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Pubblicazioni recenti - cardiac failure
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Microstructural white matter changes following gait training with Hybrid Assistive Limb initiated within 1 week of stroke onset.
J Neurol Sci2020 May;415():116939. doi: S0022-510X(20)30276-8.
Ando Daisuke, Yokota Chiaki, Koshino Kazuhiro, Yasuno Fumihiko, Sato Takeo, Yamamoto Akihide, Odani Hirotaka, Nakajima Takashi, Higuchi Takahiro, Tatsumi Eisuke,
Abstract
The early initiation of robot-assisted gait training in patients with acute stroke could promote neuroplasticity. The aim of this study was to clarify the microstructural changes of white matter associated with gait training using Hybrid Assistive Limb (HAL) by diffusion tensor imaging (DTI). Patients with first-ever stroke and requiring a walking aid started gait training within 1 week of stroke onset. The patients were quasi-randomly assigned either to the conventional physical therapy (CPT) group or gait training using HAL (HAL) group. Motor function and DTI were examined at baseline and after 3-5 months. Voxel-based statistical analyses of fractional anisotropy (FA) images were performed using diffusion metric voxel-wise analyses. Volume of interest (VOI)-based analyses were used to assess changes in FA (?FA). Twenty-seven patients (17 in the CPT group and 10 in the HAL group) completed the study. There were improvements in motor function and independency in the CPT and HAL groups (p < .001). Compared to baseline, there were decreases in FA in the ipsi-lesional cerebral peduncle in the CPT group (p < .001) and increases in the contra-lesional rostrum of the corpus callosum in the HAL group (p < .001) at the second assessment, consistent with the mean ?FA in each group from VOI analysis (CPT/HAL: cerebral peduncle, -0.066/-0.027, p = .027; corpus callosum, 0.002/0.042, p < .001). Gait training using HAL initiated within 1 week after stroke onset facilitated the recovery of inter-hemispheric communication and prevented the progression of Wallerian degeneration of the affected pyramidal tract.
Copyright © 2020 Elsevier B.V. All rights reserved.
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Immunoglobulin free light chains as an inflammatory biomarker of heart failure with myocarditis.
Clin Immunol2020 May;():108455. doi: S1521-6616(20)30098-X.
Matsumori Akira, Shimada Toshio, Nakatani Eiji, Shimada Miho, Tracy Steven, Chapman Nora M, Drayson Mark T, Hartz Vernon L, Mason Jay W,
Abstract
BACKGROUND:
In this study, we measured immunoglobulin free light chains (FLC), a biomarker of inflammation in the sera of patients with heart failure due to myocarditis.
METHODS:
FLC kappa and FLC lambda were assayed in stored serum samples from patients with heart failure with myocarditis from the US myocarditis treatment trial by a competitive-inhibition multiplex Luminex® assay.
RESULTS:
The median concentration of circulating FLC kappa/lambda ratio was significantly lower in the sera from patients with heart failure with myocarditis than in healthy controls, and FLC kappa/lambda ratio had good diagnostic ability for identification of heart failure with myocarditis. Further, FLC kappa/lambda ratio was an independent prognostic factor for overall survival, and allowed creation of three prognostic groups by combining with N-terminal pro-B-type natriuretic peptide.
CONCLUSIONS:
This study suggests that FLC kappa/lambda ratio is a promising biomarker of heart failure with myocarditis.
Copyright © 2019. Published by Elsevier Inc.
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Atrial fibrillation in the elderly: A risk factor beyond stroke.
Ageing Res Rev2020 May;():101092. doi: S1568-1637(20)30227-0.
Bencivenga Leonardo, Komici Klara, Nocella Pierangela, Grieco Fabrizio Vincenzo, Spezzano Angela, Puzone Brunella, Cannavo Alessandro, Cittadini Antonio, Corbi Graziamaria, Ferrara Nicola, Rengo Giuseppe,
Abstract
Atrial fibrillation (AF) represents the most common arrhythmia worldwide, and its prevalence exponentially increases with age. It is related to increased risk of ischemic stroke or systemic embolism, which determines a significant burden of morbidity and mortality, as widely documented in the literature. AF also constitutes a risk factor for other less investigated conditions, such as heart failure, pulmonary embolism, impairment in physical performance, reduced quality of life and development of disability, mood disorders, and cognitive impairment up to dementia. In the elderly population, the management of AF and its complications is particularly complex due to the heterogeneity of the ageing process, the lack of specific evidence-based recommendations, as well as the high grade of comorbidity and disability characterizing the over 65 years aged people. In the present review, we aim to summarize the pieces of the most updated evidence on AF complications beyond stoke, mainly focusing on the elderly population.
Copyright © 2020. Published by Elsevier B.V.
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NSAIDs in CKD: Are They Safe?
Am J Kidney Dis2020 May;():. doi: S0272-6386(20)30724-1.
Baker Megan, Perazella Mark A,
Abstract
The management of pain in patients with chronic kidney disease (CKD) is challenging for many reasons. These patients have an increased susceptibility to adverse drug effects due to altered drug metabolism and excretion, and there are limited safety data for use in this population despite a high pain burden. Non-steroidal anti-inflammatory drugs (NSAIDs) have long been regarded as dangerous for use in chronic kidney disease patients because of their risk for nephrotoxicity, and thus alternative classes of analgesics, including opioids, have become more commonly used for pain control in this population. Given the well-established risks opioids and other analgesics pose, further characterization of the risk posed by NSAIDs in patients with CKD is warranted. NSAID use has been associated with acute kidney injury, progression of renal impairment in CKD, electrolyte derangements, and hypervolemia with worsening of heart failure and hypertension. The risk for these nephrotoxicity syndromes is modified by many comorbidities, risk factors, and characteristics of use, and in CKD patients the risk differs between levels of renal impairment. In this review, we offer recommendations for the cautious use of NSAIDs in the CKD population after careful consideration of these risk factors on an individualized basis.
Copyright © 2020. Published by Elsevier Inc.
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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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Clinical Impact of Valvular Heart Disease in Elderly Patients Admitted for Acute Coronary Syndrome: Insights From the Elderly-ACS 2 Study.
Can J Cardiol2019 Nov;():. doi: S0828-282X(19)31439-4.
Crimi Gabriele, Montalto Claudio, Ferri Luca Angelo, Piatti Luigi, Bossi Irene, Morici Nuccia, Mandurino-Mirizzi Alessandro, Grosseto Daniele, Tortorella Giovanni, Savonitto Stefano, De Servi Stefano, ,
Abstract
BACKGROUND:
Elderly patients are under-represented in clinical trials and registries, and a gap of evidence exists for clinical decision making in the setting of acute coronary syndromes (ACS). We aimed to assess the prevalence and independent prognostic impact of valvular heart disease (VHD) diagnosed during the index hospitalization on clinical outcomes among elderly patients with ACS. Included VHDs were moderate-to-severe mitral regurgitation (MR), moderate-to-severe aortic stenosis (AS), or both combined.
METHODS:
We explored the Elderly-ACS 2 dataset, which includes patients older than 74 years of age diagnosed with ACS and managed invasively. The primary endpoint was a composite of all-cause death, myocardial infarction, disabling stroke, and rehospitalization for heart failure at 1 year; the secondary endpoint was death for cardiovascular causes. Patients were stratified into 4 groups: no VHD, moderate-to-severe MR, moderate-to-severe AS, and both moderate-to-severe MR and AS.
RESULTS:
Of the 1443 subjects enrolled, 190 (13.2%) had moderate-to-severe MR, 26 (1.8%) had moderate-to-severe AS, and 13 (0.9%) had both moderate-to-severe MR and AS. When compared with those with no VHD, patients with moderate-to-severe MR had hazard ratios (HRs) for the primary endpoint of 2.04 (95% confidence interval [CI], 1.36-3.07], those with moderate-to-severe AS had HRs of 3.10 (95% CI, 1.39-6.93), and those with both moderate-to-severe MR and AS had HRs of 4.00 (95% CI, 1.65-9.73] (all P < 0.01). Patients with moderate-to-severe MR also had increased risks of cardiovascular death (HR 3.17; 95% CI, 1.57-6.42; P < 0.01), whereas in those with moderate-to-severe AS or both moderate-to-severe MR and AS, a nonsignificant increased risk was observed.
CONCLUSIONS:
In a contemporary cohort of elderly patients admitted for ACS, VHD was found in 1 of 5 subjects and had an independent, consistent impact on prognosis.
Copyright © 2019 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.
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Interstitial Fibrosis and Diastolic Dysfunction in Aortic Stenosis.
JACC Basic Transl Sci2020 May;5(5):481-483. doi: 10.1016/j.jacbts.2020.03.014.
Canty John M, Weil Brian R,
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Oxytocin: A New Therapeutic for Heart Failure?
JACC Basic Transl Sci -
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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Mitochondrial DNA Copy Number and Incident Heart Failure: The Atherosclerosis Risk in Communities (ARIC) Study.
Circulation2020 Jun;141(22):1823-1825. doi: 10.1161/CIRCULATIONAHA.120.046001.
Hong Yun Soo, Longchamps Ryan J, Zhao Di, Castellani Christina A, Loehr Laura R, Chang Patricia P, Matsushita Kunihiro, Grove Megan L, Boerwinkle Eric, Arking Dan E, Guallar Eliseo,
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Implications of Altered Ketone Metabolism and Therapeutic Ketosis in Heart Failure.
Circulation2020 Jun;141(22):1800-1812. doi: 10.1161/CIRCULATIONAHA.119.045033.
Selvaraj Senthil, Kelly Daniel P, Margulies Kenneth B,
Abstract
Despite existing therapy, patients with heart failure (HF) experience substantial morbidity and mortality, highlighting the urgent need to identify novel pathophysiological mechanisms and therapies, as well. Traditional models for pharmacological intervention have targeted neurohormonal axes and hemodynamic disturbances in HF. However, several studies have now highlighted the potential for ketone metabolic modulation as a promising treatment paradigm. During the pathophysiological progression of HF, the failing heart reduces fatty acid and glucose oxidation, with associated increases in ketone metabolism. Recent studies indicate that enhanced myocardial ketone use is adaptive in HF, and limited data demonstrate beneficial effects of exogenous ketone therapy in studies of animal models and humans with HF. This review will summarize current evidence supporting a salutary role for ketones in HF including (1) normal myocardial ketone use, (2) alterations in ketone metabolism in the failing heart, (3) effects of therapeutic ketosis in animals and humans with HF, and (4) the potential significance of ketosis associated with sodium-glucose cotransporter 2 inhibitors. Although a number of important questions remain regarding the use of therapeutic ketosis and mechanism of action in HF, current evidence suggests potential benefit, in particular, in HF with reduced ejection fraction, with theoretical rationale for its use in HF with preserved ejection fraction. Although it is early in its study and development, therapeutic ketosis across the spectrum of HF holds significant promise.
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The impact of COVID-19 on heart failure hospitalization and management: report from a Heart Failure Unit in London during the peak of the pandemic.
Eur J Heart Fail2020 Jun;():. doi: 10.1002/ejhf.1925.
Bromage Daniel I, Cannata Antonio, Rind Irfan A, Gregorio Caterina, Piper Susan, Shah Ajay M, McDonagh Theresa A,
Abstract
AIMS:
To examine the impact of COVID-19 on acute heart failure (AHF) hospitalization rates, clinical characteristics and management of patients admitted to a tertiary Heart Failure Unit in London during the peak of the pandemic.
METHODS AND RESULTS:
Data from King's College Hospital, London, reported to the National Heart Failure Audit for England and Wales, between 2nd March - 19 April 2020 were compared both to a pre-COVID cohort and the corresponding time periods in 2017-2019 with respect to absolute hospitalization rates. Furthermore, we performed detailed comparison of patients hospitalized during the COVID-19 pandemic and patients presenting in the same period in 2019 with respect to clinical characteristics and management during the index admission. A significantly lower admission rate for AHF was observed during the study period compared to all other included time periods. Patients admitted during the COVID-19 pandemic had higher rates of NYHA III or IV symptoms (96% vs. 77%, p=0.03) and severe peripheral oedema (39% vs. 14%, p=0.01). We did not observe any differences in inpatient management, including place of care and pharmacological management of heart failure with reduced ejection fraction (HFrEF) CONCLUSION: Incident AHF hospitalization significantly declined in our centre during the COVID-19 pandemic, but hospitalized patients had more severe symptoms at admission. Further studies are needed to investigate whether the incidence of AHF declined or patients did not present to hospital while the national lockdown and social distancing restrictions were in place. From a public health perspective, it is imperative to ascertain whether this will be associated with worse long-term outcomes. This article is protected by copyright. All rights reserved.
This article is protected by copyright. All rights reserved.
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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 .
This article is protected by copyright. All rights reserved.
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Association of Ischemic Stroke, Major Bleeding, and Other Adverse Events With Warfarin Use vs Non-vitamin K Antagonist Oral Anticoagulant Use in Patients With Atrial Fibrillation With a History of Intracranial Hemorrhage.
JAMA Netw Open2020 Jun;3(6):e206424. doi: 10.1001/jamanetworkopen.2020.6424.
Tsai Chuan-Tsai, Liao Jo-Nan, Chiang Chern-En, Lin Yenn-Jiang, Chang Shih-Lin, Lo Li-Wei, Hu Yu-Feng, Tuan Ta-Chuan, Chung Fa-Po, Chao Tze-Fan, Lip Gregory Y H, Chen Shih-Ann,
Abstract
Importance:
Current guidelines recommend the use of non-vitamin K antagonist oral anticoagulants (NOACs) for stroke prevention in patients with atrial fibrillation (AF). Data regarding warfarin sodium use compared with NOAC use in patients with AF with a history of intracranial hemorrhage (ICH) are limited.
Objective:
To compare the clinical outcomes of warfarin use and NOAC use in patients with AF with a history of ICH using a nationwide cohort with AF.
Design, Setting, and Participants:
A nationwide cohort study from January 1, 2012, to December 31, 2016, was performed using data from the Taiwan National Health Insurance Research Database. The dates of analysis were July 1 to September 1, 2019. The study population comprised patients with AF with a history of ICH and a CHA2DS2-VASc score (congestive heart failure, hypertension, age ?75 years [doubled], diabetes, prior stroke/transient ischemic attack/thromboembolism [doubled], vascular disease [prior myocardial infarction, peripheral artery disease], age 65-74 years, sex category [female]) of at least 1 for men or at least 2 for women who had received warfarin or NOACs. The clinical outcomes were examined using Cox proportional hazards regression analyses among the study population before and after propensity score matching.
Exposures:
Oral anticoagulation with warfarin or NOACs.
Main Outcomes and Measures:
The clinical outcomes measured were all-cause mortality, ischemic stroke, ICH, major bleeding, and adverse events.
Results:
The study cohort included 4540 patients (mean [SD] age, 76.0 [10.5] years; 2653 men [58.4%]), with 1047 patients receiving warfarin (mean [SD] age, 75.1 [11.4] years; 571 men [54.5%]) and 3493 patients receiving NOACs (mean [SD] age, 76.3 [10.2] years; 2082 men [59.6%]). Compared with warfarin use, NOAC use was associated with statistically significantly lower risk of all-cause mortality (adjusted hazard ratio [aHR], 0.517; 95% CI, 0.457-0.585), ICH (aHR, 0.556; 95% CI, 0.389-0.796), and major bleeding (aHR, 0.645; 95% CI, 0.525-0.793), whereas the rate of ischemic stroke was similar in the 2 groups (aHR, 0.879; 95% CI, 0.678-1.141). These results were generally consistent after propensity score matching among 973 patients in each group.
Conclusions and Relevance:
Among patients with AF with prior ICH, NOAC use was associated with lower rates of ICH and major bleeding compared with warfarin use, whereas the rate of ischemic stroke was similar in the 2 groups. Among patients with AF with prior ICH, NOACs could be the preferred choice for stroke prevention.
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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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Takotsubo syndrome without major stress mimicking myocarditis.
Anatol J Cardiol2020 Jun;23(6):349-350. doi: 10.14744/AnatolJCardiol.2020.45773.
Taghavi Sepideh, Chenaghlou Maryam, Mirtajaddini Marzieh, Naderi Nasim, Amin Ahmad,
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Perspectives by a position statement on atrial fibrillation in acute heart failure a: Mechanisms and therapeutic approaches.
Anatol J Cardiol2020 Jun;23(6):308-311. doi: 10.14744/AnatolJCardiol.2020.17064.
Okutucu Sercan, Görenek Bülent,
Abstract
The co-existence of atrial fibrillation (AF) and acute heart failure (AHF) is frequently reported and can exacerbate either or both of them. Their combination leads to increased morbidity and mortality. Although there has been a lack of studies on the prevalence and significance, as well as the treatment, of AF in patients with AHF, a position statement from the Acute Cardiovascular Care Association and European Heart Rhythm Association has recently reviewed the latest evidence on AF in the setting of AHF. The purpose of this paper is to briefly overview the crucial aspects of this consensus document.
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Myopathy secondary to empagliflozin therapy in type 2 diabetes.
Endocrinol Diabetes Metab Case Rep2020 Apr;2020():. doi: 10.1530/EDM-20-0017.
Gao Frank, Hall Stephen, Bach Leon A,
Abstract
Summary:
Sodium/glucose co-transporter 2 (SGLT2) inhibitors are novel oral hypoglycaemic agents that are increasingly used in the management of type 2 diabetes mellitus (T2DM). They are now recommended as second-line pharmacotherapy (in conjunction with metformin) in patients with type 2 diabetes and established atherosclerotic heart disease, heart failure or chronic kidney disease due to their favourable effects on cardiovascular and renal outcomes. We report a case of a 69-year-old man who developed muscle pain, weakness and wasting after commencing the SGLT2 inhibitor empagliflozin. This persisted for 1 year before he underwent resistance testing, which confirmed muscle weakness. His symptoms resolved within weeks of ceasing empagliflozin, with improvement in muscle strength on clinical assessment and resistance testing and reversal of MRI changes. No other cause of myopathy was identified clinically, on biochemical assessment or imaging, suggesting that empagliflozin was the cause of his myopathy.
Learning points:
Empagliflozin, a commonly used SGLT2 inhibitor, was associated with myopathy. A high degree of suspicion is required to diagnose drug-induced myopathy, with a temporal relationship between starting the medication and symptom onset being the main indicator. Recognition of drug-induced myopathy is essential, as discontinuation of the offending drug typically improves symptoms.
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