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Pubblicazioni recenti - cardiac disease
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Activated FMS-like tyrosine kinase 3 ameliorates Angiotensin II-induced cardiac remodeling.
Acta Physiol (Oxf)2020 Jun;():. doi: 10.1111/apha.13519.
Ma Wenzhuo, Liang Fanfan, Zhan Heqin, Jiang Xixi, Gao Chenying, Zhang Xin, Zhang Kaina, Sun Qiang, Hu Hao, Zhao Zhenghang,
Abstract
AIM:
FMS-like receptor tyrosine kinase 3 (Flt3) has been reported to be increased in cardiomyocytes responding to ischemic stress. This study was to determine whether Flt3 activation could ameliorate pressure overload-induced heart hypertrophy and fibrosis, and to elucidate the mechanisms of action.
METHODS:
In vivo cardiac hypertrophy and remodeling experiments were conducted by infusing angiotensin II (Ang II) chronically in male C57BL/6 mice. Flt3 specific ligand (FL) was administered intraperitoneally every two days (5µg/mouse). In vitro experiments on hypertrophy, apoptosis and autophagy mechanism were performed in neonatal rat cardiomyocytes (NRCMs) and H9c2 cells with adenovirus vector-mediated overexpression of Flt3.
RESULTS:
Our results demonstrated that following chronic Ang II infusion for 4 weeks, the mice exhibited heart hypertrophy, fibrosis, apoptosis and contractile dysfunction. Meanwhile, Ang II induced autophagic responses in mouse hearts, as evidenced by increased LC3 II and decreased P62 expression. These pathological alterations in Ang II-treated mice were significantly ameliorated by Flt3 activation with FL administration. In NRCMs and Flt3-overexpressed H9c2 cells, FL attenuated Ang II-induced pathological autophagy and inactivated AMPK/mTORC1/FoxO3a signaling, thereby efficiently mitigating cell hypertrophy and apoptosis. Conversely, the AMPK activator metformin or the mTORC1 inhibitor rapamycin reversed the effects of FL on the alterations of autophagy, hypertrophy and apoptosis in cardiomyocytes induced by Ang II.
CONCLUSION:
Flt3 activation ameliorates cardiac hypertrophy, fibrosis and contractile dysfunction in the mouse model of chronic pressure overload, most likely via suppressing AMPK/mTORC1/FoxO3a-mediated autophagy. These results provide new evidence supporting Flt3 as a novel therapeutic target in maladaptive cardiac remodeling.
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Challenges in the Management of patients with systemic light chain (AL) amyloidosis during the COVID-19 pandemic.
Br J Haematol2020 Jun;():. doi: 10.1111/bjh.16898.
Kastritis Efstathios, Wechalekar Ashutosh, Schönland Stefan, Sanchorawala Vaishali, Merlini Giampaolo, Palladini Giovanni, Minnema Monique, Roussel Murielle, Jaccard Arnaud, Hegenbart Ute, Kumar Shaji, Cibeira Maria Teresa, Blade Joan, Dimopoulos Meletios A,
Abstract
The SARS-CoV-2-associated disease (COVID-19) is primarily manifested as a respiratory tract infection but may affect and cause complications from multiple organ systems (cardiovascular, gastrointestinal, kidneys, hematopoietic and immune systems) while no proven specific therapy exists. The challenges associated with COVID-19 are even greater for patients with light chain (AL) amyloidosis, a rare multisystemic disease affecting the heart, kidneys, liver, gastrointestinal and nervous system. Patients with AL amyloidosis may need to receive chemotherapy, which probably increases infection risk. Management of COVID-19 may be particularly challenging in patients with AL amyloidosis who often present with cardiac dysfunction, nephrotic syndrome, neuropathy, low blood pressure and gastrointestinal symptoms. In addition, AL patients may be more susceptible to toxicities of drugs used to manage COVID-19. Access to health care may be difficult or limited, diagnosis of AL amyloidosis may be delayed with detrimental consequences, treatment administration may need modification. Both patients and treating physicians need to adapt in a new reality.
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Impact of hospital-acquired complications in long-term clinical outcomes after subarachnoid hemorrhage.
Clin Neurol Neurosurg2020 May;194():105945. doi: S0303-8467(20)30288-2.
Unda Santiago R, Labagnara Kevin, Birnbaum Jessie, Wong Megan, de Silva Neranjan, Terala Harshit, de la Garza Ramos Rafael, Haranhalli Neil, Altschul David J,
Abstract
OBJECTIVE:
Patients with subarachnoid hemorrhage (SAH) usually have prolonged hospitalizations due to the need to closely monitor their neurological status. Therefore, these patients have higher risk of experiencing hospital-acquired complications (HACs), which can complicate their clinical course and recovery. However, there is no evidence on the impact of HACs of long-term clinical outcomes. We aimed to identify if HACs are independent risk factors for poor clinical outcomes at 12-18 months of follow-up.
PATIENTS AND METHODS:
Retrospective analysis of 323 patients with SAH diagnosis from 2013 until June 2018. We collected patient-related factors (age, sex, body mass index (BMI), ethnicity), comorbidities (hypertension, smoke status, diabetes, coronary heart diseases, prothrombotic diseases and hypercholesterolemia), clinical variables (Hunt-Hess grade, modified Fisher grade, treatment, delayed cerebral ischemia), aneurysm characteristics (location, size) and HACs (pneumonia, deep vein thrombosis (DVT), urinary tract infection (UTI), external ventricular drainage (EVD) infections, sepsis, hyponatremia and acute respiratory distress syndrome). Poor outcomes were defined as mRS???3.
RESULTS:
204 patients were included in the primary analysis. 82 (40.2%) experienced one or more HACs during their hospital course. Patients that developed HACs have significantly increased ICU (12.1?±?6.6 vs 24.3?±?23.6, p?
CONCLUSIONS:
HACs are an independent risk factor of sustaining poor clinical outcomes 12-18 months after a SAH. Furthermore, HACs are significantly related with the occurrence of DCI, with non-routine discharge and 90-day poor functional outcomes.
Published by Elsevier B.V.
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Ambient fine particulate matter pollution and years of life lost from cardiovascular diseases in 48 large Chinese cities: Association, effect modification, and additional life gain.
Sci Total Environ2020 May;735():139413. doi: S0048-9697(20)32930-2.
Li Jie, Zhang Xiao, Yin Peng, Wang Limin, Zhou Maigeng,
Abstract
Existing evidence on the associations between fine particulate matter (PM) and years of life lost (YLL) from cardiovascular diseases (CVD) is limited and inconclusive, and the role of potential modifiers, especially those at city-level, is not fully understood. In this study, a time-series study was conducted in 48 large Chinese cities from 2013 to 2017. Generalized additive model coupled with random effects model were used to estimate national-average associations of PM with YLL. Effect modification by individual- and city-level characteristics obtained by linking with China Chronic Disease and Risk Factors Surveillance was explored. Moreover, additional life gain was evaluated under scenario where PM concentration would be reduced. For 10 ?g/m increase in PM concentration at lag01 day, the relative increment of YLL was 0.22% from CVD, 0.20% from ischemic heart disease, 0.26% from stroke, 0.23% from hemorrhagic stroke, and 0.31% from ischemic stroke. Some associations were stronger in elder and less educated people, warm season, as well as cities characterized by higher temperature and prevalence of binge drinking and excess red meat intake, or lower PM and prevalence of usual exercise. Additional life gain attributable to avoidable YLL from CVD was estimated to be 0.08 year if PM concentration could fall to the standard recommended by World Health Organization (25 ?g/m). This large epidemiological investigation demonstrated robust evidence of short-term associations between PM exposure and YLL from CVD. Potential modifiers should be considered to develop efficient intervention strategies. Implementation of more stringent standard is beneficial to alleviate YLL caused by PM.
Copyright © 2020 Elsevier B.V. All rights reserved.
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Embolization Techniques for Arteriovenous Malformations in Parkes-Weber Syndrome.
Ann Vasc Surg2020 May;():. doi: S0890-5096(20)30446-5.
Conway Allan M, Qato Khalil, Tran N Nguyen, Short Heather, Giangola Gary, Carroccio Alfio, Rosen Robert J,
Abstract
OBJECTIVES:
Multiple high-flow arteriovenous malformations (AVMs) are the hallmark of Parkes-Weber syndrome (PWS). Surgical resection has historically shown poor outcomes with PWS. The aim of this study was to assess the management of PWS in the current era.
METHODS:
A retrospective review was performed from 2004 to 2017 on all patients presenting to a single institution for the management of PWS. Presentation, techniques, complications, and outcomes were reviewed.
RESULTS:
Fourteen patients (50% male) with PWS were seen at our institution and mean age was 19.9 years (range, 4.7-68.8). The lower extremity was affected in 12 (86%) and the upper extremity in 2 (14%) patients. All patients presented with pain and swelling in the affected limb. Seven (50%) patients presented with ulcers, of which 3 (43%) had extensive wounds. Five (36%) patients had echocardiographic evidence of high-output cardiac failure. All patients underwent angiography with the intention to treat. Three (21%) patients were found to have diffuse arteriovenous communication with no discrete AVM nidus and thus did not undergo intervention. The remaining 11 (79%) patients underwent transcatheter embolization of the AVM's arterial inflow. Six (55%) patients required multiple or staged inflow embolization procedures, with a mean of 3.3 (range, 1-10) interventions. Thirty-two arterial embolization procedures were performed in total. n-Butyl cyanoacrylate (nBCA) adhesive was used in 22 (69%), microspheres in 8 (25%), and a combination of coils and adhesive in 2 (6%) cases. Technical angiographic success was seen in all patients. Six (55%) patients also had interventions to treat the venous component of the malformation, either concomitantly or during a separate procedure. This included radiofrequency ablation in 1 (17%), coil embolization in 1 (17%), sodium tetradecyl sulfate (STS) sclerotherapy in 2 (33%), and a combination of STS, coil embolization, and vein stripping in 2 (33%) patients. Ten (91%) patients experienced a partial response and 1 (9%) patient experienced no response to treatment. No patients had a complete response, as expected with the diffuse nature of this disease. There were no peri-procedural complications. Two of 3 patients with complex wounds required major amputations for gangrene, including one above-knee and one below-knee amputation at 128 months and 66 months after the index procedure respectively.
CONCLUSIONS:
AVMs in PWS can be successfully treated by a transcatheter approach. Multiple interventions are usually required. Patients with extensive wounds remain at risk for loss of limb.
Copyright © 2020 Elsevier Inc. All rights reserved.
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Does physical activity influence the association between depressive symptoms and low-grade inflammation in adults? A study of 8,048 adults.
Physiol Behav2020 May;():112967. doi: S0031-9384(20)30281-X.
Werneck André O, Christofaro Diego G D, Ritti-Dias Raphael M, Cucato Gabriel G, Stubbs Brendon, Oyeyemi Adewale L, Conceição Raquel D O, Santos Raul D, Bittencourt Márcio S,
Abstract
This study investigated whether physical activity (PA) influences the association between depression risk and low-grade inflammation. This was a cross-sectional study including 8,048 adults (18-59y). Depression symptoms were evaluated by Beck depression inventory (BDI) and physical activity through international physical activity questionnaire. Adults with infectious and inflammatory diseases were excluded. Blood samples were collected, including high sensitivity C-reactive protein (CRP), a marker of low-grade inflammation when ?3mg/L. Additional measures of LDL-C, HDL-C, triglycerides and fasting glucose were also determined. Tobacco smoking and alcohol consumption and body mass index were used as covariates. Mediation models were conducted using the procedures of Karlson Holm Breen. Adults with elevated CRP (?3mg/L) presented with higher BDI scores [8.5%(95%CI:7.2%-10.1%) vs. 5.8%(95%CI:5.2-6.4)] as well as higher prevalence of physical inactivity 67.4% (95%CI:64.9-69.9) vs. 59.7% (95%CI:58.4-60.9). The prevalence of elevated CRP was highest in physically inactive adults with greater depression risk. Models revealed that physical activity risk explained 13% of the association between depression risk and elevated CRP (p=0.035), independently of potential confounders. Physical activity may reduce the association between depression symptoms and elevated CRP. Future longitudinal research is required to determine the directionality of the relationships observed.
Copyright © 2020. Published by Elsevier Inc.
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Endovascular Treatment of a Migrated Superior Vena Cava Stent in the Right Atrium.
J Invasive Cardiol2020 Jun;32(6):E168-E169.
Vijayvergiya Rajesh, Kanabar Kewal, Kaushal Sanjeev, Lal Anupam, Krishnan Sabari,
Abstract
A 42-year-old female with end-stage chronic kidney disease, who was on maintenance hemodialysis for the last 3 years, presented with facial and upper-limb swelling of 2-month duration. A computed tomography (CT) scan confirmed significant stenosis of the superior vena cava (SVC). Following discussion in a multidisciplinary meeting, it was proposed to perform a repeat endovascular intervention to relieve the SVC obstruction and manage the migrated stent.
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Characteristics and Outcomes of Patients Who Are Denied From a Percutaneous Edge-to-Edge Mitral Valve Repair After Being Referred to a Transcatheter Mitral Valve Program: Impact of a Dedicated Multidisciplinary Mitral Heart Team Approach.
J Invasive Cardiol2020 Jun;32(6):E151-E157.
Poulin Anthony, Beaupré Frédéric, Gravel Caroline, Hadjadj Sandra, Bernier Mathieu, Beaudoin Jonathan, O'Connor Kim, Ferreira-Neto Alfredo Nunes, Wintzer Jérôme, Dumont Eric, Dagenais François, Rodés-Cabau Josep, Paradis Jean-Michel,
Abstract
BACKGROUND:
Many patients referred for a MitraClip intervention are finally refused for this intervention, and data are very scarce on their outcomes. Our study sought to determine the characteristics and outcomes of patients who are referred to a mitral valve clinic and are finally denied from a percutaneous mitral edge-to-edge repair.
METHODS:
A total of 210 patients referred to our clinic for severe mitral regurgitation were retrospectively analyzed. Fifty-seven patients underwent a MitraClip procedure. For exploratory purposes, a propensity-matched cohort comparing the patients accepted for a MitraClip procedure and those refused for any mitral intervention was analyzed.
RESULTS:
Among the 153 patients who were refused for MitraClip, 46% had functional MR, 42% had degenerative MR, and 11% had mixed disease. Reasons for denial included unfavorable anatomy, patient refusal, mitral valve surgery referral, cardiac resynchronization therapy, other advanced heart failure therapies, and palliative care. After a mean follow-up of 13 months, 50% were in New York Heart Association class I or II, 63% had less than severe MR, and mortality rate was 29%. In the propensity-matched cohort, there was no difference in symptoms improvement, but there was less overall mortality (P=.01), cardiovascular mortality (P<.01) and severe MR (P<.01) in the MitraClip group.
CONCLUSIONS:
A multidisciplinary heart team evaluation for complex MR patients can be useful not solely for selecting the ideal MitraClip eligible patients, but also to select the best treatment strategy in each individualized context.
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Cardiovascular Risk of Isolated Systolic or Diastolic Hypertension in Young Adults.
Circulation2020 Jun;141(22):1778-1786. doi: 10.1161/CIRCULATIONAHA.119.044838.
Lee Hokyou, Yano Yuichiro, Cho So Mi Jemma, Park Jong Heon, Park Sungha, Lloyd-Jones Donald M, Kim Hyeon Chang,
Abstract
BACKGROUND:
Little is known regarding health outcomes associated with isolated systolic hypertension (ISH), isolated diastolic hypertension (IDH), or systolic and diastolic hypertension (SDH) among young adults with stage 1 hypertension, defined using the 2017 American College of Cardiology/American Heart Association blood pressure (BP) guideline.
METHODS:
From a nationwide health screening database, we included 6?424?090 participants, aged 20 to 39 years, who were not taking antihypertensive medication at the baseline examination in 2003 to 2007. Participants were categorized as having normal BP (untreated systolic BP [SBP] <120/diastolic BP [DBP] <80 mm?Hg; n=2?665?310); elevated BP (SBP 120-129/DBP <80 mm?Hg; n=705?344); stage 1 IDH (SBP <130/DBP 80-89 mm?Hg; n=1?271?505); stage 1 ISH (SBP 130-139/DBP <80 mm?Hg; n=255?588); stage 1 SDH (SBP 130-139/DBP 80-89 mm?Hg; n=711?503); and stage 2 hypertension (SBP ?140, DBP ?90 mm?Hg; n=814?840). The primary outcome was composite cardiovascular disease (CVD) events, including myocardial infarction, stroke, heart failure, and CVD-related death.
RESULTS:
The median age of the participants was 30 years and 60.9% were male. Over a median follow-up of 13.2 years, 44?070 new CVD events occurred. With normal BP as the reference, multivariable-adjusted hazard ratios (95% CIs) for CVD events were 1.14 (1.09-1.18) for elevated BP, 1.32 (1.28-1.36) for stage 1 IDH, 1.36 (1.29-1.43) for stage 1 ISH, 1.67 (1.61-1.72) for stage 1 SDH, and 2.40 (2.33-2.47) for stage 2 hypertension.
CONCLUSIONS:
Among young adults, stage 1 ISH, IDH, and SDH were all associated with higher CVD risks than normal BP. The CVD risks of stage 1 ISH and IDH were similar to each other but lower than the risk of stage 1 SDH. Categorizing young adults with stage 1 hypertension further into stage 1 ISH, IDH, and SDH may improve risk stratification for identifying high-risk individuals.
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Lipoprotein(a) in Alzheimer, Atherosclerotic, Cerebrovascular, Thrombotic, and Valvular Disease: Mendelian Randomization Investigation.
Circulation2020 Jun;141(22):1826-1828. doi: 10.1161/CIRCULATIONAHA.120.045826.
Larsson Susanna C, Gill Dipender, Mason Amy M, Jiang Tao, Bäck Magnus, Butterworth Adam S, Burgess Stephen,
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Current perspective on fibrinogen concentrate in critical bleeding.
Expert Rev Clin Pharmacol2020 Jun;():. doi: 10.1080/17512433.2020.1776608.
Leal-Noval Santiago R, Fernández Pacheco Jose, Casado Méndez Manuel, Cuenca-Apolo Diego, Múñoz-Gómez Manuel,
Abstract
INTRODUCTION:
. Massive hemorrhage continues to be a treatable cause of death. Its management varies from prefixed ratio-driven administration of blood components to goal-directed therapy based on point-of-care testing and administration of coagulation factor concentrates.
AREAS COVERED:
. We review the current role of fibrinogen concentrate (FC) for the management of massive hemorrhage, either administered without coagulation testing in life-threatening hemorrhage, or within an algorithm based on viscoelastic hemostatic assays and plasma fibrinogen level. We identified relevant guidelines, meta-analyses, randomized controlled trials, and observational studies that included indications, dosage, and adverse effects of FC, especially thromboembolic events.
EXPERT OPINION:
. Moderate- to high-grade evidence supports the use of FC for the treatment of severe hemorrhage in trauma and cardiac surgery; a lower grade of evidence is available for its use in postpartum hemorrhage and end-stage liver disease. Pre-emptive FC administration in non-bleeding patients is not recommended. FC should be administered early, and in a goal-directed manner, guided by early amplitude of clot firmness parameters (A5- or A10-FIBTEM) or hypofibrinogenemia. Further investigation is required into the early use of FC, as well as its potential advantages over cryoprecipitate, and whether or not its administration at high doses leads to a greater risk of adverse events.
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Evidence for Exacerbation-Prone Asthma and Predictive Biomarkers of Exacerbation Frequency.
Am J Respir Crit Care Med2020 Jun;():. doi: 10.1164/rccm.201909-1813OC.
Peters Michael C, Mauger David, Ross Kristie R, Phillips Brenda, Gaston Benjamin, Cardet Juan Carlos, Israel Elliot, Levy Bruce D, Phipatanakul Wanda, Jarjour Nizar N, Castro Mario, Wenzel Sally E, Hastie Annette, Moore Wendy, Bleecker Eugene, Fahy John V, Denlinger Loren C, ,
Abstract
BACKGROUND:
Cross-sectional studies suggest an exacerbation-prone asthma (EPA) phenotype and the utility of blood eosinophils and plasma interleukin 6 (IL-6) as predictive biomarkers.
OBJECTIVE:
To prospectively test for EPA phenotype and utility of baseline blood measures of eosinophils and IL6 as predictive biomarkers.
METHODS:
Three-year asthma exacerbation data were analyzed in 406 adults in the Severe Asthma Research Program-3. Transition models were used to assess uninformed and informed probabilities of exacerbation in year 3. Binomial regression models were used to assess eosinophils and IL6 as predictive biomarkers.
RESULTS:
83 participants (21%) had > 1 exacerbation in each year (EPA) and 168 participants (41%) had no exacerbation in any year (exacerbation-resistant asthma [ERA]). The uninformed probability of an exacerbation in year 3 was 40%, but the informed probability increased to 63% with an exacerbation in year 2 and 82% with an exacerbation in years 1 and 2. The probability of a year 3 exacerbation with no year 1 or 2 exacerbations was 13%. Compared to ERA, EPA was characterized by lower FEV1, and a higher prevalence of obesity, hypertension and diabetes. High plasma IL6 occurred in EPA, and the incident rate ratio (IRR) for exacerbation increased 10% for each 1 pg/uL increase in baseline IL6 level. Although high blood eosinophils did not occur in EPA, the IRR for exacerbations increased 9% for each 100 cell/uL increase in baseline eosinophil number.
CONCLUSIONS:
Longitudinal analysis confirms an EPA phenotype characterized by features of metabolic dysfunction. Blood measures of IL-6, but not eosinophils, were significantly associated with EPA, and IL-6 and eosinophils predicted exacerbations in the sample as a whole.
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Antiatherosclerotic Activity of Eriocitrin in High-Fat-Diet-Induced Atherosclerosis Model Rats.
J Environ Pathol Toxicol Oncol2020 ;39(1):61-75. doi: 10.1615/JEnvironPatholToxicolOncol.2020031478.
Wan Jia, Feng Yaoyu, Du Lingjuan, Veeraraghavan Vishnu Priya, Mohan Surapaneni Krishna, Guo Shikui,
Abstract
Atherosclerosis is a multifactorial disease that develops and progresses in the arterial wall in response to a variety of stimuli. Among various other stimuli, hyperlipidemia is an extremely important factor that is correlated with the development of atherosclerosis. Lemon and citrus fruits contain various bioactive flavonoids, such as eriocitrin, that prevent obesity and related metabolic diseases. Therefore we concentrated on eriocitrin, a potent flavonoid with numerous therapeutic properties, particularly its beneficial lipid-lowering action in rats subjected to high fat diet. The anti-atherosclerotic efficacy of eriocitrin was assessed in rats administered a diet rich in fat. Wistar rats were divided into five groups consisting of six animals in all groups. Group I served the control, Group II was fed a high-fat diet (HFD), and the third and fourth groups were fed an HFD supplemented with varying doses of eriocitrin, and the last group was administered simvastatin for the last 30 days. Body weight, organ weight, lipid and lipoprotein parameters, cardiac and inflammatory markers, and histological examination were evaluated in animals induced with an HFD. Eriocitrin displayed a significant anti-atherosclerotic action by lowering the body weight, organ weight, reduction in lipid content, cardiac and inflammatory markers, myocardial changes confirmed by histopathology, malondialdehyde and increased antioxidant enzyme activities, nitric oxide, as well as 6-keto-PGF1? and high-density lipoprotein levels in rats fed an HFD. The findings of the experiment suggest that the anti-atherosclerotic action of eriocitrin was due to its modulatory activity in lipid metabolism. Considering the overall results of the study it can be validated that a use of flavonoid eriocitrin might be beneficial in altering HFD-induced alterations in atherosclerotic rats.
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SARS-CoV-2 and Guillain-Barré syndrome: AIDP variant with favorable outcome.
Eur J Neurol2020 Jun;():. doi: 10.1111/ene.14368.
Lascano Agustina M, Epiney Jean-Benoît, Coen Matteo, Serratrice Jacques, Bernard-Valnet Raphaël, Lalive Patrice H, Kuntzer Thierry, Hübers Annemarie,
Abstract
The entire world has been experiencing the outbreak of a novel infectious agent known as severe acute respiratory syndrome corona virus 2 (SARS-CoV-2), which is responsible for the coronavirus disease 19 (COVID-19) . Life-threatening complications described in SARS-CoV-2 infected patients include acute respiratory distress syndrome, acute kidney failure and cardiac injury . Nonetheless, only few neurological complications have been described so far .
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Post-transplant survival in ACHD patients as compared to dilated and ischemic cardiomyopathy patients; an analysis of the thoracic ISHLT registry.
Clin Transplant2020 Jun;():. doi: 10.1111/ctr.13985.
Kinsella Aisling, Rao Vivek, Fan Chun-Po, Manlhiot Cedric, Stehlik Josef, Ross Heather, Alba Ana C,
Abstract
Previous studies have shown that adult congenital heart disease (ACHD) is associated with high early post-transplant mortality but improved long-term survival in comparison to the overall heart transplant population. We aimed to evaluate survival outcomes of ACHD in adult transplant recipient patients as specifically compared to ischemic (ICM) and dilated cardiomyopathy (DCM) groups. Adult heart transplant recipients between 2004 and 2014 were identified from the ISHLT registry. We used Kaplan-Meier analysis to evaluate overall survival, 1-year survival and 1-year conditional survival among etiology groups and multivariable Cox proportional hazard (PH) models to assess the association between etiology of cardiomyopathy and 1-year and long-term all-cause mortality and cause-specific mortality. We included 30,130 heart transplant recipients. One-year survival was 78.3% in ACHD, 84.3% in ICM and 86.2% in DCM patients (p<0.001). By multivariable analysis, during first post transplant year, ACHD and ICM patients were at significantly higher mortality risk than DCM. Adjusted post-transplant mortality risk, conditional on one-year survival, was not statistically different in ACHD and DCM while ICM patients had 17% higher long-term mortality risk than DCM patients leading to overall worse outcomes in ICM patients. Therefore, ICM patients have poorer outcomes in comparison to both DCM and ACHD patients.
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A Doxorubicin-Induced Murine Model of Dilated Cardiomyopathy In Vivo.
J Vis Exp2020 May;(159):. doi: 10.3791/61158.
Liu Yihai, Zhang Wenfeng, Hu Tingting, Ni Jie, Xu Biao, Huang Wei,
Abstract
Dilated cardiomyopathy (DCM) refers to a spectrum of heterogeneous myocardial disorders characterized by ventricular dilation and depressed cardiac performance in the absence of hypertension, valvular, congenital, or ischemic heart diseases, and which may be related to infection, autoimmune or metabolic abnormalities, or family inheritance. It can progress into congestive heart failure with a poor prognosis. Doxorubicin (Dox) is widely employed as a chemotherapeutic drug, but its use is limited because it causes DCM-like changes of the myocardium. Its myocardial toxicity is attributed to oxidative stress, chronic inflammation, and cardiomyocyte apoptosis. A model of DCM exploiting these Dox-induced DCM symptoms has not been established.
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Quantification of Biventricular Function and Morphology by Cardiac Magnetic Resonance Imaging in Mice with Pulmonary Artery Banding.
J Vis Exp2020 May;(159):. doi: 10.3791/60837.
Koop Anne-Marie C, Hagdorn Quint A J, van de Kolk Kees C W A, van Oosten Annemieke, Weij Michel, Silljé Herman H W, Willems Tineke P, Berger Rolf M F,
Abstract
Right ventricular (RV) function and failure are major determinants of outcome in acquired and congenital heart diseases, including pulmonary hypertension. Assessment of RV function and morphology is complex, partly due to the complex shape of the RV. Currently, cardiac magnetic resonance (CMR) imaging is the golden standard for noninvasive assessment of RV function and morphology. The current protocol describes CMR imaging in a mouse model of RV pressure load induced by pulmonary artery banding (PAB). PAB is performed by placing a 6-0 suture around the pulmonary artery over a 23 G needle. The PAB gradient is determined using echocardiography at 2 and 6 weeks. At 6 weeks, the right and left ventricular morphology and function is assessed by measuring both end-systolic and end-diastolic volumes and mass by ten to eleven cine slices 1 mm thick using a 9.4 T magnetic resonance imaging scanner equipped with a 1,500 mT/m gradient. Representative results show that PAB induces a significant increase in RV pressure load, with significant effects on biventricular morphology and RV function. It is also shown that at 6 weeks of RV pressure load, cardiac output is maintained. Presented here is a reproducible protocol for the quantification of biventricular morphology and function in a mouse model of RV pressure load and may serve as a method for experiments exploring determinants of RV remodeling and dysfunction.
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Headache is an important symptom in patients with coronavirus disease 2019 (COVID-19).
Diagnosis (Berl)2020 Jun;():. doi: 10.1515/dx-2020-0048.
Lippi Giuseppe, Mattiuzzi Camilla, Bovo Chiara, Henry Brandon Michael,
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Patient care protocols and personal safety measures for health care professionals in cardiac catheterization rooms during the COVID-19 outbreak in the National Institute of Cardiology.
Catheter Cardiovasc Interv2020 Jun;():. doi: 10.1002/ccd.28979.
Eid-Lidt Guering, Farjat Pasos Julio Iván,
Abstract
The COVID-19 was first described in late 2019 that quickly became a pandemic affecting every health system as we know it. The high transmissibility among humans represents a well-known high burden of morbidity and mortality not only for cardiovascular patients but also for a higher risk between health care professionals that must deliver high-quality care to them in any scenario, and cardiac catheterization rooms are no exception. This creates a new dilemma, minimize exposure to patients and health care professionals to COVID-19 while maintaining high quality in cardiovascular therapeutics. In order to achieve this, several international recommendations on treatment algorithms modifications and in safety measures in the catheterization room have been published, always aiming to solve this dilemma in the best possible way. Hereby, we present a summary of the most recent treatment algorithms in the most important cardiovascular interventions (acute coronary syndromes, structural and congenital heart diseases) as well as specific safety measures with a step-by-step preparedness before and after any interventional procedure during COVID-19 outbreak. The objective of this document is to inform and to train health care professionals that works in cardiac catheterization rooms on the risks as well on the plan for containment, mitigation, and response to the global situation of COVID-19 infection in order to apply this in their own local work environments.
© 2020 Wiley Periodicals LLC.
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Resting distal to aortic pressure ratio and fractional flow reserve discordance affects the diagnostic performance of quantitative flow ratio: Results from an individual patient data meta-analysis.
Catheter Cardiovasc Interv2020 Jun;():. doi: 10.1002/ccd.28976.
Westra Jelmer, Eftekhari Ashkan, Tu Shengxian, Campo Gianluca, Escaned Javier, Winther Simon, Matsuo Hitoshi, Qu Xinkai, Koltowski Lukasz, Chang Yunxiao, Liu Tommy, Yang Junqing, Andersen Birgitte Krogsgaard, Wijns William, Böttcher Morten, Christiansen Evald Høj, Xu Bo, Holm Niels Ramsing,
Abstract
OBJECTIVE:
To evaluate the diagnostic performance of quantitative flow ratio (QFR) related to fractional flow reserve (FFR) and resting distal-to-aortic pressure ratio (resting Pd/Pa) concordance.
BACKGROUND:
QFR is a method for computation of FFR based on standard coronary angiography. It is unclear how QFR is performed in patients with discordance between FFR and resting pressure ratios (distal-to-aortic pressure ratio [Pd/Pa]).
MATERIALS AND METHODS:
The main comparison was the diagnostic performance of QFR with FFR as reference stratified by correspondence between FFR and resting Pd/Pa. Secondary outcome measures included distribution of clinical or procedural characteristics stratified by FFR and resting Pd/Pa correspondence.
RESULTS:
Four prospective studies matched the inclusion criteria. Analysis was performed on patient level data reaching a total of 759 patients and 887 vessels with paired FFR, QFR, and resting Pd/Pa. Median FFR was 0.85 (IQR: 0.77-0.90). Diagnostic accuracy of QFR with FFR as reference was higher if FFR corresponded to resting Pd/Pa: accuracy 90% (95% CI: 88-92) versus 72% (95% CI: 64-80), p
CONCLUSION:
Diagnostic performance of QFR with FFR as reference is reduced for lesions with discordant FFR (?0.80) and resting Pd/Pa (?0.92) measurements.
© 2020 Wiley Periodicals LLC.
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