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Pubblicazioni recenti - cardiac failure
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Orthopaedic vs. Neurosurgery - Does a surgeon's specialty have an influence on 90-day complications following surgical intervention of spinal metastases?
Clin Neurol Neurosurg2020 Feb;192():105735. doi: S0303-8467(20)30078-0.
Malik Azeem Tariq, Baek Jae, Alexander John H, Khan Safdar N, Scharschmidt Thomas J,
Abstract
OBJECTIVES:
Spinal metastases are routinely managed and/or operated on by both orthopaedic surgeons and neurological surgeons. However, controversy still exists as to whether the operating surgeon's specialty has an impact on post-operative complication rates.
PATIENTS AND METHODS:
The 2007-2017 Humana Administrative Claims database was queried using Current Procedural Terminology codes to identify patients undergoing fusions, laminectomies or osteotomy/corpectomy for spinal metastases. Physician taxonomy codes were used to identify the operating surgeon's specialty (orthopaedic vs. neurosurgery). Multivariate logistic regression analyses were used to assess difference in 90-day complications, readmissions and mortality between the two specialties while controlling for age, gender, race, co-morbidity burden, procedural characteristics (fusion, laminectomy and/or osteotomy/corpectomy) and type of primary cancer.
RESULTS:
A total of 887 patients undergoing surgical intervention for spinal metastases were included - out of which 204 (23.0 %) patients were operated on by orthopaedic surgeons and 683 (77.0 %) by neurosurgeons. Following adjustment for difference in patient demographics and baseline clinical characteristics, no statistically significant differences were noted between the two specialties with regards to wound complications (p?=?0.992), pulmonary complications (p?=?0.461), cardiac complications (p?=?0.631), thrombotic complications (p?=?0.177), sepsis (p?=?0.463), pneumonia (p?=?0.767), urinary tract infection (p?=?0.916), acute renal failure (p?=?0.934), hardware complications (p?=?0.892), emergency department visits (p?=?0.934), 90-day readmissions (p?=?0.277) and 90-day mortality (p?=?0.786).
CONCLUSIONS:
Based off our findings, it appears that a surgeon's specialty has no influence on intermediate-term complications following surgical intervention for spinal metastases. The findings of the study should support the need for maintaining access of patients to both specialties for appropriate surgical consultation.
Copyright © 2020. Published by Elsevier B.V.
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Human In Vitro Models for Assessing the Genomic Basis of Chemotherapy-Induced Cardiovascular Toxicity.
J Cardiovasc Transl Res2020 Feb;():. doi: 10.1007/s12265-020-09962-x.
Pinheiro Emily A, Magdy Tarek, Burridge Paul W,
Abstract
Chemotherapy-induced cardiovascular toxicity (CICT) is a well-established risk for cancer survivors and causes diseases such as heart failure, arrhythmia, vascular dysfunction, and atherosclerosis. As our knowledge of the precise cardiovascular risks of each chemotherapy agent has improved, it has become clear that genomics is one of the most influential predictors of which patients will experience cardiovascular toxicity. Most recently, GWAS-led, top-down approaches have identified novel genetic variants and their related genes that are statistically related to CICT. Importantly, the advent of human-induced pluripotent stem cell (hiPSC) models provides a system to experimentally test the effect of these genomic findings in vitro, query the underlying mechanisms, and develop novel strategies to mitigate the cardiovascular toxicity liabilities due to these mechanisms. Here we review the cardiovascular toxicities of chemotherapy drugs, discuss how these can be modeled in vitro, and suggest how these models can be used to validate genetic variants that predispose patients to these effects.
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Decision regret in implantable cardioverter-defibrillator recipients : A cross-sectional analysis on patients that regret their decision after ICD implantation.
Herzschrittmacherther Elektrophysiol2020 Feb;():. doi: 10.1007/s00399-020-00675-x.
Varghese Swaroop, Geller J Christoph, Ohlow Marc-Alexander,
Abstract
BACKGROUND:
Implantable cardioverter-defibrillators (ICDs) are designed to deliver therapy in the event of malignant ventricular arrhythmias. Despite their benefits, some ICD recipients regret their decision on device implantation.
OBJECTIVES:
The aim of this study was to evaluate the incidence, predictors, and consequences of recipients that regretted their decision after implantation.
METHODS:
A questionnaire-based cross-sectional survey of consecutive ICD recipients examined during a routine outpatient follow-up visit was conducted. Their level of depression and anxiety was assessed with the hospital anxiety and depression scale (HADS). Quality of life (QOL) was assessed using the Minnesota living with heart failure questionnaire.
RESULTS:
Of 434 ICD recipients invited to the study, 423 (97.5%) agreed and completed the survey, 349 (83%) had a primary prevention indication, and 339 (80%) ischemic cardiomyopathy. A total of 41 recipients (9.7%) regretted their decision to undergo ICD implantation. These patients were: (1) younger (63 versus 69 years), (2) more frequently in New York Heart Association (NYHA) ?2 functional class (63% versus 22%), (3) had higher education levels (more than high-school: 76% versus 60%), (4) felt that preoperative information was lacking (22% versus 4%), (5) had more complications in the perioperative period (15% versus 3%), (6) felt less safe after ICD implantation (54% versus 5%), and (7) considered more frequently ICD deactivation during near end-of-life situations (54% versus 29%). Mean QOL and HADS scores were significantly worse in these patients (36 versus 30 and 12 versus 8.8 points, respectively; p?
CONCLUSION:
Almost 10% of ICD recipients regretted their decision after implantation. Predictors included younger age, higher education levels, complicated perioperative period, and lack of preoperative information.
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Effects of Myocardial Function and Systemic Circulation on Regional Coronary Perfusion.
J Appl Physiol (1985)2020 Feb;():. doi: 10.1152/japplphysiol.00450.2019.
Namani Ravi, Lee Lik Chuan, Lanir Yoram, Kaimovitz Benjamin, Shavik Sheikh Mohammad, Kassab Ghassan S,
Abstract
Cardiac-coronary interaction and the effects of its patho-physiological variations on spatial heterogeneity of coronary perfusion and myocardial work are still poorly understood. This hypothesis-generating study predicts spatial heterogeneities in both regional cardiac work and perfusion that offer a new paradigm on the vulnerability of the sub-endocardium to ischemia, particularly at the apex. We propose a mathematical and computational modeling framework to simulate the interaction of left ventricular mechanics, systemic circulation and coronary microcirculation. The computational simulations revealed that the relaxation rate of the myocardium has a significant affect whereas the contractility has a marginal effect on both the magnitude and transmural distribution of coronary perfusion. The ratio of sub-endocardial to sub-epicardial perfusion density () changed by -12 to +6% from a baseline value of 1.16 when myocardial contractility was varied respectively by +25 and -10%; changed by 37%, when sarcomere relaxation rate was faster, , increased by 10% from the baseline value. The model predicts axial differences in regional myocardial work and perfusion density across the wall thickness. Regional myofiber work done at the apex is 30-50% lower than at the center region, whereas perfusion density in the apex is lower by only 18% compared to the center. There are large axial differences in coronary flow and myocardial work at the sub-endocardial locations with the highest differences located at the apex region. A mismatch exists between perfusion density and regional work done at the sub-endocardium. This mismatch is speculated to be compensated by coronary autoregulation.
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Direct Modulation of RyR2 Leading to a TRICky Ca Balance: The Effects of TRIC-A on Cardiac Muscle.
Circ Res2020 Feb;126(4):436-438. doi: 10.1161/CIRCRESAHA.120.316532.
Gonano Luis A, Vila Petroff Martin,
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Targeting Age-Related Pathways in Heart Failure.
Circ Res2020 Feb;126(4):533-551. doi: 10.1161/CIRCRESAHA.119.315889.
Li Haobo, Hastings Margaret H, Rhee James, Trager Lena E, Roh Jason D, Rosenzweig Anthony,
Abstract
During aging, deterioration in cardiac structure and function leads to increased susceptibility to heart failure. The need for interventions to combat this age-related cardiac decline is becoming increasingly urgent as the elderly population continues to grow. Our understanding of cardiac aging, and aging in general, is limited. However, recent studies of age-related decline and its prevention through interventions like exercise have revealed novel pathological and cardioprotective pathways. In this review, we summarize recent findings concerning the molecular mechanisms of age-related heart failure and highlight exercise as a valuable experimental platform for the discovery of much-needed novel therapeutic targets in this chronic disease.
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Mitochondria Do Not Survive Calcium Overload During Transplantation.
Circ Res2020 Feb;():. doi: 10.1161/CIRCRESAHA.119.316291.
Bertero Edoardo, O'Rourke Brian, Maack Christoph,
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Is Cardioprotection Salvageable?
Circulation2020 Feb;141(6):415-417. doi: 10.1161/CIRCULATIONAHA.119.044176.
Heusch Gerd, Gersh Bernard J,
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Cost-Effectiveness of Tafamidis Therapy for Transthyretin Amyloid Cardiomyopathy.
Circulation2020 Feb;():. doi: 10.1161/CIRCULATIONAHA.119.045093.
Kazi Dhruv S, Bellows Brandon K, Baron Suzanne J, Shen Changyu, Cohen David J, Spertus John A, Yeh Robert W, Arnold Suzanne V, Sperry Brett W, Maurer Mathew S, Shah Sanjiv J,
Abstract
In patients with transthyretin amyloid cardiomyopathy (ATTR-CM), tafamidis reduces all-cause mortality and cardiovascular hospitalizations, and slows decline in quality-oflife compared with placebo. In May 2019, tafamidis received expedited approval from the US FDA as a breakthrough drug for a rare disease. However, at $225,000 per year, it is the most expensive cardiovascular drug ever launched in the US, and its long-term cost-effectiveness and budget impact are uncertain. We therefore sought to estimate the cost-effectiveness of tafamidis and its potential effect on US health care spending. We developed a Markov model of patients with wild-type or variant ATTR-CM and heart failure (mean age 74.5 years) using inputs from the Transthyretin Amyloidosis Cardiomyopathy Clinical Trial (ATTR-ACT), published literature, US Food and Drug Administration review documents, healthcare claims, and national survey data. We compared no disease-specific treatment ("usual care") with tafamidis therapy. The model reproduced 30-month survival, quality-of-life, and cardiovascular hospitalization rates observed in ATTR-ACT; future projections used a parametric survival model in the control arm, with constant hazards reduction in the tafamidis arm. We discounted future costs and quality-adjusted life years (QALYs) by 3% annually, and examined key parameter uncertainty using deterministic and probabilistic sensitivity analyses. The main outcomes were lifetime incremental costeffectiveness ratio (ICER) and annual budget impact, assessed from the US healthcare sector perspective. This study was independent of the ATTR-ACT trial sponsor. Compared with usual care, tafamidis was projected to add 1.29 (95% uncertainty interval, 0.47-1.75) QALYs at an incremental cost of $1,135,000 (872,000-1,377,000), resulting in an ICER of $880,000 (697,000-1,564,000) per QALY gained. Assuming a threshold of $100,000 per QALY gained and current drug price, tafamidis was cost-effective in 0% of 10,000 probabilistic simulations. A 92.6% price reduction from $225,000 to $16,563 would be necessary to make tafamidis cost-effective at $100,000/QALY. Results were sensitive to assumptions related to long-term effectiveness of tafamidis. Treating all eligible patients with ATTR-CM in the US with tafamidis (n = 120,000) was estimated to increase annual healthcare spending by $32.3 billion. Treatment with tafamidis is projected to produce substantial clinical benefit but would greatly exceed conventional cost-effectiveness thresholds at the current US list price. Based on recent US experience with high-cost cardiovascular medications, access to and uptake of this effective therapy may be limited unless there is a large reduction in drug costs.
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The Prognostic Significance of Quantitative Myocardial Perfusion: An Artificial Intelligence Based Approach Using Perfusion Mapping.
Circulation2020 Feb;():. doi: 10.1161/CIRCULATIONAHA.119.044666.
Knott Kristopher D, Seraphim Andreas, Augusto Joao B, Xue Hui, Chacko Liza, Aung Nay, Petersen Steffen E, Cooper Jackie A, Manisty Charlotte, Bhuva Anish N, Kotecha Tushar, Bourantas Christos V, Davies Rhodri H, Brown Louise A E, Plein Sven, Fontana Marianna, Kellman Peter, Moon James C,
Abstract
Myocardial perfusion reflects the macro- and microvascular coronary circulation. Recent quantitation developments using cardiovascular magnetic resonance (CMR) perfusion permit automated measurement clinically. We explored the prognostic significance of stress myocardial blood flow (MBF) and myocardial perfusion reserve (MPR, the ratio of stress to rest MBF). A two center study of patients with both suspected and known coronary artery disease referred clinically for perfusion assessment. Image analysis was performed automatically using a novel artificial intelligence approach deriving global and regional stress and rest MBF and MPR. Cox proportional hazard models adjusting for co-morbidities and CMR parameters sought associations of stress MBF and MPR with death and major adverse cardiovascular events (MACE), including myocardial infarction, stroke, heart failure hospitalization, late (>90 day) revascularization and death. 1049 patients were included with median follow-up 605 (interquartile range 464-814) days. There were 42 (4.0%) deaths and 188 MACE in 174 (16.6%) patients. Stress MBF and MPR were independently associated with both death and MACE. For each 1ml/g/min decrease in stress MBF the adjusted hazard ratio (HR) for death and MACE were 1.93 (95% CI 1.08-3.48, P=0.028) and 2.14 (95% CI 1.58-2.90, P<0.0001) respectively, even after adjusting for age and co-morbidity. For each 1 unit decrease in MPR the adjusted HR for death and MACE were 2.45 (95% CI 1.42-4.24, P=0.001) and 1.74 (95% CI 1.36-2.22, P<0.0001) respectively. In patients without regional perfusion defects on clinical read and no known macrovascular coronary artery disease (n=783), MPR remained independently associated with death and MACE, with stress MBF remaining associated with MACE only. In patients with known or suspected coronary artery disease, reduced MBF and MPR measured automatically inline using artificial intelligence quantification of CMR perfusion mapping provides a strong, independent predictor of adverse cardiovascular outcomes.
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ICD-Cybersecurity.
Circ Arrhythm Electrophysiol2020 Feb;():. doi: 10.1161/CIRCEP.119.008261.
Alexander Bryce, Neira Victor, Campbell Debra, Crystal Eugene, Simpson Chris, Enriquez Andres, Chacko Sanoj, Abdollah Hoshiar, Redfearn Damian, Baranchuk Adrian,
Abstract
Medical device cybersecurity has gained increasing attention in recent years. While many devices have been targeted, security vulnerabilities in cardiac implantable electronic devices (CIEDs) are of particular concern as implantation of these devices is invasive and patients can be reliant upon these devices for life-sustaining therapy. The first major incident with CIEDs that received wide-spread attention occurred in 2016, when Muddy Waters LLC, in conjunction with vulnerability research firm MedSec, issued a report identifying potential cybersecurity concerns in several models of St. Jude Medical's (now Abbott) pacemakers following demonstration of a "crash attack" and a "battery drain attack". Replication of these attacks under experimental conditions failed to produce any clinical harm. The publication of this report prompted Abbott, in conjunction with the United States Food and Drug Administration (FDA), to release a firmware upgrade with enhanced cybersecurity features. As part of this release, Abbott published estimated rates of complications extrapolated from similar circumstances, which included complete loss of device function, loss of programmed device settings, and failure of the update, among others. As there had been no instances of patient harm and a small but non-negligible risk involved in the firmware upgrade, clinicians were asked to utilize a shared decision-making model when deciding whether to pursue the upgrade and to take individual factors such as pacemaker dependence and age of the device into account. Since that time, additional data have been collected on complications rates and patient attitudes toward the upgrade. Saxon et al. analyzed a population of 10,854 patients who were offered the firmware upgrade in the United States. Of those, only 25% elected to proceed once the risks and benefits were explained.
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Initial Precipitants and Recurrence of Atrial Fibrillation.
Circ Arrhythm Electrophysiol2020 Feb;():. doi: 10.1161/CIRCEP.119.007716.
Wang Elizabeth Y, Hulme Olivia L, Khurshid Shaan, Weng Lu-Chen, Choi Seung Hoan, Walkey Allan J, Ashburner Jeffrey M, McManus David D, Singer Daniel E, Atlas Steven J, Benjamin Emelia J, Ellinor Patrick T, Trinquart Ludovic, Lubitz Steven A,
Abstract
- Atrial fibrillation (AF) may occur after an acute precipitant and subsequently resolve. Management guidelines for AF in these settings are unclear, since the risk of recurrent AF and related morbidity is poorly understood. We examined the relations between acute precipitants of AF and long-term recurrence of AF in a clinical setting. - From a multi-institutional longitudinal electronic medical record database, we identified patients with newly diagnosed AF between 2000-14. We developed algorithms to identify acute AF precipitants (surgery, sepsis, pneumonia, pneumothorax, respiratory failure, myocardial infarction, thyrotoxicosis, alcohol, pericarditis, pulmonary embolism, and myocarditis). We assessed risks of AF recurrence in individuals with and without a precipitant and the relations between AF recurrence and heart failure, stroke, and mortality. - Among 10,723 patients with newly diagnosed AF (67.9 ± 9.9 years, 41% women), 19% had an acute AF precipitant, the most common of which were cardiac surgery (22%), pneumonia (20%), and non-cardiothoracic surgery (15%). The cumulative incidence of AF recurrence at 5 years was 41% among individuals with a precipitant compared to 52% in those without a precipitant (adjusted hazard ratio [HR]: 0.75, 95% confidence interval [CI]: 0.69-0.81, p<0.001). The lowest risk of recurrence among those with precipitants was postoperative AF (5-year incidence 32% in cardiac surgery and 39% in non-cardiothoracic surgery). Regardless of the presence of an initial precipitant, recurrent AF was associated with increased adjusted risks of heart failure (HR: 2.74, 95% CI: 2.39-3.15, p<0.001), stroke (HR: 1.57, 95% CI: 1.30-1.90, p<0.001) and mortality (HR: 2.96, 95% CI: 2.70-3.24, p<0.001). - AF after an acute precipitant frequently recurs, although the risk of recurrence is lower than among individuals without an acute precipitant. Recurrence is associated with substantial long-term morbidity and mortality. Future studies should address surveillance and management after newly diagnosed AF in the setting of an acute precipitant.
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Angiocrine FSTL1 (Follistatin-Like Protein 1) Insufficiency Leads to Atrial and Venous Wall Fibrosis via SMAD3 Activation.
Arterioscler Thromb Vasc Biol2020 Feb;():ATVBAHA119313901. doi: 10.1161/ATVBAHA.119.313901.
Jiang Haijuan, Zhang Luqing, Liu Xuelian, Sun Wei, Kato Katsuhiro, Chen Chuankai, Li Xiao, Li Taotao, Sun Zhiliang, Han Wencan, Zhang Fujing, Xiao Qi, Yang Zhongzhou, Hu Junhao, Qin Zhihai, Adams Ralf H, Gao Xiang, He Yulong,
Abstract
OBJECTIVE:
Angiocrine factors, mediating the endothelial-mural cell interaction in vascular wall construction as well as maintenance, are incompletely characterized. This study aims to investigate the role of endothelial cell-derived FSTL1 (follistatin-like protein 1) in vascular homeostasis. Approach and Results: Using conditional knockout mouse models, we show that loss of FSTL1 in endothelial cells () led to an increase of pulmonary vascular resistance, resulting in the heart regurgitation especially with tricuspid valves. However, this abnormality was not detected in mutant mice with deletion in smooth muscle cells or hematopoietic cells. We further showed that there was excessive ?SMA (?-smooth muscle actin) associated with atrial endocardia, heart valves, veins, and microvessels after the endothelial FSTL1 deletion. There was also an increase in collagen deposition, as demonstrated in livers of mutants. The SMAD3 phosphorylation was significantly enhanced, and pSMAD3 staining was colocalized with ?SMA in vein walls, suggesting the activation of TGF? (transforming growth factor ?) signaling in vascular mural cells of mice. Consistently, treatment with a TGF? pathway inhibitor reduced the abnormal association of ?SMA with the atria and blood vessels in mutant mice.
CONCLUSIONS:
The findings imply that endothelial FSTL1 is critical for the homeostasis of vascular walls, and its insufficiency may favor cardiovascular fibrosis leading to heart failure.
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Association between potassium level and outcomes in heart failure with reduced ejection fraction: a cohort study from the Swedish Heart Failure Registry.
Eur J Heart Fail2020 Feb;():. doi: 10.1002/ejhf.1757.
Cooper Lauren B, Benson Lina, Mentz Robert J, Savarese Gianluigi, DeVore Adam D, Carrero Juan-Jesus, Dahlström Ulf, Anker Stefan D, Lainscak Mitja, Hernandez Adrian F, Pitt Bertram, Lund Lars H,
Abstract
AIMS:
Hyperkalaemia and hypokalaemia are common in heart failure and associated with worse outcomes. However, the optimal potassium range is unknown. We sought to determine the optimal range of potassium in patients with heart failure and reduced ejection fraction (
METHODS AND RESULTS:
We assessed the association between baseline potassium level and all-cause mortality at 30?days, 12 months, and maximal follow-up, in uni- and multivariable stratified and restricted cubic spline Cox regressions. Of 13?015 patients, 93.3% had potassium 3.5-5.0?mmol/L, 3.7% had potassium <3.5?mmol/L, and 3.0% had potassium >5.0?mmol/L. Potassium <3.5?mmol/L and >5.0?mmol/L were more common with lower estimated glomerular filtration rate and heart failure of longer duration and greater severity. The potassium level associated with the lowest hazard risk for mortality at 30?days, 12 months, and maximal follow-up was 4.2?mmol/L, and there was a steep increase in risk with both higher and lower potassium levels. In adjusted strata analyses, lower potassium was independently associated with all-cause mortality at 12 months and maximal follow-up, while higher potassium levels only increased risk at 30?days.
CONCLUSION:
In this nationwide registry, the relationship between potassium and mortality was U-shaped, with an optimal potassium value of 4.2?mmol/L. After multivariable adjustment, hypokalaemia was associated with increased long-term mortality but hyperkalaemia was associated with increased short-term mortality.
© 2020 The Authors. European Journal of Heart Failure © 2020 European Society of Cardiology.
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Trends of antihypertensive agents in patients with hypertension and coronary artery disease in a tertiary hospital of China.
Int J Clin Pharm2020 Feb;():. doi: 10.1007/s11096-020-00986-6.
Zheng Yingming, Li Dandan, Zeng Na, Guo Heng, Li Hongwei, Shen Su,
Abstract
Background Except for hypertension control, antihypertensive agents play an essential role in the secondary prevention of coronary artery disease. Objective This study aimed to describe the use of antihypertensive agents in patients with hypertension and coronary artery disease by assessing the compliance to the updated European and Chinese hypertension guidelines through analyzing the frequencies, monthly trends and the influencing factors of antihypertensive agents. Setting Beijing Friendship Hospital, Capital Medical University, a 2000-bed tertiary Chinese university teaching hospital. Method Prescriptions of patients diagnosed with hypertension and coronary artery disease were extracted from medical records of this tertiary hospital from 2013 to 2016. Frequencies, trends, co-existing prescription patterns of five classes of antihypertensive agents were analyzed. Influencing factors of prescription patterns were evaluated by logistic regression. Main outcome measure The frequencies and monthly trends of different antihypertensive agents within four years. Result In total, 286,155 prescriptions met the inclusion criteria. ?-blockers (64,0%) were the most widely used antihypertensive agents, followed by calcium channel blockers (53.57%), angiotensin receptor blockers (42.6%), angiotensin-converting-enzyme inhibitors (23.7%) and diuretics (16.4%). During the 4 years, frequencies of ?-blockers, angiotensin receptor blockers, calcium channel blockers and diuretics increased over time, while that of angiotensin-converting-enzyme inhibitors declined. Multivariate logistic regression indicated that gender, age and comorbidities including stroke, diabetes, heart failure and arrhythmia could affect antihypertensive selections to varying degrees. Conclusion The compliance to guidelines is overall well for patients with hypertension and coronary artery disease, but improvements is needed for patients with type 2 diabetes. Multi-center studies with large-scale data are required to further assess the usage of antihypertensive agents in patients.
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Intracoronary compared with intravenous bolus tirofiban on the microvascular obstruction in patients with STEMI undergoing PCI: a cardiac MR study.
Int J Cardiovasc Imaging2020 Feb;():. doi: 10.1007/s10554-020-01800-0.
Ma Quanmei, Ma Yue, Wang Xiaonan, Li Shanshan, Yu Tongtong, Duan Weili, Wu Jiake, Wen Zongyu, Jiao Yundi, Sun Zhaoqing, Hou Yang,
Abstract
To investigate the potential effect of intracoronary administration of the glycoprotein IIb/IIIa inhibitor tirofiban on the microvascular obstruction (MVO) assessed by cardiac magnetic resonance (CMR) imaging compared to the intravenous route in patients with ST-segment-elevation myocardial infarction undergoing primary percutaneous coronary intervention (PCI). Two hundred eight patients were randomized into two groups (tirofiban i.v. and tirofiban i.c.). CMR was completed within 3-7 days after ST-segment-elevation myocardial infarction. One hundred thirty-two patients had a follow-up CMR at 6 months after discharge. The primary end point was the CMR measurements including myocardium strain, myocardial perfusion index, final infarct size, prevalence and extent of MVO, and the change of left ventricular end-diastolic volume (LVEDV) at six months follow-up. The second endpoint was major adverse cardiovascular events (composite of all-cause death, nonfatal reinfarction and congestive heart failure) in one year. The MVO prevalence and extent [56% versus 36%, p?=?0.004; 2.08 (IQR: 1.18-5.07) g versus 1.68 (IQR: 0.30-3.28) g, p?=?0.041] showed a significant difference between the intravenous and intracoronary groups. Global left ventricular peak longitudinal strain was significantly different in intracoronary groups compared to intravenous groups, -?12.5 [IQR:?-?13.4 to -?10.9] versus -?12.3 [IQR:?-?13.4 to?-?10.4], respectively (P?=?0.042). Infarcted myocardial perfusion index was significantly different in intracoronary groups compared to intravenous groups, 0.11 [IQR:?0.08 to 0.15] versus 0.09 [IQR:?0.07 to 0.14], respectively (P?=?0.026). Intracoronary tirofiban was associated with a higher change in LVEDV compared with intravenous group (-?10.2% [IQR:?-?13.7% to?-?2.6%] versus 1.3% [IQR:?-?5.6% to 6.1%], p?
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Atrial fibrillation and successful transcatheter mitral valve repair using MitraClip.
Int J Cardiovasc Imaging2020 Feb;():. doi: 10.1007/s10554-020-01782-z.
Imamura Teruhiko,
Abstract
Ledwoch and colleagues demonstrated in their article entitled "Impact of transcatheter mitral valve repair using MitraClip on right ventricular remodeling" that right ventricular function improved in most of the patients following MitraClip implantation whereas 20% of them experienced worsening of right ventricular function which associated with worse prognosis, despite the latter cohort achieved comparable improvement in the mitral regurgitation. Given most of the latter cohort had atrial fibrillation, aggressive catheter ablation to improve atrial fibrillation before or after MitraClip implantation might reverse left atrial function as well as improving biventricular function and long-term prognosis.
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[Novel cancer treatment and the cardiovascular risk : What should cardiologists know?]
Herz2020 Feb;():. doi: 10.1007/s00059-020-04902-6.
Totzeck Matthias, Rassaf Tienush,
Abstract
Cardiotoxic side effects can significantly limit the quality of life and survival of tumor patients under treatment. Acute and chronic effects include hypertension, venous and arterial thromboembolic events, acute and chronic coronary syndromes, heart failure and arrhythmias. Patients with previous cardiovascular diseases are often more frequently affected by side effects. The triggers are not only irradiation and conventional chemotherapy but increasingly also newer forms of cancer treatment. These include targeted therapy and immune checkpoint inhibitors (ICI). The goals of oncological cardiology are the prevention, timely diagnosis and treatment of these side effects in order to optimize patient outcomes.
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High-sensitivity cardiac troponin assays for cardiovascular risk stratification in the general population.
Eur Heart J2020 Feb;():. doi: ehaa083.
Farmakis Dimitrios, Mueller Christian, Apple Fred S,
Abstract
Cardiac troponins (cTns) I and T have long been the most successful cardiac-specific circulating biomarkers in cardiovascular (CV) medicine, having changed dramatically the diagnosis of acute myocardial infarction, while being independent predictors of outcome in several cardiac conditions and non-cardiac conditions. The latest-generation high-sensitivity (hs) cTn assays demonstrate both enhanced diagnostic performance and improved analytical performance, with the ability to measure detectable concentrations in a substantial proportion of the asymptomatic and presumably healthy populations. Given this unique analytical feature, recent evidence suggests that hs-cTn can be used for the stratification of CV risk in the general population. High-sensitivity cTn predicts future CV events, are responsive to preventive pharmacological or lifestyle interventions, change in parallel to risk modifications, and offer incremental risk prediction when added to well-established prognosticators. The implementation of CV risk stratification and prevention strategies incorporating hs-cTn requires further investigation to define the optimal target populations, timing of measurement, and preventive interventions.
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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Incident heart failure risk after bariatric surgery: the role of epicardial fat.
Eur Heart J2020 Feb;():. doi: ehaa072.
van Woerden Gijs, van Veldhuisen Sophie L, Rienstra Michiel,
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