DONA ORA
Pubblicazioni recenti - cardiac failure
-
Trials and Tribulations: mHealth Clinical Trials in the COVID-19 Pandemic.
Yearb Med Inform2021 Apr;():. doi: 10.1055/s-0041-1726487.
Indraratna Praveen, Biswas Uzzal, Yu Jennifer, Schreier Guenter, Ooi Sze-Yuan, Lovell Nigel H, Redmond Stephen J,
Abstract
INTRODUCTION:
Mobile phone-based interventions in cardiovascular disease are growing in popularity. A randomised control trial (RCT) for a novel smartphone app-based model of care, named TeleClinical Care - Cardiac (TCC-Cardiac), commenced in February 2019, targeted at patients being discharged after care for an acute coronary syndrome or episode of decompensated heart failure. The app was paired to a digital sphygmomanometer, weighing scale and a wearable fitness band, all loaned to the patient, and allowed clinicians to respond to abnormal readings. The onset of the COVID-19 pandemic necessitated several modifications to the trial in order to protect participants from potential exposure to infection. The use of TCC-Cardiac during the pandemic inspired the development of a similar model of care (TCC-COVID), targeted at patients being managed at home with a diagnosis of COVID-19.
METHODS:
Recruitment for the TCC-Cardiac trial was terminated shortly after the World Health Organization announced COVID-19 as a global pandemic. Telephone follow-up was commenced, in order to protect patients from unnecessary exposure to hospital staff and patients. Equipment was returned or collected by a 'no-contact' method. The TCC-COVID app and model of care had similar functionality to the original TCC-Cardiac app. Participants were enrolled exclusively by remote methods. Oxygen saturation and pulse rate were measured by a pulse oximeter, and symptomatology measured by questionnaire. Measurement results were manually entered into the app and transmitted to an online server for medical staff to review.
RESULTS:
A total of 164 patients were involved in the TCC-Cardiac trial, with 102 patients involved after the onset of the pandemic. There were no hospitalisations due to COVID-19 in this cohort. The study was successfully completed, with only three participants lost to follow-up. During the pandemic, 5 of 49 (10%) of patients in the intervention arm were readmitted compared to 12 of 53 (23%) in the control arm. Also, in this period, 28 of 29 (97%) of all clinically significant alerts received by the monitoring team were managed successfully in the outpatient setting, avoiding hospitalisation. Patients found the user experience largely positive, with the average rating for the app being 4.56 out of 5. 26 patients have currently been enrolled for TCC-COVID. Recruitment is ongoing. All patients have been safely and effectively monitored, with no major adverse clinical events or technical malfunctions. Patient satisfaction has been high.
CONCLUSION:
The TCC-Cardiac RCT was successfully completed despite the challenges posed by COVID-19. Use of the app had an added benefit during the pandemic as participants could be monitored safely from home. The model of care inspired the development of an app with similar functionality designed for use with patients diagnosed with COVID-19.
IMIA and Thieme. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).
Guarda su PubMed
-
[New aspects in Fournier's gangrene - a rapid review].
Aktuelle Urol2021 Apr;():. doi: 10.1055/a-1472-5553.
Kranz Jennifer, Dräger Desiree L, Schneidewind Laila,
Abstract
Fournier's gangrene (FG) is a sporadic, life-threatening, necrotising infection affecting the perineum, perineal region and genitals. Published literature provides hints that the outcome of this disease has failed to improve in recent years. We have therefore performed a rapid evidence synthesis by searching the database MEDLINE. The literature from 2020 was studied to identify new aspects to improve the care of FG patients and plan further therapeutic research. 18 publications were chosen for this review, 15 of these were original research and three systematic reviews. 12 were retrospective case series, 2 epidemiological studies, with one prospective clinical study, one systematic review and 2 systematic reviews, together with a meta-analysis. Most of the authors of the studies concluded that FG is still a severe disease with unacceptable mortality rates, so that there is urgent need for therapy improvement. New risk factors for higher mortality in FG have been identified in these studies, namely dyslipoproteinemia, diabetes mellitus, heart disease, as well as both acute and chronic kidney failure. Furthermore, 4 of the included studies investigated the association of SGLT2- and DDP4-inhibitors, which are drugs used in diabetes mellitus, and the incidence of FG. No studies reported a significant association between these drugs and FG, especially not a meta-analysis with 84 included studies. New promising concepts for wound conditioning are hyperbaric oxygenation (HBO), vacuum-assisted wound closure (VAC) and Maggot therapy (blowfly larvae). In summary, FG is still a severe disease, the prognosis has not improved in recent years and so there is an urgent need for improved therapy. This could only be achieved with further research in FG. In our opinion and due to the rarity of FG, this would be possible with a national registry study. For example, it might be possible to calculate risk stratification from this registry to identify patients who would benefit from treatment in a centre or with special wound conditioning.
Thieme. All rights reserved.
Guarda su PubMed
-
Emerging causes and risk factors of heart failure: amyloidosis, myocarditis, immune checkpoint inhibitors, air pollution, and visceral adipose tissue.
Eur Heart J -
Telemedicine for adult congenital heart disease patients during the first wave of COVID-19 era: a single center experience.
J Cardiovasc Med (Hagerstown)2021 Apr;():. doi: 10.2459/JCM.0000000000001195.
Grandinetti Maria, Di Molfetta Arianna, Graziani Francesca, Delogu Angelica Bibiana, Lillo Rosa, Perri Gianluigi, Pavone Natalia, Bruno Piergiorgio, Aspromonte Nadia, Amodeo Antonio, Crea Filippo, Massetti Massimo,
Abstract
AIM:
To summarize our experience on the implementation of a telemedicine service dedicated to adult congenital heart disease (ACHD) patients during the lockdown for the first wave of COVID-19.
METHODS:
This is a prospective study enrolling all ACHD patients who answered a questionnaire dedicated telematic cardiovascular examination.
RESULTS:
A total of 289 patients were enrolled, 133 (47%) were male, 25 (9%) were affected by a genetic syndrome. The median age was 38 (29-51) years, whereas the median time interval between the last visit and the telematic follow-up was 9.5 (7.5-11.5) months. Overall, 35 patients (12%) reported a worsening of fatigue in daily life activity, 17 (6%) experienced chest pain, 42 (15%) had presyncope and 2 (1%) syncope; in addition, 28 patients (10%) presented peripheral edema and 14 (5%) were orthopneic. A total of 116 (40%) patients reported palpitations and 12 had at least one episode of atrial fibrillation and underwent successful electrical (8) or pharmacological (4) cardioversion. One patient was admitted to the emergency department for uncontrolled arterial hypertension, five for chest pain, and one for heart failure. Two patients presented fever but both had negative COVID-19 nasal swab.
CONCLUSION:
During the COVID-19 pandemic, the use of telemedicine dramatically increased and here we report a positive experience in ACHD patients. The postpandemic role of telemedicine will depend on permanent regulatory solutions and this early study might encourage a more systematic telematic approach for ACHD patients.
Copyright © 2021 Italian Federation of Cardiology. All rights reserved.
Guarda su PubMed
-
Congestive Heart Failure-associated Chronic Diffuse Alveolar Hemorrhage.
Am J Respir Crit Care Med2021 Apr;():. doi: 10.1164/rccm.202008-3149IM.
Okazaki Akihito, Takeda Yoshihiro, Kiyama Masaru, Okeie Kazuyasu, Shibata Kazuhiko,
Guarda su PubMed
-
Symptoms of anxiety after heart transplantation and their association with mortality: a secondary analysis.
Clin Transplant2021 Apr;():e14323. doi: 10.1111/ctr.14323.
Bürker Britta S, Malt Ulrik F, Gude Einar, Grov Ingelin, Authen Anne Relbo, Dew Mary Amanda, Gullestad Lars,
Abstract
BACKGROUND:
Few studies, with inconclusive results, have examined the association of anxiety with mortality after heart transplantation (HTx). We examined whether anxiety symptoms, measured several years after HTx, are associated with increased mortality during long-term follow-up.
METHODS:
Anxiety symptoms were measured with the anxiety subscale of the Symptom Checklist-90-R (SCL-90-R) in 142 HTx recipients at a mean of 5.7 years (SD: 3.9) after HTx. Anxiety symptoms' impact on mortality during follow-up for up to 18.6 years was examined with Cox proportional hazard models. We accounted for relevant sociodemographic and clinical variables, including depressive symptoms (measured by the depression subscale of the SCL-90-R), in the multivariate analyses. In additional analyses, we explored the combined effect of anxious and depressive symptomatology.
RESULTS:
Anxiety symptoms were not significantly associated with mortality (univariate analysis: HR (95% CI): 1.04 (.75-1.45); p=.813). Exploration of the combined effect of anxious and depressive symptomatology on mortality rendered non-significant results. Depressive symptoms were independently associated with mortality (multivariate analysis: HR (95% CI): 1.86 (1.07-3.24); p=.028).
CONCLUSIONS:
Depressive symptoms' negative impact on survival after HTx was confirmed, while anxiety symptoms were not significantly associated with mortality during long-term follow-up. Anxiety symptoms' predictive role after HTx requires further study.
This article is protected by copyright. All rights reserved.
Guarda su PubMed
-
Six-month Risk of Pneumocystis Pneumonia following Acute Cellular Rejection: A case-control Study in Solid Organ Transplant Recipients.
Clin Transplant2021 Apr;():e14322. doi: 10.1111/ctr.14322.
Hosseini-Moghaddam Seyed M, Shokoohi Mostafa, Singh Gagandeep, Nagpal Atul D, Jevnikar Anthony M,
Abstract
BACKGROUND:
Solid organ transplant (SOT) recipients are at risk of Pneumocystis pneumonia (PCP). PCP is associated with significant morbidity and mortality. The effect of acute T cell-mediated rejection (TCMR) on post-transplant PCP has not been determined yet.
METHODS:
In this case-control study, we estimated the risk of PCP following acute TCMR during a lookback period of 180 days. We also determined the effects of contributing factors such as CMV infection.
RESULTS:
We compared 15 SOT (8 kidney, 4 heart, 2 liver and 1 kidney-pancreas) recipients with PCP with 60 matched recipients who did not develop PCP (control group) during the study period (December 2013 to February 2016). PCP occurred after a complete course of prophylaxis (i.e., late-onset PCP) in 60% of patients. Patients with PCP frequently required intensive care unit (ICU) admission (73.3%). Post-transplant PCP was associated with considerable allograft loss (53.4%) and mortality (26.7%). In the 6-month lookback period, acute TCMR (OR: 13.1, 95% CI: 3.2, 53.2) and CMV infection (OR:15.1,95% CI:4.0, 53.2.1) were significantly associated with post-transplant PCP.
CONCLUSIONS:
Post-transplant PCP is associated with substantial risk of ICU admission, allograft failure and mortality. Anti-Pneumocystis prophylaxis for at least 6 months following acute TCMR may reduce the risk.
This article is protected by copyright. All rights reserved.
Guarda su PubMed
-
Identification, localization and expression of NHE isoforms in the alveolar epithelial cells.
PLoS One2021 ;16(4):e0239240. doi: 10.1371/journal.pone.0239240.
Kinaneh Safa, Knany Yara, Khoury Emad E, Ismael-Badarneh Reem, Hamoud Shadi, Berger Gidon, Abassi Zaid, Azzam Zaher S,
Abstract
Na+/H+ exchangers (NHEs), encoded by Solute Carrier 9A (SLC9A) genes in human, are ubiquitous integral membrane ion transporters that mediate the electroneutral exchange of H+ with Na+ or K+. NHEs, found in the kidney and intestine, play a major role in the process of fluid reabsorption together via Na+,K+-ATPase pump and Na+ channels. Nevertheless, the expression pattern of NHE in the lung and its role in alveolar fluid homeostasis has not been addressed. Therefore, we aimed to examine the expression of NHE specific isoforms in alveolar epithelial cells (AECs), and assess their role in congestive heart failure (CHF). Three NHE isoforms were identified in AEC and A549 cell line, at the level of protein and mRNA; NHE1, NHE2 and mainly NHE8, the latter was shown to be localized in the apical membrane of AEC. Treating A549 cells with angiotensin (Ang) II for 3, 5 and 24 hours displayed a significant reduction in NHE8 protein abundance. Moreover, the abundance of NHE8 protein was downregulated in A549 cells that were treated overnight with Ang II. NHE8 abundance in whole lung lysate was increased in rats with 1-week CHF compared to sham operated rats. However, lower abundance of NHE8 was observed in 4-week CHF group. In conclusion, we herein show for the first time, the expression of a novel NHE isoform in AEC, namely NHE8. Notably, Ang II decreased NHE8 protein levels. Moreover, NHE8 was distinctly affected in CHF rats, probably depending on the severity of the heart failure.
Guarda su PubMed
-
Distinct Types of Plexiform Lesions Identified by Synchrotron-Based Phase Contrast Micro-CT.
Am J Physiol Lung Cell Mol Physiol2021 Apr;():. doi: 10.1152/ajplung.00432.2020.
Westöö Christian, Norvik Christian Carl, Peruzzi Niccolň, van der Have Oscar, Lovric Goran, Jeremiasen Ida, Tran Phan-Kiet, Mokso Rajmund, de Jesus Perez Vinicio A, Brunnström Hans, Bech Martin, Galambos Csaba, Tran-Lundmark Karin,
Abstract
In pulmonary arterial hypertension, plexiform lesions are associated with severe arterial obstruction and right ventricular failure. Exploring their structure and position is crucial for understanding the interplay between hemodynamics and vascular remodeling. The aim of this research was to use synchrotron-based phase contrast micro-CT to study the three-dimensional structure of plexiform lesions. Archived paraffin-embedded tissue-samples from 14 patients with pulmonary arterial hypertension (13 idiopathic, 1 with known BMPR2-mutation) were imaged. Clinical data showed high median PVR (12,5 WU) and mPAP (68 mmHg). Vascular lesions with more than one lumen were defined as plexiform. Prior radiopaque dye injection in some samples facilitated 3D-rendering. Four distinct types of plexiform lesions were identified: (1) localized within or derived from monopodial branches (supernumerary arteries), often with connection to the vasa vasorum; (2) localized between pulmonary arteries and larger airways as a tortuous transformation of intrapulmonary bronchopulmonary anastomoses; (3) as spherical structures at unexpected abrupt ends of distal pulmonary arteries; and (4) as occluded pulmonary arteries with re-canalization. By appearance and localization, types 1-2 potentially relieve pressure via the bronchial circulation, as pulmonary arteries in these patients were almost invariably occluded distally. In addition, types 1-3 were often surrounded by dilated thin-walled vessels, often connected to pulmonary veins, peri-bronchial vessels or the vasa vasorum. Collaterals, by-passing completely occluded pulmonary arteries, were also observed to originate within plexiform lesions. In conclusion, synchrotron-based imaging revealed significant plexiform lesion heterogeneity, resulting in a novel classification. The four types likely have different effects on hemodynamics and disease progression.
Guarda su PubMed
-
Human cardiac fibroblasts produce pro-inflammatory cytokines upon TLRs and RLRs stimulation.
Mol Cell Biochem2021 Apr;():. doi: 10.1007/s11010-021-04157-7.
Li Zhe, Nguyen Tuan T, Valaperti Alan,
Abstract
Heart inflammation is one of the major causes of heart damage that leads to dilated cardiomyopathy and often progresses to end-stage heart failure. In the present study, we aimed to assess whether human cardiac cells could release immune mediators upon stimulation of Toll-like receptors (TLRs) and Retinoic acid-inducible gene (RIG)-I-like receptors (RLRs).Commercially available human cardiac fibroblasts and an immortalized human cardiomyocyte cell line were stimulated in vitro with TLR2, TLR3, and TLR4 agonists. In addition, cytosolic RLRs were activated in cardiac cells after transfection of polyinosinic-polycytidylic acid (PolyIC). Upon stimulation of TLR3, TLR4, MDA5, and RIG-I, but not upon stimulation of TLR2, human cardiac fibroblasts produced high amounts of the pro-inflammatory cytokines IL-6 and IL-8. On the contrary, the immortalized human cardiomyocyte cell line was unresponsive to the tested TLRs agonists. Upon RLRs stimulation, cardiac fibroblasts, and to a lesser extent the cardiomyocyte cell line, induced anti-viral IFN-? expression.These data demonstrate that human cardiac fibroblasts and an immortalized human cardiomyocyte cell line differently respond to various TLRs and RLRs ligands. In particular, human cardiac fibroblasts were able to induce pro-inflammatory and anti-viral cytokines on their own. These aspects will contribute to better understand the immunological function of the different cell populations that make up the cardiac tissue.
Guarda su PubMed
-
Retention rate of a second line with a biologic DMARD after failure of a first-line therapy with abatacept, tocilizumab, or rituximab: results from the Italian GISEA registry.
Clin Rheumatol2021 Apr;():. doi: 10.1007/s10067-021-05734-3.
Sebastiani Marco, Venerito Vincenzo, Bugatti Serena, Bazzani Chiara, Biggioggero Martina, Petricca Luca, Foti Rosario, Bortoluzzi Alessandra, Balduzzi Silvia, Visalli Elisa, Frediani Bruno, Manfredi Andreina, Gremese Elisa, Favalli Ennio, Iannone Florenzo, Ferraccioli Gianfranco, Lapadula Giovanni, ,
Abstract
OBJECTIVES:
EULAR recommendations do not suggest which biologic disease-modifying anti-rheumatic drug (bDMARD) should be preferred after failure of a first bDMARD in the treatment of rheumatoid arthritis (RA). In particular, few data are available regarding the effectiveness of a second-line bDMARD after failure of abatacept (ABA), tocilizumab (TCZ), and rituximab (RTX). The aim of this study was to analyze the retention rate of a second line with tumor necrosis factor inhibitors (TNFi) or other mechanisms of action (MoAs), after the failure of either RTX, TCZ, or ABA.
METHODS:
Two hundred and seventy-eight RA patients from the Italian GISEA registry were included in the study. RTX was the first bDMARD in 18% of patients, ABA in 45.7%, and TCZ in 36.3%, while the second bDMARD was a TNFi (group 1) in 129 patients and an agent with a different MoA (group 2) in 149.
RESULTS:
During a median follow-up of 22 months (IQR 68), 129 patients discontinued their treatment; patients of group 1 discontinued the treatment more frequently than patients of group 2 (p<0.001) with retention rates of 33.6±5.7% and 63.6±4.6% after 104 weeks for group 1 and group 2, respectively (p<0.001). At multivariate analysis, the mechanism of action was the only predictor for the maintenance in therapy.
CONCLUSIONS:
According to our data, ABA, RTX, and TCZ seem to maintain a good retention rate also when used as a second-line therapy, suggesting their use after the failure of a non-TNFi as first-line therapy. However, specifically designed studies are needed to evaluate the more appropriate therapeutic strategies in RA, according to the first-line drug, including new targeted synthetic DMARDs. Key Points ? A large proportion of rheumatoid arthritis patients fail the first biologic DMARD. ? Few data are available about the efficacy of biologic DMARD after the failure of a non-TNF inhibitor. ? Abatacept, rituximab, or tocilizumab seem to maintain a good retention rate after the failure of a first-course therapy with a non-TNF inhibitor.
Guarda su PubMed
-
Integrating Measures of Myocardial Fibrosis in the Transition from Hypertensive Heart Disease to Heart Failure.
Curr Hypertens Rep2021 Apr;23(4):22. doi: 10.1007/s11906-021-01135-8.
Stacey R Brandon, Hundley W Gregory,
Abstract
PURPOSE OF REVIEW:
This review aims to summarize recent developments in identifying and quantifying both the presence and amount of myocardial fibrosis by imaging and biomarkers. Further, this review seeks to describe in general ways how this information may be used to identify hypertension and the transition to heart failure with preserved ejection fraction.
RECENT FINDINGS:
Recent studies using cardiac magnetic resonance imaging highlight the progressive nature of fibrosis from normal individuals to those with hypertension to those with clinical heart failure. However, separating hypertensive patients from those with heart failure remains challenging. Recent studies involving echocardiography show the subclinical myocardial strain changes between hypertensive heart disease and heart failure. Lastly, recent studies highlight the potential use of biomarkers to identify those with hypertension at the greatest risk of developing heart failure. In light of the heterogeneous nature between hypertension and heart failure with preserved ejection fraction, an integrated approach with cardiac imaging and biomarker analysis may enable clinicians and investigators to more accurately characterize, prevent, and treat heart failure in those with hypertension.
Guarda su PubMed
-
Long-Term Outcomes After Fenestration Closure in High-Risk Fontan Candidates.
Pediatr Cardiol2021 Apr;():. doi: 10.1007/s00246-021-02619-9.
Ozawa Hideto, Hoashi Takaya, Ohuchi Hideo, Kurosaki Kenichi, Ichikawa Hajime,
Abstract
The study aimed to assess the long-term outcomes after fenestration closure in patients at risk for Fontan failure. Of 119 patients who underwent Fontan operation between 1995 and 2004, fenestration was not created in 89 patients (NF group) and created in 30 patients with hypoplastic left heart syndrome, heterotaxy syndrome, high pulmonary arterial pressure, high systemic ventricular end-diastolic pressure, low ventricular ejection fraction, or atrioventricular valve regurgitation. All fenestrations were closed spontaneously or by catheter/surgical interventions, excepting two patients, and therefore, they were excluded. In fenestration group, patients with pre-Fontan mean pulmonary arterial pressure???15 mmHg or systemic atrioventricular valve regurgitation???moderate were classified as high-risk Fontan candidates (F-HR group, n?=?16), and the remaining patients were as standard-risk (F-SR group, n?=?12). Protein-losing enteropathy-free survival rates did not differ among the three groups (p?=?0.72). Serial follow-up catheter examinations after Fontan operation were completed in 69 patients in NF group and 11 patients in both F-SR and F-HR groups. Cardiac index and pulmonary vascular resistance significantly and similarly decreased over time in all groups, though the F-HR group showed lowest arterial oxygen saturation, lowest cardiac index, and highest pulmonary vascular resistance. The F-HR group also showed much veno-venous collaterals (p?=?0.049), low peak oxygen consumption (p?=?0.019), and low anaerobic threshold (p?=?0.023) as compared to those in the F-SR group. In F-HR group, cyanosis remained after fenestration closure due to transformation from fenestration to veno-venous collaterals, which resulted in elevation of pulmonary vascular resistance, low cardiac index, and deterioration of exercise tolerance.
Guarda su PubMed
-
Assessment of arrhythmia mechanism and burden of the infarcted ventricles following remuscularization with pluripotent stem cell-derived cardiomyocyte patches using patient-derived models.
Cardiovasc Res2021 Apr;():. doi: cvab140.
Yu Joseph K, Liang Jialiu A, Franceschi William H, Huang Qinwen, Pashakhanloo Farhad, Sung Eric, Boyle Patrick M, Trayanova Natalia A,
Abstract
AIMS:
Direct remuscularization with pluripotent stem cell-derived cardiomyocytes (PSC-CMs) seeks to address the onset of heart failure post-myocardial infarction (MI) by treating the persistent muscle deficiency that underlies it. However, direct remuscularization with PSC-CMs could potentially be arrhythmogenic. We investigated two possible mechanisms of arrhythmogenesis-focal vs reentrant-arising from direct remuscularization with PSC-CM patches in two personalized, human ventricular computer models of post-MI. Moreover, we developed a principled approach for evaluating arrhythmogenicity of direct remuscularization that factors in the VT propensity of the patient-specific post-MI fibrotic substrate and use it to investigate different conditions of patch remuscularization.
METHODS & RESULTS:
Two personalized, human ventricular models of post-MI (P1 & P2) were constructed from late gadolinium enhanced (LGE)-magnetic resonance images (MRI). In each model, remuscularization with PSC-CM patches were simulated under different treatment conditions that included patch engraftment, patch myofibril orientation, remuscularization site, patch size (thickness and diameter), and patch maturation. To determine arrhythmogenicity of treatment conditions, VT burden of heart models was quantified prior to and after simulated remuscularization and compared. VT burden was quantified based on inducibility (i.e., weighted sum of pacing sites that induced) and severity (i.e., the number of distinct VT morphologies induced). Prior to remuscularization, VT burden was significant in P1 (0.275) and not in P2 (0.0, not VT inducible). We highlight that reentrant VT mechanisms would dominate over focal mechanisms; spontaneous beats emerging from PSC-CM grafts were always a fraction of resting sinus rate. Moreover, incomplete patch engraftment can be particularly arrhythmogenic, giving rise to particularly aberrant electrical activation and conduction slowing across the PSC-CM patches along with elevated VT burden when compared to complete engraftment. Under conditions of complete patch engraftment, remuscularization was almost always arrhythmogenic in P2 but certain treatment conditions could be anti-arrhythmogenic in P1. Moreover, the remuscularization site was the most important factor affecting VT burden in both P1 and P2. Complete maturation of PSC-CM patches, both ionically and electrotonically, at the appropriate site could completely alleviate VT burden.
CONCLUSION:
We identified that reentrant VT would be the primary VT mechanism in patch remuscularization. To evaluate the arrhythmogenicity of remuscularization, we developed a principled approach that factors in the propensity of the patient-specific fibrotic substrate for VT. We showed that arrhythmogenicity is sensitive to the patient-specific fibrotic substrate and remuscularization site. We demonstrate that targeted remuscularization can be safe in the appropriate individual and holds the potential to nondestructively eliminate VT post-MI in addition to addressing muscle deficiency underlying heart failure progression.
TRANSLATIONAL PERSPECTIVE:
If safety from ventricular arrhythmias can be addressed, direct remuscularization with PSC-CMs-achieved either through engineered myocardial patches or intramyocardial injections-holds the potential to halt heart failure progression post-MI. Using personalized 3?D models of the post-MI ventricles derived from LGE-MRI, we provide evidence that arrhythmogenesis following remuscularization with PSC-CM patches is driven by a reentrant as opposed to focal VT mechanism. Moreover, the existing patient-specific fibrotic substrate together with the remuscularization site were primary determinants of arrhythmogenesis. These results suggest that the clinical safety of remuscularization can be achieved through patient-specific optimization guided in-part by computational modeling.
Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2021. For permissions please email: journals.permissions@oup.com.
Guarda su PubMed
-
Retraction: Development of functional hydrogels for heart failure.
J Mater Chem B2021 Apr;9(15):3412. doi: 10.1039/d1tb90051j.
Han Yanxin, Yang Wengbo,
Abstract
Retraction for 'Development of functional hydrogels for heart failure' by Yanxin Han et al., J. Mater. Chem. B, 2019, 7, 1563-1580, DOI: .
Guarda su PubMed
-
Implantation of an Innovative Intracardiac Microcomputer System for Web-Based Real-Time Monitoring of Heart Failure: Usability and Patients' Attitudes.
JMIR Cardio2021 Apr;5(1):e21055. doi: 10.2196/21055.
D Ancona Giuseppe, Murero Monica, Feickert Sebastian, Kaplan Hilmi, Öner Alper, Ortak Jasmin, Ince Hueseyin,
Abstract
BACKGROUND:
Heart failure (HF) management guided by the measurement of intracardiac and pulmonary pressure values obtained through innovative permanent intracardiac microsensors has been recently proposed as a valid strategy to individualize treatment and anticipate hemodynamic destabilization. These sensors have potential to reduce patient hospitalization rates and optimize quality of life.
OBJECTIVE:
The aim of this study was to evaluate the usability and patients' attitudes toward a new permanent intracardiac device implanted to remotely monitor left intra-atrial pressures (V-LAP, Vectorious Medical Technologies, Tel Aviv, Israel) in patients with chronic HF.
METHODS:
The V-LAP system is a miniaturized sensor implanted percutaneously across the interatrial septum. The system communicates wirelessly with a "companion device" (a wearable belt) that is placed on the patient's chest at the time of acquisition/transmission of left heart pressure measurements. At first follow-up after implantation, the patients and health care providers were asked to fill out a questionnaire on the usability of the system, ease in performing the various required tasks (data acquisition and transmission), and overall satisfaction. Replies to the questions were mainly given using a 5-point Likert scale (1: very poor, 2: poor, 3: average, 4: good, 5: excellent). Further patient follow-ups were performed at 3, 6, and 12 months.
RESULTS:
Use and acceptance of the first 14 patients receiving the V-LAP technology worldwide and related health care providers have been analyzed to date. No periprocedural morbidity/mortality was observed. Before discharge, a tailored educational session was performed after device implantation with the patients and their health care providers. At the first follow-up, the mean score for overall comfort in technology use was 3.7 (SD 1.2) with 93% (13/14) of patients succeeding in applying and operating the system independently. For health care providers, the mean score for overall ease and comfort in use of the technology was 4.2 (SD 0.8). No significant differences were found between the patients' and health care providers' replies to the questionnaires. There was a general trend for higher scores in patients' usability reports at later follow-ups, in which the score related to overall comfort with using the technology increased from 3.0 (SD 1.4) to 4.0 (SD 0.7) (P=.40) and comfort with wearing and adjusting the measuring thoracic belt increased from 2.8 (SD 1.0) to 4.2 (SD 0.4) (P=.02).
CONCLUSIONS:
Despite the gravity of their HF pathology and the complexity of their comorbid profile, patients are comfortable in using the V-LAP technology and, in the majority of cases, they can correctly and consistently acquire and transmit hemodynamic data. Although the overall patient/care provider satisfaction with the V-LAP system seems to be acceptable, improvements can be achieved after ameliorating the design of the measuring tools.
TRIAL REGISTRATION:
ClincalTrials.gov NCT03775161; https://clinicaltrials.gov/ct2/show/NCT03775161.
©Giuseppe D´Ancona, Monica Murero, Sebastian Feickert, Hilmi Kaplan, Alper Öner, Jasmin Ortak, Hueseyin Ince. Originally published in JMIR Cardio (https://cardio.jmir.org), 21.04.2021.
Guarda su PubMed
-
Urinary peptides in heart failure: a link to molecular pathophysiology.
Eur J Heart Fail2021 Apr;():. doi: 10.1002/ejhf.2195.
He Tianlin, Mischak Michaela, Clark Andrew L, Campbell Ross T, Delles Christian, Díez Javier, Filipatos Gerasimos, Mebazaa Alexandre, McMurray John J V, González Arantxa, Raad Julia, Stroggilos Rafael, Bosselmann Helle S, Campbell Archie, Kerr Shona, Jackson Colette E, Cannon Jane A, Schou Morten, Girerd Nicolas, Rossignol Patrick, McConnachie Alex, Rossing Kasper, Schanstra Joost P, Zannad Faiez, Vlahou Antonia, Mullen William, Jankowski Vera, Mischak Harald, Zhang Zhenyu, Staessen Jan A, Latosinska Agnieszka,
Abstract
AIMS:
Heart failure (HF) is a major public health concern worldwide. The diversity of HF makes it challenging to decipher the underlying complex pathological processes using single biomarkers. We examined the association between urinary peptides and HF with reduced (HFrEF), mid-range (HFmrEF) and preserved (HFpEF) ejection fraction, defined based on European Society of Cardiology guidelines, and the links between these peptide biomarkers and molecular pathophysiology.
METHODS AND RESULTS:
Analysable data from 5,608 participants were available in the Human Urinary Proteome database. The urinary peptide profiles from participants diagnosed with HFrEF, HFmrEF, HFpEF and controls matched for sex, age, estimated glomerular filtration rate, systolic and diastolic blood pressure, diabetes and hypertension were compared applying the Mann Whitney test, followed by correction for multiple testing. Unsupervised learning algorithms were applied to investigate groups of similar urinary profiles. 577 urinary peptides significantly associated with HF were sequenced, 447 of which (77%) were collagen fragments. In silico analysis suggested that urinary biomarker abnormalities in HF principally reflect changes in collagen turnover and immune response, both associated with fibrosis. Unsupervised clustering separated study participants into two clusters, with 83% of non-HF controls allocated to cluster 1, while 65% of patients with HF were allocated to cluster 2 (p<0.0001). No separation based on HF subtype was detectable.
CONCLUSIONS:
HF, irrespective of ejection fraction subtype, was associated with differences in abundance of urinary peptides reflecting collagen turnover and inflammation. These peptides should be studied as tools in early detection, prognostication, and prediction of therapeutic response.
This article is protected by copyright. All rights reserved.
Guarda su PubMed
-
Data in a Vacuum? The Desperate Need for a Paradigm Shift to Prevent Heart Failure in Black Americans.
J Am Heart Assoc -
Epidemiology of Heart Failure Stages in Middle-Aged Black People in the Community: Prevalence and Prognosis in the Atherosclerosis Risk in Communities Study.
J Am Heart Assoc2021 Apr;():e016524. doi: 10.1161/JAHA.120.016524.
Vasan Ramachandran S, Musani Solomon K, Matsushita Kunihiro, Beard Walter, Obafemi Olushola B, Butler Kenneth R, Chang Patricia P, Mosley Thomas H, Fox Ervin,
Abstract
Background Black individuals have a higher burden of risk factors for heart failure (HF) and subclinical left ventricular remodeling. Methods and Results We evaluated 1871 Black participants in the Atherosclerosis Risk in Communities Study cohort who attended a routine examination (1993-1996, median age 58 years) when they underwent echocardiography. We estimated the prevalences of 4 HF stages: (1) : no risk factors; (2) : presence of HF risk factors (hypertension, diabetes mellitus, obesity, smoking, dyslipidemia, coronary artery disease without clinical myocardial infarction), no cardiac structural/functional abnormality; (3) : presence of prior myocardial infarction, systolic dysfunction, left ventricular hypertrophy, regional wall motion abnormality, or left ventricular enlargement; and (4) : prevalent HF. We assessed the incidence of clinical HF, atherosclerotic cardiovascular disease events, and all-cause mortality on follow-up according to HF stage. The prevalence of HF Stages 0, A, B, and C/D were 3.8%, 20.6%, 67.0%, and 8.6%, respectively, at baseline. On follow-up (median 19.0 years), 309 participants developed overt HF, 390 incurred new-onset cardiovascular disease events, and 651 individuals died. Incidence rates per 1000 person-years for overt HF, cardiovascular disease events, and death, respectively, were Stage 0, 2.4, 0.8, and 7.6; Stage A, 7.4, 9.7, and 13.5; Stage B 13.6, 15.9, and 22.0. Stage B HF was associated with a 1.5- to 2-fold increased adjusted risk of HF, cardiovascular disease events and death compared with Stages 0/A. Conclusions In our large community-based sample of Black individuals, we observed a strikingly high prevalence of Stage B HF in middle age that was a marker of high cardiovascular morbidity and mortality.
Guarda su PubMed
-
Management of older hospitalized patients with type 2 diabetes using linagliptin: Lina-Older Study.
Panminerva Med2021 Apr;():. doi: 10.23736/S0031-0808.21.04085-4.
Pérez-Belmonte Luis M, Osuna-Sánchez Julio, Ricci Michele, Millán-Gómez Mercedes, López-Carmona María D, Barbancho Miguel A, Bernal-López M Rosa, Jansen-Chaparro Sergio, Lara José P, Gómez-Huelgas Ricardo,
Abstract
BACKGROUND:
Older patients managed with intensive antidiabetic therapy are more likely to be harmed. Our study's primary endpoint was to analyze the safety and efficacy of linagliptin in combination with basal insulin versus basal-bolus insulin in patients with 75 years of age or older hospitalized in medicine and surgery departments in real-world clinical practice.
METHODS:
We retrospectively enrolled non-critically patients ?75 years with type 2 diabetes admitted to medicine and non-cardiac surgery departments with admission glycated haemoglobin <8%, admission blood glucose <240mg/dL, and without at-home injectable therapies managed with our hospital's antihyperglycemic protocol (basal-bolus or linagliptin-basal regimens) between January 2016 and December 2018. To match each patient who started on the basal-bolus regimen with a patient who started on the linagliptin-basal regimen, a propensity matching analysis was used.
RESULTS:
Post-matching, 198 patients were included in each group. There were no significant differences in mean daily blood glucose levels after admission (p=0.203); patients with mean blood glucose 100-140mg/dL (p=0.134), 140-180mg/dL (p=0.109), or >200mg/dL (p=0.299); and number and day of treatment failure (p=0.159 and p=0.175, respectively). The total insulin dose and the number of daily injections were significantly lower in the linagliptin-basal group (both, p<0.001). Patients on the basal-bolus insulin regimen had more total hypoglycemic events than patients on the linagliptin-basal insulin regimen (p<0.001).
CONCLUSIONS:
The linagliptin-basal insulin regimen was an effective alternative with fewer hypoglycemic events and daily insulin injections than intensive basal-bolus insulin in very old patients with type 2 diabetes with mild-to-moderate hyperglycemia treated at home without injectable therapies.
Guarda su PubMed
