Pubblicazioni recenti - cardiac failure
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Racial Differences in Treatment Intensity at the End of Life Among Older Adults with Heart Failure: Evidence from the Health and Retirement Study.
J Palliat Med2024 Mar;():. doi: 10.1089/jpm.2023.0369.
McCleskey Sara G, Vargas Bustamante Arturo, Ahluwalia Sangeeta C, Nuckols Teryl K, Kominski Gerald F, Chuang Emmeline,
Abstract
Black Americans experience the highest prevalence of heart failure (HF) and the worst clinical outcomes of any racial or ethnic group, but little is known about end-of-life care for this population. Compare treatment intensity between Black and White older adults with HF near the end of life. Negative binomial and logistic regression analyses of pooled, cross-sectional data from the Health and Retirement Study (HRS). A total of 1607 U.S. adults aged 65 years and older with HF who identify as Black or White, and whose proxy informant participated in an HRS exit interview between 2002 and 2016. We compared four common measures of treatment intensity at the end of life (number of hospital admissions, receipt of care in an intensive care unit (ICU), utilization of life support, and whether the decedent died in a hospital) between Black and White HF patients, controlling for demographic, social, and health characteristics. Racial identity was not significantly associated with the number of hospital admissions or admission to an ICU in the last 24 months of life. However, Black HF patients were more likely to spend time on life support (odds ratio [OR]?=?2.16, confidence interval [CI]?=?1.35-3.44, ?=?0.00) and more likely to die in a hospital (OR?=?1.53, CI?=?1.03-2.28, ?=?0.04) than White HF patients. Black HF patients were more likely to die in a hospital and to spend time on life support than White HF patients. Thoughtful and consistent engagement with HF patients regarding treatment preferences is an important step in addressing inequities.
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Lithium Toxicity: A Case Report of Toxicity Resulting in a Third-degree Heart Block.
Clin Pract Cases Emerg Med2024 Feb;8(1):53-56. doi: 10.5811/cpcem.1442.
Gaetani Samantha L, Amaducci Alexandra M, Fikse Derek, Koons Andrew L,
Abstract
INTRODUCTION:
Lithium is a medication used to treat bipolar disorder. It has a narrow therapeutic index, which frequently causes toxicity in patients.
CASE REPORT:
We present an unusual case of a 66-year-old female with a history of bipolar disorder on chronic lithium, who developed a third-degree heart block, encephalopathy, and acute renal failure because of lithium toxicity.
CONCLUSION:
This case highlights a rare but life-threatening case of complete heart block in the setting of lithium toxicity. The patient was treated with hemodialysis and pacemaker placement.
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Long-term outcomes for pediatric heart transplant recipients transitioning to adult care teams.
Clin Transplant2024 Apr;38(4):e15282. doi: 10.1111/ctr.15282.
Donald Elena M, Oren Daniel, DeFilippis Ersilia M, Rubinstein Gal, Moeller Catherine M, Lee Hannah Y, Maldonado Alejandro, Portera Mary Virginia, Fuselier Byron, Jackson Ruslana, Clerkin Kevin J, Fried Justin A, Raikhelkar Jayant, Lee Sun Hi, Latif Farhana, Lytrivi Irene D, Zuckerman Warren A, Richmond Marc E, Sayer Gabriel, Uriel Nir,
Abstract
BACKGROUND:
There are limited data evaluating the success of a structured transition plan specifically for pediatric heart transplant (HT) recipients following their transfer of care to an adult specialist. We sought to identify risk factors for poor adherence, graft failure, and mortality following the transfer of care to adult HT care teams.
METHODS:
We retrospectively reviewed all patients who underwent transition from the pediatric to adult HT program at our center between January 2011 and June 2021. Demographic characteristics, comorbid conditions, and psychosocial history were collected at the time of HT, the time of transition, and the most recent follow-up. Adverse events including mortality, graft rejection, infection, and renal function were also captured before and after the transition.
RESULTS:
Seventy-two patients were identified (54.1% male, 54.2% Caucasian). Mean age at the time of transition was 23 years after a median of 11.6 years in the pediatric program. The use of calcineurin inhibitors was associated with reduced mortality (HR .04, 95% CI .0-.6, p = .015), while prior psychiatric hospitalization (HR 45.3, 95% CI, 6.144-333.9, p = .0001) was associated with increased mortality following transition. Medication nonadherence and young age at the time of transition were markers for high-risk individuals prior to the transition of care.
CONCLUSIONS:
Transition of HT recipients from a pediatric program to an adult program occurs during a vulnerable time of emerging adulthood, and we have identified risk factors for mortality following transition. Development of a formalized transition plan with a large multidisciplinary team with focused attention on high-risk patients, including those with psychiatric comorbidities, may favorably influence outcomes.
© 2024 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.
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The impact on thirty day readmissions for patients hospitalized for acute exacerbations of chronic obstructive pulmonary disease admitted to an observation unit versus an inpatient medical unit: A retrospective observational study.
Chron Respir Dis2024 ;21():14799731241242490. doi: 10.1177/14799731241242490.
Bell Jacob, Lim Steven, Mikami Takahisa, Bahk Jeeyune, Argiro Stephen, Steiger David,
Abstract
OBJECTIVES:
We aimed to evaluate the utility of an Observation Unit (OU) in management of acute exacerbations of chronic obstructive pulmonary disease (AECOPD) and to identify the clinical characteristics of patients readmitted within 30-days for AECOPD following index admission to the OU or inpatient floor from the OU.
METHODS:
This is a retrospective observational study of patients admitted from January to December 2017 for AECOPD to an OU in an urban-based tertiary care hospital. Primary outcome was rate of 30-day readmission after admission for AECOPD for patients discharged from the OU versus inpatient service after failing OU management. Regression analyses were used to define risk factors.
RESULTS:
163 OU encounters from 92 unique patients were included. There was a lower readmission rate (33%) for patients converted from OU to inpatient care versus patients readmitted after direct discharge from the OU (44%). Patients with 30-day readmissions were more likely to be undomiciled, with history of congestive heart failure (CHF), pulmonary embolism (PE), or had previous admissions for AECOPD. Patients with >6 annual OU visits for AECOPD had higher rates of substance abuse, psychiatric diagnosis, and prior PE; when these patients were excluded, the 30-day readmission rate decreased to 13.5%.
CONCLUSION:
Patients admitted for AECOPD with a history of PE, CHF, prior AECOPD admissions, and socioeconomic deprivation are at higher risk of readmission and should be prioritized for direct inpatient admission. Further prospective studies should be conducted to determine the clinical impact of this approach on readmission rates.
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Generic substitution of amlodipine is not associated with increased risk of mortality or adverse cardiovascular events: An observational cohort study.
Clin Transl Sci2024 Apr;17(4):e13779. doi: 10.1111/cts.13779.
Zhao Boya, Wu Jing, Lu Chengzhi, Feng Xing Lin,
Abstract
This study aims to assess clinical outcomes following switching from originator to generic amlodipine. This population-based, matched, cohort study included users of originator amlodipine using claims data during 2018-2020 from a health system in Tianjin, China, in which usage of generic amlodipine was promoted by a drug procurement policy, the national volume-based procurement. Non-switchers refer to those remained on originator after the policy, while pure-switchers were those who switched to and continued using generic amlodipine, and back-switchers were those switched to generic amlodipine but then back to the originator. Propensity score matching generates comparable non-switchers and pure-switchers pairs, and non-switchers and back-switchers pairs. The primary outcome was major adverse cardiovascular events (MACEs), defined as all-cause mortality, stroke, and myocardial infarction during follow-up (April 1, 2019 to December 30, 2020). Secondary outcomes included heart failure, atrial fibrillation, and adherence to amlodipine. The hazard ratio (HR) for each clinical outcome was assessed through Cox proportional hazard regression. In total, 5943 non-switchers, 2949 pure-switchers, and 3061 back-switchers were included (mean age: 62.9?years; 55.5% men). For the matched pairs, pure-switchers (N?=?2180) presented no additional risks of clinical outcomes compared to non-switchers (N?=?4360) (e.g., MACEs: 2.86 vs. 2.95 events per 100 person-years; HR?=?0.97 [95%CI: 0.70-1.33]). Back-switchers (N?=?1998) also presented no additional risk compared to non-switchers (N?=?3996) for most outcomes except for stroke (HR?=?1.55 [95%CI: 1.03-2.34]). Pure-switchers and back-switchers all had better amlodipine adherence than non-switchers. Generic substitution of amlodipine is not associated with increased risk of cardiovascular events or all-cause mortality, but improves medicine adherence.
© 2024 The Authors. Clinical and Translational Science published by Wiley Periodicals LLC on behalf of American Society for Clinical Pharmacology and Therapeutics.
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The effects of high-intensity interval training and Iranian propolis extract on serum levels of TRPV4 and CYP2E1 proteins in patients with nonalcoholic fatty liver.
Tunis Med2024 Jan;102(1):19-25. doi: 10.62438/tunismed.v102i1.4669.
Irandoust Khadijeh, Gholamhosseini Mahsa, Samimi Rasool, Dergaa Ismail, Ben Saad Helmi, Taheri Mortez,
Abstract
INTRODUCTION:
Non-alcoholic fatty liver disease (NAFLD) is the most common cause of liver failure, fibrosis, cirrhosis, and liver cancer, which can eventually lead to death.
AIM:
To investigate the effects of high-intensity interval training (HIIT) and iranian propolis extract on serum levels of transient receptor potential cation channel subfamily V member 4 (TRPV4) and cytochrome P450 2E1 (CYP2E1) proteins in patients with NAFLD.
METHODS:
Thirty-two patients with NAFLD (mean±standard deviation of age: 45.1±3.6 years; body mass index: 30.0±3.6 kg/m2) were assigned in a randomized control trial to one of the following groups: HIIT (n=8), propolis supplement (n=8), propolis + HIIT (n=8), and controls (n=8). The subjects participated in eight weeks of HIIT (one bout of 1-min intervals at 80-95% of the maximal heart-rate, interspersed by two min at 50-55% of the reserve heart-rate). The Propolis supplement was taken three times a day by the patients in the form of 50 mg tablet after the main meals. Body composition, liver injury test (eg; Alanine- and Aspartate- aminotransferase levels), liver ultrasound and serum levels of TRPV4 and CYP2E1 were measured before and after intervention. One-way analysis of variance was used to compare post-tests among the groups.
RESULTS:
HIIT significantly reduced serum levels of TRPV4 protein (p=0.001). The reduction in CYP2E1 was not significant in HIIT group (p=0.075). Propolis consumption had no significant effect on serum levels of CYP2E1 protein (p=0.059), and TRPV4 (p=0.072). There was a significant decrease in TRPV4 and CYP2E1 in the HIIT (p=0.001) and propolis supplement (p=0.032) groups.
CONCLUSION:
HIIT and propolis supplementation can be used to reduce TRPV4 and CYP2E1, which in turn reduces oxidative stress and inflammation in patients with NAFLD.
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Effectiveness and safety of Danshen injections in treatment of cardiac failure: a network meta-analysis.
Front Pharmacol2024 ;15():1319551. doi: 10.3389/fphar.2024.1319551.
Song Yuchen, Song Nan, Jia Lianqun, Pei Yupeng,
Abstract
The purpose of this network meta-analysis (NMA) was to compare the therapeutic effects of various Danshen ( Bunge [Lamiaceae; Salviae miltiorrhizae radix et rhizoma]) injections on heart failure to determine the optimal Danshen injection combined with conventional treatment. 8 databases were searched from the inception of these databases to May 2023 to collect randomized controlled trials (RCTs) on the effectiveness and safety of Danshen injections in the treatment of heart failure. This NMA was performed using Stata 16.0 software and R 4.1.3 software. A total of 24 RCTs involving 2,186 subjects were included. The intervention group received Danshen injections plus conventional treatment, involving the following 7 Danshen injections. The results of the NMA showed that Compound Danshen injection + Common (SUCRA: 79.6%) and Sodium tanshinone ?A sulfonate injection + Common (SUCRA: 78.0%) exhibited higher total effective rates. Sodium tanshinone ?A sulfonate injection + Common (SUCRA: 94.3%) and Danshen injection + Common (SUCRA: 68.2%) were superior to other traditional Chinese medicines in improving left ventricular ejection fraction (LVEF). Danshen injection + Common (SUCRA: 99.9%) and Shenxiong glucose injection + Common (SUCRA: 77.2%) were the most effective in reducing brain natriuretic peptide (BNP). In addition, compared with conventional treatment, all Danshen injections did not increase the risk of adverse reactions. Current evidence shows that all seven Danshen injections are effective for heart failure. Due to the limited quantity and quality of the included studies, our findings need to be verified by more high-quality studies.
Copyright © 2024 Song, Song, Jia and Pei.
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Long-term impact of home-based monitoring after an admission for acute decompensated heart failure: a systematic review and meta-analysis of randomised controlled trials.
EClinicalMedicine2024 May;71():102541. doi: 10.1016/j.eclinm.2024.102541.
Clemente Mariana R C, Felix Nicole, Navalha Denilsa D P, Pasqualotto Eric, Morgado Ferreira Rafael Oliva, Braga Marcelo A P, Nogueira Alleh, Costa Thomaz Alexandre, Marinho Alice D, Fernandes Amanda,
Abstract
BACKGROUND:
Patients with heart failure have high rehospitalisation rates and poor cardiovascular outcomes. Home-based monitoring (HBM) has emerged with promising results in different settings. However, its long-term effects on patients recently admitted for acute decompensated heart failure (ADHF) remain uncertain.
METHODS:
We systematically searched PubMed, Embase, and Cochrane Library for randomised controlled trials (RCTs) comparing HBM with usual care (UC) that were published between database inception and June 24, 2023. We included studies with patients admitted for ADHF in the previous 6 months and with a minimum follow-up of 6 months. We excluded studies with patients hospitalised for reasons other than ADHF and studies with disproportional education interventions between arms. Statistical analyses were performed using R software version 4.3.2. We pooled risk ratios (RR) and mean differences (MD) with 95% confidence intervals (CI) for categorical and continuous outcomes, respectively. Cochrane Collaboration's tool for assessing risk of bias in RCTs (RoB 2) was used to assess study quality. Publication bias was assessed via funnel plots and Egger's test, and heterogeneity was assessed through I statistics and sensitivity analysis. The protocol for this systematic review and meta-analysis was registered in the International Prospective Register of Systematic Reviews (PROSPERO, CRD42023465359).
FINDINGS:
We included 16 RCTs comprising 4629 patients, of whom 2393 (51.7%) were randomised to HBM and 3150 (68%) were men. Follow-up ranged from six to fifteen months. As compared with UC, HBM significantly reduced all-cause mortality (RR 0.75; 95% CI 0.61, 0.91; p = 0.005), all-cause hospitalisations (RR 0.82; 95% CI 0.70, 0.97; p = 0.018), cardiovascular (CV) mortality (RR 0.53; 95% CI 0.36, 0.79; p = 0.002), hospitalisations for heart failure (RR 0.75; 95% CI 0.62, 0.91; p = 0.004), and CV hospitalisations (RR 0.72; 95% CI 0.55, 0.95; p = 0.018). There were no significant differences in length of hospital stay (MD 0.97 days; 95% CI -0.90, 2.84; p = 0.308).
INTERPRETATION:
In patients recently admitted with ADHF, HBM significantly reduces long-term all-cause mortality and hospitalisations, CV mortality and hospitalisations, and hospitalisations for heart failure, as compared with UC. This supports the implementation of HBM as a standard practice to optimise patient outcomes following admissions for ADHF. However, future studies are warranted to evaluate the efficacy and safety of implementing HBM in the real-world setting.
FUNDING:
None.
© 2024 The Authors.
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Anomalous origin of left coronary artery from the pulmonary artery: Our 30 years of surgical experience and outcomes.
Turk Gogus Kalp Damar Cerrahisi Derg2024 Jan;32(1):26-36. doi: 10.5606/tgkdc.dergisi.2024.24426.
Sundara Rao Chaganti Yogi, Aravind A, Nelam Desai,
Abstract
The aim of this study was to evaluate our 30 years of surgical experience and outcomes in management of anomalous origin of left coronary artery from the pulmonary artery with various age groups. Between March 1992 and August 2022, a total of 21 patients (10 males, 11 females; mean age: 16.3±15.9 years; range, 1 to 64 years) diagnosed with anomalous origin of left coronary artery from the pulmonary artery who underwent successful surgical repair were retrospectively analyzed. An initial diagnosis was made with two-dimensional echocardiography. Cardiac catheterization and angiography were performed in all our patients. The median follow-up was five (range, 1 to 14) years. The mean left ventricular ejection fraction was 43.47±14.30% with associated moderate-to-severe mitral regurgitation in seven (33.33%) patients. Coronary button transfer was performed in 15 (71.42%) patients, Takeuchi repair in four (19.04%) patients, and ligation of anomalous left main coronary artery and ligation with great saphenous venous graft in one (4.76%) patient. There was no mortality. However, two (9.52%) patients had prolonged intensive care unit stay (>7 days). At the final follow-up, the mean left ventricular ejection fraction improved to 57.47±4.97%. Regression of moderate mitral regurgitation was observed in four (66.6%) patients. Preoperative left ventricular function is a major risk factor of perioperative mortality and morbidity. Mitral valve intervention is not warranted concomitantly in patients with moderate mitral regurgitation, if there are no structural lesions. Early diagnosis and meticulous surgical technique can yield excellent results and good long-term outcomes.
Copyright © 2024, Turkish Society of Cardiovascular Surgery.
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Pericardiectomy after constrictive pericarditis associated with second dose of BNT162b2 vaccine: A case report.
Turk Gogus Kalp Damar Cerrahisi Derg2024 Jan;32(1):97-100. doi: 10.5606/tgkdc.dergisi.2024.25357.
Demirtas Huseyin, Ozer Abdullah, Burak Gulcan Mehmet, Shide Issa, Delibas Hac?, Oktar Gürsel Levent,
Abstract
Constrictive pericarditis is quite rare complication of messenger ribonucleic acid-based severe acute respiratory syndrome-Coronavirus 2 (SARS-CoV-2) vaccine. It is a severe clinical picture with clinical symptoms of right ventricular failure. Initial physical examination, laboratory work-up, and chest X-ray may yield non-specific findings. Echocardiography, computed tomography, and cardiac catheterization are other diagnostic tools. Surgery with pericardiectomy is the definitive treatment option. Herein, we report a case of pericardiectomy after constrictive pericarditis associated with the second dose of BNT162b2 vaccine.
Copyright © 2024, Turkish Society of Cardiovascular Surgery.
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Contemporary approach to cardiogenic shock care: a state-of-the-art review.
Front Cardiovasc Med2024 ;11():1354158. doi: 10.3389/fcvm.2024.1354158.
Mehta Aditya, Vavilin Ilan, Nguyen Andrew H, Batchelor Wayne B, Blumer Vanessa, Cilia Lindsey, Dewanjee Aditya, Desai Mehul, Desai Shashank S, Flanagan Michael C, Isseh Iyad N, Kennedy Jamie L W, Klein Katherine M, Moukhachen Hala, Psotka Mitchell A, Raja Anika, Rosner Carolyn M, Shah Palak, Tang Daniel G, Truesdell Alexander G, Tehrani Behnam N, Sinha Shashank S,
Abstract
Cardiogenic shock (CS) is a time-sensitive and hemodynamically complex syndrome with a broad spectrum of etiologies and clinical presentations. Despite contemporary therapies, CS continues to maintain high morbidity and mortality ranging from 35 to 50%. More recently, burgeoning observational research in this field aimed at enhancing the early recognition and characterization of the shock state through standardized team-based protocols, comprehensive hemodynamic profiling, and tailored and selective utilization of temporary mechanical circulatory support devices has been associated with improved outcomes. In this narrative review, we discuss the pathophysiology of CS, novel phenotypes, evolving definitions and staging systems, currently available pharmacologic and device-based therapies, standardized, team-based management protocols, and regionalized systems-of-care aimed at improving shock outcomes. We also explore opportunities for fertile investigation through randomized and non-randomized studies to address the prevailing knowledge gaps that will be critical to improving long-term outcomes.
© 2024 Mehta, Vavilin, Nguyen, Batchelor, Blumer, Cilia, Dewanjee, Desai, Desai, Flanagan, Isseh, Kennedy, Klein, Moukhachen, Psotka, Raja, Rosner, Shah, Tang, Truesdell, Tehrani and Sinha.
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Lipoprotein(a) as a risk factor for atherosclerotic cardiovascular disease in patients in non-metropolitan areas of Brandenburg, Germany.
Front Cardiovasc Med2024 ;11():1302152. doi: 10.3389/fcvm.2024.1302152.
Hillmeister Philipp, Li Kangbo, Dai Mengjun, Sacirovic Mesud, Pagonas Nikolaos, Ritter Oliver, Bramlage Peter, Bondke Persson Anja, Buschmann Ivo, Zemmrich Claudia,
Abstract
BACKGROUND AND AIMS:
In the non-metropolitan region of Brandenburg (Germany), which is characterized by high rates of cardiovascular diseases and underserved medical care, there is a lack of awareness regarding lipoprotein(a) [Lp(a)] as a risk factor. In addition, data from patients with atherosclerotic cardiovascular disease (ASCVD) in diverse regional backgrounds, including the understudied Brandenburg cohort, and various healthcare statuses remain insufficient.
METHODS:
In this WalkByLab study, Lp(a) levels were monitored in a non-metropolitan cohort (?=?850) in Brandenburg, Germany, comprising 533 patients at high cardiovascular risk and 317 healthy controls. Patients underwent a comprehensive angiological screening, which included blood serum analysis, assessment of medical and family history, cardiovascular risk, and disease status, and evaluation of lifestyle and quality of life. All parameters were evaluated with regard to two groups based on Lp(a) levels: low (
RESULTS:
Brandenburg patients with cardiovascular diseases showed higher Lp(a) levels than healthy controls (24.2% vs. 14.8%, ?=?0.001). Logistic regression analysis with different characteristics revealed that Lp(a) was an independent risk factor significantly associated with ASCVD (OR 2.26, 95% CI 1.32-3.95, ?=?0.003). The high-Lp(a) group showed a higher proportion of patients with coronary artery disease, peripheral artery disease, or cerebrovascular disease compared to the low-Lp(a) group (50% vs. 36.8%; 57.7% vs. 45.8%; 17.6% vs. 9.2%; ?=?0.004); also, a higher percentage of patients in the high-Lp(a) group had heart failure (72.8% vs. 53.2%, ?=?0.014) and myocardial infarction (24.7% vs. 13.9%, ?=?0.001). The high-Lp(a) group exhibited higher rates of statins (63.1% vs. 50.4%, ?=?0.003), ezetimibe (14.8% vs. 5.5.%, ?=?0.001), and beta-blockers (55.7% vs. 40.7%, ?=?0.001) use. Lp(a) levels were found to be independent of physical activity or smoking behavior and did not change over time (12 months).
CONCLUSIONS:
Our study highlights the significance of elevated Lp(a) levels in Brandenburg cardiovascular patients and identifies them as an independent risk factor for ASCVD, which has implications for addressing cardiovascular health of non-metropolitan populations.
© 2024 Hillmeister, Li, Dai, Sacirovic, Pagonas, Ritter, Bramlage, Bondke Persson, Buschmann and Zemmrich.
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Healthcare needs in elderly patients with chronic heart failure in view of a personalized blended collaborative care intervention: a cross sectional study.
Front Cardiovasc Med2024 ;11():1332356. doi: 10.3389/fcvm.2024.1332356.
Gostoli Sara, Bernardini Francesco, Subach Regina, Engelmann Petra, Jaarsma Tiny, Andréasson Frida, Rasmussen Sanne, Thilsing Trine, Eilerskov Natasja, Bordoni Barbara, Della Riva Diego, Urbinati Stefano, Kohlmann Sebastian, Rafanelli Chiara,
Abstract
INTRODUCTION:
Few studies explored healthcare needs of elderly heart failure (HF) patients with comorbidities in view of a personalized intervention conducted by Care Managers (CM) in the framework of Blended Collaborative Care (BCC). The aims of the present study were to: (1) identify perceived healthcare needs/preferences in elderly patients with HF prior to a CM intervention; (2) investigate possible associations between healthcare needs/preferences, sociodemographic variables (age; sex) and number of comorbidities.
METHOD:
Patients aged 65 years or more affected by HF with at least 2 medical comorbidities were enrolled in the study. They were assessed by structured interviewing with colored cue cards that represented six main topics including education, individual tailoring of treatment, monitoring, support, coordination, and communication, related to healthcare needs and preferences.
RESULTS:
Thirty-three patients (Italy?=?21, Denmark?=?7, Germany?=?5; mean age?=?75.2?±?7.7 years; males 63.6%) were enrolled from June 2021 to February 2022. Major identified needs included: HF information (education), patients' involvement in treatment-related management (individual tailoring of treatment), regular checks of HF symptoms (monitoring), general practitioner update by a CM about progression of symptoms and health behaviors (coordination), and telephone contacts with the CM (communication). Regarding communication modalities with a CM, males preferred phone calls (=?6.291, =?0.043) and mobile messaging services (=?9.647, =?0.008), whereas females preferred in-person meetings and a patient dashboard. No differences in needs and preferences according to age and number of comorbidities were found.
DISCUSSION:
The findings highlight specific healthcare needs and preferences in older HF multimorbid patients, allowing a more personalized intervention delivered by CM in the framework of BCC.
© 2024 Gostoli, Bernardini, Subach, Engelmann, Jaarsma, Andréasson, Rasmussen, Thilsing, Eilerskov, Bordoni, Della Riva, Urbinati, Kohlmann and Rafanelli.
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The value of speckle-tracking stratified strain combined with myocardial work measurement in evaluating left ventricular function in patients with heart failure with preserved ejection fraction.
Quant Imaging Med Surg2024 Mar;14(3):2514-2527. doi: 10.21037/qims-23-1143.
Lan Jin, Wang Yan, Zhang Rui, Li Jiacheng, Yu Tianle, Yin Luyao, Shao Tingting, Lu Hongtao, Wang Chao, Xue Li,
Abstract
BACKGROUND:
Heart failure with preserved ejection fraction (HFpEF) is a highly prevalent progressive disease accompanied by poor quality of life, high utilization of medical resources, morbidity, and mortality. However, the role of left ventricular (LV) systolic dysfunction has yet to be well elaborated despite the preservation of the LV ejection fraction. This study aimed to explore the diagnostic value of speckle-tracking stratified strain combined with myocardial work (MW) measurement in evaluating LV systolic dysfunction in patients with HFpEF.
METHODS:
A total of 125 study consecutive individuals, 64 HFpEF patients, and 61 controls were prospectively enrolled in the Fourth Affiliated Hospital of Harbin Medical University. In addition to the conventional echocardiographic parameters, LV stratified strain and MW parameters were statistically compared between the HFpEF and control groups. The global longitudinal strain (GLS) of the subendocardium, myocardium, and subepicardium (GLSendo, GLSmyo, and GLSepi); the transmural gradient (?GLS); the global myocardial work index (GWI), global myocardial work efficiency (GWE), global myocardial constructive work (GCW), and the global myocardial wasted work (GWW) were included. Area under the receiver operating characteristic curve analysis was used to evaluate the diagnostic performance of these univariate and multivariable logistic models in detecting impaired LV systolic function in HFpEF. Ten-fold cross-validation was used to evaluate the generalizability of the predictive model.
RESULTS:
Stratified strains values showed a gradient decline from GLSendo to GLSepi in both control and HFpEF patients. Compared with the control group, HFpEF patients had a significantly reduced GLSepi, GLSmyo, GLSendo, ?GLS, GWI, GWE, and GCW and a significantly increased GWW (all P
CONCLUSIONS:
Both speck-tracking stratified strain and MW measurement may sensitively detect impairment of LV myocardial function at an early stage for patients with HFpEF. Combining the two techniques may improve the quality of HFpEF diagnosis and may provide a reference value for the early diagnosis of HFpEF in the future.
2024 Quantitative Imaging in Medicine and Surgery. All rights reserved.
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Evaluation of all-cause mortality and cardiovascular safety in patients receiving chimeric antigen receptor T cell therapy: a prospective cohort study.
EClinicalMedicine2024 Mar;69():102504. doi: 10.1016/j.eclinm.2024.102504.
Korell Felix, Entenmann Lukas, Romann Sebastian, Giannitsis Evangelos, Schmitt Anita, Müller-Tidow Carsten, Frey Norbert, Dreger Peter, Schmitt Michael, Lehmann Lorenz H,
Abstract
BACKGROUND:
Assessment of cardiovascular risk is critical for patients with cancer. Previous retrospective studies suggest potential cardiotoxicity of CAR T cell therapies. We aimed to prospectively assess cardiotoxicity and the predictive value of cardiac biomarkers and classical risk factors (age, cardiac function, diabetes, arterial hypertension, smoking) for cardiac events and all-cause mortality (ACM).
METHODS:
In this prospective cohort study, all patients treated with CAR T cell constructs (axi-cel, tisa-cel, brexu-cel, ide-cel, or the 3rd generation CAR HD-CAR-1) from Oct 1, 2018, to Sept 30, 2022 at the University Hospital Heidelberg were included. Surveillance included cardiac assessment with biomarkers (high-sensitive Troponin T (hs-cTnT), N-terminal brain natriuretic peptide (NT-proBNP)), 12-lead-ECG, and 2D echocardiography. ACM was defined as the primary study endpoint, while cardiotoxicity, defined by clinical syndromes of heart failure or decline in ejection fraction, served as a secondary endpoint.
FINDINGS:
Overall, 137 patients (median age 60, range 20-83, IQR 16), were included in the study. 46 patients died during the follow up period (median 0.75 years, range 0.02-4.33, IQR 0.89) 57 month, with a median survival of 0.57 years (range 0.03-2.38 years, IQR 0.79). A septal wall thickness above 11 mm (HR 2.48, 95%-CI = 1.10-5.67, = ) was associated with an increased risk of ACM, with a trend seen for reduced left ventricular ejection fraction prior to therapy (LVEF
INTERPRETATION:
Reduced pre-lymphodepletion ejection fraction and early post-infusion biomarker kinetics may be associated with increased ACM and cardiotoxicity events. These findings may help to identify patients who could benefit from intensified cardio-oncological surveillance.
FUNDING:
The German Center for Cardiovascular Research, German Research Foundation, and the Federal Ministry of Education and Research.
© 2024 The Author(s).
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Effect of plasma exchange with albumin replacement on albumin functionality and organ dysfunction in acute-on-chronic liver failure.
JHEP Rep2024 Apr;6(4):101017. doi: 10.1016/j.jhepr.2024.101017.
Fernández Javier, Lozano Miquel, Torres Mireia, Horrillo Raquel, Afonso Natalia, Núñez Laura, Mestre Anna, Pérez Alba, Cid Joan, Costa Montserrat, Arroyo Vicente, Páez Antonio,
Abstract
BACKGROUND & AIMS:
Effective treatments for acute-on-chronic liver failure (ACLF) are a major unmet need. This proof-of-concept pilot study was aimed at evaluating the effects of plasma exchange (PE) with albumin 5% (PE-A5%) on albumin functional capacity and organ dysfunction in patients with ACLF.
METHODS:
Ten adult patients were enrolled in a single-center phase II, prospective, open-label, non-controlled study. Six PE-A5% sessions were performed in 10 days followed by a 1-month follow-up visit. Albumin functional capacity and circulatory function were assessed, as were renal, cerebral, and liver function, and systemic inflammation. The main safety variable was the percentage of PE sessions associated with at least one procedure-related adverse event (AE).
RESULTS:
Patients with ACLF showed lower albumin binding capacity, lower antioxidant capacity, and lower levels of albumin with preserved structure compared to healthy donors (n = 19). From baseline to day 11, PE-A5% treatment increased albumin levels and improved albumin binding capacity to Sudlow site II (15.3±1.6 mg/ml to 18.9±1.7 mg/ml; 0.003), fatty acid-binding capacity (8.2±1.4 ?M to 3.1±1.5 ?M; 0.013) and antioxidant capacity (human mercaptalbumin 9.5±1.5 mg/ml to 14.6±1.6 mg/ml; 0.001). Native albumin levels were increased throughout day 1-11 PE-A5% sessions (6.5±1.0 mg/ml to 10.2±1.4 mg/ml; 0.035). PE-A5% improved systemic hemodynamics (mean arterial pressure, heart rate, cardiac index), renal function (creatinine level, blood urea nitrogen), cerebral function (hepatic encephalopathy grade), liver parameters (transaminases, bilirubin) and inflammatory parameters (C-reactive protein, leukocyte count). All patients had at least one of the 78 AEs reported, mostly mild (product/procedure-related: 36%). Sixteen serious AEs were reported in eight patients (procedure/product-related: none).
CONCLUSIONS:
PE-A5% was a safe procedure associated with positive effects on albumin functionality, and circulatory, renal, cerebral, and liver function in patients with ACLF.
IMPACT AND IMPLICATIONS:
Acute-on-chronic liver failure (ACLF) is a clinical condition characterized by severe systemic inflammation, organ failure, and high mortality. Plasma exchange removes patient's plasma containing pathogenic substances, replacing it with 5% albumin and fresh frozen plasma (PE-A5%). In this study, cirrhotic patients with ACLF were treated with PE-A5%, which was a safe procedure that increased binding and antioxidant capacity of patients' albumin, while improving circulatory, kidney, brain, and liver functions. These beneficial effects could impact survival in ACLF.
CLINICALTRIALSGOV IDENTIFIER:
NCT01201720.
EUDRACT NUMBER:
2010-021360-15.
© 2024 The Authors.
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The prognostic value of collateral circulation in coronary chronic total occlusion underwent percutaneous coronary intervention.
J Geriatr Cardiol2024 Feb;21(2):232-241. doi: 10.26599/1671-5411.2024.02.004.
Hu Xiao-Ying, Yang Wei-Xian, Guan Chang-Dong, Xie Li-Hua, Dou Ke-Fei, Wu Yong-Jian, Yuan Jin-Qing, Qian Jie, Yang Yue-Jin, Qiao Shu-Bin, Song Lei,
Abstract
BACKGROUND:
The prognostic value of coronary collateral circulation (CC) in patients undergoing chronic total occlusion (CTO) percutaneous coronary intervention (PCI) is underdetermined. The purpose of the study was to assess the prognostic value of current two CC grading systems and their association with long-term outcomes in patients with CTO underwent PCI.
METHODS:
We consecutively enrolled patients with single-vessel CTO underwent PCI between January 2010 and December 2013. All patients were categorized into well-developed or poor-developed collaterals group according to angiographic Werner's CC (grade 2 grade 0-1) or Rentrop (grade 3 grade 0-2) grading system. The primary endpoint was 5-year cardiac death.
RESULTS:
Of 2452 enrolled patients, the overall technical success rate was 74.1%. Well-developed collaterals were present in 686 patients (28.0%) defined by Werner's CC grade 2, and in 1145 patients (46.7%) by Rentrop grade 3. According to Werner's CC grading system, patients with well-developed collaterals had a lower rate of 5-year cardiac death compared with those with poor-developed collaterals (1.6% 3.3%, = 0.02), those with suboptimal recanalization was associated with higher rate of 5-year cardiac death compared with optimal recanalization (4.7% 0.8%, = 0.01) and failure patients (4.7% 1.6%, = 0.12). However, the similar effect was not shown in Rentrop grading system.
CONCLUSIONS:
In patients with the single-vessel CTO underwent PCI, well-developed collaterals by Werner's CC definition were associated with lower rate of 5-year cardiac death. Werner's CC grading system had a greater prognostic value than Rentrop grading system in patients with CTO underwent PCI.
© 2024 JGC All rights reserved; www.jgc301.com.
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Atypical post-infectious glomerulonephritis with c-ANCA positivity followed by endocarditis.
Nephrology (Carlton)2024 Mar;():. doi: 10.1111/nep.14298.
Ryou Seyoung, Park Hyeran, Chae Seung Yun, Kim Yaeni, Choi Yeong-Jin, Park Cheol Whee,
Abstract
Post-infectious glomerulonephritis (PIGN), an uncommon variety of glomerulonephritis (GN), is characterized by emergence of nephritic syndrome within a few weeks following an infectious event. PIGN typically presents as a mild condition and tends to resolve by the time of diagnosis for GN. Aggregatibacter actinomycetemcomitans belongs to the HACEK group of bacteria, which constitutes less than 3% of bacteria responsible for community-acquired infective endocarditis. We present a case of 29-year-old man suspected of lymphoma with B-symptoms along with severe splenomegaly and nephromegaly. Shortly after, he developed an episode of nephritic syndrome accompanied by acute kidney injury (AKI) and high titers of cytoplasmic ANCA (c-ANCA)-positivity. Kidney biopsy revealed PIGN with tubulointerstitial nephritis. Despite treatment with antibiotics and corticosteroid, he visited the emergency room due to worsening dyspnea and multi-organ failure. An echocardiogram showed a bicuspid aortic valve with vegetation unseen on previous echocardiogram. He underwent aortic valve replacement immediately without adverse events. Four months after valve replacement, his renal function and cardiac performance have remained stable. We report a case of PIGN with AKI and high titers of c-ANCA appearing later as an infective endocarditis due to Aggregatibacter actinomycetemcomitans. With careful clinical observation and appropriate and timely management, satisfactory outcomes for patient health are possible.
© 2024 The Authors. Nephrology published by John Wiley & Sons Australia, Ltd on behalf of Asian Pacific Society of Nephrology.
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The safety of a low protein diet in older adults with advanced chronic kidney disease.
Nephrol Dial Transplant2024 Mar;():. doi: gfae077.
Windahl Karin, Chesnaye Nicholas C, Irving Gerd Faxén, Stenvinkel Peter, Almquist Tora, Lidén Maarit Korkeila, Drechsler Christiane, Szymczak Maciej, Krajewska Magdalena, de Rooij Esther, Torino Claudia, Porto Gaetana, Caskey Fergus J, Wanner Christoph, Jager Kitty J, Dekker Friedo W, Evans Marie,
Abstract
BACKGROUND:
A low protein diet (LPD) is recommended to patients with advanced chronic kidney disease (CKD), whereas geriatric guidelines recommend a higher amount of protein. The aim of this study was to evaluate the safety of LPD treatment in older adults with advanced CKD.
METHODS:
The EQUAL study is a prospective, observational study, including patients ?65 years, incident estimated glomerular filtration rate
RESULTS:
Out of 1738 adults (631 prescribed LPD at any point during follow-up) there were 1319 with repeated SGA measurements of which 267 (20%) declined in SGA ? 2 points and 565 (32.5%) died. There was no difference in survival or decline in nutritional status for patients prescribed LPD ?0.8 g/kg ideal bodyweight (Odds Ratio (OR) for mortality 1.15 (95% Confidence interval (CI) 0.86-1.55) and OR for decline in SGA 1.11 (95% CI 0.74-1.66) in the adjusted models. In patients prescribed LPD 75 years, lower SGA, and higher comorbidity burden for both mortality and nutritional status decline.
CONCLUSIONS:
In older adults with CKD approaching end-stage kidney disease, a traditional LPD prescribed and monitored according to routine clinical practice in Europe appears to be safe.
© The Author(s) 2024. Published by Oxford University Press on behalf of the ERA.
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Technical considerations and sizing of external annuloplasty in the ross procedure.
Eur J Cardiothorac Surg2024 Mar;():. doi: ezae118.
Myjavec Andrej, Gofus Jan, Zacek Pavel, Vobornik Martin, Shahin Youssef, Vojacek Jan,
Abstract
Pure aortic regurgitation and dilation of aortic annulus are the most significant risk factors for the failure of pulmonary autograft after the Ross procedure. Aortic annuloplasty has a positive effect on the durability of the autograft. Previously we described a technique for external annuloplasty with dedicated Coroneo ring (Coroneo, Extra-Aortic, Montreal, QC, Canada). In the present manuscript we suggest the sizing of annuloplasty based on the diameter of pulmonary autograft annulus.
© The Author(s) 2024. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.
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