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Pubblicazioni recenti - cardiac disease
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Proteostasis in thermogenesis and obesity.
Biol Chem2019 Dec;():. doi: 10.1515/hsz-2019-0427.
Bartelt Alexander, Widenmaier Scott B,
Abstract
The proper production, degradation, folding and activity of proteins, proteostasis, is essential for any cellular function. From single cell organisms to humans, selective pressures have led to the evolution of adaptive programs that ensure proteins are properly produced and disposed of when necessary. Environmental factors such as temperature, nutrient availability, pathogens as well as predators have greatly influenced the development of mechanisms such the unfolded protein response, endoplasmic reticulum-associated protein degradation and autophagy, working together in concert to secure cellular proteostasis. In our modern society, the metabolic systems of the human body face the distinct challenge of changed diets, chronic overnutrition and sedentary lifestyles. Obesity and excess white adipose tissue accumulation are linked to a cluster of metabolic diseases and disturbed proteostasis is a common feature. Conversely, processes that promote energy expenditure such as exercise, shivering as well as non-shivering thermogenesis by brown adipose tissue (BAT) and beige adipocytes counteract metabolic dysfunction. Here we review basic concepts of proteostasis in obesity-linked metabolic diseases and focus on adipocytes, which are critical regulators of mammalian energy metabolism.
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High miR-133a levels in the circulation anticipates presentation of clinical events in familial hypercholesterolemia patients.
Cardiovasc Res2020 Feb;():. doi: cvaa039.
Escate Rafael, Padró Teresa, Suades Rosa, Camino Sandra, Muñiz Ovidio, Diaz-Diaz Jose Luis, Sionis Alessandro, Mata Pedro, Badimon Lina,
Abstract
AIMS:
Presentation of acute events in patients with atherosclerosis remains unpredictable even after controlling for classical risk factors. MicroRNAs (miRNAs) measured in liquid biopsies could be good candidate biomarkers to improve risk prediction. Here, we hypothesized that miRNAs could predict atherosclerotic plaque progression and clinical event presentation in familial hypercholesterolemia (FH) patients.
METHODS AND RESULTS:
Circulating miRNAs (plasma, exosomes, microvesicles) were investigated by TaqMan Array and RT-qPCR assays. Patients with genetic diagnosis of FH and healthy relatives from the SAFEHEART cohort were included. A differential signature of 10 miRNA was obtained by comparing two extreme phenotypes consisting of FH-patients suffering a cardiovascular event (CVE) within a 8-year follow-up period (FH-CVE, N=42) and non-FH hypercholesterolemic relatives from the same cohort, matched for age and treatment, without CVE during the same period (nFH-nCVE, N=30). The validation studies included two independent groups of patients with FH-background (Discovery-Group, N=89, Validation-Group N=196), developing a future CVE (FH-CVE) or not (FH-nCVE) within the same time period of follow-up. Of the 10 miRNAs initially selected, miR-133a was significantly higher in FH-CVE than in FH-nCVE patients. ROC-analysis confirmed miR-133a as the best microRNA for predicting CVE in FH-patients (0.76±0.054; P<0.001). Furthermore, Kaplan-Meier and COX-analysis showed that high plasma miR-133a levels associated to the higher risk of presenting a CVE within the next 8 years (HR: 3.89 [95%CI: 1.88-8.07], P<0.001). In silico analysis of curate biological interactions related miR-133a with target genes involved in regulation of the cell-membrane lipid-receptor LRP6 and inflammatory cytokines (CXCL8, IL6, TNF). These predictions were experimentally proven in human macrophages and endothelial cells transfected with agomiR-133a.
CONCLUSION:
Elevated levels of miR-133a in the circulation anticipate those FH-patients that are going to present a clinical CVE within the next 2 years (average). Mechanistically, miR-133a is directly related with lipid- and inflammatory-signalling in key cells for atherosclerosis progression.
TRANSLATIONAL PERSPECTIVE:
The present study in patients with familial hypercholesterolemia shows that epigenetic markers can allow the identification of those patients that are going to present an acute clinical event within the next two years (average). There are currently few prognostic biomarkers able to identify subjects at risk of developing major acute cardiovascular events. Here, by using a non-targeted approach of miRNA-discovery, we show for first time that plasma levels of miR-133a have prognostic value to predict incident cardiovascular events in patients with familial hypercholesterolemia treated as per guidelines. Future studies with larger independent cohorts are needed to validate the prognostic value of miR-133a in the general population.
Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2020. For permissions please email: journals.permissions@oup.com.
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Estimation of increased pulmonary wedge pressure by an algorithm based on noninvasively measured pulmonary diastolic pressure in cardiac patients independent of left ventricular ejection fraction.
Echocardiography2020 Feb;():. doi: 10.1111/echo.14581.
Barbier Paolo, Cucco Cuono, Guglielmo Marco, Simioniuc Anca, Fabiani Iacopo, Pugliese Nicola Riccardo, Savioli Gabriele, Dini Frank Lloyd,
Abstract
AIM:
Pulmonary artery diastolic pressure (PADP) correlates closely with pulmonary wedge pressure (PAWP); therefore, we sought to evaluate whether an algorithm based on PADP assessment by the Doppler pulmonary regurgitation (PR) end-diastolic gradient (PRG) may aid in estimating increased PAWP in cardiac patients with reduced or preserved left ventricular (LV) ejection fraction (EF).
METHODS AND RESULTS:
Right heart catheterization, with estimation of PAWP, right atrial pressure (RAP), PADP, and Doppler echocardiography, was carried out in 183 patients with coronary artery disease (n = 63), dilated cardiomyopathy (n = 52), or aortic stenosis (n = 68). One-hundred and seventeen patients had LV EF <50%. We measured the pressure gradients across the tricuspid and pulmonary valves from tricuspid regurgitation (TRV) and PR velocities. Doppler-estimated PADP (e-PADP) was obtained by adding the estimated RAP to PRG. An algorithm based on e-PADP to predict PAWP, that included TRV, left atrial volume index, and mitral E/A, was developed and validated in derivation (n = 90) and validation (n = 93) subgroups. Both invasive PADP (r = .92, P < .001) and e-PADP (r = .72, P < .001) correlated closely with PAWP, and e-PADP predicted PAWP (AUC: 0.85, CI: 0.79-0.91) with a 94% positive predictive value (PPV) and a 55% negative predictive value (NPV), after exclusion of five patients with precapillary pulmonary hypertension. The e-PADP-based algorithm predicted PAWP with higher accuracy (PPV = 94%; NPV = 67%; accuracy = 85%; kappa: 0.65, P < .001) than the ASE-EACVI 2016 recommendations (PPV = 97%; NPV = 47%; accuracy = 68% undetermined = 18.9%; kappa: 0.15, P < .001).
CONCLUSIONS:
An algorithm based on noninvasively e-PADP can accurately predict increased PAWP in patients with cardiac disease and reduced or preserved LV EF.
© 2020 Wiley Periodicals, Inc.
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Differential diagnosis of toothache to prevent erroneous and unnecessary dental treatment.
J Oral Rehabil2020 Feb;():. doi: 10.1111/joor.12946.
De Laat Antoon,
Abstract
Toothache represents the most common example of orofacial pain. Its origin is mostly odontogenic, but several other conditions may mimic dental pain or present themselves as such. Well-known examples are myofascial pain, trigeminal neuropathies like neuralgia and painful posttraumatic trigeminal neuropathic pain, orofacial neurovascular pains, cardiac pain and sinus disease. This review first discusses the current knowledge on the underlying pathophysiology of heterotopic tooth pain. Afterwards, several conditions potentially presenting as toothache will be illustrated regarding clinical features, diagnosis and management.
This article is protected by copyright. All rights reserved.
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Clinical observation of noncoronary cardiac abnormalities in Chinese children with Kawasaki disease.
Eur J Clin Invest2020 Feb;():e13210. doi: 10.1111/eci.13210.
Liu Fei Fei, Liu Hui Hui, Qiu Zhen, Wang Jing Jing, Samadli Sama, Wu Yue, Wu Yang Fang, Xu Yao, Luo Huang Huang, Chen Wei Xia, Zhang Dong Dong, Hu Peng,
Abstract
BACKGROUND:
Kawasaki disease (KD) is an acute, self-limited vasculitis. Coronary artery aneurysm (CAA) serves as a major contributor to the long-term prognosis of KD. In addition, acute KD usually also leads to several kinds of noncoronary cardiac abnormalities (NCA) involving the pericardium, myocardium and endocardium.
MATERIALS AND METHODS:
A total of 142 Chinese children with KD were recruited from July 2015 to April 2018. Blood samples were collected at 24 h pre-Intravenous immunoglobulin (IVIG) therapy. Several inflammatory mediators and biomarkers for acute myocardial infarction were detected. Echocardiography and electrocardiography (ECG) were performed.
RESULTS:
Plasma white blood cells counts (WBC) was significantly increased in patients with IVIG-nonresponsive KD when compared with their IVIG-responsive counterparts. A total of 106 children (74.65%) suffered from NCA, including 8 patients (5.63%) with pericardial effusion, 23 patients (16.20%) with acute myocarditis, 101 patients (71.13%) with valvular regurgitation, and 8 patients (5.63%) with abnormal ECG. No significant differences were observed in the distribution of clinical classification and the response to IVIG therapy regardless of NCA exhibited or not.
CONCLUSIONS:
NCA is almost universal in acute KD and mainly manifests as valvular regurgitation. However, it has no influence on clinical classification and the response to IVIG therapy.
This article is protected by copyright. All rights reserved.
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Autonomic function in gastroparesis and chronic unexplained nausea and vomiting: Relationship with etiology, gastric emptying, and symptom severity.
Neurogastroenterol Motil2020 Feb;():e13810. doi: 10.1111/nmo.13810.
Nguyen Linda, Wilson Laura A, Miriel Laura, Pasricha Pankaj J, Kuo Braden, Hasler William L, McCallum Richard W, Sarosiek Irene, Koch Kenneth L, Snape William J, Farrugia Gianrico, Grover Madhusudan, Clarke John, Parkman Henry P, Tonascia James, Hamilton Frank, Abell Thomas L, ,
Abstract
BACKGROUND:
Autonomic dysfunction can be present in patients with idiopathic and diabetic gastroparesis. The role of autonomic dysfunction relating to gastric emptying and upper gastrointestinal symptoms in patients with gastroparesis and chronic unexplained nausea and vomiting (CUNV) remains unclear. The aim of our study is to evaluate autonomic function in patients with gastroparesis and CUNV with respect to etiology, gastric emptying and symptom severity.
METHODS:
We studied 242 patients with chronic gastroparetic symptoms recruited at eight centers. All patients had a gastric emptying scintigraphy within 6 months of the study. Symptom severity was assessed using the gastroparesis cardinal symptom index. Autonomic function testing was performed at baseline enrollment using the ANX 3.0 autonomic monitoring system which measures heart rate variability and respiratory activity measurements.
KEY RESULTS:
Low sympathetic response to challenge (Valsalva or standing) was the most common abnormality seen impacting 89% diabetic and 74% idiopathic patients. Diabetics compared to idiopathics, exhibited greater global hypofunction with sympathetic (OR = 4.7, 95% CI 2.2-10.3; P < .001) and parasympathetic (OR = 7.2, 95% CI 3.4-15.0; P < .001) dysfunction. Patients with delayed gastric emptying were more likely to have paradoxic parasympathetic excessive during sympathetic challenge [(Valsalva or standing) 40% vs. 26%, P = .05]. Patients with more severe symptoms exhibited greater parasympathetic dysfunction compared to those with mild-moderate symptoms: resting sympathovagal balance [LFa/RFa 1.8 (1.0-3.1) vs. 1.2 (0.6-2.3), P = .006)] and standing parasympathetic activity [0.4 (0.1-0.8) vs. 0.6 (0.2-1.7); P = .03].
CONCLUSIONS:
Autonomic dysfunction was common in patients with gastroparesis and CUNV. Parasympathetic dysfunction was associated with delayed gastric emptying and more severe upper gastrointestinal symptoms. Conversely, sympathetic hypofunction was associated with milder symptoms.
INFERENCES:
Gastroparesis and CUNV may be a manifestation of GI autonomic dysfunction or imbalance, such that sympathetic dysfunction occurs early on in the manifestation of chronic upper GI symptoms, while parasympathetic dysfunction results in more severe symptoms and delayed gastric emptying.
© 2020 John Wiley & Sons Ltd.
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Management of the axilla in breast cancer: outcome analysis in a series of ductal versus lobular invasive cancers.
Breast Cancer Res Treat2020 Feb;():. doi: 10.1007/s10549-020-05565-x.
Corona S P, Bortul M, Scomersi S, Bigal C, Bottin C, Zanconati F, Fox S B, Giudici F, Generali D,
Abstract
INTRODUCTION:
Axillary lymph node dissection (ALND) has been considered essential for the staging of breast cancer (BC). As the impact of tumor biology on clinical outcomes is recognized, a surgical de-escalation approach is being implemented. We performed a retrospective study focused on surgical management of the axilla in invasive lobular carcinoma (ILC) versus invasive ductal carcinoma (IDC).
MATERIALS AND METHODS:
1151 newly diagnosed BCs, IDCs (79.6%) or ILCs (20.4%), were selected among patients treated at our Breast Cancer Unit from 2012 to 2018. Tumor characteristics and clinical information were collected and predictors of further metastasis after positive sentinel lymph node biopsy (SLNB) analyzed in relation to disease-free survival (DFS) and overall survival (OS).
RESULTS:
27.5% of patients with ILC had???3 metastatic lymph nodes at ALND after positive SLNB versus 11.48% of IDCs (p?=?0.04). Risk predictors of further metastasis at ALND were the presence of?>?2 positive lymph nodes at SLNB (OR?=?4.72, 95% CI 1.15-19.5 p?=?0.03), T3-T4 tumors (OR?=?4.93, 95% CI 1.10-22.2, p?=?0.03) and Non-Luminal BC (OR?=?2.74, 95% CI 1.16-6.50, p?=?0.02). The lobular histotype was not associated with the risk of further metastasis at ALND (OR?=?1.62, 95% CI 0.77-3.41, p?=?0.20).
CONCLUSIONS:
ILC histology is not associated with higher risk of further metastasis at ALND in our analysis. However, surgical management decisions should be taken considering tumor histotype, biology and expected sensitivity to adjuvant therapies.
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Oral health complications after a heart transplant: a review.
Br Dent J2020 Feb;228(3):177-182. doi: 10.1038/s41415-020-1244-0.
Gruter M O, Brand H S,
Abstract
Background Heart transplants have become a successful treatment for some cardiovascular diseases. To prevent rejection of the transplanted heart, patients have to take immunosuppressive medication.Aims The aims of this study were to identify and review oral health complications after heart transplantation.Methods The electronic database PubMed was searched for relevant articles. The search yielded 332 papers, of which 24 matched the criteria for this review.Results Gingival hyperplasia was observed in 8.3-67% of the patients. Heart transplant patients who received professional periodontal treatment starting six months after transplantation showed significantly better scores on the Gingival Index (GI) and gingival hyperplasia. In comparison to a control group, heart transplant patients did not differ significantly in the DMF(T) index. The incidence of fungal infection in patients receiving a heart transplant varied between 10% and 25%. Heart transplant patients had a 4.3 times higher chance of developing oral cancer.Conclusion Patients who underwent a heart transplant and subsequently used immunosuppressive medicines appear to have a higher risk of gingival hyperplasia, periodontal conditions, the presence of Candida species and oral malignancies, in comparison to healthy individuals. The association between heart transplants and dental caries was unclear. It is recommended that heart transplant patients receive frequent oral examination and professional dental cleaning.
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Benefit of lifestyle-based T2DM prevention is influenced by prediabetes phenotype.
Nat Rev Endocrinol2020 Feb;():. doi: 10.1038/s41574-019-0316-1.
Campbell Matthew D, Sathish Thirunavukkarasu, Zimmet Paul Z, Thankappan Kavumpurathu R, Oldenburg Brian, Owens David R, Shaw Jonathan E, Tapp Robyn J,
Abstract
The prevention of type 2 diabetes mellitus (T2DM) is a target priority for the WHO and the United Nations and is a key priority in the 2018 Berlin Declaration, which is a global call for early actions related to T2DM. Health-care policies advocate that individuals at high risk of developing T2DM undertake lifestyle modification, irrespective of whether the prediabetes phenotype is defined by hyperglycaemia in the postprandial state (impaired glucose tolerance) and/or fasting state (impaired fasting glucose) or by intermediate HbA levels. However, current evidence indicates that diabetes prevention programmes based on lifestyle change have not been successful in preventing T2DM in individuals with isolated impaired fasting glucose. We propose that further research is needed to identify effective lifestyle interventions for individuals with isolated impaired fasting glucose. Furthermore, we call for the identification of innovative approaches that better identify people with impaired glucose tolerance, who benefit from the currently available lifestyle-based diabetes prevention programmes.
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Pigs with ?-sarcoglycan deficiency exhibit traits of genetic cardiomyopathy.
Lab Invest2020 Feb;():. doi: 10.1038/s41374-020-0406-7.
Matsunari Hitomi, Honda Michiyo, Watanabe Masahito, Fukushima Satsuki, Suzuki Kouta, Miyagawa Shigeru, Nakano Kazuaki, Umeyama Kazuhiro, Uchikura Ayuko, Okamoto Kazutoshi, Nagaya Masaki, Toyo-Oka Teruhiko, Sawa Yoshiki, Nagashima Hiroshi,
Abstract
Genetic cardiomyopathy is a group of intractable cardiovascular disorders involving heterogeneous genetic contribution. This heterogeneity has hindered the development of life-saving therapies for this serious disease. Genetic mutations in dystrophin and its associated glycoproteins cause cardiomuscular dysfunction. Large animal models incorporating these genetic defects are crucial for developing effective medical treatments, such as tissue regeneration and gene therapy. In the present study, we knocked out the ?-sarcoglycan (?-SG) gene (SGCD) in domestic pig by using a combination of efficient de novo gene editing and somatic cell nuclear transfer. Loss of ?-SG expression in the SGCD knockout pigs caused a concomitant reduction in the levels of ?-, ?-, and ?-SG in the cardiac and skeletal sarcolemma, resulting in systolic dysfunction, myocardial tissue degeneration, and sudden death. These animals exhibited symptoms resembling human genetic cardiomyopathy and are thus promising for use in preclinical studies of next-generation therapies.
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Cats with thermal burn injuries from California wildfires show echocardiographic evidence of myocardial thickening and intracardiac thrombi.
Sci Rep2020 Feb;10(1):2648. doi: 10.1038/s41598-020-59497-z.
Sharpe Ashley N, Gunther-Harrington Catherine T, Epstein Steven E, Li Ronald H L, Stern Joshua A,
Abstract
Recent increases in the prevalence and severity of wildfires in some regions have resulted in an increased frequency of veterinary burn patients. Few studies exist regarding diagnostics and management of burn wounds in veterinary patients and current knowledge is extrapolated from human literature and research models. Post-burn cardiac injury is a common finding and predictor of mortality in human patients and echocardiography is an important tool in monitoring response to therapy and predicting outcome. We describe the notable findings from cats naturally exposed to California wildfires in 2017 and 2018. Domestic cats (n?=?51) sustaining burn injuries from the Tubbs (2017) and Camp (2018) wildfires were prospectively enrolled and serial echocardiograms and cardiac troponin I evaluations were performed. Echocardiograms of affected cats revealed a high prevalence of myocardial thickening (18/51) and spontaneous echocardiographic contrast and thrombi formation (16/51). Forty-two cats survived to discharge and 6 died or were euthanized due to a possible cardiac cause. For the first time, we describe cardiovascular and coagulation effects of thermal burn and smoke inhalation in cats. Further studies in veterinary burn victims are warranted and serve as a translational research opportunity for uncovering novel disease mechanisms and therapies.
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Indian Guidelines for Indications and Timing of Intervention for Common Congenital Heart Diseases: Revised and Updated Consensus Statement of the Working Group on Management of Congenital Heart Diseases. Abridged Secondary Publication.
Indian Pediatr2020 Feb;57(2):143-157.
Saxena Anita, Relan Jay, Agarwal Ravi, Awasthy Neeraj, Azad Sushil, Chakrabarty Manisha, Dagar Kulbhushan S, Devagourou Velayoudam, Dharan Baiju S, Gupta Saurabh K, Iyer Krishna S, Jayranganath M, Joshi Raja, Kannan B R J, Katewa Ashish, Kohli Vikas, Koneti Nageswara Rao, Kothari Shyam S, Krishnamoorthy K M, Kulkarni Snehal, Kumar Rohit Manoj, Kumar Raman Krishna, Maheshwari Sunita, Manohar Krishna, Marwah Ashutosh, Mishra Smita, Mohanty Smruti R, Murthy Kona Samba, Suresh P V, Radhakrishnan S, Rajashekar Palleti, Ramakrishnan Sivasubramanian, Rao Nitin, Rao Suresh G, Reddy Chinnaswamy Hm, Sharma Rajesh, Shivaprakasha Krishnanaik, Subramanyan Raghavan, Kumar R Suresh, Talwar Sachin, Tomar Munesh, Verma Sudeep, Raju Vijayakumar, ,
Abstract
JUSTIFICATION:
A number of guidelines are available for management of congenital heart diseases from infancy to adult life. However, these guidelines are for patients living in high income countries. Separate guidelines, applicable to Indian children, are required when recommending an intervention for congenital heart diseases, as often these patients present late in the course of the disease and may have co-existing morbidities and malnutrition.
PROCESS:
Guidelines emerged following expert deliberations at the National Consensus Meeting on Management of Congenital Heart Diseases in India, held on 10th and 11th of August 2018 at the All India Institute of Medical Sciences, New Delhi. The meeting was supported by Children's HeartLink, a non-governmental organization based in Minnesota, USA.
OBJECTIVES:
To frame evidence based guidelines for (i) indications and optimal timing of intervention in common congenital heart diseases; (ii) follow-up protocols for patients who have undergone cardiac surgery/catheter interventions for congenital heart diseases.
RECOMMENDATIONS:
Evidence based recommendations are provided for indications and timing of intervention in common congenital heart diseases, including left-to-right shunts (atrial septal defect, ventricular septal defect, atrioventricular septal defect, patent ductus arteriosus and others), obstructive lesions (pulmonary stenosis, aortic stenosis and coarctation of aorta) and cyanotic congenital heart diseases (tetralogy of Fallot, transposition of great arteries, univentricular hearts, total anomalous pulmonary venous connection, Ebstein anomaly and others). In addition, protocols for follow-up of post surgical patients are also described, disease wise.
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Prevalence of Congenital Heart Disease Amongst Schoolchildren in Southwest China.
Indian Pediatr2020 Feb;57(2):138-141.
Han Shen, Wei Chuan-Yu, Hou Zong-Liu, Li Ya-Xiong, Ding Yun-Chuan, Guang Xue-Feng, Huang Dong, Na Zhu-Hui, Chen Wen-Min, Jian G Li-Hong,
Abstract
OBJECTIVE:
To investigate the prevalence and risk factors of congenital heart disease in Yunnan, China which has diverse ethnic groups.
METHODS:
This cross-sectional study enrolled 244,023 children from 2010 to 2015. To diagnose CHD, a conventional physical examination was used to screen suspicious cases, which were further confirmed by echocardiography.
RESULTS:
A total of 1695 children were diagnosed with CHD. The estimated prevalence was 6.94%. Atrial septal defects were the most common cardiac abnormalities. A higher prevalence of CHD was observed with preterm birth, low birth weight, maternal age ?35 years, and high-altitude regions. The prevalence also showed differences between diverse ethnic groups.
CONCLUSIONS:
The prevalence of CHD in China may have ethnic differences.
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Peri- and Post-operative Amplitude-integrated Electroencephalography in Infants with Congenital Heart Disease.
Indian Pediatr2020 Feb;57(2):133-137.
Gui Juan, He Shaoru, Zhuang Jian, Sun Yunxia, Liu Yumei, Liang Suixin, Chen Chen, Ren Yuan, Wang Bi, Chen Jimei,
Abstract
OBJECTIVE:
To identify the factors influencing brain injury in infants with congenital heart disease (CHD) after cardiac surgery.
METHODS:
This retrospective study investigated 103 infants with CHD undergoing cardiac surgery between January 2013 and February 2016. Pre- and postoperative amplitude-integrated electroencephalography (aEEG) recordings were assessed for background pattern, sleep-wake cycle pattern and seizure activity. Logistic regression model was used to determine the influencing factors of brain injury.
RESULTS:
Pre-operatively, most infants in our study exhibited a normal background pattern, with 16.5% showing discontinuous normal voltage, whereas this pattern was observed in only 7.8% of infants postoperatively. The improvement in background pattern after surgery was significant (P<0.05) in infants at no more than 39 weeks of gestational age. Infants with postoperative sepsis or severe postoperative infection were prone to show a worse sleep-wake cycle pattern after heart surgery.
CONCLUSIONS:
The improvement in brain function of infants with CHD after cardiac surgery was associated with the gestational age and postoperative infection.
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Data-driven discovery of changes in clinical code usage over time: a case-study on changes in cardiovascular disease recording in two English electronic health records databases (2001-2015).
BMJ Open2020 Feb;10(2):e034396. doi: 10.1136/bmjopen-2019-034396.
Rockenschaub Patrick, Nguyen Vincent, Aldridge Robert W, Acosta Dionisio, García-Gómez Juan Miguel, Sáez Carlos,
Abstract
OBJECTIVES:
To demonstrate how data-driven variability methods can be used to identify changes in disease recording in two English electronic health records databases between 2001 and 2015.
DESIGN:
Repeated cross-sectional analysis that applied data-driven temporal variability methods to assess month-by-month changes in routinely collected medical data. A measure of difference between months was calculated based on joint distributions of age, gender, socioeconomic status and recorded cardiovascular diseases. Distances between months were used to identify temporal trends in data recording.
SETTING:
400 English primary care practices from the Clinical Practice Research Datalink (CPRD GOLD) and 451 hospital providers from the Hospital Episode Statistics (HES).
MAIN OUTCOMES:
The proportion of patients (CPRD GOLD) and hospital admissions (HES) with a recorded cardiovascular disease (CPRD GOLD: coronary heart disease, heart failure, peripheral arterial disease, stroke; HES: International Classification of Disease codes I20-I69/G45).
RESULTS:
Both databases showed gradual changes in cardiovascular disease recording between 2001 and 2008. The recorded prevalence of included cardiovascular diseases in CPRD GOLD increased by 47%-62%, which partially reversed after 2008. For hospital records in HES, there was a relative decrease in angina pectoris (-34.4%) and unspecified stroke (-42.3%) over the same time period, with a concomitant increase in chronic coronary heart disease (+14.3%). Multiple abrupt changes in the use of myocardial infarction codes in hospital were found in March/April 2010, 2012 and 2014, possibly linked to updates of clinical coding guidelines.
CONCLUSIONS:
Identified temporal variability could be related to potentially non-medical causes such as updated coding guidelines. These artificial changes may introduce temporal correlation among diagnoses inferred from routine data, violating the assumptions of frequently used statistical methods. Temporal variability measures provide an objective and robust technique to identify, and subsequently account for, those changes in electronic health records studies without any prior knowledge of the data collection process.
© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY. Published by BMJ.
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Guillain-Barré syndrome complicated by takotsubo cardiomyopathy: an under-recognised association.
BMJ Case Rep2020 Feb;13(2):. doi: e233591.
Jones Timothy, Umaskanth Neelan, De Boisanger James, Penn Henry,
Abstract
A 41-year-old woman was admitted with progressive paraesthesia and weakness and was diagnosed with Guillain-Barré syndrome. Following an initial period of recovery with intravenous immunoglobulin treatment, she developed acute chest pain associated with electrocardiographic changes. Investigations excluded acute coronary syndrome and instead confirmed a diagnosis of takotsubo cardiomyopathy, which was treated medically. The patient made an excellent neurological and cardiac recovery. Here we discuss the rarely described association between these two conditions and suggest that patients admitted with Guillain-Barré syndrome may benefit from routine screening with echocardiography.
© BMJ Publishing Group Limited 2020. No commercial re-use. See rights and permissions. Published by BMJ.
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Case report of a 66-year-old woman with atypical takotsubo syndrome and concomitant coronary artery disease.
BMJ Case Rep2020 Feb;13(2):. doi: e230164.
Niederseer David, Ghadri Jelena Rima, Manka Robert, Templin Christian,
Abstract
Takotsubo syndrome is increasingly recognised worldwide. As both, takotsubo syndrome and acute myocardial infarction can present with similar findings, including chest pain, elevated troponin and creatine kinase, it is often difficult to differentiate these conditions. Here, we present a challenging case that illustrates (1) difficulties to diagnose takotsubo syndrome in the presence of a significant coronary artery stenosis; (2) how takotsubo syndrome could be misdiagnosed as acute coronary syndrome if diagnostic workup does not include echocardiography or left ventriculography; (3) the importance of cardiac MRI which can contribute to the diagnosis of takotsubo syndrome.
© BMJ Publishing Group Limited 2020. No commercial re-use. See rights and permissions. Published by BMJ.
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Acute exacerbation of idiopathic pulmonary fibrosis: International survey and call for harmonisation.
Eur Respir J2020 Feb;():. doi: 1901760.
Kreuter Michael, Polke Markus, Walsh Simon L F, Krisam Johannes, Collard Harold R, Chaudhuri Nazia, Avdeev Sergey, Behr Jürgen, Calligaro Gregory, Corte Tamera, Flaherty Kevin, Funke-Chambour Manuela, Kolb Martin, Kondoh Yasuhiro, Maher Toby M, Molina Maria Molina, Morais Antonio, Moor Catharina C, Morisset Julie, Pereira Carlos, Quadrelli Silvia, Selman Moises, Tzouvelekis Argyrios, Valenzuela Claudia, Vancheri Carlo, Vicens-Zygmunt Vanesa, Wälscher Julia, Wuyts Wim, Wijsenbeek Marlies, Cottin Vincent, Bendstrup Elisabeth,
Abstract
AIM:
Acute exacerbation of idiopathic pulmonary fibrosis (AE-IPF) is an often deadly complication of IPF. No focused international guidelines for the management of AE-IPF exist. The aim of this international survey was to assess the global variability in prevention, diagnostic and treatment strategies for AE-IPF.
MATERIAL AND METHODS:
Pulmonologists with ILD expertise were invited to participate in a survey designed by an international expert panel.
RESULTS:
509 pulmonologists from 66 countries responded. Significant geographical variability in approaches to manage AE-IPF was found. Common preventive measures included antifibrotic drugs and vaccination. Diagnostic differences were most pronounced regarding use of KL-6 and viral testing, while HRCT, BNP and D-Dimer are generally applied. High dose steroids are widely administered (94%); the use of other immunosuppressant and treatment strategies is highly variable. Very few (4%) responders never use immunosuppression. Antifibrotic treatments are initiated during AE-IPF by 67%. Invasive ventilation or extracorporeal membrane oxygenation are mainly used as a bridge to transplantation. Most physicians educate patients comprehensively on the severity of AE-IPF (82%) and consider palliative care (64%).
CONCLUSION:
Approaches to the prevention, diagnosis and treatment of AE-IPF vary worldwide. Global trials and guidelines to improve the prognosis of AE-IPF are needed.
Copyright ©ERS 2020.
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Inpatient Mortality and 30-Day Readmission Rates Associated with Troponin Testing in Patients without Acute Myocardial Infarction.
Clin Med Res2020 Feb;():. doi: cmr.2020.1513.
Widmer R Jay, Wilson Gibbs, Haneke Travis, Lee Mary, Fan Jerry, Davis Arthur, Fry Ethan, Kurian Kevin, Urbanczyk Jonathan, Potter Jordan, McMahon Matthew, Rhodehouse Bryce, Song Joon J, Michel Jeffrey B,
Abstract
BACKGROUND:
Troponin values above the threshold established to diagnose acute myocardial infarction (AMI; >99 percentile) are commonly detected in patients with diagnoses other than AMI. The objective of this study is to compare inpatient mortality and 30-day readmission rate in patients with troponin I (TnI) above and below the 99th percentile in those with type 1 AMI and type 2 myocardial injury.
METHODS:
Between January 1, 2016 through December 31, 2016 there were 56,895 inpatient hospitalizations and of these, 14,326 (25.2%) patients received troponin testing. We evaluated mortality and readmissions in the entire cohort based on the primary discharge International Classification of Diseases, Tenth Edition (ICD-10) diagnosis and grouped into type 1 AMI versus other diagnoses comprising the type 2 AMI group (including ICD-10 codes for congestive heart failure (CHF), sepsis, and other). Among those with TnI drawn, we evaluated in-hospital mortality and 30-day readmissions based on troponin values > 99 percentile (>0.1 ng/ml).
RESULTS:
Among the entire cohort, the inpatient mortality rate was significantly higher in those with TnI testing (5.0%, 95% CI 4.6%-5.3%) compared to those without testing (0.7%, 95% CI 0.6%-0.7%, p<0.01). In the tested cohort 3,743 (26%) patients had troponin levels above the 99th percentile (>0.1 ng/ml) and 10,583 (74%) had troponin levels below the 99th percentile (<0.1 ng/ml). Comparing type 2 AMI with type 1 AMI and troponin testing, TnI values >0.1 ng/ml were associated with higher inpatient mortality (11.6% vs. 3.9%) and 30-day readmission rates (16.9% vs. 10.7%).
CONCLUSIONS:
A higher inpatient mortality and 30-day readmission rates were found in patients with type 2 AMI compared to type 1 AMI group.
© 2020 Marshfield Clinic.
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Clinical Outcomes of Various Management Strategies for Symptomatic Bradycardia.
Clin Med Res2020 Feb;():. doi: cmr.2019.1507.
Abrich Victor A, Le Rachel J, Mulpuru Siva K, Friedman Paul A, Barsness Gregory W, Cha Yong-Mei, Lennon Ryan J, Lewis Bradley R, Yang Eric H,
Abstract
OBJECTIVE:
To determine clinical outcomes of various management strategies for reversible and irreversible causes of symptomatic bradycardia in the inpatient setting.
DESIGN:
Retrospective observational study.
SETTING:
Emergency Room and Inpatient.
PARTICIPANTS:
Patients presenting to the Emergency Department with symptomatic bradycardia.
METHODS:
We retrospectively reviewed electronic health records of 518 patients from 2 Mayo Clinic campuses (Rochester and Phoenix) who presented to the emergency department with symptomatic bradycardia (heart rate ?50 beats/minute) from January 1, 2010 through December 31, 2015. Sinus bradycardia was excluded. The following management strategies were compared: observation, non-invasive management (medications with/without transcutaneous pacing), early permanent pacemaker (PPM) implantation (?2 days), and delayed PPM implantation (?3 days). Study end points included length of stay and adverse events related to bradycardia (syncope, central line-associated bloodstream infections, cardiac arrest, and in-hospital mortality). Patients who received a PPM were further stratified by weekend hospital admission.
RESULTS:
Heart block occurred in 200 (38.6%) patients, and atrial arrhythmias with slow ventricular response occurred in 239 (46.1%) patients. Reversible causes of bradycardia included medication toxicity in 22 (4.2%) patients and hyperkalemia in 44 (8.5%) patients. Adverse events were similar in patients who underwent early compared to delayed PPM implantation (6.6% vs 12.5%, =.20), whereas adverse events were higher in patients who received temporary transvenous pacing (19.1% vs 3.4%, <.001). Weekend admissions were associated with increased temporary transvenous pacing, prolonged median time to PPM implantation by 1 day, and prolonged median length of stay by 2 days.
CONCLUSIONS:
Delayed PPM implantation was not associated with an increase in adverse events. Weekend PPM implantation should be considered to reduce temporary transvenous pacing and shorten length of stay.
© 2020 Marshfield Clinic.
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