-morbidities. Subgroup analysis found that the efficacy of pill formulations was superior to other formulations, and CPM showed better lipid-lowering response in the context of comorbidity. The TSA confirmed the robustness of the analysis of the LDL-C level. No significant difference was observed in the incidence of adverse events between the treatment group and the control group [risk ratio (RR) =0.89; 95% CI: 0.69-1.16; P=0.40].
Conclusions: CPM can yield superior therapeutic effects in ameliorating dyslipidemia without exacerbating adverse effects as an alternative and complementary therapy. In addition, the therapeutic effect can be improved by emphasizing pill formulation and strengthening the standardization of syndromes.
{"title":"Efficacy and safety assessment of traditional Chinese patent medicine for dyslipidemia: a systematic review of randomized clinical trials with meta-analysis and trial sequential analysis.","authors":"Yini Fang, Haoran Wu, Xue Liang, Tianxing Li, Ruiting Jia, Yang Dong, Yanfei Zheng, Qi Wang, Lingru Li","doi":"10.21037/cdt-24-146","DOIUrl":"10.21037/cdt-24-146","url":null,"abstract":"<p><strong>Background: </strong>The overall prevalence of dyslipidemia continues to increase, which poses a significant risk for coronary artery disease. Some patients with dyslipidemia do not respond to or benefit from conventional lipid-lowering therapy, which warrants the need for alternative and complementary therapies. Chinese patent medicine (CPM) has shown great potential in the treatment of dyslipidemia, but its clinical value needs to be further explored. This study aims to systematically evaluate the efficacy and safety of CPM in treating dyslipidemia.</p><p><strong>Methods: </strong>This study was registered in INPLASY as INPLASY202330090. The randomized controlled trials included in this study were published in January 2013 to March 2023 and retrieved from the Web of Science, PubMed, Embase, Cochrane Library, SinoMed, China National Knowledge Internet, WanFang, and VIP. The bias risk in the study was independently evaluated by two reviewers using the Cochrane Randomized Trial Bias Risk Tool (RoB 2) Review Manager 5.4 software was used for the overall effect analysis and subgroup analysis of four blood lipids, and the trial sequential analysis (TSA) was conducted to check the results.</p><p><strong>Results: </strong>A total of 69 studies were included, involving 6,993 participants. The methodological quality was in the middle level. Meta-analysis showed that CPM markedly improved the levels of total cholesterol (TC) [mean difference (MD) =-0.54 mmol/L; 95% confidence interval (CI): -0.71 to -0.37; P<0.001], triglyceride (TG) (MD =-0.43 mmol/L; 95% CI: -0.53 to -0.33; P<0.001), low-density lipoprotein cholesterol (LDL-C) (MD =-0.40 mmol/L; 95% CI: -0.50 to -0.30; P<0.001) and increased levels of high-density lipoprotein cholesterol (HDL-C) (MD =0.23 mmol/L; 95% CI: 0.18 to 0.27; P<0.001), in patients with dyslipidemia. Though CPM did not differ significantly from statins when used alone, it could improve lipid profile better in all cases when used in combination with statins and with drugs used for comorbidities or co-morbidities. Subgroup analysis found that the efficacy of pill formulations was superior to other formulations, and CPM showed better lipid-lowering response in the context of comorbidity. The TSA confirmed the robustness of the analysis of the LDL-C level. No significant difference was observed in the incidence of adverse events between the treatment group and the control group [risk ratio (RR) =0.89; 95% CI: 0.69-1.16; P=0.40].</p><p><strong>Conclusions: </strong>CPM can yield superior therapeutic effects in ameliorating dyslipidemia without exacerbating adverse effects as an alternative and complementary therapy. In addition, the therapeutic effect can be improved by emphasizing pill formulation and strengthening the standardization of syndromes.</p>","PeriodicalId":9592,"journal":{"name":"Cardiovascular diagnosis and therapy","volume":"14 3","pages":"419-446"},"PeriodicalIF":2.1,"publicationDate":"2024-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11223937/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141554191","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-30Epub Date: 2024-06-11DOI: 10.21037/cdt-23-385
Ji-Gang He, Si Li, Xin-Xin Wu, Xin-Hao Chen, Dan Yan, Xue-Juan Wang, Zhong-Wen Dang
Background: Both early detection and treatment for acute coronary syndrome (ACS) have positively affected prognosis. A microRNA, miRNA-21 (miR-21), may have additional diagnostic potential for ACS among the others. This systematic review and meta-analysis aimed to evaluate the potential role of miR-21 in identifying ACS.
Methods: PubMed, EMBASE and CENTRAL databases were searched up to March 17, 2024, for case-control and cohort studies assessing the diagnostic value of circulating miR-21 in patients with ACS. The search was limited to studies published in either English or Chinese. The primary outcome was the discriminative ability to circulate miR-21 for ACS, represented by the area under the standard receiver operating characteristic curve (AUC) analysis. Meta-analyses combined the AUCs using a random-effects model. Heterogeneity among the studies was detected by the I2 and Q statistics. The quality of the studies included was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2. Publication bias analysis was assessed constructing by the Egger's test (PROSPERO: CRD42020209424).
Results: Eleven case-control studies containing a total of 2,413 subjects with 1,236 ACS cases and 1,177 controls were included. The mean age of participants in these studies ranges between 51.0 and 69.0 years. The meta-analysis showed an overall pooled AUC of 0.779 [95% confidence interval (CI): 0.715-0.843], with high heterogeneity noted between the studies (Q statistic =190.64, I2=94.23%, P<0.001). In subgroup analyses according to the subtypes of ACS, a pooled AUC of 0.767 (95% CI: 0.648-0.887) was derived from the studies focused on acute myocardial infarction cases only. The pooled AUC for unstable angina was 0.770 (95% CI: 0.718-0.822). In subgroup analyses according to the types of control groups, pooled AUC for ACS versus healthy controls was 0.779 (95% CI: 0.715-0.843), whereas the pooled AUC for ACS versus unhealthy controls was 0.740 (95% CI: 0.645-0.836). The quality assessment showed that the studies' overall quality was moderate. No evidence of publication bias was noted (P=0.49).
Conclusions: Circulating miR-21 shows abilities to differentiate between ACS and non-ACS, suggesting its potential as a novel diagnostic biomarker for ACS. However, the evidence is weakened by high heterogeneity observed among the studies. Further research is essential before it can be applied in clinical practice.
{"title":"Circulating miRNA-21 as a diagnostic biomarker for acute coronary syndrome: a systematic review and meta-analysis of diagnostic test accuracy study.","authors":"Ji-Gang He, Si Li, Xin-Xin Wu, Xin-Hao Chen, Dan Yan, Xue-Juan Wang, Zhong-Wen Dang","doi":"10.21037/cdt-23-385","DOIUrl":"10.21037/cdt-23-385","url":null,"abstract":"<p><strong>Background: </strong>Both early detection and treatment for acute coronary syndrome (ACS) have positively affected prognosis. A microRNA, miRNA-21 (miR-21), may have additional diagnostic potential for ACS among the others. This systematic review and meta-analysis aimed to evaluate the potential role of miR-21 in identifying ACS.</p><p><strong>Methods: </strong>PubMed, EMBASE and CENTRAL databases were searched up to March 17, 2024, for case-control and cohort studies assessing the diagnostic value of circulating miR-21 in patients with ACS. The search was limited to studies published in either English or Chinese. The primary outcome was the discriminative ability to circulate miR-21 for ACS, represented by the area under the standard receiver operating characteristic curve (AUC) analysis. Meta-analyses combined the AUCs using a random-effects model. Heterogeneity among the studies was detected by the I<sup>2</sup> and Q statistics. The quality of the studies included was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2. Publication bias analysis was assessed constructing by the Egger's test (PROSPERO: CRD42020209424).</p><p><strong>Results: </strong>Eleven case-control studies containing a total of 2,413 subjects with 1,236 ACS cases and 1,177 controls were included. The mean age of participants in these studies ranges between 51.0 and 69.0 years. The meta-analysis showed an overall pooled AUC of 0.779 [95% confidence interval (CI): 0.715-0.843], with high heterogeneity noted between the studies (Q statistic =190.64, I<sup>2</sup>=94.23%, P<0.001). In subgroup analyses according to the subtypes of ACS, a pooled AUC of 0.767 (95% CI: 0.648-0.887) was derived from the studies focused on acute myocardial infarction cases only. The pooled AUC for unstable angina was 0.770 (95% CI: 0.718-0.822). In subgroup analyses according to the types of control groups, pooled AUC for ACS versus healthy controls was 0.779 (95% CI: 0.715-0.843), whereas the pooled AUC for ACS versus unhealthy controls was 0.740 (95% CI: 0.645-0.836). The quality assessment showed that the studies' overall quality was moderate. No evidence of publication bias was noted (P=0.49).</p><p><strong>Conclusions: </strong>Circulating miR-21 shows abilities to differentiate between ACS and non-ACS, suggesting its potential as a novel diagnostic biomarker for ACS. However, the evidence is weakened by high heterogeneity observed among the studies. Further research is essential before it can be applied in clinical practice.</p>","PeriodicalId":9592,"journal":{"name":"Cardiovascular diagnosis and therapy","volume":"14 3","pages":"328-339"},"PeriodicalIF":2.1,"publicationDate":"2024-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11223935/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141554148","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-30Epub Date: 2024-06-27DOI: 10.21037/cdt-24-15
Antônio da Silva Menezes Júnior, Izadora Caiado Oliveira, André Maroccolo de Sousa, Ricardo Figueiredo Paro Piai, Vinícius Martins Rodrigues Oliveira
Background: A subcutaneous implantable cardioverter-defibrillator (S-ICD) is an alternative to a transvenous implantable cardio defibrillator (TV-ICD). An S-ICD reduces the risk of transvenous lead placement. However, further research is required to determine how S-ICDs affect patients with hypertrophic cardiomyopathy (HCM). In this study, we investigated the comparative efficacy and safety of S-ICDs versus TV-ICDs in HCM.
Methods: On December 6th, 2023, we performed a comprehensive search of the PubMed, Embase, Scopus, and Cochrane databases to identify randomized clinical trials (RCTs) and observational studies comparing S-ICDs with TV-ICDs in HCM patients published from 2004 until 2023. No language restrictions were applied. The primary outcome was appropriate shocks (AS), with inappropriate shocks (IAS), and device-related complications considered as secondary outcomes. Odds ratios (ORs) and 95% confidence intervals (CIs) were pooled using a random effects model. The ROBINS-I tool was used to assess the risk of bias of the studies.
Results: The search yielded 1,114 records. Seven studies comprising 4,347 HCM patients were included, of whom 3,325 (76.0%) had TV-ICDs, and 1,022 (22.6%) had S-ICDs. There were 2,564 males (58.9%). The age range was from 39.1 to 49.4 years. Compared with the TV-ICD group, the S-ICD cohort had a significantly lower incidence of device-related complications (OR 0.52; 95% CI: 0.30-0.89; P=0.02; I2=4%). Contrastingly, there were no statistically significant differences in the occurrences of AS (OR 0.49; 95% CI: 0.22-1.08; P=0.08; I2=75%) and IAS (OR 1.03; 95% CI: 0.57-1.84; P=0.93; I2=65%) between the two device modalities. In the analysis of the overall risk of bias in the studies, we found 42% of them with several, 28% with moderate, and 14% with low risk of bias.
Conclusions: In HCM patients, S-ICDs were associated with a lower incidence of device-associated problems than TV-ICDs. AS and IAS incidence rates were similar between groups. These findings may assist clinicians in determining the most suitable device for treating patients with HCM.
{"title":"Subcutaneous versus transvenous implantable cardioverter defibrillator in hypertrophic cardiomyopathy: a systematic review and meta-analysis.","authors":"Antônio da Silva Menezes Júnior, Izadora Caiado Oliveira, André Maroccolo de Sousa, Ricardo Figueiredo Paro Piai, Vinícius Martins Rodrigues Oliveira","doi":"10.21037/cdt-24-15","DOIUrl":"10.21037/cdt-24-15","url":null,"abstract":"<p><strong>Background: </strong>A subcutaneous implantable cardioverter-defibrillator (S-ICD) is an alternative to a transvenous implantable cardio defibrillator (TV-ICD). An S-ICD reduces the risk of transvenous lead placement. However, further research is required to determine how S-ICDs affect patients with hypertrophic cardiomyopathy (HCM). In this study, we investigated the comparative efficacy and safety of S-ICDs versus TV-ICDs in HCM.</p><p><strong>Methods: </strong>On December 6<sup>th</sup>, 2023, we performed a comprehensive search of the PubMed, Embase, Scopus, and Cochrane databases to identify randomized clinical trials (RCTs) and observational studies comparing S-ICDs with TV-ICDs in HCM patients published from 2004 until 2023. No language restrictions were applied. The primary outcome was appropriate shocks (AS), with inappropriate shocks (IAS), and device-related complications considered as secondary outcomes. Odds ratios (ORs) and 95% confidence intervals (CIs) were pooled using a random effects model. The ROBINS-I tool was used to assess the risk of bias of the studies.</p><p><strong>Results: </strong>The search yielded 1,114 records. Seven studies comprising 4,347 HCM patients were included, of whom 3,325 (76.0%) had TV-ICDs, and 1,022 (22.6%) had S-ICDs. There were 2,564 males (58.9%). The age range was from 39.1 to 49.4 years. Compared with the TV-ICD group, the S-ICD cohort had a significantly lower incidence of device-related complications (OR 0.52; 95% CI: 0.30-0.89; P=0.02; I<sup>2</sup>=4%). Contrastingly, there were no statistically significant differences in the occurrences of AS (OR 0.49; 95% CI: 0.22-1.08; P=0.08; I<sup>2</sup>=75%) and IAS (OR 1.03; 95% CI: 0.57-1.84; P=0.93; I<sup>2</sup>=65%) between the two device modalities. In the analysis of the overall risk of bias in the studies, we found 42% of them with several, 28% with moderate, and 14% with low risk of bias.</p><p><strong>Conclusions: </strong>In HCM patients, S-ICDs were associated with a lower incidence of device-associated problems than TV-ICDs. AS and IAS incidence rates were similar between groups. These findings may assist clinicians in determining the most suitable device for treating patients with HCM.</p>","PeriodicalId":9592,"journal":{"name":"Cardiovascular diagnosis and therapy","volume":"14 3","pages":"318-327"},"PeriodicalIF":2.1,"publicationDate":"2024-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11223932/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141554196","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-30Epub Date: 2024-06-14DOI: 10.21037/cdt-23-450
Zheng Wang, Banglong Xu, Yan Tan, Tingting Fan
Background: Many studies have pointed out that iron overload in the body is a risk factor for coronary atherosclerosis (AS), while there are also studies that show that iron deficiency is associated with coronary AS. There is still no consensus on how iron metabolism affects coronary artery disease (CAD). This study aimed to analyze the relationship between iron metabolism indexes and CAD, investigate the diagnostic value of soluble transferrin receptor (sTfR) in suspected CAD, and establish a diagnostic model.
Methods: This was a retrospective study. A total of 268 people with CAD-like symptoms who underwent coronary angiography in the Department of Cardiovascular Medicine, The Second Affiliated Hospital of Anhui Medical University from September 2022 to May 2023 without other chronic diseases or related medication history were included in the study and formed a continuous series including 188 CAD patients and 80 control subjects. Each iron metabolism index was divided into a grade variable according to tertile. The comparison of CAD morbidity between the tertiles and nonlinear correlation test was conducted to investigate the relationship between iron metabolism indexes and CAD risk. We used restricted cubic spline (RCS) to plot the relationship curve between sTfR and CAD risk and to determine the sTfR value corresponding to the minimal odds, according to which we divided the total sample into the "sTfR low level" subgroup and the "sTfR high level" subgroup. Logistic regression analyses were used to establish diagnostic models in both subgroups. The diagnostic efficiency of the indexes and models was compared by receiver operating characteristic (ROC) analysis.
Results: There is a "J" shape correlation between sTfR and CAD risk. Age/sTfR ratio [area under the curve (AUC) =0.690, 95% confidence interval (CI): 0.598-0.782, specificity 0.488 and sensitivity 0.842] has the best diagnostic efficiency in the "sTfR low level" subgroup. The diagnostic efficiency of sTfR (AUC =0.701, 95% CI: 0.598-0.803, specificity 0.541 and sensitivity 0.797) in the "sTfR high level" subgroup was higher than that of cardiac troponin I (cTnI) (AUC =0.674, 95% CI: 0.564-0.784, specificity 0.719 and sensitivity 0.653). The specific diagnostic methods were as follows: (I) When sTfR ≤1.087 mg/L, calculate the age/sTfR ratio, which indicates the diagnosis of CAD when the result is >58.595; (II) We can directly make a preliminary clinical diagnosis of CAD when sTfR >1.205 mg/L. Except for the above 2 cases, we can initially rule out a diagnosis of CAD.
Conclusions: The iron metabolism index sTfR correlates with CAD morbidity in a "J" shape. With superior diagnostic efficacy than cTnI, sTfR can assist in diagnosing CAD in patients with CAD-like symptoms. In addition, sTfR can provide guidance for the management of body iron levels in CAD patients.
{"title":"Diagnostic value and method of soluble transferrin receptor for suspected coronary artery disease: a case-control study.","authors":"Zheng Wang, Banglong Xu, Yan Tan, Tingting Fan","doi":"10.21037/cdt-23-450","DOIUrl":"10.21037/cdt-23-450","url":null,"abstract":"<p><strong>Background: </strong>Many studies have pointed out that iron overload in the body is a risk factor for coronary atherosclerosis (AS), while there are also studies that show that iron deficiency is associated with coronary AS. There is still no consensus on how iron metabolism affects coronary artery disease (CAD). This study aimed to analyze the relationship between iron metabolism indexes and CAD, investigate the diagnostic value of soluble transferrin receptor (sTfR) in suspected CAD, and establish a diagnostic model.</p><p><strong>Methods: </strong>This was a retrospective study. A total of 268 people with CAD-like symptoms who underwent coronary angiography in the Department of Cardiovascular Medicine, The Second Affiliated Hospital of Anhui Medical University from September 2022 to May 2023 without other chronic diseases or related medication history were included in the study and formed a continuous series including 188 CAD patients and 80 control subjects. Each iron metabolism index was divided into a grade variable according to tertile. The comparison of CAD morbidity between the tertiles and nonlinear correlation test was conducted to investigate the relationship between iron metabolism indexes and CAD risk. We used restricted cubic spline (RCS) to plot the relationship curve between sTfR and CAD risk and to determine the sTfR value corresponding to the minimal odds, according to which we divided the total sample into the \"sTfR low level\" subgroup and the \"sTfR high level\" subgroup. Logistic regression analyses were used to establish diagnostic models in both subgroups. The diagnostic efficiency of the indexes and models was compared by receiver operating characteristic (ROC) analysis.</p><p><strong>Results: </strong>There is a \"J\" shape correlation between sTfR and CAD risk. Age/sTfR ratio [area under the curve (AUC) =0.690, 95% confidence interval (CI): 0.598-0.782, specificity 0.488 and sensitivity 0.842] has the best diagnostic efficiency in the \"sTfR low level\" subgroup. The diagnostic efficiency of sTfR (AUC =0.701, 95% CI: 0.598-0.803, specificity 0.541 and sensitivity 0.797) in the \"sTfR high level\" subgroup was higher than that of cardiac troponin I (cTnI) (AUC =0.674, 95% CI: 0.564-0.784, specificity 0.719 and sensitivity 0.653). The specific diagnostic methods were as follows: (I) When sTfR ≤1.087 mg/L, calculate the age/sTfR ratio, which indicates the diagnosis of CAD when the result is >58.595; (II) We can directly make a preliminary clinical diagnosis of CAD when sTfR >1.205 mg/L. Except for the above 2 cases, we can initially rule out a diagnosis of CAD.</p><p><strong>Conclusions: </strong>The iron metabolism index sTfR correlates with CAD morbidity in a \"J\" shape. With superior diagnostic efficacy than cTnI, sTfR can assist in diagnosing CAD in patients with CAD-like symptoms. In addition, sTfR can provide guidance for the management of body iron levels in CAD patients.</p>","PeriodicalId":9592,"journal":{"name":"Cardiovascular diagnosis and therapy","volume":"14 3","pages":"402-418"},"PeriodicalIF":2.1,"publicationDate":"2024-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11223933/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141554190","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-30Epub Date: 2024-06-21DOI: 10.21037/cdt-24-182
Mikołaj Seostianin, Paweł Burchardt
{"title":"Myocardial involvement in post-COVID-19 condition: a note from the surgical approach.","authors":"Mikołaj Seostianin, Paweł Burchardt","doi":"10.21037/cdt-24-182","DOIUrl":"10.21037/cdt-24-182","url":null,"abstract":"","PeriodicalId":9592,"journal":{"name":"Cardiovascular diagnosis and therapy","volume":"14 3","pages":"314-317"},"PeriodicalIF":2.1,"publicationDate":"2024-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11223941/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141554193","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
扫码关注我们
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号